First Line of Defence - IOM Health Services for UN Staff

In July 2020, amid the COVID-19 pandemic and to ensure that United Nations staff can continue to work where they are needed, IOM and the UN system signed a Memorandum of Understanding for the provision of health services consequential to COVID-19 by IOM.

The framework, named “First Line of Defence” (FLoD), is designed to ensure that personnel deemed eligible by the UN and their dependents have access to high-quality, reliable health services in contexts where health-care systems may be overwhelmed  and minimize the need for medical evacuations, considered to be the “second line of defence”.

In its first phase, IOM is implementing this project in 18 countries.

Services provided vary from one context to another and may include:

  • Laboratory services: testing for COVID-19, other laboratory tests;
  • Clinical services: management of COVID-19 patients and contacts, medical prescribing, isolation and quarantine facilities, primary care for other conditions, mental health and psychosocial support, women’s and child’s health, preventive health care and health promotion, radiology, referral for a higher-level of care, including hospitalization and medical evacuation where needed;
  • Telehealth: in-home monitoring and treatment of COVID-19 patients and patients with other medical conditions (either within countries or internationally) and specialist consultations;
  • Medical movement support: assisting COVID-19 patients to the airport, provision of medical escorts for non-COVID-19 patients
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GENERAL INFORMATION BOOKLET

Please note that due to the fluid situation, the information presented here is subject to changes without notice and we invite you to confirm all information through your organization, the IOM country team, or the IOM clinic directly.

ONLINE BOOKING: for the following duty stations, bookings for appointments can be made directly online on the Humanitarian Booking Hub: Burundi, Cambodia, Egypt, Ethiopia, Kazakhstan, Kenya, Nepal and Sri Lanka. 

Overview of services offered

COVID-19 RELATED SERVICES

1. Tele-health, home monitoring and out-patient services

In certain countries (please refer to section IV of this document for a detailed breakdown of services offered per country), IOM’s offer of services within the FLoD framework includes the provision of remote tele-health consultations and home monitoring for patients with confirmed or suspected COVID-19 infection and for contacts who have had direct exposure to COVID-19 cases. The purpose of home monitoring is to reduce the requirement for people to be commuting outside their home for care management and number of clinic visits, and identify in a timely manner any need for higher level of care. If patients are clinically stable and home environments are deemed appropriate and safe, remote home monitoring is the preferred method for care management of COVID-19 patients and contacts.

Tele-health services and home monitoring include the provision of: screening , explanation of quarantine and isolation requirements, training in use of medical equipment for self-monitoring (if necessary), regular (daily or more frequent) checks, if necessary – provision of medication and home monitoring kits, remote care management support for symptomatic patients, referrals and escalation of care if needed. If clinically indicated, IOM may arrange home visits or invite a patient to the IOM clinic for additional investigations.

2. Testing for COVID-19

IOM is implementing different reliable testing systems in different settings based on availability, caseload and complexity for implementation. IOM offers testing for COVID-19 with tests that detect the presence of the virus in a nasopharyngeal swab. IOCutM does not conduct rapid tests on blood that do not detect active infections. 

3. Isolation and quarantine

Quarantine for contacts of confirmed COVID-19 patients as well as isolation of confirmed COVID-19 patients may be offered at IOM premises or in other facilities arranged by IOM. This is to be an alternative to home isolation and quarantine, if conditions at home are not suitable for this purpose, for example if the household members cannot be effectively separated. Where possible, IOM runs 24-hour facilities, including catering and a 24-hour hotline to respond to any urgent concerns. The monitoring of staff and dependents in isolation and quarantine facilities will follow the same principles as home monitoring.

PRIMARY CARE FOR OTHER CONDITIONS

In some countries, where capacities of health-care systems to provide regular health services are overstretched due to COVID-19, IOM may support the UN personnel and their dependents deemed eligible with primary services other conditions. These services include consultations and treatment by general practitioners, additional investigations, such as X-ray imaging, blood chemistry, blood count, serology for different infections and urine tests, medical prescriptions and referrals for specialist consultations and higher levels of care. IOM health facilities and laboratories adhere to safety and quality standards which are equivalent to the UN-recognized standards and, as such, satisfy the UN’s requirement for patient safety and health-care standards.

MEDICAL MOVEMENT SUPPORT

In case there is a need for a medical evacuation out of the duty station, IOM can assist patients to the airport, and provide medical escorts for the duration of the travel for non-COVID-19 patients.

