LRPS-2024-9193235 Assessment of facility KMC and implementation research on Community KMC and community follow up of SCANU/NSU/KMC discharge babies”

TERMS OF REFERENCE FOR INSTITUTIONAL CONTRACT

 

Assessment of facility KMC and implementation research on Community KMC and community follow up of SCANU/NSU/KMC discharge babies

 

          Study (an initiative to establish current knowledge around a specific topic through the descriptive summarization, interpretation or assessment of information and data)

          Research (systematic process of the collection and analysis of data and information, in order to generate new knowledge, to answer a specific question or to test a hypothesis)

          Evaluation (rigorous, systematic and objective process in the design, analysis and interpretation of information to answer specific questions)

 

 

Purpose

1. To assess the implementation status of Kangaroo Mother Care services in public facilities across the nation
2. To conduct implementation research on implementation of Community Kangaroo Mother Care (KMC)
3. To conduct implementation research on follow-up care for babies discharged from Special Care Newborn Units (SCANU) and Newborn Stabilization Unit (NSU).

Location

• For Kangaroo Mother Care services- nation wide
• For community KMC and SCANU follow up -Bhola, Khagrachari, Kishoreganj, Bagerhat, Sherpur, Sirajganj, Kurigram, Sunamganj, Cumilla, Cox’s Bazar

Estimated Duration

1st October 2024 to 31st June 2025

Technical Supervisor of the assignment

Health Specialist ( Newborn and Child Health)

 

1. Background and Context

Maternal and child health remains a critical component of global health priorities, particularly in low- and middle-income countries (LMICs) where the rates of maternal and neonatal morbidity and mortality are disproportionately high (Ref). Ensuring the survival and health of both mothers and newborns is essential for fostering healthy communities and enhancing the overall well-being and economic stability of societies (Ref). In this context, innovative care models such as the Special Care Newborn Unit (SCANU) and Kangaroo Mother Care (KMC) have emerged as pivotal interventions aimed at improving neonatal outcomes (Ref).

Despite notable progress in health status, there is high rate of newborn death in Bangladesh which is 20 per 1000 live birth as per BDHS 2022, which means, near about 68,000 newborn dies every year before completing their first month of life. This large number of deaths occur mainly for three causes which are Prematurity and or LBW, Birth Asphyxia and Infection but 32% deaths happening due to LBW and or prematurity for which KMC is the most effective and no cost intervention to prevent death (Ref). Since 4th Health Sectoral program, Bangladesh had undergone comprehensive newborn health intervention package which aim to ensure the survival of newborn particularly on small and sick newborn. Kangaroo Mother Care (KMC) is the evidence-based, low-cost intervention that promotes skin-to-skin contact between the mother and her newborn. 

 

This method has been shown to enhance thermal regulation, breastfeeding, and bonding, thereby improving neonatal survival rates and overall health outcomes.

Kangaroo Mother Care (KMC) was introduced in Bangladesh in the early 2000s, initially as a pilot project in a few hospitals. The program gained momentum with the establishment of the National KMC Policy in 2010, which emphasized the importance of KMC for improving neonatal health outcomes. In 2014, nationwide KMC guideline was launched and KMC services were upscaled within the newborn care services across the country. Since then, KMC has been progressively implemented across the country, with significant progress in scaling up the program.  While KMC is now available in more than 450 health facilities, challenges remain in ensuring consistent access and utilization.  Efforts are ongoing to further expand KMC services, particularly in rural areas.

Unlike traditional care models that may involve lengthy hospital stays, Community Kangaroo Mother Care extends KMC practices into the home and community settings, empowering mothers, and families to continue this critical care beyond the confines of the hospital (ref). The latest BDHS 2022 report indicates more than 35% of total deliveries are happening in homes and unable to come to the facility for delivery. Following this calculation, about 1.2 million births will occur at home. 40% of facility deliveries are happening at private facilities where KMC service is rarely present (Ref). The low-birth-weight babies (LBW) rate for entire country is 23% (The Lancet Global Health 2023) and hence among 1.2 million home delivery and in private hospital, more than 500,000 babies will be born as low birth weight with rare chance to receive KMC service.

