Rwanda: National consultancy to consolidate & finalize RMNCH EMR documents , Kigali, Rwanda (For Rwandans only)

By UN Children’s Fund Organization: UN Children’s Fund
Country: Rwanda
Closing date: 14 Oct 2018

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Background

Through partnership with UNICEF, MCH program outlined key highlights and recommendations for improving the service delivery by expanding existing Medical record platform to a comprehensive, holistic and integrated system that encompasses the entire RMNCH and nutrition programs. Further, the review recommended leveraging this platform towards achieving results along the continuum of care using a cascade approach from hospital, health center and community levels. The EMR is currently implemented in 340 health facilities, and is limited to only a few modules including the HIV package, eHealth Management System – eHMS (also referred to as the primary care package) now implemented in 37 hospitals for billing and registration and Bushenge is the only hospital implementing additional modules in EMR including registration, lab, clinical notes, pharmacy and billing. By implementing EMR with comprehensive RMNCH modules, the government of Rwanda would like to address problems related to continuity and quality of care at health facilities and community.

The Government of Rwanda took a decision to adopt the Open Source Electronic Medical Record (EMR) system as a national system to support health care services within hospital and health centers across the country. EMR was created in 2004 as an open source medical record system platform for developing countries. OpenEMRS is a software platform and a reference application, which enables design of customized medical records. The system is based on a conceptual database structure, which is not dependent on the actual types of medical information required to be collected, or on particular data collection forms and so can be customized for different uses. This system is based on the principle that information should be stored in a way that makes it easy to summarize and analyze, i.e., minimal use of free text and maximum use of coded information.

This far, some hospitals and health centers have already started using the EMR, however, the benefits so far are immeasurable. Great interest has shown in the health sector to embrace technologies as such and its capabilities to strengthen RMNCH and nutrition health service delivery across the continuum of care and supporting innovative interventions towards achieving the results. Additionally, Rwanda Ministry of Health is committed to achieving the Sustainable Development Goals (SDGs) 2030. The maternal and child health program Plan 2030 and key policy and program documents reaffirm the commitment to the SDGs. The Maternal and child Health program is spearheading several policy and program strategies towards achieving the health targets for the national and global overarching goals. Strengthening the service delivery platform and ensuring equity in coverage and quality are critical components integral to achieving the targets for maternal, newborn and child health and nutrition.

Objectives of the consultancy

The main objective of this consultancy is to review, consolidate and finalize RMNCH EMR draft documents (protocols, high-level workflows/flow charts, decision flows, messages & defining EMR indicators).

Specific objectives.

Phase 1:

  • Development of RMNCH EMR documents content
  • Reviewing and inserting details in the draft high-level workflow charts and protocols (ANC, PNC, Intrapartum, IMNCI, Nutrition/growth monitoring, immunization)
  • Developing and completing development of the remaining unfinished modules (FP, GBV, ETAT, , SRH, ECD)
  • Developing detailed decision flows and data input requirements for the different RMNCH programme thematic areas
  • Creating specific decision flows interlinking each of the RMNCH thematic area, including mandatory and optional decisions
  • Developing decision flow for different levels (HC, district hospital and referral hospital).
  • Technical definition of tasks to guide case management by different levels and supervisors.
  • Creating protocols linking high level workflows, decision workflows, and explaining data flow protocols
  • Defining linkages, indicators, reports and messages for the new EMR integrating RMNCH.
  • Customizing messages linking EMR and mHealth (RapidSMS or RapidPro) to ensure continuum of care between health facilities, CHWs and community.
  • Describing mandatory and optional decisions, preparing dashboards, report formats
  • Incorporating HMIS/DHIS-2 indicators and defining/adopting quality of care indicators.
  • Technical definitions for new indicators (including quality of care indicators
  • Presenting final drafts of RMNCH EMR documents to the RMNCH technical teams and MCCH TWG for inputs and validation
  • Inserting inputs from the technical teams and MCCH TWG, finalizing the documents, submission to RBC and UNICEF for approval
  • Phase 2.

    Working with IT consultant to customize the new RMNCH EMR documents within EMR platform.

  • Working with the IT consultant to customize developed RMNCH EMR protocols
  • Pre-testing of the new updated RMNCH EMR documents in one Hospital and One Health center
  • Finalization and validation of the new updated RMNCH EMR documents ready for implementation
  • Capacity Building and Knowledge Transfer.

    In Rwanda, we strive to build local capacity as much as possible on any project under implementation. Hence, knowledge transfer will be integral to this process. As a technical RMNCH EMR Consultant, he/she will be responsible for sharing material knowledge therein confined in his/her consultancy deliverables for an effective knowledge transfer. It is important to note that the project owner – RBC holds full ownership rights of the work undertaken on the project as well as the right to distribute the work among the stakeholders. We take knowledge sharing and dissemination very important to ensure sustainability and functionality of the RMNCH EMR documents at the end of contract.

