START DATE: ASAP
DURATION: 3 months (Up to March 2004)
ALLOWANCE: £10,680 - £16,680 pa ($18,156 -$28,356 pa) - dependent on relevant experience. Plus comprehensive insurance cover, accommodation, return flights, a per diem to cover daily living expenses, holiday allowance and other benefits.
Only short-listed applicants will be contacted. Due to the urgency of this position, applications will be shortlisted on a regular basis and we may offer this post before the closing date.
Project Summary:
Merlin has been in Sierra Leone since 1996. Throughout the most severe parts of the civil conflict, Merlin continued to deliver uninterrupted emergency health and nutrition services to the most vulnerable populations in Kenema and in Freetown. At the height of the emergency phase Merlin was employing in excess of 400 health staff and dealing with a beneficiary population of 1.5 million people. The conflict in Sierra Leone is now officially over, with the country disarmed and under the control of the UN. The second largest peace keeping force in the world, numbering some 17,500 UN troops, is deployed throughout the country ensuring the highest level of security and law enforcement enjoyed by the Sierra Leonean population for more than a decade. Rebels of the Revolutionary United Front (RUF) have joined the political process and were formed a political party to contest the May 2002 elections. Security is vastly improved although a careful watch of the current political and military picture is required at all times.
Merlin currently has programmes in Kenema District, Kono District, Bo District and Tonkolili District.
Activities include:
- Lassa fever (ward, outreach) Kenema District
- Primary health care (40 health facilities) Kenema, Tonkolili and Kono District
- Paediatric ward/Therapeutic feeding centre Kenema District
- Reproductive health (Maternity ward, health centre and TBA -Traditional birth attendant-) Kenema District
- Way station and Refugee camp, Kenema District
- Sexual Gender based violence Kenema District
- Impregnated bed net distribution programme and insecticide residual spraying Tonkolili and Kenema District
- Community Water and sanitation Kono District
- Cost recovery at both Primary health unit and hospital level Kono, Tonkolili and Kenema District
Kenema has been the main focus of our continuing work with the Ministry of Health and Sanitation, and in 2002 Merlin began both healthcare and watsan programmes in Tonkolili, Kono and Bo. The support office in Freetown offers a base for communication, representation and management of activities throughout the country.
In Kenema Merlin supports the maternity, paediatric and Lassa fever wards in Kenema General Hospital and 22 primary health centres in Kenema district. In Kenema we also support health care in a refugee camp and two way stations.
A longer-term strategy is currently being developed for Eastern Sierra Leone as a development funding cycle begins at the end of 2003.
The operation in Kenema has recently developed substantially in response to the changing political and humanitarian environment, and Merlin has moved from the role of service provider to that of supporter for the MoHS. Throughout 2002 and into 2003 Merlin's strategy in Kenema is to develop the capacity of the health service through training and technical support, with a number of significant development initiatives planned. As emergency donors exit the more stable regions, we are working in Kenema to sustain the improvements already delivered and hand over to the local health providers. Key objectives have been to provide quality emergency health care and nutrition services to the resident and displaced populations in Kenema town and District as well as to build capacity at all levels. Merlin aims to assist the MoHS to achieve a sustainable (both financially and technically) health care service. Until cost recovery is fully taken on board and the MoHS is 100% committed, strategies to provide health care still need to be developed.
The current team includes fifteen international staff and one hundred and thirty-five national staff ranging from emergency health staff to experienced national supervisors and support staff.
This is an exciting and challenging position involving adherence to a high degree of quality assurance and professional responsibility and supervision. It demands high standards of reporting to stringent donors. This role includes elements of health economics and health management planning as well as technical support and advice. It demands a high degree of professional expertise and people management skills.
Merlin has worked hard to ensure good relationships with the hospital and the District Health Management Team (DHMT). This has been key in Merlin's past projects and will continue to be in the development phase. Even with a good working relationship there continue to be constraints and difficulties in working with these institutions. The challenges include; getting national hospital clinicians to practice in Kenema, increasing DHMT capacity and ensuring the effective implementation of community drug cost recovery against a general background of low resource levels and poverty of beneficiaries.
This proposal reflects Merlin's commitment and understanding of the importance of establishing a phased, planned exit and hand-over to MoHS, integration of technical and general emergency health efforts into the government health sector and maintaining a high level of quality, sustainable health care
- IRC is engaged in a programme to strengthen and build DHMT management capacity as well as the Health Information system.
- A lack of MoHS capacity has been a barrier to the introduction of cost recovery in KGH. Steps have been taken towards cost recovery but the MoHS staff, led by the DMO, have not been able to proactively take responsibility for the full management and cost recovery process.
- Primary health care is delivered on a partial cost recovery basis from the 19 Merlin-supported PHUs. In Lowoma and Weima PHUs the cost recovery process is less advanced as these areas have only recently become accessible.
- A functional District Pharmacy is needed to ensure a smooth transition from Merlin drug supplies to the MoHS and cost recovery drug supplies. All Merlin activities, except for the Lassa ward, are subject to fee-for-service arrangements. The MoHS cannot at this moment provide a sufficient quantity of essential drugs.
- There remain many destitutes in Kenema district whose health care, ability to feed themselves properly and maintain good levels of health is constrained for economic, agricultural and logistical reasons
- Merlin's strategy for the provision of healthcare in Kenema district is determined by the need, on the one hand, to increase health care uptake for the poorest, and on the other to increase the quality and sustainability of health care in Sierra Leone. In the context of the assessment findings, it is apparent that the major hurdles are to build the capacity of the MoHS and provide a safety net for communities to be able to address their own health care needs where possible.
This is a very delicate situation that needs to balance the humanitarian imperative with a long term view.
Despite an on-going strategic process to achieve the above, the MoHS thus far, has been unable to achieve its aim to commence cost recovery at KGH. Moreover, the cost-sharing principles discussed in workshops prior to that have not come into place in KGH. It is still the case that fees from elective surgery and paying patients cause an imbalance in the focus of management and nursing care from the KGH management. Merlin will continue actively in the process of implementing sustainable cost recovery in KGHwith unqualified support from donors and other organisations active in KGH (see risks and assumptions). An expatriate hospital administration capacity builder will be key in this role to help make the hospital staff aware of the advantages of an efficient cost-recovery system.
Responsibilities:
- Act in advisory capacity to the Medical Administrator/Director of the hospital in Kenema on hospital management
- Work with hospital management to put a comprehensive hospital health and safety policy and manage its implementation
- Conceptualise and develop a phased-approach program for implementing sustainable cost recovery in the hospital
- Implementing the developed cost recovery scheme in the hospital
- Support the hospital and district pharmacies to set up an efficient drug management system to compliment the cost recovery scheme as it progresses beyond fee-for-services only
- Management of project and budget in accordance with donor and international guidelines of good practice
Reporting
- Monthly reports to head office through line manager containing key statistics and addressing program objectives as stated in the program proposal
- Quarterly reports to donors through head office articulating progress as chronicled in HQ monthly reports
Skills/experience
- Health professional with MPH or equivalent
- Proven experience in working with cost recovery programmes
- Experience in working with hospital management in a developing country
