Health Emergency Readiness

for Response Operations (HERO)

HERO Introductory Training - Core modules

Script for Module 3 - Readiness Tool (<25 minutes)

Free WHO online courses:

https://openwho.org/courses/health-emergency-readiness-ops

More about Readiness here: https://partnersplatform.who.int/

More about the HERO tool here: https://partnersplatform.who.int/tools/hero-cape/training
Contents
Slide #1 -Welcome ................................................................................................................................................................... 2
Slide #2 - Learning Objectives............................................................................................................................................. 2
Slide #3 - HERO Tool Objectives ........................................................................................................................................ 2
Slide #4 - Intended Users ...................................................................................................................................................... 2
Slide #5 - Dashboard ............................................................................................................................................................... 2
Slide #6 - Benefits of the HERO Tool ................................................................................................................................ 3
Slide #7 – HERO Tool Structure ......................................................................................................................................... 3
Slide #8 - HERO Tool Workflow ......................................................................................................................................... 3
Slide #9 - Readiness Status ................................................................................................................................................... 4
Slide #10 – Definition for Capabilities ............................................................................................................................. 4
Slide #11 - Readiness Status ................................................................................................................................................ 5
Slide #12 - Readiness Status ................................................................................................................................................ 5
Slide #13 – HERO Tool: Example with Laboratory..................................................................................................... 5
Slide #14 - Assess Readiness Status for Laboratory .................................................................................................. 6
Slide #15 – Plan for Anticipatory Actions ...................................................................................................................... 6
Slide #16 - Workarounds in Constrained settings ...................................................................................................... 7
Slide #17 - Type of Constraints........................................................................................................................................... 7
Slide #18 - Example of Workarounds for Laboratory Function............................................................................ 7
Slide #19 - Example in Context – Surveillance in Hard-to-reach/ Insecure areas ........................................ 8
Slide #20 – Example in Context – Surveillance in Hard-to-reach/ Insecure areas ....................................... 8
Slide #21 – Example in Context – Laboratory, Mass Gathering Events ............................................................. 9
Slide #22 – Example in Context – Laboratory, Mass Gathering Events ............................................................. 9
Slide #23 - Key Message ........................................................................................................................................................ 9
Slides #24 - Key Message ................................................................................................................................................... 10
Slide #25 - Key Message ..................................................................................................................................................... 10
Slide #26 - HERO Assessment and Planning tool ..................................................................................................... 10
Slide #27 - Congratulations ............................................................................................................................................... 10
Slide #1 -Welcome
● Welcome to Module 3 on Health Emergency Readiness for Response Operations.
● This module focuses on the HERO tool.
● It is a rapid self-assessment and planning tool to help countries assess and strengthen their
readiness level.

Slide #2 - Learning Objectives

By the end of this module, you will be able to:
● Facilitate a rapid self-assessment of critical capabilities to respond timely and appropriately
to health emergencies.
● Identify anticipatory actions for readiness contingency planning.
● Identify workaround solutions in constrained settings.

Slide #3 - HERO Tool Objectives

● During the readiness process, the HERO tool can be used to assess readiness capabilities
and develop a list of anticipatory actions.
● It is a government-facing tool available online via the Partners Platform
(https://partnersplatform.who.int/)
● It is also available online for anyone who needs to use it. Links to the online tools are
provided at the end of this module.

Slide #4 - Intended Users

Who are the intended users for this tool?
This tool is designed for three main groups of users:

● Government Officers: Those responsible for emergency management, such as surveillance

and response officers. They can use the HERO tool to assess readiness at national, sub-
national, and community levels. If chosen as a country representative, they can update the
tool online through the partners platform.
● High-Level Government Officials: These officials can access the HERO tool results to get a
high-level overview, which is crucial for decision-making.
● Partners and Donors: Particularly those active in countries where domestic resources are
insufficient. On-site staff from these organizations can use the tool to identify readiness
status in specific risk areas.
Slide #5 - Dashboard
● Additionally, countries may choose to share results with other partners and nations through
a dashboard via the partners platform.
● It helps high-level officials and partners make decisions by visually displaying the country's
capabilities.
● Partners, including donors, can use it to identify and address specific limitations in technical
areas, offering targeted support.

Slide #6 - Benefits of the HERO Tool

What are the benefits of the tool?

● A series of HERO tools are developed to assess readiness status

● The cross-cutting multi-hazard HERO tool covers all biological and non-biological hazards
and is useful for assessing cross-cutting readiness status.
● This is key to strengthening core technical functions to respond to unknown or unexpected
threats.
● In addition, a series of Threat-specific HERO tools are also developed. It is important to
strengthen readiness functions to respond to priority risks and imminent health
emergencies.
● These tools are designed with varying levels of technical expertise in mind and provide
links to other relevant references and tools

Slide #7 – HERO Tool Structure

Now let’s look at the structure of the HERO tool.

