Day: July 9, 2022

The World Health Organization (WHO) held a ground-breaking ceremony today in Nairobi for a WHO Health Emergency Hub, which will include a Centre of Excellence for the Health Emergency Workforce, laying the cornerstone for a wider initiative that aims to change the way the continent handles emergencies.

The African region experiences over 100 health emergencies per year, more than any other region in the world. In recent years, much progress has been made with the efforts of countries, WHO and partners. For example, the time required to end outbreaks has plummeted from 131 days in 2017 to 45 days in 2019.

Despite the advances, the COVID-19 pandemic has exposed huge gaps, particularly the continent’s lack of emergency responders. WHO analysis finds that fewer than 10% of countries in the African region have the workforce required to prepare, detect and respond to public health risks.

The new hub will help train a corps of 3000 elite responders from across the region. The aim is for each country in Africa to have at least one integrated team of emergency experts who will be ready to deploy within the first 24 hours of a national health crisis. A wide range of professionals including laboratory experts, epidemiologists, data managers, anthropologists, field logisticians and mental health and psychosocial experts will receive training.

The President of Kenya, H. E. Uhuru Kenyatta, the Director-General of WHO, Dr Tedros Adhanom Ghebreyesus and the WHO Regional Director for Africa, Dr Matshidiso Moeti attended the ground-breaking ceremony.

“Kenya is proud to be at the forefront of efforts to improve the response to emergencies across the continent,” said Kenyan Minister of Health, Sen. Mutahi Kagwe, who joined the ceremony. “The Centre of Excellence and the Emergency Hub builds on Kenya’s global health security leadership and will lead to an empowered Africa which can contain outbreaks and other emergencies rapidly. It complements the country’s health response developments that have seen the establishment of local manufacturing capacity and robust research into emerging health challenges.”

The Government of Kenya is contributing US$ 31 million toward the Emergency Hub. This includes the allocation of 12.14 hectares of land, with US$ 5 million for construction and free office space for 120 WHO staff at the nearby Kenyatta University Hospital for three years.

The Emergency Hub will also oversee a variety of sub-regional activities in Eastern Africa, including maintaining stockpiles of medical and logistical supplies and stationing WHO staff to ensure quick deployment during emergencies.

One such emergency is the deepening drought and food insecurity in the region. Over 80 million people in the eastern African region are food insecure and with rising malnutrition, a health crisis is looming.

“I thank the Government of Kenya for its leadership and generosity in supporting the Emergency Hub,” said Dr Tedros. “The Hub will improve the capacity of African countries to prepare, detect and respond to health emergencies, support resilient health systems, and strengthen the regional and global health architecture.”

The Hub will be fundamental for WHO Africa’s flagship initiative for health security, also launched today. The initiative aims to ensure that one billion Africans are better protected from health emergencies by the end of 2025. WHO is contributing US $47 million in funding for the implementation of the regional flagship initiative.

“COVID-19 has exposed how critical it is for Africa to be self-reliant,” said Dr Moeti. “By developing our own national elite responders, building robust surveillance systems and investing in pandemic preparedness, we are strengthening the speed of the response and creating a better future for our children. I thank the Government of Kenya for its visionary leadership which is ensuring the continent can stand tall and proud and not be brought down to its knees by a virus.”

The WHO flagship initiative is the result of extensive consultations with more than 30 African government ministers, technical actors, partners across the continent, which have contributed to shaping the priority activities.

Source: World Health Organization

Over the last decade, resilience has continued to be elevated as an analytic, programmatic, and organizing concept in development discourse and practice. In line with this, approaches to measuring resilience have proliferated, giving rise to a nascent evidence base on both the impact of resilience programming and the sources of resilience that explain why some households, communities, systems, and countries fare better in the face of shocks and stresses than others. Despite clear progress, significant challenges and gaps in resilience measurement and evidence remain. The demand for resilience evidence has also grown exponentially as conflict, Covid-19 and the accelerating impacts of climate change have reversed development gains on a massive scale and pushed hundreds of millions of people into crisis levels of poverty and hunger.

On May 17-18th 2022, the University of Arizona, the Global Resilience Partnership, and the United States Agency for International Development convened a group of 50 experts and development practitioners at the University of Arizona, DC Center for Collaboration and Outreach in Washington, D.C. with the aim of advancing resilience measurement and setting a common agenda for addressing these challenges and gaps. The group of experts and development practitioners included representatives from USAID, the State Department’s Special Envoy for Climate, UN agencies, the World Bank, private foundations, universities, and research institutions, NGOs, and governments and regional institutions, including the Government of Kenya and the Sahelian West Africa Permanent Committee for Drought Control.

Source: US Agency for International Development

• Public revenues are the cornerstone of funding for governments’ response to health emergencies; as such, public financial management (PFM) – the rules and mechanisms governing the allocation, execution and reporting of public funds – has been an integral part of the health response to the COVID-19 pandemic.

• This rapid review highlights the importance of PFM for health emergencies, by analysing various countries’ experiences of financing their national health response to COVID-19 and identifying some early lessons. This review can help countries to enhance their understanding of good practices, and key requirements for adjustments to their PFM systems.

