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KENYA CO TERMS OF REFERENCE (TOR) FOR INDIVIDUAL CONTRACTORS/ CONSULTANTS
PART I
Purpose of Assignment
Consultant to design the Boresha Afya ya Mama na Mtoto programme in Vihiga County
Location of Assignment
Nairobi with frequent travel to Vihiga County
Duration of contract
30 Days in period of 2 months
Start date
From: 15th January 2019
To: 15th March 2019
Reporting to:
UNICEF, Social Protection Specialist
Background and Justification
In 2017 Vihiga county had an estimated number of 22,426 pregnant women (3,3% of the total population). The coverage of key reproductive, maternal, newborn, child and adolescent health (RMNCAH) indicators in Vihiga remain undesirable, and the county stands to drag the country progress to 2030 SDG targets behind unless they can be accelerated. For example, Vihiga County’s maternal mortality ratio (MMR) stands at 531 per 100,000 live births, the fourteenth highest in the country while coverage with routine childhood vaccinations as measured by the fully immunized child (FIC) indicator stands at 78%, below expected levels of at least 80%. The low percentage of mother attending the 1st and 4th ANC is also alarming with respectively 35 % and 34,6 % and only 50 % of mothers give birth under skilled attendance which is way below the national target of 65%[1].
In spite of some improvements in the area of RMNCAH over the last couple of years, the county still experiences a large number of challenges preventing women in reproductive age to access RMNCAH services in a satisfactory manner, increasing the potential risk of maternal and neonatal fatalities. The county has not yet undertaken a thorough bottleneck analyses to identify the main barriers to RMNCAH services. Such an analysis will be urgently needed in order to assess which barriers are demand driven and which ones are due to supply side constrains. However according the most recent review of the County Health Sector Strategic and Investment Plan (October 2017), based on a qualitative assessment of the major health indicators by key stakeholders in the county the major constrains with regard to the uptake of RMNCAH are related to limited specialized care, severe gaps across all cadres of health workforce, and inadequate essential health products and technologies that affected the provision of quality services. The following indicators are particularly alarming and need urgent and close attention.
Antenatal care
Antenatal is care given to a pregnant mother from the time of the conception up to delivery time. Focused antenatal care aims at early identification and management of complications in order to achieve good outcomes for the mother and baby. Currently, the focus for the Country and County is on the first and fourth ANC visits.
The clients who attended 4th ANC visits were gauged against those who made the 1st ANC visits. All mothers who attend the 1st ANC visit are expected to complete the four visits. The uptake of 4th ANC visit has been low due to late 1st ANC initiation and poor coverage by CUs in the county. The average attendance of 4th ANC visit stands at approximately 60% across all the sub counties. This indicates first ANC visit across all the five sub counties is delayed. To improve on ANC attendance there’s need to have a mechanism to ensure there are outreaches in hard to reach areas and to ensure that community coverage is up to date. Lack of understanding of the importance of ANC, inadequate male involvement in the community to enhance awareness on the significance of ANC, cultural beliefs and religion beliefs, poor health-seeking behavior and minimal health promotion interventions have hampered the attendance of all 4 ANC visits.
Skilled deliveries
There was a significant improvement on skilled deliveries from a low baseline of 38% (KDHS 2008/2009) as indicated in the CHSSIP to 51% in 2013/2014 in the subsequent years. This could be attributed to free maternity services, acquisition of equipment and improved referral system. However, the downward trend experienced in FY 2016/2017 was as a result of frequent industrial action by health care workers. It was noted that most of the health facilities in Emuhaya and Luanda Sub Counties do not have 24-hour service provision thus hampering many skilled deliveries. Vihiga Sub County has been performing well-above 80%- across all the years in skilled delivery because of the presence of the County Referral Hospital and accessibility of most of it health facilities.
