International Development Committee

Oral evidence: Sub-Committee on the Work of the Independent Commission for Aid Impact Reports- Child Mortality in Kenya; and Rapid Review of DFID’s Humanitarian Response to Typhoon Haiyan in the Philippines, HC 405
Wednesday 25 June 2014

Ordered by the House of Commons to be published on 25 June 2014.

Watch the meeting Wednesday 25 June

Members present: Fabian Hamilton (Chair); Fiona Bruce; Sir Malcolm Bruce; Sir Tony Cunningham; Jeremy Lefroy; Fiona O’Donnell

Questions 1-70

Witnesses: Graham Ward CBE, Chief Commissioner, Mark Foster, Lead Commissioner, Lynne Elliot, contractor team leader, Kenya, and Stephen Blakeley, contractor team leader, Philippines, ICAI, gave evidence 

Q1   Chair: Good morning, ladies and gentlemen.  Welcome to this Sub‑committee on ICAI.  We are discussing two very important issues: Kenya and the Philippines.  Can I first ask you to introduce yourselves very briefly? If there are any opening remarks you want to make, please tell me.  Mr Blakeley.

Stephen Blakeley: I am Stephen Blakeley.  I am part of the ICAI team, and led the Philippines Review.

Mark Foster: I am Mark Foster, Commissioner, and I was the Lead Commissioner on both of the reports we are discussing today.

Graham Ward: Graham Ward, Chief Commissioner of ICAI.

Lynne Elliot: Lynne Elliot.  I was one of the team members for the Kenya Report.

Q2   Chair: Lovely.  Any opening remarks you want to make, Mr Foster, as you were the Lead Commissioner?

Mark Foster: I believe we are going to be starting by talking about the Kenya Report.  I do not think we have any particular opening remarks other than to say this report obviously was an overall green-amber report, so we had an overall positive view around the wider impact that DFID was having with regard to child mortality in Kenya.  At the same time, we identified some areas where we felt there was more that could be done.   That is the summary picture.  We also felt that overall DFID has been doing some good things globally with regard to policy in this area as well, but now the challenge is on particularly focusing on health system strengthening in a place like Kenya.    

Q3   Chair: That coincides with the current report of the International Development Committee.  In your report you recommend that DFID should focus on health system strengthening.  How should DFID do this, given that it does not finance the Government of Kenya directly?

Mark Foster: We certainly see a number of situations around the world where DFID is working in the health arena but not actually able to work directly with Governments.  In our work in Burma and our review of health in Zimbabwe, we saw two situations where we really cannot work directly with the Government, but through careful interventions and the creation of the right kinds of strategies, we are able to lead to the strengthening of those systems by having the right balance particularly between commodity-based and service-based interventions.

In the case of Kenya, it is obviously a very well-developed marketplace and is a country that has a huge amount of experience of donors trying to work in the health sector.  Our sense is that DFID’s ability to bring its expertise to bear with regard to strengthening in the Kenyan environment, even though it is not working with the government, should be much greater than it has been. 

Q4   Chair: You say that it is inconsistent for DFID to fund multilateral organisations that finance the Government of Kenya when it has decided not to provide such financing itself.  How can DFID address this without further reducing its capacity to strengthen Kenya’s health systems?

Mark Foster: We do respect the fact that DFID does try to find some good partnerships to work in the absence of working directly with the Government.  In the case of this particular programme, the use of WHO to work effectively with some of the county-based structures was a strong and positive use of partnerships.  We see a window of opportunity for DFID insofar as they are not able to work so directly through the central Government to interact with the emerging county organisations in Kenya, for which health is a major priority.  There are definitely openings for DFID to work with them on strengthening their capacity. 

Q5   Chair: As you say, the Government is devolving health care to local and regional government, but surely that is a move that actually risks weakening health systems.  You do suggest a number of ways that DFID can handle the risk, but are you satisfied with their response?

Mark Foster: I think there is more that they can do.  We do appreciate the fact that DFID has tried to work with WHO and other organisations to influence, if you like, and de‑risk what has happened with regard to health in the counties.  The fact of the matter is, though, that the speed of the implementation of that structure, the way the money flows and the financial management structures that sit in place behind that move to devolution raise huge risks for the health delivery services.  One of the things we think DFID should be doing is putting a particular focus on having very strong feedback mechanisms on what is happening to the effective delivery of services in these counties as the new model rolls out, and being able to flex its response as it sees potentially key indicators dropping off as county structures prove inadequate. 

Q6   Sir Malcolm Bruce: This report has a slightly interesting insight into those dynamics of ICAI versus the Committee.  As you know, we had our first evidence session yesterday on strengthening of health systems, and it would be helpful to get your input into that on the basis of what you have learned.  You have looked at Zimbabwe, Pakistan and Burma; we have been in Ethiopia, Sierra Leone and Liberia in recent times.  The interesting thing that came out yesterday is that you have these vertical funds; you are trying to build up health systems and you are trying to make sure that they both work in the same direction rather than undermine each other.  Do you feel that you have got ideas on how health system strengthening could work in the light of what you have seen and heard? 

Mark Foster: The heart of this review was trying to understand particularly how we saw these vertical interventions from GAVI and the Global Fund interacting with the broader health strengthening agenda on the ground.  What we saw was that system trying to work towards a more coherent and co-ordinated approach, but the reality is it still remains somewhat disjointed.  We believe that DFID are particularly strong in terms of their intellectual leadership with regard to health system strengthening and their research base.  To some extent, as we said in the report, our sense was that because of some of the challenges of who they can work with and through at the moment, they have been pushed towards perhaps more working with the vertical interventions than working on these more system strengthening interventions, which we think play to their natural strengths. 

Q7   Sir Malcolm Bruce: The point made to us yesterday was that it is almost as if there is a contradiction between DFID’s central policy on health and its bilateral programmes.  The bilateral programmes strengthen the health systems, the central policy delivers the outcomes from the vertical, and the question is really whether or not they come together or undermine each other.  It would be helpful if you could give us a memo on what you found informs that, because it is very timely in terms of our current Inquiry.  Also, you mentioned the local government devolution and some reservations that you had about it.  Again, we have seen, certainly in Ethiopia and elsewhere, that community health workers can be a very effective part of strengthening the system.  They cannot deliver it all, but they are the first point of contact.  Do you see that as the case, or are you just worried that the local government capacity is not good enough?

Mark Foster: We see as much of an opportunity in the county structures as a challenge.  The opportunity to be closer to the individual situations in each place, and organise health interventions around that particular circumstance and context, is really important.  One of the big challenges with Kenya is the huge disparity of outcomes in different parts of the country.  If the county structure can be more targeted to making sure that it is responding to those health issues in that county, it is a way to deliver better results.  It is also a chance to be close to communities and use that feedback mechanism to drive the interventions.

Q8   Sir Malcolm Bruce: It would be helpful if you could draw the threads from the inquiries you have done together, in the light of our Inquiry.

Graham Ward: We certainly could do that.  Lynne had something to add as well, if we may, Chairman.

Lynne Elliot: One concrete example of good dovetailing was that DFID had strengthened systems for malaria through the bilateral programmes.  DFID provided support for a malaria strategy, which then other donors and funders could gather around so that there was a more strategic and cohesive approach to malaria.  This then tailed in with the other programmes like the Global Fund and GAVI.  DFID gave that focus through the bilateral programmes.  That was a concrete example of where it had used the system strengthening.

Also, DFID was very key in the multi-stakeholder group in Zimbabwe.  This is a key way that DFID could use its influence and support, as it was doing in Zimbabwe, to really galvanise a more strategic focus around health.   

Q9   Fiona O'Donnell: You recommend that DFID develop a clear exit strategy for funding basic supplies in Kenya, such as bed nets, and focusing on health systems instead so as to ensure recent gains in child survival are sustainable.  There are two parts to my question; first, are you satisfied with the response from DFID?  Also, Lynne, given your comments that part of fighting malaria has been about strengthening health systems, it is clear from the Malaria Consortium’s work that, where we see any stepping back in terms of spend on malaria, the disease very quickly increases in its incidence.  Does your recommendation not put at risk some of the benefits and gains that we have made in Kenya in terms of malaria?  

Mark Foster: DFID’s response rightly points out some of the risks there are in inappropriately ceasing to support some of the commodity-based interventions, because in all those cases, you are absolutely right: any gain that is made has to be continually redone in terms of the next generation—the inoculation of the next generation.  Our view is that there needs to be an appropriate structure for maintaining continuity in that part of the system, but the overarching message we have is that that is only part of the solution.

