International consultancy to support Government of Tajikistan to assess effectiveness and efficiency of financing for adolescent health –services, Dushanbe Tajikistan

The consultancy is for provision of support to the Government of Tajikistan in assessing effectiveness and efficiency of budget allocations and spending for adolescent health-related services including mental health in education and health sectors

UNICEF works in some of the world’s toughest places, to reach the world's most disadvantaged children. To save their lives. To defend their rights. To help them fulfill their potential.

Across 190 countries and territories, we work for every child, everywhere, every day, to build a better world for everyone.

And we never give up.

For every child, 

In Tajikistan, adolescent girls and boys face several challenges related to the quality of basic services responding to their needs. The social sector infrastructure in Tajikistan, partly inherited from the Soviet time, provides a diverse range of social services. Since that period, the health promotion services for adolescents were established and are still operational at schools, vocational training venues and in special institutes. However, these health services are not adapted to adolescents needs, hence not adolescent-friendly. Mental health and psychosocial services are underdeveloped.

Up to now there is a gap in understanding to what extent these services are effective in terms of accessibility, availability and coverage.

UNICEF supported the establishment of 26 Youth Friendly Health Services (YFHS) at primary health care level. The package of YFH services in the area of HIV, sexually transmitted infections (STIs) and reproductive health for vulnerable young people and most-at-risk groups (MARA) aged 10- 24 is institutionalized. The legal framework to integrate and scale up YFHS in the health system is endorsed and used to increase access by vulnerable young people, with a special focus on at risk groups on a sustainable basis. However, the current capacity of YFHS can cover only one third of the target population.

In June 2017, the Ministry of Health and Social Protection (MoHSP) approved the revised regulation on Adolescent Friendly Health Services (AFHS). The regulation envisages the integration of the adolescent health friendly services AHFS into the primary health care (PHC) system. Its expansion is expected to take into consideration innovative methods of receiving counselling through virtual services and the guarantee that adolescents, boys and girls, have an equal access to health promoting services irrespective of geographic location, gender and vulnerability profiles.

In parallel, the definition and costing of the essential Reproductive, Maternal, New-born, Child and Adolescent Health (RMNCAH) Service Package (RMNCAH) (hereinafter, "costed package", with engagement of MoHSP and the Ministry of Finance (MoF) experts at national and sub-national level, was completed in 2017. This is expected to complement the ongoing financing reform of the PHC system. The costed package of the services for adolescents will assist the health system to improve governance of the PHC system, strengthen accountability and monitoring, optimize the use of restricted resources and ensure both sustainable coverage and equal access for girls and boys. Efficiency of YFHS varies across centers, corroborated by the examination of the program funding and service utilization per each YFHS center revealed 30% of YFHS centers to be inefficient. The analysis shows these YFHS centers to be established in 2012, whereas other centers have longer experience of operations. Shall this analysis been conducted during program implementation, focus could have been put on enhancement of outreach activities.

How can you make a difference?

The main purpose of the study is to provide support to the Government of Tajikistan in assessing effectiveness and efficiency of budget allocations and spending for adolescent health-related services including mental health in education and health sectors.

The outcome of the study will serve the line ministries, such as the Ministry of Finance, the Ministry of Education and Science and the Ministry of Health and Social Protection as the roadmap for the development of the future of action in regard of optimization and rational distribution of restricted resources in order to improve access by adolescents to quality health services at education and health sectors with particular attention to gender and equity issues. It will also assist the development of the National Child and Adolescent Health Strategy for 2019-2024 by applying the set of recommendations of the study with a Child Rights approach within the Finance for Children (F4C) initiative.  The findings of the study will inform policy makers in their efforts to prioritize resources for better health outcomes for children and adolescents in Tajikistan.

This activity contributes to Output 2 of the UNICEF Country Programme Document for 2016-2020 by addressing a bottleneck related to adolescents ability to demand and access youth-friendly services. The AMH programme activities and indicators are incorporated into the joint work plan between the UN agencies and the Government of Tajikistan.

