Consultancy Services for Supporting the Harmonization of a Public Health Community Strategy for UNICEF Somalia.

Title:	Technical Consultant
Category and Grade Level:	P4 Equivalent
Type of Contract:	Special Service Agreement
Length Of Contract:	3 months
Organization Unit:	Health, to be supervised by Nutrition
Duty Station:	Nairobi
Date of Issue:	15 May 2013
Closing date of Application:	23 May 2013

Purpose of the Assignment

Somalia is characterized by one of the worst health statuses globally. Women, adolescent girls and children are disproportionately affected largely due to the pervasive gender inequities that occur across all of Somalia’s three zones which negatively affect women’s right to health.

Some of the main access barriers to essential health services across Somalia include distance; costs; low demand and understanding of health needs. The quality of health services provided is very low and most facilities operate at a level far below their intended capacity. Somalis on average only use health facilities once every eight years. The biggest barrier to good health in Somalia is perhaps the ineffective and almost non-existent, functioning health system. This has been destroyed after two decades of conflict and civil strife and has brought about numerous parallel and fragmented systems and structures.

A significant amount of evidence shows the impact that community level workers can have the reduction of morbidity and mortality in mothers, newborns and children^[1]. Community level health workers have been proven to be especially vital in contexts where the health system is weak or there is a shortage of highly skilled workers, both applicable to Somalia.

Coverage of health facilities in Somalia is inadequate and in some cases there is distrust of services provided by a “community outsider”. Community health systems are largely underdeveloped and where they exist are often not holistic and are driven by the interests and priorities of the implementing agency. Several new cadres of community level health workers are being developed for Somalia although their expected outcomes and operational modalities differ.

Since a community health cadre system is inadequate defined within the EPHS, alternative programs are being proposed by WHO, UNICEF and other key partners. These cadres differ based on recruitment criteria (especially in terms of gender and education level), training length and curriculum, expected responsibilities, links with facility health system, remuneration, reporting, and supportive supervision structure. Even internally within UNICEF there is not agreement of the modalities of a community approach which then weakens UNICEF’s ability to advocate for harmonization of community systems externally. Lack of agreement on one system causes confusion among communities, NGOs, governments and donors.

UNICEF joined FAO and WFP to develop a joint strategy for resilience to address the root causes of the famine and other emergencies, and to enhance coping strategies and resilience in Somalia. This is a ‘paradigm shift’ from top down interventions to ones aimed at strengthen and empower communities and households. Support for a community system in itself is key in the resilience agenda. Somalis want and prefer frontline services to be provided at a community level. Ensuring that the basic skills and support structures for health, nutrition and hygiene are available at community level and are delivered by community members themselves will support sustainability of some of these services even if there is a withdrawal of external aid. In addition, it permits a faster quality response to emergencies at a local level.

One of the critical interventions under this strategy is to develop capacity of communities, especially human resources, through whom various services are delivered, and people’s demand, knowledge and awareness is enhanced.  UNICEF has been supporting capacity development and mobilization of community human resources, delivery of social services, advocacy and communication for behavioral change at community and household level.  However, mapping and analysis of these activities among the various programmes of UNICEF is necessary, especially in preparation for the upcoming WHO/JHNP supported process for defining MoH-led community systems.

Objectives

In close consultation with the implicated programme sections the consultant will:

• Review available information on current community programmes in Somalia and others showing success globally
• Facilitate the development and harmonization of an integrated public health community strategy for UNICEF Somalia with three levels of costing scenarios
• Ensure gender, resilience, and equity perspectives are integrated into the system

Scope of Work and Deliverables

The staff member will work closely with UNICEF Somalia colleagues to facilitate a process that focuses on the integration of high-impact and evidence-based public health interventions for health, nutrition, WASH and child protection at community level. The proposed strategy will take into account the operational realities of Somalia and will include suggested actions for the core competencies and selection process of community-level workers, training and learning systems, supply systems, referral systems, information management, supportive supervision, and remuneration. The strategy will seek not only to deliver at a community level but it will also seek to improve the continuum of care with the facility-based health system.

The strategy document will include an operational framework which considers three costing scenarios. The basic level focuses on women and young children and includes activities related to prevention, promotion, and referral. The middle level costing scenario includes also the treatment of common communicable disease. The high-level funding scenario is in inclusive of other age groups and considers a wider variety of diseases. In addition it includes responsibilities of the community worker as a community organizer.

The strategy and action plans will be based on the Somali Nutrition Strategy and the Nutrition Plan of Action, and will take into account the Health System Strategic Plans. Objectives and activities will consider evidenced-based and cost-effective interventions based on most recent knowledge of deficiencies and possibilities in Somalia. They will be developed in a consultative manner with the various stakeholders (government ministries, UN agencies, local and international NGOs, professional bodies, training institutions, and CBOs).

Deliverables

1. A synthesis report of on-going community-based initiatives in Somalia, with best practices and lesson learned. Report should include highlights from other successful community initiatives globally which may apply to the Somali context – 2 weeks from start
2. A harmonized and integrated public health community strategy document – 9 weeks from start
3. A costed plan of action and a result framework which is structured by three different costing scenarios (basic, mid-level, and high-level – described in further detail in the section below) – 12 weeks from start

Management and Organization

The staff member will report to the Chief of Nutrition. The staff member will be based at USSC/Nairobi but travel to the field will be required.

• The staff will be provided with office space within the zonal offices and USSC as required, as well as other administrative needs. The consultant should provide their own laptop.
• A working week is defined as 5 working days
• DSA for travel to Somalia will be provided at UN rates
• In the event of an international consultant who is not Nairobi-based, travel and DSA for Nairobi will be negotiated

Remuneration

Remuneration will be made deliverable-based. 

1. 30% on completion of the synthesis report (deliverable 1);
2. 40% on completion of the strategy document (deliverable 2);
3. The remaining 30% on completion of a costed plan of action and results framework (deliverable 3)

Qualification, Specialised knowledge and Experience

·         Advanced degree in Public Health, or other related field

·         At least 8 years of hands-on relevant professional experience in public health programs in developing countries.

·         Experience in facilitating and defining strategic documents related to community work in complex environments required.

·         Solid technical background, analytical, diplomacy and facilitation skills required.

·         Strong writing and reporting skills

·         Good communication skills and ability to work in a team and with minimum supervision.

·         Fluency in English with excellent facilitation skills.

·         Knowledge of Somali operational context and readiness to travel to Somali land, Puntland and South Central zones.

·         Knowledge of Somali language is desirable

Interested and qualified candidates should send their applications with updated UN Personal History Form (P.11) form, updated CV attaching copies of academic certificates to the email below. UN staff are requested to provide the last two Performance Evaluation Reports (PERs). Applications submitted without a duly completed and signed Personal History Form (P11) will not be considered. Please indicate your expected fee for providing the services of the said assignment. Applicants must quote the vacancy number and post title in the subject line of the application.

Email to: somaliahrvacancies@unicef.org

Only short-listed applicants will be contacted

UNICEF is committed to diversity and inclusion within its workforce, and encourages qualified female and male candidates from all national, religious and ethnic backgrounds, including persons living with disabilities, to apply to become a part of our organisation.

More vacancy announcements are posted on UNICEF Somalia website http://www.unicef.org/somalia/index.html

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[1] Bhutta, 2005; Bhutta, 2008; Cochrane Review; Freeman, 2009; Hill 2004; Lancet Child Survival Series 2003; Lancet Neonatal Survival Series 2005; Lancet Maternal and Child Undernutrition Series 2008; Lassi, 2010. Ect.