Terms of Reference
Title:
Procurement of Services for drug users in Malindi in
Kilifi County, Kenya – Under Project KENY16
Organisational Section/Unit:
United Nations Office on Drugs and Crime (UNODC) – Regional
Office for Eastern Africa; HIV prevention, treatment and care for
people who use drugs in Kenya.
Duty Station:
Malindi, Kilifi County, Kenya
Proposed period:
1 August 2015- 31 July 2016
Actual work time:
1 year (with a provision of an extension for three more
Years subject to the conditions defined in the ToR below)
1. Background of the assignment:
Kenya has a population of 38 million, 45% of them below 15 years of age. As of December 2011, an
estimated 1.6 million people in Kenya were reportedly living with HIV. Evidence shows that the HIV
epidemic has shifted from a generalized to a mixed one, with concentrated epidemics among key
populations. According to the Kenya Modes of Transmission (KMoT) 2008 study, 3.8% of all new adult
HIV infections were attributed to injecting drug use, reaching as high as 17% for the Coastal Counties
(KMoT 2008).
Heroin use and injecting drug use have been documented in Kenya for more than two decades.
According to the UNODC World Drug Report 2013, prevalence of heroin use is 0.22%, approximately
49,000 users among the population aged 15 to 64 years. A 2012 Rapid Situation Assessment (RSA) of the
Status of Drug and Substance Abuse in Kenya by the National Authority for the Campaign against Alcohol
and Drug Abuse (NACADA) revealed an increase in lifetime use of heroin among persons aged 15-65
years from 0.4% in 2007 to 0.7% in 2012. The Kenya Consensus Report on Size Estimations for Key
Populations published in April 2013 determined a point estimate of 14,716 persons who inject drugs
within clients who are on MAT Nairobi and Coast provinces. However, the UNODC/ICHIRA Rapid
Situational Assessment of HIV Prevalence and Risky Behaviors among People Who Inject Drugs (PWID)
(2011) revealed a much higher estimate of between 10,000 to 49,200 people who inject drugs (PWID) in
the two regions. Although the Kenya Consensus Report estimates about 18,327 PWID for all regions,
there is paucity of data on IDU for other parts of Kenya.
Both the UNODC/ICHIRA RSA of PWID in Nairobi and Mombasa and Population Council’s Integrated BioBehavioral Survey (IBBS) conducted in 2011 revealed that males comprise 90% of PWID. Almost all PWID
inject drugs daily, with 75% injecting at least thrice per day. Between 33-50% of them ever shared
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injecting equipment with close friends or primary sex partners. HIV prevalence for PWIDs in Nairobi and
Mombasa was confirmed as 18%, which is significantly higher than 6.3% for the general population
(KDHS 2008/09). Although females comprise a small proportion of PWID, their HIV prevalence was 44.5%
compared to 16.0% for males.
According to WHO/UNODC/UNAIDS and USG/PEPFAR guidance on HIV prevention among PWID, two
critical and interrelated components of an effective response to drug and HIV epidemics are (i) Opioid
substitution therapy (OST) as well as needle and syringe programmes (NSPs), together with (ii) HIV
Testing and Counselling and the provision of antiretroviral therapy for those who need it. NSP has
recently been implemented and plans are underway to implement Opiate Substitution Therapy (OST).
Kenya is embarking on an ambitious plan to rapidly scale-up of interventions to prevent new HIV and
hepatitis infections among people who inject drugs (PWID) and enhance their well-being and quality of
life by the introduction of the core elements of the United Nations and USG/PEPFAR guidance on HIV
prevention among PWID. Achieving high coverage rates and monitoring progress in reaching PWID for
core interventions is critical to impacting and the further spread of HIV among PWID. Kenya, with
support from USG/USAID, UNODC and UNAIDS will be implementing a comprehensive HIV public
health harm reduction programme with a major focus on introducing and scaling-up core interventions
methadone maintenance services in Kenya and particularly Mombasa. There is strong supporting
literature and evidence indicating that high quality and high coverage OST programmes that retain PWID
in treatment reduce drug use, injection frequency, prevent HIV transmission and facilitate entry and
adherence in ART programs. Critical to the programme is monitoring the progress towards achieving the
overall goal of averting new HIV infections, preventing morbidity and mortality is establishing a robust
programme centered Monitoring and Evaluation approach that includes setting targets according to the
WHO, UNAIDS and UNODC Technical Guide for countries to set targets for Universal Access to HIV
Prevention, Treatment and Care for Injecting Drug Users.
