Promoting better health for poor people
Spreading educational opportunity
Bridging the digital divide
Re-thinking the mobility of people
Encouraging pro-poor research
Intellectual property regimes and developing countries
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The UK Government will: · Promote better health and education for poor people, and harness the new information and communications technologies to share skills and knowledge with developing countries. · Help focus more of the UK
and global research effort on the needs of the poor, and make intellectual
property regimes work better for poor people. |
97. Poor people suffer disproportionately from poor health and malnutrition. The poorest 20 per cent of the global population have a 14-fold higher risk of death in childhood than the richest 20 per cent. Similarly, more women die from pregnancy in India in a week than in the whole of Europe in a year.
98. Better health is essential if poor people and countries are to benefit from globalisation. For individual families, better health means less suffering and less time and expense invested in caring for ill family members, improved physical and intellectual development, enhanced school attendance and learning, and higher productivity at work. For countries, better health is now accepted as a central long-term driver of economic growth. For example, it has been estimated that controlling malaria in those parts of Africa where it is endemic would raise Gross Domestic Product by 20 per cent over a fifteen year periodxi.
99. Globalisation has had a number of major health effects, as people, money and goods have become more mobile. The increased movement of people seeking employment; urbanisation; changes in behaviour and the wider availability of illicit drugs have led to the more rapid transmission of diseases like malaria, HIV/AIDS, and Tuberculosis (TB). TB kills more than 2 million people each year, malaria more than a million. More than 36 million people worldwide are infected with HIV.
100. Increased migration, whether for economic or political reasons, conflict or natural disasters, has also caused health problems arising from the loss of traditional safety nets and the adaptation to new environments. Displaced populations tend to be particularly vulnerable to communicable diseases such as malaria, meningitis, pneumonia and diarrhoea. Conflict and rapid population movement is also associated with an increase in sexually transmitted diseases, in particular HIV/AIDS. And changing consumption patterns are leading to an increase in non-communicable disease. Based on current trends, 70 per cent of tobacco-related deaths will be in developing countries by 2030. The UK will support developing countries' efforts to develop tobacco control strategies within the World Health Organisation (WHO) Framework Convention.
BOX 4
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THE IMPACT OF HIV/AIDSxii HIV/AIDS is both a human and a development tragedy. Around 22 million people have died of AIDS, with 16,000 new HIV infections every day. More than 90 per cent of the infections are in the developing world, with nearly 70 per cent in sub-Saharan Africa. In India over 3 million adults have HIV/AIDS, and in Cambodia, Thailand and Burma over 2 per cent of the adult population is estimated to be infected. In a number of sub-Saharan African countries, average life expectancy has fallen by 20 years. The cost of treatment and care for people living with HIV/AIDS impoverishes many families and communities. The need for care forces potential wage earners to stay at home, young girls to miss school, changes to agricultural practice which reduce nutritional value, and leads to valuable family assets being sold to pay for treatment. Within the next five years there could be as many as 40 million maternal orphans as a result of HIV/AIDS, children with reduced likelihood of attaining good health and having a good education. The cost to the economy of HIV/AIDS is also massive. Health
budgets have to be increased, at the expense of other sectors. Government
finance comes under pressure as expenditure increases and tax revenues decrease.
Death and absenteeism reduce labour supply and productivity. In the worst-hit
countries the workforce is likely to be more than 17 per cent smaller in 2015
than it would have been without AIDS. Zambia, for example, lost 1,300 teachers
from AIDS in the first 10 months of 1998, more than two-thirds of the number of
all new teachers trained that year. And economic growth is weaker. For the 16
countries in eastern, central and southern Africa with HIV infection rates above
10 per cent of adults, GDP growth will be at least 1 per cent a year lower. One
estimate for South Africa is that overall GDP will be 17 per cent lower in 2010,
and GDP per capita 7 per cent lower. |
102. The UK Government is committed to working to meet the International Development Targets for health. And we work closely with developing country governments and key international institutions, including the WHO, UNAIDS, the United Nations Population Fund, the World Bank and the European Commission. We have recently agreed a further £35 million of support for WHO work on polio eradication. This is part of an internationally agreed strategy, led by WHO, to eradicate polio within five years.
103. The UK Government is working to strengthen the international effort to combat the diseases of the poor, with a greater focus on communicable diseases, including the development of new drugs and vaccines to help tackle these. The effectiveness of this effort depends critically on basic health care systems at the national level, drawing on the resources of both the public and private sectors. We need to ensure not only that affordable drugs and vaccines are available, but also that there are effective systems to deliver these to all who need them. Strong national leadership is essential if these health care systems are to be put in place.
