Global Fund to Fight AIDS, Tuberculosis and Malaria

Lord Chidgey Excerpts

Thursday 12th December 2013 Lords Chamber

Asked by

[Lord Chidgey]

To ask Her Majesty’s Government what assessment they have made of the impact of the replenishment pledges for the Global Fund to Fight AIDS, Tuberculosis and Malaria, made by world leaders in Washington in early December.

[Lord Chidgey (LD)]

My Lords, at their meeting in Washington at the beginning of this month, world leaders confirmed their pledges on the fourth replenishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria. The Global Fund congratulated the UK on demonstrating strong leadership in global health, with a major contribution pledged to the Global Fund for the next three years. The United Kingdom will contribute £1 billion to the Global Fund for the 2014-16 period, the second largest pledge by any Government so far after the United States of America. Dr Nafsiah Mboi, the Global Fund chair, cited the extraordinary generosity and leadership of the United Kingdom since the fund was founded in 2002. She said that this new commitment would underline a transformative step forward for the Global Fund partners in their fight to defeat HIV/AIDS, TB and Malaria, and gave an inspiring model of responsible global partnership.

Perhaps I may say at this stage how pleased I am that my noble friend Lord Fowler is in his place and will be contributing the benefit of his wealth of knowledge on these issues to the debate. I also welcome my noble friend Lord Verjee, who I am delighted to say has chosen to make his maiden speech in this debate. I know that my noble friend is able to speak from his personal experience in these matters and I look forward to his contribution today and to many more in the future.

The United Kingdom commitment to the Global Fund is geared towards encouraging other donors to maximise their own pledges and thus unlock additional funds with each new pledge. Can my noble friend the Minister say in her response what has been the impact so far of the Washington pledges on securing new pledges, or even indications of new pledges, at this time?

In its contribution towards ending world poverty, the United Kingdom is helping to halve malaria deaths in 10 of the worst affected countries by 2015. The United Kingdom has targeted saving the lives of 50,000 women in pregnancy and child birth, and 250,000 new-born babies, as well as helping to immunise more than 55 million children against preventable disease. The Global Fund pledging conference has set a target of $15 billion for the fourth replenishment. So far it has received $5 billion from the USA, the equivalent of $1.6 billion from the United Kingdom, and $612 million from Canada. A number of other pledges, notably from northern Europe, bring the total pledged to date to more than $12 billion.

The Global Fund was created in 2002 as a public-private partnership to raise funds to change the course of HIV/AIDS, TB and malaria. The United Kingdom has now become the second largest donor after the USA, pushing France into third place. Since 2002, the fund has approved more than $23 billion for grants spread over more than 150 countries. The fund accounts for 21% of all international funding for HIV/AIDS, 82% of international funding for TB and 50% of global malaria funding. It is the biggest funder of programmes to prevent, treat and care for people with these diseases. Big strides have been made, with 9.7 million people receiving antiretroviral therapy for HIV/AIDS and a further 30 million mosquito insecticide-treated nets being distributed in the first six months of 2013, making a total of 340 million nets. My noble friend may be aware, however, of disturbing reports that in some areas these bed nets are being used as fishing nets, which is clearly totally inappropriate. Does her department have any details of this departure and the effect it may have on the impact of the fourth replenishment?

The Global Fund’s TB programmes are continuing to expand, with the number of cases being supported now exceeding 11 million. However, the UK could be doing more, to which I shall return later. The UK’s latest £1 billion pledge to the Global Fund will maintain the record of “a life saved every three minutes”. Taking a lead in the worldwide fight against HIV/AIDS, TB and malaria, United Kingdom support over the next three years will deliver antiretroviral therapy to 750,000 people, 32 million more insecticide-treated mosquito nets to protect against malaria, and TB treatment for over 1 million more people. The UK’s allocation to the Global Fund will save a life every three minutes over the next three years and it will dramatically improve the lives of millions of people across the globe. Your Lordships will be aware that there are those who question the efficacy of organisations such as the Global Fund and its ability to channel the generosity of the United Kingdom into effectively combating diseases such as AIDS, TB and malaria. However, serious analysis confirms that the statistics demonstrate incontrovertibly that we can win this global battle on behalf of the poor.

