Background

Overview:

This consultancy is requested by the United Nations Development Programme’s Regional Bureau for Asia and the Pacific (Bangkok Regional Hub) which acts as the Principal Recipient for the TB/MDR-TB interventions among Afghan refugees, returnees and mobile populations in Afghanistan, Iran and Pakistan (The Programme), funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund).

The Islamic Republic of Afghanistan (Afghanistan) has one of the highest numbers of refugees, returnees and internally displaced peoples (IDPs) in the region. In 2017, over 610,000 Afghans returned from Iran and Pakistan. This includes 60,000 registered refugees that returned from Pakistan, 100,000 undocumented returnees from Pakistan, and over 450,000 undocumented returnees from Iran. In 2016, following the arrival of more than 1 million documented and undocumented Afghan returnees, the existing capacity to absorb new arrivals in country is under significant strain and negative coping mechanisms such as remigration are increasingly prevalent[1].

Returns are taking place against a backdrop of increased internal displacement due to conflict and the nationwide drought (the worst in a lifetime- affecting over 3 million Afghans and resulting in massive displacement across the western region) and high civilian casualties due to persisting instability in several regions of Afghanistan. During 2018, over 300,000 individuals were newly displaced, while over 500,000 individuals were displaced in 2017. The continuing insecurity and limited capacity to absorb returning Afghans and those displaced within Afghanistan could lead to secondary displacement and onward movement.

Afghanistan, Iran and Pakistan have established strong national tuberculosis (TB) programs which have to date successfully ensured appropriate TB diagnosis, care and control services to populations, including migrants, refugees, returnees and IDPs. However, some of the TB services provided are not yet fully harmonized among the three countries. Moreover, the information on migrants, refugees, returnees and IDPs with TB is not routinely collected within the National TB Program networks of the three countries, and if it is, it is fragmented and not standardized.

Although in the previous years, there were some attempts among the NTPs of Afghanistan, Iran and Pakistan to collaborate in order to strengthen TB services provision to migrants and refugees moving across national borders, there is still no formal coordination mechanism to ensure i) harmonized strategy and policy development ii) implementation of a system to exchange standardized information on TB among migrants, refugees and returnees, iii) standardized and mutually supportive capacity building approaches, iv) regional approach to advocate for sustainable TB services for migrants, refugees, IDPs and returnees, v) regional and in-country dialogue on human rights and gender issues which affect access of target population to TB services and  vi) development of a regional network of partners.

There are three target groups important for cross-border collaboration on TB control and finding missing TB/MDR-TB cases amongst mobile Afghan populations:

• Afghan migrants living within the general population in Iran and Pakistan. There is a considerable number of these migrants in both Iran and Pakistan, who would receive similar levels of services as the general population of the host country.

• Afghan refugees or returnees living in camps/villages/settlements. This group is easier to reach out with targeted public health interventions. These camps/villages/settlements are covered by the neighboring health facilities, which need to be strengthened and equipped to handle the additional workload. No parallel structures operated by non-NTP affiliated entities should be additionally established, for the sustainability of services and capacity building of the local service providers for the long term. Existing health services within these settlements will be supported for establishing a functional referral mechanism to the nearest TB services. People living in camps are a congregated population and may need a specific algorithm for diagnosis of TB, which should be sputum examination by GeneXpert. There is also a need to develop mechanism for active case finding. The recommended options include use of digital X-rays and GeneXpert as follow-up/confirmation.

• Afghan migrants/refugees/returnees travelling across the national borders.  Diagnostic protocols differ between the three countries and even within the same country because of the diagnostic facilities/equipment availability and the different approach needed for different target populations (Annexes for each country’s approach). Iran has a specific lab algorithm for patient of Afghan origin.

Summary of the current treatment regimens is provided in Annex 1.

First line treatment is currently seen as being aligned. This is yet to be confirmed with involvement of the WHO-EMRO. All three countries are still using Category II treatment regiments, which all are planning to phase out. From 2020 there would be no Category II regimen in the three project countries.

Second line treatment algorithms are mostly aligned[2], except for:

• A minor difference in the standard MDR-TB treatment regimen in Pakistan – one medicine on the list (Ethionamide) is different from the other two countries, but this is not seen to be a big difference by the NTPs and WHO.
• The short course regimen is similar in all countries. However, differing levels of roll-out of the short course regimen in the three countries require careful and coordinated selection of treatment for patients:
  • Pakistan already offer short course regimen to more than 40% of MDR-TB patients;
  • Short course regimen has not started in Iran, but it will be applied during 2nd half of 2018 in the frame of an interventional (pilot) study in the country;
  • Afghanistan currently has two sites (Kabul and Kandahar) where short course regimen is available. Once more LPAs will be available in Afghanistan (in Nangahar, Mazar and Herat) the short course treatment will be offered there.

