Local/International Consultant – Baseline study on maternal and newborn care in Eswatini

In Eswatini, there is approximately 33,000  births annually. Access to maternal and newborn health services is high in Eswatini with 99 per cent of pregnant women attending at least one antenatal care (ANC) visit while 76.2 per cent attend the recommended four ANC visits. Further, 88 per cent of women deliver at health facilities and 88.3 per cent of births are attended to by skilled birth attendant (MICS 2014). Despite the high coverage of births by a skilled attendant and institutional delivery, maternal mortality remains high at 593/100,000  live births. In addition, the high HIV rates among pregnant women at 41 per cent increase the risk of mother to child transmission (MTCT) of HIV. This has increasing the risk of MTCT during breastfeeding with 6.0 per cent MTCT at 18 months, yet transmission by two months of age is lower at about 2 per cent  despite the increased access to antiretroviral treatment (ART) for HIV infected pregnant women. Furthermore, neonatal mortality is high at 20/1,000 live births and under five mortality remains high at 67/1,000 live births. United Nations Children Fund (UNICEF) Eswatini is supporting the government to implement a project to improve maternal, new born and child health, and nutrition in Eswatini. It is against this background that UNICEF Eswatini is recruiting a Health Specialist, (Maternal and Newborn Specialist) to lead execution of the project with government. This project therefore aims at improving the lives of the most vulnerable women and children in Eswatini by ensuring pregnant women and new-borns, and children access a package of quality, integrated maternal, neonatal and child care services, which will promote physical and cognitive development of children. This will be achieved by increasing access to an integrated package of essential services which include the following services: delivery by skilled birth attendants, essential new born care including management of premature babies, nurturing counselling, enhanced post-natal follow up with focus on women living with HIV and their babies, ART adherence, early infant diagnosis and immunization services, infant and young child feeding practices and improving early stimulation and nurturing of the children for improved cognitive development which is key to socio economic development of the country. Understanding the current state of the situation is therefore critical to inform progress assessment achievement of intended results hence need for the baseline assessment.
The anticipated theory of change for the project is that if delivery is attended by a skilled attendant trained in basic emergency obstetric and newborn care, AND high risk pregnancies are identified early, AND birth plans outlining actions to be taken in emergency are followed; and IF the quality and coverage of services for newborn care (including breastfeeding) and sick infants improves, AND more HIV exposed infant gets tested for HIV early AND caregivers (mothers, community health personnel, family members, primary health care professionals) have adequate knowledge on danger signs and take appropriate action, AND health facilities have capacity (knowledge and skills) to provide specialized care for newborns and sick infants and implement standards for newborn care, including death audits; and IF strong leadership and accountability health system for newborn health are clearly defined across the continuum of care, AND there is sufficient quantity of qualified and supervised health personal deployed to all health facilities, AND health information is accurate, timely and used for decision making; AND health commodities and equipment are sufficient, THEN fewer perinatal and neonatal deaths will occur.

2. PURPOSE

 

The purpose of the assignment is to collect and provide adequate, relevant and reliable information, which sets the baseline for the DFID funded maternal and neonatal health (MNH) project to guide and inform progress on achievement of planned results and form basis for the project evaluation. The baseline assessment will focus on areas being supported by project at national level, health facility and community levels. Additionally, the assessment will indicate how UNICEF shall, in the future, evaluate the MNH project, using information from the baseline assessment. 

3. OBJECTIVES

 

The overall objective of this assignment is to carry out a Baseline Survey, which provides evidence useful in realizing the full potential of the MNH Initiative in Eswatini.

The specific objectives of the study are to assess knowledge, attitudes and practices of the target population on maternal and neonatal health (MNH):

1. To assess knowledge and practices on antenatal, delivery, post-natal and essential neonatal care (against World Health Organisation standards) among health workers that protect or predispose newborns to morbidity, disability and deaths
2. To assess health facilities capacity to provide quality newborn care services (guidelines, SoPs, equipment, supplies, infrastructure, human resources) targeting those providing maternity services (against WHO standards).
3. To assess knowledge and skills of community health workers in delivering the package of MNH at community/household level against the country standards
4. To assess knowledge and involvement of community leaders on newborn care issues

Additionally, the consultant will develop an Evaluation Framework that will provide the overall research design and methods that UNICEF shall use, upon completion of the end-line survey, to answer the main evaluation questions. Such a framework will, among other things, specify clearly how the baseline information shall be used later on to evaluate the project.   

