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GlobalHealth Cluster

IASCInter-Agency Standing Committee

Meeting Summary

14 and 16 November 2007

Hosted by WHO, Geneva

Participating Agencies: Meeting Agenda

AHA, CDC, ECHO, HHI, IFRC, IMC, IOM, IRC, MDM, MERLIN, OFDA, SC UK, UNFPA, UNHCR, UNICEF, WC, WHO, WVI Complete list of participants

1. Opening Remarks, Dr. Samir Ben Yahmed, Director HAC/WHO WHO is pleased that so many have been able to attend today and grateful for the commitment and contribution which many have made to the work of the Global Health Cluster since the last meeting in NY. Participation and involvement of partners remains one of the strengths of the Global Health Cluster.

This meeting comes at an important juncture. There have been three developments over the past month that should be mentioned: First, the Cluster Evaluation report. WHO has some reservations about methodology and about the evidence for some of the findings. But there are two key points to note: (1) the report is positive overall about the cluster approach and states that it is widely supported and resulted in "some systemic improvement in coordinated humanitarian response" and (2) the issues raised about health (and other) clusters about leadership and operational capacity are issues we should take seriously.

Second, the views of donors. There was an important meeting between cluster leads and donors on 30 Oct to discuss the evaluation report among other subjects. The donor position can be summarized as supportive of the cluster approach but donors want to see results for their $60m investment in global clusters and they want to see convincing plans for mainstreaming cluster work.

Third, re-affirmation of the commitment to the cluster approach by the IASC Working Group. The pace of roll out of the cluster approach over the past year has not proceeded as fast as was planned. But there is a re-affirmation of the commitment of the IASC WG which is very significant. The Rome Statement commits to the roll out process over the next year.

What does all this mean for our meeting? That the cluster approach is here to stay and has the backing of the international humanitarian community and that the Global Health Cluster must do

more to provide relevant support to clusters at country level. We must deliver on our work plans and show results for donor investment. And we need to deliver quickly. We have too little to show for the money and time invested. We need to review why it has taken so long to develop training, guidance and other products. And more importantly, we need to act. But since we all share a common goal and a determination to make this work, I am sure we will succeed in doing so.

2. Report back from working groups: WG Coordination and Management • WG reported on the status of its ongoing products. • The WG is aiming to close the current work in the coming few months by field testing and

finalizing the tools and guidelines on health mapping of partners, gap analysis guidance, coordination guidance and health sector recovery guidance.

• The new focus of this group will turn towards the production of the GHC Pocket Book; the steering committee has been formed with representatives of the GHC WGs; the first version of the PB skeleton is complete

• The WG recommended that the work on "benchmarks" be transferred to the IM WG to encourage a bottom up approach.

• The groups estimated funding needs for 2008 are $80,000. • For more details see the power point on Report back from WG on Coordination and

Management and the Meeting summary of the WG on Coordination and Management WG Information Management • For details see the Meeting summary of the WG on Information Management • The WG discussed the field testing of the initial rapid assessment tool and the future work of

the WG. A revised and achievable 2008 work plan for this WG would be develop by the chair in consultation with members before the break out session on products on 16 November.

• Estimated funding needs $280,000

WG Training and Rosters • See Meeting summary of the WG on Training and Rosters • Tony Laurance and Robin Nandy are now co-chairing this WG • The HCFC training competencies are now final and an agreement has been made that the

training should revolve around those rather than any technical issues. • Estimate funding needs for 2008 are $350,000.

WG Capacity Building of National Stakeholders • See Meeting summary of the WG on Capacity Building of National Stakeholders • See Terms of Reference Health Cluster on Capacity Building of National Stakeholders • The guidance will focus on acute emergencies and provide instructions or tips to ensure that

country clusters keep the focus on capacity building of national stakeholders to provide basic health services.

• This guidance could be used as an entrance to getting southern NGOs on board • The WG will close when the guidance is complete, by the end of February.

Ad Hoc Group • The objectives of the Ad hoc group were to determine the relative priority levels of activities

currently on the Health Cluster work plan that have not been undertaken by a working group, to identify those activities that should remain on the 2008 work plan, and to determine expected result, timeline and resources required to complete each. The group looked at four specific work plan items: emergency library, contingency planning, stockpiles and cross cutting issues products.

• To begin the discussion about a possible an health cluster emergency library, Dr Nada Al

Ward, of WHO/HAC presented a power point of the HELID (Health Library for Disasters), its history, its inter-agency origins, its listings, and its role in strengthening capacity at country level. The Global Health Cluster could choose to adopt and adapt the HELID as a resource; it could also consider having representation on a future editorial review board so cluster interests are taken into consideration and so that Health Cluster products are included. This would require some financial assistance for participation such as travel. The Ad Hoc group continued to support the idea of a Health Cluster library of references. It was suggested that the HELID could fill that purpose, but that other similar libraries needed to be researched as well before a decision was taken. The proposal was made that the Pocketbook Steering Committee should review the HELID and other libraries in relation to the bibliography that it is currently putting together. Due to limited funding for 2008, this was not set as a priority except within the Pocketbook budget, however, it was agreed this should be considered for work after 2008.

• For Contingency Planning, Dr. Alessandro Loretti, Director, ERO in HAC/WHO presented

a power point on Planning for Emergencies. He reiterated that the agreed cluster-wide planning parameters are for three emergencies per year affecting 500,000 each with the possibility of two simultaneous events. Planning includes mechanisms and routines, an operational platform and preparedness for early action. He clearly differentiated between global contingency planning and country level contingency planning. There was agreement that the Health Cluster partners should individually and collectively promote health in various existing mechanisms and to make incremental improvements in how we work jointly at the global level before and during emergencies. It was agreed to make a collective effort to network around the Early Warning quarterly bulletin, to hold a teleconference periodically to discuss specific areas of concern, and to read and promote the new contingency planning guidelines. It was agree that common mechanisms and procedures for global action during emergencies should be developed; however, partners in this Ad Hoc group did not see this as a priority for 2008 due to all the other products they were working on jointly. This should be among the Global Health Cluster's next priorities after the current work plan is completed. No funding was deemed necessary to put aside at this time.

• For common stockpiles, a print out of a presentation was distributed entitled Health Cluster

Stockpiles that outlines the considerations and decisions required by the Global Health Cluster to make headway on the procedures and arrangements for common stockpiles. The Ad Hoc group found the information very useful and recommended that ideally a few partners would work with WHO on making headway on this issue. However, once again, the group preferred to prioritize the pared down 2008 work plan and prioritize the finalization of the ongoing work and the country focus. This however should remain on the Global Health Cluster work plan for when the current work is complete, even in the second half of 2008, but that no funding would be required.

• For the cross-cutting issues products, the Ad Hoc group reviewed the items on the 2007 work plan. The agreement was to use the limited funding to ensure that all Health Cluster products are reviewed by the various cross-cutting experts, and also to ensure that all the cross-cutting documents are reviewed to ensure that the health sections are consistent. In addition the group agreed that if funding is available that the Health Cluster should uphold its commitment to finalize the mental health guidelines translation, printing and dissemination. However, other cross-cutting issues products should only be funded if any funds remain after the 2008 work plan is drafted.

3. IAWG on Reproductive Health in Crises, Sandra Krause, Women's Commission

• There was a power point presentation on the IAWG on Reproductive Health in Crises. • The IAWG Field Manual, which is currently under revision, is setting the standards for

reproductive health. NGOs and UN agencies are working jointly on reviewing and updating the field manual.

• Minimum Initial Service Package (MISP) for reproductive health is a set of priority activities that should be implemented in the beginning of every crisis. The MISP consists of activities to prevent sexual violence and provide care to survivors, reduce the transmission of HIV/AIDS, prevent maternal and infant death and a plan to provide comprehensive reproductive health services.

• IAWG has requested WHO to have one person assigned to reproductive health so that this issue does not get fragmentized and overlooked in the case of a crisis.

• There was discussion as to why reproductive health has somehow "fallen off the radar screen". This issue must be taken up by the Health Cluster to ensure its visibility and application.

• For more information please visit: • Women's Commission • IAWG on Reproductive Health in Crises Situations The IAWG calls upon WHO, the lead of the Global Health Cluster, to demonstrate its commitment by including comprehensive reproductive health--as defined by the ICPD and outline in the IAFM-international humanitarian program work plan and budget • IAWG also calls upon the Global Health Cluster to include comprehensive reproductive

health as a specific core component of humanitarian response. 4. Health Cluster Benchmarks, Richard Garfield, HAC/WHO

• There is an expectation (not least from the IASC) that the global clusters will develop measures for assessing their impact on beneficiaries. Such measures have sometimes been called benchmarks but that is a misnomer. There is a need to decide what can be measured, what is going to be measured and what is not going to be taken into consideration. It is also important to consider who will do the measuring and who and what the measures are for. There is no point in developing methods unless someone will use them and this may include other organizations as well as those of the Global Health Cluster. We also need to clarify if we are trying to assess the impact of clusters or of the humanitarian intervention or both. The focus for the data collection should always be: what is the data going to be used for?

http://www.womenscommission.org/projects/rh/index.php

http://www.rhrc.org/iawg/

In discussion, it was pointed out that:

• Impact on beneficiaries in terms of health outcomes (e.g. mortality) would be difficult to measure and would be a longer term undertaking.

• Process indicators might focus on coordination mechanisms, participation, the quality of plans etc. These might be difficult to assess or measure objectively but that does not mean they are invalid.

• Output indicators could include the coverage of projects, the speed of response, etc. • Richard finished his presentation by stating that the discussion had been focusing on

indicators and not benchmarks. The term benchmark mistakenly implied that we have a lot to measure. We should determine if the cluster approach is working, but we will not learn this by doing a comparative evaluation 'before and after' model.

Action: The IM WG will develop a concept paper to clarify and explain more fully these ideas and to propose next steps. 5. Presentation of Pocketbook, Mary Pack, IMC, Pocketbook Steering Committee Co-Chair • A Steering Committee has been formed with representation from all the Global Health

Cluster Working Groups. • The pocketbook should be seen as a common road map for the cluster lead and cluster

partners to follow. • The process was agreed that the SC would provide expert input on the individual sections

and that a writer would be commissioned to pull it all together. Action: The Steering Committee to meet regularly to complete the pocketbook by deadline of March 2008.

6. Presentation of the HHI's Humanitarian Health Conference Report, Regan Marsh, HHI

• The Humanitarian Health Conference Report is now available, based on the conference hosted at Harvard 6-8 September 2007.

• The next meeting is planned for early 2009. 7. Overview: Evaluation, Rome Statement, Roll Out, Mainstreaming, Donor Expectations Daniel Lopez Acuna, Director HAC/WHO

• This overview was accompanied by a power point presentation on Evaluation, Implementation and the Rome Statement.

• The final version of the evaluation report is complete. This evaluation is more a survey of opinions than a credible evidence-based report. It is important to have standard methods for evaluation.

• The Rome Statement is an important affirmation coming out of the latest IASC WG meeting in Rome. It clarifies that states have the primary responsibility in emergencies and that local governments and existing structures must be taken into account.

• The statement confirms that the cluster approach is not to be seen as a parallel exercise to already existing frameworks. It is to be a complement to national actors, to support structures that exist, give a clear division of labor, and develop existing capacity. The Health Cluster needs to make sure that the approach is a country driven process and that support is given to empower national stakeholders. The GHC needs to build up country capacity to do the process of implementing the cluster approach. In the case where the government is not sufficient, it is not to be overrun by external actors; it is to be taken into the account. The implementation process needs extensive support from the member organizations.

• The statement also outlines a plan to map the capacities of countries with Humanitarian Coordinators by March 2008 with a plan for how to strengthen that capacity to ensure readiness as quickly as possible. This could be a constructive area of collective work for the Global Cluster to assess capacity and provide necessary gap filling measures. Considerable strengthening may be required in some countries. This stocktaking exercise could entail getting countries briefed, ensuring that the country cluster is knowledgeable, mapping stakeholders, and designing a roadmap for implementing the cluster approach in terms of the steps and resources required to move forward.

• Donors will have to be brought into the stocktaking process to understand the needs and to ensure that all ingredients are available.

• It is important for WHO, as the cluster lead, and partners to have a clear picture of the gaps that need to be filled in all the countries where the cluster approach will be implemented.

• There is no blue print to be used for every country. In each country we have to ask the questions: Who are the actors? What is the need? There has to be an agreement with the Humanitarian Coordinator in each country and we need to ensure there is a mapping of the all humanitarian actors.

• In any case, the implementation of the cluster approach and the need for global backstopping is an ongoing effort over the longer term.

• Many partners noted that they have capacity, willingness, expertise that should be tapped and pooled with the aim of reinforcing the country cluster at country level.

• IASC WG also approved the Contingency Guidelines and stated the importance of preparedness in acute as well as chronic emergencies.

7. Report from Country Cluster Representatives on Priority Needs from Global Cluster

• The country cluster and regional representatives together developed a power point presentation on Country Cluster Issues that presented the issues for the Global Health Cluster to consider from the country perspective.

• There are too many misconceptions and a lack of information on the cluster approach and the work of the Global Health Cluster in the field; a common misperception is that the cluster approach is a UN driven process.

• There is a need to orient/educate the UN agencies, IASC partners as well as local partners about the cluster approach.

• The cluster lead agencies need to strengthen existing capacities in countries. • The partners need to consider actions towards sustainability of the cluster work before,

throughout and post emergency. • The IASC should clarify triggers for implementation and triggers for exit. • Levels of implementation need clarification depending on the country situation and the

level/magnitude of the emergency.

• The implementation and the guidelines need to be improved. The recipient of these guidelines will probably be one person, so how will this person use them? It is time to think about coherence between the clusters.

• The global cluster needs to advocate for the approach, its added value, and what the global cluster can provide as support.

• Suggestion was made to create a "one pager" with more accessible information explaining the cluster approach and how it supports the government and national stakeholders.

• National stakeholders are not going to accept the cluster approach if they think that their power will be taken away from them.

• The capacity of the lead is the key to success of the approach in any country. • Why only about response and recovery? Why not get together in country beforehand?

How does a cluster relate to a UNDMT? How will the HCFC be accepted…by the WR, by WHO and by cluster partners?

• The global cluster can support by providing a common reporting template, common information, common guidelines (often countries have their own), etc.

• The common website is already a positive step to support the cluster approach. • It is essential to remember that the cluster approach exists to support the government;

HCFC must recognize this. 8. Introduction of Health Cluster Strategic Planning Session, Tony Laurance, HAC/WHO

• The framework for the development of the Health Cluster work plan is outlined in the paper entitled Global Health Cluster and the Way Forward which was circulated in advance.

• Priority areas were developed in light of the experience and knowledge of the Global Health Cluster since initial funding was received in late 2006. These priority areas are:

1. Continuing to strengthen collaboration and coordination at global level through joint meetings and activities

2. Finalizing policies and products (tools, guidance, training etc) which support implementation of the cluster approach at country level; and reviewing and updating them over time in the light of field experience

3. Promoting implementation of the cluster approach and use of global products at country level within partner agencies and organizations and within regional and national stakeholder organizations

4. Strengthening leadership 5. Implementing joint strategies for resource mobilization and advocacy

• To discuss the way forward on these five areas of work and to appropriately include related activities in the 2008 work plan, while considering the activities still underway, and the funding and staffing limitations, participants were asked to participate in four breakout groups as follows:

1. Health Cluster leadership and membership 2. Existing work plan and completion of products 3. Promotion, integration and implementation of the cluster approach and of

global products at field level 4. Resource Mobilization/Advocacy

9. Report back from Break Out Groups Products • The objectives of the break out session on products • The current work plan was discussed line by line with representatives from each Health

Cluster working group to make sure that the plans were realistic in terms of time and money. • The group made significant progress towards developing a Draft Work Plan of Global

Cluster Products for 2008, but did not have time to finish. This draft should then be used as part of the final work plan that will include elements from the other break out groups.

Implementation/promotion/integration • The objectives of the break out session on implementation/promotion/integration • Two priorities: promotion of the cluster approach and promotion of cluster products • To promote the approach: orientations at country level, stocktaking exercise in countries

with HC, fund vertical integration of individual partners, piggyback on OCHA workshops and encourage WASH and Nutrition representatives to do the same.

• To promote pocketbook: collective and individual efforts through visits, training, workshops • Need to promote not only in chronic but also in preparation for acute emergencies. • Recommend training of trainers about the approach and about the pocketbook • Recommended budget $300,000

Leadership and Membership • The objectives of the break out session on leadership and objectives of the break out session

on membership • To improve leadership we need leadership training that is situation specific; HCFC are only

one part of the solution; field exposure and experience as well as exposure to other agencies and organizations is crucial; we need also to develop a mentoring programme. All this will raise the chances of success for the clusters.

• Good leadership requires a strong team; cluster partners have to look to train and support their cluster staff

• Strong health leaders can be constrained by weak HC or Nutrition or WASH leadership. • The Global Cluster should find solutions in order to bring in missing key health actors such

as CARE, MSF, ICRD, etc; research is needed to understand why they do not participate • The Global Health Cluster should tap regional networks to seek out southern based NGOs • No specific recommendation were made concerning criteria for Global Health Cluster

membership Resource Mobilization/Advocacy • The objectives of the break out session on resource mobilization/advocacy • WHO and partners have agreed to mainstream Global Health Cluster costs; partners should

budget for travel expenses required and for additional staff to ensure participation in various activities of the Global Health Cluster; small or southern based partners should be supported by the Global Health Cluster, perhaps through WHO funding

• Number of annual meetings of the Global Health Cluster should be reduced to save money; location should be the (collectively) least expensive.

• Any country cluster costs would be included in individual country project costs and appeals. • Any projects of the Global Health Cluster after 2008 would be appealed for individually.

• While HAC and the Health Cluster are completely separate, they are intrinsically linked. One cannot do well without the other; partners should help HAC to reach out to donors for HAC funding.

• The cluster should send representatives to the Humanitarian Aid Committee (involving 27 donor countries); this takes place every couple of months.

• By May 2008, the Global Health Cluster should begin to have a strategy and work plan for 2009.

• Advocacy issues should include funding for functions and not only for activities; work to get donors on board now and not only in 2009, meet with donors continuously; consider revolving fund for emergency health

• Recommended budget 66,000

10. The Way Forward • By this session, the elements of a strategy and work plan for 2008 came together.

Agreement was reached to move from product development to country focused activities, to promote both the approach and the Global Health Cluster products (pocketbook). It was agreed that products should be completed within the first quarter of 2008, so that funding and time could then be shifted to the stocktaking exercise and field visits of global partners. Given the lessons learned about the time and resources of individual partners to contribute to the Global Health Cluster, it was agreed that the work plan should be pared back to a realistic and achievable set of activities for 2008, while keeping a list of those activities that might be appropriate for 2009 and beyond.

• The Support Hub was tasked with pulling together a work plan from the information and

priorities outlined by the working groups on 14 November and by the break out groups on 16 November, keeping in mind the funding limitation for 2008.

Action: Support Hub to complete a draft work plan and send out to WG chairs and Break Out Group chairs for comments. Work Plan to be finalized by 30 November. End of summary



Breakout Session:

Leadership Strengthening: Identify Actions and Funding Allocation

Friday 16 November 2007

Objectives:

Make practical suggestions strengthening leadership of country health clusters and be as specific as possible (who, when, where and funding requirement):

• other ideas for developing health cluster leaders

• how can country partners help to strengthen the cluster and the lead

• consider the question of co-leadership; would this help? If so, how should it be taken forward

Keep in mind:

• ongoing work on rosters, HCFC training, pocketbook (and all related products)

• the global cluster for 2008 has limited partner time and resources ($1.4 m) for ALL its activities within the 5 priority areas (of which this is one)

• recommendations will then be weighed in plenary against those of the other break out groups



Breakout Session:

Global membership and meetings

16 November 2007

Objectives:

• determine criteria for membership to global health cluster

• make recommendations to the plenary on how the global cluster can enhance its membership

Keep in mind:

• criteria must be specific enough to allow for selection

• consider the question of southern membership and what Dawit has suggested

• note conspicuous absentees (MSF, CARE, ICRC, MDM, Mercy Corps); can we do anything about this

• recommendations should include the actions required to achieve the recommendation, who will do those actions, by when and the estimated resources required





Breakout Session:

Resource Mobilization: Identify Actions and Funding Allocation


Objectives:

Make concrete recommendations on the following (and be as specific as possible):

• How will global cluster partners fund their ongoing work with the global health cluster (participation in meetings and activities in 2008)?

• How will global cluster partners fund their ongoing work with individual country clusters?

• Is there any case for collective advocacy for the costs of clusters?

Keep in mind:



Country Cluster Issues

Neil Claire KalulaDemissiePatrick Roderico

Questions

What is the context and background in which the cluster approach is applied? Does the concept still stand ?

What are the misconceptions we need to clarify?

What is the added value?

Should we consider extending the cluster to preparedness and recovery work ?

Is this where we are headed ?

Steps we need to consider


Orient/educate UN, IASC partners and local partners

Misconceptions clarifiedLegal mandate policy Implementation of guidelines needs improvement Other parallel UN structures: UNDAC UNDMT


Staffing structures Clarity of roles with existing EHA staff Reporting issues

Cluster leads need to strengthen capacities Consider actions towards sustainability of the cluster work pre, during and post crises- eg, funding issues- CERF etc


Clarify triggers for implementation and triggers for exit

Levels of implementation need clarification depending on country situation and level/magnitude of emergency

Future direction/priorities

Refocus –country roll out and cluster leadership is the priority



The Way Forward

Framework for Developing a Strategic Plan and Work Plan

I. Purpose One of the objectives of the next global health cluster meeting is jointly to take stock of the Global Cluster's contribution to the cluster approach and to determine the way forward for its further work. This paper provides a framework to help shape the discussion. It describes the role of the Global Health Cluster, the main accomplishments to date and some of the challenges, both at global and country level. It proposes a revised set of strategic priorities for the work of the Global Health Cluster for 2008. It also discusses ways of working - how it could carry out its business more efficiently and expeditiously The two year funding for the global cluster ends in March 2008. While current funding and activities may run into the later months of 2008, the Global Health Cluster needs to take stock of progress and decide on both the shorter term and the longer term priorities at the November meeting II. Role of the Global Health Cluster Within the greater scope of the cluster approach, the role of the Global Health Cluster is to contribute to a more effective humanitarian health response at the country level by:

• Bringing together key international humanitarian health agencies and organizations to develop a shared approach to this common purpose

• Jointly producing and endorsing common guidance, tools and training. • Ensuring that its principles and its products are integrated and supported within

and throughout individual member organizations • Providing a forum for collective advocacy and resource mobilization • Maintaining health's profile on the humanitarian agenda • Work collectively to improve the coordination of the humanitarian health

response at the country level The contribution of the Global Health Cluster should be measured by the value it adds to the work of the health cluster at country level. That is very difficult to do in practice. One thing, however, is certain: it will not have impact unless it delivers products and services which are both used and useful at country level. The Global Cluster does not have an operational role. It is not directly responsible for the effectiveness or the performance of the health clusters at country level. That is the responsibility of the cluster lead agency in the country concerned and of each partner in relation to his/her individual agency.

