Consultancy: Review of the Guideline for the Establishment of a District Health Management Office, Pretoria, South Africa, 48 days (Remote)

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For every child, HEALTH.

Health | UNICEF South Africa

The National Department of Health (NDOH) identified and developed a guideline for District Health Management Offices (DHMO) in 2018. The DHMOs are a “national government component”, established by a new section of the National Health Act of 2003 (section 31A), and entrusted to “manage, facilitate, support and coordinate the provision of primary health care services” at district level. The establishment of uniform structures for District offices has been identified as one of the requirements for the successful implementation of Primary Health Care. The DHMOs have been adopted as one of the strategies for ensuring Universal Health coverage through the National Health Insurance (NHI). The organizational structure of the District Health Management Office (DHMO) is the framework that will enable District health to implement Primary Health Care and NHI and work towards its goals. To achieve its goals, it is essential that the DHMOs are resourced, with amongst other things, filling the posts on the proposed structures with competent staff. Key to the resources needed for a well-functioning DHMO, is an organisational structure that caters for the required managers, technical expertise and support staff.

Following the approval of the Guidelines and orientation of the provinces on the Guidelines for implementation, NDOH conducted a baseline assessment of what the current status of the District Health Management Teams is, as well as the implementation of the proposed DHMO structures. The outcome of the audit revealed that all Provinces were encountering similar challenges with regard to appointments of district managers support, PHC Managers, allied professionals, clinical support staff with specific reference to the District Clinical Specialists Teams. Challenges provided by provinces in implementing the proposed structures and appointing relevant personnel as articulated in the guideline include:

• moratorium on appointment of staff and freezing of posts
• recommended posts not included or non-existing in the current existing organograms
• the inability of some districts in attracting suitable candidates due to the rural nature of the province
• provinces and districts not aware of the existing Guidelines
• earmarked posts available in the staff establishment but having different names to those proposed in the Guidelines

How can you make a difference?

The audit report made the following recommendation to address the gaps identified regarding the implementation of the Guidelines:

• There is a need to clarify the functions and roles of the three spheres of government in relation to the ongoing healthcare reforms in South Africa. This will assist in minimizing potential conflicts and duplication of functions because of the lack of clarity on the roles that should be performed by various stakeholders. Between DHMOs and Contracting Units for Primary Health Care (CUPs) in relation to the role of DHMTs, Sub-districts.
• The roles and functions that the districts and sub-districts are expected to fulfill have been outlined in the NHA 61 of 2003 and the NHI bill as roles that would be performed by the DHMOs and CUPs. There seemed to be a lack of clarity as to the exact roles that provinces and DHMTs will play as well as the role of the soon to be created DHMOs and CUPs. Various options should be explored to avoid confusion on the roles of these various structures, which may include, amongst others; delegating functions as envisaged in the NHI Bill to DHMTs and established sub-districts.
• Review the DHMO guideline in lieu of the current reforms related to the increasing and changing burden of diseases, aligned to the goals for Universal health coverage, NHI and diminishing allocation of resources. Develop a guiding framework on structures for sub-districts in line with DHMOs configuration. Duplication of structures at district and sub-district level should be avoided and rationalisation of personnel should be considered in line with the recommendations in the NHI Bill.

It is against this background that a consultant is required to review and update the 2018 Guidelines in line with the recommendations of the audit report, as well as key inputs from policy makers and other key informants.

Work assignment overview:

Task/milestone

Deliverable/output

Timeline

Estimated budget

Develop an inception report which include the methodology and the draft detailed workplan

• Inception report

5 days

20%

Review the existing Guidelines in line with the existing recommendations from reports, senior management and stakeholders inputs

• Data collection tools and a guide on submitting inputs
• Key informants identified, consulted and interviewed in line with NDOH recommendations
• Report on stakeholders' inputs and recommendations, submitted to the PHC Branch at NDOH
• Presentation on stakeholders' inputs and recommendations

7 days

10%

Develop the first draft guidelines

• Draft Guidelines

8 days

20%

Consult with various stakeholders as identified on the draft Guidelines

• Workshop with Provincial and National stakeholders on the first draft Guidelines organised and facilitated.
• Stakeholders' meetings planned and conducted

15 days

30%

Finalize the Guidelines

• Final draft guidelines developed

3 days

0%

Produce the final draft Guidelines and key recommendations emanating from key stakeholders

• 2 Print- ready version of the documents in PDF (high resolution);
• PDF version for website and electronic distribution (low resolution);
• Detailed print specifications
• Final report and key recommendations

10 days

20%

To qualify as an advocate for every child you will have…

• An advanced university degree (Master’s or higher) in public Health, medicine, social sciences, or any relevant qualification
• Extensive experience and technical expertise in district health system development
• Project management from conceptualisation to implementation, with an interest or experience in primary health care and health systems strengthening
• Field experience in the South African health system is desirable
• At least five (5) years of experience in developing guidelines of this nature (i.e., medical and health), especially work with National, Provincial and District health personnel
• Excellent understanding and command of English at native level
• Plain English writing and editing and designing skills

For every Child, you demonstrate…

UNICEF's values of Care, Respect, Integrity, Trust, Accountability, and Sustainability (CRITAS).

To view our competency framework, please visit here.

UNICEF is here to serve the world’s most disadvantaged children and our global workforce must reflect the diversity of those children. The UNICEF family is committed to include everyone, irrespective of their race/ethnicity, age, disability, gender identity, sexual orientation, religion, nationality, socio-economic background, or any other personal characteristic.

UNICEF offers reasonable accommodation for consultants with disabilities. This may include, for example, accessible software, travel assistance for missions or personal attendants. We encourage you to disclose your disability during your application in case you need reasonable accommodation during the selection process and afterwards in your assignment.

UNICEF has a zero-tolerance policy on conduct that is incompatible with the aims and objectives of the United Nations and UNICEF, including sexual exploitation and abuse, sexual harassment, abuse of authority and discrimination. UNICEF also adheres to strict child safeguarding principles. All selected candidates will be expected to adhere to these standards and principles and will therefore undergo rigorous reference and background checks. Background checks will include the verification of academic credential(s) and employment history. Selected candidates may be required to provide additional information to conduct a background check.

Remarks:

Only shortlisted candidates will be contacted and advance to the next stage of the selection process.

Individuals engaged under a consultancy will not be considered “staff members” under the Staff Regulations and Rules of the United Nations and UNICEF’s policies and procedures, and will not be entitled to benefits provided therein (such as leave entitlements and medical insurance coverage). Their conditions of service will be governed by their contract and the General Conditions of Contracts for the Services of Consultants and Individual Contractors. Consultants are responsible for determining their tax liabilities and for the payment of any taxes and/or duties, in accordance with local or other applicable laws.

The selected candidate is solely responsible to ensure that the visa (if applicable) and health insurance required to perform the duties of the contract are valid for the entire period of the contract. Selected candidates are subject to confirmation of fully-vaccinated status against SARS-CoV-2 (Covid-19) with a World Health Organization (WHO)-endorsed vaccine, which must be met prior to taking up the assignment. It does not apply to consultants who will work remotely and are not expected to work on or visit UNICEF premises, programme delivery locations or directly interact with communities UNICEF works with, nor to travel to perform functions for UNICEF for the duration of their consultancy contracts.