IASC - WHO · Global r IASC Inter-Agency Standing Committee. Meeting Summary . 7- 8 May 2008 . John Knox Center . ... • The aim is to establish a common understanding of the meaning

GlobalHealth Cluster

IASCInter-Agency Standing Committee

Meeting Summary

7- 8 May 2008

John Knox Center Geneva

Participating agencies: CDC, ECHO, ICN, IFRC, IMC, IRC, Merlin, STC UK, STC USA, UNFPA, UNHCR, UNICEF, Women's Commission, WADEM, WVI and WHO Click here for full list of Meeting Participants Click here for Meeting Agenda Wednesday 7 May 2008 Morning Chairperson: Linda Doull, Merlin 1. Opening remarks- Robin Nandy UNICEF Robin Nandy welcomed everybody to the ninth Global Health Cluster (GHC) meeting. He mentioned that Dr Eric Laroche, the Assistant Director General for Health Action in Crises, had requested a welcome address from a partner organization and that he felt honoured to be the one opening the GHC meeting. The GHC had a slow start but there has been a lot of progress in the past 12 months. Among the highlights is the completion of the first tri-cluster training for cluster coordinators, the progress on the health cluster guide and on the Initial Rapid Assessment (IRA) tool. The GHC also began the Joint Country Missions with a first trip to the Ivory Coast. This meeting will start with an update on progress on the GHC 2008 Work Plan, then explore how the GHC can better support country clusters, and then look towards the role of the GHC in 2009 and beyond. Robin emphasized that the GHC is a valuable forum and that all partners have a responsibility to make it useful and worthwhile. He asked the chairs to ensure that at the end of each session we have concrete action points to move things forward. 2. Review of agenda, meeting objectives, introduce chairpersons- Erin Kenney Administrative details were covered. The agenda and meeting objectives were reviewed for comments. Two new members were welcomed to the Global Health Cluster: the Women's Commission represented by Sandra Krause and The World Association for Disaster and Emergency Medicine (WADEM) represented by Marvin Birnbaum.

3. Progress on the GHC 2008 Work Plan- presented by members of various WGs Capacity building of National Stakeholders - Altaf Musani (WG chair) • The Working Group had a difficult start but now the guidance and strategy document is

progressing well. The WG will ensure linkages and consistency with the guidance from the IASC concerning contingency planning. The WG will review the first draft in the next couple of weeks. The document should be complete as planned by July 2008.

Health Cluster Guide - Ron Ockwell (consultant) • See power point presentation on Health Cluster Guide • The Health Cluster Guide Steering Committee has had several teleconferences and has

finished a first working draft. • The chapters were presented and an updated version was circulated. Ron needs more help

on specific chapters from the relevant GHC working groups by end May at the latest. • Chapters requiring significant input from the GHC WGs are:

o Assessment and monitoring o Analysis, strategy development and planning o Mobilizing, sharing and managing resources o Reporting, performance monitoring and evaluation o Managing and disseminating information *significant input required o Standards and protocols *significant input required o Promoting early recovery; rebuilding national systems *significant input

required • The plan is to have a draft by mid-June and start field testing from July to September. The

targeted users are senior staff members, Health Cluster Coordinators, medical directors working in the field and the donor community.

ACTION: WG chairs to ensure that input is provided to Ron as required by end May so that the guide can be complete as planned by mid-June. Health Recovery Paper- Egbert Sondorp (consultant for WG C&M) • See power point presentation on Health Sector Recovery • The development of this guidance has proven to be a complex undertaking and issues are

still maturing. • A sub-working group of the WG C&M has been formed to work with the consultant to

finalize this guidance. So far three drafts have been produced after rounds of discussion. • This guidance is aimed at persons in a position to influence the recovery process. • The aim is to establish a common understanding of the meaning of health recovery. • We need to move from the distinction between acute vs. chronic to disaster vs. conflict. • The paper will focus on chronic conflicts and give an intro to health systems. • It will provide an update on burning issues like service provision, basic packages,

contracting, human resources, training certification, information management, assessment tools, health finances and user fees. The guidance will provide options not answers.

• This guidance is not aimed at being a comprehensive tool; instead aims to fill knowledge gaps.

• A first draft for wider circulation is expected by end July 2008. Stakeholder Mapping -Nevio Zagaria (co-chair WG C&M) • See power point presentation on 4W • Measure who is doing what where and when by health sub-sector and also by service

provision within the sub-sectors • The draft tool has been tested in Darfur; the tool and case study will be circulated to

partners. • The tool should be finished and available by this fall 2008.

Gap Analysis Materials- Linda Doull (manager of this product of the WG C&M) • Consultant Nadine Ezard is going on missions to field test the Gap Analysis Materials at

the sub-national levels in Uganda and DRC. • Gap Analysis Materials will in finalized by September. • The questions surrounding this product are: how can this be used to augment existing

tools (the IRA for example). How and when should country clusters use these materials? Should a specific tool be developed based on these materials? Would it be suitable to both chronic and acute situations?

Mental Health Guidance - Mark van Ommeren • See power point presentation on Mental Health Task Force Update to GHC • Thanks to the GHC, 11,000 copies were printed of the Mental Health Guidelines. • An inter-sectoral reference group is working to promote the implementation of the

guidelines, and looking to do this by specific sectors/clusters. • They are proposing to the GHC to consider a guidance note and checklist specific to the

health cluster, drafted by the reference group, that could be promoted by the GHC. A draft should be available for review by the GHC by end June.

• Mark emphasized that there needs to be increased dialogue and coordination between the GHC and the global protection cluster.

ACTION: Mark to circulate draft health guide and checklist to GHC for review by end June. Products of the WG on IM - Jonny Polonsky (WG IM) Initial Rapid Assessment Tool • The IRA tool and guidance are nearly finalized. Both the GHC and the Nutrition Cluster

have agreed on the tool, and are awaiting the approval by WASH. • The IRA tool has been used in Kenya in the aftermath of the election violence. The tool

was most successful when tested by multi-sectoral groups. The goal is to use the IRA tool in the assessment of the situation in Myanmar. When testing in Kenya the acute phase had already passed. The hope is that the Myanmar crisis will show if the tool works in acute onset situations. Country level officers in Myanmar have asked for the IRA and the GHC has shared it with partner organizations.

• Countries are expected to adapt the tool to their specific context. • The 3 cluster WG is considering seeking endorsement from the IASC. • The focus for the moment is on developing a dissemination plan. • The electronic version and electronic aids, like database, reporting template will be

developed. The goal is to try to obtain the $100 computer for children as a platform for the electronic version.

• Much more work is needed to move from the tool to analysis, intelligence, and an evidence based work plan. Analysis capability and guidance is lacking.

• Many voiced the opinion that the tool was too long. There is some agreement. The country specific tools will probably be much shorter as they adapt the tool to their time frame and needs.

Comprehensive tool • Work is now beginning on this. This might be a collection of specialty tools since the

health sector has so many sub sectors. Unlike WASH who is creating just one comprehensive tool due to the specific and limited subject matter, health will require many tools.

Benchmarks • Work is just beginning on this now. Start with a review and compilation of existing

benchmarks from Sphere and other sources. • GHC needs to define a few key benchmarks by which country clusters will be measured

in the Phase 2 evaluation sometime in early 2009.

Health and Nutrition Tracking Services (HNTS) - Richard Garfield • The HNTS is in the process of hiring one epidemiologist and one nutritionist. The two

jobs have been advertised and the nutritionist position will be filled shortly. The other position will need to be re-advertised due to a lack of qualified candidates.

• The work on the HNTS is progressing in Uganda, thanks to the cluster coordinator who is bringing the work forward. Chad will be the next country of focus.

