TERMS OF REFERENCE (TORS) FOR CONSULTANCY FOR ASSESSMENT OF THE PHARMACEUTICAL MANAGEMENT SYSTEM AND TRAINING

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1 TERMS OF REFERENCE (TORS) FOR CONSULTANCY FOR ASSESSMENT OF THE PHARMACEUTICAL MANAGEMENT SYSTEM AND TRAINING OF STAFF MANAGING PHARMACEUTICAL PRODUCTS IN CHURCH OPERATED HEALTH FACILITIES IN ZAMBIA Summary Assessment of inventory management practice, and compliance to logistics management standard operating procedures Assessment of prescribing and dispensing practices Reporting on findings, successes and challenges Designing and conducting of training for health workers engagement in drug supply management and use Recommendations for on-going on-site support Background/current situation/challenges The Ministry of Health of Zambia and other sectors of public health have invested in the development of pharmaceutical practice in public health.. These investments have been through a variety of mechanisms such as research projects, seminars, talks and short-term training programs. Over the last few years, the MOH and its Cooperating Partners have invested heavily in the strengthening of support services such as logistics and supply chain management. On its part, CHAZ has an established Pharmaceutical and Logistics Support Service to its constituency, accounting for about 30% of the formal health services in Zambia. The MOH, working with its partners including CHAZ, has a vision to create high levels of competence in the provision of services, based on a caring and clean working environment and attitude towards work and clients. Strategies are now being developed to implement these decisions, among which is a need to improve pharmaceutical services in the sector, through a 1

2 national Supply Chain Strategy. To meet the increasing needs of good pharmaceutical and health products management at district and health facility level, a formal model of increasing health facility system capacity and staff skills in a sustainable way is required. A key strategy, which standardizes systems and practice through the use of Standard Operating Procedures, is being pursued. CHAZ will apply this to the districts and health facilities which it supports. Promotion of the Rational Use of Drugs Irrational use of medicines is a major problem worldwide. WHO estimates that more than half of all medicines are prescribed, dispensed or sold inappropriately, and that half of all patients fail to take their medicines correctly. The overuse, underuse or misuse of medicines results in wastage of scarce resources and widespread health hazards. Examples of irrational use of medicines include: use of too many medicines per patient ("polypharmacy"); inappropriate use of antimicrobials, often in inadequate dosage, for non-bacterial infections; over-use of injections when oral formulations would be more appropriate; failure to prescribe in accordance with clinical guidelines; inappropriate self-medication, often of prescriptiononly medicines; non-adherence to dosing regimens. Under this initiative, CHAZ will document medicines use practice and implement appropriate educational and management interventions to promote the rational use of medicines. Logistics Management Standard Operating Procedures With support from the USAID DELIVER Project, Zambia developed SOPs to standardise the management and logistics of Essential Medicines (last revision March 2012). These SOPs are however weak on health facility level drug supply management related to the promotion of the rational use of drugs and other medical supplies. The SOPs are also not rolled out in CHAZ-supported facilities. Under this initiative, CHAZ will train health workers on these SOPs, as well as print and distribute copies to all health facilities. In addition, CHAZ will also implement interventions to improve hospital ward-level supply and use of drugs. SOPs will be adjusted according to challenges identified during assessment/support visits to health facilities. Measurable Changes in Management and Medicine Use Practice 2

3 Capacity development needs to be based on a rigorous scheme of measurements of baseline circumstances and of evidence of changes produced by interventions. In this way, the design of the project will collect and provide evidence on what works and what doesn't. On-the-ground technical support by consultants will help in conducting PSM capacity assessments of health facilities, and facilitate the designing and executing PSM capacity development responses Based on these, CHAZ will set up systems that measure change in PSM capacity over time as support is provided to health facilities and as SOPs are adopted and used. More importantly approached to change management will be implemented using methodologies and approached that are sustainable and that will have long-lasting impact to the system,. 2. Objectives The proposed Consultancy objectives are aimed at meeting these broad goals will be to: 2.1 Assist CHAZ to design an indicator based assessment of health facility medicines storage, prescribing, dispensing/distribution (within health facilities), and use. 2.2 Assist CHAZ to carry out a baseline assessment of medicines storage, prescribing, dispensing and use. 2.3 Design interventions to be employed to address challenges found with regard to the medicines storage, prescribing, dispensing and use. 2.4 Conduct training on interventions and SOPs to be rolled out by CHAZ health facilities. 2.5 Make recommendations on non-training interventions that CHAZ may implement to support PSM performance and promote the rational use of medicines 3. Scope of Work 3

