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Summary Type of Contract Consultant ContractTitleNational consultancy - Evidence synthesis on Programme for Urban Reproductive Health Services (PURSE) in Dar es Salaam, Dodoma and Unguja in TanzaniaPurposeTo conduct baseline assessment and produce compendium of evidence in order to inform evidence-based planning and interventions on the Urban Reproductive Health ProgrammeLocationDar es Salaam, Dodoma and UngujaDuration40 days (between November 2023 – February 2024)Start date04th December 2023Reporting toTTCIH, UNFPA and the Task Force for this assignment 1.0. BACKGROUNDContinuing convergence of a number of barriers undermine the sexual and reproductive health (SRH) of women, girls and vulnerable populations in many countries at the Sub-Saharan Africa including Tanzania. These include inequalities in access, weaknesses in the delivery of integrated people-centred care services, gaps in sustainable financing, and inadequate laws, policies, and financial protection. Evidence show that universal access to sexual and reproductive health (SRH) is essential in realization of the 2030 Sustainable Development Goals (SDGs) particularly goal 3 on good health and wellbeing. It also advances goal 5, which calls for gender equality, as well as many other goals included in the 2030 Agenda. The Government of Tanzania is committed to improve the SRH and overall health and wellbeing of its people as demonstrated in various national strategic documents including the Vision 2025, the Health Policy, Health Sectors Strategic Plans (HSSPs), the ‘One Plans’ to accelerate progress in reproductive, maternal, newborn, child and adolescent health (RMNCAH) etc. Tanzania is also committed to domesticate and implement a number of global strategies and protocols on SRH which include the SDGs[1]. For example, achieving the zero preventable maternal deaths and unmet needs for family planning are among the goals Tanzania recommitted at the Nairobi Summit on the International Conference on Population and Development and the FP2030 in 2019 and the government has continued to prioritize these services in the past decade and in the context of the SDGs. Despite the political will and commitment, challenges remain: High adolescent fertility (112 pregnancies per 1,000 girls aged 15-19 years) and a high teenage pregnancy rate of 22 per cent[2] impact health and general welfare of girls. The UN comprehensive country analysis report indicates that child marriage and teenage pregnancy account for 30 per cent of all cases of school dropouts. Only 15-25 per cent of primary and secondary schools provide sexuality education and only 30 per cent of health facilities offer youth-friendly services. Moreover, adolescents with disabilities face significant challenges to inclusion and access to SRH services, resulting in low levels of knowledge and utilization. The recent TDHS (2022) has reported a sharp decline in maternal deaths from 556 per 100,000 live births in 2015/2016 to 104 per 100,000 live births[3]. Despite this new data the country still have a long way to go to achieve the SDG 3.1 target of less than 70/100,000 MMR as significant bottlenecks still remain where other SRH indicators that also determine the reduction in maternal mortality in the country are lagging behind. For example, unmet need for family planning reduced from 22.2% to 21% among married women, contraceptive prevalence rate (CPR) has gone done from 32% to 31% and teenage pregnancies have reduced from 27% to 22%, although there are still regional variations, with one region recording rates as high as 44.7%. Only 22 per cent of the health facilities that are closest to the population provide a full package of emergency obstetric and newborn care services. Also Ministry of Health (MOH) reports shows that most of the maternal deaths (over 90%) are occurring mostly within health facilities in the peripartum period, thus raising concerns on the quality of care and the competencies of providers. More maternal deaths are being recorded in poor urban and peri-urban areas. The HIV prevalence is 4.7 per cent, though significantly higher among female youth (3.4 per cent), compared to their male counterparts (0.9 per cent). Only 37 per cent of young people have comprehensive knowledge on HIV prevention; and only 32 per cent use condoms for dual protection. Early sexual debut, transactional and cross-generational sex, poor risk perception and harmful gender norms are negative factors that perpetuate HIV transmission. In addition, large gaps exist in combination HIV prevention for young women, their male partners and key populations. In addition, the United Republic of Tanzania ranks 140 out of 162 countries on the United Nations Gender Inequality Index. Some 42 per cent of the women aged 15-49 years had ever experienced physical or sexual violence while 31 per cent of young women aged 20-24 years are married by the age of 18. Gender inequalities including conflicting laws and policies, weak institutional systems for prevention and response, socio-cultural norms and values such as power dynamics within the families and poverty has implications in the uptake of SRH services. UNFPA, the United Nations Population Fund has developed its 9th Country Programme (2022-2027) in collaboration with the government of Tanzania and NGOs partners to address the above mentioned challenges. To address the critical and emerging SRH issues in the urban and semi-urban settings, the UNFPA programme is focusing, among others, on implementing a Programme on Urban Reproductive Health Services (PURSE) in Dar-es-salaam, Dodoma and in Unguja. These selected sites are fast growing cities with rapid population growth contributed by rural-urban migration and relatively high fertility rates[4]. More importantly is also slow progress on the SRH indicators. It is in this context that UNFPA in collaboration with Maternal Health Consortium led by TTCIH; the MOH in mainland and Zanzibar; PORALG; and the government authorities in Dar-es-salaam, Dodoma and Unguja, intends to engage a consultancy firm to conduct a baseline assessment to determine requirements for the key SRH essential service packages as stipulated in the Universal Health Coverage (UHC) and national protocols as well as set benchmarks for the performance measurements of the programme. 