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TERMS OF REFERENCE (ToR)
Consultancy to develop Comprehensive Policy Framework for integration of GeneXpert in diagnosis of TB, COVID – 19 and HIV.
- Job Title: Consultancy to develop comprehensive policy framework for integration of GeneXpert in diagnosis of TB, COVID-19 and HIV.
- Duty Station: Federal Government of Somalia and Somaliland
- Type of contract: Short term Consultancy
- Expected Starting date: October 2022
- Duration of Assignment: 90 days
Burden of Tuberculosis, HIV/AIDS and Covid-19
Tuberculosis (TB), HIV and Covid-19 are communicable diseases of public health concern globally and in Somalia. Tuberculosis a major cause of ill health, one of the top 10 causes of death worldwide and the leading cause of death from a single infectious agent. The disease typically affects the lungs (pulmonary TB) but can also affect other sites (extra pulmonary TB). An estimated 10.0 million (range, 8.9–11.0 million) people fell ill with TB globally in 2019. Geographically, Africa accounted for 25% of the people who developed TB in 2019. In 2020 the total number of TB cases notified in Somalia was 16,953 cases, a number close to that of 2019 (19,300) cases. Case notification rate has improved between 2009 and 2020 by about 50%; yet almost three fifths of the increase (30%) has to be credited to the natural population growth, the mean annual increase thus being about 2%. For the year 2019, the World Health Organization (WHO) estimates the TB mortality rate in Somalia, including HIV+TB, at 68.5 (41-105) per 100k population. Between 2015 and 2019, mortality rate decreased by about 19%.
HIV/AIDS is a manageable chronic health condition thanks to increasing due to increasing access to HIV prevention interventions, diagnosis, treatment and care. As of November 2021, the disease has claimed 36.3 million [27.2–47.8 million] globally out of which WHO African region accounted for over two thirds (25.4 million). In 2020, the incidence of HIV was 1.5 million [1.0–2.0 million] with 680 000 [480 000–1.0 million] reported deaths. As of 2014, HIV prevalence had reduced enough to be considered a low-level epidemic in all states. As of 2018, the antenatal HIV prevalence stood at 0.1%. By state, it was 0.15% in Somaliland, 0.17% in Puntland and 0.04% in other federal member states. “The low HIV prevalence in Somalia can be attributed to Somali culture and society, and few risk factors as a result of behaviour,” said Dr Sadia Abdisamad Abdullahi, National HIV/AIDS Programme Manager.
Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus. At the end of January 2020, the WHO declared COVID-19 outbreak a public health emergency under the International Health Regulations (2005). As of February 2020, there were more than 400 million cases and over 5.7 million deaths globally out of which over 8 million cases were reported in Africa. Somalia reported 26,203 cases and 1.3040 deaths.
Diagnosis of Tuberculosis (TB), HIV/AIDS and Covid-19 in Somalia
WHO’s End TB Strategy calls for early diagnosis of TB and universal drug-susceptibility testing (DST),. There is a global call to strengthen TB diagnosis with recent global initiatives to “find the missing cases”, and the new global target set at the UN high-level meeting on TB in September 2018. The Ministries of Health (MOH), Federal Government of Somalia and Somaliland in collaboration with WHO, World Vision International and other health sector partners have undertaken several initiatives and efforts aimed at improving the diagnostic capacity. At present, smear microscopy remains the main stay diagnostic method. The Country has however been rolling out the utilization of GeneXpert for the diagnosis of drug resistant TB. It has allowed screening of thousands of TB cases, quickly and efficiently. With the Global Fund partnership there is investment in the expansion of this technology, but the need continues to be bigger than the resources available. There is also need to expand the testing for resistance to second line medications. This is important in helping identify patients with drug-resistant TB to initiate them on more effective and less toxic treatment regimens as recommended by WHO.
HIV testing is fundamental to HIV prevention, treatment, care and other support services. HIV diagnosis is done in health-care facilities, free-standing sites and a wide range of community-based approaches, as well as HIV self-testing (HIVST). In Somalia, people living in urban areas have access to HIV tests and antiretroviral therapy in 17 health facilities across different states for free.
In view of COVID-19 pandemic and consequent need for automated rapid diagnostic technologies with a rapid turnaround time, the potential use of GeneXpert technology to diagnose Covid-19 come into focus. In 2020 when Somalia reported the first case of covid-19, the country found itself in a challenging situation as it did not have a single laboratory with the capacity to conduct any molecular test to diagnose cases. With support from WHO and other partners, the Ministry of Health was able to set up 3 sites with capacity to carry out RT-PCR to diagnose Covid-19 cases. With sustained efforts and varying support, the ministry was able to operationalize 24 sites for Covid-19 testing across Somalia. This included 21 TB testing sites that were provided with cartridges to diagnose Covid-9 using the GeneXpert technology.
