DFID's health strategy

Abstract

Last week, the UK Government's Department for International Development (DFID) launched its new health strategy in London with responses from Margaret Chan, Director-General of WHO, Joy Phumaphi, Vice President of Human Development at the World Bank, and Michael Kazatchkine, Executive Director of the Global Fund. The presence of such a high-level group indicates DFID's current status as a leading participant in global health. Hilary Benn, Secretary of State for International Development, outlined three challenges for DFID which are also three key priorities in the health strategy: to vastly increase financial support to developing countries; to better support basic health services; and to improve the coordination of donor aid. A call for more financial resources is, unfortunately, one that the international community is well used to hearing—and ignoring. For instance, it is already largely agreed that many, if not most of, the Millennium Development Goals will be met. Yet as highlighted at the G8 summit in Germany last week, there is little political will to do more. DFID's own aid strategy is refreshingly diverse. In 2005–06, it spent £481·4 million in health via its bilateral programme, and £173·6 million in its multilateral programme. A sizeable proportion of this financial support was in areas that are often neglected, such as sexual and reproductive health. In addition, DFID is committed to spending at least half of its direct support to developing countries on basic services, including health care, rather than on specific diseases. DFID implements the rather unusual, but much needed, donor practice of budget support, where after agreement about the recipient government's development strategy, funds are disbursed through that government's financial management system and not earmarked for specific projects. This aid-giving method helps governments to deliver sustainable basic services to their population and also helps to address DFID's second priority of supporting health systems. Hilary Benn stressed the importance of providing support to deliver broad services that deal with major health problems, and warned, “We must do no harm. We must make sure that our well meaning efforts to deal with a single health issue do not damage our wider effort.” For example, the prevalence of HIV/AIDS in Rwanda is relatively low—3%—yet this condition receives 75% of donor support. Conversely, under-5 mortality is 20%, yet only 2% of donor aid goes to health services for childhood illnesses. There is also an urgent need to coordinate donor aid—another of DFID's priorities. There are currently 40 bilateral donors, 26 UN agencies, 20 global and regional funds, and 90 global health initiatives, which, according to Hilary Benn, are not working together properly and are not trying hard enough to do so. However, Benn said that all three high-profile speakers were in agreement about the importance of working in partnership: “We wanted to make the point that if we continue to act alone we will fail.” The health strategy further describes the problems with multiple donors. It states, “There is no agreed vision of who is best placed to do what, or what means of accountability there are.” DFID has gone some way to address its own accountability and transparency issues by publishing the evidence base for its health strategy. The importance of making evidence-informed decisions is a main theme, and DFID has pledged to double its budget for research. DFID also recognises that the current enthusiasm for linking aid to results often means that donors favour focusing on specific diseases where it is easier to measure outcomes, rather than broader health areas and systems that urgently need such support but which are more difficult to evaluate. However, there is a growing body of evidence that shows the effectiveness of supporting health systems. For example, intensive support to the district health system in one region of Tanzania dramatically reduced child mortality by 50%. DFID promises that it will report progress on implementing the commitments made in its strategy with the caveat that even though it may support broader institutions and other players, it cannot be held directly accountable for their actions. Such a disclaimer is a missed opportunity. Last year, Hilary Benn with-held £50m from the World Bank until he had evidence that the bank was reforming the conditions it attaches to aid. DFID should continue to use its considerable reputation, and take similar direct action to influence decisions made by other donors. Such a stance would signal true leadership and be a clear sign that DFID means serious business. Department of ErrorThe Lancet. DFID's health strategy. Lancet 2007; 369: 1973–74—In this Editorial (June 16), the second sentence of the third paragraph should have read: “For instance, it is already largely agreed that many if not most of the Millennium Development Goals will not be met.” Full-Text PDF