Consultancy for Conducting Baseline Surveys around Knowledge, Attitudes and Practices (KAP) and Improving the Health Resilience of Rural Communities

Introduction

CARE Germany has been working in Libya since 2021 where the organization started a health resilience program targeting rural Tripoli and Sabha who have a gap in accessing health services for the poor and vulnerable communities.

This was instigated after the organization conducted a needs assessment in the targeted municipalities where the health system has collapsed because the central government could not deliver and provide rural community health services on reproductive health, specialist health treatments, provision of basic essential drugs, safe delivery services for women, messaging of health information to adolescent, and quality care for pregnant and nursing women.

A 5-year project “Improving the Health Resilience of Rural Communities in Libya” is being implemented by a consortium between CARE Germany and Action Against Hunger (ACF) funded by Federal Ministry for Economic Cooperation and Development (BMZ).

ACF, leads health system strengthening outcomes 1 & 2, CARE leads outcomes 3-5 through focusing on changing behaviours and social norms to support girls’ and women’s decision-making, leadership and access to Reproductive services as well as maternal, new born, child and adolescent health (RMNCAH) services thereby increasing the accountability and responsiveness of health providers to the communities they serve, and increasing the health system’s allocation of resources for RMNCAH services.

The consortium works closely with the Libyan Ministry of Health, Primary Health Care Institute (PHCI), Primary Health Care Centres at Municipal level, community leaders and coordinates with health actors like WHO, WFP, UNFPA and IOM who currently work in Libya. Primary Health Care services are currently overstretched due to the demand for quality services and the project is looking to increase access to services for vulnerable communities and lowering the cost of seeking more services at referral hospitals, which is expensive.

Project Overview

Improving the health resilience of rural communities in Libya. This consortium program will be implemented by CARE Germany (Lead) and ACF, in Rural Tripoli and Sabha. The project aims at improving Primary and specialist Sexual, Reproductive, Maternal, Newborn and Child health (SRMNCAH) services, and community-based activism and accountability to increase the health outcomes and resilience of vulnerable rural communities in Libya.

This program was designed to revive the collapsing health systems in Libya after the Arab spring that led to a collapse of the basic primary health care system for the vulnerable communities, affecting women and girls and this has also compromised other services like SRH, awareness and messaging of health information, quality rights service provision, information systems for tracking diseases, accountability platforms and hence sustainability of the health service providers.

The project targets 7 health facilities in two municipalities and will be working with Municipal authorities who will be the grass roots administration under which the PHCC/PHCI are managed. The program will seek to achieve the following outcomes:

• Increased availability of rehabilitated and capacitated primary health services in rural areas that meet basic standards, and provide an enhanced model of SRMNCAH quality of care and referrals for women, girls and people with disabilities
• Increased availability, access to clean, safe delivery, life-saving emergency obstetrics and newborn care (EmoNC), and other critical services for women and girls in rural areas
• Vulnerable women, girls and other marginalized groups have improved health behaviors and self-reliance, social capital is strengthened, and households and communities show greater support for gender equality and can better withstand shocks
• Primary and specialist services (public and private) are more responsive to needs of vulnerable members of rural communities, and communities more actively engage, support and hold these services accountable
• Health authorities provide sufficient and sustainable allocation of resources for SRMNCAH services and are more resilient through the institutionalization of care in rural communities

The project has conducted some initial assessments to inform the project design. ACF conducted a rapid health facility assessment in 2022 to help select health facilities for intervention and accordingly proceeded an in-depth WASH assessment in the selected PHCCs to launch the rehabilitation works by the end of 2022.

CARE conducted a rapid gender analysis in summer of 2022 to understand the different needs, capacities and coping strategies of women, men, boys and girls in rural Tripoli and Sabha and to identify key issues contributing to gender inequalities, many of which also contribute to poor RMNCAH outcomes.

Consultancy Objective

CARE seeks a consultancy to conduct a baseline study for the Improving the Health Resilience of Rural Communities in Libya. This study will include three components: 1) a health facility assessment to determine the readiness of health facilities to provide quality primary and specialist RMNCAH services; 2) a population-based survey to understand factors (e.g. individual agency, knowledge, behaviors, social norms, etc.) influencing women’s, girls’ and people living with disabilities’ access to and use of primary health information and services, especially RMNCAH; 3) a desk review of RMNCAH protocols & norms for service delivery.

