Aid and Trade
Baroness Hayman Excerpts(8 years ago)
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Lord Bates
It is certainly true to say that we were a leading force in securing that agreement in Paris and building on it at the recent G20 summit in Hangzhou. We are very committed to that. We are addressing all the humanitarian issues that were talked about. The UK is one of the largest economies—in fact, it is the only major economy—to achieve its 0.7% commitment. We do that in humanitarian aid but, under the rules of the OECD and the DAC, we also allow certain amounts to be introduced and used to build capacity and to build business and economic development within those countries, and that is an example of one of those.
Baroness Hayman (CB)
The Minister talked about economic development as the route out of poverty for people in the developing world, which is absolutely right, but will he accept that it is not only through trade that economic development happens? The investment that DfID has made over the years in health and education is absolutely a prerequisite to that economic development.
Lord Bates
The noble Baroness, with her great experience, has put her finger on the point here—that it is placed in context. That is why it is very important that, in order for economic development to happen, we need to stop the conflict, we need to start getting people into school, we need to eliminate discrimination and we need to improve economic development. It is across the range, and that is what DfID’s policy tries to address.
Health: Ebola
Baroness Hayman Excerpts(8 years, 9 months ago)
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Baroness Verma
My Lords, the noble Baroness raises an important point about causes, but these are lessons that we will learn as we review all the work that we ourselves, other agencies and the Sierra Leone Government have done. We are also undertaking a lot of research in this area, so I thank the noble Baroness for her question.
Baroness Hayman (CB)
My Lords, I saw for myself at the height of the Ebola crisis last year and again on the return visit to the Parliament in Sierra Leone last month the value that communities there put on the work of the Minister’s department, the Foreign Office, NHS volunteers and international development agencies. One thing that they did not value was the suspension of direct flights to west Africa. Could the Minister look very carefully at that decision and not have a knee-jerk reaction in future? It did not stop people travelling from west Africa—it just made life a lot more difficult for volunteers and those going out and actually impeded public health screening, because people came back through a variety of routes rather than direct routes.
Baroness Verma
The noble Baroness is of course aware that as a Government we have to put the safety of the British people first.
Neglected Tropical Diseases
Baroness Hayman Excerpts(8 years, 10 months ago)
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Baroness Hayman (CB)
My Lords, I am delighted to follow other noble Lords in today’s debate, and I draw attention to my interests as declared in the register. I am delighted, too, not to be introducing the debate tonight but speaking last from the Back Benches, because so many other speakers have dealt with the basics around NTDs. That includes the devastating effects that they have, not only on individuals in terms of debilitation or disfigurement and people often being excluded from their own society because of the effects of the diseases, but also the later effects on child development, educational attainment and pregnancy outcome, and of the interrelation of NTDs with other diseases such as HIV or malaria. All these things together are not only the results of the poverty in these communities but in themselves engender that poverty again. So NTDs are both the result of and the cause of poverty. We have done a great deal to recognise that and much progress has, as has already been stated, been made through the WHO road map, the London declaration, the announcement of the Ross fund and the inclusion of NTDs in the sustainable development goals. But there is much still to be done.
The funding gap, even for the provisions that we know about, has been pointed out tonight, but it goes wider than that because, as other noble Lords have pointed out, we need to tackle this problem not in individual silos. The public health measures that will defeat these diseases are to do with water and sanitation, public health education and the provision of basic services; without those, we will not get very far, and those are expensive items.
In the minute or so that I have left, I want to concentrate on the issue of vaccines. We know that we need to improve the toolbox that we have already. We know that we need better diagnostics, better medicines and better insecticides, and that is something that may become much more important in terms of Zika. But also, we need vaccines. There is some evidence that although for many diseases mass drug administration is extremely effective, for other diseases it is not so effective. Therefore, we need to not take our eye off the ball of vaccine development. We saw this in relation to Ebola, a different sort of disease that has already been mentioned tonight. Zika, I think, is a neglected tropical disease, but it is so neglected that it is not even included with dengue and chikungunya as one of those insect-borne diseases of the poor. It is not one of the 17 top priorities for the WHO. However, that is changing. It changed tonight by the declaration of an emergency. We need vaccines as well as all the other measures, and we know that product development partnerships are very important in getting round the failure of the market often to provide. So my question to the Minister is: what consideration is given within the Ross fund to extending its remit so that it would also cover vaccine development?
