Insert page number The Partnership on Health and Mobility in East and Southern Africa (PHAMESA II) Programme SRHR-HIV Knows No Borders: Improving SRHR-HIV Outcomes for Migrants, Adolescents and Young People and Sex Workers in Migration-Affected Communities in Southern Africa 2016-2020 Title of assignment: SRHR-HIV Knows No Borders: Improving SRHR-HIV Outcomes for Migrants, Adolescents and Young People and Sex Workers in Migration-Affected Communities in Southern Africa 2016-2020 Duty Station: International Organization for Migration (IOM), Regional Office for Southern Africa Unit: Migration Health Unit Assignment duration: 3 months from date of signing contract Commencement date: 1. INTERNATIONAL ORGANIZATION FOR MIGRATION The International Organization for Migration (IOM) is a dynamic and growing inter-governmental organization, with over 162 Member States. IOM works to help ensure the orderly and humane management of migration, to promote international cooperation on migration issues, to assist in the search for practical solutions to migration problems, and to provide humanitarian assistance to migrants in need, including refugees and internally displaced people. IOM address the migratory phenomenon from an integral and holistic perspective, including links to development, in order to maximize its benefits and minimize its negative effects. Migration Health IOM s vision in terms of Migration and Health is to deliver and promote comprehensive, preventive and curative health programmes which are beneficial, accessible, and equitable for migrants and mobile populations. Bridging the needs of both migrants and IOM s Member States, and to contribute to the physical, mental and social well-being of migrants, enabling them and migration affected communities to achieve social and economic development. IOM s Migration Health programmes in East and Southern Africa address the health needs of individual migrants as well as the public health needs of migration affected communities by assisting governmental and non-governmental partners in the development and implementation of relevant policies and programmes. IOM addresses migration health through three global programme areas: 1. Migration Health Assessments and Travel Assistance: Providing health assessment services to migrants and refugees on behalf of destination governments. Services include physical examination, laboratory diagnostics, vaccinations, DNA testing, and treatment of excludable conditions as per the specific guidelines of receiving governments. 2. Health Promotion and Assistance for Migrants: Providing health services that meet the specific needs of migrants and their host communities, across a wide range of priority areas such as sexual and reproductive health and rights (SRHR); mental health; immunizations; environmental health and hygiene; outbreak preparedness; and communicable disease prevention, surveillance, and control. Furthermore, this programme area involves health promotion and education on migration health, while developing government and community
capacity in identifying and responding to the health-related challenges of migration and population mobility. 3. Migration Health Assistance for Crisis-affected Populations: Supporting governments and populations during the acute phase and in the aftermath of emergencies by managing health issues related to the mass movement of people, and arranging medical evacuation for individuals. Activities include psychosocial assistance, communicable disease control and response, and reconstruction of damaged health infrastructure. Partnership on Health and Mobility in East and Southern Africa (PHAMESA) Programme, Phase II Building on nearly ten years of experience in East and Southern Africa, in 2014, IOM commenced implementation of the second phase of the four year bi-regional programme, Partnership on Health and Mobility in East and Southern Africa (PHAMESA II), with financial support from the Swedish International Development Agency (SIDA). Aligning to the 2008 World Health Assembly Resolution on the Health Migrants (61.17), as well as the corresponding Operational Framework, the overall objective of PHAMESA II is to contribute to improved standard of physical, mental and social wellbeing of migrants and migration affected populations in East and Southern Africa, enabling them to substantially contribute towards the social and economic development of their communities. This will be achieved through four interrelated outcomes: Outcome 1: Improved monitoring of migrant s health to inform policy and practices Outcome 2: Policies, legislations and strategies with international, regional and national obligations with respect to the right health of migrants. Outcome 3: Migrants and migration-affected communities have access to and use migration sensitive health services in targeted spaces of vulnerability in countries of origin, transit and destination. Outcome 4: Strengthened multicounty /sectoral partnerships and networks for effective and sustainable response to migration and health challenges in East and Southern Africa. 2 BACKGROUND AND RATIONALE Migration is a key livelihood and survival strategy for many households in Southern Africa. Many people including young women and girls are migrating to escape hardship resulting from failed economies, protracted civil unrest, social marginalization and other reasons. Crossing international borders, they may face harsh conditions, making them vulnerable to negative SRH consequences. Sub-Saharan Africa has the greatest Sexual Reproductive Health (SRH) challenges, including high unwanted pregnancies, maternal mortality and morbidity, unmet family planning needs, high prevalence of STIs, HIV and reproductive tract infections, cervical cancer, clandestine/unsafe abortion. Such problems are heightened among migrant women and girls as many are pressured into risky migration decisions for their survival whilst having limited choices regarding their sexuality and sexual health. This is due to their desperate financial situation, vulnerability to sexual exploitation and abuse, combined with poor physical, mental and social well-being resulting from being away from home. Due to their irregular migratory status, many migrants are often neglected in national SRHR initiatives, which has a lasting impact on their human development. Mobile groups often face health inequities, human rights violations, stigmatization, marginalization and discriminatory policies. During transit and upon arrival, such vulnerability is influenced by legal status, poverty, stigma/discrimination, insecure living conditions, fear of authorities and cultural and linguistic differences. For instance, migrant women often work in unregulated and often poorly paid informal sector, e.g. trade, domestic work, agriculture, sex work, etc., are exposed to conditions that
increase their health risks as well as their vulnerability to SGBV, and reduce access to SRH-HIV and tailored SGBV services. Most migrant women possess little information on SRHR and other health concerns, including where and how to access services. Thus, they often experience higher incidences of SRH negative outcomes. The International Organization for Migration (IOM), Save the Children Netherlands (SC) and the University of the Witwatersrand School of Public Health (WSPH) formed a consortium the SRHR-HIV Knows No Borders Consortium, collaborating to implement a holistic, regional project to improve sexual and reproductive health and HIV (SRH-HIV) related outcomes amongst migrants (including migrant adolescents, young people and sex workers) as well as non-migrant adolescents, young people, sex workers and others living in migration-affected communities in six countries in the Southern African Development Community (SADC) region including Lesotho, Malawi, Mozambique, South Africa, Swaziland and Zambia. The goal of the project is to improve SRH and HIV related health outcomes amongst the target populations in selected migration affected communities in the SADC region. However, sustainable improvement in SRH-HIV related health outcomes amongst migrant, non-migrant, adolescents and young people (AYPs), sex workers (SWs) their clients and individuals in migration affected communities is significantly dependent on change at the household and community levels in order to support individual level change. Freedom of choice by the target group is a critical building block for the realization of improved health outcomes. Such freedom of choice is influenced by attitudes, norms and behaviours that the project aims to influence over time. In order to truly attain freedom of choice about sexuality, changes in social and cultural norms that underlie barriers to the attainment of SRH- HIV rights are required. Working toward such changes, the project will influence individual and collective attitudes towards SRH-HIV rights of migrants, AYP and SWs and community members, which will lead to changes in collective and individual behaviours with regard to SRHR-HIV, and a reduction in stigma and discrimination towards migrants, AYPs and SWs. Thus, the project aim to contribute to significant positive change in collective knowledge and attitudes in communities and institutions in a way that promote sexual and reproductive health for all members of the communities. In order to benchmark the results, an initial activity of conducting a comprehensive baseline survey is necessary. The purpose of the baseline survey is to establish or determine the quantitative value or qualitative description of each indicator in the results matrix at project start. This will serve as a benchmark for evaluating project milestones. Furthermore, the baseline information will be used to prioritize areas that needs more attention and may therefore be used to adjust project targets. The baseline will focus on selected relevant outcome indicators as per the project Theory of Change and the result matrix particularly, those indicators for which information is not available on the project target groups. The following baseline data is already available: data on use of contraceptive methods and condoms; HIV testing coverage; data on linkage to care (referral completion rate) is available and will be consolidated to benchmark related project indicators. However, other data including those related to antenatal coverage; unmet needs for family planning, access to contraceptive commodities, gender role in child bearing decisions, prevalence of intimate partner violence and data on satisfaction with SRHR related services among migrant AYP, SWs and other community members exist in some sites but often scanty. Baseline survey will be undertaken to collect additional data to complement existing data. The baseline assessment will also include a policy review component to determine policy barriers to migrant AYP and SWs SRHRs not only to benchmark the indicators related to policies but also to inform targeted policy advocacy. It should be noted that in addition a needs assessment will be undertaken as part of the baseline process. This aim of needs assessment guided by the consortium
