Drug-resistant Tuberculosis (Developing Countries)

Debate between Baroness Featherstone and Tony Cunningham

Tuesday 4th June 2013 Westminster Hall

[Lynne Featherstone]

My right hon. Friend makes an excellent point. South Africa is an epicentre, so far as its spend on what is a relatively confined industry is concerned.

I was talking about Burma. It is estimated that between 2013 and 2016, the 3MDG fund will spend $20 million on tuberculosis. Funding is an important strand. DFID also supports a number of global partnerships that work on strengthening basic TB control. For example, the Stop TB Partnership plays a critical role in helping countries to strengthen their TB policies, and in supporting the improvement of funding applications for large TB-control grants.

The UK’s contribution to UNITAID, of up to €60 million per year, has funded new laboratory infrastructure in 18 countries, 10 of which now routinely diagnose MDR-TB. The network will have detected approximately 12,000 MDR-TB cases by the end of 2011, compared with only 2,300 cases in the same countries in 2008.

I will move on to the Global Fund to Fight AIDS, Tuberculosis and Malaria, because I know it is of particular interest—this is not the first occasion on which it has been raised with me. The majority of UK funding to global TB control is channelled through the Global Fund to Fight AIDS, Tuberculosis and Malaria, and we have increased and accelerated our funding and are on track to meet our £1 billion commitment to the fund for 2008 to 2015. The fund is, as hon. Members have mentioned, absolutely critical to achieving many of the UK’s health-related international development objectives, so it is important to us that it continue to deliver ever-more impressive results. The UK intends to increase its contribution, pending, as we have said, progress on the implementation of crucial reforms. That obviously falls within my portfolio, and I have had reports from all DFID offices around the world, having asked them to report to me on the fund. Recently I was in Nigeria and had a meeting with recipients of global funding from across the three diseases, to understand the changes that are being heralded in with the reforms at the global fund—so far so good.

We are committed to working with others to ensure that the planned autumn replenishment is a success. We are a world leader, but sometimes it would be nice to be at least equalled in some of these things by other donor countries. We will use our influence to draw in more overall financing. I understand the call to go early, but there are many multinational decisions to be made and, as I have said, this all depends on progress.

On investment in research and innovation, which I think all Members would agree is critical, DFID has a strong record of supporting research and development for effective treatments, diagnostics and vaccines. An example of that is our effort to increase the affordability of diagnostic testing for MDR-TB. DFID’s support of the Foundation for Innovative New Diagnostics has contributed to the development of a rapid molecular test, GeneXpert, which has the potential substantially to improve the diagnosis of TB and drug-resistant TB.

DFID aims to continue our strong record of supporting investment in TB research and development, including through product development partnerships, and we will strive for value for money in such investments. On DFID’s support for innovation, we will consider the hon. Gentleman’s request that we fund TB REACH against, obviously, the competing priorities and commitments in our international health financing decisions.

[Sir Tony Cunningham]

Will the Minister recognise the importance of TB REACH? We can have all the drugs in the world, but if we cannot find the people with TB, we cannot use those drugs.

[Lynne Featherstone]

Absolutely. The point is that we are waiting for the evaluation. TB REACH worked by giving a small amount to a great number of organisations to test how to reach people in difficult circumstances. It had precise pre-specified targets and cost-effectiveness benchmarks, and we have to await the evaluation of that first phase to assess what our funding might be for the second phase. We cannot go ahead of that, although I understand that reaching people is critical. We should also work to strengthen health systems, because ultimately we want health systems that are able to reach every individual in a country and dispense whatever medical care is necessary, but I understand the point in relation to TB.

On Ethiopia, about which I have not yet responded, DFID provides significant support to its health system, directly supporting community health workers, and we agree that they do a great job, including on TB. I have been to Ethiopia myself—twice, in fact.

