Consultancy - Programme integration of Infection Prevention and Control (IPC) to prevent the spread of infectious diseases in health care facilities, schools and communities

The purpose of this consultancy is to assist UNICEF COs and ESARO in enhancing integrated IPC programming within Health, WASH and C4D programmes taking into account the specificities and capacities in each CO. This will contribute directly and indirectly to enhancing Member States implementation of integrated IPC and WASH in HCFs and schools.

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                                                                     TERMS OF REFERENCE

Background and Justification

1.1/ WASH & IPC in Health Care Facilities (HCFs) improve quality of care, saves life, and reduce morbidity among patients, co-patients and health care workers

HCF play a vital role in maternal and child health from deliveries to provision of curative outpatient and in-patient care for all patients as well as preventive health interventions. Reliable, safe water in health facilities is required for medical, hygiene and drinking purposes. water, sanitation and hygiene (WASH) services are critical for reducing sepsis among mothers and newborns in HCFs, as well as preventing the transmission of other infections. , are important for provision of respectful health service provision including maternity care where clean toilets are a felt need for women and service providers. . Hand washing, maintaining asepsis and medical waste management are important areas highlighted in “infection-prevention” efforts at HCFs. The multiple benefits of WASH and IPC in HCF are presented on the graphic hereunder, extracted from the WHO guidelines on Core Components of Infection Prevention and Control Programmes at the National and Acute Health Care Facility.

However, the current pandemic threatens to jeopardize efforts to improve WASH services in HCFs and reverse gains made over the years and undermine efforts to achieve SDGs by 2030. The impact of COVID-19 on already weak health systems has been unprecedented. In HCFs with limited or no WASH services and infection prevention supplies, patients and health care workers are at a higher risk of getting infected with COVID-19. In addition, the fear of contracting the disease has contributed to declining service utilization (via health facilities) by communities. With increasing reports of health care workers infections, service utilization is expected to decline further due to closures of HCF, lack of health care workers and not delivering essential health services or COVID-19 treatment, resulting in preventable illness and death. The reported reasons for suboptimal IPC measures in HCF are: (i) inadequate PPE (appropriate quantity and quality), (ii) Suboptimal IPC related skills and (iii) weak WASH and IPC systems and facilities in HCFs

As countries continue to battle the disease, the importance of Infection Prevention and Control (IPC) cannot be overemphasized. The WHO guidelines on Core Components of Infection Prevention and Control Programmes at the National and Acute Health Care Facility Level outline 8 core components for prevention of current and future threats, strengthen health service delivery and resilience of services.
Core component 8 of the guidelines is on, ”Built environment, materials and equipment for IPC at the facility level (acute health care facility only)”, which recommends that patient care activities should be undertaken in a clean and/or hygienic environment that facilitates practices related to the prevention and control of HAI, as well as AMR, including all elements around the WASH infrastructure and services and the availability of appropriate IPC materials and equipment.

1.2/ WASH & IPC in schools are critical components of safe school operation
School closures are one of the public health interventions implemented widely to curb the spread of the SARS-CoV-2 virus. As of 31 August 2020, some 70 million children in ESA countries were out of school due to COVID-19 related school closures, in addition to 37 million already out of school prior to the COVID-19 crisis.
The role of IPC stakeholders, including UNICEF, is critical for facilitating and sustaining safe school reopening and operations, in line with the national strategies and plans for school reopening, and following recommendations from the new WHO UNICEF global guidance on “Considerations for school-related public health measures in the context of COVID-19” : https://apps.who.int/iris/bitstream/handle/10665/334294/WHO-2019-nCoV-Adjusting_PH_measures-Schools-2020.2-eng.pdf

1.3/ UNICEF supported interventions in IPC in HCF and home-based care

In UNICEF’s Eastern and Southern Africa Region, 21 countries are implementing WASH programmes with at least one core component of Infection Prevention and Control (IPC) in Health Care Facilities, and 11 of the countries, (Burundi, Ethiopia, Kenya, Madagascar, Malawi, Rwanda, South Sudan, Tanzania, Uganda, Zambia and Zimbabwe ) have a more comprehensive IPC in HCF’s in line with six of the eight of WHO’s IPC Core Components in HCF .: IPC program coordination and implementation at facility and national levels ; creation or revision of IPC guidelines, IPC SOPs, and IEC at facility and national levels ; IPC knowledge and skills development ; assessment/audit of IPC performance at HCF level ; IPC improvement planning and monitoring and lastly improvement of “built environment”: water, sanitation and handwashing facilities, waste management, equipment and consumables for IPC implementation at the facility level.

