Senior consultant to support evidence generation in mental health: Prevalence and determinants among adolescents in various age groups in Rwanda, Kigali Rwanda, 4 months (Remote/ Work from home) at United Nations Children’s Fund (UNICEF): (Deadline 18 October 2023)

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Background:

Mental health conditions constitute a major burden of disease for adolescents globally. Many mental health disorders emerge during adolescence, anxiety, and depression account for almost 50 per cent of mental disorders among adolescents in Africa, with higher rates seen among girls.  According to UNICEF (2023), ensuring that adolescents are fully supported in all facets of life, including their mental health and well-being, is critical for fostering the transition from childhood to adulthood and laying the foundation for healthy and productive adulthood. Mental health conditions constitute a major burden of disease for adolescents globally. In 2019, it was estimated that one in seven adolescents experience mental disorders [i]. This amounts to an estimated 166 million adolescents (89 million boys and 77 million girls) boys and girls globally.

Being pregnant or a young mother increases mental health challenges. GBV among young women and girls is directly linked to many poor health outcomes including long term mental health disorders such as anxiety and depression (Robert, Sherr et al 2022 (analyses still in progress).

Rwanda is among countries in Africa with the highest burden of mental health problems, in part due to the impact of the 1994 Genocide against the Tutsi, which for Rwanda’s adolescents and youth today, has been linked to intergenerational trauma (Kagoyire et al. 2023). However, mental health of adolescents in Rwanda has been the subject of few studies. The Rwanda Mental Health Survey (RMHS) conducted in 2018 showed that 1 in 5 people (20.49%) among the general population had at least one mental health disorder while among the genocide survivors, 1 in 2 (52.2%) were identified as having one or more mental disorders. However, the sample studied for the RMHS did not include adolescents under 14 years of age. According to Kayiteshonga et al, 2019, the prevalence of mental health problems among adolescents aged above 14 was reported to be 10%. Another pilot study conducted on adolescents aged 13 and above from 7 districts focused only on alcohol and substance use and reported the prevalence of 14.4 per cent for alcohol binge drinking, 4.36 per cent for cannabis use, 0.2 per cent for opiates use and 0.1 per cent for cocaine use (Gishoma et al, 2021).

The Violence Against Children and Youth (VACY) Survey of 2016 revealed a strong connection between mental health conditions and experience of violence in childhood. Furthermore, WHO Global Health Estimates (GHE 2019) on the burden of disease among adolescents 10-19 years old in Rwanda  revealed that boys and girls suffer from depressive disorders, childhood behavior disorders and anxiety disorders.

In addition, UNICEF’s Adolescent Mental Health Landscape Assessment (2020) highlighted that the adolescent mental health situation in Rwanda is likely to be mainly negatively affected by family conflict, poverty, childhood traumatic experience induced by the 1994 Genocide against the Tutsi, violence against children and women resulting in unintended pregnancies, substance abuse and addiction and risky behaviours. Overall, none of the research, studies and surveys have captured and reported on the magnitude and prevalence of mental health problems among adolescents and looked holistically at their multidimensional determinants across key age and gender categories.

Data collected through Health Management Information Systems (HMIS) also provides limited information about numbers of adolescents seeking mental health care at health facilities, since under 20 is treated as one group, which precludes analysis for children and adolescent sub-groups.

Adolescent mental health is increasingly being seen as a critical area of action at global and national levels. The psychological and emotional wellbeing of adolescents has become an important priority for the Government of Rwanda. The Ministry of Health/Rwanda Biomedical Centre (RBC) recently started the school-based mental health program to take care of adolescents and has also deployed a mental health workforce in health centers to take care of mental health needs of the population, including needs of adolescents. To further bring services closer to children and families, the National Child Development Agency has deployed in all districts, psychologists and social workers as child protection and welfare officers who focus on provision of psychosocial support and referrals to other mental health services.

Given the limited availability of data on adolescents’ mental health, UNICEF Rwanda in collaboration with Rwanda Ministry of Health through RBC, Mental Health Division, is seeking to recruit the services of a consultant or a team of consultants to conduct a study to assess the prevalence of mental problems among adolescent girls and boys (ages 10-14 and 15-19 years) in Rwanda and to identify the determinants influencing their mental health and well-being.

Purpose of Activity/Assignment:

The purpose of this assignment is to design and conduct a national survey to assess the prevalence of mental health problems among adolescents in Rwanda and identify the significant determinants influencing their mental health and well-being. The findings from this study will contribute to strengthening the evidence-base for adolescent mental health programmes, will provide insights into the factors contributing to mental health challenges and will guide the development of tailored, needs-based interventions for girls and boys. It will specifically help to define priorities, guide policy, and sharpen programming, as well as provide baseline data to track progress in the improvement of adolescents’ mental health.

