Supporting the Mental Health of Aid Workers

October 10th marks World Mental Health Day. The theme of this year’s Mental Health Day is “Mental Health in an Unequal World”, highlighting the importance of global equality around mental health support.

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This year’s theme offers an opportunity to not only advocate for those in difficult contexts where the potential for mental health struggles can be most severe, but also, as the WHO reminds us, empower people to focus on their own mental wellbeing.

For organizations working in difficult humanitarian and development contexts, this means not only greater attention to the mental health of those they are supporting, but also focusing on the mental health of individuals working for the organizations themselves. Aid workers frequently expose themselves to stressful situations and engage with individuals experiencing mental health challenges because of conflict and crisis.

These concerns are particularly acute for local staff who are typically located at the frontlines because of their greater contextual and linguistic familiarity. These staff members often live in the same mentally distressing situations as the communities they are supporting – and are also affected by the challenges and traumas of those they are supporting.

These landscapes are difficult to navigate. They require intentional care to mitigate the risks of burnout, vicarious trauma, moral injury – and many other potential consequences.

Below are five ways that organizations can support the mental health of their staff:

• Establish policies: Having organizational protocols in place for staff struggling with mental health will increase the likelihood that mental health crises are responded to appropriately. Informing staff that such systems exist can also help create an atmosphere of safety and reassure staff that they can bring up problems or concerns with their management. It is also crucial that broader policies are put in place so that staff are not required to continually fight for their needs and entitlements; crisis situations involve myriad dynamics that are beyond the control of organizations, so providing order where possible is helpful.

• Conduct in-house-assessments and/or therapy: New hires often have previous field experience. Understanding any pre-existing trauma or mental health struggles will enable the organization to better support new members of their team. Having in-house therapy is not always financially possible, but it can be an invaluable means of offering support.

• Set initiatives: Celebrating awareness month, having group chats, or simply organizing lunches can help others to feel a sense of connection and belonging – as well as lift their moods. These initiatives constitute practical ways of supporting staff members' mental health.

• Offer workshops: Conducting workshops on stress management, psychoeducation, or self-care can equip staff member with the necessary tools to practice taking care of themselves and identify when they need additional help.

• Provide resources: Ensuring that staff have access to resources (therapy recommendations, list of support groups, financial help, etc.) can encourage them to seek support.

And here are five ways staff members can take care of their own mental health:

• Set work boundaries: The pressures of project delivery amidst volatility can be demanding, but setting boundaries around your work time, how you allow people speak to you, what you expect from yourself, and the types of tasks (and how many) you take on can help mitigate negative impacts the job may have on your mental health.

• Take time off: Use vacation days (and R&R if it’s provided). Ensure that when you are taking time off, you are truly off – and offline. Of course, it can be more difficult for local staff members to unplug from the work context, but taking smaller breaks can also help. Even two hours without checking your phone can beneficial.

• Take care of your physical health: Physical health impacts your mental health. Although it can be difficult in some situations, try to exercise, get fresh air, and eat foods that nurture you. Mistreating your body also affects your mental health.

• Spend time with people you love: Connecting with the people you love can help you switch your focus from work and feel a sense of meaning. Try to set regular times to see (or call/video chat) with family and friends.

• Express your feelings: Regardless of whether you want to have coffee with a friend, book an online session with a therapist, or spend time journaling, it’s important to stay aware of how you are experiencing your work and the impact it’s having on you.

Sara Kuburic is a mental health columnist (USA Today) and writer (Random House) who focuses on trauma. Find her on Instagram: @millenial.therapist

What I’ve Learned from My Work with Third-Party Monitoring

Twelve years of working with third-party monitoring (TPM) in fragile contexts has taught me a crucial lesson: TPM agents are more effective when they collaborate with – rather than police – project implementers.

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The Role of Third-Party Monitors

TPM is an increasingly common feature of the monitoring, evaluation, and learning landscape. It is most often used in non-permissive delivery environments to supplement monitoring data, with the TPM agent acting as a donor’s eyes and ears in the field.

The main services provided by TPM agents are 1) verifying the reports of implementing partners by assessing the extent to which goods, commodities, and equipment have been delivered and services have been provided as indicated by the implementing partners, 2) collecting feedback from beneficiaries, 3) triangulating and analyzing data to determine if delivery is on track, and 4) collecting data to track broader socio-political and economic dynamics in the delivery context.

