Capacity Building for MNCHN workers
UNITED NATIONS CHILDREN'S FUND
STRENGTHENING PRIMARY HEALTH CARE AND COMMUNITY RESILIENCE FOR IMPROVED MATERNAL, NEW-BORN, CHILD HEALTH & NUTRITION (MNCHN) OUTCOMES IN ADAMAWA, BAUCHI AND KEBBI STATES OF NORTHERN NIGERIA
SUPPORT TO THE CAPACITY BUILDING OF HEALTH CARE WORKERS ON INTERGRATED REPRODUCTIVE, MATERNAL, NEWBORN, CHILD HEALTH AND NUTRITION
REQUEST FOR PROPOSAL
SECTION A
UNITED NATIONS CHILDREN'S FUND
STRENGTHENING PRIMARY HEALTH CARE AND COMMUNITY RESILIENCE FOR IMPROVED MATERNAL, NEW-BORN, CHILD HEALTH & NUTRITION (MNCHN) OUTCOMES IN ADAMAWA, BAUCHI AND KEBBI STATES OF NORTHERN NIGERIA
SUPPORT TO THE CAPACITY BUILDING OF HEALTH CARE WORKERS ON INTERGRATED REPRODUCTIVE, MATERNAL, NEWBORN, CHILD HEALTH AND NUTRITION
REQUEST FOR PROPOSAL
SECTION A
Summary and Background:
Nigeria is still on the journey to achieving the globally agreed Sustainable Development Goals (SDGs), with poor health indices, and food shortage due to ongoing insurgency and draught in some States, especially among women and children. Northern Nigeria bears a larger proportion of this burden, particularly in the North West and North East. The current trend of insecurity and insurgence in the North East has worsened the situation in the face of an already poorly functional primary health care system. In order to significantly and sustainably improve the nutritional and health situation of children and women, a multi-pronged approach that will strengthen primary health care systems, build community resilience and strong governance is needed. Integration of interventions in health and nutrition including HIV/AIDS, complemented with water, sanitation, social protection initiatives, and strong governance structures are bound to be more effective and efficient than single or vertical initiatives.
UNICEF is currently accepting proposal to support the Governments of Adamawa, Bauchi and Kebbi States in the design, implementation and monitoring of a programme that will build the capacity of 3,000 health care workers in integrated maternal, newborn, child health and nutrition to improve their skills and competencies for quality service delivery in 774 health facilities, 774 wards, 62 LGAs in 3 States. States will be supported and brought to scale to provide 24 hour integrated MNCHN services.
The Overall Objective is to improve the nutrition and health status of women and children through a sustainable primary health care delivery system and improved community resilience.
Specifically, the proposal is expected to
Design, implement and monitor a programme that will build the capacity of 3,000 health care workers in 3 states
RATIONALE
The maternal and new-born mortality and morbidity in Nigeria is one of the highest in the world with an estimated 576 maternal deaths per 100,000 live births 69 and 128 deaths per 1,000 live births for Infant and under-5 mortality rates in the past five years (NDHS 2013) respectively while Under-5 mortality rate is estimated at 108.8 per 1,000 live births for 2015 as per the interagency model on U5R. Globally, undernutrition contributes to 45% of all under-five deaths in 2011(Black et al, 2013) and this probably holds same for Nigeria. Nigeria contributes about 10% of the global burden of maternal deaths and 10% of burden of children with Severe Acute Malnutrition (NNHS 2014). An estimated 110 Nigerian women die each day with a greater proportion occurring in northern Nigeria where the health indices are poorer.
Health indices in Nigeria are poor due to multiple factors amongst which is human resources incapacity including but not limited to
- Huge funding gaps for PHC service delivery
- Shortage of skilled health personnel especially in the rural areas
- Inadequate, poorly trained health workforce at all levels.
- Incessant health workers strike
- Use of TBAs rather than skilled health personnel for deliveries
- Absence of and poor adherence to SOPs and Job Aids related to MNCH
Systematic approach to the implementation of interventions in health and nutrition, complemented with water, sanitation, and social protection initiatives are bound to be more effective and efficient than single or vertical activities. This integrated package will be based on the NPHCDA Ward Minimum Health Care Package (WMHCP see annexe II). The project will support the provision of services under one PHC per Ward. The main purpose is to strengthen primary health care in the 3 targeted States in northern Nigeria by investing in one main PHC centre per ward approach where health, nutrition, birth registration, water and sanitation, and social protection interventions would converge. This will be realized by gradually dedicating additional resources to fewer, well selected and representative one focal PHC centre per ward in each State. The rationalization will enable these facilities to provide a standard ward minimum PHC package 24 hours, 7 days a week while at the same time supporting integrated high impact PHC outreach services and effective targeting and mobilization of particularly hard to reach settlements and communities in each ward. The minimum PHC package provided in each PHC centre would be as stipulated in the ward minimum health care package for primary health care in Nigeria by the National Primary Health Care Development Agency (NPHCDA).
