1. Slide 1 Dr Jenny Amery, Chief Professional Officer Health and Education, DFID Wales for Africa Health Links Conference 7 July 2011 What can UK Health Workers contribute to International Development ?

2. Slide 2

3. Slide 3 Who’s who Secretary of State –Rt Hon Andrew Mitchell (May 2010 – present) Minister of State –Alan Duncan (May 2010 – present) Parliamentary Under Secretary of State –Stephen O’Brien

4. Slide 4 DFID Context Structural Reform Plan Departmental Priorities: –Honour the UK’s international commitments and support action to meet MDGs –Wealth creation –Governance and security - and especially conflict and stabilisation. –Climate Change –Humanitarian assistance Key issues:: –Value for money – effectiveness in reducing poverty –Focus on the vulnerable : eg women and girls –Use and generation of evidence for action –Innovation / private sector –Results, tracking and monitoring –International system and partnerships

5. Slide 5 Aid review process Bilateral Aid Reviews –Proposed results from each country with funds and justification –Ambitious –Focused on results that DFID will deliver –Consistent with decentralised country led approach, working with others –DFID focus on 27 countries, 3 overseas territories and three regional programmes

6. Slide 6 Aid review process Multilateral Aid Review –Evaluation against explicit criteria to assess value for money –Critical role in meeting development objectives –Attention to cross-cutting issues e.g. gender –Focus on poor countries –Contribution to results –Strategic/ performance management –Financial resource management –Cost and value consciousness –Partnership behaviour –Transparency and accountability –Likelihood of positive change

7. Slide 7 MAR – Value for money findings

8. Slide 8 Aid review process Humanitarian and Emergency Response Review Chaired by Lord Ashdown – Anticipatory approach – Building resilience –UN reform to strengthen global leadership – Innovation, including new technologies – Accountability – Protect the humanitarian space – Partnerships

9. Slide 9

10. Slide 10 Deliver frameworks for results and evidence papers Commitment to results –Malaria: contribute to reduced mortality of at least 50% in at least 10 high burden countries backed by spending of up to £500m p.a. by 2014/15 –Reproductive,Maternal and Neonatal Health: prevent 50,000 maternal and 250,000 newborn deaths, 10m new FP users. With USA/Australia/Gates Foundation contribute to RHSC goal of 100m new FP users –Undernutrition: 10 million children under 5 reached by nutrition programmes

11. Slide 11 Choices for women: planned pregnancies, safe births and healthy newborns The UK’s Framework for Results for improving reproductive, maternal and newborn health in the developing world Launched - 31 December 2010

12. Slide 12 Unable to choose: Unmet need for family planning source: White Ribbon Alliance, Atlas of Birth, 2010 Uganda (40%) Rwanda (38%) Ethiopia (34%) Ghana (34%)

13. Slide 13 source: White Ribbon Alliance, Atlas of Birth, 2010 The 15 least developed countries that have been affected by conflict during the years 2000 to 2006 have worse indicators than non- conflict affected countries 11 countries account for 65% of maternal deaths – including India, Nigeria, Ethiopia, DRC, Afghanistan, Bangladesh, Pakistan, and Tanzania

14. Slide 14 The UK’s support will have saved the lives of at least 50,000 women during pregnancy and childbirth and 250,000 newborn babies: At least 10 million more women can use modern methods of family planning, contributing to a global total of 100 million through partnerships; Up to 1 million young women aged 15–19 to access family planning with wider action for adolescent girls that enable them to delay their first pregnancy; More than 5 million unintended pregnancies prevented. At least 2 million safe deliveries, with long lasting improvements in access to quality maternity services, particularly for the poorest 40%. Focus on results by 2015

15. Slide 15 Pillars of the Framework Women and newborn lives saved, more women using family planning Unintended pregnancies prevented, safe deliveries Target groups: Adolescents, the poorest, those affected by conflict and natural disaster. Pillar 1 Empower women and girls to make healthy reproductive choices Education, information, economic assets Legal frameworks Women’s groups Social change Pillar 2 Remove barriers that prevent access to services, particularly for the poorest and most at risk. Pillar 3 Expand the supply of quality services delivering cost effective interventions for family planning, safe abortion, antenatal care, safe delivery and emergency obstetric care, postnatal and newborn care – through stronger health systems with public and private providers Pillar 4 Enhance accountability for results at all levels

16. Slide 16 Malaria Framework for Results Launched 31 December 2010 Headline goal –contribute to reducing mortality by at least 50% in at least 10 high burden countries Resourcing –backed by spending of up to £500m p.a. by 2014/15 Delivery –Bilateral, multilateral, research and global public goods

