Established in 1915, Helen Keller International (HKI) works to save the sight and lives of the most vulnerable and disadvantaged. We combat the causes and consequences of blindness and malnutrition by establishing programs based on evidence and research in vision, health and nutrition. Headquartered in New York City, HKI currently conducts programs in 22 countries in Africa and Asia as well as in the United States. 

HKI-NG has initiated number of projects in neglected tropical disease (NTD) control, behaviour change communication for IYCF (SPRING project) and orange-fleshed sweet potato (Reaching Agents of Change). In 2013, HKI obtained a grant from DFID through UNITED Consortium to implement an integrated NTDs (LF, Trachoma, STH and Schisto) elimination in Katsina state.

POSITION : CONSULTANCY TO OVERSEE NTD BCC ACTIVITIES IN DFID - UNITED SUPPORTED STATES IN NIGERIA 

UNITED consortium is a DFID funded four-year programme for the integrated control of Neglected Tropical Diseases (NTDs) in Northern Nigeria (UNITED). The programme is led by Sightsavers in consortium with Non-Governmental Development Organisations (NGDOs), academic partners, private sector partners and private sector suppliers. The main partners are Sightsavers, Helen Keller International (HKI), Christoffel Blinden mission (CBM), Mission to Save the Helpless (MITOSATH), Crown Agents, Health Partners International (HPI) and Accenture Development Partners (ADP). The key stakeholders are the Federal Ministry of Health (FMOH) and the State Ministries of Health (SMOHs) in the five programme States. 

The program’s goal is to reduce the prevalence and interrupt the transmission of seven NTDs that are amenable to preventive chemotherapy. Its aim is to strengthen the health system including drug supply chain management to deliver drugs to those in need. The programme is being implemented in the five states of Kaduna, Kano, Katsina, Niger and Zamfara. 

Overview 
Neglected Tropical Diseases are a group of infectious parasitic and bacterial diseases that cause substantial illness and are a source of tremendous suffering because of their disfiguring, debilitating, and sometimes deadly impact. They are called neglected because they affect the poorest, most marginalized communities and have been largely wiped out in the more developed parts of the world.

Affecting the world's poorest people, NTDs impair physical and cognitive development, contribute to mother and child illness and death, and limit productivity in the workplace. In addition to causing physical and emotional suffering, social stigma is a major consequence of NTDs. The loss of productivity results in children out of school, and prevents families and communities from thriving, trapping the poor in a cycle of poverty and disease.

Although safe and cost-effective interventions for prevention and elimination are available, these diseases have continued to cause immense suffering and often life-long disabilities for the rural poor due to neglect. The effort towards the elimination of NTDs is being spearheaded by the Federal Ministry of Health along with development partners and other stakeholders. 
Lymphatic Filariasis

Globally, Nigeria is ranked the third highest with LF disease burden. Lymphatic Filariasis is caused by thread-like parasitic worms: Wuchereria bancrofti or Brugia malayi and Brugia timori and transmitted through the bite of infected mosquitoes. The adult lives 5-6 years in lymphatic vessels producing millions of microfilariae (mf). LF is mostly acquired in childhood but remains silent for a long time after infection.

Acute manifestation of LF during the early stage includes general symptoms such as fever, chills, headache and weakness.  However, acute episodes of local inflammation involving skin, lymph nodes and lymphatic vessels often accompany the chronic lymphoedema or elephantiasis 4. Lymphoedema (tissue swelling) elephantiasis (skin/tissue thickening) is more frequent in the legs but can also affect breast, genitals and arms.

ONCHOcerciasis
Onchocerciasis is a skin and eye disease caused by a filarial parasite Onchocera volvulus. It is transmitted by a small black fly, Simulium species, which breeds in well oxygenated water such as fast flowing rivers, streams and dams. The risk of blindness is higher for patients living close to these water bodies.

The life cycle of onchocerciasis involves infected black flies spreading worm larvae through bites on the skin. The larvae enter the body at the bite site, form subcutaneous nodules under the skin (approximately 2 years), and mature into adult worms that have a life span of over 15 years.  Female worms release millions of microfilaria (mf) into the body which eventually die and lead complications.

The signs and symptoms of onchocerciasis are usually caused by the mf and not by the adult worm. Most common symptom is itching, which is caused by the body’s reaction to mf dying in the skin.  The itching continues and leads to skin changes: leopard skin (de-pigmented spots), atrophy, hanging groin and genitals. Large and disfiguring subcutaneous skin nodules are formed by adult worms.

As the number of mf in the body increases, they find their way to the eyes, eventually causing inflammation, tissue damage and scarring. This leads to gradual loss of vision and eventually to irreversible blindness, often as early as the age of thirty-five.

