Health Emergency and Disaster Risk Management Framework - World ...
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Health Emergency and Disaster Risk Management Framework
Health Emergency and Disaster Risk Management Framework
Health Emergency and Disaster Risk Management Framework ISBN 978-92-4-151618-1 © World Health Organization 2019 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization. Suggested citation. Health Emergency and Disaster Risk Management Framework.Geneva: World Health Organization; 2019. Licence: CC BY-NC-SA 3.0 IGO. Cataloguing-in-Publication (CIP) data. CIP data are available at http://apps.who.int/iris. Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. To submit requests for commercial use and queries on rights and licensing, see http://www.who.int/about/licensing. Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any third-party-owned component in the work rests solely with the user. General disclaimers. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO 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 and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. Design by Les Pandas Roux Front cover design by Freepik Printed in Switzerland
iii
TABLE OF CONTENTS
FOREWORD v
ACKNOWLEDGEMENTS vi
LIST OF CONTRIBUTORS vii
ABBREVIATIONS viii
EXECUTIVE SUMMARY ix
01. INTRODUCTION 1
02. CONTEXT: THE HEALTH CONSEQUENCES OF EMERGENCIES AND 2
DISASTERS
03. HEALTH EDRM: AN INTEGRATED APPROACH TO MANAGE HEALTH 3
RISKS AND BUILD RESILIENCE
3.1 KEY CONCEPTS AND CHARACTERISTICS OF HEALTH EDRM 3
04. HEALTH EDRM: VISION, EXPECTED OUTCOME AND GUIDING 6
PRINCIPLES
4.1 VISION AND EXPECTED OUTCOME 6
4.2 GUIDING PRINCIPLES 6
05. COMPONENTS AND FUNCTIONS OF HEALTH EDRM 9
5.1 POLICIES, STRATEGIES AND LEGISLATION 9
5.2 PLANNING AND COORDINATION 9
5.3 HUMAN RESOURCES 10
5.4 FINANCIAL RESOURCES 10
5.5 INFORMATION AND KNOWLEDGE MANAGEMENT 10
5.6 RISK COMMUNICATIONS 10
5.7 HEALTH INFRASTRUCTURE AND LOGISTICS 10
5.8 HEALTH AND RELATED SERVICES 11
HEALTH EDRM FRAMEWORK
5.9 COMMUNITY CAPACITIES FOR HEALTH EDRM 11
5.10 MONITORING AND EVALUATION 11
06. WORKING TOGETHER TO IMPLEMENT HEALTH EDRM 12
6.1 KEY STEPS IN DEVELOPING HEALTH EDRM STRATEGIES AND IMPLEMENTING 12
PRIORITY ACTIONS
6.2 AREAS FOR MULTISECTORAL ACTION AS A FOUNDATION FOR HEALTH EDRM 13iv
07. ROLES AND RESPONSIBILITIES FOR HEALTH EDRM 15
7.1 WHOLE OF GOVERNMENT, WHOLE OF SOCIETY 15
7.2 MINISTRY OF HEALTH 15
7.3 NATIONAL DISASTER MANAGEMENT AGENCY 16
7.4 COMMUNITIES AND COMMUNITY-BASED ORGANIZATIONS 16
7.5 WHO 16
7.6 INTERNATIONAL COMMUNITY 17
08. CONCLUSION 18
REFERENCES 19
ANNEXES 21
ANNEX 1. WHO CLASSIFICATION OF HAZARDS 22
ANNEX 2. COMPONENTS AND FUNCTIONS OF HEALTH EMERGENCY 24
AND DISASTER RISK MANAGEMENT
ANNEX 3. LIST OF STAKEHOLDER GROUPS FOR HEALTH EMERGENCY 30
AND DISASTER RISK MANAGEMENT
HEALTH EDRM FRAMEWORKv
FOREWORD
protect health. It outlines the need to work together
– because EDRM is never the work of one sector or
agency alone. It shows how the whole health system
can and must be fundamental in all of these efforts.
The Framework also details the clear need for com-
munities to be in the driving seat. While emergencies
affect everyone, they disproportionately affect those
who are the most vulnerable. The needs and rights of
the poorest, as well as women, children, people with
Emergencies and disasters take a profound toll on disabilities, older persons, migrants, refugees and
people’s health, often well after the headlines fade. displaced persons, and people with chronic diseases
must be at the centre of our work.
Every year, over 170 million people will be affected by
conflict, and another 190 million by disasters; yet the WHO is fully committed to working with Member
full impact on people’s health is far greater than this. States and partners to ensure that the Framework is
Some will be large national, regional or even global implemented effectively.
crises, from cyclones and drought to major outbreaks.
Others will be more localized, like traffic collisions and This document is the result of extensive consultations
fires, but can still be devastating in their collective and inputs from Member States and partners, as well
costs to human life. as WHO colleagues across offices and programmes
around the world. I would like to thank each and every
Too often these events set back development – one of those who have contributed to its development.
sometimes for decades – and jeopardize universal
health coverage along with other development agendas Moreover, I encourage everyone to use this Framework:
of a country. They shatter the aspirations of children you should be able to see yourself and your role in
and adults, and the communities they live in or call these pages. Not all emergencies can be predicted,
home. They can overwhelm health systems and dec- but they can be prepared for. Let us act together to re-
imate the economies that fund them. duce the risks they pose before, during and after emer-
gencies, and achieve a safer, healthier world for all.
