Terms of Reference (ToR)

Endline Survey of Strengthening Approaches for Maximizing Maternal, Neonatal, and Reproductive

Health (SAMMAN - Phase IV); GSK Phase IV Project

Nuwakot, Rasuwa, Sindhupalchok, Kavre and Sindhuli Districts, Nepal

1. Introduction CARE has been working in Nepal since 1978 and has one of the longest histories of any International Non-

Governmental Organisation (INGO) in the country. It has placed a particular emphasis on community-based

‘human infrastructure’ development with a focus on training, capacity building and facilitating

empowerment. Partnership plays central roles in our operations and our programmes work to address

human condition, social position and the enabling environment to address the underlying causes of poverty.

With the financial support of GSK UK, CARE Nepal has been implementing SAMMAN project with an aim of

improving maternal and neonatal health outcomes by strengthening and increasing effectiveness of frontline

Health Workers (HWs) to positively impact maternal, neonatal, and child health (MNCH) goals. The project

was launched in different phases. In the first phase, project was implemented in Doti and Dadeldhura for one

year from 2011 to 2012. In the second phase, it was implemented in Doti, Dadeldhura and Kailali for three

years from 2012 to 2015. In the third phase, with the continuation of the previous three districts, it has been

implemented in two other districts: Kavre and Sindhuli of province 3 for three years (2015-2018). In the last

phase of the project (2018-2021), with the continuation of 2 distircts (Kavre and Sindhuli) from the previous

phase, three new districts; Nuwakot, Rasuwa and Sindhupalchok have been added.

The goal and specific objectives of the project are as follows:

Goal: 292,451 women and adolescent girls, from marginalised and poor, vulnerable and socially excluded backgrounds in five districts in Nepal, can exercise their reproductive and sexual rights by 2020. Objectives

Improve delivery of quality SRHR services and information by Frontline Health Workers (622 Health Workers and 2,600 Female Community Health Volunteers) from 251 health facilities with a focus on the most marginalized and disadvantaged groups.

Improve health system governance and quality of SRHR services through strengthened community health systems (51 Local governments and 251 health facilities).

Increase access to and utilization of SRHR services by 292,451 women, adolescent girls and newborns from marginalised, and socially excluded populations.

2. Geographical coverage The project in phase IV has been working in 5 districts viz, Kavre, Sindhuli, Sindhupalchok, Nuwakot and Rasuwa. Out of these 5 districts, 2 districts viz. Kavre and Sindhuli has been contriued from the previous phase i.e. phase 3, while the other 3 districts, viz. Sidhupalchok, Rasuwa and Nuwakot have been newly added for this phase. The project has been implemented in a total of 25 Rural municipalities of these 5 districts.

The details of the district and their respective municipalities are listed below:

District Name of Rural municipality (RM) No. of RM

Kavre Mandandeupur, Roshi, Bethanchok, Mahabharat (but

activities are covered in whole district)

4

Sindhuli Tinpatan, Dudhauli, Marin, Hariharpurgadhi, Fikkal 5

Sindhupalchok Tripura sundari, Barabise, Bhotekoshi, Balephi, Sunkoshi,

Lisankhupakhar

6

Nuwakot Kispang, Meghang, Tarkeshwor, Tadi, Suryagadhi 5

Rasuwa Gosaikunda, Parbati kunda, Uttar gaya, Kalika , Naukunda 5

3. Major Area of Program Intervention

Maternal and child health including family planning

Capacity building of health workers

Promoting social accountability for quality health

Community mobilization and empowerment

4. Core Activities 1. Maternal and child health including family planning

2. Capacity building of health workers

Training to health workers on long acting reversible contractive (LARC), Skilled Birth Attendance

(SBA),

Equipment support to birthing centres

Onsite coaching and mentoring to service providers on LARC and SBA

Roll out the interim guideline of RMNCH and FCHV modular package

3. Promoting social accountability for quality health

Use of community Health Score Board (CHSB) to improve the social accountability of health

workers. It has been scaled up in to XXX health facilities in total in all five districts

Training to HFOMC Recognition and motivation of good performing health facilities, health

workers and volunteers, and HFOMC through public recognition and learning visits

4. Community mobilization and empowerment

Promote health behaviour change among women and their families (preventive measures,

service utilization, giving up harmful practices)

Improving health-seeking behaviour:

