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Global Health Cluster (GHC) Partner Meeting

3-4 October 2017, Geneva, Switzerland

Note for the Record

The 23rd Global Health Cluster (GHC) Partner Meeting, held on 3-4 October 2017 in Geneva, Switzerland, was attended

by 60 participants (see annex 1) representing 30 members, 3 observers, 3 Country Health Clusters, 2 other Global Clusters

and 2 Global Cluster Areas of Responsibility, WHO at global and regional level and the Global Health Cluster unit.

The meeting objectives were to:

Review the Emergency Operations Centres and the interface with the coordination architecture.

Address key technical and thematic issues based on partners’ interest and requests.

Review implementation of the 2017 work-plan , including the work of the Health Cluster Support Programme and

the Task Teams.

Finalise the next biennium 2018-2019 work-plan to input into the WHO planning for 2018-2019.

All material related to the meeting is available at http://www.who.int/health-cluster/about/structure/ghc-oct2017-

meeting/en/.

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DAY 1: 3 October 2017

Chair: M. Mustaffa, Mercy Malaysia

Session 1: Openings and introduction (L. Doull)

M. Mustaffa, Chair, opened the meeting and welcomed participants . She invited L. Doull GHC Coordinator to outline the

objectives of the GHC Partner Meeting, and participants to introduce themselves.

Session 2: Opening remarks and update on current situation (L. Doull)

L. Doull gave an update on GHC’s current situation since the previous Partner Meeting in April 2017. This included the

GHC’s newly published Strategy for 2017-19 and its five strategic priorities: 1. Strengthen capacities 2. Inter-cluster and

multi-sector collaboration 3. Strengthen health information 4. Strategic and technical guidance 5. Advocacy. Copies of

the Strategy publication were distributed amongst participants.

L. Doull led a global update, remarking on the number of escalating crises. Hurricanes Irma and Maria had a strong

regional response including deployments from the WHO Regional Office for the Americas, with no request for GHC

support. Emergency Medical Teams (EMTs) from the region were deployed. This move towards regionalized capacity

and response is positive but questions what degree of support the GHC is able to offer and what role it has to play.

LD also discussed the inter-cluster response to famine in the Horn of Africa, and the need to further strengthen integrated

programming by the Health, Nutrition, WASH and Food Security Clusters as part of the famine prevention strategy

discussed at the Joint Nutrition Food and Security Clusters meeting in Rome in April 2017. LD also highlighted technical

gaps in treating cholera in children with Severe Acute Malnutrition (SAM) . Interim protocols have been issued by WHO

but a stronger evidence base is needed.

To date, the response to the rapidly escalating Myanmar/Bangladesh crisis has been regionally led by the WHO Regional

Office for South-East Asia. The IASC Principles are currently considering L3 declaration. WHE EMO Director, R Brennan is

currently in country, there has been an early identification of substantial technical and operational gaps but details of

scale up requirements awaited.

The Democratic Republic of Congo (DRC) presents an already challenging situation, worsened by Kasai crisis, with very

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low partner capacity and extremely limited access. Plague in Madagascar and several other current outbreaks clearly

demonstrates the need for deeper collaboration with the Global Alert and Response Network (GOARN). to address them.

In Yemen, whist daily suspected cholera case numbers remain, there may be over-reporting due to poor adherence to

case definitions in some locations. Confirmatory testing rates are also quite low. Partners are being encourage to place

more emphasis on quality assurance to improve reporting.

LD updated on the state of health cluster partner mapping, numbers and by type, revealing 711 individual partners, with

national partners comprising 55%. She questioned the gaps in cluster response when there are so many partners, and

asked what should be done to increase national partner capacity. Many global partners are absent from cluster

countries, with only 27 out of 49 present in countries, and a maximum of 18 present in any one country.

She remarked on the need to more effectively communicate about cluster needs and impact, as current information

gaps hinder GHC and country cluster ability to leverage sufficient support. The GHC has developed specific country

cluster pages for the GHC website, which the most updates bulletins and other information will be posted. Updates from

Health Cluster Coordinators must be encouraged in quality and frequency.

LD informed partners of GCCG discussions, including on the potential extended role of United Nations Disaster Assessment

and Coordination (UNDAC) to strengthen cluster coordination and fostering closer collaboration with national

coordination mechanisms. There is a need to develop regional partners in preparedness and response.

Finally, L. Doull discussed the potential of the DARES initiative – a collaboration between WHO, UNICEF, WFP and the World

Bank, which aims to more proactively invest in health systems in fragile contexts to prevent their collapse and promote

early recovery (see more in Session 5).

Key discussion points Key actions/recommendations Limited presence of global partners (27 out of 49 partners) in countries was

acknowledged by partners. Partners expressed difficulty in being present in

certain countries due to insecurity, lack of funding, operational risks and scale

of the emergencies. One partner commented they have started partnering

with other organizations to try to overcome some of these challenges.