Trachoma
Trachoma is an ocular infection with Chlamydia trachomatis and is a major cause of blindness worldwide. Within endemic countries, trachoma is found in areas that are rural, economically underdeveloped, without good water supply and with large numbers of eye-seeking flies. Disruption of the infection cycle of trachoma can be effected by antibiotics, regular cleaning of faces and improved hygiene and environmental improvements including water, proper domestic waste management and avoiding animal proximity to the household.

Trachoma infection often starts in children and with repeated infections scarring and deformity of the eyelid. This eyelid deformity leads to in-turned eye lashes or trichiasis which may rub on the eyeball, causing pain redness and eventually blindness. 

The SAFE strategy developed by WHO is an approach for treatment, prevention and elimination of trachoma. It involves surgery, to corrective trichiasis, antibiotic use to treat active infection, facial cleanliness to remove eye discharge and discourage eye-seeking flies, and environmental improvements like water provision and proper disposal of faecal waste in latrines.

Schistosomiasis
Nigeria also has the highest burden of Schistosomiasis in Africa. Three types of this worm cause human schistosomiasis, two of which occur in Nigeria. These are S. haematobium which causes urinary Schistosomiasis and S. mansoni that causes intestinal Schistosomiasis. Schistosomiasis can cause diseases such as cancer of the bladder, anaemia, liver dysfunction etc.

In Nigeria, Schistosomiasis is a disease of considerable and growing concern due to inadequate potable water and activities related to water resource development schemes such as irrigation, fishing and hydro-electricity. Generally, the disease mainly affects rural poor and vulnerable age groups like school children.

Transmission of schistosomiasis is by urine and faecal contamination of fresh water bodies and is facilitated by poor hygiene and sanitation. Schistosomiasis mostly affects poor and rural communities, particularly agricultural and fishing populations and women doing domestic chores in infested water, such as washing clothes, are also at risk 5
. It is usually geographically confined, although communicable, strictly linked to the environment and has a complex reproductive cycle.

Transmission of Schistosomiasis can be disrupted through the use of drugs to treat infected individuals, sanitation, and provision of safe water and use of molluscide, health education, and behaviour change including avoiding infected water.

Purpose of the BCC Program

The purpose of this NTD BCC program is:

To develop and implement a strategic framework to identify and prioritize key NTD issues in need of BCC intervention
To offer solutions towards addressing key issues of knowledge, attitude and practice in relation to NTDs
To Change misconceptions and identify state specific channels of effective communication
To Draw up BCC implementation and action plans
To implement BCC strategy that will positively impact on prevention and treatment and eventual elimination of the 5 prioritized NTDs (LF, Trachoma, STH, Oncho and Schisto) in UNITED consortium states (Kano, Katsina, Niger, Kaduna and Zamfara)
To track the implementation of the BCC strategy using a monitoring checklist and report relevant road map towards improvement in uptake of NTD drugs in all the communities
Scope of Work
HKI Nigeria requires the services of a consultant to perform the following tasks:
Coordinate the implementation of BCC activities by the BCC sub-committees in DFID / UNITED states (Zamfara, Kano, Katsina, Niger and Kaduna states)
Design and implement a BCC strategy with specified work plan, checklist and timelines (See copy of checklist herewith attached)
Ensure the establishment of state BCC subcommittee within the states NTD task force leading towards state ownership of the BCC
Supervise and monitor the implementation of BCC by each BCC subcommittee within the context of NTD task force in each state leading to wider acceptance of the mass drug administration and in the long run, good therapeutic and geographic coverages
Conduct pre MDA, in-process and end process assessment of the MDA activities in DFID UNITED supported states and submit report for onward sharing with stakeholders  
Identify peculiarities for each state in terms  of BCC activities that produce best results
Hold meetings with chairman of state NTD task force and share BCC strategy; thus leading to full state-drive of the BCC activities 
Conduct FGD or KIM and other methods in NTD endemic communities to understand the perception of the public towards IEC materials, radio jingles, and health education messages. This is with the view to advice on best practice to get the donated drug in the mouth of the persons at risk or affected by NTD
Provide supportive but technical BCC advice to states advocacy team and states NTD task force that will foster ownership and wider acceptance of NTD drugs
Any relevant TOR that will make BCC activities effective in UNITED supported states.
The Consultant is to monitor the implementation of BCC activities according to agreed timelines in 5 DFID supported states
Submit periodic and final reports after implementation of the BCC strategy to HKI in accordance with the timelines specified in this ToR

Timeline for implementation
Activity    Timeline
Invitation to Consultant    18/04/2016
Sign contract by Consultant    19/04/2016
Start work    20/04/2016

Deadline for submission Thursday, 7th April 2016. Interested persons are to submit CV and a proposal either in hard copy format; addressed to

How To Apply
The Admin Coordinator
Helen Keller International Nigeria
6 Angola Street, Wuse Zone 2
Abuja 

Or electronically to nnwatu@hki.org