National Consultant for avoidable Hospitalization for mothers and children in Tajikistan

1. Purpose of the Position

WHO intends to involve a National Consultant to conduct hospital and ambulatory level assessment of conditions for hospitalization of children under 5 years old and pregnant women for the period of 2010-2019 and elaborate criteria for avoiding excessive hospitalization in the Republic of Tajikistan. The assessment will involve establishment of technical working groups on maternal and child health under the Ministry of Health and social protection of Tajikistan.

The brief assessment tool to interview healthcare providers should be developed jointly with technical working group and used during the survey.

Along the survey it is proposed to classify hospitalizations based on diagnosis, type of treatment, hospitalization days and linkages to primary diagnoses to estimate the likelihood of a potentially avoidable hospitalization, primary care and mortality.

The Consultant will work under supervision of WHO NPO on sexual, reproductive, maternal, newborn, child and adolescent health, WHO Representative in Tajikistan and Child and Adolescent Programme Coordinator at WHO Regional Office in Copenhagen.

2. Organizational context

Observations from completed WHO missions show that pediatric patients with conditions such as upper respiratory virus infections, diarrhea, or pneumonia were often admitted to hospitals for treatment. Available data support such observations. Such conditions, however, could often be managed in primary care rather than in an inpatient context. Multiple studies have previously shown that hospitalizations of children and adolescents can lead to unnecessary psychological, emotional and physical disturbances. Hospitalizations can also lead to increased familial stress, disruption of education due to missed school days, an increased risk of nosocomial infections, and a considerably larger financial burden incurred both by patients and health facilities.

Previous literature has described Potentially Avoidable Hospitalizations (PAH) and Ambulatory Care Sensitive hospitalizations (ACSH). PAH could be prevented by adequate socioeconomic conditions (social support, income, safe living conditions), affordable timely access to primary care and presence of health promotion strategies to avoid child illness (smoking cessation). ACSH are a subset of PAH, where early access to primary care could have prevented hospitalization of a condition and could have been managed entirely in a primary health care setting.

Obtaining data on PAH and ACSH on further WHO missions could significantly aid in understanding of current barriers to primary health care access, identify socioeconomic factors that influence seeking behaviors for health care, and help with recommendations on improving the appropriate use of health services.

Less is known about avoidable hospitalization of pregnant women and women in the post-partum period. This work will include the development of a methodology on pregnant women and women in the post-partum period.

Complications and different health conditions associated with pregnancy affect many women and investigating the Potentially Avoidable Maternity Complications (PAMC) and Ambulatory Care Sensitive Conditions (ACSC), as well as reasons for hospitalization for ambulatory care sensitive conditions, is crucial and potentially will help to identify which elements of primary health care (PHC) need strengthening to avoid unnecessary hospitalizations of pregnant women.

PAMC is a well-established indicator of the accessibility and overall effectiveness of primary health care and are defined as a comprehensive set of pregnancy complications affecting mothers. Potentially Avoidable Maternity Complications (PAMC) is conditions that may often be preventable through access to prenatal and primary care of reasonable quality. Ambulatory Care Sensitive Conditions (ACSC) is health conditions for which hospitalization or emergency care can be avoided by addressing the barriers and opportunities to effectively prevent, diagnose and treat conditions at PHC.

3. Description of duties

The consultant is expected to accomplish the following activities: - Collect data on hospitalization for children (i.e. 29 days – 5 years of age) between 2010-2019 in selected hospitals; and hospitalization of pregnant women in the same period - Refine methodology for the assessment of hospitalization of children and pregnant women - Review collected hospitalization rates for children and pregnant women and classify primary care diagnoses into Potential Avoidable Hospitalization or Ambulatory Care Sensitive Conditions categories using tools (ICD-10-AM code); - Produce data including annual number of potentially avoidable hospitalizations and ambulatory care sensitive hospitalizations – the rate per 1000 and the percentage of total admissions; - Participation in the working meetings of the national technical working groups on assessment methodology, interim amendments and follow-ups for reporting; - Carry out hospital-based observation at admission in different departments (department of pathology of pregnant women, department of miscarriage) and follow up the main treatment protocols; - Interview heath care providers on potentially avoidable hospitalizations; interview patients on causes and route to hospitalization; - Draft survey report and outline power point presentation getting WHO Technical Unit in Copenhagen endorsement and inputs. - Assess the polypharmacy practices using of antivirals and antibiotics based on the approved protocols, latest evidences and global practices. - Evaluate the access to diagnostic testing – labs, Xray, CT scan, Sonography, Sputum smear tests, etc. - Conduct the workshop for national counterparts and present the findings and recommendations as a first step of a policy dialogue to address potential findings

