Rwanda: International Consultant - Newborn Case Study

Summary:

Position Title: Newborn Case Study International Consultant

Location: Kigali, Rwanda

Duration: 3 months

Start Date: February 2016

Reporting to: UNICEF Rwanda, Section Chief (Child Survival and Development Section-Health Unit)

1.Background and Purpose

There have been dramatic improvements in Rwanda in the last decade as far as maternal and child health is concerned. The progress made can be attributed to a combination of factors that contributed to strengthen the Rwanda health system and improvements in services accessibility to the population. Despite the tremendous progress and reaching the MDG 4 and 5 targets in 2015, Rwanda still bears a heavy burden of maternal, high neonatal and child mortality. The first 28 days in life – the neonatal period – is the most vulnerable time for a child’s survival. Within the first month, 20 neonates out of 1,000 live births die each year (DHS 2014/2015). This represents about 63% of the infant mortality and 40% of the under-5 mortality (DHS 2014/15). Approximately 20,000 children under the age of five continue to die annually from diseases like diarrhoea, acute respiratory infection, malaria and neonatal causes. Many deaths in the first month of life and U-5 children result from diseases and conditions that are readily preventable or treatable with proven and cost-effective interventions.

Data from the HMIS 2014, shows that 91 percent of childhood mortality in Rwanda is attributed mainly to Neonatal causes (preterm birth, asphyxia, infection, diarrhoea, congenital abnormalities), Pneumonia, Malaria and diarrhoea. Universal coverage of maternal and newborn care would avert 54% of maternal deaths; 71% of newborn deaths and 33% of stillbirths, by 2025; reducing preterm, intrapartum and infection–related deaths by 58%, 79% and 84% respectively (Lancet Every Newborn Series, 2014).

A short consultancy is therefore necessary to analyze and document changes (increase or decrease) of key facility and community maternal and newborn interventions and practices using the best available data (2000-2015); to provide a detailed analysis on equity in MNH intervention coverages (socio-economic status, rural/urban and education); conducting in-depth desk review, focus group discussion, and interview of key informants to know and determine the facilitating factors for change and remaining bottlenecks and barriers; and document the success stories to scale up within Rwanda and share lesson learnt with other countries. The development of the Rwanda New-born Country case study will use a standardised guidelines and framework for country case study on newborn health, under the guidance of the Rwanda Neonatal Technical Working Group.

2. Justification

Mortality rates of children aged 1-59 months decreased much faster than those in neonates. This case study is timely to understand possible factors behind the remaining excess of maternal and newborn mortality and existing gap in effective interventions provision for maternal and newborn health (MNH) and propose suitable strategies/or interventions for ending preventable or treatable causes of death for maternal and newborn in Rwanda with strong attention to the continuum of care.

Newborn is a high priority of the MoH of Rwanda which has requested UNICEF to provide technical assistance to conduct National Newborn Case Study.

In order to facilitate a systematic, consultative and evidence-informed decision in the area of newborn health, UNICEF Rwanda CO will support the identification and deployment of a consultant with the required technical expertise to conduct the newborn care study in close coordination with the MoH and Neonatal Technical Working Group.

3. Objectives

The overall objective of Rwanda country newborn case study is to examine country progress in new-born health within the larger context of progress in child and maternal health, with a specific focus on analyzing the enabling factors that contributed to change and “how” progress was achieved over the past decades (2000 -2015).The scope of the country case study is mainly observational and descriptive. However further and in-depth analysis will be conducted to examine levels, trends, community practices and determinants on neonatal mortality in Rwanda, using data from DHS 2000 to 2014/15, at country and subnational level if possible to identify knowledge gaps. The study is also focusing on factors that may explain progress made to reduce neonatal mortality in Rwanda, what remaining bottlenecks are and what strategies/actions must be prioritized and accelerated in the future and can inform prioritization and focus for the new Sustainable Development Goals (SDGs).

4. Methodological Approach

The methodology will follow the newborn case study framework in line with newborn bottleneck analysis tool to identify the country efforts on newborn survival and health; considering the outcomes (MNH intervention coverage, equity and behavior change quality), outputs (improved delivery and demand/utilization of MNH services), inputs and process (MNH policies, programmes, strategies, resources and initiatives) that led to the impact while bearing in mind other relevant contextual factors. The exercise will involve assessment of changes in maternal and child survival between 2000 and 2015.

In addition, through the use of LiST, the case study will highlight the impact (decrease in neonatal mortality rate) over time for the interventions being implemented This will allow to explore and explain the causes of mortality changes and highlight lessons learnt during past implementation. Whenever possible, all analyses will be disaggregated at subnational level.

