Terms of Reference for the development of a Project proposal on reducing Maternal and Child mortality
- Context and Justification To reduce child mortality, improving the health of pregnant women and new mothers is critical. More than half million women die each year in the world due to pregnancy-related causes, and many more suffer debilitating long-term effects, such as fistula. These deaths, that could easily be avoided, occur because poor, marginalized women have no access to functioning health facilities or skilled professionals. Furthermore, improving maternal health is vitally important for a child’s prospects of survival. Evidence shows that a motherless child is more likely to die before reaching the age of two than infants whose mother survive. In Equatorial Guinea where the under-five mortality is at 93 per 1000 live births and 350 maternal death per 100,000 live births happens every year, improving the health and nutrition of mothers-to-be and providing adequate health services are pivotal to address many underlying causes of child mortality. Poor nutrition in women can result in preterm births and babies with low weight at birth. Visits to, or from, a trained health care provider can help avert early deliveries and neonatal tetanus, which is almost always fatal. A skilled attendant present at delivery, backed by emergency obstetric care, decreases the risk of a woman dying in childbirth of hemorrhage, complications of unsafe abortion, pregnancy-induced hypertension (eclampsia), obstructed labor (including ruptured uterus)and can also help prevent infections. Postnatal care has a central role in encouraging new mothers to breastfeed, in the resuscitation of newborns, if necessary, and in averting hypothermia and pneumonia. This is also an opportunity to sensitize them for the utilization of a family planning method.
In spite of the importance of maternal health, the data available in Equatorial Guinea reflects an inadequate access to care and midwifery services. As stated in the State of the World Midwifery report of 2011, “quality midwifery services that are coordinated and integrated within communities and within the health system ensure that a continuum of essential care can be provided throughout pregnancy, birth and beyond. Midwifery services also facilitate referrals of mothers and newborns from the home or health centre to the hospital and to the care of obstetricians, pediatricians and other specialists when required”. Yet, across the country, 40% of the pregnant women receive no antenatal care and almost 50% give birth without the assistance of a skilled attendant. Even for those who give birth in a health centre or hospital there is no guarantee that they are receiving quality care. For instance, in the first national survey on obstetric fistula, 40 % the women who developed this condition had given birth in a hospital!
Given the situation, UNFPA and UNICEF whose mandates relate to the well being of women and children have consulted with the Ministry of Health and proposed to develop a five year maternal and child mortality reduction project with the aim to increase the availability and quality of services obstetric and neonatal care and reduce maternal death, help children survive and thrive and create a protective environment for women and children.
- Description of the Assignment 2.1 Objective The objective of this assignment is two-fold: to review available documentation on the state of the maternal and neonatal health in Guinea Equatorial and, to elaborate a five-year project contributing to the reduction of maternal and neonatal mortality and morbidity in this country.
2.2 Requested services, including suggested methodology
This consultancy will be provided through the mobilization of three consultants as follows: a) A team leader in charge of the planning, implementation and coordination of the consultancy. He or she will also be in charge of technical aspect linked to monitoring an evaluation as well as the production of the administrative, financial and institutional design of the project. Finally, the team leader has the overall responsibility to insure the coherence of the final product. b) A reproductive health person will be in charge of all aspects linked to maternal death reduction including family planning and midwifery services. In addition he or she will collaborate with the rest of the team on such aspect as training, communication and monitoring evaluation. c) A child health expert will be in charge of developing all the aspect in line with infant mortality reduction, prevention care, and community based intervention.
The consultants should report on a weekly basis on progress made to the direct supervisors of the assignment, i.e. the representatives of UNFPA and UNICEF in Equatorial Guinea. The assignment is envisaged to include the following steps: - Review of key documentation - Interviews with all relevant parties at the national level, including partners involved in the implementation of other maternal and neonatal health related projects - If deemed necessary visit to 1-2 selected regions and interviews with relevant parties - Presentation of suggested broad areas of intervention to the supervisors of the assignment two weeks into the consultancy - Presentation of a first draft three weeks into the consultancy - Finalization of project document and submission of assignment report
2.3 Key interventions
The key interventions needed to address the major causes of child and maternal mortality in Equatorial Guinea is well established and accepted. The most basic, yet important, services and practices identified include:
Prenatal care Skilled attendant at delivery including the availability of emergency obstetric care; Skilled newborn care; Care of low birth-weight infants; Hygiene promotion; Exclusive breastfeeding; Micronutrient supplementation to boost immune systems; Immunization Antibiotics to fight pneumonia Effective medicines to prevent and treat malaria; etc. Availability of family planning services; Availability of PMTCT; Improvement of midwifery training and services
Scaling up coverage of these interventions has the potential to prevent most child and maternal deaths. Though, these vertical interventions are not enough by their own, attention also needs to be paid to integrating services and strengthening the national health system so that the country can take the lead and “own” the solutions to its health problems.
