Prepared to respond to disaster emergencies

Kirsty Scott

2 October 2020

This is an article from the CSC Development Themes: Strengthening Resilience and response to crises
{

People need sexual and reproductive health services, whether in the normal development context or in a crisis. And in crisis, normal systems and services are disrupted.

Vincent Otieno Okullo

For the past three years, Commonwealth Alumnus Vincent Otieno Okullo has worked as a public health consultant, supporting development, emergency and relief work for the United Nations Population Fund (UNFPA) in collaboration with other UN agencies, including the United Nations Development Programme (UNDP). He is also on the roster of consultants for the (UNDP), and the Joint United Nations Programme on HIV/AIDS (UNAIDS).

Here, Vincent shares his ongoing preparation for his new role and wider career experiences in public health and emergency relief work. During emergencies, the UN and other organisations and NGOs play a critical role in delivering humanitarian relief in response to natural and man-made disasters in areas beyond the capacity of national authorities. When emergencies occur, clusters are activated to ensure coordination of relief and recovery efforts at the national level. Clusters are humanitarian groups including UN and non-UN organisations that support assistance to national governments during emergencies. These include health, water and sanitation, and logistics among others.

At the time of interview in October 2020, Vincent is in the process of taking up a humanitarian position with the UNFPA as a Sexual and Reproductive Health (SRH) Sub-Cluster Coordinator, based in Nepal. He will support the delivery of a UNFPA nationwide response to strengthen access to essential sexual and reproductive health (SRH) services as part of COVID-19 Preparedness and Response Plan for Nepal (CPRP), working with partners. The mission will involve support to communities in Nepal that are recovering from the devastating impact of recent flash flooding as a result of heavy monsoon rain, which has resulted in landslides, displaced populations, and deaths. The challenges of delivering this support will be further compounded by the COVID-19 pandemic.

“We are in a COVID-19 period and I’m a little anxious, but also I’m very motivated to take up this responsibility. It’s a huge undertaking and I’m happy that I’ll be joining again UNFPA to support them to deliver these critical services to communities in Nepal who are most affected by the dual emergency, now COVID-19 and monsoon floods”, says Vincent, highlighting how countries can face a broad range of threats to public health, from infectious diseases, poor sanitation and waste disposal, conflict, climate change, and natural disasters, all at the same time.

In emergency settings, a wider health response is led by the World Health Organization (WHO) and sub-clusters are created to deliver specific services within this framework. As the coordinator of the SRH sub-cluster, Vincent’s role will include working with SRH partners in Nepal, such as NGOs and private sector organisations, to deliver sexual health services during the emergency. The focus of his work will be on providing technical support to SRH sub cluster partners, to strengthen response systems, enhance access and continuation of SRH services, coordinate a review of monsoon and COVID-19 emergency preparedness and response plans to integrate minimum initial service package for reproductive health in emergencies, support the mobilisation of resources to scale-up service delivery, and report on results and experiences during the early response period.

On the critical need to respond and deliver services quickly and efficiently, Vincent says, “People need sexual reproductive health services, whether in the normal development context or in a crisis. And in crisis, normal systems and services are disrupted. People are not able to go to health facilities as usual.

“The criticality of emergency response is to try and overcome some of these barriers that have been interrupted by the emergency conditions. Many women in poor countries may already have challenges accessing these services. So, if there’s an emergency, that’s exacerbated. It gets worse. And so, there’s an urgency in terms of response time and mobilisation of resources, and getting to the last mile to deliver these services to the most vulnerable, those who are directly affected by the disasters.”

In response to any emergency settings, global humanitarian agencies have developed a standard package of minimum SRH services to be delivered throughout affected communities at the onset and during response phases. These are designed to address critical services, such as maternal health, HIV prevention, family planning, and the prevention of gender-based violence (GBV).

Following the delivery of this package in Nepal, Vincent will work with the Nepalese government to expand and restore access to these services in the usual context, such as via local health centres.

