Terms of Reference. Home-based medical and social care services assessment in the Republic of Moldova

Transcription

1 Terms of Reference Home-based medical and social care services assessment in the Republic of Moldova Country Timeframe of mission/consultancy of international expert(s) Republic of Moldova June 2017 December 2017 General information This ToR was developed by the National Network of Home Care Service Providers (NNHCSP) from Moldova, involving more than 30 sector-ngos. The NNHCSP has the main objective to consolidate the networking among the providers of home-care services, to make it a solid tool of lobby and advocacy activities toward the development of the home-care sector in the Republic of Moldova. In this regard, the NNHCSP commissions the assessment at hand, with the main objective of assessing the existing home-based care services in the country, the needs of the population in these services and the potential of their further development. More detailed, this ToR define the work that must be carried out to perform an assessment which is to: assess the degree of coverage (mapping) of HBC 1 services (public (state) health and social services providers, private sector providers (businesses, NGOs). The assessment is expected to reflect the situation in home-care sector, share of services among different type of providers and coverage with HBC. find out the real needs of home based care services in the Republic of Moldova, using the sample method of the selected communities/municipalities and extrapolation of the data for the whole country; analyse the existing home based care models, and provide recommendations for the best service model that will meet the existing needs and will increase access to services for vulnerable people; assess the use of the available funds and potential resources of the national and local budget, including health and social insurance funds, other sources; analyse the cost of HBC services and propose a benchmark costification formula/methodology of the HBC services. A local company, Sciopolis, has been selected and the international expert(s) will cooperate with this company in order to deliver the outputs. 1. BACKGROUND INFORMATION Moldova is the poorest country in Europe, with a Gross Domestic Product of $1804 per capita in Moldova s living standards and human development indicators still rank amongst the lowest in Europe, even in comparison with other transition economies. The 1 HBC services include social and medical home care services according to the existing national standards 1

2 UN s Human Development 2015 ranks Moldova 107 out of 188 countries. The Moldova Government Social 2014 rates poverty level at 12.7%, with poverty mostly concentrated among vulnerable groups such as elderly people and children. Uncontrolled urbanization and out-migration produce a widening gap between the urban and rural population, dependent on subsistence farming and remittances. Social exclusion, therefore, is largely driven by poverty and sharp increase in economic inequality. The Moldovan legal framework regarding the organization of medical HBC services was approved in 2008 by the Ministry of Health (MoH) and in 2010 by the Ministry of Labour, Social Protection and Family (MLSPF). The first medical HBC service provider was contracted by National Health Insurance Company in The HBC service providers need to have an accreditation to be contracted by National Health Insurance Company (NHIC) and access state funding. These funds are limited and cover only the insured people with advanced chronic diseases, people with low mobility and bed-ridden patients, based on doctors recommendation. The funds from the NHIC, allocated for medical HBC, have increased from about 4.7 million MDL in 2013 to more than 8.0 million MDL in 2015, but compared with the total budget for health sector, it still remains a negligible amount of about 0.16% 2. The cost for a medical HBC visit is Lei (~7 CHF), including the costs for staff, transport, administrative cost and necessary medical supplies. The maximum number of visits per patient per year could not be bigger than 36. In very special cases the patient can benefit twice, receiving a total of 72 visits. None can benefit from more visits, even patients in very difficult health conditions or bedridden patients who need daily assistance. Social assistance is mainly provided through the social protection system and is under the responsibility of the Ministry of Labour, Social Protection and Family (MLSPF). The development and provision of social services at the community/municipality level is the responsibility of Local Public Authorities (LPAs). The current mechanism for financing the social services at local level doesn t create motivation that would ensure their efficiency and sustainability. The main sources of funding for social services are the transfers from the state budget to the LPA and the local taxes. This funding model is incompatible with the increased need for social services at the local level, resulting from the high level of poverty, migration and ageing. This need is difficult to be covered from the available state funds as well as small local tax revenue of the LPAs. A Regulation on Procedures of Accreditation of social services providers, was approved by the Government in December 2013 and during there started the accreditation of the social services that already have an established mechanism (evaluation and self-evaluation forms), such as: Mobile Team Service, Personal Assistant, Professional Parental Assistance Service and Temporary Placement Centres for Children at Risk. For the time being, no one of the existing providers of social HBC have passed the accreditation, as the evaluation tools are still in development. All the existing social services will be accredited gradually. Also, the Government has introduced changes in the legal framework that regulates the HBC services in Moldova and, thereby, has given legal rights to private providers in the provision of HBC services. The observations made during the last few years show that the demand for social HBC far exceeds the state funding capacity, although comprehensive data of the real demand 2 NHIC annual reports 2013, 2014, 2015 ( 2

