The World Health Organization should establish a single, unified WHO Center for Health Emergency Preparedness and Response — but not with Director-General Margaret Chan at the helm.
In its final report, launched Tuesday, July 7, the panel tasked to review WHO’s early response to the Ebola crisis asked the leadership of the U.N. health agency to establish an independent board to oversee the center, which it deemed needed “new organizational structures and procedures.”
The panel tasked to review the World Health Organization's initial response to the Ebola outbreak released its interim report ahead of the 68th World Health Assembly, which kicks off next week. We highlight the recommendations and remaining questions.
The center needs to be headed by a different individual who must have “full operational authority” in emergencies. The post, the panel argued, should be “advertised immediately” — based on the phrasing, the panel seems to suggest that a competitive application process is needed to find the head of the new center, instead of going through an appointments system.
“The head of this new center must be: a strong leader and a strategic thinker, with political, diplomatic, crisis coordination, organizational and managerial skills; and able to make sound decisions quickly, and to discern when to move from a situation of normal readiness and alert to rapid response in the field. A finely honed sense of how to coordinate with many other partners and actors is essential,” the report reads.
In her opening speech at the 68th World Health Assembly in May, Chan announced the creation of a single program for health emergencies that will be directly under her, and for which she personally pledged accountability.
A leader fit for purpose
The panel’s findings from its monthslong review appear to have influenced the qualifications of the new center’s head. The final report concluded there was a clear absence of “independent and courageous decision-making by the director-general and WHO Secretariat” in the early months of the Ebola response. This, the panel suggested, was partly the reason for the delayed declaration of the crisis as a public health emergency of international concern, which was instrumental in mobilizing a huge international response.
WHO does not have a “culture of rapid decision-making” nor one that allows open and critical dialogue between senior officials and staff. Neither does it have a culture that allows one to take risks or make critical decisions, if need be. It’s not accustomed to “challenging its member states” as well.
“In the early stages of the Ebola crisis, messages were sent by experienced staff at headquarters and the Regional Office for Africa, including after deployments in the field, about the seriousness of the crisis,” the report notes. “Either these did not reach senior leaders or senior leaders did not recognize their significance.”
The center’s role
The center, once established, will have a long list of things to do. Apart from establishing the appropriate emergency procedures and policies — such as in terms of the provision of medical care, evacuation, insurance, and hazard and death benefits to deployed personnel — it needs to clarify the role of the police and military in emergencies.
“There may be a place for military support for emergencies (for example, in construction and transport) but as agreed in civil/military guidelines, this must be under civilian control. In view of the increased potential for outbreaks in fragile states or war-torn areas, more attention needs to be paid to the role of the security sector — both domestic and foreign — in health emergencies,” the panel argued.
The center also has to cultivate better understanding among stakeholders on how the humanitarian system works — and how public health emergencies fit into that picture.
In addition, it has to develop a system that would allow it to coordinate across WHO’s Secretariat, and the country and regional offices, and establish “excellent working relationships” with these offices. This would be vital to ensure WHO’s robust response, and pave the way for country and regional directors to openly “step aside,” if need be, during emergencies.
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This means ensuring that only the most qualified person is leading the organization’s emergency work, even if that person is a junior team member or not from the respective WHO country or regional office. Interestingly, this approach became widely used during the Ebola crisis. In Liberia, for instance, President Ellen Johnson Sirleaf appointed an assistant minister from the health and social services ministry to coordinate the country’s national response.
This is critical especially during Grade 2 or 3 emergencies, when, as the panel suggests, regional emergency teams and the head of emergency operations in the affected country should report directly to the WHO center head.
WHO officials should also adopt a “no regrets” policy in that “predictable” levels of support — be it staff or funds — are made available, even when these resources eventually turn out to be more than what was required.
“This policy affirms that it is better to err on the side of over-resourcing the critical functions rather than risk failure by under-resourcing,” the report said.
While not explicitly stated in the report, the center could also tackle the issue concerning the length of staff deployments, which is sometimes as short as two weeks and therefore makes learning and relationship-building difficult, and ensure there are enough social scientists with the expertise to help responders better understand local beliefs, behaviors and customs, and therefore respond accordingly.
The Ebola crisis served as an eye-opener on the importance of understanding local contexts, an important but sorely lacking element in the early response.
Revisit the 5 percent increase
The panel has been very vocal about the responsibilities member states share in emergencies, and has emphasized the need for them to increase core contributions to WHO.
But despite calling for reforms at the U.N. health agency, several member states have either expressed concerns or voiced outright opposition to a 5 percent increase in assessed contributions to the organization — a setback WHO had no choice but to accept.
Member states agree the World Health Organization is due for reforms, but providing additional resources to ensure the agency accomplishes this task is a different story.
The panel was “extremely disappointed” at this development and is requesting member states to reconsider their decision at the next executive board session and at the 69th World Health Assembly.
“At a time when spending by member states on health has risen globally by about 25 percent, the weighted purchasing power of WHO’s mainly U.S. dollar-based resources has lost a full third of its purchasing power since 2000,” it stated. “The recommendations in this report can be delivered only if resources are forthcoming.”
This extends to the center, which needs the necessary resources to be up and running. The panel recommends the plan for the center should be “costed and financed.”
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