Background

Thanks to political commitment and with the support from key development partners, mainly WHO, the Global Fund and DFAT, the MOHMS and the National Tuberculosis Program, through sustained TB prevention and control efforts, have already achieved the Millennium Development Goals (MDG) and the global targets set by the Stop TB Partnership for 2015:  the burden of morbidity and mortality has been decreasing steadily since 1990, falling respectively by 76% and 84% in comparison with 1990 figures.

Similarly, the country has already reached the WHO Western Pacific Region’s goal to reduce by half the morbidity and mortality from all forms of TB by 2015, relative to 2000 levels. By 2013 the morbidity was reduced by 59% and the mortality by 64%.

In 2014 the country kept on strengthening TB control by notably introducing GeneXpert, developing tools for screening risk groups for TB, revising the recording and reporting system based on the introduction of the new WHO definitions and the GeneXpert, the gradual integration of the TB specific information system in the DHIS2 and the revision of the diagnostic algorithm based on GeneXpert.

Despite the huge achievements, more efforts are still needed to sustain and increase the gains as the disease still represents a public health problem in the country with WHO estimating the TB burden in 2013 to 151 prevalent cases per 100000 population and 15 deaths per 100000 population and socioeconomic drivers of the disease are far from being eradicated.

Moreover the country has been detecting none of the estimated MDR TB cases and the stigma attached to HIV is such that HIV testing among TB patients is sub optimal; and the detected cases appear to be much lower than what is expected according to the estimates and taking into consideration the high prevalence of STIs. Adding to this, the proximity of PNG is deemed to be a risk for introducing both MDR and HIV in the country.

To this end the NTP together with stakeholders undertook an in-depth review of the situation of the disease along with the national response so far as well as the underlying health and community system challenges, and programmatic and financial gaps. As part of the exercise a thorough situation analysis by provinces was undertaken using an ecological analysis in the absence of prevalence surveys and estimates at the sub national level.

This provided the basis for a strategic thinking exercise that resulted into the development of priority high impact interventions as part of the GF NFM concept note. The interventions are meant to address the remaining challenges and gaps in a focused way so as to target high burden geographic locations, and key populations affected by the disease including patients’ contacts, people with debilitating diseases and conditions (HIV and diabetes), inmates, children, smear negative persons with presumptive TB, including children and people living with HIV, and people living in informal settlements and remote areas, using high impact interventions based on technically sound tools and approaches.

The immediate purpose of the interventions is to ensure universal access to TB care and prevention through improving institutional and human capacity within the health system, empowerment and involvement of communities with meaningful patient support, collaborative activities with other disease programs including, HIV, malaria, and child and mother health, and engagement of all heath care providers beyond the TB program and the public sector.

To this end the TB program will make use of enhanced existing technologies, tools and approaches as well as new ones using among others modern technologies including new rapid diagnostic tests, SMS notification of lab results and electronic recording, reporting and follow up of TB patients.

All TB control actions planned in the concept note take into consideration the health system and community system realities and strive to strengthen their different components pursuing synergies, optimizing the use of shared resources across disease control programs and reducing duplicative structures and functions.

They also take into consideration lessons learned through previous program implementation and implementation of GF grants.

The expected impact is to sharpen the decline of the burden of the disease towards elimination as per the internationally agreed targets in the framework of the post 2015 development agenda.

The application was submitted in the 15 October 2014 window and was successful without further submission, the TRP having deemed it strategically focused and technically sound.

The grant making phase went smoothly and was marked by proactive interactions between the TB program/PR and the GF team through TCs, email exchange and meetings in Suva and Honiara.

There was a final agreement on the grant documents (Budget, PSM template, performance framework, grant description, grant agreement clauses), on the modalities of the COD implementation including independent data verification, and on the implementing institutions.

WHO will be sub recipient for technical assistance and procurement of medical equipment, supplies and commodities, and pharmaceuticals. The related funds are outside the COD model and the relevant activities are grouped as non COD activities.

The Ministry of Health as Principal Recipient will be in charge of implementing the remaining activities, that is the COD activities, by frontloading the funding, and the GF will disburse all or part of the related award funding based on the achievement of the agreed targets and fulfilment of the conditions put forth during the grant negotiation according to agreed criteria, that is the COD funding scale.

This funding scale is such that the calculation of the amount of Cash on Delivery Funds that will be disbursed throughout the implementation period will be based on a two-step approach: in Step One, the reported performance of the two indicators will be assessed against their targets and the preliminary amount of Cash on Delivery Funds will be calculated; in Step Two, the data quality rating derived by an independent data quality and programmatic assessment will be applied to the preliminary calculation determined under Step 1, and the final amount of Cash on Delivery Funds to be disbursed will be set.

