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BACKGROUND AND CONTEXT
Somalia is emerging from a long period of conflict that has brought public health infrastructure to a state of near collapse. Over the past decade, the Federal Ministry of Health in collaboration with health partners has embarked on a process of health system rehabilitation with the goal of ensuring access to essential health services for all.
The goal is to put the country onto a path towards achievement of equity in health service delivery, and to lay the foundation for progress towards Universal Health Coverage (UHC) 2030. Core health indicators suggest some early successes, though much work remains to be done.
Although they remain very high, maternal, infant and child mortality rates are gradually declining. In 2015, the maternal mortality ratio was estimated at 732 maternal deaths per 100,000 live births [ ], further declined, although modestly, to an estimated 692 maternal deaths per 100,000 live births [ ]. The proportion of births assisted by skilled health personnel has increased from 9% (2016-2017 data) , to 32% in 2020 which could partially explain the gradual reduction in maternal mortality over the past decade and reflects improvements in service demand and delivery.
Infant and child mortality rates remain the highest in the region, under-five mortality has improved to 117 deaths per 1000 live births [ ], from 200 deaths per 1,000 live births in 2009-2010, and 142 deaths per 1,000 live births in 2013-14. The infant mortality rate at 74 deaths per 1,000 live births , has also improved from 119 deaths per 1,000 live births in 2009-10 and 91 deaths per 1,000 live births in 2013-14.
The trajectory is promising though there is still high burden of mortality and morbidity in the country that can be prevented and treated at community level through a community cadre of health workers, supported through the health and local governance structures. Over the past two decades, there has been a multitude parallel community health programs, including cadres trained to provide specific services only. In 2015, a Somali Community Health Strategy was released with the aim of improving health service delivery at the household and community level, centered on two key cadres of community-based workers.
The two main delivery platforms outlined in 2015 strategy are: 1) Primary Health Unit (PHU) where Community Health Worker (CHWs) deliver primary health services at the health facility and serves as a critical bridge between community and health facilities and 2) House-hold level with care provided by Female Health Workers (FHWs). FHWs are fully community-based, and they focus on providing an integrated package of community health services (health, nutrition, and WASH interventions). While their role is mainly noted in education and awareness raising, prevention and curative services, they also play a key role in referral and follow-up mechanisms and in addressing the poor treatment seeking practices, with the delivery of household and community level service seen as a key strategy to improve continuity of care and equitable service coverage.
The situation on the ground is fragmented and there remain challenges on accountability and supervision for the Community health support, the quality of care provided at this level and the reporting on the services provided. The fragmentation is more pronounced in the CHWs as compared to FHWs because of limited adherence to the approved manuals and standards and poor coordination among actors. This is continued to be aggravated by the security risk challenges and the communicable diseases outbreaks such as cholera, recurrent droughts, and flooding in some parts of the country and the challenge of the COVID-19 pandemic leading to increased demand on the already limited resources. Opportunity exists to ensure that the Somali Community Health Strategy (CHS) can be implemented to give positive result. The universal health coverage plan for Somalia, the national health strategic plan, RMNCAH and the EPHS all indicate the need for ensuring that the community level platform is made key to the delivery of health services in the country.
 United Nations Population Fund, “Somalia Overview,” UNFPA, Mogadishu, 2019.
How can you make a difference?
The purpose of this assignment is to conduct a review of the current Community Health Strategy. The current document was written in 2015 and needs to be revisited to take into consideration the developments which have taken place in the last six years and to allow for the plans which are being developed to be in line and guided by the strategy. The Ministries of health, World Bank, UN agencies and other implementing partners have been working to ensure that the compendiums and the cadres are trained to be able to offer the services required by the communities and at the same time the EPHS has been revised and gives more clarity to the roles of the two main community cadres in the health sector, the Community Health Worker based in primary health units and the Female Health Worker (Marwao Caafimaad) who works within their community.
The review will be conducted with the main Stakeholders in Somalia which will include representatives from community worker cadres, Community leaders, Community members, professional associations (Midwives etc.), Clusters Coordinators, UN agencies, Implementing partners, Donors, the Federal Ministry of Health and the state Ministries to:
The selected consultant will work under the direct supervision of the Health Manager- Global Fund and Head of Community Health in the Ministry, Federal Government of Somalia (FGS) with technical oversight support of the Director of Policy and Planning, and in close collaboration with other UNICEF sections and Field offices staff. The other sectors such as nutrition, education and WASH will be worked with to enhance multi-sectoral coordination. In addition, the consultant will coordinate with the Forums to be established for the purpose of bringing stakeholders together to discuss the inputs into the revision of the strategy.
