****Terms of reference for an Individual Consultant****
****Assessing the Institutionalization of Youth Friendly Services in Pre and In-Service Training Programmes for Health Providers in East and Southern Africa****
****1. Summary****
UNFPA East and Southern Africa regional office with support from GIZ is seeking the services of a consultant to assess the status of institutionalization of youth friendly services (YFS) in pre- and in-service training programmes for health providers in the East and Southern Africa (ESA) region. The findings of the review will feed into a recommendations for UN, Regional Economic Communities, Ministers of Health and partners to develop state of the art YFS training programmes for in-service and pre-service health providers so as to scale-up youth friendly services in the region.
****2. Background****
Adolescents and young people have been estimated at 160.2 million in the 23 East and Southern Africa (ESA) countries in 2013, representing nearly 33 per cent of the total population. This number is expected to reach 282.2 million by the year 2050. This means that the region has and will have significant number of dependent adolescents 10 to 19 as well as large cohort of young people 15 to 24 year olds requiring access to education, health care, employment, as well as other social services.
Although adolescence is often considered a period of relatively good health, adolescents and young people in Sub-Saharan Africa and the ESA Region face significant sexual and reproductive health and rights related challenges, including high prevalence rates of HIV, stigma and discrimination, child marriage, early and unintended pregnancies, maternal mortality, sexual and gender based violence and exposure to harmful practices. Although overall condom use has been increasingly slowly, however, consistent use is a major issue because young people’s knowledge levels regarding HIV remain low. Unmet need for contraception is also quite high in the region especially among adolescent females and young women.
The evidence presented by a 2013 regional diagnostic report on ASRH[1] (including comprehensive sexuality education (CSE) and youth friendly service (YFS) delivery) and country assessments from Malawi, Namibia and South Africa, suggest that many countries in the ESA Region have some form of policy or guidelines on providing youth friendly services to adolescents. However, the quality and coverage of youth-friendly services in these countries vary, and many young people do not access these services. Insufficient budget and poor institutional capacities of government and other implementing agencies affect quality of national guidelines, training manuals and other relevant tools, service providers capacities and attitudes, and monitoring and evaluation of YFS. Also, a number of existing legislative and policy frameworks in many ESA countries continue to be barriers for young people to access SRH information and services. Even in countries where significant progress has been made regarding policies, a lot remains to be done to develop appropriate guidelines and integrate them into service providers’ training modules and tools to facilitate increased access to YFS.
****3. Rationale****
In December 2013, Ministers of Education and Health from twenty ESA countries affirmed and endorsed their joint commitment to deliver Comprehensive Sexuality Education (CSE) and Sexual and Reproductive Health (SRH) services for young people (the ESA Commitment). Two of the ESA Commitment targets are:
- Pre- and in-service sexual and reproductive health (SRH) and CSE training for teachers and health and social workers are in place and being implemented.
- Decrease the number of adolescents and young people who do not have access to youth-friendly SRH services by 50%. This includes equitable, accessible, acceptable, appropriate and effective services related to HIV.
While health providers’ negative attitudes and inadequate capacity to serve adolescents with quality services has been documented extensively, information about their level of preparation both while in training institutions and during service has not been systematically studied in the ESA Region. Yet introduction of comprehensive sexuality education and youth-friendly services could first improve the skills and capacity of trainee health providers and prepare them with the non-judgemental attitude and competencies needed to serve the needs of different categories of adolescents and youth (married, unmarried, in-school, out-of-school, young key populations, victims of sexual abuse, those living with HIV, those involved in drug use etc.).
To advance the YFS component of the ESA Commitment and support the implementation of the two ESA Commitment targets on YFS mentioned above, it is therefore important to review the status of YFS training programmes for health service providers who are in-service or in pre-service training institutions.
The Assessment Report will be shared with all the institutions participating in the Assessment, Ministries of health, youth-serving organizations, UN, Regional Economic Communities (RECs) (IGAD, EAC, SADC) and other relevant development partners to inform future programming.
This assignment will build on the work of the UNFPA, GIZ, ESA regional UN interagency Task Team for young people (including UNESCO, WHO, UNAIDS, and UNICEF), civil society, and the RECs, and young people that have been working to strengthen comprehensive sexuality education and youth friendly services in the region. It will also respond to the accountability framework of the ESA Commitment.
