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JULY 2023 The Emergency Medical Teams initiative in the WHO European Region Governance structure 2.0 (2023) JULY 2023 The Emergency Medical Teams initiative in the WHO European Region Governance structure 2.0 (2023) Contents Abbreviations i Background 1 Part 1. Background and governance 2 European EMT governance evolution 2 European EMT governance structure 2.0 4 The European RG 4 The RSC 4 Composition and structure 4 The advisory board 6 The Secretariat 7 Part 2. Strategies, roles and responsibilities 8 Strategic priorities and operations 8 Roles and responsibilities: terms of reference 10 EMT-NFPs 10 TFPs 11 The RSC 12 The RSC chair and co-chair 13 The advisory board 13 Procedures 14 Eligibility for voting during European RG meetings 14 Nomination for election to the RSC 15 Electoral process for the RSC 15 Regular meetings 16 Annex 1. Regional Steering Committee nomination and election process 17 Abbreviations CBRNE chemical, biological, radiological, nuclear, and high-yield explosives DG-ECHO European Commission Directorate-General for European Civil Protection and Humanitarian Aid EMT Emergency Medical Teams EMT-NFPs National Focal Points for the EMT Initiative EU European Union European RG EMT Regional Group for Europe IHRs International Health Regulations (2005) NFP national focal point NGO nongovernmental organization RCG Regional Chairmanship Group RSC Regional Steering Committee TFP EMT focal point WHE World Health Emergencies Programme Background WHO established in 2010 the Emergency Medical Global governance decides the direction of the EMT Teams (EMT) initiative with the goal of ensuring rapid Initiative as a whole, while the Regional EMT Groups deployment of quality-assured medical personnel serve as the primary platform for implementation of to emergencies. The Initiative comprises a network the EMT Initiative at the regional level and a forum for of diverse stakeholders involved in emergency close dialogue and connection between National Focal preparedness and response, including governments, Points for the EMT Initiative (EMT-NFPs) designated academic institutions, nongovernmental organizations by WHO Member States, EMT focal points (TFPs) and and more, all dedicated to a common methodology other stakeholders and allow them to shape, guide and constantly evolving and improving based on the and drive the regional implementation of the Initiative. contributions and experience of all its members. The EMT Regional Group for Europe (European RG) The five core areas of work include governance, is a part of the global EMT governance structure and capacity-building, quality assurance and mentorship, is the bidirectional platform working to adapt the emergency response and coordination in the field five core areas of work of the EMT Initiative to the and standards settings – and governance is critical to regional and country-specific contexts, as well as the success and implementation of all other areas of contributing to and influencing and shaping of the work. Strong governance supports team and network global level strategy of the EMT Initiative. Meetings of performance, development, coordination and the the European RG have proved instrumental in steering identification of important opportunities to evolve and the direction of the regional and global Initiative, meet the needs of the workforce and the communities upholding global standards of care in emergencies and they serve. fostering collaboration and support from the various Member States and partners of the network involved in EMT surge response. 1 PART 1. Background and governance European EMT governance evolution the development of regional groups, representing the 6 geographical WHO regions. The EMT Initiative With the growth and increased participation for the WHO European Region established an initial worldwide in the EMT Initiative since its inception governance structure early on to guide and set in 2010, the Global Meeting in Panama in December priorities for regional activities and to advise the EMT 2015 discussed and recommended the strengthening general Secretariat on the global level (Fig. 1). of the overall governance structure which included WHO Regional Office for the Eastern Mediterrenean WHO Regional WHO Regional Office for South- Office for the East Asia Western Pacific EMT Global Secretariat in WHO headquarters WHO Regional WHO Regional Office for Africa Office for the Americas EMT Focal Point at the WHO Regional Office for Europe European Regional Chairmanship Group (RCG) European RG Fig. 1. Governance structure v.1.0 (2018) 2 In April 2018, the First Regional Meeting of the EMT for a structure more representative of the range of Initiative for the WHO European Region took place in Member States. During 2023, the governance group Brussels, Belgium, and set forth recommendations will transition to a Regional Steering Committee and priority actions, including a stronger emphasis on (RSC), which from 2024 will act as a coordinating body the role of each designated EMT-NFP as an important between national, subregional and regional needs liaison between Member States and the WHO Regional and global programmes and priorities, but be more EMT Secretariat, as well as that of the EMT Regional horizontally oriented and feature a larger and broader Focal Point at the WHO Regional Office for Europe. group of constituents. This new governance structure Members also noted a need for timely communication represents a wider range of stakeholders, ensuring and information exchange between the Regional EMT broad and inclusive representation at the highest level Secretariat and key stakeholders at the national and of regional collaboration. regional levels. Key topics and goals addressed in this updated The recommendation was made to promote inclusivity governance structure include: and transparency and to avoid potential bias, which informed an updated governance note and the • expanding the regional leadership to represent the development of the Regional Chairmanship Group diversity of the network; (RCG), also known as the “troika”, aimed at further • ensuring more inclusivity within the leadership defining the leadership and governance structure structure to support stronger regionalization and and providing a clear rotation of responsibilities. This subregionalization of the network and adaptation was in addition to increasing the involvement of of priorities; nongovernmental organizations (NGOs) to represent and facilitate participation of a broader range • strengthening partnerships at the regional, stakeholders. subregional and national levels; • prioritization of national responses and capacity- Since the Global EMT Meeting in 2019 the Initiative and building; its network, both globally and regionally, have made • supporting Member States with the expansion of significant strides. More than three years of COVID-19 EMT capacities to provide quality health services; response and recent, additional complex emergencies and have demonstrated the need for the restructuring and diversification of the EMT Initiative to be even • effective coordination and support for the further fit for purpose. EMT stakeholders have had implementation of EMT methodologies. opportunities to revisit the existing governance structure and adapt it to meet the observations, The RSC will provide