Senior Consultant for Assessment of Maternal, perinatal, Newborn and Child deaths in the Community, Kigali Rwanda – 3 months ( Remote/ Work from home) at United Nations Children’s Fund (UNICEF): (Deadline 2 August 2022)

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For every child, health

To learn more about UNICEF work in Rwanda, please visit the country website https://unicef.sharepoint.com/sites/RWA/

How can you make a difference?

Rwanda has made progress in reduction of maternal mortality and was among the nine developing countries that achieved the MDG goal 5 related to reduction of maternal mortality by 2/3 in 2015. According to the recent DHS 2019-2020, the maternal mortality ratio dropped from 1071 to 203 in past 20 years; however, newborn mortality is stagnating, now at 19/1,000 live births. Hence the need to expand coverage and increase access to high impact maternal, perinatal, newborn and child interventions in order to sustain results and speed up progress. As part of Fourth Health Sector strategic plan and Sustainable Development Goals, Rwanda has made respectively an ambitious but attainable target of further reducing maternal deaths to less than 126/100,000 livebirths by 2024 and 70/ 100,000 live births by 2030; neonatal mortality to 15.2 by 2024 and less than 12 by 2030; and under five child mortality to less than 35 by 2024 to less than 25 deaths /1000 live births by 2030. This will require innovation and renewed efforts to identify and address avoidable child deaths as well.

Maternal deaths audits (MDA), first introduced in Rwanda in 2008, provide information needed to understand how many women die, where and why they die, and provide a platform to tackle the causes and factors affecting such maternal deaths. Over time, this evolved to maternal death surveillance and response (MDSR). Maternal Deaths Surveillance and Response brings in a public health aspect with routine identification and timely notification of maternal deaths in a form of continuous surveillance linking health information system and quality improvement processes from community to national level. Neonatal and child deaths audit was initiated in 2010, while the audit of stillbirths started in 2013. In 2015, the Ministry of Health established a MPCDSR committee as an independent technical and advisory organ to support the Ministry to further improve the tracking of MPNC deaths and support the identification of modifiable causes of deaths as well as deploy effective strategies to address preventable deaths.

In hospitals and health centres, MPCDSR is done by hospital based MPCDSR committees through audits of each maternal death and under-five death, as well as some stillbirths and neonatal deaths and subsequent formulation and implementation of recommendations and actions to address avoidable similar deaths. At national level this is monitored through notification of deaths in HMIS, analysis of deaths and supportive supervision of National MPCDSR Committee, analysis of data, and formulation of recommendations. This is complemented by a confidential enquiry on MPNC deaths. Verbal Autopsy is an audit method used for audits of Maternal, Neonatal and Child deaths which occur in the community and this involves some staff from a health centre of that catchment area and local governance authority at Cell/Village level.

Scope of Work:

The individual consultant will conduct a desk review of existing documentation; prepare for and conduct interviews with staff from government, health facilities, key selected stakeholders and community-members; participate and present in different workshops; produce a draft report of MPNC deaths in the community; present results to the MPNC death assessment steering committee and Reproductive, Maternal, Newborn, Child and Adolescent Health Technical working Group (RMNCAH TWG);account for inputs/comments; and consolidate into a final MPNC death report. The report shall comprise root causes and factors contributing to MPNC deaths and identify bottlenecks hindering the decrease of mortality in community, with recommendations and an improvement plan covering different levels of health sector (central, referral, district and community).

Rationale – conducting national assessment of MPND in the Community

Even though the verbal autopsy methodology is used to do audits of MPNC deaths in community, there is still a large gap in determining the causes, bottlenecks and factors causing deaths that occur in the

community and in turn determine evidence-based measures to prevent MPNC deaths in community. During the National MPCDSR committee workshops, data shared showed increase in MPNC death in the community and the members of MPCDSR national committee recommended conducting an assessment to identify contributing factors and bottlenecks and come up with a plan to avert deaths at community-level.

