Health & Migration

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. [36] 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 clinic — in their country of origin, in transit, and on arrival — and for a clinic that may be this patient's very first contact with a new health system, care that ignores this context misses real, clinically relevant information from the outset.

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 Adaptation is strong for the first visit but isn't sustained as the patient continues in ongoing primary care.

An ongoing relationship depends on this understanding genuinely persisting, not fading after the initial encounter.

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 Revisit adaptation as the ongoing patient relationship develops.

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. [37] 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 whose primary health clinic may be their first genuine contact with an entirely new health system, understanding how that system actually works matters as much as understanding any single care decision — a patient who nods along without genuinely understanding can carry that incomplete picture into every future encounter across the entire system.

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

Understanding how to actually use the system matters as much as understanding the immediate care plan, especially for a first-contact patient.

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

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

3 Staff assume system literacy for patients registered for a while, missing gaps that may still exist.

Length of registration does not reliably correlate with genuine system understanding.

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

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

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

Ongoing Spot-check patient understanding of both care and system 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 accessing care again, including if they relocate.

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

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

REFERENCES

1. [38] WHO Competency Standard 3 explicitly 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 the physician but not consistently reinforced with the limited support staff available.

A critical safeguard needs to be embedded across the whole small team, not held only by the physician.

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 reliable access to professional interpretation, including remote or telephone options where in-person isn't feasible.

Week 3 Brief all staff, however few, on the firm exclusion of children as interpreters, without exception.

Ongoing Audit interpreter use records for consistency.

Ask staff directly whether a child has ever interpreted for a parent here.

A direct question often surfaces what a general policy question won't.

Observe an actual encounter with a limited-proficiency patient if timing allows.

Direct observation reveals whether professional interpretation is genuine practice, not just stated policy.

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

REFERENCES

1. [39] 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, and a practice that treats health in isolation from these factors, or that fails to hand over migration-related context when referring elsewhere, 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 Referral to specialist care includes clinical information but omits migration-related context that shaped the initial presentation.

The receiving provider benefits from the same contextual understanding this practice 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 referral and 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 referral 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 Blocks accreditation until resolved.

REFERENCES

1. [40] Refugees are consistently described as facing a documented "triple burden" of infectious disease, non-communicable disease, and mental health issues, with integrated multi-disease screening at first primary care contact shown to achieve better uptake and feasibility than single-disease screening approaches, despite most health systems still lacking systematic implementation.

Refugees and migrants are consistently, disproportionately affected by infectious disease, non-communicable disease, and mental health difficulty simultaneously, and evidence specifically shows integrated, multi-condition screening at first contact achieves meaningfully better uptake than single-disease screening — yet most systems still fail to implement this systematically, leaving genuine, documented needs unidentified at exactly the point they could first be caught.

1 Infectious disease and vaccination screening are thorough but mental health screening is less consistently included.

Mental health is a genuine, documented part of the triple burden, not a secondary consideration.

2 The assessment is comprehensive when time allows but abbreviated during busy periods.

A newly arrived patient's genuine need for this assessment doesn't diminish because the clinic is busy that day.

3 Screening happens but isn't specifically adapted to the patient's actual country of origin and risk profile.

Genuine risk-appropriate screening reflects the patient's real background, not a generic checklist.

Week 1 Review current initial assessment practice for genuine coverage of all three triple-burden dimensions.

Week 2 Build a structured, comprehensive initial assessment protocol including vaccination review.

Week 3 Train staff on country-of-origin-appropriate risk screening.

Ongoing Audit initial assessment completeness for newly registered patients.

Ask to see a specific, real initial assessment and check for genuine coverage of all three dimensions.

A real, specific example reveals whether this is genuine practice, not policy language.

Ask how the assessment is adapted for a patient's specific country of origin.

A specific, informed answer reveals genuine, risk-appropriate practice, not a generic checklist.

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

REFERENCES

1. [41] 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, and 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. [42] 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, even in a very small practice.

1 Reflective practice happens informally but is not structured into any genuine, regular process.

Individual good practice does not reliably generalise without a defined, shared process, even at small scale.

2 Support exists but is genuinely difficult to access given the demands of a very small practice.

A benefit's existence does not guarantee genuine, comfortable access to it, particularly for a solo practitioner.

3 Support exists for acute incidents but not for the cumulative emotional weight of this work over time.

Cumulative impact deserves the same genuine support as acute incidents.

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 feasible for the practice's actual size.

Week 3 Identify genuine, accessible psychological support options appropriate to solo or small practice.

Ongoing Revisit reflective practice and 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 directly whether support has been used, 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. [43] Continuity of care as genuine infrastructure, distinct from an assumption that relocation automatically ends the possibility of continuity, is established practice for protecting health outcomes in mobile and displaced populations specifically.

Refugee and migrant populations move more frequently than the general population, often for reasons entirely outside their control, and this document's whole foundation rests on genuine continuity of care — a practice that treats relocation as simply ending that continuity, rather than actively supporting it across the move, abandons exactly the patients most likely to need it preserved.

1 A summary is provided but isn't updated close to the point of relocation, so it quickly becomes outdated.

A summary's real value depends on reflecting the patient's genuinely current status at the time they carry it forward.

2 Handover is attempted when the new provider is known well in advance but not for sudden, unplanned relocations.

Sudden relocation doesn't reduce a patient's genuine need for continuity support.

3 Support exists in principle but staff aren't confident in how to actually provide a portable summary in practice.

A principle without practical, confident execution provides limited real protection.

Week 1 Review current practice for genuine continuity support versus assumed end at relocation.

Week 2 Establish a standard, portable patient-held summary format.

Week 3 Train staff on attempting genuine handover when a new provider becomes known.

Ongoing Confirm summaries are updated close to the actual point of relocation.

Ask for a real, recent example of continuity support provided to a relocating patient.

A real example reveals whether this is genuine practice, not an assumed impossibility.

Ask to see an actual patient-held summary and check how current it genuinely is.

A specific, current document is the real evidence of genuine support, not a stale or theoretical one.

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

REFERENCES

1. [44] 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, and stateless 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 practice still encounters.

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

2 Differentiation exists in the physician's own understanding but isn't shared with the wider practice team.

Every staff member interacting with patients benefits from the same genuine understanding.

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 practice 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. [45] 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 practice applies a different standard based on status only reinforces that fear — genuine equal treatment, documented the same way for everyone, is what makes primary care genuinely accessible to this population.

1 The principle is understood by the physician but not consistently by administrative or reception 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 staff, not only the physician, 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.