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6 Mar 2008 : Column 496WH—continued
We must not be afraid of making the structure of the international health partnership as ambitious as the targets that we have set. Here in the western world, we are blessed with some of the finest doctors and health care professionals in the world, with a fantastic level of
training. If we are to build the national health partnerships in the developing world that the Minister mentioned and that we aspire to, we need to tap this resource. Yet the British Medical Association has raised clear concerns that although there is willingness within the medical community to offer such assistance, far more could be done to encourage and facilitate doctors from this country to travel to help the developing world. Not only could those professionals assist with immediate shortfalls in qualified staff; they could establish a system of training for local doctors to provide long-term cover. It is a shame that doctors who have gone to work overseas have often had to fund such secondments from their own savings, and that they have concerns about their ability to return following their time abroad. Surely a bit of joined-up thinking between DFID and the Department of Health would enable something to be done.
The Conservative party has pledged to improve the links between health systems in the UK and developing countries, and to reduce the barriers to health care professionals when they travel abroad. That will come about through the introduction of a health systems partnership fund worth around £5 million a year, with money to come from DFID. It will be administered jointly by DFID and the Department of Health, thus reducing, I hope, some of those barriers. As my hon. Friend the Member for Sutton Coldfield (Mr. Mitchell) suggested, given the good that that programme would do, it is one policy that the Government are welcome to steal. It is worth noting that it would also benefit our own health care system through the skills that staff would pick up while working abroad. Without that in place, we will only ever be able to take a short-term approach to providing training for local doctors, as our medical professionals will continue to be reticent about taking such risks.
On co-ordination, it is important to strengthen the linkages between the various health agencies and donors, and we must consider linkages to other aid programmes because health cannot be separated from them. Too often, health programmes become an enforced necessity through a failure to deal with other, intertwined problems, just as a failure of health care programmes impinges on the success of other, linked goals.
The Earth Policy Institute has built 12 millennium villages in 10 African countries, which will demonstrate how, through working with local people to improve health schemes, along with water, agriculture, education and technological aid, the goal of halving extreme poverty can be achieved for just £55 per person. If that scheme is successful, it would be worth replicating it elsewhere.
Equally, increased spending on education programmes, infrastructure programmes, which have been discussed, and agricultural schemes can yield real gains in health issues. On the other hand, climate change is having a knock-on effect on people’s health, which demonstrates the intertwined nature of our world and how one thing can have a knock-on effect elsewhere.
I hope that the Minister will assure us that real co-operation can be achieved within the international health partnership, and between it and Germany's
providing for health initiative. After all, it was our Prime Minister, with the German Chancellor, Angela Merkel, who launched the international health partnership in the first place. I hope that we are expecting full participation from the German Government in that partnership. Furthermore, I would be interested to hear what discussions the Minister’s Department is having to further co-operation with other development agendas, both domestically and internationally. I hope that that will ensure that we do not pay twice for the same work to be done, nor have contrasting approaches to the same end.
I am aware that there have been many calls for an increase in funding for health programmes, particularly through the international health partnership. What I am most concerned about, before increased funding is pledged, is an assurance that there will be increased accountability for and auditing of the money that is spent through the international fund. I was delighted to hear the Minister say that one of the Government’s key aims was that British taxpayers’ money, and other countries’ taxpayers’ money, should be spent effectively in achieving real results. I was delighted to hear that, because it is a change of emphasis in what we have heard previously about how British aid is spent.
Until we can be absolutely certain that money is being targeted in the right areas and is being spent effectively, any increase in expenditure will not be met with a proportional gain in global health. All too often—although I hasten to add, not always—what is needed is not more funding, but for the money to be better spent through increased co-operation and a core strategy. I would like to emphasise that that should not preclude an increase in our country’s spending when the money can be spent in a truly meaningful way.
One matter of concern is the level of staffing cuts in DFID’s headquarters. During the demonstration on world AIDS day, some AIDS professionals were particularly concerned about cuts in the number of health care specialists in DFID, and its ability to deliver its worldwide health care programme. I hope that the Minister will bear that in mind, and reassure us. Wherever I have travelled around the globe, DFID’s staff are internationally respected, and I would like an assurance that those cuts will not affect its ability to implement real change where it is needed.
On an afternoon when there is a debate in the main Chamber on international women’s day in preparation for 8 March, which is international women’s day, it would be remiss of me not to mention the matter of maternal health, which is of huge concern. Half a million women die each year during childbirth. Women also suffer disproportionately from conflict and poverty.
The health of a country’s women is a test of the strength of its health care system. The Select Committee on International Development has said that in the developing world there is an urgent need to increase the number of midwives and improve access to drugs and treatment. I hope that those words will be noted by the Minister. After all, the Nobel peace prize winner Wangari Maathai has reminded us that
“throughout Africa, women are the primary caretakers, holding significant responsibility for tilling the land and feeding their families”.
