International Development Committee
Tuesday 27th October 2026
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14:01
Sarah Champion
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Sarah Champion
Order, order! We are starting this first session of the International Development Select Committee on Global Health. Something which cuts across all of the work and inquiries we do, but sadly, something we're seeing less and less funding and acknowledgement going to. In recent years, we're joined by three panelists virtually for our first panel. What I'm going to do is ask each of you to introduce yourselves and a little bit about the organization that you work for, and then we'll go into specific questions.
Gerard, could I ask you to introduce yourself and your organization first, please?
Gerard, could I ask you to introduce yourself and your organization first, please?
14:02
Speaker 1
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Speaker 1
Hi, everyone. My name is Gerard Klimo. I am the executive Director of organization based in Nairobi, Kenya, called ambassador for Youth and Adolescent Reproductive Health Program. A lot of our work is really centered around providing holistic support and care for adolescents and young people living with and affected by HIV and holistic support, in the sense that our ministry or our health system will provide the diagnostics, the medicine, which is more biomedical. And then as a civil society organization, we offer the behavioral, we offer the services, we offer the support. And really just to ensure that the young people are able to access quality care at the end of the day.
14:02
Speaker 2
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Speaker 2
Hi, everyone. Good afternoon. I am joining you from Kitwe, Zambia. My name is Doctor Natasha Kama. I am the CEO of Zambia. Copper rose is a youth focused organization that exists to build a conducive environment for young people to thrive. In a nutshell, our work sits at an at the intersection of health and economic opportunity. And so for us, our health portfolio has mostly reproductive health, mental health and health system strengthening. And our economic opportunity portfolio works on entrepreneurship and employability. And many people might ask us, like, how on earth do you do with health and entrepreneurship?
But really, from where we stand, our name comes from the fact that Zambia's biggest natural resource. However, we think that one of the biggest resources we are ignoring is, is Zambia's women and young people. And so we exist to unleash their potential. And one thing we've seen is that for health outcomes to be adjusted, we also need to look into social determinants of health. So our organization is one of the is actually the biggest youth focused organization in Zambia where women led. We are led by young people and we work to look at social determinants of health as well as as a means to improve health outcomes.
Yeah. So that's pretty much about me and my work. Thank you.
But really, from where we stand, our name comes from the fact that Zambia's biggest natural resource. However, we think that one of the biggest resources we are ignoring is, is Zambia's women and young people. And so we exist to unleash their potential. And one thing we've seen is that for health outcomes to be adjusted, we also need to look into social determinants of health. So our organization is one of the is actually the biggest youth focused organization in Zambia where women led. We are led by young people and we work to look at social determinants of health as well as as a means to improve health outcomes.
Yeah. So that's pretty much about me and my work. Thank you.
14:04
14:04
Speaker 3
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Speaker 3
Thank you. Good afternoon. I am Abadi, executive director of Family Guidance Association of Ethiopia. It is the oldest family planning organization in the country. We are about 60 years in business. We have worked along with the government to reach people who are under hard to reach. We founded in 1966. We are accredited. Member of Ippf family since 1971. We work with the chain of 774 service points across the country. FDA clinics, public clinics, private clinics, as well as workplace clinics. We work also in refugee and IDP and displaced people. We are a key partner to the Ministry of Health.
We. We are part of the national system. Thank you.
We. We are part of the national system. Thank you.
14:05
Sarah Champion
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Sarah Champion
Thank you all very much for joining us. And thank you for the absolutely vital work that you do. I know it's a very tough, tough landscape to be working in at the moment. And if I could start with you and then I'll ask the other panelists, I wonder if you could tell us in recent years, what have you been witnessing in the field of work that you operate in? And also, if you could look at how you work with the government and has the government's approach to health changed in recent years?
14:06
Speaker 1
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Speaker 1
Thank you so much for that. Let me just start by saying that I've I've worked in the HIV space for ten years now. Started when I was still in high school. So I have kind of grown in the system, but also just being a young person living with HIV myself and having been in this journey for over 20 years, and I have actually interacted with the health system for a very long time. Let me start by saying we we were at a point where we were saying, things have progressed. Science has evolved many years back when we were taking more than five pills as people living with HIV, and now we're just taking one pill.
So things have changed and there are so many successes. And then we wake up one day and the first text I actually found on my phone that in that day after the funding cuts, was the US government has cut money. And so we are going to die, all of us. That was the first text, and it was from one young person who was panicking. I work with young people. I am a leader of so many young people that really seek help, and we support in our programs. And so I remember even thinking to myself, what is this?
What is going to happen? People are looking up to us as an institution or organization to give support and guidance, but we are also in darkness. I always say the HIV system was created parallel away from the primary healthcare system for a reason. It was because people living with HIV had very I wouldn't call them special, but very distinct needs. We are diverse. We have young people, we have girls and young women. We have men, we have queer people, we have key populations. And so we had moved and evolved to a point where we had service providers who were patient, who are kind.
For my community, young people, it was that clinician that had just become so familiar to you that you felt safe with them. And, and overnight, all this is gone. So one aspect for me is that we had a proper functional system, not proper. It was it was a bit in between, of course, it had its own challenges, but we had a system that we had gotten used to for so long and we were familiar with it. And all overnight all these things has changed. So what our Kenyan government did was to talk about the need for integration.
Integration is now combining these two systems. So it becomes everyone goes through the primary healthcare system, which is good, but on paper integration cannot happen overnight. It's a process. You're shifting people, you're shifting a system, you're changing healthcare providers, all the things that we were familiar to have gone. And so people are most likely to be confused, to retract from the health system in itself. And up to date, I can confidently say that we are still dealing and trying to find people who are lost from the healthcare system during that transition. So now we are implementing the integrated system where all of us are accessing care in one system.
It has it's a lot of challenges, and I use the word chaos. I think our health system is chaotic as of now. We're yet to find our footing majorly because a lot of money had been invested in this holistic healthcare system that was supposed to offer distinct services to different populations and serve us all equally. And overnight, all that is gone, and we are all expected to go through one service and system, which is not the easiest thing. I think one thing the government did nice was to just react and try and figure out. Then how do we ensure this continuation of services?
How do we ensure that people are still accessing medicine? But in the same breath, there are so many gaps and challenges. Just to mention that I feel.
So things have changed and there are so many successes. And then we wake up one day and the first text I actually found on my phone that in that day after the funding cuts, was the US government has cut money. And so we are going to die, all of us. That was the first text, and it was from one young person who was panicking. I work with young people. I am a leader of so many young people that really seek help, and we support in our programs. And so I remember even thinking to myself, what is this?
What is going to happen? People are looking up to us as an institution or organization to give support and guidance, but we are also in darkness. I always say the HIV system was created parallel away from the primary healthcare system for a reason. It was because people living with HIV had very I wouldn't call them special, but very distinct needs. We are diverse. We have young people, we have girls and young women. We have men, we have queer people, we have key populations. And so we had moved and evolved to a point where we had service providers who were patient, who are kind.
For my community, young people, it was that clinician that had just become so familiar to you that you felt safe with them. And, and overnight, all this is gone. So one aspect for me is that we had a proper functional system, not proper. It was it was a bit in between, of course, it had its own challenges, but we had a system that we had gotten used to for so long and we were familiar with it. And all overnight all these things has changed. So what our Kenyan government did was to talk about the need for integration.
Integration is now combining these two systems. So it becomes everyone goes through the primary healthcare system, which is good, but on paper integration cannot happen overnight. It's a process. You're shifting people, you're shifting a system, you're changing healthcare providers, all the things that we were familiar to have gone. And so people are most likely to be confused, to retract from the health system in itself. And up to date, I can confidently say that we are still dealing and trying to find people who are lost from the healthcare system during that transition. So now we are implementing the integrated system where all of us are accessing care in one system.
It has it's a lot of challenges, and I use the word chaos. I think our health system is chaotic as of now. We're yet to find our footing majorly because a lot of money had been invested in this holistic healthcare system that was supposed to offer distinct services to different populations and serve us all equally. And overnight, all that is gone, and we are all expected to go through one service and system, which is not the easiest thing. I think one thing the government did nice was to just react and try and figure out. Then how do we ensure this continuation of services?
How do we ensure that people are still accessing medicine? But in the same breath, there are so many gaps and challenges. Just to mention that I feel.
14:09
14:10
Speaker 1
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Speaker 1
Yes, for me, that was the first time, actually, and I didn't understand what that meant because I was just going through emails and and ex and trying to figure out what does this actually mean? I also think our government did not did not know. I have had the privilege of working with the government. And in 2024, we sat in a committee put together by our Cabinet Secretary for health, thinking about sustainability, and we would sit in this rooms, and I was representing civil society and young people, and we'd sit with government and members of Parliament, and we'll talk about sustaining our health system and the HIV response in general.
But I don't think we all envisioned that it would happen that soon. Neither did our government, because from their reaction, no one was prepared for what happened. Yeah.
But I don't think we all envisioned that it would happen that soon. Neither did our government, because from their reaction, no one was prepared for what happened. Yeah.
14:11
Sarah Champion
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Sarah Champion
14:11
14:11
Speaker 1
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Speaker 1
Now the problem comes in because there's there's what you can say on paper and instruct and give memos to healthcare providers and county officials. But the actualization of it requires a lot of resources. So I would say I don't think they had money. One aspect is heavily a lot of funding for the HIV response was coming from PEPFAR and USAID programs and the Global Fund. And so our country was divided into two. We had some areas that were fully funded by USAID and some areas that were funded by Global Fund, because they did not want to double deal in areas.
And so we had a whole part of our country that didn't have donors and support. And so we have one basket. The government has a basket, and we're just trying to see how the money can be shared across. But I think for me, one aspect in Kenya is that health is devolved, meaning counties have the responsibility of putting money into health and making independent decisions. So we did see some counties actually quickly react and tell the healthcare providers, we know you don't have jobs, but please continue going to the hospital. We will figure out your salaries, continue offering services.
And on this other end, as communities, as an organization, we positioned ourselves as the bridge to remind communities that the medicine is still there. The hospital is open. Please make sure and access your service. So I would say they didn't have the money, but we made, we made, we made it work.
And so we had a whole part of our country that didn't have donors and support. And so we have one basket. The government has a basket, and we're just trying to see how the money can be shared across. But I think for me, one aspect in Kenya is that health is devolved, meaning counties have the responsibility of putting money into health and making independent decisions. So we did see some counties actually quickly react and tell the healthcare providers, we know you don't have jobs, but please continue going to the hospital. We will figure out your salaries, continue offering services.
And on this other end, as communities, as an organization, we positioned ourselves as the bridge to remind communities that the medicine is still there. The hospital is open. Please make sure and access your service. So I would say they didn't have the money, but we made, we made, we made it work.
