Disability and Development

Debate between Lord Bruce of Bennachie and Fiona Bruce

Thursday 11th December 2014 Westminster Hall

[Sir Malcolm Bruce (Gordon) (LD)]

I will try to be brief and simply highlight the main points. We decided a couple of years ago to do a report on disability. Although it took us a while to get round to doing it, for various reasons, the fact that we were going to do it had a galvanising effect on the Department for International Development, which found itself in a better position to explain what it was doing than might otherwise have been the case. Our announcing the inquiry well in advance was therefore quite a good thing to do.

The first thing we wanted to identify was just how big an issue disability is. There are reckoned to be about 1 million people suffering disabilities in developing countries, and they are mostly very poor—they are the poorest of the poor. They are not often visible, and they are subject to a lot of prejudice and stigma. They are often hidden away, disadvantaged and kept poor.

[Fiona Bruce (Congleton) (Con)]

I apologise for interrupting the right hon. Gentleman, but did I mishear him or did he say 1 million?

[Sir Malcolm Bruce]

The correct figure is 1 billion, and if I mis-said it, I am glad that my hon. Friend has given me the opportunity to put the record straight.

The challenge is huge, so we felt it was critical that the Department addressed it specifically and explicitly in a way that had not been done before. We issued a challenge, to which the Department has responded, which I think is a classic example of the galvanising and dynamic effect of the Committee’s relationship with the Department. We were disappointed when the Government rejected our recommendation for a disability strategy; however, we have been extremely pleased with the framework document that has emerged, so frankly I think we can park that disagreement. The framework document has been widely welcomed by organisations and others representing disabled people.

I would like to pay a personal tribute to my right hon. Friend the Member for Hornsey and Wood Green (Lynne Featherstone), a former Minister in the Department, for taking up the challenge. When she came into the Department, she basically said to me, “I’m a junior Minister. I can only do a limited amount, and the best way I can do it is to pick up two or three issues and make them my own,” and this issue was one of them—the others were women and girls and female genital mutilation. She is a great campaigner. My understanding—the Minister may correct me—is that direct responsibility has been transferred to my right hon. Friend’s successor, Baroness Northover, who has also given me an undertaking that she is determined to ensure that the commitments made by her predecessor are taken forward.

That is all very welcome. Hon. Members will know that I have an interest in disability, having a grown-up deaf daughter and being chair of the all-party group on deafness. I have always recognised the fact that if nobody rises up and challenges the problems that disabled people face, and if nobody works with disabled people, their problems will not be addressed.

Having welcomed the framework, I want to ask a few questions. We think that the process has been enormously positive and that the framework is ambitious. The Department is doubling the size of the disability team, making new commitments in humanitarian response—water, sanitation and hygiene—and advocating for a disability-inclusive post-2015 agenda. Put simply, if the aim is to eliminate absolute poverty by 2030 and leave no one behind, it is not possible to do that without specific policies to address disability and the needs of disabled people. What is being done for the first year of the framework to try to achieve measurable impacts? There are more staff and there is more awareness, but will the Department set some objectives that it hopes will be met by the end of the year?

Will the Minister consider committing the Department to an annual stocktake or progress report? The current Secretary of State for Health used to be a member of our Committee—many of the best people in the House of Commons, including the hon. Member for Glasgow Central (Anas Sarwar), have been members of the Committee—he recognised that the international community had set a commitment to halve the number of people with HIV/AIDS who were not receiving treatment. That was a five-year programme, but he insisted, and secured agreement, that the target would be hit only if we had annual reviews and targets. I commend his initiative. The Committee and the Government accepted the proposal, which ensured that the target was hit. The logic is that annual targets require us to keep our eye on the ball, whereas a five-year target can be left until there is a push upwards at the end, like a hockey stick. I ask the Minister to consider that.

There have been criticisms from some organisations that represent disabled people. Some of those criticisms are a bit sharp, and I will not report them here, but they boil down to the Minister and the Department needing to understand that organisations representing disabled people are not the same as disabled people’s organisations. Disabled people should be a visible part of the process of addressing disability in development. Indeed, people within the Department who have a disability should be encouraged to take part in the process and be a role model—I am not talking about tokenism, nor should the Department specifically recruit such people. Again, I hope the Minister might consider that. What specific measures will the Department take to engage disabled people’s organisations? At the moment, such organisations still feel that they have not been properly engaged. Some of them have been sharply critical, but that is the nature of such organisations. I get a lot of that in my work with the deaf community. Let us just take it is a practical thing to be addressed.

DFID has acknowledged that we are a long way from being in the lead on disability. I understand that a member of DFID staff has been seconded to Australia to look at their examples, and I hope that in a relatively short period of time, as in so many areas, DFID will be a leading world role model. I am glad that the Department is looking to learn from international partners that may be ahead of the game. What more might the Department do to build on the experience of international organisations?

My right hon. Friend the Member for Hornsey and Wood Green recently held a seminar on collecting data, and part of the problem is that, precisely because they are hidden, we do not know the exact nature of the challenges. I was invited to the reception at the end of the day, and I got the impression that people were pleased that that was taking place. A progress report on how data collection will be taken forward would be helpful.

