International Consultancy- Technical support for the introduction of remote MCH services (Telecare, telemedicine, tele-education) in rural PHC clinics in Georgia

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Purpose of Activity/Assignment: The Law on Health Care in Georgia envisions a broad and ambitious PHC system. According to the Law, the PHC provider is the first point of contact in the healthcare system and is expected to provide a wide spectrum of continuous, comprehensive, and coordinated services, including health promotion, disease prevention, treatment, rehabilitation, and palliative care, as well as ensuring access to essential medicines and providing maternal and child healthcare and family planning services.

However, PHC, as envisioned in the Law, has not been realized to date. PHC services are delivered under multiple separate programs including the Universal Health Care Program, the Rural Doctors Program as well as several vertical/disease-specific programs: maternal and child health (MCH), immunization, tuberculosis (TB), mental health services, diabetes, HIV, Hepatitis C, cancer, and additional screening programs. Additionally, urban, and rural PHC delivery models differ and neither correspond to internationally recognized PHC models. As a result, PHC service utilization in Georgia is extremely low. As of today, only a fraction of registered beneficiaries in Georgia (17-23% by facility) use these services.

The current family medicine PHC model does not adequately align with the health needs of mothers and children as well. In fact, the system is re-active instead of being pro-active. The only preventive component that is in place is the routine immunization service. Well baby care and well -child care is no longer in the PHC portfolio. It is recognized that the preferable solution is to train providers on how to provide good well child-care and link them to specialized physicians for more complex cases.

The PHC system continues to face numerous challenges due to design, workforce, infrastructure, and health system barriers such as weak legal, regulatory and policy frameworks, and poorly defined legal status of PHC providers thereby undermining the gatekeeping role of PHC providers and contributes to fragmented purchasing, weak governance, and low incentives for preventive work. The COVID-19 pandemic has underlined weaknesses of the PHC system has in Georgia. The country has faced problems in managing COVID-19 and recovered patients, in addressing mental health issues but, also, in continuous delivery of timely and effective essential health services to the population, including mothers and children.

While aligning with the strategic plan of the Ministry of Internally Displaced Persons from the Occupied Territories, Labour, Health and Social Affairs (hereafter “the Ministry”), PHC is envisioned as a critical foundation for modernizing the healthcare system based on clinical evidence, using a patient-centred model.

At the same time, Georgia’s health system reliance on alphanumeric technologies in increasing. Since 2016, cancer and birth registries and an electronic prescription system have been functioning and work has been ongoing on the system of electronic medical records at the PHC level. PHC Electronic Medical Records linked with unified patient scheduling software and existing medical billing software are under development.

A shift to digital platforms and telemedicine solutions for PHC was prioritised by the Ministry before the COVID-19 pandemic and the introduction of digital technologies has been accelerated to address COVID-19 needs.

While not widespread, telemedicine use is growing in Georgia:

• It has been widely used in TB control by linking specialists from the National TB Program with care providers in the regions via videoconferencing to support case discussions and clinical decision-making.
• During the 2018-2019 flu season, remote (telephone) clinical consultations were introduced via “fever clinics” for case evaluation, triage, and management by specially trained family doctors and nurses in Tbilisi. This remote telemedicine model was successfully replicated in 2020 and used for the triage and remote management of COVID-19 cases throughout the country.
• UNICEF supported the introduction of a new service delivery model – Shared Medical Appointments (SMA) – to ensure the continuity of antenatal care services in the context of the COVID-19 pandemic. All pregnant women in Georgia were invited for remote antenatal consultations delivered via SMA to groups of 20-25 pregnant women simultaneously. This format has enabled pregnant women to spend more time with their clinician and to interact with one another, both of which showed to be calming in the context of social isolation.
• UNICEF supported the establishment of a communication platform for rural PHC doctors. The latter connects all rural PHC professionals via videoconferencing tools and creates a possibility for them to attend the thematic trainings in groups of 20-25 participants.

Considering all the above, the Government decided to introduce comprehensive telemedicine solutions at the PHC level and to pair the implementation of these solutions with the investment in Georgia’s health system and increasing the capacity of PHC. UNICEF is invited to support the process, with a specific focus on maternal and child health services, including child development-oriented care and support.

