UNICEF Evaluation Management Response

UNICEF Evaluation Management Response Evaluation title: Evaluation of UNICEF s Response to the Ebola Outbreak in West Africa, 2014 2015 Region: Global Office: New York headquarters Evaluation year: 2016 Evaluation report sequence number: 2016/010 Person in charge for follow-up to management response: Mr. Omar Abdi, Deputy Executive Director, Programmes Overall response to the evaluation: The Ebola epidemic in West Africa was a grim reminder of the stark threat posed to humanity by communicable diseases. In the aftermath of the outbreak, there is widespread agreement that such threats will continue to arise and concerns that they may become more complex (because of drug resistance, population growth and other factors). Drawing on the key findings from this evaluation, the recommendations presented in this report have been key to ensuring that UNICEF can be better prepared and capacitated to deal with future health emergencies. Planned use of evaluation: UNICEF is already responding to the recommendations of this evaluation report; most actions outlined below are under way. The findings are being used to strengthen key management functions to better prepare for and respond to health emergencies, including through global coordination, strategy development, planning and monitoring. Strategies and results related to public health emergencies are being integrated into the UNICEF Strategic Plan, 2018 2021. Actions are also under way to strengthen capacities for rapid, large-scale deployment of financial, human and material resources in all emergencies. Building on lessons learned from the response to Ebola, UNICEF is focusing on strengthening capacities and systems for health and child protection at the community level in countries at highest risk of a future health emergency. UNICEF will also strengthen the capacity of staff at headquarters, regional and country levels as well as government partners on community engagement and social mobilization to better prepare for and respond to health emergencies in high-risk countries.

Evaluation recommendation 1: The UNICEF West and Central Africa Regional Office (WCARO), Country Offices (COs) and partners in the three mostaffected countries (Guinea, Liberia and Sierra Leone) should ensure at minimum that: (a) health systems retain a rapid response capacity to prevent Ebola outbreaks and develop International Health Regulations (IHR) core capacities; (b) community health systems are reinforced in the most-affected communities; and (c) children most affected by Ebola receive adequate protection. Management response: Agree. However, community health systems should be strengthened in all communities in these three countries, as future health emergencies may affect populations beyond those most affected by Ebola. In addition, actions to retain rapid response capacity and strengthen IHR capacities are predicated upon partner commitments, and the role of UNICEF is determined within the context of national plans and strategies. 1.1 Retain rapid response capacity to respond to epidemic/infectious disease outbreaks. This includes establishing/maintaining response coordination structures at national and decentralized levels; strengthening human resource capacity at all levels, including training community health workers; providing the necessary infrastructure and equipment for rapid response, including the maintenance of epidemic/infectious disease care and treatment centres, improving water, sanitation and hygiene (WASH) Health, WASH, Supply, Social policy, Communication for development (C4D) Deputy Representative and Chief of Emergency Child Survival and Development (CSD/)/Chief of Health Throughout (and ongoing) All three COs have retained and continue to fine-tune the rapid response mechanism at country level, in coordination with Governments and key stakeholders and in line with the components outlined in action 1.1. Country office reports, publications and situation reports 1 National plans for post-ebola recovery, and national health policies and plans 1 See: www.scoop.it/t/ebola-by-ebola-news-and-views 2/20

infrastructure in health facilities and disease surveillance and early warning detection systems; and prepositioning of supplies, including Rapid Isolation and Treatment of Ebola kits. 1.2 Reinforce community health systems in all three countries, including in the most-affected communities. This includes supporting development and implementation of the necessary health policy frameworks and health emergency strategies; building human resource capacity, including training community health workers, and strengthening capacity to monitor epidemics for early warning at community level. COs/Deputy Representatives/ CSD/Health Section, C4D Deputy Representatives and Chief of CSD/Health Section As part of their support to implementation of national post-ebola recovery plans, all three UNICEF COs are strengthening community health systems in the mostaffected communities. Actions have included development and improvement of national community health policies, community health strategic plans, and community contingency plans, providing technical Country office reports, publications and situation reports 2 National post- Ebola recovery plans and national health policies and plans 2 See: www.scoop.it/t/ebola-by-ebola-news-and-views 3/20

and financial support to community health programmes with paid community workers, and training community health workers. UNICEF is also modelling innovative approaches for early warning and monitoring of epidemics at the community level using RapidPro. 1.3. Document good practices, including Community Care Centre models in the three countries (Guinea, Liberia and Sierra Leone), and share these with all countries in the West and Central Africa region (WCAR) and with partner organizations. Regional office (RO) Chief of CSD/Health Section, in coordination with Chief of Planning, Monitoring and Evaluation, and Chief of Communication in consultation with the Office of Emergency Programmes (EMOPS), Programme Division (PD), WASH 4/20

