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6 Mar 2008 : Column 503WH—continued

3.19 pm

Gillian Merron: I am grateful to those hon. Members who have attended for their constructive contributions to this important debate. I hope that the debate will produce real results, because we are talking about improving people’s health and well-being and about saving the lives of millions of people across the world. I shall focus on the points that have been raised because they have been very useful in developing my argument and they allow me to say a bit more about the actions that the Government are taking.

Clearly, we are all appalled by the awful levels of child and maternal mortality in the poorest countries and by the devastating impact of diseases such as AIDS and malaria. I am encouraged to find in the House a universal wish for the UK to continue to play a leading role in addressing the health crisis. I believe that people look to us to do that. Many agencies, Governments, organisations and individuals are doing great things, and we should welcome, support and applaud those efforts. Our job is to develop a way forward that allows us to maximise and see more of such efforts. Clearly, the crowded place in which aid is delivered is something that we must tackle, and the international health partnership is critical. The delivery of health care is a complex area and it is our duty to find the best way forward.

Everyone would agree that finances are crucial. More money is always welcome, but we must look at how we use that money and at how we can achieve the results that we want, because results matter. Three of the eight millennium development goals are on health. They are off track, but we are not prepared to be complacent about that. I believe that the world can do more. Aid effectiveness is the key and that has been at the core of our discussions today.

I assure hon. Members that addressing maternal health is a priority for the Government. Our strategy covers a range of factors. It is important to understand that it is about not just the delivery of health care, but enabling women to have access to family planning and safe abortion, and overcoming cultural and financial barriers to accessing care. It is about getting research to guide us so that we do the best that we can. We also need to ensure that women have greater access to midwives, doctors, and the correct, proper, skilled, sympathetic and empathetic health care workers to provide maternity and emergency care where it is needed. We expect all those things in this country, and they can make a difference.

Achieving such goals is complex and requires much navigation and determination. I, like other hon. Members, welcome the International Development
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Committee report. It agrees that improving maternal health, which is millennium development goal 5, is one of the biggest challenges facing developing countries. I will ensure that we respond in full to that report and I look forward to doing so, not least so that I can explain why maternal health and the health care of women matter. It is very simple to me: if we are to see true development through which countries are able better to serve their people, that cannot be for half the people—that is just an impossibility. There is a very strong lobby on that, which I welcome. As constituency MPs, we should welcome the fact that our constituents have taken a great interest in the matter and are pushing us to do more.

Mr. Drew: I agree with my hon. Friend. Will she go on to say that, sadly, one of the biggest problems with maternal health is the connection with conflict? In the Darfur region, which I know only too well, the biggest problem for women is access to much-needed health care. Health care is needed because of continuing rape and violence against women. The conflict has led to an imbalance in the population because, for all sorts of reasons, there are no men in many of the villages. That has a deleterious effect on the way in which the whole structure of the population operates and on maternal health, in particular.

Gillian Merron: My hon. Friend raises an extremely important point. Violence against women in non-conflict and conflict situations creates huge problems for women’s heath and for the future that they and their children can or cannot look forward to.

In Ghana, our DFID officials have worked well with civil society to encourage that country’s Government to pass legislation in respect of domestic violence, which has just happened. As we know only too well, this is about not just legislation. There is also a question of whether support will be in place for those women and whether there is somewhere for them to go if they have to leave their homes. There is a range of factors to consider. We know that global poverty and conflict often go hand in hand and that the violence against women that my hon. Friend describes is a feature of that. Such violence creates the big problem of the spread of HIV and AIDS. We therefore have to tackle not just conflict, but attitudes as well, and that is tough.

I hope to respond to all the comments that have been made and I will attempt to do justice to them. With regard to Lord Crisp’s report, I can assure hon. Members that the inter-ministerial group on global health will shortly issue the Government’s response to outline how to take forward the recommendations, which we welcome.

The role of the United States has been raised. I confirm that the United States is clear that it supports the principles of the international health partnership. The Government work very closely with the US, in four countries in particular, on developing the health work force, and I will return to that important matter in a second. We also work with the United States through the G8 to improve effectiveness and the volume of aid for health systems, so we see the United States as an important partner.

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We need more countries to want to be part of the IHP. I am delighted that Nigeria and Madagascar are asking to join. As I have mentioned, the event at the World Health Assembly in May will be an opportunity to promote the partnership still further. I hope that more developing countries will see the benefits and want to sign up. We will continue to encourage new countries to approach the World Health Organisation and the World Bank.

I have been asked to make reference to progress in countries so far. I am very happy to give hon. Members greater detail on any of those countries if they so wish. In the past few weeks, Burundi has signed a country-level compact. In Ethiopia, the IHP road map was launched early last month and the compact will take that further. Every country is different, so we need to tailor the compact and the international health partnership to achieve the right approach. Tremendous progress is being made and I am heartened by the fact that new countries are clamouring to sign up.

Mr. Clifton-Brown: The hon. Member for Berwickshire, Roxburgh and Selkirk (Mr. Moore) was right to raise the issue of compacts. Without a proper health plan in each of the recipient countries, it is difficult to know where the help needs to be targeted. Can the Minister give us any idea of how many of the developing member countries will have a compact in place by the anniversary in six months’ time?

Gillian Merron: For the reasons that I have explained, it is difficult to give an exact answer. Every country is different. Let me give another example to illustrate that. In Kenya, where there is a particular situation at present, the Government and the partners have agreed that there should not be a separate IHP document, because as I mentioned, the IHP is not about creating new bureaucracies, but about delivery. If a compact is needed, we should have that. In Kenya, the country compact will instead be the action plan, which is following a mid-term review of Kenya’s health sector. The best thing that I can say to hon. Members is, “Don’t judge the IHP by the number of compacts. Judge it by the results—by delivery,” because that is what I am committed to.

