Gabrielle Smith, Oxford Policy Management
In his report to the UN World Humanitarian Summit taking place this week in Istanbul, UN Secretary-general Ban Ki-moon writes that during crises: “social protection mechanisms and infrastructure may be unavailable or overwhelmed by the volume of demand. Those displaced in camps often survive on inadequate humanitarian assistance”. Unfortunately, the frequency, severity and length of humanitarian crises has increased over recent years. We have also seen increased levels of forced displacement. The rising cost of international assistance is widening the gap between humanitarian needs and international resources, bringing questions about aid effectiveness and critical appraisals of the humanitarian system to the fore. There is a growing realisation of the need for new approaches to humanitarian assistance.
Shock-responsive social protection systems are one such approach. Interest has been growing amongst practitioners and policymakers in the potential for a system that allows irregular humanitarian needs to be built into and addressed as part of longer-term development programming, through longer-term predictable funding sources and with greater engagement of governments. The most effective ways of developing and implementing such a system for different contexts, and the implications for the humanitarian sector and national governments, remain unclear.
We have therefore conducted a thorough literature review, commissioned by DFID, the UK Department for International Development, to improve understanding of the interaction between social protection, humanitarian and disaster risk management systems, and to identify ways in which long-term social protection can be effectively scaled up to provide support in humanitarian emergencies.
This literature review of over 400 documents (scientific and grey literature) has consolidated current thinking and emerging evidence. Evidence comes from several countries such as Brazil, Vietnam and Indonesia, where social protection schemes were scaled up to support households affected by the food, fuel and financial crisis, as well as national social protection programmes that were scaled up to respond to needs caused by disasters such as droughts and typhoons – including in Kenya, Ethiopia, Malawi and the Philippines.
Social protection makes use of a number of different instruments: social transfers, subsidies, fee waivers, public works programmes, social insurance, active labour market policies and social care services. This review identifies the most natural overlap between social protection and humanitarian assistance as being social transfers provided as cash (and food). Cash assistance in emergencies is growing and cash transfers are a core building block of all emerging social protection systems. Emergency and social protection cash transfers have similar administration requirements, making transition from one to another relatively straightforward. The limited coverage of other policy instruments in low- and even middle-income countries limits their use as alternative responses to a shock. Key differences between emergency and social protection cash transfers, such as their objectives, underlying principles and assistance durations will, however, have a bearing on the ease and effectiveness with which social protection programmes can be scaled up to meet the needs of people affected by a crisis.
So far, government social transfer programmes have been scaled up during emergencies in three main ways. They have been expanded ‘vertically’ – increasing the benefit value or duration of assistance to existing beneficiaries – as well as ‘horizontally’, by adding new beneficiaries to an existing programme. Vertical expansion has been easier to implement than horizontal expansion. In some cases, new social protection programmes have been introduced to meet needs that no existing programme could cater for. For an elaboration of these options and to learn more about a further two added by the research team, the concept note is available here.
The review finds clear evidence that scaling up national cash transfer programmes in emergencies can both improve the timeliness of assistance and provide cost efficiencies.
Some key challenges to scaling up social transfers identified by the literature include: Ensuring coverage of geographical areas that were not covered by the administrative system of the original long-term programme; how to avoid over-burdening the administrative capacity of existing staff and systems; ascertaining the best way to scale down again post-crisis; how to reach the worst affected groups using existing targeting mechanisms; and how to meet the needs of informal sector workers if they are excluded from social insurance and from most social assistance.
A number of important determinants of effectiveness emerge from the literature, including: links to an established early warning system, timely and accurate data on needs and vulnerability, well-developed systems for targeting, verification and disbursement of funds, institutional capacity to manage the increase, coordination through a single central agency, guaranteed financing to enable governments to invest and build systems and deliver a rapid response, and innovative partnership arrangements with public, private and non-state actors.
The full literature review is available for download here from Oxford Policy Management’s website.
If you have any questions or would like to discuss this research with a member of the team, please contact Jenny Congrave at [email protected].
The OECD Development Centre’s work on social protection systems
The European Union Social Protection Systems Programme (EU-SPS) is a new European Union action co-financed by the OECD and the Government of Finland. The OECD’s Development Centre and the Government of Finland’s National Institute for Health and Welfare (THL) manage its implementation. The EU-SPS supports low- and middle-income countries in building sustainable and inclusive social protection systems. The programme will be implemented from 2015 to 2018 in partnership with national and regional social protection authorities, think-tanks and expert institutions in ten countries.
