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 for 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.

Lady Winterton, it is a great pleasure to serve under your chairmanship today and it is a great pleasure to welcome the Minister. She and I have had various co-operative ventures since we have been in this House. We were both in the armed forces parliamentary scheme for the Royal Air Force, and we were in our respective Whips Offices at the same time. We have always had a good and cordial relationship. My speech this afternoon will do nothing to antagonise that, although I have some questions for her and I do not know whether she will be allowed to reply. If she is not allowed to reply this afternoon, perhaps she would write to me.

On a point of order, Lady Winterton, will the Minister be allowed to reply?

May I reassure the hon. Gentleman that, with the number of speakers we have this afternoon, it is imperative that the Minister reply?

I am pleased to hear that, Lady Winterton. We look forward to her doing so.

I look forward to dealing with as many points as the hon. Gentleman, or any other hon. Member, raises.

In terms of both development and health goals, we in the United Kingdom and others in the developed world have set ourselves a long series of ambitious targets. The interaction between health and development can often leave us in a Catch-22 situation, as improvements in development can lead to a healthier population, but a healthy population is a spur to development. It is therefore no surprise that, as the Minister has spelled out this afternoon, three of the eight millennium development goals—reducing child mortality; improving maternal health; and combating tuberculosis, AIDS, malaria and other preventable diseases—aim directly at delivering improvements in health, and that the international health partnership should target those.

It was with that in mind that I recently returned from a visit to the World Health Organisation in Geneva, where I met Dr. Ian Smith, an adviser to Margaret Chan, the director-general of the WHO, whom the Minister mentioned, and Dr. Bruce Aylward, who is leading the WHO’s campaign for polio eradication. From both doctors I was able to further my understanding of the scale of the health crises faced by residents of some of the poorest countries across the globe, and of the challenges that stand in the way of the experts in mitigating those crises.

One of the most salient points that arose from this debate came from Dr. Smith, who mentioned the change in the global health framework. As the Minister mentioned at least twice in her speech, in 1948 when the WHO was established, and for some 20 years subsequently, it was the only key global health player. In recent years, the picture has become far more crowded, with competing non-governmental organisations, the World Bank, the Bill and Melinda Gates Foundation and increasing private sector involvement. That is all to the good, but as the Minister made clear, we must avoid duplication and waste.

On the shortfall in respect of the millennium development goals, which the Minister mentioned, unfortunately, as we have passed the halfway mark set for those goals, it seems that global efforts may well fall short of achieving a number of the targets, despite much good work and will from the WHO and many other organisations working in the health arena. As the Minister said, globally, half a million women die each year in childbirth, 10 million children will not reach their fifth birthday and malaria kills half a million people a year.

The international health partnership is clearly a welcome addition to the fight for global health, through the emphasis that has been placed upon ensuring that all the 40 donor countries, 26 United Nations agencies, 20 global funds and 90 health initiatives are able to work together, as the Minister said, pulling in the same direction and attempting to avoid an overlapping of responsibility. I am glad to see that Governments and agencies representing half the global spending on health are involved in the IHP. Alongside a meaningful strategy, it is through the support of these agencies and organisations that the IHP can make the changes and improvements that the Government and all Members of the House want to see. I hope that the Minister can tell us today what communication she is having with these agencies and nations to increase still further their involvement in this matter and to strengthen the international base in support of the IHP.

I note with interest that the UK has provided £3.5 million of the £4 million that has so far been raised through the IHP. I should be interested to know what representations the Minister is making to encourage increased funding from our other partners in this valuable scheme. As she said, it is almost the six-month anniversary to the day, and it will soon ratchet up a year. We need this valuable time if the millennium goals are to be met. In particular, I hope that she can elaborate further on the participation of the United States, which surely must be expected to play an important role, being one of the largest health donors.

There is a welcome focus on improving local health systems in poor countries. If people do not have the means of accessing or receiving available treatment, they cannot benefit from it. I was delighted that the Minister mentioned the work being done in Nepal, which I visited 18 months ago, and how health fees have been reduced, thereby increasing access in that country. That is a welcome development.

