Nurse, Palliative Care Transformation Project

Consultancy terms of reference

Background

Médecins Sans Frontières/Doctors Without Borders (MSF) provides life-saving emergency relief and longer-term medical care to some of the most vulnerable and excluded communities around the world. As an independent medical humanitarian organisation, we deliver care based only on need, regardless of ethnic origin, gender, religion or political affiliation.

Around 40,000 patients die in MSF’s projects every year.

Despite the valuable efforts of Palliative Care clinicians working with MSF, we have not yet been able to address quality of death and dying for most of these.

Medical managers in charge of MSF projects need a simplified tool (algorithm / decisional tree) allowing them to identify specific service needs and integrate Palliative Care tools and resources appropriately from a programmatic / operational perspective.

Gap analysis/assessment of current need

In previous years, MSF developed Palliative Care guidelines, toolkits, and training material for our Project Medical Managers. However, despite these and a few pilot projects, quality palliative care needs remain unmet in most projects.

Pilot projects to date, required high intensity specialist input and produced poorly adaptable tools which are non-user friendly. We need high-standard tools to support our medical staff to prioritise quality of death services.

MSF wishes to integrate palliative care services in more structural and sustainable ways in all its projects to improve quality of death and dying.

Expected results/outcomes A simplified decision-making algorithm for our Palliative Care offer.

Task-shifting support provided to selected Projects.
Development of a user-friendly repository Palliative Care toolkit.
Identification of external Palliative Care partners.
Development of a dissemination process with clear direction on use, adaptation, and feedback.

Activities

Collaborate with the Palliative Care Transformation Project Public Health Specialist.
Lead the process of ensuring person-centred care and adaptation to essential social dynamics surrounding death and dying, including the role of families, community, spiritual leaders, and local healers.
Ensure that the project maintains a strong focus on Paediatric Palliative Care in its multidimensional aspects.
Accompany task-shifting processes centring on Nurses when possible and necessary in any MSF service.
Create partnerships within and outside MSF ensuring the availability of specialised support for projects.

Methodology

The consultancy will:

Collaborate with the leadership and management of the Palliative Care Transformational Project aimed at designing, prototyping, implementing, and evaluating adapted and customisable solutions to integrate Palliative Care in all MSF Projects.
Revise MSF’s and external guidelines and toolkits with the aim of ensuring necessary supportive material for nursing project staff.
Develop and improve MSF’s understanding of the challenges and barriers to MSF Project service implementation.
Network with MSF Nursing Care Advisor, Nursing Project Manager, and Nursing Association to ensure buy-in in the implementation of the projects’ outcome.
Network with Paediatricians, Health Advisors, and external associations or organisations working on Paediatric Palliative Care to develop children and family-centred services.
Represent MSF with associations and institutions specialised in Palliative care, particularly those located near MSF projects.
Share with the specialist support for existing projects providing palliative care.

Assumptions made / areas of uncertainty.

MSF is a complex and ever-changing organisation, composed of a variety of medical and operational structures. The consultant will be required to navigate this complexity while creating generalised buy-in for the project implementation.

Nurses represent the majority of MSF’s staff in projects but are often under-represented in operational decision-making structures. The consultant will be required to identify and make recommendations to bridge these gaps, in collaboration with the specialist consultant.

It is presently unclear what percentage of the consultant’s time will be required in the support of existing projects.

In / out of scope

The initial focus of the project concerns patients who are dying and their families. Broader aspects of palliative care, although very important, are out of scope at this stage.

Deliverables and deadlines

The deadline for the project is 12 months from its conception, with five key outcomes:

Collaboration in task-shifting efforts in a few projects, piloted for the Minimum Viable Product (MVP) consisting of:
- support provided to projects identified for their simple mortality patterns
- development of tools, trainings, and networking support to MSF projects
- development of a Monitoring, Evaluation, Accountability, and Learning (MEAL) framework for implementation and integration, to be piloted in these settings.

Deadline: 5 months

Contribution to the networking and identification of external Palliative Care partners who could support MSF’s patients when possible.

Deadline: 6 months

Development of a user-friendly repository of all documents and tools in a central location with clear versions, dates, and responsibilities for document owners.

Deadline: 7 months

Support provided to the Palliative Care Transformation Project Public Health Specialist in creating a simplified decision-making algorithm accessible for MSF Projects medical managers to indicate which type of Palliative Care offer is adapted to each existing type, size, and urgency of medical services.

Deadline: 9 months

Development of dissemination processes, documents, and tools to all relevant colleagues with clear direction on use, adaptation, and feedback to ensure that documents remain relevant, up to date and available where they are most needed.

Deadline: 12 months

Profile of consultant

Nursing qualification.
Prior work experience as Nursing Manager of Palliative Care projects / activities.
Strong knowledge and connection in Lower-or-Middle-Income- Countries (LMIC) and countries near MSF interventions (preference for Nurses who conducted their studies and a substantial part of their career in LMIC).
Proven skills in Paediatric Palliative Care, both from a medical and management perspective
Good understanding and knowledge of person-centred care.
Teaching capabilities and experience.
Strong communication and interpersonal skills including clinical person-centred communication, communication with families and communities, and communication among medical colleagues.
Proven networking and representation skills.
Ability to complete work within specific timescales.
Fluent English language abilities
Research experience is advantageous.
Commitment to the aims and values of MSF.

How to apply

Please submit to admin.mu@london.msf.org a brief proposal, including:  

1. Proposed approach to achieve the deliverables including:

Commentary on Death and Dying presentation – which are the relevant aspects to work on – max. 2 pages.

2. What you see as being in/ out of scope.

3. CV(s) of those involved including examples of previous similar work.

4. Total fee proposal.

Deadline for applications

21 May 2023

For questions, further background information please contact: admin.mu@london.msf.org