Terms of Reference for a National Consultant to assess Enabling Laws and Policies, Services, Solutions and Systems domains to Inform the development of HIV and TB sustainability roadmap for the Kingdom of Lesotho
Purpose
The Government of Lesotho is leading the country in planning to sustain the gains made in the HIV and TB response. A Multi-Sectoral National HIV and TB Sustainability Working Group (SWG) chaired by the National AIDS Commission (NAC) provides technical leadership to this process. With financial and technical support from UNAIDS, the country seeks a suitable and qualified Individual or Local Consultancy Firm to co-lead the development of Lesotho’s HIV and TB Sustainability Roadmap.
The purpose of this consultancy is for the identified Individual or Local Consultancy Firm to support the Government of Lesotho to assess aspects of the HIV and TB epidemic and response within three critical domains: 1) Enabling Laws and Policies, 2) Services and solutions, 3) Systems, and to contribute in the development 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 and TB 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 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 and TB response sustainability; and predictable funding, with expected results being diversified funding sources, including increased domestic financing and improved efficiencies. The recommended strategic actions include the development of a national HIV and TB sustainability plan that includes the transition from donor funding. The country will need continued strong national leadership, governance, and programmatic transformations to sustain the HIV and TB response.
The Government of Lesotho has embarked on the critical phase to develop a multisector HIV and TB response sustainability roadmap that sets out a 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 sub themes within each of the five 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, and the global and national targets for TB. It will help identify the programme and system transformations that are required to sustain long-term impact by and beyond 2030.
Responsibilities
- The Individual or Local Consultancy Firm will conduct a detailed and comprehensive assessment and provide a synthesis in three of the five domains of sustainability of the HIV and TB response: 1) Enabling Laws and Policies, 2) Services and solutions, 3) Systems. https://www.unaids.org/en/resources/presscentre/featurestories/2024/april/20240430_sustainability
- Facilitate and document discussions amongst the various Technical Task Teams and other stakeholders within the three domains.
- Provide technical support working in collaboration with the Lead Consultant and the technical experts who are part of the Sustainability Working Group (SWG) to underpin developing the sustainability roadmap, including:
- Ensure completion of the Sustainability Assessment in the three domains
- Review and synthesize the findings, outcomes, and priority actions in the HIV and TB response sustainability roadmap
- Desk review of available information, data analysis and synthesis.
- Conduct stakeholder consultations, and qualitative interviews, ensuring multi-sectoral inclusivity.
- Contribute to writing of the narrative draft and final reports of the Sustainability Roadmap and working alongside the lead consultant.
- Provide expert guidance to the sustainability working group
- Prepare and provide progress reports and presentations to the SWG and country stakeholders as will be required.
Deliverables
- Inception Report.
- HIV and TB response Sustainability Assessment narrative report and excel tool for the three domains.
- 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.
- The Individual or Consultancy Firm will report to the National SWG leading this assignment through the Chair.
- The Individual or Consultancy Firm will work directly with the Chair and technical task team leading the 3 domains.
- The Individual or Consultancy Firm will work closely with the Secretariat (NAC), that is supporting implementation of this assignment.
- The SWG will provide the Consultancy Firm with detailed guidance, an analytical resource package, tools, and documents to facilitate successful delivery of this assignment.
- The Individual or Consultancy Firm will work closely with other consultants who may be recruited for this assignment.
Duration: 35 Days from October to December
Required Skills and Experience
- Individual Consultant or The Lead consultant of the consulting firm will possess a Masters’ degree in Public Health, epidemiology, Economics or another related field
- Experience in strategic planning and developing/writing strategic documents.
- Excellent communication and facilitation skills
- Background knowledge of the HIV response and the health sector of Lesotho will be an added advantage as the team will be leading and facilitating dialogues on health-related content
- In depth understanding of and experience in health systems including community systems.
- Excellent analytical skills in qualitative and quantitative data analysis and secondary data analysis managing large volumes of data
- Excellent writing skills.
- Ability to develop and maintain effective working relationships and engagement with government, development partners and civil society.
- Fluency in spoken English and Sesotho is required.
Application Requirements
Interested Local Consultancy Firms should submit the following in one email titled “Application for Sustainability Roadmap Consultancy” to: [email protected] copying [email protected] by close of business on 3rd October 2024.
- An expression of interest maximum 2 pages outlining how they will undertake the assignment and indicating a daily consultancy rate in $USD.
- Curriculum vitae of the individuals that will support the exercise demonstrating relevant experience and skills as required in the terms of reference.
- Evidence of similar assignments completed and /or references.