Strategic Plan 2013-2018. Disaster Risk Reduction and Response

A more resilient health sector in the Americas

targeting efficient and innovative approaches

Strategic Plan 2013 – 2018 Disaster Risk Reduction and Response A more resilient health sector in the Americas Targeting efficient and innovative approaches

Strategic Plan 2013 – 2018 Disaster Risk Reduction and Response

Our vision:

“A health sector with adequate, nationally-led and sustained capacity to ensure that member states are resilient enough to protect the physical, mental and social wellbeing of their communities and rapidly recover from disasters.”

A more resilient health sector in the Americas – Targeting efficient and innovative approaches

Contents Foreword...... iii Executive Summary ...... v 1 . Introduction...... 1 2 . Situation Analysis...... 3 2 .1 Trends and Overall Risk in an unequal Western Hemisphere...... 4 2 .2 Changing Profile of Hazards and Vulnerability in the Region...... 5 2 .3 Health Sector Response to Disasters...... 7 2 .4 Moving Forward from the Strategic Plan 2008 – 2012: Key Achievements and Lessons Learned...... 10 3 . Strategic Framework ...... 14 3 .1 Vision ...... 14 3 .2 Strategic Objectives ...... 14 3 .3 Cross-Cutting Priorities...... 16 4 . Expected Results and Approaches ...... 19 4 .1 Expected Results...... 19 4 .2 Strategic Approaches...... 26 5 . Structure and Management ...... 29 5 .1 PAHO’s Institutional Commitment to Manage Disasters ...... 29 5 .2 PED Program Staffing and Structure...... 30 5 .3 Partnerships for Health Preparedness ...... 30 6 . Monitoring and Evaluation...... 31 6 .1 Internal Monitoring ...... 31 6 .2 External evaluations...... 31 7 . Assumptions and Risks...... 32 7 .1 Assumptions ...... 32 7 .2 Risks...... 32 Annex 1 - PAHO – PED Strategic Framework...... 34 Annex 2 - PAHO/PED Organizational Chart 2012 ...... 35 Acronyms...... 36

A more resilient health sector in the Americas – Targeting efficient and innovative approaches

Foreword

The Pan American Health Organization (PAHO), Regional Office for the Americas of the World Health Organization, established the Program on Emergency Preparedness and Disaster Relief (PED), at the request of Member States in 1976, to define the Organization’s disaster policy, to formulate a plan of action for various types of disasters and to support countries to strengthen their capacity to prepare and respond to natural disasters through the efficient use of existing resources. Subsequent Resolutions expanded the mandate of the Program to include support for the coordination of international assistance and disaster risk reduction in the health sector.

Pandemic influenza A(H1N1) 2009 and the 2010 earthquake in Haiti led to the largest and most challenging emergency response operations since the this Program was established. Due to their magnitude, these challenges were faced not only by the affected countries and those providing support to the response, but by the entire international community.

In the course of consultation meetings and lessons learned exercises carried out in the Re- gion, participants acknowledged that, even though the Region had made important progress in the field of disaster management, new approaches were needed to ensure that the health sector’s capacity was sufficiently up-to-date to assume the disaster management responsibilities the populations expects and requires.

There has been a steady increase in the number of actors working in risk reduction and disaster relief, many of whom are involved in the health sector. Among this multitude of actors, PAHO must emerge as the normative leader of the health sector in Latin America and the Caribbean. More than ever, PAHO must work with its Member States to identify and address the needs that other organizations cannot meet. Occupying a place at the crossroads between highly advanced and fragile states, Latin America and the Caribbean is an ideal testing ground for new initiatives. PAHO must not only clearly demonstrate its added value, but also must reach out to other organizations, as part of the U.N. Humanitarian Reform and among the increasing global network of multi-sectorial actors in disaster risk management.

Considering the current environment, this Strategic Plan is based on a renewed view of cooperation in disaster risk reduction. It was developed jointly with PAHO’s Member States and partners in order to jointly achieve the goal of a more resilient health sector in the Americas.

iii iv A more resilient health sector in the Americas – Targeting efficient and innovative approaches

Executive Summary a. The Latin American and Caribbean region is often considered a region of middle-income countries, yet it has one of the highest ratios of income inequality in the world, with pockets of highly vulnerable populations. Over the last decades, it has been the scene of some of the deadliest disasters, including the Haiti earthquake and cholera epidemic, and was the epicentre of a new type of crisis with the emergence of the new A(H1N1) virus and the first pandemic under the International Health Regulations. The Western Hemi- sphere is a mosaic of vulnerable and non-vulnerable populations living in close proximi- ty. These characteristics make it an ideal region in which to implement new disaster risk reduction approaches and foster South-South cooperation. b. The present strategic plan will govern the Pan American Health Organization’s disaster risk management and response work for the period 2013-2018. It is in accordance with the Organization’s broader strategic documents, approved by its Governing Bodies and is aligned with the priorities of the World Health Organization (WHO), approved by the World Health Assembly as part of the WHO reform. It sets the overall objectives and expected results of PAHO’s work in the field of disaster management. c. This strategic document is a product of extensive consultations with Member States and other stakeholders, including, but not limited to: Disaster Programs in the Ministries of Health; National Civil Protection Systems, UN programs and agencies; international financial institutions; international NGOs; the Red Cross Movement; PAHO/WHO Disaster Focal Points and other senior staff, independent international disaster management experts; , traditional and emerging donors and other regional and sub-regional institutions. d. This document will serve as a roadmap for the Organization’s work in disaster management, increasing transparency and facilitating better understanding of the programmatic objectives and expected results to be achieved. It will also serve as the basis for the development of PAHO’s biennial work plans, which include detailed information on the direct activities to be implemented by the Organization and its Member States. e. The ultimate goal of PAHO’s work in disaster management is to ensure health security by reducing the morbidity and mortality following any type of emergency. To achieve this goal, PAHO will work towards increasing the resilience of the health sector in order to reduce the health consequences of emergencies, disasters and crises and ease their social and economic impact.

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f. To achieve this objective, PAHO will support the development of human resources and networks; strengthen the national leadership roles of the Ministry of Health Disaster Programs; promote the adoption of benchmarks to demonstrate institutional commitment to disaster preparedness; further develop disaster preparedness partnerships with sub-regional intergovernmental bodies and other entities and organizations; enforce WHO’s Emergency Response Framework and strengthen PAHO’s response capacity.

g. Clear differences exist between the efforts required to strengthen the Member States’ disaster resilience and preparedness and those required for readiness and humanitarian response. Therefore, the present strategy has been separated into three complementary areas of work. One area focuses on humanitarian activities and encompasses health sector readiness and response. A second area focuses on risk reduction, including the development of health disaster programs, preparedness, and activities geared toward safe hospitals and other risk reduction activities. The third area targets PAHO’s own surge capacity in disaster situations and the implementation of the Health Cluster.

h. The strategic objectives and expected results (ER) of this strategic plan are: i. Improved capacity of Member States to provide a timely and appropriate response to disasters, complex emergencies and other crises. ER 1: A health sector ready to respond to emergencies and disasters. ER 2: Effective implementation of response operations. ER 3: Prompt recovery and rehabilitation needs assessments of national health systems affected by disasters. ii. Enhanced capacity of National Health Systems on Emergency Preparedness and Disaster Risk Reduction. ER 1: National health disaster programs functioning according to established criteria. ER 2: Health services resilient and functioning after a disaster. iii. Increased effectiveness of PAHO and the Health Cluster in responding to disasters. ER 1: Enhanced capacity of PAHO to support Member States in disasters. ER 2: Enhanced capacity of the Health Cluster to respond to disasters.

i. This strategic plan incorporates PAHO’s cross-cutting priorities. Mainstreamed across all activities are important aspects of: 1) gender; 2) ethnicity; 3) human rights, 4) primary health care, 5) health promotion, and 6) social protection in health.

j. The final sections of this document cover implementation mechanisms; funding; risks and assumptions; and performance monitoring and assessment.

vi A more resilient health sector in the Americas – Targeting efficient and innovative approaches

Introduction

The present strategy will govern the work of the Pan American Health Organization (PAHO) in disaster management for the period 2013-2018. It is in line with PAHO’s current organization-wide Strategic Plan (2007-2013) and with the new Strategic Plan (2014-2019) that is being finalized, as well as with the World Health Organization’s (WHO) new priorities, approved by the World Health Assembly as part of the WHO reform. It is also in line with UN guidelines, the IASC transformative agenda, regional agreements and the work plans of intergovernmental sub-regional bodies.

This strategic document was prepared after careful consideration of the advances made by Member States in disaster management and the remaining gaps Most Latin American and Carib- as well as the need to better protect the lives and health of the population in emergency situations and to ensure quick recovery of communities following bean countries now have the catastrophes. The document also addresses the need to improve and strengthen capacity to respond to minor and the Organization’s response capacity to better support the countries when exter- moderate events that affect the nal assistance is needed. health of their population with In order to reflect the needs, priorities, interests, and views of the Member a single-hazard approach and States and stakeholders at various levels, and focus specifically on PAHO’s added value, participatory and broad consultative processes were used in developing without international support . The this 2013-2018 strategy. They included: challenge arises when respond- • A Technical Advisory Meeting on the Future of Disaster Management ing to large and/or multi-hazard in the Health Sector in Latin America and the Caribbean, in Bogota, emergencies with overwhelming Colombia (April 2011), in which senior multidisciplinary disaster external cooperation . experts from Ministries of Health and other national authorities, representatives from international financial institutions, major donor partners, UN agencies, and independent experts participated; and • A Health Disaster Coordinators Meeting held in Mexico City, Mexico, in October 2011, in which Health Disaster Coordinators from the Ministries of Health throughout the Region, along with disaster focal points from the PAHO/WHO country offices, discussed priorities. Its conclusions served as an outline for future collaboration in disaster management.

