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Guidelines for Visiting Medical Specialists (VMS)

4.    Guidelines for Visiting Medical Specialists

(Component two)

4.1 Background

In the past the majority of MTS funds have been used for the treatment of patients in New Zealand.  However treating patients in New Zealand is an expensive approach and severely limits the number of patients able to be treated from limited bilateral MTS allocations.  Treating patients in New Zealand also provides few opportunities for the MTS to contribute to capacity building of local medical, nursing and other support staff.  There are many situations where consultations, clinical assessments and operations can be carried out more cost effectively by Visiting Medical Specialist teams.  These teams can also support capacity building of local medical and nursing staff. The past 4 years has seen an increasing utilization of funds in VMS type activities in most countries.

VMS teams can comprise any type of registered health professional including medical and nurse specialists and other technical health personnel e.g. anaesthetic technicians. It is important to view Visiting Medical Specialist Teams in its broadest context to allow for the opportunity to support the development of capacity building in-country as well as providing capacity supplementation where necessary, e.g. through provision of locums. In addition, the programme may also be utilized for providing locum relief cover where a country may suddenly be without a particular type of health professional. For example where a sole surgeon in a country is unavailable to work a locum surgeon may be funded under the programme.

4.2 Goals and Objectives for Visiting Clinical Specialist teams

The objectives for Visiting Medical Specialists are:

  1. To assess and, where appropriate, provide treatment for identified individuals where not normally available in-country
  2. To maximize opportunities for capacity building through a range of modalities from mentoring  and on-the-job-training to structured training such as seminars for groups such as medical, nursing and allied health staff.

The intention of the programme is to ensure maximum flexibility so that countries may utilize this mechanism for on-going capacity development as well as the provision of expert clinical services.

The VMS fund may be used for the provision of specialist medical supplies and consumables for the patient, where necessary for patient treatment where this becomes more cost effective than referring a patient overseas or sending a specialist to the country. Examples of this include but are not limited to the provision of shunts, PIC lines etc. It may be utilised to support new skills acquired by clinicians through capacity building activities. It does not include the acquisition of permanent assets for the hospital such as a dialysis machine.

4.3 MTS Stakeholders: roles and responsibilities of stakeholders in the organisation of visiting medical specialist visits

4.3.1 Participating Country Overseas Referral Committee

The Overseas Referral Committee will:

  • identify needs for VMS visits taking into account the programmes of other agencies and donors providing assistance for secondary and tertiary health care
  • consult  with the MSC to develop an annual programme of VMS visits
  • provide a written request signed by the Chairperson of the Overseas Referral Committee for the programme of visits, or alternatively for  each visit,  to the MSC  for approval
  • Agree TOR with the MSC for each team including the purpose, scope, expected outputs and outcomes, risks and how they will be managed, resources, timing and team membership. The TOR should be attached to the VMS visit reports sent to MFAT
  • Determine the dates for the visit.
  • Identify the country contribution e.g. transport for teams, availability of staff, facilities and equipment etc.
  • Identify a clinical point of contact for the team. This will most likely be the clinical head of the services under which the visit will be operating
  • prepare for the visit ensuring attention is given to availability of staff, facilities and equipment, ensuring information about the visit is communicated throughout the health system (including in outer islands and rural areas),
  • ensure pre-assessments and patient selection
  • where necessary ensuring appropriate follow-up care is available
  • ensure relevant staff are available to participate in structured and/or on-the job training provided by the VMS team
  • participate in a debriefing with the VMS team at the end of each visit
  • Ensure systems/procedures are in place to maintain records of patients treated by VMS teams and report annually on patient outcomes.


4.3.2. New Zealand-based Management of the VMS

The MSC will, with each Overseas Referral Committee and relevant senior clinical staff:

Identify and agree on opportunities for provision of VMS individuals and teams to provide treatment and build local capacity. These visits should:

  • reflect the current health priorities 'in country',
  • be consistent with health planning priorities,
  • reflect in-country capacity to manage complications should they arise post-visit, and
  • Reflect coordination with other regional capacity building mechanisms and approaches.
  • Provide an opportunity for Pacific trainees to be attached to Visiting Clinical teams to continue links with home countries and to extend skills and experience.
  • Develop an indicative annual programme and budget for VMS teams detailing the composition of the team and logistical requirements such as accommodation, internal flights, medical supplies and consumables.
  • identify suitable personnel to participate in VMS teams attempting to build a consistent pool of Visiting Medical Specialists who will provide on-going mentoring to participating country health personnel
  • make pro-active efforts to involve women and Pacific health professionals resident in New Zealand and the region in Visiting Clinical Specialist teams and where appropriate involve Pacific resident specialists and trainees at all levels of training, in teams to other Pacific countries.
  • ensure all members of visiting teams:
  • Have current practicing certificates that meet country requirements. These must be sighted and copied by the MSC. It is the responsibility of the MSC to ensure this requirement is met.
  • have annual letters of good standing from professional bodies of which they are members
  • Have professional indemnity cover and have appropriate arrangements in place for Accident Compensation cover.
  • Make appropriate arrangements for visits (or training attachments) in consultation with the relevant country official(s). This includes organizing flights, payment of per diems etc.
  • Ensure that the participating country host organisation is ready and organised to receive the VMS team and that the local organisation is in place.
  • Inform MFAT and the relevant Aid Programme Post at least 1 month before any proposed VMS visit. Cooperate with any requests from Aid Programme Posts for publicity for the visit.
  • provide visiting teams with the agreed TOR detailing what is expected from the visit in relation to assessment, treatment, formal and on-the-job training, the budget available and reporting required
  • brief teams on 'in country' facilities and conditions and any cultural constraints or sensitivities
  • Provide a letter of engagement for each member of the team outlining the TOR including requirements for reporting, providing documentation and what is included for the visit.
  • reimburse VMS teams, in accordance with agreed payment schedules, on completion of their assignment and receipt of a satisfactory report
  • Analyse any recommendation in VMS team reports and decide on the appropriate response for each recommendation.  Ensure that MSC responses are included in 6 monthly reports to MFAT.
  • report annually on outcomes, trends, issues relating to the VMS scheme
  • advocate for VMS as a cost-effective option


