Speech
5 June 2007
Westminster Central Hall, London
Hilary Benn, Secretary of State for International Development
Launch of the DFID Health Strategy
Thanks Richard. It’s a great pleasure to be here today with all of you to launch our health strategy, and I’d like to thank all those excellent people in DFID who have helped to make this happen. And I’m very fortunate today to have alongside me, Margaret, Joy and Michel, who together represent some of the most important international organisations working to improve the health of poor people in developing countries. I’d like to thank you and your colleagues for the work you do and for the contribution you are making.
We live in a rapidly changing world and developing countries face the greatest challenges. It’s become the definition of humanity at the beginning of the 21st century. No country, no society, can meet them without good health. Look at the history of our own country – this wonderful building we are in today played its part in this history - we went through similar changes – industrialisation, the movement of people to the cities, many people living in poverty.
And it was the advances in health we made that built the foundation of our progress. Bad sanitation caused the “Great Stink”, which stopped Parliament sitting because of the smell of the river Thames. Pioneers in local government brought us clean water and decent sanitation. The visionaries who created the National Health Service almost 60 years ago; a radical idea that to this day commands huge popular support. What we should learn from all this is that if you put your mind to it, and have the right politics, you can change things for the better.
We should take hope from the progress that is being made.
In the past 40 years, life expectancy in the developing world has increased by a quarter. It’s the 30th anniversary of the eradication of smallpox this year, I hope polio will be next. More people are using better contraception and fertility has halved since the 1960s.
Advances in new drugs have transformed AIDS from a death sentence into an illness that – possibly – can be managed. There are now more than a million people on treatment in sub-Saharan Africa – more than one million compared with 100,000 just three years ago. Is it enough? No. Is it progress, you bet it is. And now two million worldwide. Tanzania has halved child mortality in one district. How? Through a decade of sustained investment in health care services.
We did these things because we willed them to happen. Today there is more money for health. More aid, and also more debt relief too. Gleneagles debt relief that just helped Zambia abolish health fees in rural areas. That too is progress, is it enough, no it isn’t, but things are better.
And there are many new organisations that are helping. The Global Fund, only 5 years old, has transformed funding for AIDS, TB, and Malaria. The International Finance Facility for Immunisation was launched last year and should save the lives of 5 million children and 5 million adults by 2015. A really simple and brilliant idea of Gordon Brown’s. If we can borrow to buy a house, to buy a car, why not borrow to vaccinate children? And we did this because we willed it.
An advance market commitment this year should help bring a pneumococcal vaccine to market in poor countries, and reduce child deaths from pneumonia. And why was this needed? Because there’s not enough research into the diseases poor people die of.
But we all know there is much more to do. Although fewer children are dying before their fifth birthday, the numbers remain frankly shocking and little progress has been made in reducing deaths in the first month. Afghanistan and Sierra Leone have the dubious distinction of the highest child mortality in the world – a quarter of children die before their fifth birthday. We need to look again at the health of both mother and child. If women got the right care during pregnancy and childbirth, half a million maternal deaths and three-quarters of the four million newborn deaths each year could be prevented.
And in many countries, we have to tell the truth, progress has stalled, particularly in sub-Saharan Africa where poor health traps millions in poverty. Africa is the only region in the world where child malnutrition is not declining - and as you all know, I’m sure, that across the world malnutrition still contributes to half, half, of all child deaths.
And despite massive increases in the money needed to fight AIDS, TB and malaria, the problem is still growing. There are 4 million people infected with the HIV virus every year, and the 15 million children affected by AIDS, many of whom have lost the love and care of those they rely on most, face a bleak future.
The fundamental problem is that poor countries are unable to finance the health care services their people need. In the UK we spend about £1,400 per person on health – and still we argue about it, but let’s leave that for another day! In sub-Saharan Africa it can be as little as £5 – £1,400 per person here, £5 per person there - it needs to be much more for a minimum basic package of services.
And while donors are doing more, we could do it better. There are now some 40 bilateral donors, 26 UN agencies, 20 global and regional funds, and 90 global health initiatives. But in many ways, the problem is a very simple one. We are not working together properly. And we are not trying hard enough to do so.
We all talk about harmonisation, and alignment and coordination – I talk about it as “ we have got to get our act together”.
Take Rwanda, it has a HIV and AIDS prevalence rate of around only 3%, yet high infant and child mortality rates. 20% of children die before their fifth birthday, mainly from easily preventable illnesses. Guess how much donor support goes to health care services for childhood illnesses in Rwanda? Just 2%. Whereas 75% of donor support for health goes just on HIV and AIDS. This can’t be right, can it? We have to do better than this.
AIDS is rightly a centrepiece of our international effort, it’ll be discussed in the G8 tomorrow, and just last week President Bush announced more money for PEPFAR. But we must also remember that there are lots of other basic health care needs that are not being met.
And we do need to put this right. I think we need to make much faster progress on health. People being able to demand and get good basic services – free where countries wish to do so, getting rid of the barriers that exclude so many.
It also means holding politicians to account, because that in the end is how you change things, and voting them out if they don’t deliver. And it means getting other services right too - better education, clean water and decent sanitation, and social security, protection, for those that need it.