The Vihiga County Department of Health aimed to improve delivery of routine health services targeting children. Universal immunization of children against 10 common vaccine-preventable diseases was prioritized. Between 2013 and mid 2015 the target set on the number of immunized children was met, however, there was a drop in 2015/16. Despite the targets being met, there was a notable downward trend in fully immunized children throughout the period under review (2013 to 2017). For example, 2013/14 FIC was 87% which was within the set targets and in 2016/17 it had dropped to 60%. The trend was similar in all sub counties as shown in figure 3. In the year 2016/2017 the performance was lowest as no sub county achieved the minimum 80%.
The contributing factors for low immunization among under-1 children include; inadequate support from GoK and partners, vaccine stock outs, inadequate refrigerators, poor data quality, staff shortages, inadequate updates, ignorance from mothers who refuse to take their children for immunization and frequent industrial actions.
In line with the above mentioned RMNCAH challenges and lessons learned from Kakamega county, Vihiga county intents to design and implement an intervention that could address these challenges in a holistic and integrated way through the “Boresha Afya Ya Mama na Mtoto” (Improve Maternal and Child Health) project. The overall goal of the “Boresha Afya Ya Mama na Mtoto” intervention in Vihiga is to reduce maternal and child mortality and malnutrition through implementation of evidence based, high impact interventions. The invention would comprise of three main components. The first component aims to address the monetary challenges faced by the mother to seek services through cash transfers. These interventions will not only increase motivation on the demand side but also address socio-cultural factors through health education to be conducted by the Community Health Workers. It will also address physical access by empowering the mother to pay for transport services, through their preferred and available options, to the health facility. The second component aims to achieve positive outcomes by increasing knowledge and awareness and changing attitudes and practices notably in terms of nutrition and health seeking behaviour by providing behaviour change communication interventions. The third key component will be targeted to CHWs and CHVs and provide them with cash incentives and encourage the referral of mother to seek RMNCAH services from a facility. Not only will this lead to increase of uptake of ANC and delivery under skilled attendant, it will also address nutritional challenges prevalent in the county, and particularly with HIV positive mothers, leading to healthier babies. The forth component will seek to address challenges associated with registration of births in collaboration with existing initiatives.
Intended outcomes of the project
The project will aim to achieve its objective of reducing maternal and child mortality through increased demand for impact interventions like increased uptake of the 1st and 4th ANC visit, skilled birth attendance and full immunization of their children by removing financial and social barriers for Women of Reproductive Age (WRA) to accessing quality services available. As illustrated in the Figure 4 below this will be realized through the provision of regular and timely cash transfers combined with behavior change communication interventions targeted to RMNCAH and nutrition messages. It will further contribute to strengthening of the community-to-facility referral by incentivizing Community Health Volunteers (CHVs) to refer women for various Reproductive, Maternal, Neonatal, Child and Adolescent Health (RMNCAH) services provided by skilled personnel at health facilities.
The project will target synergetic relationship with existing and planned programmes and projects currently provided by other partners like the Transforming Health Services initiative supported by the World Bank in Vihiga County which focuses on improving primary health care services. This will enhance the impact of the “Boresha” project. Further it will leverage on the existing governance structures in order to play an advocacy role for increased support to RMNCAH agenda in Vihiga County.
Achievement of the outcomes set out above will only be possible through concerted efforts by the national and county governments, development partners, implementing partners and the communities. Women enrolled in this project will also be encouraged to systematically register their newborn children at birth and should also be linked to the NHIF managed ‘Linda mama’ scheme in order to benefit from free services at public and faith-based health facilities.
UNICEF in partnership with the County Government of Vihiga would like to engage the services of an experienced and competent a consultant to design the programme, integrating the lessons learned from the first phase of the programme (as mentioned in the paragraph above) including systematic linkages to other social protection programmes as well as with the productive and economic sector , to ensure sustainability of the programme and economic empowerment of its beneficiaries.