As per the Operational Plan for Maternal, Neonatal, Child and Adolescent Health, newborn health is a priority component and has a target to establish SCANUs in all 64 Districts. The Directorate General of Health Services (DGHS), UNICEF, USAID and other development partners have been working together in this regard since 2011 and till now 62 SCANUs established including three 3 under Family Planning Department all over the country in tertiary and secondary level facilities along with Newborn Stabilization Unit (NSU) at sub-district level facilities and have saved the lives of thousands of newborns. UNICEF supported DGHS to establish 39 SCANUs out of 62. 

In one study which assessed the performance of SCANU, revealed that 60% of SCANU facilities provided Kangaroo Mother Care (KMC) services, and 27% offered rooming-in and specialized sick baby ward services, which were absent in non-SCANU facilities. Also, equipment such as resuscitation bags, radiant warmers, phototherapy machines, and CPAP machines and oxygen blenders were mostly available and functioning well in SCANUs. However, more than half of the SCANUs still lacked or had non-functional oxygen blenders, CPAP machines, and transcutaneous bilirubinometers. Additionally, a web-based 'Individual Case Tracking' system has been implemented by the Health Management Information System (HMIS) of the DGHS, with UNICEF aiding its integration into the district health information system (DHIS-2). There was a significant disparity in admission rates between SCANUs and non-SCANUs, with SCANUs serving as referral centers for sick and small newborns, as 41%-45% of admitted infants were born at home or in other facilities.

Follow-up care for babies discharged from Special Care Newborn Units (SCANU) and facility KMC corner is a critical component of the continuum of neonatal care, designed to ensure the ongoing health and development of these vulnerable infants. Babies who have required specialized medical attention in SCANUs often face a range of potential health challenges after they are discharged, including issues related to growth, nutrition, neurodevelopmental delays, and susceptibility to infections. Follow-up care for babies discharged from SCANUs is essential for ensuring their continued health and development. Early detection of complications, tracking growth and developmental progress, and providing ongoing support to parents are critical components of follow-up care. Regular check-ups help identify and address any health issues promptly, which can prevent readmissions and promote better long-term outcomes. Additionally, follow-up visits facilitate timely immunizations and reinforce preventive care practices. By closely monitoring these vulnerable infants, healthcare providers can offer necessary interventions and guidance, ultimately enhancing the well-being and survival of newborns post-discharge.

The primary goal of follow-up care is to ensure that the health gains achieved during the hospital stay are sustained and that babies continue to thrive in the home environment. By bridging the gap between hospital discharge and primary healthcare in the community, follow-up care plays a vital role in improving long-term outcomes for infants including survival who have overcome significant health hurdles in their early days. Effective follow-up care typically involves regular monitoring and assessments by healthcare professionals to track the infant’s progress, identify any emerging danger signs early, and provide timely interventions (Ref). This ongoing follow up care includes physical examinations, developmental screenings, nutritional support, and parental education on aspects such as breastfeeding, infection prevention, and recognizing signs of potential complications.

1. Rationale / Purpose of the evidence activity

 

The primary purpose of this study is to analyse (i) To assess the implementation status of Kangaroo Mother Care services in public facilities across the nation , (ii)  To conduct implementation research on implementation of Community Kangaroo Mother Care (KMC) and lastly (iii) To conduct implementation research on follow-up care for babies discharged from Special Care Newborn Units (SCANU) and Newborn Stabilization Unit (NSU). This research is essential to provide policymakers, healthcare managers, and program implementers with robust evidence to optimize and scale up effective neonatal care interventions.

 

1. Necessity: Neonatal mortality and morbidity remain significant public health challenges, particularly in low- and middle-income countries like Bangladesh, where many births occur at home without adequate medical supervision and utilization and quality of available services is very low.

