Maternity Unit

Princess Margaret Hospital

Primary Health Care Units

Ministry of Health

Commonwealth of Dominica

As part of Neonatal Health Strengthening

 

Terms of Reference

 

October 2013

 

CONTEXT

The Commonwealth of Dominica is an upper middle-income country with a population of 72, 660 and a per capita GDP (PPP) of EUR 7, 874 (est. 2010).  According to the United Nations Development Programme (UNDP) Human Development Report for 2009, Dominica ranks 73 among 182 countries on the Human Development Index.  Social indicators are significantly good: access to primary and secondary education, primary school completion, adult literacy and life expectancy are significantly higher than the averages for upper-middle income countries and similar for the poor and non-poor within the country, reflecting a long-standing tradition of productive investments in human development, including social protection.  Consequently, Dominica has already achieved many of the targets set for the various indicators under the Millennium Development Goals (MDGs) initiative in health, education, gender equality and environmental sustainability.  Findings of the most recent Survey of Living Conditions dropped from 39 per cent of the population in 2002/2003, when the previous survey was conducted, to 28.8 per cent.  Extreme poverty as measured by the indigence level has fallen from 15 per cent of the population to 3 per cent.

The health sector falls within the Ministry of Health, under the political directorate of the Honorable Minister of Health and the Chief Accounting Officer, the Permanent Secretary.  Public health care services are provided at the primary and secondary care level and limited tertiary care services.  The Primary Health Care System comprises of a model where the country is geographically divided into seven (7) health districts, each comprising of several villages/ communities with varying sizes and populations.  There are two district hospitals and 52 Health Centers (Level 1 and 111) providing community services. The Level III Health Center is an administrative unit located in each district, managed by the team leader - the District Medical Officer and a health team, comprising of the Community Health Nurse, District Nurse, Midwife, Primary Care Nurse, Family Nurse Practitioner, Environmental Health Officer, Dental Officer, Pharmacist, driver, ancillary staff, and community representation.  Secondary Health Care services are provided at the main 228 bed hospital – the Princess Margaret Hospital which is managed by a team (Hospital Services Coordinator, Matron and Medical Director) under the supervision of the Permanent Secretary.  In patient Clinical Specialties / services include medical, surgical, gynecological, ophthalmological, orthopedic, pediatric, obstetric, neonatal, psychiatric, intensive care, operating theatre/ recovery, accident and emergency, and an outpatient unit.  Outpatient services are provided for every in patient service in addition to hemodialysis and oncology services.

Maternal and Child Health (MCH) Care is an integral part of the Primary Health Care (PHC) program in the Commonwealth of Dominica and it is implemented based on the MCH Manual that provides guidance for the achievement of targets and which is currently being reviewed to be brought in line with WHO standards. While Dominica has made significant progress in combating childhood diseases, a high Infant Mortality Rate (IMR) has been identified as one of the major challenges within the health care sector, and a reduction in the IMR from 29.9 per 1000 live births to 10 per 1000 live births by the end of 2019 has become one of Government’s priorities. As a means of addressing this problem, a project was submitted to the European Union (EU) for funding, emanating from an assessment conducted on MCH services .One of the main priority areas identified based on the situation analysis was the health care delivery system, and among the strategic activities is the implementation of a mentorship program for MCH care providers and quality improvement initiatives. A team of Consultants will be contracted, comprising:

1. A senior Registered Nurse with clinical expertise/ management experience in Neonatology / Neonatal Nursing education.

 

1. A senior Registered Nurse with clinical expertise/ experience in the management of the Operating Theatre and teaching in Operating Theatre techniques.

 

1. A senior Registered Nurse Midwife with clinical expertise/ management experience in Midwifery and Midwifery education.

 

OVERALL OBJECTIVE

 

To increase/ reinforce the capacity of the maternal and neonatal care for the provision of quality services to mothers and newborns in line with global standards and guidelines and within a continuum of care perspective.

 

PURPOSE

 

To set an enabling environment to ensure quality maternal and neonatal health (MNH) service at the PMH and PHC facilities, by strengthening the capacity of MCH care providers through pre-service and in-service training, mentoring and coaching, and appropriate care delivery processes through a quality improvement program.

 

SCOPE OF WORK

 

The Consultant will be responsible for the establishment of a mentorship program specific to the midwives of the Maternity Unit (PMH) and Primary Heath Care Midwives in collaboration with the other MCH Mentorship Consultants.  He/she will also be engaged in the development of local post basic midwifery refresher course.  The development of an orientation program for the Maternity Unit, as well as the review of current clinical and unit policies and procedures is also anticipated in order to ensure the sustainability of the newly acquired skills, behaviors, and practices. The Consultant will be contracted in Dominica for a one year period during which time he/she will engage in collaborative work with staff of the Ministry of Health Administration, the Maternal and Child Health Improvement Committee, the Management Team of the Princess Margaret Hospital, Nursing Administration, Consultants and Senior Medical and Nursing Staff of the relevant unit(s).

