Terms of Reference for the Recruitment of a National Consultant to Develop the National School-based Oral Health promotion program in Rwanda.

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1. Overall task

To develop a national school-based oral health promotion program including implementation plan, budget, and policy proposal  

The national program shall be based on experiences from a model developed by SOS Children’s Villages Rwanda (SOS CV RW) in partnership with Dental Health Without Borders (DHWB) and with respect to Rwanda’s National Oral Health Strategic Plan and The World Health Organization’s (WHO) recommendations. It shall contain the following:

Daily toothbrushing with fluoride toothpaste and handwashing programs to be implemented in every primary school across Rwanda combined with education in oral health and healthy diet.    

2. Introduction 

Oral health is the state of the mouth, teeth and orofacial structures that enables individuals to perform essential functions, such as eating, breathing and speaking, and encompasses psychosocial dimensions, such as self-confidence, wellbeing and the ability to socialize and work without pain, discomfort and embarrassment. Oral health varies over the life course from early life to old age, is integral to general health and supports individuals in participating in society and achieving their potential. 

According to WHO and FDI – World Dental Federation, there is a direct linkage between toothache, school absenteeism and school performance – when improving children’s oral health, their absenteeism from school is reduced and they concentrate better in school, thereby improving their learning. By working primarily in schools, many people from less privileged social strata can be reached, thereby creating interventions and tools through which relevant policy makers can establish effective and appropriate preventive services for the public. 

Globally, an estimated 2 billion people suffer from caries of permanent teeth and 514 million children suffer from caries of primary teeth. The WHO Global Oral Health Status Report (2022) estimated that oral diseases affect close to 3.5 billion people worldwide, with 3 out of 4 people affected living in middle-income countries.

By age 8, over half of children (52%) have had a cavity in their primary teeth. Poor oral health can have a detrimental effect on children’s quality of life, their performance at school, and their success later in life. 

WHO country profile, shows that in Rwanda 40% of children with ages between one (1) and nine (9) have untreated dental caries in deciduous teeth and the prevalence of untreated dental Caries of permanent teeth is 31.4% among the children with more than 5 years. The main risk factors highlighted in the country profile include sugar consumption, alcohol use, tobacco use and poor oral hygiene.

In Rwanda, the first national oral health survey indicated that: (64.9%) of the participants in the survey had experienced dental caries, while 54.3% of them were untreated. Among adults aged 20 years and above, 32.4% had substantial oral debris and 60.0% had calculus, while the majority (70.6%) had never visited an oral health provider.

Due to these oral conditions, 63.9% of patients reported pain, difficulty chewing (42.2%), and difficulty in participating in usual activities (35.4%). Tooth and gum diseases rank 6th (6.2%) in the top ten causes of morbidity among U-5 children, 4th (4.2%) among people over 5 years and adults and first cause of consultation in hospitals (22.4%) (https://pubmed.ncbi.nlm.nih.gov/29860930/ ) 

Dental Health Without Borders (DHWB) and SOS Children’s Villages Rwanda (SOS CV RW) has for years worked with WHO’s Basic Package of Oral Care (BPOC) in Rwanda.  A strategy based on prevention and oral health promotion in primary schools, focusing on daily toothbrushing with high fluoride-containing toothpaste, oral health education for students, teachers, and parents combined with oral treatment. The evaluation report indicated that among the primary school children recruited for the project in 13 schools, 45% had visible dental caries, 44% had pain in the mouth, while 64% had bleeding gums (https://ajoh.oauife.edu.ng/index.php/ajoh/article/view/123)

At the end of that project in 2018, the proportion of dental caries reduced to 16%, bleeding gums to 18%, and pain was observed in only 7% of students. This means that implementation of the BPOC can result in improvement of oral health in schools and in the community. 

The successful approach is built on a vision that schools can be an environment where a healthy lifestyle is not only taught but also practiced. Data collected from intervention schools clearly indicate that by a relatively small and cost-efficient intervention it is possible to improve children's health, well-being, level of knowledge, school test results and school attendance. 

2. Purpose of the consultancy 

Despite its successful implementation at targeted schools in Rwanda, there are no guidelines and protocols guiding school-based oral health programs in Rwanda.

Hence, the main objective of this consultancy is to develop a national school-based oral health promotion program in Rwanda.

