Universal access to health and care services for NCDs by older men and women in Tanzania 1

Transcription

1 Universal access to health and care services for NCDs by older men and women in Tanzania 1 1. Background Globally, developing countries are facing a double challenge number of new infections of communicable diseases (CD) remains high, and at the same time the prevalence of noncommunicable diseases (NCDs) is rising fast. 2 Tanzania Health Sector Strategic Plan recognises this epidemiological transition. The plan reinforces the government s commitment to provision of quality HIV and AIDS programmes, prevention and control of malaria, and early detection and treatment of tuberculosis and leprosy. It also calls for health facilities to step up the diagnostic and therapeutic capacities for NCDs. 3 However, there is a risk that older men and women might not benefit from these efforts. Firstly, global frameworks such as Agenda 2030 and WHO NCD Global Indicators that inform national plans focus on premature mortality (defined as mortality of population aged 30-70). Yet it is estimated that 75 per cent of older people aged 70 and over in low- and middle-income countries die from NCDs. 4 Second, statistics and evidence are not fit for decision making purpose. Major survey like WHO s STEPS only collects data up to age 64, and there is paucity of quality timely data disaggregated by sex, age, disability and location. 5 Finally, financing of services for NCDs remains a fraction of expenditure on CDs. 6 A concerted effort is required from relevant stakeholders (e.g. civil society, policy makers, service providers, private sector, donors and academia) to ensure that coverage and quality of health services meet needs of all older men and women in relation NCDs, and that no individual and their family is pushed into poverty due to high healthcare costs. 1 The following ToR represents a starting point for discussion with consultants in relation to content and structure of the report. AARP/HelpAge are looking for a critical assessment of what is feasible and what new evidence can be produced given the time frame, budget and available data, evidence in this area. The final ToR will be shaped jointly with AARP/HelpAge and the appointed consultant. 2 Global Burden of Disease Study Global Burden of Disease Study 2016 (GBD 2016) Results. Seattle, United States: Institute for Health Metrics and Evaluation (IHME), United Republic of Tanzania Ministry of Health and Social Welfare, Health Sector Strategic Plan July June 2020 (HSSP IV) Reaching all Households with Quality Health Care, p. XIII, _Sector_Documents/Induction_Pack/Final_HSSP_IV_Vs1.0_ pdf 4 Global Burden of Disease Study Global Burden of Disease Study 2016 (GBD 2016) Results. Seattle, United States: Institute for Health Metrics and Evaluation (IHME), United Republic of Tanzania Ministry of Health and Social Welfare, Health Sector Strategic Plan July June 2020 (HSSP IV) Reaching all Households with Quality Health Care, p Institute for Health Metrics and Evaluation (IHME), Financing Global Health, (Accessed 15 June, 2018)

2 2. Purpose and analytical approach The overarching aim of this project is to assess access to quality affordable health services and care in relation to NCDs by older people 7 in Tanzania. HelpAge International will build on existing knowledge and expertise generated through our extensive programmes on health and social protection like assessment of older people s barriers to healthcare 8, and improving universal access to HIV/AIDS services. We will engage with a range of stakeholders in order to draw on their expertise. We intend to collaborate with our long-term partner and the network member the Good Samaritan Social Service Trust (GSSST). The organisation has a strong experience in the area of prevention and control of NCDs in rural Tanzania, and training health workers on early detection of NCDs. HelpAge International will identify a national academic to lead the project and will invite experts from the government (the technical Working Group on Care and Treatment, Ministry of Health, Community Development, Gender, elderly and Children), civil society and research institutions to contribute to the project. 3. Impact The impact that we would like to see is: Greater understanding of scope and breadth of barriers to NCDs services faced by older people; Greater awareness of chronic conditions among older men and women; Better decision making by national and international stakeholders in relation to achievement of priority actions outlined in the National Noncommunicable Disease Strategy, the WHO Global Strategy and Plan of Action on Health and Ageing ( ), Sustainable Development Goal 3 in the context of ageing; Older people are not left out from the governments SDGs commitment to ensure healthy live and promote wellbeing for all at all ages; To ensure we achieve a strong impact we will draw on lessons from our successful advocacy and influencing work in relation to HIV/AIDS which contributed to raising upper age cap in the National HIV/AIDS impact assessment 2016/18 from 49 to 65 years, and development of the National Age-friendly health services monitoring and evaluation tool. 4. Broad research questions: Based on health and care needs of older people assess universal health coverage (services package, coverage, affordability and quality) in relation to NCDs 9 7 For the purpose of the analysis we propose to focus on population aged 50 and over. 8 HelpAge International, Cash transfers and older people s access to healthcare: A multi-country study in Ethiopia, Mozambique, Tanzania and Zimbabwe

