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Authors: Christine South, Mark James Johnson Jamie LeSueur, and Mununuri Musori
Executive Summary and Overview of Key Lessons
In May 2018, the International Federation of the Red Cross Red Crescent Societies (IFRC), launched an emergency operation in the Democratic Republic of Congo (DRC) to support the DRC Red Cross (DRCRC) in their response to the 9th outbreak of the Ebola Virus Disease (EVD) in Équateur province. While this outbreak was successfully controlled within three months, the Government of DRC and humanitarian partners, including the Red Cross Red Crescent Movement had to scale up their work in early August, to respond to the new outbreak in North Kivu province, which resulted in the declaration of the 10th outbreak of EVD in DRC. The outbreak in North Kivu happened within an active conflict environment and led to the revision of a One International Appeal for the RCRC Movement response. Despite delivery of a massive emergency response, the 10th outbreak continues to plague DRC and is widely considered one of the most complex humanitarian emergencies of recent times.
The IFRC’s Africa Regional Office commissioned this internal “Lessons Learnt Review” of the category “Red” response is this complex environment to capture learning from the EVD operations in DRC and to inform the ongoing work and future epidemic responses in Africa. The review has been carried out by a small internal team and highlights lessons in six areas to support the management of similar operations in future. This has been carried out according to an analytical framework and comprised secondary data analysis and primary data collection but did not include a field visit due to time, budget and access issues. It included support from a Technical Review Group of experienced operations / health managers to advise on process.
This review did not assess the quality of technical interventions, which is covered in other research commissioned by the IFRC, such as the technical review of Safe and Dignified Burial (SDB) and Risk Communication and Community Engagement (RCCE) interventions by the London School of Hygiene and Tropical Medicine (LSHTM). This review does aim to build on lessons learnt from the West Africa EVD response operation and assess how that learning has been applied (see annex 2). This will feed into a final joint lesson learning meeting. To date, there has been no other review or evaluation of the overall operation and it will be important to have a full, final evaluation of the EVD response in DRC at the end of the Appeal. The six thematic areas of learning and the key learning in each are summarised below:
1. Delivering a category “Red” protracted public health response
The response to the EVD outbreak in DRC was rapidly declared a category “Red” response and the linked support (DREF, Emergency Appeal, surge capacity etc) were quickly scaled up and put in place. However, the challenge came in the IFRC’s capacity to sustain a category “Red” for this PHE and to access the human and financial resources to respond to the changing and growing needs over a sustained period in such a complex environment. The IFRC needs to take time at the outset plan for a longer-term health response at scale and develop strategies to support sustained engagement. This could include re-deployment of personnel from the wider Secretariat and IFRC network and full-time engagement from a senior coordinator or manager, with clear authority to take decisions. It was seen as important to be able to re-assess the “Red” categorization and amend as necessary, as well as to clarify and adapt the roles and responsibilities across the different levels (Geneva, Regional and Country / Country-Cluster Offices) as the response went on. The IFRC should prioritize a formal, external evaluation of this category “Red” response, before the end of the operation, as no formal review or evaluation has yet been carried out.
2. The Emergency Response Framework (ERF) – roles, responsibilities and decision-making
The IFRC applied the steps of the ERF appropriately, in terms of the coordination of support and the enabling of the task force mechanism and these were sustained for the duration of the response. Relevant additional support was provided, through the Regional Ebola Cell, set up in the Africa RO, which was seen to have provided valuable operational and technical up stop for the operation. It is recommended that this type of Cell be set up for any future cross-border outbreaks. However, as mentioned above, there were still issues around the clarity of management and reporting lines between office levels and a call to reinforce in-country capacity for an operation of this scale and to facilitate discussion and resolution of operational issues as they arose. The role of the Emergency Coordinator (EC) was not seen to have been able to resolve these challenges and needed work to further clarity the role’s scope, decision-making authority, and relations to operational and field management. There is also a need to reinforce links between operational and health management for an epidemic response and IFRC should consider a dual management between Operations and Health across the three levels, to increase cohesion in future health emergency responses cohesion.
