Assessing feasibility and preprogramming for the rehabilitation of the Medical Research and Care Centers at the University of Mosul
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I - Présentation of EXPERTISE FRANCE
Expertise France (EF) is a public agency created on January 1, 2015 and merging six French public agencies under the supervision of the French Ministries of Foreign Affairs and Economy and Finance with a strong inter-ministerial vocation. EF offers project engineering and technical assistance by developing and implementing international cooperation actions worldwide. EF operates in various fields of development and institutional cooperation including safety and security reform, post-crisis/ stability, public health, human rights, strengthening of institutions and NGOs and governance. Carrying out large-scale, multi-stakeholder programs, EF can ensure the cooperation between individuals, teams and institutions with very different statuses, cultures and specialties. Besides, EF has acquired a sound experience in administrative and financial management of large-scale international programs.
Expertise France in Iraq
Expertise France opened its first office in Iraq on October 2019 with the financial support of the Crisis and Support Centre of the Ministry for Europe and Foreign Affairs (CDCS). EF is currently working on three main thematic in Iraq: youth, entrepreneurship and mental health.
Expertise France is implementing a project to support universities in Mosul funded by the CDCS. In the framework of this project, the “Mosul Student Contest” has been launched in partnership with the universities of Mosul and Nineveh. It allows student project initiatives to benefit from technical and financial support aiming at revitalizing student life and vocational integration. In addition, given the negative mental health consequences of war-related traumatic events, Expertise France has supported the initiative of the Nineveh University to establish a university course in clinical psychology.
The Yanhad (“recover” in Arabic) ongoing project wish to extend the range of tools to support young entrepreneurs in Mosul, Baghdad and Kurdistan Region of Iraq (KRI). The idea is to support young people whose projects may have a lever effect on the socio-economics opportunities. Yanhad project will also promote the sense of citizenship by supporting initiatives by civil society that also help young people or initiatives launched by young people.
II - Background
Nineveh Governorate was once known for its good healthcare services and highly qualified doctors. Between 2008 and 2014, a substantial number of facilities were rehabilitated and equipped with new medical instruments. Before the conflict between Islamic State of Iraq and the Levant (ISIL) group and the Iraqi forces, Mosul city had six private medical centers, including 16 hospitals with 4,600 beds. All these facilities were managed by specialist doctors and were working properly until ISIL occupied the city.
At that point, hospitals that were not destroyed by air strikes continue to receive patients, but health services have been severely affected by the ISIL occupation: many medical staff members have fled, priority access to surgeries is given to non-civilians, medical fees for services and operations have increased significantly, segregation which is affecting maternal health, poor sanitation in hospitals, absence of obstetric and neonatal care, etc. Although many pharmacies are still open, their stock is limited. Medicine, when available, is largely unaffordable.
During the conflict, 9 out of 13 public hospitals were damaged in Mosul, slashing healthcare capacity and the number of hospital beds by 70%. The reconstruction of health facilities has been extremely slow and there are still less than 1,000 hospital beds for a population of 1.8 million people. This is half of the internationally recognized minimum standard for health service delivery in a humanitarian context. Over four years after the ISIL was forced from the embattled city of Mosul, the city’s healthcare system remains in ruins and struggling to cope with the needs of the growing population. Thus, accessing healthcare services is a daily challenge for thousands of children and adults in Mosul.
The unsafe living conditions in Mosul – poor hygiene due to a lack of water and electricity, falling rubble, buildings collapsing and the presence of improvised explosive devices and booby traps – also pose a risk to people’s health and increase the need for healthcare facilities. National authorities and the international community are required to urgently rebuild public health infrastructure, provide patients with access to affordable medication and ensure medical facilities are supplied with the necessary equipment.
College of Medicine
Two public universities coexist in the Mosul campus (Nineveh Governorate): the University of Mosul (founded in the late 1950s) and the University of Nineveh (founded in the early 2000s). The University of Mosul (UoM) was one of the largest and most respected educational and research institutions in the Middle East, and the second largest in Iraq behind the University of Baghdad. It was located on the west bank of the Tigris, within the Al-Shifa hospital complex in Mosul. This site was heavily damaged during the 2014 Northern Iraq Offensive, until it was recaptured in 2017. Mosul University is now located on the same campus as the University of Nineveh.
Each one of them has its own “College of Medicine” managed by the Ministry of Higher Education and Scientific Research (MOHESR). There is a clear lack of cooperation between this ministry and the Nineveh Health Directorate regarding ongoing projects to rebuild the health sector. However, there is a shared willingness between both College of Medicine and their teachers to restore the capacities of the public health sector and improve health-care facilities.
