Government response
Introduction
The UK Government welcomes the opportunity to respond
to the International Development Committee's (IDC) Report on Responses
to the Ebola Crisis. We appreciate the Committee's support for
the immediate response and longer-term recovery within the affected
countries and agree that it is important that the UK continues
in its efforts.
Since 2010, during this parliament, the UK has spent
a total of £63.8 million in the health sector in Sierra Leone,
compared to a total of £22.9 million spent from 2005-2010
under the previous government. This includes the launch and rollout
of the landmark Free Health Care Initiative in 2010.
| 2005-06 | £1.7m
|
£22.9m |
| 2006-07 | £1.8m |
|
| 2007-08 | £3m |
|
| 2008-09 | £5.5m |
|
| 2009-10 | £10.9m |
|
| 2010-11 | £22m |
£63.8m
|
| 2011-12 | £11.6m |
|
| 2012-13 | £15.9m |
|
| 2013-14 | £14.3m |
|
The UK has also supported the health sector through our contributions
to the Global Fund and GAVI. The UK has provided significant funding
to both of these organisations and most recently pledged up to
£1 billion to the Global Fund over the 2014-2016 period and
£1 billion to GAVI for 2016-20.
| Disbursements to Sierra Leone by fund by programme year ($)
| GAVI | GF |
| 2005 | 140,300 | 6,365,300
|
| 2006 | 521,000 | 6,993,100
|
| 2007 | 2,941,800 | 4,367,700
|
| 2008 | 3,996,700 | 14,372,100
|
| 2009 | 3,359,400 | 11,224,600
|
| 2010 | 6,039,400 | 17,843,600
|
| 2011 | 3,919,900 | 24,077,500
|
| 2012 | 5,228,200 | 14,932,200
|
| 2013 | 6,475,800 | 17,309,700
|
| 2014 | 6,247,400 | 31,062,600
|
| Total 2005-2014 disbursements | 38,869,700
| 148,548,400 |
In the last financial year, DFID spend in Sierra Leone in 2013-14
was £68.6 million, making the UK the biggest bilateral donor.
Of this, over 20% was spent on health programmes, and half of
that was focused on maternal and newborn health. Prior to
the Ebola outbreak, health systems in Sierra Leone were on an
upward trajectory. For example, thanks to DFID support since 2011,
over 50,000 more births were delivered by skilled health personnel
and almost 40,000 women have started using a modern method of
family planning for the first time.
The UK has been at the forefront of the response to the Ebola
outbreak in Sierra Leone. We have disbursed over £211 million
to date to tackle Ebola and the UK remains the biggest bilateral
donor. This has enabled a rapid, multi-faceted response including;
supporting more than half of all the beds available for
Ebola patients in Sierra Leone, funding over 100 burial teams,
training over 4,000 frontline staff, trebling the country's capacity
to test for the virus, and delivering over one million personal
protective equipment (PPE) suits and 150 vehicles. With the help
of the UK; Sierra Leone now has enough treatment and isolation
beds for Ebola patients, enough labs to test for the virus quickly
and effectively, enough trained burial teams to make sure bodies
are buried quickly, safely and with dignity, and a command and
control structure that is making the Ebola response more efficient
and more effective.
The UK is playing its part; other donors need to live up to their
promises. The UK's strong leadership and the PM's engagement have
led to improved international commitment and coordination around
the Ebola crisis in Sierra Leone. On 2 October, the Foreign Secretary
and the International Development Secretary co-chaired an international
conference on defeating Ebola in Sierra Leone, during which over
£100 million and hundreds of additional healthcare workers
were committed. The PM's lobbying secured a further €1 billion
pledge at October's European Council. We welcome the significant
contribution of healthcare responders made by the Governments
of Australia, Canada, Cuba, Denmark, Estonia, Ireland, the Netherlands,
New Zealand, Norway, South Korea and the US to support the UK's
efforts in Sierra Leone.