The development of school-based oral health programs will refer to the existing model by SOS Children’s Villages and dental Health without borders to inform on how the same model can be implemented countrywide. It will highlight gaps and challenges countered during implementation. hence provide clear and actionable recommendations to address the challenges and gaps identified in the schools that implemented the BPOC to inform the implementation of an nationwide. With the above background there is a need for interventions to increase awareness and early detection of oral health problems at an earlier stage of life in the schools. The interventions can be used for advocacy and executing of appropriate policies to improve school-based oral health status in Rwanda.

3. Objectives 

The school-based oral health programme is expected to meet the following objectives: 

• Provide specific information on the type and extent of the school-based oral health practices that children have adopted for their wellbeing.
• To create deep understanding of the magnitude and root causes of dental caries in children in Rwanda
• Provide information on how dental caries in the children is being addressed.
• Provide information on the availability and scope of local oral health initiatives aimed at addressing dental caries in children.
• Identify existing program and/or interventional approaches used by other stakeholders in addressing dental caries in children and what has been achieved
• Identify the strength and weaknesses of existing school-based oral health interventions run by key stakeholders.
• Recommend needs-driven program interventions targeted at reducing dental caries among children.
• Present a structure for a national school-based oral health promotion program including implementation plan, budget, and policy proposal 

4. Scope of the service and duration

The development of the school-based oral health promotion program will be done in different phases, with thorough consultations of key national stakeholders (Ministry of Health, Rwanda Biomedical Centre, Ministry of Education, University of Rwanda, professional bodies), beneficiaries (Primary schools, Ministry of Education), NGO partners (Dental Health without borders and SOS Children’s Villages) and other relevant stakeholders at different levels of the program implementation for the informative and rational decisions. Detailly, the consultancy will consist of research-based works which will be carried out in a three-month time (90 days) including handing in the final school-based oral program  including with plan, budget, and policy proposal.

For the school-based program to be well-designed and informative to the end users and policymakers, it should include data that will be collected from different stakeholders from different districts and institutions in the country along with data presented by DHWB and SOS CV RW

The consultant/s should begin the work as soon as the agreement is entered between the two parties. The first draft report is expected to be submitted to the designed team within 60 working days after work agreement is signed, and the consultant/s should allow up to 10 days for providing comments to the first draft report. The consultant will again be given 20 days to address comments and will again present the document for final touches and validation. The final report will be submitted no later than 90 working days after signing of the agreement. 

5. Responsibilities and duties of the consultant 

• To conduct a situational analysis on the status of Oral Health promotion program in schools
• Work closely with the Oral Health Promotion Committee during the whole process of consultancy. The primary contact person being the one that has Oral Health in her/his assignments at Rwanda Biomedical Centre, NCDs Division/Injuries, Disability & Oral Health Unit.
• To coordinate the planning process from the preparation and drafting up to the approval of the school-based oral health promotion program;
• To consult concerned stakeholders during the process of development of the school-based oral health promotion program;
• To be available and present the progress of the school-based oral health promotion program when requested.

To be more specific, the consultant/s should cover the followings important steps and functions for all the studies:

• Plan, design and undertake the study including:

• Preparing detail work plan for the planned assessments
• Identify and review relevant literatures
• The research design, methodologies, data collection tools, data collection process, data analysis
• Consult the Oral Health Promotion Committee at meetings
  • Develop draft and final reports and submit them along with relevant documents, data collection tools and the raw data to the respective programs;
  • Incorporate inputs and feedback obtained from the program locations, produce final reports both in hard and soft copy.
  • Attend the orientation session organized by SOS Children’s Villages in Rwanda before getting into the actual process. 

6. Methodology 

The school-based oral health program guiding document to be reliable and data-driven, the consultant firm or/and individual will strategically and technically indicate how they will design, organize their research work.

Significantly, they clearly will outline different approaches, methods, techniques they will employ to engage different people from whom they get information. Importantly a clear structure of how best the consultant will develop the school-based oral health program should be well-elaborated herein.

Equally, in a clear manner the consultant (firm) will indicate the categories of the people who will be consulted and their relevance in the program development. Furthermore, precisely, the consultant will indicate how they will collect data and use it during the program development and how other more or less information from the publications and other sources of information will be incorporated in, for rich and rational school-based oral health promotion program.

7. Reporting

Consultant will provide a monthly progress report to the Oral Health Promotion Committee. However, if necessary, the Oral Health Promotion Committee shall respond when called upon. All logistical support for the review will be organized by the core team ahead of the groundwork and in consultation with the consultant.

