Select Committee on International Development Minutes of Evidence

Examination of Witnesses (Questions 80 - 99)



  80. One of the important areas is clearly the replacement of the numbers of teachers. Are you stepping up the amount of money you are devoting to teacher recruitment and training?
  (Mr Grose) I am not aware that we are at the moment, but the programme is coming to headquarters for approval next month for a large education programme in Malawi, which is one of the first which is really taking AIDS very seriously indeed and includes elements to try to find a solution or to help the government find solutions in Malawi. That undoubtedly would include a human resource development angle.

Ms King

  81. Could you tell us what DFID's view is of businesses' responsibility in this area? Recently the Secretary of State was saying if programmes were established to cut infection rates in the workplace this could be done for a cost of $25 per employee and lead to a reduction in infection by one third. What does DFID actually do to try to get employers to introduce these programmes?
  (Mr Grose) Up to now, working directly with the large employers in developing countries has not been part of our approach. It has been much more working with government or NGOs. We are aware though that a lot of the big employers throughout southern Africa have been working on both prevention and care programmes and meeting their obligations. The picture is mixed and some have not been meeting their obligations as much as they should have done. There is a programme which DFID finance in southern Africa working in five of the countries of southern Africa which is very close to being finalised; it is now simply awaiting ministerial approval in those countries. A large part of it is to help large mining companies to roll out the very good experience which I mention in the memorandum where a small group of companies has had a tremendous effect in reducing STD prevalence amongst their workers and within the local community. DFID is going to be working with a larger group of companies to ask how we can help them roll it out, not to finance the services, which the companies have to finance, but to provide some of the technical assistance so that they can do it.

  82. Are there any programmes similar to this in India and Bangladesh?
  (Mr Ackroyd) It is an area which we are beginning to explore. It would be misleading to say we have got very far with it. We are doing some work in the garment industry in Bangladesh, we have been talking to some of the large employers' federations in India who are quite active in these areas. These might lead to something. There are very attractive opportunities because you are dealing with large workforces in single places and they are largely male as well, so it is an opportunity to reach populations which you would not otherwise reach with messages. If you can demonstrate to the employers it was actually in their interests to protect their labour force, you have a win-win situation. It is something which is very much on our agenda, but we are in the early stages of working on it.

  83. I should not have left out Pakistan. Does it have a similar prevalence and response in terms of government response?
  (Mr Ackroyd) In Pakistan there is a national HIV/AIDS programme. It is not terribly well funded, although it is getting a little more profile. Generally speaking there is not a high rate of prevalence in Pakistan at the moment. It tends to be concentrated, interestingly, largely in the drug industry. There is quite a big problem there of intravenous drug use and that is a problem area which needs to be concentrated on.

Mr Colman

  84. I want to follow up the response of the business sector and the way DFID is working with them and really on a joined-up thinking basis, areas like the fair trading initiative, which is an attempt to ensure that where goods are in fact bought from abroad they are produced under ethical bases. In your backing for this initiative are you in fact suggesting that health care, particularly HIV/AIDS protection, should be part of checking to ensure that the employer who is employing the groups in the countries abroad, who are supplying the goods maybe to UK retailers, are actually looking at this whole area of health care and particularly HIV/AIDS?
  (Mr Ackroyd) I think you are referring to the ethical trading initiative.

  85. Yes, I am indeed.
  (Mr Ackroyd) The ethical trading initiative is not a DFID programme, although it is one which we sponsor. The ethical trading initiative is an activity by a group of concerned businesses themselves. What they do is determine what their priorities are, although we are broadly supportive of it and we provide them with some funding. I am afraid I do not know the details of exactly what elements they look at, so I cannot answer that specific question, but we could provide you with additional information on that if you wanted us to do so.[5]

  86. In terms of any ECGD backing which is given for projects which are working abroad, maybe the oil industry in Angola is a very good example of that, where in fact that backing is done does DFID have an interaction with DTI in ensuring that areas such as health care and HIV/AIDS protection and prevention should be part of the advice which is given and attached to any ECGD agreement?
  (Dr Lob-Levyt) The same response that Mr Ackroyd made. I cannot give you the information on that. We are engaged in other areas with DTI on pharmaceuticals. That is one to follow up.

