Post Title:
Level of consultancy:
Duration of contract:
Office location:
International Consultant on Causal Analysis of Infant Deaths in Selected
Maternity Hospitals as a Technical Assistance to the Ministry of Health of the
Republic of Tajikistan
International Professional (P4) level
1st-2nd quarter of 2013 (32 w/ds)
Dushanbe
Closing date:
11 Nov.2012
BACKGROUND
Child survival remains one of the greatest challenges for Tajikistan’s fragile health system. According
to the international estimates, in recent years Tajikistan succeeded in sharply decreasing the Infant
Mortality Rate (IMR) from 75 per 1,000 live births (LB) in 2000 to 52 in 2010 and the Child Mortality
Rate (U5MR) from 93 in 2000 to 63 in 2010 (Tajikistan Health Profile, Countdown – 2015 Report,
2012). The neonatal mortality rate is estimated to be as high as 25 deaths per 1,000 live births in 2010
and represents 41 per cent of all deaths of children under-five, despite the fact that 88 per cent of births
are delivered by a skilled attendant1. Deaths of neonates during the first week of life are believed to be
caused by conditions originating in pregnancy or during childbirth. They are a result of inadequate or
inappropriate care during pregnancy, childbirth, or the first critical hours after birth. According to the
official statistics, each year some 1,500-2,000 newborns die during the first week of life due to
infectious diseases, birth trauma and asphyxia. Official MoH data (2010) further indicate that
congenital malformations contribute to more than 20 per cent of infant deaths and only 21 per cent of
deaths of children under-one are due to infectious diseases, such as diarrhoea and pneumonia.
Reliable national and sub-national data on causes of perinatal, neonatal and infant mortality are limited
in Tajikistan. Another issue is the discrepancy between the official MoH data and the data reported by
the State Statistical Agency on the number of births and deaths. According to MoH statistics, the IMR
in 2010 was 16.8 per 1,000 live births whereas the data reported by the State Statistics Agency
indicated the IMR to be 34 per 1,000 LB. It is believed that this discrepancy occurs due to high home
delivery rates and non-registration of births of a certain proportion of newborns within the first months
of life. Naturally, it’s difficult to determine the causes of infant and newborn deaths when babies are
delivered and die at home and when contact with the health system before and after delivery is limited.
These facts and issues limit the understanding of the situation and make it difficult to determine the
appropriate strategic direction to contribute to the reduction of perinatal, neonatal and infant mortality.
Thus, one of the recommendations of the 2011 Ministry of Health – UNICEF Annual Programme
Review meeting was to support the MoH in conducting a retrospective analysis of infant deaths (causal
analysis) and an assessment of the access and the quality of existing perinatal/neonatal care services
(human resources, equipment, capacity, etc). The findings and proposed recommendations of this
analysis (study) will greatly assist the MoH in development of evidence based life-saving strategies
and subsequent interventions in perinatal and neonatal care and child survival overall.
The Government of Tajikistan (GoT) has made a series of efforts to reduce infant and child mortality.
At the policy level, the GoT endorsed the National Child and Adolescent Health Strategy. It also
identified maternal, neonatal and child care and nutrition as priority areas in the recently adopted
Comprehensive Health Sector Strategy for 2010-2020. However, the implementation of these
strategies is hampered by factors both within and outside the health sector. Within the health sector,
issues of concern include: limited access to quality services, partly as a result of inadequate human
resources, a poor referral system and inadequate availability of commodities, equipment and supplies.
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Tajikistan Health Profile, Countdown – 2015 Report, 2012, www.countdown2015mnch.org/country-profiles/tajikistan
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In 2010, the MoH established the Neonatal Technical Working Group (TWG) and invited leading
neonatal care specialists from the national MCH institutions. The TWG aims to provide technical
assistance to the MoH in the analysis of neonatal care services, development of national protocols,
standards, monitoring tools and capacity building of health staff in the field.
In June 2012, a Government of Tajikistan delegation represented by the First Deputy Minister of
Health and the Director of Paediatric Research Centre attended the global meeting on Child Survival in
Washington, DC. During that meeting, the GoT committed to renew efforts in accelerating child
survival interventions with greater focus on those addressing challenges in the neonatal and postnatal
periods. In a follow up meeting with UNICEF, USAID and WHO, the First Deputy Minister of Health
called for a national conference to review existing child survival interventions and discuss evidencebased priority areas.
SCOPE OF WORK:
The study aims to identify the key causes of infant deaths by period (perinatal, neonatal and infant),
using qualitative and quantitate analysis. It will provide key recommendations /actions to be taken to
reduce infant mortality in Tajikistan.
The specific objectives of this study are:

To determine the main causes of why neonates die from the 28th week of pregnancy until the
first 28th day of life;

To determine the main causes of why infants die within the first 365 days of life;

To determine whether socio-economic status, geographical access or any other contributing
factors such as home delivery, have a direct causal relationship to neonatal and infant deaths;

To determine if complications during pregnancy and in delivery have adverse effects on the
pregnancy outcome, including disabilities;

To assess the availability of essential equipment, medicines other supplies, human resources
and guidelines required for the provision of curative and promotive maternal and newborn care;

