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UNICEF Evaluation Management Response
Evaluation title: Evaluation of UNICEF’s Response to the Ebola Outbreak in West Africa, 2014–2015
Region: Global
Office: New York headquarters
Evaluation year: 2016
Evaluation report sequence number: 2016/010
Person in charge for follow-up to management response: Mr. Omar Abdi, Deputy Executive Director, Programmes
Overall response to the evaluation: The Ebola epidemic in West Africa was a grim reminder of the stark threat posed to humanity by
communicable diseases. In the aftermath of the outbreak, there is widespread agreement that such threats will continue to arise and
concerns that they may become more complex (because of drug resistance, population growth and other factors). Drawing on the key
findings from this evaluation, the recommendations presented in this report have been key to ensuring that UNICEF can be better
prepared and capacitated to deal with future health emergencies.
Planned use of evaluation: UNICEF is already responding to the recommendations of this evaluation report; most actions outlined
below are under way. The findings are being used to strengthen key management functions to better prepare for and respond to health
emergencies, including through global coordination, strategy development, planning and monitoring. Strategies and results related to
public health emergencies are being integrated into the UNICEF Strategic Plan, 2018–2021. Actions are also under way to strengthen
capacities for rapid, large-scale deployment of financial, human and material resources in all emergencies. Building on lessons learned
from the response to Ebola, UNICEF is focusing on strengthening capacities and systems for health and child protection at the
community level in countries at highest risk of a future health emergency. UNICEF will also strengthen the capacity of staff at
headquarters, regional and country levels as well as government partners on community engagement and social mobilization to better
prepare for and respond to health emergencies in high-risk countries.
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Evaluation recommendation 1: The UNICEF West and Central Africa Regional Office (WCARO), Country Offices (COs) and partners in the three most-
affected countries (Guinea, Liberia and Sierra Leone) should ensure at minimum that: (a) health systems retain a rapid response capacity to prevent Ebola
outbreaks and develop International Health Regulations (IHR) core capacities; (b) community health systems are reinforced in the most-affected communities;
and (c) children most affected by Ebola receive adequate protection.
Management response: Agree.
However, community health systems should be strengthened in all communities in these three countries, as future health emergencies may affect populations
beyond those most affected by Ebola. In addition, actions to retain rapid response capacity and strengthen IHR capacities are predicated upon partner
commitments, and the role of UNICEF is determined within the context of national plans and strategies.
1.1 Retain rapid response
capacity to respond to
epidemic/infectious disease
outbreaks. This includes
establishing/maintaining
response coordination
structures at national and
decentralized levels;
strengthening human resource
capacity at all levels, including
training community health
workers; providing the
necessary infrastructure and
equipment for rapid response,
including the maintenance of
epidemic/infectious disease
care and treatment centres,
improving water, sanitation
and hygiene (WASH)
Health, WASH,
Supply, Social
policy,
Communication for
development
(C4D)
Deputy
Representative and
Chief of Emergency
Child Survival and
Development
(CSD/)/Chief of
Health
Throughout
2017 (and
ongoing)
Under way All three COs have
retained and
continue to fine-tune
the rapid response
mechanism at
country level, in
coordination with
Governments and
key stakeholders
and in line with the
components outlined
in action 1.1.
Country office
reports,
publications and
situation reports1
National plans for
post-Ebola
recovery, and
national health
policies and plans
1 See: www.scoop.it/t/ebola-by-ebola-news-and-views
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infrastructure in health
facilities and disease
surveillance and early warning
detection systems; and pre-
positioning of supplies,
including Rapid Isolation and
Treatment of Ebola kits.
1.2 Reinforce community
health systems in all three
countries, including in the
most-affected communities.
This includes supporting
development and
implementation of the
necessary health policy
frameworks and health
emergency strategies; building
human resource capacity,
including training community
health workers, and
strengthening capacity to
monitor epidemics for early
warning at community level.
