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Consultant to conduct a qualitative study on home visits for mothers and children health and wellbeing

Pristina (Kosovo)

Consultancy

UNICEF Kosovo Office

Terms of references to conduct a qualitative study on home visits for mothers and children health and wellbeing

5 June 2017

Background

The need of identification and early treatment of different illnesses has forced policy-makers and providers of health services to focus on new methods for the increase of health care efficiency. One of the methods that has been globally proved that affects the improvement of health and wellbeing especially that of mothers and children, is by providing primary health services through home visits. Home visits are also seen as a gateway to support parents in ensuring a better starting point in life for their children.

Following conference held in Prishtina in 2013 on Early Childhood Development and child-wellbeing, with technical support from UNICEF the Kosovo institutions at the central and local level has developed package for the introduction of home visits in Kosovo. Ministry of Health and UNICEF Office in Kosovo signed a Memorandum of Cooperation with the purpose to integrate the services of home visits  in the family medicine system – as a model for the provision of interpectoral services  and to improve the quality of health services for mothers and children in Kosovo. Based on the approved roadmap, the home visits for mother and children wellbeing are being implemented in 7 Kosovo municipalities. Primary health care institutions at local level started with implementation of home visits in two municipalities starting from 2014 and scaling up to 7 municipalities through 2016 (Ferizaj, Prizren, Gjakova, Dragash, Fushë Kosove , Gjilan and Mitrovica)

Despite the continuous progress, the maternal and child health status in Kosovo is considered to be among the poorest compared to the neighboring countries and rest of Europe. Data from Multiple Cluster Indicator Survey shows that infant mortality rate is estimated at 12 per 1,000 live births, while among Roma, Ashkali and Egyptian children is estimated 41 per 1000 live births. Findings from MICS have shown that 79 % of children 24-35 months old are fully immunized according to the Kosovo immunization schedule. However, only 30 %, which means only less than one third of Roma, Ashkali and Egyptian children 24-35 months old, are fully immunized. Exclusive breastfeeding rate under 6 month is estimated 39 %. Regarding education and early childhood development the MICS Study suggested that only 13.9% of children from 36-59 months after birth participate in early childhood educational programs.

UNICEF and the Ministry of Health, suggested that the impact of home visiting services should go beyond the support of ensuring infant survival. Home visits play an important role in supporting children’s development, his/her performance at school.

Referring to home visiting standards that are endorsed by Ministry of Health, family medicine team (consisted by nurses and doctors) is responsible for conducting home visits for pregnant women and children age 0-3 years. For pregnant women at least 2 home visits should be conducted during pregnancy, while for children age 0-3 years at least 5 home visits should be conducted. Additional home visits can be planned based on family needs. During the home visits families receive counselling on health and related issues on early childhood development, including immunization, breastfeeding, education and early stimulation, injury prevention, responsive and sensitive parenting and maternal health based on the home visiting package. The service aims the improvement of the mothers and children health and wellbeing with special focus on promotion of health in the family and local community; Identification of risk factors and needs during pregnancy; Connection of families with health care; Social protection and other services in the community depending on family needs; Early identification of difficulties in the development and violence situations and finally adequate references and interventions for families with special needs.

The Ministry of Health has established a working group that consists from representatives of central and local authorities, different sectors and civil society to lead development and implementation of home visits. The working group meets regularly to address and discuss the needs, report, problems in each municipality.  The service package that determines number of visits, specific activities during services, recording forms, and work process has also been determined and being implemented in 7 municipalities.

Regarding capacity development, UNICEF and Ministry of Health delivered the regional package training based on 8 selected modules to family medicine teams, social workers and education officers in five municipalities including participants from seven municipalities. During the period of October-December, 2016 estimated 200 health professionals, social workers and officers from education sector are trained in topics including; early childhood development, accident prevention, working with other sectors, keeping children safe from maltreatment, children who develop differently and parental wellbeing. Training of the health professionals is continuing through 2017 and 119 participants are trained during the period April - May, 2017. 

Objectives of the universal/core home visiting service are

Specific objectives for home visits services for mother and children wellbeing are as following:

  • Improvement of the health, psycho-social functioning, living conditions and identification of risk factors to the health of the family
  • Promotion of the health of the family and the local community and the education about healthy life styles of all family members
  • Identification of risk factors and needs during pregnancy and the early years
  • Promotion of mother, child health, growth, and development
  • Promotion of responsible parenthood and a positive relationship between parents and children even before the child is born to support healthy attachment
  • Linking of the family with the services of health care, social protection and other services in the community in accordance with the needs of the family
  • Health monitoring and adequate interventions for families with special health and social needs
  • Nurturing relations of mutual respect and confidence between the home visitor and the family members.

    Justification of consultancy

    UNICEF in Kosovo plans to recruit 2 local consultants to conduct qualitative research through focus group discussions as part of home visiting monitoring framework. Monitoring and evaluation framework of home visiting services has been developed, and it is consist by four types of indicators: Baseline, performance indicator, process indicators and indicators at national level, which are set and have been developed by home visiting working group.

    Among other quantities indicators, the monitoring and evaluation framework of home visits requires qualitative measures, therefore UNICEF plan to undertake this exercise through Focus Group Discussions with beneficiaries of home visiting programme and service providers (health professionals and social workers).

