2. Purpose of work: Development of guidelines for professionals on provision of YFHS for MARA and EVA

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1 UNICEF Moldova TERMS OF REFERENCE International Individual Consultancy Specialist in the area of provision of friendly services for most at risk and especially vulnerable adolescents (consultancy) Support to UNICEF Moldova in development of guidelines and in strengthening the capacities of youth friendly health services in the area of provision services for most at risk and especially vulnerable adolescents boys and girls Duration: 54 days (including 15 within the country), between July 2016 March 2017 Location: Chisinau, with travel to other locations 1. Background In Moldova, young people face various health and development issues such as sexual health problems (STIs and HIV, unwanted pregnancies and abortions), substance abuse (excessive alcohol consumption, smoking, illicit drug use), mental health issues and suicide. By the end of 2014, some 8,557 new HIV cases have been cumulatively registered (including Transnistria region), with stable annual average number of newly registered HIV cases in the past three years around 700 cases. The most affected site is the city of Balti (HIV prevalence in Balti 764 cases per 100 thousand, HIV prevalence in Transnistrian region cases per 100 thousand, HIV prevalence in Chisinau -115 cases per 100 thousand, General prevalence of HIV cases per 100 thousand (Source: Third National MDG Report). The HIV epidemic in Moldova remains concentrated largely among risk groups, particularly drug users, commercial sex workers, men having sex with other men, and prison populations. The structure of the new cases as related to the probable ways of transmission highlights an increase of vulnerability to infection among women (52% in 2011 as compared to 16% at the beginning of the epidemic). The main route of transmission is via sexual intercourse (92% in 2013 as compared with 10% in 1996). The transmission level through injectable drug use has decreased considerably, shifting the epidemic to the partners of key risk groups. More than half of new cases are young people. Comprehensive knowledge about HIV transmission among young people years of age is low: 36% of young women have comprehensive knowledge about HIV transmission and 28% of young men. Only 49% of women years old who had sex with more than one partner in the last 12 months used condom and 68% of young men (Source: MICS 2012). Around 11% of teenagers, aged were offered drugs and 3% of the adolescents have experience with the use of narcotics. (Source: KAP Study in adolescents health and development, 2012). Around 6% of the total number of registered drug users in Moldova are between 15 and 17 year of age (MoH, administrative statistics). In order to address adolescent s health issues the Ministry of Health established Youth Friendly Health Centre (YFHC) in all 35 districts and 2 municipalities of the country. Number of adolescents and youth (aged years old) that accessed YFHC increased more than twice during last 5 years (44,642 beneficiaries in 2011 versus 134,877 beneficiaries in 2015). Unfortunately, the share of most at risk * and especially vulnerable adolescent s is around 10%. * In accordance with the Regulation of YFHC approved by MoH on , most at risk adolescent and youth are young men who have sex with men and young people who sell sex or inject drugs In accordance with the Regulation of YFHC approved by MoH on , especially vulnerable adolescents and youth are: street children, adolescents without parental supervision, adolescents from families with parents that abuse

