Oral evidence: Global Health, HC 208

Oral evidence, 27 October 2026.

Witnesses

Jerop Limo, Dr Natasha Kaoma and Abadi Assefa.

Chair

We are starting this first session of the International Development Select Committee on global health, something that cuts across all of the work and inquiries we do but, sadly, something we have seen less and less funding and acknowledgement going to in recent years. For our first panel we are joined by three panellists, virtually. I will ask each of you to introduce yourself and say a little bit about the organisation that you work for, and then we will go into specific questions. Jerop, please introduce yourself and your organisation first.

Jerop Limo

My name is Jerop Limo. I am the Executive Director of a youth and adolescent organisation based here in Nairobi, Kenya, called Ambassador for Youth and Adolescent Reproductive Health Program. A lot of our work is really centred around providing holistic support and care for adolescents and young people living with and affected by HIV—holistic support in the sense that our Ministry or health system will provide the diagnostics, the medicine, which is more biomedical and then, as a civil society organisation, we offer the services and support and ensure that young people are able to access quality care at the end of the day.

Dr Kaoma

Good afternoon. I am joining you from Kitwe in Zambia. My name is Dr Natasha Salifyanji Kaoma. I am the CEO of Copper Rose, Zambia. Copper Rose is a youth-focused organisation that exists to build a conducive environment for young people to thrive. In a nutshell, our work sits at the intersection of health and economic opportunity. For us, our health portfolio has mostly reproductive health, mental health and health system strengthening, and our economic opportunity portfolio works on entrepreneurship and mobility. Many people might ask how on earth we deal with health and entrepreneurship, but really from where we stand, our name Copper Rose comes from the fact that copper is Zambia’s biggest natural resource. However, we think that one of the biggest resources we are ignoring is Zambia’s women and young people, so we exist to unleash their potential. We have seen that for health outcomes to be adjusted, we also need to look into the social determinants of health. Our organisation is the biggest youth-focused organisation in Zambia. We are women-led, we are led by young people, and we work to look at social determinants of health as a means to improve health outcomes. That is pretty much about me and my work. Thank you.

Chair

Thank you so much. Sadly, it seems the potential of women and girls is being rolled back all around the world. Abadi, please introduce yourself and your organisation.

Abadi Assefa

Thank you. Good afternoon, I am Abadi Kalayou, Executive Director of the Family Guidance Association of Ethiopia. It is the oldest family planning organisation in the country. We have been in business about 60 years. We have worked, along with the Government, to treat people who are hard to reach. We were founded in 1966. We have been an accredited member of the IPPF family since 1971. We work with a chain of 774 service points across the country—EFDA clinics, public clinics, private clinics and workplace clinics. We work also with refugees, IDPs and displaced people. We are a key partner of the Ministry of Health; we are part of the national system. Thank you.

Chair

Thank you all very much for joining us and thank you for the absolutely vital work that you do. I know it is a very tough landscape to be working in at the moment. Jerop, I will start with you and then I will ask the other panellists. What have you been witnessing in recent years in the field of work that you operate in? Could you also look at how you work with the Government and has the Government’s approach to health changed in recent years?

Jerop Limo

Let me start by saying that I have worked in the HIV space for 10 years now, so I have kind of grown in the system. I am also a young person living with HIV myself, and having been on this journey for over 20 years, I have been in the health system for a very long time. Let me start by saying, we were at a point where we were saying things have progressed and science has evolved—many years back, we were taking more than five pills as people living with HIV, and now we are just taking one pill, so things have changed and there are so many successes. Then we woke up one day and the first text I found on my phone on that day, after the funding cuts, was: “The US Government have cut money and so we are going to die, all of us”. That was the first text, just from one young person who was panicking. I work with young people. I am a leader of so many young people seeking help who we support in our programmes. I remember thinking to myself, “What is this? What is going to happen?” People are looking to us as an institution or organisation to give support and guidance, but we are also in darkness. I always say that the HIV system was created in parallel, away from the common healthcare system for a reason: because people living with HIV have very—I wouldn’t call them special, but very distinct needs. We are diverse: we have young people, girls and young women, we have men, we have queer people, we have key populations. So, we had moved and evolved to a point where we have service providers who are patient and kind. For my community of young people, it was that clinician who had just become so familiar to you that you felt safe with them, and overnight all this is gone. One aspect for me is that we had a proper, functional system—or not proper; it was a bit in between. Of course, it had its own challenges, but we had a system that we had become used to for so long, and we were familiar with it, and overnight all this has changed. What our Kenyan Government did was to talk about the need for integration. Integration is now combining the two systems, so that everyone goes through the primary healthcare system, which is good on paper, but integration cannot happen overnight. It is a process: you are shifting people and shifting a system. You are changing healthcare providers. All the things that we are familiar with have gone, so people are most likely to be confused, to retract from the health system itself, and to date I can confidently say that we are still trying to find people who are lost from the healthcare system during that transition. Now we are implementing the integrated system; all of us are accessing the one system. It has a lot of challenges, and I use the word “chaos”. I think our health system is chaotic as of now. We are yet to find out footing, especially because a lot of money had been invested in this holistic healthcare system that was supposed to offer distinct services to different populations and service all equally. Overnight, all that is gone and we are all expected to go through one service and system, which is not the easiest thing. I think one thing the Government did well was to react to that by trying to figure out how to ensure the continuation of services and to ensure that people are still accessing medicine, but the same breath, there are so many gaps and challenges, just to mention a few.

Chair

Thank you so much for sharing your personal experience of this as well. When you got that first text message, was that the first that you knew about the cuts? Do you think the Government had any more advance notice than that?

Jerop Limo

Yes, that was the first time for me, and I didn’t understand what that meant, because I was just going through emails and X, trying to figure out what it actually meant. I also think our Government did not know. I have had the privilege of working with the Government. In 2024, we sat on a committee put together by our Cabinet Secretary for Health, thinking about sustainability. We would sit in these rooms, and I was representing civil society and young people. We would sit with Government and Members of Parliament, and we would talk about sustaining our health system and the HIV response in general, but I don’t think any of us envisioned that it would happen that soon and, based on their reaction, neither did our Government. No one was prepared for what happened.

Chair

It sounds as though your Government responded really well by pooling all the services together, rather than having the ones that are more tailored to distinct groups. Does your Government have the money to do the procurement and delivery specifically for HIV/AIDS?

Jerop Limo

I think that is where the problem is now, because there is what you can say on paper and in memos for healthcare providers and county officials, but the actualisation of it requires a lot of resources. I don’t think they had money. One aspect is that a lot of funding for the HIV response was coming from USAID programmes and the Global Fund. Our country is divided into two. We had some areas that were fully funded by USAID and some areas that were funded by the Global Fund, because they did not want to double deal in areas. We had one whole part of our country that did not have donors and support, so we have one basket—the Government has a quota basket—and we are trying to see how the money can be shared across. One aspect in Kenya is that health is devolved, meaning counties have the responsibility of putting money into health and making independent decisions. We saw some counties react quickly and tell the healthcare providers, “We know you don’t have jobs but please continue going to the hospital. We will figure out your salaries. Continue offering your services.” At the other end, as communities, as an organisation, we positioned ourselves as the bridge to remind communities: “The medicine is still there. The hospital is open. Please make sure you access your service.” They didn’t have the money, but we made it work.

Chair

Natasha, the same question to you: what recent changes have you seen and how are your Government responding to them?