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Frequently Asked Questions

ELIGIBILITY

1. Which organizations within the UN system are covered by IOM’s FLoD agreement with the UN system?

All UN agencies which are members of the UN Country Team are eligible for the IOM services in duty stations where the relevant agreement(s) between the UN/UNCT and IOM were signed.

2. In which duty stations is IOM delivering FLoD-related health services?

In its first phase, IOM is delivering FLoD-related health services for UN staff in 19 countries. The services offered vary depending on the extent and scope of the agreement signed by the various UN Country Teams. 

3. Which UN personnel can access to IOM’s FLoD-related health services?

If deemed eligible by the UN, personnel, their families and other individuals may receive health services under the framework of the memorandum of understanding between IOM and the UN.

In general, this includes: all international and national UN staff and their eligible dependents; non-staff personnel engaged by UN system organizations (including UNVs, gratis personnel, individual contractors, consultants, individual service providers, and labourers on an hourly fee) and their eligible dependents. Coverage includes military and police personnel deployed by the United Nations and eligible dependents; United Nations Guard Unit personnel, and Troops of the African Union (Somalia – AMISOM). Also covered are internationally deployed personnel of international vendors/contractors providing goods and/or services to UN system organizations under existing contractual arrangements.

For any specific questions about eligibility, please contact your organization. 

4. Are international/national NGOs, members of the donor community and diplomats covered by this service?

IOM acknowledges the crucial role of international and national NGO workers, the donor and the diplomatic community in lower-resource settings and the personal risks that they take to remain present in some of the world’s most challenging environments. Within the FLoD framework, the current capacity and funding does not allow for the UN to expand eligibility beyond eligible UN personnel and their dependents. However, separate fee-based arrangements can be put in place in each country as necessary. Please contact your IOM health centre directly for more information on such possible arrangements.

PRIMARY CARE AND TELE-HEALTH

5. In which countries primary care and telehealth services are available?

Please consult the country-specific guides available on this page. 

6. What are tele-health services used for?

Tele-health is an excellent tool to enable people to receive medical advice while at home and to avoid unnecessary visits to the hospital. It allows to identify remotely those who may need to seek an additional level of care, which could include hospitalization or even medical evacuation. If necessary, IOM can also organize tele-health specialist consultations.

7. When should I use tele-health services?

There are several situations where you can use tele-health services:

If you need to be in quarantine because you were in contact with a COVID-19 patient or if national regulations require you to undergo quarantine upon return to your duty station;
If you were diagnosed with COVID-19, but your condition is stable and does not require hospitalization;
If you have symptoms of COVID-19, but your condition is stable and does not require hospitalization;
If there is limited access to the health services in the country or if attending medical facilities is linked to a high risk of getting infected with COVID-19.

8. How does home monitoring work?

IOM monitoring team will instruct you via telephone or videoconference on how to monitor your signs and symptoms. They will contact you daily or more frequently if needed and check your condition. IOM clinical staff will provide advice remotely, and if necessary, prescribe and deliver medication, refer you for additional investigations, schedule a visit to a clinic or notify the UN COVID-19 Coordinator who oversees MEDEVAC needs in your duty station, if a higher level of care is required.

9. Will IOM provide monitoring if I am quarantined after travel as required by government regulations?

Yes, in countries where IOM provides tele-health services, IOM will provide monitoring for quarantine after travel.

10. If I need a medical evacuation to a different location, will IOM arrange it?

Medical evacuations or “MEDEVACs” are the second line of defence. IOM will notify the UN COVID-19 Coordinator in charge of MEDEVACs in your duty station, but the responsibility of arranging MEDEVAC lies with the UN. A separate SOP has been developed by the UN system for medical evacuations related to COVID-19, and there are existing procedures in place for medical evacuations related to other conditions. We invite you to check these documents for information about your specific case, your organization and your duty station.

TESTING

11. In which countries is IOM offering COVID-19 testing services?

Please consult the country-specific guides available on this page. 

12. Can I get tested for COVID-19 even if I don’t have any symptoms, for example as part of a travel requirement?

Due to the ongoing worldwide COVID-19 tests shortages, IOM’s testing capacity remains strained, particularly with the use of rapid testing platforms such as Cepheid GeneXpert. Joint efforts to secure the needed supply capacities are ongoing to facilitate testing provision in IOM health facilities.

Testing is prioritized for persons presenting clinical symptoms and contacts of confirmed COVID-19 patients. However, if tests are readily available with a good supply chain, testing of asymptomatic persons for travel purposes referred to IOM by UN organizations will be provided.

