International Development (Official Development Assistance Target) Bill

Lord Bishop of Derby Excerpts

Friday 23rd January 2015 Lords Chamber

[The Lord Bishop of Derby]

My Lords, I, too, congratulate the Government and the leaders of all the major parties on, at a time of amazing austerity and financial challenge, this bold commitment to a generous settlement in our public finances for the support of those in developing countries, especially the poorest of the poor. As we have heard, the 0.7% is an international target and therefore a very important sign that we play our part in an international community in a responsible way. Many activists, and church members in particular, are concerned for us to make that witness to global citizenship, and see this as an important issue. We have heard that it is important for us to be able to plan and be efficient and effective in the deployment of these resources. We have also heard that it creates more stable and peaceful societies, and gives us better communities with which to trade.

Some of your Lordships were in a debate in December about soft power. This is a very important sign to the world of a narrative of a generous country that has high values. We need that narrative in an age when our young people are being radicalised by other, more violent and narrow-minded narratives. This is very important sign not only to our own society but across the world, especially to young people, about generosity and commitment to others. Some of us, too, were involved in the legislation proposed for slavery. I met a young man who, when he was six, was sold by his family into slavery in the fishing trade in Africa because they were so poor. I met a young woman who, when she was 12, was sold into sex slavery in Nigeria because her family were poor. This kind of policy and this kind of committed, regular and properly audited investment in building societies across the world joins up with other concerns we have, such as the slavery issue, and the fact that it is not just an issue here but across the globe.

Like my colleague, the noble and right reverend Lord, Lord Williams, I am privileged to be a trustee of Christian Aid. The noble Lord, Lord Purvis, gave some statistics, and we are proud to be involved in the provision of clean water, schools and financial services, and in working with women and girls. They all provide stability and capacity for local societies to be healthy, peaceful and forward-looking. The OECD estimates that for every pound spent on some of these enterprises, developing countries gain an additional £350 in increased revenue, which shows how effective targeted and planned investment can be. Christian Aid is proud to work with DfID in programmes such as those to eradicate malaria; to give priority to women and girls, as the noble Baroness, Lady Royall, said; and to provide mobile technology to help health services develop appropriately in rural areas. All those things need consistent and planned investment, as does the response to climate change. There are more and more signs of flooding in El Salvador, for example, and more and more problems relating to a lack of water supply in Kenya as the climate changes. Christian Aid is proud to work with DfID and others to be proactive in being able to plan to tackle those issues and to invest in them properly.

I say thank you to the noble Lord, Lord McConnell, for his inspiring words and say to the noble Lord, Lord Lipsey, that it is not just a matter of neat systems. This is a moment for giving a sign, to our own people and across the globe, about our commitment to generosity, the development of others and a mutual world that works through partnership—a narrative that is radical in the proper way.

Developing World: Maternal and Neonatal Mortality

Lord Bishop of Derby Excerpts

Thursday 15th January 2015 Lords Chamber

[The Lord Bishop of Derby]

My Lords, I too congratulate the noble Baroness, Lady Hayman, on securing this debate and on introducing it with such expertise and such a challenging sense of the statistics. Millennium development goals 4 and 5 are not being met and, as other speakers have said, the consequences are horrendous. My contribution will be from my own experience working with people at the grass roots, and I will then tease out what the implications of that experience should be.

I work in the diocese of Derby, in England, and we are twinned with the Church of North India, which extends from Calcutta to Mumbai—the whole of north India is twinned with our diocese in an ecumenical link. I work with people in a number of Indian communities where this issue is enormous. In 2012, one-third of global neonatal deaths happened in India. The highest rate of first-day mortality is in India. That is the context in which we are working with our partners, through whose eyes we discern some factors.

The first, as other noble Lords have said, is poverty. People just do not have the means to call medical help and there is no local infrastructure available anyway even if they could. That kind of poverty is a major factor. The second factor is the lack of education about basic hygiene. I visited slums in Calcutta with the Cathedral Relief Service, which trains very young girls of 10 to 12 to wander in and out of people’s houses, giving good advice about hygiene and childcare. This helps families learn good practice in an unthreatening way and will produce a new generation of young mothers with those skills. This is a practical, grass-roots response.

