House of Commons - International Development Committee

DFID's Performance in 2008-09 and the 2009 White Paper - International Development Committee Contents

Written evidence submitted by RESULTS UK

ABOUT RESULTS UK

Part of a global movement, RESULTS UK is a non-profit advocacy organisation which works internationally to generate the public and political will to end poverty. Currently, our work focuses particularly on education, health, microfinance and water and sanitation.

We currently lead a network of more than 30 organisations in the UK Coalition to Stop TB, provide the secretariat to the APPG on Global Tuberculosis, and belong to the Advocacy to Control TB Internationally (ACTION) network and the Stop TB Partnership. We also belong to the Action for Global Health Network, the UK AIDS Consortium and the British Overseas NGOs for Development network (BOND).

RESULTS UK provides the secretariat for the APPG for Microfinance and Microcredit, and seeks to promote the best use of microfinance tools to reduce poverty in the developing world. We belong to the Global Campaign for Education, a world-wide movement promoting progress toward the Education for All goals. We also belong to the End Water Poverty Network, which seeks to address the global crisis in clean water supply and sanitation.

SUMMARY

We welcome the opportunity to contribute to the Select Committee Inquiry. The determined tone of the DFID White Paper, in spite of economic pressures, is praiseworthy. Constructive commitments on basic services, the abolition of user fees, microfinance, and the reform of multilateral institutions show DFID continues to lead the international community in targeting aid effectively.

Like DFID, we are keen that the UK's increased aid budget be spent how and where it will do the most good. There are some issues we would urge the Select Committee to clarify and review to enhance the efficacy of DFID spending into 2010 and beyond. Much of what we aspire to for DFID amounts to enhanced practice and prioritisation on its existing commitments, with which we are in broad accord.

Our comments are based on research and communication with actors on these key issues around the world, including DFID partners.

Key recommendations

We would like to emphasise the need for the following actions:

— DFID should formulate a strong poverty-reduction framework for the Multidonor facility for Africa.

— While supporting pilot projects on the ground, the UK should promote micro-insurance on the international stage as a tool for climate-change adaptation.

— A strong focus should be given to education within new funding for fragile states.

DFID should increase monitoring and partner engagement to facilitate access to education for disabled children.

— Spending commitments to strengthen health system should be specified.

— An integrated UK strategy to tackle global Tuberculosis should be formulated.

— The UK must prioritise sanitation and water, engaging actively toward a Global Framework for Action including ensuring high-level Ministerial representation at the high-level meeting.

— DFID should disaggregate data on water and sanitation to enable better evaluation of both.

— UK representatives should communicate expectations of reform with clear parameters to multilateral partners.

The following submission addresses in detail the specific focus areas outlined in the call for evidence.

Education

1.1 We commend the UK's recommitment to double its support to education, and the formulation of a new global strategy for education.[47] The input of civil society actors in the UK and crucially in the developing world should be actively sought to make this effective. RESULTS UK will be submitting evidence to DFID through their upcoming consultation to reinforce some of the points raised below.

Conflict-affected areas

1.2 By continuing to tackle poverty in conflict-affected countries, DFID makes an exemplary commitment not to forsake these regions, and instead to invest in their long-term future. Within this, education as a long-term path to recovery and stability must be a priority, and RESULTS UK stresses that education should receive significant investment from the 50% of new bilateral funding promised to fragile states[48]

1.3 It is crucial that DFID work to establish an effective international financing mechanism for education in fragile states, for example through an accelerated reform of the Education for All Fast Track Initiative (FTI), which is the leading multilateral financing instrument for education but which to date has struggled to work in fragile states. The White Paper commits DFID to "supporting the FTI to deliver more assistance to countries furthest from achieving the MDGs, including an increased focus on fragile countries,"[49] but gives no details on how this is to be done.

1.4 DFID should consider all options for reform of the FTI, including independence from the World Bank, which has imposed overly restrictive conditions on disbursements from the FTI's trust funds, delaying payments and causing serious problems for partner countries.[50] "Speed and responsiveness of funding and implementation, including average times for appraisal and from approval to disbursement" is highlighted as one of the essential factors in "getting the most out of international institutions" in the White Paper,[51] and therefore DFID should prioritise this issue.

