April 27, 2016 —  RT HON DAVID MILIBAND

PRESIDENT AND CEO, INTERNATIONAL RESCUE COMMITTEE

SPEECH AT GEORGETOWN UNIVERSITY

APRIL 27, 2016

The impetus for this speech comes from two sources.  First, every day in my work at the International Rescue Committee, I hear stories and see evidence of how vulnerable people in desperate straits around the world are not getting the help they need.  The scale and complexity of current humanitarian needs are increasingly out of step with the resources, policies and practices available to meet them.  Second, there are a series of events over the next year that offer the chance to encapsulate and enact reforms that make a material difference to the lives of the people we and other humanitarian agencies seek to serve.  There is the first ever U.N. World Humanitarian Summit on May 23-24, which the U.N. Secretary General has boldly committed to "fundamental reform."  There are successive U.N. and U.S. government sponsored summits in September on migration and refugees.  There is the election of a new U.N. Secretary General, also in September, who will take office in January 2017, when there will also be a new US President.  These are vital opportunities to bring new hope and dignity to some of the most vulnerable people in the world.

So much humanitarian action is genuinely heroic. The work of U.N. and NGO staff, not to mention those afflicted by conflict and disaster, is remarkable.  They work in the highest risk environments, seeking to uphold the highest humanitarian and professional ideals, in places notable for their absence. But more heroism is not an adequate response to the scale of humanitarian suffering; instead we need to update our thinking about what humanitarian action is, and how it can be delivered.  

The argument of this speech is the need for better aid not just more aid. My argument is that the guiding light of reform should be the idea of turning humanitarian action from a mission driven but fragmented sector of activity to a high performing and dynamic system. Speeches, articles and books often talk interchangeably of a humanitarian sector and a humanitarian system.  In fact a sector and a system are not the same.  A sector is a diverse group of organisations, each with a different focus, operating on the basis of shared principles.  Think of the private sector or the NGO sector. A system, for example an incentive system, or a judicial system, by contrast, is directed towards shared outcomes not just shared principles; has agreed metrics of success not just multiple measures of activity, and a commitment to inform all practice with objective evidence on what works rather than a generalised belief in sharing positive experience. A system has common methods of accountability not just voluntary methods of coordination, and a financing methodology that supports rather than subverts the outcomes that the system is trying to achieve.  

The obvious charge against trying to harness diverse activity into a single system is that bureaucracy and hierarchy would triumph, unable to adapt to different contexts. My argument is the opposite: a system with clear goals, a dedicated evidence base, and the right financial incentives, would be better able to adapt to and even anticipate change than the current sector. Such a system will need to break out of the categories that currently constrain us; emergencies versus protracted crisis, humanitarian relief versus sustainable development, helping people survive versus helping them thrive. These are meaningless categories to individuals and families coping with crises.  Changes in the wider world have left these distinctions behind, so it is time for public policy to do so too.

The Context

The current scale of human displacement is staggering.  Sixty million people, split two to one between internally displaced people and refugees, are now fleeing for their lives.  In 2014, only one percent of the world’s refugees were able to return home. Old conflicts are continuing, from Somalia to Afghanistan, and new wars are starting, from Syria to South Sudan.  One in every 122 people on the planet is fleeing conflict.  Over 40 percent of the world's extreme poor live in conflict or fragile states.  

These people are becoming the poorest of the poor.  Half the world's maternal mortality occurs in war torn states. Children living in countries affected by humanitarian crises account for nearly half of all under-five deaths and countries affected by humanitarian crises account for 43 percent of all out-of-school children at the primary and lower-secondary levels. 

This is what creates the case for more aid.  Despite the fact that fragile states produce 60 percent of the world's displaced, and host nearly half of the world's displaced and 43 percent of the world's extreme poor, they receive just 30 percent of total overseas development assistance.  As the U.N. High Level Panel on Humanitarian Financing recently said: "Never before has the world been so generous towards the needs of people affected by conflicts and disasters, and never before has generosity been so insufficient."

