To conduct facility assessments of the status of SRH/HIV/TB and SGBV integration and implementation in 10 health facilities in Alfred Nzo and uThukela Districts

TERMS OF REFERENCE FOR CONSULTANT OR ORGANISATION

Background

Globally significant progress has been made in reducing both the spread of HIV and the number of maternal deaths. Despite these impressive gains, HIV and maternal mortality are still two primary causes of death in women of reproductive age worldwide. Nine countries in this region have the highest HIV prevalence in the world (Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland and Zimbabwe) with HIV resulting in the single sharpest reversal in human development in the region. The region also continues to experience high rates of preventable maternal mortality, teenage pregnancy and gender based violence. 

South Africa has a complex burden of disease characterized by four simultaneous epidemics of communicable, non-communicable, perinatal and maternal and injury related disorders referred to as a quadruple burden of disease. In addition to having the largest number of people living with HIV estimated at 7 million, it has the largest number of people on ART in the world; almost at 4 million. South Africa continues to exhibit high levels of new infections in comparison with counterparts the world over. Of particular concern is the high rate of infection among girls and young women aged 15-24. Although HIV prevalence is declining in this vulnerable group, the pace of decline has been slower than anticipated. The HIV prevalence among females aged 15-19 in 2012 was nearly eight times higher than males 15-19 (0.7% vs 5.6%).  Furthermore, it is estimated that 1,744 new HIV infections occur among women and girls aged 15-24 years every week (HSRC: 2012).

The interactions between SRH and HIV are now widely recognized.  Majority of HIV infections are sexually transmitted or associated with pregnancy, childbirth and breastfeeding. Sexually transmitted infections can increase the risk of HIV acquisition and transmission. An effective response to the HIV/AIDS pandemic cannot be achieved without addressing the social and structural drivers such as poverty, migration, gender inequality and gender-based violence that underpin and fuel the pandemic. These drivers facilitate new infections, deter individuals from undergoing HIV testing, inhibit retention in care and treatment, and contribute to internal and external stigma.

In recent years, there has been strong international consensus on the benefits of providing integrated SRH, HIV, TB and SGBV services, particularly as a strategy to increase the effectiveness of the HIV response.

Integration of SRH, HIV, TB and GBV     

The importance of linking sexual and reproductive health (SRH) and HIV response has been increasingly gaining momentum. SRH services can provide a platform for reaching individuals, especially women and children with HIV prevention, care and treatment interventions. At the same time, HIV services can provide an effective entry point for key SRH services such as family planning, cervical cancer screening, Gender Based Violence care and antenatal care. Emerging evidence demonstrates that integrating comprehensive SRH and HIV services provides an opportunity to increase access to and uptake of quality maternal and reproductive health services and improves programme efficiencies and effectiveness.

Evidence from a number of countries suggest that through rapid scale up of specific interventions that integrate sexual and reproductive health (SRH), TB and HIV services  it is possible to:

·         Promote health, wellbeing and rights of women and children

·         Reduce maternal morbidity and mortality

·         Prevent new HIV infections

·         Eliminate AIDS related deaths

The South African National Department of Health commissioned a joint review of the HIV, TB and PMTCT programme in 2013 to assess the performance of HIV, TB and PMTCT programme and identify issues critical to the delivery and impact of HIV, TB and PMTCT. The findings of this review indicate among others that there is successful, functional integration of HIV, TB and PMTCT services, particularly at primary care level.

In addition, a rapid appraisal of integration of SRH, HIV and TB services conducted in 2015 in three districts (EThekwini, Gert Sibande and Dr Kenneth Kaunda) found that there is incomplete integration for family planning services as HIV counselling is only provided on request by the clients and thereafter patients are referred to the necessary services as required. There is no TB screening for patients attending family planning services. Hence, there is a need to assess integration of SRH, HIV, TB and SGBV services in the UNFPA supported districts in the Eastern Cape to identify gaps and develop interventions to improve and scale up integration of services.  

UNFPA in collaboration with Department of Health is therefore seeking for a service provider to conduct a rapid assessment and project roll out in Alfred Nzo (Eastern Cape) and uThukela (Kwazulu Natal), covering five health facilities in each of the two districts. In Alfred Nzo district the following facilities have been selected; St Patricks PHS, Ntabankulu Clinic, Lubaleko Clini, Rode Clinic and Imizizi Clinic, while in uThukela district;   Injisuthi Clinic, Ntabamhlophe clinic, Wembezi Clinic, AE Havilland Clinic and Ncibidwane Clinic

 Purpose of the consultancy

The assignment is aimed at conducting a rapid assessment on the status of SRH/HIV/TB and SGBV integration and implementation in Eastern Cape and Kwazulu Natal. 