COs/Deputy
Representatives/
CSD/Health
Section, C4D
Deputy
Representatives and
Chief of CSD/Health
Section
December
2017
Under way As part of their
support to
implementation of
national post-Ebola
recovery plans, all
three UNICEF COs
are strengthening
community health
systems in the most-
affected
communities.
Actions have
included
development and
improvement of
national community
health policies,
community health
strategic plans, and
community
contingency plans,
providing technical
Country office
reports,
publications and
situation reports2
National post-
Ebola recovery
plans and national
health policies and
plans
2 See: www.scoop.it/t/ebola-by-ebola-news-and-views
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and financial
support to
community health
programmes with
paid community
workers, and
training community
health workers.
UNICEF is also
modelling
innovative
approaches for early
warning and
monitoring of
epidemics at the
community level
using RapidPro.
1.3. Document good
practices, including
Community Care Centre
models in the three countries
(Guinea, Liberia and Sierra
Leone), and share these with
all countries in the West and
Central Africa region
(WCAR) and with partner
organizations.
Regional office
(RO)
Chief of CSD/Health
Section, in
coordination with
Chief of Planning,
Monitoring and
Evaluation, and Chief
of Communication in
consultation with the
Office of Emergency
Programmes
(EMOPS),
Programme Division
(PD), WASH
December
2017
Not started
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1.4. Develop a roster of
experts for health
emergencies, for rapid
deployment to countries
when requested.
RO Chief of Health
Section, in
coordination with the
Emergency Section,
PD, EMOPS, WASH,
C4D, Supply Division
December
2017
Not started
1.5. Develop strategies to
support the Governments of
Guinea, Liberia and Sierra
Leone in designing and
implementing enabling
policies, strengthening
human resource capacity,
and identifying innovative
financing for community
health systems. These
strategies will be based on
rebuilding trust in health
systems, community-based
disease surveillance and
strengthened community
capacity to maintain basic
social services in outbreaks
and broader humanitarian
situations.
RO CSD (Health, WASH,
Nutrition, C4D, Child
Protection) in
coordination with PD
and EMOPS
December
2017
Not started
1.6. Continue case
management so that child
survivors of and children
affected by Ebola benefit
COs Chiefs of Child
Protection
December
2017
Under way All three countries
are:
(a) following up on
Ebola-affected
Reports generated
from the child
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from family visits and home-
based psychosocial support.
children through
case management;
(b) mapping child
survivors or children
affected by Ebola
who did not receive
at least two post-
reunification family
visits; and (c)
conducting follow-
up visits during
post-reunification.
All three UNICEF
COs are also
providing a
minimum package
of child protection
services to children
who lost one or both
parents or
caregivers.3 In
Guinea and Liberia,
respectively, 6,220
and 5,401 children
affected by Ebola
received protection
services,. In Sierra
protection
databases
Child Protection
Information
Management
System (Sierra
Leone)
CO situation
reports
3 This package includes (a) psychosocial support provided through community-based child protection network members; (b) referral of children to other basic social services as
required (e.g., health, education, justice, etc.); (c) distribution of basic supplies, including hygiene kits; (d) family tracing and reunification for children who lost both parents; (e)
placement in alternative family care for orphans whose extended families have not been found; and (f) family visits to ensure effective and sustainable reunification.
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Leone, out of 12,012
children provided
with child protection
services, 5,236 are
orphaned by the
Ebola virus disease.
The case
management has
been successful
partly because of the
establishment of the
Child Protection
Information
Management
System, a database
run by both the
Ministry of Social
Welfare and non-
governmental
organizations
(NGOs).
1.7. Strengthen community-
based child protection
systems (CBCPS) so they can
identify cases early on and
provide necessary support.
COs Chiefs of Child
Protection
December
2017
Under way All three countries
have mapped the
existing CBCPS
that were
established during
the Ebola crisis, and
have activated early
warning systems.
Reports generated
from the child
protection
databases
Child Protection
Information
Management
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System (Sierra
Leone)
Country office
situation reports
1.8. Advocate and provide
technical support for
including child survivors or
children affected by Ebola in
government social protection
schemes.
