Terms of Reference for Institutional Consultancy

Terms of Reference for Institutional Consultancy

Technical assistance in development and introduction of a National concept on

Developmental Pediatrics and Early detection and intervention services in Turkmenistan

Background and Justification

Developmental difficulties during early childhood are increasingly recognized as important contributor to morbidity in children and adults and the major cause of inequity and deprivations throughout the life course. While health care systems in high income countries provide multiple opportunities for the prevention, early identification and management of developmental difficulties in young children, interventions to improve the development of young children are becoming increasingly available in low and middle-income countries as well, and include low-cost strategies, such as addressing malnutrition and iron deficiency, training caregivers, increasing psychosocial stimulation and providing community-based rehabilitation[1].

Turkmenistan, the country with an upper-middle income status as per WB classification since 2012, despite making considerable progress in reducing child mortality over the last years, is still being listed among Countdown countries with high child morbidity and mortality rates. The national inputs to the UNICEF CEE/CIS regional survey on early childhood development and services for young children with developmental difficulties conducted in 2012, has revealed serious gaps in the health system of Turkmenistan in terms of early identification of developmental difficulties in children, provision of counseling and early intervention services for their management in line with international standards[2]. Data on children with disabilities and developmental delays in the country is very limited.

However, there are great opportunities for improving this situation in the country. In 2011, President of Turkmenistan has approved the National Programme on Early Child Development (ECD) and School Readiness for 2011-2015. In August 2012, the government of Turkmenistan signed the Pledge on A Promise Renewed reassuring commitment to improvements in the area of child survival and development. In 2013, the Ministry of Health and Medical Industry (MOHMI) developed a National Strategy on Maternal, New born, Child and Adolescent Health, which is currently under the government approval. In 2012, MOHMI initiated an assessment of its home visitation system and in 2013 completed a road map for increasing effectiveness of the PHC home visiting system with more focus on ECD, early identification of child developmental difficulties and provision of early intervention services for children. UNICEF CO has initiated assessment of social services in Turkmenistan, which is to be finalized by the end of 2014 and planned to conduct a special survey on the situation of children with disabilities in November 2014.

As a result of UNICEF CO’s systematic advocacy work with the government through technical consultation meetings, advisory round tables, support to participation at international conferences and workshops on developmental pediatrics and home visitation, as well as familiarization with experience of Turkey, Lithuania, Belarus and UK, the government has become dedicated to meet its global commitments and pursue national priorities through strengthening early detection services at the PHC home visitation system level and introduction of a developmental pediatrics concept in Turkmenistan. The importance of keeping child/family/community focused inter-sectoral, multi-disciplinary approach is being emphasized by UNICEF with necessity of increasing the role of community based social services and education sector along with strengthening health system in this area.

The Rolling Workplan for 2014-2015 signed by UNICEF Country Office with the Ministry of Health and Medical Industry of Turkmenistan (MoHMI) reflects the abovementioned technical assistance need.

Objective:

Technical assistance to Government of Turkmenistan in developing and introducing the national concept of developmental pediatrics and early intervention services for management of developmental difficulties in children in line with international standards.

Expected result: By the end of the assignment a draft of the evidence-based national concept note is prepared in cooperation with partners and ready for submitting to government’s consideration for approval.

Work Assignments, scope and deliverables:

Taking into account complexity of the country context and scope of the assignment, it is expected that the assignment will be accomplished by the team of experts, consisting of experienced developmental and behavioral specialist, health systems expert and expert experienced in ECD Center management, representing one or more institutions of CEE/CIS region. It is expected that overall management of the assignment will be provided by project manager/health system specialist and the technical lead will be ensured by expert in Developmental Pediatrics. It is planned that the expert team will be working with a team of local experts in the area of mother and child health under the guidance of MOHMI. It is also expected that the team will be in contact with the international expert team conducting assessment of the existing social protection services in the country under the contract of Social Protection section of UNICEF CO at the same time period and use results and recommendations of that assessment.

It is anticipated that the above-mentioned objective will be achieved by the assigned expert team in three phases.

The inception phase will include desk review of available materials and methodology design.

The task of the-in-country data collection phase will be to undertake data collection and, based on the analysis of available service for young children, and through a participatory and consultative process, agree on how development pediatrics could be incorporated in the existing health care system of Turkmenistan taking into account the main strengths and weaknesses of the health system building blocks and linkages required with other systems (social services, education, child protection etc.). A debriefing meeting with UNICEF will close this in-country work phase.

The synthesis phase will be for drafting the concept, including, an executive summary with analysis of gaps and bottlenecks and recommendations on introduction of development pediatrics system in Turkmenistan.

