The next item on the agenda is a statement by the Cabinet Secretary for Health, Well-being and Sport on Wales for Africa, and I call on the Cabinet Secretary to make his statement—Vaughan Gething.

Thank you, Presiding Officer. I visited Mbale in Uganda during the half-term recess as part of the celebrations of the tenth anniversary of the Welsh Government’s Wales for Africa programme. The programme has supported and encouraged people in Wales to make a difference in sub-Saharan Africa. Whilst people from Wales have active partnerships in many parts of sub-Saharan Africa, probably the greatest concentration of activity is in the Mbale region of eastern Uganda, about five hours’ drive from the capital, Kampala.

During my time in Uganda, I visited health centres, a regional hospital, schools and several tree nurseries. I was shown around the main slum in Mbale, launched a women’s honey co-operative, and signed a memorandum of understanding with our key partners in the area. I distributed tree seedlings, planted a mango tree—that was an experience and a half—and turned on new LED lights powered by a mini hydro unit in a rural school. And I met many volunteers from Wales involved in a variety of activities, along with six people from Wales on eight-week placements with our international learning opportunities programme.

I also saw some shocking things: bare and stained foam mattresses in a desperately under-resourced health centre where women give birth by torchlight, a six-bed delivery suite in the main hospital that serves a population larger than Wales struggling to cope with women in labour—sometimes as many as 50 in one day—an enormous smouldering pile of clinical waste dumped at the back of the same hospital because the incinerator was broken, and children drinking dirty water drawn from a polluted river in the middle of a slum. Those children are vulnerable to abuse of all kinds.

But, wherever I went, I also saw evidence of people from Wales working alongside local people, making a genuine difference: there were three young men from Carmarthenshire working with Engineers for Overseas Development to build a desperately needed maternity unit in rural Kachumbala—an electrician, a plumber and a carpenter, working alongside Ugandan workmen; there were volunteers from the Wrexham-based Teams4u, that I know my colleague, Lesley Griffiths, is well aware of, engaging a whole school in learning about sexual and reproductive health and testing everyone for HIV, including parents, training a total of 1,500 volunteers from across the region in community health and hygiene promotion—they’re doing a great job in helping to prevent and control outbreaks of diarrhoea and even cholera; a solar-powered water pump, designed and installed by a team from Engineers for Overseas Development, providing clean water to over 1,000 people and 4,000 cattle; and improved neonatal care as a result of training from Wales—that’s meant that neonatal mortality in the Mbale regional referral hospital has dropped from a shocking 52 per cent to a still unacceptably high 17 per cent in just two years, but an enormous drop in mortality—and the very famous motorbike ambulance service for the entire region devised by volunteers from the Welsh ambulance service, supported by the south Wales charity PONT and the district councils of the Mbale region with money from UK Aid and the Welsh Government.

Much of the activity that I saw was delivered by non-governmental organisations such as PONT, which started in Pontypridd, Engineers for Overseas Development in Carmarthen, and Teams4u from Wrexham. Many of the projects have benefitted from small and medium-sized grants from the Wales for Africa programme, with more money having been levered in from other donors or raised by volunteers.

One of the highlights of the trip was visits to several of the 45 community tree nurseries run by the 10 Million Trees project through the Size of Wales. I met with many of the dedicated staff who have this year raised and distributed 1.2 million seedlings to small farmers. I witnessed two different drama presentations that are used to encourage and inform rural communities both about the need to plant more trees and how to look after them. I also saw how Plant!, the Welsh Government initiative to plant a tree in Uganda and Wales for every child born or adopted in Wales, works. Through Plant! a family can have a fruit tree—often a mango, an avocado or jackfruit tree—to plant near their house. It not only provides shade but also much needed additional nutrition to their diet. Actually, that’s a really important point, because much of the diet in that part of Uganda is heavily concentrated on carbohydrates, without much else to add to their diet. So, the role of fruit in their diet is particularly important.

I also met with Her Excellency Alison Blackburne, the British High Commissioner to Uganda, and key officials from the UK Department for International Development. There’s much more to gain from that particular engagement as well. They agreed to work more closely with our officials in the future, particularly in the important area of carbon financing, which we hope will enable many more trees to be planted over the coming years.

