Skip to main content

Sierra Leone: Ebola

Volume 785: debated on Monday 30 October 2017

Question for Short Debate

Asked by

To ask Her Majesty’s Government what assessment they have made of progress in the recovery of Sierra Leone from the effect of the Ebola outbreak; and what assistance they are offering the Government of Sierra Leone in the recovery effort.

My Lords, I am grateful for the opportunity to introduce this debate tonight and to the other noble Lords who will be speaking, albeit too briefly. I declare my interests as set out in the register, and add that my husband chairs an international NGO active in Sierra Leone.

It is almost exactly three years to the day that the Disasters Emergency Committee launched its appeal for the victims of the Ebola outbreak in west Africa, the first time DEC had ever launched an appeal for a health emergency. The disease was raging throughout Guinea, Liberia and Sierra Leone. In August, an international emergency had been declared, and the UN was warning that if the epidemic was not brought under control before the end of the year we would face a global crisis.

The initial international response to the outbreak was desperately slow and inadequate, but the seriousness of the situation was eventually grasped. Epidemiologists and medical staff poured into the affected areas from all over the world. Community mobilisers in those countries worked tirelessly to break down the distrust of official advice among those most at risk and to persuade communities of the need to change burial practices in particular. International NGOs rose to the challenge of working in areas completely new to them, such as safe and dignified burials and contact tracing of potential patients. The UK sent 1,500 military personnel to Sierra Leone to implement a national emergency response centre under the guidance of that country’s President.

I went to Sierra Leone in February 2015 and saw for myself both the terrible devastation that the disease was causing and how effectively the UK, as international lead partner, was working through our NGOs, DfID staff, brave NHS volunteers and the outstanding work of the then high commissioner, Peter West. I will never forget what I saw during that visit and there is much that I could say tonight about the outbreak and the response to it, but I want to concentrate on the future and how the UK can support Sierra Leone going forward. However, it is important to acknowledge that the developed world was never interested in Ebola until this outbreak brought the disease to its TV screens and, potentially, to its borders. The reason that there was no vaccine, no rapid diagnostic test and no effective treatment for Ebola was not because haemorrhagic fevers are particularly complex or difficult diseases to treat. It is because they are, fundamentally, diseases of the poor. We often call such afflictions “neglected tropical diseases” but actually they are the diseases of neglected peoples. In our shrinking global world, we need to understand not only the moral imperative but also the self-interest in spending more resources and effort on finding solutions for these diseases. In this context I particularly welcome the setting up of the Ross fund to nurture British research. In London and Liverpool we have extraordinary centres of excellence and scientific expertise and we should support them.

In 2016, I visited Sierra Leone again after the country had been declared free of Ebola. It was a pleasure not to see burial workers in protective clothing; not to have ones temperature taken at roadblocks or to have to wash ones hands at every building’s entrance; not to have a curfew and a palpable sense of fear wherever you went. However, the Ebola epidemic, like any natural disaster, left behind it a trail of destruction and long-term problems. These were not helped by the disastrous floods this year, where the vulnerability of the infrastructure and the communities in which many of Sierra Leone’s people live was graphically illustrated. The country was poor before Ebola struck and it reversed much of the progress that had been made after the civil war, some 50% of its population living on under $2 a day.

The effects of Ebola were devastating: 4,000 deaths; some 14,000 people either infected or believed to be so; children orphaned and schools closed. For many girls, their education was not only interrupted but completely ended. There was a spike in teenage pregnancies, much of it related to the exploitation of young girls in poverty by older men. Survivors are left with a range of health problems, and in some cases have suffered social stigma as, cruelly, did some of the Sierra Leonean heroes of the epidemic who worked on burial programmes. During the outbreak, health workers were 20 times more likely to be infected than the general population, and 220 lost their lives, a significant number in a country whose health service was already desperately underresourced. Vaccination rates fell from their high of 92% in 2013 and were still nearly 10% lower than that last year. During Ebola, maternal deaths increased by 30%, and newborn deaths by 24%. It is chilling to remember that maternal deaths in Sierra Leone are 100 times those in our own country. As far as the economy was concerned, in 2015 GDP actually fell by 21%. Major industries such as tourism were devastated, but the closure of markets during the epidemic meant that many small businesses also went to the wall.

In recognition of all these problems, the UK Government allocated £240 million to support the President’s recovery plan in Sierra Leone. The strengthening of health systems, as well as women’s education, health and empowerment have been high priorities. However, there are also a number of deep-rooted structural challenges that have to be faced. Next year, there will be elections in Sierra Leone and constitutional changes are proposed. I know from my visits to the Parliament there how underresourced it is and how difficult it is for MPs to act as a constituency advocates, particularly for the poorest in Sierra Leonean society. I hope that the Minister can reassure me that the strengthening of parliamentary democracy will remain a priority for the UK.

