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Millennium Development Goals

Volume 701: debated on Thursday 1 May 2008

rose to call attention to the targets of the millennium development goals in the poorest countries and the action required to achieve them by 2015; and to move for Papers.

The noble Earl said: My Lords, I warmly thank our Convenor and my fellow Cross-Bench Peers for giving me this opportunity to address the issue of the millennium development goals. I also welcome the Minister and, as a former staff and board member of Christian Aid and former trustee of Anti-Slavery, I congratulate DfID on its inclusiveness. Many of its staff now come from the voluntary sector and its more recent policies owe a great deal to NGOs and civil society. These policies place the UK firmly in the avant-garde of international development. A French madrigal reminds us that May is a good month to open the window and think positively, even daringly. Today is May Day and this debate is about world poverty. This is the year of action on the millennium development goals.

I shall avoid the overused word “crisis”, but the background in poor countries in 2008 is rising prices, the old inequalities of gender, caste and class, and the ravages of conflict. Any poverty or debt reduction today is being cancelled by the effects of steeply rising food and energy prices. While the number of poor remains at about 800 million, the number of extreme poor is still rising and is close to 300 million. The number of malnourished children is set to rise in 32 countries. Some statistics are quite startling. Two million children die on their first day of life and four people die of TB every minute. I do not have to persuade noble Lords that poverty is a scourge much greater than terrorism or even natural disaster. It is an insidious and avoidable waste of human life, and for millions it is intolerable. Yet we go on tolerating it as inevitable. It was for that reason, and to mark the start of a new millennium, that world leaders decided to establish the MDGs, only to realise that they had set targets that they could not possibly reach.

We are now more than halfway to 2015 and it is clear that, although there are gains in health and education, especially in Asia, we are missing most of those goals altogether in the countries where they matter most: in the poorest, least developed, landlocked and conflict-ridden countries. That is confirmed by all the UN websites and the highly respected Countdown initiative.

The MDGs have accelerated the rate of aid giving, and perhaps the level of awareness, but I suspect that they have also become a vast propaganda weapon, a means by which donor Governments can claim almost systematically that they are doing far more than they possibly can. In Davos, the Prime Minister accepted failure. He said that the only means of attaining the MDGs now is through an emergency response, and we know that that will not happen. But I welcome his commitment and his current efforts to engage the private sector in this Herculean task.

I will concentrate on the health MDGs, MDGs 4, 5 and 6, today, because so much preventable ill health lies at the root of poverty. Men and women cannot claim their human rights, fight against oppressive authority or create a sustainable livelihood without good health. Children cannot attend school, learn skills or even, as they so often must, look after their ailing parents.

MDG 4 is to reduce child mortality. Here the results are generally quite positive. Under-five mortality rates on average fell from 185 to 166 per thousand live births between 1999 and 2005, but the target is two-thirds. Measles cases and deaths on the Asian subcontinent fell by nearly 75 per cent between 1999 and 2005, but there are 50 per cent more infant deaths in conflict countries than in peaceful ones. Save the Children recently published a telling wealth and survival index showing which countries could do much better.

MDG 5 is to reduce maternal mortality. DfID admits that that target is way off track. The odds that a sub-Saharan African woman will die from complications in pregnancy or childbirth in her life are one in 16, compared to one in 3,800 in the developed world. The global target is to reduce that ratio by three-quarters. Many more women who survive suffer disability and serious illness.

In Afghanistan, I am glad to say that the number of women receiving antenatal care or skilled assistance through childbirth has increased more than threefold since 2002, but such support is available only to one woman in five. Maternal mortality rates there remain among the highest in the world. We must do more about training. Can the Government explain why they are not placing more emphasis on the upgrading of traditional birth attendants in the poorest countries? I was disappointed in the Minister's answer earlier this year that TBA training has little demonstrable impact on reducing maternal death. I shall return to that later.

MDG 6 is to reverse HIV/AIDS, malaria, TB and other diseases. Prevalence rates of AIDS have levelled off, but new cases have grown, and there is a high level of new TB cases in sub-Saharan Africa. We all know that malaria is defying drugs, but out of 9 million new TB cases annually, only half a million are now multi-drug resistant. The Government have made a long-term commitment to the global fund against AIDS, TB and malaria and claim to be active in 132 countries with the aim of halving TB by 2015. Vulnerable groups, such as HIV/AIDS patients, are much more susceptible to TB. In Africa, one in three living with HIV/AIDS is dying of TB.

Here I briefly mention mental health, which is a gap in international health policy. According to the health charity BasicNeeds, neuropsychiatric disorder alone accounts for 14 per cent of all death and disability in the world. There is evidence that mental illness is a factor contributing to poverty, and this has not been adequately addressed through the MDGs. The noble Lord, Lord Joffe, will say more about that. Studies carried out in south Asia showed that children of depressed mothers were four times more likely to be underweight. Depression among mothers also increases their vulnerability to sexual abuse, which in turn exposes them to HIV/AIDS.

There is, paradoxically, a risk that if we throw money at individual MDGs, we may ignore the wider picture. Bold new initiatives to deal with major life-threatening disease or to meet a particular target can and do cut across developing countries’ own national strategies that have developed over time, often with donor encouragement. AIDS funding, for example, should not take priority over strengthening regular health services. This is not a new problem. I remember waves of UNICEF child health initiatives that bought new Land Rovers and paid higher salaries than governments could ever afford. The wide disparity between the salaries of civil servants and foreign organisations in developing countries means that the international agencies continually attract the best staff away from governments. I know that DfID has tried to deal with this in Afghanistan with some difficulty.

One answer is to work more through NGOs, but more important is the way in which governments engage with one another and the partnerships that can be forged between richer and poorer countries. My noble friend Lord Crisp will, I am sure, refer to his former department’s latest response to his ground-breaking report last year. This signals a new relationship between our own government departments and the developing world. The International Health Partnership, which was launched last September, already places more emphasis on better links from within our own health services.

Another way is a greater use of volunteering. The latest VSO initiative to expand its Civil Service pension scheme is a modest beginning, but it has won Cabinet support and should act as a catalyst to the NHS trusts to promote this partnership. Incidentally, it is 50 years since the VSO began from an office at Christian Aid, and I pay tribute to all its staff and volunteers.

I must mention the essential role of migration. The House of Lords Economic Affairs Committee recently poured cold water over this subject, rather in contrast to the earlier European Union Committee report, but I hope that the Home Office will follow through with its official welcome to Recommendations 11 to 13 in the Crisp report. Migrant health workers in effect subsidise our health services because of the added value of their training overseas. Countries such as Uganda are literally sacrificing one in six of their own trained staff. My local NHS hospital in Yeovil tells me that without migrant workers it would seriously struggle to deliver a service, and that because of our new immigration laws it can no longer fill paediatric posts from countries such as Malawi. Commonwealth countries are in particular demand because of English-language training.

Meanwhile, health services in some favoured African countries do receive aid from DfID, in line with central budgetary support, which is important. Ethiopia is one of these, although budgetary aid has been suspended there on human rights grounds. This has led to a more plural arrangement that combines central government funding with special projects and NGO assistance. DfID can therefore be proud of its support for health extension workers in countries such as Ethiopia, in which two women are trained for a year after completing high school and sent back to their own communities. The Community District Nursing Association is also training staff in Ethiopia, and the Royal College of Obstetricians and Gynaecologists is active throughout Africa. Ethiopia has developed its network of health workers faster than most other African countries, and as a country where rural health was long neglected it could still become a model of sustainable healthcare.

In conclusion, I recognise that the canvas is much wider than the one painted by the MDGs. Although I applaud our efforts to increase aid, I am not one of those who believe that aid represents a solution. All our aid to Africa under this Government has, I am reminded by Saferworld and other organisations concerned about arms in the world, been cancelled out by the cost of conflict. We are making notable progress in rebuilding southern Sudan, but it is painstaking work. Too much of our aid, whether in health, education or employment, is still led by outside consultants. We need to pay much more attention to local initiatives in Africa, fairer trade, more microenterprise and, above all, to supporting the largest employer of the very poor—agriculture.

For obvious reasons, I have not been able to cover all the millennium development goals. I shall leave education to others. Safe drinking water and sanitation are, I know, a high priority for DfID and they are essential to improving health. Another priority is the empowerment of women, who are in the front line of development, which should never be forgotten. The elimination of trade barriers remains vital, while the share of world trade for the poorest countries continues to decline. The caste system in India deserves a much higher priority for this Government within the human rights dialogue going on there, which one could compare to the dialogue with China over Tibet and the Muslim minority.

There is an urgent concern about food prices, which others will mention. The International Monetary Fund is to create a new programme to offset food and fuel prices in the poorest countries, but that will not be enough. At this rate, it appears that we will not make poverty history in the lifetime of Members of this House. I beg to move for Papers.

My Lords, I thank the noble Earl, Lord Sandwich, for giving the House the opportunity to debate this important subject. The millennium development goals are a set of admirable strategic targets, which are designed to uplift the lives and experiences of people in what Jeffrey Sachs, director of the Millennium Project, has described as “the interconnecting world”.

I shall comment on millennium development goal 3, which is,

“to promote gender equality and empower women”.

The 2007 UNICEF report, The State of the World’s Children, sets out in graphic detail why there continues to be an urgent need for international action to improve the circumstances of women. We learn, for example, that only 43 per cent of girls of the appropriate age in the developing world receive secondary-level education. In some parts of Africa, the figure is only a little over 20 per cent. We also read of the continuing practice of child marriage. We read that girls under the age of 15 are five times more likely to die in pregnancy than post 18 year-olds and that babies born to girls under the age of 15 are 60 per cent more likely to live for less than 12 months.

The most shocking information that I have found relates to decision-making in the home. In four African countries—Burkina Faso, Mali, Nigeria and Malawi—more than 70 per cent of male heads of households make the sole decision on matters relating to their wife’s health and medical care. In Malawi, Nigeria and Mali, more than 60 per cent of such men solely decide on household expenditure. In Mali and Burkina Faso, 60 per cent of men make the sole decision on whether the family will visit friends and relatives.

Interestingly, in 2003, research conducted by the International Food Policy Research Institute in Washington DC, showed that major determinants of decision-making in the home included access to or control over income and, importantly, levels of education. Of course, education is important for improving access to employment, but we can see here that it is also about improving confidence and providing these women with the means to gain control of their lives and to instil a sense of confidence and dignity into themselves and their children.

The objectives of the MDG programme are admirable. However, recent reports, including the Action Aid report on women and the millennium development goals, show that those MDGs farthest off track are those relating to women. Forty countries risk not achieving equal school enrolments for boys and girls until after 2025. The same report highlights the position of women under each of the MDGs and provides statistics to show that women and girls continue to be the majority of those experiencing hunger, those with little or no access to land and those with no access to education. They are not included in decision-making bodies, they die younger and they die of preventable and avoidable pregnancy-related causes. Also, more women than men live with HIV/AIDS and women are mainly responsible for fetching water.

WOMANKIND Worldwide, one of the NGOs that has campaigned on these issues for many years, has expressed disappointment at the level of progress being made and believes that this is due to a failure to address discrimination against women in all areas of the MDGs. MDG 8, for example, which is about global partnerships, should require Governments to build on and honour existing international agreements such as the United Nations Convention on the Elimination of Discrimination Against Women, commonly known as CEDAW. Closer monitoring is called for on how aid impacts on gender inequality and there are calls for the diversification of aid to make sure that it reaches the smaller local and grass-roots organisations.

