TORs: National Senior STTA – Quality of Care Expert

Strengthening Regulatory Functions of The KP Health Care Commission: Embedded Support for Quality Registration, And Licensing (Phase 1)

Programme

Evidence for Health (E4H) is a Foreign, Commonwealth & Development Office (FCDO)-funded programme aimed at strengthening Pakistan's healthcare system, thereby decreasing the burden of illness, and saving lives. E4H (2023-2027) provides technical assistance (TA) to the Federal, Khyber Pakhtunkhwa (KP), and Punjab governments. E4H works in partnership with the Health Department in KP. Through its flexible, embedded, and demand-driven model, E4H delivers TA across three outputs:

Output 1: Strengthened integrated health security, with a focus on preparing and responding to health emergencies, including pandemics.

Output 2: Enhanced capacity for evidence-based decision-making to drive health sector performance and accountability.

Output 3: Improved implementation of Universal Health Coverage, with a focus on ending preventable deaths.

Background

The Foreign, Commonwealth & Development Office (FCDO) leads the United Kingdom's (UK's) global efforts to end extreme poverty, deliver the international Sustainable Development Goals (SDGs) and tackle a wide range of global development challenges. With support from the FCDO in Pakistan, the Evidence for Health (E4H) Programme aims to provide technical assistance (TA) in Khyber Pakhtunkhwa (KP) and at the Federal level to build durable government capacities to strengthen health systems that are resilient and capable of responding to emergencies, responsive to the latest evidence, and supportive of efficient and effective health service delivery – particularly for those who are most vulnerable.

The E4H Programme focuses on three main outputs: 1) Strengthened integrated health security, with a focus on preparing and responding to health emergencies, including pandemics; 2) Enhanced evidence-based decision-making to drive health sector performance and accountability; 3) Improved implementation of universal health coverage (UHC), with a focus on ending preventable deaths.

The Healthcare Commission (HCC) in KP has sought assistance for this TA within the scope of Output 3 of E4H to enhance its ability to carry out its mandate amid the province's ongoing health reforms.

Problem Statement

• The KP Health Policy prioritises quality of care (QOC) as one of the interventions for its five policy actions. Still, it lacks a clear direction to integrate quality into its programmes and planning, leading to coordination challenges. The Department of Health (DOH) is responsible for improving the quality of services in public health facilities, while quality regulation through legislation is within the purview of the HCC.
• There is ongoing TA support through E4H on advancing the DOH towards the QOC strategic plan, essential for integrating quality management into health system programming, implementation, and decision-making processes. It will also outline the regulatory role of the KP HCC and its alignment with broader strategic frameworks for quality and provincial reforms.
• Assess if there can be a linkage to draw lessons from the ongoing Federal E4H workstream on the roundtable consultation of all HCCs and the Islamabad Healthcare Commission (IHRA).
• Concurrently, other development partners are supporting the KP HCC to execute its mandate successfully; for example, the World Bank supports some geotagging of private health service providers.
• Implementing the QOC strategic plan will enable the DOH to cultivate a culture of quality management within the health system, thus enhancing its internal capabilities to implement the Minimum Service Delivery Standards (MSDS) and ensure quality care across different domains within the healthcare system.
• A key strategic approach of the HCC involves streamlining the efficiency and accessibility of the licensing process for healthcare establishments by implementing e-governance initiatives. This transition from manual to digital registration processes is geared towards achieving targets for the registration and licensing of healthcare establishments, aligning with the broader goals of the UHC rollout efforts. The KP HCC is in the process of garnering support for this aspect.
• While the HCC has made significant strides towards fulfilling its mandate, it faces challenges related to inadequate human resources and capacities for effective implementation. As part of its efforts for UHC rollout, the Commission prioritises (1) the revision of the MSDS within the UHC framework and (2) exploring innovative methods to expand its reach.

The overall objective of technical support is to advance the regulatory framework and enhance the operational efficacy of the HCC. This objective focuses on two pivotal areas:

1.     The reinforcement of the HCC's proficiency in quality assurance, registration, and licensing. Stringent regulatory frameworks will support this strategic endeavour.

2.     The refinement and customisation of MSDS for primary healthcare (PHC) facilities.

Scope of Work and Methodology

The team is expected to establish a strong coordination and work in-tandem with the Universal Health Coverage (UHC) roadmap and Quality of Care (QOC) strategic plan teams to ensure seamless integration and alignment with the overarching UHC roadmap objectives. As part of the assignment, the team is expected to perform the following activities through embedded support to KP HCC for both TAs:

TA1: Provide embedded support to the HCC in quality regulation, registration, and licensing.