There is a specific issue on which I would be grateful for comments from the Minister. One of the main pillars of DfID support has been the Saving Lives programme, to which £150 million was pledged over five years and which focused particularly on improving the availability of reproductive, maternal, neonatal, child and adolescent health services by 2021. Several UK-based NGOs involved in these areas have flagged concerns to me about the management of that programme; about abrupt changes late in the setting of contracts; and about whether funding has been reduced and resources diverted to other areas. I hope the Minister can give me some reassurance about the programme and assurance that UK NGOs and institutions which have worked for decades in Sierra Leone will be supported by DfID in their future work.

One of the lessons from the Ebola crisis was how, in the end, the Sierra Leonean Government, international donors, NGOs and community groups worked effectively together to defeat the outbreak. In the long, hard slog ahead, not just to recover from the effects of Ebola but for Sierra Leone to become a thriving, successful, democratic country within Africa, that commitment to integrated and sustained effort will be necessary once again. I hope that our DfID representatives in the country and our high commission will take the lead in ensuring that sort of co-operation. Most of all, I hope that the Minister will be able to assure us today that Her Majesty’s Government are committed to working with the Government of Sierra Leone and other partners across a wide range of fronts: economic development and increasing the tax base; health infrastructure; water and sanitation; the empowerment of women; and, perhaps especially, the horribly high rates of FGM and what can be done to reduce them. I hope that Her Majesty’s Government will agree to commit the necessary resources to meet all those challenges, not just in the short term but for the sustained, long-term effort that will be necessary for success.

My Lords, I thank the noble Baroness for introducing this debate so ably and for her constant campaigning, particularly on neglected tropical diseases. I have only visited Sierra Leone once, and before the Ebola outbreak, but it was easy for me to visualise, as the noble Baroness was speaking, the challenges I saw even then, before it was so ravaged by this terrible disease.

The 2014-16 outbreak in west Africa was the largest and most complex Ebola outbreak since the virus was first discovered in 1976. There were more cases and deaths in that outbreak than in all others combined. It spread between countries, starting in Guinea then moving across borders to Sierra Leone and Liberia. Following a delay in international action, Britain played a leading role in the fight against Ebola in Sierra Leone and continues to lead the way in supporting developing countries to quickly and efficiently tackle such threats at their source and prevent them from spreading.

A number of reports and studies commissioned in the aftermath of the crisis have recognised that community engagement is a key strategy to successfully controlling future outbreaks. It is clear that any attempt to guard against future outbreaks must prioritise community engagement and education. Linked with the concept of community engagement is that of community resilience and preparedness for disasters and emergencies. The prospect of the re-emergence of the Ebola virus is an issue of real, live concern in Sierra Leone. Individuals and communities that were most affected by Ebola are perceived to be most at risk of re-emergence and, as a result, remain stigmatised, marginalised and vulnerable, while much of the promised welfare support for these communities has yet to materialise. Preparedness and resilience of communities is crucial in the light of possible re-emergence. Thankfully, important lessons have been learned with regard to transmission of communicable diseases through good hygiene practices, phasing out high-risk cultural practices and road blocks to prevent mobility. The real test, however, would be the speed of an effective response and the degree of co-ordination of government, NGO and community efforts and resources, having learned these recent lessons.

Alongside DfID initiatives in this area, NGOs such as Restless Development—I declare an interest as a patron—have been at the forefront of efforts to support and promote community engagement schemes in Sierra Leone, uniting high-level strategic response with a bottom-up approach. Much of their work has been around their tried-and-tested model of mobilising youth energy to address safety and protection, as well as adopting an intergenerational approach to restoring livelihoods and stability. I pay particular tribute to the efforts of the Social Mobilisation Action Consortium, formed by Restless Development, GOAL, Focus 1000, and BBC Media Action, which have worked hard over the last few years to promote greater awareness. The consortium has been instrumental in leading the largest community mobilisation ever seen in Sierra Leone, with over 1,500 youth around the country trained by Community-Led Ebola Action, reaching over 3 million people with life-saving messages—and mobilised at speed, unlike much of the international response which was slow and clunky. The bottom-up approach has built a foundation of trust, at the community and national level, which may be successfully built upon to ensure that communities are more resilient and better prepared to prevent further outbreaks and deal with what happens if an outbreak occurs.

