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For every child, quality health and nutrition services
Vanuatu consists of about 82 geologically newer islands of volcanic origin and 65 of them inhabited. Vanuatu's total area is roughly 12,274 square kilometers, of which its land surface is roughly 4,700 square kilometers. Vanuatu is a lower middle income country according to the World Bank, 2018. Vanuatu has a total population of 270,000. Half of its population is aged under 24 years old and its annual birth cohort is about 9,000.
Vanuatu’s infant mortality rate is 28 per 1,000 live births in 2013 with an Under Five Mortality Rate (U5MR) of 31/1,000 live births. The country did not achieve its 2015 MDG targets either for infant mortality or for U5MR. In response, the Vanuatu government set new targets for child mortality under the National Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH) Policy and Implementation Strategy 2017-2020 at 20 for IMR and 25 for U5MR per 1000 live births respectively to be met by 2020.
The Global Action plan on Pneumonia and Diarrhea (GAPPD) set specific targets for IMR and U5MR due to pneumonia and diarrhea through improving coverage for key interventions to be at or above at 90% . Coverage for life saving interventions for pneumonia and diarrhea are low in Vanuatu. For example: the proportion of children with diarrhea who are given oral rehydration therapy (ORT) increased from 54% in 2007 to 62% in 2013, and the proportion of children with suspected pneumonia treated with antibiotics also decreased from 48% in 2007 to 29% in 2013. In 2016, ARI visits of under 5 years old was 1136 and diarrhea was 381 according to the MOH. Highest number of diarrhea was reported in May, June and July. Other life-saving key intervention coverage are low including nutrition interventions while U5 mortality due to pneumonia and diarrhea takes 27 (13.6 each) percent of U5MR. According to DHS 2013 data, both IMR and U5MR is high among rural, poor and less educated population of Vanuatu. Child mortality estimates-by the WHO and Maternal and Child Epidemiology Estimation Group (MCEE) 2017 report showed that approximately 30% of under 5 deaths are due to pneumonia and diarrhea.
IMCI is a core component of the GAPPD which consists of three key elements: 1) improving case management skills of health-care staff; 2) improving overall health systems and 3) improving family and community health practices. Evidence suggests IMNCI was significantly associated with a 15% reduction in child mortality when activities were implemented in health facilities and communities.
In 2016, WHO conducted a Global review of IMCI implementation and revealed that IMCI implementation was uneven with coverage at scale rarely achieved. Failure to agree on sustainable funding and fragmentation of support led to a loss of built-in synergy around IMNCI’s three components while implementation focused on health worker training, more than health systems and family/community practices. Insufficient attention was paid to programme monitoring, targets and operational research. WHO and UNICEF did not provide sustained, focused leadership - as time went on, interest and funding for IMNCI waned. IMNCI suffered from blind spots in the lack of explicit emphasis on equity, community engagement and linkages to other sectors (education, WASH…).
Vanuatu was not exempt from the situation described above. Health systems are weak and offer limited support to child health and other health targets. According to the MOH planning unit, 24 per cent of provincial PHC facilities have no clinical staff, 53 per cent do not meet minimum staffing requirements and 70 per cent do not have the recommended number of health staff. Health facility visits show that some essential commodities are not available. For example, low osmolality ORS is not available with health facilities still using the old ORS formula. Amoxicillin dispersible tablets were not available at any health facilities as per new WHO standard, aid posts have benzyl-penicillin and co-trimoxazole while health center and dispensaries have amoxicillin tablets and syrups for treatment of pneumonia. Zinc is available in dispersible form. Counselling materials on pneumonia and diarrhea including use of dispersible tablets were not available at all health facilities. While aid posts are close to the community, “there is no clear strategy for the skilled health workers at health facilities (health centers and dispensaries) to engage with communities”.
The MoH Vanuatu seeks technical assistance in defining its national strategy on IMCI through reviewing the IMCI program, national guidelines, training modules/packages, and developing a costed multi-year action plan for the next five years inclusive of the recent WHO recommendations.
How can you make a difference?
Purpose of Assignment:
The overall purpose of the assignment is to work in collaboration with the Ministry of Health in developing a country specific IMCI plan of action and tailored guidelines and tools to meet Vanuatu specific needs to health services and respond to the high infant and under 5 mortality rates. The assignment will inform Vanuatu’s current situation in managing childhood illness, the barriers that impede a sustainable IMCI implementation and the steps in moving forward.
