Consultancy For The Realization Of’A Situational Analysis On Mental Health And Psychosocial Support In The Hodh El Chargui Region At Land of men

1. Presentation of Terre des hommes – Lausanne

Terre des hommes – Lausanne is an independent, neutral and impartial Swiss organisation, founded in 1960, which, dedicated to making meaningful and lasting changes in the lives of children and youth, especially those most at risk[1]. We ensure their well-being and the effective implementation of their rights as defined in the Convention on the Rights of the Child and other human rights instruments. To make a difference, we focus our efforts on maternal and child health, children and youth in migration, and access to justice.

Tdh-L operates in 32 different countries around the world, in humanitarian and development contexts. In its interventions, Tdh-L promotes a human rights-based approach, as well as a general improvement in quality and accountability by ensuring meaningful access to services for all, including, in safety and dignity. Tdh-L has adopted the Core Humanitarian Standard as a quality and accountability framework, which is fully integrated with widely accepted industry standards, including the Sphere Manual, minimum standards for the protection of children in humanitarian action and the IASC Principles of Accountability to affected populations.

Tdh-L’s work is based on the following principles[2] :

• Acting in the best interests of the child ;
• To promote the participation and empowerment of children, young people, their families and communities ;
• Working in partnership to strengthen local capacities, dynamics and systems ;
• Acting for the humanitarian interest, development and peace ;
• Promote continuous improvement, collaboration and learning ;
• Be transparent and accountable to recipients, partners, donors and ourselves.

Tdh-L has been present in Mauritania since 1984, and operates in three main areas :

• Access to justice for children and young people in contact with the law.
• Supporting migrant and refugee children and young people to improve their living conditions.
• Strengthening systems for the protection of the CHILD’.

As such, Tdh-L enjoys broad recognition and credibility with the state authorities ( Ministry of Social Action for Children and the Family, Ministry of Justice, Directorate for the Judicial Protection of Children, … ) and also donors, in particular the European Union, the French Development Agency ( AFD ), UNICEF, the Spanish Agency for International Cooperation for development, Monegasque Cooperation, and the Andalusian Agency for International Cooperation for Development ( AACID ).

Tdh-L operates in nine regions of Mauritania, including Hodh El Chargui, Mauritania, through support to the Ministry of Justice for the application of justice for all and the coordination of customary and formal justice, thanks to funding from’AFD for the period 2022-2026. As part of’a larger project, which will be carried out in Consortium with other’s ONGI, Tdh-L is preparing to start activities on strengthening the child’ protection system in this region. Mental health will also be a strategic focus of’intervention aimed at meeting the mental support and mental support needs of host and refugee communities.

These terms of reference are used to describe the objectives, duration and mandate of the consultants in charge of conducting this study, the results of which will serve as a basis for building the intervention strategy in the field of SMSSPS in the Hod El Charghi region.

1. Background and rationale

Mauritania and its people in Hodh Chargui have been welcoming Malian refugees fleeing violence in their country for years. As of February 2024, UNHCR estimated that more than 187,000 refugees are currently in Hodh Chargui, representing 20% of the total population in the region. UNHCR and other partners are trying to respond quickly and effectively to emerging challenges, ensuring that displaced people have access to’abris, food, food, food, and more, ’eau and essential protection services, such as’psychosocial assistance.

Hodh El Chargui, January 31, 2024, the number of new arrivals from Mali was estimated at 71,301 out-of-camp refugees, including 14,410 new arrivals for January 2024 alone. This massive influx is putting great pressure on already fragile natural resources and basic services in the few places where they are available. The majority of actors and services are concentrated in the commune of Bassikounou, at the’ refugee camp of Mbera. With the exception of certain one-off interventions, there are few services provided at the level of the other municipalities that host these populations. The actors (NGOs, UN agencies, local authorities) seem to be in a phase of’ needs analysis and planning of the first responses outside the camps.The’ registration campaign for newcomers settled outside the Mberra camp will probably start before the end of the first half of the’year.

In the Hodh El Chargui region, Psychosocial Support and Mental Health are not systematically considered in the majority of interventions. Institutional and humanitarian actors have very little’ information and data on the psychosocial needs of affected communities, because the topic’ is not often included in the assessments of the needs of communities. However,’ is unanimous that access to psychosocial support services is an absolute necessity and one of the priorities for communities.