8. Expected Deliverables

This assignment is supposed to be completed within a three (3) month-period starting from the signature of the contract by both parties. At the end of contract, the consultant will submit the deliverables listed below:

• Documentation of activities (e.g., interviews) carried out
• Detailed inception report on a school-based oral health promotion program baseline assessment
• First draft report
• Report fact sheet
• Provide finalized PowerPoint Presentation for the school-based oral health promotion program
• A final structure of a national school-based oral health program including implementation plan, budget and policy proposal

9. Required skills for the consultant/s

Specifically, the consultant/s should:

• Be a healthcare professional with public health qualification and experience of 5 years in similar work.
• Have experience in developing national health models and socio economic analysis
• Have proven experience in program development with the health sector in Rwanda.
• Have a good knowledge and understanding of the national health and education system
• Have commitment to advancing public health and a country-led approach to policy change.
• Be flexibility and ability to thrive in a fast-paced environment and meet timely and detailed project goals.
• Be able to work in Rwanda and comply with the laws.
• Be an individual or a firm/company.
• Have excellent analytical, research and report writing skills
• Have good facilitation and interpersonal skills
• Be experienced in monitoring, evaluation, and reporting
• Have proven experience in conducting assignments in complex institutional environments
• Displays cultural, gender, religion, race, nationality and age sensitivity and adaptability.
• Have understanding on the local context of Rwanda, especially the language and other cultural settings is advantageous.

10. Proposal Content

Proposals have to reflect the instructions described in the Request for Proposal and Terms of Reference.

Technical Proposal

The Technical Proposal is limited to a maximum of 10 pages and should demonstrate knowledge and understanding of the tasks set forth as well as the consultant’s capability and capacity to perform the assignment. The following information should be provided in the technical proposal:

• In-depth description of the consultant’s recent experience with assignments of a similar nature.
• Description of the methodology proposed to reach the outcomes outlined above.
• Estimated days for preparation and completion.
• Up-to-date C.V of the consultant.
• The understanding of the assignment:
• References – listing previous contracts of similar nature,
• Fill in the previous experience using the below format

Financial Proposal

The financial proposal should be submitted in Rwandan Francs in the format normally used by the consultant. It must provide sufficient detail to allow cost comparison and assessment. Taxes will be borne by the consultant (Consultancy costing should include Taxes). 

11. Evaluation of proposals

Technical proposals will be evaluated and ranked on the basis of the assessment specified below. The technical evaluation will also include interviews with the consultants. The results of these interviews will be factored into the final technical score of the proposals and the original ranking of the consultants will be adjusted accordingly.

All consultants will be required to submit each of the following documents that will be weighted on a scale of 100 points:

• Quality and Relevance of Technical Proposal/approach and methodology (40 Points)
• Qualification and expertise of consultant/ academic document and CV signed by the consultant (10 points)
• Evidence of previous similar work proved by presentation of certificate of completion (20 Points)
• Consultants’ Interviews (30 Points)

The minimum technical marks to be considered to financial evaluation shall be: 80%

12. Intellectual Property Rights

Any report, documents, or other materials prepared by the consultant/s for the assessments shall belong to and remain the property of SOS Children’s Villages in Rwanda.

• All documents, reports and other such outputs and information submitted to SOS Children’s Village Rwanda under the terms of this agreement shall not be disclosed to any third or other party by the Consultant.
• The Consultant/s shall not disclose or use the reports, documents, or information to and for the benefit of any other party for purposes unrelated to the present agreement.
• All outputs under this contract shall become the property of the SOS Children’s Villages Rwanda.

13.  Administrative requirements for the consultancy firm

The interested consultant (s) must submit together with their technical and financial proposals, the following documents:

• A tax clearance from Rwanda Revenue Authority
• RDB certificate of the company registration
• A submission letter of the proposals duly signed by the legally authorized representative of the consultancy firm.

14. Submission of Proposal/Application

Competent consultant/s shall prepare both technical and financial proposal separately addressing all the requirements in this TOR and indicate acceptance of the terms and conditions set out herein.  The technical proposal shall not exceed 10 pages. Other supporting material deemed to be relevant to the proposal may be attached as an annex. 

Submission of Proposals

Detailed and well organized technical and financial proposals shall be submitted to sos.procurement@sos-rwanda.org and copy to sosbnc@sos-rwanda.org  not later than 10/07/2023 at 5:00PM. Late proposals shall not be considered.