National consultancy for technical assistance to (MoHSP) for strengthening of national capacity for scale up/ integration of Paediatric AIDS into Primary Health Care (PHC) services in Tajikistan

The national consultant will provide technical support to the MoHSP to implement the recommendations from recent programme review for the improvement of quality coverage of eMTCT and Pediatric AIDS services in a sustainable manner. S/he will in collaboration with an International Consultant work closely with Mother and Child department of the MoHSP, AIDS Centers, Family Medicine Centers, as well as managers and service providers responsible for ANC, MCH, TB, and PHC, to building their institutional capacity to develop and maintain a pool of core PMTCT/PA specialists. In addition, s/he will identify entry points for integration of these important services in PHC and in close consultation with the MOHSP develop a road map to achieve this goal.

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Post Title:                 National 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 (for Tajik nationals only)

Duration of contract:   11 months (June 2018 – May 2019)
Location:                      Dushanbe, Tajikistan
Closing date:                30 May 2018

TERMS OF REFERENCE

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 was quadrupled since 2010. 
The proportion of officially registered cases among children to adults group living with HIV is 10, 7%. 
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  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 , 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 was contracted to assist the Government of Tajikistan to strengthen the National commitment to combat AIDS epidemic in the country through the  a gender and children lens. The technical support primarily focused on effectiveness of integration of Elimination of Mother-to-Child HIV Transmission (EMTCT) and Pediatric AIDS into the primary health care (PHC) services in Tajikistan. The technical support 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 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 among HIV positive pregnant women at PHC requires 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 LLT. The Early Infant Diagnosis (EID) programme in Tajikistan to detect the HIV status among infants born from HIV positive mothers in the first 48 hours using Dried Blood Spot (DBS) at the PCR laboratory increased coverage 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 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 monitor in what extend the training course covered health workers and the quality of acquired knowledge and skills. 

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” , 18% of children living with HIV have been infected with TB. Lack of coordination between vertically established 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. 

UNICEF, along with other UN agencies such as the UNAIDS, has also received funding through global Unified Budget, Results and Accountability Framework (UBRAF) for 2018-2019 to support acceleration of HIV response in Tajikistan. 

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 national consultant will provide technical support to the MoHSP to implement the recommendations from recent programme review for the improvement of quality coverage of eMTCT and Pediatric AIDS services in a sustainable manner.

S/he will in collaboration with an International Consultant work closely with Mother and Child department of the MoHSP, AIDS Centers, Family Medicine Centers, as well as managers and service providers responsible for ANC, MCH, TB, and PHC, to building their institutional capacity to develop and maintain a pool of core PMTCT/PA specialists. In addition, s/he will identify entry points for integration of these important services in PHC and in close consultation with the MOHSP develop a road map to achieve this goal.

SCOPE OF WORK:
The national consultant will be responsible for the assignments as stipulated below.

1. eMTCT

1.1 System development and capacity building

• In consultation with the MoHSP and guidance of International consultant, develop a plan for capacity building of 100 PHC managers to develop a work plan and schedule for procurement of HIV rapid tests and ELISA
• Support the development of mechanisms and tools for better better forecasting of resources needs, quality assurance of procured supplies; reporting and overall monitoring.
• Facilitate on-the-job training for 100 PHC focal points in advanced level for administering of ART according to revised clinical protocol with B+ option.
• Facilitate a training for selected Family Medicine / PHC doctors on revised PMTCT policy and clinical protocol. Prepare syllabus for  the training sessions, outlining the sessions contents, learning objectives, and list of training / reference materials for each session, as well as a package of the handouts distributed during the training sessions, in order to facilitate the integration into future Family Medicine curriculum.
• Complement the work of International consultant by pproviding refresher’s training for ANC/PHC service providers administering ART for HIV positive pregnant women to address gaps in their knowledge and skill.
• Complement the work of International consultant and to assist in development of an 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 administration; assess their compliance in practice, and provide necessary follow-up / mentoring. 

1.2  Monitoring

• Support the International consultant and MoHSP in monitoring and analysis of PMTCT programme data collected from ANC/PHC reporting cards: № 109; 101 and 104 and the electronic database. Provide recommendations to improve the reporting system to ensure accuracy, timeliness and completeness of data.
• Assist the International consultant to monitor/assess the mentoring programme implementation and provide guidance to AIDS centers on their roles and responsibilities in supervision of the ANC/PHC service providers trained on ART administration for HIV positive pregnant women.
• Provide on-the-job refresher training for PHC managers and ANC focal points in reporting, quality assurance of procured supplies. 
• Provide support in monitoring of implementation of revised clinical protocol with newly proposed ART regimes in line with the latest WHO recommendation and B+ option.
• Assist the International consultant to monitor the knowledge and practice of prevention of hospital infection at MCH institutions.

2. Pediatric Aids (PA)

• Provide support to the Republican AIDS Center, Family Medicine Center, and the Pediatric AIDS Working Group in revising of the clinical protocol for PA in alignment of the latest recommendations provided by WHO 2017.
• Under the guidance of the International consultant to support in integration of PA programme into 10 new PHC services in selected regions with a high registration of new HIV cases among children of Khatlon and Sougd. This will include contribution particularly in the following areas: 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 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
• Co-facilitate the Training of 20 ANC Focal points in administration of ART for children and counselling as well as responsible for management of the Child Friendly Rooms courses on Pediatric AIDS for trainers of Family Medicine Centre.
• Jointly with the trained master trainers from Family Medicine Centre, develop a training programme and facilitate training sessions on Pediatric AIDS for CFR specialists at PHC including TB centers across the country. 
• Support Republican Family Medicine centers and under the guidance of International consultant to revise the current curriculum and mechanism to retain a pool of master trainers on Pediatric AIDS programme for future scale-up.
• Facilitate a refresher training based on identified needs for 23 trained specialists of 11 CFR located at PHC services in Dushanbe and RRS (Vakhdat, Rudaki, Gissar) and become operational since in 2017

2.3  Multi-disciplinary mobile team
• Support the MoHSP and under the guidance of the International consultant in development of an institutional mechanism of the multi-disciplinary mobile team with an aim to expand a basic package of services for children living with HIV
• Ensure on-the-job refreshers’ training on ART regimes and TB treatment for health specialists responsible for PA programme at remote areas

2.4  Enforcement of testing criteria
• Conduct monitoring and assess the implementation of the national criteria for HIV testing among children at hospital services in districts, particularly in remote areas. Facilitate necessary follow-up activities (such as on-the-job training and informal orientation sessions) to address identified gaps.

3. Infection control

• Support the MoSP in monitoring of the implementation of the introduction of CBT on Infection control including HIV, HCV and other nosocomial infections at health facilities. 
• With a reference of findings and developed key recommendations to work out on a plan of action to continue with introduction of the on-line course across on Infection control across the country at sustainable scale.

DELIVERABLES:

The consultant should deliver the following:

№/ Deliverables/ Expected time:
1. Revised PA clinical protocol with new ART schemes in line with WHO recommendations, by July 2018
2. Facilitated  workshop and revised clinical protocol was shared among 40 leading experts  of AIDS, FM centres and CFR, by August 2018
3. Capacity building of 100 PHC managers in development of procurement work plan and schedule for HIV rapid tests and ELISA, by November 2018
4. On –job training for 100 PHC focal points in advanced level for administration of ART on revised clinical protocol and B+ option is completed (full list with contacts of each trained specialist, pre and post training evaluation)- 50 % -by November 2018; 50 % - by February 2019
5. Capacity building of 20 ANC/MCH/PHC Focal points in ART; performance monitoring of trained specialists; strengthening of mentoring of 100 ANC/MCH/PHC service providers by AIDS centre specialists, by January 2019
6. 10 new PHC /CFR services are selected in priority regions with a high registration of new HIV cases among children of Khatlon and Sougd; by March 2019
7. Refresh on job training for 23 specialist of 11 CFR is conducted. Reporting system is improved. Report with statistic on handover of the list of beneficiaries is attached; by December 2018
8. Analysis of eMTCT and PA programme data with recommendations for improvement of the monitoring system (forms for reporting from ANC/MHs  to AIDS centres ); annually 2018
9. Mechanism  for paediatric AIDS multidisciplinary mobile team and guidance for its institutionalization within health system is developed; by October  2018
10. Report on monitoring of implementation of Prikaz (Order) #427 Introduction of HIV eligible criteria is;  by April 2019
11. Inputs to the operational guidelines for integrated paediatric AIDS services in PHC – particularly a capacity assessment report and a capacity development plan; by November 2018
12. On-job refreshers’ training on ART regimes and TB treatment for health specialists responsible for CFR programme; by February 2019
13. Training for 50 TB specialists on ART is provided;  50 % -by March  2018; 50 %; by April 2019
14. The curriculum and mechanism to retain a pool of master trainers on Pediatric AIDS programme for future scale-up is developed; by May 2019
15. Plan of action to support the MoHSP to continue scale up the on-line course on Infection control at health facilities is developed with a reference to results of the monitoring; by September 2018.

QUALIFICATIONS:

• Advanced University Degree in Medicine or Public Health and AIDS epidemiology.
• At least 5 years of proven academic and clinical experience in HIV/AIDS prevention and control, including PMTCT, paediatric AIDS, and ARV treatment/prophylaxis.
• Experience working with UNICEF, WHO or other international organizations in the similar field.
• Rich experience in training of health specialists in the areas of HIV epidemiology and PMTCT and Paediatric AIDS clinical protocols.
• Very good organizational skills.
• Solid experience to lead learning courses, training sessions in the area EMTCT and PA. 
• Excellent facilitation and communication (both verbal and written) skills.
• Fluency in Russian and Tajik.
• Advanced computer skills.

DURATION OF THE ASSIGNMENT:
The duration of local consultancy is for 11 months from 1st June 2018– 1st May 2019. 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*.

TERMS OF PAYMENT/ SCHEDULE:
The consultant will receive a consultancy fee at monthly basis upon submission of the monthly progress report with required deliverables to UNICEF and MoHSP and subsequent approval through bank transfer.

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.

_________________________________________________________________________________________________________________________________________________________

*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)
*MoHSP, Republican AIDS Center sentinel HIV surveillance data in 2015.
*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.
*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.
*This does not only include one-time training activities but also the mechanism of performance monitoring and continuous capacity development. 
*UNICEF Tajikistan will cover field trip related costs including UN-approved Daily Subsistence Allowance (DSA) for sub regions and districts of Tajikistan

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UNICEF’s core values of Commitment, Diversity and Integrity and core competencies in Communication, Working with People and Drive for Results.

View our competency framework at:

http://www.unicef.org/about/employ/files/UNICEF_Competencies.pdf

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/513234?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 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