The point is easily demonstrated by comparing Moldova and Angola. In Moldova, the gross domestic product is $2,962 per capita and in Angola it is $2,813, yet in Angola a child is 16 times more likely to die before reaching its fifth birthday: this in a country where the average citizen earns only $149 less than in Moldova. So two countries with broadly similar GDPs have hugely dissimilar health services. We need to start eliminating that sort of disparity. I hope that the IHP, which should be broadened, as I will mention in a minute, will be able to reduce such disparity. How can we account for those figures in Angola and Moldova? The percentage of GDP spent on health in Moldova is four times higher. There are 33 times more physicians per 1,000 of the population in Moldova. Until we begin to address these imbalances worldwide, and unless all the necessary factors are aligned, improving a country’s GDP will not necessarily result in improved health.

On preventable diseases, no one said that winning the health battle would ever be easy. What the Minister said today proved that. Alongside infrastructure improvements, we must not take our eye off existing health programmes. Although HIV/AIDS is often the focal point, given that only one in four people in Africa who needs AIDS treatment receives it, other important battles remain to be fought. Every year, 500,000 people die worldwide from malaria, but for just $3 billion a year a complete malaria programme could be established within three years. That would involve not just a net for every bed in need, but clinics, treatments and diagnostics. The Conservative party’s policy is to spend $500 million a year, every year, until the millennium development goals for malaria are met.

Dr. Bruce Aylward of the WHO, whom I met in Geneva, is heading the global initiative to eradicate polio. He is an extremely impressive man. He and Margaret Chan, director-general of the WHO, have raised a huge amount of funds and come up with a programme that has worked. Their work in eradicating polio is most welcome. He was keen to express the critical role that the UK has played through both fundraising and advocacy. However, with the end of this important programme nearly in sight, the UK has apparently cut its donations by more than half—from $236 million in 2003-05 to just $101 million for 2006-08.

If that is so, it is a worrying development, and I ask the Minister to investigate whether the Department for International Development could divert some of its resources to meeting the funding gap of approximately $525 million in 2008-09, so that the programme can be well on its way. What a huge boost that would be to some of the poorest countries. We have managed largely to eradicate smallpox, and if we could largely eradicate polio as well, that would be a major triumph.

As a country we have a vital role to play in helping the WHO, which is a key player in the international health partnership, as the Minister made clear, along with the World Bank and the global health fund. If we do not find that funding somehow, the disease will return to blight much of the world, as it did in the 1980s when it was endemic in 125 countries. It is now endemic in only about three countries, Pakistan and Nigeria being two.

We must not be afraid of making the structure of the international health partnership as ambitious as the targets that we have set. Here in the western world, we are blessed with some of the finest doctors and health care professionals in the world, with a fantastic level of training. If we are to build the national health partnerships in the developing world that the Minister mentioned and that we aspire to, we need to tap this resource. Yet the British Medical Association has raised clear concerns that although there is willingness within the medical community to offer such assistance, far more could be done to encourage and facilitate doctors from this country to travel to help the developing world. Not only could those professionals assist with immediate shortfalls in qualified staff; they could establish a system of training for local doctors to provide long-term cover. It is a shame that doctors who have gone to work overseas have often had to fund such secondments from their own savings, and that they have concerns about their ability to return following their time abroad. Surely a bit of joined-up thinking between DFID and the Department of Health would enable something to be done.

The Conservative party has pledged to improve the links between health systems in the UK and developing countries, and to reduce the barriers to health care professionals when they travel abroad. That will come about through the introduction of a health systems partnership fund worth around £5 million a year, with money to come from DFID. It will be administered jointly by DFID and the Department of Health, thus reducing, I hope, some of those barriers. As my hon. Friend the Member for Sutton Coldfield (Mr. Mitchell) suggested, given the good that that programme would do, it is one policy that the Government are welcome to steal. It is worth noting that it would also benefit our own health care system through the skills that staff would pick up while working abroad. Without that in place, we will only ever be able to take a short-term approach to providing training for local doctors, as our medical professionals will continue to be reticent about taking such risks.

