Haiti: Terms of Reference for External Contractor

Terms of Reference for External Contractor

End of project evaluation, Enhance Community Health Program, HAITI

03/29/18

Type of evaluation

end-of-projectevaluation

Expected evaluation methodologies

Mixed methods (both quantitative and qualitative).

Number of evaluators

A team of 2 evaluators, one lead evaluator (national or international), one local assistant (national only), with experience in evaluation and mainly in Public Health program.

Applications will be accepted from teams of contractors to cover all positions.

Individuals and firms can apply.

Expected start/end dates, number of work days

Evaluation might start 04/23/18 to 06/15/18, for approximately 45 days of work

34 days are expected from the lead evaluator, and 20 days from the local assistant.

Budget

$ 42,000

Deadline for receiving applications

04/09/18 at 11:59 PM

1.Description of project/program to be evaluated

1.1.Background and objectives of project/program

The Enhanced Community Health Program is designed to strengthen HRC in its role as an auxiliary to the Haitian government by increasing the skills and outreach of its volunteer network to enhance community health services in partnership with MSPP.

Haiti’s nationwide Demographic and Health Survey, which examined changes in the health, health care access and utilization patterns between 2006 and 2016, showed gradual improvements in key health indicators affecting reproductive, maternal, newborn and child health. While this progress shows that efforts of government and other partners to improve community health care are having some impact, Haiti still presents some of the world’s worst health indicators^[1].

Limited access to safe water and sanitation, low levels of education among care givers, grinding poverty and rising food insecurity are some of the factors contributing to low health status of the Haitian population. Due to their vulnerability to disasters from earthquake and extreme weather events, Haitian women and men are exposed to increased risk of injury and disease spread. Haitians also face risks from epidemics due to poor sanitation, the density of urban areas and weakness of disease control systems.

According to MSPP’s 2012-2022 National Health Plan, the national primary health care coverage currently stands at 60% overall. In communities where higher concentrations of socio-economically disadvantaged groups are found the coverage of essential health services is noticeably lower. The MSPP estimates that that 70% of the population seeks care from traditional healers as the first source health care. The low incomes and limited access to resources faced by Haitians reduces household capacity to transport members to clinical care centers, or afford the medicines and clinical health care they need.

Haitian communities living in poor peri-urban areas and in hard to reach rural areas face financial, physical and information related constraints to accessing health services. This burden additionally weighs most heavily on the most vulnerable – including those stigmatized by diseases such as HIV/AID or women and men with disabilities – and the poorest households who are the most inadequately prepared to cope with and recover from health problems. Women in particular face increased health risk and lack of resources to meet their own health needs and that of newborns, infants and children in their care.

Organizations with national coverage like the Haitian Red Cross Society and other international partners have committed to enhance community health services, under the leadership of the Haitian Ministry of Public Health and Population (MSPP). MSPP’s 2012-2022 National Health Plan has a goal “to ensure that morbidity and mortality from major health problems is reduced through an efficient, accessible, and universal health system”. This strategy also promotes extension of social protection platforms and calls upon all of its partners to support its efforts to accelerate universal access to essential health services.

1.2.Scope and reach of project/program

The ECHP will support the strengthening and expansion community based health services in three large underserved zones of the West Department: Canaan (Canaan, St. Christophe, Jerusalem, Onaville/Corail), Carrefour-Feuilles and Le Gonâve Island. These areas have health service and immunization coverage rates that are below the national average.

The areas have been selected based on their need for community health support as well as with the objective to actively seek synergies with other ARC, and HRC programs. Carrefour-Feuilles is a disadvantaged urban area that faced even greater challenges of poverty, urban density, lack of hygiene and sanitation, and poor health and other services following the 2010 earthquake.

Canaan is mostly populated by internally displaced families who resettled after the devastating 2010 earthquake on a previously unexploited stretch of land spanning four communal sections of Croix de Bouquet, and one communal section each in the adjacent communes of Cabaret and Thomazeau. The inhabitants of the two communes of La Gonâve Island are recognized to live in hard to reach areas both due to the gulf that separates the island’s inhabitants to the rest of the West Department but also because of its dispersed, low density settlements.

The selection of these zones of intervention is in keeping with HRC’s mandate to assist vulnerable communities and MSPP’s request that partners focus on underserved areas.