Indeed, during all the evaluations carried out by the actors of the different sectors, the newcomers shared their difficulties in overcoming the events experienced, by, to face their new living conditions and to find a sense of peace and serenity. This strongly impacts their well-being and manifests itself mainly through social’ isolation, sleep-related disorders (nightmares, insomnia),’anxiety, psychosis, etc, the feeling of’ insecurity related to the events experienced and the intense stress related to the lack of resources and’opportunities. These signs are becoming worse in the weeks following their arrival, thanks in particular to the WARM welcome of the host communities, but a significant proportion of’men, women, young people and’children need a specific support.

Whether refugees in the camp have access to a continuum of psychosocial services ranging from access to basic services adapted and respectful of their dignity to individualized psychological/psychiatric care, and, newcomers settled outside the camp do not’ have access to these services. In addition, in the area concerned, there is a dissociation between Mental Health support services, carried by actors involved in the health sector, and psychosocial support[3], usually driven by protection actors. Collaboration between the two sectors is limited.

The present study is’ in the will of the French Agency for Development and Terre des hommes – Lausanne d’ to accompany the Ministry of Health in its efforts to improve the’integration of mental health and psychosocial support in the Hod El Charghi region, in complementarity with other actors involved in the sector in this same area. It aims to assess the state of mental health of the newly arrived Malian displaced as well as the psychosocial support needs of the vulnerable population in the region.

1. Objectives and fields of’

Field of the’situation analysis

The field of’analysis is the Hodh El Chargui Region (Mauritania) including urban centers and villages hosting new arrivals (about 100 villages), equivalent to a population of’ approximately 187,000 refugees outside the camp as at 31 January 2024, including 14,410 new arrivals for the month of January 2024 alone. The number of refugees represents 20% of the’ host population about 37,400 individuals in the Hodh El Chargui wilaya.

Displaced populations in Mali have fled because of attacks by armed groups. They have suffered or have witnessed multiple forms of violence such as killings, rape, abuse, etc.

• Refugees are displaced with a large number of cattle in villages whose population had very limited access. The needs in terms of’abris, food,’eau and health care as well as the challenges in terms of’integration and protection reinforce their vulnerability. An analysis of the SMSPS of the newly displaced from Mali would be crucial given the traumas that’ils have suffered. Forced displacement, violence and loss of family ties can have significant impacts on their psychological well-being.
• This study will make it possible to know the approaches developed by the communities for psychosocial support, so that the strategy of the project is developed on the’existence. An in-depth analysis may also examine the responses of the authorities and TFPs for long-term prospects for these displaced persons

General objective

The general objective of the Consultancy is to deepen the understanding of the context and needs related to mental health and psychosocial needs of refugee populations, including, back and hosts in the Hodh El Chargui area. Concretely it will’ from :

• To assess the prevalence of common mental disorders among displaced populations ;
• Identify the risk factors, social determinants and mental health of the displaced ;
• Evaluate the’accessibility and’effectiveness of existing psychosocial support services at institutional or community level ;
• Make recommendations to improve the humanitarian response in the area of mental health and psychosocial support ;
• Develop a’ action plan based on the recommendations that will serve as the basis for the formulation of a’ project on SMSPS in the Hodh El Chargui region.

Proposal of’specific objectives and questions of’study :

Specifically, the objectives envisaged for this consultation will be :

1. Understanding what is the context in terms of mental health and psychosocial support in Mauritania :

• Is there a policy in the field of mental health and psychosocial support in Mauritania ?
• What are the prospects at the national level for mental health and psychosocial support ?
• What is its declination at the level of wilayas and moughataa ?

1. L’analysis of socio-cultural perception at the community level. He S’agira d’identifier et d’analyse :

• What are the cultural conceptions and characteristics of psychosocial distress and mental disorders for the community ? What is the community’s perspective on psychosocial distress and mental illness ?
• How do refugee, returnee and host communities define, identify and treat people with mental or psychosocial disorders ?
  • What are the signs of cultural manifestations of well-being, psychosocial distress or mental disorders ?
  • What cultural/traditional care has been put in place by communities to help these people ?
  • What are the mechanisms of’ adaptation to manifestations of psychosocial distress and individual and collective mental disorders before/after displacement ?