The deliverable's will ensure Vanuatu has in place standard guidelines to address the case management of sick children under the conditions typical of peripheral facilities, focusing on the most common serious conditions, such as ARI, Diarrheal diseases, Malaria and Malnutrition. In a resource constrained setting, integrated (combined) guidelines will optimize health service delivery to children, instead of separate guidelines for each illness which can affect a child.
The IMCI guidelines and tools will;
- Guide the health workers to treat sick children appropriately hence reducing mortality and morbidity associated with the major causes of childhood illness.
- Be used by supervisors for onsite training of health workers during supportive supervision
- Inform the planning and procurement of essential drugs and supplies
The deliverable's will inform MOHMS to;
- Establish and scale up the implementation of IMCI coverage in all health care facilities
- Strengthen the healthcare system through increasing access to essential medicines, vaccines, strengthening supply chain management, increasing healthcare financing, improving leadership & management
- Strengthen a referral patient oriented system
- Strengthening coverage of curative and preventative measures for sick children
This assignment will provide a road map to the MoH on how to build capacity of the health sector to provide quality IMCI services at PHC facilities. Key deliverable's will assist the government to approve and implement costed 5-year action plan, evidence based, high impact child survival interventions through IMCI and IMCI training modules specifically designed for Vanuatu.
The deliverable's should be able to answer the following three questions:
- What is the current status of IMCI implementation in Vanuatu?
- What are the barriers that impede sustainable IMCI implementation in Vanuatu?
- What needs to be done differently to scale up IMCI?
- How much will be the cost for scaling up IMCI nationwide?
Scope of Work/ Work Assignments: Under the MOH Task Force close guidance and supervision, the consultant will undertake the following assignments in Vanuatu:
- Conduct a comprehensive review of current IMCI practices (facility based and community based IMCI) and implementation to identify successes and gaps. This will include targeted interviews with stakeholders in government and partners with field visits to select sites or clinics;
- Identify gaps of health system component of IMCI through field visits to urban and rural health facilities and meeting relevant focal points of the MOH, identify opportunities to remove bottlenecks and possibilities to align IMCI with anticipated developments of leadership/governance, human resource, information/monitoring, communication, and essential supplies.
- Identify opportunities to strengthen community components of IMCI in order to reach every child.
- Develop a costed multi-year IMCI action plan which will encompass among other things (a) improving case management skills of health staff (b) Improving the health system (c) Improving family and community practices based on recent WHO/UNICEF global review findings.
- Develop a clear monitoring and evaluation matrix for the multi-year IMCI action plan
- Review the currently used IMCI training curriculum, develop training modules and job aid package through adapting standard WHO/UNICEF guidelines into Vanuatu context. Each guideline should not exceed more than 20 pages. Explore options for scaling up ICATT and using distance IMCI (d-IMCI) modules and community based IMCI in the country.
- Review current pre-service IMCI training curriculum; revise and make recommendations for improvement
- Conduct a training of trainers (ToT) with the finalized training package.
- Prepare a brief (3 pager) reflection/observations document on this consultancy
- Conduct end of assignment briefing with MOH, the IMCI and UNJP partners and UNICEF Pacific Suva.
To qualify as an advocate for every child you will have…
- University (preferably advanced) degree is required in medicine, public health, international/global health, maternal and child health, pediatrics or any other relevant field.
- At least 7 years of experience, at the national and international levels, on IMCI program design and implementation, maternal and child health, pediatrics with strong program management skills
- Familiarity with the development and implementation of IMCI action plan, and designing IMCI training packages including ICATT, dIMCI and C-IMCI.
- Experience working in the Pacific and in low resource settings will be an advantage
- Proven ability to conceptualize, innovate, plan and execute ideas.
- Good writing and communication skills.
- Computer skills, including strong quantitative analysis and reporting tools.
- Fluency in written and spoken English required.
- Solid analytical, negotiating, communication and advocacy skills.
- Demonstrated ability to work in a multi-cultural environment and establish harmonious and effective working relationships, both within and outside the work place.
- Versatility, judgment and maturity.
The duration of consultancy is for the period of 3 months in two phases from October – November, 2018 and February, 2019. The consultant is expected to work in Vanuatu to deliver the output.
Consolidated consultancy fee including living allowance and anticipated travel costs should be included in the financial offer by the applications. Financial offer should provide the detailed breakdown of the cost items.
Attached is the detailed Terms of Reference: TOR- Integrated Management of Childhood Illness Consultant, Vanuatu.docx
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