Background and Justification
UNICEF has been working in Malawi since 1987 and its current strategies lay great emphasis on improving quality of maternal, newborn child and adolescent health care in the country. The strategies include strengthening capacity of health care providers, supporting scaling up of MNCH services at village outreach clinic level, district health systems strengthening, among others.
While all this has contributed to a steady decline in under-five mortality at an annual average rate of 5.4%, over the past decade, the decline has been relatively smaller for newborn health. While Malawi will be well within the MDG targets for child mortality, further improvements in this area will need evidence-based investments in newborn care. The main causes of neonatal death are prematurity and low birth weight, asphyxia and sepsis. At 18.1%, Malawi has the highest recorded preterm birth rate in the world.
The association between coverage of essential interventions and its effect of health outcomes, especially for mothers and newborns, has been debated in recent literature and quality has been argued to be one of the key components of interventions for them to move from adequate coverage to effective coverage. Quality has been described as the third revolution in global health. With more than 89% of the deliveries happening in health facilities in Malawi, it is possible to achieve high impact on newborn mortality by focussing on the quality of care that these newborns receive at the facility. However, improvements in quality of maternal and newborn care has to be alongside interdependent levels of the health care system, which is what UNICEF Malawi is trying to achieve with its newborn initiatives and interventions. A comprehensive documentation of this improvement process will help the Malawi government and other similar countries with resource poor settings, to take their interventions to scale.
Rationale
A consultant is needed to support the operations research design, development of tools and protocols and technical support to PACHI for documenting and learning how UNICEF’s RMNCH initiative in Malawi leads to improvements in the quality of care and health outcomes for mothers and newborns.
Furthermore, UNICEF in collaboration with WHO is interested in documenting a pilot study on innovative interventions in preterm care.
UNICEF would also like to document the adaptation of the real time monitoring system in relation to newborn care, in the Malawian setting.
Scope of Work
Purpose
To provide UNICEF with documentary evidence highlighting the progress achieved so far in newborn health, through their current investments in Malawi, and to consolidate a robust evidence base for future investments in newborn care.
Goal
To document and learn the improvements in quality of newborn care achieved by UNICEF-Malawi in its districts over the period 2015-2016
Objectives
- To document and share the learning from UNICEF’s RMNCH initiatives in Malawi
- To explore the scale up of a joint UNICEF-WHO pilot project to improve preterm care
- To examine the scope of a real time monitoring system for newborn care
Work assignment
- Examining UNICEF’s theory of change for its newborn care initiatives.
o A joint workshop of implementing partners on their individual theories of change
o Documenting a common theory of change for all of UNICEF Malawi’s MNH initiative.
- Identifying the intervention and implementation characteristics as well as the context in which the interventions are being implemented.
o Developing tools for analyzing implementation theory
o Data collection on key interventions using tools developed
- Analysing implementation strength and its effect on quality of care
o Collate and review monitoring data and other key documents from implementing partners
o Analyse and document linkage between programme implementation strength and quality of care
- Understanding the mechanism and context in which the interventions are being implemented and its effect on health outcomes.
o Develop hypothesis using a C-M-O (Context-Mechanism-Outcome) configuration
o Establishing program theory on the success (or failure) of program initiatives.
- Assessing the effect of a preterm improvement intervention on newborn case fatality in the facilities
o Development of a draft proposal and budget
o Develop implementation plan with implementing partner
o Monitor operations research activities
o Analysis and report-writing
- Piloting the establishment of a real time monitoring system in selected heath facilities
o Develop an operations research plan identifying the research methods, developing workplan and budget.
o Monitor operations research activities
o Analysis and report-writing
Research questions and proposed methodology
The primary research question is how does UNICEF’s current investment in MNH improve the quality of care and health outcomes for newborns in Malawi? The research also looks into other potential interventions to improve quality of newborn care such as preterm care interventions and real-time monitoring system.
Improving quality of care involves understanding the relationship between different inter-dependent layers of the health system. In trying to develop a holistic understanding of the programme and its effect, we use a theory-based approach to analyze the various interventions being supported by UNICEF.
Theory based research has been widely used in analyzing large scale programme interventions and is especially helpful for complex interventions. It maps out the causal chain from inputs to outcomes within a given context and tests the underlying assumptions.
In analyzing interventions using theory based approach, we will look at both the implementation theory as well as the programme theory[1]. This is done through two main methods Theory of Change (ToC) approach and realist evaluation (RE) approach, respectively. This provides a complete explanation of the mechanism of the intervention.
The research will focus on a research strategy (rather than a particular method) to analyse the various elements of the study. The research strategy includes the following components:
· Building a theory of change. It begins by identifying the key interventions and conceptualizing the theory of change of these interventions (including the risks and assumptions) and its intended outcomes. This includes a series of iterations with the program commissioners and program implementers to develop an understanding of the Theory of Change, followed by further revision and refinement.
· Identifying key characteristics within each intervention. This includes factors that influence the rate of adoption of the intervention as well as the broad organizational context within which the intervention is being implemented ie the relationship between the organization and its individuals (degree of belief, trust in the organization, hierarchy and channels of communication). Key elements of the implementation characteristics will be identified using the CFIR framework (Consolidate Framework for Implementation Research).
· Measuring implementation strength. This includes measurement of the dose, duration, specificity and intensity of the interventions as well as the implementation fidelity. This will also involve incorporating the monitoring and other documents available from implementation teams. Analysis of the implementation strength will also include measuring the immediate outputs such as knowledge of clinical staff, staff motivation etc.
· Explaining program theory Program theory will elicit the relation between the interventions and its effect on quality of care and ultimately on outcomes. This includes mechanism for improving responsiveness/utilization, improving access and improving accountability for MNCH at both facility level and community level.
Research management
Ethical considerations
Identification of key intervention characteristics as well as measurement of implementation strength will involve primary data collection. Ethical approval for this will be sort from the NHSRC (National Health Sciences research Committee).
Informed consent will be obtained from subjects involved in surveys, interviews or focus group discussions.
Desired competencies, technical background and experience
- Minimum of MPH or MSc in public health, specializing in implementation research
- Minimum 8 years of experience with health sector, health systems issues, monitoring and operations research.
- Excellent management and coordination skills and an ability to communicate effectively with diverse partners at international, regional and country levels
- Excellent skills and experience to deliver timely and high quality products.
- Ability to function effectively in English
[1] Implementation theory hypothesizes and analyzes links between programme activities and its anticipated outcomes. Programme theory establishes the causal links between the mechanism released by an intervention and its anticipated outcomes.
HOW TO APPLY:
Qualified candidates are requested to submit a cover letter, CV and Personal History Form (P-11 form) (which can be downloaded from our website at
http://www.unicef.org/about/employ/index_53129.html) on or before 29 January 2016 via e-mail address: hrmalawi@unicef.org
