Global Fund to Fight AIDS, Tuberculosis and Malaria
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Baroness Northover
My Lords, I, too, thank my noble friend Lord Fowler for securing this important debate and, like others, I pay tribute to his leadership in this field. Both he and the noble Lord, Lord Collins, are right to say that this debate follows a stunning endorsement of our commitment to equality and fairness for all. The noble Lords, Lord Lexden and Lord Fowler, and others flagged the difficulty of tackling disease and explained how stigma, criminalisation and lack of equality hold us back.
The United Kingdom Government are strongly committed to the fight against these three diseases, which represent some of the leading causes of mortality and morbidity in developing countries, posing the largest threat to achieving the health-related MDGs. They also slow economic activity, widen inequality and cause severe financial and emotional strain on affected households. We heard from my noble friend Lord Chidgey and the right reverend prelate the Bishop of Derby about the individual human impact of these diseases.
As we have heard, the global fund plays a key role in the fight against these diseases, and we recognise that its results to date have been very impressive. In a little over 10 years it has enabled a significant and sustained response that has changed the course of these diseases around the world, as my noble friend Lord Fowler highlighted. Thus, Bangladesh has seen a 92% reduction in malaria deaths. In Cambodia, TB prevalence has declined by 43% and malaria deaths have declined by 80%. In South Africa, life expectancy has risen for the first time in a decade from 51 years in 2005 to 60 years in 2010. In HIV there have been huge gains, as my noble friend Lord Fowler and others noted, with 700,000 fewer infections globally in 2011 than in 2001.
Challenges remain, however, such as the growth of drug-resistant TB and HIV epidemics driven by drug injection, as the noble Baroness, Lady Masham, pointed out. From 2001 to 2010, the number of people living with HIV rose 250% in eastern Europe and central Asia, again a problem flagged by my noble friend Lord Fowler.
We are currently the fund’s third largest contributor. As the noble Lord, Lord Collins, pointed out, in 2007 the United Kingdom committed up to £1 billion from 2008 to 2015 for the fund. Europe generally is also an active supporter. Taken together, the European Commission and the EU countries that contribute to the fund account for well over 40% of its receipts.
A year ago, my right honourable friend the previous Secretary of State Andrew Mitchell confirmed to the International Development Committee that the United Kingdom would contribute £128 million to the fund in the years 2012 to 2014. He also said that the United Kingdom would consider increasing that commitment depending on progress with the fund’s crucial reforms, to which the noble Lord, Lord Collins, referred.
DfiD Ministers have indeed increased or accelerated our funding to help the fund through short-term difficulties. In 2010, we advanced a payment so that all the proposals under the fund’s 10th round of applications could be approved, and in 2011 we brought forward another payment so that these same grants could be signed off. Because of this, we are on track to meet in full and one year early our £1 billion pledge, even before any increase. The United Kingdom also continues to be an active and engaged member of the fund and its committees in Geneva.
At country level, the United Kingdom provides a range of complementary funding and other support to national plans and global fund-supported programmes, as well as through in-country governance bodies, most notably the country co-ordinating mechanisms that manage global fund grants. However, as noble Lords have flagged, there have been some recent challenges; the noble Lord, Lord Collins, referred to this. The fund invites scrutiny and is a highly transparent organisation. In 2011, the Global Campaign for Aid Transparency ranked the fund fourth in their “Publish What You Fund” data, and in 2012 the global fund ranked joint third. That is very encouraging. As my noble friend Lord Chidgey and others have noted, we rated the fund as providing very good value for money in the multilateral aid review.
However, press reports in 2011 claiming fraud and corruption caused the fund to examine its systems and procedures. It became apparent that the reports were exaggerated and extrapolated from audits that the fund itself had published. None the less, they triggered a series of events, including the cancellation of the fund’s 11th round of applications for funding. A high-level independent review panel was established to look at the fund’s fiduciary controls and oversight mechanisms. The panel concluded that the fund’s purpose was right and that it had achieved significant results, but that it had outgrown its original structures and was in urgent need of reform, including changes to its business model.
