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Special Reports
/ 1 October 2020

Kingdom of Lesotho Ministry of Health Request for CVs (Individual Consultants)

By
Lesotho Coat Of Arms
DEPARTMENTProject Implementing Unit
JOB TITLEQuality Assurance Specialist
PROJECTLesotho Nutrition and Health System Strengthening Project (LNHSSP)
RESPONSIBLE TOProject Co-ordinator
DATE OF ISSUESeptember 29 2020

BACKGROUND

The Government of Lesotho (GOL) is planning to implement the Lesotho Nutrition and Health System Strengthening Project (LNHSSP) with the financial and technical support from the International Development Association (IDA). One of the key Health Systems Strengthening (HSS) activities to be implemented in this project is related to the service delivery building block. Service delivery is central to achieving Universal Health Coverage, which is the key underlying mechanism for expediting progress towards the UN’s SDG3. The service delivery component plays a critical role in building systems towards the availability, access and utilisation of quality health services by all. To achieve quality of service at health facilities, a wide spectrum of interventions is needed, including health facility performance management through Quality assessment and quality improvement.

The Ministry of Health (MOH) developed the Quality Assurance policy in 2011, and the strategic plan for the period runs from 2018 to 2023. Despite substantial efforts to improve the quality of care in Lesotho, most facilities struggle to deliver high-quality services. Major barriers to accessing services include long distances to health facilities, and high non-medical out-of-pocket expenditures (especially for transport) experienced by patients, and unfriendly services. The referral system also has severe challenges, including a limited number of ambulances, unco-ordinated and ad-hoc referrals to tertiary hospitals, and inadequate community-based facilitated referrals. In response to these challenges and the need for greater facility accountability, the MOH is planning to implement quality assessments, and a facility rating system.

The MOH therefore seeks to engage a Quality Assurance (QA) specialist to assist it to develop a comprehensive Quality Assurance programme for Lesotho. The programme will objectively and systematically monitor and evaluate the quality and appropriateness of all Health Services, pursue opportunities to improve patient care and resolve identified problems. The programme will use the Stepwise Health Facility Quality Improvement Process towards Accreditation.  

The quality assessment will play a pivotal role in quality improvement in healthcare, as well as an effective measure for the interventions in other performance management initiatives and work-streams. The quality assessment should be customised to the country’s challenges and the key issues facing primary healthcare facilities, faith-based and private health facilities, and be very tuned to the local situation.

PERFORMANCE MANAGEMENT QUALITY ASSURANCE

Quality assurance activities will be done at health facilities to accurately assess the health facilities’ level of performance in relation to established standards, and to implement ways to continuously improve.  The programme aims to manage quality at four key areas of focus, listed below:

 1. Reliable delivery of standards-based care;

 2. Patient/Client safety;

3. Patient/Client Centered Care; and

4. Health worker performance, engagement and attitudes.

Target Population and Coverage

The target audience for this QA programme consist of all health providers, planners, and programme managers, partners in the private and public sectors, patients, families and communities. The programme covers all facilities and communities in Lesotho.

The broad objective of the QA programme is to assess, rate and develop Quality Improvement Plans (QIPs) for respective facilities to reach desired outcomes.  The specific objectives among others include:

1) To assess all the primary health facilities in the country and assign a scores/stars according to the quality of services provided;

2) To identify strengths and gaps existing in the health facilities;

3) To facilitate development of Quality Improvement programs QIPs for all primary health facilities in the country; and

4) To facilitate all primary health facilities to implement their specific QIPs to achieve at least an 80% score or above. One of the crucial enabling environments to institutionalise this system and to implement the QIPs is to devolve financial capacity to the health facilities.

Quality Improvement Grants will be provided to the health facilities to promote independence in health facilities to systematically and continuously work towards achieving measurable improvement in health care services.  All these will be geared towards facilitating accountability of results by all health facilities and subsequently improved quality of services at health facility level.

Lesotho embarked in accreditation of health facilities through the COHSASA program following the development of the QA policy and strategic plan. However, the two accreditation assessments done were proven to be complex and did not translate into visible improvement in the quality of health services. The country would like to learn from other countries and what the health systems have been undertaking for some time through the stepwise improvement towards accreditation process. Different mechanisms for comprehensive quality assurance will be discussed during the planning phase. 

OBJECTIVES OF THE POSITION

  1. To support MOH in the intensive phase of design and implementation of the Health Facility QA program;
  2. To support the Quality Assurance unit to review and implement the National Quality strategic plan and provide strategic direction to the Ministry of Health in terms of quality assurance;
  3. To capacitate quality improvement (QI) planning processes within the central level (Quality assurance Department), District level (DHMT and District and local hospitals) and Community level (Health centres (decentralize QI);
  4. To enhance the synergy and learning from the concurrent work streams to accelerate quality improvement and deliver a quality package of health services nationwide.

