Dr Douglas Noble, Global Incident Manager for the UNICEF mpox response, visits Matondo Primary School with Red Cross partners to learn about measures in place to protect children from mpox in Mbandaka, Equateur Province, DR Congo on September 18, 2024.
Dr Douglas Noble (HF 2012-13) is Global Lead for Public Health Emergencies for UNICEF (see here.) In a Harkness Interview in November 2024, he explained how UNICEF sets priorities and responds to public health emergencies.
During his Harkness Fellowship, Douglas studied the relationship between accountable care organisations and public health. Networking opportunities during the Fellowship year in New York introduced UNICEF connections. His initial role as Regional Health Advisor in South Asia was focused on maternal and child health, providing support to country level programmes, such as vaccination and newborn interventions and monitoring health initiatives. During his time as Deputy Representative in China for UNICEF, he further developed leadership and management skills, which included UNICEF’s COVID-19 pandemic response and support in China (see here). In his current role, Douglas coordinates responses to global crises like mpox, working across all levels of the organisation.
Recognising there may be different levels of knowledge in the audience, Douglas was asked to give a quick overview of UNICEF and its primary focus areas. Established in 1946 as part of the international machinery of the United Nations to provide supplies and support for children living in poverty after WWII, it now operates in over 190 countries and territories with a workforce of 17,000 and an annual income of ~$9 billion.
Clarity is achieved by having goal areas and guiding principles; UNICEF is guided by the UN Convention on the Rights of the Child (see a useful summary here) and aligns its programs with the Sustainable Development Goals (SDGs). UNICEF has five goal areas for its work:
-
- Child survival and thriving, often through nutrition interventions.
- Learning and skills development, ensuring children not only attend school but also receive quality education.
- Protection from violence, exploitation, and abuse, including for mothers and women of reproductive age.
- Water and sanitation, sustainable environments, and climate change adaptation.
- Poverty reduction and social protection, addressing the difficult underlying factors affecting children’s well-being.
Where does UNICEF get its funding? UNICEF is 70% funded from public sources (governments) and 30% from private sources (corporations, individual donors, and foundations). There are National Committees in 32 countries, such as UNICEF UK, which are non-governmental organisations that focus on fundraising and raising awareness about children’s needs.
Priorities are set out in the Strategic Plan (2022–2025). This defines the five key areas above, which are then tailored into programs contextualized at country level through discussions with host governments. Priorities filter down into results areas, with specific outputs and outcomes. A five-year country program document aligns global priorities with specific local needs, as seen in the cooperation agreement with China.
Asked how UNICEF prepares for and responds to public health emergencies, Douglas noted that UNICEF combines long-term development programs with separate funding for emergency response mechanisms, ensuring those crises do not derail progress. The development programmes address systemic needs such as education, nutrition, and access to water and sanitation. The emergency programmes allow for rapid responses with dedicated funding and streamlined processes.
UNICEF also collaborates in monitoring public health threats reported to WHO under the International Health Regulations (IHR) and engage with others such as Africa CDC. When a public health emergency is declared, additional funding is then unlocked for that specific incident.
Paulin Mwendanga, a community outreach worker since 2017, raises awareness about the mpox outbreak in Cibingu village, Kabare territory, South Kivu province in DR Congo, on 2 December 2024.
Douglas used the recent outbreak of mpox to explain public health emergency response. The new strain (Clade 1B) of mpox in DRC showed signs of higher transmissibility and severely impacting children (60% of cases and 80% of deaths were in children under 15). UNICEF set up an internal Incident Management Support Team (IMST) and worked globally to address health, education, and societal impacts and to ensure good coordination. The actions taken fall into different categories: declaring a Level 3 emergency to focus resources; distributing supplies, including vaccines (coverage in UK press here); engaging in risk communication campaigns to combat misinformation; and, implementing interventions in affected regions. He also noted that for mpox, concern is not about a new disease but a new strain. And, that there was a lot of learning/evidence to build on from previous outbreaks, such as the COVID-19 pandemic.
