International consultant-PSA

Consultancy:      International consultant

Location:            Vientiane Capital, Lao PDR

Timeframe:        40 work days between April and July 2015

1. BACKGROUND

Introduction:

The UNFPA Laos country office has been operating in Lao PDR since 1976 and is currently in the penultimate year of its 5^th Government of LAO PDR-UNFPA Country Programme.

The Country Office (CO) is now embarking on the development of the 6^th Country Programme 2017-2021 (CP) which is expected to be aligned with the new UNDAF and the 8^th National Socio-economic Development Plan (NSEDP) of Lao PDR. In preparation of the UNDAF, the UNCT has commissioned an evaluation of the UNDAF and discussions on the CCA/UNDAF process are underway.

 While lessons learnt from the UNDAF evaluation will be useful in the design of the new CP, more specific analysis of Sexual and Reproductive Health (RH) and Population Dynamics as they relate to development more broadly, is required to design a more focused and strategic Country Programme. In addition, such an analysis will also be invaluable in providing reliable data and evidence-based arguments to influence the UN inter-agency process of the CCA/UNDAF as well as the 8^th NSEDP to ensure that RH and Population Dynamics are integrated in the priorities of the upcoming UNDAF and 8^th national plan. 

The Country Office will, therefore, commission a meta-analysis of the population and SRH situation in Lao PDR that will provide an integrated appraisal of population and reproductive health dynamics and their linkages and impacts on poverty, inequality and development.  The CO’s decision to opt for meta-analysis is based on the fact that several thematic analyses of the relevant topics already exist. These include, among others, a comprehensive assessment on Family Planning, a situational analysis on Sexual and Reproductive Health of Adolescents and Youth, evaluations on the implementation of the national SBA development Plan and the UNFPA Community-based Distributors and Individual, Family and Community (IFC) Programmes, a Prevalence Survey on Violence Against Women and an issue paper on Population and Development, all of which were commissioned by the CO during 2014-2015. In addition, other analyses conducted by development partners on related topics, including the MDGs are also available.

The primary purpose of meta-analysis is to assess the population and sexual and reproductive health dynamics, to analyze their inter-linkages with broad development issues and to provide a strong evidence-base for the development of a strategic and focused 6th Country Programme that responds to the needs, priorities and national development strategies of the country, within the framework of UNFPA Global Strategic Plan.

The intended audience and users of meta-analysis are the UNFPA Country Office, government counterparts in Laos, and other development partners.

 Context:

Lao PDR is a landlocked country, and is categorized among the ‘Least Developed Countries’ (LDC) worldwide.

Geographic conditions pose difficulties in the development of social infrastructure, transportation, communication and trade, which are compounded by a highly dispersed and thinly spread population. As of 2013, Lao PDR has an estimated population of 6.8 million, which is projected to grow to 8.3 million in 2025, and 10.6 million in 2050.

71% of the population resides in rural areas and about 27% of the population lives below the poverty line.  While reforms aimed at the gradual transformation from a centrally planned economy to a more market oriented one have been introduced over the years and yielded significant result of 8% annual economic growth during last 10 years, disparities between rural and urban areas in terms of wealth, economic opportunities and access to basic social services appear to be growing. The country’s goals of graduating from LDC status by 2020 and integration into the ASEAN Economic Community by 2016 present both opportunities and challenges, highlighting the need to increase its competitiveness and reduce vulnerabilities to external factors. This is particularly significant given that 50% of its population is under the age of 20, presenting the country with a unique opportunity to benefit from the demographic dividend through increased investments in human capital development, particularly in the areas of education, employment and health.

 The country has a weak health system with only 9% of its national budget being allocated to the sector. As a result, access to health services is limited, particularly of poor people from minority ethnic groups, living in remote rural areas.

While significant progress has been made in reducing the Maternal Mortality Ratio (MMR) at an estimated 220 deaths per 100,000 live births in 2013, it still remains as the highest in South-East Asia. Skilled-birth attendance at deliveries is low at 41%.  The contraceptive prevalence rate is 42% for modern contraceptive methods as at 2011/12. After peaking at 48% among women with primary education, use of a modern method declines along education levels. The unmet need for family planning, which is currently 20%, is higher among women with no education (26%) and decreases with increasing wealth.  The total fertility rate of 3.2 ranged from 2.0 in Vientiane to 4.5 in Sekong province (as at 2011/12). The fertility rate of adolescent girls aged between 15-19 years is approximately 94 per 1,000, while the fertility rate of young people aged between 20-24 years is about 185 per 1,000 people

Though the prevalence of HIV and AIDS remains relatively low, there is an increased risk of dissemination, especially in urban areas, where vulnerable groups like young people with risky behaviour, sex workers, and men having sex with men (MSM) are growing.

