Consultant - Obstetrics and Clinical Research

Purpose of consultancy

To facilitate development of the optimized ACS implementation model through multiple model iterations with the aim of reaching 70% safe coverage of ACS in the networks of care of the four countries and support the technical teams at evaluating the impact of optimized model on coverage of safe ACS use and neonatal and perinatal mortality.

Background

Preterm birth is a leading cause of under-five mortality globally. Antenatal corticosteroids (ACS) remain the main intervention for reducing the adverse effects of preterm birth. ACS is one of the effective tools that we have to prevent preterm birth, a major cause of neonatal mortality, especially in low middle-income countries.

While coverage of ACS is high (>90%) in high-income countries, it remains low (~40%) in LMICs. We need to learn how to implement the ACTION trial strategy for ACS use in routine health systems in low-resource settings. Effective translation of the WHO led ACTION-I trial findings into routine practice in low-resource countries requires several safeguards to ensure ACS is used safely. This includes improving access to obstetric ultrasound for GA dating (both in antenatal care and at time of clinical assessment), clear criteria and protocols by which eligible women are identified and administered dexamethasone and other co-interventions in a timely fashion, as well as measures to ensure the necessary maternal and preterm newborn care are available. It is therefore critical that to understand how to increase ACS coverage while adhering to treatment criteria that would optimize outcomes for women and their babies in low-resource settings.
WHO has proposed to use country-led implementation research to understand the challenges and opportunities in implementing the WHO criteria for ACS use, develop effective solutions, and apply them in different contexts to achieve high coverage of safe ACS use.

This multi-country implementation research project aims to develop and evaluate an implementation model in each country that will achieve at least 70% population-level coverage of safe antenatal corticosteroids (according to WHO criteria for use) in women having an early preterm birth (<34 weeks), and a reduction in neonatal mortality. The study will also evaluate the performance of these optimized implementation models, with safety, coverage and neonatal mortality impact outcomes. The project will be implemented in Bangladesh, Ethiopia, Nigeria and Pakistan.

Deliverables

The study is envisioned in two phases, Phase I, dedicated to development of the optimized ACS implementation model through implementation of the ACS implementation model through multiple model iterations with the aim of reaching 70% safe coverage of ACS in the networks of care of the four countries (total duration 2 years) and Phase II, trial phase, a stepped-wedge, cluster-randomised trial phase aimed at evaluating the impact of optimized model on coverage of safe ACS use and neonatal and perinatal mortality (total duration 2.5 years).

Currently, the study is in Phase I, with about 6 months left before initiation of Phase 2.

The aim of this Terms of Reference is to:

For Phase 1

1. 1. Provide technical support to integrate formative research findings into the ACS implementation model development.
   2. Provide technical support to contribute to the evaluation of the ACS implementation model iterative cycles.
   3. Contribute to data management and quality control.
   4. Contribute to manuscript writing.

For Phase II

1. 1. Provide technical support to conduct process evaluations at cluster level at the beginning of each cross-over period of the stepped wedge trial.
   2. Provide technical support to conduct ongoing learning activities throughout the stepped wedge trial phase.
   3. Provide technical support to conduct the trial process evaluation.
   4. Contribute to data management and quality control.
   5. Contribute to manuscript writing.

• Deliverables for Phase I
  • Deliverable 1: Prepare SOPs, manuals, data collection instruments, and other programme learning tools as needed for the optimisation of the ACS model.
  • Deliverable 2: Prepare training materials, training sessions, and conduct field visits as needed.
  • Deliverable 3: Prepare report on the iterative cycles evaluation and support the development of a draft manuscript on the intervention/model development from the iterative cycles phase.

• Deliverables for Phase II
  • Deliverable 1: Prepare SOPs, manuals, checklists for direct observation, and tools for data collection such as guides for semi-structured interviews and/or surveys and/or questionnaires.
  • Deliverable 2: Prepare training materials, training sessions, conduct field visits as needed for monitoring training of country teams during the process evaluations.
  • Deliverable 3: Data analysis of the process evaluations during the stepped wedge trial, prepare the report on the process evaluation conducted during the stepped wedge trial and contribute to manuscript drafting describing the results of the learning activities and process evaluations.

Qualifications, experience, skills and languages

Educational Qualifications

Essential:

• A first university degree in social sciences from an accredited university.

Desirable:

• An advanced university degree (Master’s or PhD) in Public Health, International Health, or a Public Health related field.

Experience

Essential:

• At least 3 years of experience in qualitative research related to sexual and reproductive health, including exposure at the international level.

Desirable:

• Expertise in iterative intervention development, qualitative research evaluating behavioural interventions, and implementation science.
• Experience in research involving multiple partners, especially involving WHO or other UN agencies.
• Experience supporting and developing tools for process evaluations.

Skills/Knowledge

• Effective communication, organizational and planning skills
• Ability to work independently and to effectively prioritize tasks
• Ability to establish and maintain effective working relationships with people from different cultures
• Multitasking and execution skills
• Proficiency with computer skills

Languages and level required

Essential:

• Expert knowledge of English

Location

Offsite: Home-based

Travel

The consultant is expected to travel.

Remuneration and budget (travel costs are excluded)

Remuneration

Band level A: USD 3,955 - USD 6,980 per month

Living expenses (A living expense is payable to on-site consultants who are internationally recruited)

N/A

Expected duration of contract

11 months part-time at 50%. Remuneration will be pro-rated accordingly.

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