Ebola: Sierra Leone
Baroness Hayman Excerpts(8 years, 11 months ago)
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Baroness Verma
The noble Lord raises the point about funding for the recovery of Sierra Leone, and Liberia as well. We want to ensure that, as a country, we play our part by pledging and by encouraging our partners. So we will continue to play our part and encourage our partners. We have very much supported the UN Secretary General’s high-level panel also to encourage that we do much more collectively and globally. Just to give the noble Lord some assurance, the World Bank has committed $650 million to make sure that, over the next 18 months or so, the reconstruction of those three countries affected by Ebola takes place.
Baroness Hayman (CB)
My Lords, following the question from the noble Lord, Lord Boateng, is it not important to recognise that we must not be diverted from the task of rebuilding and regenerating the economy and the health service in Sierra Leone? Does the Minister agree that all the leading authorities warned that individual sporadic cases would be reported and that, while it is tremendously important to deal effectively with them, we should not allow that to colour the judgment that the situation in west Africa is as it was, sadly, a year ago?
Baroness Verma
My Lords, there are two main issues. One is being able to deal with the recovery and making sure that there is sufficient funding and support for us to be able to help strengthen the health systems in countries whose growth was very good before the outbreak but whose systems were not as strong as they should have been—those systems need strengthening. We will probably see the occasional case, but we must continue to encourage others to make sure that we rebuild west Africa in such a way that economic growth continues on a much more sustainable pathway. That can be done only if all global partners come together to be very supportive of what the UK has often done. The UK has led by example. Part of that is our commitment to 0.7% to ensure that our aid budget will always be protected.
West Africa: Ebola
Baroness Hayman Excerpts(9 years, 2 months ago)
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Baroness Verma
My Lords, the noble Lord is right to say that we need to work at many levels. The noble Lord, Lord Giddens, asked about the work and the commitment of major investors such as the International Monetary Fund. While this work must be done at several levels, I agree that we need to work at local level with civil society and local communities to ensure that they can recognise the situation and respond. The work we have done to date shows the effort we have put in trying to reach a zero rate of Ebola cases. It is important to note that this will be an ongoing, long-term recovery. We are one of the partner countries, and we have led on this issue in Sierra Leone. We now need to ensure that, at all levels, we commit to and retain sustainable, long-term development.
Baroness Hayman (CB)
My Lords, I echo what was said about the long-term health consequences for survivors of Ebola here and in the countries affected. One thing that would help economic reconstruction would be the resumption of direct flights to Freetown from this country. Will the Government urgently reconsider their position on this issue? In February of this year, I saw for myself how much co-ordination was needed in the different areas of work to help in the fight at the height of the epidemic. Exactly that sort of co-operation will be needed for the long term. Can the Minister reassure me that the processes are in place to co-ordinate and complement the different agencies and government initiatives from this country that will be there for the long term?
Baroness Verma
My Lords, initially, the noble Baroness asked about direct flights. The Government introduced a ban on direct flights to Sierra Leone when the number of cases increased rapidly. We continue to keep the situation under review but, ultimately, the safety of the British public has to be at the heart of any decision on the resumption of flights. On greater collaboration, we are working closely with the President on his recovery strategy, and with other agencies on the ground.
Sierra Leone
Baroness Hayman Excerpts(9 years, 5 months ago)
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Baroness Hayman
To ask Her Majesty’s Government what is their assessment of the current situation in Sierra Leone, and what are their plans to assist the country to recover from the effects of the Ebola outbreak.