Dr Kaoma

Thank you so much for that question. First, I want to give you the background on the context, based on my experiences. Copper Rose is an organisation that we started 11 years ago. We are primarily focused on reproductive health and HIV programmes, up until about two years ago, when we incorporated an aspect of development. From what we saw from the stop work order and the reduction in funding, especially over the last two years, is that we have lost scale and scale pathways. As a community-based organisation, as we moved from reaching one community, two communities, we were reaching more than 400 communities and more than 200,000 people every year, with access to information and services. Now we are down to 45,000, and this is not only us, as Copper Rose; we have seen it in many other institutions. There has been a reduction in the community-level support. Just for context, about 84% of Zambia’s programme funding for HIV was coming from PEPFAR and almost 80% to 90% of the SRH funding was coming from other funders—UK and other European funders. With the reduction in funding, what we are seeing on the ground is that, while the facilities in the hospitals are continuing to work—the hospitals are still there—looking at the social and cultural barriers around reproductive health and HIV stigma and things like that, they need a lot of community interventions. Last year, the Government came up with an essential services package, and the community interventions have been removed. They have also removed standalone sexual health centres that used to exist. There were about 32 centres for HIV, and DREAMS centres in more than 21 districts that we were part of, and they no longer exist. I did my master’s at the London School of Hygiene and Tropical Medicine, and one of the things I remember is that I could go to a sexual health clinic there and access services, because in a clinic that is designed like that, there is no issue of stigma or discrimination. I don’t have to explain several times to a provider why I need something. We had a similar arrangement here with the different kinds of wellness centres, DREAMS centres, but we don’t have those any more. Now, everyone has to go to the main health facility, which deals with TB, malaria. As we know from even insurance data, in any community, only about 15% of people are comfortable enough to go to a hospital, so we are losing a lot of people and a lot of prevention opportunities, and that has been a very big challenge. Some of the other challenges we have seen is a loss of momentum in some of the work that we are doing. In the last few years before the funding cuts, Copper Rose was able to influence about seven policies in Government. We influenced the Family Planning 2030 commitments and we ensured that the Government had a specific commitment for adolescents’ access to reproductive health services. Last year, we were working on a gender strategy with the Ministry of Health, because they did have a strategy—there is a national gender strategy, but it has not been brought into direct ministries like the Ministry of Health. We were working on the USAID programme for gender, and from the time the stop work order happened, that gender strategy has just remained hanging. That is a missed opportunity, because there is no funder who is now willing to continue with that work. We have a draft, it is there, but it is just not going to go on because there is no support. Lastly, we have seen also that there is a loss of staff and a lot of people who have lost their jobs following the funding cuts. UNAIDS estimated that about 16,000 people lost their jobs and only about 6,000 have managed to get their jobs back. That means that there are still many people who are not only unemployed but are underemployed because with a lot of these programmes, highly technical expertise is required—to interpret data, epidemiologists, statisticians—but a lot of those people are not working or they are going down to a job that just earns them an income. From where I am standing, that is one of the biggest challenges I see. However, what works and what has been working so far is that those organisations whose models are embedded into the Government way of working have continued. However, in the immediate sense, in the first three months, what we saw, which was very scary and has raised a lot of trust issues, was to do with data management. A lot of data was sitting on USAID sites, and some of the health management information systems and many other systems were on US Government servers. As soon as the funding was cut, a lot of those servers have been lost, but also a lot of staff who sit even in the government facilities, like M and E, and data staff, have been lost and some of them have not come back. This has also brought a lot of trust issues, because while we want and need to be self-sufficient as countries, we think that it has been very disturbing to be abruptly removed from a system. We think that good partnership lies in effective communication. A lot of trust has been lost, but I still think that there are a lot of opportunities going forward. But if I am being very honest, that is where we are. The biggest hit has been on the community. If I had to quantify the data—and research has been released. A study was published in 2025 in the Open Forum Infectious Diseases journal, and it was qualified by Ministry of Health staff. They estimated that in the first three months since the funding cuts, there were 32,000 new preventable deaths—for the first three months’ interruption. They said that if the disruption continued for a further four years, we should estimate 330,400 deaths. These deaths are greater in children, because if you understand the reproductive health landscape, which is HIV most importantly, there is 1.3 million people living with HIV in Zambia right now. When you look at the UN targets, the UN has said 95-95-95, which means 95% of people should know their status, 95% of people should be on treatment, and 95% of those on treatment should be virally suppressed. As a country, we have achieved these targets, which goes to show that whatever these programmes were, they were working. However, these targets have not been met in children. From zero to 14, these targets have not been met. In children, 82% know their status, 88% are on treatment and 86% have suppression. What that means it that we have missed an opportunity either in preventing mother-to-child transmission of HIV or in testing children who have already been delivered. When it comes to additional work that needs to be done, it will definitely have to be in children, and we should not overlook that. I will just pause there. I could talk all day, but I will just pause there so that others can come in.

Chair

We could listen all day because the information that you are giving to us is both shocking and gripping. I think it was particularly wicked of DOGE to wipe that data, because it was not theirs to destroy. Abadi, I will ask you the same question: what recent changes have you seen in your field and how your Government are responding to it?

Abadi Assefa

In the current development in the organisational overseas development assistance, we have been observing significant cuts in ODA assistance at a national level. Practically, it was sudden and impactful. For us, we lost 40% of our budget in 2025, due to the US cut. For these cuts, it is women and young persons living with HIV/AIDS who are paying the price. The cut also accounts for a reduction in human resource. In terms of personnel, we lost about 162 technical personnel and have been forced to withdraw from 366 public health facilities in the community, which are highly affected by the funding. While we estimate the impact of those withdrawals to be about—

Chair

Abadi, I think we are going to have to come back to you because the line is not good. I will pass over to Brian for the next set of questions.

Brian Mathew

I will start with Natasha. I have just come back from Zambia, but it was on a different mission. We have lost your picture, though. [Interruption.] Ah, you are back. Good. Natasha, you have given us some idea of the impact of cuts to funding for health in the communities you serve, but perhaps you could elaborate a bit more. Also, what concerns do you have for the sustainability of the historic gains that you have seen?

Dr Kaoma

Thank you so much. Can you hear me?

Brian Mathew

Yes, we can.

Abadi Assefa

Yes. Sorry, the—

Chair

Abadi, we are going to come back to you in a moment, if that is okay. Natasha, over to you.

Dr Kaoma

We definitely have lots of statistics around the long-term impact, and the sad part about negative health outcomes is that by the time you realise how many more deaths will be caused, I honestly think it is too late. Most of the data has to be done through modelling studies, where we try to estimate what the impact of this will be. The impact, for example, on HIV and access to reproductive health services is only an estimation right now. A lot of the commodities were being supplied by donor funding, and one of the things that really helped with the commodity side has been forecasting. For example, most of the drugs are procured eight to 10 months in advance. From the time we received the funding cuts last year, we only had to procure one more time, so most of the impact we anticipate will be seen more clearly in the coming years. One way that I think would be very effective and would create sustainability is ramping up the private sector. As a serial entrepreneur, I must say that I also run a pharmaceutical business, and in that business I have been able to see that, because there is not a lot of contraceptives in the health facilities, there are more women who are willing to purchase contraceptives from the community. That means there is a market for private sector investment and engagement, and I think that is a long-term sustainability plan. If you look at developed countries that have a national health insurance scheme, while it guarantees free services for many of its citizens, it receives a lot of bailouts from billionaires and Government, and generally wealthy people. But on this side, there are very few billionaires in Zambia, I must say, but people still have money. Even if someone is living on a dollar a day, they can spare five cents a day towards health or some kind health plan, and we do see them spending money on many things for life and living. I think that ramping up the private sector or doing some private sector development work in health would be an investment that would bring about long-term sustainability. That is one of those areas. Another area would be to see how best to improve the way government works. We work a lot with community health workers and peer educators, and it is very common for there to be a very high attrition rate, of between 60% to 80%, depending on the job. High attrition means that organisations like us are constantly training healthcare providers. Just last year, medium-sized organisations like Copper Rose trained more than 700 healthcare providers. You can imagine how many people large organisations are training. More than 20,000 healthcare workers are trained every year, and these people need to constantly be trained. We believe that putting up a digital training platform or a digital training system, investing in something like that, would be very effective in dealing with some of the costs of delivering healthcare to the last mile. There is a lot of training in the supply chain in many different areas, and I think that investment in more long-term sustainability measures would be much more effective. Lastly, one of the things that really helped make local organisations like Copper Rose was the localisation agenda, where a certain amount of resources was designated, to ensure that local organisations received a certain amount of funding—you put on a cap or a percentage, to say, “At least this amount of funds should go to local organisations,” because local organisations work. Whether there is funding, whether there is no funding, we will continue working in our communities, so investing in local partners is a long-term sustainability measure. For me, even if I have no money to go to a meeting, I will still receive the call, “Natasha, where are you? You need to come and work on this document.” Even today, I received a call about a meeting that is probably 10 hours’ drive from where I live, and I might still find myself there, even if I am no longer on an organisational salary. Investing in local leaders is one of those things that would move the needle when it comes to sustainability. I hope that answers the question.

Brian Mathew

Abadi, are you able to answer that same question? What has been the impact of cuts to funding for health in the communities you serve and what concerns do you have for the sustainability of the historic gains you have seen?

Abadi Assefa

On the current HIV/AIDS funding, the funding has been provided by a grant, almost 50%, and because there was a cut in funding, the contracts of around 5,000 of the health workforce have been affected. The cost in this regard is that some clinics may stay open but they have no commodities and no HIV drug alternatives. There is no outreach programme and even no follow-up support. This is just to give you an example. In Gambela, where the HIV prevalence rate is very high, 23%, young positive teenagers are currently sharing their antiretroviral medication due to a shipment stoppage as well as stockouts. In the Amhara region, girls of 14 years old, survivors of sexual violence, are now pregnant because the nearby clinics that they could access have run out of contraceptives. Parents are forced to get them married—early marriage at the age of 14. It becomes a denial of the opportunity to continue their education as well. The effect is not only on access to contraceptives but on future earnings as well. On funding cuts, including from the UK, we are fortunate enough to have funding support from the UK Government through WISH. In WISH1 we were implementing in 15 countries and one of them is us. In WISH2 we are currently implementing in seven countries, so there is a reduction in implementation of 45%. In terms of the regions, we are operating in Oromia, the Southern region and some better regional areas, which accounts for about 65%. Now we are ready for conflict-affected regions, which require additional funding. The provision has been significantly reduced. In WISH1 we were operating 645 health facilities, including private health facilities— public health facilities in universities. Now we are operating in only 129 health facilities, which is a 20% reduction. On development, the FDR has witnessed the UK Government investment making significant progress over the last 25 years, including the WISH programme. It was a critical part of that successful development. When we look at the national progress, contraceptive use rose from 8% to 35% of married women. The infant mortality and child mortality rate has fallen by about two thirds. The WISH contribution has been significant. Around 13.4 million pregnancies and 68,000 maternal deaths were averted due to this intervention from WISH to Governments of 15 countries. The new WISH is focusing on the conflict-affected regions in Amhara, Tigray and Oromia as well as in Afar region. This shows that the UK has reached the hardest places, and FGAE knows how to deliver in those places because we are community driven.