14:12
14:13
Speaker 2
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Speaker 2
Thank you so much for that question. First of all, I just want to give a background on the context based on my experiences. First of all, copper Rose is an organization that we started 11 years ago, and primarily we are focused on reproductive health and HIV programs. Up until about three years ago, when we incorporated other aspects of development and from what we saw from the stop work order and the reduction in funding, especially over the last two years, is we've been seeing we've lost scale and scale pathways. So as community based organizations, we move from reaching one community, two communities.
For us, we're reaching more than 400 communities and more than 200,000 people every year with access to information and services. And now we're down to 45,000. And this is not only us as copper, but we have seen it in many other institutions. There has been a reduction in the community level support. Just for context, about 84% of Zambia's program funding for HIV was coming from PEPFAR, and almost 80 to 90% of the funding was coming from other funders, UK and other European funders. So with the reduction in funding, what we are seeing on the ground is that while the facilities in the hospitals are continuing to work, like the hospitals are still there and looking at the social and cultural barriers around reproductive health and HIV stigma, things like that, they need a lot of community interventions.
So last year, the government came up with an essential services package , and the community interventions have been removed. They've also removed standalone sexual health centers that used to exist. There were about 32 wellness centers for HIV and dream centers in more than 21 districts that we were a part of, and they no longer exist. I did my masters at the London School of Hygiene and Tropical Medicine, and one of the things I remember is that I could go to a sexual health clinic there and access services, because in a clinic that is designed like that, there is no issue of stigma, discrimination.
I don't have to explain several times to a provider about why I need something. And we had a similar arrangement here with the different kind of wellness centers, dream centers, but we don't have those anymore. And so now everyone has to go to the main health facility, which deals with TB, malaria. And as we know from even insurance data in any community, only about 15% of people are comfortable enough to go to a hospital. So meaning that we are losing a lot of people, we are losing a lot of prevention opportunities. And that has been a very big challenge.
Some of the other challenges we've seen is a loss of momentum in some of the work that we're doing as corporates. We were in the last few years before the funding that we were able to influence about seven policies in government. So we influence the family planning, 2030 commitments, and we ensured that government had a specific commitment for adolescents access to reproductive health services. And last year we were working on a gender strategy with the Ministry of Health because they did have a strategy. There is a national gender strategy, but it hasn't been brought into direct ministries like the Ministry of Health.
So we were working on a USAID program for gender. And from the time this happened, that gender strategy has just remained hanging. So that's a, a a missed opportunity because there's no funder that is now willing to continue with that work. We have a draft. It's there, but it's just not going to go on because there's just no support. Lastly, what we've seen also is there's a loss of staff, and a lot of people have lost their jobs. Following the funding cuts, UNAids estimated that about 16,000 people lost their jobs , and only about 6000 have managed to get jobs back.
So what that means is that there is still many, many people that are not only unemployed but underemployed, because with a lot of these programs, there is a high technical expertise that is required to interpret data epidemiologists, statisticians. But a lot of those people are not working, or they've just gone down to work a job that just ends them. And so for me and where I'm standing, that's one of the biggest challenges I see. However, what works and what has been working so far is for those organizations whose models are embedded into the government way of working.
We've seen them continue, however, in the immediate sense, like in the first three months, what we saw very which was very, very scary on our end. And that has brought a lot of trust issues is data management, because a lot of data was sitting on USAID side, some of the systems, health management information systems, and many systems were actually on US government servers. So as soon as the funding cut, a lot of those servers have been lost, but also a lot of staff who sit in, even in the government facilities like MD and data staff have been lost and some of them haven't come back.
So what this has also brought is a lot of trust issues because while we want and we need to be self-sufficient as countries, we think that it was it's been very disturbing to be abruptly removed from his system, because we think that good partnership is in effective communication. And so there's a lot of trust that has been lost. But I still think that there's a lot of opportunities going forward. But if I'm being very honest, that's where we are. The biggest hit has been in the community. And if I had to quantify the data and there has been a research that has been released, a study was published in 2025 in the Open Forum Infectious Disease Journal, and it was co-authored by Ministry of Health Staff.
They estimated that in the first three months since the funding cuts, there were 32,000 new preventable deaths for the first three months. Interruption. And they said that if the disruption continued for a further four years, we should estimate 330,400 deaths. And these deaths are greater in children, because if you understand the reproductive health landscape, which is the HIV, most importantly, there's 1.3 million people living with HIV in Zambia right now. Now, when you look at our UN targets, so the UN has said 95, 95, 95, which means 95% of people should know their status, 95% of people should be on treatment, and 95% of those on treatment should be virally suppressed.
As a country, we have achieved these targets, which goes to show that whatever these programs were, they were working. However, these targets haven't been met in children. So from 0 to 14 these targets have not been met in children. We are at 82% of them know their status, 88% are on treatment and 86% have suppression. So what this means is that we have missed an opportunity either in preventing mother to child transmission of HIV, or in testing children who have already been delivered. And so when it comes to additional work that needs to be done, it will definitely have to be in children.
And, and that's something that we shouldn't overlook. I'll just pause here. I could talk all day, but I'll just pause here so that.
For us, we're reaching more than 400 communities and more than 200,000 people every year with access to information and services. And now we're down to 45,000. And this is not only us as copper, but we have seen it in many other institutions. There has been a reduction in the community level support. Just for context, about 84% of Zambia's program funding for HIV was coming from PEPFAR, and almost 80 to 90% of the funding was coming from other funders, UK and other European funders. So with the reduction in funding, what we are seeing on the ground is that while the facilities in the hospitals are continuing to work, like the hospitals are still there and looking at the social and cultural barriers around reproductive health and HIV stigma, things like that, they need a lot of community interventions.
So last year, the government came up with an essential services package , and the community interventions have been removed. They've also removed standalone sexual health centers that used to exist. There were about 32 wellness centers for HIV and dream centers in more than 21 districts that we were a part of, and they no longer exist. I did my masters at the London School of Hygiene and Tropical Medicine, and one of the things I remember is that I could go to a sexual health clinic there and access services, because in a clinic that is designed like that, there is no issue of stigma, discrimination.
I don't have to explain several times to a provider about why I need something. And we had a similar arrangement here with the different kind of wellness centers, dream centers, but we don't have those anymore. And so now everyone has to go to the main health facility, which deals with TB, malaria. And as we know from even insurance data in any community, only about 15% of people are comfortable enough to go to a hospital. So meaning that we are losing a lot of people, we are losing a lot of prevention opportunities. And that has been a very big challenge.
Some of the other challenges we've seen is a loss of momentum in some of the work that we're doing as corporates. We were in the last few years before the funding that we were able to influence about seven policies in government. So we influence the family planning, 2030 commitments, and we ensured that government had a specific commitment for adolescents access to reproductive health services. And last year we were working on a gender strategy with the Ministry of Health because they did have a strategy. There is a national gender strategy, but it hasn't been brought into direct ministries like the Ministry of Health.
So we were working on a USAID program for gender. And from the time this happened, that gender strategy has just remained hanging. So that's a, a a missed opportunity because there's no funder that is now willing to continue with that work. We have a draft. It's there, but it's just not going to go on because there's just no support. Lastly, what we've seen also is there's a loss of staff, and a lot of people have lost their jobs. Following the funding cuts, UNAids estimated that about 16,000 people lost their jobs , and only about 6000 have managed to get jobs back.
So what that means is that there is still many, many people that are not only unemployed but underemployed, because with a lot of these programs, there is a high technical expertise that is required to interpret data epidemiologists, statisticians. But a lot of those people are not working, or they've just gone down to work a job that just ends them. And so for me and where I'm standing, that's one of the biggest challenges I see. However, what works and what has been working so far is for those organizations whose models are embedded into the government way of working.
We've seen them continue, however, in the immediate sense, like in the first three months, what we saw very which was very, very scary on our end. And that has brought a lot of trust issues is data management, because a lot of data was sitting on USAID side, some of the systems, health management information systems, and many systems were actually on US government servers. So as soon as the funding cut, a lot of those servers have been lost, but also a lot of staff who sit in, even in the government facilities like MD and data staff have been lost and some of them haven't come back.
So what this has also brought is a lot of trust issues because while we want and we need to be self-sufficient as countries, we think that it was it's been very disturbing to be abruptly removed from his system, because we think that good partnership is in effective communication. And so there's a lot of trust that has been lost. But I still think that there's a lot of opportunities going forward. But if I'm being very honest, that's where we are. The biggest hit has been in the community. And if I had to quantify the data and there has been a research that has been released, a study was published in 2025 in the Open Forum Infectious Disease Journal, and it was co-authored by Ministry of Health Staff.
They estimated that in the first three months since the funding cuts, there were 32,000 new preventable deaths for the first three months. Interruption. And they said that if the disruption continued for a further four years, we should estimate 330,400 deaths. And these deaths are greater in children, because if you understand the reproductive health landscape, which is the HIV, most importantly, there's 1.3 million people living with HIV in Zambia right now. Now, when you look at our UN targets, so the UN has said 95, 95, 95, which means 95% of people should know their status, 95% of people should be on treatment, and 95% of those on treatment should be virally suppressed.
As a country, we have achieved these targets, which goes to show that whatever these programs were, they were working. However, these targets haven't been met in children. So from 0 to 14 these targets have not been met in children. We are at 82% of them know their status, 88% are on treatment and 86% have suppression. So what this means is that we have missed an opportunity either in preventing mother to child transmission of HIV, or in testing children who have already been delivered. And so when it comes to additional work that needs to be done, it will definitely have to be in children.
And, and that's something that we shouldn't overlook. I'll just pause here. I could talk all day, but I'll just pause here so that.
14:26
Sarah Champion
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Sarah Champion
We could listen all day , because the information that you're giving to us is, is both shocking and gripping. And I think it was particularly wicked of Doge to wipe that data because it wasn't theirs to destroy. Abadi, I wonder if I could ask you the same question, sort of recent changes that you've seen in your field and how your government is responding to it.
14:26
14:27
Speaker 3
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Speaker 3
Which due to us . That account due to the. So for this cut, the people paying the price are women, young, young person, people who is living with HIV Aids. The cut . It accounts also. Reduction in human resource. In terms of personnel. We lost the technical personnel about 162. Personnel. We have to be forced to withdraw from 366 public health facilities from the community, which are highly affected by funding.
It has been. While. When we estimate the impact of those withdrawal. Of about.
It has been. While. When we estimate the impact of those withdrawal. Of about.
14:29
14:30
Brian Mathew
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Brian Mathew
Thank you. And if I can start with you, Natasha, I've just actually come back from Zambia, but it was on a different mission. We've lost your picture there. Are you back? Good, good. So, Natasha, you've given us some idea of the impact of cuts to funding for health in the communities you serve, but perhaps you could elaborate a bit more. And also what concerns you have for the sustainability of the historic gains that you've seen.
