Universal Health Coverage (UHC) is a simple but powerful concept that unites people across the world: that everybody should get the health services they need without suffering financial hardship. Exactly two years ago, following a unanimous vote at the United Nations, all governments committed themselves to achieving UHC. Now, on the anniversary of this historic resolution, over 500 organisations from 100 countries are celebrating Universal Health Coverage Day and are campaigning to accelerate progress towards this goal. These organisations include the World Bank, WHO all the major NGOs and many development agencies of national governments. David Cameron once said he was ‘proud of the NHS’ – so what has his government done to support universal health coverage around the world?
In 2009, under a Labour Government, the United Kingdom was the leading G8 country promoting UHC. This was demonstrated at the United Nations General Assembly, where Gordon Brown co-hosted a meeting with the World Bank during which 6 low income countries announced that they would extend the provision of free publicly financed health care. These countries included Liberia and Sierra Leone who are currently at the epicenter of the current ebola crisis. Britain also announced that it would set up a special centre, to be called ‘The Centre for Progressive Health Care Financing’ to help countries develop financing strategies to reach UHC, largely using their own resources.
Now under the coalition Britain has dropped the ball on UHC and everyone is asking why the country famous for celebrating its NHS at the Olympics isn’t celebrating UHC worldwide.
One of the Coalition Government’s first acts was to stop our plans for the UHC centre from getting off the ground. They’ve slashed support for health care budgets in developing countries by 30%, including in Sierra Leone and Liberia prior to Ebola breaking out. In the talks to determine the Sustainable Development Goals that will replace the MDGs, the UK Government has actively blocked calls for a Universal Health Coverage goal.
Perhaps the main reason is that the Tories don’t believe in UHC themselves. You’ll remember that Jeremy Hunt didn’t want us to showcase our wonderful NHS during the opening of the Olympics and we know there are many in the Tory party plotting its downfall. How hypocritical would it look for the Tories to champion UHC internationally whilst overseeing the wanton vandalism and underfinancing of the NHS at home.
The Labour Party, however, is totally committed to saving the NHS and UHC in Britain and helping other countries make sure their populations get the health services they need. Our shadow secretary of state, Mary Creagh MP has pledged that Labour will “demand that universal healthcare is at the heart of the Sustainable Development Goals settlement.”
Each country’s route to UHC will be different depending on their circumstances but one thing is absolutely clear, if you want to reach UHC, public financing is crucial. Here Britain and the Labour Party has a great story to tell and, unlike the Tories, we’ll be proud to share our experiences with the rest of the world.
This week Labour released a pre-manifesto report, outlining summary of some of the key policies Labour have announced already. You can read the full document here – below is the section on foreign policy and development.
“Changing Britain Together: Leading in the World
Globalisation has increased connectivity between countries and people, as global challenges increasingly demand global solutions. Instead of building upon Britain’s role in addressing global challenges, David Cameron has been content to watch from the sidelines. Time and again he has put his Party before his country – he is sleepwalking Britain towards exit from the European Union, trying to keep his Party in line while putting British jobs at risk.
Meanwhile, Britain’s commitment to climate change, human rights and multilateral organisations has frequently fallen by the wayside, with a reliance on the private sector for the delivery of development assistance not being met with adequate levels of transparency and accountability.
The next Labour Government will put Britain back at the heart of global affairs. We believe Britain must play a proactive role in tackling international issues and we won’t shy away from the big challenges: working to eliminate extreme poverty, supporting countries transitioning to democracy, tackling terrorism and climate change.
With Labour, Britain will lead by example, working with our partners worldwide to promote our values and defend our national interests. Only by doing so can we hope to build a better, safer and more secure world.
And because Britain will be better off remaining at the heart of a reformed EU, Labour will make the hard-headed, patriotic case both for reform in Europe, not exit from Europe.
- Work with our partners to reform the EU to make it work better for Britain, reforming free movement so that people coming to the UK have to wait longer to receive benefits and making it easier to deport those who commit crimes.
- Guarantee no powers will be transferred to Brussels without an in/out referendum.
- Ensure an outward-facing Britain, using our assets to amplify our influence worldwide.
- Lead by example on human rights, upholding them domestically through the Human Rights Act, and advocating them overseas.
