National Consultancy for Assessment of the quality of maternal and newborn care and related documentation, in selected private hospitals of Iraq
Application deadline 8 months ago: Wednesday 11 May 2022 at 20:55 UTCOpen application form
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The MOH is the main health care provider in Iraq through a network of 1852 primary health care centers that provide both preventive and promotive services, and 281 different types of public hospitals that provide clinical care. Hospitals include general district and specialized hospitals for general care, and tertiary referral hospitals for advanced care (MOH data 2020). Public sector health facilities (HF) of both types are not equitably distributed across governorates and between rural and urban.
While medical services in Iraq’s public hospitals charge only low fees, many people seek care in private hospitals to avoid long waiting times in public facilities, and due to adverse perceptions of quality. According to available data from the MOH, more than half of Iraq’s 150 private hospitals are located in the capital city of Baghdad (Total 54 hospitals; 18 in Karkh and 36 in Ressafa districts) and in Erbil, capital of the Kurdistan Region in Iraq’s north (24 private hospitals). Other private hospitals are distributed across the other governorates, ranging in number from 18 in Sulaymania to only one private hospital in each of Muthana, Missan, and Wassit.
The private health sector plays an important role in delivering health care in Iraq, and expanded over the last few years, starting mainly in 2015 when the government of Iraq adopted the federal law that liberated the capital investment in the private health sector, and allowed the establishment of private health projects by any investor regardless of his original profession after fulfilling the required conditions according to the Ministry of Health regulations, and partly as the government allowed “dual practice” – by which public sector health staff are also employed and work privately outside government facilities. Providers of health care in the public sector are allowed by law to practice their profession in the private sector beyond routine working hours (from 0800-1500) in the public sector and on weekends. There are no official or formal mechanisms for public-private collaboration and partnership; no officially accepted or clear policy or guidelines or system that governs the interaction between the public and private health institutions. There is also no registration of the package of services provided by facilities, no oversight of the quality of care provided in the private institutions (hospitals or private clinics), no regulation of private practice or maintenance of professional standards program.
The main scope of service provision in the private sector was limited mainly to primary care services, elective surgical procedures, and obstetrics and gynecology services.
Overall, the public sector is still dominant in providing health services, and the ratio of governmental hospitals per 100,000 population between 2016 and 2018 was 0.7 in the public sector compared with 0.3 for the private. The total ratio of hospital beds per 1,000 population for the same period was 1.2 in the public sector versus 0.11 for the private sector.
For most medical care in Iraq, patients can choose freely between public and private sector facilities (when financially capable) to have their medical needs met. In regard to maternity care, deliveries in Iraq are mostly institutional (ID), with 84% of pregnant women delivering in a HF in 2020, according to MOH data. Of the 84% ID, 22% were in private hospitals. While private hospitals must be approved by the nongovernmental department at the MOH to establish MNH units and services, there is no mechanism to regularly assess or supervise services provided in private hospitals, and no standard criteria for follow up on the quality of care.
Data reporting to the national health information and management system (HMIS) from private hospitals include mainly the total number of women delivered, and the percentage of cesarean deliveries (CD; 85% in private hospitals, MOH data 2020)) which is much higher than the acceptable range defined by WHO. National checklists adopted by the MOH for regular monitoring of the quality of care in public HF are not usually applied at private hospitals. All private hospitals in Iraq are for profit. The distribution of private sector hospitals reflects urbanization rates; they are mostly located in center of cities leaving rural areas underserved. There are no complete and accurate numbers regarding the private sector health workforce, and there is no reporting system in place from private hospitals, mandated from the ministry of health (Private health sector and private health management for universal health coverage in Iraq, WHO 2020).
In addition, the main two main national health facility assessment studies conducted during the last decade by MOH have not included a sample from private hospitals:
- The emergency obstetric and neonatal care (EmONC) needs assessment study conducted in 2014 (EmONC – Needs Assessment, by MOH in collaboration with UNFPA, UNICEF, Columbia University, and the American University of Beirut).
- The maternal, neonatal and child health (MNCH) study that was conducted in 2017 for assessing the availability of MNCH services according to WHO availability and readiness tool (MNCH- Health Facility Assessment in select districts of Iraq, by MOH and UNICEF)
There is clearly a need to appraise the quality of MNH services in the Iraq private health sector, related physical facilities, human resources, and the content and standard of documentation recorded and reported. UNICEF is seeking a consultant to undertake a study of these issues.
How can you make a difference?
Scope of Work:
The purpose of this study is to fill a major gap in knowledge of the function of the private MNH sector in Iraq. The objectives are:
- Provide technical assistance to the Iraqi MOH and UNICEF Iraq on an assessment of the quality of MNH care/services provided by the private sector, including:
- Antepartum care in the outpatient clinic of private hospitals.
- Maternity care at the time of delivery.
- Mother and newborn care during the early postpartum stay in the hospital.
- Care provided to babies born preterm or with low birth weight or with suspected complication or developed any complications.
- Qualification, knowledge, and practice of the personnel working in the provision of MNH care.
- Assessment of hospitals’ infrastructure, management and communication policy, including referral.
- Availability of registers, data, and reporting mechanisms (paper-based or digital).
- Conduct literature review on the contribution of the private sector to universal health coverage (UHC), with a focus on MNH care outcomes, the quality of MNH care in the private sector according to WHO criteria, and the advantage of the private sector over the public sector in terms of quality of care, client satisfaction, and preference.
- Identify global tools used for assessing MNH services, with a focus on the quality of care.
- Create an online data collection tool by use of an iPhone or iPad, to be utilized for data collection by trained field workers.
- Establish a baseline of existing capacity at private health facilities to provide necessary life–saving MNH care, through mapping of private hospitals that provide MNH care in 18 governorates across Iraq, including KRG governorates in collaboration with MOH and KMOH. This is to be followed by selecting a sample of private hospitals for assessment of MNH care, in terms of the policy, infrastructure and amenities, and the availability and quality of MNH services, including client satisfaction, for both outpatient and inpatient care.
- Data cleaning and analysis.
- Develop tables, graphs, and figures to highlight the main results.
- Develop a short policy brief on MNH private services to inform decision-makers on the main results related to the quality of care at the private hospitals, including infrastructure, regulations and SOP, data reporting, patient satisfaction, coordination with the public sector, and referral mechanism.
- Develop manuscript for publication in Peer-Reviewed Journal.
To qualify as an advocate for every child you will have…
- Advanced university degree (PhD) in in public health/ community medicine, a subspeciality in epidemiology is an asset.
- 5- 8 years demonstrated experience in health system research, maternal and newborn health, a record of scientific publications in national and international journals is required.
- Special skills:
- Advanced computer skill with statistical packages is a prerequisite.
- Excellent writing and presentation skills in English
For every Child, you demonstrate…
UNICEF's values of Care, Respect, Integrity, Trust, and Accountability (CRITA).
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UNICEF is committed to diversity and inclusion within its workforce, and encourages all candidates, irrespective of gender, nationality, religious and ethnic backgrounds, including persons living with disabilities, to apply to become a part of the organization.
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.
Mobility is a condition of international professional employment with UNICEF and an underlying premise of the international civil service.
Only shortlisted candidates will be contacted and advance to the next stage of the selection process.
Individuals engaged under a consultancy or individual contract 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 and individual contractors 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.