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MPC

Multisectoral Coordination for Health Security Preparedness
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Background

Countries must be better prepared to detect and respond to public health threats in order to prevent public health emergencies and the devastating impact they can have on people’s lives and well-being, as well as on travel and trade, national economies, and society as a whole. Public health challenges are complex and cannot be effectively addressed by one sector alone.

A holistic, multisectoral and multidisciplinary approach is needed for addressing gaps and advancing coordination for health emergency preparedness and health security and is essential for the implementation of the International Health Regulations (IHR 2005).

Health emergencies, including disasters, take a heavy toll on populations around the globe. Human and animal diseases, chemical, radiological and nuclear accidents, and natural disasters cause ill-health, disability, loss of lives, food insecurity, environmental damage, displacement, and destabilization of trade and economic development, as well as of societies as whole. Diseases can spread, and they can do so even more significantly where health systems are fragile or are faced with newly emerging and re-emerging diseases, as seen in recent outbreaks of Ebola virus disease, Zika virus disease, yellow fever, cholera, and COVID-19, affecting entire countries and regions. As a result, health security is high on the international agenda. Health security is a continuous process in which action, financing, partnerships, and political commitment must be sustained.

The IHR (2005) represents the legal basis for multisectoral coordination for emergency preparedness and health security. WHO promotes the participation of all relevant sectors to contribute to the improvement of the capacity of States Parties to prevent, detect and respond to public health emergencies of international concern and accelerate the implementation of the IHR (2005). An intersectoral approach is among the guiding principles for implementation of the IHR (2005) set out in a report by the WHO Secretariat to the Seventieth World Health Assembly, May 2017, which states: “Responding to public health security threats requires a multisectoral, coordinated approach (for example with agriculture, transport, tourism, and finance sectors)”. Furthermore, as stipulated in the 2021 World Health Assembly Resolution, WHA 74.7, there is the need “to adopt an all-hazard, multisectoral, coordinated approach in preparedness for health emergencies, recognizing the links between human, animal and environmental health and the need for a One Health approach”.

Under the WHO Thirteenth General Programme of Work 2019–2023, the WHO Health Emergencies Programme has an integral role in contributing to the strategic priority of 1 billion more people being better protected from health emergencies by building and sustaining the national, regional, and global capacities required to keep the world safe from health emergencies. In support of implementation of the Thirteenth General Programme of Work and attainment of Sustainable Development Goal (SDG) 3, the MPC provides evidence-based information on how to establish functional multisectoral coordination, primarily within but importantly also beyond the government structures, for countries to better prevent, detect and respond to all potential public health threats.

MPC Framework

The multisectoral preparedness coordination (MPC) framework was developed by the Multisectoral Engagement for Health Security Unit, led by Ludy Suryantoro, Unit Lead, and Romina Stelter, Technical Officer, with the support of Stella Chungong, Director, Health Security Preparedness Department, and Jaouad Mahjour, Assistant Director-General, Emergency Preparedness and International Health Regulations. It followed the expert roundtable on multisectoral preparedness coordination (MPC) for International Health Regulations (IHR 2005) and health security which was convened by the World Health Organization (WHO), at the World Organisation for Animal Health (OIE) headquarters in Paris on 4–5 October 2018. The aim of this roudtable was to develop a guide for multisectoral preparedness coordination for IHR (2005) and health security to provide Member States with tools to support the practical implementation of national action plans for health security. Thirty-seven representatives from Member States, international organizations, and non-state actors (NSAs) discussed best practices, models and lessons learnt from countries’ experience in MPC, to inform key content and strategy of the guide.

The MPC framework provides States Parties, ministries, and relevant sectors and stakeholders with an overview of the key elements for overarching, all- hazard, multisectoral coordination for emergency preparedness and health security, informed by best practices, country case studies and technical input from an expert group. Those elements form the basis of the MPC framework that aims at improving coordination among relevant public stakeholders, particularly actors beyond the traditional health sector, such as finance, foreign affairs, interior and defence ministries, national parliaments, non-State actors, and the private sector, including travel, trade, transport, and tourism.