The other part of it is about putting the systems in place that will wrap around those interventions, because the other part of sustainability is that the system itself is able to manage itself.  Some of the challenges that DFID has faced by the way it has had to approach work in Kenya, particularly now, is the creation of parallel systems alongside government systems as opposed to supporting the development of government capacity, and particularly government capacity at the different levels, district and below.  Our sense therefore, in terms of exit, is yes, DFID should carry on, but should be thoughtful about transitioning its focus, but there are many others who could focus on spending their money and their competency around the vertical interventions, and DFID could use its real strength to be the binding force around system strengthening. 

Q10   Fiona Bruce: In your report you recommend that DFID should specify its policy on equity more clearly so that it is clear why resources are targeted as they are.  DFID’s response states that its reproductive, maternal and new-born health framework already includes guidelines on equity.  Do you think this is sufficient?

Mark Foster: I start off by saying that we certainly see that there was a high disparity in the health outcomes in a place like Kenya.  We saw evidence of the local programming team doing some good work to flex their responses to where they saw the greatest need; for example moving resources to the slums in Nairobi as much as working in particular far‑flung regions.  Our sense was, though, that to some extent that was a fairly locally based initiative around that as opposed to a clear, more policy-led approach to how to think about the more disadvantaged and difficult parts of the health system more generally.  Our feeling is having looked at the guidelines that do exist from the centre, which we have seen recently, although they raise some important parts of the solution, our overall sense is there could be much more done to really make it clear why DFID chooses to work in certain places, and to make sure that that is really matching where the biggest needs are. 

Q11   Sir Tony Cunningham: You said DFID programmes have had a substantial impact on reducing under-five mortality in Kenya.  Are you satisfied that DFID could not have had a bigger impact by focusing on neglected areas such as neonatal health?  How well do you think DFID considers factors such as unmet needs and cost-effectiveness in allocating its health spending?

Mark Foster: We did identify the neonatal area as one where we thought of increased and further focus.  Lynne, it might be a good idea if you comment on that, given your experience.

Lynne Elliot: This is an area that has been neglected not only in Kenya but in many other countries as well.  I believe this is a key area, and certainly this very much ties in with the issue of quality of services.  So rather than looking at simply just coverage of services, which is important, it is really ensuring the quality of services.  We believe that is where the focus should be: that the quality of those services available to women are of the right standard.  That means having the right staff in the right place at the right time with the right skills, and not only medical skills but other skills such as communicating with the women and treating people with respect.  All of these things make perfectly common sense, but are not always common practice. 

Mark Foster: One particular focus of our review was to do a fair amount of beneficiary voice work by talking to mothers who had recently gone through the system.  The clearest message out of that was that, while access to services had clearly been a big focus and had improved, the quality and some of the experiences of those services when they actually accessed them were in some cases extremely disappointing and clearly life-threatening in some cases, and very disturbing.  Our big focus, which particularly hits the neonatal problem, is that point when they come back after the initial system has worked its way through.  If they have actually had terrible experiences—

Fiona Bruce: They will not come back.

Mark Foster: They will not come back.  As a result of that, you do not get that indicator moving.  If you look at the indicators, they have stayed stubbornly flat on neonatal in Kenya.

Q12   Sir Tony Cunningham: It is a similar situation in education, where you get the numbers in, but do you really get the quality?  We found that DFID Kenya was not aware of all DFID projects under way in the country.  Obvious question: how can DFID make meaningful decisions on priority projects if it does not have a complete picture?  Incidentally, we were in Sierra Leone recently, and we found a similar situation there.  Have you found other data gaps in your work in other countries?

Graham Ward: We have.  For example, we have also found that in DRC.  What we find is there are situations where decisions are taken in the centre that something should be done.  The centre of DFID then enters contracts with delivery agents within a country, but there is no full liaison or even exchange of information with the local country office.  You may recall, Chairman, from when we were responding on the European Union work that is funded by DFID, there were similar issues there.  Things were being done in the same area, but there was no real effective co-operation between the two.  Clearly that must reduce the effectiveness of the work that is being carried out.  This is a relatively straightforward question of will and liaison to make this work properly. 

Chair: Mark.

Mark Foster: One of the challenges we raise in our report is that there has been quite a proliferation of global initiatives that come out from various structures, particularly around this particular area.  The more initiatives there are, by their very nature that tends to lead to more central programming to get behind those programmes’ initiatives. That means you have more places where there is something coming in from outside of the local environment.  There seem to be some basic gaps in the information systems and the flagging of that work, and the operating model that sits behind it that means that a country knows what is going on inside its borders.  As more programming does come from the centre, for DFID to understand how its country is going to have some contextual primacy is an important question going forward.  

Lynne Elliot: I have one small comment on the central programmes.  Obviously they are very key for learning for DFID as well.  For example, relating back to the under-five mortality in the report, the Making it Happen Programme, which DFID has running in several countries, real lessons have been learned there across those countries.  Although we have seen these issues of some programmes slipping through the net, there is no doubt that there is important learning coming from these multi-country centralised programmes as well, which are actually having an impact on the ground.

Chair: Thank you very much. 

Q13   Jeremy Lefroy: Your report seems to indicate that the problems with management of the Global Fund, which were highlighted a couple of years ago, have substantially been addressed, certainly at the international level.  What is your view of how the Global Fund is operating in Kenya at the moment, particularly as it obviously has to operate through Government?

Mark Foster: We saw clearly that the Global Fund had had a major issue, as you know, with funding its programmes in Kenya.  That led to an audit that identified major issues around delays and the financial management of what they were doing, which obviously has put in place a number of reforms.  It is still too early to say whether that is fully playing itself out on the ground.  Clearly there has been a big focus in the Global Fund on improving its game in Kenya.  We notice they are also trying to work out what part to play in health system strengthening versus their more traditional, more vertical interventions.  Again, the question for us is will they be playing to their strengths, and will they be able to build up sufficient capacity around health system strengthening to work in that area?  Or are they better putting in place more robust structures around their original core competencies?

Q14   Jeremy Lefroy: If I could just follow that up a little bit—obviously, as the Chairman has already mentioned, we are doing an Inquiry on health system strengthening at the moment—what kind of work are they looking at on health system strengthening?  In the evidence we received yesterday there is clearly a concern that the more vertical approaches, such as the Global Funds or GAVIs, are not sufficiently broad at operating within health systems, but you are saying that they are looking at that.  What sorts of things are they looking at, at the moment, as to how perhaps to broaden it out?   

Graham Ward: Lynne, do you want to pick up the detail of that?

Lynne Elliot: Just coming back on more of the detail, I would concur with what you have mentioned.  GAVI, for example, will strengthen immunisation systems; and the Global Fund will strengthen the structures it is using for its programmes on HIV, malaria and so on.  The important point is the across the board, and I do not see that depth with these programmes on that with GAVI or the Global Fund.

Q15   Jeremy Lefroy: Could I just ask, with the Global Fund programmes, or indeed GAVI, are they using existing health system structures to deliver them through local clinics, local staff, and so on?

Mark Foster: You do see that.  You see some mixed models about whether they use the Government delivery mechanism, or they could use some of the parallel delivery mechanisms.  We saw that in Kenya.  There will be a bit of a mix going on, but generally speaking the end point of delivery tends to be within the local clinic that is part of, if you like, the state system around delivery.  There is very much that model.

Q16   Jeremy Lefroy: Is there proper support given to that so they are not just, for instance, covering the cost of the commodities involved but also covering the cost of the time and the people as well?

Mark Foster: That is one of the places where we start to bump up against the challenges.  It is about the alignment of the whole organisation models and the funding models that sit behind a system that supports the delivery of a particular intervention.  Their skill sets and their ability to influence the people who are making decisions around what skills to have at a district and a local level, for example, is the area where an organisation like DFID has a big role to play in helping to provide some blueprints as to what that looks like.  You tend to otherwise see imbalances in skills caused by the vertical interventions that are coming in: lots more people who are dealing with HIV, when that may only be a small part of the disease burden in a particular area. 

Q17   Jeremy Lefroy: One final thing that just struck me from your report was that the total ODA supplied to health in Kenya was approximately equivalent to that supplied from Government funding, between 5% and 6%, which of course is far short of the Abuja target of 15%.  By far the most significant contributors were USAID, and a very large percentage of their money went on HIV/AIDS.  Has that got a distorting impact upon the Kenyan health system, in your view? 

Mark Foster: Our view is it must have a distorting effect just in terms of the balance of the numbers that are there.  Clearly, we did hear from district doctors and people in the local clinics saying that they felt they were unable to serve their local communities.  They had large stockpiles of stuff coming down the system for HIV/AIDS, for example, but nothing that covered the rest of the things they had to deal with.  It is having a distorting level both at a local level but also obviously in terms of the extent to which the Kenyan Government itself is stepping up to its obligations around funding. 