On co-ordination, it is important to strengthen the linkages between the various health agencies and donors, and we must consider linkages to other aid programmes because health cannot be separated from them. Too often, health programmes become an enforced necessity through a failure to deal with other, intertwined problems, just as a failure of health care programmes impinges on the success of other, linked goals.

The Earth Policy Institute has built 12 millennium villages in 10 African countries, which will demonstrate how, through working with local people to improve health schemes, along with water, agriculture, education and technological aid, the goal of halving extreme poverty can be achieved for just £55 per person. If that scheme is successful, it would be worth replicating it elsewhere.

Equally, increased spending on education programmes, infrastructure programmes, which have been discussed, and agricultural schemes can yield real gains in health issues. On the other hand, climate change is having a knock-on effect on people’s health, which demonstrates the intertwined nature of our world and how one thing can have a knock-on effect elsewhere.

I hope that the Minister will assure us that real co-operation can be achieved within the international health partnership, and between it and Germany's providing for health initiative. After all, it was our Prime Minister, with the German Chancellor, Angela Merkel, who launched the international health partnership in the first place. I hope that we are expecting full participation from the German Government in that partnership. Furthermore, I would be interested to hear what discussions the Minister’s Department is having to further co-operation with other development agendas, both domestically and internationally. I hope that that will ensure that we do not pay twice for the same work to be done, nor have contrasting approaches to the same end.

I am aware that there have been many calls for an increase in funding for health programmes, particularly through the international health partnership. What I am most concerned about, before increased funding is pledged, is an assurance that there will be increased accountability for and auditing of the money that is spent through the international fund. I was delighted to hear the Minister say that one of the Government’s key aims was that British taxpayers’ money, and other countries’ taxpayers’ money, should be spent effectively in achieving real results. I was delighted to hear that, because it is a change of emphasis in what we have heard previously about how British aid is spent.

Until we can be absolutely certain that money is being targeted in the right areas and is being spent effectively, any increase in expenditure will not be met with a proportional gain in global health. All too often—although I hasten to add, not always—what is needed is not more funding, but for the money to be better spent through increased co-operation and a core strategy. I would like to emphasise that that should not preclude an increase in our country’s spending when the money can be spent in a truly meaningful way.

One matter of concern is the level of staffing cuts in DFID’s headquarters. During the demonstration on world AIDS day, some AIDS professionals were particularly concerned about cuts in the number of health care specialists in DFID, and its ability to deliver its worldwide health care programme. I hope that the Minister will bear that in mind, and reassure us. Wherever I have travelled around the globe, DFID’s staff are internationally respected, and I would like an assurance that those cuts will not affect its ability to implement real change where it is needed.

On an afternoon when there is a debate in the main Chamber on international women’s day in preparation for 8 March, which is international women’s day, it would be remiss of me not to mention the matter of maternal health, which is of huge concern. Half a million women die each year during childbirth. Women also suffer disproportionately from conflict and poverty.

The health of a country’s women is a test of the strength of its health care system. The Select Committee on International Development has said that in the developing world there is an urgent need to increase the number of midwives and improve access to drugs and treatment. I hope that those words will be noted by the Minister. After all, the Nobel peace prize winner Wangari Maathai has reminded us that

“throughout Africa, women are the primary caretakers, holding significant responsibility for tilling the land and feeding their families”.

I quoted that statement on Monday during the launch of Oxfam’s photo exhibition entitled “Sisters of the Planet”, which the hon. Member for Bristol, East (Kerry McCarthy) and I attended. It was a very interesting launch and she will remember the point made by Sahena Begum who had come all the way from Bangladesh. She is the elected president of a 25-member women’s committee based in her tiny rural village in Bangladesh and she is determined to help women prepare for the increased difficulties that they face during floods, which in recent years have become increasingly severe. After having lived in only a very small, remote rural community, imagine what it must have been like suddenly to be brought to our Parliament in the centre of London. Yet through an interpreter, she was able graphically to describe the difficulties and the conditions that she faces in her local community.

