Somalia: Integrated Health Care Programme (IHCP)

Summary

1.1. Purpose: To assess the effectiveness and relevance of the IHCP to the target communities in particular and within the overall health sector development in Somaliland and Puntland.

1.2. Audience: The results will be used by the Somali Red Crescent Society (SRCS) and its partners to plan future programmes and to share good practices with international humanitarian actors

1.3.Commissioners: This evaluation is being commissioned by IFRC Somalia Country Representation in collaboration with SRCS in compliance with the IFRC Evaluation framework.

1.4.Reports to:**The consultant will report to the IFRC Somalia Country Representative and work directly with the SRCS National Health Officers in Puntland and Somaliland respectively**.

1.5. Duration:The consultant will be engaged for 30 working days spread over a month and half. The 30 days will include the preparation of the inception report, development of tools, desk review, field work and report writing.

1.6. Timeframe: The consultant will be engaged for a total of 30 days between the last week of October and the middle of December 2015

1.7. Methodology summary: It is expected that the consultant will use a mixed methods approach which will include focus group discussions, key informants interviews, facility checklist and a household survey. The consultant is expected to be well versed in vulnerability and capacity assessment, statistical analysis and comfortable with collecting and analysing both qualitative and quantitative data.

1.8.Location: The consultancy will take place in Somaliland and Puntland

1.9. Application requirements: The consultant should be well versed with the OECD-DAC criteria for evaluation and must have strong writing skills in English.

2. Background

Somalia has been plagued with over 2-decades of civil conflict with no visible signs of abating, particularly in the South/Central Zone of the country. In spite of the spirited joint effort by the Somali Federal Government (SFG) and the African Union Forces (AMISOM) to end the insurgency, only mixed successes have been achieved so far. Although fragmented into political enclaves, relative peace and stability prevail in the breakaway region of Somaliland and also Puntland that has more affiliation with the Federal Government in Mogadishu.

Under-capacity public service infrastructure has resulted in a huge gap in access to basic social services such as health and education while climate-induced recurrent disasters such as drought, tropical cyclones and flooding, have exacerbated the vulnerability levels of a large segment of the population with significant loss of livelihoods, food insecurity, massive displacements, widespread disease and malnutrition.

The Somali Red Crescent Society (SRCS) is reputed as the largest humanitarian concern with branches in all the 19 regions of the country as well as a number of sub-branches and a large network of volunteers. The National Society has since the beginning of the civil conflict built a strong foundation, capacity and competence in the development and delivery of basic health care services under the Integrated Health Care Programme (IHCP) with complimentary community based activities by staff and volunteers. This has largely been spurred on by the huge service delivery gap occasioned by the conflict. The IHCP comprises a network of Maternal and Child Health/Outpatient Department (MCH/OPD) clinics that provide a range of basic health care services. The IHCP has since its inception in 1993 grown from 20 MCH/OPDs and currently, the SRCS, with the support of Red Cross/Crescent Movement partners and the Government of Japan, are managing 57 static and 17 mobile health clinics spread across the three zones of the country and distributed as below:

Location and support for static clinics in Somalia (as at 2015).

a) Somaliland - 12 static clinics and 6 mobile clinics.10 static clinics are supported multilaterally through IFRC while 2 static clinics are supported bilaterally by the Qatar Red Crescent Society.

b) Puntland - 20 static clinics and 4 mobile clinics with Multilateral support through the IFRC

c) South/Central Somalia - 25 static clinics and 7 mobile clinics supported by ICRC

The shift in the focus of the National Societys core activities from emergency/relief to development by way of setting up the MCH/OPDs follows the realization of the huge gap in access to basic health care services, as a result of the conflict and the need for the SRCS to intervene. The IHCP has over the years expanded not only in terms of the number of MCH/OPD clinics and coverage but also in terms of the range of services provided, particularly the provision of delivery and basic laboratory services.

