Save the Children is the leading independent organization for children in need, with programs in over 120 countries, including the United States. We aim to inspire breakthroughs in the way the world treats children, and to achieve immediate and lasting change in their lives by improving their health, education and economic opportunities. In times of acute crisis, we mobilize rapid assistance to help children recover from the effects of war, conflict and natural disasters. Each year, we and our partners reach millions of children in communities around the world. Join our dedicated and diverse staff in their work to improve the well-being of children everywhere.
- Every year, about 6 million children die globally before they reach their fifth birthday, many during the first year of life (UNICEF, 2016).
- Half of these deaths are due to acute respiratory infections, diarrhoea, measles, malaria, malnutrition; or often to a combination of these conditions which are largely preventable and treatable conditions.
- The risk of a child dying before completing five years of age is highest in the WHO African Region (81 per 1000 live births), about 7 times higher than in the WHO European Region (11 per 1000 live births) according to statistics from WHO (2005).
- Various factors bordering on socioeconomic determinants of health have been proposed as possible underlying factors for these outcomes.
- Reducing these inequities across countries and saving more children’s lives by ending preventable child deaths are therefore important priorities.
- As part of efforts to address these challenges, Save the Children with funding from GSK is currently building the capacity of frontline health workers in the delivery of MNCH interventions.
- The project aligns with the National Strategic Health development plan (2010-2016), the Integrated Management of Maternal, Newborn and Child Health Strategy (IMNCH) 2013, and IMCI and ICCM guidelines and implementation strategies.
- The IMCI guidelines which was developed by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) promotes prompt identification of childhood illnesses in the outpatient settings and provides appropriate treatment and referrals when necessary.
- The guideline also helps to improve the quality of care of sick children at the referral level by providing an effective link between the care provided at the community and the management approach in the facility and promotes the rational use of resources. Currently, the number of health workers trained on the IMCI guideline in Gombe State is low.
- This situation coupled with the deficit in human resources for health in the state and the high cost associated with traditional IMCI trainings (6 days training) increasing the pool of health workers with the requisite skills in IMCI at facility level is challenging.
- To address this challenge, Save the Children has developed an On-site training and mentoring approach which aims to increase the number of health workers with knowledge and skills to manage common childhood illnesses at the PHC level, that involves multiple visits to health workers’ at their respective facilities for the purpose of building/strengthening their individual capacities in IMCI.
- To increase the number of health workers with knowledge and skills to manage common childhood illnesses at the PHC level using the IMCI guidelines.
- To enhance the skills of frontline health workers from selected health facilities in Lagos state in tackling common childhood illness at the facility level.
- To use an on the job approach for reinforcing learning and addressing skills gap of trained health workers for the purpose of building/strengthening their individual capacities on IMCI.
Purpose of the Assignment
- The purpose of this consultancy is to conduct a rapid spot assessment of the health workers in identified facilities that are underserved and hard to reach.
- Based on the findings of the assessment, Consultant would conduct an on the job training on IMCI for the health workers using the IMCI guidelines (IMCI chart booklet and exercise booklets)
Approach for the OJT Activity:
- The consultancy period will be for 50 days spanning from 30th September 2017 to 30th March 2018
- Initial assessment of health workers ability to properly manage a child with childhood illnesses - malaria, pneumonia, diarrhea. This will be by onsite observation of health workers in the child welfare clinics using a skills checklist.
- After the clinic session, the consultant will review the skills checklist findings with the health workers and agree on the findings.
- A training plan would be developed for the health facility workers, the plan would include dates of the training, names of health workers that would be trained and the training course curriculum for each day
- The training plan would be shared with the MNCH Advisor before commencement of the facility visits
- The consultants using the IMCI chart booklet trains the health workers on how to appropriately assess, classify and treat a child presenting in the facility with malaria, diarrhea and pneumonia. Also the health workers will be trained on how to counsel the caregivers on appropriate home management for the illnesses and when to return.
- The consultant will pay six (6) visits to the same health facility to ensure that the health workers have been fully trained on the necessary skills required to properly manage a child presenting with Malaria, Pneumonia, Diarrhoea and be able to check for malnutrition and initiate treatment, give vaccines that are due or missed. Under the supervision of the Consultant, trainees would undergo clinical sessions in nearby secondary health facilities or comprehensive flagship health facilities.
- Consultant then leaves behind a chart booklet for the use of the health workers
- Consultant will also conduct a follow up visit to selected health workers based on their performances during the training. (within six weeks of training completion) to assess the knowledge and skills change amongst the health workers in that facility
- During the follow up visit, the consultant will observe the health workers again using the skills checklist and feedback provided to the health workers.
- During and after the OJT sessions in the health facilities, assessment would be carried out by MNCH Advisors using the training quality checklist.
- After the training sessions in each facility, the consultants would also be assessed for quality by applying training evaluation forms on all trained health workers.
- Consultants will keep the attendance of all health workers mentored or trained in the health facilities in a format that will be determined by Save the Children.
