TERMS OF REFERENCE 

TECHNICAL ASSISTANCE TO CONDUCT TB COMMUNITY, RIGHTS AND GENDER

(CRG) ASSESSEMENT AND DEVELEOP A COSTED ACTION PLAN- LEAD CONSULTANT 

Background

Lesotho is one of the 30 high TB burden countries in the world with an estimated annual incidence of 654 TB cases per every 100,000 population and prevalence of 581/100,000 as per 2019 nationwide TB prevalence survey. 72% of whom the TB cases are co-infected with HIV. This high co-infection rate makes Lesotho one of the countries with high TB related mortality. The mortality rate in TB/HIV coinfected TB patients is 223 per 100,000 populations. Additionally, the MDR-TB is worrisome with 3.2% and 6.8% of new and retreatment TB cases respectively being MDR-TBⁱ. Despite the high burden of TB, TB/HIV and MDR-TB cases in Lesotho performance in critical TB indicators remain suboptimal according to the TB Control program. TB case detection rate is only 49% which means that more than half of the estimated incident TB are not diagnosed or treated

It has been widely proven that TB disproportionately affects the poorest communities. Equally, human rights and gender-related barriers that affect TB prevention, treatment and care are deeply rooted in poverty and inequities. Poverty and low socioeconomic status as well as policy, legal, structural and social barriers prevent universal access to quality TB prevention, diagnosis, treatment and care. Lack of investments and efforts towards  addressing these barriers would prevent the Lesotho TB Programme from achieving targets and commitments to end TB.

Lesotho conducted the TB prevalence survey in 2019 and one of the things identified was that men are disproportionately affected by TB. While the prevalence survey report established that men are a “TB key population”, the survey does not provide strategic information on the policy, legal, socio economic and cultural drivers of TB in the general population and other vulnerable populations to inform a bottom-up and community-informed planning, implementation, monitoring and evaluation of TB services. This information gap was also identified by the Global Fund’s technical review panel  (TRP) as an issue that will negatively impact the planning and implementation of equitable quality TB and support services to ALL. TRP recommended for Lesotho to roll out the Stop TB Partnership CRG assessment toolkit.

Notably, the TRP highlighted that there was “lack of a gender-responsive and human-rights based analysis and interventions in TB”. TRP further stated that while men were disproportionately affected by TB (2019 TB prevalence survey); the funding request did not present an analysis of specific factors such as labor and migration- that influence use of services or access to diagnostics, treatment and care by both men and women; and did not discuss or address the legal or human rights barriers faced by people with or affected by TB.  The TRP provided strong recommendations for the country to conduct an “integrated TB communities, rights and gender assessment” to understand the barroers related to gender, human rights, stigma and discrimination in accessing and utilizing TB services. This assessment would further inform the advocacy, communication and social mobilization (ACSM) strategy and plan- replacing a stand-alone KAP survey to identify stigma issues. In addition, the TRP recommended that the results of the integrated assessment should translate to a “costed action plan” to address the identified barriers.

These TRP recommendations are well aligned  with Lesotho’s TB National Strategic plan, that demonstrates Lesotho’s global commitment to ending TB. This commitment begins with assessing community engagement, human rights and gender-related barriers to accessing TB services and developing a robust action plan to overcome identified barriers. It is against this background, that Lesotho’s Ministry of Health/ National TB Program (MOH/NTP) is seeking  to engage a local consultant that will coordinate and co-lead a multi-disciplinary team of consultants (including M&E expert, TB expert, costing expert, international CRG expert) in conducting a comprehensive TB CRG assessment in Lesotho. 

Aim and Objectives of the TB CRG assessment:

The TB CRG Assessment intervention aims to generate strategic information for the development of national action plans towards rights-based, gendertransformative and people-centered TB responses. The TB CRG Assessment and follow-up actions are expected to result in increased availability, accessibility, acceptability and quality of TB prevention, diagnosis, treatment, and care for All people affected by TB.

The specific objectives are:   

1. To Improve country capacity to respond to needs of TB key and vulnerable populations (KVPs) through a structured process of prioritizing local Key and vulnerable populations to TB
2. To generate strategic information and recommendations related to community engagement, Human rights and Gender (CRG) related barriers and facilitators to access equitable quality TB services
3. To develop a costed multi sectoral costed action plan to systematically address the barriers identified

Scope and methodology 

Guided by the “Stop TB Partnership’s Global Plan to End TB” and the “World Health Organization (WHO) End TB Strategy targets” that further link  to the Sustainable Development Goals (SDGs), the CRG assessment and action planning process is designed to be a community- led and country- owned process that, through an inclusive and multi-sectoral approach, allows countries to identify and address human rights and gender-related barriers and ensuring community and people centered approaches are central to the national TB response.

The assessment and action planning will be participatory and consultative. The multi-disciplinary team of consultants will conduct the TB CRG assessment using the “Stop TB Partnership TB CRG assessment toolkit”.

Duties, Responsibilities and Reporting Obligations

The lead consultant, working under the strategic guidance of the National TB Programme, will act as a lead researcher and  facilitate the active engagement of the core group and all participating stakeholders  in the planning and implementation of the STP CRG assessment toolkit.  The lead consultant, in collaboration with the multi-disciplinary team, will:

1. Lead in protocol development using the STOP TB Partnership CRG assessment protocol templates and budget, in preparation for and presentation at a “core group inception meeting”. It is anticipated that this protocol shall be ready in 7 days from the commencement of the contract
2. Prepare for and co-facilitate at least 4 core group meetings during the assignment period
3. Undertake stakeholder mapping of actors and stakeholders across sectors, working on end TB efforts in Lesotho, including government and non-government agencies, technical partners, civil society and communities affected and impacted by TB; and engage them throughout the process, including validation of results and action plan endorsement
4. Plan and co-facilitate a multi-stakeholder inception workshop to orient the identified stakeholders on the on the assessment toolkit, protocols, methods and plan of work.  It is anticipated that this will be presented to the stakeholders within 14 days of the inception report
5. Plan and co- facilitate training of identified data collectors and supervisors on the approved protocol
6. Conduct a document review of the programs and related data sources to identify gender and human rights aspects of the epidemic’s geographical distribute Consolidate inputs from other consultants and develop a first draft report of the findings, recommendations and costed action plan, which stem from CRG assessment processes. This draft report is anticipated within 14 days of field work
7. Plan and co- facilitate multi-stakeholder validation workshops to build consensus on the first draft report and
8. Incorporate inputs from the validation workshop to produce the final CRG assessment report and accompanying costed action plan

Deliverables

Duration of the TA:

• 45 consultancy days spread within the period December 2021 to April 2022

Education

• Master’s degree in Public health, Law, Social Sciences, Public Policy or related field;
• A higher post graduate qualification such as a PHD will be an added advantage.

Experience and Skills

• A senior mixed method Researcher with master’s level degree with a minimum of 10 years’ experience
• Proven previous experience in CRG related assessments and conducting studies, minimum 10 years of experience
• Demonstrated experience and knowledge of National TB programme
• Experience in leading and coordinating a multi-disciplinary team of consultants and/ researchers in related assignments
• Experience in engaging with national government agencies, technical partners and civil society/ communities is desirable
• Familiarity with the STOP-TB CRG assessment framework is desirable

Language

• Excellent oral and writing skills in English;
• Knowledge of local languages is desirable

Application procedure

Applicants are requested to submit a Technical proposal, including:

• A CV highlighting the relevant experience;
• A technical proposal detailing how the task will be executed and proposed workplan;
• Financial Proposal.