104. Education and skills are the commanding heights of the modern global economy. Globalisation - and the growth of knowledge-based systems of production - is both increasing the rewards for education and raising the costs of exclusion from it. If globalisation is to work for poor people, increased investment in education, lifelong learning and skills is essential.
105. One of the ways in which globalisation could help to eliminate poverty is by speeding up the diffusion of knowledge and technology to developing countries. But for countries to make use of modern technology, they must improve education and skills training.
106. And that starts at the primary level. Where countries invest in high-quality primary education for all - particularly for girls - the development dividends are enormous. Education of girls is probably the single most effective investment in development that any country can make.
107. But huge numbers of children today - girls and boys - do not take even this initial step. An estimated 113 million children of primary-school age have never gone to school (see figure 3.1). Around 150 million children have dropped out after a few years, still unable to read, write or work with numbers. And one in four adults in the developing world - that is 870 million people - are unable to read or writexiii.
108. It is for this reason that, over the last three and half years, the UK Government has greatly strengthened its commitment to education, particularly at the basic and primary level. Since our last White Paper in 1997 we have committed over £400 million to support the development of primary education systems.
109. We now have total education commitments of £800 million, with nearly 80 per cent of these resources allocated to basic and primary education sectors. We have focused these extra resources on the poorest countries in Africa and south Asia, the regions with the worst education indicators.
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FIGURE 3.1 The primary education challenge Source: ‘A Better World for All’ 2000 |
110. And we are spending that money in new ways - working with governments to develop well-integrated and sustainable education systems, helping them to provide high-quality primary education to all their children. These sector-wide education partnerships are characteristic of our work in countries such as Uganda, South Africa, Ghana, Malawi, Rwanda, China, Vietnam, and in the states of West Bengal and Andhra Pradesh in India.
111. This focus on the sector as a whole recognises that countries need a balanced approach to the expansion of education. Success in improving access and quality at the primary education level leads to increased demand for post-primary education and for teacher training. This in turn requires improvements in higher education. Jobs, whether in the modern manufacturing or service sectors, increasingly have a strong information processing and knowledge content. East Asia's experience shows that sustained export-led growth, and the development of the learning economy, require the investment in secondary and tertiary education essential to enhance capacity to research, analyse, train and manage.
112. New technologies are offering new ways to improve the supply of education, particularly through the use of distance learning. The UK Government is working with the Commonwealth of Learning to encourage the development of distance learning. And through the Prime Minister's education initiative (see box 5), we are exploring new opportunities for using distance learning and information technology for teacher training and the sharing of skills and knowledge, with a particular focus on Africa.
BOX 5
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THE PRIME MINISTER'S INITIATIVE The Prime Minister's initiative on technology in teacher training, known as 'Imfundo' (Ndebele for education), is a new kind of public/private partnership dedicated to finding new ways to enhance educational opportunity in developing countries, with a particular focus on sub-Saharan Africa. The initiative has been developed in partnership with Cisco, Marconi and Virgin. Imfundo will use information and communication technologies such as radio, satellite, computers and the internet to support teacher training, professional development and support, and the management of education systems. Through the initiative, resource centres can be established in district centres to which teachers can travel periodically. These centres will provide access to a wide range of resources, including printed materials, audio, video and the Internet. This will enable trainees to interact with their tutors and with each other. Distance learning of this kind permits developing countries to
train many more teachers to a much higher standard than would be possible by
conventional means. At the same time, teachers can learn new skills and become
familiar with computers and the Internet, increasing their status and bringing
wider benefits to the community. |
114. Dakar also affirmed that 'no countries seriously committed to Education for All will be thwarted in their achievement of this goal by lack of resources'. The UK Government will act in support of that aim, working with other development agencies to increase support for countries with a clear commitment to universal primary education. We will work with international institutions and developing countries to make faster progress towards the education development targets.
115. No child should be denied access to a basic education because she or he, their parents or guardians cannot pay for it. Even when education is nominally free, some direct costs are often passed on in the form of charges for books, uniforms, exams and transport. These direct costs can reach up to 20 per cent of a family's income, making it unaffordable to many. The UK Government will continue to work to improve poor people's access to education.
116. New technologies have slashed the cost of processing, storing and moving information. They have the potential to help poor people leapfrog some of the traditional barriers to development, by linking them into the global economy, improving their access to knowledge and making government machinery work betterxiv, xv.