● The tool is organized around the key technical functions or pillars that need to be addressed
for a timely and efficient response to health emergencies.
● These pillars can be grouped according to different frameworks, such as the Health
Emergency Preparedness and Response framework, which includes the elements of
collaborative surveillance, community protection, scalable clinical care, access to medical
countermeasures, and emergency coordination.
● Alternatively, pillars can be grouped according to the Incident Management System based
on the State Party Self-Assessment Annual Reporting Tool or SPAR framework. This
framework includes:
o Surveillance and Laboratory
Emergency operation center, workforce, Finance and resources
o Logistic and resources
o Risk communication and community engagement, public health and social measures
and
o Case management, Essential Health system, and Infection Prevention and control
Slide #8 - HERO Tool Workflow
• We now move on to the HERO workflow. This tool provides a systematic approach to assess
and strengthen your readiness status.
• It starts with defining minimum readiness requirements for each capability. Each key
capability comprises three readiness requirements for sub-capabilities.
• Using a dropdown list, users can assign the status of each sub-capability, ranging from not
reviewed to completely ready.
• Once key gaps are identified, users can select anticipatory actions from a list to address
those gaps.
• Additionally, in constrained settings like severely resource-limited or conflict-affected
areas, users can choose from a list of pragmatic workaround solutions to ensure critical
functions are ready for operations.

Let’s start with a series of definitions and examples.

Slide #9 - Readiness Status

First, what do we mean by readiness status?
● The primary readiness capability status reflects how effectively a country can ensure that a
critical function is operational when needed.
● Each readiness capability is sub-divided into 3 sub-capabilities.
● The readiness sub-capability is the ability for a technical pillar to achieve a specific task
necessary to fulfill a critical function.
● For example, it is crucial to get decentralized testing capabilities in areas at risk. This is a
key readiness sub-capability for the laboratory pillar.

Slide #10 – Definition for Capabilities

What do we mean by readiness capabilities?

● Readiness capabilities encompass not only the physical or quantitative aspects of the health
system to respond to an emergency, like the number of hospital beds or available medical
supplies, but also the knowledge, skills, expertise, and processes an organization has to
respond to health emergencies effectively when required.
● It is critically important that countries scale up their readiness capabilities for imminent
and recurring priority risks, including seasonal threats. This can be done with hazard
specific HERO tools.
● It is also critical to ensure core readiness capabilities are in place for unexpected and high-
impact threats that might unfold anytime. This can be done with the multi-hazard HERO
tool.
● Given the time-compressed nature of the readiness process, simulation exercises to
demonstrate the ability of the country to perform specific functions or tasks effectively and
efficiently for a rapid and appropriate response to health emergencies is crucial.
 ● Gaps identified during this exercise should then be addressed rapidly via anticipatory
actions and workarounds.

Slide #11 - Readiness Status

The HERO tool provides a standard way to assess the readiness status from a drop-down list.
● There are 6 statuses:
o Completely ready
o Mostly ready
o Partially ready
o Minimally ready
o Not ready
o There is also an option for “Not reviewed” that is not visible here

Slide #12 - Readiness Status

What are the key criteria for selecting the right readiness status?
This is done by checking whether your sub-capabilities are in place.
● If they are in place at all levels: national, subnational and community level, in areas at risk
● And there is no need for external support, then the status is “completely ready”
● If they are in place at all levels with the help of external resources including technical,
workforce or financial assistance, the status is “mostly ready”.
● Now, if the capabilities are in place only at national level with some limitations, then the
status is “partially ready”.
● An example of limitations could be that laboratory reagents, kits and supplies are available
at national reference laboratories but not in place in all sub-national laboratories in areas at
risk.
● Or the surveillance tools, guidelines, procedures, reporting forms, and digital tools are
available at national level, but they are not available at sub-national level.
● When only documentation and tools are updated and integrated to decision making, but
resources for implementation are not yet in place, no refresher trainings or simulation
exercises were conducted to test functionality, or no financial or dedicated human
resources are ready to be mobilized, the status is “minimally ready”.
● When there are no or few updated guidelines, protocols or strategies and tools.
● And additionally, no resources are available for training and testing the plan or equipping &
deploying staff, then the status is “not ready”. The overall capability is not in place.
● And finally, “Not reviewed” means there is a need to conduct an assessment rapidly. There
is insufficient information to assess the readiness status.

