Study Summary: ‘Strengthening Global Capacity for Emergency Health Action’
Friday, 29th March 2019
GHC Partners Meeting:
GHC Emergency Response
Final Report
GHC Emergency Response
Overview
2
▪ Introduction
▪ Methodology
▪ Findings & Discussion
▪ Country case study
▪ Recommendations
▪ Questions
3
▪ Introduction
▪ Methodology
▪ Findings & Discussion
▪ Country case study
▪ Recommendations
▪ Questions
GHC Emergency Response
Overview
4
Workforce
Study Objective:
Clarify critical emergency health gaps and actions being taken by international and
national health actors, specialised agencies and training institutes to address the
current imbalance between response capacity supply and demand
GHC Emergency Response
Introduction
Study Research Questions:
1. How can the evolving demand for
humanitarian health workers be more
effectively met?
2. How can organizations better meet the
demand for humanitarian health delivery?
3. How can health responses be better
coordinated to ensure timely, appropriate
and effective addressing of emergency health needs?
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Collaboration
Programme Delivery
Workforce
Context
GHC Emergency Response
Introduction
Study Considerations
▪ Focus on acute phase of emergencies
▪ Tangible and targeted recommendations
▪ Inform different stakeholder groups
▪ Not a mapping
▪ Not a discussion of humanitarian financing or security
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Workforce
GHC Emergency Response
Introduction
7
▪ Introduction
▪ Methodology
▪ Findings & Discussion
▪ Country case study
▪ Recommendations
▪ Questions
GHC Emergency Response
Overview
8
Workforce
GHC Emergency Response
Methodology
Key informant stakeholder group distribution
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GHC Emergency Response
Methodology
Study Limitations
▪ Sample Size
▪ Non-traditional actors
▪ English Language
▪ Technology/Access
▪ Not a systemic or exhaustive literature review
▪ Recommendations based on the study data
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GHC Emergency Response
Methodology
▪ Introduction
▪ Methodology
▪ Findings & Discussion
▪ Country case study
▪ Recommendations
▪ Questions
11
GHC Emergency Response
Overview
Findings
▪ Key informant identified gaps
▪ Key informant identified solutions
▪ Literature identified gaps
▪ Literature identified solutions
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GHC Emergency Response
Findings
Workforce Gaps
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GHC Emergency Response
Findings
Workforce Gaps
Expertise
▪ Technical Skills
▪ Public health
▪ Medical skills
▪ Understanding the humanitarian system
▪ Operational Skills
▪ Management
▪ Supply chain
▪ Experience
“Basic management [is a
gap]. This is where the
strategy gets lost” (UN008)
“Getting people with no
humanitarian experience to
the field is a massive
challenge in the sector.”
(INGO010)
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GHC Emergency Response
Findings
Workforce Solutions
Expertise
▪ Technical & Operational Skills
▪ Leverage organizations with existing trainings
▪ Partnerships for training
▪ Regionalize approach to training
▪ Experience
▪ Expand mentorship systems
▪ Formalize mentorship systems
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GHC Emergency Response
Findings
Workforce Gaps
Availability
▪ Insufficient health sector workers
▪ Limited numbers at baseline
▪ Limitations in types
▪ Brain drain
▪ Long term availability for response
▪ Expense
▪ Release for deployment
▪ Security of deployment locations
“we have few actual clinicians;
[…] some health workers -- such
as midwives, assistants, lab
technicians and ORC technicians
and anaesthetists -- you [can]
count the number on your hand”
(GOV001).
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GHC Emergency Response
Findings
Workforce Solutions
Availability
▪ Insufficient health sector workers
▪ Little if anything to be done to build national workforce in an emergency
▪ Maintain clearances for national staff
▪ Harmonize salary for national
▪ Long term availability for response
▪ Develop partnerships (ex Iceland)
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GHC Emergency Response
Findings
Workforce ▪ Define standardised competencies for specific categories of humanitarian
health workers
▪ Allow for targeting of education and training program content
▪ Use the most relevant learning modality
▪ Include management training for all levels
▪ Investment plan for education
▪ Evaluate educational programs
▪ Develop structured systems for gaining experience
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GHC Emergency Response
Discussion
Programme Delivery Gaps
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GHC Emergency Response
Findings
Programme Delivery Gaps Human Resources
▪ Permanent staff management
▪ Funding for core positions
▪ Core funding to NNGOs
▪ Surge management
▪ Recruitment processes timing
▪ Diversity
▪ Readiness of surge staff
▪ Staff burnout
▪ Flexible funding
“We have one grant, then get
another grant. Because the
positions are paid through the
grants, we lose people when we
finish grants. We spend time and
money to build up the capacity of
staff and we have to release them
when we finish our grants”
(INGO006)
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GHC Emergency Response
Findings
Programme Delivery Solutions Human Resources
▪ Permanent staff management
▪ Raise unrestricted core funds
▪ Full time emergency response staff (ex SAVE)
▪ Watch country emergency teams (ex IRC)
▪ Surge management
▪ Global & regional recruitment (ex Africa CDC)
▪ NGO – Academic partnership a for roster
▪ Expanding/develop staff well-being programs
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GHC Emergency Response
Findings
Programme Delivery Gaps Operations & Logistics
▪ Supply chain
▪ Weak systems
▪ Drug purchasing restrictions
▪ Emergency protocols
▪ Data driven response
▪ Decision making
▪ NNGO organizational capacity
▪ Inclusion of non-traditional actors
▪ Transitioning from humanitarian to development
▪ Flexible funds
“much like with our NGO
colleagues, [logistics] is an issue.
