Operationalisation of Nutrition Investment Plan

Post Title: International Consultant on Technical Review of the Expanded Programme of Immunisation in Tajikistan, on Consultancy Contract Level of consultancy: International Professional (P4) level Duration of contract: Oct.-Nov. 2012 (20 w/ds) Office location: Dushanbe Closing date: 12 August 2012

Background:

The Expanded Programme of Immunisation (EPI) is one of the main preventive health care services in Tajikistan. It is performed by primary health care level facilities (polyclinics and rural health centers) in both urban and rural areas as well as in maternity houses for newborns. The EPI Programme in Tajikistan generally operates as a vertical programme (at least at national level), with its own funding stream, dedicated staff at national level, specific procurement and logistics systems, and separate planning and information system. This separation was determined by historical patterns of government funding and donors’ investments. EPI functions that are most integrated into health systems were service delivery and surveillance of vaccine-preventable diseases. At service delivery level, vaccination services are mostly integrated with primary health care (PHC) services and delivered by PHC health workers; through they retained a vertical element when vaccination is offered through outreach services. Governance of EPI Programme tends to be less integrated within the health system at higher levels, while being more integrated at district level or below. This is also a case for overall EPI Programme planning and management.

As articulated in UNICEF Country Programme Document for 2010-2015, UNICEF continues to work with the Ministry of Health to strengthen health system components and immunisation services. In 2011 UNICEF Tajikistan conducted a Country Assessment of Essential Commodities, which included immunisation-related commodities. The recommendations outlined in the report will form the basis for future support to the country multi-year plan on immunisation (cMYP). UNICEF will continue its support in the areas of policy development, safe injection practices, capacity building and community empowerment. For details of the background, please refer to the general ToR (Annex 1). Purpose of the review : The last EPI Programme review in Tajikistan was conducted in 2007. The overall objective of the current EPI review is to improve the performance of the immunisation programme with particular attention to the areas of programme management, coordination, funding and service delivery. Thorough analysis of the achievements and constraints of the routine immunisation programme in Tajikistan with a view to guiding future performance towards sustainable EPI target diseases control will bring maximum impact on child survival. The EPI Programme review will assess the main functions of immunisation services as part of the overall health system. The technical areas to be reviewed are as follows:  Governance, planning and data analysis and programme management;  Immunisation financing and sustainability;  Cold chain management and logistics/procurement;  Immunisation coverage and monitoring;  Human resources/capacity building;  Immunisation service delivery;  Demand generation and social mobilization;  Health system related issues and impact of health reforms;  Vaccine-preventable disease and adverse events following immunisation (AEFI) surveillance. Scope and Focus:

The EPI Review should:  Review, analyse, measure and evaluate progress towards achievement of short, mid, and long term outcomes of the national immunisation programme (NIP) outlined in cMYP 2010-2015 with focus on achieving financial sustainability as per cMYP;  Identify constraints and limitations in the national immunisation and vaccine preventable disease control programmes by data analysis, interviews with focal persons and field visits;  Review the appropriateness of the National immunisation programme planning, design and implementation;  Assess if the EPI programme is well placed/emphasized within the overall on-going Health System Reforms;  Review existing standard M&E indicators and tools to identify gaps in the M&E process and propose recommended actions for further improvement, focusing particularly on the use of M&E evidence in decision making;  Review if planning and implementation of the programme is rights-based (considering particularly the needs of children with disabilities and from low-income families), available and provided in equitable manner (gender, geographical and socio-economic including marginalised groups of populations such as lulis, etc.,);  Assess emergency preparedness/response and availability of standard operation procedures (SOP) to respond to vaccine-preventable diseases (VPD) outbreaks, cuts/limitations of electricity during the winter period, etc.,);  Provide evidence-based recommendations to improve key programme areas as well as overall financial sustainability of the immunization; The EPI Review will be conducted by a team of stakeholders which should review the following: The impact of the immunisation system should be evaluated through available health statistics of Tajikistan and population-based surveys like MICS and assist in comparison of vaccination rates against incidence and prevalence of communicable diseases controlled through vaccination – aiming to judge the success of the vaccination programme in controlling these diseases. The effectiveness should be assessed based on the total number of vaccinated children by group of routine vaccines per year. Additionally, the percentage of the population (children) completely covered by the National Immunisation Programme should be taken into consideration. The efficiency may be assessed by comparing planned and actually used quantity of vaccines by the groups of vaccines, including what are the main factors influencing the regional disparities in the immunisation coverage. The sustainability of immunisation programmes should also be taken into consideration, such as budget allocations and budget utilisation for the routine immunisation programme from the Ministry of Finance. How is the Government going to finance immunisation programme needs beyond 2015? Will the fiscal space to cover the immunisation programme be created/increased to achieve self-sufficiency and on what timeframe? What is the proportion between allocation of budget for immunisation and for other health care expense items?