Reducing these impacts is one of our most pressing
priorities. It will be central to achieving the triple billion
goals of the World Health Organization (WHO): for uni- Dr Tedros Adhanom Ghebreyesus
HEALTH EDRM FRAMEWORK
versal health coverage, for health security, and health Director-General
for all. World Health Organization
This Health Emergency and Disaster Risk Manage-
ment (EDRM) Framework is a substantial response
to this challenge. It emphasizes the critical impor-
tance of prevention, preparedness and readiness, to-
gether with response and recovery, to save lives andvi
ACKNOWLEDGEMENTS
The Health EDRM Framework is the culmination of with partners and countries led by WHO country and
a process of face-to-face and virtual consultations regional offices and their respective Regional Emer-
among WHO and experts from Member States and gency Directors: Ibrahima Socé Fall (African Region),
partner organizations who have contributed to the Ciro Ugarte (Region of the Americas), Roderico Ofrin
development, review and revision of the document. It (South-East Asia Region), Nedret Emiroglu (European
is derived from the good practices and achievements Region), Michel Thieren (Eastern Mediterranean Re-
in many related fields such as humanitarian action, gion), and Li Ailan (Western Pacific Region).
multisectoral disaster risk management, and all-hazards
emergency preparedness and response, including for The Health EDRM Framework was reviewed and fi-
epidemics, health systems strengthening and com- nalized at a Technical Workshop on Concepts and
munity-centred primary health care. The Framework Technical Guidance for Health EDRM (Geneva, 21–23
has drawn inspiration from World Health Assembly November 2018) with participation from countries,
and regional committee resolutions, regional strate- WHO leadership at all levels and experts, including
gies, national policies, international and national stan- from academia. The leadership of Mike Ryan, Jaouad
dards and guidelines, the United Nations Sustainable Mahjour, Stella Chungong and Qudsia Huda at WHO
Development Goals, the Sendai Framework for Disas- headquarters were very instrumental in finalizing the
ter Risk Reduction 2015–2030, the Paris Agreement Framework. The contributions of Rick Brennan and
on Climate Change, guidance on implementing the Rudi Coninx, and Jonathan Abrahams who coordinat-
International Health Regulations (2005), and activities ed the development process, are gratefully acknowl-
of the WHO Thematic Platform for Health EDRM and edged.
its associated Research Network.
WHO thanks the governments of Australia, Finland,
The extensive process of developing this document Republic of Korea and the United Kingdom for their
was based on the evidence gained from WHO’s work financial support.
HEALTH EDRM FRAMEWORKvii
LIST OF CONTRIBUTORS
WHO wishes to recognize particularly the following Member and Agriculture Organization of the United Nations (FAO),
States, experts and partner organizations for their technical Switzerland; Kaisa Kontunen, International Organization
contributions to the Framework. for Migration (IOM), Switzerland; Peter Koob, Consultant,
Australia; Daniel Kull, World Bank, Switzerland; Shuhei
Member States: Australia, Bangladesh, Cambodia, Canada, Nomura, University of Tokyo, Japan; Michel le Pechoux,
China, Egypt, Ethiopia, India, Indonesia, Islamic Republic United Nations Children’s Fund (UNICEF), Switzerland;
of Iran, Japan, Lao People’s Democratic Republic, Mexico, Czarina Leung, Hong Kong SAR, China; Gabriel Leung,
New Zealand, Oman, Peru, Philippines, Qatar, Republic of Hong Kong SAR, China; Michael Mosselmans, World
Moldova, Singapore, Sri Lanka, Sudan, Turkey, United Food Programme (WFP), Italy; Loy Rego, Asian Disaster
Kingdom, United Republic of Tanzania, United States of Preparedness Center, Thailand; Panu Saaristo, International
America (USA) and Viet Nam. Federation of Red Cross and Red Crescent Societies
(IFRC), Switzerland; Valérie Scherrer, CBM, Belgium; Rahul
National experts: Walid Abu Jalala, Qatar; Salim Al Wahaibi, Sengupta, UNDRR, Germany; Margareta Wahlstrom,
Oman; Sergio Alvarez, Peru; Ali Ardalan, Islamic Republic of UNDRR, Switzerland; Chadia Wannous, United Nations
Iran; Haithem El Bashir, Sudan; Paul Gully, Canada; Didier System Influenza Coordination (UNSIC), Switzerland.
Houssin, France; Alistair Humphrey, New Zealand; Ute Jugert,
Germany; Margaret Kitt, USA; Mollie Mahany, USA; Ahamada Experts from WHO: Usman Abdulmumini, Onyema Ajuebor,
Msa Mliva, Comoros; Virginia Murray, United Kingdom; Yahaya Ali Ahmed, Nada Alward, Bruce Aylward, Nicholas
Guilherme Franco Netto, Brazil; Sae Ochi, Japan; Somiya Banatvala, Maurizio Barbeschi, Samir Ben Yahmed, Rayana
Okoud, Sudan; Peng Lim Steven Ooi, Singapore; Ravindran Bouhaka, David Brett-Major, Sylvie Briand, Nilesh Buddh,
Palliri, India; Thierry Paux, France; Mihail Pîsla, Republic of Alex Camacho, Diarmid Campbell-Lendrum, Zhanat Carr,
Moldova; Ossama Rasslan, Egypt; Nobhojit Roy, India; Mehmet Frederik Copper, Paul Cox, Stephane de La Rocque, Xavier
Akif Saatcioglu, Turkey; Sri Henni Setiawati, Indonesia; John De Radigues, Linda Doull, Osman Elmahal Mohammed,
Simpson, United Kingdom; Theresa Tam, Canada. Ute Enderlein, Florence Fuchs, Keiji Fukuda, Michelle Gayer,
Andre Griekspoor, Kersten Gutschmidt, Fahmy Hanna,
Experts from intergovernmental & partner organizations: David Harper, Dirk Horemans, Gabit Ismailov, Hamid Syed
Vincent Lee Anami, International Medical Corps (IMC), Jafari, Kalula Kalambay, Kande-Bure Kamara, Nirmal
Kenya; Paul Arbon, Torrens Resilience Institute, Australia; Kandel, Youssouf Kanoute, Ryoma Kayano, Hyo-Jeong
Frank Archer, Monash University, Australia; Marvin Kim, Rebecca Knowles, Helena Krug, Ben Lane, Jostacio
Birnbaum, World Association for Disaster and Emergency Lapitan, Vernon Lee, Jian Li, Matthew Lim, Tarande Manzila,
Medicine, USA; Lourdes Chamorro, European Union; Emily Adelheid Marschang, Susana Martinez Schmickrath,
Chan, Chinese University of Hong Kong (CUHK), Hong Kong Elizabeth Mason, Elizabeth Mumford, Altaf Musani, Maria
Special Administrative Region (SAR), China; Gloria Chan, Neira, Tara Neville, Dorit Nitzan, Ngoy Nsenga, Isabelle
HEALTH EDRM FRAMEWORK
CUHK, Hong Kong SAR, China; Massimo Ciotti, European Nuttall, Olushayo Olu, Heather Papowitz, Yingxin Pei,
