Consultant for Continuity in Crisis – Ensuring continuity of NCD care for crisis-affected populations in East Africa Feasibility Assessment

Danish Red Cross is looking for a consultant to conduct a feasibility assessment to explore the potential to integrate NCD interventions into existing interventions in Sudan, South Sudan, Ethiopia and Somalia with a focus on areas such as disaster preparedness and response, health, resilience, mental health and psychosocial support and migrant/refugee projects.

Non-Communicable Diseases (NCDs), including cardiovascular diseases, cancers, respiratory diseases, diabetes and mental health conditions currently represent the fastest growing disease burden in Africa adding to the existing high burden of communicable diseases such as malaria and HIV/AIDS[1]. It is estimated that 34% of all deaths in Africa are caused by NCDs (WHO 2015). By 2030, NCDs will be the leading cause of death in Sub-Saharan Africa increasing from 28 to 46 percent of the total disease burden. In the Eastern African countries of Burundi, Rwanda, Kenya, Tanzania, South Sudan and Uganda, 40% of all deaths on average are attributable to NCDs. Most of these deaths occur when people are in the productive age, causing economic hardship to families and countries. Furthermore, every year 703 000people take their own life and there are many more people who attempt suicide. Every suicide is a tragedy that affects families, communities and entire countries and has long-lasting effects on the people left behind. Suicide occurs throughout the lifespan and was the fourth leading cause of death among 15–29-year-olds globally in 2019. (WHO, 2021) In the Sub Saharan African, Cases of suicide and other Mental Health conditions have been on the rise and have become a major of grave concern.

Migrants, refugees and internally displaced people (IDP) may face additional risks as they often do lack or have limited access to basic services including health and NCD care. It is estimated that East Africa and the Great Lakes Region currently hosts more than 4.7 million refugees and asylum seekers with almost 4 million residing in Uganda, Sudan, Ethiopia, Kenya and South Sudan (2021).2 The region thus hosts some 67 percent of the refugees on the African continent and 20 percent of the global refugee population. The largest number come from South Sudan, with significant arrivals from Burundi, the Democratic Republic of the Congo, Eritrea, Somalia and Sudan. Most governments have generally continued to maintain open-door asylum policies by adopting progressive national refugee frameworks and promoting the inclusion of refugees into national health, education, and social protection/security systems.

Disasters, particularly those associated with weather related hazards such as floods, storms and drought triggered 2.6 million new displacements during the year(2018). Conflict and disaster events caused by climate change in 2019 suggest that the number of displacements is likely to continue rising. Risks and vulnerabilities linked to disasters and conflict, exacerbated by the COVID-19 pandemic-, have highlighted the importance of addressing health risks holistically while integrating comprehensive NCD care, both in humanitarian response and in efforts to strengthen health systems and reduce risks especially in contexts affected by crisis and disaster. There is an urgent need to ensure continuity of NCD care for vulnerable and marginalized crisis-affected populations without access to NCD care in Africa.

The Danish Red Cross with funding from the Novo Nordisk Foundation, plans to implement a project that seeks to replicate NCD project experiences from Kenya and integrate them into relevant NCD interventions into DRC supported programmes in the East and Horn of Africa, including Ethiopia RC (ERCS) South Sudan RC (SSRC), Sudan RC (SRCS) and Somalia RC (SRCS). The unique access and mandate of RC/RC National Societies to provide lifesaving assistance to migrant and displaced populations and health care and MHPSS in emergencies will form the basis for integration, but the specific target groups and interventions will depend on needs and opportunities in the country contexts selected.

Based on the feasibility assessment conducted, this project will support the four countries in the East and Horn of Africa in planning, designing and integrating NCD activities into ongoing DRC supported programs. This will entail providing technical support, capacity building of staff and the National Society as well as resources for implementation of pilot interventions for 1-2 years. As part of the evaluation, DRC will support the development of case studies of the pilots, which will feed into the documentation and learning objectives of the projects.

The assignment will entail compilation and desk review of existing documents and information about existing services for the target group, review of real time programme data from health facilities, and review of programme documents from Sudan Red Crescent, South Sudan Red Cross, Ethiopia Red Cross and Somalia Red Crescent on services offered so far on the ongoing Health facilities and other relevant documents. The desk review will focus on Sudan, South Sudan, Somalia and Ethiopia health care systems and access to NCD care and MHPSS services in these Countries. More data and information will be collected from Focus group discussions, Key Informant interviews and Household/ Individual questionnaires.

We expect that you apply as a firm or as team of consultants with the following areas of Expertise: Public Health with additional training/experience in NCD management, Counselling Psychology and Social Science with additional training/experience in Migration/ population movement/displacements. The team should also have relevant knowledge about the African region. Be familiar with the Red Cross Red Crescent Movement. Full proficiency in English is a requirement for this consultancy.

The consultancy is expected to take place in July and August 2022.

[1] Fighting non-communicable diseases in East Africa: assessing progress and identifying the next steps | BMJ Global Health