To Develop Health System Norms and Standards

Purpose:

Justification of the norms and standards

Rationale

Despite these achievements, the health system continues to face persistent challenges in service delivery, quality assurance, infrastructure development, workforce capacity, and regulatory oversight. There is broad consensus among stakeholders on the need for increased domestic investment in health through sustainable financing mechanisms to reduce reliance on international partners. Gender equity and human rights have been strategically prioritized, particularly within Reproductive, Maternal, Neonatal, Child, and Adolescent Health (RMNCAH) indicators, underscoring the government’s commitment to inclusive health service access.

Primary Health Care (PHC) is widely regarded as the foundation of an effective health system and plays a pivotal role in achieving Universal Health Coverage (UHC) (WHO, 2023) as well as the health-related Sustainable Development Goals (SDGs). According to the Declaration of Astana (2018) (WHO, 2018), PHC must be comprehensive, equitable, accessible, and community-driven to address the diverse health needs of populations worldwide (Jungo et al., 2020; The Lancet Infectious Diseases, 2018; Walraven, 2019). Aligned with this vision, many countries including Sierra Leone, strive to ensure that PHC services are responsive to a range of health challenges, including maternal and child health, chronic diseases, and emerging threats such as pandemics.

The Government of Sierra Leone has developed and adopted several national policy and planning frameworks, including the National Health and Sanitation Policy (2021–2030), the National Health Sector Strategic Plan (2021–2025), the National Quality of Care (QoC) Policy, and the RMNCAH Strategic Roadmap. These strategies aim to guide and enhance health service delivery and outcomes (WHO, 20231).

The Second National Health Sector Strategic Plan (NHSSP 2021–2025) provides the strategic vision for advancing health within the context of the Universal Health Coverage (UHC) Roadmap. It marks a paradigm shift from a focus on illness management to health promotion. A sector-wide approach is central to this plan, aiming to harmonize partner contributions for improved coordination and impact. A key feature of the strategy is the Sierra Leone Essential Health Services Package for UHC (SL-EHSP-UHC), which outlines a comprehensive suite of integrated services accessible to all citizens. Delivering this package effectively requires the optimal alignment of inputs—human resources, infrastructure, and essential commodities.

To support implementation SL-EHSP-UHC ,  norms and standards will be established to guide the efficient, effective, and sustainable delivery of health services. These include clear expectations for service provision at each level of care, along with the required human resources and input quantities to meet these standards.

WHO Sierra Leone Country Cooperation Strategy 2022–2025. https://www.afro.who.int/sites/default/files/2023-06/WHO%20Sierra%20Leone%20Country%20Cooperation%20Strategy%202022-2025.pdf ↩ ↩2

Ministry of Health and Sanitation. Norms and Standards for Health Service Delivery in Sierra Leone (2006). https://fountainafrica.org/wp-content/uploads/2020/01/MOH-Norms-and-Standards-for-Health-Service-Delivery-2006.pdf 

To develop comprehensive, context-appropriate norms and standards to guide health system development, service delivery, and quality improvement across public and private health facilities.

Sierra Leone’s shift in health sector priorities, from managing illness to ensuring overall health demands corresponding changes in the types and scope of services delivered. This transformation underscores the need for a more efficient, equitable, and rights-based health system, ensuring that all individuals can access defined health outcomes on equal terms. Achieving this requires appropriate adjustments in the inputs to health service delivery, including human resources, infrastructure, and commodities.

However, the current absence of comprehensive, enforceable, and context-specific norms and standards has resulted in significant inconsistencies in service quality, unequal access across regions and populations, and inefficiencies within both public and private health facilities. Establishing national norms and standards is therefore critical. These standards will serve as a benchmark for quality service delivery, professional competencies, facility operations, patient safety, and system accountability (WHO Global Health Observatory1).

The development and institutionalization of norms and standards in health care will:

• Promote equity and consistency in health service delivery.
• Provide a framework for accreditation and regulatory oversight of health facilities.
• Strengthen accountability and governance in the health sector.
• Improve patient safety and health outcomes through adherence to quality benchmarks.
• Guide training, supervision, and continuous professional development of health workers.
• Align with SL EHSP and Universal Health Coverage agenda.

Specific Objectives

• Review existing national policies, strategies, and regulatory frameworks relevant to health system standards
• Develop norms and standards for health infrastructure across levels of care
• Define standards for human resources for health, including staffing norms and skill mix
• Establish standards for medical equipment, medicines, and health commodities
• Develop standards for laboratory and diagnostic services
• Develop the health system norms and standards in a format and structure similar to the Sierra Leone Essential Health Services Package (SL-EHSP-UHC), clearly defining the expected services, inputs, staffing, infrastructure, equipment, commodities, and service delivery requirements at each level of care.
• Ensure alignment with national priorities, WHO guidelines, and international best practices

The consultant will undertake the following tasks:

1. Conduct a desk review of relevant national and international standards and guidelines
2. Assess existing gaps and inconsistencies in current health system norms and standards
3. Develop draft health system norms and standards, structured in a format similar to the Sierra Leone Essential Health Services Package (SL-EHSP-UHC), covering, but not limited to:

• Health infrastructure (facility design, space requirements, utilities)
• Human resources for health (staffing ratios, competencies, deployment norms)
• Medical equipment and medical supplies
• Medicines and essential health commodities
• Laboratory and diagnostic services
• Tiers of PHC services to achieve UHC, including referral pathways

1. Ensure that the norms and standards clearly define the minimum requirements and service delivery expectations at each level of care, in alignment with the SL-EHSP-UHC
2. Facilitate stakeholder consultations and validation workshops
3. Revise and finalize the norms and standards based on stakeholder feedback
4. Produce an implementation and dissemination framework for the standards

• Advanced degree in Public Health, Health Systems Management, Health Policy, or related field
• At least 7–10 years of experience in health systems strengthening or standards development
• Proven experience in developing health regulatory frameworks
• Strong knowledge of WHO health system building blocks
• Experience working with Ministries of Health and development partners
• Excellent analytical, facilitation, and report-writing skills

   Competencies

• Strong policy analysis and technical writing skills
• Stakeholder engagement and consensus-building ability
• Ability to work independently and meet deadlines
• Familiarity with low- and middle-income country health systems

Payment Schedule

Ethical Considerations

• Inception report with methodology and workplan
• Draft health system norms and standards document
• Stakeholder consultation and validation report
• Final approved norms and standards document
• Implementation and dissemination guide

Payments will be linked to satisfactory completion of agreed deliverables, as follows:

• 20% upon approval of inception report
• 40% upon submission of draft standards
• 40% upon submission of final approved documents

The consultant shall adhere to confidentiality, ethical standards, and national regulations throughout the assignment