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This plan is consistent with the principle that each Member State has the primary responsibility to serve the health needs of its population before, during and after a disaster, and that the Organization and its partners will work towards enhancing this capacity. At the same time, this strategy intends to put in place the mechanisms needed to ensure that, when affected countries require external support, the Organization is ready and able to fulfil its responsibility of supporting their requests and coordinating international health assistance.

During the implementation of the previous Strategic Plan, the Region experienced demanding and unprecedented response operations. The present Strategic Plan therefore incorporates the lessons learned from different disasters, most importantly the regional response to the pandemic influenza A(H1N1) 2009 and the health response to the earthquake in Haiti in 2010, and the subsequent cholera epidemic. In order to better understand these two com- pletely different disasters – the latter encompassing a massive sudden-onset disaster affecting a large but limited geographical area and the former a progressive epidemic with an unknown potential area of influence and level of lethality that required the first Region-wide response operation and the involvement of all Member States – the Organization requested an independent evaluation of the response to the pandemic influenza and coordinated a lessons learned exercise focusing on the first three months of the health response to the Haiti earthquake. The recommendations from both documents, when relevant and feasible to implement, have been incorporated in this Strategic Plan.

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2. Situation Analysis

The dramatic consequences of the 2010 Haiti earthquake1 – which killed about 10% of the population of Port-au-Prince, crippled all major infrastructures of the capital city and drastical- ly reduced the government’s capacity – and the world-wide impact of the influenza A(H1N1) pandemic that began in the Americas in 2009, significantly challenged previously established response and recovery approaches. These events, as well as other major catastrophes such as the 2011 tsunami and radio-nuclear emergency in Japan and superstorm Sandy in 2012, required an in-depth redefinition of the health sector’s ability to ensure that the immediate health needs of the affected populations are met during and after The new Knowledge Center a disaster and that progress in improving health indicators in the Western Hemi- sphere is not set back. for Public Health and Disasters provides a one-stop shop for The Western Hemisphere is a region of sharp contrast, in which statistics and averages mask serious discrepancies. Yet, the combination of acute needs, information on all aspects of available local expertise and overall stability and governability make the Latin health disaster management . It American and Caribbean (LAC) Region an ideal ground for the development is an innovative first step towards and successful implementation of innovative approaches—a place where carefully-crafted initiatives can bring about change and progress to both this hemi- integrating contributions from a sphere and the rest of the world. The Safe Hospitals Initiative, for instance, wide scope of known and previ- was first developed in the Americas and is now being implemented in many ously undiscovered experts . countries of Africa, Europe, Western Pacific and South East Asia, while the Hospital Safety Index (HSI) has been applied worldwide to assess the safety of existing hospitals and prioritize improvement interventions. Additionally, in 2012, WHO representatives from around the world met in Turkey to review the hospital safety evaluation instruments used in the different continents and agreed to take the HSI as a basis for a global instrument that can be adapted to different realities. Some regions of the world adopted the HSI as such, while others adapted it to their own context.

PAHO’s institutional response to emergencies and disasters is another example of the ground-breaking character of LAC initiatives, as it served as the basis for the development of the WHO Emergency Response Framework. Similarly, the Knowledge Center on Public Health and Disasters, a recently-launched information portal developed by PAHO was presented at a 2012 global consultation meeting. Participants expressed a keen interest in replicating this initiative in other regions.

1. Health response to the earthquake in Haiti - January 2010: http://bit.ly/1bH4qQr.

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2.1 Trends and Overall Risk in a Region of Inequalities

In spite of the solid economic performance of the Latin American and Caribbean Region, the Inter-American Development Bank (IDB) reports that LAC countries face potential crip- pling economic and social costs from natural disasters, and highlights the need to do more to reduce risks and prepare to respond to eventual catastrophes.2 Earthquakes, floods and storms caused $34 billion in economic losses in 2000 - 2009 in the Region. In 2010 alone, the total losses from disasters exceeded US$49 billion, including US$7.8 billion due to the Haiti earthquake – 20% above the country’s GDP figure for 2009 – and US$30 billion as a result of the earthquake in Chile. In 2012, a new record was reached with economic losses for the year conservatively estimated in the region of US $138 billion, with losses from Super Storm Sandy alone at an estimated US$ 50 billion. More generally, the IDB’s new edition of Indicators of Disaster Risk and Risk Management3 indicates potentially significant economic losses for 17 countries of the LAC Region in the event of a natural disaster, based on how well governments can anticipate and manage risks.4

Latin America is one of the most unequal regions in the world and a recent study reveals that the gap is widening.5 Income inequality in the LAC Region, as measured by the Gini coef- ficient, is 65% higher than in high-income countries, 36% higher than the income inequality observed in East Asian countries, and 18% higher than the level reported for sub-Saharan Africa. These sharp socio-economic and health inequalities result in increased vulnerability of some segments of the population. People living in poverty and without access to health care are notably more exposed to the effects of disasters and are more likely to see their health de- teriorate as a result of these events.

The threat of a financial crisis or a rapid escalation of food prices are other major concerns for the health of the population of LAC, as these events trigger social and political turmoil and put lives at risk. In Haiti, for instance, increases in food prices in 2008 led to civil unrest and extreme violence with casualties and, consequently, to the fall of the government.6 In Guatemala, severe drought in 2009 and 2010 resulted in a rise in the number of cases of acute malnutrition to unexpected levels.

Latin America and the Caribbean already rank among the most violent regions of the world. Some LAC countries experience on-going violence, which has led to the displacement of an estimated 5.4 million people throughout the Region. There is increasing concern that trends in violence could escalate during disasters, further stressing limited resources and weak-

2. IDB (2010). Natural Disaster Risk remains high in Latin America and the Caribbean. http://www.iadb.org/en/news/webstories/2010-09-30/ idb-natural-disaster-risks-in-latin-america-and-caribbean,8017.html. 3. IDB (2010). Indicators of Disaster Risk and Risk Management – Program for Latin America and the Caribbean –Summary Report. IDB- TN-169 September 2010 (http://bit.ly/IROMJ0). 4. For example, if Peru was to be hit today by an earthquake, similar to the one that hit Chile recently, it could suffer an economic losses to an extent of $15.8 billion. However the economic loss for a similar earthquake in Mexico would only be $5.2 billion, $3.8 billion in Colombia and $3.5 billion in Ecuador. 5. Gray Molina, G. and E. Yañez (2009) “The Dynamics of Inequality in the Best and Worst of Times, Bolivia 1997 - 2007”, Research for Public Policy, Inclusive Development, ID-16-2009, RBLAC-UNDP, New York. 6. Report for the Secretary-General of the United Nations - Haiti: From Natural Catastrophe to Economic Security – Paul Colliers, Department of Economics, Oxford University, January 2009.

4 2 . Situation Analysis

ening the response and recovery capacity as seen in some part of Guatemala, El Salvador, Colombia, Venezuela and Haiti. The health sector, therefore, plays a The experiences from previous key role in monitoring, anticipating and mitigating the health consequences emergencies show that when of such crises, which must be taken into account in disaster management and fewer and more specialized actors response planning. get involved in the response oper- Beyond the socio-economic determinants that affect the impact of disasters ations, it makes for a better orga- on the health of the LAC population, changes at the international level are creating new challenges that countries must face when responding to crises. The nized and more effective response . increased number and capacity of international humanitarian actors as compared A mechanism is needed to ensure to the relatively lesser capacity of some developing countries is one such challenge, as it threatens the countries’ capacity to absorb and properly coordinate external a more effective participation of assistance. For instance, the presence of 400 health partners in one Cluster in the actors in the Health Cluster . aftermath of the Haiti earthquake or the decision by the headquarters of many international agencies to disregard pre-established regional agreements highlighted the downside of overwhelming humanitarian aid in unprepared countries. To ensure the quality, efficiency and effectiveness of a major international response, Member States, as well as PAHO, must be better prepared.

At the same time, there has been a substantial increase in knowledge about disaster situations and faster access to information through a wide variety of communication technologies and social media, even in the most remote communities of both rich and poor countries. This reality has significantly increased expectations of a rapid and life-saving response to disasters, and is another incentive to ensuring that the nationally-led health sector is resilient enough to protect the physical, mental and social well-being of its population and allow a rapid post-disaster recovery.

2.2 Changing Profile of Hazards and Vulnerability in the Region

Pandemic and Epidemic Threats in the Region The pandemic influenza A(H1N1) 2009 that was first reported in late April of that year had a significant impact on the entire Region; all 357 Member States in the Americas reported con- firmed cases. This pandemic created an unprecedented crisis and required an emergency response from all Member States, PAHO and the international community at large. Thanks to pandemic and disaster response planning and simulation exercises that PAHO developed and held in 2008, with the Organization’s principal donors, the health sector was better prepared to face this threat. The Organization was also able to immediately mobilize and deploy human and organizational resources, first to Mexico and later to many other countries, under very demanding and time-sensitive conditions.

7. PAHO has 35 Member States in the Americas and three Participating States (France, the Netherlands, and the United Kingdom).

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Once the emergency phase had ended, the regional and institutional response was assessed by convening an international technical meeting and an internal lesson learned meeting as well as conducting an external evaluation.8 These exchanges highlighted the fact that several factors were key to ensuring an effective response: proper coordination of a variety of stakeholders and an on-going exchange of information through reporting, teleconferences and web-based video- conferencing. The external evaluation recommended taking steps to improve PAHO’s and the Member States’ surge capacity for response and to better respond to media requests for information. The threat of another pandemic is real and the Region may still not be sufficiently prepared.

More generally, there has been a significant change in how the public perceives other potential epidemics, such as dengue, which is increasingly being seen as a threat to human security and the economy. This reinforces the need to enhance the countries’ capacity to respond to any public health crisis.