III. Current Strategic Priorities Since 2006, the Global Health Cluster has worked on five strategic areas of work: coordination and management guidance and tools, common information management systems and tools, surge capacity, capacity building of national stakeholders, and strengthening links between partners, with country clusters and with other clusters.

IV. Where we are now A key success of the global health cluster so far has been the participation and involvement of most of the key international agencies in the humanitarian health sector - although the representation and participation of southern NGOs in the global cluster remains limited. There has been a shared commitment to the cluster approach and a willingness to work together to provide effective and relevant support to the field. A joint work plan has been developed and cluster members have played an active role through participation in the different working groups. The working methods adopted have, to date, ensured consensus on the activities and products. This has provided the vital platform for the global cluster to achieve its purpose On a less positive note, few tangible products have been delivered so far because the pace of work on individual tasks has been slow. The reasons include the lack of dedicated staff resources for the cluster work plan, lack of time and competing priorities for those who have been undertaking or supervising the work and the time required to build consensus among all cluster partners. The main burden of work has fallen on WHO/HAC, with other partners contributing mainly through their involvement in the working groups. There has also been a substantial, perhaps excessive, reliance on consultants to carry out the work. As a result of these working arrangements, staff time has been spent on selection, appointment and supervision of consultants and there has been a lack of any real accountability for the quality and timely completion of tasks. At country level the health cluster approach has been activated in a number of acute and on-going crises and there appears generally to have been buy-in to the concept on the part of the agencies involved. The HQ-level participation of these agencies in the global cluster may have contributed significantly to this. There is also some evidence of the cluster approach having a positive impact in some of the places where it has been activated, mainly in improving coordination, to some extent also in joint planning and resource mobilization. Clusters are facing significant challenges. Many of these have been confirmed by the recent evaluation report. They include:

• Lack of leadership and coordination skills and of operational capacity in some countries

• Difficulties in establishing effective coordination mechanisms without over-burdening participants

• Some mutual reservations and distrust between some cluster leads and other partners • Finding ways to ensure participation of national and local health actors • Lack of additional resources for establishing cluster infra-structure at field level • Lack of consistent preparation, guidance and training of staff responsible for

implementing the cluster approach at country level

V. Developing strategic priorities for 2008 and beyond In line with the roles of the Global Health Cluster described above, the Global Health Cluster might wish to consider the following five strategic priorities for 2008 and beyond:

1. Continuing to strengthen collaboration and coordination at global level through joint meetings and activities

2. Finalizing policies and products (tools, guidance, training etc) which support

implementation of the cluster approach at country level; and reviewing and updating them over time in the light of field experience

3. Promoting implementation of the cluster approach and use of global products at

country level within partner agencies and organizations and within regional and national stakeholder organizations

4. Strengthening leadership 5. Implementing joint strategies for resource mobilization and advocacy

The following paragraphs amplify these priorities to provide a basis for discussion at the meeting 1. Global Health Cluster membership and meetings The global cluster has an essential role. It is the only mechanism for bringing together international humanitarian health partners at the global level both to demonstrate continued collective commitment to the cluster concept and to develop common products and communications to enable the approach to take root. There is need to consider how often the Global Health Cluster should meet in 2008 and the format and focus of these meetings There is also a need to review the membership of the Global Health Cluster. Among the issues to consider are the criteria for members to join and whether we should be making greater efforts to get better representation from the south. Some initial ideas on how we might improve representation from the South will be presented at the meeting 2a. Review of existing work plan and completion of products (ending March/June 2008) This should be the global cluster's top priority, not least to justify the funding contributed by donors. There is a substantial amount of work still to do. Annexes 1 and 2 summarize the main tasks outstanding and make a number of recommendations for prioritizing them and for wrapping up the work of the current working groups. These recommendations will be considered by the global cluster working groups on the first day of the meeting and they will report back to plenary with their proposals. 2b. Consideration of additional tasks of the Global Health Cluster There may be products which were not included in the existing work plan which it would be desirable to develop. One important example is work at global level on contingency planning and capacity mapping. IASC guidance on contingency planning has now been approved and there is an expectation that all clusters will develop plans for dealing with three major emergencies, two of them simultaneous. Cluster members may have other suggestions. There may also be a case for the global health cluster to initiate some fresh thinking about how the

humanitarian health system could be reformed and improved. This should probably be deferred for consideration at the next Global Cluster meeting so that efforts are focussed on completing the work plan and the other strategic priorities identified It will be important in considering any new proposals to be realistic about what funding will be available and how much can be accomplished. 3. Support implementation of the cluster approach and of global products at field level It will not be sufficient to promulgate the global cluster products for them to be widely and successfully adopted - it will be essential to promote them in the field and across partner organizations and to provide on-going training. This applies also to promoting the cluster approach in general. This might involve:

• Ensuring that the Global Health Cluster products are explicitly endorsed by the technical departments/desks of individual partner organizations

• Helping and encouraging partners to promote the cluster approach within their own organizations through training, manuals, field visits

• Promoting the cluster approach and global health cluster products at field level through regular joint field visits and joint presentations and workshops

• Providing coaching, ongoing learning and global workshops to health cluster coordinators and other key team members

• Developing an ongoing communications strategy for the global health cluster utilizing the website and other key channels

In taking this forward, it might be more effective and practical for Global Cluster members to concentrate their efforts on a limited number of countries to achieve maximum impact. The health cluster work plan should outline specific actions to be taken in this regard and funding requirements. 4. Strengthening Leadership Leadership is a key issue in the cluster approach. This has been highlighted again recently in the cluster evaluation report and elsewhere. WHO recognizes its importance and the need for it to further build its internal leadership capacity. In the past three years, WHO has significantly increased the number of staff who are working in emergencies at country level and has invested in their development. This work will continue. The Global Health Cluster has continually prioritized the development of strong health cluster field coordinators (HCFC). The Global Health Cluster products, including the HCFC training, the roster and the pocketbook, aim to build this capacity. WHO is developing a strategy with regional offices and country offices to develop potential and current cluster leadership in chronic situations. The Global Cluster needs to consider other ways of building leadership capacity at the national and sub-national levels, including the option of co-leadership when appropriate. 5. Resource Mobilization The global cluster may also wish to consider resource mobilization, distinguishing for this purpose the resources for its own ongoing activities, for cluster implementation at country level and for humanitarian health response in specific emergencies. In relation to the ongoing activities of the Global Health Cluster, there is also a need to consider who will pay for what.

VI. Methods of Work The global cluster needs to review how more effectively to fulfil its mission in the light of the shortcomings discussed above. The methods adopted must take account of what priorities are agreed, the nature of the tasks involved and the funding available. Some of the options which could be considered are:

• Partners taking the lead on more of the tasks with funding ( if available) being allocated accordingly

• Reviewing the terms of reference and membership of working groups with an expectation of more active participation by all members (i.e. not confined to attendance at meetings)

• Reviewing the scope for more use of dedicated staff rather than consultants to carry out tasks

• Reviewing how often the global cluster as a whole should meet: is once a year enough?

VII. Recommendations The Global Cluster is invited to consider the above suggestions in order to agree:

• The membership of the global health cluster and plans for further meetings • The revised strategic priorities of the global cluster • A revised and achievable work plan for 2008 and agreed methods of work • How resource requirements for the on-going work of the global health cluster will

be addressed

Annex 1

Global Health Cluster

Finalizing Products and Services undertaken by the Working Groups

Coordination and Management • Four products near finalization: gap analysis paper, recovery paper, coordination

guidance, health stakeholder mapping tool as expansion of 3W (who is doing what where)

• WG has also discussed developing templates with health cluster brand for meeting invitations, meeting summaries, cluster bulletins, etc. This should be discussed and action taken (if agreed). This can easily be outsourced and finalized quickly

• Outstanding products should be finalized, formatted, and put on website and incorporated into health cluster pocketbook and its bibliography

• Field testing of some products is required and is currently ongoing in parallel to development of pocketbook

• Pocketbook outline has been initiated by this group; proposal to form a new pocketbook working group has been put forward by this group

• Concept paper with first draft list of key indicators and related benchmarking to monitor and measure the impact of humanitarian health interventions on target population to be distributed at the November meeting. Agreed list of indicators and benchmarks to be finalized asap

• Estimated costs in work plan: $ 143,000

Proposal 1: above to be completed by end January 2008 when Working Group should be dissolved; decision should be taken at November global health cluster meeting

Information Management • IRA currently being field tested; tool should be finalize by end 2007; WG needs plan for

its dissemination and promotion • Need to complete work on the comprehensive health assessment guidance and tool (with

some parts preferably built with WASH and Nutrition),and develop an overview of assessment tools including the IRA and other assessment tools currently being developed (particularly by UNDP)

• Work on health information system has not been progressed. Requires dedicated resource - should be taken forward separately as resources allow.

• Estimated costs in work plan: $ 939,000 • Estimated costs to complete: ? Proposal 2: WG in November should review work plan, timelines and membership to achieve above tasks

Training and Rosters • Roster. WG should determine process for nomination and criteria for selecting those

eligible for roster, review current short list and develop global health cluster position on the use of the roster and deployment procedures (including whether there should be separate rosters for acute and on going crises)

• Training .Take forward recommendations on training options to ensure that first bespoke training programme for health cluster coordinators is delivered early next year. Requires decisions to be made and implemented on training delivery, who will be trained, where and how the costs will be met Proposals for supporting and on going development of health cluster coordinators also need to be drawn up

• Estimated costs in work plan: $ 106,000 • Proposal 3: WG in November should review membership, work plan and time line and

identify who will undertake the tasks Capacity Building of National Stakeholders • Consultant has been hired to develop guidance on how country clusters can coordinate

and improve capacity building efforts at country level in priority areas for inclusion in the health cluster pocketbook

• The capacities list, the guidance and the integration strategy should be completed by end January 2008

• Estimated costs in work plan: $ 72,000

Proposal 4: Working group should be dissolved by early 2008; decision should be taken at November global health cluster meeting

Pocketbook • Small WG to be established by 1 November to manage the development of the

pocketbook; group must choose WG chair • Outline to be developed and presented and discussed at November meeting then

finalized with input from all partners; writer needs to be identified and hired; pocketbook should be complete by end March 2008

• Printing (1000 copies) and translation • Estimated costs in work plan: $ 110,000 Proposal 5: WG should commit to complete the work on the pocketbook by end March 2008, agree roles and working method to accomplish this

Annex 2


Finalizing Products and Services not undertaken by the Working Groups

Core Areas

• In developing the pocketbook, the core areas list will be incorporated with an appropriate disclaimer that is has not been endorsed. Further work on it will depend on feedback from country clusters about its use and utility over time.

• Estimated costs: nil Proposal 6: Incorporate in pocketbook

Stockpiles • The health cluster needs to determine and document procedures for health cluster use

of global stockpiles and determine a system/resources to ensure continually sufficient global stockpiles.

• The costs should not be met from existing global cluster funds because they are recurrent and not developmental.

• Estimated costs: nil

Proposal 7: WHO/HAC to develop paper for comment by Global Cluster Global Cluster meetings and secretariat

• The covering paper discusses the working methods of the global cluster and how often it should continue to meet. Estimated costs are largely dependent on these decisions

• There are also costs for the secretariat and costs for country representatives' involvement in global cluster work and meetings.

• Estimated costs for one year: $ 539,000 Proposal 8: The Secretariat should remain for at least 2008 Emergency library

• We need a proposal on how to move forward and a decision as to whether this is indeed still a health cluster priority

• HELID the inter-agency Health Emergency Library has already been developed with WHO/PAHO in consultation with many other agencies and organizations; HELID appears to provide an excellent source of relevant reference material of interest to country health clusters

• The global cluster may wish to consider the proposal to establish an e-library as discussed in the note

• Estimated costs from work plan: $ 124,000 • Estimated cost: ?

Proposal 9: Promote use of HELID by country clusters and consider the proposal for development of an expanded form of HELID as a health cluster e-library

Cross Cutting/Other Issues

• The Global Cluster has committed to integrating cross cutting issues in all its products and services. Cross cutting themes should be integrated and woven throughout the pocketbook, the global products, and the bibliography. Decisions are needed on how this will be accomplished and what other action, if any, is required as indicated below.

• Training. $175,000 was included for training modules in the various cross cutting areas. Could this be subsumed within an overall training plan in support of the pocket book?

• HIV/AIDS. The work plan includes an estimate of $88,000 for various products related to HIV/AIDS including the development and dissemination of policies and technical recommendations, key indicators for HIV/AIDS in emergency health and a mapping tool for health services, plus another $220,000 for a health mapping database. The priority of these products needs to be reviewed.

• Mental Health and Psychosocial Support. This is considered a cross cutting issue between the health and protection clusters. The Global Cluster agreed to fund the translation, printing and dissemination of the Mental Health and Psychosocial Support guidelines and has already provided a total of $25,000 in funding from the 2006 and 2007 cluster funding and has committed to another $75,000 to complete the translation and printing.

• Environment. $ 250,000 was allowed for UNEP for the development of environmental guidelines and related training materials in emergency health, (in close collaboration with the global cluster). Is this still a priority?

• Gender: Please not that this has been appealed for separately by the Subgroup in the 2007 cluster appeal. Some funds may be considered to ensure a proper gender review of Global Health Cluster products.

• Total estimated costs from work plan: $ 733,000 Proposal 10: Global Cluster to review the priority of these activities, the factors that may influence their completion and the funding to be allocated to them. Mapping global capacity for humanitarian health response • All global clusters are tasked with mapping global capacities for the cluster concerned.

This has not yet been undertaken by the health cluster. • Estimated costs: ?

Proposal 11: Global Cluster to consider Using agreed planning parameters to determine coordinated global response in acute emergencies

• All global clusters have agreed to planning parameters of three sudden onset emergencies per year of 500,000 affected population, with the potential for two simultaneous. Planning should consider the most resource intensive scenario. This planning exercise and its implications have not yet been undertaken by the global health cluster.

• Estimated costs: ? Proposal 12: Global Cluster to consider

Annex 3


Budget Structure for Revised Work Plan

(costs listed are estimated costs from 2007 appeal) Global collaboration and membership

Global Cluster meetings and secretariat $ 539,000 ? Policies and products

Coordination and Management $ 143,000 ? Information Management $ ? Training and Rosters $ 106,000 ? Capacity Building of National Stakeholders $ 72,000 ? Pocketbook $ 110,000 ?

Emergency library $ ? Cross cutting issues $ ? Capacity mapping $ ? Planning within parameters $ ?

Implementation

Vertical integration and promotion of approach and products within $ ? partner agencies and organizations Global Cluster promotion of approach and products at regional $ ? and country levels

Leadership Strengthening $ ?

Resource Mobilization $ ? _________________________________________________________________________ Note: Available funding: $ 1,937,000 The Global Health Cluster must obtain a no-cost extension for contributions against the 2007

appeal until end 2008 and decide priorities for use of the unallocated budget



Breakout Session:

Products: Weighing Priorities and Funding Allocation


Objectives:

• examine the submitted work plans for the four WGs

• subject them to rigorous scrutiny: are the plans and deadlines realistic? Is it clear who will undertake the tasks? Do they have the time to do so? If consultants are involved, who are they and where do they come from?

• If the total costs involved exceed $1.4m , then recommend cut off point (either to defer to delete certain products or activities)

• Make recommendations concerning what working groups or task forces are needed to take forward this work plan; should the existing ones continue (til when) or close? Are new or merged ones needed

Keep in mind:

• the existence of specific working groups should not determine priorities; some working groups might need to be closed down


• recommendations will then be weighed in plenary against those of the other 4 break out groups



Breakout Session:

Implementation/Integration of Approach and Products at Country Level:

Identify Actions and Funding Allocation


Objectives:

• Identify actions required to promote the cluster approach and the cluster products at country level, both by individual partners and collectively

o Refer to suggestions in Way Forward Paper; develop and add to these ideas and be as specific as possible (who, when, where and funding requirement):

Ensuring that the Global Health Cluster products are explicitly

endorsed by the technical departments/desks of individual partner organizations

Helping and encouraging partners to promote the cluster approach within their own organizations through training, manuals, field visits

Promoting the cluster approach and global health cluster products at field level through regular joint field visits and joint presentations and workshops

Providing coaching, ongoing learning and global workshops to health cluster coordinators and other key team members

Developing an ongoing communications strategy for the global health cluster utilizing the website and other key channels

Keep in mind:

• Rome Declaration which asks clusters to assess and build the capacity of countries to apply the cluster approach (possible collective effort at promotion and implementation)

• Will partners commit that appropriate senior staff from global cluster join collective field level efforts




Inter-Agency Standing Committee



Health Cluster Stockpiles

- points for a discussion -



Agenda

WhyBenefitsStockpile optionsRationalisation with and links to existing stocksCorporate Function (all partners)Executive Decisions (agreed upon working group)OperationalisationWhat WHO is doingWhere WHO is Do you want to be part of this?



WhyTo ensure availability of material required for a

predictable and efficient operational response to humanitarian health emergencies

BenefitsRapid access via a global network or network of networks

to the standardised material resources required for the initial response by the Health Cluster to humanitarian

health emergencies.



Stockpile options

No stockpileIndividual, unconnected stockpilesFixed assets in a global Health Cluster network comprising a combination of:

Health Cluster stocks in the HRD Network;Health Cluster partner stocks held in various locations;Vendor stocks (virtual stocks)

Vendor heldVendor owned but held in HRDs/pay on release

Government held stocks



Rationalisation with & links to existing stocks

Coordination of stockpiles of Health Cluster partnersEstablish in a share point a database of who has what where

This is a guide onlyMonthly update by each partner of what they have in stock

Agree on access & priorities



Corporate Decisions

(all partners)Determination of what should go into Health Cluster stocks

Medical/Health suppliesOperations support equipment

Determination of request, access, prioritization and release processesFunding for shipment to site - goods re-order - shipment to HRD



Executive Decisions

(agreed upon working group)Prioritization of stock useAuthorise release of goodsRe-orderMovement to initial destination

WHO/WFPMovement to EDP or final destination

Clients with local partners (MoH, NGO, WFP, Unicef, IOM, etc.)



Operationalisation

Agree on and designate executing authorityWho will act on behalf of the Health Cluster in an emergency to:

Prioritise use of the stockpileWithin an emergencyGlobally

Communicate to partnersDispatchArrange receipt & storageReplenish



What WHO is doing

Building a network of hubs with WFP and other partnersStocking the network with medical/health suppliesStocking operational support suppliesLogistics staff to HRDs for regional/continental supportLogistics trainingLeveraging the stocks of partners



Where WHO is now

WHO - WFP technical agreementson logistics planning, cooperation and privileged access for healthon access to the HRD Network

WHO - WFP proposal for fundingMedical/Health kit stocks in HRDs Brindisi, Dubai and Accra; Subang, Malaysia planned for 2008Health Cluster stocks ordered

HRD DubaiVendor held virtual stocks

Interagency Logistics Capacity AssessmentsChadZimbabwePakistan / Haiti



Do you want to be part of this?

Do our current systems, resources, anD practices enable us to responD promptly, efficiently, anD humanely — or can we Do better?

2007Humanitarian HealtH ConferenCe

presented by the Harvard Humanitarian Initiativeand Darmouth Medical School

September 6–8, 2007Harvard UniversityCambridge, MA

final report

�Final RepoRt

contents

introduction ........................................................................... 2

summary of outcomes ........................................................... 4

WG�: Human Resources Development ................................... 8

WG2: civilian protection in the Health sector ...................... ��

WG3: Health information & Data Management .................... �6

WG4: Health sector collaboration & collective action ......... 22

excerpted Remarks by andrew s. natsios ........................... 29

excerpted Remarks by peter W. Galbraith .......................... 38

acknowledgements ............................................................. 48

2

2007 HuManitaRian HealtH conFeRence

intRoDuction

The humanitarian response to disasters and war-related crises has been gradually evolving toward increasingly systematized interventions. Aid orga-nizations, technical experts, United Nations agencies and donors alike have recognized the need to advance the field through professional development, minimum standards of quality, and epidemiological assessments to drive programming and measure impact.

The movement toward professionalization, however, has been limited to large organizations—and mechanisms for collective action across organiza-tions remain elusive. As donor organizations increasingly emphasize the use of standards and benchmarks, non-government organizations (NGOs) must address the technical and manpower requirements necessary to assess population-based needs, utilize data to inform the provision of services, and monitor outcomes.

At the request of several international relief organizations, the Harvard Humanitarian Initiative and Dartmouth Medical School formed this annual forum in 2006 with the goal of providing a platform for dialogue on opera-tional issues. The 2007 Humanitarian Health Conference at Harvard Uni-versity advanced the outcomes of the inaugural conference hosted in 2006 by Dartmouth Medical School. Four Working Group themes were identified by the planning committee and participants as the most pressing topics in the health sector of humanitarian response. Over three days, 130 senior ad-ministrators, technical experts, policy planners, and field officers sought to outline recent progress, major gaps, technical and training needs, and next steps on the following key issues:

Human Resources Development: Defining the Profession of Humanitarian Response

Civilian Protection in the Health Sector: Implementing Human Rights Principles on the Frontlines

Health Information & Data Management: Advancing Methods for Improved Data Collection

Health Sector Collaboration & Collective Action: Facilitating Inter-agency Dialogue

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2007 planning committee

Michael VanRooyen, Chair Harvard Humanitarian Initiative

Richard J. Brennan International Rescue Committee

Frederick M. Burkle, Jr. Harvard Humanitarian Initiative

Bev Freeman Harvard Humanitarian Initiative

P. Gregg Greenough Harvard Humanitarian Initiative

Karen Hein Child Fund International

Jennifer Leaning Harvard Humanitarian Initiative

Erin Lyons Harvard Humanitarian Initiative

Sharon McDonnell Dartmouth Medical School

James C. Strickler Dartmouth Medical School

Mary G. Turco Dartmouth Medical School

3Final RepoRt

The following proceedings of the 2007 Humanitarian Health Conference re-count the discussions for the working groups and the keynote themes. The proceedings are more than a record of the conference; they highlight action-able steps to move forward in each area of discussion. At the close of the 2007 conference, participants came to consensus that this forum serves a useful function within the humanitarian community and should continue on an annual basis.

The participants and planning committee also agreed to take responsibil-ity upon themselves for making progress toward the future steps outlined here and will correspond or meet informally throughout the year to advance the agenda for improvement. We look forward to keeping stakeholders up to date on the progress toward these action points and our collective goal of promoting excellence and professionalism in the humanitarian community.

Michael VanRooyen, MD, MPH2007 Conference ChairCo-Director, Harvard Humanitarian Initiative

2007 Board of advisors

Mary B. Anderson CDA, Inc.

Nancy Aossey International Medical Corps

Peter Bell The Carter Center

Luca Barbone World Bank

Nils Daulaire Global Health Council

Susan Dentzer Dartmouth College

Ala Din Alwan World Health Organization

Debarati Guha-Sapir Centre for Research on the Epidemiology of Disasters

Steve Hollingworth CARE

Julian Lambert Adaptive Eyewear

Charles F. MacCormack Save the Children

Ray Offenheiser Oxfam America

George Rupp International Rescue Committee

Curtis R. Welling AmeriCares

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suMMaRy oF outcoMes

KEy CONSENSUS POINTS

WG�: Human Resources Development

Recruitment and retention of an adequately trained workforce is essential to improved performance;

Supportive supervision of workforce is needed;

Funding streams to include workforce development are essential;

Competencies need to be defined and developed for the work-force; and

More information needs to be gathered regarding all aspects of HR in the humanitarian health field, including outcome mea-sures and specific recruiting and retention practices.