It is more than plausible that the humanitarian effort is underfunded to the tune of $15 billion (the figure given by the U.N. High Level Panel).  But while $15 billion would be very welcome, and make a real difference, it would not solve the problems that exist.  The organic growth of the humanitarian sector over 70 years—spurred in recent decades by the creation of OCHA, the entry of Gulf state donors and the growth of a private sector role—has not kept up with the needs of the people.  For example:

So the mismatch is not just one of resources. It is also one of concept, institutions and mindset. And the mismatch is likely to grow if you think for a moment about the likely context going forward, from growing climate risks and economic imbalances, to the deep trend towards flight and urbanisation, the reticence at best on the part of most wealthier countries to accept refugees, and continued pressure on humanitarian finance, at a time when there are increasing pressures on domestic budgets.  

In the face of these facts, there are a range of necessary responses. One is to reinvigorate international action for conflict prevention and response.  Another is to do more to protect civilians and aid workers, to reverse the degradation of humanitarian law that has come to characterise current conflicts. Another is to do more to protect civilians and aid workers in conflict situations.  Another is to raise more resources.  These are very important.  But I focus today on what we are trying to achieve, how we can achieve it, and how we can finance it.   

Outcomes

The humanitarian community has always embraced fundamental principles of action. The principles of independence, neutrality, impartiality and humanity are important every day in our work - protecting our staff and supporting our beneficiaries. But unlike our “development” counterparts, we have yet to define limited and specific results to guide our programmes and investments and to measure progress and performance. 

It is true that the world is not short of results. The Sustainable Development Goals alone contain 17 goals and 169 targets.  But for people displaced by conflict, there are weak commitments specific to them. 

We do have SPHERE standards which define the minimums for what should be provided for water and sanitation, food, shelter, and health. And these standards have in some places made a difference. But they cover a limited range of items, and are often not enforced. We have the nine commitments of the Core Humanitarian Standard on Quality and Accountability, but they focus more on the “how” rather than the “what”. And while donors have many (and disparate) metrics for intervention, in the overwhelming majority of cases they focus on accounting for the completion of activities (inputs and sometimes outputs) rather than a meaningful measurement of the improvement in the lives of the people we serve (outcomes). Outputs measured may include the number of schools constructed or the number of women counselled. These are important but they don't tell us very much about whether kids are actually learning, or if women are safe in their homes.   

Over the past few years I have argued that the absence of a limited set of agreed upon outcome measures prevents us from operating like a proper system, with clear focus of activity and effort. The result is energy is wasted, accountability is undermined, responsibility is dispersed, silo mentality is reinforced, and the divide between people and institutions who consider themselves to be working on “development” rather than “humanitarian” issues is reinforced. 

Outcomes, measured by meaningful indicators and context specific targets, are not a magic cure, but they are the starting point for a serious attempt to build a system that effectively and accountably meets the needs of people displaced by conflict. The debate should clarify purpose and accountability in a positive way. If we don’t agree on what constitutes success then “results” become a chimera.    

It is therefore significant that the recent U.N. report One Humanity mentions "collective outcomes" not 10 or 20 times, but 60 times. It rightly calls for "agreement on collective outcomes that are strategic, clear, quantifiable and measurable,” and says that “over a multiyear horizon [collective outcomes] is ultimately how we transcend the humanitarian-development divide."  

It stands to reason: until development and humanitarian players working in the same countries with overlapping populations share performance metrics they will continue to operate in silos rather than in tandem. As Tony Lake, the director of UNICEF, said in a powerful clarion call to his executive board last September: “We cannot reach the Sustainable Development Goals without reaching the millions of children living in the midst of humanitarian emergencies.” With a goal to have all kids in school by 2030, 57 million children out of school, and nearly half of them in conflict-affected countries, he’s right.