3 What services for promotion, prevention, treatment, rehabilitation, long-term and palliative care of NCDs are covered by national health plan and what is excluded? What is service coverage across different groups of older population (i.e. by gender, socio-economic characteristics, age, disability and location)? What inequalities in accessibility to services exist and what drives them? What is the level of individual/household expenditure on health and how affordable the services are? 10 Quality of health services: To what extent health facilities are accessible and safe; medical staff are well-trained and respond to patient s needs and preferences; and services are delivered in a timely manner and without age-based discrimination. 11 What proportion of older population (disaggregated by sex, age, disability, location and other socio-economic characteristics) with NCDs who don t have access to health services and are at risk of catastrophic health expenditure? What are data and evidence gaps in relation to assessment of Universal Health Coverage (UHC) for older men and women? Frameworks, policies, and accountability mechanisms to support realisation of UHC in the context of NCDs. Political will and commitment to deliver UHC in relation to NCDs: What national frameworks, policies, and plans for action exist to achieve UHC in relation to promotion, prevention, treatment, and provision of rehabilitation, long-term and palliative care of NCDs? Are these policies and plans implemented in an equitable and transparent way vis-a-vis service coverage, access and financial protection of older people? How are the marginalised groups within older population voice/exercise their right to UHC to ensure health policies and services are tailored to needs of all older men and women? 12 What redressing mechanisms are available to the marginalised groups? What gaps exist in policies, implementation and accountability? 9 Given constraints of time and availability of quality timely and varied data on health, the scope of the study is proposed to be limited to examination of NCDs: cardiovascular disease, diabetes, stroke, cancer, chronic respiratory disease and cognitive conditions. However, consultants may propose to broaden the scope to include other impairments under the WHO Guidelines on Integrated Care for Older People (ICOPE) e.g. visual and hearing impairment, urinary incontinence, falls, etc. 10 The proposed definition of catastrophic costs is individual/household expenditure on health greater than 10% and 25% of total expenditure. 11 We request consultants to either conduct and/or inform a design of a limited consultation with a focus group of older women and men in the country to collect qualitative evidence and case studies on quality of health services and rights to health by marginalised groups (see footnote 7). 12 Assessment of how older people are able to claim their right to UHC can be undertaken as part of consultation referred in in the footnote 6.

4 Progress towards UHC: prioritising and fast tracking needs of marginalised groups of older adults What action is being taken by relevant stakeholders (e.g. government, health care providers, other public sectors, private sector, donors, civil society, academia, etc.) to ensure the furthest behind are reached first? What steps i.e. programs to promote increased access to preventive, diagnostic, treatment management and follow-up services for NCDs, allocation of funding and resources, collection of new data and evidence have been taken to seek out missing older men and women who are at risk of NCDs or currently have NCDs and to provide targeted services to them? What is the country progress on SDG3.8, the WHO Global Strategy and Plan of Action on Health and Ageing ( ), and the National Noncommunicable Disease Strategy? What is the country progress towards UHC in relation to other countries in the region? Recommendations Based on the study findings what should relevant stakeholders do to facilitate progress towards UHC in relation to: coverage, accessibility, and affordability of health services and care policy, implementation and accountability availability of quality data and evidence partnerships other areas 5. Specific tasks for consultant i. Provide comments on the scope and timeline of work ii. Develop, in collaboration with HelpAge, a detailed plan for the work and the in-depth country study iii. Based on existing literature produce a draft report iv. Conduct or facilitate secondary data analysis The project does not require collection of new quantitative data. The consultant is asked to undertake further analysis of secondary data (e.g. longitudinal surveys, ageing studies, household surveys, administrative data, etc.) of the profiled country and report data by gender, age cohorts, disability, location, and relevant socio-economic characteristics. v. Develop methodology and conduct a limited focus group discussion Jointly with the HelpAge team develop methodology for a focus group discussion with older people to collect qualitative evidence on quality of health services and care, and how older men and women claim their rights to health. vi. Develop ToR for case studies and collect five testimonials

