National Consultancy on Primary Health Care Performance Index development

Consultant Medical & Health Programme & Policy

Contract

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TERMS OF REFERENCE

The 1978 Alma Ata Declaration on Primary Health Care (PHC) was touted as an integral step to achieving health for all (WHO, 1978). PHC is recognized as the foundation of any health system and as the most effective, efficient, and equitable approach to delivering essential health services to most of the population for the lowest cost . Today PHC is considered as the trajectory to UHC and to achieving SDGs. To strengthen primary health care, data and evidence is required to drive evidence-based improvements. Strong primary health care requires quality, easy-to-understand data to pinpoint strengths and weaknesses, and measure and monitor improvements helping to track progress and ensuring decision makers have the data they need to strengthen primary care systems on the way to achieving health for all.

In October 2018, WHO, UNICEF and the Ministry of Health of Kazakhstan held the Global Conference on Primary Health Care in Astana, Kazakhstan to commemorate the 40th anniversary of the signing of the Alma Ata Declaration on Primary Health Care. The conference brought together members of the global health community around a shared belief that primary health care is critical to achieving health for all. The Primary Health Care Performance Initiative (PHCPI) is established which is a partnership of the Bill & Melinda Gates Foundation, World Bank Group, World Health Organization and UNICEF, in collaboration with Results for Development and Ariadne Labs. The main objective of this partnership is to transform the global state of primary health care, starting with better measurement. PHCPI works with policymakers, donors, advocates and development partners around the world to ensure that the benefits of strong primary health care reach all people and communities.

In Kenya, the Kenya Vision 2030, Constitution of Health (2010), Public Finance Management Act (2012), Medium Term Plans, Kenya Health Policy (2014-2030), Kenya Health Sector Strategic and Plan (2019-2023), Kenya Primary Health Care Strategic Framework (2019-2024) among other policy documents aim to provide equitable and affordable health care of the highest standards in the country. However, limited fiscal government space and low budget allocation on social pillars with high expenditure in curative services,

demographic shifts, epidemiologic transition, globalization and urbanization have constrained the national efforts to ensure Kenyans enjoy their right to quality health and Universal Health Coverage (UHC) is achieved. There is renewed political commitment in Kenya to focus on PHC that is human centered and responsive to meet life course health needs and achieve UHC which is one of the country’s Big four agendas.

PHC is considered as the trajectory to UHC and to achieving Sustainable Development Goals (SDGs) in Kenya. The national PHC Strategy 2019-2024 prioritizes investments in service delivery at community level (level 1) and addressing gaps in the delivery of quality services in primary healthcare facilities (dispensaries, health centers and sub-county hospitals: levels 2-4, respectively. To strengthen primary health care in the country, data and evidence is required to drive evidence-based improvements. Strong primary health care requires quality, easy-to-understand data to pinpoint strengths and weaknesses, and measure and monitor improvements, helping to track progress and ensuring decision makers have the data they need to strengthen primary care systems on the way to achieving health for all.

Vital Signs Profile (VSPs)

The Primary Health Care Vital Signs Profile provides a snapshot of the strength of primary health care in low- and middle-income countries. The VSP assesses different areas of the health system that are important to provide quality primary health care for all, categorized into four domains; financing, performance, capacity and equity;

• Financing domain; measures PHC financing prioritization.

• Capacity domain: assess functional capacity, including governance, inputs and management of population health and facilities.

• Performance domain; focuses on service delivery; access, quality and service coverage, Equity; highlights difference in equity related to wealth, geography and education.

In 2018, PHCPI partnered with several “Trailblazer” country governments to develop and launch the first set of Vital Signs Profiles. Kenya is among trailblazer countries for which Vital Signs Profiles (VSPs) for monitoring progress in Primary Healthcare were developed and launched in October 2018, at the Global PHC conference in Astana. The VSP tool is key in fostering continued improvements on PHC in various dimensions.

In 2018-2019, the Ministry of Health, in collaboration with the Primary Health Care Performance Initiative (PHCPI) and with the technical and financial support of WHO, developed and launched the National and County Primary Health Vital Signs Profiles (VSP), to help track and prioritize primary healthcare at these levels. Nevertheless, these VSPs are not complete, having gaps mainly in the ‘Capacity Pillar’ since the progression model was not developed during that time. The planned activities of the MoH to develop the progression model were interrupted due to funding constraints and the COVID-19 pandemic that started in early 2020. There is also a need for the MoH to update the data used in developing the existing VSPs since the data used in developing the VSPs are outdated.

Progression Model (PM)

The Primary Health Care Progression Model is a mixed-methods assessment tool used to populate the Capacity pillar of the Vital Signs Profile. The “capacity” of a Primary Health Care (PHC) system refers to the foundational properties of the system that enable it to deliver high quality PHC. It systematically measures

core primary health care capacities – like governance, inputs and population health management – that are insufficiently measured by existing quantitative, globally comparable data sources.

