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International Health Partnership

I am grateful to have this opportunity to participate in a debate in parliamentary time about the international health partnership because I believe, as I am sure we all do, that the state of the health of the world's poorest people is one of the great injustices of our time, and we are keen to put that right. This debate is timely, as yesterday marked the six-month anniversary of the IHP's launch. I would like to begin by setting out the scale of the global health challenge and the depth of human suffering that we need to address. In 2000, the Governments of the world set out a vision to reduce poverty by 2015. That vision, which was enshrined in the millennium development goals, included reducing by two thirds the number of deaths among children under five, reducing by three quarters the number of maternal deaths, and reversing the spread of AIDS, malaria and other diseases. Today, we are still a long way from achieving those goals. Every day that passes, more lives are lost—every three seconds, one child under the age of five dies; every minute, a mother dies in childbirth; and every day, more than 10,000 people are infected with HIV—yet much of the suffering can be prevented through simple and affordable measures. That is why the international community is devoting more resources than ever before to tackling the crisis in health. Funding for global health has doubled from $6 billion in 2000 to $13 billion in 2005. Last year, the UK Government committed £1 billion up to 2015 to the Global Fund to Fight AIDS, Tuberculosis and Malaria. Much of the increased funding has targeted specific diseases, with impressive results. For example, the global fund has put more than 750,000 people on to antiretroviral treatments to fight AIDS and has distributed more than 18 million bed nets to prevent malaria. Every day, it helps to save 3,000 lives. The Global Alliance for Vaccines and Immunisation, with the support of the international finance facility for immunisation, has prevented nearly 3 million deaths by dramatically increasing the use of vaccines. The challenge now is to lever that success to deliver enduring health systems that the poorest people can get to and use. Such systems should include networks of clinics, health workers and available drugs and treatments. Without them, medical tests are not carried out, drugs go undelivered and the regular monitoring of patients and the improvement of their health breaks down, often with tragic results. The Government and I believe that building stronger health systems is critical to meeting the health millennium development goals. The second challenge that we face is ensuring that we make the most effective use of aid for health. Every pound can save a life, and we have a duty, not only to the poorest in the world but to the UK taxpayer, to ensure that every pound is used to its maximum. The truth is, however, that the global health system is a crowded place. More than 100 different agencies are involved. That is often reflected on the ground in developing countries with fragmented approaches to health provision that function outside the Government's own planning and budgeting processes. For example, in Rwanda, 21 donors and 40 non- governmental organisations are active in the health sector. As a result, the figures are worrying. Administration consumes more than one quarter of all health spending. The central Government are managing only 14 per cent. of donor expenditure, and only $1 million of donor money goes to the integrated management of childhood diseases, compared with $18 million for malaria and $47 million for AIDS. We need to tackle those figures. It was because of those two challenges—building stronger health systems and making aid more effective—that, six months ago almost to the day, our Prime Minister launched the IHP from Downing street. The time was right. New people in charge of the World Health Organisation, the World Bank and the global fund were all committed to working more effectively, and 2007 presented a unique opportunity to forge a new alliance for better health. This morning, I spoke at the Women and Children First conference, where Dr. Songane, the chairman of the Partnership for Maternal, Newborn and Child Health, described 2007 as a turning point. He was right, and it is our duty to make it such. That is why, under our Prime Minister's leadership, developing country Governments, other bilateral donors and heads of the major health agencies have come together to launch and work on the IHP. Without any doubt, this is an important milestone. For the first time, members of the global health community signalled that, working together, they would challenge the idea that business as usual can go on. In other words, we agreed to work together to change the status quo. However, we need to do that without creating a whole new bureaucracy—another piece of crowding in a very crowded place. We need to do it without creating yet another global fund, or an exclusive club for the few. The IHP is none of those things. What is important is that it is about all partners working together around a set of three principles aimed at transforming the health of the poor. First, there must be robust, country-led national health strategies. Indeed, some national health plans are very good, while others set out how existing resources will be spent. Some countries have no health plan. Some have several health plans: one for AIDS, one for health systems, and another one the health work force. The second principle is that funding should be co-ordinated around those strategies. Alongside the national Governments, there are several international funders of health, including the WHO, the World Bank, the global fund and bilateral donors such as the UK Department for International Development. The third principle is that health systems must be central to national strategies. They are essential to complementing and sustaining the success of disease-specific innovations and interventions, including those for AIDS. Health strategies are important for improving child and maternal health, and for addressing other major killers in developing countries, such as diarrhoea and respiratory illnesses. Developing country Governments agreed to invest more in their own health systems, to address bottlenecks to stronger health systems, and to strengthen planning and accountability systems. The political commitment that we saw in September was critical to all this, but the success of the IHP will be in its implementation. Obviously, the proof of the pudding will be in the eating, and that is our challenge. It is only if we can change the way in which we work that we will deliver much-needed change and improvements and thereby progress towards meeting the health millennium development goals. The IHP is already fast becoming recognised as the organising framework for support to the health sector. I pay tribute to the efforts of Margaret Chan, Joy Phumaphi and their staff at the WHO and World Bank. Their determination to implement the IHP has been critical to achieving the progress that has been made in the first six months. Let me give just a few examples of progress. One of the challenges with focusing aid on health systems is the difficulty in showing the impact of additional spending. I am particularly impressed with Burundi's country-level IHP compact, which was signed just two weeks ago and focuses on achieving tangible improvements in health, such as increasing the number of people attending medical facilities and improving immunisation coverage and deliveries in clinics. One of the most visible and damaging signs of a weak health system, which was raised with me this morning at the Women and Children First conference and of which we are all aware, is a lack of trained health workers. The World Health Organisation estimates that we have a global shortage of some 4 million health workers—1 million are needed in Africa alone. In Mozambique, a central part of the IHP will be developing and implementing a co-ordinated strategy to increase the number of health workers. The United Kingdom Government are supporting that. We must not forget that even if there is a fully equipped and staffed clinic, that will not lead simply to improvements in health care, if people cannot afford to use it. That is a major issue for us, because fees account for more than 60 per cent. of total health spending in the poorest countries and are, without doubt, one of the most regressive and ineffective sources of health financing. I am delighted that, in Nepal, the IHP has given momentum to a new policy of free health care. I recognise the important role of civil society and organisations such as Save the Children, which has taken an interest in today's debate, in providing health services to the poor. In Zambia, the IHP further encouraged the Ministry of Health to engage with civil society. Finally, looking ahead to the next six months, I am delighted that Margaret Chan has agreed to arrange an event at the World Health Assembly to widen support for the IHP. The next milestone for us will be the one-year anniversary of the international health partnership in September. I look forward to being able to report then that it has continued to develop and to deliver real improvements to the health of millions of the world's poorest people.