Type de contrat
Contrat de prestation de services
Les maladies non transmissibles ; Les maladies transmissibles ; Politique de la santé
Santé mentale ; Tuberculose ; VIH/sida ; Prestation de services de santé
Date limite de candidature
Durée de la mission
Département Santé - DEPSAN > Pôle Initiative 5% et Pandémies
Mis en ligne le : 14/03/2023
Objectives and expected outcomes
The overall objective of the mission is to assess the feasibility to mainstream the mental health component in Alliance Myanmar’s existing HIV and TB activities and develop a budgeted strategic plan with capacity building component to reshape program activities and the environment that influence mental health of people infected and affected by TB and HIV.
Some of the beneficiaries dropped out at different stages along the continuum of care. Especially the dropped-out rate from being tested HIV positive to treatment is high and the situation among people who inject drug is the worst even though there is comprehensive HIV counselling including ART information. It is highlighted that there is a gap for mental health support to provide early and successful ART treatment. Similar experiences are encountered for TB beneficiaries.
And most of the people affected by TB and HIV are more vulnerable to mental health issues compare to general community due to many long-standing social issues such as self-stigma, stigma & discrimination and poorer economic status compared to other general populations. It is especially important for young key populations such as young transgender people, young MSM, young female sex workers and young drug users to have mental health support to ensure they practice safer sex and drug consumption practices following the preventive measures.
In addition, many HIV/TB infected and affected people are often subjected to human right violations and Gender Based Violence which can be major crisis for them where they need mental health support seriously to be able to handle these issues properly, overcome the crisis and survive.
There is no mental health support in the current program activities for HIV/TB infected and affected people and it is a major gap which hinders the outcomes of prevention, testing, care & support and treatment activities. AM aims to provide people centred, comprehensive service provision for the beneficiaries and it can be possible only by filling the gap of mental health element.
The organization aims to integrate mental health in its existing activities by adding key mental health elements in its prevention, testing, care and support and treatment activities which were implement in partnership with community-based organizations. It hopes to have cost effective community based mental health activities integrated in its TB/HIV works which can later further expand to other health services such as Maternal and Child Health and Sexual and Reproductive health activities.
Key milestones and activities of assignment
Following deliverables, documents and methodological approaches are expected:
Any other suggestion may be made by the expert if this is necessary for the proper conduct of the assignment.
The consultant will provide regular feedback/communication to the CCM throughout the assignment. The expert should liaise with Expertise France, the Regional Counsellor in Global Health for South-East Asia (based at the Embassy of France to Thailand) and the Health and SCAC of the Embassy of France in Myanmar at the beginning and at the end of the mission to present the objectives of the mission and debrief on the conclusions and recommendations.
Myanmar is facing an unrest crisis of political, human rights, socioeconomic and humanitarian crisis since the military coup and a severe COVID-19 third wave in 2021. The spreading out of armed conflicts and the nationwide Civil Disobedience Movement (CDM) seriously damaged the existing fragile health sector, further restricting people’s access to essential health services. Doctors and nurses were among the first to lead the protests – walking out of their jobs days after. This had a direct and an overwhelming impact on the public healthcare system.
According to the Global fund, Myanmar is the second most affected country by HIV/AIDS in the region, after Thailand. In 2019 there were an estimated 240,000 people living with HIV, including 10,800 children. Among 230,000 adults living with HIV, 38% were women and 62% were men. National HIV prevalence among adults (15+ years) was approximately 0.57% with higher and concentrated HIV prevalence among Key Populations (KPs), including people who inject drugs (PWID), men who have sex with men (MSM), female sex workers (FSWs) and the intimate partners of all these groups in specific key geographic locations. In 2017, 75% of the total number of people living with HIV (PLHIV) lived in 5 states/regions including Kachin, Shan North, Sagaing, Mandalay and Yangon.
Despite the long-standing public-health challenge in the country, that the HIV prevalence represents, Myanmar was recognized before the coup for its robust response to HIV, supported by the Government and various donors, including the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), US Presidential Emergency Plan Fund for AIDS Relief (PEPFAR), Access to Health, and the Japan Fund for Poverty Reduction through the Asian Development Bank (ADB).
