Terms of Reference
Moldova Service Delivery Indicators (Health)
The Government of Moldova places strategic importance on health. Given the rapid epidemiologic and demographic transitions underway, the Ministry of Health, Labor and Social Protection (MoHLSP) and the World Bank (WB) want to ensure that Moldova’s health facilities are prepared for the changing burden of disease and that services are of good quality and are responsive to the needs of the population they serve. The MoHLSP, in partnership with the WB, is undertaking a survey to measure health facility quality and capacity across the country. This survey will not only inform the plans of the MoHLSP, but also, will provide key insights for World Bank work in the country and region.
Service Delivery Indicator (SDI) surveys generate nationally-representative data on the quality of health services. The data that are collected generate a platform for social sector accountability and benchmarking of results, within and across countries, and over time. Since the inception of the program in 2010, 24 surveys have been completed in 12 countries in Africa, capturing the health and primary education service delivery experience of over 500 million people. The surveys now extend around the globe: data collection for the first SDI surveys in Latin America (Guatemala), East Asia/Pacific (Indonesia), and Middle East/North Africa (Morocco), and South Asia (Bhutan) are currently underway.
The health SDI in Moldova will measure service delivery across all levels of primary health care providers in the country, with a special focus on measuring:
(i) Providers’ knowledge: Are health care providers accurately diagnosing and treating common health conditions, adhering to MoHLSP clinical guidelines?
(ii) Providers’ effort: Are health care providers present at their facilities during their shifts? Are providers seeing a high number of patients each day? Are providers proactively addressing risk factors in their catchment areas?
(iii) Inputs: Do health facilities have the equipment (e.g., medicines, infrastructure, supplies) and resources they need to deliver high-quality care? Are providers receiving adequate on-the-job training?
The Moldovan health team, in collaboration with the Human Development Chief Economist’s Office, will implement a health SDI survey in 2020. This survey will be the first SDI to take place in the Europe Central Asia region and will therefore require special considerations and adaptation of the standard SDI tools. The team will engage in groundbreaking work that will be used to guide future health facility surveys in similar settings.
2. Scope of work
The consultant will provide oversight and technical guidance at all steps of the survey, which will be implemented by a survey firm. This section describes the survey; the consultant must serve as an on-the-ground technical advisor to the firm, leader during training and pretesting, and liaison between the World Bank and firm, ensuring that communication goes smoothly, and any bottlenecks are addressed. During the development of the survey tool, field manual and training material, the consultant will liaise with the clinical expert consultant and will incorporate his/her deliverables into the broader set of survey materials.
The firm will conduct surveys in health facilities using the SDI survey methodology in the selected sample. The sample will include facilities at multiple levels, including Centrul de Sanatate (CS - Health Center), Oficiul Medicului de Familie (OMF – Family Doctor’s Office), Oficiu de Sanatate (OS - Health Office), Cabinet Individual al Medicului de Familie, and pharmacies. The list of facilities to be surveyed will be provided by the World Bank and MoHLSP team.
The survey instrument is comprised of 5 modules (as described in Table 1 below) which will be administered by 3 enumerators per facility (including one Supervisor). Each survey is expected to take 1.25 days, allowing for movements to and from facilities. There will be two visits per facility in the sample: (i) a first announced visit; and (ii) a second unannounced visit done at least 3 full working days after the announced visit.
Table 1: Health SDI instrument overview
In support of this objective, the following tasks/activities will be undertaken by the consultant:
1. Completion of the adaptation and finalization of the survey tool. A draft version of the tool will be provided to the consultant by the WB SDI team. The consultant is responsible for taking a leadership role in convening experts from various disciplines and in revising the survey and liaising between the survey firm, the clinical expert contracted for the SDI project, and the MoHLSP to ensure that all parts of the survey are adapted and approved by the relevant MoHLSP departments. The consultant is responsible for quality assurance of all details of the questionnaire. The consultant must also format the survey tools so that they are easy-to-use and visually-appealing in both CAPI and paper forms. At least some parts of the survey draft will be in English and translated into Romanian, and the consultant is responsible for ensuring that the translation is completed accurately by the survey firm. The tools must be shared with the WB SDI team for final approval after approval from the MoHLSP.
2. Finalization of the survey manual. The survey manual used for an SDI in another country will be provided to the consultant, and the consultant should lead the revision of the manual to ensure that the manual is adapted to the context of Moldova and to the nuances of the Moldova SDI survey tool. Important additions to the manual will be required to reflect the additions to the survey. The consultant will be responsible for ensuring that the survey manual is easy-to-use and visually appealing to users. The manual must be shared with the WB SDI team for final approval, and any edits incorporated accordingly.
