High-level national/International consultancy - to update Community Health Policy

High-level national/International consultancy - to update Community Health Policy in Rwanda, 12 Weeks

Job Number: 528902 | Vacancy Link
Locations: Africa: Rwanda
Work Type : Consultancy

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For every child, Equity
Rwanda’s Community Health Program (CHP) was initiated by the Ministry of Health (MoH) in 1995 after the devastating 1994 Genocide against the Tutsi, to address challenges related to healthcare access and a shortage of the healthcare providers.
Community Health Workers (CHWs) constitute one of the Rwanda’s Home-Grown Solutions (HGS). For two decades, the program has been empowering communities to take charge of their lives. Since its inception, it was extended to all villages in Rwanda and uses about 60 thousand CHWs, who provide healthcare services at the community and household that contributed to the country’s remarkable progress in the health sector.
Rwanda has made tremendous progress in implementing successful, innovative and high impact health interventions to improve the health status of Rwanda population. Such achievements include a decrease in maternal and U-5 mortality rates, an increase in prenatal care visits and utilization of delivery services, a steady decline in the total fertility rate, and relative stability in malaria and HIV prevalence, slight increase in the utilization of modern contraceptives and higher immunization rates for children with 12-23 months. This was due to strong commitment from the country’s leadership from the highest level of government to the lowest at community level, coupled with innovative and effective interventions.
The national Community Health programme was subject to an extensive external evaluation in 2016 and the recommendations need to be implemented to ensure that these key health workers are optimally used. The evaluation found that there is a high turnover of CHWs (10 per cent on average), ageing population of CHWs, financial sustainability, current model of deployment of CHWs, issue of recruitment, retention, performance and motivation, etc.
The Government of Rwanda recognizes the problem of access to primary care is not only a health sector issue, but rather a multi-sectorial challenge that requires all sectors to work together in a synergetic manner to deliver a comprehensive health package – ranging from promotive/preventive to curative interventions with community participation, specifically, the community health package consist of the community case Management(CCM), Mother and New Born Health Program (MNH), Community Provision Family Planning (CBP), Community Based Nutrition Program (CBNP), Behaviour Change Communication (BCC), Adolescent Sexual and Reproductive Health (ASRH) and Rwanda Community Management Information System (RCHMIS). These programmes are primarily designed to the reduction of Maternal and Child Mortality. Additionally, the package includes the community Performance-Based Financing (C-PBF) through community Health Workers cooperatives, which aims to improve the quality of health care, while at the same time improving the motivation of community health workers by way of creating income –generating projects.

However, despite tremendous progress in improving the health of Rwandan population, there are still challenges;
• The need to reach the whole population and to protect the health of the most vulnerable population or some isolated communities/under privileged populations still have problems with geographic or financial accessibility to health services;
• Sustainability of financing of the health system is a central problem as external funding is decreasing faster than internal resources are increasing. Limited resources lead to making choices in terms of cost-efficient interventions and of target populations for maximum impact on the health status of the population, but this situation represents a threat to maintaining the desired availability and quality of services;
• Insufficient involvement of private sector for strengthening of health insurance schemes to ensure financial self-reliance of health services;
• Insufficient community participation in the management of health care services because of lack of knowledge by population of their rights and lack of awareness of the role they can play;
• Insufficient integration between decentralized health services (health facilities) and local government bodies for management of health care delivery;
• Coordination with several development sectors (agriculture, education, social protection) in the fight against malnutrition (Prevalence of stunting 38% still high) needs to be strengthened;
• Gaps in the integration of infectious diseases at decentralized level, particularly in supervision and mentorship;
• NCD, prevention, mental health services and first aid services are not yet available at community level.
• Limited management skills for community health workers to manage the cooperatives
• current training model is inefficient and not supportive of an effective program, that it does not provide timely access to training to all the CHWs recruited and deployed in Rwanda.
• The low ratio of in charges to CHWs and the lack of means and resources cause an inconsistent level of implementation of supportive supervision across the country.
• The availability of functional equipment is unsatisfactory. And the inconsistent availability of medicines – high in facilities, low at CHWs level -suggests that there are issues related to the system of quantification and distribution of medicines at the lower level of the chain.
• Ageing population of CHWs and risks of high turnover in future;
• Long term trends of urbanization and of increasing burden of non-communicable diseases, which may affect the patterns of demand for services and hence the relevance of the CHP;
• The lack of a formal, institutional framework that allows a formal dialogue between a regulatory entity (MoH) and an institutional body representing the implementing agent (CHWs) around duties and rights of each party involved in the CHP.
The current policy is expiring, and the development has to be evolved with the new SDGs hence the need to write and/or revise existing policy. In this context the Ministry of Health is looking a highly motivated consultant to develop the community health policy aligned with national priorities, regional and global agenda.

