Terms of Reference for Individual Consultant / Firm on Implementation Research for Digital Health Solutions

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TERMS OF REFERENCE FOR INDIVIDUAL CONSULTANT / FIRM ON IMPLEMENTATION RESEARCH FOR DIGITAL HEALTH SOLUTIONS

1. INTRODUCTION

Partners in Health (PIH), locally known as Abwenzi Pa Za Umoyo, in collaboration with the Ministry of Health and with support from the World Diabetes Fund, is implementing the Diabetes Compass project in Malawi. This digital health project aims to improve care pathways for Non-communicable diseases (NCDs), particularly for diabetes and hypertension. The project seeks to carry out an impact assessment to evaluate its feasibility, effectiveness, and potential challenges in real-world settings. Eligibility to satisfy the following, minimum of 7 years of experience in global health research, with at least 3 years focused on digital health interventions. Excellent written and verbal communication skills in English; proficiency in relevant local languages) is an advantage. Experience in cost-effectiveness analysis of health interventions

Non-communicable diseases (NCDs) are responsible for 41 million deaths annually, with 77% occurring in low- and middle-income countries (LMICs). Globally, a staggering 87.5% of undiagnosed diabetes cases are found in LMICs. Projections indicate that 94% of the anticipated increase in diabetes prevalence by 2045 will occur in LMICs, driven by high population growth rates. Alarmingly, fewer than one in ten people with diabetes in LMICs receive coverage of guideline-based comprehensive diabetes treatment.Similarly, a study analyzing data from 1.1 million adults across 44 LMICs revealed that among individuals with hypertension, 39% had received a hypertension diagnosis before the survey, 30% had undergone treatment, and only 10% had their blood pressure adequately controlled. The intertwined relationship between hypertension and diabetes, affecting 70% of individuals with diabetes, further complicates the health challenges faced by these populations.

Beyond the immediate health implications, the elevated burden of diabetes and hypertension in LMICs is intrinsically linked to economic and sociopolitical challenges, such as limited health expenditure on diabetes and insufficient coverage for comprehensive treatment. As demographic transitions contribute to an anticipated 50% increase in diabetes prevalence, there is an unequivocal and urgent imperative for health systems to be fortified and equipped to manage this escalating health crisis. In this context, universal health coverage (UHC) in LMICs is not merely an aspirational goal but an imperative necessity.

2. REPORTING

For all planning and execution of activities, the Consultant will work and report to the office of Director Non communicable Disease and Mental Health in Partners In Health (APZU).

3. PRIMARY OBJECTIVE

Evaluate the effectiveness of digital health solutions in strengthening the care pathway and improving health outcomes for individuals with diabetes and hypertension.

4. SPECIFIC OBJECTIVES

  • Assess the acceptability and usability of digital health solutions among healthcare providers (HCPs) and community health workers (community health nurses etc. (CHWs).
  • Evaluate the effectiveness of technology-enabled CHWs in identifying individuals at risk for undiagnosed diabetes and hypertension.
  • Assess the effectiveness of technology-enabled HCs in diagnosing and managing diabetes and hypertension.
  • Evaluate the impact of technology-enabled care pathways on patient outcomes, including glucose control and blood pressure control.
  • Explore how improved access to NCD-specific health information has enhanced diabetes and hypertension services.

5. SCOPE OF WORK

The consultant will be responsible for the following tasks:

Study Design

Mixed-methods longitudinal study in 8 health facilities and surrounding communities.

Theme 1 – Technology Adoption

Quantitative Research

1. Solution usage

Number of CHWs using Community Health Platform, community screening conducted and HCPs using facility-based diabetes and hypertension and all patients being medically managed through the EMR at baseline, 3 months, 6 months, 9 months, and 12 months

Qualitative Research

2. User experience

CHW experience adopting and using the community health platform to screen and refer people at risk of undiagnosed diabetes and hypertension to a health facility at 3 months, 6 months, 9 months, and 12 months

HCPs experience adopting and using the facility-based EMR to diagnose and manage people at risk of undiagnosed diabetes and hypertension to a health facility at 3 months, 6 months, 9 months, and 12 months

Theme 2 – Care Pathway Strengthening

Quantitative Research

1. Screening and referral data to be routinely monitored over 12 months. Aggregate for whole study population and disaggregated by District and Facility/Catchment area

Qualitative Research

2. Explore and discuss reasons for attrition among those leaving the care pathway at 3 months, 6 months, 9 months, and 12 months

Theme 3 – Health Outcomes

Quantitative Research

1. Blood glucose and blood pressure to be routinely monitored over 12 months.

2. Aggregated for whole study population and disaggregated by District and Facility/ Catchment area

  • Blood glucose control
    Hypertension control
  • Proportion of patients with controlled blood pressure and blood glucose at 3 months, 6 months, 9 months, and 12 months

Qualitative Research

3. Explore and discuss challenges and barriers to blood glucose and blood pressure control among poorly controlled patients and their health care providers

Theme 4 – Using health information to improve health services

Quantitative Research

1. “Download” of diabetes and hypertension quality management reports to be routinely monitored over 12 months. Reports access should be counted at facility level, district level, and national level.

2. Hosting of quality review meetings to be routinely monitored over 12 months. Hosted meetings should be counted at facility level, district level, and national level.