My colleagues in India would say that the third factor is that a lack of respect for women and girls is behind these terrible statistics. The attitude so often is that this is their role—illness is not taken seriously—and their job is to run the household. New mothers are expected just to get up and carry on with things. Fourthly, in the urban areas, the issue is not so much a matter of the infrastructure being hundreds of miles away but that whole families live on pavements and give birth there. I was in Calcutta in December and saw families living in the street with no resources, cutting the cord with an ordinary knife because that was all that was at hand.

That was a snapshot of some of my experiences; what are the responses? I work with ISPCK—the Indian version of the publishing house—and the Cathedral Relief Service in Calcutta. As the noble Baroness, Lady Kinnock, was hinting, they say that the key is to have strong, empowered women. Research by the Cathedral Relief Service in Calcutta shows that 63% of pregnant women in the slums are anaemic. That is an appalling starting place. I visited a slum where they had just invented a green goo to give to people to build up their resources—I had to taste it, and it was a really testing moment in intercultural activity. People have to take this kind of local initiative to build, literally, physically strong women.

Women have to be empowered, too, and many people in development know that it is by building up women that families survive and have structure and leadership. We spend a lot of time in our diocese raising funds to provide sewing machines for women so that the family has a livelihood. This year, we are raising funds to create businesses for recycling in Delhi, where all the waste from industrialising India needs dealing with. It is only by giving women that kind of strength and security that they will be able to deal with some of the issues about family planning and their self-respect and standing in the community.

Other things that we do with our partners include running education and immunisation programmes, as well as doing home visits. We show films in the slums, and some villages have health days, when volunteers go out and gather people around. So what are the implications that I am learning? The key one is partnership. There is a partnership between the people of Derbyshire and people in the slums and rural areas of India around this issue, which provides practical help and tries to empower women and provide infrastructure.

I am privileged to be a trustee of Christian Aid, which specialises in partnership working with local agencies. We work in Kenya, Malawi and Bangalore, in India, and there are lots of stories that I could tell—like the ones from Derbyshire—of partnership working. Most exciting is our partnership at the moment with DfID. The Minister came to the Christian Aid carol service and launched a match funding scheme for a project in Kenya on this very topic. We should congratulate the Government on their approach to partnering with organisations such as Christian Aid, which have a lot of expertise on the ground and grass-roots connections and can deliver real change. I am proud of the way that our Government are investing in that. Clearly, we can always do more and clearly we need millennium development goals that will challenge the Government more, but I record on behalf of Christian Aid our positive experience of working with DfID and what a good job comes out of it.

I finish with two questions for the Minister. If developing countries need encouragement to ensure provision for maternal healthcare, what can the Government do to up their game about partnership with those who have grass-roots contacts? That is where we need to operate—with those who are excluded at grass-roots level. We need to connect with those people. How can the Government up their game, working in partnership and investing their funds, while using their influence with other Governments for grass-roots activities?

Secondly, we all know that a lot of problems in developing countries are caused by the unsatisfactory tax base. So much of what could be raised by taxation to provide money for health and other infrastructure is shifted out of the country by the way that corporations operate financially. Both the Prime Minister and the Chancellor have spoken out against this practice, commendably, and we have had debates in this House about it. I would be interested to know what the Minister thinks about the part that getting a better tax structure in developing countries plays if we are to equip people in their own places to take up this work and meet the challenge.

Human Rights

Lord Bishop of Derby Excerpts

Thursday 21st November 2013 Lords Chamber

[The Lord Bishop of Derby]

My Lords, I, too, congratulate the noble Lord, Lord Alton, on securing this debate, and I also associate myself with the remarks of the noble Lord, Lord Selkirk.

Many of the pictures painted are dramatic and challenging, and I invite the House to think a little about the context that we are in and how we might approach some of these huge issues. The Government have identified six key priority areas, including women and freedom of religion, and those are the two things that I will look at in particular. We are in a world where we have ideals and fall short of them, and need to negotiate between the two.

In my own language, I start by inviting us all to look at the motes in our own eyes. I am embarrassed that my church has legislation in place to discriminate against women, as much religion still does. We are moving towards tackling these things, and the prime movers have been women themselves. One point that the noble Lord, Lord Alton, made is that the victims need to be listened to so that they can help us understand what changes are required. It is not legislation but the stories of the victims that need to come first.

We as a church have been criticised, rightly, for the long and tortuous path of giving women full access to leadership in our institution. It is very easy for society to think that we have already done that: we have sex equality legislation and human rights legislation. Noble Lords will know that next Monday is White Ribbon Day, when in this country we remember the increasing levels of violence against women in our society. That is part of the context.