Q18   Jeremy Lefroy: Did you see, therefore, any signs of interaction between DFID and USAID about this issue, and whether perhaps a more holistic approach could be taken, given the sheer amount of money going into the health system in the country from outside?

Mark Foster: I do not think we saw any particular evidence of that.  From my meetings, I did not.

Graham Ward: This indicates really just how important it is to engage in a meaningful way with the intended beneficiaries before programmes are finalised.  There is a natural tendency for a donor to give money for things in which the donor is interested.  That is not necessarily the things that the recipients have the greatest need for.  It does underline this point, but it has been a theme in our reports over the last three years: do really respect the needs and views of the intended beneficiaries before finalising programmes.  

Q19   Chair: Thank you for that.  I have just chaired a Commonwealth Parliamentary Association breakfast on exactly this issue of engaging Parliaments in terms of donor countries, so not just the areas of interest of the donor countries but the Parliaments of the countries donated to have an involvement in the use of that ODA. 

Graham Ward: Absolutely.

Q20   Chair: We are going to leave the subject of child mortality in Kenya, and move on to the response to the typhoon in the Philippines, and I believe only your third-ever green rating, which obviously shows something is going right.  What were the key factors in DFID’s success, and how can it ensure that its response to future emergencies is equally effective?

Graham Ward: I will start off with that one, Chairman, if I may.  If we look at three major key factors in DFID’s success, one is the preparatory work that was carried out.  It was anticipated that this sort of humanitarian disaster would arise in the Philippines.  There had been data from the Met Office, for example, over quite some period, indicating that this was likely to happen, and at about this time as well, so there was preparatory work being done in terms of what needed to happen.  Secondly, the team was developed in advance, so deciding who was actually going to contribute what in providing the relief.  Finally, we worked really hard on getting pre‑established relationships in place, and the biggest success story under that aspect is the relationships with the MOD, which were really outstanding.

Q21   Chair: I was going to move on to that, because you praised DFID’s collaboration with the Ministry of Defence.  I wondered what lessons DFID can learn from that collaboration.

Mark Foster: The first thing is we had a chance to spend quite a bit of time with the teams on both sides to understand how they had come together.  The thing that struck me about that was it was actually quite a multi-level interaction going on around this.  It was not just a case of the Ministers of State; it was actually a multi-level interaction that went on.  It was against the backdrop of an MOU that laid out the ground rules for how this was going to work, which I think was important, and then there was an appropriate set of judgments made by DFID about what kind of resources would be most useful from the various offers that were made by the MOD to actually provide resources. 

Most importantly, there was the relationship between the MOD and DFID around not quite command of control on the ground but the fact that DFID was given a very strong lead by the MOD on the ships, and as to how the resources should be deployed once we got on the ground.  Uniquely, on the ground, the role of DFID vis-à-vis the MOD resources compared with other militaries on the ground was very strong. 

Q22   Chair: I also note that DFID provided a direct contribution to the Disasters Emergency Committee for the first time.  Would you recommend a similar approach to future crises?  Was it a successful way of dealing with the issue?

Mark Foster: It will be interesting to see how this particular piece of the jigsaw works out in the future.  It was clearly a strong stimulus to say how important people felt this particular challenge was.  It was clearly very successful insofar as the DEC campaign raised a very large amount of money from the British people.  It is hard to judge how much DFID’s stimulus was to that versus everything else that was stimulating people to engage with it. 

For us, the challenge is around the joining up, if you like, as a result of that money, on the back of the humanitarian input.  One of the things that we were looking at on the ground was, just as we were there, the main push of our humanitarian funding was pretty much coming to an end.  We were seeing the beginning of the NGOs spooling up to scale out about spending the money on the debt funding that was coming.  There were definitely questions in our minds around how joined up that was going to be, and indeed the extent to which therefore there is a chance for DFID, through engaging in things like the DEC structures, to actually influence the joined-up thinking if you move from humanitarian into post‑humanitarian reconstruction, particularly given some of the speeds of disbursement that actually lie behind the DEC model, which requires most of the money to be spent in a fairly short period of time.  To make sure that is spent wisely was always a question mark that we had. 

Q23   Sir Tony Cunningham: I saw the aftermath of a previous typhoon in the Philippines.  One of the things that struck me was there was a lot of planning for the immediate emergency response.  There are then intermediate needs and long-term needs, but they seemed to wait until the intermediate needs were required before they started planning for them.  My view was that they should be planning right from the very outset for emergency, immediate and long-term response.  I wonder if lessons have been learned.

Fiona O'Donnell: Could I just come in on that as well?  One example at the time was the planting of rice, because it was the season, and there were concerns there was going to be food insecurity in the region.

Mark Foster: We saw some better evidence than your prior example.  We saw examples of people thinking ahead.  In the medium-term issues, we saw explicitly examples where people had managed to get in, with DFID’s support and the UN agencies, so as not to miss the rice harvest.  We saw explicitly that that had not been missed by the fact there was a timely intervention around that piece of the planning.  We saw evidence of thinking a bit more ahead about reconstruction.  I will say the reconstruction piece was still the weakest part of the plan that we saw, not least because the UN Fund was massively underfunded for reconstruction.  In the UN appeal, the money just did not come in for the reconstruction piece. 

The Government did engage quite strongly about its own medium-term planning and reconstruction plan of its own, and to some extent that is the real challenge around this particular area.  The Philippines Government obviously had a fairly strong point of view about what its role would be around the reconstruction agenda.  I felt that the DFID input to that, both directly and through the UN system, seemed to be pretty effective in terms of how they were providing guidance about it.  There was an individual who was on the ground very early on from ASCOT, the regional DFID structure, working with the Asian Development Bank to try to make sure that they were thinking about the medium term in their planning, and helping to think about the shape of a trust fund, for example.  I saw evidence that was not completely there for a complete humanitarian‑stop view, but clearly more that could be done. 

Q24   Sir Malcolm Bruce: It is interesting that when Paddy Ashdown was doing his report, he said that those areas that had had a previous crisis were best equipped to deal with it.  He made that point about the Pakistan floods when the second one happened.  Those communities that had been flooded before were much more resilient than those that had not been, so there are lessons learned even within the country.  Also, on the point about funding the DEC, there have been quite a lot of representations from some of the humanitarian NGOs that they have the capacity to respond very quickly, but the UN does not always have the capacity to fund them quickly enough.  Presumably that is part of the thinking, to ensure that there was no delay because of bureaucracy or cash flow. 

Mark Foster: Certainly we saw that our money generally got there fast for the NGOs.  That is one of the benefits they identified: the speed of response to the funding.

Stephen Blakeley: The rapid response facility that DFID has set up and used, and this was the largest response they have used it for, helped to mobilise NGOs very quickly.  The difference between that and the DEC funding is of course DFID has control over how the funds are spent.  There is much more accountability when it goes through that facility, so the DEC funds are channelled in a slightly different way that DFID does not have the oversight of.

Q25   Sir Malcolm Bruce: Obviously DFID was responding immediately to a crisis in a country where we do not have an office or a programme.  They are pretty good at doing that quick response.  Your criticisms, not surprisingly, as they were on the Humanitarian Review, are levelled at the UN agencies.  That is not the first time we have heard that.  To what extent were DFID able to improve the performance of UN agencies?  Given that you were critical of the UN agencies, what more could it do to increase their effectiveness, bearing in mind the UN is the UN and there is a limit to what one single Government can do?

Mark Foster: We have to recognise the UN is a very big thing, and it tried to respond to a very big and complex challenge like this disaster.  It is always going to have some challenges.  We certainly saw DFID having effective influencing at a number of levels, and indeed from the Secretary of State’s influence over, for example, a focus on violence against women and girls as part of the way the UN should respond to things and making sure that was a bigger part of their perspective.  We saw evidence of DFID supporting the hub structures that were in place to deliver on the individual parts of the response. 

The challenge that the UN system faced was that it was one of the first times they had really deployed the Level 3 response in anger.  As a result of the balance of that response, the skills that came in somewhat swamped the existing local UN capacity.  There were some clunky movements there with the sheer number of people that suddenly came in from outside into the system, which did not help.  We certainly saw gaps, which the UN itself has acknowledged, between the central co‑ordination and the hubs.  DFID played its part in keeping information flows, but everyone told us the one thing that we had done very well, particularly through the use of the military assets, was the provision of up-to-date information about what was happening where, and the situation in terms of crisis in far-flung islands and the real status of that.  Therefore, we helped provide an information flow to the UN system.  How it then responded to it is where some of the clunkiness came in. 

