High level meeting on building resilient systems for health in Ebola-affected countries December 2014 Geneva, Switzerland

Transcription

1 High level meetig o buildig resiliet systems for health i Ebola-affected coutries December 2014 Geeva, Switzerlad

2 Geeva, Switzerlad December 2014 World Health Orgaizatio 2014 All rights reserved. All reasoable precautios have bee take by the World Health Orgaizatio to verify the iformatio cotaied i this publicatio. However, the published material is beig distributed without warraty of ay kid, either expressed or implied. The resposibility for the iterpretatio ad use of the material lies with the reader. I o evet shall the World Health Orgaizatio be liable for damages arisig from its use. Meetig rapporteurs: Dr Carme Dolea, Techical Officer, World Health Orgaizatio, Geeva Switzerlad Dr JoAe Eppig-Jorda, Idepedet Health Cosultat, Seattle, USA Meetig report prepared by: Dr JoAe Eppig-Jorda, Idepedet Health Cosultat, Seattle, USA Techical iformatio cocerig this publicatio ca be obtaied from: Mr Gerard Schmets Coordiator, Health System Goverace, Policy ad Aid Effectiveess Health Goverace ad Fiacig Departmet World Health Orgaizatio 20, Aveue Appia CH-1211 Geeva 27 Switzerlad 2

3 High level meetig o buildig resiliet systems for health i Ebola-affected coutries Table of Cotets Backgroud to the meetig...1 Curret situatio ad key health system challeges...2 Health systems pre-ebola...2 From outbreak to epidemic...4 The direct ad idirect effects of the epidemic...5 Turig crisis ito opportuity...6 Iovative health system solutios...7 Guiea...7 Liberia...7 Sierra Leoe...8 Areas for further actio...8 Next steps...8 Coclusio...10 Aex 1. Meetig programme...12 Aex 2. List of participats

4 High level meetig o buildig resiliet systems for health i Ebola-affected coutries Backgroud to the meetig As of 10 December 2014, early people have bee ifected with the Ebola virus ad 6388 have bee reported to have died. More tha 99% of cases have occurred i three adjacet West Africa coutries: Guiea, Liberia, ad Sierra Leoe. Part of the reaso that the virus has progressed to epidemic levels i these coutries is that their health systems were already weak followig years of civil coflict that left health ifrastructures badly damaged or destroyed. Sice the outbreak started, existig public health services which were already quite limited have bee diverted to Ebola. I additio, may health workers have become ill ad died from the virus. The et result is that people have ecoutered sigificat barriers i accessig eeded care. I some areas, all forms of essetial care, whether for malaria treatmet or safe childbirth, have ceased to fuctio. Progress made i movig towards the health-related Milleium Developmet Goals has bee reversed. Give the importace of these issues, the Africa Developmet Bak, the West Africa Health Orgaizatio, the World Bak, ad the World Health Orgaizatio coveed a High Level Meetig o Buildig Resiliet Health Systems i Ebola-affected Coutries from December 2014 i Geeva, Switzerlad. Miisters of Health ad Fiace of Ebola-affected coutries, iteratioal orgaizatios ad developmet parters discussed the curret state of the health systems i Guiea, Liberia ad Sierra Leoe. They also cosidered what eeds to be doe to rebuild ad stregthe essetial health services i these coutries. Specific objectives of the meetig were to: Idetify the mai costraits ad challeges faced by coutries i rebuildig ad developig more resiliet health systems; Idetify medium- to log-term solutios o how best to build ad ivest i atioal ad sub-atioal systems that deliver good-quality essetial health services ad also have the capacity to respod adequately to future emergecies ad crises; Discuss the roles ad resposibilities of differet stakeholder groups (govermets, o-state actors, doors ad iteratioal techical agecies) i assistig coutries to build resiliet health systems. 1

5 Geeva, Switzerlad December 2014 Curret situatio ad key health system challeges Meetig participats discussed the situatio aroud the curret Ebola epidemic i the most-affected coutries. They cosidered the factors that cotributed to the rapid spread of the epidemic, as well as the mai obstacles to a effective respose. Participats also discussed the effects o o-ebola health services ad o the coutries ecoomies. Health systems pre-ebola Prior to the Ebola outbreak, Guiea, Liberia, ad Sierra Leoe had differet forms of decetralized service delivery systems. Guiea has a highly decetralized health-care etwork with sigificat rural-urba disparities. Liberia s orgaizatio of health services is uder reform, trasitioig towards a decetralized delivery system divided ito 15 couties. Service delivery is pluralistic with a mix of public ad private providers. Sierra Leoe has 19 local coucils that are resposible for maagig the delivery of primary ad secodary health-care services. Like Liberia, service delivery is pluralistic with a mix of public ad private providers. All coutries had atioal plas prior to the outbreak. Guiea s atioal health pla eded i 2012 but a ew Politique Natioale de Saté is uder developmet. The ew policy will cover disease ad emergecy maagemet ad cotrol, promotig health across the life course, ad overall stregtheig of the atioal health system. Its health services are orgaized i a decetralized cotext, which is aimed at icreasig commuity participatio ad itersectoral cooperatio. Liberia has a Natioal Health ad Social Welfare Policy for 2011 to 2021, which calls for basic health services close to commuities, expadig the essetial package of health services ad icreasig huma resources for health. Sierra Leoe also has a Natioal Health Sector Strategic Pla for 2010 to The pla is aimed at health system stregtheig ad movig progressively towards uiversal health coverage. Pervasive health system weakesses challeged all coutries. Prior to the Ebola outbreak, weakesses existed throughout the three coutries health systems. All lacked adequate umbers of qualified health workers, most promietly i rural areas. Laboratories were few i umber ad cocetrated i cities. May large referral hospitals had o electricity ad ruig water or were made usafe by electrical fires ad floods. Health iformatio, surveillace, goverace ad drug supply systems were weak. Guiea had severe shortages of health workers (see table below), especially i rural areas, ad a limited availability of health facilities. Its health maagemet iformatio systems were weak ad fragmeted ito sub-atioal sub-systems. The procuremet ad supply of medicies ad medical products were weak but improvig, thaks to strog efforts from atioal-level maagemet. 2