broader representation for, and needs and priorities of the EMT community, and to stronger input from, World Health Emergencies support regional and global goals after a period of Programme (WHE) priority countries1 and other dynamic learning and development. The fifth EMT partners, reflected in the nomination of focal points Global Meeting in October 2022 served as a crucial from across Member States within WHE hubs, national opportunity for discussion and review of the past focal points (NFPs), TFPs, the European Commission few years and further engagement of stakeholders Directorate-General for European Civil Protection and across the Region in deciding the strategic direction Humanitarian Aid (DG-ECHO), various international of the Initiative and its network for the next 8 years, organizations, and the continued engagement of culminating with the outlining of the EMT 2030 the Regional Focal Point and Secretariat at the WHO Strategy. Regional Office for Europe. Since 2019, the RCG has served as the primary body of governance, characterized by a troika comprising an active chair and both incoming and outgoing vice-chairs, with an aim to promote wider ownership and opportunities for stakeholders to participate in governance. While this mechanism is effective, the scale and diversity of the WHO European Region calls 1 Currently, the 17 priority Member States and territories within the European WHE Programme include Albania, Armenia, Azer- baijan, Bosnia and Herzegovina, Georgia, Kazakhstan, Kosovo,2 Kyrgyzstan, North Macedonia, the Republic of Moldova, Serbia, Tajikistan, the Republic of Türkiye, Ukraine and Uzbekistan. At the time this document was circulated, each of these countries has an NFP or an arrangement between the WHO Regional Office for Europe and their government to provide a representative on a case-by-case basis. The presence of these countries will provide valuable perspective to the decisions made by the elect- ed members of the RSC and ensure that the diversity and entirety of the WHO European Region is included in EMT activities. 2 All references to Kosovo in this document should be understood to be in the context of United Nations Security Council Resolution 1244 (1999). 3 European EMT governance structure 2.0 The RSC The European RG reaffirms its commitment to The mission of the RSC is to support regionalization supporting and leading the implementation of the EMT and subregionalization of the EMT Initiative, including Initiative with the support of WHO headquarters and implementation and regionalization of the 2030 the WHO Regional Office for Europe, promoting the Strategy. With support from the WHO Regional Office for implementation of the EMT Initiative at the regional, Europe and at global level by the WHO EMT Secretariat, subregional and country levels, in line with the overall the RSC as the governing body of the European RG strategy on a global level. will perform the executive Secretariat function for the European RG, as well as the tasks and priorities as outlined in the terms of reference for the RSC. The European RG Composition and structure The European RG works to adapt the 5 global areas of work of the EMT Initiative to the regional and The RSC is composed of six positions: country-specific contexts, providing guidance to Member States on implementation of the EMT • four are reserved for officially appointed Initiative methodologies, in alignment with the 2030 government representatives: NFPs or team focal Strategy. The regular meetings of the European RG points from national EMTs (designated “GOV”); and are the highest level of regional governance, and all • two are allocated to TFPs from NGO-run EMTs key decisions are officially made through and during classified by WHO (designated “NGO”). these meetings with European RG members. These provides the basis for governance and setting strategic priorities and further ongoing efforts to strengthen This composition (Fig. 2 and Fig. 3) of the RSC has the implementation of the EMT Initiative in the WHO been updated following direct regional group European Region in a transparent and inclusive feedback. Instead of categorizing positions as manner. NFP or TFP, these spots are allocated by either governmental and nongovernmental affiliation. This Membership in the European RG is open to: transition transparently ensures that at least two positions will be occupied by NGO TFPs while the • designated EMT-NFPs as appointed by the remaining four positions are open for NFPs or TFPs competent authority responsible for the activation from governmental teams. The NFP role is important, and implementation of the National Health as it facilitates direct country-level advocacy, Emergency Preparedness and Response Plan. All and government authorities remain the official Member States are expected to designate an NFP; counterparts for WHO. NFPs are often representatives • TFPs, both governmental and nongovernmental, of various health or emergency authorities’ nationally where they are either: supported teams. TFPs from governmental teams, with endorsement and support from the NFP,3 can o classified by WHO; or be nominated to governmental positions. NGOs are o are teams under the WHO mentorship and also important within both the Initiative and regional classification process; and2 contexts, and should not go unrecognized as they • key stakeholders, such as representatives from remain crucial stakeholders within the EMT Initiative partner networks or international organizations and among Member States. with experience in EMT development and response in the WHO European Region (e.g. DG ECHO, the International Federation of Red Cross and Red Crescent Societies and others) may participate in an advisory and observational role, as detailed in the advisory board section. • All EMTs are expected to designate a TFP. This focal point is also the person that is contacted in case a deployment is requested. More details on these positions are outlined within the section Roles and responsibilities: terms of reference. 2 For a team or an organization to state its interest and confirm its membership in the European RG and globally in the EMT ini- tiative, they must officially register through the EMT website (https:///extranet.who.int/emt/) and enrol in the mentorship and classification programme. 3 TFPs from governmental teams who wish to run for a position on the RSC are requested to obtain endorsement and support from the NFP whenever possible. Situations where this is not possible and where TFPs of governmental teams request to waive this endorsement will be reviewed by the RSC on a case-by-case basis. 