Q26   Sir Malcolm Bruce: You said you were disappointed about the response on women and girls.  Again, that happens every time.  They say they have to get food or whatever, but they forget that that is the point at which women and girls in particular are most vulnerable.  Are they learning anything?  Is there anything DFID can do to improve that? 

Mark Foster: We think there absolutely is.  Certainly, what was good was that the vast majority of agencies that we saw, both the UN agencies and the NGOs, had got a strand of work or a piece of activity relating to protecting women and girls in their plans, so they all had a piece of it.  Our sense was it was rather ad hoc and being created on the ground as opposed to part of prepared approaches and stockpiles of appropriate resources­—for example, prepared plans for this, given that it is always going to be a big part of the challenge that people face.  Our view would be that DFID, as a leader in this space, has a role to play in helping all these agencies to have that right at the heart of their planning and preparedness, and not just in their execution on the ground. 

Q27   Sir Malcolm Bruce: You are implying that you think DFID is a big enough and influential enough player to have an impact on the UN that perhaps other players could not have.  You said that some of the delays could have been prevented through closer monitoring by DFID.  To what extent would DFID monitoring UN agencies be accepted and actually work? 

Chair: Good question.

Mark Foster: That is the reality.  All I can say is in these humanitarian situations, the first person on the ground with the eyes on the ground has a unique role to play in influencing the whole system.  One of the benefits of DFID was they had eyes on the ground very quickly.  They had managed to get the team deployed before it happened.  The eyes on the ground allow you to have a disproportionate influencing effect, we believe.  It should be applying that, both tactically and operationally on the day, but perhaps a wider point is around taking the learnings that have now been created among this pretty substantial group of experts within CHASE, and asking how that expertise is now playing itself out more fundamentally with some real driving of leadership into the humanitarian system. 

Graham Ward: The humanitarian situation is one where it really is all hands to the pump.  There is less formality and process involved in this, so there is a real opportunity to lead by example on the ground.  Then people from the UN, for example, really can see what it is that DFID are able to do, and they really can learn hot in terms of the emerging situation.  That can be worth a thousand conferences and whatever between the two organisations as a whole. 

Q28   Fiona Bruce: DFID has pledged around £22 million for the Philippine Government’s reconstruction plan.  You recommend that we should continue to support that.  I am interested to know whether you are satisfied, and how that support has been used so far, and could you elaborate on your recommendations for further long‑term support?

Mark Foster: We were encouraged by the fact that there was a positive statement of intent around the fact that we were not just responding to the humanitarian crisis; we saw a chance to help with the next stage.  This was an unusual situation in terms of our pre‑existing relationship with the Philippines.  In a way, people were quite surprised positively by what a huge impact the UK had had on the humanitarian response.  The opportunity for us to take advantage of that good will to help influence the next stage is very powerful, and therefore these commitments of funds are important.  The real question—the earlier comment that was made—is around whether the plan that the Government is coming up with is good enough for us to have our funds spent wisely inside it.  Can we make enough of a difference, given the scale of the reconstruction is billions and we are providing millions? 

Q29   Fiona Bruce: Regarding DFID’s strategy for humanitarian relief where it does not have an in-country presence, you suggest that perhaps a clearer strategy should be developed.  It is a one-page summary of criteria at the moment.  Do you think that is sufficient?  Is it sufficiently transparent?

Mark Foster: Given our earlier comments on centralised programming and initiatives, it is more and more likely that quite a lot of the work that DFID will be funding around the world will be in places where they do not have an office.  This is obviously one particular example.  If you are looking at things like long-term climate change resilience in the Philippines, how will we actually impact that in a positive way?  There is a huge role to be played by the FCO—an interaction with the FCO as a partner, because they do have presence on the ground in these places.  The second would be around strengthening the regional structures in DFID.  We see the regional structures at the moment as being somewhat subordinate to the country structures in terms of strength, skills and knowledge.  If we are going to start working in more places where we do not have offices, those regional teams become key.

Chair: Stephen.

Stephen Blakeley: Also, one of the big successes of this response is not just the individual components and options that DFID has set up in advance; it is how they use them together—for example, funding NGOs while also using back-office logistical support to book flights in advance, and offering that space to the NGOs as well as using it for DFID goods, and combing all the different aspects that DFID has.  In terms of the opportunities for DFID to be able to respond in future disasters in a way that is as strong as or better than this case, it is how those elements are used together that really make it a success.

Q30   Fiona O'Donnell: This was a rapid review, and you said that was so that you could quickly give DFID feedback and an appraisal of the response.  I just wondered, first, if you thought that the number of beneficiaries that you spoke to, which was 215, which is 0.00—I cannot remember, but a very small proportion of the number of people affected—was enough.  It has also been reported that you did not look at fraud in your report.  Do you, perhaps with hindsight, think that a longer review or a review in two parts would have given a fuller picture?

Mark Foster: First of all, this was the first time we had done a rapid review model like this.  We are very comfortable that the fieldwork—the beneficiaries that we spoke to, the spread of beneficiaries that we spoke to, in terms of where we were able to speak to them, the kinds of people we spoke to, and the honesty we saw in what they were talking to us about—was very comparable with other reports that we do with regard to getting a sense of the number of beneficiaries we spoke to.  We were also able to speak to a huge number of stakeholders across the Philippines, UN, NGOs and other structures in a very condensed period of time.  That was very much down to huge co-operation, particularly from DFID leadership, and also huge co-operation from the other agencies that we dealt with.  All of that meant that this worked pretty well as a different kind of intervention. 

It is true that we were not able to go deep into things like the counter-fraud areas.  We were of course able to ask, though, and see as best we could, whether individual stakeholders we spoke to were seeing evidence of anything that was concerning them in this area.  We came away with no red flags being raised to that.  If we had seen something, that would have been a trigger for us to do something more substantive as a follow-up around that.  Our sense is that, in this kind of circumstance, the benefit came in our being able to be on the ground so close after the event, to talk to people affected, with it so fresh in their minds as to what had worked and not worked, when frankly in a humanitarian situation many of the players are gone within about six weeks after an event.  Most agencies are leaving after six weeks.  We caught most of those teams while they were still just about there, which allowed us to speak to them directly.  The feedback mechanism, which allowed us to feed back into the review systems they were all doing and provide speedy feedback to DFID, was the real benefit in this particular case. 

Q31   Sir Malcolm Bruce: You have given a very positive view about the speed and effectiveness of DFID’s response, but you then said we should be looking at the medium to long term.  The Philippines are not a priority for DFID, but we wanted to help out in the crisis.  Do you think there is a danger in what you are saying that we get drawn into providing development support post‑crisis into countries or areas that otherwise we would not have?  It is exercising this Committee quite a lot at the moment, given what we are spending in the Middle East, which again is all in middle-income countries.  It is not that we do not think we should be providing humanitarian relief, but we are having difficulty getting DFID to tell us how they budget for it.  The worry, from what you said, Mark—it is understandable you have seen some good stuff—is the next thing you know you have got a bilateral programme in a country that would not have been a priority.    

Graham Ward: The Philippines are an area where we are likely to see recurrent natural disasters and recurrent needs for humanitarian emergency relief.  An investment in actions to reduce the effect of those sorts of disasters in the future taken now is likely to mean that future interventions are more effective and more cost-effective.

Sir Malcolm Bruce: I do not think the Committee would disagree with that.  The question is whether it is DFID’s role to do that.

Fiona O'Donnell: On climate change resistance and sustainability, those are not priority areas for DFID in a country like Bangladesh, where there are ongoing problems.  Why prioritise it in the Philippines and not in Bangladesh?

Chair: Before you respond, Sir Tony was waiting there.

Q32   Sir Tony Cunningham: It comes in on the back of what you were saying.  It is one thing dealing with natural disasters; it is another looking at how you prevent them or militate against them.  I just wonder whether DFID has a big enough role in the disaster risk reduction process of the UN.  For example, there is a huge conference coming up in Japan, I think, in 2015.  I wonder whether DFID has the role that it should have in disaster risk reduction. 

Mark Foster: First of all, DFID is actually trying to play a role in those kinds of processes around the resilience agenda.  It is appropriate that it has a point of view about resilience and it is working both sides of the field here in terms of being strong on humanitarian issues and trying to think about resilience as a theme.  Genuinely that was the other part of the HERR, which said we should be doing a lot more around resilience alongside what we are doing with regard to this.  It does point to stronger and more transparent frameworks for the risk view of the world, so being clear about where we do think the key risks are.  Therefore, in a sense, that is going to lie behind our priorities in these kinds of situations.  It also talks to what kinds of global programmes we think DFID should prioritise and get behind.  If it is a big push like the ICF, where the ICF plays out, that needs to be linked to the thinking around this and a clear sense, therefore, that we understand the link between humanitarian responses where we have to do them, but also a critical map of the world where we think our broader medium-term plays are going to play out, and being comfortable about that picture

Graham Ward: Work is being done in Bangladesh.  In fact one of our first reports examined work that was being done to improve resilience against flooding in Bangladesh. 