3. Internal and External cooperation and coordination
The EVD outbreak in North Kivu happened in a context of prolonged conflict and required an important investment in building cooperation between Movement partners. From the outset there were tensions around the priorities of each partner, particularly in relation to the ICRC’s lead for security and logistics coordination for the response, although this improved over time and as trust was built. There was a clear need at the outset to build greater mutual understanding of each other’s needs and priorities – this could have included recruiting delegates with experience of working with Movement partners – and there was a clear need for a Movement Coordinator and SMCC mechanisms to support systematic and effective cooperation. There was also a clearly identified need for the IFRC to strengthen its country-level support for the DRCRC’s development and capacity strengthening across all levels – some capacity was strengthened at branch level due to the operation. It would have been useful to have had a liaison person between the CO and the operation to facilitate such support and an experienced NSiE delegate to manage this work in alignment with the operation and with partners in-country (as in Mozambique).
With regard to external coordination, the IFRC took on a clear role in coordinating the SDB pillar of the response and was a thought leader in its CEA feedback mechanism work. However, there was a clear need to reinforce the coordination roles for these two pillars and for wider engagement with the main partners and donors in country, particularly as this context saw new coordination approaches, through the WHO’s Strategic Response Plan and with new donors in place and the IFRC needed a more experienced and reinforced coordination function at country level. The placement of a liaison person in WHO headquarters in Geneva worked well and should be replicated in future.
4. Risk management, business continuity planning and operational strategy
There is good learning in this operation around the work on scenario, business continuity and transition planning in this volatile situation. This includes learning from the Transition Plan for the exit from Equateur province, the hibernation planning for the election period at the end of 2018, and the work on “remote management” modalities and programme monitoring during the evacuation in the Spring of 2019, all of which can inform future work with and handover to national / NS teams. Based on the experience in DRC, the IFRC should strengthen its security culture and its risk management focus in such a complex context (e.g. agree its “risk threshold”) and should agree clear channels to share information and local knowledge during the evolving situation. Risk management needs to be more central to all operational planning and to be regularly updated as the epidemic spreads to new areas or neighbouring countries. Risk management should include financial, security, operational and reputational risk and duty of care for staff and volunteers and should be a regular discussion point in the TF system. The IFRC should invest in adequate security training for all personnel and deploy a security coordinator to set up all necessary systems.
5. Programmatic relevance
Across the board the work in the pillars applied in the context, was relevant and of a good standard. In particular, the work of the RCRC on the CEA and SDB pillars was critical to the response. There was clear feedback on the need to further integrate the work across the pillars, particularly between CEA, SDB and PSS teams in future responses, to support inter-related community approaches. There was clear evidence from the field that the information gathered from communities had informed changes in the RCRC’s work, however, it will be important to strengthen this utilization of community feedback in future and to show communities their voice is being heard. An issue that came up was the need for the IFRC to re-examine the opportunities and risks of taking on the coordination role for SDBs and, potentially, for CEA in future responses and, if agreed, to be ready to resource additional support to carry out such coordination roles. In future PHEs, IFRC should prioritise the provision of PSS support for national and international staff, as well as for volunteers, as part of if its “duty of care” and could consider wider inclusion of PSS for survivors and families, as part of its SDB pillar, if resources were available.
6. Corporate services and operational support.
Human Resources – There were real challenges in identifying appropriate human resources for this operation - people with the right technical / managerial experience, language skills and conflict / EVD aware profiles. Many delegates and partner NSs were reluctant to deploy and some key positions, such as Health, Logistics and Finance Coordinator positions proved difficult to fill over time. Surge deployments were used over and again to fill vacant long-term positions. The IFRC needs to reflect on the learning from the DRC and consider some new ideas around HR for protracted crises of this scale in complex environments. To ensure future HR capacity for “Red” responses, particularly for PHEs, IFRC will need to identify ways to recruit and maintain necessary staff levels. This could include developing surge capacity for extended ‘emergency’ deployments, temporarily reallocating staff from other Secretariat offices, proactively engaging with partner NSs to pre-identify and train key profiles, reinforcing the pool for the key Operations Manager (and Deputy Operations Manager) positions and supporting the early identification and fast recruitment of longer-term positions earlier in the response.
