After the occurrence of an earthquake causing mass casualties and injuries, a surge of generosity and solidarity often leads to the rapid dispatch of foreign medical teams. This situation can raise complex questions: How can the quality of care be ensured? How can the necessary care be provided without duplications or gaps? How can these medical teams gain access as fast as possible to patients in crucial need of care?
It was with these questions in mind that the Global Health Cluster began in 2011 to explore the possibility of an international register of such teams. Mr. Andre Griekspoor of the Policy, Practice and Evaluation Unit in the Emergency Risk Management and Humanitarian Response Department at the World Health Organisation (WHO), was kind enough to answer a few of our questions about the initiative.
In a few words, could you tell us what this initiative is about?
In brief, it is all about increasing the quality of trauma care offered by foreign medical teams in the aftermath of earthquake disaster. We started working on this through two essential aspects: first a classification system of foreign medical teams according to the level of care provided and their quality standards, and second by developing mechanisms of coordination on the ground with the national authorities. In addition, we are now also exploring the added value of a global registration. This should allow for faster deployment of such teams and better matching of demand and supply. Reporting mechanisms involve developing simple tools to monitor the work of the teams and should allow to better integrate their work with the national response.
We started our work by concentrating on surgical trauma care in one type of sudden-onset disaster – earthquakes – however, we hope that in the longer term this might also be used for surgical care offered in other types of disasters, as well as beyond the initial response period.
How have interested stakeholders reacted to this initiative?
Affected countries, although they would prefer not to require any such international assistance, do acknowledge the need to develop such procedures in anticipation of an earthquake. They also realize that they may use the work to develop their national capacity for pre-hospital care and mass casualty management. Assisting countries see the benefit of defining standards and benchmarks for performance. We have also encountered strong support from the IFRC, the ICRC and various NGOs, mostly after observations of the ineffective coordination in Haiti after the earthquake and numerous examples of unacceptable or dubious practices by surgical teams or individuals.
How is your initiative linked to the IFRC’s work on disaster law?
The main link with disaster law is preparedness. Indeed, a registration procedure is only useful if there are, early before a disaster, efforts to strengthen the domestic first response surgical capacity, and efforts to prepare legally and institutionally on how to deal with foreign medical teams. Our initiative will provide tools for affected states to establish procedures for screening and authorisation of foreign medical teams, as well as the required regulation to ensure commitment of such teams to be part of the national response coordination mechanisms and be accountable to the national health authorities.
Regarding the IDRL Guideline 16(c) on the recognition of professional qualifications, I think that this is complementary to a register of foreign medical providers, because they will need authorization from the authorities to practice medicine.
How does the registration of foreign medical teams relate to other existing initiatives, especially the debate around certification?
Registration could be a first step in a certification/accreditation procedure for health NGOs. However it is important to differentiate: our plans for registration only include self declared commitments to meet and uphold a set of standards, without peer-review or other external accreditation mechanisms. We hope to encourage foreign medical teams to sign up and become part of a better coordinated process and commit to minimal standards of practice.
What are the next steps you will be taking?
The working group overseeing the process will first finalize both the paper on classification and minimum standards, and the paper on authorizing and monitoring foreign medical teams arriving in the aftermath of sudden-onset disasters. We will then concentrate on engaging stakeholders with whom we haven’t been able to engage as much as we wanted and organise a series of consultations, and publications to create better awareness around this work. One of the avenues that we will probably explore is presenting the issue to WHO member states during the World Health Assembly. We will also further develop the option of having a global registration, its purpose and value, including considering the possible risks involved with its creation. Of course all this depends on whether we can have funding for these ambitious projects.
Some concluding words?
We do not have all the answers yet. But we know that how things are done now, without any form of regulation of the trauma care given by foreign medical teams in large scale disasters, cannot continue. But of course, with each step forward that you take, you open room for new questions and challenges.