SCOPE OF WORK

The scope of work includes assisting the Quality Assurance Unit (QAU) to develop and implement the comprehensive Quality Assurance programme. These include:

  1. Establish and define QA model to be used, including development and implementation of QIPs through the development of the appropriate Standard Operating Procedures (SOPs) and Work-plan for the chosen model;
  2. Develop or formulate the chosen QA model tools for all health service levels and operating procedures and incorporate proposed indicators and scoring methods into the tools;
  3. Develop training instruments including user manuals for all health service levels and train trainers and assessors;
  4. Develop database and offline scoring tool through database development, testing electronic data capture and Offline scoring tool, including On-site scoring and data interpretation;
  5. Developing dashboards for reporting and analysis at different levels and train users at all levels;
  6. Developing standard operating manuals, training manuals and tools for developing, implementing and reporting on quality improvement programmes or initiatives;
  7. Develop procedures for providing quality grants to health facilities and fiduciary procedures for utilisation of these grants. This also include development of training and user manuals and training of trainers.
  8. Review and support implementation of the Quality Assurance strategic plan, including defining roles and responsibilities of the staff; review of standards and development monitoring tools.
  9. Facilitate quality improvement initiatives in the primary health care and hospital operations.
  10. Provide technical trainings to the quality assurance staff at all levels.

The Quality Assurance Specialist will ensure continuity and dedicated support for the QAU ,who are responsible for the work-plan QA model. This work plan is focused on accomplishing baseline assessment of health facilities nationwide, database development, data management and analysis. This will be complemented by “deep diving” to inform other Health systems strengthening work-stream initiatives for the health facilities. Formative work is required to develop criteria for repeat assessment (“readiness”), for efficiency and for sustainability of the model to be chosen through decentralised structures, with appropriate capacity building support. Lessons learned to accommodate the emerging issues during implementation will be utilised to finalise the documents developed during this assignment.  

The Quality Assurance Specialist will establish the mechanism for monitoring quality improvement (QI), building on the QA database in DHIS, with linkage to the performance monitoring and key performance indicators (KPIs).  Ownership of the QA system by District Management and health facilities and developing capacities for data use in decision making will be essential for this system to function. Successes and good models identified through quality assessments will inform the development and dissemination of QI solutions and innovations that will accelerate the quality improvement processes and results, as measured by repeat assessments at health facilities.  By the end of the assignment, the implementation role of district management and health facilities will have increased, capabilities will have been demonstrated, and capacity building and/or further Quality Assurance Specialist can be planned accordingly.

Roles and responsibilities

The focus of the candidate will be on the following specific tasks and activities:

  1. Initial organization and conceptualization through discussion with the MOH (the QAU) to define the system;
  2. Conducting desk reviews, interviews, discussions to study all the QIPs in the country in an effort to harmonise all the approaches, identify gaps and provide recommendations on the way forward regarding the QA model of interest including QIPs and the quality improvement grants;
  3. Define the domains with detailed criteria and indicators for measuring performance at all levels, including weights attached for all indicators;
  4. Develop assessment tools including an electronic (Excel) tool and calibration and develop user manuals and pilot them;
  5. Train the trainers (TOT) for assessors and develop training manuals and tools (Presentations);
  6. Facilitate baseline assessment for all health facilities and report writing;
  7. Support development of electronic data capture, and database applications that will link the  performance scores to the quality improvement planning and monitoring processes; advise on the system requirements for data quality assurance, QA model approval process, data visibility and access by all DHIS2 users to reports and visualization of  findings; enhance use of the scorecards and QI tools;
  8. Evaluate capability for self-assessments or QI monitoring by the management team and engage management teams in collaborative processes for learning and sharing of successes in quality improvement, giving examples and costed solutions that may be applied in all Health Facilities/ settings;
  9. Identify further training needs and tools for quality assessment teams; propose refinements in the model of training and implementation support from diverse stakeholders and partners; look for synergies with other QI work streams to achieve the best possible results;
  10. Develop and advice on the management and procedures for provision and utilization of quality grants including results-based incentives, advice on the equations to be used for provision of quality improvement grants to health facilities (which include  QIP results) and how health facilities can provide results-based incentives to staff for better performance, develop reporting mechanisms for QIPs and Quality grants;
  11. Draft analysis plans and advise on evaluation design for the rating/evaluation system and related initiatives for promotion of service quality within the health sector to inform future programming and policy;
  12. Review and update the strategic plan with clear direction and measurable outcomes;
  13. Provide mentoring and on the job training for all the quality Assurance unit staff in implementing and monitoring the strategic plan; and
  14. Support integration of quality assurance elements in the provision of health service at all levels.

