Global Fund-Somalia Program – TB program Laboratory Consultant Laboratory Consultant Consultancy

Word Vision International – Global Fund-Somalia Program – TB program Laboratory Consultant

Terms of Reference (ToR)

1. Activity Summary

Project Name: Somalia Global fund Tuberculosis (TB) program

Activity Type: TB program laboratory consultancy

Purpose of the consultancy: Improve TB diagnostic system. Improve Increase access to quality Tuberculosis diagnosis services.

Proposed Methodologies

1. Support supervision of TB regional / Culture laboratories
2. Support supervision of MDR Facilities laboratories
3. Training and mentorship of TB laboratory staff
4. Analysis, evaluation and reporting of TB laboratory data
5. Monitoring laboratory services and providing recommendation

Proposed Monitoring Dates:1^st January, 2021 – 31^st December, 2023

Reporting Dates: Monthly (Every 1^st of the following month after end of month)

2. Description of Program

Project Goal: Reduce the incidence of TB (all forms) by 50% by 2025 and 90% by 2035 (from 2015 baseline figure)

Project Objectives

1. Increase TB treatment coverage (case detection ratio) to 50% by 2020 (from baseline of 47% in 2015)
2. Increase treatment success to at least 90% in all forms of detected non- Multi-Drug Resistant (MDR) TB cases
3. Increase annual case detection of MDR- TB to 400 by 2020 (from baseline of 243 in 2016) and improve management of MDR-TB cases through country-wide implementation of the shorter MDR-TB treatment regimen
4. Ensure that 100% of new staff receive induction training and that 50% of TB service facilities receive regular supervision and monitoring by 2022

Project Outcomes

1. TB O-1a: Case notification rate of all forms of TB per 100,000 population – bactSectorseriologically confirmed plus clinically diagnosed, new and relapse cases
2. · TB O-5(M): TB treatment coverage: Percentage of new and relapse cases that were notified and treated among the estimated number of incident TB cases in the same year (all form of TB – bacteriologically confirmed plus clinically diagnosed)
3. · TB O-5(M): TB treatment coverage: Percentage of new and relapse cases that were notified and treated among the estimated number of incident TB cases in the same year (all form of TB – bacteriologically confirmed plus clinically diagnosed)
4. · TB O-6: Notification of RR-TB and/or MDR-TB cases – Percentage of notified cases of bacteriologically confirmed, drug resistant RR-TB and/or MDR-TB as a proportion of all estimated RR-TB and/or MDR-TB cases
5. · TB O-4(M): Treatment success rate of RR TB and/or MDR-TB: Percentage of cases with RR and/or MDR-TB successfully treated

Project location (Districts and # of villages/ sub locations) -Puntland, Somaliland and Federal Government of Somalia

Number of target beneficiaries Sectors: 16, 109,000 which is the total population of Somalia (Worldometer)

TB patients,Health

Key Project Activities

1. Drug sensitive TB diagnosis
2. Drug sensitive TB treatment
3. Drug resistant TB diagnosis
4. Drug resistant TB treatment
5. TB/HIV collaborative activities (ACSM, PPM)
6. Procurement and supplies distribution

Donor:Global Fund to fight TB, AIDS and Malaria

Duration of the Program:3 years

Available Project Documentation

Somalia TB strategic plan, performance framework, project log frame, Inventory study report, Patients’ perspective toward TB treatment report (Quote Study), Impact Evaluation report, KAP Surveys, PU/DRs

3. Brief Background of Project

Globally, 6.3 million new cases of TB were reported in 2016, equivalent to 61% of the estimated incidence of 10.4 million. According to WHO World TB report 2016, Somalia has one of the highest TB incidences rates in the world estimated at 270/100,000 with a prevalence rate of 481/100,000 and estimated mortality (excluding HIV/TB) rate of 64 per 100,000 population. According to the latest UNFPA report, Somali population is estimated to be 12.3 million. TB continues to contribute to the disease burden in Somali, with the latest WHO TB report estimating a Case Detection Rate (CDR) of only 49%, meaning 51% for all the cases (estimated) are being missed or undetected and majority of these are believed to be at the community level. In the last 5 years, case notifications have shown continued fluctuation and decline.

In Somali, TB control service provision is managed under the National Tuberculosis Programme (NTP) within the Ministry of Health (MOH). However, after the collapse of the central government in Somalia in 1990, TB control service provision have been implemented through key partners who consist primarily of international and national Non- Governmental Organizations (NGOs) with WHO providing the technical expertise in collaboration with Somalia government. From 2004, TB control have been funded chiefly by the Global Fund for AIDS, Malaria and TB (GFATM). World Vision (WV) is the principle recipient. Further, the government contributes to the implementation through provision of infrastructure, security support and facilitation of the NGOs involved in the TB control.

Despite being at its infancy stage and the complex political and security in the country, the Somali government has made progress in TB control and management. Access to TB services has generally improved through an increase in the Out-Patient Department (OPD) services and laboratory network for microscopy services implemented according to the Stop TB Partnership global DOTS strategy. With uninterrupted funding from the Global Fund since 1995, access to TB services and treatment have increased from 12 TBMUs in 1995 to 83 by December 2016. Quality diagnosis and treatment resulted in a treatment success rate of above the 85% global threshold. In 2015, the government finalized the development of the second National TB 2015-2019 strategic plan. This was followed by the completion of the monitoring & evaluation (M&E) plan that will guide the implementation of the strategic plan. The Strategic Plan contributes to the Somali Health Policy goal of improving the health status of the population through health system strengthening interventions and providing quality, accessible, acceptable and affordable health services that facilitate moving towards Universal Health Coverage (UHC) and accelerate progress towards achieving the health-related Sustainable Development Goals (SDGs).

