International Development Committee, Impact of Coronavirus in Developing Countries – Written evidence from Health Poverty Action

Introduction

1. Health Poverty Action is an international NGO that acts in solidarity with health workers, activists and communities worldwide to improve health and challenge the causes of poverty. We currently work across eighteen countries in Africa, Asia and Latin America.
    
2. We welcome the opportunity to submit evidence to this inquiry exploring the impact of the new coronavirus in developing countries. We respond to the following areas the inquiry is seeking information and views on, as outlined in the inquiry terms of reference:
• The direct and indirect impacts of the outbreak on developing countries, and specific risks and threats;
• The UK’s response, bilaterally and with the international community, to the spread of coronavirus to developing countries;
• The impact of the outbreak, and consequential mitigation measures, on fund-raising by UK-based development charities/NGOs.
• The impact of the outbreak on UK aid funding in the longer term.
   

The direct and indirect impacts of the outbreak on developing countries, and specific risks and threats

3. The global COVID-19 pandemic poses an unprecedented challenge for health systems globally. Prolonged underfunding and a failure to prioritise the health sector has left many countries with chronically weak public health systems. In these countries, health facilities are likely to be overwhelmed should COVID-19 infections take hold, risking catastrophic impacts as a result of the virus, and as other conditions go untreated. The pandemic and its effects are already hindering the response to other diseases such as TB, the roll-out of critical vaccination services, and increasing burdens on rural health services where people have left cities en masse under lockdowns[1].
    
4. Specific threats and existing dynamics which compound these impacts of the outbreak, include:
    

• Systematic neglect and underfunding of public healthcare systems in many contexts. Half the world’s population are facing the pandemic without access to essential healthcare[2].
• The persistence of user fees and other requirements to pay out-of-pocket for health services. Direct payments for health push 100 million people into poverty each year, and see countless more deterred from accessing health services, and will deepen both the economic and health costs of the virus[3].
• Fragmented and tiered health systems, comprising a diverse range of healthcare service providers, where those who can afford to tend to seek high quality private care, leaving the rest of the population seeking healthcare where they can (often within underfunded public systems or through poor quality/unregulated private providers). This dynamic risks fuelling the pandemic as scarce resources - such as tests and PPE - are allocated on the basis of ability to pay over public health need. The challenges of a fragmented health system are also made more acute by the urgent need for coordination, surveillance and information sharing during the pandemic, and sufficient regulation to ensure quality care across diverse healthcare providers.
• Lockdowns, which are threatening millions of peoples’ livelihoods, particularly of informal sector workers who earn wages on a daily basis. Enforcing lockdowns, curfews and similar measures has also seen an increase in human rights violations and brutality by security forces.
   

5. In addition, we are hearing of the following specific challenges from the remote communities we work with within HPA’s programmes:

• Little to no availability of PPE, testing, access to health services, hand washing stations, masks, and sanitisers.
• Little information about how to respond making its way to communities e.g. not to shake hands, to socially distance and not to have mass gatherings.
• Many communities we work with are based in very remote locations, making access to healthcare services extremely challenging. Where services do exist these are very under-resourced - one example being doctors in a health centre in Guatemala having to use watered-down hand sanitiser to clean their hands before surgery – or are not free at the point of use making them inaccessible for many people without means to pay, and pushing others into poverty through paying out of pocket.
• Increasing neglect of priority health issues such as maternal healthcare, child immunisation, TB, malaria, and HIV programmes, which is negatively affecting people’s health.

The UK’s response, bilaterally and with the international community, to the spread of coronavirus to developing countries

6. Health Poverty Action welcomes the new funding provided by the UK for the development of vaccines to prevent COVID-19, but sees a need for further action from the UK Government in the following areas:

7. Increase aid financing for public healthcare systems, including through restoring sector budget support. In 2015, the UK government stopped providing traditional budget support to governments, and aid provided as sector budget support to the health sector has also collapsed, dropping from £186 million in 2013, to just £11 million by 2018[4]. At the same time, aid has been increasingly channelled through piecemeal project interventions, often administered through a complex arrangement of actors[5]. Overall aid to health channelled via DFID must significantly increase to address the unprecedented crisis COVID-19 presents, to deliver a comprehensive response to the complex impacts of the pandemic, while maintaining existing interventions. Restoring sector budget support would help get money to health systems directly, where it is most needed, and help build the resilience of health systems for the long term.
    
