A review of disability and older age inclusion training – what works, what doesn’t and what needs to be done

It is estimated that people with disabilities and people over 60 years of age make up more than 15% and 11% of the world’s population respectively 1. Age and Disability Consortium (2018) Humanitarian inclusion standards for older people and people with disabilities (https://www.helpage.org/resources/publications/?ssearch=standards&adv=0&topic=0&region=0&language=0&type=0). .This means that, of the 201 million people affected by disasters and in need of international humanitarian assistance in 2017, just over 30 million were people with disabilities and 22 million were older people. Given this, it is essential that inclusion is prioritised in humanitarian practice.

Progress on inclusion among humanitarian NGOs is, however, patchy and limited – with larger organisations able to invest in a system-wide approach leading the way. Over the past few years, the Age and Disability Capacity Programme (ADCAP), a multi-stakeholder partnership of eight agencies working on these issues, has done a great deal to raise awareness of the need for greater inclusion in all aspects of humanitarian interventions, providing a model, training, toolkits, templates and guidance on best practice.

Inclusion training study

As part of a wider gap analysis around Disability and Older Age Inclusion (DOAI), a top-line scoping study focusing on training was commissioned by HelpAge International as part of the Elrha Humanitarian Innovation Fund’s Thematic Working Group on Disability and Older Age Inclusion in late 2019. The study sought to scope out the DOAI training landscape, highlight gaps and identify what type of training participants felt had more impact, greater reach or better outcomes. The study does not claim to be comprehensive (in the time available, we identified 42 training initiatives and conducted 15 interviews). It was designed instead to present a sample and cross-section of some of the training currently being offered, available in the public domain and within a selection of humanitarian agencies. The aim is to provide donors, grant-makers, Organisations of People with Disabilities (OPDs) and Older People’s Associations (OPAs), as well as other agencies engaged in the humanitarian sector, a sense of what type of training initiatives are most effective, where resources can be accessed, and what the gaps in provision are and what could be done to fill them. Using desk and online research and key informant interviews, we built a matrix of which training addressed each of the Humanitarian Inclusion Standards to get a sense of either over- or under-provision. The report is designed to be a living document that it is hoped will grow into a useful resource on inclusion-relevant training.

Findings

The report identified four principal types of training and 10 challenges (see Box 1, and refer to the report itself for a more in-depth analysis around each of the 10 challenges) 2. See https://www.elrha.org/researchdatabase/review-of-training-for-the-inclusion-of-people-with-disabilities-and-older-people-in-the-humanitarian-sector/. . Here we discuss those challenges that are currently more overlooked than others. For example, data disaggregation has long been acknowledged as a major constraint to identifying older people and people with disabilities and addressing their specific disability needs, whereas to be truly effective at the OPD level, resources need to be translated into or co-created in local languages and accessible formats – a resource-intensive process that donors frequently overlook.

Discussion

In the humanitarian sector, the inclusion agenda is mainly being taken forward by key individuals within organisations focusing on a particular group, such as older persons and persons with disabilities. There is limited buy-in from colleagues in other departments (programmes, finance, human resources), other aid organisations, donors, governments of crisis-affected countries and UN agencies.

Although departmental silos exist within most organisations, it is possible to overcome them. One member of the ADCAP programme, Islamic Relief, did this by sensitising, training and building the capacities of staff at different levels, aiming to integrate inclusion throughout all departments. The organisation gradually built a cadre of champions who now sustain this work. Once monitoring and evaluation staff were involved it was relatively straightforward to reframe the organisation’s work for more nuanced data disaggregation to reflect the more detailed reality of people with disabilities and older people in order to bring about more effective humanitarian action – whether disaster risk reduction (DRR), response or recovery (see Box 2 for more detail on the ADCAP model).

There is a need both for humanitarian agencies to be more inclusive, and also for ‘inclusion specialist’ organisations to be more aware of humanitarian policies and practice in order to identify key points during the humanitarian cycle where their input would be most effective. Much of the training we identified focuses on disaster risk reduction (DRR), rather than actual humanitarian response, so this is one area that could be strengthened. The ADCAP model has the potential to bring about greater coherence in terms of inclusion sensitivity and awareness, but does not address the need for inclusion specialist agencies to be more aware of the policies and practice of humanitarian response.

One interviewee suggested that, while it may have been necessary in the past to focus on a single issue or identity category – such as disability or older age – we now need to view inclusion through an intersectional lens, recognising that each individual has multiple intersecting and overlapping identities and characteristics, including age, (dis)ability, gender, sexuality and ethnicity. This dovetails well with the trend towards more user-centred programme design.

Communication and training materials

Communication and training materials need to be contextualised and translated into local languages to improve understanding and uptake of inclusion principles and approaches. HelpAge International Pakistan has worked to reach communities in remote areas by advertising for positions via text message and developing communication guidelines in local languages. This helped staff to better understand the barriers faced by people with disabilities and older people in these communities. However, this is also a resource-intensive activity, and many interviewees noted that most inclusion materials were only available in English, with a few recently available in French and Arabic.

Role of local and government agencies

Not involving the government/state sector was seen by some as the biggest obstacle to mainstreaming and sustaining inclusion work. The Special Talent Exchange Programme (STEP) in Pakistan included government actors and promoted inclusion within the country’s National Disaster Management Agency (NDMA) from the outset. This brought inclusion standards into government practice, particularly in DRR work. However, there is a concern that, once the two-year funding window is closed, and with continuous staff turnover, momentum around inclusion mainstreaming within the NDMA could falter. If each inclusion drive culminates in the funding of a one-off, one- to two-year INGO project, the agenda will certainly struggle to gain traction across the sector.

