Country: Tajikistan
Closing date: 04 Jun 2018
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Post Title: International consultancy to provide technical assistance to the Ministry of Health and Social Protection (MoHSP) for the strengthening of national capacity for the scale up and integration of Paediatric AIDS into Primary Health Care (PHC) services in Tajikistan.
Duration of contract: July - December 2018 (80 working days)
Location: Dushanbe, Tajikistan
Closing date: 04 June 2018
BACKGROUND AND JUSTIFICATION
As of 31 December 2017, Tajikistan has reported a cumulative total of 9, 957.0 cases of HIV since the beginning of the epidemic in 1991. The annual number of new reported HIV cases among children aged 0-18 quadrupled since 2010.
The proportion of officially registered cases among children to adults group living with HIV is 10, 7%.[1]
The number of new HIV cases reported among children has steadily increased over the past years. In 2017 alone, 66. 5% children were recorded to have acquired HIV through unknown source of transmission. The share of boys living with HIV is two times higher in comparison to girls. According to information of the patient (or history) cards, the frequency of hospitalization of boys before they were detected with HIV was higher than girls.
Adolescents, 10-18 age group who are living with HIV make up 20 per cent of all children living with HIV. According to the latest statistics, parents of 60 percent of children living with HIV are HIV Negative, leaving questions on the route through which these children were infected. The remaining 40% of children got HIV through vertical transmission from mother to child. The RAIDS center attributed new HIV cases among infants to weakness in health systems, monitoring and quality assurance of procured supplies at PHC level for HIV testing among pregnant women.
HIV Sentinel Surveillance data[2] shows gradual decline of the injecting route of transmission and increasing trend of sexual transmission with increasing HIV infection among women. According to the findings of the 2015 study on national programme for Prevention of Mother-to-Child Transmission of HIV (PMTCT) in Tajikistan[3], out of 395 assessed patient cards, 26.6% of their heterosexual partners of women living with HIV had engaged in injecting drug use (IDUs) and 38.5% were migrants. This data suggests the potential shift of the HIV epidemic in Tajikistan from concentrated to more generalised epidemic with increased risk of HIV infection for young women and children.
Within the framework of the joint work plan for 2017 between UNICEF and the Ministry of Health and Social Protection of the Population (MoHSP), a national consultant is in the process if being contracted to assist the Government of Tajikistan to provide technical support for the forward the National commitment to combat AIDS epidemic through a gender and child lens. This technical support primarily focuses on ensuring effective integration of Elimination of Mother-to-Child HIV Transmission (EMTCT) and Pediatric AIDS into the primary health care (PHC) services in Tajikistan. UNICEF in close collaboration with the specialists of the Mother and Child Health Department of the MoHSP, Republican AIDS Center, Clinical & Training Center of Family Medicine, the National Center for Reproductive Health and the State Health Surveillance Service conducted monitoring which shed light on the implementation of EMTCT and Pediatric AIDS programmes across the country.
The findings of the joint monitoring revealed key bottlenecks that are primarily impacting on the timely and efficient detection of HIV among pregnant women, with implications for prevention of HIV transmission from mother to child. These includes:
1) De-centralized approach in procurement of supplies resulting in increased unit cost of goods and thus puts unnecessary burden on already limited financial resources at the district level;
2) Weak capacity of PHC managers in forecasting of resources and budget including governance of stock of supplies and its monitoring negatively affecting access by pregnant women to quality services and care; 4) low quality of procured HIV Rapid Tests Kits. Kits with low sensitivity and delay the identification of HIV status and further delays the initiation of Life Long antiretroviral treatment (LLT).
To ensure quality of services and capacity of focal points administering ART to HIV positive pregnant women at PHC there is need for supportive supervision, systematic monitoring and the development of capacity of existing health care providers.
Progress has been made in the implementation of EMTCT in Tajikistan. Through a pilot project initiated in 2014, currently, all pregnant women whose have tested positive to HIV are receiving Life Long Treatment (LLT). The Early Infant Diagnosis (EID) programme in Tajikistan to detect the HIV status of infants born from HIV positive mothers in the first 48 hours using Dried Blood Spot (DBS) increased from 32,5% in 2015 to 64% in 2017. Another progress worth highlighting is an increasing trend in ART coverage among children and adolescents living with HIV. UNICEF and partners have tested an approach to involve parents, caregivers and children in removing self-stigma and addressing psycho-social needs of families resulting from isolation or discrimination. It is imperative with the success of this intervention, to consider integration of Paediatric AIDS services at PHC level as an effective way and address stigma while providing essential services to children affected by HIV.