Dara Source and analysis: Data compilation will be carried out, using standard worksheets to be provided from diverse data sources for relevant information (e.g. HMIS/RapidSMS, survey/studies, DHS, interviews and focus group discussions). Analysis will use quantitative and qualitative methods and data from different sources will be triangulated in order to yield more information.

5. Major Tasks, Deliverables & Timeframe

Activities and tasks:

• Compile and conduct desk review of all documents and databases related to the overall political, strategies and social-economic country context related to MNH in general.

• Mine the health information system and databases for subnational and aggregate data to discern newborn specific service provision and outcomes, to identify gaps.

• Conduct qualitative analysis from semi-structured interviews of key personnel such as representatives of Ministry of Health, other government institutions, development partners and Neonatology Technical Working Group and focus group discussion (FGD) with health care professionals at facility and community levels.

The qualitative component will draw existing studies as well as the understanding and perception of the main stakeholders involved in the area of MNH including mothers and communities.

The Rwanda national newborn case study will include three phases:

Phase 1: Inception

• Develop the case study clear work plan, to be submitted for approval,

• In-depth desk review of available documents related to MNH/newborn health, data on MNH from different surveys, DHS, HMIS and RapidSMS, national/district reviews and other literature related to Rwanda’s Maternal-Newborn Health programme.

• Preliminary discussions with the Rwanda MoH/MCCH Division Head, members of the National Maternal Child and Community Health Technical Working Group/ Neonatal TWG and UNICEF. This will facilitate a common in-depth understanding of the conceptual framework, refining the data collection tool and interview/FGD questions and adjusting data collection methods, tools and sources.

• Inception report (**deliverable 1**), summary of the desk review including the details of the methodology, timeline and a detailed analysis plan, to be presented and approved by UNICEF. The proposed methodology needs to be appropriate to capture all agreed indicators.

  Phase 2. Data collection:

• In-depth interviews with national level MoH officials, national level health managers and providers, Neonatal TWG members and development partners and focus group discussion with health care professionals at facility and community levels. The consultant will submit a report with the key information and findings of interviews and focus group discussion (deliverable 2).

  Phase 3. Analysis and reporting phase:

• A draft report andPPT presentation of the key findings (deliverable 3) a preliminary draft Rwanda Newborn Case Study report with a summary of maternal and newborn health evolution process between 2000 and 2015 and the current status disaggregated by district, recommendations/lessons learned, specific strategies and interventions to be implemented, knowledge gaps in Rwanda and presented to MoH, Neonatal TWG, UNICEF and other key stakeholders working on MNCH.

• Once the findings are discussed and validated by the Neonatal TWG and UNICEF, the final full case study report, a summary final report and final PPT presentation (deliverable 4), and an academic article for publication (deliverable 5) as end products, are subject to approval by the MoH/RBC-MCCH and UNICEF**.**

Outputs/Deliverables:

Tasks

Expected Deliverables

Timeframe

Schedule of payment

1. Developing work plan, Desk review of available documents, coverage data of MNH indicators and literature related to the Maternal and New-born Health programme and, designing of data collection tools for interview and focus group discussion and preliminary discussions

Feedback meeting on findings from desk review. Inception report(deliverable 1) including summary of desk review including details of the methodology and instruments to be used for data collection/interview and FDG, timeline and detailed analysis plan, and annotated outline of final report), to be presented and approved by the MoH/RBC-MCCH and UNICEF.

Week 1-2

Month 1

1. Data collection: interview National level stakeholders (MoH/RBC-MCCH, Neonatal TWG, UNICEF and other partners meetings and Focus Group Discussion with health providers from health facilities and community

Brief report of the national in-depth interviews with the key informants or stakeholders and focus group discussions and findings (deliverable 2).

Week 3-5

Month 2

1. Analysis of findings and preparation preliminary draft report of Newborn Case Study with a summary of maternal and newborn health evolution process between 2000 and 2015 and the current status disaggregated by district, recommendations/lessons learned, specific strategies and interventions to be implemented in Rwanda.

Preliminary draft case study report, draft academic article for publication and PPT presentation(deliverable 3)

Week 6-9

Month 2

1. Incorporate comments from key stakeholders and finalization of the full new-born case study report; finalizing one article for publication.

