Can WHO bring speed and predictability to emergency work?

Director-General Margaret Chan’s promise a year ago of creating a single program for health emergencies is coming together, but it will require strong support from across three levels of the organization as well as member states. At this week’s World Health Assembly, the World Health Organization chief will be presenting before member states the agency’s progress report on the design, implementation plan and other requirements of its new health emergencies program, borne in response to calls a year ago by the WHO’s executive board to strengthen emergency operational capabilities. Some of the functions are already being tested, though the unveiling of the full program will take place from 2016 to 2019. Health experts and humanitarian organizations, Médecins Sans Frontières being among the most vocal, heavily criticized the pace of WHO’s response to the Ebola outbreak in West Africa, and the ensuing panels and committees all arrived at the conclusion that change was needed at the U.N.’s health agency. The new health emergencies program, in the director-general’s words, is designed to “bring speed and predictability to WHO’s emergency work.” It will be a single program with “one clear line of authority, one workforce, one budget, one set of rules and processes, and one set of standard performance metrics.” The program will be headed by a yet-to-be-named executive director, whose tasks will involve providing technical oversight and standards across WHO’s emergency operations, strategic and operational planning, risk assessment and performance monitoring, budget and staffing, as well as developing interagency and partner relations. He or she will also have the authority to repurpose staff, as needed, at headquarters as well as across WHO’s regional and country offices. But those functions are not exclusive to the new executive director alone. To complicate matters, regional directors may also be tasked with the similar functions, as determined by the director-general on a case by case basis. “It’s the magnitude of the problem that determines the level of authority,” Peter Graaff, acting special representative and head of the United Nations Mission for Ebola Emergency Response until its mandate ended in July 2015, told Devex in an exclusive interview ahead of this week’s World Health Assembly. Under the program, the director-general may delegate oversight and management of a particular emergency to the executive director if it falls under WHO’s Grade 3 emergencies or those that require “substantial WHO response.” Today, this would include the Ebola-vulnerable countries of Guinea, Liberia and Sierra Leone; and the conflict-affected states of Iraq, South Sudan, Syria and Yemen. The responsibility over the Zika virus, currently a “Public Health Emergency of International Concern,” could also fall under the health emergency executive director’s authority. The authority for Grade 2 crises or those requiring moderate WHO response, meanwhile, is less clear. The director-general may delegate the task either to the executive director or WHO’s regional directors depending on the nature of the emergency and risk of escalation, countries’ response capacity, the required WHO assets like medicine stockpiles as well as the necessity of international coordinated response. The decision will be done following major risk assessments on the ground. There appears little change on authority when it comes to Grade 1 emergencies, which under the WHO’s Emergency Response Framework falls under WHO’s respective country and regional offices. Protracted crises that are more than three to six months, and are no longer graded 3 or designated as Level 3 by the Inter-Agency Standing Committee will “by default,” be delegated to regional directors — unless the director-general finds that leadership at country level is lacking, the situation is still unstable or there is a “major reputation risk to WHO,” according to a document on the new emergencies program obtained by Devex. The document also details a new standard on risk assessment, emergency grading, and risk or incident management, “closely aligned” with the IASC system, which is what’s being used in the wider humanitarian setting. It gets complicated The new program will have an additional set of key players, Graaff said. The yet to be named executive director and WHO’s regional directors will be tasked to recruit emergency regional directors, who will be charged with providing technical guidance to country representatives in case of an emergency. But even when there’s no crisis, regional emergency directors are expected to provide technical support and guidance to country representatives to help them capacitate member states in preparing for an emergency, Graaff explained. It’s no simple org chart, he added. There’s another layer: incident managers, who will be expected to work with country representatives in case of an emergency. Unlike regional emergency directors, incident managers will not be a fixture in the WHO emergency structure. The position will only be activated when the delegated authority deems it necessary, and he or she will have to return to his or her “day job” when the need subsides. The position can be filled by someone within or outside WHO, Graaff said. The incident manager will be expected to report to the emergency regional director at country or regional level, or to the executive director if working at headquarters, according to Graaff. Unlike the other positions, incident managers may be present at all three levels of the organization. In the case of the yellow fever outbreak, the senior WHO official said the organization has incident managers at the country level, such as Angola and the Democratic Republic of Congo, at the WHO regional office for Africa, and at headquarters in Geneva. Important next steps WHO is looking forward to the selection of the executive director, as this would also set the stage for the eventual appointment of regional emergency directors, which Graaff hopes takes place between now and July. As for the design of the new program, the next step for the organization is the roll out of standard operating procedures and writing the job descriptions for the various positions. The director-general, in her report, meanwhile, will be asking member states for an additional budget of $160 million to ensure proper roll out of the program for the 2016 to 2017 biennium. But the organization is still at the very beginning of the process, Graaff said. The new program will require training for those directly involved in the process, such as incident managers, WHO representatives, and technical people within the organization who may also be called in during an emergency. “It’s a new way of working so it requires training, but it also requires cultural change,” he said. “Unfortunately, the emergencies that come our way are an excellent way of testing whether we are getting better at running the system.” What are your thoughts on the suggested structure of WHO’s new health emergencies program? Let us know by leaving a comment below. Devex Professional Membership means access to the latest buzz, innovations, and lifestyle tips for development, health, sustainability and humanitarian professionals like you. Our mission is to do more good for more people. If you think the right information can make a difference, we invite you to join us by making a small investment in Professional Membership.