Strengthening health mothers’ groups (MGs) using Self Applied Technique for Quality Health

(SATH) tool

Community health scoreboard (CHSB) and Self-applied technique for quality health (SATH) have been used by the project as the innovative tools for improving social accountability in health system and revitalization of health mothers’ groups respectively in the project districts; Community Health Score Board: CHSB is an effective tool to increase accountability between service providers and service users at the community level and improve the quality of services. The CHSB supports the development of all downward, upward and horizontal accountability of health facilities. The tool also ensures wider engagement of community members in the management of health facilities. The meetings organised during the process of CHSB provide opportunities for poor and marginalised people to raise their voice about the services. This is proven to increase collaboration at the heath facilities and increase ownership and accountability of the services. CHSB has been used as a regular health accountability tool in new communities based on their performance (XX health facilities) of 5 project districts to ensure the social accountability in health service delivery. This makes the CHSB an official part of the review process and progress indicator at the provincial, municipal and federal levels, making the community's voice an official part of the government's evaluation of the work and increasing dialogue between service providers and the service users. Health facilities with low performance and poor indicators have been prioritised for the CHSB scale-up. The CHSB are reviewed semi-annually. This method is proven to increase coordination among the health workers at the health facilities along with the management committee and the service users. This will help to increase the coverage and quality of services as its performance based and the team sets their own goals. Self-applied technique for quality health (SATH): SATH is a technique in which communities themselves, with the help of health institutions and health workers, participate in the process of assessing the health status of the community. This assessment is based on certain health indicators and identifies gaps contributing to poor health outcomes and poor quality health as well as activities to address those gaps which are implemented through regular monitoring and evaluation. SATH aims to improve utilization of primary health care services, increase participation of poor, vulnerable and socially excluded people in primary health care, strengthen mothers group for health and empower FCHVs and members of mothers group.

5. Working modality

Project has been implemented through the local NGO in each district.

Have worked closely with Family Welfare Division (FWD) and Nursing and Social Security Division

(NSSD) at federal for policy guidance and support.

Have worked with Ministry of Social Development and public health directorate at province for

coordination and implementation of the project activities

Worked with local government for planning, implementation and monitoring of the project

activities.

6. Objectives and Scope of work of consultancy CARE Nepal is hiring a consultant team for carrying out the endline evaluation of SAMMAN project of

phase IV (2018-2021). The consultancy work aims to conduct an end line survey at the 5 project districts

viz. Nuwakot, Rasuwa, Sindhupalchok, Kavre and Sindhuli so as to identify the effectiveness of the

project activities/approaches and capture the progress, achievements, learnings and future

recommendations The survey will be carried out in each district and the findings will be consolidated and

compared with the data of national survey, government report, and other internal and external studies

conducted in the districts.

The project has an endline evaluation report carried out for the last phase of the project which will act

as a baseline for Kavre and Sindhuli district. However, for the additional 3 districts, i.e. Nuwakot, Rasuwa,

Sindhupalchok, the data from national reports, HMIS data, etc will be referred as a baseline.

The specific objectives of the final survey will be to:

1. Review and collection of relevant information and sources (Desk/Literature reviewfrom

primary and secondary sources)

2. Identify/ determine-

Levels of knowledge, attitudes and practice among the women having child of less than two years

towards maternal and child health among peoples in each of the targeted municipalities/districts

Levels of knowledge, attitudes and practices among mother having child of less than two years

towards family planning issues

Effectiveness of the community health scoreboard to improve the social accountability in health

Effectiveness of SATH to revitalize the health mother’s groups at community.

Effectiveness and utilization of birthing center equipment support.

Along with the project objectives and indicators, the consultant is also required to refer to the MEL

framework of the ‘Gender Justice and access to Health and Education Rights’ program and capture

some of the relevant indicators in the Endline tools of this project.

7. Methodology The end line survey will make use of mixed methods research, which means an approach that

combines/mixes or associates both quantitative and qualitative approaches1. More than simply collecting

and analyzing both types of data, the end line survey consultant will involve the use of both approaches

in tandem so that the overall strength of a study is greater than either quantitative or qualitative

1 Creswell, 2009

research2. Based on the objectives and indicators to be traced for the study, the consultant may propose

sequential or concurrent mixed methods3 and will conduct both the desk review and the survey at

communities and health facilities. The consultant should propose representative sampling including

sample size calculated on a scientific basis from among community people at households, FCHVs, and

Health Workers. Also, s/he will propose appropriate tools, and techniques of data collection, data analysis

and interpretation of mixed type of data.