13. How should I prepare to ensure the best result for my COVID-19 test?

There are no preparations needed for a test. You have to be referred by your Organization for testing, and you will need to provide information on the presence of any symptoms (such as fever, cough or fatigue) and if you have been in contact with a person who has been confirmed to have COVID-19.

14. What will be tested, blood, saliva or something else?

Diagnostic tests for COVID-19 use nasopharyngeal or oropharyngeal swabs for the detection of the virus. Blood tests are available but these tests detect the presence of antibodies to COVID-19 that develop weeks after an initial infection and cannot be used to determine if a person has an active infection. IOM only performs testing for the virus on nasopharyngeal swabs.

15. Who will take the sample? How is it done? Can I bring a sample from my relative to the IOM laboratory?

The nasopharyngeal swab will be collected by a trained nurse or a laboratory technician. To collect the sample, a swab is inserted into a person’s nostril and rotated to collect a sample from the back of the throat’. The swab will then be inserted into tube with liquid to preserve the sample until it is received in the laboratory for testing. All persons including relatives of UN staff requiring a COVID-19 test must have the sample collected by an IOM health-care worker.

16. How long will it take to get the results?

On average, and depending on local demand, test results should be available within 24 hours of your sample being collected.

17. Does a negative result mean I don’t have COVID-19?

A negative result does not exclude an active infection with COVID-19. False negative results can sometimes occur if a person is tested when they are in the early stages of infection and before the appearance of symptoms.

18. What if I have a negative result, but have symptoms?

A negative COVID-19 result obtained from a person with symptoms could indicate an infection with another respiratory virus such as seasonal influenza. In some cases, if the symptoms persist, your doctor may decide to re-test you for COVID-19. You should follow your doctor’s advice regarding the need for self-isolation and treatment.

19. I heard about tests which can give results very quickly, within 15 minutes. Can I have such a test?

There are rapid diagnostic tests (known as “RDTs”) that detect either COVID-19 antigens or IgG and IgM antibodies.  The tests which detect antibodies are not recommended by the World Health Organization for diagnosis of active infections as the immunological response to COVID-19 infection may take weeks to develop. The diagnostic accuracy of antigen tests is currently lower than of molecular tests used at IOM. IOM does not offer RDTs.

20. After testing positive for COVID-19, I’m being asked to provide information on where I’ve been and whom I’ve met in the past few days. Why?

A big part of outbreak response is the ability of public health actors to trace back the steps and contacts of the people who test positive for the disease. This is called “contact tracing”. Rest assured: the information is kept strictly confidential and is used only to warn contacts of their possible risk of infection so they can monitor any potential symptoms and self-isolate for a pre-determined amount of time to avoid further transmission.

Where IOM is responsible for contact tracing, direct contacts of COVID-19 will be followed up on and managed by an IOM clinician.  Information about contacts may be communicated to local public health authorities, as per local mandates on public health notifications. All cases will be required to provide informed consent to receive care by IOM.

The contact will be medically cleared if there are no symptoms of COVID-19 after 14 days. If symptoms do develop, the contact will be recommended COVID-19 testing, and will be managed as a COVID-19 case accordingly.

21. Will I be asked to pay for my COVID-19 test?

The cost of the test, when performed for clinical reasons (symptomatic persons,  contacts of COVID-19-confirmed patients or persons in quarantine for any reasons) is covered via cost sharing arrangements by participating UN agencies (“UN funding”) at dedicated locations. These UN central cost sharing arrangements have been put in place until 31 December 2020 for countries as listed in the Table 1 while local cost sharing arrangements might be in place in other countries as agreed between IOM and the UNCT. In such cases, you will not be asked to pay a fee. In case of doubt, please contact your Organization to gain further confirmation on whether there are existing arrangements at your duty station.

However, if the test is performed for non-clinical purposes, for example for travel, you will need to pay a fee and will receive a payment receipt and might be able to request reimbursement form your Organization through the usual channels (travel expense claim or insurance) in line with the guidelines provided by your Organization.

22. Who will receive the test result?

The test result will be communicated to you and, if the testing is done for clinical purposes, to the referring physician.

23. What do I do if my test is positive?

If you have a positive result and if your condition is stable you will be required to self-isolate for 10 days after the onset of symptoms and for at least another three days without fever or respiratory symptoms. If your condition is unstable, you may need to be hospitalized.

24. Will I be eligible for other IOM services if my COVID-19 test result is positive?

If IOM provides clinical services in addition to testing in your country, you may be eligible for them; otherwise, you will need to use other UN or local health-care services.

