1

Report of the

Second Regional Health Cluster Coordinators

meeting

Cairo, Egypt

8–10 October 2019

2

Contents

1. INTRODUCTION .......................................................................................................................... 4

Opening Remarks by Richard Brennan (RED) ........................................................................... 4

Opening Remarks by Linda Doull (GHC) .................................................................................. 5

2. Summary of sessions and discussions............................................................................................. 5

2.1 Cash - Based Programming ................................................................................................ 5

2.2 Humanitarian Development Nexus and Recovery .............................................................. 6

2.3 Cluster guided discussion on GBV ................................................................................... 10

2.4 Research under health cluster ........................................................................................... 10

2.5 Information Management for health cluster ..................................................................... 11

2.6 Data Interpretation: Introduction to data interpretation .................................................... 13

2.7 Data Interpretation: data options ....................................................................................... 14

3. Compiled Action Points ................................................................................................................ 17

4. Conclusions ................................................................................................................................... 18

5. Annexes......................................................................................................................................... 18

3

Abbreviations

AAP Accountability to the Affected Population

CMR Clinical Management of Rape

CVA Cash and Voucher Assistance

EMO Emergency Operations

EMR Eastern Mediterranean Region

GBV Gender-Based Violence

GHC Global Health Cluster

HCC Health Cluster Coordinator

HDN Humanitarian-Development Nexus

HESPER Humanitarian Needs Assessment Perceived Needs

HIM Health Emergency Information and Risk Assessment

HIRA Hazard Identification and Risk Assessment

HMIS Health Management Information System

HRP Humanitarian Response Plan

HSEL Health Systems in Emergencies Lab

IASC Inter-Agency Standing Committee

JHU Johns Hopkins University

MCNA Multi-Cluster Needs Assessment

MIRA Multi-Sector Initial Rapid Assessment

MPC Multi-Purpose Cash

MSP Minimum Services Package

OIM Operational Indicator Monitoring

PDM Post-Distribution Monitoring

PHIS Public Health Information Services

PHSA Public Health Situation Analysis

WASH Water, Sanitation and Hygiene

UHC Universal Health Coverage

UNSDF United Nations Sustainable Development Framework

4

1. INTRODUCTION

The Second Regional Health Cluster Coordinators meeting was held from 8 to 10 October 2019 in Cairo,

Egypt. The meeting was organized by the Operational Partnerships team of the World Health Organization

(WHO) Regional Office for the Eastern Mediterranean, in coordination with the Global Health Cluster

(GHC) of WHO headquarters. Participants included health cluster coordinators (HCCs) and information

management officers from nine Member States of the Region, who are working to drive the emergency

operational response on the ground and fulfil WHO’s mandate as Cluster Lead Agency for coordinating

health emergency response.

The overall purpose of the meeting was to strengthen Country Cluster and Co-Cluster Coordinator’s

capacity to work through operationalized cluster standards and documents and exchanging success stories

among clusters in Eastern Mediterranean Region (EMR). The specific objectives of the meeting included:

• Strengthening the understanding of how clusters align with WHO at the regional and country

level.

• Identify set of core indicators for health in emergencies and methods to improve data

interpretation and presentation.

• Improve Cluster Products with focus on outcomes/ impact of Health interventions at country

level.

The programme for the three-day meeting was developed to address issues and challenges faced during

emergency operations, and to determine how the Regional Office for the Eastern Mediterranean and

GHC can support HCCs in overcoming the challenges.

Opening Remarks by Richard Brennan (RED)

The Eastern Mediterranean region is very challenging. The humanitarian burden is gigantic: more than

40% of the IDPs and more than 33% of the people in need of humanitarian assistance worldwide are in

the region. The responsibility on the health clusters is enormous and thus is very important to come

together to share updates and experiences, discuss challenges and solutions. The reach of the HCs is

extraordinary, with 12 coordination mechanisms in place and 15 operational hubs.

The humanitarian-development nexus (HDN) needs to be operationalised. HCCs have a role to play in

taking the HDN forward. They should promote collaboration and integration with other partners to move

from a humanitarian to a development working mode.

Information management is a key issue, and health indicators in particular need more attention. It is

necessary to move to indicators that are technically sound and appropriate to measure whether responses

are addressing the needs. Rather than just presenting absolute numbers of outputs, indicators must be

compared against targets and against international standards, which will allow us to ascertain the impact

of the HCs’ operations.

