International Consultancy - enhancing the performance and quality of existing Maternal and perinatal death surveillance and response (MPDSR) system, Windhoek, Namibia in Namibia, 25 days

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Scope of Work Maternal and perinatal death surveillance and response (MPDSR) is emerging globally as an important strategy to improve the quality-of-care women receive around childbirth. As a systematic process, it equips health care providers with information around the systemic failures that result in death of both mothers and their babies around childbirth. Though some maternal and perinatal deaths show some decline in certain Namibian regions, the pace of the decline is not encouraging, with an increasing proportion of maternal and perinatal deaths recorded when comparing with 2019 and 2020: 18 maternal deaths were recorded in January to June 2019, and increased to 25 from January - June 2021. Stillbirths reflect the quality of care provided during antenatal care and intrapartum period, yet still births are at an alarming rate at the hospitals targeted jointly by UN agencies. With the stillbirth rates ranging from 12/1000 – 22/1000 per total births in 2019, and 9/1000 -20/1000 total births in 2020 for Ohangwena, Khomas, Kavango (East and West) and Zambezi regions respectively.Further analysisof the intrapartum stillbirths show that fresh stillbirths accounted for 21%-48% in 2019 and 25%-45% in 2020. Zambezi region, in northeast Namibia is recording the highest stillbirths’ rates as well as proportion of fresh stillbirths at 20/1000 -22/1000 total births, and 45%-48% out of all the total stillbirths. Figures from Rundu hospital in Kavango region, using the MPDSR monitoring tool show around 78% early neonatal deaths (0-7 days) for the period June 2019 - May 2020. These figures call for intensified maternal new-born quality improvement around time of birth when most mothers and their neonates are at the highest risk of dying.

Scope of the skills building and review To end preventable maternal and neonatal deaths, accurate information on how many women/newborns died, where they died and how they died is extremely important. It has been said that “You cannot manage what you cannot measure.” Knowing the magnitude of newborn and maternal mortality is essential for advocacy and policy dialogue. Information on where and how they die informs the development and implementation of evidence-based policies, strategies, and guidelines to ensure availability, utilization, and quality of maternal and newborn health services. The goal is to reduce preventable maternal and perinatal deaths by employing and scaling up evidence based MNH quality improvement approaches such as MPDSR. Thus, to reduce preventable maternal new-born deaths more providers need to be trained on MPDSR skills building/data management, supported to set up facility MPDSR Quality Improvement (QI) review teams, monitor, improve data quality and to document challenges, best practices and lessons learnt for future scale up. UNICEF seeks the services of a Consultant to support MPDSR interventions in the five regions` maternity settings with worst maternal new-born indicators to address lifesaving skills gaps around labour and childbirth, and immediate postnatal.

Specific objectives of the MPDSR technical support General Objective: The MPDSR skills building workshops and quality improvement review proposes to improve the availability, quality and reporting of maternal and perinatal death and cause-of-death data in national and regional Health information systems through enhancing the performance and quality of existing MPDSR systems in Namibia during and post COVID.

This will involve the following: • Increase the pool of trainers to scale up perinatal death surveillance and response skills-building workshops for health workers and their supervisors working with pregnant women, antenatal care, labour and delivery and postnatal care. • Strengthen the capacity of health workers to identify and report all maternal and perinatal deaths. • Strengthen the capacity of health workers to correctly assign and code maternal and perinatal deaths. • Strengthen country capacity for analysis of maternal and perinatal death data

Key Analytical questions To achieve the set objectives, the skills building, and quality of care review will focus on the following components:

I. Training on (maternal) perinatal death surveillance and response:

1. What is MPDSR? 2. What are the goals and objectives of MPDSR? 3. Why MPDSR skills building/trainings? - objectives 4. What are the capacity gaps, and expected results? 5. What are the challenges facing MPDSR in the facilities? 6. What are the guiding principles in MPDSR? 7. What are the myths and misconception around MPDSR? 8. Definitions of indicators? 9. What are the six steps of the review cycle? a. Step1. How to identify perinatal deaths and select cases for review? b. Step2. How to collect information: facility progress and index cases? c. What is the minimum data set? d. Step3. How to analyse data? e. How to assign causes of deaths using ICD-11 principles (PM&MM) f. How to identify and classify modifiable factors (understanding what are modifiable factors)? g. Step4. How to make recommendations? (Introduction to a monitoring tool). h. Step5. Why implements recommendations? How is MPDSR approach linked to quality improvement i. Step6. Why evaluate and refine recommendations?

10. How to establish, revitalise or strengthen team formation. 11. What is the team composition, and its functions? 12. What are the ethical and legal frameworks for MPDSR?