The group she represents meet to discuss how they can improve health and hygiene issues, and make provisions for the effects of flooding. The value of such work in relation to health concerns cannot be overstated. The continued high mortality rate acts as a fuel to many other problems. I hope that we can receive an assurance that issues of maternal health will have a starring role in the work of the international health partnership, and that women across the globe will be involved in new health care strategies at all stages.

I conclude my comments by commending the principles behind the development of the international health partnership and the sterling work of those charged with implementing its proposals. There is truly a great need for the work and funding that has been pledged. The road towards achieving the millennium development goals is long and difficult, and in approaching that, our policies should be nothing less than ambitious. Our resolve should not weaken and our strategies must be defined and practical. The increased co-ordination of our delivery of aid and an invigoration of the work on building basic health care systems are a step in the right direction. I hope that the Minister will use proposals from today to enable us to keep moving forward.

I am sure that people in Cambodia, Zambia, Ethiopia, Kenya, Mozambique, Nepal and Burundi are grateful for the work being done through the international health partnership. Perhaps the Minister can say whether any other aspirant countries are being considered to join the system. There was a rumour that Malawi may be joining and there may be other countries that are also being considered, so perhaps the Minister could comment on that. We must now strive to increase the beneficiaries of all this good work.

After the sometimes stormy weather in Parliament this week, it is a real pleasure to be in the relative oasis of calm consensus. It has been instructive to listen while the Minister and the Conservative spokesman have introduced the debate. The problem with consensus is that by the time the third person speaks, many of the best statistics and points have been mentioned. I do not wish to try your patience, Lady Winterton, or that of my colleagues by being overly repetitive, but I apologise in advance if some of my points cover ground that has already been discussed.

The Minister and the hon. Member for Cotswold (Mr. Clifton-Brown) were both right to focus on the millennium development goals and on the particular ways in which they draw our attention to horrific problems. Halfway through the period covered by the programme we are still tragically off the pace and struggling to reach the noble goals that were set a few years ago. We must never lose sight of how shocking the statistics are on child mortality, which has already been mentioned. Only 32 of 147 countries are on track to cut child mortality for those under five by two thirds in the period before 2015. In Asia, a number of countries are off track to a greater or lesser degree, but in Africa almost every country will miss the target, which is a wake-up call for us all.

The Conservative spokesman has mentioned the issue of maternal health. Like him, I was impressed by the “Sisters of the Planet” exhibition in Parliament this week. I was unable to attend the official opening, but I spent some time at it yesterday. The stories from different parts of the world were a reminder that we should not be complacent about the challenges and the difficulties facing people as they go about their everyday lives in different parts of the world. The exhibition and the messages from the Oxfam people who assisted us to understand and take on board all the information brought home to us that complacency is not an option. On HIV/AIDS and malaria, as has been mentioned, the figures are staggering. It is mind-boggling to think that nearly 40 million people in the world live with HIV/AIDS. Sadly, contrary to what the millennium development goals seek to achieve, the numbers are going up, rather than down.

As the Minister pointed out, there are a number of different priorities for our country, which have been explicitly set out by the Government over time. Funding is a big part of that and there has certainly been a great increase in funding by the Government over recent years. We pay tribute to that; it is a very welcome development. In this country we also have a particular role in relation to health professionals and the expertise that they have and can share with others around the world. Again, a key theme of the international health partnership is the need for better co-ordination in all the various programmes that exist—not just from non-governmental organisations, the Government and charitable foundations in this country, but across Europe and the world.

A year ago, in his report “Global Health Partnerships” commissioned by the then Prime Minister Tony Blair, Lord Crisp set out the need for partnerships to be established along the lines of those that the Government have now set up. Importantly, he stressed that developments must be based on the needs of the countries themselves and the needs that they have identified for themselves. Proposals put forward must improve the practical value of what is happening and should not simply layer on more bureaucracy. Lord Crisp has established some important principles—for example, that developing countries themselves need to take the lead, and that when we are scaling-up resources they should be in relation to the training, education and employment of health workers. More importantly, he also said that we need to be more rigorous in our research and evaluation of what actually works and that we should not simply keep reinventing the wheel—we are guilty of doing that too often. The Minister demonstrated how those principles have been boiled down into factors that are particularly emphasised in the international health partnership, such as the need to develop and support a country’s own health plans, to provide better co-ordination among the donors and to focus on health systems as a whole, not just on single diseases.

