UNFPA-CMR Capacity Building support-P3-Sudan

Location: Khartoum and Field Locations, Khartoum and Field Locations, Sudan
Date Posted: 27-08-2018
Country Background
As per the 2017 HNO for Sudan, an estimated 3.2 million people are in need of humanitarian protection support, including children and women at risk. The total number of people in need of humanitarian protection support is estimated at about 60 per cent of the total number of IDPs and returnees. Groups in need of protection support include (a) children at risk i.e. unaccompanied or separated children, children associated with armed forces and groups, child survivors of physical and sexual violence, children at risk of recruitment by armed groups, child caregivers and children in need of psycho-social assistance. (b) Women and girls at risk i.e. single heads of households (38 per cent of women and girls), survivors of gender-based violence (GBV), women in prison and pregnant and lactating women.
Gender Based Violence
GBV has been exacerbated by the conflict, as well as by inadequate living conditions and the lack of privacy which IDPs face in camps and elsewhere. Vulnerable women and girls in areas of conflict need support to prevent risks of GBV, in particular to reduce their exposure, for example during movements for water or firewood. Limited mobility, lack of information on available services and the distance to services, social exclusion and fear of social stigma hamper the ability of vulnerable people to access adequate social protection and assistance. As outlined above, GBV continues to be a life threatening concern for populations in conflict prone areas in Sudan. Women and girls continue to face the risk of different types of the GBV due to various factors such as insecurity, low economic status and lack of livelihood opportunities, lack of community awareness on women’s rights and GBV due to cultural and societal norms. The protection response is often hampered by difficulties of accessibility to conflict affected areas affecting timely response to the needs of survivors, limited presence and capacity of GBV actors including government, national and international NGOs, and UN agencies.
In September 2017, a CMR assessment on quality and availability of services was conducted in two states i.e. North Darfur and South Darfur. The findings highlighted major gaps both in availability and quality of care. Below are the summary findings and recommendations.
Summary Findings
  • The overall competencies of the health care providers were inadequate to enable them to provide quality CMR for the survivors in both basic and tertiary health facilities. 

  • The written CMR protocol was not available at the health facilities and the health care providers did not frequently use it resulting in provision of unstandardized management for the survivors. 

  • The CMR rooms were mainly established in few hospitals and they were poorly equipped, staffed, furnished and lacking standards to ensure survivors’ privacy, the confidentiality of their medical information and providing a safe clinical environment. 

  • The referral mechanisms were poorly functioning from the basic health facilities to the tertiary hospitals and the survivors were either referred verbally or self- referred. 

  • The survivors’ records were not available in the majority of health facilities and thus it is too difficult to obtain any information about the diagnosis, treatment etc. 

  • The necessary medications were not regularly supplied and most of the health facilities were suffering stock outs and shortages. Thus the survivors could not easily access such drugs exposing them to further problems.

  • The follow up services were inadequately available for the survivors at the health facility level and the survivors did not have the chance to visit the facility for further care and support.
Summary Recommendations
  • It is necessary to build the capacity of the health care providers on CMR through organization and implementation of quality competency based training courses using appropriate methods and techniques. 

  • The written CMR protocol (English and Arabic versions) has to be disseminated to all health care providers to be used to deliver standardized management for the survivors. 

  • Channels of collaboration and coordination with the International non- governmental organizations engaged at the state level are to be established and activated to effectively contribute to CMR 

  • It is strongly recommended that the CMR rooms at the hospitals are to be established/ renovated, equipped, and furnished to ensure survivors’ privacy and respect. 

  • It is requested to strengthen the referral mechanisms from the basic health facilities to the tertiary hospital to enable the survivors to access the necessary care. 

  • The supplies of the necessary drugs are to be regularly delivered to minimize stock outs and shortages at the health facility level. 

  • The follow up services are to be provided through scheduling visits to enable the survivors to receive further care and support when needed.
Rationale of this intervention
As can be seen from the findings of the assessment as well as from discussion with stakeholders, Sudan suffers from inadequate human resources with experience and skills to handle GBV cases including on CMR. GBV case management is almost non-existent and this affects GBV survivors access to other available services in a safe and confidential manner. This has also affected the availability of functional referral mechanisms. One off trainings without mentorship and coaching has been deemed insufficient in improving the service delivery. This thus calls for a dedicated and enhanced CMR capacity building to ensure better quality service provision. In addition to the robust capacity building, a national CMR consultant has been recruited to support field offices in CMR work. The CMR interventions being carried out will be closely linked to enhanced case management capacity building which is being rolled out in September.