The country has made progress in achieving gender equality in the national legislative and policy arenas and is ranked 60^th out of 142 countries in the Global Gender Gap Index. However, gender disparities persist, with social attitudes and traditions contributing to the low status of women. While gender imbalances are apparent in access to education, school continuation rates and access to employment opportunities, prevalence of violence against women is widespread with nearly 12% of women reporting the experience of domestic violence during their lifetime.

II.            PURPOSE AND OBJECTIVES OF META-ANALYSIS

Purpose:

• Produce an integrated appraisal of sexual and reproductive health, population dynamics and their impacts on development in order to inform the strategic direction of the 6^th UNFPA Country Programme and to contribute to the new UNDAF and the 8^th NSEDP

Objectives:

• To synthesize the findings of existing assessments, reports and other documents and provide an integrated appraisal of sexual and reproductive health, population dynamics and their relationship with social, economic, political and cultural processes in the country.
• To examine, analyze and interpret from the existing assessments, key population and SRH challenges confronting the country, specifically on Adolescent Sexual and Reproductive Health (ASRH), Family Planning (FP) and Skilled-Birth Attendance (SBA) as they relate to the broader developmental context, including priorities of the 8^th NSEDP, the health-sector reform and the integration into the ASEAN community.
• To identify opportunities for action with strategies and programmatic recommendations for the 6^th Government-UNFPA CP.
• To provide insights and specific recommendations on the strategic role UNFPA could play, taking into consideration UNFPA’s niche and comparative advantage vis-à-vis other development actors.
• To make an analytical contribution from a population perspective to the upcoming UNDAF and the 8^th NSEDP

III.           SCOPE AND METHODOLOGY

This analysis will be a light version of what is outlined in the UNFPA’s Conceptual and Methodological Guide for Population Situation Analysis.  In terms of content and methodology, this analysis will assume the form of a meta-analysis, drawing from recent analytical products, surveys and studies and will include the following:

• A meta-analysis of available assessments and surveys to provide a comprehensive overview of the situation of the country as it relates to PD and SRH (specifically FP, SBA and ASRH), including progress in complying with international agreements and goals, particularly the MDGs and the ICPD Plan of Action. This overview will consist of an assessment of the economic, socio-cultural, political and institutional context, including implications of ASEAN integration, particularly on young people.
• An assessment of SRH and population dynamics in the context of economic and social processes, specifically:

• Changes in the situation of SRH with an emphasis on fertility, including early marriage and adolescent fertility and changes in overall maternal mortality
• Emergence of adolescents and youth as a priority group
• Settlement patterns and population mobility, including emerging challenges of urbanization and internal migration with a specific focus on Vientiane, the capital province.
• Health systems and service delivery in relation to unmet need and family planning, including an overall analysis of programme implementation and service delivery in the context of devolution, including structures of governance and decision-making processes between the centre and the provinces in transforming policies into action
• Assessment of existing mechanisms to enforce/implement policies and decrees
• Space for public-private partnerships and the role of the private sector and civil society organisations in service delivery

• An assessment of inequalities based on socio-economic, geographical location, gender and ethnicity, demonstrating and contrasting situations that characterize these different groups in the country. Based on data available, this will include:

•  Population inequalities by poverty (including trends in reproductive inequality, mortality and morbidity)
• Generational inequalities (adolescents and older adults)
• Gender inequalities (the Gender Gap Index, Gender-based Violence, harmful cultural practices)
• Inequalities by ethnicity and habitat
• This section will therefore assess the ways in which social, gender, age-related and ethnic differences and their demographic repercussions feedback upon each other through various pathways and mechanisms. It will also include an assessment of the application of Rights and its impact on the different kinds of inequality.

• An analysis of the connections between population dynamics, gender and SRH (FP, ASRH, SBA) and their actual or potential implications for public policies as they relate to reducing poverty and inequalities and guarantee human rights.  This would include analysis at the micro level of how women’s empowerment is linked to poverty reduction and to MDGs 2, 4 & 5 demonstrating how RH and FP (e.g.; through birth spacing and reduction of unwanted births) could contribute to poverty reduction. At the macro level, it would include analysis of how population growth, age structures and migration are linked to development and poverty reduction.

• The identification and analysis of the main population and RH challenges confronting the country, including opportunities for action with strategies and programmatic recommendations (including actions in the short and medium term), taking into consideration the availability of resources, capacity and commitment.

• Insights and recommendations for strategic interventions in the 6^th CP, taking into consideration the strategic role UNFPA could play given its niche and comparative advantage vis-à-vis other development actors in Lao PDR.

