Background
(1) South Sudan HIV Programme Review: 35 working days from 28th November 2019 to 21 January 2020
(2) Review and Completion of the South Sudan National HIV and AIDS National Strategic Plan for 2018 to 2022: 20 Weekdays from 27 January to 28 February 2019
Phase 1: NSP Review and Completion Including a 1-Week Retreat 25 Working days from 27 January to 28 February 2019
South Sudan has a generalized HIV epidemic, with pockets of hyper-endemicity in the southern states and a concentration among key and vulnerable populations, including individuals in the uniformed services, sex workers, truck drivers, men who have sex with men, prisoners, and youth. Knowledge of HIV among the general and key populations in South Sudan is generally low while the practice of risky sexual behavior is high. Other cultural and social practices, such as the low status of women and girls, sexual and gender-based violence, the misconceptions about HIV/AIDS, and high levels of stigmatization and discrimination render them vulnerable to HIV/AIDS. Male circumcision is not a norm in South Sudan and most men in the country, who are not Muslim, are not circumcised.
UNAIDS estimates the HIV prevalence in South Sudan at 2.5% in 2018 and the number of PLHIV in South Sudan by end of 2018 at about 190,000 and the estimated new HIV infections at 19,000 (UNAIDS 2018). The AIDS Indicator Survey (AIS) planned to take place in 2017 could not be implemented due to the security situation in the country. The country has been relying on the data from the ANC survey, and as well as the annual spectrum analysis done in collaboration with UNAIDS. A 2014 mode of transmission report [South Sudan GARP report 2016] estimates that most of the new HIV infections are mainly in clients of sex workers (42.6%), children born by HIV infected mothers (15.7%), men and women involved in casual sexual relationships (14.5%), FSWs (11.2%) and couples in stable relationships (9%). Other modes contributing to new infections include MSM (3.9%), partners of the KPs (0.6%) and partners of those who engage in casual sex (1.6%). Medical injections and blood transfusion are estimated to contribute 0.02%.
Over the past years the country has noted steady increase in the number of people enrolled for HIV care and antiretroviral therapy (ART). A total of 31,585 (17% of PLHIV) were on ART by December 2018. The ART coverage has largely been affected by insecurity and the high defaulting and lost to follow-up rates as a result of population displacements.
South Sudan has an ongoing HIV National Strategic Plan (NSP) covering 2017-2022. In 2019, the Government finalized and released results of ANC Sentinel Surveillance Survey conducted in 2017. In addition, a number of Integrated Behavioural and Biological Surveys (IBBS) for sex workers and men having sex with men have been conducted and disseminated. This new strategic information including the annual UNAIDS country AIDS estimates will provide key information towards the impact and outcome targets of HIV programs in the country. At the same time, the current Global Fund supported HIV grant will end in 2020 and the country has planned to submit a new Concept Note (CN) to the Global Fund in March 2020. The lessons learnt from the programme implementation and the forthcoming recommendations from the programme review will feed into the next Global Fund request as well as the annual PEPFAR Country operational planning in South Sudan.
Assignment 1: National HIV Programme Review
Objectives of the National HIV Programme Review
The purpose of the HIV programme review is to determine whether the implementation of the national programme is moving in the right direction and is on course to meet the targets defined in the strategic plan. In addition to implementation, this programme review will also examine progress in the services being provided (outputs) and how the relevant populations use these services (outcomes). This programme review shall also review impact where data are available, or time has been sufficient to demonstrate impact. Depending on the outcome, this programme review shall be used to make adjustments to the strategic plan (reprogramming). The adjustments could involve modifying targets, priority population groups or types of interventions.
This Program Review Aims to Answer 5 Review Questions
Are the right HIV interventions being implemented in South Sudan?
- Adequate policies, plans and targets defined.
- Appropriate interventions for the type of epidemic and right population groups identified.
- Adequate resources available and allocated in line with priorities.
- Sufficient human resources, infrastructure, equipment, supply chain and information systems.
Are the HIV programs being implemented in the right way?
- Service delivery models appropriate for reaching the right population groups.
- Decentralization of services and community empowerment.
- Partnership and inclusive planning, implementation and accountability.
- Integration with other health and development programmes.
- Effective programme management, coordination and quality assurance.
Are the HIV program interventions being done on an enough scale to produce impact?
- Type and quantity of services and products provided.
- Number and distribution of service delivery sites relative to target populations.
Are the right people being targeted and reached by planned interventions?
- Coverage of services.
- Behavior change
Is the HIV programme as currently implemented making a difference?
