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1.35 pm
Baroness Rawlings: My Lords, a brief glance at the news wires would make anyone think that the outlook is bleak. I quote:
Those are all headlines for articles that discuss our progress towards meeting the millennium development goals. A key theme in all those articles seems to be that of time—how there is not going to be enough. Thus, as we head into the second half of the period set aside to reach the millennium development goals, it is with pleasure that I, too, thank the noble Earl, Lord Sandwich, for moving this important debate. I totally agree with him in his opening May quotation, “To think positively”, also mentioned by the noble Baroness, Lady Young.
Now is indeed the time to re-evaluate our progress and to set out as clearly as possible what needs to be done to reach those most laudable goals. The millennium summit in September 2000 was a watershed moment for global development. For a decade, agreements and resolutions were made that culminated in the United Nations firmly committing itself to working towards sustaining development and eliminating poverty. The millennium development goals were the result of that summit; they were clear objectives that promised real improvements. Now, more than half way to the target of the year 2015, we are faced with the woeful fact that we may not be able to deliver on our commitments. The importance of that cannot be overestimated. It would be a double cruelty to have provided such a ray of hope to the world's neediest only to have it dashed through mismanagement.
There has been some progress, boosted by the economic progress in China and India. My noble friend Lady Verma highlighted so clearly the big problems that still face people in India—gender discrimination, health and education—and our responsibility. DfID has committed £252 million to reduce maternal and infant mortality in India.
The UN noted that the proportion of people living on less than a dollar a day had fallen from 23.4 per cent in 1999 to 19.2 per cent. It reported that, overall, the world was on track to hit the 15.8 per cent target for 2015. The noble Lord, Lord Joffe, spoke about DfID’s aid budget. I noted that there is a new DfID programme of £27 million for education in China for more than 5 million disadvantaged children.
Those statistics betray a troubling fact about our progress. As the noble Lord, Lord Jay—I commend his work with the Merlin charity—mentioned, it has not been evenly achieved. Although the world target for poverty might be within our grasp, the UN admitted that the benchmark proportion of 23.4 per cent living on less than a dollar a day in Africa will not be met through current efforts, as the noble Baroness, Lady Northover, said.
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The goal of universal primary education is similarly unbalanced: 30 per cent of the children in sub-Saharan Africa and 12 per cent globally are out of school. Ninety per cent of all child deaths occur in only 42 countries, 39 of which are in sub-Saharan Africa. The amount of aid sent to sub-Saharan Africa is considerable. Yet in terms of progress, it is still lagging far behind. How does the Minister plan to address this? What plans does she have to target this region more effectively and to make certain that the focus is on outputs, not inputs?
According to the UN, the status quo commitment would mean that the target of halving the proportion of underweight children will be missed by 30 million children. Does the Minister have a plan to get us back on target? This issue is particularly poignant in the current economic climate. This year, the price of grain and rice commodities has increased by 40 per cent, which has largely been attributed to changing uses of land and to maladministration. The concern now seems to be not only about making progress, but also about the ability to afford even maintaining current levels. What conversations has the Minister had with the Treasury on the impact of current economic difficulties on the effectiveness of foreign aid? Could she outline ways in which strategies have changed to take into account the increased price in providing food aid?
Of all the millennium goals, those focused on healthcare seemed to be the least likely to be met. For this reason, the UK-led International Health Partnership was launched on 5 September 2007 to address the insufficient progress. What has been its effect? Can the Minister point to any specific impacts that the partnership has had to date, particularly on the shortage of health workers, about which the noble Lord, Lord Crisp, asked a very good question? In particular, what is being done to address the spread of HIV/AIDS? The UN report cites that by the end of 2006, an estimated 39.5 million people worldwide were living with HIV, up from 32.9 million in 2001. That is to say that in five years the increase in the number of people suffering from HIV is greater than the entire population of Switzerland. The number of people dying from AIDS has also increased, up to 2.9 million in 2006. The UN cites the use of non-sterile injecting drug equipment as the primary means of transmission. These are very sad facts indeed.