During my short visit, I was able to see just a few of the projects being supported by Wales in Mbale, but I’m well aware that over the last 10 years over 500 projects across sub-Saharan Africa, originating from every constituency in Wales, have been supported. In a few short days, I saw for myself how Wales for Africa is making a profound difference to the lives of people in Mbale and in Wales. I’ve seen some very difficult sights that will stay with me for a very long time, but I pay tribute to the many thousands of people from Wales that volunteer to help make the world a much better place through this programme.

Thank you, Cabinet Secretary, for your statement. I’m very pleased to be able to respond on behalf of our group, and extend our continuing support for the Wales for Africa programme and the excellent work that it is doing in making connections between the people of Wales and the people of sub-Saharan Africa.

The Cabinet Secretary will know I visited South Africa a couple of years ago—in fact, on two occasions in the past few years—and I’ve seen some of the excellent work that is being done as a result of the support of the people of Wales in that particular country, and indeed, heard a lot more about the more extensive work that is going on in the southern Africa region. I’m sure that you will join with me in congratulating the work of faith groups in particular that have been involved with those particular projects. The diocese of St Asaph, of course, has a link with south-west Tanganyika where they’ve got civic links that have been developed, supporting subsistence projects, improving the water supplies and, indeed, helping to train teachers in that particular area. And indeed, an organisation called Preferred Future, which raises money here in Wales amongst different individual churches, is helping to deliver projects right across South Africa and beyond in places like Lesotho, Zambia, Mozambique, Malawi and many other nations, very often working with underprivileged children, helping to provide them with education and, indeed, helping to educate them in terms of the health risks that there are in some of those very needy communities, particularly those where HIV is very prevalent indeed. If it wasn’t for the support of the different faith groups and church groups in particular in Wales for those projects, many of them would simply not be happening.

I wonder, Cabinet Secretary, if you can tell me what work the Welsh Government is doing to try to establish links with the Welsh diaspora in some of these nations to harness the opportunities that they might have to bring something extra, if you like, in terms of their skills to be brought to bear in helping to support some of the Wales for Africa programme. One of the highlights, I suppose, of the last visit I made to South Africa was a meeting with the Cape Welsh Society at the High Commissioner’s residence, where there are people who have many talents. Very often, they’ve retired to South Africa and want to still volunteer in some capacity. I know that we’ve got lots of people travelling from Wales to sub-Saharan Africa to support some of the projects that you’ve referred to in Uganda and that I’ve referred to in other places, but the individuals who are permanently on the ground there, but have origins in Wales, also have something to offer. I wonder if you could just comment on whether that is a group of people that you are particularly looking at trying to engage with.

Secondly, I’m sure that you’re aware of the tremendous link that’s been established through the Betsi Cadwaladr university health board on maternal health issues in the Lesotho area, where they’ve managed to decrease the rate of child mortality—you mentioned some of the maternal mortality figures in Uganda earlier on. You’ll also be aware that similar achievements—in fact, more impressive achievements—have been realised in Lesotho as a result of the work of clinicians from Wales and nursing staff from Wales who’ve been travelling out over a number of years now, into Lesotho, and helping to drive improvements in health outcomes for people in that particular nation.

I thank Darren Millar for his positive and constructive comments about this programme. Of course, I do recall the aftermath of one of his visits to South Africa, when he returned with a notable injury. I think many of us enjoyed the sight of him with his leg in the air in a wheelchair rather more than he did. But you’re right, in particular—to take your first broad point about the role of faith and faith communities—lots of the people whom we met and saw were driven by their faith to do the right thing. That includes people who go out as volunteers, as well as people who are local leaders on the ground. In fact, our key contact in the Mbale Coalition Against Poverty, pastor Apollo Mwenyi—a lot of his status and standing comes from the fact that he is a pastor and lots of people recognise him. In lots of the areas we went to, the local pastor was a key person in keeping people honest and keeping people going and actually drawing together different people. So, I’m happy to recognise the significant role of faith communities. In particular, in the Namatala slum—the main slum that I referred to—the Child of Hope school is driven by a coalition and a coalescence of faith communities within this country working alongside faith communities in Uganda to actually deliver something in a really terrible part of the world where children really are left to really significant and truly appalling risks.

On your point about the Welsh diaspora, actually I met with the Welsh diaspora in the leaving event that the High Commissioner hosted. We met members of the Welsh diaspora in Uganda, some of them more recent arrivals than others, but there were some really useful conversations about what we can do to further improve the programme. So, it is something that we do actually think about with all of our different engagements. I'm not sure whether meeting me was of more interest than the fact that the High Commissioner invited them for a free drink, but who knows. But, yes, it's definitely something that we want to take advantage of in the future.