Thus, it is expected that the team will review all the possible interventions and proposed the most opportune ones, that are more likely to have impact and that are not yet addressed by other programs or partners in the country. In addition, it is expected that consultants will be able to describe potential linkages with existing interventions as to avoid duplications and to maximize the utilization of available resources. This information should enable the team of consultants to recommend implementation in one or more geographic areas where no other donors implement the same activities, and where there is the best potential to establish partnership, collaborate with INGOs already present in the region and/or enforce linkages with existing projects.
2.4 Required Outputs:
The required outputs include:
- After two days present a tentative work plan for the duration of the assignment
- A presentation of all key interventions to be proposed and other possible interventions
- A draft proposal to be submitted to UNFPA and UNICEF
- A final version of a 5 year proposal including a budget and an exit strategy plan
- A trip report including methodology of the mission, any recommendations for the future.
- EXPERTS’ PROFILE
3.1 Number of requested experts per category The preparation of this proposal requires three experts to be mobilized as follows: One team leader for 6 weeks One RH advisor for 6 weeks Once Child Health advisor for 6 weeks
3.1.1 The Team Leader a) Duties and responsibilities The team leader (TL) will have the following responsibilities in the context of this assignment: Coordinate the overall implementation of the mission, including reporting, and monitoring. Guide the design team and coordinate all the aspects of the work in country; oversee the progress, help with arranging the appropriate support, help with overcoming bottlenecks, ensure proper exchanges of information and be responsible to propose the administrative and financial management arrangement for the future project. Take specific responsibility for the design of the monitoring and evaluation aspect of the project; make proposal for the administrative and financial management aspect of the project; as well as the institutional positioning of the project within the Ministry of Health. Propose a five year budget for the project. Propose the operational and staffing requirements for the project team. Oversee and provide guidance to the other two consultants in order to ensure the quality of their work and outputs. Take responsibility for the overall design of the project and for the finalization of the document. Coordinate the collaboration between the UNFPA, UNICEF, the donor and the Ministry of Health in the context of the design of this project. b) Competencies Demonstrate professional competence and is conscientious and efficient in meeting commitments, observing deadlines and achieving results Team Player Display open, co-operative behaviour with other team members. Self-Management Remain calm and in control, and good humoured even under pressure Demonstrate respect and a clear interest in people by what he/she says and does Drive to Achieve Results Focus on achieving results for external and internal clients. Communication Speak and write clearly and effectively
c) Requires skills and experience Advanced university degree in, public health, social studies, demography, women & gender, economics, international development and other related subjects. Post-graduate training in public health or health management with comprehensive maternal and neonatal health expertise preferred. 10 years international and national experience in leading and managing large maternal and neonatal health projects/ programme in the field at regional and at global level. Familiarity is required with current issues and debates in maternal and neonatal health and related topics. At least one successful experience leading a design team for the elaboration of a five year maternal and neonatal health project At least five year of successful experience as a consultant Experience collaborating with donors, government officials, international organizations, and NGO representatives concerning maternal and neonatal health issues; Some experience working in Africa and/or Guinea Equatorial will be an advantage d) Language Fluency in English and Spanish is required
e) Consultancy fees The team leader will be paid a lump sum of USD 10,000. UNFPA will be responsible and will pay all travel related expenses including DSA for Equatorial Guinea at the approved UN Rates
f) How to Apply: Please send a completed UN P-11 form and curriculum vitae, marked " Maternal and neonatal death prevention project” by 24 July 2011 at chevallier@unfpa.org or erodriguez@unicef.org