COs Chiefs of Child
Protection and Chiefs
of Social Policy
December
2017
Under way All three COs are
documenting and
monitoring children
in need of
government social-
protection schemes,
providing technical
support so that
national social-
protection
programmes include
these children in the
existing schemes,
and will conduct
family visits to
verify if all referred
children benefit
from the schemes.
CO monitoring
reports
1.9. Support fundraising to
strengthen child protection
systems at decentralized
level, particularly for
prevention services, early
warning, case management
and referral of children to
RO, COs Chiefs of Child
Protection, Regional
Child Protection
Advisers and Child
Protection Specialists
December
2017
Not started
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other basic social services.
This includes identifying
potential donors and joint
proposal development by the
RO and COs.
1.10. Improve the existing
Child Protection in
Emergencies (CPiE) regional
human resources roster and
train staff and partners on
CPiE, including through the
certification programme on
CPiE developed with the
Bioforce Institute.4
RO, COs UNICEF CO
Representative,
Regional Child
Protection Adviser,
Regional CPiE
Specialist, and
Division of Human
Resources (DHR)
December
2017
Under way The RO is pre-
screening CPiE
profiles for
inclusion in the
CPiE regional
roster. As of
February 2017, the
roster contained 270
profiles.
UNICEF staff
members and staff
in partner
organizations are
being identified for
CPiE training,
which includes a
module on case
management.
CO CPiE
preparedness plans
Existing updated
CPiE regional
roster
Bioforce Institute
curricula for CPiE
Project
Management
Certificate
Training reports
4 In 2016, UNICEF worked with the Bioforce Institute (www.institutbioforce.fr/en), a French organization that provides training, support and accredited certification for humanitarian
professionals, to develop a CPiE Project Management Certificate programme. UNICEF headquarters and WCARO, the Child Protection Area of Responsibility and the Child
Protection Global Alliance have supported implementation of this programme for UNICEF national staff and local NGO partners.
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In addition, the RO
is identifying Child
Protection staff who
will participate in
the more intensive
three-month
Bioforce
certification
program on CPiE.
As a complement to
the RO roster, the
RO is making sure
that country- level
CPiE- preparedness
plans are completed.
Evaluation recommendation 2: The UNICEF Global Management Team (GMT) should develop a policy and accountability framework for responding to
public health emergencies that includes: (a) specific goals; (b) programme guidance; (c) global partnership objectives; and (d) assessment of broader
humanitarian risks. Whether produced as an addendum to the Core Commitments for Children (CCCs) in Humanitarian Action or a separate policy, it should
complement and build on rather than duplicate existing UNICEF emergency response policies and processes.
Management response: Partially agree.
The UNICEF accountability framework does not recognize the GMT as the body for policy or procedure authorization, but rather it is an advisory body, and
delegates this to the ‘business owner as appropriate (defined in the responsible section/s column)’. The CCCs provide the overall framework for action in
humanitarian contexts. We agree that UNICEF should develop the necessary procedures and guidance for responding to public health emergencies as a
complement to the existing CCCs and Simplified Standard Operating Procedures (SSOPs), as outlined in this recommendation.
2.1. Identify key areas of
work that need to be
strengthened to improve
PD/EMOPS/
Supply Division
(SD) and DHR
Health Emergencies
Preparedness
Initiative (HEPI)
March 2017 Under way Under HEPI,
UNICEF has
defined principles
Core Commitments
for Children in
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preparedness, response and
recovery for health
emergencies based on the
existing organizational
accountability framework.
Coordinator/
Principal Adviser on
Health Emergencies
and areas of work5
for preparedness and
response to health
emergencies.
Humanitarian
Action6
UNICEF Approach
to Health System
Strengthening7
UNICEF Health
Emergencies
Preparedness
Initiative (internal)
2.2. Integrate strategies and
indicators aligned to public
health emergencies into the
UNICEF Strategic Plan.
PD/Division of
Data, Research and
Policy
(DRP/)/EMOPS
Directors/Chiefs
PD/DRP
September
2017
Under way Health emergencies
included in the
UNICEF Strategic
Plan, 2018–2021
UNICEF Strategic
Plan, 2018–2021
2.3. Develop sectoral and
intersectoral programme
guidance on preparing and
responding to health
emergencies and recovery.
