Sub-Saharan Africa: Healthcare

Lord Collins of Highbury Excerpts

Thursday 16th July 2015 Grand Committee

[Lord Collins of Highbury (Lab)]

My Lords, I, too, would like to thank my noble friend Lord Boateng for initiating this debate. It was only a few weeks ago that we had a debate on this subject; nevertheless, I am extremely grateful that my noble friend has raised this issue again because it gives us the opportunity to focus on key priorities as we move forward. As my noble friend and all noble Lords in today’s debate have stressed, the main lessons from this outbreak relate to the strengthening of health systems, increasing the number of primary healthcare staff, improving their training, building scientific capacity in diagnostics and public health laboratories and supporting public health messaging and outreach generally. These are all topics that we touched upon in the last debate but I want to come on to some specific points.

I, too, have previously acknowledged the Government’s incredibly positive response to Ebola on the ground and the incredibly significant role of British volunteers and their bravery. In the previous debate I mentioned how much I appreciated the Government recognising their courage with a medal.

As we have heard from my noble friend, over decades Sierra Leone has had insufficient investment in its health systems. Universal health coverage can make countries more resilient to health concerns such as Ebola before they become widespread emergencies, as highlighted by my noble friend. I therefore welcome the clear commitment given in recent debates by Ministers—the noble Baroness in particular—to support universal health coverage, free at the point of access, in the language of the health goal in the SDGs. I welcome their commitment to this in the forthcoming New York negotiations in September.

Like the noble Baroness, Lady Northover, I think that we are extremely lucky to have someone like Professor Chris Whitty and I have attended many of his briefings about the crisis. In recent briefings he particularly stressed the impact of Ebola on other diseases. That is one of the key lessons for us to focus on. It is clear, as my noble friend Lord Giddens said, that gains made against malaria are at risk as health systems are pushed to breaking point and people avoid using them because they fear contracting Ebola. Many children have missed out on routine vaccination services since 2014. Modelling by the Johns Hopkins Bloomberg School of Public Health on the long-term impact of Ebola on routine immunisation suggested that as many as 1 million children could miss out on measles vaccinations as a result of the knock-on impact of Ebola.

One of the big issues affecting immunisation has been trust in the health service, another issue touched upon in today’s debate. Rumours circulating in the region have falsely claimed that childhood vaccines, such as those protecting against measles, pneumonia and diarrhoea, could be linked to Ebola. Tackling that misinformation is key. This has dealt a severe blow to immunisation coverage, with parents refusing to allow their children to be immunised against common but potentially fatal conditions, leaving hundreds of thousands of children at risk. Additionally, as we have heard from all noble Lords, hundreds of health workers in the three countries were among the 10,000 people who lost their lives to Ebola during the crisis and many were forced to abandon their posts as the epidemic took hold. As the three countries begin their return to normality, there is now a severe shortage of trained health workers to administer vaccines, let alone carry out other primary care work.

In her written response following the recent debate, which I managed to get this afternoon and which was quite helpful, the Minister outlined the immediate steps that were taken to reinstate basic healthcare as safely as possible. Picking up on the point made by the noble Baroness, Lady Northover, could the Minister set out for us today the longer- term strategy to develop more resilient and sustainable health services, particularly in Sierra Leone? What steps have been taken by the department to support the Government of Sierra Leone in developing a comprehensive strategy aimed at supporting communities to recover from the crisis and to put the country back on track to meet all the development targets that it has? Can the Minister tell the Committee whether the department, in considering the lessons of the outbreak, has examined the impact of previous changes to funding commitments to Sierra Leone? In doing so, can she tell us whether the department has reversed or rethought any planned funding cuts?

One other clear lesson on the outbreak highlighted by my noble friend Lord Boateng has been the role of community engagement—another issue that we touched on in the previous debate. I welcome the noble Baroness’s written response in relation to this, particularly on the Social Mobilisation Action Consortium, which brought together BBC Media Action, Centres for Disease Control, GOAL and Restless Development, all funded by DfID. In the debate I touched on the issue raised by the noble Baroness, Lady Northover, about the lessons in terms of FGM. I am disappointed with the written response on that. I know—I share the concern of the noble Baroness, Lady Northover—that there are huge cultural issues but if we were able to address the issue and raise awareness during such a difficult period, surely we need to ensure that we continue with that and not back away from it.

It is important that we ensure this work continues and is extended to enable civil society organisations to work with communities, to hold meetings, to brief village chiefs and, as my noble friend said, to work with religious leaders not only on basic health issues but on the importance of immunising children. We also need to ensure that there are enough trained health workers to provide the vaccines to the children.

Last week I met with Dr Seth Berkley of Gavi, the Vaccine Alliance. Unfortunately I could not attend the briefing organised by the noble Baroness, Lady Northover, but I was able to meet him separately. He made clear that as the initial Ebola epidemic recedes we face a race against time to prevent outbreaks of other dangerous diseases by ensuring that children receive the vaccines they need to protect them. That is a key element of restoring trust. Rebuilding trust among parents and carers is critical, as is ensuring that they are provided with the services they need to protect their children.