Re-advertised: International Lead Consultant on Baby Friendly Hospital Initiative (BFHI) and Infant and Young Child Feeding (IYCF) to support the health system in Montenegro

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Job title: International Lead Consultant on Baby Friendly Hospital Initiative (BFHI) and Infant and Young Child Feeding (IYCF) to support the health system in Montenegro to adopt national standards on BFHI and IYCF

Duty Station: home based and in Podgorica, Montenegro

Type of Position: International (short-term)

Type of Assignment: Individual Consultancy

Contract Duration: 8 July 2021 until 23 December 2021

1. Background

Optimal health and nutrition are among the key ingredients that enable a child to grow physically, mentally and socially, even before birth and for the first 3 years of life. It is estimated that over 820,000 deaths among children under age 5 could be prevented worldwide every year if all children were adequately breastfed. Breastfeeding promotes brain development, reduces the risk of obesity in children, and protects women against breast and ovarian cancer and diabetes.

Recent data indicate a lack of adequate nutrition practices in Montenegro, noticeable from early pregnancy and throughout childhood, with only one out of four newborns (24%) breastfed within first hour, 20% of newborns being exclusively breastfed within the first 6 months, 14% continually breastfed until 2 years of age, while 48% of children age 6-23 months do not receive the minimum acceptable diet in order to reach optimal development[1]. Overall, 41% newborns in Roma Settlements are first breastfed within one hour of birth, while only 14% are exclusively breastfeed within the first 6 months, and 36% are continually breastfed until 2 years of age[2]. Only one-fifth (22%) received the minimum acceptable diet by the age of 2 years[3]. Furthermore, 7% of children under five are stunted and 7% of children under 5 are overweight at national level, while 21% of Roma children under five are stunted and 3% are overweight[4]. Although child overweight during early years does not seem to be very high in Montenegro, according to the COSI study report conducted by Institute for Public Health in 2016 in Montenegro, by age 7 the rates increase dramatically 37% of boys aged 7 are overweight and 19% are obese, while for girls aged 7, figures are 29% and 9% respectively[5].

Baby Friendly Hospital Initiative (BFHI)

About 30 years ago, the World Health Organization and UNICEF came together to advocate for the protection, promotion and support of breastfeeding in facilities providing maternity and newborn services, given their unique role in providing new mothers and babies with the timely and appropriate support and encouragement they need to breastfeed successfully. The 1989 Joint WHO-UNICEF statement included a list of measures that came to be known as the Ten Steps. Since 1991, maternity wards and hospitals applying the Ten Steps have been designated “Baby-friendly” but many countries still struggle to maintain the programme and take it to full scale. Starting in 2015, WHO and UNICEF coordinated a process to review the scientific evidence behind the Ten Steps and to strengthen implementation of the Initiative resulting in Revised Guidelines and an updated BFHI training course (WHO and UNICEF, 2020).

Montenegro has one tertiary-level National Obstetrics and Gynaecology Hospital in the capital city Podgorica and the Neonatal Intensive Care Unit (NICU), which is a separate entity as part of the national paediatric hospital, and seven public hospitals/ maternity wards across the country (Bar, Berane, Bijelo Polje, Cetinje, Kotor, Niksic and Pljevlja) with semi-intensive care units. The BFHI was introduced in Montenegro in 2000 as a joint project of the Ministry of Health and UNICEF. However, not all maternities were awarded the BFHI status, and even those that implemented the initiative do not fully comply with it at present. Despite the fact the intention to harmonize hospital facilities with the standards prescribed for BFHI was clearly spelled out in policy documents[6], this has not materialized. Montenegro adopted a national Code of Practice for health institutions and health professionals regarding the marketing of breastmilk substitutes (BMS) in 2017, however, it only refers to the health sector role and does not seem to be fully adhered to in practice.

Following UNICEF advocacy efforts, the country expressed readiness to revitalize the BFHI initiative. In that regard, UNICEF Country Office Montenegro is supporting the Clinical Centre of Montenegro to develop national BFHI standards and a national training programme for gynaecologists, midwives, nurses, nutritionists and other relevant health staff on BFHI.

