Consultant: Clinical Expert

1. Background

D-tree International, in partnership with the Government of Malawi, is designing an intervention to strengthen the continuum of care for maternal and newborn health. The intervention aims to strengthen linkage, referral, and counter-referral between community and facility levels, ensuring that pregnant women, mothers, and newborns are identified early, appropriately assessed, correctly treated, and reliably followed up across the care continuum. 

D-tree is seeking a clinical expert to provide technical guidance during the intervention design phase. The expert will bring clinical evidence to define what quality care looks like at each level of the maternal and newborn care journey–including screening, counseling, assessment, treatment, and follow-up–and identify where the current pathway falls short. This includes pinpointing where care quality breaks down, what improvements are needed, and which health outcome indicators are both a priority for improvement and realistically influenced by the intervention. D-tree will work with the clinical expert throughout the engagement alongside MOH clinicians, and then lead the translation of clinical inputs into intervention design decisions, including revising workflows and guidance in health worker digital tools. 

Note: D-tree is in the process of selecting a specific clinical focus area within maternal and newborn health–for example, care for women with high-risk pregnancies or management of premature or low birthweight newborns–for this collaborative care initiative in Malawi. We will select the specific focus area prior to the consultant beginning their work. This SOW references maternal and newborn health broadly as a placeholder, but the consultant's work will be scoped to the selected focus area once confirmed.

2. Objective

To provide the clinical evidence base and expert judgment D-tree needs to design an intervention grounded in best practices and quality service delivery at the community and primary health facility levels across the maternal and newborn care journey. In addition to supporting intervention design and clinical quality, the expert will clearly define health outcome indicators that demonstrate impact on maternal and newborn health, health system cost savings, and patient or caregiver experience. The expert will work in coordination with a health economist to link clinical indicators to quantifiable cost implications, and with a patient experience expert to ensure the care pathway is designed to improve the experience of women and their caregivers.

3. What We Need From the Clinical Expert

The clinical expert provides specialized clinical knowledge. D-tree will synthesize these inputs with findings from the health economist and patient experience expert to produce the final intervention design.

A. Review and Validation of Clinical Protocols

• Review existing D-tree and MOH protocols for community-level maternal and newborn assessment, classification, and referral. Are they aligned with current WHO guidelines and best practices? Where are the gaps?
• What clinical criteria should trigger referral from community to facility level, and what are appropriate thresholds for danger signs as defined by Malawi MOH guidelines?
• What clinical criteria should trigger referral to a higher-level facility?
• What pre-referral actions (if any) should HSAs be authorized and equipped to take, and what are the clinical risks and benefits?
• What does an evidence-based management protocol look like at the facility level for both patients who attend the facility directly and for maternal and newborn cases referred from the community?

B. Identifying Where Collaborative Care Could Have the Greatest Impact

Once the clinical focus area is confirmed, the clinical expert will review the Malawi-specific evidence to understand the landscape of complications, challenges, and care gaps within that area–and identify where HSAs and facility providers could most meaningfully drive change through improved service delivery and collaboration.

• What are the leading causes of poor outcomes for women and newborns within the selected focus area in Malawi? Where in the care pathway are complications and deaths most commonly occurring or is there a missed opportunity for prevention–at community level or at facility?
• What are the most critical clinical challenges and bottlenecks within this focus area, and what does the evidence say about how they are best addressed in similar low-resource settings?
• Where are the gaps in coordination between HSAs and facility providers most significant for this population? What does improved collaboration look like in practice, and where could it most meaningfully change outcomes?
• For this population, which points in the care pathway present the greatest opportunity for earlier identification, better management, or more effective follow-up–and what would HSAs and facility providers each need to do differently?
• What evidence exists from comparable settings on the effectiveness of collaborative care models for this specific population or condition area?

C. Identifying Critical Failure Points in the Care Pathway

Note: Findings from the patient experience expert's formative work with women and caregivers should be reviewed alongside the clinical analysis below. A joint review of clinical failure points and caregiver-reported experience gaps will produce a more complete picture of where the care pathway breaks down. D-tree will lead the synthesis of both perspectives into integrated design decisions.