The Conservative Party has committed itself to increasing international aid, working towards achieving the UN’s target of spending 0.7 percent of national income on aid by 2013. Yet we must be ever mindful of the trap that this Government seem to be almost too keen to fall into—throwing money at problems and ignoring the results. This is why my honourable friend Andrew Mitchell in another place proposed to establish an independent aid watchdog to provide impartial and objective analysis, as I said in a Question to the Minister on 24 April,
As well as being independently reviewed, aid must be transparent, which is why we propose publishing the
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I could recite more proposals—there is, as the right reverend Prelate the Bishop of Winchester stressed, the basic problem of conflict, and, as the noble Baroness, Lady D’Souza, said in her challenging speech on the impact of development programmes, the question of how to deal with wrong aid—because they all stem from a similar position; namely, that aid needs a rethink. The noble Lord, Lord Hannay, emphasised the importance of getting back on track to meet the goals that begin with progress towards better governance in the affected countries. Aid needs to be scrutinised, focused on outputs and directly linked to empowering the poor.
We feel that we can meet these goals, but it will take an aid overhaul. Spending should be untied. That is the first step. It should be linked, too, to genuine progress on the ground that is verified by independently audited evidence. Essentially, we must make certain that the money that is being spent is being well spent and that the aid we provide is making a real difference and having a positive impact.
1.45 pm
Baroness Crawley: My Lords, this debate has been, as I knew it would be, a potent mixture of measured, moving analysis and urgent advocacy by a group of noble Lords who have said with one experienced voice that there is no time to lose, that this is no time for business as usual and that getting the millennium development goals back on track must be the top priority for 2008. I could not agree more. I thank noble Lords for their positive support for the work of DfID.
I thank the noble Earl, Lord Sandwich, for initiating this extremely important debate and I thank noble Lords for their thoughtful and expert contributions. The millennium development goals were agreed by 189 countries with the aim of securing more prosperous, healthier and environmentally secure lives for millions of women, men and children by 2015. At this half-way stage, it is indeed timely to take stock of what progress has been made in meeting these problems and promises. The plea made by the noble Baroness, Lady Young of Hornsey, for recognition of the creativity in developing countries reminds us that we must always celebrate progress.
I begin by briefly reviewing where the world stands in meeting these promises. We are on track to meet the first MDG target to halve the proportion of people living on less than $1 a day. However, this global progress hides serious regional differences, as the right reverend Prelate the Bishop of Winchester, the noble Baroness, Lady Rawlings, and several other noble Lords said. Strong growth in Asia is not matched by similar progress in Africa. Despite improved growth in many African countries, regional levels are not yet sufficient to sustain an expanding population above the poverty line.
We face real challenges in reaching the second target, which is on reducing hunger. Improvements in east Asia, in Latin America and in the Caribbean are
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The Prime Minister has recently written to other world leaders, calling for co-ordinated responses to addressing this problem. DfID itself has pledged an extra £30 million to support the World Food Programme’s work. The noble Lord, Lord Hannay, with all his experience, quite rightly said that this is the hot issue of the time. It is. As I said, we are giving an extra £30 million of support to some of the countries that are most affected by food-price inflation, including Zimbabwe, Somalia and Kenya. We will also take increased food prices into account when responding to humanitarian crises. In the longer term, DfID is investing £400 million over five years for agricultural research to increase yields and to make crops more robust.
The second MDG focuses on education. More children now have the opportunity that school provides—opportunity that is essential to individual prosperity and national economic growth. Since 2000, 26 million more children are now in school in Ethiopia and Bangladesh alone. That is progress. Despite such successes, however, as the noble Baronesses, Lady Rawlings and Lady Northover, said, 72 million children do not finish primary school. In answer, DfID has committed to provide £8.5 billion for education in poor countries in the 10 years to 2015, with spending set to rise to £1 billion a year by 2010.
Reaching the education target is also essential to meeting MDG 3, which is on gender inequality. The UK is committed to ensuring that girls and boys have equal access to the opportunities that education provides. We also want to see the rights of women integrated into the national plans of developing country partners and we are working to that end. My noble friend Lady Prosser, the noble Baroness, Lady Verma, and many noble Lords have said that there must be a stouter advocacy of women’s rights. In their description of women’s powerlessness, we reaffirm our commitment to poor women around the world.