Adapting to COVID-19 restrictions

In preparation for joining the ongoing emergency response, Vincent is reviewing information from the rapid assessment conducted at the start of the emergency to identify critical gaps or areas of support which will need to be strengthened moving forward. From here, Vincent will coordinate across all SRH partners to support service delivery and provide assessment and guidance as required. Key to this will be developing an understanding of the strength of different partners delivering SRH services in Nepal to start conversations and initiate partnership arrangements.

Staying in contact with partners and holding regular coordination meetings to track progress and assess delivery will be particularly challenging due to COVID-19 restrictions.

“In terms of what needs to be done, it’s always very effective to meet and talk and someone gets a better sense of urgency and what needs to be done. Now we are limited to virtual engagements mostly, and sometimes it has its limitations, but I think can also be very effective, no doubt about that, if well-planned and we all understand our mission and objectives well.”

Keenly aware of the added pressure that has come from the COVID-19 pandemic to emergency relief work within an existing fragile health system, Vincent feels confident in his capability to deliver emergency responses. He plans to improve this service by introducing new innovations, drawing on his previous experiences.

On international humanitarian services

Vincent’s experience in this sector spans several years and he has worked across Africa and in Southeast Asia to deliver public health responses. Following his undergraduate degree, he initially supported HIV prevention programmes in Kenya at a time when it was declared a national disaster. He then took up a post in Bangladesh as HIV Advocacy Advisor with the Voluntary Service Oversees (VSO). During this posting, Vincent felt that to contribute to international humanitarian services more effectively, he needed to expand his skills and knowledge.

“I felt I really needed to strengthen my skills, particularly in areas like research, design of public health programmes, policies, and services. This is because my interactions in professional circles I felt I had certain limitations, I could not engage fully and support the government to the extent that I really wanted to.”

In 2010, he was awarded a Commonwealth Shared Scholarship to complete an MPH Public Health at the University of Glasgow.

“Postgraduate study was an amazing experience… I was exposed to an enormous amount of knowledge in public health and research resources at the university. And that transformed my career significantly, because it’s after that I suddenly started getting a lot more high-level technical positions to provide technical support to government-led health programmes, support strengthen systems, contribute to formulating policies, national planning processes, development of guidelines for health promotion in different areas, but mostly in sexual and reproductive health and HIV.”

Seychelles declared a state of emergency

Following his studies, Vincent took up a UNFPA post in Seychelles as Advisor for HIV Prevention and Control and the focal point for Seychelles programme under directive of UNFPA Representative, working closely with the government. In this post, he was responsible for strengthening HIV prevention and control responses. Working with the UN Country Team, he coordinated HIV Legal Environment Assessment, which assessed the extent to which laws and policies were barriers to delivering HIV services on the island. The report and recommendations informed actions to support the inclusion of key populations in the national HIV response, enhancing treatment access and reducing stigma. Gains in new knowledge and skills from his postgraduate study in MPH, including health policy formulation, implementation, evaluation, and public research design and methods, were particularly valuable and relevant for these tasks.

In 2013, Seychelles declared a state of emergency because of the devastating impact of tropical cyclones, which caused flash flooding and landslides, affecting thousands of people. In response to the emergency, as the only UNFPA member on the ground, Vincent coordinated the implementation of a Minimum Initial Service Package for Reproductive Health Within Humanitarian Settings. In his role, he quickly led and coordinated rapid assessments to plan and mobilise reproductive health supplies, including medicines, and technical assistance.

The response provided SRH and maternal services to over 13,000 women and girls during the emergency and Vincent is proud to report it had a far wider, indirect impact as part of the recovery phase he implemented.

“We transitioned to train social and healthcare workers on what we call the standards of service delivery, that is minimum initial service package for sexual and reproductive health services in emergency settings. We did training, we supported the government to incorporate sexual and reproductive health in national health emergency plans.”

Training of health and social workers and technical support for planning contributed to enhanced national capacity for the preparedness and response to future emergencies in the small island country of Seychelles.

