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UNICEF  is looking for International / National Consultant for the Assessment of The Gambia Health Service Delivery

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UNICEF  is looking for International / National Consultant for the Assessment of The Gambia Health Service Delivery

Job no: 522331
Work type: Consultancy
Location: Gambia
Categories: Health

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    1. Context and justification

The health sector has been experiencing increasing pressure due to a number of problems such as high population growth rate, high morbidity and mortality rates (maternal, infant and child mortality, morbidity and mortality associated with communicable and non-communicable diseases), shortage of qualified health personnel and its high attrition rates, inadequate financial and logistics support, ageing health infrastructure and limited medical equipment and supplies, lack of efficient referral system and health neonatal care services. Despite these issues, The Gambia has obtained considerable achievements in maternal and child survival. Between 1990 and 2013, the maternal mortality ratio declined significantly from 1050 to 433 per 100,000 live births and under five mortality fell from 165 to 54 per 1,000 live births (GDHS 2013).

The leading causes of maternal deaths are haemorrhage (34%), hypertensive disorders in pregnancy (19%), and sepsis (9%) (GDHS 2013). Further evidence has revealed that maternal mortality was largely due to teenage pregnancy, limited access to skilled birth attendants (57.2%), and low quality of emergency obstetric.

The leading causes of death in children under five are neonatal causes (40%), following malaria (23%), pneumonia (16%), and diarrhoea (14%). With an estimated mortality rate of 22 deaths per 1,000 live births among neonates in 2013, neonatal mortality now accounts for a big share of all under-five deaths. It is estimated that every year in the Gambia, about 2,400 children die during their first 28 days, of which 816 (34%), 672 (28%), and 552 (23%) because of preterm, infection and asphyxia respectively (GDHS 2013).

This assessment will review the health service delivery as part of the wider support to a comprehensive review of the health sector. With the advent of the new government, it is envisaged that this assessment will enable decision-makers at all levels of the health system to identify progress, problems, and needs; make evidence-based decisions on health service delivery and allocate resources to achieve health improvement priorities in line with the NDP and SDGs.

Since maternal and Newborn services required special focus, a national level consultant was taken on board for in depth assessment of these critical services. This national level consultant (separate ToRs) was able to complete assessment of MCH services which will also inform this holistic assessment of health services using the USAID’s Health System Assessment Approach v3.0

    1. Objectives

The assessment will be a comprehensive review of health service delivery to assess the status, identify gaps, specific recommendations to build in accountabilities, and identification of effective measures to demonstrate change results in order to attain UHC. Overall objective is to facilitate policy makers and decision makers with requisite information to be able to design efficient and effective quality health service delivery.

The specific objectives are to:

  •  Plan, develop and implement a detailed health service delivery assessment tool with a special focus on maternal and newborn health
  •  Validate findings with selected stakeholders
  •  Draft a report of the assessment based on the outcome of assessment
  •  Review and finalize the draft report based on comments and feedback received from various stakeholders
  •  Disseminate information collected and recommendations stakeholders

    1. Roles and Responsibilities

The Consultant will report both to the Permanent Secretary, MoHSW and the UNICEF Head of CSD section in accordance to the Terms of Reference and will be the focal person of the overall assessment.

The consultant will work under the overall supervision of the Permanent Secretary, MoH. The supervisor will have frequent interactions with the consultant at various stages in order to brief the consultant on the situation/assignment; agree on the process and clarify the deliverables; provide feedback and comments on intermediary products; and track the progress made by the consultant. The supervisor will evaluate the consultant’s work and certify delivery of work.

  1. Activities
  •  Develop and finalize Service delivery assessment tools in consultation with all partners as identified by the client
  •  Assessment and Data Collection
  •  Data analysis
  •  Draft and share the report to stakeholders
  •  Facilitate workshop to seek feedback on draft report
  •  Finalise the report inclusive of feedback from the stakeholders and disseminate
  1. Deliverables
  •  Development of questionnaire adapting the SARA tools for service delivery
  •  Development of In-depth interview guidelines and questionnaires
  •  Completion of data collection
  •  Provide technical assistance to the local data collection team in administration of service delivery assessment tool
  •  Completion of data analysis
  •  Completion of draft report
  •  Completion of workshop
  •  Submission of final report
    1. Methodology

Wholistic assessment of health services using the USAID’s Health System Assessment Approach v3.0 will be carried out.

