This week the FCDO published its long awaited International Development Strategy. The Strategy sets out how the Government will deliver on the priorities identified in the integrated review – a process STOPAIDS and its membership were closely involved in.
STOPAIDS welcomes the level of ambition of the strategy and that commitments to global health have been retained. However the fact that ‘aid for trade’ and geopolitical advantage remains the foundation of the FCDO’s approach to international development is deeply concerning. It indicates a failure to address the historical and structural problems the strategy is seeking to address. Coupled with the cuts to 0.7% and the reduction of spending on multilaterals, we are concerned that this strategy, even on its main priority to provide women and girls with the freedom to succeed, will not be able to meet all the commitments it has set itself.
These broader comments are also relevant to how the strategy delivers for the HIV response and ensuring all people can realise their right to health and wellbeing (STOPAIDS new strategic vision). Below we have analysed the IDS against our own advocacy goals to identify where we need to be pushing the UK to do more to fulfil its responsibilities to reach these goals.
Global equitable access to life-saving health technologies for Covid-19 and future pandemics.
We welcome the UK’s commitment to increasing access to vaccines, therapeutics and diagnostics to reduce the impact of COVID-19 and other diseases and to investing in innovation to develop more effective pandemic tools and health technologies. However, we are concerned that the strategy does not set out how it will address the structural barriers that have prevented COVID-19, and other health innovations, from being widely accessible.
To ensure this happens going forward the UK must ensure that ‘British Investment’, funded by public money, has a public return and has conditions attached to it that ensure products will be considered global public goods, available to all. In addition, to strengthen or ‘unleash’ potential in low- and middle-income countries in the context of health systems and access to medicines, the UK must increase support for improved local innovation and manufacturing capacity for health tools in LMICs, for example by supporting the WHO’s mRNA hubs. Next, to demonstrate their commitment to transparency and sharing, the UK Government must support the original TRIPS waiver proposed by South Africa and India and commit to improving transparency within biomedical research and development processes. Lastly, equitable access must underscore all efforts to improve pandemic preparedness.
Regulating the role of the private sector in global health
The strategy gives a heightened role and resourcing for British International Investment (BII), the UK’s development finance institution. Considering the issues around BII’s predecessor, CDC, which invested significantly in private healthcare in India and sub-Saharan Africa but had questionable development impact – a heightened role for BII could continue to pave the way for the financialisation of health. Although BII has taken some welcome steps in their strategy BII plan to continue to invest into private healthcare. This is despite the overwhelming evidence that the privatisation of education and healthcare undermines public services and exacerbates inequalities. In implementing the international development strategy, we hope the FCDO considers the evidence and works with BII to stop investment in the expansion of private for profit healthcare facilities and services where profit is prioritised over equitable access. Instead, BII and FCDO should follow a set of principles for the investments and dedicate resources to public goods in national and global contexts, with a priority for strengthening public services for health.
Prioritising ‘Quality of Life’ within HIV services for women and girls
STOPAIDS welcome the FCDOs focus on empowering women and girls through education and ending gender-based violence. While these are very important factors we are concerned that health, including mental health, has not been given an adequate mention within this priority area. The promotion of women’s health is a fundamental strategy for empowering them. Specifically, ensuring the funding of services and community programs for diseases that disproportionately affect women globally, such as HIV.
Mental health is also crucial to women’s and girls’ empowerment. The problems facing women and girls that are identified in this strategy all have an impact on mental health and women who suffer from mental health problems are at higher risk of exploitation and abuse. Mental health services are extremely limited in many low and middle-income countries yet this strategy makes no mention of funding for mental health services or objectives for women and girls that are related to mental health. We welcome FCDOs plan to work to ensure women’s voices are heard. However, in order for those voices to be heard the mental well-being of those women must be ensured.