Chair

Abadi, I am going to pause you there, so that we can ask some more questions. It is amazing what your organisation is doing, but I want to get into more of the details around it.

Tracy Gilbert

I am going to speak about the rollback of rights, and I will come to Jerop first. I know that Natasha mentioned this already, and it will be interesting to hear a bit more. Have you experienced ideological or political resistance to your work and that of the groups that you work with? Probably more importantly, what can the UK Government do to help counter the rollbacks on human rights?

Jerop Limo

I will start by giving the context. For the first time after the funding cuts, our President made a public remark about where he stood on issues of gender, and I remember he said he recognises that we only have male and female. That statement alone caused an uproar of confusion about the rights of queer people and issues of reproductive health and rights. I remember people coming at organisations that are funded—who work in the HIV response, attacking us and saying we are the ones who are promoting all these things. When a leader of a country makes such a statement, it influences communities and people to just decide the direction of what should happen, and what services should be accessed. At that particular time, our organisation and other organisations in Kenya had taken the Government to court over missing links in our reproductive health policy. It had omitted issues of rights. We are no longer even allowed to say the word “rights”. We are no longer allowed to say “freedom of expression”. There were questions around all of this conversation, and we had made a lot of progress in conversations around the country on comprehensive sexuality education. All of us then were not allowed to even mention that name in any space, in any conversation or even in documents. Of course, we saw this start with the US Government redacting and changing documents, and that moved down to what our Government were allowing us to say. After that statement, it was the way the Government say things should be done and no other way. Our Minister of Health was saying integration is the way; there was no other way. It doesn’t matter if it is just for the people, or just for communities; that was the way the Government had restricted this to happen. We have seen Government really questioning why abortion should be allowed in Kenya, because abortion in Kenya is legal but only under certain circumstances. We had organisations that offer services that would offer safe abortion to women and girls, reproductive health rights and contraceptives, having to close down and then being attacked by communities because their Government had given a direction that these are not things we should be practising as a country. I would say, yes, we have seen a lot of pushback on women’s rights, and confusion about at what age young people and young women should access reproductive health services, what services they can receive and what services they cannot receive. I will give an example. Under the HIV policy, a young person aged 15 can walk into a clinic and get tested, but the reproductive health policy does not allow that. You have two policies serving the same population but saying different things. One of the things we are pushing for as civil society is the alignment of policies, guidelines and law. We were completely shut out, hence why we chose to go to court. We did not win that case, and that policy will be serving us for the next 10 years or so. It is sad. We went to the streets because of that, but it goes to show how confident our Government became about gender, the cultural African way of living and saying, “This is not what we practise as a country”. That means access to contraceptives, safe abortion, sitting in rooms and defending human rights; women’s rights are no longer on the table. Government officials do not allow it even in spaces where we are supposed to negotiate, converse and plan together jointly.

Dr Kaoma

Thank you so much for that question. There has been evidence of a rollback on sexual and reproductive health and rights. Let me start with that the phrase sexual and reproductive health and rights, because it can no longer be used in any Government setting. They removed the word “rights” and we can no longer say SRHR. We have to say SRH. Every Government document, every meeting, every setting that we are in can no longer add “rights” to SRH.

Chair

Natasha, can I pause you? Either why do you think that is, or what was the explanation for why that change was made?

Dr Kaoma

That is a tough one. I am trying to think whether I should give a factual reason or my own individual opinion.

Chair

It is your choice.

Dr Kaoma

I don’t know the facts. Let me be honest, I don’t know the facts behind this, but as a spectator or someone who is in the second round—not in the actual room but someone external who doesn’t work at the Ministry of Health—I am seeing that if I am going to pay for this, I am going to do that on my own terms. When someone else was supporting the Government—when another entity was supporting the Government—they could determine the terms, but now that I am in charge I am going to determine the terms. That is kind of what it felt like, and we saw this rollback even in comprehensive sexuality education. Last year a movement came up against CSE training. That is training that is given to adolescents, preparing them for life, so it a life skills programme that really embeds the sexual and reproductive aspects. A religious movement came in. There have been anti-rights movements growing, but what made the anti-CSE movement unsuccessful when it was trying to remove CSE from schools some time last year was the fact that CSE has been embedded in every single subject. Even when a movement comes up, it means they have to fund a whole curriculum revision, and that is expensive. As we roll out programmes, I also learnt that we need to think long term and what does a backlash look like if resistance comes. That is what I saw. The third thing I have seen so far is that the word “gender” in documents is being taken out. I will give you an example: “gender” in some documents has been replaced with “sex”, “gender-based violence” has been replaced with “violence against women and men”, “sexual gender-based violence” has been replaced with “sexual violence”. This is guidance coming from the Department of State and what is left of US-funded programmes. That is affecting how people work. Lastly, from a CSO perspective, we were providing a lot of technical assistance to Governments, but with the shrinking of the funding a lot of CSOs are spending most of our energy on survival fundraising rather than true advocacy. Our advocacy capacity has shrunk as the civil society sector in proportion to the funding crisis. Where I see a problem in one area because we don’t have access to the funds, we are going to go where the funds are. I don’t think that is an enduring way of doing it, and that is not what we are doing, but a lot of organisations are. I was just looking at FCDO funding in Zambia and three quarters of the funding is going towards social cash transfer programmes, agriculture and climate resilience. Half of the organisations are now doing climate work, even though they started off as health organisations. I feel like we are losing a lot of the health advocates because they are doing what we call survival fundraising instead of advocacy. Also, that means we have lost of technical expertise to the other sectors outside health.

Tracy Gilbert

Abadi, is there anything you want to add briefly?

Abadi Assefa

Thank you, yes. We are observing the role of foreign actors. Especially we are seeing them using funding and influence to shape the Ethiopian health system and policy. We have observed some changes in the framing of the MOUs for the health strategy, one of which Ethiopia has signed. This has also been seen across the region in Kenya, Uganda and Ghana. There is a new draft that has been presented to the African Charter on family values. This is a co-ordinated effort to make the rollback more effective. Ethiopia has signed the MOU. We don’t know the details or the full conditions, and the effect of the lack of transparency worries us a lot. On the organised actors, they are targeting parliamentarians, especially individual parliamentarians and indigenous Government officers, to make policy change. At the same time, they are targeting health professionals, specialists and religious leaders to influence their cause. They are also engaging in disinformation and misinformation, targeting service providers. Even our service provider has been targeted because of carrying out a survey for safe abortion care, and now our facilities have been switched. It is very worrisome to see that.

David Mundell

Natasha, I will ask you this first. Do you see any opportunities at all from this new situation with the reduction in outside aid? Do you think anything positive can come from it?

Dr Kaoma

One of the first positives is that as countries in the global south, we had a lot of work done on policy development and good economic and social policies. We have a strong policy background on which different programmes can be layered. Just before I answer this question, something I didn’t mention earlier is that when you look at the way the different country Governments were operating, I don’t know about Jerop in Kenya but in Zambia you would find that if the UK Government are working in these provinces, the EU or other governments are working in other provinces and the US Government are working in these provinces. There was a geographic allocation, and also the programmes were layered on top of others. For example, if the HIV programme was the one that was carrying the digital health information system, a family planning programme or a different programme would not need to create a new government system. A lot of those systems still exist, and I think that means that we don’t need as many resources as we did when those systems were being developed. One of the opportunities is to rely on the systems that are already built. The second thing is private sector and blended finance, which is very important. I have seen FCDO working with the private sector in different sectors outside health, and that opportunity could also be opened up to the health space. I honestly think that there is some room to fill parts of the gaps with in the private sector investment. One of the opportunities also is that when it comes to things like abortion, Zambia has law almost identical to the UK law on access to abortion services. However, many of the gaps are in training and development. For example, if resources are reducing, some of the high-reward, low-effort opportunities are to focus a lot on the workforce and the health information systems. When the US Government came back, as I think Abadi mentioned, on the MOUs, a lot of them are leaning on the workforce and on data. A lot of stakeholders were looking at it from a sovereignty point of view, and I totally agree with that. A nation should have access to its own data. However, I think that the lack of data is one of the things that affects planning and budgeting. An opportunity from here would be looking into digitisation and data systems, because there are still definitely a lot of opportunities there. While funding decisions seem like a catastrophe, I feel like they are an opportunity to rebuild things in a different way and an opportunity to make changes to what is known as business as usual. I think there are a lot of opportunities in how things could be rectified.

Noah Law

Thank you, Natasha. Earlier Jerop mentioned the need to reduce costs and find ways to be innovative in today’s environment. Specifically on bringing in a bit more innovation and private partnerships, how would you like to see FCDO engage in that and support you to find the partners to help you deliver some of the things you have described, whether it is on data, AI-type interventions or making sure, as I think was alluded to earlier, that you are doing local sourcing in all of that where you can?

