Slide 1 Dr Jenny Amery, Chief Professional Officer Health and Education, DFID Wales for Africa...

Dr Jenny Amery, Chief Professional Officer Health and Education, DFID

Wales for Africa Health Links Conference 7 July 2011

What can UK Health Workers contribute to International Development?

Slide 2

Who’s who

• Secretary of State– Rt Hon Andrew Mitchell (May 2010

– present)

• Minister of State– Alan Duncan (May 2010 – present)

• Parliamentary Under Secretary of State

– Stephen O’Brien

DFID Context• Structural Reform Plan • Departmental Priorities:

– Honour the UK’s international commitments and support action to meet MDGs– Wealth creation– Governance and security - and especially conflict and stabilisation .– Climate Change– Humanitarian assistance

Key issues::– Value for money – effectiveness in reducing poverty– Focus on the vulnerable : eg women and girls– Use and generation of evidence for action– Innovation / private sector– Results, tracking and monitoring – International system and partnerships

Aid review process

• Bilateral Aid Reviews–Proposed results from each country with funds and justification–Ambitious–Focused on results that DFID will deliver–Consistent with decentralised country led approach, working with

others–DFID focus on 27 countries, 3 overseas territories and three regional

programmes

Aid review process

• Multilateral Aid Review– Evaluation against explicit criteria to assess value for money

– Critical role in meeting development objectives– Attention to cross-cutting issues e.g. gender– Focus on poor countries– Contribution to results– Strategic/ performance management– Financial resource management– Cost and value consciousness– Partnership behaviour– Transparency and accountability– Likelihood of positive change

MAR – Value for money findings

Aid review process

• Humanitarian and Emergency Response Review• Chaired by Lord Ashdown

– Anticipatory approach– Building resilience–UN reform to strengthen global leadership– Innovation, including new technologies– Accountability– Protect the humanitarian space– Partnerships

Deliver frameworks for results and evidence papers

• Commitment to results–Malaria: contribute to reduced mortality of at least 50% in at least 10

high burden countries backed by spending of up to £500m p.a. by 2014/15

–Reproductive ,Maternal and Neonatal Health: prevent 50,000 maternal and 250,000 newborn deaths, 10m new FP users. With USA/Australia/Gates Foundation contribute to RHSC goal of 100m new FP users

–Undernutrition: 10 million children under 5 reached by nutrition programmes

Slide 11

Choices for women: planned pregnancies, safe births and healthy newborns

The UK’s Framework for Results for improving reproductive, maternal and newborn health in the developing world

Launched - 31 December 2010

Slide 12

Unable to choose: Unmet need for family planning source: White Ribbon Alliance, Atlas of Birth, 2010

Uganda (40%)Rwanda (38%)Ethiopia (34%)Ghana (34%)

Slide 13

source: White Ribbon Alliance, Atlas of Birth, 2010

The 15 least developed countries that have been affected by conflict during the years 2000 to 2006 have worse indicators than non-conflict affected countries

11 countries account for 65% of maternal deaths – including India, Nigeria, Ethiopia, DRC, Afghanistan, Bangladesh, Pakistan, and Tanzania

Slide 14

• The UK’s support will have saved the lives of at least 50,000 women during pregnancy and childbirth and 250,000 newborn babies:

• At least 10 million more women can use modern methods of family planning, contributing to a global total of 100 million through partnerships;

• Up to 1 million young women aged 15–19 to access family planning with wider action for adolescent girls that enable them to delay their first pregnancy;

• More than 5 million unintended pregnancies prevented.

• At least 2 million safe deliveries, with long lasting improvements in access to quality maternity services, particularly for the poorest 40%.

Focus on results by 2015

Slide 15

Pillars of the Framework

Women and newborn lives saved, more women using family planning

Unintended pregnancies prevented, safe deliveries

Target groups: Adolescents, the poorest, those affected by conflict and natural disaster.

Pillar 1

Empower women and girls to make healthy reproductive choices Education, information, economic assets

Legal frameworks

Women’s groups

Social change

Pillar 2

Remove barriers that prevent access to services, particularly for the poorest

and most at risk.

