Examination of Witnesses (Questions 40
- 59)
THURSDAY 22 OCTOBER 2009
MR MICHAEL
FOSTER MP, MR
JERRY ASH
AND MR
ALASTAIR ROBB
Q40 Mr Lancaster: A couple of years
ago, the UK led by doubling its replenishment of the African Development
Bank to £116 million and other countries followed, so, given
the deficit, is the UK going to lead again by helping to fill
this deficit?
Mr Foster: Well, in terms of our
contribution, I think we set the direction that we would like
others to follow by setting out a long-term commitment, so we
were not looking at just annual change, we were saying, "Look,
here is a seven-year programme for £1 billion". In terms
of an example of what the UK's individual contributions are year
on year, last year, 2008, we put £50 million into the Global
Fund and this summer we have just handed over £115 million,
so our contribution has indeed doubled year on year, but it is
part of a £1 billion long-term commitment, and I think it
is the long-term commitment, Mr Lancaster, that people need to
make to make sure that the Global Fund has the predictability
of finance to enable them to plan their work. Without that predictability,
it makes it very difficult to do proper work on the ground.
Q41 Mr Lancaster: I think that is
absolutely right and I agree with the Minister wholeheartedly
on that, but it does not answer the question of how we are going
to plug this gap, so how does the Minister anticipate that the
$3 billion deficit will be filled?
Mr Foster: Well, I think that
there are discussions that we can have with the G8, as leading
funders of the scheme, to try and leverage in more support from
them, I think there are other avenues to support the work of the
Global Fund perhaps through innovative health financing options
which can make up some shortfall in the cash, and I think we have
to also try to make what money is in and has been pledged work
better, to make it more effective on the ground. I think there
is a job for us to do with others on that front as well, but it
is a lobbying exercise, Mr Lancaster, and it is very difficult.
We are not in a position to tell others to pay their fair share.
There are opportunities, I am sure, for CSOs internationally to
make and to do their lobbying, which is perhaps another direction
of travel, and they have been highlighted in the public as a route
that they can follow to put pressure on their governments to fulfil
the payment of what is only seen as a fair share towards the Global
Fund.
Q42 John Battle: I would like to
ask about the Cross-Whitehall Strategy Group. We would all agree
generally with joining up government and there is a strategy to
pull together the Home Office and the FCO and they have got a
clear remit. The remit says, "The Home Office, FCO and DFID
will work together to improve the international environment for
harm reduction" by increasing the coverage of HIV prevention,
and the rest of it. I sometimes think, whether at ministerial
level or department level, one department, rightly, is taking
the lead and trying to get the others and corale them together,
but ends up doing all the work and the others are not quite joining
in, so my question comes in the most friendly way to say: is DFID
getting enough support from the other departments, are they taking
it seriously and are there enough personnel gathering round it,
and is there a budget? Could you tell us a bit about the Cross-Whitehall
Working Group.
Mr Foster: It is an informal group.
It is a meeting of officials and not ministers.
Q43 John Battle: It meets how often?
Mr Foster: It meets on a quarterly
basis. The last meeting was on 7 October and the meeting before
that was on 15 July, but it is an informal meeting of officials.
In terms of what it discusses, Jerry?
Mr Ash: Well, it was very useful
in both developing the Strategy and in helping develop the Monitoring
and Evaluation Framework and the subsequent baseline. I believe
that the other government departments represented on it are committed
to it and the issues that we deal with, but I am not sure I could
go very much further than that in committing colleagues in other
departments to do more or to commit more resources.
Q44 John Battle: I assume you and
your section are the secretariat of it, that you keep the notes
of the meetings and you run it and organise it and they come along?
Mr Ash: That is correct, yes.
Q45 John Battle: I am just pressing
on the depth of their commitment to it really. Do you publish
the notes of the meetings? I know they are informal, but are they
shared around?
Mr Ash: No, we have not published
the minutes of the meetings as yet, but we are happy to consider
doing so, if the Committee would want it.
Q46 John Battle: Harm reduction in
fact is a massive issue and to take, as with everything, the myopic
world which operates around my constituency, we have a huge prison,
so the Home Office might well need to be there. Am I daft to ask
why the Health Department are not on the group?
Mr Ash: They are.
Q47 John Battle: Are they? I thought
it was just the Home Office, DFID and FCO.
Mr Ash: No, certainly not.
Q48 John Battle: So it is Health
as well?
Mr Ash: The Department of Health
are fully represented.
Q49 John Battle: Good. Do they make
any contribution in funding and support then?
Mr Ash: I am not aware of the
Department of Health putting official development assistance into
AIDS. On a domestic basis, research and issues like that, I am
sure they are fully active, but they play a full part in the group.
Q50 John Battle: Do not get me wrong,
I am encouraged you get together, but I am just stating it and
make sure DFID does not carry all the work of it, that we share
the work and perhaps other bigger departments can make a bigger
contribution, and we might learn, and hopefully internationally,
from what is going on by sharing the information and knowledge
through that group. That could be quite an exciting, pioneering
development actually.
Mr Foster: What I can do, Mr Battle,
is perhaps write to you with some more information about the Cross-Whitehall
Group, who is on the group and how it is funded so that it enables
the Committee to then make an informed decision as to what they
make ask of us.[7]
Q51 John Battle: Okay, but I think
you know where I am coming from on that.
Mr Foster: Yes, I understand fully.
Q52 John Battle: As a second question,
DFID, rightly, in the last 10 years has been promoting whole programmes
to the poor, poor countries, fragile states, so there was some
withdrawal, rightly, from middle-income countries. Then there
is a bit of a gap and I am now picking up that the Foreign Office
seems to have been invited to take the lead role, particularly
in HIV/AIDS, in middle-income countries. I wonder what that means.
Have they got expertise? Do they have people in the field that
can work on HIV/AIDS, have they a budget, or are they just keeping
a watching brief on it? I am just interested in what the Foreign
Office is doing in middle-income countries.
Mr Foster: First of all, just
to explain again, Mr Battle, exactly why we have moved DFID offices
out of middle-income countries, it is because they have graduated
to middle-income status and 90 % of our spend is on the low-income.
I know it is well-rehearsed, but that is why those decisions have
been taken. Then it is left with the Foreign and Commonwealth
Office having a watching brief over the work on HIV/AIDS, and,
Alastair, you have got some examples.
Mr Robb: I was going to give examples
of countries where we do work together and maybe Jerry would like
to talk about the middle-income. In the countries where we work
together because we still have a presence, for example, Burma,
the Foreign Office were really important in enabling us to enter
into Burma to do the important bits of work on HIV. So DFID, with
the Foreign Office, led the way in tackling an epidemic in a very
fragile state through a joint UN programme, which has grown to
include others now working on the epidemic. We are at all times
keeping the EU common position and, with the advice of the Foreign
Office, ensuring that we are working in that politically sensitive
environment in the best way. The UK Ambassador in Burma has also
sat on the board of this initiative for the three diseases, so
they are very active and very important.
John Battle: Burma is a good case and
actually, if I may say, a brilliant example of absolutely excellent
work by Foreign Office staff and ambassadors there working with
DFID together in a very difficult situation, if I can put it that
way.
Chairman: We put on record, John, also
that the increase in the funding was as a direct result of the
recommendation of this Committee!
Q53 John Battle: Indeed! Could you
give me any examples and, for example, one which we ought to keep
an eye on big time, Brazil?
Mr Ash: I do not have an example
of how the FCO is supporting the implementation of the strategy
in Brazil. In the baseline, we had talked about some of their
activities in countries, like in Singapore where they have supported
local NGOs, in the Solomon Islands where, using their strength
and expertise in human rights, they worked with the Australian
Government to make progress with the Government on voluntary counselling
and testing, and also they have supported and worked with DFID
in Nigeria on human rights strategies.
Mr Foster: Obviously, Jerry mentioned
it is in the baseline, but also what the Foreign Office do and
what they do in middle-income countries will of course be a feature
of the biennial reports that we publish as well in terms of what
we are committed to on that.
John Battle: It is just that in this
area of public policy perhaps more than others, the integration
across income countries might be slightly more important than
in other areas that I might emphasise where there is a strong
emphasis on poverty and poor policies, and I am totally behind
that, but in HIV you might find it does not simply cut across
the poverty bracket, as it were, and, without taking into account
middle-income countries, the whole strategy could be undermined
as well. I think I have made my point clear.
Q54 Chairman: The Gleneagles Summit,
which was now four years ago, secured very substantial commitments
from the international community and a very specific pledge to
achieve universal access to HIV/AIDS treatment by 2010. I think
we know that that target is not going to be hit, but the question
I want to ask first is: to what extent has the economic downturn
affected the commitment of those other G8 countries specifically
in this area? We know of countries that have cut their aid, but
are you able to evaluate where they have specifically cut their
commitment to achieving this target?
Mr Foster: Certainly, it is on
the record, Mr Chairman, our position on the long-term commitment
to aid, and Mr Lancaster recommitted his side to it as well, the
0.7 %. As you know from events earlier in the autumn, the Prime
Minister said that we will be looking to legislate for that as
well, so the United Kingdom's position in terms of whether we
have been affected by the economic downturn is very much a clear
case that we are committed to carry on with our spending programme.
In terms of some of the threats that have been posed by funding
decisions of other countries, we are aware obviously of other
countries starting to shy away from commitments that they may
have made as part of the EU towards the 0.56 and then the 0.7
target, and I think those countries are well documented and are
known. We believe there is a strong case for the "fair share"
argument of spending on HIV/AIDS and we know that we are there
already as the United Kingdom. In terms of what we are trying
to do to encourage others where there are concerns, first of all,
the Kaiser Foundation and UNAIDS actually do a measurement, they
actually do the check to see who is paying their fair share, and
that is good information to be made available for us in lobbying.
Through the G8, I think, there is a role for us there and holding
governments to account for their commitments. For the first time
in July this year, the G8 published an interim accountability
framework showing individual country progress towards their G8
commitments, including their spending on health, which we also
think is a step forward, and we will be pushing actually for a
target on HIV/AIDS spend from 2010 onwards and we are supported
by the Canadians. They assume the Presidency of the G8 in 2010
and they are very keen on making accountability the central part
of their Presidency, so we think there is some work that we can
do now, but also there is some potential to show exactly where
we can hold governments to account for the commitments that they
have made.
Q55 Chairman: But, given that there
are people who have cut back, our previous witnesses gave testimony
to the fact that a great deal has been achieved, in other words,
an awful lot of people are getting treatment that were not getting
treatment and, had that commitment not been made, that presumably
would not have happened, but it is not going to achieve the target,
so you are left with two problems. What happens in 2010 when you
miss the target, what are the implications, and also of course,
having achieved the target, how do you sustain it? The worst of
all idiocies would be to get to 2010 and say, "Ah well, we've
achieved 80 %", or 70 %, "and now we're going to stop
funding".
Mr Foster: I think again that
justifies the logic of our approach on health system financing
rather than perhaps whole-project or vertical-led financing in
that, if you have achieved a target, you pat yourself on the back
and psychologically you just sort of move on to work out what
the next target is you want to aim for, whereas, if we have got
health systems generally being funded, it needs some mainstreaming
before it does make it easier to cement and build in as a permanent
feature of healthcare in particular countries so that we do not
fall foul of the idiocy that you have just described. It also,
I think, from what you said, reinforces our argument about prevention
being the focus of our work on HIV/AIDS because that tends to
be the area that can be cut if there are limits on spending. It
is easier to cut prevention work than it might be treatments that
people are already being given and are embarked on, so our focus
on prevention, I think, will help deal with some of the unintended
consequences of cuts in funding.
Q56 Chairman: We had again in the
previous evidence session some indications that some governments
in developing countries are saying, "Well, we're going to
stop adding people to the treatment list", so one of their
responses for not having funding is to say, "Well, we have
enough difficulty treating the people we have got and we are not
going to add any more", which clearly means that you have
got a growing problem.
Mr Foster: And again, from what
they have said, the best course of action in the longer term is
to focus more and more on the prevention. In preparation for this
hearing, Mr Chairman, we have been looking at the prevention bit
and there is a phrase which has cropped up which I was determined
to get on the record in this particular committee hearing, and
I think it comes from Uganda, Alastair, and it is, "You can't
mop the floor properly until you've turned the tap off",
and that is very much central to the message about prevention
being the direction for us to make the most impact in dealing
with HIV/AIDS.
Mr Robb: I just want to add a
very quick comment from a country perspective where I think there
is a level of complacency about HIV that, by not hitting this
target. It will further highlight the actual problem in-country
where we are seeing rising numbers of new infections. In Uganda,
a country that was once stated as a success, even during the time
when prevalence was coming down in the mid-1990s, there was a
rising number of new infections per annum. It does give us a bit
more momentum behind why prevention matters, the focus that DFID
is putting on prevention.
Q57 Chairman: Perhaps a separate
question comes in there which I did not anticipate, but are we
in a better environment for the prevention mechanisms? Are we
in a better across-the-piece acceptance that some of the more
difficult issues can be addressed?
Mr Robb: I think we are in a much
better position than we were and I think that, in part, that is
due to DFID working with the UN to bring the evidence to the table
about why prevention matters, knowing your epidemic and knowing
where we are in an epidemic and understanding that it is not about
a single prevention strategy, it is about, in the same way as
you have combination treatment, having combination prevention.
Chairman: I think John Battle might want
to come to that in a minute.
Q58 Mr Lancaster: Building on that
in a way and the implications of the DFID White Paper published
in July where we saw a move towards multilateral funding rather
than bilateral funding, and we have talked about that already,
there was a feeling really from witnesses that perhaps DFID is
de-prioritising HIV/AIDS, quoting a reduction in the number of
staff, so I guess, Minister, we are really after not just reassurance
that that is not the case, but also perhaps some form of evidence
that demonstrates that the Department's commitment to this is
strong and will continue.
Mr Foster: I would have argued
that the fact that we had the AIDS Strategy, that we have had
that baseline assessment, that we are doing the biennial reports,
against that baseline, it would reinforce the fact that actually
DFID is as committed as ever to working on HIV/AIDS, and the fact
that we have this £6 billion commitment to health systems
on top of the £1 billion to the Global Fund would suggest
that the resources are also being put in to deal with HIV/AIDS.
Health systems, we think, are the right direction for us to go
and we believe that other donors are in agreement with that, so
I would counter any argument which says we were de-prioritising
HIV/AIDS; I do not think we are at all.
Q59 Mr Lancaster: But there certainly
was a consistent theme that this is the perception, so why then
do you think this perception has been allowed to grow? Is that
the fault of the Department? Have you felt engaged or what? It
is definitely there.
Mr Foster: I do not hold the view,
so it is difficult for me to work out why that perception is there.
I can only envisage that it is because other health issues have
perhaps come more to the fore as a concern, so, if you take maternal
health as an issue, suddenly it has become more important in terms
of the public eye perhaps. That is not to say that we are de-prioritising
our HIV work or spending more attention now on maternal health,
it is just that, in terms of lobbying, in terms of perhaps press
attention, maternal health is perhaps getting a greater share
of the attention than HIV/AIDS did, or perhaps it is taking some
of the attention away from HIV/AIDS, but it is not taking away
resource and it is not taking away our commitment.
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