6 High level meetig o buildig resiliet systems for health i Ebola-affected coutries Liberia also had severe workforce shortages ad limited availability of health facilities, especially i rural areas. I additio, it had iadequate maagemet capacity at sub-atioal levels. Its health maagemet iformatio system did ot cover the largest hospital or most of the smaller facilities i rural areas. Sub-stadard, couterfeited medicies were a pervasive problem. Sierra Leoe s workforce shortages were similar to that of Guiea ad Liberia, with slightly greater availability of health facilities. The coutry had developed a district-level health iformatio system but moitorig was still weak. Procuremet was decetralized for basic essetial medicies but their availability was limited ad variable. Health system capacity pre-ebola Guiea Liberia Sierra Leoe Number of physicias per populatio Number of health facilities per populatio I terms of disease surveillace, oe of the three affected coutries attaied the miimum IHR (2005) core capacities requiremets by The Itegrated Disease Surveillace ad Respose (IDSR) guidelies were implemeted i Guiea, but oly adapted for Liberia, ad did ot start implemetatio i Sierra Leoe. Substatial support is required to stregthe preparedess ad implemet core capacities requiremets uder IHR (2005) i these coutries, as well as may other coutries i the regio. Despite these weakesses, all coutries were makig progress. Before Ebola, the coutries had made sigificat improvemets i key areas, particularly those related to the Milleium Developmet Goals (MDGs). Uder-five mortality was decliig ad all coutries had expaded coverage of basic itervetios ito sub-atioal rural districts. Skilled birth attedace was icreasig ad materal mortality was decliig. Guiea had improved its rates of skilled birth attedace ad immuizatio coverage from 1999 to 2013 (see table below). At the same time, both child mortality ad materal mortality had declied sigificatly. Liberia had improved family plaig overage, skilled birth attedace ad immuizatio coverage from 2007 to Child mortality had declied beyod MDG 2015 target levels ad materal mortality had early halved betwee 1990 ad Sierra Leoe had made good progress o family plaig coverage, skilled birth attedace, ad immuizatio coverage betwee 2000 ad Child mortality ad materal mortality had declied sigificatly, although they were still the highest amog the three coutries i Key health idicators pre-ebola (2013) Child mortality per 1000 live births, 2013 Materal mortality per live births, 2013 Guiea Liberia Sierra Leoe

7 Geeva, Switzerlad December 2014 Resources for health were risig but still limited overall. Health expeditures were risig i all coutries, but still overall at low levels ad directed maily at HIV/ AIDS, tuberculosis, ad malaria. So while major ivestmets were beig made i battlig specific diseases ad health issues, the coutries overall health systems remaied fragmeted ad uable to cope with uexpected challeges. Guiea s total geeral govermet expediture for health, icludig Official Developmet Assistace (ODA), fell well below the Abuja target of 15%, as well as the estimated USD $86 per capita that would be eeded for a basic beefit package (see table below). Out-of-pocket expeditures were high, at 67% of all expeditures per capita, suggestig households suffered from fiacial hardship whe usig services ad also that govermet expeditures were relatively low. Liberia s total geeral govermet expediture for health exceeded the Abuja target, but still fell short of the amout eeded to fud a basic beefit package. Out-of-pocket expeditures were 21%; this relatively low percetage might be due to the populatio s limited ability to access services. Sierra Leoe s geeral govermet expediture for health did ot meet the Abuja target ad its outof-pocket expeditures were 76%, meaig that may people were uprotected from the fiacial cosequeces of ill health. Key fiacial idicators pre-ebola Guiea Liberia Sierra Leoe Official Developmet Assistace disbursed, Total geeral govermet expediture for health, icludig ODA, 2012 USD $95 millio USD $198 millio USD$ 142 millio 7% (USD $9 per capita) 19% (USD $20 per capita) 12% (USD $20 per capita) From outbreak to epidemic Ebola spread from its iitial outbreak to crisis ad epidemic levels i Guiea, Liberia, ad Sierra Leoe i large part because of the coutries weak health ad surveillace systems, coupled with socio-cultural factors. Several health-system fuctios that are cosidered essetial were ot performig well, ad this hampered iformatio sharig ad the developmet of a suitable ad timely respose to the outbreak. The first kow case of Ebola was a youg boy who died i Guiea, close to borders with Liberia ad Sierra Leoe, o 28 December From that sigle case, the virus spread, udetected, for more tha three moths, i multiple chais of trasmissio ivolvig urba as well as rural areas. The virus etered the capital city of Guiea, Coakry, at the begiig of February. The disease was misdiagosed twice as cholera ad later thought to be Lassa fever. As late as mid-march, whe the govermet raised its first alert, cases of sudde death, reported aroud the coutry, were thought to be idepedet outbreaks caused by differet diseases. By the time Ebola was idetified as the causative aget, o 21 March 2014, the virus was firmly etreched i Guiea. This was largely the result of a sigificatly uder-resourced ad uprepared health system. The epidemic also uveiled a very importat trust issue betwee commuities ad the health system. Commuities i these three coutries are deeply distrustful of Wester medicie ad foreig medical teams. May prefer to seek care from traditioal healers, who i rural areas are ofte the oly optio. 4

8 High level meetig o buildig resiliet systems for health i Ebola-affected coutries The virus quickly spread ito Liberia ad Sierra Leoe via their lad borders with Guiea. The coutries did their best to respod yet were uable to cotai the virus due to weak surveillace systems, widespread fear i commuities, isufficiet hospital beds, ad the loss of may health workers due to the virus. The total umber of deaths due to Ebola i each of these coutries is ow larger tha the total umber of Ebola deaths i Guiea. Whe the outbreak started, the coutries had o reserve capacity to mout a effective ad timely respose, particularly without compromisig essetial health services for other coditios. I this sese, their health systems lacked resiliece. The direct ad idirect effects of the epidemic Ebola has devastated the already-weak health systems of Guiea, Liberia, ad Sierra Leoe. Recet reports from Guiea, Liberia, ad Sierra Leoe idicate that basic essetial (o-ebola) health services have bee severely disrupted. Whe the outbreak started, all existig public capacity was diverted to fightig the virus, ad other basic health services were largely suspeded. Health worker deaths combied with widespread commuity fears about visitig health facilities have further complicated the situatio i the esuig moths. As of 7 December 2014, 642 health workers have bee ifected with the Ebola virus i these three coutries ad 342 have died (see table below). The absece of these health workers is o top of preexistig dire shortages i the umbers of qualified health workers. Health-care workers with Ebola, as of 7 December 2014 Guiea Liberia Sierra Leoe Cases Deaths Health facilities have also bee affected. I Liberia, 62% of health facilities have bee closed sice the outbreak started. Those facilities that have remaied ope have experieced sigificat declies i visits ad admissios. Guiea has experieced a 58% drop i outpatiet visits ad a 54% drop i hospital admissios. Istitutioal deliveries have declied to 11% i Guiea, 23% i Sierra Leoe ad 50% i Liberia. The impact of the Ebola outbreak spas well beyod health: ecoomies have bee affected, food is becomig scarce, ad developmet has stalled. Prior to the outbreak, Guiea, Liberia, ad Sierra Leoe were amog the poorest coutries i the world, yet were experiecig high rates of ecoomic growth. Major ecoomic sectors icluded miig, agriculture, ad services. Sice the outbreak bega, the ecoomic picture has chaged dramatically. Ebola has affected the ecoomy through two mai chaels: the direct impact of the epidemic, ad the risk aversio behaviour of the rest of the populatio. May flights have bee suspeded, cross-border trade has bee hampered, ad multiatioal corporatios have left the area. Tourism to all of Africa has bee affected. The World Bak estimates that i 2015, the three affected coutries will forego two billio USD due to the virus, while the broader regio of West Africa will forego 30 billio. Major sources of employmet i the 5

