Download TWINNING LIGHT PROJECT, BOSNIA AND HERZEGOVINA

TWINNING LIGHT PROJECT, BOSNIA AND HERZEGOVINA
Project title:
Strengthening of the institutional capacity of the Agency for
healthcare quality and accreditation (AKAZ of Federation of
Bosnia and Herzegovina (FBIH) and Agency for Accreditation and
Health Care Quality improvement (AAQI) of Republika Srpska
(RS)
Twinning Light No:
Funding Programme:
Beneficiaries:
BA06-IB-OT-08-TL
CARDS National Programme 2006
Agency for Healthcare Quality and Accreditation in FBiH
and Agency for accreditation and health care quality
improvement of Republika Srpska (RS)
Maximum Budget: 170.000
TERMS OF REFERENCE
1. BACKGROUND
i. General
The goal of EU membership is widely recognised as perhaps the single most important
objective for Bosnia and Herzegovina's (BiH) future security and prosperity. The
European integration process is fully accepted and supported by all political parties.
The EU's interest in BiH's potential membership was re-affirmed and strengthened at the
Thessalonica European Council in June 2003.
The BiH Government has adopted the action plan for implementation of midterm
priorities of the second, updated European Partnership, which was prepared on the basis
of EC findings in the 2005 Progress Report.
The negotiations on the Stabilisation and Association Agreement with the EU were
completed at the end of 2006 and the SAA was initialled, but not yet signed, on 4
December 2007.
The Thessalonica agenda for the Western Balkans (European Council of March 2003)
reiterated that the future of the Western Balkans is with the EU and therefore Western
Balkan countries should receive support for economic development.
After the Dayton Peace Agreement, health authorities in BiH have embarked on health
sector reform. Adequate Laws on Health Care and Health Insurance have covered most of
the issues related to reforming health service delivery in separate health systems the
Federation of Bosnia and Herzegovina, Republika Srpska and Brcko District. Reform
emphasis is on introducing the family medicine model and ensuring basic care for each
individual.
The last several years have seen the beginnings of wide-ranging reforms in the health
sector, covering the scope, financing, costing, organization, management and quality of
health care services. As with the other social sectors, the most important challenge is to
modernize health services, while reintegrating the system so as to allow better
exploitation of economies of scale in the delivery, financing, and administration of health
care thus improving quality of care. As a part of the reform process in both entities in
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BiH, agencies for quality of health care have been established and operational. In the next
section a description of each of two agencies is provided. It is important to mention that
due to constitutional structure of the country, with two entities (Republika Srpska and
Federation of Bosnia and Herzegovina) and one district (Brcko District) and their sole
responsibility for planning, financing, organization and delivery of health care, it was
necessary to establish two Agencies for accreditation and quality in health care. Although
separate organizations, two Agencies are working very closely on implementation of joint
projects and programs. In the next section, we are providing description of activities of
two Agencies.
ii. Agency for Healthcare Quality and Accreditation in FBiH (AKAZ)
During the Basic Health Project (WB), the Policy on health care quality and safety; Law
on quality improvement, safety and accreditation; and Strategic and Business Plan were
developed for Agency for healthcare quality and accreditation of Federation of Bosnia
and Herzegovina (AKAZ). However, the delay in approving the law on the establishment
of quality improvement and accreditation in health care, including professional resistance,
has had an impact upon positioning of the AKAZ within the health system.
The founder of AKAZ is Federation of BiH and founder’s rights and obligations in the
name of Federation are under the jurisdiction of the Government of the Federation of
BiH. Agency is established on the basis of the Law on improvement of system of quality,
safety and accreditation in healthcare in Federation BiH (Official Gazette of Federation
BiH 59/05). According to the decision of opening of AKAZ on the 24 November 2005.
(Official Gazette of Federation BiH 68/05) circumstances were formed for the Agency to
organize development of the system of quality improvement and safety in health
institutions in Federation BiH and based on the Policy of quality and safety of healthcare
and Law on improvement of system of quality, safety and accreditation in healthcare.
AKAZ is financed through the budget of the Government and partly by selling its own
services. Main bodies of the Agency are Steering Committee and Advisory Committee.
By definition, AKAZ is the principal organisation for the definition, measurement and
improvement of standards of clinical practice and service management. The standards are
developed with the assistance of representatives of the federal and cantonal statutory
organisations, chambers, professional bodies, health care providers and professionals,
together with international experts. In this context, the accreditation standards are
intellectual property of the Agency and health professionals from the Federation of
Bosnia and Herzegovina.
AKAZ is developing an accreditation program for hospitals, dom zdravljas (DZs) and
family medicine teams seeking to demonstrate the quality and safety of their facilities,
health care delivery and clinical practice. The program consists of a framework of
standards, which address every aspect of the organisation and delivery of health care,
together with an organisational development and assessment process, leading to the award
of accreditation.
iii. Main operational issues or project justification
The two Agencies are operating in different entities and as separate institutions but as it is
evident from the text bellow they are facing almost the same problems.