In the MPCDSR workshop done with the members of verbal autopsy teams at a health centre in October 2021, after analysis of deaths occurred in the community, participants identified the following gaps:

• Antenatal care (ANC) and Postnatal consultation (PNC) not well done
• Inadequate health seeking behaviour and reliance on traditional healers.
• 1^st, 2^nd, and 3^rd delays, and not keeping appointments.

This assessment will therefore help to verify gaps, factors and bottlenecks affecting communities and propose improvement plan with strategies to avert MPNC deaths in the community. This assessment by an individual consultant shall as well provide evidence-based recommendations to inform appropriate programming of maternal, newborn and child health services in the community to significantly decrease preventable deaths.

Objectives of the assessment

• To assess the root causes of MPNC deaths in community.
• To assess factors contributing to MPNC deaths in community.
• To identify bottlenecks hindering the decrease of MPNC deaths in community.
• To explore why the causes are not properly identified or documented in the verbal autopsies.
• To develop recommendations and improvement plan for different levels of health sector (central, referral, District, and community) for decreasing MPNC deaths.

Work Assignment Overview

Specific tasks/Milestones:

• Preparation of an inception report based on the terms of reference, describing how the assessment shall be conducted including timelines for the deliverables, research questions, sampling plan, tools, methodology and process of data collection and analysis, and outline of the report. To be validated by steering committee.
• Desk review of documentation already done in Rwanda on factors and bottlenecks contributing to community deaths, including secondary analysis of the available data (published and unpublished) from existing verbal autopsies and other sources. Development and adaptation of assessment tools.
• Orientation/training of data collectors and field-testing tools.
• Data collection and quality assurance, with regular updates to the steering committee.
• Data review, analysis/interpretation of qualitative and quantitative data
• Triangulation of data from desk review and primary data collection
• Report writing and validation:
  • Develop content and zero draft of report and submit to the steering committee composed of National maternal, postnatal death surveillance and response (MPCDSR) committee and MoH/RBC team for review, inputs/comments.
  • Present key findings, recommendations, and improvement plan to the steering committee for enhancement and validation
  • Incorporate the inputs from the steering committee; share draft with RMNCAH Technical Working Group for input.
  • Incorporate inputs from the RMNCAH Technical Working Group and steering committee and present for finalization.
•   Submit a final report with PowerPoint presentation approved by RBC to UNICEF.

Expected outcome

Evidence based recommendations will be formulated and improvement plan prepared to be implemented by Ministry of Health/RBC and other stakeholders through Maternal, newborn, Child, and Community Health programs. The approach shall be participatory and consultative. The report will include: a situation analysis, an evidence-based methodology, objectives, findings/results (including primary and secondary data collection), key priorities and improvement plan. Quantitative results should come in graphs and data charts describing status, overtime trends, and comparison between different indicators. Qualitative data should include quotes and visual schema/frameworks.

Deliverables/Outputs:

• Final approved inception report including tools – presented to and validated by the MPNC steering committee.
• A draft of the assessment report and presentation submitted to RMNCH TWG.
• A final MPNC death assessment report and presentation approved by RBC.

To qualify as an advocate for every child you will have…

• A university degree in Medicine or Nursing and an advanced university degree (Masters or higher) in in Public Health, Child health or Global Health.
• Familiarity with MNCAH including having conducted similar studies, assessments, and surveys for at least 8 years.
• Familiar with the Rwanda health system from decentralized (Primary health care level) to National level.
• Prior similar experience in conducting MNCH/MPNC assessments or verbal autopsies will be an advantage.
• Prior experience in carrying out successfully the consultancy in Maternal, Newborn and child health domain.
• Demonstrated competence in oral and written English language skills, including a proven ability to prepare reports and proposals in a clear, concise manner. The program may ask short listed applicants for copies of previous evaluation reports.
• Working experience with UN and or other international organizations will be an added advantage,
• Fluency and excellent writing skills in English required,
• Ability to work under tight deadlines.

For every Child, you demonstrate…

UNICEF’s values of Care, Respect, Integrity, Trust, and Accountability (CRITA).

To view our competency framework, please visit here.

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.

Remarks:

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).

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