14:31
14:31
14:31
14:31
14:31
14:31
Speaker 2
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Speaker 2
All right. So I was saying that some of them impact we've seen the long term impact. Definitely. We have lots of statistics around that. And. You know the sad part about health negative health outcomes is by the time you realize how many more deaths would be caused, then I, I honestly think it's too late. So most of the data has to be done through modelling studies where we try and estimate what the impact of this would be. So the impact, for example, on, on, on HIV and access to reproductive health services is right now only an estimation.
One of the things that really helped when it comes to the commodity side, because a lot of the commodities were being supplied by donor funding has been forecasting. So, for example, most of the drugs are procured 8 to 10 months in advance. And so from the time when we received funding cuts last year, we've only had to procure one more time. So most of the impact we anticipate will be seen more clearly in the coming years. One way that I think would be very effective and would create sustainability is ramping up of the private sector.
As a serial entrepreneur, I must say that I also run a pharmaceutical business, and in my pharmaceutical business, I've been able to see that because there are not a lot of contraceptives in the health facilities, there are more women that are willing to buy and purchase contraceptives from the community. And what that means is that there is a market for private sector investment and engagement. And I think that is a long term sustainability plan. If you look at developed countries with a national health insurance scheme, while the National Health Insurance Scheme guarantees free services for many of its citizens, it does receive a lot of bailouts from billionaires and government and generally wealthy people.
But on this side, there is very few billionaires in Zambia, I must say. And so I think that. But people still have money. Even if someone is living on a dollar a day, they can spare $0.05 a day towards health or some kind of health plan. And we do see them spending money on many things for life and living. So I think that ramping up the private sector or doing some private sector development work in health would be one of those investments that would bring about long term sustainability. And I think that's one of those areas.
Another area would be to see how best to improve the way government works. So we work a lot with community health workers and peer educators. And one of the things that is very common is that there's a very high attrition rate of between 60 to 80%, depending on the region. And with high attrition, it means that organizations like us are constantly training healthcare providers. Just last year, a medium sized organization like us trained more than 500 healthcare providers. You can imagine how many people large organizations are training. More than 20,000 healthcare workers are trained every year.
So and these people need to constantly be trained. So we believe that putting up a digital training platform or a digital training system, investing in something like that would be very effective at dealing with some of the costs of delivering healthcare to the last mile. There is a lot of training in supply chain and many different areas, and I think that an investment in more of long term sustainability measures would be a much more effective. Lastly, one of the things that really helped local organizations like us grow was the localisation agenda, where a certain amount of resources was designated or.
Was it was ensured that local organizations received certain amount of funding. So you put a cap or a percentage to say at least this amount of funds should go to local organizations, because local organizations will work, whether there's funding, whether there's no funding, we'll continue working in our communities. And so investing in local partners is one of those long term sustainability measures. Because for me, even if I have no money to go to a meeting, I'm still receive the call. Natasha, where are you? You need to come and work on this document. Even today, I received a call about a meeting that is probably ten hours drive from where I live, and I might still find myself there, even if I'm no longer on on organizational salary.
So investing in local leaders is one of those things that will definitely move the liver. And when it comes to sustainability, I hope that answers your question.
One of the things that really helped when it comes to the commodity side, because a lot of the commodities were being supplied by donor funding has been forecasting. So, for example, most of the drugs are procured 8 to 10 months in advance. And so from the time when we received funding cuts last year, we've only had to procure one more time. So most of the impact we anticipate will be seen more clearly in the coming years. One way that I think would be very effective and would create sustainability is ramping up of the private sector.
As a serial entrepreneur, I must say that I also run a pharmaceutical business, and in my pharmaceutical business, I've been able to see that because there are not a lot of contraceptives in the health facilities, there are more women that are willing to buy and purchase contraceptives from the community. And what that means is that there is a market for private sector investment and engagement. And I think that is a long term sustainability plan. If you look at developed countries with a national health insurance scheme, while the National Health Insurance Scheme guarantees free services for many of its citizens, it does receive a lot of bailouts from billionaires and government and generally wealthy people.
But on this side, there is very few billionaires in Zambia, I must say. And so I think that. But people still have money. Even if someone is living on a dollar a day, they can spare $0.05 a day towards health or some kind of health plan. And we do see them spending money on many things for life and living. So I think that ramping up the private sector or doing some private sector development work in health would be one of those investments that would bring about long term sustainability. And I think that's one of those areas.
Another area would be to see how best to improve the way government works. So we work a lot with community health workers and peer educators. And one of the things that is very common is that there's a very high attrition rate of between 60 to 80%, depending on the region. And with high attrition, it means that organizations like us are constantly training healthcare providers. Just last year, a medium sized organization like us trained more than 500 healthcare providers. You can imagine how many people large organizations are training. More than 20,000 healthcare workers are trained every year.
So and these people need to constantly be trained. So we believe that putting up a digital training platform or a digital training system, investing in something like that would be very effective at dealing with some of the costs of delivering healthcare to the last mile. There is a lot of training in supply chain and many different areas, and I think that an investment in more of long term sustainability measures would be a much more effective. Lastly, one of the things that really helped local organizations like us grow was the localisation agenda, where a certain amount of resources was designated or.
Was it was ensured that local organizations received certain amount of funding. So you put a cap or a percentage to say at least this amount of funds should go to local organizations, because local organizations will work, whether there's funding, whether there's no funding, we'll continue working in our communities. And so investing in local partners is one of those long term sustainability measures. Because for me, even if I have no money to go to a meeting, I'm still receive the call. Natasha, where are you? You need to come and work on this document. Even today, I received a call about a meeting that is probably ten hours drive from where I live, and I might still find myself there, even if I'm no longer on on organizational salary.
So investing in local leaders is one of those things that will definitely move the liver. And when it comes to sustainability, I hope that answers your question.
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Speaker 3
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Speaker 3
Sorry for the inconvenience. The network has been, you know, unstable in terms of the current HIV Aids funding. The funding has been provided by a grant almost 50% because of the Can funding, around 5000 health workforce. Their contract has been affected. So the hidden cost in this regard is . Some clinics may stay open, but they have no commodities. They have no. HIV drug outlets, and there is no outreach program even. There is no follow up support as well. So this is just to give you an example, in Gambia, where the HIV prevalence rate is very high, it accounts to 23%.
Young teen age positive teenage. They are currently sharing their entry retrieval medication due to the shipment stoppage, as well as stockout at that level in Amhara region, where a 14 years of years old survival of sexual violence is now pregnant . Because the nearby clinics, which are. She could access is out of run off contraceptives. So a same time the parents are forced to get married for early marriage at the age of 14 as. As such, it becomes a denial of the opportunity to continue her education as well. So the effect on contracted contraceptive is not only in terms of the access but in terms of the future earning as well.
So in terms of funding, including UK, we are fortunate enough to have funding support from UK government through which in which one we were implementing in 15 countries as global. So one of them are ours in which to. We are currently implementing seven countries, so there is only a reduction of implementation area of 45%. In terms of the regions we were operating in Oromia southern region, and some better region areas, which accounts about 65%. Now we have reduced to conflict affecting regions which are highly protracted, which requires additional funding, but in terms of the proportion has been significantly reduced.
We had in which one we were operating 645 health facilities, including private health facility, public health facility and the universities. Now we are only operating in 129 health facilities, which is a count only 20% of due to reduction. So in terms of. The development, FDA are also witness the UK government investment workers. Ethiopia has made a significant progress over the last 25 years, including the UK, which program as well. It was critical part of that success development. When we look into the national progress . Contracted contraceptive use rose from 8 to 35% of married women children.
This falls by two thirds in terms of maternal mortality as well as child mortality rate. So which contribution has been significantly impacted, contributing around 13.4 million pregnancies and 68,000 maternal deaths was averted due to this contribution from the wish. Thanks to the US government, 15 countries, the new wish phase is focusing on the conflict affected region in Amhara, Tigray and Oromia, as well as in afar region. This shows that UK's reach the hard. The hardest place and FDA knows how to deliver those on those plates . Because we are at the community level, the government.
Young teen age positive teenage. They are currently sharing their entry retrieval medication due to the shipment stoppage, as well as stockout at that level in Amhara region, where a 14 years of years old survival of sexual violence is now pregnant . Because the nearby clinics, which are. She could access is out of run off contraceptives. So a same time the parents are forced to get married for early marriage at the age of 14 as. As such, it becomes a denial of the opportunity to continue her education as well. So the effect on contracted contraceptive is not only in terms of the access but in terms of the future earning as well.
So in terms of funding, including UK, we are fortunate enough to have funding support from UK government through which in which one we were implementing in 15 countries as global. So one of them are ours in which to. We are currently implementing seven countries, so there is only a reduction of implementation area of 45%. In terms of the regions we were operating in Oromia southern region, and some better region areas, which accounts about 65%. Now we have reduced to conflict affecting regions which are highly protracted, which requires additional funding, but in terms of the proportion has been significantly reduced.
We had in which one we were operating 645 health facilities, including private health facility, public health facility and the universities. Now we are only operating in 129 health facilities, which is a count only 20% of due to reduction. So in terms of. The development, FDA are also witness the UK government investment workers. Ethiopia has made a significant progress over the last 25 years, including the UK, which program as well. It was critical part of that success development. When we look into the national progress . Contracted contraceptive use rose from 8 to 35% of married women children.
This falls by two thirds in terms of maternal mortality as well as child mortality rate. So which contribution has been significantly impacted, contributing around 13.4 million pregnancies and 68,000 maternal deaths was averted due to this contribution from the wish. Thanks to the US government, 15 countries, the new wish phase is focusing on the conflict affected region in Amhara, Tigray and Oromia, as well as in afar region. This shows that UK's reach the hard. The hardest place and FDA knows how to deliver those on those plates . Because we are at the community level, the government.
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Tracy Gilbert
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Tracy Gilbert
Thank you. I'm going to speak about the rollback on rights, and I'd like to come to Europe. First of all, please. I know that you, Natasha, have mentioned this already, and I'd be interested to hear a bit more. Could you tell us a bit about have you experienced ideological or political resistance to your work and that of the groups that you work with? And probably more importantly, what can the UK government do to counter those rollbacks on human rights? To help? I'll start with you, please.
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Speaker 1
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Speaker 1
Giving context. I think for the first time after the funding cuts, our president made a public remark about where he stood on issues of gender. And I remember the first thing he said is he recognizes that we only have male and female. And that statement a lot alone caused an uproar of confusion among rights of queer people, issues of reproductive health and rights. And I remember people actually coming at organizations who are funded, who work in the HIV response, attacking us and saying, we are the ones who are promoting all these things. So when a leader of a country makes such a statement, then it influences communities and people to just decide the direction of what should happen, what services should be accessed.
