Call for Proposal: Evaluation of MSF SGBV project in Kananga, DRC – readvertisement (English)

Doctors Without Borders/Médecins Sans Frontières (MSF) is an international medical humanitarian organization determined to bring quality medical care to people in crises around the world, when and where they need regardless of religion, ethnical background, or political view. Our fundamental principles are neutrality, impartiality, independence, medical ethics, bearing witness and accountability.

The Stockholm Evaluation Unit (SEU), based in Sweden, is one of three MSF units tasked to manage and guide evaluations of MSF’s operational projects. For more information see: evaluation.msf.org.

Promoting a culture of evaluation is a strategic priority to be accountable, seek for continuous improvements and achieve organizational learning. MSF does not evaluate only because of external requirements, for example donors related ones. Evaluation is seen as a duty, for MSF to be accountable, seek for continuous improvements and achieve organizational learning. These Terms of Reference should be seen as a starting point for the evaluation process. The evaluator(s) are welcome to challenge them and suggest for example different or additional perspectives, as they see fit during the inception phase. The evaluation process should rely on solid methodology to achieve credible results and should also ensure to put values and use in the forefront. The evaluation must involve and include different actors and counterparts in an adequate manner during the whole process.

Special considerations:

a) This evaluation has a time span of approx. a year. The evaluation is developmental in its approach.

b) It is an evaluation divided into two main phases (ex-anted, mid-term) that should generate continuous feedback to allow the adaptation of the project during the implementation itself (and not waiting until the final report).

The exact timing of the evaluation is likely to be adjusted according to the reality on the ground vs. planning, as well as the methodology suggested by the evaluation team.

THE PROJECT AND THE EVALUAND

Médecins Sans Frontières Brussels Operational Center (OCB) has been working in the Democratic Republic of Congo (DRC) since 1977, through varied long-term projects, as well as through a local Emergency Response Pool (PUC).

The Kananga project (Kasaï Central) started in 2017 and experienced frequent changes in strategy and direction (surgery, malnutrition, primary care in mobile clinics, management of sexual violence) in line with the changing context. From October 2017, in line with its medical activities, MSF further engaged with the community to increase awareness of sexual violence (SGBV) and of MSF services in this area. New cases treated monthly quickly reached more than 200 per month. In April 2019, the project took on a more ‘vertical’ approach by focusing solely on medical and psychological care for survivors of sexual violence at the Kananga Provincial Referral Hospital (HPRK). The care package also included family planning (FP) for all patients who requested it at the HPRK level.

In 2020, the project added a decentralization component of its activities in the HPRK by integrating its SGBV and FP activities in the Health Centres of Kananga city. The decentralization strategy aimed to:

• Improve access to SGBV and FP care,

• Strengthen capacities of staff to provide care for victims of sexual violence at the level of Health Centres,

The decentralization support was gradually implemented in four Health Centres in the Kananga and Bobozo Zones de Santé (district health zones) from June 2020 onwards. Later in 2020 however, the project pulled out from the East District Health Centre in the Bobozo Zones de Santé due to the facilities being in poor condition and without the possibility of renovation and the low impact of medical activities.[1]

In 2021, the support was extended to two new Health Centres in the peri-urban Zones de Santé of Tshikaji and Lukonga. During the last quarter of 2021, 25% of new SGBV patients (out of a total of 752 new patients) received care in structures supported by MSF’s decentralization work. The project also saw an increase in the number of patients accessing care within 72 hours of the assault (43% in Q4 2021).

From January 2022, the project wishes to implement these activities in a decentralized and integrated way in a new Health Centre (referred to as CdS 1 – Centre de Santé – in these ToRs) while adopting a more systematic, planned, and concerted approach. This Health Centre still needed to be identified (as of February 2022), but it would be located within the Tshikula Zone de Santé.

