REGIONAL COMMITTEE
Provisional Agenda item 5.3
Sixty-fifth Session Yogyakarta, Indonesia 5–7 September 2012
SEA/RC65/9 16 July 2012
Role of WHO in managing emergencies This agenda item related to emergencies was discussed in two parts. The first part relates to the World Health Assembly resolution WHA65.20 on WHO’s response and role as the health cluster lead in meeting the growing demands of health in humanitarian emergencies, while the second part deals with the utilization of the South-East Asia Regional Health Emergency Fund (SEARHEF) as a follow-up to the Regional Committee resolution (SEA/RC/60/R7) adopted by it at its Sixtieth session. The new World Health Assembly resolution on emergencies confirms the commitments of Member States to: (i) strengthen and integrate risk management capacities into the health sector; (ii) build capacities in this area of work across various phases of risk reduction, preparedness, response and recovery; and (iii) coordinate with other sectors. It also describes WHO’s work as the health cluster lead and its commitments for better response through a new emergency response framework. SEARHEF was established through Regional Committee resolution SEA/RC60/R7. As per the fund’s policies and guidelines, a working group was established to oversee the management of the fund. The working group comprised representatives nominated by all 11 Member States of the WHO South-East Asia Region. The fund’s resources have been successfully managed and utilized in respect of 13 emergencies since it was made operational in January 2008. These include emergencies that were either small in magnitude or chronic or insidious at onset. The High-Level Preparatory (HLP) Meeting held in the Regional Office in New Delhi from 3 to 5 July 2012 reviewed the working paper and made the following recommendations: On the World Health Assembly Resolution WHA65.20 Actions by Member States
To support capacity building and efforts aimed at integrating emergency risk management into the health sector. To coordinate with relevant sectors outside the health sector, to further support health interventions to reduce, prepare for, respond to and recover from emergencies and disasters.
Action by WHO-SEARO
To provide technical and operational support to Member States to integrate risk management capacities into the health sector in line with the recommendations of the World Health Assembly resolution and discussions held at the recent regional meeting on disaster risk management in the health sector, held in Bangkok, Thailand (June 2012).
On SEARHEF Action by Member States
To support mobilization of additional resources for SEARHEF.
Action by WHO-SEARO
To provide support to SEARHEF as the Secretariat of the fund and implement the recommendations made by the SEARHEF Working Group.
The working paper and the HLP meeting recommendations are submitted to the Sixtyfifth Session of the Regional Committee for its consideration.
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Part 1 World Health Assembly resolution 65.20: WHO’s response, and role as the health cluster lead, in meeting the growing demands of health in humanitarian emergencies Background 1. The mandate of the World Health Organization (WHO) in humanitarian emergencies derives from Article 2(d) of the Constitution and the World Health Assembly resolutions WHA34.26, WHA 46.6, WHA 48.2, WHA 58.1, WHA 59.22 and WHA 64.10. WHO’s role is substantially influenced by the United Nations General Assembly resolution 46/182 on humanitarian assistance, which in 1991 created the Inter-Agency Standing Committee (IASC), chaired by the Emergency Relief Coordinator (ERC). 2. As a result of emergency response during the earthquakes and tsunamis in 26 December 2004, the United Nations General Assembly resolution 60/124 (2005) introduced further humanitarian reforms and this includes: “cluster” system, financial reforms including pooled funding mechanisms, and a stronger Humanitarian Coordinator mechanism. 3. WHO is the lead organization for the health cluster with the goal of improving the coordination, effectiveness and efficiency of health action in crises. Within the health cluster, the key roles that are emphasized include ensuring that health partners jointly assess and analyse information, prioritize interventions, build an evidence-based strategy and action plan, monitor the health situation and sector response, adapt/re-plan as necessary, mobilize resources and advocate for humanitarian health action. As lead agency for the cluster at country level, WHO also has the responsibility to act as provider of last resort. 4. To scale up capacity and competency to meets its expanded responsibilities in humanitarian emergencies, WHO in 2003 established the Health Action in Crises (HAC) programme of work. Standard operating procedures for emergencies were developed and a partnership agreement was established with the World Food Programme to allow the stockpiling and rapid deployment of medical supplies from four regional warehouses. A training process was initiated and a roster of experts developed, with eventual expansion to include Health Cluster Coordinators (HCC). 5. A new WHO Emergency Response Framework to support more efficient response contains the following: (i) a clear statement of WHO Core Commitments in Emergencies for which the organization will be accountable; (ii) a process and criteria for WHO Grading of Emergencies to classify all acute emergencies within 12–24 hours in terms of the support that a country office would require from each level of the Organization; (iii) the Management of WHO's Major Functions in Emergencies which clarifies the roles and responsibilities of each level of the Organization; and (iv) WHO Emergency Policies in the areas of surge capacity and leadership to ensure a more predictable response to major emergencies.
