This section looks at funding mechanisms for both preparedness and response in the health sector.

• Multilateral Organizations are those agencies through which funding comes from many different countries (as well as from non-governmental sources) and is distributed to many different countries. Examples of multilateral organizations that provide funding for these activities include United Nations agencies, of which the World Health Organization and the Pan American Health Organization are part and the World Bank, the Inter-American Development Bank and the regional development banks in Latin America and the Caribbean. In the Americas, the European Commission’s Humanitarian Aid and Civil Protection Department has become a major funder of these initiatives.
• Bilateral Agencies are governmental agencies in a single country that provide aid, in this case for preparedness, risk reduction and humanitarian response. Most industrialized nations have this type of governmental agency. Political and historical reasons often determine which countries receive donations from bilateral agencies and how much they receive. For example, in the Americas, three European countries (France, the U.K., the Netherlands) still have territories in this Region). In the last decade, the primary bilateral funders of disaster preparedness and risk reduction in Latin America and the Caribbean have been the Office of U.S. Foreign Disaster Assistance of the U.S. Agency for International Development (USAID); the Canadian International Development Agency (CIDA); the Spanish Agency for International Development Cooperation (AECID) and the U.K. Department for International Development (DFID).
• The United Nations, as a system, has several major funding mechanisms for humanitarian aid.

1. United Nations Flash Appeal: The Flash Appeal is a tool for structuring a coordinated humanitarian response for the first three to six months of an emergency. The Flash Appeal process was created via UN resolution A/RES/46/182 of December 1991, which states that "… for emergencies requiring a coordinated response, the Secretary-General should ensure that an initial consolidated appeal covering all concerned organizations of the system, prepared in consultation with the affected State, is issued within the shortest possible time and in any event not longer than one week.” The UN Humanitarian and/or Resident Coordinator triggers the Flash Appeal in consultation with all stakeholders. It contains an analysis of the context and of humanitarian needs (citing whatever specific needs assessments are available), response plans (at the general strategic level as well as sector plans including specific proposed projects), and statements on roles and responsibilities.

Because the first release of the Flash Appeal must be issued fast, it inevitably is based on early estimates and best guesses, focusing on urgent humanitarian needs in addition to whatever early recovery projects can be assessed and implemented during this early. Given that Flash Appeals necessarily are based on early estimates, they and their projects can be revised at any point after the launch as more information emerges. Usually, there is a scheduled general revision about a month after launch to incorporate fuller information and more recovery projects. The Flash Appeal may be developed into or succeeded by a consolidated appeal if an inter-agency response is needed beyond six months.

In summary, the Flash Appeal must:

• Be prepared quickly (ideally within 72 hours).
• Reflect the contribution of all sectors and agencies working in the response.
• Contain activities that are emergency in nature (can be completed in six months).

The U.N. has published Guidelines on the Flash Appeal process. These guidelines discuss in depth the process of preparing the Appeal, the timeline and the actors involved. Most importantly, a template for the preparation of a Flash Appeal is added as an annex to the end of the document. Following the January 2010 earthquake in Haiti, the UN launched an extensive Flash Appeal for Haiti, which was revised in February of the same year. In this Revised Flash Appeal, the health sector collectively (partners included PAHO/WHO, UNAIDS, UNICEF, UNFPA, IOM, SC, WV, International Medical Corps (IMC), MERLIN, Médecins du Monde (MDM), and the International Rescue Committee) sought funding in the amount of US$134 million. Review this appeal to learn more about the scope of the health projects under this Flash Appeal. View another Flash Appeal issued following the severe flooding in Guatemala as a result of tropical storm Agatha in May 2010.

• United Nations Consolidated Appeal. The Consolidated Appeals Process (CAP) is a planning and fundraising mechanism for chronic or complex emergencies. The process usually begins with a CAP workshop bringing together UN agencies and partner NGOs to review needs and set priorities. The Appeal (usually one per country) is launched in November each year, with a mid-term review the following June/July. As a coordination mechanism, the CAP fosters closer cooperation between host governments, donors, aid agencies, and in particular, between NGOs, the Red Cross movement, IOM and UN agencies. Working together in the world’s crisis regions, they produce a Common Humanitarian Action Plan (CHAP), a strategic plan for humanitarian response in a given country or region. The CHAP is the foundation for developing a Consolidated Appeal. View the Consolidated Appeal launched for assistance to internally displaced persons through the global clusters 2009.
• United Nations Central Emergency Response Fund (CERF). The CERF was established in 1991 as a US$50 million emergency loan facility for United Nations (UN) organizations and specialized agencies. In December 2005 it was upgraded to incorporate a grant facility, which was launched in March 2006 to:

1. promote early action and response to reduce loss of life;
2. enhance response to time-critical requirements;
3. enhance response to time-critical requirements.

The CERF is funded by voluntary contributions from around the globe including Member States of the UN, private businesses, foundations and individuals. It is managed by the UN Office for the Coordination of Humanitarian Affairs (OCHA) on behalf of the United Nations Emergency Relief Coordinator (ERC).

The CERF is intended to complement – not substitute for – Flash Appeals. The CERF acts as a donor, and the flash appeal is the strategic plan and list of projects that CERF (and other donors) should fund. Flash Appeals are necessary to form a framework of coordinated strategic response, and to obtain funding after and beyond the CERF (which cannot fully fund the humanitarian response in most situations).

Government and health authorities have no direct access to CERF funding, and there is no requirement that country authorities are consulted in the definition or implementation of CERF-funded projects. Despite the fact that the UN General Assembly Resolution (A/RES/60/124) approving the CERF reaffirmed that “Each State has the responsibility first and foremost to take care of the victims of natural disasters and other emergencies occurring on its territory. Hence, the affected State has the primary role in the initiation, organization, coordination, and implementation of humanitarian assistance within its territory”, there may be times when the ministry of health is not formally a part of the process to formulate priorities or review health proposals.

A Few Key Points about the Flash Appeal and the CERF

• Humanitarian emergency situations requiring international assistance often require both a Flash Appeal and CERF funds.
• The Humanitarian Coordinator, in consultation with the humanitarian Country Team, allocates available CERF funds to the highest-priority Flash Appeal projects, taking into consideration the least funded sectors where contributions are less likely to be received.
• CERF doesn’t replace Flash Appeals; it interacts with them.
• Flash Appeals and CERF requests are developed in tandem.
• CERF generally provides the initial injection of funds for the most urgent life-saving projects in the Flash Appeal to cover the time lag between issuance of the Appeal and receipt of commitments and funds from donors.