[Sandra Osborne in the Chair] — Health Systems (Developing Countries)

Part of the debate – in Westminster Hall at 2:26 pm on 11th December 2014.

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Photo of Jeremy Lefroy Jeremy Lefroy Conservative, Stafford 2:26 pm, 11th December 2014

It is a pleasure to serve under you, Mrs Osborne, and to follow Hugh Bayley, who speaks with such knowledge and passion on these matters, and my two colleagues, my right hon. Friend Sir Malcolm Bruce and my hon. Friend Fiona Bruce.

I was delighted when the Committee agreed to do a report on strengthening health systems, because the subject is not one that commands a great deal of attention. The report does not look at a particular country or disease, but instead seems more to do with bureaucracy than anything else, although that is not at all the case. As our report states, health systems are fundamental to the improvement of outcomes and self-sufficiency in health services in developing countries.

I hope that one of the sustainable development goals next year will be universal health coverage, which is impossible without strong health systems. Strong health systems are in place not only to provide better outcomes for life or to prevent morbidity and mortality, however important those things are, but to alleviate poverty, which is a direct responsibility of DFID. Strong health systems are also in place to increase fairness: if everyone has access to a health system, life chances are immeasurably improved. People who go to school and have worms are much less likely to be able to concentrate. If people have blinding trachoma, the consequences are obvious for their life chances. In so many other cases, disease brings not only disability—which we will discuss in the next debate—but an inability for people to fulfil their human potential. That is why health systems are so important to international development. In the Ebola tragedy in Sierra Leone, Liberia and Guinea, we have of course seen the consequences of weak health systems, to which my colleagues have already referred.

In this country, we have a unique thing to offer in the strengthening of health systems, which is our national health service. For all the brickbats sometimes thrown at the NHS—in my constituency we have had our difficulties, but I am glad to say that we are working through and overcoming them with the tremendous support of local staff and of the NHS as a whole—it gives us a system that is efficient, and acknowledged as such, and effective. It has its faults and failings, but it is not only chance that caused the Commonwealth Fund to put the NHS at the top of the league in an august company of health systems.

We have heard a little about the so-called problem of vertical as against horizontal programming in systems. I want to dwell on that a little. One of the things that people in our inquiry referred to was the great emphasis over the past 14 or 15 years, since 2000, on vertical programming, or disease-specific programming. The Global Fund to Fight AIDS, Tuberculosis and Malaria,

Gavi and other programmes have all been successful, but there is always the risk that they will focus entirely or mainly on the disease without looking at how they can strengthen the health system within the country, which would bring far wider benefits than simply the elimination or reduction in prevalence of that disease.

I do not think this is an either/or question—that we need either vertical or horizontal programmes. Rather, it is a case of using both. I will give a couple of examples of interventions I have seen that were made through, and so reinforced, health systems. In June we visited Sierra Leone. I was privileged to go into a village on the peninsular near Freetown and see the results of the mass bed net distribution that was taking place—at a time, let us remember, when although Ebola had not reached a critical phase, it was beginning to become significant. That mass distribution of bed nets still went ahead, as far as possible, and did so through the existing health system, weak though it was. The distribution was effective: I went into homes where the new nets had been installed, and people clearly viewed them as being of great importance, particularly for their children and for pregnant women, who are the most liable to be affected by malaria.

Those mass bed net distributions, often through health systems, have resulted in the tremendous fall in the incidence of and mortality from malaria that we found out about this week from the World Health Organisation annual malaria report—I had the pleasure of chairing the launch of that report, in the company of His Royal Highness the Duke of York, in my role as chairman of the all-party group on malaria and neglected tropical diseases. Work by the global fund, DFID, and the US and many other Governments has probably saved around 4 million lives—mainly of young children and pregnant women—in the past 14 years. Even if we concentrate more on health systems and horizontal work, we should never let go of the gains that have been made. It is absolutely vital that we do not return to the situation we saw in the 1960s, and again in the 1980s, when, after a really strong effort on malaria, we let our grip on it go and saw a resurgence of malaria across the world. Vertical interventions are vital when they work through horizontal health systems as well.

My second example is from Tanzania, where I visited a programme run by the Tanzanian Government with the support of Imperial college, London, and various NGOs, such as Sightsavers. The programme tackles neglected tropical diseases. Instead of looking at only one—lymphatic filariasis, for instance, or worms—it is tackling four of those debilitating diseases alongside each other.