On a human scale, I am sure that noble Lords can recall, like me, witnessing the suffering of those afflicted by these diseases and their like. I think of my visit to a hospice in Soweto in 2004, where volunteers were comforting and caring for patients dying from AIDS. Many were too weak to speak and unable to understand what was happening to them, having been abandoned by their families. Left to die on the streets, they were brought into the hospice by volunteer community workers who had been trained in basic healthcare by a handful of dedicated nurses. Almost 10 years on, thanks to organisations such as the Global Fund, the ravages of AIDS are gradually diminishing, with the hope that they will become something of the past in due course.

More recently, indeed just this summer, under the sponsorship of the charity RESULTS, I visited a district hospital outside Lilongwe in Malawi where small children were being comforted by their mothers as they struggled for breath and literally for life against the advances of pneumonia and TB. Further afield, at village health posts, I watched children being vaccinated by health workers, who were hampered by the fact that the transport of the cold boxes essential for the storage of vaccine was at the mercy of the poorly maintained and therefore unreliable fleet of motorbikes. Just to add to the difficulties, it was a 14-kilometre walk to the health posts for families living in the most remote communities.

Considering the Global Fund’s present challenges and the UK’s responses, it is the case that the poor relation in the three worldwide health campaigns seems to be tackling tuberculosis. TB is contagious and airborne. It is the second most deadly infectious disease in the world, and last year it was responsible for 1.3 million deaths and 8.6 million new cases. TB is the leading cause of death for HIV/AIDS-positive people and is responsible for one in five HIV deaths—that was 320,000 deaths last year alone. TB is estimated to have killed more people than any other pandemic in history, and is developing a drug resistance which makes it more expensive and more difficult to treat, with many more adverse implications and side-effects for patients. An estimated 3 million people a year who develop TB are not officially diagnosed or treated, with no guarantee of treatment outcomes.

The Global Fund has demonstrated that, with investment and leadership, significant gains can be made, but it needs to work with agencies such as DfID to be fully successful. It cannot operate in isolation. DfID can and should invest in issues such as TB which have an impact on health outcomes in the UK. DfID can and should prioritise issues that are important to the UK taxpayer. DfID can and should invest in new and innovative projects that could represent significant steps forward.

TB is a largely neglected disease. Only one new drug has received regulatory approval in 42 years and the old-fashioned BCG procedure offers no protection to adults and cannot be used on people with HIV. Moreover, it does not protect against the most common type of the disease. It is estimated to cost the EU region alone almost €6 billion a year, yet the region accounts for only 4.7% of global cases. Leadership from DfID in a country like the UK could be transformative. It could lift the profile of the disease and show that it is still a major issue, which could lead to additional investment. DfID has provided a model response to malaria, putting it at the forefront of the global aid agenda. The 1.3 million people dying every year from TB and the 8.6 million who suffer from the disease need the level of support and commitment that only an aid agency like DfID can provide.

I should be very grateful if, in her response, my noble friend could address this and the other issues that I have raised.

Rana Plaza: Fashion Industry

Lord Chidgey Excerpts

Tuesday 10th December 2013 Lords Chamber

[Baroness Northover]

The noble Lord is right to identify responsibilities here. There are responsibilities, as the noble Baroness indicated in her original Question, in terms of the brands themselves and the work that they do. Clearly there are responsibilities in the countries concerned. In the case of Bangladesh, there is a legally binding accord that includes the unions representing garment workers, and independent structural and fire safety inspections are being undertaken of the factories from which these companies are sourcing. It is very important to make sure that regulation is in place and that it is properly implemented,

[Lord Chidgey (LD)]

My Lords, the Rana Plaza and Tazreen disasters would have been avoided if statutory building codes and fire regulations had been observed. As DfID staff in Dhaka have noted, non-compliance poses a real threat to workers across the country. What were the outcomes of the UKTI-led discussions in Dhaka this May about the availability of British services to improve the quality of construction in Bangladesh? Does my noble friend agree that with Bangladesh lying at 136th out of 175 in Transparency International’s list of perceived most corrupt countries, some progress in DfID’s initiatives on fighting corruption there is imperative?