****4. Purpose****
The purpose of the consultancy is to assess the status of institutionalization of youth friendly services in pre- and in-service training programmes for health providers in the 23 countries in the East and Southern Africa region. The Assessment will serve as a baseline and provide recommendations for the development of national human resource training policies and a regional State of the Art (SOTA) in-service and pre-service YFS training courses which can then be adopted by the RECs, training institutions and ministries of health in the region.
It is expected that the training courses will in-turn contribute to the improvement of the quality and coverage of services being provided to adolescents and youth in the short and long-term.
****5. Specific Objective and Expected Outcomes of the Consultancy are to:****
- Review the extent to which youth-friendly services is integrated and delivered through the curricula of health provider training institutions especially in medical and nursing schools (pre-service training);
- Review the extent to which youth friendly services is integrated and delivered in continuing education programmes for health providers (medical doctors, nurses, midwives and other allied personnel) (in-service training);
- Review whether YFS training Programmes are in line with WHO Guidelines and conferring adequate competencies to providers to enable them address the sexual and reproductive health needs and rights of adolescents and young people;
- In addition to conducting the study above, the consultant will establish a YFS Advisory Committee and manage their involvement and input into the study.
****6. Methodology****
- Conduct literature and content review of curricula (in-service and pre-service) from 23 ESA Countries[2];
- Conduct a survey of a sample of in-service and pre-service health providers;
- Conduct in-depth interviews with key informants (professors of medical schools, instructors from nursing schools, Ministry of Health departments in-charge of continuing education and youth friendly services);
- Data analysis and report writing with key findings and recommendations on the three specific objective areas including institutionalization of YFS in pre- and in-service training programmes.
****7. Process****
- Collect relevant literature and curricula from countries;
- Develop survey and in-depth interview tools;
- Collect data;
- Analyse data and write Report;
- Submit draft Report to partners/technical advisory committee for review and comments;
- Present 2nd draft Report at a Regional Consultation to be organized by the partners and incorporate comments from the consultation;
- Finalize Report;
- Print and distribute Report to institutions surveyed, ministries of health, ESA Commitment Partners and youth-serving civil society organizations.
****8. Deliverables****
The consultant is expected to produce the following deliverables:
- ESA YFS pre and in-service training Assessment Report[3] and country summary annexes;
- Power point presentation summarizing the Assessment Report;
- Recommendations for harmonization and scale-up of YFS training, including human resource training policies and the development of a regional State of the Art (SOTA) YFS in-service and pre-service training courses.
The Assessment Report should be regional in nature, with examples from countries and practical recommendations for Ministry of Health and relevant policy makers as well as development partners and civil society, especially programme developers and implementers training health workers.
****9. Project Management****
UNFPA ESARO’s Adolescents and Youth Policy Advisor will manage the Project and will set up a technical committee from UNFPA, GIZ and other partners to oversee the quality of the work, and clear data collection tools and reports.
****10. Profile of consultant****
The candidate is expected to have the following qualifications and skills;
- Advanced academic degree in a related field (preferably public health education, social sciences, education and/or international development);
- Extensive professional knowledge and at least 7-10 years’ experience in the field of continuing health education and training in Africa, HIV prevention, sexuality education and youth friendly service delivery; familiarity with government health systems an asset;
- Demonstrated experience in regional evidence/literature review, stakeholder interviewing, analysis and synthesis of findings;
- Strong consultation and facilitation skills;
- Experience in involvement of diverse and inter-disciplinary stakeholders;
- Excellent writing and communication skills;
- Language skills in English, and preferably French and Portuguese.
[1] UNESCO, Young People Today. Time to Act Now – Why adolescents and young people need comprehensive sexuality education and sexual and reproductive health services in Eastern and Southern Africa, 2013
HOW TO APPLY:
Interested consultants may submit a cover letter, a CV together with a brief proposal on the methodology/approach for the assignment and a sample writing to jobs.esaro@unfpa.org
Applying candidates must be residents of South Africa.
Duty station will be the UNFPA East and Southern Africa Regional Office which is based in Sunninghill, Johannesburg.
Deadline for application is 13 February 2015.