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House of Lords Hansard
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Millennium Development Goals
07 October 2008
Volume 704

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asked Her Majesty’s Government what progress is being made with the millennium development goals, particularly in relation to levels of child mortality.

The noble Lord said: My Lords, this short dinner-hour debate revolves around a Question that I tabled seeking to establish what progress has been made in achieving the millennium development goals, particularly as they relate to child mortality. If the aim of the goals—to halve poverty by 2015—were to be realised, it would save the lives of 350,000 children a year. Sadly, it is because we have drifted so far from the targets that I invite the House to return to a subject so ably raised in a Cross-Bench debate initiated by my noble friend Lord Sandwich on 1 May.

First, I express my gratitude to all noble Lords who are to speak tonight. In particular, I know that we wait in eager anticipation for the maiden speech of the noble Lord, Lord Bates, who was a good friend when we served together in another place. His presence and the expertise that he will bring to your Lordships’ House are really welcome.

Just two weeks ago, I spent several days in Turkana and the Elemi triangle, where Ethiopia, Sudan and Kenya meet. Turkana is an arid desert covering 24,000 square miles and supporting about 500,000 nomadic people. The rains did not come this year, and the pressure on grazing land and families unable to feed themselves has been disastrous. For the Turkanas and their Ethiopian neighbours the Dassanech, or Merilles, whether we achieve our millennium goals is not simply of academic interest.

A young African priest, Father Steven Ochieng, took me to Merille and Turkana villages, between which he had brokered a ceasefire after years of debilitating conflict. In one settlement, many miles from any medical facility, a father approached us with his six year-old son, Juma Nyesej. Several days earlier, the boy had badly burnt himself and his wound had become infected. It was 150 miles to the nearest hospital in Lodwar. In the absence of roads, for most of the journey Father Steven used rough tracks to drive the child to the hospital.

The boy is now out of danger; one life has been saved. However, as the millennium development goals disappear into the ether, millions of other children will not be so fortunate. Juma’s story is a good example of what his Grace the most reverend Primate the Archbishop of York said in July is the unique capacity of faith communities to reach some of the poorest regions in the world. “Yet”, as he correctly observed,

“the effort involved in getting donor governments not to bypass indigenous faith communities for the sake of mega grants direct to UN agencies is unnecessarily difficult”.

In places such as Turkana, and all over Africa, the church has put most of the educational, health and social infrastructure in place. The World Health Organisation estimates that 40 per cent of healthcare in developing countries is provided by faith-based organisations. If we targeted more direct support to those groups instead of bypassing them, we might be closer to achieving our millennium goals.

I was struck that, while Governments fail to meet millennium targets for the provision of clean water, Steven Ochieng’s community has built 50 water catchment dams and drilled bore-holes that save lives every day. If we refocused some of our MDG strategy to work more closely with such providers, we would have a much better chance of achieving our targets. Our money is also less likely to disappear into phantom projects, corrupt contracts and dishonest pockets. Progress on providing clean water and sanitation, which is crucial to good health, especially children’s, is currently so far off-track in sub-Saharan Africa that the millennium development goals will not be met this century, let alone by 2015.

I particularly welcome the Minster’s response to the report that appeared in the Financial Times on 11 September saying that less than a quarter of international aid intended to give poor people access to clean water and sanitation is going to the regions where it is most needed. Clearly we need to do much more in monitoring both the targeting of resources and the progress being made in achieving objectives and honouring promises. That is especially true with regard to children’s health and malnourishment. Two million children die on the very first day of their life, often for wholly avoidable reasons.

Many deaths are linked to maternal health and, as the Royal College of Midwives pointed out in an excellent briefing distributed in advance of today’s debate, many of those deaths are avoidable. A child dies from malaria every 30 seconds. Yet recent analysis by the Kenya Medical Research Institute in Nairobi found that global spending on malaria control in 2007 amounted to less than $1 per person at risk and is up to 450 per cent less than what is required. The noble Baroness, Lady Chalker, will concentrate her remarks on malaria. I welcome that, as she knows far more about this than I do.

We must also have a care that our solutions to problems do not make the situation worse. In Turkana, I visited St Luke’s home for the deaf, which was opened in 2004. Here there are 74 deaf children, half of whom are girls and half of whom are boys. Ben Janssen, the Dutch co-ordinator, told me that these children are “the tip of an iceberg”; many more lie abandoned in their villages. Tragically, more than half the children at St Luke’s were not born deaf; their hearing was lost after being given too great a dose of quinine as a treatment for malaria. Other causes of deafness are meningitis and measles. Good primary healthcare could have saved the hearing of these children, but now at least, thanks to St Luke’s, some possibilities are opening up for them and, unlike many children, they are at least well cared for, properly nourished and fed. By contrast, every day, 25,000 people die of hunger-related causes. Many are children; one child dies of hunger every five seconds. Save the Children does an admirable job in keeping us briefed on their plight.