And at that particular time, our organization and other organizations here in Kenya had taken the government to court over missing links in reproductive health policy. It had omitted issues of rights. So we are no longer even allowed to just say the word rights. We are now no longer allowed to say freedom of Issues of rights. So we are no longer even allowed to just say the word rights. We are no longer allowed to say freedom of expression. There was questions around all this conversation. We had made a lot of progress in conversations around comprehensive sexuality.
And at that particular time, our organization and other organizations here in Kenya had taken the government to court over missing links in reproductive health policy. It had omitted issues of rights. So we are no longer even allowed to just say the word rights. We are now no longer allowed to say freedom of Issues of rights. So we are no longer even allowed to just say the word rights. We are no longer allowed to say freedom of expression. There was questions around all this conversation. We had made a lot of progress in conversations around comprehensive sexuality.
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Speaker 1
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Speaker 1
And even in documents. And of course, we saw this start with the US. government retracting and changing documents, and it poured down to what our government was allowing us to say. And after that statement, it was the way the government says things should be done and no other way. Our Minister of Health, you know, was saying integration is the way. There was no any other way. It doesn't matter if it works for the people, if it works for communities. That was the way the government had detected things to to happen. And so we've seen. government really.
questioning why should abortion be allowed in Kenya, in Kenya, abortion in Kenya is legal, but only under certain circumstances. So we had. organizations and who offer services that would offer safe abortion to women and girls, reproductive health rights.
questioning why should abortion be allowed in Kenya, in Kenya, abortion in Kenya is legal, but only under certain circumstances. So we had. organizations and who offer services that would offer safe abortion to women and girls, reproductive health rights.
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Speaker 1
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Speaker 1
Having to close down, dioceses having to close down and even them being attacked by. communities because their government had given direction that these are not things we should be practicing as a country. So I would say, yes, we have seen a lot of pushback on women's rights. confusion in terms of at what age should young people and young women access reproductive health services? What service can they receive and what service can they not receive? So I'd give an example. In the HIV policy, we say a young person who is at the age of 15 can walk into a clinic, they can get tested.
But in the reproductive health policy, it does not allow that. So you have two. policies serving the same. population but speaking different things. So one of the things you are pushing for as civil society is the alignment of policies. guidelines and law. But so we were completely shut out and hence why we chose to go to court. We did not win that case. And that policy is going to be serving us for the next ten years or so. It is sad. And we actually went to the streets because of that. But then it it goes to show you how confident our government became in terms of.
But in the reproductive health policy, it does not allow that. So you have two. policies serving the same. population but speaking different things. So one of the things you are pushing for as civil society is the alignment of policies. guidelines and law. But so we were completely shut out and hence why we chose to go to court. We did not win that case. And that policy is going to be serving us for the next ten years or so. It is sad. And we actually went to the streets because of that. But then it it goes to show you how confident our government became in terms of.
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Speaker 2
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Speaker 2
And Natasha, maybe next. Thank you so much for that question. So there has been evidence of a rollback on sexual reproductive health and rights. Let me just start by the word sexual. reproductive health and rights. I mean the phrase it can no longer be used in any government setting. So they've removed the word rights and we can no longer say SRHR. We have to say SRH. So every government document, every.
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Speaker 2
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Own individual opinion. It is your choice. I don't know the facts. Let me be honest. I don't know the facts behind this, but as a spectator or someone that's in the second round, like not in the actual ring, but just someone external who doesn't work at the Ministry of Health. What I'm saying is like, if I'm going to pay for this, then I'm going to do it at my own terms. When someone else was supporting me financially, like supporting the.
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Speaker 2
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Speaker 2
When another entity supporting the government, they could they could determine the terms. But now that I'm in charge, I'm going to determine the terms. That's kind of what it felt like. And we saw this robot even with comprehensive sexuality education. So last year there was a movement that came up that was a comprehensive sexuality education movement. They were. against CS states. So comprehensive sexuality education is training that is given to. adolescents preparing them for life. So it's a life skills program which really embeds the sexual reproductive health aspects. It talks about aspects of gender and many other things.
Now there was a religious movement that came up. So there has been anti rights movements that have been growing. But what made the CS movement. unsuccessful when it tried to remove CS from schools sometime last year, was the fact that CS has been embedded in every single subject. So it's been embedded in every single subject. So even when a movement comes up, it means they have to fund a whole. curriculum revision for the. And that's expensive. So as we roll out programs, I also learned that we need to think long term and we need to think about what does a backlash look like?
And if. resistance comes out. So that's what I saw. The second the third thing I've seen so far is the word gender in documents is not being taken up. So I'll give you an example that gender in some documents has been replaced with sex. Gender based violence has been replaced with violence against women and men. Sexual gender based violence has been replaced with sexual violence.
And this is guidance that has been coming from the Department of State and what's left of US funded programs. So a lot that is affecting how. people work.
Now there was a religious movement that came up. So there has been anti rights movements that have been growing. But what made the CS movement. unsuccessful when it tried to remove CS from schools sometime last year, was the fact that CS has been embedded in every single subject. So it's been embedded in every single subject. So even when a movement comes up, it means they have to fund a whole. curriculum revision for the. And that's expensive. So as we roll out programs, I also learned that we need to think long term and we need to think about what does a backlash look like?
And if. resistance comes out. So that's what I saw. The second the third thing I've seen so far is the word gender in documents is not being taken up. So I'll give you an example that gender in some documents has been replaced with sex. Gender based violence has been replaced with violence against women and men. Sexual gender based violence has been replaced with sexual violence.
And this is guidance that has been coming from the Department of State and what's left of US funded programs. So a lot that is affecting how. people work.
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Speaker 2
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Speaker 2
We were doing a lot of providing a lot of technical assistance to governments. But with the shrinking of the funding, a lot of CSOs are spending most of our energy on survival fundraising rather than through advocacy. So our advocacy capacity has shrunk as a civil society sector in direct proportion to the funding crisis. So whereas we see a problem in one area, because we don't have access to funds, we are going to go where the funds are. And I don't think that's an ideal way. And that's not something we as corporates are doing. But a lot of.
organizations I was just looking at, for example, Fcdo funding in Zambia and three quarters of the funding is going towards social cash transfer.
organizations I was just looking at, for example, Fcdo funding in Zambia and three quarters of the funding is going towards social cash transfer.
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Speaker 2
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Speaker 2
So half of the organizations I know are now doing climate work, even though they started off as health organizations. And for me, I feel like we are losing a lot of the health. advocates because they are doing what we call survival fundraising instead of advocacy. And, and also, that means we've lost a lot of the technical expertise to the other sectors outside health.
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Speaker 4
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Speaker 4
Is there anything you wanted to add briefly. Thank you. Yes. We are observing the rollback effect on rights especially. We are seeing foreign. actors using funding and influence to shape the Ethiopian health system. And in terms of policy. We have been. observing some changes in terms of the framing, in terms of the MOU, what the American first health.
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Speaker 4
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Speaker 4
To make policy change. At the same time, they are targeting using a health professional, including an end of. specialist religious leaders, to influence their course. So they are also engaging in. disinformation and. misinformation as well. targeting service providers. Even our service provider has been. targeted because by availing a service for safe abortion care service in our .
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Speaker 2
The EU or other governments will be working in other provinces, and the US government will be working in these provinces. So there was a there was a geographical location. And another thing that was. There was also the programs were layered on top of the other. So, for example, if the HIV. program was the one that was carrying the Digital Health. Information system, whenever there was a family planning program or different program, it would not need to create a new government system. So a lot of those systems are still existing. And that is something that I think means that we don't need as much resources as we did when those systems were being developed.
So one of the opportunities is to rely on the systems that were already built. The second thing I see is private sector and blended finance is something that's very, very important. I have seen. Fcdo and working with private sector in different sectors outside health, and I think that A that that. opportunity could also be opened to the health space, because I honestly think that there is some room to fill parts of, of, of, of the gaps with a private sector investment. And one of the opportunities also is when it comes to things, for example, like abortion, Zambia does have good a, I think almost identical to the UK law around access to abortion services.
So one of the opportunities is to rely on the systems that were already built. The second thing I see is private sector and blended finance is something that's very, very important. I have seen. Fcdo and working with private sector in different sectors outside health, and I think that A that that. opportunity could also be opened to the health space, because I honestly think that there is some room to fill parts of, of, of, of the gaps with a private sector investment. And one of the opportunities also is when it comes to things, for example, like abortion, Zambia does have good a, I think almost identical to the UK law around access to abortion services.
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Speaker 2
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Speaker 2
Many of the gaps are in training and development. So what. For example, if resources are reducing some of the high. High reward. Low effort. opportunities are to focus a lot on the. workforce and the health and information systems. And so when the UK, the US government came back with, I think Abadi mentioned them, the the MOU, a lot of them are leaning on the. workforce and they are leaning on data, and a lot of stakeholders were looking at it as from a sovereignty point of view. And I totally agree with that. A nation should have access to its own data.
However, I think that the lack of data is one of the things that affects, for example, planning, budgeting. So one way or an. opportunity from here would be looking into. digitization data systems. because there's still a lot, definitely a lot of. opportunities there. So while funding. decisions seem like a.
However, I think that the lack of data is one of the things that affects, for example, planning, budgeting. So one way or an. opportunity from here would be looking into. digitization data systems. because there's still a lot, definitely a lot of. opportunities there. So while funding. decisions seem like a.
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Speaker 2
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Speaker 2
All right. I would say that. investments in health would start from, first of all, investments in data. And because one, one of the ways to understand, for example, how much investment needs to go into a certain sector or in certain areas, and even the gaps, I would start with investing in data to understand the landscape. And then from there, then they would be a need to. I know there are so many like.
hackathons or. entrepreneurial driven.
hackathons or. entrepreneurial driven.
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Speaker 2
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Speaker 2
Similar to how grant funding would come, but with more of like better conditions because it's feeding into something that has the ability to regenerate. And so, you know, when we write proposals, we're always talking about sustainability. And it sounds good on paper, but more often than not, we are looking for the next funding after that funding has come through. And in this case, I would say weight bearing . Some of the heaviest parts about running a healthcare business would definitely go a long way in sustaining it long term. So if I have to be honest, I would say the two pain points for most health businesses right now is data and access to data.
And AI is, is one of those things that we could leverage. But with AI also comes with things like data protection. I know Europe has very strong data protection.
And AI is, is one of those things that we could leverage. But with AI also comes with things like data protection. I know Europe has very strong data protection.
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Speaker 2
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Speaker 2
If I could be the health Minister for a day, I would. introduce fees into our health system, minimal fees, but they would. definitely be a step in the right direction as far as. sustainability is concerned, because I see even people who can afford going to access health healthcare for free. And I honestly think that that. reduces the amount of commodities that are available for those people who genuinely cannot afford it right now, the Zambian government even pays for people to be evacuated to other countries to receive treatment. And most of the times, rich people are the ones that get that kind of healthcare support.