The Sustainable Development Goals (SDGs) provide an ambitious framework – but for people affected by conflict it is only a framework because specific targets relating to their situation are lacking. I believe we need to drill down from the SDGs to get more traction. Collective outcomes need to specify the improvement we want to see for the conflict affected and displaced. Not just numbers of kids in school, but whether they have literacy and numeracy skills. In countries where needs most outpace resources, we need to agree on the most pressing changes that our shared activity must achieve. Setting targets for improvements in the situation of displaced populations that are both ambitious and feasible will motivate all of us to be more disciplined in our interventions. Measuring our progress together will help all of us improve accountability to beneficiaries and incentivise collaboration. In essence, these targets would form the bedrock of a system-wide performance framework.

The task of the WHS and then the September U.N. Summit is to agree to the details. I offer three points to inform this process.

First, there should be some clear priorities for collective outcomes relating to health for those displaced by conflict, to education for children displaced by conflict, to protection from violence for women and children displaced by conflict, and to economic wellbeing of those displaced by conflict.  Helen Clark and Filippo Grandi, the heads of two key U.N. agencies, are committed to crossing the humanitarian-development divide to achieve these.

Second, the indicators to measure these outcomes need precision and care to have the requisite effect. For example, in education, whether a child has access to education should be indicated not simply by an enrollment rate demonstrating that she is signed up for school, but by attendance and participation rates, signaling that she indeed was able to go to school and participate for a minimum number of hours needed for learning. In health, it's not enough to say that clinics are open and that patients are getting treatment. We need to know that, for the most common and dangerous conditions, people are getting the right treatment, at the right time.

Third, the power of this approach comes in the word collective as well as in the word outcome. That is because at the moment different donors ask implementers to measure different indicators. This means even if one donor simplifies reporting requirements, it doesn't have the intended effect of easing the burden on implementation in a material way. For example, IRC in Cote d'Ivoire is required by a combination of donor, host country and internal management demands to track over 1,200 indicators on a weekly and monthly basis. This information is time consuming and costly to collect and not well used to drive programing. So collective outcomes need to be a discipline on donors to drive out wasteful information collection in favour of harmonised and effective accountability. 

Effectiveness

Focusing on outcomes is the first part of the battle for effective aid. The second is making sure we have the evidence necessary to choose and prioritise interventions that work. This requires serious commitment over time, with resources from the public and private sector, to build cumulative evidence of what works to achieve results for people.

Since 2006, the IRC has completed, or is in the process of conducting, 66 research studies, including 29 impact evaluations, across 24 crisis-affected countries and in the U.S. But while there have been over 2,000 rigorous evaluations of programming in stable countries in the last ten years, we've seen only 100 in conflict settings. And in the absence of a strong evidence base, the humanitarian world is relying on assumptions, experience and intuition, rather than research founded on fact or evidence.  

Evidence-based interventions have so much to offer to improve outcomes. Cash transfers are a good example but there are others. The use of community committees as a means to keep children safe is a common intervention but there is little evidence that these committees are effective. On the other hand, targeted programmes for parents and caregivers have been shown to reduce violence and promote children's healthy development in high-income and stable countries. IRC has now tested a family-based approach in Burundi, Thailand and Liberia, and set a new standard for effective practice.  

A commitment to the use of evidence needs to have five components:  

The humanitarian community stands to gain from aligning behind what works, and where we don't have evidence of what works, investing in evidence generation. There is an urgent need for international investment in evidence generation in key aspects of humanitarian practice. The IRC believes that between the WHS and the U.N.’s September summit there needs to be agreement on the priorities for this evidence drive. 

Our first three candidates would be: 

The IRC has created an Outcomes and Evidence Framework that defines the improvement we want to see in people's lives—women protected from violence, children achieving literacy and numeracy and developing socio-emotional skills, people able to generate income and assets. The Framework brings together the best available evidence for how to achieve those outcomes. We've pulled this information into an online tool that everyone from practitioners to donors, grant managers and programme planners, can use to design, implement, and manage effective programmes. And we have paired it with meaningful indicators to help track progress against our goals.