• A nationwide assessment of Kangaroo Mother Care (KMC) services in Bangladesh is crucial for several reasons. Firstly, it would provide a comprehensive understanding of the current state of KMC implementation across the country, identifying gaps specially in utilization & compliance and areas for improvement. Secondly, the assessment would allow for informing the effectiveness of existing KMC programs, including existing modality, guideline, training modules ensuring their alignment with best practices and overall outcome. Thirdly, it would facilitate the identification of barriers to KMC adoption, scale up to all health facilities, enabling targeted interventions and resource allocation for improved access and utilization of this vital care practice. By shedding light on the strengths and weaknesses of KMC services, the assessment can contribute to a more equitable and impactful healthcare system for newborns in Bangladesh.
• Community KMC has been proposed as a cost-effective and accessible intervention to improve neonatal outcomes, yet its implementation on home-delivered newborns and its integration with facility-based care remains insufficiently understood. Furthermore, this is the very first initiatives in the country and thus more evidence are needed in order to comprehend better and able to scale it nationwide.
• Similarly, while SCANUs provide critical care for newborns with severe health conditions, the long-term effectiveness of post-discharge follow-up care is crucial to ensure sustained health improvements and prevent deaths after discharge.  The importance of follow-up care for newborns after discharge from hospital settings, including SCANUs, is underscored by evidence showing that many infant deaths occur post-discharge due to preventable causes. Studies have shown that inadequate follow-up can lead to missed opportunities for early intervention in cases of complications such as infections, feeding difficulties, or respiratory issues. For instance, a study by Chotigeat et al. (2004) highlighted that a significant number of neonatal deaths occurred after discharge, with sepsis being a predominant cause. The study also emphasized that many of these deaths could have been prevented with proper follow-up care.  Furthermore, a systematic review by Liu et al. (2015) on global causes of child mortality noted that nearly half of neonatal deaths occur at home, emphasizing the importance of follow-up care to prevent such outcomes. The follow-up ensures timely immunizations, parental education, and early detection of complications, which are critical for reducing neonatal mortality.

 

1. Key Gaps in Knowledge:

• A comprehensive assessment of Kangaroo Mother Care (KMC) services in Bangladesh requires addressing several key knowledge gaps. First, data availability and quality are crucial. While some data might exist, it is often fragmented, inconsistent, and not representative of the entire country.  We need nationwide data on KMC implementation, utilization rates, compliance of protocol, outcome, training programs, and parental knowledge and attitudes. This information is crucial for understanding the current state of KMC services and identifying areas for improvement. Secondly, KMC-specific challenges in Bangladesh need to be explored. Cultural beliefs and societal norms can influence KMC practices, and understanding these factors is vital to overcome barriers.  Finally, the implementation of KMC on health outcomes must be thoroughly researched this include, research on the long-term impact of KMC on child development and well-being is needed. By addressing these knowledge gaps, a comprehensive assessment can provide valuable insights to improve KMC services and ensure better health outcomes for newborns in Bangladesh.
• There are critical gaps in the understanding of how Community KMC implementation will have implication on newborns delivered at home versus in facilities and also what are the barriers (both from caretaker and community health workers) in order to expand this program into nation-wide.
• For SCANU follow up, the further understanding of how follow-up care for discharge babies from SCANU and facility KMC influences long-term health outcomes. Specifically, there is limited empirical evidence on the comparative effectiveness of these interventions in differing settings and populations, which is vital for crafting targeted healthcare policies. Additionally, real-world data on the sustainability and scalability of these interventions are needed to inform future program expansion and funding decisions.

 

1. Why Now?

• Conducting this study at this juncture is particularly timely given the increasing global and national focus on achieving the Sustainable Development Goals (SDG), particularly target 3.2 which aims to end preventable deaths of newborns and children under five by 2030.

 

• While Bangladesh embraced Kangaroo Mother Care (KMC) with the launch of its national guideline in 2014, a significant gap has emerged.  Since then, there has been minimal to no updating of the national guideline, despite the rapid advancements in global KMC practices including WHO recommendations for KMC and the evolving needs of the country. With over a decade since its inception, the Bangladesh guideline requires a comprehensive revision to align with the latest World Health Organization (WHO) recommendations and adapt to the country's unique context. This update is critical to ensure that KMC services in Bangladesh are evidence-based, effective, and tailored to the specific needs of newborns and their families.

 

• Furthermore, the recent expansion of maternal, newborn and child health programs in Bangladesh, including the integration of KMC into community health services, provides a unique opportunity to evaluate these interventions implementing under existing health systems. The results of this study will be instrumental in refining current strategies, ensuring evidence-base resource allocation and potentially guiding policy adjustments and implementation status.

 

By addressing these key questions, implementation research aims to fill significant knowledge gaps and provide actionable insights that can be used by healthcare administrators, policymakers, and international health organizations to improve neonatal care practices and outcomes. The findings will help shape more effective, context-specific strategies for both home and facility-based newborn care, ultimately contributing to reduced neonatal mortality and long-term health improvements for the newborn.

