NATIONAL CONSULTANT -EENC

Contract

This is a No grade contract. More about No grade contracts.

Terms of reference for National consultant/s for EENC introduction in West Bank

NOC level

1. Purpose of the Consultancy: To provide technical support to the MoH to introduce EENC – “the first embrace” component - in one early implementing hospital in the West Bank

2. 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].

International evidence suggests that there are several opportune moments during which prevention of newborn deaths is possible through provision of high-quality routine care during labour, delivery and the immediate postpartum period.[3] Additional deaths can be prevented through simple actions for prevention and care of preterm, low-birthweight babies and sick newborns. Hence, the focus of attention needs to include not just the time after birth, but also the time during labour and delivery. Hence, even where a high proportion of births are attended by skilled health professionals, there is a need to ensure that quality essential care is provided during all these critical moments.

In the West Bank, past studies have shown that health workers often use outdated and harmful clinical practices during and after delivery which increases risk for newborn morbidity and mortality[4],[5],[6],[7]. CS rate in the WB is high and has alarmingly increased over the last decade[8].The risk of death associated with caesarean sections (CS) was found to be six times higher than the risk associated with normal delivery[9].

To redress this challenge, in 2017 the ministry of health in Palestine has endorsed the Every Newborn Action Plan[10]. One main focus of the plan is on improving the quality of care at health facilities - where 99,9% of all deliveries occur - using early essential newborn care (EENC)[11]. Implementation of EENC involves coaching health facility staff on appropriate childbirth and immediate newborn care practices using adult learning methodologies. Subsequently, a quality improvement approach is used to address contextual factors that influence practice such as local policies, reorganization of work spaces, health worker roles, sequencing of tasks, and availability of supplies and equipment.

Planned steps

1. Alia Hospital, Hebron; Medical Complex, Ramallah; Rafidia Hospital, Nablus have been identified, where clinical coaching should begin. One of them will be selected to be targeted during 2021, while the others will follow.

• Potential to become centers of excellence (CoE)
• Can facilitate coaching in all hospitals over time

2. Conduct first EENC clinical coaching for key staff at the targeted hospitals (5-days: coaching of facilitators)

• Select staff for coaching from obstetrics, pediatrics, neonatology, midwifery (about 12 per hospital)
• External WHO facilitators
• Develop 6-month plan of hospital activities

3. Form a EENC hospital team in each implementing hospital

• 6-12 members from obstetrics, pediatrics, neonatology, midwifery
• Formally endorsed by hospital manager
• Oversee hospital EENC introduction and scale-up, including procuring supplies and planning coaching

4. Scale-up EENC coaching for key staff in implementing hospitals (2 days: coaching of staff)

• Done by EENC facilitators
• Keep database of staff coached and written and practice scores

5. Update newborn policies, protocols and plans (in tandem with clinical coaching)

• Adapt, approve and introduce EENC clinical pocket guide (In agreement with the new National Neonatal Protocols)
• Modify hospital standing orders and work guidelines as needed
• Develop annual plans for EENC scale-up after initial introduction

6. Introduce EENC quality improvement approach in implementing hospitals (2 days)

• 3-6 months after first coaching when a high proportion of staff in early implementation hospitals have been coached
• External WHO facilitators
• EENC facilitators collect practice and systems data with checklists; and use of data for identifying gaps and taking actions to address gaps
• 1-year plan of activities developed, including regular self-monitoring

7. Evaluate progress at the end of the year (5-7 days)

• Conduct EENC Annual Implementation Review (AIR)

  3. Planned timelines

Start date: 1st July 2021

End date: 15 November 2121

4. Work to be performed during

Output 1**: Baseline information**

1. Assist the international consultant/s to collect baseline data on quality of childbirth care in 1 West Bank targeted hospitals (if Alia hospital in Hebron is selected to start with, then hospital baseline data has already been collected there)