Just yesterday I was involved in a debate for Parliament Week—where the theme, as we know, is “Women in Democracy: Women in Society”—about lads’ mags and the fact that companies such as Tesco sell these magazines along with cheese and cornflakes. They objectify women and normalise the offensive attitude of making women commodities. We give large companies such as Tesco the freedom to degrade the women in our midst. That is the context in which we come to this debate: the motes in our own eyes.

I will suggest a way in which we might move forward. I think that the Government already have some line on this: the Foreign Secretary talks about engaging with complexity and the Minister talks about being pragmatic. We need to be pragmatic in negotiating between ideals and reality. As a trustee of Christian Aid, I know that women are key to development, with new voices and new perspectives, but I also know through my work with Christian Aid that the human trafficking of women and girls is increasing exponentially. Therefore, the ideals and the practice are in enormous tension.

I turn briefly to my specific point. The 2012 list of countries about which we have particular concern does not include India. My diocese works with churches in north India and is especially involved with Christian Dalit peoples—the lowest caste. In the past week, I have been in touch with a colleague in Delhi who worked with Christian Dalit women. She told me about Lakshmi, who works on a construction site from six in the morning till six at night and has to sign a register saying that she is getting the minimum daily wage, although in fact she is paid less than half of it. She also told me about a girl called Anjum, who was put into a brothel at the age of 15 and, last week, was rescued by the churches. She had found herself in that position because she was a Dalit woman in that culture.

The Prime Minister has just visited India and is talking about a special business relationship with that country. We need that: it will be good. However, what can we put into that relationship that will lead these issues to be taken seriously? In your Lordships’ House earlier this year, we made a decisive intervention during the passage of the Enterprise and Regulatory Reform Bill about Dalits in our own country. First, how can we take that learning and that experience into our work with business in India to help people aim for a similar result?

Secondly, how can we maintain concern for women and girls caught up in the ever-expanding criminal work of human trafficking? Thirdly, how can we look at the motes in our own eyes and challenge the right of large companies such as Tesco to degrade women in the midst of selling cheese and cornflakes and make it normative? As has already been asked, how can we better play a role in the UN? Finally, I guess that I and my colleagues on these Benches need to go back to our own institution and ask how women can play a more constructive and creative role among us so that we have more integrity in contributing to this debate.

Tourism: Music

Lord Bishop of Derby Excerpts

Thursday 11th July 2013 Lords Chamber

[The Lord Bishop of Derby]

My Lords, I, too, congratulate the noble Lord, Lord Storey, on securing this debate. The noble Lord, Lord Clement-Jones, mentioned the iconic Rolling Stones concert in Hyde Park in 1969. Perhaps I should put on record the fact that I was there.

As we have just heard, music is not only important but a much underrated offer that we make to the rest of the world through tourism. When people come here for music tourism, they engage in making community and in being joined with others in a common culture through hearing a common language. Such things are very important for us to offer across the world as well as across the regions in this country. It is important that we do not just measure its significance in terms of economic impact, although that is important, but that we recognise a cultural, human hinterland that is enriched from Plato onwards and we must be proud of it and contribute to it.

The VisitBritain document, Delivering a Golden Legacy, identifies four principles to encourage this kind of tourism. The first is to recognise our international image, which is about heritage, arts and music—as the noble Lord, Lord Black, mentioned. The second is to develop an overall product so that performance, hotels, shopping and local businesses are all connected. The third is to be ambitious in our invitation and the variety that we offer. Fourthly, tourism needs to be embedded in other strategies for other sectors. Many noble Lords have spoken in this debate to illustrate some of those principles.

The UK Music report, Destination: Music, starts, as did the noble Lord, Lord Storey, in his speech, with Glastonbury. The research is based on concerts and events of 5,000 people or more. That is very important, but I want, in just a few brief words, to go to two other areas which fall below the radar of that kind of scale but which show the importance of music and culture for tourism.