2.0. JUSTIFICATION Evidence-based programming continues to play a pivotal role in ensuring the provision of services that are tailored to meet the specific requirements of maternal and child health, adolescents, and young people. Ultimately, this approach aims to achieve positive health and development outcomes. Nevertheless, the accessibility of high-quality evidence to inform decision-making, planning, and healthcare provision in these domains can pose challenges for decision-makers, planners, and healthcare professionals. This endeavor is a significant step toward gathering robust evidence that can be harnessed to formulate innovative solutions for addressing service delivery gaps. 3:0 OBJECTIVES 3.1 Overall objectiveTo conduct a baseline assessment of the key SRH essential service packages to determine requirement for the Programme on Urban Reproductive Health Services (PURSE) to inform evidence based decision making, planning and provision of quality SRH services. 3:2 Specific ObjectivesThe specific objectives are presented according to the SRH essential services package and forms the key areas of this assignment and are as follows:EmONC: This will include assessment on the infrastructure, availability of commodities, skills of the health care providers, equipment, functionality including assessing the signal functions including availability of blood and blood products, human resources etc.Newborn care: The assessment will include, infrastructure like NCU, KMC, NICU, availability of commodities, equipment, skills of the health care workers in providing newborn care for example HBB, emergency preparedness and availability and the use of guidelines and SOPs.Family Planning: This will include availability of commodities, comprehensive skills and competencies on proving family planning methods, supportive infrastructure, integrations of family planning services and other health services like CTC, and community outreach services.Adolescent sexual and reproductive health (ASRH): This will include assessment on the availability of commodities, infrastructure to support adolescent and youth services such as youth friendly corners, knowledge, skills and attitudes of health care providers, presence of youth forums that allow peer-to-peer discuss of their needs and challenges, life skills, empowerment, innovations, higher learning institutions reproductive health clubs and availability and utilization of guidelines to provide ASRH servicesReferral system: Assessment will include availability of ambulances (basic & advanced), innovations and referral management (referral letters, communication, feedback, escort).Antenatal care including PMTCT, and Post-natal care: This will include assessment on availability of commodities, supplies and supportive infrastructure, health education provision (danger signs, nutrition, post-partum FP etc) and other preventive services, skills of health care provider on assessment of clients and counselling, early booking, quality and available services provided, and availability of health learning materials (IEC/SBCC)Sexual gender-based violence (SGBV) This will include assessment on skills of health care workers in providing counseling to the victims, supportive infrastructure (one stop center etc), commodities (sample collection), and referral pathways.Cervical cancer screening: assessment will include, skills of the health care providers, commodities and supplies, innovation such as smartphone VIA (SMVIA). Referrals, treatment and linkages, and presence of community mobilization and outreach services.Human resource for health: This is a cross-cutting area that will include assessment on the availability (number and skills as per human resource protocols), presence of expertise in specific areas such as anesthesia and sonography, competences in midwifery skills, as well as leadership and governance in overall management of the health service provision at all levels of the health care system.Data: This will include assessment on availability and use of various data collection tools such as registers, HMIS and DHIS tools and systems, data completeness and frequency, evidence of data review meeting, data quality assessment (DQA), innovation based on real time data etc.MPDSR and Clinical audit: This includes availability of Guidelines and tool used for MPSDR and clinical audit reviews, presence of human resources to support MPDSR and clinical audit e.g focal person and committees, evidence of MPDSR/Clinical Audit schedules, meetings, action plans developed and implemented etc.CPAC: Assessment will include availability of commodities and supplies, skilled health care providers, presence of guidelines and supportive infrastructure.Male engagement: This will include assessment on the involvement of men in provision of SRH services such as advocacy and promotion of companionship during delivery, decision making at family and household level, existence of male friendly services and supportive infrastructure, provider’s attitude and presence of client exit interview.Socio cultural: This will include assessment of some taboos, traditions, customs, myth and misconception etc that can impact uptake of SRH services.Financing: All aspect of the key areas of the assignment including availability, utilization and overall financial management. 4:0 DESCRIPTION OF THE ASSIGNMENT (SCOPE OF WORK)The assignment will be confined to the following aspects:Review of documents (national policies, plans, strategies including training materials, SOPs and reports), published and unpublished evidence related to SRH in Tanzania including from Dar es Salaam, Dod