As with the problems faced by women and girls, in the humanitarian disaster agenda we have been shocked by the lack of awareness of the needs of disabled people. If there has been a disaster, by definition there will be newly disabled people who have suffered injury, been shot or wounded, or been affected by that catastrophe. The needs of disabled people, as well as the needs of women and girls, must be prioritised in the immediate aftermath of disasters because they tend to be forgotten at a critical and vulnerable time. The World Bank has an ongoing review. It would be good to know how DFID, as a very influential player in the World Bank, is trying to ensure that the bank also takes a strategic view of the needs of disabled people.

Finally, people need support when they are disabled, but quite often those disabilities are preventable, whether they be caused by illness or accident—road traffic accidents are devastating. What will DFID do to reduce the incidence of disability? Yes, we must provide for those who are disabled, but we must also help to reduce the incidence of disability. The consequences of female genital mutilation can be catastrophic, as can the consequences of disease. We have had that debate, but it is relevant in this context. I draw out mental illness and incapacity, on which we took specific evidence. Mental illness is a major problem. Frankly, poor people have a higher chance of suffering mental illness, yet that is almost unrecognised—it is stigmatised. I ask that mental illness and mental disability be included in the strategy.

I have some practical suggestions. I say that I speak on behalf of the deaf community, but there are others with specific disabilities. Surely we can provide cost-effective access to wheelchairs, hearing aids and hearing tests, simple interventions on sight, and so on. How will that be built into the strategy, so that we can create partnerships? I suggest cross-Government and cross-society partnerships, because it should not all be down to DFID, although DFID can provide the leadership.

In order to ensure that other colleagues have an opportunity to speak, I will finish by saying two things. I am glad that the Committee undertook this report. More evidence was submitted to this inquiry than to any other we have done. The engagement and participation of disabled people throughout the process has been very strong. They were passionate about the need for the strategy. Having had a slight stand-off with the Department, we can honestly say that the disability framework is more than we might have expected, provided it is delivered. I therefore commend the report, and the Government’s response, to the House. I hope the Minister will be able to answer some of my questions, because a wonderful declaration is meaningless without a series of measures and reports that enable us to make progress. I hope that in five years’ time disability will be mainstreamed and that the UK, once again, will have a leading role across the world in encouraging others to do the same.

Health Systems (Developing Countries)

Debate between Lord Bruce of Bennachie and Fiona Bruce

Thursday 11th December 2014 Westminster Hall

[Sir Malcolm Bruce (Gordon) (LD)]

I am pleased to have the opportunity to debate these three reports, which as it happens are timelier in their outcomes than we realised when we started them. The Select Committee on International Development decided that we should visit Sierra Leone and Liberia to see how the Department for International Development was working in post-conflict situations and how it was working with development partners, particularly the Americans, in Liberia. That was an interesting and informative inquiry. When we visited the two countries in June, Ebola was present, but at the time, it was apparently not imminently as out of control as it has become. At the same time, we had also been doing an inquiry into DFID’s role in helping to strengthen health systems. One can see a certain irony in how those things came together at the time we were conducting our inquiry.

I will take things in that order, concentrating on health and then adding a couple of points about the development programmes. In those countries where we have a bilateral partnership and health is a significant part of the engagement, DFID has a good record, supported by all the evidence, of using the funding to help build stronger and more effective and coherent health systems.

About half of DFID’s health money goes in that direction, but the other half goes to the vertical and multilateral funds, where we found much less concentration on building health systems, perhaps for the understandable reason that targets were being set to deliver reductions in malaria and HIV/AIDS and everything was set in those terms. However, to achieve those targets, an infrastructure for delivering them is ultimately needed. We were anxious to ensure that the money going into vertical funds left a legacy of stronger health systems. What has happened with Ebola vindicates the argument that we made.

In Sierra Leone and Liberia, we saw health systems that were beginning to show some signs of effectiveness, but as we now know, they were totally overwhelmed by the Ebola crisis, which they are incapable of handling. The Liberian system was probably in slightly better shape than Sierra Leone’s, but then it was ahead on the curve. Nevertheless, both of them were overwhelmed.

One thing we are clear about is that if the international effort now going into bringing Ebola under control is to have a lasting legacy, it should also go into ensuring that when the immediate emergency is ended, Sierra Leone, Liberia and Guinea, on which there is more of a French lead, have health systems in place that will be resilient and robust enough to withstand any further similar outbreak. The situation also makes it clear that strong health systems are an essential component of development and in the global national interest, because such diseases, whether resistant, endemic or epidemic, can spread everywhere if not contained in their own territory. Strong health systems are in everybody’s interest.