The final point you make, about the link between health boards, I'm happy to recognise, because every health board has a link with a part of Africa that is aided and assisted by this particular programme. So, many of them actually do focus on maternal care as well, because there are real risks in the rates of mortality for both mothers and babies, and there’s a really significant job that we can do to help them do that, and to work alongside people when we get there. But there are challenges about how that programme and exchange of knowledge works, because, unfortunately, we are running up against some visa problems with visitors from different parts of Africa to come and work in our healthcare system. I note that Betsi had a real issue recently. We're in correspondence with the Department of Health and the Home Office to try and understand how we work through that, because I think the exchange of knowledge has to go both ways—about people from NHS Wales, who are tremendously positive and motivated about their experience, as well as providing some of that professional interchange and knowledge to go back to staff who will then return to their own country as well.

I thank the Cabinet Secretary for his statement today. Also, I extend our congratulations as a group to the Wales for Africa programme. Of course, Plaid Cymru is entirely supportive of the collaboration between Wales and developing nations and this programme is a great example of that.

Such relationships are of course beneficial to us and to those nations, but from Wales’s point of view, it’s certainly beneficial to us as we make a difference, we share expertise and provide unforgettable experience for people from this country. I do think that the programme and policy more broadly could benefit if the Government could consider publishing quantitative outcomes in order to build on the excellent work that has been done with some intention to expand the policy in future. I would appreciate the Minister’s comments on this point in terms of how we can outline the outputs.

In the current political climate, would the Cabinet Secretary accept that the need is greater than ever to build an international Wales? If he does agree with that, would he agree to recommend to the First Minister to introduce to this Assembly a strategy for an international policy for Wales, which would include a commitment to a humanitarian policy, which would be more broadly built on the very firm foundations set by the Wales for Africa programme? As some in this state try to isolate us, the Welsh Government must make a decision to do the opposite. By building a uniquely Welsh brand, through policies such as this one, we can promote Wales as an open place, a good place to invest in, and a good place to develop relationships internationally. So, I would appreciate the personal comments of the Cabinet Secretary—and perhaps he will take the opportunity, as the First Minister isn’t in the Chamber, to be more open on this. Is he in favour of developing a paradiplomacy policy for Wales that would be broad and would include humanitarian policy, and would take consideration of the current political climate?

Thank you for the comments and questions, and an invitation to take advantage of the First Minister not being in the Chamber. I'll decline the opportunity to try and set policy on the fly. This is, as you know, quite properly the remit of the First Minister in terms of external engagement from Wales. But, look, in terms of where we are as a Government, I think we've been really clear that, through all the difficulties of this year—and we all have seen the response within our own country about people who look or sound different and the way they're being treated, in the referendum campaign and afterwards—regardless of what side you were on in that campaign, none of us should try and soft-soap or avoid the reality that our constituents have been made to feel unwelcome, and that is not something that any of us should try and avoid talking about. And it's been really important for this Government to restate the fact that we want an outward-looking country that is positive and confident about our place in Britain, Europe and the wider world. And that’s more than trade, although, of course, trade is an important means of engaging with other countries. Much of what I saw is not about trade, it’s about our engagement with improving public services and actually recognising we’ve got a role in supporting sustainable development in different parts of the world and that we’ve got a direct benefit and interest in doing that as well. That means working with people and alongside them, rather than telling them what to do. So, that’s the nature of our engagement and our relationship, our place within the world, but also what sort of country do we want to be as well. I actually think that this Government has been really consistent about that as well. You see it in a range of different areas that we talk about and the way we talk about people who live here: that we have an outward-looking group of public services that require and rely upon people from different parts of the world coming here. We should welcome them not just for the jobs they do but for the contributions they make to our community and our country. I take on board what you say about how we assess the impact of this particular process and that people do give thought to not just the 10 years of what’s been done, but getting beyond the anecdotes and saying, ‘What is the sum, the total of the impact?’ I think there’s more work to be done on that.

I want to finish with a point about the reciprocal benefit to people. I mentioned about the NHS staff and those three young men I met from west Wales. Their two weeks working in Uganda had a significant impact on them. What they saw and experienced within the first few days was truly amazing, and not just about their points about the workplace and the safety requirements that don’t exist. Just a simple example: there was a workman who never had any boots and one of the lads bought this guy some boots. The next day, after he’d taken them home, he came back not wearing them and he said they were the best boots that he had and he was keeping them home for best. So, that’s someone who’s working in bare feet on a construction site. It tells you something about the real difference between this country—and all that we should be incredibly grateful for and what is just normal in a different part of the world. We have much to gain and much to give and should be looking at it in both those senses.