• HNTS will create better data when more assessments are complete. • The HNTS plans to move quicker and be more present in the field. • A main goal is to ensure the quality of the data coming out of the HNTS. Joint Assessment Missions - Anne Golaz (partner in first JCM to Ivory Coast) • See power point presentation on Joint Country Missions: lessons learned • A concept note for the Joint Country Missions was shared in March and the first mission

to Cote d'Ivoire, took place the same month. 12 country missions are planned for 2008. • The first mission allowed GHC partners to test the mission concept and propose

changes/improvements for future missions. • The mission proposed dates have to be shared with partners well in advance to ensure a

broad participation in the missions. • The Côte d’Ivoire mission included three WHO and one UNICEF, global and regional

participants, it didn’t include any NGOs or donors. The inclusion of NGOs and/or donor in the mission team is essential to represent the partnership. The meetings should include all key in-country partners

• The joint mission should be divided in two parts: the assessment and the country support. The mission assesses gaps and weaknesses in performing cluster functions, and also provides country support in producing a plan of action based on the mission recommendations that should be discussed during a workshop at the end of the mission. The country support is the most important part, but unfortunately didn’t happen with the Côte d’Ivoire mission. The follow-up of the agreed plan of action is essential.

• Joint missions are opportunities to present the CA and GHC tools to country partners. ACTION: HAC to set firm dates asap for 11 remaining missions to get commitment from partners to be part of the team; all partners to inform their country offices that visits will take place and encourage their participation. Training and Roster - Robin Nandy (co-chair WG T&R) • The first tri-cluster (Health, Nutrition and WASH clusters) training for future cluster

coordinators finished 3 May. A total of 29 participants from the three-clusters got training including nine participants from the Health Cluster. The training was successful and the participant feedback was very positive. The training focused on building skills and learning about the cluster approach.

• Agreement that 3-cluster format was positive; it is difficult to organize but rewarding for the participants since it is key they meet and get a common understanding of the cluster and the different needs before meeting on an acute onset. The concept is to be considered for future trainings.

• WG must review and improve selection process for training; Need to solicit new CVs and nominate more candidates for the future training.

• WG must redraft TOR of HCC given feedback at training and given that the TOR was drafted in fall 2006 before even the guidance note was finalized.

• Aim to finish three more trainings during 2008 (two in English and one in French); decision needs to be made by the WG if these will be 3-cluster or only health cluster

• WG must consider if the training is suitable to both acute and chronic situation HCC • WG must develop process for identifying HCC for long term chronic posts

Inclusion of Cross Cutting Issues- Erin Kenney • Contact has been made by the Support Hub to IASC focal points for age, gender,

environment, AIDs, protection, mental health. • The focal points for age, protection and mental health have already reviewed some near

final products (IRA, gap analysis). Gender is willing and ready to begin review. We await the name of the person who will do the review. HIV/AIDS has not yet provided a response about their willingness to review GHC products. Environment (UNEP) is unable to spare the resources to review GHC products. WHO will therefore ask its environment department to review the GHC products until UNEP has secured the necessary resources.

• No budget has been allotted for this task. Integration of the cluster approach- Erin Kenney • A group of 6 partners has had two teleconference to advance on this work plan item • The group has determined that the priority is to conduct 2-3 regional workshops in 2008

with a focus on country level implementation • The aim is to get maximum impact on current and future implementation of the cluster

approach using the limited funds available by targeting partners' emergency response field staff (both international and national) that would be mobilized to work in or support other emergencies

• The aim would be to seek participation from many different organizations; both international and national staff

• The group suggests that the TOR of the JCMs be revised to include a one day workshop in country for all stakeholders on the cluster approach and GHC products

• Partners in this group plan to explore where existing inter-agency emergency groups might be able to support these workshops

• Priority locations Nairobi and Dakar; one English and one French • IMC to circulate a draft concept note for comments by those on the teleconference • Proposal for combining this work into a new WG to be proposed in the next session • No funds spent so far. Total available $150,000 Public Private partnerships- Erin Kenney • Recognition that private sector is increasingly important in humanitarian work. • WHO and 4 partners attended meeting in NYC in January with WEF and their Health

Care Industries Group. Opened communication; encouraged bilateral discussions and agreements; suggested secondment at regional or country level to explore options but WEF only interested in global level

• So far no concrete multilateral activities have been identified to take forward, but the contacts have opened the door for some bilateral discussions. Exploration on going.

• No chair has ever come forward to take this work forward. • Budget of 20,000, remaining $15,857 Advocacy- Erin Kenney • Aim has been to develop a paper that explains costs of cluster leadership and participation

at country level and that encourages donors to fund country appeals. • One suggestion was to use in part feedback from the Joint Country Missions, even

thought this is not in TOR of the JCMs • No chair has ever come forward to take this work forward. • Next session, determining way forward to complete these tasks in 2008. Proposal of WG

to take on this and other advocacy issues. • None of $34,000 funds used so far. Planned to bring in partners to WHO fund raisers,

conduct donor visits, or attend other donor events together. GHC meetings- Erin Kenney • $40,000 allocated; $4,800 spent; remaining $33,400

Wrap Up - Linda Doull (morning chair) • All products are getting closer to be finalized. However, there are question marks

regarding the dissemination. We need to consider if training is required or if guidance is sufficient.

• We need to ensure coherency and linkages between the products and the WGs. • WG should share lessons learned with other WGs. • We need to keep momentum going and stick to our timeframes and deadlines. This will

mean participation from everyone. Special Session on Myanmar-Alessandro Loretti • See power point presentation Cyclone Nargis • Update on situation • We need to look into who is doing what where • Challenges, constraints, opportunities, synergies • Most probably we will send in an HCC, but not yet determined • GHC partners need to encourage their staff in Myanmar to work with WHO as cluster

lead and communicate and attend coordination meetings • A communicable disease assessment document will be issued in the coming days Afternoon Chairperson: Paul Spiegel, UNHCR 4. Commitment to work plan, participation, working arrangements- Erin Kenney • See power point presentation on GHC working arrangements and structure • Aim of this session is to agree to any changes to our working arrangements to facilitate

the participation of partners and the completion of the 2008 work plan • Currently we have 4 WGs, 2 Task Forces, 1 Steering Committee; Active participation in

GHC plenary meetings but limited participation in working groups; WHO chairing or co-chairing all working groups; lots of email traffic and teleconference schedules; Work not mainstreamed into all organizations (many have not included GHC in job descriptions of staff)

• Proposal of the following actions: Merge working groups to bring together related products while keeping focus on priority areas of work; Reduce number of working groups; Ask each partner to participate in only one working group to concentrate our efforts; Establish WG co-chairs (one UN and one non-UN); Reduce email traffic by using website; Establish regular teleconference schedule; Circulate internal monthly update on progress (to avoid partners joining WGs simply as observers)

• Agreement was reached to merge existing structure into 3 working groups: Guidance and Tools, Country Support, and a third group to look at the unresolved issues

• WG Guidance and Tools to include: IRA, comprehensive tool, benchmarks, 4W, early recovery paper, gap analysis, health cluster guide, monitoring and evaluation tools

• WG on Country Support to include: Health Cluster Coordinator roster and training, integration of cluster approach and related capacity building, promotion of capacity building of national stakeholders

• The third group would take on advocacy, public/private partnership, attracting southern partners, endorsement/obligations issues, membership, health cluster branding, and evaluation of achievements and impact of the GHC so far

• Agreement that partners would split into one of the three groups during the afternoon session to discuss the role of the group, its TORs, and the way forward. Feedback to be provided by each of the three new groups the next day. See meeting summary, session 9 below for outcomes and final decisions based on group work.

5. Remarks by Dr Eric Laroche, Assistant Director General for HAC • The ADG noted that this was his first Global Health Cluster meeting and that he was very

pleased to attend and to meet everyone. • We need to ensure that what we are doing really makes the humanitarian health response

more predictable, accountable and effective. • We have to work for the affected populations. • We have to be accountable to deliver at the field level. • We need to get partners sitting at the same table; different responsibilities and

competencies but the same level of engagement. • The cluster was meant to make a difference to the people in the field. The cluster means

equal partnership but not equal responsibility. The one who is ultimately accountable is the Humanitarian Coordinator (HC).

• We have to ask ourselves what we are working for. What we are discussing here needs to be relevant for the field and whatever happens here needs to have a connection to the field.