Teachers

1.5 In the new education strategy consultation document DFID commit to prioritising quality in their education aid.[52] The number and quality of teachers is a determining factor in the success of any education system, and the progress toward MDG2. They must be well-trained, motivated professionals. Crucially, as acknowledged in the White Paper,[53] a better pupil-teacher ratio is needed, and we agree that DFID should accelerate their work to ensure that the ratios reduce to 35:1.[54]

1.6 The continued investment in pre-service training of new teachers is welcome; nonetheless, the maintenance of in-service training is essential to maintain reliable standards.[55] This may not result in the same impressive "bottom-line" numbers of new teachers, but continuing professional development is a necessary hallmark of a culture of improvement in education, and one which should also feature in the new education strategy.

1.7 The measures to increase teacher numbers that are set out in the Paper relate solely to training, but one of the major impediments to achieving and maintaining sufficient numbers of teachers in many countries is the inability of the government to finance the recurrent costs of wages. In many cases this is due to macroeconomic conditions set in countries' IMF programmes.[56] In order to make real in-roads into quality, DFID will need to tackle this issue with far more vigour than seen previously.

Disability

1.8 As stated by DFID in 2007, "disabled children, disabled girls in particular, constitute a significant group that is denied access to education".[57] Indeed, an estimated one-third of the primary age children who are out of school globally have a disability,[58] and having a disability makes a child more likely to be excluded from school than any other factor.

1.9 We are therefore disappointed that no specific commitment was made in the White Paper to support the participation of disabled children in education. Not only is this a human rights imperative as defined in the recent Convention of The Rights of Persons With Disabilities; it has also been shown that an inclusive classroom benefits all its learners through introducing better quality, more responsive educational approaches.[59]

1.10 RESULTS UK would urge that monitoring this area of work be given stronger than nominal priority. At present there is little emphasis placed on disability in many of DFID's country education programmes.[60] DFID need to take a far more rigorous approach to ensuring their education work is inclusive for all groups, and particularly disabled children who are currently the most marginalised group in much of the developing world.

2. MICROFINANCE

Microfinance in Africa

2.1 RESULTS UK commends the announcement of a new Multidonor Facility to extend microfinance infrastructure across Africa.[61] As yet there are few details available about this new facility, although some concerns have been expressed over whether the facility will be focused strongly on poverty reduction. Our basic recommendations on the design of the facility are as follows:

1. The facility must have poverty reduction as its basic aim.

2. Strong quality controls and targeting are needed to ensure that the initiative reaches the very poor, and enables them to actually escape poverty—for example the facility should require that the Microfinance Institutions (MFIs) supported by the facility measure and report on the number of clients moving out of poverty.

3. Agriculture is an immensely important sector in Africa, and has traditionally been difficult for microfinance providers to serve. However, recent innovations have pioneered ways in which to do this, and we recommend that there should be a strong focus on agricultural microfinance in the new facility.

4. We would encourage DFID to help small MFIs to build their capacity in microinsurance and microsavings as well as microcredit, as it is critical that the rural poor have access to a range of services to enable them to manage their volatile income.[62]

Micro-insurance

2.2 Micro-insurance is a tool to tackle the dual imperatives of climate change adaptation and poverty reduction, and could greatly contribute to DFID's goal of building "resilient growth."[63] Scaling up the provision of microinsurance would give the poor the security to rebuild after the short, sharp shocks of weather-related disasters, and give them the security needed to make the necessary investments (for example in more resilient crop varieties) to adjust to climate change's more long-term impacts on agriculture. This will prove crucial as climate change increasingly imperils populations and livelihoods in the developing world.

2.3 Only 3% of the population of the world's 100 poorest countries currently has any insurance coverage,[64] and we therefore encourage DFID to expand quickly beyond the pilot programmes[65] announced in the White Paper, and to work co-operatively with local organisations to scale up agricultural microinsurance in the face of a changing climate.

2. WATER AND SANITATION

3.1 We value the renewed pledge of doubled investment in water and sanitation to £200 million.[66] However, as a proportion of aid, investment in water and sanitation has more than halved since 2005.[67] Given that water access is a key indicator for DFID's delivery,[68] the issue should be given still greater priority by DFID. To meet MDG 7, Target 10, an estimated $72 billion[69]global investment will be required annually.

3.2 Within DFID's commitment to water and sanitation, we believe that sanitation must be given a higher priority—it has in the past been largely overlooked in favour of provision of clean water, even though the two issues are crucially intertwined and investments in sanitation are often more cost effective in terms of preventing ill-health and high mortality rates. It is welcome that the White Paper contains specific commitments to help 55 million more people gain access to sanitation. However, to allow parliamentary oversight and civil society to more accurately assess DFID's contribution to expanding sanitation coverage DFID should disaggregate its reporting on water and sanitation.

