Vacancy Announcement

Senior Policy Advisor / Consultant on Mother and Child Health, UNICEF Georgia

BACKGROUND

Situation

Despite decreasing child mortality (U5MR dropped from 34.1 per 1,000 live births in 2000 to 20 in 2013), Georgia is only halfway towards achieving MDG 4 (U5MR target: 11.4 per 1,000 live births). Child mortality is the second highest in Europe. The largest share in child mortality is still attributed to infant mortality (87.5%) and this situation has not changed much since 2000 when the Infant Mortality Rate fraction in U5MR was 90%.

The 2010 Reproductive Health Survey indicated significant difference in child mortality rates in urban and rural areas – 1.7 urban vs. 2.2 rural. UNICEF’s 2013 equity analyses of the excessive infant deaths in Georgia suggests that (a) infants outside Tbilisi were 1.4 times more likely to experience a death than infants in Tbilisi and (b) infants born outside Tbilisi weighting 1,500+ grams are 1.9 times more likely to die than infants in Tbilisi before the discharge from maternity and 1.5 times more during the post discharge period.

The situation with regard to maternal mortality has not been improving. On the contrary it has been worsening since according MMEIG[1], in 2000 the MMR estimate was 58 per 100,000 live births, while in 2010 the MMR estimate was 67 per 100,000 live births.

Although when reporting on child and maternal mortality related to MDGs, the Government uses the estimates of IGME and MMEIG, for other purposes nationally produced statistics are being used, as well. There has been a discrepancy between the inter-agency groups’ estimates and national statistics. According to national statistics, in 2013 U5MR was 14 per 1,000 live births while in 2010 MMR was 23 per 100,000 live births. The latter indicates the need for through review and further strengthening of the national data collection and reporting system.

The 2012 UNICEF study on the Economic Consequences of Malnutrition in Georgia indicated that nearly 300 annual deaths of children below five years of age result from maternal anaemia, low birth weight, folic acid related birth defects and suboptimal breastfeeding. Over the next ten years the national burden of malnutrition is estimated at USD 1.3 billion,including about 3,400 premature deaths of children. Stunting prevalence rates, which have not changed during the past 10 years, highlight inequities between the poorest and the richest.

As a result of continuous isolation and the sensitive political context caused by armed conflict, in Abkhazia 42,000 children receive basic services of lower quality than those available to their parents a few decades ago. Availability and quality of basic services, including maternal and child healthcare is low, mainly due to inadequate infrastructure and the inadequate capacity of service providers.

UNICEF programme

Within the country programme, the introduction of regionalized perinatal care was considered as one of the important steps towards improving maternal and child health care. Extensive advocacy efforts in 2011 resulted in the adoption of the regionalized perinatal care master plan by the Ministry of Labour, Health and Social Affairs to ensure that pregnant women deliver at the right place and the new-born receives care in a technologically appropriate setting. Although the plan has not been fully translated into action, a number of interventions have been undertaken to improve the quality of care Minimum set (20) of basic protocols in neonatology and obstetrics were developed and adopted by the Ministry for use. However, due to the absence of quality monitoring and improvement mechanisms at the facilities the implementation is lagging behind.

In 2013, UNICEF started addressing issues related to the fragmentation of mother and child health services by recommending a new MCH Management Information System which will (a) track mother and child through pregnancy, delivery and perinatal care until the child reaches the age of 6; (b) ensure systematic collection of relevant data and (c) transform the raw data into useful information and serve as a powerful tool for MCH quality management and evidence-based decision and policy making.

To support the ministry in addressing the inadequate quality and organization of preventive and counselling services for mothers and children, the primary health care level was assessed and new models for effective reorganization were defined. These models will be coasted in 2014 and will support the further improvement of PHC services within the context of the on-going health sector reform.

UNICEF study on the economic consequences of malnutrition was followed up by development of an integrated portfolio of cost effective interventions tocombat malnutrition in Georgia. The said portfolio was recommended to the Government and agreement was reached on the introduction of mandatory flour fortification and micronutrient supplementation for 6-24 month children and pregnant women. The amendment to the Law on Prevention of Iodine, Other Micronutrient and Vitamin Deficiencies’ was submitted to the Parliament in the second half of 2013.

The main objective of the interventions supported in the conflict-affected region of Abkhazia has been to ensure access to quality healthcare for targeted vulnerable populations, especially in maternal and child health care. The capacity of health workers was enhanced, best practices in pre-natal care and obstetric and neonatology protocols were introduced. In 2013, a new immunization calendar in line with WHO recommendations was adopted, new vaccines were introduced, the immunization database was regularly used and a central cold storage room in Sukhumi installed.

