Saverio Bellizzi,1 Humayun Asghar2 and Khalif Bile3
1Jordan Country Office, World Health Organization, Amman, Jordan (Correspondence to: Saverio Bellizzi:
2Polio Eradication Programme, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt.
3Health Systems and Policy, Somali and Swedish Researchers’ Association, Vällingby, Sweden.
Abstract
Background: The WHO Regional Office for the Eastern Mediterranean and the United Nations System Staff College (UNSSC) launched the Leadership Programme on Epidemic and Pandemic Preparedness and Response during the second half of 2021.
Aims: To reflect on the leadership roles and actions played by the WHO Jordan Country Office from the onset of the COVID-19 pandemic to date via the unique lens provided by the WHO EMRO/UNSSC course.
Methods: The role of the Jordan WCO was reflected on through the unique lens provided by the WHO EMRO/UNSSC course, whose first cohort included COVID-19 pandemic responders in the Eastern Mediterranean countries.
Results: The Jordan Country Office was successful in leveraging several aspects included in the Leadership Programme, such as leadership in times of crisis, strategic thinking and planning, emotional resilience, preparedness, adopting a system approach and multisectoral partnership-building. This was particularly evident through the generation of evidence for policy-making and promotion of equitable access to health.
Conclusion: The experience of WHO country offices during COVID-19 can be examined through the lens of the EMRO/UNSSC course, which can further advance the search for better leadership in collaboration with national counterparts and partners.
Keywords: leadership programme, preparedness and response, COVID-19, Jordan
Citation: Bellizzi S; Asghar H; Bile K. Public health crisis leadership: the COVID-19 response experience of the WHO Jordan Country Office in line with the WHO EMRO/UNSSC Programme. East Mediterr Health J. 2023;29(5). https://doi.org/10.26719/emhj.23.035
Received: 07/03/22; accepted: 19/10/22
Copyright: © Authors; licensee World Health Organization. EMHJ is an open access journal. All papers published in EMHJ are available under the Creative Commons Attribution Non-Commercial ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).
Introduction
Jordan was particularly successful in flattening the epidemiological curve during the first months of the COVID-19 pandemic, up to April 2020, due to the implementation of strict nonpharmaceutical interventions (1). However, the progressive easing of restrictions resulted in an exponential increase in cases. The recent (mid-January 2022) significant upsurge in cases, mainly because of the emergence of the Omicron variant of concern, and is prompting the Government of Jordan and its national and international partners to consider additional preparedness and response actions.
The World Health Organization (WHO) Jordan Country Office has been a key actor and a primary supporter of the Jordanian Government, including the Ministry of Health, throughout the response to the COVID-19 pandemic. To further support, strengthen and sustain the leadership capacity of the WHO country offices and their collaborating ministries of health, the WHO Regional Office for the Eastern Mediterranean (EMRO) and the United Nations System Staff College (UNSSC) launched the Leadership Programme on Epidemic and Pandemic Preparedness and Response during the second half (July–November) of 2021 (2).
Leadership is essential in coordinating a response to public health emergencies, and weak leadership may result in worsening of the effects of public health emergencies (3). The expected role of leadership entails establishing and leading effective partnership with flexibility and adaptability to changes. This specifically entails evidence-based decision-making with attention to health-equity and continuous monitoring and evaluation of the preparedness and response (3). This report reflects on the critical leadership roles and actions played by the WHO Jordan Country Office from the onset of the COVID-19 pandemic to date, including staff well-being, via the unique lens provided by the WHO EMRO/UNSSC course.
WHO EMRO/UNSSC Leadership Programme on Epidemic and Pandemic Preparedness and Response – COVID-19 pandemic cohort
Outline
The programme included openly accessible leadership lecture recordings and resources. The exclusive element for the programme participants comprised individual coaching and mentoring via globally recognized champions such as high-profile former WHO staff involved in emergency response. Subjects discussed included leadership in times of crisis, strategic thinking and planning, emotional resilience, preparedness, adopting a system approach and multisectoral partnership building (2).
