We currently have one opportunity to work with WAAF on a project. Please read through the details before applying and call with questions.
Customer: WASOHO Consortium (West Africa AIDS Foundation, Socioserve-Ghana, Hope for Future Generations)
Activity: Baseline Assessment to identify patient and staff levels of knowledge on corruption, as well as their experiences and opinions of extortion and quality of service in district public healthcare facilities
Download the full application information document here: TOR Consultant.
The WASOHO consortium is a recipient of a grant under STAR-Ghana’s Anti-Corruption call, with funding from UK Aid, DANIDA and the European Union.
Corruption within the health service decreases the efficiency and quality of care for all patients, and diminishes trust and confidence in healthcare workers. llegal extortion within the healthcare system is harmful towards the health of the public in general, and the impact is particularly acutely felt by the poorest individuals who are easily exploited due to their lack of knowledge of their rights, including people who do not speak English. Those who live in rural communities who may have made a long journey for medical attention then face a choice between paying a higher price than they had anticipated or can afford for treatment, or going home with their problem unsolved.
Those who cannot afford to pay the bribes for quicker treatment are pushed down the queue, which can make serious health issues worse. Often this can include PWDs. The health of women and girls may not be prioritized in such a situation in farming households where male family members provide financially for the rest of the family. Extortion at the point of use within both private and public sectors can take several forms. These include:
- Demands of unapproved and unnecessary fees by healthcare workers, without issuing of official receipts;
- Healthcare workers referring patients to private facilities or services where suitable public alternatives are available – ‘quiet corruption’;
- Doctors vacating or using paid hours for locum;
- The extortion of bribes in order to be treated more quickly;
- Demands for payment for items covered by the patients’ insurance; and
- Unnecessary overnight admission of patients for profit.
Main Objectives of the project:
To reduce the occurrence of corruption within the private and public healthcare systems through:
- Improving communication channels between senior and frontline staff within the healthcare sector
- Increasing the exposure of corruption
- Increasing client confidence in healthcare system delivery
Studies have been conducted including a 2012 KNUST paper ‘Corruption in Ghanaian Healthcare System: The Consequences’, which focused on patient experiences of corruption in the Ashanti Region. The paper concluded that public perception of ‘quiet corruption’ is that it is endemic across both public and private sectors, with doctors viewed as the most corrupt workers in the healthcare system. This can and does lead to loss of life resulting from delay in medical care and/or lack of financial capacity.
When patients are dying as a result of corruption, we must act. Our alliance is focusing on corruption within the public healthcare system. Specifically, we aim to address the widespread illegal extortion of monies from clients and patients by healthcare workers. This project will run a number of activities with the aim of addressing some of the root causes of corruption within the healthcare sector using an inclusive approach to change. These will include:
- A comparative nationwide baseline study on patient/client knowledge of corruption, experiences of extortion and opinons on overall quality of care conducted by post-consultation satisfaction surveys and mini-household interviews. This will provide a focus for the challenges facing healthcare provision across the country, and highlight ‘hotspots’ where levels of corruption are particularly high. Conversely, it will also show districts or providers with good practices, which will provide opportunities for cross-region learning.
- High level engagement with key stakeholders and senior staff of the Ghana Health Service on the issue of staff welfare. This is intended to detect and address some of the issues which can lead to individuals engaging in corrupt practices including late or insufficient payment of salaries, unmanageable workloads, scarcity of resources and ill health. This activity looks at closing the communication gaps in the staff hierarchy, and will consult with national and district health professionals to identify areas where we can provide support, for example by delivering welfare monitoring training and developing a welfare toolkit.
We theorise that the better a person is taken care of, the more able they are to take better care of others.
- Public education on the rights of the patient and the types and consequences of corruption within the healthcare system will be conducted, using as many dynamic forms as possible to reach wide audiences. These will include visual elements such as flyers, radio documentaries such as Joy FM’s Corruption Watch, newspaper articles, social media campaigns and ‘flash mob’ dramas. These will be conducted in local languages to reach individuals whose inability to navigate official systems and structures is easily exploited.
- Whistleblowing must be destigmatized in order for both staff and patients to feel more able to report instances of corruption they are aware of when it does happen. Building on the success of existing anti-corruption measure, anti-corruption help desks with specially trained staff will be installed at the health facility level in each district to provide a space for anonymous reporting, both written and verbal, and to provide guidance and advice about official procedures. It will also be crucial to use smart technology to make reporting easy, quick and confidential. We will work with Ghana Integrity Initative to develop an app affiliated with their ‘I Paid a Bribe’ site, where concerns about or evidence of unfair practice can be submitted instantly. These will then be submitted for internal investigation, and the results will be added to a specially created database of corruption incidents and reported in public reports and local media channels.
Whistleblowing will also be incentivized – departments or individuals will be nominated for awards for evidencing clean and transparent practices and high levels of patient satisfaction.
- Engagement of key populations including people living with HIV and persons with disabilities, PWDs is essential in ensuring the accountability of this program. Therefore the final component of the project is a sustained advocacy agenda for increased supplies of basic and affordable health commodities to deprived or at-risk communities, to increase availability of medicines for those who are least able to afford them. Where informal key population organisations exist, mobilization sessions will be held to sensitize them to good governance strategies in order to unite and lobby local authorities for change.
- Objectives of this assignment
We require the services of a consultant to undertake a baseline study across our 14 implementation districts to identify issues of extortion and poor quality service in healthcare provision across Ghana. Data may be gathered both at the health facility and the household level as appropriate.
The results of the baseline survey will be used to provide justification for the project to implementers to ensure fullest cooperation.
The survey should seek to answer the following questions:
- What is the level of public knowledge on the patient’s charter?
- What is the level of public knowlege on what constituties corruption and extortion among the general population?
- What is the level of public knowledge on how to report corruption and extortion in the healthcare sector?
- What is the level of patient statisfaction among clients who access healthcare services in selected facilities within the implementing district?
- What is the level of staff knowledge about determining factors of extortion at the facility level?
- What opinions do health workers have on the solutions for tackling extortion in health facilities?
6.1 Expected Output of the assignment
The output of the assignment is a report on a baseline survey on issues of extortion and quality of service in healthcare facilities in 6 regions in Ghana.
The survey document should include the following:
- List of facility and facility staff representatives (various categories of staff) who have been interviewed;
- For the household study: breakdown of household selection;
- Agenda/schedule of the visits;
- Visual and narrative breakdowns of the data;
- Copy of Data collection tools
- Recommendations for further study and project implementation
- Presentation of findings at a stakeholder meetings for validation meeting in Accra
- Submission of final report in soft copy, 4 hard copies and power point
6.1.1 Payment Schedule
60% upon signing of contract
30% after submission of draft report to WAHOSO for inputs
10% after submission of dissemination and submission of final reports and in power points
6.2 Requirements for financial auditors:
- Hotel invoices (if applicable)
- Invoices of local transport (if applicable)
- Proof of consultancy fees which have been charged and paid (receipt of payment)
- Final assignment report
- Report on dissemination meeting
- List of participants/stakeholders present at dissemination meeting
- Hotel invoices from dissemination meeting