The main problems that Agency in FBIH (AKAZ) has confronted are:
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1. Statement: Non-resolved Agency's status within healthcare system and funding.
Explanation: It is not clear yet whether the Agency is an extramural part of the
Ministry of Health (MoH) due to budgeting and strong financial control by people
from MoH, or the Agency has a quasi-independent position (planning under
supervision of Board of Directors within very limited resources).
Reading and preparation: The Policy on healthcare quality and safety; The Law on
Healthcare Quality, Safety and Accreditation; the Agency's rule of procedures; the
Law on Health Care, the Law on Health Insurance; interviews with key persons (e.g.
lawyers) in MoH, Agency, chambers and Federal Health Insurance Fund.
Expectations from external assistance: to talk to the Minister, lawyers, representatives
of chambers and other people to define (in the generic way) the Agency itself
(functioning of an agency is not clear in our social system and very often is mixed
with 'institute'; the word 'Agency' is taken over from the Western vocabulary without
a full understanding of the real significance of this term; in legal terminology and
classification scheme there is no room for an Agency, etc). Secondly, by our opinion,
there is a need to adapt The Law on Health Care and The Law on Health Insurance
regarding the Agency's positioning (in the above mentioned Law do not exist any
explicit notions about quality, safety, the Agency, accreditation, and so on), including
improvement of some chapters from the Law on Healthcare Quality, Safety and
Accreditation.
2. Statement: Despite of the extended activities and employment of three new people in
the middle of last year, the budget for this year (approx. 150,000 Euros) is diminished,
in accordance with the Law.
Explanation: The article 33 of The Law on health care quality, safety and
accreditation regulates that the Agency will be funded from the Government only 3
years from the foundation. This time expires in February next year. After this period,
the Agency must find any financial resources on the service market. Such obligation
is in sharp discrepancy with the general level of quality culture in our health system,
and overlooks a general lack of interest for quality and safety improvement in health
institutions through the country, and their very limited opportunities for purchasing
Agency's services (education, facilitation, external surveys, and accreditation) due to
lack of money. Therefore, the Agency, quite possibly, will not be able to earn money
in such non-existing market.
Reading and preparation: above mentioned laws; the results and conclusions of the
Conference on stimulative financing of health institutions which meet contracting
accreditation standards and criteria; Agency's Methodological guidance for health
institutions and family medicine teams, Agency's packet of services.
Expectations from external assistance: to propose to MoH that in an urgent procedure
change and supplement the existing Law on healthcare quality, safety and
accreditation in order to assure much more clearly obligations and duties (regarding
quality improvement and accreditation) of health institutions, health insurance funds,
cantonal ministries of health, professional chambers, as well as amend the Law on
health care and health insurance in accordance with the Policy on healthcare quality
and other legislative. Also, we expect that external assistance propose the sound
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arrangements between health insurance funds and health institutions in accordance
with laws and institutional obligations to establish internal quality systems. In this
context, a marketing plan and marketing operations will be, hopefully, added values.
There is a good will from health insurance funds, especially from Federal Health
Insurance Fund to pay health institutions for performance, so to indirectly assure
sustainability of the Agency. But, this process is very slow and depends on financial
possibilities of cantonal health insurance funds, less than cantonal health policies.
3. Statement: The lack of awareness of the Federal MoH about the Agency's role
Explanation:: Lack of sustainable financial support, lack of staff and persevering on
non-professional project status of the Agency (as an amateur organisation), all above
mentioned are in a discrepancy with expectations that the Agency can solve all health
care quality problems (accreditation standards, CPGs, clinical pathways, indicators,
benchmarking on incident reporting, external surveys, accreditation of health
institutions at all level, etc). Yet, there is only one professional person (MD)
employed in the Agency.
Reading and Preparation: The results of the CARDS project in Bosnia and
Herzegovina – quality assurance and accreditation; questions for MoH and other
stakeholders; interviews with Agency personnel.
Expectations from external assistance: to persuade MoH and other key stakeholders
that quality and safety of health care system can not be reached without a serious
support, involvement and understanding; to go beyond our isolation and to clearly and
widely establish the Agency on the map of our health care system.
Agency for Accreditation and Health Care Quality Improvement of Republika Srpska
(AAQI)
Agency for Accreditation and Health Care Quality Improvement in Republika Srpska
(AAQI) was established in 2002 and has become operational in 2003. It is officially part of
the Ministry of Health and Social Welfare of Republika Srpska Government. Its work is
regulated by Law on Health Care and Law on Ministries of Republika Srpska. Agency has 4
full time employees and over 40 of external collaborators. Agency has developed internal
regulations and accreditation standards for primary health care service providers. So far,
Agency has accredited over 60 family medicine teams in 5 major health centres. Agency is,
besides accreditation, working on other care standardization and quality improvement issues,
such as introduction of care pathways in health care institutions. AAQI is presently
developing hospital accreditation program and is involved in establishment of quality systems
in hospitals in RS.
