UN Children’s Fund ,National Consultant – eMTCT Operational Plan in Rwanda

Position
Title: National Consultant – eMTCT Operational Plan

Level:
Middle

Location:
Kigali

Duration: 30
days

Start Date:
Mid-June 2016

Reporting
to: HIV and AIDS Specialist

1. Background and Purpose

The HIV prevalence
in Rwanda has remained stable at 3% over the last ten years1. The
principal mode of transmission of HIV in the general population is heterosexual
intercourse and for children is vertical transmission from HIV infected mother
to her child during pregnancy, child birth and breastfeeding period.
Interventions for prevention of mother to child transmission (PMTCT) can reduce
the risk of HIV infection in children. Since the launch of the national PMTCT
Programme in 1999, embarked on a national scale up of PMTCT services by
increasing access to HIV testing, antiretroviral drugs for pregnant women and
HIV exposed infants. Following the global agenda to eliminate mother to child
transmission of HIV and to keep mothers alive, Rwanda re-affirmed its
commitment to the global agenda and developed a five year (2011-2015) national
strategy for elimination of mother to child transmission of HIV (eMTCT) with
the goal to reduce the rate of MTCT to less than 2%. To date, over 90% of the
health facilities are offering PMTCT services, 93% of HIV infected pregnant
women are utilizing the services and the MTCT rate by 18 months of aged has
reduced to 1.8%.

An end term review
of the eMTCT strategy for 2011-2015 has shown excellent level of implementation
of the eMTCT strategy, so the observed programme coverage and impact is not a
surprise. However, the review indicated that the implementation was not at the
same level across the four outcome results areas and made recommendation
tailored to address challenges:

Primary
prevention of HIV
– Gaps in accessing youth friendly services (knowledge and skills for positive
behavior, HIV testing, medical male circumcision and condom use) at strategic
entry points, limited routine program data for monitoring and evaluation of
interventions for primary prevention other than national surveys like DHS, and
low quality of HIV prevention services and limited mechanisms for linkages and
referral between community based interventions and health facility for
specialized HIV prevention services such as post-test. Prevention of unwanted
pregnancy among HIV infected women – Low demand for utilization
of modern family planning methods and challenges in reporting of indictors on
FP among HIV infected women

Reducing
vertical transmission from MTCT and HIV related deaths – Limited access to PMTCT
service in private sectors and capacity of health care workers to deliver
comprehensive HIV treatment and care services for HIV infected mothers and
children at every step within the continuum of care and strengthen mechanisms
for retention and adherence to treatment

Cross-cutting – Gaps in
Programme coordination across the four prongs, monitoring and evaluation at
national, subnational and community levels

2. Justification

According to
spectrum estimates, approximately 10,000 HIV infected pregnant women are in
need of interventions to prevent vertical transmission of HIV and over 450 new
HIV infections through MTCT will occur in 2016 alone[i] if the current coverage
and quality of PMTCT services remains the same. Primary prevention of HIV among
young women of reproductive age and unmet family planning needs among HIV
infected women have been identified as major’s challenges of the PMTCT
programme. In addition, HIV infected mothers and HIV exposed children are lost
to follow-up and are not receiving the range of services to achieve the desired
impact. Furthermore, utilization of available PMTCT service is relatively low
among vulnerable women including young women[ii] resulting in relatively higher
MTCT rates. In order to reduce MTCT rate and work towards achieving eMTCT as
per the WHO definition of less than 50 new case per 100,000 live births, RBC
plans to develop operational plan for eMTCT to address challenge and key
programmatic gaps that are an impediment to achieving eMTCT

3. Objective

To develop 2016-2018
eMTCT operational plan that is informed by analysis of the causes of the
bottlenecks/barriers to achieving the set targets of main interventions for
each of the outcome results, and outline priority activities to address the
bottlenecks.

4. Methodological Approach and
Expected Outputs

The consultant will
conduct a desk review of Programme documents such as HIV national strategic
plan 2013-2018, HIV national guidelines 2015, current national strategic plan
for HIV EMTCT End term report, HIV annual report 2015 etc.; Will use the most
recent validated national level data to determine baseline indicators on each
of the EMTCT result outcomes. Barriers to achieving the desired coverage of key
interventions will also be identified from the end term review report of the
2011-2015 eMTCT strategy and any other national documents. The consultant will
then present the information to the national HIV prevention, care and treatment
TWG as reference and work with them to set impact and outcome targets for 2018
and to discuss what needs to happen (determinants) to improving coverage and
identify barriers/bottlenecks to be addressed in order to reach these targets.
This information will then be presented to a larger stakeholders’ workshop to
collectively discuss and agree on root causes of each of the
barriers/bottlenecks and propose key corrective actions to effectively address
them. In consultation with the TWG, the consultant will use the information
obtained to develop output result statements, indicators and targets for 2016
and 2018 for each of the EMTCT outcomes, and develop a logical framework for
2016-2018. The consultant will consolidate the inputs and draft the operational
plan and submit it to the TWG for inputs before validation by stakeholders.