8. Stop supporting private for-profit healthcare through aid, and support countries to remove healthcare user fees. The UK Government should ensure all future aid for health is utilised to strengthen, quality, free, public healthcare for all. The COVID-19 pandemic has further highlighted the limits of for-profit private approaches in health, which exclude those who cannot afford to pay fees or private insurance premiums, and see scarce resources prioritised based on ability to pay over public health need. As well as scaling up aid to health systems and sector budget support, the UK Government should end its financial and technical support for pro- private approaches in health service delivery in future. This includes halting investments in for-profit private hospital companies via the Commonwealth Development Corporation (CDC), and ensuring hospitals in which the CDC holds a stake provide capacity for countries’ overarching public COVID-19 responses, without generating profit at this time. The UK should also support countries to make all healthcare free, removing fees for healthcare and insurance co-payments, throughout the pandemic and beyond.
    
9. Ensure COVID-19 vaccines and medicines are available to all. The UK has made commendable investments to support vaccine development for COVID-19, but must ensure resulting COVID-19 vaccines come with conditions to ensure they are affordable for all countries, and free for the public. This can be achieved by attaching conditions that promote the sharing of know-how, clinical trial data and health technologies. Intellectual property including patent monopolies and other exclusivities on any COVID-19 medical products developed using public funding should not be permitted. Conditions should also demand full transparency of funding, research costs and product prices. The UK Government should also support the Costa Rican proposal for the WHO to create a global pool for rights in COVID-19 related technologies[6].
    
10. Support the World Health Organisation. The UK Government should increase unrestricted financing of WHO, in line with needs outlined to tackle the COVID-19 pandemic, and to fill any gaps caused by the withdrawal of US funding. The UK must champion global coordination and solidarity at this time of a global pandemic, and the WHO is the best institution to deliver this.

The impact of the outbreak, and consequential mitigation measures, on fund-raising by UK-based development charities/NGOs.

11. The pandemic is posing a grave challenge to the fundraising activities of NGOs, including Health Poverty Action. In particular, we have seen a decline in our income from fundraising events and other sources which contribute to our ‘unrestricted’ funds. Delays implementing project activities resulting from lockdowns are affecting HPA’s ability to spend grants, which in turn also impacts our receipt of administration contributions from donors. Both of these challenges particularly affect our ability to cover our core costs, i.e. staff, rent and utilities, and core organisational functions like finance teams. The tasks supported through our core costs are all vital to the daily operations of our organisation. As 90% of our core costs of covered through the administration contributions from restricted grants, delays to projects’ implementation have particularly severe consequences for our ability to stay afloat as an organisation.
     
12. Existing government efforts to mitigate the impact of the virus on charity fundraising have had limited impact on Health Poverty Action’s funding situation to date. This is because we are largely financed through ‘restricted’ project contracts which we are required to fulfil, meaning we are unable to furlough key project staff for example.
     
13. We urge the UK Government to temporarily ‘unrestrict’ existing grants to charities as an immediate action therefore. This will not only give NGOs more flexibility to allocate restricted funds to their core costs - keeping organisations both afloat and able to deliver critical work - but will also allow NGOs like Health Poverty Action to rapidly reallocate funding to the pandemic response. A scale-up of pandemic response programmes is urgently needed in many contexts. Temporarily unrestricting charities’ existing grants would provide the flexibility to respond to COVID-19, without requiring the administrative burden of renegotiating existing complex contracts or seeing government face additional costs.
     
14. Moreover, there would also be no significant risk of the funds being misused in this eventuality, as charities are still regulated by the Charity Commission to ensure all their funds are spent in ways that further their charitable objectives. Temporarily unrestricting grants in this way could have a profound impact on charities response to the pandemic, and ability to survive its impact on fundraising, even if implemented for a comparatively short period of time, e.g. 3-6 months. Additional measures may be needed as the pandemic evolves to ensure charities are able to cover their core costs, including longer-term and more flexible funding agreements.
     

The impact of the outbreak on UK aid funding in the longer term.

15. In the long-run, it will be critical to increase aid to address the pandemic and its long-term consequences, including through increasing support directly to countries’ health systems through budget support. However, aid must also evolve to acknowledge and address the historic power imbalances which have shaped global poverty and inequality, and become instead a force for global solidarity, redistribution and compensation. The UK government should play a convening role in a global conversation on how aid and global governance should change and respond to the pandemic and its consequences - as well as address historic inequalities - , ensuring voices of countries from the South determine a new direction for aid. The UK must also avoid any withdrawal of funds or support for global solidarity mechanisms in a post-pandemic landscape. International cooperation and solidarity are more vital than ever before.

Ends.