EXECUTIVE SUMMARY

This is a Senior Management role in the National Health Insurance Management Authority (NHIMA) responsible for ensuring all accredited Health Care Providers (HCPs ) have capacity to provide quality assured health services to members of the National Health Insurance Scheme (NHIS). The role requires close collaboration with the Ministry of Health (MOH) Quality Improvement (QI) structures at all levels and accredited HCPs Quality Improvement Committees. This is to ensure that, HCPs as mandated by the NHI Act. 2, 2018 in Sections 38 and 39 comply with all the relevant quality standards as prescribed by the Ministry of Health and other regulatory bodies including the Authority. The role is responsible for management, coordination, monitoring and evaluation of all quality assurance activities of the Scheme to enhance member satisfaction.

Reporting to the office of the Director Quality Assurance and Accreditation, the role will ensure that annual accreditation renewal is granted only to those health care providers who meet the minimum quality standards as prescribed by the Authority and subsequently to monitor and evaluate quality improvement efforts. The role will require extensive travel within Zambia as part of quality assurance monitoring and evaluation and abroad for learning of best practices.

KEY FUNCTIONS/RESPONSIBILITIES

The key functions of the role will include but not limited to;

Policy

Develop, interpret, adhere and enforce compliance to and ensure implementation of policies of quality assurance to enhance adherence and compliance to the contractual and regulatory requirements..

Stakeholder & Facilities Outcomes

• Coordinate quality assurance activities within the Authority;
• Further, the role will be responsible for the on-going monitoring and evaluation of quality in health services delivered in accredited HCPs to ensure compliance to Regulatory Body’s and Authority prescribed quality standards throughout the tenure of agreement with NHIMA;
• Must maintain a good relationship with all accredited health facilities;
• Provide technical oversight to development of standards and tools for clinical audit and monitor and evaluate performance of the accredited HCPs to ensure adherence to National Standard Treatment Guidelines;
• Provide technical oversight to the development and review of the Quality Assurance Manual;
• Receiving, investigating and determining complaints by members and accredited health care providers;
• Establish and maintains lines of communication with internal and external customers to ensure timely response to quality assurance needs and expectations;
• Ensure that annual stakeholder surveys are done, and satisfactory perception outcomes are received from accredited health service providers;
• Liaising internally with the Health Insurance Department on any relevant information that relates to quality of health service delivery trends and patterns by HCPs; and
• Coordinate in collaboration with counterparts at the Ministry of Health (MOH) periodic engagement of accredited HCPs to jointly review of quality assurance performance of accredited HCPs.

Finance & Solvency Outcomes

• Initiating, development in conjunction with Finance, Departmental expenditure estimates;
• Managing quality assurance reporting, monitoring and evaluation within set cost parameters and budget.

Staff & Learning Environment Outcomes

• To supervise a team of staff in the Quality Assurance Unit; Undertakes and ensure timely, supervisory activities to facilitate adherence to the scheme’s quality assurance standards by all technical and operational staff;
• Oversee that quality assurance personnel have the appropriate education and experience, receive appropriate training and mentorship for the type and complexity of the services they offer including continuing professional development to improve skills and knowledge;
• Ensure optimal staffing levels in the Quality Assurance Unit to meet Quality Assurance monitoring and evaluation of accredited HCPs;
• In charge of staff development, performance management and staff career development in the Quality Assurance Unit; and
• Ascertaining the training needs and staff technical support supervision within the Quality Assurance Unit.

Predictable Systems and Control Outcomes

• Report on matters relating to service provider performance, customer satisfaction;
• Use insights from reports to facilitate business processes and improvements in quality of health service delivery by accredited HCPs;
• Coordinate training of accredited HCPs on NHI processes and customer services;
• Integration & alignment of IT systems to incorporate Quality Assurance system requirements;
• Designing relevant internal procedures, processes and practices that minimise the Authority’s risks of dealing with accredited HCPs;
• Carrying out scheduled and unscheduled quality assurance inspections at points of delivery of insured HCPs;
• To conduct periodic clinical audits and performance reviews of all accredited health care providers;
• To conduct on-going inspection of health care providers’ premises, facilities and general infrastructure to ensure adherence to set standards;
• Research and makes special visits to various health facilities with a view of ascertaining those which are recommended for initial , renewal or termination of accreditation and make the necessary review as needed;
• To recommend for immediate remediation for all identified service gaps and follow up on the same;
• To proactively meet all health care service providers to discuss, resolve or receive proposals for process improvement;
• Deals with and/or takes measures to solve problems arising from management of clinical cases;
• Working with the Health Care Providers so that they remedy any exceptions highlighted in previous clinical audits; and
• Undertaking any task/assignment which the supervisor may delegate from time to time.

