Consultancy - For developing a Surge Response model for health and nutrition service delivery for both International & National professionals for 5 months
UNICEF Uganda is looking for a consultant to to support the Ministry of Health and the District Health Management Teams for timely response to spikes in acute malnutrition among children under 5 and other morbidities, including malaria and diarrhoea. The approach will contribute to health system strengthening (HSS) for a more resilient response to surges in acute malnutrition, malaria and other diseases in the Karamoja region. The lessons learned will be used to scale-up the response approach to other parts of the country, including refugee-hosting districts.
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Under the supervision of the UNICEF Nutrition Specialist (Nutrition specific) the consultant will support the Ministry of Health and the District Health Management Teams for timely response to spikes in acute malnutrition among children under 5 and other morbidities, including malaria and diarrhoea. The approach will contribute to health system strengthening (HSS) for a more resilient response to surges in acute malnutrition, malaria and other diseases in the Karamoja region. The lessons learned will be used to scale-up the response approach to other parts of the country, including refugee-hosting districts.
While Uganda has made great strides in reducing poverty, the rates of malnutrition in children and mothers are still unacceptably high, compromising their health and survival. While wasting affects 4 per cent of children under 5, 1.3 per cent are severely wasted (UDHS 2016). Rates of malnutrition vary by region. More recent data indicates that child wasting among children 6-59 months in Karamoja is 10.4 per cent (FSNA, 2018), which is considered to be ‘high’ as per WHO classification criteria. Even within Karamoja, some districts have acute malnutrition rates which are at or close to 15 per cent child wasting and considered to be ‘very high’ or ‘critical.
Generally, infant and young child feeding (IYCF) practices have remained suboptimal throughout the country and in Karamoja. The immediate causes of malnutrition in Karamoja are poor diet, which is a result of both inadequate feeding practices and food insecurity, and extremely high levels of infectious disease-related morbidity, such as acute respiratory illness (ARI) and malaria. Karamoja has the highest malaria prevalence in the country (70 per cent), while Acute Respiratory Infection (27 percent) is nine percentage points higher than the next worst region (UDHS 2016). Prevalence of diarrhoea is high among the younger aged children (39 per cent among 6 to 11 month-old infants and 31 per cent among 12-24 months). This is the age group when complementary foods are introduced, and children are at increased risk of exposure to unhygienic environment during this exploratory phase. Open defecation, inadequate hygiene practices and insufficient use of insecticide treated nets (ITN) to prevent malaria are likely to contribute to high prevalence of infectious diseases among children in Karamoja.
The Integrated Management of Acute Malnutrition (IMAM) programme in Karamoja has a coverage of 49 per cent (2015 Coverage Assessment). This coverage needs to be increased further if services are to reach every child in need. With funding support from DFID under the Karamoja Nutrition Programme (KNP), UNICEF and WFP are supporting the Ministry of Health at national and district levels to strengthen the IMAM programme. Ministry of Health has recently updated the IMAM guidelines for the country, and many achievements have been attained under KNP to integrate the different components of IMAM within the health system. At the moment, SAM and MAM services are provided through health facility or community services (e.g. outreaches). Furthermore, data collection has been improved through standard and innovative approaches (e.g. SCOPE CODA). In line with the guidelines on IMAM in Uganda and within the framework of UNICEF and WFP support for health system strengthening, KNP is also supporting the development and roll out of a SURGE model as a tool for evidence-based decision making in the context of surges in acute malnutrition, malaria and diarrhea. The aim is to improve coverage and quality of IMAM and other essential services even during possible surges, with minimal disruption of ongoing health services.
The Government of Uganda has few systems and tools in place that trigger an intensified support for essential services, mainly human resources and supplies. However, this is mainly focused on disease outbreaks and specific emergency contexts (e.g. floods). The current governmental systems do not include nutrition triggers. Over recent years, there have been attempts by partnes and non governmental organizations (e.g. surge model by CONCERN Worldwide) to strengthen the capacity of government health systems to manage increased caseloads of children with acute malnutrition (both SAM and MAM) during predictable and unpredictable emergencies without undermining ongoing health services. The surge model specifically focused on improving planning and management of treatment services during seasonal spikes or surges in case-loads of acute malnutrition. However, these approaches have not been sustained or scaled up.