1.3.Project/program management

Enhancing Community Health is a program that is drawing on existing initiatives, and systems of HRC, MSPP and ARC. The program vision is to develop HRC’s capacity to have a key role, under its mandate as an auxiliary to the Government of Haiti, in the implementation of national community health strategies. The ECHP is building on existing initiatives of HRC. The program will build on HRC’s existing systems for enrolling, managing and training volunteers – ensuring these systems are responsive to the needs of community health programming. The initiative will complement efforts that HRC has invested in developing and extending its Community-based Health and First Aid training. It will also strengthen activities HRC has already taken, in partnership with ARC, to assist with national cholera prevention programs and national and regional programs for HIV/AIDS prevention and care.

In addition, the target zones of the Enhancing Community Health Program have been selected in order to building on existing ARC-HRC Programs, including:

i. The ARC supported HRC Organizational Development Program aimed at strengthening the capacity of HRC branches in the West Department, District of La Gonave and in the Commune of Croix de Bouquet;

ii. The Canaan Urban Community Development Program, in particular Ansanm Nou Kapab implemented directly by the American Red Cross through its partnership with HRC;

iii. LAMIKA – ARC/HRC’s urban renewal program in Carrefour-Feuilles.

A close coordination across these agencies is critical to the program’s success and to maximizing results of ARC/HRC’s overall programming. The Partnership Program will also actively seek to mobilize appropriate partnerships with other NGOS and agencies working on health related issues through communal section level local development coordination. The Program Manager will supervise a program team as well as work in coordination other ARC program teams for each target zone.

1.4.Previous evaluation activities

A baseline study has been conducted within la Gonave and Canaan for ECHP. For Carrefour Feuilles data for key indicators have been collected during the end line survey implemented for an AmCross former project named LAMIKA executed within the same area.

Recommendations ensuing from the ECHP Baseline

§ Access to education needs promoting throughout the neighborhoods

§ Access to good effective, affordable and available healthcare services needs enhancing by bringing healthcare closer to communities

§ Careful assessment of existing medical facilities would enable tailored interventions to address problems to delivering quality healthcare services across existing facilities

§ Strengthening the capacities and promoting community based health workers would enhance the delivery of primary healthcare

§ Individual neighborhood level tailored interventions are recommended based on disparities found across the neighborhood level findings

§ The content, timeliness and delivery of antenatal and postnatal care requires careful assessment and reinforcement to better serve the needs of mothers and children

§ The capacities of traditional birth attendants providing birthing care could be built to maximize the important role the latter already plays for mothers in these communities

§ Availing and training skilled birth attendants is highly advisable

§ The values of full immunization require promoting heavily throughout the area

§ The importance of up to date medical records needs emphasizing

§ Strengthening mobile health care services, such as mobile vaccination clinics, would have a beneficial impact on vaccine uptake and simultaneously ensure adequate vaccine dosages are received thus maximizing resources

§ Assessing barriers to vaccine adoption would be recommended to tailor immunization interventions to adequately tackle these barriers

§ The distinction between breast feeding and exclusive breast feeding, and the benefits of the latter to the child should be highlighted and promoted through education campaigns, possibly embedded in antenatal care activities

§ Education dissemination campaigns on symptoms and treatments of common illnesses in children are highly advisable

§ Assessment and education on traditional treatments for common illnesses could reduce illness in infants

§ The distribution and promotion of LLIN would go a long way in protecting children from malaria

§ Promoting healthy diets, balanced nutrition and assisting in the distribution of supplements for young children is recommended

§ The important unmet need for family planning can easily be addressed by enhancing the availability of modern contraceptives

§ Barriers to the use of modern contraception need understanding and tackling through information dissemination campaigns and getting key community figures to reinforce the message

§ Knowledge of HIV/AIDS transmission and the importance of knowing one’s status should be strengthened through education campaigns

The end line survey is ongoing and expect to be done by the time the consultants for this final evaluation will be on board.

2.Evaluation Overview

2.1.Objectives of evaluation

This project was conceived to contribute to the overall HAP recovery strategy of working in the health sector (improving access to health care) at multiple levels, leveraging and strengthening the capacity of (HRC) volunteers to support national health efforts and to contribute to improved health status.

The following are the key objectives of the evaluation;

1. Assess and describe overall effectiveness of the AmCross’s ECHP program and how it has contributed in achieving the defined outcomes such as leveraging and strengthening the capacity of (HRC) volunteers to support national health efforts and to contribute to improved health status.

