Terms of Reference
Providing medical male circumcision service to infants: working with countries and stakeholders
1. Overview
Male circumcision (MC) is one of the oldest and most common known surgical procedures and is practiced for religious, social and medical reasons. It involves the complete removal of the foreskin which is the fold of skin that covers the head of the penis. The prevalence of circumcised men aged 15 years and over varies greatly according to regions and countries with an estimated 30-33% of adult men being circumcised worldwide[i]. MC is common in many African countries and almost universal in North Africa. It is common in West Africa but less common in southern Africa, with a self-reported prevalence ranging from around 15% to 93%. MC is almost universal in the Middle East and Central Asia and in Muslim Asian countries.
An estimated 34 million adults and children were living with HIV at the end of 2012, with sub-Saharan Africa accounting for 69% of all people living with HIV worldwide[ii]. Although sub-Saharan Africa has seen a 25% decline in the number of people acquiring HIV infection since 2001, it is still severely affected by the epidemic with nearly 1 in every 20 adults living with HIV. HIV in the region is predominantly transmitted by unprotected heterosexual intercourse and effective prevention strategies include behaviour change programmes that generate healthier patterns of sexual behaviour coupled with new potential methods such as male circumcision.
Three large randomized controlled trials of more than 10,000 men conducted in South Africa[iii], Kenya[iv], and Uganda[v] demonstrated conclusively that male circumcision decreases the risk of heterosexual HIV acquisition by men by 50% to 60%. In 2007, WHO in conjunction with the Joint United Nations Program on HIV/AIDS (UNAIDS) recommended male circumcision as a key prevention intervention, to reduce heterosexually-acquired HIV in men in countries in sub-Saharan Africa with low circumcision rates and high heterosexually-transmitted HIV incidence.
As a result several countries in Africa have given priority to MC as a prevention strategy and have established national targets for the number of voluntary medical male circumcision to be performed by 2015. These countries are: Kenya, Botswana, Ethiopia, Lesotho, Malawi, Mozambique, Namibia, Rwanda, South Africa, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe. All of these countries have initiated adult and adolescent VMMC programs that are at various stages of scale-up. PEPFAR has so far supported about 3 million VMMC procedures in the 14 priority countries. Currently, there is a doubling of the total number of VMMC procedures carried out each successive year.
Early Infant Male Circumcision
WHO /UNICEF/UNAIDS recommends Early Infant Male Circumcision (EIMC) where it is culturally acceptable, noting that: neonatal circumcision is easier, safer and less complicated than circumcision for young boys, adolescents and adults; it is cheaper; there is no risk of sex before wound healing; and there is no loss of time from work or school. Other specific benefits include prevention of urinary tract infections, penile cancer, paraphimosis, phimosis and transmission of some sexually transmitted infections, including HIV. EIMC also reduces the risk of cancer of the cervix and vaginal infections in future female sex partners.
The impact of EIMC on HIV transmission will take longer to realize than adult MC. However, since EIMC is carried out long before an individual becomes sexually active, there is no risk of acquiring HIV through sex during the healing period. The introduction of EIMC offers a unique opportunity to sustain high male circumcision prevalence long-term. However, EIMC can only be sustained if the intervention is provided within the maternal, neonatal and child health services. UNICEF organized a Global Partners meeting to review the current status of EIMC service provision in the 14 priority countries and identifying opportunities and challenges to move forward.
2. Purpose
Under the supervision of the technical leads UNICEF NYHQ and in close collaboration with the UNICEF for East and Southern Africa Regional Office, the main purpose of this consultancy is to support HQ to coordinate and support country efforts to provide early infant male circumcision as routine part of MNCH services.
3. Expected results
Support HQ to:
4. Timeframe
The contract will be for 6 months starting 15 May to 15 November 2014
5. Location
This consultant will be based in the HQNY offices and work full time during the contract period.
