Consultancy service for conducting midterm review of Health Systems Strengthening Project in Sudan – EU funded.

Executive Summary

GOAL has been responding to a wide range of humanitarian and development needs in Darfur since 2004 and is currently supporting the provision of primary healthcare services in 17 facilities across Kutum and Al-Waha localities, North Darfur. To response to the changing security and political context in Sudan, GOAL has developed HealthPro project to promote durable solutions for displacement-affected communities, as well as long term access to quality health services. The project is designed to strengthen the capacity of the decentralized health system in North Darfur to provide sustainable services in the target localities of Kutum, Serf Umra and Umbaro in North Darfur, by increasing the quality of, and demand for, services. Activities range from infrastructure rehabilitation and financial support to the health system, to improving monitoring and supervision, quality assurance, data collection for enhanced planning and decision making. It links top-down approaches, via health systems strengthening, with bottom-up approaches via community systems strengthening, in order that demand, access and quality of health service provision and delivery are optimized.

Project Background

HealthPro is a project funded by the European Union Trust Fund and aims to build capacity of the North Darfur State Ministry of Health (SMoH), the LHDs of Kutum, Umbaro and Serf Umra, 10 PHC facilities, and community structures within the catchment areas of the health facilities for a sustained delivery of health services in the areas. In addition, the project provides targeted reproductive health support to Serf Umra Rural Hospital to strengthen the referral linkages with the PHC facilities in the locality. HealthPro employs a health system strengthening (HSS) approach whereby project stakeholders jointly conduct capacity-building while gradually transitioning all health system functions of the targeted localities and facilities to the government. Ensuring the LHDs have infrastructure, resources, and systems in place, linkage of the health facilities to the National Health Insurance Fund (NHIF), training health workers and managers, and infrastructure and equipment support to the health facilities and the National Medical Supplies Fund (NMSF) are among the key project interventions at the level of institutions. Improving the Health Management Information Systems (HMIS) to strengthen planning, decision-making and resource allocation in the decentralized system is another focus area of the project.

In terms of governance and accountability, HealthPro aims to ensure the three LHDs have qualified and skilled staff, infrastructure, facilities, systems, and tools to own the management of health service delivery in their locality. In addition, the project strengthens existing community-level social accountability mechanisms through capacity building and support to Community Health Committees (CHCs) with the aim to promote strong relationships between the target communities and service providers and ensure that services are shaped by feedback from users and are responsive to their needs.

In relation to healthcare financing, HealthPro promotes increased access to health insurance provided by the NHIF and financial risk protection, initially through financial support for premiums and other health system costs, while linking the poorest of the poor to community groups and social funds to promote sustainable financing of these costs. In addition, the project supports the establishment and registration of Village Savings and Loans Associations (VSLAs) to enhance the capacity of community members to pay for insurance. Thus, the project enables vulnerable households to access high quality health services through a sustainable system, while avoiding financial hardship.

At community level, HealthPro has rolled out GOAL’s existing community-based preventative health and nutrition programming, including the Care Groups (CGs), Nutrition Impact and Positive Practice (NIPP), and School Health Clubs activities. The project provides technical and financial support to selected National Non-Governmental Organizations (NNGOs) to implement these interventions and awareness creation campaigns to promote healthy behaviors and mobilize communities to enroll to NHIF.

Purpose of the Review

The purpose of the review is to assess the impact of the intervention so far on the beneficiaries as per this grant and to document lessons learned, best practices as well as evaluate GOAL’s performance in strengthening the health systems in North Darfur State.

Scope of the assignment

The mid-term and final evaluation process will involve all relevant project stakeholders including GOAL staff, NHIF, NMSF, LHD, SMoH, communities, national NGOs, The study process will include desk review, field visits, interviews, group discussions with stakeholders and beneficiaries.

Geographical locations: The studies will be conducted in three localities where the project is implemented including Kutum, Umbaru, and Serf Umra. Towns, IDP settings and villages within catchment of ten targeted health facilities will be identified purposively and randomly for data collection. Specific details on Annex 1.

Evaluation type

This is a mid-term project review to assess the performance of the project so far and provide recommendations on actions to ensure objectives are met by the end of the project.

Key Evaluation questions

The evaluation questions which will be addressed by the evaluation will include relevance, coherence, sustainability, and efficiency.

1. Efficiency

The evaluation of the efficiency of the project will investigate answer to the following questions:

• To what extent were the resources well used in the project implementation
• Did the project make the best use of the available resources?
• What better ways, if any, would there be ways to achieve the objectives of the project more economically?

1. Relevance

The evaluation of the relevance of the project will investigate and make conclusions on the following areas:

• To what extent did the intervention objectives and design respond to beneficiaries, country, and partner/institution needs, policies, and priorities”
• Does the project have the right data to assess progress, does anything need to change there?
• Does the project have the right type of interventions to achieve the desired outcomes? Does anything need to change there?
• Has the context changed? Is the project still relevant and appropriate for the context where it was implemented?

1. Coherence

The evaluation of the coherence of the project will investigate how well this intervention fit, the compatibility of the intervention within the strengthening a decentralized health system in the country as laid down by the FMOH strategy.

• To what extent did the project intervention fit?
• To what extent was the consistency of the intervention with the relevant international norms and standards and how did GOAL align its implementation with the strategy of FMOH
• What were the synergies and interlinkages between the intervention and other interventions carried out by the government and to what extent was support given to the federal ministry, state ministry and locality health departments?

1. Sustainability

The evaluation of the sustainability of the project will investigate and make conclusions on the following

• To what extent are the net benefits of the intervention likely to continue.