1. Identify the actors and services contributing to the prevention/response to cases of psychosocial distress and evaluate their technical and operational capacities to provide quality services :

Analyze the functioning of the actors of the formal system of mental health and psychosocial support in the HeC region on the whole’ scale of the health pyramid starting with the Community Health Agents ;

• List available SMSPS activities/services as well as gaps in response (on levels 1 to 4 of the IASC pyramid) ;
• Identify non-formal actors involved in the care of people with psychosocial distress and mental illness ;
• Identify formal/informal referencing mechanisms and analyse their limits ;
• Identify barriers to’ access to services for host, displaced and returned populations ;
• Identify and analyze the capacities and skills of frontline actors (health, education, security..) and community actors in terms of prevention, and, d’orientation and provision of psychological first aid as well as the limits in terms of skills

1. An accurate assessment of the mental health and psychosocial support needs and resources of the’accueil community and refugees/returns. It is’agira d’identifier et d’analyse notably :

• What situations do people who have experienced trauma experience ? And their families? What are their remedies ? To deduce the differentiated needs of communities in terms of mental health and’ psychosocial support, including those of children, youth and ethnic minorities where appropriate.
• What are the stressors and specific needs of children and young people on the move (refugees, returnees) and their families before and during their migratory journey and during their settlement ?
• Which groups are most affected or at risk in the face of psychosocial distress and mental disorders ?
• What are the community and family support systems of host and refugee populations to preserve their mental health and psychosocial well-being ?
• What are the means that facilitate access to formal and non-formal mental health services and psychosocial support (i.e information, referral, etc.) ? What are the obstacles ?
• What are the needs of host and refugee populations regarding the types of support/services needed ?

1. Make recommendations to sponsors and other stakeholders to strengthen/improve the SMSPS service offering in the Hodh El Chargui.
2. Methodology and technical approach

The consultation will be conducted in a six-step process :

Stages

Launch of the consultancy after validation of the proposed methodology and the work plan by the Steering Committee (in particular to confirm the selected study questions).

• Review of secondary data conduct a literature review of existing SMSPS information for people of all ages and genders (e.g., national SMSPS system, policies and plans, country context, etc, affected population, previous assessments and published reports).

Knowledge of the SMSPS framework of Tdh-L and the Mauritanian context.

• Quantitative survey of’a representative sample of displaced and host communities
• Qualitative interviews with displaced people, host communities, humanitarian workers, government and community leaders to understand the challenges and gaps in available responses
• Data analysis and drafting of’a report including specific recommendations
• Recruitment and training of staff and investigators in charge of data collection in the field, the’animation of workshops and focus groups on ethical principles, and, the basic skills necessary for this type of’activity and on the tools of collection.

Supports the translation of tools into Arabic and local languages.

• Pilot the collection of primary data in the field in connection with the’ team of Tdh-L and the investigators under the supervision of the Steering Committee.
• ’ workshop analysis of the data collected with the Steering Committee and with local stakeholders.
• Elaboration of recommendations specific and adapted to the context.
• Drafting of the 1st draft report and inputs of the Steering Committee as well as local stakeholders.

Governance

The consultant will work under the direct supervision of the Coordinator “Children and Youth in Mobility”.

A Steering Committee will be set up for the monitoring of the process, the’alignment with strategic reference documents, the reading of deliverables and the monitoring of the quality of deliverables. This committee will be composed of:

• Tdh-L team Mauritania:
  • Program Coordinator “Children and Youth in Mobility” from Tdh-L
  • National Protection Coordinator of Tdh-L.
• Tdh-L regional team:
  • Regional Advisor Transversal Protection
  • Regional Advisor for the “Children and Youth in Mobility” Programme
  • Technical Advisor Monitoring, Evaluation, Accountability and learning.
• AFD:
  • Mental Health Referrer of the’AFD headquarters ;
  • Mission officer of the’Agenzia AFD de Nouakchott.
• EU :
  • Head of Mental Health Project Tawefoug
• WHO:
  • Focal point non-communicable diseases.
• State:
• PointFocal SMSPS within the Ministry of Health
• Director of’Enfance or its representative

The’ team of consultants will be supported by the logistics department of Tdh-L in Mauritania for the organization of workshops, ticket booking or any other activity requiring their services.

1. Duration and deliverables :

The consultation will be carried out over a maximum of 40 days, spread over a maximum period of 3 months from the signing of the contract.

The expected deliverables of the mission are :

1. A scoping report including : the document review, the methodology and collection tools used, the’analysis plan and the work plan.

2. One mapping services existences and actors present in the HeC region on the SMSPS.

3. One report d’situation analysis containing :

– One executive summary n’not exceeding 5 pages containing the main conclusions of the evaluation and the recommendations ;

– One in-depth presentation the context including the needs identified in terms of SMSPS and the capacities of the actors ;

– One analytical section who provides results and conclusions on research questions ;

– A section of operational recommendations in order to strengthen and improve the offer of SMSPS services in the Houd El Chargui (in accordance with section II of these Terms of Reference), which will serve as a basis for the definition of the SMSPS strategy and the implementation of activities in the Hod El Charghi region.

