Global Health Cluster Orientation Package Module 2: Introduction to the Health Cluster Explain that this is the second of 4 modules: the other 3 are: Module 1: Background and principles of Humanitarian Reform Module 3: Humanitarian Financing Module 4: Guidance, Tools and Resources

Module 2: Learning Objectives On completion of this module participants will have a good understanding of the: Role, functioning and membership of the health cluster at global and country level Roles and responsibilities of all stakeholders at global and country level Explain that these are the learning objectives for this module

The Health Cluster Guide World Health Organization 19 April 2017 The Health Cluster Guide The Global Health Cluster has developed a practical guide for country-level implementation of the Health Cluster Available in English and French: www.who.int/hac/global_health_cluster/guide online hard copy CD/ROM The modules are primarily based on the Health Cluster Guide (HCG). Ideally participants will have access to a copy of the HCG. Go through how to access one: e.g. How to get a hard copy from own agency, request hard copies from the Global Health Cluster Secretariat healthcluster@who.int , or on line at the link above. Say also that the HCG will be updated in 2011 and that the GHC welcomes feedback which should be forwarded to the GHC Secretariat healthcluster@who.int This orientation package will also be updated from time to time on the WHO website, so check that you have the most recent version 3

What is a “Cluster”? A group of agencies (international & national) that are interconnected by their respective mandates, and that come together around a set of humanitarian interventions in a common area, for purposes of synergies, surge, effectiveness, efficiency, and accountability. The Cluster Approach is one of the three “pillars” of Humanitarian Reform, i.e.. 1. Strengthening Humanitarian Coordination 2. Strengthening Humanitarian Financing 3. The Cluster Approach – to provide adequate capacity and predictable leadership in all sectors

The role of a Cluster is to: Identify and address gaps Strengthen humanitarian partnerships Ensure predictability and accountability by clarifying the division of labour among agencies, and making the humanitarian community more accountable

The Health Cluster does this by: Improving the predictability, timeliness, effectiveness of a response Improving accountability Preparing recovery efforts Setting higher standards Providing global support

The Health Cluster Operates at: Global level Country level - in some contexts at national and sub-national level Global Level – The Secretariat is based in Geneva healthcluster@who.int

The Global Health Cluster Forum of the Inter Agency Standing Committee (IASC) and comprised of key international health entities mandated to build global humanitarian response capacity The WHO is the lead agency and is accountable to the Emergency Relief Coordinator IASC: A special unique interagency forum composed of UN and Non UN partners – comes under UN Emergency Relief Coordinator. Has responsibility for policy development and revision of responsibility on various aspects of Humanitarian Assistance and identifies gaps in response. Composed of NGO consortia, Red Cross and Red Crescent Movement, IOM, World Bank and UN agencies Humanitarian agencies acknowledged that no single agency can cover all humanitarian needs A recognition that IASC led reform needed broader support from all partners

The Global Health Cluster (2) Made up of 39 full members and 4 observers Two Working Groups made up of partners and co chaired by WHO and an international NGO: Technical – development of guidance and tools, country support missions, Health Cluster Coordinator Training Policy and Strategy - development of position papers on User Fees, Civil /Military Collaboration Technical Working Group – has developed the Health Cluster Guide, health cluster tools, facilitated country support missions for awareness raising, capacity building and evaluation, and the design and delivery of Health Cluster Coordinator training courses. Policy and Strategy Group – develops and implements strategy and policy and GHC position papers. Global Health Cluster position papers The position papers developed by the GHC Policy and Strategy team aim to provide guidance to policy makers and other health actors in humanitarian crises. The first GHC position paper 'User Fees in Humanitarian Situations' was finalized in the beginning of March, 2010 and the development of a second paper exploring 'Civil Military Cooperation' has begun. The foundation for the position paper on user fees are the Humanitarian Principles which states that humanitarian interventions should be provided 'based on needs alone', should be accessible without discrimination and should be affordable to all. Therefore, access to Primary Health Care needs to be provided to the most vulnerable and excluded groups. The position paper - on User Fees - provides guidance for the removal of user fees for the provision of primary health care services during humanitarian crises. The Global Health Cluster partners have jointly prepared the position paper and it will be available shortly. The next position paper will explore civil-military coordination in humanitarian situations, a recurrent issue that is of great importance today. The GHC Policy and Strategy team aims to provide insight to the problematic situation that many partners face while working at country level and to provide guidance on how to coordinate with military actors in a humanitarian health response.