EDUCATION AND EXPERIENCE

• Must have Grade twelve (12) School certificate with 5 ‘O’ levels with credit or better including Mathematics and English Language;
• A degree in clinical medicine and a postgraduate degree in Management, Business Administration, Public Health, Clinical Medicine, Nursing or its equivalent from a recognized training institution; and
• Must be familiar with the tools of monitoring and evaluation of quality assurance processes.
• Must have atleast 5 years in a similar role;

ATTRIBUTES AND SKILLS

• Must be familiar with accepted general health and medical standards in Zambia and Worldwide;
• Must be able to write comprehensive and analytical reports and PowerPoint Presentations;
• Must be able to communicate effectively in English;
• Must be Computer literate and have effective clinical investigative skills;
• Must be proficient office applications such as Word, PowerPoint and many other relevant applications;
• Must be assertive and decisive;
• Must have good interpersonal skills;
• Must have strong leadership skills and able to lead teams effectively;

• Develop, interpret, adhere and enforce compliance to and ensure implementation of policies of quality assurance to enhance adherence and compliance to the contractual and regulatory requirements.
• Coordinate quality assurance activities within the Authority.
• Responsible for the on-going monitoring and evaluation of quality in health services delivered in accredited HCPs to ensure compliance to Regulatory Body’s and Authority prescribed quality standards throughout the tenure of agreement with NHIMA.
• Maintain a good relationship with all accredited health facilities.
• Provide technical oversight to development of standards and tools for clinical audit and monitor and evaluate performance of the accredited HCPs to ensure adherence to National Standard Treatment Guidelines.
• Provide technical oversight to the development and review of the Quality Assurance Manual.
• Receiving, investigating and determining complaints by members and accredited health care providers.
• Establish and maintains lines of communication with internal and external customers to ensure timely response to quality assurance needs and expectations.
• Ensure that annual stakeholder surveys are done, and satisfactory perception outcomes are received from accredited health service providers.
• Liaising internally with the Health Insurance Department on any relevant information that relates to quality of health service delivery trends and patterns by HCPs.
• Coordinate in collaboration with counterparts at the Ministry of Health (MOH) periodic engagement of accredited HCPs to jointly review of quality assurance performance of accredited HCPs.
• Initiating, development in conjunction with Finance, Departmental expenditure estimates.
• Managing quality assurance reporting, monitoring and evaluation within set cost parameters and budget.
• Supervise a team of staff in the Quality Assurance Unit.
• Undertake and ensure timely, supervisory activities to facilitate adherence to the scheme’s quality assurance standards by all technical and operational staff.
• Oversee that quality assurance personnel have the appropriate education and experience, receive appropriate training and mentorship for the type and complexity of the services they offer including continuing professional development to improve skills and knowledge.
• Ensure optimal staffing levels in the Quality Assurance Unit to meet Quality Assurance monitoring and evaluation of accredited HCPs.
• In charge of staff development, performance management and staff career development in the Quality Assurance Unit.
• Ascertaining the training needs and staff technical support supervision within the Quality Assurance Unit.
• Report on matters relating to service provider performance, customer satisfaction.
• Use insights from reports to facilitate business processes and improvements in quality of health service delivery by accredited HCPs.
• Coordinate training of accredited HCPs on NHI processes and customer services.
• Integration & alignment of IT systems to incorporate Quality Assurance system requirements.
• Designing relevant internal procedures, processes and practices that minimise the Authority’s risks of dealing with accredited HCPs.
• Carrying out scheduled and unscheduled quality assurance inspections at points of delivery of insured HCPs.
• Conduct periodic clinical audits and performance reviews of all accredited health care providers.
• Conduct on-going inspection of health care providers’ premises, facilities and general infrastructure to ensure adherence to set standards.
• Research and makes special visits to various health facilities with a view of ascertaining those which are recommended for initial , renewal or termination of accreditation and make the necessary review as needed.
• Recommend for immediate remediation for all identified service gaps and follow up on the same.
• Proactively meet all health care service providers to discuss, resolve or receive proposals for process improvement.
• Deals with and/or takes measures to solve problems arising from management of clinical cases.
• Working with the Health Care Providers so that they remedy any exceptions highlighted in previous clinical audits.
• Undertaking any task/assignment which the supervisor may delegate from time to time.

• Familiar with accepted general health and medical standards in Zambia and Worldwide.
• Able to write comprehensive and analytical reports and PowerPoint Presentations.
• Able to communicate effectively in English.
• Computer literate and have effective clinical investigative skills.
• Proficient in office applications such as Word, PowerPoint and many other relevant applications.
• Assertive and decisive.
• Good interpersonal skills.
• Strong leadership skills and able to lead teams effectively.

• Grade twelve (12) School certificate with 5 ‘O’ levels with credit or better including Mathematics and English Language.
• A degree in clinical medicine and a postgraduate degree in Management, Business Administration, Public Health, Clinical Medicine, Nursing or its equivalent from a recognized training institution.
• Familiar with the tools of monitoring and evaluation of quality assurance processes.