WHO and Emergency Preparedness at Global Level

Department of Emergency and Humanitarian Action, WHO

In her speech at the 52nd World Health Assembly, Dr Brundtland stated that “at an international level, there is a need to improve the collective capacity for humanitarian assistance and response to complex emergencies when national health systems cannot cope…"[1]

In 2000, there were 41 UN Consolidated Appeals. They covered different natural and man-made emergencies distributed in 32 countries. Only two of these countries, Madagascar and Mozambique, albeit poor, enjoy a degree of political stability. The others, including seven in Europe, are passing through war or post-conflict transitions.

Taking a wider view, information available on Relief Web suggests that at least 73 out of the World's 199 countries and territories move along an ideal "spectrum of instability" that goes from situations of difficult socio-economic transition to full-blown complex emergencies. And complex emergencies, although difficult to manage, are easy to predict. Natural disasters are another affair: they may occur along predictable patterns, but they are mostly sudden and "unexpected". Between January 1998 and August 2000, 90 countries were affected by major natural calamities.

There is growing consensus that the distinction between natural and human-induced disasters is artificial. There are no "natural" disasters: there are natural hazards, which impact upon human vulnerabilities that are mostly determined by human causes. In this sense, all disasters have political causes: either by commission or by omission, disasters reflect the ways societies structure themselves and allocate their resources (Kent, 1997). And this applies to the local level as well as to the national and the international levels. Social inequalities and economic downturns heighten vulnerability to natural disasters; fast changes in social structures can engender new hazards. Economic development increases the threat of technological disasters. The interaction of social, natural and technological hazards can trigger off an emergency whenever a country lacks the capacity to cope.

In an emergency, health is always called to respond: sometimes to lead, e.g. in the case of an epidemic, more often to provide essential back-up, e.g. in rescue operations after an earthquake. The health sector and the ministries of health have the most challenging and visible responsibilities in the response during disasters. Failure on their part is particularly costly, not only in terms of lives lost, but also technically and politically.

Within WHO, there is now solid consensus that emergency preparedness and response are core functions of the Organization[2] and one key priority of WHO's programme budget of 2000 and 2001 is “getting better at responding to increasingly diverse kinds of emergencies and humanitarian crisis…"

Preparedness

"Getting better at responding" means getting prepared. There are many definitions of preparedness, that range from illustrating an individual state of mind to describing a set of institutional objectives or capacities (see boxes). For working purpose, this paper defines preparedness as the set of measures that ensure the organized mobilization of personnel, funds, equipment and supplies within a safe environment for effective relief, with a deliberate stress on the word "safe".

This paper also contends that being prepared for emergencies is simply good management. Are we fully informed about the world where we are operating? Are our plans realistic? Are our procedures adequate? Are our programmes strong enough to withstand a crisis?

Responsibility for emergency management and, therefore, for preparedness lies with the local, national and regional authorities. Levels of preparedness vary between regions and between countries. Preparedness requires long processes, institutional stability and capital investment. All commodities that can be rare in new or developing countries. While both beneficiaries and humanitarian agencies acknowledge the importance of preparedness, few have the resources to make a significant investment[3]. In spite of the many initiatives born under the International Decade for Natural Disaster Reduction (IDNDR) international funding for disaster prevention/mitigation has been slow in materializing and not necessarily focused on preparedness. At least much slower and less focused than that for humanitarian response. With few notable exceptions - e.g. WHO/PAHO - only recently have indigenous efforts at preparedness been given international support.

The experience is that for a national effort at preparedness to be sustainable and successful, the responsible institution - be it the Prime Minister Office, the National Prevention and Relief Agency, the Ministry of Health, etc. - must have credibility vis-à-vis the public, and among the other national institutions. There is no quick-fix technology for emergency preparedness, which is essentially a process of investment in people and institutions. Political credibility and momentum (and budget guarantees, see below) are essential for a programme to have enough continuity and stability to induce positive changes.

As far as WHO regions are concerned, AMRO/PAHO's preparedness programme has been ongoing for over 20 years now, and gives WHO the primacy of the oldest initiative aimed at developing national capacities in this domain. As far as the other regions are concerned:

  • EURO adopted a resolution on the International Decade for Natural Disaster Reduction in 1989;
  • SEARO Regional Committee adopted a resolution on Disaster Preparedness in 1989;
  • AFRO adopted a resolution on Natural Disaster Reduction in 1990;
  • EMRO adopted a resolution on Emergency Preparedness and Relief Operations in the Case of Natural Disasters in 1990;
  • WPRO Regional Committee adopted a resolution on the Health Aspects of Emergency Preparedness in 1990.

These resolutions were followed up by others, reflecting the international trends and debate on disaster reduction and humanitarian assistance. Relevant WHO activities and programmes were launched and are on-going in all regions. All in all, though, the level of capacities for emergency preparedness - within and outside the health sector - tends to reflect more the economical development and political stability of each country rather than its needs in terms of disaster risk.