Quality of care and research are also very important topics. Concerning research, we should be

documenting better the work we are doing.

5

Opening Remarks by Linda Doull (GHC)

There are ongoing, persistent topics such as quality of care and cluster coordination. On quality of care,

there is a large number of partners in all the clusters, yet the response to the needs of the population falls

short and quality issues must be addressed. In a recent workshop of the Quality Improvement Task Team,

experts identified gaps where work on quality of care is needed, and discussed as well ways to improve

the ability to engage with the affected community.

Regarding coordination, inter-cluster collaboration and multi-sectorial response, we are unable to

demonstrate the effectiveness and impact of the work done since data are not available, which is a point

to reflect and improve on. It is also important to take the cluster deactivation as a learning opportunity and

to share lessons learned from those clusters who are on the verge of deactivation.

The GHC’s purpose is to assist and guide the partners on the ground, and its work must lead to actual

implementation and practical delivery of services where needed.

2. SUMMARY OF SESSIONS AND DISCUSSIONS

2.1 Cash - Based Programming

Update on HQ/EMRO work to set up Cash-Based Programming in the Region: Findings and

recommendations from the expert meeting on cash in EMRO.

The EMRO Expert meeting on CVA for humanitarian health interventions (Beirut, 25-26 September

2019) brought together cash- and health experts, who discussed how to make cash for health work.

CVA is essentially another modality to look at financial barriers. Other sectors, such as food security

and nutrition, have considerable experience in it and some health partners have started using CVA as well.

Money to pay for transport to access health facilities, or money to pay for services and/or medicines are

some examples of using CVA for health. The modalities can be demand- and/or supply-side based. In any

case, when considering CVA, it is essential to assess the quality of care provided by the facilities supported

(either public or private) and to reflect about the potential consequences on the health system (could be

positive and/or negative).

Several partners have MPC programmes and it should be possible to include in their PDM,

household surveys or MCNA a couple of questions on health to identify main barriers to access health

services. This direct feedback from the community is important to estimate the proportion of catastrophic

expenditure and negative coping strategies in place and would allow health partners to better respond to

the needs identified.

CVA can play a role in achieving UHC and it should be complementary to investments in the health

system.

6

Discussion:

In Afghanistan, there are many barriers to access health care, the biggest of which is poverty. There is

a MPC programme, which also covers health, but there are many challenges to monitor it. It would be

very useful to have a workshop to learn more about and better implement CVA.

In Sudan, there is a multisectoral CVA initiative in West Darfur since 2017. It provides health

insurance to IDPs and among the main challenges of the project are the criteria to assess vulnerability and

the ability of the IDPs to pay for medicines (discrepancy between IDPs who work and earn some money

and those who don’t).

CVA can be used as means to increase access to health services by the people in need. However, cash

alone is not sufficient, and it is necessary to look into the context and assess whether cash-based initiatives

can be used or not in a particular setting. Priorities of donors should also be included in any considerations

to use CVA.

Another important aspect to consider is the protection dimension. Whenever CVA is implemented,

close monitoring is fundamental to ensure it does not increase health inequities and does not lead to

preferential treatment of some patients.

For the HCs to start working on CVA, clarity and guidance is needed on how to analyse the context

to consider cash initiatives, as well as technical assistance (guidelines; helpdesk).

EMRO is processing the ToR for a consultant to support the regional office in advancing CVA.

2.2 Humanitarian Development Nexus and Recovery

Presentation of EMRO work on recovery.

There is a good number of protracted crises in the EMR, which make the continued provision of

humanitarian life-saving assistance and the thinking about development very complex and challenging.

The HSEL was created to improve health systems resilience of the EMR Member States by integrating

health system strengthening and health emergency preparedness, response and recovery works.

The HSEL finalised a Framework for Action on Health Systems Recovery in Emergencies. It aims to

unify the strategic actions needed for health systems recovery and provide direction for national health

systems, WHO and other health sector partners on how to take a structured approach to the recovery and

resilience-building processes of national and local health systems in different types of emergencies. The

framework is structured around the health systems building blocks and makes links with global

frameworks and initiatives related to health, emergencies and disasters. It is broad and flexible enough to

be easily applied to a wide range of settings, leaving space to consider the specificities of a given

emergency.

The HSEL is also working on a guidance document on implementation of humanitarian-development-

peace nexus. In this regard, the team differentiates response and recovery interventions based on three

criteria (urgency, sustainability and cost-effectiveness) and disaggregates “recovery” phase into i) early

recovery and transition and ii) long-term recovery.