4  ADVISORY BOARD(6) RSC EMT SECRETERIAT • DG-ECHO EMT Regional Focal • International EMT Point and Secretariat stakeholders • WHE hubs TFP* TFP* or NFP representing NGOs representing governments *TFP may be from classified EMT or unclassified EMT with mentor approval Fig. 2. Governance structure v.3.0 (2023) GOV GOV 2024-2027 2026-2029 NGO NGO GOV GOV Fig. 3. RSC rotation (2023) 5 The positions of the RSC are structured as two The advisory board overlapping, 4-year rotations of the three focal points to ensure continuity and facilitate smooth The advisory board aims to ensure that the views and transition within the leadership structure and sharing opinions of donors, international organizations and of institutional knowledge as well as allowing for priority countries are considered regarding technical interested, official focal points of the European RG to and operational issues in EMT development and apply to take on leadership roles at the regional level. response, as well as providing lessons learned and During each election cycle, two governmental and one specific context. nongovernmental focal points will be introduced into the RSC structure. As seen in Fig. 4, the advisory board will consist of a minimum of six seats with: The current three-person RCG will continue through • one representative from DG-ECHO as host of the 2025 as a second group of nominated and elected European Medical Corps, of which EMTs are an representatives begin four-year terms to join and important asset (one seat); expand the group in 2024. Ultimately, this staggering of overlapping cycles means that every 2 years, • one internally nominated NFP from among the half of the positions on the RSC will be filled with 15 Member States under each of the three existing newly elected members and the heterogeneity of WHE Hubs4 (three seats). Until these positions are both governmental organizations and NGOs will be filled, relevant WHE Hub coordinators will occupy maintained. the seats; and • two representatives from international EMT Starting with the 2024 constituency, candidacy for stakeholders with experience in EMT development the positions is open to all NFPs and their TFPs from and response in the WHO European Region, governmental teams and TFP from NGOs. Voting is including the Regional Focal Point for the open to both teams already classified and those under International Federation of Red Cross and Red mentorship as well. The incoming three members Crescent Societies and other international of the RSC are elected by the membership of the organizations (two seats). European RG during the regional meeting in the election year where the representatives are appointed through a defined and agreed election process. The nomination and election process has been developed in collaboration and following consultation with the European RG at the European EMT Regional Group meeting in Berlin, Germany in March 2023, and the preliminary process can be viewed in the section Procedures. 4 The current hub system of the World Health Emergencies Programme (WHE), comprising Balkan, southern Caucasus and cen- tral Asian Republics, are inclusive of 15 of the 17 priority countries and territories in the WHO European Region where support for strengthening emergency preparedness and response capacities(as per the International Health Regulations (2005) (IHRs) is noted by WHO as a top priority. The countries within the hubs are: Albania, Armenia, Azerbaijan, Bosnia and Herzegovina, Georgia, Kazakhstan, Kosovo,2 Kyrgyzstan, North Macedonia, the Republic of Moldova, Serbia, Tajikistan and Uzbekistan. 6  ADVISORY BOARD(6) western southern central Asian Balkans Caucasus Republics DG-ECHO Three positions allocated International EMT to a focal point nominated stakeholders from within each of WHE Programme hubs in the WHO European Region Fig. 4. Advisory board structure (2023) These stakeholders are included in the steering assured teams in the event of an emergency. The committee/working group in an observational Secretariat also works with EMTs from Governments, capacity, but contribute to key discussions and NGOs and militaries to improve response, manage the provide input. The RSC can decide to include, coordination of EMTs, strengthen existing capacities temporarily or permanently, more representatives if and develop best practice guidance in areas such applicable or viewed as supportive for the Initiative. as clinical care, logistics and field support, training, emergency management and coordination within The inclusion of the subregional hubs ensures Emergency Operations Centres. representation of the perspectives of countries that may not have EMT capacity as of yet, but have a The Regional Secretariat is based in the WHO Regional designated NFP who can continue to advocate for the Office for Europe in Copenhagen, Denmark and serves development of national capacities and engage further to coordinate with the European RG, with the Regional with existing teams. Additionally, representatives from Focal Point acting as a link between the RSC and these countries that do have existing EMT capacities or the EMT Secretariat at WHO headquarters (Fig. 1), as classified teams are able to apply for a position in the RSC. well as liaison for capacity-building and mentorship activities of the national EMTs and any other inquiries from teams and NFPs. The Regional Secretariat also plays an important role in multilateral communication, The Secretariat working to secure the nomination or renomination The global Secretariat is based within WHO of NFPs through regular and official communication headquarters in Geneva, Switzerland, and oversees with Member States, dissemination of expressions of the global classification process of EMTs. A directory interest to all focal points in response to emergencies of all classified EMTs is held by the Secretariat to help and sharing all other relevant information from the to expedite mobilization and coordination of quality- global or regional level with the European RG. 7 PART 2. Strategies, roles and responsibilities Strategic priorities and operations • innovations including the further digitalization of all areas of EMT Initiative work; Regional and key strategic priorities, in line with the Global EMT 2030 Strategy (2022) and as indicated by • promoting quality assurance and a patient-first the European RG, include a renewed emphasis on approach; further regionalization and strengthened governance • applying an all-hazards approach, being (Fig. 5) as well as: better prepared for outbreaks and other types • enhancing strengthening of national capacities, emergencies, including those related to migration, including network of EMT-NFPs and building armed conflicts and climate change; national EMTs, with focus on both preparedness and response; • further flexibility of the classification system and adaptation of the EMT standards to the local • addressing inequities in the region with support to context; and local health systems; • identifying opportunities for resilient and • addressing lessons learned, identified gaps sustainable financing, a shift in investment. and integrating best practices as shared by EMT members; • strengthening interoperability between EMTs and other rapid response capacities and partners; 2030 STRATEGIC PRIORITIES Investment shift Digitalization Further and innovation regionalization All hazards Strengthened preparedness 2030 governance and response National EMT Interoperability capacity strengthening Fig. 5. 