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This is a re-advertisement Terms of Reference: Documentation of Best Practices and Development of Key Operational Considerations Document for Improved Community-Facility Linkage Strategies to Promote the Uptake and Retention in PMTCT Programmes

UNICEF HQ, in collaboration with UNICEF ESA Regional Office (ESARO), is seeking to contract a highly experienced consultant to provide guidance and support to improved programming on community- facility linkage strategies that promote better uptake and retention in PMTCT programmes.

1. Background

The April 2012 World Health Organization (WHO) programmatic update1 outlined a third antiretroviral (ARV) protocol for HIV+ pregnant women, antiretroviral treatment for life, often referred to as “Option B+” after the protocol first pioneered by Malawi. Under this protocol, all HIV-positive pregnant women, who choose, receive antiretroviral therapy (ART) for life, regardless of CD4 count. This option was bolstered by the scientific review on the safety of Efavirenz in pregnant women2, opened a new opportunity to significantly increase access to ART through delivery of the one pill once-a-day fixed-dose combination in lower level facilities including primary health care clinics.

Lifelong ART for pregnant and breastfeeding women (Option B+) is expected to help accelerate elimination of HIV among children: 40-60% of HIV-positive pregnant women accessing prevention of mother-to-child transmission of HIV (PMTCT) need treatment for their own health; these women account for approximately 80% of all vertical HIV infections3. Option B+ also has operational advantages over prophylactic PMTCT Options A and B protocols, including harmonization with ART programmes, higher protection against mother-to-child transmission in future pregnancies, a prevention benefit against sexual transmission to sero-negative male partners in a discordant relationships, and avoiding stopping and starting of ARV drugs in settings of high fertility.

Over the last 12 months, in addition to Malawi, many other high-HIV-burden countries have begun to rapidly adopt lifelong ART (Option B+) protocols for pregnant women. As of June 2013, 19 (86%) of the 22 priority countries for the Global Plan for the Elimination of New Paediatric Infections in Children by 2015 and Keeping their Mothers Alive (The Global Plan) adopted policies to initiate ART in all pregnant and breastfeeding women regardless of CD4, including 12 (55%) of 22 which have national guidelines recommending ART for life (Option B+) and 7 (32%) which have national guidelines supporting initiation of ART for all pregnant and breastfeeding women through the end of MTCT risk period (Option B).

This shift towards a simplified lifelong ART protocol for pregnant and breastfeeding women will help decentralize ART access to lower level health facilities and initiate a chronic health care intervention in these settings. This shift from a time-bound to chronic model for pregnant women, requires even more focus on how to ensure the continuity of care over the long term so that women are supported to remain on treatment. As a result, the HIV community is actively seeking effective strategies to both ensure that

1 WHO, Use of antiretroviral drugs for treating pregnant women and preventing HIV infection in infants, 2012, access date 02/01/13 2 WHO, Use of Efavirenz during pregnancy: A public health perspective, access date 02/01/13 3 UNICEF and Business Leadership Council, A Business Case for Options B and B+, July 2012. HIV+ pregnant women initiative ART in a timely manner and ensure that they are retained in care over the long term.

Presently, UNICEF is managing a three-year initiative (2013-2015) aiming to support countries (Cote d’Ivoire, Democratic Republic of Congo (Katanga Region), Malawi, and Uganda) transitioning to a treatment protocol for PMTCT. The Optimizing HIV Treatment Access (OHTA) for pregnant women Initiative has three key objectives: 1) Strengthen the capacity of primary health care systems to deliver lifelong HIV treatment for pregnant women through the maternal, neonatal and child health platform. 2) Increase demand, timely uptake and retention in PMTCT services 3) Enhance monitoring and evaluation for timely decision-making to improve service delivery.

