UN Children’s Fund ,Health Specialist Jobs in Malawi

Background
and Justification

UNICEF has been
working in Malawi since 1987 and its current strategies lay great emphasis on
improving quality of maternal, newborn child and adolescent health care in the
country. The strate
gies include strengthening capacity of health care
providers, supporting scaling up of MNCH services at village outreach clinic
level, district health systems strengthening, among others.

While all this has
contributed to a steady decline in under-five mortality at an annual average
rate of 5.4%, over the past decade, the decline has been relatively smaller for
newborn health. While Malawi will be well within the MDG targets for child
mortality, further improvements in this area will need evidence-based investments
in newborn care. The main causes of neonatal death are prematurity and low
birth weight, asphyxia and sepsis. At 18.1%, Malawi has the highest recorded
preterm birth rate in the world.

The association
between coverage of essential interventions and its effect of health outcomes,
especially for mothers and newborns, has been debated in recent literature and
quality has been argued to be one of the key components of interventions for
them to move from adequate coverage to effective coverage. Quality has been
described as the third revolution in global health. With more than 89% of the
deliveries happening in health facilities in Malawi, it is possible to achieve
high impact on newborn mortality by focussing on the quality of care that these
newborns receive at the facility. However, improvements in quality of maternal
and newborn care has to be alongside interdependent levels of the health care
system, which is what UNICEF Malawi is trying to achieve with its newborn
initiatives and interventions. A comprehensive documentation of this
improvement process will help the Malawi government and other similar countries
with resource poor settings, to take their interventions to scale.

Rationale

A consultant is
needed to support the operations research design, development of tools and
protocols and technical support to PACHI for documenting and learning how
UNICEF’s RMNCH initiative in Malawi leads to improvements in the quality of
care and health outcomes for mothers and newborns.

Furthermore, UNICEF
in collaboration with WHO is interested in documenting a pilot study on
innovative interventions in preterm care.

UNICEF would also
like to document the adaptation of the real time monitoring system in relation
to newborn care, in the Malawian setting.

Scope of
Work

Purpose

To provide UNICEF
with documentary evidence highlighting the progress achieved so far in newborn
health, through their current investments in Malawi, and to consolidate a
robust evidence base for future investments in newborn care.

Goal

To document and learn
the improvements in quality of newborn care achieved by UNICEF-Malawi in its
districts over the period 2015-2016

Objectives

Work
assignment

1. Examining
   UNICEF’s theory of change for its newborn care initiatives.

o A joint workshop
of implementing partners on their individual theories of change

o Documenting a
common theory of change for all of UNICEF Malawi’s MNH initiative.

1. Identifying
   the intervention and implementation characteristics as well as the context
   in which the interventions are being implemented.

o Developing tools
for analyzing implementation theory

o Data collection on
key interventions using tools developed

1. Analysing
   implementation strength and its effect on quality of care

o Collate and review
monitoring data and other key documents from implementing partners

o Analyse and
document linkage between programme implementation strength and quality of care

1. Understanding
   the mechanism and context in which the interventions are being implemented
   and its effect on health outcomes.

o Develop hypothesis
using a C-M-O (Context-Mechanism-Outcome) configuration

o Establishing
program theory on the success (or failure) of program initiatives.

1. Assessing
   the effect of a preterm improvement intervention on newborn case fatality
   in the facilities

o Development of a
draft proposal and budget

o Develop
implementation plan with implementing partner

o Monitor operations
research activities

o Analysis and
report-writing

1. Piloting
   the establishment of a real time monitoring system in selected heath
   facilities

o Develop an
operations research plan identifying the research methods, developing workplan
and budget.

o Monitor operations
research activities

o Analysis and
report-writing

Research
questions and proposed methodology

The primary research
question is how does UNICEF’s current investment in MNH improve the quality of
care and health outcomes for newborns in Malawi? The research also looks into
other potential interventions to improve quality of newborn care such as
preterm care interventions and real-time monitoring system.

Improving quality of
care involves understanding the relationship between different inter-dependent
layers of the health system. In trying to develop a holistic understanding of
the programme and its effect, we use a theory-based approach to analyze the
various interventions being supported by UNICEF.

Theory based
research has been widely used in analyzing large scale programme interventions
and is especially helpful for complex interventions. It maps out the causal
chain from inputs to outcomes within a given context and tests the underlying
assumptions.

In analyzing
interventions using theory based approach, we will look at both the
implementation theory as well as the programme theory[1]. This is done through
two main methods Theory of Change (ToC) approach and realist evaluation (RE)
approach, respectively. This provides a complete explanation of the mechanism
of the intervention.

The research will
focus on a research strategy (rather than a particular method) to analyse the
various elements of the study. The research strategy includes the following
components:

· Building a theory of change.
It begins by identifying the key interventions and conceptualizing the theory
of change of these interventions (including the risks and assumptions) and its
intended outcomes. This includes a series of iterations with the program
commissioners and program implementers to develop an understanding of the
Theory of Change, followed by further revision and refinement.

· Identifying key
characteristics within each intervention. This includes factors
that influence the rate of adoption of the intervention as well as the broad
organizational context within which the intervention is being implemented ie
the relationship between the organization and its individuals (degree of
belief, trust in the organization, hierarchy and channels of communication).
Key elements of the implementation characteristics will be identified using the
CFIR framework (Consolidate Framework for Implementation Research).

· Measuring implementation
strength. This includes measurement of the dose, duration,
specificity and intensity of the interventions as well as the implementation
fidelity. This will also involve incorporating the monitoring and other
documents available from implementation teams. Analysis of the implementation
strength will also include measuring the immediate outputs such as knowledge of
clinical staff, staff motivation etc.

· Explaining program theory
Program theory will elicit the relation between the interventions and its
effect on quality of care and ultimately on outcomes. This includes mechanism
for improving responsiveness/utilization, improving access and improving
accountability for MNCH at both facility level and community level.

Research
management

Ethical
considerations

Identification of
key intervention characteristics as well as measurement of implementation
strength will involve primary data collection. Ethical approval for this will
be sort from the NHSRC (National Health Sciences research Committee).

Informed consent
will be obtained from subjects involved in surveys, interviews or focus group
discussions.

Desired
competencies, technical background and experience

1. Minimum
   of MPH or MSc in public health, specializing in implementation research
2. Minimum
   8 years of experience with health sector, health systems issues,
   monitoring and operations research.
3. Excellent
   management and coordination skills and an ability to communicate
   effectively with diverse partners at international, regional and country
   levels
4. Excellent
   skills and experience to deliver timely and high quality products.
5. Ability
   to function effectively in English

[1] Implementation theory
hypothesizes and analyzes links between programme activities and its anticipated
outcomes. Programme theory establishes the causal links between the mechanism
released by an intervention and its anticipated outcomes.

Qualified candidates
are requested to submit a cover letter, CV and Personal History Form (P-11
form) (which can be downloaded from our website at

http://www.unicef.org/about/employ/index_53129.html)
on or before 29
January 2016 via e-mail address: hrmalawi@unicef.org