Technological Hazards Over the past five years, PAHO has While most countries have made great strides in facing natural hazards, developed a great deal of technical the health sector in Latin America and the Caribbean is ill-prepared to face material and guidelines on a variety large-scale chemical, radiological or other technological disasters. Technological disasters constitute a significant potential risk to countries that have reached a of critical topics . We will continue to certain level of industrial development, but where little has been done in terms develop resources to improve the ca- of regulation and/or prevention. pacity of the health sector to prepare Exposure to toxic chemicals is a serious public health issue in the Region, for and respond to adverse events, particularly among seasonal migrant populations. WHO estimates that per cap- ita exposure to pesticides is twice as high in LAC as compared to the global including climate change, pandemics average, and that exposure may increase considerably following floods or earth- and technological risks . quakes, due to chemical spills, leakage of radioactive materials or water contamination with pesticides. PAHO will develop guidelines and technical material to help LAC improve its level of preparedness to chemical, radiological and other technological risks.

Climate Change and Extreme Events Scientific evidence has demonstrated that global warming is, in fact, occurring and that it is affecting the environment worldwide. Risks associated with climate change have a serious direct and indirect impact on public health in the form of: increased number of injuries and deaths related to extreme heat and cold weather events; outbreaks of epidemics; malnutrition; food and water contamination, among others. Major meteorological changes have the potential to significantly impact political, economic, and social stability throughout the world, particularly Small Island Developing States and impoverished coastal areas in many countries.

8. The publicly accessible report of the international technical meeting is available at: http://bit.ly/1d9Xaxa.

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Increases in the frequency and intensity of storms, heat and drought, and changes in rainfall patterns compel the health sector to modify its risk analysis and emergency response planning. For the small islands, such as those in the Caribbean, and low-lying coastal areas in several Latin American countries, a rise in sea level or major erosion from flooding threaten infrastructure, which may cause major population movements and disrupt socio-economic stability in the area.

Climate extremes may also disrupt health systems, for example, by leading to damage to health infrastructure or roads. The carbon footprint of the health sector is also very large; however green criteria are not always compatible with safety requirements. It is of paramount importance to ensure that health infrastructure is safe from disasters while, at the same time, has a reduced environmental footprint. To help address this issue, PAHO has launched the SMART Hospital Initiative, which combines safety, through a risk reduction strategy, with an environmentally-friendly or ‘green’ approach.

2.3 Health Sector Response to Disasters

The primary objective of a national disaster management system is to ensure that all sectors and components of a society are disaster resilient. This requires Although disaster management that countries guarantee the continuous operation of essential services and crit- functions are ingrained within the ical infrastructure that save lives and ensure the well-being of the population in Ministries of Health of all Member emergency and disaster situations. States, capabilities vary from country The health sector is the principal entity responsible for safeguarding the to country and some still require sus- life and health of individuals. Its activities are designed to prevent and control diseases and provide care for the ill, according to evidence-based practices. The tained support from PAHO in terms Essential Public Health Functions (EPHF) is the set of actions defined by the of advocacy and human resources Ministers of Health of the Americas that must be performed in order to ensure and improve the health of populations. One of these functions targets the “re- capacity building . duction of the impact of emergencies and disasters on health”. Along with other sectors, the health sector must therefore have a disaster risk reduction policy with established objectives and strategies to ensure the achievement of this essential public health function.

While disaster reduction and emergency response are primarily the responsibility of the countries, PAHO supports national efforts to improve disaster preparedness and response capacity by providing technical cooperation before, during and after disasters. At the international level, PAHO’s role is to ensure that the priorities of the health sectors in Member States are compatible with the UN Humanitarian Framework and aligned with OCHA and ISDR guidelines and procedures.

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Capacity to Respond It has become more and more common for LAC countries to manage the response to a minor emergency or small-scale disaster with their own resources (human and others), without seeking aid from the international community.9 However, countries will continue to require international aid and PAHO’s support for larger and medium-size disasters.10 Despite efforts to provide disaster management training to the Regions’ human assets over the past years, there continues to be insufficient human and institutional resources to respond to these events— including emerging threats such as chemical or radio-nuclear—at a level that conforms to national and international expectations.

While some countries have advanced in the development of independent and operational health disaster programs, maintaining these programs, with credible leadership and the ability to coordinate at the national level, is an on-going challenge. This challenge is compounded by the high turnover and migration of trained health personnel in many LAC countries and the limited budgetary capacity of some governments. Existing programs must be strengthened and new ones developed in the countries that lag behind.

While PAHO’s response to the 2009 influenza A(H1N1) pandemic and the 2010 Haiti earthquake was recognized and appreciated by all stakeholders, PAHO’s own ability to provide a quick and efficient response was challenged and stretched to the limit. It was clear that this effort could not have been sustained much longer and the coordination shortcomings at headquarters could have been detrimental in a more severe and demanding pandemic and/or disaster. With countries’ increasing capacity to deal with catastrophes, there is a growing demand for a different level of technical cooperation with increased specificity to countries’ particular realities, both at strategic and operational levels. PAHO must therefore focus on strengthening its own capacity to assist countries in preparing and responding to disasters according to this new reality.

Ability to Coordinate and Provide Up to-date Health Information Despite the significant advances in information management, many coun- The PAHO Emergency Operations tries in the region lag behind in creating and empowering health sector teams Center (EOC), inaugurated in June to collect, asses, and make health information available in the first 48 hours of 2012, aims to improve the delivery of an emergency. cooperation during disaster response The task of collecting post-disaster data (including gender disaggregated data), operations . Included in the EOC’s analysing and interpreting it in operational terms and transforming it into action for disaster response is complex and is not always carried out properly following mandate is the training of PAHO a major event. The health sector generally relies on health situation rooms for the senior staff, staging of simulation on-going collection and analysis of information on epidemiology, communicable exercises, and increased interaction diseases and other public health data. Yet, these situation rooms are not always link with emergency operations centres (EOCs), which are the coordination hub for with other WHO regions .

9. This was the case in the aftermath of several floods in Latin America (e.g. flooding in Ecuador), drought and volcanic eruptions (Geleras and Nevado de Huila volcanoes in Colombia). 10. In addition to the earthquake in Haiti in January 2010 which required exceptional international support, due to its magnitude, there were other mid-size events, such as Tropical Storm Agatha in Central America which required the intervention of the international community.

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response actions. In fact, some countries are actually limited in their capacity to organize and run EOCs.

PAHO must also strengthen the capacity of its own EOC at headquarters and sub-regional level to analyse information and coordinate operational needs.

Vulnerability of Health Infrastructure Sixty-seven per cent of the health facilities in the Region are located in di- The Plan of Action on Safe Hospi- saster-prone areas. Every hospital that is unable to function means that 200,000 people on average are without health care. The loss of emergency services during tals 2010 – 2015, adopted by the disasters significantly reduces the potential for saving lives. Between 2000-2009, 50th Directing Council of the Pan more than 45 million people in the Americas were without health care for months American Health Organization in and sometimes years because health facilities were damaged by a disaster. Yet there are encouraging signs. The commitment of the Member States to invest in health 2010, seeks to facilitate Member sector disaster mitigation has increased significantly in recent years, thanks pri- States’ adoption of “Hospitals Safe marily to the success of the Safe Hospitals Initiative and the application of the Hospital Safety Index11 in many countries. from Disasters’ as a national risk reduction policy and their setting This commitment is also reflected at the highest levels of the Organiza- tion. In 2009, PAHO’s Directing Council approved the final report of the of the goal that all new hospitals roundtable “Safe Hospitals: A Goal within Our Reach.” This document rec- are built with a level of protection ommends that the countries prepare work plans to reach the goal of hospitals that better guarantees that they safe from disaster by 2015. will remain functional in disaster With PAHO’s support, during the period of the 2008-2012 Strategic Plan, 28 situations . countries and territories in the Americas applied the Hospital Safety Index and developed mitigation programs within their Ministries of Health. However, the physical and functional vulnerability of their health systems remains an overall challenge. Members States often have neither the capacity nor resources to implement recommendations to improve safety, especially those requiring structural investments. The result is that the availability of health services varies widely from country to country following a disaster.12 While increasing the number of health facilities that apply the Hospital Safety Index is an important first step, what is more important is the need to work with Member States to ensure that, once vulnerabilities are identified, necessary measures are taken to improve the resilience of the health facilities.

11. The Hospital Safety Index is a diagnostic tool that provides a snapshot of the probability that a hospital or health facility will continue to function in emergency situations, based on structural, nonstructural and functional factors, including the environment and the health services network to which it belongs. By determining a hospital’s Safety Index or score, countries and decision makers will have an overall idea of its ability to respond to major emergencies and disasters. The Hospital Safety Index does not replace costly and detailed vulnerability studies. However, because it is relatively inexpensive and easy to apply, it is an important first step toward prioritizing a country’s investments in hospital safety. 12. For example, in the city of Port-au-Prince, most of the health services (including the University General Hospital) were non-operational following the earthquake. In Pisco, Peru, more than 97% of the hospital beds were destroyed in the August 2007 earthquake. Field hospitals had to be installed all across the affected areas in Haiti and a temporary module had to be erected in Pisco, although these were not the optimum solution. On the other hand, Chile’s health infrastructure withstood the February 2010 earthquake relatively well, with most services continuing or re-starting shortly after the quake. It is worth noting that field hospitals were still provided. Also, all health structures in Belize continued to operate during and after hurricane Richard in October 2010.

