UNDP Jobs - 73191- Lead Consultant for the Audit of HIV Patients Trea

Lead Consultant for the Audit of HIV Patients Treatment Data in Selected Health Facilities in Angola

Location :

Luanda, ANGOLA

Type of Contract :

Individual Contract

Starting Date :

17-Jul-2017

Application Deadline :

11-Jul-17 (Midnight New York, USA)

Post Level :

International Consultant

Duration of Initial Contract :

60 days

Languages Required :

English Portuguese

Expected Duration of Assignment :

3 months

UNDP is committed to achieving workforce diversity in terms of gender, nationality and culture. Individuals from minority groups, indigenous groups and persons with disabilities are equally encouraged to apply. All applications will be treated with the strictest confidence. UNDP does not tolerate sexual exploitation and abuse, any kind of harassment, including sexual harassment, and discrimination. All selected candidates will, therefore, undergo rigorous reference and background checks.

Background

In Angola, the United Nations Development Programme (UNDP), is implementing the country’s Global Fund HIV grant (AGO-H-UNDP) in the capacity of Principal Recipient over the 2016-2018 period. Such a role is carried out by UNDP in support of the national response to HIV led by the Instituto Nacional da Luta contra VIH/sida (INLS), under the Ministry of Health, and within the framework of the 2015-2018 National Multisectoral Strategic Plan for HIV/aids

With an estimated prevalence of 2.2% [1.5 – 3.1 %], Angola faces a generalised, albeit concentrated HIV epidemic (UNAIDS, 2015). 93?318 over an estimated total of 350?000 adults and children living with HIV were reported to be on antiretroviral treatment (ART) as of 31st December 2016. (INLS, March 2017).

The major challenge facing the national response to HIV in Angola is the lack of an integrated health information management system (HMIS) which would allow for the timely collection, transmission and analysis of accurate, national data related to the number of HIV cases diagnosed, provided with treatment and adhering to treatment. Since 2016, a range of partners, including UNDP/Global Fund, are providing technical and financial support for the introduction and operationalisation of the Demographic Health Information System 2 (DHIS2) in the country. The information package related to HIV is the first to be developed under the DHIS 2 initiative, with INLS taking the lead in designing and printing new instruments for the collection of HIV patient data. Trainers of health professionals have been trained in the use of the new tools, which are currently piloted in a selected number of health facilities.

While the new tools under the DHIS2 are being introduced, UNDP and INLS have to operate with data generated by a computerised health information system (no DHIS 2) which presents deficiencies in terms of indicators. Also, since 2016, due to lack of funds, the system, designed by an international service provider, is no longer fully functional due to the interruption of administrator and maintenance services. As a result, the transmission of data from health facilities to the INLS is characterised by a combination of electronic and paper-based transmission, depending on the provincial health authorities’ access (or not) to the existing system. Also, as the country transitions to DHIS 2, the newly piloted system under DHIS 2 co. exists with the partially functional current system.

Last but not least, treatment adherence rates are reported to be as low as 34% one month after the initiation of treatment (INLS, June 2017). Consumption of ARV drugs is overall at lower levels than planned, leading to preliminary conclusions about a possible overestimation of the number of PLHIV on treatment. Compliance of health professionals with national ART guidelines is also an issue with multiple treatment regimens being prescribed, including obsolete ones. Deficiencies in the logistics management information system imply that the reported number of PLHIV on treatment is not fully correlated with ART consumption data.

Duties and Responsibilities

Prior to the Audit, under the supervision of the Audit Oversight Committee, the Lead Consultant will:

Advise on the treatment site selection and the cohort definition, balancing the need to have comprehensive data with the time constraints of the Audit.
Advise on the composition and formation of audit teams and on site allocation per team. Audit teams will have team leaders who will liaise directly with the Lead Consultant.
Design the audit schedule, in terms of phasing of sites, itineraries and time spent per treatment site
Design and deliver a training package for audit teams
Design standard audit tools to be used by audit teams, including standard audit schedule in each site and reporting template
Ensure that provincial and municipal health authorities receive prior notification of the audit terms of reference
Ensure that all treatment site Senior management receive prior notification of the audit for them to give access to patient files (electronic and paper-based), site treatment reports (electronic and paper-based), prescription forms/books/registers, stock cards, etc.