So the first thing I would do if I was a minister for a day is. introduce service fees, because they would generate some income. I would also restructure the national health. insurance system, because the national health insurance system could be doing a lot more. I mean, the insurance was a good start, but I think we could do a lot more in making it more functional and better able to support our citizens.
So the first thing I would do if I was a minister for a day is. introduce service fees, because they would generate some income. I would also restructure the national health. insurance system, because the national health insurance system could be doing a lot more. I mean, the insurance was a good start, but I think we could do a lot more in making it more functional and better able to support our citizens.
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David Mundell
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David Mundell
Those are the two things I would do if I was a minister for a day. Excellent. Thank you for that very clear answer. Can I come to you and basically ask you the same questions? I mean, what opportunities or positives, if any, can you see from the the impact of the reduction of aid and what's happening in Kenya with the government to a, a just .
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Speaker 1
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Speaker 1
To health. And even if they did, it didn't end up actually being used for health. So for me, I think it was a wake up call that this man is here today. Tomorrow, it may not be there. So as a government, we actually need to do something about it and make sure we put money into healthcare and, and ensure that that is actualized at the end of the day. So for me, I think that's the biggest opportunity, but also integration. It is a beautiful system on paper, honestly. And even prior to the funding cuts, one of the things we kept on pushing for a civil society was we want a young person to walk into one room in a.
facility and access all the services under that one roof so that then it's a one stop shop. They don't have to be sent to the other side of the hospital to get. contraception and then to the other side for lab results. You kind of end up losing the client in between the referrals and linkages. So already designing and thinking. about a one stop center that offers all the services for this. individual was something we had in mind. And integration really looks good on paper. But the one essential aspect is it takes time and the time is with the people.
So you have a system that looks really nice on paper, but it really doesn't serve the people as it should be. So you one of the most essential thing is integration provides an opportunity for people to interact less with the clinic. So I just entered a room, I get my services and I go home, quote unquote, no special services. It's not necessarily special, but that's how we look at it. And so people can access services at the same time. But there are still limitations. So for example, someone has TB, they are seated in a waiting bay with over 50 clients.
All these people are at risk of contracting TB if that. structure of the facility is not well.
facility and access all the services under that one roof so that then it's a one stop shop. They don't have to be sent to the other side of the hospital to get. contraception and then to the other side for lab results. You kind of end up losing the client in between the referrals and linkages. So already designing and thinking. about a one stop center that offers all the services for this. individual was something we had in mind. And integration really looks good on paper. But the one essential aspect is it takes time and the time is with the people.
So you have a system that looks really nice on paper, but it really doesn't serve the people as it should be. So you one of the most essential thing is integration provides an opportunity for people to interact less with the clinic. So I just entered a room, I get my services and I go home, quote unquote, no special services. It's not necessarily special, but that's how we look at it. And so people can access services at the same time. But there are still limitations. So for example, someone has TB, they are seated in a waiting bay with over 50 clients.
All these people are at risk of contracting TB if that. structure of the facility is not well.
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Speaker 1
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Speaker 1
It doesn't have enough windows, there are no masks. So there are so many gaps. Even though this integration system really looks good on paper. So for me, those are the two positive things. When I think about what our government needs to do, there are lots. I am a Gen Z, we've had a problem with our.
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Speaker 1
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Speaker 1
The first essential aspect is people to trust that system. If they can't trust it, they will question it. It doesn't matter if one person had the best services. It takes one person to have a bad experience , and then that is all of a sudden everyone's approach and thoughts. And so we have our national health insurance. It's now called our social health insurance. That is really good because then depending on the level of earning or job that one does, there is a certain amount that is cut. So if you're really earning little, then you're going to be charged little, but at the same time, you're going to be able to access care.
But then at the end of the day, the question is, even if you tax people and they walk into a clinic and there's no. medicine there, there is no test tubes, the pharmacy is not there. The watchman was rude, the the. latrines and are unusable. At the end of the day, people question then why do you deduct this, this money or tax for health and give me bare minimum in terms of health? So I think for me it's really. actualizing what is on paper and making it a reality. So in terms of our systems and our social health.
But then at the end of the day, the question is, even if you tax people and they walk into a clinic and there's no. medicine there, there is no test tubes, the pharmacy is not there. The watchman was rude, the the. latrines and are unusable. At the end of the day, people question then why do you deduct this, this money or tax for health and give me bare minimum in terms of health? So I think for me it's really. actualizing what is on paper and making it a reality. So in terms of our systems and our social health.
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Speaker 1
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Speaker 1
But it takes a peer educator who understands how scary it is to live with HIV and be a queer person at the same time, and be a young person at the same time, to actually. understand and give me the support that needs me me. I need to remain adherent to my treatments. And so you have a facility on this side. It has.
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Speaker 4
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Speaker 4
The other. 30% from from. individual pocket. So from after the incident of this. instant cut, the first thing the government do is, you know, to look into the funding . portfolio . So they make at least some. commitment as a feeling, especially to allocate to the richer from. 7% to 9% in terms of the real outcome. But in terms of the gravity and the gap we have still, it is a long way to go as such.
So the country. ownership initiative has been, you know.
So the country. ownership initiative has been, you know.
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Speaker 4
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Speaker 4
Meaning the private sector has been pulling to the to the front to take part on investing in some local. manufacturing in partnership with other development partners. This is a new initiative which has been introduced in industrial parks, special economic zones and so on. The third is in terms of the space which is given to the local civil society.
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Speaker 1
The adolescence is adolescence and use health strategy as well as. reproductive strategy has been jointly designed previously. So we're doing at government level. Now the civil society and other actors has been involved. We we make sure the SRH agenda has been there as part of the commitment. But in terms of the stage, it is a gradual move to make country ownership at, at, at, at national level.
So working with the government has been very.
So working with the government has been very.
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Speaker 1
By by Finance minister, as well as by. allocating specific amount of money to run the business. So the good thing is they are positive in terms of they make even some commitment at global level. But in practice, we are looking into tracking how they could be. implemented on such area. So I think in terms of the.
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Sarah Champion
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Sarah Champion
Just because of time. We're going to have to stop there. But you've ended on a good note that the government is looking to make those changes. We would actually write to you, if that's okay, about civil. society and panelists. There's a few other questions we'd like to follow up. Thank you so much for your time. You've given us loads of. information at the start of our inquiry. It's good to hear some some potential.
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Sarah Champion
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Sarah Champion
But let me personally say I'm very sorry for the cuts that came from the UK. And like you, we were all really, really shocked and surprised at the cuts that came from us aid both the severity of them and how swiftly they were delivered. But thank you for still going. Thank you for what you do every day. And please do relay our gratitude to your teams as well. Order, order. We're now going to suspend .
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Sarah Champion
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Sarah Champion
We are now starting our second panel on the International Development Committee's inquiry into global health. Thank you very much, everybody, for joining us. Doctor Kennedy, thank you for joining us remotely. We appreciate it. If I could start by asking the people in the room to introduce themselves and their organisations. Doctor, if I could start .
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Speaker 3
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Speaker 3
We work both on the fundamental. mechanisms of how this bacteria infects humans and causes disease. But we also work on more applied work. So at the moment, we're very actively engaged on trying to develop a new diagnostic test that would help us better diagnose and detect this disease. So both fundamental research and some more applied work. I have lived and worked and run research labs for extended period of time in Thailand and also in the USA. And I relocated to Cambridge University four years ago, and the evidence that we. submitted was as part of a consortium.
So three other academics at the University of Cambridge and my colleague Professor Bhavesh Khanna in South Africa. And so I'll try to the best of my ability to share both my own. experiences and also experiences that have been shared with my colleagues. So what I'm hoping to be able to share as our. perspectives on .
So three other academics at the University of Cambridge and my colleague Professor Bhavesh Khanna in South Africa. And so I'll try to the best of my ability to share both my own. experiences and also experiences that have been shared with my colleagues. So what I'm hoping to be able to share as our. perspectives on .
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Speaker 5
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Speaker 5
For our audience and committee members if you could introduce yourself and your work, please. Thank you so much. So my name is Monica Ferro. I'm the head of the United Nations Population Fund office here in London. And as you probably know, the United Nations Population Fund is the UN leading agency on population data and on sexual reproductive health and rights. We work to uphold the rights of choices of women and girls, young people, and all population groups in situations of.
vulnerability and more. In about. 150 countries and.
vulnerability and more. In about. 150 countries and.
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Speaker 5
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Does and its relationship with UK funding. My pleasure. And also please stop me. So we are as I was saying, we are the leading agency on sexual reproductive health and rights, which means that we work to deliver a world where you can actually meet zero preventable mortality. So we work. It's not only a health issue, it's also a human rights issue. So we work to remove all. obstacles between women and , and access to healthcare services, to information. We work on. The other big outcome of our strategic plan is, is securing universal access to family planning.
Then we have another big goal where we we commit to ending gender based.
Then we have another big goal where we we commit to ending gender based.
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Speaker 5
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Speaker 5
Where we include harmful practices such as child marriage and female genital mutilation, we call it with Unicef, the two global programs to end this harmful practices. And we've also decided to highlight, again our work on demographic. intelligence and. providing countries with information so they can build.
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Speaker 5
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When it comes to social welfare, when it comes to health, because what we've seen in the last couple of years, it's different, but still a lot of. resemblance with what we had when we when UNFPA was created in the end of the 60s, which is a lot of demographic anxiety. And in the 60s, the demographic anxiety was. towards an exploding population. And now the anxiety has very much to do with low fertility. And this has to do with so much of the issues we heard on the first session, how rights are being.
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Speaker 5
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But but it's it's becoming. We heard also about misinformation. This has become a big topic when we talk about rolling back on rights. So it has to do with what the colleagues share in the first panel. But it also has to do with this issue from our. experience in analyzing what's happening in many, many countries, because as Honourable Sarah Champion mentioned, we do work with a lot of.
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Speaker 5
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Products, equipments. And it's and the investment the UK has done in this in our supplies. partnership has helped to establish our supplies partnership as a flagship global health initiative. It's in this the current moment, the largest public sector provider of contraceptives. Just to give you an example. And we know the power of family planning when it comes to reducing maternal mortality and empowering women, allowing women to decide over their bodies and their fertility. So it has a rippling effect that's very, very positive. And I know the UK is very focused on impact and efficiency of the of the investment.
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Sam Rushworth
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Sam Rushworth
So we do think this is a good initiative. But when showcase when this committee was in Washington and we met with the remnants of. USAID in the State Department and the Doge team that's been put in charge of them, they were talking about how they that they're still funding drugs for HIV. But but, quote, we've got rid of the woke stuff. What I'm what I'm understanding is that maybe that woke stuff is actually quite important.
