terms of reference 12ini105-cmb-cnm cambodia … · mission no. 12ini105-cmb-cnm cambodia ......

12INI105-CMB-CNM

1

TERMS OF REFERENCE

Mission No. 12INI105-CMB-CNM

CAMBODIA

Technical Expertise for the National Center for Parasitology, Entomology and Malaria

Control

Applicant: National Center of Parasitology, Entomology and Malaria Control (CNM)

I. BACKGROUND

Malaria remains a major public health problem and its elimination is a key priority of the

Royal Government of Cambodia. Out of the 14.7 million people in Cambodia, about 2.5

million live in malaria-endemic area, mainly in areas covered by forest. Malaria prevalence in

these areas ranges from 15% to 40%, while in the plains and surrounding rice fields,

prevalence ranges from 0% to 3%1. Moreover, Cambodia is considered the epicentre of the

emergence of P. falciparum resistance to most antimalarial drugs recommended by the

WHO.

Since 2008, several clinical studies have shown declining efficacy of artemisinin derivatives

(which are a component of ACTs – Artemisinin-based Combination Therapies), especially

along the Thai-Cambodian border (Palin Province). ACTs are currently the only effective

treatment available against P. falciparum infections. The risk of resistant strains of malaria

spreading to other endemic areas, such as Africa, is a major public health risk, especially

when no efficient epidemiological tools are available (such as in vitro tests or molecular

markers).

Cambodia is currently a recipient of two supported grants from the Global Fund to fight

HIV/AIDS, Tuberculosis and Malaria (GFATM) concerning the malaria component of Rounds 6

and 9. The programs supported by these grants aim to implement, strengthen and expand

effective strategies to fight against malaria: vector control, access to and utilization of

effective diagnosis and early treatment, community awareness, capacity building of

stakeholders, and the prevention of the spread of antimalarial drug resistance.

The National Center for Parasitology, Entomology and Malaria Control (CNM), established in

1984 within the Ministry of Health (MoH), was a Sub-Recipient (SR) to the (MOH) under

Rounds 2, 4 and 6. CNM became a Principal Recipient (PR) under the Rolling Continuation

Channel (RCC) grant and then for the malaria component under the Single Stream of Funding

Grant (CAM-M-CNM), aiming at “containing artemisinin-Resistant Plasmodium Falciparum

Parasite and moving toward malaria pre-elimination status in Cambodia”.

CNM is supported by other donors such as the Malaria Consortium and the Clinton

Foundation, and the National Malaria Control Program in Cambodia is supported through

the provision of funding and expertise by the WHO (Geneva, WHO country office and WPRO

Philippines) and the Pasteur Institute of Cambodia. This support contributes to the yearly

1 World Health Organization. Malaria morbidity and mortality by province in Cambodia. 2011 [cited 2011 Aug 3]:

http://www.wpro.who.int/sites/mvp/epidemiology/malaria/cam_graphs.htm

12INI105-CMB-CNM

2

monitoring of the evolution of parasite resistance to recommended antimalarial drugs

through the implementation of Therapeutic Efficacy Tests in 3 or 4 sentinel sites.

Despite progress over the past several years (significant decrease in malaria morbidity and

mortality) with the financial and technical support from the GFATM, a continuous support to

the CNM in Cambodia remains necessary.

This support to the CNM should be focused on the fight against the emergence and spread

of multidrug-resistant strains of malaria while building the capacities of CNM staff involved.

II. DESCRIPTION OF THE EXPERTISE MISSION

1) General objective of the mission

The overall objective of this expertise mission is to strengthen the technical capacities of the

CNM in the fight against the emergence and spread of multidrug-resistant strains of malaria

while building the capacities of CNM staff.

2) Specific objectives

1. To strengthen the technical capacities of the CNM in monitoring the emergence and

spread of multidrug-resistant strains of malaria:

i. Improving the quality of laboratory diagnosis, by training staff in the

implementation of a quality assurance (QA) system according to

international standards (supported by one expert in biology / QA).

ii. Implementation of a monitoring system and an efficient clinical

evaluation of the resistances to ACTs (supported by one expert in

operational research).

