Somalia: Baseline Survey South Central Somalia - Consultant

Background

The Joint (UNFPA, UNICEF, WHO) Health and Nutrition Programme (JHNP) is a comprehensive multi-donor and multi-partner five year programme for health and nutrition in Somalia 2012 - 2016. It aims at improving maternal and child health and reducing mortality, while strengthening the systems that support improved quality and access to health care.

Somalia is both the world’s most fragile state and a country with some of the most challenging global health and nutrition indicators. However, although the 20-year conflict resulted in the collapse of the national health system and the exodus of many health workers, some progress has also been made, particularly in the last few years. The Ministries of Health for each of the three zones are gaining in capacity for providing leadership, as evidenced by the production of national health sector policies and strategic plans. With international assistance, significant advances have been made in improving immunization coverage and eliminating new cases of polio. Meanwhile, the private sector healthcare arena, in particular, has managed to grow and prosper despite the many environmental constraints.
While scaling-up the delivery of essential reproductive, maternal, new-born and child health (RMNCH) and nutrition services for women, young girls and children, in Somaliland, Puntland and Central South Somalia (CSS), the JHNP is addressing the WHO six building blocks for efficient health system functioning, building and strengthening foundations in order to improve the health and nutrition status of Somali People.

Critical planning activities as well as services are planned through this health systems approach, focusing on six main outputs, with consideration for the specific contexts of Somaliland, Puntland and CSS. These outputs are: 1. Governance and Leadership: Improved governance and leadership at all levels of the health sector; 2. Health Workforce: Skilled and motivated health workforce distributed equally and equipped to deliver quality RMNCH and nutrition services through a continuum of care; 3. Health Care Delivery: RMNCH and Nutrition services available, accessible, affordable, of acceptable quality and adaptable, within the EPHS framework; 4. Medicines, Vaccines and Technology: Improved access, availability, quality and rational use of essential medicines, vaccines and medical equipment and physical structures; 5. Health Information: Improved access, availability, acceptability, quality and use of health information that covers disease surveillance as well as management information system; and 6. Health Financing: Steady progress made to an equitable and efficient health financing system.

The JHNP has been developed through a wide consultation processes (throughout 2011), involving a wide range of key stakeholders including, WHO, UNICEF and UNFPA, development partners, the Somali Health Authorities and other actors, through the Somali Health Sector coordination mechanism. The sectorial approach supports, complements and leverages other existing programs that are currently operating across Somali’s health sector, and aligns to broader planning such as the UN Strategic Assistance for Somalia (UNSAS).

Routine data collection on health is scanty and often unreliable; health stakeholders have relied on MICS (multiple indicator cluster survey) data that was collected every five years. It was not possible to carry out MICS in Federal Government of Somalia in 2011, hence, there is a need to carry out a baseline survey in selected regions to guide the program.

In order to track, monitor and evaluate program performance and impact, the JHNP partners have designed an M&E framework. The logical framework provides a set of core output, outcome and impact indicators, with baselines, milestones and targets for each zone. While MICS 2011 provides baseline for most indicators for Somaliland and Puntland, there is no comparable data for Federal Government of Somalia, particularly related to impact and outcome indicators. The key indicators of concern on which reliable data is not available includes • Maternal mortality ratio • Under 5 mortality rate • Prevalence of stunting children < 5 (height for age); • Prevalence for underweight children < 5 • Antenatal care coverage • Prevalence of Female Genital Mutilation (FGM) • Proportion of deliveries attended by Skilled Birth Attendants (SBA) • Contraceptive prevalence rate (CPR) • % of children under 1 fully immunized through routine services • % of children < 5 acutely malnourished who are treated through routine services; • Proportion of women initiating breastfeeding within one hour of birth; • Knowledge of mothers of: benefits of exclusive breastfeeding; danger signs during pregnancy and childbirth; and, immunization schedule.

Keeping in view the time and resource constraints, the Technical Coordination Group (TCG) recommends that a cross sectional household survey be conducted for selected indicators in the three intervention regions of Federal Government of Somalia namely Benadir, Gedo and Galgadud.

From the above list of indicators, specifically, the survey will measure a subset of the key indicators of concern including Under 5 mortality (using indirect method); Proportion of deliveries attended by Skilled Birth Attendants; Antenatal care coverage; Contraceptive prevalence rate; % of children under 1 fully immunized through routine services; Proportion of women initiating breastfeeding within one hour of birth; and knowledge of mothers of: benefits of exclusive breastfeeding; danger signs during pregnancy and childbirth and immunization schedule.

In addition to these JHNP indicators, the baseline survey will also measure General Fertility Rate (which will be derived from the data already collected and is relevant to CPR) ; % of children given exclusive breastfeeding for 6 months; and care seeking behavior for diarrhea, pneumonia and malaria in under 5 children. The last two indicators are important in terms of understanding the practices and behaviors and will help in defining a behavior change communication strategy. No significant additional cost or time is required to collect data on these indicators.