A range of activities, tools and training will be set up in the CdS 1 by MSF teams to further strengthen the capacity of health providers, via the Ministry of Health (MoH) staff, in providing quality SGBV and FP care. Health promotion activities are also aimed at making these services known to the population and increase the use of a medical service within 72 hours after a rape. The community and provincial health authorities will be involved in the project as implementing partners. Indeed, it is key that they take ownership of the integrated approach so that services continue to be provided and used after MSF’s activities are fully handed over to the Health Centre. Rehabilitation works are also planned if necessary.

From July 2022, the Kananga project plans to follow the same approach as in CdS 1 in two other Health Centres (CdS 2 and CdS 3). Ultimately, the objective of the project is that the decentralized and integrated activities approach in the Health Centres is taken over by the MoH, or other humanitarian medical organizations and ideally replicated in other structures in the Province of Kasai Central, and potentially beyond. The project foresees a closure in September 2023, after the handover of activities in CdS 1, 2 and 3.

Fifteen (15) months are planned to implement these activities in each Health Centre: preparation (3 months), implementation (3 months), reinforcement (3 months), disengagement (4 months) and handover (2 months).

PURPOSE AND EXPECTED USE

This evaluation has a dual purpose:

• (1) As a first step, to evaluate the design and planning of the project for CdS 1 and its prospective implementation process, and to what extent it seems to be able to achieve the defined objectives, which are improving patient care, capacity-building of the Health Centre staff and MSF’s quality of delivery of SGBV-related activities, as well as to suggest adjustments if applicable.

• (2) In a second step, to evaluate the results of the implementation in CdS 1, to learn from this first experience and to inform the next phases of the project (i.e.: exit and hand-over strategy for CdS 1 and lessons learnt for implementation of CdS 2 and 3).

This evaluation is divided into two main phases and will rely on continuous feedback throughout the project implementation to allow the adaptation of the project during the implementation itself. The exact timing of the evaluation is likely to be adjusted according to the reality on the ground vs. planning, as well as the methodology suggested by the evaluation team.

The evaluation will foremost be used by the Kananga project to optimize its implementation in CdS 1 and draw lessons learnt for CdS 2 and 3, before handover of the project in CdS1, 2 and 3.

The evaluation may also inform other or future SGBV projects, MSF and non-MSF ones, in the DRC or elsewhere.

EVALUATION QUESTIONS

First phase: Evaluation of the project design and planning for CdS 1 as well as its prospective implementation process.

=> Continuous feedback for real-time adjustment during CdS 1 project implementation as well as restitution and interim reporting by July 2022 at the latest.

QE 0: Description of the project and its intended application in CdS 1 (activities and how they will be implemented)

QE 1: Do the project objectives seem relevant given the observed and expressed needs, the context, and MSF’s priorities?

QE 2: Are the strategy, design, planning and prospective implementation process of the project coherent given the context and existing resources? How could the approach become more coherent?

QE 3: Has the implementation of the project been planned while sufficiently considering the different actors?

EQ 4: To what extent has the project design considered lessons learnt and experiences by MSF and, if relevant, by other actors?

EQ 5: What is the likelihood for the project, as it has been designed, to achieve its objectives?

QE 6: What are the prospects for replicability of the project, as it has been designed, and under what conditions?

Second phase: Evaluation of the results obtained in CdS 1 and informing next phases of the project.

=> Continuous feedback as well as restitution and final report by May 2023 at the latest.

QE 0: Description of the project as implemented in CdS 1 (activities and ways in/how they were implemented).

EQ 1: Were the project objectives relevant in view of the observed and expressed needs, the context, and MSF’s priorities?

QE 2: Were the strategy, design, planning and implementation of the project coherent given the context and existing resources? How could the approach have become more coherent?

QE 3: Has the implementation of the project sufficiently considered the different actors?

QE 4: Has the project achieved its expected results?

§ To what extent are the outputs in line with the quality standards and expected results?

§ What were the reasons (facilitating or preventing factors, expected or unexpected challenges) for whether the expected results were achieved?

§ How could the project have become more efficient?

EQ 5: What resources has the project required, have they been available, and could they be mobilized more efficiently?

QE 6: Has the project had an impact?

§ To what extent has the project achieved its general and specific objectives?

§ To what extent has the project achieved sustainable results?