The MPC framework complements the International Health Regulations Monitoring and Evaluation Framework (IHR MEF) and contributes to the strategic goal in the WHO Thirteenth General Programme of Work of 1 billion more people better protected from health emergencies and supports the achievement of Sustainable Development Goal 3 – ensure healthy lives and promote well-being for all at all ages.
It discusses key elements for effective multisectoral coordination for health emergency preparedness, including high-level political commitment, country ownership and leadership, and formalizing mechanisms that contribute to multisectoral preparedness coordination.

Parliament’s role in strengthening health security preparedness

The Resolution on Achieving universal health coverage by 2030: The role of parliaments in ensuring the right to health was adopted during the 141st IPU Assembly in Belgrade, Serbia, held between the 13th and the 17th of October 2019. The Resolution acknowledged the importance of a multisectoral coordination approach to health and stated, “Also urges parliaments to address the political, social, economic, environmental and climate determinants of health as enablers and prerequisites for sustainable development, and to promote a multisectoral approach to health;”.
Resilient health systems are vital for preparing for and responding to emergencies, and for maintaining essential health services during a crisis. The IHR (2005) are an important tool of international law, reflecting the commitment by States to prevent, detect and respond to emergency health risks.

Parliaments and parliamentarians play a unique and powerful role in achieving preparedness through their various responsibilities: law-making, oversight, budgetary allocation and citizen representation. High-level reviews of the response to the COVID-19 pandemic emphasize the importance of State capacity, social trust and leadership when it comes to preparedness. Parliaments and parliamentarians are extremely well positioned to help build and strengthen all three.
The 34th Handbook for Parliamentarians on Strengthening health security preparedness: The International Health Regulations (2005) prepared by the World Health Organization (WHO) and the Inter- Parliamentary Union (IPU), was created to enhance parliamentary contributions to health-security preparedness. It is designed to be used by parliamentarians and parliamentary staff as they consider important aspects of preparedness that need to be established or strengthened at all levels including communities. The handbook contains key questions that can help guide parliamentarians in their capacity-building efforts.

Civil-Military Collaboration for Health Emergency Preparedness

To ensure effective civil–military health collaboration that supports health emergency preparedness interventions required to combat existing or potential threats, and for longer-term health security capacity-building, it is critical to identify pathways for partnership well before a response to a health emergency is required. To this end, WHO together with Member States and partners developed the National civil–military health collaboration framework for strengthening health emergency preparedness. The aim of this framework is to provide the public health sector and military actors and services at the national level with guidance for establishing, advancing, and maintaining collaboration and coordination, with the focus on country core capacities required to effectively prevent, detect, respond to, recover from and build back better after health emergencies.

Development of this framework was initiated following a meeting on “Managing future global public health risks by strengthening collaboration between civilian and military health services” (Jakarta, 24–26 October 2017), which brought together more than 160 public health and security representatives from 44 countries, international organizations, partners and donors. Guiding principles were agreed on how to strengthen collaboration between the security and civilian health sectors in line with the commitment made by members of the Group of 20 to strengthen global health security and accelerate the implementation of the IHR (2005). Furthermore, in December of 2018, the WHO Secretariat (Multisectoral Engagement for Health Security Unit) convened a global technical consultation on national cross-sectoral collaboration between security and health sectors in Hong Kong Special Administrative Region, China. The Technical Consultation included 51 expert participants representing 19 Member States, as well as partners, WHO and non-governmental actors. The participants emphasized that it is critical to ensure civil-military collaboration for preparedness, not just joint action in times of emergency. A key point of discussion was to ensure that agreements are flexible and tailored to the national context. Militaries have different roles and competencies in different countries. Participants agreed that militaries cannot be seen only as a last resort, and they have capabilities for preparedness that go far beyond that of rapid response to emergencies. A draft version of the NCF Framework was circulated to all participants who discussed it at length and provided valuable feedback on it.

Health Emergency Preparedness in Cities and Urban Settings

Cities and urban settings are crucial to preventing, preparing for, responding to, and recovering from health emergencies, and therefore enhancing the focus on urban settings is necessary for countries pursuing improved overall health security. Urban areas, especially cities, have unique vulnerabilities that need to be addressed and accounted for in health emergency preparedness.

