Evaluation of UNICEF Work in Public Health Emergencies At UN Children’s Fund

1. Purpose and Objectives

Consistent with the UNICEF Evaluation Policy, this evaluation serves interrelated purposes in support of the organization’s mandate to support learning and accountability. The evaluation supports learning and decision-making pertaining to recent and on-going challenges that UNICEF confronts with PHEs. The evaluation focus on accountability will involve examining actions taken in accordance with defined responsibilities, roles and performance expectations. This includes an assessment of UNICEF compliance at both the country, regional and global levels with standards such as the CCCs, the Simplified Standard Operating Procedures (SSOPs), the International Health Regulations (IHR), Accountability to Affected Populations (AAP) Guidance, and other relevant agreements.

The overall objective of the exercise is to assess the extent to which UNICEF is ‘fit for purpose’ to prepare for and respond to public health emergencies. The evaluation will aim to provide credible evidence to inform and guide decision-making processes of UNICEF and stakeholders. The more specific objectives are to:

1. Examine the appropriateness and adaptability of UNICEF work in PHEs.
2. Examine efficiency and effectiveness in terms of human and financial resources and capabilities as well as operational policies, procedures and tools in preparing for and responding to PHEs.
3. Assess the coherence and sustainability of UNICEF’ work and its synergy with the work of local, national and international actors, including for systems strengthening.
4. Make actionable recommendations that help UNICEF optimize its contribution to public health emergencies.
5. Identify and capture lessons learned and experiences that can be shared to improve UNICEF contribution to PHE responses.

The primary audience for the evaluation includes the UNICEF Executive Board and UNICEF sections at every level responsible for all strategic, design, implementation, coordination, and monitoring-evaluation-learning aspects of public health emergencies (Health, Water, Sanitation and Hygiene (WASH), C4D and Supply). The secondary audience for the evaluation is the following:

• UNICEF divisions, sections and stakeholders interested in or impacted by PHE programming (Education, Child Protection, Communication, Emergency Operations, Supply, Gender, etc.).
• Partners involved in PHEs (e.g. governments, WHO, World Food Programme (WFP), UN Office for the Coordination of Humanitarian Affairs (OCHA), MSF, The Alliance for International Medical Action (ALIMA)).
• Donor agencies that technically and financially support UNICEF’s work in public health emergencies and strategic and implementing partners of UNICEF at HQ, regional and country levels, whose efforts have been technically or financially supported by UNICEF.
• Rights holders, primarily in communities and institutions where UNICEF has intervened and might intervene in the future.

1.1 Scope

For the purposes of this evaluation, it is important to distinguish between differing types of emergency events or occurrences in relation to health. This evaluation covers public health emergencies. .

Table 3: Emergencies and public health

Health in fragile and humanitarian settings are emergency situations, brought about by conflicts, natural disasters, migration, urbanization, or political and economic instability, and which can result in life-threating circumstances. Emergency responses include support for the health and well-being of those affected.[1]

A public health emergency (PHE) is defined as “an occurrence or imminent threat of an illness or health condition, caused by bio terrorism, epidemic or pandemic disease, or (a) novel and highly fatal infectious agent or biological toxin, that poses a substantial risk of a significant number of human fatalities or incidents or permanent or long-term disability”.[2]

Public health emergencies are distinguished by the health consequences wrought with the potential to overwhelm routine capabilities to address them.[3]

A public health emergency of international concern (PHEIC) is a formal declaration by the World Health Organization of “an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response”, formulated when a situation arises that is “serious, sudden, unusual or unexpected”, with implications for public health beyond the affected State’s national border.[4] Under the 2005 IHR, States have a legal duty to respond promptly to a PHEIC.

Following previous evaluations of Ebola and cholera interventions, UNICEF made several changes and adaptations in structures related to PHE as well as preparedness and response processes. These included the establishment of a HEPI initiative and a PHE unit, which currently sits within the Programme Group’s Health Team. COVID-19 also led to the introduction of revised organizational approaches.

In order to capture these shifts, the evaluation will examine two phases of UNICEF PHE work. Phase I will cover the period of 2015-2019 and will be a summative assessment. It is expected to provide a comprehensive, retrospective assessment of UNICEF’s work prior to the onset of the global pandemic and to help to set the stage for the assessment of Phase II, including refinement of key questions. Phase II will cover the “COVID-19 period” of 2020-2021, including non-COVID-19 PHEs, and will be both a formative and early summative assessment with a primary learning purpose

[1] United Nations Children’s Fund, https://www.unicef.org/health/emergencies, health in emergencies, , retrieved on 15 October 2020.

[2] World Health Organization, Humanitarian Health Action – emergencies: definitions, , retrieved on 15 October 2020.

[3] Bruce Jennings et al., Emergency Ethics: Public Health Preparedness and Response, Oxford University Press, 2016.

[4] World Health Organization, Emergencies: International health regulations and emergency committees, Q&A, 19 December 2019.