AIDS (Africa)

Part of the debate – in Westminster Hall at 12:00 am on 23 June 2004.

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Photo of Hugh Bayley Hugh Bayley NATO Parliamentary Assembly UK Delegation 12:00, 23 June 2004

Several colleagues on both sides of the House and I made applications for this debate to enable the House to discuss the findings of the Africa all-party group's report on AIDS, which was published two weeks ago. We are grateful that Mr. Speaker saw fit to call a one-and-a-half hour debate on this important subject so soon after the publication of our report. We also sought this debate so that we could press the Government to implement our recommendations. I say "the Government" and not just "the Minister" advisedly, because we have made recommendations for Secretaries of State in several Departments.

I wish to thank colleagues on both sides of the House for their contributions to the report, particularly to the oral evidence-gathering sessions that we held to collect views on the subject. I also wish to thank the all-party AIDS group, which gave a great deal of support and advice to our relatively younger, more recently formed group. I wish to thank those who submitted evidence to our group, and Penny Jackson, the administrator of our group, who did a tremendous job of analysing the evidence, preparing drafts of the report and dealing with dozens of redrafts from members of the group, many of which were mutually inconsistent and contradictory.

As the chairman of the group, I should declare as interests the money that we received to enable us to produce the report, from the Royal African Society, the Henry J. Kaiser Family Foundation, Merck and Co. Inc., the Catholic Fund for Overseas Development and ActionAid. I would also like to thank officials of the Department for International Development for providing informal briefing to our all-party group and for drafting formal evidence, which was submitted to us, and my right hon. Friend the Secretary of State for International Development, who gave a great deal of time at the oral evidence session at which he appeared.

The UK Government have significantly increased the priority given to fighting AIDS in Africa. That is made clear by their "Call for Action" document, which was published on world AIDS day last year. DFID is currently in the process of reviewing its policy on HIV/AIDS. Since 1997, the Government have almost doubled aid to Africa. They have increased funding for HIV/AIDS work from £38 million, which it was in 1997, to £270 million a year, and committed more than $280 million over an eight-year period to the global fund to fight AIDS, tuberculosis and malaria, which makes the UK the world's second-biggest donor in this field. Our Government have also led the donor community in supporting the UNAIDS Three Ones proposal: each country affected by the HIV/AIDS pandemic should have one national strategy for combating the disease, one national AIDS commission to oversee that work and one way to monitor and report progress in the fight against the disease. So much has been done by our Government, but the report's key finding is that much more still needs to be done.

The AIDS pandemic in Africa is an exceptional humanitarian crisis. At present, more than 25 million people, perhaps even as many as 28 million, in Africa are infected by the disease; 70 per cent. of those in the world who have HIV infection are in Africa, and there are now 11 million to 13 million orphans—children who have lost one or both parents to the disease—in Africa.

In 2002, there were seven countries with an HIV prevalence rate of more than 30 per cent. for those aged 15 to 49. In nearly every African country the situation is getting worse, and the long-term social and economic effects will get worse still. Richard Feachem, director of the global fund who gave oral evidence to the all-party group, described the HIV/AIDS pandemic as the worst disaster in human history—worse than the black death, which halved the population of this country in the 14th century and affected people across Europe.

It is a disaster that to a significant extent could have been avoided if African and donor Governments had acted sooner, and the disaster is still accelerating. How much worse it will get depends on how soon and how effectively African Governments, donor countries and the private sector respond to the disaster. However, there is still a window of opportunity to mitigate some of the effects and to develop coping strategies to deal with the consequences of a pandemic—the rapidly increasing number of orphans in Africa, for example. But as the months and years go by, the opportunities to cope and to mitigate will reduce. We therefore urgently recommend that the Government provide additional support and take further action in the matter. This is an exceptional crisis, which requires an exceptional response from the donor community.

The report makes several key recommendations: first, that the UK aid budget should be increased. The Government already support the target to devote 0.7 per cent. of our gross national income to official development assistance, and we now ask them to set a timetable for reaching that target.