Strengthening Zambia’s healthcare

Vincent has also been involved in strengthening existing healthcare services in low-resource settings, outside of emergencies. In Zambia, he was Technical Officer for Sexual and Reproductive Health Rights and HIV linkages, involved in a multi-agency initiative led by UNFPA and UNAIDS to strengthen linkages between SRH and HIV and improve the efficiency and impact of these services to reach more women and girls and vulnerable populations.

To support the initiative, Vincent carried out an initial assessment to understand the status of sexual and reproductive health and HIV services integration and linkages in health facilities across four provinces in Zambia. Following his assessment, Vincent identified gaps in integrated service delivery, including low funding, low prioritisation of integrated service delivery, fragmented policies, and the inadequate training of nurses, midwives, and SRH and HIV professionals. This assessment enabled him to present to the government and other agencies recommendations on areas to improve and the technical assistance required to deliver the initiative.

Based on the results, Vincent coordinated the development of national guidelines for integrating sexual and reproductive health and HIV services, including gender-based violence (GBV) services and provided technical leadership in developing a training manual for integrating sexual and reproductive health and HIV services, including GBV services

“This manual essentially is a capacity-building tool and at a national level to help build capacities of health facilities and the human resource for health to acquire the knowledge and skills they really need on how to harmonise and build more linkages and integration across services. And in a layman’s language to say, if a woman comes to a health facility, they should be able to receive all the services and not be fragmented and scheduled on several days and time.”

The pilot of the training manual in four initial provinces was well received. Both the training manual and the national guidelines for the integration of SRHR and HIV services supported the scale up of integrated services across the country.

“Condom man”: Improving access to condoms in South Sudan

As an international consultant, Vincent has also worked in South Sudan to support the development and implementation of a national comprehensive condom programme.

UNFPA supports over 180 countries around the world to strengthen national condom programmes and to improve the supply, distribution, and access to male and female condoms. In this role, Vincent contributed to the development of a five-year National Comprehensive Condom Programming Strategy 2018 -2022. Following a campaign launch in 2019, the strategy has so far contributed to improved coordination amongst government and delivery partners, public awareness, and access to male and female condoms in both development and humanitarian settings.

“They used to call me a condom man, but it’s okay, because a condom from a UNFPA perspective of development work, it offers triple protection against HIV, sexually transmitted infections, and also unintended pregnancies.”

More to be done for the future

Despite working across several countries and supporting emergency responses and SRH planning and implementation, Vincent is aware that there is more to be done.

“…the demand is immense, I know. In all countries I’ve worked in, you just feel you’re doing a little bit. So, the demand is immense in terms of what the countries need to really deliver to the populations that are suffering…

 

“And I think in the future, we certainly need more and more technical capabilities, that we don’t just look within health boundaries, but see where all those determinants and complexes that make it difficult for countries to achieve their health national goals.”

Thinking about his new role and the added challenges of the COVID-19 pandemic, Vincent acknowledges it will be a new experience for all those involved in the relief effort, but new ways of working can be identified.

“For COVID-19, it’s a new experience, and I’m very open to learn in Nepal, and also understand the context well, monitor progress, and decide on what could we do best.  Nobody really had a prior experience to know what best to do with regard to COVID-19 response, but I think, based on our previous experience with previous emergency responses, like in Africa, we have experienced many health emergencies before, so it will be helpful to see how to adapt some of these experiences, strategies, to work in Nepal context.”

Based in Lalitpur District, Kathmandu, Nepal, Vincent continued his services and led the SRH sub cluster coordination effort during COVID-19 pandemic (under Ministry of Health and Population and UNFPA leadership). In this role, he strengthened coordination effectiveness through regular coordination meetings and thematic discussion forums, assessments, performance monitoring, and capacity building activities involving more than 32 partner organisations working in reproductive health sub-sector in Nepal.

Vincent Otieno Okullo is a 2010 Commonwealth Shared Scholar from Kenya. He studied for an MPH Public Health at the University of Glasgow.