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FIGURE 3.2 Who uses the Internet? Installed base of Internet hosts, January 1991-July 1999, and distribution by region, July 1999 Internet hosts, worldwide, millions Distribution of Internet hosts, July 1999 Notes: In the top chart, data refer to January of the following year. |
118. But there is a real risk that poor countries and poor people will be marginalised, that the existing educational divide will be compounded by a growing digital divide (see figure 3.2). Watching the staggering growth of new technologies in the developed world, it is easy to forget that more than half the people in Africa have never used a phone. It is not that access is physically impossible. You can surf the Internet in almost every country in the world. But in many developing countries, particularly in Africa, logging on is more expensive than in developed countries.
119. A key constraint on Internet access in most developing countries is the lack of a legal and regulatory framework for a competitive telecommunications sector. Without this, there is no hope of attracting the necessary investment in infrastructure or encouraging the competition needed to bring down costs. Governments need to move from state-run telecoms monopolies, with administered prices, to a regulatory environment which allows competition, including over international routes, and to cut tariffs on imported hardware. But the reforms necessarily present difficult challenges in the short-term, requiring governments to forego significant sources of revenue. The International Financial Institutions have a key role to play in working with developing countries in smoothing this adjustment process.
120. Some developing countries have been concerned that Internet backbone companies (the infrastructure which carries Internet traffic) will not interconnect with their Internet Service Providers (ISPs) on a no-charge basis; instead their ISPs have to pay the costs of interconnection and of the international leased line. At the International Telecommunications Union World Telecommunication Standardisation Assembly in October 2000, the UK helped to achieve agreement by developing and developed countries to a statement of the principles which should underpin future commercial negotiations in this area.
121. We are also keen to see developing countries become more fully involved in the negotiations on communications related agreements in the World Trade Organisation (WTO) and for them to play a greater role in other international organisations which have an impact on Information and Communications Technology (ICT) policy. Poor countries are currently on the sidelines of the global information economy and it is important that the international community agrees policies and standards that encourage rather than act as a barrier to their entry.
122. But if they want to make the most of the new technologies, developing countries need to look inwards as well as outwards. There is a risk that richer people in cities will get increasingly connected, while their poorer fellow-citizens are increasingly marginalised. Communal access programmes are one way of reducing that risk. Combining new technologies with communal access models or pay as you go schemes means that access can become economic, even in remote rural areas. In Bangladesh, for example, there is a scheme through which poor people can get a loan to buy a mobile phone and set up a tiny telecentre. The scheme has proved highly successful: the loans have been paid back and remote communities have access.
123. Access can also be broadened by combining new technologies with the old. For example, although less than one in a thousand Africans currently has access to the Internet, radio has wide penetration, even into the remotest of villages. A growing number of community radio stations are getting connected to the Internet, allowing new material to be shared with much larger audiences.
124. Developing countries also need to raise skill levels and to develop locally relevant applications and content, including in local languages. We believe public-private partnerships have a key role to play in mobilising the resources to do this. We welcome the increasing focus by multinationals on training information and technology professionals in developing countries, and we are keen to work with them - for example on trade and investment promotion packages, and teacher training materials. The Commonwealth Business Council, for example, has developed a gateway (CBCmarketplace.com), which they hope will lead to increased e-commerce within developing countries in the Commonwealth.
125. We believe new technologies can play an important role in improving education in developing countries, from primary through to the tertiary level. There is also growing interest in the way they can improve public sector performance. The state of Andhra Pradesh in India, for instance, is using new technologies effectively in its health care, education and poverty reduction programmes and to improve its tax collection.
126. The world is at a critical juncture in the development of ICT with a number of different technologies (e.g. mobile telephones, the Internet, and digital) coming together and with costs falling. This is changing fundamentally the way business is conducted. For poorer developing countries - faced with urgent health and education priorities - this might not seem immediately relevant. But the constraints on access to ICT for developing countries are in the first instance regulatory, and can and should be addressed alongside investments in education and health. The international community must also play its part through ensuring that international agreements are supportive, and in helping to address revenue shortfalls as the telecommunications sector adjusts to a more open and competitive environment.
127. Globalisation also requires us to re-think our approach to the mobility of people. The spread of ideas and technical know-how lies at the heart of successful development. The development of modern communication technology has made this easier and cheaper. And quicker and easier transport has made it possible for those with expertise to move around the world, living in one country but working in others.
128. Transnational companies and long-term supply contracts both provide important channels for the transfer of knowledge. For example, foreign buyers provide technical assistance in design, production and packaging to firms in Indonesia producing shoes and clothes for the US market, and advice on crop selection, growing and logistics to farms in Kenya producing vegetables for European supermarkets.