Centre for Disease Prevention and Control (ECDC), Sweden; Charles Penn, William Perea, Arturo Pesigan, Jean-Luc
Ioana Creitaru, United Nations Development Programme Poncelet, Pravarsha Prakash, Jukka Pukkila, Adrienne
(UNDP), Switzerland; Marcel Dubouloz, Consultant, Rashford, Gerald Rockenschaub, Guenael Rodier, Alex Ross,
Switzerland; Mélissa Généreux, Sherbrooke University, Cathy Roth, Dalia Samhouri, Irshad Shaikh, Iman Shankiti,
Canada; John Harding, United Nations Office for Disaster Rajesh Sreedharan, Ludy Suryantoro, Joanna Tempowski,
Risk Reduction (UNDRR), Switzerland; Teodoro Herbosa, Lisa Thomas, Angelika Tritscher, Heini Utunen, Willem Van
University of the Philippines, Philippines; Hossein Kalali, Lerberghe, Liviu Vedrasco, Elena Villalobos Prats, Kai von
UNDP, USA; Mark Keim, DisasterDoc, USA; Wirya Khim, Food Harbou, Michel Yao, Nevio Zagaria, Wenqing Zhang.viii
ABBREVIATIONS
CADRI Capacity for Disaster Reduction Initiative
EDRM emergency and disaster risk management
GOARN Global Outbreak Alert and Response Network
GPW General Programme of Work (WHO)
IASC Inter-Agency Standing Committee
IFRC International Federation of Red Cross and Red Crescent Societies
IHR International Health Regulations
JMP Joint Monitoring Programme (WHO/UNICEF)
NDMA National Disaster Management Agency
NGO nongovernmental organization
SDGs United Nations Sustainable Development Goals
SOP standard operating procedure
UHC universal health coverage
UN United Nations
UNDP United Nations Development Programme
UNDRR United Nations Office for Disaster Risk Reduction
UNICEF United Nations Children’s Fund
WHE WHO Health Emergencies Programme
WHO World Health Organization
HEALTH EDRM FRAMEWORKix
EXECUTIVE SUMMARY
All communities are at risk of emergencies and di- Large-scale events due to natural and technological
sasters including those associated with infectious dis- hazards in the Caribbean, Japan, Mozambique and
ease outbreaks, conflicts, and natural, technological Nepal, disease outbreaks in the Democratic Republic
and other hazards. The health, economic, political of the Congo, Republic of Korea and Saudi Arabia, and
and societal consequences of these events can be protracted crises in many countries have highlight-
devastating. Climate change, unplanned urbanization, ed that no country is immune from emergencies and
population growth and displacement, antimicrobial disasters. While these events may have the great-
resistance and state fragility are contributing to the est impact, the cumulative effect of smaller-scale
increasing frequency, severity and impacts of many events also has a significant impact on communities
types of hazardous events that may lead to emergen- worldwide. All of these events demonstrate the public
cies and disasters without effective risk management. health imperative to scale up risk-informed actions
to reduce hazards, exposures and vulnerabilities, and
Reducing the health risks and consequences of emer- build capacities to protect public health from emer-
gencies is vital to local, national and global health gencies and disasters.
security and to build the resilience of communities,
countries and health systems. Sound risk manage- In order to address current and emerging risks to
ment is essential to safeguard development and public health and the need for effective utilization and
implementation of the Sustainable Development Goals management of resources, the conceptual frame
(SDGs), including the pathway to universal health or paradigm of “health emergency and disaster risk
coverage (UHC), the Sendai Framework for Disas- management” (Health EDRM) has been developed to
ter Risk Reduction 2015–2030 (Sendai Framework), consolidate contemporary approaches and practice.
International Health Regulations (IHR) (2005), Paris
Agreement on Climate Change (Paris Agreement) and The Health EDRM Framework provides a common
other related global, regional and national frameworks. language and a comprehensive approach that can be
adapted and applied by all actors in health and other
While countries have strengthened capacities to re- sectors who are working to reduce health risks and
duce the health risks and consequences of emer- consequences of emergencies and disasters. The
gencies and disasters through the implementation Framework also focuses on improving health out-
of multi-hazard disaster risk management, the IHR comes and well-being for communities at risk in different
(2005), and health system strengthening, many com- contexts, including in fragile, low- and high-resource
munities remain highly vulnerable to a wide range of settings.
hazardous events. Fragmented approaches to dif-
HEALTH EDRM FRAMEWORK
ferent types of hazards, including over-emphasis on Health EDRM emphasizes assessing, communicating
reacting to, instead of preventing events and preparing and reducing risks across the continuum of preven-
properly to be ready for response, and gaps in coordi- tion, preparedness, readiness, response and recovery,
nation across the entire health system, and between and building the resilience of communities, countries
health and other sectors, have hindered the ability of and health systems. Drawing on the expertise and
communities and countries to achieve optimal devel- field experience of many experts who contributed to
opment outcomes including for public health. the development of this Framework, Health EDRM isx
derived from the disciplines of risk management, Health EDRM functions are organized under the fol-
emergency management, epidemic preparedness lowing components.
and response, and health systems strengthening. It {{ P O L I C I E S , S T R AT E G I E S A N D
is fully consistent with and helps to align policies and LEGISLATION: Defines the structures,
actions for health security, disaster risk reduction, roles and responsibilities of governments
humanitarian action, climate change and sustainable and other actors for Health EDRM; includes
development. Effective implementation of Health strategies for strengthening Health EDRM
EDRM is therefore critical to achieve UHC in all coun- capacities.
try contexts. {{ PL ANNING AND COORDIN ATION:
Emphasizes effective coordination
The vision of Health EDRM is the “highest possible mechanisms for planning and operations
standard of health and well-being for all people who for Health EDRM.