Sir Malcolm Bruce: The Committee actually has been there.

Graham Ward: We are looking at the ICF as we speak, and will present you with a report of our conclusions in respect of the ICF this autumn.  We are looking at that, and there is a lot of money being invested there.

Chair: Thank you very much.  Stephen.

Stephen Blakeley: That is right.  The other important angle to look at is the regional structure that DFID has, and how it can use that to work in countries like the Philippines, which are not a priority but it may be strategic for us to be involved in influencing how things are playing out.

Q33   Fiona O'Donnell: What do you mean by “strategic”?

Stephen Blakeley: In terms of the way in which DFID can influence those actors that are working there on a long-term basis.  There are many different ways, but it could be through technical assistance or helping to join up different things that are happening across the region.  

Chair: Stephen Blakeley, Mark Foster, Graham Ward, Lynne Elliot, thank you very much indeed.  We have another Panel to give us evidence.  I am going to take just a three-minute comfort break, and then we will resume at 10.36.  Thank you very much.

Examination of Witnesses

Witnesses: Lisa Phillips, Head of DFID Kenya, Rachel Turner, Director, East & Central Africa, and Julia Watson, Senior Economic Adviser, Human Development Department, DFID, gave evidence.

Q34   Chair: Sorry for the slight delay.  Would you like to introduce yourselves as our next Panel?

Rachel Turner: Thank you.  I will start; I am Rachel Turner, the Director for East African in DFID, so I cover eight countries in the region including Kenya.  I am based here in London.

Lisa Phillips: I am Lisa Phillips, the Head of the DFID office in Kenya.

Julia Watson: I am Julia Watson, a senior economic adviser working on health systems in DFID in London.

Q35   Chair: Lovely.  Thank you very much for coming this morning.  You accepted partially, I think, all three of ICAI’s recommendations in their recent report.  Have you got any comments on the overall evaluation in terms of what it covered, the process and so on?

Rachel Turner: Yes, a couple of points to kick off with.  We thought this report was very helpful both in Kenya and in headquarters.  Personally I very much enjoyed this report, and it gave me a lot of good pointers for challenging my team as well.  Overall we thought it was a thorough and balanced report. 

A couple of points: I think the timing was particularly helpful for us.  We had just designed a new neonatal programme, so it was particularly helpful to have that coincidence of timing and the validation of that programme, but also some good ideas for the team to pick up and think about as they worked forward.  The points that the report focused on in terms of how we interact with the Global Fund and the vertical funds absolutely reflect the kind of challenges that our teams everywhere are trying to work through and that are very important for us.  In Kenya, we also lead all the donor partners in health, so these were wider issues that are being worked through by the whole international health community in Kenya.  To that extent they were helpful.

The point that I would make around that is that it can sometimes be a little bit easy to put health systems in a box that is slightly separate from commodities and the flow of commodities.  The way commodities flow through a system is absolutely central to the robustness of that health system, so it is really important to see the commodity flow and the vertical piece as integral to building a robust health system.  Maybe we can talk some more about that.  To that end, the reforms that the Global Fund and GAVI have been making just about some of the simple things that they need to do in terms of visibility of financing, for example, are still fundamental to strengthening a health system, regardless of whether they are doing the technical advisory work. 

I was just going to say one thing about the challenges around working outwith a Government’s financial systems.  The point for me, as a Director, that is very useful about this report is that, although this is the situation we are in in Kenya, as we think ahead about our evolving relationships with countries as they get better off, these are exactly the set of challenges that we need to think through.  As we move, we hope as countries themselves take on financing burdens, we move away from a financing relationship to technical and expertise‑based relationships.  These are the challenges we are grappling with, so it was very helpful also in that regard.

Q36   Jeremy Lefroy: Thank you very much, and good morning.  There is obviously the question of direct financing of the Kenyan Government, which the UK does not do at the moment yet.  At the same time, we are working with organisations such as the Global Fund or others who might be working directly with the Kenyan Government.  Does that give DFID any particular problems in respect of governance? 

Rachel Turner: The report raises the question of inconsistency.

Q37   Jeremy Lefroy: It may be inconsistent and that may be, if you like, ideologically a problem, but is that practically a problem?

Rachel Turner: Our decision has been taken in the round.  I think you know our conditionality policy and our partnership principles policy; our decisions were those taken by an assessment in the round of the Government’s commitment to tackling fiduciary and anti-corruption concerns.  It was not specifically about the health sector.  The implications of that practically are that we expect, as members of the Global Fund and GAVI, for them to have strong fiduciary systems specifically focused on the health sector.  In terms of coherence, we would not necessarily expect the Global Fund and GAVI to have those same broad partnership principles that we have in thinking about how we relate to partner Governments.  They are there; they have a specific mandate that requires them to focus on the health sector. 

Q38   Jeremy Lefroy: So that is not a problem, provided that you are content with the assessment and risk management of the Global Fund and other partners who are operating in a slightly different way.

Rachel Turner: It is not, but we definitely expect them to be all over the risks in the health sector, and continue to make those points both at the board level but also in‑country.  We certainly would expect in Kenya that the fiduciary risks are ones that they are focused on.  Particularly with the move to devolution and the introduction of new fiduciary and fiscal systems, it is very important that they stay alive to those risks in that sector.

Q39   Jeremy Lefroy: Thank you.  A lot of the health care in Kenya is delivered outside the Government system.  There is a tendency to describe anything outside the Government system as the private sector, which is of course misleading, because a lot of health care is delivered by the faith‑based sector or other sectors, which are not for profit but they are not part of the Government.  What is DFID’s relationship with those particular sectors in health, which are very important in Kenya?  How much work do you do through it?

Lisa Phillips: We certainly work through some of the NGOs and multilaterals to deliver services at the county level.  For example, I visited several clinics that we have provided funds or bed nets to.  Now those clinics are within communities.  They are not strictly in a Government system, but they do charge.  So that is the way that we interact with the non-Government side of things. 

Rachel Turner: We have worked on the overall financing.  We are advising the Government on Kenya’s overall approach to financing, including the way in which charges, for example, are handled by those parts of the system that are outwith the absolute core.  We are absolutely at the heart of that difficult set of relationships between the core of the public sector offer and, as you say, this periphery of non‑Government that is still part of the system, and parts of the system that do charge and are involved in the financial relationship.

Q40   Jeremy Lefroy: As a matter of information, what sort of percentage of health care is delivered in Kenya outside the state system?

Rachel Turner: Do you know?

Lisa Phillips: No.

Rachel Turner: We will follow up on that.

Q41   Jeremy Lefroy: If you could, that would be very helpful.  Given that DFID in other countries—for instance, Myanmar/Burma—does reasonably extensive work outside the specifically Government‑run sector, what learning is there between DFID offices on this particular subject?

Rachel Turner: I will ask Julia, who is in our central policy team, to answer. 

Julia Watson: There are various mechanisms for health advisers, particularly, in different countries to learn from each other, ranging from weekly health adviser meetings, twice-weekly VCs across all of the Africa health advisers and annual events where we bring them together to share evidence.  We share knowledge in various different ways.  As Ms Elliott said earlier, that works well across different countries.

Of course, health advisers move.  It is purely coincidental, but the advisers who were in Zimbabwe and in Burma at the time of those reports are now both in Kenya.  They bring that experience from one country to another.  There is a series of mechanisms. 

Q42   Jeremy Lefroy: Could I just raise, if I may, Chair, one question that I raised with the ICAI panel before?  This is the question of the overall health funding within Kenya, where you have almost as much coming in through ODA, and a very substantial part of that comes in through USAID and is specifically directed at HIV/AIDS.  I raise the question there of whether DFID is engaging, first, with the Government in terms of increasing its proportion of public expenditure on health, which is far below the Abuja Declaration, to which I imagine Kenya is a signatory, and, secondly, whether it is engaging with USAID on the impact of a considerable amount of money going into one particular, very important sector, HIV/AIDS, and the potential distortion that has on the health system.

We heard from the previous Panel that there were potentially cases of commodities unused that were being funded out of that particular programme.  That is money that could have been used in other programmes that were essential for other people.

