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Tenth Strategic Advisory Group

Face-to-Face Meeting (22 October 2019)

Note for the record

Attended: Apologies: GHC Unit (GHCU):

Claire Beck (CB)

Andre Griekspoor (AG), Chair

Trina Helderman (TH), Co-chair

Michelle Gayer (MG)

Jorge Martinez (JM)

Sonia Walia (SW)

Haley West (HW)

Rachael Cummings (RC)

David Lai (DL)

Linda Doull (LD)

Elisabetta Minelli (EM)

10.1 Introduction

Discussion Decision Action

AG presented the meeting agenda and objectives. • SAG agreed on agenda

and meeting objectives.

10.2 Update on current GHC status and workplan deliverables (L. Doull)

Discussion Decision Action

LD presented the update and progress report for Q3 and

highlighted priority activities for Q4.

• LD reported on the GHC presentation at the WHO Health

Security Council on 21 October and the following asks to

the Director-General: 1) Strengthen investments in Health

• SAG agreed on

questions for M. Ryan.

• SAG to address M.

Ryan in the afternoon

with the agreed

questions.

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Cluster Coordinator & Information Management

positions; 2) Spearhead the launch of new Health Cluster

Coordination Guidance for Heads of WHO Country

Offices as Cluster Lead Agency; 3) As IASC Principal /

CLA – advocate at the highest level to protect & enable

partners to coordinate & deliver collective action.

• LD provided an overview of the latest IASC

developments: review of coordination architecture has

been postponed; Grand Bargain workstreams

expanding to implement the New Way of Working.

• LD updated on the recent developments from the

Transformation and explained the revised structure of the

WHO Health Emergencies Programme including the 3

partner networks. GOARN is situated in the office of the

Assistance-Director General for Response; EMTs within

Country Readiness Team under the Preparedness Division

and the GHC sits within Health Emergency Interventions

within Emergency Response Division. WHE Executive-

Director’s view is that the previous concept of

centralising the operational partnership networks

diminished understanding of their different identities’ and

role: while GOARN and EMTs are specialist surge

mechanisms, the GHC is a coordination platform that

delivers services. LD also described the organizational

shift from a process-based to a result-based

management approach aligned to the strategic

outcomes of delineated in the General Programme of

Work 13 and the 10 strategic outputs for the WHE

Programme. The GHC cuts across three outputs focused

on country readiness; acute response; and fragile,

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conflict and vulnerable countries1. Output networks are

being created across the three level of the organization

with budget allocation based on the following

assumptions: 70% previous biennium budget; 20% at

discretion of output network team lead ; 10% ADG

discretion. Resource mobilization function has been

centralised and currently not clear whether funding will

be available for the GHC activities beyond 31 January

2020, when the current USAID WHO HLTH EMGY PROG

award ends. No-cost extension on this award is not

permitted.

• Regional activity and staffing plans for 2020-2021 have

yet to be shared. Output consultations between

headquarters and regional offices will happen in

November.

SAG noted the following points:

• Recognition of the trend for WHE to focus on outbreaks,

rather than humanitarian emergencies. All hazard

approach is mentioned less often.

• Importance of linking HC work to preparedness and

readiness.

• Revised language from “alternative” to

“complementary” coordination solutions.

In addition, SAG discussed the following points:

• Current WHO leadership prioritizes strengthening national

health systems as first responders to emergencies.

1 Output 2.1.3 Countries operationally ready to assess and manage identified risks and vulnerabilities

Output 2.3.2 Acute health emergencies rapidly responded to, leveraging relevant national and international capacities

Output 2.3.3 Essential health services and systems maintained and strengthened in fragile, conflict and vulnerable settings.

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However, this may not be feasible in certain contexts

and more conflict-sensitive analysis is needed. Discussion

should focus on: when the country requires assistance,

what is the vision on coordination and strengthening

national capacities? International partners often work

through national partners, capacitating the national

staff.