Before we rose for the Recess, on 3 July I initiated a debate in your Lordships’ House on the effects of the world food crisis. As things stand, despite the goals set out eight years ago, it is anticipated that the number of malnourished children will rise in 32 countries. Even before the crisis, about 3.5 million children died annually of malnutrition; the World Bank says that 854 million people were already hungry before prices started to rise, including 178 million children under the age of five who were stunted. Malnutrition will grievously set back our proclaimed hopes of progress for children in many parts of the world. I should very much like to hear the Minister’s assessment of current levels of food aid necessary to fend off starvation, particularly in places such as Ethiopia. The acute nature of the crisis in some parts of the world has already forced the World Food Programme to reallocate some of its resources. It has suspended some of its feeding programmes in various parts of the world, for example to 450,000 children in Cambodia, because it simply does not have funds to meet all the challenges. World Food Programme representatives in 78 countries around the world are facing similar dilemmas.

What impact will this situation and the slide towards recession faced by many of our economies have on our ability to meet our declared objectives? The auguries are not good. When he spoke to the Lambeth Conference in July, the Prime Minister admitted that on current rates child and infant mortality will not be cut to the proposed 2015 levels until 2050, universal child education will not be achieved by 2015 and poverty will not be halved,

“in this century or the next”.

Whose fault is this? On 5 September, it emerged that 22 of the world’s wealthiest nations are delivering less than half the aid that they promised to developing states. Only Denmark, Sweden, Norway, the Netherlands and Luxembourg honoured a pledge to raise their giving to 0.7 per cent. The rest averaged just 0.28 per cent. Where does the United Kingdom stand in this regard?

It is not merely government whose rhetoric and actions have not always converged. Huge corporations have ethical policies in place but fail to walk the talk. Christian Aid, in a recent report, said that 5.6 million children’s lives could be saved if the world’s largest companies were to stop cheating the poorest countries out of tax revenues to which they are entitled, which are worth £82 billion a year. However, the millennium goals are not simply about what government can do. We can all play our part. In Turkana I saw many examples, from irrigation schemes to new classrooms, of how British generosity is helping to save lives. I saw a girls’ orphanage built by young people from Stonyhurst College in Lancashire. I also saw some wonderful self-help sustainable initiatives. Lake Turkana is the world’s largest permanent desert lake. Although the water is saline and undrinkable, the Turkana refer to the lake as “anam Ka’alakol”, which means the sea of many fish. It was the lake’s fish that provided the inspiration to begin a programme of building boats for the Turkana nomads.

Believing in the truth of the old adage that it is better to teach a man how to fish than to give him a fish, Steven Ochieng’s community has been building boats. Each boat costs about £900 and is used by 10 men, each of whom supports up to 10 others. Many have been paid for by schools and individuals in the UK. One I saw was generously donated by my noble and gallant friend, Lord Guthrie. It has been named by the Turkanas as the “St Charles”. We should never despise such small-scale initiatives, which are often far more successful than grand plans. EF Schumacher was right to argue that we should.

“think globally but act locally”,

and practise small-scale economic initiatives,

“as if people mattered”.

In conclusion, it is worth reminding ourselves of the targets that we committed ourselves to realising by 2015. We said that we would halve the proportion of people living on less than $1 a day; ensure that all children complete primary school; educate boys and girls equally; reduce the mortality rates among children under five by two-thirds; reduce the mortality rates by three-quarters; halt and begin to reverse the spread of HIV/AIDS, malaria and other major diseases; halve the proportion of people without access to safe water and sanitation; and increase aid and improve governance. The question for us is how far our words now match our deeds.

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My Lords, I much welcome this debate introduced by the noble Lord, Lord Alton. I particularly welcome the maiden speech that we will hear from my noble friend Lord Bates. I was born a Bates, so we have a certain link, although, I hasten to add, it is not a blood link. In three minutes, I shall touch on three aspects of the millennium development goals: first, malaria; secondly, maternal mortality; and, thirdly, the whole problem of the supply chain for medicines, particularly in Africa, which underlies all the rest of the millennium goals.

