| Previous Section | Back to Table of Contents | Lords Hansard Home Page |
Another way is a greater use of volunteering. The latest VSO initiative to expand its Civil Service pension scheme is a modest beginning, but it has won Cabinet support and should act as a catalyst to the NHS trusts to promote this partnership. Incidentally, it is 50 years since the VSO began from an office at Christian Aid, and I pay tribute to all its staff and volunteers.
I must mention the essential role of migration. The House of Lords Economic Affairs Committee recently poured cold water over this subject, rather in contrast to the earlier European Union Committee report, but I hope that the Home Office will follow through with its official welcome to Recommendations 11 to 13 in the Crisp report. Migrant health workers in effect subsidise our health services because of the added value of their training overseas. Countries such as Uganda are literally sacrificing one in six of their own trained staff. My local NHS hospital in Yeovil tells me that without migrant workers it would seriously struggle to deliver a service, and that because of our new immigration laws it can no longer fill paediatric posts from countries such as Malawi. Commonwealth countries are in particular demand because of English-language training.
Meanwhile, health services in some favoured African countries do receive aid from DfID, in line with central budgetary support, which is important. Ethiopia is one of these, although budgetary aid has been suspended there on human rights grounds. This has led to a more plural arrangement that combines central government funding with special projects and NGO assistance. DfID can therefore be proud of its support for health extension workers in countries such as Ethiopia, in which two women are trained for a year after completing high school and sent back to their own communities. The Community District Nursing Association is also training staff in Ethiopia, and the Royal College of Obstetricians and Gynaecologists is active throughout
1 May 2008 : Column 330
In conclusion, I recognise that the canvas is much wider than the one painted by the MDGs. Although I applaud our efforts to increase aid, I am not one of those who believe that aid represents a solution. All our aid to Africa under this Government has, I am reminded by Saferworld and other organisations concerned about arms in the world, been cancelled out by the cost of conflict. We are making notable progress in rebuilding southern Sudan, but it is painstaking work. Too much of our aid, whether in health, education or employment, is still led by outside consultants. We need to pay much more attention to local initiatives in Africa, fairer trade, more microenterprise and, above all, to supporting the largest employer of the very poor—agriculture.
For obvious reasons, I have not been able to cover all the millennium development goals. I shall leave education to others. Safe drinking water and sanitation are, I know, a high priority for DfID and they are essential to improving health. Another priority is the empowerment of women, who are in the front line of development, which should never be forgotten. The elimination of trade barriers remains vital, while the share of world trade for the poorest countries continues to decline. The caste system in India deserves a much higher priority for this Government within the human rights dialogue going on there, which one could compare to the dialogue with China over Tibet and the Muslim minority.
There is an urgent concern about food prices, which others will mention. The International Monetary Fund is to create a new programme to offset food and fuel prices in the poorest countries, but that will not be enough. At this rate, it appears that we will not make poverty history in the lifetime of Members of this House. I beg to move for Papers.
11.51 am
Baroness Prosser: My Lords, I thank the noble Earl, Lord Sandwich, for giving the House the opportunity to debate this important subject. The millennium development goals are a set of admirable strategic targets, which are designed to uplift the lives and experiences of people in what Jeffrey Sachs, director of the Millennium Project, has described as “the interconnecting world”.
I shall comment on millennium development goal 3, which is,
The 2007 UNICEF report, The State of the World’s Children, sets out in graphic detail why there continues to be an urgent need for international action to improve the circumstances of women. We learn, for example, that only 43 per cent of girls of the appropriate age in the developing world receive secondary-level education. In some parts of Africa, the figure is only a little over 20 per cent. We also read of the continuing practice of child marriage. We read that girls under the age of 15 are five times more likely to die in pregnancy than
1 May 2008 : Column 331
The most shocking information that I have found relates to decision-making in the home. In four African countries—Burkina Faso, Mali, Nigeria and Malawi—more than 70 per cent of male heads of households make the sole decision on matters relating to their wife’s health and medical care. In Malawi, Nigeria and Mali, more than 60 per cent of such men solely decide on household expenditure. In Mali and Burkina Faso, 60 per cent of men make the sole decision on whether the family will visit friends and relatives.
