IRAQ HEALTH CLUSTER TRANSITION PLAN 2020/2021 - RELIEFWEB
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Iraq Health Cluster Transition Plan - 2020/2021
10th September 2020
Background
During 2019 and into 2020, Iraq has been witnessing returns of people to their Areas of Origin (AoO),
although this may not be voluntary, safe and dignified in all instances. This is mainly because the
Government of Iraq (GoI) has several times stated its intention of closing down all the existing IDP camps
by the middle of 2020.
However, as of mid-2020, despite 4.7 million people returning since the beginning of the conflict,
approximately 1.4 million people remain displaced, nearly 300,000 of whom are in camps and require
assistance from humanitarian partners.1
Over the years, the lack of government remuneration coupled with the conflict situation, has resulted in a
brain-drain of specialized health professionals from the country, in search of livelihoods. As an example,
the Iraqi Ministry of Health (MoH) have a recent count of 138 psychiatrists and 60 social workers country-
wide, where there is a population of more than 38 million individuals.2
The additional shock of the COVID-19 pandemic has further worsened the health system’s coping capacity.
This is mainly because of the low numbers of trained medical professionals (as evidenced by the number
of health workers infected with the virus), shortage of testing equipment and supplies and a secondary
healthcare system not able to satisfactorily manage severe and critical cases. As of 10th September 2020,
the cumulative number of cases is 273,821 with 7,732 associated deaths.3
The inadequate hygiene conditions in the South of the country continue to pose a potential risk for water-
borne communicable diseases, while being exacerbated by the COVID-19 pandemic. Meanwhile, the
national disease surveillance and response mechanism is not up to the mark in terms of early warning and
provision of timely response to alerts and potential outbreaks. Support needs to continue in strengthening
the Early Warning, Alert and Response Network (EWARN) and the gradual integration of this system into
the national surveillance system.
Iraq has undergone wars and post-conflict crises during the past three decades that has led to weakened
national institutions. In addition to the brain-drain of technical experts, the unstable political situation in
the country, leading to frequent change of government officers, has affected the capacity of the MoH to
implement adequate policies or reforms both at national and governorate level. Although there is
participation of the MoH and the Directorates of Health (DoH) in the national and sub-national cluster
coordination mechanism, lack of capacity affects their performance in some governorates while shortage
of resources does the same in others.
1
DTM Iraq: http://iraqdtm.iom.int/MasterList#Returns
2
The New York Times Magazine: https://www.nytimes.com/interactive/2019/10/31/magazine/iraq-mental-health.html?smid=nytcore-ios-share
3
Iraq - COVID-19 Dynamic Infographic Dashboard:
https://app.powerbi.com/view?r=eyJrIjoiNjljMDhiYmItZTlhMS00MDlhLTg3MjItMDNmM2FhNzE5NmM4IiwidCI6ImY2MTBjMGI3LWJkMj
QtNGIzOS04MTBiLTNkYzI4MGFmYjU5MCIsImMiOjh9Based on results of the Common Country Analysis (CCA), mainly Key Findings 1 and 3, post-conflict Iraq
is in need of transparent, responsive, and inclusive structural reforms of state and civil institutions, as well
as to build human resource capacity to takeover services currently supported by the humanitarians.
However, this needs to be conducted in a gradual manner, while simultaneously coordinating with the
developmental actors and the Government, so that the people in need of basic services are not left missed
out during the handover.
A National Action Plan for Health Security (NAPHS) of Iraq was developed during a workshop in Baghdad,
in March 2019. This plan was based off the Joint External Evaluation (JEE) also conducted between 12-18
March 2019. The 19 areas in the JEE (under prevention, detection, response and hazards/Points of Entry)
were used as a guideline to identify indicators to bring Iraq’s national health system up to International
Health Regulation (IHR) standards in the upcoming 5 years.
While it is true that stabilization partners are conducting infrastructure rehabilitation, provision of
equipment to health facilities and subsequently, will train health workers on the adequate use of this
equipment, this is a long-term process that will at least continue for the coming two years, depending on
such factors as the availability of funding, the GoI’s readiness to facilitate the implementation of these
projects, etc. Therefore, in the interim, it is vital that short-term support to public health primary and
secondary healthcare facilities through humanitarian funding be focused on, while developing the capacity
of the government and national institutions to ensure sustainable service provision upon
handover/integration of services, with health system strengthening being the long-term goal.4 This should
go hand in hand with maintaining essential primary health care services to people in protracted
displacement, whether in camps or informal settlements, for as long as they remain in displacement and in
need of humanitarian assistance, based on the emerging needs identified by the Humanitarian Needs
Overview (HNO) and other assessments.
Objective
The aim of this plan is to operationalize the durable solutions and humanitarian-development nexus
components of response through identification of activities that the Health Cluster partners can implement
during the transition phase, in line with the Humanitarian Response Plan (HRP) 2020/2021, to ensure a
smooth handover of humanitarian activities to the development actors and the GoI, while ensuring sustained
quality healthcare services are in place through capacity building of the national institutions.
