Home-based Consultancy: Home Visiting Expert – Assessment of the current status of the primary health home visiting programs in ECA region through a maturity model approach (37 working days; with travel as needed) – ECARO

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Purpose of Activity/Assignment

The purpose of the assessment exercise is to take stock of the current status of universal progressive home visiting services across the countries in ECA region. The assessment based on a maturity model should provide information on the state of UPHV policies, organization, scope, coverage, staffing, financing, reporting and monitoring and identify what are the specific country level and common bottlenecks that impede expansion and access to quality home visiting programs. The assessment findings will be used to identify priority areas that need to be addressed within countries and through the technical assistance and support of the Regional Office. UNICEF Regional Office for Europe and Central Asia is seeking to engage an international expert for this assignment, with expertise and experience in home visiting programs delivered as a part of primary health care services. The selected consultant shall work in a team with a consultant with expertise in development of maturity models in the area of health care whose tasks are described in a separate ToR and subject of separate recruitment process.

Background

Action to improve child health and development is a key priority for the Region, and is reflected in the WHO European Child and Adolescent Health Strategies, Nurturing Care Framework (2018), Framework on Early Childhood Development in the WHO European Region (2020), Health 2020, UNICEF Programme Guidance for ECD and UNICEF regional ECD Strategy closely aligned with the global 2030 Agenda for Sustainable Development, the Global Strategy for Women’s, Children’s and Adolescents’ Health 2016-2030 and the United Nations Convention on the Rights of the Child. Investments in the earliest years represent a major opportunity to reduce mortality and morbidity, as well as address health and social inequalities in the Region. Nevertheless, progress has been undermined by the COVID-19 crisis, which has increased the household poverty and food insecurity, and highlighted the importance of access and availability of services for children and their families.

The health sector plays a crucial role during early years as it is uniquely positioned to provide support to children and their families with early and universal services, and acts as a gateway for multisectoral coordination and integration. Both WHO and UNICEF have been supporting the primary health system strengthening and the provision of accessible and quality health care for child health and development. UNICEF has been particularly involved in strengthening quality home visiting (HV) services for young children and their families, provided as part of the primary health care.

The rationale for investing in HV came from the notion that the health sector in the Region had the strongest connection to young families through universal access to patronage nursing services, present in majority (80%) of countries. However, traditional approaches to HV offered a limited range of services and focused mostly on child’s (physical) health. Thus, the HV reforms brought opportunities to provide support for child development and well-being more broadly and to offer specialized support to the most vulnerable families to reduce health inequalities. This upgraded package of HV services has been modelled by UNICEF in many countries in the Region under the label “Universal Progressive Home-Visiting” (UPHV) – where the universal services are available to all families for universal primary prevention, while progressive services are provided to a limited number of families based on assessment of risk and identified need.
The importance of supporting parents and caregivers in providing nurturing care to their children is one of the key features of UPHV and the scope of the package includes focus on nutrition, immunization, safety and security, child health and development but also on building of parental competences to provide optimal support for nurturing care. Up to date, UNICEF supported the reform of HV in 17 countries, developed HV resource package (UNICEF Regional Recommendations for the Reform of Home Visiting Systems in Europe and Central Asia) and conducted a multi-country evaluation of progress so far.

UNICEF works with governments to integrate UPHV into existing service delivery systems, advance capacity of home visitors, ensure adequate financial and human resources, supply the inputs and commodities needed for service provision, and develop effective monitoring and evaluation systems to track results and make adjustments as needed. The multi-country formative evaluation of UPHV in 2019 found that UNICEF -supported UPHV initiative is “one of the most pioneering efforts” in the region’s health sector: “For the first time, the science behind early childhood in all its complexity has been incorporated into health care.” Overall, the evaluation concluded that the HV model design is adequate, evidence-based and able to deliver expected results with good prospects for UPHV to be sustainable and scalable in a significant number of countries.

The Evaluation also found that the progress in reforming or introducing UPHV has been uneven across countries reflecting their differing policy contexts, goals, existing services, staffing and funding levels, targeted populations and delivery and implementation methods. It recommended that in the future, the adequacy of the HV content and visit frequency needs to be better justified considering scope and focus of HV as well as the minimum number of universal and progressive visits determined within the means of the state budget.

One of the lessons learned emphasized by the evaluation was that introduction of UPHV requires a holistic view of the primary healthcare system. A ‘whole system’ approach to health-system analysis, planning and intervention design enhances the potential to scale up and sustain the new home visiting model. It is essential that countries consider how UPHV will be placed within their primary health-care system, and how these services will link to other parts of health care and to other sectors – as well as what services will be delivered and to which age groups. All these factors have important implications for determining the human resources and funding that will be required from national or international sources.