7

The experience of Yemen in HDN

In Yemen, the number of people in need (PIN) of humanitarian assistance increased by more than 50%

when compared to the 2015 pre-crisis level; an estimated 80% of the population (24,4 million people)

require humanitarian or protection assistance.

The needs for health care are enormous (high burden of infectious diseases, NCDs, trauma, etc.), yet

the capacity to address such needs is limited and very compromised. Only 51% of all health facilities in

the country are functional, human resources for health are insufficient (less than half the number of

qualified health workers available), and the funding for health operations falls short of what is needed

(only 44% of requested funding secured).

The reality on the ground is that humanitarian response and development are under different work

streams and alignment of the two isn’t always straightforward. The focus of the humanitarian response is

to provide life-saving assistance and support. Several of the humanitarian response activities implemented

in Yemen can pave the way for the development stage, namely the development and delivery of a

Minimum Package of Health Services (MSP), the expansion of the Electronic Disease Early Warning

System (eDEWS), the EmONC Diploma Training Program, the rehabilitation of health facilities, among

others. Nonetheless, progress on the HDN is compounded by several factors, among which different

programme management mechanisms for humanitarian and development; annual versus multi-annual

planning frameworks; a HDN pre-requisite is political and economic stability and in Yemen the

environment is highly unpredictable and unstable, with two governments (North and South).

Discussion:

Operationalizing the HDN is very challenging: different workstreams; there are no coordination and

information sharing mechanisms in place; need for multi-annual planning and funding; unclear how to

work with a government that is party to the conflict; need for high level support and push for HDN in the

countries, are some of the challenges.

The Framework for Action on Health Systems Recovery in Emergencies is very useful and holistic

yet working on all health system’s building blocks simultaneously is impractical. It could be improved by

incorporating more clarity on what the “nexus” means, and how to implement, monitor and evaluate the

framework. Information management activities could provide the basis for some of the longer-term

development planning. Also, the areas of interest to donors cannot be disregarded.

In Afghanistan, for instance, there has been a big effort to improve the trauma care services (e.g.

rehabilitation of hospitals; building of advance trauma care centres; training of surgeons and other health

care workers; upgrade of operating theatres). While responding to the needs, the HC is also helping to

build structures and resilience into the health system beyond the emergency phase, which will ease into

the development stage.

The UNSDF could be a helpful tool for step by step implementation of the HDN on the ground.

When talking about recovery, it is important to differentiate between “early recovery” and “long-term

recovery”.

8

What about the role of the HCCs in targeting the rest of the population, those not included in the PIN?

And how do governments understand “development’? The HCCs can establish bridges and support

collaboration with development partners; however, the WHO must take a more prominent role and lead

the dialogue with other entities (clusters, agencies, governments) to have a common understanding of the

HDN and build entry-points to facilitate the work on this transition.

Quality of Healthcare. Facility monitoring checklist.

In a recent workshop of the Quality Improvement Task Team, a definition of the quality of care in

humanitarian settings was agreed upon, in that quality is not just about health facility performance and

patient safety, but also about population needs being addressed, and it intersects with protection and

accountability to the affected population (AAP). A study examining 79 quality assessment tools identified

there are key gaps in tools for i) community-based care; ii) community / household perception of health

needs; iii) AAP at community and health facility level, and iv) equity.

A Primary Care Health Facility Quality Assessment Tool has been developed to improve quality in

primary care facilities in emergencies. It is part of a collaborative effort to create a generic quality of care

monitoring and evaluation framework for health services. The assessment should take place regularly,

with results tracked over time, to see how availability and quality of services improve over time and how

standards are being enforced.

The tool will be field tested in 3-4 countries. It should be finalised in the coming months, along with

the implementation guide.

Discussion:

Many health partners are already making good progress in applying a quality of care improvement

culture. In Iraq, for instance, the HC is in the process of piloting a quality improvement tool subsequent

to having implemented two phases of the Quality of Care assessment in 2018. The assessment has assisted

partners in becoming conscious of their level and taking corrective measures to improve. It is relevant to

discuss quality because although minimum quality standards to be applied have been defined, it is

important to monitor adherence to those minimum standards and how they are being followed.

