House of Commons - DFID Annual Report 2008 - International Development Committee

DFID Annual Report 2008 - International Development Committee Contents

3 Progress on specific Millennium Development Goals

15. Malaria is the leading cause of death for children around the world; 500 million people suffer acutely from malaria each year; and around one million die annually.[17] As we made clear in our recent Report on HIV/AIDS, the interaction between malaria and HIV poses serious public health challenges in developing countries and we believed DFID's updated HIV/AIDS Strategy did not sufficiently address this.[18]

16. A Global Malaria Action Plan was announced at the High Level Event. The Plan aims to achieve "near zero preventable deaths" by 2015, with the ultimate aim of eradicating the disease. The initiative focuses on relatively simple prevention efforts such as insecticide-treated bed nets and boosting vaccine research. A vaccine is currently entering the final stage of trials. Although it is likely to be only partially effective, it is expected to save thousands of lives.[19]

17. DFID officials explained to us that it had been calculated that it costs $17 to "restore a lost year of life" from disease or death caused by malaria—a standard calculation used for health expenditure known as a disability adjusted life year (DALY). Andrew Steer, DFID's Director General Policy and Research, stated that a DALY of "anything under $1000 is traditionally regarded as a pretty good investment."[20]

18. Funding pledges of £1.6 billion ($3.2 billion) were made at the High Level Event—one of the largest ever commitments to the disease. Around one-third of the new funding will go towards a World Bank campaign in Nigeria and the Democratic Republic of Congo, which account for at least 30% of all malaria deaths. The largest pledges were made by the Global Fund to Fight AIDS, Tuberculosis and Malaria ($1.6 billion) and the World Bank ($1.1 billion). The campaign's organisers said additional investments of at least $1 billion a year would be needed to reduce the number of deaths to zero over the next seven years.[21]

19. The UK pledged:

£40 million in support of the Affordable Medicines Facility for Malaria
to increase funding for malaria vaccine research to up to £5 million per year by 2010
to provide 20 million of the 125 million bed nets that are needed to close the global shortfall in bed nets by 2010.[22]

DFID officials told us how they had approached the Event in terms of deciding in advance what outcomes were required on malaria and working back from that point to establish an effective strategy for achieving this. Andrew Steer, DFID's Director General Policy and Research, told us that, although the amount of money pledged was "absolutely essential", the focus had been on desired outcomes and "delivery on the ground".[23] The Secretary of State was clear that "the very specificity" of the Plan and the engagement of the private sector were what made him optimistic that it would be effective.[24] In our recent report on DFID's new HIV/AIDS Strategy, we contrasted DFID's admirable focus on outcomes in its approach to tackling malaria with the one it had adopted in the Strategy, which instead emphasised the amount of money to be spent.[25]

20. We welcome the pledges DFID has made to support the Global Action Plan on Malaria. We agree with DFID that this is a "wonderful investment" which will make a real difference to people's lives by using simple techniques such as bed nets and spraying to prevent unnecessary loss of life. We request regular updates from DFID on the impact of the Plan as it is implemented. We recommend that the outcome-focused approach adopted in relation to the Malaria Action Plan be followed in other DFID initiatives of this kind.

Maternal health

21. Millennium Development Goal 5 seeks to reduce maternal mortality by three-quarters and to achieve universal access to reproductive health services by 2015. In our Report on Maternal Health in February 2008, we highlighted that at least 536,000, but possibly as many as 872,000 women, were dying each year due to the failure to make progress on this MDG. We concluded that, without urgent action, reaching the Goal by 2015 would become impossible.[26]Under its Public Service Agreement 29, DFID measures the progress of 22 countries towards the MDGs. DFID's 2008 Autumn Performance Report shows that only one of these 22 countries is on track to meet MDG 5.[27]

22. At the High Level Event, the Prime Minister announced a new Taskforce on Innovative Financing for Health Systems, which he will co-chair with World Bank President Robert Zoellick. The Taskforce will seek to mobilise money and develop new sources of funding in order to strengthen health systems. The Taskforce is intended to be a complementary mechanism to the International Health Partnership (IHP), which has no funding capability but seeks to promote co-ordination.[28]It will have a particular focus on meeting the maternal and child mortality MDGs, both of which desperately require increased numbers of health workers and stronger health systems to see progress.