If, if, if what that woke stuff is, is, is.
If, if, if what that woke stuff is, is, is.
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Speaker 5
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And it's one of the first areas, once you've reduced the funding, it's one of the areas where you see immediately the. impact because you may still have a clinic, but there's no doctors in it. You may still have a hospital, but maybe there's no maybe there's no medicines, there's no skilled birth. You know, the clinic is there, the lights are on, but there's no services for women. And this has a tremendous impact on on women and girls and on this goal that we like, that we are so proud of as a as a community to say we .
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Speaker 5
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FGM a part of your work and a part of reducing. Yes, yes, yes, yes, we call it the Global Programme to End FGM. And on that we also have good news. The. The rates are really lower, but still we know there is. There are millions of girls and women at risk if. Because the funding is also being reduced. So if you cannot sustain the .
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Speaker 5
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You know, a lot of countries have made. tremendous advancements on law. But law alone is not enough. We also need budgets to implement the programmes. We need to monitor the success of the of the projects. So we do need investment and we need investment that's sustainable because otherwise the continuation of the.
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Speaker 5
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It's it's it's at risk. And once you've interrupted a program, we see the setback. And also, if I just may add, the crisis and climate change are. exposing a wider number of women and girls to FGM because some of them are being married off earlier because their parents maybe believe they are better protected if they are handed to someone who can actually feed them, take care of them. And in many scenarios, we know that comes with FGM. So it's it's sometimes one of the cases that it's not at first sight. So when we make the point of connecting the dots to show how even climate change and conflicts are affecting child .
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Speaker 3
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Speaker 3
Aid cuts. But I wondered if I could turn to you first, Jean, and ask your perspective. Yes. So this is obviously quite a different perspective from what we've been hearing about so far. I think the headline would be that the sort of rapid and unexpected cuts that we heard about earlier , overnight in the context of infectious disease.
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Speaker 3
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Speaker 3
Meant that research programmes, diagnostic labs, as we were talking about labs that have the lights, have the buildings, have the equipment, but now no longer have the funding to do those things that they were trained in, established to do, and no longer able to do that from sort of from one day to the next. And that has led to and will lead to sort of in scientific terms, two things. And one is an increase in the spread of antimicrobial resistance, because that important work in controlling those pathogens is no longer able to go ahead. And a reduction our ability to detect and identify outbreaks early on and control them before they get out of control.
So sort of as an example, to illustrate that first point. So I happen to be in South Africa in. February 2025 at a conference of microbiologists from all over the world. And my colleague Bhavesh Khan, who contributed, was there. And I remember a conversation with him. So he is an academic scientist based in South Africa, but he runs over 40 or ran over 40 clinical trials on TB. So over 30 clinical trials on TB across South Africa. And he told me that, you know, they'd got the announcement that their NIH funded grants would stop. So from one day to the next, those patients who were enrolled in those trials could no longer be treated.
And so, of course, these were research trials looking at sort of whether the disease is transmitted in households and so on. So they were studying research questions, but in fact, what they were doing was delivering healthcare. And TB is very difficult to treat. We have a limited number of drugs available, and you need to take a cocktail of drugs every day. And so what he told me was that from day one day to the next, these cohorts, these communities that they had established, trust worked with over long periods of time. They had the medicines in their freezers, but they could not administer them.
So these people had to go and look for treatment elsewhere. So what are the consequences of that? Of course, for the individual. treatment that's catastrophic there. TB is no longer controlled. In theory. They can seek treatment elsewhere. In reality that's not always available. So you'd have, you know, people sort of looking around trying to find desperately treatment where they can. TB you really have to be careful about using the right treatment.
So these individual.
So sort of as an example, to illustrate that first point. So I happen to be in South Africa in. February 2025 at a conference of microbiologists from all over the world. And my colleague Bhavesh Khan, who contributed, was there. And I remember a conversation with him. So he is an academic scientist based in South Africa, but he runs over 40 or ran over 40 clinical trials on TB. So over 30 clinical trials on TB across South Africa. And he told me that, you know, they'd got the announcement that their NIH funded grants would stop. So from one day to the next, those patients who were enrolled in those trials could no longer be treated.
And so, of course, these were research trials looking at sort of whether the disease is transmitted in households and so on. So they were studying research questions, but in fact, what they were doing was delivering healthcare. And TB is very difficult to treat. We have a limited number of drugs available, and you need to take a cocktail of drugs every day. And so what he told me was that from day one day to the next, these cohorts, these communities that they had established, trust worked with over long periods of time. They had the medicines in their freezers, but they could not administer them.
So these people had to go and look for treatment elsewhere. So what are the consequences of that? Of course, for the individual. treatment that's catastrophic there. TB is no longer controlled. In theory. They can seek treatment elsewhere. In reality that's not always available. So you'd have, you know, people sort of looking around trying to find desperately treatment where they can. TB you really have to be careful about using the right treatment.
So these individual.
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Speaker 3
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Speaker 3
Their disease is no longer controlled. Some of them the disease would have escalated and got much worse. There would also be increased onward transmission. So there would be greater spread in the community because their disease is no longer controlled. And over the longer term, we know that if you don't carefully control. bacterial your treatment regimen with antibiotics, those bacteria evolve to be resistant to those drugs. We're really limited to the number of drugs that we have available for TB. And so following up with Bhavesh six months, 12 months later, he tells me anecdotally, he starts to hear more and more cases of doctors when he's able to scramble together some money or come back to his cohort of patients six months, 12 months later, who had TB strains that at that time could be controlled by the available.
antibiotics and now are resistant.
antibiotics and now are resistant.
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Speaker 3
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Until this point you've been primarily talking about the US aid cuts. Is that correct? So the yeah. So I was talking primarily about the US cuts. But here I'm now talking about specifically because I want to talk a little bit and pivot and talk a bit about diagnostics and the importance of diagnostics. And an example I want to give, which I don't know if it's linked to USAID or Oda, but the recent Ebola outbreak, you may be aware, but it's been reported that one of the reasons why there was a significant delay was that the initial diagnostics were done using a test for a different species, and I don't know the reason for that.
Probably it's because that was the test that was available in the lab at that time. And so that patient tested negative, and it was only two and a half weeks later when the sequencing data became available, that it was confirmed as an Ebola case. Now , that means there was a two and a half week delay before it was recognised that there was an outbreak. And I think Doctor Kennedy can probably speak a lot more to that, to that particular case. So I'm not saying that that's directly linked, but I'm giving that as an. example of the importance of having these really.
Probably it's because that was the test that was available in the lab at that time. And so that patient tested negative, and it was only two and a half weeks later when the sequencing data became available, that it was confirmed as an Ebola case. Now , that means there was a two and a half week delay before it was recognised that there was an outbreak. And I think Doctor Kennedy can probably speak a lot more to that, to that particular case. So I'm not saying that that's directly linked, but I'm giving that as an. example of the importance of having these really.
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Speaker 3
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Where the diagnostics are good, the diagnostics are funded, and we're not just, you know, buying a PCR machine and dumping it somewhere and then walking away, but we're actually investing in the reagents that we need and the people training the people and making sure that there's that. continuity and that the. laboratories are well connected locally and regionally. And so because in reality, that's how outbreaks are detected, that there's an unusual cluster of cases and someone phones their colleagues, that they've got long term relationships with, that they've got these partnerships and they say, hey, I've got these cases.
Have you got these cases? And then you start to do an investigation. And so the sort of reduction of investment in that .
Have you got these cases? And then you start to do an investigation. And so the sort of reduction of investment in that .
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Speaker 3
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In data sharing and therefore knowledge. So is that something that you've experienced? So that's a little bit outside my expertise. So I don't know. But I wouldn't be at all surprised. And I could certainly comment that the consequences of that would be exactly what I'm saying, that if those data sharing networks are not .
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Speaker 4
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Reality of less global funding? Question. I think from from the. So I really can speak from Msf's perspective. And to be honest, we. Listening to the first session, listening to my colleagues here, we as MSF, end up seeing the sort of final. results of so much we've talked about today. So when there's been a lack of funding in that primary healthcare , in the family planning clinic in those labs, so many of those people end up on our doorstep as MSF. When we are still open, our lights are still on, we still do have supplies. And so, so often now we are really seeing that those.
opportunities for simpler, cheaper. Earlier health. interventions has been missed already. So we're sort of ending up and we're, we're collecting data and seeing how much our increases in admissions for, for children with.
opportunities for simpler, cheaper. Earlier health. interventions has been missed already. So we're sort of ending up and we're, we're collecting data and seeing how much our increases in admissions for, for children with.
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Speaker 4
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For women with, with complications. So we're really seeing really the final results of all of this. And it's a health ecosystem. We all we'd love a world where we didn't need an MSF, but we still do. And we know that we have different. organizations who partner with local. organizations different who partner with government. As MSF, we don't take any funding from governments, which does keep us more.
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Speaker 4
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But it doesn't mean that we're not part of that system. So we do start to see when other surfaces services are suffering. We're trying to scale up, but we can't fill all those gaps. So for us, in terms of what we're going to come back and ask the UK government for, we're not naive. And, you know, we know that it's not just the UK government funding cuts. We've seen. It's it's very. complex funding landscape. But I mean, my my specialty is nutrition. And so sort of my comfort zone to talk about that. And from my perspective, the UK government Fcdo has been an incredibly strong intellectual leader in nutrition from the first nutrition for Growth.
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Speaker 4
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But really protect that existing funding. We can't see. further breakdowns in these services which lead these people really falling at our door. But also to be, you know, you're known as a very reliable and responsible donor when it comes to nutrition. And so we, we ask to keep to keep that, keep that role and to sort of to keep standing up for those rights of people. So that's kind of what we are coming to you with. We also understand that a lot of the strategy is to invest in multilaterals. And that's, you know, that's that's been that decision.
But I think, again, with the evidence we had earlier about the importance of those local partners, but also that we really do ask that, again, that accountability for those. multilaterals is maintained from the UK government and asking the right.
But I think, again, with the evidence we had earlier about the importance of those local partners, but also that we really do ask that, again, that accountability for those. multilaterals is maintained from the UK government and asking the right.
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Speaker 4
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Little bit? What do you mean? Have you got any examples of that? So I mean, I've also worked in other UN agencies. So so it's what it means. It's so that we know when we're writing our donor reports, when we're reporting back to you, we really ask you to, to have the systems in place that would really allow an. interrogation of the data, the explanations you're given to really make sure that it's getting to exactly the people who are in need, that the action is being based on need,
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It's been taken away, support or aid has been taken away or overspent. Yeah. So I mean, again, for us, you know, as you a lot of, you know, malnutrition often isn't just about hunger. So often it's about this interplay of hunger and disease. And so if you have a child who's had multiple episodes of diarrhoea, hasn't been able to access care for that, which could have been simple. rehydration solutions and. monitoring that child can end up in our services really sick, really dehydrated with malnutrition. And those children are really complex to manage. I manage them myself.