Under the second objective, OHTA countries are employing a number of strategies to try to better promote demand, timely uptake and retention in care. The initiative is sustaining both facility-based and community- based strategies to improve these outcomes. Some strategies include active defaulter tracing, communication strategies, facility-based and community-based peer supporters, better linkage with community-based health workers, vouchers for antenatal care (ANC), engagement of community health committees, among others. Under the initiative, work is underway to assess which practices are working by employing periodic surveys to make associations between patient support services and better and timely ANC uptake and retention outcomes, but results will not be known for some time.

2. Purpose:

The purpose of this work is to bring relevant evidence and experience to bear to help ensure programming strategies under OHTA improve demand, timely uptake and retention in care are evidence based and to inform future programming developments.

This work will directly support improved programming in 4 focus countries: Cote d’Ivoire, Democratic Republic of Congo (DRC), Malawi, and Uganda, but should be applicable more broadly. Strategies considered through this review should aim to impact the following health results: 1) ANC care uptake and continuity in care; 2) earlier ANC uptake (first trimester); and 3) Retention on ART through the breastfeeding period and beyond, looking at retention through the antenatal period, 6-month retention on ART and 12-month retention on ART.

This work includes:  A literature review of strategies that improve specific outcomes mentioned above, drawing on PMTCT, Maternal Newborn and ART literature (published and grey).  Rapid field-based documentation of identified “best practices” to determine key success factors and development of a key considerations document to guide programming.  Design and facilitation of a 4-country workshop to bring together strategies being currently employed in those countries, findings from best practice review and key considerations to lead discussions and action planning regarding how to improve this work.  Support to the dissemination of the Key Considerations Document. 3. Expected results: (measurable results)

The selected consultant will be expected to deliver on the below specified scope of work below. Before commencing on the assignment, the consultant will deliver a Plan of Action outlining the detailed approach and methodology to this assignment and will come to UNICEF NY/HQ to discuss and agree on the plan. Work can begin after this plan of action has been signed off by UNICEF technical staff.

1. Design a framework and approach for synthesizing evidence and format for reviews

 Framework should consider effectiveness, affordability (including cost drivers), scalability, and sustainability

Expected output: framework to structured review.

2. Document best practices4 in promoting timely uptake and retention in PMTCT through literature review and a select number of rapid field-based case studies to unpack key success factors.  Review journal articles and grey literature of strategies that improve specific outcomes of interest, drawing on PMTCT, Maternal Newborn and ART literature (published and grey).  Select key cases for further probing and documentation in the Africa region.  Work with in-country stakeholders to conduct further rapid review and documentation of select cases

Expected output: compendium of 7-10 best practices on effective and scalable community-facility linkage approaches to promote early initiation, adherence and retention in care.

3. Develop a draft key operational considerations document to guide community-facility linkages for better and moretimely uptake and retention in care approaches in support of the e-MTCT agenda  key considerations should aim to help facilitate better programming in the 4 OHTA countries, but should be applicable to the effective roll out of Option B/B+ overall.  Interviews with key OHTA partners should be undertaken to inform this document.

4 A “Best Practice” is commonly defined as “a technique or methodology that, through experience and research, has proven reliably to lead to a desired result”. According to WHO (2008) in the context of health programmes and services, a practical definition of a “Best Practice” is “knowledge about what works in specific situations and contexts, without using inordinate resources to achieve the desired results, and which can be used to develop and implement solutions adapted to similar challenges in other situations and contexts”.

The use of the word “best” should not be considered in the superlative sense as the term “Best Practice” is not about “perfection”, the “gold standard” or only elements that have been shown to contribute towards making interventions work or successful. Results can be partial and may be related to only one or more components of the practice being considered. Indeed, documenting and applying lessons learned on what does not work and why it does not work has to be an integral part of “Best Practice” so that the same types of mistakes can be avoided by other programmes and projects.

There are several creative and constructive actions by people and organizations in the health sector to improve facility-community linkages and increase initiation and retention in care. Documenting and sharing “Best Practices” affords one the opportunity to acquire knowledge about lessons learned and to continue learning about how to improve and adapt strategies and activities through feedback, reflection and analysis in order to implement larger-scale, sustained, and more effective interventions. A commitment to using a “Best Practice” is a commitment to using the body of knowledge and evidence at one’s disposal to ensure success. Expected output: draft version of key considerations document which will inform programming and serve as a basis for a 4-country workshop.