4. One PPT presentation with main results from consultancy.

1. Recipients and uses of the results of’analysis :

• Delegation Tdh-L of Mauritania : Inform the development of strategies for implementation of the’ intervention and inform the MHPSS project which will be formulated based on the results of this study.
• Donor and Ministries of Health/MASEF : Have tangible’s to validate their positioning and intervention strategies.
• Humanitarian actors : Inform actors on the needs and context of SMSPS in order to promote a wider consideration of issues related to SMSPS, including, d’improve coordination and strengthen the’response service offer.

Communities : Make recommendations for improving prevention/response at Community level.

1. Desired profiles

• The consultant ( or team of consultants ) sought for the accomplishment of this mission must have a higher diploma ( minimum BAC + 5 ) in psychology, psychiatry or any other related fields such as health or the humanities.
• Have at least 5 years of experience in the field of Psychosocial Support and Mental Health, preferably in North and / or West Africa.
• Justify of proven experience in carrying out studies on the subject, with at least three similar exercises / mandates.
• Familiarity with Standard Minimum Child Protection Standards, MHPSS IASC framework, gender and diversity issues and cross-sectorality.
• Justify d’a proven experience in the development of’research tools /study /situation analysis, methods of’assessment adapted to children and young people and within the framework of development projects / humanitarianists.
• Excellent communication skills in French (oral, written). Good synthesis ability,’analysis spirit.
• Ability to produce analytical syntheses accessible to diverse audiences.
• Perfect mastery of the’computer tool.
• Experience in facilitating’ workshops and joint work, with varied audiences.
• Experience in the’organization of training and extension of technical/complex themes.
• Capacity for planning,’organization and management and proactive attitude, ability to manage potentially conflicting situations.
• Impeccable ethics, in particular on the principles of confidentiality, data protection, impartiality.

Knowledge of the Mauritanian and Malian context is a real asset.

How to apply

1. Modalities for submitting applications :

The file must be sent by email no later than June 23, 2024 to the following address: mrt.recruitment@tdh.org

• Deadline to send a request for’lightening : 12/06/2024 at 17h 00
• Deadline for TdH clarification: 17/06/2024 at 17:00
• Deadline for submission of tenders : 26/06/2024 at 17h 00
• ’assessment of tenders : 01/07/2024 at 10h 00
• Notification of the contract award to the successful tenderer : 02/07/2024 at 17:00

Applications must include :

• Updated CV of each consultant.
• At least 3 references per member of the’team.
• Proof of the’ registration as a legal legal’entity.
• A technical proposal which should at least highlight the following elements :
  • Description of the participatory methodology for obtaining quality information representative of the situation, including the proposed’sampling methodology ;
  • The essential’study questions that will allow the’ to achieve specific objectives with regard to the ambitions of the project ;
  • The consideration, during each phase, of the different groups of populations according to the genus, the section of’age, the status (refugees, refugees, returnees or host communities) and ethnic group when relevant ;
  • A work plan with clearly defined phases according to the deliverables requested and a breakdown of the number of consulting days ;
  • Taking into account the ethics and safeguarding of the child in a transversal way ;
  • In the case of a team of consultants, a clear distribution of the role of each member of the team and the distribution of working days.
• A financial proposal integrating all the costs associated with the technical offer ( transport, organization of workshops, accommodation, … ).
• Possibly a list of questions, requests for clarifications or comments that the consultant wishes to send to the sponsor. If the application is selected, elements of responses will be provided during the interviews.

1. Analytical framework :

The consultant will be able to read and refer to the following different frameworks to guide the analysis of the results :

• Towards psychosocial resilience and well-being; operational framework , Tdh-L 2021
• Cpi Guidelines on mental health and psychosocial support in situations of the’ emergency, 2007, CPI
• The Common Framework for monitoring and’assessment for mental health and psychosocial support in’urgenc situationse, CPI, 2021
• Who is Where, When, doing What (4Ws) in Mental Health and Psychosocial Support: Manual with Activity Codes (field test-version). MHPSS IASC-RG. 2012
• Mental Health and Psychosocial Support needs and resources assessment, UNHCR, IOM, 2011
• Policy on alternative to camps, unhcr.org/sites/default/files/legacy-pdf/5422b8f09.pdf, UNHCR, 2014