To sustain the gains of the pilot programme, there is a need to build additional capacity to meet the growing need, to monitor, address challenges and make programmatic adjustment as required. There is in addition, a need to review the and adapt HIV testing policy for pregnant women, taking into account the diversity of the context in different geographical areas and to strengthen the supply component of the PMTCT programme with special attention to the financial sustainability and the supply chain management capacity.
In 2015, UNICEF assisted the MoHSP to develop the Computer Based Teaching tool (CBT) on Prevention of hospital infection for service providers for in- patient services. The CBT tool was tested and implemented in selected Mother and Child hospitals of Dushanbe and owned by the Republican Centre of Family Medicine. However, there is a need to establish to what extend the training course covered health workers and the outcome of the training in actual improved knowledge and skills of trained personnel.
One of the challenges facing pediatric AIDS programme is HIV/TB co-infection. Partly due to the better detection of HIV cases in health facilities providing TB treatment services, an increasing number of HIV/TB co-infection has been reported in the country. HIV positive children are particularly susceptible to multi-drug resistance TB (MDR-TB). This presents a special challenge in rural areas where availability of pediatric-TB specialists is limited. According to the data collected by project, “Improving Quality of Life and Support to Children Living with HIV in Tajikistan”[4], 18% of children living with HIV are co-infected with TB. Lack of coordination between vertical services systems for TB, AIDS and maternal and child health (MCH) services in the health sector is one of the bottlenecks to the holistic approach in pediatric AIDS programme. In this context, the MoHSP has just started working on the gradual integration of pediatric AIDS/TB services into primary health care (PHC) system with significant grounds remaining to be covered.
Towards accelerating the on-going effort of MoHSP, a consultant with both clinical and health system expertise is required to assist the MOHSP to move the agenda of EMTCT and Pediatric AIDS forward to accelerate results for children and their mothers.
OBJECTIVES
The International consultant will provide expert technical guidance on eMTCT and Pediatric HIV technical support to a UNICEF local consultant and the MoHSP to implement the recommendations from recent programme review with account of the best International standards and practices for the improvement of effective response to AIDS epidemic through quality eMTCT and Pediatric AIDS services in a sustainable manner.
The International Consultant in close collaboration with the local consultant would work with the Mother and Child Department of the MoHSP, AIDS Centers and Family Medicine Centers to build institutional capacity for a sustained pool of core PMTCT/PA specialists. In addition, s/he will guide the decision makers in the health sector on the integration of eMTCT and Pediatric HIV services into PHC and develop a road map to achieve this goal.
SCOPE OF WORK
The International consultant will be responsible for the assignments as stipulated below.
1.1 System development and capacity building
1.2. System strengthening in management of supply
1.3 Monitoring
1) analysis of the existing human resource and service delivery capacity at PHC and MCH facilitates 2) development of a capacity building plan[5] for selected PHC providers on Pediatric AIDS; and 3) development of a coordination mechanism between vertically established institutions (AIDS centers, Family Medicine and PHC); 4) monitoring of supply component (rehabilitation and equipment) of selected PHC facilities.
