Consultant, LN – (3428)

The Federal Republic of Somalia is a low-income and conflict-affected state in the Horn of Africa. As a result of anthropogenic climate change, both average temperatures and the probability of extreme heat events are increasing in Somalia. These climate-related effects are forecast to lead to increased mortality among the Somali population, with certain population groups—including people affected by cardiovascular disease, the elderly, poor and displaced people in urban environments, underserved people living in remote locations, pregnant women and young children—at particularly high risk.

International Medical Corps strengthens local capacity and sustainability through training, mentoring, and collaborative supportive supervision programs. In Somalia, we have trained Ministry of Health staff and District Health Management Teams (DHMT) on mass casualty incident management, management of emergency operations centres, health data management, and monitoring and evaluation.

International Medical Corps collaborates closely with both Federal- and State-level Ministries of Health on all program design and implementation to ensure that they support and strengthen the health system and align with national strategies and key policies, such as Somalia’s Essential Package for Health Services. Furthermore, we ensure ongoing coordination and collaboration with hospital- and health center-level committees

International Medical Corps proposes improving the resilience of the health system to climate change-induced extreme heat in four regions of Somalia. The project will accomplish this outcome by improving the health system’s ability to respond to heat-related morbidities, particularly those associated with cardiovascular diseases, and ensure continuity of care.

To that end, activities will include assessing heat vulnerability and adaptation; community-level screening for cardiovascular disease; enhancing the local capacity to treat cardiovascular disease; public health education related to increased and extreme heat; training for the health workforce in responses to increased and extreme heat; and developing district-level preparedness plans for extreme heat events.

The focus of this assessment will be to evaluate the direct impacts of increased temperatures and of extreme heat events (heatwaves) on the health of the general population, and on particularly vulnerable subgroups of the population,[1] currently and over the next 10 years. The assessment will not include indirect impact of increased temperatures, such as nutritional impacts resulting from decreased crop yields, or health impacts related to changes in the prevalence of vector or waterborne diseases. The assessment will also not consider other impacts of climate change (such as changes in precipitation or air quality) on the health outcomes of interest.

The objectives of the assessment are to provide information to inform the design and implementation of the project: Supporting the Somali Health System to Respond to Increased Heat and Extreme Heat Events, specifically with respect to the three project outcomes:

1. Policies and related actions of the Somali government, and of partners in the health sector, recognize and address the health-related vulnerabilities associated with increased heat and extreme heat events.
2. Improved health outcomes for individuals presenting with cardiovascular morbidities who are experiencing increased heat and extreme heat events.
3. Health facilities, health workers and communities respond more effectively to the health impacts of increased heat and provide improved quality and continuity of healthcare services during extreme heat events.

The assessment should also provide information to allow an assessment of the suitability of relevant assessment tools to the Somali context and identify areas where adaptation of this guidance is required. It should consider, specifically:

1. The WHO Climate change and health: vulnerability and adaptation assessment guidance.
2. The WHO Checklists to assess vulnerabilities in health care facilities in the context of climate change.

The Consultant is to conduct a vulnerability and capacity assessment related to heat and health in Somalia’s Bay, Banadir, Middle Shabelle and Mudug regions.

Key questions

The Consultant will be expected to answer the following questions.

I. Risk Assessment: Heat in Somalia

1. Determine the current situation in Somalia regarding heat and atmospheric humidity (including annual and seasonal means; annual and seasonal maximum and minimum; distribution of hot and of humid days; frequency, duration, and degree of ‘extreme heat’ (as defined by national standard of agreed international standards).
2. Identify has this situation changed and how have any changes been affected by climate change?
3. Determine forecasts for changes in this situation over the next 10 years

II. Vulnerability Assessment: The current burden of heat-sensitive health outcomes and current  vulnerabilities

1. What is the main heat-sensitive conditions and health outcomes for consideration in this programme? What is the current prevalence of these conditions and outcomes?
2. Are there (geographical, seasonal or other temporal) trends in the drivers of heat sensitive health outcomes?
3. Are particular population groups at risk? (Physiologically, socially, economically? Include elderly people, pregnant women, newborns, infants, those with NCDs aggravated by heat and other relevant groups)
   1. What are the size and location of these population groups?
   2. What, if any, are the specific constraints that they face that add to their vulnerability?
   3. Specific information on the scale of diagnosed and undiagnosed CVD (as this is the key focus of the project)
4. Are health facilities adapted to high temperatures / heatwaves, and if so, how? Are logistics and storage (including cold chain) vulnerable to high temperatures / heatwaves, and if so, how?

(Note – in answering these questions, the Consultant should make use of the WHO ‘Checklists to Assess vulnerabilities in Health Care Facilities in the Context of Climate Change’, using the checklist as the main tool to identify the degree to which health facilities are adapted. The Consultant will also be requested to comment on the utility of the checklist for this task)

III. Capacity Assessment: The capacity of health and health relevant systems to address heat-related health outcomes

1. What are the policies and programmes that influence the health outcomes of interest (policies and programmes related to heat and health, CVDs, and possibly other health outcomes)

1. What are the current interventions that influence the health outcomes of interest,

• What is the coverage of this programs
• How effective are these interventions?
•  What are the key constraints?