GHC to further explore partners’

operational presence/capacity,

challenges and opportunities in order to

ensure equitable coverage in

humanitarian response.

Session 3: Strategic Advisory Group report (A. Griekspoor)

A. Griekspoor, Strategic Advisory Group (SAG) chair, introduced the outcomes of the SAG meeting that was held on 29-

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30 August 2017 in Geneva, Switzerland. He highlighted progress against the GHC strategic priorities and challenges in the

delivery of the 2017 work-plan . He recognized the good progress made and the need to further support Country Health

Clusters to implement the guidance provided by the global level.

Key discussion points Key actions/recommendations • Partners recognized the extensive work-plan and confirmed interest in

participating to its implementation. Partners requested the GHC unit to clarify

where partners could best contribute and partners were also encouraged to

proactively offer contributions based on their interests.

• Health Cluster Coordinators flagged the need for timely development and

access to user friendly tools rather guidance. Information management is still

recognized as one of the major needs.

• Financing gap to support implementation of the GHC work-plan and cluster

response was recognized as one of the major concerns and partners

concurred that appropriate advocacy needs to be prioritised.

• Partners to engage based on clear

asks from GHCU and partners to identify

their areas of interest to implement the

workplan (e.g. task teams, country

missions, responding to calls to

comment on global guidance, e.g.

upcoming IASC guidance on dealing

with national authorities, remote

management, etc.)

• GHCU/SAG to finalize advocacy

strategy and plan by the end of the

year. GHCU to hire a consultant and

work together with SAG and interested

partners.

Session 4: Bridging the Humanitarian Development Divide in Health to improve collective outcomes (Chair: L.

Brearley)

The session purpose was to inform partners on what the Humanitarian Development Nexus means for the health sector

and how it influences humanitarian programming.

L. Brearley introduced the Humanitarian Development Nexus and commented on the need for practical approaches to

be taken.

A. Griekspoor led a presentation on the Humanitarian Development Divide, and how it might be bridged. He discussed the

need to encounter the divide flexibly, according to different situations, cultures, approaches and planning frameworks. He

outlined the proposal of joint analysis, joint operational planning and collective outcomes. He finally remarked on the

necessity of a coordination architecture that provides links between humanitarian and development partners.

A. Mallik, Health Cluster Coordinator (HCC) Sudan, discussed the Humanitarian Development Nexus in Sudan, particularly

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the role of the Health Partners Forum and joint multi-year planning, the centrality of the Ministry of Health to the Health

Sector Coordination Forum, and the role of the President as Chair of the National Health Coordination Council.

D. Lai, HCC Afghanistan, highlighted that following 20 years of conflict and substantial funding, humanitarian and

development have already been fairly well integrated. Issues such as maternal and neo-natal health are still very pressing –

shared issues between humanitarian and development. He remarked that emphasis should be on the people affected

rather than on whether the health needs are classed as humanitarian or development. He questioned what the role of

humanitarian response would be if humanitarian and development were fully integrated.

World Vision discussed how they entered South West Somalia in an emergency role. From 2006, their partnership with the

Ministry of Health (MoH) supported the development of the National Tuberculosis Program. Since 2015 they piloted a new

model of partnership for delivery of health and nutrition services, developing a Memorandum of Understanding with the

Ministry of Health (MoH) that was used as template by other NGOs. WV built the capacity of the MoH, gave technical

support on financing, resource mobilization, quality supplies, human resources and recruitment, and leadership. They also

worked on clinical capacity-building, developed standards for management and for services, and were able to leverage

funding from donors to increase services. This lead to reduced child mortality, improved trust of MoH in community, and

qualified staff in mother and child facilities and mobile teams.

Save the Children spoke about the Humanitarian-Development Global Health Task Force convened by the CORE Group

and discussed their four objectives: 1) community health program learning; 2) organizational collaboration; 3) advocacy

for improved resources; 4) advocacy for efficient policy.

The Global Fund discussed the need to adopt flexible approaches for working with humanitarian partners. It noted

potential opportunities for efficiencies in coordination efforts through use of the Health Cluster for some of the Country

Coordination Mechanism (CCM) functions and encouraging participation of humanitarian partners in CCM discussions for

better service delivery.

Key discussion points Key actions/recommendations There is the need for common indicators and benchmarks on how

humanitarian work might connect with existing development work, and

how to transition after. Existing GHC core indicators shall be considered.

Concerns over integrating fully into government run systems when the

national systems might marginalise populations, rather than targeting the

vulnerable.

Need to ensure high quality of medicines and services as much in

GHC to define how to more

effectively undertake joint gap

analysis – humanitarian and

development – to better inform multi-

year planning.

Individual agencies should internally

discuss on bridging their humanitarian

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humanitarian and development.

Working on one year funding plans makes it difficult to integrate into work

of development actors.

If longer term funding is required, there is the need to demonstrate

improvement of services over these years.

Need for funding that is flexible to the situation rather than prescriptive.

and development mandates.

