EENC Consultant

Purpose of the Consultancy

To provide technical support to the Ministry of Health (MOH) in oPt to:

1. Scale up the implementation of EENC in Caesarean sections in Gaza in the main MOH hospitals (5 hospitals).
2. Strengthen the application of EENC “the first embrace “in preterm and low birth weight babies in all EENC implementing hospitals (9 hospitals)

Background

In Palestine, where the neonatal mortality rate is 9,4 deaths per 1000 live births, neonatal deaths account for two thirds (66%) of deaths in children under the age of five (14,2/1000)[1]. In the West Bank, according to the most recently published findings, the neonatal mortality is higher than in Gaza - for the first time ever – and has not significatively improved over the past decade. One half of neonatal deaths occurs in the first day of life, mainly from complications related to prematurity, birth asphyxia, and infection, as well as birth defects[2].

Additional deaths can be prevented through simple actions for prevention and care of preterm, low-birthweight babies and sick newborns. The focus of attention needs to include not just the time after birth, but also the time during labour and delivery, even where a high proportion of births are attended by skilled health professionals.

Health workers often use outdated and harmful clinical practices during and after delivery which increases risk for newborn morbidity and mortality[3],[4],[5],[6]. The risk of death associated with caesarean sections (CS) was found to be six times higher than the risk associated with normal delivery[7].

The 2017 Palestinian Every Newborn Action Plan[8] aims is to improve the quality of care at health facilities - where 99,9% of all deliveries occur - using early essential newborn care (EENC)[9]. EENC involves coaching of health facility staff on appropriate childbirth and immediate newborn care practices using adult learning methodologies. Other focus areas are policies, reorganization of workspaces, health worker roles, sequencing of tasks, and availability of supplies and equipment.

In Gaza, EENC policies, clinical protocols and methods have been scaled up since 2017 in the main public and NGO hospitals (covering about 85% of total births) with now widespread adoption of core EENC practices for term babies in vaginal deliveries and recently also in CS. Significant improvements were documented in Gaza on key coverage indicators like % of babies receiving skin-to-skin (STS) contact, and early and exclusive breastfeeding[10]. Steady improvement in practices for both mother and newborns thanks to EENC at most government and NGO maternity hospitals in recent years has been well documented[11]. The recently published findings on neonatal mortality show a significant reduction of neonatal mortality in Gaza, which seem to suggest the positive impact of EENC.

Introduction of EENC for CS was introduced in one Gaza hospital in 2019[12]. Most preterm babies, even when stable, are routinely separated and referred to Neonatal Intensive Care Units (NICUs) for observation, exposing them to risks of infection, hypothermia and bottle feeding. Therefore, EENC activities shall focus on childbirth care in CS and on care for preterm and low birthweight babies.

Annual Implementation Review (AIR) and Planning Guide, is the first EENC module and is used at the national and subnational levels to collect data for the development of annual implementation plans and five-year national action plans. AIR is essential for evaluating the quality of maternal, delivery and postnatal care in facilities.

In Gaza, AIRs are supposed to be conducted twice a year by the EENC national coordination team, consisting of 7 EENC facilitators. The EENC team is responsible for AIR data collection, entry, verification, and analysis.

Also, MOH established an EENC online quality assessment platform to facilitate access to key data for decision making on maternal and child health care service delivery at health facility level, using standardized indicators on issues such as preterm or low birth weight babies.

[1] Palestinian Central Bureau of Statistics, 2021. Palestinian Multiple Indicator Cluster Survey 2019-2020, Survey Findings Report, Ramallah, Palestine.

[2] Validation of UNRWA survey findings on Infant Mortality in Gaza: Summary of Main Findings, August 2016.World Health Organization (WHO), Ministry of Health (MOH), UNWRA

[3] Wick L, Mikki N. Childbirth in Palestine. Reported practices and evidence-based guidelines. Birzet University, 2004

[4] Wick L, Mikk N, Giacaman R, Abdul-Rahim HF: Childbirth in Palestine. Int J Gynaecol Obstet, 2005.