In September 2008, the UN high-level panel review of the millennium development goals will meet. Calls are made for Governments to commit additional resources to the delivery of the MDGs, and MDG 3 in particular. Reference is made to the need to address violence against women and to the protection of women and girls during and after armed conflict. Again, we already have a mechanism to deal with this; namely, United Nations Resolution 1325, which must be much more widely promoted and built on.

I have two final thoughts. First, the lack of quality gender-disaggregated data stymies our ability to determine the most productive way forward and to target effectively our resources. Secondly, we call for gender budgeting; that is, the analysis of the particular impact of expenditure on women and girls. This is a useful tool and can help to ensure that programmes and policies hit the intended targets.

My Lords, I, too, congratulate the noble Earl, Lord Sandwich, on securing this hugely important debate. It allows us once again to concentrate our mind on issues that are so often pushed to the side of people’s immediate thought processes. I shall concentrate on India, which is unique among the developing countries as it boasts massive economic progress and yet, in what is almost a contradiction in terms, is facing greater disparity and less economic access and opportunity for those at the bottom of the social and economic ladder.

As a frequent visitor to India and as one of Indian origin, I am incredibly proud of the huge progress that my country of origin is making on the world stage. India is undergoing a phenomenal transformation and we should all applaud its achievements. Yet I hope that we do not lose sight of the fact that 600 million people live on less than $2 a day, with 300 million of them on less than $1 a day. Social and economic inequality is detrimental to the health of any society, especially when the society is as diverse, multicultural and overpopulated as that of India. Slow and unequal social mobilisation in various parts of the country has led to uneven economic growth, caste and social polarisation, low levels of literacy and educational attainment, and limited access to natural resources. All these impact on the life qualities of individuals.

In rural areas of India, the ratio of hospital beds available to the population is more than 15 times lower than it is for those in urban areas, while the ratio of doctors is around 6 per cent lower and per capita expenditure on public health is more than 7 per cent lower than in urban areas. This growing inequality in health and healthcare spending affects largely the marginalised and socially disadvantaged population. The infant mortality rate of the poorest 20 per cent of the population is 2.5 times higher than that of the richest 20 per cent. A child in the low standard of living economic group is almost four times more likely to die in childhood than one in the high standard of living group and a female child is 1.5 times more likely to die before her fifth birthday than a male child. At the last census in 2001, the statistics showed that there are just 927 girls per 1,000 boys, a ratio that had declined from 945 per 1,000 in 1991.

I was in West Bengal a few weeks ago and I am grateful to the West Bengal Legislative Assembly for its invitation. The visit provided parliamentarians with an opportunity to have free and frank discussions about many of the issues that this debate will raise. Given our historical links with India, it is crucial that we encourage its politicians at all levels to recognise that the prosperity of a nation is valued by what happens to the poorest in its country.

It deeply troubles me that a person from the poorest quintile of the population, despite facing greater health problems, is six times less likely to access hospital care than someone from the richest quintile. There are three main reasons for this: geographical distance, socio-economic distance and gender. Poor access to health centres and basic healthcare is pronounced among families with little or no education. Poor transportation facilities add to the difficulties of access and little in the way of incentives is given to doctors and nurses to move to rural areas. Maternal mortality therefore remains much higher in rural locations.

The picture remains bleak in urban slums, too, where mortality rates for infants and those under five of the poorest 40 per cent are as high as those in rural areas. Urban dwellers remain extremely vulnerable to macroeconomic changes which impact on their earning capacity. Rising food and utility costs add to the difficulties of accessing nutritional food and people therefore opt for cheaper versions. Added to this are poor sanitation systems, poor housing and inadequate education, which expose urban dwellers to the increased risk of disease.

Particularly affected is the female population. In countries such as India, gender discrimination still exists on a large scale and females remain socially, culturally and economically dependent on men. They are still predominantly excluded from decision-making and are seen as an economic liability, mostly due to the dowry system. Maternal mortality rates have increased from 424 maternal deaths per 100,000 live births to 540 maternal deaths per 100,000 live births.

India has also seen a resurgence of many infectious but curable diseases, such as dysentery and diarrhoea, which kill about 600,000 children each year.

Greater focus on education and healthcare are the major pins in the eight millennium development goals. I understand only too well the complexities of India—a hugely successful multicultural, multilingual and multireligious country—so I understand that the solutions are equally complex. DfID and major aid agencies do excellent work in India but it is crucial that proper outcomes are set, recorded, tracked and monitored, that scrutiny takes place and that there is more equal partnership work to give ownership to the recipient countries.

My Lords, I, too, congratulate the noble Earl on bringing this subject to us today. It is a most important issue. I will spend my allotted time stressing and underlining many of the issues he and other contributors have already raised. I shall concentrate my remarks on the progress with the MDGs in Africa, noting my interests as a founding vice-chairman of the Africa All-Party Parliamentary Group and as a council member of the Association of European Parliamentarians for Africa.

Not all African countries are poor, but all are to an extent off target in plans to meet the MDGs. In the UN’s progress by region report, produced at the halfway stage in 2007, the most extreme region by far is sub-Saharan Africa. In only one of its bands—measles immunisation, which is a subset of Goal 4, to “Reduce child mortality”—was the region on target. On the other seven goals, sub-Saharan Africa’s column was sending out alarm signals; every one either off target, making no progress or actually in reversal.

While sub-Saharan Africa might be the cause for broadest concern, some specific MDGs across the developing world in themselves were resisting progress. With regard to Goal 6, combating HIV/AIDS was off target or showing no progress in all the regions looked at in the developing world, while reversing the spread of malaria and tuberculosis was off target or showing no progress in five out of eight regions.

I return to Goal 4, which aims to reduce child mortality of under-five year-olds by two-thirds. Four out of the eight developing regions were on target in 2007 to meet that MDG. That is encouraging, to a degree, but you have to consider that, according to Save the Children’s latest work, nearly 10 million children globally are still dying before the age of five every year. Of those, 4.8 million deaths occur in sub-Saharan Africa. At this rate of progress, the target to reduce mortality by two-thirds will not be met until 2045.

That fact could well highlight a design flaw in the MDGs. They seem to ignore the issues of equity and distribution, which Save the Children is rightly calling for Governments to place a much greater focus on. Although the United Nations maintains an MDG indicator database for individual countries as well as regional trends, there are problems with some of the data used for calculating the MDGs. There are data quality issues with birth and death registrations and cases of malaria and TB, which will remain until the PARIS2l consortium is successful in promoting high quality statistics in developing countries.

The question is: how will the goals be achieved? More aid seems to have been, to some extent, the accepted knee-jerk reaction—the argument is merely about how much aid. Some $50 billion per year in additional assistance seems to be the figure generally used as the amount needed to meet the MDGs, according to the United Nations’ Zedillo report, and the Gleneagles summit agreed to the doubling of aid by 2010. It has to be pointed out, however, that while increased aid will certainly help the more successful developing countries to reach their MDGs, it is not in itself the solution to pulling the poorest out of poverty.

In its report on strengthening parliaments in Africa, the Africa All-Party Parliamentary Group stressed that development partners must work in step with one another. Approaches need not be uniform but they should be co-ordinated, sharing information and insights, reducing duplication and dividing labour according to comparative advantage. Donors should do more to form common streamlined arrangements. Aid to developing-country Governments, particularly in Africa, through direct budget support, strengthens the particular recipients but risks making them more accountable to the donors and less accountable to their people through their parliaments. In that regard, the current European Commission Paper, The EU a Global Partner for Development: Speeding Up Progress Towards the Millennium Development Goals, is welcome.

The lack of clarity over accountability for delivery and the national, regional, or global focus of the MDGs are highlighted by the Commission as outstanding concerns. It has identified four priority areas for action by the EU: aid volumes; aid effectiveness; EU policy coherence; and aid for trade. From the Explanatory Memorandum prepared by DfID, it appears that our Government are solidly behind the proposals set out in the European Commission document, but perhaps the Minister could elaborate on that in her response.

While the global response towards the MDGs, particularly regarding poverty reduction, has been encouraging, there is a risk of Africa being left behind. The key to Africa’s destiny lies in and with Africa, but the support of the international community, as pledged at Gleneagles, can serve to bolster African nations in their efforts; in particular, with help in developing the health and education systems that are essential precursors to the continent making real progress towards the achievement of the MDGs. In that regard, the United Kingdom has a responsibility to continue to play a leading role.

My Lords, I, too, thank the noble Earl, Lord Sandwich, for initiating this debate. It is entirely right and proper that, at a time when the focus of so much of our media is on City bonuses and house prices, we should focus on those for whom one meal a day and a roof over their head at night is a luxury.

Targets have their detractors, but those of the Millennium Development Goals really matter, because meeting them will save the lives of millions and failing to meet them will cost the lives of millions. Furthermore—and this is an important point—all countries have accepted and reiterated their commitment to them in the 2005 Millennium Development Goals summit. All countries have an obligation to do all they can to fulfil them, and that means the Governments of poor countries as well as the rich. This is a global task and a global responsibility.

As other noble Lords have said, there have been successes, particularly in Asia and Latin America, with some targets met and others on course. That is hugely encouraging. But elsewhere, particularly in sub-Saharan Africa, the lack of progress on many of the goals is deeply worrying.

I shall focus specifically on the three health goals: reducing child mortality; improving maternal health; and combating disease. I want to focus, too, on the challenges of meeting these goals in the most difficult circumstances of all: in fragile states where conflict, extreme poverty or sheer bad government mean that people are simply not getting the basic care that they need and deserve. I must declare an interest as chair of the trustees of Merlin, a medical aid NGO which operates in around 20 countries in just these circumstances.

The figures for sub-Saharan Africa are appalling. I take child mortality as an example. The proportion of children who die before they are five in the region as a whole was in 2005 about 17 per cent. In some countries, it is far worse. In the Democratic Republic of Congo, it is more than 20 per cent; in some regions, it is higher than that. More than one child in five dies before the age of five. Or let us take maternal health. The chances of a woman dying in childbirth are one in six in Sierra Leone and one in 38,000 in Britain.

Of course, not all is as bad as that: as the noble Lord, Lord Chidgey, has just said, the incidence of measles, a huge killer in Africa, is falling as vaccination spreads. But overall, this degree of poverty and vulnerability anywhere in the world in the 21st century is simply unacceptable. And conflict makes it worse still. The war in Liberia reduced the number of doctors in the country from 237—which is not, one might think, a huge number—to fewer than 20.

As the noble Earl, Lord Sandwich, said, poverty and vulnerability of this kind are insidious but avoidable. That, too, is a point on which we need to focus. So what is to be done? As other noble Lords have said, part of the answer is finance. Like others, I congratulate DfID on its commitment over the years to poverty eradication. I hope that it and the Government as a whole will continue to lead both by example and by exhortation, notably at the European Union and G8 summits coming up this summer and the UN summit this autumn. I also welcome the Government’s commitment to the International Health Partnership, which is crucial in ensuring that the many committed actors in this field work together. I would welcome an assessment from the Minister at the end of this debate of progress in the International Health Partnership, launched last year.

As other noble Lords have said, the key point about funding is that it needs to be properly directed if it is to have effect. During and in the immediate aftermath of conflict, emergency humanitarian aid is essential. I pay tribute to the humanitarian operations of both the United Nations and the European Union in responding to really very difficult circumstances at present. The role of NGOs is also crucial. But even at this emergency stage, just after conflict, particularly as things begin to stabilise, donors need to focus not only on meeting emergency needs but on building up the basic capacity of health systems to cope with longer term needs. If that does not happen right from the beginning, there will be no chance of moving through that rather difficult process from emergency through transition to, we hope, recovery. In that context, training medical, nursing and support staff is fundamental—and I greatly look forward to hearing what the noble Lord, Lord Crisp, will say on that.

