Zimbabwe

Dan Poulter Excerpts

Wednesday 8th December 2010 Commons Chamber

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

We have heard a lot this afternoon, and about a number of issues. As the right hon. Member for Gordon (Malcolm Bruce) said, it is important not to ignore the politics of Zimbabwe in our debate today. The global political agreement—the GPA—was a step in the right direction for Zimbabwe, but, as a number of speakers have acknowledged, it was not ideal. A lot more is required from the Government of Zimbabwe on addressing the health care and education problems that were so eloquently outlined by the hon. Member for East Londonderry (Mr Campbell).

The right hon. Member for Gordon also pointed out that the people of Zimbabwe have a tremendous capacity for resilience. That is absolutely right, and it has already been shown. He mentioned the example of the hospital in Bulawayo, but there is another issue that we have to acknowledge in this debate. The infrastructure of Zimbabwe—a country that had one of the leading economies in southern Africa, boasting some of the best universities and hospitals—has been destroyed and degraded by Mugabe over a number of years. Although we want to see teachers, doctors and nurses returning to Zimbabwe, whatever we do with our aid, the key challenge is to help to rebuild that infrastructure, and particularly that university and hospital infrastructure. We still see a great rural-urban divide in health care—something that I want to talk about a little more—especially in women’s health, which the hon. Member for East Londonderry also mentioned.

Other Members have talked about the need for a southern Africa-based solution to the problems in Zimbabwe, and that is absolutely right. Other countries, particularly South Africa, have a role in addressing the issues in Zimbabwe and taking responsibility for their region. However, we have to be wary of that, given the example of what happened in the Congo. We must ensure that those African countries are not exploitative in their interactions with Zimbabwe. Although it is absolutely right that those countries should take a more active role, there are examples from history, including in the Congo, that indicate that such interest from neighbouring countries is not always benevolent.

One thing that we need to stress is that all the aid to Zimbabwe from DFID needs to be results orientated and target driven. We need to ensure that the aid gets to the people. The right hon. Member for Gordon mentioned Zimbabwe’s indigenisation restrictions, which prevent many companies and organisations from taking an active role in helping to build up the Zimbabwean economy, because of the need for the state to have a 51% share in those companies. That forms an important backdrop to the debate, because the restrictions prevent the engagement and interest of overseas companies in the Zimbabwean economy. When we focus our aid and our attentions through DFID, it is important to look at where that aid can be effectively targeted. A particularly important aspect of that is health, which I want briefly to talk about now.

As Members will be aware, I have a background in obstetrics, and I have always taken a keen interest in improving women’s health, not only in the United Kingdom but overseas. The leading cause of death among women in many countries in Africa is the problems associated with childbirth, including haemorrhage and eclampsia. The single most important focus of intervention in any health care system in many African countries is to ensure that assistance is available at the time of delivery. The World Health Organisation tells us that one of the great problems in Zimbabwe, particularly in rural areas, is the fact that, since the collapse of the health care system, the infrastructure of midwives and obstetricians has been completely degraded and destroyed. If we are going to focus aid effectively, we need to ensure that we provide assistance around the time of childbirth.

I want to highlight a few of the problems that exist. The WHO tells us that, in 1997, the maternal mortality rate in Zimbabwe was 700 per 1,000 live births. In 2005-06, it had more than trebled to 2,500. That is a significant increase, and it dramatically demonstrates the degradation of the health care service in Zimbabwe. Rates of HIV are also increasing. The hon. Member for East Londonderry made the point very well that some of the targeted interventions are working when dealing with the vertical transmission of HIV from mother to child. The rate of contraception use, particularly in urban areas of Zimbabwe, is also rising. Having said that, the HIV rate in Zimbabwe is 15.3% at the moment. The life expectancy for women in many parts of Zimbabwe is only 47, and the primary reason for that is HIV and AIDS.

I alluded earlier to the rural-urban divide. The problem is particularly pronounced in many rural areas of Zimbabwe, where women—and people generally—have difficulty accessing health care. Part of the reason for that is the breakdown of the hospital structure, but there is also a need to improve people’s knowledge about health care services through education.

We have seen models of health care developed in many other countries in Africa, such as Rwanda, where maternity and other health care services have been built up. Part of that has involved insurance coupons schemes that people can buy into in order to insure themselves against ill health. Another part of the access to health care involves teaching the population to have an awareness of when someone is ill—for example, in maternity, when someone is having an obstructed or difficult labour—and when they need to go to hospital or seek further help. Even when they do that, however, we need to ensure that the vital expertise that they need is available in hospitals. That involves not only supporting the development of the universities but ensuring that doctors and nurses feel safe enough to travel back to Zimbabwe to work there. At the moment, despite all the efforts, that is not happening.

