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Westminster Hall

Thursday 6 March 2008

[Ann Winterton in the Chair]

International Health Partnership

Motion made, and Question proposed, That the sitting be now adjourned.—[Mr. Alan Campbell.]

2.30 pm

The Parliamentary Under-Secretary of State for International Development (Gillian Merron): I am grateful to have this opportunity to participate in a debate in parliamentary time about the international health partnership because I believe, as I am sure we all do, that the state of the health of the world’s poorest people is one of the great injustices of our time, and we are keen to put that right. This debate is timely, as yesterday marked the six-month anniversary of the IHP’s launch. I would like to begin by setting out the scale of the global health challenge and the depth of human suffering that we need to address.

In 2000, the Governments of the world set out a vision to reduce poverty by 2015. That vision, which was enshrined in the millennium development goals, included reducing by two thirds the number of deaths among children under five, reducing by three quarters the number of maternal deaths, and reversing the spread of AIDS, malaria and other diseases. Today, we are still a long way from achieving those goals. Every day that passes, more lives are lost—every three seconds, one child under the age of five dies; every minute, a mother dies in childbirth; and every day, more than 10,000 people are infected with HIV—yet much of the suffering can be prevented through simple and affordable measures.

That is why the international community is devoting more resources than ever before to tackling the crisis in health. Funding for global health has doubled from $6 billion in 2000 to $13 billion in 2005. Last year, the UK Government committed £1 billion up to 2015 to the Global Fund to Fight AIDS, Tuberculosis and Malaria. Much of the increased funding has targeted specific diseases, with impressive results. For example, the global fund has put more than 750,000 people on to antiretroviral treatments to fight AIDS and has distributed more than 18 million bed nets to prevent malaria. Every day, it helps to save 3,000 lives. The Global Alliance for Vaccines and Immunisation, with the support of the international finance facility for immunisation, has prevented nearly 3 million deaths by dramatically increasing the use of vaccines.

The challenge now is to lever that success to deliver enduring health systems that the poorest people can get to and use. Such systems should include networks of clinics, health workers and available drugs and treatments. Without them, medical tests are not carried out, drugs go undelivered and the regular monitoring of patients and the improvement of their health breaks down, often with tragic results. The Government and I believe that building stronger health systems is critical to meeting the health millennium development goals.


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The second challenge that we face is ensuring that we make the most effective use of aid for health. Every pound can save a life, and we have a duty, not only to the poorest in the world but to the UK taxpayer, to ensure that every pound is used to its maximum. The truth is, however, that the global health system is a crowded place. More than 100 different agencies are involved. That is often reflected on the ground in developing countries with fragmented approaches to health provision that function outside the Government’s own planning and budgeting processes.

For example, in Rwanda, 21 donors and 40 non- governmental organisations are active in the health sector. As a result, the figures are worrying. Administration consumes more than one quarter of all health spending. The central Government are managing only 14 per cent. of donor expenditure, and only $1 million of donor money goes to the integrated management of childhood diseases, compared with $18 million for malaria and $47 million for AIDS. We need to tackle those figures.

It was because of those two challenges—building stronger health systems and making aid more effective—that, six months ago almost to the day, our Prime Minister launched the IHP from Downing street. The time was right. New people in charge of the World Health Organisation, the World Bank and the global fund were all committed to working more effectively, and 2007 presented a unique opportunity to forge a new alliance for better health. This morning, I spoke at the Women and Children First conference, where Dr. Songane, the chairman of the Partnership for Maternal, Newborn and Child Health, described 2007 as a turning point. He was right, and it is our duty to make it such.

That is why, under our Prime Minister’s leadership, developing country Governments, other bilateral donors and heads of the major health agencies have come together to launch and work on the IHP. Without any doubt, this is an important milestone. For the first time, members of the global health community signalled that, working together, they would challenge the idea that business as usual can go on. In other words, we agreed to work together to change the status quo.

However, we need to do that without creating a whole new bureaucracy—another piece of crowding in a very crowded place. We need to do it without creating yet another global fund, or an exclusive club for the few. The IHP is none of those things. What is important is that it is about all partners working together around a set of three principles aimed at transforming the health of the poor.

First, there must be robust, country-led national health strategies. Indeed, some national health plans are very good, while others set out how existing resources will be spent. Some countries have no health plan. Some have several health plans: one for AIDS, one for health systems, and another one for the health work force.

The second principle is that funding should be co-ordinated around those strategies. Alongside the national Governments, there are several international funders of health, including the WHO, the World Bank, the global fund and bilateral donors such as the UK Department for International Development.