First, I am delighted that we have ended the high-level event on the MDGs at the mid-point to the 2015 deadline with the news that $3 billion will be spent on malaria, as well as $4.5 billion on education. I say that because more lives can be saved through the better application of the available healthcare and diagnostic tests to fight malaria, to which we give little attention. I am chairman of the Medicines for Malaria Venture, which is developing new malaria drugs. In the next few months, it will launch Coartem dispersible, which is cherry flavoured specially for children. I am particularly interested in making sure that the drugs reach the children, as that is one of the biggest problems that we face. To eradicate malaria we must scale up our efforts massively, including by developing new and better tools of diagnosis. That also touches on training, to which I shall turn in a moment.

The UK has made big commitments towards the MDGs and the £40 million to support the affordable medicines facility for malaria is extremely welcome. In addition, the commitment to increase malaria research and development funding to at least £5 million a year by 2010 and to provide 20 million of the 120 million bed nets that are needed is a good step forward, but I fear that much more needs to be done. In industry, we know that that must happen.

Under MDG 4, improving maternal health is vital. That also turns on better provision of primary healthcare. I hope that noble Lords will forgive me for mentioning my foundation, the Chalker Foundation for Africa, of which I am a patron. We sponsored a young Kenyan doctor, who is now working in Turkana, by paying for his education. We have a Ugandan doctor training in Poland. We are also funding basic level health workers. Finally, please will the department take action about the supply chain of medicines, which for Global Fund supplies, I am reliably informed, is being sent through the UN, whose supply chain expertise needs much improvement?

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My Lords, I, too, thank the noble Lord, Lord Alton, for initiating this debate. I declare an interest as a vice-president of Tearfund, an agency working with partners around the world that is hoping to achieve the millennium development goals. I am both encouraged and discouraged. I am encouraged because there is progress around the world in countries such as China and India where development is improving along with economic progress, but I am concerned and discouraged because of the inequality gap, especially in child mortality.

I congratulate the Government on the amendment that they accepted to the Climate Change Bill. Noble Lords may recall that the amendment said that the Committee on Climate Change now has to have concern for international social impacts. In other words, it has to have a concern for the poor. There is no earthly use in trying to achieve the millennium goals if, at the same time, we ruin people’s harvests and undermine their sustainable development.

As we know, the millennium development goals are interconnected. I wish to draw attention to the lack of progress in clean water and sanitation, which causes one in five deaths. The noble Lord, Lord Alton, referred to the World Health Organisation survey that stated that 40 per cent of healthcare services in the developing world are provided by the faith communities. It is frustrating that some international agencies, such as the United Nations and even the World Bank, do not fully recognise the role that the faith communities have to play. I should like to say a word from this Chamber to those faith communities and ask them to work together more closely so that they can maximise their own potential.

Eight years ago, when we heard the Governments around the world pledging themselves to the millennium development goals, we were all filled with hope. What better way to celebrate the birth of the one who helped the poor? But eight years on this is the issue: how do we deliver those goals and, more important, how do we hold Governments accountable for the promises that they make?

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My Lords, I, too, congratulate the noble Lord, Lord Alton, on initiating this debate. At a time when so much of our focus is on the billions of dollars at risk in the financial markets, it is good to remember those for whom $1 a day is wealth. I shall focus on the effect of conflict on vulnerability and poverty, and what we should do about it. In 12 countries, one child in every four will die before the age of five. Nine of those countries have recently experienced conflict, which is no coincidence. The vast majority of the victims of conflict are civilians, often women and children. Conflict destroys hospitals, schools, markets, families and lives. In sub-Saharan Africa, 13 million people are refugees in their own country and 3.5 million are refugees in someone else’s. Conflict makes the millennium development goals far harder to achieve.

There is a gap in our response to conflict. In the immediate aftermath of conflict, the humanitarian agencies provide essential help, but, after a while, the press caravans and the humanitarian agencies move on to the next conflict. It takes time—far too long—for the development agencies, bilateral and multilateral, such as the World Bank, to arrive to take their place. Meanwhile, millions of vulnerable people struggling to pick themselves up after conflict continue to suffer. We need to be far more imaginative in helping countries in this twilight zone between conflict and recovery. Multilateral and bilateral aid needs to be more flexible and focused much more directly on those who need its help. Governments need to work more closely with and through NGOs. I declare an interest as chair of the medical aid charity, Merlin.