   Chairman: It is indeed one to follow up because in not every case is the Department for International Development actually consulted by the Department of Trade and Industry. It does need to be followed up.

Mr Colman

  87. On national responses, what is DFID's assessment of the effectiveness of the various national AIDS control organisations in developing countries? Particularly does DFID prefer to work through such AIDS-specific government bodies or through health departments? Which is the preferable way forward do you think?
  (Dr Lob-Levyt) You have highlighted the main problem. They have been located in health departments, they have been relatively weak, with some exceptions, and we should prefer to see them at a higher level and outside of health. We are seeing that happening in a number of countries. We are seeing some of the AIDS committees beginning to perform a lot better. We are about to put a substantial amount of some of the funds into Kenya in support of the national AIDS programme, which is outside the health sector.

  88. What is the balance in donor support between central government initiatives and community-based approaches? Is there any evidence that one works better than the other?
  (Dr Lob-Levyt) I do not think this is an either/or question but the principles of building up from the community and reflecting and listening to the communities as the main stakeholders in building national programmes is the principle by which we work in all our programmes. That requires direct support to communities. It also requires national responses through governments.

  89. Bottom up is essentially getting the community support to go forward even if it is central government initiative.
  (Dr Lob-Levyt) That is right; absolutely. That is part of our general "Pro-Poor" development agenda.

  90. We have something like seven co-sponsors of UNAIDS. I am not going to go through the alphabet soup but how effective do you believe it is to have this situation? How effective is the international coordinated response of donors to the HIV/AIDS crisis?
  (Dr Lob-Levyt) I should say that UNAIDS has become an extremely important agency in promoting the better coordination and raising the political stakes at the highest level and getting it at the top of the agenda of all agencies and governments. We will respond very positively to what UNAIDS has achieved internationally at that high level. We have had some concerns about the effectiveness at the country level, but we are now beginning to see a lot of improvements at the country level on that. In terms of coordination, it may be useful to ask Ms Graham to talk about the Africa Partnership as an example of coordination of a number of donors' efforts in Africa which is being led by UNAIDS.
  (Ms Graham) The International Partnership against AIDS in Africa is essentially an initiative to bring together both the private sector, NGOs, the donors and the UN co-sponsors which UNAIDS work with. The partnership works at three different levels. At the international level its main role is advocacy, the sorts of issues which Dr Lob-Levyt was talking about, getting HIV/AIDS at the top of the international agenda, as we saw with the Security Council in January. They also work both at the regional level and at the country level and this is where we really want to see the partnership be successful. It is in its very early stages at the moment, but essentially its objective at the country level is to work with African governments behind their priorities and to coordinate all these different actors in the context of one national AIDS strategic plan. It is in its early stages, it is being piloted in six countries at the moment and I must admit the evidence is a little mixed as to whether it is being successful, but certainly we would want to see it being a success. This is perhaps part of the key to getting a strengthened response, particularly in Africa.

  91. Do you think the Commonwealth is sufficiently coordinating its response or do you see the situation where we should really work through the UN institutions and the UNAIDS?
  (Ms Graham) The main role of the Commonwealth would be in international advocacy and getting HIV/AIDS as an issue which is spoken about. We saw the Prime Minister speaking about HIV/AIDS at the recent Commonwealth heads of government meeting and it was very significant that was on the agenda there. At the country level it really is this issue of coordination, how we get donors and civil society and the private sector working together behind an African government.

Ann Clwyd

  92. May I put to you a couple of points made by a group called Alliance which sent evidence into us? At the beginning they praise DFID for what they say are some of the most important innovative activities in the developing world. Then they go on to say these are seemingly outside any overall strategy for ensuring a broad impact. DFID is by no means a leader on this issue amongst bilateral aid agencies. The lack of DFID strategy is particularly evident in regard to civil society responses to AIDS as reflected in a recent decision in India to phase out support to a remarkable Healthy Highways project without ensuring an adequate transition plan. What would your response to that be?
  (Dr Lob-Levyt) Firstly, there are some factual errors here. The Healthy Highways project has not been phased out, it is moving into another phase with a different emphasis to the programme.