To conclude, I ask my noble friend the Minister: how are the Government building on and recognising the contributions that both younger and older people play in strengthening resilience within their communities? To what extent are the Government considering how intergenerational responses to development challenges such as the Ebola crisis can be used to fulfil their commitments to leave no one behind?

My Lords, I congratulate the noble Baroness, Lady Hayman, on procuring this debate. It is very timely and important that we debate Sierra Leone. I declare an interest: my son has spent the last seven years running a charity in Sierra Leone which he has sought to finance with a variety of agrarian businesses. Sierra Leone is at this moment at a crossroads.

Prior to Ebola, Sierra Leone was enjoying a very high rate of growth from a very low base. It was not just Ebola that brought Sierra Leone to its knees but the collapse in the iron ore price. There were two iron ore mines: one was closed and the other was taken over by the Chinese. Sierra Leone is a country completely dependent economically on commodities and aid. The two commodities on which it is dependent are diamonds and iron ore. It imports practically everything else. Despite the fact that it is a poverty economy, everything is hugely expensive in Sierra Leone because it is all imported. Freetown, which is an incredibly undeveloped city, is one of the most expensive places to go to in the world.

Sierra Leone is a year away from a general election. The British Government did terrifically in relation to the Ebola outbreak. Both DfID and the UK military performed tremendously in bringing the outbreak to an end. Now there is an almost greater challenge: to provide structural benefits to Sierra Leone. I suggest four areas on which the British Government may wish to focus. First, the aid that they give should be focused on diversifying the economy away simply from the commodities-based economy. In particular, it should focus on agrarian businesses and tourism. Agrarian businesses have a good base in Sierra Leone and yet that country imports practically all its food. It is time that investment was made in those agrarian businesses.

Secondly, the future of Sierra Leone depends crucially on there being private investment. It cannot survive on aid alone. The Department for International Development should consider investing in private businesses. The problem with Sierra Leone is that there are very low barriers to entry: you can get businesses going but they are never sustainable. DfID should see whether there are private sector partners with which it can operate to try to get more sustainable businesses.

Thirdly, as the noble Baroness, Lady Hayman, said, investment needs to be made in the infrastructure of Sierra Leone, in particular the rule of law and democratic institutions. Parliament and the courts are underfunded but this action means in particular really fighting corruption. People will not invest in a country where they perceive corruption to be widespread. Genuine efforts are being made to fight corruption but investment needs to be made by the British Government to support those efforts.

Fourthly, and finally, the Sierra Leonean Government should be encouraged to enter into more bilateral investment treaties with countries other than just China, the UK and Germany, which are the three countries with which it has bilateral investment treaties now. The more there are bilateral investment treaties with other countries, the more that encourages countries other than the three I have mentioned to invest in Sierra Leone.

I have been regularly to Sierra Leone over the last eight years through the good times and the bad times, and there have been a lot of very bad times. However, there are real opportunities in Sierra Leone if the investment is right and it is aimed at creating a sustainable, diverse economy. I believe that is where the British Government, who have been a stalwart friend of Sierra Leone, should focus their efforts.

My Lords, I would like to draw attention to a group of people whose work is rarely acknowledged but who have been vital to the recovery from Ebola in Sierra Leone and elsewhere: the interpreters and translators who work alongside health professionals on both treatment and prevention. I am most grateful for information from the organisation Translators Without Borders—or TWB—which has been an essential part of the recovery in Sierra Leone. I pay warm tribute to its work. I should also declare my own interest as vice-president of the Chartered Institute of Linguists.

When Ebola took hold the initial response was painfully slow, as we have heard, and language was one of the main difficulties faced by humanitarian workers. Language is not usually seen as a priority in emergency responses and, as a result, misinformation and panic can spread quickly. Information was available mainly in English or French, but only a minority of people spoke either of these. In Sierra Leone, only 13% of women understand English. Most Sierra Leoneans, particularly in rural areas, speak Krio, Mende and Temne. This led to important knowledge gaps: 30% believed that Ebola was transmitted via mosquitoes, another 30% thought that it was an airborne disease. Four out of 10 believed that hot salt-water baths were an effective cure, so TWB developed its Words of Relief project, the first translation crisis relief network in the world. It was funded by the Humanitarian Innovation Fund and Microsoft.

Started in Kenya in January 2014, the project extended in November that year to Ebola-affected countries. It created what TWB calls “spider networks” of crisis translators. These are virtual teams of translators trained to respond rapidly to language needs. They were based around the world, in the US, Ghana, Sierra Leone, Mali, France, Switzerland, Germany and Kenya. They were recruited because they are native speakers and have strong links to the affected countries. Their language skills were vetted and they underwent high-quality, rigorous, expert online training, even ensuring that correct dialects were being used. Hundreds of Ebola-related items were translated and disseminated, including posters, videos, cartoons and maps. One of the most effective outputs was a series of simple posters that suggested ways to prevent the spread of Ebola, describing symptoms and emphasising the urgency of medical attention. Others targeted children and other carers.

