Hiring Office:

UNFPA Mozambique Country Office

Purpose of consultancy:

INE has recently completed the nationally representative households survey – Mozambique Demographic & Health Survey (MDHS) – 2022-23. It has been held for 11 years—the last DHS was held in 2011. This important piece of data comes at the right time because it provides the baseline indicators for both ICPD and 2030 SDGs agenda. The Mozambique DHS survey is particularly provided the set of core indicators (Age-sex and household structure, fertility and family planning, maternal mortality and reproductive health care including fistula, childhood mortality, women empowerment, and GBV) for the two most relevant global frameworks: 1) SDG Indicator Framework and 2) the Global Monitoring Framework for the ICPD. Analyzing demographic and health survey data in Mozambique is important for several reasons: 1) The evidence gathered through the in-depth analysis of DHS helps policymakers make informed decisions regarding public health interventions, resource allocation, and policies aimed at improving healthcare services and outcomes in Mozambique. 2) By analyzing the Mozambique DHS, MISAU and MEF officials will identify trends in health indicators such as maternal and child health, prevalence of diseases, access to healthcare services, and other vital statistics. This information is crucial for designing targeted interventions and programs. 3) Regularly conducting in depth analysis of demographic and health surveys allows for monitoring the progress of SDGs and ICPD30 milestones over time. This helps UNFPA to track improvements or setbacks in outcomes and identify areas that require special attention or additional resources. 4) Analyzing Mozambique DHS will also help to uncover disparities in access and outcomes among different population groups, such as rural versus urban areas, different income levels, and various demographic groups. This information is crucial for promoting health equity and ensuring that healthcare services reach all segments of the population. UNFPA is planned to conduct five in depth analysis using the several rounds of the Mozambique DHS.

Scope of work:

(Description of services, activities, or outputs) Total Fertility Rate (TFR) was 4.9, Contraceptive Prevalence rate (CPR) for modern methods remains at 25 percent, and 48 percent of women were married before reaching the age of 18. Early pregnancy and childbearing for child/underage brides carries added health risks for mother and child; including maternal mortality and stunting, high neonatal and infant mortality, increased vulnerability to obstetric fistula and undermining their overall prospects to development. UNFPA is seeking the service of individual consultants to facilitate in depth statistical analysis of the available data from several rounds of Mozambique Demographic and health surveys. The assignment will consist of different studies and described as follows:

1) Fertility Analysis by birth order (parity), teenage pregnancies and proximate determinant analysis at the provincial level in Mozambique

2) Further analysis of maternal and newborn mortality by provinces as well as assess the quality of care for maternal health.

3) Identify factors associated with contraceptive prevalence, unmet need, discontinuation and switching of contraceptive methods from a quality-of-care perspective.

4) Further Analysis of level, trends and consequences of child marriages in Mozambique

5) Estimation for key demographic indicators using small area estimation techniques.

6) Produce the national and provincial level briefs using the MDHS 2022-23 data.

The summary of each study is described as follows:

1. Fertility Analysis by birth order (parity), and proximate determinant analysis at the provincial level in Mozambique.

The analysis on fertility will focus on the level and trends of total fertility rate in Mozambique with a special emphasis on the parity-specific fertility measures and methods to calculate fertility by birth order as well as teenage pregnancies. It will introduce data sources and will demonstrate the calculation of fertility rates by parity using individual-level data. Very limited studies exist on the demography of Mozambique. Using the only national survey with complete birth history data, this study will describe the recent fertility changes in the country from a parities specific perspective. From 2003 to 2022, parity progression ratios, average birth intervals, sex ratio at birth by parity and synthetic lifetime average parity will be examined. The level and trends of teenage pregnancies will further study to support the analysis.

2. Maternal, newborn, child, and adolescent health in Mozambique: Challenges and Way Forward.

Maternal mortality remains a major public health problem in Mozambique, adequate use of maternal health care services including the family planning could be effective means for reducing maternal mortality. This chapter aims to examine the situational analysis of reproductive health care as well as the sociodemographic determinants of maternal health care usage among women. Using appropriate statistical models, this chapattended, and post-natal care services in Mozambique and subnational variations. The increase in utilization of these services is expected across geographies and population sub-groups, but little is known about the extent of inequality in maternal care use across socioeconomic groups over time. Using data from Demographic Health Surveys, this chapter will also examine the extent of inequality in utilization of full ANC, SBA and PNC in Mozambique and its provinces. Descriptive statistics and potentially use concentration index and decomposition analyses[1] to understand the pattern and change of inequality in use of maternal care.

● Estimating maternal mortality at the provincial level using the robust statistical methodology from DHS 2022-23

● Level and trend analysis of sexual and reproductive health and new-born care (antenatal, delivery and postnatal care levels and changes, including skilled birth attendance)

● New-born and child health (malnutrition, respiratory tract infections, acute diarrhoea)

3. Identify factors associated with contraceptive prevalence, unmet need, discontinuation and switching of contraceptive methods from a quality-of-care perspective.

It is essential to examine the levels and trends in contraceptive switching, contraceptive failure, and abandonment of contraception while still in need of pregnancy prevention. The reasons for discontinuation of modern contraceptive methods and the characteristics of the women who discontinue contraception are necessary for the evaluation of FP strategy and the required resource allocation that can ensure the quality of and equitable access to FP information and services. The reduction of failure and discontinuation rates can make a substantial contribution to reducing unwanted fertility.

● To document overall trend and levels of contraceptive use, unmet need and discontinuation, and method-specific and reason-specific rates of discontinuation at national, subnational level

● To estimate the associations of discontinuation with selected socioeconomic, demographic characteristics and quality of care services.

● To examine contraceptive behavior following a discontinuation for failure and fertility consequences.

● To assess the utility/linkages of contraceptive discontinuation as a reflection of the quality of the service environment

● To maintain the high quality of the analysis, all STATA syntax will be dually verified by the technical expert.

4. Estimation for key demographic indicators using small area estimation techniques.

Most household surveys such as the Demographic Health Surveys (DHS) provide reliable estimates of survey indicators primarily at the national level, as well as the first subnational administrative level – Admin 1 (provinces). Since national-level estimates are useful for comparing nations and aggregating data across large world regions, their natural audience includes international policy makers and donors. The analysis at Admin 1 is useful in understanding the distribution of health and demographic phenomena, but it does not provide comprehensive estimates at lower levels such as the second subnational administrative level (Admin 2 districts), where health programs are designed and implemented. Countries now have an even greater need for these data because health program planning and implementation are increasingly decentralised to the Admin 2 level. Decision-makers at this level are often constrained by a lack of routinely available local data for key indicators that would allow for data-driven policymaking. A need exists for local data that is routinely produced, encompasses a variety of demographic and health subject areas, and is easily accessible and interpretable. As local needs demand, this data can be used for priority setting at the admin 2 level, identification of poorly performing localities, and more equitable resource allocation. During the last several years and within the framework of the Sustainable Development Goals (SDGs), there has been an expressed need to improve the measurement and understanding of local geographic patterns to support more decentralised decision-making and more efficient program implementation.

● Review the international studies and propose the methodology to estimate the selected indicators using the small area estimation technique.

● Prepare the database to estimate indicators using the small area estimation.

● Prepare the syntax to estimate the indicators using small area estimation and test the validity of indicators.

● Develop the GIS maps and graphs to present the results and prepare the PPTs for decimation of results.

5. Further Analysis of level, trends and consequences of child marriages in Mozambique

● To estimate the prevalence of child marriages (15+ and 18+) for Mozambique and provinces using two rounds of MDHS surveys (2011, and 2022- 23), preferably in STATA.

● Estimate the consequences of child marriages on the selected thematic areas: The potential list of indicators will be finalized at a later stage. o On the fertility, early childbearing, and its associated determinants o On the infant and childhood mortality (under-5), adolescent and maternal mortality. o Reproductive health (ANC, PNC, SBA) and family planning use (mCPR, Traditional) o Gender based violence and women decision making.

● Support in writing the detailed report and policy brief. To maintain the high quality of the analysis, all STATA syntax will be dually verified by the technical expert.

Duration and working schedule:

The assignment should be completed within 8 months spread from 1st July 2024 to 31st March 2025.

a. Inception report (for all studies): includes the expanded details on the list of indicators and data sources identified.

b. Draft presentation in PowerPoint which included the graphs and tables

c. Validation meeting (for all studies).

d. Final report for all studies including maps and graphs

Place where services are to be delivered:

The consultant will work remotely and will have close coordination with UNFPA.

Delivery dates and how work will be delivered (e.g. electronic, hard copy etc.):

All material will be submitted to UNFPA in soft/electronic form.

Monitoring and progress control, including reporting requirements, periodicity format and deadline:

The consultant will be in close coordination with UNFPA, and technical staff will ensure quality and standards before release of payment.

Deliverables and payment schedule:

The consultant will be paid monthly based on the satisfactory progress report.

Deliverables:

Submission of the monthly progress report

Payment Schedule:

Monthly payment upon approval of the report.

Supervisory arrangements:

The Consultant will work under the direct supervision of the Technical Specialist (P&D Team Leader), UNFPA.

Expected travel:

N/A

Required expertise, qualifications and competencies, including language requirements:

● Master’s degree or higher in Public Health, Demography, Statistics and social science or a relevant combination of education.

● Minimum 7 years of professional experience in the field of data analysis of sample surveys (DHS and MICS) in sexual and reproductive health, family planning and GBV.

● Excellent programming skills in STATA/R programs for analysing survey data

● Knowledge of FP landscape, population dynamics, and socio-cultural issues including child marriage, family planning in developing countries.

● Proven ability to analyse large survey data sets.

● Proven ability to work effectively with government officials.

● Languages: Fluency in oral and written English.

● Excellent interpersonal and general communication skills.

Inputs / services to be provided by UNFPA or implementing partner (e.g support services, office space, equipment), if applicable:

Consultant is expected to use his/her own laptop or any other equipment if required.

Other relevant information or special conditions, if any:

Individual consultancy contracts will be signed between the Consultant and UNFPA Mozambique Country Office.