LOCAL CLINICAL SUPPORT (LCS) LEAD – To integrate quality issues while developing proposals and planning for service delivery in Kenya.

1.INTRODUCTION

The Fred Hollows Foundation (The Foundation / FHF) is a non-profit public health organisation based in Australia, which was founded in 1992 by eminent eye surgeon Professor Fred Hollows. The Foundation focuses on strengthening eye health systems; treatment and prevention of avoidable blindness and visual impairment caused by Cataract, Trachoma, Diabetic Retinopathy, and Refractive Error (R.E). The Foundation operates in more than 20 countries across Australia, The Pacific, South, and Southeast Asia, and Africa. The Foundation was named The Australian Charity of the Year 2013 in the inaugural Australian Charity Awards.

The Foundation in Kenya began working in 2004, partnering with the Ministry of Health (MoH) to deliver comprehensive eye health care in the three hitherto districts (now counties) of Nakuru, Homa Bay, and Migori, evolving to eventually cover 20 counties based on the needs identified in the National Plan for Blindness Prevention (NPBP). Working in partnership with the MoH, The Foundation strives to improve access to high quality eye health services through community empowerment, development of appropriate infrastructure to enhance coverage of effective eye health programmes, and improvement of the quality of eye health workforce education and training through capacity strengthening of health professional training institutions.

The Foundation’s priority is to advocate and work with governments, rural communities, and relevant NGO partners to ensure all people, particularly the poor and the vulnerable, can access necessary quality eye health services. We do this through a health system strengthening approach that ensures sustainability of our programs.

FHF KENYA STRATEGIC OBJECTIVES

The Fred Hollows Foundation Kenya Country Strategic objectives (2021-2025) are as follows: –

1. Increase equitable and effective coverage of Integrated People-Centred Eye Health Services, with financial risk protection.
2. Improve eye health outcomes by strengthening the quality of cataract and trachoma services.
3. Strengthen the enabling environment for the provision of comprehensive eye health services.
4. Contribute to the elimination of trachoma as a public health problem in the counties where we work in Kenya.

These objectives will be achieved through the following strategic initiatives:-

FHF KENYA STRATEGIC INITIATIVES

1. Strengthening and Expanding Equitable Access to Integrated People-Centred Eye Care.
2. Financial risk protection and coverage through insurance and sustainable financing.
3. Developing Systems, Tools and Policies to Support Clinical and Service Quality.
4. Improving clinical quality and coverage by strengthening the eye health workforce.
5. Eye Health Data Collection and Eye Health Planning.
6. Eye Health Coordination, Leadership and Governance.
7. Kenya Trachoma Elimination Initiative.

The goal of clinical quality improvement is to ensure quality service delivery by all stakeholders involved at all levels including eye health professionals who have been engaged by the national and county governments. Over the years, The Foundation has supported the training of eye health professionals including ophthalmologists, ophthalmic clinical officers and ophthalmic nurses in addition to supporting of eye health manuals and guidelines development and utilisation, supportive supervision, commodity management, infrastructure and equipment development etc with an aim of providing quality eye health service delivery to the communities.

However, adequate supportive supervision and support to the eye care workers has been minimal and ad hoc at best. This is caused by inadequate specialised eye care personnel at the ophthalmic services unit, while the other specialists in the institutions of higher learning are pre-occupied with research and rigorous academic programmes.

The intention is to engage one eye health specialist in public service as a quality lead or as Medical Advisor, for a short period to support continuous quality improvement in the provision of eye services to ensure quality. FHF also provides continuous clinical quality improvement through a medical advisor who provides support to 10 countries in the region and thus the country CQI lead will be an additional resource to provide closer support to promote continuous quality initiatives.