II. Rapid assessment/Review of the quality improvement programme

a. What indicators are being monitored for the period under review (November 2019 – March 2022)? b. What progress has been made against the indicators? c. How are the implementing facilities` performance against the monitored indicators? d. What achievements, challenges, lessons learnt, and best practices have been documented by implementing facilities? e. Are there functional hospital quality improvement teams? If yes, what is the composition, review their minutes/records. f. What change ideas were successfully implemented, and why? g. How is the national level dashboard for maternal newborn improvement care (MaNICare) collaborative for quality of care being monitored and used to support the programme?

Expected Outputs There are two key deliverables from this consultancy. First, is a detailed report highlighting the key components of the training, cadre, and location of those trained with resourceful materials and links, for the trained trainers and/ or trainees.

Second, is a comprehensive and clear report highlighting the key achievements, challenges, lessons learnt, and progress made toward the indicators being monitored in the implementing hospitals. (Ref. Quality of care concept note, and the programme design meeting report). The report should stipulate feasible recommendations based on identified strengths and weaknesses for scalable future investment by the government, and for internal and external resource mobilization.

Target audience The training(s) will target national and regional health training centres, selected national, regional and district health information system officers, nurse managers, and senior medical officers. The quality improvement review will focus on the quality-of-care work in the 21 implementing hospitals. The review will scrutinize the reports of activities and trainings conducted. The review will also include survey of programme documents, key informants in all the implementing hospitals, but only 1-2 selected sites will be visited.

To qualify as an advocate for every child you will have…

Qualification:

Masters in Public Health, Epidemiology, Medicine

Work Experience: • A minimum of 5 years’ experience in implementing maternal perinatal death surveillance and response (MPDSR), quality improvement for maternal and newborn health, Public Health, Epidemiology, Social sciences, and/ or related fields. • Previous work experience with ministries of Health, UN Agencies, in quality improvement for maternal and newborn, maternal perinatal death surveillance and response is a merit • Experience with the public health context in Namibia or similar context within southern Africa. • Strong analytical and critical thinking skills • Strong coordination, convening and persuasive skills • Proficiency in Microsoft Office applications • Strong verbal and written communication skills (fluent in English) • Ability to work under pressure with minimal supervision and without compromising quality and integrity • Must be able to work in a team with diversity

Competency Profile i. Core Values Required • Care • Respect • Integrity • Trust • Accountability

ii. Required Competencies • Manages ambiguity and complexity • Thinks and acts strategically • Works collaboratively with others • Drive to achieve results for impact • Demonstrates self-awareness and ethical awareness.

Administrative issues:

The assignment is both home and office based.

The selection and conditions of service of consultant will be governed by and subject to UNICEF’s Policies and General Terms and Conditions for individual consultants/contractors.

No contract may commence unless the contract is signed by both UNICEF and the consultant/contractor.

Consultant/Contractor will be required to complete mandatory online courses (e.g., Ethics, Prevention of Sexual Exploitation and Abuse and Security) upon receipt of offer and before the signature of contract.

Consultant/Contractor will be required to sign the Health Statement for consultants/contractors and to share an applicable proof of health insurance prior to taking up the assignment.

Payment of professional fees will be based on submission of agreed deliverables. UNICEF reserves the right to withhold payment in case the deliverables submitted are not up to the required standard or in case of delays in submitting the deliverables on the part of the consultant.

How to Apply

Qualified and interested candidates to submit an online application before the closing date.

Please submit expression of interest together with:

• A cover letter, no longer than 1 page, and curriculum vitae showing how the consultant meets the required qualifications, experience, and expertise.
• 2-pager Technical Proposal demonstrating the consultant’s understanding of the ToRs, the proposed methodology/approach, and timelines for the respective deliverables; and
• A financial proposal/budget, which must include all expenses related to the assignment. The financial proposal should include provision for travel outside Windhoek for field mission. UNICEF will not provide separate transport support.

Incomplete applications e.g., without financial/budget proposal will not be considered. If you have not been contacted within 2 weeks of the closing date, please accept that your application was unsuccessful. Regret emails will be sent only to shortlisted/contacted candidates.

For every Child, you demonstrate…

UNICEF's values of Care, Respect, Integrity, Trust, and Accountability (CRITA).

To view our competency framework, please visit here.

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 be expected to adhere to these standards and principles and will therefore undergo rigorous reference and background checks. Background checks will include the verification of academic credential(s) and employment history. Selected candidates may be required to provide additional information to conduct a background check.

Remarks:

Only shortlisted candidates will be contacted and advance to the next stage of the selection process.

Individuals engaged under a consultancy or individual contract will not be considered “staff members” under the Staff Regulations and Rules of the United Nations and UNICEF’s policies and procedures, and will not be entitled to benefits provided therein (such as leave entitlements and medical insurance coverage). Their conditions of service will be governed by their contract and the General Conditions of Contracts for the Services of Consultants and Individual Contractors. Consultants and individual contractors are responsible for determining their tax liabilities and for the payment of any taxes and/or duties, in accordance with local or other applicable laws.