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Agreement for Performance of Work (APW)
Assignment Title: Assessment of Health Care System, Social Protection & Support Mechanisms to identify Gender based Violence (GBV) related Risks, Vulnerabilities, Impacts, Needs, Service Delivery Readiness and Response during Post COVID-19 Situation in Sindh Province of Pakistan
TERMS OF REFERENCES
Unit/Cluster: Promoting Health through Life course
Department: Health Promotion and Protection (HPP)
Project Line: WHO-UNWOMEN Partnership: Joint Programme on Essential Services to Respond Gender based Violence in Pakistan – Phase III
Gender based violence (GBV) is a serious public health problem and violation of a fundamental human right. In a society like Pakistan, patriarchal values and structures are culturally deep rooted and GBV issues do not receive the sort of public recognition that they should. Public health response to GBV is partially integrated into Health System of Pakistan at policy, programme and service delivery level. PDHS 2017-18 reflects 34% of ever-married women have experienced spousal physical, sexual, or emotional violence. The most common type of spousal violence is emotional violence (26%), followed by physical violence (23%). Five percent of women have experienced spousal sexual violence. 26% of ever-married women who have experienced spousal physical or sexual violence have sustained injuries. Nine percent of women have experienced violence during pregnancy. 56% of Pakistani women never sought help or disclosed GBV due to socio-cultural and other problems regarding accessibility to health care and psycho-social support services. In Sindh Province GBV prevalence is 18%. COVID-19 Pandemic has increased the prevalence of GBV particularly domestic and intimate partners violence against women and children globally during the period when governments were implementing social distancing and lock down measures to control the spread of COVID-19. There is a significant gap regarding reliable data. The available information sources are only media reports, helpline case data and trend-based analysis. The reported global increase is 20-40% while in WHO’s Eastern Mediterranean Region the increase is 50-60%. Pakistan comes under EMR region. Therefore, the country specifically KP and Punjab provinces are of no exception. According to Rozan Counselling helpline, 17 cases of GBV were reported in Sindh respectively during April-July 2020. This data shows increase in GBV cases during COVID-19 situation.
According to different studies usually health service providers and health facilities are often the first point of entry for survivors of GBV including sexual violence whether they decide to disclose or not GBV incident and seek help. However, the health sector readiness and response is limited to address the needs of survivors and vulnerable population during the course of public health service provision, and may not succeed in providing the necessary redress to them. This is also due to negative attitudes towards survivors, influenced by patriarchal cultural beliefs and social norms that support acceptance of GBV and discriminatory behaviours. Moreover, the health sector has week coordination and referral mechanisms with other sectors, and service delivery departments in the course of service provision. Therefore, strengthening enhancing the health system’s response to effectively address GBV is a key area of intervention, which has to be put in place/ strengthened through multisectoral coordination and response mechanisms.
WHO Support in Pakistan
In order to address these challenges, WHO Pakistan substantially provided technical support to Government of Pakistan, Ministry of National Health Services Regulation and Coordination (MNHSR&C) and provincial health departments to develop nationally endorsed health system Response to Gender based Violence and sexual violence Package to be implemented as multi-sectoral responsibility (in coordination with other sectors) including clinical protocols/SOPs to provide care to GBV survivors. The package is developed to be implemented both in development as well as humanitarian and emergency crisis including disease outbreaks., The package is complemented by WHO guidance covering prevention framework; health system tools for strengthening capacities of multi-disciplinary teams of care providers and GBV related research, assessment of health facilities’ readiness and response. It further includes clinical handbook with SOPs and protocols for care provision to GBV survivors including identification, examination & clinical treatment, management of GBV (physical, sexual and psychological) cases, referral pathways, first line and psycho-social support with mental health treatments, medical legal care including legal interpretations, GBV case reporting and management of facility based register etc. The package is being implemented at filed level, The key interventions to implement the package include prevention and community outreach; policy advocacy; technical support for integration in essential health service packages and multisectoral coordination mechanisms; in service training of health care staff including community health workers, practitioners and service providers from multi-sectors, policy makers; GBV related research & integration into medical and public health education for pre-service capacity strengthening through WHO’s core support and multiple interagency partnerships all over Pakistan.
2. Purpose of the Assignment
The assessment is being conducted under WHO and UNWOMEN interagency partnership of Essential Service Programme to respond GBV through multisectoral interventions. The purpose of this assignment under the above venture is to conduct assessment based on WHO methodology and tools already adapted in the context of Pakistan for developing evidence base on GBV related Risks, Vulnerabilities, Impacts, Needs, Service Delivery Readiness and Response of health care system and social protection & support mechanisms during and Post COVID-19 Situation in Sindh Province of Pakistan.
The findings of this would address gap of reliable data related to GBV and during and Post-COVID 19 dimensions; inform implementation as well as overall outcomes of the above interventions through the evidence based analysis as well as information about target beneficiaries (both direct and indirect) and their risks, vulnerabilities and needs to be met associated with post-COVID 19 impacts. Moreover, the gaps in functioning of existing healthcare service delivery, social support systems and safety nets to be addressed through multi-sectoral collaboration.