§ What are the effects of the project as perceived by patients and other counterparts?

§ What are the negative and positive consequences, expected or unexpected, of this project?

QE 7: What are the prospects for replicability, by MSF or other actors (MoH, other organizations) and under what conditions? What are the lessons learnt to consider for CdS 2 and CdS 3?

EXPECTED RESULTS

1. Inception report in French.

According to SEU standards, after a preliminary desk review of documents and initial interviews with key informants. It will include a detailed evaluation proposal, including methodology and timeline.

Phase 1

2. Continuous feedback.

Continuous feedback (modalities to be proposed by evaluator) by sharing observations with the project team and the consultation group for the evaluation, in real time. This is particularly important in order to feed into the ongoing project implementation and to make any adjustments deemed necessary, without waiting for the draft interim report.

1. Interim report in French (Phase 1) – July 2022 at the latest.

According to SEU standards, it will answer evaluation questions and include conclusions, lessons learned and possible recommendations (where appropriate, and ideally generated collaboratively, see Working Session).

Finalization of the report after addressing the feedback received from the SEU and the Consultation Group.

4. Presentation during a restitution session.

Phase 2

1. Continuous feedback (see Phase 1 – point 2 above).

2. First version of the final evaluation report (Phase 2) – May 2023 at the latest.

According to SEU standards, it will answer evaluation questions and include conclusions, lessons learned and possible recommendations (where appropriate, and ideally generated collaboratively, see point 6. Working session). This report will also analyse the first phase of the evaluation and to what extent conclusions in the draft interim report were addressed by/in the project.

1. Working session.

With the participation of the Commissioner and members of the Consultation Group. This session is an integral part of the final report writing process: the evaluator(s) will present the findings, to gather initial feedback from participants, as well as start a discussion on it, lessons learned and recommendations (if applicable, and ideally generated collaboratively).

1. Final report in French (the SEU will organize the translation into English).

After sending the feedback received during the working session, as well as the written comments of the Evaluation Manager (SEU) and the Consultation Group, finalization of the report.

1. Webinar presenting the evaluation, questions and answers and discussion (target audience: MSF OCB all staff, and beyond if deemed relevant). Other dissemination activities may be suggested during the evaluation, including by the evaluation team.

TOOLS AND METHODOLOGY

In addition to the proposal submitted during the selection process (see the Evaluator Profile section below), a detailed evaluation protocol should be prepared by the evaluators in the initial phase of the evaluation and presented in the inception report. It will include an explanation of the proposed methods as well as a justification based on validated theory(s). This protocol will be reviewed and approved at the end of the initial phase, under the coordination of the SEU.

RECOMMENDED DOCUMENTATION

§ Project documents (baseline, narratives, logframe, monthly and annual reports, medical database, flowcharts, presentations, visit reports, decision-making, etc.).

§ Direct contact with person(s) in charge of collecting and managing medical and other types of data at project level.

§ MSF sources (strategic orientations, operational priorities, protocols and policies, operational research, etc.).

§ External literature, similar experiences, other actors, standards, etc.

Implementation of the Evaluation

Number of evaluators: To be suggested by applicant(s)

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Evaluation Timeline: April 2022-May 2023

Field visit for data collection: Field data collection in Kananga. Date(s) of data collection to be defined during the initial phase of the evaluation, in consultation with the SEU and evaluation stakeholders. Data collection will also need to take into consideration possible restrictions regarding COVID-19.

PROFILE/requirements for the Evaluator(s)

§ Requirements:

o Demonstrated expertise in evaluation

o Experience in managing humanitarian medical programs, ideally focused on sexual and reproductive health (SRH) and sexual and gender-based violence (SGBV).

o Excellent command of French and English within the team. The evaluation will be conducted in French and ideally the evaluator(s) will produce the report in French and English (or organize the English translation once the report has been validated).

o Adherence to humanitarian principles and MSF values.

§ Merits:

o Clinical experience and training in SRH, with a focus on SGBV.

o Training in public/global health.

o Experience and/or training in health systems, with a focus on capacity-building.

o Knowledge of the context.