Refugee & Migrant Health

Requires Standards 1–7 verified first

10 criteria

ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Blocks accreditation until resolved.

REFERENCES

1. [111] World Health Organization. Refugee and Migrant Health: Global Competency Standards for Health Workers. Geneva: WHO; 2021 — Competency Standard 3 states health workers have a responsibility not to engage minors to facilitate interpretation, given the associated significant risk, and identifies inaccuracy, information distortion, and compromised confidentiality as documented risks of family-member interpretation generally.

Family members interpreting, especially minors, carries real, well-documented risks — inaccurate interpretation, withheld or distorted information, compromised confidentiality, and trauma to the family member themselves. This is one of the clearest, most specific safeguards in the entire WHO framework, and it exists because the alternative genuinely and measurably harms patients.

1 Trained interpreters are used for major appointments but family members fill in for quick or informal interactions.

Risk doesn't scale down proportionally with how brief or informal an interaction feels.

2 The no-minors rule is understood by senior staff but not consistently reinforced with newer or part-time staff.

A critical safeguard needs to be embedded in onboarding, not assumed as common knowledge.

3 Interpreter access exists during clinic hours but reverts to family members for same-day or urgent visits.

Coverage gaps at specific times undermine an otherwise sound policy.

Week 1 Review recent language-discordant consultations for interpreter engagement patterns.

Week 2 Establish or reinforce trained interpreter access, including for same-day and urgent visits.

Week 3 Brief all staff explicitly and unambiguously that minors are never used to interpret.

Ongoing Audit family-member interpretation instances to confirm they're confined to genuinely low-risk situations.

Ask the minor-interpreter question directly and expect an immediate, confident answer.

Any hesitation on this specific point is a serious signal worth investigating further.

Check interpreter coverage specifically for same-day or urgent appointments.

This is where the policy is most likely to quietly lapse.

ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Blocks accreditation until resolved.

REFERENCES

1. [112] WHO Competency Standard 1 (Refugee and Migrant Health: Global Competency Standards for Health Workers, 2021) requires health workers to adapt practice to migration and displacement experiences, address trauma-informed care and psychosocial needs, and support continuity of care regardless of legal status.

A refugee or migrant patient's health needs and vulnerabilities are shaped by what happened before they ever reached this facility — in their country of origin, in transit, and on arrival. Care that ignores this context, treating every patient as though their history began at the clinic door, misses real, clinically relevant information and can retraumatise someone who has already experienced significant hardship.

1 Adaptation happens for patients who disclose their history but isn't proactively considered otherwise.

Not every patient will volunteer this history unprompted, even when it is clinically relevant.

2 Staff are aware of the principle but haven't received specific training on applying it.

General awareness doesn't reliably translate into genuine practice adaptation without specific training.

3 Continuity of care support exists for patients with stable documentation but not those without it.

Documentation instability is itself a common feature of this population's situation, not an exception to plan around.

Week 1 Review current practice for genuine adaptation to migration and displacement history.

Week 2 Train staff specifically on trauma-informed, migration-adapted practice.

Week 3 Build awareness of legal-status access barriers into standard practice.

Ongoing Review practice adaptation periodically using real case examples.

Ask staff to describe a specific example of adapting care for a patient's migration history.

A real, specific example reveals genuine practice, not familiarity with the principle.

Ask about continuity of care support specifically for patients without stable documentation.

This is where genuine adaptation is most tested.

ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Blocks accreditation until resolved.

REFERENCES

1. [113] WHO Competency Standards 2 and 4 (Refugee and Migrant Health: Global Competency Standards for Health Workers, 2021) require health workers to assess and support health system literacy as distinct from condition-specific understanding, and to actively verify genuine understanding through methods such as teach-back rather than assuming comprehension from silence.

For a refugee or migrant patient, understanding an unfamiliar health system can matter as much for long-term health as any single treatment decision, and a patient who nods along without genuinely understanding — particularly through the added layer of interpretation — can leave with a dangerously incomplete picture of both their care and how to access it again.

1 Teach-back is used for major treatment decisions but not extended to booking or navigation information.

Understanding how to actually use the clinic matters as much as understanding the immediate care plan.

2 Navigation support is given verbally but not reinforced with anything the patient can review later.

Complex information delivered once, verbally, under stress is easily forgotten.

3 Staff assume system literacy for patients who have visited before, missing gaps that may still exist.

Prior visits don't reliably correlate with genuine system understanding.

Week 1 Observe current practice for both understanding-verification and navigation support.

Week 2 Train staff on teach-back technique and develop translated navigation guidance.

Week 3 Brief staff to proactively cover navigation alongside the immediate clinical matter.

Ongoing Spot-check patient understanding of both care and navigation periodically.

Observe an actual consultation if possible, watching specifically for teach-back covering both care and navigation.

This is a practice that is easy to describe in policy and easy to skip under time pressure.

Ask a patient directly what they understand about booking again or reaching the clinic urgently.

This tests actual system literacy, not just satisfaction with the immediate visit.

ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Requires improvement plan.

