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A strategic framework for emergency preparedness
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ii
CONTENTS
Acknowledgements ..........................................................................................v
List of contributors ............................................................................................vii
Executive summary............................................................................................ix
1. Introduction..................................................................................................1
2. Purpose, objectives and use of this framework ........................................1
3. Context of this framework...........................................................................2
4. Principles for emergency preparedness .....................................................3
5. Framing emergency preparedness..............................................................4
6. Elements of emergency preparedness .......................................................6
7. Operationalizing emergency preparedness................................................7
8. The way forward...........................................................................................8
Annex 1. Elements of preparedness at all levels..............................................9
Appendix 1. Different types of emergencies....................................................13
Appendix 2. Working definitions for this framework.......................................14
Appendix 3. Frameworks and assessment tools for
emergency preparedness..................................................................................15
iii
A STRATEGIC FRAMEWORK FOR EMERGENCY PREPAREDNESS
Acknowledgements
WHO would like to thank Professor Ronald Waldman for his contribution to the
development of this framework.
WHO would also like to express gratitude to all Member States, partners and WHO
Departments and Regional Offices (see list of contributors) for the extensive input received
in particular before, during and after the Bali meeting on Advancing Global Health Security
held from 27 – 29 June 2016.
v
vi
A STRATEGIC FRAMEWORK FOR EMERGENCY PREPAREDNESS
List of contributors
Contributors marked with an asterisk provided The following donors and foundations:
substantive input during a WHO-convened African Development Bank Group (AfDB);
workshop held from 8 to 9 June 2016. Further Asian Development Bank (ADB); Asian Pacific
contributions were received during, and Cooperation (APEC); Bill and Melinda Gates
subsequent to, the High-level Meeting on Foundation; United Kingdom Department for
Advancing Global Health Security held from 27 to International Development (DFID)*; European
29 June 2016 in Bali, Indonesia. Commission; German Federal Ministry for
Economic Cooperation and Development (BMZ);
Japan International Cooperation Agency (JICA);
Delegates from the following countries:
Korea International Cooperation Agency (KOICA);
Afghanistan; Armenia; Australia; Bangladesh;
Mekong Basin Disease Surveillance Foundation;
Bhutan; Burkina Faso; Cambodia; Cameroon;
World Bank Group (WBG)*; Skoll Global Threat
Canada; El Salvador; Ethiopia; Finland; Gambia;
Fund; United States Agency for International
Germany; Ghana; Indonesia; Italy; Japan; Kingdom
Development (USAID)*.
of Saudi Arabia; Malawi; Maldives; Malaysia;
Mauritania; Morocco; Myanmar; Nepal; The
Netherlands; Nigeria; Oman; Pakistan; Republic The following WHO Regional Offices: WHO
of Korea; Singapore; South Africa; Suriname; Regional Office for the Americas (AMRO); WHO
Tanzania; Thailand; Timor-Leste; Togo; Uganda; Regional Office for Africa (AFRO); WHO Regional
United Kingdom; United States of America; Office for the Eastern Mediterranean (EMRO);
Vietnam; and Zambia. WHO Regional Office for Europe (EURO); WHO
Regional Office for Southeast Asia (SEARO); WHO
Regional Office for the Western Pacific (WPRO).
The following international organizations: Food
and Agriculture Organisation (FAO); International
Civil Aviation Organization (ICAO); International The following WHO Headquarters departments:
Federation of the Red Cross and Red Crescent Country Preparedness and IHR (CPI/WHE);
Societies (IFRC); International Organization Infectious Hazards Management (IHM/WHE);
for Migration (IOM); International Medical Emergency Operations (EMO/WHE); Health
Corps (IMC); United Nations Children’s Fund Emergency Information and Risk Assessment
(UNICEF); United Nations Office for Disaster Risk (HIM/WHE); Service Delivery and Safety (SDS/
Reduction (UNISDR)*; United Nations World Food HIS); Public Health and Environment (PHE/FWH);
Program (WFP)*; United Nations World Tourism Health System Governance and Financing (HGF/
Organization (UN-WTO); World Organisation for HIS).