Regarding AAP, HCCs mentioned that in some countries there is not enough investment in it. In

others, like Iraq, AAP is key. There is the Iraq IDP Information Centre, a nationwide hotline for displaced

people to access information on humanitarian assistance and provide feedback on the humanitarian

response. In addition, for the HC and under the quality of care monitoring framework, exit interviews are

routinely carried out with patients to gather feedback of their experience in the health facility.

How EMRO can help CO to develop Essential Package of Health Services

UHC - all people and communities receive the quality health services they need, without financial

hardship - is a key global health policy goal. An important step toward ensuring access to health care for

all is to define which programmes, services and interventions should be provided and financially covered

9

for the population. There is a move from delivering a MSP to defining Priority Benefits Package (PBP) in

emergency and recovery settings to improve the coverage of quality essential health services without risk

of financial hardship, while accelerating progress towards UHC for people affected by armed conflicts,

fragile settings, health and other emergencies. Such UHC-PBP is a set of evidence-informed prioritized

health interventions, services and programmes, to be available for all, in good quality, at the appropriate

service delivery platform using an integrated people-centred approach and covered by relevant financial

protection arrangements. The UHC-PBP does not only cover treatment but also services which help

prevent poor health and promote well-being for individuals and communities alike.

EMRO is working on a guide to develop national UHC-PBP. The process will include:

To achieve UHC-PBP, it is necessary to make the best possible investment decisions to support

demand for and delivery of services to the most feasible standards, for the greatest health impact.

Discussion:

To one HCC, the MSP, despite being called “minimum”, is rather ambitious. Instead, there should be

a “standard” essential health services package that could be linked to UHC and health systems

strengthening. For another, having WHO’s guidance would be helpful in the discussion of what “essential”

is, and the package should be ambitious, not just “minimum”.

The concepts of “minimum” or “essential” are not clear to health care workers, neither to the

communities; the focus should be on balancing the expectations between just receiving care and what is

available and possible in a specific setting.

The UHC-PBP seems like a customisation of MSP based on the context and could contribute to more

accountability and sustainability of the services delivered.

The bottom line, and first step, is to think about prioritisation, not adding new interventions; discuss

with health partners which interventions to focus more on, and consider quality, financial barriers and

access to care. After that, services to be provided can be decided on.

10

In general, the HCCs agreed that the guidance can be helpful. Lastly, there was a request for EMRO’s

support to the HCCs when doing unit costing for the HRP.

2.3 Cluster guided discussion on GBV

Health System Response to GBV in Emergencies

The GBV in emergencies (GBViE) project aims to improve capacity to deliver services to GBV

survivors and to enhance prevention, by i) improving health sector/health care providers’ capacity to

prevent and adequately respond to GBV, ii) supporting the work of the HC to improve global and country

level action on GBV, and iii) strengthening coordination between HC and the GBV area of responsibility

(GBV AoR constitutes a focus area within the Global Protection Cluster).

Several HCs in the EMR have made substantial progress in incorporating GBV in their operations. A few

examples are: Afghanistan (National Health GBV treatment protocol; HRP 2019 includes 2 GBV

indicators; a GBViE strategic plan for the MoH is under development); Syria (GBV included in health

sector protection analysis 2019 and 2020; training of health providers on First-line support); Iraq (there is

a dedicated GBV NPO and a health cluster GBV focal point; GBV included in the HNO and HRP 2019;

publication of a HC GBV advocacy sheet; CMR indicator in the HRP); Sudan (GBV indicators included

in HNO 2020; training of health providers on first-line support and CMR); Somalia (HC prioritized GBV

as a main activity in 2020 HRP; a GBViE consultant scoping mission will take place in November 2019);

Libya (a scoping mission planned for beginning of 2020).

WHO aims to improve the quality of health sector response to GBV by developing, in partnership with

the JHU, a readiness assessment and quality assurance tool adapted to humanitarian settings. As part of

the research plan, they will examine facilitators, barriers and bottlenecks to access and provision of quality

care for GBV survivors, adapt the tools and use them to assess the quality of health services for GBV

survivors in DRC and Iraq.

Discussion:

Considering the new HNO and HRP structure and focus on mainstreaming protection, how could the

HCCs and the technical unit work together towards a more systematized integration of GBV?

GBV and disability aren’t usually discussed in the beginning of projects; rather, they are often

considered as an afterthought. GBV is not mainstreamed in the health literature and the WHO has a main

role in bringing it to the fore.