The Global Health Cluster (3) Builds consensus on humanitarian health priorities and related best practices, and strengthen system-wide capacities to ensure an effective and predictable response by ………..

Strategy and planning at global level Providing guidance and tools, and standards and policies Establishing systems and procedures for the rapid deployment of experts and supplies Building global partnerships to implement and promote this work

Members of the Global Health Cluster UN Partners FAO UNFPA UNHCR UNICEF Non-UN Partners African Humanitarian Action American Refugee Comm CARE Catholic Relief Service Center for Disease Control Columbia Concern Worldwide ECHO Handicap Intl Harvard Help Age Intl IFRC IOM ICMH Intl Council of Nurses Intl Medical Corps Intl Rescue Committee Johns Hopkins Medecins du Monde Merlin OFDA Save the Children, US/UK Terre des Hommes WADEM Women's Commission World Vision International Observer ICRC Interaction MSF Sphere Project Agencies wishing to joint the Global Health Cluster should contact the Secretariat in Geneva at:

Health Cluster Activation AFRO (10) Burundi CAR Chad Côte d'Ivoire DRC Eritrea Ethiopia Sudan Guinea Kenya Liberia Niger Uganda Zimbabwe EURO (2) Georgia Tajikistan EMRO (6) Afghanistan Iraq OPT (Palestine) Pakistan Somalia Sudan Yemen PAHO (2) Colombia Haiti SEARO (5) Indonesia Myanmar Nepal Sri Lanka Timor-Leste Based on WHO regions: AFRO - Africa EMRO – Eastern Med SEARO – South East Asia EURO - Europe PAHO – Pan American Countries in italics are where the Health Cluster has been deactivated.

Health Cluster Activation Dedicated HCC with NGO involvement in coordination Democratic Republic of the Congo, Haiti, Myanmar, Somalia, Philippines Double hatter HCC Bangladesh, Burundi, Central African Republic, Colombia, Côte d'Ivoire, El Salvador, Ethiopia, Guinea, Honduras, Indonesia, Kenya, Lao People's Democratic Republic, Liberia, Madagascar, Mozambique, Nepal, Niger, Samoa, Sri Lanka, Timor-Leste, Uganda Dedicated HCC Afghanistan, Chad, Dominican Republic, Georgia, Iraq, Lebanon, occupied Palestinian territory, Pakistan, Sudan, Tajikistan, Yemen, Zimbabwe Countries where the cluster approach is implemented with a Humanitarian Coordinator are listed in normal text. Countries where the cluster approach is implemented with Resident Coordinator are underlined. HCC – Health Cluster Coordinator Double Hatter – HCC role combined with Emergency Health Officer Source WHO: The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.

The Health Cluster at country level The Health Cluster can be activated in a country with a Humanitarian Coordinator in case of a sudden major new emergency requiring a multi-sectoral response. The humanitarian architecture is complex!

Humanitarian Country Team RC/HC Government Non – State Actors M O H Humanitarian Country Team UN Country Team OCHA Designated Health Cluster Lead Agency Health Cluster Coordinator Lead Agency Country Rep Health Cluster Emergency Health Officer Complex humanitarian architecture are country level, presents many challenges for effective coordination and collaboration. The relationships among the Cluster Lead Agency Representative (CLAREP), the Health Cluster Coordinator, the cluster, the RC/HC and the government/MoH are shown here. Note that: The CLA Representative is accountable to the RC/HC for the satisfactory fulfilment of the overall CLA function. Inter-cluster coordination is assured at two levels, namely: As one of the health partners with programme activities that contribute to the overall health response, the CLA should normally be represented in the health cluster by the CLA Emergency Health Officer. The HCC is a staff member of the CLA who reports to the CLA Representative and is a representative of the cluster as a whole. –– At the strategic and operational levels, the coordinators of all clusters meet regularly together under the chairmanship of the OCHA team leader in the context of an inter-cluster coordination group. –– At the policy level, the country representatives/directors of the designated CLAs meet together under the chairmanship of the RC/HC in the context of the humanitarian country team or in separate meetings, when needed. The Inter Cluster Coordination Group (ICCG) is a key mechanism for the clusters to work together, identify humanitarian needs that require a multi-sectoral response, and strategize and plan accordingly. This is the body where the cluster coordinators have to report and discuss how the different cross-cutting issues and other humanitarian needs have been mainstreamed and where and how concerted action with other clusters is Inter-cluster coordination group Management: Strategic & Operational Coordination: Consultation/information:

The Health Cluster at county level At country level the Health Cluster is a mechanism for participating agencies to: work in partnership harmonize efforts and use available resources efficiently use agreed objectives, priorities and strategies The impact of the cluster approach will depend on the building of sustainable and effective partnerships

The Principles of Partnership Equality Transparency Result-oriented approach Responsibility Complementarity Background: Geneva 2006 – an interagency meeting on enhancing the Effectiveness of Humanitarian Action brought together the three main “families” of the humanitarian community - NGOs, the Red Cross and Red Crescent Movement, and the UN and related international organizations: Overall goal: to enhance the effectiveness of humanitarian action An outcome of the meeting was a decision to create the Global Humanitarian Platform and to agree the "Principles of Partnership" for humanitarian action. Agencies participating in the Global Humanitarian Platform agreed to base their partnerships on these principles. The Principles of Partnership: Equality: Equality requires mutual respect between members of the partnership irrespective of size and power. The participants must respect each other's mandates, obligations and independence and recognize each other's constraints and commitments. Mutual respect must not preclude organizations from engaging in constructive dissent. Transparency: Transparency is achieved through dialogue (on equal footing), with an emphasis on early consultations and early sharing of information. Communications and transparency, including financial transparency, increase the level of trust among organizations. Result-oriented approach: Effective humanitarian action must be reality-based and action-oriented. This requires result-oriented coordination based on effective capabilities and concrete operational capacities. Responsibility: Humanitarian organizations have an ethical obligation to each other to accomplish their tasks responsibly, with integrity and in a relevant and appropriate way. They must make sure they commit to activities only when they have the means, competencies, skills, and capacity to deliver on their commitments. Decisive and robust prevention of abuses committed by humanitarians must also be a constant effort. Complementarity: The diversity of the humanitarian community is an asset if we build on our comparative advantages and complement each other’s contributions. Local capacity is one of the main assets to enhance and on which to build. Whenever possible, humanitarian organizations should strive to make it an integral part in emergency response. Language and cultural barriers must be overcome.

The ten functions of the Health Cluster at country level Coordination mechanisms and inclusion of key actors within the Health Cluster and inter-cluster forums Relations with other key stakeholders Needs assessment, situation monitoring & analysis, including identifying gaps in health response Strategic development and gap filling Contingency planning Application of standards Training and capacity building, including emergency preparedness Monitoring and reporting Advocacy and resource mobilisation Provider of last resort (POLR) Refer to RASCI Handout – Health Cluster Guide Chapter 1 page 37 Figure 1b RASCI diagram for Country responsibilities RASI ACCOUNTABILITY FRAMEWORK FOR THE HEALTH CLUSTER AT COUNTRY LEVEL    DEFINITIONS RESPONSIBLE (R) Those who do the work to achieve the task. There can be multiple resources responsible ACCOUNTABLE (A) The person/people ultimately answerable for the correct and thorough completion of the task SUPPORT (S) Those who may help in the task CONSULTED (C) Those whose opinions are sought INFORMED (I) Those who are kept up to date on progress. One-way communication  