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2.4 Moving Forward from the Strategic Plan 2008 – 2012: Key Achievements and Lessons Learned

During the past five years, PAHO supported its Member States to improve the disaster preparedness of their health sector, better protect health services from the impact of hazardous events, respond more efficiently and effectively to disasters and forge stronger strategic partnerships at national, sub-regional and global levels. A selection of some key achievements and lessons learned are presented below:

• Most Latin American and Caribbean countries now have the capacity to respond to minor and moderate events that affect the health of their population with a single-hazard approach and without international support. The challenge arises when responding to large and/or multi-hazard emergencies with overwhelming external cooperation. • The concept of a health disaster program is finally fully ingrained in all Member States as a requirement for proper emergency planning and response. All LAC countries have established disaster management functions within their Ministry of Health. While 27 of them have formally created a disaster program, only 15 are staffed full-time and have a dedicated budget. This is another illustration of how the situation varies from country to country and why it requires sustained support from PAHO in terms of advocacy and human resources capacity building. • Over the past five years, PAHO has developed a great deal of technical material and guidelines on a variety of critical topics. These have been broadly adopted and used by Member States as well as by countries in other regions of the world. The development of a simple tool, such as the widely-adopted Hospital Safety Index, has demonstrated that low-cost, practical tools can enhance participation and serve as a stimulus to identify priorities and The use of social media and switch from theory to practice. Technical resources and guidelines will continue to need to other internet based com- be developed to assist Member States in taking into account the changing environments affecting the health of LAC populations and the capacity of the health sector to respond to munication channels will events, including climate change, pandemics and technological risks. increase PAHO’s capacity • PAHO also developed a Health Sector Self-Assessment Tool to carry out a comprehen- to reach out to individuals sive assessment of key aspects of disaster risk management in the health sector (notably as well as to benefit from mitigation and preparedness). This innovative instrument allows countries themselves all available sources of to measure the overall level of preparedness of the health sector. Since 2009, 16 coun- information. tries have used this tool to set priorities and fill gaps in risk management. The chal- ISO 64 lenge that remains is to measure the overall impact on the countries’ level of prepared- 26 ness, ideally, using commonly-agreed-upon criteria. • The disaster management technical materials and publications developed by PAHO have been integrated into a new Knowledge Center for Public Health and Disasters (an online learning portal), launched in 2012. This new site provides a one-stop shop where users can access practical information and test their knowledge on all aspects of health disaster management. This Knowledge Center will require continuous revisions and improvements, both in its design and technical content, but is an important first step toward introducing a new way of gathering and integrating contributions from a 26A 26 wider scope of known and previously-unknown experts.

10 2 . Situation Analysis

• PAHO has succeeded in bringing the countries of the Region to consensus on the identification of two meaningful indicators to assess progress of the health sector within the Hyogo Framework for Action. This has permitted efforts to focus on achieving a unique, visible and measurable result: ensuring the safety of health facilities, by implementing the Regional Plan of Action on Safe Hospitals, 2010-2015, as approved by the Region’s Ministers of Health. Almost all LAC countries have incorporated a disaster risk reduction approach in their health sector’s priorities and 16 of them have formally established a safe hospitals program. Despite this progress, ensuring that all new health facilities are safe from disasters and improving the safety of existing ones, so they remain functioning after a disaster, remains a major challenge. • The Hospital Safety Index, developed by PAHO to assess the probability of whether a health facility will remain functioning in emergency situations, was broadly and successfully applied in the Region. The development and use of this tool has enabled countries to transition from a purely qualitative approach to a semi-quantitative Index or score that provides national authorities with an overall vision of the level of safety of their health services, in order to prioritize interventions and update health disaster response plans. Thirty-one countries and territories in Latin America and the Caribbean are applying the Hospital Safety Index and more than 3,000 health facilities have been assessed. In more than 400 health facilities, the recommended actions and works to improve resilience were undertaken. The challenge is not only to assign and implement priorities but also to convey them to the financial sector and higher political/decision levels.

13. The World Health Organization embraced this policy in preparing its Emergency Response Framework.

The Hospital Safety Index, developed by PAHO to assess the probability of whether a health facility will remain functioning in emergency situations, was broadly and successfully applied in the Region.

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• Over the years, the countries of the LAC Region have adopted and used a Logistics Support System/Supply Management System (LSS/SUMA), developed by PAHO, to manage humanitarian health supplies during emergency response. National authorities are also using this system in the day-to-day management of health supplies in ware- houses. LSS/SUMA is also being used beyond the Americas in countries such as Libya, Angola, Somalia, Cambodia, Turkey, and Pakistan, to facilitate proper and efficient use of resources, encourage transparency in the management of supplies, and control and rotate stocks of medicines, to avoid losses due to expiration. Despite being well known and accepted among disaster professionals, the system is still implemented on an ad- hoc basis. To improve the transparent management of health humanitarian assistance in the future, PAHO will need to provide limited but sustained support to the health sector in the Region to ensure a broader and more systematic use of this strategic tool. • Improving PAHO’s Regional Health Response Team was an important area of work during the last five-year period. The Team—which includes specialized sub-teams for -ep idemiological surveillance, alert and response, emergency logistics, water and sanitation, mental health and risk communications, among others—has been mobilized to respond to and support Member States in disasters, when the situation warrants. However, one of the greatest challenges is to maintain a team of experts with up-to-date knowledge and skills, while coping with a high level of rotation of the members and/or their unavailable for immediate deployment. During the upcoming five years, PAHO will continue to keep this group of experts trained and engaged. The Organization will also foster stronger alliances and partnerships with institutions and networks that are able to bolster the Team, making additional human resources available when needed. • In June 2012, PAHO inaugurated its new Emergency Operations Center and adopted a new policy outlining the Organization’s institutional response to emergencies and disasters. It aims to improve the delivery of cooperation during response operations and incorporates the Incident Management System model and definition of three levels of activation. The next steps will be to operationalize and fully implement this new policy, which will include disaster management training for PAHO’s senior staff, simulation exercises, and increased interaction with other WHO regions. • Experiences from previous major emergency response have stressed the fact that, at times, the number of stakeholders involved in decision-making processes for response operations should be reduced in order to increase focus and produce more effective results. This does not imply exclusion from making a contribution, but rather a stream- lining of the decision making processes. A good example is the contrast between the uncoordinated and disorganized first response to the Haiti earthquake and the better organized and effective response to cholera made possible by the involvement of fewer and more specialized actors. This allowed for synergies among agencies with known strengths and weaknesses. There is therefore a need for a mechanism to ensure a more effective participation of actors in the Cluster. • Many Member States have started to review how they approach the management of international assistance to obtain greater benefits from the new opportunities offered

12 A more resilient health sector in the Americas – Targeting efficient and innovative approaches

by humanitarian assistance and, at the same time, overcome the challenges posed by a greater international response. The Americas is the first region to have adopted a resolution that integrates the principle of The Americas is the first Region to the UN humanitarian reform while respecting the needs and priorities have adopted a resolution, approved of sovereign countries.14 This resolution approved by the 2012 Pan by the Pan American Sanitary American Sanitary Conference calls for practical national and inter-country institutional arrangements that will be supported by PAHO. Conference in 2012, that integrates • In view of the growing complexity of disaster management and increased the principle of the UN Humanitarian competition for funding, a programmatic approach has proven to be more Reform, while respecting the needs efficient and effective in the financing of PAHO’s disaster management and priorities of sovereign countries . activities when compared to project funding. This has allowed for the continuity in staff resources, the preservation of institutional memory and the immediacy of emergency needs assessment. In the future, PAHO will continue to focus on such a strategy. In addition, PAHO will concentrate on pioneering cost-effective initiatives and areas where the organization has a comparative advantage.

14. Resolution CSP28.R19, approved at the 28th Pan American Sanitary Conference, 17-21 September 2012: Coordination of International Humanitarian Assistance in Health in Case of Disasters (http://bit.ly/1dtBIo4).

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3. Strategic Framework

A graphical depiction of the Strategic Framework for this 2013-2018 Plan is included as Annex 1. It encompasses a strategic goal, three strategic objectives, and a number of expected results. The cross-cutting themes and priorities (see section 3.3) are an integral part of achieving the indicated results.

3.1 Vision

Improving disaster resilience is a public health priority. It is essential that the health sector is prepared to not only meet the health needs of disaster victims, but to also focus on changing behaviours and practices that cause vulnerability and have repercussions on public health. Embracing the values of equity, excellence, solidarity, respect and integrity, our vision for the Americas, is:

“A health sector with adequate, nationally-led and sustained capacity to ensure that member states are resilient enough to protect the physical, mental and social wellbeing of their communities and rapidly recover from disasters.”

3.2 Strategic Objectives

PAHO has defined three strategic objectives in order to reach the overarching goal of developing a more resilient health sector in the Americas.

I. Improved capacity of Member States to provide a timely and appropriate response to disasters, complex emergencies, and other crises Latin American and Caribbean countries have substantial experience in disaster readiness and response, particularly as related to natural hazards. In 2010, the Region faced 94 disasters, encompassing drought, earthquakes, epidemics, and floods, as reported by the Centre for Research on the Epidemiology of Disasters (CRED). The response to the overwhelming majority of these disasters (approximately 88%) was handled primarily by national authorities, with limited outside assistance. However, large complex disasters such as the earthquakes in Haiti and Chile, the influenza A (H1N1) pandemic, the dengue outbreak in Latin America, and the cholera outbreak in Hispaniola required coordinated international assistance.

14 A more resilient health sector in the Americas – Targeting efficient and innovative approaches

This strategic objective aims to ensure that a disaster-affected population receives an efficient and effective response and that a greater number of lives are saved. In order to achieve this objective, PAHO will focus on activities that lead to three expected results: 1) A health sector ready to respond to emergencies and disasters; 2) Effective implementation of response operations; and 3) Prompt recovery and rehabilitation needs assessments of national health systems affected by disasters.

