Location: Namibia
Job Code: 999
# of Openings: 1
Background
information:
There is broad consensus among global development partners and
governments that HIV and sexual and reproductive health programs are strongly
linked and when offered in an integrated model, can bring about overall
improvements in health systems. Integration can take several forms, including
the incorporation of family planning and reproductive health services into
existing HIV service delivery models, and the integration of Prevention of
Mother to Child Transmission (PMTCT) and other HIV services into sexual and
reproductive health services, or existing primary health care delivery. Within
integrated sites, there is also variation with respect to how referrals are
made, and how much time staff members spend across various disciplines. The
type of integration is largely driven by broader health sector reforms and is
likely to be unique in each setting. As PEPFAR examines how best to scale up
PMTCT services, it is important to evaluate different types of integrated
models, and to assess both the effectiveness and efficiency of these models.
Since 2011, UNAIDS and UNFPA has supported seven countries to address barriers
in the efficient and effective delivery of integrated sexual and reproductive
health (SRH) and HIV services. In Namibia, the Ministry of Health and Social
Services, UNFPA and UNAIDS conducted a baseline evaluation across 7 pilot sites
that were selected for integration by the UNAIDS and UNFPA teams in urban,
peri-urban and rural areas. The pilot sites were partially integrated, but the
level of integration varied across sites and was measured using a percentage at
baseline. In a partially integrated model all services are available at one
facility, yet patients are referred to different nurses for different services.
In a non-integrated model, patients are referred to different facilities for
different services. The evaluation included a rapid assessment at the policy
level, interviews with key informants, direct observation and client interview.
The evaluation was conducted to measure patient wait times, satisfaction, etc.
UNAIDS, UNFPA and WHO will then oversee the full integration of SRH and HIV
services at these sites for the course of a year at least. In this case, full
integration refers to the implementation of a system in which one nurse
provides one patient with care in one room. After one year, UNAIDS, UNFPA and
WHO will conduct a study to understand how integration affected quality and
efficiency of service delivery. The study will look specifically at how nurse
productivity and patient wait times vary across the models. However, to get a
true measure of efficiency, and to be able to say whether or not the fully
integrated model is cost-effective, there is a need for data on the costs of
the different models. To assist with the process, the Health Policy Project
(HPP) in partnership with UNAIDS, UNFPA and WHO will conduct a baseline costing
by collecting cost data retrospectively or prior to the SRH and HIV integration
at the 7 pilot sites. In other words, for sites that have already been
integrated, HPP will collect the cost information from retrospective financial
and service delivery data, as well as hold discussions with facility managers
about the previous service delivery model. For sites that have not yet
integrated, HPP will collect baseline data. HPP will also collect cost data at
a midpoint to assess costs after approximately 6 months of integration. Cost
data will be collected for a range of SRH and HIV related services such as
PMTCT, antiretroviral treatment (ART) and Family Planning (FP). Outside the
scope of this protocol, an endline evaluation and costing will be conducted
approximately one year after integration. The baseline and midline costs derived
during this activity will be compared to each other, and later to those costs
collected at endline. Understanding the costs of integration will provide an
evidence base for countries considering the adoption of integrated SRH and HIV
services. Evidence from this study will allow countries to assess cost drivers,
resources needed and additional resources that need to be requested. Study Aim
The aim of this study is to derive the cost of serving the average individual
for a range SRH and HIV clinical services in Namibia prior to and at the
midpoint of integration.
Study Objectives
The specific study objectives are to: 1) Calculate pre-integration
provider-side unit cost of serving the average individual for a range of SRH
and HIV clinical services in Namibia. 2) Calculate mid-integration
provider-side unit cost of serving the average individual for a range of SRH
and HIV clinical services at Namibian pilot sites that have actively integrated
these clinical services for a minimum of six months. 3) Combine data from the
costing study with data from the evaluation to obtain measures of efficiency of
service delivery in the partially integrated model.
Activities
1. Lead data collection for a costing study to understand the costs
before and after integration of HIV and Sexual and Reproductive Health Services
in Namibia.
2. Collect all data, or, if working with another data collector, train
data collector and monitor data collection.
3. Lead the pilot study in at least one of the seven sites where data
will be collected. The sites are: a. Khomas Region: Khomasdal Health Center,
Hakahana Clinic, and Namibia Planned Parenthood Association (NAPPA) b.
Otjozondjupa Region: Nau-Aib Clinic c. Omaheke Region: Epako Clinic d. Oshikoto
Region: Okankolo Health Centre e. Caprivi Region: Kanano Clini
4. Submit a write-up of the pilot study, including any problems
experienced, whether the tool was useful in collecting the right information,
and whether any changes need to be made to the tool or methodology.
5. Lead implementation of data collection from implementing partners and
key local organizations at seven sites in Namibia.
6. Enter data into costing spreadsheet provided by HPP.
7. Write up any observations or qualitative findings from site visits to
be used in the final report.
Deliverables
1 Summary of pilot test, including any problems experienced, whether the
tool was useful in collecting the right information, and whether any changes
need to be made to the tool or methodology
2 Data collected from seven sites and entered into costing spreadsheet
provided by HPP 3 Written observations from study (Microsoft Word document,
4-10 pages in length)
Key
qualifications
• Masters degree in Economics, Finance, Public Health, or similar field
• Experience working in Namibia collecting costing data
• Experience collecting costing data from either HIV or Sexual and
Reproductive Health (SRH) Programs
• Familiarity with SRH and HIV services, including Prevention of Mother
to Child Transmission (PMTCT)
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