International consultancy to provide technical assistance to establish continuous quality improvement (CQI) mechanism in selected districts of the Republic of Tajikistan

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UNICEF works in some of the world's toughest places, to reach the world's most disadvantaged children. To save their lives. To defend their rights. To help them fulfill their potential.

Across 190 countries and territories, we work for every child, everywhere, every day, to build a better world for everyone.

And we never give up.

For every child,

Background Maternal and Child Health (MCH) remains a priority in Tajikistan's National Development and Health Sector policies and strategies including Tajikistan's commitment to the attainment of Sustainable Development Goals (SDG). Despite significant gains in the last decade, Maternal and Child Health (MCH) outcomes in Tajikistan are worse than the average in Central Asia and Caucasus regions. Rates of malnutrition and micronutrient deficiencies are high. Preventable illnesses contribute to a considerable proportion of all child deaths in Tajikistan. Acute infections are the leading cause of death in the post-neonatal period. Acute respiratory illness (ARI), pneumonia, and acute diarrhea still account for more than half of reported child deaths within the first year of life, a pattern that has remained persistent over the last decade. Unsafe home deliveries are considered to be a major contributing factor to the high infant and maternal mortality rates in Tajikistan. Poor quality of care is a major concern of the Ministry of Health for number of reasons: insufficient training of health workers, lack of evidence-based clinical guidelines, underuse of generic drugs, poor infrastructure, limited budget and lack of essential equipment at primary and secondary levels of health care (Health System Review, 2016) . Though the Ministry of Health introduced an accreditation system and review of maternal death and near-miss cases, there is no emphasis on continuous quality improvement at all levels of care. The Quality of care has suffered significantly from brain drain, beginning with the civil war and continuing into the present, as health workers seek higher wages abroad.

Since 2016 UNICEF has been supporting the Ministry of Health and Social Protection of the Population to establish a Continuous Quality Improvement (CQI) mechanism in selected health facilities in Tajikistan. Under this support, the WHO “Hospital care for mothers and new-born babies’ quality assessment and improvement tool” (second edition, 2014) was adapted to the country context and used to conduct health facility quality assessment in maternity and new-born departments of 11 selected districts of the country. The assessment findings informed the design of capacity strengthening interventions and the procurement of essential equipment. In 2020, UNICEF within the ADB Maternal and Child Health Integrated Care (MCHIC) Project supported Ministry of Health in updating assessment tools, conducting a baseline assessment of quality services in the project districts and capacity building of health managers on Continuous Quality Improvement (CQI) mechanism and institutionalization of MCH supportive supervision system. Through a local company data collection for the assessment of child care practices at family level was accomplished. Assessment of refferal mechanism and development of regional and tailored referral system is ongoing. In December 2020, UNICEF signed an agreement with the MoHSP to provide technical support to MOHSPP to implement the Project for Improving Maternal, Neonatal and Child Health (MNCH) Services in the four districts of the Khatlon Region of the Republic of Tajikistan supported by Islamic Development Bank (IsDB). The IMNCH Project focuses on the reduction of maternal and infant mortality rates and burden of infectious diseases in Dangara, Khovaling, Nurek and Baljuvon target districts particularly focusing on the improvement of maternal and child health care delivery at primary and secondary health care level, including community mobilization for behaviour change. Similarly to the ADB MCH project, improving the quality of health services to mothers and children at both primary and secondary levels of care through the establishment of Continuous Quality Improvement (CQI) mechanism and institutionalization of MCH supportive supervision system is a core component of this project.

How can you make a difference?

The purpose of this assignment is to support the Ministry of Health and Social Protection of Population to establish Continuous Quality Improvement (CQI) mechanism for the provision of quality services to mothers and children at various levels of healthcare service provision in the target districts.

The required technical support will include technical support in secondary analysis of data collected and report writing of KAPB study, guidance and follow up in implementation of the recommendation of the assessment of quality of healthcareВ services for the ADB target districts, supporting local experts in conducting assessment of quality services at maternal and newborn units of district hospitals and PHC facilities of the IsDB projects districts and assisting the MoHSP, oblast/district health authorities, and selected health facility staff В of both ISDB an ADB projects in establishing a systematic process of continuous quality improvement (CQI) for maternal and newborn care.