4 The Consultants will be responsible for leading the activities to achieve the set of objectives listed above. They will be responsible for production of the reports within the defined timeframe and parameters. The overall activities will cover but are not necessarily be limited to: 3.1 Design of data collection tools to collect information/data on storage, prescribing, dispensing and medicines use practice 3.2 Implementation of the study in a sample of 20 church run health facilities in Zambia 3.3 Production of the study results, including findings, analysis of challenges and possible solutions to address them. The report should be produced to publication standard in a peer reviewed journal. 3.4 Development of training to address challenges identified and to orient CHAZ health facility staff on PSM SOPs to be implemented training workshops are expected, one in each province. 3.5 Production of a report on the training activities, as well as on other noneducational interventions recommended for PSM and medicines use practice improvement 4. Expected Outputs 4.1 A tool to facilitate collection and monitoring of performance of health facility medicines storage, prescribing, dispensing and use practice 4.2 A study report on a survey of performance of health facility medicines storage, prescribing, dispensing and use practice in 20 CHAZ health facilities 4.3 A training syllabus to address challenges identified in the 20 sample CHIs to be surveyed 4.4 A report on 9-10 training workshops to be implemented 4

5 4.5 Recommendations on any non-educational interventions to be implemented by CHAZ to improve performance of health facility medicines storage, prescribing, dispensing and use practice 5. Method of Work The objectives of CHAZ fall within the Ministry of Health mission to ensure the availability of safe and efficacious medicines in the country. These should then be managed and use rationally. Standards and systems to uphold this mission ensure that products are managed well and that prescribing and use is rational. This Consultancy will provide baseline measures and tools for improving PSM management and medicines use in CHAZ health facilities. Participatory approaches will be used to formulate the study tool, training materials and other intervention designs to improve storage, prescribing and use of medicines in CHAZ health facilities. The Consultants will draw upon expertise in local partners such as MOH, UNICEF, WHO, USAID implementing agencies and CHAZ. 6. Implementation Two Consultants (one senior and the other junior) will be recruited and shall propose and agree (with the Executive Director, CHAZ) a methodology and schedule of work (including implementation plan and global cost budget) that meets the requirements of the above objectives before the end of the October. Thereafter, the Consultants will continue for a period of 4 months. Proposed work schedule is as follows: Agreement of methodology, budget, schedule of works and contracts by January 30, 2014; Design of study tool completed by February 15, 2014; PSM and medicines use study survey completed by March 15, 2014; Training of CHAZ health facility staff (provincial training) completed by May 30, 2014; Study report for publication submitted by June 2014 Final Report on training activities, plus other recommendations submitted by July 30, 2014; 5

6 7. Consultants Profiles Senior Consultant 1. Advanced degree (PhD, Mph or Masters Degree), in a health-related field with specialized training and/or experience relating to pharmaceutical management required; physician, nurse, or pharmacist qualification preferred. 2. At least 10 years demonstrated relevant experience in pharmaceutical management and/or health care systems development and strengthening in developing country context required 3. Relevant experience in public health and pharmaceutical management and systems strengthening strongly preferred, particularly those related to the implementation of Global Fund related programs for HIV/AIDS, Malaria, TB prevention, care, and treatment programs in developing countries. 4. Experience in running pharmaceutical management training programs and developing related curriculums 5. Experience in developing pharmaceutical management assessment tools and conducting pharmaceutical systems assessment in developing countries 6. Experience in undertaking drug supply and management research, with proven ability to produce peer reviewed standard level reports. 7. Demonstrated managerial and organizational skills in a development country setting with flexibility to adapt to changing priorities and deadlines. 8. Excellent interpersonal skills; demonstrated ability to interact professionally with culturally diverse staff, clients, and consultants. 9. Proven record of aligning diverse, multi-level teams with project mission and vision. 10. Track record of strong commitment to sharing knowledge, documenting experiences and, publishing. 11. Demonstrated strategic agility, diplomacy, conflict management, team building, written and oral communication, and negotiation skills. Excellent writing and presentation skills in English are essential. Junior Consultants 6

7 1. Advanced degree in a health-related field with specialized training and/or experience relating to pharmaceutical management required; physician, nurse, or pharmacist qualification preferred. A bachelor's degree in Pharmacy plus five years of additional relevant experience is accepted in lieu of an advance university degree 2. At least 5years demonstrated relevant experience in pharmaceutical management and/or health care systems development and strengthening in developing country context require 3. Relevant experience in in a developing /sub-saharan country procurement and supply management system 4. Excellent interpersonal skills; demonstrated ability to interact professionally with culturally diverse staff, clients, and consultants. 5. Experience in developing pharmaceutical management assessment tools and conducting pharmaceutical systems assessment in developing countries 6. Experience in running pharmaceutical management training programs and developing related curriculums. 7. Demonstrated competence to assess priorities and manage a variety of activities in a time-sensitive environment and meet deadlines with attention to detail and quality. 8. Proven record of aligning diverse, multi-level teams with project mission and vision. 9. Track record of strong commitment to sharing knowledge, documenting experiences, supporting creative initiatives, and sharing credit. 10. Excellent writing and presentation skills in English are essential. 8. Application Process Please apply by submitting your full resume to the Executive Director, CHAZ by 27 th January, 2014 via: Hard copies may be submitted to the attention of : Mrs. Chishiba Chibuta Manager Procurement. Any resume received after the aforementioned dated shall be accepted. Only short-listed applicants will be contacted and invited to discuss financial proposals with CHAZ. 7

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