International consultancy to provide technical assistance to the Ministry of Health&Social Protection (MoHSP) to establish quality improvement (CQI) mechanism for maternal and neonatal care in selected districts of Tajikistan, Dushanbe, Tajikistan

The proposed consultancy aims to: • Lead a baseline (external) health facility assessment at maternities, maternal and newborn units of district hospitals in the 12 selected districts in Tajikistan • Assist the MoHSP, oblast/district health authorities, and selected health facility staff in establishing a systematic process of continuous quality improvement (CQI) for maternal and newborn care • Review the organisation of neonatal care in the 12 selected districts (with referral mechanism to oblast/national levels as relevant), including service standards for hospitals providing different level of neonatal care

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Post Title: International consultancy to provide technical assistance to the Ministry of Health and Social Protection (MoHSP) to establish continuous quality improvement (CQI) mechanism for maternal and neonatal care in selected districts of Tajikistan

Duration of contract: 15 August 2017 - 31 July 2018 (120 working days)
Office location: Dushanbe, Tajikistan
Closing date: 24 July 2017

1. BACKGROUND:
Maternal and child health (MCH) remains a key priority area for the health sector in Tajikistan. In spite of the progress in the reduction of under-five mortality rate over the past fifteen years (declined from 93 per 1000 live births in 2000 to 45 in 2015) (UN IGME Report, 2015) , it fell short of the MDG4 (Reduce Child Mortality by two-thirds, between 1990 and 2015) target of 36. The same report estimates infant mortality rate at 38.5 per 1000 live birth and neonatal mortality rate at 21 per 1000 live births. This means that the neonatal mortality now accounts for as high as 54% of infant mortality and 48% of under-five mortality rate in Tajikistan. UNICEF-supported causal analysis of infant mortality showed that nearly 80% and 70% of infant deaths at hospitals in Tajikistan occurred during the first month and the first week of life, respectively. About two-thirds of early neonatal deaths were recorded among the low-birth weight (LBW) and 70% of neonatal deaths amongst premature babies (born before 37 weeks). These statistics point to the vital need for accelerated efforts to address neonatal mortality, with special attention to the perinatal and early neonatal period. Top three causes of deaths accounting for 35% of all infant deaths include birth asphyxia, respiratory distress of newborns, and birth trauma. This fact, along with the strong association between maternal and neonatal health, confirmed by infant mortality causal analysis , underscore the importance of improving a coverage of ‘quality’ ‘continuum of care’ for reproductive, maternal, and neonatal health, in order for Tajikistan to achieve the new target set under the Sustainable Development Goals (SDGs) .

Poor quality of healthcare remains a major concern due to: insufficient training of health workers, lack of evidence-based clinical guidelines, poor infrastructure, limited budget and lack of essential equipment and commodities at primary and secondary levels of health care (Health System Review, 2016) . The Ministry of Health and Social Protection (MoHSP) has recognized the challenges of improving quality of care and made significant efforts in addressing them including through revision and development of clinical protocols and introduction of accreditation system. However, implementation of protocols on the ground is hampered by a number of factors, and accreditation system has not yet been functional as a quality assurance mechanism for the facilities across all levels of care.

UNICEF, in close collaboration with the MoHSP, implements ‘Young Child Survival and Development Project', and management of the continuous cycle for quality improvement (QI) is an important area of support under the proposed project. This will be started with the application of the monitoring and supportive supervision and quality assurance tools in the maternities and maternal and newborn units of the hospitals in the 12 selected districts (Panjakent, Zafarobod, Devashtich, Mastcho, Mountain Mastcho, Asht, Darvaz, Murgob, Ishkoshim, Rudaki, Rasht and Lakhsh).

Against this background, UNICEF seeks for an international consultant to support MoHSP, oblast/district health authorities, and selected health facility staff, to establish continuous quality improvement (CQI) mechanism in the selected facilities/departments in Tajikistan.

2. OBJECTIVES:
The proposed consultancy aims to:
• Lead a baseline (external) health facility assessment at maternities, maternal and newborn units of district hospitals in the 12 selected districts in Tajikistan
• Assist the MoHSP, oblast/district health authorities, and selected health facility staff in establishing a systematic process of continuous quality improvement (CQI) for maternal and newborn care
• Review the organisation of neonatal care in the 12 selected districts (with referral mechanism to oblast/national levels as relevant), including service standards for hospitals providing different level of neonatal care