PD/EMOPS/SD Principal Adviser on
Health Emergencies
in collaboration with
the Directors of PD,
EMOPS and SD
September
2017
Under way As part of HEPI,
first drafts of
‘packages of
support’ for
Category 1 diseases
have been
developed.8
Guidelines and
standards for
Draft packages of
support for
Category 1 diseases
5 Areas of work identified include (a) internal organization and prioritization, (b) disease-specific preparation, (c) institutional strengthening, and (d) cooperation with partners. 6 See: www.unicef.org/publications/files/CCC_042010.pdf 7 See: www.unicef.org/health/files/UNICEF_HSS_Approach_-_5Jun16.pdf 8 Category 1 diseases are Yellow Fever, Dengue, Zika, Chikungunya, Avian Flu, Pandemic flu, Ebola, Marburg, Cholera, Malaria, Measles, Meningococcal disease and Polio. The ‘packages
of support’ for each Category 1 disease include disease-specific quick notes, programme sector guide, supply requirements, repository of guidance, tools, training materials and C4D guidance
and tools.
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UNICEF
community-based
risk assessments still
need to be
developed.
PD/Child
Protection Section
PD Director December
2017
Under way Addendum to the
inter-agency
Minimum Standards
for Child Protection
in Humanitarian
Action, featuring
recommendations
for child protection
preparedness and
response in
epidemics, is being
developed.
Minimum
Standards for Child
Protection in
Humanitarian
Action, Child
Protection Working
Group9
Terms of reference
for developing an
addendum to the
Minimum
Standards for Child
Protection in
Humanitarian
Action
PD/WASH Section PD Director May 2017 Under way Development of a
module on Health
Emergencies in the
UNICEF WASH in
Emergencies
training, which will
be provided to all
Draft training
module
9 See: www.unicef.org/iran/Minimum_standards_for_child_protection_in_humanitarian_action.pdf
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UNICEF WASH
staff.
Evaluation recommendation 3: The UNICEF GMT should recognize areas for improvement and strengthen coordination, strategy and information capacities
for public health emergencies. Drawing on lessons learned from the Ebola response, UNICEF should develop tools, guidance and mechanisms and strengthen
capacities for: (a) global emergency coordination; (b) planning, programme support and performance monitoring; and (c) information and knowledge
management functions.
Management response: Partially agree. The GMT is an advisory body and is not accountable for action on the recommendations.
As noted in response to recommendation 2, tools and guidance are the accountability of the relevant business owner as defined in the responsible person/s and
responsible section/s columns. We agree with the need to strengthen capacities on global emergency coordination; planning, programme support and
performance monitoring; and the information and knowledge-management functions. This will be done in line with the Inter-Agency Standing Committee
(IASC) guidance on L3 activation for disease events.10
3.1. Define leadership and
coordination structure
within UNICEF to prepare
and respond to health
emergencies and identify
and address capacity gaps.
EMOPS/PD/SD Directors of EMOPS,
PD and SD, under the
guidance of the
relevant Deputy
Executive Directors
September
2017
Under way Proposal to
strengthen
leadership and
coordination
structure for health
emergences in
UNICEF was
submitted to the
Office of the
Executive Director
and was agreed to.
Recruitment of
Principal Adviser
for Public Health
Proposal to
strengthen
leadership and
coordination
structure for health
emergencies
(internal)
Terms of reference
for Principal
Adviser for Health
Emergencies
(D-1)
Draft addendum to
L2 and L3 SSOPs
10 The IASC guidance on L3 activation for disease events (December 2016) outlines procedures for the assessment of infectious disease events, the consultation and decision-making processes
on L3 activation for such events, the activation and deactivation criteria and procedures, and the implications for IASC members and other collaborating organizations.
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Emergencies (D-1)
is under way.