Strengthening health emergency preparedness at the urban level requires the support of multiple sectors and partners beyond health at all levels – from global to national, subnational and local levels, including within cities and urban settings. Coordination across sectors and partners is vital to ensure coherence in preparedness activities and increase resilience, and should include all actors, including the private sector and civil society. This requires the use of whole-of-government and whole-of-society approaches, with coordination often coming from the highest level of each government, including the offices of city leaders (e.g. Mayors and Governors), as well as potentially mainstreaming preparedness across departments at the operational level.

Multisectoral preparedness coordination may face challenges partly due to siloes existing at different levels of government – national, regional, and local, including those arising from the fundamental foundations and structure of organizations and institutions. Some stakeholders also may not be aware of the relevance of emergency preparedness for themselves, leading to less willingness to collaborate, especially once the acute phase of an emergency is over. There is therefore a benefit in including these sectors and actors in simulation exercises and other drills, as these activities promote coordination, build relationships, open soft and informal avenues for communication, and help facilitate the working cultures necessary for multisectoral coordination.

Urban Preparedness

Foreign Policy for Health

In today’s interconnected world foreign policy and international relations have a direct influence on how countries can work together for health emergency preparedness. Epidemics can lead to economic decline, social destabilization and unrest, with implications for national and international security. Travel and trade sanctions imposed by governments on countries affected by outbreaks can harm economies and relations. As viruses and diseases do not respect borders, public health needs to be understood as a decisive factor in international diplomacy, with foreign policy bearing a responsibility for strengthening global health security. Health emergency preparedness is a matter of national and global security and is critical in enhancing collaboration on cross-border health security threats. Collaborative foreign policy on global health allows for better access to information, technologies, medicines and vaccines, and improves accessibility to these resources by vulnerable populations.

This includes both building up preparedness capacities within countries and enabling access to capacities in other countries when health emergencies occur. Foreign policy can also serve to mitigate the potential threat to national and global health security of deliberate actions, such as intentional release of biological agents, and can act as a bridge for peace.

MPC Online Training Tool

The MPC Online Training Tool provides users with key information about multisectoral preparedness coordination, sets out specific learning objectives, and is split into 5 modules to facilitate learning and the achievement of the objectives. It is designed to help users, both health and non-health stakeholders, familiarize with the topics.

The first module provides an overview and contextualizes the multisectoral preparedness coordination framework by explaining its critical role in emergency preparedness. Module 2 identifies the relevant stakeholders for health emergency preparedness and health security. Module 3 outlines how to establish the necessary high-level political commitment and support. Module 4 explains how to formalize and develop multisectoral preparedness coordination structures. Whereas module 5 shows the key factors, such as communication, funding, and transparency, needed to successfully implement MPC.

Urban Preparedness

Strengthening health emergency preparedness in cities and urban settings

Urban areas, especially cities, have unique vulnerabilities that need to be addressed and accounted for in health emergency preparedness. An unprepared urban setting is more vulnerable to the catastrophic effects of health emergencies and can exacerbate the spread of diseases, whilst they are also very often the frontline for response efforts. This has been seen in past disease outbreaks, as well as during the COVID-19 pandemic. It is therefore crucial that health emergency preparedness in cities and urban settings is addressed through contextualized policy development, capacity building, and concrete activities undertaken at the national, subnational, and city levels.

At the 75th World Health Assembly (WHA) in May 2022, WHO Member States underlined the importance of this area through the adoption of resolution WHA 75.7 on Strengthening Health Emergency Preparedness and Response in Cities and Urban Settings. It was co-sponsored by 18 countries from across all six WHO regions, underlining the broad support for WHO to strengthen its work in this area to support countries.

This built upon on the Member State request in WHA Resolution 73.8 to enhance a focus on urban preparedness, which led to WHO convening, jointly with the Government of Singapore, a Technical Working Group on the topic in early 2021. An outcome of this is the WHO Framework on Strengthening Health Emergency Preparedness in Cities and Urban Settings, intended to support member states and policymakers at the national and city levels. The Framework is supported by the guidance document Strengthening health emergency preparedness in cities and urban settings: guidance for national and local authorities.

