Introduction
10. The Global Health Cluster was established in 2005 under the leadership of WHO to promote and support collective action at the global and country levels to ensure more effective, efficient and predictable humanitarian health action.
20. In 2012, the World Health Assembly, through resolution WHA65.20, called on the WHO Director-General to:
- have in place the organizational capacity and resources to enable itself to discharge its function as the Global Health Cluster lead agency and assume a role as health cluster lead agency in the field; and
- define the Organization's core commitment, core functions and performance standards in humanitarian emergencies, including its role as the Global Health Cluster lead agency and the health cluster lead agency in the field.
WHO responsibilities as Global Health Cluster lead agency
30. WHO is ultimately responsible to the Emergency Relief Coordinator for ensuring it fulfils its lead agency role in the Global Health Cluster. At the global level, these responsibilities include:
- mainstreaming the cluster approach and the Transformative Agenda within WHO and ensuring they are understood within WHO departments and offices at global, regional and country levels;
- negotiating with other United Nations agencies around cluster issues that need to be reflected in global-level documentation;
- engaging in advocacy at the highest levels of the Inter-Agency Standing Committee (IASC) (including the Emergency Directors Group) and with donors and other concerned bodies on the needs and position of the Global Health Cluster;
- ensuring that adequate human and financial resources and administrative structures are available at global, regional and country levels; and
- liaising and collaborating with other global clusters to enhance holistic multi-cluster humanitarian responses for improved health outcomes and improved health.
Activating a health cluster at the country level
40. Cluster activation may be recommended where the following criteria are found to apply:
- response and coordination gaps exist due to a sharp deterioration or significant change in the humanitarian situation; and
- existing national response or coordination capacity is unable to meet needs in a manner that respects humanitarian principles due to the:
- the scale of need;
- the number of actors involved;
- the need for a more complex multisectoral approach; or
- other constraints on the ability of national mechanisms to respond to the situation or apply humanitarian principles.
50. In consultation with the humanitarian country team, The Resident Coordinator/Humanitarian Coordinator (RC/HC) determines which clusters should be recommended for activation. When a humanitarian country team has not yet been established, the UN country team takes on this role.
60. WHO is generally the cluster lead agency for the country health cluster, mirroring the global arrangement, but this may not always be the case. Other organizations may be better placed to lead the health cluster in exceptional circumstances.
70. Upholding and promoting policies on sexual exploitation and abuse (SEA) is critical in all operations in all countries. The health cluster is committed to the protection of sexual exploitation and abuse. One of the minimum commitments of being part of the health cluster is that all cluster partners must commit to the humanitarian principles, the principles of partnership, cluster-specific guidance and internationally recognized programme standards, including the Secretary-General's bulletin on special measures for protection from sexual exploitation and sexual abuse (Source Health Cluster Guide, p. 80).
Purpose and functions of the country health cluster
80. National authorities are primarily responsible for caring for the victims of natural disasters and other emergencies occurring in their territory. Still, the magnitude and duration of an emergency may require international cooperation to strengthen the response capacity of a country, as stated in UN General Assembly resolution 46/182 of 1991 (paragraphs 4–6).
90. At the country level, the purpose of the health cluster is to have all participating organizations working together in partnership to harmonize efforts and use available resources efficiently within the framework of agreed objectives, priorities and strategies for the benefit of the affected population and towards collective outcomes. The role of the country health cluster follows the six core functions of the Cluster Coordination Reference Module (IASC Reference Module for Cluster Coordination at Country Level, revised July 2015):
- support service delivery
- inform strategic decision-making
- plan and implement strategy
- monitor and evaluate performance
- build national capacity in preparedness and contingency planning
- support robust advocacy.
Health cluster roles and responsibilities at the country level
100. The designated cluster lead agency (CLA) leads and manages the cluster. It does so in co-leadership with government bodies and nongovernmental organizations where possible.
110. When WHO is designated as the CLA for health, the WHO Country Office (HWCO) has a dual role: representing both WHO and the other partners of the Health Cluster. The HWCO is responsible and accountable for the activities of the Health Cluster. As the head of the cluster, the HWCO is ultimately accountable to the Resident/Humanitarian Coordinator (RC/HC) for carrying out the CLA responsibilities and securing dedicated resources to establish strong health cluster coordination mechanisms to implement the six core functions of a country level cluster as defined by the IASC. The CLA also ensures accountability to affected populations (AAP) and protection mainstreaming.
120. The health cluster coordinator (HCC) is the neutral representative of the cluster as a whole and is responsible for the day-to-day coordination and facilitation of the cluster's work, including information systems. The cluster coordinator will ensure the accountability and transparency of the decisions and work of the cluster. Co-coordinators, subnational coordinators, information managers and other health cluster team members report to the national cluster coordinator.
130. At the operational level, the health cluster coordination meetings are often chaired by a representative of the Ministry of Health, where possible, with the support of the cluster team. Cluster partners are drawn from national and international agencies (UN, government, non-governmental organizations, representatives of the International Federation of Red Cross and Red Crescent Societies and other stakeholders). Provision is also made in the cluster for those humanitarian actors that may wish to participate as observers, including donors, mainly for information-sharing purposes.
140. The structure of the health cluster, terms of reference (TOR) for the health cluster, and TORs for the various groups established under the auspices of the health cluster should be communicated to the wider health cluster membership. The structure of the health cluster should be periodically reviewed and amended accordingly. On activation of a health cluster, TORs for the national health cluster and information management protocols should be established to ensure transparency and increased understanding of health cluster functioning. Both should be agreed upon by the health cluster members and health authorities and endorsed by WHO as the cluster lead agency.
Health cluster transition and deactivation
150. Cluster deactivation is the closure of a formally activated cluster. It includes transferring core functions from clusters with international leadership and accountability to other structures. Functions may be transferred to existing or pre-crisis emergency coordination and response or new structures.
160. The deactivation of formally activated clusters may be considered when at least one of the conditions that led to its activation is no longer present:
- the humanitarian situation improves, significantly reducing humanitarian needs and consequently reducing associated response and coordination gaps; or
- national structures acquire sufficient capacity to coordinate and meet residual humanitarian needs in line with humanitarian principles.
170. A cluster's deactivation does not mean humanitarian funding is no longer required. Funding will be required to conduct transitional activities, including capacity-building, and to enable national and other authorities to coordinate residual or continuing humanitarian needs or strengthen preparedness. These ongoing costs should be included in WHO budgets for emergency health programming. Lack of funding is not a reason to deactivate a cluster.
190. Cluster transition refers to the process (and potentially the activities) by which the transfer of leadership and accountabilities is planned and implemented, leading to deactivation or emergency coordination entirely led by local health authorities.