The fund responded in full to the panel’s recommendations. Subsequent reforms have been rapid and far-reaching. It has changed its business model and practices and made significant and strategic senior appointments so that the senior management team is even stronger than before. It has redirected staff towards active grant management and working more closely with high-burden countries.
My noble friend Lord Chidgey asked about an incident in Djibouti. We and the fund take a zero tolerance approach to fraud and corruption, which he will not be surprised to hear me say. We have supported the fund in appointing a chief risk officer, undertaking a grant-by-grant and country-by-country assessment of risk and strengthening the secretariat to manage risks better. The fund is further improving its audit investigation units, and recovery of any and all fraud is being vigorously pursued.
A new funding model, intended to ensure that the fund improved its performance and better met the needs of poor people affected by the three diseases was agreed late last year. I reassure my noble friend Lady Chalker that the secretariat is focusing in particular on the 20 high-impact countries in Africa and Asia that account for 70% of the burden of the three diseases and 54% of the fund’s grants. We are very glad that the global fund appears to be back on track and even stronger than before. On 28 February this year, it allocated £1.9 billion to 50 countries to test its new funding model, and on 15 May we learnt that the first five country concept notes have passed their review stages and will be recommended to the board for funding later this year.
I was asked a number of questions, and I shall go through some of them. The right reverend Prelate the Bishop of Derby asked about civil society involvement and emphasised the significance of that, and of course that is right. Roughly 33% of global funding grants go to civil society recipients in parallel to Governments. My noble friend Lady Chalker asked about the training of health workers. As she probably knows, the global fund supports health workers, including through general health system strengthening and through the countries’ own national programmes. She was concerned that there should be better targeting on prevention, which the noble Lord, Lord Fowler, emphasised, and we agree. Clearly, the 310 million bed nets—again the noble Lord, Lord Fowler, referred to this—are a demonstration of what can be done.
Various noble Lords emphasised the reduction of stigma, including my noble friends Lord Lexden and Lord Fowler. My noble friend Lord Fowler interestingly linked that to vaccines. We agree that the support for the development of vaccines is very important and we have increased funding. As part of a package of interventions, even an inefficient vaccine can have its uses.
My noble friend Lord Lexden suggested that we needed to work closely with private sector foundations and individual contributors, and we agree. We are doing that generally across DfID. He will note that Bill Gates will be joining us on Friday and Saturday at the hunger summit, for example, outside this debate.
The noble Baroness, Lady Masham, asked about diagnostics. I assure her that DfID is providing £6.5 million to the Foundation for Innovative New Diagnostics to develop new diagnostic tests for a range of diseases. She is absolutely right about the importance of that. She and my noble friend Lady Jolly emphasised the importance of TB research and taking this forward. DfID supports a range of research, including £23.3 million to the Global Alliance for TB Drug Development and various other projects.
We liaise closely with our colleagues on the fund’s board, including those from the United States, France, Germany, Japan and the EC, and—I hope this reassures the right reverend Prelate—with those from civil society. We recognise President Obama’s request to Congress of $1.65 billion for 2014 as a strong vote of confidence in the fund and its reforms. Like the noble Lord, Lord Fowler, we pay tribute to the United States’ record here.
Our own reform priorities are to reduce transaction costs levied on recipients and on partners, as flagged by my noble friend Lady Chalker; to gain even better value for the money spent; to continue the focus on the poorest and most vulnerable; and to develop the longer-term sustainability of global fund-supported programmes. Clear, positive developments have already been made and we are seeing early signs of the impact of these reforms. The multilateral aid review update for the global fund, which will be published in the summer, will help to provide further important evidence.
I welcome the interest of all noble Lords in this area. The focus is to make sure that in a period of global austerity, when we all face major health problems, such as those resulting from HIV/AIDS, malaria and TB, resources are used as effectively as possible. The global fund has an impressive track record and it is vital that such international players, whose reach is far wider than that of individual countries, are as efficient as possible as we seek to combat poverty and disease around the world.