are at risk of emergencies, and stronger communi- {{ HUMAN RESOURCES: Includes planning
ty and country resilience, health security, universal for staffing, education and training across
health coverage and sustainable development”. The the spectrum of Health EDRM capacities at
expected outcome of Health EDRM is that “countries all levels, and the occupational health and
and communities have stronger capacities and sys- safety of personnel.
tems across health and other sectors resulting in the {{ FINANCIAL RESOURCES: Supports
reduction of the health risks and consequences as- implementation of Health EDRM activities,
sociated with all types of emergencies and disasters”. capacity development and contingency
funding for emergency response and
Health EDRM is founded on the following set of core recovery.
principles and approaches that guide policy and practice: {{ INFORM ATION AND KNOWLEDGE
{{ risk-based approach; MANAGEMENT: Includes risk assessment,
{{ comprehensive emergency management surveillance, early warning, information
(across prevention, preparedness, management, technical guidance and
readiness, response and recovery); research.
{{ all-hazards approach; {{ RISK COMMUNICATIONS: Recognizes
{{ inclusive, people- and community-centred that communicating effectively is critical
approach; for health and other sectors, government
{{ multisectoral and multidisciplinary authorities, the media, and the general
collaboration; public.
{{ whole-of-health system-based; {{ H E A LT H I N F R A S T R U CT U R E A N D
{{ ethical considerations. LOGISTICS: Focuses on safe, sustainable,
secure and prepared health facilities, critical
Health EDRM comprises a set of functions and com- infrastructure (e.g. water, power), and
ponents that are drawn from multisectoral emergency logistics and supply systems to support
and disaster management, capacities for implement- Health EDRM.
HEALTH EDRM FRAMEWORK
ing the IHR (2005), health system building blocks, and {{ HEALTH AND RELATED SERVICES:
good practices from regions, countries and commu- Recognizes the wide range of health-care
nities. The Framework focuses mainly on the health services and related measures for Health
sector, noting the need for collaboration with many EDRM.
other sectors that make substantial contributions to
reducing health risks and consequences.xi
{{ COMMUNITY CAPACITIES FOR HEALTH The Framework proposes the following areas for action
EDRM: Focuses on strengthening local that could be considered by the health sector as the
health workforce capacities and inclusive foundation of a comprehensive strategy: surveillance,
community-centred planning and action. early warning and alert systems; emergency
{{ MONITORING AND EVALUATION: Includes preparedness for response across all hazards, the
processes to monitor progress towards health system and all sectors, including operational
meeting Health EDRM objectives, including readiness and mass casualty management systems;
monitoring risks and capacities and and resilient hospitals and health facilities that are
evaluating the implementation of strategies, safe, secure and sustainable, and that can continue to
related programmes and activities. function in emergency or disaster situations. Strong
advocacy and participation by the health sector in
The success of Health EDRM relies on joint planning international and national forums, including through
and action by ministries of health and other government the National Disaster Management Agency (NDMA),
ministries, the national disaster management agency, is needed to ensure that the health of the populations
the private sector, communities and community- remains central to multisectoral policy, planning, and
based organizations, assisted by the international resource allocation dialogues, and in operational
community. At the core of effective Health EDRM are coordination at local, subnational and national levels.
efforts to strengthen a country’s health system with
a strong emphasis on community participation and WHO is committed to working with Member States
action to build resilience and establish the foundation and partners to support implementation of the IHR
for effective prevention, preparedness, response and (2005), the Sendai Framework, the SDGs and the
recovery from all types of hazardous events including Paris Agreement. Effective management of the risks
emergencies and disasters. of emergencies and disasters by all stakeholders
will make a substantial contribution to strengthen
All countries require multidisciplinary and multisectoral community and country resilience, health security,
policies, strategies and related programmes to UHC and sustainable development. It will also
reduce health risks of emergencies and disasters enable all communities at risk of emergencies and
and their associated consequences. The design disasters to attain the highest possible standard of
of Health EDRM strategies requires a systemic health and well-being. Implementation of the Health
approach that takes account of the risks, capacities EDRM Framework provides a solid foundation for
and the availability of resources to implement risk all stakeholders to work together and achieve these
management measures at local, subnational and objectives.
national levels. Strategic health emergency risk
assessments, assessments of capacity across
Health EDRM components and functions, and reviews
of existing plans and past experience can assist
the development of comprehensive strategies and
identification of priorities for action.
HEALTH EDRM FRAMEWORK1
1
INTRODUCTION
People across the world are faced with a wide and types of hazards. While its leadership in managing in-
diverse range of risks associated with health emer- fectious risks and responding to outbreaks is clear, the
gencies and disasters. These comprise infectious health sector also has a critical role in preventing and
disease outbreaks, natural hazards, conflicts, unsafe minimizing the health consequences of emergencies
food and water, chemical and radiation incidents, due to natural, technological and societal hazards. It
building collapses, transport incidents, lack of water can only fulfil these responsibilities in close collab-
and power supply, air pollution, antimicrobial resis- oration with at-risk communities and other sectors.
tance, the effects of climate change, and other sourc-
es of risk (Annex 1). Small-scale hazardous events
with limited health consequences occur on a regular
basis, while other events may lead to emergencies
“Universal health coverage and health
or disasters with significant consequences for public security are two sides of the same
health, well-being and for health development. The coin.”
health, economic, political and societal consequences
of these events can be devastating, both in the acute Dr Tedros Adhanom Ghebreyesus,
phase and in the longer term. Developments such as Director-General, WHO,
climate change, unplanned urbanization, population
17 May 2018
growth, migration and state fragility are increasing
the frequency, severity and impacts of many types of
emergencies throughout the world.
