National assessment on situation analysis of local burden/epidemiology of NCDs particularly among children and adolescents.

TERMS OF REFERENCE FOR INSTITUTIONAL CONTRACT

 

Title of the assignment

National assessment on situation analysis of local burden/epidemiology of NCDs particularly among children and adolescents

Purpose

To understand the current situation/burden of pediatric NCD in the country for formulation of policy/strategy of pediatric NCDs for early detection and treatment of NCDs, supply chain and community awareness

Location

Nation-wide

Estimated Duration

The assessment will take place within 3 months, which will be effective based on the agencies on board and expecting to start from 1st August -30 October 2022.

Reporting to Technical Supervisor of this assignment

Health Specialist UNICEF Dhaka with the involvement and support of the section Officer and any relevant team members.

 

 

Background

Non-Communicable Diseases (NCDs), a set of diseases resulting from the interaction of a combination of genetic, physiological, environmental, and behavioral factors, present a significant burden on individuals, communities, and economic resources. People of all age groups irrespective of regions and countries are affected by NCDs. Rapid unplanned urbanization, globalization of unhealthy lifestyles and population ageing are also contributing to NCDs.[1] Non communicable diseases (NCDs) kill 41 million people each year, equivalent to 71% of all deaths globally, and 85% of these "premature" deaths occur in low- and middle-income countries.[2] In recognition of this increasing burden, heads of government and ministers of health convened in 2011 for the United Nations General Assembly Special Session (UNGASS) for the first ever UN High Level Meeting (HLM) on non-communicable diseases (NCDs). They committed to a set of targets for reducing the overwhelming and rising burden of NCDs across the globe which resulted in inclusion of a target in Sustainable Development Goals to reduce premature deaths from NCDs by one-third by 2030.

Though NCDs are predominantly adults and elderly people’s disease but children and adolescents are also vulnerable to the risk factors (unhealthy diets, physical inactivity, exposure to tobacco smoke or the harmful use of alcohol) contributing to NCDs. Young people under the age of twenty account for more than one-third of the world’s population. Children, adolescents, and young people are increasingly being affected by NCDs and this population remains hidden from global surveillance, targets, and priorities. In 2017, more than 2.1 billion children were affected by non-communicable diseases (NCDs).[3] Children and adolescents affected by NCDs often face a lifelong challenge to manage and treat their conditions.  Poverty is closely linked with NCDs. In low-resource settings, health-care costs for NCDs quickly drain household resources, exorbitant costs of managing NCDs, which is often lengthy and expensive, combined with loss of income, force millions of people into poverty annually and impede development. Vulnerable and socially disadvantaged people get sicker and die sooner than people of higher social positions, especially because they are at greater risk of being exposed to harmful products, such as tobacco, or unhealthy dietary practices, and have limited access to health services.[4]

 

Much is written about NCDs and premature mortality globally, but this definition starts at 30 years of age, Bangladesh is no exception though one-third of the country’s population is in this age group. Multi-sectorial Action Plan for Prevention and Control of Non Communicable Diseases 2018-2023 in Bangladesh was developed and accordingly, specific programs were included in NCDC Operational Plan for prevention and control of NCDs in Bangladesh under 4th HPNSP by the leadership of Non Communicable Disease Control (NCDC) Program of Directorate General of Health Services (DGHS) under Ministry of Health and Family Welfare (MOHFW), but this multi-sectorial plan and operational plan primarily focused on prevention and control of NCDs among adults and elderly population which made the children and adolescent more vulnerable to NCDs.[5] Specific countrywide representative data on NCDs in children and adolescent are available in Bangladesh to estimate the true burden of NCDs in this age group, as this age group is not included in countrywide STEPS Survey for estimating NCD burden or in routine data collection through DHIS2[6]. However, it is assumed that a significant proportion of this age group is suffering from various NCDs particularly Type 1 Diabetes (T1D), Rheumatic Heart Disease (RHD), Sickle-Cell Disease, Asthma etc.  As per the International Diabetes Federation Atlas, T1D prevalence among 0-14yrs children in Bangladesh is 4.2 new case of T1D/100,00 children per year, prevalence of RHD .9/1000,[7] 3.6% of children in the country are suffering from mental disorders,[8] Prevalence of Obesity (6-15 Yrs), 3.5%, Overweight: 9.7%, Thalassemia (Prevalence): (Beta thalassemia trait) 4.1% and Haemoglobin E trait is 6.1% in school children.[9]

 

