Thought Leadership Consultant to Support Case studies on Quality Improvement and Clinical Mentorship. at PACT

Background
The State Accountability for Quality Improvement Project (SAQIP) is a six-year project funded by the Bill & Melinda Gates Foundation in Nigeria officially launched in mid-January 2015. It is designed to develop the capacity of the State Primary Health Care Development Agency (SPHCDA) and its associated Local Government Area (LGA) structures to carry out their mandate to provide quality maternal, newborn and child health (MNCH) services through public primary health care centers (PHCs), while empowering community structures such as Ward Development Committees (WDCs) to provide the oversight needed to ensure delivery of quality health services at PHCs. The project works towards achieving this impact through four key approaches:

• Improved governance, capacity, and performance of the public health system
• Improved accountability and community participation in the public health system
• Increased utilization of public MNCH services

The SAQIP Quality Improvement (QI) approach uses an iterative process whereby QI teams share and learn from one another and build upon each other’s findings and results. Using the Model for Improvement tool, QI teams identify non-clinical and clinical maternal and newborn Health (MNH) problems in their communities and develop appropriate interventions.

Each of the 57 SAQIP supported PHCs have QI teams comprising of 4 healthcare workers, 4 WDCs and 1 traditional ruler and have tested changes in different domains: ANC, labor and Delivery, postnatal care and facility system strengthening. 35 of these facilities have layered use of WHO safe birth checklist on their QI structures. 19 changes have so far been tested for period ranging from 18 - 24 months. The teams have recorded remarkable success such as improved used of partograph to monitor labor, improved use of uterotonics and decrease in client waiting times. The facilities have also recorded increase access: ANC, skill delivery and post-natal visits.

In Gombe state, health care providers at primary health care level usually have little access to experienced clinicians and specialists to call upon for consultation, review cases, solve problems and reinforce clinical diagnosis and decision making. Most health workers at these levels are likely to have limited experience in managing complicated and emergency cases. Health care providers were trained to provide quality maternal and newborn care and were followed up with supportive supervision.

However, because of limited contact time between the care providers and the supervisors there has been slow improvement in skills and competence of the trained care providers that is expected to translate into improved maternal and newborn outcomes. This fact gave birth to the concept of S AQIP clinical care mentorship program. Experienced nurses and midwives were deployed as residential mentors to reinforce the skills of birth attendants at PHCs. 6 months into the program. Many successes were recorded in skills, adherence to protocols and attitude of the birth attendants at PHCs.

Purpose of the Consultancy

• To develop case study that will showcase the effective practices and innovations that evolved due to the implementation of the State Accountability and Quality Improvement Project (SAQIP) in Gombe State under clinical mentorship and quality improvement. The focus will be on the 3 following topics:
  • Synergizing for Impact - Layering WHO safe birth checklist on Quality improvement interventions
  • Community involvement in facility level Quality improvements: leveraging communities for impact
  • knowledge to action - Accelerating and maintaining health care provider’s capacities to provide BEmONC services in primary health care system

Description of Key Tasks

• Desk review of relevant literatures and program documents
• Literature review of how stand-alone WHO safe birth checklist pilot test in other countries fared
• Background of SAQIP QI approach
• Operationalization of the QI approach
• Roles of QI teams
• QI Monitoring data
• Background of SAQIP clinical mentorship approach
• Operationalization of the clinical mentorship approach
• Monitoring data on service delivery and skills of birth attendants
• Develop protocol for qualitative study and dissemination plan for findings
• Develop interview guides and identify respondents for study
• Obtain ethical approval where relevant
• Interview and collect data from respondents using appropriate methods
• Interviews with clients and birth attendants
• Interviews with clinical mentors, mentors of mentors, LGA PHCD, GSPHCDA staff and SAQIP staff
• Interviews of birth attendants, clinical mentors, mentors of mentors and clients
• Interview with WDCs and traditional rulers
• Analyze qualitative data and information gleaned from desk review
• Develop report describing the effective practices and solutions due to SAQIP

Requirements
Candidate with:

• At least an MSc degree in Development Studies, Social Sciences, Public Health, Political Science, or Economics and at least eight years of research experience
• Experience in designing and conducting qualitative studies in the development/humanitarian space with evidence of conducting at least one in the last three years
• Experience using NVIVO and/or any other qualitative data analysis tool
• At least one peer-reviewed publication in a reputable national or international journal in the last five years
• Excellent verbal and written communication skills
• Excellent interpersonal skills
• Ability to speak Hausa fluently
• Readiness to share sample(s) of similar work done in the last three years
• Ability to carry out assignment in Northeast Nigeria

Language:

• Fluency in written/oral English and Hausa is required
• Expected Outcomes
• Study protocol
• Developed Interview guide and consent form
• List of respondents for study and justification for selection
• IRB ethical approval
• Taped recordings of interviews
• Copies of transcripts of interviews
• Final report of study

Milestones and Deliverables
Activities/Tasks Timelines Days Outputs

• Inception report/Desk review 29th - 31st August, 2018 3 Soft copy of Inception report
• Study protocol and submit application for ethical approval 3rd to 5th sept 2018
• 3 Soft copy of study protocol
• Interview guide and consent form 3rd to 5th September 2018 Soft copy of Interview guide and consent form
• List of respondents for study and justification for selection 6th to 7th September 2018
• 2 Soft copy of respondent list and justification for selection
• IRB ethical approval 6th to 7th September 2018 Soft copy Ethical approval
• Taped recordings of interviews 10th to 27th September 2018
• 14 Soft copy of recordings
• Transcripts of interviews Soft copy transcripts

Working Relationships:

• The Consultant will be expected to work in collaboration with the following SAQIP staff – Project director, Health System strengthening Advisor, IS Advisor, Clusters Team, LGA PHCD Team, Gombe state primary Healthcare Development Agency.