We intend for this to be an open source system, which raises a key point.  A system needs a common evidence base, not separate evidence bases for different players. Donors and implementers need to come together and agree on not just an approach to evidence generation, but standards of evidence that are required to inform programing. So the WHS needs to agree:

Finance

Funding requested through humanitarian appeals has swelled by 660 percent since the Millennium Development Goals were announced in 2000. The rise in actual funding over the same period has been 366 percent. Various aspects of the financing system are out of sync with the modern reality of humanitarian need.  Refugees are displaced on average for 17 years, but the IRC's median grant length is 11 months. The attendant accountability systems are multiple, overlapping, and divergent, all with their own costs. Aid dollars sometimes go on a circuitous route to the beneficiary, from the donor to the U.N. to an international implementing partner to a local organization.

The High Level Panel on Humanitarian Financing has raised the standard for a more efficient and effective financing system. It is vital that its insights are turned into daily practice.

For donors, that means embracing a shift to predictable multiyear funding dedicated to clear outcomes for affected populations. It means funding measurement, evaluation and evidence-generation at appropriate levels. It means pooling funds across agencies (humanitarian, development) and sometimes across sectors (health, education for women and children) to make sure money is targeted on people's needs and not on organisational mandates.  It means a harmonised reporting framework that cuts the costs of managing grants. 

A good example is USAID’s child survival and health programme. This small programme is remarkable in several ways. The grants are focused on a limited number of specific, evidence-based outcomes: increasing the use of bed nets and breastfeeding, increasing access to treatment for the most common killer diseases such as malaria. Second, USAID has made monitoring and evaluation a priority, giving the resources needed—typically between 5 and 10 percent—to make sure that the projects are monitored by technical specialists. Third, USAID has progressively expanded the time frame of grants, from two years at the outset to the current four to five. Last but not least, the grants programme, while fiercely competitive, is also fiercely collaborative: all agencies involved become part of a community where technical advisors and field staff work together on joint teams to define common outcomes, indicators, and tools such as survey questionnaires. This program helped demonstrate that integrated community case management works. Thanks to this approach, in 2014 IRC provided over 1 million treatments to children for diseases such as malaria, diarrhea, and pneumonia. 

For implementers, NGOs and the U.N., it means one thing above all others: open books. Transparency is essential for the trust that comes with outcome-oriented funding over longer periods. But obviously the agenda goes beyond that to include more extensive cooperation at the local level: to embrace client voices and choices in programme design and delivery and to upgrade our own human resources and compliance systems.  

One test of the financial system will be the measurement of cost efficiency and cost-effectiveness. We are convinced that by better understanding the cost of different programmes in different places, we can dramatically increase the number of people who benefit. 

We know from research in Kenya that while there is good evidence that a number of programmes can improve children's literacy, they vary widely in cost effectiveness. According to a review by the economist Patrick McEwan, an investment of $8,900 could upgrade the reading skills of 100 students by 20 percent if the money were spent on computer-assisted literacy instruction. But the same amount of money could get the same result for 423 students if it were spent on performance incentives for teachers, and for 695 students if it were spent on remedial tutoring. In other words, with the same amount of funds, we can achieve the same outcome for six times more people. Money spent in different ways can allow us to serve dramatically more, or dramatically fewer, of the millions of people in need. 

Within the sector, cost is widely recognised as important. U.N. appeals often state the "cost per beneficiary" and NGOs, like my own, report on the percentage of donated funds that go directly to programs. For example we say, accurately, that 93 cents per every dollar given goes directly to programmes and services. 

While a step in the right direction, this form of reporting has significant limitations. It assumes that low administrative costs are equivalent to efficiency. It tells us very little about how those costs relate to the actual outcomes that programmes have achieved. Because each NGO has a different methodology, even if the benchmarks exist, the costs are not comparable.  And we do not know the UN cost structure. 