Thank you for your statement, Cabinet Secretary. I’m pleased to see that the Wales for Africa programme continues to be a success, particularly the Wales for Africa health links. I was delighted to learn that, last year, we saw 38 skills exchange visits from Wales to Africa. As we saw from the Ebola outbreak, it’s vital that we take an international approach to many of the global health challenges. By maintaining these links, our medics not only get vital experience, but also help those communities in sub-Saharan Africa. Staff from Welsh hospitals are able to learn from their colleagues in Africa and share their experiences when they return home, while at the same time bringing real health benefits to African communities.

Cabinet Secretary, I have only a couple of questions to ask. Can you update the Chamber on how you intend to expand upon the Wales for Africa health links programme in the future? Will NHS Wales be expanding the exchange programme, particularly in those areas with high incidences of HIV/AIDS? Finally, what public health lessons have been learnt as a result of the Wales for Africa health links?

Cabinet Secretary, we look forward to another successful 10 years of the Wales for Africa programme and hope that communities across Wales and Africa continue to benefit from closer links between our respective health services. Thank you.

I thank the Member for her points and questions. From the health perspective, it’s about maintaining the links we have and what we then want to build on, because this is not a programme with a huge budget attached to it. Much of what is actually achieved is achieved with a very small amount of money. Much of it is actually the knowledge transfer and equipping people to make their own choices. That was a recurring theme in the visit. It wasn’t about Wales saying, ‘We have the answers for you, now do as we say’, it was, ‘How do we work alongside local decision makers? How do we equip people to make their own choices?’ It was about how they want to live their own lives and a recognition of the knowledge that we can equip people with to be able to do that.

The most successful thing about the tree nursery is the fact that local farmers came and wanted to actually have—. They’d recognised there was something to having that because one of the awful things we saw recently was they’d had landslides and they’d had awful recurrences of events that have taken place in Wales, like the one we commemorated recently in Aberfan. There was a disaster that was very similar; a slide came down a hill and covered a school. The loss of life was more than double what had happened in Aberfan. So, there’s something about how we help people to understand the different changes and the way that they actually need to live their own life and to be able to have enough food to live on and to be able to have different industries to make those different choices. Now, that’s difficult; it’s easier to talk about than it is to actually deliver, but it’s the long-term nature of our commitment and working with people that allows us to make some of that progress.

In terms of the public health lessons that we’ve learned, it reinforces the very simple public health interventions that we already practice—vaccination and immunisation being one of the key issues and actually, where they don’t have a significant programme, lots of people lose their life for what we would consider to be simple issues. So, it really does reinforce the value of what we are very privileged to enjoy in this country in having a national health service, and it reinforces the danger of not having that, where you will see health inequalities, not just globally, but within that country to levels that none of us could or should find acceptable.

Thank you, Cabinet Secretary, for your statement marking 10 years of Wales for Africa and the really interesting experiences that you had in Uganda. I think it’s been fascinating to listen to. I declare an interest as a trustee for Life for African Mothers, which does all it can to make life safer for women giving birth in sub-Saharan Africa by helping with medication and with training, and the charity is also 10 years old. I noted what the Cabinet Secretary said about the scenes that he witnessed in the hospitals in Uganda, and I’ve been to Africa on a number of occasions and have also seen similar scenes, and I suppose you really have to say it is life-changing when you see such situations.

Angela Gorman founded the charity Life for African Mothers, and she had a great deal of help from the Wales for Africa programme, because it supported her secondment from the neonatal intensive care unit at the University Hospital of Wales in Heath, and grant funded her activities training midwives and providing medicines. And the initial grant from Wales for Africa enabled the charity to flourish and now means it is not dependent on any grants from the Wales for Africa programme. Doesn’t he think that this is an ideal progression: to start off with small grants to help organisations grow, and then they find other sources of funding and develop?

As well as support from the Wales for Africa programme, Angela in particular cites the special leave policy in the NHS in Wales as being absolutely crucial to the deployment of Welsh professionals to support training and health systems in Africa. And I wondered if the Cabinet Secretary was able to tell us if that leave programme is applied consistently throughout Wales and whether he feels that this is absolutely something that we would want to encourage.

