Word Vision International – Global Fund-Somalia Program – TB program Laboratory Consultant
Terms of Reference (ToR)
Project Name: Somalia Global fund Tuberculosis (TB) program
Activity Type: TB program laboratory consultancy
Purpose of the consultancy: Improve TB diagnostic system. Improve Increase access to quality Tuberculosis diagnosis services.
Proposed Monitoring Dates:1st January, 2021 – 31st December, 2023
Reporting Dates: Monthly (Every 1st of the following month after end of month)
Project Goal: Reduce the incidence of TB (all forms) by 50% by 2025 and 90% by 2035 (from 2015 baseline figure)
Project location (Districts and # of villages/ sub locations) -Puntland, Somaliland and Federal Government of Somalia
Number of target beneficiaries Sectors: 16, 109,000 which is the total population of Somalia (Worldometer)
Key Project Activities
Donor:Global Fund to fight TB, AIDS and Malaria
Duration of the Program:3 years
Available Project Documentation
Somalia TB strategic plan, performance framework, project log frame, Inventory study report, Patients’ perspective toward TB treatment report (Quote Study), Impact Evaluation report, KAP Surveys, PU/DRs
3. Brief Background of Project
Globally, 6.3 million new cases of TB were reported in 2016, equivalent to 61% of the estimated incidence of 10.4 million. According to WHO World TB report 2016, Somalia has one of the highest TB incidences rates in the world estimated at 270/100,000 with a prevalence rate of 481/100,000 and estimated mortality (excluding HIV/TB) rate of 64 per 100,000 population. According to the latest UNFPA report, Somali population is estimated to be 12.3 million. TB continues to contribute to the disease burden in Somali, with the latest WHO TB report estimating a Case Detection Rate (CDR) of only 49%, meaning 51% for all the cases (estimated) are being missed or undetected and majority of these are believed to be at the community level. In the last 5 years, case notifications have shown continued fluctuation and decline.
In Somali, TB control service provision is managed under the National Tuberculosis Programme (NTP) within the Ministry of Health (MOH). However, after the collapse of the central government in Somalia in 1990, TB control service provision have been implemented through key partners who consist primarily of international and national Non- Governmental Organizations (NGOs) with WHO providing the technical expertise in collaboration with Somalia government. From 2004, TB control have been funded chiefly by the Global Fund for AIDS, Malaria and TB (GFATM). World Vision (WV) is the principle recipient. Further, the government contributes to the implementation through provision of infrastructure, security support and facilitation of the NGOs involved in the TB control.
Despite being at its infancy stage and the complex political and security in the country, the Somali government has made progress in TB control and management. Access to TB services has generally improved through an increase in the Out-Patient Department (OPD) services and laboratory network for microscopy services implemented according to the Stop TB Partnership global DOTS strategy. With uninterrupted funding from the Global Fund since 1995, access to TB services and treatment have increased from 12 TBMUs in 1995 to 83 by December 2016. Quality diagnosis and treatment resulted in a treatment success rate of above the 85% global threshold. In 2015, the government finalized the development of the second National TB 2015-2019 strategic plan. This was followed by the completion of the monitoring & evaluation (M&E) plan that will guide the implementation of the strategic plan. The Strategic Plan contributes to the Somali Health Policy goal of improving the health status of the population through health system strengthening interventions and providing quality, accessible, acceptable and affordable health services that facilitate moving towards Universal Health Coverage (UHC) and accelerate progress towards achieving the health-related Sustainable Development Goals (SDGs).
Without diminishing the TB control and management progress made in Somali, TB program have not expanded as desired. There has been a slow progress in improving the existing infrastructure to increase their capacity as well as establishing new health facilities to meet the community needs or ensuring quality of the services. Required additional resources in terms of workforce, infrastructures, equipment and supplies have been limited. At present, the Global –Fund supported TB program in Somali is implemented by World Vision International Somalia Program (WVI-S) working in with other Somalia TB program implementing partners. The Somalia Health Sector Committee (HSC) and the TB Coordination Team (TBCT) provides the Country Coordination Mechanism (CCM) for the program.
4. Purpose and Objectives of the engagement
Laboratories are an essential and fundamental part of health systems and contribute directly to the improvement of health services. Reliable and timely results from laboratory investigations are critical elements in decision-making in all aspects of health services.