Even better would be to prevent conflict. I wonder if, at the end of the debate or perhaps later, the Minister could say what progress has been made in putting into practice the doctrine of responsibility to protect which was agreed in the UN summit in 2005—the principle that states are primarily responsible for protecting their own populations from genocide, war crimes and ethnic cleansing but, if they do not, they should be or can be encouraged to do so by others. I know that that is a delicate issue but if that doctrine could be developed and put into practice, with a very clear humanitarian objective, it could make a difference.

My Lords, I, too, thank the noble Earl for this very timely debate. I am especially grateful to follow the noble Lord, Lord Jay, because some of the things that I want to draw attention to have been notably taken up in his remarks.

I want to pick up on a word used by the noble Earl in his introduction, and in the speech that we have just heard—the word “conflict”. I begin by quoting a paragraph from the UN’s 2007 report. On page 4, it says:

“Insecurity and instability in conflict and post-conflict countries can make long-term development efforts extremely difficult. In turn, a failure to achieve the MDGs can further heighten the risk of instability and conflict. Yet in spite of a technical consensus that development and security are mutually dependent, international efforts all too often treat them as independent of one another”.

I want to illustrate the deadly seriousness of those words in this context, with reference to only two areas of the world—though among far too many; namely, the DRC, with particular reference to its eastern side, and the West Bank and Gaza in Palestine.

In the DRC, after so many terrible years and elections a couple of years ago with vast EU and other support, and with the assistance of the largest UN force currently operating, the January Goma accord is by no means working. There are a range of armies and militias; the national army is profoundly inadequate and a damage to security in itself. Well over 1 million people are away from their homes and their fields, whether in camps or in the bush. Thousands are dying every month from violence, disease, exposure and malnutrition, aided and abetted by the systematic trashing of the basic facilities, such as schools, churches and rudimentary health facilities. NGOs are greatly hampered from operating and the levels of rape are as high as ever, if not higher. There are other places where that is the case. Progress with the MDGs is clearly going backwards on every count and according to every witness.

There is a horrifyingly similar story in everything that is to be read and learned and listened to, not only about Gaza but throughout the West Bank. Palestinians have recently been described as the highest per capita recipients of aid in the world. Any aid is for survival: for humanitarian needs rather than development. A very recent report on a number of aid agencies spoke of a humanitarian implosion in Gaza. It described the West Bank as now being equal in deprivation, difficulty and insecurity to the poorest developing world countries. Here, too, progress with the MDGs is frankly impossible.

If we are serious about the MDGs—as our own and other Governments admirably mean to be and have been working to be—we have to be particularly serious about the most intractable places and the most vulnerable among the many vulnerable millions. That is a serious matter, because the former Prime Minister's Africa report of 2005 was much better at the places where things were less difficult than about where they were more difficult. I have tried to chase up the work of the Africa Partnership Forum, to which, amazingly, the Government have delegated work. Has this House ever had a debate on the Africa Partnership Forum? No. I have asked Ministers on a number of occasions for one but to date it has not happened. The Africa Partnership Forum is dealing with easier rather than more difficult issues—the most attractive issues, not with the most intractable places. The question posed by the noble Lord, Lord Jay, about what is to be done is critical. It requires fresh prioritising by our own and other Governments—by the EU Governments in particular and therefore our own among them.

What is to be done would be another debate in itself, but there are all kinds of questions about joined-up government. There is the delicate matter for this House and for this Government of reviewing the wisdom of running down the Foreign Office and the skills of sheer, persistent diplomacy, even if it has sometimes been run down in favour of DfID. There is patient, energetic, skilled and knowledgeable diplomacy to be done. There are huge questions, not only about accountability for aid in the most difficult and conflict-ridden places, but, as the noble Lord, Lord Jay, suggested, about protection and how that can be offered in places of extreme difficulty.

In the case of Palestine, we have to get into a position where we are not simply sitting apathetically assuming that that terrible situation will go on and on, especially as I continue to believe—whatever I am told by Government Ministers—that our failure to work at the issues of Palestine is serious for a whole range of other issues throughout the Middle East and in this country. In my last sentence I want to take up the noble Earl’s point that everything that we were talking about points to a scourge much greater than terrorism—now there is a challenge for the Government’s priorities.

My Lords, I, too, thank the noble Earl for initiating this debate. My concern is not so much with the nature of the MDGs themselves but with how possible it is to calculate progress or measure achievement with anything approaching scientific credibility.

I declare an interest as a patron of an organisation called Evidence for Development, which specialises in assessing the impact of development programmes. Evaluation, assessment and measurement, when talking about human societies, is a tricky science to which many hours of statistical study have been devoted. Such evaluation is increasingly refined and figures are constantly re-jigged. There is now, because of the MDGs, a worldwide commitment to numerical targets and deadlines. The problems are as follows. For each MDG the baseline from which most surveys take off is more often than not flawed, but most aid organisations, including the UN agencies, continue to rely on distorted government statistics which are manipulated for political benefit. Armies of evaluators regularly carry out surveys which may be too simple to be useful, too limited to assess overall impact or too technical to be implemented with any confidence in the results.

We may argue about what the MDGs actually represent: a common vision of what matters most for improving the lives of people in poor countries, as one commentator has put it; or a measuring exercise. To aim to reduce maternal mortality but fail to prove that it is in fact decreasing seems to me not only irresponsible but senseless. To have a genuine desire to help a community without knowing how best to do so is neither cost-effective nor honest.

Is a reduction in child mortality due to health intervention or is it a more general effect of factors such as knowledge transfer, access to markets and the like? Tanzania's decrease in child mortality is probably due to massive inputs of anti-malarials, bed nets and immunisation. But no one will know exactly unless these inputs suddenly cease. In fact, AIDS aside, mortality in Africa has been falling steadily for decades and no one is entirely sure why.

MDG 6 aims to reverse the incidence of malaria. However, the indicators chosen to chart progress are essentially unmeasurable. A WHO report funded by the UK Government is damming. It talks of

“a failure to clearly define goals and priorities”

of the measurement strategy at all levels; insufficient guidance given to countries on data collection; and no acceptable sampling methodologies employed, with the result that the data

“are essentially meaningless and impossible to interpret”.

Does it matter? After all, is not some aid better than none? It does matter because the wrong aid may be worse than none, and ineffective aid necessarily precludes more appropriate assistance. Furthermore, if progress by whatever means is detected surely we should know what has caused it. Otherwise how can we build our knowledge of what works and what does not? A second and more persuasive argument for getting it right questions the understanding of development itself. Is it a slow but logical process of political and economic change leading to greater national income and a subsequent increase in services leading to reduced mortality, more HIV drugs, education and communications? And if so, can it be speeded up by vast injections of money, including budgetary support? If it is the former, one has to ask what will happen when the foreign aid flow stops, as it must do at some stage.

No one should argue for less investment in global development, but it is legitimate to ask whether the MDGs are the best tools to advance the well-being of the poorest communities of the world and, if not, what would be a better approach.

As 2015 approaches, the UN still lacks data to prove whether the MDGs are being met. Journalists will be quick to challenge claims and disclose errors and these will be used to discredit foreign aid. This would not be a happy outcome but there is still time to act to pre-empt the embarrassment of failure.

My Lords, I, too, congratulate my noble friend Lord Sandwich on securing this debate and on his wide-ranging and challenging introduction. As he and others said, the debate takes place in the context of the UK being one of the leading—perhaps the leading—and most influential countries in international development today. I approach this debate in the hope of being able to influence policy, even to a tiny extent, to enable it to become more effective and have greater impact not only as regards its own activities but in its influence on other people’s.

This leading role is greatly to the credit of the Government, but it is also greatly to the credit of the very many people in the UK who are active in the field of international development, whether they are individuals doing things on their own account—we have examples of such people in your Lordships’ House—NHS organisations or universities. The UK has a great tradition, body of knowledge and expertise in international development. I am grateful for the Government’s recent response to my report, in which they said that they would do more to support people to deliver their international development goals.

In the short time available, I will pick up one key issue, which is that the principal constraint on better progress with the health millennium development goals is the shortage of trained health workers. Something like a billion people in the world do not have access to any kind of health service. That means that they do not have anyone to turn to for advice, information or help—sometimes for the simple knowledge that is needed. As a result, as we have heard from many noble Lords, many millions of people die or are disabled or damaged needlessly from things that could be avoided.

Why is there a great shortage of health workers? It is partly about migration, which we have heard about, not just to the developed world but to South Africa and other countries in Africa. It is partly about death; indeed, in southern Africa, there has been a higher incidence of death from HIV/AIDS among health workers than among the population at large. It is partly about an economic framework that in some countries, such as South Africa and Kenya, means that there are unemployed trained health workers. But above all it is because not enough people are being trained and educated.

Let me take a simple example in Ethiopia, a country with a population of some 75 million, a quarter more than the UK population. If every doctor who had been trained in Ethiopia in the past 30 years were still working there today, there would be 4,500 doctors. If you made the same calculation for the UK, there would be more than 100,000 doctors. In practice, there are some 5,500 doctors in Ethiopia—about 2,000 Ethiopians and 3,500 foreigners. Whatever else needs to be tackled, there is a pressing need to strengthen the training and education of health workers in such countries. That applies not just to the more stable countries. As my noble friend Lord Jay said, one of the first things that needs to be done by a country is to move out of active or hot conflict.

My second point is about what sort of workers there should be. Of course, this is about doctors and nurses, but what is needed in Ethiopia, for example, is a very large number of very local health workers who know how to do 20 things right, and do them right all the time, to tackle the things that people die of. It is about clean water, mosquito nets for beds, safe sex, immunisation and knowing what to do with a child who has diarrhoea. A range of simple things can be done.

All the evidence—and there is a great deal of it—shows that such approaches have failed in some places but that, where they have succeeded, they have done so because the health workers have been supervised and well trained, have been able to be trained again and are able to refer on to other workers. You need the whole range, but you need to start and you can do that quickly with a large body of health workers of that sort. Although I will not pursue this, there is, in addition, a great deal of evidence that the way in which health workers are trained and educated is important. That needs to be much more community-based and team-based if services are to be delivered at a local level.

In that context, I was pleased at the announcement 10 days ago by the Prime Minister and Mr Bush that they would support four African countries, including Ethiopia, in developing their health workforces. Can the noble Baroness who is to respond give us a little more information about what that will mean? There are three questions in particular. First, is this new support for increasing the number of health workers in those countries a welcome sign that a higher priority will be given by the Government to the development of health workforces in developing countries? Secondly, in supporting workforce development, will Her Majesty’s Government ensure that the evidence and the lessons that I have briefly referred to about the types of workers and the training that are needed—evidence that comes from as far afield as Brazil, Iran and Pakistan, as well as Ethiopia—are used and applied? Thirdly, will Her Majesty’s Government also ensure that there is proper evaluation and real-time learning from the scaling-up of the workforces in those countries?

In conclusion, there is evidence that a great deal more can be achieved by taking some practical steps and that this can be done if the United Kingdom gives greater priority to the development of trained health workers internationally as a central strand to all its strategies. If the UK also brings into play the extraordinary expertise, good will, experience and track record of the many British institutions that are able to support this, and if it uses its leverage, it can encourage others to do the same.