- Put reducing inequality, climate change, and promoting universal health care at the heart of international development, pushing for an ambitious agreement in 2015.”
by Anas Sarwar MP, Shadow International Development Minister, to the OECD Political Financing and Averting Policy Capture Conference
As a parliamentarian in the United Kingdom, working in the “Mother of Democracies” is both an honour and a huge responsibility. Being the gold standard for Parliamentary systems means that we must have the highest standards of governance and best practice, not just at home, but in our interactions around the globe.
As we continually move towards a more integrated and globalised world, the political actions we take and the examples we set, must earn the trust and respect of UK citizens and also do no harm to our global neighbours.
More than that, we should be leaders in ensuring that our style of governance promotes prosperity and wellbeing right around the world. Whilst the UK may enjoy the historic title of good governance, there are still many ways in which we need to improve.
In Transparency International’s Global Corruption Barometer 2013, 90% of respondents believed that the UK Government is run by a few big entities acting in their own interest.
This shows that the social contract in Britain is broken. The erosion of trust in authorities is creating disconnect between the parliamentarians and the people that they seek to represent. People are angry with the establishment and the cosy interactions of the power brokers.
• They’re angry with banks following the global financial crisis and soaring bankers’ bonuses
• they’re angry with the Big Five energy companies who have increased prices to record highs whilst ordinary people
have to choose between heating their homes and eating
• they’re angry with the media who have invaded people’s privacy
• They’re angry with politicians who they feel do not represent them
The same study showed that in the UK, people’s appraisal of their leaders’ efforts to stop corruption is worse than before the financial crisis began. In 2008, only 31% people said the government’s efforts to fight corruption were effective, with that number falling even further to 22% of respondents.
The MPs expenses scandal which was uncovered in 2010 would likely be a significant impact on this. It was found that a minority of MPs were making excessive and ineligible expense claims which was then reported continuously and in great detail in the media. The result was the resignation of six ministers, more than a dozen MPs named chose not to stand for re-election, four MPs and two peers faced criminal charges of false accounting.
The UK public felt massively betrayed by this abuse of power and the whole issue has left a legacy of mistrust. Democratic systems can only be effective if they have input of both the government and the citizens they represent.
This relationship breaks down when people believe that corporate money can be used to buy influence and political
This disenchantment with political systems is becoming more and more apparent. We’ve seen the rise of anti-establishment, civil protest movements like Occupy Wall Street, Anonymous, Wikileaks and most significantly the Arab Spring. From hyper local to global, each of these movements successfully mobilised grassroots activists and overturned oligarchies, with varying degrees of success.
People are demanding a change in political practice. They want the representatives that they elect to govern in the interests of the masses, and they want to know exactly how politicians can achieve this.
The UK has recognised and made changes on some of the big issues of transparency and accountability.
Following the MPs’ expenses scandal, the Independent Parliamentary Standards Authority was created which now oversees all of MPs’ spending.
The Serious Fraud Office was created in 1988 and is now responsible for reducing fraud and corruption, delivering justice and maintaining confidence in the UK’s business and financial institutions.
The Bribery Act 2010 is now among the strictest legislation internationally on bribery. The legislation creates four prime offences: the receipt or provision of bribery, the receipt or provision of advantage, bribery of a foreign official and failure by a company to prevent these.
Lobbying is one of the most harmful threats to British democracy. A worrying 67% of UK respondents consider political parties to be corrupt or extremely corrupt. In light of this, the Lobbying Bill sets out to cap donations to political parties, end the revolving door of employment between big business and senior government officials, reform the honours system and renew emphasis on ethical conduct for parliamentarians.
However, despite these, public opinion of politics has not improved. The current UK government has been reluctant and duplicitous in its willingness to combat corruption, most recently displayed with the consideration of abolishing the Serious Fraud Office.
BOND, a coalition of around 600 NGOs recently wrote to the government to express their “serious concern about the recurring suggestions from [the] government that the Serious Fraud Office might be abolished, while failing to propose an adequate replacement.”
This paired with the government’s sacking of the Anticorruption Champion and the continual delay in publishing the Anticorruption National Action Plan since October 2013, does not present the best scorecard for the current UK government.
Despite the UK having one of the strictest anti-bribery legislation worldwide, not one charge has been enforced in nearly four years since the Bribery Act came into law.
The introduction of IPSA to handle MPs’ expenses has made little difference, with this year’s bill a similar cost to the year the scandal was uncovered. To add insult to injury, IPSA has suggested an 11% increase to MPs’ salary. This would take it to three times the average wage, whilst public sector workers above £21,000 suffer a pay freeze.