REFERENCES

1. [114] WHO Competency Standard 5 requires engagement with broader social and community support services and effective handover of care that specifically includes cultural, language, and migration- and displacement-related considerations.

Housing, legal status, and social support don't just sit alongside a refugee or migrant patient's health — they actively shape it. A facility that treats health in isolation from these factors, or that fails to hand over migration-related context to the next provider in a patient's care, misses information a purely clinical view wouldn't capture.

1 Engagement happens with legal services but not consistently with housing or employment support.

Each of these factors can independently and significantly affect a patient's health.

2 Handover includes clinical information but omits migration-related context that shaped the care given.

The next provider benefits from the same contextual understanding this facility relied on.

3 Staff know general categories of support exist but not specific, current local contacts.

Specific, current knowledge is what makes a referral actually actionable for the patient.

Week 1 Map current engagement with relevant social support services.

Week 2 Establish or strengthen specific, current local service contacts.

Week 3 Build migration-related context into standard handover documentation.

Ongoing Refresh knowledge of local services periodically as availability changes.

Ask staff to name a specific local service they would refer a patient to, not a general category.

Specificity reveals genuine, current knowledge rather than assumed awareness.

Review a real handover document for migration-related context inclusion.

A real example reveals whether this happens in practice, not just in policy.

ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Requires improvement plan.

REFERENCES

1. [115] WHO Competency Standard 7 requires health workers to use evidence-informed guidelines specific to refugee and migrant health where they exist, recognise where the health needs of this population differ from the general population, and identify where evidence gaps remain.

Refugee and migrant health needs genuinely differ from the general population in ways that matter clinically — different disease prevalence patterns, different exposure histories, different care-seeking barriers. Care that ignores this and applies general guidelines uncritically can miss real, evidence-based adjustments this specific population needs.

1 Awareness exists for well-known differences but not for more specific or recent evidence.

Evidence in this area continues to develop, and awareness needs to stay genuinely current.

2 Guidelines are known but not consistently applied under time pressure.

Consistent application under real conditions is what gives awareness genuine protective value.

3 Evidence gaps are acknowledged but staff default to general population assumptions rather than flagging genuine uncertainty.

Recognising a genuine gap honestly is different from silently defaulting to a possibly inapplicable assumption.

Week 1 Review current awareness of population-specific evidence-informed guidelines.

Week 2 Establish access to current, relevant guidelines for staff.

Week 3 Train staff on specific, genuine population differences relevant to practice.

Ongoing Refresh awareness as evidence in this area develops.

Ask staff for a specific example of a practice adaptation based on population-specific evidence.

A real example reveals genuine application, not just familiarity with the concept.

Ask how staff would handle a genuine evidence gap for this population.

A thoughtful, honest answer reveals genuine engagement rather than a default assumption.

ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Blocks accreditation until resolved.

REFERENCES

1. [116] WHO Competency Standards 8 and 9 (Refugee and Migrant Health: Global Competency Standards for Health Workers, 2021) require health workers to maintain structured awareness of their own biases and institutional discrimination's impact, and to engage in self-care within a supportive team environment addressing the wellbeing impacts of migration-context care.

Unacknowledged bias shapes clinical judgement in ways that are genuinely hard to see from the inside, and staff providing this care are regularly exposed, secondhand, to accounts of hardship and trauma — both are real, documented occupational realities of this work, and both require structured, deliberate support rather than being left to individual capacity alone.

1 Reflective practice happens informally among some staff but is not structured or clinic-wide.

Individual good practice does not reliably generalise without a defined, shared process.

2 Support exists but staff are unaware it is available or feel discouraged from using it.

A benefit's existence does not guarantee genuine, comfortable access to it.

3 Difficult cases are discussed informally but there's no routine, structured opportunity for it.

Vicarious trauma often builds cumulatively, and a structured, regular opportunity provides more reliable support than informal conversation alone.

Week 1 Review current training content and support access for genuine coverage of bias and staff wellbeing.

Week 2 Establish a structured reflective practice process and a real space to discuss difficult cases.

Week 3 Deliver specific training on institutional discrimination and normalise use of available support.

Ongoing Revisit reflective practice and staff wellbeing periodically, using real case examples where appropriate.

Ask for a specific personal example, not a general statement of awareness.

A concrete instance distinguishes genuine reflective practice from familiarity with the concept.

Ask staff directly whether they have used available support, not just whether it exists.

Genuine uptake, not nominal availability, is the real test.

ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Requires improvement plan.

REFERENCES

1. [117] WHO's Competency Standards explicitly distinguish these legal status categories throughout, noting that access to health care and legal entitlements vary meaningfully by status and by country, and that health workers need specific awareness of this rather than a single generalised assumption.

Asylum seeker, recognised refugee, stateless person, and internally displaced person are not interchangeable categories — they carry genuinely different legal access rights in different countries, and treating them as one undifferentiated group risks either wrongly denying care someone is entitled to, or missing a specific vulnerability tied to a particular status.

1 Staff can name the most common category served but not less frequent ones the facility still encounters.

Even infrequent categories deserve genuine, specific awareness, not the risk of misapplied assumptions.