8. Coordination The consultant will work in close coordination with Program Manager (Santa Dangol) and M&L Specialist

(Prativa K.C.) to finalize the design of the study. Within each district, the consultant will work with a district

Project Coordinator from the partner organizations for data collection at the field level.

9. Main tasks of the consultancy

Develop a study proposal (technical and financial) detailing out the methodology of the endline study

based on the TOR

Propose robust sampling design and sample size considering the indicators of the project log frame,

population covered by all municipalities/ rural municipalities of the project districts, health facilities,

and program implementing agencies including NGOs.

Carry out a desk‐review of relevant project documents including project log‐frame, and other relevant

documents, a range of which will be agreed upon and made available prior to the implementation of

the study. This should also include documents and reports review of all three previous phases of

SAMMAN project- baseline/endline report and tools, methodologies to ensure alignment of project

indicators and tools to allow programmatic consolidation

Develop a Sampling protocol and Data Collection & Management Protocol for field team that is

standardized for the 5 working districts.

Finalize the proposal, methodology, study tools and guidelines in consultation with CARE-Nepal.

Submit the proposal to National Health Research Council (NHRC) in designated format for ethical

clearance before data collection.

Develop an inception plan, work plan schedule and budget to carry out the assignment.

Conduct pre ‐testing of data collection tools and finalize it.

Co‐ordinate/Supervise collection of data and verify the compliance of collected data

Carry out entry of data into suitable software for cleaning and analysis. (if paper based)

Analyze and interpret the findings

Develop and submit the first draft of the end‐line assessment report.

Finalise the report in consultation with CARE Nepal team.

Debriefing of findings to CARE Nepal

2 Creswell & Plano Clark, 2007 3 Tedlie and Yu, 2007

The report should be comprehensive with detailed specific findings and key recommendations for

implementation under each specific objective.

Submit the final end line survey report to CARE Nepal (both in Hard Copies and soft copies). The

raw data, the data‐base which has been cleaned (both qualitative and quantitative, including

original field notes for in‐depth interviews or focus group discussions, as well as recorded audio

material), and data collection tools used in the evaluation should be submitted together with the

report.

10. Study Team

Under the supervision of the principle investigator, the study will be conducted by a team of experts

comprising of following members. Please note that CARE prefers inclusiveness in the composition of

the team. The expected profile of each of the team members is presented in the annex

Principal investigator (PI)-1: the profile of PI is attached to the annex (1)

Field supervisors (3)- the profile of the field supervisors is attached to the annex (2)

Enumerators (15)- the profile of the enumerators is attached to the annex (3)

Data entry officers (2)- the profile of the data entry officers is attached to the annex (4)

11. Copyright CARE Nepal has sole ownership of all final data and any findings shall only be shared or reproduced with

the permission of CARE Nepal.

12. Timeline The duration of consultancy is for 21 working days (11 days for field work and remaining days for desk

review, finalization of methodology, pre-testing of questionnaire, data entry and analysis, reporting

writing). The ethical approval from NHRC is expected to be done by January 2021. The field data collection

is to be completed by February 2021. The consultant is expected to compile and submit the draft report,

make a presentation to CARE Nepal, incorporate comments and submit a final report by 31st March, 2021.

13. Deliverables

Final proposal

Filled-up data collection tools, data sets

Draft and final Survey Reports (final report in hard copies and a soft copy)

Original and cleaned data sets in relevant software including quantitative data sheet,

original/extended field notes, audio tapes, and transcribed materials

14. Time-Frame The assignment is expected to commence from the second week of January, 2021 and is expected to take

a maximum of 21 days spread over till 31st March 2021, which includes desk review, preparation, field

data collection, data analysis and report writing.

15. Role of CARE Nepal and partners CARE Nepal will provide the project documents and other relevant document. It will also review tools and

provide support in the evaluation process. CARE Nepal will coordinate with the partner organizations in

getting the individuals/groups in place for data collection. The partners will assist the research team to

collect data at community level and at the health facilities. The consultant will be responsible for guiding

the entire evaluation process and all other specific responsibilities as stipulated in the TOR.

