UNICEF Zimbabwe is inviting proposals from individual national consultants foor the Development of a “package of services and information on differentiated EMTCT of HIV & Syphillis, SRH, GBV forpregnant & breastfeeding adolescents & young women” in Zim

The overall objective of this assignment is to develop a comprehensive, disability and adolescent sensitive and integrated HIV and SRHR information packages for adolescent mothers, including adolescents living with HIV in order to contribute to dual elimination of mother to child transmission of HIV and syphilis.

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UNICEF Zimbabwe is inviting proposals from individual national consultants for the Development of a

“package of services and information on differentiated and integrated Elimination of Mother To Child

Transmission (EMTCT) of HIV and syphilis, Sexual and Reproductive Health (SRH), Gender Based Violence

(GBV) for pregnant and breastfeeding adolescents and young women” in Zimbabwe

1. Background

   Zimbabwe has made significant progress  towards achieving the national and global targets of elimination of mother to child transmission (EMTCT) of HIV to less than 5% through the scaling up of EMTCT services from 3 pilot sites in 1999 to 1,560 health facilities to date providing effective EMTCT services, ensuring adequate stock of antiretroviral (ARV) drugs and essential commodities as well as  posting trained health workers, adopting the Option B+ and the Treat ALL strategies.  In addition, several other strategies have been put in place to enhance EMTCT including, integration of antiretroviral treatment (ART) in Maternal Neonatal Child Health (MNCH) services, the use of a family centred approach, index  HIV testing of family members, enhanced retesting of women during pregnancy, early infant diagnosis (EID) with testing of HIV exposed babies at 6 weeks and at ceassation of breastfeeding, and mother- baby pair follow up systems. By end of December 2017, 95% of pregnant and breastfeeding women living with HIV were initiated on antiretroviral treatment (ART).

    

   At the same time, Zimbabwe has adopted the national Adolescent Sexual Reproductive Health (ASRH) Strategy (2016-2020) that provides guidance and strategic direction on implementation of adolescent friendly HIV sensitive ASRH services as well as  defines an age appropriate  comprehensive standard of care package to be provided at the different SRHR service delivery levels including health facilities, schools and communities.  Despite great achievements from the above initiatives, it  is estimated that more than half of the 64,000 new HIV infections in 2015 in the country was among young women under the age of 25 years (Zimbabwe National HIV Estimates, 2016). Young females aged 20 to 24yrs are disproportionately infected with HIV; with prevalence in this age group being 2.78 times higher than in male counterparts in the same age group (8.5% in females compared to 2.7% among males) (ZIMPHIA 2016).

    

   Worse still, adolescents 15-19 years contribute 20.2% of maternal mortality (ZDHS 2015/16) . The unmet need for family planning for adolescents 15-19 years is high at 39.6% (ZDHS 2015/16) and this is evidenced by the high rate of adolescent fertility where 1 in every 10 girls age 15-19 gives birth every year. The rural-urban differential is striking with girls residing in rural areas close to 3 times (27.2%) as likely to have begun child bearing than their urban counterparts (10.3%). Adolescent and young mothers face various challenges among them rejection by families and partners, poor nutrition for the mothers and their babies, poor parenting skills and delayed physical and cognitive development of their babies. The situation of adolescent and young mothers living with HIV is more dire as these challenges are compounded by difficulties related to their status such as  stigma and discrimination and challenges of disclosing status to their partners and in- laws resulting in poor adherence to treatment. A study conducted by Africaid in 2010 “The Third Generation Study” revealed lack of parenting skills, non-disclosure to partners and poor adherence to HIV treatment among young mothers living with HIV. Opportunities to reach adolescent and young mothers are available through existing services such as adolescent and youth friendly heath services and Maternity Waiting Homes where the majority of clients are young first-time mothers.

    

   Despite all these efforts to provide integrated HIV and SRHR services for all mothers, such services have not adequately addressed the needs of the group of adolescent and young mothers during the ante-natal and postnatal periods. In addition, male partner testing in EMTCT remain low at less than 50% by end of 2017. Currently, pregnant adolescents receive the same service package as older women, but it is often accompanied by stigma and judgmental attitudes from health care providers, family members and their communities. A defined package of differentiated, SRH/eMTCT/GBV services and information that target this sub group of young mothers will greatly enhance responsiveness of the public health system and communities to their specific needs and situations with the overall goal of reaching an AIDS-free generation: living positively with HIV or staying HIV negative with a baby free of HIV in line with the 2018-2022 Plan for EMTCT of HIV and Syphilis in Zimbabwe  .

    

   It is from this background that a consultant is being sought to develop a comprehensive package of integrated, differentiated care services and information for adolescent and young mothers, including those living with HIV, most vulnerable and living with disability in order to increase access to and utilization of comprehensive eMTCT/SRH services, that is disability and adolescent sensitive and includes referral to other services such social protection, gender based violence (GBV) response and others as well as include how to engage the mothers’ close family members.

