Integrating Traditional Medicine into health care service delivery system in Kiribati

Purpose of the Consultancy

This STC aims to support 1) conducting a situation analysis of Traditional and Complementary Medicine (T&CM) in the healthcare system in Kiribati and how T&CM is being utilized in the country; 2) developing with the Ministry of Health an integrative healthcare delivery model incorporating both conventional medicine and T&CM based on the situation analysis; 3) supporting the implementation of a pilot project on small-scale to test components of the developed model.

Background

Aligning T&CM with other components in primary health care (PHC) setting and healthcare system is often an unexplored area for many Member States and the consequences of integrating T&CM in the health system should be carefully explored. To reduce the negative impact that may occur after the health system reform, integrative service delivery models should be developed and implemented with careful and in-depth consideration. Therefore, WHO supports Member States in the Region in developing and implementing an integrative service delivery model of T&CM services.

In Kiribati, traditional medicine is an integral part of the living knowledge and culture of the peoples and communities and is many times considered a first-line option for health care. Recognizing this, the government has formulated plans to include traditional medicine in Kiribati in national health systems and public health services to make the best use of the traditional medicine while ensuring safety, quality, and effectiveness. The Kiribati Ministry of Health and Medical Services issued The Ministry Strategic Plan 2016-2019 which includes a strategic approach to strengthen the collaboration with traditional birth attendants (TBA) to improve maternal, newborn, and child health. The approach includes exploring ways to increase the role of TBAs in providing care and support in hospitals, investigating further training for TBAs, and improving the data collection process for maternity care from TBAs operating outside of the formal health care system.

However, barriers exist to the implementation of the traditional medicine sector in the ministry strategic plan 2016-2019. This inclues fragmented information on how T&CM is being practiced in Kiribati, inconsistent inclusion of traditional medicine in national health policies and regulatory systems, ongoing concerns about safety and quality, and uncertainties around how traditional medicine can be best utilized to strengthen the health systems.

To address the challenges and appropriately integrate traditional medicine into the national health system, the ‘Designing integrative models for T&CM services in existing service delivery systems in Kiribati’ project has been planned and a team composed of experts from the WHO Kiribati Country Office, related divisions of WHO WPRO, will closely collaborate with the Kiribati Ministry of Health & Medical Services (MHMS) to perform this project.

The project consists of three activities. First, a situation analysis will be conducted to understand how T&CM is currently integrated in Kiribati and the features of the current integration including the implication of such forms on people-centered PHC. Secondly, based on the situation analysis and the country’s reality, appropriate service delivery models of integrated healthcare that accommodate strengthened T&CM for PHC will be explored. Lastly, a pilot project will be conducted to test out components of the preferred model.

Planned timelines

Start date: November 2022 End date: October 2023

Work to be performed

A) Situation analysis

The consultant will conduct a situation analysis of the current system and utilization of T&CM in Kiribati. Considering that traditional medicine has been developed within the context of the local culture of Kiribati, the situation should be analyzed from two points of view. First, from the viewpoint of health systems, traditional medicine policy, types and modalities of traditional medicine service, identification and prioritization of frequently used local medicinal plants and T&CM products, which in future will be assessed for safety and bioactive constituents, education of practitioners, safety, effectiveness, costs, relationships and trust, and regulatory status will be reviewed. Second, to better understand the local context, the analysis will also adopt an anthropological lens and will review opinions and lived experiences of community members, users of traditional medicine, traditional medicine practitioners, conventional medicine practitioners, and other stakeholders, while employing a gender and equity lens. In collaboration and discussion with MHMS, the situation analysis will be conducted by literature review and qualitative methods such as Focus Group Discussion (FGD) and Key Informant Interview (KII) with the stakeholders. The information will be essential to inform policy and its implementation.

Based on the situation analysis, in close collaboration with MHMS a priority area and potential action plan/way forward to improving the use/linkage of traditional medicine in the health system in Kiribati will be developed.

B) Development of an integrative service delivery model for Kiribati

Based on the situation analysis and the Kiribati context, the consultant will support developing appropriate service delivery models of integrated healthcare that accommodate strengthened T&CM for PHC. This includes identifying which forms of T&CM might be prioritised to be integrated, and how. The best delivery models are often developed by partnerships and collaborations. These models should be people-centered and rely on approaches that are safe, appropriate, and cost-effective. Also, they should meet the conditions of sustainability, feasibility, equality, and effectiveness. The appropriate method of development will be identified as the program proceeds.

C) Pilot project

The consultant will support planning and conducting a pilot project to monitor the performance of components of the preferred model. The pilot project will investigate feasibility, efficiency, and effectiveness. When deciding the target population, it would be worth taking into account to set priorities in provision where T&CM is prevalently used and accepted. The consultant will also provide inputs in developing and implementing the training of involved practitioners and staff for improved collaboration. The areas of training will include infection prevention and control, the scope of practice, referral system and communication. Also, if possible, testing the model in different environments to discover any unexpected favorable or unfavorable effects on population health in advance will be encouraged.

Output/s

1. Situation analysis

• Situation analysis of the current system and utilization of T&CM in Kiribati.

2. Developed integrative model tailored for Kiribati based on the situation analysis and priority area, which meets MHMS needs and preferences

3. Final report for the pilot project

• Planning document for pilot project including project design, proposal, and protocol
• Final report for the result of the pilot project, including potential ways forward

Specific requirements

- Qualifications required:

Degree in traditional and complementary medicine, public health, anthropology, or other social sciences.

Desirable Educational Requirements:

Degree in medical anthropology will be desirable

- Experience required:

At least 5 years of knowledge and experience in the context of T&CM in low and middle income countries especially in Pacific Island Countries

- Language requirements:

Written and spoken fluency in English is essential. Knowledge of local language is an asset.

Competencies

• Technical Expertise
• Overall Attitude at Work
• Respecting and Promoting Individual and Cultural Differences
• Communication
• Community engagement

Place of assignment

Manila, Philippines and Kiribati

Travel

All travel arrangements will be made by WHO – WHO will not be responsible for tickets purchased by the Consultant without the express, prior authorization of WHO. While on mission under the terms of this consultancy, the Consultant will receive subsistence allowance.

Visas requirements: it is the consultant’s responsibility to fulfil visa requirements and ask for visa support letter(s) if needed.

Compensation & Deliverables

The STC is required to submit a monthly progress report. Compensation will be paid based on the monthly report submission.

*Deliverables required during the contract period

• Situation analysis of the current system and utilization of T&CM in Kiribati.
• Final report for Integrated healthcare service delivery design tailored for Kiribati
• Proposal/design/protocol for the pilot project

• Final report for the pilot project

• WHO prides itself on a workforce that adheres to the highest ethical and professional standards and that is committed to put the WHO Values Charter into practice.

• WHO has zero tolerance towards sexual exploitation and abuse (SEA), sexual harassment and other types of abusive conduct (i.e., discrimination, abuse of authority and harassment). All members of the WHO workforce have a role to play in promoting a safe and respectful workplace and should report to WHO any actual or suspected cases of SEA, sexual harassment and other types of abusive conduct. To ensure that individuals with a substantiated history of SEA, sexual harassment or other types of abusive conduct are not hired by the Organization, WHO will conduct a background verification of final candidates.