VSO Submission to the International Development Select Committee Inquiry on the impact of Coronavirus
VSO is an international development agency with over 60 years’ experience of addressing poverty and marginalisation through our unique approach of working through international, national community volunteers. VSO’s volunteering model is particularly relevant in the fight against COVID-19. Our volunteers build strong relationships and trust in the communities in which they work - a key factor when ensuring interventions meet community needs, but also crucial when disseminating essential information to prevent the spread of COVID-19. In spite of us having to make some key operational shifts in response to the COVID-19 crisis, VSO’s staff and volunteers continue to work directly with all key stakeholders to ensure that this pandemic response plan is driven by the communities we serve. Our approach specifically works with vulnerable and marginalised groups, including people with disabilities, women, and people living with HIV, youth, those in prisons, refugee camps and hard-to-reach areas. Through this model we are principally focussing on providing support to government-led initiatives to ensure continued access to education, and strengthening health systems - specifically in building the capacity of community health staff to deal with the pandemic.
We welcome the opportunity to submit evidence to this inquiry.
- The emergence, incidence and spread of coronavirus virus infections and the Covid-19 disease in developing countries
- The direct and indirect impacts of the outbreak on developing countries, and specific risks and threats (particularly relating to countries with existing humanitarian crises and/or substantial populations of refugees or internally displaced persons)
- COVID-19 is a global crisis presenting challenges across all programmes and geographies in which VSO works. Some of the challenges flow from the virus itself, others from the increasing restrictions governments are introducing as a response. Together they threaten to overwhelm already overstretched and inadequate health services. Poor hygiene conditions and limited access to accurate information and resources to keep safe, particularly for the most marginalised and vulnerable, exacerbate the challenges still further.
We are seeing these manifest in a number of ways:
- Health workers on the front line have an increased risk of developing symptoms due to increased exposure to the virus, reducing the health workforce when it is needed most. Equally, caregivers for people with disabilities, the elderly and those living with chronic illnesses may become sick, isolated or be unable to travel, meaning vulnerable individuals are left without essential care. This disproportionately impacts women who make up the majority of front-line health workers and health facility staff. Social distancing also impacts mental health and wellbeing, particularly of front-line workers facing extreme pressures at work and home. The fact that the crisis is affecting countries across the world has also increased pressure on health resources such as PPE across countries where VSO works, including in Tanzania and Uganda.
- To date 165 countries have instituted school closures leading to 1.52 billion learners being out of school and over 90% of students being affected by school closures. Interruptions to education can cause short term safeguarding issues, as when children lose access to education, they lose a critical opportunity for protection, as well as longer term implications including underage employment and loss of attainment particularly for those whose basic education was weak to begin with. Inequalities are also being exacerbated as children from marginalised communities are unable to access remote and digital learning, and across the world, parents are struggling to engage in their children’s learning.
- As restrictions on movement are enforced (potentially for extended periods of time) food insecurity is likely to rise- for example in Sierra Leone prices have already risen. In many countries a large proportion of the population work in the informal sector with a limited safety net and who are often faced with a choice between contracting Coronavirus and being able to feed their families. Globally livelihoods are under threat due to the slowdown in business in key economic sectors. COVID-19 is a sudden onset shock which is likely to have production, pricing and political impacts which will collectively impact the market systems that individuals and households rely on for income, food and basic needs. The long -term impacts of these measures have the potential to be much greater than the direct health impacts of the pandemic itself. For example, there an estimated 300 million informal workers in Africa, and McKinsey has predicted that at least one third of these workers are vulnerable to losing their livelihoods as a result of the pandemic.
- There is also the risk that other more localised crises- such as the current Locust plagues in East Africa, and localised floods- not to mention ongoing large-scale humanitarian crises- will not get the attention or resources that are required.
- Holding governments to account is more challenging. Social mobilisation is difficult when restrictions on movement are enforced, and emergencies often give governments opportunity to introduce more draconian power in the name of containing the virus. We have seen restrictions introduced in all of the countries where we work, as well as a centralisation of decision -making processes, and this is already having an impact on the ability of citizens to effectively engage with decision makers.
- Marginalised and vulnerable populations are likely to face additional challenges during this pandemic including remote communities who struggle to access accurate information to keep themselves safe, communities who lack basics like access to water, women and girls who may face increased gender based violence, those who are incarcerated, those living in refugee or IDP camps, people living with HIV/AIDS who cannot access health services (including access to anti-retroviral medicines) or those already living in poverty who lack access to savings. Ensuring that the response is tailored to the needs of these communities will be critical - for example a lot of national public messaging is being produced in English, rather than local languages. VSO is supporting the translation of public health information into local language as well as into sign language in many countries.
- People with disabilities, who make up 15% of the world’s population are particularly vulnerable to the impacts of COVID-19, facing key challenges around access to public health information, practical challenges caused by social distancing requirements, lack of access to social security and increased stigmatisation.
- Disruption in essential health service delivery may have long-term implications for infants and children unable to obtain immunizations and other basic health services. Pregnant women may be unable to access antenatal care; people with emergent conditions may present late for treatment due to fear of infection, or lack of service provision for non-COVID related emergencies. We are receiving anecdotal reports of women in several countries including Kenya not attending antenatal clinics for fear of contracting COVID 19, and health workers’ fear of contracting the virus.
- There is also a de-prioritisation of Sexual and reproductive rights services, including a lack of access to family planning. UNFPA have predicted that for every 3 months that the current global lockdown continues, there will be 7 million additional unwanted pregnancies. Levels of Gender Based Violence and sexual violence have already risen across the world, as access to prevention, protection efforts and social services has decreased, and levels of violence have risen. If global restrictions continue, it has been predicted that there will be an additional 15 million cases of Gender Based Violence.
- Volunteers and communities across the world are stepping forward to respond to this crisis demonstrating a tremendous spirit of reciprocity, however, if not properly supported, volunteers can inadvertently cause harm. VSO will be building on the new Global Standard for Volunteering (which we led the development of) and working with partners including the African Union, to promote and embed responsible and impactful volunteering and ensure that both the volunteers and the people they work with are kept safe.
- In summary, there is a huge risk that this crisis, and in particular the Global economic recession which is likely to follow will exacerbate all of the challenges that the SDGs are seeking to resolve, setting back global progress at a time when the world requires precisely the opposite and we approach the final “decade of delivery” of the SDGs.
- The UK’s response, bilaterally and with the international community, to the spread of coronavirus to developing countries
- The UK government has demonstrated its commitments in supporting the response to COVID-19 through a number of measures including through its financial support to vaccine development, in advocating for debt relief for developing countries with the IMF and World Bank, and focus on the need for a coordinated global response. As has been highlighted by other INGOs and parliamentarians, global co-operation and collaboration is pivotal to ensuring a successful response.
- As a donor, DFID has demonstrated flexibility in allowing key suppliers to quickly adapt programming to the needs of the communities where they are working in response to the pandemic. Whilst this flexibility is welcome, there are further ways in which DFID could provide support to partners, for example by reviewing the turnaround time submission for proposals, which can present significant challenges for NGOs, particularly given that staff and partners around the world are dealing with the practical effects of lockdowns. We also note that the existing supplier list on DFID’s Rapid Response Framework has not been recently updated and could be reviewed.
- We would highlight the importance of adopting a long-term, multi-sectoral approach to dealing with the crisis and subsequent process of “building back better” which focuses on the building of strong, resilient health systems, protecting livelihoods and supporting and communities to be adequately prepared for future disasters. We welcome DFID’s engagement with the sector to date in the UK through Bond, and would also encourage more proactive dialogue (where possible) at country level to inform DFID’s country plans and response.
- In order to address some of the risks presented by the pandemic outlined in section one and two, it is important that DFID supports innovation amongst its partners to ensure that they are able to pivot work to respond to needs of marginalised communities most impacted by the pandemic. For example, VSO is adapting its education programmes to develop accessible materials for remote learning (both digital and non-digital), supported by expert remote e-volunteers and academics. We have mobilised and supported our youth networks – many of them related to the UK’s International Citizen Service - to serve as information volunteers raising awareness on COVID-19 and safe health practices and with a particular focus on hard to reach groups such as disabled people and young people from marginalised backgrounds. We are continuing to provide psychosocial support for children in refugee camps along the Uganda/South Sudan border through remote supervision of teachers and community workers, and we have been providing training to local SMEs in Tanzania to develop affordable and locally available PPE in line with Tanzanian government guidelines.
- Impact on DFID’s operations
- Understandably, many of DFID’s staff have been re-deployed back to the UK following the introduction of global travel restrictions. It would be helpful to communicate their continued availability to partners once they are back in the UK so that staff are clear on who can be contacted.
- Lessons identified and learned/applied from previous experience with infectious diseases (for example, Ebola); the implications for DFID’s policy on a global heath strategy
18. Specific lessons learnt from the Ebola crisis which could be applied to the COVID-19 response include:
- The need to advocate for continuation of essential service delivery, and take steps to strengthen overall health systems in developing countries particular the health workforce- for example in 2018 all developing countries had fewer than 10 medical doctors per 10,000 people and 98% had fewer than nursing and midwifery personal per 10,000 people, well below World Health Organization’s Human Resources for Health recommendations.
- The need for targeted community engagement and public health messaging to ensure that accurate information is reaching communities- using methods such as community radio where face-to-face mobilisation is not possible and adapting approaches to ensure people with disabilities, women and other marginalised groups are not left behind. Community volunteers (and especially youth volunteers) can play a particularly important role in this respect due to their positions of trust and respect that they hold.