WG2: civilian protection in the Health sector

The profile of civilian protection in humanitarian action needs to become a priority for all humanitarian actors;

The role of various stakeholders in providing protection must be recognized, and the unique and crucial responsibility of humani-tarian actors in civilian protection should be promoted;

Incentives to improve civilian protection should be promoted;

Civilian protection indices should be developed as evaluation, monitoring and research tools;

Agencies should strive to empower communities to prepare for security threats and to protect themselves when faced with such threats;

Explicit protocols must be developed for communication of agen-cy activities to the community and other stakeholders;

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�Final RepoRt

The role of information sharing and advocacy merits further exploration;

Staff adherence to rigorous ethical standards must be mandated;

Organizations should invest in training and education of agency staff at all levels; and

Agency protection preparedness should be promoted, includ-ing instituting standard operating procedures and training for security, educating all staff on agency protection, and developing specific health protection measures.

WG3: Health information & Data Management

Data collection may be improved by using simple, universal indi-cators and emphasizing quality over quantity — and consensus should be achieved across the humanitarian health sector on minimum required indicators;

Middle management staff should be involved in the design of data systems to create institutional “buy-in” and professional development should be prioritized to reduce staff turnover and ensure continuity in data collection;

Technology should be familiar to personnel and personally ben-eficial (e.g. cell phones), and the use of XML tagging and SMS messaging is strongly encouraged;

Data summaries should have consistent formats and visual dis-plays for decision-makers;

A peer review system should be adopted to incentivize sector-wide health information management; and

A critical need exists for sustained funding that mandates evi-dence-based decision-making.

WG4: Health sector collaboration & collective action

Successful collaboration is predicated on leadership at the insti-tutional and individual level;

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6


A common agenda for action must be established;

Shared information must be made more accessible;

It is important to recognize the power of collaboration at the policy and board level;

Agreed-upon metrics can lead to institutional change; and

Acceptance among all participants of a governing system is es-sential to progress.

KEy ACTION STEPS

WG�: Human Resources Development

Develop informational materials for potential expatriate staff;

Draft a report for donors on HR funding for humanitarian health; and

Organize a conference of public and private donors to launch re-port and advocate for HR focus in funding.

WG2: civilian protection in the Health sector

Explore issues in documentation and transmission of information that relates to protection;

Develop an educational program for humanitarian health work-ers that addresses the intersection between medical ethics and population-based care; and

Convene a group to identify and develop appropriate indices and methodologies for civilian protection.

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7Final RepoRt

WG3: Health information & Data Management

Work with the HNTS to develop universal standards and indicators;

Actively participate in upcoming global forums, including the International Data Standards and the OCHA-sponsored Global Symposium +5 forums;

Encourage pilot studies of minimum standards in non-camp settings; and

Work with donors to develop budget lines for health data man-agement, monitoring and evaluation.

WG4: Health sector collaboration & collective action

Promote the IASC Health Cluster as the appropriate body to seek future collaboration and collective action within the member organizations;

Create a steering committee to explore models of collaborative mechanisms and research their applications in the humanitarian health field; and

Utilize the Humanitarian Health Conference as a forum for ongo-ing discussion on collaboration, with a pledge to increase partici-pation from humanitarian organizations from the Global South, donor agencies, members of the academic community.

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WORKING GROUP 1

HuMan ResouRces DevelopMent:

Defining the Profession of Humanitarian Response

Background & current challenges

There exists an inadequately addressed human resource (HR) crisis in hu-manitarian health work. The challenges of acquiring, maintaining, and ap-propriately utilizing human resources are not unique to this field. However, while HR enjoys prominence and substantial investment in other industries, it is poorly defined within the humanitarian health field. Humanitarian health work requires a diverse range of backgrounds, skills, and educational ex-posure, and the work settings range from acute emergencies to protracted emergencies and long-term recovery. As a result, the HR challenges are uniquely complex. No two career paths in humanitarian health work are identical, making comprehensive recommendations difficult.

The Working Group focused on three broad problematic areas for discussion: human resource development, supportive supervision and funding.

Human Resources Development

Recruitment and retention of an appropriately trained workforce were iden-tified as two distinct challenges. Commonly voiced complaints among health professionals, particularly expatriates, include the difficulty obtaining cred-ible field experience and the lack of clear career paths and available men-tors. Many humanitarian health agencies lack the funding to provide paid internship experiences and to invest heavily in HR development. A gap ex-ists between the expectations of humanitarian agencies and those of young professionals entering the field regarding field duties, salary, work/life bal-ance, and career advancement. For expatriate and national staff, the lack of opportunities for career development and additional training and the toll

chair:

Nan Buzard, Director of International Disaster Response Unit, American Red Cross

Rapporteurs:

Jacob Chapman

Ann Kao

9Final RepoRt

on personal lives have been cited as reasons for decreased retention. While a wealth of institutional experience and knowledge exists among NGOs and UN agencies regarding recruitment and retention strategies, research on these subjects has not been undertaken in a systematic fashion and many questions remain regarding best practices for recruitment and retention.

supervision

Another challenge was the lack of supportive supervision of humanitarian health staff. Supportive supervision specifically includes regular non-puni-tive assessment and feedback mechanisms and the potential use of com-petencies as checklists for assessments. Barriers to providing supportive supervision include lack of time, funding, and emphasis of its importance within agencies.

Funding

Overlying all these issues is the absence of funding for HR. This is generally due to the lack of awareness of among donors and the tendency to rely on an agency’s overhead as a marker of efficiency. Many grants and cooperative agreements are for one or two years, contributing to the under-emphasis on HR development which can take decades.

points of consensus

Based on the issues discussed above, the 2007 Humanitarian Health Confer-ence Working Group on Human Resources Development agreed that:

Recruitment and retention of an adequately trained workforce is essential to improved performance;

Supportive supervision of workforce is needed;

Funding streams to include workforce development are essential;

Competencies need to be defined and developed for the work-force; and

More information needs to be gathered regarding all aspects of HR in the humanitarian health field, including outcome mea-sures and specific recruiting and retention practices.

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participants:

Nancy Aossey, International Medical Corps

Stephen Atwood, UNICEF-East Asia and Pacific Region

Paul Barach, Miami Medical School

Richard Brennan, IRC

Carlos Cardenas, Mercy Corps

Maikaiskwarrie Audrey Ford, UN OCHA

Robert Galbraith, National Board of Medical Examiners

Kevin Gilrain, AmeriCares

Ralf Graves, FAIMER

Langdon Greenhalgh, Global Emergency Group

Karen Hein, Child Fund International

Marisa Herran, Rainbow Center for Global Child Health of Cleveland

David Lange, Johns Hopkins University

(continued on next page)

�0


action plan & Future steps

Develop informational materials for potential expatriate staff.

To address the need for consistent information for staff, the Working Group proposed developing an informational “FAQ” for those interested in humani-tarian health careers, posted online and broadly disseminated to likely appli-cants (students/residents). Ideally these will be vetted by field-experienced Working Group members who are in leadership positions of their respective agencies. The “questions” will come from a survey of the younger members of the group. The FAQ would be housed on a web-site such as the HHI site (www.hhi.harvard.edu) with broad dissemination capacity to other organiza-tions, including educational and training institutions. The FAQ should also include links to institutions with international health programs that also of-fer field experiences

Draft a report for donors on HR funding for humanitarian health.

To raise donor awareness on the need for HR funding, the Working Group proposed writing a report outlining the importance of HR investment and analytical research that encompasses outcomes measures, competency measures at all staff levels, the cost of not addressing the HR crisis, and mechanisms for implementation of change. The report would specifically advocate for the inclusion of HR funding within every institutional grant.

organize a conference of public and private donors to launch report and advocate for HR focus in funding.

To facilitate further discussion among donors regarding these HR challeng-es, the Working Group proposed assembling a conference of public and pri-vate sector donors. At this conference, the above report would be released, and leaders from major NGO and governmental humanitarian agencies would be present to answer questions from the donors regarding HR issues.

(continued from above)

Nick Lawson, MSF USA

Tejaswini More, yale Medical School

Heather Papowitz, OFDA (USAID)

Anna Pomykala, Synergos

Adam Richards, yale New Haven Hospital

Amin Samia, World Bank

Brian Sorensen, yale New Haven Hospital

Mary Turco,

Dartmouth Medical School

��Final RepoRt

WORKING GROUP 2:

civilian pRotection in tHe HealtH sectoR

implementing Human Rights principles on the Frontlines


Over the last several decades, armed conflicts have had a disproportionately greater impact on the lives of civilians. The number of civilian casualties has reached unprecedented levels and millions of individuals have been dis-placed from their homes and livelihoods. Among recent conflicts, civilians comprise the vast majority of casualties, compared to 10% in World War I. In modern day warfare, there has been deliberate targeting of civilians as well as a lack of respect for the provisions of humanitarian law. The civilian burden of conflict has risen at least in part because of critical changes in the conflict environment. Modern day warfare is characterized by:

Asymmetrical warfare: non-traditional military, assassinations, and revenge killings;

Ubiquitous insecurity; and

Protracted violence that often translates into institutional and public health collapse with a concomitant significant adverse im-pact on the health of the civilian population.

There has also been a recent blurring of roles amongst military and hu-manitarian actors, which can serve to threaten humanitarian objectives and neutrality. In the midst of such ambiguity, the importance of civilian protec-tion becomes an even greater priority. However, possibly because of the relative abstraction inherent in the concept of protection (compared to other humanitarian disciplines such as water and sanitation, health services, or nutrition), civilian protection has not received adequate attention.

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chair:

Geoff Loane, Head of U.S. Delegation,

ICRC

Facilitator:

Jennifer Leaning, Co-Director,

Harvard Humanitarian Initiative

Rapporteurs:

Susan Bartels

Brett Nelson

�2


A large number of stakeholders play key roles in protecting civilians from violence and from the threat of violence. These stakeholders include local communities, humanitarian agencies, human rights organizations, arms carriers (e.g., state military, non-state armed groups, international forces), the media, academia, and states (e.g. local, regional, international). It is important to recognize the interdependency of and competing priorities be-tween these various stakeholders, in particular between arms carriers and humanitarian agencies, between humanitarian agencies and human rights organizations, and between community priorities and stakeholder interests.

Civilian protection addresses the fear that is generated from violence and aims to mitigate the fight or flight response that often stems from that fear. International and domestic legal frameworks (e.g. The Geneva Conventions) form the fundamental basis of civilian protection.

Successful protection interventions are dependent on an interdisciplinary approach to needs assessment, intervention, and evaluation. The local, re-gional and international context of each security situation is unique and the importance of understanding this specific context cannot be overstated. For any given protection intervention, there is a spectrum of possible outcomes and due consideration must always be given to balancing the anticipated se-curity benefits with the range of possible outcomes.

Holding true to the ethic of “first, do no harm,” thoughtful and cautionary intervention is important in addressing civilian protection. For example, it is imperative that organizations consider the intended and unintended conse-quences of their actions. A wealth of literature examines historical examples of the negative consequences of many well-intended humanitarian efforts (see the Do No Harm Project at CDA Collaborative Learning Projects, www.cdainc.com/dnh). Projects must, therefore, be tailored with a clear under-standing of the community’s needs and of the risks that are inherent to pro-tection activities. All efforts should be made to negotiate a priori with state and non-state actors to carry out civilian protection interventions. Organiza-tions must frequently weigh the delicate calculus of the proportionality of the threats to civilian health with risks and benefits of their organization’s proximity to the civilian population. In some instances, organizations may determine that their presence places a population at greater risk of abuse.

points of consensus

The 2007 Humanitarian Health Conference Working Group on Civilian Pro-tection proposed the following operational objectives for the provision of civilian protection:

participants:

Kathleen Allden, Dartmouth Medical School

Frederick “Skip” Burkle, Harvard Humanitarian Initiative

Edith Cheung, UNICEF

Tracy Cushing, Harvard School of Public Health

Henia Dakkak, UNFPA

Hedwig Deconinck, AED Fanta Project

James Eliades, CDC

Sheri Fink, Harvard Humanitarian Initiative

Adrienne Fricke, Consultant

Mary Lou Fisher, Samaritan’s Purse

Christoph Gorder, AmeriCares

Gregg Greenough, Harvard Humanitarian Initiative

Steven Hansch, Consultant

Sandra Krause, Women’s Commission

�3Final RepoRt

To assess the frequency and intensity of abuses against civilian populations;

To assess the violence-induced disruption of social and economic systems;

To prevent, mitigate, and respond to these abuses and disrup-tions; and

To monitor and evaluate these analyses and interventions.

Prerequisite to accomplishing these objectives is the development of ap-propriate indicators for civilian protection. Such indicators would provide the means through which early warning surveillance is conducted, assessments completed, vulnerable groups identified and impact evaluations performed. The development of indicators, both qualitative and quantitative, is integral to the ability of a humanitarian agency’s ability to improve and strengthen protection interventions. Four categories of protection indicators are pro-posed by the Working Group:

Change in the pattern of people’s behavior: examples include changes in population movement, civilian visibility, and social activity (e.g. dress code, hate media, gender-based violence, al-coholism, children not going to school, suicide incidence, etc.).

Change in people’s experiences: based on self-reports from in-dividuals, households and communities and including threats to life and livelihoods, threats to culture and religion, and outrages upon personal dignity.

Change in availability and utilization of community services: in-cluding restriction of access to essential services and undermin-ing of community capacity such as denial of self-governance.

Change in demographic and health indices: examples include number of deaths, causes of deaths and age/gender of the de-ceased. Health indices also include deviations in burden of dis-ease and disability from the baseline.

In many cases, the indicators relevant to protection are negative indicators, meaning that they are more easily measured by their absence. For instance, the absence of children playing outside and walking to/from school is much more indicative of the security situation than is the presence of children.

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4.Dan Maxwell,

Tufts University

Stephen Murphy, Tufts University

Raghu Venugopal, MSF-Holland

Earl Wall, Johns Hopkins University

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Discussions of the Working Group yielded the following active recommendations:

Raise the profile of civilian protection in humanitarian action such that it becomes a priority for all humanitarian actors;

Recognize the role of various stakeholders in providing protec-tion and promote the unique and crucial responsibility of human-itarian actors in civilian protection;

Promote incentives to improve civilian protection – examples in-clude highlighting the cost benefits of providing security, improv-ing the personal security for aid workers and other stakeholders, boosting the morale of agency staff who bear witness to civilian insecurity and responding to what is often one of the highest pri-orities at the community level;

Develop civilian protection indices as evaluation, monitoring and research tools to include developing best practice methodologies for collecting and analyzing the chosen indices;

Contribute to community efforts to enhance protection by em-powering the community to prepare for security threats and to protect themselves when faced with such threats;

Develop explicit protocols for communication of agency activities to the community and other stakeholders;

Explore the role of information sharing and advocacy;

Mandate staff adherence to rigorous ethical standards since ef-fective protection interventions depend on the integrity of the implementing body;

Invest in training and education of agency staff at all levels with front line staff adequately trained in surrounding issues of civil-ian protection (including the identification of security threats and the appropriate response to these threats) and mid and high level providers informed about the dissemination of information on civilian security; and

Promote agency protection preparedness including instituting

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standard operating procedures and training for security (e.g. exit/evacuation protocols for all national and expatriate staff), educat-ing all staff on agency protection, and developing specific health protection measures (e.g. stocking and distributing rape kits).

Accomplishing these recommendations will require increased commitment by the humanitarian community and other stakeholders. Practical next steps include:

Exploring issues in documentation and transmission of informa-tion that relates to protection;

Developing an educational program for humanitarian health workers that addresses the intersection between medical ethics and population-based care; and

Convening a group to identify and develop appropriate indices and methodologies for civilian protection.

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WORKING GROUP 3:

HealtH inFoRMation & Data ManaGeMent

advancing Methods for improved Data collection


A summary of endpoints discussed at the plenary of the 2006 Working Group on Monitoring and Evaluation Requirements for Health Programs, the pre-cursor to this Working Group, provided the background for this year’s dis-cussion. These points state specifically that:

the information needed for programming is rarely obtained;

the reason people do not collect data is rarely due to a lack of ability;

the attributes of a good surveillance system need to be defined along with process indicators to monitor whether those in the field have the necessary tools; and

the current data collection systems rarely generate the kind of data that is needed thereby preventing maximal “buy-in”.

The major challenges of humanitarian health data that emerged were around the questions of when, how, by whom, and for what purpose?

Data collection is not universal in all settings. While much attention has been given to acute emergencies, chronic and protracted emergencies may have worse indicators and inaccurate surveillance mechanisms and thus re-quire a different approach. Post-emergency phases are especially challeng-ing due to the lack of consistent human resources (high personnel turnover and lack of institutional data memory), changing data needs (transition to

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Paul Spiegel,

Senior HIV/AIDS

Technical Advisor,

UN High Commissioner

for Refugees

Rapporteurs:

Hani Mowafi

Helen Ouyang

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surveillance), and uncertainty as to how to make the data systems sustain-able in the transition to development (who will do it and when). Populations in crisis may not be in an organized camp environment. More emergencies are happening in urban or semi-urban environments and persons of concern are sheltered in dispersed settings throughout less affected communities where key data simply goes un-measured. Creating a surveillance system to monitor for events in these settings is very challenging since vulnerable re-gions often have no functioning surveillance prior to the emergency.

How data is acquired and used presents its own challenges. Data collectors suffer from “fatigue” when they are unsure of how the data will ultimately be used or are not privy, in a relevant time frame, to seeing how data can make valuable policy and program changes. External or internal abuse and manip-ulation can diminish confidence in data. Data “faking” by field staff who may not understand the specific goals of the data being collected or who want to appear to have better data to renew donor funds is not unusual. Poorly defined or inappropriate case definitions may lead to misdiagnosis by non-clinical staff. Aggregation of data into large data sets that cannot be easily disaggregated may result in homogenization of good data with bad data.

Much of the currently derived data is not “actionable” and does not sub-stantively drive or guide programs. Rather, data is often driven by advocacy or convenience rather than evidence: the “you-only-find-what-you’re-look-ing-for” phenomenon. When coupled with an over-reliance on passive data reporting, analysts can miss significant outcomes and events and estimate poorly the impact of humanitarian emergencies. The lack of financial sup-port and adequate time are major disincentives to data collection, manage-ment and analysis in emergencies. While other priorities in the relief effort take precedence, data collection is often incomplete and the analysis is delivered too late to be useful in real-time. Also, a lack of standardization in case definitions, indicators, and reporting formats creates confusion and makes data-sharing and interpretation meaningless for guiding programs.

points of consensus

The 2007 Humanitarian Health Conference Working Group on Health Infor-mation and Data Management proposed operational objectives that focused on the collection, management, analysis and integration, and dissemination of health data in humanitarian emergencies, as well as the funding commit-ment required to institutionalize information management.

participants:

Ribka Amsalu, Save the Children USA

Michael Anastario, CDHAM

Miriam Aschkenasy, Oxfam America

Judy Austin, RAISE Initiative, Columbia University

Oleg Bilukha, CDC

David Bradt, USAID

Muireann Brennan, CDC

Chris Cornier, UNHCR

Patricia David, ARC

Emmanuel D’Harcourt, IRC

Shannon Doocy, Johns Hopkins University

David Eastman, Relief International

Pape Gaye, IntraHealth International, Inc.

Michelle Gayer, WHO

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Data collection

The Working Group agreed that in the collection of data, humanitarian orga-nizations need to:

Use simple, universal indicators and clear case definitions in easy-to-use formats while avoiding cumbersome data collection systems;

Aim for accuracy and consistency without compromising rapid turnaround;

Resist the temptation to collect too much superfluous data, but rather focus on data that has clear and defined utility;

Insure that data collection is useful to field managers for micro-decision making; and

Use readily deployable and easily understood technology (i.e. cell phones with short messaging service (SMS) capacity) to facilitate data collection.

Data Management & integration

In furthering the improvement of quality health information and data man-agement, the Working Group recommended that organizations:

Streamline data collection and dissemination systems by advo-cating for more consistent and visually accessible data summa-ries for decision makers; and

Adopt a peer review system consisting of:

An equitable reward system where agencies are penalized less for programs that report negative data and higher for programs that report incomplete or inadequate data;

Field-based rapid auditing teams that would determine if consensus standards (e.g. Sphere, SMART) should be ex-panded to include indicators of sensitivity and to determine completeness of data sets – ultimately they would decide if the reality on the ground is accurately being reflected in the data;

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Anne Golaz, UNICEF

Philippe Guerin, MSF

Chris Haskew, UNHCR

Ryan Kelley, AmeriCares

Julian Lambert, Adaptive Eyewear

Ondrej Mach, CDC/NCIRD

Sharon McDonnell, Dartmouth Medical School

Patrick Meier, Tufts University

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Incentives to give beneficiaries control over data;

A semi-public, beneficiary real-time review mechanism, creating a social network model of auditing and horizontal enforcement; and

A periodic review of business models and case studies to foster brainstorming and discussion of lessons learned and innovative solutions to real problems.

Successful health information and data management systems also depend on motivated, competent personnel. Regardless of the donor commitment to human resources development, specific non-monetary recommendations to develop human resources call on humanitarian health agencies to:

Agree on simplified indicators and data collection processes to make the system less burdensome;

Involve middle management in the design of data systems for multi-level institutional “buy-in;”

Promote ongoing capacity/skills training for continuous career development in order to reduce staff turn-over; and

Use technologies that are both familiar to personnel and person-ally beneficial (e.g. cell phones).

Application of innovative technologies that are easy to use, field durable, and easily interfaced and well-networked yet secure and transmittable in real-time will raise the quality of the data management process. The Working Group recommended that:

Heterogeneous systems are likely inevitable and investigation should be made into how data management strategies and tech-nology can be leveraged to make decentralized systems more possible;

“Data clouds” could be used to attach XML tags to each data point such that individual data is packaged in a standard way al-lowing for aggregated analysis of different types of HIS and data collection systems;

Large agencies who routinely use data should be enjoined to create consensus on which indicators should be the minimum

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Patrick O’Connor, Johns Hopkins School of Public Health

Ruwan Ratnayake, Consultant

Les Roberts, Johns Hopkins School of Public Health

Nigel Snoad, Microsoft Humanitarian Systems

Armand Sprecher, MSF-Belgium

Hoa Tran, BPRM

Alexander Vu, Johns Hopkins University

Ron Waldman, Columbia University

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collected by all programs – this quorum can take these standard indicators to technological forums where data standards are de-veloped for the internet and for international databases;

The internet should be used more for routine, automated trans-mission of data;

Short Message Service (SMS), or text-messaging, can be used for transmitting small standard data sets to central computers for aggregation – it has the added benefits of prompting users for missing data and distributing data analysis rapidly and globally in easily accessible format; and

Cheaper and damage-resistant laptops (water, dust, and vibra-tion resistant) that are powered on solar/gear power are more field worthy and capable of instantly creating ad hoc networks that allow for distribution of data internally (between all data col-lectors) and externally (to a global, central system).