3 is not available. The LPAs undertake measures to further develop the social home care service, to cover a larger number of inhabitants. Thus, in some districts of the country, the local public authorities have initiated partnership with civil society organizations and donors for developing such services. The government also issued a series of regulations in the sector, to be able to monitor and standardize the services provided by other nonstate institutions. The Government is willing to continue the development of policies and laws, meant to facilitate the situation in the field of home based care, giving more freedom to the NGOs and improving the quality and accessibility of the service for population. In this context, several donor-driven services / projects have been developed during the last years, supplementing the existing state-provided HBC services. These projects are covering only a small part of the existing demand and are not sustainable, being dependent of the available external funding. 2. OBJECTIVES OF THE ASSESSMENT: 2.1 Overall objective The objective is to assess the existing HBC service providers (private and public) and assess the needs of the population in HBC, for developing sustainable HBC services. 2.2 Specific objectives The specific objectives are to receive sound and evidence based data about: 1. Mapping of HBC services (national expert team Sciopolis): Mapping of the existing home care social and medical service providers (public (state) health and social services providers, private sector providers (businesses, NGOs), including their profile; Type of provided HBC services; Geographical distribution of services; Number of clients. Comprehensive report on the existing HBC services, including geographical coverage, type of the services, source of funding and number of population covered. 2. Assessment of the real needs of home based care services (national expert team Sciopolis): Number of people in need of HBC (male/female, rural/urban; single or with family, disability degree etc.) using the sample method of the selected communities/municipalities and extrapolation of the data for the whole country; Type of needed services (medical, social etc.); Human resources needs (nurses, social workers, caretakers etc.). Analytical report of the actual needs of the population in HBC services and projections of the demand of home care services for the future. 3

4 3. Assessment of the use of the available funds and potential resources for HBC services (national expert team Sciopolis with support of the international expert(s)): Desk review of the existing laws and regulation on HBC; Local budget potential and forecast; Share of the NHIC funds in the health system for HBC, potential and needs; Social Insurance funds, potential use for HBC services; Contribution from the clients; Other sources. Estimation of the savings for the health system due to preventive and effective care through HBC services; Identification of the potential funding sources for the HBC services from health and social insurance funds, local and national public budgets, private funds and other sources; Propose clear and concrete suggestions and recommendations for the necessary adjustment of relevant laws, policies and procedures, governing HBC services, to increase access to HBC services. 4. Analyse the existing home based care models, (international expert(s) with support of national expert team Sciopolis): Assessment of the medical HBC services vis-a-vis the needs of the clients; Assessment of the social HBC services vis-a-vis the needs of the clients; Assessment of the integrated HBC services; Desk review of existing national and international sustainable models of HBC services, relevant for the context of the Republic of Moldova (2-3 similar countries); Recommendations on the most suitable model of HBC services for Moldova that would be the best to meet the needs of the country/vulnerable people; Development of recommendations (for the providers of the HBC services, for the sector related state institutions, LPAs), that would increase the sustainability of the home-based social and medical care services funded from state funds. 5. Analyse the cost of HBC services and propose a benchmark costification formula/methodology of the HBC services (national expert team Sciopolis with support of the international expert(s)): Analysis of the real costs of the HBC services for public/private providers, for social/health service related to visit/service/hour; Analysis of the need of the minimal, optimum and high quality HBC services costs; A benchmark costification formula/methodology of the social and medical home care services. Evidence based recommendations in favour of HBC services vs institutional treatment. 4

5 1. EXPERT TEAM and METHODOLOGY Expert team The team will be composed of national expert team Sciopolis and international expert(s). The national experts will have the overall lead and responsibility to plan and carry out this assessment. They will also be responsible to organise and lead the debriefing /briefing and will have the overall responsibility of the report. The national experts are to gather data on HBC mapping and the needs in HBC services (age, sex, urban/rural) in a professional manner together with the home care network members, the ministry/state and other relevant stakeholders. The national experts estimate the available funds for HBC and use of funds. The international expert(s) will contribute to the report writing and active participating at debriefing and briefing events. The international expert(s) is expected to support the development of methodology for this assessment, to support the local experts to assess the use of the available funds and potential resources for HBC services, to analyse the existing home based care models, to provide recommendations on the most suitable model of HBC services, to support the local experts in analysing the cost of HBC services and proposing a benchmark costification formula/methodology of the HBC services. The Advisory Committee of the NNHCSP will approve the report. Given the experience information and field presence of the NNHCSP, its members will have a strong involvement in the assessment process. Thus, their involvement will be in terms of data and logistics. Expected profile of the international expert might require more than one expert to cover different assessment needs. It is foreseen to have international support on the /research, HBC services financing and legal framework, benchmark costification of HBC services. Methodology Elaboration of detailed methodology will be done by expert team Sciopolis with support of international expert(s). It will be used a mix of quantitative and qualitative methods: - Review of all relevant legal framework, related to the provision of HBC and financing mechanisms; - Review of all relevant data, surveys/studies where is needed; - Semi-structured interviews/ focus group discussions / key informant interviews; - ; 2. EXPERIENCE and EXPERTISE OF INTERNATIONAL EXPERTS: International expert (s): University degree in health, social, economics, and/or any other relevant fields. At least 8 years of work experience in social policy and public health field; Wide knowledge and international experience in social and public health sector, in home care services; Experience in assessments for/of the home care sector/ or any other relevant sectors; 5

