Global Health Cluster
Orientation Package
Module 4:
Guidance, Tools and Resources
Module 4: Learning Objectives
On completion of this module participants will be
aware of:
• The tools and guidance which have been
developed by the Global Health Cluster
• The aims and practical applications of these
tools and guidance
3
The Health Cluster Guide
The Global Health Cluster has developed a practical
guide for country-level implementation of the Health
Cluster
Available in English and French:
www.who.int/hac/global_health_cluster/guide
• online
• hard copy
• CD/ROM
The Health Cluster Guide
• Country level: outlines how the Health Cluster
Lead Agency(WHO) and partners can work
together during humanitarian crises
• Highlights the key principles of humanitarian
health action
• Explains how working in partnership can
increase the effectiveness and efficiency of
health interventions
5
The Health Cluster Guide (2)
Each Chapter:
• Highlights key points
• Summarises activities to be carried out and
issues to consider
• Lists and explains the tools and guidelines
available
• Indicates challenges likely to be faced
• Provides practical hints and references for
further guidance
The Health Cluster Guide
http://www.who.int/hac/global_health_cluster
/guide/en/index.html
The Health Cluster Guide
Content
Chapter 1: Role and functioning of a health cluster
Chapter 2: Assuring effective coordination
Chapter 3: Assessing and monitoring the health situation
Chapter 4: Analysing and prioritizing
Chapter 5: Developing a strategy; planning
Chapter 6: Ensuring standards
Chapter 7: Advocacy and resource mobilization
Chapter 8: Monitoring cluster performance
Chapter 9: Standard services and indicator list
The Health Cluster Guide
Annexes
A. Generic Terms of Reference for Sector Leads
B. Types and phases of assessment in a humanitarian
crisis
C. General principles for all data collection activities
D. Drawing up an assessment plan, schedule and budget
E. Stakeholder analysis
F. Priority Cross-cutting Issues
G. Analysing response options; examples of negative
effects
H. SPHERE standards
Core health indicators
Four categories :
• Health Resources Availability (A 1-8)
• Health Services Coverage (C 1-6)
• Risk Factors (R 1-7)
• Health Outcomes (0 1-5)
Total of 26 suggested indicators
10
Assessing the health situation
Information is needed on:
• Health status and risks
• Resources availability
• System performance
Assessing the health situation (2)
Data and analysis should be:
• Regularly up-dated
• Collected with the maximum possible
involvement of national and sub-national health
authorities and other partners
• Based on common, gender-sensitive indicators,
standards, protocols and case definitions
• Disseminated in time to inform decisions on the
planning and management of response
activities
Core aspects of information needs
Health Status
and Risks
Health Resource
and Availability
Health System
Performance
• Current health
status of affected
population groups
(mortality &
morbidity & major
causes) & health
risks (e.g. potential
outbreaks)
Initially
• facilities
• personnel
• supplies and services
state and non state
• Coverage and
quality of
available services
• Access for all
population groups
to services and
their utilisation of
services
Later • all above &
• other health system
components
(management, finance,
etc.)
13
Tools for data collection & analysis
1. Initial Rapid Assessment (IRA)
2. Health Resource Availability and Mapping
System (He RAMS)
3. Early Warning and Response System
(EWARS) and the HANDS software produced by
the Health and Nutrition Tracking Service
4. UNHCR Health Information System (HIS)
14
IRA tool: background
Recent experience of inter-agency, inter-cluster
rapid assessments in a number of countries has
shown:
• Extremely haphazard and ill-prepared
needs assessments
• No standard tool available
• Multiple assessments/surveys with variety of
methodologies from different agencies
15
IRA tool (2)
• A multi cluster/multi sectoral tool
• Collects, compiles and analyses information
on:
 the health status of the population
 the determinants of health (nutrition, water
 supply, sanitation, etc.)
 current health services characteristics
 (coverage, resources, services available,
 access, etc.)