1.4. Develop a roster of experts for health emergencies, for rapid deployment to countries when requested. RO Chief of Health Section, in coordination with the Emergency Section, PD, EMOPS, WASH, C4D, Supply Division 1.5. Develop strategies to support the Governments of Guinea, Liberia and Sierra Leone in designing and implementing enabling policies, strengthening human resource capacity, and identifying innovative financing for community health systems. These strategies will be based on rebuilding trust in health systems, community-based disease surveillance and strengthened community capacity to maintain basic social services in outbreaks and broader humanitarian situations. RO CSD (Health, WASH, Nutrition, C4D, Child Protection) in coordination with PD and EMOPS 1.6. Continue case management so that child survivors of and children affected by Ebola benefit COs Chiefs of Child Protection All three countries are: (a) following up on Ebola-affected Reports generated from the child 5/20

from family visits and homebased psychosocial support. children through case management; (b) mapping child survivors or children affected by Ebola who did not receive at least two postreunification family visits; and (c) conducting followup visits during post-reunification. protection databases Child Protection Information Management System (Sierra Leone) CO situation reports All three UNICEF COs are also providing a minimum package of child protection services to children who lost one or both parents or caregivers. 3 In Guinea and Liberia, respectively, 6,220 and 5,401 children affected by Ebola received protection services,. In Sierra 3 This package includes (a) psychosocial support provided through community-based child protection network members; (b) referral of children to other basic social services as required (e.g., health, education, justice, etc.); (c) distribution of basic supplies, including hygiene kits; (d) family tracing and reunification for children who lost both parents; (e) placement in alternative family care for orphans whose extended families have not been found; and (f) family visits to ensure effective and sustainable reunification. 6/20

Leone, out of 12,012 children provided with child protection services, 5,236 are orphaned by the Ebola virus disease. The case management has been successful partly because of the establishment of the Child Protection Information Management System, a database run by both the Ministry of Social Welfare and nongovernmental organizations (NGOs). 1.7. Strengthen communitybased child protection systems (CBCPS) so they can identify cases early on and provide necessary support. COs Chiefs of Child Protection All three countries have mapped the existing CBCPS that were established during the Ebola crisis, and have activated early warning systems. Reports generated from the child protection databases Child Protection Information Management 7/20

System (Sierra Leone) Country office situation reports 1.8. Advocate and provide technical support for including child survivors or children affected by Ebola in government social protection schemes. COs Chiefs of Child Protection and Chiefs of Social Policy All three COs are documenting and monitoring children in need of government socialprotection schemes, providing technical support so that national socialprotection programmes include these children in the existing schemes, and will conduct family visits to verify if all referred children benefit from the schemes. CO monitoring reports 1.9. Support fundraising to strengthen child protection systems at decentralized level, particularly for prevention services, early warning, case management and referral of children to RO, COs Chiefs of Child Protection, Regional Child Protection Advisers and Child Protection Specialists 8/20

other basic social services. This includes identifying potential donors and joint proposal development by the RO and COs. 1.10. Improve the existing Child Protection in Emergencies (CPiE) regional human resources roster and train staff and partners on CPiE, including through the certification programme on CPiE developed with the Bioforce Institute. 4 RO, COs UNICEF CO Representative, Regional Child Protection Adviser, Regional CPiE Specialist, and Division of Human Resources (DHR) The RO is prescreening CPiE profiles for inclusion in the CPiE regional roster. As of February, the roster contained 270 profiles. UNICEF staff members and staff in partner organizations are being identified for CPiE training, which includes a module on case management. CO CPiE preparedness plans Existing upd CPiE regional roster Bioforce Institute curricula for CPiE Project Management Certificate Training reports 4 In 2016, UNICEF worked with the Bioforce Institute (www.institutbioforce.fr/en), a French organization that provides training, support and accredited certification for humanitarian professionals, to develop a CPiE Project Management Certificate programme. UNICEF headquarters and WCARO, the Child Protection Area of Responsibility and the Child Protection Global Alliance have supported implementation of this programme for UNICEF national staff and local NGO partners. 9/20