2 Adolescent drug users, commercial sex workers, men who have sex with men, adolescents who work, live, or spend their time in the street or who live in institutions, etc. are extremely vulnerable to infection with HIV due to the conditions in which they live or the risky practices they have adopted. Living and working on the streets usually means that they end up selling their bodies for money and becoming addicted to drugs and alcohol. These adolescents have nothing to live for, receive no love or support, and have no future prospects. They face the highest risk of becoming infected with HIV and passing the virus on to others. They live in a self-destructive spiral. UNICEF supported study revealed that, the mean age for first injection of drugs in Moldova was 17 years (the lowest level for drug injecting - 12 years old), 41% adolescents and youth injected drugs in private apartments/ house (in Balti 57%) and 85% of respondents reported indirect sharing of injection equipment (Source: Assessment of risk of HIV among MARA, 2010). To address the challenges faced by most at risk and especially vulnerable adolescents and youth, the Government of Moldova created a network of youth friendly health services (YFHS) aiming to provide friendly services to younger generation, including to most at risk adolescents. With financial aid from Swiss Agency for Development and Cooperation (SDC), the Ministry of Health expanded the network of youth friendly health services in every district of the country. UNICEF and the Health for Youth Association provide continuous support in improving the quality of YFHS, and building capacity of health service providers in youth friendly approaches. Under a new project with the Swiss Agency for Development and Cooperation ( ), UNICEF works to improve the legal, policy and regulatory framework in order to remove legal barriers for adolescent to access YFHS, to strengthen the capacities of YFHS staff in delivering quality services, including for most at risk adolescents and to promote social change in adolescent health and development through communication and community mobilisation. 2. Purpose of work: UNICEF Moldova is looking for an international expert in provision of YFHS for most at risk and especially vulnerable adolescents boys and girls to develop guidelines and to strengthen the capacities of youth friendly health services in provision of services for MARA and EVA, especially outreach Objectives: The international expert will: Development of guidelines for professionals on provision of YFHS for MARA and EVA. The expert will have to develop a practical guideline for YFHS on provision of services for MARA and EVA from the perspective of YFHS, especially in seven health priority areas. The guideline will provide information related to the social aspects of the life of MARA and EVA (their special needs as distinct from general youth, the major influences, and factors that contribute to their situation). It will provide terms, categories and definitions. The guideline will contain theoretical aspects and practical ones, to help YFHS to provide services for MARA and EVA, including outreach, so that they are better able to meet the specific needs. It will examine gender interplays with HIV vulnerability for young people and adolescents. The guideline will refer to best practices on provision services for young IDU, MSM, CSW in the country and in the region. The guideline also will refer to development of programs for street children, adolescents living without parental guidance and support, adolescents durgs or alcohol and from social vulnerable families (affected by HIV, TB, violence, in conflict with the low, adolesnets with special needs. The 7 health priorities for YFHS, according to YFHS Quality Standards: 1. STI/HIV/AIDS; 2. Unwanted pregnancy; 3. Mental health problems as a result of substance abuse (alcohol, drug, addiction); 4. Psycho-emotional and identity disorders; 5. Health problems occurred as a result of violence; 6. Nutritional deficiencies and malnutrition (I, Fe); 7. Development disorders during the puberty.

3 exposed to physical and sexual violence and abuse, ethnic minorities etc. The guideline will provided information on the characteristics of at risk groups, tools for their identification / community mapping, and recommendations how to work with them. The guideline will look through different approaches to ensure that MARA are reached and linked with the services that they need. Strengthen the capacities of youth friendly health services in the area of provision of services for most at risk and vulnerable adolescents, including outreach. The expert will conceptualise, prepare and conduct two similar 3-days trainings for three groups of YFHS staff, at least 20 participants per group. The training will be conceived as a practical one. The training will be prepared in partnership with specialists form National Center of Reproductive Health. Participants will examine STI issues, and sexual, reproductive, HIV and other needs of MARA and EVA. Training will help service providers to learn from the experience of the region on working with at risk group of adolescents boys and girls. Additionally, participants will learn about key communication and counselling skills in working with MARA and EVA. There will be an evaluation after each module and at the end of the training course. Development of recommendations on further provision of services for MARA and EVA and clinical protocols on service provision for MARA and EVA based on YFHS quality standards. The expert will support working group in development of YFHS clinical protocols that will include specific intervention for MARA and EVA, including outreach. Additionally, the expert will formulate recommendations for further development of services for MARA and EVA based on Guidelines on working with vulnerable and at risk adolescents and on local and international experiences in the area 3. Objectives The consultants will: - Develop the guidelines for professionals on provision of YFHS for MARA and EVA; - Develop the training concepts, agendas and support materials for training course; - Deliver training courses for YFHS professionals 3 training courses; - Formulate recommendations for further provision of services for MARA and EVA, including outreach. 4. Details of how the work should be delivered. Delivery dates (based on the work plan): The contract is planned for 54 days (including 15 within the country), between July 2016 March The specialist will develop activities according to the schedule bellow, and in close consultation with UNICEF.