A more meaningful analysis would be to look at the cost-efficiency and cost effectiveness of specific programmes. A cost-efficiency analysis compares the cost of a programme to the outputs it achieves (for example, cost per latrine constructed, or cost per family provided with cash assistance), while a cost effectiveness analysis compares the costs of a programme to the outcomes it achieves (for example, cost per diarrheal death avoided, cost per increase in nutritional status). Within public health, for example, groups like the Medical Research Council and the London School of Hygiene and Tropical Medicine have set standards for how to assess the costs of HIV-prevention programmes. When new approaches to testing, prevention, and treatment are introduced, they are assessed not only for their impact but on whether they are a better use of resources than existing approaches. This is exemplified by the battle against HIV in Africa. 

The truth is that better costing of aid has the potential to save and improve more lives. But the multiplier effects of costing will only be realised when the sector is able to behave like a system. This means having a common methodology for costing that allows cost figures to be compared across agencies, systems that help to automate calculations so they can be done quickly and consistently, and common indicators that we are striving towards.

This will not happen unless it is driven forward by donors, and capacity is built within implementing organisations. We would like to see a successor to the High Level Panel on Humanitarian Financing—a High Level Panel on Humanitarian Costing—which brings together all sides of the debate, under independent chairmanship, to develop the cost benchmarks and guidelines that the sector so badly needs, and to target support for implementers who build transparent and rigorous in-house systems to produce this data. 

Everyone expects NGOs to call for more aid. If we call together for better aid then we are really doing justice to our beneficiaries.

Conclusion

There are good grounds for believing that there is an emerging consensus about what should be done to reform humanitarian aid. Yves Daccord, Director General of the International Committee of the Red Cross put it well: “As humanitarian organisations and their leaders strive to remain relevant and effective in this dramatically changing environment, carrying out ‘business as usual’ is clearly not an option.” 

There is one other especially striking aspect of the consensus. It concerns the need to help those displaced by conflict gain an economic livelihood.

One of the most important developments underway at the moment relates to the World Bank's commitment to provide jobs to displaced people in middle income countries. The proposals agreed to at the London Summit for the Syria region—where it was agreed to provide international financing (and trade preference) in return for work permits for refugees—shows the way forward. The leadership of World Bank President Jim Yong Kim in this area has been nothing short of transformational. He put it best himself in a speech at this month’s Spring Meetings: “I think that we now have a much, much clearer sense of how fragility and conflict can lead to the exodus of refugees which then will have an impact on the world as a whole… I think we're going to have to be extremely creative and innovative, using every single resource that we have.” Significantly, Christine Lagarde of the International Monetary Fund agrees. She has said of the refugee crisis, “This is not just a humanitarian issue—it is an economic issue that affects everyone. Everyone has an obligation to help.”

It is vital to acknowledge the widespread skepticism about whether there is sufficient unity of leadership in this diverse sector to deliver change. We are a donor-driven sector and the main donors have wide areas of agreement. But they still run different systems. The U.N. is coordinator, implementer, fundraiser and donor, but each U.N. agency has a different mandate, and so a different set of incentives. The implementing NGOs are funded to deliver programmes, not to exist, and so are in a constant battle to raise core funds.

The absence of leadership was highlighted in the letter from major donors (member states and observers) to the U.N. Emergency Relief Coordinator. It said: "The Inter Agency Standing Committee is the nominal my emphasis) foundation of the U.N.-led humanitarian architecture, but needs to be a more dynamic, proactive and agenda-setting body."

This speech has not focused on organisational issues and I will not start now.  But the biggest challenge for the World Humanitarian Summit, and other events, is about sustainable follow-up. My own view is that this has to be led by the donors. They have the money; therefore they have the leverage; therefore they have the responsibility. If they remain fragmented, focused on inputs not outcomes, and siloed in their thinking, then the sector will remain fragmented and siloed as well. Overcome this inheritance, harmonise their efforts, put the beneficiaries at the centre, and the extraordinary commitment of all the players could build a system worthy of its name. That is the purpose of this contribution, and of our work during the rest of this year and beyond.