• To be able to effectively adapt and quickly respond to health emergencies, PFM may need to be overhauled. Key PFM policy actions summarized in Table 1 include recommended adjustments for each phase of the budget cycle (formulation, spending, and reporting), to ensure health financing is more agile, flexible and responsive to emergency needs, while assuring transparency and accountability.

• One of the key PFM-related lessons emerging from the COVID-19 health response is the need to shift from budgeting by line items to budgeting based on programmes. Programme-based budgets are more readily structured to allow for more flexible allocations of public resources, and are thus more effective responses to health emergencies.

• The COVID-19 pandemic has shown the need to prepare expenditure management systems by updating emergency spending protocols and proactively empowering frontline providers to access, manage, and account for public funds in an agile way.

• The adoption of measures to balance speed and accountability is another key lesson. Better equipping financial management information systems to provide integrated reporting of emergency-related spending is a critical step to ensuring public trust for the response.

• Countries can better prepare for future health emergencies by strengthening their regular PFM mechanisms and capacities, while limiting the proliferation of parallel mechanisms which can exacerbate fragmentation of health financing and hinder alignment with national response plans. The use of extra-budgetary mechanisms without well-defined procedures is unlikely to result in the efficient use of public resources for health emergency response.

Introduction: why PFM matters for the response to health emergencies

Public revenues are the cornerstone of funding for the response to health emergencies. While private financing can contribute to a country’s response, public sources make up the largest share of the funding available for this purpose. This has been exhibited during the current pandemic, with the health response to COVID-19 predominantly funded from public sources, even in countries facing revenue constraints [1,2]. For example, in Ghana, COVID-19-related health spending in 2020 was mostly funded through domestic government funds (83%) with external and private funding representing 10% and 7% of the total, and in Burkina Faso, domestic public funding represented 53% [2]. The predominance of public funding promotes consistency, efficiency and equity in the response [3].

Given the importance of public finances, the ongoing COVID-19 pandemic has also shown that public financial management (PFM) should be an integral part of the response. Effectiveness in financing the health response depends not only on the level of funding but also on the way public funds are allocated and spent. This is determined by the PFM rules that guide how public funding is allocated, executed, and reported, and in turn how money flows to health service providers [4,5]. Early assessments have shown that PFM systems ranged from being a fundamental enabler to acting as a roadblock in the COVID-19 health response [6,7].

When the crisis hit, many countries’ domestic PFM systems were not ready or agile enough to support an effective emergency response. Challenges commonly faced by countries include [6,8-10]:

i) estimating and formulating budget provisions to align with response needs;

ii) tailoring spending modalities to ensure funds are quickly available for service delivery units and disbursed flexibly and on time;

iii) adjusting tracking and reporting systems to ensure public funds for emergency response are accounted for effectively and transparently.

While problems in service delivery have been extensively documented [11], the underlying PFM mechanisms of the response also merit attention. To highlight the importance of PFM in health emergency contexts, this policy brief analyses various country PFM experiences and identifies early lessons emerging from the financing of the health response to COVID-19. The policy brief is focused on documenting lessons from the budgeting and spending mechanisms and processes; it does not discuss the sources of funding, nor the content of fiscal policies in response to COVID-19, which are covered extensively elsewhere [12]. The assessment is done by stages of the budget cycle: budget allocation, budget execution, and budget oversight. Identifying lessons from PFM modalities used to finance the health response to COVID-19 is fundamental both for health policy-makers and for finance authorities, to enhance PFM system preparedness to respond effectively to future health emergencies. It can help to enhance understanding of good practices, as well as key requirements for future system adjustments.

The assessment is built on a non-systematic review of several activities initiated by WHO in 2020 to monitor countries’ health response from a PFM perspective (see Table 2). The evidence reviewed included a desk-based survey initiated in March 2020, which analysed budgeting, spending, and accounting modalities in financing of the health response in 183 countries. Technical consultations were conducted in 17 countries (Argentina, Australia, Brazil, Chile, China, Costa Rica, Dominican Republic, Ecuador, Indonesia, Lao People’s Democratic Republic, Malawi, Mexico, Mongolia, Peru, Philippines, South Africa, Ukraine) between June and September 2020 by WHO to further the understanding of PFM modalities. Complementary analyses conducted in 2021 to unpack specific PFM aspects of the health response, including an analysis of 40 extra-budgetary funds used to channel resources for the response [13], a mapping of PFM issues related to COVID-19 vaccine roll-out [7], and an in-depth assessment of PFM modalities in selected countries, including Argentina, the Philippines and South Africa [14,15] were also reviewed. In late 2021, the emerging findings in this paper were further explored and validated during the 5th Meeting of the Montreux Collaborative, a virtual meeting that gathered over 900 participants and 50 speakers over 5 days to explore policy options to help countries rebuild and strengthen health financing and PFM systems to make them more responsive to future shocks and able to sustain efforts towards universal health coverage (UHC). Finally, in early 2022, to gather the latest information on the response, another non-systematic review of published literature and publicly available audit reports on COVID-19-related expenditures was conducted to complement the understanding of the opportunities and risks associated with the use of emergency procedures.

Source: World Health Organization