We can’t expect citizens to enthusiastically contribute to society and the common pot when they feel like they are not getting a fair deal.
Whilst austerity inhibits growth in the UK, on the international stage there are examples of extreme misappropriation of public funds, like in Nigeria. Subsidiaries of Italian oil company ENI and Royal Dutch Shell paid Nigerian government US $1.1billion for oil block OPL 245. Suspiciously, the same amount then paid to Malabu Oil and Gas, a company owned by former oil minister Chief Dan Etete, which has been investigated by several authorities including the UK Crown Prosecution Service.
Nigeria has enjoyed a 50 year oil boom but at the same time has lost $400billion in oil revenues, whilst 84% of the population live on less than $2 a day. This loss of revenue could provide education to 1.7million of the 5.5million girls out of school. It also equates to around two thirds of the health budget.
This outlines the importance and need for smarter and more efficient investments, especially of DFID sponsored aid.
In 1998 DFID under Labour invested £20million into creating a Rwandan Revenue Authority. In the first year it collected £60million and by 2006 it collected £240million a year. Consequently, poverty levels fell from 74% in 1994 to 56% in 2006. One of the most telling figures is that government expenditure received from aid is down from 85% in 2000 to 45% in 2010.
The Rwanda model is a great example of how political finance, if it is raised and directed by transparent and competent agencies, can truly serve its citizens.
The UK has enjoyed the rights of a global leader, but more importantly it must live up to the responsibilities of a global leader. Whilst our priorities must be to honestly and transparently represent our constituents in the UK, we must ensure that our domestic politics do not spill over to the detriment of our neighbours in today’s globalised village.
By David Jepson, Bristol West CLP
There was considerable media coverage last month as the last few British soldiers climbed into a helicopter and flew out of Helmand in Afghanistan for the last time. There was much less media attention last week for a major conference which took place in London, co-hosted by the Afghan and British governments, with the aim of proving a platform for the international community to demonstrate their solidarity and support for Afghanistan following the military withdrawal.
In these hard times it may seem difficult to ask hard pressed British taxpayers and potential Labour voters to contribute even more expenditure to a “far away country” after all the money and the lives already committed. However, though a poor country now, Afghanistan is rich in mineral deposits and occupies an important spot on the map in both economic and strategic terms. Commercial links with China are developing rapidly, so surely the UK needs to position itself in the future global economy. On the other hand, if Afghanistan stays poor, instability, outmigration and other issues, will continue to be on-going problems for us here in the UK. And of course, the Labour Party is committed to global social justice and therefore it is right that we support development, not least because of our tangled role in the country’s history.
The conference confirmed that the reform programme produced by the Afghan government entitled “Realizing Self Reliance: Commitments to reform and renewed partnership” provided a credible framework for development of the country. It mostly says the right things about the need for improving security, political stability, economic and fiscal stabilisation, good governance, promoting the rule of law and human rights, especially in relation to women and girls, as well as fighting corruption and the illegal economy.
Labour’s approach should surely stress the key role of good governance at all levels and the important role of civic society. As the economy develops, it is important that the fruits of growth are widely shared, government and civil society can play a major role in attaining this. Huge numbers of international donors, NGOs, consultancies are active in the country causing a major challenge for coordination and control. It is important that not only the priorities but also the delivery mechanisms for the support offered reflect the needs of and are accountable to the government of Afghanistan.
Development needs to come from the bottom up. It is also important that the support is used to develop capability and to meet the needs of ordinary people on the ground across the country. At the end of the day, democratic governance and a functioning economy are built from the grass roots up. Using the skills and abilities of every community and individual is key and is also the best way of avoiding growth which simply benefits a small elite. This means avoiding large and complex programmes that are hard to access by smaller, locally based organisations and means controlling the use of major international contractors and providers. It also means multi-lateral and bilateral donors and agencies keeping overhead costs under control and ensuring scrutiny of their activities. International experts and consultants should only be used where bringing genuine expertise and commitment and not simply because programmes are so complicated to manage!