129. Government policies in developing countries should promote the mobility that will make this sharing of know-how possible. Good airports and telecommunications are vital - and if the poor are to benefit, there must be easy access to many parts of the country, not just to one or two large cities. Simple measures to reduce delays and difficulties - in customs and immigration procedures, or in approving contracts and projects - and action to improve personal security, can also yield large benefits.
130. Trade in services has become increasingly important in the global economy. The General Agreement on Trade in Services identifies the temporary movement of people to another country - in order to provide the service there - as one of the ways in which trade in services takes place (this is defined in the Agreement as the 'movement of natural persons ').
131. Developing countries are particularly concerned that regulations governing the temporary entry, stay and working conditions of their nationals should not unfairly restrict their ability to sell services into developed country markets. The current negotiations on services in the WTO offer an opportunity for all countries to move forward in ensuring that such regulations do not unnecessarily restrict trade in services, and are applied in a transparent, consistent and non-discriminatory way.
132. A further feature of globalisation has been intense global competition for people with scarce skills in areas such as information technology and the health sector. Developed countries are responding to shortages of health personnel by actively recruiting skilled staff from low and middle income countries.
133. There are benefits to individuals - in terms of career opportunities and earnings - as well as to the health or information and technology sectors of developed countries. For developing countries, these outflows of skilled people generate significant remittances. Longer-term benefits may include the new skills and contacts brought back by returning migrants. But these outflows can also be a drain on human resources in critically short supplyxvi. We are undertaking more research on this issue.
134. The UK believes that developed countries need to be more sensitive to the impact on developing countries of a skills drain. They need to ensure that policies in this area do not unfairly restrict the ability of developing country service suppliers to sell into their markets, yet also do not worsen skill shortages in developing countries. In line with this principle, the National Health Service has developed a set of ethical guidelines which rule out recruitment from a particular country if this has a negative effect on that country's healthcare services.
135. Most research and development capacity is in developed countries and is oriented to their needs. Research that benefits the poor is an example of a global public good which is underfunded. Not enough of the world's knowledge is relevant for the needs of the poor. For instance, 90 per cent of the world's disease burden is the subject of less than 10 per cent of all international research on healthxvii.
136. More and more research is done in the private sector, and the low purchasing power of poor people means that there is little commercial incentive to invest in research to meet their needs. Governments and development agencies must therefore work to create more partnerships and must also invest directly and substantially in research that benefits poor people.
137. In agriculture, because most enterprises are too small to do research, publicly funded research remains important. The work of the Consultative Group on International Agricultural Research is vital. It is essential that it moves forward with reforms to its governance, organisation and structure so that it can deal with the increasing complexities of its role in public goods research and in the organisation and management of genetic resources and intellectual property. Efforts must also be made to strengthen the capability of developing countries to produce, adapt and use knowledge, whether produced locally or internationally.
138. In health, innovative partnerships between public agencies, foundations and private sector companies are tackling globally important diseases by creating programmes to develop and test new international public goods, such as the International Aids Vaccine Initiative and the Medicines for Malaria Venture.
139. Promising new ideas are also under discussion, such as public purchase funds to help develop new vaccines against HIV/AIDS, malaria or TB. Under such a scheme, governments would guarantee to buy vaccines for developing country markets, at a fixed price, from any firm that could develop an effective new product, thus providing the private sector with the financial incentive that is now missing. The expenditure would be incurred if, and only if, a successful product was developed.
140. Other proposals aimed at developing incentive frameworks are under discussion. These include differential pricing - selling drugs and vaccines at a lower price in developing countries than in developed countries; extending the period of intellectual property protection, allowing companies exclusive rights to market drugs and vaccines over a longer period, at a more affordable price; and the use of tax credits.
141. The UK Government has commissioned urgent work to develop new proposals to tackle the lack of incentives for, and the perceived risks of, increased investment in research into vaccines and treatments to tackle HIV/AIDS, malaria and TB. This will look at the full range of possibilities. We will decide on possible financial support in light of the findings of this work. We will also share these findings in full with WHO, as well as with our EU partners, and with other members of the G7/G8 as part of the preparations for the Summit in 2001xviii.
142. Intellectual Property Rights (IPR) - for instance, conferring copyright, patent or trade mark protection - provide an essential incentive for private investment in research and development. This is particularly so in medicine and agriculture, where research can be costly and long-term, and where the results are uncertain.
