INTRODUCTION
The Fred Hollows Foundation (The Foundation) is a secular non-profit public health organization based in Australia, which was founded in 1992 by eminent eye surgeon Professor Fred Hollows. The Foundation focuses on strengthening eye health systems and the treatment and prevention of avoidable blindness caused by Cataracts, Trachoma, Diabetic Retinopathy, and Refractive Error. The Foundation operates in more than 25 countries across Australia, The Pacific, South and South East Asia, and Africa.
The Foundation in Rwanda, together with the Government and its partners, have been working closely to implement national policies and strategies to restore sight and eliminate avoidable blindness by increasing access to comprehensive eye health services, with a focus on cataract treatment, through a Health System Strengthening (HSS) approach for sustainability. From 2019 the Foundation’s approach shifted to working with the Ministry of Health (MoH) to integrate cataract and eye care service indicators into the Performance Based Financing scheme through Integrating Eye Health into Performance Based Financing (PBF). The Foundation was the pioneer NGO to support this innovative model. The PBF project is complemented by a Health System Strengthening (HSS) component to enhance Human Resources for eye health, strengthen equity, demand and uptake for eye care services; strengthen national-level supply chain management; build strategic partnerships with key stakeholders for comprehensive eye health care and undertake critical research to inform eye health programming.
Despite the existence of a conducive policy framework for universal accessibility to eye health services in Rwanda, the prevalence of blindness and visual disability is widespread and eye health is among top NCDs prioritized in Rwanda. According to the Rwanda Integrated Household Living Conditions Survey (EICV5: 2017), 4.2% of the Rwandan population aged 5 and over have a disability, of which 6.6% have a visual disability. There are slightly more people with visual disability in rural areas (6.7%) than in urban areas (6.2%), and more male (6.8%) than females (6.2%). With regard to age, figures show that visual disability tends to increase with age, as prevalence rates are higher among the 50-54 and 60-64 age bracket respectively.
The Fred Hollows Foundation’s vision is a Rwanda where no person is needlessly blind or visually impaired and the organization is determined to deliver Fred Hollow’s vision of preventing blindness and restoring sight. We work to realize impact on eye health in line with the strategic direction of The Foundation, and the Rwanda National Strategic Plan for Eye Health (NSPEH). We aim to increase equitable access to quality eye care services including cataract and integrated eye health services through capacity building, health systems strengthening, strategic partnerships and empowered communities. We want to see and advocate for government-increased financing for eye health – all these geared towards increased sustainability.
We are committed to establishing strategic partnerships that will be integral to the success of the Foundation’s work in Rwanda, bringing in other stakeholders such as the Rwanda Ophthalmology Society (ROS), Rwanda International Institute of Ophthalmology (RIIO), Onesight, Fondazione Leonardo Del Vecchio Rwanda, Christian Bind Mission (CBM), National Union of Disability Organisations in Rwanda (NUDOR) and Rwanda Men's Resource Centre (RWAMREC) to ensure program outcomes are achieved.
PROJECT BACKGROUND
The Rwanda Country Strategy and Heath System Strengthening (HSS) project envisages leveraging on private sector partnerships as a catalyst across the various health system pillars, particularly enhancing skilled human resources to reduce the cataract surgical backlog. Human Resources for Eye Health (HReH) is the backbone of the health system and it’s important to have an adequate number of ophthalmologists and complementary skilled surgical staff well equipped to provide eye care services. We will enhance partnerships through a public-private model to increase productivity and access to quality eye health services to the last mile.
RIIO is a private, international teaching institution founded in 2011 in Rwanda to enhance eye health, provide technical advice, support the delivery of ophthalmic services, and promote eye health in Rwanda and in the Region. It is also the MOH’s recommended training centre for the residents in ophthalmology and continues to be a key strategic partner for The Foundation in Rwanda over the years.
RIIO’s adoption of Kibagabaga hospital (public facility) demonstrated how the public/private partnership can enhance the training of ophthalmologists and other cataract surgical teams aimed at upgrading eye health system infrastructure and increase access to cataract surgeries. The Fred Hollows Foundation (FHF) is partnering with RIIO to replicate some components (draw learning) of this Adopt An Eye Clinic model in the 'Accelerate An Eye Clinic Model’ which will support strengthening of more secondary eye care facilities and provincial hospitals around the 4 ophthalmologists who graduated from RIIO in October 2022, and those in subsequent years. The ophthalmologists will ensure continuity of service delivery so that we have a deviation from only relying on the weekend outreaches as we have recognized that the current outreach model through visiting ophthalmologists is not sustainable and leaves equity gaps. The same will be modeled in such a way that the ophthalmologists carry out outreach activities in the secondary eye hospitals within the province, and as such it would help address the aspects of access to specialized care and help address the gap in geographical mobility.
RIIO has been able to demonstrate, how the public/private partnership can enhance the capacity of an eye unit through upgrading eye health system infrastructure to provide practical training facilities for ophthalmologists and other surgical teams to increase productivity and quality of eye health.
FHF in collaboration with RIIO seeks to hire a consultant with the key purpose of supporting and strengthening the 4 eye health facilities in the Accelerate An Eye Clinic Model through clinical, surgical and mentorship services, implement and integrate The Foundation’s CQI (Continuous Quality Improvement) initiatives in Rwanda and other selected African countries.
ROLE PURPOSE WITHIN THE PROJECT
The Ophthalmology consultant’s role will be to provide technical support in the 4 provincial/district hospitals (Musanze, Rwamagana, Karongi, Kibagabaga) where newly graduated ophthalmologists were posted to provide eye care services at scale. The accelerated eye clinics/facilities will be supported towards a maturity model with proper infrastructure and equipment to enable newly graduated ophthalmologists to effectively serve communities across Rwanda.
We are looking for a consultant to provide technical support that would be crucial for the successful implementation of the Accelerate An Eye Clinic Model. The role will be critical in mentoring of the new residents as well as on-the-job training, strengthening outreaches, and working with ROS and FHF medical team to institutionalize CQI through internal CQI engagement within The Foundation. The consultant will use the upgraded eye health facilities hosting the ophthalmologists to provide practical training for the new ophthalmologists (junior surgeons) to increase and enhance productivity and quality cataract surgeries as per the Cataract Surgical Outcome Monitoring (CSOM) in the Eye tracker tool in the HMIS.
SCOPE OF WORK
The roles and responsibilities for the Ophthalmology Consultant in the Accelerate An Eye Clinic Model and CQI engagement within The Foundation are detailed below;
Clinical services (30%)
- Liaison between RIIO, FHF and local partners on the clinical components of the projects whereby partner refers to entities supported by RIIO or FHF under the Accelerate An Eye Clinic Model.
- Provide expert opinion on the equipment for partners that include review of equipment lists, specifications, technical considerations, and functionality of equipment and learnings.
- Ensure that all direct eye care services of partner hospitals are delivered safely and conform to the standards.
- Track, measure, evaluate, and report on the clinical outcomes and impact of projects and programs including support in implementation and rollout of the Cataract Surgical Outcome Monitoring tool (CSOM) tool.
- Ensure that data from the partner hospitals has been customized to fit the Eye Tracker tool in the HMIS.
- Advise partners and the RIIO and FHF teams on medical emergencies and complications if they arise and share for RIIO and FHF guidance.
Training and Research Responsibilities (40%)
- Ensure newly graduated ophthalmologists/junior surgeons are highly trained and provided with clinical support to improve quality and productivity and mentorships to build their confidence and skills to work independently both clinically and in running eye departments at the health facilities where they were posted.
- Provide on job training to the junior surgeons and residents during outreach activities in secondary eye hospitals within the province to help address the aspects of access to specialized care and help address the gap in geographical mobility.
- Ensure the newly graduated ophthalmologists in partner hospitals are properly trained on equipment and biometry use and that the upgraded infrastructure and equipment provide an enabling operating environment to allow the junior surgeons to serve the inflow of patients and the populations within their catchment in the most productive way.
- Work closely with the School of Ophthalmology in delivering didactic training to residents as defined by teaching schedules.
- Participate in any other RIIO training activities as assigned by the RIIO Director of Training and Research or Medical Director.
- Promote RIIO vision and mission through networking with professional societies, forums and actively participate in public relations activities, and represent RIIO at professional forums and national/international events when called upon.
- Initiate, review/draft and finalize research concept notes, protocols/proposals, budget, and engage in conducting research including IRB approval, finalizing manuscripts for publication related to the Accelerate and Eye Clinic Model.
- Conduct MSAT (minimum standard assessment tool) for FHF-Rwanda partners. Support other country partners within FHF Kenya cluster to carry out MSAT and PDSA cycles (only at 2 or 3 accelerate clinic model hospitals) targeted for improving sections of service improvement.
Quality and standards (20%)
- Guide program team to integrate quality issues, appropriate training including RIIO and FHF strategic tools while developing proposals and planning for service delivery.
- Plan and support the program team for training of clinical staff of partner hospitals that includes training needs assessments, designing training courses, develop plans and schedules including liaison with RIIO and FHF and through RIIO to partner hospitals.
- Facilitate partner eye clinics to assess and develop Quality Assurance Systems (QAS) for patient care and safety to that of internationally accepted standards.
- Provide oversight/quality assurance during cataract surgical camps.
- Actively participate in monitoring of quality of care and services, clinical training and recommend areas of improvement.
- Serve as a focal person for matters related to Continuous Quality Improvement (CQI) initiatives on cataract service pathway and serve as liaise for FHF Rwanda with key stakeholders including MOH, ROS, RIIO and others. This will involve supporting CQI activities on eye care service delivery in general and on cataracts services in particular.
