National Family Planning Policy and Developing Guidelines

Background:

The IRC responds to the world’s worst humanitarian crises and helps people whose lives and livelihoods are shattered by conflict and disaster to survive, recover, and gain control of their future. IRC was founded in 1933 through the advice of Albert Einstein to respond to the needs of people vulnerable to conflict around the world. Since then, it has expanded and evolved to become one of the world’s leading humanitarian organisations. In 2016, more than 26 million people benefited from IRC programs and those of its partner organizations.

The IRC with funding from UNFPA is implementing a project Provision of Integrated Reproductive Health/GBV/ASRH Information and Services Bentiu PoC, Maluakon, Aweil and Rumbek Hospital with an expected output on National systems, especially for maternal health and family planning are strengthened for the provision of quality integrated sexual reproductive health information and services and for accountability on sexual reproductive health and rights. With this regard, the IRC in collaboration with the MOH and the UNFPA is seeking a consultant to update the current South Sudan national Family Planning Policy and developing Guidelines to improve access to quality and human right-based family planning information and services. 

South Sudan is the world’s newest nation and covers a geographical area of approximately 640,000 square kilometres. The population of South Sudan was estimated at 13 million (2019) and is predominantly young with about 51 percent of the people aged below 18 years and 72 percent under 30 years. Women constituted 48 percent of the population, men account for 52 percent. Women of childbearing age (15-49 years) constitute about 24 percent of the total population, with a total fertility rate of 6.7 per woman. Overall life expectancy at birth was estimated to be 57 years.

South Sudan has been facing protracted humanitarian crisis since 2013 because of political and armed conflict. At present, four million people have been displaced: 1.9 million internally and 2.1 million as refugees in neighboring countries. South Sudan also hosts 280,000 refugees mostly from Ethiopia and Sudan. Most of the displaced population are women, young people and children who need basic social services. Every year, about 2 million people are affected by floods.

With the signing of the Revitalized Agreement on the Resolution of the Conflict in the Republic of South Sudan in 2018, there has been a general improvement of the political and security situation in the country. This is underpinned by the continued observance of the Permanent Ceasefire and an absence of armed conflict between the different conflict parties. However, there are isolated instances of armed conflict between government forces and parties that are non-signatory to the agreement as well as intercommunal conflicts. This relative peace has resulted in some return of internally displaced persons and refugees to their original locations.

South Sudan is one of the world's least developed countries with little existing infrastructure. The gross domestic product growth was estimated to be 5.8 percent in 2019, a large increase from 0.5 percent in 2018. The oil sector remained the key driver of the economy, followed by services and agriculture. The economic situation in the country remained unfavorable, characterized by high inflation rates that fluctuated between 379% in 2016 to 83% in 2018 and 175% in December 2019. The GDP per capita declined from USD 1,309 in 2014 to USD 275 in 2019. This together with the decline in oil production because of the conflict, global oil price fall, low revenues from oil exports and depreciation of the local currency, undermined the government’s ability to deliver basic services including health care.

The country has had some of the world’s worst social indicators, particularly for women. Recent United Nations statistics estimated the maternal mortality ratio at 1,050 per 100,000 live births in 2017 up from 789 in 2015. The high maternal mortality ratio was mainly due to limited coverage and availability of quality services, confirmed by the extremely low skilled birth attendance rate of 1952 percent. Only 40 percent of health facilities were functional, though most still lacked equipment, supplies and enough and mix of health personnel, especially midwives. The contraceptive prevalence rate was 4.5 percent with modern methods at 1.7 percent and the unmet need for FP was 23.9 per cent. South Sudan is among the ten countries in the world with the highest prevalence of teenage pregnancy. The South Sudan Household Health Survey 2010 reported that about 31 percent of teenagers had begun childbearing: 26 percent of female adolescents 15–19 years of age reported a live birth; 5 percent were pregnant with their first child; and 3 percent had given birth before the age of 15.

Gender inequality is highly prevalent in South Sudan, and it manifested itself in high maternal mortality rate, as well as high rates of child marriage, with more than half of the girls marrying under age 18 years. In South Sudan, it’s estimated that only six per cent and 20 per cent of enrolled girls complete primary and secondary education respectively Both child marriage at 45 per cent and teenage pregnancy at a rate of 300 per 1,000 adolescent girls are high and are contributing factors to low school enrollment. The on-going conflict exacerbated the issue of SGBV. Women and girls who experienced SGBV during the conflict were impacted by psychological trauma, HIV/AIDS, social marginalization as well as the effects of unwanted pregnancy.

Scope of Work: 

In the process of updating the National Family Planning Policy and developing the necessary guidelines, full recognition has to be given to the sensitivities that would be involved in adopting a Policy and its implementation. As the success of the policy will be contingent upon changes in individual behavior and attitudes towards the family and resource planning decision-making process, it is important to underline that the policy has to be formulated keeping in view the essence of South Sudan culture and traditional values, while respecting the views of religious leaders and the complexities of post war situations.