 

The Departmental Supervisor for the main units involved, that is the Maternity and Neonatal unit will be the local counterpart assigned to coordinate activities of the Consultant during the contracted period in the Ministry of Health.

SPECIFIC TASKS

 

The Consultant will

 

• Ensure that all processes are in keeping with set timelines and decisions.

 

• Conduct an assessment of human resource capacity of the Maternity unit of the Princess Margaret Hospital, and Districts and present specific recommendations.

 

• Conduct an assessment of the status of material resources, equipment and supplies and present specific recommendations.

 

• Assess clinical and functional policies, protocols and practices on the Maternity Unit and Health Centers in relation to international standards and make recommendations. (World Health Organization)

 

• Review/ Develop clinical and unit policies, and protocols incorporating existing relevant documents where necessary  in collaboration and supported by a core team  comprising the MCH Mentorship Consultants, Nurse Educator, Nursing Supervisor, Ward Manager, Quality Officer, Infection Control Officer and Physician.

 

• Submit reports with recommendation for improved practices where necessary in keeping with World Health Organization standards.

 

• Develop a mentorship program for Midwives on the Maternity Unit and the Districts.

 

 

• Implement training of trainers for District Medical Officers, Family Nurse Practitioners and Community Health Nurses on the revised MCH Manuals and guidelines.

 

• Coordinate training sessions for Primary Health Care staff on the revised MCH manuals and guidelines during district team meetings.

 

PROFESSIONAL EXPERIENCE

 

• A senior Registered Nurse (manager) with over five (5) years’ clinical experience in Midwifery, within a tertiary care level institution.

 

• Senior Registered Nurse (manager) with expertise in Midwifery Education.

 

• Knowledge of the operations of health systems in small island states

 

• Experience in developing/facilitating mentorship programs

 

• Experience and/ or Training in mentoring/coaching

 

• Excellent oral and written communication skills (English)

 

• Proficiency in the use of computers for reporting, making presentations and general communication is essential

 

 

• Work experience within the healthcare sector in a resource limited setting will be an advantage

 

• Training / experience in management will be an asset

 

• Work experience in curriculum development and /or engagement in training/educational institution will be an asset.

 

DELIVERABLES

 

1. A mentorship plan that sets targets and describes the content of the training and the assessment criteria of the staff benefitting from the mentorship.

 

1. Sustainable refresher training program for Registered Nurse / Midwives and Primary Care Nurses

 

 

1. Sustainable mentorship program for Registered Nurse Midwives

 

4. In Service education program for MCH care providers

 

5.   Quality improvement program to review care delivery processes for the Maternity Unit

 

6. Report on assessments conducted and recommendations for immediate and medium term

 

7. Cadre of competent and skilled Midwives on the Maternity Unit and Districts

 

8. Primary Health Care Staff trained / with competences and skills as per revised MCH guidelines and protocols

 

REQUIRED OUTPUTS

 

The Consultant is expected to implement a comprehensive, sustainable mentorship program; ensure relevant educational programs for nurse midwives, and initiate specific quality improvement activities.

OPERATING GUIDELINES

 

To operate within the guidelines set out in the Maternal and Child Health manual. In addition the Consultant will work together with the Maternal and Child Health Improvement Committee, team of MCH Mentorship Consultants, Nursing administration team, Departmental Nurse for Maternity and NNU and Community Health Nurses. The Consultant will be supervised by a local Supervisory Core Committee. The Matron/Designate will coordinate his/her day to day activities at the PMH

 

 

ACADEMIC QUALIFICATIONS

 

• Post RN diploma/certificate in midwifery
• MSC Nursing degree or  other health related degree

DURATION AND LOCALIZATION

The Consultant will be expected to reside in Dominica for the duration of the Mentorship program. Vacation time is negotiable. The mentorship program is anticipated to run from Monday, March 3^rd 2014 to Friday, February 27^th 2015.

 

SUPERVISION AND OFFICE SPACE

Supervision of the mentor will be provided by the Matron at the Princess Margaret Hospital.

There will be monthly meetings between the Consultants and the local supervisory Core Committee.  Office Space will be provided at a site to be located at PMH

 

PROPOSAL

The proposal should include but not necessarily be limited to the following:

 

• A brief description of the applicant’s experience on projects of similar nature. The applicant must provide any other information that will facilitate the evaluation of the Applicant’s reliability and capacity to meet the Ministry of health requirements
• Nursing Registration/ Licensure status
• Names and contact information of two (2) references.
• A detailed description of the manner in which the applicant will meet the terms of Reference work program.
• Financial proposal which must indicate how the overall fees have been developed including man hours, travel and other relevant costs.  The proposed payment schedule is to be included.

 

Consulting Agreement

The successful Bidder will be required to enter into a Consultancy Agreement with the Ministry of Health of which this Terms of Reference (TOR) will form an integral part.