ghc partners meeting - who · integration of humanitarian and development knowledge of the...

Study Summary: ‘Strengthening Global Capacity for Emergency Health Action’

Friday, 29th March 2019

GHC Partners Meeting:

GHC Emergency Response

Final Report


Overview

2

▪ Introduction

▪ Methodology

▪ Findings & Discussion

▪ Country case study

▪ Recommendations

▪ Questions

3

▪ Introduction

▪ Methodology



▪ Recommendations

▪ Questions


Overview

4

Workforce

Study Objective:

Clarify critical emergency health gaps and actions being taken by international and

national health actors, specialised agencies and training institutes to address the

current imbalance between response capacity supply and demand


Introduction

Study Research Questions:

1. How can the evolving demand for

humanitarian health workers be more

effectively met?

2. How can organizations better meet the

demand for humanitarian health delivery?

3. How can health responses be better

coordinated to ensure timely, appropriate

and effective addressing of emergency health needs?

5

Collaboration

Programme Delivery

Workforce

Context


Introduction

Study Considerations

▪ Focus on acute phase of emergencies

▪ Tangible and targeted recommendations

▪ Inform different stakeholder groups

▪ Not a mapping

▪ Not a discussion of humanitarian financing or security

6

Workforce


Introduction

7

▪ Introduction

▪ Methodology



▪ Recommendations

▪ Questions


Overview

8

Workforce


Methodology

Key informant stakeholder group distribution

9


Methodology

Study Limitations

▪ Sample Size

▪ Non-traditional actors

▪ English Language

▪ Technology/Access

▪ Not a systemic or exhaustive literature review

▪ Recommendations based on the study data

10


Methodology

▪ Introduction

▪ Methodology



▪ Recommendations

▪ Questions

11


Overview

Findings

▪ Key informant identified gaps

▪ Key informant identified solutions

▪ Literature identified gaps

▪ Literature identified solutions

12


Findings

Workforce Gaps

13


Findings

Workforce Gaps

Expertise

▪ Technical Skills

▪ Public health

▪ Medical skills

▪ Understanding the humanitarian system

▪ Operational Skills

▪ Management

▪ Supply chain

▪ Experience

“Basic management [is a

gap]. This is where the

strategy gets lost” (UN008)

“Getting people with no

humanitarian experience to

the field is a massive

challenge in the sector.”

(INGO010)

14


Findings

Workforce Solutions

Expertise

▪ Technical & Operational Skills

▪ Leverage organizations with existing trainings

▪ Partnerships for training

▪ Regionalize approach to training

▪ Experience

▪ Expand mentorship systems

▪ Formalize mentorship systems

15


Findings

Workforce Gaps

Availability

▪ Insufficient health sector workers

▪ Limited numbers at baseline

▪ Limitations in types

▪ Brain drain

▪ Long term availability for response

▪ Expense

▪ Release for deployment

▪ Security of deployment locations

“we have few actual clinicians;

[…] some health workers -- such

as midwives, assistants, lab

technicians and ORC technicians

and anaesthetists -- you [can]

count the number on your hand”

(GOV001).

16


Findings

Workforce Solutions

Availability


▪ Little if anything to be done to build national workforce in an emergency

▪ Maintain clearances for national staff

▪ Harmonize salary for national


▪ Develop partnerships (ex Iceland)

17


Findings

Workforce ▪ Define standardised competencies for specific categories of humanitarian

health workers

▪ Allow for targeting of education and training program content

▪ Use the most relevant learning modality

▪ Include management training for all levels

▪ Investment plan for education

▪ Evaluate educational programs

▪ Develop structured systems for gaining experience

18


Discussion

Programme Delivery Gaps

19


Findings

Programme Delivery Gaps Human Resources

▪ Permanent staff management

▪ Funding for core positions

▪ Core funding to NNGOs

▪ Surge management

▪ Recruitment processes timing

▪ Diversity

▪ Readiness of surge staff

▪ Staff burnout

▪ Flexible funding

“We have one grant, then get

another grant. Because the

positions are paid through the

grants, we lose people when we

finish grants. We spend time and

money to build up the capacity of

staff and we have to release them

when we finish our grants”

(INGO006)

20


Findings

Programme Delivery Solutions Human Resources


▪ Raise unrestricted core funds

▪ Full time emergency response staff (ex SAVE)

▪ Watch country emergency teams (ex IRC)


▪ Global & regional recruitment (ex Africa CDC)

▪ NGO – Academic partnership a for roster

▪ Expanding/develop staff well-being programs

21


Findings

Programme Delivery Gaps Operations & Logistics

▪ Supply chain

▪ Weak systems

▪ Drug purchasing restrictions

▪ Emergency protocols

▪ Data driven response

▪ Decision making

▪ NNGO organizational capacity

▪ Inclusion of non-traditional actors

▪ Transitioning from humanitarian to development

▪ Flexible funds

“much like with our NGO

colleagues, [logistics] is an issue.

