1. National and international staff care 26 th November 2008

2. 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

3. 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.”

4. Health, safety & security policies published Region specific health, travel & security risk assessment Pre-departure briefing Health clearance Full medical Travel clinic & supplies Psychological Screening Travel clinic & supplies Regular medical Work-life balance support Training – stress Health support Before Clear plans for security incidents & evacuation Record keeping and work plans In-country support Identify local reputable practitioners ISOS clinics etc. Remote support Psychological Support THAC EAP/ buddy/ line manager debriefings Email/phone advice Trauma management During In-field response Psychological 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

5. Before - indicators of good practice Health, safety & security policies published Region specific health, travel & security risk assessment Health clearance & pre-departure briefing Medicines & supplies

6. Before - Risk assessment – psychological Risks to your agency: Strategic – Organisational reputation Compliance - Health and safety legislation Operational – Disruption in functioning Human Resources – Motivation Financial – Prevention vs remedial costs

7. Before - indicators of good practice Health, safety & security policies published Region specific health, travel & security risk assessment Health clearance & pre-departure briefing Medicines & supplies

8. 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)

9. 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

10. 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

11. 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

12. 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

13. Before - indicators of good practice Health, safety & security policies published Region specific health, travel & security risk assessment Health clearance & pre-departure briefing Medicines & supplies

14. During - indicators of good practice Security plans/ evacuation Record keeping & work plans In-country health support

15. During - Security plans Critical incident & trauma management Clear guidelines Front line responses Psychological first aid available Standing arrangements with international specialists

16. 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

17. After – indicators of good practice Debriefing/ exit interview Health checks

18. 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.

19. After - psychological health De-briefing Operational vs. emotional/personal Mandatory vs. optional In-house vs. out of house

20. 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

21. Health, safety & security policies published Region specific health, travel & security risk assessment Pre-departure briefing Health clearance Full medical Travel clinic & supplies Psychological Screening Travel clinic & supplies Regular medical Work-life balance support Training – stress Health support Before Clear plans for security incidents & evacuation Record keeping and work plans In-country support Identify local reputable practitioners ISOS clinics etc. Remote support Psychological Support THAC EAP/ buddy/ line manager debriefings Email/phone advice Trauma management During In-field response Psychological 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

22. 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?

23. 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