9 Geeva, Switzerlad December 2014 miig, agriculture, ad service sectors have bee hit hard; the impact o poverty is large ad growig. The social ad ecoomic gais of the past decade are ow at risk for the three coutries, ad ideed for the etire sub-regio. I Guiea, the Ebola epidemic has bee a ecoomic shock. Projected 2014 ecoomic growth has declied to 0.5% (versus 4.5% before the crisis). Agricultural ad maufacturig exports to eighbourig coutries have come to a stadstill; ad projects ivolvig expatriate workers, icludig miig, have slowed or stopped. Liberia was amog the fastest-growig ecoomies i Africa prior to the outbreak, with a aual growth rate of 11.3%. As of August, it had declied to 4%. Meawhile, iflatio has rise from 7% to 10.4%, ad is expected to be at 14% by year s ed. Farms have bee left uatteded i Ebola-affected areas, which has affected employmet, agricultural output, ad food supply. Miig, which has bee a driver of growth i coutry, has bee largely disrupted. Sice the outbreak, Sierra Leoe s ecoomic growth rate has declied from 9.5% to 1%, while total reveues are dow by 16% ad expeditures are icreased. Food productio, miig, ad the service sector have bee adversely affected. Turig crisis ito opportuity Meetig participats cosidered the potetial opportuities preseted by the Ebola crisis ad how best to capitalize upo them. Curretly, the mai focus of the govermets of Guiea, Liberia, ad Sierra Leoe ad their parters is to ed their epidemics ad to get to zero Ebola cases. Respose activities i the three coutries cotiue to progress i lie with the Uited Natios Missio for Ebola Emergecy Respose (UNMEER) aim to isolate ad treat 100% of Ebola cases ad safely bury 100% of people dyig from Ebola deaths by 1 Jauary At a atioal level, there is ow sufficiet bed capacity i Ebola treatmet facilities to treat ad isolate all reported cases i each of the three coutries, although the ueve distributio of beds ad cases meas there are serious shortfalls i some areas. Beyod Ebola, these coutries eed to be able to maage a broad rage of health issues. The broader ad o-goig populatio health eeds of Guiea, Liberia, ad Sierra Leoe are diverse ad spa commuicable, ocommuicable, ad materal child health issues. The top three causes of death across the three coutries are acute respiratory ifectios, cardiovascular diseases, ad eoatal coditios. Malaria, the fourth-leadig cause of death, is associated with more tha deaths aually more tha three times the total umber of Ebola deaths to date. Meawhile, chroic ocommuicable diseases ad their uderlyig risk factors (icludig tobacco use ad obesity) are becomig icreasigly prevalet. Despite the tremedous challeges ad huma sufferig that Ebola has caused, the crisis also presets opportuities for health systems stregtheig i affected coutries. Media iterest, techical support, ad fiacial resources have surged ito Guiea, Liberia, ad Sierra Leoe i the wake of the Ebola crisis. The World Bak, for example, has already committed oe billio USD to fightig Ebola, the Iteratioal Moetary Fud (IMF) has disbursed USD $130 millio i budget support to the three coutries, ad the GAVI board recetly decided to allocate up to USD $90 millio to support coutries to itroduce Ebola vaccies ad to help rebuild their health systems. 6

10 High level meetig o buildig resiliet systems for health i Ebola-affected coutries This creates a widow of opportuity for reiforced actio o health systems stregtheig. The surge of aid, combied with sudde, focused attetio o the health of the populatio, creates uparalleled opportuities to stregthe health systems for the log term. But mometum eeds to be geerated at a early stage so that substatial ivestmets will cotiue after the acute crisis. This opportuity is importat o two frots: for meetig o-goig ad predictable health eeds, ad for buildig resiliece to future health shocks that might arise. Iovative health system solutios Represetatives from Guiea, Liberia, ad Sierra Leoe described actios the coutries have bee takig, before ad durig the Ebola epidemic, to stregthe their health systems at atioal ad sub-atioal levels. They also cosidered how these iovatios could be used i the future. Iovative actios are already beig udertake by the three affected coutries to rebuild their health systems. While details vary, commoalities shared amog the differet coutries iclude a emphasis o stregtheig sub-atioal systems as the primary mechaism for deliverig itegrated services, ad egagig commuities at all levels of health system plaig ad implemetatio. Key aspects of each coutry s plas are described below. Guiea Guiea has a pla to eradicate Ebola, as well as a broader 10-year atioal health pla that was i developmet prior to the crisis. This draft atioal pla will be further revised i light of the impact that the Ebola epidemic has had o the coutry s health system. Commuity egagemet ad mobilizatio were uderscored as a key strategy movig forwards. I particular, faith-based groups will be called upo to act as a iterface betwee the commuity ad the atioal authorities. Shortages i the health workforce also eed to be addressed. I the short term, Guiea is deployig ew graduates to rural ad remote areas. Liberia Prior to the Ebola outbreak, may structural ad fuctioal health system reforms were uderway. The Miistry of Health had bee restructured ad services were beig decetralized ito 15 admiistrative couties. The coutry also had established a Office of Fiacial Maagemet ad a iteral audit uit. Today, it has a pooled fud for co-miglig door fuds ad aligig them with atioal priorities. The atioal level ca cotract i by allocatig fuds to sub-atioal levels which helps realize its goal of miimizig outsourcig of service delivery to ogovermetal orgaizatios (NGOs) i favour of couty health teams. The atioal govermet is also startig to use performace-based fiacig models at couty levels. More recetly, the govermet has established a health equity fud as part of its effort to icrease coverage, ad it is usig exteral auditors to track the use of Ebola-related fuds. 7