The challenge for the Mosul and Nineveh College of Medicine remains the creation of a university hospital, in a context where the quality of education and training of medical students has deteriorated. In fact, the renewal of healthcare workers in Nineveh, the partial or complete destruction of teaching hospitals, the overwhelmed and disorganized services, the decay of primary health centers in the governorate, etc. has led to the decreasing of the number of enrollments students in the two College of medicine and the disorganization of the education system.
Both Colleges of Medicine seek international funding to build a university hospital in Mosul. As a first step, the priority is to rehabilitate the existing Medical Research and Care Centers within the campus and ensure its proper functioning. This could relieve overcrowded Mosul's hospitals, improve access to comprehensive and quality health care services in the governorate and support university research. In the longer term, the objective would be to enhance the capacity of the Medical Research and Care Centers to become a university hospital.
Medical Research and Care Centers
Within the Mosul campus, there is a site called “Medical Research and Care Centers”. This site - built and equipped by the Turkish company Tek-Imas Medical - was delivered a few weeks before the capture of Mosul. It is a complex of two-floors buildings divided into several specialized consultation centers (surgery, pediatrics, obstetrics, cardiology, gastroenterology, renal dialysis, hematology, oncology, etc.). This complex also has several operating rooms and a hospital wing with a capacity of 50 beds. Some teachers from the Mosul College of Medicine had been sent to Turkey to be trained to use equipment (CT scan, PET scan, radiotherapy, endoscopy, etc.).
This site suffered very slight damage and most of the sophisticated medical equipment was saved from destruction and looting during the fighting. The Turkish company Tek-Imas has already done some rehabilitation work during the first semester of 2020.
III - Presentation of the project
The French Development Agency (Agence française de Développement - AFD) has set up a dedicated financing instrument for peace and resilience in the Middle East, called the Minka Middle East Initiative. This instrument finances projects aiming at increasing living conditions and access to essential services of crisis-affected population. These projects should also contribute to build trust between State and society and reduce tensions between communities.
In Mosul, AFD aims at launching activities in the newly rehabilitated Medical Research and Care Centers established within and under the leadership of the University of Mosul (UoM). This project proposal received strong support from the Iraqi authorities and stakeholders met on AFD’s first mission in the health sector in Iraq, during the second quarter of 2019.
AFD expressed interest to participate in the final investments required to upgrade the current medical equipment and ensure the proper functioning of this site with a granted amount of around 5 to 10 million euros. On the one hand, AFD would finance the acquisition, maintenance and/or repair of medical equipment. This may include small renovations as well as mechanical, electrical and plumbing engineering (based on identified needs) to ensure the proper functioning of the material and equipment. On the other hand, AFD would participate in the training of medical, paramedical, and administrative personnel.
The overall objective of the project would be to improve access to quality and accessible healthcare services for the population of Nineveh Governorate. It breaks down into three specific objectives:
to support the proper functioning of the newly rehabilitated Medical Research and Care Centers in the UoM;
to strengthen the capacity, skills and resources to attract and retain qualified employees of the Medical Research and Care Centers;
to support the UoM's management capacities to ensure the long-term sustainability of the project.
IV - Objective of the assignment
The objective of the assignment is to conduct a feasibility study of the Medical Research and Care Centers at the University of Mosul (UoM).
The feasibility study aims to inform the project described above by providing a comprehensive update on the Medical Research and Care Centers priority needs in order to upgrade its service-delivery capacities.
The scope of this study covers three specific areas, which are (i) the infrastructure, (ii) the medical equipment and (iii) the governance/HR management. Therefore, the consultant team will be composed of several profiles and expertise (public health, health systems strengthening, public health infrastructure and biomedical engineering, administrative and economic management of health, medical/social facilities).
The expected results are:
The strategic medical and functional orientations stated by the University of Mosul are known and analyzed with regard to the healthcare priority needs at city/governorate level;
The capacity of the Medical Research and Care Centers to deliver planned services in terms of infrastructure, equipment, human resources and management is evaluated;
An assessment of organizational and functional needs of the Medical Research and Care Centers is conducted, fostering local participation and ownership;
The needs for repairs, renovation, upgrading or replacement of infrastructure and equipment are identified, and the related cost is estimated ;
An overall capacity building strategy and action plan is proposed (on the specific components covered by the study), including a description of the necessary means and resources to be mobilized for its implementation.