The UK's response has been supported by the deployment of UK personnel
on the ground, including over 800 Defence Personnel who have helped
construct the six UK Ebola treatment centres and delivered training
for over 4,000 healthcare workers. Over 1,600 National Health
Service (NHS) health workers have volunteered with UK-Med, and
over 110 staff have deployed to Sierra Leone to work in UK treatment
units. Over 100 staff have been deployed by Public Health England
to set up and run state of the art laboratories that allow for
the speedy diagnosis of people with Ebola-like symptoms. Further
volunteers are also deployed under separate independent initiatives.
Additional support is being provided by RFA Argus, with 3 Merlin
helicopters to provide logistical assistance.
We have reached a turning point in the epidemic. The reproductive
rate has slowed in Sierra Leone. However, we cannot be complacent.
There is still much to be done. We must continue our efforts on
the national and district level until Ebola is defeated in Sierra
Leone. The UK's objective is to support the Government of Sierra
Leone to reach zero cases as quickly as possible. While rapid
progress has been made at controlling the generalised outbreak,
getting to zero will not be as quick.
The nature of the UK's response has already changed, evolving
in line with the nature of the outbreak. With significant differences
between districts, in terms of the causes and number of cases,
we are tailoring our response to proactively seek out hotspots
of transmission as the epidemic declines. This will require continued
UK investment to ensure we defeat Ebola in Sierra Leone.
It is also right that we start planning for recovery. The Ebola
crisis has disrupted markets and access to food and other essentials
for many families, put a massive strain on the country's healthcare
system and caused a generation of children to miss nearly a year
of school. We will continue to stand alongside the Government
of Sierra Leone and, working with the international community
and non-governmental organisations (NGOs), we will ensure that
sufficient resources continue to be available.
The UK Government is grateful to the Committee for focusing on
the UK's role in the response to the Ebola crisis. We are pleased
that the Committee recognises the progress made in the region,
while wishing to be responsive to its recommendations for improvements.
The international response
1. We recommend the UK Department for International Development
(DFID) press for a review of the international approach to health
emergencies, incorporating the function, structure and funding
of the World Health Organisation and the role and expectations
of major donors. DFID should not wait for its 2015 Multilateral
Aid Review to do this; the urgency of the situation warrants immediate
action.
Agree. Reform and improvement of worldwide response mechanisms
to global health threats is clearly required; in particularly
surveillance, stronger early warning and response mechanisms,
and the international community's identification and reaction
to potential future crises. The responsibility for the weaknesses
in the Ebola response does not fall to the World Health Organisation
(WHO) alone, but it has highlighted the need for WHO to play its
role more effectively. Lessons are already being applied across
the region, and we have not suffered a fourth country outbreak
yet. New resources for preparedness, detection and response will
need to strengthen national and international systems, to ensure
we can respond promptly to future large scale health emergencies
and public health crises.
The UK pressed for reform of the international approach to health
emergencies at the Special Session of the WHO Executive Board
on 25 January. The decisions made at the Special Session put into
practice the measures proposed by the PM at the Brisbane G20. At
the Special Session the UK's Representative, Chief Medical Officer
Professor Dame Sally Davies, challenged WHO, Member States and
the wider international community to step up their game in responding
to health emergencies. To help WHO respond quickly in the future
the UK announced an advance commitment of up to 10 million US
dollars as part of the WHO contingency fund, when one is established,
and in the event of future outbreaks and emergencies with public
health consequences. We welcome the reforms announced at the Special
Session including: the establishment of a rapid response team,
improvements in international co-ordination and information sharing,
greater support for countries in responding to emergencies, and
support to vaccine development and trials. The Special Session
also reaffirmed the WHO Director General's leadership at all three-levels
of the organisation during emergencies and her authority to move
staff as required, to take steps to address performance, and to
reallocate and disburse resources quickly in the event of emergencies
to meet greatest need.
DFID's response in Sierra Leone
2. We recommend DFID write to us on a monthly basis detailing
progress on, and plans for, aid disbursement, staff deployment
and other actions to tackle Ebola.
Agree. The Secretary of State will write to the IDC on
a monthly basis, providing the information requested. To date,
the Secretary of State has kept parliamentary colleagues informed
through regular correspondence.