4. Design and facilitate a four-country workshop to systematically review the current state of community-facility linkage programming within the OHTA Initiative, highlight findings from the best practice review and draft key considerations. Work with the country teams to draw out priorities for improving programming based on what is being implemented and what is known to work.  Design a workshop that helps take stock of what countries are doing, the findings of the evidence review and where strategic shifts may be needed.  Lead facilitation of workshop, with UNICEF support.  Get input on the key considerations document in order to facilitate finalization and identify outstanding information gaps.  Help countries develop an action plan for how to improve strategies and monitor effectiveness.  Based on outcomes of the workshop, finalize Key Considerations Document  Post-workshop, plan and execute a webinar on the key considerations document with the inter-agency task team (IATT). Develop a 15-slide PowerPoint (.ppt) Presentation, with speaker notes, covering the content of the final version of the evidence-informed framework and a summary of the best practice compendium.  Produce an abstract of the evidence informed framework, no longer than 300 words, for submission to a scientific conference.

Expected output: The outcome of the workshop will be a consensus on key considerations for community- facility linkage strategies, country-specific action plans for how to strengthen programming and identification of information gaps to inform new and emerging efforts to improve this area of work. In addition, the consultant will be expected to produce: 1: Final Key Considerations Documents, based on input from the workshop participants and discussions. 2. A webinar to disseminate the Key Considerations workshop with the eMTCT IATT. 3. A short abstract of the work for submission to scientific conference.

4. Start date: o/a 24 April 2014 End date: 30 September 2014

5. Timeframe and Deliverables:

Deliverables Duration Deadline (Estimated # of days) Plan of Action for the assignment & discussion with 3 days Within 5 days of UNICEF contract start Framework to structured review & discussion and 3 days Within 10 days of refinement with UNICEF contract start Draft ccompendium of 7-10 best practices on effective 10 days By end April and scalable community-facility linkage approaches to Deliverables Duration Deadline (Estimated # of days) promote better and early initiation in ANC and retention in PMTCT, based on Lit Review and proposal for case studies for field investigation. Final compendium of best practices based on case 25 days By end May study findings and Draft Key Considerations Programming Note. Proposal for workshop design (concept note, expected 4 days By 11 June outcomes, agenda) for discussion Execution of Workshop 3 days By end July Final key considerations document based on workshop 15 days By mid August input, webinar presentation and abstract. TOTAL 63 days

6. Key competences, technical background, and experience required:

1. At least 8 years of relevant experience. Masters or doctoral-level qualifications in Public Health, Development Studies or Social Science preferred. 2. Sound technical knowledge and operational experience of qualitative research methodologies and best practice case study methodologies 3. Sound technical experience in HIV/health programming, particularly around community-based approaches to health promotion. Proven track record and solid understanding of community- facility linkage strategies and community-based approaches. 4. Strong data analysis and data interpretation skills. 5. Consultant should be recognized regionally and globally as a respected player in the area of health care and community engagement 6. Excellent English communication and writing skills and previous experience with the development of evidence informed best practice frameworks. Sample of writing work will be required 7. Experience planning workshops and excellent facilitation skills. 8. Creative thinking, drive for results and strong commitment. Excellent commitment to time and delivery deadlines and good track record of producing quality deliverables 9. Good inter-personal relationship even in diverse work environment and professional background 10. Added advantage: work experience in the Global Plan priority countries