• The cluster lead in country must have the right to decide who they want to hire as health cluster coordinator. We at the global level need to have the mechanism and rosters in place to be able to deploy the right people.

• We have to think about how we can involve and include NGOs in the field. Working together takes a lot of time but is crucial. We cannot work in a vacuum; we all need to work together.

• Myanmar offers an immediate example of the challenges: how to get government on board, how to avoid stove piping between sectors, how to make inter cluster linkages, how to move from normal coordination mechanisms to more active cluster mechanisms, how to link in GHC products, how to integrate early recovery from the start?

• How can we get the message of the cluster approach to the field level? Should the global clusters be involved in the circuit from risk reduction to preparedness to response to recovery to risk reduction, or only in response?

• We have to look at ways to measure the effectiveness of the response and the benefits of our work. HNTS should be one measure. We need to get and present baseline data. WHO should be able to provide that: a health landscape.

• The role of the GHC should be to give parameters within which health actors should work. • There is an increasing professionalization of the work we do. We have to consider issues

such as access and humanitarian space. • There is an important role for this group and we need to use this opportunity. 6. Streamlined working groups meet separately to determine chairs, TOR, and next steps • Three newly formed Working Groups met separately to determine the way forward to

ensure coherency between products and prepare to report back on Thursday. Thursday 8 May 2008 Morning Chairperson: Muireann Brennan 7. Open second day of meeting; review objectives of the day- Muireann Brennan 8. Report on issues from IASC and their implications on global and country cluster work - Jamie McGoldrick, Head of Humanitarian Reform Support Unit/OCHA • It has been two years since the humanitarian reform was adopted and the response in the

ongoing crises in Myanmar will show if it made a difference.

• With the cluster approach we started using a new 'vocabulary' that has been confusing for the field. We have learned our lessons about imposing this on the countries. We need to de-mystify what the cluster is and show that it is a field driven response. We need more help on this from global clusters and leads.

• Leaders within the United Nations are supportive of partnerships and the cluster approach. • OCHA should not be operational; we should be the facilitators and give guidance and

support to the clusters. • We have started to bring in southern countries in our discussions with the G8. We have to

show that the cluster approach will be an improvement and lead to positive change. • Where we are now: The Rome statement confirmed support for the cluster approach and

the continuation of the humanitarian reform. • All three areas of the reform are mutually reinforcing. • We have three types of countries: countries that have introduced the cluster approach,

countries that are on their way to adopting the approach and countries that are resisting the cluster approach. OCHA is supporting the countries in the process.

• We have to feel that what we do here at HQ has an impact at field level. So far the field is not feeling the impact of the global clusters.

• Contingency planning needs to be an ongoing project and we need to have a pre-determined leader and stockpiles for a crisis.

• The cluster is the first step in delivering as one. • There is a coming together of the various levels and players: ERC, HC, Cluster Leads. • The donors have not closed the door for future funding to the global clusters. We are sure

that the stand alone cost will go down the longer we continue. • We want to create a general monitoring tool that shows the effectiveness. We have to

track the effects and the benefits and show to the donors and G7. • And there are many other issues we need to be looking at now: economic meltdown,

climate change, food insecurity and prices. • We have to keep an eye on the beneficiaries and the reasons why we are all in this work. • We need to work more on preparedness and operational predictability. • And we have to show impact through monitoring and evaluations. • Issues raised by GHC plenary include: leadership in cluster approach still unclear; lots of

responsibility without the authority; cluster won't work well until Delivery as one works well; the partnership reflex does not exist yet; government support does not exist yet; IM support not yet there; collective thinking should lead to better answers; there is no performance evaluation for HCs yet; culture change takes time; donors need to be pressured to really take on the good humanitarian donorship

9. Report back from Streamlined Working Groups Working Group on Guidance and Tools • See power point presentation: WG Guidance and Tools report back • Co-Chairs: Nevio Zagaria (WHO) and Nichola Cadge (Save UK) • Plan to work and have monthly updates through teleconferences. • WHO will organize the translations that need to be done. • Co-chairs will ensure work is finished and that there is coherence between products. • Co-chairs to look for ways of linking guidance and tools to Joint Country Missions • Products and their focal points:

1. Health Cluster Guide - Nevio Zagaria 2. Reference document for identifying and addressing gaps-Linda Doull 3. Reference document on health recovery and transition-Nevio and Samuel Petragallo 4. Development of software for the IRA and HNTS-Jonny Polonsky, Richard Garfield 5. Benchmarks-Jonny Polonsky and Richard Garfield. 6. Development of generic tool for monitoring implementation-?

Working Group on Country Support • See power point presentation: WG Country Support report back • Co-Chairs: Gillian O'Connell of Merlin and not yet determined • Products: Health cluster coordinators training (Robin), Joint Country Missions, Roster

process (Edith), building national capacity of stakeholders (Jonathon), regional and country training and integration of cluster approach (Elizabeth)

• Propose to reduce from 12 JCMs to 6 JCMs; revise JCM TORs; add one day workshop curriculum; identify WHO focal point on this

Working Group 3 • See power point presentation: GHC Steering Committee report back • Proposal that WG 3 should become the GHC Steering Committee to determine direction

for the GHC, the strategy for realizing it, and the conceptual framework for addressing the various issues that have not yet been fully taken on: advocacy, membership, partnerships (including with the private sector and with southern based actors), endorsement obligations, marketing and branding, and evaluation of achievements and impact of the GHC so far

• Chairs: Mary Pack of IMC and Eric Laroche of HAC/WHO • Members: to be determined; suggested mix of UN and NGO and perhaps a donor

representative (not more than 6) • Products: paper describing the options for the GHC after 2008; depending on the option

chosen, another paper is anticipated that would be a concept paper including a strategy that could be used as an advocacy and resource mobilization document describing the GHC achievements so far, plan of work for beyond 2008 and related required resources

• This proposal was fully supported by the plenary 10. Common current concerns, plans and operations- Alessandro Loretti • Contingency planning and joint appraisals are important • GHC should consider Risk Analysis as a key function • We need to move from information to intelligence to judgements to decisions • We need to share information and make it useful • Proposal to have periodic teleconferences to discuss issues of concern; proposal to do this

either right before or right after the circulation of the IASC Early Warning Report; several partners expressed interest in being involved in this

ACTION: Alessandro Loretti to follow up to arrange next ER teleconference. Afternoon Chair: Johan Heffinck, ECHO Short presentation on the Health in Fragile States Network by Nichola Cadge of Save the Children UK. A steering committee that includes Linda Doull, Robin Nandy and Nichola meet via teleconferences two times per month to exchange information. Concentration on policy issues. Short presentation on WADEM by Marv Birnbaum to explain the work of this new GHC partner organization. See WADEM background document.

11. Field realities: implementing the cluster approach and improving the humanitarian health response This session included the following presentations as a basis to discuss support needed by country clusters:

(1)Perspectives from WHO: Daniel Lopez Acuna, Director, REC/HAC/WHO (2) Perspectives from HCC: Videotaped interviews: Olu Olushayo (Uganda) and Ahmed El Ganainy (Sudan) (3) Perspectives from Cote D'Ivoire JCM: Anne Golaz, UNICEF (4) Perspectives from recently trained HCC. Elizabeth Berryman, Save UK

(1) Daniel Lopez Acuna reminded the plenary we should not be asking ourselves how we can respond to all country requests for help, but rather to consider particular process challenges, especially in the chronic countries. We need to look at supporting the country process of adopting the new working method. The decision has been made to use the cluster approach in all HC countries, but we need to monitor the process and look for impact. The JCM are an opportunity to take stock and identify gaps. We need to look at the most useful support from the GHC in each specific country case. Not all countries require the same support. (2) Support requested included:

• Direct communications with GHC for sharing information and for requesting support • Efforts to build awareness and commitment within partner organizations • Technical experts • Development, dissemination and adaptation support of guidance and tools • Clarification of functions within cluster lead country office • Compile, document and disseminate lessons learned and best practices from cluster

implementation in different settings • Training and capacity building • Inter-cluster linkages at global level • Advocacy • Regional stockpiles and related procedures • Systems for monitoring and evaluation (of effectiveness of country and global

activities) (3) See the power point presentation on JCM to Cote d'Ivoire

• Main findings included; cluster approach adopted in February 08, a month before assessment mission; no HCC; limited WHO field presence weakening its ability to coordinate health at field level; MoH weak capacity; little knowledge of cluster approach; worry about who would handle and ensure follow up to the JCM; consider aligning JCMs with CAPs and CERF preparation; JCM need to include workshop to bring partners together and discuss plan of action based on mission recommendations, and learn about cluster approach and GHC products.