NCDs among pediatric and adolescents require urgent attention and actions in Bangladesh which is highly time sensitive to achieve country’s SDG target 3.4 by 2030. UNICEF is supporting and collaborating with NCDC program of DGHS under MOHFW and other relevant stakeholders (GOB, Academia, INGO, NGO, and UN Organizations etc.) to perform a situation analysis on the burden and risk factors of pediatric and adolescents NCDs and to develop a comprehensive and scalable NCD service delivery model through Primary Health Care and referral facilities to provide both preventive and curative services, demand generation through age specific, gender sensitive social behavioral change communications by strengthening required components of health system building blocks following the    Integrated Chronic Lifelong Care Model (CLC). Lastly, the proposed NCD service delivery model through primary health care will be piloted in UNICEF supported district to observe effectiveness of the project, lesson learned and further scaling up.

 

2. Objectives and Expected Results

Overall Objective:

The nation-wide assessment will provide evidence of the current situation/burden of pediatric NCD in the country to support formulation of policy/strategy for pediatric NCDs for early detection of pediatric NCDs hence to reduce the burden of those disease in the adult life to some extent. In addition to this, thorough analysis of availability of health information system will allow integration of vital NCD related indicators into HMIS which will allow the data visualization of NCDs with real-time basis and enables the hospital managers/ administration at the national and sub-national level to understand the burden of pediatric NCDs. Furthermore, based on the findings of the analysis up-to-date guidelines/ SOP/ treatment modules focusing on pediatric care will be produced.

 

Specific Objective:

1. Analyze the existing policy & strategy documents on current management and health service delivery system
2. Identifying burden of major pediatric NCDs and their risk factors in pediatric NCD. 
3. Ascertaining programmatic gaps in terms of availability of services for care and treatment of NCD, supply chain, routine health information system, current expenditure, investment, and program coverage of key interventions as compared to norms and standards for proving quality NCD care for children and adolescents.
4. Recommending cost-effective health sector interventions with their associated costs and impacts

Expected results:

 

1. A quality assessment report on situation analysis on burden of NCDs and risk factors among children and adolescent
2. Dissemination materials including policy brief and presentation
3. Recommendation on service delivery model, supply chain, national guidelines, comprehensive SOP

3. Description of Assignment

 

3.1 Scope of Work

 

The agency will conduct a systematic desk review/literature review on key documents, other journal articles, program documents, presentations, project proposals and HMIS database.  Inception report including findings from desk review, review of existing documents & data sources and specification of assessment tool/questionnaire, finalized primary data collection methodology including sampling techniques, detailed implementation matrix will be produced. The agency will conduct field visit for primary data collection after consensus with relevant stakeholders and government counterparts. After the confirmation of data collection sites, qualitative interviews with program managers and policy makers should be conducted as key informants, direct observation of health facilities with key practices and lastly conduct Knowledge, Attitude and Practice analysis from children, adolescents, and their caregivers for identification of risk factors for NCD.  The agency will produce dissemination materials and organize the national dissemination workshop as guided by UNICEF.

 

The major packages of work, with key tasks are outlined below.

 

1. Situational analysis on burden of NCDs and identifying major NCDs with risk factors among children and adolescent

 

• Selected candidate/organization is to conduct desk-review for overall understanding of current situation of paediatric NCD in the country. This include i) literature review on published reports/articles/research, ii) treatment guidelines/training modules/ availability of government supply, iii) health information system, iv) community perception of paediatric NCD in the country.
• Initial report on findings of desk-review of paediatric NCD.  
• Design the methodology for performing the situation analysis
• Communicate with line director NCD and other stakeholders for identification of primary data collection sites
• Conduct the situation analysis and prepare a comprehensive report for identifying major NCDs and their risk factors in this age group, ascertaining gaps in supply chain, routine health information system, current expenditure, investment, and program coverage of key interventions as compared to norms and standards for proving quality NCD care, recommending cost-effective health sector interventions with their associated costs and impacts.
• Dissemination of findings with government counterpart and other stakeholders following endorsement of the report by UNICEF and National Multisectoral NCD Coordination Committee (NMNCC)/ Paediatric NCD Technical Working Group.
• Organize workshop on dissemination of findings of nation-wide survey to government counterpart and corresponding partners
• Adjustment of survey findings based on recommendation obtained in dissemination workshop

1. Produce publications and policy document

• Produce final report on situation analysis findings
• Develop briefing note with key findings and recommendations for policy brief and advocacy
• Facilitate dissemination workshop

3.2 Research Questions on Implementation Challenges

 

During the inception phase, the agency will conduct an in-depth desk review of progress reports, program documents, any other grey literature relating to the subject, HMIS, supply and logistic for pediatric NCD and identify the gaps.