Final case study report witha summary final report and final PPT presentation(deliverable 4), and one academic article for publication (deliverable 5)** as end products,

Week 10-12

Month 3

6. Stakeholder Participation

The main members of stakeholders are Ministry of Health/RBC, MCCH TWG/Rwanda Every New-born Core Team/ Neonatal TWG and UNICEF CSD-Health Unit, which will function as a reference group for the new-born case study and assume the following responsibilities:

• Plan, and provide technical inputs to the new-born case study design through consultation with the main parties involved;
• Provide guidelines to consultants and monitor the implementation;
• Review the consultant’s inception report (including proposals for desk review of documents, new-born case study instruments and annotated outline of the report);
• Review preliminary findings for validation of facts and analyses and help generate recommendations;
• Review and approve the final report, verify the findings and propose a management response on how to implement recommendations;
• Ensure that new-born case study findings are used for future planning and MNH or new-born health programmatic interventions as well as advocacy purposes.

UNICEF Rwanda will be responsible for selection of the international consultant to conduct the new-born case study. The consultant will be managed by UNICEF Rwanda.

MoH/RBC-MCCH will be responsible for providing relevant information at country level, providing access to relevant reports/statistics, providing inputs for data analysis and organizing meetings with different stakeholders.

7. Qualifications and Requirements

Education: Advanced university degree (Masters as a minimum), skilled in public health with solid experience in case study.

Prior Work Experience:

• At least 8 years of experience in public sector maternal-newborn and child health programs at national or international level, preferably with experience in designing, managing and/or documenting decentralized public sector programs. Preferable experience in MNH case study.

• At least 3 years of research experiences, preferably using both quantitative and qualitative methods to tell a story using existing data and research techniques for developing case studies.

• At least 3 years’ experience with writing case studies and/or academic manuscripts. Ability to translate large amounts of data into a concise and clearly communicated case study.

Language Proficiency:

• Fluency in written and spoken English is required. Fluency in speaking/reading/writing in French or Kinyarwanda is recommended.

Knowledge:

• Comprehensive knowledge of Maternal and New-born issues, and interventions, including behaviour change communication for effective implementation of Maternal and New-born services

• An in-depth understanding of Maternal, New-born and Child Health programs, policies, regulations and precedents applicable to development and administration of national/international public health programs

• Detailed knowledge of the international health care systems and structures, including familiarity with Rwanda MOH policies, program priorities and regulations

• Working knowledge of techniques to plan, organize and direct multidisciplinary project teams and activities

Skills and Abilities:

• Demonstrated analytical and decision-making abilities

• Demonstrated ability to identify priority actions, generate and complete work plans within short time frames

• Strong oral and written skills and ability to clearly communicate new program and technical concepts to technical and non-technical counterparts

• Strong interpersonal communication and negotiation skills in achieving results with a wide range of program partners

• Strong computer literacy and use of modelling tools, database management and statistical package (e.g. LiST, Access, Excel, SPSS, STATA, etc.…)

• Ability to rapidly create text, spreadsheets and other types of documents to meet specific program and reporting needs

8. Supervision

The consultant will be based in UNICEF Kigali office. The consultant will be supervised by UNICEF CSD- Health Unit.

9.Duration

The consultancy will be for three (3) months from the date of contract signature.

10. Terms and conditions:

• The consultant will work primarily in UNICEF Kigali office and closely work with the MoH/RBC-MCCH division on daily basis.

• On-field (in-country) transport will be arranged by UNICEF and Consultant will complete Waiver for Non-Staff issued with travel authorization in accordance with UNICEF Financial and Administrative Policy 5, Supplement 4 (B.2):

• Consultant must complete basic security and advanced security in the field prior to travel.

• The candidate selected will be governed by and subject to UNICEF general terms and conditions for individual contracts.

• The consultant will use private computer for the consultancy period.

• The consultant will be paid by UNICEF on monthly basis based on the submission report on the deliverables

• Non-UNICEF staff (including individual consultants) issued with UNICEF Travel Authorization are not covered by the insurance which automatically applies to UNICEF staff, and are fully responsible for arranging their own insurance cover.

• .

• Consultant need to provide lump sum total fee that includes consultancy fee and living allowance and flight. Qualification and lower fee requested will be a basis for selection

• UNICEF reserves the right to withhold all or a portion of payment if performance is unsatisfactory, if work/outputs is incomplete, not delivered or for failure to meet deadlines

• All materials developed by the consultant will remain the copyright of MoH/RBC-MCCH and UNICEF.

Qualified individuals are requested to submit their cover letter, CV and P11 form (which can be downloaded from: http://www.unicef.org/about/employ/files/P11.doc), to Human Resources at: rwajobs@unicef.org by 7^th February 2016, quoting the indicative all-inclusive fee range and the consultancy with subject: “International National Newborn Case Study for Rwanda-SSA.”

You may also submit to: Human Resources Specialist, UNICEF Rwanda, and P.O. Box 381, Kigali, Rwanda.

Applications submitted without an all-inclusive fee/ rate (fee, travel and living expenses) will not be considered. Please note that only shortlisted candidates will be contacted.