    Justification

    Although currently, various data elements are entered separately and exist in virtual silos, clinicians are required to fill out different and mutually exclusive forms, exacerbating strains on a system facing a scarcity of health professionals. Quality of clinical care depends on the knowledge and practice of the health care provider and there is a high degree of variance among providers. An electronic system at point of care can guide providers to ensure a minimum standard of quality. Moreover, data for cohort analysis is not available at real time to inform program management and policy decisions. The system-level improvement is expected to resolve many of these issues, but much more work is necessary to successfully upgrade the existing EMR version, including the creation and integration of new RMNCH modules/forms and making them interoperable with existing EMR modules.

    Key responsibilities / tasks

    The Technical MNCH Consultant will review, consolidate and finalize RMNCH EMR documents including protocols, high-level & decision flow charts, indicators (HMIS/DHIS-2 & quality of care), reporting formats, dashboard and working with EMR developer. This approach must be in line with internationally accepted best practices. During the execution phase of this consultancy, the technical RMNCH EMR Consultant will participate in the validation RMNCH EMR documents.

    The consultant will ensure decision flow capture all data reported in HMIS/DHIS-2 and work with the IT consultant to develop EMR business analysis reports. The RMNCH EMR should capture more indicators (including quality of care indicators) than in HMIS/DHIS-2.

    Although the list of expected deliverables is shown below, the Technical RMNCH EMR Consultant must understand that this list may require changes during the consultancy period. These changes may happen in cases the priority of tasks change or a specific stakeholder / user requires implementation of the changes.

    Deliverables.

    Phase 1.

  • Road map for review, consolidation and finalization of the RMNCH EMR technical documents with clear process and implementation timeline
  • The final new developed RMNCH EMR documents ready for customizing in the EMR system
  • A comprehensive report describing components of the new developed RMNCH EMR documents including high-level workflow charts and protocols, specific decision flows for each of the RMNCH thematic area, decision flow for different levels (HC, district hospital and referral hospital), definition of tasks to guide case management by different levels and supervisors, protocols linking high level workflows, decision workflows, and explaining data flow protocols, messages for mHealth, and dashboards and reporting formats that include HMIS/DHIS-2 and new indicators (including quality of care indicators).
  • Phase 2.

  • Final new updated RMNCH EMR documents approved by RBC and UNICEF customized within the new EMR platform
  • All deliverables need to be developed in consultation with and approved by RBC/MOH and UNICEF. The expected duration to complete all these deliverables is 3 months. Additional one month will be sprit with period while working with IT, inserting inputs & finalizing the EMR documents with a possibility of extending consultancy period based on need.

    Reporting

    UNICEF will issue the contract and pay the consultant, based on the payment schedule mentioned below and after the approval of the deliverables by MOH and UNICEF. UNICEF Health Specialist – in collaboration with MOH – will manage the contract and be the focal point for all contractual matters.

    Payment schedule:

    Deliverable

    Payment proportion

    Output 1: Road map for review, consolidation and finalization of the RMNCH EMR technical documents with clear process and implementation timeline

    20%

    Output 2: The final new developed RMNCH EMR documents ready for customizing in the EMR system

    25%

    Output 3: A comprehensive report describing components of the new developed RMNCH EMR documents including high-level workflow charts and protocols, specific decision flows for each of the RMNCH thematic area, decision flow for different levels (HC, district hospital and referral hospital), definition of tasks to guide case management by different levels and supervisors, protocols linking high level workflows, decision workflows, and explaining data flow protocols, messages for mHealth, and dashboards and reporting formats that include HMIS/DHIS-2 and new indicators (including quality of care indicators).

    30%

    Output 4: Final new updated RMNCH EMR documents approved by RBC and UNICEF customized within the new EMR platform

    25%

    The consultant will be responsible for all logistical arrangements associated with this contract. UNICEF / MOH will provide a letter of support to facilitate field visits where needed (for quality assurance). Other expenses such as local travels, banking/cash services, or office space and equipment (including computers and photocopiers) shall be under the responsibility of the consultant.

    For all contractual issues, the consultant will report to UNICEF. For technical issues, the consultant will work directly with the technical team, led by UNICEF and MOH. All deliverables must be approved by MOH and UNICEF to be considered final. The consultant is expected to use his or her own equipment, including computers. UNICEF premises will be available for the meetings and collecting inputs from other partners.

    The consultant shall not make use of any unpublished or confidential information, made known while performing duties under the terms of this agreement, without written authorization from MOH/UNICEF. The products of this assignment are not the property of the consultant and cannot be shared without the permission of MOH/UNICEF. The consultant shall respect the habits and customs of the local population and abstain from interfering in the country’s political affairs. Law no 31/2007 on intellectual property right will be applicable where necessary.

    The consultant shall abide by and be governed by UNICEF Procedure on Ethical Standards in his duties.

    Payment will only be made for work satisfactorily completed and accepted by UNICEF. UNICEF reserves the right to withhold all or a portion of payment if performance is unsatisfactory, if work/outputs is incomplete, not delivered or for failure to meet deadlines.

    All materials developed by the consultant will remain the copyright of MoH/UNICEF, who will be free to adapt and modify the materials for future use.

