Expert of the Week   for  23 Feb - 01 Mar 2015

Dear Ms. Sliwinski,

Thank you for bringing up the role of membership associations. This is a type of organization whose contribution to health emergencies is not commonly discussed. I admit I have limited knowledge on the full range of ways that membership associations can participate in an emergency response, but I can speak to the general question on how associations can engage in disasters.

Membership associations have an existing platform to reach a wide number of community members. They are a trusted resource for their members, and it can be incredibly powerful to leverage this trust and communication to the benefit of both the members and the community. As with everyone who has a platform to reach people I always recommend finding creative ways to include disaster preparedness messages. The more prepared that members are, the more resilient their communities are. That awareness can also lead to more informed members once a disaster does strike, which will make them more open to supporting disaster response activities that are appropriate to the needs of those affected. Few things are more dangerous in a disaster response than misguided good intentions.

Once you have begun this conversation with your members, I would recommend actually opening up a dialogue with them, or with select representatives, to explore ways to engage in future disasters. Associations have diverse memberships with a wide range of talents and resources. Tapping into this can be result in creative and productive results, given two caveats:

1) This conversation needs to be guided by someone with expertise in disaster response to ensure decisions regarding future assistance are in line with disaster management best practices.
2) This conversation should happen during the preparedness phase, rather than in the furious pace that occurs during a disaster response. That will allow associations with few staff to be able to facilitate this process at their leisure.

This process can lead to impactful volunteership opportunities, engagements with business, and other valuable community resilience ideas. For organizations with especially limited time and resources who wish to engage in this process, I strongly suggest working with a local community organization that currently has a successful disaster preparedness and response program. Red Cross/Red Crescent national societies are engaged in many communities around the world, and often partner with local organizations. There are also sector-specific organizations (health, communications, logistics, etc.) that may be a good fit for partnership.

Working in partnership not only gives associations access to necessary expertise, but has an added benefit during the disaster response. The partner will often serve in a leadership role during a disaster, allowing the association’s personnel to continue focusing much of their attention on non-disaster business priorities.

Mr Burich,

Waste and inefficiency are constant challenges for disaster preparedness and response, as you have highlighted. There is not just one obstacle to overcome, this is an incredibly multi-faceted problem that crosses all sectors and expands in many directions. Disasters are highly political as well, and regardless of how good plans and coordination is leading up to the disaster, the response may be impacted by political choices that are ill-informed or ill-intended.

This is not to say there aren’t communities across the world who haven’t found a good formula. Many of these successes have relied on the age-old formula of having a champion, be it a person or an institution, who moves disaster preparedness forward no matter the challenge. This approach can be incredibly effective, at least for the short term, but inherently includes the danger that the gains are sustainable only as long as the champion remains.

For the purpose of this discussion, I think it is worth highlighting that some of the most interesting examples of preparedness initiatives that have real potential for sustainability have actually started outside the disaster preparedness arena. By approaching the challenge from a new angle, resilience champions have been able to change the dynamic of the conversation in a way that opens up new opportunities to navigate existing politics or systemic obstacles. Rallying points such as the threat of climate change impacts, the opportunities presented by new technologies, or the fear of pandemics have all been used to good effect to spark new conversations.

In recent years many of the most exciting and innovative examples of disaster preparedness appear to be coming from the city level. For specific examples of cities overcoming the difficulties of waste, inefficiency or stagnation, I would recommend looking at UNISDR’s “Role Model City” program whose winners in recent years have spanned cities in Africa, Europe, the Americas and the Pacific. Makati City in the Philippines has also done some interesting work on city-to-city learning with Quito, Ecuador and Kathmandu, Nepal, which is a good reminder of the importance of South-South learning. Additionally, the Rockefeller Foundation’s 100 Resilient Cities program offers to provide future good examples by introducing standards, accountability, and leveraging a sense of friendly competition. Certainly there was a lot of interest worldwide among officials as cities competed to prove that they could commit to deliver what it takes become (and stay) resilient, and it is hoped that this interest foreshadows the results that will be produced in the coming years.

Mr. Roy,

Thank you for these questions – the answers to these questions are currently being debated by experts around the world as we try to learn lessons from the Ebola response and other related disasters. Please note, that for this response I will be referring to the health sector and humanitarian organizations as if they are completely separate sectors, though we know that the reality is much more integrated.

1) The health sector examines needs related to a disaster slightly differently than the rest of the humanitarian community. They specifically look at patient care needs – immediate and near future, as well as the needs of health systems to respond the existing and anticipated needs. There are common tools to address both aspects, and these tools continue to be revised as more lessons are learned and better technology allows for better data collection. “Data collection” is actually the phrase I would use to categorize the difference between the health and humanitarian communities in needs assessments. The health sector looks to gather facts and analyze them in accordance with their standard response mechanisms. This leaves little room for engagement with the community, except as a source of data. What we saw in the Ebola response was the health sector learning what humanitarian organizations have been learning for awhile now – that to effectively understand the situation and the best way forward, you need to engage the community. It is clear that the current tools used by health care do not accomplish what is needed in a humanitarian situation.