My Lords, I, too, am grateful to my noble friend Lord Sandwich for initiating this debate on this most pressing subject. I shall try to rise to his challenge of doing a little bit of positive thinking. Many of us from the African diaspora who live here experience a complex range of emotions in relation to Africa. Joy, sorrow, fear, pride and hope jostle for ascendancy as we watch news bulletins that appear to be able to tell us only of conflict, disease, poverty and corruption. This narrative is pernicious and distorts reality. Of course I am not suggesting that the continent does not face huge problems in these areas, but I and others object to the impression that people here are left with: that Africa is solely a continent of failed states with people who can only hold out their hands for charity from donor countries. On the contrary, Africans at home and abroad are energetic in their efforts to unlock the creative and economic potential of the continent. It is this aspect on which I shall focus.

I am grateful to Onyekachi Wambu of AFFORD, an organisation that supports African diaspora entrepreneurs to create and sustain economic development in Africa, for a briefing on some of the areas that I shall outline. The UN Economic Commission for Africa says that every year 8 million new people come on to the job market in sub-Saharan Africa. There is a clear need for a far greater focus on job creation that leads to self-sufficiency. This requires substantive shifts in policy and practice. In particular, it requires recognition that Africans and the African diaspora can harness their intellectual, financial and political capital to support entrepreneurship and to create and sustain jobs in a variety of sectors.

It is my belief that, across the continent, the creative talent that exists is huge and largely untapped. I also believe that supporting the systematic development of the creative and cultural industries can contribute to addressing the majority, if not all, of the millennium development goals. This is particularly the case with visual culture—fine art, carving, sculpture and film. According to the Daily Telegraph, nearly half of the 10 greatest sculptors of wood in the world come from Zimbabwe. Last year, I travelled to Maputo in Mozambique. I was immediately struck by the wealth of visual art in the streets and the markets—virtually everywhere. The artists and craft workers were poor people, often using found materials, working as a collective, trying to entice tentative tourists to buy beautifully crafted material at, what were for us, very reasonable prices.

Investment in the infrastructure and resources to enable creative expression that goes beyond producing clichéd work for the tourist market are sorely needed. Opening up markets for artists and creative workers across Africa and, importantly, in Europe and the USA could not only eventually make a vital contribution to economies but help to dispel myths about the lack of African achievement and about so-called “primitive” cultural traditions that have never engaged with modernity.

Consider this. A bright, intelligent student at a local school was surprised to learn that Africa was a continent, not a country, and was shocked to learn that there were cars in Africa. Imagine the impact of that lack of knowledge on the ways in which people here view African peoples. Conversely, think of the sense of pride and achievement that could come from global promotion of the diverse, vibrant artistic expression of sub-Saharan African people.

I draw the attention of your Lordships’ House to Nollywood. For those unfamiliar with that term, let me explain that it is a play on the word “Hollywood” in a similar vein to Bollywood. Nollywood is straight out of Nigeria and looks set to replicate some of the extraordinary cultural and economic success enjoyed by Bollywood. Since its birth in the early 1990s, Nollywood has generated $200 million in revenue and, with 350,000 people employed in the sector, it is one of the top employment generators in Nigeria. It is extraordinary, therefore, that this success story was not, I believe, mentioned in the 2005 Commission for Africa report.

As well as contributing to economic growth, fostering community and national pride and emancipating the human spirit, the arts can play a significant role in getting messages across to populations with varying levels of literacy and educational facilities. I have met people working in theatre in Kenya who spread knowledge about, and diminish the stigma of, HIV and AIDS through plays and workshops devised for rural and urban communities. I also draw attention to projects such as “Throne of Weapons”, an artwork made of weapons submitted after an arms amnesty in Angola, which not only produced a stunning art object but provoked vigorous debate and conveyed the need to avoid violent conflict in southern Africa. There are many other examples of good practice, which I hope will attract investment and support.

Earlier, I mentioned AFFORD. This UK-based organisation aims to maximise the potential of the millions of pounds-worth of remittances that flow into impoverished households in the developing world from diaspora peoples in the UK. AFFORD is proposing that the Treasury support its scheme RemitAid, an initiative that focuses on practical ways of optimising the benefits and mitigating the negative impacts of remittances through a genuine partnership between African diaspora peoples and the public and private sectors. The idea is that tax relief would be claimed on the charitable remittances sent from the UK to developing countries by UK taxpayers through formal money transfer channels regulated by HMRC. The scheme would be similar to existing tax incentives such as Gift Aid. AFFORD is proposing that the Treasury work with it to devise a workable, secure scheme. I urge the Minister to see whether there is a way of making progress on this important project.

Of course, none of us thinks that remittances or the arts and creative industries on their own will solve Africa’s problems, but each can make a significant contribution and, importantly, help to dispel an assumption of dependency on donor countries. They can help to recognise the agency of Africans and their diaspora and move us towards fulfilling the promise of the continent that is the birthplace of humanity.

My Lords, I, too, congratulate the noble Earl, Lord Sandwich, on securing this important debate. In my view, it should be the topic of an annual debate.

I declare an interest. For 36 years I have been an obstetrician. I was born in Tanzania and I support several charities that work in maternal health in Africa. I am a patron of a charity called SafeHands for Mothers, whose director, Nancy Durrell McKenna, works tirelessly with Ethiopia. Another patron—also a Member of your Lordships’ House—is the noble Baroness, Lady Kennedy of The Shaws.

Today, I wish to speak only in relation to millennium development goal 5, which relates to maternal health. Its target is to reduce maternal deaths by 75 per cent by 2015 and increase the percentage of women who have birth attendants. Those targets were set in 2000. In 1999, in a debate on international women’s day, I spoke on the same subject—at that time, more in hope. Today, I speak less in hope and more in despair.

During the time allocated for this debate, approximately 35,000 women will become pregnant, 5,000 of whom will suffer severe pregnancy-related complications. Many will live out the rest of their shortened lives with disability and increasing poverty, some discarded—yes, discarded—by their families and communities, and tragically around 180 to 200 will die, 99 per cent of them in developing countries. During every minute that your Lordships speak in this debate, one woman will die—one every minute. A mother’s death leaves a child without a mother; it sucks the lifeblood out of the family, drives the family further into poverty and destitution, and contributes to poverty in that society.

The current figure for global maternal deaths is likely to be grossly underestimated. There has been zero progress on millennium development goal 5, and it is the target that we are least likely to meet. Overall progress in reducing the number of maternal deaths—bar that in a few countries which have been successful in this regard, such as Sri Lanka, Malaysia and Thailand—varies from 0.1 to 1.1 per cent. We need a reduction in the maternal mortality rate of at least 5.5 per cent annually if we are to meet the target, although it is most unlikely that we will. At the current rate, south-east Asia will meet it by 2076, and Africa will probably do so 30 to 50 years later. In my view, the key impediments are a total lack of political commitment—more words than deeds—gender inequality and a lack of women’s rights in relation to health. It is true that Governments, including ours, are investing money and we hear reports of how the projects are supported, but there is no total commitment.

Therefore, I am absolutely delighted to congratulate Mrs Sarah Brown, who on several occasions recently has spoken powerfully and with passion and commitment on this issue in her role as patron of the worldwide organisation, the White Ribbon Alliance. Mrs Brown and many other influential women from the world of politics, business, the professions and other walks of life have come together in speaking out and committing themselves to the cause. I believe that women and women’s movements such as that will change Africa. As Mrs Sarah Brown said in one speech:

“It is clear that we are facing a global tragedy in maternal mortality. And I do not believe that we can begin to resolve any of the problems facing the developing world if we cannot first save the lives of these women. And when we know that 80 per cent of these deaths are easily avoidable, there is no excuse for delay in reducing them”.

For every woman who dies, 30 to 40 suffer from severe pregnancy-related complications. Dreadful conditions, such as obstetric fistula, affect upwards of 2 million women in sub-Saharan Africa alone. I feel that we need a new vision and a new strategy focusing on health systems, because changes in health systems have demonstrated success. I hope that the Minister can provide that vision. Let all of us here today and all those who listen to this debate make a pledge to mothers lost—tens of millions of them—that we will lose mothers no more.

My Lords, here we are, beyond the half-way mark between 2000 and 2015, and yet both overall and in many countries we are nowhere near hitting the targets that we set ourselves. The UN Secretary-General has—rightly, in my view—called for a high-level meeting in September this year to review progress and, we must hope and urge, to carry out a mid-course correction of a substantial kind. In declaring an interest as the chair of the United Nations Association of the UK, I should like to add how strongly that organisation supports both the noble Earl’s initiative in calling this debate and the UN Secretary-General’s review conference.

The title chosen for our debate, which focuses attention on the poorest countries, reveals in itself one of the weak spots in any system which sets overall goals for a huge diversity of countries—some already beyond the point where they can really be considered developing countries at all, some making good progress towards the goals, and some even moving sharply away from them in the wrong direction. In such a system, the successes of the few—particularly if, as is the case with a number of Asian countries, they are also hugely populous—can mask the failure of the many. Those poorest countries, many of them in sub-Saharan Africa, make up what has eloquently but shamefully been called by Professor Paul Collier the “bottom billion”. Not only are they at the bottom now but they are fated to stay there unless we and they do something about it. The plight of those countries, mainly in Africa, was recognised at Gleneagles, when specific targets were set for the delivery of increased aid to Africa, but those targets are not being met and they need to be if the situation of the bottom billion is not to get even worse.

Another weakness of an overall system of targets such as the MDGs is that it gives the impression that, if sufficient financial resources are made available, all will be well and the targets will be met. That is far from being the case. Civil wars, regional mayhem and bad governance can all completely frustrate any progress being made towards the MDGs in individual countries and in whole regions. One has only to look at the Congo, Liberia, Sierra Leone, Côte d’Ivoire, Somalia or the Darfur region of Sudan to see the first two of those phenomena in action and at Zimbabwe and Burma to see the third of them. So, stabilising the security situation, bringing civil wars to an end and post-conflict peace building are, and often will continue to be, a sine qua non for making any progress towards achieving MDGs across a considerable range of countries. That is why we need to devote more effort and give more support to the UN and regional organisations, such as the African Union, to help in these situations. I hope the Minister can say something of what is being done in that respect, and in particular what steps are being taken to make a reality out of that responsibility to protect—to which my noble friend Lord Jay referred—which was endorsed with such a flourish at the UN summit in 2005 but which has remained virtually a dead letter ever since.

Bad governance is perhaps even more difficult to remedy, particularly when the neighbours of the countries so misgoverned are so reluctant to see any meaningful steps taken, and yet it is that same bad governance which can render the MDGs completely nugatory. You cannot progress towards the goals when your inflation rate is measured in thousands of percentage points or when a massive proportion of your gross national income goes into military expenditure. And yet that same international community which sets these laudable objectives and insists that they be met turns a blind eye to actions that make them inoperable. We surely need to move away from such an unhealthy tolerance of bad government.

We should recognise that such progress as has been made so far towards the MDGs has been due as much to the prolonged spell of economic growth which has benefited the whole world, developed as well as developing, as to the provision of official development aid. The combination of the two remains crucial. But with a probable global economic slowdown in the offing—indeed upon us in the developed world already—it will be even harder to achieve that than in the past. We must never forget that the economic slump of 1929 onwards which inflicted terrible damage worldwide to both developed and developing countries was caused by a financial crisis being turned into an economic crisis as a result of protectionist trade measures. The siren voices of trade protectionism are already being raised across the Atlantic in the US presidential campaign; they are to be heard in Europe too in connection with the development of policies to deal with climate change. They will need to be resisted if we are to have even the slightest chance of achieving the MDGs. If we are to allow false economies to be made in official aid as a result of an overall squeeze on public spending, then any hope of achieving them would rapidly disappear.

