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As other noble Lords have said, the key point about funding is that it needs to be properly directed if it is to have effect. During and in the immediate aftermath of conflict, emergency humanitarian aid is essential. I pay tribute to the humanitarian operations of both the United Nations and the European Union in responding to really very difficult circumstances at present. The role of NGOs is also crucial. But even at this emergency stage, just after conflict, particularly as things begin to stabilise, donors need to focus not only on meeting emergency needs but on building up the basic capacity of health systems to cope with longer term needs. If that does not happen right from the beginning, there will be no chance of moving through that rather difficult process from emergency through transition to, we hope, recovery. In that context, training medical, nursing and support staff is fundamental—and I greatly look forward to hearing what the noble Lord, Lord Crisp, will say on that.
Even better would be to prevent conflict. I wonder if, at the end of the debate or perhaps later, the Minister could say what progress has been made in putting into practice the doctrine of responsibility to protect which was agreed in the UN summit in 2005—the principle that states are primarily responsible for protecting their own populations from genocide, war crimes and ethnic cleansing but, if they do not, they should be or can be encouraged to do so by others. I know that that is a delicate issue but if that doctrine could be developed and put into practice, with a very clear humanitarian objective, it could make a difference.
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12.16 pm
The Lord Bishop of Winchester: My Lords, I, too, thank the noble Earl for this very timely debate. I am especially grateful to follow the noble Lord, Lord Jay, because some of the things that I want to draw attention to have been notably taken up in his remarks.
I want to pick up on a word used by the noble Earl in his introduction, and in the speech that we have just heard—the word “conflict”. I begin by quoting a paragraph from the UN’s 2007 report. On page 4, it says:
“Insecurity and instability in conflict and post-conflict countries can make long-term development efforts extremely difficult. In turn, a failure to achieve the MDGs can further heighten the risk of instability and conflict. Yet in spite of a technical consensus that development and security are mutually dependent, international efforts all too often treat them as independent of one another”.
I want to illustrate the deadly seriousness of those words in this context, with reference to only two areas of the world—though among far too many; namely, the DRC, with particular reference to its eastern side, and the West Bank and Gaza in Palestine.
In the DRC, after so many terrible years and elections a couple of years ago with vast EU and other support, and with the assistance of the largest UN force currently operating, the January Goma accord is by no means working. There are a range of armies and militias; the national army is profoundly inadequate and a damage to security in itself. Well over 1 million people are away from their homes and their fields, whether in camps or in the bush. Thousands are dying every month from violence, disease, exposure and malnutrition, aided and abetted by the systematic trashing of the basic facilities, such as schools, churches and rudimentary health facilities. NGOs are greatly hampered from operating and the levels of rape are as high as ever, if not higher. There are other places where that is the case. Progress with the MDGs is clearly going backwards on every count and according to every witness.
There is a horrifyingly similar story in everything that is to be read and learned and listened to, not only about Gaza but throughout the West Bank. Palestinians have recently been described as the highest per capita recipients of aid in the world. Any aid is for survival: for humanitarian needs rather than development. A very recent report on a number of aid agencies spoke of a humanitarian implosion in Gaza. It described the West Bank as now being equal in deprivation, difficulty and insecurity to the poorest developing world countries. Here, too, progress with the MDGs is frankly impossible.
If we are serious about the MDGs—as our own and other Governments admirably mean to be and have been working to be—we have to be particularly serious about the most intractable places and the most vulnerable among the many vulnerable millions. That is a serious matter, because the former Prime Minister's Africa report of 2005 was much better at the places where things were less difficult than about where they were more difficult. I have tried to chase up the work of the Africa Partnership Forum, to which, amazingly, the Government have delegated work. Has this House ever had a debate on the Africa
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What is to be done would be another debate in itself, but there are all kinds of questions about joined-up government. There is the delicate matter for this House and for this Government of reviewing the wisdom of running down the Foreign Office and the skills of sheer, persistent diplomacy, even if it has sometimes been run down in favour of DfID. There is patient, energetic, skilled and knowledgeable diplomacy to be done. There are huge questions, not only about accountability for aid in the most difficult and conflict-ridden places, but, as the noble Lord, Lord Jay, suggested, about protection and how that can be offered in places of extreme difficulty.
