Why We Did This Audit
USAID plays a key role in the United States’ global response to health emergencies, sending staff and providing financial assistance to help manage infectious disease outbreaks such as Ebola, Zika, pneumonic plague, and COVID-19. According to the World Health Organization (WHO), in 2019 there were an unprecedented 55 active health emergencies around the world. However, just 4 years later, the number of health emergencies increased to 72. Thus, it is imperative that USAID remains prepared to simultaneously respond to multiple global health emergencies. We conducted this audit to determine the extent to which USAID developed plans to mobilize staff and funding and respond to global health emergencies in accordance with identified best practices. We worked with a global health expert to identify 14 best practices that organizations used in their emergency response planning when responding to global health emergencies.
For this audit, we defined a global health emergency as a situation where the scale, timing, or unpredictability threatens to overwhelm routine capabilities and requires additional assistance to respond to health threats, crises, or health system instability, including public health emergencies of international concern as determined by the WHO.
USAID’s Revised Framework for USAID Response to Infectious Disease Outbreaks outlines the Agency units that would lead the response to such global health emergencies. Our audit focused on the response plans of the Bureau for Global Health (GH), the Bureau for Humanitarian Assistance (BHA), and Agency-led task forces.
What We Found
USAID plans for responding to global health emergencies aligned with most identified best practices. The three units that lead USAID’s responses to global health emergencies developed plans that aligned with more than half of the identified best practices for staffing, plan content, planning process, and funding. Specifically, BHA’s plans aligned with nearly all best practices that we identified (12 out of 14). GH’s plans generally aligned with 10 of the 14 best practices while Agency task force-led plans generally aligned with 7 out of 11 best practices, excluding two financial and one staff deployment elements that did not apply to them.
Gaps remain in contingency planning, staffing, testing, and documenting lessons learned—which may hinder the Agency in responding to future global health emergencies. For example, Agency plans did not contain updated rosters of USAID staff with key skillsets. In addition, the plans lacked contingency planning for situations when not enough staff are available for a task force.
By failing to identify staffing needs and address gaps, task forces responding to global health emergencies may face challenges, such as those experienced with the Agency’s two COVID-19 task forces, in recruiting and retaining sufficient staff with appropriate skills.
Global Health’s plan, on the other hand, lacked staff deployment procedures. While its plan indicates that the bureau could surge up to 30 full-time staff to the field, it had not developed details about how this could take place.
Finally, response plans by GH and Agency-led task forces lacked provisions for conducting periodic tests and documenting and addressing lessons learned—all of which could help improve USAID’s preparation and effectiveness in a global health emergency.
What We Recommend
We made four recommendations to improve the Agency’s preparation for a global health response. USAID agreed with all of them.