The Assessment of Health Services delivery component will be a part of overall Health System Assessment, which is being coordinated by a team comprising of MoHSW, UN agencies etc., with a team leader and focal points for different functional areas (Governance, logistics, admin/finance etc). An Overall, under the direct supervision of the Permanent Secretary, Director of Planning and WHO are coordinating and providing technical backstopping to the process. Regular meetings of all the stakeholders are organised by MoHSW, where updates from various components are shared, reviewed and feedback is provided to ensure that the process and results reflect high quality.

The consultant will liaise with stakeholders in all steps of the assessment from planning the work through conducting the assessment and disseminating and validating the findings and recommendations.

A pre-assessment stakeholder meeting to define common objectives, identify specific areas of focus, and get input and guidance on the approach will maximize the use of the assessment outputs. The tool to be used will be revised in reference to local context by the consultant and submitted to the team and approved before proceeding further. Similarly, questionnaire will be designed for data collection and approved.

Depending on the availability of resources, preferably small teams will be formed in each region, led by a team leader with clear terms of reference mainly responsible for planning, implementation and supervision of data collection at regional level and sharing with the consultant.

Service delivery assessment will examine the factors that affect service delivery outputs and outcomes, including demand for services; development of service packages; organization of the provider network including public, private, and community-based providers; and management of health services including safety and quality, and the physical infrastructure and logistics of the system. It will specifically look at:

  • The availability of services-Essential Package of Health Services (range of services provided by level);
  • Accessibility (proportion of the population living within a certain time or distance of a health facility, as a rough measure of geographical access.);
  • Affordability (to look at the significant financial barriers);
  • Acceptability (looking at main socio-cultural barriers to access);
  • Utilization (OPD consultation rates per capita); and
  • Coverage of services
  • Quality may also be assessed using a patient/client satisfaction survey (exit interviews in sampled facilities).

The technical proposal should include major tasks to be accomplished with timelines in a systematic phased approach. However, duration of each activity/phase can be overlapping and time-invariant according to the priorities of Technical Committee/supervisor.

As part of the process, the team will engage stakeholders in a variety of ways (interviews, focus groups), culminating with a stakeholder workshop for validating findings, identifying priorities, and discussing recommendations. Recommendations should reflect priorities and objectives of the client and key stakeholders, and should serve as the basis for an action plan for health system strengthening.

USAID’s Health System Assessment Approach v3.0 will be used for the purpose

The output of the assessment will be:

  •  An assessment report presenting key findings, highlighting important strengths, critical weaknesses that limit performance, and recommendations for priority interventions.
  •  A set of actionable and specific recommendations for health system strengthening through improvement of services delivery in The Gambia
    1. General Conditions: Procedures, Logistics, and Ethics
  • It is an office-based assignment with visits to the field during the data collection phase. The consultant will be provided an office space in UNICEF CO in The Gambia.
  • UNICEF the Gambia will introduce the consultant to the relevant stakeholders and public institutions.
  • The consultant is bound by all UNICEF rules and ethics regulations in the conduction of his work
  • The consultant is held by strict confidentiality rule regarding all aspect of his work with UNICEF
    1. Qualifications required

The consultant should hold at a minimum:

  • Graduate level degree (MA, MPH) in International Health and Development or related program (coursework in Health Systems/ Population Studies is preferred)
  • 5 years’experience working in health and development in general, and development of Health Information System, preferred
  • Excellent judgment, conceptual and analytical thinking ability
  • Skills (Experience) in advocacy, communication and interaction with governmental and non-governmental partners in Health
  • Ability to communicate effectively in English (orally and in writing)
  • Strong skills in MS Word, complex MS Excel documents and Power Point
  • Sound knowledge of the context of West Africa
  • Similar work experience can be an added advantage
  1. Length of Assignment

The assignment is expected to take 45 working days to complete. A detailed timeframe will be agreed upon selection of the Consultant.

  1. Fees

The daily fees are established on the basis of the financial offer made by the candidates selected after the analysis of the files. In the event of a mission, the mission costs payable to the consultant shall not exceed the amount of daily mission allowances (DSA) according to the current United Nations scale.

The last payment will be made after acceptance of the final report at the end of the mission.

In case of bank transfer to an account abroad, the costs and charges will be charged to the consultant.

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 sexual exploitation and abuse, and on any kind of harassment, including sexual harassment, and discrimination. All selected candidates will, therefore, undergo rigorous reference and background checks.


  • * All applications must include a financial and a technical offer (methodology)
  • * Only shortlisted candidates will be contacted and advance to the next stage of the selection process

Advertised: 14 Jun 2019 Greenwich Standard Time
Applications close: 23 Jun 2019 11:55 PM Greenwich Standard Time

Apply here

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