TERMS OF REFFRENCE FOR A COMMUNITY BASED INTERVENTION TO PROMOTE EARLY REGISTRATION FOR ANTENATAL CARE SERVICES AMONG PREGNANT WOMEN IN DAR ES SALAAM INTRODUCTION Management and Development for Health (MDH) is a leading non-profit Tanzanian public health organization that focuses primarily on public health service, education and research in Tanzania. MDH seeks to advance the public health and health care interests of the people of Tanzania through collaboration with the government, non-governmental institutions, academic institutions, and the private sector. MDH works with its collaborators to address key public health challenges in Tanzania including communicable diseases such as HIV/AIDS, Tuberculosis and Malaria; Maternal, new-born and child health (MNCH) issues; as well as non-communicable diseases. MDH realise its vision of a healthy and prosperous society by addressing public health priorities through evidence-based interventions and partnership. MDH is in its fourth year of implementing the MDH Kagera (GH001179-04) project, a comprehensive HIV Prevention, Care and Treatment program funded by the United States Government President s Emergency Plan for AIDS Relief. The overall aim of the project is to contribute towards improving quality and outcomes of HIV prevention, care and treatment services in Tanzania. In MNCH settings this includes: prevention of mother-to-child transmission of HIV (PMTCT) through the use of lifelong anti-retroviral therapy (ART) for all HIV-positive pregnant and breastfeeding women, as well as comprehensive care for infants born to HIV-positive mothers. Early registration for ANC services, during the first 3 months of pregnancy, is an important entry point for effective PMTCT and Focused Antenatal Care (FANC) services. It enables early HIV testing and counselling (HTC) of pregnant women and their partners, and linkage to ART and PMTCT for those testing HIV-positive. To realise the national goal of elimination of mother-tochild transmission of HIV (emtct), all pregnant women should be encouraged and supported to start ANC services within the first 3 months of pregnancy. Nevertheless, the 2015/16 Tanzania Demographic and Health Survey (TDHS) estimates that only 25% of women in mainland Tanzania registered for ANC services before the fourth month of pregnancy. In Dar es Salaam, the national District Health Information System (DHIS-2) database indicate that between 1 st Oct 2015 30 th Sep 2016 only 23,007(15%) of pregnant women registered for ANC before 3 months of pregnancy. It is in this regard, in the current project year (2016/17), MDH seeks to partner with and engage a credible Civil Society Organization (CSO) to implement a community-based intervention to promote and improve early registration for ANC services among pregnant women in Dar es Salaam, 1
Tanzania. Through these efforts, MDH hopes to accelerate efforts to achieve the national goal of elimination of HIV transmission from HIV-positive mothers to their babies SCOPE OF WORK; At the onset/outset of the project, MDH will utilize the technical expertise of identified CSOs to work with CHWs to increase early uptake of ANC services and create awareness at the community on importance of early booking. Selected CSO will work hand in hand with MDH to conduct community sensitization meetings and engage CHWs and local community leaders to identify pregnant women early (before 12 weeks of pregnancy), register and refer them to health facilities for early ANC registration and care. CHWs will be followed up weekly with focal persons to assess progress, strategies and best approaches. This intervention will start in 50 wards (10 from each five districts) reported with high population but low number of pregnant registered at nearby health facilities. This intervention will facilitate at least 77,290 (50%) of pregnant women to register for ANC early (before 3 months of pregnancy) by the end of September 2017. These efforts will allow for timely HTC among women registering for ANC early. Subsequent, pregnant women testing HIV-positive will be timely linked to ART, PMTCT and other existing support services. Objectives 1. To raise awareness to 510 among community health workers and community leaders from 51 (50%) Dar es Salaam wards on early (<3months pregnant) registration of new pregnant women for antenatal care by September 2017 2. To increase the number of pregnant women registering for antenatal care services early (<3 months pregnant) to 77,290 (50%) in Dar es Salaam by September 2017 3. To engage community leaders and community health workers from 51 (50%) Dar es Salaam wards in promoting and monitoring progress on early registration of new pregnant women Target group: - Primary target: Pregnant women in 51 Dar es Salaam ward - Secondary target: o Women of reproductive age in 51 Dar es Salaam wards o Community health workers from 51 Dar es Salaam wards o Community leaders from 51 Dar es Salaam wards Implementation strategy The implementation of this project will be in three phases Phase I: Introductory Phase. Duration: 4weeks This phase involves conducting inception and sensitization meetings with key stakeholders including: CHWs from selected wards, Community Based Health Care Providers (CBHC) 2
Coordinators, Health Care Providers (HCPs) and District Health Managers. During these meetings key stakeholders will be orientation to the intervention and various tools for registering, referring and following up pregnant women visited in the community. Activities that will be implemented include: - Courtesy calls to relevant stakeholders for planning and engagement - Baseline sensitization meetings with CHWs, community leaders and other stakeholders - Mobilization of various tools required for documentation, monitoring and reporting - Orientation of CHWs to the implementation strategy and reporting tools Phase II: Intensive Phase. Duration: 6 months This phase is the most important and constitutes the project s key activities of household visits by CHWs for health education/ sensitization, identification of new pregnant women as well as registering, referring and following up identified pregnant women. Each registered pregnant woman will be given referral letter and special card to access ANC services in preferred health facility. A week after all registered pregnant women will be followed