Republic of the Philippines
Philippine National AIDS Council
Office of the Philippine National AIDS Council Secretariat
3rdFlr. Bldg. 15, Department of Health, San Lazaro Compound,
Rizal Ave., Sta Cruz, Manila
Tel. (632) 743-05-12 Trunkline: 743-83-01 loc. 2551
TITLE OF TA: Midterm Review of the 5th AIDS Medium Term Plan (AMTP5)
TYPE OF TA: Assessment
TA RECIPIENT: Philippine National AIDS Council (PNAC)
SUGGESTED TA PROVIDER: Consultant – PROGRAM EVALUATION SPECIALIST
TA RECIPIENT: Philippine National AIDS Council (PNAC)
SUGGESTED TA PROVIDER: Consultant – PROGRAM EVALUATION SPECIALIST
1. BACKGROUND AND RATIONALE
HIV prevalence in the Philippines remains under 0.1%, but rapidly expanding among key affected populations (KAP). By 2011, HIV prevalence rose to 4-6% among males who have sex with males (MSM) in the cities of Cebu, Quezon and Manila; 53% among people who inject drugs (PWID) and 5% among female sex workers (FSW) in Cebu City. (2012 GARPR)
The number of cases reported has shown a steep increase in the last 6 years - from less than 1 case a day in 2006 to 9 cases a day in 2012. As of May 2013, there are already 12 HIV cases reported per day or 4,400 new cases by the end of 2013. This is likely to increase every year. In 2012, PNAC has projected that the total number of HIV cases in the Philippines could reach 37,000, or as high as 54,000 by 2015. Those infected are young with a median age of 27, with period of initiation to sex and drug use among key affected populations as early as 14 years old. Sex is still the main mode of transmission with 85% of new cases were reportedly through male-to-male sex in 2012. (2012 Spectrum Projections, 2013 AIDS Registry)
HIV cases among Overseas Filipino Workers (OFW) continue to increase (43 cases per month since Jan 2013) despite the decrease in proportion of OFW to the total cases. This indicates that local transmission has outpaced infections reportedly contracted overseas. (2013 AIDS Registry)
The Philippines was categorized as one of the countries with the lowest level (less than 25%) of coverage of prevention programs among MSM and HIV testing among MSM and PWID. Very few KAPs were tested for HIV (merely 14%) and zero for key affected populations under the age of 18 (2012 GARPR).
While substantial increase in the ART coverage and high ART retention were documented, PMTCT leaves a large room for improvement.
The 2012 Philippine MDG Report to the UN regards MDG 6, particularly HIV, as among the MDG targets that are least likely to be achieved. The Global Fund, who had the largest investment on HIV in the Philippines since 2004, concludes that, given the available information, Philippines' national program currently stands at "limited progress toward impact”. Current strategies to reach KAP, particularly MSM and PWID, should be revised to reverse the current increase in HIV incidence and prevalence.
Given these, and as planned, PNAC will review AMTP5at midterm, in collaboration with UNAIDS and WHO, an external team of consultants will be convened to determine the magnitude of the country’s HIV epidemic and assess the current achievement of the AMTP5 in terms of the coverage and quality of interventions and the efficiency of interventions in terms of availability, accessibility and delivery in achieving the outcome and impact.
As part of the review, the Department of Health (DOH), with support from WHO, will support another team of consultants (but part of the AMTP5 midterm review team) to assess the Health Sector HIV response including key components of the National AIDS/STI Prevention and Control Program (NASPCP).
The main objectives of the midterm review is to assess the country’s HIV epidemic and the first 3 years of AMTP5 implementation (2011-2013). In particular, the review aims to:
a) To determine the HIV burden in the country over the past decade (covering both AMTP4 and AMTP5) in terms of incidence, prevalence and mortality and its variation by demographic (e.g. age and gender), geographic, and socioeconomic characteristics.
b) To assess progress towards achievement of AMTP5 targets per output (by strategic objective);
c) To determine investments into AMTP5 both at national and local levels and assess whether these investments address sufficiently the resource requirements of AMTP5;
d) To determine whether AMTP5 has been implemented in a multisectoral manner i.e. it includes achievements in both health and non-health sectors. The health sector will include particular assessments of HIV counseling and testing, ART for and care of PLHIV, and STI management among key populations;
e) To determine programmatic and policy issues that facilitated and hindered the achievements of AMTP5 targets
f) To determine the efficiency of the HIV monitoring, evaluation and information system in the country particularly up-to-date projection of HIV incidence, prevalence and mortality; timely publication of the surveillance/ IHBSS reports; reporting on prevention programs among MSM and PWID; reporting ART;
PNAC expressed that, out of the midterm review, key recommendations on strategic priorities for 2014-2016 will be developed, highlighting lessons learned and specifying ways for PNAC to redirect AMTP5 particularly in updating its Investment Plan. PNAC also wishes that the review will look into the High Level Meeting (HLM) targets set by ASEAN countries.