This assignment will involve also travel within Somalia to conduct the review but most frequent consultations with relevant stakeholders including government institutions (Ministries of Health, Representation of health worker at primary health care level), NGO partners, community structures, professional associations, various UN agencies, WB and FCDO will be held in Mogadishu. At least the consultant should visit one of the states in person while the rest of the physical meetings will be held in Mogadishu. In instances where some important contributors could not attend the meeting in person, the consultant will reach out to them virtually. Feedback sessions will be set-up with various stakeholders, with debriefs in Somalia in the consultation forums at key steps in the process to build consensus and valid the findings.
The methodology will consist of:
1.1. Establishment of Consultation Forums in the different States: Various stakeholders will form part of the required technical working group to have an overall oversight of the process, coordinate the activities and provide operational guidance for the consultants. The forums will be led by the Ministries of Health, and Key stakeholders include WHO, and other members as relevant.
1.2. Literature Review and data gathering from key stakeholders:
1.2.1.Gather baseline/background information: examine the relevant background literature about community health work in Somalia and conduct a situation analysis of the current community health initiatives and mapping of the existing efforts and documentation of the best practices employed by the actors on ground for evidence decision making.
1.2.2. Careful understanding of the current community health strategy and any other relevant reviews, assessment and evaluations done by national or international organizations in Somalia and similar contexts on community health work.
1.2.3. Review of the national strategic plan for the country and the health strategic plan as this relates to the community health and any policies in nutrition, WASH and health, in particular the provisions of the Community health component of RMNCAH which will enlighten this process.
1.2.4. Study and examine the EPHS and its implications to the roles and responsibilities of Community Cadres. This document will give core background information on expectations from the health delivery platform and more so how this is hinged on community health work.
Key stakeholder consultation
3.3.1. Conduct key informant interviews with key Ministry of Health staff, related Ministries, UN Organisations, disease specific lead teams and identified community leaders in order to draw down on their expectations and the gaps they have found in the current strategy and areas which need to be further developed and identified community leaders.
3.3.2. Meet with experts in C4D and Social Policy, Gender, education, and WASH sectors to draw down on their expertise and inform the review of the strategy.
.3.3. Consider and analyse innovative ideas such as digital health to be considered in the new strategy.
3.3.4. Gather feedback from different communities that are served by community health workers to understand their needs, this can be done through focus group discussions.
3.3.5. Feedback to consultation forums on the area coming out from the data collected from the field. Regular meetings to ensure that the work is going according to plan and use the forums as a sounding board for fostering shared vision and an inclusive strategy.
Reporting and Production of final Community Health Strategy: This should include
Prepare a draft of the revised strategy under the guidance of the government counterparts and in consultation with the TWG and/or stakeholders and a summary draft report to summarise the process of the review of the strategy.
4.2 Ensure the production of a valid and relevant document which can lead to easy development of plans to implement the strategy. 4.3 Disseminate the findings and actively seek comments from the varied stakeholders
4.4 Consolidate and share the final strategy for the Ministry’s validation.
Tasks/Milestone: Deliverables/Outputs: Timeline (days)
Develop a workplan and Draft inception report to be shared with UNCEF and the Federal Ministry of Health
Draft of Inception report and detailed workplan with timeframes developed tools as well that will be used, data collection process, it is analysis and validation shared with UNICEF and the Ministry of Health for review and comments.
Address the comments on the inception report.
Final inception report submitted
Desk review of literature (the existing Community Health strategy, EPHS, RMNCAH and other relevant strategies, research et.c. and Mapping of the existing community health interventions.
Desk Review in electronic copy shared with UNICEF and FMOH to analyse and document key finds to guide the next step
Commence the work
Recording of the discussion with key information from the communities.
Conduct face to face workshop(s) and interviews with key stakeholders, documenting findings and triangulating information to identify priorities for the community health strategy
Meeting minutes, Interview notes and recordings shared with UNICEF
Prepare a draft revised strategy and a summary draft report to summarize the process of the review of the strategy
Draft of the revised community strategy and summary report shared with UNICEF/MOH for review
Address comments received from stakeholders and share final draft with UNICEF and the Federal Ministry of Health for validation and finalization
Final Revised Community Health strategy shared with MOH for validation
Conduct Dissemination meeting
Final Revised strategy
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UNICEF’s values of Care, Respect, Integrity, Trust, and Accountability (CRITA).
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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.
Only shortlisted candidates will be contacted and advance to the next stage of the selection process.
Kindly include an all-inclusive financial proposal together with your application.
Kindly also include medical insurance that covers medevac evacuation.
UNICEF only considers Higher education 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 at http://www.whed.net.
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.
The selected candidate is solely responsible to ensure that the visa (applicable) and health insurance required to perform the duties of the contract are valid for the entire period of the contract. The candidate may also be subject to inoculation (vaccination) requirements, including against SARS-CoV-2 (Covid).
Advertised: Jun 29 2022 E. Africa Standard Time Application close: Jul 17 2022 E. Africa Standard Time