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Scope of Work: 

A robust strategy is needed to comply with the Astana Declaration to strengthen Primary Health Care (PHC) services (2018), address high attrition and low incentives for Village Health Workers (VHWs) and to recognize the important roles the VHWs play. The number of VHWs has declined from 1,200 to 700 during the last few years. Section 5.3 of the National Health Policy 2011 states that primary health care shall also reach out to the communities through Outreach Clinics, Village Health Workers and other available modes of communication, section 6.9 states that Village Health Workers shall be trained in order to sustain achievement of universal health coverage and to encourage community participation in the health care delivery system, and section 13.1 of the National Health Policy 2011 states that active community participation and empowerment in the healthcare delivery system shall be encouraged to facilitate achieving universal health coverage especially to unreached rural population. The Bhutan CHN strategy and national action plan will also be a tool to advocate for budget allocation for community health and nutrition (CHN) programme for PHC at various levels.

Methodology:

The suggested methodology is to use both quantitative and qualitative tools to collect from all the stakeholders representing both the central and community levels including beneficiaries. Focus group discussions and key informant interviews should be conducted where necessary. The selected consultant will work under the direct supervision of the Chief Programme Officer, Health Promotion and Risk Communication Division (HPRCD) and in close collaboration with other programme officers, Department of Public Health, Ministry of Health and UNICEF Health, Nutrition and WASH Section. In addition, the consultant in consultation with the HPRCD will coordinate the meetings/workshops for the purpose of bringing stakeholders together to discuss the inputs into the revision of the strategy and action plan. This consultancy will also involve travel to the selected districts and communities as per the implementation plan to carry out the assignment. Feedback sessions will be organized with various stakeholders and debriefing to the senior management of Ministry of Health and UNICEF Bhutan.

Key Assignments:

1.1. Produce an inception report including workplan:

1.1.1.   Hold a Pre-inception meeting with UNICEF (Health, Nutrition, SBC, Social Policy, Child Protection, Gender, and WASH etc) to  develop a better understanding of the assignment.

1.1.2.   Submit an inception report/workplan for the two assignments- the situation analysis and update of the Community Health and Nutrition Strategy and Action Plan.

1.2  Mapping of stakeholders to conduct analysis for updating of Village Health Workers Strategy and Action Plan:

1.2.1 Conduct a rapid stakeholder analysis crucial for the successful review and update of the CHN Strategy. A stakeholder engagement matrix will be developed from this process.

1.2.2 Develop a TOR for the technical working group (TWG) and support MoH and UNICEF to establish it. Selected stakeholders including VHWs will be represented at the technical working group led by the MoH. The TWG will have an overall oversight of the process, coordinate the activities, and provide operational guidance for the consultant.

1.2.3 Meeting with TWG to discuss and finalize inception report/Workplan.

1.3 Conduct a situation analysis on community health and nutrition (CHN) for primary health care (PHC) in Bhutan:

1.3.1 Desk review of relevant documents/literature and any other relevant reviews, assessment and evaluations on community health and nutrition works in Bhutan including relevant policies, strategies, action plans in health, nutrition, and WASH, SBC, and community engagement among others in particular the provisions of community health component of RMNCAH for conducting a situation analysis of the current community health initiatives, and update CHN Strategy with Action Plan. Within the review, the consultant will ensure that the inclusion of the institutional framework, service delivery strategies and models, including the package of services provided by VHWs.

1.3.2 Develop data collection tools including FGDs, KIIs among others.

1.3.3 Conduct meeting with TWG to discuss to finalise data collection plan and tools.

1.3.4 Conduct primary data collection from stakeholders including VHWs and their clients.

1.3.4.1  Conduct Focus Group Discussions and Key Informant Interviews with relevant stakeholders from Ministry of Health staff, Khesar Gyalpo University of Medical Sciences of Bhutan, National Medical Services (Department of Medical Products and Department of Clinical Services both at JDWNRH, Regional Referral Hospitals, District technical teams across sectors, District Hospitals and PHCs at in the districts), District Public Health Officers, UN Organizations, local government, NGOs/implementing partners, and Monastic body. The consultant will ensure that there is multisectoral representation across sectors – Health, Nutrition, SBC, Social Policy, Child Protection, Gender, WASH, Multisectoral Task Force (MSTF), Community Based Support System (CBSS) etc.

1.3.4.2 Conduct interviews or focus group discussions with VHWs, including a sample of those who have dropped out, to understand the reasons for their dropout and the factors that motivate them. Additionally, document the career progression of VHWs, including both intentional and unintended developments.

