My Lords, I add my congratulations and thanks to my noble friend Lord Sandwich on securing a debate that has an urgency now sadly obscured by political developments elsewhere in the world, particularly in the Middle East. As has been pointed out by other noble Lords, the Department for International Development has set crucial targets for southern Africa. The foremost of them is the reduction of poverty by half by 2015—the so-called millennium development goals which also have associated targets such as the provision of basic healthcare and universal access to primary education by the same date. They are essential to the welfare of poor people, particularly of women and children.
I will focus on the needs of women and children living in the five southern African countries of Botswana, Lesotho, Namibia, South Africa and Swaziland. I intend to ask the Minister how models of good practice funded by DfID in other developing countries may be implemented in southern Africa for improving the health of women and children.
As all noble Lords agree, the most important health problem in southern Africa, and in other countries of Africa, is HIV/AIDS. Recent ante-natal surveys of pregnant women by the UN AIDS department of the WHO revealed that between one in five and one in three South African women between the ages of 15 and 49 years—that is, those in the reproductive age range—are infected with the HIV virus. As the noble Earl, Lord Sandwich, said, some 60 million people in Africa have been infected with HIV.
This finding means that in the next 10 years some 5 to 7 million people in southern Africa will die during their prime years, leaving some 2 million orphaned children. I have gleaned this information from DfID's report on southern Africa of October 2002.
Poor people with HIV infection, eating inadequate food, lacking access to medical treatment and living in poor conditions are vulnerable to other opportunistic infections such as tuberculosis. Malaria is also endemic in southern Africa. A combination of HIV, TB and malaria kills millions of people, particularly in Africa.
Currently, 10 per cent of new HIV cases in southern Africa arise from mother to new-born baby transmission, an infection that can be reduced substantially if retroviral drugs are given to pregnant women. But these drugs are not available to many pregnant women in southern Africa. Instead, we read of advice being given—which we would give to women in western developed countries—that "If you have HIV, do not breast-feed your baby". If this kind of advice were followed in southern Africa it would almost certainly mean that the baby of an HIV-infected mother who was not breast-fed would die of diarrhoea.
Infection rates of HIV among girls between 15 and 19 years is alarmingly high. This reflects the low rate of condom use in sexual activity—yet another area of healthcare on which we need to focus.
But other hazards also cause premature deaths among pregnant women. The lack of access to ante-natal services will lead to women dying from undiagnosed high blood pressure, anaemia and difficult births that require admission to hospital.
Treatment of tuberculosis in young adults and children can save lives. A BCG vaccination is particularly helpful in preventing tuberculosis in children. Malarial infection can be mitigated by giving children anti-malarial drugs as a preventive measure, and the doses required are much smaller than those needed for treatment.
In South Africa, the majority of poor people are black Africans. Only one in four has access to health services compared to eight in 10 white people.
Although the picture of poor health I have reported is very depressing, solutions to address them are available and have proved to be life-saving in poor countries, in Uganda and in Asia. We know that women with primary education are able to keep themselves and their children in better health than uneducated women. The best example of this success is in Kerala, a southern state of India, where the majority of people are poor but have health indicators similar to those in richer countries such as Thailand. The reason is clear. A woman who is educated makes good decisions about the care of her family, of her children and, particularly, of herself. One of DfID's targets is universal access to primary education. Girls in southern Africa must be made a priority group for such education.
Access to basic healthcare is denied to three out of four black Africans. Surely this is an area of service in which DfID should encourage African governments to invest and to work in partnership with NePAD, our own Government, the European Union and voluntary organisations and charities which have a track record in the successful transfer of skills in developing countries.
In the 1980s and early 1990s, DfID's predecessor encouraged British institutions to work in partnership with governments in developing countries. I was privileged to work with my colleagues in northern India on such a scheme. I spent about 10 years going to and from this country into the five poorest and most populated states of northern India to develop and improve basic services for pregnant women and babies. This process took between three to five years in the poorest state of all, Orissa—which had a problem with overwhelming floods only four years ago—but we were able to leave Orissa with local doctors, midwives and trained birth attendants to continue running a good-standard, sustainable service for poor people.
Even if we no longer want to engage in this kind of aid, we can encourage health teams from other countries, such as Thailand, to go to southern Africa to share their skills and their system for controlling the spread of HIV/AIDS. Thailand has been particularly commended by the WHO and other agencies for its successful control of the spread of HIV/AIDS.
I was privileged to take a team of doctors, nurses and managers from northern India to Thailand in 1992 to learn how HIV/AIDS was managed in the community in a developing country. The members of the team returned to India to implement what they had learnt in another developing country. I know that they have done well and are particularly satisfied with the sustainable pattern of management of this disease. Would this pattern of partnership be helpful in southern Africa? We will not know if we do not try it out. I await with interest the Minister's answer.
Medicines are expensive but they are essential for the treatment of people with infections. If products from western countries are too costly, why not buy generic drugs manufactured in Asian countries, such as India, where there is quality control of the drugs of companies based in this country?
We are all aware that the Government have done well in the area of overseas aid, but we need to work in more imaginative ways in partnership with our African colleagues. I have been in touch with people from southern Africa who are living in the United Kingdom. They have said that they will be delighted to return to work in their former countries to assist in establishing and developing health services for mothers and children, but as British citizens.
I look forward to the Minister's response. I have not given her notice of these questions but I hope that she will be able to comment on them.