Examination of Witnesses (Questions 474
- 479)
MONDAY 31 MARCH 2008
Dr Sylvia Meek, Mr Alastair Burtt, Mr Paul Sommerfeld
and Ms Tina Harrison
Q474 Chairman:
Can I welcome you all? Our focus is on intergovernmental organisations,
the effectiveness of them and how that can be improved. Your comments
are being recorded. The transcript will be sent to you for any
factual corrections. Again, if you want to add anything that occurs
to you after this session, please feel free to do so. The first
question is about the fragmentation and confusion that is alleged
to be the case in intergovernmental organisations dealing with
these infectious diseases and whether there needs to be some rationalisation
of those organisations, whether they are overlapping, competing
or contradictory in some way, or whether it is working quite effectively.
Within that question there is also the obvious one of the leadership
of the WHO.
Mr Sommerfeld: Talking from the perspective
of tuberculosis, we would say that there is no particular problem
of fragmentation. We clearly deal with the World Health Organisation
and its adjunct partners, Stop TB Partnership, as the lead agencies
at an international level for talking about tuberculosis matters.
We are well aware of other players—the Global Fund, the
World Bank, UNITAID, UNAIDS and so on—but that is the way
the world is. We are not perceiving any big, terrible, territorial
battles between any of these that are causing difficulties to
us.
Q475 Chairman:
Or overlapping?
Mr Sommerfeld: Or even serious overlapping.
Every now and again there are some boundary issues but they are
not particularly significant or major ones. It is more that we
perceive the WHO as the centre of this little world and we are
well aware of some of the other players. We deal with them and
occasionally find ourselves having to deal with small boundary
questions between them. There sometimes are issues because the
Global Fund has slightly different criteria about the ways in
which it wants to behave or to give out grants which do not quite
tally with the way that we are running things like the Global
Drug Facility, but these are not major, fundamental problems.
Dr Meek: Looking at the malaria side, in the
past there have been major problems perhaps of a certain amount
of competition between intergovernmental organisations. The problem
is diminishing, partly as a result of efforts by all the organisations
and NGOs and others to work through the Roll Back Malaria Partnership
which, although it has had its ups and downs, has helped the different
organisations to think through their roles more clearly. Although
the WHO is clearly the technical lead organisation in controlling
malaria, the control of malaria has required a lot of interventions
which are not technical, much more related to delivery. For instance,
bringing in the private sector, a lot of issues related to other
sectors which perhaps the World Bank has a comparative advantage
in. It is a problem that is getting under control better than
in the past.
Q476 Chairman:
Do you see the World Health Organisation as being an effective
leader, or not?
Dr Meek: It varies from time to time, depending
on individual personnel within different parts of the organisation.
I used to work for them for several years. That is its role and
it has some very strong parts and some less strong parts. It was
in a certain amount of competition with the Partnership about
two or three years ago but I think people have moved on from that,
so its leadership is getting clearer. There are one or two areas
where perhaps they need a bit more technical strength and they
have set up groups to advise them.
Q477 Chairman:
Mr Burtt, you speak for Target TB. Do you have a different view
to those just expressed?
Mr Burtt: No. I would say we agree, not least
because we managed a word about it beforehand. The messages that
we give and that intergovernmental organisations give are the
same. We do not find ourselves saying things that contradict each
other, which perhaps is an indication of the coordination between
the different organisations. They do work well together, in our
opinion.
Mr Sommerfeld: Dr Meek raised the importance
of these partnerships. In the TB world it is called the Stop TB
Partnership. Roll Back Malaria and equivalent bodies are very
effective, informal groups through which a lot of collaboration
and coordination take place. I am here because I am Chair of TB
Alert but for the past two years I have also been Chair of the
Advocacy and Communication Working Group of the Stop TB Partnership
and so I sit on its Coordinating Board, where many of the other
players are represented. Once every six months we all sit down
together and the leading lights of the world hear all the same
papers, reflect on them and a lot of informal collaboration just
simply happens.
Q478 Lord Hannay of Chiswick:
All the questions have been answered so far from the point of
view of donor organisations or donor governments or donor international
organisations. Could you perhaps answer the question from the
point of view of a small, developing country which finds itself
in the presence of an extraordinary multiplicity of organisations,
all doing different variants of the same thing? To what extent
are you as confident as you are about donor coordination about
the ability of a not necessarily very strong developing country
to cope with this multiplicity? To what extent, if they cannot
cope, are they liable then to become very easy to manipulate by
whatever donor's consensus there is?
Dr Meek: It is a useful perspective. There is
an issue in some countries. A lot of it boils down to how much
money different technical organisations bring to the table. In
countries where people are not getting enough to pay a living
wage, clearly they have to prioritise the use of their own time,
so that does become quite an issue. There are efforts in most
countries to try to have some mechanisms of coordination among
the different technical agencies. They work quite well in some
countries. In others they do not. We do sometimes see examples
of conflicting advice being given to countries. The malaria world
is trying its best to move to a much more harmonised way of working.
Through Roll Back Malaria, they have set up a harmonisation working
group at international level. At regional level, which is multi-country
and groups of countries, they have networks which aim to coordinate
technical assistance. Within countries there is usually some mechanism
of coordination, but it is variable and there are examples where
it could be improved. Finance is a major part of it.
Mr Burtt: My experience is mostly of working
alongside local partner organisations. Certainly one of the principles
that we follow is that these organisations must be working within
the national TB control programme. It is true to say that in the
countries in which we are working the national TB control programmes
have perhaps sorted that out. If there are conflicts, they seem
to be higher up and we are not seeing it down at local level.
There are sometimes issues. For example, the implementation of
what is called DOTS in TB control, Directly Observed Therapies.
It is sometimes seen to be too prescriptive from the top.
What is prescribed by international organisations
is not always easy to implement at a local level so perhaps there
is not a sensitivity to local conditions.
The Committee suspended from 5.09 pm to 5.17
pm for a division in the House
Q479 Lord Howarth of Newport:
I am encouraged by what Mr Burtt has just said. You have been
painting a very rosy picture of the beauty of the coordination
between intergovernmental organisations, which does not entirely
tally with some of the evidence that we have previously heard.
Whether or not they are perfectly harmonised, there is the question
of what kind of effective coordination is achieved on the ground,
particularly among NGOs. I draw from an observation that I made
in Uganda three years ago, where there was a plethora of UN organisations
and NGOs operating up in the north of the country with devastating
incidence of malaria and particularly child mortality. If mosquito
nets are provided, they are cheap and useful and yet they would
only be provided on a pitifully inadequate scale; and yet there
were all these players, all these organisations, paddling in the
pool. What sort of coordination is that? Why is it not better
and how should it be made better?
Mr Sommerfeld: I would make a distinction between
that which is coordination between intergovernmental organisations
and—
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