Examination of Witnesses (Questions 26
- 39)
TUESDAY 22 NOVEMBER 2005
MR HANS-MARTIN
BOEHMER, MS
ROBIN GORNA
AND MR
DANIEL GRAYMORE
Hugh Bayley: Welcome. Thank you for coming
to give evidence to us. You have had the benefit of hearing some
of the previous questions, I know. To set the proceedings going,
I turn to Joan Ruddock.
Q26 Joan Ruddock: I
would like to refer to the NAO report that was published in June
2004.[17]
On the face of it, this looks like a devastating indictment of
what DFID is doing in respect of HIV/AIDS. They said that you
did not have a separate system for monitoring the implementation
and impact of the strategy; that you had exaggerated how much
money is being spent directly on HIV/AIDS, because it had been
put into a package of reproductive health spending; that eight
out of 14 strategy papers for working with multilateral bodies
did not mention HIV/AIDS; and that only two out of seven planned
technical guidance notes for staff on how to implement the strategy
had been published. What has happened since then? What sort of
changes have you made to improve reporting, monitoring and evaluation
of your policies and practices?
Mr Boehmer:
I will suggest that Robin Gorna takes this question. Robin is
the team leader on HIV/AIDS. Let me just say that the Taking
Action[18]
strategy came out after this report and now we are going through
the phase of implementation where the NAO report is a very important
guideline for us on the areas that we need to improve. Let me
take one aspect of what you were saying, the link between sexual
and reproductive health and HIV/AIDS. We all know—and we
have talked about prevention—that if we are serious about
treating AIDS we must link it with sexual and reproductive health
advice. Therefore, in our view the programmes of treating AIDS
or prevention of AIDS or tackling AIDS need to be commensurate
and packaged together with sexual and reproductive health. That
is why the programme we want to support, both in countries with
budget support but also stand-alone projects, we would very much
like to have as a package whenever that is possible. Therefore
separating out, in terms of the accounting, which part of it goes
towards HIV/AIDS, which part goes towards sexual and reproductive
health, might very well set the wrong incentives in programme
design.
Ms Gorna:
As Dr Boehmer says, the NAO report came out just immediately before
the Taking Action strategy and many of the issues that
the NAO highlighted were indeed issues that the Department had
already noted and were underpinning the reason why the strategy
was developed. Specifically on the institutional strategy papers,
we made commitments in Taking Action that we are following
through, and indeed all of our new institutional strategy papers
are now addressing AIDS. In terms of the guidance notes, we have
up-scaled the guidance notes and we now have worked with Civil
Society to produce a web-based system (known as the AIDS Portal)
which is now functional and is providing a very wide range of
advice to our own DFID advisers and also more broadly to Civil
Society in countries, so I think we have moved a long way since
then. To build on this point about the linkage with sexual and
reproductive health, I think the UK's approach is distinct from
other donors, in that it takes a comprehensive, multi-sectoral
approach to AIDS. That does complicate the tracking of finance.
We acknowledge in our strategy, in the approach we take, to identify
things which are specifically about AIDS and also the broader
environment within which AIDS programmes work. For example, Dr
Dhaliwal spoke about the work we are doing in Malawi, which is
clearly having a big impact on AIDS but is not the kind of direct
focused AIDS activity that perhaps a PEPFAR programme would identify.
We have been in quite an active dialogue with UNAIDS and other
bilateral donors about trying to get a better international system
for tracking AIDS spending because we do understand that there
are differences between different donors. We have taken the NAO
criticism very seriously but we think that to revise our tracking
of spending at this point would lead to a reductionism in the
approach we take to AIDS and that could not be helpful. Finally,
in terms of systems for monitoring, we have upgraded our monitoring
systems. With the spending target that has been introduced through
Taking Action, we have more robust systems of accountability.
Many of you ask us questions regularly on how we are spending
our money, and of course there is an evaluation process underway.
