Oxfam reaction to Select Committee report on Investment for Development

“The FCDO’s ‘hands-off’ approach to BII has resulted in some horrific human rights abuses, from patients being overcharged, exploited or denied emergency healthcare to shocking cases of people actually imprisoned in UK funded private hospitals because they were too poor to pay their eyewatering bills.

“The Select Committee is right to call for greater oversight and accountability, but the gravity of BII’s failures in both health and education requires immediate government action to halt all future direct and indirect BII investments in these critical sectors and to fully investigate any harm caused.

“Oxfam shares the Committee’s concerns that BII is investing in companies owned by high-net-worth individuals. Oxfam’s own research found BII are investing taxpayers’ money into some of the biggest billionaire owned corporate hospitals in the Global South, while turning a blind eye to unacceptable practises.

“BII’s delegation of its human rights responsibilities and poverty reduction mandate to profit-hungry private equity funds sitting in tax havens is unacceptable and is leaving millions of people exposed to harm.

“Oxfam has long warned of the dangers of spending development funds on private fee-charging schools, many of which have been found to violate rights and increase inequality and we welcome the Committee’s findings. There are no more excuses for BII not to follow the World Bank Group's lead in pulling all investments in private schools. Furthermore, a failure to act on health risks undermining any UK commitments made at the high-level meeting on Universal Health Coverage at the UN General Assembly next week.”

/Ends

Notes to editors:

The Select Committee report has made recommendations that the FCDO should increase its oversight of BII and take a non-voting seat on the BII board - to ensure that BII's strategy and operations are consistent with the International Development Strategy and FCDO objectives, to protect taxpayers' interests and to ensure that BII's investments help the world's poorest people. The Select Committee also said that BII must ensure that its entire portfolio is aligned with the UK Government’s development agenda.

Oxfam's submission to the IDC Parliamentary Inquiry on education was made together with other organisations and can be found here. In March 2022, the World Bank’s International Finance Corporation (IFC) divested from New Globe Schools/Bridge Academies after a series of serious complaints to the IFC’s independent accountability mechanism, the Compliance Advisor Ombudsman (CAO). In June 2022, the IFC announced that it would not resume its investments in fee-charging kindergarten through grade 12 (K–12) private schools, following the release of an independent evaluation by the World Bank Independent Evaluation Group (IEG) on the IFC’s investments in this area and their impacts on educational outcomes, poverty, and inequality.

Oxfam’s report, Sick Development, which was submitted as evidence to the Committee and published in June, found that hundreds of millions of pounds of UK development spend - made via BII and bankrolled by UK aid - is going to expensive private healthcare providers who are excluding, exploiting, further impoverishing and even imprisoning the very people they are supposed to be helping. Key findings include:

• Dozens of cases, from a BII funded hospital chain in Kenya, of patients being imprisoned until they paid medical fees, including a secondary school student who was held hostage in hospital for 11 months, a new-born baby whose twin had died and a refugee who was involved in a car accident whose son had been killed. There have also been several cases of the hospital refusing to release dead bodies until fees are paid, in at least one case for over two years. BII’s funding came a year after the hospital director publicly confirmed the hospital policy of detaining patients for non-payment of bills. BII’s suggestion, as included in the IDC report, that they changed the management of the hospital in response to these cases mischaracterises the facts. The equity fund manager was changed due to an unrelated case of fraud, while the hospital management was changed at the time of a different scandal in which the hospital was accused of unnecessarily admitting and over-charging patients. In July 2023 it was reported that this Nairobi Women’s Hospital was sold back to its founder who publicly confirmed his policy of detaining patients in the hospital a year before BII invested.
• In India, private hospitals funded by BII have been denying people treatment, even though they had government health insurance cards entitling them to free care. Oxfam spoke to people who had been pushed into poverty by health fees of up to $36,000 (almost £29,000). There were also cases of emergency patients, including a stab victim, not being treated until relatives turned up with cash. Oxfam also heard allegations of patients being pressured to have unnecessary surgery, and of aggressive, deceptive and manipulative behaviour to extract more money - for example mis-selling of private insurance that didn’t actually cover patients. Fees charged to patients who sought care at these hospitals ranged from between three-and-a-half months to 14 years’ worth of wages for an average earner in India.
• At the height of the COVID-19 pandemic – where deaths were four times higher in lower-income countries - some BII funded hospitals denied entry to patients or sold intensive care beds to the highest bidder at eyewatering costs. One BII funded hospital in Zimbabwe reportedly charged between $800 and $1000 a day (between £650 and £800) for a COVID-19 intensive care bed. Another BII funded hospital in Uganda, reportedly charged one patient $32,000 (£25,500) for two weeks of treatment and care for COVID-19.
• The numbers of women dying in pregnancy and childbirth is rising across the world, yet BII funded private hospitals are charging astronomical fees for maternity care. In one hospital in Nigeria the lowest price for an uncomplicated birth, is the equivalent of 12 years’ wages for the poorest 10 per cent of the population, and the price for a Caesarean is the equivalent of 24 years’ wages. In one private hospital in Uganda, childbirth costs rose by an extraordinary 60 per cent following BII’s investment. In another BII supported hospital in India, a mother was reportedly charged $63,000 (£50,460) for the treatment of her premature twins, who both sadly died - the equivalent of 35 years income for more than 70 per cent of the population who live on $5.50 or less (£4.40) per day.
• While the hospitals being funded by development finance should be providing care for those who can least afford it, many have become go-to destinations for wealthy elites including health tourists. Examples include a Chinese Dental hospital and a retirement community development with medical care in Costa Rica marketed to expats and tourists.