National and international staff care

26th November 2008

Brief agenda

• People In Aid Code – Principle 7

• A model of health care for international staff

• Our experience with regional and national staff care

• Group discussions – key questions

Principle 7 – Health, safety and security“We recognise that the work of relief and development

agencies often places great demands on staff in conditions of complexity and risk. We have a duty of care to ensure the physical and emotional well-being of our staff before, during and on completion of their period of work with us.”

Health, safety & security policies

published

Region specific health, travel & security risk assessment

Pre-departurebriefing

Health clearance

Full medical Travel clinic& supplies

PsychologicalScreening

Travel clinic& supplies

Regular medical Work-life balancesupport

Training – stressHealth support

Before

Clear plans for security incidents

& evacuation

Record keepingand work plans

In-country support

Identify local reputable

practitioners

ISOS clinics etc.

Remote supportPsychological

Support

THAC EAP/ buddy/line managerdebriefings

Email/phone advice

Trauma management

During

In-field responsePsychological

first aid

After

Relief/development worker

Frequent traveller

International staff model of care

Post assignment health clearance

Debriefing/ personal review

Full medical + tropical screening

Ongoing trauma management

support

Before - indicators of good practice

Health, safety & security policies

published

Region specific health, travel & security risk assessment

Health clearance& pre-departure

briefing

Medicines & supplies

Before - Risk assessment – psychologicalRisks to your agency:

• Strategic – Organisational reputation

• Compliance - Health and safety legislation

• Operational – Disruption in functioning

• Human Resources – Motivation

• Financial – Prevention vs remedial costs

Before - indicators of good practice

Health, safety & security policies

published

Region specific health, travel & security risk assessment

Health clearance& pre-departure

briefing

Medicines & supplies

Before - Health clearance

Face to face medical

(Pre-assignment medical or Adult Health Screening)

For development & humanitarian workers

Travel clinic

(advice, vaccinations, supplies & briefing)

Psychological Clearance

(focus on resilience)

Before - Health clearance

Face to face medical

•Medical history •Physical examination and blood tests – FBC, Blood group, liver & kidney function tests•Managing pre-existing health conditions- asthma, epilepsy, diabetes, depression/anxiety, obesity, low immunity, high blood pressure…•Access to medications and local health facilities

Before - Health clearance

Psychological clearance

•Preventative better than curative •Selecting individuals who are psychologically robust for role•Assessing individuals resilience•Stress factors, coping mechanisms, past experiences, self-awareness•Suitability for specific role/environment

Before - Health clearance

Annual/biennial face to face medical

For frequent travellers

Travel clinic

(advice, vaccinations, supplies & briefing)

Annual/biennial work-life balance

/stress management review

Before - pre-departure briefing

•Operational briefing

•Security briefing

•Medical health briefing – risks, awareness, know what to do if….

•Psychological health briefing – stress awareness and emotional self-care

Before - indicators of good practice

Health, safety & security policies

published

Region specific health, travel & security risk assessment

Health clearance& pre-departure

briefing

Medicines & supplies

During - indicators of good practice

Security plans/ evacuation

Record keeping & work plans

In-country health support

During - Security plans

Critical incident & trauma management

• Clear guidelines • Front line responses• Psychological first aid available• Standing arrangements with international specialists

During - In-country health support

Medical

•InterHealth – THAC, remote email support, emergency phone•Access to local services – recommended providers, guarantee quality of care?

Psychological

•Buddy support, EAP, Centre for Humanitarian Psychology etc.•Trauma / critical incident support

After – indicators of good practice

Debriefing/ exit interview Health checks

After - health checks

End of Assignment medical

•45-70% cumulative stress/aggravated prior health condition, new health issue – tropical disease related

•High levels of stress manifested in weight loss, sleep deprivation, loss of appetite, relational breakdowns etc.

After - psychological health

De-briefing

•Operational vs. emotional/personal• Mandatory vs. optional•In-house vs. out of house

What about regional and national staff?•Staff in developing countries play down health issues as problems are normalised (anaemia, diabetes etc.)•Many have bilharzia, malaria which have not been addressed•Malarial strains differ between regions•Outside of region for 6 months or more then lowered immunity•Less easy access to reliable health care•More at risk from fake or substandard drugs or unaccredited health providers

Health, safety & security policies

published

Region specific health, travel & security risk assessment

Pre-departurebriefing

Health clearance

Full medical Travel clinic& supplies

PsychologicalScreening

Travel clinic& supplies

Regular medical Work-life balancesupport

Training – stressHealth support

Before

Clear plans for security incidents

& evacuation

Record keepingand work plans

In-country support

Identify local reputable

practitioners

ISOS clinics etc.

Remote supportPsychological

Support

THAC EAP/ buddy/line managerdebriefings

Email/phone advice

Trauma management

During

In-field responsePsychological

first aid

After

Relief/development worker

Frequent traveller

International staff model of care

Post assignment health clearance

Debriefing/ personal review

Full medical + tropical screening

Ongoing trauma management

support

Group 1 discussion

•What staff care provisions do your agencies have for international and frequent travelling staff? •Are these models of care working? •How are you measuring the impact/effectiveness of your practices?•What are the issues?•Where can they be improved?

Group 2 discussion

•What ‘model’ of care do your agencies apply for national and regional staff?•Is the international staff model presented an appropriate model of care for these staff? •Where are the current gaps?•How can agencies ensure support accessed is culturally appropriate?•What are the issues do you face with national and regional staff and how to these differ to the UK? E.g. resources, insurance, legislation