They both come from the east Midlands, which is where I operate and which has the exact national average proportion of music tourists—that is, 5% of the tourist mix. We need to increase that of course. The first area is the story of the Buxton Opera House and the Buxton Festival. If any noble Lords are looking for some wonderful entertainment this weekend, I can tell them that the Buxton Festival is still in operation—you can go to its website. In 1976, a fairly decrepit building with “Opera House” over its door was on the verge of being turned into a cinema. Three years later, by 1979, local residents together with the Royal Northern College of Music and the Welsh National Opera—contacts in those places—opened the first Buxton Festival. It now has a turnover of £1.4 million and receives only 10% of its income from grants. I want to emphasise that, because many people look at the arts, especially music, and think that it needs very heavy subsidy. In fact, a mere 10% of the building’s running costs enable a turnover of £2 million into the local economy. We are not asking a great deal, but strategic investment can create such opportunities locally for music tourism to flourish. The Buxton Festival works through a partnership between local enterprise, VisitEngland, Visit Peak District and local businesses.

Of course, the opera house has to be very nimble in what it offers because it needs to run all year. It runs a programme that includes everything from Abba tribute concerts to opera and all the things in between. It has to be nimble and offer a very catholic range of music.

I have told this story because it has moved from 1979 to 2015, which is the projected opening date for the Buxton Crescent and spa hotel—a crescent that has been carefully restored and will become a hotel destination for international tourists in that part of England in 2015. It has taken all that time, from 1979 to 2015, to establish a festival, to establish international links and for there to be a demand to come and stay in that kind of quality of accommodation. I therefore urge the Government to take seriously not only the regions and the small scale but the need for secure and sustained support for such incremental growth that will be the backbone of a national policy for music tourism.

The second area that I want to mention but which, again, does not feature in the most recent report of UK Music is of course—and you would expect me to say this from these Benches—church music and especially cathedral music. We have recently launched in Derbyshire a diocesan tourism website, because churches are a key part of the fabric of the tourism offer and we need to be organised to present them attractively. A key bit of that is music, because churches are among the few places that you can go where there will be a guarantee of music of some sort or other. Just this last weekend, in the parish of New Mills, we have had a festival of choirs—five choirs making the festival over the weekend. On the same weekend, in a parish called Fairfield, there was a five-day music festival with blues, the vicar getting together an impromptu jamming band and all kinds of music to bring people in. Our cathedral, like others, has an extensive programme of concerts, organ recitals and lunchtime events.

I go to a lot of these things and I spent 10 years working in a cathedral. Something that strikes me all the time is that when one goes to the door after a concert, particularly of the English choral tradition, it is people from overseas who want to say how amazing that kind of music is. It is something they rarely experience live in other cultures. The English choral tradition and English church music are a great jewel in our musical armoury and we need to ensure, as part of a tourist offer, that we can make them available and support them in small ways. That 10% investment in the Buxton Festival is an example of how small support can create stability, incremental growth and an attractive offer.

I invite the Minister to comment not just on the large-scale music offer to tourists but on how the Government can encourage support for smaller-scale events such as the Buxton Festival and for the English choral tradition and English church music, something that is unique and right at the heart of how we are perceived internationally in terms of heritage, art and music culture. How can we make that a key part of what we offer? I want to finish by reiterating that I think our musical heritage is a key ingredient for encouraging international tourism. In an age of terror and despair, we have a rich gift to offer and we must do all we can to make it available and to secure its sustainability.

International Development: Budget

Lord Bishop of Derby Excerpts

Tuesday 11th June 2013 Lords Chamber

[The Lord Bishop of Derby]

My Lords, I, too, would like to add my thanks to the noble Lord, Lord Empey, for introducing this debate, and I hope that noble Lords will see that not only do the right reverend Prelate the Bishop of Chester and I sit on the same Bench, we have a similar view on this issue. I thank my friend and colleague the noble Lord, Lord Judd, for his wisdom. I hope that I can simply embroider his words because he has said all that needs to be said. Not least is the point that this is not simply about a crude choice, it is about priorities and the particularity of aid alongside the necessity of the military.

I need to declare some interests. I am a trustee of Christian Aid, but tomorrow night I shall be having dinner with the adjutant of the Royal Hospital Chelsea, so I have some military friends and connections as well. I want to take a steer in my brief remarks from the Book of Common Prayer. The morning prayer, the second collect, is as follows:

“O God, who art the author of peace and lover of concord”.

I shall explore the difference between peace and concord. Peace is a spiritual state. It wells up in our hearts, developing harmony and good will towards others. It is what drives aid, it is what unites us across this House, and it is what unites the British people in the Government’s policy to protect 0.7% of our income for aid. There is a desire for peace through harmony, generosity and connection.