3.3 We praise DFID's commitment to support A Global Framework For Action[70] with all that this implies: annual high-level meetings and reviews, and a commitment to provide adequate resource allocation.[71] DFID should ensure Ministerial attendance at the upcoming high-level meeting. The coordinated approach represented by the Global Framework will be crucial if stronger international action is to be galvanised. Progress in this arena will have manifold benefits in health, education and economic capacity. We encourage the Select Committee to ask DFID for details of the action DFID will take to make the Global Framework a reality.

4. HEALTH

4.1 We commend the UK's long-term commitment to health, including to the Global Fund to Fight AIDS, TB and Malaria and encourage DFID to push other donors to provide more long-term, predictable aid. We encourage DFID to indicate clearly how they intend to spend the £6 billion committed to health services and systems by 2015.

4.2 We urge the UK to respond immediately to the resource gap faced by the Global Fund of £4 billion for 2008-10, as well as review their funding commitments to health, based on the recommendations of the High-Level Taskforce on Innovative International Financing for Health Systems.[72]

A Global TB strategy

4.3 RESULTS UK welcomes the bold commitments made in the White Paper to tackle malaria through a range of interventions. This is commendable, as malaria is a serious global health-threat. However, it is of great concern that a similar commitment was not made to other diseases of poverty, such as TB, which currently kills more people than malaria[73] and presents an additional threat in terms of drug-resistant strains and the effect on people living with HIV and AIDS.

4.4 DFID have clearly acknowledged through Achieving Universal Access the need for disease specific strategies to tackle global epidemics, and that integration of these strategies can play an important role in the strengthening of broader health systems.

4.5 Due to the changing face of the TB epidemic, with an increasing threat of drug resistant strains and the impact of TB on people living with HIV/AIDS, there is a clear need for a DFID strategy outlining the UK's response to tuberculosis. RESULTS UK strongly urge the Select Committee to request that DFID review their practice paper The challenges of TB and Malaria control (December 2005) and develop a comprehensive strategy on TB which fully integrates with DFID's overarching health related goals.

4.6 The UK Government strongly supported the launch of the 2006 Global Plan to Stop TB[74], and has committed to address HIV and TB[75] co-infection, so we are disappointed that specific commitments on TB control were not made in the White Paper. TB control must remain an enduring priority as the disease is far from being forced into retreat.

4.7 While DFID acknowledges the responsibility to maintain long-term financial support for treatment in poor countries,[76] which will enable stronger planning within health services, an integrated strategic approach to TB is urgently required to improve research, screening, counselling, patient management and treatment. This should be dealt with in full-collaboration with DFID's health and HIV strategies, incorporating monitoring indicators to allow the evaluation of input and outcomes. Further recommendations are outlined in RESULTS UK's submission to the International Development Committee's Inquiry into Achieving Universal Access.

4.8 The UK commitment of £1 billion for the Global Fund to fight AIDS, TB and Malaria[77] will prove essential, given the need for long term sustainable funding. However, an immediate donor response is required to address the funding gap of US$4 billion for 2008-10. A delay in future funding rounds will have a devastating effect on the lives of millions of people, many of whom are more vulnerable in the present economic crisis. The UK should take bold steps to address funding shortfalls in health financing, and use their influence internationally through the EU and the G8 to push other donors to equally contribute.

4.9 A proportion of the pledge of £6 billion for health by 2015 should be used to contribute to TB control and address the threat of HIV-TB co-infection. We urge DFID to be more transparent regarding specific spending plans within the latter macro commitment, enabling partners to plan long term, and civil society to provide input.

Maternal and Child Health

4.10 We welcome the strong prioritisation of maternal mortality.[78] We welcome further specificity on how this priority is to be achieved, building on the goals outlined in the White Paper.[79]

4.11 RESULTS UK was encouraged by the pledge to "scale up international support for maternal and newborn health,"[80] and delighted by recent multilateral progress toward the abolition of user fees in six developing countries, alluded to in the White Paper[81] and recently specified by Gordon Brown.[82] This will pay dividends for people in the countries concerned, as evidenced by recent history,[83] and repetitions should be sought.

4.12 We also recommend that the UK continue to encourage other major donors to follow its lead in setting clear policies against user fees and supporting countries who wish to remove them. In particular, the UK should push the World Bank to declare an unambiguous policy, whereupon poorer countries will be able to develop national policy in confidence.