I was surprised at the limited

medical logistical capacity

within [the organization]”

(UN002).

22


Findings

Programme Delivery SolutionsOperations & Logistics

▪ Flexible funding*

▪ WHO contingency funding for emergencies

▪ Novel funding sources (ex START Network)

▪ Non-traditional donors (ex ICVA)

▪ Public-private partnerships (ex Africa CDC)

▪ Supply chain

▪ Front loading supply

▪ Partnerships with strong logistic organizations


▪ Used of shared data platform (ex Ebola)

▪ Multi-year funding to support transition (ex Sida, ECHO)23


Findings

Programme Delivery Gaps Security

▪ Risk management

▪ Institutional risk tolerance

▪ Access

▪ Infrastructure investment

▪ Technical expertise

▪ Logistics

“[…] In the place where people

were dying there was [a couple

organizations] but hard to

access and hard to help. But in

the periphery, there was a lot of

access and actors. So, they had

less effect and there was a

partial market. So, it looked like

there was enough people but in

reality, not enough.” (UN003)

24

Programme Delivery Solutions*Security

▪ Thorough risk assessments

▪ Strategy

▪ Investment


Findings

Programme Delivery▪ Define core staffing needs

▪ Target recruitment

▪ Surge roster management best practice guidance

▪ Conduct roster readiness activities

▪ Self assessment of organization’s operational effectiveness

25


Discussion

Programme Delivery▪ Emergency protocols and SOPs for expedited processes

▪ Delegated decision making – ‘no regrets’ approach

▪ Integrate situational appropriate data collection into all programmes

▪ Regionalise response

▪ Invest in NNGO organizational development

▪ Flexible funding

26


Discussion

Collaboration Gaps

27


Findings

Collaboration Gaps

Coordination

▪ Expertise

▪ Expertise of the cluster coordinator

▪ Management skills

▪ Integration of humanitarian and development

▪ Knowledge of the humanitarian system

▪ Inclusion of nontraditional actors

“…we need to respect authority

and leadership of member states

and encourage them to develop

the capacity, technology and

knowledge, rather than go with

backpacks and leave and they

benefit nothing. So that

philosophy of capacity building

and authority is important”

(GOV004)

28


Findings

Collaboration Solutions

Coordination

▪ Expertise

▪ Trial other methods of coordination (ex CORE)

▪ Integrate coordination mechanisms (IMS)

▪ Knowledge of the humanitarian system

▪ Engage nontraditional actors in the system

29


Findings

Collaboration Gaps

Partnerships

▪ Strategy for partnering

▪ Use of partnerships

▪ Localization

▪ Developing local partners

▪ Power dynamic

30


Findings

Collaboration Solutions

Partnerships


▪ Define partnership strategies

▪ Monitor partners

▪ Localization

▪ Develop partnerships in advance

31


Findings

Collaboration

▪ Evaluate partnerships for humanitarian health response

▪ What is the strategy?

▪ What is most effective and when?

▪ What are successful examples/models and why?

▪ Engage national organizations in a meaningful context appropriate way

▪ Build NNGO capacity

▪ Develop partnerships in advance for crises prone areas

▪ Engage with government

▪ Invest in and build at-risk countries’ emergency health coordination capacity

32


Discussion

Collaboration

▪ Engage with non-traditional actors

▪ Continue efforts for humanitarian systems education

▪ Study best practices from their engagement in response

▪ Define tangible definitions and approaches to the HDN

▪ Define common language and terms

▪ Integrate coordination mechanisms

33


Discussion

Summary

of the

Gaps

34


Findings & Discussion

▪ Introduction

▪ Methodology



▪ Recommendations

▪ Questions

35


Overview

Iraq Country Case Study Purpose

1. Gain field perspective on the gaps in humanitarian health response capacity identified by global key informants

2. Assess how the recommendations may be interpreted in a specific response context


Country Case Study

Key Informant Interviews

▪ 38 key informants across stakeholder groups

▪ Semi-structured interview

▪ Prioritisation exercise based on global data

▪ Interviews in Baghdad and Erbil

▪ Direct observation - cluster meetings & field programming in Mosul

37


Country Case Study

Summary of

Findings

38


Country Case Study

Workforce

39


Country Case Study

Workforce Gaps Expertise

▪ Technical Skills

▪ Public health – absence of system/training

▪ Medical skills – emergency context

▪ Understanding the humanitarian system

▪ Operational Skills

▪ Management

▪ Supply chain

▪ Experience

▪ Recruiting high caliber international staff

“We only had 2-3

epidemiologists to rely on. We

don’t have an academic

specialization in public health in

Iraq.” (GOV-IRAQ-04)