II. Enhanced capacity of National Health Systems in Emergency Preparedness and Disaster Risk Reduction There have been significant advances in the institutionalization of disaster programs within Ministries of Health in the Region. Yet, while almost all countries have integrated disaster management functions into their health systems, only 15 countries report the existence of a health disaster program in the Ministry of Health, with full time staff and a specific budget. The ability to continue delivering health services in the wake of disasters, a The UN Cluster approach key objective of PAHO’s disaster risk reduction efforts, is still not ensured in a number of makes it necessary countries in the Region. Moreover, the availability and capacity of personnel, equipment, for the health sector to have infrastructures and non-structural assets is often compromised as health facilities become access to more advanced unavailable when they are most needed. systems and skills. This strategic objective aims to ensure that MOH embraces a national culture of disaster prevention and adopts an all-hazards approach, incorporating health risk reduction into national plans. In order to achieve this objective, PAHO will focus its activities on two expected results: 1) National health disaster programs functioning according to established criteria; and 2) Health services resilient and functioning after a disaster.

III. Increased effectiveness of PAHO and the Health Cluster in responding to disasters The world of humanitarian operations has changed significantly, especially as a result of the United Nations Humanitarian Reform. PAHO and the Member States must therefore improve their ability to contribute to these operations. The UN Cluster approach15 and the multi-sectoral manner in which many emergencies, particularly large-scale disasters, are managed, makes it necessary for Ministries of Health and the health sector as a whole to have access to more advanced systems and skills. PAHO must

15. Adopted in 2005, it is primarily a mechanism of the UN and international organizations within the framework of humanitarian reform. The Cluster Mechanism seeks to coordinate the humanitarian response, which had become increasingly challenging due to the increased prolifera- tion of humanitarian and non-humanitarian actors working in disaster preparedness and response.

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take into account the UN Humanitarian Reform to mobilize and more efficiently manage the Health Cluster,16 when called upon, and better assist the affected countries. Other challenges include coordination of the increased number of actors who compete for funding from the same sources, and advocating among countries which remain reluctant to embrace the UN Cluster approach, even though they have indicated their support for the UN Hu- manitarian Reform.

This strategic objective aims to ensure that PAHO is more effective and ready to support its Member States in disaster response, in addition to leading and providing the required support to the Health Cluster and to health humanitarian actors. In order to achieve this strategic objective, PAHO will focus its activities on two key expected results: 1) Enhanced capacity of PAHO to support Member States in disasters; and 2) Enhanced capacity of the Health Cluster to respond to disasters.

3.3 Cross-Cutting Priorities

Gender Disasters can often accentuate gender inequalities. For example, girls are more likely to become victims of violence in the aftermath of disasters, especially when families are living in emergency or temporary housing. Gender-based violence is also of special concern in emergency settings.

16. Health Cluster Guide (2009) World Health Organization (http://bit.ly/IS9rg4).

Women must be seen not as victims but as actors and/or potential leaders in building disaster resilience.

16 3 . Strategic Framework

Risk reduction, emergency preparedness and disaster response activities must therefore pay particular attention to women’s needs and priorities before, during and after an event. Women must be seen not only as victims but also as actors and/or potential leaders in building disaster resilience, especially since many have key roles in the community and are primary caregivers in their household. PAHO’s Gender Equality Policy, adopted by the Directing Council, estab- lishes that gender equity considerations should be integrated into all facets of PAHO’s work. There is still a need for increased efforts to ensure the mainstreaming of this cross-cutting issue in humanitarian activities.

Human Rights A human rights approach is particularly relevant during response to emergencies and disasters, as it enhances the protection value of disaster assistance activities17. Careful attention must be paid to promoting interventions that combat stigma and discrimination and ensure adequate preparation to meet the needs of the vulnerable populations. In the context of emergencies, vulnerable groups may include, but are not limited to, individuals with disabilities, pregnant women, children, older persons, prisoners, individuals with physical and mental disabilities, certain members of ethnic minorities, people with language barriers, and the impoverished. The main problems faced by these populations are: unequal access to assistance; discrimination in aid provision; and, sexual and gender-based violence, among others. Inadequate preparation to meet the needs of the vulnerable populations can lead to negative consequences.

Ethnicity In the Region of the Americas, there is close attention to the evolving concepts of ethnicity and definition of ethnic groupings. We understand these groups to include indigenous peoples among others, as outlined in PAHO Resolution CD47/13. Despite their invaluable contributions, the highest inequalities in health and mortality within the region can be seen among indigenous and other ethnic groups. Yet little is known about the extent of the disaster risks they face. Targeting these populations in situations of vulnerability is one of the most urgent needs to meet health goals. Accordingly PAHO will continue work to increase knowledge and understanding of the disaster risks and needs faced by indigenous populations and to develop culturally sensitive tools to better protect and improve their health during and after disasters. The entity will also advocate for Gov- ernments and humanitarian actors to address the unique needs of this population by tailoring re- sponses accordingly. The Inter-Agency Standing Committee (IASC) Guidelines on Human Rights in Natural Disasters calls for greater focus on protecting these populations in disaster situations as, in many instances, their socio-cultural characteristics and needs are not taken into account.

Governance “Efforts to reduce disaster risks must be systematically integrated into policies, plans and programmes for sustainable development and poverty reduction. Sustainable development, poverty reduction, good governance and disaster risk reduction are mutually support- ive objectives …”18

17. IASC Operational Guidelines on the Protection of Persons in Situations of Natural Disasters (2011). 18. Hyogo Framework for Action 2005 - 2015.

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Governance is the umbrella under which disaster risk reduction takes place. Public aware- ness, political will and sufficient human and financial capacity are key to making disaster risk reduction an underlying principle in all relevant development sectors.

Governance is one of the priorities of the Hyogo Framework for Action—“Ensure that disaster risk reduction is a national and local priority with a strong institutional basis for implementation.” Governance includes institutional, policy and socio-economic factors that affect all aspects of disaster management—preparedness, disaster risk reduction, and response. The governance context influences the ability of countries, communities and their organizations to access resources, skills, technologies, and markets to influence policy, such as the adoption of livelihood centred approaches to DRR. Principles of good governance include broad participation, transparency, accountability, efficiency and responsiveness.19

This Strategic Plan reflects governance as a cross-cutting theme in its various results, approaches, and outputs, through activities linked to policy directions, timely information management, capacity building, and advocacy.

19. Good Governance Practices for Protection of Human Rights. OHCHR, United Nations, New York and Geneva 2007.

Countries must guarantee the continuous operation of essential services and ensure the well-being of the population in emergencies and disasters.

18 A more resilient health sector in the Americas – Targeting efficient and innovative approaches

4. Expected Results And Approaches 4.1 Expected Results

The following Expected Results will contribute to achieving Strategic Objective I

Improved capacity of Member States to provide a timely and appropriate response to disasters, complex emergencies and other crisis.

ER 1.1: A health sector ready to respond to emergencies and disasters To ensure that Member States are prepared and ready to respond with their own resources, PAHO will continue to support countries in their preparedness and readiness activities, particularly through the development and implementation of simulation exercises and drills for health sector disaster plans. These multi-hazard plans will be developed with the participation of health and non-health partners.

A large number of professionals and institutions—both from the affected country and from the international community—play a significant role in the response to disasters that require an international humanitarian response. However, in most situations, the country can cope with the support of national or local response teams - the most cost-effective way to respond. These teams while increasing local capacity can also benefit neighbouring countries that are affected by disasters. They must however be well-trained and equipped. Although there are situations that require specialized care or additional treatment capacity, it should be borne in mind that foreign medical assistance can overwhelm affected countries or even disorganize the health system and health professionals, with consequent negative outcomes.

The Regional Health Response Team,20 a regional health response mechanism, currently has a Roster of 93 experts. Their deployment depends on their availability and the needs on the ground. Experience in recent disasters has shown that many more experts should be identified and trained in order to respond to requests from Member States - considering the level of spe- cialty required and the difficult task of obtaining clearance for deployment from the employer of team members.

20. The Regional Health Response Team was established upon request from the Ministers of Health (PAHO Directing Council Resolution). It is comprised of various technical experts who support the ministry of health in assessing immediate needs and potential risks, providing advice to national and international counterparts, generating data and information for situation reports and funding appeals, and helping to develop a health sector response plan of action.

19 Strategic Plan 2013 – 2018 of the Pan American Health Organization

A regional stockpiling sys- Results from a technical consultation meeting with global humanitarian partners high- tem significantly improves lighted the need to establish international standards for foreign medical teams as well as a response operations by system for accreditation. In the future, only foreign medical teams that are registered prior to ensuring the availability of a disaster should be accepted by countries and funded by donors. the stocks necessary for the Similarly, the activation of the UN cluster mechanism following a health sector. disaster, without input or participation of the Government of the affected country can disrupt the national institutional structure and undermine the credibility of national authorities. The objective of the Cluster approach is not to replace the existing institutions, but rather to support national mechanisms and improve coordination. It is therefore in the countries’ best interest to rapidly improve skills to manage international humanitarian response operations, to establish procedures and to identify staff to participate in and benefit from the Cluster approach. PAHO will support its Member States to develop internal procedures and protocols to improve their capacity to welcome international assistance and better integrate the Cluster mechanism within the national institutions.

Various logistics gaps have been identified that affect the supply chain and operational activities in the field (the ‘last mile’). A regional stockpiling system significantly improves response operations by ensuring the availability of the stocks necessary for the health sector. Such stocks can be physically and strategically located or held virtually, such as one based on a network of national stockpiles. Strong political will from a few countries could make a network of national stocks sustainable and reduce the response time in the health sector. Promoting more national stockpiles for inter-country assistance in the Region would also improve bilateral assistance among LAC countries, a trend that is being advocated.

The use of a common logistic platform has proved beneficial to the management of -in formation and supplies in emergencies. Prior to the implementation of the Logistics Support System/Supply Management System (LSS/SUMA), warehouse space was lacking, information on deliveries and stock was not properly managed and logistics was not a priority. Thanks to its capacity to generate and share reports, LSS/SUMA has helped improve the management of supplies and facilitated more transparent communication among response actors and national authorities. PAHO will continue to support the adoption and implementation of the LSS/ SUMA platform in its Member States.