However, the main problem was getting content from the aid agencies. TWB believes that this is partly because the agencies were stretched too thinly during the crisis, as well as due to a lack of incentive because the use of local languages is not one of the effectiveness measures for projects. Another major concern was illiteracy. According to UNESCO, adult literacy rates in the three most affected countries are below 48%. In TWB’s experience, priority needs to be given to audio and video material in local languages.

It is clear that a greater focus on translation is needed to help control crises such as the Ebola outbreak. Aid agencies and Governments alike need to collaborate and provide content for translation, and provide it quickly. Will the Minister take this issue back to his department and seek to establish a firm protocol, that wherever Her Majesty’s Government are involved—whether in an emergency response or their follow-up recovery programme, and whether through DfID directly or through funding the work of an NGO or an aid agency—explicit measures are built into the project to integrate language and translation work, and that evaluating the success of any intervention includes looking at the impact made by translators and interpreters?

My Lords, I thank the noble Baroness, Lady Hayman, and congratulate her on securing this debate and on bringing her own experience to bear on it. I will raise two issues briefly. The first is the dreadful initial response of the World Health Organization and what lessons are being learned from it, and the second is the very recent development at a British university of a rapid blood test for diagnosing Ebola.

On the first issue, I make it clear that I am not criticising all those who worked incredibly hard under very dangerous conditions to bring this terrifying epidemic under control, including those working for the World Health Organization and the UK Government. My target is what happened at an earlier stage. I will quote from a devastating report prepared by Médecins Sans Frontières a year into the 2014 outbreak. It says:

“On 31 March, MSF publicly declared the outbreak as ‘unprecedented’ due to the geographic spread of the cases … On 1 April, the World Health Organization … via its chief spokesperson in Geneva, was the first to call into question MSF’s declaration, objecting that the virus dynamics were not unlike those of past outbreaks, nor was the outbreak unprecedented … We raised the alarm publicly again on 21 June, declaring that the epidemic was out of control and that we could not respond to the large number of new cases and locations alone … It was like shouting into a desert”.

The report says that,

“members of the WHO in Guinea and Sierra Leone downplayed the epidemic’s spread, insisting it was under control and accusing MSF of causing unnecessary panic”.

At the end of June, there was a World Health Organization meeting in Geneva. Marie-Christine Ferir of MSF says:

“I remember emphasising that we had the chance to halt the epidemic in Liberia if help was sent now … It was early in the outbreak and there was still time. The call for help was heard but no action was taken”.

She said that meetings happened but action did not. It was not until 8 August, after more than 1,000 people had already died, that the WHO at last declared the outbreak a,

“public health emergency of international concern”.

The WHO Executive Board has since resolved to enact reforms for epidemic response, but very little has happened. Could the Minister tell us what pressure we in the UK are bringing to bear on the WHO, an organisation to which we pay $21 million a year, and which recently thought fit to make Robert Mugabe a good will ambassador?

The second issue is technical. During the 2014 outbreak, it took five days or more to get a result from a blood test to see whether somebody had Ebola. That was eventually reduced to between five and eight hours, but it still cost $100 a test. One of WHO’s mistakes, which puzzled people at the time, was to insist on one technology that was laboratory-bound and expensive: GeneXpert, made by Cepheid. It was hardly used, because it was simply too complicated.

Dr Sterghios Moschos at Northumbria University announced last month that in collaboration with BioGene Ltd and PHE at Porton Down he has developed a simple 70-minute diagnostic test that detects the Ebola virus reliably when spiked into cow’s blood. He has not been able to test it on people for the good reason that at the moment nobody has Ebola. But he says that,

“in the future, stockpiling instruments and tests for known high-risk diseases, such as Ebola virus disease, would make mass screening capacity available in a matter of days or even hours”.

Could the Minister say whether the British Government will look into this to see how his test could be developed and stockpiled as he suggests? Could they perhaps consider deploying it at ports of entry for protection against not just Ebola, because it is a platform that could work for Lassa, dengue, West Nile, yellow fever and Zika? I should declare a possible interest. I have no interest in Dr Moschos’s work or in BioGene but I have one in another Newcastle company, QuantuMDx, which is working on similar rapid and inexpensive tests for diseases, although not Ebola.