This will be – first and foremost, a quantitative population-based (10-19 years) survey to assess the prevalence of mental health problems among adolescents and could also include interviews or innovative groups sessions which are qualitative to gain deeper insights into the determinants of adolescents’ mental health. It is recommended to use existing tools on measuring mental health among adolescents and youth  at population level, such as the MMAPP, which is a culturally adaptable and clinically validated data collection tool.

Key Tasks:

Technical scope

• Assess the prevalence of the main mental health problems among adolescents in various age groups in Rwanda (younger adolescents 10-14 years and older adolescents 15-19 years).
• Identify and analyze the significant determinants contributing to mental health problems among adolescent subgroups, considering sex, residence, age group, education level, and socioeconomic status. Some potential determinants include family situation (e.g., losing more than one parent, family experience in the 1994 Genocide Against the Tutsi), experience of sexual or physical violence, HIV status, experience of teenage pregnancy, substance abuse, and other determinants reported in the literature.
• Develop an adolescent mental health conceptual framework to illustrate important determinants and the interlinkages for key sub-groups.
• Assess the use of mental health care or psychosocial support by adolescents and identify gaps in seeking services, as well as linkages and referrals to mental health care or psychosocial support.
• Develop the list of mental health indicators to benchmark and be monitored by stakeholders.
• Provide general and specific recommendations based on the main findings of the study for policy makers, care providers and other stakeholders on strategies and interventions for improving adolescents’ mental health and well-being in Rwanda.

Specific Tasks

• Develop an inception report based on the terms of reference and discussions with UNICEF, Government of Rwanda (including RBC, NCDA, Education), and other key stakeholders, that includes a workplan, methodology and detailed timeline for the work.
• Conduct a literature review to identify priority mental health problems and the main determinants of mental health problems among adolescents that will inform questionnaires and models.
• Develop a study protocol ensuring strong and valid methodology based on the objectives of the survey, including a rigorous analysis plan and data collection tools.
• Apply for ethical clearance from recommended bodies in Rwanda
• Train research assistants/data collection team
• Conduct/manage fieldwork data collection, including rigorous quality assurance
• Data cleaning and analysis
• Presentation of results to policy makers, care providers and other key stakeholders
• Report preparation, revision, and finalization, including report, executive summary, and slide deck that visually represents key results
• Draft manuscript for peer review Journals

Deliverables

Payment 1: 20%

• Quality inception report
• Literature review report with summary of key findings

Payment 2:10%

• Study protocol and ethical clearance (including data collection tools)

Payment 4: 20%

• Quality draft comprehensive report and accompanying slide deck

Payment 4: 20%

• Presentation of the final findings to the stakeholders

Payment 5: 30%

• Submission of final report, incorporating inputs from stakeholders including UNICEF Rwanda and Rwanda Biomedical Centre, Mental Health Division
• Submission of final manuscript

Duration and Duty Location

This  consultancy will be completed within 4 months. The consultancy is home based.

Selection Criteria

Applications shall be assessed based on their technical and financial proposals. Maximum scores for technical and financial applications will be 75% and 25%, respectively.

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

• An advanced university degree (PHD or Master’s degree) in public health/epidemiology, clinical psychology, psychiatry, mental health nursing, Global Mental Health or other health related field
• Proven track record in undertaking similar work: The consultant must demonstrate (8years of experience or more) experience in leading national surveys
• The consultant should provide at least two previous studies with contactable references.
• Understanding of the prevalence and determinants of mental health problems or other health problems
• Experience of working in mental health and psychosocial support field or Social Sciences
• Experience of working with children and adolescents
• Experience in quantitative and qualitative data analysis including developing models and conceptual frameworks

For every Child, you demonstrate…

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

To view our competency framework, please visit here.

UNICEF is here to serve the world’s most disadvantaged children and our global workforce must reflect the diversity of those children. The UNICEF family is committed to include everyone, irrespective of their race/ethnicity, age, disability, gender identity, sexual orientation, religion, nationality, socio-economic background, or any other personal characteristic.

UNICEF offers reasonable accommodation for consultants with disabilities. This may include, for example, accessible software, travel assistance for missions or personal attendants. We encourage you to disclose your disability during your application in case you need reasonable accommodation during the selection process and afterwards in your assignment.

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 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. Consultants 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. Selected candidates are subject to confirmation of fully-vaccinated status against SARS-CoV-2 (Covid-19) with a World Health Organization (WHO)-endorsed vaccine, which must be met prior to taking up the assignment. It does not apply to consultants who will work remotely and are not expected to work on or visit UNICEF premises, programme delivery locations or directly interact with communities UNICEF works with, nor to travel to perform functions for UNICEF for the duration of their consultancy contracts.