Roles and Responsibilities Government Cluster Lead Agency (CLA) Health Cluster Coordinator (HCC) Partners (NGOs, Civil Society, UN agencies, Donors) Refer to RASCI Handout – HGC Chapter 1 page 37 Figure 1b RASCI diagram for Country responsibilities The country-level Health Cluster (or existing sector coordination group adopting the cluster approach) should serve as a mechanism for participating organizations to work together in partnership to harmonize efforts and to use available resources efficiently within the framework of agreed objectives, priorities and strategies, for the benefit of the affected population(s). This includes avoiding gaps and/or overlap in the international humanitarian health response and resources (human and financial). The cluster should provide a framework for effective partnerships among international and national humanitarian health actors, civil society and other stakeholders, and ensure that international health responses are appropriately aligned with national structures. Membership of the Health Cluster The Health Cluster at national level should normally include: organizations providing or supporting health services in the affected areas – UN agencies (WHO, UNICEF, UNFPA), other international organizations (e.g. IOM, IFRC), the national Red Cross/Red Crescent society, international and national NGOs, and representatives of key private-sector health service providers; and the main health-sector donors and other important stakeholders. Clusters at zonal (sub-national) level should normally include the health agencies active in the zone and any donor representatives or other health stakeholders present at that level.

Roles and Responsibilities: Government & State Institutions Depends on the willingness or capacity But need to remember that ownership should be with the host state If the MoH is in a strong position, the cluster should organize the response in support of the host government’s efforts In some contexts the MoH representative and the Cluster Lead Agency co-chair Health Cluster meetings at both national and sub-national levels In humanitarian contexts the initial relief work is carried out by the affected population, government and civil society. Refer to RASCI Handout – HGC Chapter 1 page 37 Figure 1b RASCI diagram for Country responsibilities

Roles and Responsibilities: The Health Cluster Lead Agency WHO Acts as a bridge between national and local health authorities and international heath actors Ensures that health actors in humanitarian response build on local capacities Ensures establishment of effective coordination mechanisms Mobilises and deploys technical and human resources and stockpiles Acts as the Provider of Last Resort (POLR) Refer to RASCI Handout – HGC Chapter 1 page 37 Figure 1b RASCI diagram for Country responsibilities. The CLA/WHO has to ensure the establishment of an adequate coordination mechanism for the health sector. This includes: adapting the generic TOR for and appointing a country-level health cluster coordinator (HCC); ensuring appropriate relations with the MoH and avoiding duplication with any existing health sector coordination mechanisms; assuring information management and other support services necessary for the satisfactory functioning of the cluster; designating health cluster focal points at sub-national (zonal) level where needed; and advocating for resources for all humanitarian health partners. The CLA also serves as “provider of last resort” . The Health Cluster lead agency’s responsibility for “Provision of Last Resort” should be activated when all three of these conditions below are met: 2. one or more of the agreed benchmarks for the health sector response as a whole is not being met 1. the Health Cluster agrees that there is an important life-threatening gap in the Health sector response 3. evidence suggests that a significant proportion of the target population is at risk of avoidable death if the gap is not filled urgently. The generic responsibilities of cluster leads at the country level are spelt out in: IASC. Guidance note on using the cluster approach to strengthen humanitarian response. Inter-Agency Standing Committee, 24 November 2006. The CLA country representative is accountable to the Humanitarian Coordinator (HC) for fulfilling these responsibilities. At the same time, the CLA is a partner in the cluster and should be represented in cluster meetings by its own emergency health programme manager.

Roles and Responsibilities: Health Cluster Coordinator Enables collaboration between partners Provides strategic leadership Facilitates cluster activities Ensures needs and risk assessments are carried out, gaps are identified and information is shared Generate consensus Ensures integration of cross cutting issues Ensures coordination with other clusters Role is to facilitate and lead not to direct Refer to RASCI Handout – HGC Chapter 1 page 37 Figure 1b RASCI diagram for Country responsibilities. There is a generic ToR for a HCC. In summary, the coordinator is expected to: Enable cluster partners to be more effective by working together, in coalition, than they could individually, and to maximize the benefit for the target population of the cluster partners’ individual inputs and efforts. Provide leadership to and work on behalf of the Health Cluster as a whole, facilitating all cluster activities and maintaining a strategic vision. Ensure that needs, risks, capacities and opportunities are assessed and understood as best possible at all stages of the humanitarian response, and that information is shared. Generate the widest possible consensus on priorities and a health response strategy to the crisis that addresses the priority needs and risks in the sector, incorporates appropriate strategies, and promotes appropriate standards. Work with cluster members collectively and individually to identify gaps in response and try to ensure that available resources are directed to addressing priority problems and that assistance and services are provided equitably and impartially to different areas population groups on the basis of need. Ensure the effective integration of cross-cutting issues into the cluster’s activities and strategies. Ensure coordination with other clusters in all activities relevant to public health. Emphasise that the role is to “facilitate” and “lead”, not to direct. The HCC should not be the emergency health programme manager of the Cluster Lead Agency.