6. Key competences, technical background, and experience required
7. How to Apply
Deadline for submissions: 23 April 2014
Qualified candidates are requested to send their submissions to
Applications must include:
• Cover letter
• Maximum 3-page curriculum vitae (CV);
• Signed P11 form (which can be retrieved at http://www.unicef.org/about/employ/index_53129.htmlhttp://www.unicef.org/about/employ/index_53129.html)
NOTE: Files should not exceed 5.0MB limit
General Conditions of Contracts for the Services of Consultants / Individual Contractors
1. Legal Status
The individual engaged by UNICEF under this contract as a consultant or individual contractors (the “Contractor”) is engaged in a personal capacity and not as representatives of a Government or of any other entity external to the United Nations. The Contractor is neither a “staff member” under the Staff Regulations of the United Nations and UNICEF policies and procedures nor an “official” for the purpose of the Convention on the Privileges and Immunities of the United Nations, 1946. The Contractor may, however, be afforded the status of “Experts on Mission” in the sense of Section 22 of Article VI of the Convention and the Contractor is required by UNICEF to travel in order to fulfill the requirements of this contract, the Contractor may be issued a United Nations Certificate in accordance with Section 26 of Article VII of the Convention.
2. Obligations
The Contractor shall complete the assignment set out in the Terms of Reference for this contract with due diligence, efficiency and economy, in accordance with generally accepted professional techniques and practices.
The Contractor must respect the impartiality and independence of UNICEF and the United Nations and in connection with this contract must neither seek nor accept instructions from anyone other than UNICEF. During the term of this contract the Contractor must refrain from any conduct that would adversely reflect on UNICEF or the United Nations and must not engage in any activity that is incompatible with the administrative instructions and policies and procedures of UNICEF. The Contractor must exercise the utmost discretion in all matters relating to this contract.
In particular, but without limiting the foregoing, the Contractor (a) will conduct him- or herself in a manner consistent with the Standards of Conduct in the International Civil Service; and (b) will comply with the administrative instructions and policies and procedures of UNICE relating to fraud and corruption; information disclosure; use of electronic communication assets; harassment, sexual harassment and abuse of authority; and the requirements set forth in the Secretary General’s Bulletin on Special Measures for Protection from Sexual Exploitation and Sexual Abuse.
Unless otherwise authorized by the appropriate official in the office concerned, the Contractor must not communicate at any time to the media or to any institution, person, Government or other entity external to UNICEF any information that has not been made public and which has become known to the Contractor by reason of his or her association with UNICEF or the United Nations. The Contractor may not use such information without the written authorization of UNICEF, and shall under no circumstances use such information for his or her private advantage or that of others. These obligations do not lapse upon termination of this contact.
3. Title rights
UNICEF shall be entitled to all property rights, including but not limited to patents, copyrights and trademarks, with regard to material created by the Contractor which bears a direct relation to, or is made in order to perform, this contract. At the request of UNICEF, the Contractor shall assist in securing such property rights and transferring them to UNICEF in compliance with the requirements of the law governing such rights.
4. Travel
If UNICEF determines that the Contractor needs to travel in order to perform this contract, that travel shall be specified in the contract and the Contractor’s travel costs shall be set out in the contract, on the following basis:
(a) UNICEF will pay for travel in economy class via the most direct and economical route; provided however that in exceptional circumstances, such as for medical reasons, travel in business class may be approved by UNICEF on a case-by-case basis.
(b) UNICEF will reimburse the Contractor for out-of-pocket expenses associated with such travel by paying an amount equivalent to the daily subsistence allowance that would be paid to staff members undertaking similar travel for official purposes.
5. Statement of good health
Before commencing work, the Contractor must deliver to UNICEF a certified self-statement of good health and to take full responsibility for the accuracy of that statement. In addition, the Contractor must include in this statement of good health (a) confirmation that he or she has been informed regarding inoculations required for him or her to receive, at his or her own cost and from his or her own medical practitioner or other party, for travel to the country or countries to which travel is authorized; and (b) a statement he or she is covered by medical/health insurance and that, if required to travel beyond commuting distance from his or her usual place or residence to UNICEF (other than to duty station(s) with hardship ratings “H” and “A”, a list of which has been provided to the Contractor) the Contractor’s medical/health insurance covers medical evacuations. The Contractor will be responsible for assuming all costs that may be occurred in relation to the statement of good health.
