South Sudan: Developing a Deployment/Tracking/Retention Plan of Health Care (International Post)”.UNFPA-South Sudan

TERMS OF REFERENCE

Hiring Office:

Ministry of Health – Government of the Republic South Sudan and UNFPA

Purpose of consultancy:

Country Context

South Sudan has experienced protracted humanitarian situation as a result of long-lasting internal conflict between government and opposition/rebel groups. The December 2013 and the July 2016 conflict has continued to have ramifications on security situation in the country. Conflict has currently spread across the entire country including Equatorial region that had hitherto been peaceful. According to update reports on implementation of the Humanitarian Response Plan, about 7.6 million people are in need of humanitarian assistance, about 1.9 million people, especially women and children continued to be internally displaced and may more have fled to neighbouring countries. UNFPA estimates about 3.5 million need Sexual Reproductive Health and Gender Based Violence services. In the first quarter of 2017, a famine crisis was declared for most parts of the country. Majority of the population depend on food aid. ,

The economic situation in South Sudan continues to deteriorate with more than 300% inflation recorded in June 2017 compared to that of June 2016. This combined with the decline in oil production as a result of the conflict, global oil price fall, and depreciation of the local currency, have all undermined the government’s ability to deliver basic services including health care and to pay some of its workers on time. Poverty is endemic with at least 80 percent of the population defined as income-poor and living on an equivalent of less than US$1 per day. The value of the South Sudan pound has greatly depreciated against other currencies. This situation has negatively impacted on the salaries of the government civil servants thus greatly affecting their productivity. The economic situation, coupled with insecurity along major supply routes from Uganda and Kenya, and bureaucratic impediments, have led to high costs for goods and services negatively impacting delivery of both development and humanitarian programmes. There is over reliance by government on donor funding.

The general transport infrastructure in the country is characterised by impassable roads with most of the States and social service delivery points inaccessible by road. A few State headquarters can be accessed by air. According to the South Sudan Access Constraints Map - 11 August 2017 produced by the Logistics Working Group, about 80% of the counties can’t be accessed by road.

The limited Government budget for basic social services especially health and its dependency on the limited number of donors, predominantly operating in humanitarian response programmes, resulted in very limited investment in health system capacity development: low employment and deployment of health care providers especially midwives in the health sector; irregular payment of health workers salaries resulting in low motivation,; the sporadic supply of essential drugs and supplies and weak logistics supply system; lack of standardized policies, strategies and standard of practice collectively affecting to the poor standard of service delivery in the country at all levels. The Ministry of Health continued to suffer severe shortage of experienced human resources and finance affecting its ability to provide quality health services across the country. Almost all county hospitals and health centres are understaffed with only about 50-60% staffing levels for the key professionals and lack formally trained health personnel. As a result primary health care services are provided by less educated and poorly equipped lower level health cadres and community health workers.

Despite the above challenges, Government and in particular Ministry of Health together with development partners has continued to place high priority in providing health services to the population. A number of initiatives are being implemented including the Boma Initiative, the Health Pooled Fund and the rapid results Project to mention but a few. Policies have been developed to guide the delivery of Sexual Reproductive Health Services including the National Health Policy, the Reproductive Health Policy and the Nurses/Midwives Strategic Plan. However, implementation of these policies remains a challenge. Some of the challenges relate to the absence of legal and regulatory framework for the different health professions.

Human resources’ aspects of SMS II

UNFPA and Ministry of Health have been implementing the Strengthening Midwifery Services Project (SMS II). The first phase of the project funded by Canada ended in March 2016. The second phase that builds on the first Phase of the Project runs from 2016 to 2020, and is co-funded by Canada (Global Affairs Canada – GAC) and SWEDEN. UNFPA is responsible for overseeing the implementation of the project in collaboration with the Ministry of Health and selected implementing partners. The ultimate outcome of the project is to reduce maternal and neonatal mortality in South Sudan. The project aims to achieve the following:

i. Increased delivery of quality midwifery education for health care providers in South Sudan

ii. Improved delivery of environmentally sound and gender-sensitive MNCH services by midwives, nurses, clinical officers and other health care professionals such as doctors, in South Sudan

iii. Strengthened enabling environment for gender-sensitive midwifery and obstetrics practices in South Sudan

The project supports Human Resources training interventions under the Midwifery education and Task Shifting components of the project.

