TERMS OF REFERENCE

FOR

FISTULA REPAIR SURGERY

1. Background to the Assignment

Trόcaire has been operational in Gedo region of Southern Somalia since 1992 responding to both humanitarian and development needs in the region. The size and scope of the programme has expanded over the years and currently consists of Health, Nutrition, Wash, Protection and Resilience Work across 5 districts of Gedo region.

In particular, Trocaire has proven, evidenced expertise in the delivery of integrated health and nutrition programming. This includes high quality health service delivery from primary health units, mobile clinics, health centres, referral health centres and hospitals and with a particular focus on maternal and child health services.

2. Context

Somalia has some of the highest infant, child and maternal mortality rates in the world. With poor access to maternal health services, the possibility of a woman dying in child birth or losing a baby are very high. Since 1992 Trócaire has been providing maternal health services for women through 4 hospitals and 25 health centres operated by Trocaire in four districts of Gedo. Even with these health interventions the poorest women in rural and remote locations of Gedo often do not have access to hospitals due to cultural as well as financial costs required to travel to locations where hospitals are. The result of this is obstructed labour, which often results in obstetric fistula.

Obstetric fistula is the presence of an abnormal tract created between the vagina and rectum (recto-vaginal fistula) or vagina and the bladder (vesico-vaginal fistula -VVF) as a result of prolonged obstructed labor without timely medical intervention-typically and emergency Caesarean section (Wall, 2012).

Fistula has devastating consequences for the women affected; incontinence leads to other health issues, social isolation, affected women are shunned by community and experience loss of ability to participate in economic activities. All these effects can in turn drastically affect the mental health of women with VVF.

Referral options for women who develop fistula are limited to Mogadishu and Borama hospital in Somaliland which are both distant and present a myriad of challenges to facilitate referral. Furthermore waiting time to have fistula surgery can be as long as a year.

Seeing this desperate need in Gedo Trocaire has mobilised funds and intends to carry out fistula surgery for at least fifteen women at Trócaire’s Luuq district Hospital in the last week of September 2020. (21^st -26^th September 2020)

3. Assignment Objectives

The objective of the assignment is to source for a consultant medical doctor to provide surgical repair services to women affected by fistula.

Key tasks:

• Guide medical doctors in Gedo on how to conduct pre-surgery and post-surgery assessments
• Undertake Fistula surgery for women from Gedo region, surgeries at Luuq District Hospital

4. Methodology

· Registration of women will be done by Trocaire health staff

· Assessment of women affected by fistula will be done by Trocaire medical doctors with guidance by the consultant

· Consultant will conduct surgery with assistance from a team of Trocaire clinicians ; Anaesthetist, medical doctors and theatre nurse

· Informal capacity building of 3 medical officers and 2 anaesthesia as operation is performed

5. Expected Outputs

The consultant will:

• Provide guidance to the resident medical team pre and post operations
• Produce a written report on the surgeries conducted and general observations, challenges etc.

6. Timeframe

It is estimated that the process will take 3 working days to conduct surgeries,2 travel days and 1 day to develop report. 2 days (at least 4 hours) pre and post- surgery guidance provided to the will be required to the resident medical team in Gedo. The proposed dates are (21^st -26^th September 2020).

7. Consultant Profile

The consultant is expected to have:

• Degree in Medicine ; Obstetrics gynaecology
• Senior level experience (at least 7 years) in obstetrician gynaecology
• At least 3 years’ experience on fistula repair surgery

8. Terms of Consultancy

The consultancy shall be undertaken through a standard agreement to be signed between the Trocaire Somalia and the Consultant which will stipulates the nature of services and the contractual obligations of parties involved.

NOTE THE BELOW THAT WILL PART OF THE CONTRACT TO BE SIGNED (CONDITION)

1. Status of the Consultant

The Consultant shall be considered as having the legal status of an independent consultant.

2. Nature of services

The Consultant shall perform the following tasks as described above

• Provide guidance to the resident medical team pre and post operations
• Produce a written report on the surgeries conducted and general observations, challenges etc.

3. Duration of services

This agreement shall commence on 21^st -26^th September 2020 for fistula camp and conclude upon satisfactory completion of the services described in the terms of reference. It is envisaged that this consultancy will require not more than 8 hours of the consultants time per day.

4. Professionalism and Confidentiality

This is a professional service, which calls for a high level of integrity, honesty and reliability in accordance with professional codes of ethics. The consultant is obliged to follow and adhere to Trocaire Somalia’s staff rules and regulations throughout the consultancy period especially those related to security. All materials and communications developed, collected or produced as a result of this consultancy remain subject to Trocaire Somalia’s rules of professional confidentiality and may not be shared with any party without the permission of the country Director.

5. Safeguarding

All Trócaire representatives working under a contractual arrangement with or on behalf of Trócaire, e.g., consultants and other third parties travelling and working in Trócaire’s programme locations and offices are expected to adhere to Trocaire Safeguarding Policies. The consultant will be provided with safeguarding policies as part of the contract to be signed.

6. Liability

The Consultant will be liable for any action which is proved to be in contravention to the professional codes of ethics and which may lead to any loss or damage to Trocaire Somalia

NB: Trocaire Somalia is not responsible or liable for the Consultant’s health or life insurance under this contract and the Consultant should therefore ensure that he/she is adequately covered.

7. Travel and Accommodation

Trócaire will be responsible for organizing logistical arrangements for all work in Luuq district including air transport (UN Flights), visa costs, local travel, security, accommodation, meals, briefings, translation and administration.

All other costs should be included in the consultant’s proposed budget.