Background and Purpose:

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Kelly Adelia Charles
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1 Position Title: Level: Location: Duration: Start Date: Reporting to: Estimated Cost: RapidSMS-Maternal and New-born International Consultant L3 Kigali 90 days 01-January-2014 Chief CSD TBD By Human Resources Department Background and Purpose: RapidSMS begun in Rwanda in 2009 as a pilot programme in Musanze District. In March 2012 a regional workshop on m-health recommended enhancing the program to cover the first 1000 days of life beyond pregnancy and new-born tracking. Following a successful assessment of the pilot project in April 2012, a joint field visit by MOH, Musanze District, UNICEF and Access Project was conducted and among the key recommendations was to upgrade RapidSMS and scale up the system to the entire country. In November 2012, a stakeholder s workshop was held in Gisenyi where the upgraded tools and functionality of the system was designed to track maternal and child continuum of care for the first 1000 days of life under the MoH direction. Rwanda has seen impressive achievements both for maternal and child health and progress made can be attributed to a combination of factors. However, like most Sub- Saharan African countries, Rwanda still bears a heavy burden of high neonatal mortality (27/1000 live births) and child mortality (U5 mortality, 54/1000; Infant mortality, 38/1000 live births), and Maternal mortality, 478/ live births. The Republic of Rwanda through the Ministry of Health is committed to achieving the Millennium Development Goals (MDGs), particularly those related to maternal and child health. To achieve its objectives on MDGs, government of Rwanda adopted implementation of RapidSMS as an innovation that will contribute towards bridging the gaps in the efforts to reduce maternal and child mortalities. RapidSMS is an open source information technology platform using mobile technology innovation. UNICEF is supporting the Government of Rwanda to realize maternal and child health related MDGs. RapidSMS was introduced by the Government of Rwanda, with technical and financial support from UNICEF, to address and track the high rate of maternal and new-born deaths as a national development priority. RapidSMS is a community based approach used by CHWs to transmit maternal and child health related indicators (early pregnancy identification, antenatal care, post natal care, nutrition, immunization, disabilities, Hygiene/sanitation and life threatening emergencies) which cause high maternal and child morbidities and mortalities. RapidSMS allows the Community Health Workers (CHWs) to collect data, on pregnant women, postpartum women and children until the age of two years. Data collected are sent via cell phone SMS to an MOH central server hosting the RapidSMS application. Automated feedbacks are sent to the CHWs and health providers to acknowledge reception of each SMS sent and the corresponding relevant actions. Page 1 of 6

2 The nearest health centre, after receiving messages sent by the CHWs in its catchment area calls an ambulance whenever an emergency is notified. This system allows real time interventions to save pregnant women and children s lives. Through RapidSMS system, the CHWs and health care providers track the pregnancy cycle, new born, infant and child continuum of care up to two years of age. RapidSMS is found to have a very high potential to save live. This is attributed to its following features: Pregnancy Tracking o Registration of confirmed pregnancy (at health facility), including height and weight of pregnant mother. o Antenatal care visits o Delivery outcomes o Risk results o Red alert results report o Death reports Child Health o Monthly child health visits tracking growth, vaccinations and basic health up to 12 months o Death reports Newborn o Newborn care visits within the first 42 days of life o Initiation of breastfeeding within the first hour of life and exclusive breastfeeding for the first 6 months. o Death reports Postnatal Care o Post natal home visits after home delivery (Day 1), and refer to hos pital for examination o Post natal home visits after assisted health facility delivery (Day 1, Day 3, and Day 28). Community Case Management (CCM) o Cases of the main childhood killer diseases treated or referred (diarrhea, malaria and pneumonia) Nutrition o Growth monitoring (height and weight of child every month between 2 and 24 months) o Early initiation of breast feeding within 1 hour and exclusive breast feeding for the first 6 months Management of RED ALERTS o When a CHW sends a red alert, a series of emergency responses are set in action. First, the CHW receives an SMS with guidance on next steps. At the same time, the CHW Supervisor and district in charge of Page 2 of 6