- HIV incidence in general population and specific populations.
- HIV prevalence in general population and specific populations.
- AIDS mortality in general population and specific populations.
- HIV-related morbidity.
The Scope of the Programme Review
This program review shall cover all HIV prevention, care and treatment interventions for the general population, key populations and vulnerable populations. Given the fact that there are multiple implementing and development partners in South Sudan, this review will cover all interventions irrespective of source of the funding. The review is expected to recommend how different interventions can leverage on the existing sources of funds including PEPFAR, the Health Pooled Fund (HPF) supporting the Basic Package of Health & Nutrition Services (BPHNS), the Rapid Results Health Project (RRHP) funded by the World Bank. Given that the geographic scope is too large to cover in its entirety, the review team, in consultation with the program review steering team shall select a sample of states and project sites to be visited during the field trip, ensuring to the extent possible, that site visits are as representative. The review team shall present the sampling criteria that the team will use in the pre-mission report.
Duties and Responsibilities
The evaluation is expected to take a maximum of 30 working days. The following is the list of activities expected to be undertaken by the Lead Consultant.
Work with the Lead Consultant to provide technical advice on the content and process of the review, and provide guidance and support to the programme review team including the other consultants
Work with the Lead Consultant to design the overall HIV Programme Review process in consultation with the review team that will include two (2) international consultants, Ministry of Health HIV/AIDS/STIs Department, National TB and Leprosy Control Program, Development partners (such as WHO, UNDP) and other relevant stakeholders
Take the lead in review of HIV Care and Treatment for the General Population, and other Population Groups, including ART services, elimination of HIV infections in children, HIV and TB collaborative services, Community Systems and related services
In liaison with the National HIV Programme and other consultants, identify background information and documents required for the review, prepare the protocol and the assessment checklists
Take lead in identifying list of facilities to be visited for field observation, list of stakeholders to be consulted during the review process
In liaison with the national coordinator, plan and coordinate data collection
Work with the Lead Consultant in compilation of field reports, overall analysis and the generation of findings
- Work with the Lead Consultant to provide leadership and discuss with technical groups at various stages of the consultancy and revise the document accordingly
- Work with the Lead Consultant to facilitate and present the draft review findings and recommendation to the MOH and stakeholders for validation
- Work with the Lead Consultant to finalize the report for review in collaboration with other consultants and review members.
5. Deliverables for the Lead Consultant (HIV Programme Review)
Inception report detailing
- Design of the review/approach/workplan
- List of documents to be reviewed
- List of stakeholders to be visited
- Data collection tools for the programme review
- Sample of facilities to be visited
- Schedule of field visits
Final review report, with clear and feasible recommendations aimed at improving Programme performance
Assignment 2: Review and Completion of the South Sudan National HIV and AIDS National Strategic Plan (NSP) for 2018 to 2022
Rationale for the NSP Review and Completion
The utilization of the draft NSP as a response guiding document has been limited. This has largely been due to the fact that the NSP performance framework lacks adequate hard evidence in form of values for baselines, annual, midterm and end of term targets which limits effective programming, interventions coverage planning, resource mobilization, process evaluation as well as results measurement. The review and completion shall therefore not fundamentally change the interventions and strategic prioritization of the NSP but will instead add value to their focus and potential to response acceleration. It is due to these limitations that South Sudan wishes to review the draft NSP to address these inadequacies to have a more effective and enabling programming and response guiding framework.
