Cost Efficiency Study on Integration of Gender Based Violence into Sexual and Reproductive Health services at the Primary Health Care level

1. Purpose of consultancy:
UNFPA is the lead UN agency for delivering a world where every pregnancy is wanted, every childbirth is safe and every young person's potential is fulfilled. UNFPA expands the possibilities for women and young people to lead healthy and productive lives. To read more about UNFPA, please go to: UNFPA about us
With the ultimate goal of improving the wellbeing of women through addressing both health and protection aspects; UNFPA initiated integration on Gender Based Violence (GBV) in Sexual and reproductive health (SRH).
The basic principle of GBV and SRH linkages and integration of services is “to make as many of the necessary services as possible conveniently available to women, without undue waiting times, delays, or multiple visits. When women are in danger or arrive in emergency rooms with severe injuries or post-rape, providing the constellation of needed services as quickly as possible –including counselling and safety planning -- can be a matter of life and death” (UNFPA, 2010).
The process towards GBV integration in health/RH was initiated by UNFPA Lebanon in 2001-2002 with piloting of a package containing basic information on GBV at the health facility followed by counselling in several centers. This pilot consisted also of a baseline study to assess providers and beneficiaries’ perceptions towards delivering/receiving GBV services in a health outlet (among other). The pilot as well as study showed some promising findings that required a more holistic exploration and approach for the integration. In 2005, and at the request of the Ministry of Public Health (MOPH), UNFPA Lebanon partnered with KAFA NGO to develop a training manual for health care providers aiming at enhancing their communication skills with GBV survivors and/or at risk women presenting to the health care facility. This was followed by rolling out the manual and training across all PHCs in 2006-2007 which generated more interest and attention to the subject matter. As a result, and also at the request of MOPH, UNFPA supported in 2009-2010 the elaboration of a chapter on GBV management within the national reproductive health services delivery guidelines followed also by a comprehensive training to all PHC service providers with refreshers every 2-3 years. In2017, UNFPA Lebanon implemented a pilot project on GBV-SRH integration in 6 health care facilities across Lebanon. The evaluation of the pilot project showed a highly cost-effective outcome in adopting the integration. Based on the evaluation findings, a guide was developed in 2020 with the support of UNFPA proposing four models for the integration of GBV in SRH. In 2021, the guide was introduced to service providers of 300 health care facilities including PHCs and health dispensaries. This was followed in 2022 by development of a detailed assessment tool with corresponding criteria to classify the health centers under each integration model as well as the development of a framework for the competencies of care providers implementing the integrated approach under each model. In 2022, UNFPA supported a comprehensive assessment of 15 PHCs using all the tools developed earlier to capture gaps, needs and opportunities for integrating GBV in SRH and based on the model under which each center falls. This allowed UNFPA to select few of these 15 PHCs and support the actual integration of GBV into the SRH package, a matter ongoing to date.

IRC is among the key leading agencies in addressing GBV in Lebanon, serving over 9,000 GBV beneficiaries per year (Syrian refugees & vulnerable Lebanese) with integrated services in Akkar, Baalbek, Beirut and Mt. Lebanon.
Since 2022, IRC has been adopting an integrative approach to address the pressing and interlinked protection and health needs of vulnerable populations, especially women and girls, in northern Lebanon.
In response to the growing protection issues and needs and wide provision gaps of SRHR and Mental Health (MH) among women, girls and other vulnerable populations, IRC collaborates with primary heath care centers (PHCCs) and other community-based health and protection organizations to deliver essential SRHR, MHPSS and GBV services.
IRC and partners approach is based on key principles focusing on increased access to quality services, shifting social norms, promoting an environment that upholds women and girls’ rights and strengthening the capacity of the system and the organizations to effectively advocate for SRH rights, respond to and condemn GBV.
Similar to UNFPA and IRC, various actors implemented integration of GBV and SRH in their practice with or without necessarily developing conceptual framework and tools however acknowledging the importance of a unified approach.
During a technical meeting lead by UNFPA in 2024, key actors involved in the GBV-SRH integration suggested to carry out a cost-efficiency study to assess the relative costs and outcomes of the integrated approach. In parallel, and with noticeable funding reduction, it become essential to assess the cost-efficiency of the integrated approach at the same location as opposed to receiving the GBV and SRH services at 2 separate locations and without compromising the quality.
This assessment is also tightly relevant and contributing to the vision set by the Ministry of Public Health in Lebanon and through its 2030 health strategy that promotes QUOTE “restructuring of the health system to become more equitable, integrated, and efficient, ensuring universal access to value-based and people-centered quality care”. UNQUOTE.
Hence this consultancy aims at assessing the efficiency of the GBV/SRH integrated approach adopted by UNFPA, through review of the related interventions including costing of the package for GBV-SRH services while ensuring a thorough analysis of various enabling factors, challenges and opportunities and offering actionable recommendations.
Internationally recognized methodologies for estimating and analyzing the costs of health services should be employed, such as GHCC methodology, the IRC’s cost analysis or any equivalent methodology.