HIV/AIDS Services in Myanmar
After the coup and the CDM, iNGOs decided to continue the distribution of Antiretroviral Therapy (ART) as their teams have been providing services as frontline staff at the IHC and many patients were concerned about access to services, their medication and treatment. By the end of 2021, iNGOs were able to provide ART to nearly 52,000 PLHIV thanks to this emergency approach. This approach was completed with a new method of medication distribution: by concern for the patients’ safety within the political context, the iNGOs provided theirs patients with medication and treatment for several months in once, to reduce up to a minimum the number of travels the patients had to make to collect their treatment. Until recently, many facilities of the National Aids Program kept offering only very limited services. Nevertheless, it is likely these facilities might not be functioning at all.
In terms of health conditions, the burden of infectious and communicable diseases remains predominant. Tuberculosis is also rampant, with an alarming rate of drug resistant infections and co-infection with HIV.
Myanmar is among the 20 highest TB burden countries, with especially high prevalence in areas where the distance to a TB diagnostic center is farther. TB diagnosis and treatment is only provided at township hospitals. In addition, hospitals often don’t have good equipment for the diagnosis of TB. This results in delay of treatment and missing TB cases, especially among less mobile people (children/pregnant women/elderly/disabled). Since the coup, things have gotten worse.
According to Myanmar National TB Prevalence survey in 2017-2018, prevalence rate was 355 (253-458) per 100,000 population in State level and 468 (398-546) per 100,000 population in National level. Utilization of public health facility as first contact for care seeking is most commonly in states (43%). The TB prevalence survey showed that clusters with longer distance to the township hospitals had higher TB prevalence. Patients in rural areas (including minority ethnic groups) had to travel 13 miles in average. 21 out of 75 clusters of TB prevalence survey were more than 20 miles from the nearest TB centers.2
Lack of supported sputum transport system for diagnosis, lack of supporting environment for marginalized population pose access barriers for early TB diagnosis and treatment. It was also mentioned that hard to reach population has poor access to care, high cost of care and poor treatment completion. TB service is rarely available in the hard-to-reach area and ethnic minority population.
Alliance Myanmar (AM)
Alliance Myanmar is a Sub Recipient of Global Fund implementation since 2011. It works in partnership with community-based organization and networks formed by HIV key populations such as men who have sex with men, transgender people, people who inject drugs, female sex workers and people living with HIV by providing technical and forward granting. It is the unique approach of the organization since it believes effective sustainable HIV/TB responses are possible only with genuine participation of community based organizations.
The organization is currently implementing GF 2021-2023 HIV/TB grant with 22 CBO/network partners to provide HIV prevention, testing, care and support and treatment services. The organization mobilized general practitioners to provide ART for which CBOs play critical roles to provide necessary adherence support such as counselling, nutrition support, follow up home visits etc . It also strengthens the link between community system and health system so that the CBOs can refer positive patients to public health facilities. The organization also implement C19 RM (2) grant where it established covid-19 centres and integrate TB activities. It also got a grant from STOP TB initiative to strengthen TB community and to get more detail information around CRG for TB patients while providing basic essential TB services. AM manages Global Fund grant which is more than 10 percent national targets of HIV key population.
The organization noticed the missing element of mental health support for HIV/TB beneficiaries and believes integrating of mental health services into existing program activities will significantly increase the effectiveness of preventing, testing and treatment services for HIV/TB beneficiaries. The impact of the political instability after the military coup and waves of covid-19 makes the needs of mental health services more prominent than ever.
The country is currently implementing 2021-2023 GF grant which is going to end by December 2023, thus it is in its preparation to develop the next funding request for the period 2024-2026 to submit for the first window end of March.
Qualifications and skills:
Professional proficiency in speaking, reading, and writing in English.
The interested consultant/each interested consultant/the team of consultants is invited to send a full proposal comprising:
Le processus de sélection des candidats s'opérera selon le(s) critère(s) suivant(s) :
Date limite de candidature : 09/04/2023 23:59
Document(s) joint(s) : ToR - 22SANIC894 - Alliance Myanmar.pdf