Crisis modifiers: An effective tool for donors to respond to health shocks? - Maintains

UK Aid is helping treat children suffering from malnutrition as a result of extended drought.
Russell Watkins/DFID

Not all health shocks are as big as COVID-19, but smaller ones can also be devastating and are often overlooked. How can donors ensure response funds are available quickly for smaller shocks? ‘Crisis modifiers’, tested for natural hazards such as droughts, offer a possible solution at the humanitarian-development nexus.

There is an interesting similarity between droughts and epidemics: the later responders react, the worse impacts get. COVID-19 is a case in point: where the response has been swift (e.g. in Taiwan), cases are fewer; where it has not (e.g. in the USA), cases are up. Droughts and epidemics are what experts call ‘slow-onset events’. This is as opposed to floods or earthquakes, that typically realise their damaging potential quickly and are thus recognised as ‘fast-onset’.

Given the global situation, everyone is talking about epidemics. But are there perhaps lessons we can learn for dealing with epidemics from how we have learnt to deal with droughts? Maintains has just published a literature review that examines the role of ‘crisis modifiers’, a financing tool used by donors in drought situations but which may also be useful for health shocks.

Why are some shocks not better funded?

In situations of droughts and health shocks, humanitarian donors face some of the same challenges: implementing a response can take time, especially when there is no existing delivery infrastructure on the ground. When the event is not exceptionally large, there are typically no response funds available on standby, delaying the response, if not disabling it altogether. At the same time, development programmes in the affected region fear losing hard-earned development gains through the impacts of the shock.

How have crisis modifiers helped?

Donors active in building drought resilience in East Africa have thus resorted to an unusual approach: spearheaded by the United States Agency for International Development (USAID) in Ethiopia some 20 years ago, humanitarian elements were embedded in development programmes. Specifically, humanitarian financial reserves were included in drought resilience projects. In the event of a drought, the funds could be accessed quickly to provide relief to affected people through existing development partners and networks on the ground.

The approach may seem like an obvious idea but it was not – efforts that reach across the humanitarian–development aisle are traditionally rare. Some donors, such as Germany, continue to strictly separate their humanitarian funding and their development funding.

However, here a humanitarian-development win-win situation was achieved: humanitarian aid could be delivered more quickly and development progress in building beneficiary resilience to droughts could be protected. ‘Crisis modifiers’ were created.

The implementation of crisis modifiers has not been without challenges, however. Their funding decision-making processes can be sluggish and they are often not tied to premeditated contingency plans in place that guide the implementation of funding once it has been provided. As a result, the response can be slower than intended. Experience also suggests that they may not always have been integrated well into the broader risk management context – a missed opportunity for the holistic management of crises. It is thus crucial to get the details of crisis modifiers right in order to achieve the desired results.

Can crisis modifiers also help fund responses to health shocks?

The UK Department for International Development (DFID) has started using crisis modifiers to provide rapid relief funds to respond to health shocks. For example, DFID’s Tackling Deadly Diseases in Africa Programme is primarily targeted at strengthening disease outbreak preparedness in different African countries. However, it also includes contingency funding elements to finance rapid outbreak response activities. These have, for example, provided more than £5 million to the recent Ebola response in the Democratic Republic of Congo.

There are important differences between using crisis modifiers to respond to droughts and using them to respond to diseases. Droughts are in some respects more easily detected, e.g. through satellites. Objective thresholds can be developed to rapidly trigger contingent funds for response in the early stages of a crisis. In contrast, it can be more difficult to predict and track the extent to which people have been affected by a disease outbreak in a remote region, thus slowing down the response. Also, the actors are different. The World Health Organization is not a humanitarian organization per se but often leads the humanitarian response to outbreaks. Likewise, funding sources do not necessarily overlap – donors such as the USA, with its Centers for Disease Control, have distinct structures to support outbreak response efforts.

The point remains the same, however. Integrating response funding elements into health development programmes can be just as effective a tool for responding to health shocks as contingent funds have proven to be as part of drought resilience programmes. This is especially the case for smaller and medium-sized health shocks, for which funding is often not readily available.

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