Term of Reference

Development of National Quality Policy and Strategy in Indonesia:
Situation Analysis on the State of Quality Policy and Strategy

Background

Quality and safety has been critical in delivering health services to the people globally and efforts to improve quality have been continuously implemented through different initiatives. Current implementation of Universal Health Coverage which significantly reduces barriers to accessing health care in many countries will also not be able to achieve its targets without ensuring quality of services delivered. In other words, quality access is the main requirement for the success of Universal Health Coverage, and for further achieving the global Sustainable Development Goals.

Recently, the WHO Department of Service Delivery and Safety (SDS) started initiating the development of National Quality Policy and Strategy (NQPS) and working with countries to institutionalize quality and catalyse global learning and action. The meeting was conducted in June 2017, held in WHO Headquaters Geneva and Indonesia was among the eight countries participating in the meeting.

Indonesia has had a long journey in developing quality and quality improvement. Among the initiatives are infrastructure and processes related to regulations on quality, implementation of hospital and primary health care accreditation, minimum service standards for hospital, licensing standards for health care facilities, clinical governance, patient safety and many others. The initiatives have been, however, organized by different sections within the Ministry of Health and also involved other stakeholders. With the new Directorate of Healthcare Quality and Accreditation established in year 2016, there is a need and a golden opportunity to document policies and strategies that have been undertaken on quality and quality improvement, their implementation and achievements for the purpose of developing a coordinated path toward achiving high quality of care in the context of Universal Health Coverage.

Objectives

This term of reference is written as part of the development of National Quality Policy and Strategy. In accordance with the need of the Directorate of Healthcare Quality and Accreditation, Ministry of Health, the consultant team will:

1. Conduct literature review and analysis of existing documents relevant to quality policy and strategy;
2. Assist in conducting the discussion on stakeholder mapping and engagement; and
3. Develop the situation analysis on the quality policy and strategy up to current.

Scope of Work and Method

The consultant team will work closely and under the guidance of the Directorate of Healthcare Quality and Accreditation, Ministry of Health, to conduct the following scope of work:

1. Review of the literature and existing documents

The review will done by conducting international literatur review and Indonesian regulatory document review. Indonesian regulatory document review will be done by compiling various policies in the form of laws, governmental regulations, presidential regulations, health ministerial regulation, health ministerial decrees related with the quality of healthcare in Indonesia. Review will also including article and document report of quality and safety implementation on healthcare services. The review will use a framework suggested by WHO in Handbook for National Quality Policy and Strategy (draft for consultation)

2. Facilitating the stakeholder mapping and engagement

Stakeholder mapping will be broken down into four phases:

1. Identifying: listing relevant groups, organizations, and people
2. Analyzing: understanding stakeholder perspectives and relevance to the quality of healthcare
3. Mapping: visualizing relationships to objectives and other stakeholders
4. Prioritizing: ranking stakeholder relevance and identifying issues

Based on ranking/level stakholder, the consultant team will proposed the engagement approach for each stakeholder. Proposed engagement methods/activities will be between Partnership, Participation, Consultation, Push communications or Pull communications approach.

Stakeholder organisation / group or individual	Engagement level	Purpose of engagement	Considerations for engagement	Proposed engagement approach

 

3. Developing the situational analysis

The situational analysis will likely consist of the following sections:

1. Introduction:
   1. Global relevance
   2. National relevance
2. Conceptual framework
   1. Donabedian’s framework on Quality
   2. Donald Berwick’s Chain for Quality Improvement
   3. WHO National Quality Policy and Strategy: co-defining a pathway for impact
3. Situational Analysis: the context of National Development plan and the Ministry of Health strategic plan and situation analysis related to quality health care
   1. Epidemiological situation of quality problems
   2. Mapping of regulations related to quality
   3. Past and Current Quality Initiatives
   4. Management and organization of quality
   5. Researching quality

The consultant team will work closely with the Directorate of Healthcare Quality and Accreditation to carry out the following tasks:

• To identify, collect and analyse literature and relevant documents related to quality
• To describe and map past and existing quality regulations in consultation with the Directorate of Healthcare Quality and Accreditation, Ministry of Health and other relevant stakeholders
• To assess the current situation and progress made related to quality initiatives and achievements
• To identify enablers and constraints based on the available information
• To facilitate meetings necessary to undertake stakeholder mapping and situational analysis
• To conduct interviews with key stakeholders and policy makers
• To present the progress of this work and final document to the Directorate of Healthcare Quality and Accreditation and relevant stakeholders
• To write the progress and final reports

In order to facilitate the consultant’s activities, the Directorate of Health care Quality and Accreditation is expected to support with the following tasks:

• Give communication support (eg invitation letter) to other Directorates within the Ministry of Health and other stakeholders external to the Ministry of Health
• Facilitate access to existing documents related to quality within the Ministry of Health
• Appoint a contact person within the Directorate of Healthcare Quality and Accreditation for coordination purposes

Duration of Work

All activities within this Term of References will be completed within the period of August 7 to December 7, 2017. The final report will be delivered before Jan 15, 2017.

Timetable

No	Activities	Month	Week
1	Review of the literature and existing documents	August - sept	1-4
2	Workshop: stakeholder mapping and engagement	october	3
3	Workshop : Situational analysis of healthcare quality in Indonesia	November	2
4	Writing Final report	November	3-4
5	Workshop: Dissemination of NQPS temporary results	December	2

Reporting requirements

1. Report of activities conducted and draft documents (on the stakeholder mapping and engagement and the situational analysis) will be used as the progress report and the final documents produced will be used as the final report.
2. Financial report

Deliverable Product

1. Executive Summary (bilingual)
2. Review of literature and background documents (bilingual)
3. Stakeholder mapping and engagement (bilingual)
4. Situational analysis on the State of Quality in Indonesia (bilingual)
5. All background documents (in original documents; will be provided as requested)

The deliverable product no 1-4 will be submitted to the Directorate of Health care Quality and Accreditation, Ministry of Health and WHO Office in Jakarta to be further processed for approval by the Ministry of Health, while document no 5 will be made available on request.

Consultant team

1. Prof. dr. Adi Utarini MSc, MPH, PhD (team leader)
2. dr. Hanevi Djasri MARS (co-team leader)
3. dr. Novika Handayani (research assistant)
4. Anastasia Noviana (project manager)