Baroness Hayman (CB)
My Lords, I am grateful for the opportunity to introduce this Question for Short Debate and to the numerous organisations and individuals who have provided briefing material. In the time allotted, I fear that I cannot do justice to the breadth of issues they have raised, so I am particularly glad to see the number and expertise of other noble Lords who will be contributing tonight. I also remind the House of my interests in health and overseas development, as set out in the register.
The Ebola outbreak in west Africa has disappeared from headlines in the United Kingdom, but the devastating effects of that outbreak are still being felt every day by the people of Sierra Leone. For a start, unlike in Liberia, Ebola cases have not disappeared. For the last few weeks, the number of cases has been bouncing along the bottom, as epidemiologists predicted, with up to 15 new cases a week being reported in June, and with a worrying number of those cases coming from unknown transmission chains. Some 1,100 people in Sierra Leone are still under quarantine restrictions, and we are now beginning to tally up the costs, not just of the epidemic itself—not only the 3,900 deaths from Ebola that we know of, and many more that we do not—but in other areas of health, where thousands more are estimated to have lost their lives because of the collapse of the already impoverished health services that existed before Ebola, and the collapse of community trust in those services.
It has been estimated that use of government health services has declined from 80% to 50% of the population since the first Ebola case was identified more than a year ago. Most experts agree that, in that year, more people will have died from the absence of treatment for malaria than from Ebola. The effects on maternal and perinatal mortality are equally if not more devastating. Services for pregnant women have virtually ground to a halt because of the particular risks for healthcare workers in treating women giving birth. There has been a terrible toll of stillbirths. The Maternal and Newborn Health Unit of Liverpool School of Tropical Medicine and VSO are even now working to bring forward a programme to build again maternity services that in the past were so inadequate that the maternal mortality ratio in Sierra Leone was the worst in the world.
There are also problems in terms of services for HIV and tuberculosis; cholera is always a risk in Sierra Leone; and there have been reports of measles outbreaks as a result of plummeting immunisation rates when patients simply stayed away from clinics. I welcome the mass drug administration programmes for malaria, and the vaccination campaigns for polio and measles that have taken place recently, but the situation remains precarious. Building sustainable universal health coverage in Sierra Leone will be an enormous long-term challenge for a country that had only 100 doctors and 1,100 health workers before the outbreak. Nearly one-third of those health workers contracted Ebola and 224 died during the epidemic.
Beyond health, the effects of the outbreak were far reaching. Schools were closed for nearly a year, and many pupils will not only have lost that part of their education but will never return to school. As so often, girl children have suffered most, with reports of increased sexual exploitation, early marriage and teenage pregnancy. Those girls will have great difficulty in ever establishing independent and free lives for themselves. Agriculture was also impacted and, while showing signs of recovery, needs further technical and other assistance if it is to contribute to economic growth and address the needs of the 35% of children in Sierra Leone who are chronically malnourished.
The effects on the wider economy were devastating—and I am sure that the noble Lord, Lord Giddens, will speak about this. The World Bank estimated that Sierra Leone will have lost $920 million from its projected GDP in 2015, and has revised its estimates of growth from 8.9% to minus 2% this year. Rebuilding that economy will be an enormous challenge, as will getting into place an appropriate tax structure, particularly in relation to the extractive industries, to provide a robust tax base for government spending on health and social services.
I should like to highlight one decision of the UK Government which contributed to the economic problems—halting direct flights to and from the country. I believe, along with the Public Accounts Committee in its report last Session, that the Government were wrong to halt those flights, not least because indirect access to the UK actually makes it more, not less, difficult to track and screen travellers. I strongly support the recommendation of the Public Accounts Committee that direct flights to Sierra Leone should be restored as soon as possible. In its response in March to the Select Committee, the Government said that they would keep the situation under review. I hope that the Minister will tonight give us some cause for optimism that licences to fly direct to Freetown will be restored in the very near future.