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6. The new structure for emergencies in WHO is now called the Emergency Risk Management department with key functions of policy development, information management and surge capacity for response.
Key elements of the resolution 7. The commitments required from WHO’s Member States and its Secretariat are outlined below. For Member States:
strengthen and integrate risk management capacities in the health sector; build capacities in this area of work across various phases of risk reduction, preparedness, response and recovery; coordinate with other sectors and agencies in both strengthening national risk management capacities, response operations in the event of an emergency and resource mobilization in the framework of UN funding mechanisms.
For WHO:
WHO’s work as the health cluster lead and its commitments for better response through a new emergency response framework which: – – –
draws on capacities of various levels of the Organization; is defined by core commitments, functions and performance standards; and is aligned with the Inter-Agency Standing Committee’s transformative agenda for emergency response.
Improve its surge capacity for response in coordination with health cluster partners and Member States. Provision of technical leadership in emergencies in the following areas: information management, monitoring of health situation and trends, developing appropriate strategies and plans for identified gaps; guidance in the recovery phase; and advocacy.
Regional perspectives 8. The Regional Committee for South-East Asia has also adopted key resolutions in emergency preparedness and response from time to time:
SEA/RC42/R6: Disaster preparedness – a focus on setting up health emergency programmes. SEA/RC44/R5: Disaster preparedness – with an added focus on disaster risk reduction.
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SEA/RC57/R3: Emergency health preparedness – with a focus on bringing in other sectors and setting up collaboration and exchange mechanisms. SEA/RC60/R7: The South-East Asia Regional Health Emergency Fund.
9. In the South-East Asia Region the cluster approach was fully implemented in the Yogyakarta Earthquake (2006); Cyclone SIDR (2007); Cyclone Nargis (2008); and the Sumatra Earthquake (2009). This way of working has always been found to be effective. Moreover, the ministries of health were the key partners in implementation of the health cluster work at all times. 10. Although in many cases the health clusters declare their own end of operations; the health cluster remains as a very good mechanism in preparedness and risk reduction work with partners and this is seen in experiences in Bangladesh, Indonesia and Nepal. 11. Clear guidelines and systems are in place in WHO-SEARO to facilitate prompt and efficient response to emergencies. Such response measures include making available human, financial and logistic support, even before other UN response mechanisms are activated. (a) Establishment of the South-East Asia Regional Health Emergency Fund (SEARHEF): the emergency fund draws its resources from Assessed Contributions. For the past two bienniums, the fund has ensured that “surge funding” is provided within 24 hours of an emergency request. Such funding covers large, small and underfunded emergencies, and is provided even prior to activation of UN funding mechanisms. A surge stockpile of health emergency medicines and supplies: stockpiles consisting of response supplies, such as the Inter-Agency Standing Committee Emergency Health Kits, have been established in Delhi and Bangkok. Such supplies have supported relief operations during several emergencies. The stockpiles have also strengthened preparedness measures in countries, especially in respect of frequent natural hazards such as seasonal monsoons Emergency and Humanitarian Action roster: The roster includes experts who have worked in the Region during recent emergencies; a global roster in headquarters is also tapped if needed. Regional training for WHO staff: A regional training course for public health response in emergencies was organized in 2008, which helped in development of training material for a country office workshop on this subject. WHO country office operational readiness workshops are conducted regularly. The output of these workshops is standard operating procedures/contingency plan, which includes a workplan for a specific emergency scenario a country office may need to act upon.
