Assessing Clinical Management Of Rape (Cmr) Services At Health Facilities In Lebanon

Background According to UNHCR, figures in Lebanon is the highest per capita host of refugees in the world, which has put a considerable strain on the already weak economy of the country. The number of registered Syrian Refugees in Lebanon is 1, 033,513 as of June 2016 of which around 31% are females between 12 – 60 years of age[1]. Refugees have access to most basic services through public and private institutions, UN agencies, NGOs and INGOs. In the 1st quarter of 2016 almost nine out of ten reported survivors have been women and girls, while reported incidents of child survivors has gradually increased from 18 per cent in January to 29 per cent in March. According to available data, more than 70 per cent of the reported violence incidents in 2015 as well as the 1st quarter of 2016 were perpetrated by either an intimate partner, primary caregiver or other family member. Over the 1st quarter of 2016, the gender based violence information management system and assessments indicate that the most commonly reported types of violence continue to be physical domestic violence, sexual violence and forced marriage, with the latter increasing from 6 per cent in January 2016 to 15 per cent in March 2016[2]. Concerns also remain in regards to the provision of CMR services for Lebanese women. Lebanese women suffer from social stigma when it comes to reporting on SGBV, as well as having limited access to services when they report on incident, and this has been observed even before the Syrian crisis. Moreover, the law on family violence was passed in April 2014 but hasn’t been properly implemented yet. Furthermore, there is a lack of awareness related to the law amongst all populations, including Lebanese women and girls, and refugee populations. Survivors are reluctant to report Sexual and Gender based violence (SGBV) or seek support due to the shame, fear and ‘dishonor’ to their families. Women risk further physical and sexual violence, including death, often from their own families, when reporting SGBV, a pattern that exists in many contexts.[3] In regards to provision of medical services for the survivors of sexual violence, there were no specific protocols or standardized service providers who were trained on CMR before the onset of the Syrian crisis. With the creation of Clinical Management of Rape (CMR) task force (TF) in 2012, UNFPA lead the coordination of CMR services at national level to provide better medical response needed for a sexual assault survivor.  The CMR TF through its advocacy and close collaboration with national and international entities, has been able  to train already existing primary and secondary health care centers spread throughout Lebanon, to become CMR service provision facilities and provision of Post-Exposure Prophylaxis (PEP) kits also known as the RH kit no 3. Since 2012, a series of health facility based training workshops were carried out by UNFPA, IRC, UNICEF, ABAAD, IMC, UNHCR, and MSF in different regions of Lebanon to sensitize service providers on CMR. Following these trainings, UNFPA took the lead in providing the RH kits number 3: Post-Rape Treatment kits to trained health facilities and since then is responsible to replenish the kit on a yearly basis for the CMR trained facilities in partnership with ABAAD.  Moreover, CMR TF coordinates closely with the SGBV TF to enhance the referral mechanisms and ensure better privacy and confidentiality for the survivors seeking medical care. A clear referral pathway was created by the SGBV TF for all regions in Lebanon that provides guidance for the SGBV case management agencies on where to refer a SGBV survivor in need to CMR services within the first 72 hours of the incident. Despite the continuous evident need to provide holistic services for survivors of sexual assault, significant gaps in quality, geographical distribution of service provision and type of beneficiaries (i.e. Syrian Vs host communities), the use of Post Exposure Prophylactic Kit (PEP) – UNFPA kit no 3 remain to be a concern. Through this assessment, UNFPA proposes to generate evidence based strategies to advocate for a way forward based on the needs and gaps identified with the provision of CMR services including PEP kit no 3 and its use. Close collaboration with CMR TF, SRH SWG, SGBV TF, Health Working group (HWG) and the Ministry of Public Health (MoPH), service providers and local experts will be required for this assessment.   Goals and Objectives The purpose of this assessment is to contribute towards improvement of CMR services across various facilities in Lebanon for both Lebanese and Syrian beneficiaries. This will be achieved through the following specific assessment objective and components; Carry out a comprehensive assessment of the available CMR services at various services delivery point including primary health care centers and hospitals including:   Accessibility Availability of laws, policy and guidelines for safe guarding the protection concerns of SGBV survivors (safety, confidentiality, respect, non-discrimination) Availability of qualified and CMR trained medical staff; Availability & use of medication (PEP, STI treatment, Emergency contraception) Availability of SGBV/CMR related awareness (IEC) material and referral mechanism active for all survivors Cost comparison and coverage between Syrian and Lebanese populations. Referral mechanism to and from the SGBV case management services Monitoring of CMR services at the health facilities level.   Tasks description Under the supervision of Program Specialist RH/HIV UNFPA Lebanon, a consultant will be identified and contracted to carry out the following tasks: Carry out literature review and internet search on the topic Review and discuss with UNFPA the TORs and expected results Prepare the set of instruments and tools for data collection Develop a timeline of visits to be carried out under this assignment Contact CMR trained facilities based on discussions with UNFPA, MoPH and CMR Task Force. Conduct a minimum of 25 interviews with CMR service providers. Prepare and ensure timely delivery of the first draft of the report (English) to be reviewed by UNFPA. Consolidate the input/feedback into a final report which includes a set of recommendations.    Methodology The methodology will consist of the following: Conduct five meetings with stakeholders (MOPH, MOSA, UNFPA, SGBV TF and CMR TF) Identify and select 25 CMR facilities based on selection criteria (to be discussed with UNFPA and CMR TF). Within each CMR facility the target groups will consist of 2  service providers (i.e. a doctor & mid-level health staff already trained on CMR services and custodian of PEP kit – UNFPA kit no 3) Conduct at least four FGDs with SGBV frontline workers from different organizations on the referral mechanism of SGBV survivors to the CMR trained facilities. Semi structured questionnaires shall be applied for the service providers Expected outcome The consultancy outcome will consist of a 25 – 30 pages report in English featuring overall analysis and specific findings pertaining to the specified objective in this ToR. The analysis should also address hindering factors for accessing/utilization of CMR services within the first 72 hours of an incident (i.e. cost, cultural sensitivity, lack of counselling, unavailability of information, lack of personnel, etc).  The report will include conclusion and action oriented recommendations. The structure of the report shall be discussed between UNFPA and the consultant.  Qualifications Advanced University degree (MPH/MS) in public health, social/development sciences or other related areas with at least 6-7 years of  work experience and considerable skills in survey design, analysis and report writing; Strong background in SRHR / SGBV including CMR and related treatments Excellent interpersonal skills and ability to establish effective and working relations with other stakeholders; Excellent written and spoken communication skills in Arabic and English.   Duration of the assessment The assessment should be concluded within 3 months from the signing of the contract including a minimum of 20 days on the field for facility visits and meetings as required.     HOW TO APPLY Interested candidates may apply online by providing: A most updated CV RFQ (download here) dully filled and signed  The above documents should be submitted to the following email address: info-lebanon@unfpa.org no later than September 27, 2016.  Please indicate the following title under subject when submitting applications: Assessing Clinical Management of Rape (CMR) services at health facilities in Lebanon UNFPA Lebanon will only be responsible to respond to those applicants submitting the required documents above and in which there is further interest. [1] http://data.unhcr.org/syrianrefugees/country.php?id=122 – UNHCR web portal [2] SGBV quarter 1 dashboard- 2016, UNHCR web portal [3] http://www.fmreview.org/detention/anani.html#sthash.gNa9SWf1.dpuf