6. Insurance
The Contractor is fully responsible for arranging, at his or her own expense, such life, health and other forms of insurance covering the term of this contract as he or she considers appropriate taking into account, among other things, the requirements of paragraph 5 above. The Contractor is not eligible to participate in the life or health insurance schemes available to UNICEF and United Nations staff members. The responsibility of UNICEF and the United Nations is limited solely to the payment of compensation under the conditions described in paragraph 7 below.
7. Service incurred death, injury or illness
If the Contractor is travelling with UNICEF’s prior approval and at UNICEF’s expense in order to perform his or her obligations under this contract, or is performing his or her obligations under this contract in a UNICEF or United Nations office with UNICEF’s approval, the Contractor (or his or her dependents as appropriate), shall be entitled to compensation from UNICEF in the event of death, injury or illness attributable to the fact that the Contractor was travelling with UNICEF’s prior approval and at UNICEF’s expense in order to perform his or her obligations under this contractor, or was performing his or her obligations under this contract in a UNICEF or United Nations office with UNICEF’s approval. Such compensation will be paid through a third party insurance provider retained by UNICEF and shall be capped at the amounts set out in the Administrative Instruction on Individual Consultants and Contractors. Under no circumstances will UNICEF be liable for any other or greater payments to the Contractor (or his or her dependents as appropriate).
8. Arbitration
(a) Any dispute arising out of or, in connection with, this contract shall be resolved through amicable negotiation between the parties.
(b) If the parties are not able to reach agreement after attempting amicable negotiation for a period of thirty (30) days after one party has notified the other of such a dispute, either party may submit the matter to arbitration in accordance with the UNCITRAL procedures within fifteen (15) days thereafter. If neither party submits the matter for arbitration within the specified time the dispute will be deemed resolved to the full satisfaction of both parties. Such arbitration shall take place in New York before a single arbitrator agreed to by both parties; provided however that should the parties be unable to agree on a single arbitrator within thirty days of the request for arbitration, the arbitrator shall be designated by the United Nations Legal Counsel. The decision rendered in the arbitration shall constitute final adjudication of the dispute.
9. Penalties for Underperformance
Payment of fees to the Contractor under this contractor, including each installment or periodic payment (if any), is subject to the Contractor’s full and complete performance of his or her obligations under this contract with regard to such payment to UNICEF’s satisfaction, and UNICEF’s certification to that effect.
10. Termination of Contract
This contract may be terminated by either party before its specified termination date by giving notice in writing to the other party. The period of notice shall be five (5) business days (in the UNICEF office engaging the Contractor) in the case of contracts for a total period of less than two (2) months and ten (10) business days (in the UNICEF office engaging the Contractor) in the case of contracts for a longer period; provided however that in the event of termination on the grounds of impropriety or other misconduct by the Contractor (including but not limited to breach by the Contractor of relevant UNICEF policies, procedures, and administrative instructions), UNICEF shall be entitled to terminate the contract without notice. If this contract is terminated in accordance with this paragraph 10, the Contractor shall be paid on a pro rata basis determined by UNICEF for the actual amount of work performed to UNICEF’s satisfaction at the time of termination. UNICEF will also pay any outstanding reimbursement claims related to travel by the Contractor. Any additional costs incurred by UNICEF resulting from the termination of the contract by either party may be withheld from any amount otherwise due to the Contractor under this paragraph 10.
11. Taxation
UNICEF and the United Nations accept no liability for any taxes, duty or other contribution payable by the consultant and individual contractor on payments made under this contract. Neither UNICEF nor the United Nations will issue a statement of earnings to the consultant and individual contractor
[i] Male circumcision: global trends and determinants of prevalence, safety and acceptability. WHO, UNAIDS. 2007
[ii] Global Report: UNAIDS report on the global AIDS epidemic 2012. UNAIDS
[iii] Auvert N, Taljaard D, Lagarde E et al. Randomized, controlled intervention of male circumcision for reduction of HIV infection risk: the ANRS 1265 trial. PLoS Med. 2005 Oct 25; 2 (11): e298.
[iv] Bailey R C, Moses S, Parker C B et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet. 2007;369: 643-56.
[v] Gray R H, Kigozi G, Serwadda D et al. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet. 2007;369:657-66.
