Background

Introductory Background

Globally, ‘key population’ groups such as sex workers, men who have sex with men (MSM) and people who use and inject drugs (PWU/IDs) are at increased risk of HIV infection compared with the general population. Each year, a significant number of new infections occur amongst these groups, influenced, in part, by the stigma and discrimination experienced in healthcare settings, including refusal of care, patient neglect, limited provision of differential treatment based on HIV status, breaches of confidentiality, isolation and verbal abuse by staff. Such experiences negatively affect the ability of key populations to engage with both prevention and treatment services, and can lead to inappropriate diagnosis, wrong or delayed treatment, negative effects on retention in care and, ultimately, to poor health outcomes or death.

 

In the Zimbabwean context, MSM, sex workers and PWU/IDs report frequent exclusion from society and high levels of stigma and discrimination in the healthcare setting. Judgmental and moralistic views towards sex work, sex between people of the same sex, homosexuality and drug use are frequently expressed within Zimbabwean communities, and more specifically by individuals working in the healthcare setting, warranting specific attention and address. Public sector healthcare providers receive limited professional training to support key populations and thus they often lack the appropriate skills or knowledge necessary to be adequately receive and manage key populations.

 

Key populations are often difficult to reach for critical testing, care, and treatment services. They face a higher risk of acquiring HIV and have higher risk for onward transmission and yet their access to services is limited. Their rates of accessing safe, effective, and quality HIV services are extremely low, while stigma and discrimination, including gender-based violence, are high among key populations compared to the general population.

 

Within the health care system, gaps exist in service provision for key populations including MSM, LGBTI and sex workers in their diversity. Key populations including MSM are to a large extent excluded in the continuum of care. Negative knowledge, attitudes, and practices (KAP) among health care workers premised on religious cultural and social norms, political rhetoric and legal restrictions have been proven to perpetuate stigma and discrimination among the MSM community. This stigma and discrimination have resulted in poor health seeking behaviours as MSM shy away from Health Care centres. Resultantly, this has contributed to sexually transmitted infections including HIV, and poor adherence to treatment, loss to follow up and high defaulter rates.

It is against this background, that SRC and partners seek to transform health services to make them more friendly towards and inclusive of key populations through direct service provision of clinical services at established community facilities like the Drop-in-Centres.

 

Overview of SRC

The SRC is a non-governmental organization established in 2007 and headquartered in Bulawayo, Zimbabwe. The SRC envisions a Zimbabwean society where the sexual reproductive health and rights of all people are respected, upheld, and protected. SRC exists to advance and promote the access, voice, agency, and empowerment of marginalised, vulnerable, and key population communities in Zimbabwe to realise quality, comprehensive and affirming sexual and reproductive health and rights. Thus, the core goal of the organisation’s work is on realizing the rights of young and adult lesbian, gay, bisexual, transgender, intersex and questioning persons (LGBTIQ+), sex workers (SW) in their diversity, people who use drugs, people with disabilities, adolescents, and young persons, including young people in tertiary institutions - to meaningfully contribute towards movement-building of the nascent movements, networks, and organisations of these populations. The secondary stakeholders include health practitioners and institutions; law enforcement officers and institutions; tertiary education institutions; religious leaders and institutions; the media; policymakers and other civil society organizations.

 

The organization is currently responding to five strategic goals (as underpinned in our Strategic Plan 2021-2025) namely:

  1. Strong and resilient individuals, movements, and communities of marginalised, vulnerable, and key population groups.
  2. Reduced stigma and discrimination.
  3. Improved and inclusive service delivery.
  4. Policy and practice change, harmonization, and full implementation.
  5. Organizational capacity strengthening, sustainability & management of change.

 

SRC is currently one of the implementing partners sub granted through UNFPA under the NFM3 Global Fund HIV MSM grant. One sticking challenge for this grant is the non-provision of clinical services at the SRC DICs. The Global Fund has approved a feasibility study to be conducted for SRC DICs on their suitability to offer clinical services. Clinical service provision for MSM at the DICs will help improve service uptake among MSM and other key population groups.  