 

1. Objectives

 

This nationwide assessment aims to study the implementation status of Kangaroo Mother Care (KMC) services in Bangladesh (facility based KMC programs), focusing on Community KMC and follow-up care for babies discharged from SCANU & KMC.

 

By systematically analysing these care models, the research aims to:

 

• To clarify the landscape of Kangaroo Mother Care (KMC) service delivery in Bangladesh and reveal its impact on newborn health outcomes, thereby guiding the development of evidence-based strategies for its widespread adoption and optimization.
• To assess the implementation progress of Community Kangaroo Mother Care on Low Birth Weight and Premature babies.
• To assess the process of post discharge follow-up care for babies from the Special Care Newborn Units (SCANU), newborn stabilization unit (NSU) and facility KMC initiative on immediate neonatal health outcome.
• To identify barriers and facilitators to the successful implementation of KMC, CKMC and follow-up care for babies discharged from Special Care Newborn Units (SCANU), Newborn Stabilization Units (NSU) and facility KMC in different community settings.
• To explore the socio-economic implications of extending KMC practices into community and home-based care.
• To develop evidence-based recommendations for policymakers, healthcare mangers and relevant stakeholder for course correction of KMC implementation including guideline, training modules and existing data set in existing health system.
• To generate evidence-based recommendations that empower policymakers, healthcare managers, and community health workers to enhance the integration, sustainability, and scale-up of Community KMC and follow-up care for babies discharged from SCANUs and NSUs, ultimately strengthening the impact of KMC on neonatal health outcomes in Bangladesh.

1. Scope

 

The selected organization will be responsible for the following tasks, which are crucial for the implementation and analysis of facility-based Kangaroo mother Care (KMC), Community Kangaroo Mother Care (KMC) and follow-up care for babies discharged from Special Care Newborn Units (SCANU) and facility KMC:

 

• Desk Review: Conduct a comprehensive desk review of existing guidelines, treatment protocols, and training modules related to KMC, community KMC and community follow-up care for SCANU and facility KMC discharged babies. This includes examining documents from both national and international sources to understand current best practices and identify gaps in the existing literature.

 

• Active Data Collection: Carry out extensive data collection activities, incorporating both quantitative and qualitative methods. This will be conducted at both national and sub-national levels, encompassing various geographic areas that are representative of the broader population. Specific focus will be on regions with active community KMC, and community followed up programs to gather relevant and diverse data.

 

• Key Stakeholder Interviews: Facilitate interviews with key stakeholders, including healthcare providers & managers, program implementers, government officials, and community representatives. These interviews aim to gather deep insights into the implementation, challenges, and perceived effectiveness of KMC and SCANU follow up interventions.

 

• Data Analysis: Perform rigorous data collection to produce feedbacks and adaptation focusing on improvement of the two piloted care models. This will encompass various aspects of the interventions, such as enablers and implementation challenges, for different target groups, including infants delivered at home and those discharged from SCANU.

 

• Comprehensive Report: Develop a detailed report summarizing the findings of the research. This report will cover the methodology, analysis, key findings, and interpretations related to the impact and effectiveness of facility KMC, Community KMC and community follow-up care.

 

• Policy Brief Paper: Draft and disseminate a policy brief paper that includes recommendations based on the research findings. This document will also outline a scaled-up plan for enhancing the implementation of community KMC and SCANU&KMC follow up programs, detailing how these evidence-based practices can be integrated into national health strategies.

 

• Publication in peer review journal: Draft and submit the findings of research in peer review journal with renowned impact factor. The selected organization need to follow the UNICEF procedure on publication.

 

 

Aspects Covered by the Evidence Activity:

• Time Frame: This study will cover the implementation phase from the initiation of the community KMC and SCANU/KMC follow up programs up to the present day, to assess longitudinal impacts and sustainability. At the same time, the study will cover the implementation of KMC in public facilities during last decade.
• Geographic Areas: The study will focus on diverse geographic regions across Bangladesh, including in rural settings, to ensure comprehensive coverage and applicability of findings.
• Target Groups: Concentrating on newborns delivered at home and private facilities, those in facility based KMC, babies receiving community KMC and infants discharged from SCANU, along with their caregivers and the healthcare providers involved in these programs.