My Lords, I begin by expressing my admiration for the noble Baroness, Lady Hayman, for her continuing dedication to and involvement in the future of Sierra Leone in the wake of this disaster. Building on what she said, four minutes is not long to speak about an epidemic that once caused headlines and panic around the world. If the same scenario had occurred in a developed country, one has to ask whether it would have drifted into such relative obscurity. I think not. I want to make a number of brief points and perhaps the Minister, who is already loaded up with questions, can respond to at least some of them.

First, Ebola has not disappeared. There will be new cases in 2017 in Sierra Leone and elsewhere. One of the most marvellous things that happened was the creation of an effective vaccine, but this covered only one strain of the virus. I would like the Minister to comment on the observation of one leading expert in the field, who says that we are just as vulnerable to an Ebola pandemic as we were in 2014.

As was said by the noble Lord, the economy of Sierra Leone was absolutely shattered by the impact of Ebola. Previously it was growing at 20% but I think the true figure of the collapse in the year that followed was minus 40%. The economic losses in Sierra Leone were more than twice those in Liberia or Guinea. How would the Minister assess the really core issue of the durability of the economic recovery? Is the UK continuing to make a direct contribution to what is needed in relation to this fundamental issue?

Some positives emerged from this horrendous episode—for example, the active attempts to develop local community care. Some of these were pretty innovative and, to add to what other noble Lords have said, the UK Government are to be commended for their efforts in this area, as in others. However, what is happening today with these endeavours? Does the UK continue to play a direct part in the evolution of these crucial local community involvements, not just to deal with the continuing consequences—Ebola survivors are still basically shunned by many people—but to further develop the resilience displayed?

As my noble and learned friend Lord Falconer said, corruption in the country is endemic at all levels. According to a BBC report this week, millions of pounds in funds raised to fight the virus have now gone missing. How much of this money has been traced?

Last week a national newspaper had the headline, “Foreign Aid: Let’s STOP it NOW”. The argument was that we should concentrate on the NHS and domestic problems. I hope that the Minister will respond very forcefully in repudiating such assertions. Commitment to overseas aid is not just a moral imperative; it is a material one for the UK. As other speakers have said, at one point there was the possibility of this outbreak becoming a pandemic, and I stress, as I said at the beginning, that the disease has not disappeared.

I have a final quick question. Did Nurse Cafferkey get to run her marathon? She was such a figure in all this. She said that she was going back to Sierra Leone to take part in the marathon, even if she had to do it in a wheelchair. I was unable to trace whether she succeeded—maybe the Minister can elucidate that.

My Lords, first, I congratulate the noble Baroness, Lady Hayman, on securing this debate.

I declare an interest as chair of the APPG on Population, Development and Reproductive Health. Members of the group visited Sierra Leone this time last year with the assistance of the UNFPA, which does much work there. While we were there, we were fortunate in bumping into the new Secretary of State, Priti Patel, at the high commissioner’s residence, so we corralled her and did not let her escape for a while.

Another memory of that visit was the plaque in memory of Jo Cox MP which had been erected in the Parliament chamber. It was shown to us by the niece of the late Satta Amara, founder of the 50/50 Group of Sierra Leone, which promoted women’s empowerment in the country. I knew Satta, and we had done exchange visits between her country and my constituency in the years before the Ebola outbreak.

I have indulged in that preamble because the empowerment of women by giving them power over their own bodies and over the number of children they have is very important to a country’s development and economic success. That means improving maternal health before all else. I do not have time to list Sierra Leone’s statistics and shall not do so. Your Lordships all know how dire they are.

After the end of the civil war in Sierra Leone, DfID was a major donor, particularly to healthcare, and efforts were made to roll out treatments for individual diseases such as HIV/AIDS. Yet during our visit, post Ebola, there was still very little evidence of a health network countrywide. Such a network does not particularly need doctors and nurses but it needs workers to impart public health messages and distribute supplies such as contraceptives, which only 16% of women in Sierra Leone can access.

We visited two hospitals: a very overcrowded and struggling government-run one, and the exemplary charity-run Aberdeen Women’s Centre. There are only 40 hospitals in the whole of Sierra Leone and few health centres, which in my view are even more important, although people were trying to create “pop up” health centres—again, to deal with HIV screening.

A worrying fact was the lack of treatment available for cervical cancer, which affects thousands of women in Sierra Leone. They test these women but there is no treatment available. It is very cruel to tell someone they have a disease but cannot do anything about it.

Also, will the Minister tell us when there is to be a campaign to vaccinate women against the HPV virus, which causes cervical cancer? I hear that something may be being done on this front; perhaps the Minister could confirm.

We were told that Sierra Leone was trying to develop health networks, but could the Minister tell the House if DfID is encouraging this? It is so important. The lack of such a network was in my view a major contributor to the spread of the Ebola epidemic. Does the Minister agree?

