TERMS OF REFERENCE FOR SCALING UP USAGE OF LONG ACTING REVERSIBLE CONTRACEPTIVES (LARC) AND PROVISION OF POST-ABORTION CARE (PAC) SERVICES AT 20 SELECTED DISTRICTS IN UGANDA BACK GROUND Uganda Total Fertility Rate (TFR) has improved slowly, and by 2011 UDHS, it stood at 6.2 (Total), with 3.8 for Urban and 6.8 for Rural populations. The Contraceptive Prevalence Rate (CPR) was 30% for all methods, and 26% for modern methods. The National FP Costed Implementation Plan has now set the 2020 Target at 50% for modern methods among Women in Reproductive Age (WRA). The method specific CPR in 2011 stood at 2.9% (Pills), 0.5% (IUDs), 14.1% (Injectables), 2.7% (Implants), 2.7% (male condoms). A look at the trend of IUD-specific CPR shows attainment of 0.2% (in 2001), 0.2% (in 2006), and 0.5% (2011) as per the respective UDHS findings. Results of the Performance Monitoring and Accountability (PMA2020) for 2014 and 2015 (PMA2014 and PMA2015), however, showed that IUD-specific CPR had risen to 0.8% and 1% in 2014 and 2015 respectively. On the other hand, the trend for Implant-specific CPR shows that Uganda had attained 0.3% (in 2001), 0.3% (in 2006), and 2.7% (2011) as per the respective UDHS findings. Results of the Performance Monitoring and Accountability (PMA2020) for 2014 and 2015 (PMA2014 and PMA2015), however, showed that Implant-specific CPR had risen to 3.3% and 4.9% in 2014 and 2015 respectively. The 2011 UDHS also showed that 39% of the IUD clients obtained the service from the public sector and 50% from the private sector facilities. This is mainly due to insufficient capacity (skills, commodities and equipment) especially at level III and below. In order for the community to be able to access FP services especially LARCs, MOH intends to strengthen the capacity of the service providers and delivery points at HC III, to offer the services. Altogether, 755,000 unintended pregnancies occur annually out of which 297,000 result in unsafe abortions. Abortions contribute to about 25% of all maternal mortality. It is estimated that if Government addressed the current unmet need for FP of 34%, the prevented unplanned births and induced abortions would reduce MMR by 85%. The above poor indices contribute to the persistent high maternal mortality ratio that stands at 438 per 100,000 live births. 1
The Government of Uganda received financing from the World Bank towards the cost of implementation of Uganda Health Systems Strengthening Project (UHSSP). The Project Development Objective is to deliver the Uganda Minimum Health Care Package to Ugandans, with a focus on maternal health and family planning. One of the core components of the project is to improve access to, and quality of maternal health, new born care and family planning services. The project has procured Emergency Obstetric and Neonatal Care equipment, long term family planning commodities, medicines and supplies. Training is also ongoing to revitalize Maternal and Peri Natal Death Audit Committees in hospitals, as well as training of health workers in provision of Long Term Family Planning, Post Abortion Care and Emergency Obstetric and Neonatal Care. The Ministry of Health now seeks the services of experienced organizations in provision of and mentoring on Long Acting Reversible Contraceptives (LARCs), as well as Post-Abortion Care (PAC), in the underserved populations of Uganda. GOAL Contribute to the increase of the national IUD-specific CPR from 0.5% (in 2011) to 3% (in 2018) and reduce maternal mortality related to abortions. OBJECTIVES To increase the number of facilities (all levels) in the public sector, that can offer quality Family planning services including LARCs, in 20 districts, by the end of the year 2016. To increase the number of facilities (all levels) in the public sector, that can offer quality PAC services using Misoprostol, in 20 districts, by the end of the year 2016 To strength coordination, by the District Health Management Teams (DHMTs), of Family Planning (FP) stakeholders on LARCs in 20 Districts by the end of the year 2016. To increase uptake of Family Planning services including LARCs, in 20 districts, by the end of the year 2016. DELIVERABLES 1. Inception report to demonstrate understanding of the assignment. 2. List of facilities that can offer quality Family planning services including LARCs (i.e. with at least 2 services especially midwives trained on FP including LARCs, with no stock-outs for FP commodities all methods, proper FP record keeping, space in the facility for FP service provision that meets standards for infection prevention and privacy). 3. List of facilities that can offer quality PAC services using Misoprostol (i.e. with at least 2 2
