1

GlobalHealth Cluster

IASCInter-Agency Standing Committee

Meeting Summary

9-10 June 2009 Conference Centre Varembé

Geneva, Switzerland

Participating partners: Centers for Disease Control, Columbia University, Department for International Development UK, Emergency Relief Agency, European Commission Humanitarian Aid Office, International Medical Corps, International Organization for Migration, International Rescue Committee, Merlin, Save the Children UK, United Nations Children's Fund, United Nations High Commissioner for Refugees, United Nations Populations Fund, Women's Commission for Refugee Women and Children, World Association for Disaster and Emergency Medicine, World Health Organization and World Vision International Observers: Health and Nutrition Tracking Service, International Committee of the Red Cross and the Red Crescent, Mary Stopes International Click here for full list of the Meeting Participants Click here for the Meeting Agenda Tuesday 9 June 2009 Day's Objective: Key issues of concern from the global arena and their influence on GHC work; update on progress against GHC workplan, related challenges/solutions Morning Chairperson: Emmanuel d'Harcourt, IRC Afternoon Chairperson: Anne Golaz, UNICEF 1. Opening remarks- Eric Laroche, ADG/HAC (WHO) The ADG welcomed new partner Emergency and Relief Agency. The ADG outlined the major events since the last GHC meeting in November 2008 in NYC including the expulsion of NGOs from Sudan, H1N1 and the situation in Pakistan and how each of these has demonstrated the importance of the health cluster. The ADG commended the GHC for its considerable progress since the last meeting both within the GHC working groups and on global inter-agency issues particularly in defining accountability and roles and responsibilities of actors at country level. Internally WHO has also been doing a great deal of work over these last 6 months: training heads of office with help from the GHC, building commitment in the regional offices, and moving to fill HCC posts. Similarly partners have been making efforts to integrate cluster within their organizations.

2

This meeting marks a turning point for the GHC because the six WHO regional emergency advisers are participating. The GHC will greatly benefit from their expertise and knowledge during this meeting and as the GHC moves forward over time. The ADG highlighted funding constraints that will force further prioritization of activities by the GHC. He spoke of the importance of HNTS and building linkages and common expectations between health clusters and HNTS at country level. The ADG ended by saying that the GHC must ensure that its work is having the necessary positive impact on country level health action and that it ultimately contributes to saving and improving the lives of populations affected by crises. 2. Key issues of concern to the GHC Daniel Lopèz-Acuña, Director, ERO and REC (WHO) Status Report on Cluster Evaluation Phase II Strengthening Humanitarian Coordinators • The IASC Working Group met twice since the last GHC meeting in November. The work is

progressing to strengthen the third pillar of the Humanitarian Reform: the role of the Humanitarian Coordinator. An effort is being made to create a pool of humanitarian coordinators who can perform Resident Coordinator/Humanitarian Coordinator functions on short notice.

Accountability • Country level lead agencies are accountable to the Humanitarian Coordinator for cluster obligations.

Country Clusters do not report to the global clusters, but linkages are important. • It is clear that not all lead agencies have the same perceptions of their roles and responsibilities

within the cluster approach. • The cluster system cannot only be accountable to donors. The challenge is reaching agreement

between cluster leads on the accountability issues. Humanitarian Country Teams • The establishment and functioning of IASC country teams (Humanitarian Country Teams) are very

important. The HCT is a platform for coordination, prioritization of processes, strategic planning, discussions, and sometimes for determining funding allocations.

Assessments • There is a need to harmonize the assessment process to enable gap identification and filling. IASC

is promoting harmonization of assessment processes both within the clusters and between the clusters.

Humanitarian Dashboard • The Humanitarian Dashboard aims to give a quick, real-time look at the severity of a humanitarian

situation to identify priority needs and to help in resource mobilization and allocation. It aims for a collective review and collective accountability of the humanitarian actors. IASC members have been consulted on the development of the Dashboard.

• Clusters will have to ensure that their data is configured to be compatible with the Dashboard. Montreux retreat • This was another opportunity for discussion between cluster lead agencies and donors particularly

looking at the CAP revision process. Subjects also included accountability issues and harmonization of assessments.

3

Phase 2 Cluster Evaluation • Preparations for the Phase 2 Evaluation are underway. The framework is much better than for the

Phase 1 Evaluation. The evaluation will look at the joint humanitarian response at country level and assess the overall operational effectiveness. Questions will include: 'How well did the cluster see the gaps'? The evaluation will be conducted in Chad, DRC, Haiti, Myanmar, oPt and Uganda.

• The partners should encourage their staff to get involved. • Preparatory country level missions are being conducted, but we were not informed of this and have

objected to the way this was arranged. 3. Key issue of concern to the GHC: Accountability discussions Linda Doull (Merlin), Mary Pack (International Medical Corps) and Nevio Zagaria (WHO) Accountability framework for the Health Cluster at country level; definitions of the RASCI diagram Global Cluster Retreat Summary Global Cluster/Donor Meeting Summary Matrix of Roles and Responsibilities within the Humanitarian Architecture at Country Level • Global Cluster/Donor Meeting and Global Cluster Retreat in April identified accountability to be a

key issue: Who is responsible to whom and who reports to whom? There is a need for clarity on accountability among actors within the humanitarian framework. The donors identified that the multi-layered system creates problems for them due to the lack of clarity on who to turn to with queries. OCHA and the IASC have been tasked to find a solution.

• At the country level, the Inter-Cluster Coordination Group (ICCG) plays a central role in ensuring a coherent and effective humanitarian response. The GHC should be involved in developing the IASC guidance note on the roles and responsibilities of the ICCG to ensure it is coherent with the matrix.

• The Health Cluster Coordinator (HCC) reports to the WR and the WR is accountable to the RC/HC for the international health response.

• The TORs of RC/HC is important for defining the roles and responsibilities at country level including those of the Humanitarian Country Team (HCT), the Inter-Cluster Coordination Group (ICCG) and the Cluster Lead Agency (CLA) at country level. These TOR are now final and have been circulated.

• There is a need to move from coordination, which can be a loose arrangement, to partnership in order to advance the common work of the country clusters. The partners need to be involved in the identification and filling of gaps and be active cluster partners. We need to define accountabilities of partners in the cluster.

• At the WR workshop in April, the WRs understood their new obligations as the representative of the cluster lead agency at country level. In such a case, the HCC is responsible for the sectoral coordination at country level but the WR is accountable for the international health response.

4. GHC Funding Situation: Use of funds in 2008 and contributions towards 2009 workplan Erin Kenney, GHC Secretariat (WHO) Resume of GHC Expenditure 2008 2009 Funding and Funding Gaps • The Global Cluster Appeal of March 2007 provided the GHC with $1,925,432 to fund its activities.

The related expenditures are explained in the Resume of GHC Expenditure 2008. These funds were exhausted by end of 2008 as per the expiration date. A consolidated cluster report was sent to donors in March 2009.

• The additional (non GHC) funding that has been invested by WHO or partners to advance the different activities and to participate in meetings are not accounted for in the expenditure resume.

• 2009 Funding and Funding Gaps shows that the GHC Work Plan 2009 has received funds only from ECHO in the amount of $1,206,500. There remains a funding gap of $2,678,500. While there

4

are not other confirmed pledges, it seems likely that some funding from Sweden and UK (DFID) is expected as well as additional support from contributions to WHO by Spain. Of these available ECHO funds, so far approximately 450,000 has been spent (or committed for GHC salaries) and 750,000 is available for activities in the second half of 2009.

5. Preparing to respond to Influenza A (H1N1) and its humanitarian effects through the cluster framework Eric Laroche and Dominique Légros (WHO) • It is important to share information and share work with partners and staff members on Influenza A

(H1N1). Unless we share the information and the burden we are not going to succeed in the response.

• The Influenza A (H1N1) has struck mostly developed countries that have done contingency planning and were prepared for a severe outbreak. The geographical concentration to the north gives us time to prepare the countries that are currently suffering from emergencies to respond to the influenza when it hits their country. WHO and partners are organizing trainings and preparing guidelines to prepare for a wider outbreak. Countries have to do contingency planning to ensure business continuation when the Influenza takes off. Countries and organizations need to map social mobilization and resources, look at the existing structure and create new ways to respond to this outbreak. WHO is uncertain of the consequences the H1N1 will have on populations in countries with malnutrition. In the northern countries 4-5% of the affected population needs to be hospitalized. This might look different in the south and consequently put a huge burden on the health systems.

• There will hopefully be a vaccine ready in October; it is currently undergoing clinical trials. The researches still do not know if the vaccine needs to be one or two doses. It will not be possible to vaccinate entire populations.

• In countries where there are not yet any confirmed cases we are asking whether or not they have the capacity to detect the virus. It gives an indication of the sensitivity of the surveillance system in countries. There are difficulties to detect the influenza since the syndromes are similar to a regular cold which makes it intricate in areas with a high malaria rate. The influenza A should not be treated as a seasonal flu and we have to be careful and prepared that the death toll will be higher in the second wave. The country offices need to take this opportunity to intensify the work on diarrheal and malaria in parallel to work on the H1N1 response.

• Surveillance system to track cases in IDP-camps and preparedness for epidemics has been ongoing for the past years. WHO Country Offices and partners need to advocate for refugees to be part of national response plans.

• The GHC should use this opportunity to make a strong statement on health rights and health access with media and governments.

6. Discussion on progress and issues of concern of the Working Group on Guidance and Tools Nichola Cadge (Save the Children UK) and Nevio Zagaria (WHO) GHC Workplan and Budget 2009 GHC Calendar 2009 Click here for the power point presentation Update • Since the last GHC meeting in November 2008, the WG has finalized the Initial Rapid Assessment

Toolkit (IRA), the Health Resources Availability Mapping System (HeRAMS) and the Health Cluster Guide. The use of these tools by country clusters will continue until June 2010 when the guide and toolkits will be finalized. The recommendations for changes and feedback will be documented and the tools will be reviewed in the third-quarter of next year based on the feedback received during this period. The tools should be seen as 'living' products even after next year's

5

revision. There will be a questionnaire sent out with the tools so the users know what feedback would be valuable to receive from them.

• Training and awareness about the tools should be done in countries in preparation for emergency situations.

• The HCG, the IRA and HeRAMS will be translated into French. IRA tool • The IRA is an initial rapid assessment toolkit and gives a first overview of a crisis situation and

should be used within 48 hours after the onset of an emergency. • The IRA has been tested in several countries. HNTS collaborated with the GHC to develop a

robust e-tool for easy entry of data. • The Nutrition Cluster along with the Health Cluster are ready to endorse the tool and present it as

the preferred assessment tool. The WASH Cluster prefers to wait and see the developments within the inter-cluster, OCHA-lead needs assessment group (NAG) before deciding whether to promote a single tool as the preferred tool. At this stage, they favour giving country clusters the option of selecting from a few tools endorsed by the Global WASH cluster. The IRA is one such tool and is available on the Global WASH cluster website as one of the tools.

HeRAMS • The tool provides information about who is doing what, where and until when in an area and

outlines what the different actors are actually supporting and what level of care is given to the beneficiaries. There are synergies and linkages between the IRA and the HeRAMS and they should ideally be used together but can also be used separately.

• The checklist and data entry form for HeRAMS have been finalised. • HNTS is collaborating with the GHC to develop an electronic tool for easy entry of data. • There was agreement to include in HeRAMS a list of the villages and population data. OCHA at

country level should provide this basic data. The tool can then show what percent of the population has access to services.

Health Cluster Guide • The Health Cluster Guide has been finalised. It is agreed to print 3000 English copies and 1500

French copies. The guide will also contain a CD with all the key reference documents and tools. Dissemination of the tools • The WG has developed a matrix to track agencies' commitment to the dissemination of the tools.

All partners should follow up and report on the missions, trainings and workshops where the tools will be used and whether support from the GHC is needed. The GHC is relying on the efforts of all its partners in the dissemination and awareness of the tools. This matrix will feed into the upcoming dissemination plan.

• Standardised training material will be developed to be available to countries and to country level workshops.

• Suggestion to share the guide with OCHA, Humanitarian Coordinators, donors and other cluster lead agencies as well as partners.

Staff • There are human resource limitations due to the limited funding received; the GHC P5-post has

been covered for 6 months. While the person on this post (Patricia Kormoss) has frequently been deployed as HCC in past emergencies, the WG underlined that Patricia Kormoss' participation in the WG's activities is crucial to disseminate the tools and that they therefore hope for her total dedication to the work of the GHC during the 6 months without any interruption for deployment. HNTS staff collaborated with the GHC to define GHC list of health indicators.

6

7. Health and Nutrition Tracking Services (HNTS) and country health clusters; and the role of the GHC in promoting linkages Pierre Salignon (HNTS) Click here for the power point presentation • PS gave a background to the HNTS and presented the goals and intended benefits. • The HNTS has given significant support to GHC, Sphere, OCHA, IPC/FAO and WFP. • The problem with funding needs to be resolved within the next few months otherwise it might be

better to discontinue the project. HNTS' field presence should start in July with the deployment of an HNTS epidemiologist in Goma, DRC. There is a lack of funding. But to be able to bring the project forward, HNTS needs to be present in the major humanitarian hubs and it needs to be a long term commitment.

• The HNTS team is moving away from primary data collection to interpreting and verifying data. Suggestion to make the academic community more aware of what HNTS is doing.

• PS asked the GHC to clarify what it wants from HNTS and which countries should be prioritized by HNTS.

8. Discussion on progress and issues of concern of the Working Group on Country Support Gillian O'Connell (Merlin) and Robin Nandy (UNICEF) Click here for the power point presentation Update • A standardised curriculum for the Health Cluster Coordination (HCC) trainings has been developed.

Yet there will be new additions to the curriculum namely protracted emergencies and civil military collaboration as well as the GHC policy briefs The curriculum needs to continue being dynamic in terms of content and methodology.

• The HCC trainings will take place at the regional level with globally standardized messages, selection and assessments. SEARO and WPRO are planning a joint training in October and AFRO will carry out a training sometime during the fall (exact date to be decided) in French.

• The HCC trainings have so far trained 60 candidates and 38 of these have passed the assessment component.

• The Humanitarian Reform and the cluster approach were part of the WR training in April and will be part of the WR training curriculum in the future.

• The NGO partner workshop in Hammamet, Tunisia in January 2009 was attended by 9 agencies represented by 23 participants. The participants got a deeper understanding of the Humanitarian Reform, the cluster approach, the GHC tools, funding mechanisms and WHO; they developed action plans for helping to promote the cluster within their agencies.

. Challenges and Recommendations • Few trained HCCs have been deployed partly due to capacity issues and restraints within WHO to

quickly deploy people from both inside and outside the organization. The initial selection criteria are now considered too high as it resulted in candidates that are too key to their organizations to be released to serve in this function. The criteria has since then been adjusted but it is key to keep the standard somewhat high to ensure quality candidates. The WG prioritizes the training of EHA focal points who are wearing two hats (EHA and HCC) in many cluster countries.

• The particular difficulties associated with releasing and deploying INGO staff as HCCs was raised i.e. Terms and conditions for deployment, INGO capacity, WHO/WR perceptions of non UN staff acting as HCCs. Do we need to reconsider the role of INGOs in GHC and focus more on developing role as co lead agency.

• Several countries are in the midst of the process of hiring HCCs. AFRO and EMRO have advertised posts and will select candidates.

• WHO needs to be more creative on retaining people and consider staff rotation to different regions.

7

• The HCC post needs to be seen as a good career move and there should be good possibilities for personal development.

• Regional Advisors need to carefully identify candidates from their regions (both WHO and other agency staff) whom they are ready to deploy to both long term and short term HCC posts.

• Some countries are lacking the necessary funds to hire a separate HCC and therefore the EHA focal point is left to carry out the two jobs and wear the two hats. The donors need to extend the support in order to hire dedicated HCCs. Such funding must be obtained through the CAP/Flash appeals.

• DFID is launching a funding mechanism for NGOs to be more involved in cluster processes. Joint Country Missions (JCM) • There is a need for a designated focal point within HAC who brings the JCMs forward. • The TORs are too ambitious, lack clarity and need to be flexible to respond to the needs of the

country. The NGO partners need to be actively involved in the planning and carrying out of the JCM. The JCM should not focus on assessment but rather on country support and cluster implementation.

Support to country clusters • GHC does not have independent mechanisms to contact country clusters. The communications go

through the normal WHO channels: from the country office to the regional office and HQ. WHO needs to regularly communicate to the GHC the requests it receives for support from the country clusters so that the GHC can look for ways to address these requests.

• Agreement that the GHC tools and Health Cluster Guide need to be a major focus in country support

• Agreement that advocacy from the GHC would be very helpful concerning the role of OCHA; concerning global partnerships, and for ensuring wide participation at country level

Staff • The duty station for the training post is Tunis. This post has not yet been filled. 9. Discussion on progress and issues of concern of the Policy and Strategy Team Mary Pack (International Medical Corps) and Pino Annunziata (WHO) Update • The Policy and Strategy Team has decided to concentrate on the development of policy briefs on

health rights, health in transition and user fees. The briefs aim to be a tool at country and global level to advocate for and create a common voice on areas of common concern. These briefs should be incorporated in the trainings. The Team will need the help of all partners to mainstream the policy briefs.

• The first brief to be produced is on user fees in humanitarian situations. The Team is collecting background material and papers produced by partners to facilitate discussion and to reach consensus. A first draft will be produced by September and the brief will be finalized before the next GHC meeting. The brief will be circulated for comments to the entire GHC.

• The Team has decided not to advance on the issue of global stockpile coordination and did not see a clear value added in this idea.

• Agreement to add civil-military relations as another policy brief topic. Membership criteria • The GHC currently consists of academic and research institutions, donors, NGOs, IFRC and UN-

agencies. The membership has been open to all stakeholders working in the humanitarian health field. There was a discussion as to whether membership should be more selective and limited. Agreement was to remain with the current open participation because the added value was too significant.

• The member organizations should be encouraged to participate actively in the Working Group or the Policy and Strategy Team and should attend the two annual GHC meetings.

8

• Inclusiveness comes with responsibility; the Team will consider whether a minimum standard for participation should be enforced

Conclusions of the day: • The GHC is succeeding in making the agreed shift away from a focus on technical work

(development of guidance and tools) to operational support (workshops, trainings and the dissemination of the guidance and tools) and towards strategic support (advocacy, policy briefs and influencing inter-cluster work…for example on accountability).

• The decision was made to merge the Working Group on Country Support and the Working Group on Guidance and Tools as their work is increasingly coming together.

• The work plan and budget for the first 6 months of 2009 will be closed. A revised work plan and budget will be created for the second 6 months of 2009 to represent the agreed priorities and the real funding situation. The workplan will be presented to the GHC by the end of June.

• The Regional Advisers are requested to become regularly involved in the WG and in GHC meetings. Their involvement in the WG’s will be particularly critical and add value.

• Membership of the GHC will remain wide and diverse. However active participation by all members is strongly encouraged.

• The GHC should remain actively involved in IASC initiatives, particularly on accountability, roles and responsibilities, assessment processes, the dashboard and the cluster evaluation Phase 2.

• GHC members should put forward their expectations of the HNTS in order to ensure that the HNTS responds to the real needs of clusters at global and country level.

Wednesday 10 June Day's Objective: Explore issues about cluster implementation at country level including support to country clusters; WHO and partner internal efforts, how to move ahead for more effective cluster implementation. Morning Chairperson: Johan Heffnick (ECHO) Afternoon Chairperson: Linda Doull (Merlin) 10. Successes, challenges, perceptions at country level: Case studies: Afghanistan, Haiti, Sri Lanka and Zimbabwe Afghanistan: Sophia Craig ( WHO), Altaf Musani (WHO EMRO) Haiti: Jean-Luc Poncelet (WHO PAHO), Muireann Brennan (CDC) Sri Lanka: Robin Nandy (UNICEF), Roderico Ofrin (WHO SEARO), Hendrikus Raaijmaker (WHO Sri Lanka) Zimbabwe: Omar Khatib (WHO AFRO), Chris Lewis (Save the Children UK) Template for Panel Discussions on Country Cluster Implementation. Matrix of Roles and Responsibilities This session was organized around the Template for Panel Discussions on Country Cluster Implementation. The questions were provided in advance to the panel. This summary highlights the key country cluster issues that were discussed. Afghanistan:

• On coordination: The formulation of the Humanitarian Action Plan (HAP) established the way forward for the cluster and its partners to coordinate and work together; it indicated the priorities and functionality of the cluster.

9

• On gaining buy-in and partner participation: The action plan is a daily managerial tool for the cluster work. The cluster did a survey among members to decide its main functions which made partners feel involved and listened to.

Sri Lanka:

• On working with the government: The government was not pleased with the INGOs involvement in the aftermath of the Tsunami. They thought there were too many actors involved and to keep track off. The government is a strong counterpart and there was a total disconnect between the actors. This made coordination more difficult.

• On the role of funding in the cluster: CERF funding triggered cluster coordination and information sharing. 10-12 organizations were part of the CHAP/HAP and the MoH was fully informed to avoid a similar situation as after the Tsunami.

• On working with the government: The MoH is also involved as co-chair in the cluster. The cluster and the government are now working side by side and feeding into each others work plans.

• On joint prioritization and planning: CHAP was used to identify priorities and activities that needed to be implemented and showed the direction of the cluster. It also facilitates the process to see what have been achieved.

Haiti:

• On preparedness: The person acting as HCC was the sitting EHA focal point. The WR was not briefed on the cluster approach. The cluster meetings took place every second day and were mainly used as a venue for information sharing. There were tensions between the HC, partners and the MoH. Mainly due to lack of preparedness and the cluster was seen for some as a disturbing element.

• On working with the government: The government did not have the resources to send staff members to the cluster meetings.

Zimbabwe:

• On working with the government: WHO is learning to work with the government as lead agency of the health cluster.

• On advocacy and having a unified voice: The cluster partners received indirect help from the visit of the UN Secretary General and high level diplomats who led the way though diplomatic difficulties.

General discussion on country cluster implementation

• On working with the government: In Myanmar, working with the government was crucial and they were invited to co-chair every other meeting. This meant that the partners could feel more at ease to share certain types of information at the meetings without the MoH. The data collected from the partners was analysed alongside with the data provided from the government.

• On prioritizing needs: In Gaza, the MoH lacked resources; the cluster was able to concentrate in those areas.

• On preparedness: More training is required at country level so that when an emergency occurs, everyone is knowledgeable about the cluster approach and the architecture and roles and responsibilities at country level. More outreach is needed to bring governments onboard. When the cluster is activated they are exposed to unfamiliar jargon and asked to collaborate.

Wrap Up Important points summarized:

• On coordination: The GHC needs to look at national and sub national coordination and leadership; we need to look at participation of members, and we need to ensure that the cluster is building on existing coordination mechanisms rather than creating parallel and burdensome structures

10

• On strategic planning: The GHC needs to ensure that the cluster action plan is aligned with the in-country processes such as CHAP and CAP; we need to ensure that the action plan is not only concerned with immediate gap-filling but that it also looks to address some of the underlying issues; we need to include addressing strategic gaps for example through advocacy

• On working with government: The GHC needs to emphasize the importance of the role of the country in relation to the clusters and the complexities of reconciling cluster with government

• On preparedness: The GHC needs to build awareness and knowledge in the cluster approach and the GHC guidance and tools pre-disaster; we need to build understanding of the activation process

Lessons for the GHC as it looks to prioritizing its work plan for the second half of 2009

• Careful selection of HCC is essential; competencies, experience and deployability are key • Training of HCC must incorporate these lessons: more time on government, civil-military,

practical challenges and good practices • Promotion of the Health Cluster Guide will address many of these concerns, but this must be

done widely, both in protracted emergency settings as well as pre-disaster settings • We must continue to build up WR awareness and skills through workshops and country level

opportunities and through the OCHA led workshops for country reps with GHC involvement • The Policy and Strategy Team needs to consider civil-military; the Team needs to appreciate

the call from regions and countries to provide advocacy tools • The IASC guidance on working with governments is under development and requires the

attention and involvement of the GHC • Individual GHC partners have a large role to play in building understanding, disseminating

and promoting the HCG and GHC policy briefs at the global and country levels.

11. Civil-military collaboration Sophia Craig, HCC Afghanistan (WHO) Click here for the power point presentation • The humanitarian context is getting worse in Afghanistan with natural disasters, increased fighting

and additional combat troops that are due to arrive. With the upcoming election, more violence is expected.