Project Locations and Partners

S. NO

County

Partner Details

1. Busia

Department of Health – Busia County Referral Hospital

2.Taita Taveta

Department of Health – Taita Taveta County Referral Hospital

3.Kilifi

Department of Health – Kilifi County Referral Hospital

4.Siaya

Department of Health – Siaya County Referral Hospital

5.Tharaka Nithi

Department of Health – Tharaka Nithi County Referral Hospital

6.West Pokot

Department of Health – West Pokot County Referral Hospital

7.Turkana

Department of Health – Turkana County Referral Hospital

8.Mandera

Department of Health – Mandera County Referral Hospital

9.Marsabit

Department of Health – Marsabit County Referral Hospital

10.Embu

Department of Health – Embu County Referral Hospital

11.Kisumu

Department of Health – Jaramogi Oginga Odinga Teaching & Referral Hospital

12.Homabay

Department of Health – Homabay County Referral Hospital

13.Meru

Department of Health – Meru County Referral Hospital

14.Makueni

Department of Health – Makueni County Referral Hospital

15.Kitui

Department of Health – Kitui County Referral Hospital

BACKGROUND ON CONTINOUS QUALITY IMPROVEMENT (CQI) on Cataract Quality Care Pathway.

The Foundation has made several efforts in the past to support and improve the clinical quality of cataract surgery, in many countries’ surgical outcomes and other clinical quality parameters are either not measured or fall well below the WHO recommended standards. Achieving health care quality is broader than just clinical outcomes, and must encompass safety, effectiveness, timeliness, efficiency, equity and people centred.

The Foundation has committed to the global strategy to a revitalized focus on quality and developed a quality framework for the cataract pathway and a set of minimum standard guidelines to guide partner facility quality improvements.

The Foundation’s continued quality improvement work begun with the pilot project named Cataract Quality Improvement Intensive Project (CatQIIP), designed and implemented with an aim to develop and test a capacity building methodology for supporting partner hospitals to achieve the long-term goals and outcomes set out in the Cataract Quality Improvement Framework (CATQIF). During this project, the capacity of FHF team members and partners was built in continuous quality improvement. This was supported by formal external training from the Institute of Health Improvement (IHI), Aravind Eye Hospitals and LV Prasad Eye Institute with a series of participatory learning sessions and IHI trained FHF “mentors” supporting partners to implement quality improvement changes within their organizations.

The CatQIIP project was an intensive 14 month mentoring and learning program aimed at increasing equity of eye health services, building partner’s knowledge and capacity in continuous quality improvement, increasing cataract clinical quality, productivity, and cost efficiency, gender equity and inclusion and reducing waste related to cataract surgical services in three pilot countries (Bangladesh, Kenya and Ethiopia with early program participation from China).

Why Continuous Quality Improvement (CQI) in the Foundation’s Programs?

The WHO Vision 2019 report has given much focus on quality and safety health service delivery including IPEC. A continuous quality improvement approach offers various benefits to organizations. At a minimum, as social service entities / service delivery organizations shift to outcomes-based models, data-driven efforts that produce measurable results satisfy funding requirements. Further, it helps to understand process, reduce unintended variation in care, eliminate errors, remove unnecessary steps in our service delivery models, and improve communication and accountability to our beneficiaries and funding organizations.

For The Foundation all these components are important for its work and eye care services delivered through its range of government and non-government partners.

CQI on cataract service pathway can also provide structural and procedural benefits. The benefits of CQI are:

• Improved safety and outcomes for patients
• Improved clinical quality, productivity/efficiency, costs, and environmental impact.
• Team member accountability
• Creativity and solution creation
• Heightened team member morale
• Improved processes, information management, and documentation
• Greater adaptability to changes within project life cycles and overall programs.
• Tools and methods to monitor program effectiveness over the time.

THE PURPOSE OF LCS (LOCAL CLINICAL SUPPORT) LEAD

The Foundation has a responsibility to its beneficiaries and donors to pursue Continuous Quality Improvement (CQI) in all its activities. The Foundation’s Medical Team have developed CQI initiatives, tools and guidelines that need to be disseminated to the partners to ensure compliance and monitored for proper effectiveness.

The LCS Lead will provide consultancy services in provision of advisory services on Clinical quality improvement for cataract services. The consultant, in conjunction with the Foundation’s medical and country office team, will provide technical support to the Ophthalmic teams from partner programmes spread across the country.

