UNICEF UKRAINE
TERMS OF REFERENCE
National Consultant for the development of the national plan of scale up of the pilot
model of integrated care and treatment for drug-dependent pregnant women and
children born to them
Level: NO-B
Duration: 25 March – 25 June 2015, three months, 10 full working days per month.
Background
HIV prevention programmes in Ukraine for most-at-risk populations are lacking gender
specificity. Major improvements have to be made to enhance the quality and the pace of the
implementation of prevention programmes for women to reach MDGs and universal access to
HIV care and treatment targets. Despite the impressive progress of Ukraine’s PMTCT
programme, challenges remain when it comes to adequate access and timely entry into antenatal
care among pregnant women using drugs.
In 2011, injecting drug use was identified as the risk factor of mother-to-child transmission of
HIV in 19.1% of HIV-positive reproductive-aged women, and 3.5% of pregnant HIV+ women
reported active drug use during latest pregnancy (probably an underestimate due to the stigma of
admitting drug use, especially in pregnancy)1 . Only 29 of 395 (7.3%) of pregnant HIV+ pregnant
women who used drugs got substitution maintenance therapy and most opioid dependent
pregnant women continued using drugs during pregnancy. Pregnant women who inject drugs
have worse outcomes than other women: more advanced disease (14% vs. 6%), less access, more
adverse outcomes (preterm delivery 16% vs. 7%), and a higher mother-to-child transmission
rate2 . They are also 3.5 times more likely to be diagnosed with HIV in labour than other women
are. Moreover, relatively few HIV+ pregnant women who injected drugs received ARV
prophylaxis (65% compared with 94.5% overall)3.
Drug using women, like women vulnerable categories of the population such as Internally
Displaced People (IDPs), and homeless women are marginalized from the health care system and
are at high risk of adverse pregnancy outcomes. In current situation of humanitarian crisis, the
impoverishment of the population, especially vulnerable groups, loss of jobs, radicalization of
the society and increased tension contribute to the drivers of the expected epidemic growth (new
HIV- infections, MTCT increase), as well as to loss of adherence to ART (violation of schemes,
increased AIDS related death). There is a threat that Elimination of HIV mother-to-child
1
Martsynovskaya, 2012.
Thorne, 2012
3
‘Impact of expanded access to combination antiretroviral therapy in pregnancy: results from a cohort study in
Ukraine’, Bulletin of the World Health Organization; Type: Research Article ID: BLT.12.114405 Page 1 of 20,
Heather Bailey et al. Scale-up of antenatal combination ART in Ukraine.
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transmission in Ukraine will not be achieved if needs of vulnerable group of women, first of all
drug using pregnant women are not adequately addressed.
At the meantime, Ukraine recently confirmed its commitments to scale up Prevention of Motherto-Child Transmission of HIV programme (PMTCT) towards elimination of mother-to-child
transmission by 2015, approving a new National AIDS Programme for 2014 -2018.
In order to remove barriers to the provision and utilization of services by drug-using pregnant
women, UNICEF in partnership with NGOs, national and local authorities piloted in four pilot
cities an innovative integrated care and treatment services model (ICM) for drug-addicted
pregnant women, which has resulted in reduction of the MTCT level in the project sites4. While
the national MTCT rate among drug-using HIV-positive mothers is 11.7%, since 2011 when the
pilot model was established, there is only one case of HIV transmission to newborn is registered
in 209 project clients, 103 of whom are HIV-positive, which comprises 0.97%. The precondition
of success was setting up functional linkages between MCH, HIV services, addiction services
and integration with social services for pregnant drug using women. The external evaluation of
the pilot findings in 2014 noticed an increased access of the vulnerable women to PMTCT
services, i.e. improved accessibility of the site of integrated care and treatment, low threshold for
services established within the model, positive environment in the project setting, which include
service providers tolerance towards women5.
The pilot model of integrated medical and social services for pregnant drug using women in four
cities has demonstrated the positive results at impact level, evaluated as effective and included
in the approved by the Parliament NAP for 2014 – 2018 for further scale up. When expanded to
the national level, the model of integrated care and treatment (ICM) will provide access to and
uptake of gender responsive, non-discriminative and integrated medical and social services
targeting HIV vulnerable groups, including drug using pregnant women. This is a precondition
for further reduction of HIV transmission to newborns and elimination of MTCT in country.
So far, the ICM being included into the national policy, namely National AIDS Programme for
2014 – 2018, is not scale up within the country. T expand the model nationally, there should be
a plan of scaling up developed and approved by the Ministry of Health for its further
implementation at regional level.