Joan Ruddock: Thank you very much.
Q27 Richard Burden: Continuing a
little on these same lines, in 2001 the UN General Assembly Special
Session (UNGASS) emphasised the importance of integrating "prevention,
care, treatment and support" and there have been a number
of reviews. The Governance and AIDS Initiative (GAIN) review in
2004, for instance, said that that had not necessarily happened
properly " . . . even for the donors such as DFID that have
taken these issues most seriously, and which have the human and
financial resources to devote to the task." In terms of the
apparent disparity between policy and in-country delivery, you
are saying that Taking Action is hopefully going to address
those things, but the Stop AIDS Campaign is still reporting growing
concerns about the translation of DFID's commitments at a country
level. How do you respond to that?
Ms Gorna: As I mentioned, we have
an external evaluation underway—which is just kicking off
at the current time—which is designed to look very carefully
at the translation of our policy commitments into action. I would
highlight that it is easy to spotlight the DFID country offices
as the locus of where we work, but obviously the ways in which
DFID works are also through the international system, through
our UN partners, through the Global Fund, through the Bank, and
so we see it as very important to look at how we contribute through
the monies we give to the Global Fund, which then reach a broader
range of countries than simply those where our country programmes
are operational. We have just had our first round of looking at
the first six months since the Taking Action strategy was
put in place and we are seeing a scaling up of activities commensurate
with the policy direction.
Mr Boehmer: When Hilary Benn said
we were going to host the Replenishment Conference for the Global
Fund—and we basically had the expectation that a significant
amount of additional funding will go to countries to fight AIDS
and the other two diseases—he also said that we will call
together the international community to get their act together,
basically, to make sure that the countries get the support at
the country level that they need in a coordinated way. That is
why the work of the Global Task Team started, which has a lot
of implications for how the multilateral system works at the country
level—how countries, in fact, get the support that they
need. That is why, when we had the Global Fund Replenishment Conference,
we also then doubled our funding for the UNAIDS system, so that
in fact they had the capacity to do it. Our own country advisers
where we have them are now working very actively to make sure
that this process moves forward at the country level, so that
the countries do actually have the support to do this. This is
part of how to make our money effective, not only the bilateral
money but also the money that then goes of course to the multilateral
system.
Q28 Richard Burden: If the Stop AIDS
Campaign were here and you were saying this to them, given the
fact that they are saying the intention is there but they still
have concerns about delivery, to which milestones would you point
them in terms of the evaluation and monitoring systems that you
are adopting so that you could say: "Well, actually, in six
months or a year's time we should know more about this"?
When will it become clear if these new mechanisms are working,
would you say?
Mr Boehmer: In the Global Task
Team there is regular reporting back. UNAIDS is tracking the implementation
of the Global Task Team recommendations. On our side, our country
offices where we have AIDS advisers are following up and reporting
regularly, certainly internally, on how these mechanisms are taken
forward. In Malawi, for example—and this is with malaria,
not with AIDS, but the Global Fund mechanisms work the same whether
it is malaria or AIDS—the Global Fund can in fact now support
the national programme. We hope that will also be very much the
case with AIDS, where the Global Fund can step in and support
the national programme. The Malawi health worker example is a
very important one. We all talked before about how the human resource
capacity is an important component to fighting AIDS. In the latest
round of applications the Global Fund was able to support the
health package, the emergency response package, in Malawi. It
is one of the very few countries where they have been effective,
where an application for this health system strengthening has
been successful through the Global Funds window. It is all an
outcome of making sure that those organisations at the country
level all support the Government's programme where a strong programme
is in place. So there is evidence that it is happening.
