Inter-Agency Review of UN System Country Contingency Plans

Inter-agency review of UN system country Contingency Plans (CP) for an avian and human influenza (AHI) pandemic

Country: Bolivia

Last update of CP: May 2006

Review team: Peter Scott-Bowden, Nankhonde Kasonde, Hermann Nicolai, Nabila Alibhai, Pier-Luigi Martenisi, Gregoire de Brancovan, Daniela Wuerz, Dr. Osman Mansoor

Review date: 27 June 2006

Indicator Yes / No Comment

Planning and Coordination The plan is based upon the UN Secretary-General’s Pandemic Planning and Preparedness Guidelines for the UN System and the UNMS Staff Contingency Plan Guidelines for an Influenza Pandemic (revised version from March 2006).

1.1 AHI Focal point No Possibly, an AHI focal point for Bolivia UNCT has been appointed. appointed, but no reference is made in the contingency plan. It is recommended to include the name of the AHI focal point and his/her contact information in the update of the contingency plan.

1.2 UNCT and/or AHI No While it is implicitly stated in the contingency plan that the coordinator has had a UNCT should assist the national government regarding their discussion and agreed on AHI preparedness, it is not mentioned in detail. In case, contact/liaison with discussion and contact/liaison have already taken place national pandemic between the UN agencies and government agencies in preparedness and Bolivia, please make reference to it in the contingency plan. response authorities? Including contacts, notification and information sharing agreements.

1.3 Coordination No Although there may be some linkages with outside (non-UN) mechanism with non- agencies, this is not indicated in the plan. It might be useful UN partners (WB, to make a reference to potential cooperation with other non- NGO, etc) active. UN agencies in the plan. Indicator Yes / No Comment 1.4 Key risks and Yes The plan contains an extensive risk analysis that identifies 8 contingencies key risks including most of the key risks mentioned in the identified by UNCT. pandemic guidelines. This is well done. However, there are two more key risks that could also be taken into account in the risks analysis: the first deals with the preparation of new programme requirements and support to the National Government and the second deals with the lack of adequate resources (logistics, communication, and infrastructure) to maintain operational capacity. Although the potential lack of human resources was mentioned, it could be extended to the lack of technical/infrastructural resources as well. Hence, the concept of planning for business continuity / ensuring maintenance of operational functions during a pandemic could be developed within the plan. The eight identified risks are assessed regarding grading of risks in front of the different WHO pandemic phases. A further contingency prioritization could be included in the contingency plan.

Overall, this risk analysis is excellent and the team should be commended on its detailed work.

1.5 Response actions Yes A detailed response action matrix that tailors the eight matrix with identified risks to risk mitigation strategies and basic actions responsibilities is included in the contingency plan. The team has gone into assigned. much detail regarding the suggested action for the risk mitigation and has even built eight committees (inter-agency groups; names and contact information also stated) that are each responsible for one of the eight risk areas and for the development of respective actions. Furthermore, the different actions have a timeline for their completion. Specifically to be commended is the fact that the Bolivia contingency plan mentions that WHO phases are global and not reflective of the situation in the country and that security responses need to be based on the situation analysis in the country itself. The only issue that could be included in the action matrix is the actual planning for business continuity (communications, IT etc.). While the contingency plan states that the critical position-holders will receive necessary resources to perform their functions while staying in the premises, no business continuity plan is mentioned. Furthermore, the business continuity should be tested through a simulation. . 1.6 Simulation exercise No Not documented. completed. A simulation exercise that considers medical aspects and business continuity may be considered. Indicator Yes / No Comment 1.7 Joint UN/national No Not documented. While a joint UN/national AHI plan is not avian influenza plan. considered a mandatory requirement, it might be useful to consider a joint plan.

Staff Health and Safety

2.1 Identification of local Yes health support facilities completed.

2.2 Assessment of local No It is very important that health facilities are not only health support identified, but also assessed regarding capacity and facilities completed. resources. The team should consider making a reference in the update of the contingency plan with a timeline.

2.3 Appropriate PPE No Individual procurement by agency is planned and the timeline states that PPE should be in place by December 2006.

2.4 Masks procured No Individual procurement by agency is planned and the timeline states that PPE should be in place by December 2006.

2.5 Oseltamivir procured No Individual procurement by agency is planned and the (sufficent for 30% of timeline states that PPE should be in place by December staff). 2006.

2.6 Antibiotics procured No Individual procurement by agency is planned and the (sufficient for 10% of timeline states that PPE should be in place by December staff). 2006.

2.7 Lead agency for No It is indicated in the plan that the individual agencies are procurement for responsible for the procurement of AHI related medical UNCT identified. items.

2.8 Staff provided with Yes The contingency plan states that three times per year staff information on members are updated on the AHI situation. Furthermore, it is keeping themselves planned to have a forum where staff members can pose safe and personal questions via email implemented by June 2006. It is preparedness. recommended to include the mentioned materials in the contingency plan. 2.9 Psychosocial support No The importance of psychosocial support for staff health and providers identified. security is often underestimated. Bolivia UNCT is requested to include this aspect in their contingency plan. Indicator Yes / No Comment 2.10 Tracing system/unit No Not documented. prepared and staff It is recommended to establish a system for tracing staff trained. members. This will involve close coordination between HR and security to track staff.

2.11 Security threat Yes Although security risks have been identified, the mitigation analysis prepared. activities have been included in the action plan. This is good. It is also evident that they have thought through the security issues related to shortages of anti-virals and possible implications for UN staff and dependents.