The desk review will be followed by series of consultations with selected stakeholders including governments, professional bodies, aid agencies and others working for the pediatrics NCD. Consultations with stakeholders will complement the results of the desk review. The objective of the desk review and consultation is to outline a detailed list of areas required for further exploration and validation, in addition to identify key implementation situational analysis questions.

Following specification of the situational analysis question (s), the Agency will map existing data sources (HMIS as well as other sources) and identify gaps in knowledge and understanding where primary data needs to be collected. Key research questions include the below (but not limited to),

1. What is the current status of paediatric NCD in the country?
2. What are the government endorsed treatment guidelines/modules/trainings/SOP for care and treatment of paediatric NCD? (up to date or need to update)
3. Which paediatric NCDs are more common in community than others NCDs and require immediate attention?
4. Where are paediatric NCD services available?
5. What are the current stocks and availability of paediatrics NCD’s supplies and logistics in health care facility? (list of drugs and commodities provided by government and actual situation in HFs)
6. What is the capacity of service providers to identify, treat and referral the paediatric NCD?
7. What is the community perception on paediatric NCD (knowledge, attitudes, and practice)?
8. Where are services currently accessed? At what cost?

 

3.3. Methodology

The agency will suggest research methods and will finalize the detailed research questions and detailed research methodologies for data collection and analysis. The detailed research plan (e.g. survey teams, methodology) must be presented to UNICEF for clearance prior to field work (through an inception report). The tool(s) and other data collection instruments for desk review and primary data collection shall be presented to UNICEF for technical inputs and clearance.

 

A. Desk Review

• Systematic desk review of key documents, other journal articles, programme documents, presentations, project proposals, HMIS database, etc.

B. Primary Data Collection

 

• Interviews with key decision-makers, program managers and beneficiaries
• Exit surveys and interviews with clients
• Direct observation of facilities and community-based services and activities
• Conduct qualitative assessment through Focus Group Discussion with targeted, in-depth interview and case studies.

 

C. Secondary Analysis of Existing Data

 

• Real-time HMIS data
• Health facility administrative data and registers
• Data from other programs and government

 

3.4: Process/details of Data Collection:

The agency will conduct data collection through site visits and observation in real world settings. It should also undertake key informant interviews with the national stakeholders from policy makers to service providers to identify the challenges in the health system. In-depth interviews and focus group discussions with beneficiaries should identify the knowledge gaps, cultural beliefs, or behavioral patterns that may facilitate understanding and action, and provide insights into what, how, and why.

In addition to the final report, the dissemination materials should include the policy brief and PowerPoint presentation for use in policy dialogues/roundtable, and journal manuscript(s).

The Agency is expected to obtain ethical approval. All data will be owned by UNICEF. The Agency, with UNICEF co-authorship, will submit a journal manuscript.

3.5 Ethical and other considerations

1. This body of work, both programmatically and in all evidence generation, will be held to the highest standards employed by UNICEF. This means, the agency will abide by the following:

• UNICEF Procedure for Ethical Standards in Research, Evaluation, Data Collection and Analysis
• UNICEF Strategic Guidance Note on Institutionalizing Ethical Practice for UNICEF Research UNEG Ethical Guidelines for UN Evaluations

 

1. The agency is expected to explain ethical considerations for the situational analysis, specifically spelling out how these above guidelines will be followed/met including training of all data collectors and supervisors in terms of guidance on ethics and communication skills.
2. Special focus should include ethical considerations/ strategies to prevent or avoid COVID-19 infection and spread.
3. Ethical clearance letters for the implementation research should be attached in the annexure of all evidence generation reports. Each report should include a section that describes the exact way ethical considerations were identified and addressed as part of design, implementation, and analysis/writing.
4. Any sensitive issues or ethical concerns arising during implementation should be raised with UNICEF right away.
5. All data collected through this body of work (programme implementation and evidence plan execution) are the intellectual properties of UNICEF and shall not be used for purposes other than those approved by the registered Institutional Review Board during the ethical clearance.
6. Additionally, the evidence generation and programmatic elements should be human rights-based (including child rights) and gender sensitive. All applicable data will be disaggregated by sex, age, and disability.

 

1. Deliverables

 

The table below outlines the main deliverables for this project. The agency should link these deliverables with objectives mentioned before and provide a detailed timeline for each work package, key activities (including review processes), and deliverables.

