TB Program Laboratory Consultant- External Quality Assurance smear microscopy

Word Vision International – Somalia

Global Fund – TB program Laboratory Consultant- External Quality Assurance smear microscopy

Terms of Reference (ToR)

1. Activity Summary

Project Name

Somalia Global fund Tuberculosis (TB) program

Activity Type

External Quality Assurance smear microscopy

Purpose of the consultancy

Quality Assurance of laboratory tests – Smear Microscopy

Proposed Methodologies

External Quality Assessment (EQA) A process which allows participant laboratories to assess their capabilities by comparing their results with those in other laboratories in the network (intermediate and central laboratory) through panel

testing and blinded rechecking. EQA also includes on-site evaluation of the laboratory to review quality of performance and should include on-site rereading of

smears

Panel testing: Sending stained and/or unstained smears from the reference laboratory

to the peripheral or intermediate laboratory to check proficiency in reading and reporting.

Panel testing is equivalent to the WHO definition of proficiency testing. The term panel testing

is used in these guidelines in order to eliminate the confusion over the different definitions of proficiency testing

Rechecking: Sending smears from the peripheral laboratory to a reference laboratory

(intermediate or central laboratory) for rereading. These guidelines recommend that

rechecking is always blinded, ensuring that the controller does not know the results from

the peripheral laboratory. In other documents, this may also be referred to as rereading

Statistically valid sampling: A method designed to obtain a random, representative

subset of all slides which allows for quantitatively accurate conclusions

Proposed Monitoring Dates

1^st January, 2021 – 31^st December, 2023

Reporting Dates

Quarterly (Every 1^st of the following month after end of month)

2. Description of Program

Project Goal

Reduce the incidence of TB (all forms) by 50% by 2025 and 90% by 2035 (from 2015 baseline figure)

Project Objectives/

Project Objectives

· Increase TB treatment coverage (case detection ratio) to 50% by 2020 (from baseline of 47% in 2015)

· Increase treatment success to at least 90% in all forms of detected non- Multi-Drug Resistant (MDR) TB cases

· Increase annual case detection of MDR- TB to 400 by 2020 (from baseline of 243 in 2016) and improve management of MDR-TB cases through country-wide implementation of the shorter MDR-TB treatment regimen

· Ensure that 100% of new staff receive induction training and that 50% of TB service facilities receive regular supervision and monitoring by 2022

Project Outcomes

· TB O-1a: Case notification rate of all forms of TB per 100,000 population – bacteriologically confirmed plus clinically diagnosed, new and relapse cases

· TB O-5(M): TB treatment coverage: Percentage of new and relapse cases that were notified and treated among the estimated number of incident TB cases in the same year (all form of TB – bacteriologically confirmed plus clinically diagnosed)

· TB O-5(M): TB treatment coverage: Percentage of new and relapse cases that were notified and treated among the estimated number of incident TB cases in the same year (all form of TB – bacteriologically confirmed plus clinically diagnosed)

· TB O-6: Notification of RR-TB and/or MDR-TB cases – Percentage of notified cases of bacteriologically confirmed, drug resistant RR-TB and/or MDR-TB as a proportion of all estimated RR-TB and/or MDR-TB cases

· TB O-4(M): Treatment success rate of RR TB and/or MDR-TB: Percentage of cases with RR and/or MDR-TB successfully treated

Project location (Districts

and # of villages/ sub-

Puntland, Somaliland and Federal Government of Somalia

locations)

Number of target

 16, 109,000 which is the total population of Somalia (Worldometer)

beneficiaries

TB patients

Sectors

Health

Key Project Activities

 Drug sensitive TB diagnosis

Drug sensitive TB treatment

Drug resistant TB diagnosis



Drug resistant TB treatment



TB/HIV collaborative activities



· ACSM

· PPM

Procurement and supplies distribution

Donor

Global Fund to fight TB, AIDS and Malaria

Duration of the Program

3 years

Available Project

Documentation

Somalia TB strategic plan, performance framework, project log frame, Inventory study report, Patients’ perspective toward TB treatment report (Quote Study), Impact Evaluation report, KAP Surveys, PU/DRs

3. Brief Background of Project

Globally, 6.3 million new cases of TB were reported in 2016, equivalent to 61% of the estimated incidence of 10.4 million. According to WHO World TB report 2016, Somalia has one of the highest TB incidences rates in the world estimated at 270/100,000 with a prevalence rate of 481/100,000 and estimated mortality (excluding HIV/TB) rate of 64 per 100,000 population. According to the latest UNFPA report, Somali population is estimated to be 12.3 million. TB continues to contribute to the disease burden in Somali, with the latest WHO TB report estimating a Case Detection Rate (CDR) of only 49%, meaning 51% for all the cases (estimated) are being missed or undetected and majority of these are believed to be at the community level. In the last 5 years, case notifications have shown continued fluctuation and decline.