[Baroness Northover]

My noble friend is quite right in his final point. DfID sent three UK experts to Bangladesh in September. They are assessing needs and helping to inform work on supporting the enforcement of regulations. It is also extremely important to support the Bangladeshi Government’s financial management and make sure that is more transparent, including on budgeting, accounting, auditing and scrutiny. We are supporting NGOs to bring corruption to light, because that is the way that these regulations will be properly enforced.

Syria

Lord Chidgey Excerpts

Tuesday 19th November 2013 Lords Chamber

[Lord Chidgey (LD)]

My Lords, some 18 months ago, Turkey was considering intervening in Syria to create a humanitarian buffer. At the same time, US State Department officials were mooting a similar no-kill zone. The massacre at Srebrenica tells us, with a very good example, why a humanitarian corridor would require a protective military presence. Who would provide it in Syria, and with whose collective agreement?

[Baroness Northover]

My noble friend is absolutely right, and that bears out the answer I just gave to the noble Baroness. We would require the buy-in of all the parties or that kind of military enforcement. That is why the major organisations working in the area—for example, the United Nations, MSF and the ICRC—have reservations about the proposal for a humanitarian corridor for the very reason that my noble friend referred to. Sometimes, these result in civilians being less safe. He pointed to the Bosnian example, but more recently, of course, there has been the Sri Lankan example. There are examples where not only civilians, who are supposed to be protected, are in greater danger, but the humanitarian workers who may appear to be shielded by particular military groups are also under greater threat.

Millennium Development Goals

Lord Chidgey Excerpts

Tuesday 22nd October 2013 Lords Chamber

Tabled by

[Lord Chidgey]

To ask Her Majesty’s Government what new millennium development goals they would prefer to see introduced post-2015.

[Lord Dholakia (LD)]

My Lords, on behalf of my noble friend Lord Chidgey, and at his request, I beg leave to ask the Question standing in his name on the Order Paper.

Overseas Aid: Post-2015 Development Agenda

Lord Chidgey Excerpts

Thursday 25th July 2013 Lords Chamber

[Baroness Northover]

I can assure the right reverend Prelate that we are already doing that. A great deal of work went into ensuring that this year’s CSW could reach agreement. It required a lot of work but we were delighted that that agreement was reached. We are already working on the next one and are delighted that the second of the 12 goals is on gender equality.

[Lord Chidgey]

My Lords, according to a report on EurActiv.com under the headline “Brussels proposes pooling world aid development funding”, the EU’s Development Commissioner, Andris Piebalgs, issued a statement on 16 July proposing that, post-2015,

“all types of development aid … be considered as ‘a whole’”,

including ODA for low-income countries. He described the statement as,

“another big step towards putting in place the … post-2015 framework”.

How can Mr Piebalgs’ initiative apparently to place world aid under a European Commission social development agenda be compatible with DfID’s vision of using ODA as a means of growing economies so that they can trade out of poverty? Will the Government be seeking clarification?

[Baroness Northover]

I have seen a copy of what Commissioner Piebalgs said and he was talking about all financing sources, which includes private finance flows, domestic resources and ODA. We quite agree that all those things can contribute to the relief of poverty. We work very closely with the Commissioner. I have certainly found, after meeting him many times, that he and DfID very much agree about how best to take this forward.

International Development: Diseases of Poverty

Lord Chidgey Excerpts

Wednesday 24th July 2013 Lords Chamber

[Baroness Northover]

The noble Baroness gets to the nub of the problem. This is why special effort must go into supporting research in these areas because it is, of course, the poorest who suffer from these diseases and cannot pay the prices for the drugs. I think about 1% of any investment went into this area of neglected tropical diseases, which is of course why Gates took it up. At the moment, he funds 49% of the research being taken forward. That is a template for what we are doing and why we are supporting it.