Action Plan
The activities in this plan will cover those targeted under the Areas of Intervention of the Health Cluster
partners and the existing Working Groups, in the locations and focusing on the population groups targeted
under the HRP 2020, which are likely to be the same under HRP 2021, based on the guidance of the
Humanitarian Coordinator in Iraq. These activities are as below:
Area of intervention Activities Outputs
Coordination • Facilitating increased • Updated information shared
participation of the regularly (monthly and ad hoc basis)
Stabilization partners such as with humanitarian partners on the
the UNDP Funding Facility activities of stabilization actors, to
for Stabilization (FFS) and assist in planning of suitable
Development actors such as interventions and covering of gaps.
4
The Humanitarian-Development Nexus: https://www.who.int/health-cluster/about/structure/new-way-working.pdfthe World Bank, in Cluster • Local health authorities more
meetings for information explicit leadership in health
sharing through regular coordination
invitation to national and (if • National/local actors’ capacity
feasible) sub-national Health strengthened to be able to
Cluster meetings implement humanitarian and, later,
• Supporting capacity recovery/resilience-building projects
enhancement of national/local • MoH/DoH capacity strengthened to
NGOs through their gradually takeover leadership and
continuous inclusion in coordination of health partners’
strategic decision-making activities from the Cluster in the
processes (e.g., Cluster SAG) transition phase.
and facilitating NGO-led
consortium projects
• Supporting the transfer of
leadership from the Cluster to
the MoH/DoH (who currently
participate in the cluster
coordination mechanism) at
national/subnational levels
through conducting training
on Risk Management and
International Health
Regulations
Mental Health & • Provide trainings* for health • Strengthened capacities on mhGAP-
Psychosocial Support care providers at primary IG / HIG for 750 Family Medicine
Services (MHPSS)5 health care, secondary health doctors and GPs working at family
care and community health medicine centres, PHCCs and
facilities to enhance the community centres
integration of MHPSS services • Improved knowledge and education
into PHC, SHC and on WHO Handbook for GBV for
community level (30 x 5 health care providers working in the
trainings for 750 family PHCCs and hospitals.
doctors and GPs) • Enhanced capacities on PM+, PFA
• Training of school personnel and Self-help + for health care
to support mental health providers working in PHCCs,
interventions at schools (TOT community health centres and
and 5 x 5 days training for 125 hospitals.
teachers) • Enhanced capacities of teachers
• Conduct workshops and working in the high-risk areas to
campaigns to raise awareness strengthen the school mental health
for 5,000 individuals at the continuum.
community level • Awareness raising sessions and
campaigns on MHPSS for
*The guidelines which will be used in MHPSS
capacity building activities have already been
individuals at the community level
adapted to the Iraqi context and have been
endorsed by MoH. The trainings will be
conducted in coordination with MoH and in
5
Building Back Better – Sustainable mental health care after emergencies:
https://apps.who.int/iris/bitstream/handle/10665/96378/WHO_MSD_MER_13.1_eng.pdf?sequence=8line with the national oOH mental health
policy, strategy and plan. Additionally, the
mentioned activities are in line with the global
mental health strategic action plan
Nutrition • Training* of health workers on • Enhancing MoH/DoHs capacity on
screening and management delivering proper nutrition and new-
methods for malnutrition, born care services and counselling
IYCF counselling to mothers enhanced.
and newborn home services
*The training will include management and
supervision by the local authorities (central
supervision by MoH, second layer of
supervision by DoH and last one by the district
level managers). However, the management
and supervision package will be a separate one
i.e. for all managers and supervisors (from all
DoHs including conflict-affected governorates)
Physical rehabilitation of • Training of health workers on • Improving MoH/DoH capacities in
patients conducting rehabilitation attending to the medical needs of
sessions for patients people with physical and functional
• Establishing Physical disabilities.
Rehabilitation Centers
Reproductive health6 • Implementation of MISP • RH program managers are enabled to
program manage MISP services provision to
• Conduct ToT on transition the affected population in the
from MISP to comprehensive humanitarian setting.
SRH • Safe delivery services and referrals
• Creating a pool of Skilled Birth are secured and risky pregnancies are
Attendants covered with qualified services for
• Awareness raising on early the targeted population in
marriages and teenage humanitarian setting.
pregnancies • Social pressure against early
• Provision of CEmONC marriage is seeded and created within
equipment and training of the targeted populations.
health workers
Support to health • Capacity building of hospitals • Governorate and district hospitals
facilities to receive cases referred from have enhanced capacity to
the Primary Care level treat/manage referred cases requiring
• Support to hospitals to admit inpatient neonatal, maternal and
cases that require inpatient care nutrition care; manage diseases that
through provision of diagnostic require specialist healthcare and
and therapeutic equipment complicated conditions.