Anne-Lise Prigent, editor in charge of development publications at OECD Publishing.
Can a Chinese herbalist emperor ever meet a Persian thinker of the Islamic Golden age? Well, you’d be surprised… “If my strength is needed, then I must go forth.” “I hope I can be of aid.” These are the words of Shennong, the father of traditional Chinese medicine. It is also the calling of Shennong & Avicenne, a French medical NGO. Shennong & Avicenne combines traditional and modern medicine, Western and Eastern approaches. A scientist and a philosopher, Persian Avicenna was the father of modern medicine, the 11th century’s famous Muslim “prince of physicians”. More than a thousand years after his time, new warfare seems to be emerging – it is agile and powerful, mobile and violently radical. Shennong & Avicenne helps war victims in Iraqi Kurdistan.
The UNHCR estimates that there are 2.5 million refugees and internally displaced persons in Iraqi Kurdistan. Many of them are Yazidis and Christians who have lost everything fleeing Daesh; others are Muslim. Some were made prisoners by Daesh and managed to escape. Despite efforts by the Kurdish authorities and the international community to build camps to shelter them, the influx has been so massive and so sudden that 90% of the refugees are scattered around the territory, in isolated regions far from the help and services they need. They are living in waste dumps, empty buildings, improvised camps… where sanitary conditions are catastrophic.
Faced with this situation, Shennong & Avicenne felt they had to be next to the scattered populations who need their help. They raised funds to buy a truck in France to use as a mobile dispensary and a bus for women and children’s health care, thanks to the support of the French Ministry of Foreign Affairs and the Alliance des Femmes pour la Démocratie. Every day, Shennong and Avicenne visits more than 30 sites in the provinces of Erbil and Duhok and takes care of thousands of ailing victims.
We asked Elise Boghossian, the organisation’s founder and president, to tell us about Shennong & Avicenne and the work they are doing in Iraqi Kurdistan. Below, she talks about the philosophy behind their approach; the people they treat; the situation on the ground; and what we can do to help.
From Paris to Viet Nam through China, Elise Boghossian has become an expert “war” acupuncturist. Her recently-published book (Au royaume de l’espoir, il n’y a pas d’hiver : Soigner en zone de guerre) recounts her journey and calling. In Armenia, Jordan and Iraqi Kurdistan, Boghossian demonstrates that acupuncture is an efficient and cost-effective way of relieving pain and healing patients. Acupuncture, she argues, can become part of health care services in conflict-affected zones, where medical products are often missing or fake.
In her book, Boghossian discusses the pitfalls of aid – and how to avoid them: “I think there are two main pitfalls in aid. First, our presence can lead to dependency and create additional needs. We must accept the limits of our action, and let those we’ve come to help be autonomous, free, and most importantly, we must ensure they keep their dignity. We should support them in this. Putting things right when they’ve gone wrong is essential. The other pitfall is the inverse relationship between our need for recognition, (…) and the risk of not respecting the Other, his difference, his culture, his living conditions.”
Boghossian’s infinite respect can be sensed throughout the book. One thinks of Levinas. The Other’s face is exposed, vulnerable. It makes one demand more of oneself. “The face opens the primordial discourse whose first word is obligation.” (Levinas, Totality and Infinity) Face to face with Daesh’s victims, Boghossian heals them and sometimes even seems to breathe new life into victims who have lost everything. Boghossian’s Armenian roots have not been forgotten and she will not let the history of genocide repeat itself without standing by today’s victims. As stated by Levinas, the face is what forbids us to kill. Yet, some of the scenes described in the book are horrific. “Wait” some of the refugees said to Boghossian, “you have not seen anything yet, this is only the beginning.” This was back in January 2015.
“They [Daesh] hate difference, whether it is Muslims who think differently, Yazidis or Christians (…)” (The Archbishop of Canterbury). Shennong & Avicenne takes care of victims, whatever their religion – Christian, Yazidi, Muslim. The organisation’s medical staff (doctors, paediatricians, nurses, gynaecologists etc.) are refugees themselves and they are employed irrespective of their race, ethnic origin or beliefs.