In recent months we have seen another threat emerging to achieving the MDGs: the rapid rise in food and energy prices. This is very much the subject of the moment with many ideas—some good, some misguided and some simply awful—being put forward to deal with these new threats. Yet there is no doubt at all that most developing countries, and certainly most of the poorest ones, are suffering grievously from high food and energy prices and the shortages that go with them. I therefore hope to hear from the Minister how the Government think we should deal with this both in the short term—strengthening the World Food Programme—and in the longer term, eschewing the sort of protectionist policies which we have heard from the French Minister of Agriculture in recent days.

As we head into choppier economic waters the European Union will surely need to continue to give a lead towards achieving the MDGs, and I welcome the Commission's recent communication on that. We need to do that not simply because we have a duty to help those less fortunate than ourselves, although that is indeed a compelling argument, but because it is in our own enlightened self-interest to do so. Globalisation means that we are all each other’s neighbours now. We will achieve neither security nor prosperity for ourselves if the poorest countries, that bottom billion, are left to founder.

My Lords, I too thank the noble Earl for initiating this debate. In this place, just two years ago, I made my maiden speech on the subject of water, sanitation and hygiene and meeting the millennium development goal for ensuring environmental sustainability. I have been very involved in that particular goal as a member of UNICEF's global task force for water sanitation and hygiene.

As we have already heard, we are now halfway through the MDG target of 2015. Although much good work has taken place, there remains so much more to do. Over 2 million children under the age of 15 live with HIV. Seventy-six per cent of deaths from AIDS in the world are in sub-Saharan Africa, even though the region accounts for only 12 per cent of the world's population. More than 1 billion people in the world struggle to find a drop of clean water. In many areas, women and children are forced to travel up to 12 hours a day to gather cooking, cleaning, and drinking water. When it is found, a single sip of contaminated water can bring disease and death, especially for children. As the noble Lord, Lord Patel, has already eloquently said, every minute, a woman somewhere dies in pregnancy or childbirth, from pregnancy-related causes—causes that could be easily prevented with the right help.

Bono, the lead singer of U2, who has been such a strong advocate for the G8 to take action in Africa, called the MDGs the,

“beatitudes for a globalised world”.

He was speaking at a national prayer breakfast in the US attended by the president, Congress and various heads of state and he said,

“It's not about charity, it’s about justice”,


“Africa makes a fool of our idea of justice”.

He was making the point that we are quite good at charity, quite comfortable with charity, but that our charity is overwhelmed by the reality in Africa and other countries where people live and die day-by-day in extreme poverty and hardship.

Now, in the midst of a financial downturn, we are talking about the need to give more. But even in the midst of the current credit crunch we remain a wealthy country and we must not lose sight of that fact. We must not lose sight of the 26,000 children under the age of five who die around the world every day, mostly from preventable causes; we must not lose sight of the fact that some 1 billion people live on less than 50p a day; and we must not lose sight of the fact that 854 million people—most of them women and children—suffer from chronic hunger or malnutrition.

However, noble Lords are, sadly, too familiar with the appalling statistics. What we sometimes do less well is to recognise how much good work gets done—much, if not most of it, by NGOs. Those NGOs, who are entirely reliant on charitable and government aid, do great work and that can get lost in all the despair, so I would like to tell you briefly about some positive work that is being done by one of the leading NGOs in the field, World Vision. I first came across its work when I met one of its executive directors, Keith Kall. I was amazed by this man. His dedication and commitment are a lesson to all of us. As we sit here today, he is back in Africa, only a few days after his honeymoon, helping some of the poorest people of that continent. I would like to share some personal stories that have been brought to my attention that show just how vital the work that people such as Keith, his colleagues and all the other dedicated staff, are doing.

Reagan is a robust, healthy African boy. He is a lively and talkative character and he makes friends quickly. He has a bright, sharp intelligence and is very funny. His friends say that he could be a comedian one day. He is known in his village, not for that reason, but for the fact that he was born to an HIV positive mother. Thankfully he is free of the virus. His mother has spoken about this in gatherings in her village and made it clear that it was no accident. In March 2004, she enrolled in a World Vision programme called Preventing Mother-to-Child Transmission of HIV. Without that kind of intervention, the rate of babies getting infected by an HIV positive mother is 30 to 40 per cent. That rate is reduced by half with intervention. We need to see much more of that type of work.

I know from my work on water sanitation just how crucial women are to meeting the MDGs. Indeed, the empowerment of women is one of the goals. World Vision shared with me another example of how they are doing that. Alice is a traditional Masai woman, but she does a lot of things traditional Masai women do not do. For example, she owns a house and cattle. She is a mother of four, but she lives apart from her husband. At 32, she graduated from primary school and she has her sights set on becoming a human rights lawyer. However, her story did not start that way. In her own words she says,

“My father pulled me out of primary school and married me off at the ripe age of 16 to a 40-year-old, abusive man”.

She endured years of beatings and after one particularly severe flogging that almost cost her an eye, she left her husband. Frustrated by her lack of education, she enrolled in the same primary school as her two sons. It was not easy. She was older than the other students and was a mother, but she kept with it and thanks to the kind of on-the-ground local support that agencies such as World Vision can provide, she will continue with her education. In fact, she is looking to a future in which she will defend Masai women and girls and perhaps even change her culture in the process. These are simple stories about ordinary people, but how extraordinary the transformation of their lives has been as a result of the drive to fulfil the MDGs. Dedicated staff such as Keith Kall and organisations such as World Vision really make a difference to people's lives, and I hope others will join me in supporting their work.

The year 2015 is around the corner and we have no time to waste in ensuring that we do everything we can to meet the MDG targets. I commend the Government and the Prime Minister for the recent announcements of increased funding, but it is still not enough. The Prime Minister has called for the global community to redouble its efforts. We have to see even more significant increases in funding and support now if we are even to hope to help the 72 million children who have no school to attend, or the 30,000 African children who will die from diseases that we know how to cure or prevent. We have to help those children because poverty kills one child every three seconds, so we are already too late to help the 120 children who have died while I have been speaking.

If the MDGs are the,

“beatitudes for a globalised world”,

the world cannot wait another 2,000 years. We have less than eight—less than eight years to make sure that all the children like Reagan and women like Alice have a chance to live happy and fulfilling lives; less than eight years to say that our time here made a difference and that we did not allow justice to be made a fool of.

My Lords, I am grateful, like others, to the noble Earl for this timely debate. At the launch of the MDGs, the then Secretary-General of the UN stated:

“We will have time to reach Millennium Development Goals … but only if we break with business as usual”.

In 2007, his successor suggested in a report foreword that there was a mixed record of delivery. He indicated that, despite some notable landmarks along the way such as the 2002 Monterrey conference and the 2005 world summit, we have fallen substantially short in realising these basic promises. Several speakers have made this point.

The 2007 report presents the most comprehensive global assessment of progress to date. The assessment is clear. Progress towards the MDGs is possible only when strong government leadership, policies and strategies that effectively target the needs of the poor are combined with adequate financial and technical support from the international community. Many developing countries—particularly in Africa—have made significant progress in preparing national strategies to achieve the MDGs, but the progress that developed countries have made in delivering fully on long-standing commitments to achieve ODA targets of 0.7 per cent of GNI by 2015 are much less impressive. The report notes that ODA fell between 2005 and 2007 as debt relief declined. We have yet to break the business-as-usual model.

It would be helpful to hear from the Minister how the Government are responding to the conclusions of that report. In particular, it would be good to hear about the steps they are taking to press other Governments to ensure that aid flows to individual countries that have secured national strategies are continuous, predictable and assured, and not tied to purchases in the donor country.

Despite the mixed picture painted in the report, I share the UN Secretary-General’s optimism that, if the political will exists, the MDGs are achievable. My optimism, however, is tempered by a growing awareness that the climate of development is become even more challenging. As our scientific understanding of climate change develops, so its impact upon development becomes ever starker. The Secretary of State for DfID in a speech last month at an event hosted at New York University's Center on International Cooperation, was right to remind his sceptical audience of the warnings of the UN's 2007 human development report. This report showed categorically that climate change is, and I quote directly,

“the defining human development issue of our generation".

Climate change is a cross-cutting issue that affects a range of development concerns, not all of which, such as migration and conflict—already referred to—are captured by the MDGs, even if it threatens all these goals. The development progress outlined by the 2007 report will be increasingly hindered and, in some cases, reversed by climate change. In this sense, the battle against poverty and the battle against climate change are increasingly interrelated. Progress on one front means nothing if we do not make substantial progress on the other.

It is not enough merely to cut significantly our own emissions; we must also help those who are already experiencing the impact of climate change to pursue suitable adaptation policies. This requires not only better integrating climate change assessments into our own development policies, but actively working with countries in the developing world to mainstream climate change into their own national strategies. Despite the encouraging raft of policy announcements and initiatives emanating from DfID, we still have a long way to go on both these issues. Many of the world’s poorest countries still lack the capacity and resources to assess climate risks. Our response to adaptation and poverty reduction is still too top-down.

The existing multilateral financing mechanisms to help finance adaptation in the developing world have so far delivered only around $26 million. This is a derisory amount when compared with the $40 billion that UNDP estimates will be needed by 2015 to strengthen national strategies for poverty reduction. The inequality between countries in their capacity to adapt to climate change is becoming increasingly apparent. Not surprisingly, a number of commentators, including the former Archbishop of Cape Town, Desmond Tutu, now talk of adaptation apartheid. Expressed in diplomatic language, the international response to adaptation, like our response to the MDGs, has fallen far short of what is required. Being a man of faith I remain optimistic that we can, if we break with a business-as-usual model, address these twin challenges in an integrated way to avoid 21st century reversals in human development and catastrophic risks for future generations.

I have spoken in macro terms, but should like to finish by speaking in micro terms; I have always been convinced that small is beautiful. I am pleased to say that in my own humble diocese of Southwell and Nottingham we are launching an environmental policy in June of this year in the hope of substantially shrinking our carbon footprint. MDGs are not micro-distant. We are all intimately and personally involved in making our contribution to this process.

My Lords, I, too, congratulate the noble Earl on introducing this important debate and his fine speech. Our Government deserve credit for their continuing commitment to reach the 0.7 per cent target of national income as aid by 2015. In September last year, in the Comprehensive Spending Review, DfID got the steepest increase of any department in order to keep the UK on track. We have much to be grateful to the leadership of the Prime Minister for.

However, debt relief is being charged against the 0.7 per cent target, as well as the costs of climate change, which were never envisaged when that target was created and were not included in the MDG costings which underpinned the commitments made. The costs of climate change have been estimated at between £50 billion and £100 billion. Already, £900 million has been allocated by the UK to climate change adaptation and mitigation. It is not clear whether this sum and additional future climate change funding will be treated as part of the 0.7 per cent target. Will the Minister clarify this critical point in her response?

Against this background, it is clear that, in addition to meeting the MDGs, funding additional to the 0.7 per cent is required and that new and creative approaches must be taken. The Prime Minister has been at the forefront of developing innovative financial instruments, first through the International Finance Facility for Immunisation which, together with UNITAID, has raised $1.25 billion, and then through the advance market commitment. In addition, other innovative proposals are being developed by organisations such as Stamp Out Poverty, a network of more than 50 UK organisations working on innovative sources of development revenue.

