DIABETES IN EAST AFRICA (DEAR) PROJECT, 2009-2012
Terms of Reference
Baseline Survey (Clinical Audit and patient satisfaction survey)
on the Quality of Care of Diabetes Clinics based
in the target zones of Kenya and Tanzania
Call for National Consultants
April 2010
BACKGROUND
a) Overview of Handicap International
Handicap International is an independent international aid and development organisation working in situations of poverty and exclusion, conflict and disaster.
In reconstruction or development activities, Handicap International works with people living with disabling diseases which could cause irreversible physical, sensorial or mental incapacities. Diabetes includes one of the disabling diseases that Handicap International is involved in trying to address. If diabetes is not properly controlled, the common symptoms and potential complications of this disease (cardiovascular disease, kidney failure, erectile dysfunction, chronic wounds in the feet with a risk of amputation) may be extremely invalidating.
b) Overview of the Diabetes East Africa Region (DEAR) Project
On December 2006, the United Nations General Assembly passed a landmark Resolution recognizing diabetes as a chronic, disabling and costly disease associated with major complications that pose severe risks for families, countries and the entire world.
Handicap International's actions on diabetes are aimed at preventing disability related to the disease; ensuring the offer of prevention, treatment and rehabilitation is available, adapted and affordable; building capacity and promoting social participation and the application and exercising of the rights of persons living with diabetes.
In carrying out its actions, Handicap International is careful not to substitute itself for local stakeholders, and seeks to pass on its competencies and support local partners in their efforts to become self-reliant.
Building on the experience of Tanzanian Diabetes Association, Kenya Diabetes Association and Celucodia (Centre for the Fight Against Diabetes) in Burundi as well as the relationship developed with time at country level, Handicap International launched the, “Diabetes East Africa Region (DEAR) Project,” in 2008 with a goal to improve the quality of life of the people with diabetes and to reduce the incidence of disabling complications of diabetes within East Africa Region.
Towards this achievement, the project expects the following results and outputs:
- Local health systems have the capacity to provide quality diabetes care and rehabilitation services to the population in pilot zones
- Local capacities to empower the general population to prevent the onset of diabetes through changes in lifestyle are promoted and reinforced
- People with diabetes are empowered to access quality diabetes care, advocate for their rights, sustain their lives and decrease social and economic impact of diabetes
- Local and regional expertise networks are developed among stakeholders on diabetes in East Africa
The project aims to jumpstart community-level action in response to the emerging threat of diabetes in rural communities where Handicap International has longstanding relationships with health ministries and local stakeholders. In addition, with links to the international community, including the International Diabetes Federation, the project will support efforts to create awareness at the global level of the needs and local responses by those most impacted by the disease. Using knowledge gained by various groups in the region, the project aims first at reinforcing the health system response at the primary health care and secondary and tertiary care levels. Linking health services with community outlets will enhance their accessibility and affordability for the rural population. Stakeholders will look at solutions to key operational barriers in provision of affordable drugs. Awareness campaigns and local, national and international mechanisms of knowledge sharing will inform general population on the disease, its related risks and possible measures of prevention. The project promotes local ownership and seeks to demonstrate how integrated diabetes management (prevention, care, rehabilitation) needs to become a priority at every level. Establishing networks will facilitate coordinated solutions at local level. Support to advocacy will contribute to recognition rights of people with diabetes in local and national policies. Establishing and facilitating exchange of experience based on best practice will contribute to maximize and avail expertise within the 3 target countries and beyond.
Partners
Funding partners: This project is jointly funded by the European Union, Sanofi Aventis and Handicap International.
Implementing partners: This project is being implemented in 3 countries by the following HI partners:
- In Burundi, CELUCODIA (“Centre de Lutte contre le Diabète”) is the first and the only centre specifically dedicated to diabetes care in Burundi.
- In Kenya, Founded in 1997, the Kenya Diabetes Association-Kitale Branch (KDA-Kitale Branch) has a total of 240 members.
- In Tanzania, the Tanzania Diabetes Association (TDA) is a new implementing partner with Handicap International. The TDA is a very strong stakeholder that has been working with the Ministry of Health in the implementation of a network of outpatient diabetes care units (“diabetes clinics”) in district and regional hospitals.