Public health leadership overview and components
Decisive, committed and responsible leadership is emerging as a key factor in determining success during the response to the COVID-19 pandemic (4), and a recognized characteristic of decisive leadership is rapid and accurate response, founded on an evidence-based understanding of the threat posed by COVID-19. Effective leaders ensure good coordination between stakeholders, given the political, socioeconomic and health dimensions of the pandemic. Being a leader also necessitates engaging with stakeholders, advocating to strengthen health systems and prioritizing investment in government-funded public health functions and programmes.
Jordan WHO Country Office leadership
Coordination, partnership and communication
From the onset of the COVID-19 pandemic, the WHO in Jordan was immediately engaged with the National Epidemiology Committee (5). The committee includes representatives from several governmental and nongovernmental sectors and, at the request of the relevant authorities within the Ministry of Health, is tasked with providing appropriate technical advice on the management of COVID-19.
The WHO Country Office was a partner in the development of the COVID-19 preparedness and response plan in March 2020; this was updated on a regular basis through active collaboration between the Country Office, other stakeholders and Ministry of Health pillar focal points. The Jordan Country Office continued playing a prominent role as leader in health and in the United Nations Country Team through technical support, awareness and advocacy. Within the activities of the office of the UN Resident Coordinator, WHO staff featured in United Nations town hall meetings by giving epidemiological updates and promoting public health and social measures and vaccination. They also provided guidance on health care under the United Nations Country Team First Line of Defence initiative.
The concerted effort of the WHO, UNICEF, UNESCO and the World Bank was of great importance in averting the reversal of years of progress in education by continuing to apply the “safe reopening framework”, which seeks to keep in-person learning at schools available for the majority of students in Jordan (6).
Science and evidence
Generation of evidence has been one of the core activities of the WHO in Jordan. Four rounds of the SARS-CoV-2 epidemiological survey were conducted in addition to risk factor assessment for coronavirus (COVID-19) infection in health workers and the continuing participation in the global initiative to collect clinical data from several hospitals.
The survey results (7) guided various operational aspects such as planning the COVID-19 vaccination campaign and introducing the COVID-19 prediction model run jointly with the WHO Regional Office for the Eastern Mediterranean (8). This model helped formulate targeted policy recommendations during the pandemic in Jordan.
The study on health workers confirmed that infection, prevention and control standard precautions represent a significant protective factor, and that hand hygiene, both before and after procedures, is a key protective measure. The results were used to tailor infection control and prevention (as well as capacity building) through the Ministry of Health–WHO joint activities in all health care facilities.
In consideration of the consequences of COVID-19 on other aspects related to health and well-being, the WHO Country Office engaged in additional research activities. A short situational review aimed to highlight how the national mental health system is an integral part of health system management and sustainability. Specifically, the current COVID-19 pandemic offers a unique opportunity to elevate the WHO supported National Mental Health and Substance Use Action Plan 2018–2021 (9).
Similarly, a report was developed on the milestone experience of the Jordanian Ministry of Health, with the support of the WHO Country Office, which issued a decision to ban all forms of smoking and vaping to ensure 100% smoke-free indoor public places during COVID-19 and beyond (10).
In collaboration with the Jordanian Ministry of Health, the Country Office was instrumental in the establishment of the first COVID-19 clinical management online training course through the WHO Regional Office for the Eastern Mediterranean (11).
Promotion of equitable access to health
The Jordan Country Office, in close coordination with the Ministry of Health, integrated equity to health services into strategies since the development of the first COVID-19 Preparedness and Response Plan in March 2020. The same principle was adopted when developing the National Deployment and Vaccination Plan (12). This whole-of-society approach is of fundamental importance in Jordan, which is hosting 658 000 Syrian registered refugees (the total estimate amounts to around 1.3 million) and more than 2 million registered Palestinian refugees (12). The whole-of-society approach translated into prompt vaccine uptake coverage in special contexts such as prisons and other environments particularly vulnerable from a public health perspective (13).