I visited Sierra Leone in February this year and saw for myself the commitment of UK volunteers, particularly in the health area, through UK-Med and other agencies, to helping Sierra Leonean colleagues and those from all over the world in the fight against Ebola. I know that many are keen to continue to support the health service in that country so that it can provide resilience against further outbreaks and basic health rights for the population. However, there are a number of issues about how that commitment could be maximised and how the Department of Health and the NHS could better support medical volunteers. They include looking at the impact on training programmes when people leave their jobs for a time, pension contributions, and the possibility of pre-release agreements with employing trusts.
Across the world, in the global response to epidemics such as this, every country, as well as the world community, needs to put in place resilient and immediate measures that can be brought forward in the case of need, and not have the sort of delays we saw with Ebola. The Royal College of Paediatrics and Child Health has, along with other colleges, put forward suggestions in this area, as has Dr Oliver Johnson, who led the outstanding work of King’s Health Partners at the Connaught Hospital in Freetown and beyond. I hope that the Minister can tell us that discussions are ongoing between her department and the Department of Health to progress these issues.
Just as the Ebola crisis went much wider than health, so did the UK’s contribution, with crucial programmes delivered by many NGOs, supported by the British public’s generous response to the Disasters Emergency Committee’s first ever health appeal. I particularly highlight the work of young Sierra Leoneans in the wide-ranging community-based social mobilisation programmes which were central to halting transmission through unsafe burial practices and to persuading people to notify the authorities of cases, providing food for families in quarantine, caring for some of the 8,000 children who lost their parents to Ebola and supporting Ebola survivors who suffer both from stigma and from long-term health effects of the disease. No one visiting could fail to be impressed by the work of our High Commission, led by Peter West, the staff of DfID, many of whom put their own lives and families on hold for months at a time, and, of course, the British military presence, which was so crucial to setting up the national emergency response centre and district centres throughout the country.
I also visited the Sierra Leone Parliament when I was in the country, and heard of the challenges in strengthening scrutiny of government and democratic accountability in the complex society, with many parallel power structures, that is Sierra Leone. I know that the CPA UK branch and the Westminster Foundation for Democracy are looking at how they, as partners, can, together with the FCO and DfID, aid this process and support, in particular, women Members of Parliament who feel very estranged from the levers of power in their country.
President Koroma showed real and effective political leadership throughout the crisis, but institutions in the country were put to the test—as, indeed, were international institutions such as the WHO—during Ebola, and no one can deny that there were real problems of both leadership and governance. At the EU meeting in Brussels this year, the leaders of the affected countries recognised the need to improve public administration and financial compliance and requested international support for long-term recovery and development plans for the region.
Just as the challenges for Sierra Leone are multifaceted and its national recovery plan will entail long-term commitment, so are the opportunities for the UK; from our science contributing to the search for vaccines, diagnostics and medicines to health service strengthening; from governance and financial advice to promoting the rights of women and children. Some great collaborative work was carried out during the Ebola outbreak. I hope that the Minister can assure us tonight that Her Majesty’s Government intend to bring all the strands together and put in place a long-term, funded and comprehensive plan of support for Sierra Leone, working alongside its Government and people.
Millennium Development Goals: Women and Girls
Baroness Hayman Excerpts(9 years, 9 months ago)
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Baroness Northover
It is extremely important to get girls as well as boys into school. A lot of progress has been made and there is almost gender parity, except in areas where there is conflict and, particularly, rural areas. The noble Baroness rightly highlights the project in Nigeria. We are working with UNICEF to manage the girls’ education project, which aims to get 1 million girls in school, and the results monitoring process has been agreed with UNICEF and is being implemented.
Baroness Hayman (CB)
My Lords, as the Minister acknowledged, the goal relating to maternal mortality reduction will not be met by 2015. However, a great deal has been achieved by programmes such as Making It Happen by the Centre for Maternal and Newborn Health at the Liverpool School of Tropical Medicine, and I declare an interest as a supporter. Will the Minister assure the House that support from her department for progress like this that has made a huge difference will continue, so that this is not unfinished business past 2015?
