MSF-OCBA is looking for an Integration of Chronic Diseases Officer (temporary contract based in any MSF-OCBA hub)

GENERAL CONTEXT

While our most common focus in primary health care has been acute care and preventive activities, chronic diseases represent a significant and growing burden in many of our projects. The classical model of care provided in many of our supported structures is mostly designed for the former, at times with some vertical program on a disease-based approach to specific chronic conditions.

Over the last decades global epidemiology has changed, and chronic conditions (both transmissible and not) have become a main cause of death, responsible for more than 70% of global mortality. Global health trends suggest that in a few years the role of chronic diseases will continue to increase.

In this changed global epidemiology, it is important to reflect upon the classic package of basic health care activities provided by MSF. Despite the growing burden of chronic diseases in most of MSF’s missions, and the declared priority of a holistic approach, MSF still struggles to integrate chronic disease care in most of the projects.

GENERAL OBJECTIVE AND JOB ENVIROMENT

The position will be under direct hierarchical supervision of the leader of CDU working group (currently HIV, TB and Hep B/C Advisor).

The work will be supported by the CD working group in OCBA: HIV/TB, NCDs, Paediatrics, Mental Health, SRH, Infection Prevention Control and Nurse Referents. Other referents will also be integrated along with the progression of the dossier (Health Promotion, Decentralised Models of Care, Nutrition,) every referent in the medical department involved somehow with the CD working group; will provide him/her with the critical technical support for the adequate development of the tasks

Cell 2 TESACO, Medco Nigeria and Pulka project medical team are expected to be consulted for work related aspects.

Integrated models of care (e.g. HIV/TB, non-communicable disease (NCD) and mental health (MH)) have been proposed by several actors from a public health perspective. The main theoretical aim advocated has been to capitalize resources from the deployment of HIV care in African settings and use it to develop successful approaches for other chronic disease, in particular NCDs. Approaches to the development of integrated models have included as well the simultaneous creation of NCD/HIV programs, the inclusion of an HIV component in existing NCD programs and the integration of MH in existing NCD or HIV/TB programs. Besides the broad public health perspective, integrated models have the potential of providing several direct benefits to our programs and the beneficiary populations:

• Stream common resources in primary health care, this can include: human resources, equipment, tools for patient administrative and clinical management and follow up, monitoring and other activities such as defaulter tracing and counselling.
• It is in line with a people centre’s approach core strategic orientation for MSF.
• There is high shared comorbidity between these conditions. Having one condition increase the risk to get another one, this happens between people with diabetes and depression^[i], TB and diabetes, people with mental disorders and NCD ,HIV, hepatitis ^[ii]; HIV and depression; asthma and depression^[iii]. Also, the presence of depression has a negative effect on the adherence to other disease’s treatments^[iv].

In general there is low detection of mental disorders among people with other chronic diseases and vice versa, leading to increased burden of disease and early mortality^[v].

When the treatment of each chronic disease is done separately it has been associated with health complications such as complex medication regimens with high risk of drug interactions and poor medication adherence, duplicative medical tests, unnecessary hospitalizations, and increased mortality. Hence, there is a need for collaborative care^[vi].

• In contrast to vertical programs they can be reproduced in many of our projects where the burden of each particular disease group is not necessarily large.
• For NCD programs that are only starting their deployment in many of our facilities, the integration with existing components may lower the barriers for implementation
• Chronic diseases can have significant adverse effects on maternal health and pregnancy outcomes, as well as a negative impact on the health of their children later in their lives (due to the effects experienced in utero). Hence the necessity of an integrated approach to maternal health and chronic diseases, with preconception and prenatal care as critical points of contact, providing benefits for chronic diseases management and maternal and new-born health outcomes.

OBJECTIVES OF THE CHRONIC DISEASE INTEGRATION DOSSIER

• Improve overall quality of care, based on a person centred approach, reducing movement of beneficiaries between different consultations and reducing potentially the stigma of certain conditions (i. e: HIV infection)
• Establish a light integrated model for patients that live with chronic diseases served by our supported facilities.
• Mutualise resources to cover for clinical and programmatic needs.

