AMREF’s “Putting African Mothers, New Born and Children First Project” aims to reduce maternal, new born and child mortality in Tanzania, Kenya and Southern Sudan, thereby contributing to regional learning on the issue and accelerating progress to the attainment of the MDGs in Africa. Across all three countries, the majority of maternal and newborn deaths and disabilities occur from preventable causes that can be averted through skilled attendance at birth, backed up with emergency care. Many of these are also the result of unsafe abortions among adolescent women, and could be prevented from access to family planning.
Children die at home, with little or no contact with the formal health services, from diseases that can be prevented and treated through action at the household level. This project will develop community-based approaches to improve knowledge and awareness on MNCH; understanding of vulnerable groups’ rights, entitlements, and the corresponding responsibilities & government structures, leading to preventive behaviour and early identification of health complications; and improved community actions on MNCH. The action expects to see increased availability, accessibility, quality and as a result, utilisation of MNCH services to improve health outcomes. The project will offer a continuum of care approach to meet the needs and constraints of the target groups. This runs from pre-pregnancy (ensuring access to family planning/reproductive health services, specifically for vulnerable groups including youth), through to pregnancy (antenatal care, birth preparedness), safe delivery (including strong referral systems and access to skilled, emergency care in the case of complications) and post natal care for mothers and newborns that includes counseling for family planning, through to management of childhood health
The four-year project works in rural coastal communities in Mtwara and Tandahimba (Tanzania), indigenous communities in Lamu District (Kenya), and internally displaced people and host communities in post-conflict Terekeka (S. Sudan). The project is implemented by AMREF in each of the targeted countries in partnership with Ministries of Health and local-level stakeholders; and is regionally co-ordinated by AMREF’s Headquarters in Nairobi, Kenya.
Overall Project Objective of the Project
To strengthen capacity of communities, civil society organisations and local authorities (District Health management Teams/Boards) to promote maternal, newborn and child health among marginalized communities in four districts by 2013.
Key Result Areas & Expected Outcomes of the Project
Result Area 1: Communities especially women and girls, are empowered with the knowledge to promote health seeking behaviour, demand and access MNCH services.
Result Area 2: Local health systems have increased capacity to manage & deliver inclusive, comprehensive & community-responsive MNCH services
Result Area 3: Civil society organisations (CSOs) have increased capacity to participate in decision-making & influence MNCH policies & practices at local, national & international levels
Result Area 4: Regional knowledge-base is established on community-based solutions to improving MNCH & used to inform policy making at national, regional & international level (Please refer to Annex A for details on the Expected Outcomes of the Project)
Objectives and Scope of Work of the Consultancy
The main objective of the consultancy is to establish a regional level base-line status on access and provision of maternal, new born and child health services. Base-line surveys will be carried out in each of the districts targeted by this project and the findings will be consolidated to establish a regional understanding on MNCH across the three countries. The base-line will determine bench-marks for target setting within each result area, as per indicators set out in the original log-frame; validate if the activities within the project design are sufficient in scale and scope, in order to meet these targets; and identify opportunities for sustainability of project activities within each country.
The specific objectives of the base-line survey will be to:
- Establish the prevailing health conditions, and health problems including diseases affecting mothers, infants and children under the age of five within each of the three targeted countries
- Determine current levels of knowledge, attitudes and practice towards MNCH issues and access to MNCH services in each of the targeted communities.
- Determine the capacity of the district health systems (including public, private and community-based health systems) to provide MNCH services. This includes the availability and accessibility of health facilities and services offered for mothers, new born and children under the age of five, in terms of distances, cultural acceptability, affordability, availability and appropriateness (client-friendly, inclusive, responsive, hygienic etc)
- Establish the capacity of communities, community structures and Civil Society Organisation partners to address MNCH and improve over-all health status of targeted communities
- Establish the capacity and opportunities for institutionalization and sustainability of MNCH initiatives among the stakeholders and the communities.
The results will be used to develop an evidence base for advocacy for MNCH interventions in all three targeted countries.
Main Tasks of the Consultancy
The consultant will work in conjunction with the M&E Technical Lead and the Director for Reproductive and Child Health at AMREF HQ to finalise the design and inception plan for the study. Within each country, the consultant will work with the Project Teams, which include the Project Manager, Project Assistants, Technical Lead and Deputy Director and local stakeholders to co-ordinate, conduct the study and disseminate the base-line findings. The consultant is expected to undertake the following tasks:
- Carry out a desk-review of relevant project documents (listed in Annex A), including project proposal, log-frame, budget and other relevant documents, a range of which will be agreed upon and made available prior to the implementation of the study
- Develop an inception report, detailing the evaluation design, methodology, indicators, tools, work plan schedule and budget to carry out the assignment in each country. This will be developed and finalized in consultation with AMREF HQ and Country teams.