Animal Health (OIE)*.
vii
A STRATEGIC FRAMEWORK FOR EMERGENCY PREPAREDNESS
Executive summary
The Strategic Framework for Emergency The Framework identifies twelve core
Preparedness is a unifying framework which components that represent distinct areas of work.
identifies the principles and elements of effective These include components associated with the
country health emergency preparedness. It adopts strengthening of the following areas.
the major lessons of previous initiatives and lays
• Governance: national policies and legisla-
out the planning and implementation process by
tion that integrate emergency preparedness;
which countries can determine their priorities and plans for emergency preparedness, response
develop or strengthen their operational capacities. and recovery; and coordination mechanisms
The framework capitalizes on the strengths of • Capacities: assessments of risks and capac-
current initiatives and pushes for more integrated ities to determine priorities for emergency
action at a time when there is both increased preparedness; surveillance and early warning;
political will and increased funding available to information management; access to diag-
support preparedness efforts. nostic services during emergencies; basic
and safe health and emergency services; risk
The health emergency preparedness framework communications; and research, development
advocates for prioritizing financial and other and evaluations to inform and accelerate
resources for community and country emergency emergency preparedness.
preparedness, and for mobilizing and sustaining • Resources: financial resources for emergency
increased domestic and international investment preparedness and contingency funding for
response; logistics mechanisms and essential
for these.
supplies for health; dedicated, trained and
equipped human resources for emergencies.
The types of events covered by in this framework
include local and national outbreaks of infectious The process for strengthening these core
diseases that have the potential to cross borders; components of emergency preparedness must
epidemics and pandemics; and other types of follow an iterative cycle. This cycle starts from
emergencies caused by natural, technological and assessing risks and capacity, and moves through
societal hazards that can have a significant impact establishing coordinating mechanisms, planning,
on people’s health and on society. financing and implementing, to evaluating and
taking corrective action.
A common, efficient, coordinated multisectoral
approach, comprising all-hazard and hazard- Exercises provide evidence-based assessments to
specific measures, is needed to ensure monitor and strengthen emergency preparedness.
preparedness for all types of emergencies at the
community, national and international levels. Ensuring health security at all levels of society
At the national level, emergency preparedness relies on coordinated multisectoral action and
should set out to achieve the following strategic investment to build consolidated emergency
objectives: preparedness. When prepared, responses are
more timely and effective, and the human,
1. Operational readiness to respond to emer- economic and societal consequences of
gencies emergencies can be significantly limited.
2. Resilient health system
Investment in this strategy to reduce the number
3. One Health at the human-animal-environ- and severity of such emergencies is critical.
ment interface
4. A whole-of-government, whole-of-society
approach.
ix
A STRATEGIC FRAMEWORK FOR EMERGENCY PREPAREDNESS
1
3. Context On the basis of past trends, an important and
frequently cited challenge to sustained action on
of this emergency preparedness has been inconsistent
framework
financing. Sustained funding from national and
international financial institutions is essential to
achieving emergency preparedness, but for the
most part resources have been insufficient to
National governments and the international
develop capacities or test even the best of plans.
community, including international financial
Emergency responses of appreciable magnitude
institutions and development partners, have
are generally followed by a rapid decline in
demonstrated their commitment to working
attention and funding. This is despite the fact
together to improve emergency preparedness
that past emergencies have reinforced the need
at all levels. Disasters caused by natural hazards,
for the world’s political, financial and health
protracted crises associated with conflicts, and the
establishments to work together to strengthen
international spread of infectious diseases – the
preparedness.
latter recently highlighted by the Ebola epidemic
in West Africa – have increased recognition Emergency preparedness is addressed by a range
of the profound effects of emergencies on of global frameworks and initiatives related to
development. The implementation of the health, emergencies and disasters. These include:
sustainable development goals (SDGs), especially
in low-resource settings, will be strengthened by • T
he SDGs
stronger emergency preparedness. Investment in • T he International Health Regulations (IHR
this strategy to reduce the number and severity of 2005)
emergencies is critical. It should be accompanied • The Sendai Framework for Disaster Risk Re-
by strengthening of health and other societal duction 2015-2030
systems to improve the availability and quality • The Pandemic Influenza Preparedness (PIP)
of, and access to, the basic services upon which Framework
communities rely. • The World Organization for Animal Health
(OIE) Performance of Veterinary Services (PVS
Countries have been working on emergency Pathway)
preparedness for many years, demonstrating • The Paris Agreement on Climate Change
that a high level of preparedness contributes • The Global Health Security Agenda (GHSA)
to effective responses to many types of • Universal Health Coverage (UHC) 2030.
emergencies, and reduces their health and other
consequences. This experiences of this work These are complemented by regional strategies
have highlighted the value of public, private that address preparedness and disaster risk
and community partnerships within and across management around the world, such as the Asia-
sectors, acknowledging and reflecting the roles Pacific Strategy for Emerging Diseases (APSED);
that various stakeholders play in emergency the Integrated Disease Surveillance and Response
preparedness. (IDSR) framework; and Health 2020 in the
European Region.