I would have liked much more time to talk about this beautiful country which has suffered so many misfortunes, from the curse of the diamond trade, as mentioned by the noble and learned Lord, Lord Falconer, to the recent mudslide and floods near Freetown— another blow to the health services trying to grow there. I hope the Minister will assure us that the UK will continue to engage with Sierra Leone and support the people there.

My Lords, I add my voice to that of other noble Lords in thanking the noble Baroness, Lady Hayman, for bringing this important debate to the House. I share wholeheartedly the sentiments of so many in your Lordships’ House expressing admiration for all involved in bringing this crisis to an end.

The deadliest outbreak of Ebola virus disease in history dominated headlines for many months from 2014 to 2016, when the international community found itself faced with a steep learning curve. Today is an opportunity for our Government to demonstrate that lessons have been learnt and planning for future such outbreaks has been accordingly modified.

We have heard from noble Lords of the great challenges that bringing the epidemic under control presented to the affected population, the authorities on the ground and the international community. I agree with the noble Baroness, Lady Jenkin, and hope our Government have taken on board how important it is to engage at an early stage with faith and community leaders. The Minister will know that it was only when community leaders were properly involved that important aspects of controlling the spread of the disease, such as safe burial practices, were brought to the fore. So may I ask the Minister: how is DfID continuing to work with faith and community leaders and civil society organisations in Sierra Leone?

I was fortunate enough to take part in a visit to Sierra Leone in November 2016, under the auspices of the All-Party Parliamentary Group on Population, Development and Reproductive Health, chaired by the noble Baroness, Lady Tonge. What we found was that a health system which had been thought to have improved immeasurably was brutally exposed by the Ebola crisis to be very fragile. How is DfID leveraging its considerable reputation in strengthening health systems and what headway is it making in pressing the Government of Sierra Leone to take ownership of delivering sustainable development goal 3, which focuses on building robust health systems?

I would briefly like to turn my attention to prevention. The WHO Ebola virus disease fact sheet, most recently updated in June 2017, mentions an experimental Ebola vaccine, rVSV-ZEBOV, which proved highly protective in trials. Could the Minister update the House on progress on rolling out a vaccine programme in Sierra Leone?

The International Development Committee’s report on the responses to the Ebola outbreak exposed shortcomings in the World Health Organization’s dealings with the crisis, a point made by the noble Viscount, Lord Ridley, specifically in delays to sounding the alarm and declaring a public health emergency of international concern. This was despite the early warnings from Médecins Sans Frontières. The report specifically recommended the need for a,

“transparent and clearly understood grading system for public health emergencies”.

Is the Minister able to confirm that that work is under way? In the same vein, what has DfID done to improve its ability to,

“independently assess international public health risks,

as asked to do so by the International Development Committee? This is important because a recurring theme in the IDC’s report is that early intervention will save not only money but, more importantly, lives also.

My Lords, I, too, thank the noble Baroness, Lady Hayman, for initiating this debate today and for giving us the opportunity to focus on the key priorities and lessons from Ebola in Sierra Leone. As we have heard, these relate to the need for strengthening healthcare systems, growing primary healthcare staff and training, scientific capacity in diagnostics and public health labs, and of course public health messaging and outreach.

In DfID’s bilateral development review, strengthening health systems across the world was a clear priority. This, too, as we have heard, was emphasised by the Commons International Development Committee. It also stressed the importance of linking this to the SDG 3 by taking into account how they work as a whole and how accessible they are. Like the noble Baroness, Lady Hayman, I welcome the support given by DfID to the President of Sierra Leone who has for the past two years identified health as one of his priority sectors. The two top goals—to bring about a significant reduction in maternal and child deaths and to be able to respond effectively to future Ebola cases—have been backed by DfID.

As we heard from the noble Baroness, the Resilient Zero and Saving Lives programmes provide for early identification and prevention, investment in sanitation, health workers training and access to good-quality basic services for women and young children. Over five years, the goal is to save the lives of over 22,000 children and over 2,000 women, as well as providing family planning for more than 134,000 women and girls. How is DfID making these programmes more sustainable in the long term? We have seen programmes work well but then, when things are pulled back, they are not as sustainable as we thought.

My noble and learned friend Lord Falconer raised the issue of the private sector, which is crucial, and we have received reports of CDC programmes which have been supporting and trying to bring in other private sector finance. One of its programmes during the outbreak was to ensure the sustainability of businesses so that they did not go completely under. I would like to hear more about those CDC programmes from the Minister and again plug the need for a proper debate on the role of CDC in Africa and its five-year plan.