• Should ideally be carried out within 72
hours of the onset of a crisis situation
IRA tool (3)
• Developed jointly by global health, nutrition,
WASH and shelter clusters
• Should be conducted jointly with Health,
WASH, Nutrition & Shelter clusters - with
Health Cluster or Inter-cluster leadership
• May need minimal customisation at country
level
17
IRA tool (4)
The tool includes:
•
•
•
•
Guidelines
Assessment form for data collection
An Aide Memoire for field teams
Data entry and analysis template & software
18
Health resources & services
availability mapping system (HeRams)
• Promotes and supports good practices in
mapping the availability of the health resources
and services in emergencies
• Strengthens the Health Cluster's informed
decision making and coordination
HeRAMS (2)
HERAMS is a software-based information
system. Developed to support the collection,
collation and analysis of information on the
available health resources and services in
emergencies.
HeRAMS (3)
There are two versions of HeRAMS:
• The Initial He RAMS (“i-He RAMS”) used
during the first few days/weeks of an acute
crisis to record and analyse aggregate data on
the numbers of active health partners, numbers
of functioning health facilities by type, numbers
of key health staff (doctors, nurses, midwives),
and the level of health services available by
administrative level (e.g. district, sub-district)
HeRAMS (4)
• The (“Full”) HeRAMS should be used as
soon as feasible and then throughout the
duration of a crisis to record and analyse data
on the available resources and the specific
services at each “point of delivery”.
HeRams data Structure
Metadata
Point of
Delivery
Modality of
Delivery
Health
Personnel
Health
Services
Additional
Modules
Early Warning and Response System
EWARS
• Weekly routine reporting of health data from
health facilities
• Immediate reporting of specific critical
conditions
• May be built around pre-existing surveillance
systems
26
Health information and Nutrition
Tracking System HANDS
• Events Analysis & Nutrition Data Surveillance
• Developed by Health & Nutrition Tracking
Service (HNTS) based in Geneva
• An Excel application which can be used to
capture and analyse data generated by
EWARS
27
Health Information System (HIS)
• A UNHCR developed system to support the
collection of standardised, facility-based
surveillance data in refugee settings
• Promotes using core Global Health Cluster
indicators in humanitarian crises
28
Information needs
Information for HCC
and HC partners is needed on:
Health Status of
Affected Populations
Health Resources
Availability
Health System
Performance
Initial Rapid Assessment
Health Resources
Availability Mapping
System
Routine reporting,
ad hoc surveys,
HIS, etc.
Tools available
(IRA)
… for the collection, collation and
analysis of this information:
Early Warning Systems
(HINTS)
(HeRAMS)
Desired situation
… expressed in terms of specific
programmatic targets,
international standards,
benchmarks, etc.
Targets – Benchmarks – Thresholds – etc.
Identification of GAPS in the Humanitarian Response
Global Health Cluster Position Papers
“Removing User Fees for Primary Health
Care Services During Humanitarian Crises”
Provides guidance for the removal of user fees
for the provision of primary health care services
during humanitarian crises.
GHC Position Papers (2)
“Civil-military Coordination in Humanitarian
Situations”
Provides insight to the problematic situation
that many partners face while working at
country level and to provide guidance on how
to coordinate with military actors in a
humanitarian health response
Module 4:
Key Messages (1)
• The Health Cluster Guide provides
stakeholders with information and resources
for country level implementation
• The 26 suggested Core Health Indicators
have been developed to assist the decision
making at country level (including coordination,
advocacy and fund raising)
Module 4:
Key Messages (2)
• The Initial Rapid Assessment (IRA) tool is a
multi cluster/multi sectoral tool which provides
essential information in the first phase of an
emergency
• Health Resource Availability Mapping
System (He Rams) is a framework for the
assessment and monitoring of health
resources and services availability
Module 4:
Key Messages (3)
The Health Cluster position paper:
“Removing User Fees for Primary Health
Care Services During Humanitarian Crises”
states that user fees should not be charged
for primary health care services during
humanitarian crises
Resources
• Health Cluster Guide
http://www.who.int/hac/global_health_cluster/
guide/en/index.html
• Tools – in English and French
http://www.who.int/hac/global_health_cluster/
guide/tools/en/index.html
Resources (2)
• Gap Guidance Materials “Assisting the Health
Sector Coordination Mechanism to Identify and
fill gaps in the Humanitarian Response”
IASC/GHC Sub Group on Management and
Coordination
• Position Paper on User fees
http://www.who.int/hac/global_health_cluster/a
bout/policy_strategy/EN_final_position_paper_
on_user_fees.pdf
Discussion & Questions