• MEDCAPs (military medical teams) are arriving in military gear in tanks to areas where NGOs and UN-agencies have difficulties to access, aiming to provide care, collect data, take pictures and service provision.

• The general consensus among cluster partners is that the military should not be providing humanitarian aid and that their provision is undermining the health community and the public health system. The cluster wants the military to create a 'safe' situation where health providers can provide health care in all areas.

• Positive contributions by military includes: emergency preparedness and response, evacuations, training on first aid, provision of standardized medical equipment to MoH, mapping of health facilities and population movements, and provide security. The MEDCAPs will also start providing medical training in Kabul in military hospitals.

• There is a need for resolutions on the right to adequate health care. Discussion • Civil military is contextual and in some countries the military can have a positive influence example

given from Liberia. • Civil military will be included in the standardized GHC training curricula • Recommendation for the Policy and Strategy Team to move forward on a policy brief on civil

military collaboration.

11

12. Co-ordination/co-leadership, successes and challenges: Myanmar and DRC Linda Doull ( Merlin) Click here for the power point presentation Myanmar (acute emergency situation) • Merlin was engaged and appointed as co-lead the second week after cyclone Nargis hit. Merlin was

included in dialogue to develop strategies, led meetings, deployed staff to advance the work of the cluster and shared the overall workload with WHO. They received specific funds to carry out the work.

• There was positive feedback from a lot of actors including the inter-agency evaluation suggested that the co-lead situation helped to address political issues and increase commitment from other NGOs.

• The challenges were to see who was doing what, the high turn-over of staff and lack of communication between the capital and country side.

• There is value in bringing in national NGOs in the work of the cluster. They helped to carry out the work.

• Co-leadership brought NGOs and MoH together. Congo (protracted emergency situation) • Protracted emergency situation. Merlin decided not to engage on capital level and instead focused

on sub-national level. The organization had a more administrative role, especially in Kinshasa. As co-lead, Merlin was involved in advocacy, data collection, fund allocation and fund decisions.

• Decision making turned out to be unequal with transparency issues on all levels. Often the cluster was being by-passed on important decisions regarding health issues. There was a lack of clarity in the cluster on the scope and objectives.

• As co-lead, Merlin staff considers that 20% of their time was taken by the cluster. And that is time and energy that cannot therefore be used for Merlin programme implementation.

Conclusions • There are clear benefits of having NGO co-leads for the cluster but obstacles like having the

capacity to commit senior staff to non-programme implementation might be difficult to overcome. There needs to be a clear agreement between the leads on the responsibilities and accountabilities.

• There are places where GHC partners are serving as cluster lead/cluster coordinator at the sub-national level. But there is little mention of these occurrences.

• The co-lead might find itself in a conflict of interest situation where they have to ask themselves what should be prioritised, what the cluster wants or what my organizations wants?

Discussion • Need for clarity: To whom does the co-lead report? What responsibilities does it take on? Is funding

required for staff involved? • Suggestion to develop paper with recommendations based on country examples and lessons learned. • The purpose of the cluster is to give a better response. It makes sense that the NGOs are keenly

involved in the responsibility of leadership at country level. 13. WHO Integration of cluster approach and support to 26 country clusters: hiring dedicated HCC and other WHO efforts at country, regional and HQ level Introduction: Daniel Lopèz-Acuña (WHO) Panel: AFRO representative: Omar Khatib; EMRO representative: Altaf Musani; EURO representative: Gerald Rockenschaub; PAHO representative: Jean-Luc Poncelet; SEARO representative: Roderico Ofrin; WPRO representative: Arturo Pesigan Update on Cluster Implementation at Country Level List of Countries Applying the Cluster Approach

12

Generic TORs of Cluster Lead Agency at Country Level Matrix of Roles and responsibilities The table Update on Cluster Implementation at Country Level was introduced and explained. We need to continually monitor the functioning and effectiveness of the clusters. This can lead to institutional strengthening. The key issues to monitor are joint strategic planning, joint assessments and prioritization, funding, and the number of active partners. The outcomes of this monitoring would be useful for the GHC and for advocacy. Each WHO regional emergency advisor then gave a brief update, as summarized below, on progress made in that region to integrate the cluster approach and lead the health clusters. AFRO • Difficult to give full support to all 13 cluster countries in AFRO due to distances, travel time,

resource limitations and the difficult protracted emergency situations in so many of them. The WRs in the region have been informed on the Humanitarian Reform.

• Serious issue of underfunding for cluster activities and for HCC posts. EMRO • In the EMRO region 10 countries have adopted the cluster approach, out of which three have

dedicated HCCs, and seven countries have EHA focal points that are double hatting. • The region is acknowledging the difficulty to find the right people for the HCC positions. • For Afghanistan, Somalia and oPt, the HCC positions were mentioned and budgeted for in the

CERF and CAP. However the funding pool is shrinking but the functionality will continue, even though the person is not labelled HCC. The regional office has a responsibility to create awareness of the humanitarian reform.

• EMRO is promoting linkages with other clusters, WASH experts are integrating health issues into their work to fight cholera.

• Countries like Iran do not welcome a large presence of external NGOs so EMRO focuses on working with the Red Cross and Red Crescent and local NGOs.

EURO • The cluster has been implemented three times in the EURO region; Russia, Chechnya, and

Tajikistan. In Georgia, the HCC had gone through training. EURO has conducted training for the EHA focal points and uses the regional coordination platform for getting out information on the cluster approach and the work of the GHC

• EURO region can help further promote training through linking with the Central-Asian working group and the regional platforms.

PAHO • The cluster implementation has not been done in systematic way in the PAHO region. The WHO

has not received any extra funding even though searched twice. The regional office is using its budget for the cluster. Staff members and partners alike had no training in the cluster approach. In March the first Health Cluster Coordinator training took place in Quite, Ecuador and 20 people were trained and assessed. Three candidates have been used for coordination missions. PAHO conducted an evaluation of the cluster in Ecuador.

SEARO • Since 2006 the cluster approach has been an agenda item on all WR meetings. At the last meeting,

the WR Myanmar advocated for the cluster approach. Regional trainings for EHA focal points, administrators and senior medical staff on the health cluster, funding mechanisms and SOPs have taken place and the participants have shared the information within their offices.

• SEARO have set up a fund for country emergencies which all countries contribute 1% of their budget to. This fund is used for underfunded emergencies and it has been functioning for a year. The money has so far been used for Myanmar, Sri Lanka and Nepal.

13

WPRO • WPRO serves 37 countries. Only the Philippines has decided to institutionalize the cluster

approach. Steps have been taken to roll-out the cluster and training courses have been conducted where the cluster is presented as the recommended approach.

• A joint HCC training is planned with SEARO in October 2009. General discussion: • Need to further train health actors at country level on the cluster approach, the goals of coordination

and partnership. • Need additional resources to carry out these trainings and provide other types of support. • Need allocation of extra funding and human resources for large countries where there is only partial

coverage now. Example of DRC where people are needed on sub-national level since the country is so big. A number of actors want country based training, however there is a problem of funding. The scaling up from 4 to 26 cluster countries with dedicated HCCs means that it will be double hatting, i.e. the EHA focal point will carry out the tasks of the HCC.

• Donors are underlining that they want to see dedicated HCC in the countries with HC/RC. If funding is a problem, the countries are encouraged to go to the donors to get funds. Co-leading with NGOs or joint fund advocacy might help get money.

• The key to advance the cluster is in-country training. The countries need to see the added value in coordination and therefore the HCC concept needs to be explained on country to country basis.

• Need to advertise for HCCs for long term contracts in protracted emergencies. • UNDAC countries should insure that the cluster is represented in the missions. Suggestion to create

a regional pool of HCC and sensitize the issue on regional level. • We all need to align our resources to support and boost the country offices and regional offices

when the cluster is implemented. • Present the HCC post as a good carrier opportunity; that, anyone being a HCC is on the career path

to become an HC/RC. 14. Partner integration of cluster approach and support to country clusters, including follow up on action plans developed at GHC NGO partner workshop in January 2009 Mary Pack (International Medical Corps) NGO Health Cluster Partner Workshop Report Click here for the power point presentation • The cluster evaluations and findings of the health cluster country missions show large knowledge

gaps for the NGOs on the Humanitarian Reform. Therefore, the GHC held a workshop for NGO partner representatives to build understanding about the cluster approach, the Principles of Partnership, humanitarian finance mechanisms and the functioning of the health cluster at country level. International Medical Corps organized this event on behalf of the GHC.

• In order to institutionalize this knowledge, the GHC NGO partners were asked to identify key staff within their organizations responsible for humanitarian response. Nine agencies were represented. 23 people participated in the three-day workshop.

• The participants went through a self assessment component to give the training team a sense of their knowledge and also to see their improvement at the end of the course.

• Recommendations that came out from the workshop included: o all HCCs and HCs should receive training on their roles and responsibilities in the

cluster; o ensure inclusion of the NGOs in the cluster at all levels (country, regional and global); o ensure clear allocation of tasks within the cluster; o ensure national government links and support to the cluster and o The GHC missions to country clusters should continue in some form.

14

• As one of the outcomes, each of the participating agencies developed an action plan to ensure that learning from the workshop would be taken forward through their organizations. And they all received CDs with key material including the tools and the guide to share within their organizations.

• The feedback received from the organizations following the training demonstrates concrete steps that have been taken, including: the developed of mechanisms to track staff participation in cluster meetings, the incorporating of the IRA and the Health Cluster Guide into their emergency response manuals; the use of the health cluster tools at country level; the development and dissemination of organizational policy/guidelines on participation in the health cluster at country level and conducting of knowledge sharing sessions for staff.

Way Forward: • Curriculum for partner training courses to be further developed. • This type of workshop should be repeated. 15. Reporting back; Priority actions with milestones for 2009 Meeting participants divided into three groups to discuss the way forward in various areas. The summary is here below. Group 1: Strategic modifications of GHC work plan and WG structure for remainder of 2009. • The WG should keep updating and developing the training curriculum and present the key

messages to OCHA. • The workplan items 1 and 4, 11, 12 should therefore merge. • The Health Cluster Guide will soon be printed and therefore activities 14 and 15 should merge to

ensure that monitoring and evaluation of the effectiveness and impact of the guide and collection of lessons learned from the promotion of the tools take place.

• The stockpile coordination at global and country level will not be brought forward as per the recommendation of the Policy and Strategy Team; therefore item 18 should be deleted.

• Workplan items 5 should included adding civil-military collaboration to the curriculum. • GHC country missions will focus on providing support to country clusters and should take place

upon the request of countries. The missions should focus on building understanding of the Health Cluster Guide and the GHC tools and on coordination strengthening activities.

• Activity 22 and 25, GHC meeting in November/December and the lessons learned workshop for experienced HCCs can be done back to back to save funds.

• Once the GHC Secretariat has finalized the available funds, the GHC will re-allocate the funds for the second half of 2009.

• Suggestion to add additional column for funds WHO and NGOs are receiving for specific GHC related activities.

Group 2: Internal actions by individual GHC agencies to improve cluster implementation • WHO should educate WRs and MoHs on the added value of the cluster approach, present the

dedicated HCC as an asset and draw examples for successful cluster countries. • GHC should train NGOs on how the WHO functions and WHO on how NGOs operate to build on a

common understanding. Draw from WASH cluster's experience of having a paid cluster coordinator on stand-by to be deployed on a 24 hrs basis.

• Reach out to organizations like ASEAN and League of Arab States aware of the cluster approach. Group 3: Actions needed by others to support health cluster: OCHA, donors, HNTS, others? • Increase the visibility of cluster work to increase funding for the global and country health clusters. • Share information between the clusters and coordinate on a higher level.

15

16. Next meeting: dates and location The GHC secretariat presented the different location options for the second GHC meeting planned for late 2009: Geneva or in a cluster country. It was agreed to hold the meeting in Nairobi. The Secretariat will communicate possible dates as soon as possible. Some local reps from the MoH, WHO country offices and partners as well as some HC and WR and HCC should be invited to participated in the meeting. The meeting will take place immediately after the HCC lessons learned workshop. (Dates later confirmed for (16) 17-18 November.) 17. Closing remarks Eric Laroche, ADG/HA (WHO) Before giving his closing remarks, the ADG asked for feedback from new GHC partners and meeting participants coming recently from cluster countries. These participants agreed that the work of the GHC was useful and on the right track, that the meeting itself was informative, productive, inclusive. They liked that the meeting was chaired by different partner representatives. The ADG thanks everyone for the ongoing hard work and the specific contributions to this meeting. The meeting objectives were met thanks to the contributions of all the participants. The GHC benefitted from the attendance and participation of the WHO Regional Advisers as well as a cluster coordinator and many participants who have been frequently on missions to or working closely with countries with clusters. The GHC has to make sure that it brings added value to the country clusters and that the cluster approach does not simply add an extra layer of administration and bureaucracy to the already overburdened country health actors. The ADG said that he has been very encouraged by many things during this meeting, especially that the Health Cluster Guide and the GHC tools are now finalized and will be widely disseminated and promoted over the coming months. This shows great progress and a concrete benefit to country clusters. This meeting has confirmed once again our dedication to the health cluster at global and country levels. Now with the added participation of the WHO regional advisors, we will move toward more tangible results at the country level. A lot of work still lies ahead. We need to develop linkages with universities and institutions to have a long term impact on the way humanitarian health is implemented. We need to focus on outreach, country level trainings and advocacy work. The Humanitarian Reform aims to put order in our houses so we can become more efficient and make effective for our beneficiaries. We need to be professional, to deliver, and to abide by humanitarian principles as well as the laws of the countries in which we work. We will face challenges due to the current financial constraints. But the beauty of the cluster is to be able to work together to find common solutions over time. --- End of Record---

Worsening Humanitarian situationWorsening Humanitarian situation

Natural disasters (drought, floods, harsh weather Natural disasters (drought, floods, harsh weather conditions)conditions)

Troop surge and increased tempo will result in Troop surge and increased tempo will result in increased civilian casualties, population increased civilian casualties, population movements, destabilization of basic social movements, destabilization of basic social servicesservices

Due to insecurity, access to health services is Due to insecurity, access to health services is decreasing (in contradiction with government decreasing (in contradiction with government statistics)statistics)

Increased threats to health workers and health Increased threats to health workers and health facilitiesfacilities

Medical Engagements by military Medical Engagements by military currently include:currently include:

MEDCAPsMEDCAPs and direct patient care and direct patient care (village medical outreach program, (village medical outreach program, Medical civil assistance projects)Medical civil assistance projects)Liaison between and mentoring of Liaison between and mentoring of Ministry of Public Health officialsMinistry of Public Health officialsMonitoringMonitoringTraining of health professionalsTraining of health professionalsAfghan National Army trainingAfghan National Army training

General consensus of Health General consensus of Health Cluster membersCluster members

I.I. The military should not deliver The military should not deliver ‘‘humanitarian aidhumanitarian aid’’ (in extremis is not (in extremis is not considered humanitarian aid)considered humanitarian aid)

II.II. The continued use of The continued use of ‘‘health diplomacyhealth diplomacy’’ by by ISAF undermines both the humanitarian ISAF undermines both the humanitarian community and the public health systemcommunity and the public health system

III.III. Military involvement in the delivery of Military involvement in the delivery of health care endangers health workers and health care endangers health workers and health facilitieshealth facilities

IV.IV.Military should focus on creating a secure Military should focus on creating a secure environment in which humanitarian aid environment in which humanitarian aid agencies can deliver servicesagencies can deliver services

The implications of The implications of military involvement in military involvement in health service deliveryhealth service delivery

Some examplesSome examples……..

2007: ISAF medical team visits 2007: ISAF medical team visits NahoneeNahonee Basic Health Centre (BHC) Basic Health Centre (BHC) in Kandahar to distribute non food in Kandahar to distribute non food items. items.

The next day, gunmen burn down the The next day, gunmen burn down the clinic, leaving clinic, leaving approximately approximately 25,000 people without access to 25,000 people without access to healthcare.healthcare.

More examplesMore examples

ISAF medical mobile health team ISAF medical mobile health team conducts a day clinic in a remote, conducts a day clinic in a remote, insecure part of the country with no insecure part of the country with no access to health care. access to health care.

Needs/data are not shared with the Needs/data are not shared with the humanitarian community, no long humanitarian community, no long term interventions are planned, term interventions are planned, community continues to live without community continues to live without health serviceshealth services

More examplesMore examples

2008: ISAF team visits 2008: ISAF team visits MywainMywainComprehensive Health Centre to distribute Comprehensive Health Centre to distribute non food items. non food items.

Clinic staff were threatened by local AGE Clinic staff were threatened by local AGE and accused of coordinating with and accused of coordinating with international forces. The village was international forces. The village was forced to close down the centre. The clinic forced to close down the centre. The clinic was looted. The clinic was mined. was looted. The clinic was mined. Approximately 50,000 people were Approximately 50,000 people were left with no access to health care. left with no access to health care.

Positive contributions by military to Positive contributions by military to the health sectorthe health sector

Medical evacuationsMedical evacuationsEmergency preparedness and responseEmergency preparedness and responseTraining (Training (““Combat MedicCombat Medic”” skills of advanced first skills of advanced first aid, airway control and haemostatic techniques, aid, airway control and haemostatic techniques, ambulance transfers and MEDEVAC transfersambulance transfers and MEDEVAC transfers””technical training in engineering for health facility technical training in engineering for health facility support)support)Provision of standardized equipment to the Provision of standardized equipment to the Ministry of Public HealthMinistry of Public HealthMapping (GIS) of health facilities and population Mapping (GIS) of health facilities and population movementsmovementsProvide security to enable humanitarian actors to Provide security to enable humanitarian actors to deliver aiddeliver aid

Health Cluster

Co-coordination/Co-leadership

Lessons from Myanmar & DRC

Myanmar

• Cluster coordination mechanism activated in 1 week.

• WR Myanmar took responsibility as the Health Cluster lead.

• WHO-HAC staff member appointed Health Cluster Coordinator.

Merlin engagement

• Merlin was proposed and appointed as Co-lead at national level by week 2

• Co-lead at sub-national level – Laputta.

Health Cluster in Myanmar

• Facilitation & coordination of the health sector• Health information collection, analysis & dissemination• Emergency disease surveillance and early warning for epidemic prone

diseases.• Responses to health threats and disease outbreaks • Provides reference and technical advisor for public health matters.• Identification and resolution of gaps in the health sector.• Priority setting and minimum package identified.• Capacity building of governmental and non-government groups.• Facilitated linkages between MoH and Cluster partners• Responsibility for technical inputs to PONJA, Periodic Review • Overseen Early Recovery/Recovery Strategic Framework (PONREPP)• Responsible for contributing to accountability framework (IMM/Financial

Tracking System)

Co-leadership modelWhat does it entail?• Co-chairing cluster meetings• Co-leading the development & implementation of the

health strategy with other stakeholders• Participating in the Cluster Lead meeting which

oversees the overall coordination mechanism

How does it work?• Merlin has provided additional staff for the cluster (co-

lead, administrator, medical doctor.)• Cluster agenda devised between the two chairs • Issues are debated and solution brought to the rest of

the group together• Burden of workload is shared between the two chairs

Who funds it?• Merlin received specific funds from a donor to cover

associated costs.

What are the benefits?• Actively represents participative philosophy

underpinning the cluster approach. Gives greater NGO influence over the cluster response

• It creates a better working environment & communication between stakeholders

What are the benefits?

• A more effective and harmonized approach of health services delivery

• A greater NGO access to the MoH through the health cluster

• Strategic level of discussion (i.e. not limited to information sharing)

• Development of useful technical tools and guidelines

• Effective meeting management, including efforts to engage local actors

• Reduce problems related to frequent cluster lead turnover and the shared workload afforded cluster leads the possibility of spending more time in the field

What was missing?• Rolling-out the model from capital to field level• Mainstreaming attendance of decision makers at the

cluster meetings• More effective communication between field &

capital (vice versa)• Support from Global Health Cluster

– A better analysis of 3W for an improved gap analysis– A joint assessment methodology– A data analysis based upon population data

• A comprehensive preparedness and contingency planning process

• A clear plan for capacity building, especially for national health authorities &non-government actors

DR Congo

• Protracted crisis

• Acute humanitarianneed – conflict/IDPs

• Recovery & transition

• Capacity issues ++

Merlin engagement

National level• Kinshasa - 2008

Sub-national level• North Kivu - 2007• Maniema - 2009

Co-leadership roleWhat does it entail?• Support to co-ordination process (co-chair)• Information collection, gap analysis• Assessment role in funding decisions (pooled fund

allocation).• Advocacy – provincial/national disconnect (HAP)• Limited technical activity

How does it work?• Merlin CHD & PMC co-chair meetings /agendas• Engagement most extensive at provincial level• Decision making unequal.

What’s missing?

• Availability of guidance & tools• Transparent decision making – bypassing cluster

system is common – leads to misfit between needs & funding allocation.

• Understanding of highly complex aid architecture• Highly variable capacities among cluster partners.• Clear ToR• Staff retention• Time!

Who funds it?• No specific funding to date. Requests toOCHA & pooled funds being considered

What are the benefits?• Enhanced MoH engagement in acute response

at national & provincial level.• Enhanced first phase NGO response at

provincial level.• Increased engagement of national NGOs at

provincial level.• Greater understanding of complex country

context & priority setting.

Conclusions & Recommendations

• NGO cluster co-lead has added value & shared benefits

But must consider;• At what level NGO co-lead value is best placed?• NGO capacity to commit senior level, appropriately trained

staff for context.• Realistic time commitment (min 20%) – separate post.• Opportunity costs – implications on programme delivery &

quality; additional staff requirements.• Agree a ToR/MoU with cluster lead agency - RASCI

– Co-lead or co-coordinate?– POLR?– Draft Operational Guidance note (OCHA)

Conclusions & Recommendations

• Provide NGOs with core funding to enable them to actively engage in the support of the co- lead/humanitarian reform.

• Support greater engagement of NGO staff in health cluster coordinator trainings.

• Document lessons learned & promote among NGO partners.

Generic Terms of Reference for Sector Leads at the Country Level

The Cluster Approach operates at two levels. At the global level, the aim is to strengthen system-wide preparedness and technical capacity to respond to humanitarian emergencies by designating global Cluster Leads and ensuring that there is predictable leadership and accountability in all the main sectors or areas of activity. At the country level, the aim is to ensure a more coherent and effective response by mobilizing groups of agencies, organizations and NGOs to respond in a strategic manner across all key sectors or areas of activity, each sector having a clearly designated lead, as agreed by the Humanitarian Coordinator and the Humanitarian Country Team. (To enhance predictability, where possible this should be in line with the lead agency arrangements at the global level.) The Humanitarian Coordinator – with the support of OCHA – retains overall responsibility for ensuring the effectiveness of the humanitarian response and is accountable to the Emergency Relief Coordinator. Sector leads at the country level are accountable to the Humanitarian Coordinator for facilitating a process at the sectoral level aimed at ensuring the following: Inclusion of key humanitarian partners:

• Identify key humanitarian partners for the sector, respecting their respective mandates and programme priorities

Establishment and maintenance of appropriate humanitarian coordination mechanisms:

• Ensure appropriate coordination with all humanitarian partners (including national and international NGOs, the International Red Cross/Red Crescent Movement, IOM and other international organizations), through establishment/maintenance of appropriate sectoral coordination mechanisms, including working groups at the national and, if necessary, local level;

• Secure commitments from humanitarian partners in responding to needs and filling gaps, ensuring an appropriate distribution of responsibilities within the sectoral group, with clearly defined focal points for specific issues where necessary;

• Ensure the complementarity of different humanitarian actors’ actions; • Promote emergency response actions while at the same time considering the need

for early recovery planning as well as prevention and risk reduction concerns; • Ensure effective links with other sectoral groups; • Represent the interests of the sectoral group in discussions with the Humanitarian

Coordinator and other stakeholders on prioritization, resource mobilization and advocacy;

Coordination with national/local authorities, State institutions, local civil society and other relevant actors

1

• Ensure that humanitarian responses build on local capacities; • Ensure appropriate links with national and local authorities, State institutions,

local civil society and other relevant actors (e.g. peacekeeping forces) and ensure appropriate coordination and information exchange with them.

Participatory and community-based approaches

• Ensure utilization of participatory and community based approaches in sectoral needs assessment, analysis, planning, monitoring and response.