- Form a Base-line Assessment Coordinating Team, which includes AMREF staff, local community members and other partners involved in the project.
- Develop a Sampling Design and Data Collection & Management Protocol that is standardized for the three areas. Basic demographic variables including religion, and socio-cultural practices should be captured within space limitations of the study tools
- Facilitate recruitment and training of field staff (supervisors, interviewers, observers/record reviewers) and pre-testing of data collection tools.
- Co-ordinate collection of data, and its entry into a suitable platform for cleaning and analysis
- Analyse and interpret the findings
- Develop and submit the first draft of the base-line assessment report and debriefing to AMREF HQ, Country Teams and local partners. The report will include three country level reports, which will feed into a regional level (Ke, Tz, SS) base-line report on MNCH. The reports should be comprehensive and provide detailed specific findings within each result area, providing key recommendations for implementation
- Submit the final evaluation report to AMREF Headquarters in Nairobi, Kenya i.e. 6 Hard Copies and a soft copy in CD-Rom. The raw data, the data-base which has been cleaned (both qualitative and quantitative, including original field notes for in-depth interviews and focus group discussions, as well as recorded audio material), and data collection tools used in the evaluation should be submitted together with the report. A simple inventory of material handed over will be part of the record. AMREF has sole ownership of all final data and any findings shall only be shared or reproduced with the permission of AMREF.
The consultant will be expected to compile and submit the draft report, make a presentation to AMREF, incorporate comments and submit a final report within 30 days of the end of the evaluation.
Deliverables
- Inception Report detailing the evaluation design, methodology, tools, work plan and budget
- Data collection tools, data set with codebook
- Draft and final Base-line Survey Reports at country and Regional levels.
- Copies of original and cleaned data sets including field notes, audio tapes, and transcribed material
Please note that the contents of the report will be analyzed and final payment will only be made upon agreement on the final Base-line Survey Report from the AMREF Teams at HQ and Country level.
Time-frame
The assignment is expected to commence starting August 1, 2010 and is expected to take a maximum of 45 days (approx.15 days in each country), which includes desk-review, preparation, implementation, report-writing
Role of AMREF and collaborators
AMREF will provide the logistics and programme documents and be the link between the consultant and the project sites. AMREF will also review tools and provide support in the evaluation process. AMREF will provide venues for discussion and mobilize the required persons for interviews. The collaborators/partners will provide the necessary resources/facilities and required persons for interviews. The consultant will be responsible for guiding the entire Evaluation process and all other specific responsibilities as stipulated in the TOR.
Expected Profile of the Consultant
- The consultant is expected to hold the following qualifications in order to be eligible for this position:
- A recognised university degree in public health, international development, medical anthropology or related social science (at a minimum of Masters level, but preferably at doctorate level).
- Sound knowledge of major development issues, especially maternal, new born and child health issues. Knowledge of the East African region is a requirement.
- At least 10 years of consultancy experience in the area of public health and reproductive health/gender issues both in organisations and in projects
- Experience in the formulation, monitoring and evaluation of projects in Maternal, New Born and Child Health/Public Health
- Similar work in the last 3 years (to provide copies of reports).
- A demonstrated high level of professionalism and an ability to work independently and in high-pressure situations under tight deadlines.
- Strong interpersonal and communication skills
- High proficiency in written and spoken English.
Response Proposal Specifications
Those interested in the consultancy must include in their application a detailed technical and financial proposal with the following components:
11.1 Technical
11.1.1 Understanding and interpretation of the TOR
11.1.2 Methodology to be used in undertaking the assignment
11.1.3 Time and activity schedule
11.2 Financial
11.2.1 Consultant’s daily rate in Kenyan shillings and USD
11.2.2 Other costs, eg; accommodation, travel and printing
11.3 Organisational and Personnel Capacity Statement
11.3.1 Relevant experience related to the assignment
11.3.2 Contacts of organisations previously worked for
11.3.3 Curriculum Vitae of key personnel
Submission of Proposals
The proposal can be sent by post, hand delivered or e-mailed so as to reach the undersigned by August 5, 2010:
Dr. John Nduba,
AMREF Headquarters,
P.O. Box 27691-00506
Nairobi, Kenya;
E-mail: john.nduba@amref.org ; cc helen.kairu@amref.org; bindu.sunny@amrefuk.org
Evaluation and Award of Consultancy
AMREF in consultation with the project partners will evaluate the proposals and award the assignment based on technical and financial feasibility. AMREF in consultation with the partners reserves the right to accept or reject any proposal received without giving reasons and is not bound to accept the lowest, the highest or any bidder.