2. Assess and describe to what extent the program did improve access to health services within the targeted areas.

3. Assess and describe the net contribution of AmCross’s ECHP program to the increase adoption and practice of healthy behaviors by community members, in particular by pregnant women, antenatal women and men and women caring for infants and young children.

4. Assess and describe overall effectiveness of the AmCross’s ECHP program transition strategy under the lens of the program vision which is to develop HRC’s capacity to have a key role, under its mandate as an auxiliary to the Government of Haiti, in the implementation of national community health strategies.

5. Draw lessons learned that will help understanding the possible replication and scalability aspects of the project and provide related recommendations on possible replication and scalability aspects of the project (for potential future application) as well as the sustainability.

2.2.Main audience of evaluation

The evaluation main audiences are ARC Haiti Delegation, ARC NHQ team, HRC and MSPP.

2.3.Coverage of evaluation

The evaluation will cover La Gonave, Canaan and Carrefour Feuille.

3.Evaluation criteria and questions

Criteria

Main evaluation questions

Sub-questions

Outcomes

1.1 What key outcomes (and or potential impacts) did the program produce in terms of enhancing HRC capacity to support MSPP in delivering essential community health services, in particular those targeting women?

1.2 In what ways did the program improve (or not) access to essential community health services (in particular for maternal health care) and health education in targeted communities?

1.3 What is the net contribution of the program in increasing adoption and practice of healthy behaviors by community members, mainly pregnant women, antenatal women and women and men caring for infants and young children?

1.1. Were there any important unintended outcomes, either positive or negative?

1.2. What were the main reasons that determined whether intended outcomes were or were not achieved, and whether there were positive or negative unintended outcomes? Which were under ARC control and which not?

Relevance

2.How appropriate was project design?

2.1. Was this program the most appropriate way to achieve intended outcomes? Were there other, more appropriate ways in which similar outcomes could have been achieved?

2.2. To what extent the program strategies and activities implemented were relevant to meet the overall objective of the Program?

Effectiveness

3.How well were project activities planned and implemented?

3.1. Were activities implemented as planned? What were the main factors that contributed to whether activities resulted in intended outputs and outcomes?

3.2. Were quality standards defined, and did activities achieve high levels of quality in implementation?

Coherence

4.How well did the project adapt its design and objectives to the prevailing health context for the target population and in the target sector?

4.1. To what extent did the program build on or fit into past or existing programs?

Satisfaction

5.How satisfied were project beneficiaries (from mothers clubs) with the project?

6.How satisfied was the Haitian Red Cross—including the local branches—with the project?

7.How satisfied was the MSPP with the project?

5.1. What were the main issues raised by beneficiaries2 concerning their level of satisfaction with the project?

6.1 What were the main issues raised by the Haitian Red Cross—including the local branches—concerning their level of satisfaction with the project?

7.1 What were the main issues raised by MSPP – including community structure- concerning their level of satisfaction with the project?

Sustainability

8.How sustainable were project outcomes?

8.1. What are the main factors that affect, either positively or negatively, the sustainability of program outcomes?

8.2. What exit strategies were incorporated into program design? Were such strategies implemented and to what extent did they contribute to sustainability?

Lessons

9.What lessons can be learned that would help inform future projects in the same sector, both in-country and in other countries?

9.1. …

4.Scope of work and Evaluation design

4.1.Scopeof work

The evaluator (s) will be responsible for the following:

1. To procure the necessary travel documents and visa(s) in the country of origin (visa fee will be reimbursed) and insurance if required (ARC does not pay for insurance)
2. To bring a working laptop
3. To print the necessary soft copies of the desk review materials while in the country of origin (cost will be reimbursed)
4. To manage the local assistant consultant during the evaluation and assign roles and responsibilities

The evaluator (s) will not be responsible for the following:

1. To hire local facilitator /translator, as needed
2. To arrange transportation for the field visit and to and from hotel and airport
3. To arrange accommodation while in Haiti

4.2.Methodologies

The Evaluation team will mainly use qualitative and rapid appraisal techniques. The following is a list of methodologies that are considered applicable; the list, however, should not be considered definitive and contractors are free to propose or add further methodologies.

