National Consultant for Fast Track Initiative Road Map, Cambodia

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Purpose of the Consultancy

This Local Short-Term Consultant (STC) will design and support implementation of highest priority activities for reducing maternal mortality in Cambodia as indicated through the Fast Track Initiative Roadmap (FTIRM) for Reduction of Maternal and Newborn Mortality 2023-2030. These will include the strengthening of maternal death surveillance and response (MDSR) and baseline work for caesarean section monitoring. The consultant will also document the activities and successes of the Early Essential Newborn Care (EENC) program and its contribution to the reduction in neonatal mortality in Cambodia.

Background

Cambodia has achieved significant gains in maternal and child health over the past decade. Both under five mortality and neonatal mortality have more than halved between 2014 and 2022 from 35 to 16 and 18 to 8 per 1000 live births (CDHS 2014 & 2021/22). Cambodia has therefore already reached its SDG target for both, set at 25 for under five mortality and 12 for neonatal in both global and national SDG frameworks. Skilled birth delivery has already reached the Cambodian SDG (CSDG) target of at least 95% being 98.7% in 2022 (up from 89% in 2014) and 97.5% of births take place in a health facility. Despite this, maternal mortality remains relatively high, declining from an estimated 170 maternal deaths per 100,000 live births in 2014 to 154 in 2021/22. In addition, key equity gaps remain in maternal and child health by education level of the mother, rural urban residence and wealth among others. Pregnancy in adolescents 15-19 carries a higher risk of maternal death and whilst the percentage of 15-19 years old ever have being pregnant declined from 12% to 9% between 2014 and 2021/22 this is currently off-track to reach a CSDG target of 4% by 2030. Caesarean section (C-section) rates have more than doubled between 2014 and 2021/22 from 8% to 18% of all deliveries and are more common in non-NGO private medical sector facilities (50%) than in public health facilities (10%) (CDHS 2021/22). Access to medically necessary C-section is crucial to protect the health of mother and baby but medically unindicated C-sections carry a higher risk of maternal death than normal delivery.

It is important that efforts to accelerate maternal mortality reduction and leave no-one behind are targeted and supported in order to reach the CSDG target of 70 by 2030 whilst building on and not losing gains made including in neonatal and under five mortality reduction. With technical support through WHO, the new Fast Track Initiative Road Map for Reducing Maternal and Newborn Mortality 2023-2030 was developed. The strategy highlights priority interventions to accelerate progress in particularly reducing maternal mortality toward Cambodian SDG target as well as maintain neonatal mortality. These include reducing unmet need for family planning and ensuring coverage of quality emergency obstetric and newborn care (EONC) particularly basic EONC (BEONC) in locations closer to communities. As indicated in the FTIRM understanding and addressing root causes of maternal death and developing initiatives early to reduce caesarean sections that may not be medically necessary or indicated will be important considerations in further reducing maternal mortality. The FTIRM It also will inform the development of sub-sectoral strategies and annual plans and resource mobilization and allocation for implementation of key interventions.

Planned timelines (subject to confirmation)

Start date: 1 September 2023

End date: 15 December 2023

Work to be performed

A consultant is being sought to support the Ministry of Health (MoH), National Maternal and Child Health Center (NMCHC) in their development and implementation of priority strategies arising from the FTIRM for Reduction of Maternal and Newborn Mortality 2023-2030. This will include a particular focus on strengthening quality Emergency Obstetric and Newborn Care and Maternal Death Surveillance and Response (MDSR). The consultant will also be part of a team highlighting contributions from the implementation of a package of Early Essential Newborn Care (EENC) to date in the reduction of neonatal mortality in Cambodia, drawing lessons and implications for further work including for maternal mortality reduction.

Output/s:

Output 1: Baseline analysis to understand drivers and inform future monitoring of C-section in Cambodia make recommendations for the future including on approaches and informational needs to support medically necessary and reduce medically unnecessary C-section.

Deliverable 1.1: Policy briefs and power point presentation on unavoidable and avoidable drivers of C section and recommendations for future monitoring and strengthening of medically necessary C-section.

Output 2: Fit for purpose review of current information and implementation of maternal death surveillance and response (MDSR) conducted including structures and processes for MDA committees at national and subnational levels, scope of current audits (including potential benefits of including near miss whilst still prioritizing deaths and the advantages and disadvantages of widening to include neonatal deaths or not) and approaches to carrying out the audits.

Deliverable 2.1: Briefing note with review and recommendations discussed including and, updated MDA committee terms of reference, membership and protocol / guidance as appropriate.

Deliverable 2.2: Demonstration of potential changes to process and scope of review in two districts (one or two provinces) to support finalization of recommendations and updated MDA protocol.

Output 3 : Input to review of contribution of Early Essential Newborn Care to reduction in neonatal and under five mortality in Cambodia and lessons learnt including application to accelerate reduction in maternal mortality whilst building on gains in neonatal mortality reduction.

Deliverable 3.1: Cambodia case study on successes and lessons in reducing neonatal and child mortality made available.

Specific requirements

Qualifications required:

Education

Essential : Advanced University degree (Master’s degree or equivalent, or PhD) in public health or in relevant field.

Experience

Essential: At least ten years of experience in working with reproductive, maternal, and newborn health, and policy and strategy development.

Desirable: Significant regional/global experience and technical competency in the areas of reproductive, maternal, and newborn. Relevant Cambodian experience is an advantage.

Skills / Technical skills and knowledge:

-Good knowledge of (and ideally in-country experience in) maternal and newborn health and health systems in Cambodia.

-Good oral and written English language skills.

-Experience in the development of reproductive, maternal, and newborn strategic plans;

-Knowledge and skills in the delivery of obstetric and neonatal care services in low and middle-income countries

-Strong working ability in Khmer is an advantage

Language requirements:

Good oral and written English language skill

Place of assignment

The consultant largely works at the National Maternal and Child Health Centre, and one day a week at WHO office.

Medical Certificate

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

Travel

The consultant is expected to conduct few field visits to provinces as necessary.

All travel arrangements will be made by WHO – WHO will not be responsible for tickets purchased by the Consultant without the express, prior authorization of WHO. While on mission under the terms of this consultancy, the Consultant will receive subsistence allowance.

Visas requirements: it is the consultant’s responsibility to fulfil visa requirements and ask for visa support letter(s) if needed.

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.

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