What does the availability of humanitarian funding for older people and children under five tell us about the humanitarian system?

Older people constitute a significant proportion of the global population. Estimates for 2013 show that people over 50 account for 22% of the population, and those over 60 12%. By 2050, over-60s will account for 22%, exceeding the number of children under 15 for the first time in history. Globally, children under five account for 9% of the total population, though there are significant regional differences. In Africa, for example, children under five make up 15% of the population.[1] Consequently, in humanitarian crises it is possible that these two groups will account for up to a third of affected people.

Humanitarian programming which recognises diversity – the specific needs of different population groups – is at the heart of commitments made by humanitarian actors to impartiality and accountability to affected populations. Yet evidence suggests that agencies continually fail to design and deliver responses which are both appropriate and adapted to the needs of affected populations. Using Consolidated Appeal Process (CAP) appeals as a proxy for funding within the wider humanitarian system, HelpAge has been conducting research since 2010 to assess the degree to which projects submitted to appeals recognise and respond to the needs of diverse population groups.

Research findings

Findings for CAP appeals in 2010 and 2011 showed that just 47 projects (0.8%) included at least one activity targeting older people, and only 18 of these were funded (0.3%). Findings also illustrated the situation facing people with disability. In 2010 and 2011, 98 projects (1.6%) included at least one activity targeting people with disabilities, and 43 of these were funded (0.7%).[2] Continued research into CAP funding in 2013 found that just 60 CAP projects of the 2,803 analysed in 2012 (2%) included at least one activity targeting older people, of which 30 (1%) were funded. Eight country appeals did not include any project in any sectors targeting older people.[3]

Given that children under five are commonly considered to be well served by the humanitarian system, the findings for this group are more of a surprise. Just 111 projects (4%) included at least one activity targeting children under five, and 65 were funded (just over 2%). Examined from a country perspective the findings show half the projects with activities targeting children under five were put forward in four countries – Kenya, Somalia, Sudan and South Sudan. Overall, this is a very bleak picture for the delivery of inclusive responses.

Designing and delivering a programme which responds to the needs of groups such as older people, children under five and people with disability demands that these projects are based on a clear evidence base of the needs on the ground. To shed light on the link between evidence and programming HelpAge’s research also examined whether or not the needs of older people and children under five were considered during CAP project assessments and, if they were, if these were then reflected in programmes. Again, the findings for both groups are stark. Just 119 projects (4%) included reference to older people in the needs assessment, yet only 17 (14% of projects that included reference to older people in the needs assessment) included one or more activities designed to address identified needs. Similarly, 46 projects (1.5%) included children under five in the assessment, yet only in seven cases (15%) did this result in activities designed to meet identified needs, despite the regular availability of detailed Sex and Age Disaggregated Data (SADD) on younger affected people.

What does this tell us about the humanitarian system?

The limited availability and use of evidence and data with which to design humanitarian responses is not a revelation. Research published by Tufts University with the Office for the Coordination of Humanitarian Affairs (OCHA) and CARE International found ‘almost no documented and published cases in which lead agencies … collected Sex- and Age-Disaggregated Data properly, analysed the data in context and used those findings to influence programming’. More worryingly, the UK Department for International Development (DFID)[4] states that ‘At present, humanitarian decisions are often based on poor information … we do not know with confidence how many people are affected, whether they are women or men, or how old they are’.[5] So even at the most basic level of analysis of total population numbers, humanitarian responses come up short.

The body of evidence compiled in HelpAge’s studies contributes to a picture of a humanitarian system which for a variety of reasons is incapable, or perhaps unwilling, to deliver assistance based purely on evidence of need. Rather than recognising that disasters affect different groups differently, humanitarian operations appear as almost automatic, delivery-based systems which assume the beneficiary population to be homogenous and undifferentiated. Humanitarian agencies often explain the lack of inclusion of different population groups on the basis that the necessary modifications to programmes are too complex, impractical or costly during humanitarian crises. The evidence presented below, however, suggests that this is not the case.

What can be done?

The field-level implementation of recent humanitarian policy developments provides an opportunity to begin changing this state of affairs. In particular, the stages of the revised Humanitarian Programme Cycle – introduced in the final phase of the rollout of the Inter-Agency Standing Committee (IASC) Transformative Agenda – represent strategic entry points for effectively reflecting, at least in protracted emergency situations, the specific needs of different groups.

At the needs assessment and analysis stage, the newly introduced Humanitarian Needs Overview (HNO) includes methodologies for identifying and prioritising needs across humanitarian sectors. Based on a wide range of primary and secondary data sources, Humanitarian Country Teams (HCTs), with support and input from experts representing different groups within the population, are required to describe the overall humanitarian dimensions of a crisis, fully taking into account the demographic profile (sex and age breakdown) of the population and other diversity factors.

At the strategic planning level, the traditional CAP has been replaced with a Strategic Response Plan which puts much greater emphasis on the link between evidence and programming – a gap clearly illustrated by HelpAge and others. HCTs are then required to produce an overall Country Strategy and individual Cluster Plans. This is the critical stage at which the results of an age- and gender-sensitive needs analysis and prioritisation must be reflected in the planning of response activities.