• Recognition of high number of national partners, mostly

national NGOs and Red Cross and Red Crescent

Societies, being partners of the clusters in countries. WHO

role is essential: acknowledging the value added of the

partnerships on the ground and enabling the work of

partners.

• Proposal that partners could be categorized in tiers

based on technical and operational capacity to assure

quality e.g.: tier 1- minimum generic capacity that

should be provided by any humanitarian health actor;

tier 2 agencies that have a specific expertise on certain

thematic issues; tier 3 – specialist expertise and/or can

deliver to all essential services at scale.

• Essential leadership roles at country level are WHO Head

of Country Office, Health Cluster Coordinator and

Incident Mangers, working hand in hand.

• Collaboration with the Universal Health Coverage

division looking at UHC and PHC in fragile conflict

affected settings is ongoing and fundamental.

SAG prepared for the afternoon meeting with M. Ryan, WHE

Executive Director, and agreed on the following questions:

• What is WHO’s vision on health coordination in

emergencies?

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• What is the expectation on partners’ role and

capacities? How can we mutually benefit each other?

• How will WHO invest in cluster capacities at all levels, i.e.

leadership, coordination, resource mobilization?

• Within the context of WHO Transformation, what is the

role of Regional Offices in supporting the cluster

coordination?

10.3 Partners’ capacity (T. Helderman)

TH presented the combined results of the HC international

and national partners’ capacity surveys and highlighted the

following points:

• Recognized gaps can be confirmed and are

concerning.

• Trends are similar across types of partners -

international, national and local – and similar to

trends from 2012 and 2015 international partner

surveys.

• Consistently, national partners seem to be providing

more services than international partners.

SAG discussed the following points:

• What do we do to address these gaps?

• Where should investments be made?

• Is it for international partners to invest in national

partners? Should we be building national partners’

capacities?

• Which technical areas we should invest in?

• SAG decided further

discussion is needed to

consolidate a follow-up

position on how to

address partners’

capacity gaps and

operational barriers.

• SAG decided to further

consider the possibility to

hold a multi-stakeholder

event on response

capacity, with

participants beyond

GHC partners.

• SAG decided on the

points for discussion to

be held at Strategy

Workshop on partners’

capacity gaps and

operational barriers,

• SAG to consolidate a

follow-up position on

how to address

partners’ capacity

gaps and operational

barriers.

• SAG and GHC unit to

explore the possibility to

hold a multi-

stakeholder event on

response capacity, with

participants beyond

cluster partners.

• GHC unit to complete

country level analysis of

national partners’

capacity survey data

and share with Health

Cluster Coordinators.

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SAG recognized that:

• Existing initiatives to build capacity of partners (i.e.

IAWG) may not be fulfilling their role in terms of

guidance operationalization and implementation.

• Partners are often unable to provide a full range of

services because of ear-marked funding they receive

to cover just a few services from a comprehensive

package. The model of one partner supporting one

facility in full - funded through development funding

to which humanitarian funding is complementary - is

not common. Provision or services is therefore very

fragmented.

• Funding often targets the service delivery, rather than

the process to ensure the quality of the delivery of

clinical care. For example, funding is not granted for

mentoring, supportive supervision, quality control. It is

appreciated to have trainings easily available (e.g.

Open WHO platform modules), but operationalisation

of the trainings is a gap.

• Partners draw on the same pool of people to address

humanitarian needs. There is need to expand the

pool of people. Reaching out to academic

institutions to clarify the reasons behind this capacity

gap is essential.

• Country specific analysis of national partners’

capacity survey data will be provided to Health

Cluster Coordinators for consideration on how to

practically address some of the identified gaps in

their particular contexts.

including questions for

GOARN and EMTs.

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SAG discussed the need for the Global Health Cluster to

have a view on how to address persistent technical gaps

and operational barriers which impact on timely and

effective response action.

LD highlighted the importance of organizing a multi-

stakeholder event where stakeholders beyond the Global

Health Cluster, including other WHE networks and external

stakeholders, be brought to the table to discuss solutions on

how to address current gaps. Donors have informally

indicted interest in such an event.

