Adequate access to essential drugs such as for HIV, TB and malaria treatment is in many countries negatively affected by irregular availability of medical items (diagnostics and medicines) or their unaffordability for patients. This undermines timely start of treatment, correct adherence and continuity of care, completeness and quality of care. Unavailable or inaccessible drugs in public services also push patients to seek alternative care providers of which quality and costs are often problematic, leading to bad outcomes and worsening poverty.
In the current landscape of reduced health financing, including for medical commodities and supply lines, we can expect more problems in terms of shortfalls and stock-outs. Similarly, the push for domestic resource mobilisation and the shortfall in international aid for health pushes countries to find alternatives, including the increase or (re)introduction of patient payments in some countries.
There is ample evidence (including published by MSF) that making patients pay for essential care has many negative effects on timely and continued uptake of care. Similarly, low or interrupted availability of medical items (drugs, diagnostics and others) is impacting negatively on the offer and access of treatment. However, most health systems do not include systematic monitoring and if they exist, underreporting is frequent due to vested interest and lack of mitigation action following these reports.
Showing the medical consequences of such failures to provide adequate care free of charge is a powerful illustration of how wider system issues affect quality and access of care and can be used as tool for mobilisation for change and accountability. Documenting the reality in the field, for patients and at health facility level is an important element to identify rapidly problems and trigger a quick reaction to mitigate medical consequences, but also to make sure the underlying problems reported will not be repeated (as frequently) and possibly show how some operational changes do or don’t provide better results.
MSF has some experience in documenting and mitigating stock-outs, as well as in verifying application of free care; some of these initiatives include collaboration with patient associations and civil society. Recently similar initiatives have been supported and funded by other organisations, such as the “Observatoires” in countries of West & Central Africa (WCA).
Patient and patient associations have a major role to play in providing feedback to policy makers and keeping authorities and donors to account. However, in many countries civil society has limited capacity and/or recognition in terms of assessment and reporting methodology. Several civil society organisations are interested to develop this capacity and MSF wants to provide support for this.
A specific priority focus on WCA and French speaking countries is envisaged because of important lag in support for these countries and for the specific problems these countries face now in next year in terms of HIV-TB but maybe wider too. Nevertheless, the principles and methodology of independent verification is applicable for any health service and will benefit all patients.
Objective of the position:
Contribute - in particular in WCA countries Guinea, CAR and DRC (French speaking)- to strengthen capacity of civil society organisations in ‘watchdog’ monitoring at health facility and community level in terms of availability of medicines (HIV, TB, malaria and essential drugs) and application of free care.
Specific Objectives and tasks:
· Capitalise on MSF and Civil Society (CSO) experience on stock out monitoring and patient fee verification in various countries
o Produce an overview of experience in various countries, with comparative advantages and difficulties
o Propose material to develop a training module and other methods of dissemination within MSF
· Develop adapted methodology and tool kit for:
o Monitor stock outs (various methods: cross-sectional assessments; continued health facility and patient-based checks; monitoring by CSO and patient associations; hotline reports etc)
o Verify (non-)payment and out-of-pocket expenses for patients
o Advocacy approaches, including targeted briefing notes for policy makers & donors, activist event creation and other change in policy & practice at country level
o reporting on supply and financial barrier issues
· In collaboration with MSF country coordination develop a strategy, including selection of context adapted methodology, selection and preparation of CSO to train and support, set-up of support in medium term
· Organise training material and workshops for CSOs in country
· Identify possible channels of continued technical and financial support for CSO in this role of monitoring, verification, reporting and advocacy
· Complement ongoing MSF work on monitoring, analysis & advocacy concerning current and future shortfalls of medicines funded by external donors and the consequences for availability, affordability and quality of essential medicines, including for patients in MSF supported projects (ARV & TB)
Set-up & interaction:
Technical referent: Analysis department- Health Politics Team
Close collaboration with Advocacy Officers in concerned missions and cells; at mission level close linkage with medical coordination and pharmacists if available.
Experience in monitoring and advocacy
Experience in working with civil society essential
MSF experience a plus
French and English – French essential
Able to work autonomously
Frequent travels and prolonged stay in selected missions in Africa. Country based to be discussed, at least 60% of time spent in the field.
The candidate adheres to the MSF principles and to our managerial values: Respect, Transparency, Integrity, Accountability, Trust and Empowerment.
12 months “MIO contract” – full-time
Field position: salary according to MSF-OCB Field salary scale
Position based in Brussels with frequent visits to the field
Start Date: August 1, 2019 [AD1] [GR2]
[AD1]Ça me parait un peu short comme start date .. Je mets août ?