2. To strengthen the technical capacities of the CNM staff at central and district levels

and in health facilities in epidemiology, management and planning, and in monitoring

and evaluation.

3) Description of Tasks

COMPONENT 1: STRENGTHENING THE TECHNICAL CAPACITIES OF THE CNM IN MONITORING THE EMERGENCE

AND SPREAD OF MULTIDRUG-RESISTANT STRAINS:

i. To improve the quality of laboratory diagnosis, by training staff in the

improvement of a quality assurance (QA) system according to

international standards (supported by one expert in biology / QA).

Microscopic and malaria Rapid Diagnostic Test (RDT) diagnosis are the two diagnostic

methods currently performed at the CNM. Quality assurance system for both methods is

currently supported by the GFATM and trainings have been regularly organized. Therefore,

achieving malaria elimination by 2015 requires the implementation of high quality molecular

diagnostic techniques within the CNM.

12INI105-CMB-CNM

3

The expert's mission will initially focus on the evaluation and strengthening of the existing

quality assurance system and then on the development of the molecular diagnostic

techniques:

- Evaluation and strengthening of the existing quality assurance system: further

refinement of laboratory Standard Operating Procedures (SOPs), including

procedures for the management of laboratory equipment, reagents, and SOPs for

internal and external quality controls.

- Strengthening of molecular biology laboratory activities at the CNM.

- Training and supervision of local specialists (mostly laboratory technicians) in the

implementation and monitoring of quality assurance system and diagnosis

techniques.

ii. Implementation of a monitoring system and an efficient clinical

evaluation of the resistances to ACTs (supported by one expert in

operational research).

- Support the development of clinical research protocols to determine the level of

"resistance" of malaria parasites to artemisinin derivatives and their geographical

distribution.

- Support the strengthening of the WHO surveillance system: implement malaria drug

resistance operational research protocols to identify the emergence of drug

resistance; ongoing trainings of CNM staff; support to the publication of research

results in international peer-reviewed scientific journals.

- Training and supervision of local specialists (mainly physicians and laboratory

technicians) on the clinical assessment of the efficacy of antimalarial drugs and on

the development of protocols.

COMPONENT 2: STRENGTHENING THE TECHNICAL CAPACITIES OF THE CNM STAFF AT CENTRAL AND DISTRICT

LEVELS AND IN HEALTH CENTERS IN EPIDEMIOLOGY (INCLUDING OPERATIONAL RESEARCH), MANAGEMENT AND

PLANNING, AND IN MONITORING AND EVALUATION.

i. Organisation of a training program in educational professional

practices

This training program will be organized at the Centre for Education Development of Heath

Professionals (CEDHP), University of Health Sciences. The program will primarily target CNM

experts and executives (training of trainers) who will be in charge of the field trainings at

district levels. Organization and supervision of this training program will be coordinated by a

training specialist with medical/laboratory background, supported by other experts

specialized in malaria and in medicine.

See practical aspects of implementation hereafter (may be subject to adjustments following

the diagnosis phase):

12INI105-CMB-CNM

4

Missions Areas of

expertise Expert(s)

Nb

experts

par

mission

Planned Modules

per mission Number of days per module

Total

Nb of Days of

expertise

provided

5 days - Meeting with CNM representatives and partners of the University of

Health Sciences (CEDHP). Needs assessment. Implementation of the training

strategy and of learning techniques.

5 days – Begin writing the program, discussions and exchanges with experts and

trainers (missions 2, 3, 4), preparation of meeting rooms and required training

equipments.

Mission 1

Preparatory

Mission

Coordination

&

Préparation

Expert 3 – Training coordinator and

specialist 1

Meeting with CNM

representatives, setting of

priorities, training

modalities and preparation

in partnership with CEDHP

representatives. 5 days – Finalization of the missions 2, 3, 4. Meetings with the experts involved.

Discussions and drafting of the final program.

15


specialist 1

Pre-mission: preparation

with CEDHP

representatives.