Preparedness as a core WHO's function

Servicing Member Countries

All societies and countries are susceptible to disasters, but by the very nature of WHO, those countries where the Organization has a stronger presence and higher visibility are also those that are more vulnerable. Therefore, fostering emergency preparedness must be a key objective of WHO strategies for technical cooperation with member countries. In Dr Brundtland's words, "WHO’s ultimate goal is to increase the self-reliance of its member countries... WHO wants them to be more resilient during a crisis, capable to absorb humanitarian assistance without being overwhelmed by it and then, once the crisis is over to move towards a recovery that takes full advantage of the lessons learnt."[4]

Long-term presence in countries gives WHO an advantage in understanding the context in which disasters take place and their real impact on people’s health. For WHO, preparedness means building local health capacity to respond efficiently[5]. Preparedness is a time-consuming activity. It is also difficult, as it must be sustained in spite of competing priorities on the basis of simple forethought: "What if?” On the other hand, it would be short-sighted for a development agency to run the risk to have to spend millions of dollars for humanitarian relief without committing itself to improve the local capacities to prevent and prepare for disasters.

Disaster reduction needs to be seen as a core function of the Ministry of Health that should establish a programme or department with specific responsibility for the health aspects of disaster reduction. This programme must coordinate with the national institution responsible for overall disaster management (Civil Protection or other) and other relevant actors in the public and private sectors[6].

Preparedness measures go from formulating disaster response plans for the health sector to developing national human resources: preparing training material, holding courses, meetings, collaboration with universities, etc. As preparedness can be futile if, when a disaster occurs, hospitals collapse when they are most needed, preparedness must be integrated by mitigation measures protecting health and health-related (e.g. water) infrastructures.

In order to support national preparedness, all WHO country/liaison offices - at least all those sited in highly vulnerable countries - should have a dedicated staff member, a focal point, tasked with all matters related to disaster reduction. This function is of a coordinating nature: supporting the national programme, building institutional memory, technical liaison with other agencies, etc. All other WHO country staff need to be aware that reducing vulnerability to disasters is everyone's responsibility in his/her area of competence and not the reserved domain of the ‘focal point’. Disaster mitigation and preparedness, in turn, provide opportunities to promote all health priorities and programmes in an inter-sectoral context.

This network of country focal points needs the support of a regional unit. A team of at least three staff can lobby with country offices, ministries of health and donors on the need for disaster reduction and for WHO's leadership in this area, prepare material to support national training, promote mitigation in health facilities, mobilize resources for regional and country activities. As disaster reduction is a core responsibility of the whole Organization – not just a technical area among others - the team should work so that all regional departments/programmes formulate a mission statement on their specific role in disaster reduction.


Preparing WHO to respond

Presence at country level and in general accountability vis-à-vis its constituents, the member countries, implies that WHO must not only build national capacities, but also be ready to provide services and an example when an emergency occurs. Disasters are occurrences that any WHO office may have to face, at any moment, and emergencies test WHO's commitment to its main partners: are we ready to assist the countries at the moment of greatest need? Are we up to the standards of preparedness that we preach? Are we present in spite of the difficult circumstances? Are we perceived as useful?

WHO’s goal in humanitarian response is to limit excess death and suffering from the preventable causes that originate from the disaster, immediately and at medium term. WHO’s function in emergency is life-saving and as such deserves to be acknowledged. But this responsibility implies that WHO needs to be prepared to react quickly to counter the primary impact of the event while at the same time plan to counter its secondary effects. There is consensus that this is best achieved by ensuring rapid health assessment, and then information flow (epidemiological and nutritional surveillance, etc.) and health coordination from the onset of the emergency to the reconstruction phase.

Credibility is crucial. The experience is that the ability of WHO to lead and to coordinate after a disaster depends directly from its leadership in preparedness before the emergency. Pro-active involvement in prevention and preparedness is the best way to gain credibility from the many actors outside the ministry of health, and this credibility with other agencies is the best asset that WHO can bring to the ministry of health in a crisis.

Predictability is crucial too: the debate started in 1997 on the role of WHO in complex emergencies[7] was instrumental in defining the Organization's strategy and practice in Emergency and Humanitarian Action. The times are now ripe for another exercise: WHO must define the public health priorities that are critical to its corporate strategy, the products that the Organization must be ready to deliver anywhere in an emergency and define the appropriate delivery mechanisms. In most of member countries, these Core Corporate Commitments will be delivered by the country office (the first one, arguably, being the safety and operationality of its staff). In other circumstances, e.g. such as those prevailing in EURO, they may have to be guaranteed through the National Liaison Officer. In either scenario, country and regional offices need appropriate delegation of authority supported by decentralized administrative procedures.

Early presence is the third critical requirement. WHO’s presence in the first few days, or even hours of relief operations, sets the pattern for the reconstruction phase[8]. Early presence implies operational readiness, that is a statement of preparedness and professional competence qualified in terms of time. It is also strictly related to issues of information, communications, logistics and administrative procedures.