Before the outbreak, the Sierra Leone Government were spending more on tax incentives for big companies than on development priorities such as health. How is DfID working with the Sierra Leone Government to encourage them to adopt the recommendations in the report, Supporting the Development of More Effective Tax Systems, by the IMF, the OECD, the UN and the World Bank? More broadly, how is it working to help Sierra Leone claim more tax revenues?

One other clear lesson that we have heard in the debate on the outbreak has been the role of community engagement, which all too often has been regarded as a soft and relatively non-technical add-on to medical interventions. Can the Minister update us on all the programmes funded by DfID that achieved tangible behaviour change around issues such as safe burials, early treatment and social acceptance of Ebola survivors? We are aware that DfID has been supporting those programmes, but it is their sustainability that we are interested in today. Clearly, we need to ensure this continues and is extended to enable civil society organisations to work with all communities.

My Lords, I join others in paying tribute to the noble Baroness, Lady Hayman, for securing this debate and for the consistency with which she has followed these issues. As we look back through the briefing packs, we can see the debates she has initiated and the Questions she has asked all the way through. That is a great example of what happens in this place in terms of people sticking with issues. It also demonstrates her personal commitment not only in this area but through her work on the Disasters Emergency Committee and in the field of neglected tropical diseases. I was also struck during the debate by how so many noble Lords drew on their personal experiences of Sierra Leone. The noble Baronesses, Lady Tonge, Lady Sheehan and Lady Hayman, my noble friend Lady Jenkin and the noble and learned Lord, Lord Falconer, all spoke about their close links to and understanding of the situation.

The World Health Organization declared Sierra Leone Ebola-free just 592 days ago. That is less than two years since the country emerged from the devastating epidemic, which killed nearly 4,000 people, destroyed livelihoods, robbed a generation of children of a year’s education and further decimated an already weak healthcare system. While a lot has been achieved in the last 592 days, this work was not just about recovering or rebuilding, it was also about laying the foundations that were absent from the start. The noble Baroness, Lady Hayman, referred to the fact that before Ebola, Sierra Leone had some of the worst health indicators in the world. A quarter of all women of childbearing age died as a result of their pregnancy, an issue referred to by the noble Baroness, Lady Tonge; one in six children died before their fifth birthday; and malaria accounted for half of all out-patient visits. Progress was being made, but not fast enough. As the UK led the international response to the epidemic, saving thousands of lives while protecting our shores, we also stood shoulder to shoulder with Sierra Leoneans during an ambitious and fast-paced recovery. However, I accept the point made by the noble and learned Lord from his own experience: the narrowness of the base of the Sierra Leone economy in terms of its dependence is a structural weakness that needs to be addressed. I shall come on to that later in my remarks.

As we look back over the past 592 days, we can be proud to have fulfilled our pledge to support Sierra Leone’s President’s Recovery Priorities, referred to by the noble Lord, Lord Collins. We have educated 700,000 girls, trained 40,000 teachers and built 393 classrooms. The noble Baroness, Lady Coussins, rightly referred to the importance of education and her points about linguistics as a part of this are important. I have noted them and will take them back to the department and respond further to her.

Defeating Ebola was the second exceptional intervention by the UK following our efforts to end the civil war, helping the country be a stable and prosperous nation that responds effectively to natural disasters. Reference has been made in the debate to the recent floods and landslides, which again have had a devastating effect on people’s lives and on the economy. We want to see a nation that can stand on its own two feet. As our recovery programme comes to an end, our support will remain high and our partnership with Sierra Leone will remain strong with DfID, the FCO, the MoD and Public Health England working hand in hand to deliver the UK aid strategy. The noble Baroness, Lady Hayman, mentioned the commitment we demonstrated following the landslides and flooding in Freetown this summer. UK personnel were at the scene within hours to co-ordinate the response. Two world-leading humanitarian experts provided specialist advice and £5 million of additional support was announced to provide clean water, food and medicines for the thousands of victims.

Our efforts are not limited to humanitarian aid. Sierra Leone will continue to be one of the best-funded countries on a per capita basis. Our focus will continue to be on improving the lives of the people of Sierra Leone, including investing in water and power as well as basic health services to help boost the private sector, which is essential to the country’s development. I recognise the point made by the noble Lord, Lord Collins, about the role played by CDC with small and medium-sized enterprises in providing liquidity at the start of the crisis, which made a major difference. I also recognise that a debate on the subject of CDC and its economic development plans is long overdue, and I am delighted to be joined in this debate by two or even three members of the usual channels. I hope that there will be an opportunity soon to explore that issue further.