4 Nr. Activity Deliverables Tentative deadlines* 1. Development of guidelines for professionals on provision of YFHS for MARA and EVA Review existing materials, resources, good practices (both in Moldova and at regional/global level). Submit first draft of the guidelines, after the concept and structure is approved by UNICEF. Submit second draft of the guidelines, based on received comments. Consultation / validation of the Guidelines (in-country mission; 1-day validation meeting). Submit final version of the guidelines based on results of validation meeting 2. Strengthen the capacities of youth friendly health services in in working with most at risk and especially vulnerable adolescent: Develop and submit a concept of a 3- days training for YFHS on working with MARA and EVA Develop and submit training modules, agenda, presentations, resources and hand-outs. Deliver three consecutive 3-days trainings for tthree groups of YFHS staff. 3. Formulate recommendations for further provision of services for MARA and EVA, including outreach: Summary of existing practices. Draft concept of guidelines. First draft of guidelines. Second draft of guidelines. Report on consultation meetings. Final guidelines. Concept of training. Training modules, agenda, presentations, resources and handouts. Trainings delivered. Training reports. Develop clinical protocols on provision YFHS clinical protocols of YFHS for MARA and EVA include provision of Develop recommendations on further services for MARA and provision of services for MARA and EVA EVA, including outreach Written recommendations. * Exact deadlines will be mutually agreed upon contract signature. November January 2017 Total of 23 days, including 5 days in country 3 days 10 days 2 days 5 days (in-country) 3 days February - March 2017 Total of 24 days, including 10 days in country 3 days 5 days 9 days for trainings plus 7 days preparation and reports writing (16 days of which 10 in-country) April 2017 Total of 7 days 7 days 5. Performance indicators for evaluation of results: The performance of work will be evaluated based on the following indicators: Completion of tasks specified in ToR; Compliance with the established deadlines for submission of deliverables; Quality of work; Demonstration of high standards of work with UNICEF and with counterparts.

5 6. Qualifications/specialized knowledge/experience required to complete the task: Advanced university degree in public health, reproductive health, social sciences or other relevant studies; At least 5 years of experience at international level in provision of services for MARA and EVA and conducting capacity building activities in the area of adolescents health, HIV prevention and provision of services for MARA and EVA; Experience in development of Guidelines/ protocols on provision of services for most at risk and especially vulnerable adolescents; Flexibility in responding to the needs of the contracting agency; Availability to work with UNICEF during the period indicated in the current ToR; Experience in working with UNICEF or other UN Agencies will be an asset; Knowledge Russian or Romanian language will be an asset. Good knowledge of English. 7. Submitting the proposal Interested individual consultants must submit the following documents/information to demonstrate their qualifications: 1) Duly filled Personal History Form P11. 2) Technical proposal in accordance with the attached template. 3) Financial proposal (inclusive of all fees and travel expenses: internal and external and fees for translators) in accordance with the attached template. 4) Other materials that will demonstrated candidate s expertise in working with most at risk and especially vulnerable adolescents. 8. Definition of supervision arrangements The selected candidates will work under the direct supervision of UNICEF Health Officer. All activities and deliverables will be discussed and planned in consultation with UNICEF. 9. Description of official travel involved The consultancy is designed for 54 days (including 15 within the country), between July 2016 March 2017 and will involve travel to Chisinau and within the country. Prior to starting the assignment, the selected candidate shall be required to undergo the UN Basic Security in the Field training and certification (on-line). 10. UNICEF recourse in the case of unsatisfactory performance: In case of unsatisfactory performance, the contract will be terminated by notification letter sent 5 days prior. In the meantime, UNICEF will initiate another selection in order to identify appropriate organisation/company. 11. Copyrights & utilization rights: The copyright and the right of utilization of all the materials will belong to UNICEF Moldova.

6 12. Support provided by UNICEF: UNICEF supervisor will regularly communicate with the consultant and provide feedback and guidance and necessary support so to achieve objectives of the consultancy, as well as remain aware of any upcoming issues related to consultants performance and quality of work. UNICEF will provide with relevant documents and available research; contacts and lists of relevant technical people to work with; constant guidance and feedback in relation to specialist s work.