[Lord Chidgey]

My Lords, with DfID’s support, health organisations have been successful in developing a wide range of new health technologies to address the diseases that we are clearly aware of in developing countries, including TB and malaria. Can my noble friend tell us how successful the outcomes have been, and how confident she is in the results, given that countries such as the DRC and Nigeria together account for some 40% of the deaths from malaria, yet they have the most inadequate data of any country?

[Baroness Northover]

DfID’s research investments have helped to develop a range of treatments plus tests across these areas. For example, there is a diagnostic test for TB which is now available in 29 countries and a child-friendly, life-saving anti-malarial is now available in 39 countries—just to give my noble friend an indication of positive outcomes. We are also working very hard at country level to improve the quality of data to strengthen accountability because he is quite right: if we are to measure this properly, it is very important to have such data coming in.

Global Partnership for Aid Effectiveness

Lord Chidgey Excerpts

Tuesday 16th July 2013 Lords Chamber

Asked by

[Lord Chidgey]

To ask Her Majesty’s Government what progress they have made, as part of the Global Partnership for Aid Effectiveness, in developing and specifying the aid effectiveness indicators outlined in the global agreement reached at the High Level Forum in Busan.

[Baroness Northover]

My Lords, 10 indicators and associated targets for a framework to track global development effectiveness were agreed internationally in June 2012. The UK has provided detailed feedback on proposed data to be used for each indicator. These data will be collected until mid-September and published in time for a major meeting on development effectiveness in early 2014.

[Lord Chidgey]

My Lords, I thank my noble friend for that reply. The Busan agreement includes the commitment to strengthen the role of Parliaments in the oversight of the development process by monitoring to ensure that aid is on budget lines that are subject to parliamentary scrutiny. What measures are the Government taking to ensure that the Busan parliamentary scrutiny includes democratic accountability, challenging the view of some that there is no relationship between democracy and development? What plans do the Government have to compensate for the drain on parliamentary capacity in developing countries caused by the high percentage of parliamentary staff trained under aid programmes leaving for more attractive posts elsewhere?

[Baroness Northover]

As my noble friend will know, parliamentarians are represented in the global partnership steering committee meetings, and DfID certainly believes that democratic government helps to promote sustainable development in the way which he has indicated. That is why we are supporting democratic elections through various programmes and other work, which we will be supporting in 13 countries by 2015. As for his point about the drain in staff, between 2011 and 2012 DfID invested £181 million in public sector reform, which includes improvement of staff performance and retention. We very much understand my noble friend’s point.

Africa: Development

Lord Chidgey Excerpts

Thursday 27th June 2013 Lords Chamber

[Baroness Northover]

My Lords, as my noble friend Lord Ahmad said on an earlier Question, the previous Government and this one have taken this matter forward. As the noble Baroness recognises, it was very actively addressed at the G8. She will also appreciate from her time in government the difficulties of taking it forward. I hope she will pay tribute to the progress that was made in this regard because we all recognise that this is extremely important. We need to ensure that companies operating in Africa contribute to the development of African countries.

[Lord Chidgey]

My Lords, in relation to elections in Africa, the AEO report notes that aspects of democratic change, such as the institutionalisation of state structures that respect citizens, social and political rights and foster political and economic transparency and accountability, have not yet taken root in many African countries. What measures are the Government taking to address that in their search for aid effectiveness across the DfID programme?

[Baroness Northover]

As my noble friend will be aware, this is clearly a major concern and it is also flagged up in the report. I note with some interest the greater success and prosperity among those countries in Africa that are making progress in this regard. Those countries should very quickly be able to see that it is in their self-interest to take this forward for their greater prosperity.

International Development: Budget

Lord Chidgey Excerpts

Tuesday 11th June 2013 Lords Chamber

[Lord Chidgey]

My Lords, I, too, congratulate the noble Lord, Lord Empey, on securing this debate, on his thoughtful contribution and on the concise way in which he presented it, which is an example to us all. I will certainly try to follow that example.

It is a delight and a privilege to follow my old friend, the noble Lord, Lord Judd, who was first elected as an MP in Portsmouth many years ago when I was a young student at Portsmouth Polytechnic. I am afraid that he did not persuade me to vote for him. Nevertheless, it is always a pleasure to hear him extolling with such oratorical skill his well-known absolute commitment to international aid and development. I shall try to follow him with a few precise words of my own.