Attention to priority cross-cutting issues

• Ensure integration of agreed priority cross-cutting issues in sectoral needs assessment, analysis, planning, monitoring and response (e.g. age, diversity, environment, gender, HIV/AIDS and human rights); contribute to the development of appropriate strategies to address these issues; ensure gender-sensitive programming and promote gender equality; ensure that the needs, contributions and capacities of women and girls as well as men and boys are addressed;

Needs assessment and analysis:

• Ensure effective and coherent sectoral needs assessment and analysis, involving all relevant partners

Emergency preparedness

• Ensure adequate contingency planning and preparedness for new emergencies; Planning and strategy development:

Ensure predictable action within the sectoral group for the following: • Identification of gaps; • Developing/updating agreed response strategies and action plans for the sector

and ensuring that these are adequately reflected in overall country strategies, such as the Common Humanitarian Action Plan (CHAP);

• Drawing lessons learned from past activities and revising strategies accordingly; • Developing an exit, or transition, strategy for the sectoral group.

Application of standards:

• Ensure that sectoral group participants are aware of relevant policy guidelines, technical standards and relevant commitments that the Government has undertaken under international human rights law;

• Ensure that responses are in line with existing policy guidance, technical standards, and relevant Government human rights legal obligations.

Monitoring and reporting:

• Ensure adequate monitoring mechanisms are in place to review impact of the sectoral working group and progress against implementation plans;

• Ensure adequate reporting and effective information sharing (with OCHA support), with due regard for age and sex disaggregation.

2

3

Advocacy and resource mobilization:

• Identify core advocacy concerns, including resource requirements, and contribute key messages to broader advocacy initiatives of the HC and other actors;

• Advocate for donors to fund humanitarian actors to carry out priority activities in the sector concerned, while at the same time encouraging sectoral group participants to mobilize resources for their activities through their usual channels.

Training and capacity building:

• Promote/support training of staff and capacity building of humanitarian partners; • Support efforts to strengthen the capacity of the national authorities and civil

society. Provision of assistance or services as a last resort:

• As agreed by the IASC Principals, sector leads are responsible for acting as the provider of last resort to meet agreed priority needs and will be supported by the HC and the ERC in their resource mobilization efforts in this regard.

• This concept is to be applied in an appropriate and realistic manner for cross-cutting issues such as protection, early recovery and camp coordination.

Humanitarian actors who participate in the development of common humanitarian action plans are expected to be proactive partners in assessing needs, developing strategies and plans for the sector, and implementing agreed priority activities. Provisions should also be made in sectoral groups for those humanitarian actors who may wish to participate as observers, mainly for information-sharing purposes.

HEALTH AND NUTRITION HEALTH AND NUTRITION TRACKING SERVICE TRACKING SERVICE

(HNTS)(HNTS)Global Health Cluster meeting, GenevaGlobal Health Cluster meeting, Geneva

0909thth June 2009June 2009

Pierre Salignon, HNTS Interim Project DirectorPierre Salignon, HNTS Interim Project Director

WHAT IS HNTS ?WHAT IS HNTS ?

An interagency initiative hosted by WHO, An interagency initiative hosted by WHO, created in late 2007 by the Intercreated in late 2007 by the Inter--Agency Agency Standing Committee Health and Nutrition Standing Committee Health and Nutrition Clusters in response to a request made by Clusters in response to a request made by the United Nations Emergency Relief the United Nations Emergency Relief Coordinator as part of the Humanitarian Coordinator as part of the Humanitarian Reform processReform process

GOALSGOALS(1) Contribute to the (1) Contribute to the improvement of improvement of humanitarian operationshumanitarian operations and promote and promote mutual accountability mutual accountability of the humanitarian of the humanitarian community and beneficiaries; community and beneficiaries; (2) (2) Detect and preventDetect and prevent, if possible, , if possible, excess excess mortality and malnutrition mortality and malnutrition in crises; in crises; (3) Ensure that(3) Ensure that informationinformation relevant to relevant to humanitarian policy and humanitarian policy and evidenceevidence--based based reportsreports on health and nutrition needs in on health and nutrition needs in humanitarian crises situations arehumanitarian crises situations areavailable at highavailable at high--level decisionlevel decision--making making forumsforums..

INTENDED BENEFITSINTENDED BENEFITSDirect support to field relief organizationsDirect support to field relief organizationsInformation for actionInformation for actionTimely assessment of needs and relief Timely assessment of needs and relief response (impact response (impact -- effects)effects)Greater transparency and accountabilityGreater transparency and accountabilitySharing of information (coordination)Sharing of information (coordination)Better readability (trends)Better readability (trends)Better quality (best practices and quality of Better quality (best practices and quality of data collection / surveys data collection / surveys -- training)training)Field presence and capacity, tools Field presence and capacity, tools development / standardisation if possibledevelopment / standardisation if possible

MAIN FUNCTIONSMAIN FUNCTIONSOOperational perational support to humanitarian teams support to humanitarian teams in the field by:in the field by:

PeerPeer--reviewing guidelines and other reviewing guidelines and other documents, participating in assessment documents, participating in assessment missions, advising on the design of surveys, missions, advising on the design of surveys, and providing technical advice to various and providing technical advice to various agencies, NGOs. agencies, NGOs.

A A normative normative function including:function including:Development of standards for data collection Development of standards for data collection and measurement, collect, analysis and and measurement, collect, analysis and dissemination of data, provision of independent dissemination of data, provision of independent technical advice (i.e. method developmenttechnical advice (i.e. method development--validation of studies), training. validation of studies), training.

WHO WE ARE ?WHO WE ARE ?A Geneva based Technical Secretariat with 1 A Geneva based Technical Secretariat with 1 Project Director, 2 health and nutrition Project Director, 2 health and nutrition Epidemiologists, 1 administrative assistantEpidemiologists, 1 administrative assistanthnts@who.inthnts@who.intWith field technical With field technical presence(spresence(s) in countries ) in countries targeted for HNTS implementationtargeted for HNTS implementation

Democratic Republic of Congo / first HNTS field Democratic Republic of Congo / first HNTS field epidemiologist through a NGO partnershipepidemiologist through a NGO partnershipOthers in the future ?Others in the future ?

The Steering Committee (SC)The Steering Committee (SC)The Expert Reference Group (ERG)The Expert Reference Group (ERG)

A roster of experts for field deployment in the future ?A roster of experts for field deployment in the future ?

COUNTRIES TARGETEDCOUNTRIES TARGETED

20082008Uganda, Myanmar, DRCUganda, Myanmar, DRC……

2009 2009 –– 20112011Democratic Republic of CongoDemocratic Republic of CongoOthers ? Asia, Africa, Central AsiaOthers ? Asia, Africa, Central Asia…… ??•• CAR/Chad/Sudan (see review of surveys)CAR/Chad/Sudan (see review of surveys)

In the future, reactivity to new crisesIn the future, reactivity to new crisesDepending requests and mobilization of Depending requests and mobilization of partners, ERC and Healthpartners, ERC and Health--Nutrition Clusters, Nutrition Clusters, NGO communityNGO community

TECHNICAL CONSULTANCIESTECHNICAL CONSULTANCIESPriority indicators in complex emergenciesPriority indicators in complex emergencies

HNTS indicators, support to SPHERE revision and other HNTS indicators, support to SPHERE revision and other data collection initiativesdata collection initiatives

Mortality estimates in crisis affected populations Mortality estimates in crisis affected populations ––inference from multiple sources inference from multiple sources

Quality scoring of surveysQuality scoring of surveys

Review of surveys for 2006 Review of surveys for 2006 –– 2008 in North Kivu 2008 in North Kivu See recommendations about systematic peer review of See recommendations about systematic peer review of surveys, trainingsurveys, training…… etc.etc.

Peer review of IRC surveys in DRC 1996 Peer review of IRC surveys in DRC 1996 –– 20082008See report and commentsSee report and comments

Review of surveys for 2004 Review of surveys for 2004 –– 2009 in Darfur (July)2009 in Darfur (July)

MORTALITY AND NUTRITION MORTALITY AND NUTRITION PRIORITIESPRIORITIES

Survey methodologies and validation of Survey methodologies and validation of surveyssurveysSurveillanceSurveillanceDetermination of needs for nutrition Determination of needs for nutrition programmingprogrammingRealReal--time monitoring of the food and time monitoring of the food and nutrition situation in vulnerable nutrition situation in vulnerable communitiescommunitiesRelative interest of different methods for Relative interest of different methods for assessing nutrition and mortality situations assessing nutrition and mortality situations and triangulation of informationand triangulation of information

SUPPORT TO EXISTING DATA SUPPORT TO EXISTING DATA COLLECTION INITIATIVESCOLLECTION INITIATIVES

SPHERE SPHERE 2010 Revision process (nutrition and health)2010 Revision process (nutrition and health)

Global Health Cluster (GHC) Global Health Cluster (GHC) Definition of health indicatorsDefinition of health indicators

OCHA OCHA Humanitarian dashboard effort and the overall ACE project + Humanitarian dashboard effort and the overall ACE project + Needs Assessment Group (NAG) Needs Assessment Group (NAG)

IPC / FAO IPC / FAO -- WFP WFP Review of health / mortality Review of health / mortality -- nutrition indicatorsnutrition indicators

WHO WHO Technical support to tools development (IRA, Technical support to tools development (IRA, HeramsHerams, others), others)

Field technical support Field technical support Development of the HINTS early warning automatic analysis toolDevelopment of the HINTS early warning automatic analysis tool

WHAT WE NEED ?WHAT WE NEED ?Mobilization of GHC and GNC partners Mobilization of GHC and GNC partners

Use of Health and Nutrition Tracking Use of Health and Nutrition Tracking ServiceService at HQ and at HQ and field levels (see operational and normative functions)field levels (see operational and normative functions)DRC / North Kivu DRC / North Kivu –– development of direct HNTS development of direct HNTS technical field support to relief organizations and technical field support to relief organizations and national authoritiesnational authorities……Review of surveys in Darfur Sudan 2003 Review of surveys in Darfur Sudan 2003 –– 2009, 2009, access to surveysaccess to surveys……Identification of new countries targeted for HNTS Identification of new countries targeted for HNTS implementation ?implementation ?

Mobilization of donors community and UN Mobilization of donors community and UN agenciesagencies

Ensure financial stability of HNTS project in the 2 Ensure financial stability of HNTS project in the 2 coming years (credibility coming years (credibility –– trust with all partners)trust with all partners)Ensure stability of competencies and HREnsure stability of competencies and HRDevelop reactivity to new emergencies / crises ?Develop reactivity to new emergencies / crises ?

HNTS / GHC cooperationHNTS / GHC cooperationExpectations from HNTSExpectations from HNTS

Active participation of GHC Active participation of GHC members to the HNTS Steering members to the HNTS Steering CommitteeCommitteeExchange of information available Exchange of information available about countries targeted for HNTS about countries targeted for HNTS implementation implementation –– access to surveys access to surveys and dataand data……

•• DRCDRC•• Others ? New crises / emergenciesOthers ? New crises / emergencies

Support HNTS project's Support HNTS project's development and products' visibilitydevelopment and products' visibilityPossible request to HNTS to support Possible request to HNTS to support Clusters partners data collection Clusters partners data collection efforts in crises, and also in new efforts in crises, and also in new emergencies, through the health and emergencies, through the health and nutrition clustersnutrition clustersDevelopment of the peer review Development of the peer review function of HNTSfunction of HNTSPossible HNTS technical Possible HNTS technical support/participation to new support/participation to new coordinated multicoordinated multi--sectoral sectoral assessmentsassessmentsEnsure GHC members political and Ensure GHC members political and financial support to HNTS projectfinancial support to HNTS project……

Questions to GHC membersQuestions to GHC members

What are the expectations of the What are the expectations of the GHC about HNTS ? Are there GHC about HNTS ? Are there specific requests from the GHC to specific requests from the GHC to HNTS ?HNTS ?How can the GHC members ensure How can the GHC members ensure political and financial support to political and financial support to HNTS project for the coming two HNTS project for the coming two years ?years ?Are the GHC members ready to Are the GHC members ready to support the development of HNTS support the development of HNTS field technical activities in countries field technical activities in countries targeted for HNTS implementation ? targeted for HNTS implementation ? How ? How ?

•• Let's start in DRC Let's start in DRC –– North Kivu ?North Kivu ?How can the GHC members better How can the GHC members better use the HNTS initiative as a catalyst use the HNTS initiative as a catalyst for the humanitarian community when for the humanitarian community when trying to strengthen data collection, trying to strengthen data collection, consolidation, analysis and consolidation, analysis and interpretationinterpretation…… ??Are YOU still convinced about the Are YOU still convinced about the need to develop HNTS and fill gaps need to develop HNTS and fill gaps in data collection, surveysin data collection, surveys…… ??

Some risks and pitfalls Some risks and pitfalls History of HNTS, "expectations" and "frustrations"History of HNTS, "expectations" and "frustrations"……pressure to "move forward" fast, lack of fundspressure to "move forward" fast, lack of funds……Independence of HNTS ?Independence of HNTS ?Timing to build trust and synergy between HNTS and Timing to build trust and synergy between HNTS and (field) partners;(field) partners;Complexity of the project because of technical aspects Complexity of the project because of technical aspects and no easy agreement between partners / donors;and no easy agreement between partners / donors;"Political factors" that could constrain the HNTS roll"Political factors" that could constrain the HNTS roll--out out in certain cases;in certain cases;Suspicion of motives around data collection in crises;Suspicion of motives around data collection in crises;Tracking work that could be delayed by access problems Tracking work that could be delayed by access problems due to insecurity;due to insecurity;Poor coordination; failure to share data;Poor coordination; failure to share data;Absence of data, unreliable and/or untimely data, Absence of data, unreliable and/or untimely data, difficulties in interpretation;difficulties in interpretation;Improvements less likely to be measured;Improvements less likely to be measured;

……"Numbers game", risk of "death inflation", inappropriate "Numbers game", risk of "death inflation", inappropriate extrapolation of data, sharing data extrapolation of data, sharing data versus versus their political their political misuse, wrong focus on "dead"misuse, wrong focus on "dead" instead instead of "saving lives", of "saving lives", etc;etc;The commitment to humanitarian system reform remains The commitment to humanitarian system reform remains fragile and will influence the extent to which cooperation fragile and will influence the extent to which cooperation at global and country levels is maintained to put the at global and country levels is maintained to put the HNTS into practice;HNTS into practice;Financial support to HNTS must be strengthened and Financial support to HNTS must be strengthened and donors group enlarged;donors group enlarged;HNTS team turn over as well as turn over of staff in relief HNTS team turn over as well as turn over of staff in relief organizations and partners.organizations and partners.

GlobalHealth Cluster

IASCInter-Agency Standing Committee

Meeting Agenda

8-10 June 2009

Monday 8 June 2009 Location: CICG/Centre de Conférence Varembé (CCV), 17 rue de Varembé, Geneva

Day's Objective: Advance on GHC work plan; plan for 9-10 June sessions

10h30-13h00 Salle E  Policy and Strategy Team

14h00-17h30 Salle D Working Group on Country Support

14h00-17h30 Salle E Working Group on Guidance and Tools

17h30-18h30 Salle E Joint meeting of the two Working Groups

19h00 tbd Working dinner of the six Co-Chairs

Tuesday 9 June 2009

Location: Salle B

Day's Objectives: Key issues of concern from the global arena and their influence on GHC work; update on progress against GHC work plan, related challenges/solutions

Morning Chair: Emmanuel d'Harcourt, IRC

Afternoon Chair: Anne Golaz, UNICEF

9h00 - 9h30 1. Opening remarks

Eric Laroche, Assistant Director-General, HAC/WHO

9h30 - 9h45 Review agenda, objectives of the day, and other announcements

Chair

9h45-10h30 2. Key issues of concern to the GHC: IASC issues, IASC representation by cluster leads, Montreux, humanitarian dashboard, assessments, phase 2 evaluation

Daniel Lopèz-Acuña, Director, REC and ERO/HAC/WHO

Background doc: Status Report on Cluster Evaluation Phase II

10h30-10h45 Coffee

10h45-11h30 3. Key issues of concern to the GHC: accountability and related discussions at the global cluster retreat and at global cluster/donor meeting

Mary Pack (IMC), Linda Doull (Merlin), Nevio Zagaria (WHO)

Background docs: Global Cluster Retreat Summary; Global Cluster/Donor meeting summary

11h30-12h00 4. GHC funding situation: use of funds in 2008 and contributions towards 2009 work plan

Erin Kenney

Background docs: Resume of GHC Expenditure 2008; 2009 Funding and Funding Gaps

12h00-12h30 5. Preparing to respond to Influenza and its humanitarian effects through the cluster framework

Eric Laroche and Dominique Légros, WHO

12h30-13h30 Lunch

13h30-14h30 6. Discussion on progress and issues of concern of WG on Guidance and Tools

Nichola Cadge (Save UK) and Nevio Zagaria (WHO), Co-Chairs

Background docs: GHC Work Plan and Budget 2009; GHC Calendar 2009

14h30-15h15 7. HNTS and country health clusters; and the role of the GHC in promoting linkages

Pierre Salignon, HNTS Project Director

15h15-15h30 Coffee

15h30-16h30 8. Discussion on progress and issues of concern of WG on Country Support

Gillian O'Connell (Merlin) and Robin Nandy (UNICEF), Co-Chairs

Background docs: GHC Work Plan and Budget 2009; GHC Calendar 2009

16h30-17h30 9. Discussion on progress and issues of concern of the Policy and Strategy Team

Mary Pack (IMC) and Pino Annunziata (WHO), Co-Chairs

Background docs: GHC Work Plan and Budget 2009; GHC Calendar 2009

17h30 Wrap up

18h00 onward Cocktails at Bains-des Paquis (no host bar)

Wednesday 10 June 2009

Location: Salle B

Day's objective: Explore issues about cluster implementation at country level including support to country clusters; WHO and partner internal efforts, how to move ahead for more effective cluster implementation

Morning Chair: Johan Heffinck, ECHO

Afternoon Chair: Linda Doull, Merlin

9h00 - 9h15 Open, review of yesterday, objectives for the day

Chair

9h15-10.15 10. Successes, challenges, perceptions at country level: Case studies: Afghanistan , Haiti, Sri Lanka and Zimbabwe

Afghanistan: Sophia Craig (WHO Afghanistan) and Altaf Musani (RA EMRO)

Haiti: Muireann Brennan (CDC) and Jean Luc Poncelet (RA PAHO)

Sri Lanka: Robin Nandy (UNICEF), Hendrikus Raaijmakers (WHO Sri Lanka) and Roderico Ofrin (RA SEARO)

Zimbabwe: Chris Lewis (Save UK) and Omar Khatib (RA AFRO)

Background docs: Template for Panel Discussion; Matrix of Roles and Responsibilities

10h15-10h30 Coffee

10h30-11h15 Continuation: Successes, challenges, perceptions at country level

11h15-11h30 11. Civil- Military Collaboration

Sophia Craig (WHO Afghanistan)

11h30-12h00 12. Co-coordination/co-leadership, successes and challenges: Myanmar and DRC

Linda Doull (Merlin)

12h00-13h00 Lunch

13h00-14h30 13. WHO integration of cluster approach and support to 26 country clusters: hiring dedicated HCC and other WHO efforts at country, regional and HQ levels

Introduction: Daniel Lopèz-Acuña

Panel: WHO Regional Advisors Omar Khatib (AFRO), Altaf Musani (EMRO), Gerald Rockenshaub (EURO), Jean Luc Poncelet (PAHO), Roderico Ofrin (SEARO), Art Pesigan (WPRO)

10 minute overview by region and then open discussion

Background docs: List of Countries Applying the Cluster Approach; Generic TOR of Cluster Lead Agencies at Country Level; Matrix of Roles of Responsibilities

14h30-15h00 14. Partner integration of cluster approach and support to country clusters, including follow up on action plans developed at GHC NGO partner workshop in January 2009

Mary Pack (IMC)

15h00-15h15 Coffee

15h15-16h15 Small group discussions based on issues raised over 2 day plenary

Group 1: strategic modifications to GHC work plan and WG structure for remainder of 2009

Groups 2 and 3: internal actions by individual GHC agencies to improve cluster implementation (with milestones)

Group 4: actions needed by others to support health cluster: OCHA, donors, other clusters ?

16h15-17h30 15. Reporting back; priority actions with milestones for 2009

17h30-18h00 16. Next meeting: dates, location

Erin Kenney

18h00 17. Closing Remarks

Eric Laroche

Country Suport Working Group

GHC Meeting9 June 2009

Geneva

Objectives

• To provide an update on the progress towards delivering the 2009 Work Plan

• To highlight the main strategic challenges and issues that need to be addressed by the GHC

• To make recommendations for the way forward

Key Progress & Achievements: • 1) Training and workshops

– Curriculum standardized incorporating tools & HCG

– Production of training pack

– 2009:• PAHO training (Mar 09)• SEARO/WPRO (Oct 09)• AFRO (TBC)

– New curriculum• Protracted emergencies• Civil military• Must continue to be dynamic in terms of content

and methodologies

– NGO integration workshop• 9 agencies• 23 participants

Key Progress & Achievements:

– 59 HCC trained• 38 passed assessment• 7 deployed (5 currently deployed)

– Target 80% of cluster countries to have trained HCC. Currently 7/26 trained (27%)

– Cluster issues integrated into WHO training and orientation

Training Officer P4 post

Progress & Achievements: Training

• 2) Rosters

– Standardization of selection criteria

– WR buy in and awareness

Challenges & Recommendations I

• 1) Low number of trained HCCs deployed- Request regional advisors to work with GHC in the identification, training and selection of suitable candidates.- Continue advocacy with WRs

• 2) Large number of untrained HCCs- Target sitting CCs in the short term- Advocate for trained designated HCC in long term

Challenges & Recommendations II• 3) Joint Country Missions

- Need for a designated focal point within HAC- Link with T&G WG- Merge WGs?-Need to review TOR- focus on support to HCFC

- Way forward (country selection & #) TBD at this meeting- Duration 1-2 wks

• 4) CSWG not aware of needs in country:i.e.->Country ->Regional ->WHO HAC

->GHC hub->CO support WG

- HAC focal point to work with WG- Suggestions from regional focal points?

Challenges & Recommendations III• 5) Unclear decision making process

- Clarify decision making role of WGs. Who makes the decision?

• 6) Lack of NGO involvement in HCC- Acute emergencies - capacity issues and no deployment mechanism- Modalities for release & deployment, terms & conditions- Cluster co-leadership at sub-national level- Is this realistic in absence of emergency agreements?- Increase support to NGOs for sub-national coord

Challenges & Recommendations IV

• 7) CC at sub-national level not addressed – Expand support to sub-national coord

• 8) Need for evaluation of activities- Standard format to evaluate impact of activities on effectiveness of humanitarian response

Way Forward

• Recommend that the WGs on CS and GT are merged – transition mechanism,TORs, chairpersons

• 2009 activities are reprioritised in light of budget shortfall

• Produce new workplan by ?

DRAFT PROVISIONAL VERSION

[Health Cluster Guide – draft provisional version, 30 Dec. 2008] 1

The roles of the HCC, the CLA, and cluster partners are summarized in the table and matrix below.

Functions 1 Health Cluster Coordinator (HCC)

Cluster Lead Agency (CLA)

Cluster Partners

1. Coordination mechanisms and inclusion of all health actors within the HC and inter-cluster (1+2)

2. Coordination with national authorities & other local actors (3)

3. Needs assessment & analysis including identifying gaps in health response [6]

4. Strategy development & planning [8], including: Community based approaches [4], attention to priority cross cutting issues [5], and filling gaps

5. Contingency planning [7]

6. Application of standards [9]

7.Training and capacity building [12]

8. Monitoring and reporting (10)

9. Advocacy and resource mobilization [11], including reporting

10. Provider of Last Resort (13)

Notes: 1 In this first column, [#] = corresponding points in the generic TOR for CLAs.

= lead responsibility for the set of activities defined in column 1.

DRAFT PROVISIONAL VERSION

[Health Cluster Guide – draft provisional version, 30 Dec. 2008] 2

Roles within a country-level Health Cluster Functions Health Cluster Coordinator (HCC) 2 Cluster Lead Agency (CLA) 3 Cluster Partners/Partners 4

1. Coordination mechanisms and inclusion of all health actors within the HC and inter-cluster (1+2) See chapters 1 & 2

1. Identify and make contact with health sector stakeholders and existing coordination mechanism, including national health authorities, national and international organizations and civil society.

2. Hold regular coordination meetings with country health cluster partners, building when possible on existing health sector coordination fora.

3. Collect information from all partners on Who’s Where, since and until When, doing What, and regularly feed the database managed by OCHA (4W). Provide consolidated feedback to all partners and the other clusters.