The above implementing partners are working in very close collaboration with the relevant ministries, including the ministries responsible for health and medical services, education, youth, social services, among others.
Target groups
The key persons from institutions and communities who will be engaged in the response to diabetes in Burundi, Kenya and Tanzania include:
- 70 health workers;
- 60 active members of diabetes associations;
- 60 community resources persons.
The people who will benefit directly from the project activities during the 4 years include:
- At least 46,200 people with diabetes, 9,240 being new cases.
- At least 180,000 people will be reached by awareness raising activities. This means that each country will reach 60,000 people
Evaluation of the DEAR project
An assessment of the DEAR project is planned in each country (Kenya, Tanzania, and Burundi) to evaluate the evolution of quality of care provided by diabetic clinics targeted by the project and the evolution of the awareness of diabetes and its complications in target zones.
This assessment will be carried out in two phases, at the beginning of the project (2010) and at the end (2012).
A baseline assessment is planned in 2010 and consists of three surveys:
- A knowledge, attitude and practice survey.
- A clinical audit
- A patient satisfaction survey:
OBJECTIVES
- The clinical audit aims to assess the quality of care for management of diabetes provided by diabetes clinics targeted by the DEAR project in order to improve the management of the diabetes.
- The patient satisfaction survey aims to assess patient satisfaction about diabetes clinics.
METHODS
Study zones:
The baseline survey will target the diabetic clinics in the intervention zones. This includes:
- Tanzania: The baseline survey will only be conducted in Arusha District Hospital. This district hospital is fully operational and has all the medical records in order. Meru and Monduli district hospitals are not yet fully operational to give substantial results.
- Kenya: The baseline will be conducted in all the district hospitals - Endebess, Kapsara and Kitale District Hospitals. These hospitals are fully operational and have all the required medical records to facilitate the survey.
- Burundi: The baseline survey will not be carried out together with the above study zones. This is because the targeted clinics are not fully operational to give substantial results.
This survey will assist in identifying the gaps that exist in the diabetic clinics with respect to quality of care. Based on the findings and recommendations, the relevant project managers, in conjunction with the staff in the target diabetes clinics, will take corrective action to ensure quality care is provided to the patients with diabetes.
Typology
- Clinical audit
The national consultant will work closely with the Technical advisor from Handicap International, who will be in charge of survey design, data analysis and report writing.
The clinical audit will be retrospective in nature. For the data collection, an audit data sheet will be developed by the Technical advisor from Handicap International to be used by the national consultant. This data collection instrument will be developed according to the standards of medical care in diabetes as recommended by the International Diabetes Federation and adapted to sub-Saharan Africa and at national level. It will include the list of Quality of Diabetes Care indicators as well as socio-demographic information. The national consultant will be required to assess the requirements for the diabetes clinic and examine the patients’ medical records and measure whether specific medical information is included in these records. Thus, the necessary materials will be provided to the national consultant to facilitate data collection.
- Patient satisfaction survey
For the patient satisfaction survey, a cross-sectional survey will be carried out using questionnaires which will be developed by the Deputy Technical advisor and the methodology as well.
For qualitative data, focus group discussions or in-depth interviews will be conducted among the out-patients of diabetic clinics targeted by the DEAR project. The consultant will be in charge to develop a methodology for the qualitative part of patient satisfaction survey.
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SCOPE OF WORK
The national consultant is expected to:
- Understand the DEAR project objectives and strategies
- Conduct a comprehensive field-based baseline study for quantitative data
- Developing the qualitative part of the patient satisfaction patient
- Develop a pre-survey report, including a literature review of similar surveys, methodology of the study (including sampling procedures, data collection methods and tools) as well implementation of the baseline survey including the timeframe and budget. The qualitative part will be studied zone-specific.
- Design, develop and refine data collection tools to generate the needed baseline information. This includes pre-testing of data collection tools and training of surveyors
- Conduct the data collection, entry, cleaning, and analysis and write up of the Baseline Report
- Submit a final Baseline Report to Handicap International and partners (for each country) with a summary of key findings and recommendations. This should include a word document as well as a power point presentation.