One disappointing thing is that although the African Union countries made a declaration at Abuja that they should spend 15% of their Governments’ budgets on health, of the 50 members, only six have actually done so. Although I commend DFID—I am looking at the Minister here—we must urge the development partners to share the commitment. Without their commitment, they will never achieve effective health systems, which requires both political will and commitment. Therefore, we conclude that we need to put even more resource into completing the job that had only just started in Sierra Leone, and ensure that the legacy of tackling Ebola is not just that we get it under control but that we leave behind something much more substantial for the future of those countries. That is essentially the major point we must make.

Interestingly, the evidence told us that the UK national health service has a significant contribution to make in this area, in a number of ways. First, contrary to some popular opinion, in a Commonwealth evaluation of health services across the developed countries, the NHS ranked top, as the best health service in the world. We know that it is not perfect, but we should not sell short what it can do. We are seconding people right now from our own health service to work in Sierra Leone; perhaps not quickly enough, but we are doing so.

However, several issues came to light. One is that there ought to be a permanent partnership across Government to use DFID and NHS capacity and expertise to help build those health systems. That was and is being done in Sierra Leone, but our inquiry revealed—my hon. Friend the Member for Stafford (Jeremy Lefroy) raised this issue with the health adviser this morning—that we are not training enough health service staff for our own needs. I argue, and to some extent the Committee’s recommendations suggest, that we should be training more than enough staff for our own needs, on the grounds that we could then second people abroad without leaving our own health service understaffed.

Although we have a policy of not recruiting directly into the NHS from a long list of developing countries in a worthy attempt to avoid brain-draining qualified health professionals from poorer countries, the fact remains that they are not prevented from coming here or applying, and there are doctors and nurses from Sierra Leone working in our health service when one would like to think they would be working in their own health service alongside our volunteers and secondees to tackle the problem. This needs a cross-Government approach and it is not the responsibility of the Minister’s Department, but I ask him to take it on board that discussions with the Department of Health should address those issues, which are in the national and international interest.

I will touch on the reason why we went to Sierra Leone and Liberia before the crisis engulfed them. Those countries had been riven by civil war. The UK effectively intervened in Sierra Leone and ended the civil war, for which I can testify the people of Sierra Leone are extraordinarily grateful. It might amuse the House to observe that one sees more Union Jacks driving through Freetown than in Ayr. It is a declaration of appreciation. The partnership is constructive and is valued by both parties.

Sierra Leone is a bit of a forgotten country. The UK is the lead donor, and there are few others. It is literally a far-away country of which many people know very little, yet it and Liberia have an interesting history that is different from anywhere else in Africa. Liberia was settled by freed slaves from America in the early part of the 19th century. Interestingly, the country that first recognised Liberia as an independent state was not the United States of America but the United Kingdom, a fact that Liberians are anxious we should know.

I will say in passing, however, that some of us were a little shocked or bemused—I do not know which—by Liberia’s national flag and symbol. I think it has a ship with a pennant saying, “We came here in search of freedom.” The vast majority of Liberians never left, and there is a dichotomy between the freed slaves and their descendants, who are the elite, and the majority of the people, who have not had good governance over a very long period of time.

The current president is to be commended, in that the situation is changing and there is a much greater will to govern for the whole country. We made only a short visit; we were only able to go to Monrovia. However, people told us that while Monrovia looked a reasonable city, the rest of the country had virtually no roads, no infrastructure and no support. Again, that is a development challenge that needs to be addressed.

Sierra Leone was founded on a similar basis, by freed slaves from the Caribbean, and it has a definite Caribbean feel to it. Obviously, it enjoyed—I think “enjoyed” is the right word to use—administration by the British for many years, before it gained full independence. There is a legacy of roads and infrastructure that, again, the people value. However, it is still at a very low base; Sierra Leone is still a very poor, deprived country.

Our Committee recommends that, first, regardless of the Ebola crisis, we continue the current level of support. However, now we are where we are and both countries have been knocked back, the Department, although it has immediately given extra resources, needs to reassess its long-term programme, especially for Sierra Leone, which will need more resources than have so far been committed. That is not a criticism but a recognition of reality. We hope the Department will be able to provide those extra resources.

We made some criticism of the centrally managed programmes—we have engaged with the Department since on this issue—because, to say the least, we were a bit disappointed to find that we were not getting all the information on what the British Government are doing in Sierra Leone. We got it in bits and pieces from different sources. When the Committee visits a country where the UK has a bilateral aid programme, we almost expect—we have asked for this for many years—to get a full breakdown, or at least an assessment, of the bilateral programme, the multilateral programmes and engagement with the international agencies such as the World Bank and the African Development Bank; of course, it may not be an absolutely precise figure. However, we found that substantial programmes were being delivered in Sierra Leone that local DFID staff had no engagement with at all, and knew very little of. There may be good reasons for that, and we have asked DFID to give them if there are, but we still think that openness and transparency and an understanding of those programmes’ interaction would be helpful.

[Fiona Bruce (Congleton) (Con)]

The right hon. Gentleman is making an extremely good point. He will recall that exactly the same issue arose when the Committee visited Brazil: it was only almost as we were leaving that we were provided with a comprehensive plan.

