Select Committee on International Development Minutes of Evidence

Examination of Witnesses (Questions 60 - 79)




  60. You are speaking about anti-retroviral treatment.
  (Dr Lob-Levyt) I am speaking specifically about anti-retroviral therapy, yes. It is part of the wider, broader agenda of the need to make affordable and accessible drugs including HIV drugs and vaccine available in poorer countries. We are doing a lot, working with industry, working with WHO and UNAIDS to explore how this can be achieved. You pointed out very clearly, as your parliamentary group pointed out, that it is not just the provision of drugs. In the case of HIV these are very toxic drugs, complicated to administer, need quite robust health systems to deliver them. We have had enormous problems doing them in our own country and in the United States for example, so it is part of a range of responses. It is certainly not the magic bullet or the answer.

Ann Clwyd

  61. Can you tell us how DFID promotes sexual health services in developing countries?
  (Dr Lob-Levyt) More broadly than reproductive health?

  62. Yes.
  (Dr Lob-Levyt) We have a very large number of programmes with governments, very substantial programmes, on reproductive health, working with governments to establish reproductive health services, working with NGOs and civil society in the provision of services. It has been one which DFID has been engaged in for a long period of time and we put substantial resources to that.

  63. Of course health systems in most developing countries are being stretched beyond their resources as they can only deal with a limited number of AIDS patients and of course the loss of healthy personnel due to death and illness. Spending on acute care is likely to take precedence unless health service funding improves significantly. I wonder what help you are able to give in that direction.
  (Dr Lob-Levyt) We work in the health sector in trying to strengthen governments' public health systems and increasingly working with the private sector and with NGOs for example in the provision of health services. The roles of governments and ministries of health are evolving and changing in developing countries to being responsible for the health sector and health services, but not necessarily the public provision of all services. Of course many people in poor countries actually buy their services from the private sector, so there are important issues about working with the private sector, be it drug sellers, or pharmacists or small clinics, to improve the quality and lower the cost and to provide subsidies for the provision of public health services. DFID is an organisation which has worked intensively in these health system issues and you are absolutely right, it is complex. Many of these public systems are collapsing and need resources, technologies, better management and planning.
  (Mr Ackroyd) Increasingly we are planning our health sector interventions in the context of a complete sectorwide package planned with the governments with all donors coming in together. The idea of this is that you address the planning issues, you address the systems issues, you look at the priorities and you make sure that the overall resource allocation is optimal for the particular situation rather than what we used to do which was going for the particular project, addressed to the particular problem. The problem with that obviously is that you do not take this overall view of what the priorities are. This is an important way forward of addressing these resource and system issues which you are quite right to raise.

  64. How much additional money is being provided by DFID to countries to combat HIV/AIDS?
  (Dr Lob-Levyt) At the moment the Government is committed over the next three years to spend £100 million on HIV/AIDS. We shall vastly exceed that commitment actually. At present we are spending between £20 and £30 million per year, but that spend is on a very steep rise, as a number of pledges are being transmitted, not least of which is the international partnership against AIDS in Africa for example.


  65. That is a very small figures, is it not? Your budget is now £2.6 billion and you are going to spend £100 million.
  (Dr Lob-Levyt) We are committed to spend at least £100 million over the next three years.

  66. One hundred million over three years, so that is one third of that per annum.
  (Dr Lob-Levyt) Yes, but we expect to spend substantially more than that.

   Chairman: I should hope so.

Ann Clwyd

  67. How is that going to be shared out between countries most at risk?
  (Dr Lob-Levyt) That will be according to where the priorities are and the priorities determined by governments largely in partnership and discussions with ourselves. Clearly the money would go to those countries where the epidemic has already taken hold. What is very important about Asia — and this is where I would expect to see a lot more resources going in the future — is that we do have a window of opportunity to intervene there.

  68. I have always felt that Asia was rather left out as far as DFID spending was concerned.
  (Mr Ackroyd) You will be pleased to know that we are hoping to go up significantly in the near future. The way we are planning this is not saying "Here is an additional sum, where are we going to allocate it?". What we are doing is in all our country programmes we are looking at the priority we are giving to HIV/AIDS and trying to increase that. We shall see, I am confident, an increase in our spend in all our significant country programmes on HIV/AIDS which in total in years to come should produce a significant increase in spend.

  69. What would you say the main problem for health departments in developing countries is? Is it lack of funds? Is it lack of planning or policies or a combination of all those things?
  (Dr Lob-Levyt) I would say that in the past it has been extremely difficult to spend substantial sums of money because of the absorptive capacity of governments to take on board the money and because of the lack of political commitment to it. I see that situation changing. I see that there will be an ability to absorb much larger sums of money in the future. It has constrained us in the past. May I just correct a figure? I have a figure for our global spend on HIV/AIDS for 1998-99 financial year which was £42 million.