The management of these risks is vital to protect The aim of this document is to provide ministries of
people’s health from emergencies and disasters, to health and other stakeholders with a summary of
ensure local, national and global health security, to policy considerations to reduce the risks and con-
attain UHC and to build the resilience of communi- sequences of emergencies and disasters, and build
ties, countries and health systems. Sound risk man- the resilience of health systems, communities and
agement is essential to safeguard development and countries. The Health EDRM Framework provides
the implementation of local, national, regional (1, 6) an overview of risk management concepts, guiding
and global strategies in health and other sectors. principles, the components and functions of effec-
This is particularly important for implementing the tive Health EDRM, and guidance on implementing the
SDGs, including the pathway to UHC and target 3d to Framework. This document does not replace existing
“strengthen the capacity of all countries, in particular regional or global frameworks or strategies, including
developing countries, for early warning, risk reduction the IHR (2005). Rather, it builds on these to incorpo-
and management of national and global health risks” rate multiple hazards and to embrace a comprehen-
(7); the Sendai Framework (8); IHR (2005) (9);1 and the sive approach to risk management. Policy guidance
HEALTH EDRM FRAMEWORK
Paris Agreement (10). also aims to assist countries to take joint action and
promote coherence in implementing the IHR (2005),
Health systems at all levels have a central role in the Sendai Framework, the Paris Agreement, the
managing the risks and reducing the consequences SDGs and other related national, regional and global
of both routine and emergency situations due to all strategies and frameworks.
1
The IHR (2005) is legally binding and provides an international mechanism for the effective management of biological, chemical
and radiological events, especially those that have the potential to cross international borders.2
2
CONTEXT:
THE HEALTH CONSEQUENCES OF
EMERGENCIES AND DISASTERS
Globally, the commonest hazardous events are trans- The financial costs of emergencies are also stagger-
portation crashes, floods, cyclones/ windstorms, ing. Emergencies caused by natural and technologi-
outbreaks, industrial accidents, and earthquakes cal hazards cost an average US$ 300 billion annually
(11). Approximately 190 million people are directly (14), while the cost of armed conflicts can run into
affected annually by emergencies due to natural and trillions. The expected annual losses from pandem-
technological hazards, with over 77 000 deaths (11). A ic risk through its effects on productivity, trade and
further 172 million are affected by conflict (12). From travel have been calculated at about US$ 500 billion
2012 to 2017, WHO recorded more than 1200 out- or 6% of global income per year (15). It is estimated
breaks in 168 countries, including those due to new that premature deaths associated with air pollution
or re-emerging infectious diseases. In 2018, a further caused about US$ 225 billion in lost labour income to
352 infectious disease events, including Middle East the global economy in 2013 (16).
respiratory syndrome coronavirus (MERS-CoV) and
Ebola virus disease (EVD), were tracked by WHO (13). Most countries are likely to experience a large-scale
emergency approximately every five years (17), and
In addition to increasing morbidity, mortality and many are prone to the seasonal return of hazards
disability, emergencies may result in severe disrup- such as monsoonal floods, cyclones and disease
tions of the health system. They interfere with health outbreaks. Although most international attention
service delivery through damage and destruction of focuses on high-consequence disasters, hundreds
health facilities, interruption of health programmes, of smaller-scale emergencies and other hazardous
loss of health staff, and overburdening of clinical ser- events occur locally each year, such as outbreaks,
vices. A single emergency can set back development floods, fires, and transportation crashes. Cumulatively,
gains in public health and other sectors by decades. these account for a high number of deaths, injuries,
illnesses and disabilities.
HEALTH EDRM FRAMEWORK3
3
HEALTH EDRM:
AN INTEGRATED APPROACH TO
MANAGE HEALTH RISKS AND BUILD
RESILIENCE
Strengthening health systems, implementing the IHR
3.1 KEY CONCEPTS AND
(2005), and developing multi-hazard disaster risk CHARACTERISTICS OF HEALTH
management strategies – together with increased EDRM
attention to climate change adaptation – are good Policies and programmes to minimize the
examples of progress made to improve management health risks and consequences of emergen-
of the health risks associated with hazardous events. cies and disasters should be based on a risk
Nevertheless, many communities, subpopulations management approach. Health EDRM is a
and countries remain highly vulnerable to emergen- continuum of measures in which the emphasis
cies and disasters. The ability to achieve optimal is placed on managing the risks of the potential
health outcomes related to emergencies has been emergency or disaster, and not solely respond-
hindered by fragmented approaches to different types ing to the event or crisis, and on building the
of hazards; over-emphasis on reacting to, rather than resilience of communities and countries.
preventing and preparing for events; and by gaps in
coordination across the entire health system, and be- {{ Risk is defined as “The combination of
tween health and other sectors. the probability of an event and its negative
consequences” (18). More specifically,
In view of current and emerging risks to public health emergency or disaster risk is defined as
and the need for more effective coordination, utiliza- “[T]he potential loss of life, injury, or destroyed
tion and management of resources, there is a need to or damaged assets which could occur to a
consolidate contemporary approaches and practice system, society or a community in a specific
through the conceptual framework or paradigm of period of time, determined probabilistically as
“health emergency and disaster risk management”. a function of hazard, exposure, vulnerability
and capacity” (19). Hazard-related risks can
never be completely eliminated, but they can
– and should – be managed. When EDRM
activities are designed specifically to reduce
“Prevention and preparedness is the the probability of events and to minimize
heart of public health. Risk manage- health consequences, the term “health
HEALTH EDRM FRAMEWORK
ment is our bread and butter.” emergency and disaster risk management”
can be used.
