National Lead Consultant for the Development of a HIV and TB Sustainability Roadmap at UNAIDS

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Terms of Reference for a National Lead Consultant for the Development of a HIV and TB Sustainability Roadmap for the Kingdom of Lesotho

Purpose

The Government of Lesotho is leading the country in planning for sustainability of the gains made in the HIV and TB response.  A Multi-Sectoral National HIV and TB Sustainability Technical Working Group (TWG) chaired by the National AIDS Commission (NAC) is providing technical leadership to this process. With financial and technical support from UNAIDS, the country seeks a suitable and qualified individual to lead in the development of Lesotho’s HIV and TB Sustainability Roadmap. The purpose of this consultancy is for the individual to support the Government of Lesotho to assess aspects of the HIV and TB epidemic and response within five critical domains, and to develop an HIV and TB response sustainability roadmap. The roadmap will guide the country and partners to reach the goal of ending AIDS and TB as public health threats by 2030 and to achieve long-term sustainable results.

Background

Lesotho is among the top 13 high HIV burden countries. The country has made tremendous progress and is at HIV epidemic control. With sustained efforts, Lesotho is on track to achieve the 95-95-95 treatment targets by 2025. The Lesotho Population-based HIV Impact Assessment (LePHIA, 2020) reported a prevalence of 22.7%, which translates to 324,000 adults above 15 years living with HIV. As of 2022 according to the UNAIDS Spectrum estimates, 95% of all people living with HIV knew their status, 91% of all people with diagnosed HIV infection were on antiretroviral treatment (ART), and 98% of all people receiving ART achieved viral suppression. These achievements have been driven by strong high-level political commitment towards achieving the country’s commitment to end AIDS as public health threat by 2030, coupled with partnerships with civil society organizations, communities of people living with HIV, and development partners.

The country however is grappling with much lower achievement of the 95-95-95 treatment targets in children, adolescents and young people, key populations, and men in the general population, with high levels of new infections, high HIV related mortality, high TB co-morbidity among those living with HIV, high rate of gender-based violence and other structural barriers to HIV prevention, weak health systems and geographic inequities. With an ageing population of people living with HIV, the country is already facing the overlapping prevalence of comorbidities of diseases and conditions associated with older people.

Financially, the country’s HIV response is heavily dependent on external investments, estimated to be between 60 – 70%. UNAIDS has warned that global financial resources for HIV have been on the decline since 2010 and by 2023 were at the level of funding experienced in 2013. The country’s HIV response is anchored in the multisectoral National HIV Strategic Plan (NSP) 2023-2028. The Ministry of Health has also developed an integrated HIV/TB Health Sector HIV Strategic Plan (2023-2028) focused on a more integrated approach to prevention, identification, and treatment for the two diseases. To sustain the gains made by 2030 and beyond, the NSP emphasizes on sustainability, estimating that from 2023-2028 the country will require LSL13 billion (US$688 million), with a funding gap of LSL 1.2 billion based on current trends. The NSP prioritizes HIV response sustainability, predictable funding, and sustainability of the HIV response with expected results being diversified funding sources including increased domestic financing, and improved efficiencies. The recommended strategic actions include development of a national HIV sustainability plan that includes transition from donor funding. The country will need continued strong national leadership, governance, and programmatic transformations to sustain the HIV response.

The Government of Lesotho has embarked on the critical phase to develop a multisector HIV and TB response sustainability roadmap that sets out long-term sustainability vision, building on previous and ongoing activities and to align these efforts with the national strategies, policies, plans, and reform efforts. This country-led activity is aligned with the goals and targets in the Global AIDS Strategy 2021-2026 and in the 2021 Political Declaration on HIV and AIDS: Ending Inequalities and Getting on Track to End AIDS by 2030 and the national HIV and TB strategic plans. The Government of Lesotho is leading these efforts towards development of the HIV and TB Sustainability Roadmap to guide the country’s long-term sustainability of the HIV and TB response to 2030 and beyond, a process that will catalyze desired political, structural, and programmatic transformations and accelerate the achievement of domestic priorities through country ownership and leadership of the HIV and TB response, leaving no one behind.