Jordan has clearly paved the way for inclusion of refugees and migrants in access to health care services under the umbrella of the universal health coverage vision. Such an outstanding approach has been highlighted in the WHO Global School on Refugee and Migrant Health (14).
Staff well-being
The WHO Amman Hub comprises the Country Office, the Regional Centre for Environmental Health Action, the Regional Office for Polio, the Yemen sub-office, and the Common Services Unit. The heads of offices of the WHO Amman Hub merged their efforts in 2020 by creating a pool of technical and administrative COVID-19 focal points, all referring back to the WHO Amman Hub COVID-19 coordinator and the WHO Country Office Emergency Team Lead. This structure led to streamlined coordination in creating and updating standard operating procedures within the office as well as for the management of staff and their dependents who had tested positive for COVID-19.
Conclusion
The Leadership Programme on Epidemic and Pandemic Preparedness and Response, established by the WHO Regional Office for the Eastern Mediterranean and the UNSSC, has been addressed in various sections of this report.
The first key message is that the WHO Country Office must be well-positioned during a public health crisis in order to provide guidance and ensure: proper coordination and communication at all levels; developing a team with clear roles and responsibilities and accountability; monitoring and evaluation of the evolving situation and the response; an inclusive approach to include all stakeholders; and equity in access to health services. It may prove difficult to ensure the sustainability of the leadership role of WHO at country level throughout the various phases of a crisis. In this case, it is critical that strategic decisions are taken (and re-taken) by highlighting the comparative advantage of WHO as a leader in health while creating models of multisectoral and intersectoral partnerships across the health system. These aspects have also been highlighted by Pereira Bajard et al., who indicated the importance of strengthening and enabling WHO country offices to enhance resilience at country level for future emergencies (15). In this regard, the authors specifically alluded to the technical and leadership role of country teams within preparedness and response actions.
The continuous participation in the generation, compilation and dissemination of evidence is a clear WHO role and this is critical in building trust, influencing policy-makers and ensuring the best public health preparedness, readiness and response (15). This represents the second key message of the Programme.
The third key message entails the need to utilize crises like the COVID-19 pandemic as an opportunity to promote innovative approaches that may be of benefit by establishing and developing new methods and approaches to promote health and the health system. Such an opportunity has been emphasized by the WHO Director-General, who has recently called for action on building health system resilience. The 7 recommendations of the related position paper specifically address pre-existing inequities of public health emergencies on marginalized and vulnerable populations (16).
The final message is pivotal for the WHO to continue to deliver and operate efficiently during public health crises. Staff well-being is an undeniable aspect to ensuring business continuity and incident management systems, where clear standard operating procedures are critical to streamline actions, especially in complex settings like the WHO Amman Hub where a diversity of offices and staff operate. In this context of changes and crisis, leadership again plays a crucial role in enabling interventions and helping staff to cope with overwhelming working situations (17).
The elements listed in this report may be useful for reflection of the experience during COVID-19 in other WHO country offices, and this can further advance the search for better leadership of the WHO in collaboration with national counterparts and partners.
References
- Kheirallah KA, Alsinglawi B, Alzoubi A, Saidan MN, Mubin O, Alorjani MS, et al. The effect of strict state measures on the epidemiologic curve of covid-19 infection in the context of a developing country: a simulation from Jordan. Int J Environ Res Public Health. 2020;17:1–11. doi:10.3390/ijerph17186530
- WHO EMRO/UNSSC Leadership Programme on Epidemic and Pandemic Preparedness and Response – COVID-19 Pandemic Cohort. Geneva: World Health Organization; 2021 (https://openwho.org/courses/leadership-programme-EMRO-UNSSC, accessed 1 November 2022).
- Fos PJ, Honoré PA, Honoré RL. Coordination of public health response: the role of leadership in responding to public health emergencies. In: Guerrero E, ed. Science-based approaches to effectively respond to public health emergencies. London: IntechOpen; 2021. doi:10.5772/intechopen.96304.
