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7 May 2009 : Column 155WH—continued

Although the £6 billion is admirable, we need to see what effect—what change—it is having. I concur with that assessment; and I would add that my hon. Friend the Member for Sutton Coldfield (Mr. Mitchell) has called for intermediate targets to be set for scaling up implementation to full access, and for detailed yearly—I emphasise, yearly—impact assessments to be made to demonstrate whether the strategy is on track.

Why should the reporting be more regular? Nearly every minute, one child dies from AIDS and two become infected with HIV. If aspects of the strategy do not work, or the goalposts move, a biennial assessment will not pick up the fact that millions of people would have died in the time needed to detect whether the strategy was wrong. I ask the Minister to consider that point.

I move on to policies relating to children that arise from the Select Committee report “Achieving Universal Access”. It notes the need for an increased focus on groups that are more affected by HIV. The Minister mentioned some groups, especially women—I would say, more particularly, adolescent women. There are also children, sex workers, men who have sex with men, injecting drug users, prisoners and migrants—the last being a particularly vulnerable group.

The Government’s strategy has moved towards expanding social protection programmes. DFID says in its response to the Select Committee report—this is an important aspect, and I ask the Minister to concentrate on it—that it will

The Minister, I am sure, will be aware of the Select Committee’s concern that

That is self-evident. If they have lost their parents, it is likely that sadly they may become part of the itinerant child population that we see in so many parts of the world. Therefore, they may not benefit from the change in strategy. Will the Minister say how the strategy will work for those vulnerable groups of children?

Children suffering from HIV find their immune systems dramatically weakened. The Select Committee makes the clear recommendation that

In his evidence to the Select Committee, Dr. Stuart Kean, the chair of the working group on children affected by AIDS, reported that co-trimoxazole costs just one or two pence a day. As the hon. Member for Northampton, North said, £2.10 could feed an entire family for a week. Such small sums can provide a huge amount of money for the third world.

The hon. Member for Edinburgh, West said that the pound is not going as far as it used to; I calculate that because the pound has devalued over the last year, £334 million of DFID aid is not going where it should. One can imagine how many drugs that money could buy. Furthermore, a World Bank report notes that eight countries now face shortages of antiretroviral drugs or
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other disruptions to AIDS treatment. Twenty-two countries, home to more than 60 per cent. of people on HIV treatment worldwide, expect to face disruptions over the next year.

I shall now speak about mother-to-child infections. The Minister will be well aware that a mother with HIV has a 30 per cent. chance of passing on the disease to her child; such means of transmission account for 90 per cent. of the disease in children. DFID has launched an ambitious strategy to increase antiretroviral treatments for HIV-infected women from 34 per cent. to 80 per cent. by 2010, to reduce if not eliminate that form of transmission. I hope the Minister will give us an update on whether that target is still attainable.

The picture is bigger than simply providing drugs, as many others have said this afternoon; on their own, they will not lead to a solution. One key fact is awareness of carrying the disease. As I said in an intervention, only 18 per cent. of pregnant women have received an HIV test. We should remember that the diagnostic testing equipment is becoming much smaller and more portable. If we can pick up on more of the pregnant women carrying HIV, the appropriate treatment can be given at an earlier stage, and we might be able to stop some of the maternal transmission and thus save more young children’s lives. As well as the equipment needed for testing, it is vital that countries’ health care systems be able to deal with such transmission effectively.

The distribution of drugs in many poor countries is important. Some excellent work has been done on the distribution of drugs, particularly by companies involved in corporate social responsibility programmes. For example, Coca-Cola is thinking about delivering drugs to remote rural communities—places that are almost impossible to reach. The company’s franchisees operating in those remote areas—it amazes me that Coke is sold in such remote places, but I am sure that it is—are considering distributing drugs with the Coca-Cola.

A proper system of distribution is necessary; once the drugs have reached those communities, someone has to be in charge of getting them to those who need them—and of ensuring that they take the correct amount. One of the tragedies is this. I have heard from more than one source that when a woman is given her drugs, she will go home; but the man will see the drugs and regardless of whether he knows he is an HIV carrier, he will seize all or part of those drugs, and the woman will get none. It is important that the drugs get through to those for whom they are intended.

The Select Committee notes that DFID’s strategy

I think that the Minister addressed that point. He said sotto voce that he could give me a country-by-country breakdown or, at least, put one in the Library so that we can all access it. That might be a very good way of communicating the information.

Although this debate focuses on children, as I have remarked already, the death of adults has a huge effect on the lives of children, and as such, although I cannot go over it in detail, a brief comment on the overall strategy remains salient. Regular monitoring of progress has been carried out, which ties in to all the areas of the strategy, because it is the only means by which success
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will be achieved. We must also address the need for continued growth in education—this is terrifically important—particularly among men, who have a role to play in this whole affair. We must ensure universal access to family planning services. That is most important, as women are disproportionately affected by the disease: two thirds of young sufferers are female. I would also like to hear how DFID has sought to engage more fully with civil society to tackle issues relating to the disease.

