Policy/Regulatory Scan of Contraception Provision by Multiple Cadres 33 views

Policy/Regulatory Scan of Contraception Provision by Multiple Cadres
Period of Performance: February 2021 – April 2021

Overview
The World Health Organization (WHO) provides international, evidence-based guidance on use and provision of contraceptive methods (family planning). In particular, WHO provides guidance on which cadre of health care worker can safely provide which contraceptive method, and also provides guidance on which methods can be safely provided through trained community volunteers, through drug shops (including “over the counter”), or by the client (self-care). Expanding what health care cadres can provide which contraceptive methods is termed “Task Sharing” and in 2017, WHO issued guidance on Task Sharing to Improve Access to Family Planning/Contraception. In June 2019, WHO also released Consolidated Guideline on Self-Care Interventions for Health, which recommends pills be available over the counter, and women be supported to self-inject subcutaneous DMPA (known as DMPA-SC or Sayana Press).
The USAID-funded project HRH2030, through its partner Palladium, conducted a multi-country desk review of countries’ national FP policies and guidelines, to explore how closely they align with current global evidence and WHO guidelines. The full report is available here: https://hrh2030program.org/family-planning-and-task-sharing/
In Kenya, HRH2030 reviewed the 2018 National Family Planning Guidelines for Service Providers (6th ed) and its Task Sharing Policy Guidelines 2017-2030. Through these documents, Kenya was found to be fairly aligned with WHO recommendations, such as allowing for self-injection of DMPA-SC, provision of DMPA-SC by pharmacies/drug shops, clinical officers to provide sterilization, community health workers to provide pills, and ECPs over the counter.
However, HRH2030 would like to do more extensive information-gathering to understand what additional policies, guidelines, and/or SOPs are or need to be in place for full implementation of task sharing to occur, as well as obtain information from select key government stakeholders and project implementors to understand to what degree implementation has occurred.
As such, HRH2030 is seeking a locally-based consultant to obtain and analyse additional relevant scopes of practice, protocols, pharmaceutical (or other) regulations, and/or training curricula to validate whether the national FP guidelines are supported or contradicted by other national government documents. The consultant will then meet with select national-level FP stakeholders and practitioners to gather information on the degree of implementation of task sharing for family planning.
Findings from this analysis will contribute to a global report on the status of country alignment with WHO guidance on task sharing and self-care for family planning, thus identifying policy and advocacy opportunities and challenges. The main audience for this analysis is government representatives, USAID, and implementing partners.
Key Responsibilities
Palladium is seeking an experienced consultant to assist in compiling and reviewing relevant policy documents, scopes of practices, regulations, and/or training curricula that address which contraceptive methods can be provided by which health care cadre in the country (community volunteers, nurses, midwives, clinical officers, physicians) and locations where methods can be provided. The consultant will also set up phone or in-person interviews with select key FP implementors, such as Ministry of Health staff responsible for FP, quality improvement, pharmacy, etc., and heads of major FP service delivery programs (e.g., local IPPF or Marie Stopes affiliates, donor-funded FP/RH programs providing support to public sector facilities, etc.) to explore the extent to which these policies are being implemented. She/he may also need to speak to professional councils or associations. The ideal candidate will have in-depth understanding of the regulations, protocols, and norms that guide human resources for health in the country, understand contraception/family planning service delivery and which methods can be safely provided by which health cadre, including those that can be provided over the counter. She/he should have experience working on or advocating for FP-related policies, and a strong network with a range of FP stakeholders at all levels (including high-level government officials and decentralized levels). The successful applicant will be responsible for completing the following tasks:
1.) Orientation: Participate in an orientation by Palladium staff on global activity and findings from a desk review of Kenya’s national policies and guidelines for family planning, as they relate to task sharing and self-care (approximately 2 hours, with documents shared by email). The consultant should ask any clarifying questions regarding the assignment and with Palladium, mutually agree on timeline in alignment with deliverables table below and communications.
2.) Implementation plan/protocol development: With technical input from Palladium, the consultant will develop an implementation plan/protocol to guide this work. This will include the tasks to be completed, the documents to be sourced and reviewed, a list of people or organizations to speak with, and a timeline to include periodic check-ins with Palladium. Paperwork on this activity will also need to be submitted to Palladium’s Internal Research Review team to receive ethical review, given some portion of this work includes interviews with human subjects. The consultant will also need to advise Palladium on whether local IRB is required, and/or any other protocols to be observed (e.g., presentation to MOH).
3.) Document collection: With technical oversight from Palladium, the consultant will identify additional policy documents, beyond what the global review uncovered, that will provide information on degree of implementation of task sharing and self-care in the country. These may include pharmaceutical regulations (e.g., documentation on how hormonal contraceptives can be sold), government circulars (recent updates that supersede older policies/guidelines), health worker scopes of work (whether they match guidelines on FP task sharing), training curricula (that may confirm whether a cadre receives training on particular FP methods), etc. The consultant will be required to produce a policy inventory summary (Palladium will provide the template), and scan/share electronically any documents obtained.
4.) Analysis: In collaboration with Palladium, the consultant will review documents collected and summarize findings on the status of task sharing and self-care in Kenya based on written documentation. Palladium will provide the task sharing and self-care benchmarks against which the consultant should analyse the documents, as well as provide a summary of the desk review findings and key questions it evoked. The consultant will be requested to resolve questions emerging from the desk review, note inconsistencies between different policies/guidelines/regulations, and provide an assessment as to which policies/guidelines take precedence. Palladium will provide a template for analysis of these documents against the benchmarks to ensure proper documentation of the analysis. This should be 2-5 pages.
5.) Key Informant Interviews (KII): In collaboration with Palladium, the consultant will develop a list of questions for select key stakeholder (e.g., Ministry of Health FP Coordinator, head of nursing council, National Drug Authority contacts, etc.), and undertake semi-structured phone or in-person interviews. Questions will focus on resolving any conflicting information found in policies/guidelines, identifying other policy/regulatory documents to consult, obtaining any information on whether these task shifting/self-care approaches are being implemented (e.g., in pilot areas or at scale), and identifying any barriers being encountered in implementing these policies. The consultant will record individual interviews and provide these recordings alongside interview notes (transcriptions will be requested if any interviews are not done in English). The consultant will then summarize the interviews, noting any inconsistent or conflicting information. Estimated number of key informant interviews required might be 5-15.
6.) Final write-up: Building on the analysis produced under Task #4, and the KII summary under Task #5, the consultant will provide a final write-up with conclusions on the status of task sharing and self-care for FP in Kenya, including what is allowed through policies/guidelines (including any conflicting or inconsistent policies/guidelines in effect), and what is being implemented through the MOH or other major FP programs (e.g., donor-funded or private sector FP provision) at a pilot level or at scale. This should be 6-8 pages + annexes if relevant.
7.) Provide updates on tasks outlined in the SOW twice a week via email or Skype/MS Teams.
Deliverables
Full deliverables and timeline will be finalized when the consultant contract is drafted. All deliverables must be approved by the technical monitor. Multiple drafts may need to be submitted before the technical monitor approves the deliverable. Payments based on final approval of deliverables.
# Reports and Deliverables Proposed Deadline
1 Implementation plan, timeline, and documents for Palladium’s internal research review 1 week after contract is executed
2 Completed Policy Inventory Template, along with soft copies of all documents collected March 1, 2021
3 Summary of findings on status of task sharing and self-care based on policies/guidelines/regulations (2-5 pages) End of March 2021
4a List of people to interview & list of questions for KIIs End of March 2021
4b Recordings and written summaries of interviews; transcriptions/translations of non-English interviews Mid-April 2021
5 Final brief summarizing analysis of policies/guidelines/regulations related to task sharing and self-care for FP, gaps and inconsistencies that might exist, and what is being implemented according to KIIs (6-8 pages) End of April 2021

