Terms of Reference (TOR)
Conduct a review and assessment of the existing national policies and
guidelines related to paediatric and adolescent HIV care in 7 African
Countries
1.0 BACKGROUND
1.1 Introduction
The African Network for the Care of Children Affected by HIV/AIDS (ANECCA) is a not-forprofit Pan African network of clinicians and social scientists with a mission to improve access to
quality and comprehensive HIV prevention, care, treatment and support services for children,
integrated within the broader maternal and child health framework.
ANECCA has its headquarters in Kampala Uganda where it is registered as not-for-profit
organization.
ANECCA has received a grant from the Global Fund to fight AIDS, Tuberculosis and Malaria to
implement a regional project on “Improving Coverage of quality services for Children and
Adolescents living with HIV (ICCA). This regional project provides a unique opportunity to
capitalize on pediatric and adolescent expertise across the continent to address disparities in
access to care and treatment for children and adolescents.
The goal of the project is to improve the coverage and quality of HIV care, treatment and support
for children and adolescents living with HIV in the seven sub-Saharan African countries. The
specific project objectives are
1. To promote the adoption and implementation of policies that increase coverage and
quality of paediatric and adolescent HIV care, treatment and support;
2. To improve the capacity of HIV service providers in provision of HIV care, treatment
and psychosocial support to children and adolescents living with HIV;
3. To identify and document innovative approaches and best practices on paediatric and
adolescent HIV care, treatment and support;
4. To promote adoption of best practices on care, treatment and support of HIV infected
children and adolescents so as to increase identification, treatment and retention of
children and adolescents living with HIV; and
1.2 Project scope
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The project targets 7 countries in Africa comprising of Burundi, Ethiopia, Malawi, Nigeria,
South Sudan, Tanzania and Uganda. These countries have the least antiretroviral treatment
coverage for children and adolescents living with HIV compared to adults. They also have
similar structural gaps and challenges that impinge on coverage and quality of care for HIV
infected children and adolescents. These include inadequate policy frameworks and guidelines
for facilitating children and adolescent access to HIV services, few ART sites offering care and
treatment to infected children, low competency of health care workers in care and treatment of
HIV infected children and adolescents, and inadequate knowledge and sharing of innovative
approaches and best practices that enhance coverage and quality of care, treatment and support
among children and adolescents living with HIV.
This regional project implements interventions that remove policy bottlenecks, build capacity,
and ensure access to appropriate information and services related to HIV testing, HIV care and
treatment for children and adolescent in the seven countries. Therefore, the targeted audiences
for the project are the national programmers and policy makers for these seven countries.
2.0
THE ASSIGNMENT
2.1
Introduction
ANECCA seeks the services of a consultant to conduct a review and assessment of the existing
national policies and guidelines related to paediatric and adolescent HIV care in the seven
African countries to identify gaps that lead to low coverage and quality of services for children
and adolescents living with HIV. The targeted countries have put in place and/or adopted some
policy guidelines that facilitate HIV care and treatment among adults and children living with
HIV. These include the national strategic plans for HIV/AIDS and PMTCT, as well as specific
guidelines on HIV counselling and testing, provider initiated testing and counselling, and care
and treatment of adults.
However, several gaps exist in the policy environment for care of HIV infected children and
adolescents. A part from the fact that all these countries do not have national specific plans
(policy documents) on paediatric and adolescent ART, the guidelines being used are not
comprehensive particularly in the areas of HIV testing as well as linkage, initiation and retention
of infected children and adolescents on ART. There is also lack of clear targets and strategies on
identifying and linking, initiating and retaining HIV infected children and adolescents on ART.
It is also evident that whereas majority of the targeted seven countries have put in place the
policy of provider initiated testing and counselling (PITC), the guidelines and training curricula
they have are mainly for adults with minimal content on children and adolescents. Therefore,
implementation of PITC for children and adolescents is minimal in the majority of health
facilities.
There are also several unresolved questions regarding policy on testing and counselling of
children and adolescents. Besides the variation in the age of consent for testing young adolescent
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across the countries, there is disharmony and uncertainty on how to deal with
children/adolescents who seek HIV services on their own due to various circumstances across
the seven countries. Policy mix-up is hampering some adolescents from seeking and getting
SRH/HIV services since they tend to visit health facilities without the knowledge and company
of their parents/guardians.