Output 2: EENC clinical coaching in the targeted hospital

1. Assist the international consultant/s in clinical coaching of facilitators:
2. Support facilitators in ensuring quality coaching during scaling up (assist during coaching)
3. Support facilitators in developing a coaching plan and in scheduling coaching
4. Follow up implementation of the coaching plan and provide support if problems

Output 3**: EENC quality improvement**

1. Assist the international consultant in QI coaching
2. Support H teams in following up plans and monitoring practices
3. Follow up with WHO procurement and distribution of needed supplies
4. Facilitate the introduction of EENC standard indicators into the routine HIS

Output 4: Policy, planning, advocacy and coordination

1. Advocate for the identification of a MoH EENC/Newborn care focal person and/or a National coordination team
2. Support the MoH team to report to the MoH policy makers and to the Hospital managers on progresses and obstacles and advocate for needed support
3. Advise the MoH and hospital managers on adopting EENC- related policies and guidelines
4. Support the MoH in developing a detailed EENC 1-year plan (2022)
5. Coordinate with the WHO international consultants and with the in-charge WHO admin officer on technical, financial and logistic support.

4. Specific requirements

Qualification:

a) Medical degree (nursing or midwifery degree in case of a second consultant focusing on outputs 1-3)

b) EENC facilitator coaching certificate

b) Desirable: Public health or other relevant master or doctorate level degree

Experience:

a) At least 5 years of clinical experience managing births, newborn care or pediatric care (including midwives, delivery nurses, obstetricians, paediatricians, neonatologists)

b) experience with planning, implementation, scale-up, monitoring, and evaluation of maternal, new born and child health programmes at hospitals or other health facilities; survey experience; other public health experience

c) experience conducting clinical coaching, on-the-job clinical support or supervision

Skills/Knowledge

a) Technical skills in the clinical area of childbirth and/or newborn care

b) experience in clinical coaching, supervision, program planning, management, monitoring

Language requirements:

a) Excellent knowledge of Arabic;

b) English speaking and writing skills.

Competencies

1. Communicating in a credible and effective way
2. Collaborating with different clinical stakeholders
3. Producing results
4. Ensuring effective use of resources

d) Building and promoting partnerships

e) Moving forward in a changing environment

Additional Information

• 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.
• A written test may be used as a form of screening.
• If your candidature is retained for interview, you will be required to provide, in advance, a scanned copy of the degree(s)/diploma(s)/certificate(s) required for this position. WHO only considers higher educational qualifications obtained from an institution accredited/recognized in the World Higher Education Database (WHED), a list updated by the International Association of Universities (IAU)/United Nations Educational, Scientific and Cultural Organization (UNESCO). The list can be accessed through the link: http://www.whed.net/. Some professional certificates may not appear in the WHED and will require individual review.
• For information on WHO's operations please visit: http://www.who.int.
• WHO is committed to workforce diversity.
• WHO has a smoke-free environment and does not recruit smokers or users of any form of tobacco.
• Applications from women and from nationals of non and underrepresented Member States are particularly encouraged.
• WHO's workforce adheres to the WHO Values Charter and is committed to put the WHO Values into practice - https://www.who.int/about/who-we-are/our-values
• Consultants shall perform the work as independent contractors in a personal capacity, and not as a representative of any entity or authority. The execution of the work under a consultant contract does not create an employer/employee relationship between WHO and the Consultant.
• WHO shall have no responsibility whatsoever for any taxes, duties, social security contributions or other contributions payable by the Consultant. The Consultant shall be solely responsible for withholding and paying any taxes, duties, social security contributions and any other contributions which are applicable to the Consultant in in each location/jurisdiction in which the work hereunder is performed, and the Consultant shall not be entitled to any reimbursement thereof by WHO.

[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] Darmstadt GL, Bhutta ZA, Cousens S, Adam T, Walker N, de Bernis L, Lancet Neonatal Survival Steering Team. Evidence-based, cost-effective interventions: how many newborn babies can we save? Lancet 2005;365:977–88.

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

[5] 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

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

[8] The WHO states that no region in the world is justified in having a caesarean section rate greater than 10–15 percent

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

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

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