When we come to the concord bit, we have to put in place arrangements to deliver it, and it is concord that we cannot agree on. That is where we need political arrangements and sometimes military interventions to try to ensure that there is some concord. These things do not fit together easily and must be properly distinguished. I want to look at each of these emphases and put some questions to the Minister.

If we think about ordering, about the concord that we have to try to create and support across the world, my military friends would remind me that the military has always been involved in creating concord through delivering what we call aid or humanitarian support. I can give examples of this from Alexander the Great to the Napoleonic Wars. More recently, there is a priest in the diocese I serve who was in the Royal Air Force. He tells moving stories about his time as a serviceperson of being involved in humanitarian work such as the rebuilding of schools and getting supplies through lines in order to feed people who were trapped behind them. There is a long and important tradition of the military playing a constructive role in the delivery of what we would call aid. In that sense, we need to look at that military capability, which is often important in a natural disaster. Aid agencies tend to need to plan and budget carefully, but the military has the resource and dynamism to get in there and connect. If the military is going to be part of the aid scenario, we have to look at how that co-ordinates with what we understand about aid, aid agencies and DfID. Is there a case for joint training and planning, especially in relation to natural disasters, and should a co-ordinated effort be made? It is a question that can be asked and it needs to be pursued.

Let us think about the peace that aid agencies, DfID and others stand for alongside the military trying to develop and preserve concord, particularly through aid exercises. Let us think about aid more narrowly—the peace that comes from the heart through trying to connect human beings by helping women and girls, reducing infant mortality or whatever it might be. As the noble Lord, Lord Judd, said, there are tensions because, to deliver aid, people try to offer a kind of neutrality about the political context of finding order and concord. Whether there is peace or disorder, aid needs to be delivered.

Aid agencies and those in partnership with DfID try to work in partnership with the local, and often the local can see aid workers, if they are associated with the military, as foreigners and the enemy. Therefore, the aid operation on the ground, working through partnership, is put in serious danger by being associated with a foreign power.

Of course, as we have heard, the whole aid thrust of DfID and the aid agencies is about poverty reduction. It is not just about good ordering and trying to create the stability that people need. It is about positive things, such as tax justice, land distribution and trade arrangements. There is a much bigger agenda than the military can ever be involved in. So there is a place for military co-operation with the delivery of aid in some contexts. However, that must not compromise the ability of DfID and aid agencies to deliver aid in complex situations where it might be a handicap to be associated too closely with military operations that are associated with interference from a foreign power.

I conclude by asking the Minister to address a number of questions. First, will poverty eradication remain the key purpose of UK aid? Secondly, will the 0.7% commitment be targeted to aid and development and ring-fenced from foreign policy costs? Could there be some kind of quadruple lock to preserve that? Thirdly, what plans are there for the MoD and DfID to work more closely together? Fourthly, does the Minister recognise our concern for aid work if we blur the boundaries between military activity and the provision of aid? That puts the whole credibility of aid and those who deliver it in serious jeopardy.

Global Fund to Fight AIDS, Tuberculosis and Malaria

Lord Bishop of Derby Excerpts

Tuesday 4th June 2013 Lords Chamber

[The Lord Bishop of Derby]

My Lords, I too want to thank the noble Lord, Lord Fowler, for his persistence and commitment to this very important work and for his prophetic leadership.

I want to focus on TB, which, as we know, is preventable and manageable but needs the right resources. I commend the enormously impressive work of the global fund and, as mentioned by the noble Lord, Lord Fowler, the importance of national Governments. I want to particularly remind us of the importance of the global fund’s aspiration to work with what it calls civil institutions: partnership with people on the ground. To explore what that might mean and to encourage the Government to take that aspiration seriously in the way that we offer funds and seek accountability, I want to talk a little about Peru, which is recognised as among the countries with the highest TB burdens in the western hemisphere. If I understand them correctly, the indicators show that TB control in Peru may actually be deteriorating.

My second reason for talking about Peru is that I am privileged to be a friend of the Bishop of Peru. He and his family come from Chesterfield in my diocese and he visits us when he is in this country. This year, we have in our diocese of Derby a harvest appeal fund to help him build a school, a clinic and a church on one site where there will be proper provision from the system, civic society and education. That is a model of partnership. Last week, I spoke to Dr Townsend Cooper who is running a project for the diocese in Peru. He describes the working of all these efforts from the point of view of civil society—the church on the ground—as “filling in holes”. They do not have a sense of working in partnership; they feel they are running round filling in holes.

