Terms Of Reference
Facilitative Supportive Supervision Consultancy
Company Information
Palladium is a global leader in the design, development, and delivery of Positive Impact - the intentional creation of enduring social and economic value. We work with foundations, investors, governments, corporations, communities, and civil society to formulate strategies and implement solutions that generate lasting social, environmental, and financial benefits.For the past 50 years, we have been making Positive Impact possible. With a team of more than 2,500 employees operating in 90 plus countries and a global network of more than 35,000 technical experts, Palladium has improved - and is committed to continuing to improve - economies, societies and most importantly, people's lives.

Project Summary
Palladium is implementing the Rwanda Integrated Health Systems Activity (RIHSA), a three-year USAID-funded task order (72069620F00001) designed to support the Ministry of Health in strengthening Rwanda’s health system to provide quality health care for Rwandans while building the capacity of the Government of Rwanda (GOR) to move away from a donor-financed health system towards a self-reliant system. The project is aimed at achieving two major objectives.
1. Reduce financial barriers to health care through a mix of public and private interventions and provide tools for improved domestic resource mobilization and improve health care financing for the GOR.
2. Improve the quality of essential health services at national, facility and community levels utilizing a health systems approach.
Through a focus on financing and quality, RIHSA provides technical assistance to the GOR on various strategies, tools and approaches that will allow Rwanda to sustainably fund its healthcare system and provide quality care at all levels. The Activity is implemented by a consortium led by Palladium International LLC (Palladium) in partnership with RTI International, the Council for Health Service Accreditation of Southern Africa (COHSASA), Zenysis Technologies, and the Rwanda Agency for Accreditation and Quality of Healthcare (RAAQH).

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Assignment overview
The district health systems guidelines (2019), which states that the District Health Unit (DHU) /District Health Management Team (DHMT) is expected to coordinate the quality assurance assessment within the health facilities and follow up on the implementation of the recommendations from the assessment carried out. In addition, the DHU/DHMT also ensures the coordination, accountability, implementation, and management of health activities at the decentralized level in order to improve service delivery, increase coverage of health services, and improve quality, cost effectiveness and ownership.
Since 2012, the Ministry of Health (MoH) has embraced hospital accreditation as a mechanism for strengthening patient safety and quality, starting with referral hospitals, provincial hospitals and then scaled up in 2014 accreditation to all district hospitals in Rwanda. Furthermore, the MoH disseminated the standards for primary healthcare to all health centers and recently through the support of RIHSA, the MoH conducted the baseline assessment for a sample of 28 Health Centers across the country with in order to set a baseline regarding compliance with primary health care standards. It is therefore important that the DHU/DHMTs are involved in facilitating supportive supervision to health facilities in their catchment areas in order to help them improve their performance in terms of quality and safety standards.
This assignment aims to increase technical support to hospitals and strengthen ownership at the decentralized level (DHU/DHMT) to improve quality leadership and governance as part of hospital accreditation standard requirements.

Objective
In this context, RIHSA jointly with the DHU/DHMT members is seeking to support the MoH by hiring a consultant or team of consultants to conduct facilitative supportive supervision to hospitals in their catchment areas with a focus in implementing critical standards that require district management support. The consultancy will cover ten (10) districts in Rwanda, focusing on those which need more support to improve their performance regarding accreditation survey findings. The consultant must show how he/she will engage the DHU/DHMTs members to jointly deliver this facilitative supportive supervision while transferring the technical know-how to the district members to carry this task in the future .

Scope of Work
• This assignment will specifically focus on the following activities:
• Discuss and share with RIHSA team a plan to conduct facilitative supportive supervision to all 10 districts; plan must include clear objectives and deliverables.
• Align the objectives of the facilitative supportive supervision with gaps identified in the accreditation survey report of each hospital, especially with those which fall into the role of district support to hospitals.
• Draft a monitoring template/tool that the DHU/DHMT can then use to monitor the implementation of recommendations from the facilitative supportive supervision.
• Conduct on-site facilitative supportive supervision for at least two (2) days per hospital.
• Support hospitals to develop improvement plans with regards to standards (both critical and core standards) supported during the facilitation.
• Mentor at least 3 members of the DHU/DHMT around how to carry out similar facilitative supportive supervision to support accreditation standards implementation by hospitals.
• Generate a detailed report with clear recommendations upon completion of the assignment.
• Develop and share with RIHSA a model showing how facilitative supportive supervision can be conducted by DHU/DHMTs to regularly support health centers and hospitals to comply with accreditation standards in the future.

Contract Type
This consultancy will be a fixed price deliverables-based contract. Acceptance of the deliverables will be determined by the project’s Quality Improvement Director. Final approval will be required by the Chief of Party.

Expected Outputs/Deliverables
1. An inception report that includes the timetable, analysis of survey findings which depict the 10 hospitals to be supported, methodology and approach to engage DHU/DHMT members.
2. A monitoring template/tool for DHU/DHMTs to monitor hospital improvement plans developed during facilitative supportive supervision.
3. Improvement Plans for the 10 hospitals are drafted.
4. A model for DHU/DMTs to conduct facilitative supportive supervision with hospitals and health centers.
5. A detailed report of the assignment with clear recommendations.

Timeline
This assignment is expected to be implemented within a timeline of 5 consecutive weeks with an estimated level of effort of not more than 25 days, starting from the date the contract is signed.
# Activities Timeframe/Deadline
1 Inception report that outlines the planning, approach, and clear objectives 3 working days upon signing the contract
2 Conduct on site the facilitative supportive supervision to 10 hospitals 20 days
3 Generate the facilitation report with clear recommendations upon completion of the assignment 2 days

Selection Criteria for Consultant and Application Requirements
All consultants that apply for this assignment will be evaluated based on the following.
# Evaluation Criteria Weight(%)
1 Qualifications 20
2 Demonstrated experience in conducting similar assignments 40
3 Understanding of Rwanda’s health system 15
4 Price 25
Total Score 100
Profile of the consultant

Required:
• University degree (Bachelor or Masters) in public health, medicine, health policy, health services management or any other health related field.
• Being a Certified Quality Improvement Facilitator
• Extensive knowledge and experience in healthcare quality and service delivery.
• Considerable experience in conducting quality improvement (QI) facilitation to hospitals in Rwanda.
• Understanding/familiarity of the Rwandan health system
• Fluency in English and French (or fluency in one language and working knowledge of other).

Desired:
• Clinical professional strongly preferred
• Experience in conducting QI facilitation

Application requirements
The application proposal must include:
1. A description of the applicant’s relevant capacity and past performance with regards to QI facilitation, including a description of similar work undertaken by the consultant. Please include client references (name, position and contact details) for reference.
2. The qualifications of the applicant should be notarized (academic credentials and QI facilitation certificates)
3. An updated CV (no more than 3 pages) with a brief description (half a page maximum) of the candidate’s past involvement or support to the improvement of the country’s health systems.
4. Cost Proposal in RWF detailing the proposed daily rate of the consultant (All logistical costs will be provided by the project: including transportation, accommodation).
5. Technical proposal that briefly propose the methodology/approach, timetable, and strategy to achieve the expected deliverables.