We know how powerful education is. If we can keep a girl in school for five years or more then her own children are 40% more likely to live beyond the age of five, and 50% more likely to get immunised.
Whichever way you look at it, educating girls is an important way to improve health, life expectancy, HIV and AIDS – education is a social vaccine because it give young women more control over their bodies, over their lives.
And we know that clean water, proper sanitation and good hygiene will help prevent the nearly 2 million deaths from diarrhoeal diseases a year, most of whom are children.
And we know that investment in social security can lead to greater use of services and reduce ill health; in Ethiopia where we support a social safety net programme, half of the population served said they now used health services more frequently, mainly because of this help.
Now, improved health also means responding better to the old challenges - communicable diseases, mother and child health, reproductive health and the new ones too - avian flu, heart disease, diabetes, cancer, the effects of tobacco, drug resistant TB. We need to learn about what works. We need to develop new approaches. We need new medicines. In the white paper last year I committed to double our spending on research, including in health.
And we are seeing big increases in access to new and more effective drugs - anti-retrovirals, ACT malaria drugs, and new vaccines. We need to make sure that corruption doesn’t prevent the right drugs from reaching those who need them most. Some countries are paying ten times the international price for ARVs.
We need more transparency and accountability over what happens to medicines in developing countries, which is why we’re working with others to develop the Medicines Transparency Alliance, to bring together developing countries, pharmaceutical companies, NGOs, donors and others to tackle corruption, excessive price mark-ups, to improve the distribution of drugs, improve quality. A survey in South East Asia showed that 30% of the anti-malarial drugs tested, were fakes, and would do no good at all to the families who bought them.
I think there are three fundamental things we need to do:
- First, a major increase in support to developing countries.
We achieved a great deal in 2005 – across Europe, at Gleneagles, and at the UN. But making promises is one thing. We have to keep our promises too.
We need more funding to fight the major causes of diseases, including in the most difficult fragile states.
We are doing our part. In the white paper, we said that within a growing budget, as we move to the UN 0.7% target by 2013, we will spend at least half of our direct support to developing countries on basic services, including health care. Today, as part of this effort, I have agreed that we will commit £102 million over the next four years to help India in its fight against HIV and AIDS.
Now, this money from our bilateral programme will do two things: First, it will ensure prevention covers more than 80% of the most at risk population in India, over 2 million people, and second, it will help put 340,000 people who are living with HIV, 40,000 of whom are children, onto anti-retroviral treatment.
It’s one example of how a rising aid programme is helping to make a difference.
- Second, we need better support for basic health care services, and not just fighting specific health problems.
The Rwanda example I mentioned earlier makes this point very well. We can’t make progress on health unless we have enough nurses and doctors, fridges, clinics and hospitals, that people can get to and use and where health fees don’t prevent them.
I’m pleased to say that next month the first medical students ever trained in Somaliland will graduate – the first in Somalia for 20 years! Why? Because this is a country which is broken. Brutalised by conflict, and if we don’t get the governance right, how can you deliver health? We’ll be supporting them as part of a £2.3 million programme, over two years, to get more and better health workers to where they are needed. A small contribution, but it shows what you can do in one part of Somalia.
And we can’t make progress on health without a continuous supply of essential medicines, good management, and better monitoring information.So we need to provide our support in ways that deliver broad services that deal with all the major health problems. And we must do no harm. We must make sure that our well meaning efforts to deal with a single health issue do not damage our wider effort.
- And thirdly, we need to get our act together. Donors and multilaterals and global funds need to get their house in order. We need to better coordinate our aid.
Which brings me back to why the four of us are here today. Because together we wanted to make the point that if we continue to act alone we will fail. But if we do act together, working with others, we can succeed.
By acting together, we’ll reduce duplication and overlap. We’ll reduce the time governments must spend dealing with so many donors. And we’ll be more effective because we will get behind governments – and in the end it is these governments who are accountable to their people for the services they need.
We need to do more to provide the long-term and predictable support that countries need in order to make the sustained investments required. They can’t do that if they can’t rely on us. They can’t take on more nurses and pay their salaries if next year or the year after we decide to cut our aid and do something else. So it is not just how much aid, but how reliable it is.
And I think we need to learn from the experiences of the Global Fund and from GAVI, and link that support more closely to the delivery of results.
UN agencies should use the “One UN” approach to prepare one coherent plan in a country that clearly sets out who does what. And donors need to do more to make this happen, including through their funding.
I think the WHO and World Bank bring complementary skills and resources. So they’ll help developing countries more if they develop joint positions on key issues, work together to support countries to plan, fund and deliver improved health services. Have a clear role in helping to provide evidence that more money is going into health care services.
Now my final point is this. The health of a nation depends on the health of its economy too – it’s how you get the money to pay for the nurses and doctors, it’s how we did it. And it depends on its politics, as well as its people. As the founding of the NHS showed, politics can radically change healthcare. And it was politics that made a difference in 2005, people and politicians called for action, politicians responded.
The same is true in poor countries, politics will have to take the hard decisions necessary to improve governance and fight corruption, to reform public services, and to decide where in the end you are going to spend your money. It was Nye Bevan who said “socialism is the language of priorities”, and it is politics that determines the choices that we make. I think we can get the politics right, and we can achieve the better world we all dream of, that motivates all of us, but only if we work together.