SCOPE OF WORK

The LCS Lead assignment is focused on but not limited to the following: –

1. Help improve quality of care for patients who use services supported by The Foundation through its partners.
2. Understand, demonstrate, and promote The Foundations’ strategy on continuous quality improvement and minimum standards (preoperative, intra operative and post operative).
3. Support and follow the implementation of a regular and routine CSOM by all partners and design a system for partners to track and report SUIs (serious untoward incidents)
4. Advise, coach and/or mentor partner clinical staff in their journey in quality improvement.
5. Become an advocate for the quality work and work with partners to present quality improvement achievements to key stakeholders including Ministry of Health meetings.
6. Support a yearly national CQI workshops that may be organized and delivered along with FHF-Kenya country office and medical advisor of the foundation. Follow implementations agreed plans.
7. Help to establish and Support Hospital Quality Teams to fulfil at least two PDSA cycles per year in any domains of quality improvement with focus on clinical quality.
8. Collaborate and work closely with Hospital Quality Champions (HQC) in their respective program areas.
9. Build the capacity of Hospital Quality teams.
10. Support locally led programming, advocacy and funding geared to improve clinical quality initiatives.
11. General advisory role in the medical aspects of Cataract programs and activities and how they can be improved to create impact.
12. Monitoring progress of implementation of SOPs for Cataract management, recommendations by the FHF Regional Medical Advisor (Africa) and to identify the problems that are hindering implementation of the agreed policies / programs.
13. Oversee implementation of policies related to good clinical practice and procedures that need to be carried out with regards to ensuring quality in clinical care
14. Advice on quality Improvement activities; gaps in quality of care, gaps in adherence to care, and opportunities for improvement.
15. Advise teams on evidence-based practices and assessment of innovation and emerging technology.
16. Support partners to conduct some relevant operational research that aimed at service improvement.
17. Review and monitor competence, identification of training and development needs of clinical staff to support provide hands on trainings and mentoring for improved service delivery.
18. Advise and encourage clinician’s participation to add more value and quality to the hospital.
19. Discuss with the teams and document establishment of a quality assurance and improvement strategies for the project.
20. Document and discuss with hospital medical superintendents and County Directors of Health on the agreed recommendations for future follow up.

SERVICES TO BE PERFORMED

Pertaining Quality and standards:

• Guide program team to integrate quality issues, appropriate training including FHFK and FHF strategic tools while developing proposals and planning for service delivery.
  • Plan and support the program team for training of clinical staff of partner hospitals that includes training needs assessments, recommending training programmes, develop plans and schedules including liaison with FHF and partner hospitals.
  • Facilitate partner eye clinics to assess and develop Quality Assurance Systems (QAS) for patient care and safety to that of internationally accepted standards.
  • Support partners to implement CSOM system and periodically review the data for service improvement.
  • Provide oversight/quality assurance system during cataract surgical outreaches / camps.
  • Actively participate in monitoring of quality of care and services, clinical training and recommend areas of improvement.
  • When necessary, assess the skills of eye care team including surgeons and provide when possible or recommend a skill enhancing training or CMEs (continuous medical education) in another institution.
  • Serve as a focal person for matters related to Continuous Quality Improvement (CQI) initiatives on cataract service pathway and serve as liaison for FHF Kenya with key stakeholders including MOH and others. This will involve supporting CQI activities on eye care service delivery in general and on cataracts services in particular.
  • The consultant will have introductory and induction meetings with FHF’s medical advisor to be appraised with current CQI initiatives in the Foundation. Subsequently support other CQI efforts (trainings, workshops, CSOM, supporting MSAT and other relevant tasks) in Kenya. This will be carried out with support from FHF medical team.
• Be ready to build self-capacity through enrollment in quality improvement training including short term (3 weeks) course at IHI (Institute for Health care Improvement), participate in and in time become faculty at FHF supported face to face and virtual CQI workshops.
• Attend and complete 24 weeks FHF’s blended CQI training (presentations and e-learnings).
• The LCS lead will serve as faculty to deliver various trainings to partners pertaining to CQI. S(h)e will closely support partners to carry out CQI tasks including ensuring implementation of facility level CSOM.

Approach:

FHF-Kenya in collaboration with MOH will support the selection of a senior consultant ophthalmologist. The consultant will be serving on part time base (30% of his/her time – approx. 30 days annually) as the local clinical support for Kenya. The consultant will closely work with MOH and the foundation’s country office team and medical advisor.

