TERMS OF REFERENCE. Development of Referral Pathway guidelines on health services for children detected with impairments or disabilities

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1 TERMS OF REFERENCE I. GENERAL OVERVIEW: Title of Program: Title of Project: Title of Consultancy: Mother and Child Health (MCH) Inclusive Healthcare (IHP) Development of Referral Pathway guidelines on health services for children detected with impairments or disabilities II. CONTEXT: Presentation of HI program: Handicap International (HI) is an independent and impartial international aid organization working in situations of poverty and exclusion, conflict and disaster. Our actions focus on the prevention of disabilities and the provision of support for people with disabilities, to respond to their essential needs, improve their living conditions and promote respect for their dignity and their fundamental rights. Presentation of HI MCH program: In 2006, HI conducted a survey of 500 families with children with disabilities and 500 families without children with disabilities in Siem Reap and Takeo provinces. Data was gathered on disability demographics, types of disabilities, suspected causes of disability and use and attitudes related to health system. With this research as a base, HI began to meet with the government and civil society health and disability partners to identify areas of greatest needs and impact. It was decided that focus should be on improving the knowledge and capacity of the local health structures and communities in identifying danger signs of disability and common types of disability, as well as, the development of a referral system. In 2007, a first project ( Happy Child ) was launched and a draft early detection curriculum and training manual was created. Trainings were initiated in Siem Reap and Takeo provinces within the health structures, as a first step in increasing the awareness and knowledge about disability. This project is still running in Siem Reap province. In 2009, the trainings and tools were updated to include comprehensive early detection and early intervention (play stimulation and home-based care) trainings for health structure staff from the provincial level down to the community health centers and village health volunteer level. IEC materials were developed and community awareness sessions were initiated. Since that time early detection and intervention capacity has been transferred to other partners including Ministry of Education, Ministry of Social, Veteran and Youth Affairs, Cambodian Red Cross, commune councils and other NGO partners. 1

2 From 2011 to 2012, HI in collaboration with the Ministry of Education and the Global Partnership for Education conducted a nation-wide disability prevalence study on Cambodian children 2-9 years old. Findings from this research showed that 1 out of every 10 Cambodian children has a disability and that cognitive, hearing and speech where the most common types of disabilities. Anecdotal evidence from the research and from the field activities demonstrated that while awareness and knowledge on disability is improving in HI s target areas, service capacity is being out-paced by demand. That is to say that, while many parents are more willing to take their children for assessment/screening and services, health structures and their staff are still lacking in their ability to identify mild and moderate disabilities and make the appropriate referrals. Additionally, it has been noted that primary eye and ear care services at the health center level would greatly improve accessibility and reduce the quantity of permanent sensory disabilities. In March 2013, HI launched the Inclusive Health Care Project in Kampot and Kampong Thom provinces, funded by GIZ. The projects focus on four thematic areas: 1. Early detection: Capacity building of health structure staff on early detection concepts and on screening under 6 years old children to detect impairments and disabilities. The screening is conducted at health center and school by trained health center staff. 2. Early intervention: Capacity building of health structure staff on early intervention concepts and referral of detected children to services that can prevent or mitigate the impact on their long-term development and function. 3. Community empowerment: empowerment of targeted community (women, youth and general population) to demand appropriate health services especially for their newborns/children from local public and non-profit health service providers. 4. Advocacy and mainstreaming: mainstreaming disability awareness, rights, and early detection and early intervention into government partners, development partners as well as community. Through the project, Services Directory has been developed in Kampot and Kampong Thom in 2013 and updated in 2014, and distributed to health centre staff to provide clear referral options for the most relevant and frequent impairments detected. An external evaluation has been conducted at the end of 2014, which showed the extent to which the project was appreciated within the health structure and communities and the excitement of the operational district (OD) and health center (HC) level. However, the evaluation emphasized the need to improve the referral system and pathways to disability related specialized services and potentially reinforcing provincial level intervention opportunities. 2

