Consultancy to develop Referral Mechanisms for health care facilities and rehabilitation centres in Kathmandu

Consultancy period: Two and a half (2 ½) months

Merlin International Profile Merlin specialises in health, saving lives in times of crisis and helping to rebuild shattered health services. Each year, Merlin helps more than 15 million people in up to 20 countries.

Merlin Nepal

Merlin started its operation in Nepal in February 2006 with the aim of improving conflict affected populations’ access to health, with a focus on maternal and child healthcare. Since then Merlin has been developing a number of humanitarian health projects serving more 100,000 population in the Mid-Western Development Region. In line with its international and country strategies, Merlin is scaling up its support to regional and national authorities with the following objectives: · Strengthen the capacity the Ministry of Health and Population to promote strong cooperation and increase ownership of community based groups · Support government move towards transitional & sustainable health provisions in line with MDG targets by focusing on the following key areas i) reproductive health, ii) Treatment of common diseases & injuries; and iii) water & sanitation in the Mid West Region · Offer emergency medical support to disaster affected populations and mainstream Disaster Risk Reduction · Ensure better representation and involvement of civil society in health sector at districts and regional level and support Merlin’s global advocacy and policy efforts.

Background

Merlin, in a consortium with WHO, Handicap International and Oxfam as well as three national NGO partners, are implementing a DIPECHO-funded project, “Enhancing emergency health and rehabilitation response readiness capacity of health system in the event of a high intensity earthquake in Kathmandu Valley”. The project focuses on strengthening national capacity to respond in the event of a major earthquake in Kathmandu Valley within framework of National Disaster Risk Reduction strategy and MoHP policies. The project will also focus on strengthening national capacity to provide a coherent, organised and coordinated disaster response in health sector and preparing communities as "first responders" in the event of an earthquake.

Merlin in collaboration with project' partners will conduct feasibility assessment in hospitals of Kathmandu district in order to select three hospitals in addition to the two Kathmandu rehabilitation centers for developing Mass Casualty Management (MCM) plans. Merlin will consult district disaster response committee members and other stakeholders responsible and involved in disaster preparedness and response in Kathmandu district.

Close coordination will be ensured with MOHA and MOHP in the selection process as the government has plan to prioritize Kathmandu valley hospitals for emergency preparedness and response capacity building. The national Red Cross movement will also be consulted to ensure and holistic approach to the plans (e.g. community integration) and since the movement is both part of Kathmandu DDRC and this project. After selecting three hospitals and the two rehabilitation centers, Merlin will review existing mechanisms to handle mass casualties during major earthquake and will draw out a plan of actions to develop MCM plans in the 5 facilities.

Proper MCM has the objective of reducing avoidable morbidity and mortality through fast and effective response. The main rule is to ensure that the injured are treated properly, as soon as possible. Referral system is one of the components of MCM which must be governed by a command and control system that is coordinated and effective to ensure the right care reaches the needy in time by linking community and the health system.

The referral mechanism will be developed to ensure the patients receive proper referral care after the initial care given. The MCM strategy will detail how this activity will be linked, the command and control system, and the coordination mechanism for all these activities and actors to work in a coordinated manner during an earthquake incident. The established referral system will also provide medical services to initially managed/operated patients and ensure that discharged patients get rehabilitation services

During mass casualty events such as a major earthquake scenario, medical care is provided to large number of needy persons in a very short timeframe. It has often been observed that not having pre-identified referral mechanisms, initially treated persons end up not having care or with critical delays or improper care which ultimately result in loss of lives and increase disability risks. Currently and since there no MCM strategy in place, MOHP does not have such a referral system in place.

Merlin utilizing its global experience and its partners' experience will assist Ministry of Health and Population as well as hospital authorities in developing a referral system which will be integrated in the MCM plans of supported facilities and endorsed by MOHP through the national MCM strategy. This will also include designing referral forms which can be easily used to refer patients among institutions providing care at various level as well as institutions stationed in different geographical areas. Forms will be electronically placed on websites and at secured place in various institutions. Based on Merlin and its partners' global experience proving initial and follow up medical care, guidelines will be developed to be used in Nepal context based on existing facilities and health system. Rehabilitation aspect will be particularly considered to ensure that the rehabilitation system is comprehensively integrated into the referral protocol as part of a continued patient management plan. Guidelines along with required referral forms will be published and electronic copy will be kept on websites. Proposed referral system will be shared with the NRCS who will be part of the National MCM strategy and is a member of the Kathmandu DDRC as well as a partner of this project. Community based referral system which will be developed by the NRCS, will be a component of this overall referral system, therefore ensuring comprehensive mechanism (community to tertiary level care).