Duties and Responsibilities

The Purpose and Scope

In Zimbabwe, key and vulnerable populations often face stigma and discrimination when accessing public health services and facilities. For example, when men who have sex with men (MSM) seek health care, the first thing that a health provider often wants to know is how they ended up in a situation where they are seeking sex with other men, with the implication that doing so indicates an illness. Sex workers are asked to bring their partners when accessing certain sexual reproductive health (SRH) services and the situation is even worse for male and trans sex workers as they can be shamed and called names in these centres. Meanwhile, the criminalization of people who use drugs has forced them to go underground, denying them access to health services due to their fear of detention or arrest. This has contributed to increased cases of depression, suicidal tendencies, and other mental health concerns among key population communities.

 

Many prefer to access private health care, which is very expensive, or go to clinics run by civil society organizations (CSOs), instead of visiting public health clinics. Most care providers in Zimbabwe do not have the adequate capacity to work with and offer services to key populations, and often demonstrate stigmatizing and discriminatory attitudes. In addition to the poor quality of services provided, there is evidence that key populations’ health concerns are being neglected, with some reports of sex workers presenting themselves late for treatment and with advanced STIs. 

Considering the situation described above, SRC and partners jointly advocated with the MoHCC to transform health services to make them more friendly toward and inclusive of key populations through the establishment of KP friendly clinical service providing facilities safe spaces like community Drop-in -Centres.

Deliverable

A feasibility report for clinical service provision for Sexual Rights Centre Drop in Centres.

 

Objective

  • To Carry out a feasibility study for clinical service provision for Sexual Rights Centre Drop in Centres

Duties and Responsibilities

 

The Consultant will:

  • Conduct desk review and present an inception report
  • Conduct Field data collection,
  • Prepare a draft report for review
  • Presentation to key stakeholders
  • Final report

Methodology/Scope of work

As part of the proposal for the conduct of the assignment, the Consultant will suggest technically sound methodology, and this will be evaluated as part of the selection process.

 

 The successful consultant will, however, propose a final methodology or approach for the conduct of the assignment, in consultation with SRC, UNFPA, NAC and UNDP, and this will reflect in the Inception Report. In the meantime, the proposed methodology or approach may consider some of the following:

 

•            Debrief meeting: - The consultant will have a debrief meeting with the UNDP Team, NAC, UNFPA and SRC to understand the scope of work. After the debrief meeting, the consultant will develop a roadmap to guide the assignment, as part of the inception report.

•            Desk Review of all relevant documents including the SRC Capacity Assessment Report, SRC programme and financial report, reports of implementation of the CD and other plans, SRC Policy and strategic documents etc.

•            Interviews with all relevant stakeholders including SRC, NAC, UNFPA, and relevant partners

•            Report on Analysis of data from desk Review and interviews to extract capacity gaps, lessons learnt, best practices etc;

•            Presentation of the results to all relevant stakeholders.

 

Expected Deliverables

  1. A description of the characteristics of the proposed clinical health facility, including geographical location and coverage, context and problems addressed, administration, services offered, adequacy of operational resources including inputs such as staffing, commodities including test kits, medicines, waiting facilities, that are essential in providing effective services.
  2. The model of HIV/SRHR service provision for KPs in the community health facility sector with reference to the minimum service packages: Particularly, to describe the nature and flow of health and HIV services that will be provided, including the standard package of services, highlighting the quality of services that will be provided by staff. 
  3. Describe the design of the integrated KP program highlighting strengths and weaknesses. The consultant will also describe the organization or group of persons whose work led to the successful changes, what was done, and with what goals in mind? To what do the team attribute success, and how do they know that they were successful? What would be the pitfalls? What would be the recommendation for other facilities?
  4. End user experiences on the quality of HIV/ SRHR service provision in the public sector: Document testimonies/ stories of change from selected clients and staff of the health facilities to determine the nature and quality of services wanted by KPs. The sample should include a representative number of people from the different key populations (MSMs, Sex workers, Transgender.) to explore experiential quality of HIV services by KPs including timeliness, friendliness of service, experiences of violence, stigma, and discrimination in facilities.
  5. Prepare a comprehensive report on the feasibility to establish clinical health facilities at community centres like the Drop-In -Centres in relation to the MoHCC evaluation criteria and give recommendations for effective service delivery for KPs.

 

Key deliverables

  1. Initial Consultations with Stakeholders to understand the scope of work (Inception Report- Week1)
  2. Desk Review (Desk Review Report - Week 1)
  3. Interviews with NAC, UNFPA, SRC (Interview Summary Report- Week 2 &3)
  4. Drafting of the report and costed plan (Draft - Week 4)
  5. Presentation of the report to Stakeholders (Presentation slides and Report of the meeting highlighting comments from stakeholders- Week 4)
  6. Finanlisation (Final Report - Week 5)

Reporting

The consultant shall report to the UNDP and all expected deliverables will be submitted to the UNDP for approval.

