Terms of Reference:
Development of SADC Regional Hygiene strategy
1.1 Context of hygiene in the SADC region
Poor hygiene practice is a major contributor to several endemic and epidemic diseases in Southern Africa. The SADC region continues to report recurrent cholera outbreaks. Outbreaks of typhoid, Hepatitis E are common. Four countries in the region are considered to have endemic trachoma. Improving hygiene practice with long term multi-sectoral behaviour change programmes is a key strategy for controlling several high health-burden diseases. Handwashing with soap and water has been proven to be the single most cost-effective intervention to prevent top causes of under-5 mortality including acute respiratory diseases such as Covid-19.
Investment in hygiene is essential to managing the current challenges presented in this time of Covid-19,and is expected to be essential in the long-term management of future pandemics. As experience demonstrates, however, these quick gains can be short-lived if the enabling environment is not nurtured. Handwashing with soap is the single most effective prevention against many diseases including acute respiratory diseases like Covid-19. The focus on hygiene is essential for the achievement of the Nutrition Action Framework that the SADC secretariat has been mandated to implement.
SADC and its development partners are keen to not only respond to this emergency in the short term but strengthen national systems that would make much more resilient WASH services where government programmes create consumer demand and a robust private sector that can respond to these needs across all markets. SADC will build on the opportunities that Covid-19 brings and use its current partnerships to support member state initiatives.
1.2 Problem Statement
Presently, over 250 million people in SADC countries do not have a handwashing facility with water and soap at home. Nearly three quarters of the people lack basic handwashing facilities with water and soap at home, and 2 out of 5 people in SADC countries have no handwashing facility at all. Moreover, field reports reliably show that even in settings where access is not an issue, people do not clean their hands when they should. Hand hygiene and WASH are not just health issues, but such services are human rights and are critical to improving education, economic, gender equality and human development outcomes.
Despite hygiene’s vital role in preventing disease and death, only 1% of water, sanitation and hygiene funding is spent on changing and sustaining hygiene behaviours. Data from the UNICEF and WHO Joint Monitoring Programme (JMP) shows that only 10 of the 16 SADC countries had data on hygiene. Most countries scored poorly and had far less than 50% of the required basic facilities for handwashing in households and healthcare facilities. The World Health Organization estimates that a new-born in low- and middle-income countries dies every minute from infections related to lack of clean water and an unclean environment. Providing water, adequate toilets and hygiene in homes and health centres would help support these new-borns to survive and thrive. Sepsis and other infections due to unhygienic conditions are also a leading cause of preventable maternal deaths.
A study of the enabling environment and institutional arrangements for the promotion of hygiene behavior change in 5 countries showed that hygiene practice varies between and within countries, and disparities exist between urban and rural areas, and between rich and poor households. Policies and strategies on hygiene are weak across Southern Africa. More than three in ten healthcare facilities, and eight in ten schools, do not have clean water and soap for handwashing. Inconsistent policy inclusion and limited available data means that hygiene is often overlooked in reviews and planning; a lack of dedicated coordination mechanism means that there is no champion for greater inclusion of hygiene in sector processes and financial allocations.
For the first time, hand washing with soap has been included as a key indicator of progress of 2030 sustainable development agenda. Sustainable Development Goal (SDG) six is focused on clean water and sanitation. This means governments need to demonstrate commitment to leaving no one behind in achieving this ambition for hygiene behaviour change. The spotlight that the Covid-19 pandemic has shone on hand hygiene represents an opportunity to radically transform our approach: to place hand hygiene at the heart of strategies to protect global health, to ensure that affordable products and services are available when needed, and to embed, more broadly, a culture of hygiene in our society.
1.3 SADC Policy and Strategic Framework on hygiene
The SADC Protocol on Health adopted in Maputo in 1999 – states that a healthy population is a pre–requisite for the sustainable human development and increased productivity in a country. SADC recognises that close co-operation in the area of health is essential for the effective control of communicable and non-communicable diseases. Whilst the Protocol makes no mention of hygiene, the first of its objectives is to “identify, co-ordinate, promote and support those activities that have the potential to improve the health of the population with the region”. Another objective is to “develop common strategies to address the health needs of women, children and other vulnerable groups”. Other instruments exist to support the hygiene priority e.g. 2017 decisions to improve hygiene.