"Third-Party Monitoring is the systematic and intentional collection of performance monitoring and/or contextual data by a partner that is not [a donor] or an implementing partner directly involved in the work." – USAID 

The Importance of Being Supportive

Attitude is crucial in TPM. There is a tendency to assume that TPM is important because it allows for the identification of problems and the raising of red flags. But the real value of TPM comes from collaborating with implementers, deeply understanding the issues they are facing, and providing recommendations to improve program design and delivery.

Closely collaborating with implementers and fostering a supportive relationship with them yields a number of benefits:

1. Access to information. If implementers believe the TPM agent is only there to report on their failures, they are unlikely to facilitate site access or volunteer information. And if the implementers are uncooperative, the TPM agent can be forced to rely on the donor for access, which can delay the whole process and decrease the frequency of visits. This adversarial relationship also yields negative working conditions for the TPM agent’s monitors. I have personally seen monitors refuse to deploy to certain sites where they are treated poorly. However, if implementers feel that the visits might also benefit their work, they typically welcome the monitors. They are also more candid and honest with the monitors, volunteering information to increase the effectiveness of support.

2. Complete picture. when the TPM agent focuses on supporting implementers rather than identifying their mistakes, they prioritize a deeper understanding of the issues. If a discrepancy between reporting and observed conditions is identified, a supportive TPM team will stay in the field, talk to the implementer, and try to understand what is happening. For example, I worked on a project where we were verifying the receipt of microloans. We found that some individuals had received loans who were not on the list of beneficiaries. Rather than immediately raising a flag, we spoke with the implementer and discovered that some younger family members had received the loans on behalf of their elderly disabled mothers/fathers and had started to establish businesses that benefitted the entire family. These intra-familiar replacements were allowed under the program, so we asked to meet with the originally registered beneficiary, we verified the stories we were told, visited the place where the businesses were operating, and verified the documentations against the records and lists. As a result, we did not report this situation as a problem; instead, we noted these intra-familiar transfers and reported them as positive developments.

3. Fresh insight. If implementers – and the beneficiaries of their programming – believe that the TPM agent is truly there to help, they may also entrust it with information that would not otherwise be shared. For instance, I worked on a project where farmers informed us that they were receiving insufficient amounts of agricultural suppliers from the implementing partner and, as a result, they were purchasing further supplies from the market. These purchases had negative impact on their business because the supplies were expensive and of lower quality than those provided by the implementer. They had not reported this shortfall to the implementer or donor because they did not want to appear ungrateful for the current support. But they volunteered this information to us, understanding that we were speaking with them to ensure that the support being provided was as effective as possible. As such, we highlighted to the donor that, due to no fault of the delivery partner, it was necessary to amend the budget and increase the amount of agricultural goods being provided to each farmer.

How a TPM Agent Can Create Supportive Relationships

Relationships of trust need to be carefully nurtured, especially because the TPM agent needs also to maintain a degree of distance from the implementers to ensure objectivity and independence.

To achieve this beneficial relationship, TPM agents should consider a few factors:

• Starting on the right foot. During first contract with the implementer, it is crucial that the TPM agent (and the donor, if possible) makes it clear that it is there to help and support programmatic improvement and learning in whatever way possible. The agent has to therefore encourage the reporting of negative feedback – and assure the implementer that the feedback will be used to push for positive improvements.

• Problem solving, not raising. The TPM agent and its monitors need to demonstrate that the identification of a problem is not a victory. Instead, it is simply the beginning of an investigation to properly understand the issue. When a discrepancy is identified (as in the microloans example above), the monitors need to demonstrate a desire to understand the issue, not simply raise a red flag.

• Focusing on clarification. It is vital that identified issues are discussed with the implementer. This means not only undertaking full investigations in the field, but also giving implementers a chance to explain situations more comprehensively before reports are submitted. In the first episode of Proximity’s new “What the MEL?” podcast, co-host Richard Harrison noted that TPM should involve triangular communication between the donor, implementer, and TPM agent. Communication between all parties is essential. Of course, identified issues need to be reported to the donor, and monitors need to stay vigilant for signs of corruption or safeguarding issues, but communication between the TPM agent and implementers ensures that 1) more accurate information is conveyed, 2) the perspective of the implementer is included, and, thus, 3) a more collaborative process is created.

Conclusion

TPM offers many advantages in non-permissive environments. Beyond providing access, TPM yields robust and independent data, reduces project and financial risks, and helps improve program design and delivery.

The last point is the most crucial. But this potential for learning and improvement can go unrealized if TPM is not approached with the right attitude.

In the end, it is in everyone’s interest for TPM to focus on helping implementers to learn from identified issues, grow, and improve their delivery.

From Sub to USAID Prime: What We Learned Along the Way

USAID recently published an article highlighting Proximity’s journey from a subcontractor to the prime implementer on multiple USAID contracts.