Work is ongoing between the GHC and the Global Protection Cluster and there is a project to develop

a joint operational framework to improve response integration and coordination. Discussions are planned

for Afghanistan and oPt, and the findings will be presented at a multi-stakeholder workshop in December

2019, in Geneva.

2.4 Research under health cluster

An exploratory session was conducted on what is relevant and what is possible for research under the

HC. A good example of applied research by a HC is oPt’s experience on trauma stabilization points; the

11

collection and analysis of trauma data demonstrated how the burden on referral hospitals was substantially

decreased and a high number of deaths was averted. Another example is the Quality of Care survey

conducted in the IDP camps in Iraq, commissioned by WHO/Health Cluster and carried out by the KIT

Royal Tropical Institute (paper awaiting publication).

In the previous meeting, it had been agreed that research was necessary, and it was important to

document the work of the HCs and share knowledge. The suggestion is to use secondary data to answer

research questions of interest to the HCs. Some HCCs highlighted that research must have an added value,

i.e. help the HC do better, support implementation; doing studies to conclude something which is already

known is not relevant. Also, to consider the expected role of the HCC (active research participant versus

facilitating data and information for researchers).

There are many high-level academic institutions in the region that could partner up with the HCs and

support research activities. Some potential ideas for research:

▪ Qualitative study of HCs experiences

▪ Impact of HC activity on population outcomes

▪ New HNO/HRP format and push for integration approach

▪ HNO and correlation to response

▪ OCHA reporting vs HRP indicators

▪ HeRAMS data and linkage to MSP delivery

▪ Health education and messaging

▪ Application / implementation of guidelines

▪ HCs work / performance during outbreaks (e.g. cholera, malaria, dengue)

The Regional HC focal point is looking into the possibility of formally engaging with academic

institutions to support the setting of a research agenda and help generate evidence and publications with

the data collected by the HCs.

2.5 Information Management for health cluster

The expectation for this session was to work towards a common approach with regards to the information

the HCs are collecting. The aim was not to develop new indicators, neither establish a list of core

indicators, rather to agree on a small set of indicators that all HCs should use in order to allow comparisons

across the countries and show the achievements of the region as a whole.

Public Health (PH) Indicators in out-of-camp Emergency Settings: JHU project

JHU is carrying a research project to define a set of PH indicators to measure adequacy (or

effectiveness) of humanitarian action that are feasible, sound and useful. The scope of the project is

outcome and impact indicators. A variety of sources (peer reviewed and grey literature; monitoring

framework of operational partners, guidance documents of relevant clusters, HRP, donor guidance) were

reviewed to take stock of current practice. Circa unique 800 indicators have been extracted from these

sources covering health, nutrition and WASH topics (acute, preventive and chronic care services;

preventive practices; population health status; health system factors). The indicators were organised

around construct/sub-construct/dimension (e.g. preventive practices/health seeking behaviour/coverage)

(complete list available in the ppt), and operationalized in 2x2 tables for humanitarian setting to reflect

multiplicity of contexts (defined in terms of availability of resources and access to population). A standard

12

approach encompassing several criteria was used to assess and select indicators (validity; instrument

availability; precision of numerator and denominator; trigger for action; user’s experience and feasibility).

When operationalizing the indicators, one must consider a trade-off between feasibility and

representativeness/generalizability/validity, and that the interpretation will vary according to data

collection method.

Field testing is planned in different crises settings (Uganda; DRC; Jordan/ Turkey; South Sudan) to

assess the feasibility and usefulness of the identified indicators.

The final set is expected during the first quarter of 2020. Guidance on how to measure and interpret

the indicators should be ready in the second/third quarter of 2020.

Discussion:

Some participants suggested adding the constructs satisfaction of clients/beneficiaries and attacks on

health care to the framework. Additionally, one participant commented that the indicators are inherently

PH-driven and take no consideration of the perspective of the affected population. Should it be the HC or

another cluster (Protection?) taking ownership of that dimension? Debate is ongoing between JHU and

collaborators about integrating the community level into the framework.

There is pressure from both donors and OCHA to go beyond just reporting numbers of activities and

to provide reliable figures such as number of people reached by humanitarian assistance – this is one of

the main difficulties for the HCCs.

Some HCCs would like to be involved in the testing of the indicators and Chiara will contact them

with further details about the testing.

Harmonizing indicators: selection of indicators for health in emergencies.