Based on this process of needs identification and prioritisation, the programmes that result must be designed so that they are accessible by, and adapted for, all different groups of the population identified in the HNO. It is important to remember that accessibility and adaptation need not be expensive or time-consuming. Very often, simple, inexpensive modifications of standard programmes (such as organising a separate queue for distributing food to older people or placing handrails in latrines) can make a world of a difference, and ensure that groups often invisible to humanitarian actors can access the assistance they need.

Beyond physical adaptation to programmes, Médecins Sans Frontières (MSF) has shown how changes in data collection and analysis practices can increase awareness of the needs of vulnerable groups. As part of MSF’s response to Sudanese refugees displaced to Jamam camp, South Sudan, MSF staff recognised the high proportion of deaths reported amongst those over 50. In response mortality surveillance systems were adapted to collect data on those over 50, with findings showing that older people, comprising 10.5% of the population, were dying at over five times the rate of those aged 5–49. MSF staff reported that the additional data collection did not greatly increase their workload.[6]

In some sectors more substantial changes may be needed to address the specific challenges faced by older people and other groups in emergencies, such as those requiring treatment for non-communicable diseases. Again, however, experience from emergency contexts including the Philippines suggests that this is possible with basic drugs for chronic disease already added to the medical kits of some agencies.

HelpAge has produced a series of technical guidelines on health, nutrition, protection, livelihoods and food security and needs assessment to support the design and delivery of programmes which are accessible to and inclusive of older people. These guidelines can be found at http://www.helpage.org/resources/practical-guidelines/emergency-guidelines.

The voice of affected people?

While the revised humanitarian programme cycle provides potential opportunities to ensure representation of the needs of diverse population groups, it is worth considering the challenges and potential risks associated with a model that relies on the expertise of expatriate field workers. There is also the question of data. In the 2010 Haiti earthquake response, for example, while the findings of the Rapid Initial Needs Assessment identified older people as the most vulnerable affected group, only seven projects submitted to the 2011 CAP appeal included activities targeting older people, and none was funded, suggesting that, despite the available data, the needs of older people were not prioritised. It is therefore legitimate to ask to what degree the needs of diverse groups will be represented in cases where data is unavailable, or where there is no technical representation of the needs of these groups during planning and programme design.

Here it is interesting to return to the findings of HelpAge’s analysis of CAP data from Somalia. In the response to the East Africa food crisis 22 projects were submitted which included at least one activity targeting older people (36% of all projects with at least one activity targeting older people). Thirty-four projects analysed as part of the research specifically included older people, not in terms of addressing their needs directly, but rather by consulting them and groups of elders during programme design. Experience from across the humanitarian sector, and HelpAge specifically, shows that when different groups are actively involved in consultation processes and give voice to their specific needs, these are better represented in overall assessments. Ensuring participation in this way can therefore help overcome many of the challenges associated with biases in assessments, lack of data or lack of expert representation in planning, and should be undertaken as a matter of good practice.

While the guidance for the development of the HNO notes that ‘all efforts should be made to include the views of crisis-affected people’, a model of response prioritisation that relies on the expertise of expatriates ultimately makes little room for this. It is therefore crucial to consider the degree to which the assessments that inform the HNO, and resulting programme design, create adequate space for the voices of all groups within the affected population, and that these voices are adequately represented.

Marcus Skinner is Humanitarian Policy Manager at HelpAge International. Piero Calvi-Parisetti is Humanitarian Advisor – Age at HelpAge International.

This is an article in HPN’s Online Exchange. To read other Exchange articles, please visit https://odihpn.org/humanitarian-exchange-magazine.

[1] All estimates used in this article are produced using data from United Nations, Department of Economic and Social Affairs, Population Division, World Population Prospects: The 2010 Revision, CD-ROM Edition, 2011.

[2] HelpAge International, A Study of Humanitarian Financing for Older People and People with Disabilities, 2010–2011.

[3] The eight were Burkina Faso, Côte d’Ivoire, Chad, Djibouti, Kenya, Mali, Mauritania and Niger. In the case of Burkina Faso, Côte d’Ivoire, Mali, Mauritania and Niger (which were part of the 2011 West Africa CAP) and Chad, specific needs of older people were not reflected for the second year in a row.

[4] DFID, Promoting Innovation and Evidence-based Approaches to Building Resilience and Responding to Humanitarian Crises, 2012.

[5] D. Mazurana et al., Sex and Age Matter: Improving Humanitarian Response in Emergencies, Feinstein International Center, Tufts University, August 2011.

[6] P. du Cros, S. Venis and U. Karunakara, ‘Should Mortality Data for the Elderly Be Collected Routinely in Emergencies? The Practical Challenges of Age-disaggregated Surveillance Systems’, Transactions of the Royal Society of Tropical Medicine and Hygiene, November 2013.