Terms of Reference for International Consultant/Consultancy Firm to Design/Develop, Test and  Pilot Integrated Community Led Monitoring (CLM) model for HIV,TB and Malaria in High Risk Groups/Key and Vulnerable Population in Rwanda 

1. Introduction 

Rwanda NGOs Forum on HIV/AIDS & Health Promotion (RNGOF on HIV/AIDS & HP) is a network of 139 NGO members working to promote health and the wellbeing of citizens with particular focus on High Risk groups/key and Vulnerable populations affected and infected by HIV, TB and Malaria including Sex Workers, Men who have Sex with Men (MSM), People Who Use/Inject Drugs “PWUD/PWID”, Transgender People, Adolescent Girls and Young Women (AGYW), Rice Farmers, Fishermen, Youth in Boarding schools, Miners, Fishermen, Prisoners, Refugees, Staffs in Hotels and Lodges, Security Staffs; Vulnerable Women, Healthcare Providers (HCP) etc.

Its mission is to promote and coordinate activities of member organizations and build their capacity, to monitor, Generate data through conducting research/studies/assessments and advocate for civil society involvement in all public policies and program formulation with regard to improving quality of health services delivered to high risk groups/key and vulnerable population. 

 2. Background.

HIV/AIDS, TB and Malaria  remain a public health priority in Rwanda with the whole population at risk of related  infection. Today, Rwanda continues to make progress in the fight against those three diseases  through multifaceted evidence-based approaches such as early  diagnosis and effective management of cases as guided by the National  Strategies. However, there is still a long way to go to eliminate the three diseases in Rwanda. 

 With an HIV prevalence rate of 2,6% among adults aged 15-49, 3,2% among women and 2,0% among men in adult population (RPHIA 2018-2019)[1], the highest rates are concentrated among certain specific and key populations. RPHIA 2020 shows that the HIV prevalence remains higher among women (7.4%) aged 50-54 and men aged 55-59 years (6.5%), translating into the shift of the HIV epidemic to elders or people ageing with HIV as an impact of reduced mortality and high retention to treatment. The sexual differentiation is particularly pronounced among young people, where young women aged 20 to 24 are three times more infected than men of the same age (1,8% Vs 0,6). Despite the low and stabilized HIV prevalence in the general population, it remains substantially higher among key populations, with 34% among FSW and 6.5% among MSM. This underlines - as in most of the world - the effectiveness of disease fighting measures (response) is variable between populations and geographies.

Estimated TB incidence rates in Rwanda are lower than the Global and AFRO Regional average but the 2021 incidence rate remains high with 56 (42-72) incident TB cases - new and relapse - per 100,000 habitants vs. 134 and 212, at global and AFRO Region level, respectively[2]. 

Once again ,Today malaria continues to represent a real public health concern with the entire Rwandan population at risk of infection. In response to malaria infection , Rwanda implemented integrated malaria control interventions including LLIN distribution through mass campaigns and routine channels, IRS, behavior change communication, and improved access to diagnostics and treatment  and those combined intervention resulted in significant malaria infection  reduction,. As per malaria annual report  almost all 30 districts of Rwanda registered a decline in malaria during the reporting period of July 2022-June 2023. With the end of Fiscal Year 2022-2023, malaria incidence in Rwanda reduced from 76 per 1,000 person per year in FY 2021-2022 to 47 per 1,000 (39% reduction) while the Slide Positivity Rate (SPR) dropped from 22% in FY 2021/2022 to 14% in FY 2022/2023. Uncomplicated malaria cases dropped from 998,811 cases in FY 2021/2022 to 622,900 cases in FY 2022/2023 (38 % reduction) with currently 58% of these cases managed at community level. Severe malaria cases reduced from 1,831 cases in FY 2021-2022 to 1,316 severe cases in FY 2022/2023 representing 28% decrease in severe malaria.