[1] The number of returnees from abroad increased by 24% in 2016 alone, compared to the period between 2012 and 2015, followed by a notable 52% decrease in returns in 2017. During all three-time frames, Nangarhar received the most returnees (499,194), nearly twice as many as Kabul (256,145)

[2] All EMR member states will be oriented on the revised MDR policies and guidelines and EMRO will provide guidance in the transition planning in April 2019

Duties and Responsibilities

Objective:

Consultancy to develop a multi-country[1] policy and referral and treatment guidelines for TB/DR TB prevention, care and control in migrants and settings with refugees, Internally Displaced Populations (IDPs) and returnees. The policy and referral and treatment guidelines will be aligned to the national strategies and guidelines.

Duties and Responsibilities

The following activities are expected to be completed as part of this assignment:

Expected Outputs and Deliverables:

The following are the expected outputs and deliverables:

1. A policy document on the TB services in settings with migrants, refugees, IDPs and returnees in Afghanistan, Iran and Pakistan. The document will describe the multi-country approach to the TB services for migrants, refugees, IDPs and returnees. (Expected up to 10 days)
2. Updated and harmonized TB diagnosis, prevention, care and control guidelines in settings with migrants, refugees, IDPs and returnees. This will result in harmonized TB prevention, care and control services. The document will propose interventions that will also improve TB services for women and children. The development of this deliverable requires country-specific actions which includes but not limited to national consultations to review, discuss and validate the proposed guidelines. (Expected up to 10 days)
3. Design a minimum package of service for cross border Tuberculosis care and services and develop three guidance documents (one in each country) on active screening in refugee settings. This document will specify (Expected up to 10 days):
   1. The criteria to select the refugee settings where the screening will be undertaken.
   2. The eligibility criteria for the refugees/IDPs/returnees who need to be screened for TB.
   3. The algorithm and standard operating procedures (SOP) to be used for active screening.
   4. The human resources that need to be involved at each step of the active screening.
   5. The information that should be collected in the process of active screening.
   6. The indicators needed for evaluation: e.g.: prevalence of TB among active screened refugees, number of refugees that needed to be screened to identify 1 TB case (NNS) and contribution of active screening to TB detection (ex.: number of TB cases identified through active screening divided by the total number of notified TB patients.
4. Recommend a standardized procedures and tools for cross-border transfer of TB cases between Afghanistan, Iran and Pakistan (expected up to 10 days):
   1. To develop a policy, strategy, guidelines and operational plan on the transfer of refugees and migrants  from one country to another while they are still on TB treatment.
   2. Develop the processes[4] and tools[5] for the exchange of information between the specialists and laboratories in Afghanistan; Iran and Pakistan to ensure the transfer of complete medical records;
   3.  Description of the cross-border continuum of care and feedback including the list of national TB focal points.
5. Compile a compendium of the developed strategies, tools and processes for use by the National Tuberculosis Programme and national stakeholders for achieving universal access to TB services for migrants, refugees and returnees. (Expected up to 10 days)
6. Develop a standardized training module for service providers on TB management in migrants, refugees, IDPs and returnees. This training module will be further adopted by each country to include gender, childhood and data confidentiality aspects in each country based on the relevant national policies. The module should include as well a component of the respective recording and reporting tools for data on TB/MDR-TB and related services for migrants, refugees, IDPs and returnees. After its adoption, the training module should be endorsed by each NTP and incorporated in the general training packages of NTPs; reproductive, maternal, newborn, child and adolescent health (RMNCHA) programs and civil society organizations dealing with the target populations in order to ensure its sustainability. (Expected up to 10 days)

Institutional Arrangement:

The Consultant shall report to the Team Leader for the Asia and the Pacific Health team at UNDP Bangkok Regional Hub. The work will be facilitated by with the UNDP Geneva Health Implementation support team in close coordination with the WHO Regional Office for the Eastern Mediterranean (EMRO) and the Stop TB partnership.

Duration of the Assignment:

The duration of the assignment is for 60 working days, 5 June 2019 to 15 November 2019.

Duty Station:

The position is home based with possible travel to Afghanistan; Iran and Pakistan.

1. In the event of authorized travel, payment of travel costs including tickets, lodging and terminal expenses should be agreed upon, between the respective business unit and the Individual Consultant, prior to travel and will be reimbursed by UNDP.

The fare will always be “most direct, most economical” and any difference in price with the preferred route will be paid for by the expert.

Travel costs shall be reimbursed at actual but not exceeding the quotation from UNDP approved travel

[1] in Afghanistan, Iran and Pakistan

[2] As listed in the outputs section below

[3] As listed in the section 5

[4] This includes : the procedures to be used in the United Nations’ reception facilities at the borders for the voluntary returnees; referral of refugees who are on treatment; refugees who are on Tb ttt and  are deported by the national authorities; cross-border referral of refugees who are on MDR ttt etc.

