Consultancy – Needs Assessment & Fact-Finding Mission MdM Germany mission in Ethiopia

1. INTRODUCTION

The humanitarian aid organisation Ärzte der Welt e. V. is the German division of the international network Médecins du Monde – Doctors of the World (MdM). The 17 members of the network implement domestic and international health care projects: currently almost 417 projects in 74 countries around the world.

MdM provides emergency medical aid in disaster and crisis situations, supports access to health care and, where possible, assists with reconstruction measures. The network is also active in risk reduction and preparedness as well as long-term development cooperations in neglected regions around the world that receive little public attention. MdM ensures that its health services are provided equally to the most vulnerable citizens, refugees, internally displaced people (IDPs), and host communities, regardless of their ethnic, social, religious, or political background.

MdM documents and publishes eye-witness reports, human rights violations and leads campaigns to raise awareness of important topics such as poverty, migration, or the costs of specific drugs. It tries to hold decision makers accountable and to convince them to support positive changes through a variety of advocacy activities.

MdM considers access to general health care to be a universal human right for everyone.

MdM has been working in Ethiopia since 1986, implementing different types of health projects from long-term interventions to emergency responses. MdM Germany is pursuing two programmatic approaches since 2021: collaboration with local partners in development-oriented projects and implementing a larger scale emergency humanitarian intervention in Somali Region.

1. CONTEXT

MdM Germany has been working in three zones in the Somali Region since 2021 with a thematic focus on SRH/MCH by supporting health centres through capacity building, provision of equipment and medicine in addition to mobile units in decentralized areas. The mission is now scaling up its programmatic reach and aims to extend its activities to the neighbouring Afar region, Zone 5.

The overarching objectives of MDM Germany’s SRHR/MNCH (sexual and reproductive health and rights/maternal, neonatal and child health) programme are focussed on enhancing sexual and reproductive health services and rights as well as maternal, newborn and child health services to mitigate maternal, infant and child morbidity and mortality rates. These objectives entail the following:

1. Improve access to and quality of primary health care services.
2. Extending and integrating SRHR/MNCH services into remote underserved areas.
3. Implementing education initiatives on health and nutrition and infections among mothers and children.
4. Promoting the adoption of safe water practices, sanitation, and hygiene along with facilitating immunizations.
5. Advocating and supporting effective family planning programmes.
6. Establishing robust referral pathways to ensure timely access to specialised care.
7. Providing beneficiaries with information and support concerning Gender Based Violence (GBV) and protection mechanisms during crises and conflict situations.

Context of Afar Zone 5

The Afar Regional State is in one of the most remote areas of Ethiopia with an estimated population of two million people and is presented with some of the harshest climatic conditions. The Region has international borders with Eritrea in the northeast and Djibouti to the east, in addition to national borders with Tigray Region in the northwest, Oromia Region in the southwest, and Somali Region in the south. The Afar Region is divided into five administrative Zones and 30 Woredas.

The deteriorating humanitarian situation in recent years has led to increased humanitarian needs across Ethiopia. The conflict in the northern parts of the country, violence also in many other parts, and natural hazards such as one of the worst droughts in recent decades, frequent floods, and landslides are the main drivers of displacement.

The health indicators of Afar Region are comparable to Somali Region, where MdM Germany already operates, and are among the lowest in the country. The humanitarian needs are caused by conflicts, drought, food insecurity, water shortages, vulnerability to diseases, forced displacement, and disease outbreaks. Access to healthcare is hindered by lack of properly functioning health centres, geographical barriers, poor quality healthcare provision and inadequate referral systems. In addition, women face significant sociocultural barriers which hamper their access to health services.

Selection of intervention areas

The planned project is in the southwestern Afar province, Zone 5, with an estimated total population of 210,000 people, and specifically in two Woredas of Zone 5, namely Telalak and Dawe. MdM France previously conducted a health project focusing on FGM (female genital mutilation) in the same Zone (5) from 2014-2017 together with a local partner, the NGO Common Vision for Development Association (CVDA). The latter has many years of experience in this remote region, where they implemented a health project to improve the maternal and child health care services at Dalifage Hospital in the same Zone. The humanitarian response capacity in the region remains minimal and inadequate, increased by a shortage of humanitarian partners due to the consequence of the northern conflict and protracted drought-impacted communities.

The big part of the region is subject to harsh, dry, and changing climatic conditions. The inhabitants are semi-nomadic pastoralist communities who organise their settlements in small communities along the pasture grounds. The distances to health facilities therefore vary and for the transport of long distances, only donkeys, camels or carriers are available in an emergency. Maternal, neonatal and child health services in these rural areas is especially poor. Maternal mortality is also elevated. Endemic anaemia and eclampsia appear to be common causes of death during childbirth. Haemorrhage associated with traditional FGM and infibulation is also reported to be common and potentially fatal.

In the latest report (January 2024) the prevalence of acute malnutrition in Afar is serious and critical for the coming period, subsequently resulted from the deficiency of rain during the 2023. 4.3% of 40,000 children in hard-to-reach areas of Afar suffering from severe acute malnutrition (SAM) and 42% diagnosed with moderate acute malnutrition (MAM). In addition, over half of the 44,000 screened pregnant and lactating women showed signs of acute malnutrition. In Addition, livestock herd sizes are low, which is key food and income source, and livestock body conditions are poor due to the drought. Furthermore, the region also hosts an estimated 56,800 internally displaced persons (IDPs) and about 222,900 returnees who are among those affected by drought.