20 4 . Expected Results And Approaches

Strategic Outputs contributing to ER 1.1 • Guidelines developed for preparation of health sector multi-hazard response plans; • Minimum standards for the classification and registration of Foreign Medical Teams (FMT) developed and criteria established for reception of FMT by a disaster-affected country; • Tools developed for the establishment of Cluster Coordination Mechanism in the Ministry of Health for management of international humanitarian assistance; • A virtual regional stockpile system created, based upon a standardized list of available national health stock and the LSS/SUMA platform; • Guidelines on health logistics developed; • Protocols established for standardization of LSS/SUMA by countries and sub-regional bodies; • Surge capacity of Health Regional Response Team improved; • Model health sector response, coordination, and management mechanism developed, based on the Incident Management System; • Guidelines and procedures developed for preparation of health sector response plans (including health cluster partners); • Guidelines and SOPs developed for establishment and operation of EOCs in the ministries of health to manage alert and response to epidemics and other hazards.

ER 1.2: Effective implementation of response operations PAHO will support response operations in affected countries, fulfilling its primary mandate in disaster situations, which focuses on coordination, rapid and independent assessment of health needs and the immediate provision of specialized public health advice. In addition, and in compliance with its mandate as Health Cluster Lead in the Americas, PAHO will also serve as the provider of last resort, in implementing public health projects.

Strategic Outputs contributing to ER 1.2 • Health Disaster Assessment and Needs Analysis (DANA) carried out; • Initial Health Rapid Needs Assessment carried out; • Basic set of essential health services that must be offered to affected populations after a disaster defined; • MOH supported to coordinate and lead national response mechanisms, including the Health Cluster, when activated; • Health international coordination mechanisms activated for health response; • Human and financial resources mobilized to respond to health needs in affected countries; and • Public health disaster projects implemented when required.

21 Strategic Plan 2013 – 2018 of the Pan American Health Organization

ER 1.3: Prompt Recovery / Rehabilitation needs assessments of national health systems affected by disasters PAHO’s involvement in post-disaster recovery efforts, although limited in the past, has increased significantly in recent years.21 During this Strategic Plan (2013-2018), PAHO will support countries affected by disasters to manage the recovery process and will increase PAHO’s and Member States’ involvement in the development of Post Disaster Health Need Assessments.

Strategic Outputs contributing to ER 1.3 • Health sector component of Multi-Cluster/Sector Initial Rapid Assessments evaluated; • Appeals involving multi-sector actors developed for the health sector; • MOH supported to develop recovery strategy and plan; and • Health recovery projects implemented in support of the affected Member States.

The following Expected Results will contribute to the attainment of Strategic Objective 2

Enhanced capacity of national health systems in emergency preparedness and disaster risk reduction.

ER2.1: National health disaster programs functioning according to established criteria The results from a 2006 study22 illustrate that nearly all countries of the Western Hemisphere have adopted formal measures within the MOH to continually improve their level of preparedness and risk reduction. These advances, although noteworthy, vary significantly from country to country and in some cases are not sufficient to provide an appropriate response. In addition, much has changed in the last five years and countries need to re-evaluate their status of preparedness against the ever-changing profile of hazards. PAHO will use its normative and technical authority to better document the impact of disasters on health and advocate for the inclusion of health disaster management in high-level sub-regional and international political agendas.

Incident Management Systems,23 which help to improve the overall organization of a response, are currently being used throughout the Americas. The application of these must be adapted according to the target group and the context of application, for example Ministry of Health versus a hospital or a small island state versus a large country.

21. During the implementation of the previous Estrategic plan (2008-2012), funds for recovery were secured for reconstruction work following the Earthquake in Pisco in August 2007 and in the Dominican Republic following Tropical Storm Noel in 2008. In addition, an agreement was signed to ensure mitigation measures are incorporated in all new hospitals in Haiti. 22. In 2006, a survey was carried out in the region—the first time the state of preparedness within the health sector of the Americas was measured. http://goo.gl/GniYyD 23. An Incident Management System is an approach used for institutional response regardless of the type of disaster or hazard. This mechanism helps define key functional areas of an organization and identifies one specific leader or “incident commander” to manage the crisis.

22 4 . Expected Results And Approaches

Strategic Outputs contributing to ER 2.1 • A mechanism developed to systematically update the progress report on the health sector’s capacity in risk reduction, emergency preparedness and response, including development of indicators and an online information system; • Health Disaster Preparedness Index (DPI) developed and advocacy efforts undertaken for its application. • The Health Sector Self-Assessment tool updated and its implementation supported; • Implementation of Incident Management Systems in the health sector at national and sub-national levels supported; • Tools and mechanisms established to support countries in accessing resources for health sector disaster programs; • Advocacy undertaken for inclusion of health disaster management on the agenda of international and sub-regional bodies; • A web-based information portal with up-to-date, authoritative health disaster infor- PAHO will continue to mation available; and promote the Safe Hospital • Guidelines developed to support the design and implementation of health recovery Initiative in Latin American projects by Member States. and Caribbean countries.

ER 2.2: Health services resilient and functioning after a disaster More than 67% of the 18,000 hospitals of LAC countries are located in high-risk areas, several of which are destroyed or severely damaged every year as a result of major earthquakes, hurricanes, and floods. In addition to the loss of lives and the in- terruption in the delivery of health care services, the destruction of a hospital has an enormous economic impact. The principles of ‘safe hospitals’24 are now at the forefront of mitigation and readiness measures for the health sector. In 2010, PAHO Member States approved a Regional Plan of Action on Safe Hospitals for 2010-2015.

A total of 28 countries and territories in the Re- gion are currently applying the Hospital Safety In- dex, and 15 countries have established a National Safe Hospitals Policy. The results of a sample application of the HSI in 1524 hospitals in the Americas show

24. The Hyogo Framework for Action called for the adoption of national risk reduction policies to ensure that new hospitals are built to a level of safety that will allow them to function in disaster situations. The PAHO/WHO Directing Council adopted a similar policy in 2004.

23 Strategic Plan 2013 – 2018 of the Pan American Health Organization

that although about half the hospitals have a high probability of continuing to function in a disaster, urgent actions are needed in at least 17% of these because they do not guarantee the safety of patients, health staff and visitors. In another 37%, intervention measures are needed in the short-term, as the hospital’s current safety levels are such that patients, hospital staff, and its ability to function during and after a disaster are potentially at risk. PAHO will continue to promote the application of the Safe Hospital Initiative in LAC countries, and support Mem- ber States in developing guidelines and implementing interventions to improve the safety and resilience of health services while trying to reduce their impact on the environment.

The concept of risk reduction has become an increasing priority for countries in LAC, and most are implementing risk reduction measures in hospitals and health facilities. However, the resources of Member States are limited, and governments do not always assign sufficient funds to implement disaster risk reductions interventions that are essential to ensuring the continuity of health services during disasters. PAHO will assist countries in making the case for health disaster risk reduction to financial institutions – whether national or international – through advocacy and the publication of scientific evidence on the cost-effectiveness of preparedness and mitigation measures.

Strategic Outputs contributing to ER 2.2

• Guidelines developed and promoted for the implementation and use of an independent quality control mechanism (Check Consultant) in the planning, design, and construction of health infrastructure; • Technical materials developed and promoted for the incorporation of principles of ‘SMART’ hospitals (disaster resilient and environmentally friendly) into the construction of new hospitals or retrofitting plans of existing hospitals; • Practical strategic guidelines created for MOH, to ensure participation and commitment by key actors, to implement disaster mitigation interventions for health facilities; • Checklist developed to assess the capacity of national health services networks to respond to emergencies through coordination institutions for health emergencies; • An online Safe Hospitals Database and Mapping Application developed for monitoring the implementation of the Safe Hospitals Initiative at sub-national, national, and regional level; • Report prepared on achievements/status of the Regional Plan of Action on Safe Hos- pitals, which ends in 2015; • Scientific, evidence-based research conducted in collaboration with International Financial Institutions (IFIs) and Professional Associations; and • Hospital Safety Index revised and updated and its use promoted to member countries to assess hospital’s resilience to disasters.

24 4 . Expected Results And Approaches

The following Expected Results will contribute to the attainment of Strategic Objective 3

Increased effectiveness of PAHO and the Health Cluster in responding to disasters.

ER 3.1: Enhanced capacity of PAHO to support Member States in disasters This Strategic Plan will focus on the implementation of PAHO’s new Institutional Re- sponse to Emergencies and Disasters Policy throughout the organization to improve knowledge and capacity to efficiently manage and respond to disasters, in the most cost-effective manner possible. This will encompass the development of internal guidelines, learning materials and standard operating procedures, as well as the reinforcement of PAHO’s surge capacity, through the identification and training of human resources to ensure rapid and proper response to emergencies.

Strategic Outputs contributing to ER 3.1 • PAHO’s surge capacity developed in order to have sufficient human resources available for mobilization when the situation warrants; • Country and regional PAHO experts from different technical units identified and trained in emergency procedures to be deployed to field operations; • Internal guidelines and operating procedures created to improve effectiveness of emergency operations; • E-learning module on emergency response, including PAHO response procedures, developed for senior PAHO management staff; • Emergency Task Force at HQ operational with a high level of technical expertise; • PAHO EOC operating according to established procedures; • Network of health EOCs within and among countries established; • PAHO’s Institutional Response to Emergencies and Disasters Policy updated.