The number of deaths due to malaria decreased significantly from 71 in FY 2021-2022 to 51 deaths in FY 2022-2023 ( 28 % reduction). 

About Community-Led Monitoring (CLM)

Community-led monitoring (CLM) is an accountability mechanism developed for HIV responses but can be applied for other diseases. Community-led monitoring (CLM) is a technique initiated and implemented by local community-based organizations and civil society groups, networks of key populations (KP), people living with HIV (PLHIV), and other affected groups, or other community entities that gather quantitative and qualitative data about HIV, TB and Malaria services. The CLM focus remains on getting input from recipients of HIV, TB and Malaria services in a routine and systematic manner that will translate into action and change[3].

In 2021, the Ministry of Health/RBC/MOPDD, in collaboration with partners have conducted an in-depth analysis using the Roll Back Malaria (RBM) Matchbox Toolkit as a guide to ensure that the interventions being implemented are addressing the documented barriers, to identify any additional specific human rights or gender barriers in the context of malaria and to provide guidance on specific interventions to address any barriers.   The assessment was done to better understand the nature and extent of barriers to equity in terms of gender and human rights in particular,  to assess the effectiveness of current efforts to address and reduce barriers in the delivery of malaria interventions, and to identify opportunities for adapting or strengthening these efforts to achieve greater equity in malaria-related health outcomes across the country. More specifically, the assessment was   aiming to identify the most vulnerable groups and key populations at increased risk of malaria infection, the barriers related to access to malaria services for these populations, how gender, humans’ rights and social issues affect malaria programs. It was also intended to contribute robust recommendations for improving malaria services coverage and decreasing malaria risk among the most affected populations. The findings of the assessment shows that the NMCP Strategy for malaria control amongst vulnerable groups in the country appears comprehensive, and programme data suggest some success in reaching most of the at-risk population, but gaps may persist. These results also indicate that there are some important gaps that could be due to these barriers.  These include the following: Insufficient involvement of vulnerable populations, Limited community commitment to addressing the use of self-medication and traditional treatment of malaria. Limited material resources compared to the needs of vulnerable populations. Referring to the assessment recommendations, in 2022,RBC in collaboration with partners have conducted the need assessment, mapping of hotspot and situational analysis among high-risk groups to orient the specific interventions being implemented in the context of malaria. From the assessment a total number of 766,647 persons among high-risk groups were identified. These vulnerable groups include Rice Farmers, Fishermen, Mining workers, truck drivers, Health Care Providers, Students at School, Hotels Staff and Clients, Female Sex Workers, Motorcyclists, Cross-border trades, Seasonal Workers, People with disabilities and travelers, etc. in this context  there is a need to establish CLM in Rwanda for the three diseases focusing on  HRGs and

,it is essential to ensure high level community involvement through community led monitoring, commitment, and own ship, this will involve communities collecting and analyzing information on their own initiatives which they then can use to better understand their context in Malaria prevention and control and action taking   and additionally   advocate for improvement. CLM allows the community to participate at all stages of the fight against malaria, we need   communities to decide what to monitor and act upon the data collected, CLM will be useful for HIV,TB ,Malaria program  and CSOs supporting SBC implementation. 

With this regard, Rwanda NGOs Forum on HIV/AIDS and Health Promotion is hiring Individual international  consultant/consultancy firm to Design/Develop, Test and  Pilot Integrated Community Led Monitoring (CLM) model for HIV,TB and Malaria in High Risk Groups/Key and Vulnerable Population in Rwanda 

3. Main Objective

The overall objective is to establish the integrated CLM model for HIV, Malaria and Tuberculosis in Rwanda. 

