Request for Expression of Interest on Analysis of Quality and Outcome Indicators for Regional and District Hospitals in Lesotho





World Bank-supported Nutrition and Health Systems Strengthening Project (NHSSP) P170278


The Ministry of Health of Lesotho with the support of the World Bank funded Nutrition and Health Systems Strengthening Project (P170278) seeks to hire a consultancy team to conduct a study of Lesotho’s regional and district hospitals. The goal of this study is to (i) conduct a baseline analysis of 17 hospitals for the NHSSP against which future progress can be assessed, and (ii) provide analysis to compare hospital performance against the performance of the Queen ‘Mamohato Memorial Hospital (QMMH) in Lesotho.

Lesotho has 17 district/regional hospitals in the public and church-owned sector: two regional and 15 district hospitals. The 2017 Public Expenditure Review (PER) identified very low bed occupancy rates in hospitals in 2015. This points to idle capacity in hospitals or problems in access to care. By contrast, the bed occupancy rate at the QMMH has been consistently higher than 70 percent.

An analysis of the QMMH quality and outcome indicators is currently being conducted by Boston University. This study compares 2018 data with the prior endline (2012) and baseline (2009) indicators to provide decision makers with information to manage and improve the performance of QMMH as a public-private partnership.

With the support of the previous World Bank health project, public and church-owned health facilities have received substantial training in quality of maternal and childcare in the past years. Hospitals now regularly prepare quality improvement plans (QIP) and conduct morbidity and mortality audits to learn from past experience. The health project also financed a performance-based payment (PBF) to eligible hospitals, which contributed to improved quality scoring.

Objective of Study

The objective of this hospital study is to:

  • measure and evaluate the performance of government and church-owned district and regional hospitals in 2018, using both quantitative data and qualitative information;
  • compare results for the hospital study with the ongoing QMMH study and the end line survey (2018) conducted for the QMMH; and
  • interpret findings from the analysis to provide explanations for variations across hospitals and the QMMH, with reference to performance, challenges and other factors.
  • based on findings, propose actionable recommendations for hospital management and policy makers.

Approach and Methods

The analysis will include quantitative and qualitative data collection and analysis. To allow comparison between public and church-owned hospitals and the QMMH, the same data collection tool will be used as for the QMMH study. The study includes the following data collection activities:

Collecting quantitative and descriptive data for indicators (Objectives 1 and 2) includes four methods for data collection.

  • First, extract and analyze existing hospital administrative data from the admissions, discharges, and transfers (ADT) and patient utilization information systems, as well as data collected in monitoring reports of hospitals (by government and donors). Assess the validity and reliability of these existing data collection systems.
  • Second, conduct medical records review to determine neonatal survival by birthweight and maternal deaths. Identify quality of care issues affecting outcomes.
  • Third, conduct direct observation to obtain data on patient flow, triage, and emergency supplies.
  • Fourth, identify and assess at least five quality of care indicators across hospitals.  

The list below shows indicators organized by data collection method. The indicators will be reviewed with key stakeholders prior to finalization. Data will be collected on the three most recent years. Data will be used to in the analyses for all four objectives.

1. Review of existing reports and calculation of indicators from routine hospital data

  • Population and demographic characteristics in catchment area
  • Number of beds by ward
  • Number of staff by ward
  • Number of inpatient admissions by ward
  • Number of readmissions by ward
  • Number of inpatient days by ward
  • Average length of stay by ward
  • Hospital occupancy rate by ward
  • Ambulatory visits
  • Prevention of mother-to-child transmission (compliance with standards)
  • Newborn care (compliance with standards)
  • Availability and completeness of medical records (compliance with standards) by ward
  • Rapid treatment of hip fractures (compliance with standards)
  • Availability of thrombolytics
  • Patient satisfaction (based on findings of hospital surveys)
  • Number of deaths by ward
  • Number of deaths due to pneumonia in children
  • Number of caesarian sections
  • Number of still births
  • Number and types of referrals to QMMH, other hospitals (specify) and to health centers
  • Surgical waiting time

2. Medical Record Review

  • Neonatal birthweight and survival
  • Morbidity and mortality audit reports

3. Direct observation on infection control, medical equipment and patient flow

  • Infection control (compliance with standards on availability of soap and water in hand washing stations)
  • Availability of emergency equipment and supplies
  • Well-functioning emergency triage system
  • Patient flow and average length of outpatient visits (waits and delays, etc.)

