Download Terms of Reference (ToR)

Strengthen National Capacities on Paediatric Ophthalmology for Quality
Child Eye Health in Bangladesh (APC-GM-0010)
Terms of Reference (ToR)
for
Conduct training of 15 MLOP & Nursing Staff of public & private
hospitals on counseling, reception, operating theatre & ward
management, record keeping and basic refraction
1. Background
Bangladesh is the seventh most populous nation with a population of 156 million. It’s
also one of the poorest and most densely populated countries in the world. The country
is ranked 139th according to the United Nation’s Human Development Index. In
Bangladesh, more than 58 million people1 live below the international poverty line,
without access to even the most basic of services. Levels of extreme poverty remain
high at 12 - 13% (or 20 million people).
It is feared that the number of blind population will go double by the year 2020 if no
intervention is initiated immediately. The Government of Bangladesh, being a signatory
to Vision 2020, a global campaign for elimination of avoidable blindness by the year
2020, formulated a national eye-care plan under the leadership of the Bangladesh
National Council for the Blind, an apex body under the Ministry of Health and Family
Welfare. Development of this plan involved stakeholders across the country, including
some international NGOs.
An Operational Plan (OP) under the Health, Nutrition and Population Sector Program
2003-2011 is named National Eye Care. The OP will continue in the Health, Population
and Nutrition Sector Development Program (HPNSDP) 2011-2016. Some of the major
areas of disease control targets the following: cataract, refractive error, childhood
blindness, diabetic retinopathy, glaucoma, low vision etc., while recognizing the need for
focusing on the sub-specialty services, such as for cornea, retina etc. as emerging
priorities. The Operational Plan emphasized the need for capacity-building from
secondary-care facilities down to the upazila level and primary care to the community
level, with effective referral chain from primary to tertiary level of eye care. This will
demand increased government investment in eye-care infrastructure and development
of various categories of ophthalmic manpower. The OP further emphasized the need for
effective national coordination as well as district-level coordination through establishing
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CIA Factbook 2010
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national and district coordination committees, bringing all active eye-care providers to
work together for the common goal.
The latest Childhood Blindness study carried out in 2003 revealed that 31% of the
blindness in the surveyed children was due to cataract, 27% due to corneal problem,
4% to glaucoma and 5% to aphakia. Thus, 67% of the childhood blindness in
Bangladesh is either preventable or treatable. It also found that 90% of the childhood
blindness was developed within first 5 years of life. It also estimated that there are
approximately 1.3 million children having visual impairment due to refractive errors. The
country’s low vision burden in children is estimated as 141,000 children.
The WHO standard for a tertiary pediatric centre is one for each 10 million children.
However, at present there are only 10 tertiary centers against a target of sixteen
offering. The ten don’t offer comprehensive pediatric eye care and only two of them are
in the public sector. There is a huge gap in the human resources for eye health .There
are only 16 pediatric ophthalmologists, 17 optometrists of whom only 11 have formal
training, 7 orthorptics, 20 low vision therapists and 80 refractionists.
The recent development needs to focus on strengthening health systems to improve
quality and sustainability of pediatric eye care.
2. Brief description of the project
A Childhood Blindness study carried out by ICEH with support from Sightsavers in 2003
found that 67% of the childhood blindness is either preventable or treatable. An
evaluation of BCCC project (2004 - 2010) which restored sight to over 9902 children
recommended the urgent need to address the issue of overall paediatric ophthalmology
in Bangladesh. It further stressed the need for national capacity enhancement in both
clinical and management aspects to increase access to quality services, monitoring and
improved supervision for quality assurance.
In response to the above gaps and needs, Sightsavers is working on a 4 year project
Combating Childhood Blindness Project, some of the key HR part of the said project is
supported by USAID under agreement APC-GM-0010 with JSI Research & Training
Institute, Inc. for 12 months (till July 2014) to strengthening national pediatric
ophthalmology capacity for quality child eye health. The project is a joint collaboration of
Sightsavers, National Eye Care, Directorate General of Health Services (DGHS),
Ministry of Health & Family Welfare (MoH&FW), National Institute of Ophthalmology &
Hospital (NIO&H) and in collaboration with NGOs such as Bangladesh Jatiya Andha
Kalyan Somiti (BJAKS).
