Post Title:
International Consultancy on Technical Assistance to the
Ministry of Health and Social Protection (MOHSP) of
Tajikistanon Strengthening Capacity in ARV Therapy for
Pediatric AIDS (PA) and Prevention Mother–to-childHIV
Transmission (PMTCT) in Tajikistan 2014
Duration of contract:
May – Sep. 2014 (26 working days)
Office location:
Dushanbe, Tajikistan
Closing date:
25 May 2014
TERMS OF REFERENCE
BACKGROUND:
1. Pediatric AIDS (PA)
As of 1 April 2014, the Republican AIDS Centre reported acumulative total of 424 HIV-confirmed
cases among children in Tajikistan. The number of new HIV cases reported among children has
increased significantly over the past years from 17 in 2010 to 74 in 2011, 137 and 134 in 2012 and
2013, with majority of them being the children under five years of age.
For more than two-thirds of the registered HIV positive children, the mode of transmissionis unknown,
which is likely to be attributed to medical interventions (unconfirmed). More than 190 newborns born
from HIV-positive mothers are still under epidemiologic observation, awaiting the final confirmation
of their HIV status at the age of 18 months. As of today, 329 HIV-positive children are covered by
anti-retroviral therapy (ART). About half of the children who receive ART face side effects and
various complications of the therapy. More than one third of HIV positive children have an
opportunistic infection including TB infection.
Pediatric AIDS forms the central part of the HIV/AIDS programme within the framework of the 20102015 UNICEF-Government of Tajikistan (GoT) Country Programme of Cooperation. However, the
capacity of medical specialists working in the field of Pediatric AIDS is still low, whichadversely
affects the access and the effectiveness of programme delivery and the quality of services provided to
HIV-positive children.
In December 2010, UNICEF supported the Ministry of Health and Social Protection (MoHSP) to build
the capacity of 14 specialists (pediatricians, infectious disease specialists and the staff of the
Republican AIDS center) on infant HIV epidemiology, early diagnosis and HIV clinical stages.
However, this basic 5-day training course on pediatric AIDS was not sufficient to establish strong
knowledge and, most importantly, clinical skills on ART, opportunistic infection prevention and care.
To further enhance the knowledge and clinical skills on Pediatric AIDS, in 2011 and 2012, UNICEF
supported the follow-up capacity building of the 7specialists (out of 14 earlier trained) through on-thejob training courses provided by the OKHMADIT clinic in Kiev, Ukraine, as well as PENTA
advanced training in Tashkent, Uzbekistan. Currently,only 3 specialist-pediatricians out of those
trained intensively in the past are actively engaged in Pediatric AIDS service delivery, while 19
specialists who are newly assigned in AIDS centre are providing ART for children without adequate
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training. All 3 specialist-pediatricians are all based in Dushanbe city. In this context, scaling up the
capacity on ART for Pediatric AIDS is a priority for the national HIV programme.
2. Prevention of Mother to Child Transmission (PMTCT)
As of 1 December 2013, there were a total of 367 pregnant women infected with HIV. In 2013 alone,
the Republican AIDS Centre reported 112 HIV cases among pregnant women, about 70 percent of
whom were identified during pregnancy and childbirth, while the remaining 30 percent had known
their status beforehand. According to the national sentinel surveillance system, the estimated HIV
prevalence among pregnant women is stable at around 0.05 – 0.06 %. As of 31 December 2013, the
coverage of pregnant women, who attend the ANC, with HIV voluntary counselling and testing (VCT)
is 90% nationwide. The percentage of HIV-infected pregnant women, who received ART to reduce the
risk of HIV transmission from mother to child ranges from 82% (national statistics) to 51.6%
(spectrum analysis) depending on the data sources.