[Sir Malcolm Bruce]

My hon. Friend is right; in fact, it was actually after we had left. We have now learned—I am smiling at the Minister—how to ask the questions. We asked in general terms what our official development assistance was, and DFID said, “We don’t have an ODA programme in Brazil, but HM Government do.” On returning from Brazil, we found that the Foreign Office had a £40 million ODA programme there. We do not object to that; we just think we should know about it, and the reason for it.

We had a similar concern regarding Sierra Leone. It is a question of transparency and understanding. Such knowledge helps us to make a good case: we are doing much more in Sierra Leone than is apparent, so why not say so? Ironically, when we went to Liberia, where our programme is a lot smaller, everything had been thrown into the pot to make the budget look bigger. So, the exact opposite approach to that taken in Sierra Leone was being adopted in Liberia.

I get the impression that the Department has learned something from this dialogue, and that the situation will change. We have asked the Independent Commission for Aid Impact to look at the centrally managed programmes, simply because the Department has not given us a clear explanation of strategy, listing exactly what should be done through centrally managed programmes, what should be done locally, and why. What is the rationale for choosing one method rather than the other? We are not saying that those ways are wrong and do not deliver, but it is not clear what they deliver and why, and we would like some clarity.

As the reports state, it is absolutely right for the UK to be the lead donor in Sierra Leone. We have a degree of responsibility, and the partnership works and is appreciated by both sides. Playing a supportive role in Liberia, with the US, benefits Liberia and the UK’s interaction with the US, because the UK and the US have a strong connection. We urge the Government, perhaps once they have gone a little further in dealing with the Ebola crisis, to tell us how they propose to set out a reconstruction programme for Sierra Leone in the coming years, because that is what is required. We urge DFID to take on board our recommendations on strengthening health systems. In particular, DFID should use its influence with the multilateral agencies to ensure that, where they put aid money into health—whether through vertical funds or other health programmes—they build in the objective of leaving a legacy of stand-alone functioning systems.

We should also open a dialogue with partner countries to get them to make health a greater priority on behalf of their citizens, not least because the aid community’s prioritising of health is almost giving some countries an excuse not to do so. The scale of the challenge is such that the aid community will never deliver a sufficiently strong health system on its own, and nor should it. Unless there is a partnership and a willingness on the part of Governments to contribute, we will not get the result we seek.

Notwithstanding the Government’s formal response, I hope the Minister will pick up on the points I have made. We are very appreciative of what DFID is doing. The circumstances have changed. There were a number of criticisms, which I hope the Department will address. Our engagement in these two countries is extremely important, but it needs to be ramped up if we are to get them back on their feet after the crisis that has engulfed them in the last few months.

[Fiona Bruce (Congleton) (Con)]

I begin by thanking the Minister for the Government’s detailed response to the Committee’s report, “Strengthening Health Systems in Developing Countries”, which I will speak to. I also wish to put on the record—and not just because we are approaching the season of good will—our appreciation of the International Development Committee’s Clerks and assistants for their expert help and invaluable contribution to our reports, and indeed to all the Committee’s work.

Strengthening health systems gets to the heart of much of what the Department for International Development must now be about, as we move from the millennium development goals to the sustainable development goals. Aid must be proactive as well as reactive, seeking prevention as well as cure. Clearly there will continue to be epidemics and tragic random events of nature or war, such as the Ebola outbreak or the current crises in Syria or Iraq. That is precisely when a robust in-country health system becomes so important. A mature and progressive approach must focus on the long-term goals of building the organisations, in-country institutions and the attitudes that will enable developing nations to become truly independent and truly developed.

One of the ways that is done is through building the networks by which health care resources can be spread, establishing training institutions that can make health care systems sustainable and bringing Governments to account, so that they realise the realistic and significant benefits of prioritising health care. If the latter in particular is not done, much of the health care action that this country’s aid workers overseas seek to undertake will be only half done.

I am reminded of the time that the Committee visited Ethiopia. We saw some dedicated community health workers, who were funded by DFID. They were young women who were going out into remote rural communities and talking to women in their homes about how to improve their health and hygiene with 10-step plans. Those women were visited and revisited until the good practices had been embedded. However, we visited the clinic in the same region, to which these women would go to give birth to their children and have treatment if they were ill, and quite frankly it was filthy. What was of even more concern was that when we challenged the Government Minister on this issue, he responded, if I recall correctly, “Yes, hygiene is a problem in Ethiopia.” Unless we have more joined-up thinking on the part of the Governments and institutions of the countries in which we are seeking to support the health systems, we will, as I say, find our work only half done. That is why this has to be a priority.

It is good that DFID takes this matter seriously and that the Government have responded positively to almost all the recommendations in our report. It is also good that much of our report recognises the excellent work that DFID does. DFID is an acknowledged leader in this field, particularly in transparency and sharing information. Our Committee is always reminded, wherever we go, of its significance in the field of development around the world.

