UNICEF South Sudan PMTCT Consultant

Summary
Purpose To update PMTCT situational analysis by assessing PMTCT programme management and implementation and to help develop 5- year National PMTCT Strategy/Scale-up Plan for South Sudan Expected fee
Location Juba, South Sudan
Duration 6 months (24 weeks)
Start Date February 10, 2013 – August 9, 2013
Budget Code/PBA No
Project and activity codes 4040/AO/01/001/006/001
Reporting to MNH/PMTCT Unit Head

Background:

South Sudan is inhabited by about 10 million people of multi-diverse culture and ethnicity origins, spread across a land area of approximately 640,000 square kilometers (km2) divided into ten states, 79 counties, 514 administrative Payams and 2,159 Bomas with varying degree of development and challenges . Population is generally young with children less than 5 years old constituting about 21% of the total population and about quarter (25%) are women of the child bearing age

Public health care delivery system is on its infancy stage picking up from the rubbles of about two decades of civil war, tribal conflicts, marginalization and insecurity. These massive deprivations to quality basic health/social services have undermined human development resulting to high rates of maternal and child deaths, malnutrition and low literacy rates. The 2009 IOM village assessment and monitoring reports showed that there is only about 6% functional health facilities for Warrap and NBeG, and about 71% travel more than an hour to reach a health facility.

South Sudan has the highest maternal mortality ratio in the world at 2,054/100,000 LBs (2006 SSHS) mostly due to pregnancy related complications. Furthermore, the increasing cases of HIV+ pregnant women, malaria and anemia further compromised the survival of women and their newborns.

South Sudan is categorized as a country with a generalized HIV epidemic with an estimated national prevalence of 3.0% based on 2009 antenatal clinic surveillance in 24 sentinel sites, varying across states from 0% to 7.2%. The HIV prevalence rates are highest in states in the south namely Western, Central and Eastern Equatoria States bordering Uganda, DRC and CAR. Western Equatoria has the highest prevalence rate at 7.2% and Northern Bahr Ghazal State with the lowest at 0.0%. In July this year, CDC EPI-AID conducted an investigation on HIV in WES through review of data, FGDs and KIIs which revealed a high HIV prevalence in western counties of WES compared to national average and similar to the high HIV prevalence observed in neighboring province of DRC. All data sources reviewed by the team indicate that sexual risk factors is the leading driver of HIV transmission in WES and the other risk factors are high prevalence in neighboring counties, increased mobility of the population, erosion of traditional norms, increased commercial and road transport, stigma towards PLHIV, limited access to HIV services and major shortage of health human resources.

Also, while a little than half of respondents (53%) heard about HIV, only 8.6% has comprehensive knowledge on HIV and only 15% has knowledge on the 3 modes to transmit HIV from mother to the child. Furthermore, of the 40.3 % pregnant women with at least one ANC visits in the past two years from the survey, only 11.5% delivered in health facilities; only 15% were counseled of which only 9% were tested.

UNICEF started its development support to MoH and SSAC on HIV/AIDS in 2008, in partnership with other development partners. This partnership resulted to the development of HIV/AIDS Strategy Framework, final draft PMTCT Guideline, PMTCT trainers’ manual and participants’ manuals, IEC materials and establishment of 48 PMTCT sites across the ten states. Specific support of UNICEF to these PMTCT sites are training of health workers, provision of supplies, outreach services, IEC on HIV/AIDS, monitoring and mentoring services, and support to coordination mechanisms. Despite the progress made to prevent transmission of HIV/AIDS from the mother to her young child, the challenge ahead is daunting requiring more strategic and systematic approach to PMTCT.

Guided by national development agenda, HIV/AIDS Strategy Framework, BPHNS, and the progress made on PMTCT services it is important for South Sudan to also have a clear and context specific roadmap to strategically move forward PMTCT services. Series of upstream advocacy resulted creation of PMTCT TWG. The first meeting has discussed on the need to update situation on PMTCT as well as to develop a 5 year National PMTCT Strategy/Scale-up Plan specific to South Sudan context. Development will be done through participatory processes with the Division of HIV/AIDS-MoH at the driving seat with technical support from the PMTCT TWG. This plan, in addition to the final draft PMTCT operational guideline, will provide the specific legal mandate to ensure the delivery of PMTCT services within HIV/AIDS Strategy Framework and health system strengthening strategy of the Ministry of Health of South Sudan.