Ongoing Interventions
Several interventions are ongoing to deliver quality GBV programming in some target localities including women centres, provision of CMR services, establishment and support to community structures as well as capacity building through support from ECHO, Japan MoFA, SIDA, Denmark MoFA, SHF and CERF. ECHO has supported UNFPA to strengthen the CMR delivery in Darfur region through rigorous training as well as on the job mentor-ship and follow up of trained personnel to ensure quality delivery of service. In addition to the training, UNFPA through different grants is procuring and distributing CMR kits to facilities with trained personnel. 5 pilot localities will further be supported the establish confidential spaces for CMR provision as well as strengthening of referral mechanisms. Sudan has benefitted twice from the international roving CMR support through DKA funding mainly focusing on the irregular migrants project in Khartoum & Kassala.
Scope of the assignment
  • The CMR Specialist will coordinate with the UNFPA resource persons, the Roving CMR specialist and the Sudan Ministry of Health to access and build on existing tools and resources for CMR capacity building. 
  • The specialist will study the available assessments a.
  • The specialist will use the approved CMR protocols for Sudan as well as other global tools and adapt them to the local context, in order to carry out trainings on basic CMR and ToT for select medical personnel.
  • The specialist will develop a capacity development action plan including training, and training of trainers, including sustainability and resource mobilization plan for the execution of step-down training by ToT participants.
  • The specialist will deliver trainings basic and ToT in Khartoum and Darfur, dependent on ability to travel.
  • The specialist will offer continued mentorship and supervision support to trained personnel.
  • The specialist will mentor the newly recruited national CMR consultant to enhance his skills in the provision of CMR support to the field locations. 
Mission Aim:
  • To sustainably improve the standard of CMR services delivered to GBV survivors in areas of concern in Sudan through improved service delivery including stronger supervision capacity.
Mission Outputs:
  • A clear action plan to address the existing gaps and effectively implement recommendations from the 2017 CMR assessment.
  • Skills of relevant health workers are built on the principles and steps of survivor-centered GBV response to ensure quality and confidential CMR provision and referral to other available services through established safe referral mechanisms.
  • A pool of CMR Trainers is established
  • A step-down training action plan for newly established Trainers, and an accompanying resource mobilization plan are developed
  • Local resources are identified for the next phases of the intervention
Proposed Actions
  • Develop an action plan to implement the recommendations from the CMR assessment and provide recommendations on effective integration of the CMR services at the level of local health facilities.
  • In collaboration with the roving CMR specialist, provide support/ input to the revision of the Sudan CMR protocols.
  • Adapt available global CMR training materials to Sudan specific context to complement existing CMR materials available in country.
  • Conduct basic case management trainings in Khartoum and field locations (Darfur etc.)
  • Identify participants for Training of Trainers on CMR from the trainees of the basic GBV CMR training and previously trained personnel who are actively providing services.
  • Conduct ToT trainings in CMR for select participants and develop practicum initiatives.
  • Develop step-down CMR Training Plan with ToT participants including resource mobilization plan
  • Provide on job mentorship for the trained staff to ensure quality of services provided
  • Mentor the national CMR consultant to enable him/ her offer continued support to services as well as leading/ conducting capacity building initiatives.
  • From the trainings & interactions, develop a roster of candidates who can deliver quality CMR trainings and supervision of the services locally.
Proposed period:
Minimum of 3 months depending on ability to travel and approved activities.
  • A pool of Health workers with ability to provide CMR services according to international guidelines.
  • A pool of CMR Trainers with ability to provide CMR trainings.
  • A roster of of candidates who can deliver quality CMR trainings and supervision of the services locally.
  • Sudan context specific CMR training tools which can be used by the CMR Trainers.
  • CMR step-down training plan and resource mobilization plan.
  • An evaluation of the capacity of the CMR consultant’s ability to support field operations on CMR.
  • A report at the end of the deployment/ mission.
Minimum Qualifications
  • An undergraduate degree in a medical field or related discipline, advanced degree will be an added advantage
  • Over 5 years of experience working on CMR, direct service provision experience with GBV survivors strongly preferred
  • Proven experience in adapting training materials and delivering trainings on CMR in humanitarian settings
  • Clear understanding of the International protocols/ training packages of CMR and the process of adaptation to different contexts. Prior experience in adaptation of protocols / training packages to deliver trainings is highly desirable
  • Good communication skills in English and Arabic
  • Good report writing and documentation skills
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