Getting Started in International Health Consultation

Anita Barbey, DrPH, CNM (adapted)

CNMs/CM can make important contributions to the world's health through their service as consultants. The following information is offered as a step-by-step resource guide for those who are exploring this opportunity.

I. Selecting an area of skill and interest.

Assess your qualifications. What specific skills can you offer that are relevant to the needs of the target organization with which you hope to serve? Do you have, for example, particular skill or expertise in education, clinical practice, research, or administration? Do you have the ability to adapt and apply these skills in a technologically appropriate ways (i.e., many countries requires very basic teaching and service techniques)?

Assess your ability to work successfully in another culture. Use your experience working with multicultural population groups in your own community or elsewhere as a benchmark.

• Do you listen well?
• Do you have good interviewing and observational skills?
• Can you take care of yourself under adverse circumstances?
• Are you flexible and adaptable, particularly when under stress?
• Can you easily adapt your way of doing things and readily adjust to such change?
• Are you in good health?

Assess your language skills. Longer term assignments usually require some proficiency in the local language as you will be developing lasting relationships, and need to be effective in sustaining them. Shorter term assignments might be accomplished with the use of a translator, but you need to be assured that a translator will be available during your term of service. Does the nature of the work you wish to accomplish lend itself to use of an interpreter? For example, if the work is highly technical, can you be reasonably certain that a translator unfamiliar with the technical nature of the task can be effective in communication? (Note that when working with Ministries of Health or other higher-order government officials, English is often a common language.)

II. Applying for a Position

Your resume or curriculum vitae should present your skills and interests in a way that clearly depicts your expertise and preparation for the task. However, it is likely that each agency will require that you complete an agency-specific form. Many use a common biodata sheet.

Many agencies maintain consultant rosters. You should update the information in these files from time to time, not only to maintain current information but also to reaffirm your interest in working with the agency.

You may be asked to write letters that attest to your availability for an assignment, should a certain scope of work be awarded to the agency. This commitment does not necessarily mean that you will be requested to do this work. Often a first job opportunity will come to you because of persistence or if you accept a position which had been offered to others who declined because of pay/lack thereof, timing, duration or location. Accepting that position is an entry opportunity and should be carefully considered. Be certain you have the expertise to accomplish the scope within the designated time frame.

III. Characteristics of an Assignment.

Agencies that employ consultants may be government or private for-profit or not-for-profit entities. They may operate as independent (solo) agencies or as collaborative partnerships. Your service may be requested as an individual, or as member of a team. Services are generally considered to be short term if less than 42 days, medium term if extending for several months, or long term if a year or more of service is scheduled.

Payment for your services is based on a number of factors related to skills and experience. It may be a negotiated rate, a rate established through previous consultant service (including domestic work) or based on the complexity of the assignment. Each agency will specify the number of paid work days in a week (usually not more than six) and hours of work per day (usually not more than eight), even if you actually contribute significantly more time to the task. Long hours are often characteristic of these assignments and may include work on days "off." You also may be asked to complete work in advance of the assignment or following it, at home, for which compensation must be negotiated. The agency may or may not also offer benefits such as medical care during the assignment, and/or reimbursement for expenses such as transportation, lodging, per diem, medical evacuation insurance, translation services, phone/fax and office supplies. Arrangements for your travel, lodging, etc. may be up to you or completed by your employer.

Consider carefully the geographic location of the assignment. Is the region politically stable? Are you assured of assistance, including evacuation, if necessary? Will you be additionally compensated for assuming the risk?

If a medium or long term assignment is offered, be certain to negotiate housing considerations. Will safe and adequate housing be located for you? Who will define "safe and adequate?" Who will bear the cost of these accomodations?

IV. Preparing for an Assignment Prior to Departure

Preparation for an assignment requires that you complete all elements of the scope of work that are necessary to establish the authority and ability to complete the assignment in-country. You may wish to speak to other individuals who have previously worked in the country to obtain their insight. Obtain relevant documents, and understand their meaning in the context of your assignment.

Scope of work

• detailed listing of expected outcomes of your assignment
• format of reports; frequency with which they must be filed; individual who will receive and review these reports.
• details concerning reimbursement and records to be kept for documentation

Project documents

• background of the assignment
• current status reports evaluating the project (if it is ongoing) on quarterly/annual basis
• policies and procedures impacting your assignment

Country and cultural profiles

• information for travel, such as specific travel regulations (restricted areas, prohibited items), visas and entry permits, required vaccinations
• weather patterns, holiday and holy days that may impact your work schedules
• travel safety, mode(s) of transportation
• food and water availability and safety
• cultural etiquette such as tipping and dress
• general information about the country itself as an introduction to the people and the region (a wealth of information is often available via official country web sites)
• demographic information specific to the assignment (e.g., if you will be providing consultation in the area of contraception, the country's contraceptive prevalence rate is relevant and important baseline data.)
• contact information (names, titles, address, telephone, fax, e-mail of key individuals.) Your employer is likely to have additional in-country contacts such as university, government, or health professional personnel who can be helpful as resources

Preliminary arrangements for your arrival

• Prior to the date of travel, make arrangements that will facilitate your arrival in country, and the ability to immediately set to the task. Leave copies of relevant documents with a contact individual in the U.S.
• obtain and forward(or carry with you if necessary) required equipment or documents after verifying what is available on site for your use
• select appropriate resource materials
• communicate with key resource individuals so that your arrival is anticipated
• arrange for your personal needs. Be certain that you have all required travel documents (passport valid for one month following date of departure, visa),extra passport size photos, driver's license, and immunizations (WHO yellow card).
• purchase malaria prophylaxis, anti-diarrhea medicine, sunscreen, mosquito netting and water purification tablets, if these needs are anticipated.
• verify and obtain what will be the most useful form of US currency/credit card/travelers checks to use to obtain local currency wherever you will be travelling. Also obtain a small amount of local currency (if available).
• confirm the specific details of travel arrangements and arrival information (Will you be met at the airport and assisted to your hotel? Whom do you contact if there are delays?)
• business cards in the relevant language may be useful-check with your employer

V. Key elements of a consulting assignment in-country

Preparing for the assignment continues when you arrive in-country. Arrange to meet key contacts in the first days. Make appointments in advance, if possible, but certainly soon upon your arrival.. Arrange for transportation if you will be making trips to areas distant from the main location. Meet with your in-country team and devise your workplan at the onset of the assignment and regularly throughout the length of stay. Adapt and adjust your workplan as indicated. Get to know your local counterparts' interest in the project. Share your expertise with your counterparts, learn from them, and recognize their contributions.

An exit report is usually written prior to departure and left with key contacts in-country at a debriefing. Final project reports are completed within a specified time frame following completion of the assignment. The final report should emphasize the contribution that your work has made to the longer term objectives of the agency and country effort and include recommendations that will lead to institution building and sustainability of the project.

Finally, be willing to disseminate the results of your work as requested through presentation at forums or through preparation of manuscripts for publication(with the concensus of your employer). This not only maximizes the positive impact of your efforts, but also contributes to your recognition as a valued professional in the international consultant role.