10. Represent the Health Cluster in inter-cluster coordination mechanisms at country/field level, contribute to jointly identifying critical issues that require multisectoral responses, and plan the relevant synergistic interventions with the other clusters concerned.

Appoint an HCC and assure the support services necessary for the effective functioning of the cluster. [CLA Rep.] Use the CLA’s existing working relations with national health authorities and with national and international organizations, civil society and non-State actors that are active in the health sector to facilitate their participation in the Cluster and relationships with the HCC, as needed. [CLA Rep./EHPM] Ensure that sectoral coordination mechanisms are adapted over time to reflect the evolution of the crisis and the capacities of local actors and the engagement of development partners. [CLA Rep.] Work within the Country Humanitarian Team to help ensure appropriate understanding and prioritization of health concerns and appropriate inter-sectoral/ inter-cluster action, when required. [CLA Rep.]

Participate actively in Cluster meetings and activities at national and local levels. Coordinate with local authorities and local health actors in the areas where working. Share information on the situation and own organization’s activities. Encourage local health actors to participate in relevant peripheral health coordination mechanisms, where such exist. Propose ways by which the Cluster can be more effective in supporting the delivering of health services in the field.

2. Coordination with national authorities & other local actors (3) See chapter 1

In coordination with the Humanitarian Coordinator, maintain appropriate links and dialogue with other national and local authorities, State institutions, local civil society and other relevant actors (e.g. local, national and international military forces, peacekeeping forces and non-State actors) whose activities affect humanitarian space and health-related programmes. [CLA Rep.]

Consult with the HCC/CLA concerning their own relations with key stakeholders in the field.

3. Needs assessment & analysis including identifying gaps[6] See chapter 3

4. Assess and monitor the availability of health services in the crisis areas provided by all health actors using GHC tool: Health Resources Availability Mapping System (HeRAMS).

5. Ensure that humanitarian health needs are identified by planning and coordinating joint, inter-cluster, initial rapid assessments adapting to the local context the IRA tool, as well as follow-on more in-depth health sub-sector assessments, as

Make CLA technical expertise and other resources available for cluster and inter-sectoral assessments, as required. [CLA Rep.] Participate actively in the analysis of available information on health status and risks, health resources, and health service performance, and the ongoing monitoring of these key aspects. [EHPM] Ensure the rapid establishment of an appropriate early warning and response system (EWARS) in

Participate in joint assessments and data analysis making staff and other resources available as required and possible. Provide regular monthly activity reports on the health services supported at all levels of care Collaborate in assuring prompt EWAR sentinel site reporting from the selected health facilities.

DRAFT PROVISIONAL VERSION

[Health Cluster Guide – draft provisional version, 30 Dec. 2008] 3

Functions Health Cluster Coordinator (HCC) 2 Cluster Lead Agency (CLA) 3 Cluster Partners/Partners 4

needed.

6. Mobilize Health Cluster Partners to contribute to establishing and maintaining an appropriate Early Warning and Response System, and regularly report on health services delivered to the affected population and the situation in the areas where they work.

7. Lead and contribute to the joint health cluster analysis of health-sector information and data (see points 3, 4, 5 and 6) leading to joint identification of gaps in the health sector response and agreement on priorities to inform the development (or adaptation) of a health crisis response strategy.

coordination with national health authorities. [CLA Rep./WHO]

4. Strategy development & planning [8], including: Community based approaches [4], attention to priority cross cutting issues [5], and filling gaps See chapter 4

12. Provide leadership and strategic direction to Health Cluster Members in the development of the health sector components of FLASH Appeal, CHAP, CAP and CERF proposals and other interagency planning and funding documents.

15. In a protracted crisis or health sector recovery context, ensure appropriate links among humanitarian actions and longer-term health sector plans, incorporating the concept of ‘building back better’ and specific risk reduction measures.

Participate actively in gap analysis, priority setting and the development of a health crisis response strategy and cluster action plan. Ensure that humanitarian responses build on local capacities and that the needs, contributions and capacities of vulnerable groups are addressed. [EHPM] Ensure that Cluster/sector plans take appropriate account of national health policies and strategies and lessons learned from, and incorporate appropriate exit, or transition, strategies. [CLA Rep./EHPM] Ensure that opportunities to promote recovery and appropriate re-building of the health system are identified and exploited from the earliest possible moment, and that risk reduction measures are incorporated in Cluster strategies and plans. [CLA Rep./EHPM]

Participate in the definitions of, and reaching broad consensus on, priorities and strategies, and in the elaboration of a health crisis response strategy and cluster action plan. Ensure that own organization’s project activities are in line with and contribute to the agreed health crisis response strategy and cluster action plan, and take appropriate account of priority cross-cutting issues. Plan/adapt own activities to contribute to filling identified gaps. Ensure that own organization’s project activities promote recovery from the earliest possible moment, and contribute to risk reduction, where possible

5 Contingency planning [7] See chapter 5

11. Lead joint Health Cluster contingency planning for potential new events or set-backs, when required.

Participate actively in cluster/inter-agency contingency planning and preparedness for new events or set-backs. [EHPM]

Conduct the joint contingency planning for possible future events/set-backs in the areas of operations with the other partners

6. Application of standards [9] See chapter 6

13. Promote adherence of standards and best practices by all health cluster partners taking into account the need for local adaptation. Promote use of the Health Cluster Guide to ensure the application of common approaches, tools and

Ensure that all Cluster partners are aware of relevant national policy guidelines and technical standards, and internationally-recognized best practices. [CLA Rep./EHPM] Where national standards are not in line with

Adhere to agreed standards and protocols and promote their adoption in the delivering of health services whenever possible

DRAFT PROVISIONAL VERSION

[Health Cluster Guide – draft provisional version, 30 Dec. 2008] 4

Functions Health Cluster Coordinator (HCC) 2 Cluster Lead Agency (CLA) 3 Cluster Partners/Partners 4

standards. international standards and best practices, negotiate the adoption of the latter in the crisis areas. [CLA Rep.]

7. Training and capacity building [12] See chapter 6

14. Identify urgent training needs in relation to technical standards and protocols for the delivery of key health services to ensure their adoption and uniform application by all Health Cluster partners. Coordinate the dissemination of key technical materials and the organization of essential workshops or in-service training.

Promote/support training of staff and capacity building of humanitarian partners, and support efforts to strengthen the capacities of the national authorities and civil society to assure appropriate, sustainable health services. [CLA Rep./EHPM]

Ensure that own staff are adequately trained for the activities undertaken Identify own training needs, make these known, and assign staff to attend trainings as and when opportunities are made available Collaborate in organizing training for staff of local health actors and other partners, making trainers and other resources available when possible

8. Monitoring and reporting (10) See chapter 9

Ensure partners’ active contribution to and involvement in joint monitoring of individual and common plans of action for health interventions; collate and disseminate this and other information related to the health sector in Cluster sit-reps and/or regular Health Bulletins.

Produce and disseminate Cluster sitreps and regular Health Bulletins using HCC input. [EHMP/Communications Officer] Advocate for donors to fund priority health activities of all Cluster partners. [CLA Rep.] Represent the interests of the health sector in discussions with the Humanitarian Coordinator and other stakeholders on priorities, resource mobilization and advocacy. [CLA Rep.]

Participate in defining and agreeing on any information and reports that Cluster partners should provide to the HCC, and provide such information and reports a timely manner. Contribute to overall Cluster efforts to advocate for appropriate attention to all public health needs (and humanitarian principles in general).

9. Advocacy and resource mobilization [11], including reporting See chapter 7

Provide information regularly to the news-media and represent the Cluster in contacts with the news-media – press conferences, interviews, etc. [CLA Rep./ Communications Officer]

Present own activities in the context of the overall health sector effort whenever possible and appropriate Emphasize the important of – and own commitment to – coordination and collaboration

10. Provider of Last Resort (13)

8. Inform the CLA Representative of priority gaps that can not be covered by any health cluster partner and require CLA action as provider of last resort.

Act as the provider of last resort (subject to access, security and availability of funding) to meet agreed priority needs. Inform the Humanitarian Coordinator and CLA’s own headquarters of resource needs and work with them to secure the necessary resources. [CLA Rep. /EHPM]

Notes: 1 In this first column, [#] = corresponding points in the generic TOR for CLAs 2 Once the cluster approach is activated and a country CLA designated, the CLA country representative and country office are responsible for fulfilling HCC functions to the maximum extent possible pending the designation and arrival of an assigned HCC.

DRAFT PROVISIONAL VERSION

[Health Cluster Guide – draft provisional version, 30 Dec. 2008] 5

Functions Health Cluster Coordinator (HCC) 2 Cluster Lead Agency (CLA) 3 Cluster Partners/Partners 4 3 The CLA Representative (CLA Rep.) is responsible for assuring that all these functions are satisfactorily fulfilled. Certain functions may be delegated to the CLA Emergency Health Programme Manager (EHPM) and other CLA staff, as indicated, but those marked [CLA Rep.] should be fulfilled by the CLA Representative personally or be delegated to the HCC. 4 Cluster partners would normally be represented in Cluster meetings by their country directors or emergency health programme managers 5 The 6 building blocks (or core components) of a health system are: leadership & governance; information; service delivery; human resources; medicines & technologies; financing [Source: Strengthening Health Systems to Improve Health Outcomes: WHO's Framework for Action, WHO, 2007].

= lead responsibility (the person finally accountable) for the set of activities defined in column 1.

Provision of Last Resort

Where necessary, and depending on access, security and availability of funding, the cluster lead, as provider of last resort, must be ready to ensure the provision of services required to fill critical gaps identified by the cluster. This includes gaps in relation to early recovery needs within the sector.

Where critical gaps persist in spite of concerted efforts to address them, the cluster lead is responsible for working with the national authorities, the Humanitarian Coordinator and donors to advocate for appropriate action to be taken by the relevant parties and to mobilize the necessary resources for an adequate and appropriate response. [IASC Operational Guidance on the Concept of “Provider of Last Resort”, Draft May 2008]

The “Provision of Last Resort” should be activated when:

1. the Health Cluster agrees that there is an important life-threatening gap in the Health sector response, and

2. one or more of the agreed benchmarks for the health sector response as a whole is not being met, and

3. evidence suggests that a significant proportion of the target population is at risk of avoidable death if the gap is not filled urgently.

Serving as provider of last resort is to be satisfied, and to have all partners satisfied, that all possible efforts have been undertaken to fill agreed priority gaps calling on additional local and international partners and advocating for additional donor commitment.

Participate in and contribute to monitoring progress and reviewing the effectiveness of the Cluster in supporting the health service delivery in the field.

GlobalHealth Cluster

IASCInter-Agency Standing Committee

Meeting 8-10 June 2009

Template for Panel Discussions on Country Cluster Implementation

Wednesday 10 June 9h15 - 11h30 The objective of these panel discussions is to explore cluster implementation in specific countries and to look at the successes and challenges and why they occurred. The aim is not to evaluate individual clusters but rather to look at what usually works well, what usually fails (and why?) and finally to look at what the GHC can do to further strengthen country cluster capacities to tackle the challenges they face. The panel will include a GHC partner representative with specific knowledge of the country cluster situation and the WHO regional advisor that covers the specific country. The panel discussion will NOT include general country background information or any context specific health issues; however, panel members are welcome to provide any pre-reading for meeting participants on the specific countries to be discussed. Panel members are not requested to prepare power point presentations as the session will be organised in the form of an interactive discussion between panel members and health cluster members. Please come prepared to answer each of these questions

1. To what extent did the cluster succeed in developing and documenting a cluster strategy and action plan? Did the cluster serve as an action-oriented coordination platform? Was it all inclusive or were major health partners absent? Describe successes and constraints and underlying reasons.

2. To what extent did the cluster succeed in jointly (and continually) assessing,

analyzing and prioritizing health needs? Was this process linked to inter-cluster processes? Describe successes and constraints.

3. To what extent did the cluster succeed in developing cluster-wide contingency plans?

Describe successes and constraints. 4. To what extent did the cluster succeed in developing and getting funding for joint

appeals (CERF, Consolidated appeal, pooled funds) based on a coherent cluster strategy and action plan? Describe successes and constraints. How did funding affect the functioning of the cluster? How did the functioning of the cluster affect funding?

5. How did the role of government vis a vis the cluster and the cluster lead affect the

functioning of the cluster? Was the cluster lead instrumental in facilitating contact with the government?

6. How did the HC and HCT affect the functioning of the clusters, and specifically the health cluster? Was there a pro-active and efficient inter-cluster coordination system established?

7. Did cluster partners feel defended, advocated for and supported by the cluster lead

agency representative vis a vis the HCT, the HC, the donors and the national authorities?

8. What would you say are the main three elements which the health cluster approach in

your country made possible or improved? What were the three main weaknesses of the health cluster approach?

9. What can the GHC do to further strengthen country cluster capacities to tackle the

challenges they face?

Countries applying the Cluster Approach

Protracted emergency countries with Humanitarian Coordinators

Formally implemented To be implemented

1. Afghanistan ● 2. Burundi ● 3. CAR ● 4. Chad ● 5. Colombia ● 6. Cote d’Ivoire ● 7. DRC ● 8. Eritrea ● 9. Ethiopia ● 10. Georgia ● 11. Guinea ● 12. Haiti ● 13. Indonesia ● 14. Iraq ● 15. Kenya ● 16. Liberia ● 17. Myanmar ● 18. Nepal ● 19. Niger ● 20. OPT ● 21. Somalia ● 22. Sri Lanka ● 23. Sudan ● 24. Timor-Leste 25. Uganda ● 26. Zimbabwe ●

IASC criteria for cluster roll out: countries with Humanitarian Coordinators and countries faced with major sudden onset crises

Protracted emergencies, countries with Humanitarian Coordinators (in chronological order of implementation)

Major sudden onset emergencies, countries with Resident Coordinators (in chronological order of implementation)

Somalia 2006* Pakistan (earthquake) October 2005

DRC 2006* Lebanon (war) July 2006

Liberia 2006* Philippines (floods) January 2007

Uganda 2006* Pakistan (floods) July 2007

Colombia 2006* Mozambique (floods) February 2007

Indonesia May 2006 Madagascar (floods) May 2007

Ethiopia April 2007 Dominican Republic (tropical storm) November 2007

Chad June 2007 Bangladesh (cyclone) November 2007

CAR July 2007 Tajikistan (cold weather) February 2008

Guinea December 2007 Ecuador (floods) March 2008

Cote D'Ivoire February 2008 Honduras (tropical depression) November 2008

Zimbabwe February 2008 Pakistan May 2009

Kenya March 2008

Myanmar May 2008

Afghanistan June 2008

Iraq September 2008

Georgia September 2008

Haiti October 2008

Nepal October 2008

Burundi December 2008

Sudan January 2009

Sri Lanka January 2009

Timor Leste January 2009

Occupied Palestinian territory January 2009

*Early 2006, IASC pilot countries.

Progress reportProgress reportWorking Group Guidance Working Group Guidance

and Tools and Tools

SessionSession• Progress• Outstanding work-plan and priorities• Dissemination, implementation and

evaluation of tools and guidance• Next steps

InitialInitial Rapid Assessment Rapid Assessment ToolTool

• Tool finalised following testing Kenya, Darfur, Uganda

• Supportive software completed• Field tested already in final form- Namibia• Field testing/evaluation process- WASH,

Nutrition • Promoting harmonisation and alignment

within GHC and across cluster• Building on existing tools for common

needs assessment

HeRAMSHeRAMS• Checklist and data entry form finalised• Synergies and linkages with IRA

• Used in Sudan, OPT in final formLessons still being collated. Clearly illustrated where gaps and priorities were inSudan

Outstanding:• Supportive software will be finalised in 3 weeks.

Health Cluster Guide Health Cluster Guide • Provision field guide FINALISED• 3/52 3000 copies in English, 1500 in

French. In addition to the electronic copy

• CD ROM containing all key reference documents, tools and guidance

Work planWork plan• Dissemination, Implementation and

Evaluation (DIE!)• HR limitations- funding for only one

post secured- requires focus• Prioritisation essential • Partner engagement and

commitment CRITICAL• Collaboration with WG CS

Microsoft Word Document

Dissemination, Implementation Dissemination, Implementation and Evaluationand Evaluation

• GHC– Launch– IASC website– Letter– CS activities and training

• Partners-– Mapping and opportunities

• Evaluation strategies– Acceptability, utility, impact.– Phase 1- process ; Phase 2- utilisation and impact – Adaptation- documenting and lessons learned

• Review 2010 Q2

Next StepsNext Steps-- combining combining forces and resourcesforces and resources

Pros• Work plan involves

dissemination through WG CS

• Production of G and T finished, no new tools planned

• Overlap in objectives with CS

• Get focus through task teams

Cons• Will we get enough focus

on all aspects of DIE in broader group

• Risk of competing priorities for Patricia Kormass

• Would we get drop out? Need to ensure critical mass and balance from both groups

•Proposition to merge WG GT and CS.

Moving ForwardMoving Forward

• Consensus to merge but with clearly defined process, review priorities roles and responsibilities

• Balanced representation in group and co-chair

• Budget remains aligned to TOR and workplan.

IssuesIssues• Focus for Patricia’s role• Commitment of partners• Improving decision making and

communication

UPDATE ON CLUSTER IMPLEMENTATION AT COUNTRY LEVEL - GHC Meeting, Geneva, June 2009

Countries Number of health partners

Needs Assessment and Analysis

Preparedness/ Contingency Plan

Strategy/ Work plan

Training and Capacity Building

Main funding mechanism(s)

Key Issues

AFRO Cluster Countries

CAR

45 total (24

huma- nitarians, 21 other)

Yes

Yes

Yes

No

- Common Humanitarian Fund (CHF) - CERF - CAP/Flash Appeal

- Health cluster activities have been decentralized with plan of action supported by the field sub-offices. - WHO support MOH Hospital plan for casualty management. - Maintaining WHO international presence in Bangui, Bossangoa sub-office, and Ndele sub-office. - Plan to open two more sub-offices in Bouar and Bambari.

CHAD 24 Yes Yes Yes No - CAP - CERF - ECHO

- Main focus on crisis in the east, the south remains a neglected crisis.

1

Countries Number of health partners

Needs Assessment and Analysis

Preparedness/ Contingency Plan

Strategy/ Work plan

Training and Capacity Building

Main funding mechanism(s)

Key Issues

CDI 22 Yes No Ongoing Yes - CAP

- Office needs strengthening in Bouake sub office. - Resource mobilization becomes huge challenge as the country is portrayed to be" less poor" and the crisis almost over.

Democratic Republic Of Congo

42 Yes Yes (provincial) Yes Yes

- HAP (Pooled Fund) - Donors - ECHO

- Sustaining a network of 12 sub-offices in DRC with international presence in Kinshasa, Bukavu and Bunia (Ituri). - Mediating between MOH, Health Cluster and Donors (GIBS). - A dedicated health cluster coordinator is being recruited. (A temporary HCC has been deployed.)

2

Countries Number of health partners

Needs Assessment and Analysis

Preparedness/ Contingency Plan

Strategy/ Work plan

Training and Capacity Building

Main funding mechanism(s)

Key Issues

Ethiopia 30 Yes Yes Yes Yes - CERF - Donors

- Currently mass immunization for meningitis and measles ongoing with partners. - Challenge to decentralize international presence in vulnerable areas (also in Ogaden).

Kenya 50 Yes Yes Yes No - Flash appeal

- WHO support the MOH in the North East (together with UNHCR). - Backup offices for South Sudan and Somalia.

Guinea 20 Yes Yes Yes Yes

- CERF - West Africa -CAP - Partnership with some States and donors

- The national policy on emergencies with related strategic plan and operational plan have been updated and adopted. - A ORSEC plan or Rescue plan for Conakry is available. - The health cluster has to provide support for the regional emergency plans

3

Countries Number of health partners

Needs Assessment and Analysis

Preparedness/ Contingency Plan

Strategy/ Work plan

Training and Capacity Building

Main funding mechanism(s)

Key Issues

elaboration and implementation. - There are challenges to improve and fund the two sub-offices in Nzerokore and Kissidougou. - Contributing with efficacy to the joint UN, government, NGOs and others partners’ recovery & transition programme for the forester Guinea, to prevent yellow fever, meningitis and cholera big epidemics by reinforcing local capacities.

Liberia 22 Yes Yes Yes No

- CHAP was completed in early 2008. - Advocacy paper for residual humanitarian needs developed in

- Resources for pooled fund. - Poor communication between National and County MoH. - Huge gaps in supply chain / weak management at

4

Countries Number of health partners

Needs Assessment and Analysis

Preparedness/ Contingency Plan

Strategy/ Work plan

Training and Capacity Building

Main funding mechanism(s)

Key Issues

March 2009. county level. - Maternal and newborn deaths. - Human resources problem. - Vertical uncoordinated programs like malaria/HIV. - National Health Policy (2006-2010), Mental health policy, Reproductive health policy, Human resource plan.

Uganda 30 Yes Yes Yes Yes - CAP

- WHO is present in 5 field offices to support the government in: coordination of different partners, conduct regular assessments, filling critical gaps, capacity building, development of guidelines, monitoring of disease outbreaks; - Health Sector recovery strategy.

5

Countries Number of health partners

Needs Assessment and Analysis

Preparedness/ Contingency Plan

Strategy/ Work plan

Training and Capacity Building

Main funding mechanism(s)

Key Issues

Zimbabwe 12-15 No No

Yes, a health cluster cholera response plan was developed but a general cluster strategy and work plan does not exist

Yes, a health cluster training was conducted at the inception of the cluster

- 2 years funding for dedicated cluster lead secured from ECHO. - Cluster activities currently being funded through the cholera epidemic funds(CERF, DFID, USAID).

- The cluster needs to be decentralized to a few strategic provinces to ensure more effective health coordination on the field.

- The activities of the cluster are still centralized in Harare and mainly focused on the cholera epidemic outbreak in the country. - The 2009 CAP midyear review has been completed. - A dedicated health cluster coordinator is being recruited. (A temporary HCC has been deployed.)

- The recruitment of the cluster coordinator needs to be fast tracked to ensure full functionality and more visibility of the cluster.

6

Countries Number of health partners

Needs Assessment and Analysis

Preparedness/ Contingency Plan

Strategy/ Work plan

Training and Capacity Building

Main funding mechanism(s)

Key Issues

PAHO/AMRO Cluster Countries

Colombia 33 Yes

(Document in Spanish)

The preparedness/contingency plan is done in the frame of this group, but inside the UN Emergency Team, UNETE. The focus is on disaster (pandemic, earthquake, natural disasters). Includes a chapter on business continuity.

Yes (Website in Spanish)

Yes

- AECID - BPRM - CERF - CIDA - ECHO - USAID

- The lack of state support for some categories of affected population, including those displaced by fumigation against coca leaves. - The magnitude and growing trend of acute needs. - The lack of perception of the international community of the gravity and acuteness of the situation. - Link between emergency and transition.

Haiti 18 Yes Yes Yes Yes

- CERF - CIDA - SIDA - OFDA In response to Flash Appeal

- National plan and Preparedness plan to be adapted regarding use of financial emergency mechanisms and evaluation tools.

7

Countries Number of health partners

Needs Assessment and Analysis

Preparedness/ Contingency Plan

Strategy/ Work plan

Training and Capacity Building

Main funding mechanism(s)

Key Issues

- Weak Supplies management. - Delay in cold chain restoration in health centers. - Concentration of activities in Gonaive and partial national coverage. - Transportation issues for logistic support only partially resolved by WFP and MINUSTAH.

SEARO Cluster Countries

Sri Lanka 8 Yes Yes Yes Yes - CHAP

- Increased risk of outbreak of communicable diseases including vector-borne diseases like Malaria, Dengue due to difficulties in implementing control measures and poor living conditions of IDPs.

8

Countries Number of health partners

Needs Assessment and Analysis

Preparedness/ Contingency Plan

Strategy/ Work plan

Training and Capacity Building

Main funding mechanism(s)

Key Issues

- Health services in Vanni have been affected due to closure of health facilities, lack of human resources, shortage of fuel for transportation and generators for functioning of hospitals and maintaining of cold chain for vaccines, and shortage of some medicine. - UN and NGO’s have left the Vanni (LTTE controled areas) due to security reasons and do not have direct access to the IDPs and host communities in those areas.

Myanmar 35

Post Nargis Joint Assessment (PoNJA) done in June 2008. Follow up

TCG lead Post Nargis Recovery and Preparedness Plan (PoNREPP) ongoing.

Joint Plan of Action was prepared in July 2008.