The criteria adopted were deemed reasonable and will not likely constitute a barrier for full disbursement of the funds as long as the TB program will undertake proper monitoring of the project and the program as a whole.

The country TB team represented by the NTP and WHO as TA provider agreed with the GF on the conduct of a mock data verification exercise that will be useful in testing the methodology and adjusting it accordingly, and in raising awareness of the TB program teams on the importance of the data quality assurance.

Since the grant implementation is officially determined to have started on 1 January 2015 notwithstanding the grant signature, which will take place in June 2015, the TB program started implementing the grant. The main activities implemented consisted of the continuing WHO technical assistance; the conduct of a mission from the Supra National Reference Laboratory to boost EQA, LED microscopy and implementation of GeneXpert; the conduct of the national evaluation and planning workshop; the celebration of World TB Day; refresher training on the DHIS2; the development of the new framework for contact tracing to enhance case finding and the WHO recommended recording and reporting system; and routine implementation and monitoring of the program.

During the implementation of these activities, a particular emphasis was put on the implementation and monitoring of the GF NFM grant. The TB program took the opportunity of this year’s World TB Day to urge TB field teams to sustain their efforts to fully implement the interventions planned in the national strategic plan, most of them operationalized in the Global Fund New Funding Model.

The NTP Evaluation and Planning Workshop was an opportunity to discuss the Performance indicators of the NFM by putting emphasis on reaching the targets as part of the COD Model.

The following actions were promoted and discussed during the workshop:

• Increase case detection while maintaining the treatment success rate around 90% with a cure rate of 80% or more.
• Intensifying contact tracing using the new simplified framework
• Starting screening among patients with diabetes using the already developed screening form
• Intensifying screening among prisoners using the already developed screening form
• Intensifying screening among HIV+ people using the already developed screening approach included in the national TB guide
• Being prepared for the implementation of community based DOTS as part of the GF NFM through actions aiming at providing DOT during the continuation phase of the TB treatment; raising community awareness of TB, its symptoms and services; providing treatment support to patients; and helping in contact tracing
• Improving follow up of patients from other provinces seeking care in the HCC province by registering them from the onset in their home province TB register making use of the TB patient notification card thereby keeping track of the patient once discharged from the hospital and ensuring appropriate follow up and confirmation of cure by performing follow up sputum smear examinations.
• Implement the new recording and reporting system ensuring that the paper based system is maintained in parallel with data entry in the DHIS2 and that the quality of data is rigorously checked and promoted through regular supervisions and feedback from the central unit’s data quality officer.
• Fully use the GeneXpert diagnostic test through proper requests of the test by clinicians at the provincial hospitals and Area Health Centres (laminated algorithms were distributed to all provinces during the present workshop) and use of established sample transportation mechanisms to the National Reference Laboratory. Use of the updated request for bacteriological examination form and the TB lab registers is essential in ensuring effective and efficient case management and proper TB surveillance and monitoring and evaluation.
• Intensify HIV testing among TB patients thereby ensuring proper patient care as well as narrowing the information gap about the HIV burden in the country

Tasks

1. Conduct and facilitate, with the help of the WHO TB Medical Officer and in coordination with the NTP manager, the exercise of analysing the TB epidemiological situation through
   1. Analysing the epidemiological situation and its trends taking into consideration TB control efforts and other drivers of the epidemic as part of an ecological analysis. Special emphasis will be on key populations and geographic areas.
2. Validate WHO estimates
3. Assess gaps in the surveillance system using the WHO impact measurement task force checklist

Deliverables

• Report on the epidemiological situation including analysis of the estimates and evaluation of the surveillance system and steps to improve it so that case notifications will eventually serve as a proxy for incidence.

Timeline

• 10 days starting 26 September 2016
                                                                                                                                                                                                                                     

Required experience and skills

Essential

• Minimum 5 years’ experience in epidemiology and TB control.
• Well-developed interpersonal communication and stakeholder liaison skills
• Experience working in a complex environment in a developing country context.

Required qualification

Epidemiology and TB control.

Interested should submit the following documents to wpfjidpsprocurement@who.int by 15 August 2016. Please use Tender Notice No  48264 as subject to all submissions. Contract start date is 26 September 2016 with a duration of 10 days.

• Expression of interest (cover letter) that includes proposed consultancy fee (per day) and availability
• WHO personal history form or CV

Please note that the application may be closed before the indicated closing date if a sufficient number of applications are received. Only successful candidates will be contacted