    

Overall objective of this assignment:

The overall objective of this assignment is to develop a comprehensive, disability and adolescent sensitive and integrated HIV and SRHR information packages for adolescent mothers, including adolescents living with HIV in order to contribute to dual elimination of mother to child transmission of HIV and syphilis. The package is primarily aimed at increasing  provision of differentiated services, access to and utilization of comprehensive, disability sensitive and integrated adolescent and youth friendly HIV/SRHR services including ANC, HIV and syphilis testing and counselling, Post Natal Care, family planning, treatment of Sexually Transmitted Infections (STIs), prevention and management of SGBV, linkages and referral to  education, behavior change programmes, social protection as well as improving partner involvement and support in EMTCT of HIV and syphilis services. At the same time, the information package, will be a good source of information for adolescents to enable them to make informed decision during pregnancy and after delivery and strengthen support and active involvement of their spouses and families.  At secondary level, the integrated adolescent friendly information package will also enhance the capacity of service providers in offering quality, efficient, accessible youth friendly and stigma-free services to the adolescents and youth population (10 – 24 year old), including education and counselling. A facilitator guide will be developed to guide service providers on how the information package will be used.

Methodology

The package will be developed through review of relevant literature, experience from other countries, consultations with key informants (service providers, health workers, adolescent and young mothers including those living with HIV, partners, care givers and their families among others), to identify needs of the adolescent mothers and gaps that need to be addressed. Male partners will also be consulted to solicit their views and perceptions on the role they can play in EMTCT and SRHR. The  draft package will be validated through a pre-test and a consultative process involving relevant stakeholders and key actors in HIV and SRHR programmes. Any materials and tools that will be developed will be pretested to assess appropriateness and acceptability by the intended users.  At the core of the comprehensive package will be three pillars of services:

1. Locate and link pregnant adolescents to the services they need;
2. Prevent HIV in pregnant adolescents who tested negative for HIV;

3. Treat and retain in care pregnant adolescents who are living with HIV. Specific interventions, such key SRHR, HIV and GBV services, under each of the three pillars  will be defined by findings from the needs assessment. The package should include clear indication on referral and integration with other key services such ANC, PNC, HIV Social Sensitive Programme (HSSP), education among others.

    

   The package should be aligned to and complement existing national Youth Friendly Health Services Guidelines, the Elimination of Mother To Child Transmission (EMTCT) plan 2018-2020 and other related national and global guidance on SRHR and HIV. It should clearly articulate effective and innovative ways of implementing the services at health facility and linkage with community level including use of social media such as the U-report, M-Health platforms and peer support groups.

   The guidelines can be adapted to suit various clinical health care settings. 

    

   Expected outputs are:

• An assessment report on facilitators and barriers in service provision in terms of what and how EMTCT services for pregnant and breast feeding adolescents and young mothers are provided, how they are integrated with SRH and GBV services, availability of information on EMTCT, SRHR, HIV and GBV services as well as needs of adolescent and young mothers and their close families’ members, health workers and other key stakeholders.
• An inception report including a framework with deliverables and timelines to guide the development of the package and related materials designed and shared with the technical working group.
• Adolescent, young people and disability sensitive, differentiated, integrated and comprehensive package of SRH/EMTCT/GBV services and  information developed. clearly articulating the key messages or information needs, sub-group of targetd population (disaggregated by age, most at risk, disability) and services to be provided, at health facility and community levels.
• Services package, job aids and IEC materials developed , pretested and finalized.

• Facilitator’s guide on use of services and information package, Power Point presentation and Final Consultancy Report documenting the process, lesson learnt and recommendations for future applications.

   

Major tasks, Deliverables, Timeframes and Payment Schedule

Consultancy Timeframe  

The consultancy will start  in July 2018 and end  on 30 September 2018

Consultancy Requirements

1. Advanced degree in the area of  Social Science, Public Health, Medicine, Sexual Reproductive health (SRH) or related fields, or A first University Degree in a relevant field combined with 2 additional years of professional experience may be accepted in lieu of an Advanced University Degree.
2. At least 5 years experience and sound knowledge of adolescents’ HIV and understanding of SRH, Life Skill Education, GBV, gender, HIV sensitive social protection programmes.
3. A sound understanding of planning processes, integration models as well as monitoring and evaluation.
4. Knowledge of the country context is highly desirable
5. Good communication and facilitation skills (workshops, data collection, etc.).
6. Fluency and excellent writing skills in English
7. Demonstrable expertise in field work including data collection, analysis and reporting, on area of HIV or health or SRH or all;
8. Practical experience in developing HIV/GBV/SRH training and IEC materials and in writing reports in HIV and AIDS, GBV and SRH area;

 Application Procedure

If interested and available, please submit your application letter, CV, Technical and an all-inclusive financial proposal detailing daily professional fees, Daily Subsistence Allowance (DSA) for field travel outside Harare for Expected maximum 20 field travel days outside Harare (field work 15 days and pre-test workshop 5 days) and other miscellaneous expenses for delivering this assignment.

UNICEF is committed to diversity and inclusion within its workforce, and encourages qualified candidates from all backgrounds to apply.