One of those proposals is a small tax on currency transactions which, according to a report last year by the UN University, has the potential globally to generate $33 billion annually. Due to the electronic automation of the markets, it can be put into operation almost immediately. The recently appointed Special Representative on Innovative Finance to the Secretary-General of the United Nations has said:

“We must have taxes on currency transactions”,

and the Secretary-General himself has expressed his support. The All-Party Group for Debt, Aid and Trade, after an in-depth inquiry, has recommended that the Government give serious consideration to the proposal. However, the Treasury has not so far been supportive of such a levy, even though more than £2 billion of extra aid revenue could be generated annually by a duty of less than one hundredth of 1 per cent on sterling transactions alone. Will the Minister outline the reasons for the Government’s opposition to such a levy? Development experts across the world believe that unless initiatives with this kind of vision and scale are introduced, it is hard to see how the MDGs will be met.

As signalled by the noble Earl, I now turn to funding for mental health, probably the most neglected health area in the developing world. Worldwide mental health accounts for 14 per cent of all deaths and disability, and 800,000 die each year from suicide, largely as a result of mental disorders. Such disorders are not simply the plight of wealthy nations; they equally burden the health of developing countries which can less afford to deal with them.

Given its worldwide prevalence, mental health is noticeably absent from the MDGs. None of the indicators for the three health-related MDGs—HIV, maternal health and child health—targets mental well-being. Despite their absence in the MDGs, mental health is present across all three health goals. The HIV infection is associated with rates of anxiety and depression five times as high among people suffering from mental disorders as the general population. In relation to the maternal health goal, I can add nothing to the eloquent address of the noble Lord, Lord Patel. In relation to the child health goal, it is hardly necessary to say that depression in mothers negatively impacts the health of children. The consequences are that babies of depressed mothers have a five times greater risk of being underweight and stunted by the age of six months.

Mental disorders do not receive any specific part of the health budgets in much of Africa or Asia. Most of the countries that do make provision for mental health care do so at a level of only 1 per cent of their health budget. It is essential to recognise that without addressing mental health, the three health-target-related MDGs will not be achievable. It is also essential to recognise that MDGs cannot be dealt with in isolation. I would urge DfID to take account of this in the application of its funds to meet the MDGs and also applaud it for its support of BasicNeeds, a UK charity which does such fine work on mental health in the developing world.

My Lords, we are privileged to be given the opportunity to take part in this important debate and I thank the noble Earl, Lord Sandwich, for initiating it. He has been well known to me during the past 20 years. He has not just come into the debate fresh, as I have, because “sustainability” must be his middle name. He has been talking about these issues for many years.

I feel humble to be in the presence of so many people I categorise as knowledgeable and expert. The topic has been debated from all sides and, more importantly, by practitioners who try to assist human beings who are less fortunate than we are who live in this country. In listening to what has been said, I have felt saddened, appalled and angry, but determined to try to do my best.

I am pleased to hear general commendations to the Government for attempting to achieve the targets. In many other spheres, targets are sometimes derided as being inappropriate, but they are sensible mechanisms, or weapons, to use in judging whether one has been serious in trying to meet commitments. I have read the excellent document produced by Ian Cruse in the Library, and we have been well served by it. I am a member of a repertory company that appears regularly in debates on other topics, but I am a stranger to this repertory company, although I intend to attend its debates much more frequently. For someone like me, a layman in the field, it is a most worthwhile document in assisting me to appreciate what has been happening.

Let me give an illustration from my background. The House is well aware, because I declare it regularly, of my commitment to the Co-operative movement and idea. In 1949, I was a student at Stamford Hall, the Co-operative college near Loughborough. Among my contemporaries—I was a secretarial student—were students in management and social science from overseas. There were students from Nigeria, Sudan and India. A special friend of mine was a man called Mavro Mavromatis from Cyprus. In the way of the world, I went to Cyprus in 1976. I had lost touch with him, but said to the official taking us around, “By any chance, does the name Mavro Mavromatis mean anything?”. He went away, came back and asked, “Would you like to meet him?”. I said, “Yes”. He appeared, and he was the registrar of co-operatives in Cyprus. That made my day. I use that to illustrate that the Co-operative movement is very much involved in trying to do what it can in this field, particularly in education and organisation.

In 1895, the Co-operative movement established a body called the International Co-operative Alliance, with millions of people all over the world combining to do what they could to lift the lot of people out of poverty. The principal of the college told me yesterday that there is a co-ordination among the co-operative movements in Europe to try to do what they can in support of these goals. I asked him to give me one or two illustrations of the kind of things that are on his plate at the moment. He told me that members of the staff are in Ethiopia, eastern and southern Africa and Dar es Salaam. They are committed to a programme of post-tsunami reconstruction. In the Andaman and Nicobar Islands, and in the European Union, they are doing what they can. I say that with no sense of self-aggrandisement because, listening to what has been said today, I am conscious that the Co-operative movement is only one of hundreds of organisations which are doing their bit.

The Minister and her colleagues have a great responsibility not to let us and other parliamentarians off the hook. It is far too easy to be sidetracked by other issues—enormous issues that need to be solved. However, in a very busy life, the Prime Minister, members of the Cabinet and everyone in this country who has a place to work and to live, and, above all, a school for their children and a hospital or GP for their wives and family to go for advice, ought to reflect on just how lucky we are to be here. Therefore, I warmly welcome the opportunity to declare my interest in humanity and to pledge to the noble Earl that he can count on me at any time in the future to assist him in his efforts.

My Lords, I should like to focus on the relatively new MDG target, 5B, which is the ambitious target to achieve by 2015 universal access to reproductive health. I am most grateful to my noble friend Lord Sandwich for giving us the opportunity to debate this issue, and in particular for his challenging speech. The reproductive health target is in tandem with the maternal mortality target under MDG 5, but with its own indicators as to whether it is being achieved. It is called 5B because it is a new target that was added in 2005.

As has been said, MDG 5 is severely lagging behind any reasonable timescale, and at present rates, it is most unlikely to be met. In the opinion of those in this field, the new reproductive health element is essential to begin to achieve anything like the intended improvement in maternal mortality, as well as to fulfil the reproductive health commitment, agreed and enunciated as long ago as 1994 at the Cairo conference, that there should be universal access to sexual and reproductive health services. The resources and the will to meet that originally declared intention were never fully forthcoming, but some very considerable progress has been made.

More recently, the faltering progress in this field has been due to a combination of a lack of resources, adverse political climate and language and simple inertia in some countries. In the background in recent years has been the unhelpful attitude of the United States, which may not continue. In this country, my impression is that the relevant department, DfID, wants to do its best in this field in securing resources and encouraging the use of clear and unambiguous language in debating and discussing this issue. DfID and its Ministers should be given credit for recently allocating £100 million pounds over five years to UNFPA for contraceptive supplies, but recently the general level of support from us and other European countries has decreased, partly in the shadow of support for HIV/AIDS and apparently more immediate issues.

Now that MDG 5B is a clearly declared target, we should fully support it and, if possible, take the lead in encouraging others to support it. Apart from anything else, such aid contributes directly to achieving other MDGs and is meant to be one of the most cost-effective forms of assistance. This MDG is about the right to sexual health as part of general health but is also about sustainable fertility levels. In the excellent briefing note by the Lords Library on this debate, our attention was drawn to an article in the Financial Times on 14 March this year by two demographers who specialise in Africa. The article was entitled “Africa’s greatest challenge is to reduce fertility”. It particularly highlighted how in many of the poorest African countries the momentum of continuing population growth will jeopardise general development efforts and, in particular, other millennium development goals. We have been hearing recently how shortages of water and food may become even more acute. This issue has more recently been partly downgraded and diminished by its politicisation and by treating sexual health as being of a contentious nature. There is a danger that we will lose the more direct and hard-won language that followed from the Cairo conference if we agree to compromise for the wrong reasons. We should be leading in resisting that, both in Europe and elsewhere, and I hope that we can continue to take the lead with confidence in future European deliberations.

I shall mention two of the indicators for this MDG target, which are ways of judging its success, although there are four altogether. One is the unmet need for family planning. That has long been a recognised measure of how further assistance can usefully and genuinely be given and is framed in terms of the expressed needs of users. The figure for this is accepted to be hundreds of millions of couples. Another indicator is the contraceptive prevalence rate, which in most poor countries is extremely low. Both these indicators testify to the huge sums of money still required to begin to come anywhere near this declared target of universal access to reproductive health. I can quote the global annual amount required just to meet MDG 5B: it is billions of dollars, of which our share should be additional hundreds of millions of pounds annually. I am not going to quote, and do not have the time to argue for, particular figures, but I remind noble Lords of the very serious amounts of money required, money that in the opinion of many would be a most valuable investment in achieving this and so many other MDGs.

I understand that the Government should be taking the lead on MDGs in the September UN conference in New York. It is vital that our Government, who have a broadly good record on this in the past, should feel able to speak out in direct language about the increased commitment, both political and financial, needed at the global level to take MDG 5 seriously.

My Lords, I, too, should like to thank the noble Earl, Lord Sandwich, for securing this debate and for all his work in this area. As ever, this has been a debate with enormous depth and range. This is indeed a key time for us to be debating the MDGs as we are over half way through the period they are supposed to cover, and the G8 and the UN meeting in September on the MDGs are coming up. It is time for us to consider where we are going, whether we are on course to get there and where we might need to take urgent corrective action.

The MDGs are, of course, an artificial construct. The noble Baroness, Lady D’Souza, is right to emphasise that they need proper evaluation. Nevertheless, as the noble Lord, Lord Jay, pointed out, they are a useful set of targets. If we meet them, we will save lives, but if we miss them, people will die. They have helped to focus attention on what needs to be done to tackle poverty, streamline country strategy plans and co-ordinate donors, although we clearly have a long way to go in all these areas.

Underlying all the MDGs is, of course, the relief of poverty. There are some welcome developments and perhaps they point to how best to take things forward. Hundreds of millions of people have been pulled out of poverty over the past 10 years in China and India alone, although hardly because of focus on the MDGs. Challenges remain even in those countries where significant numbers of people remain in absolute poverty, as the noble Baroness, Lady Verma, pointed out in the case of India. This has promoted other concerns, such as the environmental consequences of rapid industrialisation and the growth of urban poverty, both of which were experienced in Britain in its own industrial revolution, though not on the scale of what we are currently witnessing.

As my noble friend Lord Chidgey pointed out, there is a risk of a whole continent, Africa, being left behind. Many of the bottom billion, to use Paul Collier’s expression, are there, as the noble Lord, Lord Hannay, pointed out. However, Myles Wickstead, lead author of the Commission for Africa report, argues that we should be encouraged that some of the conditions necessary for progress towards the MDGs, such as better governance and peace and security, have already started to feed through into significant economic growth in some parts of Africa. The noble Baroness, Lady Young, rightly gave us hope in this area. As the noble Lord, Lord Graham, pointed out, many noble Lords are playing a key role in this field.

That said, none of the MDGs will be met in sub-Saharan Africa if current trends continue. One-third of sub-Saharan Africa’s population is malnourished and, without decisive action, one in six people globally—almost one billion people—will still live on less than a dollar a day in 2015 according to the UN. The risk to us all is clear. Poverty and unrest in one area of the world help to destabilise others. It is in all our interests to address these problems, as the noble Lord, Lord Hannay, pointed out.

How can we generally promote progress? There is a new and encouraging focus on social provision, which is an interesting development. After all, as Britain industrialised, a welfare safety net was put in place at the beginning of the 20th century with pensions, unemployment and sickness benefit that helped to underpin further development. We already know how microfinance transforms the situation of many poor women and their families, and social protection programmes, now recommended by the World Bank, mean that hunger is reduced and children are more likely to be in school. Families prioritise first survival and then their future interests by educating their children.