- The consultants will keep an activity timesheet which will be shared with the MNCH Advisor every week.
- Training reports are at the end of the satisfactory training will then be developed by the consultants and shared with SCI office.
- The Consultant is expected to train 140 health workers on IMCI
- All trained health workers have skills in tackling common childhood illnesses at community and facility level
- Monthly report of activities from the consultant
- A comprehensive report of the training activity upon completion.
- Photos and Attendance list of all health workers reached with OJT, indicating the following - Names, Name of health facility, Cadre, Gender, phone number, email address, others.
Desired consultant should possess the following:
- Postgraduate Degree in relevant course.
- IMCI certified.
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Introduction to Save the Children and Project Background
- Save the Children has over 20 years’ experience of supporting the health sector in Nigeria, focusing mainly on the primary health care. It has been engaged in a number of support areas ranging from providing local technical capacity at service delivery points to a broader health system strengthening at central level.
- At community levels, Save the Children has sound experience of working with community structures and building relationship between them and health facilities. The organization has been operational in the Northern Nigeria since 2001.
- The Stop Diarrhoea project is an initiative supported by Reckitt Benckiser aimed at contributing to a two third reduction in diarrhoea-related deaths among children under the age of five in Somolu, Lagos State, Nigeria.
Incidence, Risk Factors and Treatment of Diarrhoea in Nigeria:
- Nigeria has high incidence of diarrhoea cases in children across the geo-political zones, especially in children 0-5years, resulting in percentage increase in children being affected by diarrhoea. Repeated episodes of diarrhoea exacerbate children’s poor health status and accelerate malnutrition, creating a deadly cycle of infection and malnutrition.
- The recent 2013 NHDS shows that 10% of children under age 5 were reported to have had diarrhoea in the last two weeks and 2% had diarrhoea with blood with an average 7.5% of children with diarrhoea cases reported in Lagos State. Diarrhoea was most common among children aged between 12–23 months (17%) and least common among those aged between 48-59 months (5%). Diarrhoea with blood was also most common in children age 12-23 months.
- Dehydration caused by diarrhoea is a major cause of illness and death among young children, even though the condition can be easily treated with oral rehydration therapy (ORT). Exposure to diarrhoea-causing pathogens is frequently related to the consumption of contaminated water and to unhygienic practices in food preparation and disposal of excreta. The combination of high cause-specific mortality and the existence of an effective remedy make diarrhoea and its treatment a priority concern for the health sector. Diarrhoea leads to stunting due to its association with poor nutrient absorption and appetite loss. Thirty-seven percent of children under age 5 are stunted, eighteen per cent are underweight.
- Children of mothers with no education were twice as likely as children of mothers with more than a secondary education to have had diarrhoea. There was also a direct relationship between family wealth and diarrhoea prevalence, with children from wealthier households being less likely to have diarrhoea. Overall, 29 percent of children under age 5 with diarrhoea were taken for advice or treatment at a health facility or provider across the LGAs in Lagos.
- Some of the key measures to prevent childhood diarrheal episodes include promoting exclusive breastfeeding, hand washing with soap, improving hygiene and quality of drinking water, vitamin A supplementation and promoting rehydration and zinc intake as prescribed in the WHO/UNICEF 7-point plan for diarrhoea prevention and control. ORS and Zinc remains the cornerstone of appropriate case management of diarrheal dehydration and is considered the single most effective strategy to prevent diarrheal deaths in children under-five.
The Stop Diarrhoea Initiative (SDI):
- Through the Stop Diarrhoea Initiative (SDI), Save the Children in partnership with the Lagos State Government and Reckitt Benckiser (RB), aim to fully implement the WHO/UNICEF 7-point plan as a Signature Programme in Shomolu Local Government Area (LGA).
- This four year programme will contribute to Save the Children and RB’s global ambition of removing diarrhoea as a top five leading cause of death amongst children by 2020. In line with Save the Children’s theory of change, the programme will: test the effectiveness and efficacy of the WHO/UNICEF 7-point plan; collate evidence to demonstrate proof of concept and value for money and advocate the Lagos State and Federal Government of Nigeria, and its partners, to replicate and scale up the approach nationally.
- The Stop Diarrhoea Initiative (SDI) focuses on the treatment and prevention of diarrhoea in the targeted communities. The aim is to contribute to at least 50% reduction in the prevalence of diarrhoea.
- The core programme elements include child health, Water, Sanitation and Hygiene (WASH), advocacy, community capacity building/participation, service delivery and partnership.
Purpose of the Study:
- The overall purpose of the process evaluation is to assess the effectiveness of selected SDI interventions and document the evidence on the process: (what is working / not working and explore the reasons why; assess whether the interventions have been implemented as design intended; the extent of uptake; challenges; lessons; whether they have achieved their intended outcomes;), and assess the level of participation of community members and children.
- In addition, the process evaluation will be used to validate the impact so far, with specific focus on the results that have been achieved in the implementation to provide a transparent basis for accountability for results, decision making, learning and for drawing lessons and for improvement on future programming.
