Evaluator, Jowhar and Balcad districts of Middle Shabelle region in Somalia, and Nairobi, Kenya

ToR for Final Evaluation for the Project 'Provision of emergency primary and secondary health integrated services, including GBV prevention and response services for the crisis affected population in Somalia'

Contract number: ECHO/-HF/BUD/2013/91017

INTERSOS Humanitarian Aid Organization is seeking an experienced evaluator to assess its ECHO-funded emergency primary and secondary health services integrating nutrition and gender-based violence (GBV) prevention and response.

1. BACKGROUND

Over twenty years of state collapse and protracted conflict have left the health care system and formal and informal mechanisms for protection of vulnerable persons in ruins in South-Central Somalia. As a result international and local non-governmental organizations have been operating under challenging security conditions to fill this crucial gap in services for the population. In Middle Shabelle region, INTERSOS has been operating the Jowhar Regional Hospital (JRRH) and network of primary health and nutrition services across three districts in the region since 1992. The JRRH is the only facility providing comprehensive primary health and nutrition and secondary health care services to more than 250,000 people in the districts of Jowhar, Balcad and Warsheikh. JRRH links with a network of five primary health and nutrition services and mobile units reaching up to 123 villages. JRRH is the only facility in the region where patients can be visited by medical doctors, receive emergency major surgical treatments and access laboratory and radiological diagnostic services. contract

Despite Middle Shabelle's proximity to Mogadishu, the capital of Somalia, large population and frequent natural disasters and inter-ethnic conflict causing population displacement the region has been largely been marginalized in terms of assistance and support for service provision. Few NGOs are operating in the area and beside INTERSOS there is one INGO and other three local non-governmental organizations (LNGOs) are offering primary health services in the Jowhar and Balad towns. However, the numerous villages situated in the riverine and pastoralist areas have minimal access to services and remain at high risk of epidemic outbreaks, particularly of AWD (Acute Watery Diarrhea). Furthermore, a period of control by Al Shabaab (AS) meant that nutrition intervention, vaccination of children and provision of clinical management of rape (CMR) services (banned by AS) have caused severe malnutrition and mortality rates for children under 5 years and neglect of those affected by different forms of GBV.

Over the past 13 months, from June 2013 to April 2014, INTERSOS has been working in partnership with the European Commission for Humanitarian Assistance and Civil Protection (ECHO) to implement a comprehensive programme to provide of integrated life-saving assistance to the population of Middle Shabelle, including components of nutrition, WASH and protection (GBV response services). As well as strengthening access for largely under-served populations to health and nutrition services, the ECHO partnership has been crucial in establishing CMR (Clinical Management of Rape) services in the region and providing case management and psychosocial support services with LNGO partner Women and Child Care Organisation (WOCCA). However, challenges still remain with high levels of stigma and denial among the community, as well as lack of knowledge of the consequences and available services for GBV survivors hindering access to services. Continued security concerns continue to hamper access by international staff to the region, however, access is gradually improving.

2. PROJECT OVERVIEW

Title of action: Provision of emergency primary and secondary health integrated services, including GBV prevention and response services for the crisis affected population in Somalia

Principal objective: To provide life saving humanitarian assistance to crisis affected population in South Central Somalia

Target locations: Jowhar, Balcad adn Warsheikh districts of Middle Shabelle, South Central Somalia

Result 1: Access to efficient and effective primary health services is improved for crisis and conflict affected beneficiaries living in urban and rural areas

Result 2: Access to secondary hospital healthcare is improved for crisis and conflict affected beneficiaries living in urban and rural areas

Result 3: Access to efficient and effective integrated primary and secondary nutrition services is improved for crisis and conflict affected beneficiaries living in urban and rural areas

Result 4: Emergency preparedness and epidemic response capacity are strengthened.

Result 5: GBV prevention and response enhanced through comprehensive case management of GBV survivors/women at risk of GBV/children victim of violence and an effective coordination among GBV actors

3. EVALUATION SCOPE & METHODOLOGY

3.1 Evaluation objectives

1. To assess the extent to which the project achieved its stated objectives and results to provide lifesaving health, nutrition and protection assistance to crisis-affected populations in Middle Shabelle region;
2. To evaluate the appropriateness/relevance, effectiveness, efficiency and sustainability of action design and implementation for achieving the expected results;
3. To identify lesson learned and provide practical recommendations to enhance implementation of INTERSOS, WOCCA and ECHO future actions.

3.2 Scope & Lines of Enquiry

The final evaluation should seek to combine various quantitative and qualitative methods to evaluate the project. It is important that all key stakeholders are meet with including government officials in the project areas, DG ECHO, UN, International and Local NGOs that are part of the cluster system and those operating in the project area, also health, nutrition and protection cluster and GBV working group coordinators. The evaluation will be divided in two branches: Priority I and Priority II.