During the last quarter of 2013 and the first quarter of 2014 the first comprehensive baseline study of the IHCP was conducted in all the three zones of the country (Somaliland, Puntland and South/Central Somalia) to establish baseline data that will help measure progress against the set goals, objectives and impact over time. However no comprehensive evaluation has been conducted of the programme since its inception although 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.

This evaluation is commissioned by the IFRC Somalia Country Representation in accordance with the terms of cooperation with the Swedish Red Cross that contributes to the Somalia Country Appeal. The outcome of the mid-term evaluation will inform and contribute to the future direction and development of the IHCP and cooperation between the SRCS and partners.

3. Evaluation Purpose & Scope

Purpose:To determine the extent to which the strategic objectives of the SRCS-managed IHCP through critical health service delivery by the network of 6 static and 2 mobile MCH/OPDs and community-based activities as well as the relevance and sustainability of the IHCP within the context of the overall health sector development in Somaliland and Puntland.

Scope: The mid-term evaluation is expected to be conducted at the clinic sites and the Berbera and Bosaso branches in Somaliland and Puntland. The entire work is expected to be carried out in 30 consultancy days and spreading one and a half months. The evaluation will cover static and mobile clinics service delivery and management as well as technical and other support at different levels – IFRC, SRCS Coordination Offices and branches. It will also examine branch/sub-branch and volunteer development as well as community-based activities undertaken by the community volunteers and partnerships.

4. Evaluation Criteria – Objectives - Questions

The objectives of the evaluation will be:

a) To assess quality/efficiency in the implementation of the IHCP by the National Society

b) To assess the effectiveness/impact of the IHCP on the target communities

c) To assess the extent to which the SRCS coordinate/collaborate with other humanitarian actors and local authorities in the implementation of the IHCP

d) To assess the relevance and sustainability of the IHCP in the light of the health sector reforms/development in Puntland and Somaliland respectively

4.2 Evaluation criteria and Questions

This evaluation will focus on six of the seven evaluation criteria as well as on coordination, accountability and lessons learning.

e) To assess quality/efficiency in the implementation of the IHCP by the National Society with specific consideration of:

o Staff capacity and competency in the management of clinics and delivery of services to the target community.

o The extent to which monitoring data has been used to influence programme management decisions

o Branch and Coordination staff capacity and competency in the management and supervision of the IHCP.

o Timely technical and logistical support at all levels (Nairobi, Coordination and Branch) to the delivery of services to the target community.

o The extent to which clinic infrastructure and tools meet minimum standards to support service delivery

o The extent to which minimum operating standards are adhered to in the management and delivery of basic health care services through the IHCP.

o The extent to which the SRCS Health Strategy (2013-2017) and other health tools guide the delivery of health services in Somaliland and Puntland

f) To assess the effectiveness/impact of the IHCP on the target communities:

o The degree to which the implemented activities have contributed to realising the goals and objectives of the IHCP.

o The extent to which local communities and beneficiaries have participated in the delivery/ implementation of the IHCP, including the extent to which the views of men, women, boys and girls are captured and how they have been able to influence the IHCP

o The extent to which accountability to the beneficiaries has been and is being addressed while implementing the IHCP, including the documentation of complaints/satisfaction.

g) To assess the extent to which the SRCS coordinate/collaborate with other humanitarian actors and local authorities in the implementation of the IHCP with particular reference to:

o Effectiveness of partner support to the SRCS health programme, whether partner support has been delivered in the most appropriate manner or not.

o Range and extent of partner resources to support the implementation of the IHCP

o Extent of SRCS collaboration with other actors and partners

h) To assess the relevance and sustainability of the IHCP, particularly with regards to:

o The future outlook of the IHCP in the wider context of health sector reform and development policies in the respective zones.

o The National Societys ability to generate/attract resources locally and externally to sustain the implementation of the IHCP

When considering the above, the evaluation will also seek to address the following cross cutting issues:

i) The institutional capacity of SRCS to effectively manage the implementation of the IHCP, specifically considering:

o Whether SRCS structures and systems (governance and management) in place adequately facilitate the efficient and effective delivery of basic health care services through the IHCP and adequately account for that.