The meta-analysis will look into various reports and documents, such as the Family Planning Situation Assessment, the  Adolescent and Youth Situational Analysis,  Evaluations on the SBA Development Plan and the Community-Based Distributors and the Individual, Family and Community (IFC) Programmes, Issue Paper on Population and Development, Prevalence Survey on Violence Against Women, Reports on MDGs, National Plans and strategies on FP, SBA, RH, Gender, VAW, etc and other relevant reports and analyses available in the country. (Please see Annex 1 for list of documents)

Since, most, if not all of these assessments have been based on causality analysis and stakeholder analyses, this meta-analysis does not envisage conducting another fully fledged causality analysis. However, consultations with interest groups, including the government and other stakeholders, both national and development partners will be conducted (individually and as a group) to complement and validate the meta-analysis.

The meta-analysis will be conducted in close collaboration with the government and national stakeholders to ensure that the final product has the buy in of the government.

IV. EXPECTED DELIVERABLES

- The consultant will initially review the aforementioned assessments, studies and reports and submit an inception report to UNFPA within 1 week upon commencement of consulatncy, outlining a plan for the meta-analysis and stakeholder consultations.

- A presentation at the validation workshop (using PPT) on the key points/findings of the meta-analysis, conclusions and recommendations to UNFPA, government and other stakeholders.  

- The final meta-analysis to be submitted by end of July 2015.

All deliverables will be drafted in English, and translated into Lao language.

V. QUALIFICATIONS REQUIRED

• Post-Graduate degree in the field of Public health, Social Sciences, and/or other related fields
• At least 10 years of professional experience in the area of Sexual and Reproductive Health and Population and Development
• Experience in socio-cultural research, epidemiological research, situation analysis and similar undertakings
• Demonstrated capacity for strategic thinking and policy advice are essential
• Familiarity with UNFPA’s mandate
•  
•  

 VI. MANAGEMENT AND RESPONSIBILITIES

UNFPA Deputy Representative will be the main contact person for the consultant. UNFPA will ensure that relevant documents are provided to the consultant, stakeholder consultations and debriefing meetings are organized and coordinated, and logistical arrangements are made. UNFPA will also ensure that comments on the draft report of the meta-analysis are coordinated and shared with the consultant in a timely manner and that technical and programmatic guidance to the consultant is provided by the UNFPA CO team.

VI. REMUNERATION, DURATION AND LOGISTICAL ARRANGEMENTS

Remuneration will be based on the consultant’s experience and in accordance with the UNFPA guidelines for fee for service for consultants. The 40 Workdays will be distributed between 01 April and 31 July 2015.

Payment of fees will be based on the delivery of outputs, as follows:

-              Upon statisfactry submission of inception report: 25%

• Upon satisfactory submission of the draft PSA meta-analysis report: 55%

-              Upon satisfactory submission of the final PSA meta-analysis report: 20%

Daily Subsistence Allowance (DSA) will be paid per night spent at the place of the mission following UNFPA DSA standard rates. Travel costs will be settled separately from the consultant fees.

The consultant is encouraged to use the UNFPA premises to work on the reports, where Internet and printing facilities will be provided.

VII. OUTLINE OF  THE META-ANALYSIS REPORT (about 30 pages)

1. Executive Summary

2. Introduction: Objectives, Background, Guiding principles, Scope and Methodology

3. Comprehensive Overview of the Situation of the Country as it relates to PD and SRH and Progress in Complying with International Agreements and Goals:

• The Economic Context
• The Socio-cultural Context
• The Political and Institutional Context
• Progress on Complying with International Agreements and Goals: MDGs, ICPD, etc.

4. Population Dynamics and Sexual and Reproductive Health in the Context of Economic and Social Processes:

• Changes in the situation of SRH with an emphasis on fertility, including early marriage and adolescent fertility and changes in overall maternal mortality
• Emergence of adolescents and youth as a priority group
• Settlement Patterns and Population Mobility, including urbanization iInternal migration
• Health Systems and Service Delivery in Relation to Unmet Need and Family Planning, including impact of devolution on programme implementation and service delivery
• Public-private partnerships for service delivery

5. Inequalities and the Exercise of Rights:

• Inequalities in Population Behavior and Trends (including inequalities by poverty and trends in reproductive inequality, mortality and morbidity);
• Generational Inequalities (adolescents and older adults);
• Gender Inequalities (the Gender Gap Index, Gender-based Violence, harmful cultural practices)
• Inequalities by Ethnicity and Habitat
• The Application of Rights and its Impact on the different kinds of Inequality

6. Relationships and Impacts: Relevance for Public Policies:

• Linkages at the Micro Level: Women’s Empowerment, SRH and their links to Poverty Reduction and to MDGs 2, 4 & 5
• Linkages at the Macro Level: Population Growth, Age Structures and Migration and their links to Development and Poverty Reduction

7. Challenges and Opportunities:

• Main Population and SRH Challenges Confronting the Country
• Opportunities for Action: Policy, Strategy and Programmatic Recommendations
• Strategic Role of UNFPA in Partnership with Other Development Actors