Moldova Health Service Delivery Indicator Survey
Terms of Reference
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.
The World Bank seeks to recruit a clinical expert consultant to provide analytic and implementation capacity to the Service Delivery Indicators team of Moldova, in support of the survey tool adaptation, training of enumerators, and piloting. This individual will serve as the survey team’s clinical expert, with expertise in the Moldovan health system. The bulk of the work for this consultant will be in adaptation of the clinical aspects of the standard SDI modules to the context and needs of Moldova, leading the enumerator training of these clinical parts, and piloting of the tool (and implementing resulting edits). In particular, a key part of this work will be to review and adapt the standard clinical case simulations (“vignettes”) to reflect Moldovan guidelines and clinical practice, and to develop training materials and field manual sections for enumerators on these materials.
C. Scope of work
Among others, specific tasks will include:
- Working with the survey manager consultant, contribute to the adaptation of the survey tool to fit the context of Moldova (with a special focus on the vignettes), including leading the examination of national and international health protocols/guidelines and medical training documents (including liaising with the MoHLSP to identify these protocols/guidelines), seeking the feedback of experts on the adaptation of the tools, and incorporating the relevant changes requested by the MoHLSP counterparts and the World Bank team;
- Review the entire survey tool to ensure consistency of medical terminology across all modules and that all questions are relevant to and comprehensible by clinicians, facility managers, and pharmacy staff (who will be responding to the survey);
- Design and develop the enumerator/supervisor training (including PowerPoint presentations, role-playing exercises, and tests of enumerator comprehension) for the vignettes and other clinical items (such as how to identify medical equipment and supplies and test their functionality, how to identify medications and determine their expiration dates, among others);
- Adapt the field manual (printed guide for enumerators to reference during field work) draft provided by the World Bank to incorporate detailed information on how to administer the vignettes, how to respond to questions from health providers that may not appear in the vignettes, how to identify and test the functionality of clinical equipment, how to identify and observe expiration dates for medications, and other aspects requested by the MoHLSP counterparts and the World Bank team;
- Work with the selected survey firm and the survey manager consultant to ensure that both the clinical enumerator/supervisor training and clinical field manual components (developed by this consultant) are incorporated seamlessly into the rest of the training materials and field manual materials;
- Revise vignettes and other clinical items of the survey tool described above based on conclusion of the piloting;
- Other related tasks, at the direction of the Task Team Leader.
D. Specific Products in relation to the Scope of Work
- Adapted clinical survey modules to the context of Moldova (with a particular focus on the vignettes), and assurance of relevance and appropriateness of questions and language
- Finalized sections of the field manual (reference guide for enumerators) describing how to accurately administer the clinical components of the survey (such as vignettes, presence and functionality of equipment and supplies, and medications, among others)
- Finalized training materials (including but not limited to PowerPoint presentations, role-playing exercises, and tests of enumerator comprehension) to train enumerators to administer the vignettes and other clinical aspects of the survey
- Incorporated/harmonized field manual sections and training materials developed by this consultant with the rest of the field manual sections and training materials to create a complete and comprehensive set of materials
- Implemented changes to the survey tool based on the findings of the pilot
- Technical guidance on all aspects of survey development, enumerator training, and implementation
- Diploma: Medical degree with experience in development research and fieldwork
- Experience: The consultant should have at least 3 years of experience in development research, health facility surveys, survey tool development/adaptation, training, piloting, and familiarity with health service delivery in Moldova. Specific experience with clinical vignettes would be an advantage. The consultant must be a self-starter and able to independently problem solve.
- Language/writing: The consultant selected must have exceptional written Romanian skills and excellent English communication skills.
- Teamwork capacity: The ability to work effectively in a team is essential, as is the ability to deliver under the constraints of tight deadlines with colleagues of varying backgrounds and experiences.
F. Time Frame and Payments
5 clinical vignettes
Four weeks after contract start
Clinical training materials and clinical field manual sections incorporated with rest of training materials and field manual sections
Two weeks after clinical vignettes accepted by MoHLSP and WB
5 clinical vignettes revised based on conclusion of piloting
No more than two weeks after the end of the piloting and not later than March 31, 2020
The deliverables should be delivered in electronic version (MSWord).
The contract will commence immediately and terminate on March 31, 2020. The work shall be carried out in 25 working days. Extensions for additional days are possible depending on the needs of the project
The daily rate based on past professional experience, place of residence / work and the responsibilities of the position. This rate will be determined independently by the Human Resources Department of the WB. The consultant may work on weekends.
G. Reporting arrangements
The consultant will report to the lead for this activity, Adrien Dozol, and Kathryn Andrews.
In addition, the consultant’s full engagement with MoHLSP, and other relevant stakeholders, will be facilitated, as needed, by the World Bank team.
H. Intellectual property
The World Bank solely and exclusively owns all rights to any work created under this agreement, including all data, documents, information, copyrights, patents, trademarks, trade secrets or other proprietary rights made during and for the work to be carried out within this contract. The consultant is not allowed to publish (electronically or in print) any information related to the project without the explicit permission of the SDI Team.
Only applications received by Sunday, December 29, 2019 will be considered.