Partners to recognize that GHC has

core indicators. Challenge to ensure

that they are applied universally.

GHCU to ensure Health Clusters

engage with Global Fund Country

Coordination Mechanisms & consider

pilot countries to establish

coordination mechanisms for TB,

malaria, HIV).

Session 5: Localization (Chair: L. Doull)

L. Doull shared information on how Health Cluster Coordinators and partners work with national and local partners and to

explore practical steps the Health Cluster can take to enhance appropriate localization for improved health outcomes.

D. Lai, HCC Afghanistan, discussed the role of localization in Afghanistan, where international NGOs have more funding,

more capacity and generally implement more activities, but where national NGOs have the greater reach and role in

conflict areas. He discussed the difficulties of localization when local partners are less able to protect their staff and

services from risks and attacks, who may have very low funding levels, and who might be limited in their access by anti-

terror legislation. In addition, while national organizations are perceived to be more accountable to the population they

serve and more knowledgeable about the needs of the communities, they are not always seen as ‘neutral’ actors in

conflict areas, that may compromise humanitarian principles.

S. Halimah, HCC occupied Palestinian territory, discussed the challenges of localization in OPT. She highlighted the mobile

clinic model being coordinated through a Mobile Clinic Working Group led by a national NGO. Through this system, 12%

more people were reached in the first 6 months. However, national NGOs have weak monitoring and coordination skills,

and HCCs are not sufficiently trained to provide further training to national NGOs. Yearly funding is not sufficiently secure

for longer planning. Ability to advocate is compromised as smaller organizations face greater pressure not to speak out for

fear of their operations being shut down. Some local organizations were unable to complete the partnering process as it

was perceived as too complex.

M. Copland and A. Nolan, Child Protection Area of Responsibility, Protection Cluster, discussed the role of localisation in

providing child protection services and in particular, the need to work with national authorities when supporting children in

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detention. MC presented a conceptual framework for localization, and used the analogy of localisation as an abacus,

where the ‘beads’ of responsibility can move back or forwards flexibly – it does not require everything to be transitioned at

once. Local actors are now members of the Child Protection’s Global Strategic Advisory Group, helping with work-plan

and monitoring progress. A number of challenges were shared for example: the majority of services are provided by

NGOs, whilst the majority of funding is received by INGOs. The principles of partnership are not universally known, NGOs

were concerned about being in competition, whilst INGOs were concerned about possibility of corruption when localizing.

Partnership can be too focused on sub-contracting and sub-granting rather than actually working together. In Nigeria, all

funding for all partners was earmarked, which meant there was no capacity to retain national and local partners who

could only work for short periods on defined projects. It may be better to implement long term mentoring, with an INGO

sitting in with a NNGO, rather than short bursts of training. Key discussion points Key actions/recommendations

Ability to build capacity of local partners in non-technical health areas,

such as project management and grant management, is missing.

Partners have a larger role to play in training and increased capacity than

do individual HCCs. The role for the cluster could be tracking capacity and

ensuring that partners receive the needed training.

The draft guidance on remote programming and monitoring includes a

section on partnering with local organization

Giving too much responsibility to partners who have recently increased

capacity can overwhelm them and eventually undermine this capacity –

need to spread out capacity building, not just work on one organisation.

Issues of bias: truly biased partners must return funding and halt partnership;

HCCs need to take a stand and ask these NGOs to leave the Cluster. Local

NGOs self-select to work on these areas based on the community they

serve, and they are serving a humanitarian need. We cannot say that these

all must be neutral as their presence gives access to otherwise restricted

areas.

Localisation involves fluctuation as partners may move around or disband,

due to political changes.

GHC to clarify role of Health Cluster in

providing training to implementing

partners.

GHC to recognize that local NGOs

are inherently more able to provide

services in one area and not others

despite perceived impartiality

concerns.

Health Cluster not to overburden local

NGOs that have been recognized as

appropriate but look for those with a

potential that could be invested in.

Provide training for core capacities -

to ensure national implementing

partners have access to appropriate

training on coordination, project

management, resource mobilization,

monitoring and information

management, etc.

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Session 6: Quality Assurance (Chair: S. Walia)

The objective for this session was to share information and explore options for the GHC to address the issue of quality

assurance and how to guarantee the quality of services provided by partners during humanitarian crisis: who should be

accountable for the monitoring and how do we go about joint monitoring. S. Walia asked partners to explore options for

the GHC to embed quality principles and approaches to enhance health service delivery coordinated by the cluster

during humanitarian crisis: who should be accountable for it and what tools can be used. She asked the following

questions and asked partners to work in groups: 1) how do we establish adequate sustainable monitoring systems to ensure

quality assurance? How do we jointly monitor? What are the key responsibilities? Who should be involved?; 2) What are the

possible consequences if an organization does not meet standards? 3) How do we bolster technical capacity for the

Health Cluster? How do we support each other to make quality better? F. Salio, Emergency Medical Teams (EMTs)

described how the concept of quality is adopted by the EMTs, by developing a checklist to assess quality, and setting up a

working group which deals with individual cases of poor quality.