[5] This includes the content of the cross-border transfer form to be used.

Competencies

Corporate Competencies:

• Demonstrates integrity by modelling the UN’s values and ethical standards;
• Promotes the vision, mission, and strategic goals of UNDP;
• Displays cultural, gender, religion, race, nationality and age sensitivity and adaptability;
• Treats all people fairly without favouritism.

Technical Competencies:

• Analytic capacity and demonstrated ability to process, analyse and synthesise complex, technical information;
• Proven ability to support the development of high quality knowledge and training materials, and to train technical teams;
• Proven experience in the developing country context and working in different cultural settings.

Communication:

• Communicate effectively in writing to a varied and broad audience in a simple and concise manner.

Professionalism:

• Capable of working in a high pressure environment with sharp and frequent deadlines, managing many tasks simultaneously;
• Excellent analytical and organizational skills.

Teamwork:

• Projects a positive image and is ready to take on a wide range of tasks;
• Focuses on results for the client;
• Welcomes constructive feedback.

Required Skills and Experience

Education:

• Advanced university degree in public health or medicine.

Experience:

• At least 7-year experience working with TB programmes in developing countries,
• Experience with projects undertaken with governments of similar nature and magnitude, and
• And preferably, experience in working for TB programme in refugee/migratory settings.

Skills/Technical skills and knowledge:

• Expertise in development of tools and strategies for TB control.
• Sound knowledge of organization, processes and challenges in Tuberculosis management.

Language

• Fluent in English

Competencies

• Proven experience in designing/developing policies;
• Proven experience in designing/developing tuberculosis guidelines.
• Proven experience in designing/developing training materials and educational tools;
• Proven experience on supporting countries implement the Stop TB strategy;
• Excellent organizational, communication, interpersonal and writing skills

Price Proposal and Schedule of Payment :

The Consultant must send a financial proposal based on the lump sum amount.

The total amount quoted shall be all-inclusive and include all costs components required to perform the deliverables identified in the TOR, including professional fee, travel costs, living allowance (if any work is to be done outside the IC’s duty station) and any other applicable cost to be incurred by the IC in completing the assignment. The contract price will be fixed out-put based price regardless of extension of the herein specified duration. Payments will be done upon completion of the deliverables/outputs and as per below percentages:

In general, UNDP shall 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 event of unforeseeable travel not anticipated in this TOR, payment of travel costs including tickets, lodging and terminal expenses should be agreed upon between the respective business unit and the Individual Consultant, prior to travel and will be reimbursed.

Travel costs shall be reimbursed at actual but not exceeding the quotation from UNDP approved travel agent. The provided living allowance will not be exceeding UNDP DSA rates. Repatriation travel cost from home to duty station in Bangkok and return shall not be covered by UNDP.

Criteria for Selection of the Best Offer:

Applicants will be evaluated based on the following methodology. The award of the contract shall be made to the individual consultant whose offer has been evaluated and determined as a) responsive/compliant/acceptable; and b) having received the highest score out of set of weighted technical criteria ( Financial score shall be computed as a ratio of the proposal being evaluated and the lowest priced proposal received by UNDP for the assignment.

Technical Criteria for Evaluation (Maximum 70 points)

• Criteria 1 Eg. Relevance of Education – Max 10 points
• Criteria 2 Eg. Relevance of work experience - Max 20 points
• Criteria 3 Eg. Relevance of knowledge of key technical areas– Max 40 points

Only candidates obtaining a minimum of 49 points (70% of the total technical points) would be considered for the Financial Evaluation.

Documents to be included when submitting the proposals:

Interested individual consultants must submit the following documents/information to demonstrate their qualifications. Please group them into one (1) single PDF document as the application only allows to upload maximum one document:

• Letter of Confirmation of Interest and Availability using the template provided in Annex III. Note: National consultants must quote prices in Thai Baht.
• Personal CV, 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.
• Financial Proposal that indicates the all-inclusive fixed total contract price supported by a breakdown of costs, as per template provided. IF an Offeror is employed by an organization/company/institution, and he/she expects his/her employer to charge a management fee in the process of releasing him/her to UNDP under Reimbursable Loan Agreement (RLA), the Offeror must indicate at this point, and ensure that all such costs are duly incorporated in the financial proposal submitted to UNDP.
• Proposed outline of methodology for conducting the study (maximum 2 pages).

Incomplete proposals may not be considered. The shortlisted candidates may be contacted and the successful candidate will be notified

ANNEXES

Annex I - TOR_Consultancy to develop a multi-country  policy, referral and treatment guidelines

Annex II- General Condition of Contract

Annex III - Offerors Letter to UNDP Confirming Interest and Availability and Financial Proposal

All documents can be downloaded at :http://procurement-notices.undp.org/view_notice.cfm?notice_id=55565