Consultant - Technical expertise on key populations and harm reduction activities

Remote | Antananarivo

Organization: WHO - World Health Organization
Location: Remote | Antananarivo
Grade: Consultancy - International Consultant - Internationally recruited Contractors Agreement
Occupational Groups:
- Population matters (trends and census)
Closing Date: Closed

Purpose of consultancy

This contract consists of two related but distinct components:

To provide technical expertise to Madagascar on HIV and viral hepatitis programming for people who inject drugs
To develop an update of the WHO implementation tool to start and scale up needle and syringe programmes

Background

Activity 1: To provide technical expertise on Harm reduction in Madagascar

The HIV epidemic in Madagascar (overall HIV prevalence of 0.3%) can be characterized as a concentrated epidemic among key populations including sex workers, men who have sex with men, people who inject drugs and their partners.

Spectrum 2023 estimates reveal that there are 70,000 people living with HIV (PLHIV) in Madagascar. However, only 17,073 PLHIV know their HIV status in 2023. Also, the estimated proportion of PLHIV on antiretroviral treatment is 24. 1% and the proportion of PLHIV under treatment with suppressed viral load is 6.1%. These figures are far from the global HIV targets of 95%, 95%, 95% by 2030. On average 1,500 people are estimated to have died from AIDS every year over the past 5 years.

According to the 2022 integrated bio-behavioural survey (IBBS), the HIV prevalence particularly high among key populations, notably 20.5% among men who have sex with men (MSM), 11.2% among Sex Workers (SW) and 13.1% among people who inject drugs (PWID).

The Coalition for Global Hepatitis Elimination reported that in 2022 the prevalence of chronic HBV (HBsAg ) was estimated at 6.41% with a modeled HBV related mortality of 3.6 per 100.000. In 2022, the chronic HCV (RNA /cAg) was 0.39% and HCV related mortality was 6.38 per 100.000 in 2019. Further data are mostly unavailable including on people who use drugs and on overall rates of diagnosis and treatment of both conditions.

Madagascar will implement a harm reduction program for PWID and will develop a formal action plan. Some small-scale NGO-run needle and syringes programmes have started, but there is a need to also initiate the implementation of opioid agonist therapy (OAT). The reference frameworks for its implementation are currently documented, including treatment protocols, the process for the registration, importation and introduction of methadone, supply chain, as well as various regulatory requirements. Technical assistance is required to help start an OAT pilot and increase the NSP coverage.

Activity 2: To develop an update of the WHO implementation guidance to initiate and scale up needle and syringe programs (NSP)

In 2007, WHO published a guide to starting and managing needle and syringe programmes (NSP) . Since then, more information and evidence and good practice examples have become available, and more countries are requesting technical expertise to implement and scale up evidence-based harm reduction.

While more countries have initiated NSP, the quality of these NSPs could be much improved. In addition, their coverage is too low in most settings in order to have a public health impact on epidemics of HIV, viral hepatitis as well as other health problems including overdose-related mortality. WHO continues to support Member States in defining and implementing evidence-based harm reduction programs and the update of this implementation guidance with most recent content and evidence is essential for this.

Deliverables

Deliverables/time frame activity 1: To provide technical expertise on Harm reduction in Madagascar
- Task 1.1: To conduct a rapid assessment and response exercise in country with focus on people who use drugs and on developing an appropriate harm reduction response.
  - Deliverable 1.1.1. Short report on findings and recommendations from assessment
    Expected by: 15 December 2024
  - Deliverable 1.1.2. Report on planning for registration and procurement and introduction of OAT medications
    Expected by: 30 April 2025
- Task 1.2: To facilitate the organization of a harm reduction training for relevant stakeholders and development of training materials
  - Deliverable 1. 2.1. Training materials for in-country training
    Expected by: 31 January 2025
  - Deliverable 1. 2.2. Training report (including evaluations forms) and slide deck or other training materials used.
    Expected by: 15 March 2025
- Task 1. 3: To contribute to the development of relevant national guidance on evidence-based harm reduction and SoP for implementers in French
  - Deliverable 1. 3.1. Draft national guidelines (in French)
    Expected by: 31 July 2025

Activity 1 overall timeframe: 75 days in period November 2024 - July 2025 with a minimum of two visits to the country in collaboration with WHO Country Office.

Deliverables/time frame activity 2: To develop an update of the WHO implementation guidance for introducing and scaling up needle and syringe programs
- Task 2.1: Set up a technical working group with expertise in NSP and low-and middle-income countries (LMIC)
  - Deliverable 2.1.1 Report of technical working group meeting
    Expected by: 15 December 2024
- Task 2.2 Review latest evidence and implementation examples of good practice and develop draft and final document
  - Deliverable 2.2.1 Draft Document
    Expected by: 30 May 2025
  - Deliverable 2.2.2 Final document
    Expected by: 31 July 2025

Activity 2 overall timeframe: 75 days in period November 2024 – July 2025

Qualifications, experience, skills and languages

Educational Qualifications:

Essential:

Advanced university degree in public health and nursing, medicine or other related science

Experience

Essential:

Minimum of 7 years of international experience in public health response to improving drug user health – of which at least 3 years working in LMIC on implementing harm reduction
Specific experience in working on harm reduction in Sub-Saharan Africa
Experience in writing public health documents and guidance

Skills/Knowledge:

Essential:

Excellent analytical and technical writing skills
Good presentation and networking skills

Languages and level required (Basic/Intermediate/Expert):

Essential:

Expert knowledge of English
Expert knowledge of French

Location

Off-site: Home based.

Travel

The consultant is expected to travel.

Remuneration and budget (travel costs are excluded):

Remuneration:

Band level B: USD 7,000 - 9,980 per month

Living expenses (A living expense is payable to on-site consultants who are internationally recruited):

Not applicable

Expected duration of contract (Maximum contract duration is 11 months per calendar year):

9 months (150 working days during this period)

Additional Information:

This vacancy notice may be used to identify candidates for other similar consultancies at the same level.
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This vacancy is now closed.