One of the primary barriers to the sustainability of effective and quality home visiting services was found to be the poor funding of the primary health-care sector in general, and UPHV in particular. Most of the funding still gets channelled to the secondary and tertiary health care levels so the overall advocacy to increase allocations to PHC level as well as reforms of PHC need to include focus to home visiting as its effective delivery platform.

Within the last five years countries tried to address the evaluation recommendations and the time has come to map the current status of implementation and common bottlenecks in order to provide the most optimal and efficient guidance and support from the Regional Office. The aim of the consultancy is to support development of a Maturity Model for home visiting and its implementation in assessing the maturity of home visiting practice and its functioning within the broader primary health care ecosystem. Maturity Models have been proposed in the health care domain with the purpose of assessing and improving the maturity of health care practices, operations and infrastructure.

To implement this task, UNICEF seeks to employ two consultants that should work together on the complementary ToRs. The first consultant with good understanding of and expertise in home visiting at primary health care level in Europe and Central Asia Region which should meet requirements of this ToR and the second consultant with expertise in development of maturity models whose tasks are described in a separate ToR.

Scope of Work

1. Develop a Maturity Model for Home visiting in ECA
2. Map and analyse the current state of implementation of UPHV using the Maturity model (with its dimensions covering policy framework, program design and implementation, workforce and its capacity, financing, and monitoring and reporting practices, and any additional relevant areas).
3. Identify common and country specific bottlenecks and priority areas that would benefit from additional technical support and guidance
4. Provide recommendations for the RO technical support

Work Assignment Overview

Tasks / Milestone	Deliverables / Outputs	Timeline / Deadline
Desk review of relevant documentation on UPHV ECARO model, its characteristics and general status of implementation across countries.	Overview of the mapping of the relevant home visiting documents	2 working days; By February 2024
Provide inputs to the Maturity Model for regional home visiting program in consultation with UNICEF ECA team. The Maturity model will include dimensions related to policy, governance, financing, workforce, service delivery and supply related to home visiting programs and be suitable for external as well as self-assessment.	Maturity model	1 working day; By February 2024
Provide inputs to the assessment methodology that will include data collection and management process and tools, informed by the Maturity model. The methodology will refer to the Maturity Model and define the process and actors within which its elements will be assessed. The data collection tools should be comprehensive, clear, user friendly for colleagues in country to collect available information and identify where missing information can be found. Methodology will include guidance for implementation of the Maturity model at country level and training resources for its use.	Assessment methodology	1 working day; By February 2024
Participate in the testing of the Maturity model in one country and based on the observations suggest revisions to the Maturity model, training for country participants and assessment methodology	Testing of Maturity model	1 working day; By March 2024
Participate and support implementation of Maturity model based assessment in 3 countries – Data collection supported by UNICEF country offices from 3 countries, with close support to country focal points, troubleshooting and data validation.	Data collected from 3 countries and database prepared to be handed over to UNICEF	3 working days; By April 2024
Analysis of data collected across 4 countries and development of a report with all findings. The report should include: (1) Executive summary, (2) Introduction, (3) Methods, (4) Results, (5) Discussion including strengths and limitations, (6) Conclusions and recommendations, and (7) References (included and excluded studies).	First draft ready for review by UNICEF ECARO and a comprehensive slide-set with summary of key results	3 working days; By April 2024
Implementation of Maturity model-based assessment in other 8 countries – Data collection supported by UNICEF country offices from 8 countries, with close support to country focal points, troubleshooting and data validation.	Data collected from 8 countries and database prepared to be handed over to UNICEF	16 working days; By May 2024
Analysis of data collected across other countries and development of the draft report and database with all findings. The report should include: (1) Executive summary, (2) Introduction, (3) Methods, (4) Results, (5) Discussion including strengths and limitations, (6) Conclusions and recommendations, and (7) References (included and excluded studies).	First draft ready for review by UNICEF ECARO and a comprehensive slide-set with summary of key results	3 working days; By June 2024
Final report with addressed comments and remarks from UNICEF	Final version available for review by COs and ECARO	1 working day; By June 2024
Develop short, glossy document presenting the regional picture, with country comparison and indication of main actions to strengthen UPHV in countries.	Summary report	3 working days; By July 2024
Presentation of the report	Webinar presentation or similar	1 working day; By July 2024
Development of recommendations for efficient and effective technical support to country offices based on recognized priorities across countries	Recommendations for prioritization of TA support from RO	2 working days; By July 2024

Estimated Duration of the Contract

37 working days between January 2024 and July 2024

Consultant’s Work Place and Official Travel

The Consultant will be remote/home-based.