My plea to the Government is for DfID to do more itself and to use its undoubted influence with others to bridge that gap. My second plea is for the Government as a whole to do more by joining up those responsible for delivering the instruments of our foreign policy—the Foreign Office, the Ministry of Defence and the Department for International Development—to prevent conflict in the first place, and to do more to reaffirm and put into practice the UN-approved doctrine of the responsibility to protect, a doctrine which means, quite simply, that no leader has the right to make his people suffer and that the international community has the right to try to stop him if he does. By a more imaginative approach to preventing conflict and by doing more to help those trying to recover from it, we shall do much to help reach the millennium development goals.

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My Lords, I am grateful for the opportunity to rise for the first time in your Lordships’ House to make my maiden speech, and to make it on such an important issue. What we are talking about are the preventable deaths of some 10 million children under the age of five each year which, as the noble Lord said, puts the other matters we are debating at this time into some perspective.

It is a particular privilege and honour to speak in a debate initiated by the noble Lord, Lord Alton, who was a role model as a parliamentarian and constituency Member of Parliament when we served together in the other place, and who will continue to be a role model in this place as well. I want also to put on the record my thanks to and deep appreciation of the officials and staff of your Lordships’ House. They have helped me when sometimes I have wandered bewildered around the corridors, and I want to pay particular tribute to those hardy souls on the parliamentary IT Help Desk who deserve special recognition. Someone asked me what I thought was the principal difference I have noticed between the other place and here. I said that the great difference is that when the Whips’ Office calls and offers to help you, over here they really mean it, and that is very welcome.

Turning to the substance of the debate, I have only one focus which follows on from the previous speaker, and that is on conflict as a cause of poverty. As we have been reminded, of the 30 current conflicts around the world, the vast majority are occurring in sub-Saharan Africa. They are responsible for drawing some 10 million children into the net of poverty and for the deaths of an estimated 2 million children over the past two years. Surely it behoves Her Majesty’s Government and all other agencies to move the issues of conflict resolution, of peace-keeping, and indeed where necessary, of peace-making, higher up the agenda. It follows that unless we are able to make advances in preventing war and initiating a war on war itself, the victory over child poverty that everyone seeks will not be achieved.

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My Lords, on behalf of the whole House I congratulate the noble Lord, Lord Bates, on the sincerity of his maiden speech. My noble friend has already mentioned his expertise. The noble Lord entered Parliament as a keen 30 year-old in 1992 as MP for Langbaurgh in North Yorkshire and was soon given jobs as a PPS here and there; he then became a Government Whip and later a Minister. I notice that he used to put family before cricket in his list of recreations, but that has now been changed to cinema and walking. After 1997, to his credit the noble Lord went back to do an MBA at Oxford and then returned to the world of high finance, now running his own firm. He comes to us as deputy chairman of the Conservative Party and we look forward to what he will have to say in the future.

Like my noble friend, I feel a degree of frustration because at the UN Millennium Summit eight years ago, 189 world leaders made a historic promise, but as we have heard, we are nowhere near the development goals. While there are overall gains in health and education, we are missing goals in the poorest countries and most isolated regions of the world. Under-five mortality rates, for example, are generally falling, but not in countries such as Ethiopia where 6 million children are malnourished. Two weeks ago, world leaders gathered again and made more solemn commitments. How much are they worth? The likes of Bono and Geldof were there to remind them. However, I believe that our own Prime Minister is sincere in keeping poverty on the G8 agenda, especially poverty in Africa. In the end, considering the crisis in the background, there was reasonable progress and consensus at the UN.

We have heard, for example, of the billions raised for malaria. A further $1 billion will be raised through the Global Campaign for Health, which hopes to mobilise more than a million health workers, as strongly advocated by my noble friend Lord Crisp. Some $2.2 billion will help to provide water and sanitation. What will be the contribution of Her Majesty’s Government to this fund? It is the International Year of Sanitation, and charities such as WaterAid, UNICEF, Pump Aid and IIED have successfully raised the profile of this issue. It is extremely important because some 2.6 billion people lack adequate sanitation, while more than 1 billion still have no access to safe water.

I am glad that civil society organisations have a higher profile in these meetings. This time the NGOs were well represented by the Self-Employed Women’s Association in India. Moreover, one leap forward was taken this year by our own DfID when it signed up to the International Assessment of Agricultural Knowledge, Science and Technology for Development. The noble Baroness, Lady Chalker, will know all about it. This began as a radical World Bank initiative in favour of the informal agricultural sector. It means that donors are at last recognising the poorest farmers as agents of reform rather than leaving them to become the victims of trade liberalisation. Under the scheme, small farmers will be given more access to urban and export markets by means of micro credit and other services.