The article prompted us to reflect on what we have learned – and what insight we can share with other small businesses thinking about taking this step. We distilled this experience into four suggestions.

Doing It Differently

There is no single path small businesses have to follow to receive prime contracts. In fact, their ability to be creative is the primary advantage of small businesses.

In Proximity’s case, we started out by providing an innovative solution to an urgent problem. Ongoing violence and volatility in Syria was preventing the collection and dissemination of timely, high-quality data. This was, in turn, limiting the effectiveness of monitoring and evaluation of humanitarian and stabilization programs. The situation was also revealing the limitations of relying on subcontracted third-party monitors; existing data-collection agencies in Syria were vastly overstretched – and overreliance on them was creating information echo chambers.

We offered a new approach to address this challenge. Rather than relying on extant data-collection firms, we directly recruited, trained, and managed our own team of researchers inside the country. As we progressively expanded these teams across Syrian communities, we were able to provide new data sets that were unbiased and directly quality assured. We consequently emerged as a go-to research firm in Syria (the location of our first prime contracts).

By the time we started bidding on USAID prime contracts in Syria, we could could conduct research as effectively – if not more so – than any large implementer operating in Syria.

Playing to Small Business Strengths

It’s hard for small businesses to compete in the same game as big-brand suppliers. But they don’t have to; there’s more than one game in town! Rather than trying to measure up against their bigger counterparts, small businesses should focus instead on the advantages their size offers.

For instance, while small businesses cannot draw on the same scale of headquarter resources as big companies, they can offer stress-tested, in-country platforms and highly local capacity. In complex delivery environments, these assets can prove much more important than the scale of backstopping. In Proximity’s case, we had years of experience in Syria conducting the operational legwork for big implementers, including hiring and managing large-scale management and research teams on the ground. This experience demonstrated our ability to perform in the environment – in a way that even the large implementers were unable without support. Crucially, this experience also showed that we could carefully manage the risk of operating in such a fragile and hostile setting. Like many small businesses, Proximity has a high tolerance for risk because we are close to that risk; we intimately understand the contexts and threats amidst which we work, ensuring we don’t expose our teams to danger.

Additionally, small businesses can usually offer richer contextual insight than their large competitors. Not only are they typically more locally embedded, but small businesses are also able to disseminate learning more effectively across their organizations, meaning that data from previous projects can be more distilled into insight for future ones. This is crucial for effective delivery, but it can also be a key asset during bidding processes. For our Syria contracts, for instance, we did not have limitless human and financial resources to throw at proposals, but we had been carefully learning from years of in-country delivery. And, just as this degree of knowledge had previously rendered us an invaluable partner for large implementing partners working inside Syria, it now allowed us to demonstrate to USAID that we possessed a unique level of insight in the country.

Small businesses can also offer more nimble, adaptive delivery. This allows them to launch quickly and turn the ship around when necessary – a characteristic that is particularly important in volatile humanitarian and development contexts. Proximity was able to show a strong record of agility. We had, for instance, been brought on as a subcontractor under the USAID Syria Humanitarian Monitoring Platform to provide data collection and field services across Syria. We were able to quickly mobilize our component by leveraging our deep network of data-collection specialists and drawing on our flexible FIELD 360 remote-training approach. In short order, we had recruited, trained, and fielded an expansive team for a multi-year monitoring and evaluation program.

Embracing Support

Small businesses don’t have to “go it alone” on prime contracts. Proximity obtained its first prime contracts through USAID's small business set-asides. For each of these contracts, we brought on subs with extensive thematic experience and long track records of working successfully with USAID. This has allowed us to benefit from their experiences whilst we navigate the new territory of being a prime.

Just as important, USAID is not just a donor – it’s also a partner. Since winning our prime awards, USAID has been extremely supportive, encouraging us to ask questions and helping to jointly iterate our programming. They recognize that they are working with a small business and are supporting us as we deliver on the contract. And, just as they are teaching us to work with them more effectively, we are helping them to work with small businesses.

Cleaning House

Finally, before small companies or organizations even consider working with USAID, they need to focus on two key prerequisites. Firstly, they have to make a deliberate effort to first get their operations and finance houses in order. They have to be confident they have the necessary systems in place to comply with USAID’s robust requirements. Secondly, they need to take the time to get to know their client. USAID is very supportive, but it takes time to learn about the institution and get a feel for its pulse.

Going from subcontractor to prime awardee is a big step, but once businesses have cleared the administrative hurdles and begin to understand USAID, the process becomes much easier.