1. Focus groups and key informant interviews of women from mothers club targeted in the programs – substantive time should be given to this aspect during field work in Haiti.

2. Desk review of key project documents such as the project proposals, the transition strategy, M&E and implementation plans etc.

3. Literature search and review of materials on the environment in which the project operates- esp. in this case national community health strategies.

4. Review of quarterly and monthly progress reports, M&E and ITT.

5. Interviews with key staff members from the project, HRC local committees and community health structure from MSPP and ARC.

6. Interviews of concerned stakeholders such as HRC, MSPP

7. Analysis of results by methodologies such as “before/after” comparison of baseline and endline;

8. To better evaluate the “mothers club” methodology and approach, we suggest a comparison with a control/comparison group

4.3.Discussionof inception report

Prior to conducting the evaluation, the Lead Evaluator will prepare and submit to ARC an inception report detailing the methodologies and work plan of the evaluation. ARC will provide an inception report template for this purpose. The inception report will be discussed with ARC staff and will be subject to approval prior to the start of field activities.

4.4.Reporting relationship

The lead evaluator will report to Camoens Rene - Sr. AM&EL Delegate, who will be the main evaluation manager responsible of all technical guidance.

4.5.Ethical Guidelines

It is expected that the evaluation will adhere to ethical guidelines as outlined in the American Evaluation Association’s Guiding Principles for Evaluators. A summary of these guidelines is provided below, and a more detailed description can be found at www.eval.org/Publications/GuidingPrinciplesPrintable.asp.

1. Informed Consent: All participants are expected to provide informed consent following standard and pre-agreed upon consent protocols.
2. Systematic Inquiry: Evaluators conduct systematic, data-based inquiries.
3. Competence: Evaluators provide competent performance to stakeholders.
4. Integrity/Honesty: Evaluators display honesty and integrity in their own behavior, and attempt to ensure the honesty and integrity of the entire evaluation process.
5. Respect for People: Evaluators respect the security, dignity and self-worth of respondents, program participants, clients, and other evaluation stakeholders. It is expected that the evaluator will obtain the informed consent of participants to ensure that they can decide in a conscious, deliberate way whether they want to participate.
6. Responsibilities for General and Public Welfare: Evaluators articulate and take into account the diversity of general and public interests and values that may be related to the evaluation.

4.6.Future use of data

All collected data will be the sole property of the American Red Cross. The contractor may not use the data for their own research purposes, nor license the data to be used by others, without the written consent of the American Red Cross.

5.Expectedactivitiesand Deliverables

5.1.Expectedactivities

Activities

Lead Evaluator

Local Evaluator

In/Out Haiti

1. Desk review and literature search

3

Out of Haiti

1. Develop and submit inception report for approval, and development of data collection tools

4

Out of Haiti

1. Preparatory work (with key ARC) before the field works begin

1

1

In Haiti

1. Field visit and beneficiary interviews/stakeholders interview

16

16

In Haiti

1. Preparation and presentation of preliminary findings to ARC team/HRC and MSPP before departure.

1

1

In Haiti

1. Submission of draft report to ARC for comments

8

2

Out of Haiti

1. Submission of final report to ARC after incorporating comments

1

Out of Haiti

Total expected work days:

34

20

5.2.Deliverables

Deliverables

Expected deadline

1. Inception report and data collection tools

April 30^th 2018

1. Preliminary key findings presentation

TBD

1. Draft evaluation report

Within 15 days after completion of field work

1. Final evaluation report (with properly filed/archived copies of transcripts of all work documents, e.g. field notes)

Within 10 days after receiving comments

6.Obligations of key participants in the evaluation

6.1.Obligations of the Contractor(s)

a.Inform the evaluation manager in a timely fashion of progress made and of any problems encountered.

b.Implement the activities as expected, and if modifications are necessary, bring to the attention of the Evaluation Manager before enacting any changes.

c.Report on a timely basis any possible conflicts of interest.

6.2.Obligations of the Evaluation Manager

a.Make sure that the contractor(s) are provided with the specified human resources and logistical support, and answer any day-to-day enquiries.

b.Facilitate the work of the contractor(s) with beneficiaries and other local stakeholders.

c.Monitor the daily work of the contractor(s) and flag any concerns.

d.Receive and signoff on deliverables and authorize payment

6.3.Obligations of the NHQ Technical Team

a.Provide technical oversight in the review of all deliverables.

b.Provide timely comments on the draft report.