GeneXpert utilization by TB, HIV and Covid-19
Limited funding in global health is a persistent global problem and Somalia is no exception. There is need to identify practical, cost-effective and time saving solutions to increase access to quality diagnostic services. This is more so as Covid-19 transitions from a pandemic to an endemic disease. The TB program relies on the GeneXpert technology to test for drug sensitivity. HIV/AIDs program uses the platform for viral load determination and Covid-19 programs look to the same technology to bolster access to rapid turnaround diagnostic services. The situation calls for a clear framework on how to share available diagnostic resources in the long term for maximum mutual benefit of all the programs. This can be achieved by leveraging on existing capacity to enable testing across multiple diseases.
OBJECTIVES OF CONSULTANCY
The objective of this consultancy is to develop a comprehensive policy framework for the integrated utilization of GeneXpert technology by TB, HIV and COVID-19 programs. This will ensure that there is rational and optimal utilization of the technology”.
Thee main objectives of the consultancy will be to:
- Develop Comprehensive desk review of country diagnostic systems for TB, COVID-19 and HIV and status of integration in the utilization of GeneXpert in the diagnosis TB, HIV and COVID-19.
- Carry out comprehensive stakeholders’ engagement on best approaches to integrate the diagnosis of TB, Covid-19 and HIV using GeneXpert.
- Document the impact of, potential opportunities offered by the integration of the diagnostic capacity, potential risks and propose mitigating measures.
- Development of comprehensive policy framework for the integration of GeneXpert in the diagnosis of TB, COVI-19 and HIV.
2. MORE DETAILS
Rationale of the consultancy
Quality and easily accessible diagnostic services strengthens case detection in the health sector. GeneXpert technology offers a unique opportunity with its capacity to run multiple molecular diagnostic assays. Device sharing results in efficient use in resource limited settings. It is against this backdrop, that WV Somalia with support from Global Fund, proposes to develop a policy framework that will guide optimal utilization of GeneXpert technology in TB, HIV and Covid-19 diagnosis.
Scope of Focus
The assessment will cover the 3 National TB Programs (Federal republic of Somalia and Somaliland) and involving partner organizations, community, and government stakeholders in these three regions.
Assessment region: Somalia and Somaliland.
Assessment population: Partner organizations, Community and Government
Assessment duration: One month
- At inception, the consultant is expected to submit a detailed inception report and plan on how the development process will be carried out including a comprehensive methodology.
- Stakeholders engagement report.
- Final consultancy report both in soft and 5 hard copies including all data sets used during the survey.
Deliverables, reporting and project schedule
- Participation at the star off meeting with World Vision, MoH and WHO, and the detailed report on the discussions and conclusion of the kick‐off meeting, including the key issues discussed and decisions made (to be delivered two weeks after the start off meeting).
- The updated project work plan for the entire duration of the contract, including general methodological approach, milestones and timelines in accordance with the objectives of the project and decisions of the kick‐off meeting.
- The two‐page synopsis of the project outlining the general scope and purpose of the project to the relevant stakeholders for their information about the project (to be delivered two weeks after the kick‐off meeting).
- The work plan, including assessment protocol, describing study design, methodological approach, analysis plan, expected outputs and timelines.
- Detailed high quality summary report on the assignment performed (to be delivered according to the approved project work plan or 1 month before expiring of the contract).
- A detailed report that should include review findings, realistic and achievable recommendations and next plan of action.
The intended target audience for the reports are: TB and HIV programme implementers and policy makers at national & international level as well as World Vision.
- Since WHO has technical mandate for TB, the results need to have the approval or at least an acknowledgement from World Health Organization Somalia. In this regard, World Vision will share the Terms of Reference with WHO Somalia. World Vision will also share the methodology of the study, the framework, results and analysis with FGS MoH and WHO Somalia once the consultant provides them.
- Immediately after completion of the assignment, a summary report should be presented for discussion by the main stakeholders – (WV, UNICEF, MoH, GFATM, WHO).
- Once this is agreed upon, the final report will be printed.
3. MANAGEMENT OF THE ASSESSMENT
While executing this assignment, the consultant and the parties involved shall be guided by the protocol summarized in the matrix below:
Stakeholder / Role
- Consultant – Undertake the assignment based on the approved design and methodology and timeline
- GF/PR technical team – Initiate the TOR, share with key stakeholders for inputs and seek approval from WV. Lead the technical recruitment of consultant. Provide technical and managerial leadership to the consultant throughout the study process.
- WV QA / GF Technical team / NTP – Technical reviews to the ToR, Inception report, study design & methodology. Participate in the technical evaluation of consultants. Review draft report and recommend approval or non-approval.