5. Major Tasks, Deliverables,
& Timeframe

Major Tasks

1. Conduct a desk review to
determine baselines indicators for impact, outcome and key interventions for
each of the eMTCT outcomes Deliverables
: Report comprised of latest baseline indictors for eMTCT, 30th May
to 3rd June

1. Using
   the eMTCT end term review report and any other resources, consolidate
   barriers/bottlenecks to improved uptake/coverage of key interventions for
   each eMTCT outcome results (categorize the barriers into enabling
   environment, supply, demand and quality)

Deliverable :
consolidated barriers/bottlenecks for each outcome results, 6-9th
June

1. Convene
   a meeting with TWG members to determine impact, outcome results for eMTCT
   by end 2018, determine outcome level result gaps and validate the barriers
   and bottlenecks

Deliverable:
Programme coverage gaps and barriers/bottlenecks identified and documented, 10th
June

1. In
   collaboration with TWG, service providers, community members and
   beneficiaries of PMTCT, conduct a causal analysis of the
   barriers/bottlenecks observed to improved uptake/coverage of key
   interventions, identify corrective actions for each intervention and the
   ideal platform for delivery of services.

Deliverable:
Corrective actions to address identified bottlenecks and ideal platforms for
delivery of interventions identified and documented, 13-20th June

5.In consultation
with the TWG, use the identified corrective actions for each of the
interventions and develop output statements, indicators and target to be
achieved by 2018. Include activities on surveys for intervention indicators
that do not have baselines.

1. Through
   application of the principles of Result Based Management, develop a
   logical framework for the eMTCT operational plan

Deliverable: Logical
framework for the eMTCT operational plan developed, 21st -27th
June6. 7. Draft the eMTCT Operational Plan, share with the TWG for feedback and
incorporate their feedback

Deliverable: Draft
Operational plan submitted to TWG, 29th June to 5th July

Deliverable:
2016-2018 eMTCT Operational Plan, 11th July

6. Stakeholder Participation

RBC, Districts, One
UN, CSO, communities, service providers and PMTCT beneficiaries, adolescent
mothers and Organizations of people living with HIV

7. Qualification and
Requirements

8. Supervision

The consultant will
be supervised by UNICEF HIV and AIDS Specialist and will receive technical
guidance technical team composed of representatives from RBC HIV Division,
UNJTA team (UNICEF, UNAIDS, UNFPA, UNESCO and WHO) and USAIDS/PEPFER
development partners

9. Terms and conditions

· The Consultant
will quote for an all-inclusive lump sum in RWF

· Payment
conditions: in case of field trips, the consultant will be reimbursed based on
incurred out of pocket expenses associated with the travel and the subsistence
allowance will be based on DSA prevailing UN rate. As a non-staff, the
consultant will not be issued a Travel Auhorisation. The claim will be based on
submitted voucher approved by supervisor.

· UNICEF reserves
the right to withhold all or a portion of payment if performance is unsatisfactory,
if work/outputs is incomplete, not delivered or for failure to meet deadlines

· All materials
developed by the consultant will remain the copyright of UNICEF and that UNICEF
will be free to adapt and modify them in future.

[i] 2014 spectrum
projections

[ii] Rwanda PMTCT
Impact Evaluation Study, 2012

Qualified
individuals are requested to submit their cover letter, CV and P11 form (which
can be downloaded from: http://www.unicef.org/about/employ/files/P11.doc),
to Human Resources at: rwajobs@unicef.org by 27th May 2016, quoting
the indicative all-inclusive fee range and the consultancy with subject: “National consultancy
– eMTCT
operational Plan.”

You may also submit
to: Human Resources Specialist, UNICEF Rwanda, and P.O. Box 381, Kigali,
Rwanda.

Please note that
applications submitted without an all-inclusive fee/ rate will not be
considered. Only shortlisted candidates will be contacted.

Financial proposal
should provide a budget and timeline, using the table below:

Deliverables

Number of
person days

Delivery date

Costs

Inception report –
Detailing methodology and action plan for the consultancy

3

4rd June

10%

Interim Report 1 –
Literature review, latest baseline indictors for eMTCT, consolidated
barriers/bottlenecks for each outcome results

6

10th June

20%

Interim Report 2 –
Comprehensive report on Output statements, key interventions and targets,
priority activities and platforms of delivery

7

21st June

20%

Interim Report 3:
Draft eMTCT operational plan with a logical framework

10

29th June

30%

Final reports
including a presentation: – eMTCT operational plan with a logical framework

4

7th July

20%

Total

30