For some months now, there has been a mounting campaign within the defence community for the MoD to be given an ability to draw upon elements of Britain’s aid and development budget. The attempt to access this ring-fenced budget as part of the comprehensive spending review has thrown up suggestions that DfID should, for example, pay for flights on RAF transport aircraft, in particular for military helicopters used to carry civilians as well as soldiers, by prepaying a guaranteed number of flights for each type of aircraft in regular use by DfID. There have also been suggestions that DfID should pay for some naval patrols and protective equipment required by civilian staff. The Royal Navy’s Atlantic Patrol Task is a case in point. Tasked with protecting our interests in the Caribbean, the APT takes on humanitarian aid during the hurricane season, together with assisting with counternarcotics and anti-terrorism operations.

There has been a push from the MoD to redefine more of its work as official development assistance, not surprisingly given the way in which the Prime Minister’s remarks about establishing effective links between defence and development have been largely, if not blatantly, misinterpreted in some quarters. They were spun to mean that more ODA should be spent on defence, increasing the momentum being created behind the campaign to that effect. However, the fact of the matter is that ODA can be spent by the military only on very specific activities due to strict guidelines from the OECD and the United Kingdom’s own International Development Act 2002, to which the noble Lord, Lord Empey, referred.

Apparently, discussions between the MoD and DfID are ongoing, so perhaps in her reply the Minister could tell us whether an options paper has yet been put to the National Security Council and, if so, when its response is expected. The Government have made it clear that they would like to see more of the aid budget diverted to defence by building up the Conflict Pool already used by DfID and the MoD.

If we can help states riven by conflict and war, and help to deliver security and provide stability, we also provide the base on which all development can proceed. The Government’s commitment to investing greater resources in preventing violent conflict before it breaks out is widely welcomed. The use of the Conflict Pool through the Building Stability Overseas strategy is widely seen as a step in the right direction.

The Independent Commission for Aid Impact’s recent report, Evaluation of the Inter-Departmental Conflict Pool, recognised that it has proved effective at identifying and supporting worthwhile conflict-prevention initiatives and has delivered some useful, if localised, results. It goes on to say that the Conflict Pool functions well as a responsive grant-making instrument for supporting small-scale peacebuilding activities by local parties in conflict-affected countries.

The ICAI report identifies a number of ways in which the Conflict Pool can be improved through greater attention to how the cross-departmental approach should work in practice, identifying more clearly how Conflict Pool spending can achieve impacts on the scale required, adopting a more conflict-sensitive approach, and improving monitoring and evaluation systems. I would be grateful if the Minister could inform the House of the actions that the Government have taken, and are taking, in this regard.

Aid is not the only mechanism that the UK can use to promote peace and support stability and development. According to Saferworld, there are a number of ways in which the defence community can contribute to conflict-prevention activities—elements such as security and justice sector reform, small arms counterproliferation and monitoring arms transfer control arrangements. Some may count as ODA while others may not. The MoD mentions the BSOS in its Defence Engagement Strategy paper but does not set out how it intends to contribute to upstream conflict prevention. This gives an impression of a lack of commitment to the BSOS and belies the MoD’s responsibility to ensure that its approach in fragile states works towards the vision of stability outlined in the BSOS. Will the Minister clarify how the MoD is working to fulfil its commitments under the BSOS, which sets out the UK’s approach to addressing conflict overseas?

Finally, I echo the words of Bill Gates who, with the Gates foundation, has set new heights in philanthropy in aid and development. When he opened DfID’s new offices in Whitehall last week—in fact, we should not really call them new; that is a misnomer as they are a refurbished conversion that will hopefully do the job—he said that the UK should take great pride in the compassion and generosity of its people and its commitment. Mostly, it should take great pride in its ability to deliver effective international aid on a scale that makes the UK a world leader, and the Gates foundation its preferred partner.