Secondly, we ask the Government to launch their proposed international finance facility, which is a means to the end of achieving the goal of higher spending on development assistance; thirdly, we ask the Government to increase the financial support that they provide for AIDS programmes; and, lastly, we ask them to raise with the European Commission the possibility of diverting the €10 billion in the European development fund that is currently unspent to an emergency package of relief for those with AIDS.

We recommend also that our Government, other donors and African Governments support the full range of health responses to the pandemic: for example, improved nutrition, because food is the first line of defence against disease; more resources devoted to prevention services and to voluntary counselling and testing; more resources for treating opportunist infections affecting people of HIV-positive status and more funding for drug therapies to prolong the lives of those who are HIV-positive.

We come, however, to the conclusion that prevention is the most effective and cost-effective response to the pandemic. Pound for pound, money spent on prevention saves more lives than money spent in any other area. The top priority must be to ensure that resources earmarked for prevention are not diverted to other interventions. We must provide the full range of treatments, but we will need additional resources to do so.

The costs facing health systems in developing countries threaten to overwhelm them. Where there is insufficient money to do everything that ought to be done, choices must be made about where the priorities lie. Those choices must be open and transparent. They must be made at a national level in Africa and based on the principles of equity—people with equal needs should be treated equally—effectiveness, and cost effectiveness, so that the maximum number of lives are saved. They also need to be open to public debate. They should not be taken by officials or Ministers in private rooms in the capital; the people directly affected must have a say in the priorities.

Few developing countries have experience of setting explicit health priorities or of having public debate about public policy issues in general. They will need technical assistance to do so. I suggest to the Minister that the Department for International Development should commission specialists—medical ethicists and health economists—to prepare a tool kit on health priority setting for developing countries. That proposal was supported by the National Audit Office, which has recently published its own assessment on the Government's work on responding to HIV and AIDS. In paragraph 22 of its report, the NAO says that DFID should

"update . . . its strategy to provide . . . supporting guidance and advice for country teams on key operational issues such as treatment".

The all-party group also felt that the Government need to address the high death rates of teachers, nurses and other key workers, such as lawyers, economists and Government administrators. If professionals dying from the disease are not replaced, there is no possibility whatsoever of sub-Saharan Africa achieving the millennium development goals by 2015. The problem with replacing those people as they die is that the colleges training teachers and nurses are also losing members of staff at an alarming rate to the disease.

The United Kingdom is particularly well placed to support and help African countries to respond to the challenge of replacing professionals dying from the disease. The UK has a wealth of experience in post-school distance learning, which has been gained from the Open university. I have had discussions with the professor of education at the Open university, the BBC World Service and programme makers, who have put together distance-learning packages. Those discussions have led me to the conclusion that distance learning is a realistic practical response that can be made to work in partnership with educational institutions in Africa. Indeed, the Open university already works in partnership with the Open university of Tanzania, which it helped to create, and a university in South Africa which provides distance-learning packages for teachers. In addition, the Open university UK provides courses in Ethiopia.

The Department for Education and Skills should seriously consider devoting resources and providing support to the Open university to expand the work done in that area. The reason for highlighting the DFES is that DFID rightly prioritises primary education. It is the DFES that has the reservoir of knowledge and experience of using the television and radio—infrastructure that generally works well in Africa, especially in urban areas—to help replace the numbers of teachers and other professionals being lost.

The NAO also offers support to this proposal. In appendix 2 of its report, it says that the UK Government should ask:

"Does the country have the capacity to deal with the results of AIDS attrition of key public sector workers (such as health and education sector workers)?"

It is right to draw the matter to our attention, but the same must be done in relation to skills employed in the private sector. The millennium development goals will not be met by aid alone. Our markets must be opened to trade from Africa, and the private sector will provide the economic growth that comes from trade.

