For frontline global development workers, caring for mental health on the job is critical

When Khulile Dlamini arrives for her shift answering a help line for children and families in Eswatini, she never knows who she may talk to. Sometimes adults call. Other times it is a child. By connecting them with crucial resources, Dlamini has helped callers face rape, child abuse and other serious trauma. The help line was supported by the Pact-led, USAID-funded Insika Ya Kusasa project, which worked to accelerate Eswatini's progress toward HIV epidemic control, in part by reducing vulnerability among youth. 

Dlamini knows her work helped people, but the challenges were immense, and the job could take a toll, she says. 

“If we are lucky, we will get a client calling us back and telling us that they have been assisted with their problem,” she says. But often she and her colleagues never learn what happened. “It has its ups and downs, to be quite honest. It can strain on us personally. It is up to us to talk with our peers or find a way to deal with the stresses.”

Dlamini is far from alone. Around the world, Pact and other NGOs provide a range of programming in communities dealing with extreme challenges, from HIV to poverty to war and conflict. While there is growing recognition that mental health care must be a part of global development programming, often development workers and volunteers themselves are overlooked. 

According to the World Health Organization, mental health and work are closely linked, and this can be especially acute for frontline workers in fields such as health and mental health care, emergency and disaster response, social work and humanitarian aid. Plentiful research has shown that aid workers are at higher risk for a range of mental health challenges. 

“Our staff and partners often work in very difficult environments and under challenging and sometimes dangerous circumstances,” says Michèle Laird, Pact’s Senior Vice President of Programs. “They assist communities that are dealing with violence, trauma, serious health issues, loss of freedoms, extreme poverty and more, often in places that are very under-resourced. There is no way one can do that without being affected personally. While our work can be extremely rewarding, and our staff and partners are committed to our mission, it is also stressful and can be heartbreaking as well.”

It's why Pact’s mental health assistance extends beyond the communities we serve to frontline workers, including our own staff. Pact provides a global employee assistance program to help staff manage stress, anxiety, depression and more. Our leadership intentionally creates spaces and opportunities for reaching out to teams and providing support.

In Ukraine, where mental health needs have soared due to Russia’s protracted war, Pact leads the U.S. government’s largest mental health program worldwide. Estimates say that 40-50% of the Ukrainian population require mental health and psychosocial support (MHPSS) of varying intensity. Pact is working in collaboration with the Ukrainian government to expand access to such care, and this includes for our own staff and partners and other frontline workers.

As part of duty of care, we foster a trauma-informed work environment that prioritizes mental health. This includes offering workshops for employees on topics such as self-care, stress management, time management, sleep hygiene, nutrition and physical activity, as well as specialized workshops for training line managers on recognizing early signs of mental health challenges and guiding staff to appropriate mental health services and resources. Our Ukraine team organizes volunteer activities for staff to de-stress and connect while supporting the war effort. This has included weaving camouflage nets and preparing snacks to send to soldiers, which staff have found meaningful.

In Tanzania, where Pact for many years has implemented HIV programming for vulnerable children and families, we take measures to ensure our staff and employees are able to cope with the trauma they witness among communities. Case workers who support families often wish they could solve every problem, but it’s simply not possible, explains Levina Kikoyo, Pact’s Tanzania country director. 

“There is emotional trauma that comes with the feeling of failure if a challenge is not resolved, or if there are deaths of clients, or if one cannot overcome a corrupt person in the legal system,” Kikoyo says. “We cannot control everything.” Sometimes staff fear for their safety when dealing with issues such as family and gender-based violence. 

Pact’s Tanzania team takes a rounded approach to caring for staff and case workers. It holds monthly meetings with partners, frontline workers and the government to discuss on-the-ground challenges and share experiences and solutions. In one-on-one sessions between staff and managers, workers are encouraged to bring up any difficulties they are facing, and mental health counseling is available for staff whenever it’s needed. Case workers are trained in self-care, and Pact provides as many resources as possible to help them feel equipped to handle difficult cases. 

It's the right thing to do for both staff and for those they serve, Kikoyo notes. “As the saying goes, you cannot pour from an empty cup.”

In Dominican Republic, Pact leads an HIV program for an especially vulnerable group – Haitian migrants. 

“Haitian people here have so many barriers,” says case worker Amancia de León. “It is difficult when you can’t solve every problem.” 

The project, Building Resilience among HIV-Affected Families, launched a self-care component for case workers because the challenges of their job can be so intense. 

“They want to provide for those families and to protect them,” says Pact’s Franklin Marmol, a senior technical officer with Building Resilience. “They often take that responsibility home as their own.” 

The self-care component helps case workers to cope and to be more resilient. Marmol says it’s vital that frontline workers find ways to disconnect when they are not working, if possible. 

Dlamini, with the child help line in Eswatini, says that can be the hardest part. 

“I'm supposed to switch off after work, but I can't,” she says. “I'm still human at the end of the day.”