Objectives of the NSP Review and Completion
- To review the draft NSP by way of updating the body of evidence to inform/ enhance the epidemiological analysis and performance framework
- To review the NSP to have it more user-friendly in regard to volume, content and content outlay or presentation
Duties and Responsibilities of the National Consultant
The national consultant shall work under the supervision of Lead Consultant, supporting the review process and as part of the technical team to provide an in depth analysis in the national multi-sectoral strategic framework document. Specific duties include:
Support the review of the NSP overall socio-economic development status, the HIV related epidemiological situation to reflect the new evidence, as much as possible, based on the most current reliable data
To review and strengthen the performance framework by updating the indicators, provision of evidence-based data on baselines and targets to the achievable standards, and to re-costing the reviewed NSP
Support the review of the NSP performance framework in order to include the new evidence as much as possible, based on the most current reliable data as baselines and performance targets for the next three years, 2019/20-2022/23
Support the revision of Rthe NSP results framework to logically reflect the alignment to the international treaties and guidelines and instruments to attain the response of 90-90-90 target cascade based on the revised/ new baselines and performance targets
Support the production of an abridged version of the NSP to make it user friendly to stakeholders and thus the enhanced buy-in
Support the review of the review of the NSP M&E Plan to correspondingly reflect/make use of the same new epidemiological evidence, new NSP results and performance framework baselines and cascaded targets and data sources
Support the review of the NSP National Operational Plan (NOP) to correspond and reflect/ make use of the same new epidemiological evidence, new NSP results and performance framework baselines and cascaded targets and data sources
Support the review of the NSP to enhance the desired re-alignment to existing and any new/ national, regional and global overarching HIV and related development policies and technical response frameworks in line with the South Sudan HIV epidemic categorization
Support the development of the NSP quick reference/ promotional /marketing fact sheets/ profiles/ in form of wall chart, NSP quick reference brochure, and as well as quick reference brochures on each of NSP pillars: Prevention; Care and Treatment and; enabling environment. These materials are aimed at enhancing accelerated stakeholder buy-in
Deliverables for the National Consultant in Support of the Lead Consultant
The overall NSP, the M&E plan and the Operational Plan are reviewed and updated, reflecting the most current reliable data
The NSP performance framework is revised and updated with new baselines and targets and well-articulated for the next three years, 2019/20-2022/23
- User friendly NSP document produced (reduced in content)
- The NSP is aligned to the new existing national, regional and global overarching HIV policies and frameworks
- NSP quick reference/ fact sheets/ profiles/ in form of wall chart, brochures, etc. are produced for distribution.
Competencies
Required Competencies for the HIV Programme Review, and the NSP Review and Completion
Corporate Competencies
- Demonstrates diplomacy and tact in dealing with sensitive and complex situations
- Able to work in difficult and remote areas for extended periods of time
Professionalism
- Demonstrates professional competence and mastery of subject matter;
- Demonstrated ability to negotiate and apply good judgment;
- Shows pride in work and in achievements;
- Is conscientious and efficient in meeting commitments, observing deadlines and achieving results;
- Excellent analytical and written skills proven by produced evaluation reports or relevant documents in English.
Planning & Organizing
- Organizes and accurately completes multiple tasks by establishing priorities while taking into consideration special assignments, frequent interruptions, deadlines, available resources and multiple reporting relationships
- Plans, coordinates and organizes workload while remaining aware of changing priorities and competing deadlines
- Establishes, builds and maintains effective working relationships with staff and clients to achieve the planned result.
Required Skills and Experience
Education
- An university degree in Medicine, Public Health, Epidemiology, Statistics, Health Economics, or Social Sciences with a proven track record in managing studies, programme Reviews, NSPs, and ensuring sound processes in data collection and analysis in the field of HIV
- Postgraduate training or diploma in TB or HIV/AIDS management is an added advantage
- Specialized training in monitoring and evaluation will be an added advantage
Experience
- At least 5 years of working experience in designing and managing program/project reviews especially in the areas of HIV/AIDS or similar public health programmes
- Proven experience in conducting independent review of national or large-scale HIV programmes
- Experience in leading multi-disciplinary team on review of large-scale public health interventions, especially HIV programme
- Good understanding of the HIV epidemic in the East and North Africa Region is an added advantage
- Good understanding of the HIV situation in post conflict Africa; knowledge of the HIV situation and response to the epidemic in South Sudan is an asset
- Excellent Knowledge of broader health policies and HIV/AIDS Control Programmes
- Knowledge of the guiding principles/recommendations on HIV/AIDS prevention, treatment and care
- Strong experience in providing technical programmatic assistance to developing countries and post-conflict settings on HIV and AIDS policy and strategic framework development
- Ability to meet tight deadlines and to work effectively under pressure
- Computer skills including Microsoft office, spreadsheet, database, etc.
Language:
- Fluent in English.
Payment Method for the two Consultancies
- The consultant shall be paid on a daily rate (based on the number of working days worked)
- The consultant shall be paid a Daily Subsistence Allowance (DSA)
- Payments shall be based on the Certificate of Payments that will be submitted
- Time Sheet will be attached and verified by the direct supervisor; and
- Final tranche upon performance evaluation from the direct supervisor.
Reporting for the HIV Programme Review, NSP Review and Completion
- For the HIV Programme Review, the lead Consultant shall report to the Ministry of Health Director General of Preventive Health Services and as well as the Global Fund Coordination Advisor. The two shall review progress and certify deliverables.
- For the NSP Review and Completion, the lead Consultant shall report to the South Sudan HIV Commission (SSAC) and as well as the Global Fund Coordination Advisor. The two shall review progress and certify deliverables.