[Sir Malcolm Bruce]

I agree, but does my hon. Friend acknowledge that we heard some evidence that, good as DFID was, it was rather hiding its light under a bushel, and that people felt that it should be doing much more to provide leadership and that it had slightly lost its edge in that area—not what it is doing, but in inspiring and encouraging others?

[Fiona Bruce]

The right hon. Gentleman pre-empts me, so I thank him for that pertinent comment. One of the thrusts of the report is that although DFID is in a prominent and influential position, it does not take advantage of that. Many of the Committee’s recommendations ask not for a change of policy, but for DFID to use its expertise and good practice to improve the practice and governance of the organisations, institutions and partners with which it works. It is good that the Government largely agree with that aspect of the report.

Let me turn to specific recommendations in the report. First, in response to recommendation 14, the Government state that they have shown leadership on working with women and girls,

“nutrition, female genital mutilation and early and forced child marriage, all of which require dismantling cultural barriers.”

I commend the Government’s work in this area, which gets to the heart of effective aid. It is not just about money pumped in or relief parachuted to problem spots; it is about dedicated work over time with locals on the ground to address fundamental barriers to health provision.

I cite, for example, the work done by aid workers in rural villages and rural communities in Ethiopia, where early child marriage involves children as young as six being married off and where children are even pledged to one another at birth. We heard a moving story of a young girl in her early teens who benefited from the teaching of some of the health workers in rural communities, who encourage young women not to allow themselves to be married early, but to stay in education and preserve their health and well-being, so that they do not end up with early sex and early childbirth. Instead, they can give themselves hope and a future and can contribute more fully to their communities than they would do were they married off early, which, in the misguided view on the part of their community, is somehow regarded as strengthening the community’s future.

It was really moving to learn that that young girl was only a few years younger than her older sister in her late teens, who had been married off early. She described how her older sister was already damaged and isolated, living almost alone, having been abandoned by her so-called husband, her education wrecked and her future looking very bleak. That is just one example of where the work of our DFID representatives, in strengthening health systems in a proactive, long-term way, is so effective.

Transparency is another area where DFID’s performance is exceptional in the field—if I remember rightly, it has been ranked second out of 68 countries. I commend this work. Will the Minister elaborate on the Government’s response to recommendation 6 in our report? The Committee recommended

“that DFID work harder to encourage its partners to make more data on their health systems strengthening work freely available.”

The right hon. Member for Gordon also mentioned that.

In their answer, the Government emphasised DFID’s good record, but regarding other organisations and partners they merely said:

“DFID will continue to set a good example to its partners on transparency and to encourage them to follow this example.”

Perhaps that could be more strongly stated. Perhaps the Minister will put some flesh on the bones of that statement. How will DFID seek to do that and what are its realistic aims and hopes in this area? The Committee’s inquiry showed that although DFID is world leading in this area, perhaps it is not leading the world as much as it could. I encourage the Minister to make use of DFID’s position, its reputation and its relationship with the various multinational organisations to have a greater impact in this area.

I now turn to recommendations that the Government partially accepted. I am pleased that the Government seem to be in general agreement with the Committee on how DFID needs to move forward to apply aid more effectively. Recommendation 4, for example, examines the need for an internationally agreed measure of

“system strengthening expenditure and efficacy as part of discussions about the post-2015 development goals.”

This is clearly an essential task over the next year.

The Government response states that such measures are not part of the post-2015 process. However, they also state:

“Some early thinking has been done about what would be required to develop a common framework for tracking health systems strengthening expenditure.”

Perhaps the Minister could expand on where that thinking is taking DFID and whether the Department has any time line on drafting such a framework.

Recommendations 15 and 16 relate to volunteering, which the Committee Chairman mentioned. I thank the Minister for his Department’s commitment to develop better frameworks and practices for volunteering in response to those recommendations. I should like to reflect with him, and with hon. Members in the Chamber, on the impact that nurses, doctors and even finance and management specialists—which the Committee made recommendations on—can have on health work in developing countries.

Let me mention the work of some volunteers with medical expertise in the Conservative party’s Project Umubano, of which the Minister—whom I am delighted to see here—is an august member, having been a part of that volunteer project virtually every year since its inception. Volunteers in the project go out for one or two weeks a year to Africa: Rwanda, Burundi and Sierra Leone. They are self-funded—so they are really on a minuscule funding basis—and go out there to make a difference in those countries. I remind the Committee of the difference that can be made, even in such a short time, and why it is therefore so important that we look at supporting volunteering from people with NHS expertise.

I should like to quote from an account from this year’s Umubano from Dr Sharon Bennett—who is, if hon. Members are not aware, apart from being a qualified and practising doctor, the wife of my right hon. Friend the Member for Sutton Coldfield (Mr Mitchell), the former Secretary of State.

“This was my 8th year in Rwanda, and it was wonderful to return to this special place, where I have made so many friends and treated so many patients over the last decade.”

She speaks of spending time at the Umubano health outpost, a clinic in a fairly remote area founded by Umubano volunteers, who raised funds to build it, and opened in 2011:

“I am happy to report that it is thriving, and we are now putting together a proposal not only to do preventative clinics—HIV, immunisation, ante-natal—but to have a daily minor ailments clinic there. This will bring healthcare closer to this extremely vulnerable group of people.

