UNICEF Cambodia
TERMS OF REFERENCE
International Consultant on
Strengthening the Quality of Newborn Care at the Hospital Level
Requesting Section: Maternal, Newborn, Child Health and Nutrition (MNCH&N)
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1. Background and Rationale:
The need. Since 2000, Cambodia has shown significant progress in the area of Child Health-deaths of children before their fifth birthday has decreased by over one-half. These improvements are likely multifactorial including socio-economic development, but are also concomitant with the improvements in birth spacing, breastfeeding, immunization and vitamin A coverage, earlier seeking health behavior and better access and to health care and the availability of the community based care and support structures. Thus, Cambodia has surpassed the official MDG 4 target of under-five mortality reduction to 54/1000 live births; however, the real mortality rates in 1990 were unknown and debated.
While infant and under-five mortality have decreased, the number of newborns who die each year remains unacceptably high- half of all deaths of under-five children occur in their first 28 days of life. Three-fourths of neonatal mortality occurs in the first week of life primarily due to infection-related causes. Therefore, further reductions in under-five mortality will require efforts to address the high burden of newborn mortality in Cambodia.
The solution: It is well known that major causes of newborn death include infection (60%), birth asphyxia (23%) and prematurity/low birth weight (14%). Immediate drying, immediate skin-to-skin contact, delayed cord-clamping and non-separation of baby from the mother for a complete breastfeed are proven interventions to save lives of newborns. Eliminating harmful practices such as routine suctioning, early bathing and unnecessary handling prevents infection and infection-related death. Providing mothers in pre-term labor with ante-natal steroids can reduce major causes of death of pre-term babies.
Hand hygiene and hospital infection control are particularly important for prevention of deaths of newborns (the smaller, the more important) and pregnant and postpartum women. Neonatal Intensive Care has the potential to save many lives. However, if key things are not in place, many lives could be lost.
Hospitals play a major role in provision of routine newborn care and care for sick newborns. It is equally important, beside improving quality of care the health facility level, to standardize the hospital based care for newborns through systematic assessment, quality improvement plans, mentoring and regular evaluation of the services- both supply and the processes.
As part of improving the routine newborn care and care of sick newborn in Cambodia, UNICEF with support of World Health Organization plans to provide technical assistance to National Maternal and Child Health Center and Kampong Cham provincial hospital- two leading hospitals that service as major training sites for midwives and doctors- with the aim of standardizing the newborn care including care of sick newborns.
Link to 2011 AWP. In order to improve the newborn care at the referral hospitals, MNCH&N Programme AWP (under Intermediate Result 1) for 2011 planned:
a. Support to newborn care strengthening: capacity building at national level in the area of newborn care programming and clinical care.
Brief description of planned activities:
Initially, the national-level team will support the NMCHC and Kampong Cham Provincial Hospital to take steps toward perfect implementation of routine and referral intrapartum and immediate postpartum care including newborn care. As part of the technical assistance, meetings will take place with the Hospital Directors/Chiefs, heads of OB, PED, Nursing, Midwifery, Infection Control Committee and the Quality Improvement Committee to present an overview of the program, gain agreements to proceed and to set up multidisciplinary working group for weekly meetings. The weekly meetings will follow the triple A-F approach (assess, analyse, agree and follow-up including follow up assessment). A baseline assessment of practices will be done using record reviews and observation to determine mortality/morbidity statistics, recording methodology; obstetric admissions – timing from gate-intervention-delivery-outcome with a particular look at emergencies such as preterm labour - antenatal steroids and hypertension; intra-partum practices including anaesthesia/analgesia; immediate newborn care practices, special care unit admission policies; standards of care for health worker to patient ratio, crib-crib space ratio; baby friendly hospital checklist; and infection control. The group will agree on priority concerns that need to be assessed and steps toward enabling the environments for essential newborn care, mother friendly interventions and hospital infection control including Policy environment (e.g., SOPs, pathways, standing/routine orders), Physical environment, Pharmacy, Laboratory, Medical Records and use of data for decision-making and Transportation. Networking with surrounding facilities including Referral and Back-referral will be facilitated. Practical short trainings and presentations will be provided to address concerns arising during the course of the hospital work.