Slide #13 – HERO Tool: Example with Laboratory

Let's dive into an example focusing on the laboratory capability of country A.
● First, decentralized testing capabilities at or near the point of care, especially in high-risk areas
facing imminent threats, need to be in place.
● Point-of-Care Testing involves conducting clinical laboratory testing close to where patient care
is provided, using rapid tests, microbiological, or molecular testing methods that can quickly
generate results.
● For the second lab requirement, the Point-of-Care testing sites should have a stock management
system in place.
● Additionally, the functionality of these sites must be tested to ensure they have the capacity to
address high-priority risks.
● To be operational, three key tasks or sub-capabilities should be implemented:
o First, revise and test the National distribution plan for Point of Care testing sites.
o Second, ensure that public and private capacities are linked to replenishment
mechanisms.
o And third, identify Point-of-Care testing sites and verify that their testing results are
integrated into the surveillance system in a correct and timely manner."

Slide #14 - Assess Readiness Status for Laboratory

Now let’s review the level of readiness for laboratory sub-capability 3 in Country A.
This sub-capability reads “Point-of-care testing identified for conducting rapid tests for high
priority risks, and test results are integrated into the surveillance system at each level. “

There is a need to verify whether this capability is in place in areas at risk. For Country A, we find
that:
● Documentation and tools are updated, and tests results are linked to the surveillance system
● However, there are no resources to test the plan and demonstrate that this sub-capability is
operational.
● The point of care testing sites are mapped to conduct rapid tests for high priority risks.
● However, they are not equipped and insufficient in number, based on the latest risk prediction
and most probable scenario
● Although the workforce is mapped, there are no funds to organize refresher training.
● In addition, if the risk increases and there is a need to equip the workforce and deploy,
resources are also insufficient to implement the readiness plan, and surge capacity is needed.
● In country A, critical needs cannot be covered by domestic resources.
● External assistance is required. Partners are mapped against country needs. However, they
have not yet been engaged in the readiness process.
● Results from this assessment show that the readiness status for this sub-laboratory capability is
minimally ready in this country.

Slide #15 – Plan for Anticipatory Actions

Now, let's explore various anticipatory actions or readiness measures that Country A can undertake
to strengthen the laboratory sub-capabilities:
 • Ensure that areas and populations most at risk are mapped to focus readiness efforts
accordingly.
• Organize simulation exercises to test the plan and identify gaps in preparedness.
• Based on simulation results, adjust the readiness action plan and implement it according to
the level of risk.
• List healthcare workers requiring refresher training to ensure the workforce is well-versed
in the latest protocols and guidance.
• Create a Learning Resource Package (LRP) available online for easy access.
• If domestic resources fall short, engage with partners early, starting from the assessment
and planning stage.
• Establish communication lines with the WHO country or regional office, or other partners,
for technical assistance and collaboration.

When the risk becomes imminent, operations intensify, and actions may include:

• Identify supplies and equip POC testing sites in areas most at risk, and
• Ensure partners are actively engaged for the implementation phase

Engaging with partners is an option. However, it might not be sufficient. In Country A, there are
clear challenges with a poor health system, limited resources, and several other emergencies are
happening simultaneously, creating competition for resources. The HERO tools also provide a list of
workarounds in such Constrained settings.

Slide #16 - Workarounds in Constrained settings

● Workarounds are alternative actions and approaches recommended to successfully activate
any given capability in constrained settings, conditions where it’s difficult to implement the
anticipatory actions as usual.
● They are usually agile and cost-effective solutions to fulfill critical functions in times of
crisis.

Slide #17 - Type of Constraints

The HERO tool defines 3 types of constrained settings:

● Type 1 is related to Health systems and Resources: It is when there is severe governance,
human resources, financial, and infrastructure constraints
● Type 2 is related to operational constraints: like Poor transport infrastructure, low security,
violence against or obstruction to health services, corruption and fiduciary risk
● Type 3 is related to an increased population vulnerability due to outbreaks, food insecurity,
lack of access to health services, exclusion of vulnerable groups, inequity, unemployment,
and lack of access to education, or water, sanitation, and hygiene.
Slide #18 - Example of Workarounds for Laboratory Function
Now let’s come back to our Country A.

We want to identify possible workarounds available from the HERO tool to rapidly strengthen
critical laboratory functions.

• Country A could establish Point-of-care testing (POCT) on-site with portable equipment,
such as handheld devices or small tabletop machines to improve diagnostic capacity.
• Or deploy mobile laboratories to areas where there are no existing laboratory facilities.
These labs can be quickly set up in tents, shipping containers, or other temporary structures
and can provide testing for a range of diseases. This is important to reduce costs related to
specimens' shipment to the national reference labs.
• Additionally, community health workers can be trained to collect and test samples locally
using simple diagnostic tools. This can help to quickly identify outbreaks and target
interventions to affected communities, reducing the cost of deployment for staff.
• And finally, Country A could also collaborate with other laboratories in the region or
leveraging existing laboratory networks, such as those established by the World Health
Organization (WHO) Other slides are available for your consultation to list possible
workarounds for technical pillars such as (next slide 18) surveillance, (next slide 19) clinical
care, (next slide 20) logistics, (next slide 21) emergency coordination and (next slide 22)
community protection.

