Desk review
Deployments of personnel
There was a total of 65 deployments of personnel from operational partners to the WHO Cox’s Bazar sub-office between December 2017 and February 2019: 43 deployments through GOARN and 22 through SBPs. Four people were deployed twice, two from GOARN and two from SBPs, giving a total of 61 individuals who were deployed during that period.
The majority of deployees fulfilled roles within the health expertise and operations function of the Incident Management System (IMS), as outlined in the WHO Emergency Response Framework (13), with the largest number of deployees fulfilling epidemiologist or surveillance officer roles. Specific job roles are included in Table 1.
Table 1
Job roles and related IMS (Incident Management System) function for staff deployed to Cox’s Bazar December 2017 – February 2019
Deployee IMS function
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Deployee role
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Number of deployments (%)
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Health expertise and operations
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Case management officer
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3 (4.6)
|
|
Epidemiologist
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18 (27.7)
|
|
Field manager
|
4 (6.2)
|
|
Health operations team lead
|
1 (1.5)
|
|
Infection prevention and control
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6 (9.2)
|
|
Laboratory technical officer
|
2 (3.1)
|
|
Public health officer
|
1 (1.5)
|
|
Surveillance officer
|
9 (13.8)
|
|
Epidemiology team lead
|
1 (1.5)
|
|
Mental health technical officer
|
1 (1.5)
|
|
WASH officer
|
4 (6.2)
|
Leadership
|
Communications officer
|
3 (4.6)
|
|
Resource mobilization officer
|
1 (1.5)
|
Operations support and logistics
|
Health logistics officer
|
1 (1.5)
|
|
Operations support and logistics team lead
|
1 (1.5)
|
Partner coordination
|
Health cluster coordinator
|
1 (1.5)
|
Planning and information
|
Data management officer
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4 (6.2)
|
|
GIS specialist
|
1 (1.5)
|
|
Information management team
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3 (4.6)
|
Gender of deployees
Of the 65 deployments, 32 were male and 33 were female. Two women and two men were deployed twice.
Nationality of deployees
Information on nationality was available for 63 of the 65 deployments. The highest number (26 deployees, 41.2%) came from the EURO region, followed by Western Pacific region (14, 22.2%) and Pan-American region (11, 17.5%). Six deployees came from countries within the Eastern Mediterranean region (9.5%), five came from the African region (7.9%) and one deployee came from within the South-East Asia region (1.6%).
Level of experience and education
Deployees’ relevant occupational experiences were not always directly linked to humanitarian or the public health sector, with some deployees having relevant experience from the private sector. The number of years of experience ranged from three to 28 (mean 9.7). This is shown in Figure 1. All deployees except one provided educational achievements on their CV, with all being in possession of at least a Bachelor’s degree. Eight were medically qualified and ten had PhDs.
Duration of deployment
The length of deployment ranged from eight days to 278 days, shown in Figure 2. The mean length of deployment was 67 days, with GOARN deployments tending to be shorter (mean 40 days, range 8-91) and deployments through SBPs lasting longer (mean 119 days, range 23-278). The longest deployments were between March and August 2018. This is also reflected when looking at the number of deployees in the Cox’s Bazar office at any given time (Figure 3). This peaked at 18 deployees in May and July 2018, then reduced gradually over time.
Interviews of personnel
Forty-one interviews were conducted with people involved in the deployments of personnel to Cox’s Bazar. Their affiliation is shown in Table 2.
Table 2
Location of interviewees
Group, by location
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Number of people
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WHO Headquarters (Geneva, Switzerland) including GOARN and SBP secretariats
|
4
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WHO South-East Asia Regional Office (New Delhi, India)
|
7
|
WHO Bangladesh Country Office (Dhaka, Bangladesh)
|
5
|
WHO Cox’s Bazar Emergency Sub-Office (Cox’s Bazar, Bangladesh)
|
11
|
Deployees
|
11
(SBP = 6, GOARN = 5)
|
SBPs: representatives from RedR Australia, Save the Children UK and Norwegian Refugee Council
|
3
|
SBP = Standby partner |
Key themes
Four key themes were elicited by thematic analysis of the interviews: “staffing”, “deployment process”, “office” and “capacity building”. Within these four key themes, there are between two and four master themes, and several subthemes. These are shown in Table 3, with example quotes where interviewees suggested areas for development for each subtheme.