Annex A: Expected Outcomes:
As seen in the log-frame, indicators selected within each result area are the same across all three target countries. Individual targets within each country will be determined based on country level base-line studies (and secondary data) carried out. Achievements by the end of the project will be tracked using the following indicators:
Result Area 1:
- Percentage of maternal morbidity from obstetric causes;
- Proportion of children at the right weight for age;
- Incidence of childhood illness due to immunisable diseases; and
- Incidence of still birth and neo natal infections.
- Contraception and utilisation of family planning services
- % of women and sexually active girls utilising modern family planning methods;
- % of non-pregnant women seeking care for reproductive health problems;
- % of households who report having necessary supplies for birth and plan in the event of complications;
- Ante-natal and Post-natal Care attendance at health facility/health post
- % of pregnant women receiving 4 episodes of antenatal care
- % of pregnant women receiving 2 doses of Tetanus Toxoid
- % of mothers receiving post-natal care within 42 days of delivery;
- % of pregnant women who sleep under a mosquito net;
- % of mothers who access maternal health services within their sub-location from a trained health worker in Kenya, Tanzania and S. Sudan.
- % of men will be actively involved in health care of their pregnant wives (attendance at ANC and delivery) and care of their young children (taking children for immunisation and treatment)
- % of women and men who can state danger signs of obstetric and neonatal complications; childhood illnesses (eg; malaria); % of target communities who have adequate knowledge on harmful traditional practices (HTPs)
- Births attended by skilled health personnel
- % of pregnant women delivered by skilled health workers
- % decrease of women with obstetric complications
- % of women with obstetric complications treated within 12 hrs of onset of labour/2 hrs on arrival at facility;
- % of mothers receiving post-natal care within 42 days of delivery
- New Borns and Children under Five receiving care and treatment
- % of children under 1 receiving immunisation for MMR;
- % of children under 5 accessing child health services within their ward, sub-location, Payam
- % of children under 5 with fever getting treatment within 24 hrs of onset of fever;
- % of newborns starting breast feeding within an hour of delivery;
- % of children under 6 months are exclusively breast fed;
- % of children above 6 months who receive correct complementary feeding;
- % of children under five years of age sleep under a mosquito net consistently;
- % of children under five who are underweight
- % of mothers who breastfeed their infants exclusively
- No. of CHWs currently serving their communities with preventive, promotive and curative health care at the Sub-location, village and Boma level in Kenya, Tanzania and S Sudan respectively, strengthening the lowest level of formal health care provision in the target districts.
Result Area 2:
Coverage of services:
- % of health facilities in the four target districts offering basic and emergency obstetric care;
- % of health facilities offering comprehensive MCH services including family planning; counselling and testing for HIV
- Quality of services
- %of Health care Providers with requisite skills to provide MNCH services provision, and adherance to quality assurance checklists
- % of facilities exhibiting client friendly sensitivity in the service delivery environment (e.g. gender and youth friendly services)
- % of mid-level health workers in four target districts (ie nurses, midwives, medical assistants and environmental health officers) trained in managing MNCH services, delivery of high quality services, community mobilisation for increased participation in health development; community and formal health information systems to track progress, and in community based referral systems that increase access to emergency services for emergency treatment of obstetric complications and for ill children.
- Responsiveness: Evidence of strong, institutionalised links between communities and health systems
- % of referrals made by Community Health Workers (CHW) in the target four districts;
- % of back-referrals for follow up from the health facilities back to CHW;
- % of health management teams meeting with CHWs and CBOs every quarter
- Improved capacity/management systems:
- Existence and utilisation of current Health information system (HIS) across targeted facilities,
- No. of referrals, back-referrals made by health workers to follow-up patient care and treatment
- % of women and young people participating in health management decision-making structures from the village to the district levels in the four target districts
Result Area 3:
- % of District and County level Health Management Teams who have received training in planning, managing, monitoring and evaluating district health services, responsive to the health needs of women and children primarily and whole communities in general
- % of managers of LA health services and development structures in 4 target districts, trained to effectively plan, implement, monitor and evaluate health programmes in a community-inclusive and participatory manner
- % of CSOs represented in annual budgeting and planning meetings with the local authorities at all levels from the village to the district level in the target districts;
- % improvement in CSO capacity in establishing
- appropriate governance structures
- management policies/systems
- HR systems/policies
- Finance resource mobilisation and management
- External relationships management
- Gender sensitive policies;
- technical skills for participatory/inclusive service provision
Result Area 4:
- Participation at policy forums at district, national and regional levels at which the project lessons learnt can be disseminated;
- Participation in at least 2 networks and alliances that the project is a member
- % allocation of resources (private, public and not for profit sector) for community focused MNCH programmes