 4. Specific objectives 

1. To develop an integrated CLM Model for HIV, Malaria and Tuberculosis
2. To test and pilot a CLM model among Key and Vulnerable population/high risk groups affected by HIV, Malaria and TB in few selected districts (Determiner for the three diseases the factors/determinants such as societal and structural barriers to community- led monitoring);
3. To identify drivers of CLM implementation success that reflecting local realities and considerations; (To lay out a series of possible stages for infected and/or affected communities establishing CLM and the same time considering its principles)
4. To identify and address potential challenges related to CLM implementation in HIV, TB and Malaria in the Rwanda local context;
5. To conduct a SWOT analysis for the CLM considers themes such as cultural aspects, local capacity, financial support, policy/political support, other stakeholders views and pressures, health system context, and the perception of Usefulness;
6. To provide recommendations for CLM national framework, strategy development and scale up.

5. Expected Results

1. Developed and Validated an integrated CLM Model for HIV, Malaria and Tuberculosis

2. Tested and piloted CLM model among Key and Vulnerable population/high risk groups affected by HIV, Malaria and TB in few selected districts (Determined for the three diseases the factors/determinants such as societal and structural barriers to community- led monitoring);
3. Identified drivers of CLM implementation success that reflecting local realities and considerations; (To lay out a series of possible stages for infected and/or affected communities establishing CLM and the same time considering its principles)
4. SWOT analysis for the CLM considering themes such as cultural aspects, local capacity, financial support, policy/political support, other stakeholders views and pressures, health system context, and the perception of Usefulness;
5. Developed and validated action plan/strategy for CLM national framework to guide the scale up 

6. Scope of assignment

The consultancy will be implemented countrywide(in selected districts) ,The International Consultant will work closely with Rwanda NGOs Forum on HIV/AIDS and Health Promotion (RNGOF on HIV/AIDS & HP) and Rwanda Biomedical Centre (RBC) in collaboration with other key stakeholders in the country where applicable, to deliver the following tasks:

• Consultations with the RNGOF on HIV/AIDS & Health Promotion; RBC (HIV Division, Malaria Division and TB Division) and other partners to ensure common understanding of the scope of the assignment and to secure collaboration foundation for the process;
• Desk Review for the extended National Strategic Plans for HIV/AIDS, tuberculosis and Malaria as well as corresponding monitoring and evaluation frameworks to better understand implementation of their related interventions and inform the model;
• Consult relevant stakeholders for an in-depth understanding of the national context with a view to proposing appropriate approaches to a contextualized an integrated CLM model for HIV, TB and Malaria consistent with UNAIDS, Global Fund and PEPFAR recommendations;
• Develop the local context adapted integrated CLM model for HIV, TB and Malaria and the CLM tools;
• Incorporate inputs from RBC and partners to improve the integrated CLM model for HIV, TB and Malaria;
• Submit the final Integrated CLM Model for HIV,TB and Malaria;
• Development of CLM piloting phase plan and methodology;
• Conduct a training of selected CSOs and Community members from High Risk Groups/Key and Vulnerable population to support the testing and piloting of the proposed integrated CLM model for HIV, TB and Malaria
• Testing and piloting of the proposed CLM model in few selected High Risk Groups/Key and Vulnerable Populations in all provinces, monitoring/evaluating the CLM, recommendations to guide scale up,.
• Write and submit a report to RNGOF outlining in detail the experiences during the execution of the TOR to suggest lessons for future support of related tasks; and
• Development of guidelines and recommendations for scaling up the CLM model at the national level;
• Prepare a budget to support implementation of the National integrated CLM scale-up plan 

7. Key Deliverables 

1. Inception report – detailing the implementation road map, and how the ToRs will be executed;
2. An integrated CLM Model for HIV, TB and Malaria;
3. CLM Data collection tools and other related tools;
4. A plan with a methodology and a list of selected sites for testing and piloting the CLM Model in few selected High Risk Groups/Key and Vulnerable Populations in all provinces, monitoring/evaluating the CLM, recommendations to guide scale up,
5. Report with findings from piloting of the CLM model in few selected High Risk Groups/Key and Vulnerable Populations in all provinces that include:
   • A list of drivers of CLM implementation success that reflecting local realities and considerations;
   • Identified challenges related to CLM implementation in the Rwanda local context and how to address them;
   • Recommendations for the National integrated CLM scale-up plan