3. SCOPE OF WORK, DELIVERABLES and TIMELINE
An external team of consultants will be convened to conduct the AMTP5 midterm review. These will be composed of the following:
a) Overall Team Leader (Evaluation Specialist - to be supported by UNAIDS, see separate TOR)
b) Program Evaluation Specialist (to be supported by UNAIDS)
c) Impact Evaluation Specialist (online support during preparatory phase thru Global Fund)
d) Health Sector Assessment Team (to be supported by WHO)
i. Team Leader
ii. Two (2) Programme Specialists
iii. Monitoring and Evaluation Specialist
e) A team of data collectors (4 research assistants) (to be supported by DOH–NEC)
This TOR assumes that the team will be grouped into 2-3 sub-teams for data collection and will travel to 9-10 sites/cities around the country (3-4 in Luzon, 3 in Visayas and 3 in Mindanao). Selected cities in Metro Manila and Cebu will also be visited.
The team will ensure conduct of the following:
The PROGRAM EVALUATION SPECIALIST will assist the Overall TEAM LEADER and will be hired for 33 days spread between September 1 and November 15, 2013:
a) Background review and preparatory phase: 10 consultancy daysb) Data Collection Phase: 13 consultancy daysc) Analysis and report writing phase: 10 consultancy days
Nationwide – including key cities in Metro Manila and around 9-10 cities around the country (3-4 in Luzon, 3 in Visayas and 3 in Mindanao). But will depend widely on the assessment framework and plan.
6. TYPE OF PROVIDER
Consultant – PROGRAM EVALUATION SPECIALIST
7. SKILLS and QUALIFICATIONS
a) At least 5 years of experience in HIV program evaluation, especially in low prevalence or concentrated epidemics. Has conducted at least 3 similar/related consultanciesb) At least 5 years of experience working in the area of HIV and AIDS particularly in local governance or local HIV responsec) Experience with both quantitative and qualitative methods of data collection and analysisd) Experienced in dealing with various sectors such as government, civil society, etc.e) Preferably based in the Philippines
a) Excellent verbal and written communication skillsb) Keen eye for detailsc) Systematic, highly organized, able to translate complicated and technical concepts into easily understood formsd) Good interpersonal skills
8. SCHEDULE OF PAYMENTS
75% advance of DSA
30 % of consultancy fees
Upon submission and satisfactory acceptance of Inception Report and Assessment Tools by the PNAC Executive Committee - by email
30% of consultancy fees
Upon submission and satisfactory acceptance of Interim Report by the PNAC Executive Committee - by email
40 % of consultancy fees
25% of DSA
Upon assignment completion with:
· All deliverables especially submission of Final AMTP5 Midterm Review Report
· Written approval by PNAC Secretariat Director that the assignment is complete and satisfactory
9. REPORTING PRACTICE
The consultant shall:
a) Shall directly report to the PNAC Secretariat Director, with all communications copied to the focal persons of PNAC and UNAIDS
b) Shall perform the services and carry out the deliverables with all diligence, efficiency and economy in accordance with general accepted professional techniques and practices
c) Shall observe sound management practices and employ appropriate advance technology and safe methods
d) Abide by terms and conditions stipulated by the contract
10. Immediate Requirement from the Consultant
Submit the following by close of business on Friday, July 26, 2013 to firstname.lastname@example.org and cc to email@example.com and firstname.lastname@example.org.
a) Letter of interest – This should explain why s/he is the most suitable person to perform the work and deliver the outputs.b) Personal CV – This should highlight past experiences in similar projects/assignments and indicating at least 3 referencesc) At least one sample evaluation report
Signatory / Manager
Dir. Ferchito Avelino
Department of Health
San Lazaro Compound,
Dr. Joselito Feliciano
Department of Health
San Lazaro Compound,
Mr. Zimmbodilion Mosende
Strategic Information Adviser
Annex A. IMPLEMENTATION ARRANGEMENTS
1. Representatives and Contract Administration Arrangement for AMTP5 Midterm Review (from herein will be referred to as the “Project”)
1.1. The PNAC Executive Committee will be the designated Project Management Committee (PMC) while the PNAC 5th AMTP Review Technical Working Group (TWG) which is composed of official representatives from the Department of Health (DOH), Department of Local and Interior Government (DILG), National Economic Development Authority (NEDA), Department of Labor and Employment(DOLE), Department of Social Welfare and Development (DSWD), Action for Health Initiatives (ACHIEVE) and Pinoy Plus.