3. MAJOR TASKS TO BE ACCOMPLISHED:
An international consultant will be responsible for the assignments as stipulated below:
• Review the existing national regulatory environment, policies, guidelines, protocols and standards (including those for accreditation and certification) in the areas of maternal and newborn health care
• Review the available health facility assessment / supportive supervision tools, and choose / adapt ones that are most appropriate for external and self-assessments as well as supportive supervision for continuous quality improvement (CQI) process at the selected facilities
• In close consultation with MoHSP, develop guidelines for external / self- assessments and CQI process, and train the assessment team selected by the MoHSP and Oblast/District health authorities. The training will include an orientation of the assessment team on the assessment tool, the CQI process, and facilitation skills.
• Facilitate an orientation session on CQI process for MoHSP national representatives, oblast/district health managers, and other relevant stakeholders (such as local academic institutions) to mobilize their commitment and to establish national steering committee and quality improvement (QI) teams at oblast, district and facility levels with terms of reference (ToR).
• Lead the baseline external assessment process as per the agreed guidelines / assessment tool at the selected facilities. This will include:
- Conduct assessment exercise together with the trained assessment team
- Identify gaps in the provision of quality of care with reference to the national standards
- Facilitate initial discussions of the assessment results with each QI team at the assessed health facilities to develop QI plans to implement the recommendations of the assessments
• Upon completion of the baseline assessment at all selected facilities, present the results and recommendations to MoHSP national representatives, oblast/district health managers, QI teams at all levels, and other relevant stakeholders. Facilitate discussions about QI plans to be implemented through the collaborative process involving different levels of health system (including actions that are beyond the authority and responsibility of the individual health facility).
• Produce a baseline external assessment report, elaborating the assessment findings, recommendations, and QI plans, and share a draft with UNICEF Country Office and MoHSP for review and feedback.
• Provide training and subsequent coaching for QI teams at all levels and district/oblast health managers to implement QI system. All QI teams and district/oblast health managers should benefit from mentoring support in continuous monitoring of performance and provision of supportive supervision and self-assessments of quality of care.
• Conduct a supplemental analysis on the organisation of neonatal care services in the 12 selected districts (with referral mechanism to oblast/national levels as relevant), including service standards for hospitals providing different level of neonatal care. Identify any gaps, if any, and provide recommendations for addressing them.
• Produce a final report, summarizing the process and outcomes of the assignment as well as a set of recommendations and follow-up actions.

4. DELIVERABLES, TIME FRAME AND PAYMENT SCHEDULE:
Deliverables/ Deadlines/
Installment I - 30% of the contract value
1. Tools adapted for external and self-assessments as well as supportive supervision for CQI process at the selected facilities/ September 15, 2017
2. Guidelines developed for external / self-assessments and CQI process/ September 15, 2017
3. Orientation session facilitated for MoHSP and oblast/district health managers and other stakeholders, followed by establishment of QI teams/ October 31, 2017
4. The assessment team trained on the assessment tool, the CQI process, and facilitation skills/ October 31, 2017

Installment II - 30% of the contract value
5. Completion of the baseline external assessment at all selected facilities/ January 31, 2018 30%, upon UNICEF approval of the deliverables
6. Presentation of the assessment results and discussion of QI plans/ February 20, 2018
7. Baseline external assessment report/ March 31, 2018

Installment III - 40% of the contract value
8. QI teams and district/oblast health managers trained and coached in continuous monitoring of performance and provision of supportive supervision and self-assessments of quality of care/ June 30, 2018 (completion of self-assessments by all QI teams with consultant’s mentoring support) 40%, upon UNICEF upon submission of final report
9. Supplemental analysis on the organisation of neonatal care services in the 12 selected districts April 31st, 2018
10.Final report/ July 15, 2018

Exact timing for in-country assignments is negotiable.

5. PLACE OF WORK:
The consultant will complete some of the tasks in distance and others in Tajikistan. While in Tajikistan, the consultant will be stationed in Dushanbe with travel to the selected districts of the country.
• 6 districts in Soghd oblast - Panjakent, Zafarobod, Devashtich, Mastcho, Mountain Mastcho and Asht
• 3 districts in GBAO - Darvaz, Murgob and Ishkoshim
• 3 districts in Rayons of Republican Subordination (RRS) - Rudaki, Rasht and Lakhsh

The consultant will closely work with a national expert/consultant who will be hired by UNICEF.

6. TRAVEL:
Two country visits are planned for this consultancy. While in Tajikistan, the consultant will be stationed in Dushanbe with travel to the selected districts of the country. UNICEF Tajikistan will cover travel-related costs, including return travel of the consultant by the most direct route in economy class from her/his home country to Tajikistan and within Tajikistan. The consultant will receive UN-approved Daily Subsistence Allowance (DSA).

7. REQUIRED QUALIFICATION:
• Advanced university degree in Medicine, Public Health or related field. Clinical background specialising in maternal, neonatal and child health care is preferred.
• Seven to ten years of working experience in the field of maternal, neonatal and child health services, with international/UN organisation. Experience in CEE/CIS countries is an asset.
• Technical expertise and experience in continuous quality improvement (including quality care assessment as per WHO guidelines) of maternal, child and neonatal health services.
• Excellent facilitation and communication skills.
• Excellent analytical and report writing skills.
• Fluency in English. Knowledge of Tajik or Russian language is an asset.

8. REPORTING ARRANGEMENTS:
The consultant will work closely with the UNICEF Health Specialist under the overall supervision of the Chief, Health and Nutrition, UNICEF Tajikistan. The evaluation of the consultant shall be completed based on the timely submission of the deliverable, and accuracy and quality of the product delivered.

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/505819?lApplicationSubSourceID=
It requires the applicant to upload the detailed CV and academic degrees/diplomas. UN candidates should upload at least two latest performance evaluation reports.
Individual contracts should, to the extent possible, stipulate all-inclusive fees, including lump sum travel and subsistence costs, as applicable.
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 view our competency framework, please click here. 

Please indicate your ability, availability and daily/monthly rate (in US$) to undertake the terms of reference above (including travel and daily subsistence allowance, if applicable).  Applications submitted without a daily/monthly rate will not be considered.

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 organisation.