3

Expert 3 - Training coordinator and

specialist

Expert A in drug procurement &

management

2

Training on drug

procurement and

management

5 Mission 2

Cycle 1

Drug

Procurement

&

Management Expert 3 – Training coordinator and

specialist 1

Evaluation CEDHP and CNM

representatives. 2

15


specialist 1 Pre-mission 3


specialist

Expert B in clinical diagnostics and case

management

2

Training on Clinical

Diagnostics and Case

management.

5 Mission 3

Cycle 2

Clinical

Diagnosis and

Case

Management Expert 3 – Training coordinator and

specialist 1

Evaluation with CEDHP

and CNM representatives. 2

15


specialist 1 Pre-mission. 3


specialist

Expert C in epidemiological surveillance

2 Training on Epidemiological

Surveillance 5 Mission 4

Cycle 3

Epidemiologic

al

Surveillance Expert 3 – Training coordinator and

specialist 1

Evaluation with CEDHP

and CNM representatives. 2

15

5 days – Debriefing with trainers. Writing and dissemination of training tools for

the trainers, including 3 interactive trilingual CDs (French / English / Khmer

summarising the full training).

5 days – Preparation of field training. Mission 5

Global

Evaluation


specialist 1 Global Evaluation.

5 days – Finalization of the report “Training of Trainers”. Finalization of field

training agenda.

15

12INI105-CMB-CNM

5

ii. Organization of field trainings (in Phnom Penh and provinces):

These workshops will allow the 7 experts and executives of the CNM to put into practice the

knowledge gained during the theoretical training. This training will also be supervised by malaria

training specialist.

Place Missions

Number

of

participants

(provincial

supervisors)

Number

of

trainers

Number

of experts Number of experts per mission

Total

Number of

Days of

Expertise /

per mission

Total Number

of Days of

Expertise


specialist

Ph

no

m P

en

h

Workshop

1 8 3 2

Expert D - Malaria training specialist

10 20


specialist

Sie

m R

ea

p

Pro

vin

ce

Workshop

2 8 3 2


10 20


specialist

Ka

mp

ot

Pro

vin

ce

Workshop

3 8 3 2


10 20

Total:

24

Total:

7

Total:

2 30 60

4) Expected Results

The technical capacities of CNM staff for the monitoring of the emergence and the spread of

multidrug-resistant strains are strengthened:

- The quality assurance system is implemented within the laboratory and the laboratory

staff follows the procedures.

- The CNM staff is trained in biologic diagnostic techniques, especially in molecular

diagnostic techniques.

- The malaria surveillance system is strengthened.

- Clinical research protocols for an increased surveillance of resistances to ACTs are

developed and implemented.

- Local specialists are trained in clinical evaluation of antimalarial drugs, in developing

research protocols, implementing them, and analysing the results of the research.

- Results of the research are published in international scientific journals with peer-

review.

The technical expertise of CNM technicians and executives, and provincial supervisors are

strengthened:

- the 7 CNM experts and executives are trained in epidemiology, management and

planning, and in monitoring and evaluation, and are trained to be trainers.

12INI105-CMB-CNM

6

- 24 provincial supervisors are trained in epidemiology, management and planning, and in

monitoring and evaluation.

III. EXPERTISE REQUIRED

1) Number of experts : 7 experts in total

Expert 1 Expert in Biology / Quality Assurance 12 months

Expert 2 Expert Physician/Clinician in Operational Research 12 months

Expert 3 Training Coordinator and Specialist 18 months

(90 days)

Expert A Expert in Drug Procurement and Management 1 week

(5 days)

Expert B Expert in Clinical Diagnosis and Case Management 1 week

(5 days)

Expert C Expert in Epidemiological Surveillance 1 week

(5 days)

International

Experts

Expert D Malaria Training Specialist 6 weeks

(30 days)

Regional

Expert

2) Coordination between activities and components, and with other organisations

involved:

The overall coordination of the mission, especially between the activities of components 1 and

2, and with other organisations involved, will be ensured by Chea NGUON (CNM) with the

support of Didier MENARD (Pasteur Institute of Cambodia).

Within component 1, the coordination of the activities will be managed by the expert in biology

/ quality assurance. Within component 2, the coordination of the activities will be managed by

the Training Coordinator and Specialist (Expert 3). For both components, experts 1 and 3 will

ensure the consistency and complementary of all activities of the interventions.