In summary, child health MDGs cannot simply be left at the door of primary healthcare because illness is caused by so many of the external factors which prevent the poor, above all, from enjoying a healthy and sustainable rural and urban environment.

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My Lords, I add my gratitude to the noble Lord, Lord Alton of Liverpool, for focusing our attention on the millennium development goals in general and child mortality in particular, and to the noble Lord, Lord Bates, for his incisive comments on the place of conflict in this debate. We face a massive challenge both as Governments and as Christian churches. In the Anglican Communion, we have been challenged by the Lambeth Conference to pay far more attention to international justice issues, in accordance with the Christian assertion of human beings made in God’s image and Jesus’ own words of especial concern for the poor. The highlight of that conference for many of us was the day here in London affirming our pressure on world Governments to act in our name to achieve those goals, and we were immensely encouraged by the Prime Minister’s support for those aims, which I invite the Minister to reaffirm now.

We have heard the depressing figures and details of the continued growth in child mortality in some countries of sub-Saharan Africa, but we need to be careful that the actions of developed countries do not put children’s lives at risk. It can be no accident that, according to Save the Children, the highest increase in child mortality in recent years has been in Iraq—150 per cent over 15 years of sanctions and war. Whatever the justification for that action, we cannot be released from its unintended consequences, and I look for an assurance that the millennium development goals will be considered not only with regard to aid policy, but also to economic and military strategies.

We must not ignore our own country where rates of child mortality are still too high. I look forward to the results of the Good Childhood Inquiry to be published by the Children’s Society in February. But there is evidence enough already of the stubborn persistence of poverty among children here, and where poverty is prevalent, it is difficult to bring down infant mortality rates. This is a crucial issue for the future health of the world and particularly so at a time of substantial financial pressure. It is essential that we do not allow that pressure to divert our attention from the importance of these goals. I look forward to a robust commitment on the part of the Government to real reductions in child mortality which until then must remain a serious blot on the consciences of us all.

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My Lords, I, too, congratulate my noble friend Lord Alton on securing the debate and the Government on the positive role they played in New York two weeks ago in securing so many commitments from the world community.

One commitment was to increasing the number of health workers in Africa by 1 million. I wish to make one simple and practical proposal. To achieve that commitment, 1 million extra health workers need to be trained, and that means there needs to be a massive increase in appropriate training and education in Africa very quickly. There needs to be a great hump of activity in the short term.

The UK is well placed to do something about this. It has a fantastic track record in health education of doctors, nurses and others, there is fantastic good will and a huge amount of voluntary activity which is already under way and which could be harnessed to better effect. So, seized with this idea, in the summer I contacted 30 or 40 leaders of UK health and education institutions and asked them whether we should be doing more and, if so, what we could do. I sent out a survey to them on 4 August; on 31 August, of the 40 that I sent out, I received 133 replies. That shows how they had passed it on to other people and how much interest and energy there is in this issue. At the same time I wrote to Africans in six countries and asked their opinion, and they came back to me. All the Africans and British who responded said the same thing—yes, we could do more—and they suggested some practical actions.

Let me list merely three. First, if you are going to expand, train the trainers. Secondly, provide us with voluntary tutors who can come and work in my college of health in Malawi. One tutor will mean that we will train 15 more nurses this year. The third action is what they call an adjunct faculty. In my medical school in Jima in Ethiopia, if you can provide me with a cardiovascular doctor for three months, they can do all the cardiovascular training in the medical course for five years in that period. These are very practical, direct things that many people are already doing in many areas.

The other interesting thing about the 133 replies from the UK is how many said that this is of mutual interest and mutual benefit because our people gain from this kind of activity in Africa. There is huge good will. I am talking to DfID and the NHS about how we can take this further. I urge the Minister to support this approach and to look at the detail of how we could harness this huge good will and the huge expertise in the UK.

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My Lords, I congratulate the noble Lord, Lord Alton, on introducing yet another important debate and the noble Lord, Lord Bates, on his maiden speech.

I will restrict myself to the maternal health target, which is the most severely off-track of all the MDG targets and which has direct relevance to child mortality. It is clear that without radical progress the target of reducing maternal deaths by three-quarters by 2015 will not be met. At the global level, maternal mortality decreased by less than 1 per cent between 1990 and 2005; worldwide, one woman dies every minute in pregnancy and childbirth, adding up to more than 500,000 deaths each year; and in many countries, such as Liberia, the maternal mortality rates are getting worse.