3. Duration, Scope & Geographical Focus
40 working days spread over 50 days inclusive of designing the assessment methodology, modifying and pre-testing the tools as per provincial context, data collection from target districts/areas based on high prevalence GBV and COVID-19 criteria of Sindh (District Karachi covering 7 sub-areas/districts) province, analysis, report writing and submissions.
The assessment is required to be conducted through using mixed quantitative and qualitative methods based on WHO adapted methodology and tools in multiple scenarios , development and humanitarian settings (refugees) at health facility level (staff); policy level (policy makers, practitioners, senior officials of health & sectoral departments) ; social support systems (crisis centre; help lines and shelters staff) and community level in the catchment area of target health facilities.
Multi cadre staff of Approximately 3-4 health facilities per each target district covering tertiary health care & teaching hospitals; secondary health care and primary health care tiers of health system would be sampled. 1-2 target communities in catchment areas of each health facility based on GBV and COVID-19 prevalence and 1-2 social support system (Crisis Centres, shelters) per districts and key help lines staff (Provincial) would be targeted in sampling framework of the assessment. In Sindh Province first assessment of this kind is being conducted. However base line information for provincial comparison can be utilised from similar nature assessments from KP and Punjab provinces since 2018-20
Required Tasks & Deliverables
The consulting public health and social research firm OR individual under WHO’s overall technical oversight and guidance would perform following tasks and deliverables;
I. Conduct Assessment covering areas of inquiry below:
· GBV prevalent forms and related Risks, in Post Covid-19 situation
· Vulnerability mapping, trends and impacts of GBV on different vulnerable population groups including women, children, adolescent, elderly and people with disabilities during COVID-19
· Needs and concerns related to GBV related Health Care, psycho-social support and other multi-sectoral services including prevention, protection, relief, rehabilitation and referral services
· Mapping of Existing Government/public Capacities; Services, service delivery Mechanisms; Policy & legal, Facility & Community based Readiness and Response to Gender Based Violence based on WHO assessment tools for GBV readiness of services as well as GBV and COVID-19 data collection.
· Mapping of existing services, readiness and response provided by private sector, UN and Civil society organization as well as nature of their liaison and coordination with target communities, with each other and public service delivery mechanisms
· Mapping of existing community-based support structures and safety nets to prevent and support GBV survivors
· Community perceptions, knowledge, level of awareness, attitudes, satisfaction on existing services and response for support including the individual risk mitigation regarding GBV issues
· Needs for strengthening community-based support system, coordination and referral mechanisms for GBV survivors
II. Development and submission of an inception report covering proposed research methods for undertaking the assessment (study design), detailed plan of data collection & analysis, description of complete methodology for desk review, quantitative and qualitative assessment (including tools e.g. Questionnaires, key informant structured interviews, facility-based readiness and response observation checklists, Focus group discussions etc.). WHO adapted methodology & tools for GBV data collection during COVID-19, readiness, response and quality assurance as well as tools for need and vulnerability assessment would be utilised to develop assessment methodology and plan.
III. Pre-test of Assessment Tools and methodology, adaptation in provincial context of Sindh Province and approval.
IV. Data collection, Analysis and submission of first draft report for review and feedback by all stakeholders and partners.
V. The report format should cover executive summary, chapters on introduction, methodology, findings, recommendations, conclusions and annexures including tools, respondents’ profile and inventory of literature review.
VI. Submission of final draft report after addressing all feedback and power point presentation on report
VII. Facilitation at dissemination meeting for report
4. Payment Schedule
The disbursements will be made upon completion of following deliverables;
I. First Deliverable: Counter-signed contract - Before inception date - 25% payment
II. Second Deliverable: Inception report (as required above) - After 7 days of inception - 25% payment
III. Third Deliverable: First Draft Report for feedback and review according to the required quality standards - After 30 days of Inception - 40% payment
IV. Fourth & Final Deliverable: Final draft report after incorporating feedback including PowerPoint presentation according to the required quality standards. - After 50 days of Inception - 10% payment
5. Required Qualification and Professional Experience
A development and research public health institute OR Individual senior level consultant/practitioner preferably having experience of working in Sindh Province is required to conduct this assessment.
The required combination of qualifications and experience for this assignment should include;
I. University Degrees in social sciences, Master’s degree in public health, epidemiology and applied research
II. Demonstrated Research experience on Public health and population studies, GBV and of conducting similar quantitative and qualitative assessments (development and public health research, facility and community-based assessments).
III. Epidemiological experience on GBV related and social issue research, information system mechanism in the health system would be an asset
IV. Experience of working with Ministry of Health, Provincial Health and other social sector departments, health academia, NGOs, CSOs, INGOs, UN agencies in Pakistan is preferable.
V. Demonstrated analytical research report writing and communication skills in local languages of target areas
Note: The copyright of the documents and material including the raw data would be reserved with the World Health Organization and cannot be circulated without consent. No HR/personnel, agility and equipment costs would be accepted in proposals
6. To Apply:
Interested and qualified applicants/development and research institute OR individual consultants are required to submit a technical proposal including, proposed stepwise methodology with sampling and work plan for the assignment deliverables along with updated CVs of team members as well as financial proposal including realistic budget breakdown.
DO NOT APPLY ONLINE.
The Proposal are required to be submitted through email at EMACOPAKHR@who.int with the Subject of assignment “APW (GBV)” by 01 August 2021;