1.2. The PMC appoints Dr. Ferchito L. Avelino as the PNAC Project Manager (PM). The PM has the authority to represent the PNAC on all day to day matters relating to the project or arising from the contract. All notices, instructions, orders, certificates, approvals and all other communications under the contract shall be communicated to the PNAC through the PM except otherwise stated in the contract.
1.3. Policies, issues and concerns affecting the AMTP5 midterm review shall be coursed through the PM who shall ensure that the PNAC TWG resolves the issue within reasonable time.
2. Reporting Obligations and Approval Process
2.1. Reports are based on expected scope of work and deliverables
2.2. All reports shall be submitted to the PNAC TWG for review and comments, through the PM
2.3. Approvals of the final products shall be done by the PNAC (Executive Committee)
2.4. Any documents shall not be disapproved except on the grounds that the document does not comply with the specified provision of the TOR and contract or that, it is contrary to good industry practice.
2.5. If the output is disapproved by the PNAC, the Consultant shall modify the output and resubmit it for approval. If the modifications required had been made, then it shall deem to have been approved unless such modification that has been agreed upon has not been done.
3. Roles and responsibilities Agencies involved in the project
3.1.1. The UNAIDS hired consultants will be the overall TEAM LEADER for the AMTP5 Midterm Review and to be supported by a PROGRAM EVALUATION SPECIALIST.
3.1.2. The consultants shall perform the services and carry out their obligations with all assiduousness, efficiency and economy in accordance with generally accepted professional techniques and practices and shall observe sound management practices and employ appropriate advance technology and safe methods.
3.1.3. Conduct all activities with due care and diligence, in accordance to the TOR and the contract and with the skill and care expected of a competent provider of the technical services required.
3.1.4. Shall provide as needed sufficient properly qualified operating and technical personnel to properly carry out the project at or before the time specified in this TOR.
3.1.5. Always act in respect of any matter relating to the contract or Services as the faithful advisers and technical provider to the PNAC. It shall at all times support and safeguard the PNAC’s and governments legitimate interest in any dealing with third party.
3.2. PNAC Secretariat
3.2.1. Shall be responsible in the coordination of members of the midterm review team, venues and food for the respondents and partner agencies who will be involved.
3.2.2. Shall be responsible for the plane fares of the midterm review team.
3.2.3. Be responsible for the timely provision of all the resources, access, information and decision making under its control necessary for the project as identified agreed and finalized project plan, except where provision of such item is explicitly identified in the contract as being the responsibility of the consultant
3.2.4. Ensure accuracy of all PNAC information and data to be supplied to the Consultants
3.2.5. Issue the acceptance report of deliverables
3.2.6. Identify control points or milestones or submission or outputs of the Consultants. These outputs are to be reviewed and will indicate whether the project should proceed or not or to take other options toward project completion.
3.2.7. Shall provide per diem to the six (4) research assistants during data collection.
3.3.1. Shall select and hire the consultants/members of the Health Sector Assessment Team
3.3.2. Shall pay for the consultants fee of the Health Sector Assessment Team
3.3.3. Shall provide for four (4) research assistants to assist the evaluation team in data gathering. (DOH-NEC will be providing for their salaries only)
3.4.1. Shall shoulder the consultants’ fee and DSA of the overall TEAM LEADER and PROGRAM EVALUATION SPECIALIST for conducting the AMTP5 midterm review (excluding Health Sector Assessment Team).
3.5.1. Shall shoulder the consultants’ fee of Health Sector Assessment Team who are hired/selected by DOH-NASPCP).
3.6. GLOBAL FUND
3.6.1. Shall appoint an Impact Evaluation Specialist who will provide online technical support to the AMTP5 Midterm Review Team.