(4) Support requirements as seen from the recently trained HCC include:

• Train the WRs in the countries with cluster approach so they are aware of the HCC and that they can provide input in the selection of the HCC when a crisis happens

• Appoint clear focal points for communication in the HQ for funding and technical expertise

• Provide additional support for non-UN HCC to navigate in the UN system • Direct communications system to HQ and regional offices • Emphasize that in acute crises the EHA coordinator and HCC are two separate people • Establish fund to enable HCC to get started

• Improve future HCC trainings:

o Provide the participants with key bullet points instead of exercises o More emphasis on tools; make training more technical on tools o More emphasis on health systems o A third of the participants were from non-UN organizations, at future

trainings, this group should be larger o Médecins Sans Frontieres (MSF) should be invited to take part in the training.

They are not part in the GHC, but they have been coming as observers, they are key health providers in emergencies

o Train on best practices, especially on coordination (check list more helpful than an exercise

12. Options for the Global Health Cluster 2009 and beyond The newly formed GHC Steering Committee that met the previous day and reported back in point number 9 above, proposed five possible options for the future of the GHC after 2008 (when the current global appeal funding ends):

1. Close up shop 2. Continue to meet for global level consultations but without activities and without any

funding requirement 3. Continue country support activities with help from the Hub 4. Continue country support activities, plus the possibility of developing other products,

with help from the Hub 5. Continue country support activities, plus the possibility of developing other products,

with the help of a reinforced Hub that includes full time technical experts preferably seconded from partner organizations

Discussion: • A paper should be written describing these options by mid June, so that the GHC can

make an informed decision on the way forward. • Agreement from all partners that option 1 was unacceptable. The GHC is a valuable

forum to continue. • The option we choose should be aligned with the thinking of donors. • Some partners voiced support for options 3 and 4, while others thought that option 5 lent

the most potential support from the GHC to a more effective humanitarian response. • Within 2008, the work of the WG on Guidance and Tools will be complete. But more

time will be required to complete the work of the WG on Country Support including training, workshops and tool dissemination. This will require a coherent approach that is expected from WG on Country Support (strategic paper required).

• Any resulting GHC work plan for 2009 and beyond should focus on country implementation and country support.

• We should set goals for the next five years instead of just annual goals. Look at medium and long term goals. State vision, mission, objective (working better together to improve humanitarian health action)

• During acute emergencies, a reinforced Hub should provide technical support and ensure that the HCC has been put in place by Cluster Lead Agency using the roster.

• Some partners wanted to see the Hub remain neutral and inter-agency, and not as a part of HAC. The Hub needs to be perceived as GHC staff and not HAC staff.

• The question was raised about who should be supporting the roll out of the cluster approach: Is it the Hub or is it HAC as cluster lead?

• If the GHC decides to continue to exist in the form of options 3-5, then funding will be required. This should be part of the concept paper from the GHC Steering Committee.

ACTION: The GHC Steering Committee must complete an options paper by mid June, a concept paper by mid September, and arrange a GHC meeting with donors in October. Strategic paper by WG on Country Support to describe a coherent plan for the various activities (HCC training, partner training, JCM, etc) AOB Next meeting will take place in November in North America. Suggestion was made to have the meeting in the field. However that means much higher costs for participants. Erin to make the next meeting arrangements. 13. The meeting was closed by Dr. Eric Laroche, Assistant Director General, HAC/WHO ---End of record---

The World Association for Disaster and Emergency Medicine Background Paper 05 May 2008 This is the 32nd year for the World Association for Disaster and Emergency Medicine (WADEM). The WADEM was formed in 1976 by a group of well-known scientists who recognized the need for a sounding board for discussions and development of ideas and innovations to the processes used and for the study of resuscitation of victims of cardiopulmonary arrest. The initial group formed the Club of Mainz (location of 1st meeting). In 1984, the organization was renamed the World Association for Emergency and Disaster Medicine (WAEDM).

World Congresses for Disaster and Emergency Medicine (WCDEM) have been convened during the odd years at many locations across the world (Pittsburgh, Buenos Aires, Mainz, Hong Kong, Stockholm, Montreal, Jerusalem, Osaka, Lyon, Melbourne, Edinburgh, Amsterdam). The 15WCDEM (Amsterdam) was the most significant and important Congress ever convened by the WADEM, and expectations for the 16WCDEM (Victoria, BC, Canada) exceed the hallmarks established by the 15WCDEM. Regional Congress were organised and convened during the even years beginning with the 1st Pan-American Congress on Disaster and Emergency Medicine (1998, San Jose, Costa Rica). Subsequent regional congresses have been convened in Mexico City, Oslo, San Salvador, Dallas, Reno, and Slovenia.

In 1982, the Association began to publish the Journal of the World Association for Emergency and Disaster Medicine. In 1988, it combined with the National Association of Emergency Medical Services Physicians to evolve its current medical journal, Prehospital and Disaster Medicine (PDM). In 1998, Prehospital and Disaster Medicine separated from the NAEMSP that form its own journal. In 2002, publication increased from quarterly to bimonthly. The Editorial Staff is supplemented by interns provided through the School of Journalism of the University of Wisconsin.

In 1991, in an effort to amplify its role in disasters, the name of the organization was changed to the World Association for Disaster and Emergency Medicine (WADEM). Its mission was revised in 1996:

WADEM is an international, humanitarian association dedicated to the improvement of disaster and emergency health. Fostering international collaboration, the organization is inclusive, culturally sensitive, unbiased, ethical and dynamic in its approach. While individual members are active in field operations, the organization remains non-operational, fulfilling its mission through: (1) Facilitation of academic and research-based education and training; (2) Interpretation and exchange of information through its global network of members and publications; (3) Development and maintenance of evidence-based standards for disaster and emergency health and provision of leadership concerning their integration into practice; (4). Coordination of data collection and provision of direction in the development of standardized disaster assessment and research and evaluation methodologies; and (5) Encourage publication and presentation of evidence-based research findings in scientific publications and international conferences and congresses.

In 1996, the organization was incorporated as a non-profit organization in the State of California.

A horizontal organizational structure for the WADEM, based on the structure of the Cockrane initiative, was approved in 2005. The new structure included the formation of Special Discipline Sections, a House of Delegates, Regional and National Chapters, and Regional Training Centers. In 2005, Monash University (Melbourne) established an Australian Office for the WADEM and the Madison Office has been staffed since June 2006.