1. What information is collected on health outcomes of interest? What are constraints to collection of key information
2. Do health workers have the relevant knowledge and skills to address health outcomes of interest in the context of increased heat?

• Are there preventive services such as health promotion and screening?
• Are health care providers trained on the diagnosis and management of the health conditions of interest?
• Are diagnostics and medications available for the correct and timely diagnosis of the health conditions of interest?
• What are the gaps?

1. Do communities have the relevant knowledge and skills (including awareness of climate change) to address health outcomes of interest in the context of increased heat? What are the gaps?

b. Do early warning systems for heat exist, and are they used:

• By health authorities (at which levels)?
• By communities?

1. Do contingency / preparedness plans, or any elements of preparedness plans, to maintain / expand health services in situations of extreme heat exist?
2. Are these plans effective?
3. In the absence of plans, how effective is the health system in responding to health emergencies, and what are the constraints?
4. What is the funding available to support interventions to address key health outcomes of heat (including building capacity in the areas outlined here) 

IV. Future risk assessment – heat and health in Somalia in the next 5-10 years

1. What will be the effect of continuing climate change on health outcomes of interest in the next 5-10 years?[2], [3]

V. Adaptation Assessment – (note that these elements should be presented as recommendations)

1. What are the priority areas among those addressed in the capacity assessment that require strengthening to address these effects?
   1. Policies
   2. Interventions and programmes (some activities included in this programme)
   3. Health information and early warning
   4. Health workforce development (some activities included in this programme)
   5. Preparedness and contingency planning (some activities included in this programme)
   6. Infrastructure and supply chain
2. What are the resources required to address these priorities?

1. DELIVERABLES DESCRIPTION:

Expected Outputs / Deliverables

• Inception report (including specific details on methodology, research questions, tools and schedules for data collection, ethical considerations, data analysis, storage, and management plans).
• A one-pager on the benefits and limitations of the assessment methodology used in the selected districts.
• Raw dataset and cleaned dataset in CSV (quantitative) and Word or Excel (qualitative) including all primary data collected, and a list of all groups/people consulted or interviewed.
• Provide Geo-Positioning system (GPS) coordinates for all study sites (including all households interviewed, should there be any).
• The Individual Consultant to provide a narrative report (including maps, pictures, tables, graphs) detailing the answers to questions outlined above, findings and recommendations, including secondary data review. This report will be presented in draft form to IMC, and a final version completed on the basis of comments received.
• Short report reflecting on the utility of the WHO vulnerability and capacity assessment guidance and the WHO Facility Checklist in the context of Somalia, detailing what was possible and what was not possible in terms of the recommended assessment process, availability of information, and any other elements of interest.

The Individual Consultant to develop the timeline

Process

To the degree possible, the assessment should follow the steps outlined in the WHO document Climate change and health: vulnerability and adaptation assessment guidance. The first step, ‘plan the assessment’, can be abbreviated, and consist of discussions with key International Medical Corps staff and external stakeholders, leading to the production of an inception report.

The assessment process should include the engagement of relevant stakeholders, including a discussion of priorities / recommendations with key stakeholders under the ‘Adaptation Assessment’ question (above).

The assessment process should articulate with the learning framework of the project.

Outputs

1. A ‘baseline’ document – the outcome of the vulnerability element of the assessment, that can be used as a baseline document for future analysis and assessments (see step 2E of the vulnerability and adaptation assessment guidance)
2. Results of assessment
3. Document outlining the process followed

Methodology

1. The Consultant is expected to submit an inception report, including a work plan within the first two weeks of the assignment and confirm the study methodology, tools, and sample size with the Monitoring & Evaluation(M&E) Manager, Project Technical lead, HQ Technical Unit and Country Director.
2. The Consultant will work with International Medical Corps Monitoring & Evaluation(M&E) Country technical leads and HQ Technical Unit (TU) to derive the best possible valid and relevant data collection tools to be used in the assessment.

International Medical Corps will review and approve the tools and support the selection of communities/clusters to be selected for assessment. International Medical Corps focal points for the assessment will organize introductions with stakeholders where required, assist in mobilizing participation and the provision of feedback to participants.

None. It is standalone assignment

N/A

• At least seven (7) years of work experience in climate and health related activities;
• Experience of working with Ministry of Health, Ministry of Environment and Climate Change (MoECC), , United Nations systems, and Non-Governmental Organizations (NGOs).
• Proven experience in conducting qualitative and quantitative data collection and analysis.
• Demonstrated experience in program assessments, evaluations, and operational research.
• Experience with mixed methods for data collection.
• Have a strong technical team to support him or firm on thematic areas, which must include at least a Medical Doctor.

• Demonstrated expertise in various data collection and analysis tools.
• Knowledge of climate change and its impact on health is an added advantage.
• Experience with mobile data collection methods and mapping of GPS coordinates.