Addendum to L2
and L3 SSOPs on
Core Commitments
for Health
Emergencies has
been drafted.
for Core
Commitments for
Health
Emergencies
3.2. Increase physical stocks
in UNICEF of supplies
identified as critical for
priority diseases.
SD SD Director First quarter
(Q1) 2017
Under way SD is finalizing
remaining long-
term agreements
(LTAs) with
suppliers for
supplies identified
in Category 1
disease-supply lists
and has put in place
physical stock at the
SD warehouse or
suppliers’ premises
for these items. All
LTAs will be in
place for Category 1
supplies by the end
of Q1 2017.
LTAs with
suppliers
3.3. Integrate outbreak risks
in the Emergency
Preparedness Platform
EMOPS/PD/ ROs EMOPS Director,
with inputs from PD
Director
Q1 2018 Under way UNICEF Procedure
on Preparedness for
Emergency
Response was
UNICEF Procedure
on Preparedness for
Emergency
Response
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(EPP),11 and monitor
preparedness actions at
headquarters, RO and CO
levels.
Regional Directors
(responsible for
monitoring
preparedness actions
at RO and CO levels)
issued in December
2016.
Roll-out started in
Feb 2017.
Development of
EPP software is
under way.
EPP specification
document
3.4. Review all country
programme strategy notes
for inclusion of anticipation,
planning and response to
health emergencies.
Field Results
Group (FRG) in
collaboration with
ROs, PD and
EMOPS
Directors of FRG, PD
and EMOPS
Ongoing as
COs develop
strategy notes
Under way All strategy notes
produced in 2016
were reviewed for
inclusion of
anticipation,
planning and
response to health
emergencies.
Country
programme
strategy notes
(internal)
3.5. Include reporting on
humanitarian indicators as
part of the annual corporate
reporting.
FRG, in
collaboration with
PD and EMOPS
Directors of FRG, PD
and EMOPS
December
2018
Under way All humanitarian
performance-
monitoring
indicators have been
included in the
Results Assessment
Module (RAM) as
standard indicators.
List of standard
indicators in RAM
11 EPP is a tool (under development) to implement the UNICEF Procedure on Preparedness for Emergency Response, which COs, ROs and HQ will use to plan effective short-
term preparedness activities and to monitor their preparedness levels.
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3.6. Jointly identify and
address key coordination
and research gaps for
cholera control (and other
outbreaks) with the United
States Centers for Disease
Control and Prevention
(CDC), World Health
Organization (WHO) and
other stakeholders.
PD/WASH
Section/Health and
Immunization
PD Director Ongoing Under way UNICEF is leading
the Global WASH
Technical Working
Group of the Global
Cholera Task Force.
Coordination and
research gaps are
currently being
identified, and a
plan will be
developed to jointly
address these with
CDC, WHO and
other stakeholders.
In addition,
UNICEF is
participating in
regional platforms
on cholera in the
Eastern and
Southern Africa
region (ESAR) and
WCAR to
strengthen
coordination and
research with CDC,
WHO and other
stakeholders.
Terms of reference
and workplan for
WASH Technical
Working Group of
the Global Cholera
Task Force
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3.7. Consolidate and
distribute:
(a) lessons learned from
UNICEF and partners’
response to outbreaks;
(b) data on morbidity and
mortality from
epidemic/pandemic-prone
diseases with a focus on
children;
(c) outbreak risk
assessments; and
(d) research articles,
guidelines, tools and training
material.
PD/EMOPS/SD Principal Adviser on
Health Emergencies,
in collaboration with
the Directors of PD,
EMOPS and SD
Ongoing Under way Updates on
morbidity and
mortality related to
Zika and other
priority epidemic
diseases have been
consolidated and
disseminated to
UNICEF
headquarters, ROs
and COs.
UNICEF Sharepoint
site on public health
emergencies, which
contains key
updates, guidance
and tools, has been
established.