5 Based on key messages from the study jointly with HelpAge identify case studies that highlight varied experiences of older men and women in relation to utilisation of health and care services. A small focus group consultation is expected to take place either at HelpAge country office or a network member s office. Logistical details will be arranged by the HelpAge team. Together with the HelpAge team agree terms of reference for case studies and collect five testimonials from older men and women. vii. Address comments and feedback on the draft report HelpAge will convene an external expert group to review the draft report. Additionally members of the Global AgeWatch Insights (GAWI) working group and an editor might have questions on the study content. The consultant is asked to respond to these comments and feedback, and reflect them in the draft where appropriate. viii. Map health data and sources used in the report and data gaps 6. Outputs Output 1: Draft report on universal health coverage of older people in Tanzania, and recommendations in relation to data, evidence and policy required to develop ageinclusive UHC. The draft should include a bibliography. Output 2: Mapping of health and care data, sources and gaps for Tanzania examined as part of the Output 1. Output 3: Collect five case studies that highlight key messages of the study 7. Time requirement and duration The consultancy is proposed to start on July 9, 2018 and to be completed by 6 January, 2019 or earlier. Early July 2018 Consultant appointment End November 2018 Draft 1 of the in-depth study completed (outputs 1) Early December mid December 2018: Peer review of output 1 6 January 2019 Final draft of the report (output 1) delivered with data mapping (output 2) and five case studies (output 3)

6 8. Qualifications of Consultant AARP and HelpAge are looking for an experienced consultant or a team. Essential Advanced degree(s) in relevant field(s); In-depth familiarity with literature and debate on UHC, and health and care issues of older people in Tanzania; Demonstrable experience in conducting quantitative research, literature reviews and/or producing similar studies on ageing and health in Tanzania; Extensive experience of working with relevant datasets and knowledge of limitations and gaps in relation to ageing and health statistics; Strong analytical and summarising skills Strong writing skills in English with a clear, simple writing style; Strong IT/computer skills; Desirable Strong experience of working with statistical packages (e.g. SPSS, STATA, R) Demonstrable in-depth knowledge of ageing and needs of older people; 9. How to apply Interested consultants are invited to submit an Expression of Interest (EOI) for delivery of the assignment. The short EOI (about 3-5 pages) should include: 1) Proposed methodology outlining: a. specific research questions to be covered by the study b. proposed analysis to answer these questions c. list of datasets to be analysed d. indicators to be assessed e. report outline f. comments on the TOR e.g. scope, gaps, etc. 2) Work plan including outputs/deliverables and time frames for each stage 3) Proposed budget. The maximum budget is USD20,000 4) Appendixes (not included in the 3-5 pages) a. CV of the consultant(s) b. Contact information for 2 professional references c. Relevant studies previously produced (1-2) Consultants are asked to confirm any relevant datasets they have access to or propose to analyse. The costing/budget for the EOI should include professional fees including daily rates and number of days per component (i.e. literature review, data analysis, etc.) and any other costs to carry out the full study (i.e. micro data access fee, statistical analysis). Travel and administrative costs to conduct a focus group discussion and collect case studies. Selection of the consultant(s) will be by the GAWI working group and based on the experience of the consultant, the quality and relevance of the EOI, and the proposed

7 budget (i.e. value for money, within the resources available). Shortlisted candidates will be asked for a follow-up interview. Final negotiated terms and fees will be specified in the consultancy contract. The deadline for submission is COB 5 July, Please contact Alex Mihnovits by at amihnovits@helpage.org for further information or to submit your EOI.