11 Geeva, Switzerlad December 2014 Huma resources for health are viewed as a priority area for further actio. The govermet has started to stregthe its health worker traiig istitutios ad would like to improve them further. It also is takig steps to ehace commuity health worker capacity. Sierra Leoe Sierra Leoe has a atioal health pla but it is expirig i The govermet sees fightig the Ebola epidemic as its top priority, followed by a trasitio to loger-term plaig for health system resiliecy. Alog these lies, a atioal cosultative process is already uderway. Commuity participatio ad egagemet with civil society ad faith-based orgaizatios are key to this process. The atioal govermet has limited core health fuctios ad is committed fully to decetralizatio as a catalyst for recovery, but recogizes that districts must be sufficietly supported ad empowered to implemet this policy. Regioal hubs are beig developed with a full complemet of professioals who ca act as stopgaps i service delivery ad who ca help improve care quality via osite traiig ad supervisio. Areas for further actio Each of the three coutries uses decetralized health systems to deliver essetial services. A focus o buildig resiliet sub-atioal systems i these coutries will be a key mechaism for providig itegrated, good-quality health services. Participats isisted particularly o the priorities highlighted below: Across all coutries, the health workforce will require sigificat stregtheig. Ivestmets are eeded for traiig ad retaiig larger umbers of health workers. Competet health maagers are also eeded, particularly at sub-atioal levels. I the shorter-term, commuity health workers ca be deployed ito uderserved commuities. Ehacig commuity trust, egagemet, ad owership will be key. Parterig with commuities i meaigful ways will be essetial to help build health systems that are resposive to the eeds ad priorities of the populatios. Traditioal healers ad faith-based orgaizatios ca serve as bridges betwee formal health services ad commuities ad should be cosidered as itegral parters i health systems stregtheig. Stregtheig core public health capacities for surveillace ad respose will be essetial to eablig the coutries to fulfil their obligatios uder the Iteratioal Health Regulatios (IHR) (2005). Predictable supplies ad coordiated supply chais will eed to be established, usig lessos leart ad capacities from the outbreak respose. Next steps Overall future processes were discussed durig the two-day meetig; key aspects are summarized below. Natioal govermets will lead the work o buildig health system resiliece. All have atioal plas that ca be used as the basis for forward plaig i light of the Ebola crisis. This will iclude esurig that the physical assets provided by developmet parters to support the respose will remai i-coutry ad be repurposed for stroger health systems. All parters ca use these plas to defie roles ad resposibilities ad to measure progress. 8

12 High level meetig o buildig resiliet systems for health i Ebola-affected coutries WHO will support govermets to covee follow-up meetigs to review, revise, ad cost atioal plas ad to prioritize the mai immediate ad medium- to log-term itervetios eeded to build resiliet health. These meetigs will be coutry-led ad will ivolve key atioal ad iteratioal parters. Oe importat follow-up milestoe will be a World Bak/IMF meetigs scheduled for April 2015, where Ebola will be discussed, particularly as it relates to IHR (2005) implemetatio, health systems stregtheig, ad multisectorality. Recogizig that the Ebola crisis spas borders ad future outbreaks will have the potetial to do the same, regioal ad iteratioal parters will cosider the developmet of a regioal surveillace system. It is evisioed that a regioal system would be able to support coutries to respod quickly to such outbreaks i the future, as well as helpig them implemet the IHR (2005) core capacities requiremets. I additio, a regioal system offers efficiecies of scale. Give that substatial ad sustaied exteral fiacig will be eeded to help Guiea, Liberia ad Sierra Leoe recover, regioal ad iteratioal parters will cosider the eed for a Marshall Pla for buildig resiliet health systems i the aftermath of the Ebola crisis. (The Marshall Pla was a large-scale ivestmet iitiative to rebuild Europe followig World War II.) Ay additioal fiacial support will have to be well coordiated, i lie with the IHP+ priciples. A importat elemet is mutual accoutability betwee doors ad recipiet coutries. Budget support ad i geeral public fiacig is critically importat i such crisis situatios. Recogizig this, IMF has provided budget support to the affected coutries ad accepted the budget deficits icurred by the crisis. A additioal techical workig meetig o the followig day provided a opportuity for coutries ad key parters to reflect o pragmatic ext steps. A prelimiary draft process was discussed ad developed at that meetig. It will be further reviewed ad each coutry will adapt it to suit its uique structure ad eeds i early

13 Geeva, Switzerlad December 2014 Coclusio Poorly itegrated ad fragile health systems have cotributed to the curret Ebola outbreak of uprecedeted dimesios. Geeral health care i the most-affected coutries of Guiea, Liberia, ad Sierra Leoe has largely ceased to fuctio, ad gais made i reducig morbidity ad mortality from HIV/AIDS, tuberculosis, malaria, ad childhood diseases are ow threateed with major reversals. These coutries ecoomies are also sufferig, with decreased ecoomic growth, food scarcity, ad stalled developmet. A major emergecy global respose has bee mouted ad good progress is beig made. Respose activities i the three cotiue to progress i lie with UNMEER aims. Thaks to sustaied ad cocerted atioal, regioal, ad global efforts, it seems likely that the day will arrive whe Ebola will be eradicated from these coutries. Forward plaig ow will help esure that the substatial assets ad ifrastructure developed to fight Ebola will remai i the affected coutries after the disease is goe. More broadly, buildig resiliet systems for health will help meet populatios o-goig ad predictable health eeds, ad will help esure that future disease outbreaks ad uusual health evets do ot result i similar devastatig effects. Ultimately, resiliet health systems are ot simply a cocer for public health experts ad authorities. As this curret crisis has demostrated, they are fudametally tied to the ecoomic developmet ad security of coutries, regios, ad the world. Health systems stregtheig should be cosidered as everyoe s busiess. The list below is a sythesis ad summary of poits that were made i the course of discussios durig the two days. 1. The Ebola crisis i West Africa presets a time-limited opportuity that should ot be wasted. Health systems stregtheig ad resiliece buildig should start ow. 2. Natioal govermets should lead the work o buildig health system resiliece. All have atioal plas that ca be used as the basis for forward plaig i light of the Ebola crisis. All parters ca use these plas to defie roles ad resposibilities ad to measure progress. 3. Parters should follow developmet effectiveess priciples. Specifically, efforts should be aliged with Iteratioal Health Partership (IHP+) priciples, icludig coordiatio uder govermet leadership, aligmet to atioal priorities ad harmoizatio of (moetary ad o-moetary) support amog developmet parters. 4. Particular attetio should be paid to buildig core capacities to detect, report, assess ad respod to public health emergecies ad public health risks, as part of coutries obligatios uder the Iteratioal Health Regulatios (IHR) (2005). 5. Istead of creatig yet aother vertical programme for a specific health coditio or to respod to a crisis, ivestmets should be used to build systems that are grouded i primary health care ad uiversal health coverage priciples ad capable of respodig to diverse ad uexpected challeges that might arise i the future. Health services should ecompass disease surveillace, health promotio, prevetio, diagosis, maagemet, rehabilitatio ad palliative care services, ad address people s varyig eeds throughout their life course Ehacig commuity trust, egagemet, ad owership is key. Parterig with commuities i meaigful ways is essetial to help build health systems that are resposive to the eeds ad priorities of the populatios. Traditioal healers ad faith-based orgaizatios ca serve as bridges betwee formal health services ad commuities ad should be cosidered as itegral parters i health systems stregtheig.