Without diminishing the TB control and management progress made in Somali, TB program have not expanded as desired. There has been a slow progress in improving the existing infrastructure to increase their capacity as well as establishing new health facilities to meet the community needs or ensuring quality of the services. Required additional resources in terms of workforce, infrastructures, equipment and supplies have been limited. At present, the Global –Fund supported TB program in Somali is implemented by World Vision International Somalia Program (WVI-S) working in with other Somalia TB program implementing partners. The Somalia Health Sector Committee (HSC) and the TB Coordination Team (TBCT) provides the Country Coordination Mechanism (CCM) for the program.

4. Purpose and Objectives of the engagement

Laboratories are an essential and fundamental part of health systems and contribute directly to the improvement of health services. Reliable and timely results from laboratory investigations are critical elements in decision-making in all aspects of health services.

A laboratory is an essential component in the continuum of TB diagnosis, care and treatment. The World Vision Global Fund TB program is tasked with improving the TB laboratory system to increase access to quality diagnostic services and therefore contribute toward management of Tuberculosis in the country.

A laboratory consultant will work to ensure progress is being achieved towards ensuring access to quality laboratory services

The main objective is to increase capacity of the TB laboratory system and therefore, access to TB laboratory services by:

· Strengthening the External Quality Assessment (EQA) and Q/A systems for microscopy, Gene Xpert, Baseline and DST tests

· Improving lab services based on EQA findings

· Building capacity of the national TB program and assisting in lab related services

· Improving the sample referral system

5. Scope of the Engagement

o All Somaliland TB laboratories

o All Puntland TB laboratories

o All Federal Government of Somalia Laboratories

6. Logistics

Based on this ToR, the successful entity will propose a suitable approach and budget for this engagement. Upon approval of the technical approach a meeting will be arranged with the project team to agree on the frame of operation and responsibilities of each party.

WV Somalia GFTB PR team together with Quality Assurance team will support the successful entity in understanding its program model and the standard tools used in monitoring related activities. WV Somalia will also ensure that necessary linkages are created between the laboratory consultant, field staff and implementing partners.

7. Responsibilities of Consultant

· Provide support to the Somalia National TB program, National and Regional Tuberculosis reference laboratories in strengthening of TB laboratory services with main focus on Smear microscopy, Gene Xpert tests, Baseline tests and SLD DST & culture

· Provide capacity building support

o national and regional capacity in EQA, biosafety,

o maintenance plan of equipment including BSC and BSL 2 and 3

o Biosafety

o Sample referral and Transport system of samples,

o reporting and recording

o Quality management system

· Support development and adherence of SOPs for laboratories, culture and DST (phenotypic and Genotypic)

· Provide technical advice and expertise on the implementation of the new TB laboratory diagnostic tools

· Capacity building through training and mentorship and continuously support transfer of skills

· Participate in laboratory TWGs and technical support in the procurement and supply chain management of laboratory supplies

· Facilitate EQA and sample referral logistics**

8. WV Responsibilities during evaluation

· Provide necessary orientation and training to the selected entity

· Provide the selected consultant with necessary documents to enable clear understanding of the project

· Create linkages with field staff, Implementing Partners/SRs and other stakeholders

· Provide on-going supervision and guidance to the selected individual/firm/NGO

· Review and approve field approaches to be used by the consultant

· Review reports and data sets to ensure quality. Equally provide on-going feedback to the consultant

· Make arrangement for the consultant travel to field locations for supervisory purposes.

9. Deliverables

· Quarterly analyzed EQA reports

· Monthly reports of slides and samples referred and analyzed

· Quarterly reports on analysis of reported data of Smear, Microscopy, Gene Xpert, baseline tests, and SLD DST & culture

· Periodic reports on training, capacity building and technical support of the Somalia TB program with respect to Microscopy, EQA, Gene Xpert, SLD DST and culture

· Periodic reports on laboratory procurement requests analysis and recommendation

· Periodic reports on the status of the TB laboratory system including recommendation on improvement

10. Proposal Contents

Proposals from Individuals consultant should include the following information (at a minimum)

1. Proposed approaches
2. Proposed budget
3. CVs of key team members for this engagement.

11. Qualifications of the Consultant

Education: **

Diploma or degree in medical laboratory science or equivalent

Experience and competence:

1. Experience in laboratory system strengthening activities in Somalia or similar developing country
2. At least 5 years’ experience in TB diagnostics (microscopy, Gene Xpert, culture and SLD DST)
3. Knowledge of liquid and solid media for TB culture and DST
4. Knowledge of laboratory quality assurance and strong experience in instituting good lab practice
5. Experience in undertaking or facilitation EQA for microscopy, Gene Xpert and SLD DST
6. Extensive experience in supervising and capacity building skills Tuberculosis laboratory staff
7. Experience with Laboratory Information System and quality management system is an advantage
8. Previous experience of working with Global Fund or WHO related programs is an advantage

12. Evaluation Criteria

1. MDR-TB and culture Laboratory technical knowledge and experience
2. Experience in undertaking or facilitation EQA for microscopy, Gene Xpert and SLD DST
3. Experience in supervising and capacity building laboratory staff
4. Experience with laboratory Information System and laboratory quality management system
5. Knowledge of solid media and liquid media for TB culture and DST
6. Please work experience in Somalia or any other fragile context
7. Experience working with National TB Program staff