Dr Kaoma

Investment in health would start from, first, investment in data, because one of the ways is to understand how much investment needs to go into certain areas and even the gaps. I would start with investing in data to understand the landscape. I know there are so many hackathons or entrepreneurial-driven activities, but I am very sure that there are already lots of tried and tested businesses that are functioning in Zambia that would need direct funding, similar to how grant funding would come but with better conditions, because it is feeding into something that has the ability to regenerate. When we write proposals we always talk about sustainability and it sounds good on paper, but more often than not we are looking for the next funding after that funding has come through. In this case I would say weight-bearing some of the heaviest facts about running a healthcare business would definitely go a long way in sustaining it long term. If I have to be honest, I would say the two pinpoints for most health businesses right now is data and access to data. AI is one of those things that we could leverage, but AI also comes with things like data protection. I know that Europe has very strong data protection policies and we just don’t have similar ones here. As we encourage the use of systems, some of this financial support could go towards strengthening our data protection laws and data protection systems, especially for health services data.

Chair

Thank you. Let me pause you there and go back to David.

David Mundell

Natasha, this is a second question for you. What can the Zambian Government do, or what should they do, to adjust to this situation, or what are they doing to adjust to it?

Dr Kaoma

They have just appointed a new Health Minister. We have not even got a full Cabinet yet. In case you are not aware, we had our election in August this year and our Cabinet is not yet fully formed, but if I could be the Health Minister for a day I would introduce fees into our health system—minimal fees, but that would definitely be a step in the right direction as far as sustainability is concerned, because I see even people who can afford it accessing healthcare for free. I honestly think that that reduces the amount of commodities that are available for those people who genuinely cannot afford it. Right now the Zambian Government even pay for people to be evacuated to other countries to receive treatment, and most of the time rich people are the ones who get that kind of healthcare support. The first thing I would do if I was the Minister for a day is introduce service fees, because they would generate some income. I would also restructure the national health insurance system, because it could be doing a lot more. The insurance was a good start, but I think we could do a lot more in making it more functional and better able to support our citizens. Those are the two things I would do if I was the Minister for a day.

David Mundell

Excellent. Thank you for that very clear answer. Jerop, I will come to you and ask you the same questions. What opportunities or positives, if any, can you see from the impact of the reduction of aid, and what is happening in Kenya with the Government to adjust or otherwise to this situation?

Jerop Limo

One good thing is that our Government woke up. Generally, I think there was so much over-reliance on donor funding and development funding, which honestly really helped us, but it had got to a point where there was zero prioritisation for reproductive health and HIV because they know a civil society organisation somewhere will support that dialogue and train healthcare providers. Government were not allocating resources to health and even if they did, it didn’t end up being used for health. I think it is a wake-up call that this money is here today and tomorrow it may not be here, so as a Government we actually need to do something about it, make sure we put money into healthcare and ensure that that is actualised at the end of the day. I think that is the biggest opportunity, but there is also integration. It is a beautiful system on paper, and even prior to the funding cuts, one of the things we kept on pushing for as civil society was that we want a young person to walk into one room in a facility and access all the services under one roof, so it is a one-stop shop. They don’t have to be sent to one side of the hospital to get contraception and then to the other side for lab results, which means you can end up losing the client in between the referrals and linkages. We had in mind designing and thinking about a one-stop centre that offers all the services for an individual. Integration looks good on paper, but the one essential aspect is that it takes time, and the time is with the people. You have a system that looks really nice on paper but it really doesn’t serve the people as it should. Integration provides an opportunity for people to interact less with the clinic, so I just enter a room, I get my services and I go home. There are no “special services”—it is not saying they are not special, but that is how we look at it, so that people can access services at the same time. But there is still a limitation. For example, someone who has TB is seated in a waiting bay with about 50 clients. All those people are at risk of contracting TB if the structure of the facility is not well ventilated, if it doesn’t have enough windows and if there are no masks. So, there are so many facts involved, even if this integrated system looks good on paper. For me, those are the two positive things. When I think about what our Government need to do, there is lots. I am Gen Z and we have had a problem with our Government, so my list is endless, but I will stick to just two things. One is that when we say we want people to utilise the system, the first essential aspect is for people to trust that system. If they cannot trust it, they will question it. It doesn’t matter if one person had the best services; it takes one person to have a bad experience, and then, all of a sudden, that is everyone’s approach and thoughts. We have our national health insurance—it is now called our social health insurance—and that is really good, because depending on your level of earning or job, a certain amount is cut, so if you earn little, you will be charged little, and you will be able to access care. If you tax people and they walk into a clinic and there is no medicine, there are no test tubes, the pharmacy is not there, the watchman is rude, and the latrines are unusable, at the end of the day people question: “Why do you deduct this tax for health and give me the bare minimum, in terms of health?” For me, it is actualising what is on paper and making it a reality for our systems and our social health insurance. The second thing is about investing in and strengthening communities and civil society. Our role is very distinct. I say it every single time: you can give me a bottle of medicine, but it takes a peer educator who understands how scary it is to live with HIV, and be a queer person and be young at the same time, to give the support that I need to remain adherent to my treatment. So, you have a facility on this side that has medicine, and on the other a community person who is in dire need of this medicine but can’t leave their house to get to the facility. That peer educator, organisations like Copper Rose or the mentor mother will be the bridge and ensure that that community person gets to the hospital. It is those two for me.

David Mundell

Thank you. Abadi, do you think there are any positives or opportunities that come from the new funding situation, and how are the Ethiopian Government responding, or how should they respond?

Abadi Assefa

Yes, there are positive areas that we have observed. One thing is the way of thinking, in terms of the entire spectrum. The system has been supported significantly—around 40% plus—by foreign aid, so the reduction of the funding is very critical. The Ministry has been assigning a budget for about 30%; the other 30% is from individuals’ pockets. After this instant cut, the first thing the Government did was to look into the funding portfolio. They made at least some commitment to filling in the gap, and especially to allocating funds to SRHR, taking it from 7% to 9% in terms of the real outcome. But given the gravity and the gap we have, there is still a long way to go. The country ownership initiative has been revitalised, which is good. The Government are promoting domestic resource mobilisation in every sector and looking at how we can avail ourselves of resources from local elements. That has been done. At national level, the Minister of Finance introduced some taxation to mitigate the effect on the emergency response programme, so in every payment—any transaction—there is at least 1% to finance emergency response programmes. The Government are taking this seriously, which is good. Secondly, they have given a space for partnership, meaning the private sector has been pulling to the front to take part in investing in local manufacturing partnerships with other development partners. This is a new initiative that has been introduced in industrial parks, special economic zones, and so on. The third point is on the space given to local civil society organisations. Civil society organisations have been mandated to generate their own local income, so as to bridge their own funding gap. We were fortunate enough to be able to look into our system and make specific adjustments to our way of doing business, in order to generate a certain amount of money, so that we could finance those who cannot pay. This is a cross-subsidising framework. From a policy perspective, Government have been looking into domestic resource mobilisation. Previously we did not have a policy for domestic resource mobilisation; now they have one. We are part and parcel of the Ministry of Health’s new strategy plan from Strategy 2026 to 2030. The adolescent and youth health strategy, as well as the reproductive health strategy, were previously jointly designed at Government level; civil society and other actors have now been involved. We are making sure that the SRHR agenda is there, as part of the commitment. But in terms of the stage, there is a gradual move to country ownership at national level. Working with the Government, which we have to do, they have been very supportive. We have to support the health system, which is on board, as early system generators. There is purposeful financing by the Finance Minister, as well as a specific amount of money being allocated to run the business. The good thing is that the Government are positive; they are even making some commitments at global level, but in practice we are looking into tracking how things could be implemented in areas. In terms of the Government, there is a new shift in locating resources. In terms of civil society—

Chair

Abadi, we will stop there because of time, but you have ended on a good note; the Government is looking to make those changes. We will write to you about civil society and, panellists, there are a few other questions on which we would like to follow up. Thank you so much for your time. You have given us loads of information at the start of our inquiry. It is good to hear some potential positives, but let me personally say that I am very sorry for the cuts that came from the UK. Like you, we were all shocked and surprised at the cuts that came from USAID—both the severity of them, and how swiftly they were delivered. Thank you for still going, thank you for what you do every day, and please do relay our gratitude to your teams as well. Examination of witnesses

Witnesses

Monica Ferro, Dr Kirrily de Polnay, Dr Jeanne Salje and Dr Kennedy Uadiale.

Chair

We are now starting our second panel on the International Development Committee’s inquiry into global health. Thank you very much, everybody, for joining us. Dr Kennedy, thank you for joining us remotely. We appreciate it. I will start by asking the people in the room to introduce themselves and their organisations. Dr Jeanne, I will start with you, please.

Dr Salje

Thank you for giving me the chance to be here and speak with you. My name is Dr Jeanne Salje. I am an academic research scientist at the University of Cambridge. My personal research is on bacterial neglected diseases, and scrub typhus in particular. We work on the fundamental mechanisms of how this bacteria infects humans and causes disease, but also do more applied work. At the moment, we are very activity engaged in trying to develop a new diagnostic test that would help us better diagnose and detect this disease. So, we do both fundamental research and some more applied work. I have lived and worked and run research labs for an extended period of time in Thailand and the USA, and I relocated to Cambridge University four years ago. The evidence that we submitted was as part of a consortium with three other academics at the University of Cambridge and my colleague Professor Bavesh Kana in South Africa. I will try to the best of my ability to share both my own experiences and experiences that have been shared with my colleagues. What I hope to share is our perspectives on infectious disease research and research partnerships, and how the cuts have affected them.