14 High level meetig o buildig resiliet systems for health i Ebola-affected coutries 7. Resiliet health systems eed strog cross-sectoral coordiatio. Coutries ifrastructure, water, saitatio, ad educatio systems have direct ad idirect impacts o health system fuctioig ad should be cosidered as part of buildig resiliece. 8. Careful thought is eeded about the massive exteral fiacig curretly flowig ito these coutries. Fiacig from exteral doors should ot add to the debt burde ad should be provided i the form of grats. At the same time, coutries should be give fiscal space to expad their deficits, provided additioal fiacig is available. Over the medium term, fiacial support should be predictable ad routed through govermet systems. This will require capacity buildig so that govermets ca resposibly deploy these fuds i accordace with their priorities ad budgets. 9. I the loger term, to move towards uiversal health coverage goals, cosideratio is eeded o how to reduce the burde of out-of-pocket health expeditures ad to promote fiacial protectio while icreasig access to quality health services. 10. A strog focus o accoutability for both govermets ad parters should uderpi all efforts. A accoutability framework ca idetify a core set of idicators for results ad resources ad explore opportuities to improve access to iformatio. 11

15 Geeva, Switzerlad December 2014 Aex 1. Meetig programme High level meetig o buildig resiliet systems for health i Ebola-affected coutries December 2014 Geeva, Switzerlad DAY 1: 10 December 2014 Day 1 morig thematic area: Curret situatio ad key health system challeges 08:00 09:00 Registratio 09:00 09:30 Opeig ad welcome remarks 09:30 11:00 SESSION 1 Settig the scee: Part 1 Curret Ebola outbreak, ogoig efforts to date ad lessos leart from affected coutries. This sessio will focus o coutries experieces regardig the difficulties faced durig the outbreak ad the impact of the outbreak o the coutry 11:00 11:30 Coffee break 11:30 13:00 SESSION 2 Settig the scee: Part 2 Health systems issues ad challeges. Followig a short presetatio that will draw the situatio i the three coutries before the outbreak, this sessio will discuss the major health system challeges, the major lessos leart regardig MDGs ad health systems stregtheig i the past decade ad the urget priorities ad perspectives, icludig health security cocers 13:00 14:30 Luch break Day 1: afteroo thematic area: Idetificatio of iovative health system solutios 14:30 16:00 SESSION 3 Sub-atioal level: Iovative approaches for rebuildig strog local health systems. The sessio will focus o ogoig coutry plas ad iovative approaches to build strog, balaced ad resiliet sub-atioal health systems that provide itegrated quality health services to the populatio. A pael of discussats will share experieces of strog sub-atioal systems followed by a discussio aroud idetifyig pragmatic solutios at the sub-atioal level 16:00 16:30 Coffee break 16:30 18:00 SESSION 4 Natioal level: Iovative approaches for stregtheig essetial health system fuctios at atioal level. This sessio aims to draw out best practices ad iovative approaches to esure that the atioal public health fuctios receive the eeded iputs to improve populatio health. It will also examie the role of surveillace ad outbreak respose ad how they should be orgaized. A pael of discussats will share experieces of iovative approaches followed by a discussio aroud idetifyig pragmatic solutios at the atioal level 12

16 High level meetig o buildig resiliet systems for health i Ebola-affected coutries Day 2: 11 December 2014 Day 2 morig thematic area: Idetificatio of resources, reforms ad accoutability mechaisms 09:00 09:30 Recap of Day 1 09:30 11:00 SESSION 5 Fiacial ladscape i the coutries. This sessio aims to portray the fiacig situatio i the coutries prior to the Ebola crisis, to explore the implicatios of the crisis for their macroecoomic ad fiscal outlook, ad to cosider the atioal ecoomic ad sectoral fiacig policies eeded to meet the resource eeds of the health system ad esure sustaied recovery. A short presetatio will highlight the curret fiacig situatio i coutries alog with the projected eed ad appropriate fiacig policies followed by a pael discussio of the key fiscal issues ad their implicatios. Special attetio will be give to how to promote fiacial protectio withi recostructio to advace uiversal health coverage goals 11:00 11:30 Coffee break 11:30 13:00 SESSION 6 Roles ad resposibilities icludig eeded goverace ad accoutability mechaisms. Through a iteractive discussio amog the groups of stakeholders, this sessio will focus o how parters ad door mechaisms ca cotribute to buildig a robust ad itegrated health system ad how best the differet actors, based o their comparative advatage, ca support the buildig of resiliet health systems takig accout of political-ecoomy issues. It will also focus o the accoutability measures that eed to be put i place to esure that the efforts are successful 13:00 14:30 Luch break Day 2 afteroo thematic area: Ageda for actio 14:30 15:30 SESSION 7 Next steps ad way forward. This sessio will brig together all participats to agree o a Ageda for actio, icludig the omiatio of a workig group to take the work forward 15:30 16:00 Meetig closure. Cocludig remarks 13