Boghossian won’t let herself be intimidated or silenced. One closes her book in awe. This woman has the determination and stamina of a Florence Nightingale. Both women have grit, “good” grit as Howard Gardner defines it – perseverance and the accumulation of valued traits, a “can-do” attitude, a positive, constructive mindset that benefits others – and brings deep meaning to their lives. Nightingale famously nursed wounded soldiers in the hellish world of Crimean warfare and revolutionised nursing practices in Britain. She was remembered as the lady with the lamp:
Lo! in that house of misery
A lady with a lamp I see
Pass through the glimmering gloom
What is less well known is that Florence Nightingale saved so many lives also because of the data she gathered and her expert use of statistics. She was passionate about data. Boghossian is not the lady with the lamp, but she has needles and data too. Data about the impact of acupuncture on the health of patients is now available (and its effect on the brain can be demonstrated). The book begs a question: why is acupuncture not more commonly used in conflict-torn areas, in conjunction with other medical practices (as is done by Shennong & Avicenne)? As Levinas pointed out, “the very relationship with the other is the relationship with the future.”
On their modest scale, Shennong & Avicenne bring a scarce commodity to those who have lost everything: a glimmer of hope. In 2015, Shennong & Avicenne was in touch with 50,000 war victims and 30,000 procedures were carried out. Grit will make a difference – it always has and always will.
Entretien avec Elise Boghossian pour OECD Insights Anne-Lise Prigent
Stephen P. Groff
Stephen P. Groff is the Deputy Director for Development Cooperation at the Organisation for Economic Cooperation and Development in Paris.
As the international community gathers in Rome to discuss the emergency in the Horn of Africa, it is important to recognize the commitment of the UN system, NGOs and donors to co-ordinated humanitarian action in the region. OECD donors alone have already directly committed USD 1.49bn to the region this year, on top of the core funding they provide through UN agencies and emergency pooled funds.
This said, the crisis in the Horn of Africa is indicative of development failure. Early warning systems predicted it a year ago. Since then, people’s household reserves have been gradually exhausted, forcing them to leave their land in search of food. We also know from experience that the populations hardest hit by disasters such as drought are the most marginalised – in this case hard-to-reach pastoralist communities, difficult to reach and often without access to basic services, development programmes and decision-making processes. Early response could have helped people to stay on their farms and protect their assets, slowing the reversal of hard-earned progress in development.
Yet opportunities to prevent the crisis – by providing timely funding and strengthening community resilience – were largely missed. Early action could certainly have provided much better value for money than today’s costly – although necessary – emergency response. Some studies say that one dollar spent on prevention is worth four in relief. This is particularly important at a time when there is increasing pressure on aid budgets in the major donor countries.
Unfortunately, lessons are always easier to affirm in hindsight. This is why today, as we scramble to relieve the desperate situation in the Horn, we must make sure we don’t look at this merely as an interruption in business as usual. Unless we do things differently by truly prioritising in our development programmes and humanitarian responses the people and communities most at risk – helping to build resilience into their livelihood systems – we will have to learn this lesson over and over again.
Development efforts need to be more creative, incorporating social protection instruments such as cash or food transfers and public works. These instruments build resilience and productivity, and can contribute to important infrastructure and environmental capital. At the same time, they provide the systems needed to enable speedy response to emergencies before they become crises.
This twin-track approach – of early action balanced with appropriate emergency intervention – is critical. Building long-term resilience – for instance through increased household assets, reserves and safety nets – is the only way to ensure that episodes of drought do not become famines and that natural disasters do not become crises. At the same time, the right type of response to emergencies – including early warning and the ability to respond quickly – is essential to strengthen the capacity of countries and communities to prevent and prepare for humanitarian crises. Climate change research and funding for adaptation also need to focus on livelihood systems like those of the pastoralists and agro-pastoralists in the Horn of Africa. And donors need to take risks, supporting peace through the creation of responsive and legitimate state structures – even where conflict is ongoing and in remote, marginalised areas.
The crisis in the Horn of Africa is still building. While we work to limit its impact and ensure that funding continues to be available, we also need to support the return to sustainable livelihoods. We know that the frequency and severity of drought is likely to increase in the region. While dealing with the present, donors and local governments need to look to the future, planning and investing in a mix of humanitarian and development tools that will build resilience in vulnerable communities, protect productive assets and promote livelihoods.
High and volatile food prices make this job much more difficult, threatening the predictability of financing for ongoing social transfer programmes and driving food insecurity in countries and households that depend on purchases from the global market. Implementing the Agriculture Market Information System proposed by the G20 will be an important measure to curb excessive global price volatility.