Like Paediatric AIDS, support to the PMTCT programme is also an important part of 2010-2015
UNICEF-GoT Country Programme of Cooperation. In 2012, with support of UNICEF, an international
expert was hired to introduce the new recommendations of WHO clinical protocol 10 published in
2012 to the Ministry of Health specialists in PMTCT and Pediatric AIDS during 10–day workshop. As
a result of this workshop, two major documents were developed: 1) Training manual for health
specialists on PMTCT and Pediatric AIDS, entitled, “HIV in pediatricians”; and 2) the revised national
PMTCT policy and clinical protocol in alignment with 2012 WHO recommendations. Subsequently,
the Ministry of Health endorsed the PMTCT / Pediatric AIDS training manual, and with UNICEF
support, it was translated from Russian into Tajik language and published. In 2013, National PMTCT
Thematic Working Group of the Ministry of Health also finalized and endorsed the national PMTCT
policy and protocol. The national policy covers the responsibility and authority of the PMTCT
programme management on national level, algorithm of HIV testing of pregnant women, procurement
of supplies and core indicators of the programme. In 2014, UNICEF involved two international experts
to organize three batches of 5-day training sessions on ARV administration for HIV+ positive pregnant
women in line with the updated PMTCT clinical protocol. The training covered 64 selected
obstetrician-gynaecologists and specialists in infectious diseases and AIDS from Dushanbe, Districts
under Republican Subordination (DRS), and Khatlon. Unfortunately, the planned training in Khujand
for health specialists from Sougd region did not take place due to the severe weather conditions, while
there is still a high need to train them as requested by MoHSP and Oblast Reproductive Health Centre:
In the first quarter of 2014 alone, 57 new HIV cases were registered among pregnant women
nationwide, out of which 15 cases were in Sougd region.
OBJECTIVES:
The proposed consultancy aims to:
- Assist the MoHSP in the revision of the national Pediatric AIDS clinical protocol in
accordance with the updated recommendation of WHO1
- Assist the MoHSP in the formulation of a national policy direction to introduce a systematic
approach for Pediatric AIDS service delivery with a view to improving access for children in
need of ART to ‘child-friendly’ services. This will include the issues of horizontal and vertical
co-ordination mechanism, algorithm of children’s examination,clear referral system, resource
management, human resource capacity scale-up plan, and monitoring mechanism.
- Assist the MoHSP in buildingknowledge and skills of health specialists (Pediatricians,
Infectious Disease Specialists and staff of AIDS centers)in ART for PediatricAIDSin
linewiththe updated recommendations of WHO2.
1
WHO ART guidelines 2013 and HIV Treatment and care for children, Clinical Protocol 11 for WHO European
Region (2012 revision).
2
WHO ART guidelines 2013 and HIV Treatment and care for children, Clinical Protocol 11 for WHO European
Region (2012 revision).
2
-
Assist the MoHSP in building a pool of health specialists in Sougd Oblast on administration of
the national ART protocol for HIV positive pregnant women in line with the updated national
protocol on PMTCT3.
This activity is a part of the UN Agency to UN Agency Contribution Agreement between UNAIDS
and UNICEF for 2014 and is funded by a Grant of the Russian Federation.
KEY ASSIGNMENTS:
An international consultant will be responsible for the assignments as stipulated below.
Pediatric AIDS
 Providesupport to the national working group on Pediatric AIDS4in revising Pediatric AIDS
clinical protocol in accordance with the updated recommendation of WHO and developing a
national policy direction to improve access to Pediatric AIDS services through the ‘child-friendly’
rooms. This will include the facilitation of a two-day consultative workshop on the same topics.
 Along with the national working group members, conduct visitsto the clinics delivering ART
services in Dushanbe, Rudaki, Vakhdat, Kulob and Khudjand districts to assess the current
practices of ART for HIV positive children. Based on the assessment findings, provide a set of
recommendations to the working group and MoHSP to improve service access and quality.
 Provide clinical coaching and mentoring support for the leading professionals in Pediatric AIDS
who are part of the national working group on Pediatric AIDS. This will be done through
providing consultation advice for the real cases – particularly the complex cases such as HIV+
childrenwho suffer from the side effects of ART, etc.
 Prepare syllabus of the 5-day training course on ART for Pediatric AIDS, outlining the course
contents, learning objectives, and a list of training / reference materials for each session; as well as
a package of the handouts to be distributed during the training courses.
 In consultation with the national experts of the MoHSP, finalize training agenda and define the key
topics to be co-facilitated by the international consultant and the national expert, respectively.
 Facilitate along with the national expert a 5-day training session for core group of 20 health
specialists on Pediatric ART with practical skills development in accordance with the updated
recommendations of WHO. The training should include sessions for “case studies” based on the
complicated cases collected during the field visit to discuss together the ART regimens and their
adjustment.
PMTCT
 Review the existing syllabus of the 5-day training course on ART for PMTCT, outlining the course
contents, learning objectives, and a list of training / reference materials for each session; as well as
a package of the handouts to be distributed during the training courses; and adjust them, if
necessary.
