13 EU development assistance to combat
HIV/AIDS, malaria and tuberculosis
| (26100)
14245/04
+ ADD 1
COM(04) 726
| Commission Communication: A Coherent European Policy Framework for External Action to Confront HIV/AIDS, Malaria and Tuberculosis
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| Legal base | — |
| Department | International Development
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| Basis of consideration | Minister's letter of 10 December 2004
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| Previous Committee Report | HC 42-xxxvii (2003-04), para 5 (17 November 2004)
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| Discussed in Council | 25 November 2004 GAERC
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| Committee's assessment | Politically important
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| Committee's decision | Cleared
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Background
13.1 This Communication sets a broad policy framework for future
Community external action on combating HIV/AIDS, TB and malaria.
It builds upon an earlier Communication — EC Programme for
Accelerated Action on HIV/AIDS, Malaria and Tuberculosis in the
Context of Poverty Reduction — which we cleared in 2001.[38]
On 17 November, we kept it under scrutiny pending further information
on the reservations about the Commission's proposed approach which
we felt were not set out sufficiently clearly by the Parliamentary
Under-Secretary of State at the Department for International Development
(Mr Gareth Thomas) in his Explanatory Memorandum of 12 November.
The Minister responded in a letter of 10 December.
The Minister's letter
13.2 The Minister recalls that, with regard to his reservations,
we asked specifically:
- what is meant by "the establishment of individual co-ordination
mechanisms around specific diseases";
- in what ways do they "pose threats to efforts
to harmonise external support around country priorities and mechanisms";
and
- how "disease targeted approaches also have
the potential to distort national policies and practice, and undermine
broad, service delivery".[39]
13.3 The Minister responds as follows:
"The suggested broad policy framework
for EC action is appropriate. In due course an implementation
plan will also be developed and will indicate how Community instruments
will be used to accelerate action. The major EC contribution to
date at country level has been through substantial financial allocations
to the Global Fund to fight HIV/AIDS, TB and malaria (GFATM).[40]
The UK also provides substantial support through this instrument.
There is a tension between aid approaches that support country
owned development processes and those that aim for targeted disease-focused
quick fixes. The former are often expressed within a poverty reduction
strategy and health sector plan, and supported through the budget.
The latter often have management structures outside government
systems and are funded off budget.
"For example, donors increasingly support
the Uganda health sector through the budget and take part in an
annual joint review of progress across all programmes within the
sector. A number of global health initiatives complement that
assistance but have separate arrangements. The Global Alliance
on Vaccines and Immunisation (GAVI)[41]
has established a specific coordination mechanism around vaccines;
the GFATM has established a country coordination mechanism around
the three diseases. In time such individual coordination groups
should be integrated within the broader sector review process.
"In pursuit of sound macroeconomic policy
the Ugandan Ministry of Finance has established budget sector
ceilings. If additional funds are made available for AIDS treatment,
for example, then another part of the budget is reduced accordingly.
If substantial amounts are made available through the Global Fund,
the WHO '3 by 5' initiative and the US President's Emergency Fund
for AIDS Relief (PEPFAR) the Impact on the budget can be significant
and national budgets and policy priorities can be distorted. Such
targeted initiatives need to demonstrate short term deliverables
to justify funding; They can also divert efforts and resources
from long-term capacity building of health systems that are able
to address all of the main causes of ill health and death. High
profile targeted initiatives can further attract the limited numbers
of health staff away from provision of broad based services to
focus only on AIDS treatment.
"This tension between long-term development
processes and short-term targeted approaches is not particularly
related to Community aid. DFID and others within the international
community are addressing this issue, including that of budget
ceilings and how to provide increased funds to the health sector
without disrupting the macro economy. There are now positive signs
that the Global Fund is making efforts to integrate its support
and country management into national plans."
Conclusion
13.4 In commenting earlier on the Communication,
we noted that in the three-and-a-half years since we considered
the last such Communication — when we feared for an over-stretched
Commission's ability to manage effectively an ambitious programme
with increased funds — the Commission's efforts had clearly
borne fruit, but immense challenges of global significance nevertheless
remained, and we agreed with the Minister that increased EU attention
to the three diseases was fully appropriate. We also recognised
that on 22 November the General Affairs and External Relations
Council would do no more than arrive at general Conclusions, and
that there would therefore be future opportunities to consider
detailed proposals. But we are nonetheless grateful to the Minister
for this explanation of his reservations. In particular, we hope
that the long-term implementation plan and the "Community
instruments to accelerate action", to which he refers, will
be able to resolve what he describes as "a tension between
aid approaches that support country owned development processes
and those that aim for targeted disease-focused quick fixes".
The example he gives of developments in Uganda is encouraging.
We look forward to scrutinising any such proposals in due course,
and in the meantime clear the document.
38 (22234) 6802/01; see HC 28- xiii (2000-01), para
13 (2 May 2001). Back
39
(26100)14245/04; see HC 42-xxxvii (2003-04), para 5 (17 November
2004). Back
40
The Global Fund to Fight AIDS, Tuberculosis and Malaria was created
to increase dramatically resources to fight three of the world's
most devastating diseases, and to direct those resources to areas
of greatest need, through partnership between governments, civil
society, the private sector and affected communities.Since 2001,
the Global Fund has attracted US$ 4.7 billion in financing and
has so far committed US $ 1.5 billion to support 154 programmes
in 93 countries. Back
41
The Global Alliance for Vaccines and Immunization (GAVI) includes
national governments, international organizations such as the
United Nations Children's Fund (UNICEF), the World Health Organization
(WHO) and the World Bank; philanthropic institutions, such as
the Bill and Melinda Gates Children's Vaccine Program; the International
Federation of Pharmaceutical Manufacturers Associations; and research
and public health institutions. The Alliance was officially launched
in Davos, Switzerland in January 2000 with an initial grant of
US$ 750 million from the Bill and Melinda Gates Foundation,
since when the Governments of the UK, the Netherlands, Norway,
the United Kingdom and the United States have joined in, pushing
its total resources to above US$ 1 billion for 2001-2005. Back
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