In the case of Palestine, we have to get into a position where we are not simply sitting apathetically assuming that that terrible situation will go on and on, especially as I continue to believe—whatever I am told by Government Ministers—that our failure to work at the issues of Palestine is serious for a whole range of other issues throughout the Middle East and in this country. In my last sentence I want to take up the noble Earl’s point that everything that we were talking about points to a scourge much greater than terrorism—now there is a challenge for the Government’s priorities.
12.23 pm
Baroness D'Souza: My Lords, I, too, thank the noble Earl for initiating this debate. My concern is not so much with the nature of the MDGs themselves but with how possible it is to calculate progress or measure achievement with anything approaching scientific credibility.
I declare an interest as a patron of an organisation called Evidence for Development, which specialises in assessing the impact of development programmes. Evaluation, assessment and measurement, when talking about human societies, is a tricky science to which many hours of statistical study have been devoted. Such evaluation is increasingly refined and figures are constantly re-jigged. There is now, because of the MDGs, a worldwide commitment to numerical targets and deadlines. The problems are as follows. For each MDG the baseline from which most surveys take off is more often than not flawed, but most aid organisations, including the UN agencies, continue to rely on distorted government statistics which are manipulated for political benefit. Armies of evaluators regularly carry out surveys which may be too simple to be useful, too limited to assess overall impact or too technical to be implemented with any confidence in the results.
We may argue about what the MDGs actually represent: a common vision of what matters most for improving the lives of people in poor countries, as one commentator has put it; or a measuring exercise. To
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Is a reduction in child mortality due to health intervention or is it a more general effect of factors such as knowledge transfer, access to markets and the like? Tanzania's decrease in child mortality is probably due to massive inputs of anti-malarials, bed nets and immunisation. But no one will know exactly unless these inputs suddenly cease. In fact, AIDS aside, mortality in Africa has been falling steadily for decades and no one is entirely sure why.
MDG 6 aims to reverse the incidence of malaria. However, the indicators chosen to chart progress are essentially unmeasurable. A WHO report funded by the UK Government is damming. It talks of
of the measurement strategy at all levels; insufficient guidance given to countries on data collection; and no acceptable sampling methodologies employed, with the result that the data
Does it matter? After all, is not some aid better than none? It does matter because the wrong aid may be worse than none, and ineffective aid necessarily precludes more appropriate assistance. Furthermore, if progress by whatever means is detected surely we should know what has caused it. Otherwise how can we build our knowledge of what works and what does not? A second and more persuasive argument for getting it right questions the understanding of development itself. Is it a slow but logical process of political and economic change leading to greater national income and a subsequent increase in services leading to reduced mortality, more HIV drugs, education and communications? And if so, can it be speeded up by vast injections of money, including budgetary support? If it is the former, one has to ask what will happen when the foreign aid flow stops, as it must do at some stage.
No one should argue for less investment in global development, but it is legitimate to ask whether the MDGs are the best tools to advance the well-being of the poorest communities of the world and, if not, what would be a better approach.
As 2015 approaches, the UN still lacks data to prove whether the MDGs are being met. Journalists will be quick to challenge claims and disclose errors and these will be used to discredit foreign aid. This would not be a happy outcome but there is still time to act to pre-empt the embarrassment of failure.
12.27 pm
Lord Crisp: My Lords, I, too, congratulate my noble friend Lord Sandwich on securing this debate and on his wide-ranging and challenging introduction. As he and others said, the debate takes place in the context of the UK being one of the leading—perhaps the leading—and most influential countries in international development today. I approach this debate
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This leading role is greatly to the credit of the Government, but it is also greatly to the credit of the very many people in the UK who are active in the field of international development, whether they are individuals doing things on their own account—we have examples of such people in your Lordships’ House—NHS organisations or universities. The UK has a great tradition, body of knowledge and expertise in international development. I am grateful for the Government’s recent response to my report, in which they said that they would do more to support people to deliver their international development goals.