 Facilitate along with the national expert a 5-day training session for a core group of 15 selected
health specialists (comprising obstetrician-gynecologists, infectious diseases and AIDS specialists)
on administration of ART for HIV + pregnant women including B+ strategy in Sougd oblast.
DELIVERABLES:
The consultant should deliver the following:
Pediatric AIDS
MoH order № 259, 06.05.2013 of the national PMTCT clinical protocol based on the updated WHO Clinical
Protocol 10, (2012 revision, WHO European Region)
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The national working group on Pediatric AIDS comprises health specialists in ART, pediatricians and infection
diseases.
3
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 Policy direction to introduce a systematic approach for Pediatric AIDS service delivery with a
view to improving access for children with HIV to “child-friendly” services;
 Revised clinical protocol on Pediatric AIDS in alignment with the updated WHO
recommendations;
 Agenda and syllabus of the 5-day training courses, outlining the course contents, learning
objectives, and list of training / reference materials for each session; as well as a package of the
handouts distributed during the training courses (incl. PowerPoint presentations), including the
case study cards for practical exercise.
 Actual facilitation of a 5-day training session.
 The participant’s evaluation form to assess the level of knowledge of the related subject before and
after the training sessions.
 Report of the training sessions, including findings, constraints, strengths and evaluation results.
PMTCT
 Agenda and the updated syllabus of the 5-day training course, outlining the course contents,
learning objectives, and list of training / reference materials for each session; as well as a package
of the handouts distributed during the training courses (incl. PowerPoint presentations)  Actual facilitation of a 5-day training session in Khujand.
 The participant’s evaluation form to assess the level of knowledge of the related subject before and
after the training sessions.
 Report of the training session, including findings, constraints, strengths and evaluation results.
Overall
 Debriefing meeting(s) with the policy makers, health and HIV managers, UNICEF officials, and
other stakeholders at the conclusion of the assignment.
 Final report, summarizing the achievements made and constraints faced during the assignment as
well as a set of recommendations and follow-up actions.
Requirement: All documents should be provided in hard and electronic copies.
QUALIFICATIONS:
 Advanced University Degree in Medicine or Public Health;
 At least 10 years of proven academic and clinical experience in HIV/AIDS prevention and
control, including PMTCT, Pediatric AIDS and ARV treatment/prevention;
 Experience working with UNICEF/WHO or other international organizations in the similar
field;
 Very good organizational, writing and verbal communication skills;
 Experience to conduct training in the specific area;
 Excellent communication and facilitation skills;
 Fluency in Russian is a must (due to the complexity of the subject and new area of learning in
specificity of ART) and knowledge of English is preferable;
 Advanced computer skills.
PROPOSED PERIOD AND DURATION OF CONSULTANCY:
Time scope
Mid-May - June
2014
Activity
Preparation:
Desk review of the literature, including the
existing clinical protocols on opportunistic
infections, ART, TB, PMTCT, etc. in
Tajikistan.
Initiate drafting of a Pediatric AIDS policy
direction.
Preparation for the training sessions –
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Consultant work days
5 days
Time scope
August – September
2014
September 2014
Activity
syllabus / training materials development.
In-country assignments:
4 days of visits to clinics;
2 days of work with the national work
groupon PA Protocol revision;
5-day training session on ART for Pediatric
AIDS;
5-day training session on ART for PMTCT;
1 day for the meeting with the decision
makers to provide feedback on the mission
and discuss the key recommendations
Wrap-up:
Polishing the revised clinical protocol and
policy direction for Pediatric AIDS.
Report writing.
Consultant work days
17 days
4 days
Consultant Work Days: 26 days
Consultancy Period: 4 months (From mid-May - end-September 2014)
Timing for the consultancy is negotiable, but the entire assignment needs to be completed by no later
than mid-November 2014.
REPORTING, LOCATION AND TRAVEL:
The consultant will be stationed in Dushanbe with travel to Rudaki andVakhdat districts of RRS,
Kulob district of Khatlon region and Khudjand city, Sougd region. S/he will work under supervision of
the Chief of Health Nutrition of UNICEF Dushanbe in close coordination with the UNICEF Young
People’s Health and Development (YPHD) and HIV Officer and the Technical Working Group of the
MoHSP.