In conclusion, I am very proud to serve in the coalition Government who, even in tough times, have protected the development budget and will reach the target of 0.7% of gross national income this year. I am also proud that we have cross-party consensus in this Parliament: it is one of our finer moments. We are equally clear about the responsibilities that come with those resources, particularly when this country is itself struggling for survival. Those responsibilities are to spend taxpayers’ money well, to deliver aid that is accounted for transparently, and to ensure that our support delivers value for money and gets to where it is most needed.

Significant progress has been made in controlling TB since 1995, with more than 51 million cases treated and 20 million lives saved. That progress was rooted in improved partnership, policy, innovation and leadership, so there is cause for optimism. I thank all hon. Members here, because the issue is really important and I appreciate their continued pressure. The issue needs to be worked on in all the ways they have proposed if we are to get the better of this disease: our progress is good, but not remarkable. The UK is playing its part, but as I have said, we are all clear that significant challenges remain.

Question put and agreed to.

Oral Answers to Questions

Debate between Baroness Featherstone and Tony Cunningham

Wednesday 30th January 2013 Commons Chamber

[Lynne Featherstone]

The Prime Minister is quite right. The work that we are doing to give land title to smallholders means that they have security and can work their land without it being taken from them.

[Sir Tony Cunningham (Workington) (Lab)]

I join Members from all sides of the House in expressing my support for the If campaign, which seeks to end food insecurity and global hunger. One of the main causes of food insecurity is the illegal acquisition of large areas of land by investors. What steps has the Department taken to support good land governance in west Africa?

[Lynne Featherstone]

As I said just now, some of our programmes involve land titles for smallholders, and the UK welcomes the successful negotiation of voluntary guidelines on the responsible government of land tenure, fisheries and forests that was concluded at the Committee on World Food Security last year. The UK is working to promote transparency of land administration and security of tenure in a number of countries. For example, in Mozambique we are helping local communities to register their land, and we want to continue that progress.

Overseas Aid (UK-based Consultants)

Debate between Baroness Featherstone and Tony Cunningham

Tuesday 20th November 2012 Westminster Hall

[Lynne Featherstone]

I assure the hon. Lady that I do meet and will meet members of the rising intellectual classes, or whatever she termed them, and that I would give them the same answer: the point is whether aid is effective and whether the British taxpayer gets value for money. That is important.

The good part of what the hon. Lady said was that the Opposition are committed to the 0.7% aid target, or are glad that the coalition have made that commitment. We will be the first country to deliver that, as set out in our manifesto and the coalition agreement, in 2013. She is right in what she says, in the sense that that is the percentage that we as a first-world developed country should give, not just because it is right, but because it is smart. It is a wise and good thing to do because it helps us and others. I am glad that both sides agree about that. The hon. Lady spoke of safety for all, and that is part of it.

There have been political shenanigans to do with aid recently, and as the hon. Lady has taken to reading The Daily Telegraph, she will have noticed that it often levels a salvo or two at the 0.7% target, and not only at the consultants. However, the whole point of a percentage is that it is geared to the fortunes of the country as they go up or down. We can maintain our commitment to the figure, because it is geared to our economic fortunes.

I want to put the debate in context. When the coalition Government came to power in 2010 we made it clear that we would ensure maximum development impact on the ground, and full accountability to British taxpayers, so that their money would be well spent. We have done much to improve value for money for UK taxpayers, and for the poor people who receive our aid and development assistance. As the hon. Lady mentioned, that has included, through the bilateral and multilateral aid reviews—which are revered across the development spectrum throughout the world for the work they have done in examining value for money, a full assessment and analysis of where and how we spend the aid budget to ensure that it gives maximum value for money. That has adjusted the focus so that it is now on a smaller number of countries, and funding to some poorly performing international agencies has been cut, in a move that gets life-saving help to many more people.

