ADVISORY GROUP OBSERVATIONS ON WHO’S CORE MANDATE, FUNDAMENTAL PRINCIPLES AND CRITICAL FUNCTIONS :: FIRST REPORT | EXECUTIVE SUMMARY | ADVANCE VERSION | NOVEMBER 6TH 2015 –
ADVISORY GROUP ON REFORM OF WHO’S WORK IN OUTBREAKS AND EMERGENCIES
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1. The Advisory Group acknowledges that at all times WHO is committed to the “attainment by all peoples of the highest possible level of health”. Hence WHO’s responsibility to provide technical assistance and aid in emergencies. This is expressly set out in Article 2(d) of the Organization’s Constitution and has been recognized in numerous resolutions of the World Health Assembly.1
1WHA34.26, WHA46.6, WHA48.2, WHA58.1, WHA59.22 and WHA64.10.

2. To fulfil this mandate, WHO needs sufficient operational capability to lead and support preparation for and responses to disease outbreaks and humanitarian emergencies with health and humanitarian consequences. In these situations, WHO must exercise decisive leadership on the health aspects of the response, while supporting national authorities and operating as one partner alongside other international and local actors for health – each of whom have their own responsibilities and expertise in the different aspects of the work in outbreaks and emergencies.

3. WHO is expected to demonstrate that it is an independent and impartial institution that gives priority to the health and well-being of all people, especially those who are vulnerable. Article 37 of the WHO Constitution stipulates that in the “performance of their duties the Director-General and the staff shall not seek or receive instructions from any government or from any authority external to the Organization… Each Member of the Organization on its part undertakes to respect the exclusively international character of the Director-General and the staff and not to seek to influence them.” Independence and impartiality underpin WHO’s mandate and are expected of WHO staff at all levels. These fundamental principles should be made much more explicit both in all work undertaken throughout the Organization and in all its external communications.

4. The Advisory Group recommends the development of an overarching Framework for WHO’s activities in Outbreaks and Emergencies that will cover all phases of the emergency management cycle – preparedness, readiness, alert, response, recovery and prevention. The Framework should incorporate six critical functions that WHO must address when working on outbreaks and emergencies – (i) leadership for the health of all people; (ii) engagement with political leaders (when necessary, beyond the Minister for Health); (iii) capacity for coordination; (iv) scientific and technical expertise (backed by research and development); (v) information and communications; and (vi) offering services to people whose urgent needs are not being met by any other provider.

ADVISORY GROUP RECOMMENDATIONS FOR THE TRANSFORMATION OF WHO
5. WHO must quickly develop the capability to provide credible leadership and offer effective support for the collective efforts to ensure the health of all people facing outbreaks and emergencies. The establishment of this capability will require political commitment from WHO’s Member States, structural change within the Organization, an evolution of internal culture, a strengthening of relationships with external actors, and the application of new authorities, mechanisms, procedures and systems for accountability.

6. The Advisory Group recommends the immediate establishment of a centrally-managed, global Programme for Outbreaks and Emergencies Management. This Programme will be a separate, dedicated entity within the Organization. It will bring together all the units and functions across the country, regional and headquarter levels that work on disease outbreaks, on emergencies and on International Health Regulations core capacities related to surveillance, alert and response. Some Advisory Group members have emphasized that the Programme would address, among other things, events that may constitute a public health emergency of international concern and include the functions of the WHO International Health Regulations contact point.

7. The Programme should be headed by an Executive Director at the rank of Deputy Director-General who reports to the Director-General and the Global Policy Group. The Executive Director will be responsible and accountable for the centralized management of the budget and human resources of the Programme.

8. The Programme should include a dedicated Platform to support readiness and response operations in countries and in communities. Given the number of outbreaks and emergencies being addressed at any one time, it is anticipated the Platform will always be operational to varying degrees. When a risk assessment or a sudden-onset event indicates that significant action is needed, an Incident Manager may be appointed: in some instances by the Director-General (at the recommendation of the Executive Director); in other instances by the Executive Director. The Incident Manager will have the delegated authority to build support teams, access financing and procure necessary supplies. While reporting to the Executive Director, the Incident Manager will also work in close consultation with the relevant Country Representative and relevant Regional Director. Depending on the outbreak or emergency, the Country Representative may be appointed as the Incident Manager. The Platform should interface seamlessly and be interoperable with other similar Platforms established by national authorities, the UN system and partners.