WADEM Background paper 05 May 2008 Page 2 of 3

ExecCom

Board of Directors

Task Forces Committees

TF1

TF7TF6

TF5

TF4

TF3

TF2 C1C2

C3

C4

C5

WADEM Sections

House of Delegates

(NGOs, IGOs)

WADEMTraining Centers

WADEM Collaborating

Centers/ ChaptersMembership

General Assembly

NSG

ADM

Vets

Other Intl Nsg Orgs

Other Intl Nsg Orgs

TC1

CCP1

WHO

MSF

ICRC

TC2

Figure 1—Organizational diagram for WADEM as of 2005 Task Forces (TF) Current task forces are responsible for the development of the science and policies associated with specific problems in disaster and emergency health and management:

1. Civil-military collaboration 2. Disaster preparedness, planning, and capacity building 3. Disaster Public Health 4. Emergency Medical Services in the Developing World 5. Landmines and Unexploded Ordinance 6. Chemical, Biological, Radiation, Nuclear, and Explosive Hazards 7. Psychosocial and Cultural Aspects of Disasters 8. Refugees and IDPs (migrating populations) 9. Safe Hospitals and Other Medical Facilities 10. Terrorism 11. Vulnerable Populations 12. Quality Control of Disaster Management (Health Disaster Management: Guidelines for

Evaluation and Research in the Utstein Style) Standing (permanent) Committees (C)

1. Executive 2. Pediatrics 3. Education 4. Research 5. International Law and Ethics 6. Publications 7. Program 8. Membership 9. Extramural Support

Professional Sections Professional Sections are designed to deal with special issues related to specific disciplines and to promote the interests of these disciplines in the parent organization. They will provide liaison with outside organizations with similar goals and objectives. The Nursing Section was proposed in 2003 and

WADEM Background paper 05 May 2008 Page 3 of 3 implemented in 2005. It publishes a tri-annual compendium and interpretation of information cogent to the practice of nursing in emergencies and disasters (Nursing Insight), is publishing an International Disaster Nursing textbook, and a publishes a biannual nursing research Supplement to PDM (May-June; November-December). Other Sections pending include veterinarians, dentists, osteopathic physicians, and administrators. House of Delegates This House of Delegates is a forum to allow external agencies (NGOs, IGOs, and other stakeholders) a voice in the directions, policies, and procedures of the Association. Currently, it is in the formative stages and will require changes in the bylaws of the Association. It is expected to be approved by the General Assembly during the 16th World Congress (Victoria, BC, Canada) in May 2009. Chapters The formation of Regional and National Chapter was approved by the General Assembly in 2007. It is anticipated that Regional Chapters will be aligned with the Regional Offices of the WHO. Several Regional (European, Oceania, Pan-American) Chapters and several National (Greece, India, Indonesia, Eastern USA, Argentina) are in the formative stages and will be formalized during the 16 World Congress. Training Centers

A consortium of Regional Training Institutes is being formalized. Current participants include: (1) Monash University-Melbourne; (2) University of Wisconsin-Madison; (3) University of California-Irvine; (4) Harvard Humanitarian Initiative; (5) ?European Masters. The goals of these Institutes are to: • Create standards and develop and implement curricula to professionalize disaster

health/management; • Design and help to implement emergency medical services systems for the developing world; • Create traditional and electronic forums for discussion and debate between academics, policy-

makers, and practitioners on these issues; • Facilitate research and publications in these areas and create a multilingual, worldwide web

resource for this material; • Facilitate the organization and structure for research and evaluation of interventions and to

encompass this material into a universal database; • Create a modern means for education and training in this area through collaborative between the

participating Universities. • Disperse the workload for development and implementation between the participating Institutes

with each Institute being responsible for the development, validation, and distribution of specific education and training modules for use by all participating institutes. Such activities will increase the efficiency and shorten the timeframe required to implement the much needed education and training in this important discipline; and

• Align these international Institutes with the WHO Regional Offices and serve as an academic and research arm of each of these offices.

Joint Mission Côte d’Ivoire, March 25 – April 5, 08

• TORs:

- Identification health sector’s challenges

- Assessment country capacity (MOH, WHO CO, partners) to perform health cluster functions

- Provision operational recommendations for improvement cluster implementation

Joint GLOBAL Health Cluster

MissionTeam Leader + 3-4

Members Un agencies

NGOs Donors

COUNTRY Health Cluster Partners:

UN agencies NGOs

Donors

Final Workshop

Final Products

Identification gaps/weaknesses to perform Cluster F

Recommendations to address capacity gaps

Plan of action to implement the recommendations

Assessment

Country support

Joint missions

Joint Mission Côte d’Ivoire• Team

WHO: 1) HAC/HQ 2) EHA/AFRO 3) IST/ West Africa

UNICEF: 4) PD Health/HQ GVA

• Meetings, national + field levels: - MOH - WHO, HC, OCHA, ONUCI, Unicef, UNFPA, FAO, WFP - Merlin, IRC, CARE, GTZ, Handicap Int, EMSF, AIP- ICRC - EC

• IAHCC weekly meeting chaired by the HC

Côte d’Ivoire: context Health Coordination

• 2002: rebellion (FN) takes control North cutting the country in half 1 million people flee the North, including all governement rep/staff, as well 85% medical staff, health facilities looted

• 2004: ONUCI, French Army create « zone de confiance », buffer zone between North and South

• 2003-2005: Unicef coordinates health in North

• 2006 Humanitarian Reform introduced (HC,CERF)

Sectoral approach introduced, WHO leads

• 2007: Ouagadougou peace agreement: one counry again

• Jan 31, 08: OCHA workshop on cluster approach

• February 08: cluster approach adopted, TORs of cluster lead agencies to be finalized by IAHCC

• March 08: GHC joint mission

Health Sector Coordination: WHO Capacity

• Central - not a full-time dedicated position- WR = coordinator, no delegation authority and task to EHA focal point, not present at strategic IAHCC meetings- EHA focal point = WR technical advisor/meeting convener- No support team set up for crisis - Lack of ressources

• FieldCoordinator: only 1 in North, irregular presence because short-term contract consultants (Unicef 15-20 staff)- irregular coordination meetings - lack of credibility

Capacity

• Ministry of Health - Weak capacity - Reliance on WHO for technical/Unicef operationnal - Requested preparedness training

• Unicef - Field presence - No partnership at national level

Cluster Approach (CA)

• OCHA workshop Jan 31, 08, adoption of CA

- no added-value seen (HC and others) - « sectoral approach worked well » (?) - little understanding, worse at field level - too vertical (some UN agencies) - to UN centric (NGOs)

Côte d’Ivoire Health Sector• Coordination: information sharing, no strategic planning

• No joint tools/assessment

• No clear population figures IDP 700’000 vs 20’000 Weak surveillance

• Disagreement: some Humanitarian situation most Transition few Development

• Financing: point above direct implications on CAP and CERF

Côte d’Ivoire Summary

Findings highlight WHO main challenges in coordinating the health cluster

• Weak operationnal capacity

• Not traditionnaly engaged in partnership

Côte d’Ivoire Key Recommendations

• Strengthen WHO coordination capacity:

- Recruit Cluster Coordinator

- Increase financial/equipment resources for national/field levels, longer contracts

- Increase WR involvement in strategic meetings(IAHCC)

- Conduct training/workshop for WHO staff and partners

Côte d’Ivoire Key Recommendations (2)

• Strengthen Ministère de la Santé Communautaire/Unité Humanitaire

National capacity - Technical support to Comité de Gestion de Crise (training, info management, policy doc, preparedness, etc) - Establish cellule de gestion crise

Regional capacity

Côte d’Ivoire Key Recommendations (3)

Lead agency/partners

• Parternship: collect data for 3Ws• Coord: regular meetings, gap analysis, etc• Strategic planning • Promote joint ass/tools• Joint monitoring• Advocacy• Provider of last resort

Côte d’Ivoire Recommendations (4)

To address weak operationnal capacity

- flexible leadership at field level: co- leadership

Next Joint Mission

Café du Soleil tonight?



Participant List

Meeting 7-8 May 2008 Geneva

1. Muireann Brennan

2. Barbara Lopes-Cardozo

Centre for Disease Control

3. Johan Heffinck ECHO

4. Mireille Kingma International Council of Nurses

5. Hakan Sandbladh International Federation of the Red Cross

6. Mary Pack International Medical Corps

7. Alessandro Colombo International Rescue Committee

8. Linda Doull Merlin

9. Ribka Amsalu Save the Children, US

10. Elizabeth Berryman

11. Nichola Cadge

Save the Children, UK

12. Wilma Doedens United Nations Population Fund (UNFPA)

13. Nadine Cornier

14. Eisa Hamouda

15. Paul Spiegel

United Nations High Commissioner for Refugees (UNHCR)

16. Edith Cheung

17. Anne Golaz

18. Robin Nandy

United Nations Children's Fund (UNICEF)

19. Sandra Krause Women's Commission

20. Marvin Birnbaum World Assoc for Disaster & Emergency Medicine

21. Mesfin Teklu World Vision International

22. Altaf Musani World Health Organization E. Med. Region

23. Samir Ben Yahmed

24. Rudi Coninx

25. Richard Garfield

26. Erin Kenney

27. Eric Laroche

28. Linda Larsson

29. Daniel Lopez-Acuna

30. Alessandro Loretti

31. Jonny Polonsky

32. Mark Van Ommeren

33. Nevio Zagaria

World Health Organization Geneva

34. Ron Ockwell Consultant, Health Cluster Guide

35. Egbert Sondorp Consultant, Health in Recovery

GHC Review May 08: Working Group 1 : Tools and Guidance Co chairs Nevio Zagaria (WHO) Nichola Cadge (SC UK) Current WG 1 Members

Muireen Brennan CDC Richard Garfield HNTS Linda Doull Merlin Nichola Cadge Save the Children UK Ribka Amsalu Save the Children US Wilma Doedens UNFPA Eisa Hamouda UNHCR Anne Golaz UNICEF Nevio Zagaria WHO Samuel Petragallo WHO Jonny Polonsky WHO Mesfin Teklu WVI Meetings Monthly teleconference updates across WG1. Within sub-groups teleconferences as required.