Levels of preparedness remain uneven across and
within countries, however, leaving communities The framework for emergency preparedness is an
and states at risk of significant short- and long- effort to help achieve greater coherence between
term health and other societal impacts. The these varied global and regional frameworks. It
recent Report of the UN Secretary-General’s captures the opportunities currently available,
High-Level Panel on the Global Response to capitalizing on the strengths of current initiatives
Health Crises, Protecting Humanity from Future for more integrated action at a time when there is
Health Crises, declared that the Ebola outbreak in both increased political will and increased funding
West Africa (2013-2016) must ‘serve as a wake-up available to support preparedness efforts. It
call for increased global action to prevent future adopts and outlines the major lessons of previous
health crises’. emergency preparedness initiatives.
2
A STRATEGIC FRAMEWORK FOR EMERGENCY PREPAREDNESS
preparedness
of communities and countries. A focus on
systems is extremely important to emergency
preparedness, because it is not only specific
This framework is built upon the following set of activities and actors that are needed to build
principles: stronger systems, but also the right rela-
tionships between them. Strong human and
1. Safeguarding, maintaining and restoring the animal health and other societal systems are
health and wellbeing of communities. These the foundations of emergency preparedness.
are the highest priorities for emergency pre- Conversely, emergency preparedness builds
paredness. Improving the state of individual, the resilience of these systems.
community, and national health security in
every country, and particularly in higher-risk, 6. Emergency preparedness should be ad-
low-capacity countries, contributes to global dressed with an all-hazards approach. Many
health security and helps raise the level of elements of emergency preparedness are
health security for all. common to all hazards, and plans for emer-
gency preparedness should be designed
2. Communities are critical to effective emer- to incorporate them. There is also a need
gency management. Community members for hazard-specific emergency prepared-
are the first responders – and the first victims ness measures based on risk assessments,
– of any emergency and, as such, essential and these should build on and supplement
members of the preparedness process. They all-hazard plans as appropriate.
should be represented in all activities around
developing and implementing plans for emer- 7. A risk management approach underpins the
gency preparedness. assessment, planning and implementation of
emergency management actions including
3. Preparedness requires sustained political prevention and mitigation of risks, prepared-
commitment, partnerships, and funding. The ness activities, coordinated response, and
management of emergencies by authorities, recovery and reconstruction. Emergency risk
including governments, often has significant management should continue to emphasize
political dimensions. Political leadership and prevention measures to avoid hazards and
attention, combined with strong community reduce vulnerability.3
and national ownership, should be accorded
to preparedness in a sustained manner, just 8. A whole-of-society approach is critical for
like funding. Emergency preparedness is a emergency preparedness. Addressing the
shared responsibility that requires coordi- health dimensions of emergency prepared-
nation between communities and national ness requires the health system to interact
and international actors. It also necessitates with other government sectors at all levels of
effective partnerships between public and the national system; the commercial sector;
private actors, civil society, donors, technical and civil society, including non-governmental
agencies and operational entities. and community organizations.
3 Despite these preventive efforts, events will occur requiring preparedness, response and recovery. This framework is concerned with the process of preparing to
respond and recover from emergencies.
3
5. Framing emergency • International and regional: Global and region-
al preparedness is essential for responses to
preparedness emergencies that surpass the capacities of
local and national authorities . Even when na-
tional authorities are capable of managing an
emergency with health consequences, they
benefit from external resources, commodities
Preparedness for emergencies relies on a set of and technical assistance that supplement
complex, multidimensional processes that are (rather than replace) national actions. Inter-
difficult to operationalize if any of the pieces national and regional actors also provide a
is missing. Although a number of approaches range of technical and financial assistance
to emergency preparedness are available, this that can strengthen country and community
framework considers two main issues: (1) the level preparedness.
at which preparedness is implemented; and (2)
2. Strategic approach to emergency
strategic approaches to preparedness.
preparedness
1. Emergency preparedness needs to be imple- Key elements of emergency preparedness
mented at all levels presented in this framework have been identified
• Community: Effective emergency prepared- from an analysis of the following four strategic
ness can only be achieved with the active par- outcomes:
ticipation of local governments, civil society
organizations, commercial organizations, local 1. Operational readiness to respond to emer-
leaders, and individual citizens. Communities gencies: a high level of readiness will allow
must take ownership of their preparedness a timely, effective and efficient response.