The core interventions and linked processes included in this project are:
o Needle and syringe programme access (NSP)
o Medication assisted treatment (MAT)
o Referral & linkage from outreach , NSP and MAT to others HIV services including HIV Testing
and Counselling (HTC) through the Opt-In and Opt-Out model, antiretroviral therapy (ART) and
psychosocial support
o Peer Education/outreach
A key component of this project is for a local services provider to provide a Drop-in Centre where people
who inject drugs (PWID) and women heroin users can access information and education on harm
reduction, namely HIV prevention, HIV testing and counselling (HTC), Needle and Syringe Exchange
Programmes (NSEP), psychosocial support and referrals to a Medically Assisted Treatment (MAT) site.
This in turn will ensure optimal client recruitment and retention in HTC and MAT services as well in
antiretroviral therapy (ART) for those who are found HIV positive and fulfil ART eligibility criteria.
2. Purpose of the assignment:
The objectives of the assignment are as follows:
1. To strengthen an existing Drop-in Centre (DIC) where PWID may easily access harm reduction
services, counselling, HTC and psychosocial support
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2. To have a number of outreach workers, both men and women, who are experienced with
community outreach work with PWID and who will interface with this key population where they
live and use drugs
3. To inform, educate and communicate with male PWID and women heroin users, both injecting
and non-injecting, on harm reduction (1,000 in year 1, 2,000 in year 2, 3,000 in year 3 and 4,000
in year 4)
4. To provide clean needles and syringes to PWID and educate them on vein care (500 in year 1,
750 in year 2, 1,250 in year 3 and 1,500 in year 4)
5. To provide condoms to PWID who are sexually active
6. To educate PWID and women heroin users on MAT (1,000 in year 1, 2,000 in year 2, 3,000 in year
3 and 4,000 in year 4)
7. To educate the larger immediate communities on the benefits of MAT to drug users, their
families and the community at large
8. To engage ongoing community advocacy for the promotion of human rights for drug users
9. To provide HTC or refer for HTC to male PWID and women heroin users (400 in year 1, 800 in
year 2, 1,500 in year 3 and )
10. To refer male PWID and women heroin users to MAT service delivery points (400 in year 1, 800
in year 2, 1,500 in year 3 and 2,000 in year 4)
11. To provide psychosocial support and facilitate peer support to clients who are on MAT
12. To collect programme-based data and feed them in a real-time monitoring system
13. To submit four quarterly, two semi-annuals and one annual progress report each year.
14. Specific tasks to be performed by the service provider:
The assignment will be carried out under the supervision of the Project Officer based UNODC ROEA, the
national project officer based in Mombasa, and the project coordination committee in Kenya.
The service provider will be required to produce all documents requested to UNODC during the
assignment including a complete report confirming details on all deliverables mentioned above.
