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Iraq Health Cluster Transition Plan - 2020/2021
                                                   10th September 2020

During 2019 and into 2020, Iraq has been witnessing returns of people to their Areas of Origin (AoO),
although this may not be voluntary, safe and dignified in all instances. This is mainly because the
Government of Iraq (GoI) has several times stated its intention of closing down all the existing IDP camps
by the middle of 2020.
However, as of mid-2020, despite 4.7 million people returning since the beginning of the conflict,
approximately 1.4 million people remain displaced, nearly 300,000 of whom are in camps and require
assistance from humanitarian partners.1
Over the years, the lack of government remuneration coupled with the conflict situation, has resulted in a
brain-drain of specialized health professionals from the country, in search of livelihoods. As an example,
the Iraqi Ministry of Health (MoH) have a recent count of 138 psychiatrists and 60 social workers country-
wide, where there is a population of more than 38 million individuals.2
The additional shock of the COVID-19 pandemic has further worsened the health system’s coping capacity.
This is mainly because of the low numbers of trained medical professionals (as evidenced by the number
of health workers infected with the virus), shortage of testing equipment and supplies and a secondary
healthcare system not able to satisfactorily manage severe and critical cases. As of 10th September 2020,
the cumulative number of cases is 273,821 with 7,732 associated deaths.3
The inadequate hygiene conditions in the South of the country continue to pose a potential risk for water-
borne communicable diseases, while being exacerbated by the COVID-19 pandemic. Meanwhile, the
national disease surveillance and response mechanism is not up to the mark in terms of early warning and
provision of timely response to alerts and potential outbreaks. Support needs to continue in strengthening
the Early Warning, Alert and Response Network (EWARN) and the gradual integration of this system into
the national surveillance system.
Iraq has undergone wars and post-conflict crises during the past three decades that has led to weakened
national institutions. In addition to the brain-drain of technical experts, the unstable political situation in
the country, leading to frequent change of government officers, has affected the capacity of the MoH to
implement adequate policies or reforms both at national and governorate level. Although there is
participation of the MoH and the Directorates of Health (DoH) in the national and sub-national cluster
coordination mechanism, lack of capacity affects their performance in some governorates while shortage
of resources does the same in others.

  DTM Iraq:
  The New York Times Magazine:
  Iraq - COVID-19 Dynamic Infographic Dashboard:
Based on results of the Common Country Analysis (CCA), mainly Key Findings 1 and 3, post-conflict Iraq
is in need of transparent, responsive, and inclusive structural reforms of state and civil institutions, as well
as to build human resource capacity to takeover services currently supported by the humanitarians.
However, this needs to be conducted in a gradual manner, while simultaneously coordinating with the
developmental actors and the Government, so that the people in need of basic services are not left missed
out during the handover.
A National Action Plan for Health Security (NAPHS) of Iraq was developed during a workshop in Baghdad,
in March 2019. This plan was based off the Joint External Evaluation (JEE) also conducted between 12-18
March 2019. The 19 areas in the JEE (under prevention, detection, response and hazards/Points of Entry)
were used as a guideline to identify indicators to bring Iraq’s national health system up to International
Health Regulation (IHR) standards in the upcoming 5 years.
While it is true that stabilization partners are conducting infrastructure rehabilitation, provision of
equipment to health facilities and subsequently, will train health workers on the adequate use of this
equipment, this is a long-term process that will at least continue for the coming two years, depending on
such factors as the availability of funding, the GoI’s readiness to facilitate the implementation of these
projects, etc. Therefore, in the interim, it is vital that short-term support to public health primary and
secondary healthcare facilities through humanitarian funding be focused on, while developing the capacity
of the government and national institutions to ensure sustainable service provision upon
handover/integration of services, with health system strengthening being the long-term goal.4 This should
go hand in hand with maintaining essential primary health care services to people in protracted
displacement, whether in camps or informal settlements, for as long as they remain in displacement and in
need of humanitarian assistance, based on the emerging needs identified by the Humanitarian Needs
Overview (HNO) and other assessments.