8. Required Qualifications

• Educational background

1. MSc and above in epidemiology, social sciences, data science, entomology, computation sciences, mathematical modelling, statistics, or related field.
2. A PhD holder in the related field is a plus

• Health strategy design and Research experience

1. Experience in developing plans, Strategies or Models for HIV/AIDS, TB and Malaria programs;
2. Experience with technical HIV/AIDS, TB and Malaria control interventions;
3. Experience supporting field activities related to HIV/AIDS, TB and Malaria research projects;
4. Have good understanding of possible factors leading to HIV,TB malaria transmission, morbidity, mortality or how it affects community behavior vis a vis prevention and control interventions in Rwanda;
5. Proven record of understanding field survey, synthesis and interpretation of epidemiological and entomological data;
6. Experience working in HIV/AIDS control program and/or TB & Malaria surveillance at the national, regional and International level is a plus;
7. Experience working with the community heath based response is a plus;
8. Prior experience with local context for international consultant is a plus;

• Policies/Strategies

1. Knowledge of broader health policies and National HIV/AIDS, TB and Malaria Control Programs

• National/Regional/International

1. Experience working in National and International environments

• Communication and technical Skills

1. Skills in strategic analysis, protocol and proposal writing
2. Communication skills in writing and speaking

• Report writing

Strong written and verbal communication skills to prepare comprehensive research reports, present findings to stakeholders, and make actionable recommendations 

9. Working language

The working language for this assignment will be English. 

10. Selection criteria

Applications will be assessed on cost reasonableness (30%) and technical competence (70%) 

11. Timeframe (duration of the assignment is for 8 months)

This assignment is expected to be implemented within a timeframe of 8 months and is expected to starting from the date of signing the consultancy contract with possibility of extension to December 2025. The effective duration of the service of the international consultant is estimated at 8 months.

12. Ethical considerations

Ensure that ethical guidelines based on the Rwanda National Ethics Committee (RNEC) for research involving human subjects are followed, including protocol presentation and approval, obtaining informed consent and protecting the privacy and confidentiality of participants. 

13. Reporting and accountability

The International consultant/consultancy firm shall report regularly to the Rwanda NGOs Forum Management Team and provide updates on progress. Quality of deliverables must be ensured by the consultant and validated by other technical working groups in HIV/AIDS, TB and Malaria Response 

14. The application file will be comprised of:

• Letter expressing interest to carry out the consultancy service required
• Detailed CV (maximum 4 pages) of the responsible consultant
• A technical proposal written in English describing the background, methodology and timeline (maximum 5 pages)
• A Financial Proposal
• Copy of Passport of the consultant
• Valid proof documents of completion of similar assignments
• At least 2 references from current and previous client organizations demonstrating your competence to deliver on similar assignments 

15. How to apply/ submit your application 

• Documents will be submitted to Rwanda NGOs Forum via email: rwandangoforumrw@gmail.com not later than 20^th December 2023 at 5:00 pm Rwanda time.
• Writing the Subject: “Application to support the design and piloting of the CLM Model for HIV/AIDS, TB and Malaria in Rwanda.”
• After submission, the applications will be reviewed. Due to an expected high volume of application, only selected International consultant/consultancy firm will be informed.

Approved on 07^th December 2023

BY:

KABANYANA Nooliet

Executive Secretary

Rwanda NGOs Forum on HIV/AIDS and Health Promotion

(RNGOF on HIV/AIDS & HP)

[1] The Rwanda Population-based HIV Impact Assessment (RPHIA), a national household-based study conducted in 2018–19.

[2] Tuberculosis and Lung Diseases National Strategic Plan, Mid 2019 - mid 2024, Extended to June 2027

[3] PEPFAR, Community-Led Monitoring Fact Sheet, 2020