Yes

- CERF - Revised Flash Appeal

- Township level cluster coordination. - Funding constraints for early recovery activities. - Phasing out of health partners from

9

Countries Number of health partners

Needs Assessment and Analysis

Preparedness/ Contingency Plan

Strategy/ Work plan

Training and Capacity Building

Main funding mechanism(s)

Key Issues

Periodic Review ongoing.

cyclone affected areas due to various reasons including funding, difficulty in maintaining human resources, completion of relief activities.

Nepal

35

(25 health, 5 nutrition, 5 health and nutrition)

Yes

Yes

Yes Yes

- CERF - WHO SEAHREF - Other donors(Korean, WB, etc.)

- Limited field presence of EHA remain key challenge for ground level coordination.

- WHO continue coordinating, supporting and monitoring the response activities with MoH and population.

- Further need to establish a mass casualty management system in country, including: training of key health workers and communities, provision of key equipments and supplies, a guideline for dead body

10

Countries Number of health partners

Needs Assessment and Analysis

Preparedness/ Contingency Plan

Strategy/ Work plan

Training and Capacity Building

Main funding mechanism(s)

Key Issues

Management. - Most of the health partners work in specific districts on specific health issues (i.e. RH issues etc), as such there is a limited number of agencies that are able to provide a national level guidance to the direction of the health cluster. - Need to establish a means to work in collaboration with the government level coordination mechanism (Disaster Health Working Group, chaired by the DG of MoHP) - Need to further strengthen the government counterparts for ground level coordination - Limited resources,

11

Countries Number of health partners

Needs Assessment and Analysis

Preparedness/ Contingency Plan

Strategy/ Work plan

Training and Capacity Building

Main funding mechanism(s)

Key Issues

especially for emergency preparedness, is leading to key partners closing down their operations in country

Timor-Leste 20

Needs assessment and analysis was conducted by the Health Coordination Group in 2006 in relation to the internal conflict, starting in March 2006 (about 100,000 IDPs). The IDPs are gradually being resettled into the

- Only for Wet Season Preparedness Plan. - Contingency Plans are only available for: Flooding, Drought and Conflicts.

- Strategy for health sector emergency preparedness and response is not updated. - Work plan of Health Cluster does not exist. - Most agencies have own plans; but no coordinated health cluster plan for emergency preparedness and

- Training to health staff are provided, especially for the Rapid Response Team on Communicable Disease Control, Surveillance, disease investigation and response (interventions). - A few MoH staff, and development partners have been trained on disaster related topics

- CAP - Donors

- Since 2006 the MoH is the leading agency for health coordination with the technical and secretariat support of WHO. - Some meetings on broad coordination mechanisms and cluster approach have been conducted by OCHA under the leadership of the Humanitarian Coordination Committee (HCC). - The decision on activating the cluster approach will be taken soon.

12

Countries Number of health partners

Needs Assessment and Analysis

Preparedness/ Contingency Plan

Strategy/ Work plan

Training and Capacity Building

Main funding mechanism(s)

Key Issues

community. The focus is on the recovery and development phase.

response, except the Wet Season Preparedness Plan, which is updated every year.

abroad. - A topic on Disaster Management was delivered as part of the Management & Leadership training attended by all the Director and Deputy of the District health Services & the manager of Community Health Centre in Timor-Leste.

EMRO Cluster Countries

Afghanistan 14 Yes No No No - CERF - HAP

- A dedicated health cluster coordinator is in place.

13

Countries Number of health partners

Needs Assessment and Analysis

Preparedness/ Contingency Plan

Strategy/ Work plan

Training and Capacity Building

Main funding mechanism(s)

Key Issues

Iraq 17 and

3 obser-vers

Yes (in

preparation of CAP 2009)

Under development Yes Yes - UNDG ITF - CAP

- Disease specific plans (cholera, pandemic influenza, polio, measles).

Occupied Palestinian territory (oPt)

Approx. 30 active

Yes (Feb 2009 - Gaza; being

updated currently)

Yes - being updated

PA early recovery plan

for Gaza provides

framework

Yes - as Part of some

health projects

- CAP - ECHO

- Relationship with MoH in Ramallah and Gaza. - Relation to pre-existing coordination mechanisms run by MoH. - Access restrictions prevent implementations of many projects in Gaza. - Health Cluster was very active during the Gaza conflict. - A dedicated health cluster coordinator has been recruited.

14

Countries Number of health partners

Needs Assessment and Analysis

Preparedness/ Contingency Plan

Strategy/ Work plan

Training and Capacity Building

Main funding mechanism(s)

Key Issues

Pakistan 22

(3 UN, 19 NGO)

Yes Yes Yes Yes - PHRP

- ONE UN pilot - 3 major emergencies in 1 year, (flood, IDP, EQ) - MOH capacity to be developed for coordination at all levels

Somalia 24 Yes Yes Yes Yes - CAP

- Cluster leadership is decentralized according to capacity in the localities.

Sudan (North)

65 approx. Yes Yes Yes Yes

- UN Work Plan - CHF

- Situation differs between Darfur and Transitional Areas. - Main issue in Darfur conflict. - More partners in Darfur than in TAs. - Cluster in process of implementation. - Global Inter Cluster Mission about to start. - A dedicated health cluster coordinator is being recruited.

15

16

Countries Number of health partners

Needs Assessment and Analysis

Preparedness/ Contingency Plan

Strategy/ Work plan

Training and Capacity Building

Main funding mechanism(s)

Key Issues

Sudan (South)

8-20 (depen- ding on

the State)

Yes Yes Yes

CD training are

coordinated with partners

- UN Work Plan

- Main focus in South Sudan is CDC.

EURO Cluster Countries

Georgia 47

Planned on mental health with MoH.

Under preparation with other UN Organizations. Yes

In cooperation with MoH for rescuers, PHC staff and health administration.

- HAC - CERF - FA - JNA

- Provision of health care services to IDPs. - Particular focus on mental health in emergencies.

Tajikistan 31 Yes Yes Yes No

- CERF - CAP - ECHO - SDC

- Response and preparedness to natural disasters (currently flooding). - MoH is engaged in cluster. - Need to encourage NGOs to engage more, - Training for health personnel needed.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

JanS S S S S S S S S

FebS S S S S S S S

MarS S S S S S S S S

AprS S S S S S S S

MayS S S S S S S S S S

JunS S S S S S

JulS S S S S S

AugS S S S S S S S S S

SepS S S S S S

OctS S S S S S

NovS S S S S S S S S

DecS S S S S S S S

HCC training: PAHO

NGO cluster workshop

GHCMeetingNairobi

HCC best practices workshop

JCM 1 (TBC)

JCM 2 (TBC)

JCM 3 (TBC)

GHCMeetingGeneva

Disrupted Health Systems Course15-26 June

HCC training AFRO (TBC)

GHC Member Holiday

HCC training SEARO/WPRO(TBC)

GHC Activity

Global Health Cluster Calendar 2009

WHO EB

WHO WHAWHO WHA

WR Workshop26 Apr-2 May

WHO EB

WHO EB

EXECUTIVE SUMMARY In response to identified gaps in the humanitarian system, the UN Humanitarian Reform agenda was introduced in 2005 that included as key components both the strengthening of partnerships among humanitarian actors and the implementation of the cluster approach. The core of this approach is grouping Inter-Agency Standing Committee (IASC) member agencies into clusters composed of UN agencies, non-governmental organizations (NGOs), and other stakeholders to work together to address specific areas of responsibility (e.g., health, nutrition, water, sanitation and hygiene, etc.). The IASC cluster approach includes goals such as improved humanitarian coordination and response, as well as more effective partnerships between UN and non-UN actors. The World Health Organization (WHO) is the designated lead agency of the Health Cluster, which at the global level comprises representatives of 31 UN agencies and NGOs. The Global Health Cluster’s mission states: 'Build consensus on humanitarian health priorities and related best practices, and strengthen system-wide capacities to ensure an effective and predictable response'. As one of the pillars of the humanitarian community, NGOs play a vital role in the clusters. Early evaluations of the cluster approach as well as recent Health Cluster missions, however, indicate a wide knowledge gap about the cluster process and humanitarian reform among NGOs. As essential partners within the clusters, it is critical that active steps be taken to close this gap and better prepare NGOs for their participation at the country level. A decision was made by the Global Health Cluster members to provide a learning opportunity for NGO partners through participation in a three-day workshop for key emergency management staff within their agencies.

NGO Health Cluster Partner Workshop

Hammamet, Tunisia 28-30 January 2009

Health Cluste WORKSHOP REPORT

Global r

IASCInter-Agency Standing Committee

WORKSHOP SUMMARY On behalf of the Global Health Cluster (GHC), International Medical Corps (IMC) organized the first NGO Health Cluster Partner Workshop, 28-30 January in Hammamet, Tunisia. Nine key partner NGOs represented by 23 emergency managers based in organizations' country and regional offices, as well as their headquarters, attended the three-day workshop. The goal of the workshop was to build institutional capacity within NGO partner agencies and to facilitate increased NGO participation at the country levels. The learning was related to the humanitarian reform process as well as the specific workings of the Health Cluster at both the global and country levels. Presentations and discussions focused on cluster functions, the roles and responsibilities of the Cluster Lead Agency (CLA), the Health Cluster Coordinator (HCC) and cluster partners; identifying gaps through assessments using tools developed by the GHC such as the IRA 1 , tracking available services with HeRAMS 2, and the expected role of the Health Cluster Coordinator and partners in each; the Health Cluster Guide and its use to them; the Principles of Partnership and their practical use in-country and building trust as a basic foundation; strategic planning and project prioritization; key documents for visibility (Flash, HAP, CHAP, CA) vs. fund raising mechanisms (CERF, pooled funds, donors); and the skills and attitudes required for clusters to work. Participants demonstrated their increased understanding in these areas by identifying many of the benefits of the cluster approach (unified and influential voice, maximizing resources, wider service coverage, improved quality of interventions, funding opportunities, visibility to partners and projects) and the costs (opportunity costs of staff and resources, process suffocating action, vulnerability to

1 Initial Rapid Assessment (IRA) tool aims to enable faster and better multi-sector rapid assessment in the first few days of a sudden-onset crisis in order to guide the initial planning of urgent humanitarian interventions, identify needs for follow-up assessments, and inform initial funding decisions. 2 Health Resources Availability Mapping System (HeRAMS) to be used throughout the duration of crises for the collection, collation, and analysis of health sector information for each facility, mobile clinic, or site with community-based interventions in order to monitor the availability of resources.

competition, perceived loss of neutrality and independence, too many meetings) and how to increase the benefits (speaking up, being engaged, using HeRAMS and the IRA to be more efficient and save time, get donors involved in partnership to reduce competition and increase transparency, and hiring qualified and trained HCC) and how to decrease the costs (having effective HCC, ensuring the application of PoP, making more use of the unified voice).

The outcome of the workshop, in addition to learning, sharing and increasing mutual understanding, was an organizational action plan by each participating NGO for increasing its understanding of and engagement in the cluster approach. These plans included proposing a written policy about the commitment, internal trainings with GHC support, modified internal job descriptions, and internal manual revisions. The workshop was considered a success by both the resource team as well as the participants. Participants evaluated the workshop through individual participant assessments against the workshop objectives (pre- and post- workshop) and a group exercise in which individuals provided feedback on the workshop. Results of the self-assessment illustrated significant progress against all workshop objectives. The workshop also proved to be a valuable opportunity for the GHC to listen to NGOs expressing their needs and making suggestions for the future of partnerships and cluster work.

WEDNESDAY, 28 JANUARY, 2009-06-26 OPENING REMARKS Eric Laroche, Assistant Director-General, Health Action in Crises, WHO Dr Laroche sent his apologies since he was unable to attend the workshop due to the on-going crisis in Gaza. Ms Erin Kenney conveyed his messages, which are summarized here below. The cluster approach is about pulling together our various competencies and comparative advantages to provide the best possible care and services to populations affected by crises in a coherent and complementary manner—whether during acute natural disasters or protracted man-made complex emergencies. NGO partners have a key function in the cluster and the success of the cluster lies in setting common goals and working united towards them. The workshop attendance shows that the NGO partners are committed to the cluster approach and to the work of the Global Health Cluster and are ready to take this commitment seriously and to work together for a better response in emergencies that will ultimately alleviate the suffering for those burdened by disaster and conflict. HUMANITARIAN REFORM AND THE CLUSTER APPROACH Gwen Lewis, OCHA Health Cluster Guide Reference: Chapter 1 Ms Lewis explained that the Humanitarian Reform was the result of an aim to build a stronger, more predictable humanitarian response. Through enhanced coordination, the international humanitarian community would reach more beneficiaries, with more comprehensive, needs-based relief and protection, in a more effective and timely manner. The reform consists of three pillars: Improved Financing, Strengthened Leadership from Humanitarian Coordinators and better and more predictable response through the Cluster Approach. There are 11 clusters (or sectoral groups): Agriculture, Health, Camp Coordination/Management, Logistics, Early Recovery, Nutrition, Education, Protection, Emergency Shelter, Water Sanitation Hygiene, Emergency Telecommunications.

And four cross-cutting issues that need to be taken into consideration and be included in the work of all clusters:

Age – Ensuring that the needs of older people are accounted for when responding to an emergency;

Environment – Disasters and conflicts, as well as relief and recovery operations, impact the environment in ways that threaten human life, health, livelihoods, and security. Failure to address these risks can undermine the relief process, causing additional loss of life, displacement, aid dependency, and increased vulnerability;

HIV/AIDS – During emergencies, vulnerability to HIV infection may be increased due to the loss of livelihoods and the disruption of family and social networks and institutions; and

Gender – Humanitarian actors must design programmes to meet the needs of young and old, male and female, and ensure that all have safe and equal access to humanitarian assistance.

Ms Lewis underlined that the Humanitarian Reform has now become 'the way we do business'. She noted that the responsibility of the Cluster Lead Agency is to be the "first port of call and the provider of last resort". Principles and good practices of humanitarian donorship form part of the Good Humanitarian Donorship (GHD) initiative.

PARTNERSHIPS; PRINCIPLES & PRACTICE Mary Pack, Vice President for Domestic and International Affairs, International Medical Corps Health Cluster Guide Reference: Page 23- 27 Ms Pack introduced the Global Humanitarian Platform—a forum bringing together the three main families of the humanitarian community: NGOs, the Red Cross and Red Crescent Movement, and the United Nations and related international organizations, working towards the common goal of enhancing the effectiveness of humanitarian action. One of the outcomes of the Global Humanitarian Platform meeting in June 2006 was the endorsement of the "Principles of Partnership," which has become a foundation for

the pillars of the Humanitarian Reform. The PoP were developed to work towards a common understanding of the concept of partnership and to serve as a support for the non-UN partners affected by Humanitarian Reform. The principles are: Equality: Equality requires mutual respect between members of the partnership irrespective of size and power. Transparency: Transparency is achieved through dialogue (on equal footing), with an emphasis on early consultations and early sharing of information. Result-oriented approach: Effective humanitarian action must be reality-based and action-oriented. Responsibility: Humanitarian organizations have an ethical obligation to each other to accomplish their tasks responsibly, with integrity and in a relevant and appropriate way. Complementarity: The diversity of the humanitarian community is an asset if we build on our comparative advantages and complement each other’s contributions. Ms Pack challenged the group by stating that the implementation of the PoP requires a change of culture and that they should be integrated in the work of the cluster and of all its partners. GLOBAL HEALTH CLUSTER Erin Kenney, Global Health Cluster Secretariat, HAC/WHO Health Cluster Guide Reference: Page 23- 28 Ms Kenney focused on the Global Health Cluster (GHC), a valuable inter-agency forum made up of key international humanitarian health entities with vast experience that has significant influence in many global forums. She described the GHC's mandate to build global humanitarian response capacity in health by developing common guidance and tools, surge systems, and global partnerships. Ms Kenney underlined that the GHC does not have the function of providing operational support to country clusters directly, but rather puts in place the systems and capacities that can provide that support at any given time. As global cluster lead agency, WHO at the regional and HQ levels work to support the country cluster lead agency. Ms Kenney explained the link between the GHC and the country clusters. She explained that the country clusters tap the resources of the GHC through communications between the country cluster lead agency (usually WHO) and the

global cluster lead agency (WHO) at regional and HQ levels. The group flagged the following issues in the subsequent discussion: What are the practicalities of partnership? Ms Pack said that partnerships are strengthened by working together within the GHC on its work plan. She also said that the participants' participation in the workshop is a result of the PoP and their organizations' commitment to partnerships. Participants suggested a need for more non-UN agencies in the GHC. The question was raised if southern-based NGOs are welcomed in the GHC. Participants wanted to know what the GHC is doing to build country capacity. The difficulties of "double hatting" were raised. The HCC is coordinating the cluster but is answering to the WHO Representative…so what is the HCC's primary commitment? And what if the HCC is also holding another job within the WHO office? WHO supports the goal of a dedicated HCC rather than double hatting. The HCC is a staff member of the cluster lead agency (either from within, on loan or seconded from another agency) that enables the cluster lead agency to fulfill its obligations to the country cluster. The HCC reports to the country cluster lead agency representative, but must maintain impartiality while implementing cluster functions. There was a discussion about the role of communities and governments within the cluster approach. Are they partners? On equal terms? How do we include them in the cluster discussions? The health cluster lead agency must lead the international health response in support of the national priorities and efforts; so while the government is the ultimate partner to the cluster, it is not usually considered as a partner within the cluster. IASC guidance is currently being developed on this subject. ROLES, RESPONSIBILITIES, AND STRUCTURE Nevio Zagaria, Coordinator, Recovery and Transition Programmes, HAC/WHO Health Cluster Guide Reference: Page 28- 38 Dr Zagaria presented the architecture of the cluster approach: the lines of reporting and the relationship between the HCC, the Cluster Lead

Agency (CLA), the Humanitarian Coordinator (HC), and the Humanitarian Country Team (HCT) in countries in emergencies. He underlined that the role of the HCC is to ensure the effective functioning of the Heath Cluster while promoting and upholding the Humanitarian Principles and the Principles of Partnership, in order to achieve an optimal response

of the health sector to a humanitarian crisis. He challenged the group by stating that the cluster approach might require a move from coordination of actors to real partnership. Dr Zagaria also introduced the RASCI (Responsible, Accountable, Support, Consulted, and Informed) diagram:

Functions 1 Health Cluster Coordinator (HCC)

Cluster Lead Agency (CLA) Cluster Partners

1. Coordination mechanisms and inclusion of key actors within the Health Cluster and inter-cluster [1+2]

R, I A R, C, S, I

R S, C, I

2. Relations with other key stakeholders [3]

R A, C R, C

3. Needs assessment [10a], situation monitoring & analysis [6] including identifying gaps in health response

R A S, R

4. Strategy development & gap filling [8], [4], [5]

R A S

4a. Provider of last resort [13] A

5. Contingency planning [7a] R A, R R

6. Application of standards [9] R, C, I A, S, C, I R, S, C, I

7. Training and capacity building [12], including emergency preparedness [7b]

R, C, I A, S, C, I R, S, C, I

8. Advocacy and resource mobilization [11], including reporting

A, R R R

9. Communication and media relations [10b]

R A, R C

RESPONSIBLE Those who do the work to achieve the task. There can be multiple resources responsible.

ACCOUNTABLE The person/people ultimately answerable for the correct and thorough completion of the task.

SUPPORT Those who may help in the task. CONSULTED Those whose opinions are sought. Two-way communication.

INFORMED Those who are kept up-to-date on progress. Two-way communication.

This helps to think about and illustrate the roles and responsibility of the HCC, CLA, and cluster partners in the country clusters. The participants articulated that NGOs are accountable for more things than what appears in the RASCI diagram, they are accountable to other organizations, donors, and beneficiaries. A discussion followed about 'what is accountability?' and 'to whom are we first and foremost accountable?' Participants expressed the idea that if NGOs are not accountable, then they cannot also be real partners. Dr Zagaria summarized the discussion by stating that we are first and foremost accountable to our beneficiaries. The question regarding relationship to donors came up in the discussion: ‘Are the donors partners to the Health Cluster or a partner in the cluster?’ There is no clear answer to this question. This varies from country to country and from donor to donor. In most cases, donors would be partners to the cluster rather than within the cluster, as they would not have specific responsibilities for implementing activities on the cluster action plan. Thursday, January 29, 2009 EXPERIENCE SHARING, CHRONOLOGY OF A CLUSTER Sophia Craig, Health Cluster Coordinator, Afghanistan, WHO Health Cluster Guide Reference: Page 39- 43 and Chapter 4 The participants were divided into groups depending on experience and knowledge of the cluster approach. The groups received the following scenarios and were asked to put the tasks in order and also to give an implementation time frame for each task. Scenarios: Liberia (Outbreak of Lassa fever) Myanmar (Response to cyclone) Zimbabwe (Cholera outbreak) Afghanistan (Chronic health emergencies due to protracted conflict) Pakistan (Earthquake) Tasks (in alphabetical order): Agreement on priority areas (geographic and health concerns) Analysis of context (opportunities and constraints) Analysis of health problems and risks Analysis of resources and services Definition of objectives

Finalization of Health Crises response strategy Identification of response options and selection of activity level response strategies List of critical gaps in health services Prioritized list of health problems and risks Ms Craig, who has solid experience in crisis management, affirmed that in a rapid-onset crisis many tasks will be done simultaneously; it is therefore important to be prepared before a crisis strikes, to be involved in the cluster and to have an action plan. She also underlined that the timeline varies markedly depending on the nature of the crisis and the political climate in the country. ASSESSING, ANALYZING, AND IDENTIFYING PRIORITIES Sophia Craig, Health Cluster Coordinator, Afghanistan, WHO Nevio Zagaria, Coordinator, Recovery and Transition Programmes, HAC/WHO Health Cluster Guide Reference: Chapter 4 Ms Craig underlined the importance of making assessments in order to identify needs and to give the appropriate response in an emergency. Dr Zagaria introduced the Initial Rapid Assessment Tool (IRA) developed by the Health, Nutrition, and WASH clusters to be used in the initial phase of an emergency or in newly accessible areas in an ongoing emergency situation. It aims to enable faster and better multi-sector rapid assessment in the first few days of a sudden-onset crisis in order to guide the initial planning and prioritization of urgent humanitarian interventions, to identify needs for follow-up assessments, and to inform initial funding decisions. He also introduced the HeRAMS, a tool to be used to map 'Who is doing What, Where' in an emergency, as well as the resources and services available in any given location. The tool covers levels of care, sub-sectors, and services, by point of delivery. WHO is committed to train HCC to use these tools and to integrate the tools into the organizations' work at country level. Dr Zagaria encouraged the participants to contact him if they were interested in receiving more information on the tools. STRATEGIC ACTION PLAN

Sophia Craig, Health Cluster Coordinator, Afghanistan, WHO Health Cluster Guide Reference: Chapter 5 Ms Craig introduced the idea that each cluster should develop a Health Crisis Response Strategy, which is a concise statement of how the cluster/sector will seek to contribute to the overall goal of reducing mortality, morbidity, and disability and restoring the delivery of, and equitable access to, preventive and basic curative care as quickly as possible and in as sustainable as possible manner. She stressed the importance of strategic planning to improve access to and quality of humanitarian aid for beneficiaries, to establish goals and measurable outcomes, and to avoid duplications within the cluster and with other clusters' activities. The development of the strategy involves: analysis of the context and relevant sector information; value judgments; “a lot of political wisdom” in ensuring that the perspectives of major players are reflected both in the process and in the final strategy. The HCC is responsible for ensuring that cross-cutting issues are included. HEALTH CLUSTER FUNDING AND RESOURCE MOBILIZATION Cristina del Pueyo, Technical Officer, External Relations HAC/WHO Health Cluster Guide Reference: Chapter 7 Ms del Pueyo stated that country level inter-agency mechanisms such as Flash Appeals or Consolidated Appeals are very important for stating sector plans and for the visibility of agencies and organizations within the sector. She encouraged all partners to make sure that their plans and budgets are included in these inter-agency documents. However, Ms del Pueyo explained that such documents do not raise funds. Fundraising is a separate process that must be done by all actors to gain funding against a Flash or CA. Fundraising (like a visit to the bank) is accomplished through visits to donors, CERF applications, or pooled funds, for example. Ms del Pueyo touched on the different appeal mechanisms that give visibility to the organizations and to their projects; and the responsibility of the HCC in the appeal process: FLASH - tool to structure a coordinated humanitarian response, duration: 6 months. HCC ensures the preparation of this health sector response plan. CAP - a longer version of FLASH - duration up to 12

months. HCC ensures the preparation of this health sector response plan. CHAP/HAP - overview of priority needs and response strategy in a country for the cluster/sector. HCC ensures the preparations of the CHAP/HAP. Pledging conferences - the HCC invites donors to a forum so that partner organizations can present their projects. Subsequently, Ms del Pueyo identified the funding sources that each partner must tap ("the bank"): Pooled Funds: Funds that are donated by donors and managed by a third party. They are delegated to Humanitarian Coordinators (HCs) and country teams to decide on the allocations based on joint prioritization exercises. A tacit reason for the unexpectedly large volume of contributions channelled through those countries’ pooled funds seems to have been donors’ desire to reduce their transaction costs and administrative burdens by subcontracting the HC to do the subcontracting. The existing pooled funds each have a distinct name: Emergency Response Funds, Common Humanitarian Funds (both under OCHA and UNDP), and the Central Emergency Response Fund (under OCHA and managed by the CERF Secretariat). BILATERAL FUNDING AGENCIES’ EMERGENCY FUNDS Ms Craig and Ms del Pueyo outlined the HCC's role in preparation of the CERF:

Facilitate preparation of project proposals (joint health cluster proposal)

Ensure that proposals submitted to Humanitarian Coordinator are of good quality

Ensure that procedures for transferring funds to implementing partners are understood by all concerned.

