DfID Merger: How the new department can create a healthier world

On 16th June, the Prime Minister announced the merger of the Department for International Development (DFID) with the Foreign and Commonwealth Office (FCO), to create the new Foreign, Commonwealth and Development Office (FCDO).

In light of Covid-19, this new department will face particular challenges in terms of global health, requiring an urgent, focused and strategic approach. Fortunately, the UK Government has a strong legacy on global health and has built up significant in-house expertise (both within DFID and beyond) which it should continue to protect and draw on throughout the merger. This continuity throughout the merger will be particularly critical as the Covid-19 crisis continues to impact the health of populations across the globe.

However, the merger also presents opportunities to improve and strengthen the UK Government’s role in global health. Covid-19 has highlighted the interconnectedness of the health of people everywhere, and the need to step up efforts to build strong, transparent, accountable and resilient health systems all around the world. A truly Global Britain must put itself at the forefront of these efforts.

In order for the UK Government to lead on global health, the FCDO must first prioritise development objectives, place development principles within its mandate, and embed development within its governance structures.

This means:

• Ensuring that all UK Overseas Development Assistance (ODA) has poverty reduction as its primary focus, adhering to the OECD Development Assistance Committee rules, commit to uphold the International Development Act, re-committing publicly to its ‘leave no one behind’ pledge, and continuing its commitment to inclusive societies by delivering on DFID’s gender and disability strategies.
• Maintaining independent scrutiny of the aid budget, so that all aid spending is accountable to the British taxpayer and those it seeks to assist. This means protecting the Independent Commission for Aid Impact and supporting the creation of a new parliamentary committee, with oversight of all ODA spend.
• Maintaining capacity for international development within the Cabinet and National Security Council, through appointing a Chief Secretary for International Development that sits in both bodies.

As the Covid-19 pandemic has emphasised, health is connected to every aspect of our lives and requires an integrated approach.

As such, Action for Global Health recommends that the UK Government maintain and strengthen their holistic approach to global health, spanning across (but not limited to) health systems strengthening and efforts to achieve universal health coverage (UHC), pandemic preparedness and response, water, sanitation and hygiene, sexual and reproductive health, health research and development, anti-corruption, and nutrition. 

Health is also intimately connected with other development issues: for example, we have seen first-hand the impact of Covid-19 on education, livelihoods, and climate change. This holistic approach requires integrated ways of working, which can only be delivered through a truly cross-government effort. The UK Government already has in place a number of structures to support this approach, which can and should be maintained and strengthened throughout the merger.

UK ODA to health is currently spent across multiple departments, including the Department for International Development (DFID), Foreign and Commonwealth Office (FCO), Department of Health and Social Care (DHSC) and the Department for Business, Energy and Industrial Strategy. Additionally, other government agencies (such as Public Health England) provide non-financial, technical support on global health issues, and decisions made by other government departments also have a significant impact on global health outcomes (eg. Department for Environment, Food and Rural Affairs). The UK has also been able to draw on the expertise of the National Health Service (NHS) to champion UHC on the global stage.

This cross-government approach is embedded in the Global Health Oversight Group, convened in 2016, with representatives from all relevant government departments. The group is currently chaired by DFID and DHSC. This group is responsible for overseeing global health policy and programming of mutual interest between government departments, including the cross-government response to global health threats.

Action for Global Health recommends that the Global Health Oversight Group is maintained and strengthened in the merger, with the FCDO chairing this group and overseeing the UK’s work in global health across all relevant government departments. 

In his speech to the House of Commons, the Prime Minister spoke of the merger delivering policy coherence across government departments or a ‘comprehensive overview’. Action for Global Health believes that there is an opportunity to establish greater policy coherence in global health through the creation of a cross-government global health strategy. The previous global health strategy, which expired in 2015, was widely considered to be an innovative model of cross-departmental collaboration. Additionally, Public Health England’s Global Health Strategy also expired in 2019.

In light of Covid-19 and the expiration of these strategies, Action for Global Health believes that now is the time for the UK Government to articulate its approach to global health, through the creation of a cross-government global health strategy. 

A global health strategy is essential because:

• It outlines and delivers synergies that will increase the impact of the UK Government’s work across global health, improving health outcomes and securing better value for money.
• It reflects the priority that the UK Government places on global health to external and internal stakeholders, as well as establishing departmental priorities for their global health investments.
• It creates a roadmap for the UK’s role in delivering all commitments under Sustainable Development Goal 3, including Universal Health Coverage and ending the preventable deaths of mothers, newborns and children (as per the UK Government’s manifesto commitment), as well as working through the synergies between SDG 3 and all other SDGs, including ending poverty (SDG 1), zero hunger (SDG2),  gender equality (SDG 5), water and sanitation (SDG 6), and building strong and transparent institutions (SDG 16), among others.

In the past two decades, momentous progress has been made in improving health in low and middle income countries. Since the year 2000, the number of children dying before their fifth birthday has halved. Twenty years ago, almost no one in sub-Saharan Africa was taking antiretroviral medication to treat HIV; today, 63% of people living with HIV in the region have access to these medicines. Between 2000 and 2017, the maternal mortality ratio dropped by about 38% worldwide. Public funding has also been instrumental in researching, developing and bringing to market effective treatments for TB, HIV and neglected tropical diseases.

As the second largest government donor of development assistance for health globally, DFID has clearly contributed to these successes.

Beyond funding, this success is also attributable to the significant in-house technical and policy expertise across all relevant DFID health teams (including WASH, SRHR, nutrition, Global Funds etc.) and through the network of in-country DFID advisers. DFID officials have also played a critical role creating and reforming various global health institutions, through seats on the boards of Gavi, the Global Fund to Fight AIDS, TB and Malaria, and UNITAID.

Protecting development expertise and relationships was also a key learning from the merger of AusAID into the Australian Department of Foreign Affairs and Trade. Former AusAID deputy director-general Richard Moore estimated that 2000 years of experience had been lost in the transition.

Action for Global Health recommends that the UK Government protects its strong legacy on global health through maintaining ODA to health, retaining DFID’s expertise and staff in the merger, and keeping their seats on the boards of all relevant global health institutions. 

The creation of the FCDO provides an opportunity for continued UK political leadership on global health, through increased focus and energy on ‘global health diplomacy’. The recent Gavi Summit provides an excellent blueprint for how this can work successfully; the UK Government combined expertise on development (DFID) and diplomacy (FCO) to champion immunisation on the international stage and leverage increased funding. The next year sees a number of further opportunities for the UK to maximise their global health diplomacy.

As Covid-19 continues to dominate the international agenda, Action for Global Health recommends that the UK Government fully utilise the UN General Assembly and 75th Anniversary celebrations, their hosting of the G7 Presidency, and the COP26 Summit next year to champion increased attention and investment in global health. 

The role of UK Government ‘Special Envoys’ is another example of successful diplomacy for development objectives; Baroness Sugg has been a fantastic champion of improving girls’ education and overseeing progress on this manifesto commitment.

Action for Global Health believes that the UK’s global health diplomacy could be further strengthened through the appointment of a Special Envoy, who would champion the UK’s role in global health on the international stage and oversee the implementation of the UK Government’s manifesto commitment to ending the preventable deaths of mothers, newborns and children.