I quoted that statement on Monday during the launch of Oxfam’s photo exhibition entitled “Sisters of the Planet”, which the hon. Member for Bristol, East (Kerry McCarthy) and I attended. It was a very interesting launch and she will remember the point made by Sahena Begum who had come all the way from Bangladesh. She is the elected president of a 25-member women’s committee based in her tiny rural village in Bangladesh and she is determined to help women prepare for the increased difficulties that they face during floods, which in recent years have become increasingly severe. After having lived in only a very small, remote rural community, imagine what it must have been like suddenly to be brought to our Parliament in the centre of London. Yet through an interpreter, she was able graphically to describe the difficulties and the conditions that she faces in her local community.
The group she represents meet to discuss how they can improve health and hygiene issues, and make provisions for the effects of flooding. The value of such work in relation to health concerns cannot be overstated. The continued high mortality rate acts as a fuel to many other problems. I hope that we can receive an assurance that issues of maternal health will have a starring role in the work of the international health partnership, and that women across the globe will be involved in new health care strategies at all stages.
I conclude my comments by commending the principles behind the development of the international health partnership and the sterling work of those charged with implementing its proposals. There is truly a great need for the work and funding that has been pledged. The road towards achieving the millennium development goals is long and difficult, and in approaching that, our policies should be nothing less than ambitious. Our resolve should not weaken and our strategies must be defined and practical. The increased co-ordination of our delivery of aid and an invigoration of the work on building basic health care systems are a step in the right direction. I hope that the Minister will use proposals from today to enable us to keep moving forward.
I am sure that people in Cambodia, Zambia, Ethiopia, Kenya, Mozambique, Nepal and Burundi are grateful for the work being done through the international health partnership. Perhaps the Minister can say whether any other aspirant countries are being considered to join the system. There was a rumour that Malawi may be joining and there may be other countries that are also being considered, so perhaps the Minister could comment on that. We must now strive to increase the beneficiaries of all this good work.
3.3 pm
Mr. Michael Moore (Berwickshire, Roxburgh and Selkirk) (LD): After the sometimes stormy weather in Parliament this week, it is a real pleasure to be in the relative oasis of calm consensus. It has been instructive to listen while the Minister and the Conservative spokesman have introduced the debate. The problem with consensus is that by the time the third person speaks, many of the best statistics and points have been mentioned. I do not wish to try your patience, Lady Winterton, or that of my colleagues by being overly repetitive, but I apologise in advance if some of my points cover ground that has already been discussed.
The Minister and the hon. Member for Cotswold (Mr. Clifton-Brown) were both right to focus on the millennium development goals and on the particular ways in which they draw our attention to horrific problems. Halfway through the period covered by the programme we are still tragically off the pace and struggling to reach the noble goals that were set a few years ago. We must never lose sight of how shocking the statistics are on child mortality, which has already been mentioned. Only 32 of 147 countries are on track to cut child mortality for those under five by two thirds in the period before 2015. In Asia, a number of countries are off track to a greater or lesser degree, but in Africa almost every country will miss the target, which is a wake-up call for us all.
The Conservative spokesman has mentioned the issue of maternal health. Like him, I was impressed by the “Sisters of the Planet” exhibition in Parliament this week. I was unable to attend the official opening, but I spent some time at it yesterday. The stories from different parts of the world were a reminder that we should not be complacent about the challenges and the difficulties facing people as they go about their everyday lives in different parts of the world. The exhibition and the messages from the Oxfam people who assisted us to understand and take on board all the information brought home to us that complacency is not an option. On HIV/AIDS and malaria, as has been mentioned, the figures are staggering. It is mind-boggling to think that nearly 40 million people in the world live with HIV/AIDS. Sadly, contrary to what the millennium development goals seek to achieve, the numbers are going up, rather than down.
As the Minister pointed out, there are a number of different priorities for our country, which have been explicitly set out by the Government over time. Funding is a big part of that and there has certainly been a great increase in funding by the Government over recent years. We pay tribute to that; it is a very welcome development. In this country we also have a particular role in relation to health professionals and the expertise that they have and can share with others around the world. Again, a key theme of the international health partnership is the need for better co-ordination in all the various programmes that exist—not just from non-governmental organisations, the Government and charitable foundations in this country, but across Europe and the world.
A year ago, in his report “Global Health Partnerships” commissioned by the then Prime Minister Tony Blair, Lord Crisp set out the need for partnerships to be established along the lines of those that the Government have now set up. Importantly, he stressed that developments must be based on the needs of the countries themselves and the needs that they have identified for themselves. Proposals put forward must improve the practical value of what is happening and should not simply layer on more bureaucracy. Lord Crisp has established some important principles—for example, that developing countries themselves need to take the lead, and that when we are scaling-up resources they should be in relation to the training, education and employment of health workers. More importantly, he also said that we need to be more rigorous in our research and evaluation of what actually works and that we should not simply keep reinventing the wheel—we are guilty of doing that too often. The Minister demonstrated how those principles
have been boiled down into factors that are particularly emphasised in the international health partnership, such as the need to develop and support a country’s own health plans, to provide better co-ordination among the donors and to focus on health systems as a whole, not just on single diseases.