7.Required qualifications

The following are the desired qualifications of the Lead Evaluator (Haitian national or International);

1. Master or preferably PhD degree in Public Health from recognized university

2. At least 10 years of experience as a team leader in numerous evaluations, of leading International organizations and up to date in the latest evaluation techniques and methodologies

3. Experience evaluating projects related to Public Health programs and skilled in managing teams and producing high quality reports,

4. Strong analytical and report writing skills in English, including writing case studies

5. Demonstrated experience in evaluating programs related to health, and capacity building

6. Experience conducting evaluations in an urban context

7. Demonstrated experience in leading focus group discussions and conducting interviews with a wide range of stakeholders

8. Professional work experience in Haiti

9. Fluency in English and French is required, and knowledge of Creole preferred

The following are the desired qualifications of the Local Assistant Evaluator (Haitian nationals only):

1. Bachelor/Master degree in public health

2. At least 4 years of experiences in program evaluation, research and assessment in Haiti, including experience with community health

3. Demonstrated experience in conducting rapid rural and urbanx appraisals using focus group discussions, key informant interviews of beneficiaries, project staff and other stakeholders

4. Fluent in French and native speaker of Haitian Creole; fluency in English required

8.Application and selection details

8.1.Applicationmaterials

The proposal should include the following four items. Please note that any proposal which does not contain all four items will be rejected.

1. One-pageSummary of experience

2.Detailed CVs of all professionals who will work on the evaluation. If there is more than one consultant on the proposed evaluation team, please attach a table describing the level of effort (in number of days) of each team member in each of the evaluation activities.

1. Professional references: please provide two or three references from your previous clients.

2. Daily rate: please mention the proposed daily rate for each consultant in USD.

The Summary of experience should be no more than one page and should include the following:

1. Experience in leading project/program evaluations

o number of evaluations led (with dates, locations and names of organizations)

o number of evaluations served as team member

1. Experience in qualitative methods

o numbers of years of experience

o tools/methods used in past

1. Experience in Community Health projects/programs

o number of years of experience

o titles of positions held

o countries worked in

o organizations worked for

1. Professional experience in Haiti

o number of years of experience

o organizations worked for

1. Language proficiency

o clearly state language proficiency in English, French and Haitian Creole

8.2.Applicationprocedures

Interested candidates should send their applications to senji.gaetane@amcrossHaiti.org and copy to gina.barreau@amcrosshaiti.org. Please put the following in the subject line: “Application for Final evaluation of ECHP Project”.

A complete application will be one with all materials listed above in one single file in either Word or pdf format. The title of this file should be the last name of the Lead Evaluator (e.g. if the Lead Evaluator is named Jon Snow, the title of the application document should be “*Snow*”.)

Interested applicants are encouraged to apply together with lead and assistant consultants.

Application received after the deadline and incomplete applications will not be accepted.

8.3.Deadlinefor applications

April 9^th, 2018 at 11:00PM EST.

8.4.Selectioncriteria

Criteria

Details *(this column can be deleted for more space)*

Evaluator 1

Evaluator 2

(if applicable)

Experience in leading project/program evaluations

Number of evaluations led (with dates, locations and names of organizations); number of evaluations served as team member

Experience in qualitative methods

Numbers of years of experience;

Tools/methods used in past

Experience in projects/programs/ evaluation

Number of years of experience;

Titles of positions held;

Countries worked in;

Organizations worked for

Experience in Public Health

Number of years of experience;

Countries worked in

Professional experience in Haiti

Number of years of experience;

Organizations worked for

Language proficiency

Proficiency in English, French and Haitian Creole

[1] USAID (2015) Global Health: Haiti Background Information [Online] Available from: http://www.usaid.gov/haiti/global-health [Accessed 01 August,2015]

[2] For the evaluation the focus will be on women from mothers club

Due date for applications is April 9.

Interested candidates should send their applications to senji.gaetane@amcrossHaiti.org and copy to gina.barreau@amcrosshaiti.org. Please put the following in the subject line: “Application for Final evaluation of ECHP Project”. i

Due date for applications is April 9.

Interested candidates should send their applications to senji.gaetane@amcrossHaiti.org and copy to gina.barreau@amcrosshaiti.org. Please put the following in the subject line: “Application for Final evaluation of ECHP Project”.