The OECD has looked at many of our hard-learned development lessons to produce guidelines for the establishment of forward-looking social protection programmes. It also promotes the Principles and Practices of Good Humanitarian Donorship and has worked with partners to develop recommendations on Transition Financing: Building a Better Response. The Accra Agenda for Action, subscribed to in 2008 by donors and developing countries alike, calls for flexible, rapid and long-term funding modalities to bridge humanitarian response, recovery and longer-term development.
Now is the time to act on these commitments, addressing potential crises effectively – preferably, before they occur. Aid budgets under pressure and donor focus on value for money may provide an opportunity. The people of the Horn of Africa – and marginalised communities worldwide – make it an imperative.
Today’s post is by Hans E. Lundgren and Megan Kennedy-Chouane of the OECD Development Co-operation Directorate
It has been called one of the worst disasters in human history. The earthquake that struck Haiti on 12 January 2010 saw destruction on an unprecedented scale.
Some 230,000 people lost their lives and 300,000 more were injured. Over 1 million people were left homeless.
In response, the international community mounted a massive humanitarian relief effort. The Red Cross, for instance, deployed the single largest country response in its 148 year history. People around the world gave millions in charitable donations and governments pledged $5.8 billion for relief and recovery.
At the peak of the emergency response, four million people received food aid and 1.7 million people were provided with material for basic shelter or tents. Over time, 158,000 families have been relocated into sturdier transitional shelters. Today, 1.3 million people have access to potable water and one million are using 15,300 newly built latrines. Immunisation against major diseases has been provided to 1.9 million children and hundreds of thousands of children are back in school.
And yet, as the world marks the one year commemoration, many of us are disappointed with the overall result. Over 800,000 people are still living in camps and day-to-day conditions are extremely challenging for many Haitians. Journalists and experts in and outside of Haiti have criticised the United Nations, the donor community and NGOs for failing to improve conditions.
We support lively public debate about the effectiveness of development aid generally and the humanitarian response in Haiti specifically. However, while anecdotes and stories are useful for highlighting individual experiences, these discussions should also be informed by credible evidence – evidence that can be provided through independent evaluation.
Here are just a few of the insights that evaluations of the earthquake have provided so far:
- Humanitarian coordination: An independent Real Time Evaluation three months after the quake showed evidence of the recurrent problems of weak leadership and limited collaboration among international humanitarian organisations working in Haiti, despite recent progress in improving the efficacy of the humanitarian system.
- The role of the government: Pre-existing governance weaknesses in Haiti were compounded by the earthquake. International groups did not do enough to consult with local and national institutions and engage them in coordination mechanisms. Long-term development cannot be a donor-led process but must be effectively driven by a legitimate government. When formed, the new government will need to act decisively to approve projects, resolve issues around land ownership and set priorities for reconstruction and job creation. (IASC, 2010 and OXFAM, 2010)
- A challenging urban setting: Reports from the Humanitarian Practice Network and OXFAM show that delivering water, sanitation and other basic services in a major city presented very different challenges than those arising in rural environments (where humanitarians tend to have more experience). For instance, new solutions had to be found for providing toilet facilities for the hundreds of thousands of people camping amid the rubble or in dense tent cities. Organisations must have the capacity to innovate and work flexibly with local communities to find technical solutions suitable for the physical, social and cultural circumstances of the disaster-affected population.
- Making the right kinds of donations: The Haiti response operation received tonnes of relief items, but the capacity to process these goods and get them quickly to people in need was limited. This lead to high storage costs, waste and the clogging-up of airports and roads. Some items sent were not appropriate, including expired medication that had to be destroyed. (IASC, 2010) Only goods for which there is a clearly expressed demand, and established means for distribution, should be sent. (Read more about how best to help.)
These evaluations can be found on the ALNAP Haiti Learning and Accountability Portal. Another source for independent evaluations of development aid is the Development Evaluation Resource Centre (DEReC), hosted by the OECD DAC Evaluation Network. This is a free online collection containing over 1700 evaluations of humanitarian and development aid programmes, including assessments of past donor efforts in Haiti and reports on other disaster responses.
In the context of broader debates about the adequacy of the Haiti earthquake response, evaluators are providing concrete lessons for the future. Sadly, some of these lessons have been highlighted before (see for example this World Bank Evaluation brief or ALNAP’s earthquake lessons note). We need to focus more on creating incentives to implement lessons, in order to ensure that mistakes are not repeated (again) in future disasters.
Read more about Aid and the Haiti Earthquake on the Development Evaluation Resource Centre (DEReC)
Find out how the Haiti Evaluation Task Force is working to encourage credible assessments of the aid response.