WHO’s Involvement in the Regional Inter-Agency Coordinating Support Office (RIACSO) for the Southern African Humanitarian Crisis
Managing Information and Producing Public Health Knowledge
By John Clarke, WHO- Information Officer, UN Regional Inter-Agency Support Office
In March 2002, a UN Inter-agency Standing Committee monitoring the vulnerability of the Southern African region to adverse weather effects found that six countries – Lesotho, Malawi, Mozambique, Swaziland, Zambia and Zimbabwe – were at risk of severe food shortages. Dr Kofi Annan appointed World Food Programme Executive Director James Morris, as his Special Envoy to lead the UN response to what was emerging as a major Southern African Humanitarian Crisis. In collaboration with the Southern African Development Community (SADC) an Interagency Consolidated Appeal for emergency assistance to these countries was launched. A Regional Inter-agency Coordinating Support Office (RIACSO) was established in Johannesburg to ensure cohesion and complementarities between UN programmes and specialised agencies. This briefing outlines the World Health Organisation’s role within the RIACSO team.
The stated goal of the World Health Organisation’s contribution to the Southern African Crisis response reads:
"In the countries mostly affected by the current humanitarian crisis, WHO will work with the Ministries of Health (MOH) and the partners from the health sectors and from the other sectors, to reduce the avoidable loss of life and the burden of disease in this crisis. To achieve this, WHO - through its country offices and the regional inter-country team in Harare- will at the regional level and specifically in the countries mostly affected, work on ensuring a Public Health approach for optimal and immediate impact"1. (WHO: 2002)
WHO Convenes Health Ministers Meeting.
Dr Ebrahim Samba, WHO AFRO Regional Director, invited all health ministers from Southern African Countries to a special meeting in late August 2002 to examine the response of the health sector to what was recognised as "the acute and large-scale humanitarian crisis facing the region."
Ministers and senior health officials met in Harare to explore ways to intensify and accelerate the response of health systems to the current situation in the region through containment of potential increase in disease burdens, and helping to prevent loss of life.
Some of the immediate challenges agreed on at the meeting were the impact of HIV/AIDS, availability of food, supply of clean drinking water and the need to ensure that health systems are working and delivering accessible and essential health services to the people.
Dr Gro Harlem Brundtland, Director General of WHO participated in the meeting, adding WHO’s voice to the appeal for action:
"People's survival and sustainable development are at stake. Our actions today have the potential to save hundreds of thousands of lives and to shape the future of this sub-region.
"We want to enable the people affected by this crisis to be able to look forward to healthy livelihoods once the worst is over.
"We want health services to have improved, not deteriorate, after this crisis is over."
She pledged WHO's commitment to developing effective partnerships with national governments, donor agencies, NGO’s and the private sector, to ensure an effective long term response.
* From DFID Revolving Fund.
WHO participated with the World Food Programme, Unicef, UNDP, FAO, UNAIDS, and the UN Office for the Coordination of Humanitarian Affairs (OCHA) in launching a UN Consolidated Appeal (CAP). The health component of the CAP amounted to $US 48,2 million. WHO appealed for $US 19,6 million. By mid January 2003, approximately 28.4% of the appeal had been funded with the following donor countries committing funds as follows.
In addition WHO's response is being supported through reprogramming regular country cooperation activities, through special grants (initially $300,000) from the Director General's and Regional Director's development fund, and through contributions from the Government of Italy rapid response arrangement.
Special Envoy’s First Mission, Sept 2002.
After the Health Ministers Meeting, Dr David Okello – WHO Representative to Swaziland – travelled with the Special Envoy as part of his mission team to the affected countries from 3-15 September 2002.
WHO’s participation served to emphasise the health dimension of the crisis. It was observed that the health services of the affected countries were struggling with staffing shortages (nurses and other health professionals were being "poached" from many of the countries, travelling to South Africa and other countries for better employment conditions), shortages of drugs especially for epidemic prone diseases, and the diminishing capacity of health surveillance systems. Moreover the HIV/AIDS pandemic added a burden of responsibility for the Health Services, challenging the prevailing paradigm of humanitarian assistance and demanding a more cooperative way of working that overcame fragmentation between sectors, agencies and departments.
WHO’s strategic approach:
From experience gained over many years of experience in assisting member countries in emergencies, WHO advocates that in the current nutritional and health crisis action should be geared as follows.
1. Countries must be enabled to mount appropriate responses at all levels: this goes from tackling prevailing causes of morbidity among children and women, to stemming the skill drain and handling public concerns, e.g. about the health consequences of consuming Genetically Modified food.
2. Up to date information must circulate regularly and widely: on health (mortality, morbidity -in particular communicable diseases- and malnutrition) and access to essential health services among different communities.
3. The responses to the health and nutritional aspects of the crisis must be effectively coordinated. This implies optimising the comparative advantages of all partners, using evidence-based strategies and seeking maximum service coverage within available resources.
4. Health systems must reach those in need as close as possible to their actual residence with adequate supplies of medicines and appropriate foods for nutritional rehabilitation, so to minimise the risks associated to people's displacement and concentration. The capacity to respond to specific health problems - including disease outbreaks - must be put in place as close as possible to where it is actually needed.
Accordingly WHO is:
WHO- RIACSO’s Challenge for 2003. Activating Health Intelligence Networks.
In the same way that a personal medical emergency provides an opportunity for individuals to develop better personal health strategies, so can countries respond to national emergencies by developing more effective public health policies and practices. The diagram below summarizes the logic that underlies WHO’s approach to disasters, and makes the important distinction between hazards, emergencies and disasters. Clearly, information needs differ between emergency response planning, contingency planning and disaster prevention planning.
Crucially, to work at the fundamental level of Development, Disaster Prevention and Preparedness Planning, requires an information network that is finely tuned to ‘the differences that make a difference’ among the most vulnerable people, and to guide interventions to amplify and affirm local support mechanisms that keep people alive and healthy, so that hazards – whether natural or man-made – don’t degenerate into disasters. An effective management response to emergencies is the key to preventing disasters.
Thus WHO- RIACSO’s challenge for 2003 is to activate and open up information feedback loops that track indicators to create knowledge and understanding, geared towards a long term preventative approach, that ensures robust methods and strategies for handling emergencies. This means focusing more on what keeps people alive and healthy, rather than what makes them sick, and developing ways of reducing vulnerability to hazards.
This diagram illustrates this challenge graphically.
The Special Envoys previous mission found that the health surveillance network of most affected countries were weak and had failed to detect critical health problems, having been undermined by the very crisis that they are aimed at addressing. It is hoped that the main legacy that WHO- RIACSO will leave after the crisis is over, will be a reinvigorated and robust health surveillance and education network, that contributes toward an integrated information management system that combines health and other indicators (agricultural yields, local environmental footprint indicators, etc), into a rich picture for each country to use in its path to recovery.
i Health Brief on Southern Africa Humanitarian Crisis, Department of Emergency and Humanitarian Action, August 2002.
ii 'Drought Reduces Gains in Health',The Herald (Harare) September 3, 2002
iii HUMANITARIAN CRISIS IN SOUTHERN AFRICA: an opportunity for health action, Draft Report, focussing on health issues, Prepared by: DR. DAVID O. OKELLO, WR/Swaziland, October 2002
iv Health in Emergencies, Issue No 15, World Health Organisation, December 2002