ER 3.2: Enhanced capacity of the Health Cluster to respond to disasters The world of international humanitarian operations is changing significantly, especially as a result of the United Nations Humanitarian Reform, WHO’s Reform and the IASC Transfor- mative Agenda. PAHO/WHO’s role as the Health Cluster lead agency in the Americas requires coordination with Ministries of Health and the strengthening of its own response capacity, while establishing links with other health actors to ensure the efficient management of an emergency. As demonstrated by the overwhelming number and difficult coordination of actors involved in health response operations to the 2010 Haiti earthquake, there is an imperative to reassess and improve the capacity of the Health Cluster25 to better organize the growing international humanitarian assistance while addressing the needs and priorities of the affected country.

25. The overall purpose of the Health Cluster is to support the national health sector strategy, prepared by the MOH with technical support from PAHO and other partners, and to ensure the implementation of national priorities in the health response to an event.

25 Strategic Plan 2013 – 2018 of the Pan American Health Organization

PAHO will therefore take into account the UN Reform, including the IASC Transforma- tive Agenda and WHO Reform to mobilize and more efficiently manage the Health Cluster, when called upon, and better assist the affected countries.

Strategic Outputs contributing to ER 3.2 • A pool of Health Cluster coordinators created; • The Global Health Cluster guidelines and standards promoted within the Region; and • Health Cluster coordination mechanism implemented in countries and with health sector partners, when activated by OCHA.

4.2 Strategic Approaches

PAHO will use the following strategic approaches to achieve the Expected Results (ER) presented in section 4.1.

Policy Directions PAHO will systematically implement the newly-approved policy on Institutional Re- sponse to Emergencies and Disasters to improve the efficiency and quality of delivery of its cooperation during response operations. This will also ensure that PAHO is in line with WHO’s Emergency Response Framework.26

During the implementation of this strategic plan, PAHO will incorporate the value-for-money27 approach defined by the National Audit Office of the United Kingdom as “the optimal use of resources to achieve the intended outcome,” in an attempt to maximize the impact from available resources.

Partnerships and Networks The establishment of strong partnership and networks is a requirement for efficient and effective performance. This is particularly true in the humanitarian field.

PAHO will use existing and new health disaster management partnerships and networks such as DiMAG (Disaster Mitigation Advisory Group), as well as partnerships outside the health sector, to ensure timely and effective interventions. This includes fostering relationship with governmental entities, civil society, the military and other UN Agencies, to ensure a comprehensive and multi-sectorial approach to PAHO’s interventions.

At higher levels, PAHO will work through structured disaster management partnerships and mechanisms, including sub-regional bodies such as: Caribbean Disaster Emergency Man-

26. WHO. Emergency Response Framework (2012) - http://www.who.int/hac/about/emergency_response_framework.pdf. 27. Value for Money in PED program means that we will maximize the use of resources used to improve the level of response of the Member States and the Secretariat.

26 4 . Expected Results And Approaches

Strategic Approaches Policy Directions

Partnerships Capacity and Networks Building Resource Information Advocacy Mobilization and Management Prioritization

agement Agency (CDEMA), the Center for the Coordination and Prevention of Natural Di- sasters in Central America (CEPREDENAC) and Andean Region Committee for Disaster Prevention and Response (CAPRADE).

Coordination with educational institutions and professional associations will also be sought to facilitate access to the latest scientific information for health professionals and to establish scientific linkages to better understand new and emerging threats. PAHO will also explore possibilities of specific contracts for emergency situations, developing agreements with selected institutions and tapping into existing networks and resources.

Working with the private sector, including profit and non-profit corporations and institutions continues to be a challenge. PAHO will explore opportunities of collaboration in order to foster partnerships with this group.

Capacity Building Increased focus will be placed on the production of guidelines related to multi-hazards and previously un-addressed risks such as technological hazards and climate change. This will provide a better understanding of the evolving threats that exists in the Region and improve the capacity of PAHO and its Member States to address them.

National capacity to manage risk and reduce vulnerability will be built through various means including advocacy, training, provision of scientific information and new tools, expert technical support, and leadership. In addition, PAHO will work with administrative and strategic areas within the Organization to further improve the response mechanisms within PAHO.

Advocacy PAHO will take advantage of its normative authority and institutional convening power to:

• advocate for the inclusion of items related to disaster management within the health sector on the agendas of high-level political and technical bodies.

27 Strategic Plan 2013 – 2018 of the Pan American Health Organization

• promote the adoption of benchmarks to demonstrate institutional commitments to disaster risk reduction and to facilitate better monitoring and evaluation of progress. • continue advocating for stronger leadership roles of the Health Disaster Units at national level, to enhance the capacity of the MOH to prepare for and efficiently manage disasters. • advocate for the integration of disaster risk reduction throughout the health sector in order to improve the resilience of health services. Information Management PAHO will continue to produce normative information on health issues to make the case for disaster preparedness and mitigation. The Organization will also increase the use of social media and other internet based communication channels. This will enhance PAHO’s capacity to reach out to individuals and all relevant information sources, for the benefit of all Member States.

PAHO will use the lessons learned approach to revise and update its emergency and disaster strategies, policies, procedures, technical guidelines, and other tools where relevant.

Resource Mobilization and Prioritization The multi-year programmatic funding approach for PAHO’s disaster program has proven to be the most efficient way of operating and sustaining results. PAHO will therefore continue to seek multi-year programmatic support under this strategic plan. Funding for pilot projects will only be sought to demonstrate potential benefits of innovative concepts and when there is a clear possibility for replication to larger scales. It is expected that where these pilot projects exist, they will be financially self-sustaining.

Special efforts will be made to appeal to emerging donors within the region, such as Bra- zil, Mexico, Argentina, Cuba, Chile, Colombia and Venezuela, as well as outside the region, including Finland, South Africa, and South Korea. PAHO will also foster inter-country collab- orations, underpinned by sharing of technical and/or financial resources.

The outputs of this Strategic Plan have been carefully selected for their potential to generate a significant leap forward in the health sector’s resilience, considering Member States’ vulnerabilities and capacities, and PAHO’s technical expertise and long-standing collaboration. It is therefore anticipated that support and full funding for the implementation of this strategic plan should be successfully secured to guarantee the achievement of the specified objectives. However, should resources not be available as anticipated, priority will be given to actions with higher value for money and broader impact on countries’ response and risk reduction capacity, such as: a) identifying and training experts in each Member State to trigger immediate response and provide continuous support to national and regional entities b) leveraging national and international capacities through low-cost activities with high return on investment, including advocacy for adoption of national legislation and policy, maintenance of experts networks and/or organization of lessons learnt exercises c) fostering the alignment of partners’ work plans with regionally agreed health agendas and resolutions d) fostering access to low-cost and high-efficient technologies among Member States.

28 A more resilient health sector in the Americas – Targeting efficient and innovative approaches

5. Structure and Management

5.1 PAHO’s Institutional Commitment to Disaster Management

PAHO was the first WHO Region to formally establish a Disaster Preparedness Unit (Governing Bodies Resolution CD24.R10, following the earthquake in Guatemala in 1976). Since then, PAHO’s commitment to disaster risk management has increased and expanded through a network of sub regional offices and disaster focal points in every PAHO Country Office, Technical Area, and Center. This coordinated support has culminated in the recently-approved Organizational policy “Institutional Response to Emergencies and Disasters.”

The core objectives of this new policy are to:

• Provide appropriate and timely technical cooperation to disaster-affected Member States in their efforts to save lives and protect health from the impact of emergencies; and • Facilitate the implementation of the UN Health Cluster, as needed. The Policy involves all technical and administrative areas and centers of the Organization, as well as its executive management. It established a new Emergency Operations Center (EOC) which coordinates the overall corporate response and information management, connecting all points of operations to ensure that the response is timely and effective, according to the three levels of activation of the institutional response.28

Building on the experience from the organizational capacity building interventions of the previous Strategic Plan, PAHO will better harness and mobilize the Organization’s public health expertise and networks and mainstream disaster management across the Organization. This will facilitate managing and responding to disasters more effectively (Strategic Objective 3 of this Strategic Plan) and be in line with WHO’s emergency response framework. This also means improving disaster management by increasing the involvement of PAHO/WHO Rep- resentatives (PWR) in managing disasters.

28. PAHO Institutional Response to Emergencies and Disasters (http://bit.ly/HrYwtA).

29 Strategic Plan 2013 – 2018 of the Pan American Health Organization

5.2 PED Program Staffing and Structure

Program staffing and structure (see Annex 2, Functional Chart) will remain fairly con- stant, a reflection of the growing importance of this field of work within PAHO and the need to meet the increasing requests for support from Member States and international partners. As a reflection of the Organization’s across-the-board commitment to disaster management, we will work to ensure that each PAHO Country Office and Area of Work has programmed in their internal work plans, at least one expected result or activity that contributes to making the health sector more disaster resilient. The PAHO Learning Board will also be strongly engaged to train staff across the Organization with internal resources.

5.3 Partnerships for Health Preparedness

PAHO`s Department on Emergency Preparedness and Disaster Relief will continue to promote liaison and dialogue with donors and agencies that support health emergency preparedness in the LAC region. PAHO/PED will continue to host periodic meetings with these stakeholders, extending invitations to agencies that express interest in making a commitment to health preparedness and/or mitigation in the Region. Both internal (e.g. core institutional capacity building processes) and external consultation mechanisms (e.g. sub regional plans, country cooperation strategies, etc.) will continue to be emphasized.

The direction of PED’s future actions will build on its current relationships and collabo- rative efforts with other agencies, as well as on the foundation of a wide network of experts. PED will expand its partnerships (in the health sector and others) with a growing number of important regional actors in health (both in quality and quantity). During this strategic planning period, PED will reorganize the Technical Advisory Group to include a broader range of partners and stakeholders, who will be available to advice or comment on specific issues. Additionally, we will continue to work to influence other health and disaster reduction entities to work towards common regional objectives and benchmarks for assessing progress.