Indeed, the Overseas Development Institute highlighted several very positive things that can flow from such an approach. We can refocus health aid away from treating individual diseases exclusively and towards developing health systems in the round. We can tackle the tendency to focus on some diseases at the expense of others, which are sometimes called orphan diseases. That is something that we understand from our constituencies and from the way in which health is debated in this country, and action in that respect would certainly be a major breakthrough. Finally, we need greater harmonisation and alignment, and that is a theme that occurs in every aspect of the development work that we consider. Instruments such as IHPs offer us the opportunity to pursue such things, and my party would certainly welcome that.
As the Minister said, we have just had the six-month anniversary of the creation of IHPs, and their implementation is now critical. The hon. Member for Cotswold asked several questions, and, like him, I am keen to hear the answers to them this afternoon or at some other appropriate moment. If I may, however, I would like to add to the list of queries for the Minister to consider.
On the individual country compacts, how far have we got with the individual countries that are listed as the starting points? Like the hon. Gentleman, I would be interested to know how many more countries are being brought on board, by which I mean both developing countries, which we hope will benefit, and developed, donor countries.
On the simplification and harmonisation of the multilateral delivery of health and other assistance, to what extent have the Minister and her colleagues taken up such issues in the EU? A number of the countries that are listed as part of the IHPs are members of the EU, but many other EU members are not listed as part of them. What work is being done to broaden involvement in IHPs across the EU?
Japan and the United States are key players in the delivery of development assistance in its many forms. They can offer a huge degree of funding and expertise, and it is important that they are brought in.
Mr. Clifton-Brown: The hon. Gentleman has reminded me of what I heard at the World Health Organisation last week. Margaret Chan has been an absolute champion at going out and getting funding from some of the emerging wealthy nations that do not usually give to the donor community. I heard how she literally sat down with the King of Saudi Arabia and got funding for the polio eradication programme. Does the hon. Gentleman not think that we should do a lot more of that? A lot of countries are emerging as very wealthy, and we need to tap into them for such programmes.
Mr. Moore:
I absolutely agree. I am sure that the Minister will tell us that she has an appointment with President Bush shortly to do exactly that. I do not wish
to be flippant, however, because key individuals, such as Margaret Chan, have gone not only the extra mile, but an extra 1,000 miles to draw attention to the fact that we need funds and greater co-ordination if we are to deliver the health assistance that it so desperately required. Anything that we can learn from the Minister about how she and her colleagues are taking such issues forward and doing their bit will be very welcome.
I was talking about Japan and the United States and I wonder whether there will be an opportunity at the G8 in Japan this summer to draw other countries into the IHPs. That would perhaps allow them to build on the work that the Government did three years ago at Gleneagles to draw the world’s attention to the poverty agenda.
We have touched on the issue of health professionals and the assistance and expertise that this country can offer developing countries. However, there is also the fraught issue of the migration of health professionals from those countries to our country. Codes have been drawn up broadly to regulate that migration, but how confident is the Minister about the way in which those codes are working? The EU is considering the issue more broadly. What input can we have in that respect?
Mr. David Drew (Stroud) (Lab/Co-op): When I was in Ethiopia about four years ago, I was staggered to hear that there are more Ethiopian doctors in the United States than in Ethiopia. We have done some work to stop that export of valuable people, but it is an international issue and cannot be tackled just at the national level. I am sure that the hon. Gentleman would agree with that.
Mr. Moore: Indeed I do. The hon. Gentleman brings the issue into stark focus with his point about Ethiopian doctors. As I said just before he intervened, it is not only our Government who need to take a lead on this issue; it is a matter for Europe and the G8, where America and others can be brought into the debate. Nobody questions the fact that health professionals and health workers will come to this country, and there are many complex reasons why they wish to do so. However, in seeking to balance such movements—I do not want to use the word “restrict”—we must ensure that there are proper facilities and procedures, so that those who wish to gain access to training and support here can still do so and can then return to their own country to provide the input that is so necessary in their own health services.
Lord Crisp’s report made several good recommendations, and I hope that the Government will publish an updated response to them at some point. He highlighted several interesting ideas, including that we should have a global health partnership centre in this country. Such a centre would be a one-stop shop for all the different parts of the national health service, non-governmental organisations, other donors and Government efforts and would allow people in recipient countries and in this country to know how they could contribute efficiently. Lord Crisp also talked about a global health exchange, or health bay, as he put it, which would offer the opportunity to share best practice, expertise and information. Another idea that stood out was that we should encourage and facilitate volunteering by people in the NHS, so that they can go to other countries, make a major contribution and benefit from the experience so that they can understand the challenges that others face.
Given the pressures on the House this week, the debate may prove to be shorter than it deserves to be, but the issues that it raises and the Government efforts that it highlights are fundamental to Britain’s contribution to reaching the millennium development goals and ensuring that we never lose sight of the truly appalling lives that many people lead and the short lives that many others have led. At the outset, the Minister set out the scale of the challenge facing us, and I hope that she will be able to answer some of our questions when she concludes.
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