The progress made towards identifying a set of common indicators across countries to be monitored

at the regional level, as agreed during the first regional HCC meeting, was presented. The process

involved: collecting indicators used by the HCs, as well as from other sources such as IASC and SPHERE;

internal matching of the HCs indicators (more often than not, the wording of the indicators varied among

the HCs; indicators were matched despite their phrasing not being exactly the same, so long they referred

to the same, or a similar, attribute or dimension); matching of HCs indicators with IASC and SPHERE;

and scoring of the indicators (simple frequency of the number of HCs using the indicator in question; each

had the same weight). A total of 11 indicators scored 5 or higher, i.e. being used by 5 HCs or more, and

were presented for discussion and related to:

1. Coverage of health services 7. Births attended by skilled personnel

2. Total OPD consultations 8. ANC consultations

3. Mental health individual consultations 9. Coverage of measles vaccination

4. Trauma consultations 10. Referral of patients

5. Physiotherapy consultations 11. Training of health care workers

13

6. Admissions to stabilization and therapeutic feeding centres

Discussion:

The HCCs stressed the importance of moving from input to output and outcome indicators. It

was agreed to not consider an indicator about therapeutic feeding centres as it is for the Nutrition

cluster and one concerning referrals, for which would be very difficult to agree on a common

indicator (e.g. referrals should be service specific) and to collect data.

Coverage of health services is important information but there are many elements to it that

need to be considered (e.g. levels of health service; packages of services being provided; functional

versus partially functional health facilities; geographic area; services for stable or unstable

populations; etc.)

Denominator options that could be considered include population in need, population reached,

target population in HRP.

The HCCs mentioned the difficulty in collecting information, especially from the MoH, even

in facilities and programmes supported by the HCs.

A small group will continue working on this and set up a conference call with the HCCs to

discuss a final proposal of indicators, to be included in the monitoring plans for 2020.

2.6 Data Interpretation: Introduction to data interpretation

(From this point onwards, it was a joint HCCs/HIM meeting.)

Humanitarian needs analysis

Humanitarian needs analysis is a process intended to estimate or provide informed opinions

about deficiencies and their consequences. It entails a systematic set of procedures undertaken for

the purposes of setting priorities and making decisions about programs, system improvement and

allocation of resources. Analyses should focus on answering the right question, at the right time,

and for the right people (e.g. What are the priorities? What are the most important problems,

creating the most disruption or endangering the most the affected population? Which group is the

most in need and where interventions should focus first?). These research questions are important

to guide the analysis and avoid diversion of efforts to data analysis which does not contribute to

the objectives.

Before the discussion, the HCCs of Iraq and oPt presented an overview of each cluster’s health

products.

Discussion:

14

General agreement that the quality of the health products has improved considerably. In the

specific case of the health bulletins, the GHC template helped systematize the type of information

to be presented, yet there is room for more improvement. For example, including time-trend

analysis, adding a target component, comparisons against benchmarks/over time/ area to area, etc.,

are suggestions to make the health bulletins more informative, meaningful and useful.

In the 4W interactive dashboard example from Iraq, which is a pilot project, it could be

interesting to explore adding bar graphs or heat maps into the dashboard. Information about which

partners report/not report is interesting. Finding a balance on the use of colours is important;

colours should facilitate interpretation, not confuse the audience. Project closures by partners are

available on page 5 to guide operational planning for the cluster. Denominators, i.e., targets, need

to be included.

oPt HC created a dedicated website (http://healthclusteropt.org/). This is an excellent

instrument to share information about the situation in oPt, and is very useful for the partners since

they can access all the HC-related documents in one single location.

Health bulletins should be tailored to the audience and it’s important to find a balance between

data and storytelling (e.g. use of Spark charts could be further exploited), and the use of

benchmarks can help unveil the story in the data. To make data more meaningful, one needs to

focus on the denominator as well, not just the numerator, and it’s important to show the progress

of some indicators along a period of time. The bulletin is also a vehicle to highlight achievements

of the HC.

The HCCs are willing to improve the clusters’ health products with concrete guidance from

EMRO and CDC. They would also like to make them more visible to the wider community (e.g.,

through GHC website and EMRO newsletter).

Data analysis exercise: Iraq and Yemen

The participants were divided in 4 groups. Each group had to analyse a set of data, make a

summary and present back to the larger group for discussion.

2.7 Data Interpretation: data options

How to improve PHIS Products?