I want to raise—again—one discordant but important point relating to DFID staffing. I am not the only one concerned; it is regularly raised by the Select Committee, including in its report, as well as by non-governmental organisations. In her evidence to the Select Committee, DFID’s permanent secretary—no less—noted that

That is a very significant admission from a senior civil servant. It is as close as one could come to saying that there are not enough staff to deliver the programme. Of course, every Department’s central office has had its fair share of Government cuts—

John Barrett: Will the hon. Gentleman give way?

Mr. Clifton-Brown: Let me conclude my point.

Each Department has been given a Treasury public service agreement target to cut staff numbers, but, at a time when DFID’s budget is increasing—thankfully—it seems a little unfortunate if not enough health advisers, for example, are in place to deliver DFID’s creditable HIV programme, which is one of the largest in the world. We want to ensure that it is delivered well and is getting results for the money spent. It is important, therefore, that we have the correct—not excessive—number of staff.

John Barrett: The hon. Gentleman clarified the point I was about to make: a reduced staffing level, when the budget is increasing, produces a unique problem, because without outsourcing DFID’s functions, it will not be as effective as it would otherwise be.

Mr. Clifton-Brown: I am very grateful to the hon. Gentleman for reinforcing my point, which DFID Ministers must make to their Treasury counterparts, so that we can have the correct balance. The Minister might assure me that we have that balance, but it would be interesting to know.

I have raised a number of questions for the Minister to respond to today. The purpose is not criticism for criticism’s sake, but to probe his Department’s performance. Everyone who has contributed to the debate knows only too well the horrific effects of this disease, and we all want to ensure that our contribution to the global fight is as effective as possible. Of significant concern is the scale of the reporting and monitoring of our achievements, because the number of lives lost every day means that we simply cannot permit any weakness in our strategy.

Sir Nicholas Winterton (in the Chair): Before I call the hon. Member for South Ribble (Mr. Borrow), I want to say that it is unusual that somebody who enters a debate
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very late is called to speak. It is not something that the Chair often wishes to do, but the hon. Gentleman was courteous enough to drop a note to the Speaker’s Office indicating that he had a very important meeting with the Under-Secretary of State with responsibility for disabled people, and I believe that it would be the wish of the Chamber—he has my sanction as well—to allow him to contribute to this debate.

4.4 pm

Mr. David S. Borrow (South Ribble) (Lab): Thank you, Sir Nicholas. I apologise to the Chamber for being late. As you said, I had a meeting with the Under-Secretary of State with responsibility for disabled people and a constituent of mine who runs a charity for the disabled in Lancashire. I travelled down especially for the meeting, and I felt that it was important that I kept it. However, as chair of the all-party AIDS group, it is also important that I make a contribution to this debate.

I shall keep my remarks fairly short. Last year, I made a visit to Malawi, funded by the Commonwealth Parliamentary Association scholarship scheme, in order to investigate AIDS and vulnerable children. Initially, I spent three days in Lilongwe, meeting Government officials and NGO personnel, to learn about the problem in Malawi, which is one of the poorest countries in the world and has an infection rate of about 14 per cent. Furthermore, it has only a handful of doctors and nurses and is really struggling to provide the sort of care needed. Certainly, the three days that I spent in Lilongwe visiting the AIDS centre in the main hospital, meeting Ministers and holding many discussions brought home to me the scale of the problem in Malawi.

The last three days of my visit were spent in Mulanje, in southern Malawi, and I had the privilege to see work being done by a charity called Friends of Mulanje Orphans, which is based in my constituency and was set up by Mary Woodworth, who comes from Mulanje and lives in Walmer Bridge in my patch. She returned to Malawi eight years ago for her father’s funeral and saw large numbers of orphans on the streets. That is unusual in Africa, where traditionally if children are orphaned, they are cared for by their extended family. It was probably a sign of the scale of poverty and the number of orphans that extended families could no longer care for them. Mary returned to Lancashire and set up a charity. When I visited, last year, it probably cared for about 5,000 orphans through 12 or 13 centres, but it has since expanded.

The charity does not use the orphanage model. It works with the extended family and provides day centres, so that when children return from school, they get a proper meal and are looked after in the afternoon. Furthermore, it provides clothing and books for them and pays school fees. The charity works with the families, so that at night the children return to their grandparents, siblings or uncles and aunts and live with their family. Very small, pre-school children spend the day at children’s nursery-type centres. This seems to work. The charity has also set up everything from mechanics to dress-making centres and a range of other things. Furthermore, it grows much of its own food, although a court case is currently under way—a landowner is arguing that the land used to grow the food belongs to them. That argument is ongoing.