• What are the critical clinical decision points in the maternal and newborn care pathway where errors or delays most commonly occur in Malawi?
• What are the known clinical causes of poor outcomes in similar settings, and which are most relevant to the Malawi context?
• At the facility level: What training gaps, supervision gaps, workflow issues, or resource constraints typically contribute to these failures?
• At the community level: What HSA protocol gaps, assessment limitations, or referral process issues contribute to these failures?
• At the interface between community and facility: Where does the handoff between HSAs and facility providers currently break down? What information should flow in each direction at referral and after a facility visit? What does the clinical evidence suggest about mechanisms–such as shared records, bi-directional notifications, or closed-loop referral tracking–that create meaningful continuity?
• What evidence exists from comparable settings on the effectiveness of specific interventions (training, supervision, checklists, digital decision-support tools) in addressing these failure points?

D. Defining Measurable Health Outcome Indicators

Note: This section requires close collaboration with the health economist to ensure each clinical indicator is linked to its cost implications and that the final indicator set reflects both clinical impact and quantifiable cost savings.

• What are the most appropriate and feasible health outcome indicators to measure the intervention's impact on maternal and newborn health? Consider:
  • Maternal and neonatal mortality rates
  • Complication rates (e.g., postpartum hemorrhage, sepsis, birth asphyxia)
  • Referral completion rate and timeliness
  • Postnatal follow-up rates for high-risk mothers and newborns
  • Time from danger sign identification to appropriate treatment
• Feasibility and influence: For each proposed indicator, can an intervention of this type realistically influence it? What would need to be in place–in terms of protocols, training, and tools–to move it?
• Causal pathway: For each priority indicator, what is the chain from intervention activities to the expected outcome? Where are the weakest links?
• Cost linkage (with health economist): For each clinical indicator, what are the cost implications of improvement? Which indicators, if improved, would generate the most significant cost savings for the health system?
• What baseline data or benchmarks exist for these indicators in Malawi?
• Which indicators can be feasibly measured through routine digital health data collection, and which require supplementary data collection?
• How should we define and measure continuity of care from a clinical perspective–what does a completed care episode look like for a high-risk pregnant woman or vulnerable newborn?

E. Informing Future Evaluation Design

A formal baseline evaluation is anticipated in 2027, ahead of piloting the collaborative care model. While the clinical expert will not be expected to collaborate directly with an evaluation partner at this stage, their input will be valuable in anticipating what a rigorous evaluation of this intervention would require. The expert should be available to advise D-tree on:

• How health outcome indicators should be operationalized for a future evaluation, including baseline and endline assessments
• What clinical data sources are most reliable in the Malawi context, and what limitations to account for

4. Deliverables

• Written review of existing clinical protocols with specific recommendations for refinement
• Identification of critical failure points in the care pathway–at facility level, community level, and the interface between them–including supporting evidence on what works to address each, and concrete recommendations for how HSAs and facility providers should collaborate differently in practice, including: 
  • What each cadre needs to do
  • Where workflows need to change
  • What information should flow in each direction at referral and post-facility follow-up, and
  • Where the greatest opportunities lie for earlier identification, better management, and more effective follow-up for the selected population
• Recommended set of health outcome indicators with definitions, data sources, measurement feasibility notes, and assessment of causal pathway strength
• Joint memo with health economist linking priority clinical indicators to cost implications and quantifiable savings potential
• Advisory input to D-tree on health outcome indicators, data sources, and considerations for future evaluation design

5. Expert Profile

• Medical doctor or clinical specialist with expertise in maternal health, newborn health, or primary health care in low-resource settings
• Experience with community health systems and task-shifting approaches, ideally in Malawi or Southern or Eastern Africa
• Familiarity with WHO guidelines for maternal and newborn care, including ANC, postnatal care, and management of high-risk pregnancies and newborns
• Experience defining clinical outcome measures for program design and evaluation
• Experience in Malawi or similar contexts preferred; familiarity with the Malawi health system and HSA cadre an advantage

6. Level of Effort and Timeline

Estimated 15 days from June-July 2026. Engagement will include remote consultations and fieldwork in Malawi (approximately 5-7 days).

7. Budget Requirements

The consultant will submit a proposed budget as part of the application, which will be reviewed and approved by D-tree. Please include a simple budget of your daily rate (if a group is applying, please list each individual and their individual daily rates) and the number of days. If applicable, any other anticipated costs should be specified. D-tree will cover costs of fieldwork directly–these costs should not be included in the proposed budget. 

8. Application

To apply for this role, please submit your application through this link.

• Upload your CV in the CV section
• Upload your cover letter and budget in the Cover Letter section

Please note that by applying to this position, you consent to your name being checked against a terrorist watch list prior to any consultancy engagement. Deadline for submitting applications: May 15, 2026.