Specific Tasks

This consultancy shall consist of the following activities which will be undertaken within the specified timeframe:

1. Review of existing hospital MCM plans/ existing mechanisms to handle mass casualties in the health care facilities
2. Review of national MCM plans to date and plans for hospitals and rehabilitation centres within this context
3. Review of existing referral systems, in Nepal and other countries, and their effectiveness/relevance in post-earthquake scenario and MCM in Kathmandu.
4. Consult key stakeholders (Ministry of Health and Social Welfare, administrators of selected hospitals and rehabilitation centres, health workers, implementing partner (Nepal Red Cross Society), consortium partners and other relevant actors for development of referral system.
5. Develop a referral system, in close liaison with MOHP and which incorporates the feedback of key stakeholders, to: a. Ensure the patients receive proper referral care after the initial care given b. Provide medical services to initially managed/operated patients and ensure that discharged patients get rehabilitation services c. Ensure referral protocols are in place for continuum of services by linking community and the health system d. Ensure that the rehabilitation system is comprehensively integrated into the referral protocol as part of a continued patient management plan.
6. Develop referral protocols/guidelines in English and Nepali, to be used in Nepal, based on existing facilities and health system
7. Design user-friendly referral forms in English and Nepali to refer patients among institutions providing care at various level as well as institutions stationed in different geographical areas
8. Assist/work closely with NRCS for development of community based referral system.
9. Link community and facility based referral system to ensure a coordinated referral mechanism is in place
10. Sharing of proposed referral system with partners agencies and other stakeholders who will be part of the National MCM strategy for inclusion in the national MCM

Key outcomes of the assignment shall be:

a. Established referral system to provide medical services to initially managed/operated patients and ensures that discharged patients get to rehabilitation services; b. Guidelines for the use and implementation of the referral system; c. Referral forms which can be easily used by medical staff to refer patients.

Person Specification Essential Qualifications, experience and competences

The consultant shall be able to demonstrate their suitability for the assignment by possessing the following qualifications, background and experience: · Paramedic, doctor or nurse with post-graduate studies in mass casualty management, trauma management and or qualified medical professional with post-graduate qualifications in hospital administration, public administration, management/public health. · Experience working in close liaison with MOHP. · Experience in developing medical protocols, guidelines and/or referral documents in the context of Nepal. · Comprehensive understanding of hospitals and rehabilitation service providers in the Kathmandu Valley. · Excellent English written communications skills. · Experience of working with UN and INGOs. · Comprehensive understanding of and experience in Disaster Risk Reduction and health management systems. · Excellent communication, work-planning and time management skills. · Advanced skills in MS Office.

Desirable · Experience of working in Nepal · Experience of working in earthquakes

Data Protection In accordance with the 1998 Data Protection Act Merlin will hold and use personal information that you have given for the purposes of recruitment and employment should an offer of employment be made. This information will be stored in manual and/or computer form. This information may also be disclosed to third parties in accordance with the Data Protection Act. In cases where a job offer is conditional on ensuring that potential employees’ names do not appear on counter terrorism lists generated by the United Nations, European Union or the United States due to donor funding requirements, Merlin will use the information that you have given for checking that your name does not appear on these lists.

How to apply:

To apply for this position

To apply for this job, please go to www.merlin.org.uk/jobs and apply using our online recruitment system. In order to apply for a job with Merlin online you will need to complete a short registration process and create an account – the online recruitment system explains how to do this. Once your account has been created, you will be able to save the information that you have entered in your application and re-visit it at any time before you submit it.

If you are unable to apply online please download and complete an application form and email it to: applications@merlin.org.uk.

Please note that we do not accept CVs and any application must therefore be made online or by completing our application form. Unfortunately due to the number of applications we receive, only shortlisted applicants will be contacted. Submission Details · Individuals interested applying for this consultancy are requested to submit the following documentation as part of their supporting statement outlining their suitability to undertake and complete the assignment.A brief proposal on referral mechanism/system consultancy outlining background information, methodology, work plans and detailed budget estimates; · A minimum of one example of previously published material which was prepared solely by the prospective consultant;