An initial site was identified in order to start piloting the integration of the management of chronic diseases into an integrated unit: Pulka project, in Nigeria. The initial group of diseases identified for integration are NCDs in adults and children (diabetes, hypertension, asthma and COPD, epilepsy, sickle cell disease and cardiovascular disease), chronic infectious diseases (HIV, TB, Hepatitis B & C) and mental health disorders (Depression, Psychosis, PTSD and others) . Other components like vaccination, nutritional support and sexual and reproductive health will be added as required.

The technical referents in the medical department involving those areas developed a concept note and started support to Cell 2 and Nigeria mission in order to guide the set-up of the CDU in Pulka. However different reasons have delayed the development of a package of resources to help full implementation, monitoring and evaluation of the integration of the CDU.

In order to move forward with the CDU, as part of the medical department priorities of integrating care and people centre approach, a request for the allocation of resources to this dossier was validated.

MAIN RESPONSABILITIES

The main expected result will be the production of the following “deliverables”, as practical tools for the CDG implementation.

• Simplified reporting tools

• Simplified set of indicators

• Flow of patients

• Files for patients

• Simplified programmatic / technical protocols

• Training materials

SELECTION CRITERIA

Education and experience

• Medical Doctor (experience with chronic diseases is desirable)

• Field Experience in MSF (1 year or more)

• Desired experience working in integrative models of care

• Desired experience in HIV/TB/Viral Hepatitis, NCD, Paediatric, and/or MHPS Programs

• Language: English (French, Arabic or Spanish are an asset)

Competencies

-Behavioural flexibility

-Team work and cooperation, even in remote.

• Stress management

-Results and quality orientation

-Planning and Organization

Conditions

· Based at any MSF OCBA Hub (Barcelona, MSF-Spain office delegations, Buenos Aires, Amman, Dakar or Nairobi).

· Full time work.

· Temporary contract; 3 months.

· Annual gross salary: HQ3A (divided into 12 monthly payments)+secondary benefits based on MSF OCBA Reward Policy.

· Starting date: immediately.

MSF OCBA is a people-focused humanitarian organization that offers a diverse, collaborative, and inclusive work environment. We believe this approach enhances our work and we are committed to equity in employment. We embrace diverse backgrounds of people working together to exhibit their passion in action for the social mission of MSF.

Médecins Sans Frontieres, as a responsible employer, under article 38 of “Ley de Integración Social del Minusválido de 1982 (LISMI)” invite those persons with a recognized disability and with an interest in the humanitarian area to apply for the above-mentioned position.

[i] Dahal P, Balamurugan G, Basavaraja AU (2017) Prevalence and Predictors of Depression among Diabetes Mellitus in Adult Population. J Psychiatry 20: 430. doi:10.4172/2378-5756.1000430

[ii] Hughes et al. Prevalence of HIV, hepatitis B, and hepatitis C in people with severe mental illness: a systematic review and meta-analysis. Lancet Psychiatry 2016;3: 40–48

[iii] Liu S, Wu R, Li L, Liu L, Li G, et al. (2014) The Prevalence of Anxiety and Depression in Chinese Asthma Patients. PLoS ONE 9(7): e103014. doi:10.1371/journal.pone.0103014

[iv] Tasoa et al . Effects of depression and anxiety on antiretroviral therapy adherence among newly diagnosed HIV-infected Chinese MSM. AIDS 2017, 31:401–406

[v] Chaoyang et al. Undertreatment of Mental Health Problems in Adults With Diagnosed Diabetes and Serious Psychological Distress. Diabetes Care 2010; 33 (5)

[vi] Madeleine Mukeshimana, Gugu Mchunu. Management of Co-Morbidity of Depression and Chronic Non- Communicable Diseases in Rwanda. Ethiop J Health Sci 2017;27(1):17-26. doi: http://dx.doi.org/10.4314/ejhs.v27i1.4

MSF OCBA strategic plan 2020-2023. https://msfintl.sharepoint.com/sites/OCBA-DIRECTORATE/Strategy_Policy_Pl…