WHO Takes Lead on Health as UN Tackles Crises: The "Cluster" Approach-As a Means of Coordinating Humanitarian Action-Emerged from United Nations Reform in 2005. Nick Cumming-Bruce Examines the Challenges the World Health Organization Faces in Leading Health Clusters in 24 Countries

Article excerpt

Rolling out a health duster for Gaza at the height of the recent conflict met with some unexpected challenges. Arriving in Jerusalem in early January this year, WHO's Patricia Kormoss, like many other aid agency personnel, could not enter Gaza because of security problems. Even personnel inside the territory could not always move around because of the intensity of the fighting. Yet the need was great. Health facilities, some of them battered by shelling, were desperately struggling to keep up with the flow of injured.

Kormoss quickly instituted biweekly meetings in Jerusalem and Ramallah with medical partners, Palestinian authorities and donors, and set up a system to report the latest health developments in Gaza in regular updates posted on the internet. Together, they set out priorities for service delivery in the crisis, which were later used as the basis for a flash appeal to the UN's Central Emergency Rotating Fund and a revision of Gaza's application for humanitarian aid to the Consolidated Appeal Process.

But on top of these challenges, Kormoss was confronted by a massive surplus of medical supplies. Governments and organizations, trying to help, had shipped some 7000 tonnes of medical supplies to Gaza, often without packaging lists. The Palestinian Ministry of Health hired nine extra warehouses to accommodate these donations and the work of sorting through them is still under way.

[ILLUSTRATION OMITTED]

Kormoss also found herself fielding phone calls from medical teams that had arrived unannounced in search of a role. Gaza's hospitals were short of some specialist skills--for example neurosurgeons--but "they did not need medical staff".

These are the kind of problems that the cluster approach, in which one agency takes on overall responsibility for coordinating and implementing the response to a specific aspect of an emergency or protracted crisis, is designed to address.

The cluster approach emerged from the reform of humanitarian assistance launched by the United Nations (UN) in 2005 to address its failure to deliver timely assistance to Darfur and to manage effectively the flood of assistance after the 2004 Asian tsunami.

As part of that reform, the UN's Inter-Agency Standing Committee agreed to establish nine global dusters (later increased to 11) in a bid to strengthen leadership, coordination, accountability and predictability in tackling crises. The approach was first used in response to the Pakistan earthquake in 2005. Since then, it has been rolled out in 24 of the 26 countries where the UN has humanitarian coordinators, and it is the agreed coordination framework for all new emergencies.

For Dr Eric Laroche, assistant director-general of Health Action in Crisis at the World Health Organization (WHO) and its representative on the UN's Inter-Agency Standing Committee, health dusters mark a major step forward from the previous looser efforts at sectoral coordination, which depended largely on the willingness of partners to share information.

Most importantly, for Laroche, the approach makes the lead agency, or co-lead agencies, accountable for the performance of their cluster by clearly stipulating their responsibility to ensure adequate coordination of activities by partners involved in its specified area.

"Ten years ago accountability was shared among all the actors, now for health it falls on WHO," says Laroche. "When people see an epidemic spreading, they turn to us and say: 'What are you going to do?' That's quite new."

Second, the duster system aims to push beyond unstructured information exchanges "to have a common analysis and a commonly agreed strategy," says Laroche, adding that this was not always the case with the sector coordination of the past.

Third, the approach seeks to deliver predictability in tackling emergencies and crises. "If something happens somewhere, we need to be predictable in our response and the coordination that we have to provide," Laroche says. …