2030 Strategic priorities 8 These priorities are also in alignment with the stronger, networks,defined by similar experiences and more inclusive health emergency preparedness, resources who can connect bi- or multilaterally with response and resilience architecture, based on neighbouring nations for preparedness and response the overarching principles of equity in access and activities (Fig. 6). outcomes; inclusivity of ownership by all countries and sectors; and coherence in the alignment of systems With EMT response and preparedness activities and their financing and governance with existing structured in four interlinked, concentric levels, instruments and mechanisms.5 These priorities are Member States, at the centre, are allowed the reflected through the reformed governance structure flexibility to focus their current resources and and within the terms of reference for each position development efforts where they are most necessary, within the European RG including the RSC and focal while working with partners at all levels to further point positions. strengthen capacities for subregional, regional and international activities and deployments. A new operational structure aims to reflect the specificities of the WHO European Region and even further regionalize the Initiative, most notably by the grouping of countries and territories or subregional At the central, national level, EMT national focal National points continue their important coordination role with national teams and across all other levels. Member Subregional States are enabled to focus national resources and Regional capacities where needed, whether expanding for sub- regional or international deployments or orienting EMT Global activities toward domestic preparedness, response and development. Building and identifying hubs would allow for focused interventions for emergency preparedness and capacity-building, such as twinning, tailored to country contexts and needs and expanded to subregions where there is shared or common experience. Governed and coordinated by the EMT Secretariat: international-level and standards-setting activities informed by experiences at the national and subregional level. Teams are still strongly encouraged to work on a global scale to assist and support other countries as well as share best practices and lessons learned. Continued regionalization of governance and activities to support a more contextualized EMT initiative supported by local resources and structured as appropriate for the region, as well as possible streamlined procedures or agreements to support interoperability. Fig. 6. Operational structure: EMTs in the WHO European Region 5 Strengthening the global architecture for health emergency preparedness, response and resilience: concept note for consulta- tion process: 24 March 2022. Geneva: World Health Organization; 2022 (https://www.who.int/publications/m/item/strengthen- ing-the-global-architecture-for-health-emergency-preparedness-response-and-resilience, accessed 13 June 2023). 9 • At the outermost, international level, governed Roles and responsibilities: and coordinated by the EMT Secretariat at WHO terms of reference headquarters are international deployments and global engagement, as well as standards-setting For the network to function efficiently and effectively, activities informed by experiences at the national, it is important to ensure and structure appropriate subregional and regional levels. Teams are still information exchange at the right levels and with the strongly encouraged to work on a global scale to right entities and people. For this purpose, the EMT assist internationally in emergencies and support Initiative encourages countries and organizations to and enable these countries to improve their own designate Focal Points who are the key counterparts national preparedness and response capacity, at national level for the national EMTs as well as at as well as to engage symbiotically to share best the regional level (the RSC, advisory board and EMT practices and lessons learned. Secretariat) as well as the global EMT community and the global EMT Secretariat. The terms of • Regionalization continues with updated reference cover preparedness and response activities governance and prioritization of activities at across the four strategic objectives of the EMT 2030 the regional level, while the development of a Strategy: strengthened partnerships, leadership and subregional level facilitates even more specific governance; provision of comprehensive, accessible and customized interventions and European and quality health services; implement and scale up RG member cooperation and coordination. This strategies for standardization and quality assurance; subregional level is characterized by groupings and strengthen information systems, evidence and of Member States which can develop working research. relationships and partnerships based on similar contexts, be they cultural, geographic or other.6,7 This subregional approach may also support EMT-NFPs the development of streamlined procedures or The EMT-NFP is the ambassador of the EMT Initiative in agreements and further interoperability, capacity- their country and is directly nominated to the position building or even the opportunity for more easily by the Ministry of Health as the competent authority accessed logistical stockpiles as possible. responsible for the activation and implementation • At the central, national level, EMT-NFPs serve as ad- of the National Health Emergency Preparedness vocates and continue their important coordination and Response Plan. NFPs are the key counterpart role with EMTs and with other partners and health at the national level for classified and EMTs under authorities at the subregional and international mentorship as well as the European RG. The primary level. This level gives Member States the ability goals of this position are to support the country to decide where to focus national resources and with adopting and adapting the EMT methodology, capacities, whether expanding for subregional or developing and strengthening EMT capacities and the international deployments or orienting EMT activi- localization and nationalization of EMT activities. ties towards domestic preparedness, response and development. Recognizing the diversity of governance and governments in the region, this position may not International deployment and emergency response always be located within the Ministry of Health. remain a cornerstone of the EMT Initiative, while also Depending on the nature of the emergency response accounting for Member States that urgently need to capacities, the NFP may be situated within the develop capacities integrated within health systems Ministry of the Interior, Ministry of Emergency at a national level or subregions within the WHO Situations, Ministry of Foreign Affairs and so in. Under European Region where more local interaction and circumstances where the NFP is not directly within coordination may be most feasible. the health authority, it is important for the focal point to support and when possible, facilitate, a whole-of- government approach to the EMT Initiative, leveraging existing national structures and working groups to increase cross-ministerial/departmental coordination when necessary. This type of coordination is crucial for effective development of EMT capacities for national or international use/deployment. 6 Priority countries for core capacity strengthening [website]. In: the WHO Regional Office for Europe/Emergencies. Copenhagen: WHO Regional Office for Europe; 2023 (https:/www.who.int/europe/emergencies/our-work-in-emergencies/priority-countries, accessed 13 June 2023). 7 While the membership of each subregion has not been formally established, it may be useful to consider the current hub sys- tem of the World Health Emergencies Programme (WHE), comprising Balkan, Southern Caucasus and central Asian Republics, covering 15 priority countries and territories in the European Region where support for strengthening emergency prepared- ness and response capacities as per the IHRs (2005) is noted by WHO as a top priority. 