23. The Taskforce comprises a "small number of leading figures in the international community selected on the basis of the perspectives they can offer on innovative financing, health systems or political feasibility."[29]Its inaugural meeting took place at the Doha Financing for Development Conference at the beginning of December 2008 and it will make its final recommendations to the G8 summit in Italy in July 2009.[30]

24. The Prime Minister said that he hoped that the Taskforce could help to save 10 million mothers and newborns by providing over a million new health workers. He pledged to spend almost £450 million over three years to support national health plans in eight IHP countries.[31] Both this £450 million pledge and the £40 million announced by DFID for the Global Fund to Fight AIDS, TB and Malaria form part of the £6 billion announced for health systems by the UK in June 2008 as part of its new HIV/AIDS strategy on which we reported in November.[32]

25. We asked the Secretary of State why the Taskforce planned to spend its first year exploring new funding mechanisms when the needs it is trying to address are so urgent. He told us that, from the UK perspective, it was not "a choice between […] exploring the issue of innovative financing mechanisms in terms of health systems and getting on with the job". He believed that the involvement of leading figures, including the head of the World Health Organisation, and, crucially, the President of the World Bank, would give the Taskforce "clout and authority".[33]

26. We have highlighted before our concerns about the lack of progress on maternal health. The Taskforce on Innovative Financing for Health Systems seems to offer a new opportunity for making progress on all the health Millennium Development Goals. It would be regrettable if time was wasted in negotiations about funding mechanisms rather than ensuring that money started reaching health systems in developing countries and producing the change which is needed. The Prime Minister is the co-chair of the Taskforce which gives the UK significant leverage to secure rapid progress. We recommend that the UK use the full weight of this influence to ensure the Taskforce starts to have a tangible impact early in 2009.

Education

27. 75 million children are currently not in school and trends indicate that this figure will only be halved by 2015.[34] DFID reports that seven of the 22 countries it monitors are off-track to meet MDG 2 which aims to achieve universal primary education by 2015; five of these are severely off track.[35] A new partnership of governments, companies and NGOs called the "Class of 2015: Education for All" was launched at the Summit. It aims to build political will to achieve MDG 2. The partnership has set an interim deadline to get 24 million children into school by 2010 as a milestone towards education for all by 2015. Pledges of $4.5 billion over three years towards the achievement of education for all were announced. These included £50 million from the UK towards the Education For All Fast-Track Initiative, funded from the £8.5 billion pledged by the UK in April 2006 for education over the next 10 years.[36]

28. It is estimated that 18 million new teachers are needed between now and 2015 if each classroom is to have a qualified teacher.[37] Kevin Watkins of UNESCO highlighted in a press article that the window of opportunity for meeting MDG 2 is closing, because achieving the target of all children completing primary education by 2015 means securing universal access to schooling by 2010. The necessary schools will therefore have to be built and teachers trained by 2010.[38]

29. The Secretary of State told us that it was important to identify the particular obstacles to children being in school in particular locations: whether this was a lack of school buildings; the absence of adequate sanitation; insufficient numbers of trained teachers; or unaffordable user fees. Offering feeding programmes as an incentive for school attendance was also sometimes key.[39]

30. One in five girls of primary school age are not in school. The MDG 3 target seeking gender parity in access to primary schooling by 2005 was comprehensively missed. This failure has a knock-on effect on the chances of achieving the other MDGs: girls who have been to primary school are healthier (for instance, they are 50% less likely to be infected with HIV) and wealthier (each year of schooling increases girls' future earning power by 10-20%).[40] Factors that perpetuate the gender inequalities that keep girls out of school are wide-ranging but it has been proved that steps such as dropping school fees and ensuring that schools are safe and have adequate water and sanitation can boost girls' enrolment.

31. The Secretary of State acknowledged that "it is impossible to build credible strategies for getting those 75 million kids into school unless you recognise the centrality" of gender. He pointed out that the ratio of girls to boys in school had improved from 94:100 in 1999 to 97:100 by 2006 but that he was "far from complacent" and the Fast-Track Initiative therefore paid special attention to gender.[41] He accepted that the 2005 gender target had been missed in 94 countries and that understanding why that had happened was key to finding solutions. He identified the issues as being: lack of international political leadership; the global funding gap; the absence of planning and local capacity; and the fact that user fees meant that girls lost out when people could not afford to educate all their children.[42]

32. We agree with the Secretary of State that identifying the specific barriers to universal primary education in different local areas is central to finding solutions and that the initiative must therefore be tailored to local needs. Rapid progress on the Class of 2015 initiative is, however, vital. Its aim is for all children to complete primary education by 2015 which means that they have to be in education by 2010. This leaves very little time for delivering on the pledges and ensuring swift implementation. We recommend that DFID work with its international partners to develop targets tightly linked to timescales so that progress can be measured towards the 2010 deadline.

