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Contract

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Background

The COVID-19 pandemic has become a global crisis – the virus has infected more than 194 million people worldwide. It has resulted in the deaths of more than 4 million people so far (July 25, 2021). The COVID-19 pandemic has also had a significant impact on the capacity of health systems to continue to deliver essential health services, especially within maternal newborn and child health. The provision of safe water, sanitation, waste management and hygienic conditions is essential for preventing illness and for protecting human health during all infectious disease outbreaks, including coronavirus disease 2019 (COVID-19). Ensuring evidence-based and consistently applied WASH and waste management practices in healthcare facilities (HCFs) will help prevent human-to-human transmission of pathogens, including SARS-CoV-2, the virus that causes COVID-19.

Health care waste is a by-product of health care that includes sharps, non-sharp blood-contaminated items, blood, body parts and tissues, chemicals, pharmaceuticals and radioactive materials. Poor management of health care waste exposes health care workers, waste handlers, patients and their families and the community to preventable infections, toxic effects and injuries. Unsafe disposal of needles and syringes, for example, increases risk of injury and presents opportunities for reuse. Other potential hazards may include drug-resistant microorganisms which spread from health facilities into the environment. Safe management of health care waste involves three key principles: reduction of unnecessary waste, separation of general waste from hazardous waste, and waste treatment that reduces risks to health workers and the community.

According to a self-assessment conducted in 2020 using the WASH FIT tool adapted to the Uzbekistan context, HCFs show a variation in health care waste management between facility types and regions.

Regional level, health care facilities (HCFs) mostly meet basic standards for WASH services, although lack of sanitation, health care waste, and management services. About three in five (15 out of 23) regional HCFs have basic waste management services. Limited waste services at the regional facility level are reported in Namangan region, RoK, Ferghana (with one facility with no waste services out of two self-reported in the region) and Andijon region.

Overall, in district level HCFs, more than two-thirds of facilities (68.6 per cent) meet basic healthcare waste services; 30.4 per cent have limited waste services and 1 per cent of HCFs have no services. No healthcare waste services are reported in Samarkand and Navoi regions (7.7 per cent and 16.7 per cent, respectively).

Compared to regional and district level HCFs, the situation in PHC level HCFs is worse, particularly with regards to waste management services. On average, at PHC level, half (52.5 per cent) of facilities have basic healthcare waste services. However, huge disparities exist. The most favorable situation is observed in Namangan region and the worst is in Surkhandarya and Kashkadarya region.

Recognizing the need to develop and implement costed national waste management roadmaps with appropriate financing. Requirements to build key decision makers, managers, and health workforce capacities to sustain waste management services. The necessity to integrate waste management in indicators in health systems monitoring, quality improvement efforts, and facility assessments, national partners should be supported by international experts. In order to provide the technical support mentioned above, an international expert in the field of the waste management system will be recruited.

Objectives

The objective of the assignment is to provide technical assistance to the Ministry of Health of the Republic of Uzbekistan in the revision and update of on healthcare waste-management (HCWM) system and in the implementation of HCWM models for future national scale-up.

Timeline & Deliverables

Start day of the assignment: August 15, 2021

End day of the assignment: May 30, 2022

The selected consultant will be hired for 97 working days.

Tasks

1. Desk review of national legislation, policies, regulatory and institutional framework on healthcare waste-management (HCWM) system, compare with international best practices and development of recommendation on improvement 2. Technical support to national partners in the development of national health-care waste-management plan/roadmap 3. Technical support to national partners to develop/update HCWM legislation, guidelines, job aids and SOPs, including infectious waste contaminated by COVID 19 virus 4. Conducted assessment of healthcare waste-management system, including handling of the infectious waste contaminated by COVID 19 virus monitoring mechanisms in model districts 5. Technical support in developing healthcare waste-management system (including monitoring mechanisms and costed roadmap) for model districts 6. Capacity building of health care managers from modelling districts on waste-management system planning and management 7. Capacity building of health care workers from modelling districts on waste-management (waste minimization, recycling, segregation, storage, transportation, treatment, and disposal methods) 8. Conduct costing of healthcare waste-management system model for urban and rural districts 9. Develop report with recommendations on national scale-up of HCWM models

