Project “Capacity building in the field of training for health care specialists and

technicians” PN 2016.2086.3-001.00
GIZ Ethiopia

Consultancy: Skill gap assessment in nursing instruction in selected institutions in

Nekemte

Terms of Reference

1) Background:

During the last decade, Ethiopia has made major improvements in healthcare. Life
expectancy rates have risen from 43 to 63 years of age, infant mortality has been reduced
from 97/1000 to 55/1000 and maternal mortality rates have been reduced to 420/100,000 by
2014 (EMDHS 2014). Despite these advances, health statistics remain higher than in other
countries in the region and unacceptable by global standards. The Ethiopian National
Strategy for Human Resource Development and the Health Sector Transformation Plan
2009-2025 (MoH 2009) are established tools which should improve the overall situation not
only in terms of capacities but also health service quality.

In response to its critical health service needs, Ethiopia has implemented a major investment
strategy with a focus on primary health care delivery. The key aspects of the strategy were to
increase infrastructures and service (HSDP III) and district hospitals as well as mass
production of nurses, midwives, doctors and engineers / technicians (HSDP IV). However,
major challenges to this strategy prevail with the population growth rate significantly passing
planning expectations. The current population growth rate is 2.5% per year and the fertility
rate is over 4 (EMDHS 2014). Furthermore, the quality of health services remains poor.
The 5-year Health Sector Transformation Plan (HSTP 2015/2016 – 2019/2020) has a key
focus to improve the quality of care and equitable access to services.

A GIZ mission team in 2016 identified a number of challenges at individual, organisational

and policy level including lack of appropriate equipment, insufficient trainer numbers are and
inadequate quality of training, out-dated training materials and training not being skills or
competence-based along with a lack of motivation. The link between pre-service and in-
service training seemed weak, and continuous professional development (CPD) trainings
and guidance missing. Managerial skills seemed to be lacking resulting in a lack of
medicines and supplies for even basic items and lack of maintenance and repair even of the
most basic of equipment devices. These combined major deficits and challenges contribute
to the limited impact to improving health service delivery at all levels.

Based on these findings in 2016 GIZ made a proposal for a new project to BMZ, which was
commissioned in February 2018. Considering the prevailing logistical challenges and
budgetary constraints within the Ethiopian context, the objective of the new project is to
improve quality of training of selected cadres of health staff; this includes clinical, medical,

1
managerial and technical aspects, the latter focussing on the correct use and maintenance of
technical equipment where appropriate. It has suggests enhancing practical training
capacities for health professionals (mainly biomedical technicians and nurses) and
supporting the Federal Ministry of Health in developing a clear national framework for
management of medical devices as two vitally important elements that need to be urgently
addressed to improve the health system capacity in Ethiopia.

Project implementation started in 2018 and a joint planning workshop was conducted in
February 2019. A crucial field of action for the project is to support the training of end-users
of medical equipment (nurses, midwifes, etc.) with their roles in the use and maintenance of
devices. GIZ staff have now been on site in Nekemte since March 2018 with a focus on
clinical preceptor training, nursing training support and biomedical equipment management.
What has been done until now is mainly observing the workflow, dynamics and existing skills
in terms of nursing instruction in both the Nekemte Health Science College and Nekemte
Specialized Hospital; furthermore, a financing contract is being set up with JHPIEGO for
support in essential teaching skills and didactics for teachers and clinical preceptors of
partner organizations as well as zonal and regional level trainers (Title: ‘Support faculty
development for improving biomedical equipment management in Ethiopia’ with expected
timeframe from September 2019 to December 2020).

To analyses and understand better the technical skills gaps of nursing teachers and clinical
preceptors when it comes to teaching students on biomedical equipment, a short-term expert
is needed to assess the situation in Nekemte Health Science College and Nekemte
Specialized Hospital systematically and give recommendations for priority support from the
project. The consultant is also expected to develop capacity building plan and drat inservice
training curriculum for users This shall be done from a biomedical point of view in close
collaboration with the GIZ Nursing Experts.

2) Tasks for this consultancy are:

a) Desk review of relevant documents (project and Government of Ethiopia)

b) Discussion with project team on focus of the assessment and planning of the visit to
Nekemte (GIZ to officially announce the consultant in Nekemte institutions)
c) Development of checklist and questionnaire and discussing it with project team
d) Assessment in Nekemte in close collaboration with GIZ Nursing experts and regular
feedback to project team
e) Analysis of Findings
f) Report writing with recommendations (draft version to be discussed with project team)
and submission of final report
g) Develop capacity building plan
h) Develop draft curriculum for training of users (clinical preceptors and teacher) on
preventive maintenance of biomedical equipment and hygiene and safety.

3) Institutions to be visited:

2
 Addis Ababa

a. Federal Ministry of Health: Pharmaceutical and Medical Equipment

Management Directorate (PMED), Human Resource Directorate
b. Oromia Regional Health Bureau
c. Federal TVET Agency
d. Oromia TVET Bureau
e. professional associations (Ethiopian Nurses Association, Ethiopia Midwives
Association and Ethiopian Biomedical Engineers/Technicians association)
f.

Nekemte

a) Nekemte Health Science College,

b) Nekemte Specialized Hospital
c) Nekemte Town Health Office
d) Nekemte Town TVET Office

4) Deliverables of the consultant:

a) Workplan with timelines

b) Preparation of Checklist and questionnaires for assessment
c) Weekly feedback to project team
d) Data Collection, organization, presentation, analysis and interpretation
e) Presentation of findings to project team
f) Report including photos from observations, analyzed findings and recommendations
g) Capacity building plan based on the recommendation
h) Draft in-service training curriculum

5) Time frame:
The timeframe for the consultancy contract is 1 Nov to 15th Dec. 2019 with the
following number of working days:

Activity Time frame Number of days

(Flexible) (up to)

Preparation time, reading of documents November 1 – 10/2019 2 days

Meeting with project team, pre-discussions November 11/2019 0.5 days

development of checklist and questionnaire November 12 – 14/2019 3 days

3
Travel Days- Assessment November 14-29 /2019 12 days

Analysis and report writing December 2-10/2019 7 days

Presentation 11/2019 0.5 days

Draft Training plan 12-20/2019 7 days

Total up to 32 days

6) Your profile:
 MSc in Biomedical Engineering/Technology or related field with proven experience
in teaching and training in Ethiopia
 Experience with biomedical technology user training in the health sector, including
practical elements and didactics
 Proven knowledge of Ethiopian vocational education system (TVET) in the field of
biomedical technology, its strategies and standards
 Experience with different regions in Ethiopia and internationally in the field of
biomedical equipment
 Fluent in English and Amharic

Attachments:

1. Results matrix and project proposal

2. First progress report with indicators
3. Report of the verification mission, September 2018
4. Assessment report of the use of biomedical equipment in nursing in Nekemte
institutions, June 2019