10 Following comprehensive discussion with the Strengthen information systems, evidence and European RG, the NFP is responsible for the following research overall assignments and subactivities. • Advocate for the strengthening of national research capacities to inform and improve EMT response. Strengthened partnerships, leadership and governance • Advocate for the establishment or strengthening of monitoring and evaluation systems to support • Serve as the country’s main point of contact with quality assurance. the EMT Secretariat for strategic, policy, legal and other organizational commitments related to implementation of the EMT Initiative. • Advocate that the EMT Initiative be nationally TFPs anchored and recognized by relevant authorities in The TFP is the designated representative for individual country. emergency medical teams. TFPs are the main contact • When the NFP position is situated to include both people for national TFPs and liaise with the EMT national and international response in its scope, Secretariat regarding mentorship and classification work to increase interoperability and coordinate planning and activities. The primary goals of this the reception of teams as well as the deployment of position are to ensure that the team adopts and teams domestically and outside of national borders. implements EMT methodologies, develops and strengthens its own capacities across the main areas • Advocate for, represent, support and convene the of EMT work, pursues classification (or reclassification EMT community in-country, as well as coordinating as necessary) and maintains two-way communication with NFPs and EMTs in the region and subregion with the team, the NFP and the EMT Secretariat. The and acting as a link between teams and WHO. TFP of classified teams also receives notification • Promote increased engagement and participation and alerts concerning potential requirements for of EMTs and facilitate two-way communication of international deployment of EMTs through the needs across all key areas of EMT activities, while Secretariat. aiding teams in their work. • Ensure their country’s representation at regional Following comprehensive discussion with the and global EMT meetings. European RG, the team focal point is responsible for the following overall assignments and subactivities. • Act as a mechanism of communication between their country and the WHO Regional EMT Strengthened partnerships, leadership and Secretariat, including cross-regional and cross- governance network partnerships, as well as with relevant WHO counterparts at the country and/or hub levels. • Serve as the teams’ main point of contact with the EMT-NFP and EMT Secretariat for issues related to Provide comprehensive, accessible and quality implementation of the EMT Initiative. health services • Share information provided by the Global and • Support the integration of EMT methodologies into Regional Secretariat with the team and ensure their national preparedness and response plans. teams’ representation at regional and global EMT meetings. • Promote the strengthening of national capacities for EMTs. • Coordinate and collaborate with EMT-NFPs and build a strong relationship, as well as relevant WHO • Serve as main point of contact for operational focal points at country level. capacity-building by EMTs at local and country level. • Ensure ongoing communication with EMT-NFPs and Implement and scale up strategies for with TFPs from other teams with the support and standardization and quality assurance engagement of the NFP, as well as communication • Track or monitor continuously the development of with other EMTs in the region and subregion. EMT capacities and partners within their country. • Advocate for continued development of the position • Oversee that national EMTs deployed to build knowledge and experience, including internationally comply with WHO minimum participation in relevant technical working groups standards for EMTs. or trainings (example: EMT coordination cell • Ensure efficient information sharing with relevant trainings, etc.). EMT actors at the national level and facilitate exchange of best practices and lessons learned. • Promote the adoption and implementation of the EMT standards and coordination methodology at national level. 11 Provide comprehensive, accessible and quality The RSC health services The RSC serves as a coordinating body for the • Ensure constant readiness of the team for European RG with a mission of supporting the further emergency deployments, nationally and regionalization of the EMT 2030 Strategy, including the internationally. strengthening of national capacities. The overarching goal of the RSC is to support the EMT Initiative in the • Work to strengthen coordination and WHO European Region in ensuring that populations interoperability with other teams and rapid affected by health emergencies have access to response capacities. quality, life-saving and essential health services through effective, scalable, interoperable and rapidly Implement and scale up strategies for deployable EMTs and other emergency capacities fully standardization and quality assurance integrated into resilient, national health systems. To this end, the RSC and its members will serve as the • Promote the implementation and continued Secretariat to the European RG and ambassadors of application of the EMT standards and coordination the EMT Initiative and manage the following overall methodology within the team. assignments and subactivities. • Take responsibility for the team’s implementation of the EMT guiding principles and minimum standards. Strengthen partnerships, leadership and • Serve as main point of contact for operational governance capacity-building by EMTs at local and country level, • Perform the executive secretary function for the as well as opportunities at the subregional, regional European RG. and global level. • Promote the EMT Initiative including principles, • Aim for participation of the team in national and standards, methodology and guidelines, among regional/international EMT trainings, exercises and countries and organizations of the Region and meetings. promote their participation in the European RG. • Share lessons learned from teams deployment with • In cooperation with the EMT Secretariat and the EMT-NFPs and the WHO EMT Secretariat. WHO Regional Offices, work with members and • Ensure two-way communication with team coordinate the definition of the regional work plan members on trainings, mentorship and needs. and strategic objectives. • Advocate for participation of the team in exercises/ • Provide input from the European RG and advisory activities that enhance interoperability of teams, board members back to the global Secretariat to including but not limited to twinning with other inform global priorities. teams (as provider or recipient) and mentorship. • Create a regular platform for exchange and input • Coordinate and manage the re-classification from the European RG and advisory board members process with the EMT Secretariat. back to the global Secretariat to inform global and regional priorities. Strengthen information systems, evidence and • Establish and strengthen collaboration with research steering or strategic groups of other