The main problems that Agency in RS (AAQI) has confronted are:
1. Statement: Inadequate status of Agency within healthcare system.
Explanation: Presently AAQI is, although independent in decision making and financing,
organizational part of Ministry of Health and Social Welfare of Republika Srpska. This is
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not ideal situation, as similar agencies should be fully professional and independent
structures.
Reading and preparation: The Policy on healthcare quality and safety in RS; The Law on
Healthcare in RS, the Agency's rule of procedures; the Law on Health Insurance in RS;
interviews with key persons (e.g. lawyers) in MoH, Agency, Medical Chamber and
Health Insurance Fund.
Expectations from external assistance: to make analysis and define proposal for future
position of the Agency.
2. Statement: Insecure financing of the Agency.
Explanation: Despite continuous support of MOH and Government, due to insufficient
number of applications of health institutions for accreditation, financing and sustainability
of Agency is questionable. It is expected that Agency will fund itself through services
provided on the market, however as long as this does not become reality, Agency funding
should be secured.
Reading and preparation: above mentioned laws; discussions with MOH and HIF
representatives.
Expectations from external assistance: to make adequate analysis and propose adequate
ways for funding of the Agency in short and long term period.
3. Statement: Lack of organizational and quality culture among health professionals
Explanation: Due to historical inheritance, quality culture and notion of necessary change
is very limited among health professionals in RS.
Reading and Preparation: The results and reports of the previous projects in Bosnia and
Herzegovina regarding quality assurance and accreditation; questions for MoH and other
stakeholders; interviews with Agency personnel.
Expectations from external assistance: to propose ways and to assist the Agency in
establishing adequate environment for quality initiatives including proposal of financial
incentives for implementing quality projects in health institutions.
1. DESCRIPTION OF THE ASSIGNMENT
1) Beneficiaries
The BiH partners of the project: Agency for Healthcare Quality and Accreditation in
FBiH and Agency for Accreditation and Health Care Quality Improvement of
Republika Srpska.
The direct counterparts are:
Dr Zoran Riđanović
Director
Agency for Healthcare Quality and Accreditation in FBiH
Dr. Mustafe Pintola 1. 71000 Sarajevo
5
Bosnia and Herzegovina
Tel: + 387 33 771 872 Fax: + 387 33 771 880
E-mail: [email protected]
Dr Sinisa Stevic
Director
Agency for Accreditation and Health Care Quality Improvement of Republika
Srpska
Vladike Platona bb
78000 Banjaluka
Republika Srpska
Bosnia and Herzegovina
E-mail: [email protected]
www.aaqi.rs.ba
2) Objectives
The global objective is to provide focused and relevant expertise to the two agencies both
in FBiH and RS and to contribute to having fully functional agencies thus improving their
capacities to embed EU standards in context to European integration.
The specific objectives are:
a) to provide targeted assistance to the Agencies in relation to examining the existing
structural, functional, legal and institutional framework regarding appropriate positioning
within health systems of FBiH and Republika Srpska.
b) to provide assistance to the agencies in promoting the need for introduction of financial
incentives models for health institutions which take effort in improving their overall quality
improvement systems.
c) to provide assistance to the agencies in revision of existing educational and training
curricula in the area of quality and safety improvement for health and allied professionals.
d) to provide assistance to the agencies to develop and implement appropriate marketing
and public relations strategies in order to secure the environment for more successful
introduction of quality systems in health care institutions.
3) Requested services are:
o Undertake analyses and draft recommendations for improvement of the statutory,
legislative, institutional and functional position of both agencies in health systems in
BiH
o Undertake analyses of the agencies internal capacities and to give recommendations for
improving their operations and services
o Undertake analyses and draft recommendations for improvement of the financial
incentives for healthcare institutions which take effort in improving their overall quality
improvement systems and purchase services provided by two agencies (education,
training, facilitation, external survey, and accreditation),
o Undertake situational analyses of internal, market and external conditions as well as
existing funding and to draft recommendations for building appropriate marketing
strategies, plans and tactics in order to secure sustainability for both agencies.
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o Undertake analyses of the accreditation program implemented by both agencies and to
give recommendations for its improvement
o Undertake analyses and draft recommendations for improvement of the education and
training curricula in the area of quality and safety improvement for health and allied
professionals provided by two agencies.
o Organise and undertake study visits to provide comparative understanding of the
subject area in other countries for staff of both agencies and related professionals.