Sound updated situational analysis on PMTCT for South Sudan is vital to ensure the development of a responsive and context specific strategy/scale-up plan. To date, sources of data can only be generated from administrative PMTCT reports, quick assessment in selected health facilities in WES, limited field monitoring and annual reports and the recently concluded 2012 ANC Sentinel Surveillance initiative. To enhance situational analysis as one key foundation to the 5- year PMTCT Strategy/Scale-Up Plan, it is important to assess/evaluate first existing PMTCT initiatives. This is to understand any good practices, progress made, other lessons learned and other programmatic/operational challenges within and outside the health system.

Justification

Rapid reduction of maternal, neonatal and child deaths and under-nutrition in the Republic South Sudan requires a strengthened RSS health system that is able to provide quality continuum of maternal, neonatal and child health care and PMTCT services from pre-pregnancy to the first two-five years of life through the three delivery modes (health facilities, outreach/community services and family).

Also, the health system must have competent, knowledgeable and women/child friendly service providers at all levels capable to deliver evidence-based cost effective interventions, with functioning oversight systems/mechanisms. Parallel to availability of services, claim holders need to foster appropriate health caring and seeking behaviours through participatory behavioral change communication activities.

Establishment of strengthened health system able to provide an integrated continuum of care to women and children is anchored to country’s evidence-based policies, development/strategic plans adapted to local context and situation with back-up technical operational guides, job-aids and tools. To date, the HIV/AIDS Strategy Framework and the final draft PMTCT guidelines provides the legal framework to PMTCT Programme/services. There are also available PMTCT training tools and IEC materials adapted to South Sudan context. To strategically respond collectively to HIV/AIDS/PMTCT challenges aimed at reducing maternal and under-five deaths, it is timely and proper to develop context specific 5-year PMTCT Strategy/Scale-Up Plan to provide a common roadmap to MoH and its partners to the provision of PMTCT services with bias to the poor and marginalized sectors of the society, regardless of fund source and implementing agencies. Collective implementation of a results-based PMTCT plan also supports the peace building initiatives of a fragile country like South Sudan.

The South Sudan context specific PMTCT Strategy/Scale up plan will be drawn from lessons learned and progress made from previous country experiences while localizing globally proven PMTCT interventions, and addressing remaining operational challenges. As such, assessment/evaluation of PMTCT programme management and implementation will have to be done first to update any available situational analysis on PMTCT.

Development of updated situational analysis on PMTCT and drafting of a context specific 5-year PMTCT Strategy/Scale-Up Plan will be through multi-sectoral and multi-level consultations requiring a full time staff. Furthermore, South Sudan, youngest country in the world trying to pick up from the rubbles of war and inter-tribal conflicts, is faced with shortage of health human resources both at programme management and implementing levels. The situation, therefore, warrants the need of a consultant to lead the process leading to the development of an updated PMTCT situational analysis and to draft a national PMTCT Strategy/Scale-Up Plan.

Main Duties

Under the guidance of MoH-Division of HIV/AIDS and PMTCT TWG, the consultant will:

1. Review all existing documents on HIV/AIDS giving more focus to PMTCT, MoH national policy and strategy, Basic Package of Health and Nutrition Services of ROSS; any available field reports and local studies on HIV/AIDS/PMTCT, if available.
2. Develop inception note, including robust sampling frame, adapt assessment tools and guide/design to local context, as guide to implement approved consultancy services.
3. Work closely with PMTCT TWG, Division of HIV/AIDS-MoH in the actual implementation of the agreed task/deliverables.
4. Conduct assessment in selected PMTCT sites, validate, collate and analyse assessment data.
5. Analyse all available data on PMTCT and come up with an updated PMTCT situational analysis for South Sudan. Present final draft SITAN to PMTCT TWG
6. Facilitate multi-sectoral and multi-level planning consultations on PMTCT.
7. Draft 5-year PMTCT Strategy/Scale-up Plan for South Sudan, present draft to PMTCT TWG and integrate comments/feedback.
8. Submit final electronic and hard copies of technical report (PMTCT Assessment Report, updated PMTCT situational analysis and 2nd final draft PMTCT Strategy/Scale-up Plan) to MoH-HIV/AIDS Division and UNICEF-SS. Make final presentation to PMTCT TWG.

Payment schedule and Reporting

It is anticipated that the payment schedule will be as follows:

• 30% will be paid after approval of the inception note.
• 30% will be paid after submission of final assessment report/updated situational analysis
• 40% upon satisfactory completion of all tasks and submission of draft 5-year PMTCT Strategy/Scale-Up Plan.

Reporting:

Monthly progress reports, mid-consultancy report, and final report at the end of the contract will be submitted to the Division of HIV/AIDS of Ministry of Health - RSS, copy furnished UNICEF.

Expected Deliverables: (Hard and e-copy)

• Inception Note
• PMTCT Assessment Report
• Updated SITAN on PMTCT
• Draft 5-year National PMTCT Plan

Desired background and experience:

1. University degree or equivalent in medicine, nursing and midwifery, social science, public health or other relevant discipline, preferably with master’s degree in public health
2. With at least 5 year work experience on PMTCT programming and management with actual field exposure, possesses working knowledge on health system strengthening, monitoring and supervision
3. Excellent communication skills
4. Creative thinking, drive for results and strong commitments.
5. Good inter-personal relationship even in diverse work environment and professional background
6. Added advantage: work experience in Southern Sudan

Duration of Assignment:
It is expected that the work will last about six months (24 weeks).

General Conditions: Procedures and Logistics
The organization will assume responsibility for the following:
• DSA for journeys outside duty station (Juba) as per existing UNICEF rules.
• While in Juba, DSA will be provided at the current Juba rate depending on choice of accommodation e.g. commercial facility, UN Guest Houses, or for other accommodation.
• The consultant will work from combination of locations such as UNICEF office, Ministry of Health- GOSS, and UNICEF supported partners in the States or remote locations depending on the availability of office space at UNICEF.
• The consultant will be required to come with his/her laptop but UNICEF will provide all other supplies related directly to the task for duration of the consultancy.
• While in the field the movement of consultant will be facilitated by UNICEF; thus access to UNICEF transport will be authorized.
• Final payment to the consultant will be dependent on the completion of deliverables as well as hand over notes and submission of the completion of consultancy Performance Evaluation Report (PER).
• UNICEF will only cover the costs of economy class from destination of Juba and back. All flight costs within Southern Sudan will also be covered by UNICEF. Unless authorized, UNICEF will buy the tickets of the consultant. In exceptional cases, the consultant may be authorized to buy his/her travel tickets and shall be agreed to beforehand.

Policy both parties should be aware of:
• The consultant is not entitled to payment of overtime. All remuneration must be within the contract agreement.
• No contract may commence unless the contract is signed by both UNICEF and the consultant.
• For international consultants outside the duty station, signed contracts must be sent by fax or email. Signed contract copy or written agreement must be received by the office before the consultancy can be undertaken by the consultant to the duty station, without prior submission of insurance cover and waiver in the event of injury while executing the duty.
• The consultant will not have supervisory responsibilities or authority on UNICEF budget.
• Consultant will be required to sign the Health Statement for consultants/individual contractor and to complete the Basic Security in the Field Course 11, prior to taking up the assignment, and to document that they have appropriate health insurance, including Medical Evacuation.
• The Form Designation, change or revocation of beneficiary must be completed by the consultant upon arrival, at the HR Section.

How to apply:

Human Resources Officer
UNICEF South Sudan Country Office, Juba
OR Preferably: Email: jubavacancies@unicef.org .