Table 3
Themes and subthemes identified from interviews with example quotes
Themes
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Master themes
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Subthemes
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Example quotes
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1. Staffing
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Team structure
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Incident Management Structure (IMS)
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“I did not feel it was a hierarchical environment”
“There are communication gaps within the IMS, both horizontally and vertically”
“Some people from partnerships are trained and well versed in how WHO works and the IMS”
|
Lead roles/team positions
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“Leadership should be taken on by more experienced deployees… if they are here long enough”
“It is better to give specific technical functions to deployees, rather than lead positions or management responsibility, as these roles should be given to people who are present for a longer period of time”
|
Continuity and transition
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Duration of deployment
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“There should be a minimum deployment length of three months” “The same time is spent on recruitment regardless of how long they stay for, but the deliverables are very different”
“Those who contributed the most were those who stayed for more than 3 months”
“GOARN deployees are usually only for six weeks, it would be good if this could be extended”
|
Long-term staffing plans
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“[Operational partnerships] should be used [only] for deployment acutely”
“We are moving towards recruiting longer term staff, especially national staff. It would work well if experienced deployees train the national staff”
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Role of deployees
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Terms of reference (ToR)
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“Terms of reference need to be clear, both for the receiving office and the deployee”
“[unclear terms of reference] results in time not being properly utilized”
“Terms of reference are very broad.”
“Contributions were greater when there was a clear ToR with tasks that could be achieved in the short space of time”.
|
Handover
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“Deployments should be staggered, with no gaps”
“There should always be handovers”
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Debriefing
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“There should be a debriefing at the end of each deployment with a focal point from the organization”
“[Deployees] would find ways of handing over what was left and gave ideas on how it could be continued. They were mature, highly qualified, and concerned about handover”
|
Quality of deployee performance
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Performance Evaluation Report (PER)
|
“(The PER) is a very rigid evaluation structure [it] needs to include softer skills as well as the technical skills”
“An alternative to the PER could be a structured conversation”
“There is a need for an internal record that is distinct from the PER”
|
Roster
|
“A roster should be formed of individuals who have been to CXB and performed well, who we could ask to return”
|
Performance review
|
“There should be a performance review process and an early evaluation”
“More feedback to deployees and deploying organizations is needed”
“An early assessment should be undertaken after two weeks”
|
2. Deployment process
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Preparation and arrival
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Preparation
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“Before initiating the deployment, you should receive letters, documents, and in good time… you need some internal documents and information”
“Deployees are usually informed about procedures for payment, leave etc by their deploying organization before leaving, so usually this is straightforward”
“Personnel deployed through GOARN have been briefed by GOARN, and there is a GOARN focal point”
|
SBP/GOARN deployment
|
“Deployments from GOARN/SBP were a life-saver when we needed one”
“Deployments need to be more timely and reliable”
“GOARN personnel deployed were highly trained and deployed quickly”
|
Organizational structure
|
“Administrative questions at times must pass through 3-4 layers: field office administration, country-office, regional office and at times headquarters/global service center… which introduces a delay”
|
Training
|
“Training needs to be provided on the systems required”
“Different SBPs may offer different training, but all will receive a degree of mandatory training on operations, finance, security”
“In every position there are some particular training needs”
|
Orientation/briefing
|
“It would be good to have a briefing for deployed personnel in a more structured way”
|
Recruitment
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SBP/GOARN recruitment and selection
|
“Technical area experts should advise the GOARN/SBP partners to recruit deployees/technical experts with the required skillsets”
“Generally there has been appropriate matching between expertise, experience and local context”
“[An] advantage of using SBPs to deploy staff is that often staff know each other through being deployed with the same people previously”
|
Telephone call/Skype
|
“Although deployees are pre-selected through rosters, would still recommend having an interview or call on Skype before agreeing to deployment to discuss expectations”
|
3. Office
|
Environment
|
Office environment
|
“There were no set seating arrangements… members of the same team were at time distributed across different rooms”
“We now pay more attention to staff wellbeing”
“We have a staff wellbeing team trying to enhance team spirit and have everyone working as one”
“The SBPs brought diversity to the office – they were from Kenya, Somalia, Afghanistan, Australia, Sudan”
|
Wider environment
|
“Individuals can have cultural sensitivity and be adaptable but it depends on the person and their experience”
“Generally, staff were experienced in working in different cultures and did not have trouble adjusting”
“There are less complex security issues than in other contexts where I have worked”
|
Policies and procedures
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Rest and recuperation (R&R)
|
“A clear [standard operating procedure] is needed to ensure there is no confusion over R&R policies applicable to different contract types and situations”
|
Research
|
“A mechanism is needed which makes it easy to do research”
|
Equipment/emails
|
“My official email came only half-way through my deployment. Some deployees were temporarily using their personal email. Official email accounts should be assigned as a matter of routine”
|
Support
|
Supervision
|
“Supervision is key for less experienced staff”
|
Relationship with SBP/ institution
|
“There should be stronger communication between [operational partners] and WHO at field level to better meet needs”
|
4. Capacity building
|
Sharing experiences
|
Mentoring
|
“[An operational partner] has a buddy system where more junior staff are linked with seniors who have 5-10 years’ experience. This works well”
|
Building collaborations
|
“No single institution has all the capacity and so we need to use surge capacity from other institutions”
|
Increase of SEARO participation
|
Pool of institutions
|
“We want to build capacity… institutions from SE Asia are not yet as active/engaged as from other regions”
“The response from Western institutions is disproportionate”
|
Regional focus
|
“It can be useful to use regional [operational partners] due to culture and regional solidarity”
“We should have a regionally focussed GOARN mechanism for this WHO region. This way the experience can be used in the region and we build local capacity”
“If people are from the region or have experience in the region, they find it easier and blend in well”
|
Key theme 1: staffing
Staffing was an issue highlighted by all interviewees. All those who were interviewed felt that staff deployed through partnership agreements played a pivotal role in the emergency response.