Interestingly, in 2003, research conducted by the International Food Policy Research Institute in Washington DC, showed that major determinants of decision-making in the home included access to or control over income and, importantly, levels of education. Of course, education is important for improving access to employment, but we can see here that it is also about improving confidence and providing these women with the means to gain control of their lives and to instil a sense of confidence and dignity into themselves and their children.
The objectives of the MDG programme are admirable. However, recent reports, including the Action Aid report on women and the millennium development goals, show that those MDGs farthest off track are those relating to women. Forty countries risk not achieving equal school enrolments for boys and girls until after 2025. The same report highlights the position of women under each of the MDGs and provides statistics to show that women and girls continue to be the majority of those experiencing hunger, those with little or no access to land and those with no access to education. They are not included in decision-making bodies, they die younger and they die of preventable and avoidable pregnancy-related causes. Also, more women than men live with HIV/AIDS and women are mainly responsible for fetching water.
WOMANKIND Worldwide, one of the NGOs that has campaigned on these issues for many years, has expressed disappointment at the level of progress being made and believes that this is due to a failure to address discrimination against women in all areas of the MDGs. MDG 8, for example, which is about global partnerships, should require Governments to build on and honour existing international agreements such as the United Nations Convention on the Elimination of Discrimination Against Women, commonly known as CEDAW. Closer monitoring is called for on how aid impacts on gender inequality and there are calls for the diversification of aid to make sure that it reaches the smaller local and grass-roots organisations.
In September 2008, the UN high-level panel review of the millennium development goals will meet. Calls are made for Governments to commit additional resources to the delivery of the MDGs, and MDG 3 in particular. Reference is made to the need to address violence against women and to the protection of women and girls during and after armed conflict. Again, we already have a mechanism to deal with this; namely, United Nations Resolution 1325, which must be much more widely promoted and built on.
1 May 2008 : Column 332
I have two final thoughts. First, the lack of quality gender-disaggregated data stymies our ability to determine the most productive way forward and to target effectively our resources. Secondly, we call for gender budgeting; that is, the analysis of the particular impact of expenditure on women and girls. This is a useful tool and can help to ensure that programmes and policies hit the intended targets.
11.57 am
Baroness Verma: My Lords, I, too, congratulate the noble Earl, Lord Sandwich, on securing this hugely important debate. It allows us once again to concentrate our mind on issues that are so often pushed to the side of people’s immediate thought processes. I shall concentrate on India, which is unique among the developing countries as it boasts massive economic progress and yet, in what is almost a contradiction in terms, is facing greater disparity and less economic access and opportunity for those at the bottom of the social and economic ladder.
As a frequent visitor to India and as one of Indian origin, I am incredibly proud of the huge progress that my country of origin is making on the world stage. India is undergoing a phenomenal transformation and we should all applaud its achievements. Yet I hope that we do not lose sight of the fact that 600 million people live on less than $2 a day, with 300 million of them on less than $1 a day. Social and economic inequality is detrimental to the health of any society, especially when the society is as diverse, multicultural and overpopulated as that of India. Slow and unequal social mobilisation in various parts of the country has led to uneven economic growth, caste and social polarisation, low levels of literacy and educational attainment, and limited access to natural resources. All these impact on the life qualities of individuals.
In rural areas of India, the ratio of hospital beds available to the population is more than 15 times lower than it is for those in urban areas, while the ratio of doctors is around 6 per cent lower and per capita expenditure on public health is more than 7 per cent lower than in urban areas. This growing inequality in health and healthcare spending affects largely the marginalised and socially disadvantaged population. The infant mortality rate of the poorest 20 per cent of the population is 2.5 times higher than that of the richest 20 per cent. A child in the low standard of living economic group is almost four times more likely to die in childhood than one in the high standard of living group and a female child is 1.5 times more likely to die before her fifth birthday than a male child. At the last census in 2001, the statistics showed that there are just 927 girls per 1,000 boys, a ratio that had declined from 945 per 1,000 in 1991.
I was in West Bengal a few weeks ago and I am grateful to the West Bengal Legislative Assembly for its invitation. The visit provided parliamentarians with an opportunity to have free and frank discussions about many of the issues that this debate will raise. Given our historical links with India, it is crucial that we encourage its politicians at all levels to recognise that the prosperity of a nation is valued by what happens to the poorest in its country.