- Al Saidi AMO, Nur FA, Al-Mandhari AS, El Rabbat M, Hafeez A, Abubakar A. Decisive leadership is a necessity in the COVID-19 response. Lancet. 2020 Aug 1;396(10247):295–8. doi:10.1016/S0140-6736(20)31493-8.
- Ben Mimoune N. Policy and institutional responses to COVID-19 in the Middle East and North Africa: Jordan. Washington DC: Brookings; 2020 (https://www.brookings.edu/research/policy-and-institutional-responses-to-covid-19-in-the-middle-east-and-north-africa-jordan/, accessed 1 November 2022).
- Schools should be “last to close, first to open”. Amman: UNICEF Jordan; 2022 (https://www.unicef.org/jordan/press-releases/schools-should-be-last-close-first-open, accessed 1 November 2022).
- Bellizzi S, Alsawalha L, Sheikh Ali S, Sharkas G, Muthu N, Ghazo M, et al. A three-phase population based sero-epidemiological study: assessing the trend in prevalence of SARS-CoV-2 during COVID-19 pandemic in Jordan. One Health. 2021 Jul 10;13:100292. doi:10.1016/j.onehlt.2021.100292
- WHO supports generating evidence for decision-making in Jordan during COVID-19. Geneva: World Health Organization; 2021 (https://www.who.int/about/accountability/results/who-results-report-2020-mtr/country-story/2020/jordan, accessed 1 November 2022).
- Bellizzi S, Alsawalha L, Samawi L, Al-Shaikh A, Alfar H, Muthu N, Profili MC. The impact of the SARS-CoV-2 pandemic on mental health in vulnerable population settings: the case of Jordan. Front Psychiatry. 2021 Jul 22;12:692541. doi:10.3389/fpsyt.2021.692541
- Bellizzi S, AlResheidat Z, Boukerdenna H. COVID-19 as a game changer for national tobacco policies: the experience of Jordan. Nicotine Tob Res. 2022 Jul 13;24(8):1319–20. doi:10.1093/ntr/ntac022
- WHO launches COVID-19 clinical management online training. Cairo: World Health Organization Regional Office for the Eastern Mediterranean; 2020 (http://www.emro.who.int/jor/jordan-news/who-launches-covid-19-clinical-management-online-training.html, accessed 1 March 2022).
- Bellizzi S, Aidyralieva C, Alsawhala L, Al-Shaikh A, Santoro A, Profili MC. Vaccination for SARS-CoV-2 of migrants and refugees, Jordan. Bull World Health Organ. 2021 Sep 1;99(9):611. doi:10.2471/BLT.21.285591
- Bellizzi S, Aidyralieva C, Al-Shaikh A, Muthu N, Al-Sadder A, Al-Raiby J. Inclusiveness of prisons in COVID-19 vaccination deployment: evidence from Jordan. Vaccine. 2022 Jan 3;40(1):1–2. doi:10.1016/j.vaccine.2021.11.022
- WHO Global School on Refugee and Migrant Health. Geneva: World Health Organization; 2021 (https://www.who.int/news-room/events/detail/2021/10/25/default-calendar/who-global-school-on-refugee-and-migrant-health, accessed 1 November 2022).
- Pereira Bajard M, Stephens N, Eidman J, Warren KT, Molinaro P, McDonough-Thayer C, et al. Serving the vulnerable: the World Health Organization’s scaled support to countries during the first year of the COVID-19 pandemic. Front Public Health. 2022 Mar 10;10:837504. doi:10.3389/fpubh.2022.837504
- Ghebreyesus TA, Jakab Z, Ryan MJ, Mahjour J, Dalil S, Chungong S, et al. WHO recommendations for resilient health systems. Bull World Health Organ. 2022 Apr 1;100(4):240–240A. doi:10.2471/BLT.22.287843
- Spagnoli P, Molino M, Molinaro D, Giancaspro ML, Manuti A, Ghislieri C. Workaholism and technostress during the COVID-19 emergency: the crucial role of the leaders on remote working. Front Psychol. 2020 Dec 23;11:620310. doi:10.3389/fpsyg.2020.620310