Ms Gorna: The evaluation of Taking
Action is due to report at the end of 2006 in order to inform
the next steps and also to give us a sense of whether the strategic
direction has made a difference to DFID's operations. I am sure
members of the Committee are well aware that the bulk of programming
in which DFID engages is determined at local country level based
on individual country priorities when we are talking about our
bilateral programme. In paragraphs 52 to 67 of the memo we have
provided,[19]
we have given some snapshots of some of the activities that are
newly underway since the strategy was launched. I think they demonstrate
a diversity of responses. In the Caribbean, for example, we are
acting on stigma and discrimination, which is a principal driver
of the epidemic globally but there are some specific activities
there. In the Ukraine and Russia we are financing work around
the "Three Ones" to support the scaling up of
country programmes. In Kenya we are extending the work of the
National AIDS Council. In Zimbabwe we are involved in supporting
Civil Society. So there is a range of different activities in
different countries. People in our bilateral programmes are not
following a sort of cookie-cutter approach directed from the centre,
but I think we can demonstrate that even in the last six months
more action is under way at country level.
Q29 John Bercow: DFID is obviously
the lead department in Whitehall on HIV/AIDS but there are a number
of other departments that have important responsibilities as well:
the Department of Health in terms of the recruitment of African
health professionals for the NHS; the Home Office in terms of
immigration and deportation policy; the Ministry of Defence in
terms of the implications of AIDS for national security; and indeed,
for that matter, the Department of Trade and Industry in relation
to international negotiations on TRIPS. There is a big picture
there of which at various times I think it has fairly been said
the Government has perhaps lost sight. In Taking Action
a commitment was made to try to improve the coherence of policy
across the piece through the establishment of an informal, cross-Whitehall
working party. I would like to know from you—and I am seriously
hoping you are about to tell me—the specific examples you
can identify of progress that has been made in policy as a result
of the establishment of that informal cross-Whitehall working
group.
Mr Boehmer: There are two working
groups: one on AIDS in developing countries and one on access
to medicines. Perhaps both Robin and Danny could answer.
Ms Gorna: On the broader AIDS
working group, we have met, I think now three times, with members
from all the departments you note and also the Treasury and the
Foreign and Commonwealth Office. Clearly there are departments
in Whitehall which have a greater emphasis on AIDS than others.
Certainly in-country we work very closely with the Foreign and
Commonwealth Office in most of the countries where we have bilateral
programmes and we obviously work very closely with our missions
in Brussels, Geneva, New York, Washington on the specific elements
with the international community. In terms of the 2005 agenda
and the highlighting of AIDS as a centrepiece of G8 and EU presidencies,
we can demonstrate good cross-Whitehall working in advancing those
agendas. We hope next week, on World AIDS day, to be producing
a new briefing paper on harm reduction linked to the prevention
issues that Mr Plumley was describing earlier, where we are working
closely with the Home Office, the FCO and the Department of Health,
and a couple of other government departments are involved, so
that we are intensifying the policy coherence.
Q30 John Bercow: That will be a published
paper, will it?
Ms Gorna: That will be published,
yes, on 30 November.[20]
So there are a number of those initiatives where we are trying
to draw together greater policy coherence. It is still relatively
early days for our cross-Whitehall group, whereas the Access
to Medicines group has been in existence for substantially
longer.