response capacities and networks in the region and globally. • Support the strengthening of team/institutional research capacities to inform and improve EMT response for continued evidence-informed Provide comprehensive, accessible and quality development and response. health services • Advocate for the development or strengthening • Promote the provision of quality health services of a monitoring and evaluation system for team care through enhanced coordination and the activities to support quality assurance. development of fit-for-purpose teams through an all-hazards approach. • Promote strengthening of interoperability between EMTs as well as with other operational response capacities in the region. → continued on the next page 12 Implement and scale up strategies for The RSC chair and co-chair standardization and quality assurance The chair and co-chair of the RSC are responsible for • Support NFPs in the implementation of their the following overall assignments and subactivities. responsibilities. • Participate and represent the European RG in the • Contribute to and facilitate technical discussions on Strategic Advisory Group meetings as well as in the the EMT global objectives. EMT global meeting. • Promote the EMT Initiative including principles, • Represent the EMT network and European RG in the standards, methodology and guidelines among Region in other relevant meetings and events. countries and organizations of the region and promote their participation in the European RG, • Coordinate, in cooperation with the EMT Secretariat including events such as simulation exercises and and WHO Regional Offices and collaboration with twinning. the RSC, the definition of the regional work plan and strategic direction including national capacity- • Promote and facilitate exchange among EMTs in the building efforts, in line with the global initiative. region on lessons learned from their deployments and experiences that can feedback into • Assist with the dissemination of relevant strengthening the functionality of the EMT Initiative information and facilitate interactions among EMTs methodology and mechanisms. in the Region. • Identify regional priorities for the development • Actively coordinate the activities of the European of standards. As a main outcome of the fifth EMT RG with the Secretariat and the vice-chairs, general meeting, the WHO Regional Office for including through regular teleconferences and Europe called for the establishment of Technical other meetings. Working Groups on development of guidance or The chair is responsible for organizing and hosting the standards, which will be open to membership. With annual meeting of the European RG with the support the RSC as Secretariat, these working groups will be of the vice-chairs, EMT Secretariat and the WHO led by the WHO European Region and European RG Regional Office for Europe. and are: o Information and knowledge management for the EMT Initiative; The advisory board o Climate change (refugee and migrants’ crisis); and The advisory board serves to ensure broad o Chemical, biological, radiological, nuclear, representation of stakeholder experiences in EMT and high-yield explosives (CBRNE)- related strategies and activities and that that views and emergencies. opinions of donors, international organizations and priority countries are considered regarding technical and operational issues in EMT development and Strengthen information systems, evidence and response. There are a number of positions available on research the board, all of which are observational and advisory. • Provide support to NFPs and TFPs working to establish and strengthen research and Some organizations, such as technical and research development, monitoring and evaluation systems institutions (including WHO collaborating centres); or information management. regional intergovernmental organizations; some international NGOs; and donor agencies have a • Identify members interested in contributing to the specific capacity, interest or mandate in the area work of the regional governing body. relevant to EMT but not related to governance. • Update on and provide a forum to contributing to These organizations are encouraged to designate international-level activities and developments representatives by their appropriate organizational (standard setting, coordination arrangements, hierarchy, in order to ensure and structure an deployments, etc.). appropriate information exchange at the right levels and with the right entities and people. These entities may not necessarily sit on the advisory board but may instead work with the European RG in an operational capacity, e.g. in technical working groups, attend trainings, etc. 13 The members of the advisory board will ultimately: Procedures • advise on how to adopt and implement the EMT standards and coordination methodology within the organization; Eligibility for voting during European RG meetings • support efficient information sharing with relevant EMT actors at the regional and global level; For NFPs, TFPs from classified EMTs and teams undergoing classification: NFPs and TFPs • represent their organization at regional and global representing teams at all stages of the classification EMT meetings; and process are eligible to vote. • share the information provided by the Global and Regional Secretariat on meetings, workshops and For key EMT stakeholders: in their capacity, simulations within the organization’s members. representatives from partner networks or international organizations with experience in EMT development In case the organization has an intergovernmental and response in the WHO European Region may mandate, it will: participate in discussions and provide feedback but will not hold a voting position for the nomination • advise on the development and implementation of and election processes that are part of European RG tools, regulations and policies for sending, receiving leadership and governance. These stakeholders must and deploying EMTs in their region in line with the globally developed methodology; submit an application to join the advisory board. • advise on the design and implementation by countries in the region of a national EMT validation Nomination for election to the RSC process, based on the global EMT standards; Each eligible EMT-NFP and TFP from a classified • advise on efficient information sharing and the EMT or from an EMT undergoing classification updating of operating procedures with EMTs and and with consent of the lead mentor (see section national TFPs; and on membership of the European RG) can declare its intention to run for an open position. In the • support countries in the region in the design and situation where an NFP plays a dual role and is also management of a national EMT accreditation system. the operational and team focal points for a national team, the individual will select and declare which position they are running under and maintain that representation throughout the term if elected to any position. • EMT-NFPs will be able to self-nominate with written support from their Member State, for a GOV position in the RSC. • EMT-TFPs from governmental teams, with an endorsement and support from their EMT-NFP,8 may be nominated to a GOV in the RSC. • EMT-TFPs from classified NGO teams will be able to self-nominate or be nominated for a position on the RSC. The individuals’ nomination must be agreed upon internally by the EMT and supported by the organization. • TFP from NGO teams currently undergoing mentorship and classification will be able to self- nominate or be nominated for a position on the RSC pending endorsement from the lead EMT mentor, as detailed below. The individuals’ nomination must be agreed upon internally by the EMT and supported by the organization. 