Consultancy for the Evaluation of Contribution Tender - 32285613

Procurement Summary

Country: Georgia

Summary: Consultancy for the Evaluation of Contribution to Georgia-s E-Health Information Management System (E-HIMS)

Deadline: 26 Apr 2019

Posting Date: 16 Apr 2019

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Notice Type: Tender

TOT Ref.No.: 32285613

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Competition: ICB

Financier: United Nations Secretariat

Purchaser Ownership: -

Tender Value: Refer Document

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72220000 - Systems and technical consultancy services

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Tender Details

Tenders are invited for Consultancy for the Evaluation of UNICEF-s Contribution to Georgia-s E-Health Information Management System (E-HIMS).
Individual National Consultancy for the Evaluation of UNICEF-s Contribution to Georgia-s E-Health Information Management System (E-HIMS)
1. INTRODUCTION
The Ministry of Labor, Health and Social Affairs of Georgia launched its e-health system in February 2011 with financial and technical support of USAID. The e-health system was designed to:

- Improve governmental control of state-subsidized healthcare programmes;

- Increase transparency of healthcare financing and decrease the fraud rate;

- Standardize and institutionalize business processes and improve service quality;

- Create space for real-time monitoring; and

- Introduce informed decision-making and policy development.
Within 3 years, USAID delivered a highly flexible and secure unified e-health system comprising more than 30 components, including a clinical case registration, an electronic reporting module, a finance and billing module, and a beneficiary registration module. The web-based e-health system ensures real-time data collection and tracking of patients, allows internal data exchange among its modules and has high external integration capabilities with the State Service Development Agency, the National Registry for Property Registration, the Customs Department of the Revenue Service, and other state agencies. All these are possible with the use of the personal identification number given to every citizen of Georgia immediately after birth.
By the end of 2014, UNICEF took over the e-health development process and committed itself to introducing maternal and child health and well-being related modules. So far, UNICEF has supported development and mainstreaming of 10 components within the existing e-health system. These modules are:

- Birth Registry;

- Immunization module;

- 0-6 child growth and development module;

