​General
10. The Incident Management System establishes rapid deployment mechanisms appropriate to the emergency to ensure WHO has the immediate response capacity to meet urgent needs. Operations Supports and Logistics (OSL) works with the medical department to assess the needs, develop proposals and set up healthcare structures according to the assessment outcome and field context, such as security, material availability and local capacities.
Health Care Facilities (HCF)
20. Emergency Health Care Facilities Definition: emergency health care facility does not intend to replace the existing local capacities but to reinforce them in the emergency context, and applies to emergencies that are officially graded by the Director General (Grade 1, 2 or 3) through the grading exercise under WHO's Emergency Response Framework protocols. This process applies to structures that are immediately required to ensure medical care provision within an emergency, and they could be divided into two different types:
- Emergency Health Care Facility: is a category of walk-in clinic focused on the delivery of ambulatory care outside of a traditional emergency department. It could be primarily focused on treating injuries (such as in a mass casualty plan response or within a war context) or illnesses requiring immediate care (such as food intoxication) and as part of an immunization campaign carried out as an emergency response (such as a vaccination site).
- Infectious Diseases Health Facility: a clinic category focused on treating specific infectious diseases with epidemic potential, endemic or not. These facilities are designed and built following specific criteria to strengthen infection prevention and control measures to provide safe medical care.
30. Emergency HCF Principles:
- Rapid deployment (or construction) and specific disease standards compliant.
- Secured, safe, equipped and adapted for specific medical care provision.
- Cost-effective in terms of operation and maintenance.
- Pre-assembled kit, disease-specific, available to allow a simple and quick installation.
40. HCF Construction Process:
The key principle for emergency health care facilities is rapid deployment/construction and quick opening. Therefore, using predefined, preassembled emergency kits with dedicated handbooks for construction and management processes ensures the provision of critical facilities and avoids any delay in the overall emergency response operation. This is also in line with WHO's "No Regrets" policy and could be resumed in the following steps:
- Needs identifications: medical and IPC needs, bed capacity, expected opening delay, ground and context assessment, etc.
- Construction proposal (including kit availability): design, setup, internal or outsourcing approach, chronogram and budget.
- Construction and opening phase.
50. HCF handover and decommissioning: When the emergency is over, a disease-specific decommissioning process has to be undertaken by OSL before dismantling the healthcare facility. In case of handover to another partner or local counterpart, a detailed inventory should be performed, and consumables donation is foreseen to assure HCF operation continuity.
OSL support to Case Management
60. OSL Responsibilities:
OSL is responsible for the overall construction and running of the healthcare facility. It includes furnishing, assuring constant supply, energy, security, management and sourcing external services to meet operational requests. Training staff and providing adequate management and follow-up tools are also OSL's responsibility.
70 . Technical Responsibilities:
OSL is responsible for the health facility layout and design, matching the adequate IPC standards and engineering measures to specific disease modes of transmission (in collaboration with the specific disease technical unit) and supporting the construction with technical recommendations and minimum requirements for WASH, IPC, construction, energy and security (in collaboration with Security department) and providing training packages for staff and adequate management and follow-up tools.
80. OSL Interface: The interface between OSL and IMS occurs between the governance of the Incident Management System and the autonomy of the OSL deployment process within the emergency response operations. Therefore, it is vital that there is a proactive and close relationship between OSL and IMS to facilitate the understanding of the requirements.
90. SPHERE standards & Guidelines: According to specific field needs, OSL will develop the health facility construction proposal considering the highest standards available (always compliant with SPHERE standards) and following the most updated guidelines and best practices.
100. Local OSL: Responsibility for assessment (structure, ground, security, etc.) design and construction is handled by the OSL - Tech team supported by the WCO function (if present).
110. OSL technical expertise: Upon request, OLS is available to provide technical advice to emergency operations, including "ad hoc" field support for specific situations.
120. Reporting: All construction and rehabilitation activities implemented during the emergency response procedure must be reported (supported by narrative, technical reports and timeframe estimation) to the IMS as they may have significant financial/operational implications.
Emergency HCF Deployments
130. The WHO administrative procedures related to health care facilities construction are also applied to the emergency process. However, the requirements in each step may be adapted to suit the emergency and/or have specific time limits placed on them.
140. HCF Kits definition: OSL and technical departments work together on designing and developing standard-specific disease kits to cover a wide range of emergency scenarios, assuring quality, rapid deployment with consumable items to ensure rapid response capacity in the field and constant updates according to the latest innovations.
150. Technical Support: HCFs constructed during an emergency need to be regularly evaluated, maintained, and, if needed, readapted to the operational needs according to the evolving scenario. This may include moving from an acute emergency with a temporary structure to a protracted situation with more permanent facilities.
160. Minimum requirements and standards: Healthcare facility minimum requirements and standards must always be met and, according to the specific disease scenario, adapted to the highest available standards.
170. Direct/indirect HCF operational costs associated: Whatever HCF would be constructed, coming from OSL kits or local construction through outsourced service or internal management, direct and indirect operational costs will be incurred. Not only for purchase, construction and transport but also for management and external service providers. Collaboration between OSL and IMS is needed to ensure proper planning and budget forecasting
180. Exit strategy: A clear exit strategy should be defined as soon as possible to ensure a smooth transition. While some diseases have clear criteria to declare the outbreak over, for other pathogens might be more complicated, and the decision taken considering other aspects. To set the exit strategy, it is essential to collaborate with the IMS team, CO and local authorities.