8 TFPs from governmental teams who wish to run for a position on the RSC are requested to obtain endorsement and support from the NFP whenever possible. Situations where this is not possible and where TFPs of governmental teams request to waive this endorsement will be reviewed by the RSC on a case-by-case basis. 14 Requirements for nomination Electoral process for the RSC Each candidate must prepare and submit the following The voting will be a peer-to-peer process among documents to initiate the nomination process. the European RG members with NGOs electing NGO candidates and representatives from the GOV category Required: (both TFP and NFP) voting for GOV candidates. If there • a motivation or vision statement clearly outlining are more applicants than available positions (with their goals, objectives and expected outcomes three open positions with each rotation), there will be (added value) in being part of the RSC and for the a vote. Regional EMT Initiative; • a “biosketch” with professional history and In the voting process each GOV and NGO qualifications; representative is allowed as many votes as there are positions vacant in their respective category; so for • an official statement or endorsement from the two empty NGO positions, each NGO TFP is allowed to relevant government/organization that clearly select a first and second candidate. The candidate that states support for their nomination and agreement gets the most votes will be elected and if there is more that if elected, the government/organization than one position, the candidate with the second understands that the position comes with certain highest number of votes will be voted in a second responsibilities, time commitments, resources and candidate and so forth. travel requirements. With this endorsement, the supporting government/organization also indicates If there is a tie in votes there will be a second round of and that they will accommodate and/or assist voting only between the tied candidates until a winner this person to fulfil their requirement to the EMT is determined. This entire process can be digitized European RG as part of the RSC; and through the Knowledge and Information Management • if an EMT is currently undergoing but has not Emergency Platform (KIMEP) to ensure accuracy and completed the classification process, they transparency. must submit an endorsement letter from their Initiative-appointed head mentor that supports Once elected to the RSC, the individual is not eligible their nomination and clearly states that they are to run for the next possible rotation, regardless of sufficiently through the process to qualify as the position they are running under if they change implementing/applying the EMT methodology. associations or position (transition to a new organization, NFP to TFP, etc.). Desired: • Demonstrated or documented experience or Efforts are made whenever possible to avoid the expertise related to EMTs and an understanding of duplication of Member State presence within the the EMT Initiative. group, with each country only allowed representation once per rotation. This means that election of an NFP and TFP from the same country cannot happen during the same election period, to allow for the most diverse representation in the group. It is important to note that applications for the RSC are encouraged from a diverse range of members and in an ideal situation, the RSC will represent stakeholders from both EU (European Union) and non-EU countries, as well as different types of EMTs including specialized care teams, maintain a gender balance and a range of experience. This having been stated, neither the candidates for the RSC or the appointees are selected but rather elected through an open election. The ultimate composition of the committee remains up to range of candidates, the membership responsible for voting and the outcome of the election. In addition, as the composition of the candidacy and European RG evolves, the nomination and election process may also be required to evolve in turn and may be revisited for updates as needed, in a transparent and collaborative manner. 15 Regarding the chairmanship in the RSC: Regular meetings • European RG meetings are held once a year, and • the RSC internally elects its chair and a co-chair include the RSC and advisory board. from among the active focal points for a 1-year period; • RSC Meetings: ideally, meetings between members of the RSC take place four times per year, two • as with the election process for the RSC, if there of which should be in person. These meetings is a tie in votes, the votes will be counted and the should alternate with European RG meetings to candidates with the highest and second highest allow sufficient time for discussion and follow-up number of votes, respectively, will serve as chair of issues and topics highlighted at RG meetings. and co-chair; and Additional in-person meetings, teleconferences • each outgoing chair must wait at least one full and other forms of remote meetings can take place election cycle (1 year) after their position ends on an ad hoc basis if the majority of the RSC is before reapplying for a chair or co-chair position. available. • Regular EMT-NFP and TFP meetings should take place approximately every three months with at least one face-to face meeting annually (during the European RG meeting). • Ad-hoc/working group meetings can be scheduled as necessary. 16 Annex 1. Regional Steering Committee nomination and election process Regional RSC GOV GOV Steering rotation Committee Governmental positions (2023) NFP or TFP 2024-2027 2026-2029 (RSC) NGO NGO Non-governmental positions GOV GOV TFP Nomination eligibility for RSC Is the candidate Is the candidate currently Not eligible for nomination an EMT-NFP? a member of RSC? Is the candidate an EMT-TFP Is the candidate an EMT-TFP from a GOV team? from a NGO team? Is the GOV-EMT classified? Is the NGO-EMT classified? Is the GOV-EMT undergoing classification? Is the NGO-EMT undergoing classification? Requires EMT’s head mentor’s endorsement Requires correspondent NFP’s Requires EMT’s head endorsement mentor’s endorsement Requires written support Requires internal agreement and support from from their Member State the organization Eligible to nominate themselves or be nominated* Eligible to nominate themselves or be nominated* for a GOV position for an NGO position * If a candidate is nominated by someone else, there must be a statement confirming the candidate agrees to the nomination 17 Nomination process continued Required documentation • motivation or vision statement outlining goals, objectives and expected outcomes; • “biosketch” with professional history and qualifications; • official statement/endorsement from relevant government, department or organization and NFP when applicable; • unclassified EMT to provide letter of approval from lead mentor. Desired: • Demonstrated or documented experience or expertise related to EMTs and an understanding of the EMT Initiative. Voting: eligibility and process Is the voter an EMT-NFP? Is the EMT classified or undergoing classification? Is the voter an EMT-TFP? Is it a GOV-EMT? Is it an NGO-EMT? Eligible to vote for a GOV position Eligible to vote for a NGO position Not eligible to vote Timeline KIMEP open for nominations Elections Results 6 weeks 2 weeks 1 week 18  Voting The incoming three members of the RSC are voted for and elected by the membership of the European RG: NFP, TFP from classified teams and TFP under mentorship. Voting will take place through the Knowledge and Information Management Emergency Platform (KIMEP) for EMT initiative. KIMEP is the official tool used to support WHO EMT governance processes and follows strict personal data protection and cybersecurity protocols required by WHO. 1. As soon as you get your confirmed personal credentials set up by the EMT Secretariat, you will be able to log in the applica- tion at https://kimep.who.int/. 