Theory of change:

If the Government of Tajikistan effectively and efficiently allocates and spends budget for provision of services to adolescents, especially to the most vulnerable girls and boys, then the health outcomes and well-being of the youth population of Tajikistan will be improved and maternal mortality rate and other chronical illnesses will be reduced, because access to relevant quality services are in place to mitigate inequity gap and adolescent will know where to seek such services.

Objectives:

To analyze the current national spending on adolescents health services and to define if there is an:

• High  impact,  cost  effective,  evidence-based services that  can  be  delivered successfully to adolescents, especially vulnerable  in context of Tajikistan
• Equity in ensuring that critical health services are provided to all adolescents, boys and girls especially vulnerable
• Sustainability of service provision in the long term - aaffordability and feasibility based on the human and financial resources available.
• Inter-relation between tiers of service to ensure continuum of care - clearly defined referral chains
• Defining a fiscal space for effective and efficient allocation of restricted resources targeted on adolescents health services, including mental health.
• Evidence based health sector financing to reaching out adolescents, especially  girls who are left behind the services

Geographical focus and coverage:

• The scope of the study will be both national and local. Nationally, the study will focus on national programme strategies, policies, reforms and legal framework as well as the financing mechanism. Locally, the study will follow to the review of a concept and strategy of the local governance of the domestic budget including expenditure, especially in terms of access by adolescents to services including mental health, through the lenses of equity.
• The consultant will propose a technic of sampling to define districts and other relevant objects of the study to ensure that the survey has a representative data.
• Mainly, the focus will be preferably given to primary health care services, educational settings and other State supported health services for adolescents.

Key assignments:

Prior to the assignment stipulated below, the International consultant should provide an Inception report with a methodology, tools and work plan required to implement the assignment.  

In addition, the consultant should assist the expert team assigned by the Ministry of Finance (MoF), Ministry of Health and Social Protection of the Population (MoHSPP) and Ministry of Education (MoE) to conduct the data collection in the field.

Desk review to learn the current situation of the reforms related to the State budgeting and financing:

•  Review of the normative framework on financing and budgeting supportive to adolescent health services in social sectors.
• Review of other relevant studies and reports describing the adolescent health situation, including disease burden, unmet medical needs, as well as healthcare system in Tajikistan. This should also include documents related to the ongoing rationalization of restricted resources to project the future financing targeted on health of adolescents;  
• Review and analysis of the current mechanism of allocations and expenditure at health and other sectors providing health services to adolescents at district levels. 

Mapping of available adolescent's health-promotion services to explore:

• Map settings at education, health and social protection sectors where adolescent health services are established and functioning;
• Identify available package of services; 
• Identify coverage, inputs and interventions per service package;
• Identify budgets allocations and actual spending per existing primary health care services targeting adolescents.

Questions of the assessment: 

The assessment should respond to the:

• Effectiveness - the benefits of healthcare services delivered to the beneficiaries measured by improvements in adolescent's health outcomes in education and health settings;
• Efficiency - normative framework of budget for allocations at PHC system in comparison with the actual spending, which relates to the cost of health services to the outputs or benefits obtained;
• Acceptability - to what extent available health services are affordable and responding to the demand side ;
• Equity - the fair distribution of health services to children disaggregated per sex, age groups and other key social determinants at primary health care and other educational settings.

Report and final agreement with the key stakeholders: 

Documentation of findings and principle recommendations based on evidence for the policy makers on optimization of scarcity of resources for their effective and efficient spending for AHS, including mental health coverage, with special attention to gender and equity analysis.

METHODOLOGY

The assignment should be performed through a continuous consultative process to allow government's decision making based on the combination of technical, political and social considerations. In addition to the desk review of existing policies/laws, strategies, programmes with budgets, situation analysis, surveys, and studies, the consultant is expected to carry out in-depth interviews with select government officials - both at national and sub-national level (MoHSP, MoF, MoE, local authorities), school and health service providers, as well as other relevant stakeholders and partners involved in supporting provision of relevant health services to adolescents (World Bank, EU, SDC, USAID, WHO, UNFPA, KfW, and GIZ, etc.).

A national team of experts will facilitate the fieldwork under the guidance of the consultant. 

