EAC Report: Development Aid

Lord Crisp Excerpts

Monday 22nd October 2012 Lords Chamber

[Lord Crisp]

My Lords, I congratulate the Economic Affairs Committee on producing this report and on provoking this debate. The report is challenging and being challenged in return. Like other noble Lords, I hope that we can have a fuller debate around development at some later date.

The Economic Affairs Committee, not surprisingly, brings a clear economic focus to this issue. That focus brings great strengths but also, I suspect, some weaknesses. I agree with much of the report. There are many interesting discussions here, but there are some omissions which slightly surprise me. For example, in the report’s critique of multilateral donors, it does not make much of the counterpoint that there is great inefficiency in the multiplicity of individual donors and in the multiple requirements that they make of countries. More than one Minister has said to me and many others that managing multiple donors is a real headache and can be very counterproductive. I note that the Government raise that in their reply to the report.

I come at this issue from a health perspective as opposed to an economic one. From this field, I strongly support the view of the noble Lord, Lord Stern, that the report is too pessimistic about the effectiveness of aid. There may not be conclusive evidence overall, but there are many examples, especially in health, as the noble Lord, Lord Stern, said.

I declare my interests on the register. I chair the trustees of Sightsavers, which receives some match funding from DfID, for which we are very grateful, and is working with DfID on eliminating two blinding neglected tropical diseases. I also co-chair with the Zambian High Commissioner the Zambia-UK health partnerships, which are using UK volunteers, doctors and nurses, to train health workers in Zambia.

I entirely agree with the noble Lord, Lord Boateng, who made the point that we do not yet use the experience and expertise we have in this country in a field such as health—which is the one I know, but I suspect also in other areas—effectively alongside the money to support development and the importance of links, of professionals working with professionals. The Government have done much to support some of those through NGOs but, as the noble Lord said, they could do much more to engage the NHS and the Department of Health as part of the delivery arm of DfID.

Looking at the field from the perspective of health, I understand that underneath the definition of economic development is a much stronger issue, which is why people support the aid given from this country. As the noble Lord, Lord MacGregor, said in his opening remarks, that is about people wanting us to relieve the distress, suffering, illness and poverty around the world and help the millions where we know what to do and can do so cheaply. As my noble friend Lord Stern, said, there are many examples, including GAVI, the organisation that provides immunisation to so many millions of children, the Global Fund to Fight AIDS, Tuberculosis and Malaria and, in my field, Sightsavers. We fund our partners to do cataract surgery at the cost of £17 an eye. That is very much value for money. In our recent research with the London School of Hygiene, the person who has gone blind with cataracts returns to economic activity at the same economic level at which they were within a month. In other words, either they get a job or their carer gets a job.

The point I make with that example is that the links between economic growth and health go two ways. It is not just that economic growth can lead to improvements in health. The Commission on Macroeconomics and Health in 2001, chaired by Professor Jeffrey Sachs, who was one of the witnesses to our report, produced the evidence then that health and education contribute to growth. As we all easily recognise, ill health damages it. There have been many analyses of the impact of HIV/AIDS on economic growth in sub-Saharan Africa—or the lack of growth.

We know that economic growth does not guarantee health. The graphs that show the economic status of the country and the health state of the country do not go in a straight line; there is not a direct correlation. We can see examples such as Kerala in southern India or Sri Lanka where, despite relative low income, they have a health status comparable with many countries with a much higher income. It is also about the policies, approaches and priorities that Governments give to those areas. My point is that we need to be careful not to overemphasise economic development at the expense of some of the other important aspects of development.

I want to go slightly further than that. There is some discussion in the report of how much aid should support the UK’s interests. There is an important point in health and elsewhere about shared interest. The most obvious is that we are vulnerable to diseases created or arising in the poorest, weakest and most vulnerable areas of the world. For example, in the 14th century, the Black Death took three winters to get across Europe; SARS took three days to get around the world at the beginning of this century. We have a shared vital self-interest in health surveillance in the poorest countries of the world.

There is more to that. There is more about the creation of vital global public goods. I suspect that people will not generally be aware how many health treatments have come out of the work between the UK, US and other richer nations working with their partners in low and middle-income countries. Much of the treatment and management of HIV/AIDS has of course been learnt there. The DOT therapy for treating TB, now increasingly important in this country, came from Uganda. The hydration therapy for use with small children with diarrhoea came from Bangladesh. Low-tech treatments for postpartum haemorrhage come from for Sri Lanka, and so on. It is, after all, no surprise that people who do not have our resources or baggage of vested interests are very innovative in health. It is no surprise that I advocate partnerships or that in health, as elsewhere, innovation needs to be sourced globally. Knowledge transfer is two-way. There is much about sharing experience and expertise.

Let me also touch on the fact that history means that the UK has a particular role with many of the countries that are recipients of aid and its former colonies and a particular leverage and ability to get things done because of our shared history. The NHS—I speak as a former chief executive of the NHS—owes a great debt to many of those countries for the staff who have come to support the NHS. In return, we owe them a debt in terms of educating more health workers.

The point I make here is that rather than thinking in terms of totally disinterested aid or narrow self interest, there is scope for thinking in terms of mutual benefits and creating public goods. I imagine that this is much the same in areas other than health, such as agriculture and food, which the noble Lord, Lord Boateng, mentioned. Some of this reflects on some rather old-fashioned definitions of aid. The world has moved on from just charity. We need to think a bit more about co-development as well as about support for development. However, redefining aid is for another debate which I hope we can have in due course.

Let me turn to the 0.7% commitment. I understand the point of the arguments that the committee makes about waste and about targeting inputs not outcomes, but I disagree with its conclusion. I support the Government’s conclusion that they have a budget and manage their programmes against results. They need to review it. There is plenty of competition for that money, as anyone who has bid for DfID money will know. There needs to be plenty of openness and no complacency. There will be a constant challenge from others, such as this committee, about whether the money is being spent well and rightly, and so it should be.

The biggest risk was mentioned by the noble Lord, Lord Tugendhat, and others. It is the pace of growth and whether, even though there is need, there is more need than money, and whether, among other things, DfID has enough staff to be able to go at the pace required. DfID needs to answer that question about pace, not about the overall target.

The 0.7% is, of course, a shared political commitment. It is not about economics but is a commitment alongside others in the world. In some ways, it seems to me that it is not unlike the payment of tithes in churches. It is about who we are. It is about the UK believing that we should support the poorest countries in the world. Very early on in this debate my noble friend Lord Hannay and other noble Lords got this absolutely right, so I shall not repeat it. It would be a terrible signal if we reneged on this. I, too, admired the way that the previous Secretary of State held to the commitment, arguing that the poorest should not pay the highest price for the financial crisis, and I agree with the tributes that were paid to him. I wish the new Secretary of State every success and hope that she will build on the past and on the achievements of the previous Government.

In conclusion, I have talked about what I know, which is health. It is only a part, but it is an important part of this debate about development. It is a plea to think beyond pure economics. Economic and effectiveness arguments are very well made by this report, but we need to bear in mind the ultimate aim. It is not just about growth but about how we think about the world and about the UK’s position in the world. When we look at it in this way we can also recognise that aid can also be about global public goods—not just some of the hard-to-measure ones which many noble Lords have talked about, such as good will, soft power and a leadership role in the world, but also very measurable health therapies and outcomes of benefit to all, which are applicable in other fields as well as in health.