16. Expected Profile of the Consultant The consultant is expected to hold the following qualifications:

I. A recognized university degree in public health, international development, or related social

science (a minimum of masters’ level but preferably doctorate level)

II. Sound knowledge of major issues under project intervention, especially SRH/FP, maternal, new

born and child health (MNCH).

III. At least 5 years of experience in the area of demography/public health (in organizations and in

projects)

IV. Experience in the formulation, monitoring and evaluation of projects in maternal, new born and

child health/public health

V. Similar work in the last 3 years

VI. A demonstrated high level of professionalism and an ability to work independently

VII. Strong interpersonal and communication skills

VIII. High proficiency in written and spoken English.

Please refer to ANNEX 1, 2, 3 and 4 for more details.

17. Response Proposal Specifications A proposal detailing the study methodology including design, tools, work plan and budget.

The technical and financial proposals will be evaluated based on following criteria (Technical 70% and

Financial 30%):

I. Technical

Understanding and interpretation of the TOR

Methodology to be used in undertaking the assignment (including sampling method, sample size,

details of tools)

Time and activity schedule

II. Financial

Detail proposed budget

Cost per unit sample

III. Organizational/Personnel Capacity Statement

Relevant experience related to the assignment

Curriculum Vitae with relevant references

Example of at least two similar completed assignments

18. Submission of Proposals The proposal can be e‐mailed so as to reach the undersigned by December 28, 2020 to Mr. Yogesh

Chapagain, Procurement officer CARE-Nepal, Kathmandu. E‐mail: yogesh.chapagain@care.org

19. Evaluation and Award of Consultancy CARE Nepal will evaluate the proposals and award the assignment based on technical and financial

feasibility. CARE 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. Only the successful applicant will be contacted.

20. Payment

30% of the contract amount will be paid to the consultant upon receipt methodology and study tools

and guidelines.

70% of the contracted amount will be paid to the consultant upon receipt of acceptable final end line

report by CARE-Nepal

Annex 1: Expected Profile of Principal Investigator

a. A recognized university degree in public health, international development, or related social

science (a minimum of masters’ level but preferably doctorate level)

b. Sound knowledge of major issues under project intervention, especially SRH/FP, maternal,

new born and child health (MNCH),.

c. At least 5 years of experience in the area of demography/public health (in organizations and

in projects)

d. Experience in the formulation, monitoring and evaluation of projects in maternal, new born

and child health/public health

e. A demonstrated high level of professionalism and an ability to work independently

f. Strong interpersonal and communication skills

g. High proficiency in written and spoken English.

Annex 2: Expected Profile of Field supervisor

a. At least bachelor level education in the sector of health esp. maternal, newborn and child

health

b. A demonstrated experience of engaging with research and assessment related to public

health

c. Trained in research methodologies, data editing and cleaning at field level

d. Have experience of working in team at field level and reporting the study team leaders

e. Good communication and team mobilization skills

f. Experience in working with the district health offices and related stakeholders esp in research

base

g. Proactive and context management skills

h. Interest in field visits at community level with enumerators and verify the reliable and valid

process are followed as planned and if necessary communicate the team leader to modify or

change

Annex 3: Expected Profile of enumerators

a. At lease higher secondary/certificate level of education in health (public health, medicine,

nursing etc.)

b. An experience of engagement in research work or project at field level with data collection

and documentation

c. Field experience of working with the community people esp. women and girls, health workers,

HFOMC members and female community health volunteers

d. A local inhabitant of the district will be preferable understanding the language and socio

cultural contexts

e. Good command in language, public speaking, probing and facilitation of the discussions

f. An experience of working in team of research/assessment

Annex 4: Expected Profile of data entry officers

a. Skills in operating excel, SPSS, , EPI Data and any one/other widely used database is the most

b. At least bachelor degree in health, and or statistics

c. Proven experience of data entry, analysis and management

d. Has experience of working in research/assessment esp. in data management

e. A good understanding of the research ethics and disciplines,

f. Trained in research methodologies and techniques and data management

Annex 5: Monitoring framework of project

Indicator Method Frequency

and schedule ( time line)

Person Responsible for:

Data Collecti

on

Data Analysis

Approval/ data

use

Outcomes 1 Improve delivery of quality Sexual reproductive health and right (SRHR) services by frontline health workers (# 622 Health Workers and 2600 FCHVs)) at health facilities (# 251) with a focus on the most marginalized and disadvantaged group