7 H.Bitar S, Narrainen S, ‘Shedding light’ on the challenges faced by Palestinian maternal health-care. Midwifery 2009

[6] H.Bitar S, WickL. Evoking the Guardian Angel: Childbirth Care in a Palestinian Hospital. Repr. Health Matters 2007

[7] Abdo SA, JarrarK, El-Nakhal S. Report on Maternal Mortality in Palestine, 2010

[8] Every Newborn Action Plan: Strategic Action Plan for neonatal care in Palestine 2017-2019.

[9] Health Annual Report Palestine 2018, PCBS, July 2019

[10] Quality of Early Essential Newborn Care in Hospitals in Gaza: a pre-post- intervention study. Abed S, Al Attar S, Shaikh Khalil B, Al Masharfa L, Skaik N, Pivetta S, Murray J, Ronfani L and the Gaza EENC team, Lancet 2021 in press.

[11]EENC- annual implementation review - Gaza, Summary report, WHO and MoH July 2019,

[12] Introduction of EENC with Caesarean Section at Sultan hospital, Summary report, WHO July 2019

Work to be performed

1. EENC around time of birth

Output 1: Advice the MOH and hospital managers on scaling up EENC with Caesarean section (5 MOH hospitals)

Deliverable 1.1. Follow up hospital plans for introduction and scale-up and support clinical coaching

Deliverable 1.2. Analyze and report on data from CS-focused annual implementation review and recommendations to MoH.

Output 2****. Advice MOH and hospital managers on scaling up of EENC of late pre-term and LBW babies

Deliverable 2.1: Follow up study recommendations and implemnation of review methods.

Deliverable 2.2. Analyze and report on data from Preterm/LBW-focused annual implementation review and recommendation to MoH.

O****utput 3****: Technical support to the MOH and IT department for management of AIR data and existing routine e-data

Deliverable 2.1. AIR report including new “mini-AIR” and CS and preterm and low birthweight-focused data analysis and reporting

Deliverable 2.2: Report on newborn routine e-data 2020-2021 and trends.

Specific requirements

Qualifications required:

1. Medical degree
2. Masters or PHD in Public health, or obstetrics or neonatal health or other relevant area.

Experience required:

1. 5 to 10 years of experience in developing country settings
2. 5 to 10 years of practical experience supporting country and health facility level planning, implementation, scale up, monitoring and evaluation of maternal, newborn and child health programmes

Desirable: Working experience in West Bank and Gaza or middle eastern countries.

Skills / Technical skills and knowledge:

1. Expertise in the gathering, analysis and use of epidemiological data – particularly in the area of maternal, newborn and child health
2. High level technical skill in core areas such as programme planning, management, monitoring and evaluation
3. Experience in planning and facilitation of meetings and workshops; writing and development of tools, methods and guidelines; publications in RMNCH topic areas; and advocacy and discussions with senior country staff about programme financing, policy and advocacy.

Language requirements:

1. English language; expert level required for reading - writing – speaking

   Place of assignment

a. Remote support: review and development of reports, policies, guidelines; data analysis and reporting; technical backup and follow up on technical issues.

b. Field work in Gaza: visits to hospitals and PHCs; observations and interviews with mothers and staff; observations of clinical practice and of facility systems; facilitation of review meetings and planning; clinical coaching in delivery room and surgical theatre settings and PHCs.

In case travel will not be possible, remote support will replace field visits. In this case, methods and tools will be developed accordingly, to allow replacing remote activities to be effective.

Medical clearance

The selected Consultant will be expected to provide a medical certificate of fitness for work.

Additional Information section

- This vacancy notice may be used to identify candidates for other similar consultancies at the same level.

- Only candidates under serious consideration will be contacted.

- Renumeration is in line with WHO applicable consultant payment rates

- Successful candidates will be included in the roster for consideration for future contractual engagement via a consultancy, as they become available. Inclusion in the roster does not guarantee any future contractual relationship with WHO

- A written test may be used as a form of screening.

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