As per the Government decision, this transformation will happen gradually, and a scale of investment will not cover the entirety of the primary health care system, territory, or full range of health conditions at once. The plan targets selected rural primary healthcare sites (50) and the selected MCH services particularly relevant in PHC settings in the context of the COVID-19 response and beyond. The approach is to be comprehensive and include interventions addressing governance mechanisms, SOPs and guidelines, direct technical support to national authorities, medical and IT/digital supplies, and capacity-building.

Thus, UNICEF is invited to support the introduction of new MCH service delivery approaches into the rural PHC system, such as telemedicine and telecare and improving the capacity of rural doctors through tele-education. This will help to:

• mitigate disruption of basic MCH services due to the COVID-19 outbreak;

and

• deliver high quality PHC services, especially in hard-to-reach areas.

 

UNICEF Georgia is looking for the technical assistance and close guidance for the realization of the above stated goal

Scope of Work:

Objective:

To support the introduction of remote MCH services (2-3 specific services) at the 50 PHC clinics in Georgia by building an evidenced – based best practice model of digital service delivery.

Deliverables:

• To technically guide the selection of MCH services that can be delivered remotely within the PHC system. The consultants /team of experts are asked to consider the local priorities and to share the international practice what MCH services telemedicine is best used for (well-baby check-ups, child and adolescent mental health, maternal postnatal care, as examples)
• To develop the policy recommendations on organization of the above selected services; referral mechanism, education, and training of PHC providers, reimbursement of service providers and oversight, role of local supports (family, nurses, schools, as examples).
• Design improved skills development in desired areas of well childcare, adolescent mental health and maternal care building on the existing group training platform.
• The identification of the transition steps from traditional service to on-line mental health services that include organization management, support systems, monitoring and adjustment mechanisms.
• To develop the patient pathway relevant for each selected MCH service and advise on the respective clinical standards (to be adjusted by local professionals to Georgia’s context) and the role of professional associations and the Ministry.
• Identify and develop tools (e.g., electronic medical record) that can be used to audit records and ensure that providers are following protocols and collecting data on the number of patients seen with diagnosis.
• To guide the identification of the technology and materials that are needed for the delivery of the selected services

It is expected that teams composed of international experts will work on more than one deliverable at a time. The start of some deliverables will be contingent on the progress of another. The exact time frame will also depend on the efficiency of the consultation, data collection and approval processes.

 Duration of Consultancy

The consultancy is for four months:

The consultancy is part-time – 100 workdays in total (mostly remotely) from 25 December 2021 to 25 April 2022. There should be a team of experts. Each expert should apply separately. The Cover Letter of every expert should be the same and other experts (team members) should be listed in it. Individual contracts will be signed with each expert separately.

Duration of Consultancy

The consultancy is for four months:

The consultancy is part-time – 100 workdays in total (mostly remotely) from 25 December 2021 to 25 April 2022. There should be a team of experts. Each expert should apply separately. The Cover Letter of every expert should be the same and other experts (team members) should be listed in it. Individual contracts will be signed with each expert separately.

Supervision and Reporting Responsibility

The team of experts will work under the direct supervision of the Health Specialist, under the general guidance of the Deputy Representative. The experts will provide activity reports aligned with the agreed tasks and deliverables.

The experts’ performance will be evaluated against timeliness, efficiency, and quality of the delivered work.

 Payment Terms and Rates

The remuneration will be negotiated between UNICEF Georgia and the selected expert, based on an initial proposal of the selected expert. Applicants are therefore requested to submit a gross daily rate in USD. If travel is involved, the price proposal should include a separate line for travel and accommodation costs. Individual contracts will be signed with each expert.

UNICEF reserves the right to withhold all or a portion of payment if performance is unsatisfactory, if work/outputs is incomplete, not delivered, or failed to meet deadlines.

 Health insurance

UNICEF does not provide or arrange health insurance coverage for this position. The consultant will be required to provide a proof of health insurance for the duration of the contract

 Termination of contract

The contract may be terminated by either party before its expiry date by giving a two-week prior notice in writing to the other party. However, in the event of termination on the ground of misconduct, UNICEF will be entitled to terminate the contract immediately, without earlier notice.