Mr Graymore: It
has been in existence since 2003. It was set up following the
report from the High Level Working Group on increasing access
to medicines in developing countries.[21]
It was set up expressly to take forward some of the recommendations
in that report, including, in relation to TRIPS, in terms of intellectual
property issues, to issues around research and development innovation;
in terms of coherence, around aid spending and technical inputs
there. That group has representation from the Treasury, from DTI,
from the Patent Office and from the Department of Health, and
obviously DFID is on there as well, and a variety of other departments
have been on that working group. I think there has been some very
good progress through that group and working very closely internally
on the AIDS agenda as well, and in time with the cross-Whitehall
group on HIV/AIDS. Examples of progress through that group include
the progress on the TRIPS agreement. DFID worked very closely
with the Patent Office and with the Department of Trade and Industry
in the run up to the Cancu«n meeting to input into and to
help to negotiate the final decision that was reached in Cancu«n
on 30 August which provided the waiver allowing countries that
did not have a pharmaceutical industry of their own to import
copies of essential medicines, or indeed copies of all medicines
that were needed. That was a very significant piece of work across
Whitehall and has been followed up subsequently with the work
that is needed to implement that decision within the national
legislation of all the Member States in the EU and also in terms
of the necessary amendment at the World Trade Organisation to
the TRIPS agreement itself, to make what at the moment is a temporary
waiver into a permanent waiver. We have continued to work very
closely with the Patent Office and DTI and indeed other departments
as appropriate on that issue. We have also worked with those departments
around addressing and trying to develop plans to help build up
the capacity of developing countries to use some of the TRIPS
flexibilities. There are other examples as well. We have done
a lot of work with the Department of Health, with the Department
of Trade and Industry (DTI) and others around the pharmaceutical
industry in the UK, and jointly published with the DTI and the
Department of Health in March this year a framework encouraging
good practice within the pharmaceutical industry around increasing
access to medicines, with a set of recommendations following a
lot of consultation with the industry.[22]
We have also worked very closely with other departments, particularly
the Treasury and Customs and Revenue on issues of R&D innovation,
to increase investment in R&D into diseases particularly affecting
developing countries.
Q31 John Bercow: I
assume it is an informal grouping consisting of senior officials,
but obviously it reports into ministers. There has really been
quite a lot of meat, I must say, in those answers, for which I
am grateful and by which I am encouraged. There was at least one
department that did not get a look in in those references and
that was the Home Office. I wonder if somebody could tell me something
about the attitude that informs discussions between DFID and the
Home Office on the highly sensitive question of the deportation
of failed asylum seekers who are HIV positive and who face the
prospect of return either to a regime where human rights abuse
or continuing civil conflict is a fact of life or to a regime
where access to HIV/AIDS treatment is inadequate, or, dare I say
it, to a grisly combination of both.
Ms Gorna: The Home Office is a
member of our cross-Whitehall group and has been consistently
involved. On the issue of harm reduction, the Home Office leads
on the relationship with the UN Office on Drugs and Crime, which
is a co-sponsor of UNAIDS, so we have had a lot of active discussion
on that. In terms of the issue which you raise, the Home Office
does occasionally communicate with us to ask for specific guidance,
and I believe they ask the FCO for guidance on the policies in
a particular country, but we do not have any formal engagement
in those matters and it really is a Home Office lead on those
questions and there is no formal conversation.
Q32 John Bercow: The use of the word
"occasionally" is so revealing, is it not? And perhaps
even—though it would not be recorded in the minutes—the
tone in which it was delivered. Could I ask you whether you would
regard it as helpful if the Home Office decided to step up its
communication and pursuit of advice on these matters from the
status of "occasionally" to the status of regularly
or even as a matter of course?
Ms Gorna: I am sure as a result
of this Committee this will be a matter that will come onto the
agenda of the cross-Whitehall group.
John Bercow: Thank you.
Q33 Mr Hunt: A question, if I may,
for Robin Gorna. You will have seen yesterday's WHO UNAIDS report
in which they talked about 2.6 million people dying from AIDS
last year, 600,000 children. The standard DFID response to that—and
we have heard it on this Committee many times from the Secretary
of State—is that this has been a year of tremendous progress
with the universal access target at the G8 Summit. How do you
square that with that which was heard earlier this morning, when
representatives from the WHO and UNAIDS point blank refused to
agree to intermediate targets towards that universal access target
by which we can measure whether progress is really being made.
Ms Gorna: We heard this morning,
from our colleagues in UNAIDS and WHO, clarity about the fact
that the "3 by 5" global target created massive ambition
and I think there has been a great deal of excitement that the
Gleneagles/World Summit commitments extend that ambition further.
