National Health Policy Expert to develop a high-quality health policy document (strategy & implementation roadmap), Tbilisi, Georgia.

Purpose of Activity/Assignment:

To formulate a strategy for Georgia’s Child, Adolescent, and Youth Mental Health and Psychosocial Support (MHPSS) system strengthening, along with an implementation roadmap and costing.

Scope of Work:

Background

Access to mental health (MH) services for adolescents and youth is restricted, primarily available in major cities, and even then, these services are fragmented and poorly coordinated. According to research conducted by UNICEF^[1], both students and MH professionals have identified several barriers to accessing these services. These barriers include a lack of information, high costs for specialist visits and medications, mistrust in the expertise and qualifications of specialists, and concerns about confidentiality breaches when receiving services.

The 2018 survey in Georgia revealed a significantly lower number of people utilizing mental health services compared to the number of officially registered cases. Over half of the patients likely avoided referrals due to stigma, poor service quality, and limited geographical and financial accessibility.^[2] Experts have identified child and adolescent mental healthcare, housing, and psychosocial care for chronic mental disorder patients as the most challenging and underdeveloped areas. There remains a substantial shortage of qualified psychiatric nurses and social workers. However, the establishment of multidisciplinary operational groups and an active National Institute of Mental Health has provided a solid foundation for future development^[3].

In recent years, changing humanitarian contexts have created a more hazardous environment for the well-being and development of children and adolescents. Reflecting global trends, the burden of poor mental health among adolescents and youth has also increased in Georgia during the COVID-19 pandemic. Research on the prevalence of mental health conditions and access to services among 18-24-year-old university students in Georgia^[4], revealed high rates of mental health issues: one in four young people experienced moderate to severe anxiety symptoms, one in three showed signs of depression, and one-third have contemplated suicide at least once in their lives.

The same research highlighted a significant lack of knowledge about mental health issues among students. While 97 per cent of surveyed students were familiar with the term “mental health,” only one-third had some information about it. Additionally, over 30 per cent of students reported not sharing their mental health-related feelings and experiences with anyone, indicating a low level of connectedness among youth.

National statistics indicate a rising incidence of mental and behavioral disorders among children under 15 years old in Georgia, with the incidence rate increasing from 82.3 in 2020 to 109.5 in 2021^[5].

Considering the significant burden of disease and disability among adolescents due to poor mental health, and its impact on their survival, growth, and development, this area is a priority for UNICEF both globally^[6] and in Georgia. UNICEF Georgia is striving to enhance the implementation of mental health and psychosocial support (MHPSS) commitments across various sectors and to support the initiation of MHPSS reforms for children, adolescents, and youth in Georgia. This effort aims to strengthen their development and maximize their potential.

UNICEF, in agreement and coordination with the Ministry of Internally Displaced Persons from the Occupied Territories, Labour, Health and Social Affairs (MoIDPLHSA), is in the process of mapping of MHPSS services country wide with the support of national MH experts. The respective report (due to become available in December 2024) will entail information on available MHPSS services across Georgia, human resources involved (including their licensure requirements for professional work) and policy gaps.

In parallel, UNICEF is engaging international experts to support the development of Georgia’s MHPSS system with clear pathways and referrals. It is anticipated that these experts will bring their knowledge and experience in multi-layered and multi-sectoral approaches, which will contribute to the development of a well-organized and smoothly functioning MHPSS system which promotes a holistic approach to child, adolescent, and youth health, development, and protection.

The efforts above will establish the foundation for developing Georgia’s child, adolescent, and youth MHPSS system strategy, along with the corresponding reform implementation roadmap. The said policy documents (strategy and implementation roadmap) are planned to be developed by the National Health Policy Expert, in close collaboration with in-country MHPSS stakeholders and under the technical oversight of UNICEF mobilized international experts.

With this announcement, UNICEF seeks to commission a National Health Policy Expert to execute the tasks as stipulated in this ToR.

Objective and scope of work

The goal of this consultancy is to create a strategy for strengthening the MHPSS system for children, adolescents and youth and a corresponding roadmap and costing. This task will require active collaboration with national and international experts (mobilized by UNICEF) and high-level decision-makers across various sectors, including health and social services, education, and justice.

The assignment is for 53 days stretched across 12 months and is expecting to meet the following objectives:

• Strengthen understanding of the mental health and wellbeing landscape for children and young people in Georgia, including the upcoming MHPSS service mapping report (available in December 2024), and co-facilitate discussions on a country specific MHPSS system model with the international experts mobilized by UNICEF.
• Formulate a model for Georgia’s MHPSS system and secure the support of decision-makers.
• After reaching a consensus on the MHPSS system model, initiate a thorough consultation process to identify Georgia Governments’ priorities in this field. This process should include discussions on all relevant contextual factors to help outline the framework for policy documents.

Co-facilitate a high-level decision-making meeting with the lead Ministry (MoIDPLHSA) to adopt the

• Create a draft strategy for the child, adolescent, and youth MHPSS system strengthening, detailing an approach to mental health for these age groups over the next five years.
• Present and discuss the draft strategy at a roundtable meeting with adolescents and youth and incorporate their feedback in the 5-year strategy.  To further enhance youth engagement, additional platforms such as youth forums and youth councils should be used to collect a wide range of opinions and suggestions.
• Facilitate policy discussions with the involved line ministries and a wider group of stakeholders to achieve consensus on the draft MHPSS system strengthening strategy.
• Convert the agreed-upon strategy into an implementation roadmap, with costing, leveraging collaboration platforms to engage not only national stakeholders but also actively involving the donor community.

 MHPSS system reform documents.

Duration: 15 December 2024 to 15 December 2025