and strengthen it for emergencies ranging Achieving readiness is a continuous process
in scale from local or national events to of establishing, strengthening and maintain-
pandemics and disasters. In addition, local, ing a multisectoral response infrastructure
subnational and national plans should include that can be applied at all levels, which follows
support for community emergency prepared- an all-hazard approach and which a focus-
ness; this means that community representa- es on the highest priority risks. Operational
tion in the development of national policies
and processes should be assured to the readiness builds on existing capacities to de-
greatest extent possible. Communities should sign and set up specialized arrangements and
also be included in the implementation of all services for emergency response. It requires
emergency preparedness activities, especial- political commitment, coordination, risk
ly locally. Local and international NGOs, the assessment, infrastructure, preparedness and
private sector and other community actors response plans, financing, human resources,
play important roles in community-based equipment, exercises, and knowledge.
emergency preparedness, providing addition-
al resources to complement the capabilities 2. Health systems resilience: Health systems—
of the state. which include essential public health func-
• National/subnational/local: The overall re-
tions and the capacities of related societal
sponsibility for safeguarding, maintaining and systems—are the foundation for emergency
restoring the health and wellbeing of commu- preparedness for known and emergent
nities lies with national governments. Many hazards, and must be strengthened. Emer-
of the rights and obligations set out by the gency risk management and preparedness
IHR (2005), the Sendai Framework and other help make a health system more resilient. It
international agreements are the responsibil- is important to recognize the importance of
ity of the Member State. Usually, national or investing in underlying health system capaci-
subnational policies and legislation describe ty: for example, emergency preparedness re-
the roles and responsibilities of ministries,
quires a health workforce which is adequately
local government and other stakeholders
for emergency preparedness. Preparedness staffed and which has an appropriate, equita-
efforts should be made for emergencies that bly distributed mix of skills and competencies.
occur on a local or national scale as well as This workforce must be properly remunerat-
for large-scale disasters and pandemics with ed, supported and motivated to carry out its
international ramifications. duties in routine and emergency situations.
4
A STRATEGIC FRAMEWORK FOR EMERGENCY PREPAREDNESS
Emergencies often require scaled-up health between human and animal health services,
services to address surges in the health needs and the cooperation of these services in
of affected people. They can also disrupt the emergency preparedness activities.
delivery of routine health services, necessi-
4. Whole-of-government/whole-of-society
tating plans for continuity of existing health
approach: Emergencies have widespread
systems, or for temporary health services in
effects on many parts of society, and the
areas affected by emergencies. These situa-
health sector has an important role to play in
tions highlight the importance of the specific
all of them. Integrated support for emergency
aspects of health systems that support pre-
preparedness across all sectors of govern-
paredness, including:
ment and society, including non-govern-
a. Development, training and equipping of a mental and private sector organizations and
health emergency workforce essential services, is paramount. Focus should
b. Maintenance of structurally and func- be on building relationships between health
tionally safe hospitals and other health and non-health sectors, and on coordinating
facilities planning and implementation of emergen-
c. A reliable supply of medicines cy preparedness. Interactions between the
ministry of health and all stakeholders at
d. Disease surveillance systems and laborato-
ry services all levels of the system are critical to emer-
gency preparedness and response, and help
e. Competent health service delivery for reduce the consequences of outbreaks and
people directly affected by the emergency
and other important health conditions other emergencies—not only for the health
and well-being of communities, but also for
f. Financing for emergency risk manage- economies, livelihoods, the environment and
ment, including preparedness as an inte-
gral part of national health financing other social assets.
g. Contingency funds for emergency situa- The national disaster management agency
tions. (NDMA) and/or the equivalent bodies
at subnational and local levels are often
designated as responsible for coordinating
3. One Health: Most emerging epidemic and
preparedness and response to many types
pandemic threats have a zoonotic origin.
of emergencies, including those caused by
Human health is intrinsically linked to the
natural and technological hazards. While the
health of animals and to the environment.
lead agency for the management of localized
The overall aim of the One Health approach
outbreaks is usually the Ministry of Health,
is to ensure connectivity and coordination at
in some situations – for example during
the human-animal-environment interface,
epidemics or pandemics – coordination of
to facilitate and improve the effectiveness of
numerous sectors is required. In such cases,
emergency preparedness at all levels. This
the lead may be transferred to another
involves strengthening all aspects of veter-
authority such as the NDMA. It is essential
inary health systems, as guided by the PVS to increase cooperation and collaboration
Pathway promoted by the OIE. For example, between health and other sectors (e.g.