Zika updates
(internal)
UNICEF
Sharepoint site on
public health
emergencies
(internal)
Evaluation recommendation 4: The UNICEF GMT should continue to strengthen capacities for rapid, large-scale deployment of financial, human and
material resources in emergencies by: (a) applying lessons and protocols from the Ebola response on duty of care; (b) significantly increasing emergency
human-resource capacities and emergency competencies in country offices; and (c) involving operational and administrative staff in strategy and programme
management.
Management response: Partially Agree.
As noted in response to recommendations 2 and 3, the GMT is an advisory body and is not responsible for such actions. EMOPS will support the designated
coordinator for health emergencies to coordinate components 1 and 2 of the recommendation. Component 3 – involving operational and administrative staff in
strategy and programme management – will be addressed through guidance under the Health Emergencies Preparedness Initiative.
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4.1. Clarify duty of care
measures and procedures for
personnel operating in
health emergencies.
DHR, with
EMOPS
DHR Director December
2018
Under way UNICEF
participates in the
Global Working
Group on
reconciling “duty of
care” for United
Nations personnel
while operating in
high-risk
environments,
which is under the
United Nations
High-level
Committee on
Management.
A UNICEF template
and procedure has
been developed to
review the duty of
care upon
declaration of a
public health
emergency.
UNICEF template
and procedure to
review the duty of
care upon
declaration of a
public health
emergency
4.2. Map existing expertise
and develop multisectoral
surge roster at global level
for outbreaks and health
emergencies response.
DHR, with support
from EMOPS, PD
and SD
Directors of DHR and
EMOPS, PD and SD
December
2017
Under way SD roster with
supply logistics and
Emergency
Response Team
staff has been
expanded to include
staff with a
SD roster
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background in
health emergencies.
Evaluation recommendation 5: UNICEF EMOPS and the UNICEF Programme Division should further develop the community-based approach as an
implementation modality inclusive of strong AAP [Accountability to Affected Populations] and community engagement components. Recognizing the central
role of communities in stopping Ebola, UNICEF should focus on strengthening local capacities and systems for health and social protection at the community
level. This effort should include means of increasing capacity within UNICEF for community engagement and social mobilization and improving programme
integration at the community level.
Management response: Agree.
5.1. Establish community
engagement coordination
platforms in key countries
(in line with cluster
arrangements). This is an
initiative co-led by UNICEF,
the United Nations Office for
the Coordination of
Humanitarian Affairs,
International Federation of
Red Cross and Red Crescent
Societies, and the
Communicating with
Disaster-Affected
Communities Network.
EMOPS/cluster
leads and
Humanitarian
Policy Section
(HPS), PD/C4D
EMOPS/cluster leads
and HPS, PD/C4D
Ongoing
through 2018–
2019
Under way The global inter-
agency
Communication and
Community
Engagement
Initiative for
emergency response
was established in
Q4 2016.
Inter-agency C4D
guidance for health
emergencies (Zika)
(internal)
Inter-agency C4D
guidance for health
emergencies
(Yellow Fever)
(internal)
Draft concept
note/workplan for
Communication
and Community
Engagement
Initiative
5.2. Strengthen UNICEF
C4D capacities at CO and
RO levels to address health
emergencies. This includes (a)
PD/Health Section,
in collaboration
with all sectors and
the C4D Section
PD Director Ongoing Under way New York
University Outbreak
Communication
course: A total of 50
Curriculum of the
Outbreak
Communication
20/20
Action Responsible
section/s Responsible person/s
Expected
completion
date
Implementati
on stage:
Not started
Under way
Completed
Cancelled
Action taken Supporting
documents
training UNICEF staff and
technical personnel on
outbreak communication; and
(b) training relevant
government institutions
involved in preparedness and
response to health
emergencies on C4D and
community engagement in the
context of outbreaks.
UNICEF CO and
RO staff (C4D and
monitoring and
evaluation) have
been trained and are
now deployable in
emergencies.
Training will be
expanded in 2017.
Staff from
Ministries of Health
in 16 countries in
ESAR were trained
on C4D and
community
engagement in the
context of outbreaks
by C4D/Polio teams
in June 2016.
Training will be
expanded to WCAR
in 2017.
course and list of
trained personnel
Reports from
training sessions
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