In the short time available, I will pick up one key issue, which is that the principal constraint on better progress with the health millennium development goals is the shortage of trained health workers. Something like a billion people in the world do not have access to any kind of health service. That means that they do not have anyone to turn to for advice, information or help—sometimes for the simple knowledge that is needed. As a result, as we have heard from many noble Lords, many millions of people die or are disabled or damaged needlessly from things that could be avoided.
Why is there a great shortage of health workers? It is partly about migration, which we have heard about, not just to the developed world but to South Africa and other countries in Africa. It is partly about death; indeed, in southern Africa, there has been a higher incidence of death from HIV/AIDS among health workers than among the population at large. It is partly about an economic framework that in some countries, such as South Africa and Kenya, means that there are unemployed trained health workers. But above all it is because not enough people are being trained and educated.
Let me take a simple example in Ethiopia, a country with a population of some 75 million, a quarter more than the UK population. If every doctor who had been trained in Ethiopia in the past 30 years were still working there today, there would be 4,500 doctors. If you made the same calculation for the UK, there would be more than 100,000 doctors. In practice, there are some 5,500 doctors in Ethiopia—about 2,000 Ethiopians and 3,500 foreigners. Whatever else needs to be tackled, there is a pressing need to strengthen the training and education of health workers in such countries. That applies not just to the more stable countries. As my noble friend Lord Jay said, one of the first things that needs to be done by a country is to move out of active or hot conflict.
My second point is about what sort of workers there should be. Of course, this is about doctors and nurses, but what is needed in Ethiopia, for example, is a very large number of very local health workers who know how to do 20 things right, and do them right all the time, to tackle the things that people die of. It is about clean water, mosquito nets for beds, safe sex,
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All the evidence—and there is a great deal of it—shows that such approaches have failed in some places but that, where they have succeeded, they have done so because the health workers have been supervised and well trained, have been able to be trained again and are able to refer on to other workers. You need the whole range, but you need to start and you can do that quickly with a large body of health workers of that sort. Although I will not pursue this, there is, in addition, a great deal of evidence that the way in which health workers are trained and educated is important. That needs to be much more community-based and team-based if services are to be delivered at a local level.
In that context, I was pleased at the announcement 10 days ago by the Prime Minister and Mr Bush that they would support four African countries, including Ethiopia, in developing their health workforces. Can the noble Baroness who is to respond give us a little more information about what that will mean? There are three questions in particular. First, is this new support for increasing the number of health workers in those countries a welcome sign that a higher priority will be given by the Government to the development of health workforces in developing countries? Secondly, in supporting workforce development, will Her Majesty’s Government ensure that the evidence and the lessons that I have briefly referred to about the types of workers and the training that are needed—evidence that comes from as far afield as Brazil, Iran and Pakistan, as well as Ethiopia—are used and applied? Thirdly, will Her Majesty’s Government also ensure that there is proper evaluation and real-time learning from the scaling-up of the workforces in those countries?
In conclusion, there is evidence that a great deal more can be achieved by taking some practical steps and that this can be done if the United Kingdom gives greater priority to the development of trained health workers internationally as a central strand to all its strategies. If the UK also brings into play the extraordinary expertise, good will, experience and track record of the many British institutions that are able to support this, and if it uses its leverage, it can encourage others to do the same.
12.34 pm
Baroness Young of Hornsey: My Lords, I, too, am grateful to my noble friend Lord Sandwich for initiating this debate on this most pressing subject. I shall try to rise to his challenge of doing a little bit of positive thinking. Many of us from the African diaspora who live here experience a complex range of emotions in relation to Africa. Joy, sorrow, fear, pride and hope jostle for ascendancy as we watch news bulletins that appear to be able to tell us only of conflict, disease, poverty and corruption. This narrative is pernicious and distorts reality. Of course I am not suggesting that the continent does not face huge problems in these areas, but I and others object to the impression that people here are left with: that Africa is solely a continent of failed states with people who can only hold out
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I am grateful to Onyekachi Wambu of AFFORD, an organisation that supports African diaspora entrepreneurs to create and sustain economic development in Africa, for a briefing on some of the areas that I shall outline. The UN Economic Commission for Africa says that every year 8 million new people come on to the job market in sub-Saharan Africa. There is a clear need for a far greater focus on job creation that leads to self-sufficiency. This requires substantive shifts in policy and practice. In particular, it requires recognition that Africans and the African diaspora can harness their intellectual, financial and political capital to support entrepreneurship and to create and sustain jobs in a variety of sectors.
