Terms of Reference (TOR) for Primary Health Care (PHC), Galkayo Project Evaluation – ,Puntland, Somalia

Terms of Reference (TOR) for Primary Health Care (PHC) Galkayo Project Evaluation

1. Summary

2. Background

Under-capacity public service infrastructure has resulted in a huge gap in access to basic social services such as health and education while climate-induced recurrent disasters such as drought, tropical cyclones and flooding, have exacerbated the vulnerability levels of a large segment of the population with significant loss of livelihoods, food insecurity, massive displacements, widespread disease and malnutrition.

The Somali Red Crescent Society (SRCS) is reputed as the largest humanitarian concern with branches in all 19 regions of the country as well as a number of sub-branches and a large network of volunteers. The National Society has since the beginning of the civil conflict built a strong foundation, capacity and competence in the development and delivery of basic health care services under the Primary Health Care (PHC) with complimentary community based activities by staff and volunteer. The PHC comprises a network of Maternal and Child Health/Outpatient Department (MCH/OPD) clinics that provide a range of basic health care services. Currently, the SRCS Galkayo branch, with the support of Norcross is managing 7 fixed clinics spread across the region.

During the year of 2017 and the second comprehensive baseline study of the IHCP was conducted in SRCS Galkayo branch to establish baseline data that will help measure progress against the set goals, objectives and impact over time.

This evaluation is commissioned by the Norcross Somalia Country Office in accordance with the terms of cooperation with Partner National Societies that contribute to the Somalia Country Appeal.

3. Evaluation Purpose & Scope

Purpose

To determine the extent to which the strategic objectives of the SRCS-managed PHC have been met through critical health service delivery by the network of static and mobile MCH/OPDs and community-based activities as well as the relevance and sustainability of the PHC within the context of the overall health sector development in Galkayo.

Scope. The evaluation is expected to be conducted in Galkayo at clinic sites and the Galkayo branch to be determined and agreed on between the consultant and the SRCS/Norcorss. The entire work is expected to be carried out in 30 consultancy days. The evaluation will cover static clinic service delivery and management as well as technical and other support at different levels – Norcorss, Coordination and branch together with (volunteer development and community-based activities) and partnerships.

4. Evaluation Criteria – Objectives – Questions

The objectives of the evaluation will be:

1. To assess quality/efficiency in the implementation of the PHC by the National Society
2. To assess the effectiveness/impact of the PHC on the target communities
3. To assess the extent to which the SRCS coordinate/collaborate with other humanitarian actors and local authorities in the implementation of the PHC
4. To assess the relevance and sustainability of the PHC.
5. To determine the current level of primary health care services utilization, heath awareness and physical rehabilitation services utilization.

4.2 Evaluation criteria and Questions

This evaluation will focus on six of the seven evaluation criteria as well as on coordination, accountability and lessons learning. 

1. To assess quality/efficiency in the implementation of the PHC by the National Society with specific consideration of:
   • Staff capacity and competency in the management of clinics and delivery of services to the target community.
   • Branch staff capacity and competency in the management and supervision of the PHC.
   • Timely technical and logistical support at all levels) to the delivery of services to the target community.
   • The extent to which clinic infrastructure and tools meet minimum standards to support service delivery
   • The extent to which minimum operating standards are adhered to in the management and delivery of basic health care services through the PHC.
   • The extent to which the SRCS Health Strategy (2013-2017) and other health tools guide the delivery of health services in Galkayo.

1. To assess the effectiveness/impact of the PHC on the target communities:
   • The degree to which the implemented activities have contributed to realising the goals and objectives of the PHC.
   • The extent to which local communities and beneficiaries have participated in the delivery/ implementation of the PHC.
   • How the volunteers for SRCS are recruited and retained (volunteers’ management)? Assess the sex and age disaggregated data of the volunteers.
   • Any obstacles to men accessing the services at the health clinics.
   • The extent to which accountability to the beneficiaries has been and is being addressed while implementing the IHCP, including the documentation of complaints/satisfaction.

