Terms of Reference – Enhancing Healthcare Services Delivery Project Elective Surgeries Outsourcing

The Ministry of Health & Wellness (MOHW) will be implementing the Enhancing Healthcare Services Delivery Project, designed to improve access to services provided at public health facilities.  This initiative reaffirms the Government of Jamaica’s commitment to the abolition of user fees in public health facilities and builds on previous efforts to reduce wait times for services and will result in shorter wait times for admissions as well as shorter hospital stays.  The project will be implemented over a two-year period under three components: (i) Diagnostic Radiology services (ii) Elective surgeries (iii) removal of social cases from hospitals.

The MOHW requires private firms to undertake elective surgeries for patients registered in public healthcare facilities and are currently awaiting these surgeries for a period of between six months and three years.  The areas of focus for the elective surgeries component as it relates to specific surgeries are the treatment of:

  • Inguinal Hernias
  • Hemorrhoidectomy
  • Lithotripsy
  • Gallstones


Performance Specifications / Standard Operating Procedures

A. Standard Operating Procedures

  1. The MOHW will utilize two modalities as outlined below for the conducting of elective surgeries:  This Technical Specification will detail modality 1, the outsourcing of the full suite of services for the completion of elective surgeries to private providers. The specifications for Modality 2, the completion of services in Public Hospitals will follow at a later date.
    • Modality 1- Outsourcing to private firms the full suite of services for the conducting of elective surgeries. The service provider will be required to provide inter alia surgical team and anesthetic and nursing services, pre and post operation visits, operating theatre and equipment required for the successful completion of the elective surgery as well as necessary post-operative care. Interested Firms must submit a Proposal including information requested in advertised request for Expression of Interest.  The MOHW will negotiate with participating firms a standard rate for the completion of each type of surgeries.  This rate will be standard across all contracted service providers for the specific surgeries. All facilities to be used must be registered by the Standards and Regulations Division of the MOHW.
  2. All patients accessing services must be registered within the Public Health Care system and possess a registration number issued by the institution.  Additionally, patients must complete a consent form and be referred through the Enhancing Healthcare Services Delivery Project
  3. The Service Provider shall provide timely reporting of the surgeries performed including Operating notes, anesthetic notes, post operative instructions and follow up plan as agreed in the Framework Agreement. A minimum six-week period for post op visits must be facilitated by the Service Provider.  Any matter of urgency must be verbally communicated to the Consultant in a timely manner to facilitate early intervention.
  4. Patient Reports/Files/Documents must be returned to the requesting health facility in the agreed format.
  5. Service Providers are required to provide reports in the following formats:
    • Electronically to the designated person at the Health Facility where applicable
    • Hard copy, sealed and returned to Health Facility where applicable
  6. The Service Provider shall designate a contact person available by phone and email.


B. Performance Specifications

  1. The Services shall be provided in accordance with generally accepted medical and legal standards, consistent with prevailing medical ethics governing the Service Provider.
  2. The Service Provider shall employ only competent and satisfactory personnel and shall provide a sufficient number of employees to perform the required services efficiently and in a manner satisfactory to the Client.  The Service provider must submit along with Proposal details of the qualifications and professional registrations of all members of the team that will perform the surgeries. 
  3. The Service Provider and its personnel shall exercise independent professional judgment and shall assume professional responsibility for all services to be provided under this Agreement.
  4. The Service Provider shall be responsible for the quality and quantity of services performed under this Agreement.
  5. The Service Provider shall store, use and maintain all equipment necessary to provide the Services strictly in accordance with the manufacturer’s instructions and with good practice in relation to infection control.  All operating theatres must have appropriate facilities in general – recovery facilities, resuscitation equipment, ambulance services for emergency situations, standby generator in the event of power outages, additional water storage facilities and must be registered under the Nursing Home Act.
  6. The Service Provider warrants that any of the Service Provider’s consumables or equipment utilized by the Service Provider are in safe and proper working order and suitable for the purpose, and all equipment is adequately and appropriately insured.
  7. The Service Provider shall have sufficient appropriately registered, qualified and experienced medical, nursing and other clinical and non-clinical personnel to ensure that the Services are provided in all respects and at all times in accordance with this Agreement.
  8. The Service Provider’s personnel shall:
    1. if applicable, be registered with the appropriate professional regulatory body;
    2. possess the appropriate qualifications, experience, skills and competencies to perform the duties required of them and be appropriately supervised managerially and professionally; and
    3. be covered by adequate insurance for the provision of the Services.
  9. The MOHW retains the right to monitor the quality of services furnished by the Service Provider.  The Service Provider shall be required to permit visits from the MOHW’s Standards and Regulations Branch and or Health Services Planning and Integration Branch.
  10. The Service Provider shall maintain as confidential all medical records of patients in accordance with medical ethics and the law. The Service Provider shall counsel its personnel, and subcontractors on their obligation to ensure that such information remains confidential.
  11. The MOHW shall provide copies of the medical records of Patients participating in the Project for initial assessments. A referral letter will be sent from referring Doctor/Hospital to the service provider inclusive of relevant tests and investigations that have been completed. The Service Provider shall return patient files to Patient’s Doctor within the Public Health System upon completion of assessment when it is deemed case is not fit for surgery.  Service Providers shall also return patient files upon completion of surgery and discharge of patients from their care.
  12. In the cases where additional diagnostic tests are required after the review of patient file, patient should be referred back to Public Health Facility for the completion of Diagnostic test under Enhancing Health Care Services Delivery Project.
  13. The Service Provider shall have in place and outline an appropriate Emergency Contingency mechanism that will be triggered in the event that there are complications during the performance of a surgery – this is inclusive of complications with the actual surgery that may require transport to Hospital and admission, loss of electricity, natural disaster etc.
  14. In the event of a death of a Patient while in surgery, the Service Provider is required to provide the Ministry with all relevant information, statements from all persons involved in the surgery, Report on the case and if necessary participate in Court Proceedings on behalf of themselves or the MOHW.  The MOHW standards and Protocols will apply in the case of this eventuality.
  15. The Service Provider shall allow for a period of at least thirty (30) days or at least six (6) follow up visits before the discharge of a patient.
  16. The Service Provider shall:
    • Ensure that the services are performed in a safe and effective manner;
    • Ensure confidentiality of patient information;
    • Have in place and maintain a Quality Management System acceptable to the Ministry of Health;
    • Be certified in accordance with applicable law;s and regulations and should possess current licenses and permits to operate
    • Ensure compliance with all applicable laws and regulations; and
    • Make available to the MOHW a copy of its Standard Operating Procedures.


C. Payment Schedule

Payments shall be made according to the following:


  1. The Service Provider shall submit monthly invoices for Services completed and provided to Patients during that month.
  2. The invoices shall indicate:
    • The patient identification number/registration number/ name
    • Details of surgical services provided for each patient including pre op and post op visits
    • Date each surgery was requested 
    • Rates per surgical services provided in accordance with the agreed Rate Schedule
  3. The Service Provider shall submit the Request for Services Form issued by a Designated Official as a condition of payment.
  4. To maintain confidentiality, the Service Provider in agreement with the Health Facility shall assign each patient with a Registration Number for identifying patients otherwise than by name. This Patient Registration Number shall be included on all correspondence pertaining to the patient.
  5. The Service Provider shall maintain medical records, test results, discharge form and other documents that may be required by the Client as evidence of the Services provided. The Client may delay payments to the Service Provider if such documentation is not maintained and provided on request in order to validate invoices.