o How the IHCP is integrated and fits within the wider SRCS strategic programmes including disaster management and its alignment to the national health delivery system

o Whether SRCS is able to effectively manage and capitalise on its volunteer network.

o Whether staff and volunteers (including Community Health Committees) have the skills and knowledge needed to efficiently manage and deliver critical health services through the IHCP.

j) The extent to which the fundamental principles of the Red Cross and Red Crescent Movement have been integrated in the implementation and monitoring and reporting on the IHCP

k) The extent to which gender, disability, child protection and HIV/AIDS have been articulated in the delivery of health services

l) To document lessons learnt and good practices in health service delivery through the IHCP.**5. Evaluation Methodology**

The evaluation will adopt a combination of desk review, interviews with key stakeholders including local authorities and field visits to the SRCS Berbera and Bosaso branches in Somaliland and Puntland. The field visit will include site visits to some static clinic communities and mobile clinic sites to collect both qualitative and quantitative data and information from community members as well as from the clinics

The consultant will be expected to use a probability based sampling method for the quantitative assessment to ensure that the results can be extrapolated. On the other hand a purposive sampling method will be used for the qualitative assessment to ensure that the needs of the different actors are met.

6. Deliverables (or Outputs)

Inception report: An inception report to demonstrate a clear understanding and realistic plan of work for the evaluation, which is in concordance with the ToR. The inception report will include the proposed methodologies, a data collection and reporting plan with identified deliverables, draft data collection tools such as interview guides, the allocation of roles and responsibilities within the evaluation team, and travel and logistical arrangements for the evaluation.

Debriefing: The consultant will present initial findings in a debrief meeting with Somali Red Crescent Society (SRCS), the Swedish Red Cross and IFRC key personnel. S/he will make a power point presentation to the SRCS and partners to highlight key outcomes of the mid-term evaluation.

Report: A clearly written, evidenced-based report in English is required. The report should:

1. Be a maximum of 30 pages (with annexes attached)
2. Make specific recommendations, clearly linked to report findings and that take account of the mandate of the SRCS, IFRC and the wider Red Cross Red Crescent Movement

Include at least two case studies (to be annexed to the report) - at least one case study each should be of a person/family that has benefitted from the clinic interventions and volunteer activities/interventions respectively

The final report can follow the headings below:

1. Executive summary
2. Abbreviations/acronyms
3. Introduction
4. Review aims and objectives
5. Methodology
6. Findings (sub headings to include but not limited to appropriateness, efficiency and effectiveness, impact)
7. Recommendations
8. Lessons learnt
9. Conclusion
10. Appendices
    7. Proposed Timeline

The evaluation exercise is expected to start during the last week of October 2015, subject to negotiations with the potential consultant, and be completed within 30 working days. The expected schedule is shown below:

Day 1 - 5\ Nairobi*IFRC and SRCS Offices

· Meet SRCS management and IFRC programme staff and ICRC Health Delegate (PHC).

· Agree an evaluation plan with the IFRC Somalia Country Representation.

· Prepare inception report

· Desk review of relevant documents

· Development of evaluation tools – quantitative and qualitative tools

Day 5 - 13 Somaliland - Berbera Branch

· Briefing with SRCS Somaliland Coordination Office

· Meet partners in Hargeisa (UNICEF, WHO, WFP, MoHL)

· Berbera Branch & local administration

· Training of volunteer enumerators

· Household survey in the Lassodawo and Sheikh clinic communities

· Qualitative survey in the Lassodawo and Sheikh clinic communities

Day 14- 23 Puntland - Bosaso Branch

· Bosaso Branch & local administration

· Meet partners in Bosaso (UNICEF, WHO, WFP, MoH)

· Training of volunteer enumerators

· Household survey in the Waciye, Rako, Ufeyn & Ishkushuban clinic communities

· Qualitative survey in the Waciye, Rako, Ufeyn & Ishkushuban clinic communities & mobile sites

· Qualitative survey in mobile sites

Day 24 - 30 Nairobi

· Data analysis and compilation of report /Preparation for presentation

· SRCS, IFRC to review the draft report and give feedback to the author within one week.