In Somali, TB control service provision is managed under the National Tuberculosis Programme (NTP) within the Ministry of Health (MOH). However, after the collapse of the central government in Somalia in 1990, TB control service provision have been implemented through key partners who consist primarily of international and national Non- Governmental Organizations (NGOs) with WHO providing the technical expertise in collaboration with Somalia government. From 2004, TB control have been funded chiefly by the Global Fund for AIDS, Malaria and TB (GFATM). World Vision (WV) is the principle recipient. Further, the government contributes to the implementation through provision of infrastructure, security support and facilitation of the NGOs involved in the TB control.

Despite being at its infancy stage and the complex political and security in the country, the Somali government has made progress in TB control and management. Access to TB services has generally improved through an increase in the Out-Patient Department (OPD) services and laboratory network for microscopy services implemented according to the Stop TB Partnership global DOTS strategy. With uninterrupted funding from the Global Fund since 1995, access to TB services and treatment have increased from 12 TBMUs in 1995 to 83 by December 2016. Quality diagnosis and treatment resulted in a treatment success rate of above the 85% global threshold. In 2015, the government finalized the development of the second National TB 2015-2019 strategic plan. This was followed by the completion of the monitoring & evaluation (M&E) plan that will guide the implementation of the strategic plan. The Strategic Plan contributes to the Somali Health Policy goal of improving the health status of the population through health system strengthening interventions and providing quality, accessible, acceptable and affordable health services that facilitate moving towards Universal Health Coverage (UHC) and accelerate progress towards achieving the health-related Sustainable Development Goals (SDGs).

Without diminishing the TB control and management progress made in Somali, TB program have not expanded as desired. There has been a slow progress in improving the existing infrastructure to increase their capacity as well as establishing new health facilities to meet the community needs or ensuring quality of the services. Required additional resources in terms of workforce, infrastructures, equipment and supplies have been limited. At present, the Global –Fund supported TB program in Somali is implemented by World Vision International Somalia Program (WVI-S) working in with other Somalia TB program implementing partners. The Somalia Health Sector Committee (HSC) and the TB Coordination Team (TBCT) provides the Country Coordination Mechanism (CCM) for the program.

4. Purpose and Objectives of the engagement

Effective control of Tuberculosis is dependent on a network of local laboratory that provide accurate and reliable testing for diagnosis, treatment and monitoring.

External quality assurance through panel testing and blinded retesting monitors local laboratory tests to ensure accuracy and therefore reliable diagnosis through smear microscopy.

5. Scope of the Engagement

o All Somaliland TB laboratories

o All Puntland TB laboratories

o All Federal Government of Somalia Laboratories

6. Logistics

Based on this ToR, the successful entity will propose a suitable approach and cost as per the following:

1. Panel testing charge per slide

a) Stained slide

b) Unstained slide

1. Blinded rechecking charge per slide

WV Somalia GFTB PR team together with Quality Assurance team will support the successful entity in understanding its program model and the standard tools used in monitoring related activities. WV Somalia will also ensure that necessary linkages are created with field staff and implementing partners and provide logistics for the movement of the slides.

7. Responsibilities of entity

1. Proposing statistical valid sampling
2. Panel testing of the supplied sample slides
3. Rechecking of the supplied sample slides
4. Reporting of the results

8. WV Responsibilities during evaluation

· Provide necessary orientation and training to the selected entity

· Provide the selected entity with necessary documents to enable clear understanding of the project

· Create linkages with field laboratory and staff

· Organize logistics for the movement of the slides to and from local laboratories

9. Deliverables

· Quarterly reports on slides and samples referred, analyzed and results of the analysis

10. Proposal Contents

Proposals from Individuals consultant should include the following information (at a minimum)

1. Proposed approaches
2. Panel testing charge per slide

a. Stained slide

b. Unstained slide

1. Blinded rechecking charge per slide
2. CVs of key team members for this engagement.

11. Qualifications of the entity

1. Established medical laboratory accredited by SANAS
2. Experience in conduction EQA (Smear microscopy) for other peripheral laboratories

12. Evaluation Criteria

1. Accreditation
2. EQA experience