International Development Committee inquiry on extreme poverty and the Sustainable Development Goals

Response from The Leprosy Mission England & Wales (TLMEW)

The Leprosy Mission England and Wales, established in 1874, is an international development organisation working in 10 leprosy-endemic countries to defeat leprosy, a disease of poverty, and transform the lives of people affected by the disease.  It uses a holistic approach to development that addresses not only the medical aspects of leprosy but promotes social inclusion and poverty alleviation of those affected through provision of training and employment opportunities.

1. Extreme Poverty & Leprosy/Neglected Tropical Diseases

There is a clear link between extreme poverty and Neglected Tropical Diseases (NTDs), including leprosy, with NTDs being both a cause and consequence of poverty1.

-          NTDs primarily affect the poorest people of the world - the “bottom billion”2.

-          NTDs are a consequence of extreme poverty with transmission accelerated through poor access to water, sanitation and hygiene (WASH), overcrowding, inadequate nutrition and an inability to access quality healthcare3

-          NTDs cause household poverty through catastrophic health expenditure which leaves households unable to pay for necessities. NTDs also often cause long-term disabilities, mental health impacts and stigma from communities and employers, which all prevent adults from working to support their families, create additional burdens of care, and trap households in a cycle of poverty. At a national level, this workforce loss stymies economic development4.

-          Research suggests that people affected by leprosy were often the first to lose their jobs or suffer severe loss of earnings due to the economic impact of the Covid-19 pandemic, pushing them into extreme poverty5. The effective suspension of non-Covid health services left thousands more at risk of disability and the economic hardship this often brings5.

Therefore, efforts to tackle extreme poverty must be holistic and include special emphasis on strengthening health systems and improving access for the poorest. We welcome the retention of Global Health as a priority for the UK FCDO but urge the government to ensure that those furthest behind are prioritised in the rebuilding of Global Health programmes and to ensure they help to lift the world’s poorest and most marginalised out of extreme poverty.

2. How the FCDO can play a more effective part in the eradication of poverty as a convener, thought leader and investor?

Interventions to alleviate poverty must be holistic and address root causes. Recognising the strong link between health and wellbeing and poverty, we make the following recommendations:

-          The FCDO should use its influence to press for full implementation of Universal Health Coverage, ensuring diseases of poverty, such as NTDs, and disability rehabilitation are covered within this.

-          The FCDO should increase its investment in Research for Global Health, particularly for diseases of poverty like leprosy where there is no viable commercial market. We recognise the previous contribution of FCDO in this area but are concerned about recent trends:

• UK funding for leprosy research and development was cut by 82% from 2019 to 20206.
• Overall, UK funding for neglected disease R&D fell 13% from 2019 to 20206.
• With the ODA spending target cut only coming into effect at the end of 2020, it is anticipated that this downward trend will be more marked in the 2021 figures.

-          The FCDO should reverse this trend and invest in collaborative R&D between UK institutions and partners in the Global South which promotes local expertise and ownership.

-          The FCDO should continue to be a leader on inclusive development and use its influence to ensure people with disabilities are included in development

3. What effect have the cuts in UK ODA had on the FCDO’s ability to address extreme poverty? What evidence is there to suggest poverty was a key consideration in deciding where the cuts should fall?

3.1.   We have seen a direct impact of the UK ODA cuts on the FCDO’s ability to address extreme poverty. Several of our programmes which had been awarded FCDO funding subsequently saw this funding withdrawn with serious consequences for those they were intended to reach:

3.1.1         The FOUND (Fuelling Opportunities for Unemployed Nepalis with Disabilities) project had its UK Aid Direct Impact funding of just under £1,000,000, completely cut. FOUND aimed to source employment opportunities for disabled people in Nepal, including those affected by leprosy.

• The cuts meant that those who were already marginalised and discriminated against within the labour market were unable to receive the support they needed to get into work.
• Those who were enrolled in on-the-job training which would have led to employment, were not able to finish their courses.
• Over 100 people had recently started new businesses which would likely fail with no support from the project team.
• The funding cuts were imposed at the height of the 2nd wave of Covid-19. Cutting project funding at this time meant that those who already had little or no income were at risk of being forced deeper into extreme poverty.

3.1.2         The RISE (Recognised, Identified, Seen, Empowered) project was cancelled when the promised UK Aid Funding of just over £1,000,000 was withdrawn. The RISE project aimed to reach 9,373 people affected by leprosy and disability and living in extreme poverty in the slums of Dhaka, Bangladesh by providing access to curative Multi-Drug Therapy for leprosy, complication management services, and health education to improve nutrition, menstrual hygiene and healthy lifestyle practices.