In other parts of the world we find the use of pooled funds—for example, pooled health funds in South Sudan and Mozambique, the development partners for health in Kenya and the health transition fund in Zimbabwe. All are excellent examples of people coming together to strengthen health systems locally, showing that it is not simply about one person making their one vertical intervention, but everyone working to bring the money together and make the best use of it.

The WHO identified six key building blocks in health systems: governance, finance, the work force, commodities —mainly drugs—services and information. In all those areas DFID plays a major role. I pay tribute to NICE International, an organisation already referred to by the hon. Member for York Central. I was impressed by the presentation it made to the Committee and its evidence to us, and I am impressed by its work. It is an example of something that most people will probably not have heard of, but which is helping health systems around the world to learn from our experience and that of others to bring better health care to their populations.

We have already heard about the financing challenges. It is vital that developing countries live up to their commitments—in the case of African Union countries, the Abuja commitment to spend 15% of their annual budgets on health. At the meeting I referred to earlier, the leader of the African Leaders Malaria Alliance—she is a former Member of Parliament and Minister from Botswana—made the same point, saying that countries with endemic malaria have to step up to the challenge and cannot simply rely on donors to fill the gap.

Indeed, let us take malaria as an example. It would take $5.1 billion of investment every year to see the elimination of malaria within our lifetimes. At the moment, something like $2.9 billion is being given. To put that into perspective, $2.9 billion would run our national health service for a week. Another $2.9 billion—another week’s worth of national health service funding—would see the elimination of malaria in our lifetimes. Surely that is not too much to ask from both the Governments of countries with endemic malaria and the international community to eliminate a disease that even less than 200 years ago was rife in this country and within the past 50 to 60 years was still present and killing people in countries in the south of Europe.

The hon. Member for York Central covered the ground on the issue of the health work force extremely well, so I will not repeat his remarks, save to say that by some estimates there will be a shortage of 13 million health workers around the world by 2035. The estimated shortage at the moment is somewhere between 4.2 million and 4.5 million, although I would say it is probably more—another estimate I have seen is 7 million. Here we have worthwhile jobs and livelihoods that could be created immediately if the training capacity was there. We know the work is there, because there is a shortfall, yet we are not training enough health workers, whether in this country or elsewhere around the world.

Those are great job opportunities for young people. As I said in our evidence session this morning, I urge the UK Government to look at providing more spaces for training doctors, nurses and other health care professionals, so that our young people can enter those professions. I was shocked to see in a newspaper this morning that half of the schools in this country do not have anyone going for training as a doctor. That figure astonishes me. There must be several pupils in every school who would both want to undertake that training and be capable of doing so, yet it is not happening. Let us put our own house in order, while helping others as they do the same to theirs.

I will not dwell extensively on the other three pillars the WHO mentions—commodities, services, which are absolutely key, but are far too big a subject for this debate, and information—except to say that the supply of pharmaceuticals to rural outposts has been a real problem for many years. I remember visiting a place in Uganda where even basic malaria drugs were not available, yet those drugs were in stock in the central store in Kampala. It is not beyond the wit of man to get drugs out from Kampala, or any other capital city, to where they are needed. It takes a bit of leadership and imagination and, possibly, some work with the private sector, which often has the logistics to get the drugs out even if the Government do not.

I have a couple of specific points to mention. In our report, the Committee referred to the work of the health partnership scheme run by DFID through the Tropical Health and Education Trust. That is a tremendous programme, and I am glad to stay that DFID has continued it and added another £10 million to its funding. Partnerships have already been created voluntarily, such as the one between Northumbria health authority and Kilimanjaro Christian medical centre or the King’s Sierra Leone partnership—there are many others, and most Members will have them in their constituencies. Those partnerships can receive support for their work training professionals on the ground in their own countries.

Finally, I want to speak briefly about health education, which we did not cover substantially in our report, but is vital. Community health education programmes can provide enormous benefits, particularly when they are not thrust upon communities. My wife ran a community health education programme in Tanzania for 11 years through a training of trainers programme, training up local people who were not health professionals to work with their neighbours on improving health in their families. The success, for a small amount of money invested, was enormous. It could be seen in the health outcomes. People improved the hygiene in their households by constructing toilets and things such as dish drying racks at very little cost, with great benefits for their children in particular, who were often the victims of diarrhoeal diseases.

In conclusion, I reiterate the importance of this subject. I am delighted that DFID takes it so seriously, but it must continue to do so. Health systems and good health are at the heart of every nation’s attempt to counter poverty and raise the livelihoods and well-being of its citizens.