The aim of this plan is to operationalize the durable solutions and humanitarian-development nexus
components of response through identification of activities that the Health Cluster partners can implement
during the transition phase, in line with the Humanitarian Response Plan (HRP) 2020/2021, to ensure a
smooth handover of humanitarian activities to the development actors and the GoI, while ensuring sustained
quality healthcare services are in place through capacity building of the national institutions.

Action Plan
The activities in this plan will cover those targeted under the Areas of Intervention of the Health Cluster
partners and the existing Working Groups, in the locations and focusing on the population groups targeted
under the HRP 2020, which are likely to be the same under HRP 2021, based on the guidance of the
Humanitarian Coordinator in Iraq. These activities are as below:
     Area of intervention                            Activities                                         Outputs
    Coordination                      •    Facilitating increased                    •    Updated information shared
                                           participation of the                           regularly (monthly and ad hoc basis)
                                           Stabilization partners such as                 with humanitarian partners on the
                                           the UNDP Funding Facility                      activities of stabilization actors, to
                                           for Stabilization (FFS) and                    assist in planning of suitable
                                           Development actors such as                     interventions and covering of gaps.

    The Humanitarian-Development Nexus:
the World Bank, in Cluster                   •   Local health authorities more
                                      meetings for information                         explicit leadership in health
                                      sharing through regular                          coordination
                                      invitation to national and (if               •   National/local actors’ capacity
                                      feasible) sub-national Health                    strengthened to be able to
                                      Cluster meetings                                 implement humanitarian and, later,
                                 •    Supporting capacity                              recovery/resilience-building projects
                                      enhancement of national/local                •   MoH/DoH capacity strengthened to
                                      NGOs through their                               gradually takeover leadership and
                                      continuous inclusion in                          coordination of health partners’
                                      strategic decision-making                        activities from the Cluster in the
                                      processes (e.g., Cluster SAG)                    transition phase.
                                      and facilitating NGO-led
                                      consortium projects
                                 •    Supporting the transfer of
                                      leadership from the Cluster to
                                      the MoH/DoH (who currently
                                      participate in the cluster
                                      coordination mechanism) at
                                      national/subnational levels
                                      through conducting training
                                      on Risk Management and
                                      International Health
    Mental     Health    & •          Provide trainings* for health                •   Strengthened capacities on mhGAP-
    Psychosocial    Support           care providers at primary                        IG / HIG for 750 Family Medicine
    Services (MHPSS)5                 health care, secondary health                    doctors and GPs working at family
                                      care and community health                        medicine centres, PHCCs and
                                      facilities to enhance the                        community centres
                                      integration of MHPSS services                •   Improved knowledge and education
                                      into      PHC,      SHC      and                 on WHO Handbook for GBV for
                                      community level (30 x 5                          health care providers working in the
                                      trainings for 750 family                         PHCCs and hospitals.
                                      doctors and GPs)                             •   Enhanced capacities on PM+, PFA
                                 •    Training of school personnel                     and Self-help + for health care
                                      to support mental health                         providers working in PHCCs,
                                      interventions at schools (TOT                    community health centres and
                                      and 5 x 5 days training for 125                  hospitals.
                                      teachers)                                    •   Enhanced capacities of teachers
                                 •    Conduct       workshops      and                 working in the high-risk areas to
                                      campaigns to raise awareness                     strengthen the school mental health
                                      for 5,000 individuals at the                     continuum.
                                      community level                              •   Awareness raising sessions and
                                                                                       campaigns on MHPSS for
                                  *The guidelines which will be used in MHPSS
                                  capacity building activities have already been
                                                                                       individuals at the community level
                                  adapted to the Iraqi context and have been
                                  endorsed by MoH. The trainings will be
                                  conducted in coordination with MoH and in