2. Scope of work: (Description of services, activities, or outputs)
The consultant will work closely with UNFPA SRH and GBV and IRC technical teams to carry out the following tasks:
Inception phase (1 day)
• Inception meeting to clarify terms of consultancy
• Delivery of brief 2-3 pages inception report detailing the consultant’s understanding of the required tasks and the proposed approach to work including a detailed study methodology, required tools, proposed stakeholders, consultation process, and detailed timeline for product delivery.
Desk Review phase (5 days)
• The consultant will carry out desk review covering background on GBV-SRH integration implemented by UNFPA partners, and other actors, including for the current relevant programs in Lebanon; overview of the healthcare and social development national policies/infrastructure/resources; analysis of the socioeconomic and cultural factors influencing access to GBV and SRH services; and identification of gaps and areas for improvement.
• The consultant will develop tools for data collection as well as for the costing exercise
• Review of UNFPA/ IRC integrated approaches (5 days)
• The consultant will conduct review of the GBV-SRH integrated interventions implemented by UNFPA’s implementing partners (total of 3). This would include setting key performance indicators, data collection and analysis, assessment of performance and deliverables.
• The consultant will carry out consultation ( onsite or remotely)with key stakeholders engaged in GBV-SRH integration services (i.e. MOPH, order of midwives, Ob/Gyn society, 2-3 donors, IRC (along with their partners) and 2-3 NGO actors significantly engaged in the integrated approach and not partners with UNFPA)
• As part of the exercise, the consultant will also selectively and randomly conduct client exit interviews to assess service quality and client satisfaction
• Costing of the GBV-SRH integrated package (10 days)
• During this phase, the consultant will proceed with costing exercise for the set of SRH and GBV services provided under each model and implemented by UNFPA
Validation phase (1 day)
• A technical meeting to be conducted with key stakeholders involved in the consultation process to gather additional inputs (based on the first draft) and to endorse the proposed costed packages
Finalization of cost efficiency doc (3 days)
• The consultant will incorporate comments received from key stakeholders including UNFPA/IRC during the validation workshop into the final document

3. Duration working schedule:
25 working days extending between August 25th and November 30th 2024
4. Place where services are to be delivered:
Lebanon. A hybrid approach can be applied
5. Job Requirements
Education:
• Master’s degree in public health, health economics or any related field
• Experience in developing costing studies and evaluation of projects/ programs
• At least 10 years of experience in the health sector including in sexual and reproductive health
• Experience in Gender Based violence is an asset
• Experience of previous work with the government, international NGOs & UN agencies
• Knowledge of the Lebanese health system and context is essential
• Excellent Arabic and English spoken and written skills
• Good communication skills
• Demonstrated ability to deliver quality results with strict deadlines
Values:
• Exemplifying integrity
• Demonstrating commitment to UNFPA and the UN system
• Embracing cultural diversity
• Embracing change
Core Competencies:
• Achieving results
• Being accountable
• Developing and applying professional expertise/ business acumen
• Thinking analytically and strategically
• Workings in teams/ managing ourselves and our relationships
• Communicating for impact
• Engaging internal/ external partners and stakeholders
Functional Skill Set:
• Advocacy/ Advancing a policy-oriented agenda
• Leveraging the resources of national governments and partners/ building strategic alliances and partnerships
• Delivering results-based programme
• Internal and external communication and advocacy for results mobilization

Languages:
Fluency in both spoken and written English and Arabic is required. French is an asset.