Develop pool of clinical mentors

Site Observation Per

activity DP

C/HO M&E PM

Partners Report Review

Onsite coaching on new-born health, Skill birth attendants, Long acting reversible contraception

Joint Visits

Per activity

DPC/HO

M&E PM

Site Observation

Partner Reports

Training to health workers on Skill birth attendants, Long acting reversible contraception, QI and IP

Joint Visits

Per activity

DPC/HO

M&E PM

Reports

Site Observation

Orientation to local Health Workers in implementing the

Participation

Quarterly DPC/HO

M&E PM Progress Reports

modular training package for FCHV

Meeting minutes

Implementation of modular training package for FCHV (˜2600 FCHVs)

Minutes

Quarterly DPC/HO

M&E PM Reports

Observation and Participation

Implementation of Quality Improvement in SRHR services in birthing center and Long acting reversible contraception sites

Minutes

Quarterly DPC/HO

M&E PM

Reports

Observation and Participation

Equipment and supplies for Birthing Centers

LMIS

Quarterly DPC/HO

M&E PM Event Reports

Observation and Participation

Support to birthing center for minor renovation and maintenance including Quality Improvement Fund

LMIS

Quarterly DPC/HO

M&E PM

Event Reports

Observation and Participation

Technical support to rural/municipalities

in developing program guideline

and planning process

Event Reports

Quarterly DPC/H

O M&E PM Observation

and Participation

Technical support to rural/municipalities in information management system, periodic review, data quality

Event Reports Quarterly DPC/HO

M&E PM

Technical and equipment support in strengthening Outreach Clinic

LMIS

Quarterly DPC/HO

M&E PM Event Reports

Observation and Participation

Outcomes 2 Improve health system governance and quality of SRHR services through strengthened community health system (51 Local government and 251 health facilities)

Implementation of community Health Score Board (CHSB)

Progress report

Quarterly DPC/HO/CHF

DPC/M&E PM Observation and Participation

Minutes

Sensitization of Health facility operation and management committee members about their roles and responsibilities

Progress Reports

Quarterly DPC/HO/CHF

FC and M&E

PM Meeting

minutes

Site observation

Regular engagement with Health facility operation and management committee to identify the agenda of health facility and implement identified action plan

Participation

Quarterly DPC/HO/CHF

M&E PM

Site visits

Facilitation

Support to functionalize the health coordination / program management mechanism at Rural/Municipalities

Reports

Quarterly DPC/HO/CHF

M&E PM Facilitation

Introduce non monitory incentive to health facility and Health Workers

Participation and Facilitation

Quarterly DPC/HO/CHF

M&E PM Event Reports

Minutes

Support Health faciltiy for adloscent friendly services

Participation Quarterly

DPC/HO/CHF

M&E PM Event Reports

Outcome 3 Increase access to and utilization of SRHR services by 292,451 women, new born and adolescent girls from marginalized, and socially excluded population

Supportive supervision to mother groups for health and FCHVs

Participation and Facilitation Quarterly CHF DPC/M&E PM

Event Reports

Promoting male engagement using for awareness through saving credit group and other users’ groups: forest and drinking water (Identify influential person and mobilize them as change agent in community for SRHR )

Event Reports

Quarterly DPC/HO/CHF

DPC/M&E PM Participation and

Facilitation

Scale up of Self applied technique for quality health approach for increasing equity and access in utilization of SRHR services

Meeting minutes

Quarterly CHF DPC/M&E PM

Event /Progress reports

Dialogue with married adolescent on SRHR service utilization

Meeting minutes

Quarterly CHF DPC/M&E PM Participation

Event /Progress reports

Organize school health programs focusing adolescents males and female

Event Reports

Quarterly CHF DPC/M&E PM Participation and Facilitation

students; reading materials supports, teaching and learning through participatory process (quiz contest, debate), radio listening groups formation, focus group discussion

Hoarding board display on Gender based violence and health services

Reports

Quarterly CHF DPC/M&E PM

Participation

Joint Visits

Airing of radio messages

Progress reports

Quarterly (Semi annual)

DPC/HO

M&E PM

Continuation of M-Health

Analytics reports Semi

annual DPC/HO

M&E PM Joint Visits

Event Reports