ISOLATION AND QUARANTINE AT AN IOM FACILITY

25. What is the difference between isolation and quarantine?

Isolation separates sick people with a contagious disease from people who are not sick. For example, persons who were tested positive for COVID-19 or those who have symptoms strongly suggestive of COVID-19 should be isolated for at least 10 days (it can be more!). Quarantine separates and restricts the movement of people who were exposed to a contagious disease to see if they become sick. For example, persons who were in contact with COVID-19 patient and who have no symptoms should be quarantined for 14 days. Sometimes, local laws and regulation impose quarantine for persons entering the country.

26. In which countries does IOM run isolation and quarantine facilities?

Please consult the country-specific guides available on this page. 

27. There are no IOM isolation and quarantine facilities in my country, where can I be isolated or quarantined?

In many cases, isolation and quarantine are implemented at home. In some countries, the government requires isolation or quarantine in specially designated facilities, such as hospitals or designated hotels. In other countries, quarantine and isolation facilities may have been established and run by the UN. Please contact your Occupational Health Unit for information.

28. If I go into the IOM facility for quarantine and isolation, how will I be able to get food, medication and hygiene supplies?

IOM will provide food, medication and a hygiene kit.

29. Can I be visited by relatives, colleagues and friends in isolation?

You will not be able to have a direct contact with your relatives, colleagues and friends. Please use electronic means of communications. Access to the facility will be restricted to IOM staff and caterers. The purpose of this is to prevent COVID-19 transmission.

30. If my dependent child is placed in isolation, can I accompany them?

Yes, you will be able to accompany your child or another dependent family member.

31. Will there be medical staff 24 hours 7 days a week at the facility? Will I be treated?

Just like at home, there will not be a medical staff present at all times, but IOM medical staff will contact you daily, or more frequently if needed, and visit you if in-person medical assessment is needed. There will be a 24-hour hotline as well as non-medical staff, which will allow you to get in touch with an IOM health professional at any time. The monitoring will follow the same principles as “In-home Monitoring”. The IOM clinicians will define the need the treatment for COVID-19 or other conditions and provide treatment if needed.

SAFETY

32. How does IOM make sure that the IOM staff providing these medical services are competent?

IOM has extensive experience in providing high-quality health services to migrants and displaced persons worldwide, stringent clinical governance, in strict adherence to global guidelines and standards of care, up-to-date licensing, constant trainings delivered to its staff. For “First Line of Defence”, the same stringent standards are applied and additional health staff credentialing and SOPs, all of which submitted to endorsement at the global level, are required.

33. How does IOM ensure that there is no COVID-19 transmission in its facilities?

IOM implements the most stringent infection prevention and control measures with tightly developed and observed protocols, which must be implemented by all patients and staff while within IOM health facilities. All infection prevention and control guidelines are in line with WHO’s recommendations and staff are regularly provided with training to ensure skills are up-to-date with latest requirements.

COST

34. Is there a fee for using IOM’s FLoD-related health services?

The majority of services are covered by a cost-sharing mechanism among UN agencies either via central funding or via local cost sharing arrangements (“UN funding”). However, some services that may be provided for non-clinical reasons (e.g. testing for travel) are not covered by the UN funding and will be provided on the fee-for-service basis. In addition, if you are referred for an investigation or specialist consultation outside of IOM, the patient will need to pay for those services and seek reimbursement through his/her usual insurance scheme.

DATA PROTECTION

35. Is my medical data going to be shared with my senior management?

Your medical data will not be shared with your senior management.

36. How is my medical data going to be handled and protected?

Your personal data, including health data and medical records, will be processed in accordance with IOM’s Data Protection Principles. If you agree to the provision of health services to you by IOM, you will be requested to read, understand and sign a consent form. Once you sign the consent form, your personal data will be:

processed by IOM for the purpose of providing health services,
disclosed only for that purpose (including to enable continuity of care, if required by your medical condition with entities external to IOM, providing health care, such as laboratories, external treating physicians and health-care facilities, and providing medical evacuation, such as by the United Nations)
shared with the UN Medical Director and the national public health authorities of the duty station, if you meet the criteria for probable or confirmed COVID-19 case, and if required by UN regulations or a national legislation.  
de-identified and aggregated for the purposes of analysis to inform policy and/or for programme evaluation.

IOM will take all reasonable and necessary precautions to preserve the confidentiality of your personal data and it process only the minimum data necessary to fulfill the purpose of providing health services.

FEEDBACK

37. How can I provide feedback on the services provided?

IOM strives to provide the highest level of care and is grateful for any feedback to improve service delivery.

To provide feedback, you can contact: [email protected]