We will continue to support children’s education and improve learning outcomes for 700,000 additional girls through to 2021. Our support for basic health services will continue until at least 2020. We will save the lives of more than 22,000 children and 2,000 women, and provide family planning for more than 134,000 women and girls, to which the noble Baronesses, Lady Tonge and Lady Sheehan, referred. We are also helping to tackle global health threats to Sierra Leone to make sure it is ready to contain future outbreaks before they grow into epidemics, protecting people in the UK. People’s preparedness is a point my noble friend Lady Jenkin referred to in particular. The noble Lord, Lord Collins, referred to the importance of that being a community health-based solution. We have looked at the community health elements. One of the approaches we have learned at DfID from previous crises is that imposing a top-down solution never works in the long term. It has to be something that comes from the bottom up. That is why so many of the valid points made in the debate are being adhered to already.

However, as we discuss the recovery of Sierra Leone from Ebola, we should not pretend that the epidemic was just a crisis of the health system; it was a crisis of governance. Several noble Lords referred to this. The noble Baroness, Lady Hayman, referred to the elections, which I will come back to in a second. It was also right for the noble Lord, Lord Giddens, and the noble and learned Lord, Lord Falconer, to refer to the endemic problem of bribery in the country and corruption in general. That is why our Pay No Bribe programme is essential to carrying through and following through our zero tolerance of bribery and corruption where DfID operates. We are also supporting the Government to increase revenue to stimulate growth and spend their resources as effectively as possible.

As we look beyond the last 592 days, the UK’s priority is the delivery of successful parliamentary and presidential elections in March next year, which the noble Lord, Lord Collins, referred to. They must be free, fair and, above all, peaceful. We are focused on ensuring that citizens can exercise their rights at the ballot box. The UK has played a central role in helping Sierra Leone to restore and deepen its democratic governance, help build peace and stability, and make progress on tackling poverty. Our focus will continue to be on improving the lives of the people of Sierra Leone and supporting critical reforms to support the clear leadership of the Government.

In the time I have available I will turn to some of the specific points raised by noble Lords in the debate. The noble Baroness, Lady Sheehan, asked about the vaccine. The vaccine she referred to was used successfully when the country suffered two cases in January 2016. The World Health Organization and the Government of Sierra Leone gave permission for it, but it is still at the trial stage. She also asked about early intervention and the assessment of public health trusts, which I have covered in the reply on vaccines.

My noble friend Lord Ridley asked about one of many innovations that have come out of the great universities of that wonderful city, Newcastle upon Tyne—Northumbria University’s tests. We do not have details on that particular test but I would be very grateful to receive further information on it from my noble friend and to make sure it is put in contact with the relevant officials in DfID. As the noble Baroness, Lady Hayman, mentioned, it is core to the objectives of the Ross fund.

The noble and learned Lord, Lord Falconer, referred to the importance of diversifying the economy. The UK is investing in infrastructure—water, power and roads—to help create jobs, open up markets and attract investment. We are helping small and medium-sized businesses to access finance and learn new skills to grow. We are bringing in UK expertise, including the British Geological Survey, to help Sierra Leone best exploit and manage its natural resources. CDC is also seeking opportunities in that area.

There was some criticism of the World Health Organization, which we recognise. The Secretary of State, who, as the noble Baroness, Lady Tonge, mentioned, has visited Sierra Leone, is adamant that we need to reform the international humanitarian organisations, the World Health Organization among them. We are working on greater transparency, stronger accountability and measurement by results.

My noble friend Lady Jenkin asked what we are doing to empower citizens, particularly young people—she made a good point about the work of Restless Development in the country, which we recognise. DfID’s strengthening accountability and building inclusion programme is building stronger accountability between citizens and service providers. We are investing £9.5 million in that programme between 2016 and 2020. We hope that it will help.

Several noble Lords, including the noble Baronesses, Lady Tonge and Lady Hayman, mentioned female genital mutilation. Sadly, Sierra Leone has one of the highest prevalence rates in the world. We have been at the forefront of looking to implement initiatives such as the Maputo Protocol in this area.

There are many points to which I have not been able to respond. Therefore, it would perhaps be a good opportunity for me to write to noble Lords to follow them up.

Particularly at this time of year, we should pay tribute to the thousands of British military personnel, NHS staff, Public Health England staff, laboratory staff, civil servants and volunteers who risked their lives to fight the Ebola epidemic when it broke out. This was a truly collective effort: the best of Britain working together to help Sierra Leone tackle this horrible disease. We could not have done it without their bravery and compassion for those in need. DfID will remain engaged so that their investment and sacrifice is not lost.

Sitting suspended.