However, fortunately change is possible even in low-income countries. Countries such as Sri Lanka and Malaysia have all slashed their maternal mortality rates in less than 10 years. What is most needed is increased long-term investment in maternal health. It is estimated that just one more midwife could save the lives of 219 women. Additionally, developing countries must prioritise maternal health and dedicate more of their national budgets to healthcare. They must also ensure that healthcare is free as cost remains a major barrier to access for women. Donors and Governments must work together to improve the quality and effectiveness of aid, which should be long-term and predictable and, where possible, provided as direct support to government health budgets.

I return to the critical importance of securing new and increased investment in maternal health. It is very encouraging that at the UN summit last month a task force headed by our Prime Minister was set up to launch an innovative international finance initiative for health systems, as pointed out by the noble Lord, Lord Crisp, which aims to raise funding for 1 million new health workers. Another initiative which could be taken is a small tax on currency transactions which, according to the UN University, has the potential to generate $33 billion annually.

It is also encouraging that the UN high-level summit last month demonstrated that there is a renewed appetite for the fight against poverty. The energy and commitment around maternal health and fighting malaria is genuine progress, as was the strong focus on new health workers. But much remains to be done in turning rhetoric into action.

In conclusion, I thank Oxfam for an excellent briefing and pay tribute to the Prime Minister, our Government and DfID for the leadership they have shown in the initiatives to reach the millennium targets.

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My Lords, I, too, thank the noble Lord, Lord Alton, for making sure that the relief of poverty, particularly of children, was on our agenda as soon as we returned from the Recess. We have had impressive and incredibly concise contributions from many experts in this area and a welcome speech from the noble Lord, Lord Bates.

The MDG meeting in New York has been overshadowed by the financial crisis, but that very crisis should make us realise how vulnerable and interconnected we all are. Those at the margins are, of course, the most at risk, but we have seen how things that we have taken for granted are not necessarily rooted as we thought they were. But, if only because we are all interconnected, the MDGs are an important reminder to us of what, for peace and prosperity if nothing else, we need to be doing.

I was in Kenya this summer and my visit served as a salutary reminder to me of how quickly violence can erupt in places, even when you think a country is unlikely to experience it. When there is such dire poverty, clashes can quickly become a reality. We all know how important it is, therefore, to promote hope, reconciliation and, above all, economic development.

The MDGs remain a vital cornerstone in development. Without education, without reasonable health and without gender equality, economic progress of the kind that revolutionised the West will simply not be possible. So it is important that the developed world keeps its focus on the MDGs whatever its own problems. The poorest are the most vulnerable, women are more vulnerable than men and children are more vulnerable still. The noble Lord, Lord Alton, is therefore right to focus on children, but all the MDGs underpin progress, with resultant benefit to children.

Given that malnutrition accounts for a third of child deaths in developing countries, what is DfID’s reaction to the International Development Select Committee’s recommendations in this area? The latest AIDS strategy produced by DfID seems not to prioritise children as the previous one did. What will be done to ensure that they remain a focus for treatment and support? Can I be assured that the promotion of gender equality remains a cornerstone of DfID’s work? What is happening to those in DfID who particularly focus on this? Reducing maternal mortality and promoting family planning are also key policies which benefit children. What further plans do the Government have?

The policies for social protection, which, of course, underpinned our own development in the 20th century, have a great deal of promise. What further thinking does DfID have in this area? We know, too, that climate change will affect those at the margins first. It is already happening, as I saw in Kenya.

Addressing all the MDGs serves to assist children at risk. The vulnerability of children in the current financial situation shows how important it is that these goals remain at the forefront of international thinking. In New York, a further $16 billion was pledged, though pledges do not necessarily materialise. Contrast this with the $700 billion which, it seems, the US alone can manage to raise to bail out the markets. It is amazing what can be achieved when there is the will to do it.

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My Lords, I, too, thank the noble Lord, Lord Alton, for this debate, which could not have come at a more important moment. The millennium development goals are still in the public eye, as financial difficulties spread through the West. This means that countries, including the United Kingdom, which are crucial to the success of meeting the goals will now, more than ever, need frank debate on how we are to meet our obligations—a difficult task for each of your Lordships in three minutes. I, too, congratulate my noble friend Lord Bates on a very special—and brief—maiden speech.

The millennium development goals were ambitious but not unachievable. Given present trends, however, they are unlikely to be met. That would be a tragedy. We need a realistic examination of what more we could do and where we are going wrong. Many noble Lords have said that this is not a job for Britain alone, but we can show leadership in bringing together a response to the needs of the world’s poorest people.