Key areas of focus for strengthening health emergency preparedness in cities and urban settings

Governance and financing for health emergency preparedness

Governance and financing are both key to effective health emergency preparedness. Focusing on preparedness at the sub-national level (such as the city/urban level) adds a layer of complexity from a governance perspective. It requires robust and effective mechanisms by which the different levels of government involved (e.g., national, regional, local) can coordinate, and a clear delineation of roles, responsibilities and accountabilities. Due to the nature of emergencies, these may differ from ‘peacetime’, and it is important that systems are ready to adapt for response when necessary. Any existing legislative gaps need to be identified and closed.

The multiple layers of governance involved may also complicate financing, as budget lines, financing flows, and the distribution of funds may be different in an emergency. This is further complicated if there is a discrepancy between political agendas at different levels of governance. It is therefore important that mechanisms are in place to ensure funds can be released and redistributed as necessary in an emergency, without delays caused by the extra layers of governance involved.

Multisectoral coordination for preparedness

This requires the use of whole-o government and whole-of-society approaches, with coordination often coming from the highest level of each government, including the offices of city leaders (e.g., Mayors and Governors), a well as potentially mainstreaming preparedness across departments at the operational level.

High population density and movement

Cities and urban settings often contain large numbers of people, leading to high population densities and crowding where people live, play and work. This increases the chance of being in crowded situations and means that health emergencies can impact a larger number of people at once, especially when it involves infectious diseases. In epidemics, especially those spread by droplets or aerosols, this increases the risk of disease spread. This includes shared spaces and public areas with high human traffic or are frequently used, and public transportation. Crowded situations often found in cities and urban settings include mass gatherings such as religious events, concerts and sporting events, or poorly ventilated areas such as bars and nightclubs.

Other locations such as nursing/care homes, dense forms of housing, refugee camps and commercial venues such as shopping centres may also pose risks, as well as mass gathering events, that often take place within cities. Further, overurbanization has also led to a proliferation of informal settlements / slums emerging, where population densities also tend to be higher, and they also rely on communal and often inadequate WASH facilities. Mobility between the mobile populations existing in these congregation points and local/fixed populations also risks the further spread of communicable diseases.

Community engagement and risk and crisis communication

As health threats emerge at local levels, communities play an important role in health emergency preparedness and risk reduction. Community members participating from the earliest stages of policy and programme formulation help clarify local priorities, challenges, and pathways for practical and sustainable action. This requires sustained and meaningful community involvement (beyond just engagement), such as through community led-approaches, participatory governance mechanisms, social participation methods, and the co-creation of solutions.

Often, there is insufficient engagement, integration, and protection of communities in cities and urban settings in health emergency preparedness plans. Whilst engagement can be challenging for a variety of reasons, the perspectives which they offer enhance policy and programme development and ensure effective translation and implementation. Doing so also engenders trust in governments and public systems at all levels. Effective involvement and engagement of communities cannot be achieved without effective communication, tailored to the respective specific target audience.

Groups at risk of vulnerability

Cities and urban settings are centres for inequalities and groups at risk of vulnerability. For instance, it is estimated that 70 percent of people displaced across or within national borders live in cities, and migrants are overrepresented among the urban poor (6). Aside from vulnerabilities specific to certain diseases or emergencies (e.g., Zika virus and pregnancy, COVID-19, and persons with medical comorbidities), there are also persons that are generally vulnerable to the direct or indirect impacts of health emergencies. Given their proximity to people, city governance structures are often best placed to identify those at risk of vulnerability and those most in need of targeted preparedness efforts.

Preparedness for a health emergency in an urban setting includes anticipating and preparing for vulnerabilities linked to the direct or indirect impact of all-hazards. For example, restricted movements risk livelihoods of those dependent on the informal economy, as well as may hinder timely access to health services. Countries and their local communities are as strong as their weakest link, and preparedness and response plans will not be as effective if the needs of vulnerable populations are not looked after. This includes building community resilience to the impacts of health emergencies. In this regard, trusted community leaders and civil society organizations including those with established initiatives in working with and supporting vulnerable populations, may serve as an important resource.