Deliverables and Duration

1. Report with recommendations on improvement of national healthcare waste management system legislation and policies - 7 working days (remotely) 2. The national healthcare waste-management plan/roadmap was developed and submitted for government approval - 5 working days (remotely) 3. The developed/updated HCWM legislation, guidelines, and SOPs - 10 working days (remotely) 4. The assessment report - 17 working days (11 working days in country and 6 remotely) 5. The healthcare waste-management system model for urban and rural districts developed including list of equipment and specification for desirable equipment - 9 working days (remotely) 6. Training materials adapted to the country context and at least 30 health care managers trained - 9 working days (4 days remotely and 5 days in-country) 7. Training materials adapted to the country context and at least 30 health care workers trained - 10 working days - (4 days remotely and 6 days in-country) 8. Report with defined model costs of the whole healthcare waste-management (HCWM) system - 20 working days - (5 days remotely and 12 days in-country) 9. Report with recommendations on national scale-up - 10 working days (remotely)

Total working days: 97 working days.

Methodology/Activities

The expert will work under the supervision of Chief of Health and Wellbeing in collaboration with Health and Nutrition Specialist, Immunization officer, Ministry of Health, national partners, and experts.

1. Desk review of national legislation, policies, regulatory and institutional framework on healthcare waste-management (HCWM) system, compare with international best practices and development of recommendation on improvement. This task includes the following actions:

• review of national legislation and policies on HCWM provided by national partners and compare with international best practices
• online discussion with partners of current practices and to collect needed information
• Develop report with recommendations on improvement of national healthcare waste management system legislation, policies guidelines, job aids and SOPs on HCWM, including infectious waste contaminated by COVID 19 virus

2. Technical support to national partners in the development of a national healthcare waste-management plan/roadmap. This task includes the following actions:

• Review of existing HCWM roadmap and develop a recommendation on improvement
• Technical guidance of the national working group on the development of national healthcare waste-management plan/roadmap, including monitoring indicators
• Final review of the HCWM plan/roadmap and provision of recommendation to be incorporated in the plan/roadmap

3. Technical support to national partners to develop/update HCWM legislation, guidelines, job aids and SOPs, including infectious waste contaminated by COVID 19 virus. This task includes the following actions:

• Based on deliverables of task one and in coordination with national partners, develop a list of HCWM legislation, guidelines, job aids, and SOPs to be reviewed with the support of the expert
• Share with national partners international best practices, examples of guidelines, job aids, and SOPs developed in other countries
• Guide national partners on what and how to develop/update HCWM legislation, guidelines, job aids and SOPs
• Review of develop/update HCWM documents and provide feedback (discuss with partners if necessary)

4. Conducted assessment of healthcare waste-management system, including handling of the infectious waste contaminated by COVID 19 virus monitoring mechanisms in model districts. This task includes the following actions:

• Identify tools (including hospital hygiene and infection control) to be used for the assessment and adapt it for the Uzbekistan context. The tool should cover the assessment of the temporary storage of health care waste within all medical service providers that are part of the public health care system. Assessment should cover evaluation of the current system of HCWM system monitoring
• Identify and engage relevant stakeholders
• Identify and agree a methodology for selection of health care facilities at PHC, district and regional levels
• Build capacity of national assessors’ team
• Conduct/facilitate data collection (fieldwork) at district/city and regional levels
• Data analysis
• Drafting report (PHC, district and regional levels) with recommendations. The report should have recommendations on improvement of monitoring and handling of the infectious waste contaminated by COVID 19 virus
• Discussion of the report with national stakeholders and finalization

5. Technical support in developing healthcare waste-management system (including monitoring mechanisms and costed roadmap) for model districts. This task includes the following actions:

• Based on the HCWM assessment findings, select the best options for urban and rural models
• Draft HCWM model (including monitoring mechanisms and costed roadmap). Propose how to monitor waste handling and disposal of the health care service providers from the private sector
• Present and discuss with all relevant partners.
• Finalize based on discussions and reached agreement

6. Capacity building of health care managers from modelling districts on waste-management system planning and management. This task includes the following actions:

• Select training package to be used for training of health care managers.
• Adapt training materials for Uzbekistan and models context and ensure that documents developed in the framework of task 3 are integrated into the training materials
• Conduct/co-facilitate training for health care managers from modelling districts on waste-management system planning and management
• Prepare training report.