4. Qualitative interviews with key informants (objective 3 and 4)

The consultants will conduct approximately 20-30 key informant interviews with hospital managers, staff, and Ministry of Health authorities. The purpose of the interviews is to gather general perceptions on current performance and to explore factors affecting performance, quality of care, challenges, effects of the QMMH on public hospitals, and lessons learned.

Data Analysis

  • Once quantitative data are collected, the consultants will conduct an analysis comparing the results of the quantitative data for public hospitals with the results of the QMMH ongoing and endline surveys. Variations in outcomes will be explained.
  • Indicators shall be grouped by category, including indicators of medical equipment, service access and capacity, utilization, quality of care, patient satisfaction, and outcomes. Analysis will be conducted in Excel and statistical software to show cross-tabulations and trend analysis where possible.
  • The consultants will replicate tables and organization of data from the QMMH endline study, in order to facilitate comparison.
  • Qualitative data shall be analyzed thematically using NVivo software.

Presentation and Reporting

The data from this study shall be submitted to the World Bank and MOH in the form of a written report and a PowerPoint presentation. A presentation of the study findings shall be made to the MOH and the World Bank to accompany finalization of the report


1. Finalize design (2 weeks: Lesotho)

  • The same protocol and tools will be used that have been developed by BU and approved by the WBG and the Ministry of Health for the QMMH study.
  • Refine data collection plan with input from World Bank, MOH and hospitals
  • Initial meetings and visit to hospitals, review of records
  • finalize inception report and commence data collection

2. Data collection and analysis (7 weeks: Lesotho)

  • Quantitative data collection and key informant interviews
  • Data cleaning and analysis
  • Preliminary draft indicator tables with summary bullet points
  • Data will be provided to World Bank and the MOH

3. Analysis and report-writing (6 weeks)

  • Write draft report
  • Give oral presentation of results in Lesotho to hospitals and the MOH
  • Revise draft report based on feedback from the World Bank and the MOH
  • Discuss results with QMMH and public- and church-owned hospitals.


The consultancy team will provide the following set of deliverables:

  Deliverable Tentative Due Date
  An inception report which includes survey design, method, questionnaire and schedule. Feb 29, 2020
  Data collection in 17 regional and district hospitals finalized and cleaned March 30, 2020
  Data transferred to the WB and the MOH April 30, 2020
  Draft summary report and workshop May 20, 2020
  Final report June 30, 2020

Duration of Consultancy and Staff Requirements

The consultancy will be for the period from February 2020 to June 2020.  The consultants draft report is required no later than end of May 2020.


The consultants will mobilize a strong team of medical and public health professionals who have experience with research of public health/hospital issues in developing countries and specifically familiar with public health issues and medical technology.  Familiarity with Lesotho is a plus.

The team must have:

Key staff Qualifications

  1. Researcher, Evaluator, Health systems specialist or equivalent qualification with a minimum of Master’s degree
  2. Medical doctor with substantial experience in evaluating hospital performance and management


  • Professional staff with experience in hospital evaluation designs and implementation of hospital surveys;
  • Strong practical evaluation experience with evaluation of public health system in low-income countries;
  • Ability to conduct interviews in both English and Sesotho languages;
  • Excellent knowledge of Lesotho’s public health and administrative systems;
  • Demonstrated (eventually attach a similar study where the data was insufficient) experience in dealing with insufficient data; and
  • Presence in Maseru, Lesotho and readiness to stay in Lesotho for extended period of time required to design and conduct the surveys. 


The Consultants will work under the guidance and supervision of the World Bank, the MOH team and the Project Implementation Unit.


  • Attention of interested Consultants is drawn to paragraph 1.9 of the World Bank’s Guidelines: Selection and Employment of Consultants by World Bank Borrowers, January 2011 (revised July 2014). (“Consultant Guidelines”), setting forth the World Bank’s policy on conflict of interest. 
    • The  Consultancy will be selected in accordance with the Quality and Cost Based Selection (QCBS) method set out in the Consultant Guidelines.
    • Further information can be obtained at the address below during office hours 0800 to 1630 hours from Monday to Friday.
    • All applications should be in English and must be properly filled in and be courier with the subject “Expression of Interest for “ analysis of quality and outcome indicators for regional and district hospitals in Lesothoor hand delivered to the below address.
    • Expressions of interest must be delivered in a written and hard Copy form to the address below in person, on or before 12th February, 2020 1200 hour Local time.

Attn: Mokhoabo Moeketsi-Procurement Specialist and copy Procurement Manager

Procurement Unit, Ground Floor, Ministry Of Health Headquarters ,Corner Constitution Road & Linare Road P. O. Box 514, Maseru 100, Lesotho, Tel:(+266) 27323277 or email. [email protected]