DESCRIPTION OF THE ASSIGNMENT:

The consultant will work in close consultation and cooperation with the MCH Department and the Department of Medical and Pharmaceutical Education, Human Resource Policy and Science (DEHRP) of the MoHSPP, the Republican Clinical Centre for Family Medicine, the Republican center for accreditation of quality of health services, and the Republican Center of Medical Statistics and Information (RCMSI) to deliver the following:

1. Provide technical support in secondary analysis of data collected and report writing of KAPB study in ADB target districts.
2. In close consultation with MoHSP experts, based on the already developed assessment tools train the assessment team selected by the MoHSP and Oblast/District health authorities. The training will include an orientation on the assessment tool, the CQI process, and facilitation skills.
3. Lead the baseline external assessment process as per the agreed guidelines/assessment tools at the selected IsDB facilities. This will include:
4. Conduct assessment exercise together with the trained assessment team
5. Identify gaps in the provision of quality of care with reference to the national standards

6. Facilitate initial discussions of the assessment results with each Quality Improvement (QI) team at the assessed health facilities to develop Facility Scorecards and QI plans to implement the recommendations of the assessments.

7. Upon completion of the baseline assessment at all selected facilities, present the results and recommendations to MoHSP national representatives, oblast/district health managers, QI teams at all levels, and other relevant stakeholders. Facilitate discussions about QI plans to be implemented through the collaborative process involving different levels of the health system (including actions that are beyond the authority and responsibility of the individual health facility).

8. Produce a baseline external assessment report, elaborating the assessment findings, recommendations, required essential equipment, capacity building needs and QI plans for primary and secondary levels of care.
9. Provide training and subsequent coaching for QI teams at all levels and district/oblast health managers to implement QI system in the ISDB project districts. All QI teams and district/oblast health managers should benefit from mentoring support in continuous monitoring of performance and provision of supportive supervision and self-assessments of quality of care.
10. Provide supportive supervision and required guidance to QI team in implementation of the recommendation of the assessment of quality of healthcareВ services for the ADB target districts.
11. Produce a final report, summarizing the process and outcomes of the assignment as well as a set of recommendations and follow-up actions.

KEY DELIVERABLES and PAYMENT SCHEDULE:

#

Tasks/Milestone

Deliverables/Outputs

Number of days

Timeline

Payment schedule

1

Provide technical support in secondary analysis of data collected and report writing of KAPB study in ADB target districts.

KAPB study report and analysis

10

By 15th May

30%, upon UNICEF approval of the deliverables

2

Provide support supervision to QI team of ADB target districts.

Field visit reports and set of recommendations

20

Throughout the consultancyВ period

3

Provide training to the assessment team on the assessment tool, the CQI process and facilitation skills.

Report of training of В assessment teamВ on the assessment tool, the CQI process, and facilitation skills

10

By 25th of May

30%, upon UNICEF approval of the deliverables

4

Supervise assessment teams in conducting baseline external assessment at selected facilities of all four districts

Completion of the baseline external assessment at all selected facilities

20

By 30th of June

5

Present the assessment results, facility scorecards and QI plans

Presentation of the assessment results, facility scorecards and QI plans

8

By 10th of July

6

To prepare external baseline assessment report

Baseline external assessment report

5

By 20th of August

7

To conduct training of QI teams and district/oblast health managers and coach in continuous monitoring of performance and provision of supportive supervision and self-assessments of quality of care

Report of training/coaching of QI teams and district/oblast health managers in continuous monitoring of performance and provision of supportive supervision and self-assessments of quality of care

20

ByВ 15th of September

20%, upon UNICEF approval of the deliverables

8

Produce a final report, summarizing the process and outcomes of the assignment as well as a set of recommendations and follow-up actions

Final report

5

By 30th of September

30%, upon UNICEF upon submission of final report

Total

98 days

100%

Note: Due to COVID 19, the work and deliverables are subject to change. Consultant need to be flexible to adjust to any unforeseen adjustments that might occur during the implementation.

Performance indicators for the evaluation of results:

The evaluation of the results will be based on:

1. Technical and professional competence (quality of the products delivered to UNICEF);
2. Scope of work (e.g. No. of meetings with the stakeholders);
3. Quality of work (quality of methodology, draft, and final report);
4. Quantity of work (completing the tasks indicated in the table above within the set timeframe)

In addition, such indicators as work relations, responsibility, drive for results, and communication will be taken into account during the evaluation of the Consultant's work.

The assignment will be carried out in 98 working days within six month 10 May - 1 November 2021.

Location: Dushanbe, Tajikistan with travel to the field.

On-location working days:В Approx. 50 days. Off-location working days: Approx. 38 days

Travel involved: Consultant is expected to travel to Tajikistan. Travel plans to be pre-approved and agreed to by UNICEF Tajikistan. Travel paid for by UNICEF shall be based on economy class travel, regardless of the length of travel. Costs for accommodation, meals and incidentals shall not exceed applicable daily subsistence allowance (DSA) rates, as promulgated by the International Civil Service Commission (ICSC). Consultants and individual contractors are responsible for assuming costs for obtaining visas and travel insurance.