 Building Back Better – Sustainable mental health care after emergencies:
line with the national oOH mental health
                                    policy, strategy and plan. Additionally, the
                                    mentioned activities are in line with the global
                                    mental health strategic action plan
    Nutrition                     •     Training* of health workers on •                   Enhancing MoH/DoHs capacity on
                                        screening and management                           delivering proper nutrition and new-
                                        methods for malnutrition,                          born care services and counselling
                                        IYCF counselling to mothers                        enhanced.
                                        and newborn home services

                                    *The training will include management and
                                    supervision by the local authorities (central
                                    supervision by MoH, second layer of
                                    supervision by DoH and last one by the district
                                    level managers). However, the management
                                    and supervision package will be a separate one
                                    i.e. for all managers and supervisors (from all
                                    DoHs including conflict-affected governorates)
    Physical rehabilitation of •        Training of health workers on                  •   Improving MoH/DoH capacities in
    patients                            conducting         rehabilitation                  attending to the medical needs of
                                        sessions for patients                              people with physical and functional
                                  •     Establishing            Physical                   disabilities.
                                        Rehabilitation Centers
    Reproductive health6          •     Implementation of MISP                         •   RH program managers are enabled to
                                        program                                            manage MISP services provision to
                                  •     Conduct ToT on transition                          the affected population in the
                                        from MISP to comprehensive                         humanitarian setting.
                                        SRH                                            •   Safe delivery services and referrals
                                  •     Creating a pool of Skilled Birth                   are secured and risky pregnancies are
                                        Attendants                                         covered with qualified services for
                                  •     Awareness raising on early                         the     targeted     population    in
                                        marriages       and      teenage                   humanitarian setting.
                                        pregnancies                                    •   Social pressure against early
                                  •     Provision      of     CEmONC                       marriage is seeded and created within
                                        equipment and training of                          the targeted populations.
                                        health workers
    Support      to      health •       Capacity building of hospitals                 •   Governorate and district hospitals
    facilities                          to receive cases referred from                     have      enhanced      capacity    to
                                        the Primary Care level                             treat/manage referred cases requiring
                                  •     Support to hospitals to admit                      inpatient neonatal, maternal and
                                        cases that require inpatient care                  nutrition care; manage diseases that
                                        through provision of diagnostic                    require specialist healthcare and
                                        and therapeutic equipment                          complicated conditions.
    Capacity building             •     Conducting 2 Quality of Care                   •   Assessment of (QoC) provided in
                                        (QoC) assessment surveys of                        facilities and communicating results
                                        health facilities supported by                     to relevant partners
                                        humanitarian partners.                         •   Improving quality of care through
                                  •     Implementing             Quality                   conduction of Quality Improvement
                                        Improvement            exercises                   Initiative (QII) in the health centers
                                                                                           supported by humanitarian partners