The national concept and action plan for introduction of developmental pediatrics to the MCH care system in Turkmenistan as a final product envision the following structure:

1 National Concept of the Development Pediatrics / Early Intervention services

1.1 Situation Analysis of the existing services for addressing developmental delays

and difficulties in children

1.1.1 Health system context

(1) Service Delivery

(2) Human resources

(3) Policies and regulations

1.1.2 Needs for development pediatrics services/early intervention services

(1) Morbidity / epidemiological trends

(2) Description of current services and patient’s flows

(3) Gaps in the development pediatrics services

1.1.3 Summary of the situation analysis (SWAT)

1.2 Conceptual framework

1.2.1 Key principles and concepts

1.2.2 Description of development pediatrics/early intervention services

models

1.2.3 Determinants of policy (model) selection

1.2.4 Summary of conceptual framework

2 Action plan for introducing the Development Pediatrics/Early intervention

practices for management of developmental difficulties in children

2.1 Description of pathways (strategies), including inter-sectoral cooperation,

vertical and horizontal continuum of care

2.2 Key action blocks

2.3 Key actors

2.4 Risks and assumptions

Methodology

Combination of both qualitative and quantitative methods will be used for data collection to triangulate data. The following techniques are expected to be employed:

Secondary data collection and analysis of services;
Questionnaires and interviews with key informants;
Direct observations while visiting health care facilities;
Focus group discussions with selected target groups.

The data collection methodology to be further elaborated by the Technical Lead and Project Manager/Health System Specialist. They should have an opportunity to discuss and propose amendments to the methodology with members of the expert team on line and during the first country visit. Data collection tools and research questions to be agreed in advance of the field visit. Proposed changes to be discussed at the initial stage and reflected in the inception report.

Stakeholders from national and sub-national levels will be engaged throughout the whole concept preparation process. The Ministry of Health and Medical Industry, the MCH centre and the task force established for the development of a developmental pediatrics concept will play an important role in commenting on the consultants’ assignments, facilitating data collection and analysis, contributing to the concept’s design, and validating approaches and the concept outline proposed by the consultant team.

Specific Tasks

Team member / Tasks
Technical lead – an expert in Developmental and Behavioral Pediatrics or related field (P5 level) / - Overall technical direction of the team work
- Review of synthesis of available government programmes, regulations, profile of existing professionals, and research results in the area of ECI produced by the rest of the team.
- Provides input to the Project Manager in the development of the methodology and instruments for data collection.
- Hold consultations with government decision makers and technical meetings with national experts to discuss and agree on main benchmarks leading to introduction of developmental pediatrics/early detection and intervention system for early identification and management of developmental difficulties in children
- Responsible for the technical content of the final concept note and action plan
- Facilitate round-table on presentation of newly developed concept note and action plan.
Project Manager -
Health Systems specialist
(P5 level) / Overall management of the expert team and main contact in working with UNICEF Turkmenistan CO and the local expert team of the MOHMI.
Phase I
- Desk review of available government programmes, regulations and research results in the area of ECD and related services
- Development of a methodology and instruments for data collection required for conducting Phase II activities with input from the technical specialists.
Phase II
- Review data collection methodology with technical experts and local partners in country.
- Train international and local team in data collection
- Field visits to selected health facilities at primary, secondary and tertiary levels supporting child care and development and ECD centers under the MOE
- Assist in the synthesis of the collected data
- Apply health systems strengthening approach to analysis of available and recommended ECI services
- Work with the Technical Lead and ECD/ECI services management Specialist, as well as UNICEF consultants conducting social protection services assessment in the country, on recommendations for the government, taking into account the current health care system building blocks and related social services
Phase III
- Contribute to concept note and action plan development through the prism of HS building blocks
- Final lay out of the concept note
- Discuss the health system implications during the national round-table on the newly developed concept note and action plan.
ECD/ECI services management specialist (P3 level) / Phase I
- Desk review of available government programmes, regulations, profile of existing professionals, and research results in the area of ECD and related services.
- Contribute to development of the concept’s design and a methodology and instruments for data collection required for the concept’s formulation
Phase II
- Conduct of mapping of facilities and services related to child development and developmental pediatrics/early interventions through:
- Field visits to selected health facilities at primary, secondary and tertiary levels supporting child care and development, including care for preterm and low birth weight newborns, and children with congenital disorders and developmental delays
- Field visits to model ECD centers under the MOE
- Familiarize with results of the assessment of existing social protection services conducted by international consultants under the Social Protection section of UNICEF CO for incorporation into the concept
- Data collection in Ashgabat and selected velayats through meetings, interviews or focus groups with:

Administration of health care facilities
Health care providers at different levels
Medical university and college teachers
Parents with children of 0-8 years old, including families with developmentally challenged young children

Phase III
- Contribute to concept note and action plan development
- Assist MOHMI in developing the regulations/statute of the ECI center
- Participate at the round-table on presentation of newly developed concept note and action plan.

Timeline: October 2014 – March 2015.