Roles and Responsibilities: Health Cluster Partners Commit to the aims of the Health Cluster Proactively exchange information Mobilize resources and build local capacity Share responsibilities for Health Cluster activities, may act as Co Steward Respect and implement Health Cluster principles, policies and standards Refer to RASCI Handout – HGC Chapter 1 page 37 Figure 1b RASCI diagram for Country responsibilities Health Cluster partners are expected to subscribe to the overall aim of the cluster and to: be proactive in exchanging information, highlighting needs and gaps and reporting progress, mobilizing resources, and building local capacity; share responsibility for Health Cluster activities including assessing needs, developing plans and guidelines, and organizing joint training respect and adhere to agreed principles, policies and standards, and implement activities in line with agreed priorities and objectives. However, it is up to individual organizations to determine their levels of participation. The cluster approach does not require that humanitarian actors be held accountable to the HCC or CLA. Individual organizations can only be held accountable to the CLA when they have made specific commitments to the Health Cluster.

Roles and Responsibilities: Working in Partnership Critical for the effective implementation of the Health Cluster An effective partnership is inclusive, complements and strengthens existing coordination structures and processes at national and sub national level Starts with realistic and achievable objectives Ensures all partners have something to gain Listens to other partners and learns from the past Ensures transparency in all cluster activities 1. Inclusiveness: need to identify and involve all health actors including local organizations Engaging partners and authorities. Ensure translation at meetings, where necessary. 2. Complement and strengthen existing coordination structures and processes at both national and sub-national levels. Avoid parallel systems. hence get buy-in, then broaden the scope (see box below). Focus on the health priorities starting with what is most feasible and expand incrementally to address other concerns as and when possible. 3. Start with realistic objectives, demonstrate value added and build trust, 4. Make sure all partners have something to gain. Benefits may include access to more/better information or expertise, opportunities for common strategizing and planning, facilitated access to the affected areas, access to resources (transport, funds, etc.) from a common pool or through the identification of opportunities for sharing. 5. Learn from the past. Find out how health sector coordination processes operated in previous emergencies in the country, 6. Ensure transparency in all cluster activities and the use of resources. what worked well and what did not, and why.

Module 2: Key Messages (1) Ten functions of the Health Cluster at country level are: Coordination mechanisms and inclusion of all actors within the health cluster and inter-cluster Coordination with national authorities & other local actors Needs assessment & analysis including identifying gaps Strategy development & planning, including: Community based approaches, attention to priority cross cutting issues, and filling gaps Contingency planning (and preparedness) Application of standards Training and capacity building Monitoring and reporting Advocacy and resource mobilization, including reporting Provider of Last Resort, (POLR)

Module 2: Key Messages (2) Effective partnership which engages stakeholders needs to: Be inclusive Complement and strengthen existing coordination structures and processes Start with realistic objectives

Module 2: Key Messages (2) The Global Health Cluster is a forum of key international health entities, mandated to build humanitarian response capacity by: Providing strategic, operational and technical guidance Establishing global partnerships Providing surge capacity and systems Developing common guidance and tools

Resources www.humanitarianreform.org Health Cluster Guide www.who.int/hac/global_health_cluster/guide Humanitarian Reform www.humanitarianreform.org Position Paper on User fees http://www.who.int/hac/global_health_cluster/about/policy_strategy/EN_final_position_paper_on_user_fees.pdf Give signposts to additional information about Humanitarian Reform and the Health Cluster 29

Discussion & Questions Allow at least 10 minutes for discussion and questions