The process evaluation seeks to address the following issues and provide specific, actionable and practical recommendations for programme improvement:
- Determine the effectiveness of selected SDI interventions that form part of the SBC strategy (School Health Clubs, Community Action Cycle and Photo Voice)
- Assess the effectiveness of the school health clubs focusing on: the functionality of the clubs according to training guidelines; effective facilitation by teachers; and meaningful participation of children as change agents for social and behaviour change around health and hygiene at school, home and in the community;
- Assess the effective uptake of the Speaking Book in school health clubs, including creating a baseline for schools yet to receive the book and setting up periodic monitoring opportunities and tools to gauge changes in knowledge, attitudes and practices of children exposed to the speaking book and their capacity built for improved health outcomes at school, home and in the community
- Assess the effectiveness of community action cycle approach on the capacity of the community to organize themselves to identify, prioritize and develop local solutions to community issues, plan, implement and evaluate their progress in a gender sensitive and empowering way for improved health and social outcomes, reaching the most marginalised;
- Assess the effectiveness of Photo Voice on children’s capacity as change agents to use the approach as a means of raising their voice on issues of concern to them to influence policy making and policy implementation.
- To document evidence on successes, challenges, and lessons learnt and actionable recommendations for improved programming for SDI on selected intervention.
- Assess the level of effective participation of community members and children in selected interventions and gather stories of most significant change for selected interventions;
- To review current monitoring tools and plans for selected SDI interventions and assess their effectiveness in gathering periodic data which can be used to document changes in behaviours and practices, as well as monitor improvements in the effectiveness of selected approaches.
- Modify and/or create new tools to improve programme monitoring, including participatory monitoring tools that can be institutionalised (used by existing structures) to enhance sustainability.
- The successful consultant will be expected to develop a detailed study methodology, data collection tools, budget and workplan to undertake the research study.
- The research consultant must be skilled and prepared to work with children. Efforts should be made to ensure that terminology and language used facilitates the integration of children into the discussions of sophisticated topics and debates.
- Child safeguarding and Ethical considerations regarding data collection, storage and analysis, including confidentiality must be clearly highlighted in the methodology. As required, the study protocol and instruments will be subject to review and approval prior to the study’s initiation.
Scope of Work:
- The scope of the research study will focus on the Process evaluation questions on programme effectiveness. These include what is working and not working, what are the successes achieved so far, what are the challenges encountered, what recommendations should be incorporated into the implementation for the next two years, which mechanisms within the interventions triggered changes and are these changes being maintained, what are the conducive conditions for the intervention to work, what is the level of child participation in Schools Health Committees and wider community members for CAC and to gather stories of most significant change.
- The work will also include a baseline for school health clubs focusing on their existence, functionality and activities to involve children as change agents; a baseline for speaking book; a baseline for community Action Learning Cycle; a baseline for photo voice; and a review of current monitoring tools for selected interventions with suggested modifications/ new tools that will facilitate participatory monitoring for the process evaluation embedded into existing structures.
The process and tasks within this work will be the following:
- Collaborate with SCUK Advisors and SDI project team to define the scope of the research study
- Carry out preliminary preparation of the research proposal for Nigiera, including a review of background literature and key project documents;
- Produce a brief inception report which will be used to input into a more detailed research proposal
- Full literature and background review and detailed methodology for the research design
- Preparation for field work, including the production of a topic guide and tools for data collection
- Preparation of logistics for field work
- Carry out fieldwork in x wards in Somolu over a xx period, carrying out xx FGDs, xx KIIs etc (detailing duration and scope). Final details will be agreed on.
- Preliminary analysis in the field at the end of data collection presented to key stakeholders for their input
- Full data analysis and a sub-set produced which will be used for benchmarking
- Produce a substantive report
- Produce a one page advocacy summary of the results which will be shared with MoH
- Represent the project and its findings as appropriate and agreed throughout this process
Key Deliverables for the Consultancy
- Tools for Baseline, Process Evaluation, and participatory monitoring
- Inception report
- Substantive report including a presentation of data collected and an in-depth analysis as well as ramifications of the data for programming
- Power Point summary of key actionable recommendations
Educational Background, Skills and Competencies
- At least MSc degree in Statistics, Sociology, Demography, Psychology or any other related Social Science. A Ph.D. holder in any of the above subject will be an added advantage and preferred;
- At least 5 to 10 years field experience in work related to survey or operational research;
- Demonstrable and practice ability indicating good experience in household survey through previous work in rural communities, in particular participative data collection work directly with children;
- Experience in quantitative and contemporary statistical packages, as well as in systematically analysing qualitative data;
- Experience in conducting high quality quantitative and qualitative research in communities in Nigeria;
- Child safeguarding and Ethical considerations regarding data collection, including confidentiality must be clearly highlighted in the methodology. Planning should take into consideration Ethical Checking Requirements in country.
Method of Application
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