By United Nations Population Fund Organization: United Nations Population Fund
Country: South Sudan
Closing date: 16 Oct 2018
TERMS OF REFERENCE FOR INDIVIDUAL CONSULTANT
Behavioral Study on Utilization of Safe Motherhood Services in South Sudan
Purpose of consultancy:
Originally conceptualized to carry out a focused behavioral study on determinants of use and non-use of family planning services in South Sudan, the terms of reference for this consultancy is hereby updated in scope of work to encompass exploration of broader issues affecting utilization of safe motherhood services. This is to maximize the opportunity to enhance understanding of these issues that affect sexual and reproductive health and rights.
Globally, and in South Sudan, safe motherhood is recognized as a critical health need and right in national health policies and strategies.
The 2010 South Sudan Household Health Survey (SHHS) reported the following Safe Motherhood indicators
• Total Fertility Rate (TFR): 7.5 children per woman
• Contraceptive Prevalence Rate (CPR): 4.5% for all methods; 1.7% for modern methods
• Ante-natal Care (ANC): 40% of pregnant women received ANC from skilled providers; but only 17% attained 4 or more visits
• Delivery: 19% of deliveries were assisted by skilled health providers
Besides low family planning uptake, the FP2020 Track20’s Family Planning Estimation Tool (FPET) for 2017 estimated unmet need of 30.5 per cent for a modern method of contraception and only 10.6 per cent of women whose demand is satisfied with a modern method of contraception. Information on family planning use levels, discontinuation, method mix, etc. remain scanty.
It is believed that socio-cultural factors are among many demand side factors that significantly influence use and non-use of safe motherhood services, including family planning in South Sudan. There are also some supply side factors that affect and sustain use of safe motherhood services. Socio-political changes over generations of conflict, displacement and nation building bottlenecks in South Sudan have resulted in radical changes in social connectedness, ethical values and social protection systems. However, there is limited research and documentation on how such changes may have impacted safe motherhood practices across the strata of communities in the country. For evidence-based programming, it is imperative these factors are rigorously examined and findings used to inform design of responsive safe motherhood interventions, including social and behavior change communication.
UNFPA is supporting the Ministry of Health to carry out a study to understand the factors that influence access to and utilization of safe motherhood services in different communities and contexts in South Sudan. The study will use qualitative methods to gain deeper insight into the situation in South Sudan and understand further factors that influence its use/ non-use.
The main objective of the study is to provide information on safe motherhood status in South Sudan and factors that influence this situation.
The specific study objectives are:
To explore the current understanding, appreciation/value-attachment, and utilization of Safe Motherhood services in South Sudan; and the factors at the individual, couple &family, service accessibility, socio-cultural and policy environment influencing this;
To explore the decision making process at the level of the individual/couple, family, other social relationships in the community, and the different points in the health service delivery system with respect to Safe Motherhood service utilization;
To explore the potential for engaging community-level social groups and structures as a platform for community mobilization and participatory learning and action to enhance Safe Motherhood
To provide policy and programming options for effective communication on Safe Motherhood at the family and other social networking opportunities in the community; and at the different points in the health service delivery system.
The result of the study will guide policy-making, programming, and monitoring and evaluation of national policies and programmes on safe motherhood, including family planning. Humanitarian access permitting, it is preferred that the data unearth any subtle differences to aid evidence-based planning at national and lower levels. It will also be used to design social and behavior change communication interventions to address individual and contextual factors that influence utilization of safe motherhood, and family planning/contraceptive use in particular.
Scope of work:
(Description of services, activities, or outputs)
An exploratory qualitative approach will be used to obtain in-depth knowledge about utilization of Safe Motherhood services in South Sudan and the factors determining use and/ or non-use of such services. Three qualitative data collection techniques shall be used to collect primary data; supplemented by secondary data from health facility records, reports and databases at different levels of the health system, and online.
A team comprising one international consultant, supported by a national consultant, and 8 zonal study coordinators will implement the study.
The study implementation process will adopt a sub-national clustering approach, based on 8 zones according to the following criteria:
a) Representation of the main geo-political and people group zones of the country
b) Alignment to the health system service levels with respect to planning and delivery of reproductive health services and training of health professionals
c) Practical considerations with respect to community-level data collection (security, road condition, etc.)