3) Expert Profiles :

Expert 1: Expert in biology / laboratory quality assurance:

The general profile required for the international technical expert is an expert in the creation of

biology laboratories (project management in infectious diseases and quality assurance).

Qualifications and skills:

- Physician / pharmacist and/or master's degree in public health.

- Extensive knowledge in project management and in laboratory quality assurance.

- Excellent skills in:

• Communication.

• Team work.

12INI105-CMB-CNM

7

• Supervision.

• Knowledge transfer.

- Excellent command of English (written/spoken).

- Knowledge of Khmer is an asset.

General Professional Experience:

- At least 5 years professional experience in project management and in quality assurance.

- Experience in communication with health authorities in emerging countries and with

partners involved in public health.

- Experience in scientific writing (drafting technical reports).

Specific Professional Experience:

- Experience in project management, especially in the analysis and identification of health

problems and the implementation of laboratory quality assurance systems.

- Professional experience in a developing country.

Expert 2: Expert Physician/Clinician in operational research:

The general profile required for the international technical expert is a physician/clinician.


- In-depth knowledge of malaria clinical trials.


• Communication.

• Team work.

• Supervision.





- At least 5 years professional experience in the fight against malaria

- Experience in communication with health authorities in emerging countries and with

partners involved in public health.

- Experience in scientific writing (drafting technical reports).


- Experience in project management, especially in the analysis and identification of health

problems, in developing and implementing new operational research protocols, in

epidemiological surveillance.


Expert 3: Training Coordinator and Specialist

The general profile required for the international technical expert is an expert in public health

training with experience in infectious diseases.


- Medical Doctor or Scientist (PhD level) or Public Health Specialist.

- Specialized in infectious diseases.

- Good knowledge of issues related to malaria and public health programs in developing

countries.


12INI105-CMB-CNM

8

• Pedagogy

• Communication.

• Team work.


• Decision-making and initiative.




- Similar experience in the field of research / program evaluation / malaria control

operations.


- Experience in designing and successfully implementing training.

- Interest in innovative training methods.


Expert A: Expert in Drug Procurement and Management:

The general profile required for the international technical expert is a senior expert in Drug

Procurement and Management.


- Pharmacist

- Specialized in infectious diseases.

- Very good knowledge of issues related to malaria and of public health programs and

drug management in developing country.


• Communication.

• Team work.





- Previous experience similar to the mission.

- Experience of training in a health facility/program level.


Expert B: Expert in Clinical Diagnosis and Case Management:

The general profile required for the international technical expert is a senior expert in the

management of febrile syndromes, especially with experience in the management of malaria.


- Physician

- Specialized in infectious diseases and in public health.

- Very good knowledge of issues related to malaria and of public health programs and the

management of febrile syndromes issues in developing countries.


• Communication.

12INI105-CMB-CNM

9

• Team work.






- Teaching experience.


Expert C: Expert in Epidemiological Surveillance:

The general profile required for the international technical expert is a senior expert in malaria,

especially in drug resistance monitoring.


- Physician or Pharmacist.

- Specialized in epidemiology and in public health.

- Very good knowledge of issues related to malaria and of public health programs in

developing countries.


• Communication.

• Team work.






- Teaching experience.

- Interest in new teaching methods.

Expert D: Malaria Training Specialist

The general profile required for the malaria technical experts is a senior expert in biology,

clinical medicine and epidemiology with local and/or regional experiences, and an in-depth

knowledge of the situation regarding malaria in South East Asia.

Qualifications and skills :

- Physician, Public Health Specialist or Pharmacist or Scientist (PhD).

- Proven skills in issues related to malaria control at local/regional and international levels.


• Pedagogy

• Communication.

• Team work.




12INI105-CMB-CNM

10

Professional Experience :

- Professional Experience in South East Asia.


IV. PLACE, DURATION AND IMPLEMENTATION DETAILS

Implementation Period:

Expert 1 in Quality Assurance: August 2012 – August 2013 (12 months)

Expert 2 Physician /Clinician: August 2012 – August 2013 (12 months)

Experts 3, A, B, C, D: starting from August 2012

Start Date:

Expert 1: August 2012

Expert 2: August 2012

The mission will begin with a briefing with CNM members to present the mission: objectives,

methodology, and expected results.