Supervisor: Health Specialist. Reporting to: Chief of Child Survival and Health Specialist

Insurances: UNICEF does not provide or arrange life or health insurance coverage for consultants and individual contractors, and consultants and individual contractors are not eligible to participate in the life or health insurance schemes available to United Nations staff members. Consultants and individual contractors are responsible for assuming all costs related to required inoculations, vaccinations and medical examinations. Consultants and individual contractors are fully responsible for arranging, at their own expense, such life, health and other forms of insurance covering the period of their services as they consider appropriate. The responsibility of UNICEF is limited solely to the payment of compensation for service-incurred death, injury or illness as per the provisions detailed below.

Recourse: 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.

Ethical considerations: Adequate measures should be taken to ensure that the process responds to quality and ethical requirements. The contracted consultant should be sensitive to beliefs, manners, and customs and act with integrity and honesty in their relationships with all stakeholders. It should also protect the anonymity and confidentiality of individual information.

Mandatory trainings: Consultants and individual contractors, regardless of contract duration, must complete the applicable mandatory trainings. The link will be provided during the selection process for the successful candidates.

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

Education

• Advanced university degree in the fields of Public Health and Epidemiology or any related fields. Clinical background specializing in maternal, neonatal and child health care be an advantage.
• The individual should be highly proficient in a range of PC/web applications, including but not limited to: MS Word, MS Excel, MS PowerPoint, MS Outlook, and Lotus Notes.

2) Work experience: Minimum seven years of practical experience in) in the field of maternal, neonatal and child health services Proven experience of adapting global standards and guidelines to developing countries context; Proven experience of developing competency-based training materials and conducting competency-based training; Consultancy experiences with international/UN organization in the field of maternal, neonatal and child health services, continuous quality improvement (including quality care assessment as per WHO guidelines), and health system strengthening; Experience in CEE/CIS countries is an asset.

3) Competencies: Strong analytical and conceptual thinking. Excellent writing skills; Excellent communication and presentation skills with stakeholders and the ability to work under pressure and commitment to work to a tight timeframe; Demonstrated cultural sensitivity and ability to establish harmonious working relations in a multicultural environment; Strong organizational, planning, and analytical skills; Good judgment, initiative, high sense of responsibility, tact and discretion.

4) Language: Excellent written and verbal communication in English; Knowledge of Russian and/or Tajik an asset.

REQUIREMENTS:

Qualified candidates are requested to submit:

1. Cover letter/application/CV.
2. A technical proposal with the proposed methodology/approach to managing the project, showing understanding of tasks.
3. Work plan.
4. Financial quote for the consultancy in USD per deliverable, stating also the timeframe for completion of deliverable and/or daily rate (as well as travel and subsistence costs, as applicable).
5. Examples of previous, relevant work related to the deliverables.
6. At least two references.

Queries can be sent to tad-procurement@unicef.org with the subject line "International consultancy to provide technical assistance to establish continuous quality improvement (CQI) mechanismВ *in selected districts of the Republic of Tajikistan".* Applications **must be received in the system by 6 May 2021 on our website: http://www.unicef.org/about/employ/index.php .

Travel costs and DSA will be covered in accordance with UN rules and regulations. No other remunerations apply. As a general principle, the fees payable to a consultant or individual contractor follow the “best value for money” principle, i.e., achieving the desired outcome at the lowest possible cost. Please note that consultants and individual contractors are responsible for assuming costs for obtaining visas and travel insurance.

EVALUATION PROCESS AND METHODS:

Individual consultants/contractors will be evaluated based on a cumulative analysis methodology. The award of the Contract shall be made to the individual consultant whose offer has been evaluated and determined as:

a) responsive/compliant/acceptable, and b) having received the highest score out of a weighted set of technical and financial criteria.

During the selection, the ratio between the technical evaluation and commercial offer is 70 to 30.

Only candidates who obtain a minimum of 49 points in the Technical Criteria evaluation will be considered for the Financial Evaluation.

Financial Proposal

Please provide a rate all-inclusive price (in US dollars) for delivery of professional services in accordance with the assignments described under this TOR. The formula for the rating of the Financial Proposals will be as follows:

FP Rating = (Lowest Priced Offer / Price of the Offer Being Reviewed) x 100

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.

View our competency framework at http://www.unicef.org/about/employ/files/UNICEF_Competencies.pdf

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.

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.