Memorandum submitted by ActionAid International
INTRODUCTION
ActionAid UK welcomes the opportunity to make
a submission to the International Development Committee Evidence
Session on AIDS orphans. ActionAid believes that the International
Development Committee can play a key role in ensuring that the
HIV/AIDS epidemic and AIDS orphans remain on the agenda of British
parliamentarians. Furthermore, the International Development Committee
can strengthen the links between HIV/AIDS focussed civil society
organisations and parliamentarians in order to better inform the
UK government's response to mitigating the impact of HIV/AIDS
on communities in developing countries, particularly with respect
to care and support for AIDS orphans.
UNAIDS estimates that over 14 million children
have lost one or both parents to the HIV/AIDS epidemic, with the
large majority of these children living in sub-Saharan Africa.
As the epidemic matures, these numbers are expected to rise dramatically
over the next 10-20 years further compounding the devastating
socio-economic impact the epidemic has already had in many countries
and regions. The greatest increase in the number of AIDS orphans
will likely occur in sub-Saharan Africa where by 2010, half of
all orphans in the region will have become orphans because of
HIV/AIDS. The impact of large numbers of orphans will also start
being felt in regions where the epidemic is still relatively new
but quickly growing, such as Asia and Latin America. Given these
projections, ActionAid believes it is imperative that initiatives
with the goal of mitigating the impact of HIV/AIDS on communities,
must be supported, strengthened and dramatically scaled up.
At the international level, ActionAid works
in partnership to change the injustice and inequality that causes
poverty and increases people's vulnerability to HIV/AIDS. At the
community and national level, we work in 16 countries in sub-Saharan
Africa with the goal of promoting absolute control of the epidemic
and supporting a sustainable quality of life for people living
with HIV/AIDS. Poverty and HIV/AIDS work together to drastically
reduce the choices available to poor people. It is our belief
that if the right type of economic and social support is offered,
communities facing HIV/AIDS will find their own solutions.
As a rich country, the UK can no longer ignore
the devastation that HIV/AIDS is bringing to poor countries and
the impact it is having on the children living in them. With this
belief, ActionAid UK supports the fight against HIV/AIDS by working
to influence the UK government to act decisively. The recently
developed UNAIDS/UNICEF Framework for the Protection, Care and
Support of Orphans and Vulnerable Children Living in a World with
HIV/AIDS estimates that approximately US$10. One billion per year
is needed to implement the framework. Currently, total expenditure
from domestic and international sources on HIV/AIDS treatment,
care and support for people living with HIV/AIDS is less than
half of this. As a G8 member, the UK must play a key leadership
role in ensuring that AIDS orphans related work is adequately
and effectively resourced. In this regard, ActionAid submits the
following attached documents reviewing and analysing UK HIV/AIDS
expenditure in developing countries to the International Development
Committee for review:[73]
1. The Best Chance We Have—the Global
Fund to Fight AIDS, TB and Malaria.
2. UK AIDS Aid—an analysis of DfID
HIV/AIDS expenditure.
3. Low Credit—a report on the World
Bank's response to HIV/AIDS in developing countries.
Also attached is a review of AIDS orphans related
work undertaken by ActionAid Kenya in partnership with local community
based organisations and non-governmental organisations.[74]
OVERVIEW OF
SUBMISSION
The extent to which UK government policies assist
developing countries to prepare for and support large numbers
of orphans is very difficult to ascertain for several reasons.
ActionAid UK's recent policy work has focused on the issue of
funding for HIV/AIDS work more broadly. What is often quoted is
that DfID is the second largest funding source for HIV/AIDS work
in developing countries, however what is also known is that current
global spending levels are a fraction of what is needed. Further
analysis of current UK HIV/AIDS expenditure raises several questions
including:
1. How much UK expenditure is for AIDS orphans
specific work in developing countries?