The overall objective of the survey is to assess the current situations of Rural health systems in Libya, the services provided, SRH services availability, accessibility and uptake by the local vulnerable reproductive age women and young populations assessing their current knowledge and attitude towards sexual and reproductive health and rights, and to identify socio-economic and cultural factors affecting the access to reproductive health services among women and young people. Furthermore, as a reference, relevant protocols will be considered in the baseline in Libya and assess the relevance in relation to the reproductive health program to be implemented and provide recommendations on how to integrate the program for efficiency and effectiveness.

The project expects the following information and data to be collected and analyzed in this baseline survey.

• Secondary data from the health statistics at county level on service uptake or utilization on the following reproductive health services including maternal health, family planning, STIs/HIV, for the reproductive age women and young people in rural Tripoli and Sabha.
• The information, knowledge, behavior, attitude toward sexual and reproductive health and rights among women of reproductive age and young people in Rural Tripoli and Sabha and their access to services.
• Services’ quality of the current local and municipal level health systems (PHCC/PHCI) and sexual and reproductive health services provided for reproductive women and young people and referral systems in place for the targeted PHCC’s.
• Availability of basic health services and accessibility to different health services and provision of sexual and reproductive health services, specifically in aspects of SRMNCAH to reproductive age women and young people in rural vulnerable populations.
• Availability of continuous supply chain on essential medicine to PHCCs and PHCI and method of accountability and administration of institutions and existing community governance and accountability for sustainability.

In order to gain a better understanding of the project based on the baseline data, it is necessary to collect, analyze, and report the key indicators with the consultancy. The following are the survey’s key indicators:

# Of women, men, girls, boys and people with disabilities who have access to a rehabilitated primary health service in target communities

# Of women and girls who have access to enhanced basic and lifesaving RMNCAH services at primary care level in target communities by

% Of women, girls and members of other marginalized groups (adolescents at increased risk, people with disabilities) in target communities with improved health protective behaviors (practice)

# Of MoUs with government reflecting commitments to sustain gains made by project

# Of people who report increased accountability of local health services

Baseline values for those indicators be estimated and provided in the report and measurement should be done to a measurable figure and reflect the true information on level of services provided at health facilities, linkage of PHCC to Central government and community involvement on sustainability of the existing health facilities.

Main tasks and scope

• Conduct desk review – Review existing national technical guidelines or SOPs for the above-mentioned health resilience program focusing on SRHMNCAH services, access to clean, safe delivery, life-saving emergency obstetric,
• Responses of public and private health facilities on special services, and accountability of health authorities on sustainability of supported facilities.
• Review core national/local statistic data about the above-mentioned health services
• Review the existing health statistics/indicators that are regularly collected at PHCC/PHCI, reported through health information system, and collect the list of project baseline indicators.
• Review ACF HFA and CARE RGA and any other data collected by project
• Review the project logframe and develop a protocol (methodology and tools) for HFA and population-based survey including sampling and data collection method based on basic data on the target population who are the rural communities in Rural Tripoli and Sabha.
• Develop data collection tools: This should be finalized with CARE Germany before putting into action and this should be tailored to the indicators of the project as per the logframe.
• Submit protocol to relevant ethical or institutional review boards
• Conduct on-spot survey – Work with the local project-implementing partner to conduct the survey and ensure the whole process of data collection is culture/language appropriate and confidentiality secured way. The consultancy should also coordinate with MoH and the PHCC to understand the actual situation of the systems in Rural Tripoli and Sabha in coordination with the target communities.
• Analyze data
• Write baseline survey report: Develop a report with clear analysis covering the SRHMNCAH services quality, referral systems, data collection and storage system, quality of delivery services, governance and accountability and gender participation and decision making on service gap (mainly from perspective of services seekers/up takers) among reproductive age women, SRHR knowledge, attitude and behaviors and socio-economic and cultural factors affecting the access to reproductive health services among women and young people.
• Get feedback on the report from key stakeholders and modify the report as needed

Are we planning to conduct key informant interviews with health providers, community leaders and CHWs? This will provide information on their knowledge, attitudes, practices, social norms, and factors that impact access to services.