In case of early termination of the contract, the Contractor will be compensated on a pro-rata basis for no more than the actual amount of work completed to the satisfaction of UNICEF.

 

Work Assignment Overview
Tasks/Milestone:	Deliverables/Outputs:	Timeline:
1. Policy paper on the selection of MCH services that can be supported with virtual care	The paper includes: the rational for selection; examples of best practices, role of different provider groups, resources required to deliver quality MCH services. Presentation and discussion of the policy paper with key stakeholder	December 25, 2021 – February 26, 2022
2. Paper outlining the organization of the above selected services	The paper includes referral mechanisms, education, and training of PHC providers, reimbursement of service providers and oversight, role of local supports (family, nurses, schools, as examples)	January 17 – February 25
3. Guidelines and for capacity building to deliver quality MCH virtual services	Review and adapt existing training modules for improved skills development in desired areas of well childcare, adolescent mental health and maternal care building on the existing group training platform	January 3 – March 4
4. Discussion paper on steps to operationalize virtual mental health services at the PHC level	The indication of, change in regulations, if necessary, support systems, monitoring and adjustment mechanisms include materials	January 17 – February 18
5. Patient pathways relevant for each selected MCH service	Patient pathways and advice on the respective clinical standards (to be adjusted by local professionals to Georgia’s context) and the role of professional associations and the Ministry of Health.	February 1- March 5
6. Guide for the improvement of quality MCH virtual services	Review current EMR usage and capabilities with recommendations for better data collection. Identify potential impact and what is required to support to support virtual care services	January 3 – February 6
7. Technological Guide for the delivery of MCH virtual services	Identify and share virtual best practices and use cases where they have been adopted (area of practice). Review current state technologies in use and deliver recommendations required to enable the delivery of safe quality virtual services	February 18 – April 5
8. Final Presentations and Report	Consultations with key stakeholders and final report	April 5 – April 25

 

Minimum Qualifications required:

Master’s degree in Healthcare organization and management.

Knowledge/Expertise/Skills required:

 

• At least ten years’ experience in PHC system policy and reorganization, health service delivery, human resources management, education, and training, and the effective use of clinical practice guidelines and protocols.
• Demonstrated experience in the organization and performance management of digital service delivery and be well-versed in matters of privacy and confidentiality
• Experienced in the delivery of MCH services in complex situations and to include a strong understanding of mental health youth services, and childhood development
• Excellent knowledge of the English language

 

Location: Home Based

 

For every Child, you demonstrate…

UNICEF’s values of Care, Respect, Integrity, Trust, and Accountability (CRITA).

 

To view our competency framework, please visit here.

 

UNICEF is committed to diversity and inclusion within its workforce, and encourages all candidates, irrespective of gender, nationality, religious and ethnic backgrounds, including persons living with disabilities, to apply to become a part of the organization.

UNICEF has a zero-tolerance policy on conduct that is incompatible with the aims and objectives of the United Nations and UNICEF, including sexual exploitation and abuse, sexual harassment, abuse of authority and discrimination. UNICEF also adheres to strict child safeguarding principles. All selected candidates will be expected to adhere to these standards and principles and will therefore undergo rigorous reference and background checks. Background checks will include the verification of academic credential(s) and employment history. Selected candidates may be required to provide additional information to conduct a background check.

 

Remarks:

Mobility is a condition of international professional employment with UNICEF and an underlying premise of the international civil service.

Only shortlisted candidates will be contacted and advance to the next stage of the selection process.

Individuals engaged under a consultancy or individual contract will not be considered “staff members” under the Staff Regulations and Rules of the United Nations and UNICEF’s policies and procedures, and will not be entitled to benefits provided therein (such as leave entitlements and medical insurance coverage). Their conditions of service will be governed by their contract and the General Conditions of Contracts for the Services of Consultants and Individual Contractors. Consultants and individual contractors are responsible for determining their tax liabilities and for the payment of any taxes and/or duties, in accordance with local or other applicable laws.