PATH’s written evidence for The International Development Committee’s (IDC) inquiry into the effectiveness of UK Aid
PATH is pleased to submit the following evidence highlighting the lifesaving impact of DFID funding in response to the International Development Committee (IDC)’s public request for inquiry into the effectiveness of UK aid. PATH is a global health non-profit organisation dedicated to accelerating health equity around the world. The following evidence is based on PATH’s years of work with DFID to advance health solutions for the world’s most vulnerable populations.
We have seen first-hand the impacts of DFID’s commitment to solving the world’s most pressing challenges through its investment in innovation and capacity building to bring lasting impact. DFID fills a critical gap not met by other nations’ ODA, and an independent DFID is critical to ensuring the UK delivers on its commitments to achieve the global goals for sustainable development.
A global leader – DFID’s vital role in R&D funding
The COVID-19 pandemic is a reminder of the critical need to invest in research and development (R&D) for new technologies, including vaccines, drugs, diagnostics, and devices to prevent, detect, and treat existing and emerging health threats. The UK is the world’s second-largest funder of global health R&D, with DFID playing a critical role supporting the development of new tools to address poverty-related and neglected diseases, and the development of innovations specifically targeted for low-resource settings. Funding from DFID fills critical market gaps where traditional incentives for investment are lacking. Over one billion people worldwide are still impacted by diseases like tuberculosis, HIV/AIDs, malaria, and other neglected tropic diseases; new innovations in health will be essential to achieving the UK’s commitment to tackling extreme poverty and helping the world’s most vulnerable. A recent analysis estimated that the cost to move current neglected disease product candidates through the pipeline and launch critical to-be-developed products, such as a highly efficacious vaccine for TB, HIV, or malaria, would cost between £3.61–4.65 billion annually over five years. This amount is within reach, but global funding for R&D for neglected diseases is still only a fraction of what is needed Although important progress has been achieved, continued investment in the development of new tools to address health challenges remains critical, and DFID is helping bridge this gap. Some technologies that have DFID investments have helped bring to market include a vaccine for meningitis in Africa, new diagnostics for TB, and lifesaving treatments for malaria and other neglected tropical diseases. By funding innovative health technologies, DFID is playing a key role that is not filled by other government departments—advancing lifesaving therapies and building critical expertise and infrastructure capacity in low-resource settings.
Maximising impact through strategic investment models
In the current funding environment, DFID’s investment in R&D is different than other donor funding models. Rather than investing in the development of a specific product with unknown potential, much of DFID’s R&D funding is invested in a portfolio of products; investment in a portfolio diversifies the inherent risk of product development, and allows for shifts in funding priorities between products toward those that show the highest promise. It allows technical experts to make the most strategic decisions about how to allocate resources among different products while helping to reduce stranded assets. In this way, DFID ensures the best value for money in their development budget. DFID currently provides core funding that accelerates the development of a portfolio of tools to prevent and treat some of the leading killers of women and children, including malaria, diarrhoeal diseases, respiratory illnesses, and childbirth. This allows product developers, such as PATH, to maintain a dynamic suite of products—dropping things that do not work and giving additional support to the products that do.
For example, with DFID’s support, PATH is working to accelerate the development, introduction, and scale-up of G6PD tests, a critical point-of-care diagnostic to help improve the management of the form of malaria that is most difficult to treat. Over 70,000 G6PD tests were distributed across malaria-endemic countries in 2019, and more than 4,000 patients were included in clinical studies to support the regulatory approval of the most advanced G6PD test. DFID’s strategic focus on cost-sharing is also critical to maximising impact—through this model, DFID encourages shared investment from other donors and partners to create a multiplying effect. For example, DFID’s initial investment in the G6PD work was more than doubled and resulted in leveraging an additional £15 million in value, maximising positive impact in low-resource settings and demonstrating an excellent return on the UK government’s investment. By requiring this measurement, DFID ensures that projects are evidence-based and that funds reach those who need them most.
This portfolio approach has also catalysed research focused on advancing affordable, accessible, safe, and effective tools to reduce maternal deaths in sub-Saharan communities. Globally, approximately 300,000 women die in childbirth every year; more than half of these deaths occur in sub-Saharan Africa. These deaths are often preventable when health providers have access to necessary medical devices and medicines that enable higher-quality obstetric care. DFID’s unique focus on innovations for maternal health targeted for low-resource settings is filling a critical donor gap. These investments have a multiplier effect—not only meeting the health needs of women, but also building local manufacturing capacity and strengthening health systems by working with local public health communities for sustainable scale-up.
Building resilient health systems
Sustained impact through local manufacturing
A key element to building up health systems and ensuring equitable access to health care is the localisation of production in low-income countries. DFID’s investment in global health R&D helps support local manufacturing and clinical trial capacity. Strengthening local manufacturing not only enables a lower cost base and price for medicines and vaccines, but it is also central to strengthening supply security for essential therapies and critical health technologies. For example, with support from DFID, PATH is working in Vietnam with a locally state-owned vaccine manufacturer and two clinical trial sites to test and produce a licenced vaccine to treat deadly diarrhoeal disease. Supporting local production of this vaccine ensures that it will be affordable and appropriate for local use, two critical components to supporting the sustainability and accessibility of this product in Vietnam and around the world. This vaccine will not only save lives—diarrhoea continues to kill half a million children globally each year—but it will also pave the way for a more sustainable and affordable immunisation programme going forward.
In addition to supporting equitable access, DFID’s support for local manufacturing is critical to strengthening supply security for essential medicines and health technologies. DFID’s investment in local manufacturing and clinical trials capacity-building contributes to economic growth and local wealth creation and helps ensure that populations in low-income countries have access to the high-quality medicines they need at home and around the world.
DFID’s global mandate makes the agency uniquely placed to understand that one size does not fit all. One of the other ways that DFID creates impact and fills critical gaps is through a commitment to build long-term country capacity through targeted technical assistance (TA). One example of this is DFID’s commitment to improve nutrition for at least 50 million people by 2020 by addressing both the immediate and underlying causes of malnutrition. Malnutrition is responsible for approximately 45% of deaths among children under five, and investment in nutrition is critical to achieving the Sustainable Development Goals. Through one of DFID’s flagship nutrition programmes, for the first time countries were able to request the TA they needed to support nutrition planning for some of the most vulnerable people in some of the hardest-to-reach places in the world, including Somalia, Yemen and Afghanistan.
DFID’s long-term investment in nutrition has resulted in robust experience supporting fragile and conflict-affected states in developing multisectoral nutrition plans. DFID is uniquely placed to encourage coordination between humanitarian and development organisations around the nutrition components that are critical to the success of their joint efforts. Since 2012, funding from DFID has provided demand-driven TA to more than 50 countries to support government-owned nutrition planning, policy, and analysis. Through this project, DFID fills a void by supporting countries who otherwise may not have had the in-country resources or capacity to advance their nutrition agenda. The project also provides TA to maximise the quality and effectiveness of DFID programmes to support achievement of global targets to reduce malnutrition. This includes working closely with governments and local partners on the ground to provide health systems strengthening in countries such as Kenya, Zimbabwe, and Uganda.
An investment in health, at home and around the world
PATH has witnessed the incredible impact of DFID funding. Through DFID’s strategic investment model that leverages expertise and additional funding, as well as the agency’s commitment to investing in local health systems to build long-term capacity, DFID is filling gaps not met by other funders. As an agency with expertise in the unique development needs of some of the poorest and hardest-to-reach places in the world, retaining DFID as an independent agency is critical to accomplishing the UK’s development commitments and ensuring foreign aid is being spent efficiently and effectively, by the agency with the most expertise.