End Date:

Expert 1: July 2013

Expert 2: July 2013

The mission will end with a debriefing of the mission with CNM members.

Effective Duration:

Expert 1 12 months

Expert 2 12 months

Expert 3 18 weeks (90 days)

Expert A 1 week (5 days)

Expert B 1 week (5 days)

Expert C 1 week (5 days)

Expert D 6 weeks (30 days)

12INI105-CMB-CNM

11

Planning/calendar:

The provisional calendar of the missions of experts 1 and 2 is as follows:

Description of the Activity Location Period Duration

Expert 1

Duration

Expert 2

Needs Assessment

CNM- Institut

Pasteur du

Cambodge

(IPC)

Phnom Penh

August 2012

M1 M1

Implementation of

activities

CNM- IPC

Phnom Penh

September 2012

-

February 2013

M2 to M7

- Quality Assurance

System

- Staff Training

- Development of

SOPs

- Coordination with

expert 2

M2 to M7

- Drafting of research

protocoles

- Submission of the

protocols to the ethics

committee

- Training of Staff

- Project

implementation

according to Good

Clinical Practices

(GCPs)

Activity Review CNM- IPC

Phnom Penh March 2013 M8 M8

Results’ Analysis CNM- IPC

Phnom Penh

March – April

2013 M8-M9 M8-M9

Writing of a procedures

manual, a guide for

internal and external

quality control and

publication in international

scientific journals.

CNM- IPC

Phnom Penh

Mai-July /

August 2013

M9-M12

M9-M12

Total 12 months 12 months

12INI105-CMB-CNM

12

V. Deliverables

Expert 1 in biology/ laboratory quality assurance:

- Evaluation report on existing QA within CNM.

- An updated laboratory procedure manual, including procedures for the management of

laboratory equipment (reagents) for the performance of biological diagnosis.

- An updated guide / SOPs for internal and external quality controls.

- Training materials on biological diagnosis techniques.

- Quarterly Implementation Reports on QA.

Expert 2 Physician/Clinician in operational research:

- Clinical research protocols to determine the level of "resistance" of malaria parasites to

artemisinin derivatives and their geographical distribution.

- Training materials on clinical assessment of the efficacy of antimalarial drugs and on the

development of research protocols.

- Draft scientific papers for publication in peer-reviewed international journals.

Expert 3: Training Coordinator and Specialist:

- Curricula, Training plan, Lesson Plans and objectives.

- Training materials.

- Protocol for training impact evaluation.

- Training evaluation (pre- and post-test evaluation as well as feedback on training

received by trainees).

- Mission’s report at the end of each mission.

Experts A, B, C / D:

- Training materials.

- Mission’s report.

VI. Mission Report

- A quarterly report will be delivered by both experts 1 and 2 within 15 days of the end of

each quarter (3 months on-site).

- A single final report is due at the end of the mission, within 30 days of the return from

the mission. Expert 1 (in collaboration with expert 2) will be responsible for the

coordination of the final activity reports.

- Language of the reports: English.

- Report terms: reports will be sent by email to FEI and shared with the CNM.

12INI105-CMB-CNM

13

VII. Practical Details

Expert 1 in biology/ laboratory quality assurance:

- Office : made available at IPC and CNM

- Computer and printer : provided by IPC

Expert 2 Physician/Clinician in operational research:

- Office: made available at IPC and CNM

- CNM and IPC will be in charge of the logistic organization

- Computer and printer: provided by IPC

Expert 3 Training coordinator and specialist and experts A, B, C, D:

- Office: made available at USS and CNM

- USS will be in charge of the logistic organization

- Computer and printer: provided by USS

Services and resource persons for the mission:

- The mission will be monitored by:

Chea NGUON (Vice Directeur CNM) with the support of Didier MENARD (IPC).

- The mission will by coordinated by the CNM coordinator and his team, Didier MENARD

(IPC) and Pascal MILLET (USS)

terms of reference 12ini105-cmb-cnm cambodia … · mission no. 12ini105-cmb-cnm cambodia ......

Documents