Qualitative Research

3. Explore and discuss how facility level staff used facility-level health information to improve diabetes and hypertension service delivery and improve outcomes for people with diabetes and hypertension

4. Explore how sub-national stakeholders used district and facility level health information to improve diabetes and hypertension service delivery at the district level

Explore how national stakeholders used health information to improve disease surveillance, reporting, and as an input to policy and planning processes

6. DELIVERABLES

  • Comprehensive implementation research plan and protocol.
  • Data collection tools and training materials.
  • Interim and final research reports.
  • Presentations and dissemination materials for stakeholders.
  • To evaluate if and how digital health solutions strengthened the care pathway and improved health outcomes for people with diabetes and hypertension.
  • Assess the effectiveness of technology-enabled community health workers (CHWs) in identifying people at risk for undiagnosed diabetes and hypertension and referring them to health facilities for diagnosis.
  • Assess the effectiveness of technology-enabled HCPs in diagnosing and medically managing diabetes and hypertension.
  • Evaluate the impact of a technology-enabled diabetes and hypertension care pathway on patient outcomes (glucose control and blood pressure control).
  • Discuss how improved access to NCD-specific health information has been used to improve diabetes and hypertension services.

7. QUALIFICATIONS AND EXPERIENCE

The consultant/team should have the following profile:

  • Advanced degree in public health, epidemiology, health informatics, or a related field.
  • Experience: At least 10 years of experience in evaluating and implementing health or digital informatics, information systems, with significant experience in report writing and conducting high-level assessments. Strong writing and presentation skills and fluency in written English.
  • Proven experience in implementation research, particularly in digital health solutions.
  • Strong analytical skills and proficiency in data analysis software.
  • Excellent communication and stakeholder engagement skills.
  • Familiarity with health systems in LMICs and experience working in resource-limited settings.
  • Competence in Evidence-Based Review: Proven skills in conducting comprehensive evidence reviews, which involve literature searches, key informant interviews, proactive identification of illustrative examples, and effective presentation and communication of findings, including the use of PowerPoint and graphics.

8. DURATION

The consultancy will be for a period of 60 (Sixty) days, from 1st October 2024 to 31st September 2025 and will run through the following timelines:

  1. 20 days (Baseline 1st and 2nd month)
  2. 10 days (3rd Month)
  3. 10 days (6th Month)
  4. 10 days (9th Month)
  5. 10 days (12th Month)

9. APPLICATION PROCESS

Interested candidates should be individuals or a small team of individuals/firm. Successful application would be based on technical approach, experience, cost effectiveness (value for money) followed by a process of co-creation and joint work planning with the consultant(s).

Full proposals need to be submitted via email to the following address with all attachments in docx or PDF strictly to apzuhr@pih.org with copy to hndindi@pih.org by the deadline of August 30, 2024. Please use subject line “DCIR RFP2024”.

For the purpose of requesting any clarification or information, please send an email to apzuhr@pih.org with a copy to hndindi@pih.org and with the subject line: “Clarification needed – DCIR RFP 2024 ” by August 25, 2024.

The application MUST include:

  1. Cover Letter: Proposals must be accompanied by a cover letter (not exceeding 1 page) with the respondent’s address and convey the Consultant’s ability and suitability to carry out the work.
  2. Detailed Technical Proposal: This should not exceed 10 pages and should include the following;
    • Project description, demonstrating a high-level understanding of the scope and purpose of the project.
    • Competencies and experience that the Consultancy would bring to the objectives.
    • Approach, with a clear narrative of the activities to be conducted to achieve each objective and a clear description of the proposed methods to be used.
    • Proposed deliverables) for each activity.
    • Work plan with a timeline. The work plan should include the proposed timelines for each of the activities, milestones, and deliverables. Preferably a Gantt chart showing deliverables and timeframes.
  3. Profile: Full Resume(s) or Curriculum Vitae (CV) of key team members must be submitted together with the Technical Proposal. Citations, examples and /or accessible electronic links to examples of relevant recent written work by key personnel should also be submitted as part of the resume/CVs.
  4. Financial proposal: The Consultant shall submit a financial proposal detailing:
  • Breakdown of expected activities and deliverables.
  • Proposed cost disaggregated by the number of days.
  • Dates when progress reports and invoices will be submitted.
  • Proposed fees should be inclusive of all tax, and standard business overheads.
  • Proposed number of travels and cost, noting that travels and per diem would be managed per APZU travel policy.

RECEIPT, EVALUATION AND HANDLING OF PROPOSAL

Once a proposal is received before the due date and time, APZU will:

  • Log the receipt of the proposals and record the business information.
  • Review all proposals and disqualify any non-responsive ones (that fail to meet the terms set out in these instructions) and retain the business details on file with a note indicating disqualification.
  • Evaluate all responsive proposals objectively in line with the criteria specified through APZU and inform respondents of the evaluation decision being made on a timely basis.

APZU reserves the right to:

  • Accept or reject any and all proposals, and/ or to annul the RFP process, prior to award, without thereby incurring any liability to the affected Respondents or any obligation to inform the affected respondents of the grounds for APZU’s actions prior to contract award.
  • Negotiate – with Respondent(s) invited to negotiate – the proposed technical approach and methodology, and the proposed price based on the Respondent’s proposals.
  • Amend this RFP at any time.

Submitted proposals will be shortlisted and the successful proposal will be identified based on the selection criteria. The selected Respondent will be contacted and will be expected to enter into a Contract with APZU for the duration of the consultancy. The terms and conditions of this current RFP will normally form part of the Contract.

The objective of the Evaluation and Selection Process is to identify the Proposal that effectively meets the requirements of this RFP and provides the best value to APZU. A Proposal may be deemed non-compliant if it is not submitted in the requested format or if requested information is not submitted.

All determinations are made at the sole discretion of APZU.

NB: Partners In Health/Abwenzi Pa Za Umoyo (PIH/ APZU) is Committed to safeguarding staff, children and communities with whom we work with. We are committed to ensuring that those who benefit from our work – including our patients, families and community members – as well as our staff are treated with dignity and respect and protected from sexual exploitation, abuse and sexual harassment. Therefore, any offer of employment or engagement is conditional upon the successful completion of applicable background checks.

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