Location and Duration: assignment workday breakdown (projections)

Out-of-country / In-country
Technical Lead (P5 level ) – 24 days / Phase I – 5 days
Phase III – 10 days / Phase II – 6 days
Phase III – 3 days
Project manager - Health Systems specialist (P5 level) - 29 days / Phase I – 5 days
Phase III – 15 days / Phase II – 6 days
Phase III – 3 days
ECD/ECI services Management Specialist (P3 level) - 24 days / Phase I – 5 days
Phase III – 10 days / Phase II – 6 days
Phase III – 3 days

Deliverables:

Stage I. Background work, including desk review, development of the concept’s design and a methodology and instruments for data collection is completed.
The main deliverable of this stage will be an inception report based on desk review (out-of-country).
Stage II. Data collection and the analysis of available services for young children is conducted and agreement on proposed development pediatrics model is achieved.
The deliverable of the second stage will be a presentation with initial findings and recommendations presented and discussed with concerned partners and UNICEF (in-country).
Stage III. National concept and action plan for introducing the Developmental pediatrics principles to health care system in Turkmenistan is drafted in consultation with national experts (out-of-country) and presented to government officials and key specialists in mother and child health area at the round-table (in-country).
Final deliverable will be the Report with national concept and action plan for introduction of developmental pediatrics/early intervention services to the MCH care system in Turkmenistan.

Qualifications and Experience requirements:

Technical Lead (P5 level)

Advanced university degree in Medicine/Public Health in area of early childhood development and certified specialist in Developmental and Behavioral Pediatrics or equivalent speciality.
Internationally recognized expertise in the development and management of family-centered early identification, assessment and early intervention services for children with disabilities and developmental difficulties.
At least 8 years professional work experience at the national and international levels in planning and programming in public health, child survival, child care and development
Relevant consultancy experience with international organizations/UNICEF/WHO in the field of public health planning and program development
Previous experience of work with UNICEF in CEE/CIS countries would be an asset

Competencies and Skills:

Strong analytical and communication skills
Conceptual thinking and strategizing ability
Strong facilitation and training skills
Excellent writing skills
Ability to work in a multi-cultural environment
Prior experience of work with UNICEF in CEE/CIS countries would be an advantage
The consultant should be fluent in spoken and written English. Working knowledge in Russian would be an asset.

Project Manager/Health Systems Specialist (P5 level)

Proven experience in policy advice and development in the area health systems strengthening , public health and MCH care;
Minimum 10 years of working experience in the field of public health policy
Proven experience in research, analysis, policy and strategy formulation in PHC and MCH in CEE/CIS region;
Previous experience in implementation of relevant or similar consultancy work in the region of CEE/CIS;
Knowledge of global policies, development frameworks of WHO and UNICEF in ECD area.

Competencies and Skills:

Excellent analytical thinking, report writing , training and communication skills
Conceptual thinking and strategizing ability
Prior experience of work with UNICEF in CEE/CIS countries; familiarity with Turkmenistan health system would be an advantage
The consultant should be fluent in spoken and written English. Working knowledge in Russian would be an asset.

ECD/ECI services management specialist (P3 level)

Advanced university degree in Medicine/Public Health in area of early childhood development and developmental pediatrics
Proven extensive work experience in establishing and management of developmental pediatrics/early interventions services for children with developmental difficulties at the national and international levels
At least 5 years professional work experience at the national and international levels in planning and programming in public health, child survival, child care and development
Relevant consultancy experience with international organizations/UNICEF/WHO in the field of public health planning and program development
Previous experience of work with UNICEF in CEE/CIS countries would be an asset.

Competencies and Skills:

Strong analytical and communication skills
Conceptual thinking and strategizing ability
Strong facilitation and training skills
Excellent writing skills
Ability to work in a multi-cultural environment
The consultant should be fluent in spoken and written English. Working knowledge in Russian would be an asset.

Evaluation process: Given that the assignment is a part of Regional Key Leadership Area 7 on A Child's Right to Comprehensive Well-being, the evaluation of proposals will be conducted by relevant staff representing CO and RO, based on technical and financial review of submitted proposals.

Performance evaluation will be done based on the following attributes:

Quality of work

Technical skills

Value for money

Meeting time schedule

Work supervision and reporting: The team will work under supervision of UNICEF Turkmenistan Deputy Representative and Health and Nutrition Specialist, in collaboration with the Ministry of Health and Medical Industry of Turkmenistan.

Funding source: WBS 4360/ AO/04/008/001/001.Country Programme Output: By 2015, health system delivers quality service in mother and child health, in line with international standards. Activity under RWP 2014-2015: Development of the national concept /vision on Early Intervention services/Developmental Pediatrics

Logistics/trip arrangements: UNICEF will provide logistical support in the organization of the consultants’ visit to Turkmenistan, in-country travels, if required, and facilitate meetings with partners.