I was surprised at the limited
medical logistical capacity
within [the organization]”
(UN002).
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GHC Emergency Response
Findings
Programme Delivery SolutionsOperations & Logistics
▪ Flexible funding*
▪ WHO contingency funding for emergencies
▪ Novel funding sources (ex START Network)
▪ Non-traditional donors (ex ICVA)
▪ Public-private partnerships (ex Africa CDC)
▪ Supply chain
▪ Front loading supply
▪ Partnerships with strong logistic organizations
▪ Emergency protocols
▪ Used of shared data platform (ex Ebola)
▪ Multi-year funding to support transition (ex Sida, ECHO)23
GHC Emergency Response
Findings
Programme Delivery Gaps Security
▪ Risk management
▪ Institutional risk tolerance
▪ Access
▪ Infrastructure investment
▪ Technical expertise
▪ Logistics
“[…] In the place where people
were dying there was [a couple
organizations] but hard to
access and hard to help. But in
the periphery, there was a lot of
access and actors. So, they had
less effect and there was a
partial market. So, it looked like
there was enough people but in
reality, not enough.” (UN003)
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Programme Delivery Solutions*Security
▪ Thorough risk assessments
▪ Strategy
▪ Investment
GHC Emergency Response
Findings
Programme Delivery▪ Define core staffing needs
▪ Target recruitment
▪ Surge roster management best practice guidance
▪ Conduct roster readiness activities
▪ Self assessment of organization’s operational effectiveness
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GHC Emergency Response
Discussion
Programme Delivery▪ Emergency protocols and SOPs for expedited processes
▪ Delegated decision making – ‘no regrets’ approach
▪ Integrate situational appropriate data collection into all programmes
▪ Regionalise response
▪ Invest in NNGO organizational development
▪ Flexible funding
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GHC Emergency Response
Discussion
Collaboration Gaps
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GHC Emergency Response
Findings
Collaboration Gaps
Coordination
▪ Expertise
▪ Expertise of the cluster coordinator
▪ Management skills
▪ Integration of humanitarian and development
▪ Knowledge of the humanitarian system
▪ Inclusion of nontraditional actors
“…we need to respect authority
and leadership of member states
and encourage them to develop
the capacity, technology and
knowledge, rather than go with
backpacks and leave and they
benefit nothing. So that
philosophy of capacity building
and authority is important”
(GOV004)
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GHC Emergency Response
Findings
Collaboration Solutions
Coordination
▪ Expertise
▪ Trial other methods of coordination (ex CORE)
▪ Integrate coordination mechanisms (IMS)
▪ Knowledge of the humanitarian system
▪ Engage nontraditional actors in the system
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GHC Emergency Response
Findings
Collaboration Gaps
Partnerships
▪ Strategy for partnering
▪ Use of partnerships
▪ Localization
▪ Developing local partners
▪ Power dynamic
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GHC Emergency Response
Findings
Collaboration Solutions
Partnerships
▪ Strategy for partnering
▪ Define partnership strategies
▪ Monitor partners
▪ Localization
▪ Develop partnerships in advance
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GHC Emergency Response
Findings
Collaboration
▪ Evaluate partnerships for humanitarian health response
▪ What is the strategy?
▪ What is most effective and when?
▪ What are successful examples/models and why?