It is difficult to draw precise distinctions between relief, rehabilitation and reconstruction. In some circumstances, WHO staff and programmes involved in preparedness or relief may be forced to maintain responsibility also in the early phase of rehabilitation. Nonetheless, "preparedness" plans should include exit strategies, allowing for a hand over to other WHO technical programmes at the earliest possible stage. Building this consensus and defining appropriate arrangements and procedures are part of preparedness activities.

At WHO Headquarters in Geneva, the Department of Emergency and Humanitarian Action (EHA) has the responsibility of facilitating regional and country preparedness and response, at global level. EHA’s function is essentially coordination, with a focus that is both developmental and relief-oriented.

A team of Emergency Health Partnership (EHP) complements and strengthens resources and capabilities of regional and country offices according to their needs. EHP activities include:

  • Coordinating and conducting rapid health assessments;
  • Mobilizing WHO’s technical departments and external partners for the delivery of essential life-saving interventions;
  • Assisting in the mobilization of external resources for emergency in line with WHO’s corporate priorities;
  • Providing technical and logistic back-stopping;
  • Facilitating coordination between national and international humanitarian actors, so to ensure that field operations are in line with best public health practices.

A team for Emergency Health Intelligence and Capacity Building (EHC) collects and produces evidence for strategic and operational preparedness and for consolidation of best public health practices in humanitarian action. EHC activities include:

  • Managing information and producing health intelligence;
  • Documenting lessons learnt, consolidating and communicating norms, best public health practices for disaster reduction;
  • Building competencies for disaster reduction within WHO;
  • Collaborating with specialized centres and academic institutions for training and research in emergency health management.

The Office of the Director ensures overall coordination, mobilizes and administers EHA’s core resources. Its activities include:

  • Formulating global policies and strategies in consultation with regional offices, other WHO departments and international humanitarian partners;
  • Ensuring regular and extra-budgetary funding for EHA core functions;
  • Ensuring accountability and transparency vis-à-vis partners
  • Representing WHO in the Inter-Agency Standing Committee and other fora.

Capacity for emergency management has been defined as resulting from a combination of information, authority, institutions and structures, plans, resources and procedures to mobilize them, and partnerships[9]. In this perspective, the global role of WHO/HQ in preparedness can be seen as:

  • Information

WHO monitors countries according to their disaster-risk. EHA gathers, analyzes and disseminates health information on countries at risk and emergency-affected populations. In-depth profiles are established for priority areas, for advanced planning and better targeted preparedness and response activities. Information is disseminated within WHO on health-relevant emergency issues, and, externally, on WHO's initiatives that are relevant for disaster reduction and emergency management. EHA can also assist regional and country offices with technical expertise in the area of information management for disaster reduction, preparedness and response.

  • Authority

At Headquarters, EHA works with and for WHO's senior management, and through the Governing Bodies, at having emergency preparedness and response recognized as core functions of WHO. Outside the Organization, EHA's advocacy concentrates on having health recognized as The cross-sectoral issue, the true "objective and yardstick of success of disaster reduction". Both lines of work are critical in order to ensure the political recognition, the resources, structures and institutional framework needed for emergency management.

  • Structures

EHA's structure in Geneva reflects WHO's Corporate Strategy, its core functions and the managerial requirements, some of them general and some fairly specific, e.g. the Department's strong dependency on extra-budgetary support. EHA's views on structures for regional and country preparedness have been mentioned above. The bottom line is that WHO can only be as good as its country offices, that it is the country level that must respond and that must be prepared. From Geneva, EHA can bring into play its own additional inputs, plus those of WHO technical departments, other regional offices, collaborating centres, etc. In this manner, the expertise of the entire Organization can be mobilized to serve the country offices for disaster reduction through a fairly flexible structure. Meanwhile, through the Inter-Agency Standing Committee (IASC) and the UN Country Teams, the UN System of Humanitarian Resident/Coordinators provides a fair global institutional framework of reference for WHO action in disaster reduction, be it prevention, preparedness, relief or rehabilitation. A special task - and a challenge - for WHO is to have the national health authorities empowered for a constructive dialogue with the many international humanitarian actors: for instance, in order to minimize the risk of having parallel health care structures established during emergencies.

  • Plans

Concrete planning for the preparedness of member countries can only be left with WHO country and regional offices. From Geneva, EHA's main role is to identify options and facilitate consensus: strategic consensus on what would be the best modus operandi for the Organization in vulnerable countries, as well technical consensus on what should be WHO's core corporate commitments. This means ensuring that the other technical departments identify the core global priorities that must be maintained in spite of emergencies, and are responsive to the needs of the country offices in situation of emergency. EHA can also assist regional or country offices with state-of-the-art tools for planning and evaluation, and advocacy with operational partners.