To determine the adequacy of data collected by the routine HMIS in deriving key maternal and
infant health indicators.
STUDY METHODOLOGY:
The analysis will be conducted on the basis of the retrospective review of perinatal, neonatal and infant
deaths in selected maternities, hospitals and at home (2010-2011) utilising medical records (newborn
files and child health charts), death certificates and interviews with parents, birth attendants at home
and health staff. Interviews with key staff from the health authorities on the availability and quality of
perinatal/neonatal care and paediatric services will also be conducted.
The Ministry of Health through its Neonatal Thematic Working Group (TWG) will lead the
organization and implementation of the study and provide administrative support by issuing of
appropriate orders (prikaz) and engagement of local institutions and specialists at national and local
levels. The MoH will identify geographical areas in the north and south of the country and in
Dushanbe City where the study will be conducted. A national coordinator will also be appointed and
will ensure that briefing/debriefing for international consultant(s) will be organized. He/she will also
ensure participation of relevant professionals from national and oblast/district health departments for
execution of proposed activities. A team of field workers will be appointed by the Ministry of Health.
The field work will be supported by UNICEF through Direct Cash Transfer (DCT) to the Ministry of
Health.
WORK ASSIGNMENT:
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The consultant(s) will work closely with UNICEF Tajikistan and the TWG of the Ministry of Health:
Phase 1: Study preparation (1st quarter of 2013):

To prepare a work plan for the infant death analysis (study) in Tajikistan;

To design questionnaires for the study;

To develop the methodology for the study at the field level and introduce it during training to
the field teams;

To train field team workers (team leaders and interviewers) on proper data collection
methodology and procedures;

To prepare and submit progress report for the preparation phase.
Phase 2: Study implementation (2d quarter of 2013):

To monitor the study team work by preparing a monitoring plan and visiting the identified field
sites;

To prepare and, based on comments, to finalise the narrative report on the results of the study;

To prepare a set of recommendations for the MoH and UNICEF Country office;

To debrief the staff of the MoH, UNICEF and partners on the results of the study;

To submit the final report to UNICEF Country office by the end of the assignment.
EXPECTED DELIVERABLES:

Phase 1: Developed survey methodology, design/framework/tools (e.g questionnaire) prior to
field visits;

Phase 2: Narrative report with executive summary (2-3 pages), including all key findings,
recommendations and suggestions (governance/management, access and quality of perinatal
care services, key contributing factors to high perinatal, neonatal and infant mortality and links
to child disability). The report should also include suggested directions/actions to reduce
mortality and potential disability, including on human resource capacity. The report should also
include an equity analysis: a variety of factors, such as poverty (socio-economic status),
gender, ethnicity, race, religious or other cultural affiliations, education of mothers, and
geographic location of residence, might affect a child’s chance to survive before, during and a
month and a year after birth. Strategies to address inequity should be recommended if such
strategies/approaches do not exist or require improvements.
WORKING CONDITIONS:
The consultant(s) will work under the supervision of the Chief of Health and Nutrition Section and in
consultations with the Health Specialist of the UNICEF Country office and in collaboration with the
Ministry of Health of Tajikistan.
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REQUIRED QUALIFICATIONS:

Advanced University Degree in Medicine with specialisation in Neonatology, Perinatology
and/or Paediatrics;

At least 10 years of experience working with mother and child health, child survival and
perinatal/neonatal care service research and practices;

Experience in qualitative and quantitative research analysis;

Working experience in CEE/CIS region;

Excellent analytical and report writing skills;

Fluency in Russian and English
CONSULTANCY FEE:
Lump Sum fee at the rate of P4 level will be paid upon satisfactory completion of all assignments and
submission of deliverables (by phases) for not more than 32 working days (see below proposed
timetable).
PROPOSED TIMETABLE FOR CONSULTANCY:
Proposed timeframe to complete this assignment is 1st-2nd quarters of 2013.
Task/assignment
Location
Duration
Prepare a work plan for the infant death analysis (study) in
Tajikistan
Distance work
2 days
Design questionnaires and methodology for the study
Distance work
3 days
Develop protocols, procedures for interviewing, data entry and
analyses, and data transmission
In-country
5 days
Train field workers (team leaders and interviewers) on proper data
collection methodology and procedures
In-country
3 days
Monitor the field work
In country
5 days
Monitor and ensure quality of data entry process
In country
3 days
Distance work
10 days
In country
1 day
Submit final report to UNICEF Country office by the end of the
assignment.
Debriefing MoH and UNICEF , on key findings and
recommendations
TRAVEL AND DAILY SUBSISTENCE ALLOWANCE:
Travel from the country of origin of the consultant(s) will be undertaken by most economical carrier in
economy class. The consultant will receive UN-approved DSA while in Tajikistan.
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DUTY STATION:
The consultant(s) will be stationed in Dushanbe, Tajikistan with travel in all regions of the country.
PERFORMANCE INDICATORS:
The consultant(s) will report to UNICEF Tajikistan Chief of Health/Nutrition. Consultant’s
performance will be evaluated against the following criteria: timeliness, responsibility, initiative,
communication, and quality of the products delivered.
UNSATISFACTORY PERFORMANCE:
In case of unsatisfactory performance the contract will be terminated by notification letter sent 5 days
prior to the termination date. In the meantime, UNICEF will initiate another selection process in order
to identify an alternative candidate.
HEALTH STATEMENT & CERTIFICATE:
Health Statement and certificate of Good Health must be received prior to signing the contract.
Supervision:
Chief Health and Nutrition, UNICEF Tajikistan.
Application:
Qualified candidates are requested to submit a Cover letter, CV and UN P-11 form to
recruitmentdushanbe@unicef.org by the deadline of 11 Nov. 2012.
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