The purpose of the consultancy is to lead and provide technical support to the process of review and update the current Community Health Policy; taking into consideration national development goals (EDPRS II, Vision 2050 and Reproductive Maternal Newborn Child and Adolescent Health (RMNCAH) Policy 2017-2030) and international Sustainable Development Goals (SDGs) Agenda. The policy will be a comprehensive guiding document encompassing community based health services system such as Community Based Maternal New Born Health, Community based Nutrition, Integrated Community Case Management, Community Based Provision Family Planning, Rwanda Community Management Information System (RCHMIS), Community Based Adolescent Sexual and Reproductive Health (ASRH), community based Supply Chain Management, the policy will include also new emerging issues in community like Non-Communicable Diseases, Mental Health and First Aid, Communication for Behavior Change, Monitoring and evaluation including its sustainability within the overall health delivery system of the country.
Therefore a short consultancy is necessary to review and update the current community health policy. The consultant will work under the guidance of MoH/RBC, community health technical working group and UNICEF health section.

How can you make a difference?

bjectives
The main objective of this consultancy is to review and update the current community health policy considering the national and global developments in community health in relation to overall health systems in the context of Rwanda. The consultant will also work on the final design and layout of the community health policy.
Scope of work

The consultant is expected to:
1. Undertake a literature review on recent global, regional and local evidence in the field of community health and national health policy and programmatic developments/issues that have a bearing on Rwanda Community Health Program
2. Undertake an assessment of implementation of the expiring policy using secondary data plus primary data if necessary.
3. Conduct interviews with key stakeholders and focus group discussions with CHWs, health personnel at Hospital and Health Centers, policymakers and beneficiary to ascertain their views with respect to gaps in community health program components and propose appropriate strategies in terms of planning/ design, implementation and monitoring and evaluation with respect to:
- Adequacy of the curriculum and frequency of training;
- Appropriate qualifications;
- Desirable career paths and certification/diploma options;
- Effectiveness and sustainability of volunteerism;
- Effectiveness of the PBF cooperative model, management and sustainability of cooperatives
- Adequacy of supervision and mentorship; and
- Availability of commodities and supplies and deployment of CHWs,
- Self –reliant and sustainable CHWs model,
- Reporting system/monitoring and evaluation and Legal framework
4. Undertake consultations with key stakeholders to get information to feed into the draft Community health policy document.
5. Coordinate the convening and documentation of a one- day stakeholders’ consultation meeting to solicit inputs for the development of the draft policy
6. Conduct an agreed number of key informant interviews with selected stakeholders and focus group discussion sessions with young people to complement the literature review, and inputs from the one-day consultation
7. Draft a comprehensive Community health policy review and update
8. Lead the process of validation of the draft policy through a workshop to get stakeholders ‘inputs
9. Submit the final agreed draft submission to the Ministry of Health and UNICEF

To qualify as an advocate for every child you will have…
Master’s degree in public Health Sciences or Health Economic with an extensive experience of at least 8 years in similar work is required.
8 years- of progressive professional experience in development, design, and implementation of Health policies in developing countries;
Demonstrated successful experience in developing of evidence-based publications, strategies, guidelines, reports;
Experience of working in Africa especially Rwanda either with Governments or UN systems will be an asset
Experience in academic or the management of Community Health related programmes at national level;
Fluency in English with excellent writing, analytical, conceptual and communication skills
Knowledge of Rwanda health system is an asset.
Computer skills (excel, word, PowerPoint)

For every Child, you demonstrate…
UNICEF's values of Care, Respect, Integrity, Trust, and Accountability (CRITA) and core competencies in Communication, Working with People and Drive for Results.


UNICEF is committed to diversity and inclusion within its workforce, and encourages all candidates, irrespective of gender, nationality, religious and ethnic backgrounds, including persons living with disabilities, to apply to become a part of the organization.
UNICEF has a zero-tolerance policy on conduct that is incompatible with the aims and objectives of the United Nations and UNICEF, including sexual exploitation and abuse, sexual harassment, abuse of authority and discrimination. UNICEF also adheres to strict child safeguarding principles. All selected candidates will, therefore, undergo rigorous reference and background checks, and will be expected to adhere to these standards and principles.


Qualified and experienced candidates are requested to submit a letter of interest including a Technical Proposal outlining a road map for review and implementation timeline (must to submit technical proposal and possible to team up with another expert who has experience in the field). In their letter of interest, candidates should highlight their previous work experience relevant to the assignment, the attributes that make them suitable, their proposed approach to the assignment.

Only shortlisted applicants will be requested to submit a Financial Proposal outlining the total costs for this consultancy with payment linked to the 3 main deliverables outlined above. The financial proposal should indicate an all-inclusive lump sum fee composed of consultancy fees, local taxes, travel costs and subsistence/living allowances. Please note subsistence/living allowances for filed visit will be based on Government rate.
UNICEF has a zero-tolerance policy on sexual exploitation and abuse, and on any kind of harassment, including sexual harassment, and discrimination. All selected candidates will, therefore, undergo rigorous reference and background checks.
Application sent without the Financial Proposal will not be considered and only shortlisted candidates will be contacted.

Closing Date Tue Jan 14 2020 22:55:00 GMT+0100 (Afr. centrale Ouest)