Terms of Reference for Consultant to Develop National Guideline and Protocols for Management of Obstetric and other Female Genital Fistula
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Background
At IntraHealth, we are a global team of creative, committed humanitarians on a mission. We are advocates, technologists, health workers, and communicators. We are passionate and diverse; and are united in our belief that everyone everywhere should have the health care they need to thrive. That’s why we work every day to improve the performance of health workers around the world and strengthen the systems in which they work.
For 40 years in over 100 countries, IntraHealth has partnered with local communities to make sure health workers are present where they’re needed most, ready to do the job, connected to the technology they need, and safe to do their very best work. Our programs are designed with a deep understanding of and appreciation for the context of human rights, gender equality and discrimination, economic empowerment, and changing populations.
Are you an experienced obstetric fistula and female genital fistula consultant? This opportunity might be of interest to you.

Scope of Work
Momentum Safe Surgery in Family Planning and Obstetrics (MSSFPO) is a five-year USAID funded project implemented by IntraHealth International aimed at contributing toward the reduction of maternal and infant mortality and morbidity in Rwanda as well as improving the utilization of informed, voluntary, consented safe maternal health (MH) and family planning (FP) services. To achieve this, USAID-MSSFPO partners with the Government of Rwanda (GOR), through the Ministry of Health/Rwanda Biomedical Center (MOH/RBC), to strengthen surgical safety and to address existing obstacles that undermine access to and utilization of safe surgery in maternal health (MH) and family planning (FP) care in 20 supported districts. This collaboration ensures that innovative and standardized evidence-based interventions are applied in routine delivery of MH and FP services to assure quality service delivery. One key area of MSSFPO’s focus is the prevention and management of obstetric fistulas.
Obstetric fistula is a debilitating condition destroying the lives of many women in developing countries, including Rwanda. The associated symptoms such as incontinence cause untold physical, social, economic, and psychological suffering among fistula victims, with affected women, often stigmatized and isolated from society. There is little data highlighting the magnitude of the fistula burden in the country although a previous MOH annual statistical booklet revealed an average of 122 annual fistula repairs from 2012 to 2016. These figures are probably underestimated due to the tendency of victims to not seek care for fear of stigmatization. To alleviate the burden of fistula on victims, prompt identification, screening, and quality repair services must be provided across the country. However, there are no national guidelines for the management of obstetric fistula, including surgical repair. Management of fistula is, thus, conducted using various techniques and protocols that are not standardized. It is in this context that USAID-MSSFPO seeks a consultant to support MOH/RBC to develop national guidelines and protocols to harmonize the management of obstetric and other female genital fistula.

Purpose of the consultancy
The purpose of this consultancy is to develop the national guideline and protocols for the management of obstetric and other female genital fistula.

Expected tasks
• Participate in an introductory meeting with USAID-MSSFPO and MOH/RBC to discuss the scope of work, deliverables, and expectations.
• Draft and submit an inception report highlighting the purpose of assignment, key tasks, proposed methodology and approaches to be utilized, deliverables and timeline for the entire assignment.
• Conduct desk review and summarize literature on the management of obstetric and other female genital fistula.
• Conduct in-depth interviews with different health providers, including obstetric fistula surgeons, MOH/RBC, and other development partners to gain a deeper understanding of the current management of obstetric and other female genital fistulas in the country.
• Prepare the first draft of the national guideline and protocols on the management of obstetric and other female genital fistula and submit it to the USAID-MSSFPO and RBC/MCCH team for review.
• Present the first draft to the Safe Motherhood sub-Technical Working Group (TWG) for technical review and to build consensus on the content of the draft guidelines and protocols.
• Incorporate the inputs from the Safe Motherhood sub-TWG, USAID-MSSFPO, and RBC/MCCH to prepare a second draft and submit to USAID-MSSFPO and RBC/MCCH teams for further review and input.
• Present the second draft guidelines and protocols to the Reproductive Maternal, Newborn, Child, and Adolescent Health (RMNCAH) TWG for additional review, input, and approval.
• Incorporate inputs from the RMNCAH TWG and submit a final draft of the guideline and protocol for the management of obstetric and other female genital fistula.

Deliverables
• Inception report detailing the scope of work, tasks, methods, deliverables, and timeline for the assignment.
• Summary of desk review on obstetric fistula and other female genital fistula, including global advances and practices to inform the formulation of guideline and management protocols for Rwanda.
• First draft of the guideline and protocol for the management of obstetric fistula and other female genital fistula presented to Safe Motherhood sub-TWG.
• Second draft of the guideline and protocols for the management of obstetric and other female genital fistula incorporating inputs from the Safe Motherhood sub-TWG.
• Final version of the national guideline and protocols for the management of obstetric and other female genital fistula presented to RMNCAH/TWG for approval and submitted to MSSFPO and MOH/RBC.