3 Justification for calling upon a consultancy and problems intended to solve: Although the current services directories give an overview of the existing and available health services for certain common impairments at an affordable price and distance (such as cleft lip or palate), the management of some impairments such as hydrocephaly or intellectual impairments remains challenging and costly. The referral system for children detected with impairment at health centre level needs to be better defined, organized and better known by those who refer. This will motivate the parents by providing them with concrete information in terms of the next referral steps and what are the practical information needed to be able to practically plan the referral visit. HI is thus calling upon 3 consultancies to develop a comprehensive tool set for referral and early intervention which can guide more efficiently the referral towards medical, physical and community based rehabilitation services for children under 6 as a guide for health structure, village health support group and commune councils in effective referral decision (a copy of the developed services directory can be made available upon request): 1. Referral intervention pathways (institutional and community based): medical and physical rehabilitation 2. Referral intervention pathways (institutional and community based): community based rehabilitation (with a focus on social, educational and home/ community based rehab services) 3. Practical client-centered referral directory development on the basis of the referral pathway guidelines and creation of a web based application These Terms of Reference detail the 1 st consultancy only. The health referral pathways will prioritize referral for neonates but will also include referral options for children up till 6 years old. Referral options will be thought essentially in Phnom Penh and Siem Reap provinces but as well in Kampot and Kampong Thom. There is a need to map out common types of referral options for detected children in order to confirm the disability or impairment by a professional assessment at the closest competent referral level and eventually to propose or refer further to existing rehabilitation services if indicated. Complementary to this, it is necessary to map out the needed medical and physical rehabilitation interventions for common types of impairments like club foot, hydrocele, cleft lip and palate, hydrocephalus which have services available at regional and national level institutions. In order to make the referral more effective, also more practical information needs to be collected on each service provider like cost and exemption systems. The referral intervention pathways needs to define: the type of institution needed, where they are in Cambodia, the type of intervention or interventions package, the options, the number of repeat visits, the total duration, the expected cost range, targeted outcome, but also the ideal age, the urgency of intervention, the effect of non-intervention in order for the 3

4 parent to be able to make an informed decision on starting the referral or not. Information will be gathered through: collection of international good practices, interviews with all referral options and through the case studies developed in 2014/2015 by HI. Based on international experience and guidelines in resource poor countries similar to Cambodia, each pathway will also indicate, when possible, to which level this service should preferably be decentralized in the (far) future in order to improve access while still being able to guarantee optimal quality of services. This information can then be used by the Ministries concerned for future planning purposes. The pathways are needed, not only to make the referral itself more efficient and to define some technical aspects of service quality standard at the referral level, but also for the parents to know what they can expect as a service, as the potential outcome/benefit of non(referral) but also to be able to estimate things like the opportunity and transport costs to the family to achieve this. III. DESCRIPTION OF THE REQUIRED SERVICE PROVISION: Objective of the assignment: To develop a referral pathway guideline on existing health services available for children with impairments in Cambodia. Requirements regarding the methodology: Before starting the assignment, the selected consultant will be oriented and supported by the MCH team, and will be provided with documents to review (end of project evaluation, service directories, case studies but also literature review of documentation on referral pathways, international good practices ). Expected tasks of assignment: To achieve the above objectives, the consultant/ consultancy team is expected to perform the following tasks: 1. Select a list of common impairments/referrals for neonates and children under 6, based on prevalence and the existence of rehabilitation services linked to the 4 provinces. 2. Provide a detailed work plan to HI team. Accordingly, the consultant will coordinate and facilitate meetings with relevant hospitals, clinics and services to discuss and collect referral services information for children with disabilities. An HI staff will be made available to support in setting appointments and collect information. 3. Develop a set of referral intervention pathways for neonates and under 6 children detected with impairment and for common types of impairment, based on international standards / good practices and later checked by key stakeholders involved locally. This will happen in close collaboration with WHO in order to assure format conformity and complementarity with what the DRIC is sponsoring through WHO. 4

5 These pathways also need to be checked and approved by the respective Ministries responsible for the service. This will therefore be supervised by an inter-sectorial committee organized by DAC with HI and UNDP support but for the health services will also be approved by the working groups. 4. A workshop with senior level clinical and MoH staff (MoH, PHD, PRH) and with WHO and DAC/ CDPO will be organized on the basis of the draft manual on the referral intervention pathways. Their feedbacks will then be incorporated back into the report. 5. On the basis of the manuals, a simple training package will be developed, to be incorporated in the Early detection and Early intervention manuals developed by HI. Consultation with HI MCH team should be made when necessary. IV. SERVICE DURATION AND LOCATION: Start date & End date: The consultancy is expected to start from 3 August and shall be completed by 18 September with all deliverables submitted. The total duration of the input is estimated at 25 working days. Location: The assignment is based in Phnom Penh, with travels to Siem Reap, Kampot and Kampong Thom provinces. V. INDICATIVE WORK SCHEDULE: No Tasks Period Responsibility 1 Call for expression of interest 29 June 19 July 2015 HI 2 Selection and contracting 20 July 31 July 2015 HI Briefing meetings with HI team (can be done over skype) on purpose of consultancy Literature review Propose a list of common impairments/referrals for neonates and children under 6, based on prevalence and the existence of rehabilitation services linked to the 4 provinces (can be done by distance) Submit a work plan defining meetings with health stakeholders for referral pathway development Organizing meetings with various health stakeholders (hospitals, clinics, physical rehabilitation centres ) to discuss and collect 3 August HI and consultant 7 August Consultant 10 August Consultant 31 August Consultant 5

