The lead Editorial in this week's Lancet focuses on global health within the UK Government's Department for International Development (DFID)—its mixed successes and failures to date, the challenges it faces with the possible change in government following the UK general election, and the problems it faces through intragovernmental tensions with both the Foreign and Commonwealth Office (FCO) and the Department of Health (DH).
Referring to DFID's successes, the Editorial says: "[DFID] has published an education strategy, launched its undernutrition strategy, and hosted an international Millennium Development Goal conference billed as 'the turning point of poverty'. Its undernutrition strategy won much praise from delegates (ranging from African Health Ministers to the more sceptical end of non-governmental organisations) at the launch event last week. DFID has clearly established itself as a respected leader in global health."
Furthermore, the performances of a series of energetic Labour DFID ministers—Clare Short, Hilary Benn, and Douglas Alexander—are praised. The Editorial says these have earned the department a strong reputation in global health. Other success are also highlighted— DFID has tripled levels of financial aid and is on track to meet the UN target of 0.7% of national income by 2013.
However, the Editorial describes a possible change in UK government (to Conservative) as 'a major concern for those who work in international health programmes'.
Referring to intragovernmental tensions, the Editorial says: "The departmental division between development (including global health) and foreign policy weakens the UK's influence internationally. Instead of using health and development as critical tools in devising, implementing, and monitoring foreign affairs, the UK operates with one hand tied behind its back. Too often ambassadors and senior politicians marginalise DFID's work in favour of the more powerful FCO. There is also intense and unattractive intragovernmental competition between DFID and DH. Both departments lay claim to the global health agenda. The chief medical officer and his staff remain the most important health advocates and influencers internationally. But there is poor coordination between DH and DFID, again weakening the UK's overall contribution."
The Editorial concludes by saying that DFID's report card is mixed. What it does well must be protected, while what it does badly must be fixed. DFID's report card is mixed. Reform is necessary. First, DFID must make evaluation a top priority—for example, the department has invested £300 million in Malawi since 2003/4, but with no evidence or evaluation as to whether this investment has delivered value for money. Good words and goodwill are insufficient. Second, a new government needs to implement a formal review of how development and foreign policy are coordinated across ministries. Global health should be a separate part of this independent review. The Editorial concludes: "The current fragmentation of responsibilities weakens the UK's beneficial influence and dilutes the important contribution health can make not only to development but also to foreign policy."