SAG decided the following should be brought for discussion

during the GHC Strategy Workshop session on partners’

capacity:

• Are existing initiatives to build capacity of partners

(i.e. IAWG) working?

• As part of preparedness and readiness, who invests in

building capacity, where and in what capacity

aspects?

• How do we pull on other assets, GOARN, EMTs, Health

System Strengthening/development partners to fill

these gaps?

• How do funding modalities support capacity

building?

• What is WHO’s role in improving quality, including

building capacity of partners?

The SAG agreed the following questions should be

specifically asked to GOARN and EMTs: given the

recognized gaps, how can GOARN and EMTs help build

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cluster partner capacity? Where do they see critical

capacity gaps, from their perspectives? Where can GOARN,

EMTs and the GHC work more effectively together?

10.4 GHC Strategy 2020-2023 (L. Doull)

LD presented the summary version of the strategy

consultation slide-deck, highlighting proposed points for

discussion under each strategic priority during the Strategy

Workshop. LD also presented the main points of the one

pagers of the four thematic areas: 1) coordination in

outbreaks; 2) inter-cluster collaboration; 3) humanitarian-

development nexus; 4) partners’ capacity.

SAG agreed on the final versions of presentation and one

pagers to be used at the Strategy Workshop.

• SAG agreed on final

presentation and one

pagers to be discussed

at the Strategy

Workshop.

• GHC unit to finalise

background

documents for the

workshop.

10.5 Finalize Strategy Workshop preparation (E. Minelli)

SAG reviewed the annotated agenda, the methodology

and process for the workshop.

SAG members considered the importance of having non-

rotating group leads in the discussions on the thematic

areas and strategic priorities.

• SAG agreed on the final

annotated agenda and

the methodology and

process for the

workshop.

• SAG members to be

group leads during

group work on

thematic areas and

strategic priorities.

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10.6 Resource mobilization and SAG members’ terms (L. Doull)

Resource mobilization

LD provided an update

• OFDA grant ends 31 January 2019.

• Netherlands grant covers SRHR work. 6-month NCE

requested, awaiting final approval.

• WHO resource mobilization is centralised. Strategic

dialogue with donors organised centrally, technical

units to contributeNeed greater assurance that CRM

promoting GHC funding priorities /requirements.

SAG members’ terms and upcoming vacancies

• WHO Region seat is vacant: Regional representation to

be reviewed pending Transformation decisions.

• Donor seat: SW’s term ends January 2020. Donors

encouraged to discuss among themselves on their

rotation.

• Co-Chair: TH’ term ended September 2019. LD

suggested TH remains until finalisation of the new GHC

Strategy in January 2020.

• SAG to write a letter to

M. Ryan to address any

funding gap, once

2020-2023 strategy and

2020-2021 work-plan

developed.

• SW to reach out to DFID

and ECHO to discuss

rotation on donor seat.

• TH to remain until

finalisation of Strategy

2020-2023. Vacancy will

open after that.

10.7 Any other business

M. Ryan, WHE Executive Director met with the SAG for the

first time.

What is WHO’s vision on health coordination in

emergencies?

• SAG to have a joint

meeting with GOARN

Steering Committee and

EMTs SAG.

• GHC unit to liaise with

M. Ryan to follow up on

the recommendation

to organise a joint

meeting with GHC

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• There is a difference between government and UN-led

emergency interventions. However, the two concepts

need to be brought together – i.e. Mozambique

response to Cyclone Idai was successful because both

government and Health Cluster managed to work well

together.

• The Health Cluster is a coordination mechanism for

health partners interventions in humanitarian

emergencies, both in preparedness and response. It

supports, facilitates and directs partner action but by its

mandate, does not command.

• EMTs should be deployable assets to any response. EMTs

are pre-trained, pre-qualified, pre-certified clinical

teams. EMTs are also building national capacity for

clinical service delivery and coordination. Building

national capacities is currently the vision for the EMTs

because international EMTs cannot always be deployed

for security reasons.