To establish a baseline for maternal mortality, UN interagency group estimates will be used and for nutrition-related indicators (prevalence of stunting, underweight children and acutely malnourished children treated), existing data from the nutrition survey conducted by the Food Security and Nutrition Assistance Unit at FAO in 2010/2011 will be utilized.

The results of the proposed survey will help establish baselines for selected indicators that can be used to define realistic milestones and targets in order to monitor progress and evaluate the outcomes and impact of the JHNP program. The findings can also be used for monitoring of Health Sector Strategic Plans.

With the establishment of the Federal Government, it is crucial to improve planning processes by strengthening the local institutions in evidence generation and use for need-based allocation of limited resources. The Directorate of Health in the Ministry of Human Development and Public Services and the Ministry of Planning will be fully involved in the survey design and implementation. This will help to establish a strong institutional base for evidence-based policy development, equitable development planning, effective implementation and results-based monitoring of investments in the public sector.

Objectives:

The purpose of this survey is to obtain data on selected indicators from three regions of Federal Government of Somalia in order to establish baselines against which to monitor progress and evaluate the impact of the Joint Health and Nutrition Program.
Specifically, this survey is expected to measure:

1. Under 5 mortality (using indirect method)
2. Proportion of deliveries attended by Skilled Birth Attendants
3. Antenatal care coverage (1+ 4+ visits)
4. General Fertility Rate
5. Contraceptive prevalence rate
6. % of children under 1 fully immunized through routine services
7. Proportion of women initiating breastfeeding within one hour of birth;
8. % of children given exclusive breastfeeding for the first 6 months
9. Knowledge of mothers of: benefits of exclusive breastfeeding; danger signs during pregnancy and childbirth; and, immunization schedule.
10. Care-seeking behavior for diarrhea, pneumonia and Malaria in under 5 children

Terms of Reference Under the supervision of the Medical Officer Primary Health Care, and working in close collaboration with the Health Authorities, the consultant will work in consultation with WHO Regional Office and will perform the following duties: • Develop tools for data collection and question by question guidelines for interviewers and supervisors • Support the training of trainers (ToT) and the in-country training of the interviewers • Coordinate the pretesting and piloting of the tool • Coordinate the fieldwork (sampling allocation and data collection) • Oversee data entry, verifications and consistency checks and the implementation of cleaning procedures • Support the preliminary and actual data analysis • Draft the final survey report • Facilitate a workshop to present the findings to the relevant stakeholders

Tasks and deliverables:

The consultants will submit the following documentation and reports:

• Design and produce the survey tools and relevant manuals and guidelines. • Train supervisors and interviewers on data collection, verifications and editing. • Coordinate the survey fieldwork: methods may include questionnaire, interviews, and meetings with local community organizations, local leaders, NGOs operating in constituencies and government units in the project regions. • Compile a master data file for analysis • Prepare and present a report of findings at a forum to be attended by the Health Authorities and JHNP stakeholders Prepare and submit final report of baseline survey, incorporating feedback from

Organization: The consultant will be stationed in Nairobi, Kenya, and will implement various visits Somalia to provide supportive supervision in collaboration with the MOH and Civil societies and to collect available data from the field.

Competencies The selected candidates should have: • Substantive knowledge of public health issues in transitional and fragile environments and knowledge on conducting and coordinating health surveys.
• Experience in data collection and analysis • Ability to work under pressure • Initiative and independence  Adaptability  Sound methodological technical skills  Excellent writing and presentation skills  Excellent facilitation and coordination skills  Excellent communication and negotiation skills, capable of developing and maintaining effective working relations across fragmented teams and different organizations – ability to maintain high-level buy-in.  Excellent communication and proven leadership skills as a team leader  Team-building capacity including strong personal communication skills, with particular attention to supporting the development of staff capacities for data collection Corporate Competencies: • Demonstrates integrity by modelling the UN’s values and ethical standards • Promotes vision, mission and strategic goals of UNICEF, WHO and UNFPA • Displays cultural, gender, religion, race, nationality and age sensitivity and adaptability. • Treats all people without favouritism

Qualifications and experience
 Advanced university degree in demography, Public Health or other related field
 Demonstrated experience in implementing surveys of similar complexity  At least 5 years of experience leading multi-disciplinary teams in challenging settings  Professional experience in Somalia is advantageous.

Additional information: Qualified female candidates are encouraged to apply. Interested candidates are kindly requested and strongly encouraged to apply in writing sending their CVs and motivational letters to:

Administrative Officer WHO Somalia recruitment@nbo.emro.who.int

Deadline for applications:14 June 2013

• WHO is committed to workforce diversity. • Any appointment/extension of appointment is subject to WHO Staff Regulations, Staff Rules and Manual. • Only qualified candidates under serious consideration will be contacted. • WHO has a smoke-free environment.