Don’t abandon Labour’s initiative to improve access to health care for world’s poor people, charities urge
Author(s)/Editor(s): Moszynski P
Publication date: 2010;340:c3153
Number of pages: 2
Last week the United Kingdom’s new secretary of state for international development, Andrew Mitchell, announced "a fundamental change in direction" in aid spending, with a new emphasis on "transparency, accountability, responsibility, fairness, and empowerment."
The announcement has been welcomed by most development charities, and Mr Mitchell’s subsequent decision to review Britain’s existing commitments to all multilateral institutions—including the World Health Organization and the Global Fund to Fight AIDS, Tuberculosis and Malaria—has been greeted with cautious support.
However, charities have expressed concern for the fate of the newly established Centre for Progressive Health Financing, which aims to support poor countries to achieve universal access to health care and which is hosted by the UK Department for International Development (www.progressivehealthfinancing.org).
A group of charities, including Save the Children, Oxfam, and the maternal health charity Interact, has written to Mr Mitchell urging that his department continue to support the new centre, established in March by the previous government.
Mr Mitchell announced his review at the launch of Oxfam’s new report, 21st Century Aid, on 3 June at the Royal Society. He said: "Development is good for our economy, our safety, our health, our future. It is, quite simply, tremendous value for money: the best return on investment that you’ll find anywhere in government. British aid pays for five million children in developing countries to go to primary school every day. That’s roughly the same number as go to primary school in Britain, yet it costs only 2.5% of what we spend here."
Announcing a new aid watchdog and a "UK aid transparency guarantee," he said that a "fundamental change of direction" was required and that "we need to focus on results and outcomes, not just inputs."
Oxfam’s chief executive, Barbara Stocking, responded by saying, "Strengthening transparency and accountability will be important in further improving the quality of British aid, but they should be pieces in a larger jigsaw."
She said it was vital to ensure that aid was "poverty focused, not politically driven," that it strengthened the public services on which poor people rely, and that it focused on making the "biggest possible difference to the lives of the world’s poorest" people.
"We look forward to working with the new government on these issues," she said.
On 9 June Mr Mitchell announced that he would be conducting an immediate "multilateral aid review."
In 2008-9 the Department for International Development spent £2.3bn ( 2.8bn; $1.5bn) of its £5.5bn programme budget through some 30 different multilateral institutions. This included £574m for the World Bank and £252m for the United Nations.
Each of these institutions will be "tested to ensure the UK is getting maximum value from its aid money," Mr Mitchell said. This will include assessing the relevance of each body to the UK’s objectives on poverty reduction and its ability to deliver results on the ground.
Mr Mitchell said: "There are over a billion people living in extreme poverty around the world. We believe it is our duty to ensure we get as much as possible out of every pound of British aid." He said that nearly half the aid budget is currently spent through international bodies, "so it is right that we assess whether this is providing maximum value for money."
Marie Staunton, of Interact Worldwide, said she "welcomed Mr Mitchell’s message that the poorest must be empowered." She added that it was crucial that he "ensured this was carried through at the outcome of the forthcoming G8 and MDG [United Nations millennium development goal] review summits."
Max Lawson, Oxfam’s head of development finance, told the BMJ: "This review should be good news for recipients of British aid, allowing it to be given to those institutions that get best value for money." He said that the government should take this opportunity "to halt funding increases to the World Bank, which often ignores the evidence of what works and allows private sector dogma to get in the way of successful aid delivery."
On the other hand, he said that "institutions such as the Global Fund have a proven track record of success and deserve to benefit from increases in the UK aid budget." He also emphasised the importance of the Centre for Progressive Health Financing "in the fight to make health care free in the poorest countries and save millions of lives."
Save the Children’s head of health, Simon Wright, also welcomed the review, telling the BMJ: "The World Health Organization is accountable to all governments and has the legitimacy to lead in global health. Its leadership in pro-poor health policies is vital, yet it is short of funds. The World Bank suffers from a lack of accountability for the policies it promotes, and its funding of health programmes has been evaluated poorly, yet the UK directs huge amounts of its aid this way."
He said that the charities had specifically written in support of the new centre because they were "eager to ensure that the approach to innovative health financing initiated by the previous government is maintained."
He explained that the centre supported the development of sustainable and long term revenue for health in developing countries through national health insurance schemes and tax. He said that without such measures "too many low income countries will continue to charge fees for health care, and the poorest women and children will continue to die because they lack the money to see a doctor or buy the drugs."
A Department for International Development spokesman was unable to comment on the centre’s current status but said that the spending review had only just begun and that no decisions had yet been made.