- Supply Chain Manager – Advertise and complete bid selection processes. Site will be shared with key stakeholders.
- WV QA / GF Technical team / WHO / NTP – Review of the study findings
4. REQUIRED SKILLS AND EXPERIENCE
Education (for individual consultants/lead consultant):
Advanced Level (Masters level) in a relevant field (Public Health, Laboratory, Epidemiology).
- Seven years’ expertise in development of policy frameworks in the health sector preferably in TB, HIV control or infectious diseases control.
- Experience in DHIS 2 configuration for health information systems.
- Previous work experience supporting countries in Countries in sub Saharan countries including experience in training DHIS administrators and health information uses.
- Previous work experience of laboratory services in fragile states like Somalia will be an added advantage.
- Experience in training facilitation, mentoring and capacity development, demonstrate oral and written communication skills, including presentations.
- Ability to manage all phases of a data system from collection to visualization.
- Proficiency with Microsoft Office applications for word processing, PowerPoint, email, and Excel. Able to work effectively in a diverse team environment
- Excellent skills and experience in training facilitation, mentoring and capacity development and fluent in English.
- Demonstrate oral and written communication skills, including presentations.
Language requirement and Corporate competencies:
- Have excellent knowledge of both written and spoken English and be computer literate
- Familiar with Somali cultures, norms and customs
- Demonstrate integrity by modelling the World Vision’s values and ethical standards
- Ability to establish and maintain good working relations with colleagues in a multicultural environment.
The maximum duration of the assignment is 90 days, which can be spread from October 2022, to December 2022. A phased approach will be employed based on the finally agreed-upon schedule of deliverables.
6. LOGISTICS, APPLICATION AND EVALUATION PROCEDURE
World Vision will provide logistical support, including visa application, facilitation in arranging meetings with partners and relevant authorities. The consultant will be provided with an air ticket to and from the country of origin to Somalia. World Vision will also cover food and accommodation costs including vehicles required to carry out field assignments.
7. Evaluation Criteria
Mandatory Requirements evaluation
- Provide a certified copy of a certificate of business registration, Certificate of incorporation, business license or similar document (Companies/Organizations)
- Provide a certified copy of tax registration, tax clearance certificates or similar documents (Companies/Organization)
- Individual tax registration documents (for individual consultants)
- Provide information on ownership structure (Name of directors of the company / Owner) (Companies/Organization)
- Provide last two years of audited financial statements or tax filing, or similar documents (Companies/Organization)
- Provide references from previous clients for similar works**. (At least three)**
Note – Applicant who will not meet the above mandatory requirement will not be considered for Technical Evaluation.
Qualified and interested parties are asked to submit the following;
Letter of interest in submission of a proposal
A detailed technical proposal clearly demonstrating a thorough understanding of this ToR and including but not limited to the following;
- Consultant/Company Profile.
- Description of methodology and sample size determination.
- Demonstrated previous experience in similar assignments and qualifications outlines in this ToR.
- Proposed data management plan (collection, processing and analysis).
- Proposed timeframe detailing activities and proposed work plan.
- Team composition and level of effort of each proposed team member (Include CVs of each team member).
- A financial proposal with a detailed breakdown of costs for the study quoted in United States dollars.
- Payment Terms
- Credit Period
As part of the Consultant selection process, the best candidates will be requested to prepare draft inception report and make a presentation of the same to the Global Fund Technical Team to inform the final decision on award of the Contract.
HOW TO APPLY
All interested bidders/consultants are requested to submit their Technical Proposals and Financial Proposals in Separate documents as attachments (Bidders who will combine both technical and financial proposals shall be disqualified) via email email@example.com on or before 28th September 2022. Bids received after deadline shall not be considered.
Email title should be; – CONSULTANCY FOR DEVELOPING COMPREHENSIVE POLICY FRAMEWORK FOR INTEGRATION OF GENEXPERT IN DIAGNOSIS OF TB, COVID-19 AND HIV
Your financial proposal should have your consultancy fees, payment terms and Credit period. Financial proposal should not be part of the technical proposal; it should be a separate document.
Provision of Taxation as per the Revenue Authority on Technical Fees:
- A 5% withholding tax is levied on the payment of technical services fees (as well as professional and management fees) where the services are provided by a resident/resident firm in Kenya. If payment is done to an entity outside Kenya, relevant tax regulations will be applied.
- The rate is 20% where the service provider is a non-resident/non-resident firm, unless an applicable tax treaty provides otherwise.
- Consultant firms must be able to demonstrate their tax compliance status at the time of bidding for this assignment as WVS will only engage with tax compliant individuals/firms.
- The proposal that complies with all the requirements, meets all the evaluation criteria and offers the best value for money shall be selected and awarded the contract. Any offer that does not meet the requirements shall be rejected.