3 emergency services and district in charge of maternity services are notified of the emergency and its location. CHW supervisor is in touch with ambulance driver; CHW supervisor alerts the in charge of emergency services and CHW that ambulance is on its way. CHW must report within 24 hours that the ambulance was on time, late, or never arrived (RAR). To be considered on time it must have arrived within two hours. A RED alert must be followed by RED alert response. Non-immunized/partially immunized children o Cases identified by Binomes of children who have not yet been immunized and those who did not complete their vaccinations. These reports are special cases that can include children up to 5 years of age. Disabilities o This refers to cases of children who have ibibari, deafness, blindness, mental disability or any other disability identified by CHW. These reports are special cases that can include children of any age. Hygiene and sanitation practices o This refers recording the existence of handwashing stations ( Kandagire ukarabe ), clotheslines, toilets, and a dish rack ( agatandaro ) in the home in order to provide appropriate intervention. These are documented in Pregnancy (PRE) reports. Most importantly is the capacity of RapidSMS to ensure that every pregnancy is reached and registered into the electronic system. This way, the pregnant mother can always be tracked and not forgotten. RapidSMS features ensure that all pregnant mothers in all villages are registered, deliver at health facilities and health centres staff are notified to plan and prepare for delivery at the health facility. RapidSMS supports documentation of pregnancies in the community, increase health facility contact through antenatal care (ANC), alerts health centres and hospitals for high risk conditions and increases institutional delivery and hence by proxy, professional care at birth. Both ANC visits and institutional deliveries are accomplished through automatic reminder features to CHWs. The RapidSMS central data system offers the opportunity to know registered pregnancies and locations as well as their conditions throughout the pregnancy cycle in real time (something that before now could only be accessed if the investigator searched the files of the ANC records in a particular health facility where the client visited, but can now be accessed even from the capital city because of the internet database). In order to be able to meet the request of the Government of Rwanda to scale-up the existing RapidSMS applications nationwide UNICEF Rwanda requires to quickly upgrade the software, address scalability issues, and incorporate new functionality for growth monitoring. Objective of the consultancy Page 3 of 6

4 A short consultancy in RapidSMS-Maternal and newborn is necessary to provide technical assistance in the conduction of refresher trainings, supportive supervisions and reporting on RapidSMS tracking maternal and child continuum of care. The consultant will therefore, ensure consistent technical back-up to the partners supporting the 10 KOICA districts to ensure quality community case management, documentation and real time reporting to the RapidSMS system. Specifically, the consultant will focus on effective use of RapidSMS to track maternal and Child continuum of care and ensure proactive response to care, save and keep the mothers and new-borns alive. The objective of the consultancy is to accelerate implementation of RapidSMS activities, to initiate bottleneck analysis in the Tracking Maternal and Child Continuum of Care for the first 1000 days and to promote a culture of using RapidSMS data in 10 KOICA supported districts. Major Tasks and Responsibilities Below are the list of key tasks and responsibilities of maternal & new-born consultant: The consultant shall provide technical assistance in conducting refresher trainings of CHWs, Health Centres and District hospitals of 10 KOICA supported districts. The 10 districts have already taken an initial training of using RapidSMS, however this time the consultant has to make sure the actual use of RapidSMS as a process in their daily activities. The consultant has to play a key role of advocacy in terms of encouraging CHWs to use the system and report through all the modules. The consultant will make sure that CHWs report all pregnant women in the system and compare it with the administrative records of MoH to make sure that RapidSMS records are either equal or exceeds the administrative records. Similarly data of each module of RapidSMS needs to be compared with administrative data of MoH. This would be the bases of cross checking the performance of CHWs. Work with CHWs and their supervisors in the reducing the rate of data entry errors in the system. Aware all districts teams on the quality and importance of data for all RapidSMS modules. Work with district teams to improve their capacity to effectively use RapidSMS to track 1000 days. Make sure that health facility supervisors are skilled enough in using RapidSMS to track and inform effective maternal and newborn care in their sectors. Work with district hospitals on the usage of data analysis & usage of Red Alert module of RapidSMS. Write reports on the overall findings (strengths, weaknesses & recommendations) of the system and its usage at district level by each key player. Deliverables 1. A consolidated, comprehensive and high quality report on refreshers trainings which include but not limited to key maternal and new-born bottlenecks, Page 4 of 6