However, it is not just money. Gender equality is key, as the noble Baroness, Lady Prosser, emphasised. Educating girls improves the position of families, and encouraging the exercise of reproductive rights is central to the empowerment of women, as the noble Viscount, Lord Craigavon, said. The noble Lord, Lord Patel, gave a moving account of the terrible and needlessly high levels of maternal morbidity and mortality. Addressing this needs a great deal of political will, and I am not yet convinced that DfID through and through, as opposed to in particular parts, fundamentally realises how important this is. I welcome the Minister’s comments.

What are the areas of particular risk? What, besides the lack of will and resources, may undermine future progress towards the MDGs? The fragility of states, civil war and bad governance are fundamental, as the noble Lord, Lord Hannay, the right reverend Prelate the Bishop of Winchester, and others have said.

There are three areas that I should like to highlight: HIV/AIDS, climate change and the scarcity of resources and increasing food prices. There may be 10 years between infection and death, so we cannot yet know whether the AIDS epidemic has peaked. We are all now well aware of the devastating impact on societies—children left without parents and economic and social breakdown—that results from the AIDS epidemic. HIV/AIDS will never be adequately combated without addressing gender inequality. It is not surprising that AIDS in sub-Saharan Africa is becoming particularly a disease of young women.

The G8 pledged universal access to prevention, treatment and support by 2010, including prevention of mother-to-child transmission, paediatric treatment and assistance to orphans and vulnerable children, but, with less than two years to go, more than 70 per cent of people are not receiving such treatment. Only 11 per cent of women are receiving treatment to prevent mother-to-child transmission. The noble Lord, Lord Patel of Bradford, emphasised the importance of that in the case of the child to whom he referred.

Will the G8 Governments provide a comprehensive plan with annual funding pledges to meet those commitments, and what are the UK Government doing? When does DfID plan to publish its new AIDS strategy, which has been repeatedly delayed? What can the noble Baroness tell us about current DfID thinking on that? The noble Lord, Lord Crisp, and others, pointed to the extremely important need to strengthen health provision, training and retention of staff. I look forward to hearing the response of the noble Baroness in those areas.

As the right reverend Prelate the Bishop of Southwell and Nottingham and the noble Lord, Lord Joffe, pointed out, we are just waking up to the potential impact of climate change. We now realise that not only is this a global problem, it is the poorest people who are likely to suffer first and most. Livelihoods in the poorest countries are often dependent on subsistence agriculture. It does not take much to knock that off course and for starvation to follow. As International Alert argues, the hardest hit by climate change will be people living in poverty in underdeveloped and unstable states with poor governance. The pressures in those societies are already very great. Add another, and some may reach breaking point. The background of poverty and bad governance means that many of those communities have a low capacity to adapt to climate change and face a high risk of violent conflict. Climate change will wipe out some of the gains made in the fight against poverty if urgent action is not taken.

I want also to consider what appears to be another downside of development: price increases, especially for such basics as food. That is surely partly the result of welcome improvement in the standards of living of populations in China, India and elsewhere, but which, without further agricultural development, will mean that those on the outside—that bottom billion—will be further marginalised. Do the Government think that the World Food Programme is capable of handling the immediate crisis? What proposals do they have for its reorganisation so that it can better tackle new crises? What research will be needed into agricultural production, and what role will the UK play so that the poorest countries can support themselves? What are we doing through the EU, the world's largest aid donor, in this and other regards?

In the 1960s, the development of Asia was despaired of. It would never develop, not least because it had the wrong religions. Africa often causes despair now, yet we see some hopeful, but very fragile, signs of development. We now need to be looking beyond 2015. What will take the place of the MDGs? Promoting good governance and the expansion of trade is surely as important as promoting aid giving. I challenge the noble Baroness to outline what she sees as the most promising trends in both delivering the MDGs and going beyond 2015 to bring that bottom billion in from the margins and out of extreme poverty. That extreme poverty is both a threat and an affront, which is why this debate and actions resulting from it are so timely.

My Lords, a brief glance at the news wires would make anyone think that the outlook is bleak. I quote:

“We are fighting a losing battle”; “eating away at children's futures”; “It's now or never”.

Those are all headlines for articles that discuss our progress towards meeting the millennium development goals. A key theme in all those articles seems to be that of time—how there is not going to be enough. Thus, as we head into the second half of the period set aside to reach the millennium development goals, it is with pleasure that I, too, thank the noble Earl, Lord Sandwich, for moving this important debate. I totally agree with him in his opening May quotation, “To think positively”, also mentioned by the noble Baroness, Lady Young.

Now is indeed the time to re-evaluate our progress and to set out as clearly as possible what needs to be done to reach those most laudable goals. The millennium summit in September 2000 was a watershed moment for global development. For a decade, agreements and resolutions were made that culminated in the United Nations firmly committing itself to working towards sustaining development and eliminating poverty. The millennium development goals were the result of that summit; they were clear objectives that promised real improvements. Now, more than half way to the target of the year 2015, we are faced with the woeful fact that we may not be able to deliver on our commitments. The importance of that cannot be overestimated. It would be a double cruelty to have provided such a ray of hope to the world's neediest only to have it dashed through mismanagement.

There has been some progress, boosted by the economic progress in China and India. My noble friend Lady Verma highlighted so clearly the big problems that still face people in India—gender discrimination, health and education—and our responsibility. DfID has committed £252 million to reduce maternal and infant mortality in India.

The UN noted that the proportion of people living on less than a dollar a day had fallen from 23.4 per cent in 1999 to 19.2 per cent. It reported that, overall, the world was on track to hit the 15.8 per cent target for 2015. The noble Lord, Lord Joffe, spoke about DfID’s aid budget. I noted that there is a new DfID programme of £27 million for education in China for more than 5 million disadvantaged children.

Those statistics betray a troubling fact about our progress. As the noble Lord, Lord Jay—I commend his work with the Merlin charity—mentioned, it has not been evenly achieved. Although the world target for poverty might be within our grasp, the UN admitted that the benchmark proportion of 23.4 per cent living on less than a dollar a day in Africa will not be met through current efforts, as the noble Baroness, Lady Northover, said.

The goal of universal primary education is similarly unbalanced: 30 per cent of the children in sub-Saharan Africa and 12 per cent globally are out of school. Ninety per cent of all child deaths occur in only 42 countries, 39 of which are in sub-Saharan Africa. The amount of aid sent to sub-Saharan Africa is considerable. Yet in terms of progress, it is still lagging far behind. How does the Minister plan to address this? What plans does she have to target this region more effectively and to make certain that the focus is on outputs, not inputs?

According to the UN, the status quo commitment would mean that the target of halving the proportion of underweight children will be missed by 30 million children. Does the Minister have a plan to get us back on target? This issue is particularly poignant in the current economic climate. This year, the price of grain and rice commodities has increased by 40 per cent, which has largely been attributed to changing uses of land and to maladministration. The concern now seems to be not only about making progress, but also about the ability to afford even maintaining current levels. What conversations has the Minister had with the Treasury on the impact of current economic difficulties on the effectiveness of foreign aid? Could she outline ways in which strategies have changed to take into account the increased price in providing food aid?

Of all the millennium goals, those focused on healthcare seemed to be the least likely to be met. For this reason, the UK-led International Health Partnership was launched on 5 September 2007 to address the insufficient progress. What has been its effect? Can the Minister point to any specific impacts that the partnership has had to date, particularly on the shortage of health workers, about which the noble Lord, Lord Crisp, asked a very good question? In particular, what is being done to address the spread of HIV/AIDS? The UN report cites that by the end of 2006, an estimated 39.5 million people worldwide were living with HIV, up from 32.9 million in 2001. That is to say that in five years the increase in the number of people suffering from HIV is greater than the entire population of Switzerland. The number of people dying from AIDS has also increased, up to 2.9 million in 2006. The UN cites the use of non-sterile injecting drug equipment as the primary means of transmission. These are very sad facts indeed.

The Conservative Party has committed itself to increasing international aid, working towards achieving the UN’s target of spending 0.7 percent of national income on aid by 2013. Yet we must be ever mindful of the trap that this Government seem to be almost too keen to fall into—throwing money at problems and ignoring the results. This is why my honourable friend Andrew Mitchell in another place proposed to establish an independent aid watchdog to provide impartial and objective analysis, as I said in a Question to the Minister on 24 April,

“of the effectiveness of British aid”.—[Official Report, 24/4/08; col. 1639.]

As well as being independently reviewed, aid must be transparent, which is why we propose publishing the full details of all British aid spending on the DfID website so that the public can see where the money is going and, importantly, its effect.

I could recite more proposals—there is, as the right reverend Prelate the Bishop of Winchester stressed, the basic problem of conflict, and, as the noble Baroness, Lady D’Souza, said in her challenging speech on the impact of development programmes, the question of how to deal with wrong aid—because they all stem from a similar position; namely, that aid needs a rethink. The noble Lord, Lord Hannay, emphasised the importance of getting back on track to meet the goals that begin with progress towards better governance in the affected countries. Aid needs to be scrutinised, focused on outputs and directly linked to empowering the poor.

We feel that we can meet these goals, but it will take an aid overhaul. Spending should be untied. That is the first step. It should be linked, too, to genuine progress on the ground that is verified by independently audited evidence. Essentially, we must make certain that the money that is being spent is being well spent and that the aid we provide is making a real difference and having a positive impact.

My Lords, this debate has been, as I knew it would be, a potent mixture of measured, moving analysis and urgent advocacy by a group of noble Lords who have said with one experienced voice that there is no time to lose, that this is no time for business as usual and that getting the millennium development goals back on track must be the top priority for 2008. I could not agree more. I thank noble Lords for their positive support for the work of DfID.

I thank the noble Earl, Lord Sandwich, for initiating this extremely important debate and I thank noble Lords for their thoughtful and expert contributions. The millennium development goals were agreed by 189 countries with the aim of securing more prosperous, healthier and environmentally secure lives for millions of women, men and children by 2015. At this half-way stage, it is indeed timely to take stock of what progress has been made in meeting these problems and promises. The plea made by the noble Baroness, Lady Young of Hornsey, for recognition of the creativity in developing countries reminds us that we must always celebrate progress.

I begin by briefly reviewing where the world stands in meeting these promises. We are on track to meet the first MDG target to halve the proportion of people living on less than $1 a day. However, this global progress hides serious regional differences, as the right reverend Prelate the Bishop of Winchester, the noble Baroness, Lady Rawlings, and several other noble Lords said. Strong growth in Asia is not matched by similar progress in Africa. Despite improved growth in many African countries, regional levels are not yet sufficient to sustain an expanding population above the poverty line.

We face real challenges in reaching the second target, which is on reducing hunger. Improvements in east Asia, in Latin America and in the Caribbean are again offset by the slow pace in sub-Saharan Africa and south Asia. A changing climate, environmental degradation and rising demand on agricultural land for non-food crops all pose challenges to ensuring that people do not go hungry. Rising food prices, as many noble Lords have said, are already putting millions at risk. The noble Earl, Lord Sandwich, observed this in his characteristically thought-provoking contribution.

The Prime Minister has recently written to other world leaders, calling for co-ordinated responses to addressing this problem. DfID itself has pledged an extra £30 million to support the World Food Programme’s work. The noble Lord, Lord Hannay, with all his experience, quite rightly said that this is the hot issue of the time. It is. As I said, we are giving an extra £30 million of support to some of the countries that are most affected by food-price inflation, including Zimbabwe, Somalia and Kenya. We will also take increased food prices into account when responding to humanitarian crises. In the longer term, DfID is investing £400 million over five years for agricultural research to increase yields and to make crops more robust.