V - METHODOLOGy
The following general principles will be applied to conduct the feasibility study:
A “lead” consultant will be recruited by Expertise France to develop and coordinate the implementation of the study process and content (scoping meetings, data collection, monitoring of national experts work, consolidation and analysis, reports writing, etc.);
The consultant team - supported by the EF’s office in Erbil and headquarter – will conduct the study in close cooperation with the Iraqi health care sector, including the UoM (administrative authorities, medical community), the Ministry of Higher Education and Scientific Research (MOHESR) and local health authorities who will facilitate the mission;
The University of Mosul management team will ensure the conditions and logistic arrangements and will provide the means in order to allow the experts to perform their field activities as planned and in line with this TOR;
The feasibility study will identify other ongoing projects/ programs planned or implemented by other actors or by the Iraqi health sector reform in order to explore potential synergies between them and avoid duplication.
a. Steering committee
A steering committee composed of members of the EF and AFD headquarter teams, will meet at the key moments of the study (final validation of the experts, select the various stakeholders to meet during the mission, revise the deliverables, formulate observations, etc.). Close coordination and regular exchanges on the progress of the mission and the difficulties encountered is expected with this committee.
b. Phases of the mission
1. Preparation / Inception report
The lead consultant will:
a) Perform a preliminary analysis of available information (document and literature review, key informant interviews, etc.);
b) Conduct a first field mission in Iraq (Erbil) to meet with EF’s team, national and international stakeholders and finalize the selection of technical experts. This mission will allow presenting the aims of the project and seeking inputs, to conduct key informants interviews and to organize meetings focused on the scoping of the study.
This phase will result in the production of an inception report that will include a detailed work plan and a proposed methodology and implementation schedule for undertaking this assignment.
This inception report will be validated by AFD and will be shared with the UoM and the Ministry of Higher Education before initiating the next phase. This report will be used as a methodological guideline throughout the mission.
2. Field missions in Mosul / Technical reports
Based on the inception report, the lead consultant will conduct a second mission in Iraq in order to work with the technical expert’s team and prepare the field missions in Mosul, jointly conducted with technical expert from the UoM.
Following these work sessions, the national experts - supported by the EF Erbil’s office - will conduct field missions in Mosul, to carry out the necessary field investigations; site observations and analysis related to their field of expertise. This will include, for each technical component concerned:
An overview of the general conditions of the Medical Research and Care Centers: inventory and diagnosis of existing infrastructures, including the health facilities system, the power and water supply systems, the waste management system, the conformance to standards, etc.
An study of the adequacy and capacity of the existing infrastructure to deliver proper services in terms of accessibility, waiting area, bathrooms, water, power supply, healthcare waste management, additional administrative and/or clinical space(s), etc.;
The identification of priority needs for restoration, rehabilitation, expansion in order to increase service-delivery capacity;
The estimation of resources required to perform each activity (type and quantities of material, human resources, equipment, supplies) and cost.
A comprehensive medical equipment inventory and diagnosis: comprehensive data collection and testing of all equipment assets functionality, specifying their condition (functional or not), the availability of maintenance skills and spare parts, etc.
A mapping of resources setting (financial, logistic, human) allocated to deliver equipment maintenance activities (at all levels of the health system);
An evaluation of the capacity of the biomedical equipment technicians to analyze, maintain, repair and upgrade equipment;
A mapping of financial and technical support already provided by the other actors/ donors to coordinate activities and assess the potential for synergy;
The identification and costing of priority needs for equipment repairing/replacing (logistics of delivery and installation, etc.);
The establishment of a technical capacity-building plan to enhance equipment management and maintenance according to priority needs identified, including human resources training needs.
Management / Human resources
An comprehensive analysis of the overall governance and organizational structure of the Medical Research and Care Centers (distribution of services and functional organization between the buildings, complementarities with the University of Nineveh, etc.);
An evaluation of all aspects related to the planning, financing, training, regulation and management of human resources for health;
A mapping of available health workforce, specifying their educational qualification and motivation, administrative level, etc.,
An assessment of the capacity and training needs of administrative and management teams;
The identification of priority actions to build leadership, to strengthen management capacities and to support the development of an enabling environment for working.
For each component, the experts will:
Undertake desk reviews of drawings, maintenance records and other relevant and available documents to conduct a preliminary analysis (national policies and strategic plans, etc.);
Identify gap in terms of human resources, equipment, infrastructure and processes/procedures
Develop appropriate recommendations to address these gaps and assess the necessary means to implement recommendations;
Assess the anticipated risks and benefits associated with the orientations proposed by the team of experts (requirement for specific supplies or materials, availability of technical support for maintenance, availability of space, availability of human and financial resources, etc.);
Raise any necessary environmental assessments highlighting any potential impacts that may need to be addressed in the framework of the project.
These field investigations will result in the production of technical reports on main findings and proposed interventions for each component of the study. Technical reports should include photographs / sketches and high level estimates for the necessary interventions required.
The lead consultant will conduct a last mission in Iraq in order to attend the restitution of the national expert’ team on key findings and recommendations. A debriefing with the Iraqi health care sector stakeholders (including the UoM, Ministry of Higher Education, local health authorities, etc.) will be organized in the framework of this last mission.