2.1 Human Resource development and capacity building
2.2 Multi-disciplinary mobile team
DELIVERABLES
The consultant should deliver the following:
Deliverable/ # of working days /Time-frame
1. Facilitation of the round table with key stakeholders to discuss the key bottlenecks in implementation of e MTCT ( testing, B+ option, gender, early infant diagnosis and integrated approach in Child Friendly Services at PHC ) - 3 w/d in July, 2018
2. Revised PA clinical protocol with new ART schemes in line with WHO recommendations - 3 w/d in July, 2018
3. Developed Plan of action of innovative methods or mechanism of retaining of acquired knowledge among trained specialists in EMTCT clinical protocol - 5 w/d in July, 2018
4. Developed mechanisms and tools for better forecasting of resources needs, quality assurance of procured supplies; reporting and overall monitoring. Developed procurement strategy and develop the proposal with guidance on for re-arrange it from the de-centralized to central level of procurement. Developed coordination mechanism between MCH and Sanitary and Epidemiological Service (SES) departments at national and oblast levels - 10 w/d by the end of August 2018
5. Developed instrument to regularly assess performance of the trained staff –PHC /ANC focal points i.e., monitor the retention of their knowledge and skills in ART administering; assess their compliance in practice, and provide necessary follow-up / mentoring - 3 w/d by the end of July 2018
6. Developed recommendations to improve the reporting system to ensure accuracy, timeliness and completeness of data - 4 w/d in July 2018
7. Developed report with integrated approach of PA programme into PHC services included the plan of action in integration of new Child Friendly rooms at PHC as well as
1) analysis of the existing human resource and service delivery capacity at PHC and MCH facilitates 2) development of a capacity building plan for selected PHC providers on Paediatric AIDS; and 3) development of a coordination mechanism between vertically established institutions (AIDS centers, Family Medicine and PHC); 4) monitoring of supply component (rehabilitation and equipment) of selected PHC facilities - 20 w/d by the end of September 2018
8. Revised the current curriculum and mechanism to retain a pool of master trainers on Paediatric AIDS programme. Monitoring tool to assess the knowledge before and after training is developed as well - 7 w/d by the end of October, 2018
9. Developed the institutional mechanism of the multi-disciplinary mobile team with an aim to expand a basic package of services for children living with HIV - 10 w/d by the end of September 2018
10. Developed report with a situation analysis based on collected data from EMTCT and PA programming - 5 w/d by the end of November 2018
11. Applied or documented an innovative method of retaining of knowledge of PHC specialists in ART administering - 10 w/d by the end of December 2018
Estimated total number of w/days required for the consultancy work - 80 w/days over a period of 5 months.
QUALIFICATIONS
DURATION OF THE ASSIGNMENT
Exact timing for the consultancy is negotiable. The consultant will be guided by the International consultant, especially in the area of policy development, PA -integration strategy including development and testing of innovative approach at on-the-job refresher trainings with efficient and sustainable retaining of acquired knowledge among PHC specialists.
LOCATION AND TRAVEL
The consultant will be stationed in Dushanbe with frequent travels in all regions of the country. The cost of the consultancy work including travel and DSA[6] is inclusive.
FEES and PAYMENT SCHEDULE
The consultant will receive a consultancy fee at P4 level upon submission of deliverables and subsequent approval through bank transfer. The deliverables should need for submission to UNICEF Chief, Health and Nutrition section.
PERFORMANCE INDICATORS:
Consultant’s performance will be evaluated against the following criteria: timeliness, responsibility, initiative, communication, and quality of the submitted monthly progress report and associated deliverables. UNICEF reserves the right to withhold all or proportion of payment if performance is unsatisfactory – e.g., assignment is incomplete, not delivered or of failure to meet deadlines.
REPORTING
Consultant reports formally to the UNICEF Chief Health and Nutrition section, as well as under the overall guidance of the First Deputy Minister of Health and Social Protection.
APPLICATION PROCEDURES
The link to review detailed Terms of Reference would be available at the following links: www.untj.org/jobs, www.unicef.org/tajikistan/resources, www.facebook.com/uniceftajikistan.
The candidates who are interested to apply for the position should follow the electronic application's instructions at:
http://jobs.unicef.org/cw/en-us/job/513417?lApplicationSubSourceID=
UNICEF is committed to diversity and inclusion within its workforce, and encourages all candidates, irrespective of gender, nationality, religious and ethnic backgrounds, including persons living with disabilities, to apply to become a part of the organization.
Remarks:
Only shortlisted candidates will be contacted and advance to the next stage of the selection process.
[1] RAIDS report, 2017 ( 798 officially registered cases among children from 0 up to 18 out of total number officially registered cases is 7, 458 PLWA)
[2] MoHSP, Republican AIDS Center sentinel HIV surveillance data in 2015.
[3] In 2015, MoHSP, with UNICEF support, conducted a Study of the National Programme on Prevention of Mother-to-Child Transmission of HIV (PMTCT) in Tajikistan.
[4] The project was implemented by NGO Guli Surkh, in partnership with MoHSP and UNICEF from December 2013 – May 2015 with an aim to improve the quality of life of children living with HIV by introducing a multi-disciplinary support team and a peer support system.
[5] This does not only include one-time training activities but also the mechanism of performance monitoring and continuous capacity development.
[6] UNICEF Tajikistan will cover field trip related costs including UN-approved Daily Subsistence Allowance (DSA) for sub regions and districts of Tajikistan
How to apply:
UNICEF is committed to diversity and inclusion within its workforce, and encourages qualified female and male candidates from all national, religious and ethnic backgrounds, including persons living with disabilities, to apply to become a part of our organization. To apply, click on the following link http://www.unicef.org/about/employ/?job=513417