the inclusion of veterinarians and other agriculture, water, energy, law enforcement,
animal health specialists in epidemiology and transport, migration, foreign affairs and
laboratory training programmes, and in all as- trade) before, during and after all types of
pects of emergency response planning, is an emergencies.
important element of emergency prepared-
ness. So too is the extension of epidemiologic The private sector plays an increasingly vital
surveillance systems to domestic animals role when limited resources are stretched
and wildlife habitats, with an emphasis on and overwhelmed. This underscores the
those areas where human-animal interaction need to strengthen private sector emergency
is most common and disease spillover most preparedness and proactive partnerships
likely. Joint review of capacity, which includes between government, small and large-
national IHR/PVS Pathway bridging workshops scale commercial organizations and other
and outbreak exercises, should be promoted. stakeholders as part of community and
It is critical to facilitate information-sharing country emergency preparedness.
5
6. Elements of
emergency
preparedness
Common elements for strengthening
preparedness, and information on their
application at community, local, subnational,
national, regional and global levels, can be found
in Annex 1. These include:
Governance
—— National policies and legislation that integrate
emergency preparedness
—— Plans for emergency preparedness, response
and recovery
—— Coordination mechanisms
Capacities
—— Assessments of risks and capacities to deter-
mine priorities for emergency preparedness
—— Surveillance and early warning, information
management
—— Access to diagnostic services during emergen-
cies
—— Basic and safe health and emergency services
—— Risk communications
—— Research development and evaluations to in-
form and accelerate emergency preparedness
Resources
—— Financial resources for emergency prepared-
ness and contingency funding for response
—— Logistics mechanisms and essential supplies for
health
—— Dedicated, trained and equipped human re-
sources for emergencies
6
A STRATEGIC FRAMEWORK FOR EMERGENCY PREPAREDNESS
7
For the development of the national
action plan, a process for prioritization and 8. The way forward
timeframes for implementation that take
into account available resources must be in The world is at a moment of convergence. The
place. All efforts should be made to secure majority of stakeholders—whether national
the resources needed to operationalize the ministries, civil society, or international agencies—
highest-priority response capacities. understand that they must take concerted action.
• Implementing: Successfully implementing Protecting public health from emergencies and
a national action plan requires a number of ensuring health security at all levels of society
things. A coordination mechanism, involving relies on coordinated multisectoral action and
stakeholders with responsibilities identified investment to build consolidated emergency
in the national action plan, should oversee preparedness. This strategic framework has been
and monitor progress. The participation of developed by the World Health Organization in
stakeholders in planning is essential to ensure collaboration with interested and committed
commitment to, and ownership of, emer- stakeholders to capture this momentum, acting on
gency preparedness measures. The priorities the universal desire to prepare for all emergencies
for strengthening emergency preparedness
should be described clearly in the action plan; that threaten people’s health worldwide.
responsibilities and accountabilities should
be clearly identified; and sufficient resources
should be available to put actions into prac-
tice over the duration of the plan. Another
important factor is the need to limit the time
lag between development and implementa-
tion of the plan, to maintain momentum and
commitment to emergency preparedness.
• Evaluating and taking corrective action:
Emergency preparedness is a dynamic
process. The implementation of emergency
preparedness plans should be monitored and
evaluated in line with pre-defined indicators
and standardized tools and processes, and
should be reported accordingly. Reviews
should be conducted at pre-agreed times by
the coordinating body, or by an independent
body convened for the purpose. Where there
are changes in risk priorities or in the avail-
ability of capacities and resources, or where
post-emergency or post-exercise reviews have
identified areas for improvement, corrective
action should be applied to the assessment,
planning and prioritization of emergency
preparedness activities.
• Exercising: Exercises provide evidence-based
assessments for the monitoring and strength-
ening of emergency preparedness. As training
tools, exercises are useful to help build indi-
vidual competencies, allowing participants to
learn and practice their roles in emergencies.
As quality assurance tools, exercises can test
and evaluate emergency policies, plans and
procedures at organization- or system-wide
levels. After exercises have been conducted,
action should be taken to institute the rec-
ommendations for strengthening emergency
preparedness.
