Leveraging the auxiliary role: opportunities for health system strengthening

The auxiliary role of the Red Cross and Red Crescent National Societies (RCRC NS)

The auxiliary role of the Red Cross and Red Crescent National Societies (RCRC NS) dates back to the foundations of the Red Cross through Henry Dunant in the 19th century [2]. National Red Cross and Red Crescent Societies were originally created to provide medical assistance to those wounded in battle, in support of their countries’ military medical services. Today, National Societies are recognized as auxiliaries to their public authorities in the humanitarian field both in times of war and peace. In order to establish and found a National Society, the National Society must be “duly recognized by the legal government of its country on the basis of the Geneva Conventions and of the national legislation as a voluntary aid society, auxiliary to the public authorities in the humanitarian field”, as stipulated in the Statutes of the RCRC Movement.

In fact, the recognition of the auxiliary role is a condition for the establishment of a National Society. Additional national Red Cross (or Red Crescent) laws and sectoral laws as well as the statutes, policies, plans and agreements of the NS determine further the auxiliary role and define the roles and responsibilities of a National RCRC Society, the national Government and local public authorities.

The primary purpose of a National Society as auxiliary to the public authorities in the humanitarian field is to complement and/or supplement them in the fulfilment of the responsibility to provide humanitarian assistance to vulnerable persons on their territory.

The respective National Society has the duty to consider seriously any request by its public authorities. However, it can also decline requests, if they are not in conformity with the statutes, the Fundamental principles [3] of the Red Cross Red Crescent Movement and the mission of the RCRC NS. Public authorities must respect this.

The large volunteer network allows reaching a large number of the population, including the most vulnerable people in hard-to-reach areas. All National Societies globally provide community based services through volunteers and staff and many are strongly engaged to provide mental health and psychosocial support. Areas, where a RCRC NS is mandated to fulfil this auxiliary role in the health sector are for example the operation of blood banks, pre-hospital care, social and health care institutions, providing First Aiders and being on the frontline of prevention and public awareness work.

The auxiliary role in practise: COVID-19 and RCRC

With the onset of the COVID-19 pandemic, Governments realised that they need support to tackle the spread and the impact of the disease. Firstly, support was required fast, locally, not complicated and “low key” without massive financial implications. Secondly, support was required at large scale, reaching equitably to the whole population in all corners of a country. And thirdly, support was required to reach the most vulnerable people, in the most hard-to-reach areas effectively and timely. Given the scope of this task, Governments addressed their national RCRC Society for help and/or the National Societies offered their services to the respective public authorities.

The support and services, which a National Society could offer, differed according to a National Society’s competence and experience. The institutional structure, previous support and services provided, public trust in the society and reputation and visibility were other important factors to leverage the auxiliary role. For some National Societies this meant for the first time to engage in the health sector, or step into a new service role. A certain risk-appetite to embark on a new journey was needed to fill the auxiliary role in a setting with many unknown variables in a fast changing environment with sufficient flexibility while desiring to achieve maximum impact.

RCRC NS contributed to the strengthening of local health systems through human resources (e.g. staff and volunteers), information (e.g. health information and awareness raising), medicines and technologies (e.g. personal protective equipment, oxygen supply) and delivering services (e.g. testing centers, support to vaccination points).

All 192 RCRC NS around the globe are active in providing community-based services through staff and millions of volunteers providing information on COVID-19 to the local population and engaging in counteracting rumours.

All 192 RCRC NS around the globe are active in providing community-based services through staff and millions of volunteers providing information on COVID-19 to the local population and engaging in counteracting rumours. According to their mandate, they ensured that most vulnerable population groups (e.g. elderly people) were at the center of attention. For example, they are accompanied to COVID-19 testing and vaccination points, and handed out food parcels to those who could not leave their houses during lockdowns. Volunteers were helping to triage people for COVID-19 at border crossings and they assisted in safe burials.

Almost all RCRC NS provided mental health and psycho-social support to their local population, operating phone hotlines and providing digital platforms to remain in touch with each other. In countries, where vaccines are available, RCRC NS support the health system with volunteers who assist in the non-medical tasks of the vaccination points, thus contributing to the vaccination of millions of people in Europe, North Americas, MENA, Asia and Pacific. As more and more vaccines are available, the coverage of RCRC NS assistance in COVID-19 vaccination is increasing globally [4].