Women's rights and the MDGs

33. ActionAid argued in a recent report that, if progress towards the MDGs is to be catalysed, new targets on women and girls must be set within the existing framework to address the specific barriers preventing women and girls from escaping poverty. ActionAid asserted that the current MDG targets for tackling gender equality—MDGs 2 and 3 on education, political empowerment and employment and MDG 5 on maternal health—were too narrow, and omitted vital issues such as women's access to land and violence against women.[43] ActionAid identified four steps that they believed must be taken by the Prime Minister and other global leaders:

Set more ambitious and specific targets on women and girls within the exiting framework
Bolster the UN's capacity to tackle discrimination against women
Monitor progress with better data
Make aid a more effective tool in achieving equality and women's empowerment.[44]

34. In our reports last year on Maternal Health and on DFID's new HIV/AIDS Strategy, we highlighted that gender inequalities were preventing women accessing health services and therefore endangering their lives.[45] Our AIDS report also stressed the need for DFID to establish dedicated strategies to address gender-based violence.[46] When we challenged the Secretary of State about the failure properly to address gender in relation to the MDGs, he told us:

I have taken on the responsibility of being the minister responsible for gender relations within the department because I wanted an unequivocal message sent out that at the highest level of the department we do and continue to take extremely seriously the gender dimension to the challenge of poverty reduction.[47]

35. Progress on the Millennium Development Goals will not be made unless tackling gender inequality is given the necessary political priority and leadership. We welcome the Secretary of State's demonstration of his commitment to progress by taking on responsibility for gender equality within DFID. We recommend that the UK Government takes every opportunity to press international partners, including developing countries themselves, to put a high priority on tackling the barriers which prevent women achieving equality. This should include a particular focus on gender issues that are not represented by specific MDG targets, such as women's access to land and violence against women.

Nutrition

36. In our report on the World Food Programme and Global Food Security, published in July 2008, we criticised DFID for not having a measurable target for malnutrition. DFID's progress on its objectives and targets is measured against its Public Service Agreements (PSAs) and monitored by HM Treasury. Neither the 2005-08 PSA nor the 2008-11 PSAs include an indicator on nutrition. DFID's PSAs are built around the MDG targets. MDG 1 has three targets: to reduce by half the number of people living on a dollar a day; to achieve full employment; and to reduce by half the proportion of people who suffer from hunger. Yet DFID chooses to measure the achievement of MDG 1 only by the first target, poverty reduction.[48] Nor do any of the other MDGs have a specific hunger or nutrition target (for instance, MDG 4 seeking to reduce child mortality). We said in our Report:

The Department's decision to measure progress towards MDG 1 using a poverty indicator alone, rather than including indicators for hunger and nutrition, implies it believes that wider poverty reduction strategies are sufficient tools with which to combat hunger and nutrition. This is far from proven. We recommend that DFID add a new indicator under MDG 1 in the 2008-11 PSA to enable its work on nutrition and hunger to be properly targeted and measured.

The Government's Response to this recommendation was that:

Progress towards the MDGs is monitored annually through the collaborative efforts of agencies and organisations within the UN system which track the progress of 48 specific indicators. These include 2 indicators of malnutrition—the prevalence of underweight children under five years of age and the proportion of population below minimum level of dietary energy consumption. We have selected eight of [the] 48 [MDG] indicators—one for each MDG—as a summary measure of progress against the PSA in 22 partner countries. We have selected a poverty measure—the proportion of population with income below $1 as our indicator of progress against MDG 1—to eradicate extreme poverty and hunger. We will, however, continue to monitor progress against all MDG indicators, including those on malnutrition, throughout the PSA period.[49]

We found this response unsatisfactory and explored DFID's approach in more detail with the Secretary of State. He was frank in admitting that "nutrition had not been a central focus of my work in the first six to eight months in the department" but told us that, more recently, he had sought to address this with officials.[50] He accepted that the issue had grown in significance in recent months and he reiterated that DFID planned to have a nutrition strategy in place by the end of 2008.[51] This was not achieved. A draft strategy on nutrition and development was put out to consultation in November 2008. DFID now says it will present "recommendations and choices" to Parliament early in 2009.[52]

37. We recommend that, as part of its renewed emphasis on nutrition, DFID re-examine our earlier proposal that it should include an indicator for hunger and nutrition in its monitoring of Millennium Development Goal 1 on poverty reduction. We welcome the Secretary of State's confirmation that DFID will produce a nutrition strategy in the coming months, which we will examine when it is published.

17 Q 110 Back

18 Twelfth Report of Session 2007-08, HIV/AIDS: DFID's New Strategy, HC 1068-I, paras 44-47 Back

19 '$3bn ploughed into fight against malaria', The Guardian, 26 September 2008 Back

20 Q 128 Back

21 'Leaders see world closing in on malaria', The Los Angeles Times, 28 September 2008 Back

22 DFID Press Release, 25 September 2008. 'World leaders commit record billions to tackle malaria' Back

23 Q 110 Back

24 Q 128 Back

25 Twelfth Report of Session 2007-09, HC 1068-I, paras 113-114 Back

26 Fifth Report of Session 2007-08, Maternal Health, HC 66-I, Summary and Conclusion Back

27 2008 Autumn Performance Report, Cm 7515, pp 56, 58-59 Back

28 The International Health Partnership was launched on 5 September 2007 as a way to help aid agencies work together more effectively on the three health MDGs, thereby reducing duplication and the time needed at country level to process individual donor demands and meet reporting requirements. Back