· Presentation of report to SRCS/IFRC & Partners

· The Consultant to take note of the comments of SRCS and IFRC and prepare the final evaluation report

8. Evaluation Quality & Ethical Standards

The evaluators should take all reasonable steps to ensure that the evaluation is designed and conducted to respect and protect the rights and welfare of people and the communities of which they are members, and to ensure that the evaluation is technically accurate, reliable, and legitimate, conducted in a transparent and impartial manner, and contributes to organizational learning and accountability. Therefore, the evaluation team should adhere to the evaluation standards and specific, applicable process outlined in the IFRC Framework for Evaluation.

The IFRC Evaluation Standards are:

1. Utility: Evaluations must be useful and used.
2. Feasibility: Evaluations must be realistic, diplomatic, and managed in a sensible, cost effective manner.
3. Ethics & Legality: Evaluations must be conducted in an ethical and legal manner, with particular regard for the welfare of those involved in and affected by the evaluation.
4. Impartiality & Independence; Evaluations should be impartial, providing a comprehensive and unbiased assessment that takes into account the views of all stakeholders.
5. Transparency: Evaluation activities should reflect an attitude of openness and transparency.
6. Accuracy: Evaluations should be technically accurate, providing sufficient information about the data collection, analysis, and interpretation methods so that its worth or merit can be determined.
7. Participation: Stakeholders should be consulted and meaningfully involved in the evaluation process when feasible and appropriate.
8. Collaboration: Collaboration between key operating partners in the evaluation process improves the legitimacy and utility of the evaluation.

It is also expected that the evaluation will respect the seven **Fundamental Principles of the Red Cross and Red Crescent*: 1) humanity, 2) impartiality, 3) neutrality, 4) independence, 5) voluntary service, 6) unity, and 7) universality. Further information can be obtained about these principles at:*

*www.ifrc.org/what/values/principles/index.asp”*9. Evaluator/s & Qualifications

IFRC is seeking for a consultant for this evaluation with a mix of technical programmatic skills and evaluation skills. The consultant will have a mix of the following skills and experience:

• Minimum qualification of an advanced degree in public health, disaster management, sociology/psychobiology/demography and/or economics
• Demonstrated experience in monitoring and evaluation: able to design, implement, analyse and synthesize evaluation processes and findings

· Health-related and Disaster Management experience in designing and implementing health and disaster preparedness and response, mechanism particularly in a complex situation.

· Knowledge of the complex disaster settings

· Good interpersonal communication skills

· Culturally sensitive and understanding of the Red Cross principles

· Excellent writing and presentation skills in English

· Strong analytical skills and ability to clearly synthesize and present findings

· Experience in participatory approaches to evaluations

· Minimum of 7 years of monitoring and evaluation experience required.

· Demonstrated competence in managing quantitative data and carrying out inferential statistics required.

· Proven track record of conducting qualitative research including the development of interview schedules and qualitative data analysis required.

· Experience in qualitative data collection and data analysis techniques (especially in the design of coding schemes).

· Excellent written and spoken English skills required or excellent analytical, writing and presentation skills.

· Strong computer skills in spreadsheet, word processing, database management (MS Access) and statistical analysis software familiarity (SPSS and others), and presentation software required.

· Strong interpersonal and organizational skills required.

· Experience in working in insecure and austere environments. Application Procedures and Remuneration

• Application Procedures and Remuneration

Application Procedures

Interested candidates should submit their application material by the 23 October 2015 by email to zonehr.africa@ifrc.org

and the application should include the following:

· Curriculum vitae (CV)

· Cover letter which clearly summarizing experience, daily rate, and three professional references

· Technical and financial proposal for the evaluation

· One sample of recent writing (a report or similar) relevant to this ToR.

· A proposal detailing how the assignment will be carried out

NB: Application materials are non-returnable, and we thank you in advance for understanding that only short-listed candidates will be contacted for the next step in the application process.

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