Qualifications
-The applicant must be a recognized expert in Family Planning service delivery programming in Kenya with significant contacts among government and non-government stakeholders implementing FP programs in the country. He/she should be currently based in and legally entitled to work in Kenya.
-The applicant must demonstrate previous experience conducting similar assignments. In particular, the applicant must demonstrate the following capabilities: conducting policy/regulatory analyses and qualitative interviews; analyzing governmental structures and health policy processes in Kenya; understanding of current FP policies and programs.
-The applicant should have an understanding of international evidence and global (WHO) guidance on demedicalizing FP as it pertains to task shifting/task sharing, and self-care (e.g., over-the-counter availability of pills, self-injection of DMPA-SC, paraprofessional provision of IUDs/implants, non-doctors performing sterilizations).
-A Master’s degree in social sciences, public health, development studies (or a related field) is preferred. Educational background in research and qualitative methods required.
-Staff working on the assignment must be proficient in spoken and written English.

To Apply
Anyone interested in applying should apply by February 15th, 2021 COB, and submit the following documents:
-A written quote and detailed budget for completing the assignment; Note: Palladium has estimated this work to require 15-20 days of one full-time experience researcher. This should be taken into account when proposing a budget and staffing plan.
-Availability and general timeline for completing the assignment
-A capability statement/cover letter, demonstrating the applicant’s qualifications, and CV
-At least two references from work performed in the past two years

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