Scope of Work
Goal and Objective
Under the supervision of the Social Protection Specialist, the consultant will hold consultative meetings and reflection sessions with the programme team to finalize the design and the operational manual of the programme. The consultant will utilize review reports and the workshop feedback to develop the second phase of the programme that is linked to the productive sector, linkages to the national safety net programme and economic empowerment for the beneficiaries.
RWPPCR/IRs areas covered
The consultancy contributes to Outcome 4, Output 1 (social protection models) of the Country Programme. It also supports two of the three strategic shifts of the programme towards a) modelling of approaches to reach the most deprived children; and b) resilience building approaches.
The broad objectives of this consultancy would be:
• To Design the programme addressing lessons learnt from Kakamega county for an effective and efficient programme.
• To link beneficiaries to the productive sector and national safety net programme
• Develop an economic inclusion design as part of a graduation model for beneficiaries
• Improve Coordination between involved sectors at county level as well as between the county government and the national government
Specifically, the consultant will perform the following activities/ tasks:
1. Programme Design
To support the re-design of the programme through consultative and reflection sessions after undertaking a thorough desk review including but not limited to: the current operational manual, the design document the documentation reports, the impact evaluation reports, the systems review report and midterm review reflection with key stakeholders. The re design will also address the following
a) Payments
Review the payment schedule to ensure timeliness and predictable payments are made that are also efficient. Reviewing the payments linked to the points of care to ensure beneficiary funds are disbursed early enough for the intended purpose. Additional soft conditions to be included to facilitate payments, such as birth registration linked to the last payment before exit.
b) Targeting
Review the proxy means test that is currently in use and improve the targeting approach that will suit in the conditional cash transfer. Integrate recommendations provided by MIS consultant team that is currently improving the MIS.
c) Community engagement
Promotion of positive health seeking behaviours in the community through participation. The positive health seeking achievements of the program reinforces the idea that conditionality work. The County Government program is conditional and achieves its results and there is need to increase community participation, male involvement, HIV AIDS prevention, family planning awareness as part of the MNCH/FP 2017 ACT
d) Complaints and Grievances mechanisms
Review the existing guide on the complaints and develop a complaint register and resolving mechanisms
e) Reporting
Review the existing reporting structure in the MIS and programme reports and regular programme monitoring reports, provide formats and schedules for senior management and funds utilization.
f) Economic Inclusion and linkages to the productive sector
Propose economic inclusion design options that will be opening of economic opportunities to the beneficiaries that is integral to achieving a transition towards economic empowerment. The options including the linkages to the productive sector as well as national safety net programmes as well as other social protection programmes (e.g NHIF etc…)
2. Data collection tools
To develop data collection tools, workshop agenda and facilitation guides for the consultations and reflection sessions for the program re design workshops
3. Lead consultations, reflections workshop
Hold consultations with the stakeholders for feedback on the design of the programme.
4. Update Operation manual and design documents
To update/ develop the program design document, operation manual that entails program management and implementation.
Deliverables:
Deliverables
Duration (Estimated # of days)
Timeline/Deadline
Schedule of Payment
Approved inception report with clear methodology on the implementation
10
July 15th
1st instalment (10%)
Data collection Materials, workshop agenda and facilitation schedule
10
July 31st
2nd Instalment (30%)
Lead consultations and reflection sessions/ workshop
10
August 15th
Develop operation manuals
30
September 30th
3rd Instalment (30%)
Final presentation of the design document
30
November 30th
4th Instalment (30%)
Total number of days
90
N.B.
· Payment is on satisfactory completion of deliverables duly authorized by the Supervisor of contract.
· Specific deliverables of acceptable quality must be submitted at the planned times.
· Performance will be evaluated considering quality of deliverables, consultation with stakeholders, timeliness of deliverables of and comprehensiveness of work as defined in the terms of reference.
· The consultant is expected to carry out the design process in accordance with professional communication development standards
Conditions
Applicants to submit cover letter, CV and all-inclusive financial proposal to carry out the deliverables above.
Applications without financial proposal will not be considered.
[1] Idem
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