Remark: Since the Agencies are entity institutions and not (officially) obliged to provide
assistance to the Brcko District as a separate entity in BiH the Contractor should also assist the
Agencies to find a solution for providing services to this part of the country as well.
4) Expected results
This project is expected to contribute to a better organization of both agencies in the European
integration process. The following results are expected:
i Report on Situational and Gap analyses
ii Report on Recommendations for Improvement
Reports should cover the following:
a) Recommendations for improvement of the legislation covering area of healthcare
quality and safety and accreditation in both entities, as well as the related rules of
procedures
b) Clearly defined structure, functions and position of two agencies in BiH healthcare
systems
c) Future funding and marketing activities of two agencies
d) Recommendations for financial incentives models for healthcare institutions which take
effort in improving their overall quality improvement systems and purchase services of
both agencies
e) Recommendations for improvement of the education and training curricula provided by
both agencies
f) Recommendations for improvement of the accreditation program and scoring system
of external survey as well as procedures for accreditation decisions implemented by
two agencies
iii Study visit completed
2. EXPERTS PROFILE
The project will be carried out with the help of "Twinning Light" arrangement, and as such
the experts should meet the formal conditions as set out in the Common Twinning Manual
(revision 2007).
It is expected that a team of three key experts, including the project leader and a pool of other
experts covering the skills and competences detailed below will be needed to provide the
services described above.
1. Project leader
2. Legal expert
3. Expert in the field of health finance
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The expertise provided should be able to provide the expected results as mentioned above.
Profiles of Key Experts
a) The profile of the Project Leader should be as follows:
 university degree;
 at least 5 years of professional experience in fields of healthcare quality matter and
accreditation;
 good knowledge of EU systems and healthcare quality policy as well as management of
complex projects;
 at least 5 years of relevant experience in the area non-profit marketing; specific
experience in defining and implementing of marketing strategies, plans and tactics as
well as in advertisement of non-profit organisations;
 good knowledge and understanding of Twinning Projects in New Member States (or
Western Balkan Countries),
 experience in policy support;
 experience in applying project management techniques;
 good communication skills;
 fluency in English.
b) The profile of the Legal Expert should be as follows:
 relevant university degree in law;
 at least 5 years of working experience in the field of legal advice;
 experience in providing technical assistance and legal advice in healthcare sector;
 fluency in English;
 good communication coordination and promotion skills.
 advantage will be given to candidates experienced in drafting of healthcare related
legislative, especially in the area of healthcare quality regulations in line with EU
requirements
c) The profile of the Expert in the field of finance
relevant university degree in economics;
 at least 5 years of relevant working experience;
 fluency in English and good communications skills;
 advantage will be given to candidates experienced in the area of health economics.
All experts should have good knowledge on European Integration issues.
4. LOCATION AND DURATION
The project will have 6 months duration. It is expected to commence in May 2008.
The project will be carried out in Sarajevo in the Agency for Healthcare Quality and
Accreditation in FBiH and in Banjaluka in Agency for Accreditation and Health care
Quality Improvement of Republika Srpska. The experts will be provided with office space
and communication lines, as well as office equipment, Internet connection and telephone
line in its offices in Sarajevo and Banjaluka, but the telephone bills will be paid by the
Contractor.
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Expected distribution of work is expected to be the following:
Person Days
Situation and gap analyses, recommendations:
1. statutory, legislative, institutional and functional framework
30
2. Position of two agencies in health systems of BiH
15
3. Operations and services of two agencies
15
4. financial incentives model for healthcare institutions which take effort in improving
their overall quality improvement systems and purchase services provided by two
agencies
30
5. situational analyses of internal, market and external conditions as well as the existing
funding; marketing strategies, plans for two agencies
30
6. Revision of accreditation program; scoring system of external survey
10
7. Education and training curricula
15
Study Tour
15
TOTAL:
160
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5. REPORTING
Preparation of inception report is anticipated after two months of project implementation
(presented in the third month) and a final report (templates and requirements same as for
standard Twinning). Reports in English will be presented in electronic version and in hard
copies with signatures of Project Leaders. For the purpose of efficient project coordination,
the Steering Committee will be established by representatives of the Delegation of the
European Commission, respective ministries of health, health insurance funds AKAZ,
AAQI and the twinning partner. Both project partners shall be responsible for holding
meetings of the Steering Committee.
The Steering Committee (meeting on a quarterly basis) shall meet two times during the
contract duration period, in order to discuss and approve of reports presented by the project
partners and decide about the schedule of training and achievement of project objectives.
6. BUDGET
The budget for this project is 170,000 Euro.
A budget of maximum 10,000 Euro within this should be set aside for the production of
printed documents, as well as for other unforeseen costs. When planning the project budget,
the MS partner should include the cost of translating key documents, as well as organising
interpretation during the meetings, travel costs in the country and study tour.
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