 

No

Deliverable

Deadline

Payment schedule

1

Inception report should include findings from desk review, review of existing documents & data sources, methodology for the situation analysis and data collection

15 working days within signing of contract

30%

2

Conduct the situation analysis, prepare, and share a draft report on the situation analysis-

• Identifying major NCDs and their risk factors in paediatric NCD,
• Ascertaining programmatic gaps in in terms of availability, supply chain, routine health information system, current expenditure, investment, and program coverage of key interventions as compared to norms and standards for proving quality NCD care for children and adolescents,
• Recommending cost-effective health sector interventions with their associated costs and impacts
• Share the draft report of findings with government counterpart and other stakeholders (UNICEF, NCDC program and Paediatric NCD Technical Working Group) for review and incorporation of feedbacks

2 months 

40%

3

Prepare final full report on situation analysis with recommendations and dissemination of findings with government counterpart and other stakeholders-

• Final report on situation analysis endorsed by UNICEF, NCDC program and National Multisectoral NCD Coordination Committee (NMNCC)/ Paediatric NCD Technical Working Group
• Dissemination of findings with government counterpart and other stakeholders following endorsement

15 working days

30%

 

1. Reporting requirements

 

All deliverables should be submitted for revision and comments to UNICEF’s focal person, the Health Specialist. These will be accepted only after the Health Section and SPEAR section (Research & Evaluation Specialist) approves. The agency will have to maintain close liaison with the Health Specialist and Evaluation Specialist of UNICEF. Brief monthly communication on activities will be conducted, with the modality and platform jointly agreed upon between UNICEF and the contracted institution.

 

For any evidence generation report, the suggested format is as follows:

• Table of contents, list of annexes/figures/tables, etc.
• List of Acronyms
• Executive Summary (2 – 5 pages)
• Introduction & Background
• Study Purpose and Objectives/ implementation status 
• Methodology, including ethical considerations and limitations
• Findings
• Conclusions and Lessons Learned
• Recommendations
• Annex (including data collection tools, IRB approval letter, etc.)

 

8. Qualification requirement of the company/institution/organization

 

Overall Qualification of the agency for all Phases:

 

• International/national firm with at least 10 years’ experience of working on maternal and children health especially on paediatric NCD
• Technical expertise in children and adolescent NCD concepts, design, and model implementation.
• Experience in developing and implementing NCD models in Bangladesh.
• Technical understanding of latest gap analysis in NCD models, globally and in Bangladesh, and expertise in developing progressive and innovative content in response.
• Deep knowledge of adult learning methods and community engagement methodology.
• Expert in monitoring, evaluation, and learning, including development of their building blocks (theories of change, results framework, monitoring plans and tools, evaluation frameworks) and implementing routine learning practices.
• Strong experience in conducting social science-related implementation research, including high quality data collection tool design, and feeding back results real-time to programme implementers.
• Extensive knowledge and experience with qualitative and quantitative data analysis and demonstrated competency in analysis using relevant software.
• Experience in developing teacher capacity assessments and plans/guides as well as supportive supervision and caregiver guides.
• Strong experience in successful advocacy and dissemination with evidence/data.
• Track record in design and implementation of sustainability/scalability plans for pilots/demonstration programs, as well as success in taking a pilot or demonstration programs to scale
• Experience in developing knowledge management plans and subsequent knowledge products for dissemination and advocacy purposes.
• Experience of organizing national and sub-national level meetings/trainings/workshops for government and non-government staffs
• Strong oral and written skills in English and Bangla;
• Familiarity with UN systems and procedures, management and monitoring tools is desirable;
• Experience developing policy recommendations, policy briefs, and accompanying data visualizations for government, community level and technical/academic audiences;

 

8a. Qualification requirement of the team (optional)

Professional requirements of the individual(s) and/or team(s) for the assignment including required experience, skills and qualifications are required as given below:

• Team members with postgraduate (preferably PhD) degrees in social science, non-communicable disease, social work, public health, anthropology, sociology, or other relevant disciplines;
• At least one team members with 10+ years of NCD program experience;
• At least one team member with 10+ years of experience in designing monitoring, evaluation, and learning systems for integrated program;
• At least one team member with deep experience and knowledge of developing appropriate SBCC materials for community engagement and demand generation
• At least one team member with 10+ years of experience in conducting implementation research or related evidence generation;
• At least one team member with deep experience and knowledge of adult learning technique and methods, with related coaching/mentoring of adults;

• At least one team member with 10+ years working with relevant government ministries with successful advocacy on policy changes