Support the establishment of Opioid Agonist Therapy (OAT) in a harm reduction approach to drug use tenders at Médecins du Monde

Background and context

For more than 40 years, Médecins du Monde, a campaigning medical organization committed to international solidarity, has been caring for the most vulnerable populations here and abroad. It has continued to bear witness to obstacles that exist in accessing healthcare and has secured sustainable improvements in health-for-all policies.

Those working for this independent organization do not solely dispense care and treatment but condemn violations of human dignity and rights and fight to improve matters for populations living in precarious situations.

MdM France currently works in 30 countries across all continents to facilitate access to healthcare through 6 political battles:

• Sexual and Reproductive Health Rights
• Migration, Exile, Human Rights and Health
• Harm Reduction
• Environment and Health
• Humanitarian Space
• Healthcare systems and rights

MdM has been present in Tanzania since 2010 and established the first comprehensive harm reduction project for PWUD in Dar es Salaam. In 2019, this project was transferred to the local NGO, Mukikute, as a successor to continue providing services while MdM remained as the technical assistance organization to continue providing technical support for local actors. MdM supported the government of Tanzania to scale up NSP (needle and syringe program) in other regions outside of Dar es Salaam.

Since 2022, MdM together with Burnet Institute, INPUD and University of Bristol engaged in CUTTS (Catalyze the Uptake of Underutilized tools for hepatitis C) research project to manage the study across 3 countries managed by MdM This research project has 3 main components ; model of care study to treat hepatitis C using Oraquick test, value and preferences for low dead space syringes among people who inject drugs, feasibility of long acting depot buprenorphine as the option for OAT.

In the meantime, since 2022, MdM supported Ministry of health and local actors in Burundi to develop OAT guideline and setting up of the very first OAT program in Bujumbura. Moreover, MdM joined the consortium with local actors (five CSO) from Rwanda in 2022 as to provide technical assistance to initiate the harm reduction services in Kigali which entails development of guidelines, training, mobilize and empower PWUD community.

Another Technical assistance project to support Kigali Mental Health Referral Center (KMHRC), will be implemented in 2025.This technical assistance project requires to develop a series of guidelines, protocols, training materials, to organize consultation meetings/workshop with local stakeholders (MoH, KMHRC, CSO, PWUD community etc.) and also to organize training for relevant stakeholders to initiate OAT service in KMHRC which will be a center of excellence for substance use treatment , training and research in the long-term.

Scope of work and activities

The role of the consultant is to review literature and develop a comprehensive report (literature review and analysis) to provide an overall state of substance use, harm reduction and existing responses).

The consultant will work closely with

• the team from KMHRC (Director, psychiatrists, nurses, social workers etc.), Rwanda Biomedical center (RBC), other mental health referral centers in Kigali, Rehabilitation centers, CSO and PWUD community representatives
• MdM team from head quarter (technical referents)
• MdM team in Tanzania to ensure smooth communication and coordination among all stakeholders.

The field harm Reduction advisor under the directions of the harm reductioncCoordinator and ceneral coordinator will be the main focal person for communication and coordination with KMHRC on behalf of MdM team in Tanzania.

Outputs / deliverables

Literature review of the substance related aspects such as

• nature of substance use and its consequences or impact for the society/country, status of HIV, Viral hepatitis and other health conditions among substance users including mental health
• population size estimates based on existing literature
• existing strategies and guidelines on prevention and treatment issues encountered by PWUD including HIV, hepatitis, SRH, mental health etc.
• existing harm reduction services in KMHRC and rehabilitation centers
• Existing harm reduction services in the public facilities managed by Rwanda Bio Medical center/ Ministry of health
• International standard of harm reduction, OAT and other services

Develop analysis report based on the literature review

• to identify gaps and propose interventions to be improved, integrated and initiated in KMHRC, rehab centers and other mental health centers, in phased approach
• funding landscape for substance use and harm reduction services

Timeline and working days

• Literature review by end of March 2025
• Landscape analysis report by the end of April 2025
• Conduct the discussions with key stakeholders (KII) to support above mentioned reports
• Working days: not more than 22 working days including the travel to Rwanda

Qualification and selection criteria

MdM is seeking a harm reduction expert with expertise in literature review, program and strategy analysis, writing proposals, guidelines, high level reports, advocacy /policy brief.

The consultant /technical expert is expected to have the following qualifications, experience and competencies:

• Advanced academic degree (Master) in the field of health, social science and other health related studies. Bachelor’s degree with strong experience (more than 5 years) in a relevant field is acceptable
• Extensive knowledge and experience in Harm Reduction for opioid dependency, HIV, HCV, TB and other communicable diseases common among people who use drugs
• Minimum of five (5) years professional experience in addiction medicine/ opioid dependency treatment, HIV, HCV, management of OAT centers and program implementation
• Proven experience of working with key populations in the area of community mobilization and engagement
• Lived experience of the issues impacting the lives of people who use drugs would be an asset
• Proven experience of working on similar assignments
• Familiarity and exposure to rights-based approaches to health care
• Ability to work proactively
• Excellent command in written English

Desirable

• Experience working with Government institutions, international NGOs and UN agencies is also highly desirable.
• Experience working in international contexts including African region, LMIC and conflict affected context is desirable

How to apply

Individual consultants are invited to share the following documents by March the 2nd 2025, with email at: doi.applications@medecinsdumonde.net

• CV
• A cover letter outlining relevant for the assignment
• An example of previous work on a similar assignment (treatment guideline, training etc )
• Technical and Financial proposal