up to check if they have made a visit. If not, weekly follow up will continue and recorded until they make a successful visit. Once the woman makes a visit a she will be eligible for monthly follow up via the phone/ physical visit as a need arise. Activities to be implemented during this phase include: - Household visits by CHWs to for health education, early identification, registration dn referral of new pregnant women to health facilities for antenatal care - Follow-up of referred new pregnant women to verify if they have reached the health facilities and continued health education and support as needed. - Monitoring documentation and reporting of all community based activities including identification, registration and referral of new pregnant women - Weekly visits by designated supervisors/mentors to CHWs to provide continuous technical assistance and support to CHWs in implementing their activities. - Monthly sensitization and data review meetings with CHWs and Community leaders to share and discuss progress in implementation of activities and performance against targets - Quarterly project review meetings with all key stakeholders to review progress towards reaching overall implementation targets. - Effective engagement of all key stakeholders at each step, across levels, particularly the respective Regional and Municipal Medical Officer of Health (R/MMOH) and Regional/ Council Health Management Teams (R/CHMTs), and community leaders - Submission of monthly written project progress summaries to be submitted to MDH on the 15 th of the following month. - Submission of quarterly project narrative and financial reports to be submitted to MDH on the 15 th of the first month of the following quarter Phase III: Final Evaluation and Reporting Phase. Duration: 4 weeks During this period, Selected CSO will be expected to conduct a thorough evaluation of performance 3
against overall implementation targets and prepare a final project report and organize a stakeholders meeting to share and discuss the performance and report. The CSO will be required to ensure that the respective R/MMOH and R/CHMTs are adequately informed, engaged and exhibit ownership of the data and outcomes. Activities to be implemented during this phase include: - Compilation of final project reports and data, and overall performance evaluation - End-line project evaluation meeting with MDH - End-line stakeholder s performance sharing meeting with all stakeholders - Submission of final project report to MDH on the 15 th October 2017 TIME LINE 7 months: 1 st March 30 th September 2016 DUTIES AND RESPONSIBILITY The selected organization will be responsible to implement and report on all the Activities stated in the section above on Implementation strategy. The selected CSO will liaise with the MDH Community linkage Manager and/or Regional/Municipal CBHC Coordinators for further assistance as per need. COORDINATION The selected CSO will be responsible to lead project coordination across stakeholders under close supervision of MDH community linkage manager.. The CSO will proactively facilitate relevant communications with the MDH Community linkage Manager and/or Regional/Municipal CBHC Coordinators to ensure adequate engagement, flow of information and efficiency in project implementation. The main contact person for the CSO at MDH will be the MDH Community linkage Manager. DELIVERABLES. Selected organization will deliver four reports after each stage mentioned above CHW sensitization meeting reports Monthly (1-page) project progress summaries Quarterly project narrative reports with associated attachments i.e. o Meeting/Orientation reports (for all meetings/orientation done during the quarter) o Quantitative project reports showing Women reached in the community, referrals issued, and follow-ups done Health facility based reports showing number of women registering for ANC early (<3 months pregnant). Quarterly financial project reports against approved budget 4
These reports will be submitted to MDH, CHMTs and Council Health AIDS Coordinator (CHAC) on the 15 th of the next month after the month/quarter has ended. Further reports may be requested from the selected CSO as per need. CONFIDENTIALITY All information contained in this project will be under the property of MDH including invitation letter and documents that will be used during the intervention. MDH will take all reasonable measures to protect this confidentiality and avoid the unauthorized use, disclosure, publication, or dissemination of confidential information. Not use this information other than for the purposes of preparation of assignment and shall disclose it only to MDH staffs, officers, directors, or employees on a specific need to know basis. Not disclose, publish or otherwise reveal any of the information contained herein except with the specific prior written authorization of MDH. REQUIREMENTS: Qualifications: - Background qualification in public health services, community health services and/or related fields - CSO legally registered and recognized by the law - Key personnel with relevant qualifications in public health and community interventions Experience: - Minimum 3 years experience in implementing community based interventions and/or services - Minimum 3 years experience in implementing reproductive, maternal, newborn and child health interventions and/or services - Experience working with community health workers, community leaders and/or local government authorities is an added advantage - CSO with differentiated referral models in the same population - Working experience with similar population in the region is an added advantage - Excellent English report writing and communication skills Interested CSOs please send your applications including the detailed budget, preferably by email to: Chief Executive Officer Management and Development for Health Plot no 802 Mwai Kibaki Road, Mikocheni B P. O. Box 79810 Dar es Salaam, Tanzania Email mdh@mdh-tz.org Deadline for receiving applications is: 15 th Feb 2017 5
Your application packet should include - Letter of intent: 3 5 pages describing Goal, Specific Objectives, Target population, Approach and Activities, Specific Deliverables (Outputs and Outcomes), Timeline and Detailed Budget); - Organization profile and - CVs of Key personnel who will be engaged in implementation 6