LRPS-2023-9182852: Strengthening WASH services in Health Care Facilities through implementing WASHFIT in 16 Upazila Health Complexes.
TERMS OF REFERENCE FOR INSTITUTIONAL CONTRACT
Title of the assignment
Strengthening WASH services in Health Care Facilities through implementing WASHFIT in 16 Upazila Health Complexes
Purpose
To hire the competent and qualified institution to implement WASHFIT in HCFs by coordinating different government stakeholders, facilitating Training of Trainers and Trainings, conducting facility assessment, implementing improvement plans including renovations and integrating the process into existing quality improvement process of facilities
Location
Dhaka and 8 selected districts (Bhola, Rangamati, Bandarban, Kurigram, Kishoreganj, Bagerhat, Sherpur, and Sunamganj)
Field visits are required to all selected facilities. List is attached in annex.
Estimated Duration
Duration: 7-8 months
Estimated starting date: 11th June 2023
Reporting to Technical Supervisor of this assignment
Health Manager, Health Section
1. Background
WASH in Health Care Facilities (HCFs) is an integral part of quality of care. It is a prerequisite for quality of care including safe, effective, and dignified health care services and infection prevention and control. Lack of basic and adequate WASH services in HCFs can endanger patients, health providers and communities.
Therefore, the vision of the SDG for WASH in HCFs is to ensure that by 2030, every HCF, in every setting, has safely managed reliable water, sanitation and hygiene facilities and practices to meet the needs of staff and patients. In Bangladesh, Ministry of Health and Family Welfare (MoHFW) in collaboration with Ministry of Local Government has developed the first ‘National WASH in Health Care Facility Strategy and Framework for Action (2019-2023)’ with the technical support of UNICEF. Through this document, WASH in HCFs strategy and framework for action was developed but the gap remains with WASH in HCFs to ensure quality of care. According to the analysis jointly conducted by UNICEF/WHO in 2021, the state of basic WASH services in HCFs for water supply is 64% (79% in hospitals), for sanitation is 31% (19% in hospitals), for hand hygiene is 38%, for health care waste management is 34%, while there was no sufficient data for environmental cleaning domain.
As one of the leading agencies on quality improvement, UNICEF together with University of Oxford and icddr,b conducted one pilot cross-sectional study in 2021 on water quality in 14 district hospitals and upazila health complexes to generate baseline data on the water quality in line with standards for safely managed water and WHO essential environmental standards for HCFs. The study revealed that the water quality deteriorated from the source to the final point of use in HCFs. Poor maintenance of water systems, and a lack of adequate waste management and environmental hygiene created risks to patients. Study also found out that the current approach prioritizing infrastructure access to improved source to supply safe water for HCF is negated by secondary contamination pathways from suboptimal maintenance and risky systems, compromising the microbial quality of water. This finding emphasizes the need to institutionalize the maintenance of WASH components in HCFs through integrating them into existing quality improvement process.
WASH FIT is a risk management tool and framework to guide progressive WASH improvements through a multistep, iterative process which include establishing WASH/IPC team, assessment and scoring a facility, risk analysis, prioritization and improvement planning, implementation and review. The tool is open for adaption at national level, aligning with existing country initiatives and its implementation provides considerable benefits in addressing the concerns. In Bangladesh, UNICEF partnered with NIPSOM (national institute for public health and social medicine) for quality improvement initiative by establishing quality improvement network in the country focusing on the newborn and pediatric standards. As of October 2022, 130 hospitals are implementing regular PDCA (Plan-Do-Check-Act) cycle through Quality Improvement Committee (QIC) in each facility or Work Improvement Team (WIT) in respective service wards. Implementing WASHFIT in HCFs by integrating the WASH FIT team into existing QIC/WIT will contribute to improve WASH maintenance in HCFs and ultimately to improve the quality of care.
Implementation of WASH FIT requires the availability of trained human resources at different levels: national, sub-national and facility level team. The national team will establish technical working group and coordination mechanism for implementation of WASH in HCFs action plans including roll out of the training, monitoring, supervision, and review. Thus, this ToR is developed to hire qualified institution to conduct WASH FIT trainings, facilitate HCFs to conduct facility assessment and develop and implement improvement plans and monitor the progress.
2. Objectives, Purpose and Expected Results
The ultimate objective of this contract is to improve quality of care by improving and strengthening WASH components in HCFs. Through this contract, UNICEF aims to hire the competent and qualified institution to implement WASHFIT in HCFs by coordinating different government stakeholders, facilitating Training of Trainers and Trainings, conducting facility assessment, implementing improvement plans including renovations and integrating the process into existing quality improvement process of facilities.
3. Description of Assignment
Scope of Work: The agency will work closely with MoHFW (DGHS and other relevant agencies of the ministry), Department of Public Health Engineering (DPHE), Public Works Department (PWD) and WASH consultant(s) in UNICEF Bangladesh Country Office and Regional Office who will provide technical support for TOT. The agency will ensure that the approaches in the assignment will be fully integrated in the existing health systems of Bangladesh and coordinate with relevant government stakeholders in both Health and WASH sector to complete deliverables described below.
Description of tasks:
- Facilitate national TOT and district level trainings (around 7-8 batches) of WASH FIT by coordinating different government stakeholders, improving existing approaches in WASH in HCF and Quality of Care
- Support facilities conducting baseline assessment and developing improvement plan following WASH FIT
- Support facilities to implement improvement plan following WASH FIT including technical and financial support for renovations and monitor the implementation
- Support facilities conducting endline assessment following WASH FIT
- Analyze baseline and endline assessment and disseminate results of the programme for scale up
4. Deliverables
Tasks
Deliverables
Items covered/Included
Time frame
Facilitate WASH FIT TOT and trainings in facilities by coordinating different government stakeholders
1. Inception report
- Submission of inception report outlining existing situation, incorporating proposed methodology and detailed timeline
- Prepare detail Project Implementation Plan along with detail site-based work plan and team mobilization plan
By 22nd June 2023
2. TOT report
- Facilitating national TOT and creating trainers pool for further trainings in district levels
- Summary report on national TOT of WASH FIT including list of trainer pool
By 30th June 2023
3. Training report
- Conducting district level WASH FIT trainings for 16 UHCs (around 7-8 batches)
By 31st August 2023
Support facilities conducting baseline assessment and developing improvement plan following WASH FIT
4. Baseline report
- Support each facility to integrate WASH FIT in the existing QIC/WIT
- Support each facility to conduct baseline facility assessment using WASH FIT module
- Support each facility to finalize development of improvement plan based on the assessment results
By 30th September 2023
Facilitate and monitor facilities implementing improvement plan following WASH FIT including renovations
5. Implementation report
- Support each facility to implement improvement plans of WASH FIT from minor changes to renovations depending on the results of the baseline assessment
- Conduct monitoring of regular meetings in each facility
By 31st November 2023
Support facilities conducting endline assessment following WASH FIT
6. Endline report
- Support each facility to conduct endline facility assessment using WASH FIT module
By 31st December 2024
Analyse baseline and endline assessment and disseminate results of the programme for scale up
7. Final report
- Analyse baseline and endline assessment results and develop final report
- Conduct one national level dissemination workshop for scale up by the government
By 30th January 2024
5. Reporting requirements
- Inception report: By 22nd June 2023
- TOT report: By 30th June 2023
- Training report: By 31st August 2023
- Baseline report: By 30th September 2023
- Implementation report: By 30th November 2023
- Endline report: By 31st December 2023
- Final report: By 30th January 2024
6. Payment Schedule
- 1st payment (10%): upon submission of deliverable 1 and 2
- 2nd payment (40%): upon submission of deliverable 3 and 4
- 3rd payment (30%): upon submission of deliverable 5
- 4th payment (20%): upon submission of deliverable 6 and 7
7. Qualification requirement of the company/institution/organization
The agency should:
- The agency should have at least 5 years of extensive experience on implementing WASH programmes
- The company should have implemented or ongoing contracts on implementing WASH programmes in health care facilities
- The agency should have previous experience working with Ministry of Health and Family Welfare or DPHE
- The agency should have at experience relating to multi-sectoral engagement and field experience
- The agency should have previous experience working with UN agencies, large NGOs or Government, but it is not mandatory
- The agency is expected to be able to leverage sufficient and experienced manpower to carry out the assignment effectively and efficiently
- The contractor should appoint an English-speaking project leader with at least 10 years of proven work experience in leading similar projects
Annex. List of selected facilities
SI
District
Name of UHC
1
Bhola
Daulatkhan Upazila Health Complex
2
Bhola
Lalmohan Upazila Health Complex
3
Bhola
Borhanuddin Upazila Health Complex
4
Rangamati
Kaptai Upazila Health Complex
5
Bandarban
Lama Upazila Health Complex
6
Bandarban
Thanchi Upazila Health Complex
7
Kurigram
Fulbari KG Upazila Health Complex
8
Kurigram
Nageswari Upazila Health Complex
9
Kurigram
Ulipur Upazila Health Complex
10
Kishoreganj
Tarail Upazila Health Complex
11
Kishoreganj
Katiadi Upazila Health Complex
12
Kishoreganj
Austagram Upazila Health Complex
13
Bagerhat
Kachua BH Upazila Health Complex
14
Sherpur
Jhenaigati Upazila health Complex
15
Sunamganj
Dowarabazar Upazila Health Complex
16
Sunamganj
Sulla Upazila Health Complex