I prefer the term “suppliers” for those to whom the hon. Lady refers as consultants, because, as she said, while a global figure is given to them, only a percentage of it is administration, and the vast majority of it is for delivering the programme in-country. It is important to recognise that the direct engagement of contractors, or suppliers, is only one of a number of channels that we use to deliver development assistance on the ground. We strengthened the business case process in January 2011, to ensure that there would be good decision making about when and how to use contractors in our programmes, and we must also acknowledge that the suppliers engaged by DFID undertake a wide range of activities to support the delivery of the development programme. The majority of those suppliers’ contracts are managing the delivery of programmes, or managing the distribution of funds to deliver programmes on behalf of DFID. Those were some of the examples that the hon. Lady raised.

[Sir Tony Cunningham]

I understand the point that the Minister makes, but I wonder how she can justify salaries of £1 million or £1.5 million to some of those people.

[Lynne Featherstone]

The proof of the pudding is in the eating: it is a question of what they delivered, whether it was value for money, whether it could have been got cheaper elsewhere, what the processes were, whether they were rigorous and whether the arrangement delivered, on the ground, the enormous programmes that we are carrying out throughout the world, in-country, across Africa and Asia. As to the suppliers we use, yes, UK firms win a significant proportion of our work, and the vast majority—90%—of the larger contracts. Technical capacity is one of the major deficits in the poorest countries, and the market for professional services and technical assistance in developing countries runs to tens of billions of pounds a year. British firms have strong expertise in the area and compete effectively in that big, global market—including for contracts awarded by DFID, but also right across the world.

UK aid is, as the hon. Member for Workington said, untied, and almost all our contracts are subject to competitive tender. When UK firms win contracts from DFID it is because they have offered value-for-money solutions to the requirements in the contract. We encourage firms from developing countries to compete for DFID business. However, local markets often lack the capacity, especially for programmes where specialist skills and experience are required to maximise results. That is particularly relevant as we have increased our focus on working in fragile and conflict-affected states. However, it is important to note that local firms and staff benefit from DFID contracts when our suppliers establish local teams in-country to deliver the programmes and to advise, just as we employ members of the local community to work in DFID offices, for the very reasons that the hon. Lady gave: they have local knowledge and experience. However, often it is not possible for local firms to mount the sorts of applications that can deliver.

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[Lynne Featherstone]

I will return to that issue in due course. The hon. Lady keeps returning to the point about local employment and local opportunities, but we agree about that. It is a question of making it happen and encouraging that, but I have explained to her how that is being done.

On the implication that somehow a tsunami of contracts is now going to management consultants, there is an increase, but there is an increase to what we are doing in all our areas. There is an increase in what we are doing through budget support. There is an increase through sector support. There is an increase to NGOs and there is an increase in the use of suppliers. That is because, as we build towards the 0.7% figure, we are having to scale up and ensure that we deliver. Having different channels through which we deliver is probably the best way forward. A mixed economy of development assistance ensures that we are working and firing on all guns.

Of course DFID’s use of suppliers has grown in recent years. That is because our overall programme has grown and because we are doing more in fragile and conflict-affected states, where the risks are such that we have to retain more control ourselves, rather than channelling money through Governments. In some places, it is just not possible to work through the Government system, and NGOs are not always in place, so we have to work through those with specialist expertise, who can work in these very difficult circumstances. We do that by using suppliers who are accountable to us; it is to us that they are accountable.

We have asked ICAI to review the use of consultants. It is in the early stages of conducting a review of DFID’s use of suppliers to deliver programmes. The report is due in May 2013. The scope of the review is such that it will examine how DFID uses contractors. I am referring to the make-or-buy decision in relation to the business case: how do we decide whether we are going to do something ourselves or whether we need to buy in the service? The review will examine how we select contractors and secure value for money in the procurement process and how we hold them accountable—the contract and supplier management. The ICAI methodology for the study is to select and review a sample of five or six contracts as case studies to identify whether DFID is achieving impact and value for money in its use of contractors.

[Sir Tony Cunningham]

Will the Minister commit to publishing the report in full?

