Public Health Steering Team-Uganda (PHSTU) Terms of Reference (TOR)-2023

 

A Public Health Steering Team-Uganda (PHSTU)

Terms of Reference

1.     Introduction

The Public Health Steering Team-Uganda, leverages their experience in a number of fields to promote research and innovations rooted in Public Health principles thereby contributing to a world where it is possible to prevent diseases; prolong life; and promote health. We work with grassroots and part of our theory of change is around increasing the application of knowledge into skills that tap into agency, autonomy, productivity and self-determination to cause good health and wellbeing. [1]

Goal: Quality Life Outcomes

Vision: Well people, green earth, eco-conscious productivity

Mission: Establish, maintain, sustain quality life systems and structures

Objective: One Health Outcomes

Values: People-centered, community centered, value based, performance-driven and results-oriented

Activities:

1. Coordination Unit, Operations Unit and Reception Unit

2. Establish regional chapters

3. Network/Movement Building/Sustenance

4. Strategies catalysing healthy living

5. Thematic approaches

6. Transformative case studies

7. Interventions

8. Conferences

9. Medical Camps

10. Report generation and dissemination

2.     Background

The Public Health Steering Team-Uganda advocates for centering Public Health principles in life promoting activities and provide opportunities for fuller life services. It is a pathway, a field of research, a healthcare component, a cue for social activism that explores ways to leverage the mutual benefits of ecosystems of health and their contribution[2] to an individual's wellbeing during all stages of their life. Public Health principles center the public and health in all interventions thus translating the broad framework of the World Health Organization's (WHO) definition of health―as "a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity"― to denote wellbeing, encompassing the contexts to access products or materials for growth and development of a person; the ability of an individual to have responsible, satisfying experiences and the freedoms in form of agency, autonomy, self-determination and productivity. The experiences of good health and wellbeing include access to health knowledge, skills, attitude-change sessions, education, access to safe, effective, affordable and acceptable methods of birth control, as well as access to appropriate health care services, such as the ability for women to go safely through pregnancy and childbirth, providing couples with the best chance of having a healthy infant, smart climate action plans, financial literacy and other interventions geared at improving and sustaining quality of life. Individuals face inequalities and inequities which vary based on socioeconomic status, education level, age, location, ethnicity, religion, and resources available in their environment. Low-income individuals may lack access to appropriate health services and/or knowledge of how to maintain their health.

 Engaging in health seeking practices is part of one’s agency, autonomy and part of the rights regime. As a right, it emphasizes one’s autonomy in form of being able to choose freely and responsibly on matters related to liberties, pursuance of happiness and health, free of coercion, discrimination and violence.^[3] This means that people are able to have a satisfying and safe life, negotiate for safer life outcomes, sex life, enjoy their maleness, childhoodness, femaleness without feeling they are objects of amusement, have the capacity to decide on who, how and when to engage in life changing activities as well as  how often they reproduce if at all.^[4] To guarantee this condition,  there is an ecosystem that must be in place. Information, Education, Communication, events, dignity, privacy, access, availability, affordability, acceptable services leading to satisfying and safer life as well as access to safe, effective, affordable and acceptable sexual reproductive products of choice must be in place.