There are several PHIS products to address the needs of information in different domains: health

status and threats, health resources and service availability, and health system performance. The

tools for measuring health status and threats include the PHSA, HIRA, MIRA and HESPER

scale. To measure resources and service availability there is HeRAMS, 3W matrix and the

partners list. Finally, for health system performance, different tools are available such as HMIS,

vaccination coverage estimation, OIM, and the HC bulletin.

15

PHIS products exercise

The participants were divided in 5 groups and each was assigned a different product (3Ws,

HC bulletin, HeRAMS, MIRA and PHSA). The group had to reflect on the benefits of the,

challenges in implementation, and recommendations to improve the product.

Feed-back from the different groups:

HC Bulletin

3Ws

HeRAMS PHSA

Benefits

▪ Snapshot of the

health situation in a

country (national

and sub-national

levels) on regular

basis (updates on

health status;

response provided

by partners;

identification of

gaps and priorities;

showcase success

stories)

▪ Reporting on

funding status,

useful for advocacy

and donor attraction

▪ Reporting

achievements of the

partners

▪ Mapping of

partners

presence

geographically

▪ Strengthened

communication,

coordination

and

collaboration

▪ Integrated and

multisectoral

participants

▪ Service

mapping

▪ Helpful in

planning

process

▪ Tracks

information on

sector and sub-

sector actors,

location of

activities

▪ Functionality of

health services

▪ Evidence base for

resource mobilization

▪ Assessment and

monitoring tool

▪ Guide intervention of

health partners

▪ Collaborative process

involving all health

sector actors

▪ Cost and time

efficient

▪ Supported by online

app

(https://primewho.org)

that maximizes data

entry and data

management

processes and

provides real-time

analysis of the

situation

▪ Decision-

making tool

that supports

HNO, with

potential to

support RRF,

NEXUS,

UNDAF

▪ Referenced

and evidence-

based

▪ Advocacy

▪ Visibility

Challenges

▪ Reporting issues

(timeliness,

completeness,

accuracy,

sensitivity)

▪ Capacity of HC

teams

▪ Clearance process

▪ Misinterpretation of

health data in some

occasions

▪ Does not

provide

information on

resources

available

▪ Does not have

means of

verification or

reference

▪ Low reporting

rate from

partners

▪ Accessibility to hard

to reach areas

▪ Lack of

harmonization and

standardization

▪ High staff turn over

▪ Internet connectivity

▪ Lengthy tool (too

many variables)

▪ Absence of

monitoring

mechanism to verify

the quality of reported

data

▪ No secondary

verification

▪ Ambitious

piece of work

(need for

interpretation

and

prediction)

▪ Limited up-to-

date secondary

data

▪ No clear

cooperation

mechanisms

for primary

data collection

/ sharing

▪ Weak on

human rights,

protection,

MHPSS,

16

SGBV, health

systems

▪ Time

consuming

▪ Technical

Staff

unfamiliar

with product

and

responsibilities

for it

▪ Difficult to

finalize /

endorse by

WR and MoH

▪ Not easy to

find for public

audience

Recommendations

for Improvement

▪ Using interactive

dashboards

▪ Revision of some

indicators

▪ Using standard and

structured reporting

▪ Making it visually

more appealing and

interactive, less use

of text

▪ Combine with

4W Matrix to

reflect HRP

indicators

▪ Establish a rule

of reporting to

improve

reporting rate

▪ Provide source

of information

▪ Set up a regular

and predictable

clearance and

dissemination

plan

▪ Agree on a 3W

dissemination

schedule

▪ Customized

dashboard to present

data visually

▪ Collecting data offline

▪ Increase

visibility and

awareness of

the product

▪ Develop

cooperation

mechanisms

for feeding

into the long

version

▪ Editing layout

tools and

support

▪ Provide tools

to assist in the

production

▪ Strengthen

links with

partner’s who

may feed

process

(REACH,

iMMAP, and

ACAPS)

Work is ongoing to develop SOPs and guidance for the use of HeRAMS.

WHE: Response Monitoring Framework (RMF)

WHE is developing the RMF to improve the efficiency, effectiveness and timeliness of

emergency response through the monitoring of services provided by WHO & partners. The RMF

is expected to lead to better practices, adaptation of resources to needs, rapid decision-making, and

better resource mobilization. The RMF is key for WHE and a response monitoring task force led

by EM WHE/HIM has been established to develop it.

17

Development of the RMF is well underway. The task force also plans to develop a dashboard,

a regional key performance indicators information database and an automated mechanism for

routine data collection of KPIs, and the Response Monitoring Framework guide.