Key discussion points Key actions/recommendations Quality needs to be defined, including both quality of care (patient safety)

and quality of programming health services. It must be related to the

definition of package of essential services. The Health Cluster Guide that is

currently under revision will include a chapter on quality.

Emphasis on quality should be on supporting and approving partners as

much as checking and inspecting them.

In most countries, the MoH is the only body qualified to assess quality.

The cluster itself should have a checklist of standards, not only the EMTs.

A survey could be conducted among Health Cluster Coordinators to solicit

(self-) assessment tools being used, processes in place, standards utilised;

and what the needs are to ensure quality is taken into account.

WHO is repository of technical guidance, and GHC’s role is to make

guidance available to partners. However, WHO general standards are

sometimes too high for emergencies situations, and therefore need to be

adapted. In addition, the technical advice is not always timely.

Partners have professional obligations to adhere to certain standards, this

should be the case even when they sub-contract national NGOs. Funding

for technical assistance when subcontracting national NGOs is often

GHC to define quality assurance for

the Health Cluster, including relation

with Essential Package of Health

Services.

GHC to recognize that each partner is

responsible for quality assurance of its

own operations – Cluster accountable

to the MOH for quality assurance.

GHC to define actions (work-plan) to

improve quality assurance at country

level.

GHC to explore possibility of having

and supporting a global roster

(advocate for the roster but also

advocate for donors to finance) of

technical experts to monitor and

provide technical support for quality

assurance, the need for Third Party

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lacking or deprioritized by donors in their grants. Country level staffing may

be funded but it is regional or HQ NGO staff that ensure quality standards

adherence through remote support to several countries as well as

supervisory missions.

Need to determine which ‘global’ standards are feasible in a range of

varying country contexts. Consideration of whether standards should be

introduced from first day of service, or be met at a later stage in

emergency response. This would depend on different contexts, for example

Ebola necessitates a high standard from the first.

There should be a focus on disseminating best practice, rather than just

minimum standards.

Measures for increasing quality may include education, training, clinical

standards, guidelines, monitoring health of patients after they have used

services, outcomes, patient surveys. It would be good to have ongoing live

platform of standards.

Where standards are not being met, it might be more effective to work on

an improvement plan which includes re-education and training rather than

shutting down services. Using a stepwise approach to improve quality

before stopping activities is recommended.

Gap analysis is key to programme technical support to countries on

specific thematic areas. A globally based surge team could be explored to

ensure this.

Accountability to Affected Populations (AAP) is increasingly important to

delivering quality services.

Monitors, Peer Review.

Session 7: Public Health Information Services Standards roll-out

O. Le Polain, Chair, PHIS Task Team referred to the PHIS Standards published on the GHC website and gave an update

about the implementation of the PHIS Task Team work-plan. He focused on the roll-out of the PHIS Standards and common

challenges, including the impossibility to provide consistent technical support to countries. This is the main reason for slow

pace of country roll-out to date.

Key discussion points Key actions/recommendations Partners welcomed the final version of the PHIS Standards and acknowledged

the progress in this area of work. They agreed on the challenges related to the

GHC to ensure dissemination of

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roll-out.

LD informed partners that current funding to support PHIS roll-out ends 30

December 2017 and whilst a no-cost extension may be possible, this would

only be until 31 March 2018, therefore securing future funding is critical.

products and outcomes from the PHIS

roll-out work (EWARS, public health

situation analysis) through the GHC

website.

Interested partners to join the PHIS

Task Teams, as well as the PHIS TT

forum and GHC SharePoint where

PHIS related information is posted on a

regular basis.

Session 8: Remote Management and Programming

T. Helderman, Chair, Remote Programming and Management Task Team, informed about the steps of the development

process of the Best Practice Guideline for Programming in Access Constrained Environments (PACE). She presented the

latest draft of the Remote Management: Organizational Framework overview and summarized the timeline for the

finalization and roll-out of the guidance.

Key discussion points Key actions/recommendations Partners acknowledged the progress in this area of work and welcomed the

draft version of the Organizational Accountability Framework.

Partners to comment on penultimate

version of the guidance document to be

circulated by mid-October.

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DAY 2: 4 October 2017

Chair: C. Beck, World Vision International

Session 1: Introduction

The session’s purpose was to recap day 1 and introduce day 2.

Session 2: Sexual, reproductive, maternal, newborn, child and adolescent health related updates by the “Every

woman, every child” partners (T. Luchesi)

The objective of this session was to provide GHC partners with an understanding of Every Woman Every Child’s (EWEC) role

in emergencies, as related to its wider Reproductive Maternal Newborn Child and Adolescent Health (RMNCAH) role. T.

Luchesi delivered a presentation on EWEC’s Global Strategy for 2016-2030 and how the GHC might engage to support the

implementation of pillar 6 “humanitarian and fragile settings”. He emphasized that targeting fragile states is essential to

achieve the Sustainable Development Goals, and that women and children are the most effected by humanitarian crises.