More precisely, the National Family Planning Policy has to be developed through a participative approach underpinned by the use of evidence from legitimate data sets from relevant authorized government bodies. This Policy has to be supported with a structured analysis of the context of the South Sudan in the field of Family Planning. It must take into consideration perspectives of leaders, religious leaders, women leaders, youth leaders, members of organized forces (Army, Policy, National Security elements…etc.) members of the Ministry of Health and Social Welfare and other relevant government institutions, including Parliamentarians, some development partners and civil society to construct a policy that reflects the needs and desires of the people of  South Sudan that is appropriate to their culture, context, structure and economic ambitions. It has to propose a delivery strategy that is contextually appropriate for South Sudan today and in line with the principle and values of Family Planning which are:  holistic; responsible parenthood; health and well-being of the family and individuals; respect the right of individuals and families; freedom for choice and decision; respect of culture, tradition and religion; voluntarism; the right to have children; human dignity; comprehensive; inclusive and non-discriminatory.

In that perspective, the International Consultant has to provide technical and strategic guidance to the Ministry of Health in the development of the National Family Planning Policy. Through the undertaking of a desk review and the facilitation of consultative meetings with relevant stakeholders, he or she has to support the design and development of the National Family Planning Policy and the necessary guidelines.

The anticipated duration of the contract is 30 working days, starting 2^nd May, 2022. The Consultant will work for the Ministry of Health on a full-time basis and be based at the IRC South Sudan Country Office within the following timeframe:

Task:

1. Write and submit inception report

2. Desk review with a focus on the SWOT analysis of the following Family Planning components:

· Service Delivery: Quality and accessibility of the family planning services to couples and individuals to achieve desired family size by assisting with pregnancy planning, birth spacing, and preventing unintended pregnancy.

· Human Resources: Availability of qualified and competent health professionals (including doctors, midwives and nurses and community-based workers) in the family planning program, in order to deliver safe and quality services to clients.

· Information, Education, and Communication: Availability of Information, Education, and Communication (IEC) services to provide comprehensive and quality family planning information to couples (and individuals).

· Commodity security: Availability of family planning commodities, logistic services, consumables and other supplies for the family planning program.

· Financing: Availability of funds to finance family planning information and services and its execution in a transparent and accountable manner.

· Leadership and Governance: Guarantee good governance and leadership in implementing good and quality family planning services through good coordination, planning, implementation, monitoring and evaluation, and through the provision of standard operating procedures (SOPs) and guidelines on family planning services.

3. Formulate a supportive policy and guidelines that embrace human right based approach  

4. Working through relevant stakeholders (religious leaders, women leaders, youth leaders, members of the Ministry of Health and Social Welfare and other relevant government institutions, including Parliamentarians, development partners and civil society) to identify additional issues on policy support to support implementation

5. Write and submit the DRAFT National Family Planning Policy and the Guidelines

6. Provide technical support to the partners on how to roll out the National Family Planning Policy

7.  Validation of National Family Planning Policy and the Guidelines

8.  Update and Finalize Policy Document and the Guidelines

Key Deliverables:

1. Consultant will produce and submit inception report detailing evaluation design and methodology, tools, and instruments to be used in this evaluation withing 5 days after the sign of the contract/agreement. The inception report will be reviewed and approved by IRC within 2 days after submission before allowing any survey activities to continue.

2. Consultant will produce and submit first draft National Family Planning policy for review and comments to IRC, UNFPA and MOH - the outline for this delivery could be as agreed in the inception report, but it should meet the scope of works as indicated in this TOR.

3. Consultant will develop a final report- the Consultant is accountable to maintain the requirements for the content, format, and length of the final report, overall quality and agreed timelines. Final endline report should incorporate all comments from the MOH in South Sudan- RH directorate, the UNFPA and IRC.

IRC Responsibility:

1. Work closely with the MCH coordinator in planning, coordination, and execution of the assignment.

2. Induction on the IRC safeguarding policy for the consultant and enumerators before undertaking any business bearing the IRC

3. Responsible for organizing meetings with the different stakeholders during the survey (if required).

4. Introducing the consultant to the Ministry of Health, key contact persons in UNFPA for easy execution of the evaluation.

5. The IRC will also facilitate the consultant to work in close collaboration with UNFPA and the Ministry of Health throughout the evaluation.

Consultant Responsibility:

1. Participate in the induction to the safeguarding policy and sign the safeguarding statement.

2. Ensure the evaluation is conducted as per the TOR and contract.

3. Ensure the highest research ethical standards and transparency are upheld during the evaluation.

4. Ensure that the time scheduled is adhered to.

5. Responsible for his or her stationaries and other items needed for the evaluation.

6. International and national flights/travel will be at the Consultant's responsibility.

7. Consultancy fee is expected to cover the Consultant's subsistence needs (food, accommodation, security/allowances, enumerator fees, training). All costs related to the evaluation should be included in the consultation fee.

8. Consultant will be responsible to train the enumerators which is agreed as per inception report, and test the tools agreed (if needed) Refinement will be checked by IRC after field testing.