The need for a clear team structure and reporting lines was emphasised, including communication of management decisions. Some interviewees believed the vertical structure of the Incident Management Structure (IMS) affected communication, at times preventing information from being shared.
Some interviewees recommended that team lead positions should be assigned to persons with considerable WHO experience and who would remain in the sub-office for longer, allowing for institutional memory and more effective functioning of the IMS. This also linked with continuity, with shorter deployments viewed as having some valuable contributions but at times being disruptive. However, it was recognised that the intensive workload, especially in early stages of the response, may not be sustainable for longer periods. Many interviewees called for a longer-term staffing plan as soon as it was clear that the emergency would be prolonged.
Clear terms of reference were raised by the majority of interviewees. Some deployees suggested for these to include a degree of flexibility and to be finalized on arrival with their supervisor to ensure that they are clear on the role requirements. Handover and debriefing were also seen as important elements, and that these processes should be formalised, ideally with both the inbound and outbound deployments overlapping on site.
Many persons interviewed expressed that the standardized performance evaluation report (PER) was not seen as sensitive enough to act as an adequate evaluation tool and had limited use in distinguishing successful deployments. Linked to this, an internal roster was seen by some as a way to positively distinguish deployees who had worked well in Cox’s Bazar. Many suggested an early performance review, within the first two weeks of a deployment, in order to identify any potential problems and correct course as soon as possible.
Key theme 2: deployment process
There were requests for more information prior to deployment, both role-specific and general information about WHO systems and the WHO Emergencies programme. Staff from the Cox’s Bazar sub-office commented that the timings of deployments would have the greatest added value if they coincide with greatest need and allow for handover from outgoing personnel. It was also felt that the process could be streamlined to reduce delays such as travel approvals and visas. Interviewees recognised that ideally everyone would be trained and familiar with WHO systems and procedures, but a minimum standard of deployees receiving training in relevant processes and IT systems would be beneficial. Alternatively, recruitment of more administrative support familiar with WHO systems could be considered. The importance of a thorough briefing was noted, specific to Cox’s Bazar and including information on context, local culture and expectations.
More transparency was requested around recruitment of deployees, including selection of candidates. It was requested by those in the sub-office that they have a more active role in the recruitment process, and for a call prior to deployment between deployee and the receiving team to improve the preparation of both parties.
Key theme 3: office
The temporary nature of the Cox’s Bazar sub-office premises, housed in hotel apartment blocks with several smaller rooms spread over different floors was raised. The layout was seen as contributing to fragmentation and detachment. It was raised that different office space might contribute to stronger coherence within and between teams.
Security restrictions and the cultural contextual challenges were raised, particularly by female deployees. Although considered important for staff wellbeing and productivity by all interviewed, applicable policies on leave and rest and recuperation were not clear for different contractual modalities and deployment types, resulting in perceived barriers in accessing this entitlement.
Some deployees noted that opportunities for valuable research and documentation which could improve public health practice for similar settings existed in Cox’s Bazar, together with some enabling factors. At the same time, it was noted that some of these were missed due to operational challenges of conducting research in an emergency, as well as lengthy and unclear approval processes, questions around ownership of data and authorships. It was felt that responsibility for coordination of research efforts should be assigned within the IMS structure to a staff member based in the office for medium term.
Many deployees reported challenges with IT equipment and access, with delays in allocations of official laptops and email accounts leading to temporary use of personal devices, emails and cloud accounts. Concerns were raised around data storage, protection, and security. Establishing use of generic email addresses and function specific accounts was recommended to promote continuity, particularly for high-turnover roles.
Operational supervision and support for issues both inside and outside of work within the office were key issues, especially for less experienced deployees, although this was seen to improve with the introduction of a staff wellbeing committee later in the emergency response. The request for support also included a stronger relationship between the operational partners and WHO at field level to permit more tailored identification of requirements, as well as to address concerns regarding deployees.
Key theme 4: capacity building
Interviewees recognised the importance of building local capacity. Suggestions for this included a roster for personnel with appropriate skillsets for different technical functions, particularly from within the region and increasing the number of local institutions and organizations with operational partnerships in place. This regional focus was seen as important to ensure that deployees have more familiarity with local customs and culture, and be better placed to quickly form relationships and build trust with the affected populations and local staff and administration.
Mentoring was mentioned several times in relation to the need for experienced staff, with suggestions for more experienced deployees to act as mentors to allow less experienced deployees to be deployed safely. Similarly, sharing experiences was linked to building collaborations between WHO and other institutions, as well as between the institutions themselves.