Global Fund to Fight AIDS, Tuberculosis and Malaria

Lord Chidgey Excerpts

Tuesday 4th June 2013 Lords Chamber

[Lord Chidgey]

My Lords, I congratulate my colleague and noble friend Lord Fowler, first, on securing this debate and, secondly, on the remarkable way in which he set out the problems which we face.

I first came face to face with the scourge of HIV/AIDS about 10 years ago, in Soweto in South Africa. I was taken to a hospice and clinic run mainly by volunteers and funded by donations from the local community. At that time, victims of HIV/AIDS whose illnesses had reached their final stages were being cast out into the street and left to die. The hospice volunteers went out into the townships each and every morning to bring in the abandoned and the dying, and to provide them with clean beds and nursing care during their last days and hours in the comfort of the hospice. I recall standing by the bed of a desperately ill young woman, possibly still a teenager, searching for some words of comfort or solace. Beyond speech, she just looked up with despairing and frightened eyes. It was yet another human tragedy unfolding.

The clinic attached to the hospice had the main task of mobilising the community, particularly those from the families of HIV/AIDS victims, to be trained in basic healthcare procedures. The concept was to provide a core of basic healthcare support for HIV/AIDS victims in their homes. At that time, the clinic had trained over 350 volunteer community healthcare practitioners, working with the families in the townships. During the same visit, we met with the leaders of the Johannesburg chamber of commerce to be briefed on the impact of AIDS on the economy. The heaviest toll was being taken in the extractive and heavy haulage industries, where the death rate was so high that employers had to expect a complete replacement of their workforce every four years. A lack of education and of access to antiretroviral drugs and a reluctance to be clinically tested all added to the difficulties in attempts to contain the epidemic. As the noble Lord, Lord Fowler, said, South Africa has made great strides since then but, as he also pointed out, the drugs are not a cure.

A little later, with a delegation to Botswana, I visited the local research centre in Gaborone, established and funded by the Gates foundation as part of a multimillion dollar project to combat the spread of HIV/AIDS. At that time, I recall that more than 35% of the population in Botswana were infected by the disease. The project was having some success, particularly among the young in the more remote areas of the country. A problem was that as their health improved under the Gates drug regime, there was a trend to return to a pattern of unprotected casual sex, in the mistaken belief that they were now cured, so the educational aspects of the programme had to be revisited.

The United Kingdom has been a major supporter of the global fund since 2002. The coalition Government have maintained the commitment to £1 billion over the period 2008-15, with annual commitments in line with this pledge. It is to DfID’s great credit that it has played a key role in supporting the fund, following the cancellation of the 11th round of funding, by bringing some payments forward—meaning that the £1 billion pledge is likely to be met a year earlier.

In 2011 the global fund was rated “very good value for money” in DfID’s multilateral aid review, or MAR, the same as the GAVI Alliance—the former Global Alliance for Vaccines and Immunisation—which, however, received a substantial increase in investment in that year. Since the MAR, DfID Ministers have repeatedly said that they will significantly increase or even double the UK’s contribution with a further £1 billion. However, a strong pledge is needed now, ready for the 2014-16 replenishment. Will the Minister provide the strongest possible indication of when the Government intend to honour their pledge?

There is no doubt that investments through the global fund and other partners in the treatment of AIDS, TB and malaria have produced dramatic results. AIDS deaths have declined by 24% since 2005, as millions have gained access to the treatment. Half of the malaria-affected countries are on track to reduce cases by 75% by 2015. The global goal to reverse the spread of TB has been achieved ahead of schedule. Nevertheless, donors must be vigilant in detecting financial abuse or incompetence. Last October, the global fund found that in Djibouti over one-third of the $23 million grant had been misused or gone missing. Six months on, what action has DfID taken with the global fund to establish how this happened, and what steps have been taken to prevent a recurrence?

The global fund sees this replenishment year of 2013 as critical for the future, with the need to raise $15 billion to tackle the three diseases in the period 2014-16. The three diseases, AIDS, TB and malaria, face an historic turning point. We now have the tools and the knowledge to curb the trajectory of all three epidemics, but we can achieve this only with an ambitious funding scale-up in the coming years.