As part of the Karamoja Nutrition programme (KNP), UNICEF and WFP will use a systems approach to support Ministry of Health and district local governments to build on the available systems (e.g. Health Management Information System – HMIS) and governmental platforms to define standard operating procedures (SOPs) for surge support, including trigger mechanisms, targeting methodologies, coordination structures, recommended response measures, reporting and monitoring systems. By utilizing existing governmental platforms, the health sector will be able to adopt surge response mechanisms with minimal additional resources, making the approach sustainable and scalable. The SOPs will be used to inform phased shock responsive actions in a timely manner, specially at early moments and through the shocks.
- Conduct desk review of global and national level models for responding to spikes in public health concerns; examine lessons learned from the extensive Uganda experience around alerts and responses to abnormal changes in communicable diseases for adaptation into the new SOPs; review the IMAM surge mechanism developed by CONCERN in Uganda and elsewhere; review and analyse the HMIS data (including DHIS2 and mTrac data sets) on IMAM, malaria and diarrhoea from health facilities for the target districts in Karamoja (where data are currently available) to describe the trends and impact of shocks on admissions and quality of services e.g. defaulters, mortality, for common morbidities and acute malnutrition.
- Interview/interact with district and health facility teams to assess and document the extent to which the CONCERN model was implemented and has been sustained.
- Engage district health teams and health facilities on their capacity to respond to health surges (e.g. malaria, diarrhoea, ARI)
- Identify overall capacity of districts and health facilities to cope with shocks by establishing thresholds, acknowledging that different health facilities might have different capacities to respond to a shock.
- Facilitate stakeholder (including members of the Nutrition Technical Working Group) meetings and consultations and lead the drafting of standard operating procedures (SOP), TORs and training manuals for responding to surge.
- Set and validate health facility capacity-sensitive surge thresholds with relevant stakeholders, including especially health facility staff and district health management teams (DHMTs).
- Agree on specific budgeted actions so that the health staff at health facilities and districts can adopt and use the surge response model in their programming for timely phased response.
- Define the expected actions, including roles and responsibilities of development partners and stakeholders (at national, district and health facility levels).
- Define a progression plan, by which health facilities and districts are expected to improve their capacity to respond to a shock. Thresholds for response will be expected to increase over time, as capacity of health facilities increases. The initial baseline thresholds should be context-specific, based on the current capacity of the health facility.
- Develop the surge response implementation guidelines, SOPs, toolkit and training manual and present to the Nutrition Technical Working Group for clearance.
- Support capacity development for the roll out of the SURGE response approach, including Training of Trainers at national, district levels and health facility level, and roll-out in at least 1 district. The consultant should mentor and guide the trained trainers in the roll-out of the training on the response model.
To qualify as an advocate for every child you will have…
- A Master’s degree or a PhD in Nutrition, public health, health sciences, medicine, or any related subject.
- At least five years of nutrition and/or health work experience, with experience in any of the following areas: IMAM, emergency nutrition, nutrition program management, nutrition monitoring/ surveillance and health system strengthening.
- Demonstrated knowledge in developing and implementing the SURGE models.
- Knowledge of health systems strengthening approach.
- Knowledge of Uganda health system.
- Significant national and/or international experience in developing contexts.
- Understanding of UN procedures and prior experience in Karamoja region
- Demonstrated facilitation skills, excellent report writing and presentation skills.
- Effective organizational skills drive for timely results, strong analytical skills.
- Teamwork and strong interpersonal skills and intercultural work experience.
Application Procedure/Call for Proposals
Interested candidates are required to submit a technical proposal on how they intend to approach the work. The proposal should include a timeline, and methodology, based on the Terms of Reference. The proposal must also include detailed CV of the consultant, as well as a financial proposal, clearly indicating daily rate for professional fees. The financial proposal must be all-inclusive of all costs (consultancy fees and where applicable air fares, airport transfers, daily living expenses). This is an international level consultancy and competitive market rates should apply.
Evaluation of Candidate:
The consultant will be competitively selected from a list of applicants based on their past experience of doing similar work (extensive experience in writing donor reports, in compiling and editing annual reports for various UNICEF offices).
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 competencies required for this post are….
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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.
UNICEF has a zero-tolerance policy on conduct that is incompatible with the aims and objectives of the United Nations and UNICEF, including sexual exploitation and abuse, sexual harassment, abuse of authority and discrimination. UNICEF also adheres to strict child safeguarding principles. All selected candidates will, therefore, undergo rigorous reference and background checks, and will be expected to adhere to these standards and principles.
Only shortlisted candidates will be contacted and advance to the next stage of the selection process.