Humanitarian Health Action

Sub-National Health Cluster Coordination in Haiti - Save the Children

By: Kathryn Bolles and Chris Lewis, Save the Children*

Save the children's staffmember provifing health care to patient

On 12 January 2010, earthquake measuring 7.0 on the Richter scale with an epicentre 17 km south-west of Haiti’s capital Port-au-Prince size hit Haiti at 21:53 local time. The Government of Haiti estimates that three million people were affected, 217 300 people were killed, and 300 600 wounded and 1.9 million lost their homes and 511 000 people have left the affected cities.

There was an extreme situation of need in a country where health needs and poverty had pre-existed the quake. The destruction of what had been very limited infrastructure - physical, social and political - exacerbated the needs and the difficulties in response.

Following the 12 January 2010, earthquake, coordination among health partners was even more critical than usual in a humanitarian response, with representation from over 100 organizations in health cluster meetings in Port au Prince, including volunteers and small agencies with limited experience in the wider humanitarian working practices and cluster system. The challenges to coordination in the Haiti context were immense, as the earthquake caused massive disruption to pre-existing UN, NGO and Government infrastructure and personnel. Large-scale humanitarian need compounded an already poor health situation.

Early coordination efforts largely targeted the immense needs of the impromptu settlements and other populated areas in and around Port au Prince. By January 15, 2010, it was reported that Leogane and the Department of the West were particular impacted by the earthquake, as well as Jacmel and the Department of the Southeast.

There were no clear channels of communication between these areas and Port-au-Prince, and a sub-national mechanism was needed to coordinate the humanitarian response in these area -, each with a scale equivalent to an “average” crisis situation. In both Leogane and Jacmel, there was a daily influx of many new organizations. Many of these were not connected to the central Cluster system.

Jacmel: Save the Children’s senior health advisor in country was in Jacmel when the earthquake hit and began coordinating with the Ministry of Health and Red Cross on the evening of the earthquake. Save the Children co-coordinated the sub-national health cluster with the Ministry of Health representative in Jacmel and the President of the Haitian Red Cross. This was initially organized informally between MoH and Save the Children at a local level but was later formalized with the WHO, the health cluster lead at the national level.

Meetings were held three times per week and focused on managing the influx of personnel and medical supplies and ensuring the continuity of health services as much as possible, despite rapid turnover of health providers and organizations. Initially, there was little transfer of information between the national health cluster and Jacmel sub-national cluster, which led to some differing guidance at the sub-national level. This communication gradually improved with time and the health cluster coordination in Jacmel has now been taken over by dedicated WHO staff.

Leogane: Prior to the earthquake, there was no existing Ministry of Health representation in Leogane. Following the earthquake, informal meetings convened with some of the large number of agencies on the ground. OCHA set up a small coordination base in Leogane around the 27 January,2010, and Save the Children agreed with the national health cluster to formally support the sub-national health cluster in Leogane. Initial meetings focused on sharing lists of needs and locations, capacities and existing supplies, collecting ‘Who? What? Where?’ information for the national health cluster and coordinating rapid assessments and interventions.

As with Port-au-Prince, there was high turnover of organizations and large numbers of participants at each meeting. The OCHA office in Leogane had little printing and email capabilities, so early challenges included simple things such as not being able to share meeting minutes and other important tools and documents. Leogane was - and continues to be - particularly challenging due to the immense impact of the earthquake, the large numbers of organizations coming into the area, difficult terrain with a dispersed population.

Save the Children is an active member of the Global Health Cluster and had previously supported national Health Cluster Coordination in the Philippines following Typhoon Ketsana in 2009. The roles of sub-national cluster coordination in Haiti were challenging as staff were “double-hatting” with the dual responsibilities of coordination of a large sub-national cluster and directing a large and growing health response for Save the Children.

The experience continues to be an important learning opportunity and Save the Children remains significantly engaged at the national and sub-national coordination levels. Early lessons-learned include the benefit of having dedicated, skilled, sub-national level health cluster coordination in place in the early phase of a large-scale crisis as well as maintaining regular communication between the national and sub-national levels. Communication and information-management should be diversified when e-mail is not fully functional, as was the case in Leogane.

The significant health needs in Haiti continue to evolve - particularly with the coming rainy season - and organizations face many challenges in meeting the scale of needs on the ground. Coordination and dedicated, long-term leadership continue to enable the humanitarian community to provide life-saving interventions at the necessary scale over these next few critical months.

*Kathryn Bolles and Chris Lewis are the Save the Children representatives on the Global Health Cluster. They were both in Haiti following the earthquake, establishing Save the Children's emergency health response to the crisis. Save the Children coordinated the sub-national health clusters in Leogane and Jacmel for the first 2 months following the earthquake on January 12th