An illustration of what is happening on the ground is provided by one small Afghan NGO; the Organisation for the Promoting of Afghan Women’s Capabilities (OPAWC). It was established in 2003 by a group of women eager to do something proactive, concrete and achievable to empower Afghan women. They volunteered their time and expertise to affect lives in the short term, whilst building a framework for long term, sustainable opportunities for women to escape the vicious cycle of dependence and victimization in a male dominated and fundamentalist social structure. They function in three areas: literacy, practical wage earning skills and health. They realized that if a significant number of women could have access to these basic human rights they could have a foothold on the journey to achieve their constitutional right of equality and even address areas of redress yet to be written into law. Literacy for women is an essential tool not only for employment and economic development and for engagement with governance and civil society. Current priorities for OPAWC include additional seeking funding to extend literacy classes from Kabul to other provinces in the country. They also runs a health clinic for women in Farah which is one of the most remote and poor provinces in Afghanistan. There is an urgent need to provide a female gynaecologist for the clinic which will require a support to cover salary, transport, housing and security needs. OPAWC is just one of many grassroots organisations that can contribute to the future of the country, step by step.
As a last observation, it would have seemed appropriate, for such a long term issue, to have had a cross party approach and consensus over future support for Afghanistan. Yet whilst the Afghan government brought both President Ghani and his chief electoral opponent and now government Chief Executive Abdullah Abdullah to London, there was no sign such an approach from the UK government, with David Cameron centre stage. Maybe Afghanistan has something to teach us too!
The bill to enshrine our country’s aid spending in law passed its third and final reading in the House of Common’s today (after a handful of Tory MPs were thwarted in their efforts to derail it). It now goes to the House of Lords, so we are very close now to securing a key part of Labour’s legacy that will transform millions of lives.
Thank you to every Labour MP who voted today – more Labour MPs voted for this bill than the rest of the other parties combined.
Tory MPs knew they didn’t have the arguments on their side, so they tried to filibuster the bill, tabling pointless amendments and trying to talk about the bill. Unfortunately for them, Labour MPs have no intention of letting that happen.
Irritating, pointless, responsible for the misery and suffering of millions…just some of the words used to describe – no not Philip Davies, Jacob Rees-Mogg and the other Tory MPs intent on wrecking the bill – but mosquitoes. Whilst they were droning on (3 hours, 9 minutes), UK aid was distributing long-lasting insecticide-treated anti-malarial bednets, 12,118 of them in fact…
The choice – quotes from the aid bill 2nd and 3rd reading debates that say it all
“Today we mark the first anniversary of Nelson Mandela’s death. Today we have an historic chance to honour his memory and to change this world for the better.
The promise to pass this legislation was in all three of our party manifestos. People complain that politicians make promises they do not keep. Today is our chance to keep our solemn promise to the poorest people in the world. Today, with this Bill, we stand with them in solidarity. The poorest people deserve more than charity. They deserve justice, so let us get on with it.”
- Mary Creagh MP, Shadow Secretary of State for International Development
“A friend of mine was at an international conference in Africa and she was making the point, which perhaps we would all have been tempted to make, that aid is not about pity; it is about empathy. It is not just about having sympathy for people; it is about helping people, because we think the same way as they do about their responsibilities to each other. She said that people would do everything for their children. But after her talk someone quietly took her aside and said one of the most devastating things I think I have ever heard. He said, “I can’t love my children as much as you love yours in the west. I can’t allow myself to, because then it would destroy me when I lose them.
How can we continue to live in a world where in a country such as Ethiopia families did not register the births of their children for months because of the fear that they were going to die in their infancy—where a father or a mother can say that they cannot love their child too much because of the fear that they are going to lose them? How can we live, therefore, in a world where there is not hope and expectation that things could get better?
Let our debate today be a message that there can be hope for the future, enshrined in law. Let us ensure that we can say that to millions of people who thought things were hopeless that we not only kept our promises, but we kept hope alive.”
- Rt Hon Gordon Brown MP
“We should be proud of what we are seeking to achieve today. A very small Bill, on just a few sheets of paper, will save many hundreds of thousands of lives of people we will never meet and whose names we will never know. …We will, in years to come, look back with a real sense of pride on what we are, together, achieving today.”
- Rt Hon Jim Murphy MP, former Shadow Secretary of State for International Development
In contrast, here’s what those Tories opposed to the bill had to say:
“Many of my colleagues seem to want to abandon their Conservative principles… I do not know whether they believe in the Bill. In many respects, I hope they support it because they think it will help their advancement, because if they genuinely believe in it, I do not see how they can call themselves Conservatives in any shape or form.”
“At a time of national austerity, it seems to me sensible that we would want to reduce the aid spending given to other countries. It would not have been a bad thing even to have frozen aid spending to other countries, but to increase it massively, as we have done, at the same time as we are making the case that we have no money and have to cut spending everywhere and cut our cloth accordingly, is completely and utterly ridiculous.”