Qualifications
The ideal candidate is required to possess the following education, experience, and skills.
• Advanced degree in medicine, midwifery, or nursing with extended experience in the management of obstetric and genital fistula.
• Proven extensive experience in working with multiple health sector partners, including government to develop maternal, newborn, and child health (MNCH) guidelines, procedures, and protocols.
• Demonstrated knowledge of, and experience working in, the Rwanda health sector will be required.
• Excellent English writing skills.
• Ability to work independently and to take initiative.
• Excellent interpersonal skills, strong organizational skills, and an ability to work effectively in a multicultural environment.

Timeframe
The estimated level of effort for this work is 40 working days. However, the duration of the assignment is expected to be between June 1, 2022 and August 30, 2022.
# Task Working days
1 Participate in introductory meetings with USAID-MSSFPO and MOH/RBC 1
2 Prepare and submit an inception report
3 Conduct desk review of available new evidence on the management of obstetric fistula and other female genital fistula. (documents for 3 interventions per day) 3
4 Conduct in-depth interviews with different health providers including obstetric fistula surgeons, MOH/RBC, and/or other development partners to gain a deeper understanding of the current management of obstetric fistula and other female genital fistulas in the country. 2
5 Conduct in-depth interviews with selected staff, beneficiaries, and/or partners to gain an understanding of the benefits and outcomes of the strategies and interventions 2
6 Develop the first draft of the national guidelines and protocols on the management of obstetric and other female genital fistula and submit to the USAID-MSSFPO and RBC/MCCH team for review. 20
7 Present the first draft to the Safe Motherhood sub-Technical Working Group for review. 1
8 Incorporate the inputs from the Safe Motherhood sub-TWG, USAID-MSSFPO and RBC/MCCH to prepare a second draft and submit the USAID-MSSFPO and MCCH team for further review and input. 2
9 Present the revised second draft guidelines and protocols to the Reproductive Maternal, Newborn, Child, and Adolescent Health (RMNCAH) TWG for additional review, input, and approval 1
10 Incorporate inputs from the RMNCAH TWG and submit a final version of the guideline and protocol for the management of obstetric and other female genital fistula 7
Total number of working days 40

Supervision
The consultant will work closely with USAID-MSSFPO and RBC/MCCH technical teams under the direct supervision of the MSSFPO Senior Safe surgery Technical Advisor.
Selection Criteria
Applications will be assessed on financial reasonableness and technical considerations. Maximum scores for technical and financial applications will be 70% and 30%, respectively.
Technical evaluation criteria/ 70 marks
Advanced degree in medicine, midwifery, or nursing with extended experience in the management of obstetric and genital fistula.
(25 pts) Extensive experience in working with health sector partners to develop maternal, newborn, and child health (MNCH) guidelines, procedures, and protocols (25 pts) Knowledge of, and experience in, the Rwanda health sector (5 pts) Previous experience in developing obstetric and other female genital fistula guidelines or protocols or other maternal health guidelines and protocols – with 3 most recent references or certificates of successful completion (10 pts) Clear and realistic Timeline (5pts)

Submission Procedure
Applications must be sent to the Chief of Party via email: ingobyiprocurement@intrahealth.org with the subject line “Development of National Guideline and Protocols for Management of Obstetric and other Female Genital Fistula” in the subject line, no later than 18 May 2022 before 5.00 pm, Kigali time.
The application file should include:
• Motivation letter and updated CV.
• Three professional references with full names, phone numbers, and email addresses.
• Technical proposal (3 pages maximum), outlining applicant’s experience in similar assignments, understanding of the current assignment, and proposed methodology for conducting the assignment.
• Proof of successful completion of similar assignments in the last 5 years.
• Financial proposal - indicating daily consultancy rate (including applicable taxes).
• Proposed timeline for the assignment.

Equal Opportunity Employer
IntraHealth International is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability status, protected veteran status, or any other characteristic protected by law, and requires affirmative action to ensure equality of opportunity in all aspects of employment. This is also to include inquiry about, disclosing, or discussing their compensation or the compensation of other applicants or employees.
Note: Only applicants fulfilling the above requirements will be contacted. If you don’t hear from us within one month from the submission deadline, consider your application unsuccessful.
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