As part of this assignment, some field travels are foreseen. The consultant will arrange her/his travel as and when they take place, and related costs will be reimbursed per UNICEF travel policy.

Travel Clause

• All UNICEF rules and regulations related to travel of Consultants apply.
• All travels shall be undertaken only upon the prior written approval by UNICEF.
• The consultant must be fit to travel, be in a possession of the valid UN BSAFE certificate, obligatory inoculation(s) and have a valid own travel/medical insurance and an immunization/vaccination card.

Estimated Cost of the Consultancy & Payment Schedule

Payment will be made on submission of an invoice and satisfactory completion of the above-mentioned deliverables. UNICEF reserves the right to withhold all or a portion of payment if performance is unsatisfactory, if work/outputs are incomplete, not delivered or for failure to meet deadlines. All materials developed will remain the copyright of UNICEF and UNICEF will be free to adapt and modify them in the future.

Please submit a professional fee (in USD) based on 37 working days to undertake this assignment, without travel fees as this will be reimbursed as and when they take place.

To qualify as an advocate for every child you will have…

• Advanced degree in health, public health, epidemiology, child development or relevant fields/ social sciences.
• Minimum seven (7) years of relevant work experience
• Familiarity with home visiting interventions in Europe and Central Asia Region
• Strong understanding of the public health systems
• Theoretical and practical knowledge of public health interventions and in particular home visiting at PHC level
• Documented experience in conducting systematic reviews of the medical or public health literature
• Documented experience in managing and analyzing a wide range of public health data
• Strong skills in analyzing and drawing conclusions based on information presented
• Excellent oral and written communication skills
• Excellent data analysis skills
• Fluency in English is required

For every Child, you demonstrate…

UNICEF’s core values of Care, Respect, Integrity, Trust, Accountability, and Sustainability (CRITAS), and core competencies in Communication, Working with People and Drive for Results.

To view our competency framework, please visit here.

UNICEF is here to serve the world’s most marginalized children and our global workforce must reflect the diversity of those children. The UNICEF family is committed to diversity and inclusion within its workforce, and encourages all candidates, irrespective of gender, nationality, religious and ethnic backgrounds, including persons living with disabilities, to apply to become a part of the organization.

UNICEF has a zero-tolerance policy on conduct that is incompatible with the aims and objectives of the United Nations and UNICEF, including sexual exploitation and abuse, sexual harassment, abuse of authority and discrimination. UNICEF also adheres to strict child safeguarding principles. All selected candidates will be expected to adhere to these standards and principles and will therefore undergo rigorous reference and background checks. Background checks will include the verification of academic credential(s) and employment history. Selected candidates may be required to provide additional information to conduct a background check.

Remarks:

Please include a full CV and Cover Letter in your application. Additionally, indicate your availability and professional fee (in USD) to undertake the terms of reference above. Applications submitted without a professional fee will not be considered. Only shortlisted candidates will be contacted and advance to the next stage of the selection process.

Individuals engaged under a consultancy or individual contract will not be considered “staff members” under the Staff Regulations and Rules of the United Nations and UNICEF’s policies and procedures and will not be entitled to benefits provided therein (such as leave entitlements and medical insurance coverage). Their conditions of service will be governed by their contract and the General Conditions of Contracts for the Services of Consultants and Individual Contractors. Consultants and individual contractors are responsible for determining their tax liabilities and for the payment of any taxes and/or duties, in accordance with local or other applicable laws.

The selected candidate is solely responsible to ensure that the visa (applicable) and health insurance required to perform the duties of the contract are valid for the entire period of the contract. Selected candidates are subject to confirmation of fully-vaccinated status against SARS-CoV-2 (Covid-19) with a World Health Organization (WHO)-endorsed vaccine, which must be met prior to taking up the assignment. It does not apply to consultants who will work remotely and are not expected to work on or visit UNICEF premises, programme delivery locations or directly interact with communities UNICEF works with, nor to travel to perform functions for UNICEF for the duration of their consultancy contracts.

UNICEF offers reasonable accommodation for consultants with disabilities. This may include, for example, accessible software, travel assistance for missions or personal attendants. We encourage you to disclose your disability during your application in case you need reasonable accommodation during the selection process and afterwards in your assignment.