- Conduct an oral presentation (using power-point) of the findings to stakeholders at local and national level.
- Conducting the clinical audit and the quantitative part of patient satisfaction survey
- Conduct the data collection as mentioned in the pre-survey report written by the technical advisor from Handicap International
- Be in charge of data-entry and of data-set cleaning.
KEY DELIVERABLES
The national consultant should submit the following to the M&E Officer.
a) Before national Consultant is selected
- Baseline qualitative part of patient satisfaction proposal
b) Once national Consultant is selected
- A pre-survey report for qualitative part of patient satisfaction survey as specified under, “scope of work.”
c) After implementation of the baseline survey
- For qualitative part of patient satisfaction survey:
- A soft and hard copy of the baseline survey report (in English language) outlining key findings in the data implications as well as recommendations.
- An oral presentation of the findings to the stakeholders in each country at local and national levels.
- All study materials including soft copies of all data sets both quantitative and qualitative and data recording materials
- For clinical audit and for quantitative part of patient satisfaction survey:
- All study materials including soft copies of all data sets and data recording materials
CONTRACT DURATION AND TIMEFRAME
The national consultant should develop a detailed and feasible costed-workplan/activity schedule that should be congruent with the timelines provided below. The costed work plan should be submitted as integral part of the proposal for consultancy. The successful consultant must commit to accomplish and deliver the consultancy services and deliverables before the dates indicated in the table below.
Table: Proposed timelines for Baseline Survey (Clinical Audit and Patient Satisfaction).
EVALUATION AND AWARD OF CONTRACT
Handicap International will evaluate the proposals based on the technical and financial feasibility. However, technical feasibility shall serve as the main guideline for screening the proposals. The consultants should meet the following minimum requirements:
- Academic background in public health or clinical research or epidemiology
- A health professional who is working or has ever worked in the medical field with, diabetes management care concentration will have an advantage
- Experience in conducting clinical audits and surveys on patient satisfaction will be an added advantage
- Experience in data collection, entry and cleaning.
- Proficiency in use of computers, especially MS Office packages as well as relevant statistical packages
- Proficient in English and Swahili.
N/B. Handicap International reserves the right to accept or reject any proposal without giving reasons and is not bound to accept the lowest or the highest bidder.
CONTRACTUAL RESPONSIBILITIES
The national consultants will be responsible to the DEAR M&E Officer.
He will be responsible for the following:
- Prepare and deliver the consultancy services as per this TOR.
- Obtain maximum input from the target diabetes clinics
- Conduct data collection, data entry and data cleaning
- Submit a complete dataset and field mission report to Handicap International before the dates indicated in the table above
PAYMENT MODALITY
The payment for the work shall be as follows: 50% down payment upon signing of the contract, 50% upon submission of an acceptable dataset, interview notes and field mission report.
EXPRESSION OF INTEREST
The national consultants who meet these requirements and are available within the time period indicated should submit the following:
- An elaborate methodology and detailed costed work plan indicating number of days and tasks and costs per main task (include number of consultant days) -this should not exceed 5 pages.
- Curriculum vitae including relevant qualifications, skills and experience as well as full contact details of two referees.
Send electronic copies of the proposal to reach Handicap International office on or before 21 May 2010; email to: hrofficer@handicap-
References, Guides and Models:
- Guide: How to do Clinical Audit – a brief guide UBHT Clinical Audit Central Office http://www.uhbristol.nhs.uk/
clinicalaudit - Model: Dhanani RH, Qureshi MM, Khuwaja AK, Ali BS, Qureshi R. An audit of the quality of care indicators for the management of diabetes in family practice clinics in Karachi, Pakistan. J Ayub Med Coll Abbottabad. 2008 Apr-Jun; 20(2):55-8. http://www.ayubmed.edu.pk/
JAMC/PAST/20-2/Dhanani.pdf - Glasgow RE, Whitesides H, Nelson CC, King DK. Use of the Patient Assessment of Chronic Illness Care (PACIC) with diabetic patients: relationship to patient characteristics, receipt of care, and self-management. Diabetes Care. 2005 Nov;28(11):2655-61. Free full text http://care.diabetesjournals.
org/content/28/11/2655.long
