Innovation, older people and disaster risk reduction: the case of Pakistan
By Toby Porter

Saturday, 7 March 2015


Pakistan is considered, and considers itself, a “young” country. At present, only 7% of the population is over 60. This figure will rise slowly, projected to reach only 16% by 2050. But the numbers of older people are impressive – already Pakistan is one of only 10 countries in the world with more than 10 million citizens over 60. This number is forecast to rise to 43 million by 2050.

HelpAge opened an office in Pakistan in 2010, after the terrible monsoon floods. Since then, we have developed an expertise in age-friendly emergency response as well as modelling and implementing DRR activities that are inclusive of older people.

I visited our operations in December 2014, going to to two villages where older people are at the centre of community DRR awareness building and preparedness activities through their local older people’s associations.

In the first village, in Jacobabad district, older people were engaged in a hazard mapping exercise – recalling the patterns of past flood waters, where the waters reached and the parts of the village which stayed safe.

I saw one of the best examples of innovation I have seen in my time with HelpAge, as the older people’s association leaders took out and started to play a specially designed game of Ludo.

The game is explicitly built around the theme of DRR, with each of the squares representing a step in being prepared for a flood in the community. Ludo is a much loved game in Sindh, and you could tell that it had been hugely successful in engaging them in the programme. Good fun, good innovation, good impact.

In the next village we visited, we saw all of the community involved in a drill – practising early warning, evacuation and how to administer basic first aid.

We have been working on DRR in Sindh province since just after the 2010 floods, funded for the first three years mainly by Age International funds raised from the UK public. The latest phase, which will end on July 2015, is funded by CordAid, a member of our HelpAge global network.

On the evidence of the high quality work and the boost from older people globally being the focus this year’s UN Day for Disaster Risk Reduction, I am confident that we will be able to find partners in Pakistan and around the world to help us continue and expand this work.

We went on from there to visit a health clinic. While we were all taken by the commitment of the doctor on duty there, it was clear that the services offered were in no way adequate to help older people enjoy the best possible health and active ageing process.

His was one clinic, understaffed, and serving a catchment population of almost 40,000. Thanks to HelpAge, he had some basic equipment on top of what the Government provided, such as a blood pressure monitor.

There had been some significant, life-transforming successes from the project that had linked older people through the older people’s associations to his clinic and onwards to the local hospitals.

The most obvious impact is where he had referred patients for successful cataract surgery, which has an immediate and wonderful effect on the life of an older person and their family.

But overall, the public health system in Pakistan is still a long way from being able to diagnose, treat and manage the most common non-communicable diseases which, if left untreated, pose the gravest threat to the health and wellbeing of older people.

At the last older people’s association we visited, I asked a group of around 15 older men to raise their hand if they had had their blood pressure checked in the past five years. Only two hands were raised.

Undiagnosed hypertension remains the number one cause of premature death for older people the world over. Equipment to test blood pressure is neither expensive, nor difficult to administer, and there are a number of low cost treatments available where cases are diagnosed.

I gained an insight into why this was the case when I had chaired a session on the health of older people at the Health Services Academy earlier in my visit. The physicians were impeccably trained, and in obvious agreement with those speaking up with better health services to be made available for older people.

But their answer was that there were other more pressing priorities – safe child birth, higher rates of immunisation coverage, more effective family planning, etc.

At one point, the senior representative there said that there would come a time when more thought and investment would have to go into health services for older people, but only when the overall percentage of older people in the population was very much higher.

This is a very good illustration of why older people need national and international policy-makers to adopt a rights-based approach to development. It also again highlights the importance of a UN convention for the rights of older people.

I made this point directly at a meeting in Islamabad with Mr Shoaib Mir, Additional Secretary at the Federal Ministry of Law, Justice and Human Rights. This Ministry has responsibility within Pakistan for international legal instruments.

Without international and national legal protection, it is clear that older people will always be expected to take their place at the end of queue when it comes to health and other social services.

“Not a priority”, “not now”, “maybe we can do this when there are more of them” are phrases we heard a lot over the course of my visit. But they have no place within a narrative of human rights, which are universal.

Older people have the same rights as any other segment of population to the best possible health, and every reason to expect Governments and international donors in countries like Pakistan to design and finance primary health services for all their citizens, regardless of their age.


Toby Porter has been CEO of HelpAge International since October 2013. He began his career as an emergency relief specialist working with first Merlin and then Oxfam, working in Eastern Europe, in and around Rwanda during the 1994 genocide, South Sudan, and in Central and South America. Since then, Toby has worked for USAID, for Save the Children UK as Director of Emergencies and as Director of Programme Partnerships, and for Save the Children India as Director of Programmes.