HEALTHCARE SERVICE DESIGNER
CONSULTANCY: HEALTHCARE SERVICE DESIGNER
To assist in developing a minimum viable product (MVP) for primary health care delivery in MSF programs with knowledge gained from desk-top based research, (complemented with collaborative field assessments) with a focus on proposing where adaptations could be made to incorporate patient and community voices (Person- Centred, Context Specific and culturally sensitive) in humanitarian settings.
DURATION: Periodically, based on project evolution between June and December 2021.
Start date: ASAP
Project: MSF Primary Health Care
Administrative: Manson Unit MSF UK
Médecins Sans Frontières/Doctors Without Borders (MSF) provides life-saving emergency relief and longer-term medical care to some of the most vulnerable and excluded communities around the world. As an independent medical humanitarian organisation, we deliver care based only on need, regardless of ethnic origin, gender, religion or political affiliation.
- To map the systems and stakeholders that influence the delivery of primary health care in two identified MSF Primary healthcare projects.
- To identify factors which positively or negatively influence the delivery of quality primary health care.
- To develop a mechanism for improving accountability to our patients and local communities
- To develop and test a minimum viable product (MVP) which allows MSF field teams to deliver contextually adapted, person-cent red primary health care across MSF projects, in keeping with organisational objectives.
Primary health care (PHC) is usually the first point of contact people have in any country’s health care system. The aim of PHC is to provide comprehensive, accessible, community-based care that meets the health needs of individuals throughout their lifetime. It is estimated that up to 80% of a person's healthcare needs can be covered by PHC.
Populations affected by humanitarian emergencies also predominantly access health services at the primary health care level. In fact, MSF conducts between eight to 10 million outpatient consultations at the PHC level annually compared to only between 250,000 – 400,000 consultations at the secondary care level.
Despite the significance of PHC service delivery in humanitarian emergency settings, there are currently no established guidelines for the implementation of PHC services by MSF or the humanitarian community at large. While the SPHERE standards (6) provide a basic overview of the health infrastructure required in humanitarian emergency settings, there are no further specifications related to the context, the existing national health infrastructure, or patient needs and/or expectations.
A scoping review of the published and grey literature over the last 30 years on primary health care service delivery in humanitarian emergencies (unpublished research by Yapa, Housen, et al.) reveal a significant gap in our knowledge on PHC delivery in these settings. Today, primary health care services in humanitarian emergency settings are delivered by numerous national and international health agencies, including MSF, according to their own practices and principles, with little account taken of the specific needs among different communities in different countries. This often results in services delivered of variable quality in a manner which is not focused on the person or their community.
To our knowledge, there have been a very limited number of studies on primary health care carried out by MSF. Two evaluations of primary health care projects carried out by MSF in Ethiopia highlight a gap in the quality of PHC and of engaging with the local community. Further, it is unclear how these evaluations have changed practice or been adapted within the wider movement.
Currently, most PHC projects in MSF are assessed quantitatively – in terms of number of patients seen or numbers of morbidities and not in terms of the quality of care we provide at the PHC level. Further, our current approach is a ‘one-size fits all’ model. It lacks adequate consideration of contextual factors such as the social, cultural, economic factors, among others and fails to incorporate community perspectives into our program design. This is not in keeping with the principles of primary health care as it was intended.
Consultation and engagement with MSF colleagues from across the movement in developing this proposal, highlight that there is a clear need to re-design MSF’s approach to primary health care.
A current lack of guidance in MSF on the best approach to delivering PHC services means that field teams are left ill-equipped to address the varying PHC needs of communities affected by disasters. Specifically, more guidance is needed on how services should be adapted to different contexts and at different stages of the project cycle. Our impact on PHC service delivery risks being ineffective if we are not delivering quality PHC that meets the needs of its users, acknowledging organisational challenges and resource-constraints.
As humanitarian emergencies become increasingly protracted, there is a pressing need to challenge the current top-down approach to PHC delivery and work harder to incorporate the perspectives of affected communities into the design of PHC programs. From needs assessment to project design to the innovation in our methods of adapting to contextual needs, MSF field teams need to be equipped with tools and best-practice guidelines to deliver safe and effective PHC.