I will give one example of a case that he is treating at the moment that he discussed with me last week. They are helping a 13 year-old girl in Ventanilla who has cerebral palsy from a birth injury and was recently diagnosed with TB of her spine. The existing system swung into action: she was admitted to hospital and had surgery and medicines. Then, of course, she was sent home to complete the treatment, and home for this 13 year-old girl is one room on the back of a family property that she shares with her mother. She was discovered in this place by one of the visitors from the diocesan medical team. She was unable to go to hospital by bus because the surgery on her back made that journey virtually impossible. Taxi drivers refused to take her because, as the noble Lord, Lord Fowler, said, there is a stigma about having TB and she is regarded as dirty. Quite frankly, she would not have the money for a taxi anyway. The diocesan medical team picked her up and began to visit her. They did very simple things: hygiene, transport, education for her and her mother about management of the treatment and co-operation. What the doctor calls a very small amount of targeted help has transformed the situation, and the initial investment in the treatment is now again beginning to bear fruit.

That is just one little story, but I share it because it shows the problems of people of good will and faith on the ground who are trying to fulfil the aspiration to work with civil society. It alarms me that the director of this project says they feel like they are filling in holes. It is not a comprehensive enough system of outreach, partnership and co-operation so that the good work being done by the fund and national Governments is not biting as much as it might to make the difference.

I would like to make two points. First, I support the request for the Minister to comment on the Government’s pledge to increase investment in this fund. I also want to ask what the Government might be able to do to encourage the fund to take seriously its aspiration to work with civil society, and how to bed that in better so that those on the ground trying to fulfil this part of the complex response to TB do not feel that they are just filling in holes but are part of a more joined-up and coherent system.

Health: Neglected Tropical Diseases

Lord Bishop of Derby Excerpts

Wednesday 30th January 2013 Lords Chamber

[The Lord Bishop of Derby]

My Lords, I, too, thank the noble Baroness, Lady Hayman, for securing this debate on a very important topic and, as we have heard, a very neglected one. There are great signs of engagement and creativity, as noble Lords have said, but the statistics and effects are absolutely horrifying. I want to develop the point that has just been made about an integrated and sustainable approach. For medical intervention and investment to be effective—I think the noble Baroness used the term “smart aid”—there has to be an embedding in the local culture. Often, there have been ways of handling these things for many years, and it is not easy for western medicine to come in with all its technology and suddenly change the situation. In fact, an article in the Lancet in March 2012 provided evidence of the hostility to this kind of intervention because people in the local community did not understand it and were threatened by it. The article said that it was important, alongside the medical intervention, to enable what it called “behavioural change” and an “integrated biosocial approach”.

I want to give an example of that and encourage the Minister, and our own investment from this country and the work of the London centre, to take this approach seriously. I declare an interest as a trustee of Christian Aid, and it is good that there are other Christian Aid supporters here. Christian Aid commends what it calls a “community health approach”, which is local, joined-up and sustainable. It has four aims: to respond to local priorities; to integrate the approach to the various diseases and health issues; to develop a local health system; and to involve local people and local resources.

I will give your Lordships an example. A cross-border malaria initiative in Zambia was launched by Christian Aid and a number of partners in July 2010. So far, 100 local people have been identified, engaged and trained up to work as volunteers to enable this integration of the care response and its embedding in the local community. That is the kind of approach that I think we must commend and invest in.

I have two other quick points. Resourcing is crucial. Although it is not the main topic of this debate, I cannot resist reminding noble Lords that before Christmas we debated the issue of tax justice. Much of the wealth that is created in countries where these tropical diseases are prevalent is through tax avoidance schemes and is taken out of the country to where it cannot be taxed to provide local resources for a local response. We need to recognise that that is part of the picture.

Finally, I will say something about vigilance. In the 1960s, sleeping sickness was virtually eradicated in Africa, but by the 1990s, it was beginning to return. There is a frightening pattern in a lot of aid and welfare interventions that almost get there but somehow do not quite integrate and create something sustainable. The problem then creeps back. That is why I commend to the Minister, and ask her to take very seriously, this approach of community health, which is local, sustainable, joined-up and able to build a system so that the approach to neglected tropical diseases will be a lasting and effective one.