PURPOSE OF CONSULTANCY

In collaboration with the Ministry of Health and Medical Services and WHO Representative Office the consultant will provide technical support to improve screening and management of diabetes and diabetic foot at primary care facilities by further developing and scaling-up the diabetes and foot care primary care assessment and planning guidelines and supporting facility and national planning

BACKGROUND

In the context of NCDs, the WHO Country Office (CO) in Solomon Islands supports implementation of strategies that address access to services, determinants of health, and availability of essential medicines and devices for primary health care. The WHO CO NCD Team provides support to the MHMS and in the context of technical and administrative support to the Noncommunicable Diseases (NCD) programme and related assignments. Additionally, the WHO CO NCD Team coordinates activities to strengthen NCD prevention and monitoring of key NCD risk factors. The team collaborate closely with key partners across and outside the MHMS.  In 2023, an assessment and planning approach to screening and management of diabetes and diabetic foot was developed and tested at primary care facilities; data were collected to begin the process of local planning and action to address practice gaps.

The objectives of the project are:

1.    Support analysis and interpretation of facility data from the first national diabetic and diabetic foot screening review – and summarize data for national planning;
2.    Support provincial and national 12-month diabetes primary health care planning using assessment data with provincial NCD coordinators and other stakeholders; develop follow-up plans for tracking progress and improving systems support;
3.    Develop clinical coaching guidelines to support early screening and management of diabetes, diabetic foot and foot wounds;
4.    Support introduction, scale-up and monitoring of clinical coaching for diabetic screening and management at national and key primary care facilities;
5.    Finalize and write national guidelines for diabetes and diabetic foot assessment and planning; and clinical coaching guidelines for diabetes and diabetic foot screening and early management.

DELIVERABLES

The Consultant will be under the supervision of the Technical Officer (NCD) and will receive guidance of the WHO Representative.

Method/s to carry out the activities:

Support the review of the status of outpatient diabetes screening and management practices by local facility teams using standard checklists;
Use of data to develop 6-12 month facility plans;
Develop clinical coaching guidelines for screening and early management of diabetes and diabetic foot;
Conduct field testing of clinical coaching methods and checklists;
Conduct coaching in small groups using coaching checklists;
Training of hospital facilitators to conduct coaching.

At the National level, the Consultant will review a summary of facility findings with key stakeholders.
Use findings to inform 1-year diabetes scale-up planning.
Develop plans for introduction and scale-up of the national approach to reduce diabetic case-load, including systems strengthening activities and clinical coaching.
Train national facilitators to support sub-national facilities.

Output 1. The consultant will support training of facilitators and multi-stakeholder teams in diabetes assessment and planning methods and tasks at focus facilities.
Deliverable 1.1 : Adapt the checklists and develop the methodology and facilitator guide for coaching for diabetes and diabetic foot screening and management.
Deliverable 1.2    : Ensure appropriate materials are procured including relevant simulated foot types.
Deliverable 1.3    : Conduct small scale tests within National Referral Hospital (NRH) Outpatient Department, diabetes center and surgical ward with only a couple people on individual sections of the facilitator coaching guide and revise and repeat until each section is effective and has no glaring problems.

Output 2. Completion of diabetic audit checklists and reviews of outpatient services;
Deliverable 2.2 : Conduct five test-revise cycles of field-testing of the full facilitator coaching guide in the 5 facilities contributing the largest number of amputations to NRH to ensure maximal effectiveness of the coaching and remedied major methodological problems. After each test, the incumbent will identify areas needing improvement, suggest track changes and discuss with the team for final changes.
Deliverable 2.3 : During these tests in NRH and Honiara City Council (HCC), and subsequently at provincial hospitals, identify potential persons who could be certified coaching facilitators.

Output 3. Observation of environments and practices for diabetes management.
Deliverable 3.1 : Support 10 national and within each province 2 persons to pass the certification test which includes:

• The skills demonstration and written exam of the coaching course
• The half-day national facilitator training course, and
• Facilitation of at least 2 supervised coaching courses.

Deliverable 3.2    : Establish test-revise cycles while backstopping certified facilitators to introduce coaching to every provincial hospital first and subsequently to reach of the five largest area health centers within each province.
Deliverable 3.3    : Adapt the checklists to include immediate problem solving and development of 100-day plans in 10 facilities including test-revise cycles.
Deliverable 3.4    : Coordinate national facility-based assessment and make recommendations for quality improvement including changing practices and environments immediately and with 100-day plans.
Deliverable 3.5    : Ensure that diabetes and foot care coaching and systems support activities are coordinated, planned and managed in collaboration with national, sub-national and facility staff (including support selection of focus facilities, coordination with facilities, integration into ongoing quality improvement activities, development and budgeting of activity plans for diabetes foot care coaching and quality improvement)

Output 4. Summary report of the main findings.
Deliverable 4.1    : Summary report each month which will include the followings:

• Compiled findings from the totality of the efforts
• Draft Facilitator Coaching Guide
• Comparison of findings pre-post coaching and at follow up

QUALIFICATIONS, EXPERIENCE, SKILLS AND LANGUAGES

Educational Qualifications: 

Essential: University degree in podiatry, medicine, public health or related health studies.
Desirable: Master’s degree in podiatry or in public health from a recognized university and/or training/s in public health at postgraduate degree level or its equivalent.

Experience  

Essential: At least five years of relevant experience in working in podiatry, data analysis and data quality, and coaching on diabetic foot care.
Desirable: Relevant experience in implementation of noncommunicable diseases programmes, especially in diabetes and diabetic foot care areas giving experience for implementing the TORs. Previous experience at the field level in developing countries, particularly in Pacific countries is an asset.

Skills/Knowledge: 

•    Knowledge of the specific or technical area of noncommunicable diseases programmes.
•    Diabetes and diabetic foot care planning at operational, subnational, and national levels, with political and technical elements.
•    Capacity-building through multiple methods, including training, mentoring and example setting.

Languages:

Expert knowledge of English

LOCATION

On site: Honiara, Solomon Islands

TRAVEL

The Consultant is expected to travel to the country according to the itinerary and estimated schedule that would be agreed with WHO Country Office. A frequent domestic travel is required for this consultancy.

REMUNERATION AND BUDGET

a.    Remuneration: Payband level B- USD 7,000 – 8,000
b.    Expected duration of contract:  10 months, 1 March to 31 December 2024

Additional Information:

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