The national team may conduct field visits and hold focus group discussions, community meetings and interviews with the stakeholders and implementing partners. They will be also encouraged to use available secondary data and information as well as data from other published sources or research / studies for triangulation and validation of the information.

The consultant will work remotely with some travel to Dushanbe and selected districts of the country when required.

The methodology will cover the following phases:

The Inception phase is the first stage of the study enabling the national team to develop a study framework with reference to the ToR. Under the guidance of the consultant, the team will develop a detailed methodology. The team will elaborate indicators to identify the means of verification. The team will assess the potential limitations to the study work and in particular, the availability and reliability of the programme data. The methodology and techniques proposed by the consultant should be described in detail in the inception report and the final report, and should contain, at minimum, information on the instruments used for data collection and analysis, whether these be documents, interviews, field visits, questionnaires or participatory techniques.

A Desk review of evidence available at country level in relation to impact and system results, reduction of equity gaps and theory of change in scope of adolescents well- being and health. Other available sources will also be verified and analyzed. The consultant will recommend and guide the national expert team on validity of a desk review of financial documents during the field work (two or three fiscal years);

In-country data collection will consist of primary data collection from interviews with the key stakeholders and the key implementing ministry (MoH), YFHS staff and local authorities; UN contributing agencies, GFATM and other donors; focus group discussions with young people including its vulnerable and at risks groups and outreach leaders.

Data analysis will be conducted by the team in collaboration with relevant responsible people for further clarification and feedback as necessary.

The report writing will start from its inception phase when the team will propose the detailed methodological approach. Following the completion of data collection and analysis a draft report will be submitted to the UNICEF Tajikistan Country Office. The draft report will be reviewed by the UNICEF. The final draft report will be shared with relevant internal and external stakeholders. The field team will collect and incorporate comments and submit the final report to the section in charge. The draft report will be discussed and shared with the national coordinator assigned by the Minister of Finance of RT for the comments and approval.

The findings of the study will be used by the UNICEF and MoF as the evidence based tool for the  the decision makers form the social sectors to optimize the limited resources and rationally spend them as per the strategy needs and priorities. Later, the increase of fiscal space for health and education sectors would contribute to:

a) increasing AFHS and mental health coverage at sustainable scale;

b) decreasing inequality gaps and better addressing gender related disparities.

ETHICAL CONSIDERATIONS

Adequate measures should be taken to ensure that the process responds to quality and ethical requirements as per UNICEF Evaluation Standards. As per UNEG Standard and Norms, a consultant and national experts should be sensitive to beliefs, manners and customs and act with integrity and honesty in their relationships with all stakeholders. Furthermore, they should protect the anonymity and confidentiality of individual information. Every information proposed or should be collected at the ground should be prior shared with the expert group assigned by the ministries. The consultant and national experts should respect the confidentiality of the information they handle during the assignment. They are allowed to use documents and information provided only for the tasks related to this term of reference. UNICEF reserves the right to withhold all or proportion of payment if performance is unsatisfactory - assignment is incomplete, not delivered or of failure to meet deadlines. 

In sake of transparency, the Ethical committee established under the MoF and MoHSP of Tajikistan will review the Methodology as well as give an approval. 

REQUIREMENTS

Duration of assignment:

The duration of this consultancy is from September 2018 up to February 2019 (6 months) and the exact timing for the consultancy is negotiable.

The selected consultant will work for a period of 50 working days.

Deliverables:

1.  Inception report with the proposed methodology, instruments and indicators. It should include a work plan, the proposed list of stakeholders for meetings, selection of facilities in health and education sectors and other expected outcomes.

Expected time:  By the end of September 2018.

2. Consultative workshop with key stakeholders discussed and agreed the questions addressed to the assessment, including methodology and plan of action. ToRs for a core group of local exerts in education and health sector, finance and economics, etc. developed and shared.  

Expected time: By the end of October 2018.

3. The report with preliminary findings is drafted and shared; A consultative meeting for validation of collected data and information by key policy makers and UNICEF is conducted.

Expected time: By the end of December 2018.