Indeed, the Overseas Development Institute highlighted several very positive things that can flow from such an approach. We can refocus health aid away from treating individual diseases exclusively and towards developing health systems in the round. We can tackle the tendency to focus on some diseases at the expense of others, which are sometimes called orphan diseases. That is something that we understand from our constituencies and from the way in which health is debated in this country, and action in that respect would certainly be a major breakthrough. Finally, we need greater harmonisation and alignment, and that is a theme that occurs in every aspect of the development work that we consider. Instruments such as IHPs offer us the opportunity to pursue such things, and my party would certainly welcome that.

As the Minister said, we have just had the six-month anniversary of the creation of IHPs, and their implementation is now critical. The hon. Member for Cotswold asked several questions, and, like him, I am keen to hear the answers to them this afternoon or at some other appropriate moment. If I may, however, I would like to add to the list of queries for the Minister to consider.

On the individual country compacts, how far have we got with the individual countries that are listed as the starting points? Like the hon. Gentleman, I would be interested to know how many more countries are being brought on board, by which I mean both developing countries, which we hope will benefit, and developed, donor countries.

On the simplification and harmonisation of the multilateral delivery of health and other assistance, to what extent have the Minister and her colleagues taken up such issues in the EU? A number of the countries that are listed as part of the IHPs are members of the EU, but many other EU members are not listed as part of them. What work is being done to broaden involvement in IHPs across the EU?

Japan and the United States are key players in the delivery of development assistance in its many forms. They can offer a huge degree of funding and expertise, and it is important that they are brought in.

The hon. Gentleman has reminded me of what I heard at the World Health Organisation last week. Margaret Chan has been an absolute champion at going out and getting funding from some of the emerging wealthy nations that do not usually give to the donor community. I heard how she literally sat down with the King of Saudi Arabia and got funding for the polio eradication programme. Does the hon. Gentleman not think that we should do a lot more of that? A lot of countries are emerging as very wealthy, and we need to tap into them for such programmes.

I absolutely agree. I am sure that the Minister will tell us that she has an appointment with President Bush shortly to do exactly that. I do not wish to be flippant, however, because key individuals, such as Margaret Chan, have gone not only the extra mile, but an extra 1,000 miles to draw attention to the fact that we need funds and greater co-ordination if we are to deliver the health assistance that it so desperately required. Anything that we can learn from the Minister about how she and her colleagues are taking such issues forward and doing their bit will be very welcome.

I was talking about Japan and the United States and I wonder whether there will be an opportunity at the G8 in Japan this summer to draw other countries into the IHPs. That would perhaps allow them to build on the work that the Government did three years ago at Gleneagles to draw the world’s attention to the poverty agenda.

We have touched on the issue of health professionals and the assistance and expertise that this country can offer developing countries. However, there is also the fraught issue of the migration of health professionals from those countries to our country. Codes have been drawn up broadly to regulate that migration, but how confident is the Minister about the way in which those codes are working? The EU is considering the issue more broadly. What input can we have in that respect?

When I was in Ethiopia about four years ago, I was staggered to hear that there are more Ethiopian doctors in the United States than in Ethiopia. We have done some work to stop that export of valuable people, but it is an international issue and cannot be tackled just at the national level. I am sure that the hon. Gentleman would agree with that.

Indeed I do. The hon. Gentleman brings the issue into stark focus with his point about Ethiopian doctors. As I said just before he intervened, it is not only our Government who need to take a lead on this issue; it is a matter for Europe and the G8, where America and others can be brought into the debate. Nobody questions the fact that health professionals and health workers will come to this country, and there are many complex reasons why they wish to do so. However, in seeking to balance such movements—I do not want to use the word “restrict”—we must ensure that there are proper facilities and procedures, so that those who wish to gain access to training and support here can still do so and can then return to their own country to provide the input that is so necessary in their own health services.