In addition, the RO is identifying Child Protection staff who will participate in the more intensive three-month Bioforce certification program on CPiE. As a complement to the RO roster, the RO is making sure that country- level CPiE- preparedness plans are completed. Evaluation recommendation 2: The UNICEF Global Management Team (GMT) should develop a policy and accountability framework for responding to public health emergencies that includes: (a) specific goals; (b) programme guidance; (c) global partnership objectives; and (d) assessment of broader humanitarian risks. Whether produced as an addendum to the Core Commitments for Children (CCCs) in Humanitarian Action or a separate policy, it should complement and build on rather than duplicate existing UNICEF emergency response policies and processes. Management response: Partially agree. The UNICEF accountability framework does not recognize the GMT as the body for policy or procedure authorization, but rather it is an advisory body, and delegates this to the business owner as appropriate (defined in the responsible column). The CCCs provide the overall framework for action in humanitarian contexts. We agree that UNICEF should develop the necessary procedures and guidance for responding to public health emergencies as a complement to the existing CCCs and Simplified Standard Operating Procedures (SSOPs), as outlined in this recommendation. 2.1. Identify key areas of work that need to be strengthened to improve PD/EMOPS/ Supply Division (SD) and DHR Health Emergencies Preparedness Initiative (HEPI) March Under HEPI, UNICEF has defined principles Core Commitments for Children in 10/20

preparedness, response and recovery for health emergencies based on the existing organizational accountability framework. Coordinator/ Principal Adviser on Health Emergencies and areas of work 5 for preparedness and response to health emergencies. Humanitarian Action 6 UNICEF Approach to Health System Strengthening 7 UNICEF Health Emergencies Preparedness Initiative (internal) 2.2. Integrate strategies and indicators aligned to public health emergencies into the UNICEF Strategic Plan. PD/Division of Data, Research and Policy (DRP/)/EMOPS Directors/Chiefs PD/DRP September Health emergencies included in the UNICEF Strategic Plan, 2018 2021 UNICEF Strategic Plan, 2018 2021 2.3. Develop sectoral and intersectoral programme guidance on preparing and responding to health emergencies and recovery. PD/EMOPS/SD Principal Adviser on Health Emergencies in collaboration with the Directors of PD, EMOPS and SD September As part of HEPI, first drafts of packages of support for Category 1 diseases have been developed. 8 Draft packages of support for Category 1 diseases Guidelines and standards for 5 Areas of work identified include (a) internal organization and prioritization, (b) disease-specific preparation, (c) institutional strengthening, and (d) cooperation with partners. 6 See: www.unicef.org/publications/files/ccc_042010.pdf 7 See: www.unicef.org/health/files/unicef_hss_approach_-_5jun16.pdf 8 Category 1 diseases are Yellow Fever, Dengue, Zika, Chikungunya, Avian Flu, Pandemic flu, Ebola, Marburg, Cholera, Malaria, Measles, Meningococcal disease and Polio. The packages of support for each Category 1 disease include disease-specific quick notes, programme sector guide, supply requirements, repository of guidance, tools, training materials and C4D guidance and tools. 11/20

UNICEF community-based risk assessments still need to be developed. PD/Child Protection Section PD Director Addendum to the inter-agency Minimum Standards for Child Protection in Humanitarian Action, featuring recommendations for child protection preparedness and response in epidemics, is being developed. Minimum Standards for Child Protection in Humanitarian Action, Child Protection Working Group 9 Terms of reference for developing an addendum to the Minimum Standards for Child Protection in Humanitarian Action PD/WASH Section PD Director May Development of a module on Health Emergencies in the UNICEF WASH in Emergencies training, which will be provided to all Draft training module 9 See: www.unicef.org/iran/minimum_standards_for_child_protection_in_humanitarian_action.pdf 12/20