2 Human Rights-Based Approach: One of the focus areas should be assessing the extent to which the program of immunization has taken into consideration the Human Rights-Based Approach to Programming and whether it was translated into action. Recommendations should be provided on how to further apply this approach into the immunization strategy for 2010-2015. Results based management approach should refer to previous experience of the Ministry of Health in cMYP (2005- 2010) and incorporation of lessons learnt with following revision of current cMYP (2010-2015). Was there any progressive result in improving the management of immunization programs and is there anything that could be applied to the current one? Equity analysis: A variety of factors, such as poverty (socio-economic status), gender, ethnicity, race, religious or other cultural affiliations, disability, and geographic location of residence, might affect a child’s chance of being immunised. To what extent the national immunisation programme analyses the multidimensional nature of inequity to precisely identify the most disadvantaged children? Are there any strategies to address inequity? Recommendations should be provided if such strategies/approaches do not exist or require improvements. Review process and methodology: The review will be implemented under the overall coordination of the Government of Tajikistan. The review exercise will be implemented at the national level, sub-national (Oblast) level, district level and health facility level through:  Analysis of existing national policies and strategies related to the EPI Programme;  Analysis of existing EPI related reports;  Development of a questionnaire for key informants (along with a list of indicators against set EPI programme review objectives);  Meetings with key international EPI stakeholders/ICC members in the country (UNICEF, WHO, JICA, WB and SDC) (see Annex 3.);  Meetings with MoH officials at national, regional and district level (MCH Department, RCIP, SES, HLSC, PHC Department, Department of Finance and Forecasting of MoH);  Observations, interviews and records review in selected health care facilities;  Meetings with regional and district authorities;  Focus group discussions with households at community and health facility level;  Compilation and analysis of information obtained at all levels; Key Assignments:  In consultation with UNICEF and other stakeholders, develop and finalize a framework for the EPI Review, including its timeframe, tools and the list of indicators against each objectives of the NIP;  Review and analyze existing documentation and reports (to be provided in advance by UNICEF);  Develop and finalize a questionnaire for key informants;  Train all team members to conduct the assessment and ensure that each team member understands the purpose and the methods of the review, thus ensuring standardization of the review process;  Hold meetings with major stakeholders, officials and key informants at national, sub-national and district levels;  Ensure data and information collected are appropriate for the purpose of the mission and that resulting conclusions and recommendations are in line with international technical norms and standards as well as with UNICEF priorities;  Lead final discussions, debriefing of stakeholders and compilation of the final report. Expected deliverables: 3  Developed review design/framework/tools (e.g questionnaire) prior to field visits;  Narrative EPI Review report with executive summary (4-5 pages), including all key indicators/components of immunization programme, including equity analysis (governance, planning and data analysis and programme management, immunization financing and sustainability, human resources, cold chain management and logistics/procurement, information system, immunization service delivery and demand generation, surveillance and social mobilization) with proposed feasible action points with a clear timeframe (as per short-term, mid-term and long-term strategies) and responsible party; The final report of EPI review should include the following chapters: 1. Executive summary 2. Background and Introduction 3. EPI programme Review Methodology 4. Review by Components: Findings and Recommendations: a. Governance, planning and data analysis and programme management; b. Immunisation financing and sustainability; c. Cold chain management and logistics/procurement; d. Immunisation coverage and monitoring; e. Human resources/capacity building; f. Immunisation service delivery; g. Demand generation and social mobilization; h. Health system related issues and impact of health reforms; i. Vaccine-preventable disease and adverse events following immunisation (AEFI) surveillance. 5. Equity analysis of the review components and recommendations. Required Qualifications:  Advanced University degree in Public Health or related Social Science:  At least 8 years of experience working with mother and child health, immunization and disease control programmes;  Experience in monitoring and evaluation of health programmes/interventions;  Experience in development of c-MYP, and specifically in costing of EPI programmes; Similar experience in CEE/CIS region;  Excellent analytical and report writing skills;  Fluency in English, knowledge of Russian or Tajik are an asset; Fee: A fee at the rate of P4 will be paid upon satisfactory completion of all assignments and deliverables for not more than 20 working days (see below proposed timetable) during Oct.-Nov.2012. Proposed timetable for EPI Programme Review:

Task/assignment Location Duration

Review methodology and Distance work 3 working days development/draft review design/framework/tools (e.g 4 questionnaires) Desk review including thorough Distance work 2 working days review of recommendations vs. action points made since last EPI Review Central level assessment In-country 1-3 working days (meetings/interviews with MoH, consultation with partner agencies, etc.,) Field assessment regional, In-country 5 working days operational district and health center (including travel) level including field visits to selected regions/districts Preparation of draft report/PPT with In-country 1 day the preliminary results/major findings for the presentation to ICC meeting; Preparation of final report and Distance work 5-6 days submission of final report

Travel and daily subsistence allowance: Travel from the country of origin of the consultant will be undertaken by most economical carrier in economy class. The consultant will receive UN-approved DSA while in Tajikistan. Duty station: The consultant will be stationed in Dushanbe, Tajikistan with travel in all regions of the country. Performance indicators: Consultant will report to UNICEF Tajikistan Chief of Health/Nutrition. Consultant’s performance will be evaluated against the following criteria: timeliness, responsibility, initiative, communication, and quality of the products delivered. Unsatisfactory performance: In case of unsatisfactory performance the contract will be terminated by notification letter sent 5 days prior to the termination date. In the meantime, UNICEF will initiate another selection process in order to identify an alternative candidate. Health Statement & Certificate: Health Statement and certificate of Good Health must be received prior to signing the contract.

Application: Qualified candidates are requested to submit a Cover letter, CV and UN P-11 form to [email protected] by the deadline of 12 August 2012.