Baseline study of the SRCS Integrated Health Care Programme

Terms of reference for consultancy

Background

Somalia has been in civil conflict since the collapse of the central government in 1991. The conflict has significantly contributed to the prevalence of insecurity, breakdown of law and order, particularly in Central/South Somalia and the disintegration of the country into clan-based and territorial enclaves that are to date not recognised internationally. Puntland in the North-East and Somaliland in the North-West however enjoy some relative peace, security and political stability but have weak functioning and grossly under-resourced public institutions, including the health sector. The socio-economic cost of the conflict threw the country into one of the worst humanitarian catastrophes ever, plunging the majority of the 9.6 million Somali population into abject poverty and diminished coping capacity. Cyclical climate change-related disasters such as drought and floods have further compounded the vulnerability of a vast majority of the population with displacements, disease outbreaks, food insecurity, malnutrition and loss of livelihoods.

Today, the Somali Red Crescent Society (SRCS) is reputed to be the largest indigenous humanitarian entity working across Somalia with branches in all the 19 regions of the country and with a volunteer strength of about 5,000. Throughout the two decades of conflict and insecurity that resulted in the collapse of public institutions and services particularly in South-Central Somalia, the Somali Red Crescent Society (SRCS) has continued to provide humanitarian assistance, including basic health care services, to the most vulnerable population in collaboration with the local health authorities and other actors such as UNICEF, WHO and WFP.

The Integrated Health Care Programme (IHCP) has been the core programme of the SRCS since 1991, with the support of Red Cross/Red Crescent Movement and non-movement partners. The SRCS-managed IHCP is in line with the strategic aims of the International Federation of Red Cross and Red Crescent Societies (IFRC) Strategy 2020 and the National Society’s Strategic Plan 2010-2014. The SRCS Health Strategy (2013-2017) is equally aligned to these strategic documents.

The IHCP comprises a network of Maternal and Child Health/Out Patients Department (MCH/OPD) clinics and community based activities. The number of MCH/OPDs under the IHCP throughout the country has progressively increased from 20 clinics at its inception in 1991 to 62 static and 26 mobile clinics in 2012.Table 1 below shows the location and source of support for the 62 static clinics currently run by the SRCS.

Table 1: Location and support for static clinics in Somalia (as at 2012).

Location	Number of static clinics	Supported by
Somaliland	12	8 are supported multilaterally through IFRC
		4 are supported by German Red Cross
Puntland	20	Multilateral support through the IFRC
South/Central Somalia	30	ICRC
TOTAL	62

Over the years, the SRCS has expanded the IHCP in terms of coverage and content. Since 1991, the IHCP has expanded the range of services provided to include primary laboratory services, delivery, and others in collaboration with international partners such as UNICEF[1], WHO[2] and WFP[3]. The IHCP targets an estimated population of 600,000. In order to address the unmet needs and increase access to basic health care services particularly vulnerable nomadic and Internally Displaced Persons (IDPs), the SRCS with support from Movement partners commenced mobile clinic services to reach out to these vulnerable targets, particularly in response to the devastating 2011 drought.

The SRCS network of MCH/OPD clinics offer a basic package of health services including Expanded Programme of Immunization (EPI), growth monitoring of children to assess their nutritional status, management of malnutrition through the Out-Patient Therapeutic Feeding Programme (OTP), case management of childhood and common ailments, provision of Oral Rehydration Therapy (ORT) for the management of diarrheal diseases, safe motherhood (antenatal, delivery and post natal care, provision of micronutrients, clean delivery kits) and the referral of complicated cases to regional hospitals. The MCH/OPDs in Central/South Somalia in addition provide basic stabilization of casualties.

Community-based activities by trained community volunteers such as awareness on disease prevention, promotion of health and health seeking behaviour, HIV/AIDS & Female Genital Mutilation/Cutting (FGM/C) prevention, water, hygiene and sanitation promotion have been integrated into the IHCP, mainly employing the CBFHA[4] and PHAST[5] approaches. Also integrated into the SRCS-managed IHCP is the dissemination of Red Cross/Red Crescent humanitarian values and principles, with activities focusing on reducing stigma and discrimination against people living with HIV and AIDS, promotion of tolerance and reduction of violence. The community-based activities, including the awareness sessions on HIV and AIDS, anti-discrimination and fighting of harmful practices have been regularly addressed through the CBHFA approach at the community level.

The baseline survey

Due to the emergency circumstances surrounding its set up in 1991, the SRCS` Integrated Health Care Programme (IHCP) did not include a baseline study and has never had a comprehensive evaluation conducted of the programme since. Some targeted evaluations have been carried out at various stages and as components of the IHCP, such as the Qarhis Project (Community-Managed Health Care Service Provision Model) supported by the World Bank in 2004. Similarly, there have been various multilateral and bilateral evaluations conducted on specific projects under the broader IHCP.