Infant and Young Child Feeding (IYCF)

The complementary feeding period occurs during a “window of opportunity” for the prevention of stunting and promotion of optimal growth, health and behavioural development[7]. Complementary feeding ideally begins at 6 months of age and continues to 24 months or beyond, reflecting the World Health Organization’s recommendations for exclusive and continued breastfeeding[8]. In practice, however, in many cases exclusive breastfeeding ends earlier than 6 months and continued breastfeeding ends prior to the second birthday.

Inadequate IYCF practices in Montenegro can be caused by several factors such as: aggressive marketing of BMS and commercial complementary food for babies, the absence of quality and effective IYCF counselling services, and lack of community awareness on optimum feeding of children 6-24 months. Among Roma children, lack of availability and access to all food groups due to socio economic reasons as well as poor skills and knowledge of families, prevents children having the dietary adequacy and diversity they require and results in high rates of stunting among this group.

In order to address these issues, UNICEF Country Office Montenegro is supporting the Ministry of Health of Montenegro and Primary Health Care Centre Podgorica to develop national IYCF standards and national training programme for paediatricians and nurses on IYCF.

2. Purpose and Objectives

The purpose of this assignment is to enhance nutritional status of children aged 0-23 months in Montenegro by strengthening capacities of health workers and enhancing relevant policies in the health system in Montenegro.

The objectives of this consultancy are:

• To review the national BFHI and IYCF standards which will be developed by two teams of national experts under the leadership of the Clinical Centre of Montenegro and the Primary Health Care Centre Podgorica, respectively, oversight of the Ministry of Health and support of UNICEF. This will also include adopting and contextualizing an assessment tool for a team of national experts to assess maternities (based on the new BFHI standards) across the country in terms of compliance with the new BFHI standards.
• In close collaboration with two other international individual consultants (a co-trainer on BFHI and a co-trainer on IYCF), to lead the process of preparation and to conduct the Trainings of Trainers (ToT) on BFHI and IYCF for respective health professionals, in order to prepare the trainees to carry out the training for front-line workers to strengthen their knowledge, skills and attitudes to effectively and consistently use and apply BFHI and IYCF standards and practices and also to run the BFHI assessment, respectively, in line with the latest international guidance and recommendations.
• To supervise undertaking of the BFHI assessment and to support development of a roadmap to institutionalize BFHI at national level.

3. Methodology and Technical Approach

Methodology to be used includes desk review, consultations with UNICEF and national partners, preparation of Trainings on BFHI and IYCF, delivery of trainings on BFHI and IYCF in close collaboration with respective Co-Trainers, preparation of brief training reports, development of assessment tool on BFHI compliance, review of roadmap and review of draft of national standards on BFHI and IYCF.

Trainings of Trainers should capacitate ToT trainees to later train front line workers to be able to learn and practice skills to engage in conversations aimed at improving adequate nutrition; improve their confidence and ability to effectively respond to parents’ and caregivers’ needs and concerns regarding nutrient needs for optimal growth and development, based on evidence, including in the time of COVID-19 pandemic; use dialogue-based communication skills to increase breastfeeding rates and decrease obesity rates in the country. Furthermore, with respect to training on IYCF, trainees should be strengthened to perform growth assessment in line with WHO Child Growth Standards.

The consultant is expected to work both in the field (Montenegro) and from home. Further details on the assignment are outlined in the section Activities and Tasks below.

4. Activities and Tasks

Under the direct supervision of UNICEF Early Childhood Development (ECD) Officer, it is expected from Consultant to complete the following tasks:

BFHI:

• Based on desk review, consultations with UNICEF and national partners, the 2020 UNICEF-WHO training course on BFHI, in close collaboration with Co-Trainer on BFHI, to develop ToT Agenda and content (e.g. in the form of a ToT participants’ guide) for the ToT accommodating basic training package, as well as components on developing skills for future roll-out training. The training of trainers should also cover international guidance on BFHI/breastfeeding in the time of COVID-19 pandemic. The duration of the training should be 4 days;
• In close collaboration with Co-Trainer on BFHI to hold the aforementioned Training of Trainers in Montenegro for between 10 and 20 participants from maternity wards (gynecologists, midwives, nurses, nutritionists and other relevant staff);
• To develop a final report with observations and conclusions from the Training of Trainers and recommendations for the roll-out of the BFHI training package in Montenegro;
• To develop an assessment tool for the national team of experts to assess all maternities in terms of compliance with BFHI standards. Based on this assessment, the national team of experts will develop a report and roadmap for revitalizing the BFHI in Montenegro.
• To review the aforementioned assessment/roadmap for revitalizing the BFHI in Montenegro as well as the draft national BFHI standards, both of which will be developed by a team of national experts under the leadership of the Clinical Centre of Montenegro, oversight of the Ministry of Health and support of UNICEF. Provide comments and recommendations on how the two documents can be improved.

IYCF:

• Based on desk review, consultations with UNICEF and national partners, relevant WHO and UNICEF training courses on IYCF, in close collaboration with Co-Trainer on IYCF, to develop ToT Agenda and content (e.g. in the form of a ToT participants’ guide) for the five-days ToT accommodating basic training package, as well as components on developing skills for future roll-out training. Topics to be covered are: infant and young child feeding including breastfeeding, complementary feeding, growth standards, quantity, variety and frequency of feeding, responsive feeding, counselling on feeding and growth, IYCF in the time of COVID-19 pandemic;
• In close collaboration with Co-Trainer on BFHI to hold five-days Training of Trainers in Montenegro for up to 20 participants predominantly from the primary health care level (paediatricians, patronage nurses and other relevant staff) divided in two parts – first part to last three days and second part, a few days/weeks later, to last two days;
• To develop a training report with observations and conclusions from the Training of Trainers and recommendations for the roll-out of the IYCF training package in Montenegro;
• To review the draft national IYCF standards which will be developed by a team of national experts under the leadership of the Primary Health Care Centre Podgorica, oversight of the Ministry of Health and support of UNICEF. Provide comments and recommendations on how the document can be improved.

5. Key Deliverables and Timeframe

Consultant is expected to produce the following key deliverables by the following tentative deadlines and with the following tentative breakdown of working days:

BFHI:

1. Training of Trainers Agenda and content of the training (in the form of ToT participant guide and handouts if needed) by 25 July 2021 (home-based, approximately 4 working days);
2. ToT successfully conducted, by 30 September 2021 (face-to-face in Montenegro, approximately 4 working days);
3. Training report with observations and conclusions from the ToT developed and relevant recommendations for planned roll-out trainings in Montenegro produced, by 5 October 2021 (home-based, approximately 1 working day);
4. Development of the assessment tool for compliance with BFHI standards, by 5 October 2021 (home-based, approximately 1 working days);
5. Comments to the assessment/roadmap for revitalizing the BFHI in Montenegro and the draft national BFHI standards, by 20 December 2021 (home-based, approximately 2 working days).

IYCF:

6. Training of Trainers Agenda and content of the training (in the form of ToT participant guide and handouts if needed) by 25 July 2021 (home-based, approximately 5 working days);
7. ToT successfully conducted, by 20 October 2021 (in Montenegro, 3 days followed by 2 days after a few days/weeks’ break);
8. Training report with observations and conclusions from the ToT developed and relevant recommendations for planned roll-out trainings in Montenegro produced, by 25 October 2021 (home-based, approximately 1 working day).
9. Comments to the draft national IYCF standards, by 20 December 2021 (home-based, approximately 2 working days).

The total number of working days should not exceed 25 days in total.

6. Management and Organisation

Management: The Consultant will be supervised by the UNICEF Early Childhood and Development (ECD) Officer.

Organization: International individual consultancy is required for this consultancy, one position, with significant experience in breastfeeding counselling, BFHI and IYCF.

Schedule: This assignment is scheduled to commence on 8 July 2021 and last until 23 December 2021. Please note that some dates might shift due to the epidemiological situation, in particular the training which needs to be conducted face-to-face. This will be mutually agreed by the consultant, UNICEF and national counterparts.

7. Qualifications and Background

The consultant is expected to have the following qualifications to complete the tasks:

Education

• Advanced university degree in medicine, pediatrics, genecology, nutrition or similar.