In our report, we also stressed the need for social rescue packages in Africa to care for the increasing numbers of AIDS orphans. I know that my hon. Friend Ms Keeble will be speaking about that later in the debate, if she catches your eye, Mr. Deputy Speaker. At present, most AIDS orphans in Africa are cared for by their grandparents, but the current generation of AIDS orphans will also have children. We know that in Botswana, the likelihood of a young man in his late teens getting HIV and dying from AIDS later in life is 90 per cent. So 90 per cent. of the AIDS orphans in Botswana who have children will themselves die from AIDS. The question that we must face is that when they die, by definition—because they are orphans—their children will not have grandparents. So who will care for that second generation of AIDS orphans?

It is not a crisis that can be solved by the public sector alone. The private sector must provide prevention services and care to their employees in Africa and their families. Some companies have already taken a lead on that, and have created models of good practice. We call on the Department of Trade and Industry in the UK to work with those British companies that have created examples of good practice to spread that practice through the UK-based business sector that is working in Africa.

We should like to see coherent and co-ordinated policies throughout all Departments in the UK Government. We think that DFID should be the lead Department, but others Departments, such as the Foreign Office, the Ministry of Defence, the DTI, the Department of Health, the DFES, the Home Office and even the Department for Constitutional Affairs and DEFRA need policies on HIV/AIDS too. Can the Minister let us know what mechanisms are in place to ensure appropriate cross-government co-ordination of policy?

When the all-party Africa group was formed, its members hoped that we would not simply be a study group, but that we would create a team of parliamentary activists who would talk up the Prime Minister's and the Government's commitment to Africa, and also help to drive Africa's needs up the political agenda in both Houses of Parliament at Westminster, and in other institutions, such as those of the European Union. Following the publication of this report, we have already met the International Monetary Fund. We met Peter Heller, the deputy director of its fiscal affairs department, yesterday to discuss the concern that was expressed to us by Dr. Peter Piot from UNAIDS, that Uganda was unable to make use of all the money that was offered to it by donor organisations to address the AIDS crisis, because it would have taken the spending in its Department of Health above the expenditure ceiling set by the IMF. There is a real problem here, although I am happy to say that the IMF is seeking to resolve it.

On Monday next week, the IMF will meet the main agencies—the World Health Organisation, the global health fund, UNAIDS, USAID and DFID—in Washington DC to work out how to resolve the contradiction between the need to increase resources for health spending as an emergency measure to combat AIDS and the untoward macro-economic pressures that might result from a large increase in public spending. The answer must be to find a way of reducing these pressures, and not to cut health spending to do so.

Interestingly, a key way to reduce the inflationary pressures that a large increase in public expenditure would create in those countries would be to train more nurses, barefoot doctors—if I may describe them so—and public servants. There would then be less inflationary pressure on wages. An Open university-inspired distance-learning package may be a way to address the macro-economic pressures that the IMF identifies.

On Tuesday next week, I will meet IMF representatives in Washington DC when I am in the chair of the NATO Parliamentary Assembly's economics committee. I have invited Mr. Heller to meet the committee to give us feedback from the meeting with the aid agencies on Monday. We will also meet the managing director of the IMF, Rodrigo Rato, to discuss the problem with him.

In passing, I should say that the NATO Parliamentary Assembly committee delegation to the United States includes Members of Parliament from 10 EU states, including an ex-Prime Minister of Italy, Lamberto Dini, and the ex-Deputy Prime Minister of Finland, Suvi-Anne Siimes.

The Africa all-party group will seek meetings with the Secretaries of State of four key Government Departments: DFID, the DFES, the DTI and the Department of Health. When the post-election settling-in period has passed, we will seek meetings with Members of the new European Parliament and the new European Commissioner for Development and Humanitarian Aid.

Finally, I congratulate the Minister on what his Department has achieved so far, which has been a step change in our Government's response to the AIDS crisis in Africa. However, a further step change is needed. Far more help is needed if we are to find a decent, human response to the worst humanitarian crisis in human history.