They keep you up all night. They you have to use completely different protocols for malnourished than you do for the non malnourished. It's they're very, really, really complex cases. And also if that child just hasn't been vaccinated, there are so many places now that we're seeing measles.
They keep you up all night. They you have to use completely different protocols for malnourished than you do for the non malnourished. It's they're very, really, really complex cases. And also if that child just hasn't been vaccinated, there are so many places now that we're seeing measles.
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Speaker 4
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You know, and again, the interaction with measles and malnutrition is awful. You know, these kids are so, so unwell. And so we're seeing just those basic services which we could have stopped that kid coming to us. We're now seeing these peaks in our admissions into hospital, which again, like I said, by the time a malnourished child reaches one of our MSF hospitals, they're really sick, they're really sick, and there's so many things that could be done.
And even, I mean, at the moment for us in South.
And even, I mean, at the moment for us in South.
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Speaker 4
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We are seeing these. increases compared to previous years in our inpatient admissions. And so many of those children are less than one years old. And so that, again, for me speaks so much about the interaction with the mother's health and the mother's nutritional. status and that so much of those services as well have been broken down. You know, if we have young mums or we have mums who are not getting antenatal care, not getting good maternity care, postnatal care, malnourished.
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Speaker 5
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We already had. £1 million donations from the UK public. And it's also very interesting that the largest donations were solicited for our campaigns to provide life saving services in Gaza and the West Bank, and also on our birth kits. So it's quite wide. heartwarming to see how the UK public is responding to our to our appeals. And I think this also kind of. encourages you to, as. representatives of, of, of the people and to also. understand that it's very much aligned with, with what the public wants. It's a very the UK is a very generous public.
So we are .
So we are .
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Speaker 4
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Very thankful for this. extraordinary level of support. Can I just add one thing? I have much smaller numbers, but I was just going through some supporter numbers, just it was actually only 31. But it's so heartwarming to see the messages that we get from the British public. And so many of them increase their their contributions to MSF directly linked to funding cuts by governments, including the UK, but also from the US and other governments. And we really cited that as their reason. And and that's it's very heartwarming. You know, we know the British public are very generous in that way.
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Speaker 6
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And I'm going to focus on the countries that I'm working currently. Uganda saw an opportunity just the way others probably would have seen the opportunity to say, let's let's begin to look inward. Let's begin to do things a bit differently to be able to absorb the shock. So Uganda was moving more and more into integration of health services, bringing HIV programs into an integrated healthcare system and trying to, you know, mount some level of response to to absorb the shock. But different countries have got different. capacity to be able to, to, to, to do that.
And if you look at the scenario in Malawi. Malawi in with all its economic.
And if you look at the scenario in Malawi. Malawi in with all its economic.
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Speaker 6
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Speaker 6
It's not it wasn't that easy to really have that switch happening. And what that means is that there is a lot of. challenges at the primary health care level, all the way to the tertiary healthcare level and, and, and maybe very quickly to also talk about the fact that even though these opportunities are there and countries try to respond.
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Speaker 6
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But the suffering of the people is, is really there. And I give you an example. Jean was talking about the Fleming Fund withdrawal. And for us, the Fleming Fund withdrawal came even beyond the impact came even beyond the issue of the laboratory. One of my colleague I was talking with a few days ago told me as soon as that happened, the the district hospital where he was working could not produce lab results for for. 150 days, owing to the fact that even the system, the data management system of the lab. No. There was no one to.
To operate that. And even looking at provision of blood culture bottles, it was not there. So that created a lot of difficulties for health workers and for us as a team that is involved in research, we have a research component that involves. ethnographic approach, and Fleming funds were the ones who were actually. sponsoring those meetings. So in the technical working group meetings that we are supposed to go when implementing that research package, we go to those meetings just to observe how people who make decision on. antimicrobial resistance policy, how do they make those. decisions and where are the bottlenecks?
What are .
To operate that. And even looking at provision of blood culture bottles, it was not there. So that created a lot of difficulties for health workers and for us as a team that is involved in research, we have a research component that involves. ethnographic approach, and Fleming funds were the ones who were actually. sponsoring those meetings. So in the technical working group meetings that we are supposed to go when implementing that research package, we go to those meetings just to observe how people who make decision on. antimicrobial resistance policy, how do they make those. decisions and where are the bottlenecks?
What are .
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Sarah Champion
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Sarah Champion
Addressed in those decision making process? So now, can I, can I pause you there? Because we pushed the government very hard on this decision that the committee thought was wrong. We had a Minister of Health and an Fcdo minister here in front of us, and they both said that the scheme was always time limited, that this was the end of the first tranche and it was up to other governments to pick up the second phase.
Do you .
Do you .
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Speaker 6
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Speaker 6
Have any sympathy with that position? Well, really, every project is time bound. That's the truth. Every project is time bound, but it does not stop halfway. There's always a. transitioning process. Whether the government is going to take it over, there is a timetable to. transition it. That's what the type is, not just closed immediately. So that's the kind of thing we have seen where the type is closed and the the the core group meetings for Amr technical working group meetings, some of them are either not happening at all, or they've moved to being virtual occasionally.
And for me, as a researcher who wants to do an.
And for me, as a researcher who wants to do an.
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Speaker 6
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Speaker 6
To really be able to support and improve how decisions are made on, on, on, on Amr, I'm not able to do that anymore because there I need to be physical in a physical meeting where I watch the way people do things around. So this is just trying to bring out those. difficulties that have come with this , though countries are trying looking at this from the side of there could be opportunities to look inward. Being able to.
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And that this is where I strongly believe that the UK can champion a number of causes, right? Like the work we do, where we are. developing rapid approaches to. antimicrobial resistance. Surveillance is sponsored by the UK. It's already a very positive thing that is happening that has got real value for money, because we know that antimicrobial resistance is one of the biggest threats to public health at the moment, and surveillance is a key pillar to addressing antimicrobial resistance. So with this work we've just done, if if countries are empowered to be able to use rapid approaches that are affordable, to be able to, you know.
identify hotspots for antimicrobial resistance, be able to target, you know.
identify hotspots for antimicrobial resistance, be able to target, you know.
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Speaker 6
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Speaker 6
When you when you look at the the. workforce funding cuts also have affected, especially the frontline workers, community health workers, you you look at countries trying to. reprioritize those community health workers are far down on the list of. priority because those ones that were sponsored by projects previously, since they don't have funding, some of them are laid off and staff who were not trained previously to probably take care of HIV patients. I didn't want taking care of HIV patients. So on some occasions where they try to want to absorb those staff that were previously working under other projects, some of them stay very long without salary.
And for every human being who works in a in in a low and medium income country, there are chains of people who depend on that person. So it's just a chain effect of things that that ends up, you know, happening from just one event. So this is just how I think the UK can come in, support countries. leverage on those.
And for every human being who works in a in in a low and medium income country, there are chains of people who depend on that person. So it's just a chain effect of things that that ends up, you know, happening from just one event. So this is just how I think the UK can come in, support countries. leverage on those.
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Speaker 6
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Speaker 6
Champion them. And lastly, just to conclude very briefly, please. I strongly believe resources can be leveraged. There are other donors who are making effort, and the UK can also can also leverage on those resources. The UK has got the technical know how for research. The UK has got the ability to provide technical .
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Speaker 4
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Speaker 4
Fragile or conflict. affected states? I think it's sort of relating to what Kennedy was saying, in that so many of the places that we're working in as MSF. Yes, we would love that domestic financing or the the that ownership to take to happen, but it can't happen overnight. And especially in those areas where we were. And if we if we be honest about in Yemen at the moment, they're not ready. They can't take over the health system. They can't sort of switch in Afghanistan. It's the same. Those places where I'm afraid there is still the need for MSF.
Yes, for sure, that would be a long term goal, but that's not the reality today. And the reality today is us having to add another 50 beds into our. inpatient ward for malnourished children. And it's not it's not an easy task. And so I think that's it's there is so there are opportunities. And we see that and there are opportunities with UN reset and efficiency. But there are just so many contexts where we can't expect that to happen overnight.
And and so then we, you know, we do need the .
Yes, for sure, that would be a long term goal, but that's not the reality today. And the reality today is us having to add another 50 beds into our. inpatient ward for malnourished children. And it's not it's not an easy task. And so I think that's it's there is so there are opportunities. And we see that and there are opportunities with UN reset and efficiency. But there are just so many contexts where we can't expect that to happen overnight.
And and so then we, you know, we do need the .
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Speaker 3
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Speaker 3
We're like wildcats. We get to do what we want. No one tells us what to do or who we work with. So you only enter into a. partnership if both parties are going to get something from it. And so the way collaborations really work, whether it's with someone in the US or with someone in Nepal, it's because both parties are getting something from it. And generally they're long term collaborations. You design a project together, you write a project together, you develop a grant together. I'd say the cuts and the loss of Newton funding and global challenges research funds has made it more difficult to establish those sorts of partnerships.
But one example that I would also speak to very quickly is we bring in students from Lmics and from other countries. And so I've just got a new MPhil student who started yesterday from Bangladesh, and he is absolutely. fantastic and sort of equivalent to to the other master's students that we have and have a very, very competitive program. And it's exciting having someone like that here in Cambridge for a year, because he will come, he'll do great things. He'll probably go on and do a PhD, have an international career, may go back to Bangladesh, may work internationally.
But through his time in Cambridge, he will build. networks both with me in my lab but importantly, with his cohort. They will all go on, become international scientists. And that's somewhere I think we really have a way of just sort of scientists, scientists investing in the next generation. And that's something I think science really lends itself bottom up to building these really solid. foundational long .
But one example that I would also speak to very quickly is we bring in students from Lmics and from other countries. And so I've just got a new MPhil student who started yesterday from Bangladesh, and he is absolutely. fantastic and sort of equivalent to to the other master's students that we have and have a very, very competitive program. And it's exciting having someone like that here in Cambridge for a year, because he will come, he'll do great things. He'll probably go on and do a PhD, have an international career, may go back to Bangladesh, may work internationally.
But through his time in Cambridge, he will build. networks both with me in my lab but importantly, with his cohort. They will all go on, become international scientists. And that's somewhere I think we really have a way of just sort of scientists, scientists investing in the next generation. And that's something I think science really lends itself bottom up to building these really solid. foundational long .
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Speaker 9
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Speaker 9
Tulip Siddiq to our committee. New member. Over to you, tulip. Thanks, Monica. You've already mentioned this role back on writes in a previous answer. And really, I just wanted to ask you a bit about how have you experienced this in your world work across the world, but in particular, just to focus on how has it. affected .