17 Geeva, Switzerlad December 2014 Aex 2. List of participats High-Level Meetig o Buildig Resiliet Systems for Health i the Ebola-Affected Coutries IterCotietal Hotel (Geeva, Switzerlad) December 2014 Provisioal List of Participats MEMBER STATES BELGIUM Dr Paul A. Cartier, Miister Couselor, Permaet Missio of Belgium to the Office of the Uited Natios ad the other Iteratioal Orgaizatios i Geeva CANADA Ms Elissa Golberg, Ambassador, Permaet Represetative of Caada to the Uited Natios Office ad other Iteratioal Orgaizatios at Geeva CHINA Dr Re Mighui, Director-Geeral, Departmet of Iteratioal Cooperatio, Natioal Health ad Family Plaig Commissio Mr Fei Geg, Third Secretary, Permaet Missio of the People s Republic of Chia to the Uited Natios Office at Geeva ad other Iteratioal Orgaizatios i Switzerlad Mr Yi Wag, Permaet Missio of the People s Republic of Chia to the Uited Natios Office at Geeva ad other Iteratioal Orgaizatios i Switzerlad CZECH REPUBLIC Mr Daiel Míc, Deputy Permaet Represetative of the Czech Republic to the Uited Natios Office ad other Iteratioal Orgaizatios at Geeva DENMARK Mr Carste Staur, Ambassador, Permaet Represetative of Demark to the Uited Natios Office at Geeva Mr Mads Filteborg Christese, Permaet Missio of Demark to the Uited Natios Office at Geeva FINLAND Ms Tiia Jortikka-Laitie, Special Evoy for Ebola, Miistry for Foreig Affairs Dr Eero Lahtie, Miisterial Adviser, Miistry of Social Affairs ad Health FRANCE Professor Jea-Fraçois Delfraissy, Coordiator of Iteratioal ad Natioal Operatios i Respose to the Ebola Crisis Mrs Christie Fagés, Ambassador Coordiator of Ebola Task Force, Miistry of Foreig Affairs ad Iteratioal Developmet Mr Thomas Wager, Deputy Permaet Represetative of Frace to the Uited Natios ad other Iteratioal Orgaizatios i Geeva 14

18 High level meetig o buildig resiliet systems for health i Ebola-affected coutries Mrs Corie Bruo-Meuier, Deputy Director, Developmet ad Global Public Goods, Miistry of Foreig Affairs ad Iteratioal Developmet Mr Marc Boisel, Health Advisor, Permaet Missio of Frace to the Uited Natios ad other Iteratioal Orgaizatios i Geeva Mr Vicet Sciama, Health Advisor, Permaet Missio of Frace to the Uited Natios ad other Iteratioal Orgaizatios i Geeva Mrs Juliette Daeschler, Project Officer, Iteratioal Actio WHO, Delegatio for Europea ad Iteratioal Affairs, Miistry of Social Affairs ad Health Mr Pierre Saligo, Project Maager, Health ad Social Protectio Uit, Agece fraçaise de développemet (AFD) Dr Nadia Khelef, Seior Advisor for Global Affairs, Istitut Pasteur GERMANY Mr Thomas Fitsche, Deputy Permaet Represetative of the Federal Republic of Germay to the Uited Natios Office ad other Iteratioal Orgaizatios i Geeva Mr Ja-Hedrik Schmitz Guiote, Permaet Missio of the Federal Republic of Germay to the Uited Natios Office ad other Iteratioal Orgaizatios i Geeva Ms Corelia Jarasch, Permaet Missio of the Federal Republic of Germay to the Uited Natios Office ad other Iteratioal Orgaizatios i Geeva Mr Björ Kümmel, Departmet of Global Health Policy, Germa Federal Miistry of Health Mr Casje Ohesorge, Divisio of West Africa, Germa Federal Miistry for Ecoomic Cooperatio ad Developmet Mrs Maria Mdaihili, Director of GIZ Coutry Office for Sierra Leoe ad Liberia, Coordiatio of Ebola-Related Activities at GIZ, Deutsche Gesellschaft für Iteratioale Zusammearbeit (GIZ) GmbH Ms Ige Baumgarte, Head of Health Divisio, GIZ GHANA Dr Victor Asare Bampoe, Deputy Miister of Health Ms Laila Heward-Mills, First Secretary, Permaet Missio of the Republic of Ghaa to the Uited Natios Office at Geeva ad Specialized Istitutios i Switzerlad GREECE Mr Dimitrios Kraias, Health Attaché, Permaet Missio of Greece to the Uited Natios Office i Geeva ad other Specialized Istitutios i Switzerlad GUINEA Dr Remy Lamah, Miister of Health Dr Mohamed Lamie Yasaé, Advisor to the Miister of Health Mr Sidi Mouctar Dicko, Secretary Geeral, Miistry of Ecoomy ad Fiaces Mr Aly Diae, Permaet Missio of the Republic of Guiea to the Uited Natios Office i Geeva ad other Iteratioal Orgaizatios i Switzerlad IRELAND Mr Séa Ó haodha, First Secretary, Permaet Missio of Irelad to the Uited Natios Office ad other Iteratioal Orgaizatios i Geeva ITALY Ms Valeria Massetai, Permaet Missio of Italy to the Uited Natios Office ad other Iteratioal Orgaizatios i Geeva 15

19 Geeva, Switzerlad December 2014 JAPAN Dr Eiji Hioshita, Director, Office of Iteratioal Cooperatio, Iteratioal Affairs Divisio, Miister s Secretariat, Miistry of Health, Labour ad Welfare Mr Hiroyuki Yamaya, Director of Global Health Policy Divisio, Iteratioal Cooperatio Bureau, Miistry of Foreig Affairs Mr Yosuke Kobayashi, Director for Health Divisio 2, Huma Developmet Departmet, Japa Iteratioal Cooperatio Agecy (JICA) Ms Tomoko Ooda, First Secretary, Permaet Missio of Japa to the Uited Natios Office ad other Iteratioal Orgaizatios at Geeva Mr Tomofumi Nishiaga, Director of Coutry Assistace Plaig Divisio 3, Iteratioal Cooperatio Bureau, Miistry of Foreig Affairs LIBERIA Dr Berice T. Dah, Chief Medical Officer, Miistry of Health ad Social Welfare Mr Mouir Siaplay, Deputy Miister for Ecoomic Maagemet, Miistry of Fiace ad Developmet Plaig Mr Berard Wieh Jappah, Public Fiacial Maagemet Reforms Coordiator, Miistry of Fiace ad Developmet Plaig Dr Emmauel T. Dolo, Natioal Youth Policy Advisor to the Presidet Mr Abraham Kamara, Permaet Missio of the Republic of Liberia to the Uited Natios Office ad other Iteratioal Orgaizatios at Geeva Mr Paul Tate, Permaet Missio of the Republic of Liberia to the Uited Natios Office ad other Iteratioal Orgaizatios at Geeva LUXEMBOURG Mr Jea-Marc Hoscheit, Ambassador, Permaet Represetative of the Grad Duchy of Luxembourg to the Uited Natios Office i Geeva Mrs Ae Weber, Attaché for Humaitaria Affairs ad Health, Permaet Represetative of the Grad Duchy of Luxembourg to the Uited Natios Office i Geeva Mr Max Lamesch, Cooperatio Aget, Directorate of Cooperatio, Miistry of Foreig ad Europea Affairs MALI Mr Ousmae Koe, Miister of Health ad Public Hygiee Dr Lamie Diarra, Adviser o Ebola, Miistry of Health ad Public Hygiee Mrs A. Thiam Diallo, Permaet Represetative of the Republic of Mali to the Uited Natios Office ad other Iteratioal Orgaizatios i Geeva Mr A. Thiam, Permaet Missio of the Republic of Mali to the Uited Natios Office ad other Iteratioal Orgaizatios i Geeva Mr Dramae Traoré, Permaet Missio of the Republic of Mali to the Uited Natios Office ad other Iteratioal Orgaizatios i Geeva MEXICO Ms Liliaa Padilla Rodríguez, Secod Secretary, Permaet Missio of Mexico to the Uited Natios Office at Geeva ad other Iteratioal Orgaizatios havig their Headquarters i Switzerlad NETHERLANDS Mr Has Docter, Ambassador ad Special Evoy for the Dutch Govermet o Ebola, Permaet Missio of the Kigdom of the Netherlads to the Uited Natios Office ad other Iteratioal Orgaizatios i Geeva Mr Gert-Ja Rietveld, Health Attaché, Permaet Missio of the Kigdom of the Netherlads to the Uited Natios Office ad other Iteratioal Orgaizatios i Geeva 16