Legacy in Sierra Leone
3. We reiterate the recommendations of our report on Strengthening
Health Systems in Developing Countries and recommend that strengthening
the health system be the centrepiece of DFID's reconstruction
plans for Sierra Leone. We further recommend that DFID and the
Department for Health undertake a review of the training of health
professionals in the UK and the impact on the developing world.
Partially agree. The future long-term development programme
in Sierra Leone is currently under consideration. The UN Secretary
General has designated the UN Development Programme (UNDP) as
the lead UN agency tasked with completing a regional Ebola Recovery
Assessment (ERA) for the region by the end of February; in partnership
with the European Union (EU), World Bank (WB) and African Development
Bank (AfDB). We will work hard to ensure that the ERA will give
priority to re-building Sierra Leone's devastated health system.
Alongside the ERA we are assessing how best to support Sierra
Leone's long term recovery plan, which will include the extent
of our support to health system strengthening.
The UK's Department of Health (DH) and DFID will continue to work
together to review their approach to the UK recruitment of health
workers from overseas. We believe the most appropriate way
of addressing health worker shortages in low and middle income
countries is to support health systems and human resource planning;
to enable retention and better distribution of the health workforce.
DH endorses the WHO Code of Practice on the International Recruitment
of Health Personnel, and has commissioned the NHS Employers organisation
to implement it. An underlying principle of the WHO Code
of Practice is that developing nations, experiencing shortages
of healthcare staff, should not be targeted for active recruitment.
Our latest figures show that only about 4.4% of UK NHS doctors
and 1.8% of other clinical NHS staff are from Africa. A number
of health staff originally from Ebola-affected countries have
recently returned to use their skills in the fight against the
virus.
In Sierra Leone, DH is funding a piece of work requested by the
WHO and delivered by CfWI (Centre for Workforce Intelligence)
that seeks to identify the workforce challenges in recovering
from the Ebola crisis. More broadly, DH backs the Medical Training
Initiative (MTI), supporting the training of doctors and the improvement
of developing health economies. Both the MTI and the International
Post-graduate Medical Training Scheme promote circular migration.
Participants in schemes can return to their home country and apply
the skills and knowledge developed during their time in the UK. The
Healthcare Partnership Scheme, led by DFID, also aims to improve
health outcomes in low-income countries through effective transfer
of health service skills.
4. We recommend that DFID convene a global conference in
early 2015 to agree a common plan for post-crisis reconstruction
in the region.
Partially agree. To date, the UK has led the international
response in Sierra Leone. The UK's strong global leadership was
demonstrated through the Defeating Ebola Conference on 2 October
2014, co-chaired by the International Development Secretary and
Foreign Secretary, during which over £100 million and hundreds
of additional healthcare workers were committed. International
engagement and commitment was also galvanised at the Brisbane
G20 gathering and through a further €1 billion pledge at
October's European Council.
When it comes to the next phase, it is vital that other countries
step up on the recovery agenda. We are pleased that the EU Commission
has agreed to co-chair a conference on Ebola on 3 March; alongside
the UN Secretary General, and high level representatives from
the African Union (AU), Guinea, Liberia, Sierra Leone and Togo.
The UK will fully participate in the Conference, which will provide
a critical opportunity to discuss the ongoing immediate response,
preparedness and early recovery, as well as principles for the
longer term recovery of the region.
We are working closely with the EU to ensure that the Conference
plays a strong role in maintaining momentum on the ongoing Ebola
response; maintaining a focus on preparedness, and ensuring a
considered, well-targeted and coordinated approach to early recovery
under the UNDP-led ERA. We would encourage all partners to get
behind the ERA at the Conference, to frame the international response.
This also presents an opportunity to revisit the "new deal"
principles already agreed by the three affected countries, to
ensure strong accountability, governance and transparency. Following
this Conference, we will continue to work with the international
system to ensure that focus on the response and recovery is maintained.
The World Bank Spring Meetings will be an important next staging
post.
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