 

 

The baseline assessment will focus mainly on the interventions relevant to the UNICEF/DFID supported project and will target public health facilities providing maternity services including those where antenatal and post natal care is provided and constuencies aroung the health facilities where implementation of the project will be done. The project targets 11 health facilities where maternity services are conducted and selected primary health care Units and clinics as well as 20 constituencies (Tinkhundla) in all the four regions of the country. The assement will therfore cover all four regions, the 11 maternity health facilities, sampled PHUs and clinics and selected Tinkhundla.

5. METHODOLOGY

 

The baseline assessment will use a mixed-method, participatory (including gender and human rights responsive, equity-focused) approach to determine the status of MNH capacities at health and community levels

The assessment design will make use of the following data collection methods:

a)    Interviews with key informants at national. Health facility and community levels, and administration of KAP questionnaires
b) Specific Focused Group Discussions with Rural Health Motivators
c)    Specific Focused Group Discussions with male and female parents/caretakers of children under one year of age
d) Newborn care equipment and facility audits/assessment
e)   Desk review

Ministry of Health in collaboration with UNICEF will provide a list of health facilities, partners and a list of key informants once the process starts. The consultant will propose the assessment design, tools and methods while ensuring that this design suits the specific objectives of this context and assessment.

6. TASKS AND DELIVERABLES

 

The consultant will:

• Undertake a literature review to inform a detailed Inception report with methodology, baseline study design, and data collection tools.
• Develop a data collection plan including a selection of respondents in consultation with SRH Programme, and M&E Unit within MoH
• Develop a data quality assurance plan
• Prepare and share fieldwork plan: The consultant will prepare a detailed plan for field work and share the same in advance with UNICEF, SRH Programme, and M&E Unit within the Ministry of Health.
• Undertake data collection as defined in the agreed methodology in the inception report
• Preparation of analysis plan: The consultant will prepare a detailed analysis plan that addressed the  objectives of the baseline study.
• Report writing: The consultant will undertake data analysis, prepare the draft report and share with UNICEF, SRH Programme, RHM Programme and M&E Unit for comments and suggestions.
• The consultant will present the baseline report to stakeholders for validation, comments, and inputs.
• The consultant will incorporate the comments and submit the final report to UNICEF.
• The consultant will develop and submit an Evaluation Framework for the MHN project. 

 

 

Payment, upon completion of each deliverable according to the following schedule:
• Submission of inception report and a draft Evaluation Framework (30%).
• Draft report validation 30%
• Submission and approval of final baseline assessment report, summary report, Powerpoint presentation and final Evaluation Framework (40%)
The payments will be made upon satisfactory completion of the deliverables mentioned above. The final remuneration will be negotiated by HR.

 

 

a) Education: 
Advanced degree (Masters or higher) in Bio-Statistics, Evaluation, Research, Public Health, Epidemiology, Economics, Social Science, or related field.
b) Relevant work experience: 
• At least 10 years of combined experience of conducting research and/or evaluation in community health systems or health systems in general
• Proven experience in design and implementation of quantitative and qualitative evaluation tools and studies; preferably at least 5 years’ experience in leading program evaluations
• Demonstrated experience in ethical research practices.
• Demonstrated expertise in undertaking gender-responsive and equity-focused evaluations
• Ability to analyze, synthesize and triangulate data from different sources for precise findings
• Demonstrated ability to prepare high quality reports in English in a clear, concise manner (a sample of the recent analytical report will be requested)
• Strong organizational skills, attention to detail, and ability to meet deadlines.
• Advanced computer and data analysis skills, including proficiency in the use of Microsoft Office software and statistical software packages (SPSS, STATA, Epi-Info etc) and relevant qualitative analysis software.
• Demonstrated understanding of the health system in Swaziland and/or Southern Africa added advantage.