These examples are not exhaustive and more can be found in the HERO tool via the Partners
Platform.

Slide #19 - Example in Context – Surveillance in Hard-to-reach/ Insecure areas

Now let’s see an example in a real context.
● Country A fears the risk of introduction of Ebola Virus Disease, or EVD, from bordering
country B where cases have just been detected.
● The border is porous and movement of people across the border is very important daily.
● In country A, functional public health surveillance is in place based on EWARS. A real time
digital reporting system for EVD was developed 10 years ago to allow data entry and
integration with surveillance systems. However, since that time, this system has not been
updated nor re-tested for EVD.
● In addition, in the specific area at risk, there are limitations to routine surveillance capacity
due to limited security and poor transport infrastructure, as well as suboptimal access to
electricity.
● Therefore, the Early Warning and Alert Response System and other surveillance tools for
reporting are not fully operational. Readiness status for surveillance capabilities is
“Partially ready” because of insecurity and sub-optimal access to electricity.
Slide #20 – Example in Context – Surveillance in Hard-to-reach/ Insecure areas
● In these constrained settings, country A decides to rapidly implement the recommended
WHO solution, EWARS in a box Kit. This is a rapidly deployable emergency kit that contains
the equipment needed to set up an electronic early warning system in a crisis. Each Kit
contains 60 mobile phones, a laptop, solar chargers, and EWARS user guides, and can serve
nearly half a million-emergency affected population.
● In addition to expanding on previous efforts, country A started adapting the real-time
digital reporting system to allow data entry from EWARS in a box. Training and a simulation
exercise are organized to ensure that this system is operational and is linked to the
decision-making process.
● What are the results of These readiness actions? Disease reporting surveillance has been
strengthened, even in areas with limited security and transport infrastructure. Early
detection of cases is key to reducing the impact of health emergencies. Now the readiness
status on the can be updated.

Slide #21 – Example in Context – Laboratory, Mass Gathering Events

● Here is another example in context.
● Country B is in the process of re-opening/conducting mass gatherings as movement
restrictions are being lifted in the coming weeks. As per WHO recommendations at this
time, all participants should be tested.
● In this context the status is not ready as there is insufficient decentralized point-of-care
testing available. At this stage, Mass Gathering events are not allowed to take place due to a
lack of resources (supplies and workforce).

Slide #22 – Example in Context – Laboratory, Mass Gathering Events

Country B identifies anticipatory actions to address those gaps and to ensure these events will be
conducted safely:

● List mass gathering events planned to take place in coming months

● Train organizers on how to assess the risk and how to conduct an event safely
● Train community health workers to collect and test samples locally with rapid tests
● Allocate and preposition resources to POC testing site

As a result, several Mass Gathering events could take place safely. Only participants tested positive
for COVID-19 using rapid tests required confirmatory molecular tests. This helped reduce the need
for the specialized capacity for molecular testing, supported the validation of the WHO rapid tests
and helped the country organize events safely. After implementing the selected anticipatory
actions, the country readiness status can be updated.
Slide #23 - Key Message
The HERO tool can be found on the WHO Partners Platform. It is intended to be used to assess a
country’s readiness status and identify priority anticipatory actions to ensure optimal readiness.

Slides #24 - Key Message

The HERO tool:

• Provides readiness requirements for critical capabilities

• Helps identify gaps
• Provides a list of possible anticipatory actions to address those gaps
• Provides a list of possible workarounds in constrained settings

Slide #25 - Key Message

Intended users of the HERO Tool are:

• Technical officers – responsible for monitoring readiness status and developing readiness
action plans
• High-level officials - to get an overview of the readiness status for decision-making
• Partners and donors for planning and collaboration for implementation

Slide #26 - HERO Assessment and Planning tool

● To gain insights on the contents of the HERO tools and how to use them, go to the partners
platform to play and train with an online HERO training version. And see our tutorials.
● For nominated country persons, please contact us for further information on how to use
the online version via the partners platform

Slide #27 - Congratulations

● Congratulations, you have now completed module 3 on HERO tool
● Please take the self-assessment questions by following the instructions
● Please also send us your feedback, click on the dedicated link and complete the
questionnaire. It is our turn to learn from you.

Link to the survey for feedback on the course: https://forms.office.com/e/wnvEyHzdT2

More resources: www.partnersplatform.who.int
Questions:
[email protected]
[email protected]

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