The Directorate General for Civil Protection and Humanitarian Aid Operations of the European Commission (DG ECHO) was created in 1992. Since then, it has established itself as one of the world's leading humanitarian donors, with an annual contribution of around €1.65 billion, of which between 10% and 15% goes to health.
In 2025, DG ECHO updated its Health Response in Humanitarian Settings Health Policy Guidelines, the previous version of which dated back to 2014. In this article, I provide a non-exhaustive review of some of the most significant changes to this policy and its accompanying technical guidance.
Table of contents:
Overview of DG ECHO humanitarian health policy guidelines
The overall objective of DG ECHO's humanitarian health assistance maintains the focus on reducing excess mortality, morbidity and disability. However, it also now places greater emphasis on prevention and alleviation of suffering, which is a true reflection of humanity as a fundamental principle. DG ECHO, moreover, has always combined an approach based on real humanitarian needs with an understanding of health as a fundamental and universal human right.
This humanitarian donor is committed to many other key values, such as quality, effectiveness, efficiency and equity in access to health services. Moreover, since this update, it has explicitly aligned itself with the core humanitarian standard and its commitments, thus broadening its vision on the participation of and accountability to people and communities affected by crises.
DG ECHO, both in its current and previous health policy guidelines, also aligns strongly with the humanitarian principles and with the mainstreaming of protection, environment, disability inclusion and gender approaches. In addition, it advocates intersectoral action (especially to prevent and treat malnutrition), a vision of health in all policies, and a One Health approach that links people's health with that of the environment in which they live.
Four keys to the 2025 DG ECHO humanitarian health policy guidelines
Commitment to the humanitarian-development-peace nexus and health systems strengthening
In its new 2025 health policy, DG ECHO promotes considerations of the humanitarian-development-peace nexus and the necessary coordination between actors. Although this is partly an update of terminology, it also reflects a way of understanding humanitarian action beyond the ultra-prioritization of basic needs. In this sense, the donor seems to emphasize in its guidelines the importance of health preparedness, public health risk mitigation, anticipatory measures, security and resilience of health facilities, and health system strengthening.
In its 2014 guide, DG ECHO already explained that humanitarian organizations should be aware of the vulnerabilities and needs of health systems in order to protect their capacities and reduce vulnerabilities. It also suggested that funded interventions should support the existing health system (always respecting humanitarian principles), thus contributing to the recovery of its capacity once the acute crisis is over, or at least without hindering this process.
In 2025, DG ECHO goes further and states that interventions should be linked or integrated into the existing health system as much as possible, looking for opportunities to strengthen it. It puts the focus not only on ensuring that humanitarian action does not hinder the recovery of the functionality of public services, but also on helping to overcome the weaknesses of the health system and improving its preparedness and resilience to future crises. For this reason, there is a new chapter on strengthening health systems in humanitarian contexts (previously relegated to an annex). It addresses the six building blocks of the classic conceptual framework of a health system. In addition, the capacity of the local health system to sustain services and outcomes is established as an exit criterion for an intervention.
Prioritization of sexual and reproductive health, especially sexual and gender-based violence
In its 2014 guidelines, DG ECHO repeatedly insisted on the importance of integrating services as broadly and horizontally as possible, always according to local needs. For that reason, it recommended avoiding vertical approaches (such as mental health or reproductive health programs), unless specifically justified.
In the 2025 update, DG ECHO maintains this recommendation. However, at the same time, they highlight some specific health areas considered priorities. These include prevention and response to epidemics, attention to the main causes of mortality and morbidity according to each context, trauma care and surgery, mental health and psychosocial support, noncommunicable diseases, maternal and neonatal health, and especially reproductive and sexual health, which is elevated to a practically mandatory level.
DG ECHO, in 2025, stresses the importance of incorporating a strong sexual and reproductive health component in all humanitarian health programs. Within this framework, while encouraging the use of the Minimum Initial Service Package for Sexual and Reproductive Health in Crisis Situations (MISP), DG ECHO places much more emphasis on some services than others. Thus, while detailing a strong rights and protection focus for prevention of and response to sexual and gender-based violence, it avoids any explicit mention of safe abortion care to the extent that each country allows, despite being a component included in the MISP since 2018.
Beyond basic coverage: quality, equity, and continuity of care
Although the 2014 guidelines addressed aspects such as quality, equity and continuity of care, the 2025 policy reinforces these as mandatory operational elements in any humanitarian intervention. This is reflected in some of the new Key Result Indicators (KRI). For example, the recommended indicator for staff training includes that they have attained the standard competencies of their job. There are also indicators that focus on adherence to treatment or the percentage of pregnant women who do not complete at least four prenatal visits.
Another of the new indicators is related to health financing. This is the percentage of households with catastrophic health expenditure. This, which reflects an interest in equity of access to health services, is also closely related to the possibility of linking health actions with Cash and Voucher Assistance (CVA) programs, something that is new in the 2025 guidelines. That said, DG ECHO limits the possibility of CVA to cover indirect health care costs and only after a proper assessment of the local market of health services and their availability is conducted. DG ECHO discourages the default use of multipurpose cash and voucher assistance to facilitate access to health services, as these may not exist or may not function properly. Instead, it is recommended that any CVA program for health be justified as helping to overcome a real, concrete, and well-identified barrier to accessing health services.
Emphasis on the role of the community and community health workers
The 2025 update gives greater importance to the role of the community and community health workers, compared to previous guidelines. The 2014 edition already stated that the community should be involved in decisions about «how» health interventions should be made (but not what they should consist of) and that there should be community health workers in any community affected by a crisis. The new 2025 policy emphasizes and expands the scope of their roles.
On the one hand, it highlights the crucial role that the community must play throughout the project cycle, based on trust and dialogue. This includes their participation in data collection, identification of needs, design of interventions, local capacity building, epidemiological surveillance, risk communication, reduction of stigma about certain health conditions, and monitoring and evaluation processes. Community involvement is now understood as a much broader key value than in the past. Still, sometimes essential evidence-based interventions can be selected, even if communities do not prioritize them (such as a vaccination campaign against measles, for example).
On the other hand, DG ECHO underlines the very important role of networks of volunteers and community health workers. In fact, it is recognized that in some crises it may be necessary to redistribute tasks when health personnel are lacking, involving less qualified personnel, but always with adequate training, supervision, and evaluation of their performance. Their possible role in ensuring continuity of care, as a link between the community and health centers, in emergency preparedness and response, and even in obtaining information on mortality, is also recognized. In any case, DG ECHO continues to recommend caution regarding the amount of responsibilities that can be attributed to these volunteers, who should not be an instrument to compensate for the weaknesses of the health facilities.
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