Annex B: CONCEPT NOTE
National Health Sector HIV Programme Review and Development of a National M&E Plan: The Philippines
(Concept note, 6 June, 2013)
The Philippines is still a low HIV prevalence country, but the epidemic is increasing very rapidly in the past five years. The number of HIV cases reported has increased from one every three days in year 2000, to one within three hours by the end of 2012 . HIV transmissions are mostly concentrated among males who have sex with males (MSM) and people who inject drugs (PWID) in certain geographic areas. From 1984 to the end of 2012, there were 11,702 diagnosed HIV cases reported to the Philippine HIV & AIDS Registry. Among the reported cases, 86% were males. Majority (62%) of the reported cases in 2011 were 21-30 years. It is estimated that 23922 people are living with HIV by 2012.
Progress has been made in terms of prevention and access to antiretroviral therapy (ART). Prevention focuses on targeted education, risk-reduction counselling and condom promotion by health workers and their trained volunteer peer educators in high risk areas. The GFATM Projects have been instrumental in the institutionalization of provision of ART. From 2004 (Round 3) until January 2012, the cumulative number of PLHIV enrolled to ART is 2,087 representing approximately 90% of those who are in need of treatment. From 6 treatment hubs in 2004, Department of Health (DOH) has expanded ARV services to 16 Treatment Hubs in the country. One important measure in ensuring continuous access to treatment, care and support services of PLHIV is the provision of medical and financial support through the Philhealth Outpatient HIV and AIDS Treatment (OHAT) Package amounting to Php 30,000 per patient per year to cover for drugs and medicines, laboratory examinations including CD4 and viral load determination, and professional fees of service providers.
Important challenges facing the HIV response in the Philippines include: stigma and discrimination to people living with HIV and key populations, long waiting time before HIV test results are given, high rate of lost to follow-up after being tested positive, insufficient coverage of interventions with key population, MSM and PWID in particular, insufficient resources and capacity, particularly for surveillance, monitoring and evaluation, as well as the need to rapidly scale up effective interventions such as testing and counselling to key populations, and harm reduction programme to people who inject drugs in some geographic areas.
The Department of Health (DOH), through the Philippine National AIDS Council (PNAC) has come up with the 5th AIDS Medium Term Plan 2011 – 2016 (AMTP) to address the HIV and AIDS situation in the country. This is in conjunction with the Medium Term Philippine Development Plan (MTPDP) in order to achieve the Millennium Development Goals (MDG). The 5th AMTP provides the overall direction of the implementation of the programs and projects on HIV and AIDS in the Philippines. The 5th AMTP has started its implementation in 2011 and will end by 2016. As AMTP5 reached halfway of its implementation, an external evaluation is needed. The evaluation will focus on the five strategic objectives of the 5th AMTP assessing the status of its implementation. The assessment would also inform the Philippine National AIDS Council (PNAC) priority actions in the second half of the 5th AMTP.
As part of the overall evaluation of the 5th AMTP led by PNAC, the DOH is requested to take the lead in the health sector HIV programme review, which would focus on HIV testing and counselling, treatment and care, sexually transmitted infections (STI) among key populations, as well as the monitoring and evaluation of the health sector response, leading to develop a National M&E Plan.
2. Purpose and objectives
The purpose is to assess the progress and quality implementation of the first three years of the 5th AIDS Mid Term Plan 2011-2016, and evaluation of the implementation of the National Health Sector HIV Strategic Plan 2008-2012. The findings and recommendations of the review will be used to inform the implementation of the remaining years of the 5th AMTP, and the adjustment/revision of the National Health Sector HIV Strategic Plan 2013-2016, which has just been drafted. The assessment of the monitoring and evaluation system will inform the development of the National HIV M&E Plan.
• To assess progress of the health sector response to HIV in terms of coverage, effectiveness, impact and quality of services, with special focus on HIV testing and counseling, treatment and care, and STI prevention and control among key populations.
• To identifying gaps and constraints and provide recommendations scaling up key health sector responses to HIV, in particular HIV testing and counseling, treatment and care and STI prevention and control among key populations.
• To assess the health sector HIV strategic information system, including surveillance, monitoring and evaluation system, and develop a health sector HIV programme M&E plan.
3. Scope and process
3.1 The review should cover the following:
• The status, trends, dynamics of HIV/AIDS and other STI infections
• An analysis of the performance of current interventions/services, achievements, obstacles and gaps in response;
• An assessment of links to other programmes (TB, RH, workplace such as call centers, etc.)