Ms Craig underlined the HCC's key role in the resource mobilization process: The HCC should get all actors together and keep them informed; ensure access to assessment data; help to get consensus on priority needs; make sure projects are proposed that cover them; ensure complementarity of projects; gather proposals

inclusively; ensure, together with partners, that prioritization of projects takes place in a transparent and agreed upon manner; advocate for projects among partners and donors. Funding can be traced in the Financial Tracking Services (FTS), a global database which records all reported international humanitarian aid (including that for NGOs and the Red Cross/Red Crescent Movement, bilateral aid, in-kind aid, and private donations). Ms del Pueyo informed the group that Health Action in Crises (HAC/WHO) receives CERF proposals from the country offices and sends them to OCHA/New York. She encouraged the participants to include overhead costs in their proposals but underlined that they need to be imbedded in a budget item to be approved. The participants raised their concern over overheads. They underlined that overheads are necessary to carry out work at country level. The inclusion of overhead costs should be negotiated with donors and allowed in the proposals. COORDINATION, ATTITUDES, AND SKILLS Bobby Lambert, Facilitator, Channel Research Mr Lambert stated that an HCC's attitude can determine the success of the cluster in engaging partners and ensuring a coherent response. The group agreed that the following attitudes were desirable for an HCC:

Approachable Seeing each other as equals Focused and engaged Positive and can-do attitude Pro-active Humility Valuing diversity of vision Good listener Good judgement Flexible Patience Mutual respect

And that the following attitudes were undesirable:

Cynicism Over-critical Arrogance Self-righteousness Condescending Inflexible

Judgemental Competitive Greed

Friday, January 30, 2009 WHO IS WHO IN WHO? Samir Ben Yahmed, Director a.i. Emergency Preparedness and Capacity Building, HAC/WHO Starting from an overview on how the UN System at large is organized, Dr Ben Yahmed gave an introduction to WHO and the relationship between the different UN agencies. WHO is a specialized agency that is dedicated to health. The organization is answering to its 193 member states and therefore the organization is closely linked to the MoH in each country. WHO consists of 6 regional offices, AFRO, AMRO/PAHO, EMRO, EURO, SEARO, WPRO, and a Headquarters in Geneva, which is divided into 9 specialised branches, also known as clusters. WHO is working on its Eleventh General Programme of Work 2006–2015. One of thirteen strategic objectives for WHO's work is dedicated to emergency preparedness and response. He elaborated on the expertise available at WHO at all levels and on the way to benefit the humanitarian sector from such a large amount of knowledge covering almost every given aspect of public and clinical health. The close relationship of WHO with MoH has positive and negative consequences for the possibility to carry out the work at country level during emergencies; it would ideally ensure the participation and the support of the relevant health authorities to the cluster. Questions from the participants: Q: Why are two UN-lead reforms taking place simultaneously, the ONE UN-reform and the Humanitarian Reform? A: Reforms are the way for big systems to progress and develop further. The need for a reform was more evident for the humanitarian sector given its nature and the direct impact on mortality and morbidity. For the development sector it was more elaborative to reach the same conclusion. I think also that the UN was encouraged by the success of the Humanitarian Reform.

Q: Is the Humanitarian Reform first and foremost a UN reform? A: No. It was initially led by the UN who served as the kick start engine. But it was not to proceed and to succeed if there was not the strong ownership and consequently the leadership of the two other partners i.e., Red Cross and the NGO community. We need also to pay tribute to the key and determinant role played by the donor community. Q: How can WHO act independently in a crisis situation when they are both cluster lead agency and partners to MoH? A: With a very few exception such as crises in stateless countries, the health authorities in general are a key and influential partner that need to be consulted, involved, and sometime empowered. It is key to the success of any given major humanitarian operation that involves the health sector. WHO playing both roles is a broker that has the capacity to bring all partners together, build coherence in action and predictability, and resolve problems when they arise. This role has proven to be effective and quite beneficial to humanitarian partners including NGOs. Many recent examples illustrate the above. Q: In a country where crises are used to advance political agenda and health rights are violated, can WHO act independently from the MoH and be a provider of health or do they have to take into consideration their mandate and role as partner? A: If we think carefully and without getting into necessary details, isn't it for this purpose that we are working through the cluster approach and no more through the independent sector approach? Situations you describe apply to more than one sector and the role of the HC is to take over such issues in collaboration with the concerned cluster leads. Q: Why have we not been more successful in health system strengthening and ensuring provision of health care in developing countries when WHO has worked with this for decades? And why is WHO allowing health systems to fail (Zimbabwe)? A: For quite some time, humanitarian actors have worked independently from development actors at country level. This was also valid within WHO. Thus, the two communities did not learn from each other and did not support each other. Thanks to the cluster approach, this is now on its way to being resolved. Health systems are listed as the number one

technical domain in the list of key areas elaborated by the GHC. Alliances are put in place at all levels and work started. We need still to invest a lot in such partnerships if we were to reverse the trend I mentioned. COST AND BENEFITS OF THE CLUSTER APPROACH FOR NGOs Mary Pack and Erin Kenney The cluster approach comes with benefits and costs for cluster partners. The participants paired up and identified the benefits and costs. Benefits

Unified voice - a benefit for the humanitarian community

Ensuring coverage (filling gaps) Encouraging standards for humanitarian

health Maximizing limited resources Visibility and legitimacy Transparency and accountability Efficiency; be prepared, knowledge of who,

where, what is the set-up in respective countries

Access to HC Communication and information sharing;

prepared documents, IT platform, and maps Ensuring participation of all stakeholders -

benefit for the CLA Platform for advocacy - benefit for all cluster

members Efficiency Joint preparedness and contingency plans NGOs can flag WHO/UN bodies to set up

clusters in countries that are at risk Better knowledge of the processes through

training/orientation/workshops Focused meeting led by trained HCC Greater effectiveness/impact

Costs

Time/additional layer/meetings Opportunity costs Loss of independence Time/human resources Vulnerable to competition (someone might

'steal' our data or project) Vulnerable to national governments

RECOMMENDATIONS TO WHO ON HOW TO PROMOTE AND IMPLEMENT THE CLUSTER Top tips to the GHC from the participants:

The GHC and the country clusters should work with the momentum of the NGOs.

Ensure that all current sitting HCC and HC receive training on their roles and responsibilities, as well as the tools developed by the GHC.

Ensure good communication and inclusivity of the NGOs at all levels: country, regional, and global.

Ensure clear allocation of the tasks in the cluster. Ensure national government links and support to

the cluster. NGO commitment to the cluster should be

reflected at the global and at the country levels. Joint Country Missions by the GHC are helpful

and should be continued. The participants were organized into four groups and asked to formulate statements to the GHC: 1. 'We appreciate the efforts of WHO to reach out and listen to the 'pulse' of us NGOs. From our side, we will try to aid in your efforts to extend the GHC knowledge into our agencies and beyond.' 2. 'Keep it simple and keep at it!' 3. 'GHC is on the right path and direction, just remember that at national level the cluster will only be as effective as the Health Cluster Coordinator.' 4. 'Thank you for including the NGOs and hosting the event. This helped to build stronger partnerships among all of us.'

THE CLUSTER APPROACH – THE WAY FORWARD The resource people closed the workshop with giving their advice for the way forward: Dr Ben Yahmed underlined that the key for success of the cluster is the HCC in order to uphold the PoP and to provide support to the partners. Therefore, WHO is encouraging GHC partners to submit their candidates for the HCC roster. Furthermore, the NGOs are engaged in the selection of the HCC candidates. The HCC roster is an inter-agency roster even though the candidates have contracts with WHO. Ms Kenney said that cluster implementation is a joint endeavour at the country and global levels; the emphasis is now on the quality of cluster implementation at country level. WHO and the GHC are committed to building capacities to improve the functioning of health clusters at country level to better serve those in need. Ms Pack emphasised that we need partnership for an effective response, which requires trust building among the various actors and organizations to enhance collaboration. Mr Lambert drew from his extensive experience from working for NGOs. He encouraged a change of mind set. NGOs needs to be willing to be coordinated and work towards the common goal—a more efficient and effective response to emergencies.

Activity Budget

Staff Budget (staff recruited

by GHC)

Working Group Timeline

1Establish core curriculum for all GHC trainings and workshops on humanitarian reform, humanitarianprinciples and principles of partnership -$

quarter 1

2 Contribute to the development and implementation of OCHA-led workshops and e-learning initiatives -$

$180,000.00ongoing

3 Conduct workshops for Regional Directors, DPM and WHO country representatives in countries with Humanitarian Coordinators 100,000$

<This equals one P4 levestaff (100%) preferablybased in NGO partner

agency at HQ level>quarter 2

4 Support in designing and conducting of regional or sub-regional and country level training and workshops (including NGO cluster workshop 28-30 January 2009 funded by 2008 work plan) 270,000$

ongoing

5

Further develop HCC training curriculum to include learning on humanitarian reform; humanitarian principles and principles of partnership; best practices; guidance on developing stronger local and national capacities; issues relevant for protracted complex emergencies such as civil-military collaboration, health sector recovery and risk reduction; cross-cutting and cross-cluster technical issues; CAP Flash and CERF; GHC positions and policies; and ensure translation and printing of materials

30,000$ <Part of line 2> Country Support ongoing

6Finalize development of core indicators and have consensus meeting; link to revision of Sphere Standards 80,000$ quarter 1

7Produce a peer-reviewed selection of suggested health sub-sector assessment tools with documented effective field utilization 30,000$ quarter 2

8 Complete the IT Support Platform to increase inter-operability of HeRAMS -$ quarter 2

9 Format, translate, print and widely disseminate provisional Health Cluster guidance and tools 300,000$ quarter 1

10 Support the extensive field utilization of the provisional Health Cluster guidance and tools 180,000$ ongoing

11Develop training strategy and training package for GHC guidance and tools (in collaboration with WG on Country Support) 100,000$ quarter 1

12 Conduct trainings in guidance and tools with priority on Training of Trainers at various levels 250,000$ ongoing

13Promote and provide technical support for field use, local adaptation and full utilization of IRA and HeRAMS tools in at least 8 humanitarian crisis during 2009 100,000$ ongoing

14Monitor and evaluate the effectiveness and impact of the provisional Health Cluster guidance and tools (also applies to Strategic Priority 4)

-$ ongoing

15Identify and review lessons learned based on outputs of activity 13 above to finalize Health Cluster guidance and tools -$ quarter 4

16Conduct two health cluster coordinator training courses and/or support regional HCC training courses; ensure that all HCC trainings consistently use standard selection criteria, curriculum and assessment of candidates; make available GHC resource persons

420,000$ <Part of line 2> quarter 2, 3, 4

100,000$ <This equals one P4 leve

staff (50%) based in WHO Geneva>

18Explore ways to increase stockpile coordination at global and country levels and identify related action points -$ -$ Policy and

Strategy quarter 2

19Based on literature review, develop and disseminate GHC position papers, with recommendations for action, on at least two specific humanitarian health issues 150,000$ -$ Policy and

Strategy ongoing

20Revise JCM concept note; establish criteria for choosing JCM countries; establish mechanism for follow up on recommendations; conduct at least 4 JCM (each with context specific TOR) 180,000$ ongoing

21Document lessons learned from trainings and workshops as basis for ongoing improvement; develop training quality assurance mechanisms -$ ongoing

22 Hold 1 meeting for experienced HCC 200,000$ November

23 Contribute to and follow up on the cluster evaluation phase II process -$ -$ Guidance and Tools ongoing

24 Ensure mechanisms for transparent dialogue, knowledge sharing and coordinated joint action -$ 350,000$ ongoing

25Hold two GHC meetings, one in Geneva with WHO regional advisors and one in Nairobi with representatives from regional health clusters 50,000$ May and

November

26 Donor relations, related meetings and resource mobilization -$ ongoing

Total Budgets: Activities / GHC Staff 2,440,000$ 1,445,000$

Goal 3.1: Open discussion and exchange of information, experience and ideas within the GHC lead to consensus on humanitarian health priorities and coordinated action to address them

Strategic Priority 3: Specify humanitarian health priorities and coordinate global actions to address them

WORK PLAN AND BUDGET 2009

Strategic Priority 2: Ensure supplementary human and material resources are readily available to country clusters, as needed

Goal 2.2: Stockpiles of emergency supplies are systematically identified, coordinated and harmonized at the global level to be tapped by country clusters

Country Support

Develop and guide the management of the GHC roster and produce operational guidance (SOPs) on how to request a HCC -$ end quarter 2

<Part of line 2>

17

Strategic Priority 4: Monitor and evaluate the progress and effectiveness of the health cluster at global and country levels over time

Activity

Goal 2.1: GHC rosters are regularly tapped by cluster leads at country level to access qualified Health Cluster Coordinators and other emergency experts for the effective coordination and delivery of health services

Goal 1.1: A widespread understanding and application of the Humanitarian Reform, Humanitarian Principles and Principles of Partnership influence the design, implementation, monitoring and evaluation of humanitarian health activities

Strategic Priority 1: Build capacities within country clusters to design, implement and monitor an effective evidence-based humanitarian health response

3,885,000$

Goal 4.1: Findings and recommendations from continuous monitoring and evaluation result in improvements in the work of the GHC and ultimately in improved humanitarian health action at country level

Partnerships

Secretariat<This equals one

professional and supportstaff (100%)>

GRAND TOTAL

Country Support

Goal 1.2: Standards, best practices, guidance and tools are identified, adopted, adapted or developed and promoted by the GHC and facilitate the planning, delivery and evaluation of humanitarian health action at country level

Country Support(in collaboration with WG Guidance and

Tools)

$ 465,000.00 <This equals one P5 levestaff (100%) and one P3

level staff (70%) based inWHO Geneva, and one P4

level staff (100%)preferably based in NGO

partner agency at sub-regional level>

Guidance and Tools

(in collaboration with WG on Country

Support)

GlobalHealth Cluster

IASCInter-Agency Standing Committee

GlobalHealth Cluster

IASCInter-Agency Standing Committee

NGO Health Cluster Partner Workshop

Hammamet, Tunisia 28-30 January 2009

GlobalHealth Cluster

IASCInter-Agency Standing Committee

Mary Pack

International Medical Corps

Workshop Objectives

Understand Humanitarian Reform and Cluster ApproachInsight into inner workings of Health ClusterUnderstand good functioning of Health Cluster

Skills, attitudes & approaches neededMain relationshipsPractical mechanisms (operating and planning frameworks)Key tools (funding mechanisms, Health Guide, HeRAMS, IRA)

Collect feedback from partners on broader cluster issues and development of toolsDevelop an action plan to share learning within respective organizationsPartnership strengthening

Workshop Preparation

Invite participantsRecruit resource personsDevelop methodology & curriculum with Channel Research & Resource TeamCollect participant information forms & surveysDistribute participant’s pack with pre-workshop reading

TOR, Health Cluster Lead AgencyTOR, Health Cluster CoordinatorIASC Guidance Note on using the Cluster Approach to Strengthen the Humanitarian Response (2006)Matrix of Roles and Responsibilities of Health Cluster Coordinator, Cluster Lead Agency and Cluster Partners

Participants & Resource Team

23 participants from 9 key partner NGOsAfrica Humanitarian ActionAmerican Refugee CommitteeCAREInternational Medical CorpsInternational Rescue CommitteeMerlinSave the Children UKSave the Children USWorld Vision

Resource Team – OCHA, WHO/HAC & International Medical Corps

Presentations & Exercises

Humanitarian Reform and the Cluster ApproachPrinciples of PartnershipGlobal Health Cluster

Roles, responsibilities and structureTable top exercise on chronology of a clusterAssessing, analyzing and identifying prioritiesDeveloping a Cluster Strategic Action PlanFunding and resource mobilization Coordination, attitudes and skills for HCCsCost and benefits of Cluster Approach for NGOsRecommendations to WHO and GHC on how to move forwardTabletop exercise to develop organization action plan

Participant Self-Assessment Results pre-and post-workshop comparison

Messages to the GHC

We appreciate the efforts of WHO to reach out and listen to the “pulse” of us NGOs. From our side, we will try to aid in your efforts to extend the GHC knowledge into our agencies and beyond.

Keep it simple and keep at it.

GHC is on the right path and direction, just remember that at national level the cluster will only be as effective as the Health Cluster Coordinator.

Thank you for including the NGOs and hosting the event. This helped to build stronger partnerships among all of us.

Resulting Actions

Organizational action plans

CD of workshop resource materials

Plans for reporting back to GHC

Action Plan Follow-up

Development and dissemination of organizational policy/guidelines on participation in the Health Cluster at country levelCirculation of health guidance note and summary of workshop report to field staffReporting by country offices to HQ on increased participation incountry Cluster, CAP process, and information sharing Dissemination of learning workshop materials (CD) to staff Incorporation of Cluster Approach and tools in revised organizational emergency response manualInclusion of IRA in revised organizational emergency toolkitInformation-sharing with in-country Cluster LeadConducting knowledge improvement sessions for emergency response staff

Cluster Evaluation phase II Status Report 21st April 2009

The following purpose and objectives for the IASC mandated Cluster 2 Evaluation have been agreed by the Cluster 2 Evaluation Steering Group (CE2StG1). The overall process and timeline are outlined in the following section 2. 1) Purpose and Objectives of the Cluster 2 Evaluation Purpose: Assess the main outcomes2 of the joint humanitarian response at country level, with particular

reference to the role of the cluster approach and other components of the humanitarian reform process

Assess the overall operational effectiveness3 of the cluster approach (including the role of the Global Clusters) in facilitating and supporting the coordinated joint humanitarian response at country level through a global analysis of common country-level findings

Objectives: Assess the role that the Cluster approach – in conjunction with other elements of the Humanitarian

Reform – had and has on effectively filling identified gaps and allowing appropriate and coordinated delivery of humanitarian assistance

Evaluate the operational results at country level (6 operations) of the joint humanitarian response delivered through the cluster approach

Assess at the global level the overall efficiency and effectiveness of the Cluster System by analyzing the country-level findings in the perspective of global Cluster’s roles

Propose practical recommendations addressed to global and country level Clusters for further improvements in the efficiency and effectiveness of the cluster approach and for improved synergies with the other elements of the Humanitarian Reform

Overall, the evaluation should assess progress made in building up humanitarian response capacity through the Cluster system in the wider context of humanitarian reform. It should yield results that will help to inform the Clusters and optimize their efficiency and effectiveness at the global and country level. Potential users include IASC members, humanitarian country teams, member states and global and country level clusters.

1 The Cluster II Steering Group members as per now are: Donors: Belgium (Emile Adriaensens) Canada (Pascal Desbiens) EU (Kim Eling) Norway (Haakon Gram-Johannesen) UK (Simon Dennison) NGO: SCF-CH (Susanne Nicolaï) AAH-UK (TBC) NRC (Arnhild Spence)

UN: FAO (Rachel Bedoin) UNDP (Janey Lawry-White) UNHCR (Vicky Tennant) UNICEF (Natascha Gomez) WFP (Alain Cordeil) WHO (Daniel Lopez-Acunha) OCHA (Tom Delrue for HRSU, plus Claude Hilfiker as chair of StG)

2 Outcome understood as likely or achieved short term and medium term effects of the response’s outputs 3 Effectiveness being the extent to which operational objectives were achieved or are expected to be achieved, taking into account their relative importance

2) Process and timing of phase 2 evaluation In February 2009, the CE2StG agreed to a revised timeline of the Cluster II evaluation, which is launched in different phases: Phase A (December-February 2008 completed): Development of methodological Evaluation

Framework Phase B (June-October/ November 2009): Six country level evaluations and individual country

reports Phase C (December 2009 – January 2010 ): Synthesis report of the six country level evaluations

3) Current Status Phase A is finalized. On 9 February, the CE2StG has agreed on the final methodological

Evaluation Framework, which was developed by the consultant Jessica Alexander. The Evaluation Framework includes a logic model (see annex), an approach and generic as well as Cluster specific key indicators and benchmarks, which will guide the subsequent six country evaluations. The framework has been established in close consultation with Global Clusters

Based on the Evaluation Framework, ToR were developed which were signed off by the CE2StG on 20 February.

In close collaboration with UNOG’s Procurement and Transport Section (PTS), a Request for Proposal of Services (RFP) was drafted and sent to consultant companies and research institutes which had expressed their interest during a previous Call for an Expression of Interest (EOI). The RFP was sent to the eligible consultant companies and research institutes on 23 February and deadline for submission / public opening of was 23rd of March.

23 expressions of interest have been received and the companies invited to bid 8 companies have sent bids by deadline. A technical evaluation committee (Belgium, UNHCR, UNICEF, OCHA) has submitted a technical

evaluation to PTS who are in the process of doing the commercial evaluation of the bids that were rated as technically acceptable.

According to a Procurement Plan developed by PTS 22nd May 2009 is targeted as the contract signing date between UNOG and a consultant company/ research institute.

4) Budget and Funding During the bidding process of the consultant companies / research institutes, OCHA ESS does not

have the right to publicly announce the budget of the evaluation. Funding has been sought from different donors, inside and outside of the Steering Group and is

secured. 5) Pending issues and next steps Communicate process and Evaluation Framework to the six selected countries Carry out preparation missions to the selected countries (Chad, DRC, Gaza, Haïti, Myanmar,

Uganda) to explain the evaluation’s rationale and framework and to assure the availability of data and support personnel during the evaluation process

Launching the main evaluations in the selected countries

Prepared by Claude Hilfiker, OCHA

Matrix of Roles and Responsibilities within the Humanitarian Architecture at Country Level

Explanatory Note

1. Purpose of this matrix This matrix aims to clarify the role of the key international actors and bodies in humanitarian settings in the main areas of work as outlined in the Terms of Reference of Cluster Lead Agencies at Country Level. 2. Explanation of Column Headings: Key actors or bodies in Humanitarian Architecture Resident Coordinator/Humanitarian Coordinator

• The overall goal of the HC is to provide leadership and coordination to ensure appropriate and effective humanitarian action. The HC has a key role in all the areas of work of the clusters.

• This is a critical pillar of the humanitarian reforms. • The TOR for this post have been agreed by the IASC and are reflected in the column. • The RC/HC is the convener of the Humanitarian Country Team.

Humanitarian Country Team

• The overall goal of the HCT is to set policy, resolve issues and advise the HC; the HCT is considered the ultimate platform for decision making and coordination for international humanitarian action.

• The HCT is headed by the HC and is made up of Heads of UN agencies, NGOs and the Red Cross and Red Crescent Movement.

• Heads of agencies who also lead clusters represent both their agency and their clusters in this forum.

• Please note that the UNCT is made up only of UN heads of agencies and any positions taken at the UNCT should feed into discussions at the HCT; likewise positions taken at the NGO Coordination Group should also feed into discussions at the HCT.

• The IASC has agreed to finalize guidance about the HCT by the end of 2009. The HCT column in this matrix and the HCT guidance must be consistent.

Inter-Cluster Coordination Group

• The overall goal of the ICC is to ensure technical and operational collaboration between sectors/clusters while integrating key cross-cutting issues and cross-cutting subsectors.

• The ICC is headed by an OCHA staff member appointed by the HC and is made up of cluster coordinators.