Methodology

GOAL recommends a mixed methods approach comprising both the qualitative and quantitative components designed to capture project performance and quantify project. A baseline was conducted at the onset of this project. The consultant is expected to integrate the methodology used for the midterm review. The study design will entail a holistic evaluation, the methodologies that may be used are listed below but not limited to:

• A comprehensive secondary literature desk review of the relevant project documents provided by GOAL to offer an insight into the project background and activities.
• Appropriate sampling strategies in line with this kind of evaluation
• Field visits, to inspect the project activities and gain first-hand information of the impact of both covert and overt nature while observing the 1-2 meters social distancing during interaction with the staff in the project locations.
• Key informant interviews: These will target the staff who participated in the program design and execution; local stakeholders whose input will be crucial in getting information about critical points of the project design and implementation. During these interviews the consultant will ensure that all participants observe the 1-2 meters social distancing

Focus Group Discussions: to capture evaluation information applicable to specific stakeholder groups, from an insider point of view held in a well-ventilated area and with limited fewer people with sufficient social distancing measures in place

• Quantitative analysis of monitoring /DHIS2 data
• Observation method, to see some of the outputs of the project, establish the stated aspects, and see how they are being used
• Photography to provide sample visual images of appropriate project outputs
• Stakeholder and staff debriefing, to corroborate collected information and incorporate the inputs of the people who were on the ground during the implementation of the project

Responsibilities of Consultant

• Refine the evaluation objectives and primary research questions in consultation with GOAL’s technical and management teams based on the ToR
• Devise and test a methodology and evaluation tools to address the specific objectives and individual research questions of the evaluation
• Conduct secondary data collection and research, including using existing project monitoring data, to identify gaps in data coverage and knowledge
• Collect primary data to establish and quantify project performance against selected programme indicators and criteria outlined above
• Incorporate GOAL feedback into a draft report and prepare a final report. The final report should both describe the results of the evaluation, and provide actionable recommendations for replicating the project on a larger scale and improving GOAL’s programming in general
• To adequately deploy male and female Field Enumerators in facilitation of project’s evaluation in all the targeted areas for gender inclusion.
• Supervision of the field work and quality (reliability and validity) of the data/information collected from the field is the primary responsibility of the consultant.
• The consultant will work closely with the GOAL MEAL team at all levels and Project Team. In each step and process, there will be consultation with the HealthPro coordinator, PQD coordinator and Head of Programs.
• Consultant will be responsible for consent, data protection, safeguarding, etc.
• The consultant should share the main findings with the project’s stakeholders and research participants in an audience-appropriate way. Later GOAL will share the findings, recommendations and lessons learned with donor, national and international partners.

Reporting

The following reports will be submitted:

• An inception report within 2 weeks of the start of the consultancy work
• An interim report to share preliminary findings 1 week after completion of data collection
• Final report (1 week after the completion of the consultancy work): soft and hardcopies. The final report shall not exceed 30 pages but can add annexes. The report shall include Executive Summary, Methodology, Mapping out of the successes and weaknesses in strengthening a decentralized health system, Analysis/Findings of the OECD DAC criteria, conclusion, and Recommendations.
• All reports should be written in English with correct grammar and spelling.
• The consultant will do a de-brief presentation for key stakeholders either in Khartoum or at the field levels and incorporate feedbacks as appropriate.

Evaluation timeline:

GOAL plans to conduct the evaluation starting from 15th June 2022 and will approximately take 30 days.

Application procedure

The proposals received will be evaluated according to the following criteria:

• Technical Methodology Proposal (Research Methodology evaluation workplan) and composition of working team (based on the qualification of the consultant) -70% (minimum threshold is 40%)
• Pricing 30%

Interested consultants/firms should submit the following:

• Research Proposal/Technical design of the research: Research Methodology including sampling techniques, data collection, data analysis, presentation and reporting
• Proposed evaluation workplan
• CVs of key consultant and other team members where relevant.
• Outline of relevant previous experience in similar kinds of evaluation assignments.
• Financial proposals (please do not include accommodation and domestic travels as it will be provided by GOAL)

Qualification and experience required

• Advance university degree in in public health or any other relevant field with minimum three years working experiences in research, monitoring, and evaluation.
• Broad knowledge of development, health systems strengthening and nexus projects, specifically in the Health and Nutrition.
• Proven good record in evaluation of development and humanitarian projects in the NGO sector/ UN and ability / commitment to meet agreed deadlines.
• Background experience in undertaking similar project evaluations including evaluating EU-funded projects.
• Professional qualification in health field will be an added advantage.
• Fluency in English is a requirement and in Arabic is preferred.
• Excellent verbal/written communication skills & strong report writing skills.
• Awareness of cultural sensitivities and local context.
• Ability to work with a team and under pressure to meet deadlines and produce agreed deliverables.

Integrity and Honesty

Throughout the evaluation process, evaluators must act with integrity and honesty in their relationships with all stakeholders including the programme participants and project staff. Evaluators shall adhere to evaluation professional ethics and ensure respect and dignity for programme participants and other stakeholders. Integrity and honesty of evaluation consultants relates to the GOAL Code of Good Practice and shall be treated as such. All GOAL contracted evaluators shall, at all times, comply with GOAL policies, including, without limitation, the following, and copies will be made available:

• Code of Conduct
• Child and Adult Safeguarding Policy
• Conflict of Interest Policy
• Anti-Fraud Policy
• Whistleblowing Policy
• Security Manual; and
• Data Protection Policy