Chair

Thank you. Your colleagues are more than welcome to follow up in writing, if they want.

Dr Salje

Excellent, thank you.

Chair

Dr Kirrily, over to you.

Dr de Polnay

Thank you very much for inviting me to represent MSF today. My name is Kirrily. I am a medical doctor trained down the road at Guy’s and Tommy’s. I started work with Médecins Sans Frontières in 2011 and worked with them for 10 years. I also did work for WHO and UNICEF. My speciality is paediatric and maternal malnutrition. As most of you will know, MSF is an independent international medical humanitarian organisation. We provide care to people affected by conflict and outbreaks, and to others excluded from healthcare, in over 70 countries. For over 50 years we have worked in some of the world’s most fragile and insecure contexts, and we deliver assistance based solely on need.

Chair

Thank you. Monica, you and I know each other from the all-party parliamentary group on global and reproductive health and rights, which the UNFPA supports, but could you please introduce yourself and your work for our audience and Committee members.

Monica Ferro

My name is Monica Ferro. I am the head of the United Nations Population Fund office here in London. As you probably know, the United Nations Population Fund is the UN’s leading agency on population data, sexual reproductive health and rights. We work to uphold the rights and choices of women, girls, young people and all population groups in a situation of vulnerability in about 150 countries and territories. We provide essential health services, protection from violence, and vital information about sexual and reproductive health and rights. We partner with governments and civil society to provide and shape evidence-based policies, strengthen health systems, and prevent gender-based violence and harmful practices. We also use demographic intelligence to inform policies; we anticipate population change and, therefore, build systems that are resilient.

Chair

Dr Kennedy?

Dr Uadiale

Thank you very much. My name is Dr Kennedy Uadiale. I am a medical doctor by background and a researcher at the Liverpool School of Tropical Medicine. I am based here in Blantyre, Malawi, where I am hosted on the Malawi Liverpool Wellcome Research Programme, and am running research that is NIHR funded here—the Opt-AMR project. Opt-AMR is “optimising antibiotic usage to mitigate antimicrobial resistance”. I am a health system researcher with a focus on antimicrobial resistance. We are doing this across four countries: Malawi, Uganda, Zambia and the UK. This is a big consortium that includes the Centre for Infectious Disease Research in Zambia, Doctors with Africa CUAMM in Uganda, Makerere University in Uganda, and here in Malawi, the Malawi Liverpool Wellcome Research Programme. Our focus as a consortium is on looking at how we could develop rapid approaches to address antimicrobial resistance surveillance, but also using the same approach to monitor quality of care at primary healthcare level because of its linkage to antimicrobial resistance. We are not just researchers; we are also looking at theory and using our partnership—leveraging it—and strong collaboration with the Ministry of Health to facilitate the use of the output of our research, thereby enhancing the health system and strengthening our agenda. I will stop there.

Chair

Thank you.

Dr Sam Rushworth

Monica, could you talk to us a bit more about what your organisation does and its relationship with UK funding.

Monica Ferro

As I was saying, we are the leading agency on sexual and reproductive health and rights, which means that we work to deliver a world where you can meet the target of zero preventable mortalities. It is not only a health issue; it is also a human rights issue. We work to remove all obstacles between women and access to healthcare services and information. The other big outcome of our strategic plan is securing universal access to family planning. Then we have another big goal: we are committed to ending gender-based violence, in which we include harmful practices such as child marriage and female genital mutilation. We co-lead with UNICEF on the two global programmes to end these harmful practices. We have also decided to highlight our work on demographic intelligence, providing countries with information so they can build resilient projects on social welfare and health. What we have seen in the last couple of years has a lot of resemblance to what we had when UNFPA was created at the end of the 1960s, which is a lot of demographic anxiety. In the 1960s, the demographic anxiety was towards an exploding population, and now the anxiety is very much to do with low fertility. This has to do with many of the issues we heard about in the first session: with rights being challenged because there is a lot of anxiety, mostly in low fertility countries. We can go back to that if you feel it is important.

Chair

Challenged by who?

Monica Ferro

We see a lot of narratives, and this is a big change in the last couple of years. In countries with low fertility and aging populations, we see a lot of pressure to take out of the curriculum comprehensive sex education, and even to reduce access to family planning, and to allow certain discriminatory narratives on gender—in a way, it is appealing to women to go home and reproduce and deliver babies. That is a very good option, if it is voluntary; we have nothing against it. We heard also about misinformation. This has become a big topic; we have talked about rolling back on rights. It has to do with what colleagues in the first panel shared, but also our experience from analysing what is happening in many countries. We work with a lot of parliamentary networks, of the kind that Sarah Champion mentioned, because we do see the value of mobilising support when it comes to our agenda. But to your question on the UK, the UK is our largest donor. In 2025 the UK invested in UNFPA a grand record of a bit over £200 million, which is very encouraging because the UK is also my second largest donor for humanitarian programmes. We know that one of the biggest investments of the UK in UNFPA is the Supplies Partnership. It is the programme we use to deliver reproductive health and maternal health commodities to 54 low-income countries—

Dr Sam Rushworth

What do you mean by “commodities”, to make it simple for us?

Monica Ferro

We mean medicines, products and equipment. The investment the UK has made in our Supplies Partnership has helped to establish it as a flagship global health initiative. It is currently the largest public sector provider of contraceptives, to give you an example. We know the power of family planning when it comes to reducing maternal mortality and empowering women, allowing women to decide over their bodies and their fertility. It has a rippling effect that is very positive. I know the UK is very focused on impact and efficiency of investment, so we do think this is a good initiative.

Dr Sam Rushworth

When this Committee was in Washington and met with the remnants of USAID in the State Department, and the DOGE team that has been put in charge of them, they were talking about how they are still funding drugs for HIV but “we have got rid of the woke stuff”. What I am understanding is that maybe that “woke stuff” is actually quite important, if it is preventing unwanted pregnancy or educating people. That is the area you are essentially working in, and you are seeing evidence on the ground of that improving health outcomes.

Monica Ferro

One of the biggest outcomes we have from the investment in family planning is the reduction in maternal mortality. It has been absolutely extraordinary. We have reduced 40% of maternal mortality in the last 30 years, which is something that we should celebrate.

Dr Sam Rushworth

What has done that? What has led to such a reduction in maternal mortality rates?

Monica Ferro

Mostly investment in healthcare facilities and assisted skilled birth. There has been a huge investment in midwifery. We do know why women die in childbirth. It is not biology; it is not fate. There are three big causes, and we know how to treat them. The data shows us that around 90% of all maternal mortality happens in low and middle-income countries. Half of all maternal mortality happens in humanitarian settings. We do know what works and we know how to reduce maternal mortality, but it requires investment and, to be very clear, it requires sustained investment. This is an area where, once you reduce the funding, you immediately see the impact. You may still have a clinic, but there are no doctors in it. You may still have a hospital but maybe there is no medicine, and no skilled birth. The clinic is there, the lights are on, but there are no services for women. This has a tremendous impact on women and girls, and on this goal that we are so proud of as a community—reducing maternal mortality by 40%.

Dr Sam Rushworth

Is FGM a part of your work and a part of reducing maternal mortality?

Monica Ferro

Yes. We co-lead with UNICEF on the global programme to end FGM, and on that we also have good news. The rates are lower, but still we know that there are millions of girls and women at risk because the funding is also being reduced. A lot of countries have made tremendous advancements in law, but law alone is not enough. We also need budgets to implement the programmes, and we need to monitor the success of the project. We need investment that is sustainable, because otherwise the continuation of projects is at risk. Also, the crisis in climate change is exposing a wider number of women and girls to FGM. Some of them are being married off earlier because their parents maybe believe they are better protected if they are handed to someone who can feed them and take care of them. In many scenarios, that comes with FGM. These things are sometimes not visible at first sight, and we make the point of connecting the dots to show how even climate change and conflicts are affecting child marriage and female genital mutilation.

Dr Sam Rushworth

That sounds like important work you are doing.

Monica Ferro

Thank you.

Chair

David Taylor.

David Taylor

Thank you, Chair. I want to continue the discussion on the implications of aid cuts. Jeanne, could I ask your perspective?