[Lynne Featherstone]

I am coming back to that report. The ICAI report will be published in May 2013.

In terms of the response to the IDC, I do not have the information to hand. I shall have to write to the hon. Member for Hackney North and Stoke Newington on that point.

The hon. Lady referred to the lack of clarity about outputs from DFID programmes. In terms of how we ensure that UK aid money is spent effectively, the main tools are the new business case process, which has brought value for money and results up front in the design of all programmes; annual reviews, which enable us to monitor the value for money of programmes during implementation; and research and evaluation to identify what works best and to learn lessons both from our own projects and from those of others.

In terms of measuring value for money, the value-for-money framework ensures that the value for money of a programme is assessed at various stages of the programme cycle, from business case to DFID’s annual review process, and projects are then scored on whether they are achieving value for money. DFID has also invested heavily in building the evidence base and conducting research and evaluations of programmes to learn lessons about impact and drive greater value for money in future programmes. That is one of the biggest changes in aid and development assistance since the days of the Government whom the hon. Lady supported. There has been a shift in focus on to the evidence base and an insistence that almost everything can be measured and we can look to outputs. The evidence base is critical to evaluating what works, so that when we spend more money, we ensure that we spend it in the most effective way.

There was an assertion from the hon. Lady that consultants add little real value and do not do real work. Contractors actually perform a very wide role. Most of the supplier contracts are buying people and services that support delivery, either by managing the implementation of programmes or by managing the distribution of funds. Sometimes that includes in-kind aid distributed by suppliers. Examples include bed nets and cash—the 40p or 50p a week given to extremely poor people by suppliers contracted by DFID. We also use contractors to provide technical assistance to country Governments to support them in the development of local capacity. Others are used to undertake monitoring and evaluation of programmes or to conduct research to help to improve the effectiveness of our aid. Many of these suppliers play a key role in DFID delivering tangible development outcomes in the world’s poorest countries. I have made clear the importance that we attach to value for money, but also the importance of delivering for the poorest.

I do not have a date for when the report commissioned by the Secretary of State will be finished. I know that the Secretary of State has announced the details of the actions being taken as a result of the review. The recommendations of the report—so it must have been finished—are still being considered, and work is ongoing to plan for implementation. The reason why the report is not in the public domain is that it comes under advice for Ministers and it includes commercially sensitive information, but what the Secretary of State is doing as a result of the report will be published; in fact, I think it has been published already.

The hon. Member for Hackney North and Stoke Newington asked why some of the suppliers working for DFID do not appear to pay enough UK tax.

[Sir Tony Cunningham]

The hon. Lady suggests that the report cannot be published because it contains sensitive material. Is she prepared to produce and provide this information? She can redact the delicate, sensitive information. We want information that is as full as it can be in order to prove that the Department is as transparent as it should be.

[Lynne Featherstone]

I am afraid I have forgotten the point that I was addressing to the hon. Member for Hackney North and Stoke Newington, because the intervention came then.

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[Lynne Featherstone]

Whoever said it, it is an insult to the work going on to change people’s lives, deliver on the ground and make future prosperity sustainable.

The private sector is part of the solution. A growing economy that can lift its people out of poverty, as well as the technical assistance that more developed countries can offer, is important.

[Sir Tony Cunningham]

rose—

[Lynne Featherstone]

I will not give way, because I am coming to my peroration.

In conclusion, contractors can perform an important role supporting the delivery of programmes that make a difference on the ground. They can, and do, deliver impressive results, often in incredibly challenging environments, but we look to them to do more. If they read the debate, they will know that they need to think about how they bid, knowing that our focus will be even sharper and our demand for value for money even greater. Our demand that they put more emphasis on how they will encourage local people along their supply chain to bid for work for them and for us is important. I am adamant that we will strive to maximise value for money, results and impact in every possible way. I am acutely aware of how important that is to those whose lives we seek to improve, as well as to UK taxpayers.