During the Audit, the Lead Consultant will ensure that Audit teams carry out the following:

Hold in briefing sessions with treatment sites senior management and staff, at the beginning of the audit visit.
Share and explain the Audit’s terms of reference to treatment sites senior management and staff: rationale, objective and expected results, methodology and tools to be used
Request the health professionals at the level of the treatment site to describe the data collection system, the documents and the tools used in recording and managing PLHIV patient data, including treatment data.
Perform a preliminary analysis of all documents and tools related to PLHIV patient in each treatment site in order to assess to what extent they provide sufficient information in terms of patient codification, age, gender, treatment regimen. If this is not the case, audit teams will need to carry out more in depth investigation in order to secure such information.
Clean” the existing data by searching for and removing duplicate data, correcting atypical values, completing missing values. This “cleaning” process has to be done in close collaboration with the treatment site staff.
Draw the correct number of PLHIV on treatment per data collection source or instrument.
Triangulate the cleaned data from the various sources and instruments analysed in order to ensure that data is consistent across data collection tools. This task will consist in matching the qualitative data contained in the various sources and instruments, while considering the variables used during the “cleaning” phase i.e. patient codes, treatment regimen, gender and age groups. Out of this process, teams will have identified concordant and discordant data.
Save concordant data in an Excel database designed to this effect and for the purposes of the Audit exercise.
Analyse the discordant data further by requesting explanations from site treatment staff in order to validate or invalidate the data. To this end, where available, pharmacy data should be used as a basis for the validation process.
Update the data contained in all the data collection instruments available on the treatment site by fully registering the newly validated data; remove all inconsistent and non-validated data from all the instruments, making reference notes wherever adequate.
Remove and archive in an adequate manner all files of patients lost to follow up, deceased or having dropped their treatment or referred to other health facilities; ensure that these files are separated from the active cohort patient files.
Document findings and observations made at the treatment site, as far as data collection, management and reporting is concerned; formulate recommendations and an improvement plan to be implemented by the treatment site.
Hold an out brief meeting with treatment site senior management and staff, focusing on validated date, strengths and weaknesses revealed in the management of HIV patients’ treatment data and recommendations
Have the data collection template designed for the purposes of the Audit printed in three copies and countersigned by the treatment site Senior Manager or his/her presentative and the Audit team leader. A copy will be left at the site, another will be sent to the Provincial Health Directorate and the third copy will be transmitted to the INLS.
Ensure that an attendance list is filled in during the in brief and out brief sessions, which will be included in the Audit team’s report to the Audit coordination team (UNDP, INLS, Lead Consultant, representatives of Pepfar, UNAIDS, WHO, etc.).

After the visits to the treatment sites, the Lead Consultant will ensure that:

Each Audit team leader transmits to the Audit coordination team a narrative report on the visit as well as the Excel database designed for the purposes of the Audit.
All the signed and countersigned Audit data collection tools completed during the visits, are rigorously organised, archived and annexed to the narrative report and the Excel database
Audit teams debrief with the Provincial Health Authority and the national Audit coordination team.
Each Audit team leader holds out briefs in the treatment sites and provinces under his / her responsibility.

Competencies

Corporate Competencies:

Demostrates commitments to UN's mission, vision and values
Displays cultural, gender, religion, race, nationality and age sensitivity and adaptabili

Functional Competencies:

Knowledge Management and Learning

Shares knowledge and best practices in the area of audit of patients with other team members
Development and Operational Effectiveness : ability to developpe tools to be used by the audit teams
Strong IT competencies
Ability to network with decisions makers
Leadership and Self-Management: Focuses on result for the client and responds positively to feedback
Responds positively to critical feedback and differing points of view
Demonstrate good oral and written communications skills.

Required Skills and Experience

Education:

Essential

University degree in public health, medicine, international development or related areas.

Experience:

Essential

At least 15 years of experience in the monitoring and evaluation of HIV/aids programmes in sub-Saharan Africa, including, but not limited to :

HIV data collection and reporting
HIV data quality assessments

At least 10 years of experience in the design and delivery of technical assistance interventions to HIV/aids programmes in sub-Saharan Africa

Desirable

Prior experience of auditing or verifying national HIV data;
Significant experience of clinical management of HIV;
Experience of HIV service delivery at peripheral leve.

Language:

Fluent in English;
Working knowledge of Portuguese.