Dr Salje

Yes. This is quite a different perspective from those that we have heard so far. The rapid and unexpected overnight cuts that we heard about earlier, in the context of infectious disease research, meant that research programmes, diagnostic labs—labs that have the lights, have the buildings, have the equipment, but now no longer have the funding to do those things that they were trained and established to do—are no longer able to do that from one day to the next. That has led to and will lead, in scientific terms, to two things. One is an increase in the spread of antimicrobial resistance because that important work in controlling those pathogens is no longer able to go ahead, and a reduction in our ability to detect and identify outbreaks early on and control them before they get out of control. To illustrate that first point, I happened to be in South Africa in February 2025 at a conference of microbiologists from all over the world. My colleague, Bavesh Kana, who contributed, was there. I remember a conversation with him. He is an academic scientist based in South Africa, and he ran over 30 clinical trials on TB across South Africa. He told me that they had got the announcement that their NIH funded grants would stop, so from one day to the next, those patients who were involved in those trials could no longer be treated. These were research trials looking at whether the disease is transmitted in households and so on. They were studying research questions, but in fact what they were doing was delivering healthcare. TB is very difficult to treat. We have a limited number of drugs available and you need to take a cocktail of drugs every day. What he told me was that things changed from one day to the next. These are communities they had established trust with, and worked with over long periods of time. They had the medicines in their freezers but they could not administer them. These people had to go and look for treatment elsewhere. What are the consequences of that? Of course, for the individual’s treatment, it is catastrophic. Their TB is no longer controlled. In theory they can seek treatment elsewhere; in reality that is not always available. You have people looking around, trying desperately to find treatment where they can. With TB, you have to be careful about using the right treatment. These individual patients—their disease is no longer controlled. For some of them, the disease will have escalated and got much worse. There would also be increased onward transmission, with greater spread in the community, because their disease is no longer controlled. Over the longer term, we know that if you do not carefully control your treatment regimen with antibiotics, that bacteria evolves to be resistant to those drugs. We are limited in the number of drugs that we have available for TB. Following up with Bavesh six to 12 months later, he told me anecdotally that he is starting to hear of more and more cases—when he is able to scrabble together some money and come back to his cohort—of patients who, six to 12 months later, have TB strains that at that time could be controlled by the available antibiotics, but are now resistant to two, three, or sometimes all the available treatments. This is being replicated across the world, not just South Africa. In all those places, the research for TB was doing healthcare as well, and so we will see this emergence of AMR. A lot of the clinics and centres that we use for antimicrobial resistance detection and diagnostics were UK-funded through the Fleming Fund. I do not know if you were aware of that. This was a big ODA funded—

Chair

The Committee has taken a very keen interest in that.

Dr Salje

That was a huge investment and it was fantastic. It was nearly 300 laboratories in 20 countries. This is a big investment the UK has made, but of course now it is unclear what will happen to that next.

David Taylor

To clarify, up until this point you have been primarily talking about the USAID cuts, is that correct? Are you now talking—

Dr Salje

Yes, I was talking primarily there about the USAID cuts, but I now want to pivot and talk a bit about the importance of diagnostics. An example I want to give—I do not know if it is linked to USAID or ODA—is the recent Ebola outbreak. You may be aware that it has been reported that one of the reasons why there was a significant delay was that the initial diagnostics were done using a test for a different species. I do not know the reason for that. Probably it is because that was the test that was available in the lab at that time. A patient tested negative, and it was only two and a half weeks later when the sequencing data became available that it was confirmed as an Ebola case. That means there was a two-and-a-half-week delay before it was recognised that there was an outbreak. Dr Kennedy can probably speak a lot more to that particular case. I am not saying that is directly linked, but I am giving it as an example of the importance of having robust networks where the diagnostics are good, they are funded, and we are not just buying a PCR machine and dumping it somewhere and then walking away. We are investing in the reagents that we need, training the people, and making sure there is continuity, and that the laboratories are well connected locally and regionally. In reality, this is how outbreaks are detected: there is an unusual cluster of cases, and someone phones their colleagues, with whom they have long-term relationships and partnerships. They say, “Hey, I have these cases. Have you got these cases?” Then you start to do an investigation. The reduction of investment in that risks leading to the loss of our ability to detect outbreaks early.

Chair

When the Committee last visited WHO we were told that the US pulling out was leading to big gaps in data sharing and, therefore, knowledge. Is that something you have experienced?

Dr Salje

That is a little bit outside my expertise so I do not know, but I would not be at all surprised. The consequences of that would be exactly what I am saying, that if those data sharing networks are disrupted that is what you would expect to see.

Monica Harding

Kirrily, could you tell us how the UK Government ODA policy could best adjust to the new reality of less global funding?

Dr de Polnay

It is a good question. I can speak from MSF’s perspective and, to be honest, listening to the first session and listening to my colleagues here, we as MSF end up seeing the final results of so much of what we are talking about today. When there has been a lack of funding in that primary healthcare, in the family planning clinic and in those labs, so many of those people end up on our doorstep at MSF when we are still open, our lights are still on, and we still have supplies. Often now we are seeing those opportunities for simpler, cheaper, earlier health interventions have been missed already. We are collecting data and seeing our increases in admissions for children with malnutrition and women with complications. We are seeing the final results of all of this. It is a health ecosystem; we all would love a world where we did not need MSF but we still do, and we know that we have different organisations that partner with local organisations and Government. As MSF we do not take any funding from Governments, which does keep us more independent, but it does not mean that we are not part of that system. When other services are suffering, we are trying to scale up but we cannot fill all those gaps. What we are going to come back and ask the UK Government for—we are not naive, we know it is not just the UK Government funding cuts we have seen; it is a very complex funding landscape. My speciality is nutrition, so my comfort zone is to talk about that. From my perspective, the UK Government, FCDO, has been an incredibly strong intellectual leader in nutrition from the first Nutrition for Growth summit. The work that you all do in the cross-party parliamentary group for nutrition has been so important. We have appreciated that every part is needed—the investment FCDO has made into prevention of malnutrition, the research and services. We are asking two things, please protect the existing funding. We would love to see a road map back to 0.7% but protect that existing funding. We cannot see further breakdowns in these services that lead to these people falling at our door. You are known as a very reliable and responsible donor when it comes to nutrition. We ask you to keep that role and to keep standing up for those rights of people. That is what we are coming to you with. We understand that a lot of the strategy is to invest in multilaterals and that has been the decision, but again we heard evidence earlier about the importance of local partners. We also ask that, again, accountability for those multilaterals is maintained from the UK Government. Asking the right questions, looking at the data and following where the money is going is also important.

Monica Harding

On that last point, can you expand a little bit? What do you mean? Do you have examples of that?

Dr de Polnay

I have also worked in other UN agencies. When we are writing our donor reports, when we are reporting back to you, we ask you to have systems in place that would allow an interrogation of the data and the explanations you are given to make sure that it is getting to exactly the people who are in need and that the action is based on need, rather than any other agendas that may be existing.

Monica Harding

On the first point you made, which was that when things come to you they are more complex and, therefore, I am guessing, more expensive and there are cheaper solutions upstream, do you have a live example that would bring that home, where support or aid has been taken away, or ODA spend?

Dr de Polnay

As a lot of you know, malnutrition, often, is not just about hunger. So often it is about the interplay of hunger and disease. If you have a child who has had multiple episodes of diarrhoea and has not been able to access care for that—which could have been simple rehydration solutions and some monitoring—that child can end up in our services really sick, really dehydrated, with malnutrition and those children are really complex to manage. I have managed them myself. They keep you up all night. You have to use completely different protocols for the malnourished than for the non-malnourished. They are really complex cases. Also, if that child has not been vaccinated, there are so many places now where we are seeing measles outbreaks. Again, the interaction with measles and malnutrition is awful. These kids are so unwell. Those basic services could have stopped that kid coming to us. We are now seeing peaks in our admissions into hospital and, like I said, by the time a malnourished child reaches one of our MSF hospitals, they are really sick. They are really sick, and there are so many things that could be done. At the moment in south Afghanistan, we are seeing increases compared to previous years in our in-patient admissions, and so many of those children are less than one year old. That, again, for me speaks so much to the interaction with the mother’s health and the mother’s nutritional status, and that so many of those services have been broken down. If we have young mums or mums who are not getting antenatal care, good maternity care or postnatal care, and who are malnourished themselves, you are going to get preterm babies. You are going to get low birth weight babies. The risk of malnutrition for those children is so much higher.

Monica Harding

That is very useful, thank you. Monica, can I come to you? In your experience, do the public in donor countries support international health spending?

Monica Ferro

They do. Maybe I should start to respond to that question by saying thank you because the UK is UNFPA’s largest market for individual giving and donations from the public outside the US, because the legislation is quite different. I asked them to pull the numbers and for the first six months of 2026 we have already had £1 million in donations from the UK public. It is also very interesting that the largest donations were solicited for our campaigns to provide life-saving services in Gaza and the West Bank, and our birth kits. It is heartwarming to see how the UK public is responding to our appeals, and I think this also encourages you as representatives of the people to understand that it is very much aligned with what the public wants. The UK has a very generous public and we are very thankful for this extraordinary level of support.

Dr de Polnay

Can I add one thing? I have much smaller numbers—I was just going through some supporter numbers and it was only 31—but it is heartwarming to see the messages that we get from the British public. So many of them increased their contributions to MSF directly linked to funding cuts by Governments, including the UK but also the US and other Governments, and really cited that as their reason. That is very heartwarming. We know the British public are very generous in that way and that must not be forgotten in these discussions.

Monica Harding

Can I clarify that? You were seeing the public give more because they saw the Government cut?

Dr de Polnay

Yes, not just the UK but the many, many funding cuts generally. People were literally writing that it was directly related to that, the increase in their direct debit.

Brian Mathew

Kennedy, to you to start with—in Malawi, muli bwanji?

Dr Uadiale

Ndili bwino, kaya inu? That was a good one.

Brian Mathew

Feel free to be completely honest with this. What opportunities, if any, has the international decline in funding created for Governments and organisations delivering health programming or research?

