Short Term Consultant - Health (Sierra Leone)

The World Bank seeks a short-term consultant to support the Sierra Leone Ministry of Health’s Directorate of Human Resources in the identification and coordination of analytics toward development of the new Human Resources for Health (HRH) Strategic Plan.

A. PROJECT BACKGROUND

At the center of every health system are health workers. Their knowledge, skills and motivation play a crucial role in delivering health services to those in need. Many countries are grappling with enormous human resources for health policy challenges, such as how to address shortages or surpluses and how to improve the skills, geographic distribution and performance of health workers. Strengthening the health workforce remains an important pillar of the World Bank's health systems strengthening agenda. As such, the World Bank supports countries to carry out analytic work to inform human resources for health policies and strategies.

As identified through Sierra Leone’s HRH Strategic Plan 2017-2021, the shortage and poor caliber of skilled health workers represents a key bottleneck to improving quality of care and health outcomes in the country. The skilled health worker density is only 6.4 per 10,000 population (23 per 10,000 is recommended by World Health Organization (WHO)), with the physician density estimated at 0.05 per 1,000 population across the country. There is an inequitable distribution of human resources, with health workers concentrated in central areas, exacerbating shortages in the periphery. Quality of care is also affected by large numbers of unsalaried health workers who form substantial proportion (estimated at about 40 percent) of frontline health workers. In addition, according to the Service Delivery Indicators (SDI) Survey (2018), health care providers can correctly diagnose less than half (44.6 percent) of five tracer conditions: 67 percent of doctors can correctly diagnose all the tracer conditions compared with Community Health Officers (59.7 percent) and nurses (44.5 percent). The SDI survey also showed significant variations in provider knowledge and practice gaps across different types of facilities. For example, while 97 percent of doctors can correctly diagnose pulmonary tuberculosis, only 5 percent can provide correct treatment. Health care providers in hospitals correctly diagnose 61.7 percent of tracer conditions, followed by health centers (49.4 percent) and health posts (46.3 percent). Quality is better in urban areas than rural areas with diagnostic accuracy higher in urban facilities (50.9 percent of clinical cases are diagnosed correctly) than rural facilities (37.3 percent).

On top of the low production capacity of Sierra Leone’s medical schools, poor working conditions have led to the migration of doctors and nurses. These include comparatively lower wages and more limited opportunities for continuous professional development, together with inadequate infrastructure and equipment, particularly in rural areas. A Health Labor Market Analysis conducted by the Ministry of Health (MOH) in 2019 estimated that roughly 7 percent of doctors have left Sierra Leone in the quest for better working conditions. It should be noted, however, that while this is a critical concern, there are limited data on the number of Sierra Leonian doctors that have migrated, and the main reasons for their departure.

In the aftermath of Covid-19, the MOH plans to develop a new HRH Strategic Plan that reflects current health workforce needs. To this end, the MOH intends to undertake a series of primary and secondary data collection and analytical exercises to support the development of key HRH policy and investment priorities. The MOH is in progress of developing a Roadmap, which specifies all of the technical needs – and their associated resource requirements, supporting partners, and timelines – for the development of the HRH Strategic Plan.

B. OBJECTIVES

The objective of the TOR is to support the MOH in strengthening the collection and use of information in HRH planning and management, including to inform the new HRH Strategic Plan:

1. To assess existing data completeness of health workforce information for identification of key challenges and priorities.

2. To align health sector leaders and partners toward filling key gaps in HRH information.

3. To advise and directly support health sector leaders and partners on key areas for capacity building in using information for HRH planning and management.

Expected Outcome:

1. Strengthened MOH and partner alignment toward collection, analysis, and use of HRH information toward identifying and addressing key bottlenecks in HRH in Sierra Leone.

C. SCOPE OF WORK

This consultancy will support the Sierra Leone Ministry of Health leaders and other appropriate organizations and committees in the following:

1. Support the coordination of the HRH Strategic Plan Roadmap (as defined above), including defining the required data and analytics, timelines, budgets, ToRs, and partner mapping.

2. Support the organization and management of consultative processes (i.e., technical working group meetings, partner and stakeholder convening, workshops) and outputs (i.e., meeting notes, reports, follow-up communications with stakeholders).

3. Implement key milestones identified in the Roadmap, such as the coordination of partners

for primary and secondary data analysis toward an updated HRH Country Profile.

4. Provide technical assistance, short training and coaching to ensure the appropriate technical stakeholders have the necessary understanding of the different aspects of health workforce challenges. This can additionally include:

a. Providing ad hoc technical assistance to ensure successful implementation of institutional capacity building tasks and program support.

b. Identifying appropriate focal person(s) and working group(s) for institutional capacity building, coaching, and training needs.

c. Recommending technical training, presentations to key decision makers, or participation in local/international workshops or conferences, relevant to the success of health workforce challenges and objectives.

D. DELIVERABLES

Over the course of the consultancy, the following (non-exhaustive) deliverables would be expected to be approved and provided to the World Bank team in consultation with the MOH:

1. HRH Strategic Plan Roadmap, which specifies all the technical needs – and their associated resource requirements, supporting partners, and timelines – for the development of the HRH Strategic Plan.

2. Meeting notes and reports, to be circulated among key stakeholders.

3. Monthly activity reports.

4. Priority analytical products identified in the HRH Strategic Plan Roadmap.

5. Summary reports of technical assistance, short trainings and coaching for capacity building.

E. REQUIRED EXPERTISE

1. Minimum Bachelors degree in economics, policy, health sciences, public health or related subjects

2. Experience in high-level and technical partner coordination, management and alignment.

3. Experience in designing, supporting, and managing large-scale HRH policies and/or programs with Government (especially Ministries of Health).

4. Experience in providing practical training, coaching and mentoring in leadership development, with a focus on HRH planning and management.

5. Knowledge and experience in community health/primary health care programs is essential.

6. Ability to work in a team and in a diverse work environment.

E. RENUMERATION AND REPORTING

This work is expected to take 20 days between 1-July-2024 to 30-Sept-2024, with possibility for extension and additional days based on performance. The consultant will report to the World Bank Task Team coordinating the project with a dotted line reporting to the Directorate of Human Resources for Health at the Ministry of Health.

Please send a cover letter highlighting relevant professional experiences and most recent resume to Daniela Hoshino via email to [email protected] and put Short Term Consultant - Health as email subject by COB July 12, 2024