7. Duty Station: The consultant will be home based. Travel to New York and the Africa region is expected.

Qualified candidates are requested to submit a cover letter, CV and P 11 form (which can be downloaded from our website at http://www.unicef.org/about/employ/index_53129.html) to [email protected] with subject line “Consultancy, Best Practices Documentation and Key Operational Considerations Document to Promote the Uptake and Retention in PMTCT Programmes” by 14 April 2014, 5:00pm EST. **Please indicate your ability, availability and daily/monthly rate to undertake the terms of reference above. Applications submitted without a daily/monthly rate will not be considered. NOTE: Files should not exceed 5.0MB limit. It is advised to send two emails if you exceed the limit. ======General Conditions of Contracts for the Services of Consultants / Individual Contractors

1. Legal Status The individual engaged by UNICEF under this contract as a consultant or individual contractors (the “Contractor”) is engaged in a personal capacity and not as representatives of a Government or of any other entity external to the United Nations. The Contractor is neither a "staff member" under the Staff Regulations of the United Nations and UNICEF policies and procedures nor an "official" for the purpose of the Convention on the Privileges and Immunities of the United Nations, 1946. The Contractor may, however, be afforded the status of "Experts on Mission" in the sense of Section 22 of Article VI of the Convention and the Contractor is required by UNICEF to travel in order to fulfill the requirements of this contract, the Contractor may be issued a United Nations Certificate in accordance with Section 26 of Article VII of the Convention.

2. Obligations The Contractor shall complete the assignment set out in the Terms of Reference for this contract with due diligence, efficiency and economy, in accordance with generally accepted professional techniques and practices.

The Contractor must respect the impartiality and independence of UNICEF and the United Nations and in connection with this contract must neither seek nor accept instructions from anyone other than UNICEF. During the term of this contract the Contractor must refrain from any conduct that would adversely reflect on UNICEF or the United Nations and must not engage in any activity that is incompatible with the administrative instructions and policies and procedures of UNICEF. The Contractor must exercise the utmost discretion in all matters relating to this contract.

In particular, but without limiting the foregoing, the Contractor (a) will conduct him- or herself in a manner consistent with the Standards of Conduct in the International Civil Service; and (b) will comply with the administrative instructions and policies and procedures of UNICE relating to fraud and corruption; information disclosure; use of electronic communication assets; harassment, sexual harassment and abuse of authority; and the requirements set forth in the Secretary General's Bulletin on Special Measures for Protection from Sexual Exploitation and Sexual Abuse.

Unless otherwise authorized by the appropriate official in the office concerned, the Contractor must not communicate at any time to the media or to any institution, person, Government or other entity external to UNICEF any information that has not been made public and which has become known to the Contractor by reason of his or her association with UNICEF or the United Nations. The Contractor may not use such information without the written authorization of UNICEF, and shall under no circumstances use such information for his or her private advantage or that of others. These obligations do not lapse upon termination of this contact.

3. Title rights

UNICEF shall be entitled to all property rights, including but not limited to patents, copyrights and trademarks, with regard to material created by the Contractor which bears a direct relation to, or is made in order to perform, this contract. At the request of UNICEF, the Contractor shall assist in securing such property rights and transferring them to UNICEF in compliance with the requirements of the law governing such rights.

4. Travel

If UNICEF determines that the Contractor needs to travel in order to perform this contract, that travel shall be specified in the contract and the Contractor’s travel costs shall be set out in the contract, on the following basis: (a) UNICEF will pay for travel in economy class via the most direct and economical route; provided however that in exceptional circumstances, such as for medical reasons, travel in business class may be approved by UNICEF on a case- by-case basis. (b) UNICEF will reimburse the Contractor for out-of-pocket expenses associated with such travel by paying an amount equivalent to the daily subsistence allowance that would be paid to staff members undertaking similar travel for official purposes.

5. Statement of good health Before commencing work, the Contractor must deliver to UNICEF a certified self-statement of good health and to take full responsibility for the accuracy of that statement. In addition, the Contractor must include in this statement of good health (a) confirmation that he or she has been informed regarding inoculations required for him or her to receive, at his or her own cost and from his or her own medical practitioner or other party, for travel to the country or countries to which travel is authorized; and (b) a statement he or she is covered by medical/health insurance and that, if required to travel beyond commuting distance from his or her usual place or residence to UNICEF (other than to duty station(s) with hardship ratings “H” and “A”, a list of which has been provided to the Contractor) the Contractor’s medical/health insurance covers medical evacuations. The Contractor will be responsible for assuming all costs that may be occurred in relation to the statement of good health.