UNICEF WASH staff. Evaluation recommendation 3: The UNICEF GMT should recognize areas for improvement and strengthen coordination, strategy and information capacities for public health emergencies. Drawing on lessons learned from the Ebola response, UNICEF should develop tools, guidance and mechanisms and strengthen capacities for: (a) global emergency coordination; (b) planning, programme support and performance monitoring; and (c) information and knowledge management functions. Management response: Partially agree. The GMT is an advisory body and is not accountable for action on the recommendations. As noted in response to recommendation 2, tools and guidance are the accountability of the relevant business owner as defined in the responsible person/s and responsible columns. We agree with the need to strengthen capacities on global emergency coordination; planning, programme support and performance monitoring; and the information and knowledge-management functions. This will be done in line with the Inter-Agency Standing Committee (IASC) guidance on L3 activation for disease events. 10 3.1. Define leadership and coordination structure within UNICEF to prepare and respond to health emergencies and identify and address capacity gaps. EMOPS/PD/SD Directors of EMOPS, PD and SD, under the guidance of the relevant Deputy Executive Directors September Proposal to strengthen leadership and coordination structure for health emergences in UNICEF was submitted to the Office of the Executive Director and was agreed to. Recruitment of Principal Adviser for Public Health Proposal to strengthen leadership and coordination structure for health emergencies (internal) Terms of reference for Principal Adviser for Health Emergencies (D-1) Draft addendum to L2 and L3 SSOPs 10 The IASC guidance on L3 activation for disease events ( 2016) outlines procedures for the assessment of infectious disease events, the consultation and decision-making processes on L3 activation for such events, the activation and deactivation criteria and procedures, and the implications for IASC members and other collaborating organizations. 13/20

Emergencies (D-1) is under way. Addendum to L2 and L3 SSOPs on Core Commitments for Health Emergencies has been drafted. for Core Commitments for Health Emergencies 3.2. Increase physical stocks in UNICEF of supplies identified as critical for priority diseases. SD SD Director First quarter (Q1) SD is finalizing remaining longterm agreements (LTAs) with suppliers for supplies identified in Category 1 disease-supply lists and has put in place physical stock at the SD warehouse or suppliers premises for these items. All LTAs will be in place for Category 1 supplies by the end of Q1. LTAs with suppliers 3.3. Integrate outbreak risks in the Emergency Preparedness Platform EMOPS/PD/ ROs EMOPS Director, with inputs from PD Director Q1 2018 UNICEF Procedure on Preparedness for Emergency Response was UNICEF Procedure on Preparedness for Emergency Response 14/20

(EPP), 11 and monitor preparedness actions at headquarters, RO and CO levels. Regional Directors (responsible for monitoring preparedness actions at RO and CO levels) issued in 2016. Roll-out started in Feb. Development of EPP software is under way. EPP specification document 3.4. Review all country programme strategy notes for inclusion of anticipation, planning and response to health emergencies. Field Results Group (FRG) in collaboration with ROs, PD and EMOPS Directors of FRG, PD and EMOPS Ongoing as COs develop strategy notes All strategy notes produced in 2016 were reviewed for inclusion of anticipation, planning and response to health emergencies. Country programme strategy notes (internal) 3.5. Include reporting on humanitarian indicators as part of the annual corporate reporting. FRG, in collaboration with PD and EMOPS Directors of FRG, PD and EMOPS 2018 All humanitarian performancemonitoring indicators have been included in the Results Assessment Module (RAM) as standard indicators. List of standard indicators in RAM 11 EPP is a tool (under development) to implement the UNICEF Procedure on Preparedness for Emergency Response, which COs, ROs and HQ will use to plan effective shortterm preparedness activities and to monitor their preparedness levels. 15/20

3.6. Jointly identify and address key coordination and research gaps for cholera control (and other outbreaks) with the United States Centers for Disease Control and Prevention (CDC), World Health Organization (WHO) and other stakeholders. PD/WASH Section/Health and Immunization PD Director Ongoing UNICEF is leading the Global WASH Technical Working Group of the Global Cholera Task Force. Coordination and research gaps are currently being identified, and a plan will be developed to jointly address these with CDC, WHO and other stakeholders. Terms of reference and workplan for WASH Technical Working Group of the Global Cholera Task Force In addition, UNICEF is participating in regional platforms on cholera in the Eastern and Southern Africa region (ESAR) and WCAR to strengthen coordination and research with CDC, WHO and other stakeholders. 16/20