In order support improving the quality of newborn care including care of sick newborn at the hospital level, the MNCH &N Programme plans to hire an international consultant with expertise in the area of newborn care including care of sick newborns.
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2. Purpose(s) of the consultancy
To provide technical assistance to National Reproductive Health Programme, National Maternal and Child Health Center and Kampong Cham Hospital to improve and standardize the quality of newborn care including care of sick newborn with the following steps:
a. Facilitate the assessment of quality of care in NMCHC and Kampong Cham Hospitals with support of members of newborn care working group (Newborn Care Focal Point of NMCHC, WHO, UNICEF, RACHA, representative of pediatric Care Association).
b. Use the findings of the assessment to develop a quality improvement plan for NMCHC and Kampong Cham Hospitals on newborn care including care of sick newborn.
c. Facilitate capacity building of the Newborn Care Unit staff of NMCHC and Kampong Cham Hospital.
d. Document the progress and revise the assessment tools based on the findings from the base line, mid- term and end term assessments.
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3. Programme Area and Specific Project Involved:
Programme areas: MNCH&N
Project involved: IR 1 (Maternal, Newborn and Child Health)
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4. Work Assignments/TOR:
A – To facilitate the assessment of quality of care in NMCHC and Kampong Cham Hospitals with support of newborn care working group members (Newborn Care Focal Point of NMCHC, WHO, UNICEF, RACHA, representative of pediatric Care Association)
- Review background documents (newborn care situation analysis, newborn section of safe motherhood protocols, training materials related to newborn care including care of sick newborn such as Integrated Postpartum Care, Helping Babies Breath, MCH supervision and monitoring check lists including EmONC check lists, Essential Newborn Care Training Course of WHO, emergency triage and treatment for children, essential pediatric care training, health facility survey reports and EmONC Assessment Report.
- Meet with key stakeholders (NRHP/NMCHC, HRD if relevant, WHO, UNICEF, UNFPA, Reproductive and Child Health Alliance (RACHA), University Research Co (URC), National Pediatric Hospital’s Newborn Care Unit staff, NMCHC Newborn Care Unit Staff, Kampong Cham Hospitals Newborn Care Unit Staff, and other relevant partners. The consultant will gather information on the partners’ perspective and recommendations about improving quality of newborn care at the hospital level in Cambodia. Besides, the consultant will meet with Hospital Directors/Chiefs, heads of OB, PED, Nursing, Midwifery, Infection Control Committee and the Quality Improvement Committee to present an overview of the program, gain agreements to proceed and to set up multidisciplinary working group for weekly meetings.
- With the support of a team of experts (both nationals and internationals) from key partners including NMCHC/NRHP, NMCHC NCU Staff, WHO, UNICEF, RACHA and others if relevant, develop/adapt tools for the newborn care assessment for hospitals.
- Facilitate the base line assessment on quality of newborn care including care of sick newborn in NMCHC and Kampong Cham Hospitals. The baseline assessment will use record reviews and observation to determine mortality/morbidity statistics, recording methodology; obstetric admissions – timing from gate-intervention-delivery-outcome with a particular look at emergencies such as preterm labour - antenatal steroids and hypertension; intra-partum practices including anaesthesia/analgesia; immediate newborn care practices, special care unit admission policies; standards of care for health worker to patient ratio, crib-crib space ratio; baby friendly hospital checklist; and infection control.
B – To carry out capacity building of the newborn care unit staff in NMCHC and Kampong Cham Hospitals
- Support the NMCHC and Kampong Cham hospital management to set up multidisciplinary working group for weekly meetings. The weekly meetings will follow the triple A-F approach (assess, analyse, agree and follow-up including follow up assessment).
- Use the findings of the assessment to support the key staff of NMCHC and Kampong Cham hospitals develop a quality improvement plan/agree on priority concerns that need to be assessed and steps toward enabling the environments for essential newborn care, mother friendly interventions and hospital infection control including Policy environment (e.g., Standard Operating Procedures, pathways, standing/routine orders), Physical environment, Pharmacy, Laboratory, Medical Records and use of data for decision-making and Transportation.