Lisa Phillips: The Government has just produced its budget—in fact, a couple of weeks ago—but it is for the central allocation.  What we have seen there is that the allocation, centrally, has actually remained about the same as last year.  It is about 4% or so, which is obviously quite low.  What we do not know yet, though, is the allocation at the county level, but we are very keen and we are going to follow up to make sure we know what the total is.

Q43   Jeremy Lefroy: Typically, what has the county level been in the past?

Lisa Phillips: Because devolution only took place last July, there is no historical data.

Rachel Turner: This is one of our fundamental concerns around devolution, which is why we are very closely involved with it.  We said in the report or to the commissioners that we have seconded somebody to work specifically on devolution and some of the fiscal aspects of devolution with the World Bank, who have a significant programme on this issue.

One of our concerns is that with devolution the resulting pattern of expenditure is not one that is so centrally directed.  Of course, there are many benefits.  It is a hot issue that is discussed internationally.  There are many benefits, of course, to taking your fiscal decision‑making powers down to the local level.  Whether health emerges as a priority from that is something that is still being worked through at county level.  This is devolution; this is not decentralisation of health budgets.  It might well be that other priorities emerge. 

Through our leadership of the donor group, we are absolutely closely involved in that conversation with Government.  That is one of the issues right on the priority agenda of that international donor group: continuing to have that narrative.  However, we agree with you that it is a concern.  In the health system, with such a significant amount of money coming in, there is a wider concern about how Governments readjust their budgets to that.  However, that is the reality of the politics of the budget process we are living in.  Certainly, however, it is a priority to lobby and focus on it.

Q44   Sir Malcolm Bruce: I have one general and one specific question.  We have had this problem in other places where we do not always get a full picture of what DFID is spending in a country, because you have bilateral programmes, central programmes and others.  ICAI said that, in fact, DFID in Kenya was not aware of everything that DFID was doing in Kenya.  We had a similar problem, having just come back from Liberia and Sierra Leone.  The memo we got from DFID did not tell us about some of the things DFID were doing.  We only found out when we were in‑country.  How can we take a strategic view if we do not have all the information about what the whole of the Department is doing?

Rachel Turner: That is a good question, Sir Malcolm.  The Secretary of State is very focused on this issue at the moment.  We have a new strand of work looking at our management information systems, putting in new systems and requiring all our central partners to commit to investing in that system so that we have a better knowledge.  Sectorally, we have a pretty good idea of the East Africa region that I cover.  We get occasional pockets where we are unaware of a programme being run in‑country.

The issue for me that is really important is that the central funds themselves have decision‑making rules that make sense.  It is absolutely important that the central funds themselves are making allocative decisions about where to work in robust and rigorous ways.  At the centre, we are engaging a lot more now in what those decision‑making rules are.  Personally, I am slightly less worried about whether Lisa knows about a research project in Kenya; I am more worried about making sure that the decision to do a research project in Kenya was absolutely the right decision and the right place to make it.  That is part of the answer.

Q45   Sir Malcolm Bruce: We are not complaining that there are different programmes and some are run from London and some are run in‑country.  We understand there might be reasons for that.  However, there are two things.  One is the simple political statement: surely we should be telling the people and the Government of Kenya the maximum amount we are engaging in.  We found that in Sierra Leone and Liberia.  We do not even know what the total figure is, but it is about twice what the bilateral programme says it is, when you look at what we are doing.  That is first political point: surely we should have everything collated.

Rachel Turner: We absolutely agree.

Q46   Sir Malcolm Bruce: The second point is—you have partly answered it—that surely you have to be sure that your country director is aware of anything to ensure anything they are planning to do is consistent with it or complementary to it.  If they do not know, there is a danger that will not happen.

Rachel Turner: Yes, absolutely—and specifically in the high‑profile sectors.  There are some sectors—research, for example—where maybe that is less of an issue, and maybe you need a coherent approach to research.  However, fundamentally, having “no surprises” is really important for the officers in‑country. 

Lisa Phillips: What we do know is that, for Kenya, we are one of the biggest recipients of the other‑than‑DFID Kenya programmes, i.e. the centrally funded programmes.  I would say we have pretty good visibility now of what they all are.

There would be pockets, I agree, but, for example, for our new maternal and newborn health programme, which covers a number of counties, we were asked about a proposal to do something similar by another bit of DFID.  We were able to say, “Do not cover these counties.  This is the approach.  Cover this county and we will keep an eye on it from our end.”

Q47   Sir Malcolm Bruce: The other thing is the more specific one, which you will have heard before.  The concentration on outcomes and measurable effects, it is suggested, occasionally means that you do not necessarily get the best overall impact.  It is much easier to say, “We have delivered so many bed nets,” or, “We have achieved so much,” but you do not necessarily look at what is making the biggest impact on the people who are benefiting from the service.  Do you need to refine that?  In a sense, it is a criticism you always knew you were going to get right from the beginning.  This sort of output has been going now for four years.  Are you in a better position or should you be in a better position to refine that so that it is not just about numbers but about quality?

Rachel Turner: There are two points there.  One is the quality point and one is the process and the systems point.  Both the numbers and the quality are really about the end result.  We feel very clear that the focus on the end result and end impact remains the right one.  We were moving from a world in which we had a focus on institutional strengthening and systems with metrics that measured some of those issues or metrics that were just input based.  However, the focus on, “What is the end impact on communities?” is the right one.

We do agree there is more work to be done on the quality piece as well as the actual access piece.  That is something that, particularly in the health sector, and also in primary education now, across the portfolio we have some very good work on.

Q48   Sir Malcolm Bruce: You mentioned earlier on that you have in fact introduced a neonatal programme, because the report obviously highlighted the fact that this is a growing problem.  Was it fortuitous that you had already addressed this or was the interaction of the programme part of it?

Rachel Turner: No, they had been working on it for a year or so.

Q49   Sir Malcolm Bruce: In other words, it was an emerging issue that you were addressing. 

Rachel Turner: Yes.

Lisa Phillips: Yes.  Newborn health, as the ICAI team said, has been a neglected area across Kenya, certainly.  It was a response to that.

Q50   Sir Malcolm Bruce: Is this programme in place or is it in the process of—

Lisa Phillips: It has just started.  It will provide birth attendants at births.

Q51   Sir Malcolm Bruce: It is that sort of traditional support.

Lisa Phillips: Yes.

Q52   Sir Malcolm Bruce: Just to go back to quality and quantity, the danger, people say, is that you go for low-hanging fruit or the easy statistics.  However, if the objective is strengthening the system, you need to have several different indicators, do you not?  I wonder to what extent you ask the beneficiaries about what they are expecting from the system and the extent to which you can respond to it.  In other words, whether it is driven by the needs expressed by the patients and the public as opposed to an externally determined set of targets.

Rachel Turner: On the beneficiary point, the report was very helpful in focusing both on beneficiary involvement in design as well as beneficiary monitoring and the ex post views from beneficiaries.  In Kenya, I am confident that the team are in a very good place in terms of involving beneficiaries in our annual reviews and our ongoing monitoring.  The challenge on design was a well taken one that we are reflecting on and are beginning to build more centrally.  DFID are getting much clearer guidance and a lot more support now from central teams on involving beneficiaries in design.

The other thing in Kenya is that we have been working with the Government on their own systems for listening to patients.  That has to be the right way to go: we are creating those sustainable feedback loops between beneficiaries that the Government systems themselves are listening and responding to.  That remains our end objective: to insert a beneficiary feedback loop right into the heart of the Government system.  We have to be a little bit careful of sucking that out ourselves and not building the Government’s approach.

Q53   Fiona O'Donnell: Can I ask, Lisa, about how then beneficiaries have been involved in the design of maternity services?  How have you done that?

Lisa Phillips: During the design, there were several visits out to the areas where the programme will work.  We talked not only to the people who were there but to people in the community that perhaps were not accessing services.  This is something the ICAI team picked up.

Q54   Fiona O'Donnell: If I could follow up on Jeremy’s questions about the Global Fund, the question is in two parts.  The first part is that DFID does not fund the Kenyan Government directly.  Is there not an inconsistency in giving money to the Global Fund, which does?

Secondly, ICAI said in its report that there is still a risk of fraud.  You spoke about all the work that has been going on.  Are you satisfied?  How are you keeping the pace of reform with the Global Fund?  How are you having oversight to make sure fraud is not occurring in terms of the Global Fund?

Rachel Turner: On the first point about whether there is any inconsistency, I tried to answer that before.  Our partnership principles assessments are these broad assessments where we look at Governments’ commitment overall.  We do not necessarily specifically look sector by sector, but we look at Governments’ overall commitment.  In Kenya, our assessment remains that the overall commitment to anti-corruption measures and to fiduciary systems, stemming back from a large fraud that happened a few years ago, is not yet sufficient for us, as DFID, to be putting money through Government systems.  That is a broad assessment.  It is not fed specifically by an assessment of the health sector.

That goes to the way DFID has set up these partnership principles.  You have seen our policies on conditionality and how they work.  We might have a fraud in the port or in the education sector, for example, which would still lead us to say, broadly, we are not willing to have that kind of relationship with the Government.  The Global Fund and GAVI have different partnership principles.  Their partnership principles are in the health sector and what they are looking for is genuine commitment and robust applications of strategies and policies in those sectors.  We do require and expect the global funds to have strong fiduciary standards and to be scrutinising the specific health sector risks, following the money in the health sector and following the commodities.  Of course, a lot of what they deliver is commodity rather than financial.  That is important.  There are different risks.

Q55   Fiona O'Donnell: I am conscious of time.  What is DFID doing to ensure there is something in it in terms of delays in spending money and fraud?

Rachel Turner: The work we have been doing with GAVI and the Global Fund over the last few years has been to strengthen their central organs of control.  There has been a significant piece of work with the Inspector General in the Global Fund.  For example, we have now required the Global Fund to put their audits on the website in a much timelier manner than they had been before.  We are tackling that centrally and that is absolutely right.  They have to be centrally accountable for those fiduciary standards.

I am sorry that was a long answer.

Fiona O'Donnell: That is all right.

Chair: I am sorry we have so little time.  The final question is from Fiona Bruce.

Q56   Fiona Bruce: This is, again, about the devolution of our systems through to country level.  Could you give us an update on that, including anything you have not already mentioned?  Also, what steps are you taking to address the risk to your track record of supporting child health care that this change might pose?

Lisa Phillips: The update on devolution is that it is still challenging.  We are helping by providing funding for training of people at the county level, i.e. county officials but also parliamentary‑type training.  We are very much in touch with the counties that we focus on.  We track through how the whole process is going.  Obviously, it does not just affect the health programmes. 

Chair: Thank you very much indeed, Lisa Phillips, Rachel Turner and Julia Watson, for attending our Panel this morning.  That was extremely helpful and interesting.  May we have our next Panel, please?

Examination of Witnesses

Witnesses: George Turkington, Head of Conflict, Humanitarian and Security Department (CHASE), and Dylan Winder, Head of Humanitarian Response, CHASE, DFID, gave evidence.

Q57   Chair: Good morning, gentlemen.  Thank you very much for your patience and thank you for attending this morning.  Could you kindly introduce yourselves, please?

George Turkington: My name is George Turkington.  I am the Deputy Director in DFID responsible for the Conflict, Humanitarian and Security Department, CHASE.

Dylan Winder: My name is Dylan Winder.  I am Head of Humanitarian Response in CHASE and I oversaw most of the Philippines response.

Q58   Chair: Thank you very much for being here.  What do you think are the lessons from the Philippines for DFID’s response to other humanitarian crises?

George Turkington: There are a number of lessons.  One of the lessons is that once we have the transformative agenda with the UN and there is progress being made with that, clearly we need to keep working with the UN to continue to improve its performance.  Whilst DFID responded quickly to this response, there are lessons to be learned about how we make sure that we get the right number of people in place quickly enough to manage the response. 

The thing that was really strongly underlined for me was that we place a high value on continuous learning.  That stood us well in the Philippines and the report really emphasised the benefit of that and the need for us to continue to prioritise that.

Q59   Chair: Thank you for that, George.  Can you tell us about any key innovations in this response that actually helped to make it such a success?  You made a direct £5 million contribution to kick‑start the Disasters Emergency Committee appeal.  Is this something you would do again in another setting? 

George Turkington: This goes back to the key lessons that we learned from the HERR process, which were very valuable.  The lessons we learned from the HERR basically were implemented very quickly.  The Rapid Response Facility is an important part of our response.  The fact that we were able to initiate that within 24 hours was critically important.  It allowed NGOs to get on and start planning their response to the emergency.  We continue to use that facility.  Dylan, you may wish to add something.

Dylan Winder: I would add something about the Disasters Emergency Committee funding.  We felt that—and we were assured by the DEC themselves—it had played a stimulating role in attracting other funding, particularly because of the sort of quality assurance of having that UK Government stamp on it.  The DEC are at the moment doing a public perception survey, which hopefully will have some research that will provide some more evidence to that and that will help us make decisions in the future.  However, we need to do that on a case‑by‑case basis.

Q60   Chair: In the first six weeks, DFID managed to bring more non‑food items into the Philippines than the United Nations itself.  I wonder whether you were successful in getting food aid as well as non‑food items into the country, too.

George Turkington: We normally would not concentrate on food aid, because there are specialised agencies like the World Food Programme within the UN system who would focus on that.  We are very proud of the fact that we managed to mobilise so many NFIs, non‑food items, very quickly for this response.  That is partly because we do keep strategic reserves both in Dubai and the UK.  It is also because we have good commercial links with suppliers of air transport, for example.

However, it was critically because in this response—this is one of the things we would want to build on—the cross‑Whitehall response was really important.  We had a seamless integrated operation with the Ministry of Defence.  Their assets were basically a critical enabler for us in making sure we had the size of response to the NFI situation that we had.  That was very swift and very good.

Dylan Winder: Can I perhaps add something on the food issue as well?  The Filipinos themselves are very resilient.  They recovered very quickly from the shock—there is a lot of long‑term support needed still—and markets started functioning.  A lot of our funding interventions went through cash programming, which is often much more appropriate in that kind of environment.

Q61   Jeremy Lefroy: The ICAI report says that DFID responded well to the Humanitarian Emergency Response Review of 2011.  I wondered if you could flesh out a little bit how DFID had, since 2011, incorporated the recommendations into its planning.

George Turkington: Yes.  I will actually turn to Dylan on that, because he has been involved for some time in the Department working on that set of issues.

Dylan Winder: First of all, it was a fundamental change for us.  It really enabled us to pre‑plan much more effectively; we built our staff capacity; we also introduced a Rapid Response Facility, which allowed us to fund within the critical 72‑hour window; we built our relationships with other Government Departments, including the MOD; we put in place a global risk register, which enables us to highlight around the world in advance where the risks are likely to be so we are better able to monitor.  It also helped us focus much more on the resilience agenda, i.e. to link the whole humanitarian piece with development and look at that longer term planning. 

A lot of those innovations came from the HERR and, also, links to the private sector.  A lot of the stockpile stuff we have done has been working with businesses, looking at what innovation is out there: for example, sending out solar fridges to help cold‑chain stocking.  There are a great number of things that have happened over the last three years that have really come together in this response.

Q62   Jeremy Lefroy: I would imagine you have already begun your learning from the Philippines for the future.  Are there any specific things you can mention there?

Dylan Winder: Yes, absolutely.  The ICAI review itself was really fundamental to that learning.  We learnt that doing a very quick, rapid review is really important.  Certainly, there were some issues for us.  There was an endorsement of the fact we had sent out a team before the typhoon had hit, but we maybe should have sent a slightly bigger team, particularly given our lead role in influencing the UN.

There were also issues around making sure we embed the resilience from the beginning.  We did look at livelihoods issues, shelter issues and stuff for the longer term.  The way in which we worked with our regional department to dovetail the humanitarian with the political from the Foreign and Commonwealth Office and then the longer term reconstruction was a really good lesson.

Finally, there was the UN co-ordination bit.  It was the first Level 3 that the UN had run, which is their highest level of emergency.  We have been really learning how that went, how we can engage in that and how we can then use that knowledge to influence the UN to perform better.

George Turkington: To add one other thing to that, what was quite fortuitous, in a way, was the TRIPLEX training that we did in the months before.  We took a bunch of people from across DFID and, with some other Whitehall partners, ran through drills on what would happen in an emergency and all the rest of it.  Dylan led that process.  It really was very insightful in terms of how we could continue to improve.  The value of that was really underlined, certainly, for me.  That is something we will continue to do. 

Q63   Jeremy Lefroy: ICAI were slightly less positive about the UN’s emergency co-ordination.  I wonder why there has not been so much progress since the HERR in the UN’s response.  Have they taken any notice of what DFID has been doing?  How are you working with them to ensure that that response can perhaps be accelerated a little?

George Turkington: It would be unfair to say that there was no or little progress in the UN system on the reform agenda.  There has been progress and some valuable progress.  For example, they have initiated an L3 response for disasters like the Philippines.  The Philippines was the first one, basically, that was initiated under the L3 response mechanism.  It does mean that the UN does pay attention to surge capacity, getting good people on the ground quickly and looking at how they can reinforce the cluster system across the range of needs.  There is progress being made. 

We have to recognise that, given the number of ongoing emergencies at the moment that the UN has to deal with, including Syria, the system is stretched.  However, that reform process continues to make reasonable progress.  We still have a way to go on some of those critical things: getting good quality people on the ground quickly; making sure there is an appropriate surge; making sure that the leader of the cluster systems—for example, on health, water and sanitation­—are really properly plugged into and plan with Government. 

We continue to give that a strong focus in DFID.  In fact, we will host the UN with the top 10 donor directors in London in July.  Looking at this transformative agenda and the progress that has been made will be a strong feature of that discussion.  The Philippines will focus quite heavily—as will Sudan and one other country.

Q64   Sir Malcolm Bruce: Just following up on that, it is good to hear that the UN has improved.  If you look at the HERR, it seems that, what was directed at DFID, DFID as a single agency has been able to respond to by definition; a UK review telling the United Nations what to do is going to have more limited appeal, but it is good to hear that there has been some progress. 

David Miliband has come up with a list of goals, which, as he puts it, would tackle fatigue and fragmentation within the community.  Have you got a view about those?  Is that a helpful contribution?

George Turkington: It is a helpful contribution.  Médecins Sans Frontières have just published a report that continues to identify some of the challenges the UN system faces in terms of surge capacity, quality of staff and so on.

Yes, there is a real, active debate in the humanitarian system about how we can build and continue to strengthen systems so that they are appropriate to 21st‑century needs.  UN reform is a difficult process and we have to be realistic about it.  However, we do want to make sure we continue to learn those lessons and we continue to think about the agenda beyond the transformative agenda to tackle issues like building better preparedness, making sure that countries become resilient and that countries that are able to can manage those situations themselves.

It is possible to do that.  If you look at the fantastic work that has been done in Bangladesh over a couple of decades in terms of flood‑preparedness, flood resistance and mortality rates, it does show you that this can be done.  India was affected by typhoon in autumn last year and the mortality rate had come down since the last typhoon in the same region.

Q65   Sir Malcolm Bruce: You were in Pakistan.  The point that Paddy Ashdown made was that those places that had had disasters were better equipped at coping with them.  The real trick is to try to ensure that people who have not had disasters nevertheless get the benefit of the learning of those places that have, although maybe it is always going to be slightly different if it is the first time you have to deal with it—the Philippines being a case in point, where it is not the first time they have had to deal with it.

George Turkington: That is an excellent point, Sir Malcolm.  The key point there is promoting learning across countries that basically have built their capacity to those countries that have the potential to do it but have not quite achieved that yet.  There was capacity in the Philippines.  They were used to having this type of event.  In fact, before the typhoon they had an earthquake to deal with, another typhoon to deal with and they had conflict in part of the islands.

Typhoon Haiyan was basically such a significant event—the strongest winds ever to hit land—the systems were completely overrun and overwhelmed.  That is when the international community does need to step in and do what we do. 

Q66   Sir Malcolm Bruce: ICAI also picked up—this is a point that has been made a number of times—that the UN agencies do not seem to prioritise women and girls early enough in the process.  They said it was disappointing.  To what extent can DFID help do that?  The other suggestion is DFID, by monitoring what is going on with other agencies, can actually help co-ordination—assuming that the agencies appreciate being monitored by DFID.  How much can we improve the co-ordination and the activity of the international agencies by our leadership?

George Turkington: Again, that is a really critical issue.  The system at the moment basically waits to find evidence that bad things are happening to women and girls.  We know from history that bad things will be happening, so we need to get on and deal with that as a matter of priority and urgency from the outset.

At the highest levels—the Secretary of State—DFID is strongly committed to this agenda.  In fact, just before the Philippines, she hosted the Call to Action in London for action on violence against women and girls in humanitarian contexts.  We had all the top donors there, the top UN agencies.  They have made commitments to sign up to the call to action, and that allowed the Secretary of State, basically, to speak to the UN system immediately about the Philippines and prioritise that situation.  Recently, we have had the Foreign Secretary hosting the Preventing Sexual Violence Initiative in London.

Q67   Sir Malcolm Bruce: I accept all of that; we accept all of that.  The problem very often is that we still do find—whether it is a camp or some kind of refugee or emergency situation—that there are not lit, safe toilets; there are not safe places for women and girls to go.  Time after time, however, we are told that should be a high priority built into the system right at the start of the crisis.  Yet it appears it still does not happen—or it does not happen quickly enough.

George Turkington: That is right: there is still work to be done there.  It is a priority for us.  We prioritised this in the Philippines.  We allocated £3 million of the response to deal with that set of issues.  DFID in its logistic stocks will be increasing the amount of stock that we level to cover an increase from 38,000 beneficiaries to 75,000.  An absolute priority for us is to look at those stocks to make sure that they are gender‑appropriate and they do cater for the needs of women in those situations.  That is a very practical measure that DFID is doing, but there is more work to be done across the international system to make sure that this issue is absolutely recognised and prioritised.

As I say, we are working very closely with a number of other donor partners—in particular, the US.  In respect of the Call to Action that we held in London, we have now passed the baton to the US, who will hold a similar event in the margins of the UN General Assembly in September.  We have strong commitment to the Call to Action and the need to do something about this.  That event will focus on accountability mechanisms and how the system is going to hold itself accountable for actually making progress on this agenda.  It is something that really is a top priority.

I am not going to pretend that it is perfect yet; it is not.  However, the issue is definitely recognised and it is a top priority for us.

Q68   Fiona Bruce: I wondered how you would assess the reliability of different donor partners, UN NGOs and other donors, bearing in mind they will be so critical to enable you to sustain your support in the Philippines without an in‑country office.  How are you approaching that?

George Turkington: The first point I would make there is, of course, that DFID is not without representation—through the Ambassador in the Philippines.  His sound counsel and advice throughout this response was really important.

The second thing I would say is that we did deploy quickly.  We had three people on the ground very quickly.  That team soon increased to 16 people within the first week.  They are our eyes and ears on the ground.

The third thing I would say is that this is one of the benefits of the RRF, the Rapid Response Facility.  We do pre‑qualify the NGOs under the RRF.  We have discussions with those NGOs about their capabilities and capacity.  We look at their financial management systems and so on and so forth.

The fourth thing I would say is that we are basically working with partners under the RRF that we trust, but also partners in the UN system that we trust.  We are very careful to make sure that the UN has capacity on the ground with its local partners—and that those are reliable—to make sure the assistance we provide, via NGOs and the UN, is getting to people who need it most and making an impact.  There is a complex layer of capacity that we have to deal with in respect of that issue. 

Dylan Winder: Perhaps I could add, very briefly, that any longer term support that we provide would be through a multi‑donor trust fund with the Asian Development Bank and the World Bank.  Obviously, we are important shareholders of those, so we have a governance process with those organisations anyway.  We do have a UK executive board member sitting in Manila, who is very aware of these issues and is looking at that within the Asian Development Bank.

Q69   Fiona Bruce: Secondly, ICAI made the point that, given the increase in the frequency of extreme weather events, you are likely to find these situations where you have no in‑country office.  How are you preparing for this more widely?

Dylan Winder: One of the key issues is the risk register that we have, which includes natural and conflict hazards.  We now have a secondee in my team who is from the Met Office, who is already looking at the El Niño effect this year.  We have developed our deployability capacity so that we are able to much more effectively put people on the ground and run our own platform.

Of course, the relationships we have with the embassies and the Foreign and Commonwealth Office—particularly the Crisis Management Department in the FCO—is now much stronger than it used to be.  We would obviously use those platforms as a kind of first route.

Q70   Chair: Do you have any further comments?

George Turkington: It is worth me saying at the end that—because you started with lessons—an important lesson for us was to make sure we do a light-touch review very quickly into a response.  We have certainly taken that on board, because we are currently doing that for the Iraq work that we are currently involved in.  This was a really critical lesson that we learned from the ICAI review.

This ICAI review was a really positive experience for us.  It was timely and the way their team interacted with my team, who were still under pressure in the midst of this response, was really good.  It was very constructive.  As I say, we learnt two or three really important lessons that we will take forward.

Chair: Thank you for that.  The Chief Commissioner is listening very carefully at the back of the room.

George Turkington: I am sure he is.

Chair: George Turkington and Dylan Winder, thank you very much indeed for your evidence this morning.  It was extremely helpful.  That concludes the business of this ICAI Sub‑Committee.  Thank you for your attendance, ladies and gentlemen.

              Oral evidence: The Work of the Independent Commission for Aid Impact, HC 405                            21