Baroness Northover
It certainly must not be allowed to be unfinished business after 2015. The noble Baroness is right that progress has been made—maternal mortality has dropped by 45%—but we need to take that much further forward.
Gender Equality: Developing Nations
Baroness Hayman Excerpts(9 years, 9 months ago)
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Baroness Northover
My Lords, the noble Baroness is quite right about the risks girls often take in seeking an education. I hope that I can reassure her by saying that one of our focuses now is to try to ensure that the most vulnerable girls and boys are able to get into school safely, and not only to primary school but to progress on to secondary school. The very fact that they can get there is an indication that they have actually succeeded in primary school.
Baroness Hayman (CB)
My Lords, I have recently returned from Sierra Leone where all the schools have been closed for almost nine months. This has had a devastating effect on the education of girls in particular, many of whom will never return to school now and among whom there are very disturbing reports of increased rates of sexual exploitation, early marriage and teenage pregnancy. Can the Minister assure me that Her Majesty’s Government will continue to support the outstanding efforts on the part of both UK government bodies and NGOs, which I was privileged to witness in that country, not only right until the end of the Ebola outbreak, which is far from finished, but also in the longer term for rebuilding education and health in that very needy country?
Baroness Northover
I thank the noble Baroness for her tribute to the work that we are doing in Sierra Leone, and I also pay tribute to that work, which has been outstanding. We are trying to get Ebola down to zero cases because that is crucial. We want to see the schools reopen, and at the moment we are focused on how to rebuild within Sierra Leone. However, she is quite right to talk about the special vulnerability of women and girls. We are seeking to protect them and ensure that the risks that she has talked about do not come to fruition.
Ebola
Baroness Hayman Excerpts(9 years, 10 months ago)
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Baroness Northover
I am sure that there will be continued discussion as to the lessons we must learn. However, it was welcome that the WHO held a special session to look at some of those lessons and try to take that forward.
Baroness Hayman (CB)
My Lords, while welcoming the progress that the noble Baroness outlined and the recognition that I understand is to come of British citizens who contributed to that progress, would she agree that the next phase of the fight in Sierra Leone will be even more challenging: not to let up on the drive to zero cases in the current outbreak; to make up for the healthcare that has not been given in terms of immunisations, maternity and neonatal care, malaria and NTDs; and to provide the structures for robust responses to any outbreaks that might occur in future?
Baroness Northover
Indeed, the noble Baroness is right that we cannot be complacent. As I am sure she knows, we need 42 days of an Ebola-free situation in all the relevant countries. We then need to reconstruct. That needs to be transparent and accountable. When I met the relevant Ministers from Sierra Leone, that was certainly something I emphasised from the UK Government.
Developing World: Maternal and Neonatal Mortality
Baroness Hayman Excerpts(9 years, 11 months ago)
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Baroness Hayman
To ask Her Majesty’s Government what progress has been made in reducing maternal and neonatal mortality in the developing world; and what plans they have to build on this work post-2015.
Baroness Hayman (CB)
My Lords, I am grateful for the opportunity to introduce this debate, and delighted that noble Lords from all Benches of your Lordships’ House are planning to contribute on this important issue. I declare my interests in health and development, particularly my chairmanship of the external advisory group of the Centre for Maternal and Newborn Health at the Liverpool School of Tropical Medicine.
It was in this role that last year I visited Zimbabwe and saw for myself the power of the Making it Happen programme run by the centre in 11 countries, supported by DfID. I saw UK volunteers, an obstetrician and a midwife, together with Zimbabwean master trainers who had been through the course before, supported by the country’s Ministry of Health, running the course for Zimbabwean health workers, giving them the skills to save the lives of mothers and babies and to pass on those skills to their colleagues to ensure sustainability and improved services countrywide.