4.3.3    Role of VMS teams

The MSC will ensure the VMS teams will:

  • In consultation with the MSC and relevant local medical and nursing staff, ensure that necessary pre-assessments have been carried out and facilities and equipment are adequate and appropriate to undertake the treatment required. Also ensure that follow-up care and medication will be available
  • arrange provision of any specialized equipment/materials required for treatment not available in-country
  • assess patients identified in pre assessments to ensure they are able to be treated in-country safely (including the provision of appropriate after-care)
  • prioritise and undertake treatment of patients within the time and resources available
  • advise local medical/nursing staff on follow-up care of patients treated and future medical options/care of those patients unable to be treated
  • In consultation with the relevant local medical, nursing and MOH staff, identify relevant staff to be involved in both structured training and on-the-job training.  This could include placements in New Zealand, Fiji (region) and Australia (Note: funding for any such placement will not come from the New Zealand- funded VMS budgets)
  • Plan and undertake seminars/workshops for identified staff. These should be available for the broadest range of health staff possible
  • Involve relevant medical and nursing staff to as great an extent as possible in on-the job training in out-patient clinics, consultations, surgical procedures, post-operative care etc.

Where appropriate, identify key individuals who might benefit from additional training/mentoring/.professional development and suggest how this might be addressed. Recommendations regarding capacity development or training must be discussed with the MSC and committee. No undertaking should be given to trainees prior to a discussion being held. VMS Team Reporting

The VMS team leader will:

  • ensure that data on patients treated, activities undertaken, and immediate patient outcomes including any adverse outcomes are collected to enable completion of a team visit report
  • at the completion of the visit, undertake a debriefing meeting with members of the Overseas Referral Committee and other relevant MOH, medical and other health sector specialists to discuss outcomes of the visit, any issues arising and recommendations for future visits  dedicate ½ day for debriefing and planning
  • provide a report (to the MSC and Overseas Referral Committee Chairperson within 1 month of completion of the assignment)
  • Provide any feedback and comments to the MSC which would assist in future visits.


4.4 Costs covered under VMS team regulations

Costs that can be covered include:

  • Travel costs, to be purchased by the individual and reimbursed or by the MSC at the lowest return economy fare available
  • Taxi costs and where necessary rental car costs are covered with reimbursement on production of a valid tax invoice and receipt
  • Travel insurance and insurance for any specialist equipment is also paid by production of an appropriate GST invoice and receipt
  • Per diems are paid at the published rate on the MFAT New Zealand Aid Programme website for the appropriate period. Per diems will cover accommodation, meals and incidentals.
  • Where an individual chooses to stay in local accommodation i.e. at a private home/accommodation a daily rate is payable which will include an allowance for a contribution to accommodation costs, meals and incidentals. This rate is available on application to the MFAT New Zealand Aid Programme by the MSC
  • A daily allowance may be paid to members of Visiting Specialist teams. The allowance should be agreed between the Visiting Specialists and the MSC before visits.  The amount will vary between countries and must be approved by the in country Overseas Referral Committee. Days spent in country i.e. during weekends or public holidays are not eligible for an allowance. Maximum Allowance rates are agreed periodically between the MSC and MFAT.
  • An allocation per team is available for equipment and supplies. This is reimbursed on production of a GST invoice.

NOTE: Allowances are payable on production of all required receipts and documentation including completed reports in the template required.

Team members are required to provide all documentation as required. This will include boarding passes and copies of hotel bills etc.

4.5 Procedures for VMS visits part funded by MFAT.

MFAT recognizes that a range of donors and organisations provide visiting team services. Where there are identified benefits in VMS visits being undertaken in collaboration with another provider and partly funded by MFAT, joint funding may occur for Visiting Teams. For instance, AusAID partially funds the visits through the PIP[2] programme and the MTS has contributed, where requested by the country, to funding valves for procedures

When these are undertaken, all the requirements of a fully funded specialist team visit must be followed. This should include

  • A jointly agreed Terms of Reference (TOR) which meets the TOR requirements below and contains a clear statement about:
  • The particular activity to be funded by each of the funding agencies. E.g. consumables, personnel, support costs etc.
  • It must be clear who has overall responsibility for managing the visit and this must be documented.
  • Who is responsible for providing a report from the visit, including visit outcomes?
  • The management of any adverse event
  • Communication procedures in the case of an adverse event.
  • The provision of invoices and the responsibilities to the MTS.
  • All participants must be satisfied with safety procedures (including post-operative care and follow-up) for the visit, particularly for more complex or high risk procedures.

4.6 Procedures for review of any adverse event resulting from MTS activities.

If there is any adverse outcome resulting immediately from any ORS referral or VMS visit, countries may request MFAT financial assistance to conduct an independent review.

  • The request should be made to MFAT by the participating country Overseas Referral Committee via the Management Services Contractor.
  • The review should commence within 1 month after the adverse event.
  • The request should set out the estimated costs of the review, the scope, and the proposed reviewer (s).
  • A copy of the report and recommendations will be sent to MFAT on completion within 3 months of the event.

MFAT will consider each request assessing each application of its merits and according to the circumstances.