I think there is a high level of concern, however, that global
targets that are imposed on countries could become counter-productive,
and so, in the conversations that we have been having with countries
and with the international colleagues, we have been really talking
about how countries themselves can scale up towards universal
access. We have agreed to work with UNAIDS and to co-chair the
process being called the Global Steering Committee to see how
to implement this agreement made at the World Summit and at Gleneagles.
As a consequence of that, we have been advised by country governments
and by bodies such as the African Union that understanding how
countries individually can scale up is very important, because
clearly the constraints and needs of Malawi will be different
from the needs of India, will be different from the needs of Brazil
(which is fundamentally at universal access), and will be different
again from South Africa. So each country's progress towards universal
access will rely upon a set of different determinants and simply
putting a blanket global target of 50%, 60%, 70% by a target date
strikes us as not necessarily likely to lead us to the overall
goal. Our understanding of the process to which we have agreed
is that by June 2006, this UNGASS High Level review, we should
be at a position where these countries' targets can be aggregated
and we can see a global road map that would help us to identify
where the blockages are in the system and whether it is the lack
of targets that is impeding people from scaling up or whether
it is a lack of technical advice or whether it is questions of
financing. It seems to us that we need to unpick some of those
questions to understand what it would take, before we go down
a road of setting interim targets.
Q34 Mr Hunt: Could I come back on
that, because I am deeply concerned by this phrase "global
targets can be counter-productive". Either you think global
targets are a good thing—which is why we had them at the
Gleneagles Summit—or you do not think they are a good thing—in
which case we should not have had that target at the Gleneagles
Summit. If we have had that target at the Gleneagles Summit which
I personally think and I am sure this Committee thinks is a huge
step forward, then surely it is not too much to ask the world
community to commit to intermediate steps towards achieving that
target.
Ms Gorna: Apologies for being
imprecise in my language. When I said targets potentially being
counter-productive I think I am referring to a simple numerical
target, whereas the universal access ambition of scaling up towards
universal access and getting as close as possible to universal
access seems to create the context within which we can enable
countries to identify the correct trajectory which will respond
to the particular needs they have.
Q35 Mr Hunt: I would not have a problem
if it were a percentage target or a target of the number of people
on ARVs, but I do have a problem if the world community (DFID,
UNAIDS, WHO) is resisting having any kind of intermediate targets
at all. Because, if you do that, it will be impossible to measure
whether you are serious about it or not. I think it is terribly
important that you do have some milestones, so we can see that
you are serious about this target. On DFID's own front would you
consider including a target for treatment as one of your PSA[23]
targets? Because you do have PSA targets on poverty reduction,
you do have them on conflict prevention, but your one PSA target
that does mention HIV/AIDS has been watered down, so that you
no longer talk about reducing "the proportion of 15-24 year
old pregnant women with HIV from 16%" but you have taken
that 16% out. That is again creating the worrying sense that you
are avoiding wanting to be tied down on any firm commitments as
to what you will actually achieve.
Mr Boehmer:
The PSA targets that we will then have in place will be for the
next comprehensive spending review period. We will have two things
in place before we get to the question of what PSA target we will
have. One is in fact this road map that UNAIDS is now developing,
which hopefully will in fact give us an indication of what would
it mean in terms of numbers for countries to be on track for meeting
the universal access goal. The second one, of course, is our own
interim evaluation of our own strategy. Both of those will inform
the kind of PSA targets that we will have. At this point, without
those pieces of information, I am reluctant to say we will have
a PSA target that will have specific numbers, because I think
we have to wait for those pieces of evidence. Let me add one piece
on the question of the target: the G8 target very usefully said
through a comprehensive "package of prevention, treatment
and care with the aim as close as possible to universal access
to treatment". I think it is very important to put the universal
access to treatment in the whole context of the package that we
agreed in Gleneagles, and finance is a big part. The Global Steering
Committee is quite deliberately not just a technical committee,
it is not just a technical agency; it includes the recipient countries
and it includes the donor countries because it has to be put into
that broader framework. That is where we need to give the credibility
that our commitment is serious, to those countries which we would
expect to develop their plans, that they can in fact be ambitious.