As part of the Midwifery Education component, the project supports;

a) implementation of midwifery and nursing education at the existing four Health Sciences Institutes of Juba College of Nursing and Midwifery (JCONAM) and diploma midwifery education at Kajo-Keji, Maridi, and Wau Health Science Institutes

b) local graduate midwives to upgrade to Bachelors and Master’s Degree level through scholarship programmes

Under the Task Shifting and Strengthening Clinical Practice component, the human resources development focuses on:

a) Completion of the Task Shifting Scholarship Initiative started in phase 1.This element provides support for the doctors and clinical officers on scholarship overseas to complete their studies and return to work in South Sudan, to strengthen clinical practice and mentoring for the local task shifting programme.

b) Institutionalization and implementation of the Task Shifting Programme with the University of Juba, this phase will ensure full transitioning of the Associate Clinicians programme to the University of Juba.

c) Support to 10 health workers to attend the annual task shifting programme at the Karolinska Institute in Sweden.

The ultimate objective of the human resources development/training under the project is to increase a pool of qualified professionals as well as have them deployed to provide the highly needed SRH and midwifery services in the country. The success measurement indicators include;

a) Number of midwives and nurses completing the nurses/midwifery training programmes (m/f)

b) Number of nurses/midwives that are upgrading to bachelors and masters level (m/f)

c) Number of doctors completing their specialist training programmes (m/f)

d) Number of clinical officers completing their training programmes (m/f)

e) Existence of Structured formal system for deploying mid-level health cadres

f) Proportion of mid-level health cadres trained with project funds deployed/employed (m/f and by profession)

To achieve the above, there is need to develop a Deployment/Tracking/Retention Strategy for the trained Health professionals under the project. This will subsequently form part of the wider development of Human Resources for health monitoring and tracking system that UNFPA and other partners are supporting the MOH to develop/strengthen.

Scope of work:

(Description of services, activities, or outputs)

Objectives

The objectives of this exercise are to:

1) Map taking into account the gender, conflict areas and rural/urban parameters

a) All existing human resources/trainees within the scope of the project

• Nurses and midwives(m/f) in the 4 HSIs, nurses/midwives that are upgrading to bachelors and masters level

• nurses/midwives (m/f) that are upgrading to bachelors and masters level

• doctors completing their specialist training programmes

• clinical officers completing their training programmes

• Associate clinicians at JCPS

This covers those that have completed their studies as well as those continuing

b) For those that have completed, establish the their (m/f) current employment status

• employed with e.g. public servant at what level – state or national level; NGO; private; or faith-based organization), short-term/contract or permanent employment,

• employment: self-employed/consultants,

• Not employed

• Left the country

• Left the profession

c) Conditions of service: Are they being paid, how regularly, how much are they being paid/stipends/benefits, are they reporting for work, are they working more than one job/position, do they have opportunity to be promoted/have they been promoted etc. Are these health care professionals from taking up positions/working in their field - do they have what they need to work.

d) The need/demand for these skilled health care professionals across the health system based on existing evidence including the EmONC Assessment reports (from all sources government, private, faith-based and NGO-run services, International Humanitarian Agencies etc.);

e) Current obstacles affecting their deployment, employment and retention building on the Cost Benefit Analysis report.

2) To propose feasible short and medium-term gender responsive strategies/options:

a) for deployment to sites/facilities with the appropriate conditions (work environment, security, equipment, salary, opportunities for promotion, accommodating);

b) tracking HSI graduates, task-shifting trainees, MOH employees receiving capacity development training through SMSI/II (m/f);

c) Retention of these individuals within their professions within South Sudan.

The strategy should take into account the different scenarios ie i) status quo (ii) worsening and (iii) improving conflict and economic situation.

Duration and working schedule:

Based on the proposals from the consultants, MOH and UNFPA will review and agree on

the appropriate duration of the exercise.

This exercise is a rapid assessment and planning process, much of the details will be

highlighted in the more comprehensive of development a HRH tracking and monitoring

system. In addition, a lot of information has been compiled at HSI level and discussions,

including donor requests/proposals, have been held with MOH on the need for deployment

and retention of the said health cadres. All this makes the development of the deployment

plan much quicker. .

Place where services are to be delivered:

The consultancy will have to take place in South Sudan, mainly in Juba with travels to the field to consult the State Ministries of Health and Health Sciences Institutes supported under SMS II

Delivery dates and how work will be delivered (e.g. electronic, hard copy etc.):

The final report is to be submitted both electronically and in hard copy by the last day of the consultancy.

Methodology

The methodologies to be used in this exercise should be those that will

• enable extraction of retrospective information regarding health professional trained since the first phase of SMS up to the current phase,

• Documenting/listing of the professionals/students currently undertaking the courses

• Follow up and tracking the employment/deployment status

• Assessing the conditions of work based of information on parameters for criteria for ideal working conditions

• Rapid assessment the existing demand for the health professionals both in government and non- government sectors

• Participatory and MOH led/owned development of the deployment/tracking and retention plan.