8
Annex 1. Elements of preparedness at all levels
Financial resources for • Availability and access to budgets • Domestic funding committed to • International funding directly aligned with
emergency preparedness and other resources for emergency emergency preparedness priorities from country preparedness plans and priorities
and contingency funding for preparedness national health financing, regular health • Multisectoral and organizational contingency
emergency response • Availability and access to budgets and emergency budgets funding for emergencies
emergency contingency funds • Establishment and resourcing of
contingency funding mechanisms for
emergency response
Dedicated, trained and • Training of health workers in all- • Multi-hazard multisectoral training courses • Technical guidance and assistance for
equipped human resources for hazards emergency preparedness include health preparedness of regional and global health
emergencies • Multi-stakeholder training of • Establishment and maintenance of emergency workforce (including teams and
community emergency volunteers specialized teams (e.g. emergency medical pools of experts)
on health aspects of emergencies teams, rapid response teams) and pools of • Pre-deployment training
experts • Agreements between countries for surge
• Health workforce development plans capacity
incorporate emergency-related functions,
address skill shortages and include public,
private and civil society sectors
Logistics mechanisms and • Access and availability to • Systems and agreements for stockpiling • Agreements for global prioritisation and
essential supplies for health emergency stocks and equipment at and maintenance of vaccines (including distribution of key supplies in emergencies
community level cold chain), antidotes, sampling, • Global and regional stockpiling, pre-
diagnostics, PPE and other essential positioning and preparedness of logistics
supplies systems for distributing essential supplies for
• Emergency preparedness of logistics emergencies
systems to support health in emergencies
A STRATEGIC FRAMEWORK FOR EMERGENCY PREPAREDNESS
emergencies
throughout history. Even a relatively
mild pandemic, such as the one caused
by influenza A(H1N1) in 2009, requires
a substantive response. A pandemic of
Emergency preparedness is required for the
greater severity would have a profound
following types of emergencies.
impact on the nature of the response in
1. Emergencies due to natural hazards many countries. Two prominent features
of pandemics that need to be considered
a. Biological hazards when undertaking pandemic prepared-
I. Local and national outbreaks: Some ness planning are as follows: (1) societal
diseases have relatively low pandemic po- functions are likely to be seriously com-
tential— Ebola, for example, because of promised; and (2) external assistance for
its route of transmission (and in spite of countries whose capacities are surpassed
how it is portrayed in much of the world’s is not assured, because by definition all
media). Others, such as meningitis, are countries will be affected and will have to
unlikely to progress beyond national or deal with their own domestic emergen-
regional outbreaks, although they have cies. Country and community emergency
the potential to be quite serious and to preparedness for pandemics involves
warrant consideration as public health readiness to reduce transmission and
emergencies of international concern manage the response with limited access
(PHEICs). Many other communicable to vaccinations, drugs and other forms of
diseases threaten communities and dis- assistance.
tricts without posing an important threat b. Emergencies due to hydrometeorological
to global health. The relatively limited and geophysical hazards: Sudden-onset
nature of these outbreaks has important and slow-onset emergencies due to natu-
implications for the kinds of preparedness ral hazards, resulting in direct and indirect
that are required; their management effects on health and disruption of societal
depends largely on the ability of national and health systems (and the further possi-
and local health systems to detect them bility of outbreaks), require multisectoral
and to respond rapidly and competently, and health sector preparedness. Techno-
albeit at times with external assistance. logical events, outbreaks of communicable
Importantly, the management of out- disease and other secondary hazards may
breaks of this nature, if well executed, can follow natural hazard events that cause
usually remain largely under the authority disruption of societal functions (including
of the ministry of health or designated health services), and countries must be
health agencies. prepared to deal with them.
II. Outbreaks due to pathogens with pan- 2. Emergencies due to human-induced hazards
demic potential: There are several known
pathogens currently circulating that are a. Emergencies due to technological hazards
potentially highly transmissible among Emergencies may arise from a range of
humans and which have been detected in technological hazards with the potential
numerous countries, but which have not to cause localised effects or to result in
yet reached pandemic status: MERS CoV widespread regional or global phenomena.
and avian A(H5N1) influenza are exam- These can originate from technological
ples. Approaches to preparing for these or industrial conditions, dangerous
may be fundamentally different than for procedures, infrastructure failures or
the other categories of threat presented specific human activities. Examples include
here. industrial pollution, nuclear radiation, toxic
13
waste, dam failures, transport accidents,
factory explosions, fires and chemical spills. Appendix 2.