Phase 1: Scoping phase (In Process)
- analyse contexts in which PHC services are delivered, including the local health system
- understand the organisational vision, obstacles and priorities for PHC delivery
- develop the best methodology required to gain an understanding of patient needs and perspectives
- identify priority areas for ‘transformation’
- formulate a collective synthesis of the needs and requirements of a person-centred approach to PHC.
Phase 2 – Development, testing and refinement of solutions (Service Designer):
- Examining each of the key priority areas across the contextually varied MSF field projects. In each of these projects, we will consider the perspectives of the patients, national health service provider (Ministry of Health (MoH) or equivalent) and MSF field teams. We will co-design potential solutions with the field consultancy groups in each location.
- Using an agile and iterative approach, we will then test/implement and refine these solutions with the input of field teams and relevant key stakeholders to develop the minimum viable product of this phase, which may be in the form of a toolkit /guideline(s) or framework.
- Development of a roadmap for ongoing learning, iteration and larger-scale implementation.
Aims of project:
In collaboration with the Project Manager, Field Focal Person and Field Team, co-develop and iteratively test solutions to the identified PHC priority areas in Phase 1.
To co-design methodology for data collection including conducting interviews responses and synthesis of data generated from the two field locations drawing from themes agreed on from the desk reviews.
- To map the process of identifying themes/factors which positively or negatively influence the delivery of quality primary health care.
- To conduct workshop remotely or desktop design of ideation to develop a prototype that can be tested.
- To work in collaboration with the Field Focal Person on Testing and Validating the prototype
- To develop a minimum viable product.
• Familiarise with Team and set objectives.
• Project documentation reviewed.
• Activity plan completed.
CO-DESIGN PROCESS OF MAPPING OF STAKEHOLDERS IN TWO SITES
- Agreed process with Project manager and Field focal persons (Workshop) on key focus areas identified by desk reviews.
- Designed questionnaires for semi-structured interviews.
- Semi-structured interviews completed.
- Methodology for process of data collation and field research planned.
- Data synthesised and analysed.
IDEATE AND PROTOTYPE
Three Workshops conducted (pre prototype and post testing of prototype)
- Introductory workshop with the field team.
- Second workshop to ideate a prototype for the gaps identified from the initial interviews and stakeholder mapping in the field.
- Third workshop to validate the prototype and produce project priority list.
DEVELOPMENT OF MINIMUM VIABLE PRODUCT (MVP) FOR PHC SERVICE DELIVERY
- Prototypes validated.
- MVP (guidelines/toolkit or equivalent) developed setting out the foundation for a context-adapted, person-centred approach to PHC. The MVP must detail an approach that provides a highly contextualised solution that is adaptable for each setting. Completed elements of the MVP:
- a comprehensive PHC assessment framework applicable to MSF field settings
- performance indicators for the PHC system and data collection tools, as required.
- Completed final report, including:
- program theory of intervention for PHC service delivery rationale
- key priority issues on PHC delivery, including enabling factors and barriers identified.
- Experience in healthcare Service Design in lower income countries.
- Proven portfolio of work on healthcare service design.
- Evidence of agile working to apply an open mindset to work in a fast-paced, evolving environment and use an iterative method and flexible approach to enable rapid delivery.
- Demonstrated evidence of context-based design work, can visualise, articulate, and solve complex problems and concepts, and make disciplined decisions based on available information and research evidence.
- Proven capability to move from analysis to synthesis and/or design intent.
- Excellent report writing skills.
- Meets deadlines for deliverables.
MISC: Place of work: As per Consultant’s independent place of work. Access to MSF UK office for designated meetings only.
Please send to admin.mu [at] london.msf.org
- An updated CV
- A financial and technical proposal highlighting past similar experience (maximum 1 page)
- A delivery plan of the deliverables
Deadline: 13 June 2021
For any question, clarifications and queries please write an email to agatha.bestman [at] nairobi.msf.org