Dr Uadiale

Thank you very much for that question. The funding cuts definitely came with a lot of challenges for Governments, mainly because of the abruptness. It happened and not too many Governments can switch immediately to take up responsibilities that were previously being covered. If you look at the way countries responded—and I am going to focus on the countries that I am working in currently—Uganda saw an opportunity, in the way others probably would have seen an opportunity, to say, “Let’s begin to look inward. Let’s begin to do things a bit differently to be able to absorb the shock.” Uganda is moving more and more into integration of health services, bringing HIV programmes into an integrated healthcare system and trying to mount some level of response to absorb the shock, but different countries have different capacity to be able to do that. If you look at the scenario in Malawi, with all its economic challenges, it was not easy to have that switch happen. What that means is that there are a lot of challenges at primary healthcare level, all the way to tertiary healthcare level. Very quickly, maybe I can also talk about the fact that even though the opportunities are there and countries try to respond differently, the suffering of the people is really there. I will give you an example. Jeanne was talking about the Fleming Fund withdrawal. For us, the impact of the Fleming Fund withdrawal was beyond the issue of the laboratory. One of my colleagues, who I was talking with a few days ago, told me that as soon as that happened, the district hospital where he was working could not produce lab results for 150 days owing to the fact that there was no one to operate the data management system of the lab. Even the provision of blood culture bottles was not there. That created a lot of difficulties for health workers. For us as a team that is involved in research, we have a research component that involves an ethnographic approach and the Fleming Fund was sponsoring those meetings. When implementing that research package, we go to technical working group meetings to observe how people who make decisions on antimicrobial resistance policy make those decisions. Where are the bottlenecks? What are areas that could be addressed in those decision-making processes?

Chair

Kennedy, can I pause you there? We pushed the Government very hard on this decision, which the Committee thought was wrong. We had a Minister of Health and an FCDO Minister here in front of us and they both said that the scheme was always time limited, this was the end of the first tranche, and it was up to other Governments to pick up the second phase. Do you have any sympathy with that position?

Dr Uadiale

Every project is time-bound. That is the truth. Every project is time-bound, but it does not stop halfway. There is always a transitioning process. When another Government is going to take it over, there is a timetable to transition. The tap is not just closed immediately.

Chair

That was what was missing.

Dr Uadiale

This is the kind of thing we have seen where the tap is closed. The core group meetings for AMR and technical working group meetings are either not happening at all, or they have moved to being virtual occasionally. For me, as a researcher who wants to do ethnographic research to be able to support and improve how decisions are made on AMR, I am not able to do that any more because I need to be in a physical meeting where I watch the way people do things. This is trying to bring out the difficulties that have come with this. Though countries are trying, and looking at this in a way that there could be opportunities to look inward, being able to transition has not been easy for those countries.

Brian Mathew

You mentioned that in Uganda they were able to look inward to see what they could do there. Can countries like the UK help to realise those sorts of opportunities?

Dr Uadiale

Absolutely. This is where I strongly believe that the UK can champion a number of causes. The work we do to develop rapid approaches to antimicrobial resistance surveillance is sponsored by the UK. It is already a very positive thing that is happening that has real value for money because we know that antimicrobial resistance is one of the biggest threats to public health at the moment, and surveillance is a key pillar to addressing antimicrobial resistance. With this work we have just done, if countries are empowered to be able to use rapid approaches that are affordable to identify hotspots for antimicrobial resistance and target interventions, it will go a long way in changing things. I would be very happy to see the UK championing these kinds of causes, which will be able to address this situation. Additionally, when you look at the workforce, funding cuts have affected especially the frontline workers and community health workers, and when you at countries trying to reprioritise, community health workers are far down the list of priority. Since they do not have funding, some of those who were sponsored by projects previously are laid off, and staff who were not trained to properly take care of HIV patients are the ones taking care of HIV patients. In locations where they want to try to absorb the staff who were previously working on those projects, some of them stay a very long time without salary. For every human being who works in a low and medium-income country, there are chains of people who depend on that person. It is a chain effect of things that end up happening from just one event. This is how I think the UK can come in and support countries to leverage those opportunities, champion them. Lastly, just to conclude—

Chair

Very briefly, please.

Dr Uadiale

I strongly believe resources can be leveraged. There are other donors that are making an effort and the UK can also leverage those resources. The UK has the technical know-how for research. The UK has the ability to provide technical advice. The UK can, on its own, employ researchers or technical people who could support in-country projects that are being sponsored by UN agencies or other donors. In-country expenses can come from that, from the funding that is already available from other donors. Leveraging and collaborating could support that. Thank you very much.

Chair

Thank you. We are running out of time and we want other people on the record.

Brian Mathew

Kirrily, how do these opportunities change when we consider fragile or conflict-affected states?

Dr de Polnay

It relates to what Kennedy was saying. In so many of the places that we are working in as MSF, yes, we would love that domestic financing or that ownership to happen, but it cannot happen overnight. If we are honest, in Yemen at the moment they are not ready. They cannot take over the health system. They cannot switch. In Afghanistan it is the same. In those places I am afraid there is still the need for MSF. Yes, for sure, that would be a long-term goal but that is not the reality today. The reality today is us having to add another 50 beds to our in-patient ward for malnourished children. It is not an easy task. There are opportunities and we see that, and there are opportunities with UN reset and efficiency, but there are so many contexts where we cannot expect that to happen overnight. We do need the UK to, again, be protecting that humanitarian funding.

Brian Mathew

Jeanne, the UK wants to base its provision of aid around the partnership model. What does a good partnership look like to you?

Chair

Ideally in no more than two lines. [Laughter.]

Dr Salje

I am quite positive about partnership in terms of research. We need partnerships at all levels. I am most familiar with scientist to scientist, and in many cases that is a genuine partnership because scientists are like wildcats: we get to do what we want. No one tells us what to do or who we work with. You only enter into a partnership if both parties are going to get something from it. The way collaborations work, whether it is with someone in the US or someone in Nepal, it is because both parties are getting something from it, and generally they are long-term collaborations. You design a project together, you write a project together, and you develop a grant together. I would say the cuts and the loss of Newton funding and the Global Challenges Research Fund have made it more difficult to establish those sorts of partnerships. One example I would speak to, very quickly, is that we bring in students from LMICs and from other countries. I just got a new MPhil student, who started yesterday, from Bangladesh. He is absolutely fantastic, equivalent to the other master’s students that we have, and we have a very, very competitive programme. It is exciting having someone like that here in Cambridge for a year because he will come and do great things, he will probably go on and do a PhD, have an international career—may go back to Bangladesh, may work internationally—but through his time in Cambridge he will build networks, both with me in my lab but also, importantly, with his cohort. They will all go on to become international scientists. That is where we have a way, scientist to scientist, of investing in the next generation. That is something I think science really lends itself to, bottom up—building these solid, foundational, long-term partnerships that can filter up through the ecosystem.

Chair

We have a parallel inquiry on higher education and research, and we may well lean into you for evidence on that as well.

Dr Salje

I would be happy to.

Chair

It is a great pleasure to welcome Tulip Siddiq to our Committee, a new member. Over to you, Tulip.

Tulip Siddiq

Thanks. Monica, you have already mentioned the rollback on rights in a previous answer. I wanted to ask you a bit about how you have experienced this in your work across the world, and in particular how it has affected future and past achievements?

Monica Ferro

Thank you for that question. If I may, I am just going to steal 30 seconds of my allocated time to mention that this message of ecosystem is very, very important. We come from three different backgrounds, Kennedy and so forth, and if I could highlight a key takeaway for this Committee, it is the ecosystem. We are all working in an ecosystem. The fact that I do not have money to deliver supplies—as I have mentioned in a previous hearing, sometimes we do not have the money to bring the ships to dock or to deliver on the last mile—is affecting the civil society organisations downstream that depend on us getting the supplies to them. Kennedy was highlighting the health workforce. We have been terminating contracts with some of our skilled SRHR professionals, midwives, and that is a pipeline that gets blocked. It takes years to train someone. It is amazing that women can still go to general practitioners, but they do need skilled attendants. This goes very much to the question on the rollback. What we are witnessing is, all over the world, language being challenged. We heard Natasha saying that in certain places, the expression “SRHR”, sexual and reproductive health and rights, has become too politicised; I prefer “too toxified” because everything is political. It is mainly the question of rights because it broadens the scope of services that you need to provide. If you have a right, it means someone has the duty of fulfilling your right, and I think that is part of the conversation. In some places we are seeing the rights being narrowed, either because there was a cut or because there is an ideological position on some of the rights that are set on the table. I am not going to make any comment on that but what we fear is that, with the rollback on rights, the agenda will be compromised and we will have bigger difficulties in fundraising for certain programmes that are included in SRHR. Let me say four very quick sentences. I think that one of the things we need to do is to reclaim the language on rights and choices. A lot of the opposition is making these niche concerns, like it is something where all the interest is to academics or scientists. No—it is a core public policy responsibility. The other thing I would say is: challenge misinformation with evidence. We often see narratives being replicated in all types of media without being challenged, like that comprehensive sexuality education sexualises children, or that access to information on abortion leads to an increased number of cases. That is not right and we need to challenge. Then, broaden the coalition. It has been referred to here that we all play complementary roles. We need Government, we need civil society organisations, we need academia, we need the media, and we need parliamentarians on this. My last claim would be: make consequences visible. Political arguments often seem abstract. This is why in a Committee like this one, you ask us to come here and tell you that due to the cuts we had to close over 10,000 health centres, 260 safe spaces were closed, and over 11 million women and girls lost access to services. This is what it looks like, the rollback on rights, and sometimes the rollback on rights also comes with funding cuts. I am sorry if I exceeded myself.