Evidence, data and information

Data represents a challenge to cities globally; sometimes it is missing or limited, or when available, fragmented, siloed, or outdated. However, local authorities of cities and urban settings often hold a wealth of data which should be used to strengthen health emergency preparedness and response. This includes but is not limited to, urban settlement data such as demographics, informal settlements and other vulnerable communities, housing and zoning, transport networks, public and private facilities and resources, emergency, disaster and risk management, for example evacuation routes, supply chains information on current and future hazards, vulnerabilities, capacities, and scenarios, and population demographics. Such information can help guide efforts to improve preparedness and build community resilience, including leveraging crowd sourced data or sentinel sites for surveillance and sense-making. Aside from event detection, it can help monitor impact and assess the uptake and effectiveness of response measures and recommendations.

Further, health considerations, including needs for emergency preparedness and response, can be better integrated into designing and building sustainable cities for the future. Where possible, data should be disaggregated by sex.

Commerce, industry and business

Cities and urban settings are also centres for commerce and many industries, employing large numbers of individuals. They are also responsible for places where groups of people spend a substantial amount of time each day. In addition to this, many local businesses are community-centred with good networks, relationships and local knowledge. Therefore, businesses and corporations can serve as a partner and resource for national and local governments in preparing for health emergencies, in particularly when it comes to innovating in order to better prepare, detect and respond to novel and emerging challenges posed by future and ongoing health emergencies.

This can cover a broad range of areas, including risk communication and risk management. Examples include occupational health and safety, including prevention of zoonosis, infection and contamination of food at live animal markets; instituting remote working arrangements where possible, and implementing public health measures to reduce the spread of infectious diseases at the workplace where remote working is not possible; providing resources in an emergency, such as the repurposing of manufacturing plants to producing personal protective equipment and the reorganization of commercial spaces or services to accommodate public health measures; and supporting risk communication and public engagement, through both customers and employees, around public health measures.

They are also important for maintaining logistics and supply chains for the continued provision of essential services, for example for food and medical supplies, or the repurposing of manufacturing plants and using hotel rooms for quarantine and temporary housing for the homeless. Furthermore, without engaging national and local private business and enterprises, it is not possible to achieve the adequate support to key workers, transport systems, reorganization of public spaces / business models that is needed in order to maintain business continuity and continue providing adapted business services to local communities during a health emergency.

Organisation and delivery of health and other essential services

Health systems, in particular the delivery of health services, play a critical role in preparedness, response and recovery for all types of hazards. These range from primary and community care to tertiary level hospitals. For example, surveillance, detection and notification; vaccinations to prevent outbreaks, including prophylaxis of major zoonotic diseases in animals; infection prevention and control to prevent further spread of disease; and treatment to save lives are all dependent on the health system. Urban settings, especially major cities, tend to hold a full suite of services that can include academic hospitals with health specialists, advanced diagnostics, medical equipment, supplies, and intensive care units, all of which are crucial capacity in an emergency.

However, there can also be huge disparities and gaps in access to services in urban settings, especially by those of lower socio-economic status and hard-to-reach populations, leading to unequal health outcomes, delays in event reporting and contact tracing.

Beyond health facilities, cities and urban areas also often host other critical infrastructure that needs to remain operational regardless of the emergency situation (e.g., PoEs, power and freshwater plants, security & safety services, communication & ICT infrastructure, financial organizations, and others). Given the breadth and variety of services that exist in cities, it is important that the organisation of services is also organised around health security objectives. This requires collaboration across services, and a holistic and multisectoral approach to service delivery.

Videos

Governance and financing for health emergency preparedness
Multisectoral coordination for preparedness
High population density and movement
Community engagement and risk and crisis communication
Groups at risk of vulnerability
Evidence, data and information
Commerce, industry and business
Organisation and delivery of health and other essential services
Videos

Multisectoral Coordination for Health Security Preparedness Document Library