In most countries, NDMAs need more information and analysis about the specific and various needs of people with disabilities and older people in preparing for, and responding to, emergencies which particularly affect these groups. In some cases, once a person with disabilities reaches the age of 60, they are then viewed as an older person and treated accordingly. Their specific disability becomes invisible to the systems in which they find themselves, so a more holistic, user-centred approach of intersectionality is required. One initiative in the Philippines has started to do this (see Box 3) – working in a highly inclusive and participatory way at Barangay level and digitising the results so that local front-line responders know which households are most vulnerable.

In India, it is at the District, rather than the community level, where there is a lack of awareness around inclusion issues and their importance for a more resilient society as a whole. For example, one interviewee noted that ‘at the local level the frontline responders are “street smart”, they know what needs doing and have a rough idea where the more vulnerable might be’, so are able to act more immediately and effectively. District-level governments have decision-making power in allocating resources, so raising awareness at this level could enable more funds to be more effectively directed towards inclusion activities. One assessment of how older people were affected by floods in Kerala highlighted a lack of data within local government on the number, location and overall condition of older people, hampering efficient evacuation. Had local district institutions completed vulnerability maps, such as those conducted in the Philippines described above, a more targeted and effective response could have been implemented.

In Gaibandha in Bangladesh, CBM piloted a model for disaster risk reduction, which integrated work with all relevant stakeholders building on existing, embedded structures of organisation already in place, believing this to be a more sustainable approach. As there were no OPDs in Gaibandha, and most people with disabilities lived in isolation and rarely participated in community life, interventions were implemented at three levels: household, community and municipal. Self Help Groups (SHGs) comprising household participants selected representatives to participate in the community-based Ward Disaster Management Committees (WDMC), ensuring a coherent, highly participatory and inclusive structure. Different types of training for each intervention level were built into the programme. SHGs, for example, received training on disability rights, relevant legislation, government structures and how to lobby and advocate.

Inclusion will not happen unless it is sufficiently resourced, and those funding DRR, response and recovery programmes need to recognise and act on this. Different means of communication are required, and older people and people with disabilities are harder to identify because of stigma or a desire not to be labelled, or are kept out of sight by other family members and care-givers. Changing long-established forms of provision and making allowances for different types of disability or for older people needs both time and money. Introducing inclusive measures at the start of a programme is cheaper than retrofitting, and some donors are now asking specifically how inclusive programmes are, with reporting against these and separate sections in grant funding proposals. However, many of these requirements refer to people with disabilities and not older people, where there is a real gap. There also needs to be a shift towards more integrated reporting that moves away from inclusion as a tokenistic add-on, to be ticked in a box on a form. This problem is not specific to the humanitarian sector, and is common in development-oriented proposals and reporting.

One of the main gaps we found was around data, which is a well-recognised and acknowledged problem. Data collection depends on organisations’ front-line staff. If these staff are not sufficiently trained in how to work with communities to identify people with disabilities and older people, if they cannot communicate with them or if they have culturally embedded biases and prejudices, this is a major block to understanding the scale of the issue, and formulating an effective DRR or response strategy. By involving people with disabilities and older people and enabling them to express their needs and requirements, a more coherent approach can be designed. It is important to note that effective communication is not just about language – it can also require different types of organisations with different operational cultures and values seeking to understand each other. As in many other areas, programmes should be owned and funding streams controlled by local and national organisations and integrated with local and national government agendas. They should build on existing community infrastructure, rather than being dictated and designed by those not affected by the issues that need to be addressed.

Conclusion

A series of recommendations emerged from the findings:

1. Donors could provide an additional percentage, over and above programmatic costs, for inclusive capacity-building within their grantees’ organisations.
2. Build up a community of practice to share learning and experiences of, in particular, the larger agencies implementing the more intersectional/user-centred approaches.
3. Provide a portal for all inclusion training resources as a ‘one-stop-shop’.
4. More resources to be made available at a local level.
5. Increase awareness of humanitarian structures, policies and processes on the part of inclusion-specific agencies.
6. Assessing the reality and identifying during which phases of the humanitarian cycle the humanitarian inclusion standards can be operationalised most effectively.
7. More emphasis on the barriers faced by older people.
8. More research around the role of care-givers as both enablers and obstructers.
9. People with disabilities and older people design and facilitate training for greater transformative change.
10. Follow up training with organisational change processes.

While everyone working on these issues acknowledges that not enough is being done, some areas – such as the lack of resourcing and inadequate data disaggregation – have received more attention than others. Findings from our report highlight that sustainable change needs a combined approach which is demand-led from Southern OPDs, includes locally owned approaches to population mapping, and integrates with national government disaster response agencies. There needs to be a recognition among INGOs that inclusion has to become part of their core business, whatever their focus. This means embedding sensitisation and training programmes into every staff member’s induction processes – from field level to HQ. Inclusion has to move away from being retrofitted as an add-on with a few mandatory tokenistic hour-long online courses, towards the normal way INGOs, national NGOs and local community organisations conduct their work. Donors have a vital role to play, and many are starting to incorporate inclusion criteria into their programmes. However, it is not enough to insist that organisations embed inclusion into their programmes; donors need to recognise that this takes time and resources, and should make funds available for all organisations to train and sensitise their staff at all levels, not just as part of a particular funded project or response.

Frances Hill is Director at Partnership for International Development (P4ID) and Effective Partnerships Manager at Elrha. Jim Cranshaw and Carys Hughes are independent consultants.