Programmes in disaster risk reduction

All-Hazard approach entails developing and implementing emergency management strategies for the full range of likely risks and emergencies (natural, biological, technological and societal). A Whole-Health approach emphasizes that emergency planning processes, overall coordination procedures, surge and operational platforms should be unified under one emergency preparedness and response unit so that the plans of the health sector can then be effectively coordinated with other sectors as well as with the designated. The World Health Assembly will be considering adoption of an Executive Board Resolution on “Strengthening national and community health emergency and disaster management capacity and resilience of health systems” in May 2011. The World Health Assembly (WHA) has adopted a number of resolutions in the past which are relevant to disaster risk reduction. WHA Resolution 58.1 (May 2005) drew on experiences and lessons learned from major crises and the outcomes of the World Disaster Reduction Conference in Kobe in 2005. This Resolution urged Member States to make their best efforts to engage actively in collective measures to establish global and regional preparedness plans that integrate risk reduction into the health sector and to build capacity to respond to health related crises. It also requested Member States to formulate national emergency preparedness plans that give due attention to public health, including health infrastructure, in order to mitigate the damage and loss of function associated with events related to hazards and to improve the effectiveness of responses to crises and contributions to the recovery of health systems.

In 2006, WHA Resolution 59.22 reiterated the importance of action needed to build national capacities in emergency preparedness.

Resolutions have been passed by every Regional Committee over the past 20 years to reinforce the mandate given to WHO and to strengthen initiatives in the area of emergency preparedness and response in Member States. In 2010, the Regional Committee for the Eastern Mediterranean adopted Resolution EM/RC57/R.2 which urges Member States to integrate health in all national emergency management and disaster risk reduction programmes, and to integrate emergency preparedness and risk reduction in all health development programmes. The Directing Council of the Pan American organisation, by adopting Resolution CD50.R15, approved a Plan of Action on Safe Hospitals, and urged Member States to prioritize adoption of a national safe hospitals policy. In 2009, Ministers of Health of the South-east Asian Region endorsed the Kathmandu Declaration on Protecting Health Facilities from Disasters, which includes a commitment to the implementation of the Hyogo Framework for Action.

Strategic Objective 5 of WHO’s Medium-Term Strategic Plan (MTSP) for 2008-2013 is: “To reduce the health consequences of emergencies, disasters, crises and conflicts, and minimize their social and economic impact.” The 2010-2011 biennial global work plan recognizes the crucial importance of supporting countries in the areas of health sector risk reduction and emergency preparedness, and building institutional capacity in WHO for emergency preparedness and response.

International Health Regulations (IHR 2005) came into force in June 2007. The agreement provides a framework for the coordination of the management of events that may constitute a public health emergency of international concerns, and will improve the capacity of all countries to detect, assess, notify and respond to public health threats. This includes efforts from WHO and partners to build capacity to reduce risks and respond to pandemics through a multisectoral approach. The Global Work Plan on Climate Change and Health and the WHO guidance and advocacy materials describe disaster risk reduction as a key climate change adaption measure. The Global Health Cluster has endorsed a guidance Note which promotes the need for a coordinated approach of Global Health Cluster partners in support of health emergency preparedness and risk reduction at national and local levels, and recommends that the roll-out of country-level Health Clusters should take fully into account of national arrangements and existing capacities for emergency preparedness and response.

HFA Priority for Action 1

Making disaster risk reduction a policy priority, institutional strengthening

WHO develops health-related standards and guidelines and provides technical assistance to national health authorities for the development of risk reduction and emergency preparedness capacities in countries at risk. WHO supports Member States in identifying policy options, strategies and enabling legislation required for enhancing the levels of health risk reduction and emergency preparedness, including prevention, preparing for and responding to the health effects of climate change.