3. COMPILED ACTION POINTS

Action point Responsible 1. Cash and Voucher Assistance 1.1. WHO Health Systems Unit to provide information on context specific

financial barriers and good practice/lessons on use of cash for health to help

HCCs better guide decisions around the use of CVA

WHO Health Systems

Unit

1.2. HCCs to inform the Regional HC focal point of the most urgent needs

/ priorities in terms of tools / guidance needs, to support health partners to

start implementing CVA under the HC framework

HCCs

2. HDN recovery 2.1. HCCs to provide feedback on the EMRO Framework for Action on

Health Systems Recovery. HCCs

2.2. Inform the HCCs of the WHO focal point for development in each

country HC Region Focal Point

2.3. EMRO (Health Systems in Emergencies Lab) to provide clarity on

the role of the HCC and Cluster Lead Agency in the nexus framework Health Systems in

Emergencies Lab 2.4. WHO to initiate/promote dialogue with other agencies, cluster

partners, governments on development, build entry points and common

understanding to facilitate the humanitarian-development transition

WHO HQ

2.5. Capture lessons learned from cluster transition / deactivation in

EMRO region (external evaluation) EMRO / External

consultant 3. Quality of care 3.1. GHC to share with the HCCs the report of the QITT Workshop GHC 3.2. HCCs to provide inputs/support to the workshop recommendations HCCs 4. Essential Package of Health Services 4.1. HCCs to determine prioritization and feasibility for implementation

of MSP in their respective clusters HCCs

4.2. WHO technical units in country office to provide advice on

development / adaptation of MSP WHO country offices

4.3. EMRO Health Systems Department will provide technical support to

develop, update and cost MSPs in different countries as needed EMRO Health Systems

Department 5. Improving GBV coverage & quality 5.1. EMRO to continue supporting mainstreaming of GBV into the HCs

work, and development and roll-out of GHC/GPC project to develop Joint

Operational Framework

EMRO

5.2. Health Cluster to collect and present GBV data/analysis effectively to

make the case /secure funding. HC

5.3. Findings from the work on GBV in different countries to be presented

at a workshop in Geneva (December 2019), focusing more broadly on

Protection issues

GHC/GPC

6. Proposed research topics to guide health policy 6.1. HCCs to collaborate with EMRO’s research opportunities and

engagement with academic institutions HCCs

18

6.2. EMRO to inform HCCs about partnerships with academic institutions

that can support them to develop, conduct and publish research EMRO

7. Data Interpretation 7.1. EMRO, with support from CDC, will continue providing support to

HCCs to assess and suggest areas for improvement regarding cluster

information products

EMRO / CDC

7.2. HCCs to send the HC health products to GHC (Elisabetta Minelli -

minellie@who.int) to publish them on the GHC website and to Inas Hamam

(hamami@who.int) for publication in EMRO’s newsletter

HCCs / GHC / EMRO

8. Health Indicators 8.1. EMRO, CDC and HCCs will continue working on the indicators in

the coming weeks to finalise the selection, phrasing and calculation of

different indicators for 2020 that all HCCs will use in 2020 (the agreed

upon list of indicators is not to be considered a comprehensive list, HCs can

add as many relevant indicators as necessary to their specific context)

EMRO / CDC / HCCs

8.2. HCCs will use the agreed upon indicators and will include them in

their data collection tools for 2020, and will agree with EMRO to share the

data for these indicators so EMRO can develop a regional dashboard

showing the response of the HCs in the region

HCCs

4. CONCLUSIONS

During the introductory session of the meeting, participants were asked to state expected

outcomes, and what the meeting should achieve. Agreement on indicators and enhanced skills for

data interpretation were the topics most mentioned by the HCCs. Action points from all the

different sessions were agreed upon and compiled for follow-up.

It was a productive meeting that touched upon several issues of high importance: HDN,

information management and interpretation, health indicators and others. A lot of good work is

being done to improve action and response towards the people in need of humanitarian assistance.

Both WHO and EMRO are willing to cooperate with and provide as much technical support to

HCCs as possible, and the joint EMO/HIM meeting was a good example of collaboration and of

how we can achieve more together.

5. ANNEXES

1. LIST OF PARTICIPANTS

LOP - HCC V1.docx

2. PROGRAMME

2nd Regional

Health Cluster Meeting-provisional programme.docx