Sub-Saharan Africa: Healthcare

Lord Boateng Excerpts

Thursday 16th July 2015 Grand Committee

Asked by

[Lord Boateng]

To ask Her Majesty’s Government what assessment they have made of lessons that can be learnt from the outbreak of Ebola in Sierra Leone regarding the strengthening and development of sustainable healthcare systems in Sub-Saharan Africa.

[Lord Boateng (Lab)]

My Lords, I draw attention to the relevant entries in the Register of Members’ Interests. In particular, I am adviser to Gilead Sciences Inc, chair of Christian Aid’s In Their Lifetime Appeal and a trustee of the Planet Earth Institute. When I was fortunate enough to have my Question chosen, I had hoped that the debate would take place in the context of an end to the Ebola crisis, an end to the outbreak in Sierra Leone and that the last case would have been reported. Sadly, that is not the case and Ebola is still very much with us.

Lawrence Summers, the distinguished economist and a former Treasury Secretary in the US has described Ebola as a “stress test” on national health systems. Sierra Leone, Liberia and Guinea have clearly been found wanting. They simply could not cope. There were too few trained health professionals, too little equipment, too few supplies and too little capacity for public health surveillance and control. It is a stress test that the world cannot afford to fail, and a stress test that in some ways the WHO did fail, and the world was threatened. I suspect that if the perception of the threat had continued as it was at the outset of the crisis, more attention would be paid to the subject in our media and elsewhere today. But we are where we are.

The threat to the rest of the world is seen by all too many in the rest of the world to have passed and the circus is already beginning to move on. There is a sense that Ebola is yesterday’s story. As those who are attending today’s debate understand, that is not the case: it is still an ever-present threat and danger. This debate is particularly timely as it takes place at the same time as the world’s leaders, including our Secretary of State, are considering the future funding of development and the millennium development goals in Addis Ababa. Their considerations will have a considerable bearing on our success or otherwise in responding more effectively to the test that Ebola has presented to the health systems of west Africa and the wider world.

However, it is worth noting that a real contrast is to be drawn—Lawrence Summers draws it—between what happened in Sierra Leone, Liberia and Guinea, and what happened in Nigeria where, to a certain extent, the stress test was passed in at least one respect. Nigeria’s response to Ebola was able to be characterised by the WHO as,

“a piece of world-class epidemiological detective work”,

which it was. It was able to launch a response of aggressive, co-ordinated surveillance and control, using a system for Ebola that it already had in place for polio. That enabled Nigeria to have a response that was not able to be replicated in Sierra Leone, Liberia or Guinea where the health systems, for a variety of reasons, were already substantially degraded and underfunded. In Sierra Leone, that was most obviously because of the conflict from which it was recovering and from problems associated with that, including investment in health, healthcare and governance.

In the Lancet Lawrence Summers, building on his 2035 commission report, put the cost of health systems strengthening in the developing world at around,

“$30 bn a year for the next two decades”.

He identified this sum,

“through a combination of aid and domestic spending”,

as,

“well under 1 per cent of the additional gross domestic product that will be available”,

from the expected growth in low and middle-income countries during the next 20 years, so that $30 billion is affordable. He goes on in the report to identify a lack of investment in public health and a lack of innovative research and development in the field of infectious diseases that affect the poor as having contributed to the crisis. We have an opportunity at this time, at the conference in Addis and the upcoming conference in New York, to do something about it.

Save the Children has estimated that the cost of dealing with the Ebola outbreak has been nearly three times the annual cost of investing in building a universal health service in all three affected countries. We have to ensure that the world learns the lessons of the crisis by a renewed focus on supporting systems of universal health coverage in the developing countries of sub-Saharan Africa. Will the Minister please tell us what steps the UK Government are taking to promote universal health coverage to give developing countries the resistance to contain this kind of outbreak in the future?

I recognise that no one-size-fits-all approach is either possible or necessary to address the issues of developing universal coverage. No one is suggesting an NHS in every country, as if one were promoting a chicken in every pot. It is much more complicated than that but there is inevitably a need for a mix of public and private, such as a role for insurance-based systems. All that has a role to play but there is at the end of the day a need for an irreducible minimum. That is, a recognition that there are some public goods the provision of which requires a role for Governments, with properly resourced departments of health, science and higher education working together with the support of ministries of finance across government to mobilise all the relevant departments in developing sustainable, effective healthcare systems that are backed up by assertive policies for public health and which tackle the root causes of the outbreak of such pandemics.

There is a need for adequate funding mechanisms and cross-sectoral work, led by finance ministries whose streams of work programmes are not dependent on the vagaries of external funding but rooted in a local set of priorities, determined locally and with a focus on value for money, local accountability and meeting the needs identified through the grassroots participation of the citizenry, who are essential to effective public health responses. All the evidence shows, as Christian Aid has shown on the ground in Sierra Leone, that you get a better response when you mobilise communities —when you work with traditional healers and leaders, alongside community healthcare workers and others, all to develop a response that is firmly rooted in communities, reflects their priorities and is capable of winning their support and confidence. It is that challenge to trust and confidence, and the lack of those now in institutions and Governments, which is one of the greatest casualties to have emerged from this crisis. It needs to be restored.

Underpinning all that work are adequate flows of revenue and resourcing which are not solely dependent on aid and development assistance from donors but rooted in the need to do better at revenue-raising locally and make sure, for instance, that we address issues and failures in the collection of revenue from extractive industries. That was a recommendation from the Select Committee of the House of Commons. There is also the need to make sure, as the Prime Minister has emphasised in a number of his interventions in this area, that we do better on illicit flows between jurisdictions and the loss to country revenues as a result of companies actively arranging their affairs and individuals to avoid tax.

So all those issues, and the response to them, need to be examined if we are to learn the lessons of this crisis. How do the Government intend to implement the Select Committee’s recommendations on improving DfID country funding and bilateral in-country assistance programmes? How do they intend to ensure that local communities are involved in that?

Finally, we need to ensure that we address an all too often neglected area of development policy—namely, the role of science and research and development. We need to make sure that diagnostic institutions and laboratories are established to build on the lessons we have learned from the Ebola crisis, and we must take account of the lack of trained personnel. The Ebola epidemic has decimated the health workforce in Sierra Leone. There are too few doctors to ensure effective recovery from the disease. The total absence of postgraduate medical training in Sierra Leone bedevils an effective response and the whole healthcare system in that country, rendering it unable to train its own doctors in-country. Will the Minister agree to receive a delegation from the Royal College of Paediatrics and Child Health, which has come forward with a proposal to address this need which it has forged, together with its partners in Sierra Leone, and other institutions in the United Kingdom, including King’s College? So we have a crisis and a problem but also an opportunity to ensure that we put in place mechanisms that not just end the present suffering but avoid the possibility of yet further suffering in the future.