People of all ages with chronic health conditions have a higher risk of serious impacts from the coronavirus. These conditions, however, are most prevalent among older people, putting them at greater risk of having severe complications. As governments and partners are scaling-up their responses, it is essential that preparation for and response to the COVID-19 capture the risks and challenges faced by older people. This blog post summarises the webinar Social protection responses to COVID-19: Actions that can make a difference for older people, which took place on 9 April 2020, and was organized by HelpAge International, International Policy Centre for Inclusive Growth (IPC-IG), Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), and Australia’s Department of Foreign Affairs and Trade (DFAT).
The webinar was moderated by Florian Juergens (Social Protection Global Advisor at HelpAge International), who counted with the expertise of Gabrielle Kelly (Senior Research Associate at the Samson Institute for Ageing Research, SIFAR), Peter Lloyd-Sherlock (Professor of Social Policy and International Development at University of East Anglia), Cecilia Mbaka (Head of National Social Protection Secretariat of Kenya's State Department of Social Protection). The speakers explained how older people are particularly at risk during the COVID-19 pandemic and presented concrete guidelines on how Governments can safeguard older people during pension payments and the opportunities of linking social protection provision with health support. The developments of the COVID-19 crisis in Kenya and the Government’s response initiatives were also discussed.
Setting the scene
Although everybody is exposed to the coronavirus and the social and economic impacts of the crisis, older people face specific dangers from health, social and economic perspectives, putting them in a condition of heightened risk. As older people are more likely to have underlying health conditions and ageing immune systems, the death rate from COVID-19 grows drastically with age. More than 80% of those who died from COVID-19 in China were over 60 years of age.
Besides being exposed to higher health risk, older people are also at high risk of income insecurity, as they rely on different income sources, including work, savings, financial support from their families and pensions, which tend to be low and irregular in many cases. It is expected that older people’s incomes and living standards will decline significantly, as many of them will have to cease any income generating activities due to health risks and as their families might be less able to support them. This picture is even dire in low-income countries, where only an average of 20% of older people have income security through a pension scheme. In this context, older women are often even more disadvantaged and more vulnerable to collapsing incomes, as they are less likely to have a pension or savings, and to own assets.
Governments should ensure continued and safe access to social protection for all, in particular pensions for older people. Social protection can help people access health services and support people in adopting prevention measures. It can also ensure income security and access to essential goods and services, thus protection human capabilities and livelihoods. Therefore, it has the potential of protecting individuals and households from the adverse social and economic fall-out of the crisis.
By 3 April 2020, 106 countries had already either introduced or adapted social protection programmes to provide enhanced support in response to COVID-19. Adjustments to pensions are amongst the most common social protection responses, and so far 34 countries have adapted or expanded old age social protection. See some examples below.
Linking social protection with health support
To further the conversation about social protection’s potential to respond to the COVID-19 crisis, Peter Lloyd-Sherlock discussed some general points about cash transfers and health outcomes and argued that pension pay-points and other social protection delivery places can be locations of health risk but also of health opportunity.
There is a common belief that cash transfers can single-handedly improve health outcomes among groups of people. However, evidence shows that cash transfers as a standalone intervention have only limited effects on health outcomes for older people and people with disabilities unless the cash distribution is combined with other interventions that have specific health objectives. This is based on, for instance, a research that reviews interventions and policy effects on the health of older people in sub-Saharan Africa.
Despite pension pay-points being places that may expose older people to health risks, they also offer unique opportunities to reach and engage with older people on a monthly basis. In many places, especially rural areas, people do not visit health clinics regularly. A pilot study has proved that providing hypertension services to older people at pension pay-points can be very effective. The opportunities include health information sharing and guidance to the population in general, or more specific to the needs of older people, that can be customised to the local contexts.
More ambitions links can be developed with local health professionals and agencies to build more specific health interventions at social protection delivery locations. For example, trained nurses and health workers could be available at pay-points to manage infection risks on-site, and observe pensioners and advise, treat or refer accordingly. These opportunities can be seized throughout the COVID-19 crisis but can also pave the way for a more holistic and coordinated approach to providing cash and health, along with other services to older people and people with disabilities.
Gabrielle focused her presentation on specific aspects that can be managed to improve the administration of pension payments during the COVID-19 pandemic and reduce older people’s potential exposure to the virus, passing important and regular information to this at-risk group, and keeping their safety and security.
a. Reducing infection risk at pay-points
One option is to make different arrangements in terms of payment. For instance, establishing staggered payment days allows older people and people with disabilities to retrieve their payments on different days or times than the rest of the population. Pension payments can also be planned less frequently, for example through advanced payments every two to three months. For these arrangements to be made, governments need to develop plans and protocols with external partners (e.g. banks, retailers), if payments are not handled by a public agency.