Lessons learned

  • Evidence-based policy making in the Ministry of Health, Labour and Social Affairs is constrained by limitations of the Maternal and Child Health Management Information System and analytical capacity.
  • The recent introduction of free universal access to maternal and child health services needs to be complemented by an improvement of the quality and organization of the service delivery models in order to reduce maternal and child mortality. This includes regular capacity development of health care providers and enforcement of monitoring and quality assurance mechanisms.
  • In order to reduce malnutrition, the envisaged adoption of the amendment to the Law on Prevention of Iodine, Other Micronutrient and Vitamin Deficiencies’ and the provision of micronutrient (and other) supplements to children and mothers needs to be complemented by an education campaign for public and health service providers.

RATIONALE AND OBJECTIVES

Recently, the Government of Georgia has been introducing major shifts in its health sector policy, including the introduction of universal health insurance and intentions to more strongly regulate the previously liberalized health sector. In the 2013 and 2014 state budgets, expenditures for the health sector have significantly increased. Consequently, this has led to increasing demands on the policy-making capacity of the Ministry of Labour, Health and Social Affairs. It also provides significant opportunities for UNICEF assistance in improving mother and child health care in Georgia.

The assignment / consultancy aims at pursuing the implementation of the recommendations of the mid-term review of the Programme of Cooperation between the Government of Georgia and UNICEF by assisting policy-making and capacity development of the Ministry of Labour, Health and Social Affairs.More specifically, it builds on earlier consultancies related to the Mother and Child Management Information System and the assessment of the Primary Health Care system.

WORK ASSIGNMENT, EXPECTED OUTPUTS AND DELIVERABLES

In cooperation with UNICEF’s Health Specialist, the Senior Mother and Child Health Policy Advisor / Consultant will provide policy advice, advocacy, technical assistance and capacity development to the Government, in particular the Ministry of Labour, Health and Social Affairs, and assist in the implementation of the recommendations of the mid-term review of the Programme of Cooperation between the Government of Georgia and UNICEF. The Advisor will coordinate and advocate with relevant stakeholders and support resource mobilization and further development of UNICEF’s programme.

Taking into account the results of earlier consultancies related to the Mother and Child Health Management Information System and the assessment of the Primary Health Care system, the above will be specifically focused on the following:

  • the restructuring of the maternal and child health system and the revision of the respective regulatory framework, namely:

-the regionalization of the maternities across the country by levels, the implementation of maternal and new-born inter-hospital transfer guidelines, the strengthening of the capacity of perinatal service providers and the development of supportive supervision mechanisms

- the strengthening of the primary health care services for mothers and children through the introduction of the home-visiting model (including antenatal care, child growth and development, monitoring of children aged 0 – 5 years and screening for developmental delays and early detection and intervention), revision of job description and development of an appropriate curricula within pre-service and post-graduate medical education system,;

  • enhancing the maternal and child health surveillance system, including the birth and death registration system, and strengthen the capacity of public health officials and experts to make evidence-based decisions and informed policy choices;
  • Other areas as identified by the Ministry of Labour, Health and Social Affairs and UNICEF, including related to UNICEF’s interventions in Abkhazia.

Deliverables

In respect of the above issues, the following deliverables are expected to be produced:

  • Government counterparts and other development partners provided with policy advice in support of key reform processes;
  • Policy papers, draft legislation, regulations, guidelines, protocols and other technical documents preparedand presented to the Ministry of Health, Labour and Social Affairs and other key stakeholders;
  • Capacity of Government counterparts, health care professionals and other stakeholders developed;
  • Government partners, key development stakeholders and other influencers provided with evidence supporting UNICEF’s recommendations;
  • Partnerships developed to advance Mother and Child Health, donor proposals prepared, new donors identified and resources mobilized.
  • Public policy dialogue supported;

QUALIFICATIONS

  • Advanced university degree in health sector policies or other related field;
  • Minimum of 8years of international experience in providing high-level policy advice to Governments on Mother and Child Health;
  • Excellent communication and writing skills;
  • Excellent English language skills

WORK SUPERVISION AND REPORTING

Assigned expert will be directly supervised by the Deputy Representative.

TIMING AND DURATION

Initial duration of the assignment for one year with the possibility for extension depending on funds availability.

HOW TO APPLY

Interested candidates are requested to submit theirCV and completed P11 form to UNICEF by e-mail at with ref. subject: Senior Policy Advisoron Mother and Child Health

Application deadline: COB 8 May 2014.

Only short-listed applicants will be contacted.

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[1] UN Inter-agency group for Maternal Mortality Estimation (WHO, UNICEF, UNFPA, UN Population Division and the World Bank)