The Enhanced Training for Uniformed Medical Personnel Deploying to UN Peace Operations project ran from 24 December 2021 to 30 January 2024 and was extended to 30 June 2024. It was funded by Global Affairs Canada (GAC) through the Department of Foreign Affairs, Trade and Development (DFATD). 

It aimed at improving the performance of UN peace operations in increasingly complex and high-risk environments by enhancing the physical and mental well-being of female and male military and police personnel deployed to UN peacekeeping missions through strengthening the capabilities, motivation (awareness) and opportunities of male and female medical and paramedical personnel (military and police) deployed to UN peacekeeping operations to address physical and psychological trauma in a gender-responsive manner and through provision of training equipment. The project targeted eight Troop and Police Contributing Countries (T/PCCs): Chad, Ghana, Kenya, Niger, Rwanda, Senegal, Tanzania, and Togo. 

Implementation of activities was supported by four implementing partners (IPs): the Rwanda Peace Academy (RPA), the Tanzania Police Force (TPF), the Administration Police Service, Kenya (APS) and the Department of Medical Services of Ghana Armed Forces.  

The evaluation assessed the project’s relevance, coherence, effectiveness, efficiency, likelihood of impact, and likelihood of sustainability to serve learning and accountability purposes. The evaluation followed a mixed-methods approach combining qualitative and quantitative tools and methods: two field visits to IP organizations in Kenya and Tanzania, a document review, interviews with 46 stakeholders, and three online surveys – trainers and basic and advanced training participants. 

The limitations encountered by the evaluation were:

1. Lack of participants’ contacts from francophone countries
2. Limited access to some stakeholders identified at the inception phase.

Mitigation strategies were implemented where possible. 

The project’s relevance was highly satisfactory. The project was closely aligned with SDG16, UNITAR’s Strategic Framework 2022-2025, and the donor efforts to promote inclusion and representation of women in the peacekeeping field. The project design was highly relevant in engaging T/PCCs vulnerable to fatalities and bridges an organizational gap in providing and upgrading predeployment training on mental health and psychosocial support (MHPSS). Project participants found the training content highly relevant to their needs. 

The project management’s expertise and close follow-up allowed for an effective learning process. The conclusions and recommendations of the project’s first phase were applied to the second phase, but challenges related to expanding the roster of female francophone trainers persisted. The contribution of the needs assessment to the development of the design of the second phase was small, which benefited more from the project management’s internal learning process. 

The project was highly coherent (highly satisfactory) and responsive to a UN environment that acknowledged the impact of mental health on the performance of peacekeeping operations and the well-being of uniformed personnel. It aligned with relevant UN frameworks on MHPSS in the peacekeeping sector, Canada’s Feminist International Assistance Policy, and UNITAR’s Gender Equality and Empowerment of Women Policy. The intervention did not overlap with other relevant programmes implemented by other organizations, standing out for its holistic approach to mental health. 

The project demonstrated satisfactory effectiveness. It implemented training activities in a timely manner and exceeded numerical targets. The mobile application was upgraded on Android, developed for iOS and translated into French, as planned, however, the promotion of the app was paused while partnership and strategic orientation were discussed. Nevertheless, structural reasons hindered the attainment of gender targets. Enabling factors include the training content, trainers’ professionalism and the combination of local and international expertise as well as the decision to engage medical and paramedical professionals, which was praised as “inclusive” by participants. Survey respondents highlighted how they applied knowledge and skills in situations of extensive bleeding, tourniquet application, stress management and psychological considerations when handling casualties as the most effective techniques included in the training.  

The contribution to intermediate and ultimate outcomes could not be assessed due to a lack of data and defined targets.  

The project also demonstrated satisfactory efficiency, with time and cost-efficient partnerships modalities, relying on proportional financial responsibilities. The project team was adaptive to changes in 

1. Partnership engagement, being able to substitute partners who were forced to step down due to external circumstances
2. Delays in the disbursal of funds to IPs. 

Project communication was also assessed as good, and equipment pre-inventory in-country and in the targeted health facilities was flagged as an efficiency factor. The mobile application efficiency was, however, found to be low due to the reasons expressed above. Unforeseen expenses also hampered training dynamics at the start of project implementation. On the other hand, IPs outlined good planning practices promoted by UNITAR to anticipate needs and organize inter-service borrowing. 