Lord Crisp’s report made several good recommendations, and I hope that the Government will publish an updated response to them at some point. He highlighted several interesting ideas, including that we should have a global health partnership centre in this country. Such a centre would be a one-stop shop for all the different parts of the national health service, non-governmental organisations, other donors and Government efforts and would allow people in recipient countries and in this country to know how they could contribute efficiently. Lord Crisp also talked about a global health exchange, or health bay, as he put it, which would offer the opportunity to share best practice, expertise and information. Another idea that stood out was that we should encourage and facilitate volunteering by people in the NHS, so that they can go to other countries, make a major contribution and benefit from the experience so that they can understand the challenges that others face.

Given the pressures on the House this week, the debate may prove to be shorter than it deserves to be, but the issues that it raises and the Government efforts that it highlights are fundamental to Britain’s contribution to reaching the millennium development goals and ensuring that we never lose sight of the truly appalling lives that many people lead and the short lives that many others have led. At the outset, the Minister set out the scale of the challenge facing us, and I hope that she will be able to answer some of our questions when she concludes.

I am grateful to those hon. Members who have attended for their constructive contributions to this important debate. I hope that the debate will produce real results, because we are talking about improving people’s health and well-being and about saving the lives of millions of people across the world. I shall focus on the points that have been raised because they have been very useful in developing my argument and they allow me to say a bit more about the actions that the Government are taking.

Clearly, we are all appalled by the awful levels of child and maternal mortality in the poorest countries and by the devastating impact of diseases such as AIDS and malaria. I am encouraged to find in the House a universal wish for the UK to continue to play a leading role in addressing the health crisis. I believe that people look to us to do that. Many agencies, Governments, organisations and individuals are doing great things, and we should welcome, support and applaud those efforts. Our job is to develop a way forward that allows us to maximise and see more of such efforts. Clearly, the crowded place in which aid is delivered is something that we must tackle, and the international health partnership is critical. The delivery of health care is a complex area and it is our duty to find the best way forward.

Everyone would agree that finances are crucial. More money is always welcome, but we must look at how we use that money and at how we can achieve the results that we want, because results matter. Three of the eight millennium development goals are on health. They are off track, but we are not prepared to be complacent about that. I believe that the world can do more. Aid effectiveness is the key and that has been at the core of our discussions today.

I assure hon. Members that addressing maternal health is a priority for the Government. Our strategy covers a range of factors. It is important to understand that it is about not just the delivery of health care, but enabling women to have access to family planning and safe abortion, and overcoming cultural and financial barriers to accessing care. It is about getting research to guide us so that we do the best that we can. We also need to ensure that women have greater access to midwives, doctors, and the correct, proper, skilled, sympathetic and empathetic health care workers to provide maternity and emergency care where it is needed. We expect all those things in this country, and they can make a difference.

Achieving such goals is complex and requires much navigation and determination. I, like other hon. Members, welcome the International Development Committee report. It agrees that improving maternal health, which is millennium development goal 5, is one of the biggest challenges facing developing countries. I will ensure that we respond in full to that report and I look forward to doing so, not least so that I can explain why maternal health and the health care of women matter. It is very simple to me: if we are to see true development through which countries are able better to serve their people, that cannot be for half the people—that is just an impossibility. There is a very strong lobby on that, which I welcome. As constituency MPs, we should welcome the fact that our constituents have taken a great interest in the matter and are pushing us to do more.

I agree with my hon. Friend. Will she go on to say that, sadly, one of the biggest problems with maternal health is the connection with conflict? In the Darfur region, which I know only too well, the biggest problem for women is access to much-needed health care. Health care is needed because of continuing rape and violence against women. The conflict has led to an imbalance in the population because, for all sorts of reasons, there are no men in many of the villages. That has a deleterious effect on the way in which the whole structure of the population operates and on maternal health, in particular.

My hon. Friend raises an extremely important point. Violence against women in non-conflict and conflict situations creates huge problems for women’s heath and for the future that they and their children can or cannot look forward to.