Tentatively, the following zones are being considered: Juba, Yambio, Wau, Rumbek, Malakal, Torit, Bor and Bentiu. In each study zone, up to three communities shall be identified and included in the study process, with the aim of including a range of community and people-group settings in the zone (e.g., rural and urban/peri-urban representation; communities living in displacement; etc.).
Study activities in each zone shall be led by a Zonal Study Coordinator, selected from existing professionals active in health and other social services; and having good potential to play a key role in leadership and implementation of the study recommendations. The zonal study coordinators will be selected at the inception phase of the study, and will work closely with the Study Consultants to manage the entire study process.
The Reproductive Health Coordination Forum will be constituted to provide technical backstopping, including: input into study design, development of study tools/questionnaires, training and report writing. For purpose of ownership, the Reproductive Health Coordination Forum will also review and endorse the consultant’s work before final approval by MOH and UNFPA.
The consultants will work in a participatory manner under the leadership of the Ministry of Health and UNFPA Representative and in close collaboration with line Ministries to collect, process, analyze and produce succinct reports.
Specifically, the consultants are expected to:
· Update the study protocol and data collection tools to capture expanded scope of work that includes key components of safe motherhood.
· Facilitate submission and securing of ethical approval from the MOH Ethics Committee, and to ensure study compliance with ethical requirements for clinical research involving human subjects.
· Plan for and advise UNFPA and MOH on appropriate logistics and other support needed for proper conduct of the study
· Support identification and training of Study Coordinators and Data Collection Assistants, and any other needed technical and support staff for proper conduct of the study
· Mobilize national and local level support for conduct of the study, maintaining good relationship with MOH, UNFPA, RH Coordination Forum, Health Cluster and other related Technical Working Groups for technical and logistical support, including strict adherence to ethical principles applicable to research involving human subjects.
· Collate and analyze the data collected in line with the research objectives.
· Based on data analysis, prepare draft study report for review by stakeholders, and selected peer reviewers, and integrate comments from these into the final study report.
· Conduct national level validation workshop on study findings and prepare a report of the workshop, while integrating relevant issues from the workshop into the study report.
· Present the final draft report to MOH and UNFPA for approval in accordance with government protocol and procedures;
· Prepare concise dissemination materials, such as dissemination plan, executive summary/ study brief and PowerPoint slides capturing key findings/ issues and recommendations for action;
· Work within tight deadlines to prepare and submit on time, all the deliverables for this assignment, ensuring the final report is copyedited, formatted, and ready to be printed;
· Other related tasks to the scope of work as determined by the Minister of Health and/ or the UNFPA Representative.
The consultants will propose appropriate qualitative, including ethnographic methods that allow for in-depth inquiry (digging deeper into the existing data and trends on utilization of safe motherhood services) into reasons behind use and non-use of safe motherhood services in South Sudan.
Populations of interest might include, but will not be limited to:
· Adolescents, ages 15-19
· Nulliparous women
· Current users of modern contraception
· Current non-users of modern contraception
· Women with heath concerns; women who don’t use contraception due to side effects
· Women who want no more children
· Women seeking to prevent both pregnancy and STI/HIV infection
· Married men
· Unmarried men
· Traditional and religious leaders
· Front line service providers, RHCS focal points, logistics managers, health planners, managers and administrators
The following dimensions shall be adopted and used as the main units of analysis under each of the key study questions:
- What are the current: understanding, appreciation/value-attachment, and utilization of Safe Motherhood services in South Sudan; as reflected in the selected study communities?
a) Sex and age-group categories; ethnic group categories
b) Geographical settings – rural/urban sites; isolation; etc.
c) Service use experience and how it impacts future use; influence on utilization by others
- What are the main factors at the level of: individual, couple/family, service accessibility, socio-cultural and policy environment that are influencing Safe Motherhood services and their utilization in South Sudan?
a) Factors that are unique to each of the levels of influence; factors that cut across multiple levels
b) Linkages and relationships between factors and how they work together
- What are the main elements in the decision making process at the level of the individual/couple, family, other social relationships in the community, and the different points in the health service delivery system with respect to Safe Motherhood services and their utilization?
a) Developing decision making tree/web for the different levels
b) Relationships across decision-making processes at different levels
- What community-level social groups currently exist or can be established to act as a platform for community mobilization and participatory learning and action to enhance Safe Motherhood in South Sudan?
