Vacancy: International consultant to review existing legal barriers to effective implementation of immunisation and MCH care in Ukraine

Locations: Central and Eastern Europe: Ukraine
Work Type : Consultancy

If you are a committed, creative professional and are passionate about making a lasting difference for children, the world’s leading children’s rights organization would like to hear from you.

For 70 years, UNICEF has been working on the ground in 190 countries and territories to promote children’s survival, protection and development. The world’s largest provider of vaccines for developing countries, UNICEF supports child health and nutrition, good water and sanitation, quality basic education for all boys and girls, and the protection of children from violence, exploitation, and AIDS. UNICEF is funded entirely by the voluntary contributions of individuals, businesses, foundations and governments.

Purpose of the Assignment

Within the context of the reforms and health systems strengthening, UNICEF is prioritizing immunization and maternal care as areas of major concern.

In recent years, Ukraine has been grappling with drastically low vaccination rates, consequent outbreaks of diseases such as Polio and Measles along with issues around distrust of vaccines, apathy of healthcare workers, vaccine stock outs, and inadequate immunization capacities of healthcare workers. Ministry of Health data for 2016 show that vaccination rates are as low as 19% for DTP3 and 42% for MMR. Additionally, due to the accumulation of susceptible individuals in the population, Ukraine is currently experiencing a measles outbreak of over 1,000 cases. During the polio outbreak, bottlenecks to immunization were identified which stemmed from health systems failures, as well as social and institutional practices. KAP studies, before and after the outbreak showed major barriers included general distrust in vaccines (32%), fear of side effects (25%), vaccine unavailability (5%), and healthcare workers advising parents against vaccination (1%). Other findings found that the highest levels of fear stemmed from the perception that vaccines were unsafe or low quality. The influence of physicians was highlighted in these surveys, demonstrating how Ukrainian parents still place a high level of trust towards medical staff and institutions.

However, the trust in medical workers has been affected following the recent suspension of mandatory immunization and introduction of new legislation that abolishes punitive measures against parents who refuse immunization. Though the aim of new legislation was to create and relax relations between health workers and parents, its enforcement resulted in tensions and increasing in refusals rates and number of conflicting situation that affecting trust in immunization. Some of the examples of includes indiscriminative use of consent forms for vaccination (even in case of outbreak response), introduction of compensation in case of AEFI and non-allocation of funds for reimbursement, mandatory forensic investigation in cases of child death, only if link to previous history of vaccination can be established which resulted in frequent association of any fatalities with use of vaccines.

The legal framework on immunization is generally rigid and prescriptive, leaving little space for doctor’s decision and is recognizing number of punitive measures in relations to vaccine administration and vaccine quality and safety that is impacting motivation and performance of health workers

EU countries adopted national strategies based on either a compulsory or a recommended approach. While the compulsory approach attempts to tackle epidemics, it can lead to feelings of coercion and can at times degrade public trust. Recommended vaccination attempts promote free choice, with clinicians and health professionals playing a key role in convincing parents and addressing vaccine concerns. Most EU policymakers have chosen the recommended and not compulsory approach: 15 out of 30 countries (the EU28 plus Iceland and Norway) have at least one mandatory vaccination within their programs, while the other 15 have no compulsory vaccination at all. The level of compliance was high, including in countries where vaccination is not mandatory. Currently, with the outbreak of measles and other communicable diseases being seeing across Europe, some countries have begun to introduce new national vaccination plans; Italy is adding 10 vaccines to the four traditionally mandatory ones, which will be covered by their national health service. Some regions in Italy have imposed vaccination requirements for school entry and adopted legislative proposals that come with disciplinary or contractual sanctions for health workers failing to support this practice.  Similarly, France will add eight vaccinations to their current list of three mandatory vaccinations in 2018..           

Contrary to immunization data, Maternal Mortality Rates in Ukraine are on steady decline since 2001. Recent data suggest that Ukraine rates are close to WHO EURO average, but yet, four times higher than the average of the European Union.  However, under-reporting and misclassification of maternal deaths are common, vital/death statistics is weak, and definition of causes of death is not adjusted to the international one that leads to major underreporting. The corruption adds another layer to the problem. Health system in Ukraine does not provide incentive for health workers to properly report, on contrary, fear of consequences after reporting  maternal deaths is high, regardless if the health workers done all to save women’s life or there was a case of mismanagement.  Those health workers that received “under-the-table” payments, would be even more interested to find legal gaps and avoid case investigation as it can reveal not just malpractice but illegal payments as well. Inability to “pay” for service could be reason for many women to delay seeking care – that often leads to lethal consequences.  

Such poor performance in immunization and MMR is in discrepancy with existing expertise in the country, wide spread access to health care in the country and enormous workforce in the sector. Therefore, as part of the reform of its healthcare system, the Ministry of Health of Ukraine is seeking to make an informed decision on which stance to take (mandatory or recommended) on a national level for the implementation of their national vaccination programme and what measures needs to be taken to improve maternity care related legislation.  This consultancy will review current laws, regulations, guidelines and policies, as well as lessons learned and experiences of other countries in order to propose recommendations to develop the current situation within the context of ongoing reforms. The consultancy will be implemented October 2017 – March 2018.

The overall objectives of the consultancy are: to provide technical assistance to the Ministry of Health in Ukraine in modelling of practice and policy for an informed national vaccination programme and to investigate the causes of maternal mortality in Ukraine.

The consultancy will allow development of appropriate and effective strategies to prevent the morbidity and mortality associated with VPDs, pregnancy and labour and therefore key contribution to the health reform process in Ukraine and efforts to protect and promote child rights and women’s reproductive rights.  The consultancy will also contribute to reaching objectives of UNICEF health programme in the CPD 2018-2022. 

The assignments of selected consultant will envisage the following results:

Result 1- Review of existing legal frameworks around immunisation and maternal care for factors that impede effective delivery of essential services, affecting the trust in service providers and potentially violating health rights of children and women.

Result 2 - Reviewed literature and evidence on experience in other countries (with focus on EU and CEE/CIS) for best practice and lessons learned in the legal frameworks on immunization and maternal health

Result 3 – Proposed recommendations for adjustment of the legislation and bylaws on immunisation and around maternal care within the context of ongoing reforms.

Expected Deliverables

1. Review of existing legal frameworks around immunisation and maternal care for factors that impede effective delivery of essential services, affecting the trust in service providers, creating corruption and potentially violating health rights of children and women.

1.1. Brief narrative report describing current legislation (including laws, bylaws, guidelines, reporting forms and other documents) in immunization and maternal care.

1.2. Mapping areas in need for revision/adjustment in line with best international practices.

1.3. Analysis of the potential gaps in the reform process related to the legal framework of immunization and maternal health. 

2. Reviewed literature and evidence on experience in other countries (with focus on EU and CEE/CIS) for best practice and lessons learned.

2.1. Identification and desk review of the legal cases, frameworks, and evidence on best practices on immunization and maternal health. The practices can include, but not exclusive to outbreak response, routine vaccination, immunization of pregnant women, etc.

2.2. List of key literature and references for further use.

2.3. Mapping key illustrative cases and evidence based practices on immunization and maternal health for public advocacy. 

3. Proposed recommendations for adjustment of the legislation and bylaws on immunization and maternal care within the context of ongoing reforms.

3.1. Set of recommendations and key advocacy messages for improvement of the legal framework on immunization within advocacy on reforms.

3.2. Mapping critical factors affecting human rights and rights to health in Ukraine.

4. Final report of the review.

4.1. Final report on findings of the assessment and recommendations that can be publicly presented and shared with external partners. 

Qualifications of Successful Candidate

Education Master’s degree in Law, Public Health or other relevant social sciences

Years of relevant experience & Competencies of Successful Candidate

• Five to eight years of relevant experience, at the national and international levels;
• Experience of development of policy documents based on facts for high advocacy;
• Experience in executing policy and legal reviews, providing technical support or leading development of the legal assessments for policies.
• Previous experience working in Eastern Europe and Ukraine;
• Experience in working with UNICEF, other UN agencies, and other international partners is desirable;
• Fluency in English and good writing skills

Estimated start date: November 20, 2018

Number of working days: 6 months (20  working days)

Workplace of Consultant: Remotely desk review of existing evidence, with frequent consultations with key stakeholders from Kyiv

To view our competency framework, please click here. 

Please indicate your ability, availability and daily/monthly rate (in US$) to undertake the terms of reference above (including lump-sum for travel, if applicable).  

Applications submitted without a daily/monthly rate will not be considered.

UNICEF is committed to diversity and inclusion within its workforce, and encourages qualified female and male candidates from all national, religious and ethnic backgrounds, including persons living with disabilities, to apply to become a part of our organisation.

Opening Date Fri Nov 03 2017 09:00:00 GMT+0200 FLE Standard Time
Closing Date Thu Nov 16 2017 23:55:00 GMT+0200

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