“Doctors think that they are not

managers, they are doctors. But

we need doctors to run the

hospitals or health centres. Is it a

shame to manage a health

centre? It is not, but it is

somehow perceived as such. In

fact, it takes more skills to

manage a hospital”

(GOV-IRAQ-02)

40


Country Case Study

Workforce Gaps Availability


▪ Limited numbers of specialists at baseline

▪ Limitations in types (e.g. no prosthetic technicians)

▪ Brain drain


▪ Experienced & specialized health sector workers unable to be recruited

▪ Security

▪ Time needed

“When I first visited district

hospitals, I was surprised. You

can find MRI and microscopic

surgery there. Iraq uses US

medical curriculum at university

[… and] doctors are trained in

English. […] The problem is that

we have a brain drain.

(UN-IRAQ-08)

41


Country Case Study

Programme Delivery

42


Country Case Study

Programme Delivery Gaps Human Resources


▪ Competition among national staff for salaries


▪ Timely recruitment processes

▪ High turn over of staff

43


Country Case Study

Programme Delivery Gaps Operations & Logistics

▪ Supply chain

▪ Weak systems

▪ Drug purchasing restrictions


▪ Data driven response

▪ Slow decision making

▪ NNGO organizational capacity

▪ Transitioning from humanitarian to development

▪ Flexible funds

“We brought in additional

logistics teams and got lots of

help from outside, but as [x] we

don’t have a logistics system.

I’ve said before in a regional

meeting: ‘why are you bearing

this pain why not hand over

logistics to Alibaba?’”

(UN-IRAQ-05)

44


Country Case Study

Programme Delivery Gaps Security

▪ Risk management

▪ Limited pool of national and international staff willing to join the response

▪ Partnerships with local organizations

“We have reached the highest

peak of risk aversion created by

a strong sense of institutional risk

related to a duty of care. INGOs

are extremely risk adverse. On

this I disagree with my

colleagues, they don’t invest in

understanding the context. They

don’t invest in security

regulations that enables action.”

(DON-IRAQ-03)

45


Country Case Study

Collaboration

46


Country Case Study

Collaboration Gaps Coordination

▪ Expertise

▪ Needed to be present early on in the crises

Successes

▪ Team approach (coordinators & data)

▪ Geographic distribution of the cluster based on the context

▪ Technical working groups

47


Country Case Study

Collaboration Gaps Partnerships


▪ Use of partnerships

▪ Localization

▪ Developing local partners

▪ Power dynamic

48


Country Case Study

▪ Introduction

▪ Methodology



▪ Recommendations

▪ Questions

49


Overview

Workforce

▪ Define standardised competencies (Donor, INGO, NNGO, UN)

▪ Accessible, competency targeting, evidence based training (Donor, Academia, INGO, NNGO)

▪ Systems for gaining experience (Donor, INGO, NNGO, Private Sector, UN)

▪ Research training effectiveness (Academia, Donor)

50


Recommendations

Programme Delivery

▪ Surge roster best practice management guidance (Donor, INGO, UN)

▪ Assess organization’s operational effectiveness (Academia, INGO, NNGO)

▪ Emergency protocols and SOPs to expedite administrative and operational response activities (INGO, UN)

▪ Regionalise response (Donor, INGO, UN)

▪ Flexible funding (Academia, Donor, INGO, NNGO, Governments, UN, )

51


Recommendations

Collaboration

▪ Evaluate how, when, and where humanitarian partnerships can enhance humanitarian response (UN, academia, donor)

▪ Engage and support non-traditional actors in health cluster activities (UN)

▪ Build emergency health coordination capacity in at risk countries (Donors, Governments, INGO, UN)

▪ Define tangible definitions and approaches to the HDN (Academia, Donors, Governments, INGO, NNGO, Private Sector, UN)

52


Recommendations

Study Summary: ‘Strengthening Global Capacity for Emergency Health Action’

Friday, 29th March 2019

GHC Partners Meeting:


Final Report

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