3. Facilitate the transfer of materials and knowledge from the WB SDI team to the firm, including facilitating transmission of the Tablets from the SDI team to the firm. Some survey materials may be shipped from the World Bank offices to Moldova, and this consultant is responsible for ensuring that the materials are accounted for and transferred to the firm for use.
4. Facilitation of communication between the firm’s CAPI experts and the WB’s CAPI experts in adapting the final CAPI tool, eliminating any glitches in the program.
5. Support and leadership of some aspects of the training of supervisors and enumerators and pretesting of the survey tool in the field.
6. Ongoing review, in real time if possible, of the data transmissions provided by the firm. The consultant will be responsible for reviewing the data provided by the firm to check for quality, reporting back key messages back to the WB SDI team. The consultant will be responsible for supporting the firm in addressing any quality issues identified by the WB and MoHLSP.
7. Pre-empt potential bottlenecks in survey design and implementation and bring them to the attention of the WB SDI team and the MoHLSP so that they can be addressed immediately.
8. Quality assurance of the final survey dataset produced by the firm, including liaising with the firm staff to implement any relevant changes to the data to ensure quality, and ensuring that the translation of the survey results into English (after data collection is complete) has been completed accurately by the firm
9. Interpretation of the data resulting from the survey, which will be presented in report, presentation, and policy brief form. This includes careful review and quality control of materials produced in Romanian (including but not limited to a report, presentation, and policy brief).
Deliverables/specific outputs expected from consultant
1. SDI survey tool that is finalized and adapted to the context of Moldova, and deemed satisfactory to the MoHLSP and WB
2. SDI survey manual that is finalized and adapted to the context of Moldova, and deemed satisfactory to the MoHLSP and WB
3. Training of supervisors and enumerators
4. Weekly review of data quality, identification of data quality issues and proposed way forward
5. Data cleaning and data analysis, including figures and tables for survey report, presentation, and policy brief
6. Capacity-building presentations/materials on survey methodology, data analysis, and other relevant topics, as needed and deemed appropriate by the MoHLSP and WB.
Schedule of deliverables
The preliminary timetable below outlines the materials and activities for which a report will be forwarded to the World Bank and the dates of transmission of reports and enforcement activities.
Table 2: Schedule of deliverables
Skills and Competencies
1. At least a Master’s degree in a statistical or economics field is required.
2. At least 10 years previous professional experience supervising large-scale surveys is required. Experience with health surveys would be an advantage.
3. Recognized expertise in survey management, with the capacity to coordinate the inputs of many complex stakeholders within the government, university, and civil society, to generate a survey tool and analytical materials of superior quality.
4. Strong experience with quality-control of data is required.
5. Demonstrated ability to independently manage/oversee a survey is required.
6. Knowledge of country and regional context is required.
7. Demonstrated understanding of the health sector in Moldova is required.
8. Excellent analytical skills particularly in data analysis, with demonstrated capability to conduct research independently and as part of a team is required.
9. Familiarity with Stata for microdata analysis is required.
10. Past policy and operational experience, preferably with an international institution, and a proven track record in research, advocacy or advisory work is required.
11. Experience conducting dialogue with or providing services to relevant government agencies in Moldova or countries in the region is required.
12. Demonstrated ability to collaborate with others as part of a multicultural and multidisciplinary team is required.
13. Excellent written, communication and presentation skills in English and Romanian is required.
Period of consultancy
The consultancy will be for 60 days from December 2019 to June 2019 and 10 days from July 2020 to August 2020. The possibility of downstream works exists.
The consultancy will be supervised by the SDI task team leader, in consultation with the appropriate Moldovan government authorities as needed.
The World Bank shall, solely and exclusively, own all rights in and to any work created in connection with this agreement, including all data, documents, information, copyrights, patents, trademarks, trade secrets or other proprietary rights in and to the work. The consultant is not allowed to post or publish (electronically or in print) any project-related information without the explicit permission of the World Bank.
1. SPECIFIC INPUTS TO BE PRESENTED BY THE CLIENT
The WB SDI team will provide draft questionnaires, a field manual used in another setting, WB consultants to create the CAPI program, training materials used in another setting, and sample code and survey reports.
Only applications received by Sunday, December 15, 2019 will be considered.