Every year I see the Health Centre grow, in all ways. The dedication of the staff at the centre is truly humbling.”

She is speaking about the staff that the volunteers have gone out to help train as they set up systems in the health outpost. She said:

“My most happy story this year, and possibly from all my visits, was reviewing a young woman with her happy and healthy seven month old baby. The outlook for mother and child was very different a year ago. In 2013”—

Dr Bennett went out in the summer of 2013—

“she came to see me late on in her pregnancy, when she was very short of breath. She had been treated for a chest infection. However, when I examined her it became clear that she was in heart failure, caused by a valve problem in her heart. If this had gone undiagnosed, she and the baby would almost certainly have died in labour from the huge amount of strain that is placed on the heart during child birth. She was transferred to Butare Hospital and put on medical treatment to take the pressure off her heart. The baby was delivered safely. In February next year, surgeons will be visiting from the United Kingdom to give her a new heart valve.”

Is that not a wonderful story and a microcosm of what can be done if we encourage volunteering from this country to such countries?

I want also to touch on the wonderful structural work being done by Mr Sheo Tibrewal, a consultant orthopaedic surgeon who has helped to set up a postgraduate orthopaedic course in a university in Rwanda. That is a wonderful piece of work he has done over many years. He has strengthened the structure of the university departments and ensured that medicine and dentistry are better able to implement a strategic plan, in conjunction with the Government’s work out in Rwanda. Those are just two examples of where volunteering can make a difference, and I am sure that, with greater support from DFID in conjunction with the NHS, we could see many more. Will the Minister update us on how deliberations on that are progressing? How can support be given to those NHS workers who would like to volunteer abroad, whether in the short or longer term?

That leads me neatly to recommendations 5 and 8, which touch on the difficult topic of how we can encourage other organisations or partners in other countries to take health system strengthening seriously. The Committee recommended:

“If DFID is not satisfied that system strengthening is being given sufficient priority by an organisation, and that organisation does not change, DFID should be prepared to withhold funds.”

That is strong—it may be a nuclear option—but as the Committee’s discussions with the Minister in Ethiopia showed, we have opportunities to challenge thinking at the highest level in those countries, and we should take them. I know how much those countries value the financial support and expertise that come from the UK and DFID, and we should not hold back from challenging Governments at the highest level on such issues.

The Government response rightly states:

“A decision to withhold funding to Gavi or the Global Fund would have a significant impact in developing countries”.

Although I am sympathetic to the Government’s caution, can the Minister satisfy the Committee that he intends to make progress in this area? Progress is vital and should not be seen as an optional extra. We should ensure that we take a tough line with Governments who are unwilling to take responsibility for the long-term health of their populations.

We also have a duty to take a tough line not only in-country, but in our country. That is critical. The Chair of the Committee touched on this, but we need to ensure that our people are made aware of the remarkable work done by DFID and representatives across the world, so that there is a greater degree of support than at present. The debate on the 0.7% Bill showed that there is a strong and vocal, but perhaps small group of people who are critical of what DFID is doing. One only has to look at the amount of private donations made to appeals to see how much the people of this country support what DFID is doing on international development. However, we need to spend some time focusing on that work to ensure not only that we challenge other Governments to take up the responsibility of communicating the importance of that work to their inhabitants and residents, but that we do the same here at home.

Post-2015 Development Goals

Debate between Lord Bruce of Bennachie and Fiona Bruce

Thursday 4th July 2013 Westminster Hall

[Sir Malcolm Bruce (Gordon) (LD)]

As you know, Mr Havard, we are having two debates this afternoon: this one, and then one on the Department for International Development’s engagement in Pakistan. They will be approximately equal in length, depending on hon. Members’ contributions.

The Select Committee on International Development took the view that it was important that we engage in the process of the post-2015 development goals, and we took evidence from a fairly wide variety of sources. We reflected first on the achievement of the millennium development goals for 2015, and thereafter on what we needed to take forward. When the MDGs were set up in 2001, they were rather slow in gathering momentum. Some people suggested that they were hatched in a basement of the United Nations, which is probably slightly unfair, but they certainly were not the product of wide consultation. Nevertheless, over time, the MDGs became a definite focus of development policy for the UK and many others. It is interesting that in its annual report, for example, our own DFID would put against the country programmes a series of traffic lights indicating how well a country was doing in relation to those goals. In time, a lot of developing countries took ownership of their responsibility for securing development goals.

However, we must also reflect that the goals were somewhat mixed in their intentions and expression, and slightly different in substance. Although they were helpful in driving the agenda, we clearly were not going to hit them, and many countries—particularly the weakest ones; the ones that the UK is most engaged in—are off course for achieving them. It would be unacceptable to arrive at 2015 and say, “Well, that was an interesting exercise. Here are the overall performance indicators of who got how far towards them,” and have that be the end of it. We recognised that we had to ensure that the job was not left unfinished and that we moved forward. The UN then appointed a high-level panel with our own Prime Minister as a co-chair, which reported a few weeks ago.