(b)
(c)
(d)
(e)
12. Much of the work for setting up WHO institutional capacity has been in place for sometime now in the SEA Region. With this experience, it can provide inputs to any further guidelines or policies as mentioned in the resolution. The priority and broader work envisages a more comprehensive programme in emergency risk management. Regarding this aspect, WHOSEARO together with Member States has developed and used the Benchmarks for Emergency
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Preparedness and Response. intensive assessments using this tool are being conducted for all countries to be completed by 2012. The assessments would lead to better planning for capacity development in emergency risk management for countries.
Areas requiring attention for implementation of the resolution 13. The following steps are crucial for implementing the resolution. These steps were also highlighted by Member States at the recently concluded Regional Meeting on Disaster Risk Management in the Health Sector held from 6 to 8 June 2012 in Bangkok, Thailand. The steps are as follows:
The existing capacities for disaster risk management in the Region need to be scaled up. For example: – –
If gaps identified in the WHO-SEAR Benchmarks assessments in countries are addressed, then capacities will be enhanced systematically; and If more funds are provided for the SEARHEF, then additional resources needed by the fund to adhere to the performance standards required for response to emergencies will become available.
A comprehensive approach needs to be adopted by the health sector to develop capacities in risk management, as is being practised in the Region through the WHOSEAR Benchmarks. Such an approach can then be aligned to sustainable development initiatives. Processes for deployment of staff, especially for technical functions, need to be streamlined. National/subnational authorities and WHO should collaborate in promptly addressing the needs of the response to an emergency, especially in terms of risk reduction and preparedness.
Part 2 Updates on the South-East Asia Regional Health Emergency Fund (SEARHEF) 14. Regional Committee resolution SEA/RC60/R7 established the SEARHEF, thereby creating a mechanism to facilitate rapid response to natural and man-made disasters. The fund was created essentially to meet the immediate financial needs during an emergency and to fill critical gaps; it is not intended to fund bulk relief, long-term recovery, reconstruction or rehabilitation work. It does not replace the existing, well-established mechanisms such as Flash Appeals, the Consolidated Appeals Process (CAP) and the Central Emergency Response Fund (CERF). These will continue to be the main funding sources for emergency and humanitarian programmes.
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15. Funding of assessed contribution (AC) and voluntary (VC) components:
the AC component of SEARHEF has been funded every biennium with US$ 1 million since 2008–2009, including the current biennium (2012–2013); for the VC portion, the Royal Government of Thailand donated US$ 100 000 in 2008, while the Government of the Republic of Timor-Leste donated US$ 10 000 in 2009.
16. The Policy, Principles and Guidelines of the fund have been duly followed while dealing with various emergencies mentioned in the introduction. Some of the key highlights are: (i) Criteria for use of the fund’s resources: there is no change in the established criteria for the use of funds resources. The criteria will continue to include: – – –
declaration of a state of health emergency/disaster; official request for external assistance by national government; or appointment of a Humanitarian Coordinator by the UN Secretary-General for that particular emergency. Within 24 hours of the request, the first tranche having a ceiling of US$ 175 000 can be released. This needs to be implemented during the first month of emergency. A second tranche, also having a ceiling of US$ 175 000, can be implemented in the next two months. Thus, the total funding for one event can amount to a maximum of US$ 350 000. The fund was made operational in January 2008. This allocation has proven sufficient in covering the early needs in emergencies. In order to streamline the internal processes governing the transfer of funds to Member States and their implementation during an emergency, specific procedures and guidelines were developed and adapted for the Global Management System (GSM).