17. Slide 17 Malaria deaths and cases in Africa - source GMAP 2008

18. Slide 18 The Burden of Malaria Estimated 225 million cases and 784,000 deaths globally 2009 85% cases & 89% deaths in SSA 20% of child deaths in Africa Rural Ghana malaria treatment costs >33% poor household income 0.55% reduction in SSA annual growth (up to 1.3% in high burden countries)

19. Slide 19 Malaria Framework for Action Improve quality of services  Scale up what works in different places  Build stronger systems  Link health and non- health services to maximise value for money and ensure sustainability

20. Slide 20 Malaria Framework for Action Increase access & build demand for services  Extend reach through public and non-state channels  Remove financial and other barriers to access  Improve choice and responsiveness of services  Increase community knowledge, demand and participation 40% – 80 % care in private sector Wider coverage and better supply chains Variable affordability, product selection and quality AMFm to improve ACT coverage, accreditation, social franchising, community oversight, demand side financing

21. Slide 21 Malaria Framework for Action Increase access & build demand for services  Extend reach through public and non-state channels  Remove financial and other barriers to access  Improve choice and responsiveness of services  Increase community knowledge, demand and participation Stop stock outs campaign

22. Slide 22 Malaria Framework for Action Support innovation & global public goods  Support evidence based global norms and policy  Contain resistance to drugs and insecticides  More efficient global markets  New products and delivery platforms  Research and innovation Emerging ACT resistance in SE Asia

23. Slide 23 Malaria Framework for Results: Principles Focus on high-burden countries in Africa and Asia Emphasis on value for money – do what works, innovate where needed Achieve demonstrable impact for the poorest and most vulnerable Ensure impact is sustainable Embed in health systems, address non-health sector drivers and deliver wider benefits Enable and ensure that the international system delivers on malaria

24. Slide 24 The 20 countries with the highest burden of undernutrition. Countries with stunting prevalence ≥ 20% in children under the age of five years that together account for > 80% of the world’s undernourished children. Colour denotes region. Source: Lancet Series on Maternal and Child Undernutrition, 2008.

25. Slide 25 Direct and indirect interventions Direct Interventions Vit A supplementation Therapeutic Zinc Iron and Folate Support for breastfeeding Nutrition education Treatment of infections Treatment of severe acute malnutrition. Indirect interventions Health systems strengthening Social protection Agricultural devt Water and sanitation Gender equality Girls education Governance

26. Slide 26

27. Slide 27 DFID Health advisers competencies Knowledge and application of public health and epidemiology Understanding global context including aid architecture Knowledge and experience of health service delivery in developing country Knowledge and application of wider determinants of health Knowledge and application of relevant evidence, innovation and results All advisers: Aid and instruments; research,analytical and statistics skills; economic literacy and value for money; evaluation and results

28. Slide 28 DFID’s work in Health will Continue to be underpinned by a strong Health Systems Strengthening focus Reach out to take account of the determinants of health (water, sanitation, nutrition, poverty, education) Build evidence, strengthen knowledge, challenge boundaries. Focus on the poorest (in terms of countries and communities within countries) Fragile and conflict affected states.

29. Slide 29 Other areas of continuing/ growing focus HIV and AIDS (especially prevention) Health financing and removing financial barriers (access) Improving the quality of health services Continued focus on vulnerable people/groups Increased focus on reaching the poorest (cost) Health workers and workforce On-going priorities: NTDs, children, immunisation, pneumonia, TB, Polio eradication, climate change impact Non-communicable diseases; mental health

30. Slide 30 The Future of Aid Recognising the impact of climate change on vulnerable populations Resource scarcity: food, water, energy, land

31. Slide 31 Figure 3: Impact of Climate Change on Agricultural Productivity in 2080 2008, Hugo Ahlenius, UNEP-GRID-Arendal (source: WR Cline, 2007, Peterson Institute, Washington DC, USA) Climate

32. Slide 32 The Future of Aid Recognising the impact of climate change on vulnerable populations Resource scarcity: food, water, energy, land Population growth, numbers ageing, urbanisation

33. Slide 33 8. Urbanisation

34. Slide 34 The Future of Aid Recognising the impact of climate change on vulnerable populations Resource scarcity: food, water, energy, land Population growth, numbers ageing, urbanisation Future location of poverty in middle income countries

35. Slide 35 Future location of Poverty – the new Bottom Billion

36. Slide 36 The Future of Aid Recognising the impact of climate change on vulnerable populations Resource scarcity: food, water, energy, land Population growth, numbers ageing, urbanisation Future location of poverty in middle income countries Changing financial and political powers: BRICs, G20 Aid flows to developing countries increasingly dwarfed by financial investment, remittances, Changing global partnerships and UK role

37. Slide 37 www.dfid.gov.uk THANK YOU