12 Dec 2019
CONSULTANCY 12 MONTHS FULL TIME
1. Purpose of the Consultancy
In the context of the WHO Health Emergencies Incident Management System (IMS), at the country level the incumbent will be responsible for supporting the WHO ‘Trauma and Emergency Care’ Programme by providing quality control technical expertise for the new limb reconstruction unit (LRU) in Nasser Hospital, in close coordination with the key stakeholders.
Responsible for the quality and patient safety initiatives including on Infection Prevention and Control (IPC) activities; leads on identification and development of quality improvement priorities; support the development & maintenance of an infection control program in the Limb Reconstruction Unit, in collaboration with the IPC and quality committees, according to WHO protocols and standards in order to ensure the quality of care and safety of patients, caretakers and staff.
The current context in the OPT remains increasingly fragile, faced with a ‘response deficit’ undermining the health sector. In Gaza, with a population of just over 2million- half of whom are children-and one of the highest population density in the world, conflict related trauma is a major burden of disease in Gaza. In 2018, the world witnessed the mass demonstrations by Palestinians along the perimeter fence with Israel as part of the “Great March of Return”. Since the mass demonstrations began, and until July 31 2019, a cumulative total of 315 people were killed and a total of 30,724 people had been injured by the response of Israeli forces. The numbers are continuing to increase each week.
The current surge in humanitarian needs takes place against a backdrop of an overall extremely precarious humanitarian situation in the Gaza Strip, expressed through a health system on the verge of collapse and increasing, widespread despair as conditions deteriorate and hope for political solutions diminish. As basic infrastructure continues to chronically decrease the health sector struggles to cope.
Hospitals in Gaza are often overwhelmed by high numbers of patients that suddenly flood the emergency departments as a consequence of airstrikes or Israeli border confrontations. Being able to deal with this patient’s surge is key to guarantee that every person in need receives the highest available care. Hospitals without a proper, drilled, mass casualty plan, and without trained staff and prepositioned supplies are highly vulnerable to this kind of events and have a higher probability of decreasing their levels of service below the minimum accepted standards. Additionally, the level of hygiene and infection control during emergencies is compromised even further, leading to an increased risk of outbreaks during these complex emergency situations. WHO has also found that the lack of data and information flow during emergencies has led to patients being lost in the health system or never returning for their treatment, resulting in severe injury pain and in some cases, later requiring additional corrective surgical interventions.
In Gaza, severe limb injuries caused by live ammunition have created a substantial burden on the already overstrained health system. Between 30 March 2018 and 31 July 2019, more than 7,500 Palestinians have been injured by live ammunition by Israeli forces during the “Great March of Return” (GMR) demonstrations along the fence between Gaza and Israel. According to the oPt Health Cluster, 87 per cent of these are limb injuries, with injuries to the abdomen and pelvis accounting for approximately five per cent.
Of the over 6,500 limb injuries, 148 have directly resulted in amputations (122 lower limb and 26 upper limb). Out of these, at least 108 cases were the result of secondary amputations, which were performed due to subsequent bone infections. The latter usually occur when a limb injury is compounded by more extensive damage to the skin, tissue, nerves and blood vessels. It is estimated that between 25 and 40 percent of patients with such complications go on to develop some form of bone infection over a 12-month period following the injury. In other cases, the injury leads to an open fracture that is either non-healing or leaves bone gaps, which also require specialized orthopaedic plastic-reconstructive surgery.
The World Health Organization (WHO) estimates that at least 1,200 of those who sustained limb injuries will require specialized limb reconstruction treatment. The WHO is dedicated to establishing a multi-disciplinary limb reconstruction unit, serving the Gaza Strip. The unit will have two dedicated operating theatres and forty ward beds. The primary staff of the unit will be from the Ministry of Health, supplemented by technical specialists deployed by WHO for on-job training.
12 months full time.
Dates to be confirmed.
Work to be performed: Under supervision of the Trauma & Emergency Care Manager, the Consultant will be responsible for the following key outputs:
Output 1: Provide technical assistance and support to the LRU in terms of quality, patient safety and IPC by transferring knowledge, attitude and practices to the local staff**
- Deliverable 1.1: -Participating in the definition of the IPC objectives and in collaboration with the IPC committee, defining, implementing and monitoring the IPC annual plan for the LRU.
- Deliverable 1.2: Set up regular monitoring mechanisms for IPC activities alongside the local focal point, analyzing the results, identifying priorities and proposing solutions when necessary.
Deliverable 1.3: Support the local designated focal point in establishing, maintaining and improving surveillance systems for health care associated infections in the facility.
Deliverable 1.4** Design and ensure the implementation of correct ‘clean and dirty flows’ inside the health facility. Ensuring that the environmental standards in the facility are respected and together with the Hospital Facilities Manager and the LRU Manager, that the essential requirements are available in the health structures.
Deliverable 1.5** Ensure and maintain the implementation of the standard precautions in the LRU and necessary support services including sterilization, laundry and kitchen and providing technical supervision and expertise, support, training and guidance to the staff on IPC related issues using existing tools such as audits, checklist, surveillance, etc. and developing training plan and materials as required.
Deliverable 1.6: Promote governance and institutionalization of quality and IPC initiatives within the health facility with higher management and facility staff;
Deliverable 1.7 Monitoring and analyzing the consumption and the quality of IPC materials and equipment
Deliverable 1.8 Conduct training and awareness on antimicrobial stewardship
Deliverable 1.9. Identify and monitor indicators to assess the appropriate use of antibiotics in the LRU
Deliverable 2.1 Develop quality improvement processes to build a culture of patient safety across the LRU, with particular reference to Safe Surgical Checklists, medication errors and the mitigation of healthcare associated infections.
Deliverable 2.2 Conduct training on quality improvement processes for medical, nursing, and administrative (director) staff
5. Specific requirements
· Nurse degree or MD/DO or PharmD
· Masters in Infection Prevention and Control is an asset
· Preferable: Previous experience working with NGOs
· Experience working as nurse, with experience in OT
Skills / Technical skills and knowledge:
· Experience designing and delivering training and implementing capacity building plans
· Strong presentation skills
· Proven ability to translate requirements into working solutions
· Demonstrated ability to analyse data and statistics
· Ability to work to meet tight schedules under stressful environment and multi-cultural context
· Ability to work in demanding physical and cultural context with governmental partners and other implementing partners, under challenging physical conditions and poor national infrastructure
· Highly motivated with a positive attitude and pro-active problem-solving approach
· Focuses on result for the client and responds positively to feedback
· Ability to interpret, analyze and resolve problems
· Demonstrated drive for continuous improvement and incorporation of lessons learned and best practices into business process routines
· Demonstration of professional behaviour and personal ethics, transparency and openness to encourage respect and similar behaviour from colleagues in the workplace
Good knowledge English. Knowledge of Arabic would be an asset.
6. Place of assignment**
Office-based consultancy in the WHO Gaza office / Limb Reconstruction Unit.