 

1. Research Questions

 

1. To what extent are existing KMC guidelines and practices aligned with current WHO recommendations and adapted to the unique context of Bangladesh, what is the compliance rate with existing guideline and what are the key challenges and opportunities for improving KMC implementation and scaling up KMC services?
2. What are the major factors influencing the utilization of KMC services in Bangladesh, including provider and parent perspectives, access to services, and cultural beliefs, and how can these factors be addressed to enhance KMC adoption and improve neonatal health outcomes?
3. What is the implementation progress of Community Kangaroo Mother Care on Low Birth Weight and or Premature babies as well as impact on facility KMC and facility follow up status.
4. What are the post-discharge health outcomes for babies who received follow-up care after being discharged from SCANU and facility KMC
5. What are the barriers and facilitators to the successful implementation of these two-care model in the country across the different settings: service providers, community workers and community.
6. What are the cost implications of implementing Community KMC and SCANU/KMC follow-up care programs?
7. What policy changes or programmatic adjustments are recommended to enhance the effectiveness, sustainability and scale up of KMC and SCANU follow-up care?

 

1. Methodology

The method should describe and provides an explanation of the chosen research question, objectives, overall scope of work which will be used by the selected organization.

6.1 The organization should include the following steps but not limited to:

• Provides a relevant list of research methodology that are explicitly justified as appropriate for the purpose of the research topic.
• Definition of the research methodology, including mainstreaming of gender equality and human rights norms and standards. Gender equality and human rights dimensions need to integrate into all aspect of research as appropriate and/or criteria derived directly from human rights principles are used (e.g., equality, participation, social transformation, inclusiveness, empowerment, etc.)

6.2 Clear and relevant presentation of the framework including:

• Clear methodology to guide the research questions linked, that include standalone and mainstreamed questions of gender equality and human rights.
• Appropriate indicators for each research question
• Gender responsive and human-rights based indicators (disaggregated, gender-specific, gender-distributive, gender-transformative)
• Rubric (reference indicators and benchmarks to denote success are included where relevant)
• A clear link between the indicators and the sources of evidence tools

6.3 Describe the design and methods, the rationale for selecting them, and their strengths and limitations for addressing the research's purpose, objectives, and scope:

• Qualitative and quantitative data collection methods and tools

• Qualitative and quantitative data analysis methods and tools and the links to answering the research questions, including triangulation of multiple lines and levels of evidence (if relevant)
• Reference to the use of a rights-based framework, and/or Convention on the Rights of the Child (CRC), and/or Core Commitments for Children (CCC), and/or the Convention on the Elimination of all Forms of Discrimination Against Women (CEDAW) and/or other rights related benchmarks in the design of the research.
• Description of how the methods employed are appropriate for analysing gender and human rights issues including child rights issues identified.

6.4 The methodology needs to describe the data sources, the rationale for their selection, and their limitations:

• Sampling methods
• Includes discussion of how the mix of data sources was used to: obtain a diversity of perspectives (or if not, provide reasons for this), ensure data accuracy, mitigate data limitations.
• Describes the sampling frame – area and population to be represented, rationale for selection, mechanics of selection, numbers selected out of potential subjects, and limitations of the sample.
• Mixed method approaches to make visible diverse perspectives and promotes participation of women and men, boys and girls, from different stakeholder groups.

 

1. Ethical Considerations

The research agency is expected to follow the ethical principles and considerations outlined in the United Nations Evaluation Group (UNEG) Ethical Guidelines for Evaluation and the UNICEF Procedure for Ethical Standards in Research, Evaluation and Data Collection and Analysis. In addition, the UNEG norms and standards will be observed. As per UNICEF standards for ethical research, the research agency must give special attention to ethical considerations and should put in place adequate measures for ethical oversight throughout the study/evaluation period. All researchers and field investigators involved in primary data collection should have undergone basic ethics training, which at a minimum includes completing UNICEF’s AGORA course on Ethics in Evidence Generation or its equivalent.

In conducting the research, research agency must ensure informed consent, respecting people’s right to provide information in confidence and making study participants aware of the scope and limits of confidentiality. Furthermore, the agency is responsible for ensuring that sensitive information cannot be traced to its source so that the relevant individuals are protected from reprisals.  Data storage and security must be ensured at all stages of the study. Only select personnel from the research agency should have access to de-identified data, and only anonymised data should be shared externally, and with UNICEF (unless stated otherwise).”