In Uganda, good health and wellbeing are a proxy for a pathway to a better life for citizens and residents.  However, in most cases attributes of adulthood; policing morals, the expectation that women, children, adolescents, teenagers and people with disabilities are docile/disinterested actors in their health and wellbeing; and that health rights are not a priority of the State particularly the health rights for marginalised adolescents and young people. Healthy living is cloaked in a veil of criminalisation of certain groups of people such as children, non-wed persons, and there are hostile treatment toward those considered immoral and despicable by society such as people considered amoral e.g., sex workers[5]. Healthy living interventions are supposed to be blind to status and gravitate to humanity.  This is compounded by social-cultural views about male and female bodies; and laws that criminalise or assume enough has been said about healthy living and there is no need for health education[6].  This has resulted in criminalizing many aspects for healthy living, gagging speech and penalizing the procuring of services. This criminality contributes risks and vulnerabilities as in the case of 26-35% of maternal deaths in Uganda[7]. What we should not also miss, is the way the medicine around the female body is prescribed. Historically, Young says, men have made “the medical science about women and their bodies, and there is an abundance of research evidence about the ways in which that knowledge has been constructed to reinforce the hysteria discourse and women as reproductive bodies discourse. One of my favourite examples is that in some of the first sketches of skeletons, male anatomy artists intentionally made women’s hips look wider and their craniums look much smaller as a way of saying: ‘Here is our evidence that women are reproductive bodies and they need to stay at home and we can’t risk making them infertile by making them too educated, look how tiny their heads are.’ And we see that again and again”[8].  Social, political, economic, cultural, gender, civic and physical enabling and responsive contexts determine access, affordability, acceptability and availability of sexual reproductive health services. This calls for a characterisation of the determinants of poor Health service demand and uptake[9] so that when the interventions are localised to reflect Healthy living-related issues in Greater Masaka Region[10] the interventions are tailored and effective. Ecosystems establishing good health and wellbeing, ownership of what works, countering risk-prone traditional or cultural ways, addressing criminalisation, stocking prophylactics and modern services will in turn impact healthy living rights. The social-cultural-political issues that arise include: a reluctance in examining how health-related services are demanded and delivered.  The strategic public health models that emphasize people-centeredness are not funded and are therefore stifled. This has led to minimizing spaces where healthy living services are provided. This has negative impact in form of: poor health seeking practices; poor safer sex negotiation skills by community members; low numbers of women who initiate attending ANC by the third trimester; higher pregnancy rates among adolescent young girls in many parts of Uganda contributing a larger number to this[11]. There is a correlation between forms of labour, age of workers, workplace, economic hardships and a higher number of early and or unwanted pregnancy among adolescent girls in Greater Masaka[12]. This is attributable to the economic hardships in many households, lack of quality health care, contraception and social economic factors created by a punitive, restrictive and censoring legal and policy framework^[13]. This creates the contexts that impact livelihoods, education opportunities, assertiveness and pursuance of a happy and fulfilling life^[14].  Furthermore the negative consequences of the lack of an empowering and enabling healthy living rights regime fuels disproportionality, inequalities and inequities which lead to progression of diseases^[15].  According to the Ministry of Health, Annual health sector performance reports, access to comprehensive health information and services is part of the continuum of care. Making healthy living education a service for all, reduces the risk of not meeting the health needs of people, improves social protections, addresses stigma and discrimination and reduces barriers that prevent access to essential healthy living services.^[16] 

The COVID-19 pandemic and Long COVID-19, compounded and, in many cases, modified inequalities and health disparities in Uganda. COVID-19 has been a perennial disruptor and source of mini epidemics such as a higher frequency of evictions, food shortages, abandonment, child pregnancies, un-met basic needs, and sexual reproductive health rights were placed at the back-burner down-grading the quality of life of people.^[17]

Uganda is a signatory to a number of International protocols. The onus is upon us to animate the spirit and recognition of health rights as a human right, through activities that make good health and wellbeing universal and popular.

3.     Objectives Leading to a Fuller Life Services

This a two-pronged objective: to roll out models that are effective; and create the critical mass of demand and uptake of healthy living services Greater Masaka Region and Uganda at large.

4.     Major Tasks  

The activity is two-pronged and has the following tasks:   

a.     Developing a knowledge hub and depository of resilience lessons: Knowledge crafting, formulation, dissemination and generating of material detailing the systems, structures and methodology of activities. The materials cover scope, scale, discussions, timelines and markers of accomplishment. The reports are as a result of meta-analysis of activities done between 2017-2023. Out of these checklists and training materials to be used for the 2023-2030 phase will be developed.

b.     Develop shareable materials: These will be in form of notes, protocols or reports that will be submitted to the in-house review board for validation, testing and roll out.  

c.      Refresher trainings of staff and other programme participants: To train, facilitate or support such mechanisms leading to implementation of activities translating into fuller life services including soliciting resources or networking with other actors.

d.     Conduct desk reviews: The consultant will conduct the desk review of the study and submit a report of the desk review. 

Second prong:

a.     Conduct planned activities: The team will engage in planned activities in Greater Masaka Region and roll out in Uganda

b.     Developing and sharing reports: The team will develop and share report and also make inputs from the feedback from the various review processes

c.      Health Support Clubs In Greater Masaka Region and Uganda at large: This is one of the outcomes of the intervention 

d.     Presenting the lessons to the stakeholders: the team will present the lessons to the stakeholders 

5.     Timelines 

The team shall be expected to deliver the final desk review report showcasing the activities of 2017-2023; and action plans for 2023-2030.

6.     Deliverables 

The following are the deliverables:

a.     A brief, concept note, ToR and Inception reports outlining details of activities with a proposed methodology and delivery dates.

b.     Proposal and research protocols  

c.      Data collection tools 

d.     Report of different reviews 

7.     Subject Matter Expertise 

The team is led by persons with over 200 years of experience in all professions based on their proven experience, qualifications, and ability to deliver good quality work in a timely and efficient manner. 

8.     Supervision 

The Internal Review Board will be in charge of supervising the entire assignment and ensuring that all terms and conditions of the assignment are executed as agreed.

9.     Remuneration  

a)  The remuneration for the assignments will be determined and agreed upon to address cost of doing these activities.

b)  70% payment of the quoted amount will be paid before engagement in all activities.

c)  The final payment will be made when the quarterly or mid-term phase report is submitted to funder and approved. 

d) All payments will be subject to statutory deductions as per the laws of Uganda in force at the time.

e)  All payments will be made by cheque or any other means as may be convenient upon submission of an invoice by MOD PHC.