For the immediate future, international health organizations are primarily focused on the long term capacity building of national health systems. While this improvement would certainly create greater resilience and better options during an emergency, it doesn’t address the gap between health needs assessments and humanitarian needs assessments. It is unlikely that a new WHO crisis response team, if developed, would effectively address this gap either. What I would suggest is that this is an issue that civil society organizations should take on. Rather than waiting for an emergency and the arrival of national or international resources, let us look at the issue from a disaster preparedness perspective. Civil society can be a powerful voice to engage health partners in a variety of disaster preparedness and resilience activities. And if they are not receiving the answers or services from the health sector that they need, this is the time to speak up and advocate for change.

2) One possible benefit that appears to be rising from the Ebola crisis is a renewed focus on health system capacity building. National governments around the world are re-committing to making this a priority, and international donors and organizations are finding ways to help support this process. Even though this is a long term process, it is the best way to address the gap between health needs and assistance provided. If a disaster-affected area is waiting for international resources, there will always be a delay in service, and it is unlikely that the services provided will be as tailored or as culturally-appropriate as if they were provided by local / national health services.

Since building health systems will not happen immediately, the humanitarian sphere cannot ignore the large gap between health needs and services during a disaster. There is a tendency to sideline health concerns as something to be dealt with by the technical experts. The more the humanitarian / emergency management community can reach out to their counterparts in the health sector prior the next emergency, the more likely that new tools and processes will be developed jointly. Both health and humanitarian organizations would benefit, as the humanitarian sector already has a number of tools that could inform the health sector, the health sector has knowledge that could inform humanitarian programs, and both sides need to be more engaged in each other’s planning process.

Mr. Mateo, I will answer your question in two parts. For both questions I will focus on the recent Ebola crisis as an example, since more has been done by the international community for this emergency than for any potential pandemic in the previous decade.

Regarding the impact of international capacity building support, we have yet to see how effective the current programs are. What we do know is that the support is quite targeted and gaps remain. Most capacity building is on technical health issues, and is at risk of only providing short term gains if the funding to sustain newly developed capacities is not identified. And as with any disaster response, there are even unfortunate examples of international donors increasing country vulnerabilities by focusing on their own agendas.

With missteps and learning opportunities aside, I am confident saying that there have been some clear gains supported by international donors, such as technical training for healthcare workers, national planning, and community outreach programming, to list a few. Additionally, due to the especially high level of transparency and reporting that is occurring during the Ebola response, we have a unique opportunity for learning lessons across countries and sectors in the coming years.

On your second question, it is clear that the international response is focusing too exclusively on the health aspects of preparedness, and we have seen the increase in secondary impacts that have resulted from this narrow approach. Personally, I would recommend the way forward is that the lessons learned by the disaster risk reduction community be applied to health emergencies as well. For this to occur will likely require those involved in disaster preparedness and response to reach out more actively to the healthcare community, at all levels, since the international donors are not emphasizing this angle.

Additionally the community level is not a priority for international donors, as this is seen as part of longer term development programming. Local organizations must find a way to voice their recommendations for how to address this gap. Hopefully the conversations at and following the WCDRR will help to address this concern.

Thank you Mr. Mateo for your very timely question. This is a great way to begin the discussion.

While it may be a few years before we can say we have identified all of the lessons from the current Ebola crisis, there are a number of issues that have been noted already related to building capacities in communities and grassroots organizations. I will list a few of the high level issues below.

1.    Top down approach:  Capacity building for health emergencies is still approached from the top down, which means that the capacities of communities and local organizations are often the last to receive attention. This approach creates a critical gap, since we know that all disasters are local. A top down approach for community capacity building also does not scale up quickly during an emergency, so assistance is late or not provided at all. The challenge, as with all community preparedness, is how to build this capacity prior to disasters.

2.    Linkages:  Many communities have both disaster preparedness programs and also community-level health services programs. But rarely do these two types of programs interact prior to an emergency. Expertise from both of these programs is essential to a health emergency since an effective response needs to be multisectoral. But if there is no joint planning to utilize their resources to meet a common goal, as we have seen across West Africa, the result will be two separate goals and two parallel responses, one for emergencies and one for health, ensuring that neither response is as effective as it could be. Health emergencies are not solely a health issue – they are a community issue, and should be addressed as such.

3.    Trust:  Because health emergencies involve difficult technical and sometimes frightening information, building trust is critical to the success of a response – both for preventative measures and during a disaster. Additionally, health emergencies require people to change their behaviors to reduce their risk. To convince people to take new courses of action requires that the message comes from a reliable source. While International Organizations have begun tapping into anthropologists to address this issue, the reality is that local organizations are much better equipped to address the lack of trust, and can do so more quickly.

In the near future I hope that we will also see lessons learned on the following topics:
-    How did urban centers factor into Ebola preparedness and response – and how would this differ in other potential health emergencies?
-    Of the many technical trainings that were provided to local organizations and communities – which were most effective and why? Were these the right trainings to meet the needs?
-    How can existing community-level systems support ongoing bio-surveillance, especially in areas with low health service coverage?
-    There is a data gap to effectively plan for health emergencies. What sort of data needs to be gathered, and what is the role of local organizations in this process?