services especially midwives trained on PAC using Misoprostol, with no stock-outs for Misoprostol, proper PAC-related record keeping, space in the facility for PAC service provision that meets standards for infection prevention and privacy). 4. Minutes of the District FP coordination meetings. 5. Bottleneck analysis to service delivery, indicating gaps and proposed strategies to address them. 6. M&E plan for data capture. 7. Quarterly report showing number of FP clients served by method and by facility. 8. End of the project report. QUALIFICATION OF THE CONSULTANT(S) The Consultant(s) shall have the following on the team: 1. The Team Leader (TL) shall hold a minimum of a Master s Degree in Obstetrics & Gynecology or a related advanced degree relevant to the broad areas of RH/FP and CS. S/he must have at least 8 years senior level experience designing, implementing and managing large, complex RH/FP programs or projects in Africa or in developing countries. S/he must have e an understanding of approaches for actively revitalizing facilities and engaging communities, local government, local stakeholders (NGOs, private providers, private sector entities) in the planning, provision, management and sustainability of Maternal and Newborn care services. The Team Leader (TL) shall have leadership qualities, in-depth technical and management expertise. S/he shall have a positive professional reputation, and strong interpersonal, writing, and oral presentation skills. S/he shall have demonstrated experience in training on LARCs and PAC, and in conducting community outreach programs.. 2. Behavioral Change Communication specialist shall be a holder of a degree in social sciences with demonstrated experience of at least seven years in undertaking Behavioral Change communication assignments. S/he should have good knowledge experience, working with District Health Teams and the community. 3. Medical Doctor shall be a holder of an advanced degree in Public Health or related field. S /he must have at least 7 years experience in engaging communities, local government, local stakeholders (NGOs, private providers, private sector entities) in the planning, provision, management and sustainability of in training on LARCs and PAC, and in conducting community outreach programs. 3
DISTRICT FOCUS FACILITIES 1 Buikwe Kawolo Hospital Najjembe HC III Wakisi HC III Busabaga HC III Buikwe HC III Buwagajjo HC III 2 Luweero Zirobwe HC III Kalagala HC IV Bombo HC III 3 Mukono Mukono HC IV Nakifuma HC III Kojja HC IV 4 Mubende Kasambya HC III Kiganda HC IV Kassanda HC IV 5 Busia Busia HC IV Buhehe HC III Mbehenyi HC III Masafu Hospital 6 Bukedea Kolir HC III Malera HC III Bukedea HC IV Kidongole HC III Kachumbala HC III 7 Pader Atanga HC III Puranga HC III Acholi-Bur HC III Pajule HC IV 8 Pallisa Pallisa Hospital Kabwangasi HC III Butebo HC IV Gogonyo HC III Kameke HC III 4
9 Iganga Bugono HC IV Namungalwe HC III Busesa HC IV Makuutu HC III Lubira HC III 10Nawandala HC III 10 Alebtong Abako HC III Alebtong HC IV Amugo HC III 11 Kaberamaido Ochero HC III Kaberamaido HC IV 12 Oyam Anyeke HC IV Agulurude HC III Ngai HC III Otwal HC III 13 Nebbi Panyimur HC III Pakwach HC IV Parombo HC III Jupangira HC III Pokwero HC III Panyigoro HC III Kalowang HC III 14 Arua Logiri HC III Ayivuni HC III Omugo HC IV Offaka HC III Aroi HC III Odupi HC III Chilio HC III Bondo HC III Rhino Camp HC III 15 Masindi Pakanyi HC III Ikoba HC III Bwijjanga HC IV Nyakitiibwa HC III 5
Nyantonzi HC III Kimengo HC III Kijunjubwa HC III Kyatiri HC III Biizi HC III 16 Buliisa Buliisa HC IV Biiso HC IV Avogera HC III Butiaba HC III 17 Kasese Kyarumba Government HC IV Bwera Hospital 18 Kyenjojo Kyenjojo Hospital Butunduzi HC III Bufunjo HC III Nyankiwanzi HC III Kyarusozi HC IV 19 Kabale Kashambya HC III Maziba HC IV Kaharo HC III Mparo HC IV Hamurwa HC IV Buhara HC III Bubare HC III Muko HC IV 20 Kanungu Nyamirama HC III Rugyeyo HC III Kihiihi HC IV Kambuga Hospital 6