Funding for Health information

The critical need for sustained funding commitments for mandated evi-dence-based decision-making was unanimously endorsed. To that end, the Working Group recommends that humanitarian health agencies attempt to:

Incorporate information management, including monitoring and evaluation systems, into donor budgets;

Seek donor commitment for funding human resources develop-ment, specifically dedicated field personnel who collect, manage, and analyze humanitarian health data into actionable program-ming by field managers;

Study the incentives and disincentives to data collection and their use in program development.


After collected data is managed and analyzed, it is integrated, with varying success, into pre-existing international and national/local data systems such as surveillance and health information systems (HIS). In addressing this is-sue, the Working Group agreed to:

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Work with health development colleagues around the challenges of data in protracted emergencies;

Perform periodic surveys in protracted situations where accurate surveillance is less likely;

Disseminate analyzed data in a standardized, simple, and visu-ally-appealing format for easy interpretation;

Support the creation of more responsive feedback loops, priori-tizing the results of analysis to the field and not just donors;

Simplify and streamline data systems for compatibility with local surveillance and management programs of host countries; and

Err on the side of integrating data into systems that are more fa-miliar to local practitioners and more easily transitioned to local control at the risk of having less robust data.

The expansion of the Center for Research and Epidemiology in Disasters’ databases and the development of the Humanitarian Health and Nutrition Tracking Service (HNTS) are opportunities to incorporate these consensus points into international data management structures at their outset.

Pilot projects in which technology can be applied in non-camp settings us-ing cell phones, SMS, and field durable laptops are practical next steps. The Working Group endorsed active participation in upcoming global forums, including the International Data Standards and the OCHA-sponsored Global Symposium +5 forums.

The analysis and interpretation against minimum standards can be dis-played in a simple, one-page visually-appealing format for emergency relief and post-emergency relief stakeholders and in 1-2 page policy briefs for UN agencies, donors, and policy makers.

The Working Group pledged to:

Work with the HNTS to develop universal standards and indicators;

Encourage pilot studies of minimum standards in non-camp settings; and

Work with donors to develop budget lines for health data manage-

ment, monitoring and evaluation.

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WORKING GROUP 4:

HealtH sectoR collaBoRation & collective action

Facilitating inter-agency Dialogue


In a dialogue about humanitarian emergency response systems, the desire among involved organizations to deliver services to beneficiaries both ef-ficiently and appropriately has led to discussions of the meaning of “coop-eration”, “coordination”, and more recently, “collaboration” and “collective action”. Although these concepts have been a component of the literature in development and humanitarian services over the last three decades, there continues to be discourse on the manner in which different organizations interact or fail to do so because of the increasing frequency of crises and an ever-changing climate of contenders in humanitarian response. In addition, there have been multiple obstacles to cooperation and collaboration such that attempts have led to a duplication of services for some populations and lack of services for others. The 2007 Humanitarian Health Conference Work-ing Group on Health Sector Collaboration and Collective Action was tasked with defining these concepts, reflecting on efforts completed thus far, iden-tifying the challenges related to collaborative action, analyzing the compo-nents of successful collaboration, and forming deliverables to guide further action.

Building upon the progress made during the 2006 Humanitarian Health Con-ference, this Working Group established tangible next steps for collaboration and collective action through consensus among the participants. Working group participants expressed their own goals for the Working Group includ-ing gaining a deeper understanding of collaboration in the humanitarian field, avoiding duplication, including all stakeholders in the collaborative ef-fort, enhancing collaboration through cultural change, and taking concrete action steps to achieve such an end. This year’s discussion was informed by

chair:

Mary Pack Vice President, International Medical Corps

Rapporteurs:

Jennifer Chan

Pina Patel

23Final RepoRt

outputs from the 2006 Conference Working Group and a related study on the form and function of collaboration, as well as updates and reflections from the UN IASC Health Cluster.

The Humanitarian Health Caucus, a consortium of NGOs within the Global Health Council, identified areas of research and advocacy and became a platform for sharing information among participants. The study, initiated by Working Group participants from Dartmouth College, interviewed 63 per-sons identified as leaders in their respective humanitarian organizations about their experiences with coordination and collaboration and described factors that influence agencies to work together. Preliminary data reflect the respondents’ skepticism that another consortium would yield any concrete results. Lack of trust, the need for independence and organization identity, and the financial competition required to obtain funding from donors were identified as obstacles to coordination. Staff turnover also compromised trust between organizations preventing collaborative progress while creating a “lack of institutional memory.” However, the respondents did agree that cooperation/collaboration needed to be incorporated into all levels of staff training, that consortia should be inclusive, and that strong leadership would be required to ensure its viability and functionality.

The IASC Health Cluster goal, described as “a collaborative effort to reach an action plan which results in coordinated action that is evidence-based for which the ultimate goal is to reduce morbidity/mortality in a more predict-able, effectively and timely manner,” includes five areas of evidence-based action including:

Guidance tools for better coordination

Information management

Surge capacity

Capacity building of national stakeholders

Operational support

The thirty members of the IASC health cluster have made some progress at the global level by showing an open willingness to reach consensus despite its challenges. They have also recognized the power of ownership and buy-in at multiple levels. Their activities include development, testing and peer re-view of products (i.e. rapid assessment tools) and the creation of task forces for advocacy and public and private partnerships. Challenges encountered by the cluster include coordination between organizations, leadership, defin-

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participants:

Renee Acosta, Global Impact

Ross Anthony, RAND

Kathryn Bolles, Save the Children

Kate Burns, UN OCHA

David Campbell, Hands On Disaster Response

Ella Goodwin, AmeriCares

Jonathan Hodgdon, AmeriCares

Erin Kenney, WHO

Thomas Kirsch, Johns Hopkins University

Lydia Mann-Bondat, Georgetown University

Elena McEwan, Catholic Relief Services

Bill Noble, Africare

Ted Okada, Microsoft Humanitarian Systems

David Olson, MSF

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ing tools necessary to accomplish effective leadership, and vertically inte-grating the concepts of partnership from global to country levels. The next steps for the cluster include motivating country level stakeholders to adopt the merits of collaboration and collective action, and approaching donors to finance resources that lead to collective action.

With the preceding as background, the Working Group focused on key issues of collaboration and collective action, including understanding the costs to organizations for collaboration, discussing the spectrum of possible collab-orative mechanisms for human resources, incentives for collaboration, and the need for interagency bodies to be inclusive and accessible.

costs to organizations for collaboration

When humanitarian organizations act on initiatives to collaborate, they do so at a financial cost by contributing human resources and relinquishing part of their sovereignty. Individual organizations contribute financially to hold meetings, often weekly at a field level and semiannually at a country or global level. Even though there is a spirit of collaboration at interagency meetings, group members also realize they are competing for the same funding from donor organizations and this often inhibits full collaboration. One solution proposed having donors incorporate collaboration into funding mechanisms to promote collaborative efforts between organizations.

Member responsibility within a collaborative body has a “cost.” For example, a group of NGOs may be responsible for providing services to a population but outputs from each organization vary in quality. Would organizations that met their targets be then held accountable for the shortcomings of other less successful organizations? Sacrificing an individual organization’s in-dependence for the collective body can have unintended financial cost; in such scenarios, organizations often act as silent members in “collaborative environments” but follow individual agendas. Organizations require a culture change for collaborative efforts to be maximized.

spectrum of possible collaboration mechanisms for information sharing and human resources

Recent Real Time Evaluations (RTEs) in the field reflect humanitarian orga-nizations’ growing emphasis on coordination, and the gradual acceptance of external evaluation. Self-regulating organizations (SROs) are another mech-anism by which to set standards and metrics among collaborative organiza-tions while ensuring accountability. Whether or not donors should regulate measuring performance and promoting collaboration is still open for debate.

Shivani Parmar, Dartmouth College

Susan Purdin, IRC

Sinho Sanjay, CARE

Tobias Stillman, Save the Children

Lori Warrens, Partnership for Quality Medical Donations

Randy Weiss, AmeriCares

Curt Welling, AmeriCares

Diane Willis, Christian Children’s Fund

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Regulatory organizations from the medical, social services, and develop-ment disciplines are models. An example of the latter—the CORE group—has been successful in nurturing positive relationships among its members while providing self-regulation. Despite competition between its organiza-tions, they have promoted the goals of quality work by sharing technical documents between them; by involving donors; by clearly defining a realistic mandate; and by meeting often to allow for ongoing communication.

Self-regulating organizations represent one end of the spectrum; on the other is a collaborative mechanism with a mandate whose role would be to set standards for accreditation for organizations. This regulatory body would be responsible for policing members to see if accepted standards are met; consequences would be applied to members if standards are not met. This model would address the non-compliance and lack of accountability associ-ated with self-regulation. A regulatory body may also address certification of health practitioners and field workers. Various models of regulation exist and the Working Group will explore these further.

Research is another sphere of collaboration. The 2007 Humanitarian Health Caucus outlined and prioritized several areas of potential research which would aid member groups in planning, designing, and implementing projects.

incentives for collaboration

Collaboration and collective action is not a natural phenomenon; it must be promoted through building trust, motivation, and a sense of ownership. Leadership and donor interest are key factors. A successful example of donor-driven collaboration through self-regulation was the professionaliza-tion of help lines. Help-line organizations came together and participated in a process of certification and accreditation. Although valued only by its participating members, those members were linked to federal and state funding. The donor funding incentive was cited as the “stick” that promoted collaboration.

need to be inclusive and accessible

Collaborative efforts need to be inclusive and accessible, especially as the changing makeup of the humanitarian environment now involves private, corporate, and military organizations, creating new potential collaborative relationships. The Global Humanitarian Platform highlighted this need in their “Principle of Partnership” document (see Global Humanitarian Plat-form, “Principles of Partnership: A Statement of Commitment,” Geneva, 2007 at www.globalhumanitarianplatform.org). National government, local

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government, civil society, and local NGOs, particularly from the Global South are frequently underrepresented or absent at key working conferences such as this; their participation should be facilitated.

points of consensus

The 2007 Humanitarian Health Conference Working Group on Health Sector Collaboration and Collective Action agreed to:

View the Global Health Council’s Humanitarian Health Caucus as a “placeholder;”

Move forward on the analysis and design of a collaborative mechanism whose mandate would be to improve practice in the humanitarian health community; and

Advocate donors to support building collaborative mechanisms into organizations, and incorporating these mechanisms at glob-al, country, and field levels.

The Working Group agreed to use the Global Health Council’s (GHC) Human-itarian Health Caucus as a “placeholder for future collaboration and collec-tive action.” The fact that participants are primarily US-based organizations and required to be members of the GHC are limitations. However, GHC par-ticipants leading the advocacy and research sub-groups could reach out to those outside of the council and incorporate their expertise and insight while leveraging their experience to approach donors to provide resources for pro-moting coordinated action through research and advocacy. Donors such as the Fogarty Group and Research America are potential untapped resources.

The Working Group agreed to move forward to further analyze the factors and mechanisms that contribute to successful collaboration. Determining these factors will be challenging if the goals of collaboration are not estab-lished, however. Proposed goals were to strengthen human resources by addressing frequent staff turnover and incorporating expectations of collab-orative action into job descriptions. Factors contributing to successful col-laboration include:

Leadership at the institutional and individual level;

Establishing an agenda for action;

Making shared information accessible;

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Recognizing the power of collaboration at the policy and board level;

Sharing agreed upon metrics which can lead to institutional change; and

Acceptance among all participants of a governing system.

The most effective mechanism for collaboration is still open for debate: while some believe that successful collective action during an event would be the catalyst for institutions to recognize the value of collaboration, oth-ers hold that the cluster and institutional approach would be more effective. Others proffer that effective collaboration begins at the “grass roots” level where two organizations gain a common understanding. This collaborative effort is further built by incorporating others and grows exponentially.

Finally, organizations can collectively advocate to donors for financial sup-port to create an environment for collaborative efforts. Open communication, a shared responsibility between leaders (i.e. cluster leads) and participants (i.e. operational agencies), and applying the “Principles of Partnership” lo-cally will create favor with donors and minimize field-level competition for funding sources.

consequences of failing to address collaboration

Without collaboration, the humanitarian response becomes uncoordinated, inefficient, and ineffective. By not making collaboration a priority, the com-munity loses an opportunity to address critical issues such as the best utilization of human resources, promoting staff retention, and further pro-fessionalizing the field. Uncoordinated data management and lack of collab-oration around infrastructure and shared goods prevent organizations from meeting basic needs vital to project initiation.


The Working Group agreed that the IASC Health Cluster is the appropri-ate body to seek future collaboration and collective action within the member organizations. Additional work needs to be done to vertically integrate this into the country and local levels. Despite these chal-lenges, the Health Cluster does have some leverage in mandating that certain standards be met. The future of the IASC Health Cluster, how-ever, is uncertain. Funding for the program is limited and there have been attempts to “mainstream” health cluster activities such that they

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are operational components of the organizations themselves (including maintenance and continuation of meetings) as opposed to a separate entity.

The Working Group called for a steering committee to explore models of collaborative mechanisms and research their applications in the hu-manitarian health field. They would review the literature on organiza-tional behavior as well as investigate models from other disciplines.

Finally, the Working Group endorsed the Humanitarian Health Confer-ence as a forum for ongoing discussion on collaboration and pledged to bring more humanitarian organizations to the table, especially leaders from the Global South. Donors from the government and private sector should also be present to view the value of collaboration and collective action and include activities to facilitate this into their funding mecha-nism. Additional key participants to future meetings are those members from the academic community, who have both an interest in the activi-ties of these organizations and also a desire to expose young clinicians and graduate students to possible careers in the field of humanitarian health emergencies and development.

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EXCERPTED REMARKS

anDReW s. natsios

Keynote address september 6, 2007

It is a pleasure to be here. I accepted this for several reasons. There’s one person I’m going to embarrass here because he’s the subject, maybe he left because I told him I was going to mention him in my talk. And that’s Geoff [Loane]. Where is Geoff? Is he here? OK. I’m going to make some comments. He’s in the back now and he’s had a couple of drinks so I think he’s relaxed. When I saw his name I said, if he’s associated with this then I want to come and say some things about executive leadership in emergencies. That’s go-ing to be my first point.

The second reason, of course, is that I went to the Kennedy School so I have a place in my heart for this institution and for this city, even though Cam-bridge may be really not part of the United States - it’s kind of in a different world, but I miss Massachusetts a lot. I ran the Big Dig for 11 months, it was the worst experience of my entire life. For those of you who are not from Massachusetts, you don’t know what the Big Dig is, but there was a massive scandal of cost overruns and I was the Chief Operating and Financial Officer, the Secretary of Administration and Finance in State Government under Gov-ernor Celluci, who is a very old friend of mine. We serviced in the legislature together for many years and our wives went to college together. We have been very close friends for 30 years. He asked me to come back and be Sec-retary of Administration and Finance and I had no idea what would happen to me.

I have to tell you this story. The Wall Street Journal leaked a story - not leaked - they wrote a story saying there are $1.4 billion in cost overruns that had been hidden for years. I was the chief financial officer and operating of-ficer for the state and the governor told me privately the reason he asked me to take the job as secretary of A&F, the most powerful appointed job in state government, is he wasn’t sure that all these rumors weren’t true. He thought maybe something was wrong, but he wasn’t sure. He said, ‘you need

andrew s. natsios has served on the

faculty of the Walsh School of Foreign

Service at Georgetown University since

January 13, 2006. In September 2006,

President Bush appointed Mr. Natsios to

the President’s Special Envoy to Sudan.

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to find out what is going on and help me fix it.’ Well, I didn’t think it was that big of a problem, but it turned out it wasn’t $1.4 billion. It was $2.4 billion. I called in the auditors from Deloitte & Touche and I said I want to know what the real figure is, not what The Wall Street Journal said and they came back to me and said it’s much worse than you thought. You have to come up with $2.4 billion in revenue to finish this project. I fired the entire management the first three days I was in the job. Everything I said was on the front pages of every newspaper in Massachusetts literally for the first two weeks. I went to give a little talk in a church, nothing to do with the Big Dig, a week after I took the job and I was on this subway and this elderly man came up and said, ‘Aren’t you Natsios?’ I said yes. I was disguised and he discovered who I was. It was very disturbing.

Anyway, the reason I’m making these introductory comments, other than try to relax you since you’ve had four or five glasses of wine already, is the fact that I actually am a public administrator. My skill set, if you look at my career, is to run large public institutions, not for-profit institutions, but the nonprofit sector, or particularly in the public sector. I’ve run four huge exec-utive jobs with thousands of employees and billions of dollars. I learned a lot over the years about what leadership is about and what public management is about in the public sector in controversial positions that are very visible. It’s very interesting because a lot of what I learned is exponentially appli-cable in the emergency management field. People used to say in the Boston Globe and the Herald and all the newspapers here that all these jobs had nothing to do with what you do in emergency work and development work around the world. I said most definitely they have a direct connection to it.

The first point I want to make tonight is that I think this work you’re doing, because I read from Dr. Strickland and various other people’s vision for this conference and the work that apparently this whole center is doing, is to try to professionalize and systematize a lot of the disciplinary work and the pro-fessional work — professionalization of the emergency health management function and emergency response. I am a very strong supporter of that, but I think one of the problems with this is, one, that we’re going sector by sector. Emergencies don’t work by sector.

Take, for example, Manuel de Silva, who is probably one of the most gifted people in the UN system, just retired as the deputy SRSG for Sudan, second command of the UN for humanitarian operations. I knew him in Angola. I knew him all over the world. When Manuel was there, I always knew it didn’t make any difference where the emergency was; things were run with integ-rity, run with moral conscience, things were done right, and if he needed help he would get the help. He didn’t have a big ego. He was an excellent manager. He had wonderful skills with people. People followed him because

3�Final RepoRt

he would do the right thing. It was a very sad thing that he finished his tour. I understand why he wanted to leave. He went back to WFP where he came from in Rome. But if we had a hundred Manuel de Silvas we wouldn’t be hav-ing a lot of problems in emergency response because, more than anything else, these massive undertakings we have — and whether it’s in Darfur or whether it was in Eastern Congo or whether it was in Northern Iraq after the first Gulf War when the Kurds went up into the mountains or whether it was in Cambodia after the Khmer Rouge — whoever is in the leadership position makes a profound difference.

Now, I’m not an advocate of this heroic view of history that all economic forces and all other forces are irrelevant, that what only counts is this sort of heroic personality — but I can tell you, from personal experience, that peo-ple with excellent executive skills, whether it’s in the UN or in an NGO or the ICRC or the US government, make a huge difference. Let me tell you why: when they choose people to take jobs, they usually put the right person in the right job. We always assume because someone is competent that they’re competent in everything. I think it was either Will Rogers or Mark Twain who said, ‘There’s nothing worse than an expert off of his discipline.’ Those of us who think of ourselves as experts think we’re experts in everything, which is a very dangerous idea.

I was a staff officer at the Pentagon after I left the first Bush Administration 17 years ago, in January of 1993. The President’s father left office for Bill Clinton to take over. I was not a very good staff officer and I realized this is not what I should be doing. I did my work, no one complained, but that was not the job I should have had. I was not trained for it; my skill set is not that. I said, ‘I’m never going to do this kind of a job again because the stuff I do is not the stuff that a staff officer does. I need to be in command or I shouldn’t be doing it.’ Or I should be an academic. I mean, I think I’m doing a pretty good job at Georgetown, although we’ll find out shortly if my contract is re-newed. Putting the right person in the right job is an extremely important executive skill. There are skills that people have in one discipline that are not transferable to another discipline, and the skills you need in an executive level in an emergency are unique. So I want to make three proposals tonight.

The first proposal I’m going to make is that, in addition to the other work you’re doing, you begin to consider the training and perhaps the creation of an interagency with ICRC, Federal of Red Cross and Red Crescent Societies, IOM, UN agencies and the NGO community to create what exists in AID in the State Department called the Senior Foreign Service and the Senior Execu-tive Service. They are a personnel system in the federal government, and the Japanese have this, the Germans have this, the British have this where peo-ple are actually recruited out of the system who were gifted with these skills

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and trained in these skills and have performed in senior-level positions and create an elite — I know that is not a popular word, ‘elite’ — but we need an elite of highly-skilled senior managers who can move and who know each other. I mean we have that now, but I’ve got to tell you, there’s a huge varia-tion in the quality of responses based on who’s running these things.

I go to some of these things and I say that these people have to be removed, they cannot run this, they don’t know what they’re doing: they’re not Manuel de Silva. I want to bring up Geoff Loane because whenever I would send people to the field when I was the head of the Office of Foreign Disaster As-sistance and then Assistant Administrator, I would ask my teams in the field to tell me who I can talk to, who knew what the hell is going on and can find a way of getting stuff in chaos. Because that’s what we do: we find a way to get things done to order chaos.

That’s what emergency response is all about, and it’s very difficult to do. For those of you who haven’t been in an emergency, you assume that when you turn a light switch on, the electricity goes on and the lights go on. In most emergencies, there is no electricity and sometimes the generators don’t work. You assume that when you turn the spigot on, clean water comes out. Well, that’s not true. There aren’t even any spigots half the time. you assume that you’re not going to get a gun stuck in your face when you open your door to leave for work in the AM — that’s also something that happens quite fre-quently in these chaotic situations. So it’s very difficult to get this work done. Finding people who are effective in the field is very difficult.

I am told there’s going to be a Hollywood movie about Fred Cuny’s life, and that Harrison Ford is going to play Fred Cuny — this is a rumor, I don’t know if it’s true; I mean certainly it’s probably completely untrue but it’s a won-derful story. I asked the person who said it, ‘Who is going to play me in the movie?’ I’m not sure I’m in the movie at all. I sent Fred out to Somalia in the mid part of 1992 when the chaos was beginning and a lot of people were dy-ing. I said, ‘Number one: what’s happening?’ He said, ‘your food aid, Andrew, is causing the chaos.’ I wrote a whole article of this on this subject for a book that also is published in ‘The Journal of International Peacekeeping.’ I think it’s called, ‘Economics of Chaos.’ He said, ‘The one person who’s get-ting stuff done, the person that understands the economics of this and has actually got his agency ICRC to function is Geoff Loane. So when you go, you need to sit down and talk to him and you need to understand when he tells you something it’s true.’

The problem with Fred was that Fred was brilliant at evaluation, analysis and telling you what you needed to do, and he could get stuff done, but there’d be broken crockery all over the place. He was not a systems person, he didn’t

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know how manage a lot of people, he was not a team person at all. But Fred was a genius when it came to intellectually understanding the forces that work in emergency. He was a great man and my mentor and my friend, and his loss in Chechnya was, I think, a terrible tragedy for the international humanitarian response community. I don’t know why they sent Geoff Loane here; he should be back out in the field where all these emergencies are going on. They sent him to Washington, which I suppose is an emergency in itself in some people’s points of view. I’m a Republican. I shouldn’t be saying these things. Maybe I’m saying it about the Democrats. I don’t know.

In any case, those kinds of skills are what we need to replicate formally and professionally through a system of education and maybe certification. I don’t know how to do it, but we need to think about it because that’s the big void now: executive leadership in emergencies. It needs to cross all of the institu-tional lines, we need to be able to take people from an NGO community and move them into government or from the head of the DART team or from AID or from one NGO to another NGO or to a UN agency and make these people available. We have a group of technical people who are available now, but you should not assume technical work is brilliance in executive management because it’s not. It’s not the same thing, believe me.