3.1.2 The Reproductive Health Expert a) Duties and responsibilities TheReproductive Health (RH) expert will have the following responsibilities in the context of this assignment: Coordinate the design of all aspects related to maternal death reduction including (but not limited to) pre-natal care, normal and emergency obstetric care,family planning, community participation and midwifery services. Collaborate with the TL on communication, capacity development and monitoring and evaluation linked to maternal mortality reduction. Participate in the elaboration of the project budget more specifically as it relates to maternal health. Collaborate with the TL for the proposal on staffing requirements more specifically as it relates to maternal health. Establish necessary linkages with the Child Health expert on issues relating (but not limited to) PMTCT, peri-natal health etc… In collaboration with the rest of the team propose the best possible positioning for the project within the Ministry of health. b) Competencies Demonstrate professional competence and is conscientious and efficient in meeting commitments, observing deadlines and achieving results Team Player Display open, co-operative behaviour with other team members. Self-Management Remain calm and in control, and good humoured even under pressure Demonstrate respect and a clear interest in people by what he/she says and does Drive to Achieve Results Focus on achieving results for external and internal clients. Communication Speak and write clearly and effectively
c) Requires skills and experience Training in medicine, nursing, midwifery with Masters in Public Health or health management with comprehensive maternal and neonatal health expertise preferred. 7 years international and national experience as RH advisor in large maternal and neonatal health projects/ program in the field at regional and at global level. Familiarity is required with current issues and debates in maternal and neonatal health and related topics. Successful experience as a consultant for the design of maternal and neonatal health projects. Experience collaborating with donors, government officials, international organizations, and NGO representatives concerning maternal and neonatal health issues; Some experience working in Africa and/or Guinea Equatorial will be an advantage g) Language Fluency in English and Spanish is required
h) Consultancy fees The Reproductive health Advisor will be paid a lump sum of USD 8,000 for this mission. UNFPA will be responsible and will pay all travel related expenses including DSA for Equatorial Guinea at the approved UN Rates
i) How to Apply: Please send a completed UN P-11 form and curriculum vitae, marked " Maternal and neonatal death prevention project” by 24 July 2011 at chevallier@unfpa.org or erodriguez@unicef.org
3.1.3. The Child Health Expert
a) Duties and responsibilities The Child Health expert will have the following responsibilities in the context of this assignment:
Coordinate the design of all aspects related to Child mortality reduction including community-based care and population-oriented outreachservices, fostering demand forquality clinical services and provision of aminimum package ofhigh impact, low-cost interventionsthat can be implemented given the current policy, human resources and capacity conditions.
Undergo a literature reviewand compilation of information on the situation of maternal and neonatal mortality, child survival and the status of response to meet MDG 4, 5 and 6.
Co-ordinate activities and exchange information/ideas with the other team members to contribute to an integrated approach of ACSDin particular and the overall proposal in general. Contribute to the development of effective M&Efor measuring progress and tracking results of the project Participate in the elaboration of the project budget more specifically as it relates to child survival
b) Requires skills and experience Master in Public Health or advanced university degree in a health-related discipline or Social Sciences plus postgraduate training in Public Health. Minimum of 7 years cognitive and progressive professional experience at both national and International levels Experience collaborating with donors, government officials, international organizations, and NGO representatives concerning maternal and neonatal health issues; Some experience working in Africa and/or Guinea Equatorial will be an advantage c) Competencies High drive for results and commitment; Working with people with strong interpersonal and intercultural skills and networking. Technical expertise and influencing Analytical and problem solving skills, Ability to produce good technical and professional reports Excellent written and oral communication skills as well as training skills, d) Language Fluency in English and Spanish is required
d) Consultancy fees The Child health expert will be paid a lump sum of USD 8,000 for this mission. UNFPA will be responsible and will pay all travel related expenses including DSA for Equatorial Guinea at the approved UN Rates
e)How to Apply: Please send a completed UN P-11 form and curriculum vitae, marked " Maternal and neonatal death prevention project” by 24 July 2011 at chevallier@unfpa.org or erodriguez@unicef.org
NB: This assignment is scheduled to start the first week of September 2011.
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