6. Insurance The Contractor is fully responsible for arranging, at his or her own expense, such life, health and other forms of insurance covering the term of this contract as he or she considers appropriate taking into account, among other things, the requirements of paragraph 5 above. The Contractor is not eligible to participate in the life or health insurance schemes available to UNICEF and United Nations staff members. The responsibility of UNICEF and the United Nations is limited solely to the payment of compensation under the conditions described in paragraph 7 below.

7. Service incurred death, injury or illness If the Contractor is travelling with UNICEF’s prior approval and at UNICEF's expense in order to perform his or her obligations under this contract, or is performing his or her obligations under this contract in a UNICEF or United Nations office with UNICEF’s approval, the Contractor (or his or her dependents as appropriate), shall be entitled to compensation from UNICEF in the event of death, injury or illness attributable to the fact that the Contractor was travelling with UNICEF’s prior approval and at UNICEF's expense in order to perform his or her obligations under this contractor, or was performing his or her obligations under this contract in a UNICEF or United Nations office with UNICEF’s approval. Such compensation will be paid through a third party insurance provider retained by UNICEF and shall be capped at the amounts set out in the Administrative Instruction on Individual Consultants and Contractors. Under no circumstances will UNICEF be liable for any other or greater payments to the Contractor (or his or her dependents as appropriate).

8. Arbitration (a) Any dispute arising out of or, in connection with, this contract shall be resolved through amicable negotiation between the parties. (b) If the parties are not able to reach agreement after attempting amicable negotiation for a period of thirty (30) days after one party has notified the other of such a dispute, either party may submit the matter to arbitration in accordance with the UNCITRAL procedures within fifteen (15) days thereafter. If neither party submits the matter for arbitration within the specified time the dispute will be deemed resolved to the full satisfaction of both parties. Such arbitration shall take place in New York before a single arbitrator agreed to by both parties; provided however that should the parties be unable to agree on a single arbitrator within thirty days of the request for arbitration, the arbitrator shall be designated by the United Nations Legal Counsel. The decision rendered in the arbitration shall constitute final adjudication of the dispute.

9. Penalties for Underperformance

Payment of fees to the Contractor under this contractor, including each installment or periodic payment (if any), is subject to the Contractor’s full and complete performance of his or her obligations under this contract with regard to such payment to UNICEF’s satisfaction, and UNICEF’s certification to that effect.

10. Termination of Contract This contract may be terminated by either party before its specified termination date by giving notice in writing to the other party. The period of notice shall be five (5) business days (in the UNICEF office engaging the Contractor) in the case of contracts for a total period of less than two (2) months and ten (10) business days (in the UNICEF office engaging the Contractor) in the case of contracts for a longer period; provided however that in the event of termination on the grounds of impropriety or other misconduct by the Contractor (including but not limited to breach by the Contractor of relevant UNICEF policies, procedures, and administrative instructions), UNICEF shall be entitled to terminate the contract without notice. If this contract is terminated in accordance with this paragraph 10, the Contractor shall be paid on a pro rata basis determined by UNICEF for the actual amount of work performed to UNICEF’s satisfaction at the time of termination. UNICEF will also pay any outstanding reimbursement claims related to travel by the Contractor. Any additional costs incurred by UNICEF resulting from the termination of the contract by either party may be withheld from any amount otherwise due to the Contractor under this paragraph 10.

11. Taxation UNICEF and the United Nations accept no liability for any taxes, duty or other contribution payable by the consultant and individual contractor on payments made under this contract. Neither UNICEF nor the United Nations will issue a statement of earnings to the consultant and individual contractor