  93. So you are still supporting it.
  (Dr Lob-Levyt) Yes. Secondly, I hope that some of what we have been saying here today gives you an idea of the high priority we do place on HIV. Maybe one or two years ago you could have said that and I would invite the Alliance to come to talk to us and understand perhaps a little better how things have changed in the last two years.


  94. Were you appointed two years ago?
  (Dr Lob-Levyt) Actually no. We do have a clear overall strategy which is reflected in our Better Health for Poor People document which summarises that internally. We are evolving a much stronger strategy which also reflects greater regional priorities and the regional responses there will be.

  95. They then go on to criticise the EU. They say the European Commission has been particularly strong in certain areas of research. Unfortunately the Commission seems to lack the necessary political will, bureaucratic structures and the technical expertise to support community and civil society responses to AIDS effectively.
  (Dr Lob-Levyt) I would judge that the European Commission centrally has been extremely useful in Brussels in pushing the HIV agenda with the European Parliament, in pushing and driving some new legislation in a number of areas for the production of new pharmaceuticals and for making some very clear statements of the importance of HIV that is beginning to affect their development programmes. Centrally I would be rather positive. When we get down to the country level the general concerns which many share on the effectiveness of EC programme aid at the country level is as applicable to HIV/AIDS as any other domain.

  96. They criticise the lack of technical capacity in HIV/AIDS at both DFID and the EU, which they say has constrained the development of appropriate responses. In contrast the United States continues to pull more than its weight in supporting developing country HIV programmes.
  (Dr Lob-Levyt) I cannot comment so much on the EC; certainly there is capacity centrally at the EC; at the country level maybe a bit less. With DFID I would judge, coming fairly newly into the organisation and having spent a lot of time visiting field offices and getting to know colleagues, that we have extraordinary capacity and in depth in many sectors on HIV/AIDS and that is being rolled out in terms of mainstreaming our work in many countries in the world. The evidence of some of my colleagues here who bring interdisciplinary skills as well as specialist skills shows that I would contest that extremely strongly and again invite the Alliance to come to meet some of these people.

  97. I am sure they will take up the invitation.
  (Dr Lob-Levyt) Yes, I am sure they will.

Mr Robathan

  98. I also saw this letter from Jeff O'Malley about the remarkable Healthy Highways project. May I tell you, just in case you get the wrong idea, having seen the Healthy Highways project in Hyderabad, I thought it was remarkable—not everything which is done as a project to combat HIV is going to be successful - it was a remarkable waste of time. As I recall, I think when we spoke to them it was a Friday and during that week they had had something like one or two people come to the mobile clinic with a STD. In one week they had seen one or two people with any sexually transmitted disease, so I do not feel it was necessarily the most cost effective way of pursuing it. We did mention this at the time to the people in India. That is not the question I should like to ask. It is terribly important that we have accurate data to base this on and Mr Grose was pointing out the difficulties which we all understand, especially in somewhere like Sierra Leone where to find a clinic is difficult enough, let alone to find blood testing. I am looking at the document which is the best we have, which you put in your submission and it says that in Bangladesh the adult infection rate at the end of 1997 was 0.03 per cent. I pick on this as an example because if we are trying to appreciate this problem, we do need as accurate information as we can get. That seems to me incredibly low. What do you think?
  (Dr Lob-Levyt) That is low. That would be a population based figure.

  99. I reckon it is lower than the United Kingdom.
  (Dr Lob-Levyt) Absolutely. If you looked in certain at risk groups, you would see higher rates of transmission. We need more data and better data to understand how that 0.03 per cent is actually distributed across society. I do not know what the latest figures might suggest.
  (Mr Grose) I do not have the latest figure for Bangladesh. I suspect it is probably still under one per cent. That is low in global standards and very low if you compare it to sub-Saharan Africa. The real issue is its concentration in groups of people who have particularly high risk behaviour, such as commercial sex workers and their clients. The strategy in response to that is to focus on those groups as it has been in the project I have already described. That would contain it.

5   See Evidence p. 72. Back

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