2. Go to “My profile” and verify or update your personal data in the Summary tab. 3. Election campaigns which are currently open for nominations or voting are displayed in the Current Elections tab of the Elections section. Select the “Go to Campaigns” button to submit your nomination information documents or to vote. 4. Once nomination and subsequent voting periods have closed, election results will be available on the election page. classified or under classification NFPs TFPs GOV-team TFPs NGO-team Vote for a GOV position Vote for an NGO position In the voting process each NFP and TFP is allowed as many votes as there are positions vacant in their respective category; if there is more than one position, the candidate with the second highest number of votes will be voted in a second candidate and so forth. European RG European Regional Group NFP EMT National Focal Point Knowledge and Information Management KIMEP RSC Regional Steering Committee Emergency Platform for EMT TFP EMT Team Focal Point 19 20 21 World Health Organization Regional Office for Europe UN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark Tel: +45 45 33 70 00 Fax: +45 45 33 70 01 Email: [email protected] Website: www.who.int/europe 22 WORLD HEALTH ORGANIZATION ORGANISATION MONDIALE DE LA SANTÉ WELTGESUNDHEITSORGANISATION Date: 12 September 2023 ВСЕМИРНАЯ ОРГАНИЗАЦИЯ ЗДРАВООХРАНЕНИЯ REGIONAL OFFICE FOR EUROPE Ms Elen Ohov BUREAU RÉGIONAL DE L’EUROPE REGIONALBÜRO FÜR EUROPA Adviser ЕВРОПЕЙСКОЕ РЕГИОНАЛЬНОЕ БЮРО European Union Affairs and International Co- Head office: operation Department UN City, Marmorvej 51, Ministry of Social Affairs DK-2100 Copenhagen Ø, Denmark Suur-Ameerika 1 Tel.: +45 45 33 70 00; Fax: +45 45 33 70 01 Email: [email protected] 10122 Tallinn Website: https://www.who.int/europe Estonia Our reference: Your reference: Notre référence: Votre référence: Unser Zeichen: Ihr Zeichen: См. наш номер: На Ваш номер: Dear Ms Ohov, Nomination of an Emergency Medical Team (EMT) National Focal Point During the first meeting of the Emergency Medical Team (EMT) European Regional Group that took place on 17-18 April 2018 in Brussels, Belgium, participants asked for Member States of the WHO European Region to designate EMT national focal points (EMT-NFP) who would act as key counterparts at the national level for governmental and non-governmental EMTs in country, both classified and under mentorship, Those EMT NFPs will also be part of the EMT Regional Group, the global EMT community and WHO as Secretariat. The critical role of this position was reaffirmed during discussions at the recent European EMT Regional Group Meeting in Berlin, Germany on 30-31 March 2023. The primary goals of this position are to support the country with adopting and adapting the EMT methodology, developing and strengthening EMT capacities and the localization and nationalization of EMT activities, as well as to structure and facilitate information exchange appropriately regarding EMT activities. EMT-NFPs serve as advocates and play an important coordination role with EMTs and with other partners, government, and health authorities at the subregional and international level. EMT-NFPs are expected to fulfil functions in alignment with the EMT Strategy 20301, including strengthened partnerships, leadership and governance; provision of comprehensive, accessible and quality health services; implement and scale up strategies for standardization and quality assurance; and strengthen information systems, evidence and research. A comprehensive terms of reference can be viewed in the updated governance note, The Emergency Medical Teams initiative in the WHO European Region Governance structure 2.0 (2023), attached for your reference. In this regard, I would like to invite you to confirm the designation of your current EMT National Focal Point, Indrek Simisker, or to nominate/select one representative who will fill this position. It is advisable for the EMT-NFP to be a health official with experience in overseeing national emergency medical operations and international cooperation and situated with the department or ministry responsible for the activation and implementation of the National Health Emergency Preparedness and Response Plan. 1 EMT 2030 Strategy | EMT (who.int) UN City, Marmorvej 51 Tel.: +45 45 33 70 00 Email: [email protected] DK-2100 Copenhagen Ø Fax: +45 45 33 70 01 Website: https://www.who.int/europe Denmark I look forward to receiving your designation or confirmation for this position, giving the name, functional title and address of the National Focal Point by 12 October 2023, by email to Dr Oleg Storozhenko, WHO EMT Regional Focal Point ([email protected]), and the EMT Regional Secretariat ([email protected]). Should you have any questions or need any further information, please do not hesitate to contact us at above email addresses. Sincerely yours, Dr Gerald Rockenschaub Regional Emergency Director Copy for information to: Ms Triin Uusberg, Head, European Union Affairs and International Co-operation Department, Ministry of Social Affairs, Suur-Ameerika 1, 10129 Tallinn, Estonia H.E. Ms Riia Salsa-Audiffren, Ambassador Representative of the Republic of Estonia, Permanent Mission of the Republic of Estonia to the United Nations Office and other international organizations in Geneva, Chemin du Petit-Saconnex 28A, CH-1209 Genève, Switzerland H.E. Mr William Mart Laanemäe, Ambassador Extraordinary and Plenipotentiary, Embassy of the Republic of Estonia, Frederiksgade 19, 4th floor, 1265 Copenhagen K, Denmark Ms Kristina Köhler, Liaison Officer, WHO Country Office, Estonia, Paldiski Road 81, 10617 Tallinn, Estonia –2– Saatja: EURO EMT <[email protected]> Saadetud: 14.09.2023 16:21 Adressaat: <"Elen Ohov"> Koopia: <"Triin Uusberg">; <"SM Info">; <[email protected]>; Kaisa.Mitt-Alvarez <[email protected]>; <[email protected]>; <[email protected]>; KÖHLER, Kristina <[email protected]>; EURO EMT <[email protected]> Teema: Nomination of an Emergency Medical Team (EMT) National Focal Point Manused: WHE-EMT NFP nominations 2023_Estonia.pdf; EMT-Governance-Note-08-09- 2023.pdf Dear Ms Ohov, On behalf of Dr Gerald Rockenschaub, Regional Emergency Director for Europe, please find attached a correspondence and relevant documentation in relation with the nomination of an Emergency Medical Team National Focal Point. For your kind consideration. With best regards, Nathalie on behalf of the EMT Secretariat for Europe