Technological hazards may also arise from Working definitions
for this framework
the impacts of other hazardous events.
b. Emergencies due to societal hazards
Societal hazards are mostly associated
with different forms of violence on scales Emergency preparedness: the knowledge,
ranging from civil unrest through armed capacities and organizational systems developed
conflicts and terrorism to the deliberate by governments, response and recovery
use of chemical, biological, radiological and organizations, communities and individuals
nuclear agents (CBRN). Armed conflicts effectively to anticipate, respond to, and recover
can cause great morbidity and loss of life from the impacts of likely, imminent, emerging, or
and disruption to basic services including current emergencies.
health that can last for many years, even
decades. A range of preparedness and An emergency: an event or threat that produces
response measures are required to deal or has the potential to produce a range of
with the consequences of these complex consequences that require urgent, coordinated
situations, which often include migration, action.
population displacement and lack of
security for affected populations and Comment: an emergency may have limited
personnel providing health and other consequences in a circumscribed area, or
services. National and local resources in catastrophic consequences on a global scale.
conflict situations are often complemented The impact of an emergency may exceed the
by international assistance from the UN capacity of a community or a state to cope using
system, non-governmental organizations its own resources, and external assistance may be
and the Red Cross and Red Crescent required. This type of emergency is often termed
Movement. Countries facing protracted a disaster. Emergencies may pose a substantial
crises may also experience other types of risk of significant morbidity or mortality in
emergencies, for example outbreaks and a community. Emergencies may result from
earthquakes, for which further emergency naturally occurring outbreaks; from accidental
preparedness, response and recovery or intentional release of pathogenic agents; from
measures are needed. the consequences of natural and technological
hazards such as earthquakes, typhoons, volcanic
Societal hazards also include financial crises, eruptions, chemical or radiological emergencies;
which can constrain national budgets, affect or from societal hazards including violence and
the socioeconomic and health status of conflict.
individuals and households, and severely
reduce access to health services, triggering A plan: a document designed to identify, at
emergency situations for communities and various levels, responsibility for a range of
countries. activities aimed at meeting specific objectives and
at implementing accompanying strategies and
tactics.
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A STRATEGIC FRAMEWORK FOR EMERGENCY PREPAREDNESS
specific ERPs, and can detail the resources, • Pandemic Influenza Preparedness Framework
capacities, and capabilities that each ministry http://www.who.int/influenza/resources/
will employ in its response. A whole-of-society pip_framework/en/
ERP also includes contributions from the private • Paris Agreement with the Framework of the
sector. United Nations Framework Convention on
Climate Change
Risk: the combination of the probability of an
• Sendai Framework for Disaster Risk Reduction
event and its consequences. Risk results from 2015-2030 http://www.unisdr.org/we/
interactions between natural and human-induced coordinate/sendai-framework
hazards, vulnerability, exposure, and capacities.
• Sustainable Development Goals http://www.
un.org/sustainabledevelopment/sustainable-
Risk assessment: the process of determining
development-goals/
those risks to be prioritized for risk management
by a combination of risk identification, risk • United National Plan of Action on Disaster
analysis, and evaluation of risk level. A risk Risk Reduction for Resilience (UNISDR) http://
assessment includes a review of the technical www.preventionweb.net/publications/
characteristics of hazards, analysis of exposures view/33703
and vulnerability, and evaluation of the • Comprehensive Safe Hospitals Framework
effectiveness of existing coping capacities. (WHO) http://www.who.int/hac/
techguidance/comprehensive_safe_hospital_
Risk management: coordinated activities to direct framework.pdf?ua=1
and control risk in order to minimize potential • Early Detection, Assessment and Response to
harm. These activities include risk assessments, Acute Public Health Events: Implementation
implementing risk treatment or response of early warning and response with a focus on
measures, and evaluation, monitoring, and review. event-based surveillance (WHO)
English: http://www.who.int/ihr/publications/
WHO_HSE_GCR_LYO_2014.4/en/
Appendix 3. French: http://www.who.int/ihr/publications/
Frameworks and
WHO_HSE_GCR_LYO_2014.4/fr/
Russian: http://www.who.int/ihr/
assessment tools
publications/WHO_HSE_GCR_LYO_2014.4/ru/
Spanish: http://www.who.int/ihr/
preparedness
• Framework for a Public Health Emergency
Operations Centre (WHO) http://www.who.
