Lessons From USAID’s Ebola Response Highlight the Need for a Public Health Emergency Policy Framework

Audit Report
Report Number
9-000-18-001-P

We conducted this audit to assess USAID’s overall management and coordination of the Ebola outbreak and the Agency’s ability to react to future international public health emergencies. Although USAID’s Ebola response strategy provided needed flexibility to adjust operations as the disease and other circumstances evolved, challenges related to funding and the transition to recovery weakened USAID’s response, as did shortcomings in leadership, staffing, and coordination. For example, officials from USAID and the Centers for Disease Control and Prevention disagreed on response priorities, and response and recovery efforts were delayed.

For future emergencies, OIG determined that USAID’s policies and processes need improvement. USAID has not developed a policy framework for responding quickly to large-scale international public health emergencies, nor has it captured Agency-wide lessons from its experiences. Without them, responders are left to re-create processes as emergencies evolve.

OIG made 14 recommendations. USAID agreed with all the recommendations.

Recommendations

Recommendation 1

The Assistant to the Administrator for Policy, Planning and Learning direct the implementation of a communication and coordination strategy that would govern how the Agency will work with external actors (such as other U.S. Government agencies, the United Nations, international organizations, nongovernmental organizations) who can respond in the event of an international public health emergency. This communication and coordination strategy should also be sufficient in the event that the United Nations' humanitarian cluster approach system is delayed.

Questioned Cost:
$0
Recommendation 2

The Assistant to the Administrator for Policy, Planning and Learning work with other U.S. agencies to clearly identify, and regularly test, roles and capabilities, and responsibilities for use in a future international public health emergency. This should include policy related to the Office of U.S. Foreign Disaster Assistance’s use of the Mission Tasking Matrix with the Department of Defense. And agreements should specify operational details; clearly define roles and responsibilities; and ensure a common understanding of standardized language.

Questioned Cost:
$0
Recommendation 3

The Assistant to the Administrator for Policy, Planning and Learning direct the creation and maintenance of an inventory, by country, of nongovernmental organizations and local actors who are involved in response, development, and other humanitarian activities; and determine which of these could potentially be called upon as implementing partners in an emergency.

Questioned Cost:
$0
Recommendation 4

The Assistant to the Administrator for Policy, Planning and Learning develop policies for rapid data and information sharing including with host governments, with the World Health Organization, and within the U.S. Government.

Questioned Cost:
$0
Recommendation 5

The Assistant to the Administrator for Policy, Planning and Learning direct the creation of procedures governing coordinating bodies (Secretariat, task force, etc.) including (1) criteria for when they are established, (2) how they are staffed, (3) their responsibilities and authorities in responding to an emerging crisis, (4) their expected level of interaction within USAID and with external stakeholders, (5) policies for how they clear documents for distribution and reporting, and (6) how they are disbanded, including the transfer of residual activities to relevant regional or functional bureaus at the conclusion of the crisis.

Questioned Cost:
$0
Recommendation 6

The Assistant to the Administrator for Policy, Planning and Learning direct the development of—and test procedures for—integrating response, recovery, and transition activities during a complex whole-of-Agency humanitarian or health emergency.

Questioned Cost:
$0
Recommendation 7

The Assistant to the Administrator for Policy, Planning and Learning direct the Office of U.S. Foreign Disaster Assistance, in collaboration with Global Health and health officers from other bureaus, to develop policies for identifying health response triggers, deploying a small team to assess a health situation in collaboration with mission staff, and provide an initial needs assessment before a disaster declaration is made.

Questioned Cost:
$0
Recommendation 8

The Assistant to the Administrator for Policy, Planning and Learning direct all regional and functional bureaus to identify and maintain a listing of key staff who would be involved in a whole-of-Agency emergency response, and provide those staff with abbreviated training on the Office of U.S. Foreign Disaster Assistance Disaster Assistance Response Team and Response Management Team to build a stronger cadre of cross-sectoral teams.

Questioned Cost:
$0
Recommendation 9

The Assistant to the Administrator for Policy, Planning and Learning direct the formation of a process for (1) identifying relevant technical experts across the Agency, (2) maintaining a catalog that includes how they can be reached in the event of another health crisis, and (3) temporarily reassigning them away from their existing duties.

Questioned Cost:
$0
Recommendation 10

The Assistant to the Administrator for Policy, Planning and Learning direct the establishment of guidelines outlining the steps missions and bureaus can take in the event of an emerging crisis, including how to reprogram existing funds (from central mechanisms and mission mechanisms) and transfer resources. This should be coordinated among the Office of Acquisition and Assistance, the Office of Budget and Resource Management, and the Chief Financial Officer.

Questioned Cost:
$0
Recommendation 11

The Assistant to the Administrator for Policy, Planning and Learning direct the Office of Acquisition and Assistance to determine what can be done to insert flexibility clauses into the missions’ program awards, as appropriate, so that missions can respond to emerging crises using existing resources and nongovernmental organizations on the ground that are familiar with the country context, and implement a policy accordingly. This additional flexibility should be accompanied by sufficient controls to prevent abuse.

Questioned Cost:
$0
Recommendation 12

The Assistant to the Administrator for Policy, Planning and Learning direct the development of an Agency-wide content management system where decisions, documents, and lessons can be tracked and accessed by staff to improve the consistency of records management.

Questioned Cost:
$0
Recommendation 13

The Assistant to the Administrator for Policy, Planning and Learning direct the development of an Agency-wide system that tracks program awards and relevant contractors and partners implementing those awards to bring all systems together, reduce duplication, and increase collaboration and oversight.

Questioned Cost:
$0
Recommendation 14

The Assistant to the Administrator for Policy, Planning and Learning direct the creation or appointment of a unit, and development of a policy that requires operating units involved in an emergency response or recovery to (1) collectively identify lessons learned, (2) develop after-action reports, (3) create a timeline for corrective actions to take place, and (4) follow up on those planned actions to ensure they occur, including updating the policy framework, if necessary.

Questioned Cost:
$0