Finally, I think the tragic death of women after childbirth is probably one of the most awful tragedies that can be witnessed, and I’d like to really express my support and gratitude to all those organisations, including Life for African Mothers, who have gone out of their way to try to improve the situation in sub-Saharan Africa.

I thank the Member for raising that for particular attention. I’ll start with your point on special leave. These are, broadly, public servants who go out and undertake these international learning opportunities—not just public servants, though. As I was leaving, a new group came in, and one was a counsellor who had taken time out of their public duties to go, and another was from the International Red Cross. So, you had different groups of people, but the special leave policy is really important to allow people to undertake those opportunities and to come back with, actually, sometimes new skills but certainly new and renewed commitment to public service and they people they work for and serve.

You’re right to highlight Angela Gorman’s role. I met her before coming to this place. Dawn Bowden will know Angela Gorman is a Unison member, and I met her as a representative within that particular trade union some years ago, when she had just started getting engaged within this particular programme. And you could see the difference it made to her about making an even bigger difference in another part of the world. Part of the reason why we supported the motorbike ambulance programme was that it allowed and enabled women to move from where they were to actually go to a delivery unit somewhere. And actually, that’s significantly improved outcomes for women and babies in that part of the world, and it’s actually been taken on and funded by some of the local district authorities because they recognise the significant benefit it had brought. There’s something there about not simply encouraging groups here with some money to help them to develop, but also, the impact of our programme means, sometimes, starting and then encouraging local partners with their own responsibilities to sustain that service themselves. That’s part of what I was referring to in making choices, about how those people need to make their own choice about their own resources and responsibilities as well, but it’s got to be a genuine partnership for it to be meaningful. So, I’m more than happy to recognise and reinforce the points the Member makes.

Finally, John Griffiths.

Diolch yn fawr, Lywydd. Cabinet Secretary, I’m very pleased that you were able to go to Mbale to see for yourself, first-hand, the very good work of the Wales for Africa programme there, and, indeed, to help strengthen the links. I was fortunate to visit there myself a few years ago as environment Minister, and I’m familiar with the great work of PONT and all those volunteers from Pontypridd who have helped with health, education, economy and community development there, working closely with the local people and agencies on the ground. I also saw the Size of Wales programme, and all that great tree planting, and some very good fair trade projects. So, I wanted to ask, really, Cabinet Secretary: given that Wales has a very good story to tell around fair trade—the first fair trade nation in the world back in 2008, with all those civil society groups achieving that status supported by Welsh Government, 90 fair trade communities, towns, churches and universities across Wales now, and the highest proportion of fair trade schools of any country within the UK—given that strength, and having gone to Mbale and seen a coffee co-op there, the Gumutindo coffee co-op, doing great things with the fair trade premium—. I stayed with one of the farmers and heard that they’d been able to send their son to university, the first time that a member of their family had gone to university, and they’d been able to do that with the fair trade premium. Given that importance, Cabinet Secretary, I wonder if you would agree with me that, with the Well-being of Future Generations (Wales) Act 2015, hopefully, we’ll be able to see more public bodies in Wales driving that progress with fair trade. We see marketing of the coffee from Mbale in Cardiff at the Fair Do’s shop, for example. We see Cathays High School now with fair trade uniforms, and, indeed, the Cwm Taf university health board using fair trade products more in their own cafes. So, the examples are there. Would you agree that we should drive that progress now through the well-being of future generations Act into the future?

Yes, I’m happy to recognise and support the comments that the Member makes, not just because I’m a Labour and Co-operative Assembly Member, but many people across the Chamber in different parties are active supporters of fair trade, and not just at Fairtrade Fortnight, both in the individual choices we make about goods that we buy and use, and you’re right to point to coffee as a particular example. I visited a group of people who had undergone fair trade accreditation—a different co-op, but you’re right to point to the Gumutindo co-op, as one of the larger ones, and the fair trade premium has made a really big difference to those farmers’ families and wider communities. So, it’s reinforcing the point that in the choices that we make in this country about how we procure and use different goods, it does make a really big difference across the rest of the world. And it’s part of the work that we do in encouraging people to want to undertake the form of fair trade accreditation, to actually then gain the benefit of the premium.

So, we can be proud of what we’ve done. We can also say there’s more that we could and should do, now here in Wales, together with our partners around the rest of the world.