Priority I

The follow key areas for evaluation include, but are not limited to:

• To evaluate the quality (based on agreed standards) of the primary and secondary health care services offered (at primary health centers MCH, JRRH, OTP and stabilization centres) and of GBV case workers. Including eliciting feedback from the patients/clients and community members on the quality, knowledge of and access to services offered. \
• To assess the facilities, equipment and supplies at the hospital, MCHs and local partner WOCCA, including performance of the laboratory and the pharmacy (stock, cleanliness, conditions, procedures, staff etc.)
• To assess the quality and origin of drugs (use of the Humanitarian Procurement Center) INTERSOS-ECHO Integrated Health, Nurtition & Protection Project Final Evaluation Terms of Reference Page 3 of 6
• To assess the effectiveness of the monitoring and evaluation system adopted and it's utilization to inform project management decisions
• To assess the analytical capacity, quality and pertinence of the Health Information System (HIS)

Priority II

The follow key areas for evaluation include, but are not limited to:

• To assess the appropriateness/relevance of the Action based on determination of the priority health, nutrition and protection (GBV) needs of the population, and specifically for address lifesaving concerns of crisis affected populations.
• To assess the application and adherence to global and Somalia-specific standards for health, nutrition and protection/ GBV and of humanitarian principles in response.
• To assess the effectiveness of technical and managerial trainings provided and level of competence of the project staff, as well as quality and impact of trainings provided to other service providers/ humanitarian agencies and community members to improve health, nutrition and GBV services and referral.
• To assess the extent to which the referral system is functioning, effectiveness of community engagement and collaboration with other actors for referral as well as methods used to strengthen the system and promote access to services for crisis-affected and particularly marginalized populations;
• To evaluate the implementation of data protection protocols for health, nutrition and GBV data, including presence and completeness of the clinical cards and case management records (intake forms, assessment forms, consent and referral forms).
• To assess the effectiveness of coordination of Action at different levels with cluster members and coordinators (government, UN, INGOs and LNGOs) and with other stakeholders (local government authorities and local traditional leaders etc.) and how were potentially conflicting interests were managed.
• To assess the extent to which the project support to the national GBV working group Co-Chair and working group activities including strategy development and support for GBV coordination workshop with field coordinators has contributed to improve coordination for GBV prevention and response in other areas of the country. Include also level of satisfaction with INTERSOS as national Co-Chair representative of the working group, challenges faced and areas for improvement.
• To assess the extent to which gender considerations and PSEA has been mainstreamed throughout the design and implementation of the project, and its impact on the effectiveness and efficiency of implementation.
• To assess and evaluate the constraints and challenges linked to the context and affecting the implementation of the Action.
• To evaluate the quality and the sustainability of the support given to the local staff and the community (trainings for health staff, network of Community Health Workers, first aid kit distribution and training for CHWs and teachers)
• To assess the management and oversight system for the effectiveness of project implementation and service delivery. Including the presence and the effectiveness of the staff employed, the presence of a register etc.
• To assess the partnership and effectiveness/added value of the partnership with WOCCA for provision of GBV case management and psychosocial support services. Including assessing the effectiveness of technical guidance provided by INTERSOS.

3.3 Evaluation Methodology

The external evaluator/evaluation team is responsible for designing the detailed evaluation methodology and tools to be outlined in the inception report, to be agreed in collaboration with INTERSOS Somalia Health & Nutrition and Protection Departments. A combination of quantitative and qualitative methods should be used and include the following requirements:

• Desk review of relevant project documents (proposal, monthly reports, GBV baseline KAPs survey) emergency assessments, GBV working group strategy (2014-16), cluster and international technical guidelines, etc;
• Use of quantitative data gathered through health services register, clinical cards and stock registers and GBV Information Management System (GBVIMS);
• Qualitative focus group discussions (per sex and age) and key informant interviews with:
  • Project staff INTERSOS and WOCCA in Nairobi, Mogadishu and Middle Shebelle;
  • DG ECHO field office in Mogadishu and Nairobi;
  • UN and I/LNGOs actors involved in the Action (attended training, cluster coordinators and members) at field and national level;
  • Interviews with hospital patients, GBV survivors and community members (based on informed consent);
• Observations through visiting of the project sites, facilities and offices;

INTERSOS values evaluations that utilise a participatory, learning-oriented and gender-sensitive approach that is in line with our organizational values. It is essential that ethical research principles are adhered to throughout the process, including the WHO Ethical and Safety Guidelines for researching, documentation and reporting sexual violence.