1. Scope of work

1. Develop and present an inception report detailing your interpretation of the terms of reference and methodology to be used for the assessment.
2. In consultation with stakeholder develop a country specific SRH/HIV/TB and SGBV integration assessment tool.
3. Conduct field visits to five health facilities in each of the two districts (Alfred Nzo and uThukela) to assess SRH/HIV/TB and SGBV integration.
4. Conduct Key Informant Interviews with relevant stakeholders including health care workers, District Management teams and officials from the National Health department.
5. Analyze data and compile prepare draft assessment report.
6. Facilitate stakeholder engagement to validate findings and finalize the assessment report with recommendations
7. Disseminate the findings and recommendations to various stakeholders at both the National and district level.
8. Facilitate the development of Action Plans by the two districts to address the gaps and implement recommendations of the assessment.
9. Facilitate a one day workshop to develop the National minimum package for integration of HIV and Sexual & Reproductive Health based on the SADC guidelines.

2. Expected deliverables

1. An assessment report of 2 districts highlighting the status of SRH/HIV/TB and SGBV integration. The assessment and report should focus on key entry points for care which include acute care, chronic care and maternal, child and women’s health and adolescent and youth friendly services.

The report should answer the following questions among others:

-        What has been integrated?

-        How are the services integrated?

-        What are the facilitators of integration?

-        What are the current gaps including capacity building needs?

-        Which entry points could be utilized to fast track integration of services?

-        Which models could facilitate integration of services?

-        Which components of SRH/HIV/TB and SGBV can be integrated? 

-        What are the opportunities for integration, including community based models?

2. Detailed Implementation plans for the two districts with clear time lines and budgets
3. Finalized National Minimum Package for integration of HIV and SRH

3. Methodology

In response to the TOR, the service provider will submit an inception report which will include an interpretation of the ToRs, the proposed methodology, tools and timelines for undertaking this assignment.

4. Assignment duration and management arrangement       

Thirty (35) days spread over March - April 2017.

·         Inception report: 3 days

·         Desk review and tool development: 5 days

·         Data collection (including field visits) and analysis: 10 days

·         Stakeholder workshops: 2 days

·         Report drafting and finalization: 4 days

·         Dissemination of the assessment findings and recommendation: 3 days

·         Development of Detailed Implementation plans: 5

·         Adoption of the National Minimum package for integration of HIV and SRH: 3 

5. Service provider eligibility

The service provider will;

1. An organization or an individual with the relevant experience in conducting facility assessments
2. Demonstrable previous experience in assessment of SRHR and or HIV programmes
3. Have a postgraduate degree in Medicine, Public health or Epidemiology.
4. At least 5 years of experience in management of sexual and reproductive health and or HIV programmes
5. Specialty or experience in monitoring and Evaluation is an added advantage.
6. Familiarity with government health policies, systems and structures.
7. Excellent interpersonal and communication skills
8. Competency in computer software applications including Microsoft Office programs (Word, Excel, PowerPoint) and internet-based applications.

6. Reporting

The successful candidate will administratively be under the overall supervision of the UNFPA but will report directly to, and work collaboratively with the two districts, Provincial Counterparts and the UNFPA National Program Officer (SRH) to deliver the assignment.

7. Proposal evaluation criteria

8. Cost of technical assistance and payment modalities

A work plan with detailed and itemised budget should form part of the proposal. Proposals submitted without a detailed budget will not be considered.

The maximum budget allocated for this assignment is ZAR 250,000. However the most competitive proposal which will be satisfying the requirements of UNFPA will be selected and awarded the contract. The proposal evaluation and the contract award will be undertaken according to UNFPA regulations.

Payment for services rendered shall be effected in tranches agreed upon between UNFPA and the successful service provider. These will be affected to pre-determined milestones and systematic submissions of acceptable deliverables within timelines agreed on between UNFPA and the service provider.

9. Proposal requirements

Interested services providers are invited to submit proposals to provide the above mentioned services. The proposal should focus on addressing the consultant’s ability to provide the services outlined in the Scope of Work. Interested applicants are requested to submit the following to zaf.admin@unfpa.org:

1. Cover letter
2. Detailed CV(s) indicating qualifications and relevant experience
3. A proposal indicating a description of the proposed approach to the scope of work, work plan with timelines and detailed budget (inclusive of VAT)
4. Sample(s) of recent written work of a similar assignment.

 The closing date for proposal is 20 March 2017