I will step back from the specific to address the scale of the problem. The statistics are chilling. Some 300,000 women die every year; 800 women die every day in pregnancy and childbirth; 50 will die in the course of this short debate. There are an estimated 2.6 million stillbirths and 3 million neonatal deaths every year; half of those neonatal deaths occur in the first 24 hours of life. A child dies somewhere in the world every five seconds, overwhelmingly of preventable causes.
These maternal and neonatal deaths are not evenly distributed. The maternal mortality ratio shows the highest discrepancy: the greatest gap between high and low income settings of all international health indicators. In the UK, the maternal mortality ratio is eight per 100,000. In Sierra Leone, it is 110 per 100,000. That is the last figure that we have; I hate to think what the figure will be for the last 12 months when the ravages of Ebola have put into abeyance the most basic health services that were available in the past. The average for neonatal mortality in developed countries is 3.7 per 1,000 live births; in southern Africa and south-east Asia it is 10 times that; 99% of all maternal deaths and 98% of all neonatal deaths occur in low or middle-income countries.
Within developing countries there are wide variations, with the poorest, the youngest, the least educated, and rural women most at risk. The deaths are not the end of the story. For every woman who dies in childbirth, it is estimated that 20 to 30 live but suffer lifelong morbidity such as fistula. The health and survival of babies is dependent on the health and survival of mothers, not only in the quality of antenatal, intra-partum and post-partum care, but evidenced by the fact—I have lost the reference for this statistic, but I am sure someone will tell me—that a motherless child is 10 times more likely to die in the first two years of its life than a child who has a mother to care for them.
It was the recognition of this tsunami of suffering and the obstacle to development that the figures represent—because we all know how crucial women are to development—that led to the introduction of millennium development goals 4 and 5, of reducing child deaths by two-thirds and maternal deaths by 75% by 2015. When the Minister comes to answer the question posed in the title of this debate, I am certain that she will outline the considerable progress that has been made since 1990.
I pay tribute to the work that has been done in developing countries by DfID and other international agencies in just about halving those deaths. The figures have been helped of course by the progress in other MDGs, for example in relation to HIV/AIDS and malaria, and perhaps point us again, looking forward, to the importance of joined-up healthcare and healthcare for all.
However, it is disappointing that the progress that has been made has, again, not been evenly distributed, and that some of the countries that have the worst figures, and which need the greatest improvements, are ones that have seen the least change in their statistics. I ask the Minister to address the issue of how, post-2015, we attend to the unfinished business in the millennium development goals and ensure that we do not take our eye off the ball in these hugely important areas where we need to make sustained efforts in order to continue with the progress made so far.
I have not said a lot so far about the causes of maternal and newborn mortality, and how this terrible toll of death and suffering can be reduced. That is partly because when I asked a local expert for help in preparing for this debate and what she thought I ought to stress and what ought to be said, she shrugged her shoulders and said, “There is nothing new to say. We know what the issues are and we know how they can be addressed. What are needed are the resources and the political will to do it”.
You can go through the list of causes of maternal and newborn death: poor nutrition, existing medical conditions—which are often the diseases of the poor, such as malaria—unsafe abortions, infections, eclampsia, haemorrhage and obstruction in labour. The last three of these can be addressed by specific programmes of maternity care, but the first are much wider issues relating to water and sanitation, education for girls, an end to child marriage, immunisation programmes, and access to family planning and antenatal intra-partum and post-partum care from trained and skilled birth attendants. That is where programmes such as Making a Difference can have profound effects: in the first phase of those programmes, maternal death rates in areas where they had been implemented reduced by as much as 50%. The decision we have to make globally is about the priority that we give to the quality of women’s lives and the numbers of women’s deaths.
In the early 17th century, Joseph Hall, who was then Bishop of Exeter, wrote:
“Death borders upon our birth, and our cradle stands in the grave”.
That is no longer true in this country. It need no longer be true in the developing world. But to stop it being the reality for millions in that world, we have to put the resources and the priority into work to reduce maternal and neonatal deaths.
Lord Bourne of Aberystwyth (Con)
As the debate gets under way, I respectfully remind noble Lords that this is a time-limited debate.