Dr Margaret Chan,
WHO Director-General,
30 October 2012 Comprehensive Health EDRM addresses a
wide scope of natural, biological, technologi-
cal and societal hazards: a range of risk man-
agement measures are employed (e.g. primary
prevention and recovery in addition to emer-4
prevention and recovery in addition to emergen- collectively contribute to the resilience of
cy preparedness and response) with the broad communities and countries. Health EDRM
engagement of the health system and multi- builds on past achievements and the trends
ple sectors, and a strong community focus. evident in public health and emergency risk
management practices worldwide. It is fully
{{ Progress has been made by countries to consistent with, and helps to align policies
reduce the health and other consequences and action for health security, disaster risk
of emergencies. The most successful and reduction, humanitarian reform, climate
cost-effective strategies often employ a change and sustainable development
comprehensive risk management approach agendas.
that aims to prevent, mitigate, prepare for,
respond to, and recover from emergencies. {{ Health EDRM reinforces implementation
This overall approach should be applied in of the IHR (2005) – an essential building
all emergency circumstances regardless of block for the development of national Health
the cause, while incorporating specificities EDRM capacities – and other relevant
relevant for each hazard (e.g. biological, international and regional agreements and
geological, chemical, hydrometeorological, initiatives such as the SDGs (with a focus
societal). Countries have also used on target 3d), the Sendai Framework, and
after-action reviews and recovery from the Paris Agreement. To be most effective,
emergencies and disasters to catalyse policy these agreements should not be applied in
change, strengthen the health systems at all isolation but considered as interrelated
levels of care, and build capacities in ways and mutually reinforcing.
to reduce the risk of future emergencies,
applying the Build Back Better principle. Health EDRM is built on the foundation of
health system capacities for the management
Health EDRM is derived from a range of disci- of routine or day-to-day risks.
plines, principally risk management, emergen-
cy and disaster management, epidemic pre- {{ Health systems play a significant role
paredness and response, and health systems in reducing hazards, exposures and
strengthening. Health EDRM serves as a bridge vulnerabilities, and in establishing capacities
between the multisectoral EDRM community to prevent the occurrence or reduce the
and the health community. It aims to provide a consequences of hazardous events that may
common language and an adaptable approach lead to emergencies. Such capacities include
that can be applied by all those in the health and primary care, disease surveillance, pre-
other sectors who are working to improve health hospital care, mass casualty management,
outcomes and well-being for communities at chemical and radiological safety, mental
risk of emergencies and disasters. health, and risk communication. Health
systems should also ensure that they have
HEALTH EDRM FRAMEWORK
{{ In order to minimize health consequences additional capacities in place to manage
and improve health, well-being and societal non-routine or emergency-related risks,
outcomes, concerted efforts from many e.g. event-based surveillance, specialized
systems and sectors are required to prevent emergency health teams, standards for
and mitigate risks, prepare for emergencies, infrastructure in high-risk areas, emergency
ensure effective response and recovery, and response plans, and simulation exercises.5
As such, Health EDRM recognizes the roles, Table 1: Summary of change in approach through Health
responsibilities and contributions of all health EDRM
system actors, the critical role of primary
health care, and the delivery of primary,
secondary and tertiary care, in effectively FROM TO
reducing the health risks and consequences
of emergencies and disasters. Event-based Risk-based
{{ Large-scale emergencies, such as
Reactive Proactive
prolonged conflicts, often have significant
health consequences and pose challenges
to the delivery of even the most basic of Single-hazard All-hazard
health services. Health systems must
therefore adapt and prioritize services, Vulnerability
Hazard-focus
and capacity focus
including assistance from national and
international actors, to address the health
Single agency Whole-of-society
needs of affected populations and respective
subpopulations. This assistance is most
Separate Shared responsibility
likely required in fragile, conflict-affected
responsibility of health systems
and vulnerable settings. Health systems
will also be required to plan and implement Response-focus Risk management
strategies to support, strengthen and restore
local capacities during protracted crises and Planning for Planning with
in post-disaster or post-conflict periods. communities communities
In summary, Health EDRM is a significant step
forward in the transformation of the prevailing
policy, practice and culture to promote and
protect health, keep the world safe and serve
people with vulnerabilities so that “no one is left
behind”. The essence of the change in approach
is summarized in Table 1.
HEALTH EDRM FRAMEWORK4
6
HEALTH EDRM:
VISION, EXPECTED OUTCOME AND
GUIDING PRINCIPLES
4.1 VISION AND EXPECTED Comprehensive emergency management:
OUTCOME The comprehensive approach refers to a se-
The conceptual basis of Health EDRM com- ries of closely interrelated prevention/mitiga-
prises the vision, expected outcome, guid- tion, emergency preparedness (including op-
ing principles and approaches, components erational readiness), response, and recovery
and functions. The vision of Health EDRM is measures. It is based on the premise that pre-
“the highest possible standard of health and vention and mitigation measures can reduce
well-being for all people at risk of emergencies, the likelihood and severity of emergencies; that
and stronger community and country resilience, sound preparedness will lead to more timely
health security, universal health coverage and and effective response; that coordinated re-
sustainable development”. The expected out- sponse will result in appropriate targeting of
come is that “countries and communities have health services to the needs of those affect-
stronger capacities and systems across health ed with a focus on the most vulnerable; and
and other sectors resulting in the reduction of that recovery and reconstruction should be
the health risks and consequences associated designed to reduce the risks of future emer-
with all types of emergencies and disasters”. gencies (Build Back Better approach, including
strengthening of health systems).
4.2 GUIDING PRINCIPLES All-hazards approach: Different types of haz-
Effective Health EDRM policies, strategies, re-
lated programmes and practice are guided by ards are associated with similar risks to health,
the following core principles and approaches. and many EDRM functions are similar across
hazards (e.g. planning, logistics, risk communi-
Risk-based approach: The risks that emer- cations). It is neither efficient nor cost-effective
gencies pose to communities are directly re- to develop separate, stand-alone capacities
lated to the communities’ exposure to hazards, or response mechanisms for each individual
their vulnerabilities to those hazards, and their hazard. Health EDRM policies, strategies and
risk management capacity both before, during related programmes should therefore be de-
and after events. Countries and communities signed to address common issues with com-
can therefore most effectively minimize the mon capacities, supplemented by risk-specific
health and other consequences of emergen- capacities.