1. To assess the extent to which the SRCS coordinate/collaborate with other humanitarian actors and local authorities in the implementation of the PHC with particular reference to:

• Effectiveness of partner support to the SRCS health programme, whether partner support has been delivered in the most appropriate manner or not.
• Range and extent of partner resources to support the implementation of the IHCP
• Extent of SRCS collaboration with other actors and partners

1. To assess the relevance and sustainability of the PHC, particularly with regards to:

• The future outlook of the PHC in the wider context of health sector reform and development policies in the respective zones.
• The National Society`s ability to generate/attract resources locally and externally to sustain the implementation of the PHC.
• What needs to be included in the program work plan in order to initiate a transition handover of the clinics to the Ministry of Health?
• If NorCross support is to shift to mobile clinics, what steps are required in order to make this transition effective?
• What would be important to consider for the standard operating procedures for these mobile clinics – catchment population, frequency of visits, and security among others?

1. To determine the current level of primary health care services utilisation, health awareness and physical rehabilitation services utilisation.
   • Number of patients that accessed services at the clinics- disaggregated by age and sex
   • The proportions of patients treated for the different common diseases
   • Children under 1 and children under 5 years immunised
   • Proportion of people reporting hand washing with soap at critical moments
   • Proportion of caretakers of infants under 6 months reporting exclusive breastfeeding in last 24 hrs
   • Proportion of people demonstrating ability to prepare oral rehydration solution (ORS)
   • Staff trained on specific technical areas/case management
   • Mothers attending Ante-natal care services 3-4 visits
   • Proportion of mothers attending ANC that are delivered by skilled health worker at clinics
   • Number of people referred for voluntary counselling and testing, including prevention of mother to child transmission of HIV (PMTCT)
   • Patients referred for secondary services at hospitals
   • Persons with disabilities accessing services at the rehabilitation centres – orthopaedic services, physiotherapy and prosthetics.

When considering the above, the evaluation will also seek to address the following cross cutting issues:

1. The institutional capacity of SRCS to effectively manage the implementation of the PHC, specifically considering:
   • Whether SRCS structures and systems (governance and management) in place adequately facilitate the efficient and effective delivery of basic health care services through the PHC and adequately account for that.
   • How the PHC is integrated and fits within the wider SRCS strategic programmes including disaster management and its alignment to the national health delivery system
   • Whether SRCS is able to effectively manage and capitalise on its volunteer network.
   • Whether staff and volunteers (including Community Health Committees) have the skills and knowledge needed to efficiently manage and deliver critical health services through the PHC.
2. The extent to which the fundamental principles of the Red Cross and Red Crescent Movement have been integrated in the implementation and monitoring and reporting on the PHC.
3. The extent to which Gender, disability, child protection and HIV/AIDS have been articulated in the delivery of health services.
4. To document lessons learnt and good practices in health service delivery through the PHC.
5. Evaluation Methodology

The evaluation will adopt a combination of desk review, interviews with key stakeholders including local authorities and field visits to the SRCS Galkayo branch. The field visit will include site visits to some static clinic communities conferring with partners.

The consultant will be expected to use a probability based sampling method for the quantitative assessment to ensure that the results can be extrapolated. On the other hand, a purposive sampling method will be used for the qualitative assessment to ensure that we meet the needs of the different actors.

6. Deliverables (or Outputs)

Inception report: An inception to demonstrate a clear understanding and realistic plan of work for the evaluation, which is in concordance with the ToR. The inception will include the proposed methodologies, a data collection and reporting plan with identified deliverables, draft data collection tools such as interview guides, the allocation of roles and responsibilities within the evaluation team, and travel and logistical arrangements for the evaluation.

Debriefing: The consultant will present initial findings in a debrief meeting with Somali Red Crescent Society (SRCS), Participating Norcross.

Report: A clearly written, evidenced-based report is required. The report should:

1. Be a maximum of 30 pages (with annexes attached)
2. Make specific recommendations, clearly linked to report findings and that take account of the mandate of the SRCS, IFRC and the wider Red Cross Red Crescent Movement

Include at least two case studies (to be annexed to the report) – at least one case study each should be of a person/family that has benefitted from the clinic interventions and volunteer activities/interventions respectively

The final report can follow the headings below:

1. Executive summary
2. Abbreviations/acronyms
3. Introduction
4. Review aims and objectives
5. Methodology
6. Findings (sub headings to include but not limited to appropriateness, efficiency and effectiveness, impact)
7. Recommendations
8. Lessons learnt
9. Conclusion
10. Appendices

