The Parliamentary Under-Secretary of State, Department for International Development (Baroness Verma) (Con)
My Lords, I apologise for my coughing and spluttering throughout the debate. I tried hard to keep it under control but sadly have failed.
I join noble Lords in thanking the noble Lord, Lord Boateng, for securing this debate and I commend his long-standing commitment to international development. I thank everyone who has contributed today and pay tribute to the recognition that noble Lords have paid to DfID and its work and to the great work that volunteers and the National Health Service have also contributed.
As noble Lords are aware, we have played a major role in Sierra Leone and the region in tackling Ebola. It is good that we have come together to discuss the lessons that can be learned from the outbreak in regard to the strengthening and development of sustainable healthcare systems in sub-Saharan Africa.
There were a great number of questions. I hope that my contribution will answer some of them but I fear that time will beat me to it. I therefore undertake to write to all noble Lords by addressing a letter to the noble Lord, Lord Boateng, sending a copy to all noble Lords and placing a copy in the Library.
New cases of Ebola have reduced from 500 per week in November 2014 to around 10 to 14 per week at the last count we have been given, which was 12 July. The UK showed incredible leadership, mobilising the international community and supporting the Government of Sierra Leone to halt Ebola’s spread. I join all noble Lords in paying tribute to the British, Sierra Leonean and other health workers who tackled this disease on the front line.
There are many lessons to be drawn from this unprecedented event. We are committed to identify them and use them to inform and reform, both inside the UK and with international institutions. We have called on the World Health Organization to up its game, securing reforms at the WHO executive board in January and the World Health Assembly in May. Dame Barbara Stocking reviewed WHO’s systems for responding to health emergencies and the UK agrees with her report’s recommendations. The noble Lord, Lord Boateng, said in his very eloquent contribution that Ebola posed a real challenge and a stress test on all health systems in Sierra Leone, Liberia and Guinea. This highlighted why we need to make sure that, in response to such crises, the World Health Organization looks at its internal systems better.
We will continue to apply pressure to improve global health security at the UN General Assembly, the World Bank autumn meetings and at the G20 update in November. The pressure needs to be continued. The European Commission has been a strong supporter of health systems in all affected countries. In particular, the Commission supports countries such as Guinea, where the outbreak started, but where the UK does not provide direct support as in Sierra Leone. The UK works as a critical partner of the Commission in Brussels and in countries, pressing it to do better.
As we identify lessons, we must remember that Ebola in west Africa is unique, as was SARS and as will be the next global health emergency. We need to be committed to improving resilience in relation to all infectious diseases. In 2013, only 10 countries were below Sierra Leone in the Human Development Index. It had the lowest life expectancy in the world. Ebola highlighted how fragile its health system was. We are committed to a “health systems approach” that helps a country organise health resources—money, workforce, buildings, supplies, services and information. Ebola shone a light on all these, but surveillance, rapid response and infection control limitations allowed the outbreak to get out of control.
We have learned three particular lessons for health systems in this respect. First, good surveillance makes the most of local context. I agree with all noble Lords that in countries with limited resources we must include local communities. People and community health workers must get basic training in what to look for. Health workers must have the right incentives to engage with local people, so that communities trust and are able to communicate with them. Communities must not fear formal health facilities.
Secondly, we have learned that health systems need capacity to respond to outbreaks fast, a functioning network of health centres and rapid mobile response teams with particular skills in managing outbreaks.
Finally, we have learned that infection prevention and control needs to be at the core of any health system. In addition to these lessons from Ebola, we have learned much about how to effectively support health systems from years of supporting health in developing countries around the world. For instance, we know from our experience that effectively supporting health systems requires a long-term approach. One reason why the UK engaged so effectively in Sierra Leone was our long-standing development partnership with the country and its Government. We also know that health workers are fundamental and in short supply in the health systems of most low-income countries. We know that they must be trained, motivated, supported and held to account.
We have learned that governance is critical. Whatever kind of health system you have—mostly private or mostly public—the Government must oversee and regulate the quality of care, and ensure that the poor are protected from poor services and financial hardship in buying services. In this respect, the UK helps by advising countries on how to finance their health systems, procure and distribute essential medicines, manage payroll systems and much more. Work to help countries build health systems needs to happen at several levels—national, regional and international. This is why we continually work to ensure that the international system is better equipped to help countries build health systems and support them in responding to disease outbreaks.
In building health systems other factors outside them are critical, including access to clean water, good sanitation and hygiene. We have learned that a good public health system must engage with private clinics. Because many people in poor countries use only the private sector, private clinics need to be informed about outbreaks when they occur. In extremely fragile states where NGOs may provide most health services, NGOs also need to be part of the surveillance and response effort. More lessons need to be learnt. I assure noble Lords that we will be taking these into account as we help Sierra Leone recover from Ebola and continue to support health in developing countries around the world.
The UK is providing up to £37 million to the health pillar of President Koroma’s nine-month recovery plan. This will support health worker and patient safety in clinics through support for staff training, water and sanitation facilities, and strengthening laboratory capacity. It will also help to re-establish basic health services through the donation of drugs left over from the Ebola response. We have also committed £13 million to help countries in the region prepare for future infectious disease outbreaks. The UK has supported more than half of all beds for Ebola patients in Sierra Leone and more than 100 burial teams, trained 4,000 front-line staff, tested one-third of all samples collected nationwide and delivered more than 1 million PPE suits and 150 vehicles. Our support will not stop there as we work to help the country get to zero and stay there by rebuilding its health system.
In the two or three minutes that I have, I will try quickly to ramble through some of the questions posed by noble Lords. The noble Lord, Lord Boateng, asked about disease surveillance, what was in place and what the UK could ensure for future outbreaks of Ebola. My department and the Department of Health are seeking greater commitment from partner countries to implement the international health regulations. These regulations require countries to put in place a national system to protect, prevent and provide a public health response to the international spread of disease and other threats. The Fleming Fund is a five-year, £195 million programme, which was announced in the Budget and will be managed by the Department of Health. We are linking up with France, the United States and the Gates foundation, which have all recently announced plans to do more on disease surveillance.
The noble Lord also asked about illicit financial flows and tax evasion. At the Addis Tax Initiative in Addis Ababa, with the United States, Germany, Netherlands, Ethiopia and others, the Secretary of State launched an initiative to ensure that we commit to doubling support for tax reform in the developing world by 2020. This initiative specifically stresses the importance of tackling cross-border tax evasion and avoidance.
The noble Baroness, Lady Walmsley, and other noble Lords asked about vulnerable groups, particularly young girls and women. We know that about 10,000 children will have lost one or both parents, or their primary care givers, to Ebola. This loss of family and protection makes them absolutely vulnerable to abuse and exploitation. We are working with UNICEF and others to set up the observation interim care centres in all districts where children can be safely quarantined if they are suspected of having Ebola, families can be found if they have become separated and counselling can be received. There is a lot of ongoing work to make sure that vulnerable people, particularly children, have the right support in place.
I have a feeling that I am running fast out of time and I am struggling to breathe. Perhaps noble Lords will agree to allow me to undertake to write. I hope that at the next debate I will not be as infected as I am now. I have quite a lot of responses to get through and I fear that time and my own energy to keep upright are failing me. I thank noble Lords.