It is all about creating the ambition at the country level that
then hopefully will create the momentum so that the commitments
that we made at Gleneagles will be translated into real action.
That is why we need to give the countries the ambition, the credibility,
but also the space to define where they will be over the next
12 months or over the next 24 months. We need to support that
by maintaining the ambition, without setting ourselves targets
before that process is completed.
Q36 Mr Hunt: I just do not buy this
idea that countries do not have ambitious targets or aspirations
for treatment. I think the commitment that we are looking for
is from the global community. The worry that we have, having had
this wonderful fanfare of that incredible G8 target, is that you,
UNAIDS, WHO, are backtracking from that now, and I think that
would be of great concern.
Mr Boehmer: The ambition, in terms
of the expectation of what they want to do, no doubt is there.
But if you look at how that ambition translates into the main
policy vehicles (the Poverty Reduction Strategies, the medium-term
expenditure frameworks), there you do not see the ambition. I
think that is where we need to help countries to make that translation
of the ambition into specific expenditures at the country level
and specific targets at the country level real. We talked earlier
about the connection with the IMF and the World Bank. It is a
very big part of the story. In Malawi, where you have the fortunate
situation where the Minister of Finance is a former IMF official,
the IMF committed to making any additional donor resources for
addressing the human resource crisis part of the fiscal framework
without ceilings. It can be done. That was a big part of the conclusion
of the Global Task Team work. Without that connection being created
between the national AIDS plans and the main drivers of national
plans through the budget processes, through the PRSs,[24]
the ambition is there but the translation into action is not.
Q37 Hugh Bayley: If
you set as a target treatment rates, that is something you will
have pretty hard data on because you are buying the drugs. But
if you use as the target prevalence rates, you are dependent upon
some measures of prevalence in the field which may or may not
be accurate. My understanding is that you dropped the 16% baseline
for your women's health HIV target because you did not believe
that the data establishing 16% as the baseline was reliable, and
yet you maintained a goal of reducing prevalence rates amongst
pregnant women. If you have already admitted that you have no
reliable data to set a baseline, why on earth retain a goal when
you have already admitted you have no reliable way of measuring
whether you achieve it or not?
Ms Gorna: The question of the
data underpinning the 15-24 year old data is perhaps better directed
to our colleagues from UNAIDS because the data on which we rely
is the data collected by UNAIDS and WHO. We do participate in
the global monitoring and evaluation reference groups which they
convene, and part of the difficulty is that there is so much data
collected on HIV that it is difficult to ensure absolute accuracy,
as you say, of some of these baseline data in some of the areas.
That has been the nature of the dialogue in which we have been
engaged with them. This has also been behind the push for the
Three Ones—as you will recall, one of the Ones
is the monitoring and evaluation framework. The observation we
have been hearing from many countries is that there is so much
requirement for data that it is often difficult for countries
themselves to be accountable about the core data that actually
they think is most important to track. I know that this will come
up next year at UNGASS.
Q38 Hugh Bayley: Crudely, you are
saying that you will be able to notice if prevalence rates reduce,
but you may not be able to say with authority if they are reduced
from 16% to 10%. That would be your short answer.
Ms Gorna: This appears to be the
problem, yes.
Hugh Bayley: Good.
Q39 Ann McKechin: Turning now to
the TRIPS agreement, which has had a somewhat troublesome history
at the WTO over the last few years and we are still working with
a temporary agreement. A variety of submissions made to us from
NGOs and other agencies complain about the fact that really the
current WTO rules do not appear to be working. Médecins
Sans Frontie"res stated in October, "This week's proposals
of the TRIPS Council do not offer real solutions of the problems
we are facing . . . This solution has been in place since 2003,
but there is not a shred of evidence yet that it actually works.
