Humanitarian Health Action

Managing WHO Humanitarian Response in the Field - 6 Defining Objectives and preparing an Action Plan

6.4 Defining priority projects; preparing an action plan

A project is an undertaking intended to achieve certain specific objectives with specified resources, usually within an overall programme and within a specified timeframe. (UNHCR Manual 1999)

An action plan outlines the activities that the Organization plans to undertake, subject to the availability of funding, and the overall rationale. It lists the proposed projects and, for each, the objectives, main activities, expected outputs, intended time frame for implementation, expected cost (total budget), and responsibilities.

2/3. Health sector response plan/WHO action plan:

  • Definition of overall objectives/goals
  • Analysis of response options; selection of strategies
  • Health sector response plan/WHO action plan

Guiding principles

The WHO action plan should focus on:

  • addressing priority health problems and needs and filling critical gaps that are not, and will not be, covered by other health actors and donors in humanitarian response; and
  • achieving the maximum health benefit for the maximum number of people in disaster/crisis-affected districts and populations.

It will be developed within the framework of the WHO core functions in humanitarian response (see section 1.1) and the context-specific objectives and strategies defined locally (see sections 6.1 and 6.2).

Priority needs and gaps in the humanitarian response will be identified during assessments, monitoring of the situation, and coordination meetings.

Activities should be directed towards achieving province-wide (or even country-wide) benefits and outcomes, wherever possible.

Gaps should be filled in ways that contribute to restoring basic public health functions in a sustainable manner, wherever possible.

Projects including supply of medical equipment should focus on equipment for public health purposes (public health laboratory, cold chain, etc.) and take account of maintenance considerations including the availability of spare parts and technicians.

Proposals for training activities must be carefully examined. In general, the focus during the early stages of response should be on in-service (on-the-job) training for specific technical tasks. More general training may be difficult to organize at this stage and not have an immediate impact. Any training activity must include follow up and evaluation.

The action plan should include, as annexes, contingency plans to deal with new crises that could arise in the course of the planned humanitarian operation. (The contingency plans referred to here are “in-crisis” contingency plans, prepared to deal with events “contingencies” that could further complicate the current critical situation.)

What to do – key management actions

First steps – during the first few days

During the first phase few days pending completion of the IRA:

  • Prepare an initial action plan for WHO assistance. Do this within the framework of the overall health sector response plan if there is one within the first 48 hours, but don’t wait longer. Use/adapt the format in Figure 4a. See the dos and don’ts in Panel 6-5.
  • Focus on identifying – and then trying, with partners, to fill – gaps in the availability of critical information or services in areas where large numbers of people are known, or believed, to be seriously affected (see Panel 6-6).
  • Make sure that the WCO has, or will have, the capacity and systems to support the anticipated field activities:
    • list the support functions to be assured by WHO (the WCO) during the first two or three weeks, and estimate the workload involved;
    • assign responsibilities and prepare an office emergency programme support work plan in the form of a simple matrix: tasks; timeframe; responsibility; resources needed; resources available; additional resources to be mobilized; and
    • include necessary provisions in the budgets of individual projects.

During the emergency phase/first month

  • Up-date the action plan for WHO assistance within the framework of the overall health sector response plan. Use/adapt the format in Figure 4a.
  • Build on any opportunities for capacity building of people and facilities for response to immediate needs. This may include:
    • support and on-the-job training for communicable disease (CD) control: e.g. surveillance, vaccination and cold-chains, laboratories, reporting systems;
    • support and on-the-job training for non-CD surveillance: e.g. water quality monitoring and sanitation measures;
    • support and on-the-job training on management of severe malnutrition
    • support to MoH operations room;
    • support and on-the-job training for logistics – transportation, supplies management, (e.g. LSS/SUMA).
  • Consolidate WHO operational support capacity and systems: Up-date the list of functions, estimates of workload, and the office emergency programme support work plan taking account of the programme action plan and the prospects for mobilizing resources for the planned projects.