UNICEF Tajikistan will cover travel-related costs, including return travel of the consultant by the most
direct route in economy class from her/his home country to Tajikistan and within Tajikistan. Daily
Subsistence Allowance (DSA) will be paid as per UN rules.
APPLICATION:
Qualified candidates are requested to submit a Letter of interest, CV, UN Personal History
Form
(P11)
(which
could
be
downloaded
from
our
website
www.unicef.org/tajikistan/resources_6744.html) and references from previous consultancies
to recruitmentdushanbe@unicef.orgor mailed to UNICEF Country Office at the following
address: UNICEF, Dushanbe, Bokhtar street 37/1, Vefa Center, 7th floor by the deadline of25
May 2014.
In their Letter of Interest, candidates should highlight previous work experience relevant to the
assignment, the attributes that make them suitable, their proposed approach to the assignment and
their anticipated daily rate fee for the assignment.
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 organization.
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CONDITIONS OF THE SERVICE:
General Conditions of Contracts for the Services of Consultants / Individual Contractors
1. Legal Status
The individual engaged by UNICEF under this contract as a consultant or individual
contractors (the “Contractor”) is engaged in a personal capacity and not as representatives of a
Government or of any other entity external to the United Nations. The Contractor is neither a
"staff member" under the Staff Regulations of the United Nations and UNICEF policies and
procedures nor an "official" for the purpose of the Convention on the Privileges and
Immunities of the United Nations, 1946. The Contractor may, however, be afforded the status
of "Experts on Mission" in the sense of Section 22 of Article VI of the Convention and the
Contractor is required by UNICEF to travel in order to fulfill the requirements of this contract,
the Contractor may be issued a United Nations Certificate in accordance with Section 26 of
Article VII of the Convention.
2. Obligations
The Contractor shall complete the assignment set out in the Terms of Reference for this
contract with due diligence, efficiency and economy, in accordance with generally accepted
professional techniques and practices.
The Contractor must respect the impartiality and independence of UNICEF and the United
Nations and in connection with this contract must neither seek nor accept instructions from
anyone other than UNICEF. During the term of this contract the Contractor must refrain from
any conduct that would adversely reflect on UNICEF or the United Nations and must not
engage in any activity that is incompatible with the administrative instructions and policies
and procedures of UNICEF. The Contractor must exercise the utmost discretion in all matters
relating to this contract.
In particular, but without limiting the foregoing, the Contractor (a) will conduct him- or
herself in a manner consistent with the Standards of Conduct in the International Civil
Service; and (b) will comply with the administrative instructions and policies and procedures
of UNICE relating to fraud and corruption; information disclosure; use of electronic
communication assets; harassment, sexual harassment and abuse of authority; and the
requirements set forth in the Secretary General's Bulletin on Special Measures for Protection
from Sexual Exploitation and Sexual Abuse.
Unless otherwise authorized by the appropriate official in the office concerned, the Contractor
must not communicate at any time to the media or to any institution, person, Government or
other entity external to UNICEF any information that has not been made public and which has
become known to the Contractor by reason of his or her association with UNICEF or the
United Nations. The Contractor may not use such information without the written
authorization of UNICEF, and shall under no circumstances use such information for his or
her private advantage or that of others. These obligations do not lapse upon termination of this
contact.
3. Title rights
UNICEF shall be entitled to all property rights, including but not limited to patents, copyrights
and trademarks, with regard to material created by the Contractor which bears a direct relation
to, or is made in order to perform, this contract. At the request of UNICEF, the Contractor
shall assist in securing such property rights and transferring them to UNICEF in compliance
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with the requirements of the law governing such rights.
4. Travel
If UNICEF determines that the Contractor needs to travel in order to perform this contract,
that travel shall be specified in the contract and the Contractor’s travel costs shall be set out in
the contract, on the following basis:
(a) UNICEF will pay for travel in economy class via the most direct and economical route;
provided however that in exceptional circumstances, such as for medical reasons, travel in
business class may be approved by UNICEF on a case-by-case basis.
(b) UNICEF will reimburse the Contractor for out-of-pocket expenses associated with such
travel by paying an amount equivalent to the daily subsistence allowance that would be paid to
staff members undertaking similar travel for official purposes.