My second point is the issues of human rights and of protecting people against violence in emergencies. Now, for those of you from UNHCR and even ICRC, don’t get offended at what I’m going to say here, because what they do is absolutely essential, but they do not have adequate skills and ad-equate tools to prevent atrocities against people in chaotic situations. ICRC, actually in my view, is the best at it. UNHCR has developed a number of very effective tools but they’re not effective enough. I brought Fred with me when I was on military duty for the first Gulf War in 1991, when Iraq invaded Ku-wait, and we had all these plans, I’ll never forget it. I was the executive offi-cer of a unit that Jim Baker and Dick Cheney, who was Secretary of Defense at the time, set up to reconstruct Kuwait. I was with all these officers, and I was a Civil Affairs officer, which is sort of the unit in the US military that deals with this stuff, and we had done a traditional response plan.

Fred said, ‘This is not what’s going to happen, Andrew. you wasted all your time. The Kuwaities will take care of this stuff. There are going to be atroci-ties against the Palestinians.’ I said, ‘The Palestinians? We’re not in Pales-tine.’ He said, ‘There are a half a million Palestinians here. The Palestinian leadership sided with Saddam Hussein who promised them that the new Palestinian state was going to be Kuwait, which was a lie. He had no inten-tion of doing that. But the Palestinians actually were seen by the Kuwaities as traitors because they sided with Saddam in support of the invasion.’

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Fred had a place in his heart for the Palestinians. He said, ‘These people are going to be the object of atrocities the minute the war is over,’ and they were. He had a whole plan that we put in place and carried out. It never got recorded, unfortunately. I did a lecture at the Fletcher School once on it. He told me that we needed to put a book out on this but I never wrote the book and Fred died. I’ve got the records. He kept a very interesting diary on it. I read it after he died, it’s the archives of what happened day by day, because he kept voluminous records, he was a voracious writer. Every night, every single day of that emergency, he sat there and wrote exactly what happened all day long.

We tested his theories during the Second Gulf War, the Iraq War now, before we went in — you know, there’s an illusion that we did no planning; that’s just not true. I cannot tell you about the Pentagon. We had 275 people, pro-fessional career officers in AID working on planning. Many of the assump-tions we made about what was going to happen did not happen. We expected mass atrocities the first two weeks after we went in, and it did not happen. We had a whole plan based on Fred Cuny’s theories and we designed a whole strategy. We had 800 Civil Affairs officers and AID, DART teams, all trained in this stuff to try to prevent mass atrocities. The atrocities took place much later, actually years later. Fred was convinced that it always took place the first two weeks after the end of a war; this is what happened in Paris after the Nazi occupation ended. There were 5,000 people executed in the streets of Paris by the French Underground. Much of it was revenge killing. It wasn’t executing people who were necessarily supportive of the Germans, be-cause there was chaos. The same thing started happening in Kuwait and we stopped it.

It’s actually a wonderful story. It got in some of the civil affairs literature, but it was never recorded in terms of what we could do in a human rights set-ting. I think what we need to do is break out of the traditional ICRC, UNHCR — not to ignore their disciplines or their processes or system, but to expand on them. Because they know a lot, they’ve learned a lot, but we need to take the lessons they’ve learned and the lessons we’ve learned from these other emergencies and put them in place to operationalize the protection of hu-man rights particularly during conflicts during chaotic situations, because that’s where we’re failing. We should not always assume that sending in troops from — I’m not going to make any comments here — but sending in a peacekeeping force from whatever country it comes from is going to solve the problem. There are things we can do with the news media, with simply locating.

One of the things we did was to locate where the atrocities were taking place. And it’s very interesting, they tend to congregate if you map them,

3�Final RepoRt

which is what we did. They were taking place in certain locations. We would send teams out to find out why, and we could deal with the situation. The notion that it’s all complete anarchy and chaos and there’s no order to it is not true. There were reasons for the atrocities that took place in each of these great conflicts and there was some order in the atrocities. There is a way under those circumstances to effect that, and I think we need to spend a lot more time studying that and creating systems that build upon the ICRC disciplines and the UNHCR disciplines in terms of protection. So, that’s my second proposal today.

The third proposal is more of a government one, but I’m writing a whole bunch of stuff simultaneously with being a special envoy. Professors are supposed to write things; special envoys aren’t. I started writing a book about the issue of implementation, which I think is the critical issue, not just for emergency response but for international development generally. The people talking about this subject, many of them in writing about it have actu-ally never run a program in a developing country, never run a program in an emergency or even in a stable country. They haven’t the slightest idea what the issues are with implementation. It’s nice to have a lot of money, it’s nice to have a big staff, and it’s very hard to get results. The question is: why? This is the third point I want to make. The structure of budgeting among the donor governments has a profound affect on the work we do in our system, and I want a make a more radical proposal. I’ve made it before but never in such a large setting.

We have basically three major responders in the US government. We have PRM that basically funds 20% of the budget of UNHCR. The United States has been the biggest funder of UNHCR since it was created, actually, con-sistently through Republican and Democratic administrations, and it is now. They do a very good job. OFDA is the Office of Foreign Disaster Assistance, which I was the director of 18 years ago. Julia Taft, my good friend, was my predecessor, and that is an extraordinary office. They tend to do the work for refugees, OFDA traditionally has done the work for internally displaced people. Then there’s Food for Peace that does the food program. If you look at the budgets, there’s a real disparity: PRM has a budget of $800 or $900 million dollars and a lot of that goes to UNHCR or to the resettlement of ref-ugees in the United States; OFDA’s baseline budget is around $235 million. If there’s a big emergency they’ll give them money through Congress. Food for Peace has a $1.2 billion budget.

People write evaluations: every emergency, we’re not spending enough on international humanitarian health. I’ve got to tell you, I think we’re actu-ally spending more than we should proportionately in the development field on health. In many countries in Africa, three-quarters of the AID budget is

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health, which is not the way it’s supposed to be. I don’t mean just HIV-AIDS. The president has a $1.2 billion malaria initiative. 70% of all family planning money in the world that’s spent through governments is spent by AID. Most people don’t know that. It’s $435 million a year, spent this year, last year, the year before for 15 years. $435 million just for family planning. If you add it all up it’s a huge amount of money. That’s because the accounts of AID, like all other federal agencies, are protected by many of us here: interest groups, the media. you touch one of the accounts by $1 million and people go ballis-tic. We should be spending a lot more money on health.

I love the food programs, but we should be spending less on food aid, espe-cially through the mechanisms we use now. I’m not opposed to food aid, I’m in support of food aid; I used to run that program. After I ran OFDA, I was head of the bureau in which Food for Peace was present. I’m a big advocate of the food program. I have been an advocate and got the President to sup-port the notion of local purchase of food so he wouldn’t send American food abroad, we would purchase the food locally. This was extremely provocative. Some of my friends in the NGO community said that I had betrayed the NGO community by proposing this. It was very controversial. It was very popular in Africa among Africans. They said, ‘We have these surpluses - why don’t you buy the food here?’ It can strengthen agricultural markets. I’m not going to spend the whole time talking about that, but the point here is this: there has been a massive reduction in the number of refugees and a massive in-crease in the number of IDPs over the last 15 years. Has there been any ad-justment in the budgets? No, there has not been.

We know in every single evaluation of emergency response that we are not spending enough on emergency health interventions. I had a friend of mine who analyzed the entire spending in responses by NGOs, the ICRC and the UN, all the major UN agencies that do response, and 70% of the amount of money spent — 70% to 80% over the last 15 years, according to this guy’s analysis, and I never saw the actual table so I don’t know if this is true — is all food aid. That’s a distortion. Why is it? It’s because of these accounts: NGOs and the UN agencies become attached to them, they develop large systems that support them, and they don’t want disruption of these systems. I’m not attacking anybody, I’m just telling you an observation.

When we try to make adjustments in the accounts to move money from one account to other, people get very, very upset because certain institutions are dependent on that money. So I propose tonight that we abolish the PRM account, the OFDA account and the Food for Peace account and put all the money into emergency response - the same amount of money, no cuts. In fact, I’d like to have it increased. We should have a committee, maybe some NGOs, maybe an advisory committee to make sure no one plays any games

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with anything, but to allocate the money based on what the needs are. Not what the requirements are of the institutions that use the money, but what the needs are on the field, because the needs are very different depending on what the emergency is. The agencies would then get the money for that year based on the kind of emergency.

If we were facing a massive refugee emergency, we may have to reduce the money spent from IDPs and food programs. By doing that, we would add in flexibility. I think we need more flexibility in all our structures, public and private, to get the work done because too much of what we do is constrained by the political economy of the donor governments in the UN system, by the responding agencies. All of this is a part of it. Again, I’m not being mean; I’m simply observing the way the incentive structures work. People don’t like the systems disrupted, and I understand that, I used to run the systems. My final comment is hard to do, I mean if someone proposed this when I was at AID, I would have gone ballistic and said, ‘you’re not touching my accounts!’ But I’m not there anymore so I can make these kinds of outrageous proposals. My final comment would improve our capacity to help people, which is really what this is all about. We need to keep in our minds what the purpose of all of this is: it’s to serve the people in the field, not to maintain the institutional mechanisms of the structures — however well-intentioned and however competent they may be.

My final proposal is to change the structure of the response funding system for the US government. I don’t understand the EU system, but I think it has actually more barnacles on it and structural impediments than we do. They have their own problems, we have our problems, and it’s not a criticism. It’s just the way government is. I think we need to begin to think through a more radical overhaul of the way the funding goes because a lot of our dysfunction in the system, our failure to respond adequately in my view is a matter of the structure of the system. Until the structure of the system is changed we’re going to keep running the same evaluations after each of the emergencies.

Thank you very much.

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EXCERPTED REMARKS

peteR W. GalBRaitH

Keynote address september 7, 2007

This turns out to be a great occasion to meet with people that I met in pass-ing in Kurdistan in 1991, in Croatia, as well as people who have also been in Iraq – and Dr. Leaning, who looked after my mother when she injured herself in 1992 at Easter time. So anyhow, it’s a great occasion.

I wanted to talk about some of the issues in a variety of humanitarian crises that I’ve been involved in to see if there are some general lessons. But I’ll begin with Iraq, which as you know is in the cradle of civilization, and the site where the Tigris and Euphrates meet, at least by legend, in the Garden of Eden. And there arose a discussion about what is the world’s oldest pro-fession (not heading where some of you are thinking) among a surgeon, an architect, and a politician. The surgeon (and here I am with doctors) insisted that his was the oldest profession because in the Bible, at the beginning, it was an act of surgery to create a woman from the rib of Adam. The architect said, ‘No, no, mine is the oldest. The Bible begins with, “Out of chaos God created heaven and earth.”’ The politician said, ‘Got you beat.’ ‘How is that possible?’ said the architect. ‘How can you get beyond the very first words of the Bible?’ The politician said, ‘And who do you think created the chaos?’

That is definitely true of the situation in Iraq today — and we can name the politicians. And it leads to my point, which is that humanitarian crises are man-made institutions. It wasn’t always so. As a child I lived in India, and there was a famine, which had natural causes, and starvation because there wasn’t enough food and there wasn’t a practical way to get food in. In Cam-bodia in 1979, actually the issue I began my career in government dealing with, there was the aftermath of the genocide and the Vietnamese takeover; the famine was man created, and the failure to help was political. The West-ern powers were very reluctant to provide humanitarian aid to a country that Vietnam had taken over.

Now, one of the things about humanitarian crises is the way in which the world has changed. I guess I’m with a group of doctors — I don’t know if

peter W. Galbraith served as the first

U.S. Ambassador to Croatia and has

held senior positions in the U.S. Govern-

ment and the United Nations. Currently,

he is the Senior Diplomatic Fellow at the

Center for Arms Control and Non-Pro-

liferation and a principal at the Wind-

ham Resources Group LLC.

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there are any lawyers here — but if you went to law school, you know the advice in torts. “What happens if you run over a child?” Well, they say what you should do if you run over child is look around: if no one is watching, back off and run over him again because once the child is dead, the liability is very small. But if he is just injured, that’s something that you’re going to have to deal with and pay for and it’s going to be very expensive. To a very real ex-tent, the members of the humanitarian community are the people who are looking around that make it impossible for the politicians to back up and run over the victim again.

Consider the situation in Kurdistan and Iraq in the 1980s and compare it to Sarajevo in the 1990s. In the 1980s, Saddam Hussein systematically de-stroyed 4,500 of Kurdistan’s 5,000 villages. His regime used chemical weap-ons against at least 200 villages, and most famously against the town of Falujia. They deported and killed between 100,000 and 200,000 people, and the mass graves are still being dug up. But there were no outside observers there. There was no humanitarian community. And when the US Senate, in 1988, passed the Prevention of Genocide Act, which would have cut off US financial support to Iraq (which was running $500 million a year) as well as impose other sanctions, that was opposed by the Reagan Administration. They agreed that Saddam was gassing his own people but the Act was op-posed as premature and too strong a response.

But when the siege of Sarajevo began, and the war in Bosnia took place, it was also the desire of both Europe and of the Bush Administration at the time to look the other way, but they couldn’t. And the reason they couldn’t is that the United Nations went in there. In many ways that mission in Bosnia was one of the most disgraceful episodes of the UN, but it also in fact kept Bosnia alive because without the UN there, and with them the ICRC and the humanitarian community, you would not have got the journalists in there. you would not have had Christianne Amanpour putting what was going on in Sarajevo in front of everybody on the television 24 hours a day with the so-called “CNN effect.” And in fact, without having the UN there, it would have been impossible for us to negotiate an end to the war. Why? Because we could not have gotten in. I mean, just even the simple logistics.

So while the UN failed to deter the aggression (and incidentally, it didn’t re-ally have a mandate to do that), and you had UN soldiers and officials sort of standing by as people were massacred most disgracefully at Srebrenica, nevertheless, the people of Bosnia would not have survived. Sarajevo would not have survived without the United Nations and without the humanitarians, both keeping people physically alive, running hospitals — and I was in there at the time, as were some of you in unbelievably awful conditions — but also enabling the journalists to be there to put that in front of everybody.

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Today, thanks to the Internet and the mushroomed NGO community (com-pared to what existed in the 1970s and ‘80s), these humanitarian crises are in front of everybody. So you can’t follow that lawyer’s advice and look around and run over the victim again.

In recent times, we’ve focused much attention on failed states and on the question of nation-building, because these are the places where humanitar-ian crises erupt. And I’d just like to draw briefly eight lessons from my own experience. And I want to discuss three different cases: the case of Bosnia, the case of East Timor, and the case of Iraq. My starting point is going to be something that Donald Rumsfeld said on February 14, 2003 to a big fund-raiser in New york. He said, ‘The way we in the Bush Administration are going to handle the post-war situation in Iraq will be nothing like what the Clinton Administration did in the Balkans.’ And he was completely right, as we will see.

The first point about failed states nation-building is, ‘How do we know it’s happening?’ ‘How do we predict it?’ I realize I’m dealing with a medical com-munity here, people who have been discussing various statistical methods of following disease vectors and that kind of thing, and there has been an ef-fort, and I actually was part of it, to try and look at various indices that might help you predict a failed state. It’s certainly true that states that have low levels of education and high levels of inequality in healthcare, for instance, are more likely to become failed states and be the location of humanitarian crises. But the fact is that there are many states that are very poor that do not fail and do not become the scene of humanitarian crises. And there are some states that are reasonably well off that do become failed states — ob-viously the former yugoslavia is one example and Iraq is another, both of which had fairly high levels of education and health care and were mid-level in income.

So I actually think that this whole effort to find a statistical model for pre-dicting what are going to be failed states is not worth doing. There are only 190 countries in the world. The basic way of doing it is common sense: it’s observation, it’s seeing what’s happening.

The second question is, ‘What do you do about it?’ And I would say early in-tervention is important, but it’s more important to get the right diagnosis. In the case of Iraq in the 80s when Saddam launched the Iran-Iraq War and was engaging in the genocide against the Kurds, there was, as I noted, op-position to cutting off aid because there was a belief that somehow Saddam could be moderated, and that he could be a pillar of stability to deter the Iranians. The fact is the first Bush Administration got the diagnosis wrong. And had we stood up to Saddam, had we imposed sanctions when he was

4�Final RepoRt

gassing the Kurds, there’s an excellent chance he would not have believed that he could have gotten away with invading Kuwait, and we might have had a rather different history.

Or to take another case: yugoslavia as it was breaking up and all the em-phasis that was placed by the Bush Administration on, ‘How do we hold the country together?’ That was not possible. The people in Croatia and Slovenia had voted unanimously to split. But what was possible was to prevent the war, and no effort was put into that, with absolutely tragic consequences. And again, as the war unfolded, we, the Europeans and the Americans, mis-diagnosed the situation. There was an imagination that the Serbs were ten feet tall, that they were the people who had tied down 40 German divisions, that military force wouldn’t work. But finally when the argument was won by those who favored military intervention (air strikes in 1995), they brought that war to an end very quickly and saved thousands of lives. And if it hadn’t happened the way it did, hadn’t been the right kind of intervention, Bosnia could have become like the Middle East: a 50 year war and we’d still be talk-ing about it.

Of course, the most amazing misdiagnosis was of Iraq. If, in yugoslavia, the doctor got it wrong, in the case of Iraq, we really had a fantasist of witch doctors who failed to understand that when you go into a country, there will be a need to provide security after you take it over; that when you eliminate all the pillars that hold a regime together (the army, the police, the Baath Party) that you might have looting. They had no plan, no plan of what they were going to do when they arrived in Baghdad, or they simply imagined that there were Iraqi people who would embrace democracy as we wanted it, and failed to understand that this was a country that had been cobbled together by these three different groups: the Sunni Arabs, the Shiites, and the Kurds. The Kurds were held very much against their will by a Sunni Arab dictator and bureaucracy, beginning with King Faisal, ending with Saddam Hussein.

I tell this next story in my book and this just reflects the failure to think about these questions. Two months before the war, President Bush was meeting with three Iraqi Americans (and I know two of them very well and have heard this story from them) and they were discussing what Iraq was going to be like after Saddam Hussein. Naturally, they started talking about the Sunnis and Shiites. These, incidentally, were strong supporters of the war. And it became clear to them the President was unfamiliar with these terms. Well, you cannot anticipate that one consequence of your invasion is going to be a civil war between two groups that you didn’t know existed. And I don’t say that to illustrate the point that Bush is ignorant. I may say it simply reflects the lack of high-level planning, because obviously you could not have had a serious discussion at the National Security Council without

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dealing with this issue. I mean, other people in the government would have known it.

Third point: international and domestic support, and by domestic, I mean domestic in the country in crisis, is essential. In the case of Bosnia, the Eu-ropean Union, Russia, and the United States eventually coalesced with a uni-fied position that led to Dayton. In fact, it was the process of bringing about a unified position which had not existed in ’93 and ’94 that made Dayton pos-sible. It came about as a result of there being no other options, and of some very robust china-breaking American leadership. Nonetheless, as we went into Dayton, we did have a degree of unity and that unity increased through Dayton, and then into Kosovo. East Timor was a success because what was being attempted there was supported by almost all the East Timorese. Indonesia accepted that it had lost the territory and moved to normalize relations, not perfectly, but nonetheless did — and the entire international community and the Security Council supported it.

Iraq has failed. I should add in the case of Bosnia and domestic support, two of the three groups in Bosnia (that is, the Bosniacs, the Muslims and the Croats) supported what the US was doing. Admittedly, the Serbs didn’t, but you did have the support from 70% of the country’s population. Iraq has failed because not one Iraqi faction supports the American project of a unified and democratic Iraq. The Kurds are pro-American, but they want independence. The Shiites believe that their majority entitles them to rule, but their idea of democracy is not the kind of Western-style liberal democ-racy that the Bush Administration imagined. In Southern Iraq, they have already created an Iranian-style theocracy, in fact more severe than what exists in Iran. There is much more freedom in Iran than there is in Southern Iraq. And the Sunnis oppose the US invasion and reject a Shiite rule. And of course, accept for Britain and Australia and I guess El Salvador and Albania and Mongolia, the entire international community opposes what the US has done, and it’s done enormous damage to our reputation.

Fourth point is that, in nation-building, professional competence is es-sential. With regard to the military: the military is either fighting a war, or when it’s not fighting a war, it’s training and preparing to fight the war. But it doesn’t have another job. In the humanitarian community, there is a cadre of people who go from one crisis to another. But there is no cadre of people who are sitting around, ready to be deployed to go run Bosnia, to go run East Timor or to go run Iraq. And in fact, it’s hard to get people for these jobs, especially really good people, because if you are a police chief on a success-ful career track, at least in a developed country, you’re not going to do any-thing for your career to go off to East Timor. And that’s true of many other professions. It is tough to find people. But of course, there are sources. In

43Final RepoRt

Bosnia, to support the post-Dayton implementation operation, we went out and gathered all the diplomats who spoke the language, and people who had relevant expertise in AID and the Foreign Service, and professionals from different parts of the government. But we couldn’t have done it as the United States. We had the advantage that something like 60-70% of the people and the money came from the Europeans, who also brought their people, who spoke the local language, and who understood the situation. East Timor had no local expertise at all. When we arrived, there was not a single police, not a single civil servant, not a single policeman, not a single teacher. There were something like 20 doctors. There were 20 lawyers with minimal train-ing. So the international community had to come in and set up an admin-istration from ground zero: a very complicated task which I won’t dwell on here. Every decision was fundamental. ‘What law would you apply? Indone-sian? Portuguese? Make up a new one? What currency would you use?’ Well, we debated the US dollar, the Australian dollar, the Indonesian rupee, the Portuguese escudo. That was a cute one, because the Portuguese thought it was a great idea that their currency should come back. A slight problem was, this was 2000 or 2001 — they were going to shift to the Euro. We kind of thought this would be a place where Portuguese who were nostalgic for the escudo could come. And, ‘What taxes? Whether to have taxes?’ The whole thing. So it was really complicated. But at least we were able to draw on two sources of expertise: the expertise that exists in the United Nations, which is actually quite substantial, and then different countries providing experts.

In Iraq, the Bush Administration specifically excluded the Foreign Service, or many of them, particularly in the initial period of the US occupation. It chose to staff the coalition provisional authority with political appointees who were paid a lot of money, but who had no knowledge of Iraq, no language skills, and no relevant competence. And I discuss this in my book: there are so many examples. It’s comic, except it’s tragic. For example, they recruited six young people who came out there and were put in charge of spending Iraq’s $13 billion budget. The oldest of these was 26, the daughter of a conserva-tive activist. Of course, they knew nothing about Iraq. They knew nothing about federal budget rules. They knew nothing about budgeting. I think one of them had a degree in accounting. One hadn’t finished college. And guess what: in six months, they spent about $100 million of the $13 billion. It’s ac-tually hard to spend that much money. It meant things weren’t happening: we all know that when you get into that kind of environment, you have to im-mediately improve people’s lives, do reconstruction. You have to get people to work. And as a result of that failure, people became discontent and joined the insurgency, or became sympathetic to it, and it is literally a decision that has killed American servicemen and servicewomen.