A laboratory is an essential component in the continuum of TB diagnosis, care and treatment. The World Vision Global Fund TB program is tasked with improving the TB laboratory system to increase access to quality diagnostic services and therefore contribute toward management of Tuberculosis in the country.
A laboratory consultant will work to ensure progress is being achieved towards ensuring access to quality laboratory services
The main objective is to increase capacity of the TB laboratory system and therefore, access to TB laboratory services by:
· Strengthening the External Quality Assessment (EQA) and Q/A systems for microscopy, Gene Xpert, Baseline and DST tests
· Improving lab services based on EQA findings
· Building capacity of the national TB program and assisting in lab related services
· Improving the sample referral system
o All Somaliland TB laboratories
o All Puntland TB laboratories
o All Federal Government of Somalia Laboratories
Based on this ToR, the successful entity will propose a suitable approach and budget for this engagement. Upon approval of the technical approach a meeting will be arranged with the project team to agree on the frame of operation and responsibilities of each party.
WV Somalia GFTB PR team together with Quality Assurance team will support the successful entity in understanding its program model and the standard tools used in monitoring related activities. WV Somalia will also ensure that necessary linkages are created between the laboratory consultant, field staff and implementing partners.
· Provide support to the Somalia National TB program, National and Regional Tuberculosis reference laboratories in strengthening of TB laboratory services with main focus on Smear microscopy, Gene Xpert tests, Baseline tests and SLD DST & culture
· Provide capacity building support
o national and regional capacity in EQA, biosafety,
o maintenance plan of equipment including BSC and BSL 2 and 3
o Sample referral and Transport system of samples,
o reporting and recording
o Quality management system
· Support development and adherence of SOPs for laboratories, culture and DST (phenotypic and Genotypic)
· Provide technical advice and expertise on the implementation of the new TB laboratory diagnostic tools
· Capacity building through training and mentorship and continuously support transfer of skills
· Participate in laboratory TWGs and technical support in the procurement and supply chain management of laboratory supplies
· Facilitate EQA and sample referral logistics**
· Provide necessary orientation and training to the selected entity
· Provide the selected consultant with necessary documents to enable clear understanding of the project
· Create linkages with field staff, Implementing Partners/SRs and other stakeholders
· Provide on-going supervision and guidance to the selected individual/firm/NGO
· Review and approve field approaches to be used by the consultant
· Review reports and data sets to ensure quality. Equally provide on-going feedback to the consultant
· Make arrangement for the consultant travel to field locations for supervisory purposes.
· Quarterly analyzed EQA reports
· Monthly reports of slides and samples referred and analyzed
· Quarterly reports on analysis of reported data of Smear, Microscopy, Gene Xpert, baseline tests, and SLD DST & culture
· Periodic reports on training, capacity building and technical support of the Somalia TB program with respect to Microscopy, EQA, Gene Xpert, SLD DST and culture
· Periodic reports on laboratory procurement requests analysis and recommendation
· Periodic reports on the status of the TB laboratory system including recommendation on improvement
Proposals from Individuals consultant should include the following information (at a minimum)
CVs of key team members for this engagement.
Diploma or degree in medical laboratory science or equivalent
Experience and competence:
Experience in laboratory system strengthening activities in Somalia or similar developing country
At least 5 years’ experience in TB diagnostics (microscopy, Gene Xpert, culture and SLD DST)
Knowledge of liquid and solid media for TB culture and DST
Knowledge of laboratory quality assurance and strong experience in instituting good lab practice
Experience in undertaking or facilitation EQA for microscopy, Gene Xpert and SLD DST
Extensive experience in supervising and capacity building skills Tuberculosis laboratory staff
Experience with Laboratory Information System and quality management system is an advantage
Previous experience of working with Global Fund or WHO related programs is an advantage
MDR-TB and culture Laboratory technical knowledge and experience
Experience in undertaking or facilitation EQA for microscopy, Gene Xpert and SLD DST
Experience in supervising and capacity building laboratory staff
Experience with laboratory Information System and laboratory quality management system
Knowledge of solid media and liquid media for TB culture and DST
Please work experience in Somalia or any other fragile context
Experience working with National TB Program staff