In Ghana, our DFID officials have worked well with civil society to encourage that country’s Government to pass legislation in respect of domestic violence, which has just happened. As we know only too well, this is about not just legislation. There is also a question of whether support will be in place for those women and whether there is somewhere for them to go if they have to leave their homes. There is a range of factors to consider. We know that global poverty and conflict often go hand in hand and that the violence against women that my hon. Friend describes is a feature of that. Such violence creates the big problem of the spread of HIV and AIDS. We therefore have to tackle not just conflict, but attitudes as well, and that is tough.

I hope to respond to all the comments that have been made and I will attempt to do justice to them. With regard to Lord Crisp’s report, I can assure hon. Members that the inter-ministerial group on global health will shortly issue the Government’s response to outline how to take forward the recommendations, which we welcome.

The role of the United States has been raised. I confirm that the United States is clear that it supports the principles of the international health partnership. The Government work very closely with the US, in four countries in particular, on developing the health work force, and I will return to that important matter in a second. We also work with the United States through the G8 to improve effectiveness and the volume of aid for health systems, so we see the United States as an important partner.

We need more countries to want to be part of the IHP. I am delighted that Nigeria and Madagascar are asking to join. As I have mentioned, the event at the World Health Assembly in May will be an opportunity to promote the partnership still further. I hope that more developing countries will see the benefits and want to sign up. We will continue to encourage new countries to approach the World Health Organisation and the World Bank.

I have been asked to make reference to progress in countries so far. I am very happy to give hon. Members greater detail on any of those countries if they so wish. In the past few weeks, Burundi has signed a country-level compact. In Ethiopia, the IHP road map was launched early last month and the compact will take that further. Every country is different, so we need to tailor the compact and the international health partnership to achieve the right approach. Tremendous progress is being made and I am heartened by the fact that new countries are clamouring to sign up.

The hon. Member for Berwickshire, Roxburgh and Selkirk (Mr. Moore) was right to raise the issue of compacts. Without a proper health plan in each of the recipient countries, it is difficult to know where the help needs to be targeted. Can the Minister give us any idea of how many of the developing member countries will have a compact in place by the anniversary in six months’ time?

For the reasons that I have explained, it is difficult to give an exact answer. Every country is different. Let me give another example to illustrate that. In Kenya, where there is a particular situation at present, the Government and the partners have agreed that there should not be a separate IHP document, because as I mentioned, the IHP is not about creating new bureaucracies, but about delivery. If a compact is needed, we should have that. In Kenya, the country compact will instead be the action plan, which is following a mid-term review of Kenya’s health sector. The best thing that I can say to hon. Members is, “Don’t judge the IHP by the number of compacts. Judge it by the results—by delivery,” because that is what I am committed to.

Rightly, a question was raised about what communication we have with other agencies and partners. I can assure hon. Members that there is regular and meaningful dialogue. The UK has been invited to speak at the second meeting of the H8—the eight agencies—and we regularly have contact with the heads of agencies such as the World Bank, UNICEF and the Global Fund to Fight AIDS, Tuberculosis and Malaria. We continue to press the heads of those agencies to deliver on the commitments to which they have signed up. That includes aligning funding with the plans of the particular Government and co-ordinating funding around those plans. Again, there is no point in having the discussion without ensuring that action follows. That is a constant theme in all our discussions.

An allied question is what we are doing to encourage funding from others. We are in close contact with other donors and particularly the WHO and the World Bank, which have received additional funds—for example, from Norway. We will continue our work through both the G8 and the EU to encourage further support.

We have had discussion about UK medical staff and I pay tribute to the staff who have given their expertise, time and skills to supporting developing countries. That is very important work. However, in the long term, the real key to all this is not just to strengthen health care systems, but to ensure that health care professionals are in such countries in sufficient numbers and with sufficient skills, and can reach the right people. That is our main focus, and we will continue to strengthen the in-country health work forces as the long-term commitment that we can make.

