Sudan – Health and Nutrition Exploratory mission / Needs assessment

Context

The ongoing economic crisis that started in 2018, characterized by spiraling inflation, bread, cash and fuel shortages, has exacerbated by months of civil unrest and political uncertainty and is making more people vulnerable. As the Government has been unable to mitigate the social impact, the crisis has highly impacted the poor and vulnerable populations. While the situation is getting more complex due to the continuous man-made and natural disasters, including conflict, floods, and drought, Sudan’s humanitarian needs has continued to grow. After an inter-sectoral vulnerability analysis, the UN has identified that over 8 million people are estimated to need humanitarian or protection assistance, about 1.86 million live in protracted displacement and nearly 27,000 people were newly displaced in areas experiencing localized armed conflict such as Jebel Marra, Blue Nile and South Kordofan. This has raised protection concerns as tensions between refugees and host communities continue to increase. IDPs and South Sudanese refugees are constantly seeking for safety in the big cities and in refugee camps, while host communities are struggling under the current economic situation and are increasingly seeking compensation and assistance support.

The economic and political crisis has also impacted negatively the delivery of and access to health services, especially for the most vulnerable communities, IDPs, returnees, and host communities. Health needs continue to grow as health services have been stretched to the breaking point due to lack of medicines, equipment, staff and inadequate infrastructure. The increasing cost of medicines and medical supplies has restricted the access to essential life-saving health care services, which has particularly impacted women, adolescents and children.  The rainy season has already resulted in floods in several parts of the country and has particularly affected the areas where people have limited access to wash and sanitation facilities and with limited health infrastructure. In November 2019, a large scale of epidemiological events were reported across the country:  337 cholera cases, 2,569 dengue cases, 319 rift valley fever cases, and 128 chikungunya cases

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Asseessment Justification

This first exploration phase will be done jointly with Triangle Generation Humanitaire (TGH). The purpose is to identify and assess the humanitarian situation as well as the health-related needs and gaps in South Kordofan, Sudan, and to draft a health intervention strategy for 2020. It will include meetings with key stakeholders, including national and local authorities, NGOs and potential donors, and visits to Kadugli and the surrounding cities and villages in order to assess the humanitarian and health indicators at field level.

The gathered information will be available in the mission’s report, which will also include an analysis of the health-related humanitarian needs as well as opportunities for humanitarian positioning for PUI and TGH. The partnership between these two organizations will be developed and structured both at HQ and field level, and complementarity will be found in the activities. For this exploratory mission PUI intend to cover the health and nutrition sector.

Assessment Objectives

The overall objective of the assessment is to enable PUI to provide an adapted response to health needs in collaboration with its partners.

The Specific Objective :

• To identify and prioritize health and/or nutrition needs, including MHPSS.
• To propose an adapted strategy of health intervention, taking into account PUI and its partner’s capacity of intervention, to answer the specific needs.

Tasks

1. Identify the main causes of mortality and morbidity

Collect key health indicators highlighting the main causes of mortality and morbidity and highlight the major health risks in the area: maternal mortality rate, ratio, infant mortality rate, children under 5 years mortality rate, crude mortality rate, etc.

2. Identify the determinants of health

Identify and analyze the determinants that could influence the health of the population: geographical and environmental determinants, demographic and health determinants; political, regulatory and security determinants; socio-economic and socio-cultural determinants.

3. Describe and analyze the health system

• Describe the national health policies: Highlight the health priorities, plans and protocols implemented in this context of health.
• Highlight the organization of the health system : Health pyramid and services offered by the different levels of care.
• Describe the supply system for medicine and medical equipment in the country: Identify stakeholders (suppliers, purchasing centers); check for the absence or presence of quality policies of medicines in the country and who are the stakeholders involved; identify import procedures of drugs; highlighting the paperwork and find the possible existence of an informal drug market.
• Evaluating healthcare services: describe the state of the structures and hygiene conditions: Describe the resources available for health systems by identifying health personnel , level of training and their geographical distribution; describe the relationship between healthcare workers and the public by highlighting their salary, motivations and the existence of potential conflicts; describe the use of healthcare services, their accessibility and coverage.
• Describe the epidemiological monitoring system for population in the area : Identify the monitoring system, the data collection and diffusion methodology.
• Describe the health financing in the country : Describe the price of drugs, the existence or not of exemption from costs and financial barriers to the use of health services.