  70. You have given us the figure for the development of vaccine at £14 million. How crucial do you think is the vaccine to the control of the epidemic in poor countries, bearing in mind that it is likely to cost a huge amount of money per injection or however you take it.
  (Dr Lob-Levyt) We have contributed to the international AIDS Vaccine Initiative and we were the first government to put this significant amount of money in. As a result several other donors have now come in and it now has increased resources. One of the principles of this particular exciting initiative is that right at the outset of negotiations with industry these vaccines will be made available at an affordable price. They have been enormously successful in doing that.

  71. But we do not have one, do we?
  (Dr Lob-Levyt) No, but they have been successful in getting those commitments from industry in the vaccines which are now going to trial which are going to point the direction for future vaccines. So industry is committed to that principle and money does not go to the industry unless they commit to that. It is quite exciting.

  72. The trouble is though that the cost of producing the vaccine and accelerating the programme, as I understand they are doing, is going to be pretty vast. I do not know what subsidy they will have to have to deliver it at an affordable price but I suggest quite a large one.
  (Dr Lob-Levyt) Certainly we need a lot more money, both to develop the vaccine and when we actually have the production of the vaccine to ensure that those investments are returnable.

  73. How crucial is vaccine to the control in poor countries?
  (Dr Lob-Levyt) In the longer term absolutely vital. Of course you already have people infected and the priority will be to support those who are infected, but for future generations there is no doubt that a vaccine, if it were available, affordable and effective, would completely change the picture of the epidemic.

Mr Rowe

  74. How involved is DFID in advocating the human and legal rights of those who live with HIV/AIDS and in reducing the stigma attached to the disease?
  (Dr Lob-Levyt) Very involved is the answer, both as an organisation in how we respond to human rights agendas and we have actually produced a consultation document Human Rights for Poor People in which HIV/AIDS is covered. That is a combination of advocacy and political commitments to those principles. It is part of all our programmes and projects.

  75. Are you able to persuade for example governments to make it illegal for insurance companies to refuse to cover people? I understand that one of the reason why AIDS never appears on the death certificate is because of the damage that is likely to do to their insurance claims, their pension or whatever. How effective is it to negotiate that with governments?
  (Dr Lob-Levyt) We play our part in that, but I should be exaggerating if I said the British Government could actually resolve those rather difficult issues. These are issues which are tackled by UNAIDS and other international bodies and we provide our strong support for them to do that.

  76. When some of your colleagues came before us I did ask the question about students coming to this country and other people coming for training to this country. There is a significant — I do not know how big it is — loss of the people who either die here or die soon after returning and the cost either to their government or the NGO which sent them is very high. On the other hand it raises all sorts of ethical issues if you try to intervene on that. I just wondered what the Department's view on this is and what guidance you give to British universities or training centres and so on.
  (Dr Lob-Levyt) At the moment we do not. This is something we need to think about.


  77. May I talk about the impact of HIV/AIDS? One of the key international development targets we have spoken about before is the universal primary education in all countries by 2015. With the growing number of orphans and children withdrawn from school to supplement the family income, what changes have been made to DFID's education strategy?
  (Ms Graham) It is an absolutely key issue in sub-Saharan Africa and it is right to say that DFID in the first instance was not particularly involved in prevention and mitigation aspects of the epidemic in the education sector. It is also right to say that is changing quite considerably now. We are scaling up our efforts both to link up with other agencies and governments to share experiences, learn lessons about how the education sector can be harnessed in terms of prevention strategies. We are also scaling up our programmes quite considerably. In particular we have a programme in South Africa at the moment to produce guidance for policy makers on how they can integrate HIV considerations into education policy and that sort of activity is happening in many of our country programmes at the moment.

  78. That is encouraging. Is there a possibility of home extension of schooling or a form of social security payment to keep children in school?
  (Ms Graham) I must admit I cannot comment on that particularly, although I would say that certainly the informal education sector is very important and perhaps might tend to get overlooked in an effort to work HIV/AIDS considerations through the education sector. Aspects such as home based care, home based education will be increasingly important for countries in Africa.
  (Mr Grose) DFID is part of an inter-agency group which involves other bilaterals and other organisations like UNDP and UNESCO, which is beginning to look for some practice solutions very much along the lines you mentioned, basically to make sure children do still get access to education, even if they cannot attend school as much as they would have done in the past. The universal primary education strategy is one way which does actually encourage them or enable them to go to school even if their families are affected. There are other ways in which schools can become places where children will learn a broader range of life skills, for example learning about farming if their fathers are dead, making sure that the schools offer more than they have in the past, which makes them more attractive to families which are under greater stress. This working group is also looking at issues like human resource development and human resource protection for ministries of education, to try to make sure that there are enough teachers available to offer education services to the pupils. It is a very diverse range of problems and we are joining with others. It is a late stage but we are now trying to get more involved.

  79. What you are saying is that in fact it is affecting and you are taking into account these things in the educational sector, which is very important.
  (Mr Grose) Yes; very much.

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