Therefore, this project will:
 Leverage the experience from the countries that have national and programmespecific strategic plans to facilitate development of detailed national plans with
clear strategies and targets for identifying, treating and retaining HIV infected
children and adolescents in the countries where they do not exist;
 Support these countries to harmonise policy guidelines on HIV counselling and
testing as well as the consent and assent ages; and
 Engage in-country stakeholders and advocate for development and adoption of
policies on task shifting for use of lay counsellors in provider initiated testing and
counselling of children where they do not exist; and
 Develop standardized operating procedures and mentorship resource materials on
provider initiated testing and counselling in children, task shifting and other
practices that facilitate increased coverage and quality of care and treatment of
HIV infected children and adolescents.
This has necessitated seeking the services of a consultant to conduct the review and an
assessment of the national policies and guidelines in the seven countries to identify gaps which
lead to low coverage and quality of care and treatment of HIV infected children and adolescents.
2.2
Objectives of the Assignment
The main purpose of the assignment is to identify strength and gaps in national policies and
guidelines in order to develop country specific action plans to improve coverage and quality of
services for children and adolescents living with HIV in each of the 7 countries.
2.3
Specific Objectives
To achieve this main purpose, the consultancy will focus on the following specific objectives:

Review and assess existing national policies and guidelines in the seven countries to
identify strengths and gaps for provision of quality services for children and adolescents
living with HIV
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To make recommendations that inform the development of regional and national plans to
promote the adoption and implementation of policies that increase coverage and quality
of paediatric and adolescent HIV care, treatment and support
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2.4 Scope of Work:
To achieve the objectives listed above, the international consultant will lead and work with
national consultants to identify strengths and gaps in national policies and guidelines that can
improve coverage and quality of services for children and adolescents living with HIV in each of
the seven countries. This will entail:
 Development of an inception report for the assignment
 Developing the methodology and tools for the review of the existing national policies and
guidelines in each of the 7 countries
 Orienting national consultants on the policy and guideline review process.
 Providing technical guidance to national consultants during the policy and guideline
review process
 Gathering and reviewing relevant national and international literature particularly on
services for children and adolescents living with HIV
 Analysing gaps and barriers from individual countries for effective provision of quality
services for children and adolescents living with HIV
 Reviewing and consolidating individual country specific policies and guidelines for
strengths and gaps for provision of quality services for children and adolescents living
with HIV
 Compiling a comprehensive review report to inform policy change
 Making presentations on findings on national policies and guidelines reviews to a
regional stakeholder meeting
 Facilitating regional dialogue on policy gaps to generate a regional position paper and
country specific action points
 Ensuring all deliverables of the assignment are met in a timely manner.
2.5
Key Deliverables
The consultant is expected to produce the following deliverables:
 An inception report;
 A comprehensive review and assessment report covering policies and guidelines in 7
countries.
 A Regional Position Paper and country specific action plans
2.6
Key Qualification, Experience and Skills
The consultant should have experience and knowledgeable in policy analysis and development.
He/she must have solid understanding of the HIV/AIDS programming in Africa with particular
emphasis on treatment and care for children and adolescents living with HIV in addition, the
consultant should possess the following skills and competencies:
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2.7
2.8
2.9
Bachelor’s degree in Medicine or related field and an advanced degree in health policy
analysis
Broad knowledge and understanding of key health policy issues in Africa;
Work Experience: At least five years of national and international experience in the
paediatric HIV services, studies and assessments,
Special skills: Updated knowledge on Paediatric AIDS programme at global and national
level
Competencies: Good leadership, communication and negotiation skills both at the
national level and at the field level, Experience and ability in partnership programming,
Good writing skills in English, Commitments and initiatives towards the professional
values; Languages: Good written and spoken English languages
Timing and Duration
The assignment is estimated to commence in January 2016, and completed within a
period of 45 working days and to be completed by 15th April 2016
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Technical and Administrative Reporting Arrangements
The consultant will report to the ANECCA Secretariat through the Program Coordinator.
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Role of ANECCA
Coordinate activities through the national project officers
To provide feedback on draft consultants reports
Provide logistical support to the consultant
Review and adopt the final report
Follow up on the implementation of national action plans
2.10
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Payments
The consultant will be paid in phases upon completion and submission of key
deliverables. The payment schedule will be discussed and agreed with the consultant and
it will be incorporated in the contract agreement.
Applications should be sent to mail@anecca.org cc ririso@anecca.org not later than 14 January
2016
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