WHO works to ensure that health dimensions are addressed within the context of global and regional risk reduction frameworks, including support for ISDR system and the implementation of the Hyogo Framework for Action and integrates disaster risk reduction and emergency preparedness across WHO’s programmes. At the International Day for Disaster Reduction event in 2009 hosted by the United Kingdom’s Health Protection Agency, the joint ISDR/WHO thematic platform on disaster risk reduction for health was launched. The platform aims to build a multi-disciplinary and multi sectoral community to advocate, share information and catalyse action on risk reduction for health, and implement the Hyogo Framework for Action through the health sector. WHO-AMRO/PAHO has had a long-standing Emergency Preparedness and Disaster Relief Programme (PED) and over the years, AMRO/PAHO’s Directing Council also has passed a number of Resolutions calling on 35 Member States to strengthen their emergency preparedness and response capacity and to focus attention on health facilities in their national risk reduction policies. Other Regional Offices have been steadily increasing their efforts to support capacity building in terms of national health emergency management systems building, mass casualty management, safe hospital construction and training at national, regional and global levels. WHOEURO and WHO-WPRO has active programmes to support country capacity development in these areas.

WHO-SEARO has developed a set of benchmarks, standards and indicators, with the objective to fully integrate the health sector risk reduction strategies in the health system of Member States, which can catalyse action and monitor progress on risk reduction and emergency preparedness.

WHO-EMRO has developed an Optimum WHO Risk Reduction and Emergency Preparedness Package which has identified elements for country risk reduction, readiness and response to emergencies.

WHO has conducted a Global Assessment of National Health Sector Emergency Preparedness and Response, which is intended to inform strategies for assisting Member States in developing and strengthening national approaches to health emergency preparedness and response. A second global assessment will be conducted in the next biennium.

HFA Priority for Action 2

Risk assessment and early warning systems

WHO supports Member States in assessing and monitoring baseline information on the status of risk reduction and emergency preparedness in the health sector at regional and country level. Technical assistance has been requested by the Member States on environmental health, surveillance mechanisms and the development of surge capacities and capabilities.

WHO has also developed capacity assessment tools that can contribute to capacity assessment of health emergency systems for risk reduction and emergency preparedness. WHO-EMRO has developed the e-Atlas of disaster risk for the Eastern Mediterranean Region: Exposure to natural hazards, Volume 1. The Atlas uses geographic information systems and various disaster models to assist disaster management decision-makers to reduce health risk to vulnerable populations. Subsequent volumes which are still under development will focus on vulnerability and risk and capacity assessments, in order to improve risk reduction and emergency preparedness in the health sector.

WHO has established the Vulnerability and Risk Analysis and Mapping (VRAM) platform within the WHO Mediterranean Centre for Health Risk Reduction (WMC) in Tunis. The objective of the VRAM platform is to support countries in developing the capacity to assess health risks (mortality, morbidity and disability) and incorporate the results in emergency and response preparedness planning. As its knowledge base grows, VRAM’s goal is to become a network of excellence in assessing health-related vulnerabilities and risks supported by a technical unit whose expertise can be utilized effectively by various partners (governments, UN and research organizations, NGOs or others) at an affordable cost. VRAM activities include partnership with organizations through the Global Risk Identification Programme (GRIP).

HFA Priority for Action 3

Education, information and public awareness

WHO works with Member States and other partners to improve skills and knowledge in risk reduction and emergency preparedness and response in the health sector. The work focuses on two main areas: (1) Developing and updating guidelines, standards and sound technical information on emergency preparedness and response; and (2) Promoting the development of sound and credible training and educational materials and the organization of courses, workshops, simulations, other mechanisms of transfer of knowledge, and platforms where health emergency managers can share experience and material at local, national, regional and international levels.

Extensive work by all WHO Regional Offices and WHO-HQ has resulted in a number of guidelines and tools for emergency preparedness and response, available on the websites of WHO/HAC and the Regional Offices:

• Community Emergency Preparedness: A Manual for Managers and Policy-Makers; Mass Casualty Management Systems: Strategies and guidelines for building health sector capacity; and Older People in Emergencies: Consideration for Action and Policy Development.

• In Latin America and the Caribbean, Member States with strong and sustained support by WHO/PAHO and the governments of the U.S. (USAID) and Canada (CIDA), multilateral and non/governmental organizations, have produced a large body of technical publications and guidelines over more than 20 years, including the Health Library in Disasters (HELID) and tools such as the Hospital Safety Index, a tool for countries to assess risk and vulnerability in health facilities.