Home-based care of mild and moderate Covid cases is a strategy adopted by the majority of ESA countries to reduce the afflux to health facilities and reduce the risk of transmission, and UNICEF Health, C4D and WASH programmes are supporting the implementation targeting the most vulnerable families with risk communication counselling and IEC material, and hygiene and IPC kit (soap, disinfectant, hand-sanitizer, surgical and clothe masks, etc...). For example in Angola, UNICEF has been working with Ministry of Health, WHO and other partners on risk communication counselling at home and skills development of social mobilizers through online training modules (biosecurity measures in infected houses, RCCE). In Burundi risk communication is accompanied with hygiene promotion campaign using local media and provision of soap and promotion of home-made tippy tap to the most vulnerable household. In Mozambique, we distributed a home care package (soap, buckets, and detergent) to quarantined households and support high risk areas with communal handwashing and messaging. In Rwanda, we only contributed to guidelines and will also contribute to IEC materials. Finally in South Africa, we defined the “household Covid kit” with the MoH: it contain a simple handwashing bucket with soap for 2 months, clothe masks for school age children and adults, bleach for disinfecting and hand sanitizer in case water is cut (frequent in informal settlements).

1.4/ UNICEF supported interventions in IPC in Schools

Through IPC and WASH interventions in schools, UNICEF play a critical support role in the process of school reopening. Currently, 112 m children in ESA region are out of school comprise of 37m before the Covid crisis and 75m due to the closure of schools. As of mid-August 2020, schools have partially or totally reopened in only 8 countries: Namibia, Botswana, South Africa, Eswatini, Madagascar, Zambia, Tanzania and Eritrea, with support from UNICEF in one or several WASH and IPC intervention components: rapid IPC-WASH assessment, advocacy, development of guidance, SOPs, and IEC; technical support, training; provision of Water & Sanitation; provision of Handwashing stations; Promotion of hand hygiene and other COVID prevention measures; Supplies (equipment, consumables, ). In other countries, we are collaborating with the Education section in supporting the MoE on the back-to-school preparation (school assessment, SOPs, provision of supplies and training of teachers).

1.5/ UNICEF supported interventions in IPC in Communities
Last but not the least, IPC in communities in a key element of Covid-19 prevention. Since March, all CO WASH programmes in communities have gradually included or scaled up a disease prevention component such as HWWS promotion, installation and management of hands free handwashing with soap stations at strategic public locations (bus and taxi stations, water points, markets, etc…), WASH promotion through social media and radio spots, and training of community WASH committees, health workers and community service organizations.
Although UNICEF HQ and Regional Offices have done a lot in supporting CO IPC programmes in HCF, schools, and communities, through bi-monthly regional calls with WASH chiefs and WASH specialists (Emergency and IPC focal points), disseminating guidelines (including UNICEF publications), launching appeals to mobilize resources, convened partners and donors around the issue, consultant support to the regions will further analyse the interventions of UNICEF in IPC improvements in health and non-health settings, map out the best practices in effective and less effective IPC strategies and interventions, review the role and responsibilities of WASH, C4D and Health programmes/sections in IPC sub-components (health and non-health settings) and work with COs on a transition model for institutionalized IPC in our programmes, strengthen human resources capacities at the regional level and provide an opportunity for UNICEF to further engage with regional actors on the role of WASH in improving IPC, and overall, the response to COVID-19.

1.6/ Role and responsibilities in IPC promotion within UNICEF programmes -Health, WASH, C4D, Education
Acknowledging the critical importance of IPC interventions in HCF, schools, communities and home for saving life and reducing morbidity among children and mothers, the following priorities were agreed upon (Joints Health-WASH-C4D global deep dive global meetings on IPC, July 2020):
(1) Continued engagement at all levels beyond COVID-19;
(2) Specific capacity building support including remote capacity building approaches/ digital platforms;
(3) Resource mobilization: Innovative approach to supporting IPC (such as a pooled fund);
(4) Surge when needed for IPC;
(5) Consistency in the approach supported by a one-stop shop for regions and countries to seek and receive support from PD and avoid dealing with multiple sections;
(6) Protocols adapted to each country context;
(7) New generation of systems strengthening; and
(8) Embedding IPC in all relevant activities.