5. REFORMING MULTILATERAL INSTITUTIONS

5.1 The commitment to review and agree a new approach to multilateral funding[84] and to fund institutions "in response to reforms"[85] is commendable; especially if truly "stretching targets"[86] are applied to all institutions, including those outside the United Nations. We are concerned that few specific proposals were made for reform of the international financial institutions, particularly the World Bank and the IMF. As a board member, the UK should use its influence to ensure genuine reforms take place as soon as possible.

5.2 DFID's requirements for reform of multilaterals need to be robust and clear; while some flexibility may be necessary, the circumstances in which funding for a programme would be reduced or withheld should be clearly communicated. The International Financial Institutions and Global Funds and Development Finance Institutions departments of DFID should not be complacent about reform, but use all their influence to promote new culture and practice.

The World Bank

5.3 It is widely recognised[87] that the World Bank needs improved monitoring machinery and transparency. Monitoring and evaluation should not only be conducted at the end of projects, but should be concurrent and formative within projects, especially those of long duration, using intelligent poverty indicators. UK civil society organisations have expressed deep concern about the findings of the IEG Report on the performance of the Bank's Health, Nutrition and Population portfolio between 1997 and 2008.[88] This found that little progress had been made in improving the health portfolio's performance in this period and that only 27% of the department's projects in Africa could be rated "satisfactory".[89] A lack of sufficient monitoring and evaluation mechanisms within the Bank resulted in failing programmes continuing for an unacceptable time period. As a key stakeholder in the World Bank, DFID need to be much more proactive in demanding thorough assessments of performance and concrete changes to address failures.

5.4 DFID must clearly articulate what specific World Bank Reforms they are seeking with respect to health. As the highest percentage investor[90] in the International Development Agency (IDA), the UK must use their influence to identify key areas for reform in anticipation of the IDA16 replenishment negotiations. It is encouraging, therefore, that the White Paper prioritises reform in international institutions, but we believe it is necessary that DFID define a specific agenda for reform, including benchmarks setting out what is "acceptable" performance. DFID's willingness to use the IDA replenishment process to drive change should be used to maximise leverage.

The International Monetary Fund (IMF)

5.5 With a significant share of voting rights on the board the UK has the influence to promote change at the IMF, and DFID should work closely with the Treasury to maximise the potential for such reform.

5.6 We share DFID's belief that the IMF needs to revise its approach to developing countries, facilitating a more open policy-making process around IMF programmes and macroeconomic policies more generally. However, currently progress is extremely slow in this area, and DFID need to engage far more closely with the issue in order to ensure that development concerns are taken into account within macroeconomic policy-making.[91]

5.7 By allowing for the individual characters of developing economies, and consulting with countries about the most appropriate fiscal policy for them, the IMF can become a more constructive partner for poverty reduction. Although we commend recent progress in reducing structural conditionality in the IMF's programmes as highlighted in the White Paper,[92] much still needs to change.The UK's further funding of the IMF should be made conditional on progress in policy and processes, rather than just on governance reform.

5.8 As it is relevant to health system strengthening under Question 3 of the Terms of Reference to the Select Committee Inquiry into the 2008 HIV/AIDS strategy, Achieving Universal Access, we have elaborated further on issues of IMF reform in that submission.

30 September 2009

47 DFID: Eliminating world Poverty: Building Our Common Future par. 5.35 p 97. Back

48 DFID: Eliminating world Poverty: Building Our Common Future, A new approach prioritising peace and State-Building (inset box), p 71. Back

49 DFID: Eliminating world Poverty: Building Our Common Future, p 98. Back

50 "We Don't Need No Education? Why the United States Should Take the Lead on Global Education", Desmond Bermingham, Centre for Global Development, February 2009. Back

51 DFID: Eliminating world Poverty: Building Our Common Future. "Value for money: getting the most out of international institutions" (inset box) p. 108. Back

52 DFID education strategy consultation paper, 2009. Back

53 DFID: Eliminating world Poverty: Building Our Common Future "Recruiting Teachers" (inset box) p. 97. Back

54 A target ratio of 35:1 is the agreed position of the Global Campaign for Education. Back

55 UNESCO, 1970: "Teachers must be given continuing opportunities for learning." Back

56 Global Campaign for Education, 2009: "Education on the Brink." Back

57 DFID Factsheet on Education, 2007. Back