UNICEF Somalia
TERMS OF REFERENCE  
International Consultant  

To Develop Basic Packages of Health Services for the Different Zones of Somalia

1. BACKGROUND AND CONTEXT

The Somali people face some of the worst health conditions in the world with high maternal and child mortality rates resulting f rom easily preventable/curable diseases. Public health services are insufficient, inadequately staffed, fragmented, dependant on vertical aid support programmes and lack capacity at every level. There is a crisis of trust in the public services and utilization rates are extremely low, even for those facilities that do function (overall utilization of the public health system is estimated to be less than 20% of the population with one person visit every 7 years to a health facility). Consequently the public system is extremely inefficient and has a low productivity/impact. There are a variety of traditional options and a vibrant private market but it is not formally regulated, nebulous in quality and excludes the poor due to high costs.

The basic health care system is support by the different MoHs and a network of national and international NGOs and the Red Crescent Society. In theory there is a tiered system compromising regional referral hospitals, district hospitals, Maternal and Child Health Centres (MCHs) and Health Posts (HPs). In practice, these facilities are insufficient in number and poorly distributed and operate according to vastly different standards. The HP tier is almost totally unsupervised and poorly staffed and supplied, leading to questionable levels of service and poor coverage of primary health care interventions.

There is limited standardization between different facilities (size, staffing, role and services) and functioning is highly questionable. It has been agreed by the 3 MoHs, NGO providers and donors alike that the most important first step in health system recovery and development is to define a very limited BASIC PACKAGE OF HEALTH CARE SERVICES - reflecting limited resource availability. The BPHS will seek to define services that are feasible and have impact within the resource envelope available (funds, human resources, management capacity, logistic capacity). Provision of a template for services must also be grounded in a desire to redress inequity and reflect the particular demographic, topographic and socio-cultural aspects of Somalia. Service delivery systems will be designed to allow for expansion of packages over time as more resources and capacity becomes available over time.

Following the definition and acceptance of basic packages of health services the information will be used to define

• standard facility blueprints
• standard staffing requirements, cadres and training requirements
• revision of the UNICEF HP/MCH drug kits

2. PURPOSE AND OBJECTIVES

To review hospital, MCH and HP facilities and develop a standard package of services according to needs, capacities and current practice.

Specific Objectives: - In each of the three operational zones:

• Define standards for different tiers of service
• Define a normative framework for how many of each service facility level are required per population/area.
• Define mobile packages and ways to service low density populated rural areas.
• Define medicine and medical materials required for the functioning of each level of service.

3. METHODOLOGY AND TECHNICAL APPROACH

The work will be conducted with respect to the 3 political entities.

• The first period will be used to interview medical coordinators of all major INGOs in Nairobi to establish current protocols in use through the different service programmes (ICRC, SRCS, MSF, COPI, COSV, IMC, SC-UK, Merlin, GHC, CISP, MDM, ….)

• The second period will be to gather information in each of the three zones. In each zone a Somali health professional will be hired to assist in the work and negotiations with MoH. The consultant will organize and partake in some of the following activities:
• visiting a sample of HPs, MCHs and lower level hospitals supported by MoH and different local community based organizations, NGOs and INGOs.
• Interview MoH, professional associations and NGOs in the zone.

In order to define levels and variations in staffing patterns, key services delivered, differences between tiers, need for change of drug kits, key problems in organizing and managing services, difficulties in achieving coverage, spatial distribution of services,

• The third period will be used to develop draft guidelines reflecting the information collected, socio-economic and demographic situation in Somalia, and international efforts in other countries to develop similar packages.

Data collection and analysis

• Review international BPHS
• Review Zonal MoH policies and SACB/CISS guidelines
• Review agency guidelines
• Develop draft BPHS
• Visit 3 zones to analyze local data, visit facilities and interview:
• Health Authorities in Somaliland (MOHL), Puntland (MOH) and Somalia (MOH-TFG)
• Health & Nutrition technical representatives of agencies
• Health workers
• ”Customers” of facilities (mothers, caretakers, local authorities, clan elders and religious leaders)
• Supervise field work.
• Conduct in-depth analysis of data, results of discussions and observations
• Develop Zonal specific BPHS
• Organize workshop (s per zone) to deliver and discuss suggested BPHS.

4. MANAGEMENT, ORGANISATION AND TIMEFRAME

• Management

Under the supervision of the Health sector development Coordinator, the consultant will be required to work in close collaboration with the Health & Nutrition Managers in CS, NW and NE Zones

5.2 Organisation

The consultant will be based in Nairobi with long and frequent field missions into Somalia according to an agreed work plan to be developed at the beginning of the consultancy.

5.3 Timeframe

The overall time frame for the consultancy is for 3 months , starting on the date of signature of the contract.

5. DELIVERABLE AT THE END OF THE ASSIGNMENT

The consultant shall deliver the following reports as follows;

At the end of the 2nd week:

• Work plan
• Analysis of external and Somali BPHS’s (and reasons for previous failures)

Analysis of variance in packages

At the end of the 2 nd month:

• 1st Progress report

At the end of the 3 rd and last month

• Consolidated final report

Note: The final report of the consultancy will contain all elements outlined above should be submitted in hardcopy and soft copies.

7. QUALIFICATIONS & EXPERIENCE

• Advanced University degree in public health preferably in the area of health systems and financing
• professional work experience in programme planning, management, monitoring and evaluation in Health and immunization
• Proven ability to plan and manage health system analyses.
• Good analytical, negotiating, communication and advocacy skills.
• Fluency in English required.
• Demonstrable experience of work related to BPHS design or similar

8. REMUNERATION

The consultancy fees will be set according to UNICEF standards applicable for International consultants. The task requires an L4 level qualification. The contract will be processed in accordance with UNICEF standard procedures for special service agreements.

The payment schedule will be based on monthly remuneration.

UNICEF will pay for the travel costs within Somalia and between Somalia and Nairobi. The consultant will be responsible for accommodation (but can be assisted to find suitable accommodation).

9. CONDITIONS OF WORK

The consultant will be provided office space by UNICEF while in Nairobi (USSC) and in UNICEF zonal offices inside Somalia. The consultant is expected to have his or her own laptop to carry out the required tasks.

10. EXIT AND PENALTY PROVISION

The consultant and UNICEF may agree to reschedule deadlines if unforeseen circumstances arise. In the event that such rescheduling has not been agreed in advance by exchange of letters, and submission of scheduled drafts should not occur within deadlines indicated within these TOR and the implementation framework, a fine of two percent of the total value of the contract may be deducted. In the event UNICEF is unhappy with the work produced by the consultant, they may opt to terminate the contract on mutually agreeable terms. Likewise, if the consultant is unhappy with new conditions given by its client he/she may opt to withdraw on mutually agreeable terms.

12/07 Austen Davis

Source: UNICEF