1 May 2008 : Column 333
It deeply troubles me that a person from the poorest quintile of the population, despite facing greater health problems, is six times less likely to access hospital care than someone from the richest quintile. There are three main reasons for this: geographical distance, socio-economic distance and gender. Poor access to health centres and basic healthcare is pronounced among families with little or no education. Poor transportation facilities add to the difficulties of access and little in the way of incentives is given to doctors and nurses to move to rural areas. Maternal mortality therefore remains much higher in rural locations.
The picture remains bleak in urban slums, too, where mortality rates for infants and those under five of the poorest 40 per cent are as high as those in rural areas. Urban dwellers remain extremely vulnerable to macroeconomic changes which impact on their earning capacity. Rising food and utility costs add to the difficulties of accessing nutritional food and people therefore opt for cheaper versions. Added to this are poor sanitation systems, poor housing and inadequate education, which expose urban dwellers to the increased risk of disease.
Particularly affected is the female population. In countries such as India, gender discrimination still exists on a large scale and females remain socially, culturally and economically dependent on men. They are still predominantly excluded from decision-making and are seen as an economic liability, mostly due to the dowry system. Maternal mortality rates have increased from 424 maternal deaths per 100,000 live births to 540 maternal deaths per 100,000 live births.
India has also seen a resurgence of many infectious but curable diseases, such as dysentery and diarrhoea, which kill about 600,000 children each year.
Greater focus on education and healthcare are the major pins in the eight millennium development goals. I understand only too well the complexities of India—a hugely successful multicultural, multilingual and multireligious country—so I understand that the solutions are equally complex. DfID and major aid agencies do excellent work in India but it is crucial that proper outcomes are set, recorded, tracked and monitored, that scrutiny takes place and that there is more equal partnership work to give ownership to the recipient countries.
12.04 pm
Lord Chidgey: My Lords, I, too, congratulate the noble Earl on bringing this subject to us today. It is a most important issue. I will spend my allotted time stressing and underlining many of the issues he and other contributors have already raised. I shall concentrate my remarks on the progress with the MDGs in Africa, noting my interests as a founding vice-chairman of the Africa All-Party Parliamentary Group and as a council member of the Association of European Parliamentarians for Africa.
Not all African countries are poor, but all are to an extent off target in plans to meet the MDGs. In the UN’s progress by region report, produced at the halfway stage in 2007, the most extreme region by far is sub-Saharan Africa. In only one of its bands—measles
1 May 2008 : Column 334
While sub-Saharan Africa might be the cause for broadest concern, some specific MDGs across the developing world in themselves were resisting progress. With regard to Goal 6, combating HIV/AIDS was off target or showing no progress in all the regions looked at in the developing world, while reversing the spread of malaria and tuberculosis was off target or showing no progress in five out of eight regions.
I return to Goal 4, which aims to reduce child mortality of under-five year-olds by two-thirds. Four out of the eight developing regions were on target in 2007 to meet that MDG. That is encouraging, to a degree, but you have to consider that, according to Save the Children’s latest work, nearly 10 million children globally are still dying before the age of five every year. Of those, 4.8 million deaths occur in sub-Saharan Africa. At this rate of progress, the target to reduce mortality by two-thirds will not be met until 2045.
That fact could well highlight a design flaw in the MDGs. They seem to ignore the issues of equity and distribution, which Save the Children is rightly calling for Governments to place a much greater focus on. Although the United Nations maintains an MDG indicator database for individual countries as well as regional trends, there are problems with some of the data used for calculating the MDGs. There are data quality issues with birth and death registrations and cases of malaria and TB, which will remain until the PARIS2l consortium is successful in promoting high quality statistics in developing countries.
The question is: how will the goals be achieved? More aid seems to have been, to some extent, the accepted knee-jerk reaction—the argument is merely about how much aid. Some $50 billion per year in additional assistance seems to be the figure generally used as the amount needed to meet the MDGs, according to the United Nations’ Zedillo report, and the Gleneagles summit agreed to the doubling of aid by 2010. It has to be pointed out, however, that while increased aid will certainly help the more successful developing countries to reach their MDGs, it is not in itself the solution to pulling the poorest out of poverty.
