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 MMEIG1, 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.
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UN Inter-agency group for Maternal Mortality Estimation (WHO, UNICEF, UNFPA, UN Population Division and the World
Bank)
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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 to combat 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
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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 policymaking 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:
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

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 prepared
and 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 8 years of international experience in providing high-level policy advice to Governments on
Mother and Child Health;
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
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 their CV and completed P11 form to UNICEF by e-mail at
hrtbilisi@unicef.org with ref. subject: Senior Policy Advisor on Mother and Child Health
Application deadline: COB 8 May 2014.
Only short-listed applicants will be contacted.
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