4. Recruitment Profile

Functional Knowledge and Skills

Essential: Functional expertise in analyzing hospital level quality of care for maternal (pregnant), newborn and children under 18. Technical competencies in proving solutions to improving quality of hospital care through achieving adequate referral mechanism a primary health care level. Ability to suggest clear and targeted strategic plan/approach tailored at areas of improvement.

Desirable: Clinical expertise in treatment protocols of pregnant women and / or newborn and children under 18 and knowledge of local context

Education Qualifications

Essential: Masters’ level university degree in Medicine, Public Health, Health Services Planning and Management, Social Sciences, Public Policy, Demography and population health, Health Economics or equivalent relevant discipline.

Desirable: Excellent knowledge of MS Office applications and computer skills including the ability to make high quality technical presentations and data analysis.

Experience

Essential: • At least 10 years’ experience of working with programs on essential health services with key focus on maternal, newborn, child or adolescent health, or on health ageing. • Experience in health sector planning and governance, epidemiology, public health, health systems management, monitoring and evaluation, or related field. • Proven experience with health sector plan reviews and assessments and analyses of health plans in resource limited countries. • Prior experience with emergency/post-emergency response and planning would be an asset.

Desirable: Involvement in Senior National Consultancy contracts in the field of maternal, newborn and child health in Tajikistan and the Region of Central Asia

Languages

Essential: Expert knowledge of English, Tajik and Russian

Desirable: Knowledge of Uzbek is welcome

5. Contract duration

The contract duration is eighty (80) working days. The service period covers August 27 to December 31, 2021.

6. Location

Dushanbe with offsite work in Soghd and RRS regions of the Republic of Tajikistan.

7. Travel

Soghd Oblast, Rayons of republican subordination, Republic of Tajikistan.

8. Remuneration and budget

The contract is for 80 days work between August 27 and December 31, 2021.

The level of remuneration determined at US$ 150 per day and based on the following: - Required qualification and experience - Sufficient experience and expertise to obtain the services required - The nature of the services to be provided, i.e. the complexity, extent of the work to be performed and the degree of expertise required to accomplish it - Current market rate for comparable work necessary to obtain the service required by the Organization - The level of expertise appropriate to the importance of the service performed - Expert knowledge of English and Russian and Tajik

Total budget: 80 days x US$150 = US$ 12 000 (travel costs are excluded)

9. Work schedule/Duration of contract

4 months - Working schedule to be agreed with supervisors

10. Additional Information

• This vacancy notice may be used to identify candidates for other similar consultancies at the same level. • Only candidates under serious consideration will be contacted. • A written test may be used as a form of screening. • If your candidature is retained for interview, you will be required to provide, in advance, a scanned copy of the degree(s)/diploma(s)/certificate(s) required for this position. WHO only considers higher educational qualifications obtained from an institution accredited/recognized in the World Higher Education Database (WHED), a list updated by the International Association of Universities (IAU)/United Nations Educational, Scientific and Cultural Organization (UNESCO). The list can be accessed through the link: http://www.whed.net/. Some professional certificates may not appear in the WHED and will require individual review. • For information on WHO's operations please visit: http://www.who.int. • WHO is committed to workforce diversity. • WHO has a smoke-free environment and does not recruit smokers or users of any form of tobacco. • Applications from women and from nationals of non and underrepresented Member States are particularly encouraged. • WHO's workforce adheres to the WHO Values Charter and is committed to put the WHO Values into practice. • Consultants shall perform the work as independent contractors in a personal capacity, and not as a representative of any entity or authority. The execution of the work under a consultant contract does not create an employer/employee relationship between WHO and the Consultant. • WHO shall have no responsibility whatsoever for any taxes, duties, social security contributions or other contributions payable by the Consultant. The Consultant shall be solely responsible for withholding and paying any taxes, duties, social security contributions and any other contributions which are applicable to the Consultant in in each location/jurisdiction in which the work hereunder is performed, and the Consultant shall not be entitled to any reimbursement thereof by WHO.