int/ihr/publications/9789241565134_eng/en/
Global strategies and frameworks • Global Action Plan on Antimicrobial
• IASC/UNDG/UNISDR Common Resistance (WHO) http://who.int/
Framework for Preparedness https:// drugresistance/global_action_plan/en/
interagencystandingcommittee.org/iasc- • Recovery toolkit: Supporting countries to
transformative-agenda/content/common- achieve health service resilience (WHO)
framework-preparedness http://www.who.int/csr/resources/
• International Health Regulations (2005) publications/ebola/recovery-toolkit/en/
http://www.who.int/topics/international_
health_regulations/en/ Regional strategies
• OIE Performance for Veterinary Services • Asia Pacific Strategy for Emerging Diseases
Pathway http://www.oie.int/support-to-oie- (SEARO/WPRO) www.wpro.who.int/
members/pvs-pathway/ emerging_diseases/APSED2010/en/
• Operational Framework for Building Climate • Disaster Risk Management: A health sector
Resilient Health Systems (WHO) strategy for the African Region (AFRO) https://
http://www.who.int/globalchange/ www.aho.afro.who.int/en/ahm/issue/18/
publications/building-climate-resilient-health- reports/disaster-risk-management-strategy-
systems/en/ health-sector-african-region
15
• Europe 2020 http://www.euro.who.int/en/ • OIE Tool for the Evaluation of Performance
health-topics/health-policy/health-2020-the- of Veterinary Services http://www.oie.int/
european-policy-for-health-and-well-being support-to-oie-members/pvs-evaluations/oie-
• Strategic Plan for Disaster Risk Reduction and pvs-tool/
Response 2013-2018: A more resilient health • PAHO Health Sector Self-Assessment Tool for
sector in the Americas (PAHO) Disaster Risk Reduction (WHO/PAHO)
• Framework of Action for Disaster Risk http://www.paho.org/disasters/index.
Management for Health (WPRO) http://www. php?option=com_content&view=art
wpro.who.int/publications/9789290617082/ icle&id=1375%3Ahealth-sector-self-
en/ assessment-tool-for-disaster-risk-
reduction&Itemid=924&lang=en
• European Strategic Action Plan on Antibiotic
Resistance http://www.euro.who.int/en/ • Toolkit for assessing health system capacity
about-us/governance/regional-committee- for crisis management (EURO) http://www.
for-europe/past-sessions/sixty-first-session/ euro.who.int/en/publications/abstracts/
documentation/working-documents/wd14- strengthening-health-system-emergency-
european-strategic-action-plan-on-antibiotic- preparedness.-toolkit-for-assessing-health-
resistance system-capacity-for-crisis-management.-part-
1.-user-manual-2012
International initiatives • WHO Emergency and Disaster Risk
Management for Health Survey Tool (WHO)
• Global Health Security Agenda
• WHO Laboratory Assessment Tool
www.ghsagenda.org
English: http://www.who.int/ihr/publications/
laboratory_tool/en/
Assessment Tools French: http://www.who.int/ihr/publications/
laboratory_tool/fr/
• Assessment Tool for Core Capacity
Russian: http://www.who.int/ihr/
Requirements at Designated Airports, Ports
publications/laboratory_tool/ru/
and Ground Crossings http://www.who.int/
Spanish: http://www.who.int/ihr/
ihr/publications/PoE/en/
publications/laboratory_tool/es/
• Benchmarks, Standards and Indicators of
Emergency Preparedness and Response Information sharing platform: the Strategic
(SEARO) http://www.searo.who.int/entity/ Partnership Portal
emergencies/topics/EHA_Benchmarks_
Standards11_July_07.pdf
The Strategic Partnership Portal (SPP) is a WHO
• Emergency Response Preparedness Guidance
(IASC) https://www.humanitarianresponse. coordination tool that provides comprehensive,
info/en/programme-cycle/space/emergency- up-to-date reporting of health security
response-preparedness-guidance-and- contributions made by donors and partners; notes
templates the collaborations between various stake-holders;
• Hospital Safety Index 2nd Edition, Guide and identifies the specific needs and gaps each
for Evaluators (WHO) http://www.who.int/ country faces in building its IHR capacities. Such
hac/techguidance/hospital_safety_index_ information is crucial to improve transparency and
evaluators.pdf?ua=1 facilitate future collaborations.
• IHR Joint External Evaluation Tool
(WHO) http://www.who.int/iris/ In addition, under WHO’s new Outbreaks and
handle/10665/204368 Health Emergencies (OHE) programme, the
• Initial Assessment of National Surveillance (in SPP plays a central role in country emergency
press) preparedness, reporting the recommendations
• Initial Assessment of Public Health of the Joint External Evaluations (JEE) and other
Surveillance of Events Related to Points of elements of the IHR Monitoring and Evaluation
Entry (in press) Framework (IHR MEF) to link countries with
• Joint Assessment of National Health donors and partners interested in supporting
Strategies (International Health Partnership +) implementation of national action plans.
http://www.internationalhealthpartnership.
net/en/key-issues/national-health-planning- • Strategic Partnership Portal (WHO)
jans/ https://extranet.who.int/donorportal/
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A STRATEGIC FRAMEWORK FOR EMERGENCY PREPAREDNESS
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