members and led by the countries, is to provide contextual information to inform the design project interventions that are tailored to the target groups needs. 3 PURPOSE/OBJECTIVE The purpose of this assignment is to carry out needs assessment and baseline survey among target population. 4. SCOPE OF WORK The research institution will lead the research in the selected country, and is expected to carry out the following activities: Needs assessment among 1. Adolescents and young people (AYP), SWs, clients of SWs (e.g. truck drivers) 2. SRHR government programme officer, and key informants - community leaders, parents, teachers, and health care workers; SRHR service providers. This will involve: Mapping of SRH service delivery points, utilities (e.g. water points, schools), hotspots for SWs, truck stops, sleeping places of mobile population List of SRH service providers/csos/forums in the area and their area(s) of focus (including contact person with details) Identification of the participants for needs assessment Translation of questionnaires Obtaining in country ethical clearance Training of fieldworkers Pilot testing of tools Collection of information from selected respondents (IDI, KII, IDI and/or FGD among AYPs) AYP (4 FGDs. One each for 15-19 and 20-24 age groups and by sex); SWs (2 IDI), clients of SWs (e.g. truck drivers 2 IDI) SRHR government programme officer (1), and key informants - community leaders (2 including religious leader), parents (2- one male and one female), teachers (1), health care worker (1); SRHR service provider (1), CSO (1) Transcribing & Translation
Conduct cross sectional survey (baseline survey) Sample selection (about 300 in total): This will be household based for AYPs; SW hotspot for SWs; sleeping places of mobile population for migrants, truck stops for truck drivers. A minimum of 30 SW should be aimed for. The sample size for the other study populations will be proportional to size. This will require a good idea of the constitution/mix of the people habiting the area. Translation of questionnaire Training of fieldworkers Piloting testing of questionnaire Data collection Data entry 4.1 Methodology This will be a mixed method research that will collect qualitative data through in depth interviews, key informant interviews as well as focus group discussions for the needs assessment and conduct a survey by administering questionnaires for the baseline. 4.2 Target population SRHR-HIV Knows No Border Consortium are collaborating to implement a holistic, regional project to improve sexual and reproductive health and HIV (SRH-HIV) related outcomes amongst STUDY SITE(S) Migrants, including adolescent and young migrants, migrant sex workers, migrant workers, irregular and regular migrants. Non-Migrant adolescents and young people in the intervention community Non-migrant sex-workers Clients of sex workers Men and women living in the intervention communities The study sites are the following migration affected communities/migration corridors Lesotho Maputsoe, Leribe District 6 DUTIES AND RESPONSIBILITIES Needs assessment (see section 4 above) Mapping of SRH service delivery points, utilities (e.g. water points, schools), hotspots for SWs, truck stops, sleeping places of mobile population List of SRH service providers in the area and their area(s) of focus (including contact person with details) Identification of the participants for needs assessment
Translation of questionnaires Obtaining in country ethical clearance Training of fieldworkers Piloting testing Collection of information from selected respondents (IDI, KII, IDI and/or FGD among AYPs) Data entry Transcribing & Translation Conduct cross sectional survey Sample selection: This will be household based for AYPs; SW hotspot for SWs; sleeping places of mobile population for migrants, truck stops for truck drivers. Training of fieldworkers Piloting testing of questionnaire Data collection Data entry Translation of questionnaires 7 TIMELINES AND DELIVERABLES List of SRH service providers in the area and their area(s) of focus (including contact person with details) Identification of the participants for needs assessment Ethical clearance Translated questionnaire Collection of information from selected respondents (IDI, KII, IDI and/or FGD among AYPs) Interview and FGD transcriptions 8 DESIRED BACKGROUND AND EXPERIENCE The research institution/consortium should demonstrate the following professional experience, qualifications and skills: This core team must have the following: - An advance degree in social sciences, public health, and population studies, preferably at PhD-level; - Very good understanding of migration dynamics in Southern Africa; - Experience in Migration and Health research - Demonstrated experience in mixed methods research - Extensive knowledge and experience in SRHR in the context of Southern Africa;
- Demonstrated skills and experience in quantitative and qualitative research; - Relevant experience in conducting regional and/or multi-country research, preferably in Southern Africa - Demonstrate cultural and language sensitivity; - Cognizance of social sensitivity of target population. 9 APPLICATION Interested candidates should respond to this ToR by submitting separate technical and price proposals. This should include electronic copies of the technical proposals and price proposals saved in separate CDs (1 for technical and 1 for price proposal) along with 1 hard copy each. Technical and price proposals should be submitted in sealed envelopes to: jmusiyambiri@iom.int International Organization for Migration 353 Corner Festival and Arcadia Street Hatfield Pretoria 0083. Closing date for applications is 18 April 2017. Questions for clarity should also be sent to jmusiyambiri@iom.int. Please note that response to questions of general interest will be posted on the website.