7. Capacity building of health care workers from modelling districts on waste-management (waste minimization, recycling, segregation, storage, transportation, treatment, and disposal methods). This task includes the following actions:

• Select training package to be used for training of health care workers waste-management (waste minimization, recycling, segregation, storage, transportation, treatment, and disposal methods)
• Adapt training materials for Uzbekistan and models context and ensure that documents developed in the framework of task 3 are integrated into the training materials
• Conduct/co-facilitate training for health care workers from modelling districts on waste-management
• Prepare training report.

8. Conduct costing of healthcare waste-management system model for urban and rural districts. This task includes the following actions:

• Define methodology to be used for costing
• Adapt to the conditions of modelling in Uzbekistan
• Conduct costing of HCWM system in model districts with the support of national partners
• Develop report with costs of the whole healthcare waste-management (HCWM) system

9. Develop report with recommendations on national scale-up of HCWM models. This task includes the following actions:

• Documentation of all lessons learned from implemented tasks
• Documentation of best practices in model districts
• Draft report based on all information gathered during implementation period with recommendations on national scale-up
• Discuss the draft report with national partners
• Finalize report

Resource requirements and payments

The basis for calculation of consultancy fee based on the complexity of work, level of expertise and the Administrative Instruction (ST/AI/2013/4) on Consultants and individual contractors. The final fees will be set up based on the “best value for money” principle.

Payments might be partially or fully withheld in case of unsatisfactory performance of duties or failure to provide quality deliverables.

The fees will be paid by bank transfer upon acceptance of deliverables.

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

• Postgraduate degree in chemistry, environmental science and management, public Health, or other relevant fields.
• At least 10 years of progressive professional experience in the field of WASH/health care waste management.
• At least 5 years of proven experience preparing national reports and assessments related to waste management and chemical management.
• At least 5 years of proven experience in Policy/Regulatory and Institutional assessments.
• At least 5 years of proven experience in capacity building on WASH/waste management.
• At least 5 years of proven experience in costing of WASH/waste management system.
• At least one year of work experience in CIS countries and knowledge of the Soviet health care system.
• Good command of written English (Examination of a previous authentic written work in English).
• Good command of Russian will an asset (Examination of a previous authentic written work in Russian).

Procedures and Working Conditions

The assignment will be performed partly as home-based and partly in Uzbekistan. At least three in-country visits are expected. Travel expenses will be paid according to UNICEF rules and regulations. The consultancy is responsible for obtaining an entry visa to Uzbekistan. However, UNICEF, within its means, shall facilitate the process. UNICEF will extend administrative/logistical support to facilitate meetings with national partners. The applicants shall be required to submit a statement of good health prior to commencement of work and take full responsibility for the accuracy of that statement. Consultants are not eligible to participate in the life or health insurance available to UN staff members.

Reservations

UNICEF reserves the right to withhold all or a portion of payment if performance is unsatisfactory, if deliverable(s) incomplete, not finalized, or fails to meet deadlines. UNICEF will reserve the copyright of all developed materials and own primary data collected through this assignment. The materials cannot be published or disseminated without the prior written permission of UNICEF. UNICEF will be free to adapt and modify them in the future. The contractor must respect the confidentiality of the information handled during the assignment. Documents and information provided must be used only for the tasks related to these terms of reference.

UNICEF undertakes no liability for taxes, duty or other contribution payable by the consultant on payments made under this contract.

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.

To view our competency framework, please visit here.

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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:

Mobility is a condition of international professional employment with UNICEF and an underlying premise of the international civil service.

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.