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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 1 CIA Factbook 2010 1 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 2 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 2 http://nasmis.dghs.gov.bd/mohfw/index.php?option=com_content&task=view&id=374&Itemid=518 3 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. 4 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; 5 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. 6 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. 7