143. Developing countries have an important interest in providing intellectual property protection, as a way of encouraging more investment, research and innovation from which they should benefit. The precise details of IPR regimes need to be tailored to the particular circumstances of individual countries. The WTO Agreement on Trade-Related Aspects of Intellectual property rights (TRIPs) sets out minimum standards of intellectual property protection. The UK Government believes that the agreement allows WTO members sufficient flexibility to implement domestic IPR regimes which take adequate account of their national circumstances.
144. One concern in this area has been that patenting regimes will restrict the availability or increase the cost of essential drugs, seeds or technological process, and thereby reduce poor people's access to them. A key issue here is the extent to which national IPR regimes permit the importing of goods from the cheapest legitimate international source. The TRIPs agreement does not prevent governments from doing this, and there are no proposals from TRIPs signatories to restrict this flexibility. The agreement also allows for the possibility of 'compulsory licensing' in exceptional circumstances, where efforts to reach agreement between the right-holder and the user have been unsuccessful.7
7 Compulsory licensing is a mechanism which enables national governments to licence a patented product to be produced domestically by a manufacturer other than the patent holder.145. At the same time, we recognise that some developing countries face real difficulties in implementing the agreement on time, that some have concerns about its impact, and that some would like to see changes to the Agreement. For this reason, we support extending deadlines in cases where countries are committed to implementing the agreement but have genuine difficulties in doing so within current deadlines. We are ready to help countries to develop and implement IPR regimes suited to their national circumstances. We are committed to monitoring the impact of TRIPs, including on poor people's access to vital drugs. And we are open to constructive suggestions on how to improve the agreement in TRIPs reviews and to more substantive negotiations in the context of a new Trade Round.
146. The TRIPs agreement does not cover traditional knowledge or access to indigenous genetic resources, and there have been some concerns that developing countries are losing potential benefits as a result. The World Intellectual Property Organisation is currently examining options for the protection of rights to indigenous knowledge. Mechanisms for access to genetic resources are being further developed under the Convention on Biological Diversity and the International Undertaking on Plant Genetic Resources for Food and Agriculture.
147. We support the development of internationally recognised standards, consistent with the objectives of intellectual property agreements, for the protection of traditional knowledge and access to genetic resources, which will help ensure fair and equitable benefit-sharing from their use. We also recognise the need to ensure that intellectual property agreements accommodate and support these standards as they are developed and that such agreements, including TRIPs and the Convention on Biological Diversity, continue to be implemented in a mutually supportive manner.
148. Another concern in this area has been that transnational companies may be able to patent the results of research which should be made freely available as an 'global public good', for instance the human genome, or plant and animal genomes. We are committed to working for international agreement on the need to release fundamental information on the human genome and the DNA sequences of the world's major naturally occurring food crop and livestock species into the public domain.
149. Given the complexities of these issues, the UK Government will establish a Commission (see Box 6), chaired by an eminent person, and including a representative group of international figures, to look at the ways that intellectual property rules need to develop in the future in order to take greater account of the interests of developing countries and poor people. This will report to the Secretary of State for International Development.
BOX 6
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COMMISSION ON INTELLECTUAL PROPERTY RIGHTS (IPR) The Commission will consider: (i) how national IPR regimes should best be designed to benefit developing countries within the context of international agreements, including TRIPS; |
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THE UK GOVERNMENT WILL: · Work to strengthen the international effort to tackle the diseases of poverty including HIV/AIDS, TB, malaria and childhood infectious disease. · Work to ensure that primary education is free for all, that no government seriously committed to universal primary education is unable to achieve this for lack of resources, and work with international institutions and developing countries to make faster progress towards the education targets. · Support, where appropriate, the use of new technologies to help with teacher training and the sharing of skills. · Work to ensure that a development perspective is included in international agreements affecting telecommunications and new technologies, and for a stronger voice for poorer countries in setting these rules in international institutions. · Seek to ensure that the entry and work permit rules and other policies of developed countries do not unfairly restrict the ability of developing country service suppliers to sell into developing country markets, whilst also taking into account the need not to worsen skill shortages in developing countries. · Seek to increase public and private sector research for development, including through new mechanisms to tackle the current lack of incentives for research into vaccines and treatments for HIV/AIDS, Malaria and TB. · Establish a Commission,
chaired by an eminent person, to look at how intellectual property rules might
need to develop in the future to take greater account of the interests of
developing countries and poor people. |
A more detailed account of the UK Government's policies on Health and Education are set out in two DFID Strategy Papers: 'Better health for poor people', and 'Education for all - the challenge of Universal Primary Education'.