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Speaker 5
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Speaker 5
It's very, very important. And I think that we come from three different backgrounds. Kennedy and so forth. And I think that's really if I could. highlight a key takeaway that I would like this committee. It's the ecosystem. We are all working in an ecosystem. The fact that I don't have money to deliver supplies, or as I've mentioned in a previous hearing, sometimes we don't have the money to bring the ships to dock or to deliver on the last mile . That's affecting the civil society. organizations that downstream depend on us to getting them the supplies. It's really and also, Kennedy was highlighting that the the worth the health workforce.
And we we have been terminating. contracts with, with some of our.
And we we have been terminating. contracts with, with some of our.
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Speaker 5
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Speaker 5
But they do need skilled attendants. And this goes very much to, to the question on, on the rollback. So what we are witnessing is a bit all over the world language being challenged. And we heard Natasha saying that in certain places, the. expression sexual reproductive health and rights has become too politicized. I prefer to toxified because everything is political, but it's mainly the question on rights because it broadens the scope of. services that you actually need to provide. Because we are when we talk about rights, we also talk about if you have a right, it means someone has the duty of fulfilling your right.
And I think that's part of the conversation. We are in some places, we are seeing the rights being narrowed, either because there was a cut, either because there's an ideological position on some of the rights that are set on the table, and I'm not going to make any comments on that, but I think if I could say , what we fear is that with the rollback on rights, the agenda will be. compromised and we will have bigger difficulties in fundraising for certain programs like that are included in our. So if I can just say, just for very quick.
And I think that's part of the conversation. We are in some places, we are seeing the rights being narrowed, either because there was a cut, either because there's an ideological position on some of the rights that are set on the table, and I'm not going to make any comments on that, but I think if I could say , what we fear is that with the rollback on rights, the agenda will be. compromised and we will have bigger difficulties in fundraising for certain programs like that are included in our. So if I can just say, just for very quick.
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Speaker 5
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Speaker 5
We need academia. We need the media. We need. parliamentarians on this. And my last claim would be make consequences visible. I'm not talking about. Political arguments. They often seem abstract. And this is why a commission like this one, when you ask us to come here and tell you that due to the cuts, we had to close over. 10,000 health centres, that.
260 safe spaces were closed, that over 11 million women and girls lost access to services. This is what it looks like. The rollback on rights and sometimes the rollback on rights also .
260 safe spaces were closed, that over 11 million women and girls lost access to services. This is what it looks like. The rollback on rights and sometimes the rollback on rights also .
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Speaker 5
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Speaker 5
It's a permanent member of the Security Council. It's a leading voice. It has an. extraordinary diplomatic network. And I think that the message has to be very clear. These rights are non-negotiable. These rights are red lines as strong as. economic rights or access to certain markets. And that would be what I would really ask from from the UK, and also that you invest your.
expertise in supporting some of our countries, some of our.
expertise in supporting some of our countries, some of our.
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Speaker 3
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Speaker 3
Impact of that is on achieving our global health goals? So honestly, that's something I've got less direct experience. I don't really want to comment on that, especially since we're short on time. The only I would say is there's organisations such as Find the Foundation for. Innovative Diagnostics and Neglected Diseases or something, and that's an example of an organization I have worked with , helps, you know, give advice and helps various academics develop diagnostics and for neglected diseases and get them out in the field. That's an example of an. organization that has rapidly contracted and is at risk of.
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Speaker 6
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Speaker 6
Anyone else briefly like to come in on this from the panel? Well, I can just a few statements, mainly from field experience. If you look at countries and how ministries of health needs to be supported in terms of standards, W.H.O. plays that role. supporting countries based on making sure that the standards are there and they are adopted contextually. One example is when you look at emergency.
preparedness plans against pandemic. Another one is the National Action Plan on.
preparedness plans against pandemic. Another one is the National Action Plan on.
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Speaker 6
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Speaker 6
These are all standards that WTO brings in. But with the funding cuts, we know that they have also reshaped the way they operate in terms of having personnel to actively do this. And I do think W.H.O. needs to be supported in that regard, not just W.H.O.. Unicef is there as well, really looking at issues related to children under fives. And, and, and I do think that these.
Multilaterals need to really be supported to continue to do their work in terms of. supporting that level of standards.
Multilaterals need to really be supported to continue to do their work in terms of. supporting that level of standards.
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Speaker 3
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Speaker 3
Has got a very strong role in this regard. Right. If I could just make a quick follow up, because you mentioned standards and I didn't get to answer any questions about the strengths of the UK, but we're particular leader in the development of standards and reference. And so. Nibsc is something I mean, we provide over. 95% of those references and standards that the W.H.O. recommends. And so this is an area which I think the UK is already a huge leader is so important in the developing. It's the sort of boring, unglamorous stuff. But on your Covid test, the bottom line is, the one you don't want to have on the top line tells you the test is working.
And without that top line, you know, you have no idea what you're doing. And so that's something where the UK has .
And without that top line, you know, you have no idea what you're doing. And so that's something where the UK has .
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Speaker 5
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Speaker 5
And member States. We believe that a man is in charge of that. We went through we went through a long process. I know the Committee has followed. I know the Committee has raised the issue with with several with several ministers. And we thank you for for the attention, because it shows that you actually care about the mandates of both agencies. So what happened was that the the executive boards of both. organizations decided they didn't have enough. information to support the merger. And when women and NFP are working on areas of collaboration where we can still move forward with the.
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Speaker 5
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Speaker 5
With the. rationalization of purposes and, and, but but we are waiting for further guidance. As far as we know, the Secretary General and member States now own the process, and we are very keen. Our. We are very keen to support, as it was said here in the in the hearing, we know the UN needs to be fit for purpose. We know the UN needs to reform. We celebrate it on.
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Speaker 5
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Speaker 5
81 years. The UN in a slightly younger. But this means that the processes that were set in place no longer fit. You know we are doing the best we can and the UN has reformed. You know, I don't like this idea of looking at us as if it was October 1945. Everything has changed. A lot has changed. But we do understand that we need to rebuild this kind of social .
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Sarah Champion
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Sarah Champion
With with the people we serve, and we are very keen. Can I step in here? I'm aware that you're in the midst of this. And so you're giving us a beautiful political answer. But can I just say that I am absolutely. incensed that when there was the. opportunity for the Secretary general to reform the UN, the two. organisations he went for out of the couple of hundred that there are, were the two that give very specific services to women that are very small. organisations that have two completely different tasks. And for us to lose the only, you know, 51, 52% of the.
population to lose the only two specific. organisations for our needs which are. documented are very, very under met. I think it was an.
population to lose the only two specific. organisations for our needs which are. documented are very, very under met. I think it was an.
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Noah Law
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Noah Law
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Speaker 4
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Speaker 4
I have seen a bit of the sausage factory, but, you know, there are so many people in country offices in those UN organisations doing an amazing job, working really hard, working with their government counterparts, supporting them. And I think that's really admirable. And that needs to go on. I think, yes, some I think how we see it in MSF is that what we would love to see? And again, I'm sort of speaking to a smaller sort of vision of the child, but sometimes we feel like some of the the mandates and the territories of UN.
organization mean that the child and the mum have to fit in with them, rather than turning around and saying, what does this mother and child need? And they can't come back next Tuesday because it took half a day to get there. So is there a way to think about some reform that actually speaks to let's try and do everything we can for this one child. And again, we've talked about HIV and TB a lot and that such a strong link for us within malnutrition as well. So that again, just looking at all those services, could we could we think about reforming into what that I mean, again, I'm biased about the mother and child, but what they need rather than we'll serve this and will serve this and will serve that.
And you all kind of fit in about our funding and our, our, and our mandates. And just the final thing, you know, especially when we are in this hyper prioritisation, when we are seeing stockouts of therapeutic foods everywhere, and we hear that one organization, one agency can't transport this type of therapeutic food because it's not their mandate. It does worry us.
organization mean that the child and the mum have to fit in with them, rather than turning around and saying, what does this mother and child need? And they can't come back next Tuesday because it took half a day to get there. So is there a way to think about some reform that actually speaks to let's try and do everything we can for this one child. And again, we've talked about HIV and TB a lot and that such a strong link for us within malnutrition as well. So that again, just looking at all those services, could we could we think about reforming into what that I mean, again, I'm biased about the mother and child, but what they need rather than we'll serve this and will serve this and will serve that.
And you all kind of fit in about our funding and our, our, and our mandates. And just the final thing, you know, especially when we are in this hyper prioritisation, when we are seeing stockouts of therapeutic foods everywhere, and we hear that one organization, one agency can't transport this type of therapeutic food because it's not their mandate. It does worry us.
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Sarah Champion
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Sarah Champion
Want to see those supplies getting to where they need to go to. I build on that with a question to all of you. If I could just have a one line answer, the previous development minister told us that she was. gambling on multilateral investment, and she was putting basically the majority of her chips into that. You've all described very well that it's an ecosystem.
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Sarah Champion
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Sarah Champion
I would be going for a spread bet on this, rather than just urging. Multilaterals to do the right thing. The world Bank has also expressed. concern over the decision that we've made to invest so heavily in multilateral banks. So is it something that you see as. creating gaps in the areas of health that your. organization specialise in? So the fact that there is less bilateral money, less direct intervention that countries like the UK .
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Speaker 4
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Speaker 4
Thank you. I think the other aspect with MSF is that often we end up in areas where there aren't any. multilaterals where they can't. access or they're unable to. And so we don't want to be telling anybody else what to do. It's just that we want to be the ones who are bearing witness. When we see that there are some patients, some communities, who are falling through those cracks and that we are there in those areas and seeing where it's not working. So as I said, we see we work, we want to work with people as best we can.
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Speaker 5
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Speaker 5
Well, first of all, there's a commitment made by the by the. humanitarian system, the grand bargain that aims to reach 25%. It means. 25% of our spending should go through local and national organisations. We've exceeded it. We we are delivering about. 38% of all our funding through national ads and and through local.
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Speaker 5
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Speaker 5
We just signed an agreement with the African Development Bank in order to to include maternal health as one of the top. priorities of the bank. And we just supported Bangladesh. That just. renegotiated an agreement with the with the European Investment Bank to repurpose alone the head of 250 million. That's now going to be. relocated to women's health and strengthening and strengthening the national health system in Bangladesh. 25 new. 25,000 new midwives are going to be trained in Bangladesh. So we are working with the financial. institutions also to. position the maternal health agenda, the mother and child survival agenda, because we also see it as an integral component of the work we do.
So it's a. challenge because we need to be constantly adapting,
So it's a. challenge because we need to be constantly adapting,
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Sarah Champion
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Sarah Champion
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