15. Expected tangible and measurable output(s):
1. A Drop-in Centre (DIC) in Malindi, Kilifi County, where PWID easily access harm reduction
services, counselling, HTC and psychosocial support fully operational
2. Outreach workers, both men and women, experienced in community outreach work with PWID
interfacing with this key population where they live and use drugs
3. Male PWID and women heroin users, both injecting and non-injecting, on harm reduction
reached, informed, educated and communicated on harm reduction as follows: (1,000 in year 1,
2,000 in year 2, 3,000 in year and 4,000 in year 4)
4. Clean needles and syringes provided to PWIDS not on MAT programme as follows: (500 in year 1,
750 in year 2, 1,250 in year 3 and 1,500 in year 4)
5. Condoms provided to all PWID who are sexually active
6. PWID and women heroin users referred and put on MAT as follows: (1,000 in year 1, 2,000 in
year 2, 3,000 in year and 4,000 in year 4)
7. The larger immediate communities educated on the benefits of MAT to drug users, their families
and the community at large
8. Ongoing community advocacy to promote the human rights of drug users
9. Male PWID and women heroin users provided with HTC or referred for HTC as follows: (400 in
year 1, 800 in year 2, 1,500 in year 3 and 2,000 in year 4 )
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10. Psychosocial support and facilitate peer support to clients who are on MAT
11. Programme-based data collected and fed in a real-time monitoring system
12. Four quarterly, two semi-annual and one annual progress reports to be submitted each year.
16. Dates and details as to how the work must be delivered:
The work will start on 1st July 2015 and end on 1st July 2016 and the schedule will follow to reach the
targets defined above for year 1. The contract may be extended for another period of three years, one
year at a time, subject to the satisfactory performance of the selected organization and to the availability
of funds.
It is to be noted that only one locally-based organization in the selected communities will be recruited to
deliver the defined services in each project site. This means that three different organizations will be
recruited to provide the defined services in each community where they are already embedded and
providing services to people who use drugs, especially those who are injecting drugs.
17. Indicators to evaluate the service provider’s performance:
1. A Drop-in Centre (DIC) in Malindi, Kilifi County, fully operational in project site
2. Outreach workers, both men and women, experienced in community outreach work with
PWID interfacing with this key population where they live and use drugs
3. Male PWID and women heroin users, both injecting and non-injecting, on harm reduction
reached, informed and educated on harm reduction as follows: (1,000 in year 1, 2,000 in
year 2, 3,000 in year 3 and 4,000 in year 4)
4. Clean needles and syringes provided to PWID clients who are not on as follows: (500 in year
1, 750 in year 2, 1,250 in year 3 and 1,500 in year 4)
5. Condoms provided to PWID who are sexually active
6. PWID and women heroin users referred and put on MAT as follows: (400 in year 1, 800 in
year 2, 1,500 in year and 2,000 in year 4)
7. The larger immediate communities educated on the benefits of MAT to drug users, their
families and the community at large
8. Ongoing community advocacy to promote the human rights of drug users running
9. Male PWID and women heroin users provided with HTC or referred for HTC as follows: (400
in year 1, 800 in year 2, 1,500 in year 3 and 2,000 in year 4 )
10. Psychosocial support and facilitate peer support to clients who are on MAT
11. Programme-based data collected and fed in a real-time monitoring system
12. Four quarterly, two semi-annual and one annual progress reports are submitted each year.
It is to be noted that the evaluation at the end of year 1 will take into consideration targets specified for
year 1 only.
13. Qualifications/expertise sought from the organization(required educational background, years of
relevant work experience, other special skills or knowledge required):
o
o
An Existing Drop-in Centre within a 5km Radius of Malindi General Hospital MAT clinic that has
been providing services to drug user in Malindi.
At least 10 years’ experience in running a Drop-in Centre and harm reduction community
outreach operations for drug users in Malindi, Kilifi County, including needle and syringe
programmes (NSP) for PWID, provision of condoms to drug users, HTC services including referral,
Antiretroviral Therapy (ART), IEC (Information, Education and Communication) on harm
reduction and referral to Medically Assisted Therapy (MAT).
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o
o
o
o
Excellent track record with past or existing donors and National agencies including NASCOP on
reporting obligations.
Established communication and engagement in advocacy with politicians, policy makers, the
judiciary, law enforcement agencies, media and communities, including people who use drugs
themselves;
Experience with data collection and reporting via electronic software for at least 1 year;
Management and staff have a good command of spoken and written English and excellent
command of spoken and written Kiswahili.
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