Terms of Reference (TOR)
Globally, FP is recognized as a key life-saving intervention for mothers and their children and postpartum women are among those with the greatest unmet need for FP. Postpartum family planning (PPFP) focuses on the prevention of unintended and closely spaced pregnancies through the first 12 months following childbirth. According to an analysis of Demographic and Health Surveys data from 27 countries, 95% of women who are 0–12 month’s postpartum want to avoid a pregnancy in the next 24 months; but 70% of them are not using contraception (Ross & Winfrey 2001). FP can avert more than 30% of maternal deaths and 10% of child mortality if couples space their pregnancies more than 2 years apart (Cleland et al. 2006). Risk of child mortality is highest for very short birth-to-pregnancy intervals (<12 months). If all couples waited 24 months to conceive again, under-five mortality would decrease by 13%. If couples waited 36 months; the decrease would be 25% (Rutstein 2008).
In Lebanon approximately 47% of Lebanese women between 15-49 years of age do not use any form of contraception. Among the remaining 53%, pills (18.5%) and IUD (17.2%) are the two most popular methods followed by male condoms (5.3%)
. On the other hand a study conducted in 2013 about Syrian women showed that 42.3% were not using any form of contraception prior to pregnancy. For Syrian women using birth control, birth control pills (23.4%) followed by IUDs (17.2%) were preferred contraceptive choices. 
Lebanon is hosting the largest proportion of refugees in the world if compared to the size of its population and the largest number in the region reaching 1,113,941 as of August 25, 2015; of which around 53% are women and about 18% are young people
. In Lebanon where Syrians refugees account for 18 per cent of the overall population, meeting the reproductive health needs of refugee women in general, and pregnant refugee women in particular, is equally essential considering that women and children account for up to 75 percent
of Syrian refugees. Given that refugees in Lebanon are scattered among 1,600 locations across the country, it is difficult to document and update pregnancy and newborn rates. UNICEF UK reported that one Syrian baby is born a refugee roughly every hour, joining the nearly six million Syrian children that are already living in dire condition.
During 2014 UNHCR reported 30,561 cases of delivery of which 36% referrals resulted in a C‐section. Before Syria descended into civil war, it had a working health system. Family planning was free and used relatively widely by 58% of women
. Yet the last time an extensive survey was carried out among Syrian refugees in Lebanon, approximately 37% of non-pregnant married women were using contraception.
To date, the focus of humanitarian agencies has been on meeting urgent and life threatening needs. A number of needs assessments of Syrian refugees have been undertaken in Lebanon; however, few include a nationally representative sample or focus on health and access to health services. In early 2014 a Multi Sector Needs Analysis (MSNA) identified a series of important data and information gaps in the humanitarian health response in Lebanon such as awareness campaigns, distribution and uptake of contraceptives/birth control; family planning information among the refugee population, as well as target group levels of awareness. One of the primary data needs arising from this exercise was for a national health access survey to be conducted to provide up to date information on the drivers and determinants of access to health care services for refugee and host community populations.
The intended assessment will reflect the unmet needs, access to, and utilization of the existing postpartum family planning (PPFP) services available in Lebanon (including Syrian women) during the post-delivery and pre-discharge time (0-24 hours for NVD & 0 – 72 hours for C-section )
The purpose of this assessment is to contribute towards improvement of PPFP services (if any) in the maternity wards of selected public hospitals accessible to both Lebanese and Syrian inpatient women. This will be achieved through the following specific assessment objectives;
- Availability of a specific minimum package of RH services and including PPFP.
- Availability of recommended modern PPFP methods at the maternities for breast feeding and non-breast feeding women as per the WHO standards.
- Availability of trained staff (physicians, nurses, midwives??) for PPFP services (counseling) at the maternities
- Availability and distribution of PPFP educational material and awareness sessions for couple together or women only.
- Perception of the women during the post-delivery and pre-discharge time (0-24 hours for NVD & 0 – 72 hours for C-section) about PPFP and preference of methods and available services at the maternities of selected hospitals.
- Cost of PPFP services if any and availability of follow up by the selected hospitals.
Under the supervision of UNFPA office and in close partnership with the Ministry of Public Health, a consultant will be identified and contracted to carry out the following tasks:
- Carry out literature review and internet search on the topic
- Review and discuss with UNFPA the TORs and expected results
- Prepare the set of instruments and tools for data collection
- Develop a timeline of visits to be carried out under this assignment
- Contact the eight hospitals pre-selected by UNFPA & the MoPH as follows as follows Rafik Hariri Hospital, Tripoli Governmental Hospital, Sayeda Governmental Hospital, Marjayoun Hospital, Hermel Hospital, Chtoura Hospital, Bekaa Governmental Hospital, Sayedet Salam Hospital.
- Conduct interviews with service providers and beneficiaries
- Conduct stakeholders meetings
- Prepare and ensure timely delivery of the first draft of the report (English) to be reviewed by UNFPA
- Consolidate the input/feedback into a final report which includes a set of recommendations.
The methodology will consist of the following:
- Conduct meetings with stakeholders (with MOPH, WHO and UNHCR)
- Identify and select eight hospitals based on selection criteria (to be discussed with UNFPA and the Ministry of Public Health).
- Within each hospital the target groups will consist of
- 4 service providers (i.e. maternity ward supervisor, midwife, pharmacist & doctor)
- 8-10 beneficiaries per hospital (pregnant/newly delivering women).
- Semi structured questionnaires shall be applied for the service providers
- Semi structured questionnaire shall be applied for beneficiaries.
The consultancy outcome will consist of a 25 – 30 pages report in English featuring overall analysis and specific findings both at service delivery level and at the beneficiary level in terms of availability, choices, cost, preference, perception, etc in relation to PPFP services for Lebanese and Syrian women during the post-delivery and pre-discharge time (0-24 hours for NVD & 48 – 72 hours for C-section)) at the secondary care level. The analysis should also address hindering factors for accessing/utilization of contraception (i.e. cost, cultural, lack of counselling, unavailability of wide range of methods, lack of personnel, etc). The report will include conclusion and action oriented recommendations. The structure of the report shall be discussed between UNFPA and the consultant.
- Advanced University degree (MPH/MS) in public health, social/development sciences or other related areas with at least 6-7 years of work experience and considerable skills in survey design, analysis and report writing;
- Strong background in maternal health / SRH / FP
- Excellent interpersonal skills and ability to establish effective and working relations with other stakeholders;
- Excellent written and spoken communication skills in Arabic and English.
Duration of the assessment
The assessment should be concluded within 2 months from the signing of the contract.
HOW TO APPLY
Interested candidates may apply online by providing:
(2) a most updated CV, and
(3) a cover letter mentioning the relevance of past/current experience with the requirements of the consultancy.
The above documents must be sent to the following email address:
Candidates who fail to submit the required documents above will not be considered for review
Only those applicants in whom UNFPA has expressed interest shall be contacted within a maximum of 5 working days following closure date.
Benage, Matthew et al. “An Assessment of Antenatal Care among Syrian Refugees in Lebanon.” Conflict and Health
9 (2015): 8. PMC
. Web. 3 Sept. 2015.