Based on these parameters, the consultants will develop detailed methodology that will be agreed upon with MOH/UNFPA as part of the proposals and inception report.

Some of the key sources of information include the

Health Sciences Institutes/training colleges (Management and faculty),

MOH Directorates of Training and Professional Development, Human Resources, Reproductive Health

Government Health Facilities (National and State level)

NGOs and UN organisations especially those working RMNH and likely to recruit the related staff

Private clinics/hospitals

Graduate Health Professionals trained under the project

Students still under the training

MOH Senior management

UNFPA management and project technical staff

Donors particularly for supporting Human Resources for Health including GAC, SIDA, DFID, World Bank etc

Monitoring and progress control, including reporting requirements, periodicity format and deadline:

Expected outputs:

The successful consultant will submit

a) An inception report detailing the methodology and work plans for the exercise including outlining the structure of the report.

b) Draft report

c) Clear and concise report covering the areas highlighted in the objectives of the exercise.

For both the inception report and draft report, review meetings/workshop will be conducted to solicit inputs from stakeholders including MOH, UNFPA, GAC and SIDA.

Supervisory arrangements

a) Ministry of Health (Directorate of Policy and Planning and Directorate of Human Resources) will be responsible for the overall management of the exercise. This responsibility includes

• Hiring the consultants within the MOH guidelines for procurement of consultancy services

• Establishing a team that will act as a reference group for the exercise. The group with comprise of MOH technical staff, UNFPA technical staff, selected representatives from the training institutions, selected members from the Health Facilities (Public, NGO/FBO and private). The group will among other things review and provide inputs to the inception report including refinement of the methodology and tool, provide information to the consultant, support in mobilisation of identified participants for the exercise, provide inputs to the draft report.

• Providing logistical support for the consultants including travel and arrangement of consultative meetings

• Providing updates to MOH Senior management on the exercise

• Arranging for consultant’s discussion and getting feedback from MOH Senior management

• Presentation of the report to MOH Senior management board for endorsement

b) UNFPA will:

• Participate in hiring of the consultant for the exercise

• Provide technical support to MOH during the conduct of the exercise to ensure technical soundness of the exercise

• Secure feedback from key stakeholders including the donors on the different aspects of the exercise

• Support MOH, when necessary, with logistical arrangements

Expected travel:

The consultants are expected to travel from home country –Juba and back to home country. One round trip will be paid (unless agreed otherwise)

Some in country field visit(s) will be expected.

Required expertise, qualifications and competencies, including language requirements:

The consultancy will be conducted by a team of specialists (International and national) including a senior human resources specialist, Gender equality expert, and a health economist/statistician. The consultants/consultant firm must offer the following demonstrated experience, knowledge and competencies:

· Consultants undertaking the task should have Master’s or PhD Degree in a relevant field (e.g. Human resources management/development, public health management, Health economics, statistician)

· At least seven years of experience working in the field of public health, human resource management & financing, Health economics, statistics. Experience in midwifery in developing countries

· Demonstrable experience of developing public health strategic documents for example, national human resources development plan, national health accounts, costing investment plans, cost effectiveness/benefit analysis of Health programmes preferably public health programmes

· Working experience with the UN is an advantage

· Ability to clearly articulate and consolidate information on findings is important

· Language requirement: excellent command and knowledge of English including reading and writing; and knowledge of Arabic will be a very strong asset for the national consultant.

· Ability to perform within timeframe and meet deadlines

· Previous working experience in health systems strengthening in Africa will be an added advantage

Inputs / services to be provided by UNFPA or implementing partner (e.g. support services, office space, equipment), if applicable:

The financial costs associated with the exercise include

• Consultant’s fees as determined by the MOH through the approved procurement process

• Consultant’s travel costs for data collection and consultative meetings

• Refreshments for the stakeholder meetings

• Report printing/production costs.

MOH/UNFPA will organise meetings/workshops to review and discuss the different products from the exercise.

Other relevant information or special conditions, if any:

The consultant should be at P4 level

Applicants are kindly requested to send their application to ssco.vacancies@unfpa.org by COB 25 October 2017. Applications received after this date will not be taken into consideration. All applications should be cleared marked with Subject Line “**Developing a** Deployment/Tracking/Retention Plan of Health Care (International Post)”.

Applicants will be short-listed on the basis of their qualifications and work experience. Only the short-listed candidates will be invited for interviews. IMPORTANT: There is NO application processing or other fee at any stage of UNFPA application processes.