HEALTH EDRM FRAMEWORK
cies by preventing or mitigating hazards, re-
ducing exposure to those hazards, minimizing Inclusive, people- and community-centred
their vulnerabilities, and/or strengthening their approach: Community members are central
capacities. to effective Health EDRM, as it is their health,7
livelihoods and assets that are at risk of any Multisectoral and multidisciplinary collabo-
hazardous event including emergencies and ration: Effective management of the risks that
disasters. They are often well placed to man- emergencies pose to health requires strong,
age their own risks through actions that provide ongoing intersectoral collaboration. The One
protection to themselves, their families and Health approach, for example, is based on col-
communities; and are often the first respond- laboration, communication, and coordination
ers to an emergency. Health EDRM employs an across public health, animal health and other
inclusive approach based on accessible and relevant sectors and disciplines to address a
non-discriminatory participation. It addresses health threat at the human–animal–environ-
the needs and capacities of people at greatest ment interface with the goal of achieving opti-
risk and disproportionately affected by emer- mal health outcomes for both people and an-
gencies and disasters, especially the poorest, imals. While the health sector takes a leading
as well as women, children, people with dis- technical role in managing the risk of infectious
abilities, older persons, migrants, refugees and diseases, for most types of hazards and events
displaced persons, people with chronic diseas- other sectors will play lead technical roles (e.g.
es, and other subpopulations with higher levels agriculture for food insecurity, meteorological
of risks. All Health EDRM policies and practices services for early warning of cyclones, civil
should integrate gender, age, disability and cul- protection for emergency response to floods).
tural perspectives, in which the leadership of Many EDRM activities required to protect
women, youth and other at-risk groups should health are also managed by other sectors, e.g.
be promoted. maintenance of critical infrastructure, water
and sanitation for human needs and function-
The resilience of communities can be strength- ing of health facilities, transportation, logistics,
ened by assisting them to identify relevant haz- emergency services, and food security.
ards and vulnerabilities, and by building their
capacities to mitigate, prepare for, respond to, The health sector needs to have strong rela-
and recover from emergencies. Building on the tionships with the many actors who have a role
“whole-of-society” concept, effective Health to play in managing risks of emergencies to
EDRM can only be achieved through the active health. These include urban planners, civil en-
participation of local governments, civil society gineers, operators of hazardous facilities, cli-
and volunteer organizations, the private sector, mate information providers, animal health pro-
and individual citizens. fessionals, the media and emergency services.
Effective coordination among many disciplines
in the health community is also required, such
as emergency medicine, disease surveillance,
Health emergency and disaster risk mental health, nutrition, water and sanitation,
management is everybody’s business. health information management and many
more.
HEALTH EDRM FRAMEWORK8
Whole-of-health system-based: Many gener- Governments, intergovernmental and nongov-
al health system strengthening measures are ernmental organizations (NGOs) should take
among the most effective for Health EDRM. account of the diverse needs of populations,
High baseline coverage rates for essential especially those with higher levels of vulner-
health services, e.g. through implementation of ability who should be included in participatory
UHC policies, will improve overall health status, approaches to planning, design and delivery
contribute to the prevention of outbreaks, and of services that affect them. People should
mitigate the health consequences of emergen- have ready access to accurate, up-to-date
cies. Improved baseline health and nutritional and easily understood information about risks
status is one of the most important contribut- of emergencies, and appropriate local and in-
ing factors to community resilience. Integra- dividual actions. The best available scientific
tion of Health EDRM principles and practices and socioeconomic evidence, analyses and
in national, subnational and local health poli- disaggregated data should be used to inform
cies, plans, programmes and services relevant planning, implementation and evaluation of the
to Health EDRM components and functions effectiveness and impact of policies and ac-
(Annex 2) is vital to reduce the health risks and tion, especially with respect to disadvantaged
consequences of emergencies and disasters. groups, so that corrective adjustments can be
made in a timely manner.
Ethical considerations: Multiple sources of
ethical challenges arise throughout Health
EDRM. Decisions about priorities in reducing
risks or responding to disasters include up-
holding health as a human right (20),1 ethi-
cal aspects, as well as pragmatic, economic,
political and other considerations. Standards of
ethics and international health law are relevant
in Health EDRM, driven by principles such as
respect for persons, justice, solidarity and cul-
tural sensitivity (21). These principles enable
ethical action with respect to Health EDRM
policy, practice, communications, evaluation
and research, and promote trust in interactions
with affected communities.
HEALTH EDRM FRAMEWORK
1
The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without dis-
tinction of race, religion, political belief, economic or social condition. Constitution of the World Health Organization (20).5
9
COMPONENTS AND FUNCTIONS
OF HEALTH EDRM
Health EDRM encompasses a wide range of functions of action by all sectors. Since health issues
and components in health and other sectors that en- are not often well represented in intersectoral
able countries to manage the health risks of emer- policies and strategies, strong advocacy may
gencies and disasters. These functions form sys- be required to ensure a more central place
tems to manage risks collectively at all levels, which for health in these important multisectoral
underscores the need for effective coordination for policies, strategies and initiatives.
successful Health EDRM.
The Health EDRM functions are grouped into the fol-
5.2 PLANNING AND COORDINATION
A range of plans are required to implement
lowing components, derived from a number of sourc- Health EDRM, including those developed to
es including adaptation of the health system building support national implementation of the IHR
blocks, multisectoral emergency and disaster man- (2005) and the Sendai Framework. They should
agement, and the IHR (2005) including epidemic pre- be informed by the findings of risk and capacity
paredness and response. Further details on the sug- assessments, exercises and reviews, especially
gested list of components and functions can be found those conducted for national multisectoral all-
in Annex 2. hazards disaster risk management and under
the IHR Monitoring and Evaluation Framework.
5.1 POLICIES, STRATEGIES AND Relevant health considerations should also be
LEGISLATION fully integrated into health and multisectoral
Health EDRM considerations should be plans, such as national action plans for health
integrated into relevant policies and strategies, security, national disaster risk reduction plans,
supported by appropriate legislation. plans for preparedness, response and recovery,
They should be included in national health and incident management systems. There
policies, strategies and plans, be aligned should be coherence and continuity between
with national planning and budget cycles, the plans of different levels and jurisdictions
and be mainstreamed in the broad range of – local, subnational and national. Plans for
national and subnational health programmes. emergency preparedness and response need
A national policy or strategy on Health EDRM to be regularly tested and reviewed. Business
should outline the roles and responsibilities of continuity plans will also be required by public
all public, private and civil society stakeholders, and private institutions to ensure that vital
across the components of all-hazards functions and services continue throughout
Health EDRM, and include those responsible an emergency (22, 23).