In 2013, the Somali Red Crescent Society (SRCS) and the IFRC Somalia Country Representation together with other Movement partners plan to conduct a baseline study into the IHCP based on existing programme indicators. It is envisaged that the study will provide inputs for the development of partner proposals for the coming years as well as providing a basis for measuring programme impact and service delivery of the clinics over time. It will also provide inputs for refining and developing SMART indicators in operationalizing the SRCS Health Strategy 2013-2017 with bilateral and multilateral partners support. Further, it will allow SRCS to identify main differences that exist between health clinics across the country (Somaliland, Puntland, South/Central Somalia) and aim to move towards consistency of health service delivery (including indicators used) by all SRCS clinics.

The planned study will focus on 16 MCH/OPDs in Somaliland and Puntland as well as 10 in South/Central zone of Somalia[6]. Annex 1 provides information on the distribution of MCH/OPD clinics that have been purposefully selected for inclusion in the baseline study.

The baseline survey will involve the use both qualitative and quantitative data collection approaches. The Rapid Mobile Phone-Based (RAMP) technology will be employed in the quantitative component of the study. The quantitative data will similarly be analysed and technical reporting produced by RAMP experts who will work in consultation with the identified consultant. The consultant will work closely with a technical team made up of SRCS and Movement partners both ain Nairobi and the field levels in planning and carrying out the survey. Insecurity in most parts of Central/South Somalia and pockets of Puntland and Somaliland will however restrict access to some sites for qualitative data collection by the identified consultant. Innovative mechanisms will therefore have to be devised to collect the requisite qualitative information in such instances for the baseline study.

Purpose of consultancy  

The SRCS/IFRC and partners are seeking the services of a consultant to immediately carry out qualitative data collection on the SRCS-managed IHCP based on the objectives below and indicators of the current programme interventions. 

The main objectives of the consultancy are:

§  To collect qualitative data/information in line with the SRCS Health Strategy indicators that together with quantitative data collected separately, will establish baseline data that will help measure progress against the set goals, objectives and impact over time.

§  Based on the analyzed quantitative and qualitative data, recommend pragmatic strategies for the SRCS to increase consistency of the services as well as measuring of progress and impact.

Specific tasks under the consultancy

§  Review literature and data on the implementation of the IHCP interventions.

§  Produce an inception report which establishes the consultants understanding of the assignment and its requirements with that of the evaluation contractor detailing the approach, methodology, key informants and work plan. The inception report should also indicate any additional requirements for information. The inception report will be reviewed and approved by a technical working group overseeing the survey.

§  Review/validate and finalise existing draft tools for quantitative data collection.

§  Develop tools for qualitative data/information collection

§  Liaise with RAMP experts (located in Nairobi for the field work and Atlanta for data analysis respectively) to obtain a complete overview of the entire study and for the requisite technical inputs for reporting on the study.

§  Meet with key Movement partners to exchange and gather additional information

§  Meet with relevant partners/stakeholders in the field (Ministry of Health, UNICEF, WFP and WHO) to exchange views and gather information.

§  Brief SRCS Coordination Offices and Branch team leaders about the study approach and ensure that they are conversant with the tools to be used.

§  Monitor the training of enumerators and data collection in the field (Somaliland, Puntland and Central/South Somalia).

§  Train SRCS Health Officers and provide guidelines on qualitative data collection.

§  Produce a draft report including findings, conclusions and recommendations that will be shared and comments sought from all stakeholders.

§  Present the baseline survey findings and key recommendations to SRCS, IFRC, ICRC and RC/RC Movement partners.

§  Provide a final report with recommendations, database and survey tools, both qualitative and quantitative, after incorporating the comments and inputs of the SRCS and its Movement partners.

Consultancy outputs

The consultant shall:

·         Produce an inception report, qualitative data/information and validated quantitative data gathering tools within 5 days on being contracted.

·         Deliver within 7 days after receiving the technical analysis and reporting on the quantitative data, a draft baseline survey report not more than 30 pages (excluding annexes), with analyzed baseline data that are in line with the current programme and SRCS Health Strategy 2013-2017 indicators.

Additionally, key recommendations to improve the IHCP programme and facilitate the realization of programme goals and objectives should be included, within the context of and mandate of the SRCS in the wider Red Cross/Red Crescent Movement.

Methodology

As part of the selection process for the consultancy, candidates will be required to submit a 1 – 2 page outline of the proposed study methodology given the details in this ToR and Annexes. For further information please contact Kwame Darko (kwame.darko@ifrc.org). 

Short listed consultants will be requested to provide evidence of their previous relevant and approved studies.

