Examination of Witnesses (Questions 20
- 21)
THURSDAY 22 OCTOBER 2009
MS FIONNUALA
MURPHY, MR
ALVARO BERMEJO,
MS SALLY
JOSS AND
MR MIKE
PODMORE
Q20 John Battle: In a sense my question
follows on not just the Global Fund but DFID published its White
Paper, Eliminating Poverty; Building our Common Purpose
in July, and there is a shift in that to support from multilateral
sources, more money would go through the fund, there would be
more emphasis on fragile states. How will that affect DFID's programmes
for HIV/AIDS, as you would see it?
Ms Murphy: This is something that
we talked about a little in our submission under the second question
on approaches to health system strengthening. Interact Worldwide
flagged up some concerns about funding the interactive tools of
the World Bank which I know some of my colleagues on the Panel
would share. The World Bank's own evaluation of this produced
a report earlier this year looking at the World Bank's health,
nutrition and population programmes and that report found that
something like a third of all the funds that had been dispersed
had been spent ineffectively, and when it came to HIV programmes
in Africa the toll was much higher. We would question the UK's
insistence that the World Bank is a good partner through which
to channel health systems funding. We know that the UK is interested
in working with the World Bank to try and take up some of the
recommendations that were contained in the report and we hope
that the UK will continue to do that, but at the same time we
would prefer to see a rebalancing of funding so that not so much
is going towards an institution which has been shown to be ineffective,
and also which in the past has very strongly promoted user fees
for health services which many of us would feel are counter productive
and exclude the poorest people. On the other hand Mike talked
about the Global Fund, which is an institution which, although
it is not by any means perfect, has made a lot of moves to reach
out to communities and to fund the community response. It is funding
health system strengthening. It also has a new gender strategy
along with a sexual orientation and gender identity strategy.
It has also been making moves to fund programmes which integrate
HIV with reproductive health and reproductive health with malaria,
so the Global Fund has a lot of strong points, yet the UK is not
paying its fair share to the Global Fund at present. The figures
are in a lot of our submissions. We would ask for that decision
to be thought about a bit more carefully in terms of how the funds
are divided up.
Q21 John Battle: It is a White Paper
and submissions can go in to respond to it now.
Ms Joss: Can I just back what
Fionnuala was saying with some of the statistics? It is said that
over the past decade, over an evaluation of World Bank's health
projects, that only two-thirds showed satisfactory outcomes, and
in Africa the results were particularly weak with 73 % of the
projects failing to achieve satisfactory outcomes.
Mr Podmore: We do strongly believe
that there needs to be a re-evaluation of the balance of how money
is being spent. We recognise that DFID is going to fund the World
Bank but we want them to proactively, as they are doing, work
with the World Bank to ensure that they address those really clear
issues. One of the ways that DFID is doing that with the Consortium
is by conducting an ambitious evaluation of the community response
to HIV and AIDS which is already welcome considering what we were
talking about before. It is that sort of work that I think is
really critical, that DFID puts the same critical eye on the World
Bank that it seems to be placing on the Global Fund.
Ms Joss: Just to say a bit more
about the project that the Consortium on AIDS is involved in with
the World Bank and DFID, the World Bank is evaluating over the
next couple of years the community responses to HIV and AIDS programmes.
We are like a conduit which can enable the World Bank and DFID
(although not quite so much) to be able to access people who are
working on the front line and people who are working in community
and grassroots organisations.
Chairman: Thank you very much indeed.
That is extremely helpful. I think you have given us some ammunition,
if you like, to put to the Minister immediately. Obviously, this
is something which not only have you helped us with in the past
and which we will continue to do and have undertaken to do, certainly
till next year when we get to the end of the five-year programme.
I do not know what we will do after that. Thank you very much;
it has been very helpful to us.
| 