Chair

What is the UK doing to address this, particularly around the ideology that is driving some of it?

Monica Ferro

I think the UK has a critical role to play in this conversation, not only because it is a member of the G7; it is a member of the G20, it is a permanent member of the Security Council, it is a leading voice, and it has an extraordinary diplomatic network. I think that the message has to be very clear. These rights are non-negotiable. These rights are red lines as strong as economic rights or access to certain markets. That would be what I would ask from the UK, and that you invest your expertise in supporting some of our countries and organisations in responding to the challenges that we have. The UK is clearly a leading voice and thought leader with a huge presence in all the forums where these policies are decided.

Noah Law

Turning back to you, Dr Salje, as well as the bilateral programmes, multilateral funding has been cut significantly. What do you feel the impact of that is on achieving our global health goals?

Dr Salje

Honestly, that is where I have less direct experience. I do not really want to comment on that, especially since we are short on time. The only thing I would say is that there is an organisation, FIND, the Foundation for Innovative New Diagnostics, which I have worked with. It gives advice and helps various academics develop diagnostics for neglected diseases and get them out in the field. That is an example of an organisation that has rapidly contracted and is at risk of closure, although it is not directly funded by USAID, because the funding that it gets is indirectly through academics who are funded. That is an example of an institution that has been going for a long time, has been foundational in the ecosystem of scientists developing infectious disease research, and is indirectly affected by those.

Noah Law

Are there any areas where you would like to see the Government pushing for more reform in the multilateral system?

Dr Salje

I do not want to comment on that because I think I am going to say something unhelpful.

Chair

I want to hear it now!

Noah Law

Would any other panellists briefly like to come in on this?

Dr Uadiale

Just a few statements, mainly from field experience. If you look at countries and how ministries of health need to be supported in terms of standards, WHO plays that role in supporting countries by making sure that the standards are there and that they are adapted contextually. One example is emergency preparedness plans against a pandemic. Another is national action plans on antimicrobial resistance. These are all standards that the WHO brings in. However, with the funding cuts, we know that it has reshaped the way it operates in terms of having personnel to actively do this, and I do think the WHO needs to be supported in that regard. It is not just the WHO; UNICEF is there as well, looking at issues related to children under five. These multilaterals need to be supported to continue to do their work to support that level of standards, and the UK, I believe, has a very strong role in this regard.

Noah Law

Thank you.

Dr Salje

A quick follow-up if I may, because you mentioned standards and I did not get to answer any questions about the strengths of the UK. We are a particular leader in the development of standards and reference. With NIBSC, we provide over 95% of the references and standards that the WHO recommends. This is an area in which I think the UK is already a huge leader, and it is so important. It is the boring, unglamorous stuff but on your covid test the bottom line is the one you do not want to have and the top line tells you the test is working. Without that top line, you have no idea what you are doing. That is something where the UK has historically been a leader, and continuing to invest in that sort of work is building on our strengths.

Noah Law

Thank you. Monica, a merger between UNFPA and UN Women has been mooted. What do you see as the inherent threats and opportunities of that?

Monica Ferro

We are now waiting for a decision. The decision is in the hands of the Secretary-General and member states.

Chair

How lovely that a man is in charge of that.

Monica Ferro

We went through a long process that I know the Committee has followed. I know the Committee has raised the issue with several Ministers, and we thank you for the attention because it shows that you care about the mandates of both agencies. What happened was that the executive boards of both organisations decided they did not have enough information to support the merger. UN Women and UNFPA are working on areas of collaboration where we can still move forward with efficiencies and rationalisation of purposes, but we are waiting for further guidance. As far as we know, the Secretary-General and member states now own the process. We are very keen to support. As was said here in the hearing, we know the UN needs to be fit for purpose. We know the UN needs to reform. We celebrated on Saturday 81 years, though the UNFPA is slightly younger. This means that the processes that were set in place are no longer fit. We are doing the best we can, and the UN has reformed. I do not like this idea of looking at us as if it was October 1945. Everything has changed. A lot has changed, but we understand that we need to rebuild the trust and social contract with the people we serve, and we are very keen—

Chair

Can I step in here? I am aware that you are in the midst of this and so you are giving us a beautiful political answer, but can I just say that I am absolutely incensed that when there was the opportunity for the Secretary-General to reform the UN, the two organisations he went for, out of the couple of hundred that there are, were the two that give very specific services to women—very small organisations that have two completely different tasks. For us—51% or 52% of the population—to lose the only two specific organisations for our needs, which are documented as being very undermet, I think was an absolutely appalling decision to make. If he does go ahead with this, that is going to be his legacy, and that is not a good legacy that I would want to have on my record. Thank you for your diplomatic answer and let me take you off the hook. Noah, I will move back to you.

Noah Law

Kirrily, we have heard about some of the potential threats and opportunities of that proposed merger, but what do you think the multilaterals could do to perhaps unlock some of those efficiencies, synergies, or better collaboration together?

Dr de Polnay

Like I said, I have worked in two UN organisations and so I have seen a bit of the sausage factory. There are so many people in country offices in those UN organisations doing an amazing job, working hard, working with their Government counterparts and supporting them. That is really admirable and that needs to go on. How we see it in MSF—again I am speaking to a smaller vision of the child—is that sometimes we feel like some of the mandates and the territories of UN organisation mean that the child and the mum have to fit in with them, rather than turning around and saying, “What do this mother and child need?” They cannot come back next Tuesday because it took half a day to get there. Is there a way to think about reform that speaks to, “Let’s try to do everything we can for this one child”? We have talked about HIV and TB a lot, and there is such a strong link for us with malnutrition as well. Looking at all those services, could we think about reforming—again, I am biased about the mother and child—based on what they need, rather than, “We’ll serve this, we’ll serve this and we’ll serve that, and you will fit in with our funding and our mandates”? The final thing is that especially when we are in this hyper-prioritisation and we are seeing stockouts of therapeutic foods everywhere, when we hear that one agency cannot transport this type of therapeutic food because it is not its mandate, it does worry us. We really want to see those supplies getting to where they need to go.

Chair

Can I build on that with a question to all of you? If I could just have a one-line answer. The previous Development Minister told us that she was gambling on multilateral investment and she was putting basically the majority of her chips into that. You have all described very well that it is an ecosystem. Personally, I would be going for a spread bet on this rather than just urging multilaterals to do the right thing. The World Bank has also expressed concern over the decision that we have made to invest so heavily in multilateral banks. Is it something that you see as creating gaps in the areas of health that your organisations specialise in, the fact that there is less bilateral money and less direct interventions that countries like the UK are now making?

Dr Salje

I am not sure exactly what you mean in terms of research. The multilateral funding for research? Are you talking about—

Chair

In the UK, the majority of the UK’s ODA spend is now going to multilateral investments rather than bilateral investments. Does that decision have an impact on your area of work?

Dr Salje

Thank you. Yes, if it means that we cannot fund the direct research partnerships that I had talked about, building long-term partnerships, such as the Newton Fund and the GCRF. Absolutely, it limits our ability to establish and maintain those partnerships.

Dr de Polnay

The other aspect with MSF is that often we end up in areas where there are no multilaterals, which they cannot access or are unable to. We do not want to be telling anybody else what to do, it is just that we want to be the ones who are bearing witness when we see that there are some patients and some communities that are falling through the cracks. We are there in those areas and seeing where it is not working. As I said, we want to work with people as best we can and we want to be a good partner, but there are many places we see it is not working.

Chair

Kennedy?

Dr Uadiale

To be honest, I cannot speak strongly to this, but I do think that the UK investments with Governments are important to push certain health-related agendas. Being able to collaborate and direct how funding should be targeted would make a lot of difference in that regard.

Chair

Thank you. Monica, UNFPA is one of those multilaterals that has benefited but, one could argue, at the expense of those direct bilateral relationships.

Monica Ferro

Not necessarily. First of all, there is a commitment made by the humanitarian system, the Grand Bargain, which means that 25% of our spending should go through local and national organisations. We have exceeded it. We are delivering about 38% of all our funding through national-led and local organisations, most of them women-led organisations, and our strategic plan aims to reach 45% between 2026 and 2029. We are very much aligned with local response first.

Chair

Is that a condition of you receiving the funding or is that a choice that your organisation made?

Monica Ferro

It is a commitment we made. Another good example—this is why I mentioned that the UK could pressure the international financial institutions—is that we just signed an agreement with the African Development Bank in order to include maternal health as one of the top priorities of the bank. We just supported Bangladesh, which negotiated an agreement with the European Investment Bank to repurpose a loan it has of €250 million. That is now going to be reallocated to women’s health and strengthening the national health system in Bangladesh, and 25,000 new midwives are going to be trained in Bangladesh. We are working with financial institutions to position the maternal health agenda, the mother and child survival agenda, because we see it as an integral component of the work we do. It is a challenge because we need to be constantly readapting, but it is a challenge that we have to face.

Chair

Thank you all very much. We really appreciate the evidence that you have given to us—it has been enormously helpful—but also the work that you are all doing on the ground. Please pass on our respects and gratitude to your teams.