2. Purpose and Objectives
There is an urgent need to scale up hygiene in general and hand hygiene in particular in health care facilities, schools, public places and homes in order to help stop the current pandemic and reduce the risk of future outbreaks, while improving health across all population groups, especially the most vulnerable. Scaling up hand hygiene in all settings is a ‘no regrets’ strategy that could potentially prevent deaths from diarrhoeal diseases and is widely-recognized as one of the most important measures to stop the spread of other infectious diseases including COVID-19.
SADC has recognised that a coordinated and concerted action is required across the region, to raise the profile of hygiene. This requires deployment of strategies that effectively support hygiene behaviour change in the region as well as support member states to create enabling policy environment to sustain people’s changed hygiene behaviours. As such WaterAid agreed to collaborate with the SADC Health and Nutrition Team and other partners including UNICEF and WHO to draw up a regional strategy on hygiene that offers practical and enforceable actions for member states with the aim of having it approved by Health Ministers in November 2020.
Now, all countries throughout the world are implementing plans to respond to COVID-19 and prevent further spread of the disease, including improving public health services, health systems organization and infection prevention and control programmes. This provides a unique opportunity to reflect on the critical gaps in existing systems to protect regional and national health and to scale up, systematize and institutionalize improved hygiene practices into these systems to reduce the risk of future outbreaks.
The SADC Regional Hygiene Strategy is expected to be an essential tool to provide member states the necessary political backing and push for change. It will also be a mechanism through which actors can be coordinated for impact and for donors to channel support to hygiene behaviour change in the region.
2.1 Objectives of the consultancy
2.1.1 Overall objectives
Deployment of a strategy that documents successes, challenges and share learnings from member states to strengthen and streamline hygiene in key health, WASH, education, labour and humanitarian efforts is key. The strategy will seek to develop communities of practice that brings together diverse stakeholders to discuss innovations and best practices on both expanding and sustaining access and hygiene behaviour change in various settings.
The purpose of this consultancy is to develop the framework to accelerate regional progress aimed at:
- Enhancing public health through sustained hygiene behaviour change
- Making hand-washing practices central and support push for the necessary changes to WASH policies and infrastructures for sanitation, food hygiene and hygiene in health care settings (i.e. hand hygiene and health care waste management)
- Enabling adequate support mobilisation for the achievement of the SADC Action Framework on Nutrition
- Supporting better financing, coordination, leadership and monitoring of hygiene promotion policies by all SADC member states.
2.1.2 Specific Objectives
The specific objectives of this consultancy are the following:
- Examine the extent to which national policies and strategies/frameworks can be aligned with the regional hygiene strategy and initiatives and how this will contribute to/ or influence the attainment of continental and global development and health aspirations and goals.
- Conduct an assessment and analysis of the current hygiene approaches used in the SADC region that can be recommended for scale up and impact in the region.
- Propose a strategy implementation plan that can be costed and rolled out.
- Complete a SADC Regional Hygiene Strategy document, with input from member states and validated by experts and other stakeholders, ready to be presented for adoption by Ministers of Health of member states.
3. Scope of work of the consultant
3.1 Tasks of the consultant
The assignment is expected to involve desk research, interviews with key stakeholders and coalitions from selected member states that will take forward the action at country level and will be supported by partnerships at global and regional level. This will include but not limited to high level political leadership; national, sub-national governments and implementing agencies; school principals, administrators, and teachers; health authorities and senior managers; employers across a broad range of private industries, businesses; producers and manufacturers of hygiene products and hand hygiene stations and supplies; financers; development partners, non-government organizations, and community associations; researchers and the academic community; media outlets and communication agencies; alliances of business and other private sector players. The selected member states will consist of a representative mix of Anglophone, Francophone and Portuguese speaking states. The selection will be agreed with the SADC Secretariat.
3.2 Expected outputs/deliverables from the consultancy
The key deliverables of this consultancy will be:
- A final detailed inception report outlining the consultant’s understanding of the assignment and the approach to be employed. The inception report will be discussed prior to the commencement of the assignment in an inception meeting
- Draft SADC Regional Hygiene Strategy which will be subjected to a validation process to be organised by the SADC Secretariat. The Consultants will be responsible for facilitating and rapporteuring the validation engagements.