Once the situation has stabilized/beyond the first month

  • Maintain support for the health and nutrition information system, an appropriate EWARN system, health communications, critical public health supplies, etc., as needed, while working to progressively reduce dependence on WHO and other external assistance as and when possible.
  • Focus on analysis of and planning for medium-term rehabilitation and recovery needs of health system facilities, human resources and equipment, keeping in mind the programmes planned by other partners.
  • Prepare contingency plans for events (contingencies) that could impact on the health of the population and/or the ongoing humanitarian assistance operations of WHO and other health-sector actors during the coming months. Do this with partners in the context of the Cluster/sector coordination group, if possible.

Panel 6-5 Some dos and don’ts when preparing a WHO humanitarian action plan
What to focus on
According to the context, give priority to projects aimed at strengthening:
• Health and nutrition information;
• health coordination;
• communicable disease control (including EWARN and environmental health);
• hospital-based management of severe malnutrition
• health system rebuilding (including human resource and supply management).
Typically, these are areas in which WHO has a “comparative advantage” and is expected, by partners, to act and make a difference.
In addition, give particular attention to the following aspects that are often overlooked by other partners: quality of injury care; water quality control; food safety; mental health; management of chronic diseases; management of essential drug supplies.
What to avoid
• Do not plan projects to provide direct services to people or communities unless urgent needs are not being met and there are severe and immediate risks to health or safety.
• Do not engage WHO in major infrastructural rehabilitation of buildings. Be ready to fill gaps for minor reactivation of facilities, provide advice on rehabilitation and reconstruction (location, coverage, retrofitting, etc.) or provision of power supplies to health facilities, but do not take direct responsibility for major physical works.

Panel 6-6 Filling gaps
• Work with partners to identify critical gaps. Look out for, in particular, gaps in expertise and supplies for casualty care, emergency water & sanitation, measles vaccination, health communications, etc.
• Use the Cluster or other coordination mechanisms, the UNCT, and bilateral contacts with agencies (and donors?) to try to mobilize competent organizations to fill the identified gaps.
• Use resources available to the WCO from regular programmes to fill priority gaps, where possible.
• Request emergency funds from RO and/or HQ, and seek donor contributions locally from embassies, etc. (see section 6.1) to fill outstanding priority gaps.
• Keep the RO, HQ-HAC, members of the Health Cluster/other coordination groups, and donors informed of outstanding priority gaps.
• Monitor (or support the Cluster Lead in monitoring) the funding and implementation of the emergency health sector response plan and advocate for additional resources when needed.

Panel 6-8 Contingency planning during an ongoing humanitarian operation
Events that could further impact on the health of the population or on the ongoing humanitarian assistance operations during the coming months must be anticipated. Contingency plans must be prepared to respond to possible new health threats and to ensure, as much as possible, the continuity of services and humanitarian assistance to the target populations.
What to do
• Decide, with partners, how the problems arising from such events will be managed- what strategies will be taken.
• Specify what additional resources – human, material, financial – would be needed.
What to consider
Events (contingencies) that might need to be anticipated include, for example:
• secondary disasters: recurrence of the primary hazard or secondary phenomena such as epidemics of communicable diseases and increased malnutrition or a forthcoming cyclone season;
• deterioration of the security situation, notably the possibility that renewed conflict could affect certain health facilities or disrupt supply corridors;
• breakdown of in-country supply chains due to overburdened provincial services;
• rumours and misinformation impairing relief activities.

Tools and other guidance

Annex C1 Core-functions analytical framework which shows how the core functions listed in section 1.4 may be used as a framework for analysis when developing objectives and an action plan.

Annex C5, Key health services and functions provides a list that may also help in putting together overall objectives and a health sector response/action plan.

Policy and strategy for WHO/EHA action in disasters, WPRO, April 2005

Humanitarian health response: south-central Somalia, WHO-EMRO May 2007. (Note, however, that a “strategy” in that document corresponds to “objectives” as used in this handbook, while the “areas of intervention” in that document correspond to “response strategies” as used in this handbook.)

The management of nutrition in major emergencies. WHO, 2000