STOPAIDS recommend that FCDO apply a quality of life approach to empowering women and girls to ensure their mental health, physical health and social well-being. A quality of life approach would address the underlying structural inequalities that contribute to the vulnerability of women and girls; and commit to multisectoral, rights-based, gender-transformative policies and programs that reflect and respond to the holistic and multidimensional nature of women and girls’ lives.
Access to and funding for HIV services
To ensure people living with HIV can realise their right to health and wellbeing, we need greater funding from the UK Government for HIV services. However the target in the International Development Strategy is to reduce aid spending to multilaterals, which provide critical funding and guidance to HIV services, from the 40% proportion today to just 25% by 2025. Last year the UK already cut funding to key agencies like UNAIDS, Unitaid and UNFPA by over 80%, the International Development Strategy could signal even further cuts and our fears being realised. Further cutting multilateral funding, against the backdrop of the COVID-19 economic recovery and the growing food crisis, will drive more people into poverty risking a resurgence of the pandemic with a heavy human and financial toll, affecting the most marginalised in societies.
This is especially concerning at the moment as 2022 is a replenishment year for the Global Fund to Fight AIDS, TB and Malaria. To prevent a resurgence of the diseases post COVID-19 and to get the world back on track towards elimination the Global Fund is asking for an increase of 30% from all funders, including the UK. If Liz Truss wants to achieve the key objectives set out in her new strategy – and stand with key allies – she must make sure sufficient funding remains on the table for the cost-efficient and powerfully effective global institutions that the UK has been a close partner with, like the Global Fund, UNAIDS and Unitaid.
Sustainable Transitions
We welcome FCDO’s mention of middle-income countries being central to the achievement of global commitments. However, we are concerned MICs will only receive ODA when “necessary”. If the determination of when is necessary for a country to receive ODA is based only on Gross National Income status (GNI), there is a risk that the complexity of health systems, equity issues and the diversity of conditions that each country brings is not taken into account.
FCDO indicates that when a country achieves middle-income status ODA will be withdrawn and the focus will be on investment and trade. However, FCDO makes no mention of how this transition from aid to trade will be implemented, or if FCDO will recommit to previous transition principles identified by (what was then) DFID. If the transition away from ODA in MICs is implemented poorly, the people most likely to suffer in those countries are vulnerable groups including women and girls, who are a focus group of this strategy. The FCDO’s intention to maximise the impact of ODA spending will not be achieved if they do not take a sustainable and holistic approach to the eligibility and allocation of ODA.
Meaningful involvement of civil society and communities within global health
STOPAIDS welcomes this strategy as a whole of Government approach and is encouraged by the commitment to working with civil society, alongside other actors to ensure the strategy delivers on its pledges.
Civil society and communities are critical partners and must be meaningfully and actively engaged in decision-making processes as well as technical areas of work. The full and meaningful participation of civil society and communities will be essential in the delivery of this strategy, recognising the strength they have at national, regional and international levels in all areas of health, particularly recognising the right to self-representation and distinct voice of communities.
Global Public Investment
STOPAIDS welcomes the FCDO’s plan to build sustainable and resilient global supply chains that benefit all. This will help Plow- and middle-income countries become trade and investment partners of the future and creating secondary benefits for donor countries. This goal could be accelerated if the UK adopted Global Public Investment (GPI), a system in which all countries contribute to resource different elements of public service spending in different ways. In this way it presents a solution for the barriers that low and middle-income countries face to trading efficiently that are identified in this strategy as it creates a transparent, democratically governed, international system to develop international financing policies.
GPI could also be the key innovative finance and insurance mechanisms to better manage and anticipate humanitarian emergencies, another need identified in the IDS. The GPI approach to PPR represents a ‘funding regime’ rather than a proposal for a single fund, wherein global public policy objectives are determined by negotiations between all parties, and funding is allocated in accordance with public health experts and civil society guidance so as to best meet overall global PPR needs. This would help even up the overall level of PPR capacity across the geographic and thematic areas that need to be mobilised to prevent and respond quickly and effectively to outbreaks of viruses of pandemic potential.