Rightly, a question was raised about what communication we have with other agencies and partners. I can assure hon. Members that there is regular and meaningful dialogue. The UK has been invited to speak at the second meeting of the H8—the eight agencies—and we regularly have contact with the heads of agencies such as the World Bank, UNICEF and the Global Fund to Fight AIDS, Tuberculosis and Malaria. We continue to press the heads of those agencies to deliver on the commitments to which they have signed up. That includes aligning funding with the plans of the particular Government and co-ordinating funding around those plans. Again, there is no point in having the discussion without ensuring that action follows. That is a constant theme in all our discussions.

An allied question is what we are doing to encourage funding from others. We are in close contact with other donors and particularly the WHO and the World Bank, which have received additional funds—for
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example, from Norway. We will continue our work through both the G8 and the EU to encourage further support.

We have had discussion about UK medical staff and I pay tribute to the staff who have given their expertise, time and skills to supporting developing countries. That is very important work. However, in the long term, the real key to all this is not just to strengthen health care systems, but to ensure that health care professionals are in such countries in sufficient numbers and with sufficient skills, and can reach the right people. That is our main focus, and we will continue to strengthen the in-country health work forces as the long-term commitment that we can make.

Questions were raised about malaria and polio. On malaria, I reiterate that the Government have committed £1 billion up to 2015 to the Global Fund to Fight AIDS, Tuberculosis and Malaria. I am sure that hon. Members are aware of our Prime Minister’s absolute commitment to the fight against malaria. We will make a further concerted effort in that regard this year. In Kenya, for example, we are supporting the WHO and NGOs in respect of treated mosquito nets. That has led to a 50 per cent. cut in malaria deaths. As part of our commitment, I am particularly keen that we talk not just about numbers of bed nets but about their usage. In the end, what is important is not just the delivery of a bed net but the fact that it is used.

We have already provided £350 million to tackle polio—we are the second largest bilateral donor. As a result of that and of success in working with our partners, the number of cases has dropped from 350,000 in 1988 to some 2,000 last year. We are keen for other donors to play their part in that.

The hon. Member for Cotswold (Mr. Clifton-Brown) raised a very important point about accountability of funds—how they are used and where they get to. As we know, the IHP is about maximising the impact of existing aid. Depending on the country and what is happening there, we ensure that our aid reaches the people of those countries through the most effective means possible. In many cases, that is through NGOs. It may be through world institutions such as the World Bank and the United Nations. It is about working with organisations such as Oxfam and Save the Children as appropriate, or with the Governments, depending on the situation. However, measuring the impact of the IHP is crucial. We have had discussion about that, and the members of the IHP have agreed a single way of doing it. I am referring to focusing on the changes that it will make to people’s lives—for example, measuring the number of people attending clinics, the number of children receiving immunisations and the number of mothers giving birth in a clinic. All those are direct measures of where money is being used.

I can assure hon. Members that we have robust systems in place to assess public financial management systems of the countries in which we work. We will, and do, investigate any cases in respect of which there is any concern. If any hon. Members wish to draw cases to my attention, I will be glad to follow that through. Aid effectiveness is what this is all about.

The EU and our work with EU colleagues were mentioned. Just last week, officials met EU colleagues. We are also active through the G8. Even if some donors do not sign up to the IHP, they are nevertheless
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committed to the principles of improving the effectiveness of health aid. At the G8 we are already working, and will continue to work, with officials and politically to ensure that we see stronger action on health systems funding and particularly on the health work force.

I would like to put it on the record that the UK has been at the forefront of efforts to prevent migration of key health workers from developing countries, which has slowed down. We now have a code of conduct that precludes active recruitment in developing countries, and we have increased training of our own UK doctors and nurses so that we no longer need to recruit so many from abroad.

I pay tribute to the staff who work for DFID, many of whom are working in-country. In my role, I am keen to ensure that they feel as much a part of our team as those working in London, because they are our teams in the countries where we are working. We have undergone some reductions in administration costs, as have a number of other Departments. I am sure that hon. Members and our constituents would expect us to do that. It is important to say that our health advisers, for example, are working more strategically. We are liaising and co-ordinating much better and to a greater degree with other countries and other donors at country level, to ensure that we are speaking with one voice in the way that the IHP wants us to do. There is a sharing of expertise.

Mr. Clifton-Brown: I am grateful to the Minister, who has been generous in giving way. My party has pledged not to cut the staff at DFID headquarters any more, because her Department is unique among
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Departments in having, rightly, an expanded budget. If there are not the staff at headquarters to be able to deliver that expanded budget, things will start to go awry. It will mean fewer bilateral programmes and more multilateral programmes. It would be a pity if the reputation that DFID has worldwide were tarnished because we were unable to deliver the programmes that the Department has set out to deliver.

Gillian Merron: I appreciate the hon. Gentleman’s point, but I can give him an absolute assurance that there is no question of DFID’s effectiveness on behalf of the UK Government being compromised, nor would we take action that would do so. In fact, wherever I go, I am delighted by the response to the UK Government, DFID and our staff in particular. I want us to use the way in which we are regarded as the world leader and, given the direction of the debate, to encourage others to do likewise. I can assure hon. Members that we will continue to deliver and to do so better, because we all want that.

I welcome the debate on the international health partnership because increasing the benefits that we can bring to people in developing countries is the reason for our development. We need to work with developing countries not as a lone country, but as a world leader, a catalyst, and by example. The international health partnership, which was launched by the Prime Minister, gives us such a framework. I hope that hon. Members will continue to support the Government in our efforts.

Question put and agreed to.

Adjourned accordingly at nineteen minutes to Four o’clock.

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