See Douglas in action in DRC on these two clips.
https://x.com/UNICEFDRC/status/1846853670371316150 https://x.com/UNICEF/status/1842143877496754260
The audience were interested in how UNICEF evaluates the success of its interventions.
Success is tracked using performance indicators (outputs, outcomes, and impacts). Progress is measured through mid-year reviews, end-of-year reporting cycles, and regular evaluations. Lessons learned from these evaluations are put into practice. Whilst he stressed the importance of these formal approaches, Douglas also noted that much can be learned from informal feedback.
There was also interest in how UNICEF is addressing modern challenges like climate change and online harm?
With regard to climate change, UNICEF invests in adaptation, sustainable infrastructure and other innovative approaches. UNICEF also focuses on creating resilient systems to protect children in the face of environmental challenges.
With regard to online harm, they collaborate with governments and communities to protect children from bullying and misinformation, an example being “web fact checkers” in DRC that counters misinformation and guides communities toward more reliable information.
Platforms like U-Report amplify youth voices globally (see here).
Curiosity was expressed about the impact of geopolitics. How does UNICEF handle relationships in politically tense situations?
Dr Douglas Noble, Global Incident Manager for the UNICEF mpox response, visits Matondo Primary School with Red Cross partners to learn about measures in place to protect children from mpox in Mbandaka, Equateur Province, DR Congo on September 18, 2024.
Douglas stressed UNICEF operates as a neutral entity, maintaining a focus on its child welfare principles. The organization stays and continues to work in conflict zones, advocating for children’s rights at local, national, and international levels, engaging with key parties. Douglas noted that UNICEF often is the last organization to leave and the first to respond in times of crisis. They also partner with local NGOs and civil society to implement programs effectively and engage community leaders to ensure culturally relevant interventions. They are always keen to increase the involvement of people on the ground.
Douglas was asked how public health institutes, especially in the Global South, could better address children’s needs during emergencies. He noted that disaggregating data by age and gender can help to better understand vulnerabilities among children. He also proposed that such bodies broaden their focus beyond healthcare to address education, child protection, and social support, and invest in local leadership to strengthen systems at grassroots level. The whole system approach adopted by UNICEF was regarded as admirable by members of the audience.
What can the UK National Health Service (NHS) learn from UNICEF? A continued emphasis on children’s wellbeing as a core societal priority, and addressing broader determinants of health, such as social and environmental factors, alongside immediate medical needs were noted as important. A global perspective helps to show interconnected health challenges.
The interview concluded with looking forward. What areas would UNICEF prioritise with more resources?
- Child Protection: Expanding social protection systems, including social workers and anti-violence programs.
- Climate Change: Building resilient systems to address environmental impacts on children.
- Health and Education: Continuing to strengthen basic services and infrastructure for long-term development.
Further Information can be found here:- https://www.unicef.org/reports/operational-response-framework
With thanks to Unicef for the photos. Donations to UNICEF can be made here:- https://www.unicef.org.uk/donate
Fabien, 3, washes his hands before his meal at the UNICEF-supported mpox treatment center in Bisengimana, Goma, North Kivu province in DR Congo on December 3, 2024.
Fabien has been in the mpox treatment centre for five days, with his 18-year-old brother Justin keeping a watchful eye on him. Justin was the first in the family to contract the illness. “This is my second time here. I spent two weeks at the centre before making a full recovery and being discharged. But as soon as I got home, I noticed that Fabien, my younger brother, had the same symptoms, so I brought him straight back here,” the young man explained. “We’ve been here for 5 days now, and the doctors are looking after us so well, I can’t believe it. And it’s all free! I know we’ll be discharged soon because Fabien is getting better. His spots are drying up and healing nicely,” Justin says.
With support from USAID’s Bureau for Humanitarian Assistance (BHA), the Foreign, Commonwealth and Development Office (FCDO), the Swiss Agency for Development and Cooperation (SDC) and Mastercard Foundation, UNICEF, in collaboration with provincial authorities and NGOs, has set up and equipped the Bisengimana mpox treatment center for a holistic response that includes medical, psychological, and nutritional care, the establishment of a daycare center for unaffected children of sick parents, as well as community awareness and engagement.