Next steps Ask if members not present want to actively contribute and participate in

WG 1 and any of the steering groups (SG 1,2 or 3) Confirm workplan with WG1 members and confirm sub-group leads Share TOR and workplan review with GHC for finalisation Follow-up with the SG leads on June and July 08 commitments Request WHO to lead on translation of documents rather than partner

agencies who may not have the capacity or access to appropriate translators

(Work plan attached)

Activity/ProductSub group or steering group members, (leads in bold) Timeline

Next draft June 08Field Testing July- Sept 08Provisional Version Nov 08Field Testing II - 1 year

Consultation and final version late 09

Currently being field tested- Uganda, DRC and ? Somalia Revision Sept 08? Further translation into tools or finalised at that point.3rd draft completed. Steering group meeting held 6th MayNext draft end July 08 Final draft Sept 08Mapping tool already piloted in Darfur, report availableFirst Draft Guidance to be shared at the end Aug 08 Guidance to be finalized by eary Nov 08 for the next GHC mtgPreliminary version to be shared by end of Aug 08Pre final draft beginning of Nov 08 for GHC mtgFinalised product Dec 08Identify intern- June 08Write to various agencies for their tools June 08Select best few of these for diff. situations end Aug 08Finalise selection and guidance notes and upload end Sep 08

Discussions and edits to agree upon revised (shortened) version- end July 08Guidance notes on adaptions July-Aug 08

Develop and Summarize Further Field experience Sept-December 08

8. Develop a database/software system to store and visualise collected IRA data WHO lead (Jonny, Richard, Samuel) First version end Oct 08 (upon IRA finalisation)

Scope partners/health orgs on their current practice July-Aug

Finalise end Sept 08

Prelinmimary draft presented at GHC mtg Nov 08. Final adustments to other tools for coherence in light of GHC mtg and review of this draft end Dec 08Final draft to generic tool end Jan 09 when all the other tools should be completed.Each sub-group is responsible for developing a detailed dissemniation plan for their tools by end June 08Linkages between plans identified and final version end July 08

9. Identify and compile common indicators that measure performance of service delivery and impact on beneficiaries.

Steering group (3)- WHO (Jonny and Richard), CDC (Muireann Brennan), WVI (Mesfin), UNHCR (Eisa), UNFPA (Wilma)

7. Finalise the IRA toolSteering group (3) WHO lead (Jonny), CDC (Muireann Brennan), WVI (Mesfin), UNHCR (Eisa), UNFPA (Wilma)

Share lessons learned report and short version with cluster partners end June 08

Steering group (3)- WHO (Jonny), CDC (Muireann Brennan), WVI (Mesfin), UNHCR (Eisa), UNFPA (Wilma)

Merlin (Linda) and consultant

Current Steering group (2) remains the same- Merlin (Fiona), SC UK (Nichola), IRC (Sandro), WHO (Marizio, Nevio), the consultant (Egbert)

All

4. Elaboration of a Guidance document for Mapping Health Infrastructure, Personnel and Services Availability

WHO lead (Nevio, Samuel)

11. Develop dissemination plan of all products and tools

6. Develop an inventory of tools for comprehensive or specialised health assessments and a guidance note on how to adapt and use them after the IRA during the reassesment of health & health sector needs after the

Terms of Reference and reviewed workplan for 08/09

5. Development of standardized IT support tools for the Mapping of Health Infrastructure, Personnel and Services Availability (Central DB, Data Collection Sheets, Canned Reports, Built-In Analysis, etc.)

WHO lead (Nevio, Samuel)

10. Develop a generic tool for the monitoring the implementation of health services and interventions

Steering group (3) -WHO (Nevio), CDC (Muireann Brennan), WVI (Mesfin), UNHCR (Eisa), UNFPA (Wilma)

Members from Working Groups are included in this steering for the purpose of continuity and expediancy. So the current Steering group (1)remains the same- SC US (Ribka) UNICEF (Ann), IMC (Mary), Merlin (Gillian and Paula), WHO (Nevio), the consultant (Ro

1. The Health cluster Operational guide (incl coordination guidance note)

3. A reference document on health recovery in humanitarian and transition contexts

2. A reference document identifying and addressing gaps in health response

Health Cluster Guide - Process

Pocketbook steering committee 2007

Teleconferences

Active contributors: IMC (Mary Pack); IRC (Sandro Colombo); Merlin (Paula Samson, Gillian O'Connell); SC-US (Ribka Amsalu); UNICEF (Anne Golaz, Robin Nandy); WHO (Patricia Kormoss, Richard Garfield, Nevio Zagaria)

Preliminary compilation WHO March 2008

Working drafts Ron 18 April, 5 May

1 Role and functioning of a health cluster 90%2 Establishing and sustaining an effective health cluster 90%3 Assessing and monitoring the situation 60%4 Analysis, strategy development and planning 60%5 Mobilizing, sharing and managing resources 60%6 Reporting, performance monitoring and evaluation 30%7 Managing and disseminating information 10%8 Standards and protocols 10%9 Promoting early recovery; rebuilding national systems 10%Annexes

Health Cluster Guide - Status

• Next draft mid-June • Field testing 3 months (to July-Sept.)• Provisional version Nov. 2008• Field use (1 year) • Extensive consultations• Final version late 2009

Health Cluster Guide – Way Forward

Health Sector RecoveryHealth Sector Recovery

UpdateUpdateon producing a guidance noteon producing a guidance note

Global Health Cluster meetingGlobal Health Cluster meetingGeneva, 7 May 2008Geneva, 7 May 2008

Objectives of the guidance noteObjectives of the guidance note

Requested by GHCRequested by GHC•• "desired priority product as formulated "desired priority product as formulated

by the Subby the Sub--group on Coordination and group on Coordination and Management"Management"

To produce guidance note on early To produce guidance note on early recovery for the health sectorrecovery for the health sector

Covering both (natural) disasters and Covering both (natural) disasters and (man(man--made) (prolonged) conflictmade) (prolonged) conflict

Key issuesKey issues

What is (early) recovery?What is (early) recovery?

Who will be the users for the Who will be the users for the intended guidance note?intended guidance note?

Will both disasters and conflict fit Will both disasters and conflict fit within same note?within same note?