The Government signed up to the development goals when times were good. We pledged that we would meet the UN target of spending 0.7 per cent of national income on aid. What assurance can the Minister give that, now that times are hard, they will still be able to meet our obligations? Can we be assured that we will fulfil those at the same time as meeting the needs, quite rightly, of people in this country who are suffering from the downturn?

I have raised the subject of China several times. China is a key player in this topic for several reasons. First, it has raised many millions of its own people out of grinding poverty. This has not been done entirely through its own efforts, but by increasing engagement with the world economy. Can the Minister tell the House what plans the Government have to encourage further liberalisation of world trade?

My second point about China is its increasing power in Africa as it searches for natural resources with which to feed its economy. What strategy do the Government have for working with China in very poor countries? Chinese development of African infrastructure, for example, could be harnessed as a catalyst for more general development.

Only last week I heard Sir David Attenborough raise the thorny topic of overpopulation, which he felt was a big contributor to environmental change as well as a big component of global poverty and, as a consequence, of child mortality rates. Sir David said that there are three times as many people on this earth as when he started making natural history programmes 50 years ago. He offered a noble solution: better education for women. This could be a decent start in realising part of our obligations to fulfil the millennium development goals.

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My Lords, I, too, congratulate the noble Lord, Lord Alton, for initiating this important debate. I would thank him with even more enthusiasm if he had done it a day or two later—that is, more than 24 hours after I found out I was going to pick up the DfID brief again. Inasmuch as this is a realistic statement in politics, I advise the House that I am the permanent spokesman for DfID in the House. I pay tribute to my noble friend Lady Crawley, who was the Government’s spokesman for DfID in many debates but has now retired from the Front Bench.

Let me turn to some of the points made by the noble Lord, Lord Alton. We note the important role played by faith groups in achieving the millennium development goals. The Prime Minister expressly acknowledged that when he launched the call to action in 2007. In highlighting the potential impact of the food crisis, we recognise that poor nutrition is estimated to be an underlying cause in more than one-third of all deaths in children under five. This is one of the reasons why the UK Government announced in New York last month a further £40 million of emergency assistance for the Horn of Africa, including Ethiopia.

The noble Baroness, Lady Chalker, highlighted the importance of health systems; that is why the Prime Minister launched the international health partnership last year. It will provide longer-term and more predictable funding for poor countries, making them better able to make long-term plans, train doctors and nurses, pay salaries and maintain infrastructure. The Government recognise the importance of health infrastructure in getting to the root of problems, and I shall say a little more on that later.

The right reverend Prelate the Bishop of Liverpool noted the important role played by faith groups and others in achieving the millennium development goals. That was expressly acknowledged by the Prime Minister when he launched the millennium development goals call to action in July 2007. In July this year, faith groups showed their commitment to the MDGs at a rally in London. Spearheaded by the most reverend Primate the Archbishop of Canterbury, more than 1,400 robed bishops—a thought that makes me cringe—and other faith leaders from all over the world walked through the streets of London to call on global leaders to deliver the MDGs. The Walk of Witness ended at Lambeth Palace, where the Prime Minister spoke of the need of all faiths to work together to eradicate poverty.

We have discussed before the funding of aid; it is an extremely complex area. We recognise how NGOs and faith groups, with their various infrastructures, are so important and we believe it is important that all agencies work together. Nevertheless, we will channel much of our aid through the UN. We will seek UN reform, but the United Nations is uniquely positioned. It has a universal membership, a global mandate, unparalleled legitimacy and neutrality and it builds countries’ capacity. It also provides the global leadership on the millennium development goals, as clearly demonstrated at the recent high-level event on MDGs. Over half of the Government’s 25 priority countries are fragile states. It is also why, by 2011, an estimated 60 per cent of DfID’s bilateral assistance will be spent in such states.

The noble Lords, Lord Jay and Lord Bates, highlighted conflicts and the extent to which they undermine development by causing death, displacement and destruction of property and preventing the delivery of basic services. Countries in or at risk of conflict tend to be the furthest from achieving millennium development goals. DfID therefore works to reduce the risk and impact of conflict in almost 50 countries by joining forces with the Foreign Office and the Ministry of Defence on the Conflict Prevention Pool, which has a budget of £112 million in the financial year 2008-09. DfID also attempts to prevent development programmes exacerbating conflict by conducting strategic conflict assessments and conflict orders, and encouraging major partners to do likewise.

I, too, congratulate the noble Lord, Lord Bates, on his maiden speech. It is always good to have an emissary from the other place, and I hope that the noble Lord finds the attitude of his Whips echoed in our debates here. This is a particularly pleasant subject to debate, because there is a high level of consensus and we agree on what we are trying to do on international development. The Government are quite properly held to account for how they do it. We look forward to the noble Lord’s continuing involvement in these discussions.