 

10.  Inception 

This is an ongoing activity.

11.  Applications Or Expression of Interest  

Any external service providers or vendors will submit the following documents/information:

1.  Organisation documents and reports about their work.

2.  Personal Resume including experience in similar projects and at least 3 references, with more than one consultancy one has been involved in, clearly indicating the overall lead consultant and responsible persons.

3.  Expression of interest explaining why one is the most suitable person for the work and providing a brief methodology on how you will approach and conduct the work.

4.  An expression of the daily rate and expected remuneration for undertaking the assignment.

5.  At least two referees from the Local Council, School, Public or Private entity and a non-profit field for whom the candidate has ever conducted any routine work.

6.  At least one final report of a related previous work

7.  Interested persons will be encouraged to send their expression of interest with all the required documents to: moduganda@gmail.com, info@mod.or.ug

 

8.  Only the successful candidates will be contacted.

 

 

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[1] http://mod.or.ug/community-health-insurance-scheme-copy/

[2] USAID Uganda Mission Director said that in the last five years, Ugandans in 20 districts in central, eastern, and northern regions received increased access to sustainable water and sanitation services and products through the Uganda Sanitation for Health Activity of USAID. These achievements have created a healthier learning environment and contributed to more girls choosing to stay in school. This reduces the number who lack access to safe drinking water and sanitation services. In Uganda, 10 million Ugandans still lack access to safe drinking water, while close to 15 million lack access to sanitation services. For more: https://www.independent.co.ug/usaid-15-million-ugandans-lack-access-to-sanitation-services/

 

[3] International Planned Parenthood Federation (IPPF), ‘Sexual and reproductive health and rights – a crucial agenda for the post-2015 framework’

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwisYecuNbzAhUnzIUKHeVUAdEQFnoECAMQAw&url=https%3A%2F%2Fwww.ippf.org%2Fsites%2Fdefa ult%2Ffiles%2Freport_for_web.pdf&usg=AOvVaw2EGawWJv1yTrpSmMLXNZwO 

[4] As above

[5] Penal Code Act Cap 120 Sections 138 and 139, criminalise sex work.

[6] As above sections 141, 142 & 143.

[7] Center for Health, Human Rights and Development & Center for Reproductive Rights, ‘Facing Uganda’s.

Law On Abortion Experiences from Women & Service Providers’ 2016.

[8] https://www.theguardian.com/lifeandstyle/2019/nov/13/the-female-problem-male-bias-in-medical-trials  

[9] Poverty, inadequate information on sexual and reproductive health services, transactional and sexual coercion, peer influence, lack of parental communication, non-contraceptive use, inadequate resources, were most influential factors for high teenage pregnancy. Effective strategies to address teenage pregnancy include providing Comprehensive Sexuality education, improving Adolescent Friendly Health Services, programs for socio-economic empowerment and community engagement (Ridemta, 2019).

[10] These include: ending child marriages, addressing causal contexts for teenage pregnancies (https://www.unicef.org/uganda/media/3901/file ) and retention in education institutions, awareness and application of life promoting skills; accessibility, affordability, acceptability, availability  and uptake emergency SRH services (https://sjhresearchafrica.org/index.php/public-html/article/view/172 )

[11] J Nabugoomu et al, ‘What can be done to reduce the prevalence of teen pregnancy in rural Eastern

Uganda?: multi-stakeholder perceptions’ (2020) 134 Reproductive Health 17

[12] https://www.independent.co.ug/masaka-registers-1000-cases-of-teenage-pregnancies/

[13] World YWCA & Asia Pacific Resource and Research Centre for Women, ‘Sexual reproductive health and rights for adolescents in Sub Saharan Africa. Youth fact sheet’ 2014 https://healtheducationresources.unesco.org/library/documents/sexual-reproductive-health-andrights-adolescents-sub-saharan-africa-youth-fact  

[14] As above

[15] S Engebretsen, ‘Using data to see and select the most vulnerable adolescent girls’ 2012 https://knowledgecommons.popcouncil.org/departments_sbsr-pgy/768/ 

[16] Global Commission on HIV and the Law, ‘Risks, Rights & Health’ 2012. https://www.undp.org/publications/hiv-and-law-risks-rights-health 

[17] N Segawa, ‘Pandemic Lockdown Could Spur a Jump in Teen Pregnancies’ 2021 Global Press Journal https://globalpressjournal.com/africa/uganda/pandemic-lockdown-spurs-jump-teen-pregnancies/ 

 

[18] n 7 above  

[19] Ministry of Health, ‘Adolescent Health Policy Guidelines and Service Standards 2012’ 2012. http://library.health.go.ug/publications/adolescent-health/adolescent-health-policy-guidelines-andservice-standards