TERMS OF REFERENCE

Hiring Office:

UNFPA Lesotho is recruiting a local consultant to assist the government of Lesotho in developing an investment case for improving maternal and neonatal health, increasing family planning uptake, preventing gender-based violence, and ending child marriage.

Background of Programme:

Lesotho is a lower-middle-income country experiencing significant poverty and inequality. As of 2017, the Gini coefficient was 44.9, and approximately 49.7% of the population lived below the poverty line. The human development index was 0.52 in 2020, with a 27.6% decline when adjusted for inequality. Economic growth has slowed, with GDP per capita growth decreasing from 4% annually (2000-2010) to 2% (2015-2019). Key economic activities include small-scale agriculture, water extraction, diamond mining, and textile manufacturing, with over 80% of exports being textiles and diamonds. Dependence on South Africa is high, with more than 80% of goods imported from there. Declining government income has led to increased domestic and international borrowing, resulting in unsustainable debt levels. External shocks, such as the COVID-19 pandemic and geopolitical tensions, have exacerbated economic fragility and uneven wealth distribution.

Expenditure on health is about 15% of the national budget , despite this  significant spending, outcomes are poor. HIV prevalence among adults is 22.7%, and maternal mortality is the second-highest in the Southern African Development Community (SADC) region, with a ratio of 566 per 100,000 live births. Neonatal mortality is also high at 26 per 1,000 live births, with major causes being prematurity, birth asphyxia, sepsis, infections, and congenital anomalies. Factors contributing to poor health outcomes include limited healthcare access, a shortage of skilled healthcare professionals, poverty, malnutrition, lack of awareness, and cultural practices.

Family planning utilisation is at 67% among married women, with a total demand of 80%. The unmet need for family planning is 13%, with  adolescent girls facing a higher unmet need at 21.2% and  teen pregnancy is  estimated at 17%. Gender-based violence and harmful practices, including child marriage, are prevalent, with 86% of women experiencing some form of violence in their lifetime. One in seven females experienced sexual violence before age 18, and 62% reported intimate partner violence. One in four girls is married by age 18.

The National Strategic Development Plan (NSDP II) aims to achieve Universal Health Coverage (UHC) by 2030, focusing on primary health care, financial risk protection, quality of care, and addressing social determinants of health. The health sector has made some strides in coverage indicators, 90% of HIV-infected people are on Antiretrovirals, 96% of pregnant women attend Antenatal care at least once, and delivery by the skilled birth attendant is 90%,  however, challenges such as limited resources, access inequalities, and quality of care persist. The situation calls for a strategic investment that will enhance the  2030 Agenda of  17 Sustainable Development Goals aimed at achieving a sustainable future for all.

Purpose of consultancy:

The objective of this consultancy is to develop an investment case for improving maternal and neonatal health, increasing family planning uptake, and preventing gender-based violence in Lesotho. The investment case will:

Identify key interventions and strategies to improve maternal and neonatal health.

Outline approaches to increase family planning uptake.

Develop strategies for preventing and addressing gender-based violence and child marriage

Provide a cost-benefit analysis of proposed interventions.

Recommend policy actions and investment priorities.

The consultant will ;

Document current financing and commitments within Lesotho’s development frameworks to achieve maternal and neonatal health targets, family planning, gender-based violence (GBV) prevention, ending child marriage, and Sustainable Development Goals (SDGs).

Define investment needs within Lesotho’s development frameworks to achieve national targets and SDGs for maternal and neonatal health, family planning, GBV prevention, and ending child marriage.

Develop a compelling investment case for a prioritised set of interventions needed to achieve maternal health, neonatal health, family planning, and GBV prevention targets and SDGs by 2030, including return on investment

Scope of work:

(Description of services, activities, or outputs)

The local consultant will undertake the following tasks:

1. Inception reports detailing methodology and requirements
2. Situation analysis and landscaping report informed by a desk review of available documentation on the national context, including relevant SRHR/GBV context and gaps, as well as sustainable financing landscape for family planning, maternal and neonatal health, child marriage, and GBV.
3. Collated resource materials including existing Investment cases related to SRHR, policies, costed program strategic frameworks, national and sub-national program reports on SRHR/GBV, health financing strategies, and resource tracking reports such as Medium Term Expenditure Frameworks, National Health Accounts, Public Expenditure Reviews, Public Expenditure Tracking Surveys, to mention a few.
4. Use the draft Toolkit and Internal Guidance Note to guide the development of investment cases
5. Draft and  Investment Case Reports detailing Impact, costing profiles, and Investment scenarios. These will reflect total financing requirements, current multi-year financing commitments (available and predictable pipeline), projected financing gaps, and return on investment for applicable scenarios.

Duration and working schedule:

• The assignment will be 40 working days in total from September  – December 2024.
• Inception report detailing methodology and requirements from the consultancy – September 2024.
• Meetings with key Government and Non-Government stakeholders –October 2024
• Situation analysis and landscaping report informed by a desk review of available documentation on national context September/ October 2024.
• Draft Investment Case Reports detailing Impact, costing profiles and Investment scenarios that will accelerate achievement of the Transformative results -Nov 2020.

Place where services are to be delivered:

Maseru Lesotho

Delivery dates and how work will be delivered (e.g. electronic, hard copy etc.):

• Inception report: Delivered electronically  within  5 man-days
• Situational analysis report: Delivered electronically within  25 man-days
• Draft Investment Case: Delivered electronically 10  man-days

Monitoring and progress control, including reporting requirements, periodicity format, and deadline:

The  Consultant working will directly report to the reference group which will provide oversight on the development of the investment cases.

An integrated Regional team and UNFPA HQ will support the process in Lesotho and provide technical oversight for the undertaking of investment cases to ensure coherent, valid, and reliable methodology and use of tools based on the focus of investment cases opted for by the country.

Supervisory arrangements:

The consultant will work under the overall guidance of the UNFPA SRHR Coordinator and Monitoring and Evaluation analyst in collaboration with the government reference team.

Expected travel:

There will be a few travels to the district for stakeholder consultation while some of the stakeholder meetings will be held in Maseru

Required expertise, qualifications and competencies, including language requirements:

The consultant should possess the following qualifications:

• Advanced degree in public health, health economics, social sciences, or a related field.
• At least 10 years of experience in health sector analysis, policy development, and investment planning.
• Proven experience in developing investment cases or similar strategic documents.

• Strong analytical and research skills.
• Excellent communication and stakeholder engagement skills.
• Familiarity with the health context in Lesotho or similar settings is an advantage

Inputs / services to be provided by UNFPA or implementing partner (e.g support services, office space, equipment), if applicable:

UNFPA will provide relevant support and guidance to ensure the successful undertaking of this consultancy, including administrative and financial support.

Other relevant information or special conditions, if any:

Confidentiality: The consultant is required to maintain confidentiality of all sensitive information gathered during the consultancy.

Travel and Logistics: Travel and accommodation expenses for stakeholder meetings will be covered by UNFPA according to UNFPA travel policies.

Signature of Requesting Officer in Hiring Office:

Date: