International Development CommitteeWritten evidence submitted by the International HIV/AIDS Alliance (herein “the Alliance”)

This submission focuses on why the 0.7% Overseas Development Assistance (ODA) target will be appropriate in the long term, especially in the response to HIV. It also highlights the critical role that civil society plays in international development, particularly in fighting the HIV pandemic, and calls on DFID to increase its support to civil society organisations via Programme Partnership Agreements (PPA’s). The submission also stresses the importance of continuing aid to Middle Income Countries (MICs), where the majority of poor and marginalised people live.

The International HIV/AIDS Alliance (herein “the Alliance”), established in 1993, is a global partnership of nationally-based linking organisations, working in over 40 countries to support community action on AIDS. We welcome this opportunity to provide a submission to the International Development Committee (IDC) inquiry on the Future of UK development cooperation. Our submission responds with a focus where appropriate on issues relating to the UK’s global HIV response.

Key recommendations:

1.The UK government should enshrine its commitment to maintaining ODA at a level of at least 0.7% of GNI, with ODA calculated in line with OECD DCD-DAC definitions to exclude money spent on defence or peace keeping.

2.The UK government should champion the inclusion of the 0.7% target in the post 2015 development framework.

3.DFID should bring the percentage of funding for civil society organisations that is spent on HIV into line with the overall proportion of ODA which is allocated to the HIV response.

4.DFID should develop mechanisms to ensure the sustainability of funding for civil society organisations and networks based in middle income countries if bilateral programmes have ended, and should actively consider the re-introducing of regional PPAs.

5.DFID should work with the FCO to combine support for networks and organisations of populations facing human rights violations, including those at higher risk of HIV, in a joint funding instrument combining access to justice, protection of human rights defenders, stigma and discrimination reduction, advocacy and research.

6.The UK should announce a new commitment for the September 2013 Global Fund to Fight AIDS, TB and Malaria (Global Fund) replenishment meeting of £1 billion over three years.

Question 1: Whether the 0.7% ODA target will be appropriate in the long term

1. The UK’s longstanding commitment to achieve the 0.7% aid pledge has determined its position as an international development and global health champion, especially in relation to the HIV response at the heart of the G8 and G20. At Gleneagles for example, the UK persuaded other G8 countries to commit to universal access to HIV treatment, a pledge which means that today more than 8 million people in poor countries are receiving lifesaving medicines. Since then, the UK has consistently been the second largest donor to HIV (behind the US) and an important supporter of the Global Fund, which was judged by the 2011 Multi Lateral Aid review as providing very good value for money1. As evidenced by the graph below, while the total amount of money the UK has delivered for HIV has increased over the last 8 years, the amount of these funds as a percentage of ODA has stabilised at between 6.6% and 7.1% from 2009 to 2011. This demonstrates how the gradual realisation of the 0.7% ODA target has enabled the UK to maintain a strong contribution to the HIV response.

2. The UK has played a key role in challenging other countries to honour their promises on aid for developing countries, especially on pledges to achieve the Millennium Development Goals (MDGs). The UK has also been a leader in delivering effective aid that achieves results for poor people and provides value for money, both for British taxpayers and for recipients.

3. The 0.7% target was first committed to by the UK in 1974, and subsequent governments from both the Conservative and Labour parties have reaffirmed their commitment to achieving it. During the 2010 UK General Election campaign, all three main parties committed to reach 0.7% by 2013 and to enshrine this commitment in law.

4. Since the Coalition came to power in May 2010, the Prime Minister David Cameron, Chancellor of the Exchequer George Osborne and the International Development Secretary Justine Greening have reaffirmed the government’s willingness to meet the UK’s long-standing commitment to reach 0.7% of UK ODA as a share of GNI in 2013. Last September, the Prime Minister stated that it would be wrong to use the economic downturn as an excuse to go back on aid pledges,2 while George Osborne and Justine Greening have both underlined that achieving the 0.7% aid target is the UK’s “commitment to the world’s poorest”3 and “is the right thing to do and the smart thing to do.”4

5. The Alliance supported these statements and welcomes the Government’s recent announcement that it will reach 0.7% this year. In doing so, the UK will become the first member of the G8 to meet the long-standing UN target. By reaching the 0.7% target, the UK stands as an example that providing support to the world’s poorest people should be a moral imperative beyond national, political and economic debates.

6. We also strongly support the inclusion of a target on achieving 0.7% under Goal 12 in The Report of the High-Level Panel of Eminent Persons on the Post-2015 Development Agenda5 David Cameron was co-chair of the High Level Panel while over 500,000 people have inputted into the Post-2015 process through national, regional and thematic submissions globally. According to analysis from the UN Millennium Project led by the economist Jeffrey Sachs, 0.7% of GNI from industrialised countries could provide enough resources to meet the MDGs.6 As we move towards a new post 2015 development framework, the inclusion of a target within the High-Level Panel’s report is a strong mandate and a call to action for other developed countries to meet 0.7%. With the post 2015 framework likely to lead up to a deadline of 2030, it also outlines why 0.7% is an appropriate for the longer term.

Protecting the 0.7% Target in Law

7. In a March 2012 report on the economic impact and effectiveness of development aid, the House of Lords Economics Affairs Committee stated that enshrining the 0.7% figure in law “would deprive future governments of the flexibility to respond to changing circumstances at home and abroad”. Lord MacGregor, Chairman of the Committee, said that development aid should be judged by the criteria of effectiveness and value for money, not by whether a “specific arbitrary spending target is reached”.7

8. The Alliance believes that changing economic circumstances or indeed political whim cannot justify cutting assistance to the world’s poorest people. If aid were cut to the Global Fund to Fight AIDS, TB and Malaria for example, this would see a decline in the availability of lifesaving HIV and TB medicines, resulting in a surge in preventable deaths as well as in drug resistance and new infections. Similarly on Malaria, if funding for insecticide-treated bed nets and other Malaria prevention interventions suddenly dropped, a generation of children who have never developed resistance to the illness would be at risk. As some scientists have put it, the gains of the last ten years could be undone in one rainy season.

9. The Alliance is also concerned by suggestions that the UK could use aid money for defence or peace keeping. This would mean a reduction in aid as it is defined by the OECD Development Co-operation Directorate (DCD-DAC). Critically, it would also mean less money for interventions which are core to development, such as health, education and livelihoods.

10. Enshrining the 0.7% ODA target in law would protect the aid budget from political whims and ensure greater accountability to Parliament and the UK public on what it is allocated to and how it is spent. Legislation could also help in shifting the debate away from quantity and towards a focus on the vital issue of aid quality and outcomes. Despite negativity in some parts of the media, we know that when the UK public is well informed about aid, people here support the 0.7% aid target. A short and inspirational film by the campaigning organisation ONE revealed that many people in the UK believed aid volumes to be much higher than they really are, with some thinking that up to 70% of the national budget was diverted overseas.8 The film also showed that when people realised how much was being achieved with just 0.7% of GNI, they were very supportive of aid, while in a Guardian online poll, 64% of respondents agreed that we need 0.7% to be enshrined in law. The Alliance joins a wide range of overseas aid and development agencies in calling on the government to deliver on its manifesto pledge and enshrine its commitment to maintaining ODA at a level of at least 0.7% of GNI, with ODA calculated in line with OECD DCD-DAC definitions to exclude money spent on defence or peace keeping.

Question 2: Whether DFID has the right mix of financial instruments and whether it should introduce new ones, including concessional loans; the balance between loans and traditional grant aid; and the role of the UK as a provider of climate finance

11. The UK government has been able to dramatically extend its reach into communities and to the most vulnerable and marginalised through its support to civil society, a key funding channel. In 2011–12 the UK disbursed £369 million through UK civil society organisations (CSOs), up from £329 million in 2010. Of this total, DFID reports that £162 million funded Programme Partnership Agreements (PPA’s); £14 million went to the Civil Society Challenge Fund; £13 million to the Governance Transparency Fund; £36 million for humanitarian assistance; and £144 million was distributed through other DFID bilateral programmes.

12. In 2010–11, 2.1% of this funding for civil society organisations was apportioned to fighting HIV.9 This is a very low level of funding compared to the 6 to 12% of UK ODA that is allocated to tackling HIV. It is also low considering the high burden of mortality for which HIV is responsible—it is still the leading cause of death among women of reproductive age in Africa. In light of the DFID-funded extensive and authoritative study conducted by the World Bank “Investing in Communities Achieves Results”,10 it is now widely accepted that civil society organisations play a critical role in the HIV response. We recommend that DFID increase this percentage to bring it at least into line with the overall proportion of ODA which is allocated to the HIV response.

13. DFID’s 2011 HIV position paper states that DFID mainly funds HIV through PPAs or direct funding for networks of key populations most affected, such as the International Network of People Who Use Drugs and the Global Forum of Men who have Sex with Men. These networks play a critical role in delivering HIV prevention, fighting stigma and ensuring that policies aimed at addressing HIV reach those most at risk. These networks often operate in contexts of criminalisation and hostility from national governments, and it is imperative that international funding be sustained. DFID is bringing bilateral programmes in middle income countries (MICs) to an end, despite the fact that the majority of those most at risk of HIV live in MICs. There is great concern about the sustainability of funding for networks and organisations based in these countries and mechanisms are needed to ensure that they are able to access funding after bilateral programmes have ended.

14. Through PPAs, DFID currently funds a number of UK organisations that deliver HIV programmes or research. DFID PPA support to the Alliance for example has played an important part in enabling us to reach 4.7 million people across 39 countries last year.11 In recent years DFID has also funded very effective regional PPAs across a number of organisations (see case study below) and funding for these should be sustained.

15. In their latest report on PPAs, the Independent Commission for Aid Impact stated that more benefit could be drawn from PPAs if DFID were to “refocus on the added value they can provide as a strategic instrument, in particular when contrasted with the other CSO funding mechanisms”. DFID failed to define what it hoped to gain from working in partnership with CSOs and, as a result, has gained less than it might have done. In particular, the CSOs’ knowledge, influence and expertise could be adding further value to DFID’s work.12

16. The recent DFID PPA reviews provide an opportunity for DFID to increase funding for CSOs that can prove they are delivering value for money and impact. DFID’s ongoing review of its HIV work includes an assessment of the way that DFID extends its reach through civil society, and based on this analysis it should expand civil society funding mechanism to deliver impact for the most vulnerable and marginalised. As discussed above, increased funding for civil society partners should be an important part of DFID’s new approach to MICs.

17. Improving co-ordination between DFID and the FCO is also essential to better support to networks and organisations of populations facing human rights violations, including those at higher risk of HIV. DFID and the FCO should combine support in a joint funding instrument13 that would entail a strategic combination of interventions such as access to justice, protection of human rights defenders, stigma and discrimination reduction, advocacy and research.

Case Study: Latin America

In Latin America HIV is concentrated among key populations (transgender women, men who have sex with men and sex workers) but government commitment to a targeted HIV response for these groups is minimal and this aspect of the response is heavily dependent on international aid. Key populations are a matter of grave human rights concern due to social stigma, violence, human rights violations and the impunity with which these are committed.

DFID’s Latin American Partnership Programme Arrangement (LAPPA) has empowered organisations of populations at higher risk of HIV to reduce HIV-related stigma and discrimination, to have a greater voice in decision making processes and to hold their national governments to account. Through the LAPPA PPA, the Alliance has worked with the Latin America and Caribbean Network of Transgender people (Redlactrans) and the Latin American Network of Sex Workers (Redtrasex). Both organisations enjoyed exponential growth under the LAPPA programme. In 2004, Redtrasex had six national member organisations, compared to 15 in 2012, representing over 15,500 individuals across the region.

Redtrasex has had unprecedented success in shaping national policies and local regulations so that they better protect sex workers’ human rights and access to HIV services. For example, Redtrasex members have secured the repeal of local regulations that prohibited sex workers’ free circulation in Panama City and three states in Argentina; replaced the stigmatising Sex Workers Health Card in Ecuador with a Comprehensive Healthcare Card which has increased access to health services.

Redlactrans’ presence increased from three countries in 2008 to 17 in 2012. Redlactrans’ advocacy focuses on changing the law to recognise the legal identity of transgender people, and was instrumental in passing historic Gender Identity Laws in Argentina, Uruguay and Mexico City. National AIDS programmes in Argentina, Nicaragua, Bolivia, Peru, Uruguay and Mexico now include “friendlier” services for transgender people, including access to HIV treatment and prevention with specific attention to their needs.

The increased participation of both networks in decision making processes has also helped to increase funding for HIV services targeted at sex workers and transgender people. A regional Redtrasex project has received $12 million from the Global Fund to increase sex workers’ access to HIV and health services over the next five years.

Despite these successes, the LAPPA programme was discontinued in 2010 on the basis that most countries in the region are classed as middle income. The empowerment of transgender and sex workers communities in Latin America is at a crossroads regardless of the perceived economic wealth of the region. The HIV response in Latin America can only be successful when governments and donors strategically target their funds to addressing the specific needs of populations at higher risk for HIV. Regional PPA’s have been a very effective way of delivering critical support and DFID should actively consider re-introducing them in Latin America and other regions.

Question 4: Whether DFID has the right balance between bilateral and multilateral aid

18. About two-thirds of UK HIV funding to date has been delivered through bilateral HIV programmes, but between now and 2015, DFID is planning a shift in favour of multilaterals such as the Global Fund. A recent analysis by the Guardian of DFID’s bilateral country spending plans found that the share of HIV funding as a percentage of health bilateral aid will drop from 16% in 2010–11 to less than 6% in 2014–15.14 This is partly a move towards greater donor co-ordination and cost-effectiveness, but also the result of major reductions in DFID HIV staff who could manage bilateral programmes.

19. The UK has been channelling an increasing share of total HIV funding through multilaterals that it assessed as “very good value for money” during its last multilateral aid review in 2011, particularly the Global Fund. The UK had made substantial contributions each year since the start of the Global Fund in 2002 and in 2007 it supported long-term predictability by making a seven year pledge totalling £1 billion. The UK is to be highly commended for consistently delivering on its pledges and, in response to recent funding crises at the Global Fund, for bringing forward contributions to cover gaps. DFID publicly assures that following the results of its ongoing mini multilateral aid review, it will make an increased commitment and the Alliance and others are calling for a new commitment for the September 2013 Global Fund replenishment meeting of £1 billion over three years.

20. At the same time, we are concerned that the major planned decrease in HIV bilateral funding may seriously hinder DFID’s ability to fund areas of particular niche/comparative advantage or ensure that funds get through to groups who may struggle to gain funding from government, multilaterals or other donor sources. For example, there is serious concern among HIV advocates in the Latin American region that they may be excluded from applying for future Global Fund grants. Should the Global Fund’s remit become more focussed on low income countries, there will be major HIV funding gaps in middle income countries. On top of this, the UK is itself shifting bilateral funding to focus on low income countries and fragile states and is in the process of pulling out or pulled out of many middle income countries where it makes critical contributions to the HIV response through its bilateral programmes (Vietnam, India, the Caribbean and South Africa). The question then remains what range of UK funding and technical support mechanisms, if any, will the UK ensure are available to meet under-supported HIV interventions in these countries. Critical technical and financial support is still needed and DFID needs to more meaningfully map out the options available for providing this.

June 2013

1 Multilateral Aid Review: Assessment of the Global Fund to Fight AIDS, TB and Malaria, February 2011. Last accessed 2 June 2013 from: https://www.gov.uk/government/publications/multilateral-aid-review-assessment-of-the-global-fund-to-fight-aids-tb-and-malaria-gfatm.

2 David Cameron reaffirms UK aid pledge at United Nations, BBC News, 26 September 2012. Last accessed 3 June 2013 from: http://www.bbc.co.uk/news/uk-politics-19709321

3 https://www.gov.uk/government/speeches/autumn-statement-2012-chancellors-statement

4 UK to become first G8 nation to meet 0.7% aid pledge, Thomas Reuters Foundation, 20 March 2013. Last accessed 3 June 2013 from: http://www.trust.org/item/?map=uk-to-become-first-g8-nation-to-meet-07-pct-aid-pledge/

5 A new global partnership: Eradicate poverty and transform Economies through sustainable Development, The Report of the High-Level Panel of Eminent Persons on the Post-2015 Development Agenda, May 2013. Last accessed 3 June 2013 from: http://www.post2015hlp.org/featured/high-level-panel-releases-recommendations-for-worlds-next-development-agenda/

6 The 0.7% target: An in-depth look, UN Millennium Project. Last accessed 3 June 2013 from: http://www.unmillenniumproject.org/press/07.htm

7 Abolish 0.7% UK aid target, say peers, The Guardian, 29 March 2012. Last accessed 3 June 2013 from: http://www.guardian.co.uk/global-development/2012/mar/29/abolish-uk-aid-target-say-peers?INTCMP=SRCH

8 What do people really think about international aid? March 2013. Last accessed 2 June 2013 from: http://www.one.org/international/blog/video-what-do-people-really-think-about-international-aid/

9 From meeting with DFID Civil Society Partnerships Team, 2012. This figure has been questioned by the DFID AIDS and Reproductive Health Team but, if incorrect, DFID should announce the correct figure.

10 Investing in Communities Achieves Results, Rosalía Rodriguez-García, René Bonnel, David Wilson, and N’Della N’Jie, The World Bank, 2013. Last accessed 3 June 2013 from: http://aidsconsortium.org.uk/wp-content/uploads/2013/01/9780821397411.pdf

11 Data from the year 2012

12 DFID’s Support for Civil Society Organisations through Programme Partnership Arrangements (PPAs), Independent Commission for Aid Impact, 17 May 2013, p.1. Last accessed 3 June 2013 from: http://icai.independent.gov.uk/2013/05/17/independent-commission-for-aid-impact-publishes-reports-on-dfids-use-of-contractors-and-programme-partnership-arrangements/

13 Making it work: Lessons learnt from three regional workshops to integrate human rights into national HIV strategic plans International HIV/AIDS Alliance and UNAIDS, October 2012. Last accessed 3 June 2013 from: www.aidsalliance.org/publicationsdetails.aspx?id=90616

14 UK aid money: the key datasets you need to know, The Guardian, 26 September 2012. Last accessed 3 June 2013 from:
http://www.guardian.co.uk/global-development/datablog/2012/sep/26/uk-aid-money-key-datasets

Prepared 11th February 2014