The present consultancy work will contribute to achieving the above corporate priorities.

Scope of Work

1. PURPOSE

The purpose of this consultancy is to assist UNICEF COs and ESARO in enhancing integrated IPC programming within Health, WASH and C4D programmes taking into account the specificities and capacities in each CO. This will contribute directly and indirectly to enhancing Member States implementation of integrated IPC and WASH in HCFs and schools.

2. EXPECTED OUTCOME

Consensus around key IPC issues and importance to invest in IPC is reinforced; linkage with global events/initiatives such as the IPC deep dive agreements (UNICEF, July 2020), the Hand Hygiene for All global initiative (HH4A ) , and AMR initiative (WHO Global Action Plan on AMR) and the global utilization of the WASH in Health Care Facility Improvement Tool (UNICEF, WHO, https://washfit.org)

• O1: IPC core components currently implemented in UNICEF programming (through WASH, Health, C4D programmes) are better defined, understood, mapped and lessons in IPC programming are learned; recommendations are available to COs for mainstreaming IPC sub-components into UNICEF programming (Health, WASH, C4D, Education): roles, responsibilities, complementarity between sections and with partners (WHO, NGOs, …); Clients: UNICEF RO programme staff, UNICEF CO programme managers, specialists, officers

• O2: National and regional stakeholders with a mandate of promoting WASH in HCF are enabled to better understand and advocate for WASH package in HCFs programmes and more importantly boosting WASH services, and mainstreaming of WASH and IPC in health systems. This outcome will align with the recommendations from the global progress report on WASH in HCF (WHO and UNICEF) due by the end of December 2020. Clients: all national and regional stakeholders engaged in supporting WASH in HCF coverage and quality

3. KEY ACTIVITIES

Related to O1 and O2: under the supervision of the RO, the IPC expert will prepare a brief inception report related to the assignment: detailed work plan with timeframe, preferred methodology for each phase of the work with proposed consultation tools, a list of key reference documents that will be analyzed and a calendar of interviews and FGD with key informants (both UNICEF and external informants)

Related to O1 (UNICEF programmes): under the supervision of the RO and in close liaison with COs and HQ, the IPC expert will analyze the IPC sub-components implemented through UNICEF programme in health and non-health settings, and provide recommendations to COs, RO and HQ for integrated and strengthened IPC in UNICEF programmes and strategies:
• Development of a regional learning note on IPC core components in health facilities, schools and communities, and embedding of these life-saving interventions across all UNICEF sectors
The IPC RLN will:
 Start with a Literature review completed by a learning review on UNICEF IPC sub-components in Health and non-Health settings (community, home care and schools) in the framework of Covid prevention and control, in selected countries; Collect, analyze and synthesize and document case studies, good practices and similar information related to WASH in HCFs from UNICEF Country Offices. Complement the review of existing documents with bilateral calls with selected country programme officers and IPC stakeholders.
 include country case studies, good practices, lessons learned and context-based intervention strategies (illustrated with examples, evidence-based, reader-friendly). Clients: IPC and WASH internal staff and external (partners);
 for RO and selected CO, the RLN will present a roadmap showing the transition from current situation in terms of IPC intervention strategies, and roles & responsibilities, to situation where IPC is explicitly embedded in the relevant sections of the Country Programme, and shows the limits of interventions strategies (role of UNICEF CO vs other IPC stakeholders) ;
 including capacity building plan and entry points for resource mobilization;
 provide recommendations for a transition and pace towards Health-driven IPC programmes in line with global re-alignment of IPC under Health;
 the RLN should clearly highlight key findings and recommendations to UNICEF WASH, Health, C4D and Education programmes;

• A short version of the RLN will be issued as a UNICEF WASH Field Note (template here )
• the RLN will be presented to key ESA region staff through a short orientation course: Development and running of an orientation to UNICEF programme staff (and partners tbc): a presentation of the RLN, the IPC implementation strategies and implementation tools used during the COVID-19 response up to December 2020, and a roadmap from 2020 situation in terms of IPC intervention strategies and roles & responsibilities, to a situation in 2021 where IPC is embedded across UNICEF programme with clear roles, responsibilities and boundaries with other key stakeholders (WHO in particular). The IPC programme orientation will be supported by both Health and WASH ESARO sections, with participation from C4D.