Deliverables:

The following deliverables are expected from the consultant:

1. A report on the recommended template highlighting recommendations and action plan relating to the scope of work.
2. A tentative work plan detailing how the consultant intends to engage in CQI initiatives.
3. Provide a monthly report on CQI initiatives delivered.

The Foundation will provide the following:

1. Focal person to support in undertaking the assignment.
2. Provide organisational clinical quality policies, minimum standards, essential ophthalmic items list, position statements on cataract services, documents required for desk review.
3. Give feedback on the approach proposed to undertake the CQI initiatives.
4. Provide feedback on draft data collection tools, reports and other deliverables.
5. Advise on the usage of the data collected for service improvements.
6. Support coordination between the consultant and partners during the entire consultancy period.
7. Payment of agreed consultancy fees.

Schedule:

The assignment is expected to start on October 1, 2024, and end on September 31, 2025, for an estimated duration of 30 working days spread out as per below timelines. This will include desk reviews, fieldwork, interviews, and report writing and final presentation to FHF. Data collection will take place in at least half of the project counties agreed between the consultant and FHF Kenya.

Tentative Timeframes:

October 2024 – September 2025 – one visit per project area per quarter (Subject to changes depending on circumstances).

LCS lead qualifications

The LCS Lead will be contracted to a reputable eye hospital or an independent and experienced consultant Ophthalmologist who will work closely with The Foundation staff and MOH in the design and implementation of the CQI initiatives. The Foundation seeks to engage the services of a reputable eye hospital / an independent individual that have the following experiences and expertise in eye health.

• Hospital – with strong policies and procedures on quality and capacity to mentor other hospitals.
• A registered and experienced Ophthalmologist, preferably a subspecialist in one ophthalmology field.
• Strong knowledge and experience working with the Kenyan health care systems and overall understanding of Kenyan health sector policies especially on Kenya quality model for health (KQMH).
• Strong analytical skills
• Ability to work independently, proactively seek information and manage feedback and input.
• Willing to travel to county hospitals.
• Excellent spoken and written communication skills in English and Kiswahili

The following additional skills and experience are highly desirable:

• Knowledge and experience in eye health and a sound understanding of programs and strategies relating to eye health in Kenya.

Confidentiality

The consultant/s agree to not divulge confidential information to any person for any reason during or after completion of this contract with The Foundation. Upon completion or termination of this contract, the consultant undertakes to return to The Foundation any materials, files or property in their possession that relate to the business affairs of The Foundation. The consultant is responsible for safety, security and administration of primary and secondary data collected from FHF or otherwise.

Intellectual Property

All intellectual property and/or copyright material produced by the consultant whilst under contract to The Foundation remain the property of The Foundation and will not be shared with third parties without the express permission of The Foundation. The consultant is required to surrender any copyright material created during the term of the contract to The Foundation upon completion or termination of the contract.

Safeguarding People

The Fred Hollows Foundation is committed to ensuring that its activities are implemented in a safe and productive environment which prevents harm and avoids negative impacts on the health and safety of all people, particularly children, vulnerable people, and disadvantaged groups. The Foundation has a zero-tolerance approach to sexual exploitation, abuse, and harassment of any kind. All personnel including contractors/consultants are expected to uphold and promote high standards of professional conduct in line with The Foundation’s Safeguarding People Policy including Code of Conduct. Contractors/consultants will be expected to sign and adhere to The Foundation’s Safeguarding Code of Conduct and provide any background checks as required.

Insurance

The recruited consultant will be required to have in place insurance arrangements appropriate to provision of the requirements in this Terms of Reference including travel insurance.

Application Procedures:

Consultants who are interested in this assessment project will provide the following application documents in English:

• Application letter for this position.
• The CV/s of proposed consultant / proposal from hospital.
• Financial proposal for the assessment includes domestic travel costs, accommodation.

Individuals interested should submit a cover letter, resume, technical and financial proposals to The Fred Hollows Foundation office in Kenya by 11th November 2024. Please reference “Consultancy for LCS Lead” and send to the following address: [email protected]. Only submissions with complete documents as stated in the Terms of Reference and those meeting minimum requirements will be considered. Qualified consultants may be subjected to a background and child protection checks as a condition for engagement.