The goal of the PHC Progression Model assessment is to bring together stakeholders who have complementary knowledge of primary health care functioning in a country to yield an objective, comparable assessment of PHC capacity. The Capacity pillar of the Vital Signs Profile provides information that can answer questions like, “does your system have the policies, infrastructure and other physical and human resources to deliver primary health care?” and “Are the fundamentals of PHC service delivery – such as strong population health management and effective facility management – in place?”

PHC Progression Model assessments are designed to be participatory and bring together diverse stakeholders who have complementary knowledge of primary health care functioning in a country. The assessment is implemented by a team of technical experts and policymakers, often including stakeholders from the Ministry of Health, development partners, and civil society organizations and non-governmental organizations.

The PHC Progression Model is made up of 33 measures (Annexed). Each measure focuses on a specific PHC system, input, or service delivery element and is assessed by assigning the level of performance for that measure to one of four categories, ranging from Level 1 (low) to Level 4 (high). Increasing Levels describe increasingly high capacity and states of performance. Results of the 33 measures of the PHC Progression Model are summarized as three scores on the Vital Signs Profile.

The PHC Progression Model assessment involves three phases: Plan, Assess, and Finalize. The assessment includes extensive document review and extraction, review of existing quantitative data, and the completion of key-informant interviews; it does not involve collecting new quantitative data or conducting health facility assessments. The PHC Progression Model is scored by the in-county assessment team and results are validated by PHCPI to ensure that findings are evidence-based and comparable to other countries. Scope of Work:

1) Goal and Objective:

The purpose of this consultancy is to strengthen the Primary Health Care Measurement and Improvement Strategy in the Ministry of Health through updating the existing Vital Signs Profile and conducting the Progression Model assessment to feed into the capacity pillar of the Vital Signs Profile to assess functional capacity, including governance, inputs and management of population health and facilities at the national level and in 47 counties.

Scope of Work

The consultancy will support the MOH to update the national VSP, county level VSPs for all 47 counties and the development of the Kenya PHC Progression Model for the national level and all Counties in Kenya.

The scope entails (i) orientation of the country team on the methodology for the PHCPI tools (VSP and Progression Model) and modification of the PHCPI tools (ii) capacity development of the national team on the development of VSP and progression model, (iii) updating of the VSPs at national and county level, and (iv) development of progression models at national and county level and (v) facilitate the internal and external validation of the PM and VSP developed. The work on the updating the VSPs and the development of the Progression Model will be steered by the Division of Monitoring and Evaluation of the Ministry of Health with

UNICEF support. A task force will oversee the implementation of the activity that will draw members from MOH, UNICEF, WHO and other partners.

2) Provide details/reference to RWP areas/UNDAF output covered: Explain briefly how this assignment links the RWP/UNDAF. Provide the RWP reference as appropriate.

UNICEF RWP 2021-2022: Support MOH to develop community health services strategy 2020 - 2025 and support targeted counties for development of CHS bills

UNSDCF Output 2.2.1: Health Systems: By 2022, National, selected County Governments and their partners have improved capacity to deliver universal health coverage through a resilient system with a focus on strengthened health governance, health financing, human resources and monitoring the quality of health services

3) Activities and Tasks: List specific tasks/activities and issues to be addressed under this assignment, including expected boundaries of the assignment. Tasks should be described as the steps taken in carrying out and completing the key activities of the assignment.

Under supervision of Information Management Specialist of UNICEF Kenya Health Programme, the incumbent will work with an international consultant to undertake:

• Document Review

• Conduct Qualitative analysis for Progression Model

• Conduct Quantitative analysis to update national and development of county’s VSPs, and

• Undertake internal and external validation of the PHCPI

1. Desk review

• Key documents and other publicly available information related to Kenya Health sector, Primary Health Care, PHCPI

• key information relevant to each measure of VSP and PM

• Consultations with UNICEF, MOH, WHO and relevant partners

2. Qualitative analysis for Progression Model

• Review the PHCPI Progression Model tool and modify the tools in line with the country context

• Prepare the PM qualitative data collection plans to cover the national and all 47 counties

• Conduct qualitative data collection for the qualitative data required for the progression model

• Ensure data from all sources is collected, complete and synthesize finding across data sources for each measure

• Record component and overall measure scores for each measure in PHCPI templates

• Assess data synthesis and score each measure component and assign overall measure score

• Summarize evidence and synthesis and do internal scoring.