Related to O2 and scaling up of WASH in HCF: under the supervision of the RO and in close liaison with COs and HQ, the IPC expert will:

• Develop an inter-sectoral regional strategy for scaling up WASH coverage investment in HCF in line with the recommendations from the WHO/UNICEF global progress report on WASH in HCF: analyze current strategies, plans, enablers and barriers; identify entry points, opportunities, and financing strategies, and prepare recommendations for scaling up WASH coverage in HCF. This activity will be conducted in close consultation with WASH in HCF stakeholders in selected countries. The consultant will also liaise with IPC focal points and WHO AFRO IPC team to understand the implications of poor WASH facilities to IPC performance in HCF. This will require a review WASH in HCF national status, development plans and monitoring systems
• Conduct a Regional event with presentation of findings and recommendations to country and regional WASH in HCF stakeholders and deciders. The conclusion of the event should present actionable recommendations to all stakeholders.

Methodology

• Desk Review
• Meetings/interviews/FGD with key UNICEF and Sector and Programme Partners through remote and face-to-face exchanges, at individual and group levels
• Presentation & validation stakeholder workshops
• Other appropriate data/information collection and analysis tools and approaches. The methodology will be detailed in the inception report.

Desired competencies, technical background and experience

The consultant should have:
• Advanced university degree in Public Health related studies
• Minimum 8 years of relevant experience (P4 level) in programming and demonstrated experience in WASH and IPC in Health Care Facilities programming
• An excellent understanding of the principles and SOPs in quality of care in HCF, importance of IPC in schools and communities
• Demonstrated ability to conduct consultations with regional institutions, governments and facilitation of meetings
• Fluent in written/spoken English and excellent English report writing skills and a track record of producing high quality reports.
• Knowledge of WHO and UNICEF working environment is an asset

Competencies of Successful Candidate

• Builds and maintains partnerships
• Demonstrates self-awareness and ethical awareness
• Drive to achieve results for impact
• Innovates and embraces change
• Manages ambiguity and complexity
• Thinks and acts strategically
• Works collaboratively with others

Payment conditions

As per UNICEF DFAM policy, payment is made against approved deliverables. No advance payment is allowed unless in exceptional circumstances against bank guarantee, subject to a maximum of 30 per cent of the total contract value in cases where advance purchases, for example for supplies or travel, may be necessary.

The consultancy will be governed by and subject to UNICEF’s General Terms and Conditions for individual contracts.

Application submission and evaluation process

The documents for the Technical Proposal should include:

- Resume/CV including relevant experience/specific role in undertaking similar consultancy, education/other trainings, knowledge of local languages, references, etc. – no more than 3 pages
- Description of other similar assignments undertaken during the last 5-10 years including name of the Project, location, name and contact details (e-mail and telephone) of the client, implementation period, cost of the Project, cost of services provided and scope of services – no more than 3 pages
- Proposed approach, methodology and workplan in response to successful complete this consultancy (including proposed number of days required to complete expected deliverables) – no more than 4 pages

Administrative and travel issues
- No equipment or office supplies will be provided by UNICEF
- Currency used must be in US dollars
- Invoicing will be in the currency of the proposal
- All outputs shall be the absolute property of UNICEF
After the contract is initiated, the consultant may, within reason and with the prior written approval of UNICEF, adjust line items within the proposed and approved budget, only if doing so does not increase the total cost of contract.

Gender and Human Rights, including child rights

The Consultant will encourage women’s participation during data collection as they are both duty bearers and rights-holders of the target population. Where possible, involving children of appropriate age is also encouraged, especially when collecting data pertaining to schools.
All data collected should be disaggregated by sex, age and location.
The evaluation process will be guided by relevant instruments or policies on human rights, including child rights and gender equality.

Conditions
As per UNICEF DFAM policy, payment is made against approved deliverables. No advance payment is allowed unless in exceptional circumstances against bank guarantee, subject to a maximum of 30 per cent of the total contract value in cases where advance purchases, for example for supplies or travel, may be necessary.
The consultant selected will be governed by and subject to UNICEF’s General Terms and Conditions for individual contracts.
All products and data developed or collected for this agreement are the intellectual property of UNICEF. The consultant may not publish or disseminate the final report, or any other documents produced from this work without the express permission of and acknowledgement of UNICEF.

How to Apply
Interested candidates should apply online using the button below and should include financial proposal for undertaking the assignment as part of their application.