Methodology

Focus group discussions with beneficiaries from seven Municipalities (Prizren, Gjilan, Ferizaj, Mitrovicë, Gjakovë, Dragash and Fushë Kosovë) and health professionals, including social workers from 3 municipalities will be conducted.

The consultancy team will be composed of 2 local consultants. Both consultant will review the home visiting package (desk review), as well data collection through focus group discussions and analytical report writing. One of consultant will be responsible to lead report writing and submission of final report and one will be responsible to organize focus group discussions.

  1. FGD-s with beneficiaries – In total seven focus group discussions are planned to be conducted

Through FGD’s is expected to obtain the following information:

1.       Mothers enrolled in home visiting during pregnancy and during maternity who initiate and continue exclusive breastfeeding for at least 6 months

Increased over time in breastfeeding initiation and continuation through 6 months.

  1. Interventions to Improve Child Health and Development – Immunization.

    Home visits contribute to improve children vaccination according to the vaccination calendar.

  2. Interventions to Improve Child Health and Development – The earlier the better.

    Promoting the use of home visiting during an infant’s first week of life (i.e., first and third day) as effective in improving neonatal outcomes.

  3. Interventions to Improve Child Health and Development: The Need to reach out for Those Most in Need

    Home visiting program provids an early intervention, by supporting the parents and families, and by reaching out for all, particularly for those most in need, are particularly fit to ensure the best start to all children. Therefore, HV is particularly appropriate for remote and disadvantaged areas and population groups where infant and child outcomes may be worse.

  4. Improved neonatal Care 

    Home visits reaching pregnant women by providing at least two visits in order to improved neonatal and pregnancy outcomes.

  5. Linking of the family with the services of health care, social protection and other services in the community in accordance with the needs of the family
  6. Health monitoring and adequate interventions for families with special health and social needs
  1. Interviews with health professionals who conduct home visits and social workers (satisfaction, knowledge and skills) – 3 FDG’s

From the FDG’s with health professionals and social workers is expected to obtain the following information’s:

  1. Reaching children with disabilities ( Do nurses who conduct home visits are reaching children with disabilities and how are they being able to identify them)
  2. Integration of early childhood development ( how much knowledge and confidence nurses possess to promote  the ECD component at families and community )
  3. Established system for supervision: Existing system for supervision and the level of satisfaction of the nurses conducting home visits  with the support provided
  4. Referring system – how much of cases nurses face during the home visits including children with different  health conditions, children  with disabilities or families in social assistance who requires further care from other professionals. 
  5. Availability of essential tools/inputs
  • Availability of parent education materials on specific issues breastfeeding, early stimulation, sensitive parenting, child development milestones, injury prevention, etc) – short films, leaflets, booklets, etc to be used as part of the home visiting service
  • Availability of books and toys to be provided to children, with a particular focus on most disadvantaged children as part of the home visiting service
  • Availability of instruments for detecting maternal depression and screening of child development at 3 years of age.

Detailed questionnaire will be finalized in collaboration with consultants.   

Deliverables / outputs

Deliverables

Deliverable due date

Desk review/preparation

2 days

Field Work - FGD’s

10 days

Report writing and submission of the report

3 days

Supervisor

 

 

Local consultants will report directly to the Health and Nutrition Officer, UNICEF Kosovo.

Estimated duration

Duration of assignment is for estimated 18 working days, tentatively beginning from June – August 2017. The dates are to be defined and agreed with consultant, but not later than September 2017.

Official Travel / working place

The local consultants will travel to other places in Kosovo.

UNICEF Kosovo Office will facilitate and provide office space, desk, access to internet equipment needed and transport for meetings and field visits.

Qualification or Specialized Knowledge/Experience Required:

  • Master degree in related field, social sciences, public health, with extensive and documented professional experience
  • At least five years of experience in the related field, at national and international level
  • Knowledge of global policies, development frameworks UN agencies, health reform and developments in MCH and home visiting
  • Proven experience in research, analysis, policy and strategy formulation
  • Ability to write concisely, clearly, and under time pressure
  • Strong facilitation, negotiation and coordination skills, participatory planning processes
  • Excellent communication and interpersonal skills and fluency in written and spoken in Albanian and English

    List of references

  • Government Action Plan 2017
  • Health Sectorial Strategy 2017 – 2021
  • Strategy for Primary Health Care
  • Road Map for home visiting and other package – standards, monitoring and evaluation framework
  • Law on Health
  • Law on Health Insurance
  • Law on Public Health
  • Law for rights and responsibilities of citizens for health
  • Other relevant secondary laws/regulations/administrative instructions
  • UNICEF reports, case study, other agencies and institutions surveys, studies, evaluations
  • Resource modules used in Kosovo

    List of reference will be updated in consultation with the Ministry of Health and consultant.

     

 

 

Before applying, please make sure that you have read the requirements for the position and that you qualify.
Applications from non-qualifying applicants will most likely be discarded by the recruiting manager.
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  • Organization: UNICEF - United Nations Children’s Fund
  • Location: Pristina (Kosovo)
  • Grade: International Consultant - Internationally recruited Contractors Agreement - Consultancy
  • Occupational Groups:
    • Public Health and Health Service
    • Social Affairs
    • Sexual and reproductive health
    • Children's rights (health and protection)
  • Closing Date: 2017-06-21

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