Public health profiles were especially hard to source at various points throughout the response, and indeed, a number of interviewees noted the challenges this posed for the operation especially at the beginning of the 9th Outbreak where there were significant challenges in deploying appropriate delegates with technical public health emergency profiles. At various periods across the 9th and 10th Outbreak, a number of surge deployments from various levels were required to fill these gaps, and whilst necessary at the time, this option was acknowledged as unsustainable and diverting resources from other critical functions. The need to build up technical capacity, especially at the Country, Cluster and Regional level in responding to public health emergencies, was noted as an especially important requirement and lesson from this response. It will also be critical to ensure an increase of public health profiles in the IFRC’s most senior emergency leadership pools—such as the Heads of Emergency Operations (HEOps)—and indeed this is a lesson that the IFRC is already applying in the latest round of recruitment for the Developing HEOps programme.
A key innovation during the response was the piloting of a new rotation system between the field and the RO, to ensure the continuity of experienced staff in key positions, while avoiding burnout (1–2 months rotations over a 6–12 month contract). This has worked well and should be a model for future protracted crisis responses. PSS and strong security training are also key to ensure a duty of care in such a context, and it was clear in DRC that this should be provided to both volunteers and to staff / delegates. IFRC should also prioritise training, support and deployment of regional and national delegates / staff (e.g. RDRTs) with experience in epidemic responses. It would be particularly useful to develop a pool of francophone staff.
Financial management – In DRC, many actors faced serious challenges with financial management and in transferring funds to the field. The IFRC experienced particular challenges with the transfer of funds to field teams through the Working Advance system, which was not set up for the scale of a “Red” response and had to find alternative means ensure funds arrived to sustain the operation – this system and criteria would need to be reviewed to enable timely cash flow for a future response on this scale. This was a specific challenge around the payment of volunteer allowances – this was finally resolved after some time, by using Orange Mobile to pay volunteers. This system was practical and effective and can be replicated as appropriate in other contexts. It could also be pre-negotiated by NSs with local providers.
There was also a lack of experienced finance delegates or staff in the initial phase of the operation, and it was noted that the situation improved once a strong Finance Manager was identified. The IFRC needs to develop its pool of experienced financial managers / analysts at regional and global levels, so they can be deployed to set-up up financial management systems in the first phase of a response. The example of deploying members of the RFU to the Mozambique operation was positive and could be replicated. There is also an urgent need to for cross-functional solutions to improve operational managers’ access to real-time financial and funding information, to enable them to make critical decisions during an emergency response of this scale. As mentioned above, there is a need for a more robust and thorough system of risk management for such operations, to manage financial risk and strategic oversight at field level throughout the response.
Logistics and Supply Chain Management – Delays in procurement and logistics were a serious challenge for this operation, especially in the initial phase. This was due to a number of reasons, including the lack of qualified and experienced logistics and procurement staff and the lack of clear understanding between the IFRC and the ICRC around logistical support. In future operations, where other Movement partners are responsible for logistics, it would be important to clarify logistics procedures in advance, to brief / train delegates on the specific procedures before deployment, and to improve engagement between logistics teams. It is also vital to have experienced logistics or procurement delegates in place from the outset, with experience or knowledge of the different approaches. IFRC should also look to optimise local procurement or pre-positioning for less specialised items where possible and investigate options to have medical procurement experience in the ROs, to minimize delays.
Partnerships and Resource Development – The mobilisation of funding for this operation started strongly, but reached a crisis in the Spring of 2019, when there was a severe shortfall in funds that risked operational continuity and impacted the staff and structure of the response. It is important that the IFRC teams across all levels develop a Resource Mobilisation Plan for an emergency of this scale, to better anticipate and manage funding over the duration and evolution of the response and that monitoring provides clearer alerts around funding levels. With changing donor presence at field level for PHEs, it will also be necessary in future for the IFRC to deploy PRD staff to support donor engagement at the country level.
There were very few PRD staff working on donor relations, particularly at the country level, and this was insufficient to deal with the new funding realities as the operation progressed. However, towards the end of 2019, it was noted that through intensive support and focus following the creation of a PRD taskforce, the funding situation improved substantially, which was also helped with renewed attention and resource allocation from donors. Nevertheless, interviewees also noted significant recent improvements in the monitoring of the funding situation of the operation, allowing for relevant staff to take early action to fill anticipated future funding gaps before they arise. Recent developments have also It is essential that the IFRC speeds up work to set up a pool of experienced PRD delegates / staff, ready to deploy in future “Red” responses. It is timely for the IFRC to strengthen advocacy with new donors and partners to ensure mutual understanding and to seek greater donor flexibility for rapidly evolving epidemic outbreaks.