The fifth rule: it helps to plan. In Dayton, as we prepared for the implemen-

44


tation period in Bosnia with the parties and with the Europeans, the treaty ran to more than 100 pages. There were 11 annexes dealing with all the dif-ferent aspects about how Bosnia would be governed and the whole range from the police to the judiciary to the political situation. We made some mistakes but there was a comprehensive plan executed by professionals. In Iraq, knowing that there was going to be a war, the Bush Administration chose General Jay Garner in January of 2003 and tasked him with putting together an occupation government. Actually, they didn’t even call it an oc-cupation government; it was the ORHA, Office of Reconstruction and Hu-manitarian Assistance. So he didn’t have a clear mandate. But he was hired, I think, on the 24th of January, less than two months before US troops were sent into Iraq. On the 30th of April (three weeks after we got to Baghdad) the Bush Administration called Jerry Bremmer on the telephone and asked him to be the administrator in a move that they explained to the world was long planned. He got to Baghdad two weeks later: he had again no service in a post-conflict environment, had never been to Iraq, and didn’t speak Arabic. He then made three fundamental decisions: first, to dissolve the Iraqi army; second, to fire all the Baathists in the ministries; and third, to run Iraq for an extended occupation, rather than turn things over to an Iraqi government. We could have a discussion about the wisdom of all those steps. I actu-ally think that there was some merit to both: to not calling back the army (although I wouldn’t have exercised my authority by dissolving it) and to removing at least some of the Baathists. In April of 2003, the United States had been in the process of calling back the Iraqi army, of getting the senior Baathists in the ministries back to work, and was in the process of forming an Iraqi interim government. Now, whatever the debate is, you cannot argue that it made sense to do both. You could have decided to do one or the other, but to do both didn’t make any sense at all. Again, a lack of planning.

Sixth rule (only two more): you have to be able to adapt. It turned out that in Bosnia we needed a stronger international role. In the first year we didn’t; the international community didn’t throw its weight around as it did later in terms of removing obstreperous politicians but it adapted. In fact the inter-national administrator in Bosnia became a more powerful figure, and it’s helped push the process along. In East Timor, the original plan was that the UN would run the country for a couple of years and then we would build a local administration from the ground up, because there was very little local expertise. It became apparent after about three months or four months that the senior East Timor leadership didn’t like this. So, instead of the idea of a turnkey administration (we’d create a government, and then hold an election and turn it over to them), we basically said, ‘OK, we’ll create a provisional government that will run the country, and we’ll let you be in it.’ That’s how I ended up as a cabinet minister in East Timor. It was initially four Timorese ministers, four internationals. The Timorese got the portfolios that had all

4�Final RepoRt

the jobs, and so it was up to them to decide how fast to Timorize the bu-reaucracy, versus how many of the international experts to retain, and they then had the competing pressure. To the extent that there were more inter-national experts, things ran better. But to the extent that there were more Timorese, they were serving their national agenda. It was for them to make the decision, and it worked well. In Iraq, for four years we have been locked in exactly the same strategy, committed to the building of a unified and dem-ocratic country where it has already broken up, and we’ve had zero success.

The seventh point is that, generally, there’s a very short time to get it right, and if you get it wrong, you can’t recover. We screwed up in Iraq, and it’s not retrievable.

Any intervention that the United States is involved in should serve our na-tional interest and be achievable at an acceptable cost. Bosnia was not a major threat, but it was a small place. If the war continued, it would have been a cancer in Europe. It could have been a breeding ground for terrorism, and it had the possibility of being an all-consuming conflict, you know: a 50-year conflict like the Arab-Israeli one. The intervention, which incidentally took place in both Bosnia and Kosovo without the loss of a single American or NATO life in combat, was not all that costly financially — obviously cost free, in terms of NATO lives. It saved hundreds of thousands of lives, and it hasn’t brought perfect harmony, but it has produced 12 years of peace.

East Timor is obviously a pretty unimportant place, but it was an important test of the international community’s ability to cooperate, and again, the cost was very low: $500 million. The US share, I suppose, was about 100 million.

Iraq has weakened the national security of the United States. We intervened against Iraq to eliminate weapons of mass destruction that did not exist, and while we were tied up in Iraq, North Korea pulled out of the Nuclear Non-proliferation Treaty. It reprocessed plutonium. It exploded a nuclear device, and we did nothing about it. Now, we may be able to get it partially back into the box through diplomacy, which would be a good thing. US prestige in the world is at an all-time low. Just one example: Turkey. In 2000, the approval rating for the US was 60%. Bill Clinton’s approval rating was 70% among the Turkish population. Today, and the Pew Trust polls show the US approval rating in Turkey at about 5%, and George Bush is even lower. Turkish Daily News’ headline was: ‘Turkey, the most anti-American country in the world.’ Now, should we worry about this, the largest country in NATO after the Unit-ed States, strategically located, bordering Iran, Iraq, Syria, the Caucasus, Russia, Balkans? yeah, I think that should be a sign of concern. It’s evidence of the way in which the intervention in Iraq did not serve our interests.

46


And finally (my father always said you should include the word ‘finally’ in a speech: it gives your audience hope), the final point I would make is that there are many conferences about humanitarian intervention and they al-ways are looking for generalities. The fact is, at least in my experience, each issue, each place is unique. As Noah Feldman, whom we are talking about now at Harvard, describes in his book: while he was flying out to Iraq on the plane, he was appalled by what his fellow passengers were reading, which were studies of the occupation of Germany and Japan. He was reading a book about the Shiites. People went in with no knowledge of Iraq and with the idea that Iraq was like Germany and Japan, that is to say a homogeneous state that had been defeated and could be remade. Well, we’d do a lot bet-ter if we would have looked at the very specifics of Iraq, the very specifics of Bosnia.

Let me just take a minute or two to say a word about the future of Iraq, since these other places are more resolved. As some of you may know, I have long argued, and as you detected from this presentation, that Iraq was not a suc-cessful state, that it was held together by force, that we have destroyed the force that held it together, and that it can’t, like Humpty Dumpty, be put back together again, and that as long as we had a strategy that was based on building a unified Iraq, we were certain to fail. What I have argued is that we can have a reasonably stable situation in Iraq by accepting that fact that the country is broken up. I want to make clear: I do not advocate the partition of Iraq. In my view, that has already happened. I’m opposed to spending Ameri-can dollars, prestige, and lives to try to put it back together — especially since the one successful part of the country that aspires to be democratic, that’s very stable, that’s very pro-American, Kurdistan, unanimously doesn’t want to be part of Iraq. They voted 98% for independence in a referendum in 2005. Furthermore, the constitution of Iraq is a roadmap for partition. It al-lows regions to have their own armies, to have their own parliaments, their own governments, and the central government has so few powers: it does not even have the power to impose taxes. I’ve also pointed out that when the Bush Administration talks about building Iraqi institutions, they’re not Iraqi institutions: they are the institutions of the victors, who are the Shiites.

The whole idea behind the surge, our current strategy, is send in another 30,000 troops. We would stabilize Baghdad, and it would give Iraq’s politi-cians an opportunity to implement a program of reconciliation that would bring in some of the Sunnis into the process, and that would give us time to train Iraqi security forces, the army, and the police, so that they could fill in behind us. The flaw with that strategy is: you cannot build an Iraqi security force where there is no Iraqi nation. The Iraqi security forces are Shiite forces, and when we train them, we can train them to be more effec-tive killers; we cannot train them to be neutral guarantors of public security.

47Final RepoRt

The fact is, the Sunnis are not going to trust the police at all, and they are only going to have marginal trust in the army. We can’t change that, nor can we force reconciliation in Iraq, because we obviously know of the discus-sion of the 18 benchmarks, which General Petreas is going to present to Congress and Ambassador Crocker in the coming days. Of course, none of these benchmarks, none of the significant ones, have been met. The reason that they haven’t been met is not because Iraqi politicians are lazy, and their parliament wants to take August off, and it’s not because their leaders are unwilling to compromise. It is because their leaders represent their con-stituents, and their constituents have diametrically opposed visions of Iraq. The Shiites believe that their 1,400 years of being oppressed as the minority branch of Islam, their 80 years of being denied their rights in Iraq, their 35 years of suffering under Saddam, the horrific killing that followed the 1991 uprising, entitle them as Shiites, as the majority, to rule Iraq, and to define it as a Shiite state. The Sunnis, including many who didn’t like Saddam Hus-sein, cannot accept that the country they feel they created is defined by a branch of Islam that is not them, does not include them, and that is closely aligned with Iran, whom they see as the great national enemy. And the Kurd-ish vision of Iraq is of a country that they’re not part of. And so the notion that a law on oil revenues or getting a few ex-Baathists back to their jobs, or giving amnesty to insurgents, that this is going to fix the problem is absurd. Amnesty is for people who have lost. If you were an insurgent, would you feel that you had lost at this point? I don’t think so. The point is that these bench-marks will do nothing. First, they’re unachievable — but even if they were all achieved, they don’t solve the problem, which is this fundamental clash of identity between the Sunnis and the Shiites (the source of the civil war) and the fact that the Kurds want out.

We are already moving now to create a situation where we are supporting three separate militaries: the Iraqi army, which is really the Shiite militia; these volunteers in Anbar; and then there’s the Kurdish Peschmerga, the Kurdistan army. The next logical step is, of course, to encourage the Sunnis to form their own region. The Shiites are moving to do that. And then there’s a role for the United States in helping to resolve some of the issues between the regions. One is the drawing of the boundaries (where do they go?) and second, the distribution of power between the very few powers that would be at the center. That is not going to create a pro-Western Iraq, but the south will be pro-Iranian. The center, if it’s Sunni, if it’s Baathist, it will hate us, but it will be less dangerous than Al Qaeda. And then we’ll have Kurdistan, which will be pro-American. It’s not going to be an achievement, but it is a way out.

48


acknowledgments

The Conference Planning Committee is grateful to the following: the 2007 Conference Board of Advisors; Dr. Marvin L. Birnbaum and the editorial staff of “Prehospital and Disaster Medicine;” Dr. Gregg Greenough; Work-ing Group chairs Geoff Loane, Paul Spiegel, Mary Pack, and Nan Buzard; rapporteurs Jacob Chapman, Ann Kao, Susan Bartels, Brett Nelson, Hani Mowafi, Helen Ouyang; conference coordinators Erin Lyons, Bev Freeman, Isa Orvieto, Margot Shorey and the volunteer staff; special presenters Ron Waldman, Heather Papowitz, Luca Barbone, Emmanuel D’Harcourt, Mi-chelle Gayer, Chris Haskew, Armand Sprecher, and Ziad Obermeyer; Mary Turco and Terri N. Farnham of Dartmouth Medical School; Sarah Appleby and Elisabeth Maguda of the Harvard Humanitarian Initiative; the Center for Government and International Studies at Harvard University; Radcliffe Institute for Advanced Study; the Weatherhead Center for International Af-fairs; Doreen Koretz, Jorge Dominguez, Shelly Coulter, and the Office of the Provost at Harvard University; Stuart Krantz, Skip Nordhoff, and the Office of Resource Development at the Harvard School of Public Health; Christina Roache and Robin Herman in the Office of Communications at the Harvard School of Public Health; Jean Brackenbury of AmeriCares; Nancy A. Aossey; Curtis R. Welling; Andrew S. Natsios; Peter W. Galbraith; Dr. Hilarie Cran-mer, Dr. Kris Olson and the staff and students of the Humanitarian Studies Initiative for Residents.

conference sponsors

We are grateful to the following for their support in sponsoring the 2007 Humanitarian Health Conference and promoting humanitarian excellence:

AmeriCares Becton, Dickinson and Company International Medical Corps International Rescue Committee RAND Corporation Schering-Plough USAID Office for Foreign Disaster Assistance World Bank

This report is a product of the Harvard Humanitarian Initiative and was edited by Gregg Gree-

nough and prepared for publication by Erin Lyons. The findings, interpretations, and conclusions

expressed here do not necessarily reflect the views of Harvard University or our sponsors.

©2007 President & Fellows of Harvard College.

Harvard Humanitarian Initiative

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Cambridge, MA 02138

www.hhi.harvard.edu.

14 story street, cambridge, ma 02138 www.hhi.harvard.edu



Terms of Reference Health Cluster on Capacity Building of National Stakeholders

Duration: 2 months (40 days)

ORGANIZATIONAL CONTEXT WHO is the Lead agency of the IASC Global Health Cluster. The mission of the Global Health Cluster is to provide health leadership in emergency and crisis preparedness, response and recovery; prevent and reduce related morbidity and mortality; ensure evidence-based actions, gap filling and sound coordination; and enhance accountability, predictability and effectiveness of humanitarian health actions. All clusters are required by the IASC guidance "to support efforts to strengthen the capacity of national authorities and civil society". The Global Health Cluster is committed to building the capacity of national stakeholders to provide basic health services. A Working Group on Capacity Building of National Stakeholders has been established to develop guidance for health cluster partners on this and to consider how else to promote and support capacity building. The definition of capacity building which has been agreed by the Working Group for this purpose is as follows:

Capacity building of national stakeholders is a process of building capabilities in individuals, groups, institutions, organizations and societies at the local and national levels to more effectively provide basic health services. This process is designed to reinforce or create strengths that mitigate health related vulnerabilities, that improve the effectiveness of the response in the health sector, and that support the rebuilding of stronger health systems.

The objective of the global health cluster in this regard is to ensure that all humanitarian health actors consider how they can build local capacity both in the response and recovery stages of an emergency and in all their activities. SPECIFIC OBJECTIVES The Working Group wishes to engage a consultant to develop guidance for the health cluster on capacity building. The guidance should provide simple and practical guidelines on how humanitarian health agencies can best (re)build the capacity of local health services in an emergency context in the course of their humanitarian work, principles and best practices , how to map and coordinate partner efforts and identify gaps and to ensure continuity of capacity building through the recovery phase into development. The roles of relevant national and international agencies in capacity building should also be covered. The importance of developing a strategy for rebuilding the local health services in the early stages of an emergency should be explained and suggestions offered on how this could be accomplished The intention is that the guidance will be incorporated in the pocketbook being developed by global health cluster, an outline of which is now available. The more detailed document produced through this consultancy could be added as an annex to the pocketbook if appropriate

1

2

OUTPUTS The consultant will be expected to produce the following outputs within the timeline indicated:

1. A work plan and timeline for the assignment, including the organisations and individuals to be consulted (within 5 working days)

2. Provide a framework which identifies the main areas that need to be considered as priorities for capacity building (for example, repairing infrastructure, finance and personnel systems, personnel, health policy and regulation) (within 10 days)

3. An outline of the guidance and initial suggestions on how it will be incorporated in the pocketbook (within 20 working days)

4. A first draft of the guidance note (within 30 working days) 5. A final version of the guidance without detailed proposals on where to include it in the

various sections of the global health cluster pocketbook - working closely with Pocketbook WG (within 40 working days)

6. Proposals for promoting the guidance through health cluster training, field visits, and through individual partner efforts (working closely with Pocketbook WG).

7. A bibliography of key documents

METHODOLOGY In carrying out these tasks, the consultant will be expected to consult a range of individuals and institutions in WHO, the UN systems, NGOs and academia as well as country-based health stakeholders and to identify relevant research and other reference materials. He/she will be expected to carry out the assignment on his own initiative while keeping the co-chairs and the rest of the Working Group appraised of progress towards planned products. The methodology will include the collection and analysis of available information and will include the incorporation of perspectives of key global and field-based stakeholders. It is also expected that consultant will contact consultants responsible for developing capacity building guidelines for the other clusters (especially WASH and Nutrition) to ensure consistency and coherence. The methodology will also need to take account of experience in building capacity in recent and major emergencies by talking with practitioners and/or review of relevant reports. EDUCATION University post-graduate degree in public health or a related field. COMPETENCIES In depth knowledge of health capacity building for team work; leadership; good interpersonal skills with excellent communication, facilitation and negotiation skills, ability to work with multiple partners to build consensus; strategic vision and judgement; ability to prioritize, organize, manage, and adapt management style according to need; ability to convene stakeholders and facilitate a policy process between UN and NGOs; well developed problem solving skills. EXPERIENCE Extensive experience (at least 7 years) in emergency and crisis contexts and in development at the international level; recognized technical skills in the area of assignment; extensive field experience in developing countries; a minimum of five years experience in field-based humanitarian response within the United Nations system or with a non-governmental organization; familiarity with the health sector and stakeholders, cluster approach and computer-based information systems; proven skills in information gathering and analysis. LANGUAGES Excellent knowledge of spoken and written English

CLUSTER EVALUATION,CLUSTER

IMPLEMENTATION AND THE ROME DECLARATION

November 16,2007

IASC's Action Points on Evaluation of the Cluster Approach

• Agreed to hold an ad hoc meeting/video-conference of the IASC Working Group in Geneva on afternoons of 10 and 11 December 2007 to discuss the findings and recommendations of the Cluster Evaluation, to agree on an action plan to address these, and to discuss the terms of reference and process for conducting Phase II of the evaluation. Took note that WFP requested to submit during the same meeting a proposal for the Emergency Telecommunication Cluster Lead. Action: IASC WG and WFP.

• Requested the IASC Task Team on the Cluster Approach to prepare for these meetings by consulting widely with relevant stakeholders and laying out options for how to address the findings and recommendations of the external evaluation. Action: IASC Task Team.

IASC's Rome Declaration on Cluster Implementation

The Working Group agrees that in rolling out the cluster approach, due regard needs to be given to the principle that States have primary responsibility for meeting the assistance and protection needs of people affected by natural disasters and other emergencies (including conflict-related ones) occurring on their territories. The role of international actors is to support national efforts to meet the humanitarian needs of affected populations and to complement national efforts including in cases where national authorities are unable or unwilling to lead the response. By helping to ensure close partnership and a clear division of responsibilities among humanitarian partners at the country level, the cluster approach aims to ensure that international actors can be a strong, reliable and predictable partner for governments and other relevant local and national actors.


It should be emphasized that flexibility in determining response structures at the country level is essential. Local government structures and existing capacities should be taken into account. There is no need to replicate all global level sectors/clusters if less are needed for the particular humanitarian operation in question. Leadership of these clusters at the country level should also be determined on a case by case basis and does not need to mirror arrangements at the global level (though global cluster leads should in all cases be consulted)


Revised IASC Contingency Planning Guidelines, incorporating the cluster approach, were endorsed by the IASC Working Group on 5 November 2007. They provide the basis for planning and implementing humanitarian responses in new emergencies. They represent a major step forward and their implementation should facilitate further progress in rolling out the cluster approach. They should be widely disseminated and the necessary training and support for their implementation should be provided. They also underline the primary responsibility of national authorities and the importance of building on national capacities wherever possible. They emphasize the importance of preparedness and provide a useful opportunity to familiarize national authorities, Resident (and/or Humanitarian) Coordinators and humanitarian partners (including national and international NGOs) with the cluster approach and to ensure that it is used in all contingency planning for potential emergencies.


All Country Teams in countries with Humanitarian Coordinators should consider what needs to be done in their countries, as a minimum, to adapt current working methods to conform to cluster approach guidance. They should present this information to the ERC and relevant global cluster lead agencies, with clear information on minimal additional capacity and resources needed, so that this can be reflected in a global cluster implementation plan and incorporated into agencies’ cluster mainstreaming exercises. This information should be provided by the end of March 2008. In cases where the Humanitarian Coordinator and humanitarian partners believe that for any reason current working methods should not be adapted to conform with the cluster approach guidance by the end of 2008, the Humanitarian Coordinator should inform the ERC of this in the submission. The ERC will then consult global cluster leads and IASC members and standing invitees before deciding on the way ahead and providing further guidance. Meanwhile, inter-agency workshops on humanitarian reform (including the cluster approach) will continue to be organized at the country level and other support will be provided to improve knowledge and understanding of it amongst field-based colleagues. .

IASC's Action Points on Application of the Cluster Approach in Sudden-onset and

Long-term Emergencies– Agreed to submit to IASC Principals the Rome Statement on Roll-Out.

Action: Chair, IASC WG.– Requested the IASC Task Team on the Cluster Approach to consult

widely with stakeholders on how to clarify and improve current guidance on ‘Provider of Last Resort’, taking into consideration the findings of the external evaluation, and to present a proposal to the IASC Working Group for discussion at the March 2008 WG meeting. It was agreed that the proposed improved guidance on Provider of Last Resort would be circulated one month before the IASC WG meeting, to enable a consultative process with the field by all agencies. Action: IASC Task Team.

– Requested the IASC Task Team to recommend practical steps to take in new emergencies, until all countries’ contingency plans have been prepared in accordance with the cluster approach. Action: IASC Task Team.

– Requested OCHA and other concerned agencies to ensure that training programmes for RCs, RC/HCs, country teams and cluster leads are adapted as necessary in line with the IASC Working Group’s Rome Statement on Cluster Roll-Out and to reflect the recently endorsed Inter- Agency Contingency Planning Guidelines. Action: OCHA and agencies.

IASC's Action Points on Application of the Cluster Approach in Sudden-Onset and

Long-term Emergencies– Requested global cluster leads to assist humanitarian country teams in assessing

additional resources or support needed to adapt their working methods to conform to the cluster approach, and requested OCHA to facilitate the development of a global cluster implementation plan and to provide by March 2008 an update on roll- out plans, based on information provided to the ERC by Humanitarian Coordinators and humanitarian country teams. Action: Global cluster leads and OCHA.

– Requested OCHA to continue facilitating country level inter-agency workshops on the cluster approach and cluster/sector lead training programmes. Action: OCHA

– Requested the IASC Task Team to revise the current Operational Guidance on the cluster approach, taking into consideration the points made in the IASC Working Group’s Rome Statement on Cluster Roll-Out, clarifying in particular relations with national authorities, the need for broad-based, inclusive humanitarian country teams, and providing concise language on exactly what constitutes ‘application of the cluster approach’. Once the IASC WG has agreed on language to clarify the Provider of Last Resort concept, the Operational Guidance should also be revised to reflect this. Action: IASC Task Team.

– Requested OCHA to ensure that once the revised Operational Guidance has been finalized, a message is sent from the ERC (as chair of the IASC) and the Administrator of UNDP (as chair of UNDG) to all Resident (and/or Humanitarian) Coordinators informing them of this, and training programmes for RCs (or RC/HCs) on emergency humanitarian response should be tailored accordingly. Action: OCHA.

• The modalities for implementation of the cluster approach are different from the ones for the acute emergencies

• Cluster is the best mechanism for advancing the agenda of harmonization and alignment in health in complex environments of ongoing crises and transition

• Need for incorporating in greater degree the national counterparts and for encouraging their leadership role

Specific Dimensions of Health Cluster Implementation in Ongoing Emergencies

and Transitional Situations

THE HEALTH CLUSTER IN PILOT COUNTRIES

• Rolling out of the cluster in DRC, Liberia, Uganda and Somalia has posed special challenges

• Need for simultaneously advancing humanitarian action and recovery work within a context of either protracted conflict or post- conflict transition

• Different and sometimes more intensive coordination efforts than during acute emergencies.