HEALTH EDRM FRAMEWORK
for planning and coordination, IHR (2005),
surveillance and early warning, emergency Health EDRM coordination mechanisms and/
preparedness and response, recovery, safe or dedicated units should be established to
hospitals, and health and related services. ensure appropriate coordination across the
Similarly, multisectoral EDRM policies and health sector and with other sectors at each
legislation should refer to the protection of level. They should also have procedures to is-
people’s health and the minimization of health sue requests for, receive and coordinate inter-
consequences as specific aims and outcomes national health partners in case of large-scale10
emergencies that exceed national capacities.
5.5 INFORMATION AND
This includes having systems in place to re- KNOWLEDGE MANAGEMENT
ceive, screen, register and task these partners, Information and knowledge management ca-
as well as anticipating, requesting and receiv- pacities will need to be strengthened to sup-
ing donations of medicines and equipment. port risk/needs assessments, disease surveil-
lance and other early warning systems, and
5.3 HUMAN RESOURCES public communications. It is important that
Dedicated personnel to manage Health EDRM information collection, analysis and dissemi-
strategies and related programmes and to im- nation be harmonized across relevant sectors,
plement activities are required at national, sub- and mechanisms put in place to ensure that
national and local levels. Key human resource “the right information gets to the right people
management considerations include planning at the right time”. Research supports the evo-
for staffing requirements (including surge ca- lution of evidence, knowledge and practice and
pacity for emergency response), education the development of new drugs, vaccines and
and training for competency development, and innovative risk management measures. Evi-
occupational health and safety. Skilled human dence-based technical guidance is required to
resources are central to the effectiveness of build capacity through training programmes
Health EDRM strategies and related pro- and health systems improvements.
grammes; they require specific and long-term
investment in education and training across
the spectrum of Health EDRM capacities in
5.6 RISK COMMUNICATIONS
Communicating effectively, including risk
technical areas such as emergency planning, communication, is a critical function of Health
incident management, epidemiology, laborato- EDRM, especially when relating to other sec-
ry diagnostics, information management, risk tors, government authorities, the media, and
and needs assessments, logistics, risk com- the public. Real-time access and exchange of
munication, and health service delivery. information, advice and opinions are vital so
that everyone at risk is able to make informed
5.4 FINANCIAL RESOURCES decisions and take action to prevent, mitigate
Adequate financial allocations are required and respond to potential emergencies. Public
from governments, including the Ministry of information activities should be coordinated
Health, and other sources to develop capac- among stakeholders in order to avoid conflict-
ities and implement programmes and activ- ing information being disseminated, and be
ities. Health EDRM, including prevention and tailored to the risks and needs of diverse at-
preparedness measures, has a recurrent cost risk populations, including those with higher
which should be fully considered and funded levels of vulnerability.
as it is in other sectors related to the safety and
security of populations. Financial mechanisms
5.7 HEALTH INFRASTRUCTURE AND
should also include contingency funding for LOGISTICS
HEALTH EDRM FRAMEWORK
response and recovery. National budgetary Making hospitals, health facilities and related
systems need to be sufficiently flexible to pro- infrastructure safe and secure, prepared for
vide financing expeditiously in the aftermath emergencies, and energy efficient will protect
of an emergency. For advocacy and planning the lives of their occupants, enable effective
purposes, it is important to document the eco- health response and recovery, protect public
nomic impacts of past disasters on health and and private investments, support sustainability
the health system, as well as to estimate the and reduce the impact of health care on cli-
costs for future potential emergencies and di- mate and the environment. Many basic ser-
sasters. vices, such as water, sanitation and energy,11
upon which health and health services depend, contribute to community-level surveillance,
should be available and continue to function household preparedness, local stockpiling, first
before, during and after an event occurs. Sup- aid training, and emergency response. Minis-
porting logistics will include stockpiling and tries and the private sector may be responsible
prepositioning of medicines and supplies, ef- for managing critical infrastructure (e.g. water
fective supply chains, and reliable transporta- supply, electricity, transport, telecommunica-
tion and telecommunications systems (24, 25). tions) and contribute to civic activities. Their
active engagement in activities related to all
5.8 HEALTH AND RELATED aspects of EDRM is therefore vital.
SERVICES
Public health, pre-hospital and facility-based
clinical services must be well prepared to re-
spond effectively in the event of an emergency
with health consequences. They should have A healthy population is a resilient
the capacity to scale up service delivery to population; a resilient population is a
meet increased health needs (e.g. through in- healthy population.
creasing bed capacity, establishing temporary
facilities or mobile clinics, vaccination cam-
paigns) and to take specific measures related
to certain hazards (e.g. isolation of infectious
cases). A range of health-care disciplines con- 5.10 MONITORING AND EVALUATION
tribute to Health EDRM and to building resil- Processes to monitor progress towards meet-
ience of communities and countries, including ing health EDRM objectives and core capacities
preventing and mitigating risk, preparedness, should be integrated into existing health sector
response and recovery. As far as possible, monitoring systems. Standardized indicators
representatives from the various disciplines to monitor risks, capacities, and programme
should contribute to risk and capacity assess- implementation are all necessary. Sources of
ments, planning, implementation, and monitor- relevant indicators include the Sendai Frame-
ing and evaluation. work Monitor for targets and indicators, IHR
Monitoring and Evaluation Framework, WHO
5.9 COMMUNITY CAPACITIES FOR global survey on country capacities for Health
HEALTH EDRM EDRM and WHO regional monitoring and eval-
Participation of communities in risk assess- uation mechanisms. Ongoing monitoring can
ments to identify local hazards and vulnera- be complemented by intermittent evaluations,
bilities can identify actions to reduce health especially of preparedness (e.g. simulations),
risks prior to an emergency occurring. Many response and recovery activities.
lives can be saved in the first hours after an
emergency through effective local response,
HEALTH EDRM FRAMEWORK
before external help arrives. The local popula-
tion will also play the lead role in recovery and
reconstruction efforts. Community capacities
and activities – including primary health care
– and the roles of local health workers, civil so-
ciety and the private sector are therefore cen-
tral to effective Health EDRM. Civil society canYou can also read