Although we can agree that the Government in Zimbabwe are better than they were, that having a joint Government is a good thing and that steps are being taken in the right direction, a lot still needs to be done. Having a global political agreement is all very well, and it is good that the economy is improving, but the health and education infrastructure is still very much lacking. I hope that the Minister will be able to tell us that the targeted aid that goes into Zimbabwe will be focused on the health infrastructure, and particularly on issues such as maternal mortality and training midwives in rural areas, as they will really make a difference to the people there.

[Hugh Bayley (York Central) (Lab)]

This has been a good debate, with lots of well-informed speeches, but I particularly admire the speech that we have just heard from the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), who spoke with a great deal of knowledge as an obstetrician. What struck me most about his speech was his understanding that health problems in Zimbabwe are fundamentally constrained within the political environment, and that unless there is a political solution to the crisis that Zimbabwe faces, basic human needs will continue to be poorly met.

I spent a great deal of my time in the 1970s campaigning for change in southern Africa. I was a member of the executive committee of the Anti-Apartheid Movement. I spent quite a bit of time standing outside Rhodesia House, as it was then called, demanding an end to the unilateral declaration of independence and calling for true independence for the country.

I am delighted that Zimbabwe is free and has been free for 30 years—independence in Zimbabwe gave a significant boost to the momentum for independence in Namibia and South Africa—but I am sad that true freedom, human rights, the rule of law, peace and, above all, prosperity for the people of Zimbabwe are yet to come.

The hon. Member for Mid Derbyshire (Pauline Latham) mentioned a southern African proverb: “Don’t look where you fell, but where you stumbled.” That is good advice. She talked about one stumble being the cave-in by Mugabe to the unreasonable demands of the so-called war veterans and the subsequent land invasions, but we would misunderstand the situation in Zimbabwe if we felt that that was the first stumble that took place.

The British colonial period did not cover our country in glory. The Jameson raid was a putsch by a white colonial adventurer. The independence process in the late 1950s and 1960s was botched and led to UDI in 1963. Then there were 17 years of an illegal regime—in defiance of this country, the legitimate authority. That delayed independence and created very serious problems for an independent Zimbabwe in 1980—not least a legacy of nearly two decades of war.

The problem of human rights abuse in Zimbabwe was clearly illustrated in the remarks of the hon. Member for East Londonderry (Mr Campbell). The country is still plagued by appallingly bad governance and by an absence of the rule of law. When Morgan Tsvangirai as Prime Minister seeks to challenge illegal and unconstitutional appointments to top jobs—for example, the appointment of Gideon Gono as director of the central bank of Zimbabwe—he is unable to use the courts to set them aside and make new appointments, despite the fact that the official procedures should allow that.

Unemployment in Zimbabwe is currently about 90%. The country used to be better off than most African countries. The latest figures I have been able to dig out show that gross domestic product per capita stands at some $450. That figure is several years old and it is possible that the position has improved, but that $450 per person in Zimbabwe compared with $618 per person in sub-Saharan Africa as a whole.

The HIV infection rate, as we have just heard from the hon. Member for Central Suffolk and North Ipswich, is extremely high—one of the highest in Africa and about three times the average for sub-Saharan Africa as a whole. Some 15% of the population are infected compared with a still appallingly high average for sub-Saharan Africa of 5%. Life expectancy at 44 years has fallen dramatically from more than 60 years, which applied at the time of independence. Again, it compares unfavourably with other sub-Saharan countries, for which the average is 52 years.

[Dr Poulter]

Is the hon. Gentleman aware that in Swaziland in the early 1980s the HIV infection rate was about 1%, but by 2000 it was nearly 40%? Although we live in an age when there is better access to HIV drugs, even in many parts of Africa, targeted interventions to deal with HIV—given the high rate in Zimbabwe—should form an important part of any aid strategy for the country.

[Hugh Bayley]

Yes, I strongly agree with that. During the Committee’s visit to Zimbabwe in February, we spent some time looking at HIV counselling and testing programmes and other measures funded by DFID that were delivered largely by NGOs. Most certainly, we should be providing aid. Even with a framework of poor governance, it is possible for British aid to make a difference. The availability of antiretroviral drugs, for instance, has improved because of the help of outside donors, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Some indicators are good. Health expenditure in Zimbabwe is higher than the average for sub-Saharan Africa, as are sanitation rates. In Zimbabwe, 69% of mothers are attended by a skilled childbirth attendant, compared with 46% elsewhere in sub-Saharan Africa. Therefore, Zimbabwe has the capacity to recover, when it finds the political leadership to enable it to address problems of catastrophically bad governance. Some of its infrastructure—literacy levels, for instance, are better than in many other countries in Africa—provides the country with the opportunity to bounce back.