▪ Engage national organizations in a meaningful context appropriate way
▪ Build NNGO capacity
▪ Develop partnerships in advance for crises prone areas
▪ Engage with government
▪ Invest in and build at-risk countries’ emergency health coordination capacity
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GHC Emergency Response
Discussion
Collaboration
▪ Engage with non-traditional actors
▪ Continue efforts for humanitarian systems education
▪ Study best practices from their engagement in response
▪ Define tangible definitions and approaches to the HDN
▪ Define common language and terms
▪ Integrate coordination mechanisms
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GHC Emergency Response
Discussion
Summary
of the
Gaps
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GHC Emergency Response
Findings & Discussion
▪ Introduction
▪ Methodology
▪ Findings & Discussion
▪ Country case study
▪ Recommendations
▪ Questions
35
GHC Emergency Response
Overview
Iraq Country Case Study Purpose
1. Gain field perspective on the gaps in humanitarian health response capacity identified by global key informants
2. Assess how the recommendations may be interpreted in a specific response context
GHC Emergency Response
Country Case Study
Key Informant Interviews
▪ 38 key informants across stakeholder groups
▪ Semi-structured interview
▪ Prioritisation exercise based on global data
▪ Interviews in Baghdad and Erbil
▪ Direct observation - cluster meetings & field programming in Mosul
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GHC Emergency Response
Country Case Study
Summary of
Findings
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GHC Emergency Response
Country Case Study
Workforce
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GHC Emergency Response
Country Case Study
Workforce Gaps Expertise
▪ Technical Skills
▪ Public health – absence of system/training
▪ Medical skills – emergency context
▪ Understanding the humanitarian system
▪ Operational Skills
▪ Management
▪ Supply chain
▪ Experience
▪ Recruiting high caliber international staff
“We only had 2-3
epidemiologists to rely on. We
don’t have an academic
specialization in public health in
Iraq.” (GOV-IRAQ-04)
“Doctors think that they are not
managers, they are doctors. But
we need doctors to run the
hospitals or health centres. Is it a
shame to manage a health
centre? It is not, but it is
somehow perceived as such. In
fact, it takes more skills to
manage a hospital”
(GOV-IRAQ-02)
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GHC Emergency Response
Country Case Study
Workforce Gaps Availability
▪ Insufficient health sector workers
▪ Limited numbers of specialists at baseline
▪ Limitations in types (e.g. no prosthetic technicians)
▪ Brain drain
▪ Long term availability for response
▪ Experienced & specialized health sector workers unable to be recruited
▪ Security
▪ Time needed
“When I first visited district
hospitals, I was surprised. You
can find MRI and microscopic
surgery there. Iraq uses US
medical curriculum at university
[… and] doctors are trained in
English. […] The problem is that
we have a brain drain.
(UN-IRAQ-08)
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GHC Emergency Response
Country Case Study
Programme Delivery
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GHC Emergency Response
Country Case Study
Programme Delivery Gaps Human Resources
▪ Permanent staff management
▪ Competition among national staff for salaries
▪ Surge management
▪ Timely recruitment processes
▪ High turn over of staff
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GHC Emergency Response
Country Case Study
Programme Delivery Gaps Operations & Logistics
▪ Supply chain
▪ Weak systems
▪ Drug purchasing restrictions
▪ Emergency protocols
▪ Data driven response
▪ Slow decision making
▪ NNGO organizational capacity
▪ Transitioning from humanitarian to development
▪ Flexible funds
“We brought in additional
logistics teams and got lots of
help from outside, but as [x] we
don’t have a logistics system.
I’ve said before in a regional
meeting: ‘why are you bearing
this pain why not hand over
logistics to Alibaba?’”
(UN-IRAQ-05)
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GHC Emergency Response
Country Case Study
Programme Delivery Gaps Security
▪ Risk management
▪ Limited pool of national and international staff willing to join the response
▪ Partnerships with local organizations
“We have reached the highest
peak of risk aversion created by
a strong sense of institutional risk
related to a duty of care. INGOs
are extremely risk adverse. On
this I disagree with my
colleagues, they don’t invest in
understanding the context. They
don’t invest in security
regulations that enables action.”
(DON-IRAQ-03)
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GHC Emergency Response
Country Case Study
Collaboration
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GHC Emergency Response
Country Case Study
Collaboration Gaps Coordination
▪ Expertise
▪ Needed to be present early on in the crises
Successes
▪ Team approach (coordinators & data)
▪ Geographic distribution of the cluster based on the context
▪ Technical working groups
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GHC Emergency Response
Country Case Study
Collaboration Gaps Partnerships
▪ Strategy for partnering
▪ Use of partnerships
▪ Localization
▪ Developing local partners
▪ Power dynamic
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GHC Emergency Response
Country Case Study
▪ Introduction
▪ Methodology
▪ Findings & Discussion
▪ Country case study
▪ Recommendations
▪ Questions
49
GHC Emergency Response
Overview
Workforce
▪ Define standardised competencies (Donor, INGO, NNGO, UN)
▪ Accessible, competency targeting, evidence based training (Donor, Academia, INGO, NNGO)
▪ Systems for gaining experience (Donor, INGO, NNGO, Private Sector, UN)
▪ Research training effectiveness (Academia, Donor)
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GHC Emergency Response
Recommendations
Programme Delivery
▪ Surge roster best practice management guidance (Donor, INGO, UN)
▪ Assess organization’s operational effectiveness (Academia, INGO, NNGO)
▪ Emergency protocols and SOPs to expedite administrative and operational response activities (INGO, UN)
▪ Regionalise response (Donor, INGO, UN)
▪ Flexible funding (Academia, Donor, INGO, NNGO, Governments, UN, )
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GHC Emergency Response
Recommendations
Collaboration
▪ Evaluate how, when, and where humanitarian partnerships can enhance humanitarian response (UN, academia, donor)
▪ Engage and support non-traditional actors in health cluster activities (UN)
▪ Build emergency health coordination capacity in at risk countries (Donors, Governments, INGO, UN)
▪ Define tangible definitions and approaches to the HDN (Academia, Donors, Governments, INGO, NNGO, Private Sector, UN)
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GHC Emergency Response
Recommendations
Study Summary: ‘Strengthening Global Capacity for Emergency Health Action’
Friday, 29th March 2019
GHC Partners Meeting:
GHC Emergency Response
Final Report