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The third principle is that health systems must be central to national strategies. They are essential to complementing and sustaining the success of disease-specific innovations and interventions, including those for AIDS. Health strategies are important for improving child and maternal health, and for addressing other major killers in developing countries, such as diarrhoea and respiratory illnesses.

Developing country Governments agreed to invest more in their own health systems, to address bottlenecks to stronger health systems, and to strengthen planning and accountability systems. The political commitment that we saw in September was critical to all this, but the success of the IHP will be in its implementation. Obviously, the proof of the pudding will be in the eating, and that is our challenge.

It is only if we can change the way in which we work that we will deliver much-needed change and improvements and thereby progress towards meeting the health millennium development goals. The IHP is already fast becoming recognised as the organising framework for support to the health sector. I pay tribute to the efforts of Margaret Chan, Joy Phumaphi and their staff at the WHO and World Bank. Their determination to implement the IHP has been critical to achieving the progress that has been made in the first six months.

Let me give just a few examples of progress. One of the challenges with focusing aid on health systems is the difficulty in showing the impact of additional spending. I am particularly impressed with Burundi’s country-level IHP compact, which was signed just two weeks ago and focuses on achieving tangible improvements in health, such as increasing the number of people attending medical facilities and improving immunisation coverage and deliveries in clinics.

One of the most visible and damaging signs of a weak health system, which was raised with me this morning at the Women and Children First conference and of which we are all aware, is a lack of trained health workers. The World Health Organisation estimates that we have a global shortage of some 4 million health workers—1 million are needed in Africa alone. In Mozambique, a central part of the IHP will be developing and implementing a co-ordinated strategy to increase the number of health workers. The United Kingdom Government are supporting that.

We must not forget that even if there is a fully equipped and staffed clinic, that will not lead simply to improvements in health care, if people cannot afford to use it. That is a major issue for us, because fees account for more than 60 per cent. of total health spending in the poorest countries and are, without doubt, one of the most regressive and ineffective sources of health financing. I am delighted that, in Nepal, the IHP has given momentum to a new policy of free health care.

I recognise the important role of civil society and organisations such as Save the Children, which has taken an interest in today’s debate, in providing health services to the poor. In Zambia, the IHP further encouraged the Ministry of Health to engage with civil society.


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Finally, looking ahead to the next six months, I am delighted that Margaret Chan has agreed to arrange an event at the World Health Assembly to widen support for the IHP. The next milestone for us will be the one-year anniversary of the international health partnership in September. I look forward to being able to report then that it has continued to develop and to deliver real improvements to the health of millions of the world’s poorest people.

2.42 pm

Mr. Geoffrey Clifton-Brown (Cotswold) (Con): Lady Winterton, it is a great pleasure to serve under your chairmanship today and it is a great pleasure to welcome the Minister. She and I have had various co-operative ventures since we have been in this House. We were both in the armed forces parliamentary scheme for the Royal Air Force, and we were in our respective Whips Offices at the same time. We have always had a good and cordial relationship. My speech this afternoon will do nothing to antagonise that, although I have some questions for her and I do not know whether she will be allowed to reply. If she is not allowed to reply this afternoon, perhaps she would write to me.

On a point of order, Lady Winterton, will the Minister be allowed to reply?

Ann Winterton (in the Chair): May I reassure the hon. Gentleman that, with the number of speakers we have this afternoon, it is imperative that the Minister reply?

Mr. Clifton-Brown: I am pleased to hear that, Lady Winterton. We look forward to her doing so.

Gillian Merron: I look forward to dealing with as many points as the hon. Gentleman, or any other hon. Member, raises.

Mr. Clifton-Brown: In terms of both development and health goals, we in the United Kingdom and others in the developed world have set ourselves a long series of ambitious targets. The interaction between health and development can often leave us in a Catch-22 situation, as improvements in development can lead to a healthier population, but a healthy population is a spur to development. It is therefore no surprise that, as the Minister has spelled out this afternoon, three of the eight millennium development goals—reducing child mortality; improving maternal health; and combating tuberculosis, AIDS, malaria and other preventable diseases—aim directly at delivering improvements in health, and that the international health partnership should target those.

It was with that in mind that I recently returned from a visit to the World Health Organisation in Geneva, where I met Dr. Ian Smith, an adviser to Margaret Chan, the director-general of the WHO, whom the Minister mentioned, and Dr. Bruce Aylward, who is leading the WHO’s campaign for polio eradication. From both doctors I was able to further my understanding of the scale of the health crises faced by residents of some of the poorest countries across the globe, and of the challenges that stand in the way of the experts in mitigating those crises.


