Terms of Reference (TOR) to Conduct Laboratory Training for Health Workers in Sahil Region, Somaliland

Reference: EPHS Lab Training
Deadline for submission of proposals: Friday, 7th June 2013

Health Poverty Action-HPA (formerly known as Health Unlimited) is a British NGO, which aims to create a world in which the most vulnerable communities can enjoy their rights to health and well-being. We give priority to the most excluded and, in particular, indigenous people and communities affected by conflict and political instability.

HPA under the financial support of DFID through the Health Consortium Somalia (HCS) is implementing a Maternal and Child Health programme piloting the ‘Essential Packages of Health Services (EPHS) in Sahil Region of Somaliland.

This is a comprehensive program with interventions ranging from human resources for health, building institutional capability of health facilities to provision of support to referrals and medical supplies and equipment.

Sahil Region – The Context
The Sahil Region (Saaxil), one of the six administrative regions of Somaliland shares boundaries with The Gulf of Eden and Maroodi Jeex, Sanaag, Togdheer and Awdal regions.

Although the capital Berbera is a modern town with urban characteristics, majority of the population live in rural areas with agro-pastoralists and nomadic lifestyles. Difficult geographic terrains and a hot harsh weather characterize Sahil. Harmful traditional practices such as FGM and GBV are common. It has the highest HIV prevalence in Somaliland with no adequate VCT facilities.

HPA under the current program covers the entire Sahil region with 4 referral health centres, 6 health centres 15 primary health care units and Berbera (regional) hospital. Since commencement of HPA support, all the 4-tiers of health facilities are now fully operational in the region. The Primary health care unit (lowest level of health service staffed by Community Health Worker-CHW) provides basic health services to community. The PHUs play a role of providing basic services and health education, and informing upper level facilities if there are any obstetric patients or where specialized care is required. TBAs and Community Health Committee support to CHW in PHU level.

The second level is the Health Centre. This facility is staffed by two qualified nurses, one midwife, two auxiliaries, one health aid, cleaner and watchman. This facility provides basic emergency obstetric care (BEOC) and other general health services such as OPD, ANC/PNC, health education, nutrition and pharmacy.

All complicated cases, if they receive are referred to the Referral Health Centre or Berbera hospital. HPA and MOH have provided 7 ambulances stationed in the RHCs and Berbera hospital to support emergency services. The Referral Health Centres provide BEOC/CEOC(CEOC service are expected to start soon) and other services such as services OPD, ANC/PNC, health education, nutrition, pharmacy, ambulance and laboratory. This facility is staffed by Clinical officer (Incharge), four qualified nurses, three midwives, one laboratory technician, one auxiliary, two health aids, two cleaners and two guards. This facility provides
24/7 services.


Berbera hospital is the final referral point in Sahil region providing specialised services such as CEOC, assisted delivery, child health, Nutrition, TB, mental health, x-ray, ultrasound, ECG, laboratory, VCT etc.
Laboratory needs HPA has supports the infrastructural establishment of the health system in the region. In the referral health centres it has established fully equipped operating theatre rooms, maternity wards and laboratory rooms to support diagnosis. Proper diagnosis of most health cases depends on laboratory services, examination and report. Accessible, high-quality laboratory services are critical to the deliver quality health services. They provide support for the day to day routines of diagnosing illnesses presented by patients, disease surveillance activities, assessment of the adequacy of treatment for infectious and chronic diseases, and development of more sensitive methods for the detection of preventable illnesses.
Sahil is a challenging terrain with harsh weather patterns. As a result, it attracts relatively youthful health workforce. Laboratory technicians working in referral health centres for instance are fresh graduates locally trained in Somaliland institutions. They don’t have any practical skills or training on laboratory. In Berbera hospital, there are 10 staffs of technician and assistant in laboratory unit (General laboratory, HIV, TB and Blood Bank). However they have not had continuing professional development related to improved laboratory skills other than blood banking and transfusion (2011), HIV counselling (2012) and chemical & biohazard safety training (2013).

They have many modern laboratory equipment supported by agencies and also donated by diaspora Somali groups and other therefore remain non-functional, due to the lack of operation skills. HPA in light of this gap is putting up efforts to revitalise human resources in laboratory sections of the hospital and RHCs through practical training and skills improvement.

This TOR development is a result of consultative efforts and request by the regional health office for skills support in laboratory field.

Main Objective: To improve clinical laboratory skills on major tests of 15 staffs of Berbera hospital and four-referral health centres of Sahil.

Specific Objectives
The training will seek to fulfill the following objectives:
Relate the role of the clinical laboratory to the total patient care and enhance
professional ownership and accountability.
Demonstrate a theoretical understanding of the major basic laboratory tests, most
specialized laboratory testing and some esoteric laboratory testing.
Review current knowledge and make clinical decisions regarding the correlation of
patient results, validity of those results and the need for additional testing.
Demonstrate proficiency by discussing, interpreting and utilizing quality control methods
to maintain laboratory accuracy and precision.
Apply established quality assurance practices in respect to patient care
Perform preventative and corrective maintenance on laboratory instrumentation and
recognize when to refer repairs to the appropriately trained source.
Provide an understanding on managing lab supplies chain
Patient and staff safety procedures and proper management of lab waste
Record keeping and reporting of lab activities


Deliverables:
Submit a protocol and tools for the skills assessment
Carry out the laboratory skills assessment of both Hospital and Referral Health Centre’s laboratory technicians and set up the three level of training i.e. Basic level, intermediate level (six months later) and advance level (one year later) Develop laboratory training protocol and materials including handouts and presentations
Prepare a report on the training including outcomes, with pragmatic future steps and
certification

Time Frame
Total duration of this assignment will be 20 days (10 days basic level, 5 days intermediate level and 5 days advance level) in field training. Preparation, travel days and report duration will be negotiable.

Supervision
The consultant (trainer) will work under the supervision of the programme manager in consultation with the APM.

Proposal submission
Qualified consultants/firms are invited to submit technical and financial proposals to consultancies@healthunlimited.or.ke. Please indicate the reference, EPHS Lab Training, of the Call for Consultancy in the e-mail subject line.

The deadline for submission of technical and financial proposals is on Friday, 7th June 2013