- With the support of the core team, facilitate a short term capacity building of the newborn care unit staff in both hospitals. The training/orientations will include theoretical updates and practical short sessions. Capacity building sessions on training methodologies will also be conducted to enable hospital staff to carry out similar capacity building sessions for the staff of provincial hospitals in Cambodia. The capacity building activities will be done alongside other activities within the current ToR and will not be approached as a stand-alone undertaking.
C- To document the progress and lessons learnt including mid- term and end term review
- Document the progress through review of the activities/observation, review of the records and data, admission books, and the client/patients files. Besides regular documentation of the progress
- Carry out the mid and end term assessment of the quality of newborn care including care of sick newborns in NMCHC and Kampong Cham Hospitals.
D- To develop recommendations for strengthening hospital based care of newborns.
- In consultation with partners and the newborn care unit staff of NMCHC and Kampong Cham, finalize the assessment tools and check lists for nation- wide use.
- Develop recommendations for strengthening hospital based care of newborns based on the lessons learnt from NMCHC and Kampong Cham Referral Hospitals experience. The recommendations will address policy issues, strengthening of human resources, supplies/equippments, supervisory/support needs among others.
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5. Qualifications/competencies required:
Advanced degree in medicine, public health or related field
Specialist in pediatrics or obstetrics with certified sub-specialization in neonatology, and newborn care trainer
At least 8 years of clinical work experience in providing care of sick newborns and routine newborn care (significant regional experience with newborn care)
Prior experience with writing assessment tools, protocols and documents
Good analytical, pedagogic, negotiating, communication and advocacy skills and report writing skills.
Computing skills
Excellent verbal and written communication skills
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6. Estimated Duration of Contract (Dates and period):
It is estimated that the consultant will work over the period of December 2011-September 2012 for 30 working days. Distribution of working days by tasks is as follows:
No. / Description of tasks / Duration1. / Facilitate the assessment of quality of care in NMCHC and Kampong Cham Hospitals / Two weeks or 10 working days in December 2011
2. / Carry out capacity building of the newborn care unit staff in NMCHC and Kampong Cham Hospitals / To be accommodated within the 10 working days in December 2011, 10 working days in April and 10 working days in
3. / Document the progress and lessons learnt including conducting a mid- term and end term review / Two weeks or 10 working days in April 2012
Two weeks or 10 working days in September 2012
4. / Develop recommendations for strengthening hospital based care of newborns. / To be accommodated within the 10 working days in September 2012
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7. Deliverables with due dates:
No. / Description of Deliverables / Timeline for submission1. / Report of the baseline assessment available and serves as a basis for the next steps including capacity building of the staff and development of plan of action / End of January 2012
2. / Report on the progress and lessons learnt from the capacity building activities, review of the records and progress of activities available. / End of May 2012
3. / Final report covering the details of the baseline assessment, data and information on the progress of activities (clinical records and outcomes), capacity building of staff, mid-term and end term assessments and recommendations finalized and disseminated to key partners / End of September 2012
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8. Payment Schedule (Please link to deliverables to the extent possible):
No. / Instalment linked to deliverable / Payment value1. / Report of the baseline assessment available and serves as a basis for the next steps including capacity building of the staff and development of plan of action / 25% of the total contract value
2. / Report on the progress and lessons learnt from the capacity building activities, review of the records and progress of activities available. / 40% of the total contract value
3. / Final report covering the details of the baseline assessment, data and information on the progress of activities (clinical records and outcomes), capacity building of staff, mid-term and end term assessments and recommendations finalized and disseminated to key partners / 35% of the total contract value
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9. Official Travel Involved (specify if yes):
As part of its mission, the consultant will undertake a number of field-visit to the Kampong Cham province to carry out the tasks as described in this ToR.
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10. Contract Supervisor:
The consultant will work under the direct supervision of the MCH Specialist (Malalay Ahmadzai), general supervision of the Section Head, Health and Nutrition (Viorica Berdaga) and WHO MCH Team Leader (Dr Howard Sobel), and National Reproductive Health Manager (Dr Tung Rathavy).
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11. Type of Supervision that will be Provided:
The supervisor will ensure compliance with the ToR and timely delivery of the expected outputs/results.
In addition, the supervisor will provide technical inputs/feedback and facilitate communication with the national partners in the process of: