Review of Cardiac Services in Fiji

Background

The Fijian population has access to a range of cardiac services:-

1. Most cardiac surgery at the main Colonial War Memorial Hospital (CWMH) in Suva is delivered by visiting teams of overseas specialists engaged by a local private operator under contract with MoHMS.
2. A cardiology service (angiography and stents) is also provided at CWMH. The service is staffed by local specialists with support from overseas colleagues who make regular visits on a volunteer basis. Most of the equipment and consumable items used by the service is also donated or provided on a subsidised basis by overseas partners.
3. Patients who require more specialised services that are not available local may be referred for treatment overseas (typically to India).
4. A number of overseas-based organisations arrange for visiting teams to deliver cardiac surgery services at CWMH and other major hospitals on a regular or ad hoc basis.
5. Fiji’s main private hospital (MIOT Pacific) in Suva is believed to be planning to offer cardiology and (potentially) cardiac surgery services in the near future.

Fiji MoHMS provides financial support for patients in categories 1 – 3 above but most are also required to make a co-payment. Services under category 4 are typically offered free-of-charge while there would be no government funding for services under category 5. Some patients may be able to access private health insurance funding to meet all or some of the costs incurred.

Fiji MoHMS is seeking to develop a clear strategy for the future delivery of cardiac services. Relevant contextual factors include:-

1. The contractual arrangement underpinning many of the cardiac surgeries carried out at CWMH (category 1 above) is due to come to an end in the fourth quarter of 2017 and a decision is needed as to whether/how it should be re-negotiated.
2. The schedule of fees levied for services under categories 1 – 3 above is believed to be outdated, and possibly inequitable and may also offer an incentive for people to obtain services overseas rather than locally.
3. The potential emergence of wholly private services provides both the opportunity for MoHMS to ‘outsource’ some services but also the risk of such services attracting key skilled staff away from public sector employment (Medical staff employed by MoHMS are currently prohibited from undertaking private work.)
4. Weak management of facilities and services at CWMH is believed to result in inadequate maintenance of equipment, poor stock-control and inefficient use of skilled staff time.
5. The need to ensure that, if visiting teams are to continue contributing to local delivery of services, adequate arrangements are in place to ensure skills transfer and capacity building for local counterpart staff.

In light of the above, the Fiji Ministry of Health and Medical Services requested to have a consultation about what will be the best approach for Fiji government to provide various cardiac services including gaps, overlaps and coordination among the various service providers and modalities, consideration of public/private roles, management and staffing, and funding options.

Planned timelines (subject to confirmation)

Start date:  07/Aug/2017

End date: 29/Sep/2017

Work to be performed

Method(s) to carry out the activity

Literature review, data collection/analysis, consultation and writing

Output/s

In collaboration with WHO Division of Pacific Technical Support (DPS) and Ministry of Health and Medical Services, Fiji, the contractor (a contracting team) will:

1. Review current status of cardiac services (CABG, stents and angiography) delivery in Fiji
   • Number of patients with case profiles and severity classification from Jan 2015 to Jun 2017
   • Service provision arrangement (workforce, facility, equipment, consumables, etc.)
   • Cost and financial (payment) mechanism (sources, flow, controllers, etc.)
2. Estimate the number of patients (population needs and demands) for cardiac services with severity classification for next 5 years
3. Propose future options in providing more equitable, efficient and quality cardiac services in Fiji
   • Suggest various options such as continuing current arrangement, or building stronger clinical team in Fiji, or more relying on visiting doctors, or others.
   • Provide cost estimation of various options
   • Based on needs, costs and international experiences, propose feasible, sustainable and equitable financing options for providing cardiac services in Fiji
   • Provide recommendations on staffing and management needed to ensure ongoing efficient operation of the full spectrum of services

Technical Supervision

The selected Consultant will work on the supervision of:

Responsible Officer: Kunhee Park, A/Team Coordinator, Pacific Health Systems and policy, Pacific Technical Support
Email:   parkku@who.int

Specific requirements

- Qualifications required:

Postgraduate studies and/or training in cardiology (or cardiac surgery), health economics, health management/financing or public health.

- Experience required:

At least seven years of working experience, including international work experience in above areas. Experience working in one or more Pacific islands would be an asset.

- Language requirements:

Written and spoken fluency in English is essential. Working knowledge of other UN languages is an advantage

Competencies

Communicating in a credible and effective way;

Producing results; and

Moving forward in a changing environment.

Place of assignment

Home based (desk review) and Suva, Fiji (data collection and field consultation)

Timeline/Duration of assignment

The duration for of the assignment is from 07 August to 29 September 2017.

• Develop a methodology: - 11 August
• Interim report on review of current status and estimation of future needs: - 25 August
• Field consultation: - 08 September
• Complete a final report: - 29 September

Detailed cost breakdown

A team of at least two experts (one for cardiac services and the other for health economics/financing) is preferred. Submit your expected days of working, expected daily rate and other expenses.

Contractual fee (expert 1)- (submit your expected days) X (submit your expected daily rate) =        
Contractual fee (expert 2)- (submit your expected days) X   (submit your expected daily rate) =        
Air-fare (your place – Suva – your place) for (2 persons) X (unit cost) =                       
Per-diem (Suva) - 251 USD X 5 nights X 2 persons =    2,510 USD
Miscellaneous (if any, please specify)                                    
TOTAL =

Applications
Qualified and interested individuals or institutions should submit an application letter with an expected quotation to wpfjidpsprocurement@who.int. Only short-listed applicants will be contacted. Application close on Thursday 20 July 2017. Please use Tender Notice No. 59285 as subject to all submissions