• Undertake detailed notes on discussions, disagreements, and/or resolutions during the internal scoring exercise using PHCPI templates

• Record process, including conversations and resolutions, to resolve discrepancies

3. Quantitative analysis to update national and development of county’s VSPs

• Review the PHCPI VSP tools and modify the tools in accordance with Kenyan context and the existing national and county VSPs

• Prepare the VSP data updating plan to cover both national and all 47 counties

• Collect the quantitative data from existing data sources to update the VSPs in consultation with the MOH taskforce and TWG

• Ensure data from all sources is collected, complete and synthesize finding across data sources for each measure

• Record component and overall measure scores for each measure and confidence values in PHCPI templates

• Assess data synthesis and score each measure component and assign overall measure score

• Summarize evidence and synthesis to communicate to internal scoring.

• Take detailed notes on discussions, disagreements, and/or resolutions during the internal scoring exercise using PHCPI templates

• Record process, including conversations and resolutions, to resolve discrepancies

4. Internal and external validation of the PM and VSPs

• Prepare final report and other dissemination materials for internal and external validation

• Facilitate internal and external validation and note evidence-based rationale for discrepancies if any

• Serve as the in-country liaison between the lead consultant, PHCPI global team and the country working group and other in-country partners, including:

o Support and Participate in weekly or bi-weekly check-ins with the PHCPI global team to update on progress, successes, and any challenges that need to be addressed and share findings to date.

o Convene working group meetings as needed, as determined by the PHCPI team, to review progress and troubleshoot any emerging challenges.

o Communicate with in-country partners, including the Ministry of health, partners ( UNICEF, WHO, WB), and other stakeholders.

4) Work relationships: State the responsibilities of the parties involved in the assignment. Elaborate on the work relationship the consultant will be engaged with (e.g. partners, stakeholders etc.)

The consultant will work under the overall supervision of the Information Management Specialist, UNICEF Kenya, with close coordination with the Partnerships and Monitoring Officer, UNICEF Kenya and the UNICEF Headquarters and Regional Office PHCPI focal points, the MOH Division of M&E and PHCPI taskforce members. The consultant will work together and support the international consultant recruited for the PHCPI in implementing the tasks of this consultancy.

5) Outputs/Deliverables: State the specific service/outputs to be delivered at a specific time as per stated objectives and performance/quality requirements.

The outputs and deliverables for this assignment is as follows with the delivery schedule

What outputs and deliverables are to be produced which will contribute to the objectives stated in the RWP? Outputs and deliverables as mentioned above. · Outline the timeline for the initiation and completion of the assignment, stages and outputs The overall duration of the consultancy is 6 months (June 1st – November 30th 2022) and the timeline is as indicated in the above table. Overall, the ultimate deliverable of this consultancy is a final set of the Progression Model and the Vital Signs Profile validated and approved by the external and internal stakeholders. 6) Required qualifications, desired competencies, technical background and experience a) Education: • Advanced university degree in biostatistics, epidemiology, public health or related fields. b) Specialist skills/Training: • Demonstrated experience in health system, stakeholder analysis and service delivery. Strong qualitative, quantitative research and evaluation skills, including interview guide development and conducting key informant interviews. • At least 10 years’ experience in public health and service delivery. General familiarity with primary health care required. • Experience of developing PHCPI progression model, Vital Signs Profile in any country context. • Familiarity with primary health care structure and delivery in the country being assessed is strongly preferred • Familiarity including prior working experience within the local and regional contexts. Experience working with high-level stakeholders and teams • Clear understanding of the health sector monitoring and evaluation system • Proven ability to conceptualize, innovate, plan and execute ideas as well as transfer knowledge and skills. • Ability to work in a team and collaboration in a multi-cultural environment. Good analytical, negotiating, communication and advocacy skills. • Experience with research, policy or implementation of maternal and child health service delivery • Previous experience with facilitating training activities or teaching • Demonstrated ability to work in a multi-cultural environment and establish harmonious and effective working relationships both within and outside the organization. Ability to quickly builds rapport with individuals and groups; maintains an effective network of individuals across organizational departments c) Years of experience: As mentioned above d) Competencies: • UNICEF's values of Care, Respect, Integrity, Trust, and Accountability (CRITA) and core competencies in Communication, Working with People and Drive for Results. • Core Competencies: Demonstrates Self Awareness and Ethical Awareness (2), Works Collaboratively with others (2), Builds and Maintains Partnerships (2), Innovates and Embraces Change (2), Thinks and Acts Strategically (2), Drive to achieve impactful results (2), Manages ambiguity and complexity (2) e) Languages required: Fluency in English

How to Apply Interested candidates should apply online using the button below. As part of their application, candidates should provide: 1. A cover letter that specifies how you meet the desired competencies, technical background and experience (no more than 2 pages) 2. A short CV (no more than 4 pages) 3. A financial proposal that should include the daily rate and total fees for the assignment which includes travel/administrative/per diems, if applicable 4. 3 Referees.

UNICEF is committed to diversity and inclusion within its workforce and encourages qualified female and male candidates from all national, religious and ethnic backgrounds, including persons living with disabilities, to apply to become a part of the organization

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Added 1 year ago - Updated 1 year ago - Source: unicef.org