6 Experience in developing regional/national strategies; Experience in development of benchmark costification for HBC services; Experience in policy development, lobby and advocacy for the social and health sector; Excellent command of English and strong writing and analytical skills. Knowledge of Romanian and/or Russian is an asset. 3. GHEOGRAPHICAL COVERAGE The assessment will take place in all regions of Moldova and will involve actual and potential beneficiaries, as well as interested stakeholders. The main respondents of the assessment will be elderly people, representatives of state health institutions, NGOs, LPAs, civil society. 4. TARGET AUDIENCE The following actors will benefit from the assessment: The NNHCSP; International donors, interested to contribute to the home-care sector; Relevant governmental bodies: MoH, Ministry of the MLSPF, NHIC; LPAs; Public and private home-care services providers. 5. DELIVERABLES and TIME FRAME The final report, will be prepared by the end of the assessment period and will reflect the expected results of the specific objectives. The report should be evidence based. During the period of the mission, the experts will be required to provide updates to the Advisory Committee, composed of representatives from the HEKS/EPER Switzerland, HEKS/EPER Moldova, SRC Switzerland, SRC Moldova and NNHCSP, relevant governmental bodies. The report needs to be approved by the Advisory Committee. The assessment will be done during the period of June October 2017 and the presentation of the final report - not later than 30 st of November Output/activity 1 st month 2nd month 3rd month 4th month 5th month 6th month 1 Methodology for each specific objective Inception report on Assessment Methodology 2 Mapping of HBC services (national expert team) Intermediary Mapping report 6

7 3 Assessment of the real needs of home based care services (national expert team) Intermediary 4 Analyse the existing home based care models, (international expert(s) with support of national expert team) 5 Assessment of the use of the available funds and potential resources for HBC services (national expert team with support of the international expert(s)) 6 Analyse the cost of HBC services and propose a benchmark costification formula/methodology of the HBC services (national expert team with support of the international expert(s)) Intermediary The assessment is expected to be completed within the above-mentioned timeframe. This might be subject to change depending on the prevailing situation on ground at the time of the assessment. The consultants should propose a timeline for deliverables submission. An Inception in 15 (fifteen) days following the signing of the contract. The Inception should include thorough and detailed methodology for the implementation of the study, detailed schedule with references to the specific methods, instruments and sources for gathering and analysing of relevant data and information. The report must include information about the identified risks and problems that may occur during the assessment, as well as measures for their reduction and overcoming. The report is subject to approval in 10 (ten) working days following its receipt. If any corrections are deemed necessary, they should be performed by the Experts team in 5 (five) working days following the receipt of the remarks. An Intermediary should be presented no later than 30 st of September The report should contain detailed description of the findings concerning the mapping, needs and costs of HBC services. The report is subject to approval in 15 (fifteen) working days following its receipt. If any corrections are deemed necessary, they should be performed by the Experts team in 10 (ten) working days following the receipt of the remarks. 7

8 A will present the findings and recommendations of the Experts team, concerning the HBC sector in the Republic of Moldova. It should be presented not later than on 30 th of November The report is subject to approval in 15 (fifteen) working days following its receipt. If any corrections are deemed necessary, they should be performed by the Experts team in 10 (ten) working days following the receipt of the remarks. At minimum, the following elements will be included in the report: Executive Summary Acronyms Introduction Methodology Findings Conclusions and Recommendations 6. LOGISTICS Accommodation and food must be reflected in the financial proposal. The logistics of local travelling will be provided by the NNHCSP. Participation Documents To participate in the contest, applicants will present the following documents: 1. Technical offer; 2. Financial offer; 3. CV / Portfolio of activities carried out. The offers should be sent to the following address: casmed.md@gmail.com till 23rd of June. 8