Better health is a basic human right and an end in itself. A healthy population is also essential to development. Recent years have seen some rapid improvements in health partly driven by the Millennium Development Goals and the large international funds set up to accelerate progress towards them. However, these improvements have at times been achieved despite the poor state of health systems in many developing countries. Stronger health systems will be required to ensure efficiency, tackle growing challenges such as non-communicable diseases and progress towards self-sufficiency. DFID has long had a good reputation for health system strengthening and this is reflected in its own work. But DFID now relies on international partners, which do not all share this reputation, in an increasing number of countries and to manage an ever-greater proportion of its expenditure. We recommend that DFID reviews in each country whether its funding arrangements enable its health systems strengthening objectives to be met. Assessing the effectiveness and value for money of health system strengthening work by DFID and its international partners is more difficult than it ought to be. Expenditure and performance figures are not published and the research base is inadequate. This must change. The UK has one of the best health systems in the world, but DFID makes only limited use of it. We call on DFID to work with the NHS in expanding volunteering schemes for doctors and nurses and making more use of NHS finance and management skills.

Government response to HC 693, 2013-14 (ISBN 9780215071750). DFID's annual report for 2012-13 published as HC 12, session 2013-14 (ISBN 9780102983241)

As the end of the 2010-2015 Parliament approaches, the Committee has taken the opportunity to look back on their work. This Report outlines some of the Committee's work, progress and effectiveness during this Parliament and sets out areas that may be of interest to their successor committee. It has also provided the opportunity to scrutinise what actions the Government has taken with regard to issues and recommendations raised in our reports.

Sierra Leone and Liberia have made remarkable recoveries since their civil wars. Ban Ki Moon was in Freetown this month to bring an end to the UN Security mission and set the UN presence on a conventional development footing from 1st April 2014. In Liberia there has been a gradual drawdown of the peacekeeping mission which will approximately halve the UN military presence by 2015. However both countries remain fragile with high unemployment and concerns about corruption. The devastating Ebola outbreak in Sierra Leone and Liberia demonstrates the dangers of ignoring the least developed countries in the world. The weak state of the health system in both countries has greatly reduced the effectiveness of the response to Ebola. There is an alarming lack of capacity in the health system, including a shortage of skilled clinicians.The Committee have determined that the scale of the Ebola crisis now unfolding in Sierra Leone and Liberia, may well be connected to declining levels of international support for health system improvements in what remain two of the poorest and least developed countries in the world.

The Ebola outbreak that has stricken Sierra Leone, Liberia and Guinea since March 2014 has had a devastating effect on the region. By 2 December 2014, more than 17,500 cases and 6,000 deaths had been reported. Ebola has had wider damaging consequences for local economies, food security, institutional stability and the broader health system. The House of Commons International Development Committee says DfID and the World Health Organisation initially failed to recognise the scale and severity of the Ebola crisis and were too slow to respond. This is in part due the WHO's member states, who have cut its funding and failed to emphasise building sustainable health systems in developing countries, leaving the global health system "dangerously inadequate" for responding to health emergencies. It recommends that DfID press for a review of the international approach to health emergencies, incorporating the function, structure and funding of the World Health Organisation and the role and expectations of major donors.

The number of low income countries is falling. At the same time, the importance of global issues - conflict, climate, migration, trade, tax, financial stability, youth unemployment, urbanisation economic development, and infectious disease - is rising. The Committee argues that aid remains vital for addressing poverty in poor countries, for encouraging economic development, for providing global goods such as tackling climate change, combating diseases such as Ebola and providing humanitarian assistance, but new forms of co-operation have to be developed in order to meet these challenges. This will include new financial mechanisms and facilitating links with UK institutions in a wide range of areas, including health, education, culture, law, culture and science. This will require the Department for International Development (DFID) to put more emphasis on working with small organisations and less on programme management.As the focus moves away from aid, policy coherence for development must be at the heart of a new approach. This means working across Government in the UK, and with global partners in the multilateral system, to maximise the impact on development of all the UK's actions. This approach and changes will require DFID staff to develop different skills.