Expected deliverables

• Detailed work plan with the approach on how he/she wants to handle the work within the stipulated timeframe.
• A SRHMCAH indictors list, a protocol (methods and data collection tools), including core indicators as per the logframe with clear definitions, reporting timeline and reporting frequency, data resource.
• ERB/IRB Ethical review board / Institutional review board approval
• Clean data sets from HFA and population-based survey at the health facility and the target population in rural Tripoli and Sabha
• A completed baseline survey report (in English and Arabic), based on collection and analysis of the key project indicators, key findings, results and recommendations.

Brief overview of existing SRHMNCAH protocols and suggestions on where they should be revised to meet global WHO standards.

Timeline

The baseline survey needs to be completed within a month period with the consultancy delivering all expected outcomes of the program survey. The consultancy should develop a detailed work plan with the approach on how he/she wants to handle the work within the stipulated timeframe.

Methodology

According to civil society and human rights, the data focus would be on collecting basic information from the MoH, PHCC, beneficiaries, and referral hospitals. Assess the HF’s accountability to beneficiaries and the advocacy of community leaders for their community. Capacity and knowledge of RMNCAH among health care providers.

The survey data (people, area, and facilities) will be collected using tools developed in collaboration with the MEAL teams from CARE and ACF.

Females, children, and people with disabilities are the target demographics. For each location, the consultancy must provide a standardized approach, practice, and testing methodology.

Requirements

The organization is looking of a professional institute with experts on health resilience projects with following qualifications:

• Extensive academia experiences in quantitative research on sexual and reproductive health, on maternal and child health, family planning, gynecology, E HIV, breast cancer and cervical cancer, health education and communication.
• Experience of working with minority populations.
• Well understanding of local ethnic culture/norms in project areas about sexual and reproductive health rights and being gender sensitive.
• Proven in-depth understanding and consulting experiences on institutional set-up of complex development programs on health resilience.
• Substantive knowledge of participatory monitoring and evaluation processes and experience with multi-stakeholder/community development interventions on reproductive health.

About CARE

CARE International (CARE) is a non-religious, non-political international development and humanitarian organization, dedicated to fighting global poverty. CARE works in around 95 countries globally, engaging diverse partnerships to support communities to overcome poverty through development projects and delivers humanitarian assistance. CARE programmes address social injustice whilst placing women and girls at the core of programming in order to create sustainable positive change in poor communities. CARE is an equal opportunity employer irrespective of nationality, religion, ethnicity, caste or gender.

CARE is currently establishing its presence in Ukraine to provide relief and development assistance to vulnerable populations affected by conflict. The core sectors of CARE Ukraine’s work encompass WASH, Sexual Reproductive and Maternal Health services, Livelihoods and multipurpose cash assistance and interventions to assist vulnerable households to meet basic needs and to increase their social-economic resilience. The Country Office continues re-orienting its programming to strengthen mainstreaming of gender and protection (GBV, Child Safeguarding, Disability Inclusion, etc.) with a focus on the empowerment of women and girls in all diversities, recognizing the disproportionate effect disasters have upon their lives.

Accountability within CARE

A commitment to CARE values and CARE’s integrity framework is critical to working with CARE. Any candidate offered a job with CARE will be expected to adhere to the following key areas of accountability:

• Comply with CARE’s policies and procedures with respect to safeguarding, code of conduct, health and safety, confidentiality, do no harm principles and unacceptable behaviour protocols.
• Report any concerns about the welfare of a child or vulnerable adult or any wrongdoings within our programming area.
• Report any concerns about inappropriate behaviour of a CARE staff or partner.

Safeguarding

Children and vulnerable adults who come into contact with CARE as a result of our activities must be safeguarded to the maximum possible extent from deliberate or inadvertent actions and failings that place them at risk of abuse, sexual exploitation, injury and any other harm. One of the ways that CARE shows this on-going commitment to safeguarding is to include rigorous background and reference checks in the selection process for all candidates.

Gender equality

CARE Ukraine is committed to meeting the standards of the CARE International Gender Policy (2019). Through this policy, CARE seeks to promote the equal realization of dignity and human rights for girls, women, boys and men in all diversities, and the elimination of poverty and injustice. Specifically, this policy seeks to improve the explicit incorporation of gender in programmatic and organizational practices.