Experience

• At least ten (10) years of professional working experience in the field of maternal and child health;
• Knowledge of international (WHO and UNICEF) BFHI, IYCF and maternal and newborn health standards;
• Previous experience in delivering trainings to health front line workers on BFHI and IYCF;
• Previous work experience with UNICEF or UN is an asset.

Language

• Excellent command of the local language (both spoken and written), knowledge of English is a strong asset;

Other

• Excellent interpersonal and communication skills;
• Excellent facilitation skills;
• Excellent writing skills;
• Demonstrated tact and high sense of responsibility and discretion;
• Demonstrates integrity and high ethical standards;
• Displays cultural, gender, religion, race, nationality and age sensitivity and adaptability.

8. Budget and Remuneration

• Consultancy fee

The candidates are requested to submit their financial offer consisting of a daily fee for the services to be provided, DSA and travel, subscriptions costs for online meetings, as applicable.

• Payment schedule

The payments will be made upon successful completion of the deliverables and submission of invoices.

• Upon submission of deliverables 1-3, 6-8 – 50%
• Upon submission of deliverables 4-5 and 9 – 50%
• Travel costs – a week prior to travel
• 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.

9. Application procedure

• To apply for the vacant position please submit P-11 form through “apply” button,
• Candidates are requested to submit a financial offer as a separate document consisting of daily professional fee and, if required, online platform subscription costs for meetings.

10. Selection method:

All applicants will be screened against the qualifications and requirements set above. Candidates fully meeting all the requirements will be further evaluated based on the criteria below:

1. Technical Evaluation - Interview – 70% of total evaluation – max. 70 points

• Education: 10 points
• Previous experience: 20 points
• Technical questions at the interview: 30 points
• Other: 10 points

Only candidates who obtain a score of at least 70% in the Technical Evaluation (i.e. who score at least 49 points) will qualify for financial proposal evaluation.

2. Financial Evaluation - 30 % of total evaluation – max. 30 points.

Financial scores will be calculated using the following formula [lowest offer / financial offer of the candidate x 30].

11. Remark

Upon conducting the recruitment process and prior to the signing of the contract, the consultant will be required to complete the following online courses. All certificates should be presented as part of the contract. ​

• Ethics and Integrity at UNICEF

• Prevention of Sexual Harassment and Abuse of Authority (PSHAA)

• Sexual Exploitation Abuse (PSEA)

Consultants and Individual Contractors must complete the following course before commencement of any travel on behalf of UNICEF.

• BSAFE security training

Any consultant or individual contractor who is issued a UNICEF email address must complete the following courses no later than 30 days after signature of contract.

• Fraud Awareness

• Information Awareness Security Course (only for consultants/individual contractors with a UNICEF email address)

The above courses can be found on Agora through the following link:

AGORA: Log in to the site (unicef.org) .

UNICEF is committed to diversity and inclusion within its workforce and encourages qualified female and male candidates from all national, religious and ethnic backgrounds, including persons living with disabilities to apply.

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.

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

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[1] MONSTAT and UNICEF, 2018 MICS, 2019.

[2] Ibid.

[3] Ibid.

[4] Ibid.

[5] WHO Child Obesity Surveillance Initiative (COSI) Report, Institute for Public Health of Montenegro, 2017.

[6] The Master Plan for Health Sector Development (2010-2013) and the Action Plan for Nutrition and Food Safety (2010-2014) envisaged harmonization of overall hospital facilities with the standards prescribed for Baby Friendly Maternity Wards. In the most recent Master Plan for Health Sector Development (2015-2020) baby friendly hospitals are mentioned but the corresponding priority is “safety” of maternities to reduce perinatal deaths. In the most recent Action Plan for Nutrition and Food Safety (2019-2020) the only activity related to breastfeeding is continuation of implementation and promotion of “Guide on breastfeeding” and “Code on the Prohibition of Marketing of Breast Milk Substitutes”.

[7] Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, De Onis M, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013; S0140-6736(13)60937-X.

[8] Global Strategy for Infant and Young Child Feeding. Geneva: World Health Organization (WHO); 2003.

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Added 2 years ago - Updated 2 years ago - Source: unicef.org