1.3.4.3 Conduct a review of the community information system and digital health tools used by VHWs. This review will include assessing the data collection and management processes including the accuracy and reliability of recorded information and identifying any gaps or inefficiencies in the system as well as linkage to health management information system.

1.3.4.4 Conduct interviews with VHWs and other key informants to understand VHWs’ role in supporting community participation in health care delivery and empowerment of communities for the achievement of universal health coverage and health/nutrition results for children especially for unreached and hard-to-reach populations; identify potential gaps and opportunities around this component.

1.3.4.5 Conduct focus group discussions (FGDs), and interviews with community members, including pregnant mothers, children and young people, vulnerable groups and hard to reach communities to gather insights into their experiences and perspectives on the health and nutrition services provided by VHWs.

1.3.5 Conduct a comprehensive analysis of both collected data and secondary data from document reviews and other sources to understand the community health and nutrition situation.

1.3.6 Draft situation analysis report. The report should detail key findings, identify major challenges, and provide recommendations for improving health and nutrition outcomes in Bhutan.

1.3.7 Present the draft findings to the Technical Working Group (TWG) for validation and incorporate feedback from stakeholders.
1.3.8. Finalize Situation analysis report (submit report together with datasets preferably in Excel or Ms. Word).

1.4 Update the community/village health workers strategy and action plan:

1.4.1 Draft updated community/village health workers strategy

1.4.2 Draft VHW action plan including community engagement modalities and approaches.

1.4.3 Validation of updated community/village health workers strategy with Action plan at the TWG meeting.

1.4.4 Finalize community/village health workers Strategy with Action plan.

1.4.5 Presentation of situation analysis report, community/village health workers Strategy with Action plan to the TWG and senior management of MoH and UNICEF.

Key Deliverables:

1. Produce an inception report and workplan

• Hold a Pre-inception meeting by 07 November 2024
• Develop and submit an inception report/workplan by 13 November 2024

2. Formation of a technical working group for situation analysis and update of community health and nutrition strategy

• Conduct a rapid stakeholder analysis crucial for the successful review and update of the CHN Strategy by 15 November 2024
• Develop a TOR for the technical working group (TWG) by 20 November 2024
• Meeting with TWG to discuss and finalize inception report/Workplan by 26 November 2024

3. Conduct a situation analysis on CHN in Bhutan

• Desk review of relevant documents/literature and any other relevant reviews by 04 December 2024
• Develop data collection tools including FGDs, KIIs among others by 09 December 2024
• Conduct meeting with TWG to finalize data collection plan and tools by 11 December
• Conduct primary data collection from stakeholders including VHWs and their clients by 27 December 2024.
• Conduct a comprehensive analysis of both collected data and secondary data by 10 January 2025
• Draft situation analysis report by 24 January 2025
• Present the draft findings to the Technical Working Group (TWG) for validation and incorporate feedback from stakeholders by 28 January 2025
• Finalize Situation analysis report by 07 February 2025

4. Update the community/village health workers strategy and action plan

• Draft updated community/village health workers Strategy by 28 February 2025
• Draft Action plan including community engagement by 14 March 2025
• Validation of updated community/village health workers strategy with Action plan at the TWG meeting by 18 March 2025
• Finalize community/village health workers Strategy with Action plan by 04 April 2025
• Share summary report on the assignment process -situation analysis, review, and update of the CHN strategy with action plan by 09 April 2025
• Presentation of final situation analysis report, community/village health workers Strategy with Action plan to the TWG and senior management of MoH and UNICEF by 15 April 2025

Remarks: Please submit your application with a financial proposal. Application without the financial proposal will not be considered.

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

Education:

• Masters Degree/Advanced University Degree in public health and nutrition, health policy, social sciences, or relevant fields.

Knowledge/Expertise/Skills required:

• At least five years professional work experience at the national and international levels in development of strategies, planning and programming for health and nutrition sector.
• Working experience in health, child survival, health, nutrition, development and care, and adolescent health programme interventions.
• Experience of working with UN, especially UNICEF and WHO on similar assignments will be an asset.
• Demonstrated communication, analytical and facilitation skills, and able to manage diverse viewpoints and work in demanding situations.
• Excellent writing skills and ability to synthesize complex information and issues. Strong analytical and conceptual thinking, ability to work in teams.
• Ability to organize and plan complex work following the established timeframes.
  Experience in liaising with public officials and capable of responding rapidly to ad hoc requests for meetings under tight deadlines; facilitating discussions among diverse stakeholders.
• Demonstrated technical knowledge on Primary Health Care and Community Health and Nutrition programmes.

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/individual contractors 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: 

Only shortlisted candidates will be contacted and advance to the next stage of the selection process. Please submit your application with a financial proposal. Application without the financial proposal will not be considered.

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. 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.