- Linked to this, the importance of maintaining trust within communities to ensure that health services are not stigmatised and fear attending clinics does not negatively impact upon wider health outcomes. For example, a study conducted by VSO and the Liverpool School of Tropical Hygiene across Sierra Leone in 2015 found that there had been an 11% decrease in women attending maternity services, and a corresponding 30% increase in maternal mortality.
- The importance of focussing on psychological support for health workers- a VSO study involving over 400 health workers conducted with the Liverpool school of Hygiene and tropical medicine and Wateraid found that health workers experienced significant levels of stress, burnout and overwork following the Ebola epidemic in Sierra Leone
- The importance of viewing COVID-19 as a long-term challenge- particularly given the length of time that it might take to develop and roll a vaccine across the world.
- Whether there are particular risks of transfer of the coronavirus from conflicted and fragile environments to other countries
- It is very difficult to achieve social distancing in refugee camps. As has been well documented by UNHR and others NGOs, there is increased risk of transmission within camps, as well as the risk of increased displacement as people move out of camps.
- The impact of the outbreak, and consequential mitigation measures, on fund-raising by UK-based development charities/NGOs
- As has been widely reported in the sector media, UK based INGOs are facing considerable financial challenges at this time in terms of being able to continue to raise income- particularly unrestricted income- in order to continue to deliver their programmes. Whilst VSO is still able to continue deliver a significant amount of its work due to rapid shifts and innovations- with 85% of our community volunteers, 75% of our national volunteers and 45% of our international volunteers remaining on placement (some of whom are now volunteering remotely), we have predicted that our overall income is due to fall by one third during this financial year.
- Public fundraising is particularly difficult at this time given the challenges faced by the entire voluntary sector and the understandable concerns of the UK public with the impact of COVID-19 at home. We cannot continue with many aspects of fundraising – events, community activities, door-to-door recruitment - that involve physical proximity. As a result, we anticipate a 15% fall in net income from public fundraising.
- We welcome the UK Government’s Furlough scheme which has provided an opportunity to make savings in unrestricted spending and keep staff employed at a time when it is not possible for them to deliver their work.
- We are very conscious of the potential impact of the outbreak of the ability of the INGO sector to generate income from public fundraising in the UK over the medium term as a result of the crisis and consequential economic recession, during a climate which has already been challenging for the sector. At the same time, regulation of the charity sector is becoming more onerous, increasing overhead and administration costs. There could be a review and rationalisation of the administrative demands being placed on charities.
The impact of the outbreak on UK aid funding in the longer term.
- The crisis provides an opportunity as the UK considers its priorities ahead of the integrated review to ensure that all UK aid funding is focussed on meeting the needs of the most marginalised communities and building resilience within the context of the SDGs, as well as a chance to fundamentally consider the impacts of climate change. We would support calls for greater investment in building the capacity of national civil society to work with governments around the world to create that resilience.
 For example VSO made the decision to repatriate all British youth volunteers participating in the International Citizen Service programme, but 75% of our national volunteers and 45% of our international volunteer chose to stay supporting their placements- some remotely, and many ICS volunteers in the UK are now volunteering to support the national response, including through our partnership with the British Red Cross Community reserve scheme. More information about VSO’s operational response to the Covid 19 crisis is available here: https://www.vsointernational.org/COVID-19
  As of 21 April 2020; https://en.unesco.org/covid19/educationresponse
 Mckinsey, April 2020 available at: https://www.mckinsey.com/featured-insights/middle-east-and-africa/finding-africas-path-shaping-bold-solutions-to-save-lives-and-livelihoods-in-the-covid-19-crisis
For example, see Civicus (2020) https://monitor.civicus.org/COVID19/
For example, see Devex: https://www.devex.com/news/how-covid-19-could-complicate-treatment-for-hiv-patients-96884
 UNFPA, 2020 https://www.unfpa.org/sites/default/files/resource-pdf/COVID-19_impact_brief_for_UNFPA_24_April_2020_1.pdf
 For more evidence on the value of investing in Disaster Risk reduction, see UNDR (2019) https://gar.undrr.org/sites/default/files/reports/2019-05/full_gar_report.pdf and ODI (2015) https://www.odi.org/sites/odi.org.uk/files/odi-assets/publications-opinion-files/9730.pdf
 https://sustainabledevelopment.un.org/sdg3 “Special report on the progress of the SDGs”, UN Secretary General 2019, available at: https://undocs.org/E/2019/68
 LSHTM, VSO and Wateraid (2015) “Exploring the impact of the Ebola outbreak on routine Maternal Health Services” available at: https://www.vsointernational.org/sites/default/files/VSO%20Sierroa%20Leone%20-%20Impact%20of%20Ebola.pdf
LSHTM, Wateraid and VSO, (2015) “Situational analysis of the stress levels of health care workers in providing emergency obstetric care in Sierra Leone”