Good health is a basic need; it is necessary for and improves with economic development. Many noble Lords, including the noble Lords, Lord Jay and Lord Chidgey, and the noble Baroness, Lady Northover, have taken particular interest in health today. It is here where progress has sometimes, as we know, been slowest. On MDG 4, by 2006 child mortality had declined by 20 per cent from 1990 levels, which is progress. But, as the noble Baroness, Lady Verma, so clearly stated, and as the noble Lord, Lord Chidgey, mentioned, the goal of reducing the number of deaths of under-fives by two-thirds will not be reached. At this rate, it will not be reached until 2045, when most of us will be long gone. However, we have many of the tools needed to do this. Improved sanitation, better maternal health and progress in preventing and treating major diseases would get us back on track. Rapid improvements in
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I turn now to MDG 5, which relates to maternal and reproductive health. One woman a minute dies avoidably during pregnancy or childbirth. Many more suffer disastrous long-term health problems. Progress on MDG 5 has been particularly slow, as the noble Lord, Lord Patel, pointed out in his moving and effective contribution. Stronger health systems and more accessible services are needed, a point to which I shall return. MDG 5 also calls for universal access to reproductive health. It recognises that women and men should have the ability to make their own decisions about the size and timing of their lives and their families. In 22 African countries, less then 10 per cent of women are using modern contraceptive methods. The UK has been a strong international advocate for sexual and reproductive health services and last year provided £100 million to UNFPA, the United Nations Population Fund. I thank the noble Viscount, Lord Craigavon, for his recognition of that work.
MDG 6 aims to tackle the devastation caused by HIV, TB and malaria by reversing the spread of these diseases. Although progress is lagging in all three areas, there are also signs of hope. More than 2 million people are now receiving access to lifesaving HIV treatments, while countries such as Uganda, Thailand and Senegal show that effective prevention can work. Later this month, and building on evidence of what works—again, this has been said by noble Lords, in particular by the noble Baroness, Lady D’Souza—the Secretary of State will launch a strategy that will confirm the UK’s global leadership on HIV and AIDS.
Progress on HIV is also essential to make progress on TB. Improvements in Asia and Latin America have been undermined by increasing rates of co-infection with TB in sub-Saharan Africa. That is why DfID has invested in promising efforts to develop new TB drugs that will be easier to take and will work if current medicines become ineffective.
Malaria is the third target for MDG 6. Today, 1 million people die each year from malaria—mostly pregnant women and children and, again, overwhelmingly in Africa. Sleeping under insecticide-treated nets can prevent infection, and effective treatment exists. Earlier this month, the Prime Minister announced that the UK would provide 20 million insecticide-treated nets over the next three years.
Across all these diseases, the UK has led the way in making donor funding more predictable. Noble Lords have talked about, and the noble Baroness, Lady Northover, challenged me to talk about, the future. Funding has to be about more predictability for our partners. DfID has made an unprecedented long-term commitment to the Global Fund to Fight AIDS, Tuberculosis and Malaria of up to £1 billion through to 2015.
As well as disease-specific action, it is vital that the basic building blocks to provide health services are put in place. As the noble Lord, Lord Crisp, highlighted—we congratulate him on his important work on this—sufficient
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We also have to address the specific needs of health workers. The Prime Minister and President Bush announced in Washington this month that DfID and PEPFAR—the President’s Emergency Plan for AIDS Relief—will work together to improve health and to strengthen the health workforce in Ethiopia, Kenya, Mozambique and Zambia.
MDG 7 relates to sustainable environment, water and sanitation. We are all becoming aware of the vital importance of protecting and sustaining the environments in which we live. This means tackling climate change and environmental degradation, increasing access to clean water and sanitation, and managing the impact of rapid urbanisation. Only progress on access to better sources of water is on track. However, as my noble friend Lord Patel of Bradford said, we cannot be complacent. We must put all these back on track.
The right reverend Prelate the Bishop of Southwell and Nottingham will welcome the fact, as I hope will my noble friend Lord Joffe, that my right honourable friend the Secretary of State has made climate change and the need for sustainable growth top priorities for DfID. These will guide the UK’s work across all other MDGs. In March 2007, the Prime Minister launched a new £800 million environment transformation fund to support developing countries in meeting the challenges of climate change and sustaining environments.