    Potential types of materials/documents to be prepared and submited to UNICEF are:

  • New final RMNCH EMR documents (in soft and hard copies)
  • A report on the content of the new RMNCH EMR documents integrating all exiting modules, explaining the changes and new inputs to the RMNCH EMR documents, definition of tasks to guide case management by different levels and supervisors, protocols linking high level workflows, decision workflows, and explaining data flow protocols, messages for mHealth, and dashboards and reporting formats that include HMIS/DHIS-2 and new indicators (including quality of care indicators).
  • Progress Reports and Minutes of MCCH and technical Meetings
  • Field Reports
  • Technical Reports
  • Draft and Final Report
  • Presentation material
  • Qualifications and specialized knowledge/experience required:

    Mandatory Qualifications – required in order to be evaluated.

  • Medical doctor with masters degree in Public Health or related field
  • 5 years or more of relevant experience in RMNCH guidelines/protocols development
  • Experience in clinical, public health and primary health care services
  • Experience in RMNCH programs implementation, monitoring and evaluation
  • Object Oriented Programming experience preferred
  • Knowledge of health management information systems, Health and EPMS/EMR is desirable
  • Computer skills (excel, word, PowerPoint)
  • Education:

  • The Technical RMNCH EMR Consultant must have at least a degree in human medicine.
  • Desired qualifications.

  • Strong analytical, problem-solving, and conceptual skills.
  • Leadership and communication skills
  • Should be flexible and a good motivator
  • Experience:

  • Knowledge of Rwanda health system structure, and health information system
  • Acquaintance with RMNCH technical working groups process
  • Good understanding of different RMNCH thematic areas
  • Working with national medical professional council
  • Language Requirements:

  • Fluency in written and spoken English is required.
  • Knowledge of French and Kinyarwanda is an asset
  • Expected deliverables and timeframe

    There are Seven Outputs associated with the assignment divided into two phases, phase 1 and phase 2 grouped into 4 deliverables:

  • Deliverable 1: Output 1
  • Deliverable 2: Output 2
  • Deliverable 3: Output 3
  • Deliverable 4: Output 4
  • Although the list of expected deliverables is shown below, the Technical RMNCH EMR Consultant must understand that this list may require changes during the consultancy period. These changes may happen in cases the priority of tasks change or a specific stakeholder / user requires implementation of the changes.

    The write up of all outputs above should be in a clear language so that they can be easily understood, avoiding long sentences, jargon, abbreviations and technical terms to the extent possible, and should as necessary define the terms used. As appropriate, the outputs must also contain drawings, diagrams or other visual materials to illustrate work done.

  • The expected duration to complete all these deliverables is full time for 3 months. One month sprit with period (working with IT, inserting inputs & finalizing the EMR documents) with a possibility of extending consultancy period based on need.
  • Evaluation Criteria:

    Shortlisted candidates will be assessed for their suitability based on the following:

  • The Technical Evaluation is weighted at 75% and 25 % for the Financial proposal.
  • How to apply

    Qualified and experienced candidates are requested to submit a letter of interest a Technical Proposal outlining a road map for review, consolidation and finalization of the RMNCH EMR technical documents with clear process and implementation timeline. The applicant should also submit an all-inclusive Financial Proposal outlining the total costs for this consultancy with payment linked to the 4 main deliverables outlined above.

    In their letter of interest, candidates should highlight their previous work experience relevant to the assignment, the attributes that make them suitable, their proposed approach to the assignment.

    General conditions: procedures and logistics:

    The consultant must be or work with an expert (s) aware of the conditions of each site/region of intervention. In some circumstances, particular logistic arrangements are required. Therefore, while conducting the consultancy UNICEF will not be responsible for any unexpected additional cost or arrangement required during the implementation of the assignment. UNICEF will only hire one consultant for this assignment and s/he will be responsible for hiring and paying own sub-contractors if need be.

    Policy both parties should be aware of:

  • Under the consultancy agreements, a month is defined as 21 working days, and fees are prorated accordingly. Consultants are not paid for weekends or public holidays.
  • Consultants are not entitled to payment of overtime. All remunerations must be within the contract agreement.
  • No contract may commence unless the contract is signed by both UNICEF and the consultant.
  • The consultant will be required to sign the health statement for consultants / individual contractors prior to taking up the assignment.
  • For every Child, you demonstrate…

    UNICEF’s core values of Commitment, Diversity and Integrity and core competencies in Communication, Working with People and Drive for Results.

    UNICEF is committed to diversity and inclusion within its workforce, and encourages all candidates, irrespective of gender, nationality, religious and ethnic backgrounds, including persons living with disabilities, to apply to become a part of the organization.

    UNICEF has a zero-tolerance policy on sexual exploitation and abuse, and on any kind of harassment, including sexual harassment, and discrimination. All selected candidates will, therefore, undergo rigorous reference and background checks.

    Remarks:

    Only shortlisted candidates will be contacted and advance to the next stage of the selection process.

    How to apply:

    UNICEF is committed to diversity and inclusion within its workforce, and encourages qualified female and male candidates from all national, religious and ethnic backgrounds, including persons living with disabilities, to apply to become a part of our organization. To apply, click on the following link http://www.unicef.org/about/employ/?job=516865

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