9. The Programme will have the following key features:
a. A standing capacity to handle outbreak surveillance, risk assessment and management, planning, partnerships, information and communications, human resources, logistics, finance, quality assurance and monitoring;
b. Standardized procedures for operations, including pre-planned and tested procedures to ensure immediate responses to imminent crises;
c. Dedicated and tailored business processes and mechanisms for managing human resources, financing and information technology

10. To sustain these capabilities the Programme and Platform will require predictable “steady-state financing” as well as prompt access to a reliable contingency fund in case of need: this contingency fund should be replenished promptly once used. The Advisory Group will examine options for financing the Programme. Some Advisory Group members have highlighted the need for increased allocations to the core budget of the Organization so that the Programme can be adequately financed.

11. An external, independent oversight body should be established by the Director General to monitor the performance of the Programme and the Platform using benchmarks established for this purpose.

ADVISORY GROUP RECOMMENDATIONS FOR WHO’S STRATEGIC COLLABORATIONS
12. The central focus of WHO’s involvement in outbreaks and emergencies is to enable national authorities, local communities and other actors for health to be more effective and resilient. In these circumstances WHO has two responsibilities – firstly, enabling countries to deal with outbreaks and emergencies themselves and, secondly, leading and supporting other actors for health through the provision of strategic direction, reliable information, coordination and technical guidance.

13. The Advisory Group recommends that to enable countries to prepare and respond to outbreaks and emergencies, WHO should lead independent and comprehensive risk assessments. These will generally be undertaken jointly with the authorities of countries affected by outbreaks and emergencies, as well as with operational partners. Risk assessments will reach conclusions on the level of alert necessary, action to be triggered and means through which the risks are communicated to different audiences. In settings where the national authorities are not in a position to participate in comprehensive risk assessments, WHO would perform this function in collaboration with local-level, national and international actors in ways that reflect the best interests of all the affected communities.

14. The Advisory Group notes that in its work to lead and support other actors for health, WHO should operate within the existing humanitarian architecture – the Inter-Agency Standing Committee, including the Global Health Cluster. The Advisory Group recommends that WHO reaffirm its commitment to stronger and more visible leadership of the Health Cluster, and to consistent high-level engagement with the Inter-Agency Standing Committee. The Advisory Group proposes that WHO seeks to build stronger linkages with other humanitarian Clusters whose activities contribute to people’s health and well-being (e.g. water and sanitation, food, nutrition and protection). WHO should ensure that its Cluster activities are treated as part of its core mandate and have predictable funding. WHO should also establish partnership agreements with humanitarian and other partners to put in place a framework for cooperation and clarify the respective roles and responsibilities of the partners.

15. The Advisory Group considers that the Global Outbreak Alert and Response Network (GOARN) is another collaboration mechanism that needs to be strengthened. Training GOARN members in teams and involving them in joint risk assessments will help enhance their readiness to deploy. WHO should encourage long-term investments in GOARN so as to increase national, regional and global capabilities for risk assessment, management and communication in outbreaks, as well as preparedness and prevention – especially in relation to risks posed by unfamiliar and potentially dangerous pathogens.

ADVISORY GROUP RECOMMENDATIONS FOR IMMEDIATE ACTION
16. The Advisory Group recommends that the Director-General take immediate action to:
a. Reaffirm WHO’s commitment to strengthened leadership of the Global Health Cluster, and to more active engagement with the Inter-Agency Standing Committee;
b. Establish standby partnership agreements with humanitarian and other partners that can be activated under defined circumstances;
c. Restructure WHO to enable it to lead and support collective efforts in outbreaks and emergencies, with the establishment of the single Programme, its Platform for operation and centralization of the budget and of accountability for its work;
d. Redesign WHO’s human resources management system to establish systems that reflect the needs of the Programme and Platform and implement the changes immediately; and
e. Transform financial management processes so that there is no delay in accessing funds required for outbreaks and emergencies and implement the changes immediately.

17. The Advisory Group recommends that the Executive Director be engaged in the redesign of Human Resources and Financial Management Processes.

This is an advance version of the Executive Summary from the First Report of the Advisory Group on Reform of WHO’s Work in Outbreaks and Emergencies with Health and Humanitarian Consequences. The definitive version will be released with the First Report when it has been completed. Target Completion Date: November 16th 2015.