- A final SADC Regional Hygiene Strategy Document detailing, among others, level and extent of hygiene priority, investment and outcomes required; national policy enabling framework, strategies, and plans required; other key recommendations/strategies for implementation success at regional and national levels.
- The final Regional Hygiene Strategy document will be accompanied by a summary popular version of no more than 6 pages and a PPT of the key strategy contents.
The consultancy will involve two key aspects of the work: 1) Assessment - a) an extensive literature review of relevant global, regional and country hygiene policies, strategies, frameworks and publications relating to hygiene; b) analysis of global, regional and country level hygiene programme and coverage for hygiene services/behaviour change c) the administration of a survey questionnaire to the sample SADC member states to triangulate desk review findings d) key informant interviews with key stakeholders using virtual means of stakeholder consultation and expert discussion (e.g. focused group discussions);2) Drafting and submitting strategy: i) based on the analysis, drafting ‘SADC Regional Hygiene Strategy’ and sharing with steering / working committee for inputs, ii) addressing inputs into the strategy, sharing with wider group for inputs and iii) final submission of the strategy.
5. Required Qualifications and Skills
5.1 Education and Training
The consultant/s should be in possession of a post graduate degree in Public Health, Social Policy or any equivalent Social Science degree.
5.2 Specific skills/Experience
- At least 10 years’ of traceable experience of working and/or conducting research, policy development and review in the field of public health, water, sanitation and hygiene (WASH) behaviour change or social policy at national, regional or international levels.
- Good analytical skills and practical exposure developing policy or strategy documents in national and/or regional context and how they impact on development and poverty alleviation.
- Strong understanding of the concept of regional integration as a strategy for promoting accelerated sustainable development and poverty eradication.
- Good knowledge of WASH, hygiene as a concept, regional strategy as a tool and its linkages to regional integration as a strategy for promoting universal health coverage, accelerated sustainable development and poverty eradication.
- Past experiences in similar assignments i.e. policy analysis, policy review and development, preferably in the region.
- Familiarity and experience with national development planning processes.
- Computer literate, workshop facilitation and good presentation skills
- Competence in MS Office computer package
- Be resident in the SADC region and/ or have experience working in the region and have knowledge of the policy and political environment
- Proficient in English ,and knowledge of all SADC working languages i.e.English and Portuguese/ French will be an advantage
- At least a team of two consultants will be preferred
5. Legal Contract
A legal contract will be signed between WaterAid (as the partner supporting this procurement on behalf of the SADC secretariat) and the consultant/s upon agreement to the Terms of References.
The Consultants shall report to, and perform the assigned tasks under the guidance
and direct supervision of the Senior Officer - Health and Nutrition, Directorate of Social and Human Development at the SADC Secretariat who will facilitate contacts with key stakeholders and facilitate access to relevant documents and information.
The consultancy is expected to be carried out over a period of 11 weeks (2.5 months, from July – early Sept 2020). A draft report should be ready for validation by member states in September. A total of 55 working days are expected for the consultant/s. A detailed work plan with timelines should be presented at the inception meeting.
7. Further notes
- Bidding consultant or team must note that all costs deemed necessary to deliver the scope of work described in the Terms of Reference have to be covered in the financial offer. This includes expert’s rates, translation & interpretation services, planning, preparation and participation in meetings.
- All contractual arrangements of this assignment will be between the chosen candidates and WaterAid. The services provided under this assignment will be provided under the direct guidance of the SADC Secretariat, Health and Nutrition, Directorate of Social and Human Development.
- Payment will be approved on agreed upon milestones as follows: 35% upon completion of Inception report; 35% upon submission of the draft SADC regional hygiene strategy and presentation for validation and 30% upon submission of final report accepted by the steering committee.
8. How to apply
Bidders are requested to submit a written proposal, detailing their interpretation of the Terms of Reference, a recommended methodological approach, including a financial proposal and consultancy team’s experience relevant to this assignment.
Submissions must be sent to firstname.lastname@example.org no later than 09 July 2020. Please be sure to indicate - SADC Regional Hygiene strategy in the subject line.
 Prüss-Ustün, Annette, et al. "Burden of disease from inadequate water, sanitation and hygiene for selected adverse health outcomes: An updated analysis with a focus on low-and middle-income countries." International journal of hygiene and environmental health 222.5 (2019): 765-777.