• Cross-cutting issues (such as ageing, environment, gender, HIV/AIDS) as well as cross-cutting subsectors (such as mental health, psychosocial support and gender based violence) need to be brought to the attention of this Group and discussed and mainstreamed within this Group by the cluster coordinators. Focal points for cross-cutting issues or cross-cutting subsectors may be invited on an ad hoc basis to participate in particular meetings of this Group but they are not permanent members.

Cluster Lead Agency including the Head of Agency and the Cluster Coordinator

• Cluster Lead Agencies are responsible for fulfilling their cluster obligations as per the agreed TOR of Cluster Lead Agencies at country level.

• Heads of the Cluster Lead Agencies are accountable to both their agencies and the HC for fulfilling their cluster obligations.

• Heads of Cluster Lead Agencies must mobilize available resources in their country offices to fulfil their cluster obligations.

• Cluster Coordinators are staff members of the Cluster Lead Agency. They work for the Head of their Cluster Lead Agency to enable him/her to fulfil the cluster obligations; however, their job description expects them to serve as impartial and inclusive actors on behalf of the cluster.

Cluster Partners

• International members of the country cluster, including a technical representative of the Cluster Lead Agency that is not also serving as the Cluster Coordinator.

3. Explanation of Row Headings: Key Areas of Cluster Work in Humanitarian Settings These 10 areas of work are taken directly from the agreed Terms of Reference of the Cluster Lead Agencies at Country Level. Some tasks have been combined into one row to provide a more coherent understanding of the work required. Among the 10 areas of work, two of them are the keys to improved humanitarian action and represent the essence of the humanitarian reform: (3) Needs Assessment, Analysis and Gap Identification and (4) Strategy Development and Planning. All of the humanitarian actors and bodies in this matrix must focus their action on achieving cross-cluster success in these areas. All the other areas of work in the matrix allow for or support success in these two areas and therefore success as a humanitarian community in providing effective action.

Accountability within the Cluster System

Co-Chairs’ Summary of the Global Clusters - Donors Meeting

Permanent Mission of Canada -- April 21, 2009

1. Opening The meeting was co-chaired by Pascal Desbiens (Canada) and Jamie McGoldrick (OCHA). In attendance were representatives of the eleven global cluster leads and NGO partners from the global clusters, focal points for crosscutting issues (Gender, HIV/AIDS, and Age), NGO consortia (ICVA, Oxfam and NRC), OCHA (HCSS, IASC Secretariat and ESS) and eighteen donor Permanent Missions (see final list of participants in Annex 1 - attached). ALNAP also participated as presenter in a stage setting session on “Accountability in the Humanitarian System”. The objective of the meeting was to reach agreement on next steps to improve accountability within the humanitarian system (from the country to the global level, with a focus on clusters) with the ultimate aim of improving collective accountability to beneficiaries. The discussion was informed by a discussion paper prepared by OCHA and Donors on “Accountability within the Cluster System” (April 17, 2009). The co-chairs recognized the complexity of the accountability issue, the significant work already being done within and outside of the humanitarian system on this matter and the importance of focussing on the operational requirements to enhance accountability in the humanitarian system.

2. Key Conclusions of the Global Cluster –Donor Meeting, October 2008

ECHO summarized the key conclusions of the Global Clusters-Donors meeting (the fourth in that format), which took place in October 2008, and highlighted the link with the current meeting on accountability. Previous meetings (2007 / early 2008) had been very much focussed on issues of cluster implementation and financing of the global clusters in the context of the two consolidated cluster appeals. A consensus had emerged in October 2008 that focus could move from a 'quantitative' to a 'qualitative' dialogue. Several key points were identified for further work, including:

accountability of clusters to the ERC, linkage between global and country clusters and Cross-cluster coordination.

Participants in October 2008 also expressed interest in further work regarding:

the role of host governments; the role of NGOs (not least in co-ordinating clusters), and inclusion of local NGOs; clusters in mixed population situations; and

1

clusters and the food sector.

3. Accountability in the Humanitarian System (ALNAP) John MITCHELL from the Active Learning Network for Accountability and Performance in Humanitarian Action (ALNAP), set the stage for the discussion with a presentation on how humanitarians have approached accountability in recent years. The presentation focussed on three key overlapping elements of accountability:

a) systematic and better delivery of aid; b) putting affected people at the heart of the process; c) enhancement of agencies’ accountability.

Three broad approaches have been used so far to enhance accountability:

1) improving participation of communities in planning and delivering assistance; 2) developing codes of best practice, and guiding principles; 3) more systematic measurements of performance and results.

Some key messages emerged from the presentation and the subsequent discussion:

• Common accountability framework Developing a common accountability framework that could realistically work across clusters requires a common understanding of the key functions of the global and country clusters and their interface, as well as clear statements of roles and responsibilities of the elements of the system;

• Cluster lead Agencies’ term of reference (ToRs) Cluster lead Agencies’ term of reference is a key tool and should be reviewed.

• Broader governance issues

Further improving accountability may require looking more carefully at the broader governance of the whole humanitarian architecture.

4. Accountability at the Global Level and within Humanitarian Architecture - Donor perspectives

Norway, with the participation of UK, US, Australia and Ireland presented a donor perspective on accountability. The following points were emphasized: • Enhanced accountability, leadership and strong partners - one of the key

recommendations of the humanitarian response review and reform agenda was a call for enhanced accountability and strengthened leadership and partnership.

• Two aspects to accountability deserve attention: a) Being responsible and taking action; and b) Accounting on the discharge of responsibilities and actions.

• Better performance and results - accountability needs to be seen as helpful and positive to enhance performance and achieve better results. It should help identify gaps, enhance confidence and improve humanitarian action.

• Donor accountability to their constituents - donors have to comply with accountability requirements related to their public financial management responsibilities and their obligations to tax payers to account on the overall effectiveness of the humanitarian system through a broad accountability chain.

• Results-based humanitarian action and accountability – it is a concern to donors that at a global level, interagency coordination and dialogue mechanisms do exist, however no

2

accountability mechanisms related to the results of humanitarian action have been established.

• Accountability and administrative burden - donors are aware of the risk of adding layers of bureaucracy and recognize the importance of balancing accountability and the administrative burden it entails.

• Mandates, partnerships and accountability frameworks - donors call for less emphasis on boundaries and limitation related to agencies’ mandate and more emphasis on collaboration within the system; partnership arrangements need to be supported by appropriate accountability frameworks.

• Using existing tools - there are lots of existing tools that cluster leads can already use, and the challenge with using these tools is to keep accountability processes simple, timely and relevant.

• Engaging at a high level in Agencies – donors are aware of the importance of engaging in a coordinated way at the level of Agency principals to promote accountability within the humanitarian system.

5. Global Cluster perspective – mainstreaming cluster responsibilities within agencies and the relationship between global cluster leads, the IASC and the ERC

Global Clusters and OCHA presented their perspective on accountability, emphasizing the following issues: • Mainstreaming cluster programmes and costs - it has been agreed to mainstream the

work related to clusters into the programme of the cluster lead agencies and to mainstream related costs. The mainstreaming process is central for global cluster lead agencies to engage with donors and to obtain support from them.

• Roles and responsibilities of cluster leads - terms of reference are the starting point to elaborate a more refined framework of roles and responsibilities of cluster leads and partners.

Review of progress with ERC - cluster leads are in favour of having periodic systematic review of progress of clusters work and achievement with ERC.

• Accountability to ERC - previous discussions in IASC and during a recent Global Clusters retreat suggest that there is recognition of the need to establish a system of accountability to the ERC. However, such an accountability system has yet to be designed. Agencies are generally interested in a simple and effective accountability system consistent with their specific roles and functions within the UN family, and not adding to the reporting burden.

Key elements to be considered include: a) refinement of humanitarian reform tracking tool; b) making the Terms of Reference smarter and more specific; c) need for operating procedures, standards for joint assessment and systematic operational tools to measure results; and d) annual review with the ERC.

Accountability adapted to clusters - it might be easier to deal with accountability from the point of view of a service provider cluster, such as logistic, than for a protection cluster. Clusters face many challenges and accountability arrangements must be tailored to cluster specific circumstances.

• Cluster as part of Agency accountability - a more integrated accountability framework within the cluster system should reconcile the need to better assess results of collective humanitarian efforts, with the requirement for various actors to account on their programs to their respective constituencies.

Agency vs. Cluster lead perspectives - In IASC principals meetings, global cluster leads have a greater facility addressing issues from an “agency” rather than “global cluster lead” perspective. Shifting the perspectives would require reinforcement at senior levels.

3

Linkages within the cluster system - the system must be reinforced so global and country clusters are more closely connected. Strengthening these links does not mean establishing a direct link between individual country cluster leads and the ERC. However the existing link between global cluster leads and the ERC through the IASC requires some consolidation within the system.

6. Accountability from a country – operational angle and global and country cluster interface

a) NGOs and Humanitarian Reform- Initial findings and recommendations from the mapping studies of the reform process undertaken in five countries ICVA presented the preliminary result of mapping studies of the reform process undertaken in five countries (Afghanistan, DRC, Ethiopia, Zimbabwe, and Northern Sudan). This initiative is a three years project involving six NGOs and ICVA. The project aims, in part, to examine accountability aspects and involvement of NGOs in the humanitarian reform. Country evidence supports Humanitarian Reform - the initial findings provide country

evidence of the existing concerns and weaknesses that the humanitarian reform (2005) sought to address.

Leadership issues - leadership as a whole and cluster leadership more specifically have been identified in the studies as two critical issues requiring further attention.

Gaps at country level - The study suggests that the fundamentals of the humanitarian reform and its implications in terms of interface with beneficiaries, working arrangements and processes among partners are not well understood in country.

NGO involvement in clusters - the study indicates that NGOs usually participate in clusters that are seen as working. NGO involvement in co-ordinating clusters was also identified as an area for improvement.

Donor support uneven - donors’ support of clusters at country level is not as good as global level; such support needs to be more consistent and appropriately balanced at the various levels.

Recruitment for Phase II - A next step for ICVA will be to recruit humanitarian officers to work on the second phase of the project, which will take a deeper look at the issue of humanitarian leadership.

Participants expressed interest in the synthesis report. Some donors asked for recommendations to address the drawbacks from an NGO perspective. Some participants also underlined the link between humanitarian leadership and the role of the HC in country. b) Discussion on the operational challenges impacting on accountability between the global and country clusters, focussing on the country level Global Cluster Leads and OCHA opened the discussion on operational challenges created by accountability within the global–country cluster system, focussing on the country level. Several observations were made on the following issues: Avoiding “stovepipes” - it is critical to avoid creating separate silos of humanitarian efforts.

NGOS, agencies and local communities, including relevant national actors, should continue their efforts to work jointly and to better understand their respective mandate, capacities and constraints.

Donors and the cluster approach - donors have to become far more demanding on humanitarian actors in terms of joint interventions and should more clearly express their expectations regarding the implementation of the cluster approach.

4

HC role in setting priorities - the HC has the responsibility to prioritise humanitarian response, to mediate and to bring together relevant actors around the table to address the prioritization challenge.

Country Team concerns and the ERC - country team should take advantage of the monthly reports to ERC/J. Holmes by HC to push their concerns.

Agency vs. NGO roles and responsibilities - it is important that agencies and NGOs have the same understanding of roles and responsibilities within the humanitarian system and comparable expectations as regards humanitarian actors, including the HC.

Agency vs. Cluster lead responsibilities - Best practices tend to show that cluster coordinators in country are more dedicated to co-leadership/coordination when they do not have additional agency related responsibilities.

NGO Cluster co-lead/coordinator - on NGOs as co-leader/coordinator of a cluster at global and country level, it is important to discuss commitment and resource implications when looking at NGO’s role. Some donors provide funding to NGOs for their cluster role.

Weeding out low performers - the procedure to strengthen or remove the under performing element of clusters is a critical issue. Donors can help address the matter if specific entry points are clearly identified. However, accountability for dealing with such situations should be an integral part of the system and be supported by appropriate information gathering and feedback mechanisms.

Donors and HCs - the HC could be an operational entry point for donors who should be mindful, however, of the risk that micro management poses to erosion of accountability of the HC.

Agencies fulfilling their commitment as cluster lead The most senior levels within the cluster leads must commit to the cluster responsibilities and ensure they are fulfilled at all levels of the agency.

Strengthening HCs and Cluster Leads in country - there is a need to empower the HC and cluster leads in country so they can interact with relevant agencies to address performance matters within the cluster system, while bearing in mind different human resources rules within agencies.

Global Clusters and country monitoring - Global and country level clusters are two interdependent systems; they should find appropriate ways to interact and collaborate effectively. It may be time to add formal country monitoring responsibilities to the global clusters’ terms of reference.

c) Good practices and lessons learned WASH cluster, Cluster Working Group on Early Recovery (CWGER) and Health cluster made presentations on operational challenges to accountability in country level clusters, good practices and lessons learned. Key good practices and lessons learned were identified, as regards:

Involvement - importance of cluster members’ involvement in work planning and financial decisions;

Strategic Framework - need for simplicity, flexibility and pragmatism, within an overall agreed framework to guide cluster’s work;

Benefits - benefits associated with periodical review and evaluation (external and self) of cluster’s work;

Division of labour vs. linkages - need for appropriate linkages between global and country clusters, with a clear separation -- but complementarities -- of roles;

Strategic advice - value-added by strategic advisory groups composed of small numbers of agencies regrouped to work on precise subjects within a specific timeframe;

Planning - early integration of accountability systems into humanitarian responses; Relationships and Reporting lines - importance of clear accountability relationships

and reporting lines between individuals playing various roles within the cluster system (humanitarian coordinators, country cluster lead representatives, country cluster coordinators, partners) respectively at the global level and at the country level;

5

Monitoring country capacity - Importance of monitoring capacity of country cluster by global cluster leads;

Technical vs. process accountability -The existence of dual accountability and reporting lines of some actors in the system, such as officials being accountable to their agency on technical matters and being accountable to cluster leads on process issues;

Deployment - Importance of deploying experienced staff from global cluster to activate the country cluster;

Training – Importance of training individuals who could fulfill the role of cluster coordinator in country;

Joint assessment - Benefits of joint assessment missions to reinforce team work in planning and implementing humanitarian responses and to develop action plan to build or supplement available capacities for improved cluster implementation.

7. Exchange of information

a) Report on the implementation of global cluster capacity building efforts – 2005/2008 The co-chairs reported on the circulation by OCHA of the Report on Implementation of Global Capacity Building, April 16, 2009. Donors noted that they did not have time to undertake appropriate review and consultations with capitals. It was suggested that the content of the report should provide a basis for the continued thinking on where to take the cluster approach in the future and on reporting requirements. The lack of understanding of the cluster approach by agency senior management who may see clusters as only technical was noted.

It was proposed to remain open regarding follow up to this report and to consider organizing a meeting on this report, as necessary.

Some cluster leads (Protection, CCCM and Logistics) briefly mentioned some challenges they are facing with respect to mainstreaming the cost of their activities within the global cluster leads' budget. They called on donors to help raise the matter in relevant Governing Boards, both UN and NGOs, and to consider transitory funding measures.

b) Cluster evaluation: Follow up on Phase I and update on Phase II OCHA (ESS) provided an update on the implementation of the Global Cluster Evaluation Phase II. ESS referred to the evaluation framework; the steering committee; timeframe; country visits; and expected evaluation products.

Draft Evaluation Report - The draft evaluation report should be completed by June, finalized by October and the findings shall be presented to IASC in November 2009.

Evaluation Material - OCHA (ESS) agreed to make relevant evaluation material available to participants.

Update on implementation - OCHA agreed with a proposal to include an update on the implementation of the recommendations of the Phase I evaluation in the Phase II report.

Joint follow-up - OCHA HCSS and ESS intend to follow up jointly on this proposal.

c) Montreux Retreat : Convenors’ Conclusions On behalf of the Convenors of the Montreux IX Retreat (Canada, Netherlands, Norway Sweden, Switzerland UK, and the USA joined by ECHO), March 5-6, 2009, Sweden reported on the Convenors’ Conclusions, as relevant to the work of clusters in the context of the Consolidated Appeal Process (CAP) and Humanitarian Financing Mechanisms (see Convenors’ Conclusions).

6

Sweden mentioned that the CAP becomes a tool for planning, prioritizing and enhancing accountability at three levels:

1) peer accountability; 2) accountability of the HC; and 3) accountability to donors who provide funding to or though the CAP.

The critical role of clusters in the CAP process, some challenges about the integration of cross cutting issues and the use of the CAP as the primary monitoring framework were also noted. d) Private sector involvement in clusters

OCHA reported on a high-level meeting on the Humanitarian Relief Initiative (joint World Economic Forum (the Forum) – OCHA initiative), co-chaired by ERC/Holmes and the CEO of TNT, with donors and private companies, which took place in Davos in January 2009. The outcome was a decision to hold three meetings between private sector and cluster representatives.

The first meeting organized by the Forum and OCHA, scheduled on April 22, 2009: 35 private sectors partners and representatives of the eleven clusters will participate in this one-day meeting.

A second and third meeting will be planned in the coming months. e) AOB Global Cluster Funding (2009 and beyond) – The WASH cluster and the Protection Cluster Working Group (PCWG) suggested discussing with interested donors challenges related to mainstreaming global cluster costs. Operational issues related to accountability – The CWGER (Cluster Working Group on Early Recovery) proposed a follow up meeting among cluster leads to develop specific solutions to operational issues related to accountability, as discussed during the meeting (such as entry points in country to address cluster’s performance; measures to improve commitment and support for the work of global clusters at senior level in global cluster lead).

8. Concluding Remarks (Co-Chairs) The co-chairs were pleased with the quality of the discussion. They noted the following on:

1) Accountability and empowerment - accountability is widely acknowledged and efforts are required at all levels to make it empowering rather than undermining.

2) Accountability tools - several tools and mechanisms exist to support accountability; the challenge in not so much to create more of them but to make people aware of the existence of these and promote consistency and timeliness of their use.

3) Gaps in tools, processes, ToRs - nevertheless gaps remain in accountability tools and processes, including with respect to clarification of responsibilities, as well as communication and reporting lines in country, between country and HQs, within HQs at working and senior levels and within IASC. TORs have to be examined accordingly.

4) Agencies fulfilling their commitment as cluster lead. The most senior levels within the cluster leads must commit to the cluster responsibilities and ensure they are fulfilled accordingly.

5) Accountability among different levels - the functioning of IASC and the accountability relationship among Principals and with the ERC are instrumental to enhancing accountability within the humanitarian system. It is desirable to develop a simple but

7

effective accountability framework at this level, since the agencies are the cluster leads at global level.

6) Mainstreaming and resources - the good functioning of a system requires adequate and well managed resources; these matters -- including challenges to mainstreaming global cluster costs, financial resources available to NGOs and shifting the balance of resource to the country level -- need to be looked at carefully to accelerate the consolidation of the cluster system.

7) Improving accountability in the future - there has been progress on accountability in recent years; no doubt humanitarian actors and cluster leads are up to the challenge of further improving accountability under a strong leadership and effective coordination.

Appendix 1 (attached), which forms an integral part of this report, proposes some actions to be taken to improve accountability within the humanitarian system with a focus on clusters. Canada and OCHA, Final 1: Version 06/05/09 16h00

8

Appendix 1

Some actions to be taken to improve accountability within the humanitarian system

Four key actions have been proposed:

Actions Responsibility 1. Clarify accountability among actors at the country level (responsibilities, communication and reporting lines, TORs, etc.)

Selected HC (jointly with humanitarian country team and global cluster leads through Matrix development as per retreat) ;

2. Clarify accountability among country clusters and global cluster leads (functions, responsibilities, communication and reporting lines, TORs, etc)

Global Cluster Task Force chaired by OCHA (Global cluster leads to develop and document agreed systems)

3. Define the accountability among global cluster coordinators and more senior level of the global cluster leads

Individual clusters develop and document systems (joint work of cluster coordinators and more senior level of the global cluster leads)

4. Define the key elements of an accountability framework for the broader humanitarian system involving Principals and ERC within the IASC

IASC WG and Principals

This work would be coordinated by OCHA (HCSS) working jointly with ESS and IASC Secretariat and other parties identified above. Outcome: The expected outcome is a document agreed by IASC clarifying accountabilities within the humanitarian and cluster system. Timeframe: Progress with respect to implementation of these four actions will be reviewed at the next global clusters – donors meeting in October 2009. The IASC Working Group will be invited to consider how to reflect these actions in its 2009 work program in preparation for its meeting in November.

9

Annex I

Global Clusters - Donors Meeting

21 April 2009

Final List of Participants

NAME

Organization Representing

MERITENS Jahal de UNDP/BCPR Early Recovery Cluster BESSUGES Pierre UNDP/BCPR Early Recovery Cluster NICOLAI Susan Save the Children Education Cluster WRIGHT Roger UNICEF Education Cluster LOPEZ-ACUNA Dr. Daniel WHO Health Cluster KENNEY Erin (alternate) WHO Health Cluster PACK Mary Int’l. Med. Corps Health Cluster MENIKDIWELA Ruven UNHCR Protection Cluster SOLBERG Atlee UNHCR Protection Cluster ROBERSON Kim UNHCR CCCM Cluster MATHESON Lea IOM CCCM Cluster SAUNDERS Graham IFRC Emergency Shelter Cluster MALIK Sajjad UNHCR Emergency Shelter Cluster CILOTE Yves OCHA Emergency Telecoms Cluster GILMAN Alfred WFP Emergency Telecoms Cluster HOLLINGSWORTH Matthew WFP Logistics Cluster RICHARDS Rebecca WFP Logistics Cluster RICHARDSON Leah IOM Nutrition Cluster CARTY Dermot UNICEF Nutrition Cluster McCLUSKEY Jean UNICEF WATSAN & Hygiene Cluster BAKER Jock UNICEF WATSAN & Hygiene Cluster GRAY Bill HelpAge Age Cross-cutting Issues BURNS Kate OCHA Gender Cross-cutting Issues SIKANDA Bellings UNHCR Environment Cross-cutting Issues KENNY Leo UNAIDS HIV/AIDS Cross-cutting Issues THOMAS Manisha ICVA NGO Consortia ANSARI Aimee OXFAM NGO Consortia SPENCE Arnhild NRC/IDMC DESBIENS Pascal Canadian Mission Chair McGOLDRICK Jamie OCHA Co-Chair CUTTS, Mark OCHA HCSS DELRUE, Tom OCHA HCSS LAWRY-WHITE Simon IASC Secretariat IASC MITCHELL John ALNAP Presenter (accountability) HILFIKER Claude OCHA Presenter (evaluation) LAFOREST Marie-Noëlle Canadian Mission Note-taker BOYER-MEYERMAN Michèle Canadian Mission Coordinator

10

11

McFARLANE Neil Australia Donor Mission ALVOET Claudine Belgium Donor Mission MAMDANI Anar Canada Donor Mission / CIDA ELING Kim EU Donor Mission RASMUSSEN Peter Denmark Donor Mission MORKEBERG Katrina Denmark Donor Mission KONTTINEN Anu Finland Donor Mission RIPERT Marie France Donor Mission BECK Herbert Germany Donor Mission LA VACCARA Alessandra Italy Donor Mission MIZUNO Mitsuaki Japan Donor Mission HOGERBRUGGE Leonard Netherlands Donor Mission SMITH Jessica New Zealand Donor Mission GRAM-JOHANNESSEN Haakon Norway Donor Mission HALLGREN Jakob Sweden Donor Mission CANGIALOSI Marcello Switzerland Donor Mission DENNISON Simon UK Donor Mission TAYLOR Rick UK DIFID LAVY Rachel UK DIFID KYLOH Nance USA Donor Mission / USAID

1

Global Cluster Leads Retreat Geneva, 13 March 2009

Summary of main recommendations

Cluster Tracking Tool

1. A small group led by the WASH Cluster to review the aim, content and process for using the draft Cluster Tracking Tool, in consultation with agency IM experts, and to report back to OCHA (HCSS) with a revised draft by 31/03/09 (Action: WASH Cluster-WVI)

Guidance on Humanitarian Country Teams

2. The Global Cluster Leads recommend that any IASC guidance on Humanitarian Country

Teams (HCTs) should specify that all clusters and relevant cross-cutting themes should be appropriately represented in HCT meetings. This means that either the country representative of the agency designated as cluster lead agency should wear “two hats” when attending HCT meetings (i.e. the agency hat and the cluster hat), or, where appropriate, a separate person should represent the cluster. OCHA (HCSS) to ensure that this recommendation is presented on behalf of the Global Cluster Leads at the March IASC Working Group meeting. (Action: OCHA)