• The cancellation of funding for RISE has resulted in missed opportunities to prevent illness and disability amongst the most vulnerable in society.
• 2,802 vulnerable people have now lost the opportunity to improve their incomes.
• 2,900 will no longer receive support to improve the nutritional quality of their diets, receive empowerment to attain rights and entitlements, and in the case of women and girls, improve their menstrual hygiene and reproductive health.
• Training programmes to help 949 Government and NGO workers to effectively diagnose and support people affected by leprosy will no longer happen
• Behaviour change communication messaging proposed to make 168,185 residents of the slum aware of the signs and symptoms of leprosy has also been cancelled.
• As a result, we anticipate that several hundred people with leprosy will experience a delayed diagnosis, an increased chance of developing complications leading to permanent disability, and a greater risk of remaining or sliding into extreme poverty.

3.2      Beyond TLMEW’s work, the ASCEND programme which aimed to eliminate or control five NTDs in the poorest communities of West and Central Africa was significantly affected by the ODA cuts. It is estimated that as a result, 72 million people missed out on treatment for NTDs7, putting them at greater risk of extreme poverty.

These examples indicate that poverty was not a key consideration in deciding where ODA cuts would fall.

4            How has the merger of the Foreign and Commonwealth Office and the Department for International Development affected the UK’s approach to extreme poverty?

Eradicating extreme poverty appears to no longer be a priority following the merger of FCO and DfID.

• As outlined in section 3, ODA cuts were implemented hurriedly and without adequately considering the needs of the extreme poor, but rather have been focused on UK economic interests.
• Large numbers of staff who previously worked in DfID have left the FCDO since the merger8. This constitutes a huge loss of expertise in development and calls into question FCDO’s capacity to ensure the effectiveness of aid spending including its ability to ensure that its interventions make a significant impact on inclusive poverty reduction.
• The continued delayed release of FCDO’s new development strategy increases uncertainty about the UK’s position and commitment to tackling poverty. We note with concern the failure of the Foreign Secretary to mention poverty, food security or global health when setting out her international policy vision9.
• The current FCDO focus on trading partners and investment, including the rebranding of the CDC as British International Investment suggests that economic return rather than the needs of the world’s poorest will now be the deciding factor in aid decisions.

References

1.               Lockwood DNJ. Commentary: Leprosy and poverty. Int J Epidemiol. 2004;33(2):269-270. doi:10.1093/ije/dyh115

2.               Hotez PJ, Fenwick A, Savioli L, Molyneux DH. Rescuing the bottom billion through control of neglected tropical diseases. Lancet. 2009;373(9674):1570-1575. doi:10.1016/S0140-6736(09)60233-6

3.               Aagaard-Hansen J, Lise Chaignat C. Negelected tropical diseases: equity and social determinants. In: Equity, Social Determinants and Public Health Programmes. ; 2010:135-157. https://www.who.int/neglected_diseases/Social_determinants_NTD.pdf

4.               Samuels F, Pose RR. Why Neglected Tropical Diseases Matter in Reducing Poverty.; 2013. https://odi.org/en/publications/why-neglected-tropical-diseases-matter-in-reducing-poverty/

5.               Goswami S, Sarah N, Awasthi J. Pandemic and People’s Plight: Experiences that echoed across India. Published online 2022. https://www.leprosy-information.org/resource/pandemic-and-peoples-plight-experiences-echoed-across-india

6.               Chapman N, Doubell A, Tuttle A, Barnsley P, Goldstein M, Oversteegen L, et al. G-FINDER 2021: Neglected disease research and development: new perspectives.; 2021. Policy Cures Research. https://policy-cures-website-assets.s3.ap-southeast-2.amazonaws.com/wp-content/uploads/2022/01/27173842/2021-G-FINDER-Neglected-Disease.pdf

7.               Worley W. 72 million people to miss treatment for NTDs due to UK aid cuts. Devex Inside Development. https://www.devex.com/news/72-million-people-to-miss-treatment-for-ntds-due-to-uk-aid-cuts-102393. Published January 6, 2022.

8.              Worley W. Over 200 ex-DFID staffers have left UK’s FCDO since merger. Devex Inside Development. https://www.devex.com/news/exclusive-over-200-ex-dfid-staffers-have-left-uk-s-fcdo-since-merger-100686. Published September 2, 2021.

9.               Truss L. Building the Network of Liberty: Foreign Secretary’s speech. Foreign, Commonwealth & Development Office. Published 2021. https://www.gov.uk/government/speeches/foreign-secretary-liz-truss-building-the-network-of-liberty