Disaster Disaster vsvs ConflictConflict

Should read: Acute Should read: Acute vsvs Chronic crisisChronic crisis•• Acute = Acute =

Most natural disasters, some conflictMost natural disasters, some conflictNo overall erosion of national institutes, No overall erosion of national institutes, governance, or health system governance, or health system

•• (at least, not caused by this event)(at least, not caused by this event)

•• Chronic =Chronic =Most prolonged conflictsMost prolonged conflictsSeriously affected institutes / health systemSeriously affected institutes / health system

•• (usually on top of pre(usually on top of pre--existing poor situation)existing poor situation)

The usersThe users

Those in a position to influence Those in a position to influence decision making regarding health decision making regarding health sector recoverysector recovery•• (in a humanitarian setting)(in a humanitarian setting)

So, fieldSo, field--based staff like:based staff like:•• Cluster coCluster co--ordinatorsordinators•• NGO medical directorsNGO medical directors•• Senior MoH officialsSenior MoH officials

Guiding the usersGuiding the users

To have a common understanding of To have a common understanding of health recovery using a health system health recovery using a health system approachapproachTo be able to formulate (initial) informed To be able to formulate (initial) informed responses to health system issues as they responses to health system issues as they emergeemergeTo stimulate taking active decisions for To stimulate taking active decisions for appropriate action appropriate action (e.g. info gathering)(e.g. info gathering)

To avoid mistakesTo avoid mistakes

Recovery and its boundariesRecovery and its boundaries

Development

Emergency Response

Reconstruction

Development

Complex undertakingComplex undertaking

(Early) recovery concept(Early) recovery conceptIssues still 'maturing'Issues still 'maturing'•• E.g. December E.g. December MontreuxMontreux meetingmeeting

How not to get 'bogged down' in too How not to get 'bogged down' in too complex health reconstruction / complex health reconstruction / reform issues reform issues -- fragile states agendafragile states agendaTo write it up in a manageable, To write it up in a manageable, readable format (30readable format (30--40 pages)40 pages)

Progress to dateProgress to date

Three draft versions producedThree draft versions producedSmall steering group establishedSmall steering group establishedSome rounds of discussions, that Some rounds of discussions, that have now led to joint understanding have now led to joint understanding of content and format of the of content and format of the guidance noteguidance notePreliminary identification of 'burning Preliminary identification of 'burning issues'issues'

Outline of guidance noteOutline of guidance note

Short introductory chaptersShort introductory chaptersIntroduction into health system Introduction into health system approachapproach•• 6 building blocks6 building blocks•• Health system performanceHealth system performance

Health System building blocksHealth System building blocks

Outline of guidance noteOutline of guidance note

Short introductory chaptersShort introductory chaptersIntroduction into health system Introduction into health system approachapproachListing of 'burning issues' under each Listing of 'burning issues' under each building blockbuilding blockMore inMore in--depth treatment of number depth treatment of number of key burning issuesof key burning issuesBibliography for further reading:Bibliography for further reading:•• Few 'must read' docs Few 'must read' docs –– annotatedannotated•• Further referencesFurther references

Preliminary (key) burning issuesPreliminary (key) burning issues

Service provisionService provision•• Basic packagesBasic packages•• ContractingContracting

Human resourcesHuman resources•• Training / certification / incentivesTraining / certification / incentives

InformationInformation•• Assessment toolsAssessment tools

Health financeHealth finance•• User feesUser fees

Recovery as an iterative processRecovery as an iterative process ((PavignaniPavignani, HLF on Health , HLF on Health MDGsMDGs paper, 2005paper, 2005))

IASC Reference Group Force on Mental Health and Psychosocial Support1

Health Cluster X

IASC Task Force/Reference Group on Mental Health and Psychosocial Support

Mark van OmmerenDep. Mental Health and

Substance AbuseWHO, [email protected]

8 May 2008IASC Health Cluster meetingGeneva


Handouts

• Brochure• Guidelines• Draft text for general health coordinators


Big thank you to the Health Cluster

• Health Cluster contributed $75000– This funded printing and dissemination of

11,000 Arabic, French, English and Spanish Guidelines

• Health Cluster members provided valuable peer review– On early versions of Guidelines– On first version of an extract of Guidelines for

general health coordinators


IASC MHPSS Guidelines• Developed 2005-2007 by IASC Task Force

(which closed Dec 2007)• Modelled after IASC HIV/AIDS and IASC GBV

guidance• Multi-sectoral, multi-disciplinary• Focus on minimum response• Embodies the collective insight and support of

27 IASC agencies• Product of extensive consultation• High demand: 28,500 copies in print (EN, FR,

SP, AR)


IASC Reference Group on MHPSS

• Started in 2008• Co-chairs: TdH, UNICEF & WHO.• ToR:

1. to interface/link with the Cluster system, ensuring that mental health and psychosocial support do not fall between the cracks of the Clusters’ work.

2. to promote implementation of the Guidelines through orientations, capacity building, case studies, and rollout activities


Interface with Health and Protection Cluster

• These 2 Clusters are main players and need to work together– Health agencies (typically have staff high on medical

hierarchy (e.g psychiatrists) worry about protection approaches that ignore mental illness

– Protection agencies (typically have much more $$$ for MHPSS) worry about overly medical approaches and about ignore key social supports

• IASC Guidelines: complimentary, collaborative approaches are needed

• Recommendation: no separate coordination mechanisms


Ongoing work• Case studies (Colombia, Peru, Sri Lanka, Jordan,

Kenya, Nepal)– Some case studies come with tools

• Brief field summary/checklist (almost ready for publication)

• Briefing papers for coordinators– Brief document on 'essential information on MHPSS for general

health coordinators' (eg of NGOs, Giv, UN agencies)• Publishable by Health Cluster?

– Brief document on 'essential information on MHPSS for protection coordinators' (eg of NGOs, Giv, UN agencies)• Publishable by Protection Cluster?

• Training of trainers being planned


Coming up:

• Small meeting between coordinators of Health and Protection and the Ref Group to discuss coordination in field, followed by broader consultation with key stakeholders.

• review of 'essential information on MHPSS for general health coordinators' and of same document of protection coordinators

• Fundraising for printing of 'essential information for general health coordinators "

Progress on Workplan: Joint Assessment Missions

•

Second year

GHC work plan (2007 -

08): partners agreed to give priority to Joint Country Missions

•

CONCEPT NOTE (March 08) -

Indicative timetable Day 1 to 14

•

First mission to test the concept and determine

approach

for future missions

Côte d’Ivoire, Mar 25 –

Apr

5, 08▪

First joint mission/12 planned

in 2008

▪

12 days: 2 travel, 7 in Abidjan, 3 in Bouaké

(North), Duékoué

(West) cancelled

▪

Part II Côte d’Ivoire mission tomorrowin Session Field Realities:findings

on cluster approach

implementation

Based

on First Mission ► Suggestions for Future Missions (1)

•

Planning: a challenge! ►set dates well

in advance, share

timetable

•

Team composition: 3 WHO (HQ-RO) + 1 Unicef (HQ)

► Essential that

NGO and/or donor

be

in team

•

Meeting planning: missed

key

NGOs, local NGOs, donors

last

►get

list

all key

NGO in country; donors

first

Based

on First Mission ► Suggestions for Future Missions (2)

•

Duration: 12 days, but not included

2 days

fo finalization

of plan of action

►Consensus on POA before

leaving

•

Workshop: none conducted, missed opportunity, little

knowledge

about cluster

approach

despite

OCHA workshop Jan 08 ►Organize

workshop briefing/debriefing, and

central/field

levels

•

Tool: Questionnaire not used ►Revise

methodology: open-ended

questions

Joint GLOBAL Health Cluster

MissionTeam Leader + 3-4

Members Un agencies

NGOs Donors

COUNTRY Cluster Health Partners:

UN agencies NGOs

Donors

Final Workshop

Final Products

Tentative list of GHC participants in country missions with WHOAll to be confirmed

Mar Apr May Jun Jul Aug Sep Oct Nov Dec

C

o

t

e d

'I

v

o

i

r

e

Guinea Afgha

nistan

T

a

ji

k

i

s

t

a

n

Ch

ad

Centr

al Africa

Zi

m

b

a

b

w

e

Eth

iop

ia

So

mal

iaDRC

S

r

i L

a

n

k

a

Hai

ti

Cote d'Ivoire: UNICEF (Anne Golaz) completed 25 March to 5 AprilAfghanistan: FAO (Charlotte Dufour in country) planned for 8-20 May

Or Florence Egal (if she is in country those dates)Guinea: UNHCR (?)Tajikistan: UNICEF (Anne Golaz)Chad: Save UK (Elizabeth Berryman), UNHCR (?), IMC (Mary Pack)CAR: UNHCR (?), IMC (Mary Pack)Zimbabwe: Save UK (Nichola Cadge), UNICEF (Robin Nandy)Ethiopia: Merlin (Linda Doull), Save UK (Elizabeth),WVI (Mesfin Teklu)Somalia: Merlin (Linda Doull),Save UK(Nichola Cadge),UNICEF(Robin Nandy), UNFPA (Wilma Doedens), IMC? (Mary Pack)DRC: Merlin (Linda Doull), Save UK (Nichola Cadge), UNFPA (Wilma Doedens), IMC? (Mary Pack)Sri Lanka: Merlin(Linda Doull),WVI (Mesfin Teklu),UNICEF(Robin Nandy)Haiti: UNICEF (Anne Golaz)



Next

Joint Mission

•

Café

du Soleil tonight?

