Quality & Patient Safety (PHC) Consultant

1. Purpose of the Consultancy

This consultation is for the the development of a training course on quality and safety in extreme adversity and conflict-affected settings.

2. Background:

A growing understanding of the Universal Health Coverage (UHC) target has opted to demand more than expanded access to healthcare services and ensure care quality and safety in all settings. Perhaps now more than ever, we need to recognise the urgent need to address UHC in fragile, conflict-affected and vulnerable (FCV) settings, a broad term describing situations of crisis, such as those resulting from weak governance, natural disasters, epidemics, armed struggles, and displacement of populations.

Poor-quality and unsafe healthcare practices burden 42.1 million patients every year with adverse events at the global level (1). In Low- and Middle-Income Countries (LMICs), between 5.7 and 8.4 million deaths annually are attributed to poor quality of care, accounting for 15% of overall deaths in these countries (2). In the current world, inadequate quality of care accounts for more deaths than lack of access to services and leads to economic welfare losses of $6 trillion (3).

Estimates indicate that 60% of preventable maternal deaths, 53% of deaths in children under 5, and 45% of neonatal deaths take place in countries with fragile settings. However, the experience in many such settings suggests the quality agenda has often been relegated to “not now” status. Yet this approach is misguided. Access to care that is ineffective, unsafe, and not trusted by the communities it serves, risks significantly worse health outcomes, increased vulnerability to further crises, a missed opportunity to build back better, and represents a poor use of valuable health funding.

The Eastern Mediterranean Region (EMR) represents a special case where 22 countries that host 645 million people face an unprecedented magnitude and scale of crises and conflicts. In 2019, the WHO reported 14 graded emergencies in 11 countries across the region. It is estimated that over 71 million people need emergency healthcare within the region, including an average of 15 million internally displaced population (4). Consequently, the health systems in the EMR show a need to acquire more resilience and end the fragility state at the level of healthcare to cope with the current circumstance.

Achieved milestones

The World Health Organization (WHO), across all its regional, local, and collaboration offices, has been relentlessly advocating health for all by all in all settings. Many projects and initiatives have been in place to support health systems in emergency contexts, such as identifying a minimum service package for emergency countries, supporting health system recovery and resilience, and the health development nexus. High-level collaborations were initiated to support the work; the involved parties include WHO-EMRO, WHO-HQ, UHS (AHS), HSEL, EMO, University of North Carolina (UNC).

The target of addressing Quality and Safety in Extreme Adversity (QSEA) was initiated by conducting a scoping review to identify challenges, gaps, and improvement measures for quality and safety in FCV settings. This review was conducted by researchers at the UNC in coordination with WHO-EMRO. In parallel, WHO-EMRO led a joint qualitative assessment of the situation in seven countries within the EMR facing emergencies (5).

The outcomes of these efforts were comprehensively described in a drafted action framework to address QSEA (6). The framework was refined by inputs from a broad range of international, regional and national experts during a first expert consultation held in February 2019 in Muscat, Sultanate of Oman. Thirty-eight experts were involved in the consultation, representing the perspectives of policymakers, healthcare professionals, NGOs’ leaders, frontline health workers, and academicians.

Based on those efforts, a set of tools for improvement has been developed and drafted. These tools were distributed among a more extensive and diverse group of experts at the global level requesting their prioritisation and inputs to refine the tools further and update the drafted framework (7). The QSEA framework was then field tested in selected EMR countries, including Libya and Palestine. A second expert consultation was held in Qatar to refine the QSEA framework and propose an action plan for dissemination across the region.

Furthermore, in the resolution of the 72nd World Health Assembly (WHA), Patient Safety (PS) and quality of health care services during emergencies were given an utmost priority in the global health agenda by holding a WHA side event to address this particular challenge. It came as a response to the urgent need to integrate quality and patient safety concepts into emergency health response during extreme adversity (8).

Moreover, three seminal publications in 2018 have emphasised the need to address quality and safety in emergency settings (3, 9, 10). The WHO-WB-OECD global report affirmed the global consensus that quality health services must be effective, safe, and people-centred, timely, equitable, integrated and efficient (10). Attention to each of these inter-related components is required as countries shape their health systems in the post-COVID era.

In 2021, WHO released a technical package on quality of care in fragile, conflict-affected and vulnerable settings. The package is a product of years of collaboration between WHO-EMRO, WHO-HQ, and UNC. It consists of a document outlining a flexible approach to taking action (11), as well as an accompanying tools and resources compendium (12) containing practical resources to support the implementation of quality improvement interventions in FCV settings.

This proposal is one of the four pillars of ongoing activities to strengthen health systems in FCV and extreme adversity settings that aims to ensure the provision of quality and safer care in FCVs. The three other pillars aim to ensure standards health services delivery norms are set and defined among health [partners serving FCV countries, allow expansion of service coverage, by quickly scaling up a package of minimum interventions and improve effectiveness and efficiency in health services delivery among health cluster partners.