• Assist in formulating a strategic plan for the HCCand its translation into an actionable agenda.
  • The strategic plan should encompass strategies, thematic areas, policy actions, activities, targets, and timelines across various domains, including registration, licensing, and accreditation mechanisms.
  • The team is expected to liaise with all development partners supporting various aspects of HCC to ensure alignment and develop a comprehensive strategic plan.
• Develop and conduct training sessions for staff members involved in quality assurance, registration, licensing processes, and field activities.
• Collaborate with relevant teams to develop comprehensive training plans tailored to the specific needs of each domain.
• Facilitate knowledge transfer sessions to ensure staff members have the necessary skills and expertise to continue operations effectively after the embedded support ends.
• Provide direct assistance and guidance in implementing MSDS to healthcare facilities.
• Assist in monitoring compliance with regulatory standards and guidelines, providing feedback and recommendations for improvement as needed.
• Serve as a subject matter expert and advisor to internal teams and stakeholders on quality assurance, registration, licensing, and field activities.
• Utilising the KP Essential Package for Health Services (EPHS) and service package of BHU and RHCs, collaborate with the DOH to develop tailored packages for General Practitioners (GP) and specialist clinics and develop MSDS for both types of clinics in adherence to established guidelines.

TA2: Revision of MSDS for PHC

• After the Strategic Plan for HCC is developed, the team will begin by reviewing the existing MSDS for PHC in the HCCs in all provinces in Pakistan (with a focus on Sindh and Punjab HCC). This would entail understanding the components, objectives, and benchmarks established in the existing standards, ensuring alignment with Essential Package of Health Services (EPHS).
• Incorporate insights from cross-province learning while identifying gaps, areas for improvement, and lessons learned from implementation, highlighting any deficiencies or aspects that need enhancement.
• Engage with relevant stakeholders, seek their input on the strengths and weaknesses of the current MSDS in KP, and, if possible, engage with stakeholders from Punjab HCC to gather feedback.
• Research and incorporate best practices and evidence-based guidelines relevant to PHC services (drawing lessons from the Punjab HCC, Sindh HCC, and IHRA).
• Customise the revised MSDS to the specific needs, priorities, and context of the PHC.
• Define clear and measurable benchmarks for each aspect of PHC covered in the standards.
• Establish quantifiable targets that can be monitored to assess progress and performance.
• Pilot test in selected PHC facilities the revised MSDS and gather feedback.
• Incorporate the feedback from the pilot test and finalise the revised MSDS for PHC.
• Develop mechanisms for monitoring these MSDS and assessing the effect on service delivery outcomes.

Deliverables

The expected deliverables are as follows:

• Embedded HCC Support
  • Strategic Plan for HCC
  • Operational Plan for HCC
  • Service Package for GP and specialist clinics.
  • Tailored support in quality assurance, registration, and licensing to enhance HCC's capabilities in enhancing the quality of healthcare at the PHC level.
  • Monthly E4H Updates: Regular progress meetings with the E4H KP team.
• MSDS Revision for Healthcare Services
  • Inception/Analysis Report: Review of existing MSDS for PHC.
  • Updated MSDS customised to PHC needs along with monitoring mechanisms.
  • Monthly E4H Updates: Regular progress meetings with the E4H KP team.

Timeline and LOE

The level of effort for the role is 60 working days, from May 2024 to August 31, 2024

Requirements

Technical Expertise

• Postgraduate degree in healthcare management, public health, health policy, etc.
• More than fifteen years of development and implementation experience with reforms/ programs.
• Strong convening, report writing, and quality of care skills with following expertise
• Extensive knowledge of evidence-based healthcare practices and guidelines, enabling the development and integration of evidence-based protocols into MSDS and healthcare processes to enhance quality of care.
• Expertise in defining and implementing measurable benchmarks for quality-of-care indicators, tailored specifically to the unique needs and priorities of PHC environments, ensuring effective monitoring and evaluation of healthcare standards.
• Skill in engaging stakeholders across various levels of healthcare delivery, including clinicians, administrators, and policymakers, to gather input, foster collaboration, and ensure alignment with quality improvement initiatives.
• Ability to drive continuous quality improvement efforts by leveraging data-driven insights, fostering a culture of learning and innovation, and implementing best practices to enhance the overall quality of care in PHC settings.
• Understanding relevant regulatory requirements and standards governing healthcare delivery ensures that MSDS and quality of care initiatives fully comply with legal and regulatory mandates.

Competencies

• Planning and delivering work;Regulatory Knowledge; Quality of Care Management; Analysis and use of information; Decision making; Influencing.

KPI's/Specific deliverables

The QOC Expert will be working alongside two other team members (Public Health Expert and Research Associate) to achieve the following deliverables:

1. Analysis Report: Review of existing MSDS for PHC, GP, and Specialist Clinics, identifying strengths and improvement areas.
2. Updated MSDS: Customised to PHC needs, integrating best practices and stakeholder feedback.
3. Benchmarking: Clear, measurable benchmarks for healthcare standards, with defined monitoring and evaluation targets.
4. Pilot Feedback Report: Insights and recommendations from pilot tests in PHC settings.
5. Monthly E4H Updates: Regular progress meetings with the E4H KP team.
6. The QOC Expert will specifically review and revise the MSDS, incorporating stakeholder input and updating the MSDS, evidence-based guidelines, and measurable benchmarks tailored to PHC needs, generate insights from pilot test.