The RCRC Movement has pushed on the international level for the equitable distribution of vaccines through the ACT Accelerator and engaged in global advocacy for including migrants as target groups in local COVID-19 responses.

According to their mandate, they ensured that most vulnerable population groups (e.g. elderly people) were at the center of attention. For example, they are accompanied to COVID-19 testing and vaccination points, and handed out food parcels to those who could not leave their houses during lockdowns.

Opportunities and challenges of the auxiliary role during COVID-19

COVID-19 has presented opportunities to the local National Societies and the Red Cross Red Crescent Movement. Many RCRC NS were able to increase the level of service delivery and proved to be a strong, reliable and trustworthy partner along the public authorities. The RCRC NS gained in visibility and public trust and received Government grants and private donor support for their activities. The visibility and trust helped to attract more volunteers, wanting to engage locally for common good and humanitarian actions. New areas of engagement allowed innovative and creative designing of the interventions, and when needed technical backstopping by partners was done virtually. Most important of all, the RCRC NS became more independent from traditional funding channelled through the NS from the global North and got empowered to lead and steer their operations on their own. Different virtual networks and regular global exchanges fostered solidarity among the different RCRC NS in the global fight against COVID-19.

Where opportunities arise, challenges exist. Fulfilling the auxiliary role entails a certain proximity to the Government and yet requires a National Society (as one of the Fundamental principles) to maintain their independence. In places where Governments deny the existence and danger of COVID-19, the RCRC NS must still remain independent and keep to evidence and truth, despite rumours and political influences. In places, where the Government is not regarded very high by its citizens, the RCRC NS may initially have a hard stand to be recognised by the public for good quality and independent services. In their willingness to step up to their auxiliary role, some RCRC NS did not have enough evidence and/or courage to decline carrying out certain national actions, such as outdoor spraying, fumigation and personal disinfectant showers.

Another challenge for NSs, not only related to COVID-19, is to constantly lobby that Governments keep focus on the most vulnerable and marginalised population. This is particularly important in situations where resources are scarce, where access to services is limited and where Governments predominantly focus only on the health consequences of COVID-19 and do not allocate safety nets of economic support. While many RCRC NS were able to successfully scale up their services, the challenge to sustain them on the long-run remains.

COVID-19 has certainly (re-) activated and re-emphasised the auxiliary role of the RCRC NS and brought about new opportunities in health system strengthening. It highlighted again the value of voluntary engagement as the unique selling point of the RCRC Movement being able to mobilise its millions of volunteers in all corners of the world to engage in community-based services, working for humanity and a common good.

Way forward

COVID-19 has certainly (re-) activated and re-emphasised the auxiliary role of the RCRC NS and brought about new opportunities in health system strengthening. It highlighted again the value of voluntary engagement as the unique selling point of the RCRC Movement being able to mobilise its millions of volunteers in all corners of the world to engage in community-based services, working for humanity and a common good. The expansion and scale up of the auxiliary role has strengthened RCRC NSs in their existence, independence and sustainability. This builds the foundation for an even stronger and publicly trusted RCRC NS, ready to serve the most vulnerable in the country in areas, where the public authorities cannot fulfil their role.

The response to COVID-19 has contributed to position the Red Cross Red Crescent nationally as important and reliable player vis-à-vis Governments, donors and communities. Building on the positive experiences, continuing the partnership approach and leveraging further the auxiliary role in health and other areas will strengthen the National Societies in their existence, independence and sustainability. At international level, the RCRC Movement has substantially contributed to global health around COVID-19. The “red pillar” is ready to play a more prominent role in global health security and international health cooperation in the future.

Annotations

[1] The Red Cross Red Crescent Movement consists of 192 National Red Cross and Red Crescent Societies, the International Federation of Red Cross and Red Crescent (IFRC) and the International Committee of the Red Cross (ICRC). The headquarters of the IFRC and ICRC are based in Geneva.

[2] Guide to Strengthening the auxiliary role through law and policy; IFRC 2021

[3] The seven Fundamental principles are: humanity, impartiality, neutrality, independence, voluntary service, unity, universality

[4] From IFRC Global COVID report, July 2021