The initial intervention is for period of 4 – 6 months, with limited resources (around 300.000 EUR total), and due to access & other logistical impediments, it is planned to be implemented in two Woredas of the Zone, namely Telalak and Dawe Woredas, with an estimated total population of about 51,000 and 57,000 respectively. However, it is envisaged to continue the project after the initial phase for 36 months. Therefore, the consultancy should take into consideration this two-part planning.

1. OBJECTIVE OF THE CONSULTANCY

Conduct a comprehensive assessment of primary health care services in selected Woredas of the Region with a focus on SRHR and MNCH that is aligned with MdM Germany’s intervention in the Somali Region and its overall strategy in Ethiopia, including the following:

1. Gather pertinent information from all centres in Telalak and Dawe Woredas of Zone 5, Afar Region, Ethiopia and assess the availability, accessibility, and quality of the provided primary health care services.
2. Identify SRHR/MNCH needs by comparing current service provisions with population requirements.
3. Assess the capacity of the existing health system to meet SRHR/MNCH needs.
4. Identify gaps in community nutrition and WASH provision, analyse root causes, and propose action plans within available resources including specific locations / health centres.
5. Assess the acceptance of health education on FGM in Afar context and provide effective methods to sensitize the community to create awareness about the harmful effects of FGM in order to change attitudes and values.
6. Establish baseline values for SRHR/MNCH, WASH, and nutrition project indicators.
7. Provide a mapping of the different stakeholders involved in SRHR/MNCH and GBV to ensure coordination between the different actors.
8. Recommend/suggest a response strategy for the interventions to address specific SRH/MCH, nutrition needs and WASH-related issues.
9. Propose potential Woredas for the extension period, starting from January 2025 and provide the necessary assessment tools to conduct detailed assessments at the facilities of the proposed Woredas.
10. In collaboration with MdM Germany’s team, conceptualize and develop comprehensive intervention packages to address identified gaps.

This list is not exhaustive. The consultant is required to use their professional knowledge and experience to review all relevant factors and bring these to the attention of MdM Germany.

1. METHODOLOGY

   Preliminary work

a) Literature/secondary data review: literature review and analysis of existing data from relevant stakeholders (MdM and others).

A thorough review of data sources to be conducted to collect existing SRHR/MNCH information on the affected population. Those statistics are available from Afar Regional Health Bureau, UN agencies, and other nongovernmental organizations, not limited but including: –

• Demographic and Health Survey (DHS) or other available survey data
• Routine surveillance or health facility data, such as those reported to district or national health information systems.
• Availability of SRHR/MNCH services, their geographical distribution, and functionality.
• National strategic plans.

b) Briefing with MdM HQ as well as the management team in Ethiopia

c) Suggestion and discussion of the field visit (sites, duration, interviews) together with the management team in Ethiopia.

d) The consultant will work in close collaboration with and will be accompanied by the Medical Coordinator and MEAL Officer of MdM Germany in Ethiopia.

Field Work

1. Two Woredas of Afar Region
2. Meetings and briefings / debriefings with the management team in Ethiopia
3. Conduct in-depth interviews with key informants to gather qualitative insights on challenges and best practices.
4. Organize focus group discussions to capture community perspectives on SRHR and MNCH services.
5. Undertake facility audits of health care facilities to assess infrastructure, equipment, and human resource capacity.

Reporting

1. Develop a response strategy, including intervention packages.
2. Present the results to MdM Germany HQ and management team in Ethiopia.
3. A written assessment reports.

The consultant will be responsible for developing and presenting a sound methodology. The methodology will be submitted as part of the application process and will be finalised before the departure to Ethiopia with MdM Germany.

1. DELIVERABLES

Before the field visit: a concept note (in English) describing the finally agreed methodological approach as well as workplan and timetables.

After the field visit: Assessment report (in English), including:

• findings, analysis, recommendations,
• a proposal for an efficient project set-up and structure
• intervention strategy for the initial phase of 6 months as well as the follow-up project of 36 months, including 2 Logical Framework (initial phase, follow-up project) which specifies the project objectives, results, activities, includes baseline indicators as well as SMART indicators to be achieved and analysis the risks.

All documentation will be property of MdM Germany and will be disseminated as appropriate.

1. LOCATION OF THE ASSESSMENT

The assessment will be carried out in Afar Region, Zone 5, Telalak and Dawe Woredas.

1. TIMEFRAME

The assessment is expected to take place between April and May 2023 for about 4 weeks. The following preliminary timeframe is foreseen while a final timetable is expected from the consultant.

Preparation and desk study, including briefing with MdM Germany HQ: 3 days

Travel to/from Ethiopia: 2 days

Field visit including project development: 10 days

Debriefing with MdM Germany Ethiopia Management and report writing: 5 days

TOTAL

20 Days

1 week after departure from Ethiopia: Submission of draft assessment report to MdM Germany to collect feedback.

2 weeks after departure from Ethiopia: Submission of final report to MdM Germany.

MdM Germany will organise transport and accommodation to and within Ethiopia and will provide administrative and logistical support.

1. REQUIRED EXPERTISE

• Advanced university degree in health-related field such as, Public Health, Medicine, Epidemiology.
• Strong research skills, incl. data research, interviews, and analysing complex information.
• Demonstrated experience in conducting health care baseline surveys/assessments, particularly in SRH and MCH. At least 5 years of proven experience in programme or project design including monitoring.
• Ideally experience in managing multi-sectoral health interventions and teams in challenging contexts.
• Strong proposal development and writing experience with a variety of donors.
• Familiarity with the local and regional context is an asset.
• Fluency in English (spoken/written).