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One of the most salient points that arose from this debate came from Dr. Smith, who mentioned the change in the global health framework. As the Minister mentioned at least twice in her speech, in 1948 when the WHO was established, and for some 20 years subsequently, it was the only key global health player. In recent years, the picture has become far more crowded, with competing non-governmental organisations, the World Bank, the Bill and Melinda Gates Foundation and increasing private sector involvement. That is all to the good, but as the Minister made clear, we must avoid duplication and waste.

On the shortfall in respect of the millennium development goals, which the Minister mentioned, unfortunately, as we have passed the halfway mark set for those goals, it seems that global efforts may well fall short of achieving a number of the targets, despite much good work and will from the WHO and many other organisations working in the health arena. As the Minister said, globally, half a million women die each year in childbirth, 10 million children will not reach their fifth birthday and malaria kills half a million people a year.

The international health partnership is clearly a welcome addition to the fight for global health, through the emphasis that has been placed upon ensuring that all the 40 donor countries, 26 United Nations agencies, 20 global funds and 90 health initiatives are able to work together, as the Minister said, pulling in the same direction and attempting to avoid an overlapping of responsibility. I am glad to see that Governments and agencies representing half the global spending on health are involved in the IHP. Alongside a meaningful strategy, it is through the support of these agencies and organisations that the IHP can make the changes and improvements that the Government and all Members of the House want to see. I hope that the Minister can tell us today what communication she is having with these agencies and nations to increase still further their involvement in this matter and to strengthen the international base in support of the IHP.

I note with interest that the UK has provided £3.5 million of the £4 million that has so far been raised through the IHP. I should be interested to know what representations the Minister is making to encourage increased funding from our other partners in this valuable scheme. As she said, it is almost the six-month anniversary to the day, and it will soon ratchet up a year. We need this valuable time if the millennium goals are to be met. In particular, I hope that she can elaborate further on the participation of the United States, which surely must be expected to play an important role, being one of the largest health donors.

There is a welcome focus on improving local health systems in poor countries. If people do not have the means of accessing or receiving available treatment, they cannot benefit from it. I was delighted that the Minister mentioned the work being done in Nepal, which I visited 18 months ago, and how health fees have been reduced, thereby increasing access in that country. That is a welcome development.

The point is easily demonstrated by comparing Moldova and Angola. In Moldova, the gross domestic product is $2,962 per capita and in Angola it is $2,813,
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yet in Angola a child is 16 times more likely to die before reaching its fifth birthday: this in a country where the average citizen earns only $149 less than in Moldova. So two countries with broadly similar GDPs have hugely dissimilar health services. We need to start eliminating that sort of disparity. I hope that the IHP, which should be broadened, as I will mention in a minute, will be able to reduce such disparity. How can we account for those figures in Angola and Moldova? The percentage of GDP spent on health in Moldova is four times higher. There are 33 times more physicians per 1,000 of the population in Moldova. Until we begin to address these imbalances worldwide, and unless all the necessary factors are aligned, improving a country’s GDP will not necessarily result in improved health.

On preventable diseases, no one said that winning the health battle would ever be easy. What the Minister said today proved that. Alongside infrastructure improvements, we must not take our eye off existing health programmes. Although HIV/AIDS is often the focal point, given that only one in four people in Africa who needs AIDS treatment receives it, other important battles remain to be fought. Every year, 500,000 people die worldwide from malaria, but for just $3 billion a year a complete malaria programme could be established within three years. That would involve not just a net for every bed in need, but clinics, treatments and diagnostics. The Conservative party’s policy is to spend $500 million a year, every year, until the millennium development goals for malaria are met.

Dr. Bruce Aylward of the WHO, whom I met in Geneva, is heading the global initiative to eradicate polio. He is an extremely impressive man. He and Margaret Chan, director-general of the WHO, have raised a huge amount of funds and come up with a programme that has worked. Their work in eradicating polio is most welcome. He was keen to express the critical role that the UK has played through both fundraising and advocacy. However, with the end of this important programme nearly in sight, the UK has apparently cut its donations by more than half—from $236 million in 2003-05 to just $101 million for 2006-08.

If that is so, it is a worrying development, and I ask the Minister to investigate whether the Department for International Development could divert some of its resources to meeting the funding gap of approximately $525 million in 2008-09, so that the programme can be well on its way. What a huge boost that would be to some of the poorest countries. We have managed largely to eradicate smallpox, and if we could largely eradicate polio as well, that would be a major triumph.

As a country we have a vital role to play in helping the WHO, which is a key player in the international health partnership, as the Minister made clear, along with the World Bank and the global health fund. If we do not find that funding somehow, the disease will return to blight much of the world, as it did in the 1980s when it was endemic in 125 countries. It is now endemic in only about three countries, Pakistan and Nigeria being two.


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