The second MDG focuses on education. More children now have the opportunity that school provides—opportunity that is essential to individual prosperity and national economic growth. Since 2000, 26 million more children are now in school in Ethiopia and Bangladesh alone. That is progress. Despite such successes, however, as the noble Baronesses, Lady Rawlings and Lady Northover, said, 72 million children do not finish primary school. In answer, DfID has committed to provide £8.5 billion for education in poor countries in the 10 years to 2015, with spending set to rise to £1 billion a year by 2010.

Reaching the education target is also essential to meeting MDG 3, which is on gender inequality. The UK is committed to ensuring that girls and boys have equal access to the opportunities that education provides. We also want to see the rights of women integrated into the national plans of developing country partners and we are working to that end. My noble friend Lady Prosser, the noble Baroness, Lady Verma, and many noble Lords have said that there must be a stouter advocacy of women’s rights. In their description of women’s powerlessness, we reaffirm our commitment to poor women around the world.

Good health is a basic need; it is necessary for and improves with economic development. Many noble Lords, including the noble Lords, Lord Jay and Lord Chidgey, and the noble Baroness, Lady Northover, have taken particular interest in health today. It is here where progress has sometimes, as we know, been slowest. On MDG 4, by 2006 child mortality had declined by 20 per cent from 1990 levels, which is progress. But, as the noble Baroness, Lady Verma, so clearly stated, and as the noble Lord, Lord Chidgey, mentioned, the goal of reducing the number of deaths of under-fives by two-thirds will not be reached. At this rate, it will not be reached until 2045, when most of us will be long gone. However, we have many of the tools needed to do this. Improved sanitation, better maternal health and progress in preventing and treating major diseases would get us back on track. Rapid improvements in immunisation coverage, supported through the Global Alliance on Vaccines and Immunisation, show what can be achieved. The UK is a leading supporter of that alliance.

I turn now to MDG 5, which relates to maternal and reproductive health. One woman a minute dies avoidably during pregnancy or childbirth. Many more suffer disastrous long-term health problems. Progress on MDG 5 has been particularly slow, as the noble Lord, Lord Patel, pointed out in his moving and effective contribution. Stronger health systems and more accessible services are needed, a point to which I shall return. MDG 5 also calls for universal access to reproductive health. It recognises that women and men should have the ability to make their own decisions about the size and timing of their lives and their families. In 22 African countries, less then 10 per cent of women are using modern contraceptive methods. The UK has been a strong international advocate for sexual and reproductive health services and last year provided £100 million to UNFPA, the United Nations Population Fund. I thank the noble Viscount, Lord Craigavon, for his recognition of that work.

MDG 6 aims to tackle the devastation caused by HIV, TB and malaria by reversing the spread of these diseases. Although progress is lagging in all three areas, there are also signs of hope. More than 2 million people are now receiving access to lifesaving HIV treatments, while countries such as Uganda, Thailand and Senegal show that effective prevention can work. Later this month, and building on evidence of what works—again, this has been said by noble Lords, in particular by the noble Baroness, Lady D’Souza—the Secretary of State will launch a strategy that will confirm the UK’s global leadership on HIV and AIDS.

Progress on HIV is also essential to make progress on TB. Improvements in Asia and Latin America have been undermined by increasing rates of co-infection with TB in sub-Saharan Africa. That is why DfID has invested in promising efforts to develop new TB drugs that will be easier to take and will work if current medicines become ineffective.

Malaria is the third target for MDG 6. Today, 1 million people die each year from malaria—mostly pregnant women and children and, again, overwhelmingly in Africa. Sleeping under insecticide-treated nets can prevent infection, and effective treatment exists. Earlier this month, the Prime Minister announced that the UK would provide 20 million insecticide-treated nets over the next three years.

Across all these diseases, the UK has led the way in making donor funding more predictable. Noble Lords have talked about, and the noble Baroness, Lady Northover, challenged me to talk about, the future. Funding has to be about more predictability for our partners. DfID has made an unprecedented long-term commitment to the Global Fund to Fight AIDS, Tuberculosis and Malaria of up to £1 billion through to 2015.

As well as disease-specific action, it is vital that the basic building blocks to provide health services are put in place. As the noble Lord, Lord Crisp, highlighted—we congratulate him on his important work on this—sufficient trained health workers are needed. So, too, are reliable health infrastructure, predictable financing and access to essential medicines. The UK has also worked with developing countries, donors and international agencies to establish the International Health Partnership, to which the noble Lords, Lord Jay and Lord Hannay, referred. The IHP aims to better organise donors, international agencies and others behind country-owned, results-focused national health strategies. This is nothing new. It is not about new mechanisms or funding; it is about doing what we do, but doing it better.

We also have to address the specific needs of health workers. The Prime Minister and President Bush announced in Washington this month that DfID and PEPFAR—the President’s Emergency Plan for AIDS Relief—will work together to improve health and to strengthen the health workforce in Ethiopia, Kenya, Mozambique and Zambia.

MDG 7 relates to sustainable environment, water and sanitation. We are all becoming aware of the vital importance of protecting and sustaining the environments in which we live. This means tackling climate change and environmental degradation, increasing access to clean water and sanitation, and managing the impact of rapid urbanisation. Only progress on access to better sources of water is on track. However, as my noble friend Lord Patel of Bradford said, we cannot be complacent. We must put all these back on track.

The right reverend Prelate the Bishop of Southwell and Nottingham will welcome the fact, as I hope will my noble friend Lord Joffe, that my right honourable friend the Secretary of State has made climate change and the need for sustainable growth top priorities for DfID. These will guide the UK’s work across all other MDGs. In March 2007, the Prime Minister launched a new £800 million environment transformation fund to support developing countries in meeting the challenges of climate change and sustaining environments.

So what more can be done? What more must be done? I have given an overview of the progress of seven of the eight MDGs. There are signs of hope, but we recognise that the world is at serious risk of breaking its promises. The eighth MDG provides a key to how we can turn the situation around. It calls for a global partnership for development. This means the Governments of rich countries meeting their commitments on international aid and being transparent about how they monitor and are accountable for that aid, as the noble Baroness, Lady D’Souza, emphatically stated. It means the Governments of developing countries and international institutions being more open and responsible for their own actions and it means that poor countries must be able to trade fairly with those that are economically more powerful.

In September 2007, the Prime Minister and the Secretary-General of the United Nations reaffirmed that we can achieve the MDGs, but only if Governments, business, faith groups and community organisations have the will to do so and the willingness to work together. The MDG call to action was launched and today more than 20 countries, representing half the world’s population, have pledged to join. The call focuses on four broad areas: the need to do more to harness growth and job creation; the need to redouble our efforts to bring the opportunity of education to the world’s children; the need to use the knowledge, tools and resources that we already have to improve health; and, last, the need to ensure that people live in sustainable environments with access to clean water and sanitation.

Next week, representatives of the biggest companies in the world are meeting in London to join the business call to action. Civil society has a crucial role to play, as my noble friend Lord Graham of Edmonton said when he spoke of the co-operative movement. Non-governmental organisations and faith groups can and do hold Governments to account for the promises that they make, and Governments must live up to their part, as the noble Baroness, Lady Northover, stated so strongly and as the right reverend Prelate the Bishop of Winchester made clear in his moving comments about the conflict in the Democratic Republic of Congo. At the G8 summit in July, Japan will re-emphasise the importance of the MDGs in focusing development efforts.

Several noble Lords asked me specific questions. I will do my best to rattle through as many as I can and I shall write to those noble Lords whose questions I have not reached before my time to speak is up. The noble Earl, Lord Sandwich, asked about the further research needed into the role of UN agencies in diverting in-country staff away from local health and other services. We agree that this is an important issue, which should be looked at in the broader context of push-and-pull factors that cause health workers to leave the public sector and/or to seek jobs overseas. DfID has committed £1 million to the Global Health Workforce Alliance, subject to performance, to support co-ordinated research, advocacy and action on addressing the human resource challenge.

The noble Earl also asked in detail about traditional birth attendants. I would say to him that such attendants are important in providing culturally sensitive care, but they often work in basic conditions, have no training in complicated deliveries and have little access to referral. DfID’s approach is to support increased access to skilled birth attendants and to encourage a healthy delivery in a safe facility. DfID is also supporting Governments to enable traditional birth attendants to accompany women in labour to the facility.

The noble Earl and the noble Lord, Lord Joffe, asked what we are doing on mental health and why it is the silent subject, as it were, in our debates. DfID supports research into understanding the impact of mental health issues in developing countries. This includes a five-year research programme in Ghana, South Africa, Uganda and Zambia. DfID is also providing money from the Civil Society Challenge Fund to support work on mental health and development. Our research into mental health is part of scoping work looking at what issues will need to be addressed beyond 2015. This also includes recognising the growing impact of other non-communicable diseases.

My noble friend Lady Prosser asked what DfID is doing to support UNSCR 1325 on women and peace-building. Her Majesty’s Government are a strong supporter of this resolution and DfID is supporting the UN Development Fund for Women to increase their involvement in peace-building and to address sexual violence, a point also raised by the right reverend Prelate the Bishop of Winchester.

The noble Lord, Lord Chidgey, asked about our response to the European Commission’s package, which was launched on 10 April. I say to him that the papers underline the need for member states to redouble their efforts to meet the MDGs. The UK is working with other member states in supporting the Commission’s efforts to reinvigorate the drive towards the MDGs in line with the call to action launched by Gordon Brown in July 2007.

The noble Lords, Lord Jay and Lord Hannay, asked whether progress has been made in the UN on making good on its responsibility to protect. In February, the UN Secretary-General appointed Ed Luck as the special adviser tasked with working in this field. The Secretary-General will report to UN member states later this year on institutionalising the responsibility to protect within the UN. The responsibility has not been applied to broader areas such as health and, as the noble Lord, Lord Jay, indicated in his remarks, agreement on the whole concept is fragile. We feel that attempting to broaden it to cover health or climate change may risk undermining the consensus achieved at the summit. I shall write to noble Lords in more detail on this point.

The noble Lord, Lord Jay, also asked what progress is being made on the International Health Partnership; I hope that I have covered that in my remarks. The right reverend Prelate the Bishop of Winchester asked what DfID is doing to support MDGs in the Democratic Republic of Congo. DfID recognises the conduct of peaceful elections in 2006, which was a major step forward for that country. However, many problems remain, particularly the high levels of violence and insecurity. We are committing £70 million to DRC this year to strengthen democratic governance, to provide a peace dividend for the population, to support the provision of health, education and water, and to reduce the suffering of the population.

The noble Baroness, Lady D’Souza, talked about the credibility of the MDG targets. They are aspirational targets and indeed there are difficulties in obtaining timely and reliable data. I shall write to her further on that. The noble Lord, Lord Crisp, rightly put to me many questions about what we are doing on health. I hope that I have covered most of them in my speech, but I will write to him. The noble Lord, Lord Patel of Bradford, asked about new strategies for the MDGs. In addition to our current approach, we aim to strengthen overall health systems, including by increasing the number of birth attendants who are skilled health workers.

I apologise to those noble Lords whose questions I have not reached; I will write to them. I thank all noble Lords who have participated in the debate—in particular, the noble Earl, Lord Sandwich—for their contributions to the cause today.

My Lords, in the remaining moments of the debate, perhaps I may thank all noble Lords who have spoken. I think that it was the noble Lord, Lord Graham of Edmonton, who said that we have been lucky enough to hear from speakers with real seniority and real experience. I will not dwell on the issues, but we shall certainly come back to them. Lastly, I thank the noble Baroness for her very comprehensive response. She is always enthusiastic and I hope that she will remain in her position. I beg leave to withdraw the Motion for Papers.

Motion for Papers, by leave, withdrawn.