2.1
Objectives of the project
The project will strengthen capacity of national pediatric ophthalmology in collaboration
with the National Institute of Ophthalmology and Hospital (NIOH) of Government of
Bangladesh, Sylhet M.A.G. Osmani Medical College & Hospital (SOMC) and NGOs
such as Bangladesh Jatya Andha Kalyan Somiti (BJAKS), and Voluntary Association for
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Rural Development (VARD). The project is aligned with WHO health system
strengthening framework, the National Eye Care Plan 2005 of Bangladesh and the
Vision 2020 plan.
2.2
Geographical coverage of the project
The Project is planned to implement its targeted activities in following areas in different
capacities:
Comilla, Chapainawabganj, Gopalganj, Noakhali, Sylhet and Dhaka
3. Rational of the training on Hands on training of 15 MLOP & Nursing Staff of
public & private hospitals on counseling, reception, operating theatre & ward
management, record keeping and basic refraction:
Regardless of specialty or work setting, nurses are responsible to perform basic duties
that include treating patients, counseling and motivating patients, educating patients
and the public about various medical conditions, and providing advice and emotional
support to patients' family members. Nurses’ also record patients' medical histories and
symptoms, help to perform diagnostic tests and analyze results, operate medical
machinery, administer treatment and medications, and help with patient follow-up and
rehabilitation.
At present there are approximately 20000 registered nurses of which 14686 nurses are
working in the Govt. Services. There are 38 Nursing Institutes in Govt. sector 5 in
private sector preparing registered nurse midwives, yearly student intake 1135. There
are 7 more Nursing Institutes are under construction in the different District of
Bangladesh and 5 new nursing institutes are awaiting for approval of ECNEC. The
College of Nursing is affiliated to Dhaka University offering B.Sc. in Nursing & B.Sc. in
Public Health Nursing, yearly students’ intake 125 including 5 foreign students. Another
College of Nursing is under construction and site selection for two more College of
Nursing is completed2.
Although healthcare personnel, especially nurses, have an unquestionably vital role to
play in the successful delivery of healthcare services, there is a scarcity of skilled
nurses in Bangladesh. Inadequate training and insufficient skills result in poor service
delivery. This definitely has an impact on the level of quality health service delivery. As
a developing country, in Bangladesh, nursing faces a divergence between supply and
demand. This is evident in insufficient nurse staffing with significant implications for
patient safety. In Bangladesh, many believe this shortage of nurses is entrenched in the
long standing problems related to the value and image of nursing and the limited role
nursing has had in identifying priorities within healthcare delivery systems. The role of
the nurse has intensified and diversified with the widespread integration of
communication technology and information science into health care agencies. The
nurse's role in providing of patient care is intensified by redefinition, refinement and
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http://nasmis.dghs.gov.bd/mohfw/index.php?option=com_content&task=view&id=374&Itemid=518
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modification of the practice of nursing. Nurses are now expected to function well and
are held responsible and accountable for the systematic planning of holistic and
humanistic nursing care for clients and their families.
Nursing has developed an extensive body of knowledge and associated skills that
require intensive study to master. There are a number of educational paths to becoming
a professional nurse but all involve intensive study of nursing theory and practice and
training in clinical skills. To offer pediatric oriented ophthalmic services to the community
it is necessarily important to educate nurses. It is intended that after having training
each nurses will able to work under the direction of Ophthalmologists and able to follow
advice pertaining to medications and treatments as well as able to ensure patient is
comfortable and well taken care of. Moreover, this capacity enhancement initiative of
nurses will promote good nursing care by ensuring that the patients are all examined
well. Considering importance of record keeping not only for effective monitoring of the
project but also to deliver service in an effective manner it is mention worthy that without
a well-trained nurse, the doctor wouldn't know how the patient's condition was from the
night before to the morning. As stated earlier that the nurse is under the direction of the
doctor/ophthalmologist, but s/he has a responsibility to patients to ensure they have the
best care possible. If s/he notices a discrepancy of any kind, s/he is responsible to
discuss that with the doctor. Many medical mistakes have been stopped by a wellobservant nurse who was on the ball and ready with a listening ear. S/he can catch
mistakes and can fight for that patient's rights if not being properly cared for.
4. Purpose of the training:
Strengthen National Capacities on Paediatric Ophthalmology for Quality Child Eye
Health in Bangladesh (APC-GM-0010) Project is planning to organize training course for
15 nursing staff from selected public sector/govt. hospitals/facilities as described under
2.2. This capacity enhancement initiative for nurses will contribute to improve both
clinical and management aspects of selected facilities/hospitals to increase access to
quality services, monitoring and support in improved supervision for quality assurance.