The noble Earl, Lord Sandwich, touched on a number of issues, but particularly important is regional disparity. When one looks at the development goals overall, one sees a so-so position; but when one looks at parts of sub-Saharan Africa and parts of south and west Asia, one sees that the position is even more difficult. Government are sensitive to that disparity and try to focus their efforts in a way that redresses some of that.

The high-level event to which the noble Earl, Lord Sandwich, referred was the first time that such a global coalition of Governments, business leaders, faith leaders and NGOs had been assembled under the auspices of the United Nations, not simply to talk but to make specific commitments. The high-level involvement and significant contributions demonstrated to the world that, in the face of economic crisis, we must do more, not less, to help the poorest countries. That touches on some of the points made later in the debate.

The noble Earl, Lord Sandwich, also rightly noted the importance of ensuring that commitments are turned into reality. This is why the Government attach particular importance to tracking implementation of the actions announced during the week of the event, and encouraging the UN to produce better analysis of where the MDGs remain off-track and what needs to be done to get them back on track.

The right reverend Prelate the Bishop of Ripon and Leeds highlighted the impact of the global financial crisis. The Government share that concern and recognise that it is now more important than ever to accelerate progress on the millennium development goals.

The noble Lord, Lord Crisp, in particular, touched on the importance of health workers. We thank him for his work in raising the profile of the global shortage of health workers. We see the Health Links Funding Scheme as the main way in which we will make available help and support in health expertise.

The noble Lord, Lord Joffe, mentioned that the health and survivability of women and children are critical to the achievement of all the MDGs. MDGs 4 and 6 cannot be met without improving maternal services.

The noble Lord, Lord Alton, noted the high proportion of newborn deaths. Forty per cent of all deaths of children under five occur within the first month of life. This is due largely to the lack of basic maternal and newborn care. Improving that is crucial to tackling the MDGs and, in particular, improving the health of mothers. Improving maternal and child health requires strong health systems, which is why the Government’s updated strategy for tackling HIV and AIDS in the developing world includes a commitment to spend £6 billion on health systems and services by 2015. It is also why the Government have committed to supporting countries with health-worker shortages to provide at least 2.3 health workers, doctors, nurses and midwives per 1,000 of population. As the noble Lord, Lord Crisp, noted, health workers are the backbone of every health service and are essential to providing a decent quality of healthcare.

Better health systems are vital to achieving the MDGs, which is why in New York in September the Prime Minister and other world leaders launched a task force on innovative financing for health systems.

The task force will mobilise additional new resources to support stronger health systems, which are key to saving the lives of 3 million mothers and 7 million babies. It follows the success of the International Finance Facility for Immunisation, an innovative financing mechanism which was launched in November 2006 and has already raised more than $1 billion to immunise more than 100 million children against polio, help poor countries to target 26 million women with immunisations against maternal and neonatal tetanus, and provide 194 million children in 32 countries with a life-saving measles vaccine. But improving the health of women and children is not just about improving systems. As the noble Baroness, Lady Northover, highlighted, the MDGs that are the most off-track are those that are most reliant on progress towards achieving women’s care and rights. The realisation of rights for women and girls has a critical role to play in achieving all of the MDGs. This is why DfID has launched a Gender Equality Action Plan to ensure that gender is at the heart of the Government’s development work. This commitment to keep women’s rights at the heart of the Government’s work continues.

In summary, achieving even the most off-track MDGs is possible, but this will become a reality only if there is a strategic step-change in the way the alliance of international agencies, Governments, the private sector, faith groups and civil society approaches these issues. The next two years will be crucial. I assure noble Lords that Her Majesty’s Government are absolutely dedicated not only to playing their part but to advocating and supporting others to play their part in achieving these goals.

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My Lords, would the Minister turn his attention to the issue that I raised about the difficulties faced by the Global Fund in delivering the medicines for which it has pledged money. There is a problem with the UN system and I hope that he will undertake to have this investigated and perhaps write to noble Lords who have participated in this debate. It is absolutely crucial for children.

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My Lords, I give that assurance and commit to write to the noble Baroness. We will review Hansard after this debate and cover in such a letter any other issues that we have not covered in my response.

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My Lords, I beg to move that the House do now adjourn during pleasure.

Moved accordingly, and, on Question, Motion agreed to.

[The Sitting was suspended from 8.26 to 8.30 pm.]