Pillar 3

Expand the supply of quality services delivering cost effective interventions for family planning, safe abortion, antenatal care, safe delivery and emergency obstetric care, postnatal and newborn care – through stronger health systems with public and private providers

Pillar 4

Enhance accountability for results at all levels

Malaria Framework for Results

• Launched 31 December 2010

• Headline goal– contribute to reducing mortality by

at least 50% in at least 10 high burden countries

• Resourcing– backed by spending of up to £500m

p.a. by 2014/15

• Delivery– Bilateral, multilateral, research and

global public goods

Malaria deaths and cases in Africa- source GMAP 2008

The Burden of Malaria

• Estimated 225 million cases and 784,000 deaths globally 2009

• 85% cases & 89% deaths in SSA

• 20% of child deaths in Africa

• Rural Ghana malaria treatment costs >33% poor household income

• 0.55% reduction in SSA annual growth (up to 1.3% in high burden countries)

Malaria Framework for Action

Improve quality of services

Scale up what works in different places

Build stronger systems

Link health and non-health services to maximise value for money and ensure sustainability


Increase access & build demand for

services

Extend reach through public and non-state channels

Remove financial and other barriers to access

Improve choice and responsiveness of services

Increase community knowledge, demand and participation

• 40% – 80 % care in private sector

• Wider coverage and better supply chains

• Variable affordability, product selection and quality

• AMFm to improve ACT coverage, accreditation, social franchising, community oversight, demand side financing


Increase access & build demand for

services

Extend reach through public and non-state channels

Remove financial and other barriers to access

Improve choice and responsiveness of services

Increase community knowledge, demand and participation

Stop stock outs campaign


Support innovation & global public goods

Support evidence based global norms and policy

Contain resistance to drugs and insecticides

More efficient global markets

New products and delivery platforms

Research and innovation

Emerging ACT resistance in SE Asia

Malaria Framework for Results: Principles

• Focus on high-burden countries in Africa and Asia

• Emphasis on value for money – do what works, innovate where needed

• Achieve demonstrable impact for the poorest and most vulnerable

• Ensure impact is sustainable

• Embed in health systems, address non-health sector drivers and deliver wider benefits

• Enable and ensure that the international system delivers on malaria

The 20 countries with the highest burden of undernutrition. Countries with stunting prevalence ≥ 20% in children under the age of five years that together account for > 80% of the world’s undernourished children. Colour denotes region.

Source: Lancet Series on Maternal and Child Undernutrition, 2008.

Direct and indirect interventionsDirect Interventions

Vit A supplementation

Therapeutic Zinc

Iron and Folate

Support for breastfeeding

Nutrition education

Treatment of infections

Treatment of severe acute malnutrition.

Indirect interventionsHealth systems strengthening

Social protection

Agricultural devt

Water and sanitation

Gender equality

Girls education

Governance

Slide 26

DFID Health advisers competencies

• Knowledge and application of public health and epidemiology• Understanding global context including aid architecture• Knowledge and experience of health service delivery in

developing country• Knowledge and application of wider determinants of health • Knowledge and application of relevant evidence, innovation

and results • All advisers: Aid and instruments; research,analytical and

statistics skills; economic literacy and value for money; evaluation and results

DFID’s work in Health will

• Continue to be underpinned by a strong Health Systems Strengthening focus

• Reach out to take account of the determinants of health (water, sanitation, nutrition, poverty, education)

• Build evidence, strengthen knowledge, challenge boundaries.• Focus on the poorest (in terms of countries and communities

within countries)• Fragile and conflict affected states.

Other areas of continuing/ growing focus

• HIV and AIDS (especially prevention)• Health financing and removing financial barriers (access)• Improving the quality of health services• Continued focus on vulnerable people/groups• Increased focus on reaching the poorest (cost)• Health workers and workforce • On-going priorities: NTDs, children, immunisation,

pneumonia, TB, Polio eradication, climate change impact• Non-communicable diseases; mental health

The Future of Aid

• Recognising the impact of climate change on vulnerable populations

• Resource scarcity: food, water, energy, land

Figure 3: Impact of Climate Change on Agricultural Productivity in 2080 2008, Hugo Ahlenius, UNEP-GRID-Arendal (source: WR Cline, 2007, Peterson Institute, Washington DC, USA)

Climate

The Future of Aid


• Resource scarcity: food, water, energy, land• Population growth, numbers ageing, urbanisation

8. Urbanisation

The Future of Aid


• Resource scarcity: food, water, energy, land• Population growth, numbers ageing, urbanisation • Future location of poverty in middle income countries

Future location of Poverty – the new Bottom Billion

The Future of Aid


• Resource scarcity: food, water, energy, land• Population growth, numbers ageing, urbanisation • Future location of poverty in middle income countries• Changing financial and political powers: BRICs, G20• Aid flows to developing countries increasingly dwarfed by

financial investment, remittances, • Changing global partnerships and UK role

• www.dfid.gov.uk

THANK YOU

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