Efforts to address these challenges include the revision of the Inter-Agency Field Manual on Sexual and Reproductive

Health in Humanitarian Settings. Breakout groups were then arranged to discuss recommendations on advocacy,

financing and technical expertise that could strengthen this collaboration. Key discussion points Key actions/recommendations

On advocacy:

Advocacy for gap filling, and on resource mobilisation is key.

Advocacy for attacks on health workers should be strengthened.

High level advocacy with heads of state through the EWEC group may help

in addressing barriers faced by humanitarian workers.

On financing:

Separate silos of funding for development and humanitarian are impairing

progress.

Economic and Social Council (ECOSOC) has resolutions to increase

implementation and call for financing, this is a an area newly requiring

coordination.

Connections with Global Financing Facility (GFF) and World Bank shall be

explored. How can the Global Financing Facility prioritise countries with

EWEC group to make a statement to

advocate for woman and child

health in humanitarian settings.

GHCU to include EWEC action in the

GHC advocacy strategy and plan.

The GHC advocacy partners’ network

to have a EWEC focal point.

Must bridge the divide between

humanitarian and development

funding.

EWEC and GHC to consider

upcoming GFF replenishment as

opportunity for additional funding for

maternal, child and adolescent

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funding outside the Humanitarian Response Plan (HRP)? Investment would

overlap with the target populations we have on HRP – transparency is

needed at the country level about different sources of funding.

Humanitarian community must dialogue with development community at

all levels including within multi-mandate organisations.

In countries where maternal and child health are not a priority, country

investment plans need to include fertility related issues.

On technical expertise:

Need to integrate nutrition and health for mothers and children.

Need guidance on costing the delivery of the package of interventions.

Need to manage psychological first aid and Mental Health Gap Action

Programme, in the same way we train for and manage trauma cases.

Need to ensure adoption of relevant guidelines by MoH in countries.

health in humanitarian settings.

Session 3: Sexual and Reproductive Health in Crises: Inter-Agency Working Group

S. Krause led a session on the work of the Interagency Working Group (IAWG) on Reproductive Health in Crises and further

engaged partners. She informed partners about their Training Partnership Initiatives which provide training on developing

technical skills for maternal and newborn care and sexual violence survivors. Their Sexual and Reproductive Health Clinical

Outreach Refresher Trainings (S-CORTS) have master trainers in place to deliver training. Priorities are increasing skills and

knowledge, an emphasis on patient rights, and non-discrimination. S. Krause emphasized the need to transition after six

months from the Minimum Initial Services Pack to comprehensive reproductive health care. Key discussion points Key actions/recommendations

IAWG has developed their tools, including S-CORTS, in order to be easy to

understand and use. Funding is being requested to translate their tools into

further languages than English (French, Spanish, Arabic).

In many countries the basics of sexual and reproductive health are not

known, and there is a need to be able to provide training as well as

guidelines .

Continued holistic work to continue between IAWG and GBV sub-cluster.

Partners commented on need for a RH sub-cluster in each country, need to

be prepared for the huge scale of sexual health needs and what we should

be doing for this.

• GHC to ensure Health Cluster

Coordinators make available SRH

guidelines to partners and facilitate

training organization – each cluster

should have a SRH working group.

• IAWG to share dissemination

strategy/plan with the Health Cluster

network and the AORs. This plan should

specify what HCCs and GHC partners

should do.

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Training that is available through partners is often fragmented and variable

– need for more consistent approach to training and ‘best-practice’

guidelines, such as on clinical management of rape.

Practically implementing IAWG guidelines and other related sexual and

reproductive health guidelines in countries can be very difficult, especially if

sub-cluster involvement is dependent on voluntary contribution of time,

and if there is high turnover of staff in these roles.

Gender-based violence should have a clear role within both Health and

Protection, working with both.

Concerns that shared GBV mandate between health and protection can

lead to it not being sufficiently prioritized by either cluster, or to confusion in

construction and dissemination of standards. Particularly, clinical

management of rape should be made consistent across countries and

across clusters, with constant emphasis on the attitude of provider to the

survivor.

GHC to attend IAWG annual

meeting on 8-10 November

Session 4: Work-plan 2018-2019

L. Doull presented the draft work-plan 2018-2019 that was developed in collaboration with the Strategic Advisory Group.

The work-plan includes activities under the 5 Strategic Priorities. L. Doull also presented the budget overview for 2017-2019.

Key discussion points Key actions/recommendations Partners recognized the extensive work-plan.

In reference to the BPRM funded proposal to further institutionalize Gender-

Based Violence action within WHO and the Health Cluster, there should be

a discussion on how to engage partners in its the implementation.

Health Cluster Support Programme funded by ECHO shall be included in

the budget. Even if the funding is owned by Save the Children, the aim is to

support the Health Cluster. Flexibility shall be maintained in deciding

whether or not to continue with the HCSP approach to surge.