IRB approval is mandatory for this research, given it involves data collection with vulnerable populations. The research agency will be responsible for getting necessary IRB approvals for the protocol and other relevant components of the study/evaluation and should factor in the IRB process, from both financial and timeline perspectives. 

The proposal and implementation should be informed and guided by “UNICEF’s Procedure for Ethical Standards in Research, Evaluation, Data Collection and Analysis.”

 

1. Use of Findings

        The findings of this research will provide evidence on the effectiveness and impact of the C-KMC and community follow up initiatives. Based on the generated evidence, appropriate adjustments to implementation will be made if necessary. Additionally, this evidence will be used to advocate to the Ministry of Health & Family Welfare, especially to LD-MNCAH, LD-CBHC, LD-UHC, LD-HSM, including ADG and DG

1. Publication Plan

• General Conditions of Contracts for Services: UNICEF entitled to all property rights regarding material created by the Contractor.
• UNICEF owns all rights in the publication and in the underlying data/research.
• In the process of undergoing external academic publication by a UNICEF institutional contractor, then the review and approval process stipulated in the contract will apply. This should normally include a quality assurance review in accordance with the UNICEF Procedure for Quality Assurance in Research
• The contract stipulates that UNICEF owns all the intellectual property in the research collected or generated as part of the contract and does not give the contractor any right to use the research materials. In such cases, the Contractor can only issue an external academic publication with the prior written consent of UNICEF. (This consent would be from the Head of the relevant office/division, based on the advice of the relevant programme manager). UNICEF can veto the publication if it determines that it is appropriate to do so
• In some cases, UNICEF may have given the contractor the right to use the research generated as part of the contract for non-commercial academic or educational purposes. In such cases, UNICEF generally requires that the contractor share the proposed draft with UNICEF at least thirty days before sharing it with the third-party publisher to allow UNICEF (a) to ensure that no confidential information is included and (b) to provide comments. (This review would be done by the relevant programme manager, who should also notify the Head of the relevant office/division of the imminent publication).
• In the interests of transparency, the following items should ideally be prominently disclosed in all external academic publications: (a) the author’s role and relationship with UNICEF; (b) any actual or potential conflict of interest by the researchers; (c) all funding sources for the research.
• Appropriate attribution of the source of the research data should be included.

1. Schedule of Tasks & Timeline

 

S. No.

Major Task

Deliverable

Specific delivery date/deadline for completion of deliverable (please mention as date/no. of days/month)

Estimated travel required for completion of deliverable (please mention destination/ number of days)

1.

Produce inception report which cover the methodology of entire research, objectives, data collection method, questionnaires, analysis and lastly timeline

Inception report approved by UNICEF and relevant government counterpart

30 calendar days after signing of contract

As per requirement to complete this deliverable. All travel related cost should be included in financial proposal bid

2

Organization of field teams and their training # Selection of teams           # Training & orientation of interviewers and supervisors

Approval by IRB.

60 calendar days after signing of contract

All travel related cost should be included in financial proposal bid

3

Produce progress report after data collection and analysis covering the initial findings of research.

This report must be submitted to UNICEF and to relevant government counterpart. In case of national level workshop for reviewing these findings, selected organization will act as main facilitators in workshop

Progress report endorsed by UNICEF and relevant government counterpart

90 calendar days and 180 calendar days after signing of contract

All travel related cost should be included in financial proposal bid

4

Produce final report comprised of overall findings, recommendation. Develop policy brief and presentation for advocacy.

This report must be submitted to UNICEF and to relevant government counterpart. In case of national level workshop for reviewing these findings, selected organization will act as main facilitators in workshop

(i)Final report endorsed by UNICEF and relevant government counterpart

(ii) 3 Policy brief document on three components of study

 

 

240 calendar days after signing of contract

All travel related cost should be included in financial proposal bid

5

Produce publications and policy document.

Prepare a manuscript(s) for a peer-reviewed journal.

Facilitate dissemination workshop

The following document will be endorsed by UNICEF and government:

(i) Manuscripts for peer-review  

260 calendar days after signing of contract

 

 

1. Estimated duration of contract

• The research plan to start from 1st October 2024 and aim to complete by 30th June,2025. The exact time and date can be flexible depending on contract signing. However, the total duration will be within 9 months.

