XVII.4.4.2 WHO Simulation Exercise Programme (SimEx)

 

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Scope

10.       In a simulation exercise (SimEx), participants explore, practice, and/or evaluate capabilities by formulating a response to a described or simulated emergency. This may require participants to undertake assigned roles as they would in a real emergency and activate real procedures or deploy equipment based on the complexity of the exercise and the objectives to be tested

20.       Simulation exercises can also be used as scenario-based training to teach participants new procedures or processes.

30.       A key component of the preparedness and response cycle, simulation exercises are integrated into the WHO Health Emergencies Programme (WHE) Simulation Exercise Workplan (WHE SimEx Workplan) to inform emergency preparedness and response at the policy, strategic, and operational levels. They also foster organizational learning and understanding of emergency management processes and procedures through training.

40.       The purpose of a SimEx Workplan includes the following:

• enable participants and decision makers to understand how plans and procedures, operational guidelines and standard operating procedures contribute to emergency planning by testing and reviewing core policies and procedures;
• reinforce interoperability between these plans and procedures;
• highlight planning weaknesses and resource gaps and point to possible ways forward;
• improve communication and coordination;
• clarify roles and responsibilities;
• practice and clarify the chain of planned operational methods;
• develop a greater understanding of emergency response; and
• gain global recognition of and trust in WHO's emergency management processes

Types of simulation exercises

50.       WHO conducts or participates in the following types of simulation exercises.

Discussion-based exercises: These are frequently referred to as tabletop exercises (TTX) and include facilitated discussions to identify and resolve problems and refine response plans. Discussion-based exercises may also have a training element so participants can explore key elements of their emergency management processes.


Operational-based exercises are more complex exercises involving real actions and/or the deployment of real equipment, personnel and/or resources. Operational-based exercises typically fall into three thematic groups:

• Drills are supervised activities to test or train a single operation or function in a response plan. Some drills repeat the activities multiple times within a short duration to reinforce good practice.
  
• Functional exercises are simulated exercises to test multiple elements of the operational plan, often focusing on the coordination, integration and interaction of policies, procedures, roles and responsibilities. These exercises may also focus on specific capacities, such as procedures for rapid response teams, Emergency Operations Centres (EOCs), laboratory analysis or sample collection and transport.
  
• Full-scale exercises assess most of the emergency management system's functions simultaneously with mobilizing personnel, equipment, and resources. These are typically large multiday events involving multiple agencies and functions.
  

WHO's past and current practices

60.       WHO has consistently used simulation exercises across the organization, ranging from testing multiple functions, such as national plans and procedures, to specific functions, such as managing disease-specific outbreaks.

70.       WHO public health simulation exercises are often used to enhance response systems (some examples include public health emergency operations centre (PHEOC) exercises, universal health care (UHC) SimEx, and pandemic influenza SimEx). WHO has also used SimEx to support the National Action Planning for Health Security (NAPHS) and Universal Health and Preparedness Review (UHPR) processes and has used the results of exercises to inform the Joint External Evaluation (JEE).

80.       Simulation-based training has included emergency medical team (EMT) training, Global Outbreak Alert and Response Network (GOARN) training, and health cluster training, among others

90.       Since 2016, WHO has supported 150 simulation exercises in Member States under the International Health Regulations Monitoring and Evaluation Framework (IHR MEF).

100.     WHO has also contributed to strategic, high-level inter-agency SimEx, such as the G7 health ministers meeting in Berlin, the large-scale International Atomic Energy Agency (IAEA) SimEx and the East African Community cross-border field SimEx.

Strategic approach

110.     The Thirteenth General Programme of Work (GPW 13), World Health Authority (WHA) Preparedness Resolution, the Global Preparedness Monitoring Board, and Health Emergency Preparedness, Response, and Resilience (HEPR) all call for a strategic approach to simulation exercises to establish and maintain effective preparedness across the three levels of WHO and in the Member States.

120.     The WHE SimEx Workplan will better protect 1 billion more people from health emergencies.

130.     The WHE SimEx Workplan will facilitate better global, regional, and national SimEx documentation. The workplan will address gaps in the global leadership and coordination of public health SimEx and strengthen the work of WHO at all levels in following up on exercise recommendations.

Objectives

140.     A WHE SimEx Workplan includes four objectives:

i. Strengthen the capacities of WHE, countries, organizations and public health institutions to systematically use simulation exercises to prepare for and manage health emergencies.

ii. Build strong and sustainable partnerships with public health institutions, academia and Member States and other relevant partners in the area of SimEx.

iii. Facilitate coordination and collaboration of public health policymakers, partners and the global SimEx community.

iv. Ensure the development, standardization and quality assurance of public health SimEx guidelines, tools and methodology.

Components

150.     A WHE SimEx Workplan includes four components:

i. Internal WHO SimEx Programme: a sustained exercise programme to test WHO`s internal emergency preparedness, readiness, business continuity and response capacities across the three levels of the organization.

ii. External SimEx Programme: supports Members States in planning, conducting and evaluating public health SimEx, as an evidence-based approach for strengthening national capacities and building resilient health systems.

iii. Inter-Agency SimEx Programme: enhances joint simulation exercises with sister UN agencies, public health partners, institutions, authorities, expert networks and other partners.

iv. Post-SimEx Implementation: supports Member States, WHO and partners to implement the SimEx findings and recommendations, document progress and best practices and share experiences.

Roles and responsibilities of headquarters, regional offices and country offices

160.     Headquarters (HQ) role for SimEx is to set the norms, standards and quality assurance of the exercises through the following responsibilities:

i. producing standard guidelines, tools and training methodologies; developing a mentoring programme; supporting a network of international experts and providing surge capacity as necessary to country and regional offices;

ii. establishing official collaboration and coordination agreements and arrangements with global (certified) partners and institutions (for example, PHE, United States Centers for Disease Control (USCDC), European Centre for Disease Prevention and Control (ECDC), universities, etc.);

iii. promoting comprehensive and inclusive SimEx (e.g. whole of government) between various programmes (WHE, HSS and disease-specific) and supporting the government to adopt the same approach;

iv. providing a framework to monitor and evaluate how SimEx outputs and findings support GPW 13 outputs; and being responsible for multi-sectoral and complex SimEx that require HQ leadership or support, as necessary.

i. supporting national training and capacity development on SimEx management;

ii. supporting Member States and (Inter-Agency) partners' SimEx as part of the Country Support Plans;

iii. monitoring national SimEx activities in line with GPW 13;

iv. promoting comprehensive and inclusive SimEx (e.g. whole of government) between various programmes (WHE, HSS and disease-specific) and supporting the government to adopt the same approach;

v. following up on the implementation of recommendations emanating from the SimEx conducted at the country level; and

vi. providing regular updates to the regional office on the progress of implementing corrective actions.