6 referral services information for children with disabilities Organise a workshop with senior 2 September Consultant level clinical and MoH 7 staff (MoH, PHD, PRH) on the basis of the draft manual on the referral intervention pathways and incorporate their feedbacks Submit draft training guidelines to 4 September Consultant 8 be included in the Early Intervention training manual and draft referral pathway manual. 9 Submission of all final deliverables 18 September Consultant This schedule is indicative and can be modified by the consultant/ consultancy team in their proposal. Some of the tasks can be carried out from a distance and do not require being in country. VI. REPORT/DELIVERABLES: By the end of consultancy date, the consultant is expected to submit the following deliverables: 1. One short report detailing the activities undertaken towards developing the manual 2. Referral pathway manual in English 3. Training guidelines on referral pathway in English 4. Dissemination workshop to key stakeholders 5. A presentation to HI MCH team VII. CONSULTANT S PROFILE: The consultancy will be carried out by an expert or a team of experts. The expert or the team of experts should combine the following skills, experience and knowledge: Knowledge in mother and child health and childhood development. Knowledge in disability. Experience in working with Cambodian health system. Familiarity with Cambodia and/or Khmer is an asset. Fluent in English. If a team of experts is selected, the consultancy will be put under the responsibility of one team leader chosen among the team of experts. This person will ensure all communication with HI Cambodia office and will be the sole responsible for managing the organization of the consultancy work. The team should comprise national experts and country based experts or international consultants. 6

7 The team leader who will endorse responsibility of this assignment should have the following skills, experience and knowledge: Relevant professional experience in the area of health and disability; particularly early detection, early intervention, and early childhood development. Sound knowledge in clinical terminology/disability-related disease (types of disabilities) Experience in developing services directory/referral pathway. Experience with Cambodian health systems. Fluent in English. Considering the context of the project, in case the team does not include an expert knowledgeable in Khmer, interpretation will have to be considered and will be part of the budget proposed. This consultancy is a part of several other consultancies planned 1 for, relating to: - Review of Early detection and Early intervention screening tools and protocols - Review of Early detection and Early intervention manuals - Development of community based rehabilitation (CBR) referral pathways - Development of a web-based application of a referral directory Consultant/ Consultancy teams are highly encouraged to answer to more than one consultancy at once. Especially, links with the consultancy for the development of community based rehabilitation (CBR) referral pathways are highly encouraged. VIII. BUDGET AND SCHEDULE OF PAYMENTS: The maximum budget available for this consultancy is at Euros. The consultant should present a financial proposal with a breakdown of all the costs incurred (professional fees, living allowances, accommodation, communication, local transport, interpretation fee, etc.) International plane tickets (if required), and others costs related to the activities of the consultancy objectives (such as fees associated to meetings with health stakeholders) will be borne directly by HI. The consultant will be paid through a lump sum amount which is all costs & tax 2 inclusive, Note that the contract price will be fixed regardless of changes in the cost component. Payment will be made as follow: 1 ToR published at the same of this consultancy or to be published by end of July 2 Depending on the status and the place of fiscal registration, Handicap International may have to declare all of the Consultant s services to the relevant tax authorities. For consultant and/or company located in Cambodia, the Cambodian law will apply and the tax will be withheld as per the law. 7

8 Thirty per cent (30%) after the signature of the contract by both parties; Forty per cent (40%) after the submission and the acceptance of the draft report; Thirty per cent (30%) after the submission and the acceptance of all final deliverables. IX. APPLICATION PROCESS: Documents requested for the submission: A technical proposal including a brief cover letter and understandings of the assignment On the basis of the proposed timetable laid down in these Terms of Reference, the applicant must set up a detailed work schedule for the performance of the service. The work schedule must clearly specify the manner in which the Consultant will approach the activities required to perform the service. CV, list of similar experiences/assignments highlighting those focused on early detection Scan of a national identity card or passport (> 9 months still valid). Two references relevant for the assignment. Relevant examples of International or National key documents (consultancy report / publication) relevant to this assignment. Elements of evidence proving the legality of its activity (copy). A budget breakdown for the consultancy Evaluation of the expression of interest will be made through a selection committee only if complete application is received. Criteria to select the best application will be based on quality of the methodology, realistic work plan, relevance of previous experiences, demonstrated expertise of the applicant(s), and coherency of the financial proposition. The complete application should be sent to: and The deadline for the submission of the application is the 19 July 2015 at 05:00PM. Applications submitted after the deadline will not be considered. Only short listed candidates will be contacted. Selected applicants may be invited for (a phone/skype) interview. Handicap International is committed to protect the rights of the children and beneficiaries from sexual exploitation and abuse. HI contractor(s) engage themselves to comply with HI institutional policies in this domain. 8

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