ActionAid UK's report UK AIDS Aid collates and
analyses available information to determine UK HIV/AIDS expenditure
in developing countries. DfID's expenditure figure of £336
million for 2002-03 falls within the range (£195 million
to £455 million) calculated in the report and this represents
a substantial increase from expenditure in previous years. In
actuality, the figure of £336 million is total expenditure
on sexual and reproductive health work including HIV/AIDS. There
is much variation at country level as to which services are included
under the umbrella of sexual and reproductive health. Such services
can include, among other things, family planning services including
abortion, maternity care, couples' relationship skill building,
legal advice, and infertility services. As such, ActionAid UK
believes that sexual and reproductive health expenditure is a
poor indicator of HIV/AIDS expenditure, as HIV/AIDS work comprises
only one element of reproductive health care. Due to the overlapping
nature of HIV/AIDS work and broader sexual and reproductive health
work, a figure for HIV/AIDS specific expenditure is unavailable
and as such, a figure for expenditure on AIDS orphans related
work is also unavailable.
2. Is expenditure being targeted to those
developing countries most affected by HIV/AIDS and with the greatest
number of AIDS orphans?
The largest proportion of DfID's HIV/AIDS expenditure
was made in sub-Saharan Africa in 2002-03 reflecting HIV/AIDS
prevalence figures. Further work, however, is needed to determine
the types of activities funded as currently DfID cannot provide
figures for HIV/AIDS expenditure categorized under prevention,
treatment and care and impact mitigation. ActionAid UK believes
such information is essential to determine whether the UK's HIV/AIDS
investments in developing countries accurately reflect regional
and country contexts.
3. How is UK HIV/AIDS expenditure best apportioned
between broad (horizontal) approaches and direct, targeted (vertical)
initiatives?
The Best Chance We Have discusses the Global
Fund to Fight AIDS, TB and Malaria. The UK government, as part
of the G8, launched this high profile initiative in 2001. The
Global Fund was designed as a transparent, participatory, and
democratic mechanism to quickly deliver need-based, untied funding
for HIV/AIDS work in developing countries. Since its launch, the
UK Government has been reticent to lend its full support to the
Fund. Based on its share of the world economy, the UK falls far
short of what it should be contributing to the Fund. This reluctance
to increase funding to the Global Fund is borne from the tension
between DfID's increased funding of horizontal programming such
as building health infrastructure and promoting implementation
of effective health policy as opposed to targeted vertical initiatives
such as the Global Fund. Vertical initiatives are criticised as
being contrary to these broader goals and are seen by some as
being difficult to integrate into country priorities and existing
frameworks. ActionAid UK believes that the scale of the HIV/AIDS
epidemic and the lack of political will still seen in many affected
countries necessitates that HIV/AIDS funding be channelled through
both horizontal and vertical mechanisms.
4. Is the UK's multilateral HIV/AIDS expenditure
channelled through the appropriate organisation?
ActionAid UK's latest report Low Credit reviews
the World Bank's role as a key institution in the fight against
HIV/AIDS. As the World Bank is only second to the EC in receiving
DfID multilateral funding, the UK Government should have a vested
interest in the nature of the World Bank's involvement in HIV/AIDS
work. The report clearly shows that during the 1980s and 1990s,
the World Bank failed developing countries with its response to
the epidemic by neglecting to consider the impact of its policies
on the poor. Specifically the Bank failed to adequately invest
in the fight against HIV/AIDS and what investments it did make
were ill chosen with respect to the countries funded, groups targeted
and interventions chosen. The Bank failed to protect social spending
during crisis and adjustment, which in turn led to deterioration
of basic services and contributed to health systems becoming a
source of HIV infection. World Bank initiated reforms such as
the introduction of user fees and privatisation, decentralisation
and integration of health systems reduced access to services aimed
at the prevention and control of HIV/AIDS. Overall, the Bank took
a narrow health sector view of HIV/AIDS and focused more on lending
money rather than achieving impact. Recently, the Bank has launched
the Multi-Country HIV/AIDS Programme (MAP) for Africa. Although
MAP represents a dramatically different approach to HIV/AIDS on
behalf of the World Bank, an initial review shows that some of
the same institutional weaknesses persist from previous Bank work
in the area. Given this, and the fact that in 2002-03 DfID gave
£250 million, roughly 17% of DfID's total multilateral expenditure,
and equivalent to three quarters of the reported DfID HIV/AIDS
expenditure over the same period, ActionAid believes it is imperative
that the UK review the Bank's work in this area.
March 2004
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