3. A matrix to be developed mapping responsibilities of and to HCs (and/or RCs), HCTs, OCHA

Heads of Office, Heads of agencies, cluster coordinators and leads of cross-cutting sub-Working Groups during different phases of preparedness and response by 15/05/09. This matrix will provide a reference for further clarification of accountabilities and development of relevant guidance and terms of reference. (Action: Health Cluster)

Inter-cluster coordination (including the role of OCHA)

4. Operational guidance on inter-cluster coordination to be developed in consultation with the

Global Cluster Leads and cross-cutting theme leads by 30/06/09. (Action: OCHA)

5. The ERC to write to IASC Principals by 15/04/09 requesting that job descriptions for country representatives of agencies designated as cluster lead agencies clarify the reporting lines/accountabilities to the HC (and/or RC) in relation to their cluster responsibilities. (Action: OCHA)

Guidance on development of TORs for Cluster Coordinators

6. The draft Generic Terms of Reference for Cluster Coordinators to be revised by the Protection

Cluster, with more focused language on cluster coordinator responsibilities for cross-cutting issues to be provided by UNAIDS and the GenCap Advisor to the Global Clusters. The revised draft will be shared by OCHA (HCSS) with the Global Cluster Leads for further comment before being sent to the IASC Working Group for endorsement. (Action: Protection Cluster to share a revised draft with OCHA by 31/03/09)

7. To accompany the TORs for Cluster Coordinators, an operational guidance note to be

developed to elaborate modalities for cluster co-chair arrangements at country level. (Action: Protection Cluster-NRC to share a draft with OCHA by 24/04/09)

2

Contingency planning and preparedness

8. A meeting of Global Cluster Leads with Co-Chairs of the IASC Sub-Working Group on Preparedness and Contingency Planning to take place by 15/04/09 (Action: OCHA)

9. Recommend to Co-Chairs of the IASC Sub-Working Group on Contingency Planning that one or more of the Global Clusters be invited to join the Sub-Working Group (Action: OCHA)

10. Ensure that information from the IASC Sub-Working Group on Contingency Planning on

upcoming country level contingency planning is made available to the Global Cluster Leads on an ongoing basis. (Action: OCHA)

TORs for Global Cluster Leads

11. A revised Generic TOR for Global Cluster Leads should be developed, based on the existing

TOR provided in Section 4 of the IASC Guidance Note of November 2006 and in conjunction with the development of a standardised mechanism to monitor Global Cluster Lead support to the field. (Action: OCHA and WASH Cluster)

System of reporting to the ERC

12. Request the ERC to chair a meeting of Global Cluster Leads once a year and ensure that Global

Cluster Leads collectively define priority issues in advance of this meeting. (Action: OCHA)

Inter-cluster coordination at the global level

13. OCHA (HCSS) to convene regular meetings of the Global Cluster Leads forum (including one chaired by the ERC), in addition to ad hoc meetings to address specific thematic or operational issues. The frequency of these meetings to be decided. Donors to be invited to one of these meetings each year. (Action: OCHA)

14. OCHA (HCSS) to propose to the IASC Secretariat that the subject of relations between the

Global Cluster Leads forum and the IASC Working Group be tabled for discussion at a future ad-hoc IASC Working Group meeting (Action: OCHA)

15. OCHA (HCSS) to initiate a dialogue between a small group of Global Cluster Lead

representatives and the IASC Secretariat to consider the subject of relations between the Global Cluster Leads forum and the IASC Working Group (Action: OCHA)

Inter-cluster surge mechanism

16. OCHA (HCSS) to complete a mapping and review exercise of Global Cluster Leads surge

mechanisms/capacity, with Global Cluster Leads to provide inputs by 31/03/09. (Action: OCHA)

OCHA (HCSS) 24 March 2009

DRAFT

Head of Lead Agency Cluster CoordinatorAreas of Work

1. Coordination mechanisms and inclusion of all actors within the HC and inter-cluster

Ensures that response efforts are inclusive and coordinated, by regularly convening and leading the Humanitarian Country Team;Ensures that there is an efficient and effective division of labour among relevant organisations for implementing the strategic plan, by securing agreement on the establishment of clusters (sectors) and the designation of cluster leads; Holds cluster leads accountable for the performance of the functions outlined in the IASC Guidance NoteEstablishes mechanisms for inter-cluster coordination

Determine overall direction of humanitarian action; help HC reach decisions on strategic areas of interest; look for solutions to strategic problems coming out of the ICC or specific clusters; support HC in position with government and other actors; help HC understand sectoral and inter-sectoral issues

Share information and build collaboration between clusters/sectors; find solutions to technical inter-cluster issues

Hire dedicated CC; ensure regular meetings are taking place; ensure cluster coordinators attend ICC on behalf of lead agencies

Identify and make contact with sector stakeholders and existing coordination mechanism, including national authorities, national and international organizations and civil society; Hold regular coordination meetings with country cluster partners, building when possible on existing sector coordination fora.: Collect information from all partners on Who’s Where, since and until When, doing What, and regularly feed the database managed by OCHA (4W). Provide consolidated feedback to all partners and the other clusters. ; Represent the Cluster in inter-cluster coordination mechanisms at country/field level, contribute to jointly identifying critical issues that require multi-sectoral responses, and plan the relevant synergistic interventions with the other clusters concerned.

Assure the support services necessary for the effective functioning of the cluster. Use the CLA’s existing working relations with national authorities and with national and international organizations, civil society and non-State actors that are active in the sector to facilitate their participation in the Cluster and relationships with the CC, as needed. Ensure that sectoral coordination mechanisms are adapted over time to reflect the evolution of the crisis and the capacities of local actors and the engagement of development partners. Work within the Country Humanitarian Team to help ensure appropriate understanding and prioritization of concerns and appropriate inter-sectoral/ inter-cluster action, when required.

Text below is taken from the GHC matrix 2. Coordination with national authorities & other local actors

Whenever possible, ensures that all humanitarian action is conducted in support of and in coordination with national and local authoritiesLeads discussion with highest levels of government; ensures government focal points assigned to each cluster; encourages inter-governmental coordination

Determine how to support and coordinate with national and local authorities while upholding the humanitarian imperative and while taking into consideration the local context; Help HC reach decision on any problem areas in relation to government bodies associated with response and clusters; present a unified voice of the humanitarian community vis a vis the government

Work to align inter-cluster work with inter-governmental structures

In coordination with the Humanitarian Coordinator, maintain appropriate links and dialogue with other national and local authorities, State institutions, local civil society and other relevant actors (e.g. local, national and international military forces, peacekeeping forces and non-State actors) whose activities affect humanitarian space and -related programmes.

Consult with the CC/CLA concerning their own relations with key stakeholders in the field.

3. Needs assessment & analysis including identifying gaps

Establishes mechanisms for inter-cluster needs assessmentPromotes an inter-sectoral rapid assessment process to take place within the first week of any crisis; assigns OCHA staff to over see coordination of this process; promotes use of single tool and joint analysis

Determine the overall humanitarian priorities across sectors/clusters based on the findings of the inter-cluster assessment processes; advise HC on sector specific issues and priorities

Work closely under leadership of OCHA to agree on inter-cluster assessment process and tool(s); ensure that specific sectors contribute time, resources, staff for data collection, entry and analysis

Make CLA technical expertise and other resources available for cluster and inter-sectoral assessments, as required. Participate actively in the analysis of available information on status and risks, resources, and service performance, and the ongoing monitoring of these key aspects. Ensure the rapid establishment of an appropriate early warning and response system (EWARS) in coordination with national authorities.

Assess and monitor the availability of services in the crisis areas provided by all actors using GHC tool: Resources Availability Mapping System (HeRAMS).: Ensure that humanitarian needs are identified by planning and coordinating joint, inter-cluster, initial rapid assessments adapting to the local context the IRA tool, as well as follow-on morein-depth sub-sector assessments, as needed: Mobilize Cluster Partners to contribute to establishing and maintaining an appropriate Early Warning and Response System, and regularly report on services delivered to the affected population and the situation in the areas where they work.

Participate in joint assessments and data analysis making staff and other resources available as required and possible. ;Provide regular monthly activity reports on the services supported at all levels of care;Collaborate in assuring prompt EWAR sentinel site reporting from the selected facilities.

4. Strategy development & planning, including: Community based approaches, attention to priority cross cutting issues, and filling gaps

Promotes consolidated humanitarian strategy based on results of assessment/analysis and priority setting as advised by HCT; encourage cluster leads through the HCT to develop concrete coherent action plans that address all issues and agreed evidence-based priorities that tap resources and comparative advantages of all cluster partners and national actors; link to government to ensure alignment of overall strategy and plan with national priorities and efforts; assign OCHA staff to lead this process and develop coherent documentExpends all necessary efforts to ensure that the strategic plan is implemented in a principled, timely, effective, and efficient mannerEnsures that a common strategic vision for humanitarian action in-country is articulated, by leading and coordinating its developmentEnsures that a common strategic plan for realising this vision (CHAP - Common Humanitarian Action Plan - or equivalent) is articulated, based on documented needs and integrating cross-cutting issues (for example age, gender, diversity, human rights, HIV/AIDS, and the environment) and activities in support of early recovery, by leading and development; Expends all necessary efforts to ensure that relief activities lead and contribute to the early as well as long-term recovery of affected populations, by cooperating closely with actors responsible for planning and implementing rehabilitation and development activities.

Determine overall humanitarian strategy; advise HC on how to resolve conflictual issues related to contradictory or duplicative strategies and action plans between clusters

Coordinate cluster strategies and action plans to avoid duplication, overlap or inconsistencies; agree to process for developing one coherent document

Participate actively in gap analysis, priority setting and the development of a crisis response strategy and cluster action plan. Ensure that humanitarian responses build on local capacities and that the needs, contributions and capacities of vulnerable groups are addressed. Ensure that Cluster/sector plans take appropriate account of national policies and strategies and lessons learned from, and incorporate appropriate exit, or transition, strategies. Ensure that opportunities to promote recovery and appropriate re-building of the system are identified and exploited from the earliest possible moment, and that risk reduction measures are incorporated in Cluster strategies and plans.

Lead and contribute to the joint cluster analysis of sector information and data leading to joint identification of gaps in the sector response and agreement on priorities to inform the development (or adaptation) of a crisis response strategy. Provide leadership and strategic direction to the Cluster in agreeing on priorities and strategies, and planning coordinated action to address critical un-covered gaps. In a protracted crisis or sector recovery context, ensure appropriate links among humanitarian actions and longer-term sector plans, incorporating the concept of ‘building back better’ and specific risk reduction measures.

Participate in gap analysis, priority setting and the elaboration of a crisis response strategy and cluster action plan. Ensure that own organization’s project activities contribute to the agreed crisis response strategy and take appropriate account of priority cross-cutting issues. Plan/adapt own activities to contribute to filling identified gaps. Ensure that own organization’s project activities promote recovery from the earliest possible moment, and contribute to risk reduction, where possible

MATRIX OF ROLES AND RESPONSIBILITIES WITHIN THE HUMANITARIAN ARCHITECTURE AT COUNTRY LEVEL

Resident Coordinator (RC)/Humanitarian Coordinator (HC)

Text in red below taken from agreed RC/HC TOR

Humanitarian Country Team (HCT)

Inter-Cluster Coordination Group (ICC)

Cluster Lead Agency (CLA)Cluster Partners

DRAFT

DRAFT

5. Contingency planning (and preparedness)

Ensure that all clusters have developed contingency plans that link into national preparedness plans and capacities; assign OCHA staff to lead this processLeads efforts to improve the response preparedness capacity of national and local authorities and their ability and willingness to work with international organisations;Ensures that the response preparedness efforts of relevant organisations are inclusive and coordinated, by regularly convening and leading the Humanitarian Country Team; Ensures that an inter-agency common planning framework is articulated, by leading and coordinating its development and regular updating; Expends all necessary efforts to ensure that the preparedness efforts envisaged in the contingency plan are implemented, by holding cluster leads accountable for the performance of the functions outlined in the IASC Guidance Note

Determine the overall contingency planning process; provide HC with necessary information to resolve related conflictual issues

Coordinate cluster efforts at contingency planning and feed into overall plan

Participate actively in cluster/inter-agency contingency planning and preparedness for new events or set-backs.

Lead joint Cluster contingency planning for potential new events or set-backs, when required.

Conduct the joint contingency planning for possible future events/set-backs in the areas of operations with the other partners

6. Application of standards Promotes the application of standards among all stakeholders and in particular with national counterparts

Advise HC on standards to promote and their implications to humanitarian action

Advise other clusters on specific standards that should be promoted through information campaigns and community outreach

Ensure that all Cluster partners are aware of relevant national policy guidelines and technical standards, and internationally-recognized best practices. Where national standards are not in line with international standards and best practices, negotiate the adoption of the latter in the crisis areas.

Promote adherence of standards and best practices by all cluster partners taking into account the need for local adaptation. Promote use of the Cluster Guide to ensure the application of common approaches, tools and standards.

Adhere to agreed standards and protocols and promote their adoption in the delivering of services whenever possible

7. Training and capacity building Promotes training and capacity building within and across clusters; promote cluster capacity building of national counterparts.

Inform HC about training and capacity building efforts of individual clusters and inter-cluster efforts

Keep other clusters informed and look for possible areas of joint activities; target cluster partners, national authorities, public servants and civil society

Promote/support training of staff and capacity building of humanitarian partners, and support efforts to strengthen the capacities of the national authorities and civil society to assure appropriate, sustainable services.

Identify urgent training needs in relation to technical standards and protocols for the delivery of key services to ensure their adoption and uniform application by all Cluster partners. Coordinate the dissemination of key technical materials and the organization of essential workshops or in-service training.

Ensure that own staff are adequately trained for the activities undertaken; Identify own training needs, make these known, and assign staff to attend trainings as and when opportunities are made available; Collaborate in organizing training for staff of local actors and other partners, making trainers and other resources available when possible

8. Monitoring and reporting Assigns OCHA staff member to develop regular sitrepsEstablishes mechanisms for inter-cluster monitoring and evaluation

Alert HC and other agencies/leads on concerns Coordinate efforts, share information, feed into OCHA sitreps

Produce and disseminate Cluster sitreps and regular Bulletins using CC input. [Communications Officer]; Advocate for donors to fund priority activities of all Cluster partners. Represent the interests of the sector in discussions with the Humanitarian Coordinator and other stakeholders on priorities, resource mobilization and advocacy.

Ensure partners’ active contribution to and involvement in joint monitoring of individual and common plans of action for interventions; collate and disseminate this and other information related to the sector in Cluster sit-reps and/or regular Bulletins.

Participate in defining and agreeing on any information and reports that Cluster partners should provide to the CC, and provide such information and reports a timely manner; Contribute to overall Cluster efforts to advocate for appropriate attention to all public needs (and humanitarian principles in general).

9. Advocacy and resource mobilization, including reporting

Expends all necessary efforts to ensure that the strategic plan is funded sufficiently and in a timely manner, by promoting and locally leading inclusive resource mobilization efforts (e.g. CAP, Flash Appeals), overseeing CERF grant applications, and managing in-country humanitarian pooled funds (e.g. CHF, ERF) where they exist;Expends all necessary efforts to obtain free, timely, safe and unimpeded access by humanitarian organisations to populations in need, where appropriate, by leading and/or promoting negotiations with relevant parties, including non-state actors;Promotes the respect of international humanitarian and human rights law by all parties, including non-state actors, by coordinating the advocacy efforts of relevant organisations and using private and/or public advocacy as appropriate; Expends all necessary efforts to ensure that Member States, regional organisations, UN entities (including integrated UN presences), civil society, the private sector, the media and other relevant actors take humanitarian concerns into due account, by coordinating the advocacy efforts of relevant organisatiprivate and/or public advocacy as appropriate

Provide HC with information on issues of particular concern; funding constraints, common issues of concern needing government or donor action

Discuss issues of concern, provide issues to HCT and possible solutions

Provide information regularly to the news-media and, where consensus points are agreed with cluster partners, represent the Cluster in press conferences, interviews, etc.

Provide leadership and strategic direction to the Cluster in developing the sector components of FLASH Appeal, CHAP, CAP and CERF proposals and other interagency planning and funding documents.

Present own activities in the context of the overall sector effort whenever possible and appropriate; Emphasize the important of – and own commitment to – coordination and collaboration

10. Provider of Last Resort, POLR

Ensures that CLA fulfil obligation of POLR Discuss gaps, need for POLR, constraints, give voice to participants other than CLA over related concerns, gaps

Identify priority gaps that might be addressed in coordinated way by more than one cluster lead agency; other resources available

Act as the provider of last resort (subject to access, security and availability of funding) to meet agreed priority needs. Inform the Humanitarian Coordinator and CLA’s own headquarters of resource needs and work with them to secure the necessary resources.

Inform the CLA Representative of priority gaps that can not be covered by any cluster partner and require CLA action as provider of last resort.

Call attention to the need for activation of the POLR function, when needed.

DRAFT

Activity Budget

Staff Budget (staff recruited

by GHC)

ECHO pledge (for GHC 2009-2010) Funding Gap

1Establish core curriculum for all GHC trainings and workshops on humanitarian reform, humanitarian principles and principles of partnership -$

-$

2 Contribute to the development and implementation of OCHA-led workshops and e-learning initiatives -$

$180,000.00 $ 188,000.00 8,000.00-$

3 Conduct workshops for Regional Directors, DPM and WHO country representatives in countries with Humanitarian Coordinators 100,000$

<This equals one P4 levelstaff (100%) preferablybased in NGO partner

agency at HQ level>100,000.00$ -$

4 Support in designing and conducting of regional or sub-regional and country level training and workshops (including NGO cluster workshop 28-30 January 2009 funded by 2008 work plan) 270,000$

270,000.00$

5

Further develop HCC training curriculum to include learning on humanitarian reform; humanitarian principles and principles of partnership; best practices; guidance on developing stronger local and national capacities; issues relevant for protracted complex emergencies such as civil-military collaboration, health sector recovery and risk reduction; cross-cutting and cross-cluster technical issues; CAP Flash and CERF; GHC positions and policies; and ensure translation and printing of materials

30,000$ <Part of line 2> 30,000.00$

6 Finalize development of core indicators and have consensus meeting; link to revision of Sphere Standards 80,000$ 80,000.00$

7Produce a peer-reviewed selection of suggested health sub-sector assessment tools with documented effective field utilization 30,000$ 30,000.00$

8 Complete the IT Support Platform to increase inter-operability of HeRAMS -$ 225,500.00$ 239,500.00$

9 Format, translate, print and widely disseminate provisional Health Cluster guidance and tools 300,000$ 120,000.00$ 180,000.00$

10 Support the extensive field utilization of the provisional Health Cluster guidance and tools 180,000$ 180,000.00$

11Develop training strategy and training package for GHC guidance and tools (in collaboration with WG on Country Support) 100,000$ 100,000.00$

12 Conduct trainings in guidance and tools with priority on Training of Trainers at various levels 250,000$ 250,000.00$

13Promote and provide technical support for field use, local adaptation and full utilization of IRA and HeRAMS tools in at least 8 humanitarian crisis during 2009 100,000$ 40,000.00$ 60,000.00$

14 Monitor and evaluate the effectiveness and impact of the provisional Health Cluster guidance and tools (also applies to Strategic Priority 4)

-$ -$

15Identify and review lessons learned based on outputs of activity 13 above to finalize Health Cluster guidance and tools -$ -$

16Conduct two health cluster coordinator training courses and/or support regional HCC training courses; ensure that all HCC trainings consistently use standard selection criteria, curriculum and assessment of candidates; make available GHC resource persons

420,000$ <Part of line 2> 180,000$ 240,000.00$

100,000$ 100,000.00$

<This equals one P4 levelstaff (50%) based in WHO

Geneva> -$

18Explore ways to increase stockpile coordination at global and country levels and identify related action points -$ -$ -$

19Based on literature review, develop and disseminate GHC position papers, with recommendations for action, on at least two specific humanitarian health issues 150,000$ -$ 70,000.00$ 80,000.00$

20Revise JCM concept note; establish criteria for choosing JCM countries; establish mechanism for follow upon recommendations; conduct at least 4 JCM (each with context specific TOR) 180,000$ 25,000.00$ 155,000.00$

21Document lessons learned from trainings and workshops as basis for ongoing improvement; develop training quality assurance mechanisms -$ -$

22 Hold 1 meeting for experienced HCC 200,000$ 200,000.00$

23 Contribute to and follow up on the cluster evaluation phase II process -$ -$ -$

24 Ensure mechanisms for transparent dialogue, knowledge sharing and coordinated joint action -$ 350,000$ 188,000.00$ 162,000.00$

25Hold two GHC meetings, one in Geneva with WHO regional advisors and one in Nairobi with representatives from regional health clusters 50,000$ 70,000.00$ 20,000.00-$

26 Donor relations, related meetings and resource mobilization -$

Total Budgets: Activities / GHC Staff 2,440,000$ 1,445,000$ 1,206,500.00$ 2,678,500.00$

17

Activity

GHC WORK PLAN AND BUDGET 2009, AVAILABLE FUNDING AND FUNDING GAP

Develop and guide the management of the GHC roster and produce operational guidance (SOPs) on how to request a HCC -$

$ 465,000.00 <This equals one P5 levelstaff (100%) and one P3 level staff (70%) based in

WHO Geneva, and one P4 level staff (100%) preferably

based in NGO partner agency at sub-regional

level>

<Part of line 2>

3,885,000$

<This equals one professional and support

staff (100%)>

GRAND TOTAL

Donor Workplan items Australia Canada Finland Norway Sweden Total

Guidance and tools 62,181 57,114 165,618 $284,913

Mental Health Guidance 63,819 11,181 $75,000

Joint Country Missions 36,000 175,543 $211,543

HCC Training 242,591 20,000 32,568 $295,159

NGO Workshop 5,000 121,464 $126,464

Horn of Africa Workshop 98,168 $98,168

GHC meetings 4,143 57,881 $62,024

Secretariat 359,571 11,180 $370,751

HNTS 267,996 $267,996

Overheads 36,245 15,023 35,362 14,415 32,369 $133,414

Total $409,836 $283,019 $540,540 $220,339 $471,698 $1,925,432

Resume of Global Health Cluster Expenditure 2008

GlobalHealth Cluster

IASCInter-Agency Standing Committee

Participant List

Meeting 9-10 June 2009 Conference Centre Varembé, Geneva

1. Oleg Bilukha

2. Muireann Brennan Centers for Disease Control

3. Eba Pasha Columbia University

4. Rachel Lavy Department for International Development UK

5. Taher Fawzy Halawa Emergency Relief Agency

6. Johan Heffnick European Commission Humanitarian Aid Office

7. Pierre Salignon Health and Nutrition Tracking Service (Observer)

8. Philippa Parker International Committee of the Red Cross (Observer)

9. Mary Pack International Medical Corps

10. Anita Davies International Organization for Migration

11. Sandro Colombo

12. Emmanuel d'Harcourt International Rescue Committee

13. Marlou den Hollander Marie Stopes International (Observer)

14. Linda Doull

15. Gillian O'Connell Merlin

16. Nichola Cadge

17. Chris Lewis Save the Children, UK

18. Edith Cheung

19. Anne Golaz

20. Robin Nandy

United Nations Children's Fund (UNICEF)

21. Hervé Isambert

22. Paul Spiegel United Nations High Commissioner for Refugees (UNHCR)

23. Wilma Doedens United Nations Population Fund (UNFPA)

24. Sandra Krause Women's Commission for Refugee Women and

Children

25. Marvin Birnbaum World Association for Disaster and Emergency Medecin

26. Mesfin Teklu World Vision International

27. Sophia Craig World Health Organization Country Office for

Afghanistan

28. Kalula Kalambay

29. Omar Khatib World Health Organization Regional Office for Africa

30. Jean-Luc Poncelet World Health Organization Regional Office for the

Americas

31. Altaf Musani

32. Irshad Shaikh

World Health Organization Regional Office for Eastern

Mediterranean

33. Gerald Rockenschaub World Health Organization Regional Office for Europe

34. Roderico Ofrin World Health Organization Regional Office for South-

East Asia

35. Art Pesigan World Health Organization Regional Office for the

Western Pacific

36. Pino Annunziata

37. Samir Ben Yahmed

38. Rudi Coninx

39. Erin Kenney

40. Eric Laroche

41. Linda Larsson

42. Daniel Lopèz-Acuña

43. Heather Papowitz

44. Jukka Sailas

45. Mark Van Ommeren

46. Nevio Zagaria

World Health Organization Headquarters