- State-subsidized programmes for social rehabilitation and child protection.
UNICEF-s support has been based on respective international and national legislation, conventions, declarations and policies, such as the Convention on the Rights of the Child, the 2014-2020 State Concept of Healthcare System of Georgia, the Socio-Economic Development Strategy of Georgia - ‘Georgia 2020-, and other.
The implementation of UNICEF E-HIMS-related interventions has been documented in the Government reports, UNICEF progress reports and donors reports.
These Terms of Reference (ToR) are designed for a national consultant (to work in a team with an international one) to evaluate the e-health information management system from the end of 2014 till present, and inform its strategic direction. This independent evaluation is expected to begin in April 2019 and to be completed by November 2019.
2. CONTEXT
Georgia is a lower-middle-income country, with a population of 3.72 million, of whom 953, 500 are children (499, 500 boys, 454, 000 girls). Despite government efforts to strengthen child survival and develop integrated early childhood services, key bottlenecks include insufficient coordination, lack of continuity and synergies among services, and inadequate referral systems in health, education, protection and other social services for young children.
Georgia has reached its Millennium Development Goal target for under-five mortality, although the infant mortality rate, at 11.4 per 1, 000 live births, is three times the European Union (EU) average. The highest rate of mortality occurs in the early neonatal period, and inequities persist between rural and urban areas. The maternal mortality ratio is 36 deaths per 100, 000 live births. Low quality antenatal, perinatal and post-partum services are the major bottlenecks that significantly contribute to infant and maternal mortality, and eclampsia is considered to be the main immediate cause of maternal deaths in Georgia. The country registers decrease in immunization coverage - Diphtheria-tetanus-pertussis (DTP3) decreased from 94% in 2015 to 91% in 2017. 9% of districts have suboptimal DTP3 coverage - below 80%. About half a million Georgians, mainly women and children, suffer from some form of malnutrition. Significant numbers of pregnant women and children have anaemia and other micronutrient deficiencies, and 11.3 per cent of children under 5 years of age are stunted. According to data from the 2010 Georgia Reproductive Health Survey, almost 98% of pregnant women received at least one antenatal examination. However, attention is needed to ensure all women have equal access to these facilities as the figures showed there was a gap in the use of these services between urban women (93%) and rural women (86%). Many internally displaced persons (IDPs) who are women living in IDP settlements also lack access to sexual and reproductive health and services information. The rate of exclusive breastfeeding up to age 6 months is as low as 55 per cent, with the remaining children facing an increased risk of mortality and morbidity. Among the key barriers are aggressive marketing of breastmilk substitutes, low awareness of the benefits of breastfeeding and inadequate knowledge and practices of parents and families on young child care, health and development. Although the Government mandates primary health care professionals to conduct home visits to families with young children (age 0-3 years) in order to monitor and educate them on child growth and development, in reality these services are not widely available.
3. OBJECT OF EVALUATION
Object of the evaluation are the e-health modules developed with UNICEF technical and financial support during the period 2014 - 2018.
Putting the products in chronological order, the first electronic module developed and implemented by UNICEF is the Birth Registry (BR). Birth Registry is a real-time electronic management information system tracking every mother and newborn through pregnancy and delivery, launched on January 1st 2016. This system is similar in structure to the Norwegian Birth Registry that has been operational since 1967. Beyond significantly improving information management in Georgia-s MCH system, the BR enabled evidence-based policy development and decision making. Thus, all meetings of the multi-stakeholder advisory MCH Committee under the Ministry of Internally Displaced Persons, Labour, Health and Social Affairs (MoIDPOTLHSA) built upon the BR-s quarterly perinatal reports and adopted several important policy decisions based on evidence derived from the BR. This included introduction of selective contracting of maternities based on critical indicators, abolishment of state funding for C-sections on demand, as well as revision of the neonatal intensive care unit (NICU) referral protocol.
Moreover, the BR is instrumental in addressing another main barrier, namely the quality of maternal and child health (MCH) services. In 2018, UNICEF facilitated elaboration of a set of 15 quality indicators for NICUs and a set of 16 quality indicators for antenatal and delivery care. Upon reaching an agreement among all relevant stakeholders, UNICEF supported the process of integrating these new quality indicators into the BR to enable automatic generation of information. Thus, the first stage of quality improvement, i.e. enabling the identification of poor performers among service providers, was successfully accomplished. During 2019-2020 UNICEF will support the MoIDPOTLHSA in the BR data quality audit process and in fully mainstreaming quality improvement into Georgia-s perinatal care system.
Following this development, and in order to guarantee continuity of care for mothers and children, UNICEF decided to expand the Birth Registry and to add Primary Health Care (PHC) component to it. As per the decision, the PHC module was thought to collect information on child growth and development and therefore, the electronic system is called 0-6 Child Growth and Development Surveillance. The module ensures the collection of routine, real-time data for children aged 0-6 years, assesses a child-s development trajectory, and reflects data related to child nutrition, as well as information on child neglect and abuse. The module incorporates age-specific messages for medical personnel, reminding them of the health topics to be discussed with parents/care-givers, as well as age-specific text messages for mothers. It includes a simple tool that allows primary health care professionals to evaluate a family-s economic conditions and help vulnerable families obtain state allowances. The module also tracks maternal health and well-being during the postnatal period and reflects all potential factors for the timely detection of maternal health complications. In addition, in 2018, UNICEF developed tablet-based web applications distributed to primary health care doctor-nurse teams in the pilot Adjara region.
The above-mentioned system is effective in flagging the need for referral as per an identified issue. Since the system is mostly focused on child development, the assumption is that the child will be referred mostly to social programs. This is what prompted UNICEF to digitalize the State Social programs for children and continue tracking the child throughout social system as well. Thus, UNICEF decided to develop E-Management Information System for social services. The system reflects all business processes related to social services for children and their families and is operated by the Social Service Agencies (at central and regional levels), health and social service providers (day care centres, small group homes, rehabilitation centres, etc.); and state contracted social workers. The E-Management Information System covers all aspects of the social rehabilitation and child protection and includes the following components: 1) rehabilitation and habilitation programme; 2) Early Child

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