Allowing older people to nominate a 3rd party to collect their pension is also an option to avoid overcrowded pay-points. As a short-term measure, this can be done by working with community organisations, including religious groups, to collect and distribute pensions for their members or congregations. However, there is a risk in ensuring that people will indeed receive their payments. On the long-term this can be done by having community health and social workers or payment agency staff visiting older people's homes to help facilitate the appointment of a 3rd party.
Another option to reduce the need for older people to attend pay-points is the use of electronic pension payments. Potential options for electronic payments are cash cards, mobile-based e-wallets or payments collected at retail merchants. When choosing this modality, it is important to remember that older people have difficulties in accessing new technologies and reaching ATMs, and they may need agents available to support them.
Although difficult, it would be ideal to have protocols for screening symptoms of COVID-19 among those collecting payments. People with detected fever should be given information and advice on where to go for testing, treatment and support. There should also be hygiene protocols in place, such as basic hand washing facilities at the pay-point’s entrance; regular compulsory hand-washing for staff at all agencies, as well as the provision of hand sanitiser for those handling cash; queuing systems with space of two metres (six feet) from one person to the other; payment desks/officials positioned at least two meters from each other; and cleaning of all biometric devices between use.
b. Information sharing
Governments, pension agencies, community organisations and involved commercial partners should keep regular communications with the general public and at-risk populations to share health information. It is important that the general public understands the risks faced by older people and are sensitised about their need to get priority access to preventative measures and healthcare. The general public should also be informed that older people are not more likely to spread COVID-19 than anyone else, as to prevent stigmatisation and discrimination.
Information on new pension payment arrangements should be widely advertised. However, as older people are more likely to have low literacy levels, physical or sensory disabilities that prevent them from accessing information, they are less likely to be exposed to mainstream media. Therefore, multiple communication formats should be used, such as braille, audio messages over loudspeakers, and easy-to-read formats that combine text and images – in local and sign language.
Lastly, targeted information sharing campaigns can be relevant, especially in rural settings and hard-to-reach communities. This can be done by generating a list of households where older people live, either from pension databases or via community identification. The older people can be reached with the help of community leaders and committees and get information on pension payment arrangements.
c. Safety and security
Sensitive safety and security measures are important to protect vulnerable people at pay-points. For instance, having well-trained security staff on-site can help manage the crowds, instruct people on exiting the pay-point, and to restrict the entry of vendors and non-recipients.
COVID-19 situation in Kenya
Ms Cecilia Mbaka shared information on the recent developments of the COVID-19 crisis in Kenya. Currently, 129 people are infected with the virus in the country, with one case considered very severe and 19 cases confirmed amongst persons aged 60 years and above (numbers from 8 April 2020). As the share of cases among older people is quite low, the Government is putting in place interventions targeted at the general population, expecting them to reach older people as well.
The Kenyan government is providing free health services and support for COVID-19 infected people in governmental hospitals. The government has also put in place awareness campaigns, including daily briefs by the Secretary of Finance addressing young people, as to sensitise them to be careful not to contract the disease and pass on to older people.
In terms of movement of persons, the Government has asked the population not to travel within and outside the country, and the Nairobi metropolitan area has been under lockdown since 6 April, which is also where most cases are found. This is expected to stop the spreading to rural areas, where the majority of older people live.
The Government has allocated USD 100 million towards COVID-19 responses for vulnerable groups, however how the money will be spent is still under discussion. As older people are at higher risk, it is expected that they will be given priority. The delivery of eventual additional support is expected to be facilitated by the fact that the majority of the Kenyan elderly population is already registered in cash transfers registries. There is also discussion happening about extending cash transfers to older persons aged 60 and above, who are currently outside of cash transfer schemes for people who are 70+. The resources are also expected to be prioritised towards urban slums and selected counties, especially where COVID-19 cases are high.
This blog post is part of the Social protection responses to COVID-19 webinar series. The series is a joint effort initiated by the IPC-IG, GIZ on behalf of the German Federal Ministry of Economic Development and Cooperation (BMZ), and the Australia Government's Department of Foreign Affairs and Trade (DFAT) collaboration with the socialprotection.org platform, and in cooperation with partners from different organisations.
Join our online community ''Social protection responses to COVID-10 [Task force]" to learn more about the initiative and future webinars.