I. Background
University hospitals, as defined in the Federal Hospitals Administration Regulation, are hospitals that are accountable to the Federal Ministry of Health (FMOH) or health service delivery and teaching hospitals under a University. These institutions also called academic medical centers usually have three different missions—service delivery, training and research. Often times, the management of such institutions face challenges in harmonizing these different and competing missions.
In last few decades, the Government of Ethiopia has radically expanded the number of its higher education institutions. Many Universities have been engaged in managing large and complex hospitals and likewise, a number of hospitals have been converted into medical schools. With the expansion continuing the issue of governance of these institutions is of imminent concern.
The government has initiated health facility governance reform in hospitals in order to improve the process of “competently directing health system resources, performance, and stakeholder participation toward the goal of saving lives and doing so in a way that is open, transparent, accountable, equitable, and responsive to the needs of the people”. Hospital governing boards have been formed and are meant to improve governance of these facilities by allowing them to be more responsive to local needs, mitigate administrative complexities and improve the engagement of communities in hospital management. Currently, many of the public hospitals, including the University hospitals have established governing boards.
However, medical schools and teaching hospitals throughout the country face challenges in balancing their competing missions of providing quality health services, teaching and research. Governance problems and lack of a consistent model in the country for managing university hospitals have resulted in poor engagement of staff in reform activities, lack of respecting hospital rules and patient etiquettes and dissatisfaction in both management and staff, limiting their efficiency and effectiveness.
Recognizing this as a major problem, the FMOH has decided to develop guidelines which clearly outline the roles and responsibilities of all key stakeholders involved with University hospitals’ management.
This TOR is for a one month consultancy to support the work of the FMOH in developing University hospital management guidelines/directives.
II. Objective of the Consultancy Service
General Objective
The objective of this consultancy is to develop management administrative guidelines/directives for University hospitals.
III. Scope of the Task and Methods
Under the supervision of Medical Services Directorate (MSD), FMOH and in close collaboration with the Task Force, the consultant will execute the following tasks:
1. Desk review
Review assessment report and other relevant literature and documents related with University hospital governance.
Compile benchmarking experiences from similar African countries
2. Consultations and meeting
Engage and consult with key stakeholders to gather relevant information and get feedback
Conduct brainstorming sessions with key stakeholders to get input for guideline
Participate in FMOH meetings as needed
Brief FMOH on progress as needed
3. Document Development
Develop guidelines for University hospitals governance which defines:
o the role and responsibilities of the FMOH, Federal Ministry of Education, and regional health bureaus
o the relationship between the University hospital and hospital governing board.
o the relationship with the Senate
o the roles/responsibilities and vertical/horizontal relationships between departments and units
o the relationship between academic staff and hospital staff. Policy on staff deployment and development
o organizational structure (prototype) that could be adopted by respective university hospitals
Share outline of guidelines/directives and gain approval from FMOH
Share draft guideline and receive feedback and input from the FMOH
Finalize draft.
Share final version which has been approved by the MSD
4. Workshops and meetings
In collaboration with FMOH organize and facilitate consultative workshop with stakeholders to review draft guidelines/directives
Attend workshops and meetings as needed
IV. Key Deliverable
1. Finalized and approved management guideline/directive
V. Duration
The guideline development is expected to take a maximum of 30 working days following the signing of contract agreement with the selected consultant. The consultant is expected to follow the indicative timeframe for meeting expected deliverables against each main milestone.
• Desk review of documents and conducting relevant consultations
• Prepare draft outline and submit to FMOH (MSD) for approval
• Prepare first draft of guideline
• Review with stakeholders and revise draft to incorporate feedback
• Finalize draft and submit to FMOH (MSD) for approval
The consultant is expected to develop a detailed work schedule showing when each of the specific tasks will commence and end within the above timeframe.
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