Myanmar, Cyclone Nargis

Situation now

• 21,000 dead and 40,000 missing

• 1 Million affected

The medium term scenario• 25 Million people living in the affected area

• Malaria• Dengue• Cholera• Snakebites• Food insecurity • Plus all that will come from loss of access to

health care

The goals

• Reduce Avoidable Mortality and Morbidity as promptly and equitably as

possible • and

• leave behind Stronger Local Health Systems

Four lines of work•• Health outcomes and health determinants are recognized,

priorities are agreed upon and monitored•• All opportunities and capacities for health are recognized and

integrated in an inclusive strategy••• Health determinants are addressed and avoidable mortality

and morbidity are equitably reduced•• Health action is sustainable and transition/exit strategies are in

place

• WHO is mobilizing for field assessment and health response coordination in Country

• Shipping first medical supplies for 300,000 people

• Searching 1 Million USD to back-stop the first operations



The aim of this session is to:

agree to any changes to our working arrangements to facilitate the participation of partners and the completion of the 2008 work plan

Session #4



Realities of current working arrangements

4 WGs, 2 Task Forces, 1 Steering CommitteeActive participation in GHC plenary meetings but limited participation in working groupsWHO chairing or co-chairing all working groupsEmail traffic and teleconference schedulesWork not mainstreamed into all organizations



Proposed improvements to working arrangements

Merge working groups to bring together related products while keeping focus on priority areas of workReduce number of working groupsAsk each partner to participate in only one working group to concentrate our effortsEstablish WG co-chairs (one UN and one non-UN)Reduce email traffic by using websiteEstablish regular teleconference scheduleCirculate internal monthly update on progress



Proposed working group structure to complete work plan of 2008

WG on Coordination and Information

WG on Country Capacity Building

WG on Advocacy and Partnerships



WG on Coordination and Information

Objectives

support countries to work together in a predictable and coordinated way by providing the guidance and tools necessary for effective coordination and an evidence-based health response help country clusters to assess their capacities to achieve a coordinated, informed and effective health response and to determine the support needed



WG on Country Capacity Building

Objective

ensure that humanitarian health personnel, including current and future HCC, are prepared and trained effectively in the cluster approach, in the roles and responsibilities of health actors within the cluster approach, and in the common products and services of the GHC



WG on Advocacy and Partnerships

Objective

champion the work of country clusters to gain the support and collaboration of donors, the private sector and southern based international health organizations



Reaching agreement on the best way forward

Working arrangements?

WG structure?

WG terms of reference?

Work plan revisions?

The new and enhanced WG 2

Country support and capacity building

Chair Jillian MerlinActing co chair Altaf, WHO

Define full team members and new tors

What does it include

• Health cluster coordinators training • Joint country missions• Rostering process• Building national capacity of stakeholders• Attracting southern partners and regional-

country training

HCC

• Team debriefing meeting – Notes and NFR to be shared– 2 more HCC trainings to be completed before

end of year – Follow up actions from 1st training

– Point of contact Robin Nandy

Joint Country Missions• New proposal to reduce number of missions to

TOTAL 6– Cote d Ivoire, Afghanistan, Zimbabwe, DRC, Sri

Lanka, Haiti – Re look at TORs and process– Ensure engaged of WHO-RO – Ensure NGO representation – Improve quality of process and outcomes

• Ie workshop– POINT OF CONTACT WHO HAC staff to be

determined

Rosters

• Learn lessons and compliment process of PHPD

• Re look at process– Selection – Admin and HR process

• POINT OF CONTACT EDITH

Capacity building of NS

• Finalize guidance document• Promotion and integration into pocket

book • Agency follow and connectivity with WG 3

regarding mainstreaming

• POINT OF CONTACT Jonathan A

Attracting southern partners and regional-country trainings

• Mini workshops in regions and countries based on UG experience, PHPD content, etc

• Engaged of national authorities and southern partners in such trainings

• POINT OF CONTACT LIZ B

Third group

• This group will serve to define priority directions and areas of work of the global health cluster for 2009 and the longer term

• It will examine and recommend the potential added value of assemblying regularly key humanitarian key actors to ensure coherent and effective humanitarian health action

Global steering committee

• Chairs: WHO/HAC plus 1 NGO • Members: WHO, UNICEF (cross to H,N,

WASH), OCHA, Technical donors, regional rep and country rep

Products

First product:• Options paper on the

role of the GHC 2009 and beyond

• 5 possible options• By mid June 2008

Second product:• Concept paper

– Identifies issues– Options– Strategies– Positions– Priorities

• by mid sept 2008

Issues listNot exhaustive• Roles and functions of GHC• Impact of products/actions• Advocacy• Mainstreaming and obligations• Partnerships (donors, private, south-based)• Branding and marketing• IASC/inter cluster• Phase 2 evaluation

Meeting Agenda



John Knox Center, Geneva 7-8 May 2008

Wednesday 7 May 2008

Day 1 Overview: Review progress on two year GHC work plan; consider new working arrangements for remainder of 2008 to complete work plan; remarks by newly appointed Assistant Director General for Health Action in Crises

Day 1 Expected result: Commitment to work plan, agreement on streamlined working group structure and working arrangements

Morning Chairperson: Linda Doull, Merlin

9h00-9h15 1. Welcome

Robin Nandy, UNICEF

9h15 - 9h30 2. Review of agenda, objectives of sessions, session chairs

Erin Kenney, GHC Support Hub

9h30-12h30

(coffee break 10h)

3. Progress on work plan

(Following the 2008 Work Plan, representatives from the Working Groups to report back on (1) progress and expenditures to date and (2) plans for finalization

12h30-13h30 Lunch

Afternoon Chairperson: Paul Spiegel, UNHCR

13h30-15h00 4. Commitment to work plan, partner participation, new working arrangements

15h00-15h15 Coffee

15h15-16h15 5. Remarks by Assistant Director General for Health Action in Crises

Eric Laroche, ADG, HAC/WHO

16h15-17h30 6. Streamlined working groups meet separately to determine chairs, TOR, and next steps

.

.

Thursday 8 May 2008

Day 2 Overview: IASC issues, field realities of cluster implementation, support needed at country level, and the way forward for GHC in 2009

Day 2 Expected results: Determine functions and responsibilities of GHC in 2009 and beyond

Morning Chairperson: Muireann Brennan, CDC

9h00-9h10 7. Review day's objectives, begin the day

9h10-10h00

8. Report on issues from IASC and their implications on global and country cluster work

Jamie McGoldrick, Head of Humanitarian Reform Support Unit/OCHA

10h00-10h15 Coffee

10h15-11h15 9. Report back from streamlined working groups

11h15-12h15 10. Common current concerns, plans and operations

Alessandro Loretti, Director of Emergency Response and Operations, HAC/WHO

12h15-13h15 Lunch

Afternoon Chairperson: Johan Heffinck, ECHO

13h15-15h00 11. Field realities: implementing the cluster approach and improving the humanitarian health response

15h00-15h15 Coffee

15h15-17h15 12. GHC functions and responsibilities in 2009 and beyond

17h15 13. Closing Remarks

Eric Laroche, Assistant Director General, HAC/WHO

Documents

IASC - WHO · Global r IASC Inter-Agency Standing Committee. Meeting Summary . 7- 8 May 2008 . John Knox Center . ... • The aim is to establish a common understanding of the meaning