The Sustainability Roadmap development and implementation will be a phased approach, engaging multi stakeholders in the response through national and targeted dialogues and consultations. It will be guided by the global sustainability framework that outlines five components that are required across all countries to achieve the global AIDS targets for 2025 and 2030 and sustain these gains beyond 2030: : 1) Political leadership and commitment, 2) Enabling Laws and Policies, 3) Sustainable and equitable financing, 4)Services and solutions, 5) Systems that are built on strong local and institutional capacities to deliver effective, context-specific, people-centred, integrated HIV services for equitable and sustained results. To develop the Lesotho HIV and TB Sustainability Roadmap, detailed assessments will be conducted focusing on specific subthemes within each of the 5 domains to assess the state of the country’s response and its sustainability.  The assessment will lead into development of the roadmap which will identify a set of prioritized high-level outcomes and priority directions through which the country may most effectively and sustainably achieve the HIV response 2025 and 2030 targets. It will help identify the programme and system transformations that are required to sustain long-term impact by and beyond 2030.

Responsibilities

  • Lead the development of the HIV and TB sustainability roadmap document from start to completion, including writing, which entails country engagement, the sustainability assessment, and the tailored country approach.
  • Provide expert guidance to the technical working group leading development and implementation of the Sustainability roadmap.
  • Provide oversight of the roadmap development process, coordinate individual technical subject matter expert(s); sequence the tasks required; plan delivery in the time available; set deadlines and manage the delivery of products and processes within these deadlines; generally, keep work on track.
  • Review and synthesize findings from dialogues and the assessment into outcomes and priority actions in the HIV response sustainability roadmap, consider barriers, risks and opportunities, set out pathways of change, and sequence the identified sustainability priorities.
  • Coordination and facilitation of the roadmap development process, including:
    • Gather large volumes of information through desk reviews and qualitative interviews, data analysis, and stakeholder analysis.
    • Conduct stakeholder analysis, prepare concept notes and/or plans and conduct stakeholder dialogues and consultations to validate and foster consensus, ensuring broad participation.
    • Establish systems and processes for effective sharing of information and data with subject matter consultant(s), TWG and other stakeholders as will be needed.
    • Coordinate regular meetings of the technical task teams, technical working group and core team.
  • Prepare and provide progress reports and presentations to the TWG and country stakeholders as will be required.
  • Support the country to develop a comprehensive picture of the status of its HIV and TB response across five domains and begin to assess its sustainability.
  • The consultant will apply the detailed UNAIDS HIV Sustainability assessment tool, and other tools as may be provided or developed, to assess 2 of the 5 domains of the HIV and TB response: a) Political Leadership, b) Sustainable and equitable financing.  https://www.unaids.org/en/resources/presscentre/featurestories/2024/april/20240430_sustainability

Deliverables

  • Inception Report.
  • HIV and TB response Sustainability Assessment Report.
  • Documentation of the National Sustainability Dialogue.
  • Documentation of the overall processes and approaches used.
  • Progress reports as may be required.
  • Sustainability Roadmap Part A – synthesis document providing the HIV and TB response sustainability vision, goals, and integrated and selective prioritized high-level outcomes, pathways for change and Key inputs for the transformation plan for HIV and TB response impact by and beyond 2030 in Lesotho.

Working arrangements

  • The Consultant will report to the National TWG leading this assignment through the Chair.
  • The Consultant will work closely with the Secretariat supporting implementation of this assignment and with the Chairs of the various task teams under the TWG.
  • The TWG will provide the Consultant with detailed guidance, an analytical resource package, tools, and documents to facilitate successful delivery of this assignment.
  • The Consultant will work closely with another consultant who will be recruited later in July and will provide technical leadership in the other three domains of a) Enabling Laws and Policies; b) Services and solutions and c) Systems.

Duration: 35 days from July to December 2024

Required Skills and Experience

  • A Masters degree in Public Health, epidemiology, Social Science, Economics or another related field.
  • A strong background in strategic and operational planning, with specific expertise in HIV/AIDS and TB and understanding of the Lesotho context. 
  • Experience managing complex projects and large volumes of information
  • Excellent analytical skills in qualitative and quantitative data analysis and secondary data analysis
  • Familiarity with sustainability assessments and good understanding of health and/or HIV financing landscape.
  • Demonstrated track record of writing and editing of high-level documents on HIV in English and fluency in spoken English.
  • Ability to develop and maintain effective working relationships and engagement with government, development partners and civil society.
  • Excellent communication and facilitation skills.
  • Knowledge of spoken Sesotho is key.

Application Requirements

Interested individuals should submit the following in one email to: [email protected] copying [email protected] by close of business on 20th June 2024.

  • An expression of interest maximum 2 pages outlining how they will undertake the assignment and indicating a daily consultancy rate in $USD.
  • A curriculum vitae demonstrating relevant experience and skills as required in the terms of reference.
  • Evidence of similar assignments completed and /or references.

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