4. The workshop is conducted and the findings with recommendations are finalized. Final report to UNICEF, summarizing the process and outcomes of the assignment as well as a set of recommendations and follow up actions.

Expected time: By the mid of January 2019.

Payment Schedule:

• Del 1-2  -30% of consultancy fee upon UNICEF approval of the work plan, methodology and ToRs developed and shared;
• Del 3 -    50% of consultancy fee upon the report with preliminary findings is drafted and shared;
• Del 4 -    20% of consultancy fee upon UNICEF approval of all deliverables.

Travel involved:

Consultant is expected to travel three times to Tajikistan. Travel plans to be pre-approved and agreed to by UNICEF Tajikistan.

Travel paid for by UNICEF shall be based on economy class travel, regardless of the length of travel. Costs for accommodation, meals and incidentals shall not exceed applicable daily subsistence allowance (DSA) rates, as promulgated by the International Civil Service Commission (ICSC). Consultants and individual contractors are responsible for assuming costs for obtaining visas and travel insurance.

Supervision:

Consultant will report to UNICEF ADAP Section Chief.

Insurances:

UNICEF does not provide or arrange life or health insurance coverage for consultants and individual contractors, and consultants and individual contractors are not eligible to participate in the life or health insurance schemes available to United Nations staff members. Consultants and individual contractors are responsible for assuming all costs related to required inoculations, vaccinations and medical examinations.  
Consultants and individual contractors are fully responsible for arranging, at their own expense, such life, health and other forms of insurance covering the period of their services as they consider appropriate. The responsibility of UNICEF is limited solely to the payment of compensation for service-incurred death, injury or illness as per the provisions detailed below.

Recourse: 

UNICEF reserves the right to withhold all or a portion of payment if performance is unsatisfactory, if work/outputs is incomplete, not delivered or for failure to meet deadlines.

Ethical considerations: 

Adequate measures should be taken to ensure that the process responds to quality and ethical requirements. The contracted consultant should be sensitive to beliefs, manners, and customs and act with integrity and honesty in their relationships with all stakeholders. It should also protect the anonymity and confidentiality of individual information.

Mandatory trainings: 

Consultants and individual contractors, regardless of contract duration, must complete the applicable mandatory trainings. The link will be provided during the selection process for the successful candidate.

 To qualify as an advocate for every child you will have...

Education: in the area of Public Health and Financing / Public Finance Management.

Work Experience: Extensive experience (at least 8 years) in the area of Public Health and Education Financing / Public Finance Management.

Relevant consultancy experience with international/UN organizations in the field of Public Health Sector Financing / Public Finance Management (esp. costing of essential health service package), Health and Education Systems Management, Planning and Programme Development.

Competencies: Experience in CEE/CIS countries is preferable. Prior experiences with UNICEF would be an advantage.

Technical Knowledge: Excellent facilitation, communication, analytical and report writing skills.

Language: The team members should be fluent in spoken and written English. Knowledge of Russian will be an added advantage.

Instruction for Applicants:

Queries can be sent to: tad-procurement@unicef.org with subject line International consultancy to support Government of Tajikistan to assess effectiveness and efficiency of financing for adolescent health

Applications must be received in the system by the 24 August 2018 at our website: http://jobs.unicef.org/cw/en-us/job/514931?lApplicationSubSourceID=

Please indicate your availability and rate per deliverable in USD to undertake the terms of reference above.  Applications submitted without a rate per deliverable in USD will not be considered. Currency of payment will be agreed upon at time of contracting.

Individual consultants will be evaluated based on a cumulative analysis methodology. The award of the Contract shall be made to the individual consultant whose offer has been evaluated and determined as:

a) responsive/compliant/acceptable, and

b) Having received the highest score out of a weighted set of technical and financial criteria.

* Technical Criteria weight - 70%;

* Financial Criteria weight - 30%;

For every Child, you demonstrate..

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

The technical competencies required for this post are….

View our competency framework at

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

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:

Mobility is a condition of international professional employment with UNICEF and an underlying premise of the international civil service.

Only shortlisted candidates will be contacted and advance to the next stage of the selection process.