a) Existing social groups – analyzed by membership and participation categories; range of activities undertaken in each group; specific health-related activities in the groups
b) Social groups that may have existed in the past but have weakened or died out
c) Social groups that exist elsewhere and may be adapted for establishment
- What policy and programming options should be utilized to enhance effective communication on Safe Motherhood at the family and other social networking opportunities in the community; and at the different points in the health service delivery system in South Sudan?
a) Actions and how they address specific elements in the analysis dimensions of focus above
b) The critical actors of focus; and the specific actions each needs to take
c) The linkages in action across actors and levels of action
Duration and working schedule:
The assignment is expected to take over a period of about 3 months from data collection to production of the final report, but will not exceed a total of 25 working days. The consultant will do part of the work from home as well as visit Juba and selected states during the survey and data collection.
Place where services are to be delivered:
Juba, with visits to selected state level destinations.
Delivery dates and how work will be delivered (e.g. electronic, hard copy etc.):
The national consultant is expected to support the international consultant and zone coordinators to complete the assignment within level of effort not exceeding 25 working days.
The following deliverables will be expected, by the following deadlines:
1) Ethical approval of study obtained from MOH Ethics Committee – September 14, 2018
2) Study Coordinators trained – September 21, 2018
3) Training of Data Collectors completed – September 28, 2018
4) Data collection and processing completed – October 19, 2018
5) Data analysis and Dataset completed – November 16, 2018
6) Draft study report produced – November 30, 2018
7) Validation workshop conducted and report completed – November 30, 2018
8) Program and policy action plan developed – December 07, 2018
9) Validated Behavioral Study Report on Utilization of Safe motherhood Services in South Sudan that integrates comments from peer reviewers and from participants at a validation workshop – December 14, 2018
10) Dissemination plan, copies of PowerPoint presentations, policy briefs and factsheets – December 14, 2018
11) Final consultancy report/ knowledge transfer note with lessons learnt – December 21, 2018
Reports are to be submitted both electronically and in hard copy by the end of the assignment.
Monitoring and progress control, including reporting requirements, periodicity format and deadline:
The consultant is expected to submit bi-weekly progress reports/ briefs on tasks and assignments. These reports must be submitted by the last day in each week they are due. A final Report/ knowledge transfer note on lessons learnt is expected at the end of the assignment.
Under the overall direction and strategic guidance of the Country Representative, and the supervision of the Deputy Country Representative, the consultant will work closely with RHCH Specialist and RH Directorate at MOH to deliver on the assignment.
The consultant is expected to be recruited and based in Juba, with field travels as deemed fit by the lead consultant and UNFPA
Required expertise, qualifications and competencies, including language requirements:
- The national consultant should have strength in quantitative and qualitative studies and with substantial experience in planning, implementing and writing reports of national level or large scale demographic, socio-economic and health surveys and in qualitative or anthropological studies. Strong background in publication of survey reports and related studies are preferred.
- A Masters degree in the area of demography and population studies, statistics, public health, social science and related research oriented disciplines with eight to ten years experience. Fluency in oral and written English is required. A working knowledge of Arabic language or “Juba Arabic” would be an asset.
- Previous in-depth knowledge and understanding of issues of sexual reproductive health and family planning inequities in South Sudan or similar context is desirable. Other desired skills include: good diplomatic skills and experience interacting with host country government agencies including development partners, and civil society organizations; and familiarity with information technology, including proficiency in word processing, spreadsheets, and presentation software.
I**nputs / services to be provided by UNFPA or implementing partner (e.g. support services, office space, equipment), if applicable:**
UNFPA will provide support services including transport, office space, telephone airtime for consultants
Other relevant information or special conditions, if any:
The proposed consultant will be recruited at NOC level
How to apply:
Applicants are kindly requested to send their application to firstname.lastname@example.org by COB 16 October 2018. Applications received after this date will not be taken into consideration. All applications should be clearly mark with Subject Line “ Behavioral Study on Utilization of Safe Motherhood Services Consultant (National Post)”.
Applicants will be short-listed on the basis of their qualifications and work experience. Only the short-listed candidates will be invited for interviews. IMPORTANT: There is NO application processing or other fee at any stage of UNFPA application processes
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