1. Deliverables

The deliverables are same as mentioned in the above table (Section 10: Schedule of tasks and timeline)

 

Sample Table of Contents for an Inception Report (no more than 30 pages, plus annexes)

 

1.  

 

•  
•  
•  
•  
•  

 

1. INTRODUCTION*

1.1. Objective of the assessment

1.2. Background and context

1.3. Scope of the work

2. METHODOLOGY*

2.1. Assessment questions

2.2. Conceptual framework

2.3. Assessment criteria

2.4 Sampling

2.5. Data collection methods

2.6. Analytical approaches

2.7. Risks and potential limitations

2.8. Ethics and UNEG Standards

3. PROGRAMME OF WORK*

3.1. Phases of work

3.2. Team composition and responsibilities

3.3. Management and logistic support

3.4. Calendar of work

1. • Terms of reference of the assessment*
   • Stakeholder map*
   • Tentative outline of the main report*
   • Interview checklists/protocols*
   • Draft Study Tools*
   • Theory of change / outcome model*
   • Detailed work plan*
   • Detailed responsibilities of team members
   • Reference documents
   • Document map
   • Project list
   • Project mapping

 

*The structure of inception reports may be adjusted depending on the scope of the work. Chapters and sections with an asterisk should be included by default.

 

1. Team composition, Qualifications & Experience required:

 

This assignment will be undertaken by an agency that is primarily engaged in the conduct of research studies including extensive experience of conducting surveys and qualitative research, and for this research especially in newborn and or child health related initiatives in the country.

The selected agency should have a successful track record of conducting high quality literature reviews, as well as designing, implementing, and analyzing both quantitative and qualitative surveys with a track record of at least five years of relevant activities in development, health, and significant experience within the government system especially on newborn health at community and facility level. The organization must have a substantial research infrastructure to support field-based data collection, electronic archiving of the data and capable of ensuring the highest level of confidentiality for research subjects as well as ensuring the validity of responses obtained.

Agencies are free to associate for this assignment to ensure that sub-studies are conducted simultaneously; it should be stated which agency is managing which sub-study, and what the responsibilities will be of the lead agency. The agencies conducting sub studies should not have any potential conflict of interest.

Senior team members should:

• Hold a post-graduate degree in master’s in public health or PhD in health, Social Sciences with specialist knowledge and experience of newborn health. Knowledge on gender equality including child rights is added benefit.
• Have clear understanding of government health structure, processes and systems.
• Be familiar with the NNHP & IMCI program, KMC program and SCANU program in the country.
• Have a minimum of 10 years’ experience, with preferably at least five years in the maternal, newborn and child health.
• Possess excellent verbal and written communication skills (English, Bengali)
• Possess excellent analytical, report writing and presentation skills.
• Be proficient in the use computer software. i.e., Windows 8, MS Office, Internet searches, including statistical data analysis software such as Stata or R.

Suggested composition of the expert team:

• A senior investigator (team leader); she/he should have the following: at least 10 years’ experience leading projects in the child health  field, including operational research; experience in interdisciplinary work related to new initiatives and reviewing the existing system; track record of relevant research and scientific publications; at least 5 years project/program management and leadership experience; personal and team skills; experience with quantitative data packages; and good working knowledge of Bengali and English languages. Previous experience in maternal, child and newborn health programs is preferred. A track record of relevant research and scientific publications is required.
• A senior health expert and statistician with the following: at least 10 years’ experience in quantitative research; experience in interdisciplinary work, including economic aspects; track record of relevant research and scientific publications; research management and leadership experience; personal and team skills; experience with quantitative data packages; and good working knowledge of Hindi and English languages. Previous experience in water and/or sanitation programs is preferred.
• A senior research field manager with the following: at least 5 years’ experience in leading field studies in the social sciences, in both qualitative and quantitative research; personal and team skills; experience with quantitative data packages; and good working knowledge of Hindi and English languages.

Enumerators must have the ability to interview respondents, facilitate and collect data in English, Bengali and other local languages and translate the research material. The enumerators should have at least two years of experience in field work, be fluent in the necessary local languages and must have completed a high school diploma.