Trained nurses will play a pivotal role in terms of patient care, record keeping, and
extending support to Ophthalmologists to run OPD, ward including pre and postoperative care and basic refraction services.
5. Objectives of the training:
The training will provide necessary know how to the participants which includes
counseling, reception, operating theatre & ward management, record keeping & basic
refraction. So that trained nurses can support their respective organization/institution to
record patients' medical histories and symptoms, help to perform diagnostic tests and
analyze results, operate medical machinery, administer treatment and medications, and
help with patient follow-up and rehabilitation. It is also aimed that trained nurses also
able to support their respective organization to achieve client’s satisfaction through
offering quality services from their end as counseling to children and their parents is a
critical element in the uptake of surgery, improve follow up for post-surgery optical
correction.
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6. Selection of training participants and geographical coverage:
The project document is stated at least 15 MLOP & Nursing Staff of public & private
hospitals will train on counseling, reception, operating theatre & ward management,
record keeping and basic refraction.
7. Description on training:
Under the project Sightsavers is willing to develop capacity of selected staff on
counseling, reception, operating theatre & ward management, record keeping and basic
refraction.
a. Duration of the training: 10 days
b. No. of participants: 15
c. No. batches: 01
d. Venue: Dhaka
e. Major areas/issues of training (in brief):
-counselling,
-reception,
-operating theatre & ward management,
-record keeping
-basic refraction
8. Scope of the work:








Draft content of the training covering major areas of training as stated above in
consultation with Sighsavers;
Develop evaluation formats (pre & post);
Develop methodologies to deliver training courses emphasizing interactive
approaches;
Develop training manual;
Develop and distribute handouts to the participants;
Arrange both theoretical and practical demonstration for participants covering all
major areas of training with equal emphasis;
Develop framework on MIS as part of the training to ensure efficient record
keeping system and comparative analysis of existing practices with gaps;
Develop a report of the training;
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9. Methodology:
Suitable methodologies to perform tasks can be proposed by the interested party where
equal emphasis will be given on both theoretical and practical demonstration to ensure
interactive participation and learning opportunity for participants.
10. Statement of background & expertise of the trainers, facilitators & resource
persons:
To ensure quality learning process and success of the training it is mandatory to deploy
adequate number of qualified resource persons with relevant expertise to deliver
messages to the participants from renowned institutions. The interested persons/firm
need to submit resume and brief statement on accomplishments of proposed
trainers/resource persons following above criteria along with the technical and financial
proposal of the action indicating their name in the training schedule.
11. Work plan/Schedule & Time frame of the action:
It is aimed to start the training under this activity November – December 2013 which is
off course subject to the availability of Nursing Staff.
12. Output/deliverables:
It is anticipated that the interested party/person will provide the following outputs to
Strengthen National Capacities on Paediatric Ophthalmology for Quality Child Eye
Health in Bangladesh (APC-GM-0010) Project through delivering training on
counselling, reception, operating theatre & ward management, record keeping and
basic refraction to selected nurses:
 Draft and final contents of the training;
 List of methodologies indicating training process to make the intervention more
interactive, effective and learning friendly;
 Pre and Post Evaluation Forms;
 Deliver training with maintaining quality and deploying eligible resource persons;
 Arrange adequate no. of days practical demonstration for counselling, reception,
operating theatre & ward management, record keeping and basic refraction
sessions;
 Deliver training manual;
 Deliver training hand-outs;
 Develop and deliver training reports;
13. Work plan/Schedule & Time frame of the action:
Project is aimed to accomplish all trainings under this activity from November to
December 2013 which is off course subject to the availability of CHC staff, management
committee members and prior to obtaining clearance of respective local administration
as well as favourable political environment.
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14. Mode of payment
Payment (respecting GOB VAT/Tax rules) will be made through accounts pay check as
per the following rate:
First (30% of total amount) instalment
Second (30% of total amount) instalment
Third (40% of total amount) instalment
15. Expenses to be mentioned in proposal
The financial proposal from interested person/parties must need to mention following
line items:
1.
2.
3.
4.
5.
6.
Training fee – Day wise per resource person
Accommodation cost – Day wise per participant
Food cost – Day wise per participant
Training material, manual, etc. production cost
Others (if any) – please specify
Unit cost –
i.
per participant/day
ii.
per participant/training
16. Deadline of Submission: Interested person/parties are requested to submit their
financial proposal to conduct the action within 2 October 2013.
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