APPENDIX

Merlin Standard Health Contract Agreement (Memorandum of Understanding)

AGREEMENT PROTOCOL WITH ……………. HEALTH CENTER

Within the OFDA funded project logical framework


Health support to war affected……….. population


This protocol is concluded this first day of March 2002 between Merlin represented by the Medical Coordinator referred as “contractor” and the …………….. Health Center represented by the Head Nurse, referred as “subcontractor,” with the aim to provide basic health care to the ………… Health Area population.

Targets enumerated for the provision of health care to the population by the subcontractor will be reached by ensuring the following:


1. MAJOR ACTIVITIES

  • The provision to outpatients and those in observation of health care and annex services for the main causes of morbidity and mortality, and the monthly recording of consultations, describing suitable diagnosis and drugs prescriptions carried out (in accordance with established health protocols).

  • The provision of community based health services and preventive services, especially routine vaccination, ante-natal consultations, and eutocic deliveries will be carried out as agreed.

  • The management of community based services of active track-



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Supporting Local Health Care in a Chronic Crisis: Management and Financing Approaches in the Eastern Democratic Republic of the Congo APPENDIX Merlin Standard Health Contract Agreement (Memorandum of Understanding) AGREEMENT PROTOCOL WITH ……………. HEALTH CENTER Within the OFDA funded project logical framework Health support to war affected……….. population This protocol is concluded this first day of March 2002 between Merlin represented by the Medical Coordinator referred as “contractor” and the …………….. Health Center represented by the Head Nurse, referred as “subcontractor,” with the aim to provide basic health care to the ………… Health Area population. Targets enumerated for the provision of health care to the population by the subcontractor will be reached by ensuring the following: 1. MAJOR ACTIVITIES The provision to outpatients and those in observation of health care and annex services for the main causes of morbidity and mortality, and the monthly recording of consultations, describing suitable diagnosis and drugs prescriptions carried out (in accordance with established health protocols). The provision of community based health services and preventive services, especially routine vaccination, ante-natal consultations, and eutocic deliveries will be carried out as agreed. The management of community based services of active track-

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Supporting Local Health Care in a Chronic Crisis: Management and Financing Approaches in the Eastern Democratic Republic of the Congo ing of vulnerable/at risk groups with limited access to ……….. health structure. The management of the exemption system for financially disabled groups (as defined with the Community Health Committee) in a responsible and transparent fashion. The prompt and complete organization of epidemiological surveillance, monthly data collection, of reports, and finally the immediate notification of epidemics in order to facilitate emergency response as appropriate. The adhesion to universal transfusion security standards including skin piercing, aseptic practice, and blood transfusion (single use of syringes and needles, 0% of blood transfusion without HIV screening). The setting up by Health Centers of protocols and directions implemented and agreed upon by both Merlin and health zone bureaus. 2. HYPOTHESIS AND TARGETS TO MEET The provision of basic health care requires the presence of qualified staff and staff continuity in the Health Centers, and requires that the necessary tools are available and used in optimal fashion. Drugs, materials, and equipment will be co-managed by the Health Centers and Health Committee. Fees in health centers for drugs and medical acts will be charged as agreed between Merlin, the health zone bureau, and the HC. A quarterly evaluation by the health zone bureau and Merlin will be organized in order to evaluate objective completion, to decide on the continuation of project implementation and eventually to revise objectives if necessary. Speedy and appropriate referral of patients to specialized wards by the Health Center will take place as necessary. 3. THE AGREEMENT PRINCIPLES Merlin and Health Center ………., agree to meet the objectives as defined in accordance with the health zone bureau. The services that the Health Center will have to provide will be constant, regular, and based on an updated populations number (resident or displaced) of the health area. The Health Center will have to abide by the contract, recognize, and accept the irrevocable nature of the health zone bureau adviser role and Merlin throughout the implementation of the project.

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Supporting Local Health Care in a Chronic Crisis: Management and Financing Approaches in the Eastern Democratic Republic of the Congo 4. HEALTH CENTER MEASURABLE AND EXPECTED OUTCOMES (population: ……….) INDICATORS MONTHLY TARGET IMMEDIATE TARGET 1 Number of out patient consultations carried out _________ > 0.6 consultations/person/year 2 Vaccination BCG, DTP3, Polio3 and measles carried out _________ Coverage > 50% 3 Number of new cases to ante-natal & pre-school clinics _________ > 70% of pregnant women attending 4 Total number of women attending 4 ante-natal visits _________ > 70% of pregnant women attending 5 Anti-tetanus vaccinations for pregnant women _________ > 70% of pregnant women attending 6 % of pregnant women who received prophylaxis for malaria/anemia _________ > 70% of pregnant women attending 7 Number of deliveries conducted by HC trained staff _________ > 60% of expected deliveries 8 % of patients cared for according to treatment protocols _________ > 80% of consultations 9 % of indigents treated at health facilities and verified by Merlin/health zone supervisors _________ 100% of indigents declared by health structure 10 Epidemiological reports, drugs consumption and financial reports submitted monthly in a timely and complete fashion _________ By the 2nd of the following month to health zone bureau, by the 5th of the following month to Merlin 11 Presence of an operational health committee _________ All population “stratums” represented including women