 UNFPA Iraq Country Programme Document (2020-2024):
between phases of QoC               •   Enhancing capacities of health
                           assessments                             workers on public health topics such
                       •   4      Quality      Improvement         as QII, EWARN, etc. Different level
                           Initiative     (QII)    exercises       medical and paramedical staff have
                           conducted (quarterly) by the            enhanced capacity to provide quality
                           Quality Teams based in the              health services
                           health centers supported by
                           humanitarian partners
                       •   A minimum of 2,000 health
                           workers trained on various
                           topics as:
                           1- Quality          Improvement
                                practices – to serve as
                                Quality Assurance teams
                           2- EWARN                refresher
                                trainings         (Infection
                                Prevention and Control
                                and case management)
                           3- On-the-job training on
                                clinical practices and data
Vaccination            •   Upgrading the implementation        •   All eligible children vaccinated
                           of routine and supplementary            against vaccine-preventable diseases
                           vaccination services in return
                           locations through fixed and
                           outreach vaccination teams.
                       •   Supporting MoH to implement
                           focused social mobilization
                           interventions/ campaigns on
                           vaccination services through
                           focus group discussion, media
                           broadcasting, mobile health
                           promotion         teams,      and
                           distribution of IEC materials
EWARN/Communicable •       Updating         the     Cholera    •   Early detection and reporting of
Disease Surveillance and   Preparedness/Response Plan              communicable diseases ensured and
Response                   based on the available/required         institutionalized
                           resources through support from      •   Trained health workers (and RRTs)
                           a consultant and conducting a           are able to prevent spread of priority
                           workshop with the Ministry of           communicable         diseases     and
                           Health         and       relevant       mitigate/manage the outcomes such
                           stakeholders.                           diseases
                       •   Developing/updating response        •   Improved detection and management
                           plans for other priority                of suspected cases at points of entry
                           communicable diseases as                (POE), including seaports, airports
                           appropriate including, but not          ground crossings and on board
                           limited to, COVID-19                    conveyances
                       •   Enhancing electronic and            •   Integration of EWARN system into
                           timely reporting by health              the national surveillance system
partners through training and
                                             dissemination of tablets
                                       •     Training of health workers
                                             (mainly virtual but also face-
                                             to-face when possible) on
                                             Infection Prevention and
                                             Control measures and case
                                             management         of      priority
                                             diseases, including COVID-
                                       •     Strengthening the IHR core
                                             capacity at the national and
                                             subnational levels at Points of
                                             Entry [PoE] and prior to,
                                             during and after mass
                                             gathering events in the areas of
                                             surveillance, testing, tracing,
                                             and isolation of COVID-19
                                       •     Strengthening Rapid Response
                                             Teams (RRT) and developing
                                             capacity on data management
                                             through provision of trainings
                                       •     Procuring and distributing
                                             medicines, IV fluids and
                                             laboratory equipment/reagents
                                       •     Upgrading laboratories to
                                             facilitate diagnostics
    Essential medicines                •     WHO to train MoH staff on the •       Enhancing capacity of staff and
                                             complete        supply       chain    partners    on   supply    chain
                                             management process to ensure          management and health system
                                             capacity building of the health       components.
                                       •     Training of Health Cluster
                                             partners on rational use of
                                             medicines,            distribution
                                             practices, etc., by WHO
The trainings planned above are to be conducted in coordination with the MoH so that they fall in line with the national
guidelines/protocols and adapted to the Iraqi MoH training curriculum on the specific topics

As per current trends, it is not expected that humanitarian funding will continue at the same levels as during
previous years, although the situation remains in need of this. As of 10th September 2020, the Health Cluster
is 20.6% funded against the HRP 2020, while the COVID-19 response component has been funded to the
order of 29%7
Therefore, while advocacy for funding humanitarian response continues, WHO and the Cluster will focus
on the best mechanisms to handover service-provision to the GoI. This can only happen if, in the interim,

    Financial Tracking Service:
sufficient capacity has been developed to ensure uninterrupted service-delivery and its coordination by the
authorities, as outlined in the NAPHS.

Transitioning Health Cluster functions to MoH/DoH
The Iraq Humanitarian Country Team (HCT) has decided to have an HRP for 2021, therefore the functions
of the Health Cluster would need to be in place to coordinate and support the implementation of the plan..
During this period, however, the Cluster will work with the MoH/DoH to support them in playing a more
active role in coordinating the humanitarian interventions, which will facilitate the gradual withdrawal of
the health partners from humanitarian coordination and service-provision.
The MoH has a policy in place that IDPs residing in camps should obtain free diagnostic and therapeutic
services at public health facilities. This can be built upon by upgrading such facilities by Health Cluster
partners so that, when handed over, better services will be available for IDPs where camp PHCCs are not
an option anymore. This will also reinforce the stance of the humanitarian community to the position of the
Government of Iraq, which intends to close camps in the near future, in that services and livelihoods would
be made available for people in areas of return before they leave the camps.
The speed of the handover will depend on the capacity of the MoH to takeover coordination and leadership
roles, which is mainly reliant on a stable political situation in the country, preventing sudden disruption of
basic service-delivery while also allowing for longer duration of government staff remaining in office.
Another factor which could affect the handover is the status of COVID-19 infection in the country, since
currently, the MoH/DoH is completely occupied with this emergency and would not be keen to take on
more responsibilities.
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