It is my belief that, across the continent, the creative talent that exists is huge and largely untapped. I also believe that supporting the systematic development of the creative and cultural industries can contribute to addressing the majority, if not all, of the millennium development goals. This is particularly the case with visual culture—fine art, carving, sculpture and film. According to the Daily Telegraph, nearly half of the 10 greatest sculptors of wood in the world come from Zimbabwe. Last year, I travelled to Maputo in Mozambique. I was immediately struck by the wealth of visual art in the streets and the markets—virtually everywhere. The artists and craft workers were poor people, often using found materials, working as a collective, trying to entice tentative tourists to buy beautifully crafted material at, what were for us, very reasonable prices.
Investment in the infrastructure and resources to enable creative expression that goes beyond producing clichéd work for the tourist market are sorely needed. Opening up markets for artists and creative workers across Africa and, importantly, in Europe and the USA could not only eventually make a vital contribution to economies but help to dispel myths about the lack of African achievement and about so-called “primitive” cultural traditions that have never engaged with modernity.
Consider this. A bright, intelligent student at a local school was surprised to learn that Africa was a continent, not a country, and was shocked to learn that there were cars in Africa. Imagine the impact of that lack of knowledge on the ways in which people here view African peoples. Conversely, think of the sense of pride and achievement that could come from global promotion of the diverse, vibrant artistic expression of sub-Saharan African people.
I draw the attention of your Lordships’ House to Nollywood. For those unfamiliar with that term, let me explain that it is a play on the word “Hollywood” in a similar vein to Bollywood. Nollywood is straight out of Nigeria and looks set to replicate some of the extraordinary cultural and economic success enjoyed by Bollywood. Since its birth in the early 1990s, Nollywood has generated $200 million in revenue and, with 350,000 people employed in the sector, it is one of the top
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As well as contributing to economic growth, fostering community and national pride and emancipating the human spirit, the arts can play a significant role in getting messages across to populations with varying levels of literacy and educational facilities. I have met people working in theatre in Kenya who spread knowledge about, and diminish the stigma of, HIV and AIDS through plays and workshops devised for rural and urban communities. I also draw attention to projects such as “Throne of Weapons”, an artwork made of weapons submitted after an arms amnesty in Angola, which not only produced a stunning art object but provoked vigorous debate and conveyed the need to avoid violent conflict in southern Africa. There are many other examples of good practice, which I hope will attract investment and support.
Earlier, I mentioned AFFORD. This UK-based organisation aims to maximise the potential of the millions of pounds-worth of remittances that flow into impoverished households in the developing world from diaspora peoples in the UK. AFFORD is proposing that the Treasury support its scheme RemitAid, an initiative that focuses on practical ways of optimising the benefits and mitigating the negative impacts of remittances through a genuine partnership between African diaspora peoples and the public and private sectors. The idea is that tax relief would be claimed on the charitable remittances sent from the UK to developing countries by UK taxpayers through formal money transfer channels regulated by HMRC. The scheme would be similar to existing tax incentives such as Gift Aid. AFFORD is proposing that the Treasury work with it to devise a workable, secure scheme. I urge the Minister to see whether there is a way of making progress on this important project.
Of course, none of us thinks that remittances or the arts and creative industries on their own will solve Africa’s problems, but each can make a significant contribution and, importantly, help to dispel an assumption of dependency on donor countries. They can help to recognise the agency of Africans and their diaspora and move us towards fulfilling the promise of the continent that is the birthplace of humanity.
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