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Supporting Local Health Care in a Chronic Crisis: Management and Financing Approaches in the Eastern Democratic Republic of the Congo 12 Number of meetings held with the health committee _________ > 1 meeting/month 13 Potential new epidemics identified by the health center and immediately reported to Merlin/health zone office _________ Within 48 hours to Merlin/health zone bureau 14 Vaccines, drugs, and medical equipment stock maintained at health structure level   No rupture at health structure level 15 % of safe blood transfusions performed in accordance _________ 100 % of donated blood tested for HIV, Hep B and Syphilis 16 Provision of out-patient curative services, vaccination, ante-natal care, supervision of traditional midwives and health education to identified village populations within the health area _________ Out-patient service organized twice a month 17 Number of mass health education sessions in HC _________ 4/month minimum 18 Number of visits to community for information and education _________ 4/month minimum 5. RESPONSIBILITIES OF THE HEAD NURSE The Head Nurse is responsible for the daily management of the health center and meeting agreed objectives from available resources provided by Merlin and health zone bureau. The Head Nurse, in collaboration with the community, is responsible for the maintenance of the structure. The Head Nurse must ensure the security of medical equipment, materials, and other valuable items at the Health Center in collaboration with the Health Committee President. The Head Nurse must strictly apply the drugs and medical service fees as defined by Merlin and the health zone bureau. The Head Nurse must manage the finances of the Health Centers in a transparent fashion and present a monthly financial re-

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Supporting Local Health Care in a Chronic Crisis: Management and Financing Approaches in the Eastern Democratic Republic of the Congo port to health committee, health zone bureau, and Merlin. He/she will use 65% of income for staff incentives and 15% (managed with health committee) for the running of the center and community projects (10% maximum for the running). The Head Nurse must ensure a rational use of supplied drugs, provide monthly requests at the agreed date using health zone bureau standard forms. In the case of exceptional drug shortages, the Head Nurse will be entitled to prepare and send Merlin an extra request, duly justified, and in a timely manner before rupture occurs. The Head Nurse is not allowed, under any circumstances, other health zone bureau partners; this in order to avoid use of low quality drugs or high charges. The Head Nurse must involve the community in the management of the Health Center to include finances, and the operational decision making process through the use of the health committee and other possible volunteers. The Head Nurse with his/her team shall carry out self-evaluation of all activities (without forgetting health education and team meetings) undertaken during the course of the month. The Head Nurse will analyze problems, propose solutions, and use to the maximum local initiatives and resources to solve them. 6. MERLIN’S RESPONSIBILITIES Merlin will supply the Health Center with basic equipment, essential drugs on the agreed list and will organize necessary training for the health staff. Merlin will provide a bonus for preventive activities as agreed. The payment of any bonus will be carried out following evaluation by health zone bureau and Merlin and in the 10 days after the end of the month. Merlin shall carry out regular supervision of the Health Center in order to help the team achieve its objectives and improve the quality of services provided. Merlin shall provide supervision calendars at the beginning of each month. In consultation with the health zone bureau, Merlin shall ensure that all recruited staff have adequate knowledge and resources for the completion of activities. Merlin will make sure that job descriptions for all health center staff have been produced by the health zone bureau, and presented to each individual.

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Supporting Local Health Care in a Chronic Crisis: Management and Financing Approaches in the Eastern Democratic Republic of the Congo 7. RESPONSIBILITIES OF HEALTH ZONE BUREAU/IPS The health zone bureau and IPS will provide qualified and competent staff to the Health Center. They will ensure the continuity of the staff working in the Health Center. Staff distribution shall be done according to the needs of each center by the health zone bureau. The health zone bureau will ensure that protocols, directions, and fees are strictly applied. The health zone bureau will impartially apply disciplinary measures under local law. The health zone bureau shall carry out regular supervision of the Health Center in order to help the team achieve its objectives as well as to improve the quality of services provided. The health zone bureau will prepare supervision reports and will provide them to Health Center staff and to Merlin not later than 7 days after the end of the month. It will be the responsibility of the health zone bureau to prepare and submit job descriptions to all Health Center staff in collaboration with Merlin. The health zone bureau will ensure the health committee is effectively associated to the management of Health Center as well as to operational decision making. The health zone bureau must audit the financial management of the Health Center on a monthly basis, report any irregularities to Merlin and the health committee, and take the appropriate disciplinary measures. The health zone bureau is responsible for calling and holding meetings to organize schedules. 8. DATES, TIME FRAME, AND CONTRACTS FOLLOW-UP The initial contract is agreed upon for a period of 6 months taking effect the day of signature. Meeting the objectives will lead to the tacit renewal of the contract for a further 6 months period. Should the objectives not be met, the contract will only be renewed following a tripartite evaluation (Health Centers, health zone bureau, Merlin) and consequent justification, in agreement with donor strategy. The community shall be constantly informed and consulted about the follow-up and evaluation of the contract through the Health Committee.

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Supporting Local Health Care in a Chronic Crisis: Management and Financing Approaches in the Eastern Democratic Republic of the Congo 9. MUTUAL RELATIONSHIPS The Health Center having signed the contract with Merlin will send its reports directly to Merlin and to health zone bureau. The health zone bureau will act according to the contract it has signed with Merlin. You can confirm your approval to the terms and conditions of this agreement protocol by signing below. [PLACE] the ……./……/2002 ___________________ For Merlin (Medical Coordinator) ___________________ For the Health Center (Headnurse) ___________________ For the Health Zone Bureau (Chief Medical Officer) ____________________ For the Health Committee (President)

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