GHC priority is resource mobilization

strategy development (both country

and global).

Partners to engage/commit in the

implementation of the work-plan.

GHCU to share updated work-plan by

end October.

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Session 5: Update from the WHO Health Emergencies Programme

L. Doull provided an update on the new WHO Director-General priorities and the links with health emergencies. The WHO’s

13th General Programme of Work 2019-2023 is under development and 2017’s new Director General Dr Tedros Anhaman

has defined his three core aims as “keep the world safe, improve health and serve the vulnerable”. Two of these three

pillars are inherently linked with the work of the WHO Health Emergencies Programme (WHE). L. Doull also highlighted the

importance of the new DARES collaboration between World Bank, UNICEF, WFP and WHO - which aims to deliver

accelerated results, effectively and sustainably in fragile contexts through a greater emphasis on prevention and

increasing national capacity to deliver essential services. The collaboration selected a number of pilot countries: Yemen,

Somalia, Libya, Central African Republic, Democratic Republic of the Congo, Djibouti, Syria, Haiti. Overall, it is recognized

that partnership is the preferred way to go ahead. WHE is also in the process to develop a global monitoring framework

that is outcome based.

P. Cox described the functional review of the WHE conducted in July 2017 that resulted in the creation of an Acute Events

Management Unit within the Emergency Operations Department. This unit aims to rapidly respond to events of public

health concern. It includes 4 roving Incident Managers, the Global Outbreak Alert and Response Network and the

Emergency Medical Teams.

J. Castilla presented the Fragile, Conflict and Vulnerable Settings Unit which will oversee most protracted crisis, with a

strong emphasis on health systems and recovery, as well as operational readiness.

Key discussion points Key actions/recommendations No discussion points were raised.

Session 6: Emergency Operations Centres (Chair: L. Doull)

L. Doull introduced the aim of the session to improve partners’ understanding about Emergency Operations Centres (EOCs)

and to address a range of issues which have recently emerged from settings, including NE Nigeria and Yemen.

P. Cox, Team Leader, Emergency Operations Centre, described the evidence-based approach and extensive partnership

characterizing the Public Health Emergency Operations Centre Network (EOC-NET). The role of the WHO team is to provide

support to member states and partners in developing public health emergency operations centres (PHEOCs). He

highlighted the Framework for a public health emergency operations centre as a landmark publication (2015) that

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describes the essential requirements for developing and managing a PHEOC. These requirements are fundamental to

ensure the PHEOC functions properly, and stem from the centre having a legal authority and physical infrastructure to

appropriate and dedicated human resources and financial resources.

P. Kormoss, GHC Unit, presented on behalf of J. Martinez, Nigeria Health Sector Coordinator, the experience of the

Northeast Nigeria Emergency Operations Centre. She discussed the triggers that led to the establishment of the EOC, the

expectations, the challenges and interface with the wider coordination architecture. Overall, she summarized how having

an EOC has improved health sector coordination and strengthened the role of the Health Sector Coordinator, who was

able to engage with and mobilized different departments beyond the Ministry of Health, as well as improve collaboration

and communication with the WASH Cluster.

L. Doull, shared observations from her recent mission to Yemen in September 2017 including the trigger to establish the

EOCs being the rapidly expanding cholera outbreak and the Humanitarian Coordinators request to improve information

management to enhance the response; conflicting understanding by partners of why EOCs were established e.g. to

address the cholera outbreak, investing in health infrastructure for the long-term, improve coordination and make the

Health Cluster redundant. Establishing EOCs has been very difficult due to political and operational challenges. There was

evident overemphasis on EOC infrastructure and equipment rather than simultaneous investment in capacitating MoH and

partners to effectively run /engage in the EOC. Aligning the EOCs to existing sub-national health cluster coordination

architecture has been challenging but will be simplified through recent appointment of dedicated SNHCCs working closely

with identified NGO focal points to be based in the EOCs. Training and Terms of Reference for the latter still needed.

Common held perception by humanitarian actors was WHO creating a parallel coordination system, even though that

was not supposed to be the purpose. Some also questioned the feasibility of establishing government run EOCs in a

context of health system collapse and ineffectual governance. OCHA has expressed the need for clear guidance for

Humanitarian Coordinators on how EOCs interface with the broader coordination architecture.

Key discussion points Key actions/recommendations EOCs are not only health focused but can also address management of

disasters with health consequences. The function of the EOC should be

made clear before its established.

Partners questioned the value added of a EOC in countries where a Health

Cluster is already in place, and especially in countries where the

government is not fully functional. Vice-versa, if all countries have a

functional EOC, there is potentially no need for the Health Cluster. Partners

agreed that there should be a clear process to decide whether to establish

Before taking the decision to establish

an EOC, Member States shall look at

existing humanitarian architecture

and define the appropriate

coordination mechanism and

interface with all stakeholders,

ensuring guidance is appropriate to

the context (lighter).