20 High level meetig o buildig resiliet systems for health i Ebola-affected coutries Ms Jeyfer Imperator, First Secretary, Permaet Missio of the Kigdom of the Netherlads to the Uited Natios Office ad other Iteratioal Orgaizatios i Geeva Mr Lader va Omme, Theme Expert, Permaet Missio of the Kigdom of the Netherlads to the Uited Natios Office ad other Iteratioal Orgaizatios i Geeva NEW ZEALAND H.E. Ambassador A. Ellis, Permaet Represetative of New Zealad to the Uited Natios Office at Geeva ad other Iteratioal Orgaizatios i Switzerlad Ms Meredith Davis, Permaet Missio of New Zealad to the Uited Natios Office at Geeva ad other Iteratioal Orgaizatios i Switzerlad NORWAY Mr Stei-Ivar Lothe Eide, Higher Excutive Officer, Sectio for Global Iitiatives, Royal Norwegia Miistry of Foreig Affairs Dr Tore Godal, Special Advisor o Global Health, Sectio for Global Iitiatives, Royal Norwegia Miistry of Foreig Affairs, Norwegia Istitute of Public Health Dr Frode Forlad, Program Director, Global Health Preparedess, Norwegia Istitute of Public Health Mr Thor Erik Lidgre, Cousellor (Health), Permaet Missio of Norway to the Uited Natios Office ad other Iteratioal Orgaizatios at Geeva PORTUGAL Mr João Mauel Freitas Pereira, Permaet Missio of Portugal to the Uited Natios Office ad other Iteratioal Orgaizatios i Geeva RWANDA Mr Fraçois Xavier Ngarambe, Ambassador, Permaet Represetative of the Republic of Rwada to the Uited Natios Office i Geeva ad Specialized Istitutios i Switzerlad Mr Moses Rugema, First Coucilor, Permaet Missio of the Republic of Rwada to the Uited Natios Office i Geeva ad Specialized Istitutios i Switzerlad SENEGAL Mr El Hadji Malick Diallo, First Secretary, Permaet Missio of the Republic of Seegal to the Uited Natios Office ad other Iteratioal Orgaizatios i Geeva SIERRA LEONE Dr Abu Bakarr Fofaah, Miister of Health ad Saitatio Mr Alhaji Foday B.L. Masaray, Miister of State, Miistry of Fiace ad Ecoomic Developmet SPAIN Mr Victorio Redodo Baldrich, Ambassador, Deputy Permaet Represetative of Spai to the Uited Natios Office i Geeva ad other Iteratioal Orgaizatios i Switzerlad Ms Karolie Ferádez de la Hoz Zeitler, Head of Uit, Iteratioal Techical Coordiatio, Geeral Secretariat of Health ad Cosumptio Ms Ágela Jiméez, Advisor, Permaet Missio of Spai to the Uited Natios Office i Geeva ad other Iteratioal Orgaizatios i Switzerlad SWEDEN Ms Aa Halé, Cousellor, Health Affairs (WHO), Permaet Missio of Swede to the Uited Natios Office ad other Iteratioal Orgaizatios at Geeva 17

21 Geeva, Switzerlad December 2014 SWITZERLAND Mr Alexadre Fasel, Ambassador, Permaet Represetative of Switzerlad to the Uited Natios Office ad other Iteratioal Orgaizatios i Geeva Mr Jacques Mader, Health Policy Advisor, Global Programme Health, Swiss Agecy for Developmet ad Cooperatio (SDC) Dr Leo Karrer, Third Secretary, Permaet Missio of Switzerlad to the Uited Natios Office ad other Iteratioal Orgaizatios i Geeva TOGO Ms Mouto Agba, First Secretary, Permaet Missio of the Republic of Togo to the Uited Natios Office ad other Iteratioal Orgaizatios i Geeva UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND H.E. Kare Pierce, Permaet Represetative of the Uited Kigdom of Great Britai ad Norther Irelad to the Uited Natios Office ad other Iteratioal Orgaizatios at Geeva Mr Mark Lowcock, Permaet Secretary, Departmet for Iteratioal Developmet (DFID) Mrs Jae Edmodso, Head of Departmet, Huma Developmet, DFID Mr Damo Bristow, Team Leader, Health Services, DFID Mr Bria McCloskey, Director of Global Health, Public Health Eglad Ms Magali Girod, Policy Adviser, Permaet Missio of the Uited Kigdom of Great Britai ad Norther Irelad to the Uited Natios Office ad other Iteratioal Orgaizatios at Geeva Ms Daisy Gouldig, Attaché, Permaet Missio of the Uited Kigdom of Great Britai ad Norther Irelad to the Uited Natios Office ad other Iteratioal Orgaizatios at Geeva UNITED STATES OF AMERICA Dr Ariel Pablos-Médez, Assistat Admiistrator for Global Health, U.S. Agecy for Iteratioal Developmet (USAID) Dr Bob Emrey, Lead Health Systems Specialist, Office of Health Systems, Global Health Bureau, USAID Dr Rebecca Marti, Ceter for Global Health, CDC Mr Mitch Wolfe, Deputy Assistat Secretary for Global Affairs, HHS Mrs Haah Burris, Office of Global Affairs, HHS Mr Doug Shaffer, Chief Medical Officer, Office of the U.S. Global AIDS Coordiator Ms Letitia Robiso, Huma Resources ad Services Agecy, HHS Mr Adrea V. Strao, Iteratioal Relatios Officer, Office of Ecoomic ad Developmet Affairs, Bureau of Iteratioal Orgaizatio Affairs, U.S. Departmet of State UNITED NATIONS OFFICES AND SPECIALIZED AGENCIES UNITED NATIONS Dr David Nabarro, Special Evoy of the Uited Natios Secretary-Geeral o Ebola Dr Aders Nordström, Advisor, Office of the Special Evoy of the Uited Natios Secretary-Geeral o Ebola Ms Alexia César, Special Assistat to the Special Evoy of the Uited Natios Secretary-Geeral o Ebola Ms María del Mar Galido, Special Assistat to the Special Evoy of the Uited Natios Secretary-Geeral o Ebola Mr Mark Grabowsky, Chief Operatig Officer, Office of the Secretary-Geeral s Special Evoy for Fiacig the Health Milleium Developmet Goals ad for Malaria 18