Questions were raised about malaria and polio. On malaria, I reiterate that the Government have committed £1 billion up to 2015 to the Global Fund to Fight AIDS, Tuberculosis and Malaria. I am sure that hon. Members are aware of our Prime Minister’s absolute commitment to the fight against malaria. We will make a further concerted effort in that regard this year. In Kenya, for example, we are supporting the WHO and NGOs in respect of treated mosquito nets. That has led to a 50 per cent. cut in malaria deaths. As part of our commitment, I am particularly keen that we talk not just about numbers of bed nets but about their usage. In the end, what is important is not just the delivery of a bed net but the fact that it is used.

We have already provided £350 million to tackle polio—we are the second largest bilateral donor. As a result of that and of success in working with our partners, the number of cases has dropped from 350,000 in 1988 to some 2,000 last year. We are keen for other donors to play their part in that.

The hon. Member for Cotswold (Mr. Clifton-Brown) raised a very important point about accountability of funds—how they are used and where they get to. As we know, the IHP is about maximising the impact of existing aid. Depending on the country and what is happening there, we ensure that our aid reaches the people of those countries through the most effective means possible. In many cases, that is through NGOs. It may be through world institutions such as the World Bank and the United Nations. It is about working with organisations such as Oxfam and Save the Children as appropriate, or with the Governments, depending on the situation. However, measuring the impact of the IHP is crucial. We have had discussion about that, and the members of the IHP have agreed a single way of doing it. I am referring to focusing on the changes that it will make to people’s lives—for example, measuring the number of people attending clinics, the number of children receiving immunisations and the number of mothers giving birth in a clinic. All those are direct measures of where money is being used.

I can assure hon. Members that we have robust systems in place to assess public financial management systems of the countries in which we work. We will, and do, investigate any cases in respect of which there is any concern. If any hon. Members wish to draw cases to my attention, I will be glad to follow that through. Aid effectiveness is what this is all about.

The EU and our work with EU colleagues were mentioned. Just last week, officials met EU colleagues. We are also active through the G8. Even if some donors do not sign up to the IHP, they are nevertheless committed to the principles of improving the effectiveness of health aid. At the G8 we are already working, and will continue to work, with officials and politically to ensure that we see stronger action on health systems funding and particularly on the health work force.

I would like to put it on the record that the UK has been at the forefront of efforts to prevent migration of key health workers from developing countries, which has slowed down. We now have a code of conduct that precludes active recruitment in developing countries, and we have increased training of our own UK doctors and nurses so that we no longer need to recruit so many from abroad.

I pay tribute to the staff who work for DFID, many of whom are working in-country. In my role, I am keen to ensure that they feel as much a part of our team as those working in London, because they are our teams in the countries where we are working. We have undergone some reductions in administration costs, as have a number of other Departments. I am sure that hon. Members and our constituents would expect us to do that. It is important to say that our health advisers, for example, are working more strategically. We are liaising and co-ordinating much better and to a greater degree with other countries and other donors at country level, to ensure that we are speaking with one voice in the way that the IHP wants us to do. There is a sharing of expertise.

I am grateful to the Minister, who has been generous in giving way. My party has pledged not to cut the staff at DFID headquarters any more, because her Department is unique among Departments in having, rightly, an expanded budget. If there are not the staff at headquarters to be able to deliver that expanded budget, things will start to go awry. It will mean fewer bilateral programmes and more multilateral programmes. It would be a pity if the reputation that DFID has worldwide were tarnished because we were unable to deliver the programmes that the Department has set out to deliver.

I appreciate the hon. Gentleman’s point, but I can give him an absolute assurance that there is no question of DFID’s effectiveness on behalf of the UK Government being compromised, nor would we take action that would do so. In fact, wherever I go, I am delighted by the response to the UK Government, DFID and our staff in particular. I want us to use the way in which we are regarded as the world leader and, given the direction of the debate, to encourage others to do likewise. I can assure hon. Members that we will continue to deliver and to do so better, because we all want that.

I welcome the debate on the international health partnership because increasing the benefits that we can bring to people in developing countries is the reason for our development. We need to work with developing countries not as a lone country, but as a world leader, a catalyst, and by example. The international health partnership, which was launched by the Prime Minister, gives us such a framework. I hope that hon. Members will continue to support the Government in our efforts.

Question put and agreed to.

Adjourned accordingly at nineteen minutes to Four o’clock.