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an EOC based on context specific needs. A steering committee, involving

all relevant stakeholders, could be set up to drive the decision-making

process. Any decision to establish and EOC should involve consideration

of how the EOC interfaces with the coordination architecture, including the

Health Cluster or other coordination platforms.

In the Yemen case, for example, more thought should have been given to

whether the EOC was going to be adding any value. The Health Cluster

was already weak and someone questioned whether it would have not

made more sense to invest in the already existing Health Cluster, instead of

trying to create a new mechanism.

In certain cases, information sharing and management is only about event

specific data and overlooks operational and contextual data.

EOCs can be effective in bringing together certain sectors under the

Ministry of Health that would normally not be engaged, as well as different

relevant ministries.

The WHO PHEOC Framework was recognized as a useful resource but it was

asked whether it would be possible to provide a lighter version for quick

reference by member states and partners.

EOCs should scale up and scale back based on needs, and could be

deactivated if needed.

According to WHO Emergency Response Framework, the Incident

Manager should represent WHO in Health Cluster meetings. The Health

Cluster Coordinator normally reports directly to the WR unless the WR

delegates authority to the Incident Manager.

OCHA specifically requested a presentation on the EOCs to the Global

Cluster Coordination Group, including guidance on principles and

evidence based solutions.

Take evidence-based approach to

document best practices and expert

opinions and produce practical

solutions on way forward in different

contexts. Study should be done in

collaboration between WHO, GHC

and OCHA (at minimum).

Session 7: Technical Guidance

The objective of this session was to update partners on latest developments and seek feedback. C. Knudsen, Director,

Sphere Project, gave a progress report on the Sphere Handbook revision and thanked Health Cluster Partners for their

help.

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A. Griekspoor led discussion on the Cash-based Interventions and Essential Package of Health Services (EPHS) Task Teams.

He discussed current developments with Cash relevant for health, including: the multisectoral basic needs assessment

surveys (useful to determine main barriers to access services or goods, and the minimum expenditure basket) but some

parts problematic for health as it includes prospective questions on predictable expenditures that are not valid for health

needs that are not predictable (how much people think they will spend, rather than what they have spent over a recall

period); how Cash shall be reflected in HRPs and how it shall be coordinated inter-agency wise; Cash working groups

should be made official and integrated into inter-cluster coordination groups; multi-purpose cash proposed to be

separate to other funding in the HRP, with sector specific cash transfers integrated under the sectors; HCCs should be

aware of the right questions to be asked when a cash programme for health is proposed.

His discussion on EPHS concerned: definition and content of the package; individual partners often can’t implement all

services at all levels, lists of an agreed lifesaving package can then be used to identify gaps and seek a partners to fill it;

EPHS needs to be flexible to different situations; we need to invest more consistently in the costing of an EPHS, and need

to give guidance for HCCs and partners on what questions to ask when asking for support to do costing and how to use

this; HERAMS can be used to evaluates availability of services but not quality.

Key discussion points Key actions/recommendations On Cash: Provision of vouchers for health in Ukraine led to the risk of lower quality of

drugs being bought.

Concerns that giving out cash is easier than funding service delivery.

Whilst cash may have some benefits for health, it cannot replace direct

support to health services. Emphasis on multi-purpose cash having benefit

for health, rather than that MPC will replace existing support systems – it

cannot.

We must consider impact of cash upon the health systems, as well as on

individuals.

Important to educate the health community about the limitations and risks

of cash-programming for health.

On EPHS:

EPHS has been implemented in Yemen, we will soon be able to monitor its

effectiveness. Evident gap in unit costs in humanitarian settings.

Must work out a balance between number of services available and the

number of people that can be reached .

Partners should document any cash

based programming they carry out,

using the template developed for

this.

Cash-TT to produce a position paper

on Cash by mid-November, then a

guidance note to follow.

Guidance on costing is a need at

country level as lack of expertise by

WHO Country Offices and partners EPHS TT will develop guidance by the

end of the year on how to design,

cost, implement and monitor an

EPHS

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Concerns that overstating the costs of EPHS so as to appeal for larger funds

will undermine efforts to fund and to work out costs.

NCDs being included in EPHS massively increases cost.

Need to work out guidelines, which services to add if there is increase in

funding, which may be dropped if necessary if there is less funding.