22 High level meetig o buildig resiliet systems for health i Ebola-affected coutries UNITED NATIONS MISSION FOR EBOLA EMERGENCY RESPONSE (UNMEER) Mr Peter Graaff, Uited Natios Ebola Crisis Maager for Liberia JOINT UNITED NATIONS PROGRAMME ON HIV/AIDS (UNAIDS) Dr Luiz Loures, Deputy Executive Director UNITED NATIONS DEVELOPMENT PROGRAMME (UNDP) Ms Izumi Nakamitsu, Assistat Secretary Geeral ad Director, Crisis Respose Uit Ms Madheep Dhaliwal, Director, HIV, Health ad Developmet Uit UNITED NATIONS POPULATION FUND (UNFPA) Mr Beoît Kalassa, Regioal Director, West ad Cetral Africa Regio Mr Luc de Beris, Seior Materal Health Adviser Ms Michaela Michel-Schuldt, Techical Officer Midwifery UNITED NATIONS CHILDREN S FUND (UNICEF) Mr Athoy Lake, Executive Director ad Uder-Secretary Geeral Dr Mickey Chopra, Associate Director of Health Mr Guido Borghese, Regioal Adviser, Child Survival ad Developmet Ms Doree Mulega, Deputy Director, Programme Supply UNITED NATIONS OFFICE FOR THE COORDINATION OF HUMANITARIAN AFFAIRS (UN OCHA) Ms Kyuag-wha Kag, Assistat Secretary Geeral of Humaitaria Affairs Ms Louise Agersap Ms Leila Bourhil INTERNATIONAL LABOUR ORGANIZATION (ILO) Dr Yuka Ujita, Labour Admiistratio ad Labour Ispectio Officer, ILO Labour Admiistratio, Labour Ispectio ad Occupatioal Safety ad Health Brach Dr Fracis Satos O Coor, Specialist i Occupatioal Safety ad Health Ms Xeia Scheil-Adlug, Seior Health Policy Coordiator, Social Protectio Departmet Ms Christiae Wiskow, Seior Health Services Specialist INTERNATIONAL MONETARY FUND (IMF) Ms Corie Deléchat, Deputy Divisio Chief i the Africa Departmet ad Missio Chief for Liberia INTERNATIONAL ORGANIZATION FOR MIGRATION (IOM) Dr Douglas MacPherso, Seior Techical Medical Advisor INTERNATIONAL TELECOMMUNICATIONS UNON (ITU) Mrs Susa Teltscher, Head of ICT Data ad Statistics Divisio, Developmet Sector Mrs Maritza Delgado, Programme Officer of Least Developed Coutries, Small Islad Developmet States ad Emergecy Telecommuicatios Divisio, Developmet Sector THE WORLD BANK Dr Tim Evas, Seior Director, Health, Nutritio ad Populatio Global Practice Mr Patricio Márquez Mr Christoph Lemière 19

23 Geeva, Switzerlad December 2014 WORLD FOOD PROGRAMME (WFP) Ms Deise Brow, Corporate Respose Director for the Emergecy Respose to the Ebola Virus Disease Crisis i West Africa Mr Bria Lader INTER GOVERNMENTAL ORGANIZATIONS AND OTHER INTERNATIONAL ORGANIZATIONS EUROPEAN UNION Mr Peter Sorese, Head, Permaet Delegatio of the Europea Uio to the Uited Natios i Geeva Mr Domiic Porter, Deputy Head, Permaet Delegatio of the Europea Uio to the Uited Natios i Geeva Ms Lourdes Chamorro, Cousellor, Permaet Delegatio of the Europea Uio to the Uited Natios i Geeva Mr Patrick Dupot, First Secretary, Permaet Delegatio of the Europea Uio to the Uited Natios i Geeva Ms Maya Matthews, Secod Secretary, Permaet Delegatio of the Europea Uio to the Uited Natios i Geeva Ms Atje Korr, Press ad Public Diplomacy Officer, Permaet Delegatio of the Europea Uio to the Uited Natios i Geeva Ms Katharia Rettig, Traiee, Permaet Delegatio of the Europea Uio to the Uited Natios i Geeva Mr Eric Satti, Iteratioal Aid/Cooperatio Officer, Health Sector, Directorate Geeral Europe Aid Developmet ad Cooperatio, Europea Commissio, Brussels Ms Nicolette Hutter, Iteratioal Aid/Cooperatio Officer, Health Sector, Directorate Geeral Europe Aid Developmet ad Cooperatio, Europea Commissio, Brussels Mr Jea-Louis de Brouwer, Director, Humaitaria ad Civil Protectios Operatios, Directorate Geeral ECHO, Europea Commissio INTERNATIONAL COMMITTEE OF THE RED CROSS (ICRC) Dr Osma Zaher, Health Departmet INTERNATIONAL FEDERATION OF THE RED CROSS (IFRC) Ms Joelle Taguy, Uder Secretary Geeral, Humaitaria Values ad Diplomacy GAVI ALLIANCE Mr Ala Brooks, Director, Health Systems ad Immuizatio Stregtheig THE GLOBAL FUND TO FIGHT AIDS, TUBERCULOSIS AND MALARIA Ms Cythia Mwase, Head, Africa ad Middle East Departmet Mrs Viviaa Magiaterra, Seior Techical Coordiator MNCH ad HSS, Techical Advice ad Parterships Departmet WEST AFRICAN HEALTH ORGANIZATION (WAHO) Dr Victor Asare Bampoe, Curret Chair of ECOWAS/WAHO Dr Johaa Austi, Director, Primary Health Care Departmet Mr Sai Ali, Professioal Officer, Plaig Dr Namoudou Keita, Professioal Officer, Health Systems Stregtheig 20