It will focus on developing health system resilience in emergencies from the lens of quality and patient safety as priorities.

The aim is to develop a WHO-EMRO-led training designed and delivered in collaboration with WHO-HQ, WHO-WHE department, HSEL, and UNC. The objectives are:

• To undertake a Training Needs Assessment (TNA) in countries that face extreme adversity settings in the Eastern Mediterranean Region (EMR)
• To identify priorities for training based on the TNA outcomes
• To devise training materials and content that cover the identified priority areas concerning quality and safety in FCV settings
• To design and provide the training as TOT to a selected number of participants from different emergency countries within the EMR
• To collect feedback and evaluation of the training materials and explore opportunities for its rollout and dissemination in other regions

3. Planned timelines

Start Date: 5 June 2022

End Date: 5 December 2022

4. Work to be performed

The project will incorporate different expertise, including WHO experts as well as frontline health professionals. The proposed TORs are:

Output 1: Training needs assessment on the skills related to Quality and Safety in Fragile, Conflict affected and Vulnerable (FCVs) settings

Task 1.1: conduct literature review at the regional and local levels, as well as relevant global literature

Task 1.2: To review local policy documents and briefs when available in countries that face emergencies in the EMR

Task 1.3: develop a survey and distribute among frontline health professionals, policymakers, and experts in the field of public health emergencies, quality, patient safety, and health system development

Task 1.4: collaborate/ liaise with WHO and other selected partners, including the Global Health Cluster Groups, IOM, UNICEF, international NGOs, and humanitarian aid agencies to validate the identified the quality and safety in FCV priorities

Deliverable 1: report on the TNA analysis outcomes that includes a narrative synthesis from the literature and policy review outcomes, expert consultations, and survey outcomes. A thematic analysis will be applied to group the identified gaps and needs.

Output 2: Training course on Quality and safety in FCVs

Task 2.1 Design the training structure: the analysis results will be the core target of the proposed training course. develop modules to cover the identified needs across the countries. A flexibility aspect will be considered to contextualise the training according to each country’s needs.

Task 2.2 Develop of the training content and materials: the TNA results and the literature review will feed the content of the training modules as per the needs. The content will cover quality and patient safety priorities and link those priorities with the broader aspect of health system building blocks and existing frameworks.

Task 2.3 propose training methodologies in consultation with experts in health education to identify the most effective tools and methods to deliver the training modules and intended outcomes.

Deliverable 2.1: Training course material that includes clear guidance on the recommended educational methodology as well as trainees’ evaluation

Output 3: Validation of the content and methodology of the course material

Task 3.1: conduct a TOT course to validate the training content and educational methods before rolling out to a broader audience. liaise with relevant countries across the EMR to nominate potential trainees. This initial TOT will be considered as a pilot test for validation.

Task 3.2: update the course structure, modules, and content if needed based on the feedback from the pilot test. A final version of the training will be proposed by the end of this stage to be ready for dissemination.

Task 3.3: Coordinate with countries’ representatives and field experts across the project to propose a dissemination strategy for the TOT course,. conclude the efforts by proposing dissemination strategies to roll out the training across the EMR as per the need.

Task 3.4: conduct an expert consultation with an advisory group to validate the course’s final structure, materials, content, and dissemination strategies in collaboration with WHO and partners across the region and globally.

Deliverable 3.1: Validate training course material on Quality and Safety in FCVs

Deliverable 3.2: Establish plan of action for the roll out of the course across emergency countries in the EMR

Deliverable 3.3: Submit Consultancy final report

5. Technical Supervision

The selected Consultant will work on the supervision of:

6. Specific requirements

- Qualifications required:

University Degree in Medical Science or equivalent in related fields (health management) for lower end of range at Band B level or Master’s degree for higher end of range at band B level.

- Experience required:

5 years’ experience on Patient safety and Quality of care and external evaluation of healthcare institutions. as well as work on quality in emergency settings for lower end of range at Band B level and 7 to 10 years of experience for higher end of range at band B level

- Skills / Technical skills and knowledge:

Excellent knowledge of Patient Safety Friendly Hospital Frameworks (PSFHF)

Skills in conducting PSFHF manual survey

Skills in conducting surveys on health care institutions as per the PSFHF Standards

- Language requirements:

English and/or Arabic (Read - Write - Speak / Expert or Intermediate)

7. Place of assignment

Where is the Consultant expected to perform her/his work (please pay particular attention to the visa requirements if any) Consultant will be working remotely – Does this require travel? NO

8. Medical clearance

The selected Consultant will be expected to provide a medical certificate of fitness for work.

9. Travel N/A

No travel will be required, and the consultant will be working remotely.

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.
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• 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.
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