Session 8: Conclusions and next steps

L. Doull concluded the meeting by summarising the key points and related recommendations.

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Organization Title Name Last Name Position

GHC Partners

Members

CARE Dr Jesse Rattan SRHR in Crisis and Emergency Settings

CDC Dr Richard Garfield Team Lead

Department for International Development

Ms Pip Millard Humanitarian Advisor

Emergency and Relief Agency - Arab Medical Union

Prof Ossama Rasslan Secretary General

European Commission Directorate for Humanitarian Aid

Mr Matthew Sayer Team Leader: Health, Shelter, WASH

European Commission Directorate for Humanitarian Aid

Dr Ian van Engelgem Global Health Expert

Helpage International Dr Juma Khudonazarov Humanitarian Health and Nutrition Adviser

International Federation of Red Cross and Red Crescent Societies

Dr Durgavasini Devanath Senior Emergency Health Officer

International Medical Corps Ms Mary Pack Vice President for Domestic and International Affairs

International Organization for Migration

Dr Haley West Migration Health Emergency Operations Officer

International Organization for Migration

Dr Poonam Dhavan Migration Health Emergency Response Officer

International Rescue Committee

Dr Michelle Gayer Director, Emergency Health

International Rescue Committee

Dr Mesfin Tessema Senior Director, Health

Johns Hopkins University - Center for Humanitarian Health and CDC - Emergency Response and Recovery Branch

Dr Mija Ververs Senior Associate/Health Scientist

Malaysian Medical Relief Society

Ms Masniza Mustaffa Health Coordinator

Malaysian Medical Relief Society

Dr Muhammad Iqbal Executive Committee member

Annex 1: List of Participants

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Medair Dr Trina Helderman Emergency Response Officer – Health and Nutrition Specialist

Office of Foreign Disaster Assistance - United States of America

Ms Sonia Walia Public Health and Nutrition Advisor

Office of Foreign Disaster Assistance - United States of America

Dr Jolene Nakao Public Health and Medical Technical Advisor

Public Health England Dr Olivier le Polain de Waroux

Chair Public Health Information Services Task Team

Save the Children UK Ms Rachael Cummings Senior Humanitarian Health Advisor

Save the Children US Mr Jesse Hartness Director, Emergency Health and Nutrition

Terre des Hommes Mr Riccardo Lampariello Head, Health Programme

The Harvard Humanitarian Initiative

Dr Sean Kivlehan Affiliate Faculty

The Harvard Humanitarian Initiative

Ms Stacie Constantian Global health education e-learning specialist

UNFPA Dr Henia Dakkak Programme Adviser

UNFPA Ms Danielle Jurman Consultant

UNHCR Dr Allen Maina Snr. Public Health Officer

UNICEF Dr Muireann Brennan Intercluster Focal Point

UNICEF Mr Jerome Pfaffmann

Women's Refugee Commission

Ms Sandra Krause Director, Reproductive Health Program

World Association for Disaster and Emergency Medicine

Dr Ilya Kovar Vice President, Partnerships

World Vision International Ms Claire Beck Director, Global Technical Team (Humanitarian Operations)

Observers

Sphere Project Ms Christine Knudsen Director

The Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria

Mr Francesco Moschetta COE Senior Project Lead- Grant Management Division

The Global Fund to Fight HIV/AIDS, Tuberculosis and

Ms Sarah Hoibak Public Health M&E Specialist, PHME West Africa Region

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Malaria

The Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria

Ms Ana Maria Baracaldo Consultant COE and Risk Analyst

WHE

Emergency Management & Support

Mr Paul Cox Team Leader

Emergency Medical Teams Mr Flavio Salio Technical Officer

Standby Partnerships Ms Indu Ajay Gautam Technical Officer

Policy Dr Andre Griekspoor SAG co-chair, Senior Technical Officer

WHO other departments

International Health Partnership for UHC 2030

Dr Lara Brearley Technical Officer

Reproductive Health and Research

Mr Rajat Khosla Human Rights Adviser

Other interested parties/speakers

Ministry of Foreign Affairs, The Netherlands

Dr Seriana van den Berg Senior Policy Officer

Permanent Mission of The Netherlands

Ms Hilde Kroes First Secretary Political Affairs / Health

Save the Children UK Mr Thiago Luchesi Senior Advocacy Advisor

OCHA Mr Ali Gokpinar Humanitarian Affairs Officer

WHO Regional Offices

World Health Organization (EURO)

Ms Annette Heinzerlmann Representing Programme Area Manager

Health Clusters

OPT Ms Sara Halimah Health Cluster Coordinator

Sudan Dr Arun Kumar Mallik Health Cluster Coordinator

Afghanistan Dr David Lai Health Cluster Coordinator

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Other Global Clusters

Gender-Based Violence Area of Responsibility

Ms Jennifer Chase Coordinator

Global Child Protection Area of Responsibility (AoR)

Mr Michael Copland Coordinator

Global Child Protection Area of Responsibility (AoR)

Mr Anthony Nolan Consultant

Global Nutrition Cluster Mr Ayadil Saparbekov Deputy Coordinator

Global Health Cluster

Global Health Cluster Ms Linda Doull Global Health Cluster Coordinator

Global Health Cluster Ms Emma Fitzpatrick Technical Officer

Global Health Cluster Dr Patricia Kormoss Technical Officer

Global Health Cluster Ms Elisabetta Minelli Secretariat (Technical Officer)

Global Health Cluster Dr Gabriel Novelo Technical Officer

Global Health Cluster Ms Carolyn Patten Assistant

Global Health Cluster Ms Freya Trevor-Harris Intern