The first thing that we were concerned to address, whatever the new process did, was much wider ownership of it through thorough consultation and engagement. I think that we can honestly say that the process has been much more inclusive than the original one. However, we also wanted it to address some of the shortcomings of the original goals, such as the fact that a goal of halving absolute poverty by 2015 could leave the other half of people in absolute poverty. Also, if absolute poverty is $2 a day, it is much easier to raise somebody to that level from $1.90 than from $1, so there is a tendency to concentrate on lifting those people just below the margin. Ironically, that means that the poorest of the poor could be left further behind. That did not always happen, but it could be the consequence, and we were anxious to ensure that such unintended consequences were not incorporated into the next round of goals.

It is also important to recall that there are huge inequalities. The question of how well we have done globally on achieving various MDGs can disguise the fact that some countries are nowhere near, whereas countries such as China and India have made the biggest progress and account for the highest proportion of the success. Even within countries, it may be possible to show that targets have been broadly met, yet some communities may have fallen completely behind. Again, we were anxious to ensure that things were much more inclusive in the future and that the disparities within communities were addressed. We also thought that, ultimately, having a livelihood—perhaps a job, but some means of earning a living—is the best way out of poverty, and that that needed to be incorporated into the goals.

In that context, we were pleased that the high-level panel was appointed, and we were extremely pleased that our Prime Minister was given such a prominent role within it. That was testimony to the UK Government’s commitment to development; we will deliver 0.7% of gross national income this year, unlike many countries. The quality and focus of what we do is also highly respected. It is essential that we acknowledge that that has been achieved through strong cross-party support, and this is an achievement of which our country can be justifiably proud.

I make a side comment on the justification for that decision for those who choose to criticise it. Any of us who engage in countries where poverty is severe and endemic understand completely that however difficult our problems in the United Kingdom, they in no way compare with the absolute poverty that exists in parts of sub-Saharan Africa and south Asia. We should be absolutely clear that as long as we have the capacity to work in partnership to help to lift those people out of absolute poverty, we should be unashamed in our commitment to doing so.

[Fiona Bruce (Congleton) (Con)]

Is it not true that if we can help countries to lift themselves out of poverty, particularly through developing businesses that will pay tax as part of the formal sector, we can also benefit from trade opportunities, particularly in countries such as those in Africa?

[Sir Malcolm Bruce]

My hon. Friend is absolutely right. In countries that have lifted themselves out of absolute poverty, whatever role aid has played—one likes to think that delivering health and education infrastructure contributes to that—ultimately it was their own economic uplift, taking people with it, that turned those countries around, although that has not solved all their problems. China still has 200 million people living in absolute poverty, while India has 400 million, but they have lifted huge numbers of people out of poverty, which is a fantastic achievement that has more to do with the dynamics of those countries’ economies than with aid, although I contend that aid certainly helped them achieve that, particularly when it was targeted and focused.

Good and valuable as the 2015 MDGs have been, they left many people behind, and in many cases, they did not deliver a clear and identifiable qualitative benefit. For example, the process of enrolling children in primary education says nothing about whether they actually learn anything, and we often found that enrolment did not lead to completion. Even when it did, the quality of the education was so poor in some cases that it was questionable whether much benefit was achieved. Nevertheless, having that driver meant that something was done that would not otherwise have happened. There was variation, because in some cases the quality of education did make a material difference and the children stuck at it.

We were anxious to contribute to the debate about what we should do next. We wanted to say first that we could not arrive at 2015 without moving forward to what happens next, and that the process had to be conducted in such a way that there was ownership around the globe right from the outset. Goals had to be drawn up together, not imposed from above.

Since we published our report, the high-level panel has reported, and I hope that it is appropriate for me to comment on the panel’s report because I hope that it reflects our contribution a little. It is a long report that includes a lot of information, but two specific aspects are the five “transformative shifts” and the 12 proposed goals, which have sub-goals attached. To be absolutely clear, the high-level panel has not sought to finish the job. Its objective was to set the framework and push out ideas about what the principles should be, and the second part of the process will turn that into clear, quantifiable, realistic goals that can take us forward for the next 15 years.

I welcome the five shifts, the first of which is to leave no one behind, which addresses one of the fundamental failings of the 2015 MDGs. The second shift—putting sustainable development at the core of things—which we also recommended, is absolutely essential. The dilemma is that we live in a rich part of the world—a very rich part of the world compared with where the poorest people live—but people in poorer parts of the world aspire to the kind of living standards that we enjoy. If they are to do that in the same way that we did, we are short of the resources of two planets.

We cannot turn around and say to those people, “Thank you very much. We are very rich, and we are sorry, but there are too many of you and you are too far behind. You can no longer have that aspiration.” That would be intolerable—indeed, it would not be accepted—so what we have to say is, “How do we work together to enable you to aspire towards our level of living standards in ways that are compatible with sustaining life on the planet?” It is therefore welcome that sustainable development is involved in one of the five transformative shifts.