The Ward Minimum Health Care Package consist of the following health interventions
- Control of Communicable Diseases (Malaria, STI/HIV/AIDS, TB)
- Child survival
- Maternal and Newborn Care
- Nutrition
- Non Communicable Disease Prevention
- Health Education and Community Mobilization
- Birth Registration
Health care providers (Doctors, Nurses, Midwives, CHEWs, CHOs, birth registrars, etc) working the PHC level will require their capacities built and supported to develop skills necessary for delivery of the ward minimum health care package. We envisage an approach that will be a departure from the traditional method, using one or a combination of the following approaches including client/age specific oriented and gender (male and female) friendly components:
- On-the-job Training (OJT) which is linked to the periodic integrated supportive supervision (ISS)
- Self-directed learning by service providers
- Task-shifting tailored to improving capacity of low-cadre health workers
- Clinical mentoring
- CORPs/VCMs Training/mentoring
- Redirecting trainings through our existing Health training Institutions with a view of strengthening their capacities for pre and in-service training on Integrated PHC Services
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Innovative approaches will be emphasized, alongside occasional recourse to conventional technical didactic training. The new approaches will strengthen the capacity development framework and also promote sustainable learning that benefits communities more.
Results
- MNCHN integrated training module and tools developed and approved
- 3,000 health care workers identified, trained and skills improved to provide quality MNCHN services
(840 in Adamawa, 870 in Bauchi and 1290 in Kebbi)
Training report developed and submitted
- necessary, to describe assignments):
State and LGA
- Work with the SMOH, SPHCDA, NPopC and other partners in the identification, coordination and delivery of the training programme in the 3 states.
- Support SMOH and SPHCDA, to develop a capacity building plan for the state and LGA that will be integrated into the state’s annual operational plans in line with the revitalization agenda of the Government.
- Support dissemination and use of approved training modules and guidelines on selected high impact Integrated Maternal New-born Child Health continuum of care interventions such as - Focused Antenatal Care (FANC); Skilled Birth Attendance (SBA); Birth Registration, Emergency Obstetric and New-born Care (EmONC); Essential Newborn Care, Postnatal Care (PNC); Community Based Newborn Care and Integrated Management of Childhood Illnesses (IMCI), PMTCT, IYCF, CMAM, MNP, MNDC, including growth monitoring and promotion, etc
Health Facilities
Priority areas of work to be supported at this level and strategy based on TSS model (Training, Supplies, Supportive Supervision) include but not limited to the following
- Set up and implement a quality of care model for MNCH services in health facilities based on few selected high impact interventions.
- Train health workers using approved training modules and guidelines on selected high impact Integrated Maternal New-born Child Health continuum of care interventions with assistance of state and LGA based TOTs. - Focused Antenatal Care (FANC); Skilled Birth Attendance (SBA); Birth Registration Services, Emergency Obstetric and Newborn Care (EmONC); Essential Newborn Care, Postnatal Care (PNC); Community-based Newborn Care, Integrated Management of Childhood Illnesses (IMCI), PMTCT, IYCF, CMAM, MNP, MNDC, including growth monitoring and promotion, etc
- Develop and strengthen strategies and mechanisms for On the Job Training, Supportive Supervision and mentoring of health workers.
- Regular training of health workers on gender responsive health care service delivery, ensuring sustainability of the impact
- Support end user monitoring of equipment and supplies provided to health facilities - exploring the possibility of the current Rapid SMS technology.
Submit monthly reports on the Status of training implementation to UNICEF
End Result
By the end of the assignment the following outputs will be expected:
- 3,000 healthcare workers trained and their skills improved to provide quality MNCH services along the continuum of care
- Training manuals, SOPs and relevant teaching aids developed and disseminated and being used in all 774 Health facilities
- Monthly reports on updates of trainings implementation submitted
The firm shall be responsible for the production and submission of reports and all other deliverables expected in the course of the assignment. UNICEF will not proceed with the final payment to the consultant(s)/firm until:
- Final report is submitted and approved by UNICEF providing quantitative and qualitative analysis of the pre-project implementation status in the implementing states as well as evidence-based clear recommendations
The overall deliverables have been certified by UNICEF
Duty Station: Adamawa, Bauchi and Kebbi States
- Supervisors: MNCH Manager - Abuja
Health Specialist – Adamawa, Bauchi and Kebbi
Qualifications or specialized knowledge/experience required
A reputable research consultant/firm with:
- Proven track record and a minimum of 10 years’ experience in relevant field.
- Evidence of having conducted and reported on gender responsive capacity building and training of health care workers within the last 10-15 years.
Evidence of previous experience working with other development and or donor organizations in a similar work area is an advantage.
Estimated time of consultancy and deadline for submission of end product:
Maximum of 12 Months
Official Travel involved: (itinerary and duration, if applicable)
Travel
Budget line items
- Professional fees
- DSA to trainers
- Transportation Costs
- Terminal expenses for trips
- Institutional Administrative charges
Payment Schedule: To be agreed based on the delivery of outputs