3. Data analysis and final report writing
Based on national expert’s technical deliverables, data collection, site investigations, field visits and desk reviews, the lead consultant will consolidate the data in order to produce a final report, which includes:
- A detailed and comprehensive overview of the existing conditions of the Medical Research and Care Centers, including:
· The physical structures of buildings: description, surface area, historical workload, staffing, general condition, type and space of existing services, available medical equipment and devices, current and anticipated operational structures, etc.;
· The status and current governance/ leadership/ management: level of autonomy, links with the supervisory authorities (UoM, MOHESR, local health authorities, etc.), internal governance of the site (decision-making, advisory bodies, administrative and medical organization, etc.);
An overall analysis of the capacity of the Medical Research and Care Centers (available resources, state of maintenance, etc.);
An exhaustive overview of all of the current sources of funding and their developments;
An detailed analysis of the long-term feasibility and relevance of the project / strategy developed by the UoM, taking into account the organizational and financial aspects as well as priority need;
The formulation of recommendations based on gap analysis identified at all level (categorized as low, medium and high priority), including actions plans and costing.
VI - Deliverables and reports
The following are key deliverables for the assignment (see above more information on the content of these deliverables):
An inception report due maximum four (4) weeks after the signing of the contract.
A technical report for each of the three technical components related to this study.
A final report as detailed above) due maximum 12 weeks after the signing of the contract. The final document needs to be limited to 50 pages (excluding annexes). Upon reception of the deliverables, Expertise France, AFD and the UoM will have 10 working days to validate the documents. If AFD or the UoM wishes to amend the deliverable, they will communicate to the consultant its comments on these deliverables no later than 10 working days after their reception. The consultant will have 5 working days to consider these comments and propose a new version of the deliverable. The procedure may be renewed as long as AFD and the UoM are not satisfied with the deliverables. The deliverable will be validated by decision of AFD and the UoM.
Terms of reference for works to be done to address service delivery gaps: proposals on the required measures and a realistic and achievable Action Plan (“roadmap”).
Discussions will take place throughout the mission in order to specify the structure, content and format of the deliverable.
It is expected to consider gender and climate change integration in the entire process of development of the deliverables.
VII - required professional skills and experience
a. Composition of the team
The consultancy team will be composed of complementary expertise (national and international) for carrying out this feasibility study.
b. Expected qualification and experiences
1. “Lead” consultant
Master’s degree in health project engineering, ideally with a qualification in public health or related fields (international health policy and systems).
Technical competencies and experience:
At least five (5) year experience acquired in the public health sector and similar context;
Experience in coordinating development projects in partnership with national and local stakeholders, including knowledge transfer and capacity building projects;
Demonstrated experience in at least three (3) assignments of similar size and scope in the last three (3) years;
Proven experience in the performance of evaluation and in-depth studies modelling in conflict areas, using a variety of methods including qualitative and quantitative analytical techniques;
Sound analytical skills to make observations, interpret and formulate findings and recommendations;
A good knowledge of the local context (political, socio-political, socio-economic);
A good knowledge of the Iraqi health care sector and reform objectives ;
High-level written and oral communications skill in English. Fluency in Arabic is an asset.
Proven experience in writing and reporting skills in English;
Proven ability to cooperate and negotiate with local and institutional partners as well as government representatives.
The consultant will requires support from a team of national experts. He will contribute to the identification of the national expert team, with support from Expertise France’s office based in Erbil.
How to apply:
I - Timeframe
This assignment is expected to cover a period of five (5) months, to be carried out between February and June 2021.
Please refer to the estimated planning of the study in Annex for more details.
II - Budget
The available budget for the international consultant fees is 45 000 €.
Expertise France will take in charge all the other costs and associated charges related to the implementation of the feasibility study (travel expenses, insurance, national consultant fees, meetings and workshops, etc.).
III - ORGANISATION of the MISSION
The consultant team will be autonomous in terms of equipment (computers, offices, etc.) and communication (telephone and internet).
Expertise France headquarter - in close link with its office based in Erbil - will provide logistic and administrative support to organize the field missions (travel, security, planning and appointments, etc.) and for the establishment of contracts with national (and/or regional) experts.
They will also make contact with public health engineer’s consultancy firms in Iraq.
The consultant team must comply with the safety rules established by Expertise France (transport, accommodations, etc.).
As this study is organized in a “red-zone area”, Expertise France will only award this contract to a consulting company and will therefore disregard any candidate that is not at least covered by an umbrella company. The consulting company should present at least three (3) previous experiences in a red zone area.
The application of the lead consultant must include:
CV of the consultant(s) ;
Details of the company applying;
A cover letter describing the relevant experiences. This letter should also mention the consultant(s)’ availabilities;
A technical offer signed and scanned presenting the understanding of the present Terms of Reference, the approach suggested including the methodology;
A financial offer signed and scanned indicating consultant fees and estimated mission expenses.
The application must be sent to email@example.com before January 31, 2021.
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