So what more can be done? What more must be done? I have given an overview of the progress of seven of the eight MDGs. There are signs of hope, but we recognise that the world is at serious risk of breaking its promises. The eighth MDG provides a key to how we can turn the situation around. It calls for a global partnership for development. This means the Governments of rich countries meeting their commitments on international aid and being transparent about how they monitor and are accountable for that aid, as the noble Baroness, Lady D’Souza, emphatically stated. It means the Governments of developing countries and international institutions being more open and responsible for their own actions and it means that poor countries must be able to trade fairly with those that are economically more powerful.
In September 2007, the Prime Minister and the Secretary-General of the United Nations reaffirmed that we can achieve the MDGs, but only if Governments, business, faith groups and community organisations have the will to do so and the willingness to work together. The MDG call to action was launched and today more than 20 countries, representing half the world’s population, have pledged to join. The call focuses on four broad areas: the need to do more to
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Next week, representatives of the biggest companies in the world are meeting in London to join the business call to action. Civil society has a crucial role to play, as my noble friend Lord Graham of Edmonton said when he spoke of the co-operative movement. Non-governmental organisations and faith groups can and do hold Governments to account for the promises that they make, and Governments must live up to their part, as the noble Baroness, Lady Northover, stated so strongly and as the right reverend Prelate the Bishop of Winchester made clear in his moving comments about the conflict in the Democratic Republic of Congo. At the G8 summit in July, Japan will re-emphasise the importance of the MDGs in focusing development efforts.
Several noble Lords asked me specific questions. I will do my best to rattle through as many as I can and I shall write to those noble Lords whose questions I have not reached before my time to speak is up. The noble Earl, Lord Sandwich, asked about the further research needed into the role of UN agencies in diverting in-country staff away from local health and other services. We agree that this is an important issue, which should be looked at in the broader context of push-and-pull factors that cause health workers to leave the public sector and/or to seek jobs overseas. DfID has committed £1 million to the Global Health Workforce Alliance, subject to performance, to support co-ordinated research, advocacy and action on addressing the human resource challenge.
The noble Earl also asked in detail about traditional birth attendants. I would say to him that such attendants are important in providing culturally sensitive care, but they often work in basic conditions, have no training in complicated deliveries and have little access to referral. DfID’s approach is to support increased access to skilled birth attendants and to encourage a healthy delivery in a safe facility. DfID is also supporting Governments to enable traditional birth attendants to accompany women in labour to the facility.
The noble Earl and the noble Lord, Lord Joffe, asked what we are doing on mental health and why it is the silent subject, as it were, in our debates. DfID supports research into understanding the impact of mental health issues in developing countries. This includes a five-year research programme in Ghana, South Africa, Uganda and Zambia. DfID is also providing money from the Civil Society Challenge Fund to support work on mental health and development. Our research into mental health is part of scoping work looking at what issues will need to be addressed beyond 2015. This also includes recognising the growing impact of other non-communicable diseases.
My noble friend Lady Prosser asked what DfID is doing to support UNSCR 1325 on women and peace-building. Her Majesty’s Government are a strong supporter of this resolution and DfID is supporting
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The noble Lord, Lord Chidgey, asked about our response to the European Commission’s package, which was launched on 10 April. I say to him that the papers underline the need for member states to redouble their efforts to meet the MDGs. The UK is working with other member states in supporting the Commission’s efforts to reinvigorate the drive towards the MDGs in line with the call to action launched by Gordon Brown in July 2007.
The noble Lords, Lord Jay and Lord Hannay, asked whether progress has been made in the UN on making good on its responsibility to protect. In February, the UN Secretary-General appointed Ed Luck as the special adviser tasked with working in this field. The Secretary-General will report to UN member states later this year on institutionalising the responsibility to protect within the UN. The responsibility has not been applied to broader areas such as health and, as the noble Lord, Lord Jay, indicated in his remarks, agreement on the whole concept is fragile. We feel that attempting to broaden it to cover health or climate change may risk undermining the consensus achieved at the summit. I shall write to noble Lords in more detail on this point.
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