The unveiling of the UK Government’s new White Paper on International Development at the end of last year was much anticipated. It came at a crucial juncture for overseas development assistance (ODA), given the complex list of global health priorities and ongoing constraints on government budgets.
The most comprehensive document produced by a UK government in this area for 14 years, it sets out policy proposals for approaches to international development until 2030. This timeline coincides with significant existing global targets, including the Sustainable Development Goals (SDGs) and the World Health Organization’s goal of reducing malaria by 90 percent.
With progress against these targets having fallen off track and new investment needed for additional challenges, such as pandemic and climate preparedness, the UK’s plans for ODA needs to maximise the reach and impact of its policies and investment. The scope of the white paper is broad but, below, we highlight four thematic areas that cut across much of the paper’s content. These areas will need to remain front and centre if we are to accelerate progress to alleviate poverty, improve health and wellbeing, and ensure a more equitable world for all.
Sustainable Development Goals
The SDGs were designed to be ambitious and transformative. They provide a platform to mobilise global collaboration and enhance collective international support to national governments to achieve the 17 headline goals, including the ultimate goal of the UK’s ODA: ending extreme poverty.
The white paper acknowledges the UK’s responsibility, as one of the countries that championed the development of the SDGs, to take ownership in delivering them and has emphasised the importance of working with civil society to ensure that community voices are heard, valued, and produce change so that no community is left behind. While this reinvigorated focus is welcomed, the SDGs are now at risk of being undeliverable. Over half of SDGs are moderately or severely off track and 30 percent have made no progress or have deteriorated.
It will be important that the UK government, through the UK Foreign, Commonwealth & Development Office (FCDO) and UK Dev (the new branding of UK development delivery organisation), is a leader in tackling these challenges through harnessing the expertise of all stakeholders. This includes taking immediate action to progress their re-affirmed commitments to address the complex challenges facing the successful achievement of the SDGs.
Financing
The white paper discusses potential innovative ways to increase financing, including reforming multilateral development banks and mobilising private sector capital (including through directing funds from pension funds). Also highlighted is the ongoing issue of high burdens of debt across low- and middle-income countries (LMICs), which has, in many cases, become unsustainable and stuck in an inflexible debt restructuring and management system.
Diversification of funding is crucial for both increased resource utilisation and for building resilience of development financing. This diversification must include the private sector, which includes both private for-profit and private non-profit organisations, as a partner in achieving development goals in the future. Our experience of working with the private sector in Nigeria to improve the market supply chain of commodities such as insecticide-treated nets and malaria rapid diagnostic tests showed how this engagement can also increase the coverage, quality and uptake of services, but there is scope to multiply this manyfold.
While discussions on diversifying financing are encouraging — and there is little doubt that innovative solutions are required to mobilise new capital — given the current gaps in development funding, this diversification should be additive to more ‘traditional’ sources of funding. In this context, there should remain concern and ongoing awareness around the reduced overall ODA funding from the UK government (which has yet to restore the 0.7 percent spending of gross national income on development) and the proportion of this budget spent within UK borders (which rose to 29 percent in 2022).
Women and girls in development
The UK’s focus on women and girls in development is clearly re-emphasised throughout the white paper, recognising the importance of gender equity in research and programming and advocating for an integrated, cross-sectoral approach to achieve health equity and prevent health disparities. Included is a commitment to ensure a focus on women and girls in 80 percent of FCDO programmes by 2030 and to champion ending preventable deaths of mothers, babies and children.
Gender norms, roles and behaviours can significantly influence how women react to health challenges, how they access health services and how health systems respond to their needs. Women and girls often face a greater number of barriers to accessing health services and influencing decision-makers in relation to their health needs. A thorough understanding of gender-related dynamics of health-seeking, decision-making and resource allocation — and their integration into programming — is critical to developing gender-responsive approaches.
Ensuring equitable opportunities for women and girls will require comprehensive engagement and investment to address existing power imbalances, and access to rights and services. It will also require acknowledging the diverse needs and challenges faced by women and girls in different contexts. Although the UK government’s commitments are well received, they come in the context of the UK sharply reducing its contributions to UN women (which is down 77 percent from 2020 to 2022, according to ICAI). It is vital that action is taken to enable these commitments to be delivered.
Partnerships
The approach to the future of the UK’s development work set out in the white paper brings a much needed and welcomed focus on partnerships between the UK, LMICs and development delivery organisations. This includes a move towards more equitable planning of bilateral aid and an increased focus on local leadership and mutual accountability for both the donor and recipient countries and organisations. The paper also acknowledges that there is an urgent need for reshaping the international system to allow for a more equitable distribution of power in areas such as trade, tax and debt restructuring.
We know from the work we undertake that to provide a realistic sustainability roadmap, policies, funding and priorities need to be aligned to national plans. Dr George Upenytho, Uganda’s Commissioner of Community Health, spoke in a recent interview with Malaria Consortium of a “one team-one plan” attitude that can support the design of people-centred interventions, catalyse resourcing for primary healthcare and build resilient heath systems that withstand future public health threats. Partnerships between ministries of health, national health programmes and local delivery partners to ensure programmes are aligned with national priorities, work within existing structures, and develop capacity at all levels will ensure long term sustainability.
The ambition set out in the white paper is encouraging. However, it will be important to see action behind the rhetoric. As yet, no firm timelines have been included for international restructuring efforts, which could be key to giving ownership and releasing further national funding for the issues discussed above. To move decisively towards partnerships, the UK must be willing to listen to the concerns of countries and organisations around the world and act accordingly. In the days before the publication of this white paper, the UK, along with other high-income countries, unsuccessfully attempted to block an African-led UN vote on establishing a framework convention on tax to move the primary control of this issue away from the small group of high-income, Organisation for Economic Co-operation and Development (OECD) member countries. We encourage the UK government to take a cross-government approach to explore reasons and concerns behind calls for change such as this and to work together with all parties to find mutual solutions.
Conclusion
The UK government’s refocusing on development through this comprehensive new strategy and partnership approach to achieving the SDGs is encouraging and we hope to see actions follow. We will continue to work with the UK government and partners, sharing our quality implementation and operations research and providing strong evidence that supports informed decision-making. In doing so, we seek to maximise the impact of the UK government’s commitments and our collective efforts to drive forward the change needed to deliver better health and improved lives across the world.
Eoin Cassidy is Malaria Consortium’s Research Uptake Manager
Photo by James Newcombe