(ii)
Fund allocation during emergencies: –
(iii) Processes updated: –
(iv)
Reporting procedure: A simple reporting procedure with a template is being followed, as per the recommendations of the SEARHEF Working Group.
Updates on the SEARHEF Working Group 17. A SEARHEF Working Group comprising representatives from all 11 Member States was constituted to provide oversight and guidance to the management of the fund. This group also developed the policies, guidelines and procedures governing the SEARHEF when it was established.
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18. The first meeting of the SEARHEF Working Group was held on 5 July 2008 in New Delhi, when the requirements of “need” and “timely use” of SEARHEF were validated. Below are the key highlights of the recommendations of the SEARHEF Working Group: (1) (2) (3) The processes developed appear to be robust enough; therefore changes are not necessary yet. Discussions on how to use any prospective balance in the AC include using it for stockpiling of essential emergency kits. The following suggestions were made on how to add to the VC part of the fund.
Countries should cooperate actively to raise funds for the SEARHEF. The following options for donors were identified: – – –
donate unspecified funds to SEARHEF; donate funds through SEARHEF for a specific emergency or country; donate a proportion of funds meant for a specific emergency to replace funds that may have already been released out of SEARHEF.
Replenishment of SEARHEF contributions to an emergency, once the larger contributions have come in from Flash Appeal or CERF, as was done in the case of the Sumatra Earthquake in 2009.
(4)
It was suggested that subsequent meetings will only be called for if there are any major changes to be suggested in the policies, guidelines and procedures governing the fund.
Updates on the use of the fund’s resources 19. The fund’s resources have been used for the following emergencies (for all these emergencies, the funds were released within 24 hours of receipt of the request for funding from Member States): Table: Financial status May 2008 – July 2012 No. 1 2 3 4 Emergency Cyclone Nargis in Myanmar Flash floods in Sri Lanka Kosi river floods in Nepal Emergency health interventions for internally displaced populations (IDPs) in conflict-affected areas in northern Sri Lanka Period Month May June September September Year 2008 2008 2008 2008 Allocation in US$ 350 000 23 000 325 000 350 000
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No. 5 6
Emergency Earthquake in North Sumatra province, Indonesia Emergency health interventions for relocated IDPs affected by conflict in Sri Lanka Fire in Dhaka, Bangladesh Mt Merapi volcanic eruption in East Java province, Indonesia Critical health-care services to the resettled population affected by conflict in Sri Lanka Floods in Thailand Torrential rains in DPR Korea Fire outbreak/explosion in Yangon, Myanmar Support for provision of emergency health care in Rakhine State, Myanmar Grand total
Period Month October January Year 2009 2010
Allocation in US$ 300 000 175 000
7 8 9 11. 10 12. 13
June November February July August January June
2010 2010 2011 2011 2011 2012 2012
175 000 139,000 175 000 350 000 310 000 25 000 12 300 2 709 300
20. In all these emergencies, the funds were used as specified by the policies, guidelines and principles of SEARHEF for the following purposes:
support to initial and periodic assessments; support to the continuity of health services; procurement and distribution of essential medicines and emergency relief supplies such as tents, bleaching powder and other support materials; support to coordination activities; mobility of health staff in affected areas and to displaced populations; support for the conduct of specific health interventions such as improved surveillance, water and sanitation, and psychosocial and mental health.
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Next steps 21. The key issues for the fund are growth of its corpus and its replenishment mechanism. In this regard, the SEARHEF Working Group has identified the following options for which continued efforts need to be made:
Clarify the use of the fund for certain emergencies, such as those that are small in magnitude, or are chronic or insidious at onset. The fund has effectively supported many emergencies over the last four years. There is a need for intensifying advocacy for the fund to raise the awareness as well as request for contributions from donor agencies, Member States and other partners.
22. Populations of Member States of the SEA Region continue to account for the most number of deaths due to disasters as per the World Disasters Report 2010. Timely help through the SEARHEF has helped, and will continue to help in preventing avoidable deaths.