1 Objectives, key functions and principles
This chapter provides brief aide-mémoire on the objectives and role of WHO in an emergency, WHO’s key functions in the provision of support and services, and its role in relation to the Health Cluster that is established at country level to ensure an effective response through coordinated actions such as joint assessments, planning, gap filling, monitoring, etc. among all health actors. The first three sections thus provide the basic framework within which WHO responds to humanitarian emergencies. The last section summarizes the overall guiding principles for that response including the criteria for WHO emergency assistance.
These “fundamentals” must be understood and respected by all involved in decision-making, planning, implementing, monitoring or evaluating WHO humanitarian response.
1.1 WHO objectives, role and core functions in humanitarian response
Overall objectives – goals
Human survival and healthy livelihoods are the ultimate goals and the true measures of success of humanitarian assistance. Within humanitarian assistance, the specific objectives of health interventions are:
- to reduce the risk of excess, avoidable mortality, morbidity and disability that could result from the disaster/crisis; and
- to restore the delivery of and access to preventive and curative health care as quickly as possible and in a sustainable manner.
Role of WHO
The role of WHO in a humanitarian emergency is to:
- provide technical advice and guidance and, where needed, material support to national health authorities, when present, and to other health partners, in assessing the situation and needs and in planning, implementing and evaluating measures to (i) provide medical care and protect the health and safety of the affected population, and (ii) (re-)rebuild the health system and capacities; and
- provide leadership to the international community in relation to health and facilitate coordination of international health assistance and the coordination of that assistance with national efforts.
This includes ensuring, to the extent possible, that humanitarian and recovery activities in the health sector and closely related sectors (such as nutrition and water, sanitation and household/community hygiene) are appropriate and sufficient in terms of quality, coverage and accessibility.
There are thus two distinct but overlapping aspects:
- working with relevant national authorities, often as leader of the IASC country-level Health Cluster or an equivalent sector coordination group, to try to ensure that the overall – national and international – health sector response is appropriate, coordinated, effective and in line with the principles outlined in section 1.2; and
- planning and implementing specific WHO emergency projects and activities within the framework of a coordinated humanitarian response.
In addition to leadership and technical guidance, WHO support may include the provision of essential supplies, equipment, training and services (including related logistic support) when needed to address serious, immediate threats to public health and the required assistance is not assured from other sources. WHO may take direct responsibility for specific operational activities, when necessary (e.g. when specifically requested by the government or in areas where there is no functioning government)
For further details, see WHA46.6 7 and WHO manual XV, 4 (accessible via SOP 1.1).
Panel 1-1 summarizes the core functions of WHO in humanitarian response – what is expected of WHO. For each function, WHO is expected to provide leadership and technical guidance so that: (i) all health actors are aware of relevant international standards and best practices in emergency health (including IHR requirements), and (ii) the strategies adopted to address current needs and risks are appropriate.
Typically, this involves:
- providing information to MoH and all other health actors on international standards and regulations (including the IHR);
- providing technical advice and guidance on best practices to MoH and all other health actors in relation to current and potential health problems and service provision; and
- working with MoH and all other health actors to (i) agree on the most appropriate strategies to address current problems and risks, and (ii) develop an overall health sector response plan.
|Panel 1-1 Core WHO functions in emergencies|
|Function||Benchmarks (desired situation)||Some typical WHO activities (examples)|
|Ensuring the best possible information, analysis and understanding||• Health needs, system delivery capacity and operational constraints known; information consolidated & displayed in a manner that facilitates consensus and decisions||Promoting collaboration among all partners in assessments & situation monitoring.|
|• Priority health threats and system's critical capacities monitored regularly with possibility of early warning||Participating in assessments; initiating & organizing assessments when necessary.|
|Ensuring informed analysis of data and evidence-based conclusions.|
|Acting to ensure that data are verified, where necessary, and that gaps in information are filled.|
|Ensuring regular, adequate monitoring of the health situation and risks for health and health services.|
|Ensuring evaluations of health-sector response and lessons-learning exercises.|
|Facilitating coordination||• Organized space and time for all health partners to discuss issues, decide actions to take and assign responsibilities; mechanisms for follow up, evaluation||Supporting existing mechanisms for coordinating international health assistance; providing effective leadership to the health cluster/sector coordination group, when designated as lead, including assuring information on who is doing what, where.|
|• Work in all other sectors geared to the survival, health and sustainable livelihoods of the population||Ensuring agreement on overall objectives, priorities and a health sector response plan.|
|Ensuring the preparation and dissemination of regular health bulletins.|
|Contributing effectively to the work of other public-health-related clusters/sector-groups.|
|Working through formal mechanisms and informally to promote effective information exchange and, to the extent possible, joint strategies and action plans among all health actors.|
|Acting to fill gaps in health service provision||• Life-threatening conditions prevented or promptly addressed, with CFR maintained within international standards||Identifying and prioritizing gaps in services or geographic coverage.|
|• Appropriate means applied to improve equitable access to health care in a sustainable way and according to international standards||Working with MoH, other agencies and donors to try to ensure that priority gaps are filled.|
|Preparing and mobilizing resources for projects to fill priority gaps for which WHO has particular competence or that are unlikely to be filled by other actors.|
|Helping to (re-) build systems & capacity||• National health partners fully integrated in, and supportive of, the delivery of humanitarian assistance||Ensuring thorough analysis of the impact on national health systems and capacities (MoH and non-government).|
|• International health partners effectively complementing national efforts||Identifying weaknesses in and opportunities to reinforce existing systems and capacities.|
|Working with MoH and other health actors to ensure that humanitarian interventions contribute to (re-) building sustainable national systems and capacities, wherever possible.|
|Preparing and mobilizing resources for projects to (re-) build sustainable national systems and capacities.|
Ensuring the best possible information, analysis and understanding, and facilitating coordination are specific tasks that must be fulfilled by WHO (see chapters 5 and 9). In some cases they may require special resources and projects to assure relevant activities. In other cases they may be fulfilled by limited support to MoH from existing WCO staff. Good information is a pre-requisite for facilitating coordination and the corner stone of appropriate response to humanitarian needs – see sections 4.2 and 5.1.
Filling gaps is a basic principle for decisions on any WHO action. The WHO action plan and individual WHO projects should aim to fill critical gaps unfilled by others in the response plan for emergency health sector action – see section 6.4.
Helping to (re-) build systems & capacity is an underlying principle for the development of the overall response plan for health sector action (see section 6.3), the selection of strategies (see section 6.2), the design and implementation of individual WHO project proposals (see section 7.1), and the guidance to be given to other health actors for the design of their interventions (see section 9.2).
The framework within which WHO fulfils these core functions depends on whether Clusters are established and WHO is designated as country Health Cluster Lead (see section 1.3), but the responsibility is more-or-less the same in all cases. The core functions – particularly the first three – have also been identified as key functions for a country health cluster and WHO will work through the cluster to ensure that they are fulfilled to the maximum extent possible. Where there is no formal health cluster, WHO will work directly with the MoH and other health actors and through whatever sector group might exist.
Section 2.3 outlines the internal WHO/WCO planning and management functions that are essential to support activities to fulfil the four core functions listed above.