2.12 Staff contact system No Not documented. Presume it is part of the Security crisis established and tested. response plan. If so, consider providing annex to cover these issues (its better to have all the information in one document than in separate ones).

Business Continuity

3.1 Programmes Yes In the response action matrix the contingency plan states that prioritised, pandemic programmes that are critical and have to be continued during critical ones identified, a pandemic will be identified by 15 June 2006. It is and agreement on recommended to attach a list of these to the updated plan. those that can be suspended/scaled back.

3.2 Critical functions Yes In the response action matrix the contingency plan states that required to continue the critical functions that are necessary to maintain the these prioritised critical programmes will be identified by 15 June 2006. It is programmes and recommended to attach a list of these to the update of the activities identified. plan.

3.3 Critical staff identified, No While this issue is mentioned in the contingency plan, no including those that will distinction is made between critical position-holders that work from home, and have to stay in the premises and those that can perform their from office/facilities. critical function from home via telecommute. It is assumed Alternates identified. in the contingency plan that all critical position-holders have to stay in the premises. The team should include the possibility of critical position-holders to also work from home, allocate the necessary resources (laptops etc.) and also identify alternates. Please include a list of critical position- holders and alternates, differentiating between those staying in the premises and those working from home in the contingency plan. Indicator Yes / No Comment 3.4 Checklists for phase 4, No Not documented. 5, 6 actions and The triggers based on WHO pandemic alert phases need to responsibilities recognize that WHO phases are global and not reflective of drafted, together with the situation in any one country. trigger events. The key triggers for a country response will be based on where the human-to-human transmission is occurring. This will apply at all phases, as even in phase 6 (pandemic), initially not all countries will be affected.

UN actions are likely to be affected by the assessment of the Pandemic Alert Phase by national authorities, and these need to be identified/discussed. This will in turn help the UN to plan when the virus starts spreading human-to-human - whether in the country, a close neighbour, or far away.

3.5 Requirements assessed Yes/No The requirements assessed in the contingency plan only and supplies arranged include PPE kits and other medical items. The team should for critical staff in also include other resources that are necessary for critical offices/facilities – six position-holders to be able to stay in the premises, such as week period. accommodation and food supplies.

3.6 Staff to ensure access No A reference is made in the contingency plan to annex 8 in the at home for food and UNMS Guidelines that includes a list of supplies for a 6 water for six week week period. period.

3.7 For those working No Not documented. The contingency plan needs to include the from home ensure that option that critical position-holders can also perform their they are able to critical function from home. perform critical functions i.e. phone, internet, radios, generators etc – geared for six weeks.

3.8 HR and Admin No Partly documented. Needs further elaboration. Reference officers clear about guidance can be found on the web link policies and actions www.influenza.undg.org regarding travel, leave, medical, pay, tracing unit etc.

Communications (UNCT) Indicator Yes / No Comment

4.1 UN System internal Yes Chapter 8 of the Contingency Plan states that an inter-agency communication committee was built to develop an AHI communication strategy agreed. strategy.

4.2 Strategy for external No Not documented. Although the Contingency Plan seems to communications with be aware of the issue, no clear reference is made to external relevant stakeholders. communications.

Budget

5.1 Budget for staff safety Yes The contingency plan includes a budget plan for the UNCT and security actions (Annex E). from medical guidelines for all agencies.

5.2 Budget for programme No Not documented. The plan for programme should include continuity and some indicative costs. additional programme activities during a pandemic.

Support for National Preparedness and Response

6.1 UN been requested to No It is not stated clearly whether the UN has been requested to provide support for the assist the local Government. However the plan infers that national preparedness the UNCT could assist the government with the development and response planning. of the national preparedness plan.

6.2 Identification of No Not documented. components of national response and preparedness plans that align with agency mandates and operational capacities. Indicator Yes / No Comment 6.3 Plan and prepare for No Not documented. The team should consider including this additional or extended aspect in the update of their Contingency Plan. operations, programmes and support if required and capacity exists.

General Comments

The plan should be highly commended on its efforts in the overall AHI Contingency Planning process. The plan reflects a joint effort between UN agencies and the risks analysis and the action response matrix are excellent examples of thorough work. The identified key risks are directly aligned with a risk mitigation strategy and respective planned actions. The UNCT in Bolivia decided to establish different inter-agency committees that are each responsible for each risk areas identified in the risk analysis. Timelines are given for each planned action. This is very well done!

Furthermore, the plan distinguishes between the global WHO pandemic phases and the situation in the country and states that security analysis should take this into account.

Overall, it appears that the security department is working closely with other departments to ensure staff safety and security, as well as business continuity.

There are some areas where the team should consider to broadening the plan including:

 Include scenario-building  Take into account the three different models (extended WHO phase 3; slow onset; rapid onset) in the risk analysis  Plan for the development of additional AHI pandemic related programmes  Differentiate between critical position-holders that have to stay in the premises and those that can perform their critical function from home; provide respective resources and test functionality of telecommute  Including the HR administrative guidelines as a reference  Linking its own planning, where possible, with the national authorities plan  Implementing and testing a business continuity and maintenance of operations plan  Assessing for national planning what services are likely to be affected first as a result of a worst-case scenario and what services will continue. In addition, chain of command issues should be considered if key people are sick/ absent.

Overall, this plan is a very good and includes some excellent matrix formats with good analysis.