5. Statement of good health
Before commencing work, the Contractor must deliver to UNICEF a certified self-statement
of good health and to take full responsibility for the accuracy of that statement. In addition,
the Contractor must include in this statement of good health (a) confirmation that he or she
has been informed regarding inoculations required for him or her to receive, at his or her own
cost and from his or her own medical practitioner or other party, for travel to the country or
countries to which travel is authorized; and (b) a statement he or she is covered by
medical/health insurance and that, if required to travel beyond commuting distance from his or
her usual place or residence to UNICEF (other than to duty station(s) with hardship ratings
“H” and “A”, a list of which has been provided to the Contractor) the Contractor’s
medical/health insurance covers medical evacuations. The Contractor will be responsible for
assuming all costs that may be occurred in relation to the statement of good health.
6. Insurance
The Contractor is fully responsible for arranging, at his or her own expense, such life, health
and other forms of insurance covering the term of this contract as he or she considers
appropriate taking into account, among other things, the requirements of paragraph 5 above.
The Contractor is not eligible to participate in the life or health insurance schemes available to
UNICEF and United Nations staff members. The responsibility of UNICEF and the United
Nations is limited solely to the payment of compensation under the conditions described in
paragraph 7 below.
7. Service incurred death, injury or illness
If the Contractor is travelling with UNICEF’s prior approval and at UNICEF's expense in
order to perform his or her obligations under this contract, or is performing his or her
obligations under this contract in a UNICEF or United Nations office with UNICEF’s
approval, the Contractor (or his or her dependents as appropriate), shall be entitled to
compensation from UNICEF in the event of death, injury or illness attributable to the fact that
the Contractor was travelling with UNICEF’s prior approval and at UNICEF's expense in
order to perform his or her obligations under this contractor, or was performing his or her
obligations under this contract in a UNICEF or United Nations office with UNICEF’s
approval. Such compensation will be paid through a third party insurance provider retained by
UNICEF and shall be capped at the amounts set out in the Administrative Instruction on
Individual Consultants and Contractors. Under no circumstances will UNICEF be liable for
any other or greater payments to the Contractor (or his or her dependents as appropriate).
8. Arbitration
(a) Any dispute arising out of or, in connection with, this contract shall be resolved through
amicable negotiation between the parties.
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(b) If the parties are not able to reach agreement after attempting amicable negotiation for a
period of thirty (30) days after one party has notified the other of such a dispute, either party
may submit the matter to arbitration in accordance with the UNCITRAL procedures within
fifteen (15) days thereafter. If neither party submits the matter for arbitration within the
specified time the dispute will be deemed resolved to the full satisfaction of both parties. Such
arbitration shall take place in New York before a single arbitrator agreed to by both parties;
provided however that should the parties be unable to agree on a single arbitrator within thirty
days of the request for arbitration, the arbitrator shall be designated by the United Nations
Legal Counsel. The decision rendered in the arbitration shall constitute final adjudication of
the dispute.
9. Penalties for Underperformance
Payment of fees to the Contractor under this contractor, including each installment or periodic
payment (if any), is subject to the Contractor’s full and complete performance of his or her
obligations under this contract with regard to such payment to UNICEF’s satisfaction, and
UNICEF’s certification to that effect.
10. Termination of Contract
This contract may be terminated by either party before its specified termination date by giving
notice in writing to the other party. The period of notice shall be five (5) business days (in the
UNICEF office engaging the Contractor) in the case of contracts for a total period of less than
two (2) months and ten (10) business days (in the UNICEF office engaging the Contractor) in
the case of contracts for a longer period; provided however that in the event of termination on
the grounds of impropriety or other misconduct by the Contractor (including but not limited to
breach by the Contractor of relevant UNICEF policies, procedures, and administrative
instructions), UNICEF shall be entitled to terminate the contract without notice. If this
contract is terminated in accordance with this paragraph 10, the Contractor shall be paid on a
pro rata basis determined by UNICEF for the actual amount of work performed to UNICEF’s
satisfaction at the time of termination. UNICEF will also pay any outstanding reimbursement
claims related to travel by the Contractor. Any additional costs incurred by UNICEF resulting
from the termination of the contract by either party may be withheld from any amount
otherwise due to the Contractor under this paragraph 10.
11. Taxation
UNICEF and the United Nations accept no liability for any taxes, duty or other contribution
payable by the consultant and individual contractor on payments made under this contract.
Neither UNICEF nor the United Nations will issue a statement of earnings to the consultant
and individual contractor.
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