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What struck me about that model for supporting orphans in Malawi is that it went with the grain of Malawian society by supporting the extended family. We should follow that model wherever possible. However, sometimes orphanages are the only option. Several years ago, I visited the SOS Children’s village in Botswana, which uses a different model arranged around a number of families with a housemother and children of both sexes and a range of ages. It tries to recreate a home environment, with a mother figure and siblings or children of a variety of ages. In each village, there will be a school and various community facilities. It tries to reproduce, as much as possible, what a child would expect in a normal family.

I point to that contrast, because about six or seven years ago, I visited an orphanage in Africa. I shall not say where it was, because it might have improved, and I do not want to criticise the charity, because it was working hard. The most distressing experience that I have ever had was visiting that orphanage, where children of all ages were kept in groups of 20 or 30 in dormitories or rooms with cots. That was before antiretrovirals—ARVs—were generally available. In each group of children, three or four were visibly ill, and they were looked after by carers. When I walked into a room of three-year-olds, all the children wanted was to be picked up and hugged. Food was provided, the place was clean and the workers were doing their best, but it was not a model place in which to bring up orphans. The contrast between that and the SOS orphanage was stark. An important lesson for me was seeing how Malawi supports its extended families. One of the reasons why I am so grateful for being a Member of Parliament is that it has given me the opportunity to learn and see how other countries handle such issues. It has shown me that things can be done well and not so well. When we give support to orphans and vulnerable children, we must consider carefully the model of care that is used. In the discussions that I have had with DFID officials in different countries in Africa, it is clear that that message has been learned.

I should like to pay tribute to FOMO, which is based in my constituency. It has virtually no paid staff, but manages to raise money, mostly from my part of Lancashire, to support 5,000-plus orphans many thousands of miles away. That shows us the type of work that can be done by a small charity.

I know that you do not want me to speak for too long, Sir Nicholas, so I shall be brief. The all-party group is carrying out an inquiry into access to medicines, and its report will be published in a few weeks’ time. We recently visited Geneva and had meetings with a range of organisations, including UNAIDS, the World Health Organisation and the World Trade Organisation. We considered some of the issues that have crystallised around access to ARVs. The first range of adult drugs for first-line treatments are now relatively cheap and can probably be delivered to most parts of the world at a reasonable price. However, after people have been on those drugs for a number of years, they need to move on to the second round of drugs, which are expensive and tied in with patents—as a way for the big drug companies to protect themselves. Over the next few years, the real challenge for the developing world will be making available that second round of drugs. There is talk of patent pools, which DFID is promoting.


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As for children with AIDS, the problem is the shortage of paediatric formulae. Many children end up having a mixture of drugs in liquid forms. We must encourage companies to produce a range of single tablets with a mixture of drugs in each one for various sizes of children. That is not cost-effective for the rich part of the world because relatively few children have AIDS. However, in the developing world, many, many children are HIV-positive and need such treatment. To get drug companies to develop those small pills will be very difficult. Some of the most efficient producers of pills are in India. They are generic producers rather than producers that work with the traditional first-world pharmaceutical companies. If we can encourage the large companies to make available the patents, and then work through international organisations to ensure that the generic producers use all their efficiencies to produce a range of ARV pills that can be used for children, that would bring things on a great deal.

Mindful of your earlier words to me, Sir Nicholas, I will end my contribution. I have made my two main points, so I will now listen with interest to the Minister.

Sir Nicholas Winterton (in the Chair): I thank the hon. Gentleman for his succinct but very relevant contribution to this debate.

4.15 pm

Mr. Ivan Lewis: The overwhelming lesson of this debate is that behind every statistic lies a human tragedy—a beautiful baby who never gets to dream let alone pursue those dreams, a child who never knows the unique love of a parent, and an infected parent who lives a soulless, numb existence, tormented by the death of their child. Any politician or civil servant engaged in tackling such a problem must remember that those are the very people whom we are trying to help. We want to see far fewer people facing such tragedies on a daily basis. Given the knowledge that we have at the beginning of the 21st century, there can be no excuses for people suffering unnecessarily. We have a collective responsibility to do something about it.

Today is also an example of Parliament at its best. The quality and sensitivity of the contributions from all hon. Members have demonstrated the positive side of a House that often gets very bad publicity. I want to pay tribute to everyone who has contributed, including my hon. Friend the Member for South Ribble (Mr. Borrow), who made an extremely focused and important speech.

I want to do justice to the key points that were raised. I shall write to my hon. Friend the Member for Northampton, North (Ms Keeble) on access to treatment in low-income countries. I have the information here, but it will take a long time to read it, and as she is not here, it is probably best that I write.

My hon. Friend also raised the question of how we track the impact of our work on orphans and vulnerable children. We are working with UN agencies such as UNAIDS and UNICEF, and directly with non-governmental organisations to find more effective ways to ensure that we get resources to the most local of levels. An example of that is the work that we are doing with UNICEF to channel resources to community-based organisations in Zimbabwe and Namibia. As I mentioned, we are reaching more than 130 such organisations in Zimbabwe.


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