Consultancy to Develop a Multi-Country Policy, Referral and Treatment Guidelines... Tender

Procurement Summary

Country : USA

Summary : Consultancy to Develop a Multi-Country Policy, Referral and Treatment Guidelines for TB/DR TB Diagnosis, Prevention, Care and Control in Migrants and Settings with Refugees, Internally Displaced Populations (IDPS) and Returnees

Deadline : 24 May 2019

Other Information

Notice Type : Tender

TOT Ref.No.: 32974934

Document Ref. No. :

Competition : ICB

Financier : United Nations Secretariat

Purchaser Ownership : -

Tender Value : Refer Document

Purchaser's Detail

Purchaser : UNITED NATIONS DEVELOPMENT PROGRAMME
One United Nations Plaza New York, NY 10017
USA
URL :https://www.undp.org/

Tender Details

Tenders are invited for Consultancy to Develop a Multi-Country Policy, Referral and Treatment Guidelines for TB/DR TB Diagnosis, Prevention, Care and Control in Migrants and Settings with Refugees, Internally Displaced Populations (IDPS) and Returnees.

Overview:

This consultancy is requested by the United Nations Development Programme-s Regional Bureau for Asia and the Pacific (Bangkok Regional Hub) which acts as the Principal Recipient for the TB/MDR-TB interventions among Afghan refugees, returnees and mobile populations in Afghanistan, Iran and Pakistan (The Programme), funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund).



The Islamic Republic of Afghanistan (Afghanistan) has one of the highest numbers of refugees, returnees and internally displaced peoples (IDPs) in the region. In 2017, over 610, 000 Afghans returned from Iran and Pakistan. This includes 60, 000 registered refugees that returned from Pakistan, 100, 000 undocumented returnees from Pakistan, and over 450, 000 undocumented returnees from Iran. In 2016, following the arrival of more than 1 million documented and undocumented Afghan returnees, the existing capacity to absorb new arrivals in country is under significant strain and negative coping mechanisms such as remigration are increasingly prevalent[1].



Returns are taking place against a backdrop of increased internal displacement due to conflict and the nationwide drought (the worst in a lifetime- affecting over 3 million Afghans and resulting in massive displacement across the western region) and high civilian casualties due to persisting instability in several regions of Afghanistan. During 2018, over 300, 000 individuals were newly displaced, while over 500, 000 individuals were displaced in 2017. The continuing insecurity and limited capacity to absorb returning Afghans and those displaced within Afghanistan could lead to secondary displacement and onward movement.



Afghanistan, Iran and Pakistan have established strong national tuberculosis (TB) programs which have to date successfully ensured appropriate TB diagnosis, care and control services to populations, including migrants, refugees, returnees and IDPs. However, some of the TB services provided are not yet fully harmonized among the three countries. Moreover, the information on migrants, refugees, returnees and IDPs with TB is not routinely collected within the National TB Program networks of the three countries, and if it is, it is fragmented and not standardized.



Although in the previous years, there were some attempts among the NTPs of Afghanistan, Iran and Pakistan to collaborate in order to strengthen TB services provision to migrants and refugees moving across national borders, there is still no formal coordination mechanism to ensure i) harmonized strategy and policy development ii) implementation of a system to exchange standardized information on TB among migrants, refugees and returnees, iii) standardized and mutually supportive capacity building approaches, iv) regional approach to advocate for sustainable TB services for migrants, refugees, IDPs and returnees, v) regional and in-country dialogue on human rights and gender issues which affect access of target population to TB services and vi) development of a regional network of partners.



There are three target groups important for cross-border collaboration on TB control and finding missing TB/MDR-TB cases amongst mobile Afghan populations:



· Afghan migrants living within the general population in Iran and Pakistan. There is a considerable number of these migrants in both Iran and Pakistan, who would receive similar levels of services as the general population of the host country.



· Afghan refugees or returnees living in camps/villages/settlements. This group is easier to reach out with targeted public health interventions. These camps/villages/settlements are covered by the neighboring health facilities, which need to be strengthened and equipped to handle the additional workload. No parallel structures operated by non-NTP affiliated entities should be additionally established, for the sustainability of services and capacity building of the local service providers for the long term. Existing health services within these settlements will be supported for establishing a functional referral mechanism to the nearest TB services. People living in camps are a congregated population and may need a specific algorithm for diagnosis of TB, which should be sputum examination by GeneXpert. There is also a need to develop mechanism for active case finding. The recommended options include use of digital X-rays and GeneXpert as follow-up/confirmation.



· Afghan migrants/refugees/returnees travelling across the national borders. Diagnostic protocols differ between the three countries and even within the same country because of the diagnostic facilities/equipment availability and the different approach needed for different target populations (Annexes for each country-s approach). Iran has a specific lab algorithm for patient of Afghan origin.



Summary of the current treatment regimens is provided in Annex 1.



First line treatment is currently seen as being aligned. This is yet to be confirmed with involvement of the WHO-EMRO. All three countries are still using Category II treatment regiments, which all are planning to phase out. From 2020 there would be no Category II regimen in the three project countries.



Second line treatment algorithms are mostly aligned[2], except for:



· A minor difference in the standard MDR-TB treatment regimen in Pakistan - one medicine on the list (Ethionamide) is different from the other two countries, but this is not seen to be a big difference by the NTPs and WHO.

· The short course regimen is similar in all countries. However, differing levels of roll-out of the short course regimen in the three countries require careful and coordinated selection of treatment for patients:

· Pakistan already offer short course regimen to more than 40% of MDR-TB patients;

· Short course regimen has not started in Iran, but it will be applied during 2nd half of 2018 in the frame of an interventional (pilot) study in the country;

· Afghanistan currently has two sites (Kabul and Kandahar) where short course regimen is available. Once more LPAs will be available in Afghanistan (in Nangahar, Mazar and Herat) the short course treatment will be offered there.



[1] The number of returnees from abroad increased by 24% in 2016 alone, compared to the period between 2012 and 2015, followed by a notable 52% decrease in returns in 2017. During all three-time frames, Nangarhar received the most returnees (499, 194), nearly twice as many as Kabul (256, 145)

[2] All EMR member states will be oriented on the revised MDR policies and guidelines and EMRO will provide guidance in the transition planning in April 2019




Duties and Responsibilities

Objective:



Consultancy to develop a multi-country[1] policy and referral and treatment guidelines for TB/DR TB prevention, care and control in migrants and settings with refugees, Internally Displaced Populations (IDPs) and returnees. The policy and referral and treatment guidelines will be aligned to the national strategies and guidelines.





Duties and Responsibilities



The following activities are expected to be completed as part of this assignment:



Activity

June

July

August

September

1. Inception phase

Outputs:

· Update the report of the Inter-Regional Workshop on Cross-Border TB Control and Care, Tehran, Iran, 2014.

· Develop the assignment work plan and assignment methodology.

· Develop a framework for the MC policy framework

· Develop a proposal on the process to update the national tuberculosis management and referral guidelines for refugees, IDPs, migrants and returnees.









2. Development of the multi-country (MC) policy document through desk work, country visits and on-line consultations.









3. Development of a harmonized management and referral guidelines through desk work, country visits and on-line consultations.















4. National Workshops to review and validate the multicountry (MC) policy and management and referral guidelines (the deliverables[2])















5. Develop a training module for service providers on TB management in migrants, refugees, IDPs and returnees















6. Facilitation of the discussions of the project deliverables[3] with Ministries of Health and Technical Agencies and finalization of the documents



















Expected Outputs and Deliverables:



The following are the expected outputs and deliverables:

1. A policy document on the TB services in settings with migrants, refugees, IDPs and returnees in Afghanistan, Iran and Pakistan. The document will describe the multi-country approach to the TB services for migrants, refugees, IDPs and returnees. (Expected up to 10 days)

2. Updated and harmonized TB diagnosis, prevention, care and control guidelines in settings with migrants, refugees, IDPs and returnees. This will result in harmonized TB prevention, care and control services. The document will propose interventions that will also improve TB services for women and children. The development of this deliverable requires country-specific actions which includes but not limited to national consultations to review, discuss and validate the proposed guidelines. (Expected up to 10 days)

3. Design a minimum package of service for cross border Tuberculosis care and services and develop three guidance documents (one in each country) on activ

Documents

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