So far, the little we know is that this solution has placed burdens
on drug procurement and could discourage rather than encourage
generic production.[25]"
How would you respond to those criticisms?
Mr Graymore:
It is true, following the agreement in Cancu«n to waive the
clause that made it difficult for countries which do not have
their own industry to import copies, that the process has been
fraught on occasions. It is a very complicated agreement and there
are a lot of different levels that need to be addressed. As I
mentioned earlier, you have to change national legislation initially,
so that individual country's intellectual property regimes are
compliant with the new decision and therefore either you are in
a position where you could use it to import the drugs or you are
in a position where you could respond to a request to produce
drugs for export to send to a country that needed them, and you
also need to change the agreement itself at the World Trade Organisation.
In terms of the national legislation, there was a clear decision
taken very soon after the decision was reached in 2003, that in
the case of the Member States of the European Union it would be
most useful and efficient ultimately to have a Community-wide
regulation rather than individual countries changing their legislation
one by one, and therefore a process has been ongoing since that
time to agree that EU-wide regulation. It falls into an area of
co-decision between the European Commission and the European Parliament
and there has been a lot of discussion and dialogue between the
two institutions and with Member States, of course, to come to
an agreement. In fact, the Parliament will sit on the 30th of
this month and that should ideally see agreement. Many of the
issues that were outstanding have now been addressed, so we hope
to see an agreement, and that means that from that point onwards
within the EU the regulation is in force and the legislation is
therefore effective. At the World Trade Organisation there are
discussions about how to bring the temporary waiver into a permanent
part of TRIPS. These have tended to focus on how you reflect the
two parts of the decision within the World Trade Organisation
TRIPS agreement. The decision itself in August 2003 was accompanied
by a chairman's statement text that clarified the decision and
helped countries that were less than entirely convinced by the
decision that this was a good thing. It enabled the decision to
be reached, basically, and therefore was very important. That
clarifying statement has a different legal weight to the decision
itself: the decision itself is primary but the clarifying statement
is important. The process that has been followed in the World
Trade Organisation is therefore how you have that, and there are
numerous arguments around the dangers of the second text having
a greater legal weight than perhaps it should do or less legal
weight than it should do and that really reflects a lot of discussion.
It is the case that it is unclear as to when those issues will
be resolved at the WTO, but it is important to bear in mind that
the agreement itself, as of 2003, is effective and can be acted
on now, but it would clearly be the case that a permanent agreement—
17 Department for International Development: Responding
to HIV/AIDS, Report by the Comptroller and Auditor General, HC
644, Session 2003-04: http://www.nao.org.uk/publications/nao-reports/03-04/0304664.pdf Back
18
Taking Action: the UK's strategy for tackling HIV and AIDS in
the developing world, DFID, July 2004: http://www.dfid.gov.uk/pubs/files/hivaidstakingaction.pdf Back
19
Ev 29-31 Back
20
HM Government, Harm reduction: Tackling drug use and HIV in the
developing world, November 2005: http://www.dfid.gov.uk/pubs/files/hivharmreduction2005.pdf Back
21
Report to the Prime Minister by the UK Working Group on Increasing
Access to Essential Medicines in the Developing World, Policy
Recommendations and Strategy, November 2002: http://www.dfid.gov.uk/pubs/files/accessmedicines-report281102.pdf Back
22
DFID/Department of Health/DTI, Increasing people's access to
essential medicines in developing countries: a framework for good
practice in the pharmaceutical industry March 2005: http://www.dfid.gov.uk/pubs/files/pharm-framework.pdf Back
23
Public Service Agreement Back
24
Poverty Reduction Strategies Back
25
"MSF to WTO: Re-think access to life-saving drugs now."
MSF Campaign for Access to Essential Medicines, Press Notice,
25 October 2005, http://www.accessmed-msf.org/prod/publications.asp?scntid=251020051332373&contenttype=PARA& Back
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