There is a need in a national consultant knowledgeable in PMTCT programming, policy, and
programme implementation who will develop a framework and identify steps for a nation-wide
scale up of the pilot based on the results of the evaluation and its recommendations.
1. Objectives of the Special Service Agreement with expected results / outcome /
products /sub products/outputs:
The objectives are:
4
Tamar Gotsadze, Prevention of mother-to-child transmission and improving of neonatal outcomes among drugdependent pregnant women and children born to them in Ukraine, final evaluation report, 2014
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ibid
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 To ensure the experience gained while piloting the model of integrated care and treatment for
drug using pregnant women (ICM) and recommendations of external evaluation are carefully
examined;
 The national scale-up of the model is developed;
 To ensure the national plan of the model scaling up submitted to the Ministry of Health for its
further approval and implementation at regional level.
Results expected:
-
The national plan of ICM scaling up is developed and submitted to the Ministry of Health
for it further approval;
The national plan of ICM scaling up at national level is approved by the the Ministry of
Health;
MCH, HIV and addiction services are integrated, providing as a routine practice of
medical and social services for vulnerable to HIV pregnant women and children born to
them.
Outputs:
1. Draft of the national plan of ICM scaling up, including desk-review of the external
evaluation of the pilot model presented at the Working Group on PMTCT;
2. Presentation of the national plan of ICM scaling up at the Forum of the specialists for its
approval.
3. Submission of the national plan of ICM scaling up to the authorities (the Ministry of Health)
for approval.
2. Delivery dates based on the work plan (to be approved by UNICEF HIV/AIDS
Officer):
 Report on desk-review of the existing researches related to the pilot project and external
evaluation of the pilot model – 20 April, 2015;
 Power Point presentation Draft of the national plan of ICM scaling up at the Working Group on
PMTCT – 15 May, 2015;
 Presentation of the national plan of ICM scaling up at the Forum of the specialists for its approval
– 10 June, 2015;
 Submission of the national plan of ICM scaling up to the Ministry of Health for approval - by 25
June 2015.
3. Details of how the work should be delivered:
The consultants have to develop and submit to UNICEF a final report.
4. Performance indicators for evaluation of results:
The evaluation of results will be based on the following indicators:
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 Technical and professional competence (will be measured by the quality of product provided
to UNICEF and feedback from UNICEF)
 Quality of work (timely submission of the drafts as it is indicated in part 2 and final product to
UNICEF)
 Quantity of work (completion the assignments indicated in parts 2, 3 above)
 In addition, such indicators as work relations, responsibility and communication will be taken
into account during the evaluation of the consultant’s work.
5. Qualifications/specialized knowledge/experience required to complete the task:
a. An advanced university degree in Medicine/Public Health, an academic degree in medical
sciences is an asset;
b. At least five years of practical experience in HIV/AIDS area, including management of the
national projects in the area of HIV;
c. Recorded experience of development of regulation (clinical protocols and guidelines),
education and training materials in the area of PMTCT;
d. Knowledge of international best practices and standards in PMTCT and understanding of a
national health and social system structure and functions and national procedures related to
the regulation development;
e. Strong writing, organizational, communication and managerial skills;
f. Good working connections with the health authorities at national and local levels;
g. Basic knowledge of English and fluent in Ukrainian, as the Instruction has to be developed in
Ukrainian.
6. Definition of supervision arrangements:
The HIV/AIDS Officer, UNICEF Ukraine, will supervise consultant.
7. Description of official travel involved:
Travels are not envisaged.
8. UNICEF recourse in the case of unsatisfactory performance:
In the event of unsatisfactory performance, UNICEF reserves the right to terminate the
Agreement. In case of partially satisfactory performance, such as serious delays causing the
negative impact on meeting the programme objectives, low quality or insufficient depth and/or
scope of the assessment completion, UNICEF is entitled to decrease the payment by the range
from 30 to 50%.
9. Support provided by UNICEF:
Technical assistance, consultations, funding.
The deadline for submission of applications is 17 March, 2015.
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Only short-listed candidates will be contacted.
Applicants that fulfil the above requirements are requested to
complete a United Nations Personal History Form (P. 11) which is
available at a web-site www.unicef.org/employ and submit it
together with a CV and a cover letter describing your professional
interests in working for UNICEF.
Please, indicate National Consultant for the development of the
national plan
Fax No. 380-44-230-2506
E-mail: recruitment_kiev@unicef.org
UNICEF is committed to diversity and inclusion within its workforce, and
encourages qualified female and male candidates from all national,
religious and ethnic backgrounds, including persons living with
disabilities, to apply to become a part of our organisation
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