New Job Opportunity at D-tree International – ToR for Primary Health System Expansion Consultant | TZ JOB CONNECTION : Tanzania Jobs Connection , Nafasi Za Kazi 2019, Ajira Mpya 2019, Mabumbe Jobs,

D-Tree International

Terms of Reference for
Consultancy to Create Blueprints for a Digitized Primary Health System
with a Strengthened Connection to the Community Health Program
A. Summary
These
terms of reference provide the background to the recruitment of a
consultant to provide technical leadership for developing a situational
analysis and system blueprint for the expansion of client-centered,
digitally enabled health systems, strengthening the connection between
the community health system and primary health care units in Zanzibar.
They also define the background of the project, period of performance,
scope of work, expected deliverables, and qualifications for the
consultant. This consultancy will be led by the Ministry of Health,
Social Welfare, Elderly, Gender and Children (MOHSWEGC), directed by the
Digital Health Strategy Technical Working Group (TWG), and closely
supported by D-tree International, a digital global health organization
committed to improving access to high quality healthcare by integrating
digital technology solutions into health systems in innovative and
effective ways.
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B. Background
To
date, significant progress has been made in the establishment of
Zanzibar’s community health system, Jamii ni Afya, which supports 2,300
community health volunteers (CHVs) to support all families in Zanzibar
through household-based service delivery. CHVs are equipped with digital
tools that support their work and generate data for system-wide
decision making. In light of this progress, the government has committed
to a digital health strategy and investment roadmap specifying the need
to strengthen digital-first initiatives at the community and primary
health facility levels. These efforts are aimed at further solidifying
the relationship between the community and primary health facility
levels, and even more critically, improving the quality of care
delivered at both levels by all providers. The drive to achieve these
ambitious goals is propelled by the success of Jamii ni Afya and
realization that digital health is critical to strengthen health systems
in Zanzibar.

Jamii ni Afya is the Zanzibar government’s
digitally enabled community health program which is advancing the goals
and objectives of Zanzibar’s Community Health Strategy, 2019-2025,
primarily by empowering local CHVs to meaningfully engage directly with
their communities. At its core is a customized digital tool built with
the Community Health Toolkit platform that aids CHVs in health promotion
and education, screening for danger signs, coaching, referrals, and
follow ups, while providing real-time performance and health outcome
data to supervisors and managers at the community, district, and
national levels. By the end of 2021, Jamii ni Afya will be supporting
2,300 CHVs and 100% of the population.

As Jamii ni Afya scales
and matures, we will be further strengthening the broader primary health
system, including developing linkages between communities and primary
health care facilities, (PHCUs) and supporting high-quality,
client-centered care at the facility level. For example, when CHVs
detect antenatal danger signs (e.g., vaginal bleeding, headache, swollen
feet), they refer clients to health facilities for targeted care. In
the next phase, we expect to see data from those visits be shared with
health facilities, and when the client receives facility-based care,
expect data from that visit to reach the CHV to aid in appropriate
follow-up care. This bi-directional feedback will help to improve
continuity and quality of care.

The ongoing success of this
program is vital in the government’s continued commitment to advance
digital-first solutions at the community and primary care facilities.
The MOHSWEGC with support from D-tree International is seeking a
consultant to lead the development of a high-level blueprint for an
integrated digital primary healthcare system to strengthen linkages
between community and primary health care facilities and to improve the
quality of care delivered at primary health facilities in Zanzibar. The
consultant will undertake efforts to understand the primary health
landscape in Zanzibar, and will subsequently provide recommendations on
the integration of the existing community-based system to primary
healthcare clinics.

C. Period of Performance: 1 July 2021 – 31 December 2021

D. Management and location of consultant:
The
consultant will receive close technical guidance from the Digital
Health Strategy TWG and work under the supervision of D-tree’s Jamii ni
Afya’s program team. The consultant will ideally be based in Zanzibar
for the period of performance, but this is not required. A qualified
applicant can conduct the majority of the work remotely with a
proposed/agreed-upon number of intensive trips.

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E. Description of Services to be provided
1.
Conduct and report on a detailed situational analysis of the primary
healthcare system structure in Zanzibar. (approx. 1 month) This
situational analysis will document the current system holistically and
identify key areas that can be strengthened to result in more efficient
care coordination and quality facility-based care provision. This
process should largely focus on the existing primary health care system
(including both public and private institutions), namely quality of care
at PHCUs; health worker training, motivation, and supervision;
systems-level gaps in referral completion (e.g., connection between
PHCUs and community-level care and electronic medical record
coordination); community-based follow-up; movement of clients among
health care providers; timeliness of facility-based service access; and
quality and appropriateness of facility-based care. This work will
entail discussions with government officials (e.g., ICT and HMIS units
within the MOHSWEGC), vertical programs that offer services through
facilities, Digital Health Strategy TWG, Community Health TWG, health
care providers, CHVs, community members, and potentially other
stakeholders. As such, the consultant must have a demonstrated track
record in respectfully conducting key informant interviews in Swahili,
and facilitating focus group discussions in Swahili, in parallel with
reviewing policy and guidelines (e.g., Digital Health Strategy) that
govern primary health care delivery and digital health strategy.

2.
Prepare a system blueprint for strengthening the connection between the
community and facility and improving the quality of facility-based
care. (approx. 5 months) This work will lead to the creation of a
blueprint outlining the development and deployment of a digital system
at PHCUs that supports the creation and sharing of client cases among
relevant community-level providers and facilities (both public and
private), and allows for real-time monitoring of service provision
quality. The PHCU digital system will be designed to improve the quality
and efficiency of health service delivery and data collection,
facilitate the provision and exchange of patient information, and foster
communications across health facilities and between community-based
providers and their clients.