Capacity building • Conducting 2 Quality of Care • Assessment of (QoC) provided in
(QoC) assessment surveys of facilities and communicating results
health facilities supported by to relevant partners
humanitarian partners. • Improving quality of care through
• Implementing Quality conduction of Quality Improvement
Improvement exercises Initiative (QII) in the health centers
supported by humanitarian partners
6
UNFPA Iraq Country Programme Document (2020-2024): https://iraq.unfpa.org/en/resources/unfpa-iraq-country-programme-document-2020-
2024between phases of QoC • Enhancing capacities of health
assessments workers on public health topics such
• 4 Quality Improvement as QII, EWARN, etc. Different level
Initiative (QII) exercises medical and paramedical staff have
conducted (quarterly) by the enhanced capacity to provide quality
Quality Teams based in the health services
health centers supported by
humanitarian partners
• A minimum of 2,000 health
workers trained on various
topics as:
1- Quality Improvement
practices – to serve as
Quality Assurance teams
2- EWARN refresher
trainings (Infection
Prevention and Control
and case management)
3- On-the-job training on
clinical practices and data
management/reporting
Vaccination • Upgrading the implementation • All eligible children vaccinated
of routine and supplementary against vaccine-preventable diseases
vaccination services in return
locations through fixed and
outreach vaccination teams.
• Supporting MoH to implement
focused social mobilization
interventions/ campaigns on
vaccination services through
focus group discussion, media
broadcasting, mobile health
promotion teams, and
distribution of IEC materials
EWARN/Communicable • Updating the Cholera • Early detection and reporting of
Disease Surveillance and Preparedness/Response Plan communicable diseases ensured and
Response based on the available/required institutionalized
resources through support from • Trained health workers (and RRTs)
a consultant and conducting a are able to prevent spread of priority
workshop with the Ministry of communicable diseases and
Health and relevant mitigate/manage the outcomes such
stakeholders. diseases
• Developing/updating response • Improved detection and management
plans for other priority of suspected cases at points of entry
communicable diseases as (POE), including seaports, airports
appropriate including, but not ground crossings and on board
limited to, COVID-19 conveyances
• Enhancing electronic and • Integration of EWARN system into
timely reporting by health the national surveillance systempartners through training and
dissemination of tablets
• Training of health workers
(mainly virtual but also face-
to-face when possible) on
Infection Prevention and
Control measures and case
management of priority
diseases, including COVID-
19.
• Strengthening the IHR core
capacity at the national and
subnational levels at Points of
Entry [PoE] and prior to,
during and after mass
gathering events in the areas of
surveillance, testing, tracing,
and isolation of COVID-19
cases.
• Strengthening Rapid Response
Teams (RRT) and developing
capacity on data management
through provision of trainings
• Procuring and distributing
medicines, IV fluids and
laboratory equipment/reagents
• Upgrading laboratories to
facilitate diagnostics
Essential medicines • WHO to train MoH staff on the • Enhancing capacity of staff and
complete supply chain partners on supply chain
management process to ensure management and health system
capacity building of the health components.
system.
• Training of Health Cluster
partners on rational use of
medicines, distribution
practices, etc., by WHO
The trainings planned above are to be conducted in coordination with the MoH so that they fall in line with the national
guidelines/protocols and adapted to the Iraqi MoH training curriculum on the specific topics
Financing
As per current trends, it is not expected that humanitarian funding will continue at the same levels as during
previous years, although the situation remains in need of this. As of 10th September 2020, the Health Cluster
is 20.6% funded against the HRP 2020, while the COVID-19 response component has been funded to the
order of 29%7
Therefore, while advocacy for funding humanitarian response continues, WHO and the Cluster will focus
on the best mechanisms to handover service-provision to the GoI. This can only happen if, in the interim,
7
Financial Tracking Service: https://fts.unocha.org/appeals/866/summarysufficient capacity has been developed to ensure uninterrupted service-delivery and its coordination by the authorities, as outlined in the NAPHS. Transitioning Health Cluster functions to MoH/DoH The Iraq Humanitarian Country Team (HCT) has decided to have an HRP for 2021, therefore the functions of the Health Cluster would need to be in place to coordinate and support the implementation of the plan.. During this period, however, the Cluster will work with the MoH/DoH to support them in playing a more active role in coordinating the humanitarian interventions, which will facilitate the gradual withdrawal of the health partners from humanitarian coordination and service-provision. The MoH has a policy in place that IDPs residing in camps should obtain free diagnostic and therapeutic services at public health facilities. This can be built upon by upgrading such facilities by Health Cluster partners so that, when handed over, better services will be available for IDPs where camp PHCCs are not an option anymore. This will also reinforce the stance of the humanitarian community to the position of the Government of Iraq, which intends to close camps in the near future, in that services and livelihoods would be made available for people in areas of return before they leave the camps. The speed of the handover will depend on the capacity of the MoH to takeover coordination and leadership roles, which is mainly reliant on a stable political situation in the country, preventing sudden disruption of basic service-delivery while also allowing for longer duration of government staff remaining in office. Another factor which could affect the handover is the status of COVID-19 infection in the country, since currently, the MoH/DoH is completely occupied with this emergency and would not be keen to take on more responsibilities.
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