Prospective Roll Out of the Clusters in Ongoing Emergencies in 2008

• In addition to the pilots, Ethiopia and Madagascar are moving towards the full implementation of the Cluster approach

• The process will follow in ten more countries : CAR, Chad, Cote d'Ivoire, Eritrea, Guinea, Haiti, Indonesia, Niger, Sri Lanka and Zimbabwe

• Possibly five more will be included: Burundi, Myanmar, Nepal, oPt, and Russia/North Caucasus

• There are expectations as well to implement it in Darfur.

Basic Principles for the Implementation of the Health Cluster in Ongoing Emergencies

• The roll-out of the Health Cluster Approach needs to be a country- driven process

• It is necessary to ensure back stopping from the Cluster Lead Agency and the Members of the Global Cluster

• We need to build the necessary in country capacity for implementing the cluster approach in a sustainable manner

• The process require substantial institutional strengthening at country level of the cluster lead agency and the cluster members

• It is important to assess the readiness of the Country Clusters to respond to the challenges associated to their effective operation and to define action plans for building the necessary institutional capacity among the cluster stakeholders

Checklist

• WHO Country Team and Health Cluster members adequately briefed on the cluster approach and its implications for WHO

• Agreement reached with HC on the scope of the health cluster work in the country

• Functional mapping of humanitarian stakeholders with a role to play in health action in the ongoing emergency completed

• A roadmap for the implementation of the Health Cluster developed

Checklist

• Activities corresponding to the cluster lead function at country level adequately identified and resourced:– Coordination and partnership development– Advocacy and communication– Information Management– Needs Assessment– Strategic and operational planning– Capacity building and training– Orchestrating implementation by partners– Monitoring and evaluation

Checklist

• Essential staffing in place with key competencies necessary to carry out the functions of health cluster lead agency

• Administrative capacity in place for supporting the implementation of the cluster

• Backstopping needs identified

STRATEGIC DIRECTION FOR THE IMPLEMENTATION OF THE HEALTH CLUSTER

IN ONGOING EMERGENCIES

Build "cluster institutional capacity" at country level• This in not only about holding meetings and exchanging information • Implies the ability to engage national and international key partners at

national and sub-national level for concerted health action in ongoing emergencies

• Involves carrying out the appropriate needs assessments for identifying priorities and translating them into short term and medium term outcome oriented cluster objectives

• Encompasses the capacity to formulate , with the contribution of all the cluster members, annual strategic and operational planning processes

• Includes the definition of projects that conform the annual work plans and integrate the CAPs or their equivalents for submission to donors ,to the CERF window for under funded emergencies, to the HC pool funds or to other mechanisms for financing recovery work

• Cluster leads have to orchestrate implementation of activities by all partners and to monitor and evaluate progress and impact

... WHAT IF ?

Planning parameters for the Global Health CLuster

A.LNo,embe,2OO7

All global clusters have agreed to setplanning parameters for

three sudden onsetemergencies

per year,each of 500,000 affected population, with

two being simultaneous.

Do we have

what it takes?

1

MECHANISMS & ROUTINES

. Global monitoring and Risk-Analysis: ensuring that atany given moment the Cluster has a global overview ofsituations that need or may need its involvement as amatter of emergency

. Contingency plans: identifying the desirable outcomesand the strategic options for the Cluster in an expectedcrisis, and setting the arrangements in place;- so to providethe most effective response if the crisis materializes

. Alert & mobilization: using the situational information andthe strategic options to activate the Cluster in timely,comprehensive and sustainable fashion

OPERATIONAL PLATFORM

the package of staff, equipment supplies, andfunds that is needed for the optimal and saferoll out of the Health Cluster in a crisis; it is

intended as ready for prompt SurgeDeployment, and supported by logistic

systems, standard operating procedures,partnerships and technical backstopping.

EARLY ACTION

. Surge: using the Operational Platform to expandthe technical, administrative, logistic and securitycapacities of an agency of organization in a countryfaced by a crisis, so to implement an appropriatepublic health programme.It includes rapid assessment and planning; it may

include Real Time Evaluation.

. Logistic services: providing services and specificknow-how to/through all the Cluster, inpurchasing, transport and delivery of supplies tocountry programmes in order to reduce costs,increase efficiency and uphold standards

2

FLEXIBILITY & ACCOUNTABILITY

. Monitoring, reporting, mode shift and handing-over: staying abreast of perfonnance and progressof the health cluster perfonnance within an evolvingcrisis, to use the information for management &accountability, and to readjust programmes andstrategies when pre-set criteria are met

. Lesson Learning: collecting and analyzing data asrelevant to an health emergency programme, andproduce and disseminate lessons for Health clusterpartners

Contingency Planning

TWO DIMENSIONS

Global contingency planning: "two majorsudden emergencies in one year"

Countrycontingencyplanning:whatsortoflearningsupportisneeded

A LogicalFramework1. SCENARIO , Whatmayhappen?

. Whatwillbe the main causes of death?

2. STRATEGY . Which factor.; of riskshall we address?

3. IMPLEMENTATIONPLAN

. Howcanwe addressthem?

4. OPERATIONAL PLAN' Whatdo weneedto impiementthepfan?

5. PREPAREDNESSPLAN

, Whatdowe needtodo NOW?

6. BUDGET . HowmuchwillN' 4 Cost ?

F= ..000'"'°0.2007

3

SCENARIO

. Humanitarian health assistance for 500,000 forthe first three months, assuming a sudden orrapid-onset medium-to-serious disaster

. Pre-disaster health profile: country of low humandevelopmentindex

. Post-disaster: at least 65% disruption of localcoping and support capacities - thusnecessitating at least 75% dependence onexternal assistance to meet basic needs

INPUTS. Initial assessments and establishment of emergency presence:

? 50,000 - Five internationals for 2 weeks: subsistence travel,plus operational funds; salaries not included

. Performance and Outcomes (Health, Nut & Mortality) Tracking:? 300,000 -Costs of nutritional and diseases surveillance, basicmortality and health and humanitarian outcomes tracking service,inciuding surveys

. Cluster Coordination services: ? 650,000- 10 intemationals intwo field offices in disaster area and in capital city for informationdissemination, appeals and resource mobilisation, programmereporting, as well costs of telecoms, in-country transport, specialistsupport, and allowance of 50,000 for HQ-based Cluster costs

INPUTS

. ~fs~~~~~~~~~8,~~g tTse8!'[;'s~~~£I~~d:n:n~n~~~~PH':;:~~~K (

withlwithout MaiaMa Module)for 500,000/3 months: Dia~oea k,s (bufferstockfor first 500 cases): 20,000; UNFPA kit; for500.000Trauma ate kits(buffer stock for 500 cases: 30% of airfreight, etc: Intematonal and iDealsupply manEgement 70.000.

. ~~~~r~~~~rr\'~~~~tT;~t~gJ~';~~~~:t~~~r~~~f~~IZm~~~n~!j>M~~,D-outbreak preparedness; waiving user-fees, outreach by mobilecircufts,community-based care, decentralized therapeLtic feeding, redeploymento!national staff

. Humanresourcesfor delivering basic primaryand hospital care:?6,000,000 USD-Front lineworkers(physicians,nurses)aswellas

rg~~I~'Wsa~~,la~~~~~~~~~~~~~~~t;~ ~~~~';~ staff. Awox 95 %

4

IASC Working Group 5-7 November 2007

Rome Statement on Cluster Roll-Out

1. At the IASC Working Group meeting in Rome on 5-7 November 2007, responding to recent concerns about the slow pace of roll-out of the cluster approach, the IASC Working Group1 reconfirmed its commitment to improving humanitarian response by ensuring greater predictability, accountability and partnership. In this regard, the Working Group takes note of improvements in response capacity at both global and country levels as a result of the cluster approach and of lessons learnt from experience to date. The Working Group also reaffirms earlier IASC agreements that the cluster approach should be the framework for response in major new emergencies and should eventually be applied in all countries with Humanitarian Coordinators.

2. The Working Group agrees that in rolling out the cluster approach, due regard needs to be given to the

principle that States have primary responsibility for meeting the assistance and protection needs of people affected by natural disasters and other emergencies (including conflict-related ones) occurring on their territories. The role of international actors is to support national efforts to meet the humanitarian needs of affected populations and to complement national efforts including in cases where national authorities are unable or unwilling to lead the response. By helping to ensure close partnership and a clear division of responsibilities among humanitarian partners at the country level, the cluster approach aims to ensure that international actors can be a strong, reliable and predictable partner for governments and other relevant local and national actors.

3. The Working Group agrees that further clarity is needed on the meaning and implications of ‘Provider

of Last Resort’. This should be addressed by the IASC as a matter of priority and any revision of current guidelines on this issue should be clearly communicated to all stakeholders.

4. In essence, the cluster approach involves strengthening humanitarian response in three main ways: (1)

ensuring that roles and responsibilities among humanitarian partners are worked out through transparent, inclusive, consultative processes, in line with the Principles of Partnership developed by the Global Humanitarian Platform; (2) ensuring leadership and responsibilities are established at the sectoral level, thereby clarifying lines of accountability and providing counterparts (or a first port of call) for national authorities, local actors, humanitarian partners and other stakeholders; and (3) ensuring that all relevant sectors and cross-cutting issues for the humanitarian operation in question are covered.

5. It should be emphasized that flexibility in determining response structures at the country level is

essential. Local government structures and existing capacities should be taken into account. There is no need to replicate all global level sectors/clusters if less are needed for the particular humanitarian operation in question. Leadership of these clusters at the country level should also be determined on a case by case basis and does not need to mirror arrangements at the global level (though global cluster leads should in all cases be consulted).

6. In the process of rolling out the cluster approach, due attention should be given to other aspects of the

ongoing humanitarian reform process. This includes initiatives aimed at strengthening humanitarian financing and efforts to strengthen the Humanitarian Coordinator system. It also involves efforts to increase awareness and build capacities of Resident Coordinators to exercise effective leadership in promoting preparedness for humanitarian emergencies in disaster prone countries and in overseeing humanitarian responses when emergencies occur in their countries.

7. The cluster approach has different origins from the Principles of Partnership, which were developed

within the Global Humanitarian Platform. They are, however, complementary and mutually reinforcing initiatives. Efforts should be made to ensure the establishment of broad, inclusive humanitarian country teams, using the Principles of Partnership as a basis for working together.

8. Revised IASC Contingency Planning Guidelines, incorporating the cluster approach, were endorsed by

the IASC Working Group on 5 November 2007. They provide the basis for planning and implementing 1 The ICRC, which is not taking part in the cluster approach, takes note of this statement.

humanitarian responses in new emergencies. They represent a major step forward and their implementation should facilitate further progress in rolling out the cluster approach. They should be widely disseminated and the necessary training and support for their implementation should be provided. They also underline the primary responsibility of national authorities and the importance of building on national capacities wherever possible. They emphasize the importance of preparedness and provide a useful opportunity to familiarize national authorities, Resident (and/or Humanitarian) Coordinators and humanitarian partners (including national and international NGOs) with the cluster approach and to ensure that it is used in all contingency planning for potential emergencies.

9. All Country Teams in countries with Humanitarian Coordinators should consider what needs to be done

in their countries, as a minimum, to adapt current working methods to conform to cluster approach guidance. They should present this information to the ERC and relevant global cluster lead agencies, with clear information on minimal additional capacity and resources needed, so that this can be reflected in a global cluster implementation plan and incorporated into agencies’ cluster mainstreaming exercises. This information should be provided by the end of March 2008. In cases where the Humanitarian Coordinator and humanitarian partners believe that for any reason current working methods should not be adapted to conform with the cluster approach guidance by the end of 2008, the Humanitarian Coordinator should inform the ERC of this in the submission. The ERC will then consult global cluster leads and IASC members and standing invitees before deciding on the way ahead and providing further guidance. Meanwhile, inter-agency workshops on humanitarian reform (including the cluster approach) will continue to be organized at the country level and other support will be provided to improve knowledge and understanding of it amongst field-based colleagues.



Participant List

Meeting 14-16 November 2007 Geneva

1. Dawit Zawde

2. Demissie Diressie

African Humanitarian Action

3. Oleg Bilukha

4. Muireann Brennan

Center for Disease Control

5. Johan Haffnick ECHO

6. Regan Marsh Harvard Health Initiative, Harvard University

7. Hakan Sandbladh International Federation of the Red Cross

8. Mary Pack

9. Neil Joyce

10. Patrick Mweki

International Medical Corps

11. Islene Araujo

12. Sajith Gunaratne

International Organization for Migration

13. Camilo Valderrama International Rescue Committee

14. Sybille Gumucio MDM

15. Gillian O'Connell

16. Linda Doull

Merlin

17. Heather Papowitz Office of Foreign Disaster Assistance, USAID

18. Elizabeth Berryman Save the Children, UK

19. Wilma Doedens

20. Ilham Abdelhai

United Nations Population Fund (UNFPA)

21. Paul Spiegel

22. Nadine Cornier

23. Heiko Hering

United Nations High Commissioner for Refugees (UNHCR)

24. Ms Edith Cheung

25. Dr Anne Golaz

26. Robin Nandy

United Nations Children's Fund (UNICEF)

27. Sandra Krause Women's Commission

28. Mesfin Teklu

29. Claire Beck

World Vision International

30. Agostino Borra WR Sri Lanka

31. Kalula Kalambay World Health Organization Africa Region

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

33. Roderico Ofrin World Health Organization Se Asia Region

34. Samir Ben Yahmed

35. Richard Garfield

36. Erin Kenney

37. Tony Laurance

38. Daniel Lopez Acuna

39. Alessandro Loretti

40. Mark Van Ommerman

World Health Organization Geneva

41. John Watson

Coord & Manag Sub-Group

1. Products under completion2. New focus of the sub-group for 20083. Work plan and budget

Products under completion (1)• Health partners' mapping:

– Interface with 3W developed (by sub-sectors)– First field test performed (in Darfur)– Finalization of generic template of health services by sub-sector to

be completed in next 3 weeks with guidance note for final revision by members of the S-G (WHO)

• Gap Analysis:– Analysis of common gaps in 10 recent crisis performed, with

document available on the web– Tool for field testing gap analysis check list and overall

methodology developed, field testing planned in 3 countries in December-March (Merlin-UNICEF)

Products under completion (2)

• Coordination guidance:– 3 cluster effort on-going (UNFPA-WHO, tbd at 3 cluster meeting)– Health component to be developed as part of the Global Health

Cluster Pocket Book (Steering Committee)

• Health Recovery Guidance:– Annotated table of content, with case studies, waiting for

comments– Steering committee to be set up by end next week, final

comments on table of content by early December, to be completed by March

New focus of the sub-group for 2008

• Close the business, field test and finalize tools and guidelines:– Health mapping of partners– Gap analysis guidance– Coordination Guidance– Health Sector Recovery Guidance

• New Focus: Production of the GHC Pocket Book– S-G focal points already appointed, – First revision of PB skeleton done

• Transfer "benchmarks" to IM S-G (bottom up approach)

2008 Work plan and budget

• field test and finalize tools and guidelines:– 1.1, 1.2: US $ 40,000– 1.6: US $ 40,000

• GHC Pocket Book (6.5): US $ 200,000

Nutrition

Health

Shelter

Etc.

Sub Sectors

Community Care

Primary Care

Secondary Care

Communicable Diseases Prevention and Control

Non Communicable Diseases Prevention and Control

Environmental Health

Sectors

3WCountry Health Cluster - Partners Mapping

Health Services

Village VolunteersHome VisitorsMobile Clinic



Working Group on Coordination and Management

Summary

Wednesday 14 November 2007


Chairs: Mary Pack, Nevio Zagaria 1. Quick review of product status and next steps ● Tool for stakeholder and health services mapping At the June meeting of the Cluster a decision was taken to use and expand upon OCHA’s 3Ws mapping tool for the Health Cluster. The proposed health component to the 3Ws was field tested by WHO in Darfur and maps and a spreadsheet from the field testing were presented by Nevio. Some issues raised: how detailed should it be, what should be the minimum included, technical capacity reflected, what about volume, etc. Action point: tool template and guidance notes with case study shared with members for comments by end of November or mid-December (Nevio). ● Gap analysis The Gap Guidance materials were developed following a review of the humanitarian health response using 10 countries. This guidance helps to identify gaps in the health response and coordinate actions to filling the most important gaps, plus guidance on provider of last resort. A bibliography still needs to be added to the document. The plan is to pilot it in 3 countries at field/district level - Uganda, Somalia, DRC - in the next 6 months. Merlin will take it forward, but needs a letter of support from the group (WHO) to get buy-in from member agencies. Other issues raised: used available benchmarks (Sphere) for the current document, but will have to agree on benchmarks in final document, and harmonization across tools. Action points: - First, Merlin needs support letter to start field testing in 3 countries (WHO). - Merlin will set timeline (Linda) ● Guidance on Coordination At last teleconference in September, it was decided to send the guidance draft to the tri-cluster partners for comments, but haven’t received all yet. Clear guidance on coordination specifically needed for health cluster, document needs to be more

focused on health. Other issues discussed: Need a condensed version for the pocketbook’s section on coordination. Action points: - Add specific health coordination guidance to document (Patricia) - Develop condensed version for pocketbook (Patricia) ● Guidance on recovery phase First draft is very general, need to give feedback to consultant. Members asked to identify technical expertise (total 4-5 people) on recovery in their own organizations and form a steering group. The steering group will achieve consensus on general outline, and provide directions to consultant. Other issues raised: need a thorough document, not only summary for the pocketbook. Capacity building working group hiring a consultant for similar issue might duplicate efforts, issue to be raised in plenary. Action points (Nevio): - Form a steering group of 4-5 people with expertise identified by members, to be appointed within a couple of weeks, to comment and provide directions to consultant - Plan side meeting of the working group at the conference on health recovery in transition situations in Montreux the first week of December - E-mail general outline (first draft) to members for comments - Discuss with Building Capacity working group to solve issue of possible duplication of two consultants ● Strategic planning document Document completed. Consensus on putting condensed version in pocketbook. No specific action point. ● Health cluster benchmarks Working group hasn’t started to work on this topic. Huge expectation from donors. Group felt topic more appropriate for Information Management Working Group. Action point: - Propose in plenary to include health cluster benchmark/indicators in Information Management working group. Next workplan All of the above action points and: ● Pocketbook The pocketbook will be the key activity of the next workplan. There is a proposition to rename the working group “pocketbook” working group. Each working group has assigned two members to participate in the pocketbook steering committee. They will become de facto members of this working group. Need to achieve consensus on outline, and move forward. Action points: - Meeting of the steering committee at the end of the Global Health Cluster Meeting to discuss way forward - Report back about way forward in plenary Budget: Mapping tool (1.2 in previous workplan) Field testing and finalizing: $40’000

Early recovery document (1.6) Consultation, finalizing: $40’000 Pocketbook (6.5) Development, production/editing, printing: $200’000



Working Group on Information Management

Summary



Present: Oleg Bilukha, CDC Murianne Brennan, CDC Nadine Cornier, UNHCR Richard Garfield, WHO Heiki Heiring, UNHCR Regan Marsh, HHI Heather Papowitz, OFDA Camilo Valderrama, IRC Johan Heffinck, ECHO Notes taken by Richard Garfield The ongoing project of the IM Group from last year, the Rapid Assessment Tool, has been tried in 'dry-runs' in Ethiopia, Sri Lanka, and Colombia. A report and PowerPoint on experiences so far is available from consultant Michael Markus. It has been a long road, with good collaboration among Nutrition, WASH, and Health clusters and there is much to learn from and build on from this experience. 3 more countries will have a dry-run of the tool, which is being streamlined along the way and tested with a variety of training and field level applications. The tool is not yet 'initial' enough. It can be done in one site in several hours, but asks for too much information. Each cluster is reducing the number of questions it is including. The tool should be applied in the first several days of an emergency, not a week later. Follow up comprehensive tools would be more appropriate for this later period. The tool should be useful for Flash appeals, but not only for this UN-based tool, the information can also be used by local authorities and NGOs. There is some confusion about the appropriate unit of analysis for the data being requested. It is not the individual, but a group of individuals, or key informants. A group of such interviews will constitute a 'site', which is the unit of analysis. This requires interviewers to make judgments to combine information from individual informants. Guidelines and training are needed to make sure that it is not applied like a more typical household survey.

Should questions be open ended or closed? The general opinion of the group was to be closed, to facilitate quantitative communication of the situation. Open ended questions are more vulnerable to interpretation and more work for low-skill interviewers. But the jury is still not entirely in on this; it may be that some questions or some interviewers should use some open ended questions. Various field tests will help to determine this better. The group decided that it is best to keep an entire shortened tool as the main IRA tool. A few key questions in each section will be highlighted and constitute a '1 hour' cut-to-the-bone tool. A 1-sentence guidance note can be put on the top of each section. What should stay in when shortening the tool? The answer depends on what we need to know initially, and how the information will be used. Sphere standards are recommended for determining what the key, super-short tool questions should be. In addition to the field test dry runs, it should be used in real emergencies. In addition to the IRA tool, there is work needed to do on developing a comprehensive tool. UNHCR and Harvard have draft tools and the original, expanded version of the IRA tool may serve as a base for this. And some others have developed work in this area. The tools need to be compared to make a model comprehensive health tool. In addition, there will be a need for sector-specific specialty tools for subjects including, for example, disability, maternal health, mental health, and HIV. Data Collation and Display With the focus of attention on the collection of information, there has not yet been much of a focus on how to process and use the IRA information. This can become a major task for the coming year. Richard recommended prioritizing this as a project activity, up to the graphical display of information on the web with users able to input their data directly into map-based systems. The Barriers Study Harvard had been contracted in the last year to conduct a study on barriers to the implementation of IRA tools. No work has been done to date, and only a first draft of a concept note for the kind of study that might be done was created to date. There was a clear interest in having a barriers study. Discussion identified a need for a several stage process: 1. Review of the literature. There are several important pieces which will help to elaborate the themes, including a doctoral thesis by Johan von Screib that I am judging next week re funder decisions that fail to use assessment information, and Les Roberts piece from a year ago re use of epi data in OFDA evaluations. There are several other pieces we thought of as well for intellectual foundations and maybe one can find more in the grey literature. 2. On the basis of all this, there is a need to elaborate the various steps, and blocks, to doing this stuff right. From the writing of instruments through to their anarchic administration, organizational proprietary use of the info, and funders not having skill at data consuming. 3. Then we need some expert opinions, on WHICH of these barriers are more important and in what ways. The hypotheses related to these can then be used to organize a series of questions to go to interviews. A few questions, each, targeted to the interviewee. For example, it would be good to have five minute conversations with ten different funders to see

if what von Schreib found in Sweden - which funders didn't use the assessment data at all or demand much from agencies - if this holds now and for other funders. There could be 4 or 5 groups to interview / NGOs yes, but also government people in countries, survey administrators, web site maintainers, alertnet journalists etc, each with targeted questions related to what they do in relation to assessments. Then the investigators could come back and say that among the 10 things that could be barriers, here are the key ones, and here are several options for overcoming each of them. The point of the research is not to be representative, but is targeted, with strategic steps, to lead to recommendations on what actions should be taken by which groups to make the whole thing work better, now that we are to have a common IRA tool. N.B. The Harvard group has taken these recommendations on and is preparing a research plan based on them. The Year Ahead There is a need to both develop the tools and projects above, and to relate to OCHA to get them into regular systems as well over time. And we should be exploring the use of new technologies to improve the collection, analysis, and display of information collected by the various tools under development.