Duration and tentative work schedule

The duration for the consultancy will be 35 days including field visit and report writing as detailed in the time schedule below:

Time line for the study

S/N	Activity	Responsibility	Remarks
1	Development of inception report, review and approval, desk review of secondary data/information, development of qualitative data collection instruments and provide quality assurance of existing draft quantitative data collection tools.	Consultant	5 days
2	Meeting of SRCS & partners in Nairobi	IFRC	1 day
3	Travel to the field, training of Branch Health Officers on qualitative data collection, qualitative data collection, meeting with key partners (MoH, UNICEF, WHO, WFP) in the field (Hargeisa, Garowe, Mogadishu)	Consultant	20 days
4	Report writing (1st  draft)	Consultant	5 days
5	Report writing (final draft)	Consultant	3 days
7	Dissemination workshop	Consultant	1 day

Roles and responsibilities

Various individuals and groups will be involved in conducting the baseline survey and their respective roles and responsibilities are detailed in the table below:

S/N	Actor	Responsibilities
1.	SRCS/IFRC/ ICRC	·         Support and facilitate the consultant’s travel in Puntland, Somaliland and Central/South Somalia, provide administrative, logistics and security related issues of the consultancy ·         Facilitate meetings and field visits. ·         Provide the relevant background materials to the consultant. ·         Provide security briefings.
2.	Technical Working Group	·         Provide technical inputs and support to the consultant
3.	The Consultant	·         The consultant will be required to abide by the Red Cross/Red Crescent security rules and procedures in place for travel to and within the target communities. ·         Security briefings will be provided to the consultant in Nairobi and in field locations - Hargeisa (Somaliland),  Garowe (Puntland) and Mogadishu (South/Central) ·         Other responsibilities as itemised in this document
4.	RAMP Experts	·         Coordinate with the consultant on the final quantitative data collection ·         Load the quantitative data on the mobile phones ·         Plan and train enumerators on the RAMP technology at Garowe (Puntland), Hargeisa (Somaliland) and possibly two locations in South/Central Somalia ·         Supervise and monitor quantitative data collection and screening ·         Analyse the quantitative data and provide technical reporting on that
5.	SRCS National  Health  Officers	·         Provide field coordination of the entire exercise ·         Supervise the data collection exercise, both quantitative and qualitative by SRCS staff and volunteers ·         Provide translation support to the expats
6.	SRCS Volunteer Enumerators	·         Participate in the enumerators training ·         Participate in the field testing of the data gathering tools ·         Participate in actual data gathering exercise

Required qualifications, experience and competencies

The consultant should have the following qualifications, skills and experience:

• University degree in Public Health, relevant Health Specialization, Social Science or equivalent qualification

§  Extensive experience in conducting health surveys and knowledgeable in sampling methodologies

§  Experience in community based development approaches / participatory methods.

• Excellent communication and reporting skills
• Team Leader experience.
• Computer literate with skills on data analysis software EPINFO, or SPSS.
• Good command of both written and spoken English.

• Familiarity with global technical issues in public health in post conflict situations.
• Familiarity, ability and willingness to travel within Somalia and under armed escort.
• Knowledge and experience with the Red Cross/Red Crescent Movement.

Remuneration and terms of payment

The consultant will be paid in accordance with the IFRC standard contract rates applicable for external consultants. Standard IFRC procedures for hiring external consultants will apply.

The payment schedules will be as follows:

• 25% upon signing the contract
• 50% after submission of first draft report
• 25% after submission of final report satisfactory to SRCS/IFRC

Notes

• The consultant will be contracted by the IFRC and the standard contractual terms will apply.

• Agreed travel expenses will be reimbursed at cost in accordance with in the IFRC’s relevant regulations.

• Somalia Country Delegation, the IFRC, 20 September 2013.

Annex 1: Location and details of MCH/OPDs to be included in baseline study (but subject to changes).

Zone	Branch	Data collection by NS	Data collection by Consultant	Remarks
Somaliland	Las Anod	Yaagori
	Erigavo	Eilafweyn
	Burao	Odwein
	Berbera		Sheikh
	Hargeisa		Allaybaday
	Boroma		Dilla
Puntland	Garowe	Eyl
		Godobjiran
			Kalabeyr
			Jallam
	Galkayo	Galkayo South
		Jerriban
		Goldogob
		Harfo
	Bosaso	Iskushuban
			Waciye
South/Central	Mogadishu (Banadir)	Afgoye
		Balad
	Beletweyn (Hiran)	Beletweyn
	Dhusamareb (Galgaduud)	Dhusamareb Galinsoor Abduwak Adado
	Baidoa	Isha
		Hulwadaag
	Kismayo (Lower Juba)	Farjano

Submission of applications:

Applications should be submitted by email to hr.eastafrica@ifrc.org; to be received not later than Monday, 30^th September 2013.

Kindly note that due to large volumes of applications received:

1. Only e-mail applications will be accepted

2. Received applications will be short-listed on an on-gong basis

3. Only short listed candidates will be contacted

---

[1] United Nations Children’s Fund (UNICEF)

[2] World Health Organization (WHO)

[3] World Food Programme (WFP)

[4] Community Based Health and First Aid (CBHFA)

[5] Participatory Hygiene and Sanitation Transformation (PHAST)

[6] Due to rapidly changing situation in South/Central Somalia these 10 locations will be confirmed shortly before the commencement of the study