2 Differentiation exists in policy but isn't consistently applied by all staff in practice.

A policy that exists on paper needs consistent application to provide real protection.

3 A verification process exists but staff are inconsistently confident applying it.

A process needs genuine staff familiarity to function reliably under real conditions.

Week 1 Review current staff awareness of the specific legal status categories actually served.

Week 2 Build specific, differentiated access guidance for each relevant status category.

Week 3 Establish a clear verification process for genuinely unclear status.

Ongoing Refresh staff awareness periodically, particularly for less frequently encountered categories.

Ask staff to name every specific legal status category the facility has served recently.

Specificity reveals genuine, current awareness rather than a general assumption.

Ask what happens when a patient's specific status is genuinely unclear.

A confident, specific answer reveals a genuine process, not improvisation.

ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Blocks accreditation until resolved.

REFERENCES

1. [118] Equal standard of care and documentation regardless of immigration or legal status, without differential record-keeping practice, is established practice in international guidance on healthcare access for migrant and refugee populations.

A patient who fears that seeking care will expose their immigration status to consequences may delay or avoid care entirely, and any indication that this facility applies a different standard based on status only reinforces that fear — genuine equal treatment, documented the same way for everyone, is what makes care genuinely accessible to this population.

1 The principle is understood by clinical staff but not consistently by administrative or front-desk staff.

A patient's first interaction is often with administrative staff, where the same principle needs to hold.

2 Care is consistent but documentation habits vary informally based on individual staff assumptions.

Consistency needs to extend to documentation practice specifically, not only the clinical care itself.

3 The principle is followed but has never been specifically, formally trained.

Informal understanding is less reliable than specific, documented training, particularly as staff turn over.

Week 1 Review current practice for any differential treatment based on status.

Week 2 Establish specific staff training on this principle, covering all staff, not only clinical roles.

Week 3 Confirm documentation practice is genuinely consistent regardless of status.

Ongoing Reinforce training periodically, particularly for new staff.

Ask administrative and front-desk staff, not only clinicians, about this principle.

This reveals whether the principle genuinely extends beyond clinical staff.

Ask how patient status information, where it becomes known, is protected.

A specific, confident answer reveals genuine practice, not just a stated value.

ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Requires improvement plan.

REFERENCES

1. [119] WHO's explanatory notes for Competency Standard 1 specifically identify patient-held records — paper or electronic — updated regularly, as a key strategy for improving continuity of care given the mobility of refugee and migrant populations.

A refugee or migrant patient's mobility isn't a hypothetical edge case — it's a defining feature of the population this standard exists to serve. A record that only exists inside one facility's own system provides no protection the moment that patient needs care somewhere else, which for this population is often exactly when it matters most.

1 A patient-held record is provided for major events but not updated for routine visits.

Continuity depends on the record reflecting the patient's actual, current health picture.

2 The record exists in paper form but isn't offered in electronic form for patients who would prefer it.

Different patients have different genuine needs for how they carry their own information.

3 Staff support the concept but aren't consistent about actually updating the record at each visit.

Consistent updating is what gives the record real, ongoing protective value.

Week 1 Review current practice for patient-held record support and update consistency.

Week 2 Establish a standard, portable record format and offer both paper and electronic options.

Week 3 Brief staff to update the patient-held record consistently at every relevant visit.

Ongoing Audit record currency for a sample of patients holding one.

Ask to see an actual patient-held record and check how recently it was updated.

A specific, dated record is the real evidence of genuine, ongoing support.

Ask whether the record format would make sense to a clinician at a different facility.

This tests genuine portability, not just internal usefulness.

ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Requires improvement plan.

REFERENCES

1. [120] Follow-up systems accounting for housing and contact instability, distinct from standard address-and-phone-based recall systems, are established practice for maintaining continuity of care with transient and displaced patient populations.

Standard follow-up systems are typically built assuming a stable address and phone number, and a refugee or migrant patient experiencing housing instability can be entirely invisible to a system built on that assumption — not because the patient doesn't need follow-up, but because the system has no way to reach them.

1 An alternative pathway exists but isn't consistently offered or explained to patients likely to need it.

An unexplained option functions similarly to no option for patients who don't know to ask.

2 Failed contact is sometimes noticed informally but isn't systematically flagged.

Systematic flagging catches gaps individual staff attention alone can miss.

3 A community organization relationship exists but hasn't been used recently, so its current functioning is unverified.

An untested relationship may not translate smoothly into real use when actually needed.

Week 1 Review current follow-up system for how it handles unstable contact information.

Week 2 Establish a genuine alternative pathway, including community organization relationships where relevant.

Week 3 Build active failed-contact identification into the tracking system.

Ongoing Confirm alternative pathways remain genuinely functional through periodic real use.

Ask for a real, recent example of the alternative pathway being used successfully.

A real example reveals whether this is genuine practice, not a theoretical option.

Ask how the system would notice if a standard follow-up call simply failed to connect.

A specific, confident answer reveals genuine active tracking, not passive assumption of success.