Health Cluster Working Group on Training and Rosters

Meeting Summary

Wednesday 14th November 2007


In Attendance: Tony Laurance, WHO Robin Nandy, UNICEF Samir Ben Yahmed, WHO Muireann Brennan, CDC Wilma Doedens, UNFPA Linda Doull, Merlin Neil Joyce, IMC Heather Papowitz, OFDA Mesfin Teklu, WVI Camilo Valderrama, IRC

Jim Catapongan , WHO Annie Lloyd, Consultant

Tony Laurance replaced Jules Pieters as the new chair of the Training and Rosters Working Group (WG); with Robin Nandy as the co-chair.

Training of Health Cluster Field Coordinators (HCFC): Annie Lloyd, training consultant, discussed the possible training, summarized into 4 papers. Her methodology included discussion with members of the Training and Rosters WG, interviews with current field coordinators, and observation of various current training workshops.

o Paper 1: Competencies and Learning Outcomes; core learning priorities include - 1) Humanitarian Reform, Context and Cluster approach

- including best practices and standards in health 2) Leadership, Coordination and Management 3) Attitudes and Behaviors

Discussion stressed the importance of selection of candidates for HCFCs, in that many of these core competencies (particularly in the area of technical knowledge) should be intrinsic to the person.

Reviewed the profile for the HCFCs, particularly focused on the extensive past field experience required by the candidate.

Thus, focus of training will likely represent the leadership, coordination and management aspects, with “updates” in new best practice/health cluster standards.

Agreed: specific curriculum components will need to be expanded. Agreed: success of HCFCs is largely dependent of pre-existing qualifications

that will be supplemented with training. o Paper 2: Methods for Training HCFCs; reviewed potential training courses (including

CLST, HELP), methodologies for adult learning, etc. However, concerned that no existing course will adequately prepare the HCFCs – particularly with aspect of leadership. Recommended 3-part training process:

1) Preliminary reading 2) Training workshop 3) Continuing education

Training workshop: ideally combines three key learning objectives in a simulation-based curriculum.

Debate: ideal length of training course with some advocating for 5 days, while others for 2 weeks (or longer).

• 1 week course: advantages include availability of participants, cost, planning.

• 2 week course: advantage includes extended time period to teach “softer” skills like attitude/behavior and leadership, extended time to evaluate candidates, team-building.

Agreed: assessment of potential candidates during the training course will be essential to success in the field.

Agreed: this training and these HCFCs are for the acute emergency situation; in the future, will need to focus on developing a cadre for chronic emergencies.

o Paper 3: Options for the HCFC Training Course; reviewed the following possibilities: 1) CSLT, managed by HRSU/OCHA 2) Independent HCFC training course 3) Joint Training for Health, WASH and Nutrition Cluster Field Coordinators

o Paper 4: Recommendations for HCFC Training from Annie Lloyd; prefers 3-Cluster training if possible, as strengthens partnership and coordination and will likely be mutually beneficial.

o General Discussion regarding training of HCFCs: Generally agreed that Option 3 for Joint/3-Cluster Training would best meet

needs; however may cause inherent delays. Ideally, would consist of primarily joint training, with small “breakout” groups focusing on the individual health, wat/san, or nutrition technical skills.

Noted WASH Cluster to have first FC training Dec 2008: send two observers to learn from this experience.

Unclear if Nutrition Cluster has done much planning for their training. Importance of harmonizing with Nutrition and WASH Clusters to ensure

information sharing and similarity of message. o Summary/Recommendations of WG for Training of HCFCs:

Success of HCFCs depends largely on a combination of selection and training, with training course focusing on leadership, coordination and management.

Prioritize moving forward with HCFC training for acute emergencies.

IASC Health Cluster, Working Group on Training and Rosters

2

IASC Health Cluster, Working Group on Training and Rosters

3

Joint/3-Cluster Training is preferential. Plan for first course in March 2008; however, if delays associated with joint preparation are prohibitive, agree that health cluster should move ahead independently.

Organization of a successful Training course will require a significant amount of preparation and will require the resources of a long-term employee to ensure longevity. Plan to solicit/appoint/contract a lead person in the upcoming weeks, by Jan 1, 2008 at the latest. Important to build on the extensive amount of background work and research that has been done.

Rosters: moving ahead with process of recruiting and selecting possible HCFCs.

o Background: 2006 WHO recruited potential applicants (total approx 60), but found that, in general, were not the best candidates. In 2007, this process was repeated with but with targeted appeals to senior leadership for the “best” candidates.

o Results: pool of 62 quality applicants o Selection Panel met on 13/11/07. Reviewed criteria for applicants and slightly

refined these characteristics of those who will be “short-listed.” Agreed: fundamental to success is strength in educational qualification

(public health or medical degree), extensive experience in emergencies (preferably minimum 8 years), past work with UN/NGO community, experience with management and coordination.

Result: 28 short-listed applicants (of which 15 are from WHO) Agreed: HCFC are “face” in the field of the health cluster and thus their

success is important to success of the cluster. Final evaluation and selection will likely take place during training program, when candidates can be “eyeballed” for suitability.

Plan: ultimately to select 15-20 HCFCs to be placed on final roster Agreed: selection process will likely need to be ongoing to ensure the best

candidates are on the roster, and that it is updated on a frequent basis (perhaps 1-2 times/year).

o Next Steps: Contact nominating agencies and selected applicants. Explore possibility for WHO appointment and begin employment processes.

Work Plan for T&R WG: reviewed prior work plan and updated (please see attached draft

of work plan).



Working Group on Capacity Building

Summary



Chair: Altaf Musani 1. Consultation for guidance on capacity building of national stakeholders ● TOR The working group has planned to hire a consultant to develop guidance for the health cluster on capacity building. The guidance aims at providing simple and practical guidelines on how humanitarian health agencies can best (re)build the capacity of local health services in the course of their humanitarian work. The TOR have been developed, and a consultant has been identified. The group discussed the TOR of the consultant. The consultant will look at previous emergencies and summarize best practices. He will not travel, but conduct a desk review of available documents, such as reports on emergencies in Latin America (good at capacity building), Indonesia, Liberia, Lebanon, etc. There is a concern that the TOR for the consultant overlap with the consultancy on early recovery. Is the capacity building consultancy necessary? The consensus is to maintain the consultancy as is, however this should be discussed with the coordination and management working group. Capacity building, although linked to recovery, is specific enough to be maintained as a separate topic, makes it easier to advocate for it if more visible. Everyone agrees capacity building of national stakeholders is essential, but usually it’s not done. ● Capacity building definition After consultation with working group members prior to the meeting, the definition has been finalized. ● Pocketbook The document produced by the consultant should be referenced in the pocketbook, as well as summarized in a separate chapter. It should include a priority list and a clear set of instructions presented as a checklist. The checklist will include what a cluster coordinator will need to know/do to buy in local actors. ● Discussion on national stakeholders In the first three days of an emergency, national/local stakeholders are the only ones in place for assisting the population. For example, they will be the ones conducting the Initial Rapid Assessment. It is essential to bring in local capacity in the picture. For instance, nurses are key players, and often an untapped resource. National nurses association should take part in

emergency preparedness. WHO/SEARO brought together nurses and midwives from the region for emergency preparedness. Issues of child support if nurses are to be involved, etc There should be an effective (two-way) mentoring system: for every international staff, there should be a designated local person. Also need clear guidance on monitoring change in local capacity, in each phase of the emergency, for example when there is repatriation of skilled professionals, etc. It’s important no to forget to tap in the beneficiaries. Issue of recognition of people’s qualifications will have to be addressed in the document. Human resource management is often weak, good opportunity to introduce (build back better) best practice in human resources. Need to include gender dimension. 2. Next steps Initially, this working group was formed to assist in the production of guidance notes on capacity building of national stakeholders, and then the plan was to dissolve the group. Monitoring of these products is a concern. The group could continue and ensure evaluation, implementation of these guidelines, go “dormant” for a while and keep the group on an adhoc basis, or dissolve. The group feels like doing more for the buy in when the rollout occurs. The group can ensure that local actors are better engaged in the health cluster. The next global health cluster meeting is in May, and by then the consultation will be over, and the product ready. We need to at least reconvene once to assess the product, and propose a follow-up.

HELID: The Health HELID: The Health Library for DisastersLibrary for Disasters

The Global Health Cluster Meeting The Global Health Cluster Meeting Geneva 14 Geneva 14 -- 16 November, 200716 November, 2007

Nada Al WardTechnical OfficerEPC/HAC/WHO

History of HELIDHistory of HELIDHELID was an interHELID was an inter--agency effort, to which more agency effort, to which more than 20 international organizations have contributed, than 20 international organizations have contributed, including UN agencies such as WHO (HQ and PAHO) including UN agencies such as WHO (HQ and PAHO) UNHCR, UNICEF, ISDR; the Red Cross movement UNHCR, UNICEF, ISDR; the Red Cross movement through IFRC and ICRC; the Sphere Project; and through IFRC and ICRC; the Sphere Project; and other nonother non--governmental and national agencies. governmental and national agencies.

The first version of HELID was launched in 1998, and The first version of HELID was launched in 1998, and the latest update was published in March 2007. Since the latest update was published in March 2007. Since 1998, there have been four versions of the HELID.1998, there have been four versions of the HELID.

The result is a long list of documents with the most The result is a long list of documents with the most important titles published by these organizations in important titles published by these organizations in the field of emergencies and disasters.the field of emergencies and disasters.

Where is and What is HELID?Where is and What is HELID?HELID (available through the Internet HELID (available through the Internet http://helid.desastres.net/http://helid.desastres.net/and in CDand in CD--ROM version) allows easy and fast access to a large ROM version) allows easy and fast access to a large amount of technical information, selected using practical and amount of technical information, selected using practical and scientific criteria. scientific criteria.

It contains more than 650 fullIt contains more than 650 full--text documents, with more than text documents, with more than 40,000 scanned text pages and over 12,000 images. 40,000 scanned text pages and over 12,000 images.

The documents include technical guidelines, manuals, field The documents include technical guidelines, manuals, field guides, disaster chronicles, case studies, emergency kits, guides, disaster chronicles, case studies, emergency kits, newsletters, and other training materials, on a variety of healtnewsletters, and other training materials, on a variety of health h subjects related to the preparedness and response to subjects related to the preparedness and response to emergencies and disasters, as well as disaster prevention and emergencies and disasters, as well as disaster prevention and mitigation. mitigation.

The material is in English, Spanish, French, and Russian.The material is in English, Spanish, French, and Russian.

All the documents are included in HTML (Hyper Text MarkAll the documents are included in HTML (Hyper Text Mark--up up Language) or PDF (Portable Document Format) format.Language) or PDF (Portable Document Format) format.

http://helid.desastres.net/

Thematic Classification of HELID Thematic Classification of HELID

Public Health Management, Public Health Management, Principles and Guidelines Principles and Guidelines Emergency Preparedness Emergency Preparedness and Response and Response Disaster Mitigation Disaster Mitigation Human Rights and Human Rights and Humanitarian Law Humanitarian Law Health of Refugees and Health of Refugees and Internally Displaced Internally Displaced PopulationPopulationEnvironmental Health and Environmental Health and Chemicals Chemicals Communicable Diseases Communicable Diseases Parasitic and VectorParasitic and Vector--Borne Borne Diseases Diseases

Food and Nutrition Food and Nutrition Reproductive Health, Child Reproductive Health, Child Health and Immunization Health and Immunization Mental Health Mental Health Essential Medicines and Essential Medicines and Management of Supplies Management of Supplies Management of WarManagement of War--wounded and Injuries wounded and Injuries Safe Blood and Laboratories Safe Blood and Laboratories Services Services HIV / AIDSHIV / AIDSSafe Hospitals Safe Hospitals

How is HELID Relevant to the How is HELID Relevant to the Health Cluster?Health Cluster?

The main objective of this effort is to The main objective of this effort is to offer a viable product and offer a viable product and a technical informative toola technical informative tool specifically designed to strengthen specifically designed to strengthen the local and national capacities for disaster prevention and the local and national capacities for disaster prevention and health humanitarian response.health humanitarian response.

The Global Health Cluster makes available this tool to local The Global Health Cluster makes available this tool to local and/or national authorities in countries affected by disasters, and/or national authorities in countries affected by disasters, and the humanitarian community as a whole, both in recipient and the humanitarian community as a whole, both in recipient and donor countries. and donor countries.

Information management and the normalization of Information management and the normalization of technical guidelines and tools are two strategic areas technical guidelines and tools are two strategic areas that have been clearly identified by health cluster actors that have been clearly identified by health cluster actors as key to strengthen health response to humanitarian as key to strengthen health response to humanitarian emergencies. emergencies.


The development of this library is a practical The development of this library is a practical action that binds or incorporates elements of the action that binds or incorporates elements of the following components: following components:

It will facilitate access to first level technical It will facilitate access to first level technical information through a common vehicleinformation through a common vehicle

It will facilitate consultation and use of technical It will facilitate consultation and use of technical instruments and guidelines prepared by different instruments and guidelines prepared by different agencies which, when together, allows for a more agencies which, when together, allows for a more comprehensive vision and makes the work of comprehensive vision and makes the work of preparedness and response easier at the local preparedness and response easier at the local level.level.


HELID is a pioneering information resource that responds to HELID is a pioneering information resource that responds to the principles and interests presented in the work plan of the the principles and interests presented in the work plan of the Global Health Cluster. Global Health Cluster.

However, it is necessary to revise and expand its contents, However, it is necessary to revise and expand its contents, improve its technical capacity, and extend its dissemination improve its technical capacity, and extend its dissemination and distribution, so that it can be accessed from anywhere in and distribution, so that it can be accessed from anywhere in the world, with or without internet access.the world, with or without internet access.

Using technologies that are simple and have broad, economic Using technologies that are simple and have broad, economic and easy access, governmental organizations and/or people in and easy access, governmental organizations and/or people in developing countries, who work to reduce the impact of developing countries, who work to reduce the impact of disasters, can consult and use an extensive collection of disasters, can consult and use an extensive collection of documents and technical guidelines to guide their work in documents and technical guidelines to guide their work in emergency response, prevention or disaster mitigation. A large emergency response, prevention or disaster mitigation. A large amount of technical knowledge, experiences and lessons amount of technical knowledge, experiences and lessons learned can be reached by all those interested, avoiding learned can be reached by all those interested, avoiding dispersion, reducing time and access cost. dispersion, reducing time and access cost.

Thank Thank YouYou

Sexual and Reproductive Sexual and Reproductive Health in CrisesHealth in Crises

Sandra K. Krause Director, Reproductive Health Program

Women’s Commission for Refugee Women and Children

Global Health Cluster, November 2007

Refugee Women and Refugee Women and Reproductive Health Care: Reproductive Health Care:

Reassessing PrioritiesReassessing Priorities WomenWomen’’s Commission for Refugee Women and s Commission for Refugee Women and

Children, 1994Children, 1994

Few reproductive health services

Few reproductive Few reproductive health serviceshealth services

ICPD ICPD --Definition of RHDefinition of RH““RH is a state of complete physical, mental and social RH is a state of complete physical, mental and social wellwell--being, and not merely the absence of disease or being, and not merely the absence of disease or infirmity, in all matters relating to the reproductive system infirmity, in all matters relating to the reproductive system and its functions and processes. and its functions and processes.

RH therefore implies that people are able to have a RH therefore implies that people are able to have a satisfying and safe sex life and that they have the satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, capability to reproduce and the freedom to decide if, when and how often to do so.when and how often to do so.””

--International Conference on Population and Development International Conference on Population and Development (ICPD) Cairo, 2004(ICPD) Cairo, 2004

RefugeesRefugees’’ right to reproductive right to reproductive healthhealth

“All migrants, refugees, asylum

seekers and displaced persons

should receive basic education and health

services”

Chapter 10, ICPD Programme of Action, 1994

““All migrants, All migrants, refugees, asylum refugees, asylum

seekers and seekers and displaced persons displaced persons

should receive basic should receive basic education and health education and health

servicesservices””

Chapter 10, ICPD Programme Chapter 10, ICPD Programme of Action, 1994of Action, 1994

InterInter--agency Working Group agency Working Group (IAWG) on RH in Refugee Settings(IAWG) on RH in Refugee Settings

Preparatory MeetingsPreparatory Meetings–– Geneva 14Geneva 14--15 December 199415 December 1994–– Geneva 5Geneva 5--6 April 19956 April 1995–– Nairobi 10Nairobi 10--11 May 199511 May 1995

INTERINTER--AGENCY SYMPOSIUM ON AGENCY SYMPOSIUM ON REPRODUCTIVE HEALTH IN REFUGEE REPRODUCTIVE HEALTH IN REFUGEE SITUATIONS, SITUATIONS, PalaisPalais des Nations, Geneva 28des Nations, Geneva 28-- 30 June 199530 June 1995UNFPA UNFPA –– UNHCR UNHCR --WHOWHO

IAWG Field ManualIAWG Field Manual

The MISPThe MISPComprehensive RHComprehensive RH

Safe MotherhoodSafe Motherhood

Family PlanningFamily Planning

GenderGender--based Violencebased Violence

STI/HIV/AIDSSTI/HIV/AIDS

MISPMISPFive activitiesFive activities–– Identify an organization or Identify an organization or

individual to facilitate theindividual to facilitate the coordination coordination and and implementationimplementation

–– Prevent and manage the Prevent and manage the consequences of consequences of sexual violencesexual violence

–– Reduce Reduce HIVHIV transmissiontransmission–– Prevent excess Prevent excess neonatal neonatal

and maternal and maternal morbidity morbidity and mortalityand mortality

–– Plan for comprehensive Plan for comprehensive RH servicesRH services

The Sphere Project

Humanitarian Charter and Minimum Standards in Disaster Response

2004 EDITION

Control of non- communicable

diseases standard 2: reproductive health

People have access to the Minimum Initial

Service Package (MISP) to respond to their

reproductive health needs

2004 IAWG Evaluation2004 IAWG Evaluation

Services generally favorable for refugees in Services generally favorable for refugees in stable settings, but with some gaps: stable settings, but with some gaps: –– Safe motherhood (problems with Safe motherhood (problems with EmOCEmOC))–– Family planning (problems with availability of Family planning (problems with availability of

methods, skills of workers, use of services) methods, skills of workers, use of services) –– GBV (weakest area of RH)GBV (weakest area of RH)–– STI/HIV/AIDS (problems with drug availability and STI/HIV/AIDS (problems with drug availability and

skills of workers) skills of workers)

Services for Services for IDPsIDPs generally very poorgenerally very poorMISP not well known or implementedMISP not well known or implemented

Improvement, butImprovement, but……

Thank YouThank You

WomenWomen’’s Commission for s Commission for Refugee Women and Refugee Women and

ChildrenChildrenwww.womenscommission.orgwww.womenscommission.org

Displaced girl in Sierra Leone

Meeting




8h30-9h00 Room II 1. Welcome and introduction to Working Group sessions

Tony Laurance, WHO/HAC

All

Room IV 2. Health Cluster Working Group on Coordination and Management

Working Group members only

(see list attached)

Room V 3. Health Cluster Working Group on Information Management


(see list attached)

9h00 - 12h30

Coffee served at 10h in main lobby

Room II 4. Ad Hoc Group-Review of other key products

(see annex 2 of Way Forward paper)

Other Partners

(see list attached)

12h00-13h30 Main Lobby Lunch All

Room IV 5. Health Cluster Working Group on Training and Rosters


(see list attached)

Room V 6. Health Cluster Working Group on Capacity Building of National Stakeholders


(see list attached)

13h00-16h00

Coffee served at 15h in main lobby

Room II 7. Ad Hoc Group-continued if necessary


(see list attached)

Global Health Cluster Plenary

16h15-16h30 8. Opening Remarks

Ala Alwan, Assistant Director General for WHO/HAC

16h30-16h45 9. Review agenda and meeting arrangements

11

16h45-17h30 10. Report back from Working Groups on plan, timeline and budget

17h30-18h00 11. Report back from Ad Hoc Group on other key products

18h00-18h15 12. Presentation on the IAWG on Reproductive Health in Crises

18h15

Room II

13. Wrap Up

All

Three Cluster Meeting

Health Cluster, Nutrition Cluster, WASH Cluster

Thursday 15 November 2007

9h00-10h00 1. Welcome and report from the three clusters on progress and plans

10h00-10h30

All

2.Engagement of southern partners in the cluster approach

Dawit Zawde, President, African Humanitarian Action

All

Room II 3-cluster session on Information Management

22

Room III 3-cluster session on Coordination Guidance

Simultaneous sessions

8h30- 10h30 Room V 3-cluster session on Training of Field Coordinators

Maximum 3 representatives

from each of the three clusters

(list attached)

10h30-10h45 Lobby Coffee

10h45-12h15

Main hall

3. Update from OCHA on roll out, evaluation, mainstreaming of resourcing, strategic priorities of the IASC

Mark Cutts, OCHA/HRSU

12h15-13h30 Lobby Lunch

13h30-14h15 4. Update on HNTS

Richard Garfield, Project Manager HNTS

14h15-15h00 5. Report on work from 3-cluster groups and way forward

(15 minute presentation and discussion per group)

15h00-15h15

Main hall

6. Wrap up of 3 cluster meeting

Bruce Cogill, Coordinator Nutrition Cluster


All

Health Cluster Only

15h30-16h30 7. Health Cluster Benchmarks and the way forward

Nevio Zagaria and Richard Garfield, WHO/HAC

16h30-17h30 8. Presentation of the Pocketbook by Steering Committee

17h30

Main hall

9. Wrap Up

Health Cluster Partners only

Room II Side meeting of the Public Private Partnerships group

(list attached) 17h30-18h30

Room III Side meeting of presenters of the strategic planning session (list attached)

Meeting




9h00-10h00

1. Global Health Cluster overview: evaluation, roll out, mainstreaming, donor expectations, Rome declaration

Daniel Lopez Acuna, Director Recovery and Transitions, WHO/HAC

10h00-10h30

Room II

2. Introduction of Health Cluster Strategic Planning Paper and day's objectives

Tony Laurence, WHO/HAC


10h45-11h30

Room II

3. Report from country cluster reps on priority needs from global cluster

All

11h30-12h30

Room I

Room II

Room III

Room VIII

Room IX

4. Break Out Groups (of the five strategic priorities)

(see section V of the Way Forward paper for details)

A. Global membership and meetings: including criteria for membership

B. Products: weighing priorities and funding allocation

C. Implementation/integration of approach and products at country level: identify actions and funding allocation

D. Leadership strengthening: identify actions and funding allocation

E. Resource mobilization: identify actions and funding allocation

See break out group

participation list attached

12h30-13h30 Lobby Lunch All

13h30-14h25 Same as above 5. Break Out Groups continued See break out group

participation list attached

14h30-15h30 Room II 6. Report back from break out groups


15h45-17h45 7. The Way Forward

17h45-18h00 8. Next meetings and AOB

18h00

Room II

9. Closing Remarks

Ala Alwen, Assistant Director-General HAC/WHO

All

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IASC - WHO · See Terms of Reference Health Cluster on Capacity Building of National Stakeholders...

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