The deadliest outbreak of Ebola virus disease in history, and the first to hit epidemic levels, struck the West African countries of Guinea, Liberia and Sierra Leone in 2014, killing 11,315 people. Despite being diagnosed in March 2014, there was a slow initial response to the epidemic. This was attributed by many witnesses to our inquiry to delays in WHO sounding the alarm and declaring a Public Health Emergency of International Concern (PHEIC), something which WHO must carry primary responsibility for. As a result, the international community did not fully mobilise until September, in the wake of the World Health Organization's designation of the outbreak as a Public Health Emergency of International Concern in August. We praise those who risked their lives to bring the epidemic under control and pay tribute to all those who lost their lives in the fight against Ebola.

The Chief Commissioner of ICAI has a crucial role in scrutinising aid spending by the UK Government and reporting to Parliament through the International Development Committee. The Committee are pleased to endorse the appointment of Dr Alison Evans to this post, but recommend that at least one of the existing Commissioners be reappointed for a further term to ensure continuity, and that one of the Commissioners be an audit professional. The selection process used resulted in an unranked list of four candidates deemed "appointable" being presented to the Secretary of State for consideration. This puts too much power in the hands of the Secretary of State for an independent scrutiny post and threatens to undermine the candidate in the eyes of the public who may assume that the candidate most sympathetic to DFID was chosen. The Committee recommend that panels for ICAI Commissioner appointments should be invited to rank candidates or otherwise advise the Secretary of State as they see fit. In the longer term, it is recommended that the Committee be able to choose the Chief Commissioner from the list of candidates.

This report discusses several different approaches that support reforming health care services in developing countries. For some time now, health care services have been supported by government funds. As demands for improving health care services continue to increase additional demands will be placed on governments to respond. This, however, will not be easy. Slow economic growth and record budget deficits in the 1980's have forced reductions in public spending. Alternative approaches to finance health care services are needed. Such possible changes could involve: decentralization of federal government involvement; the promotion of nongovernment involvement; the imposition of user fees; and, establishing health insurance. Finally, the role of the Bank in pursuing new financing strategies is discussed.

This book provides a practical guide to the design and implementation of health information systems in developing countries. Noting that most existing systems fail to deliver timely, reliable, and relevant information, the book responds to the urgent need to restructure systems and make them work as both a resource for routine decisions and a powerful tool for improving health services. With this need in mind, the authors draw on their extensive personal experiences to map out strategies, pinpoint common pitfalls, and guide readers through a host of conceptual and technical options. Information needs at all levels - from patient care to management of the national health system - are considered in this comprehensive guide. Recommended lines of action are specific to conditions seen in government-managed health systems in the developing world. In view of common constraints on time and resources, the book concentrates on strategies that do not require large resources, highly trained staff, or complex equipment. Throughout the book, case studies and numerous practical examples are used to explore problems and illustrate solutions. Details range from a list of weaknesses that plague most existing systems, through advice on when to introduce computers and how to choose appropriate software and hardware, to the hotly debated question of whether patient records should be kept by the patient or filed at the health unit. The book has fourteen chapters presented in four parts. Chapters in the first part, on information for decision-making, explain the potential role of health information as a managerial tool, consider the reasons why this potential is rarely realized, and propose general approaches for reform which have proved successful in several developing countries. Presentation of a six-step procedure for restructuring information systems, closely linked to an organizational model of health services, is followed by a practical discussion of the decision-making process. Reasons for the failure of most health information to influence decisions are also critically assessed. Against this background, the second and most extensive part provides a step-by-step guide to the restructuring of information systems aimed at improving the quality and relevance of data and ensuring their better use in planning and management. Steps covered include the identification of information needs and indicators, assessment of the existing system, and the collection of both routine and non-routine data using recommended procedures and instruments. Chapters also offer advice on procedures for data transmission and processing, and discuss the requirements of systems designed to collect population-based community information. Resource needs and technical tools are addressed in part three. A comprehensive overview of the resource base - from staff and training to the purchase and maintenance of equipment - is followed by chapters offering advice on the introduction of computerized systems in developing countries, and explaining the many applications of geographic information systems. Practical advice on how to restructure a health information system is provided in the final part, which considers how different interest groups can influence the design and implementation of a new system, and proposes various design options for overcoming specific problems. Experiences from several developing countries are used to illustrate strategies and designs in terms of those almost certain to fail and those that have the greatest chances of success