Back National Consultant, Rapid Assessment on Key Barriers to Adolescent Sexual and Reproductive Health (ASRH) Services

Background context:

National Level

Mozambique faces significant challenges in sexual and reproductive health, characterized by high fertility rates (5.1 compared to the region - South Africa 2.4, Zimbabwe 3.5, Eswatini 3.0, Tanzania 4.8 

and Malawi 4.1), early childbearing, and limited access to essential services. Women, especially in rural areas, struggle to access modern contraception, leading to a high unmet need for family planning (only 26% of women aged 15-49 currently married/in a marital union use some form of contraceptive method; with 83.8% of girls aged 15-19 reporting that they do not use any form of contraception (DHS, 2022-2023) and 39% of adolescent girls pregnancy. Maternal mortality remains a critical issue, with an estimated maternal mortality ratio of 233 deaths per 100,000 live births (DHS, 2022-2023). Many women experience complications due to inadequate healthcare, especially during adolescent pregnancies. The country also faces high rates of HIV and sexually transmitted infections, compounded by limited sexual education and restricted healthcare access for young people. Moreover, widespread gender-based violence coupled with high vulnerability to early and forced marriage, further undermines the reproductive health of women and girls.

Provincial level

Nampula and Zambezia province represent the largest provinces in Mozambique with a population that totals about 40% of the population of the country (2017 Census). The majority of the population lives in rural areas, and more than half of the population (about 68%) is under 25. Access to healthcare remains a significant challenge in Nampula and Zambezia provinces, reflected in several key indicators. The contraceptive prevalence rate (CPR) for modern methods has stagnated for two decades, with Zambezia at 18% and Nampula at 22%. Unmet family planning needs are highest in Zambezia (29.8%) and 18.9% in Nampula, with limited access to long-acting contraceptives. Interventions to improve sexual and reproductive health include expanding access to family planning, addressing intersections of gender, poverty, education, and cultural practices. Zambezia has the lowest institutional delivery rate (42%) and Nampula the third lowest (68%), compared to the national average of 70%. Births attended by skilled personnel are lowest in Zambezia (46%) and 74% in Nampula, against a national average of 85%Prenatal visits (4+) are lowest in Nampula (41.4%) and Zambezia (41.9%). Adolescent pregnancy is linked to poverty and education levels, while child marriage remains a major obstacle, affecting 61% of girls in Nampula and 48% in Zambezia.

UNFPA’s intervention: 

In response to the identified needs, UNFPA, supported by FCDO and in collaboration with implementing partners, has been working since 2021 at both the policy and grassroots levels to foster an enabling environment for the adoption and sustained use of modern family planning, particularly among women and adolescents. Efforts have pregnancy rates. The aim is to produce actionable recommendations that can guide programmatic interventions and policy improvements.Despite UNFPA’s work across Zambézia and Nampula provinces to: 
a. Tackle the barriers to accessing essential sexual and reproductive health services such as family planning counseling, 
b. Fill the national family planning commodity gap,
c. Provide capacity building of health service personnel in family planning techniques,

The sexual and reproductive health-related data to the two provinces together with the results from various monitoring visits to the project’s sites show a low uptake of long-acting family planning among adolescents, a high rate of pregnancies and weak access to comprehensive abortion care services. In this context and in relation to the objectives of the FCDO’s project, a more profound understanding of what are the barriers for adolescent girls and boys to access key SRH services is needed, coupled with the effort to identify solutions that can be integrated into programs and implemented.

For the aforementioned reason, UNFPA Mozambique is seeking a consultant who could perform adolescent-centered mixed methods formative research across four districts in two provinces where the project is taking place. The research will encompass communities in the selected districts and include a selected number of health facilities. The target population includes adolescents (aged 10 to 19), with a focus on pregnant adolescent girls, their families, healthcare providers, community members,in and out of school adolescents including community health workers (APEs, APSs), and traditional birth attendants (TBAs).).
Barrier Identification: Analyze data to identify barriers such as:

Can we include some political barriers- how policies support or alienate adolescents?

Gap Analysis: Compare the existing SRH services to international standards and best practices for adolescent-friendly health services.

Methodology

It is proposed that this research will use a mixed-methods approach to cover the two objectives. 

The study will be comprised of:

  The consultant should submit the following key deliverables on the following dates, all deliverables should be submitted through a soft copy in both English and Portuguese version:

Final report incorporating feedback from UNFPA. Presentation of the final reports with findings and recommendations (40%) -      Two weeks       after submitting deliverable #4 - 40%

Proposed timeline (3 months)

Deliverables are expected to be submitted on a rolling basis, enabling the implementation of recommendations while the research is ongoing.     

Duration of the consultancy: 3 months (60 working days);

The above-referenced reports will be prepared by the consultant, reviewed by the SRH Team lead, SRH Program Specialist, UNFPA Nampula province coordinator, and M&E officer, and signed off by the Deputy Representative

The Consultant shall work under the direct supervision of the SRH Technical Specialist, and SRH Program Specialist, and coordinate with the UNFPA Nampula sub-office head.

The work is expected to be conducted in a mixed approach presential and remote. Travel will be requested by the UNFPA Mozambique country office for data collection and key informant interviews in target districts. 

In addition, travel will be requested by the UNFPA Mozambique country office for the presentation of the findings and recommendations to UNFPA and IPs, Zambezia and Nampula

It is expected to travel to some of the project's selected districts to collect data and focus group interviews at the project's target communities and health centers. Locations in the following districts will be agreed upon during the initial meeting:

The consultant will be responsible for arranging and covering the costs of logistics (such as accommodation, transportation, flight tickets, taxi, etc.) associated with the formative research process. All expenditures to be based on the itemized costs to be submitted by the consultant as part of the consultancy package.

The workshop will be paid by UNFPA as well as accompanying team members from UNFPA will fund their travel.

Education:

Working Experience:

For the proposed consultant, knowledge and at least 5 years of professional working experience including: 

UNFPA Core Competencies:

UNFPA Functional Competencies:

The proposed consultants' willingness to comply with UNFPA’s confidentiality and conflict of interest rules.

The consultant shall be entitled to fees as per UNFPA policy guidelines.