7. Proposed Timeline

The evaluation exercise is expected to start during the 4th week of November 2020, subject to negotiations with the potential consultant, and be completed within 30 working days. The expected schedule is shown below:

8. Evaluation Quality & Ethical Standards

The evaluators should take all reasonable steps to ensure that the evaluation is designed and conducted to respect and protect the rights and welfare of people and the communities of which they are members, and to ensure that the evaluation is technically accurate, reliable, and legitimate, conducted in a transparent and impartial manner, and contributes to organizational learning and accountability. Therefore, the evaluation team should adhere to the evaluation standards and specific, applicable process outlined in the Norcorss Framework for Evaluation.

The Evaluation Standards are:

1. Utility: Evaluations must be useful and used.
2. Feasibility: Evaluations must be realistic, diplomatic, and managed in a sensible, cost effective manner.
3. Ethics & Legality: Evaluations must be conducted in an ethical and legal manner, with particular regard for the welfare of those involved in and affected by the evaluation.
4. Impartiality & Independence; Evaluations should be impartial, providing a comprehensive and unbiased assessment that takes into account the views of all stakeholders.
5. Transparency: Evaluation activities should reflect an attitude of openness and transparency.
6. Accuracy: Evaluations should be technical accurate, providing sufficient information about the data collection, analysis, and interpretation methods so that its worth or merit can be determined.
7. Participation: Stakeholders should be consulted and meaningfully involved in the evaluation process when feasible and appropriate.
8. Collaboration: Collaboration between key operating partners in the evaluation process improves the legitimacy and utility of the evaluation.

It is also expected that the evaluation will respect the seven Fundamental Principles of the Red Cross and Red Crescent: 1) humanity, 2) impartiality, 3) neutrality, 4) independence, 5) voluntary service, 6) unity, and 7) universality. Further information can be obtained about these principles at:

www.ifrc.org/what/values/principles/index.asp”

9. Evaluator/s & Qualifications

SRCS/Norcross is seeking for a consultant for this evaluation with a mix of technical programmatic skills and evaluation skills. The consultant will have a mix of the following skills and experience:

• Minimum qualification of an advanced degree in Public Health, Epidemiology and Biostatistics, disaster management, sociology/psychobiology/demography and/or economics
• Demonstrated experience in monitoring and evaluation: able to design, implement, analyse and synthesize evaluation processes and findings
• Disaster Management experience in designing and implementing disaster preparedness and response, mechanism particularly in a complex situation.
• Knowledge of the complex disaster settings
• Good interpersonal communication skills
• Culturally sensitive and understanding of the Red Cross principles
• Excellent writing and presentation skills in English
• Strong analytical skills and ability to clearly synthesize and present findings
• Experience in participatory approaches to evaluations
• Minimum of 5 years of monitoring and evaluation experience required.
• Demonstrated competence in managing quantitative data and carrying out inferential statistics required.
• Proven track record of conducting qualitative research including the development of interview schedules and qualitative data analysis required.
• Experience in qualitative data collection and data analysis techniques (especially in the design of coding schemes).
• Excellent written and spoken English skills required or excellent analytical, writing and presentation skills.
• Strong computer skills in spreadsheet, word processing, database management (MS Access) and statistical analysis software familiarity (SPSS and others), and presentation software required.
• Strong interpersonal and organizational skills required.
• Experience in working in insecure and austere environments.

10. Application Procedures and Remuneration

Application Procedures

Interested candidates should submit their application material by the 25^th November 2020 to SRCS Galkayo Branch office (Bisha Cas) and the application should include the following:

• Curriculum vitae (CV)
• Cover letter which clearly summarizing experience, daily rate, and three professional references
• Technical and financial proposal for the evaluation
• One sample of recent writing (a report or similar) relevant to this ToR.
• A proposal detailing how the assignment will be carried out

Please bring your documents required to the SRCS Galkayo Branch office in Galkayo, by latest 25^th November 2020

NB: Application materials are non-returnable, and we thank you in advance for understanding that only short-listed candidates will be contacted for the next step in the application process.

Remuneration and terms of payment

The consultant will be paid in accordance with the SRCS standard contract rates applicable for external consultants.