- The consultant will have introduction and induction meetings with FHF’s medical advisor to deal with current CQI initiatives in the Foundation. Subsequently support other CQI efforts (trainings, workshops, CSOM, implementing MSAT and other relevant tasks) in Africa focusing on the Kenya cluster (Kenya, Rwanda, Uganda, Tanzania, and Burundi).
- Be ready to build self-capacity through enrollment in quality improvement training including short term (3 weeks) course at IHI (Institute for Health care Improvement), participate in and in time became faculty at FHF supported face to face and virtual CQI workshops and monthly PDSA follow up calls.
- Attend and complete 24 weeks FHF’s blended CQI training (presentations and e-learnings).
- The Clinical Advisor will serve as faculty to deliver various trainings to partners pertaining to CQI. He will closely support partners to carry out CQI tasks including ensuring implementation of facility level CSOM, other methodologies include MOH, national ophthalmic societies, national prevention of blindness, adoption of CQI culture and practice including national data bases strengthening in Rwanda and establishment in other African countries.
Program quality and development (10%)
- To define project-specific clinical indicators and establish a system of data collection, support the program team in analyzing data, interpretation and developing follow-up actions.
- Collaborate and liaise with clinical services, quality, technology, and research team members at RIIO for optimum utilization of RIIO resources.
APPROACH
The Fred Hollows Foundation in collaboration with RIIO will select a consultant ophthalmologist to support the Accelerate An Eye Clinic Model and CQI work within The Foundation. The selected consultant will be required to work independently while closely collaborating with the FHF teams both in Rwanda and Kenya Cluster as well as Rwanda Institute for International Ophthalmology (RIIO).
The role will be contracted under RIIO as FHF and RIIO will be collaboratively to successfully implement the Accelerate An Eye Clinic Model in the 4 health facilities – Rwamagana, Ruhengeri, Kibuye and Kibagabaga. The Accelerate An Eye Clinic Model will take a phased approach and lots of learnings will be drawn from the RIIO Adopt An Eye Clinic Model. This arrangement has been discussed and agreed on with RIIO, with the finer details to be drafted upon contracting.
DELIVERABLES
The following deliverables are expected from the consultant:
- Monthly report detailing key activities, engagements, achievements and challenges. Each monthly invoice must have a report attached to it before processing.
- Deliver on the Accelerate An Eye Clinic Model based on deliverables set by RIIO. Details of the Accelerate An Eye Clinic Model are yet to be finalized and agreed between The Foundation and RIIO.
DURATION
The work is expected to start on January 8, 2024, to December 31, 2024, with the possibility of extension for a duration of two years.
CONFIDENTIALITY
The consultant agrees not to divulge confidential information to any person for any reason during or after completion of this contract with RIIO and The Foundation. Upon completion or termination of this contract, the consultant undertakes to return to RIIO and The Foundation any materials, files or property in their possession that relate to the business affairs of The Foundation.
INTELLECTUAL PROPERTY
All intellectual property and/or copyright material produced by the consultant whilst under contract to RIIO and The Foundation remain the property of the two organizations and will not be shared with third parties without the express permission of RIIO and The Foundation. The consultant is required to surrender any copyright material created during the term of the contract to RIIO and The Foundation upon completion or termination of the contract.
SAFEGUARDING PEOPLE
The Fred Hollows Foundation and RIIO are committed to ensuring that its activities are implemented in a safe and productive environment which prevents harm and avoids negative impacts on the health and safety of all people, particularly children, vulnerable people, and disadvantaged groups. The Foundation and RIIO has a zero-tolerance approach to sexual exploitation, abuse, and harassment of any kind. All personnel including contractors/consultants are expected to uphold and promote high standards of professional conduct in line with RIIO and The Foundation’s Safeguarding People Policy including Code of Conduct. Contractors/consultants will be expected to sign and adhere to The Foundation’s Safeguarding Code of Conduct and provide any background checks as required.
INSURANCE
The consultant involved in this assignment will be required to have in place insurance arrangements appropriate to provision of the requirements in these Terms of Reference including travel insurance.
ETHICAL AND OTHER CONSIDERATIONS
The consultant is expected to maintain high professional and ethical standards. RIIO and The Foundation are committed to ensuring a safe environment and culture for all people, including children, with whom we come in contact during the course of our work.
How to apply
MANAGEMENT AND LOGISTICS
This assignment is being commissioned by The Fred Hollows Foundation Rwanda in collaboration with Rwanda International Institute of Ophthalmology (RIIO) within the context of “Accelerate An Eye Clinic Model” and CQI. The Rwanda program and global medical teams will work closely with the selected consultant. The consultant will be managed by RIIO in collaboration with The Foundation
Individuals or institutions interested should submit (in soft copy) a cover letter, resume, technical and financial proposals by 20th October 2023. Please reference “Consultancy to Accelerate An Eye Clinic Model and Clinical Quality Improvement (CQI)” and send to the following address: procurementkenya@hollows.org. Only submissions with complete documents as stated in the TOR and those meeting minimum requirements will be considered. Qualified consultants may be subjected to a background check on child protection as a condition for engagement.