3.7. Consoli and distribute: (a) lessons learned from UNICEF and partners response to outbreaks; (b) data on morbidity and mortality from epidemic/pandemic-prone diseases with a focus on children; (c) outbreak risk assessments; and (d) research articles, guidelines, tools and training material. PD/EMOPS/SD Principal Adviser on Health Emergencies, in collaboration with the Directors of PD, EMOPS and SD Ongoing Ups on morbidity and mortality related to Zika and other priority epidemic diseases have been consolid and disseminated to UNICEF headquarters, ROs and COs. UNICEF Sharepoint site on public health emergencies, which contains key ups, guidance and tools, has been established. Zika ups (internal) UNICEF Sharepoint site on public health emergencies (internal) Evaluation recommendation 4: The UNICEF GMT should continue to strengthen capacities for rapid, large-scale deployment of financial, human and material resources in emergencies by: (a) applying lessons and protocols from the Ebola response on duty of care; (b) significantly increasing emergency human-resource capacities and emergency competencies in country offices; and (c) involving operational and administrative staff in strategy and programme management. Management response: Partially Agree. As noted in response to recommendations 2 and 3, the GMT is an advisory body and is not responsible for such actions. EMOPS will support the designated coordinator for health emergencies to coordinate components 1 and 2 of the recommendation. Component 3 involving operational and administrative staff in strategy and programme management will be addressed through guidance under the Health Emergencies Preparedness Initiative. 17/20

4.1. Clarify duty of care measures and procedures for personnel operating in health emergencies. DHR, with EMOPS DHR Director 2018 UNICEF participates in the Global Working Group on reconciling duty of care for United Nations personnel while operating in high-risk environments, which is under the United Nations High-level Committee on Management. UNICEF template and procedure to review the duty of care upon declaration of a public health emergency A UNICEF template and procedure has been developed to review the duty of care upon declaration of a public health emergency. 4.2. Map existing expertise and develop multisectoral surge roster at global level for outbreaks and health emergencies response. DHR, with support from EMOPS, PD and SD Directors of DHR and EMOPS, PD and SD SD roster with supply logistics and Emergency Response Team staff has been expanded to include staff with a SD roster 18/20

background in health emergencies. Evaluation recommendation 5: UNICEF EMOPS and the UNICEF Programme Division should further develop the community-based approach as an implementation modality inclusive of strong AAP [Accountability to Affected Populations] and community engagement components. Recognizing the central role of communities in stopping Ebola, UNICEF should focus on strengthening local capacities and systems for health and social protection at the community level. This effort should include means of increasing capacity within UNICEF for community engagement and social mobilization and improving programme integration at the community level. Management response: Agree. 5.1. Establish community engagement coordination platforms in key countries (in line with cluster arrangements). This is an initiative co-led by UNICEF, the United Nations Office for the Coordination of Humanitarian Affairs, International Federation of Red Cross and Red Crescent Societies, and the Communicating with Disaster-Affected Communities Network. 5.2. Strengthen UNICEF C4D capacities at CO and RO levels to address health emergencies. This includes (a) EMOPS/cluster leads and Humanitarian Policy Section (HPS), PD/C4D PD/Health Section, in collaboration with all sectors and the C4D Section EMOPS/cluster leads and HPS, PD/C4D Ongoing through 2018 2019 The global interagency Communication and Community Engagement Initiative for emergency response was established in Q4 2016. PD Director Ongoing New York University Outbreak Communication course: A total of 50 Inter-agency C4D guidance for health emergencies (Zika) (internal) Inter-agency C4D guidance for health emergencies (Yellow Fever) (internal) Draft concept note/workplan for Communication and Community Engagement Initiative Curriculum of the Outbreak Communication 19/20

training UNICEF staff and technical personnel on outbreak communication; and (b) training relevant government institutions involved in preparedness and response to health emergencies on C4D and community engagement in the context of outbreaks. UNICEF CO and RO staff (C4D and monitoring and evaluation) have been trained and are now deployable in emergencies. Training will be expanded in. Staff from Ministries of Health in 16 countries in ESAR were trained on C4D and community engagement in the context of outbreaks by C4D/Polio teams in June 2016. Training will be expanded to WCAR in. course and list of trained personnel Reports from training sessions 20/20