[The bill] “will just be a hand-out to make a few middle-class, Guardian-reading, sandal-wearing, lentil-eating do-gooders with a misguided guilt complex feel better about themselves.”
- Philip Davies MP, Con
“This measure would be grossly distorting and un-Conservative.”
- Sir Edward Leigh MP, Con
If this law makes it onto the statute books, it will help ensure Britain continues to transform millions of lives. All for less than a penny in every pound, or…
Friday underlined that poverty is political – fight it with us. Become a member of LCID today by clicking here.
Last night, Mary Creagh, Labour Shadow Secretary of State for International Development wrote to Justine Greening demanding the Tories step up and deliver a promise all three parties made.
You can help by contact your MP today and urging them to turn up and save lives this Friday – click here for details.
by Ben Simms is Director of STOPAIDS and writes here in his personal capacity as an LCID Member
Today is World AIDS Day, an opportunity to remember the 1.5 million people who died of AIDS in 2013, and the 39 million who have died in the last 30 years.
World AIDS Day is also an opportunity to remind ourselves of one of Labour’s proudest moments in government. Ten years ago, as Labour were planning the 2005 G8 Summit in Scotland, AIDS related deaths were at their peak, with 2.4 million people dying in 2005 alone. Just 700,000 people were accessing treatment.
Ten years on, 13.6 million people are alive today thanks in large part to the commitment to deliver Universal Access made at Gleneagles.
With renewed leadership, financial and political commitment, a further 21 million lives could be saved by 2030. And if we achieve that we will be looking at the end of AIDS as a public health threat.
This is surely a prize worth having, and a success story worthy of silencing even the most diehard critics of overseas development.
The response to AIDS is a story that resonates naturally with Labour as the party that founded the NHS, went on to put global health at the centre of an independent Department of International Development, and is now setting its sights firmly on Universal Health Coverage for people of all nations.
To achieve this goal Labour must take the initiative and drive the discourse on international development at the General Election. Ending AIDS will require ongoing UK investment, but UK leadership must go beyond aid. We will need to overcome the structural and systemic barriers which impact on the health and wealth of developing countries. To achieve this, three lessons (at least) need to be learnt from the past decade responding to HIV and AIDS.
First, Labour need to look at access to medicines. Between 2000 and 2011, the total cost of treating someone living with HIV has fallen from $10,000+ a year, to just $350 a year. Not because of the goodwill of pharmaceutical companies, but because, in defiance of them, we have seen the growth of competition from manufacturers of generic medicines. Labour must take a strong stand against initiatives such as the Trans-Atlantic Trade and Investment Partnership and other trade agreements that pose a threat to future access to medicines in Europe and the developing world.
Intrinsically related to this, as the current outbreak of Ebola reminds us, we need to prioritise non-commercial funding of R&D for diseases of the poor. Until we do people will continue to die in their millions from diseases we could cure, but choose not to.
Compulsory reading this World AIDS Day will be the ‘Access Denied’ report launched today by Pamela Nash MP as Chair of the APPG on HIV and AIDS. The report highlights multiple access to medicine challenges facing the next wave of the AIDS response.
Second, Labour needs to define and measure its commitment to Universal Health Coverage in ways that ensure every person has access to quality healthcare. We have learnt from 30 years of responding to HIV and AIDS, that having a fully staffed clinic and a well-stocked pharmacy mean nothing if you are a gay man, transgender woman, sex worker or drug user and are prevented from accessing services because of fear, stigma or persecution. This World AIDS Day, we should turn out thoughts to Uganda in particular, where its parliament are on the cusp of re-introducing an Anti-Homosexuality Bill that would make it illegal to run an LGBTI-sensitive health service.
Third, if we are serious about wanting countries to develop and fund a greater proportion of their own healthcare, Labour needs to be serious about addressing the underlying drivers of global poverty and inequality. Our development policy must reflect the complexity of the modern world – where inequality within countries is greater than between. There is a need to build a new model of responsible capitalism to replace that which has savaged the developing world and resulted in the greater flow of resources from south to north – for example through corporate tax evasion and the flow of health workers.
All of the above will require Labour to adopt a strategy for global health in government. But it must be a strategy built on the lessons of how we have responded to HIV and AIDS, one that embraces a vision of overseas development which never forgets the impact of effectively targeted funding, but also remembers the foundations of a better society are social justice and human rights.