• Identification of the leading issues and constraints facing the programmes on HIV and STI
• A gap analysis and recommendations for improving the national health sector response to HIV
• For assessment of the M&E system:
o Assessment of the existing health sector’s monitoring and evaluation system, including infrastructure, manpower capacity, technology, resources, policies
o Harmonization of the reporting systems, indicators, reports within the HIV program, and with other programs like TB, MCH, and universal health care (eg. FHSIS, KP dashboard)
o Develop a 5 year health sector M&E costed plan, with the purpose of improving the quality, accuracy, timeliness, completeness and availability of information; increasing the utility of existing data at national and sub-national levels, triangulating data, and disseminating information
3.2 Following activities are expected to be carried out:
• Desk review (policy and programme documents, progress reports, project proposals survey and research reports, evaluation reports, media reports and other data sources. A check list of documents and related information will be provided in advance by WHO Philippines)
• Technical briefing by the National HIV programme about epidemiological situation, programme priorities, interventions, achievements, challenges and future perspectives
• Interviews with key stakeholders (government institutions, non-government, civil society, clients of STIs, HIV and AIDS services, PLHIV, sex workers, MSM population, UN agencies, researchers, private sector)
• Group discussions (care providers, populations at risk, young people at higher risk including staff from call centers)
• Site visits to organizations and institutions implementing HIV/AIDS and STIs prevention, treatment, care or support programmes or services
• Stakeholder meetings
• Dissemination workshop of the draft review report
• Holding a press conference to share the major findings and recommendations and
• Submission of the final report within one month after the mission.
• Summary of preliminary findings and recommendations to the national counterparts at the end of the mission.
• A comprehensive programme review report in both hardcopy and electronic form. The report should clearly identify the achievements and strengths, weaknesses, gaps, and challenges, and make recommendations for consolidating and improving programme effectiveness.
• An assessment report of the National M&E system, against the Global Fund M&E guide;
• A draft National Health Sector M&E Plan, which is costed.
The review will be coordinated by the National HIV Programme, DOH of the Philippines. External and internal consultants will be recruited to work with the programme managers and staff. WHO Country Office in the Philippines and the WHO Regional Office for the Western Pacific will provide necessary technical and financial support to conduct the review.
A team of 6-8 consultants (3-4 international and 3-4 local) will be recruited. A team leader will be appointed among the consultant to lead the review. They will be funded by WHO.
The international consultants should be leading experts working in the areas of HIV testing and counselling, antiretroviral therapy and STI, with rich international experiences, particularly in the low and concentrated Asia epidemic settings. S/he should have experiences for programme review and assessments, and with good track records working with governments and agencies.
The local consultants are national experts in the areas of health programme implementation and management, with experiences of data collection, collation and analysis. They should have training on health sciences related disciplines, with master degree of public health or epidemiology. S/he should be able to work with the international teams to provide data collection, encoding and analysis, conduct the field survey and provide other inputs as necessary.
In consultation with the National AIDS Programme, and in consideration of the overall timeline of the 5th ATMP evaluation, the following timeline is proposed for the health sector HIV programme review and M&E plan development.
Scope of Work
Convening the panel of experts/consultants
4 research assistants recruited (funded by DOH-NEC)
4 international consultants recruited (funded by WPRO)
Development of review plan, methodologies and tools; background documents and data collection and review - preparation phase
Review plan, methods and tools, initial desk review
1 - 30 Sep., 2013
Research assistants working with DOH, international consultants and WHO. Team Leader of health sector review to discuss and harmonize with overall team leader.
Joint thematic programme review through desk review, interviews, focus group discussions, site visits, and others
Joint programme review done with three thematic teams: HTC/ART, STI, Strategic Information (SI); Interim report submitted by the end of the mission
The site visit takes place on 14-24 Oct
Consultants working with the DOH and WHO.
Report writing, discussions and revisions, and submission of the final report
25-31 Oct. 2013
Consultant team, led by team leader, with inputs from Overall Team Leader
AMTP5 Final Report writing and submission
Inputs to the AMTP5 Final report
15 Nov. 2013
Consultant team, led by team leader, coordinated with Overall Team Leader
Dr Jose Gerard B. BELIMAC
Medical Specialist II
National Center for Disease Prevention and Control
Infections Disease Office
Building 19, Department of Health, Sta. Cruz
Manila, the Philippines
Tel No. : (632) 495 0149
E-mail : email@example.com
Dr Zhao Pengfei (Act as interim focal point for WHO Country Office in the Philippines) and Dr. Yu Dongbao (act as focal point for WHO WPRO)
World Health Organization Regional Office for the Western Pacific