3.4 Target Audience

The evaluation has three primary audiences: 1) INTERSOS and partner WOCCA will use the evaluation findings to identify lessons learned and take steps to improve health, nutrition and protection project quality, methodology, and implementation processes in the future; 2) the European Commission (ECHO) requires this evaluation to assess INTERSOS's effectiveness and to inform future strategies in Somalia; 3) the target communities in Middle Shabelle region should be actively engaged during the evaluation process and key findings presented back to improve accountability, transparency and future service delivery.

3.5 Expected Outputs & Deliverables

1. Evaluation inception report detailing the process, methodologies, tools and work plan to be employed to achieve the evaluation objectives (due 5 days upon signing the contract);
2. Undertake desk review of the relevant project (5 days upon signing the contract);
3. Conduct 7 days comprehensive field-based data collection in the project target locations according to the agreed evaluation methodology;
4. Conduct a debriefing meeting/ presentation with INTERSOS and WOCCA to discuss the outcome of the evaluation and conduct presentation to DG ECHO after the report is approved by INTERSOS;
5. Final evaluation report and recommendations (maximum 25 pages).

4. EVALUATION IMPLEMENTATION

4.1 MANAGEMENT

The evaluator will work closely with INTERSOS Somalia Health Coordinator, Health Project Manager and Protection Coordinator and approval of the inception report must be agreed with INTERSOS before commencing implementation. Although the evaluator is ultimately responsible for designing the methodology, implementation plan, developing evaluation tools and implementing the evaluation.

4.2. LOCATION & DURATION

The evaluation will take place in Jowhar and Balcad districts of Middle Shabelle region in Somalia as well as locations in Nairobi, Kenya. The evaluation duration should be a maximum of four weeks work in total starting from the day of signing the contract. The work is to be conducted during July 2014 with the following anticipated schedule:

Preparation (1 week/5 days): Desk review, inception report and initial interviews with project staff.

Site visits, data collection & debriefing (1.5 weeks/8 days): field evaluation component, including in- country visit to project sites, qualitative interviews/discussions and triangulation of findings. Provide initial debriefing on key findings to INTERSOS and WOCCA project staff.

Analysis & report writing (1 week/5 days): Analysis and draft report for review by INTERSOS and WOCCA.

Finalise report & presentation (2 days): The evaluator should incorporate feedback on the evaluation and submit the final report within 2 working days of reception of feedback. Conduct presentation for DG ECHO after the finalisation of the evaluation report.

5. EVALUATOR PROFILE & PROCESS OF SELECTION

5.1 Bid qualification and selection criteria

The external evaluator will be chosen based on the following criteria:

• Professional medical person (degree in Medicine preferred or Public Health);
• Competency to carry out the assignment and experience of carrying out similar tasks;
• Strong technical skills in the field of humanitarian intervention in health, nutrition and protection (specifically GBV) with previous familiarity with the Somali context;
• Accessibility in Somalia, specifically project locations in Middle Shebelle;
• Excellent English and good Somali language writing/oral skills;
• Qualifications and experience with international organizations working in Somalia
• Cost of the consultancy service.

5.2 Terms and Conditions

1. The external evaluator will be contracted by INTERSOS Somalia.
2. Daily consultancy fee is negotiable, although it must fit within the evaluation costs allocated under the ECHO project budget;
3. 50% payment of the agreed consultancy amount will be paid on submission of inception report with the remaining 50% payment upon submission and acceptance of the final evaluation report and deliverables;
4. The external evaluator must ensure that competent and qualified staff that are included on the contract and working as part of the evaluation team;
5. INTERSOS will support the external evaluator to access to the project areas, including supporting set- up of interviews with project stakeholders (where required);
6. All costs associated with the field mission will be responsibility of the external evaluator, who shall take into account these costs when proposing the daily consultancy fee as per point 5.2.2.; however INTERSOS will provide to the external evaluator(s) free accommodation in Jowhar at Jowhar Hospital Guesthouse;
7. The external evaluator is responsible for logistical arrangements, although INTERSOS will support where possible;
8. The external evaluator is responsible for the safety and security of the evaluation team while working on the evaluation.

5.3 Applications Process

Interested parties should send their expression of interest (EOI) which must include:

1. CV and evaluation firm profile (if affiliated with a firm);
2. Expression of Interest application with tentative budget;
3. Copy of a previous external evaluation report (in English) conducted by the lead evaluation consultant.

Please submit the EOI application by email to hr.somalia@intersos.org or in a sealed envelope addressed to INTERSOS Somalia: #17 Sports Road, Westlands, P.O. Box 57801-00200, Nairobi. Please submit the bid between 8.30am-5.30pm Monday to Friday at the INTERSOS office by Saturday 5 th July 2014 at 5pm (Kenya/Somalia time).