1. Duty Station

The organization will be based in Dhaka with frequent travel to community KMC implementation sites. The sites are listed as below, however subject to changes as per need. (Dhaka, Bhola, Khagrachari, Kishoreganj, Bagerhat, Sherpur, Siraganj, Kurigram, Sunamganj, Bandarban, Cox’s bazar.)

For the effective assessment of Kangaroo Mother Care (KMC), it is strongly recommended that the selected organization undertake a comprehensive calculation of the number of sites that need to be visited. This calculation is crucial to ensure that the assessment accurately reflects the implementation of the entire program. Given that Kangaroo Mother Care has been an integral part of the Ministry of Health and Family Welfare initiatives and has been effectively implemented across various districts over the past ten years, it is essential that the assessment encompasses a representative sample of these sites. This approach will ensure that findings are robust and can inform future strategies, ultimately supporting the continued success and expansion of KMC practices nationally. The list of facilities is in the annex.

1. Management and Supervision

1. The contracted research or evaluation agency will play a critical role in executing the activity with a clear set of responsibilities and expected standards. Primarily, the agency will be responsible for designing the study, collecting data, and analysing the results. They will ensure rigorous adherence to quality assurance measures, such as the meticulous recording and reporting of any suspected adverse events. Further, the agency will implement robust data handling and record-keeping protocols with quality check to maintain data integrity and confidentiality. Quality control will be integral to their processes, with regular audits and validations to ensure accuracy and reliability of the data collected. The agency will also be required to provide comprehensive, transparent reports and updates to keep all stakeholders informed and engaged throughout the study period. This combination of roles and responsibilities, along with stringent quality measures, will ensure that the research is conducted to the highest standards and yields actionable insights.
2. UNICEF: UNICEF will provide overall technical management for this research. The contracted agency will operate under the supervision of a health specialist, who will report to the health manager and, ultimately, to the Chief of Health. All materials, including reports, questionnaires, and other documents, must be certified by the health specialist before being finalized. The selected agency is required to share drafts of all materials and present them to government counterparts after receiving endorsement from UNICEF.

1. Official travel involved

 

• All travel related cost needs to include in the financial proposal. In line with UN procedure for contracted partner, only economy class travel is applicable, regardless of length of travel.

1. Payment Schedule

 

• 1st payment (15%): upon acceptance of, IRB approval letter, onboarding of team member, finalized inception report (to be shown in inception report) (Deliverable-1-2)
• 2nd payment (20%):  upon finalization of 1st progress report including findings, as agreed with UNICEF (Deliverable-3)
• 3rd payment (20%):  upon finalization of 2nd progress report including findings, as agreed with UNICEF (Deliverable-3)
• 4th  payment (30%): upon submission and acceptance of final report and policy brief, as agreed with UNICEF (Deliverable-4)
• 5th payment (15%): upon submission and acceptance of dissemination workshop and acceptance of all finalized deliverables and raw data (Deliverable-5)

 

18. IDENTIFICATION OF RISKS FOR THE CONSULTANCY AND PLAN FOR MITIGATION

• Environmental risk - the political environment, market environment or delivery infrastructure environment, among others.
• Program risk - the complexity associated with the nature of the service to be acquired, among others.
• Implementation risk - risk associated with the capacity of the implementation unit/team.

 

Risk Identified

Mitigation measures

Environment Risk-

The political environment- The country is undergoing rapid changes, potentially leading to unrest such as roadblocks, protests, and civil disturbances during the implementation period.

UNICEF will collaborate closely with national and local security teams to safeguard the staff's safety and well-being involved in this initiative.

The selected organization will be responsible for the safety of its staff when traveling outside Dhaka and must promptly report any delays to UNICEF.

Program risk – the need to secure approval from the country's Ethical Board for the implementation research (IR).

The selected organization will be tasked with obtaining Institutional Review Board (IRB) approval for this research.

During the selection process, the organization's capacity to conduct IR and secure IRB clearance will be thoroughly evaluated.

Implementation Risk – Challenges in securing government endorsement for the initiation of IR, its reports, and policy briefs.

UNICEF will support relevant programs to host multiple workshops at national and sub-national levels.

Key stakeholders, including ADG, LD, PM, and technical experts in newborn health, will participate in these workshops to discuss methodology, timelines, and data collection of IR.

This approach aims to gain government buy-in from the onset, facilitating the endorsement process.