DELIVERABLES

Expected outputs from the plan to support the QA plan are:

  1. Well formulated and documented design for the Health Facility QA model that is aligned and harmonised with related initiatives within the MoH.
  2. Functional and well-integrated toolkit for the QA model comprising database, scorecards, data driven quality improvement processes, reporting and analysis plans, performance monitoring and procedures for remuneration through quality grants.
  3. Fully functional and efficient quality assurance system throughout the entire health system.

Outputs

  1. Revised Strategic plan including revised standards based on the MOH key priority areas;
  2. A fully functional QA system throughout the system including well capacitated staff at the national level to lead the QA strategy;
  3. QA Implementation model and budget per district and health facility;
  4. Clarified roles and responsibilities for assessors and for stakeholders at all levels;
  5. Locally Developed QA Standards and tools;
  6. Training approach and capacity building model evolving in stages;
  7. Basic curriculum and training materials ‘fit for purpose;
  8. SOPs for approval and certification of the rating;
  9. Trained assessors;
  10. Baseline QA report for all health facilities;
  11. Database/ Offline tools /Dashboards;
  12.  Costed solutions for common QI needs (water, power, equipment, PPM);
  13. Focused quality improvement plans at health facility and district;
  14. Support for data entry and data administration in place;
  15. Basic data quality audits; and
  16. Evaluation design for the initiative.

KEY QUALIFICATIONS REQUIRED

  1. Advanced university degree in Public Health, Social Sciences or any other related field;
  2. Strong background (>than 10 years) in Public Health field, Health Systems Strengthening and or Research;
  3. Good understanding of the dimensions of quality in health care systems;
  4. At least five years’ experience in designing and implementing the comprehensive Quality Assurance program, including star rating system and step-wise improvement towards accreditation programmes (evidence of this will be required during the engagement process);
  5. Knowledge of health care standards, quality improvement methodologies, and the QI framework and strategic plans in Lesotho;
  6. Technical competencies for design, development and testing of tools for quality assessment in a low resource setting;
  7. Skills in data collection, data management, analysis and interpretation for decision making;
  8. Experience in training needs assessment, capacity development and institution building;
  9. Good communication and facilitation skills, process orientation, and adaptability to a given environment;
  10. Familiarity with local conditions and service delivery issues in primary health facilities: health professional background is useful;
  11. Conversant with health systems, health sector strategies and planning, and the broader development agendas in low- to middle-income countries;
  12. At least 10 years’ experience in technical assistance, research or quality assurance in Lesotho or Southern Africa; and
  13. Fluency in spoken and written English is a requirement.

Key skills required

  1. Ability to work independently and be creative and innovative; integrity and ability to work in a team;
  2. Good listener with demonstrated ability to present and win support for ideas as well as make effective and timely decisions;
  3. He/she shall have the overall responsibility for reporting progress on social safeguards and must possess adequate communication and documentation skills;
  4. Good mastery of standard computer applications: Microsoft Office Package;
  5. Must be result focused and be able to work under pressure and tight deadlines;
  6. Ability to think strategically and conduct dialogue on social development policies and priorities, while maintaining a strong sense of realism with regard to in-country conditions and competing demands for resources;
  7. Team player with strong leadership abilities: experience in working with large teams of people from different background; and
  8. Demonstrate ability to work independently with limited supervision on a wide range of social development activities, and achieving results.

REPORTING

The candidate will report directly to Director – Quality Assurance Unit. The contract will also be managed by the Project implementing Unit Co-ordinator.

Duration

The scope of work requires a full-time specialist for the period of two years commencing from November 1 2020 and it is subject to a probation period of four months and satisfactory performance. The Contract period will also be subjected to satisfactory performance.

Duty Station

The duty station shall be the Ministry of Health Head Office, Maseru, with frequent field visits to project sites and health facilities.

Remuneration

Successful candidates will be offered performance-based contract aligned with the market for the entire assignment period.

Application Instructions

Interested and suitability qualified candidates should forward their applications indicating the advertisement and position on the subject line of letter with detailed curriculum vitae indicating work experience. (Day time telephone contacts, names and telephone contacts of three referees to reach the undersigned not later than October 15 2020) to: 

Procurement Unit,

Procurement Unit Ground Floor, Room 11 Ministry of Health, Corner Constitution & Linare Roads, Kingdom of Lesotho,

Telephone: (+266) 27323277

Email: [email protected]