In its report on strengthening parliaments in Africa, the Africa All-Party Parliamentary Group stressed that development partners must work in step with one another. Approaches need not be uniform but they should be co-ordinated, sharing information and insights, reducing duplication and dividing labour according to comparative advantage. Donors should do more to form common streamlined arrangements. Aid to developing-country Governments, particularly in Africa, through direct budget support, strengthens the particular recipients but risks making them more accountable to the donors and less accountable to their people through their parliaments. In that regard, the current European Commission Paper, The EU — a Global Partner for Development: Speeding Up Progress Towards the Millennium Development Goals, is welcome.
1 May 2008 : Column 335
The lack of clarity over accountability for delivery and the national, regional, or global focus of the MDGs are highlighted by the Commission as outstanding concerns. It has identified four priority areas for action by the EU: aid volumes; aid effectiveness; EU policy coherence; and aid for trade. From the Explanatory Memorandum prepared by DfID, it appears that our Government are solidly behind the proposals set out in the European Commission document, but perhaps the Minister could elaborate on that in her response.
While the global response towards the MDGs, particularly regarding poverty reduction, has been encouraging, there is a risk of Africa being left behind. The key to Africa’s destiny lies in and with Africa, but the support of the international community, as pledged at Gleneagles, can serve to bolster African nations in their efforts; in particular, with help in developing the health and education systems that are essential precursors to the continent making real progress towards the achievement of the MDGs. In that regard, the United Kingdom has a responsibility to continue to play a leading role.
12.10 pm
Lord Jay of Ewelme: My Lords, I, too, thank the noble Earl, Lord Sandwich, for initiating this debate. It is entirely right and proper that, at a time when the focus of so much of our media is on City bonuses and house prices, we should focus on those for whom one meal a day and a roof over their head at night is a luxury.
Targets have their detractors, but those of the Millennium Development Goals really matter, because meeting them will save the lives of millions and failing to meet them will cost the lives of millions. Furthermore—and this is an important point—all countries have accepted and reiterated their commitment to them in the 2005 Millennium Development Goals summit. All countries have an obligation to do all they can to fulfil them, and that means the Governments of poor countries as well as the rich. This is a global task and a global responsibility.
As other noble Lords have said, there have been successes, particularly in Asia and Latin America, with some targets met and others on course. That is hugely encouraging. But elsewhere, particularly in sub-Saharan Africa, the lack of progress on many of the goals is deeply worrying.
I shall focus specifically on the three health goals: reducing child mortality; improving maternal health; and combating disease. I want to focus, too, on the challenges of meeting these goals in the most difficult circumstances of all: in fragile states where conflict, extreme poverty or sheer bad government mean that people are simply not getting the basic care that they need and deserve. I must declare an interest as chair of the trustees of Merlin, a medical aid NGO which operates in around 20 countries in just these circumstances.
The figures for sub-Saharan Africa are appalling. I take child mortality as an example. The proportion of children who die before they are five in the region as a whole was in 2005 about 17 per cent. In some countries,
1 May 2008 : Column 336
Of course, not all is as bad as that: as the noble Lord, Lord Chidgey, has just said, the incidence of measles, a huge killer in Africa, is falling as vaccination spreads. But overall, this degree of poverty and vulnerability anywhere in the world in the 21st century is simply unacceptable. And conflict makes it worse still. The war in Liberia reduced the number of doctors in the country from 237—which is not, one might think, a huge number—to fewer than 20.
As the noble Earl, Lord Sandwich, said, poverty and vulnerability of this kind are insidious but avoidable. That, too, is a point on which we need to focus. So what is to be done? As other noble Lords have said, part of the answer is finance. Like others, I congratulate DfID on its commitment over the years to poverty eradication. I hope that it and the Government as a whole will continue to lead both by example and by exhortation, notably at the European Union and G8 summits coming up this summer and the UN summit this autumn. I also welcome the Government’s commitment to the International Health Partnership, which is crucial in ensuring that the many committed actors in this field work together. I would welcome an assessment from the Minister at the end of this debate of progress in the International Health Partnership, launched last year.
| Next Section | Back to Table of Contents | Lords Hansard Home Page |