5 actions and indicators and areas for further training needs on RapidSMS, maternal new born care tracking maternal and child continuum of care in 10 districts shared and submitted. 2. Data analysis and comparison report of comparing each RapidSMS module s data with administrative records. 3. A detailed report with information on health facilities and staff supervised including main findings on strengths, weaknesses and subsequent actions to strengthen community and health facility services in 10 KOICA supported districts. 4. A good quality report with number of health facilities and health professionals to which capacity has been built on use RapidSMS data and appropriate actions to save lives of Mothers and newborns. 5. Ensure effective conduct and report on RapidSMS coordination meetings at the central, district and community levels. Profile of the RapidSMS-Maternal and Newborn Consultant Education: Master s degree or equivalent in public health (MPH-CES), a degree in medicine (MD) or post-graduate pediatrics is a requirement, with formal training in at least two of the following disciplines: maternal, child and new-born health Prior Work Experience: A minimum of five years of progressively responsible experience managing regional and/or national level health programs in maternal and child health At least four years of experience designing and managing decentralized public sector programs at national/or international level Language Proficiency: Fluency in written and spoken English is highly recommended. Fluency in speaking/reading/writing in French or Kinyarwanda is required. Knowledge: Comprehensive knowledge of Maternal and Newborn issues, and interventions, including behavior change communication for effective implementation of Maternal and Newborn services An in-depth understanding of Maternal, Newborn and Child Health programs, policies, regulations and precedents applicable to development and administration of international public health programs Working knowledge of techniques to plan, organize and direct multidisciplinary project teams and activities Demonstrated understanding of overall administrative requirements, budgeting and fiscal management of contracts/cooperative agreements/grants Skills and Abilities: Demonstrated managerial, administrative, analytical and decision-making abilities Ability to readily analyze, understand, and discuss new program design, management, and implementation approaches Demonstrated ability to identify priority actions, generate and complete work plans within short time frames Strong oral and written skills and ability to clearly communicate new program and technical concepts to technical and non-technical counterparts Strong interpersonal communication and negotiation skills in achieving results with a wide range of program partners Strong computer literacy and aptitude to rapidly acquire and apply additional skills Page 5 of 6

6 Ability to rapidly create text, spreadsheets and other types of documents to meet specific program and reporting needs General Conditions: The consultant will be located in UNICEF Rwanda and work with the national consultant to support implementation of RapidSMS in 10 KOICA districts. Supervisor and frequency of performance reviews: The Health Specialist will provide supervision at regular intervals in consultation with the Chief of Child Survival and Development The consultant is expected to spend at least 40% of her/his time on field travel Payment Plan: Monthly payment based on outputs to deliverables, certified upon monthly review and report with supervisor UNICEF recourse in case of unsatisfactory performance: Payment will only be made for work satisfactorily completed and accepted by UNICEF Due to the end of the current country programme, consultant will be given a 3 months contract in the first instance with a possibility to renew for another 3 months upon good and satisfactory completion of assignments and deliverables NB: RapidSMS system is implemented in close collaboration with government of Rwanda and very good interpersonal relationship with the government partners is very essential in the satisfactory assessment of successful performance. Page 6 of 6

RWANDA S COMMUNITY HEALTH WORKER PROGRAM r

RWANDA S COMMUNITY HEALTH WORKER PROGRAM r Summary Background The Rwanda CHW Program was established in 1995, aiming at increasing uptake of essential maternal and child clinical services through education