A further shift, which is relevant to my hon. Friend’s intervention, is transforming economies for jobs and inclusive growth, because ultimately that is fundamental to sustainable poverty elimination. Another shift is to build peace, and effective, open and accountable institutions for all. That is not just a pious declaration, because we know that the greatest poverty persists where there is conflict or in post-conflict situations. Ending conflict and moving people out of conflict are absolutely essential if we are to eliminate absolute poverty. The final shift is to forge a new global partnership, which I think means that every country should sign up to the new agenda, including those in the developed world, so that this is not an “us and them” scenario, but a global compact.

From those shifts, the high-level panel has proposed an outline of 12 goals, the first of which is to end poverty. The second is to empower girls and women, and achieve gender equality. As I have said on many platforms, I believe that that is one of the core necessities for poverty reduction and development. In too many poor countries, the exclusion of women, and indeed how they are treated, holds back their entire society. In my Committee’s recent report on violence against women and girls, we make the point that if women are treated as chattels, if they are beaten and mutilated and if they are denied rights to livelihood, legal representation and land, the whole society is denied the benefits of a proper partnership for growth and development. We feel strongly that that is an absolutely central issue.

The third goal is to provide quality education and lifelong learning in recognition of the fact that when primary and secondary systems have failed, people have to be given opportunities as adults. We must ensure that we deliver quality education. The fourth goal is to ensure healthy lives and basic health provision, while the fifth is to ensure food security and good nutrition. Again, a report that the Committee has just published identifies the changing patterns of what is needed if we are not just to feed the world, but to feed the world nutritiously. Too often we find that whole generations are stunted and blighted for life because of their poor diet.

The sixth goal—to achieve universal access to water and sanitation—is a huge challenge, but absolutely essential, while the seventh, which is to secure sustainable energy, has the potential for a great deal of global co-operation. I have already mentioned the aim of the eighth goal, which is to create jobs, sustainable livelihoods and equitable growth. The ninth goal is to manage natural resource assets sustainably, the 10th is to ensure good governance and effective institutions, and the 11th is to ensure stable and peaceful societies. The 12th goal is to create a global enabling environment and catalyse long-term finance. Those goals are just suggestions, because the point is that the process has to continue.

The Committee welcomes the fact that the high-level panel read our report. I am not suggesting that all members of the panel read it, but quite a few of them did. We know that for certain because two participants—or three, if the Prime Minister’s appearance before the Liaison Committee can be counted—gave evidence to us. I certainly hope that the Prime Minister and his advisers read the report, and I am sure that Michael Anderson, the distinguished and experienced civil servant who leads for us on these issues, has done so. We are pleased that a lot of the issues on which we tried to focus appear to have been taken forward, and we will continue to feed into the process.

There is a danger that setting an objective to eliminate absolute poverty by 2030 would lead to the conclusion that, if we succeed in doing that, it is job done, meaning that aid and development are no longer required. Raising people out of poverty means that they have an income equivalent to $2 a day, which is hardly a dream of untold wealth—we are talking about people who are still extremely poor.

As an aside, because it is exercising the Committee in another inquiry, it is said that countries graduate from low income to middle income at about $1,200 or $1,300 per capita a year, but countries such as the UK are approaching income of $40,000 per capita a year. I am not sure that I would regard a country in which the per capita income is $1,500 or $2,000 a year as anything like a rich country, or one that can solve absolute poverty in its own territory without co-operation and partnership with outside agencies. It seems to me that we can continue to provide such assistance for as long as the need persists.

I am pleased to have had a couple of opportunities to talk to the president of the World Bank, Dr Kim, who has made two things clear: we really must work to try to eliminate absolute poverty; and we should recognise that we need to raise the game beyond that and look to improving living standards way above the basic minimum that defines absolute poverty. He is clear that that means that we must engage with those middle-income countries that may be out of the bottom level of poverty but still have huge pockets of very severe poverty that require global shared responsibility and cannot just be left to be dealt with by the country’s own resources. I am speaking with countries such as India in mind. I think that our Committee will return to that matter over the next few months, and I hope that we will make further recommendations on how the Government should change their relationship with India and countries of a comparable ilk.

I am glad to have had the opportunity to present the Committee’s report to the Chamber, and I hope that we have made a useful contribution on where we think the focus should be. We absolutely support the case for ensuring that we have replacement development goals as soon as possible after 2015—in other words, by no later than 2016—and that those goals are sufficiently developed and refined so as to avoid the pitfalls of the first goals. The goals should enable us to deliver a clear strategy to address the fundamental problems of poverty and hardship over 15 years.

My only plea is regarding whether even 12 goals represents too many. We certainly do not want to have so many targets that people can pick and choose, or lose sight of them. One of the reasons why I like the five fundamental shifts is because, right at the core, they cover several fundamental issues on which we all agree, while the details are slightly more negotiable. In that context, the broad approach of the high-level panel is highly welcome, and we very much look forward to seeing how the process works.