The project's likelihood of impact was assessed as satisfactory. Participants who had been deployed to peace operations had used the skills they learned, however, they represent a small proportion of the overall trained participants. The most impactful skills in-country and when deployed related to the treatment of extensive bleeding and tourniquet application, followed by Cardiopulmonary Resuscitation (CPR) and triage skills. It was found that training in stress management and listening skills changed professionals’ approach to mental health. No major differences were observed between male and female participants.  

The sustainability of the project was found satisfactory, as it largely depends on governmental prerogatives to deploy trained participants and to support skill maintenance at work. The instruction of trainers appeared as a simple and effective tool to replicate and propagate learning. The evaluation highlights the expansion of the training to other partners and options on TCCC and MHPSS as a sustainability factor. Equipment support and guarding were found to be important factors against skill fade. 

Five high and medium priority recommendations were issued by the evaluation: 

High priority

• R1. UNITAR should deepen engagement with T/PCCs and project IPs on the role of health in the safety and well-being of peacekeepers and a mission’s performance. This should be expanded to other T/PCCs that rank among the most vulnerable to fatalities. UNITAR should consider adapting training content to include the biggest risks experienced by T/PCC personnel. It should also explore the need for the confidential exchange of information on the causes of deaths and injuries of personnel deployed to tailor the training offer accordingly, for example, by confirming DPO statistics with the T/PCC. This recommendation focuses on building a new narrative around a mission’s performance and promoting a comprehensive approach and awareness about the impact of predeployment preparation.
• R2. UNITAR should continue to raise the awareness of health professionals on gender-sensitive needs in peacekeeping environments and the consequences on medical management. It should establish the link between a conducive health environment and recruitment attractiveness. It should illustrate modules with examples from other GAC research, such as barriers to peacekeepers with caring responsibilities. It should also expand modules on the consequences of cultural expectations of men on mental health, sexual and reproductive rights, and sexual orientation, with examples.
• R3. UNITAR should strengthen its stocktaking of existing medical equipment within T/PCCs to better define needs. It should strengthen inventory stocktaking of equipment of the host facility to better establish how UNITAR can complement and bridge equipment gaps during and after training, including practical exercises, to obtain a precise list for material support that IP FNR recommendations do not reflect, except for the Administration Police Service (APS), Kenya. UNITAR should follow-up with recipients on the use of equipment.
• R4. UNITAR should mainstream the mobile app or other learning reinforcement tools in the training. The future deployment of the app should define its use and users to differentiate it from other apps. UNITAR should clarify if the app aims to support training and learning or to address on-the-spot emergencies. Depending on the dissemination strategy adopted, the layout could display a more intuitive table of contents, with a search option, reduced length of text and increased visuals. 

Medium priority

• R5. UNITAR should either reformulate intermediate outcomes/indicators or ensure that those that are formulated are supported with data to enable measurement and monitoring of progress towards defined targets. Consideration should be given to the formulation of the project’s intermediate outcome (enhanced physical and mental well-being of male and female military and police personnel deployed to the four high-risk missions) and the void in data on the impact of mental health in the performance of peacekeeping missions. With these considerations in mind, it is recommended to either include questions on mental health in pre-training questionnaires to collect internal baseline information and inform targets while respecting the anonymity of respondents and the principle of do no harm or reformulate intermediate outcomes/indicators related to MHPSS that can be realistically measured. 

• L1. Adaptive management is key when project interventions are highly dependent on the national security context. Selecting new intervention countries indicated agility in project management. An example of adaptative management is to partner with T/PCCs as soon as they commit to deploy troops, which also requires flexible and available funding, increasing the likelihood of knowledge application and project impact.
• L2. Mobile applications can potentially be useful tools for learning reinforcement and sustainability when appropriately promoted.
• L3. Communicating participant selection criteria, including gender and scheduled deployment to a UN peacekeeping mission, to beneficiary countries helps to influence the target group characteristics. However, these remain highly dependent on external factors related to gender imbalance in the military and police, as well as UN peacekeeping mission troop requirements.
• L4. Training of trainers has a double benefit:
  • having trainers with an understanding of the local context to deliver training activities and
  • strengthening training capacities within countries to train additional participants outside of the project and in the future as part of its multiplication effect. Furthermore, clear trainer selection criteria are key when applied throughout, resulting in higher satisfaction rates from training participants.
• L5. Adequate and similar equipment is key to allow for the successful application of knowledge and skills in the medical context.
• L6. Training medical and paramedical professionals jointly is innovative, ignoring hierarchy and favouring the exchange of very diverse experiences.