30 A more resilient health sector in the Americas – Targeting efficient and innovative approaches

6. MonitoringMonitor And Evaluation

Monitoring and evaluation of the progress and impact is a critical part of PAHO/WHO’s work and we continuously strive to improve these functions.

6.1 Internal Monitoring

Staff will monitor and analyse progress against planned activities through the Organiza- tion’s internal monitoring and reporting system for its biennial work plans (BWPs). Progress will be assessed against output indicators and products and services established in the BWPs, and an analysis will be conducted of factors or challenges hindering progress and the actions required to address such challenges. This performance monitoring and assessment process is conducted throughout the Organization on a six-monthly basis.

PAHO will utilize this information to inform the Regional and Global Expected Results, as established in the new PAHO/WHO Strategic Plan (2014-2019)29 and WHO General Program of Work 2014-2019. Category 5 of these work plans relates to preparedness, surveillance and response.

A Logical Framework for implementation of this Strategic Plan has already been developed. It outlines SMART (specific, measureable, achievable, realistic and time bound) indicators for the expected results in the results chain. Each year, PED will prepare comprehensive annual reports to inform of the level of progress towards the achievement of these expected results. Additionally, PED will continue to submit disaster-specific reports, as requested, and collect informal information throughout the course of the implementation period. The De- partment will also be sensitive to changes in the external environment, which may trigger adjustments in the expected results or activities. These will be discussed with partners and relevant amendments will be instituted as necessary.

6.2 External evaluations

PAHO and its Department on Emergency Preparedness and Disaster Relief value the independence and rigor of external evaluations and the valuable recommendations that have come from these in the past. We welcome an “end of Strategic Plan” evaluation, and also pro- pose that our core donors commission a mid-term review during the implementation period, to allow for an assessment and adjustment of the plan, if necessary.

29. In the current Strategic Plan (2007-2013) it is Strategic Objective 5.

31 Strategic Plan 2013 – 2018 of the Pan American Health Organization

7. Assumptions And Risks 7.1 Assumptions

A key assumption that has been made while preparing this Strategic Plan is that all Mem- ber States will remain relatively stable during the next six-year period, to allow growth on past gains, both at the institutional and individual level. Other key assumptions include:

• Climate variability and change will continue to have significant impact on lives, health, food security and livelihoods in the Region; • Continued population migration towards urban areas and population growth along the coastline will create greater vulnerability to natural and technological hazards, including hydro-meteorological extremes; • High levels of vulnerability and humanitarian needs will continue in geographical pocket areas, such as the Andean region; • Disaster preparedness and risk management will continue to receive strong political support at all levels across Member States, increasingly spurred on by the population’s heightened demand for social protection; • The positive momentum in the Region will continue even after the end of Hyogo Framework for Action in 2015, mid-way through this Strategic Plan period; • Disasters that may occur in the next six-year period would themselves reinforce the demand for better risk management measures.

7.2 Risks

However carefully planned, achieving the expected results in this strategic plan is not without risks, due to various internal and external factors. We have however identified these possible risks, assessed their likelihood and severity, and indicated the steps which we can take to make them less likely (prevention) and to address them if they do occur (mitigation). A summary of this analysis is presented in Table 1.

32 7 . Assumptions And Risks

Table 1: Principal risks for the PED Program and likely prevention/mitigation measures

Risk Likelihood* Severity** Prevention and/or mitigation A perception that effort in the area of 2 3 With the new PAHO’s Institutional Response emergency preparedness and response framework, there is an increased corporate commit- is an additional responsibility that is ment to this area of work, making risk management secondary to PAHO’s regular devel- mandatory. We will build on this institutional com- opment initiatives. mitment by providing relevant training, information, and tools to facilitate any adaptation necessary of portfolios in other Departments. Lack of qualified staff will hold-back 3 3 We will continue our efforts to directly provide our efforts to build capacity in the training and to also support the planning, design health sector. and execution of professional training materials and courses that can be delivered through our established networks and partners. Diversion of staff from risk manage- 3 4 The increased corporate commitment augurs well ment activities to attend to disaster re- for institutionalization of disaster risk management sponse, in large multi-country disasters within PAHO. This will facilitate shared imple- such as H1N1 pandemic, may affect mentation of the Plan with PWRs and technical implementation of this strategic plan. programs. We will also refrain from submitting proposals that may be difficult to implement. Multiplicity of actors in humanitarian 3 3 We plan to involve the key players to take the lead response demand increased levels of in various regional activities and also potentially in coordination, and therefore addition- the advisory groups. al inputs of resources from PAHO. Political changes can result in high 3 5 We plan to continue advocating and supporting the staff turnover, which can set back ca- institutionalizing of the program within the Minis- pacity building efforts by years. try of Health, including working to convince political decision-makers that DRR is an essential core function of the health services. Continuation of the global finan- 4 4 We plan to continue providing leadership and cut- cial crisis can lead to a reduction of ting edge scientific analysis that makes the case for financing for disaster risk reduction DRR, as well as advocacy for political support and activities - both from donor countries a multi-sectoral approach in the LAC region. In ad- and within budgets of the countries dition, partnerships with the private sector and oth- in the Region. er regional actors will be fostered or strengthened. Long-established bureaucratic proce- 4 4 As changing internal procedure is a long and com- dures may hamper humanitarian re- plex process, we will seek to establish clear contin- sponse due to its demanding nature gency plans for response operations, including se- in terms of expert time and adminis- curing flexible and fast channels for the immediate trative support. disbursement of funds in response to an emergency. Changing approaches in funding mo- 3 3 We will ensure closer engagement with donors, in- dalities by donors (e.g. project orient- cluding jointly analyzing value for money projec- ed vs. program based funding). tions of various approaches and assessing outputs feasible according to levels of investment. This will also help to maintain trust and credibility with donors, especially those who fund long-term programs.

*On a scale of 1 to 5, 1 being very unlikely and 5 being likely. **On a scale of 1 to 5, 1 being trivial and 5 being severe.

33 Strategic Plan 2013 – 2018 of the Pan American Health Organization

Annex 1 Contribution to the international development goals development international the to Contribution Enhanced capacityEnhanced of the Health Cluster of the Health to respond to disasters to respond to Disaster Management Governance Management Disaster Increased effectiveness of PAHO and of effectiveness Increased in disasters in disasters Member States Member States the Health Cluster in responding to disasters to in responding Cluster the Health Enhanced capacityEnhanced of PAHO to support to of PAHO after a after disaster functioning resilient and resilient Health servicesHealth Climate Change Climate Advocacy and Communication Advocacy Management Information and Prioritation Mobilization Resource Disaster RiskDisaster Reduction on Emergency Preparedness and on Emergency Preparedness criteria established functioning according to according National health National Enhanced capacity of National Health Systems Systems capacity Health Enhanced of National disaster programs disaster Strategic Approaches Strategic Cross-Cutting Priorities Cross-Cutting Human Rights assessment of assessment A more resilient health sector in the Americas resilient A more Prompt Recovery / Recovery Prompt affected by disasters affected Rehabilitation needs Rehabilitation national health systems health systems national Policy DirectionsPolicy / Networks Partnerships BuildingCapacity PAHO – PED Strategic Framework (2013 – 2018) Framework – PED Strategic PAHO Effective operations of response implementation complex emergencies and other crisis emergencies complex Gender timely and appropriate response to disasters, disasters, to response timely and appropriate Improved capacity of Member States to provide a provide to capacity of Member States Improved and disasters A health sector to emergencies to ready to respond to ready Strategic Goal Strategic Expected Results Strategic Objectives Strategic

34 A more resilient health sector in the Americas – Targeting efficient and innovative approaches

Annex 2

Costa Rica Costa Center Regional Disaster Disaster Regional (CRID) Center Information Emergency Operations Program Management Program South America Office Advocacy, Info. Management Info. Advocacy, and Risk Reduction Partnerships Department Director Central America Office Central Subregional Disaster Offices Disaster Subregional FUNCTIONAL CHART Readiness and Response Department of Emergency Preparedness and Disaster Relief and Disaster Department of Emergency Preparedness Caribbean OfficeCaribbean (Haiti) and Mitigation Special Projects Disaster Preparedness Disaster Internally Displaced Population (Colombia) Population Disaster Disaster Project Preparedness

35 Strategic Plan 2013 – 2018 of the Pan American Health Organization

Acronyms

BWP PAHO Biennial Work Plan

CAPRADE Andean Committee for Disaster Prevention and Response

CDEMA Caribbean Disaster Emergency Management Agency

CEPREDENAC Centre for the Prevention of Natural Disasters in Central America

CRED Centre for Research on the Epidemiology of Disasters

DANA Disaster Assessment and Needs Analysis

DiMAG Disaster Mitigation Advisory Group

DRR Disaster Risk Reduction

ECLAC Economic Commission for Latin America and the Caribbean

EOC Emergency Operations Centre

ER Expected Result

FMT Foreign Medical Teams

IASC Inter-Agency Standing Committee

IDP Internally Displaced People

IFRC International Federation of Red Cross and Red Crescent Societies

IHR International Health Regulations

IASC Inter-Agency Standing Committee

IPCC Inter-governmental Panel on Climate Change

IRNA Initial Rapid Needs Assessment

LAC Latin America and the Caribbean

LSS / SUMA Logistics Support System / Supply Management System

36 Acronyms

MOH Ministry of Health

MOU Memorandum of Understanding

NGO Non-governmental Organization

PAHO Pan American Health Organization

PED PAHO’s Department of Emergency Preparedness and Disaster Relief

PWR PAHO / WHO Representative

RRT Regional Response Teams

UN United Nations

UNDP United Nations Development Program

UNICEF United Nations Children’s Fund

UNISDR U.N. Office for Disaster Risk Reduction (formerly International Strategy for Disaster Reduction)

WHO World Health Organization

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