• GOARN has developed as a deployment mechanism to

provide technical experts, particularly in epidemiology &

surveillance, to support Ministries of Health and WHO in a

government-led outbreak response. GOARN is also

facing challenges related to security.

• Health Cluster partners are often already on the ground

delivering services and are the first to respond. Health

Cluster needs to have a view on how to better align with

EMTs and GOARN and vice-versa. We need to come

together to clearly define roles and responsibilities and

structures in different emergency scenarios, and within

the broader government and IASC humanitarian

architecture.

• SAG to continue

discussion with M. Ryan

on specific thematic

issues on a regular basis.

SAG, GOARN Steering

Committee and EMTs

SAG.

• GHC unit to plan

regular calls between

SAG and M. Ryan on

proposed thematic

issues.

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• However, how can the cluster maintain the humanitarian

principle of independence if the response is led by the

government?

• Question remains how to scale-up quickly in an Ebola-

like situation in a way that responds to everybody’s

needs - how coordination between government and

NGO partners can happen.

What is the expectation on partners’ role and capacities?

How can we mutually benefit each other?

• Most NGOs are working through the national

government and build capacity of national partners,

rather than through an MSF approach of direct medical

capacities.

• It takes time and preparation to build the capacity of an

NGO to scale up. Most NGOs are already stretched to

the limit and it is difficult to expect they will do more.

However, some NGOs have scaled up their capacity to

respond to Ebola. Given the scale of needs, all

humanitarian actors are expected to expand their

capacities to respond to other emergencies. Most NGOs

also have a flexibility issue - NGOs are constrained to

certain activities in certain areas based on ear-marked

funding. What can be done in advance as part of

preparedness to be able to scale-up as needed at a

given point in time?

• Cluster partners have better ability and a unique

opportunity to grow in areas, such as infection

prevention and control, community mobilization, risk

communications. As humanitarian space is decreasing,

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national partners are increasingly often the only ones

who can access some areas.

• Bringing all partners together is needed, as none

individually has the capacity to respond alone. Each

partner has a different role to play. How can we build on

what we have?

• Given the identified gaps in the response, we should

initially bring together a core group of partners, prioritise

the identified gaps and discuss how collectively we are

going to fill these gaps. We should eventually think of

going beyond the usual partners, as currently we cannot

scale up at the reach and speed we need.

• This should be done both for acute and protracted

emergencies. Current work on universal health coverage

and primary health care in FCV contexts is key to define

an essential package of health services, which we

should be able to guarantee at all costs, with quality.

WHO Heads of Country Offices have an important role to

play to advocate for a functional health system based

on primary health care.

• Localisation is also to be considered, but not as the only

answer. International response is still needed in many

contexts. Localisation takes strong commitment and

longer-term funding, with the risk of losing control. It

therefore has an implication on accountability to donors

and costs to monitor the performance of other actors.

About regionalization of WHO within Transformation process,

what is the role of regional offices in terms of supporting the

cluster on coordination?

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• WHO Heads of Country Offices need to be guided to

better understand the role of the Health Cluster and

Health Cluster Coordinators.

• Cluster needs to be recognized as platform for

coordination of humanitarian interventions and

disentangled from GOARN and EMTs which have a

different function. Common understanding is needed at

HQ and regional level. Cluster should not be perceived

as an imposition from headquarters but as a useful

coordination platform, with leadership and information

management capacity.

• If an Emergency Operations Centre has been

established, it was questioned whether a cluster

approach embedded in EOC would enable or hinder

cluster response. Would it allow partners to implement a

response and respect humanitarian principles, in

particular neutrality and impartiality?

• Within the WHO country plans, WHE is committed to

invest in cluster core capacities: Health Cluster

Coordinator and Information Management Officer.

• Preparedness should also consider and plan how the

capacity built among national staff during an

international response will be transferred to the national

health system. This will be different from context to

context, i.e. mobile health care in Syria is not necessarily

building the health system.

Both SAG and M. Ryan acknowledged the relevance and

importance of such discussion and agreed to have

conversations on pre-identified topics on a regular basis.