Evaluation

Candidates will be evaluated using a combined scoring method with the qualifications and methodology weighted at 70% and the price offer weighted at 30%.  Only candidates obtaining a minimum of 49% (out of 70%) points on the technical qualifications part will be considered for the Financial Evaluation.

Criteria for financial evaluation (30 points maximum):

  • p = y (µ/z), where
  • p = points for the financial proposal being evaluated
    y = maximum number of points for the financial proposal
    µ = price of the lowest priced proposal
    z = price of the proposal being evaluated

 

Payment Method

 

  • Payment: All-inclusive Daily Fee
  • The consultant will be paid as a daily rate (based on the number of days worked).
  • Payments will be based on the Certificate of Payments that will be submitted on a monthly basis;
  • Time Sheet will be attached and verified by the direct supervisor; and
  • Final tranche upon performance evaluation from the direct supervisor. Security: Individual Consultants are responsible for ensuring they have vaccinations/inoculations when travelling to certain countries, as designated by the UN Medical Director. Consultants are also required to comply with the UN security directives set forth under https://trip.dss.un.org

 

All envisaged travel costs must be included in the financial proposal. In general, UNDP does not accept travel costs exceeding those of an economy class ticket. Should the IC wish to travel on a higher class he/she should do so using their own resources. In the case of unforeseeable travel, payment of travel costs including tickets, lodging and terminal expenses should be agreed upon, between the respective business unit and Individual Consultant, prior to travel.

Application Submission Process

Step 1: Interested individual consultants must include the following documents when submitting the applications in UNDP job shop (Please note that only 1 (one) file can be uploaded therefore please include all docs in one file):

  • Personal History Form (P11), indicating all past experience from similar projects, as well as the contact details (email and telephone number) of the Candidate and at least three (3) professional references (the template can be downloaded from this link: http://sas.undp.org/Documents/P11_Personal_history_form.doc

Step 2: Submission of Financial Proposal

The Candidate must include all costs related to the assignment in the financial proposal.

The term ‘all-inclusive” implies that all costs (monthly professional fees, travel related expenses if applicable, communications, utilities, consumables, insurance, etc.) that could possibly be incurred by the Contractor are already factored into the financial proposal.

ANNEX 1 - INDIVIDUAL CONSULTANT GENERAL TERMS AND CONDITIONS is provided here: http://www.undp.org/content/dam/undp/documents/procurement/documents/IC%20-%20General%20Conditions.pdf

Competencies

Competencies and Qualifications

The SRC and partners, seek to commission the services of an experienced consultant to carry out the above assignment. The Consultant must possess the following Qualifications and Experience:

  • Education: A master’s in public health and any other related field will be an added advantage
  • At least 5 years’ experience in conducting documentation of best practices on HIV, SRHR, GBV programme.
  • At least 7 years demonstrable experience working in Health, HIV and Human Rights at global, regional and national levels in the context of Key populations.
  • Experience working with UN agencies, aids service organisations, and public health facilities. 
  • 3 years’ experience of working with key populations in their diversity.
  • Excellent analytical, writing and presentation skills.
  • Experience: In consulting for/ on LGBTIQ+ organizations and issues will be an added advantage
  • Language: Fluency in Ndebele and Shona will be an added advantage. An excellent command of the English language is a requirement.

Required Skills and Experience

Competencies and Qualifications

The SRC and partners, seek to commission the services of an experienced consultant to carry out the above assignment. The Consultant must possess the following Qualifications and Experience:

  • Education: A master’s in public health and any other related field will be an added advantage
  • At least 5 years’ experience in conducting documentation of best practices on HIV, SRHR, GBV programme.
  • At least 7 years demonstrable experience working in Health, HIV and Human Rights at global, regional and national levels in the context of Key populations.
  • Experience working with UN agencies, aids service organisations, and public health facilities. 
  • 3 years’ experience of working with key populations in their diversity.
  • Excellent analytical, writing and presentation skills.
  • Experience: In consulting for/ on LGBTIQ+ organizations and issues will be an added advantage
  • Language: Fluency in Ndebele and Shona will be an added advantage. An excellent command of the English language is a requirement.