• The Regional Disaster Information Center (CRID) has published a CDROM with a large collection of documents from different agencies regarding climate change, disasters and health.

• WHO-EURO has developed a capacity assessment tool for evaluating country capacities for crisis management in after extensive field testing in Member States of the European Region.

• WHO-SEARO has developed extensive information on emergency preparedness and response, including case studies on recent emergencies in India, Indonesia, Bangladesh and Sri Lanka. The

Region has developed Hazard Profiles and Disaster Preparedness in SEAR Countries. A report of a regional consultation on Emergency Preparedness and Response: From Lessons to Action contains updated information and recommendations for action for the countries in the region.

• WHO-WPRO has developed a number of emergency guidelines and tools, including a pocket emergency manual which contains a section on preparing for emergencies. It has also produced Field Manual for Capacity Assessment of Health Facilities in Responding to Emergencies.

Training focuses on awareness raising, advocacy and sensitization on risk reduction and emergency preparedness health issues, planning processes, needs assessment in emergencies, inter-sectoral emergency management and standardizing and building technical skills within all health disciplines involved in emergency preparedness and response:

• WHO-SEARO and WPRO have a Public Health and Emergency Management in Asia-Pacific Programme with the Asian Disaster Preparedness Center (ADPC) which provides training courses at bioregional and national levels for the development of health system capacities to prepare for and respond to emergencies. EMRO have a similar programme - Management of Public Health Risks - which has been conducted at regional and national levels, while EURO have conducted a regional PHEM-EURO course.

• WHO-HQ and Regional Offices organizes Public Health Pre-deployment Training courses which prepare health professionals to work effectively in providing health programmes to populations affected by emergencies, disasters and other crises.

HFA Priority for Action 4

Reducing underlying risk factors

References are provided above to WHO’s policy commitment and continuing support for country programes to make hospitals safer and better prepared for emergencies and disasters. The World Disaster Reduction Campaign 2008-2009 “Hospitals Safe from Disasters: Reduce Risk, Protect Health Facilities, Save Lives” led by WHO and the UNISDR, with support from the World Bank was aimed at building the resilience of hospitals and other health facilities to disasters, and on making sure health workers are prepared, so that they will be functional under emergency situations.

WHO also dedicated World Health Day 2009 to the theme of health facilities in emergencies. Through WHD 2009, WHO promoted the safe design, building and operation of all types of health facilities so they (and their staff ) can withstand any type of emergency and the emergency preparedness of health facilities to provide health care services during the emergency and in their aftermath.

The campaign provided a platform for strengthening of hospitals, health facilities and systems in the context of risk reduction and emergency preparedness and response. The campaign also provided visibility and a platform for advocacy on risk health reduction and emergency preparedness at global, national and community levels.

HFA Priority for Action 5

Preparedness for effective response

WHO promotes the establishment or strengthening of a risk reduction and emergency preparedness unit in each Ministry of Health reporting directly to the highest relevant authority. This unit works as the focal point for the designated national emergency management agency and for other sectors involved in emergency preparedness and response. WHO advocates that proper preparedness requires improvement and protection of the baseline capacities including health care facilities, services and skills. WHO assists Ministries of Health to integrate emergency preparedness into existing community structures. The strategy to support all-hazard emergency preparedness for the communities includes joining forces with UN agencies, non-government organizations, development cooperation partners, academic institutions and other partners to reduce risks to public health, facilities and health systems. WHO and partners are focusing on advocacy and measures to scale up the community-based health workforce for health emergency risk management.

WHO is the designated lead of the Global Health Custer, the role of which is to build global capacity for humanitarian health action by developing global guidance, standards, tools and resources to inform, enhance and facilitate the implementation of the Cluster Approach at the country level as well as to improve surge capacity, access to trained technical expertise and material stockpiles to improve response operations. The strengthening of the preparedness capacity of countries and communities particularly at risk before emergency strikes is a major part of the cluster approach. Risk reduction is integrated in the health component of Post-Disaster Needs Assessment tools and processes. This ensures that planning for disaster recovery and reconstruction will take account of measures to reduce health risks, and strengthen health emergency risk management capacities as part of building the resilience of health systems.

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