The consultant will prepare a
system blueprint that will serve as guidance for strengthening different
components of multi-level care coordination and facility-based service
provision using a human-centered, client-first approach, in alignment
with internationally-recognized digital development principles. This
blueprint will serve to communicate the system vision, describe the
system configuration, how its components fit together and how they will
interface with other relevant systems.

The blueprint will:
define
the scope for a subsequent requirements analysis and development phase,
and should be created with participation of relevant stakeholders
identified in the situation analysis. It is critical that the blueprint
consider local contextual factors including, but not limited to, health
system, culture, technological infrastructure, and human resources. The
consultant will additionally need to provide a system specification
reflective of contextual factors, companion resources, and a proposed
implementation roadmap for successful integration.

System
specification: While conducting the situational analysis, the consultant
will be identifying opportunities to strengthen care coordination
between CHVs and the PHCUs, evaluating the potential for a
widely-distributed electronic medical record (EMR) system, and
identifying areas of growth for quality care provision at the facility
level. Additionally, the consultant will become intimately familiar with
the government’s digital health strategy and roadmap, and progress
achieved to date. To successfully integrate the primary healthcare
service delivery points and rapidly improve facility-based care
provision, in addition to the system blueprint, D-tree will require
system specification that will govern any digital system expansion
outlined in the system blueprint. Details could include, but are not
limited to: quality of care indicators; feedback mechanisms for clients;
system recommendations to accommodate patient load at health
facilities; electronic clinical support tools to address skills and
knowledge levels of healthcare providers; EMR recommendations; and
technical resource availability in Zanzibar (e.g., network capacity,
device specifications, etc.)

Companion Resources: An integral
part of fully realizing a stronger connection between community-level
services and facility-level services will be understanding the patient
or client’s point of view, from seeking out health services, to
receiving them, to being monitored thereafter. To this end, the
consultant will develop client journey maps detailing clients’
understandings of care and resource access, as well as service
blueprints for respective journey maps and client goals associated with
these journeys. The consultant will also compare illustrative actual
client journeys to ideal client journeys, highlighting any differences
and suggested areas for intervention, and noting what is realistically
deliverable by primary health care facilities and what must be done at
higher-level care facilities. These journey maps should also take
primary health care provision from private providers into consideration.
Additionally, the consultant is welcomed to suggest and/or provide
additional ancillary resources to aid the eventual design and
implementation of this effort.

Proposed implementation roadmap:
Understanding the significant complexity of this undertaking, the
consultant’s expertise will be needed to develop a roadmap for design,
testing, and implementation of the blueprint including an estimate of
required cost, resources, and key stakeholder involvement. The
consultant should ensure that this roadmap fits within the Digital
Health Strategy through collaboration with the Digital Health Strategy
and Community Health TWGs.

F. Expected Deliverables

Situational
analysis including: core problems underpinning efficient primary care
coordination and high-quality facility-based care provision; gaps in
PHCU information systems; existing information systems at various levels
of public health facilities for both electronic and paper-based
systems; recommendations for systems-level care coordination and service
provision quality improvement
System blueprint which include:
system specification with a complete, high-level description of
hardware, software and other infrastructure to strengthen primary care
coordination; requirements for system(s) to identify gaps in quality
care provision and provide feedback to PHCUs to service provision
improvement; client journey maps and service blueprints; roadmap for
implementation; recommendations for integration into national-level
digital systems

G. Consultant Responsibilities

Conduct
all activities of the consultancy and submit quality and agreed
deliverables according to predetermined and agreed-upon schedule;
Collaborate closely with D-tree International and the Digital Health Strategy TWG in all activities; and
Incorporate input and feedback from Community Health TWG.

H. Digital Health TWG responsibilities

Ensure the objectives for the consultancy are accurately articulated to all relevant stakeholders;
Make available all relevant background documentation to the consultant;
Be available for frequent in-person consultations and meetings throughout the process;
Review of draft documents from the consultant and provide timely feedback to the consultant; and
Approve the final deliverables.

I. Other Stakeholder responsibilities

MOHSWEGC
ICT unit: Provide consultant access to current system architecture,
data sharing and storage protocols, and other similar information;
MOHSWEGC
Digital Health Strategy TWG: Facilitate communication with CHVs, PHCU
staff, private care providers, and local pharmacies to obtain timely
responses to inquiries from the consultant on current status of the
primary health care system
Other MOHSWEGC divisions: Be available to consultant for in-person consultations and meetings; and
Other
implementing partners: Contribute vertical program digital tools to the
consultant in order to fully map out the full digital ecosystem.

J. Minimum qualification and experience requirements
The consultant should have the following qualifications:

Advanced University degree holder in a relevant field (i.e., public health, community health and development, digital design);
At least 5 years of professional experience in service design and human-centered design for systems strengthening;
Demonstrated
deep expertise in human-centered design, service design, digital
health, and experience contributing to driving program strategy;
Experience developing client journey maps and digital system blueprints;
Experience in identifying issues in primary healthcare quality and providing digital-first recommendations for mitigation;
Knowledge
of health systems including community health programs in East Africa is
required. Experience in Tanzania and Zanzibar is an added advantage;
Familiarity
with digitally-driven comprehensive health systems, Zanzibar’s primary
healthcare structure, and health systems strengthening is ideal;
Ability to work independently and in teams within a multicultural environment;
Excellent analytical, conceptual, communication and writing skills;
Excellent command of English, both written and oral;
Fluency in Swahili required; and
Familiarity with the Zanzibar health system preferred.

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K. Application instructions
Qualified
individuals should submit a cover letter, CV, proposed detailed work
plan (with budget and timeline), and methodology to tor-2021-05@d-tree.org by 30th June 2021.