4. Identify stakeholders and potential partners

Using tables or maps (eg UN, SARC and Ministry of Health), list the different actors (civil society, governments, NGOs, UN agencies, donors) and classify them according to their degrees of interest and influence. The area of intervention of each actor, his mandate and the dynamics that exist between them should be summarized.

5. Analyze and prioritize health needs

Highlight health needs identified through the information gathered in the previous chapters and prioritize them by criteria (frequency, severity, consequences … etc.) based on quantitative and qualitative data. Among the identified problems, list those on which PU-AMI could intervene in accordance with the organization’s health intervention framework.

6. Propose recommendations for action

Provide answers to every identified need/problem, mainly those where PUI could intervene.

7. Identify constraints, limitations and opportunities on the field

Describe security, institutional or logistical constraints that may cause difficulties in the implementation of the project. Identify opportunities and factors that promote the implementation of the project.

Methodology

PREPARATORY BRIEFING

One week of briefing with PUI HQ and potentially TGH HQ and of literature review research and analysis will be organized.

QUANTITATIVE AND QUALITATIVE METHODS

Data collection will be done through primary and secondary data collected with health authorities, different stakeholders and potentially communities, according to security and administrative authorization.

Standard PUI assessement tools will be shared with the consultant, the consultant can propose modification or additional.

KEY DOCUMENTS

2019 South Sudan Humanitarian Needs Overview:https://reliefweb.int/sites/reliefweb.int/files/resources/South_Sudan_2019_Humanitarian_Needs_Overview.pdf

PUI health framework.

ORGANISATION OF THE MISSION

COMPOSITION OF ASSESSMENT TEAM

The team will be composed of 1 head of exploratory mission and 1 health and nutrition evaluator.

LOGISTICS, SECURITY AND ADMINISTRATIVE ORGANISATION

• Soudan entry Visa will be organized and managed by PUI.
• The consultant will be responsible to organize his/her health insurance.
• The consultant will follow up PUI security rules and policy in the field.
• PUI will be responsible for consultant’s security during all period in Soudan, including security evacuation if necessary.
• PUI will assure all movements and transportation in Soudan.
• Accommodation in the field will be organized and assured by PUI.
• Translation will be assured by PUI in the field.

FOLLOW-UP MANAGEMENT

• Regular appointments will be organized with deputy head of mission to follow up the ongoing mission.
• Weekly updates will be shared with health advisor at HQ level.

TIMETABLE

EXPECTED DELIVERABLES

assessment / exploratory mission report

Following the established framework and a maximum of 25-30 pages, excluding appendixes.

• A draft of the report must be presented on the 8 of February a week before the definite meeting date.
• The health referent, Head of Mission, Emergency officer can request corrections or modifications after the report is released and the evaluator must ensure that he is available if necessary.
• PPT summarizing main results and information collected.

Concept PAPER

It will review:

• Principal elements of the exploratory mission
• Set out the intervention strategy, on the form of a concept note including a logical framework.
• The principal elements of the project program (general objective, specific objective, results, indicators, resources).
• An estimated budget description

Applications

Interested candidates should submi in English:

• A technical offer with:
• Understanding of the challenges of the study and the Terms of Reference (ToR): development of a problematic and formulation of questions, which the offer proposes to respond to
• The methodology and tools proposed for the evaluation
• The timetable showing the details for the completion of each of the evaluation phases. The proposed schedule should include time for briefing and debriefing on the mission and as much as possible at headquarter.
• A financial offer including a budget with detailed sections (fees, other costs)
• An updated CV
• An example of similar studies
• References

Applicants should send all of this documentation in electronic format to: Tinou-Paï BLANC [email protected]

The deadline for the submission of applications will be the 15/01/2020