Fred Hollows Foundation
Introduction
The Fred Hollows Foundation (The Foundation) is a secular non-profit public health organisation based in Australia, which was founded in 1992 by eminent eye surgeon Professor Fred Hollows. The Foundation focuses on strengthening eye health systems and the treatment and prevention of avoidable blindness caused by Cataract, Trachoma, Diabetic Retinopathy, and Refractive Error. The Foundation operates in over 20 countries across Australia, The Pacific, South and South East Asia, and Africa. The Foundation was named The Australian Charity of the Year 2013 in the inaugural Australian Charity Awards.
The Foundation began working in Kenya in 2004 Today, it is one of the leading Eye care International non-governmental organisations (INGO) in Kenya. The Foundation works in partnership with 21 county governments department of health and other community based organizations and private entities
The Foundation conceptualized the idea of working on healthy ageing and eventually funded the project idea for a one-year pilot in between January to December 2023.
Project background
The Fred Hollows Foundation Kenya has been implementing a pilot project on healthy ageing in Siaya county with a focus on Alego Usoga Sub-county. This project was designed to address knowledge gaps on healthy ageing and eye health care through improving access to knowledge on healthy ageing and eye health care for older persons, their families and communities. The project was addressing the limited access to healthcare services for older people with a specific focus on inclusive and age-friendly eye health services that include eye health education, community screenings, referrals, treatment and management of eye health conditions. In addition, the project also covered related activities around advocacy, capacity building and community engagement to promote access to healthcare services for older people. The project targeted the county department of health, the county referral hospital eye health units, the department of social services and other organizations like Help Age International Kenya who work with community-based organizations that work within the healthy ageing space or with older persons like KESPA to run a chain of older persons associations within Siaya county.
The project’s target population was older persons aged 60 years and above in Siaya County. According to 2019 KNBS census data for older persons, there are 80,519 older persons of 60 years and above in Siaya County (31,146 males and 49,372 females).
The healthy ageing framework is poorly understood in Kenya and the health system of the country is to date unresponsive to the specific needs of older populations, lacking guidelines and protocols to guide the health sector response, as well as formal training for healthcare workers.
Government funding for healthy ageing is also limited and there is currently no free, universal access to healthcare services, including eye health care, making the few services that are available unaffordable and therefore inaccessible to older people, who are among the poorest in the country. This is illustrated by the limited number of cataract surgeries performed in this population group. Although older people experience 65% of the burden of cataract, only 35% of beneficiaries of cataract surgeries conducted by the Fred Hollows Foundation are older people, with older women being significantly underserved.
Older people also have limited awareness of their rights and of existing social support mechanisms, which further hinders their access to services and their mobilization to demand better coverage of interventions.
Project goal: To enhance access to knowledge on healthy ageing and to eye healthcare for older people (60+) in Siaya and Embu counties through improved access to educational opportunities and eye healthcare services and strengthened capacity of institutions to advocate for more and better projects for older people.
Project outcomes:
- Improved access to knowledge on healthy ageing, inclusive of eye health for older persons, their families, and communities.
- Increased access to inclusive and age friendly eye health services for older people through education, screenings, referrals, treatment, and management of eye conditions.
- Strengthened capacity of healthy ageing institutions, older people’s associations and supporting organizations to advocate and amplify the voices of older persons.
Purpose of the evaluation
The purpose of this evaluation is to assess whether the project achieved its intended objectives and how lessons gained from the project can be integrated and used for ongoing improvement. This means that there are two overall purposes of this evaluation:
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Accountability – proving what has been achieved.
- Assess to what extent the project achieved its key outputs, outcomes, and impact.
- Demonstrate the value of the integrated care for older people approach in improving system efficiencies and generating better health outcomes for older people.
- Verify the monitoring data that has been collected by the in-country program teams throughout implementation
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Improvement – understanding learnings to inform decisions about future work.
- Capture lessons regarding project implementation to help improve current and future programming in the country and support the development of future projects.
- Assess the potential scalability of the project focused on older populations in the country.
Evaluation Methodology
The consultant is expected to complete the final evaluation and will be provided with a package of pre-designed methodology and tools that will only require local contextualisation. Additionally, the consultant will be provided with a detailed evaluation protocol that includes country specific guidance as well as an evaluation plan outline that should be used by the consultant to develop the country evaluation plan.
Evaluation scope and key questions
The evaluation aims to provide detailed information on all pre-defined indicators for the project and to understand the extent to which the project achieved the intended aims and objectives, and also their relevance, effectiveness, efficiency, impact, coherence and equity. Specific guidance on how to carry out the evaluation, including the country specific evaluation framework, and information on how the work will be coordinated with the global evaluator team that will oversee the evaluations across the five countries implementing healthy ageing pilots for the Fred Hollows Foundation; and the way in which information should be presented in the evaluation report and other deliverables will be provided to the selected consultant upon contracting. Below is an overview of the key evaluation questions that we aim to respond to:
Evaluation criteria
Key evaluation question(s)
Effectiveness: (Is the project achieving its objectives?)
KEQ 1: To what extent has the pilot’s outcomes been achieved and to what extent has the project contributed to achievements against the outcomes?
SQ 1.0: To what extent has the pilot project identified and seized opportunities to develop new or strengthen existing partnerships?
SQ 1.1: To what extent has access to integrated care for older people improved in the targeted geographic locations? (Note: this question will also look at reach)
SQ 1.2: To what extent has the capacity of healthcare providers (and others where relevant) increased to provide integrated care for older people?
SQ 1.3: To what extent has the pilot project raised awareness of health conditions affecting older persons, and increased understanding of when and how to seek help? (Note: this links to health literacy and self-care)
Efficiency (How well are resources being used?)
KEQ 2: To what extent has the pilot delivered results in an economic and timely way?
Relevance (Is the project doing the right things?)
KEQ 3: What is the additional value of taking a focused approach on older populations compared to a general eye care project in relation to improving the health of older populations?
Impact (What difference does the project make?)
KEQ 4: To what extent has the quality of life of older people reached by the pilot improved? How significant was the Foundation’s contribution to this and were there any differences between men and women? (Note: only relevant to beneficiaries who received treatment through the pilot projects)
KEQ5: To what extent has the health of older men and women improved, and how significant was the Foundation’s contribution to this?
KEQ 6: Were there any unintended outcomes (positive or negative) that resulted from the pilot project?
Coherence (How well does the project fit?)
KEQ 7: To what extent does the pilot align with government objectives in relation to promoting the health and wellbeing of older populations?
(Note: this is generally focused on external actors, rather than just those internal to the project, and looks at coherence with the broader agenda within each context)
Equity (How well is the project addressing inequity?)
KEQ 8: To what extent has the pilot project reached all of the target population (i.e. older people living within the target communities, including different age groups, genders, people with a disability, people in rural and urban areas, etc.)?
Lessons learned
KEQ 9: What recommendations, if any, are there to improve the delivery of healthcare services for older populations?
SQ 9.1 What have been the enablers and barriers for implementing the pilot project? (e.g. contextual issues, internal workforce issues, available partnerships)
SQ 9.2: How effectively has the M&E framework been implemented and is the data accurate?
SQ 9.3: How have the knowledge learning sessions supported ongoing project improvement?
Approach
The evaluation will consist of a desk review of existing project documents and monitoring data, key information interviews with the stakeholders involved in this project such as healthcare provides (e.g. county health management team, community health workers, specialist mid-level and tertiary eye health workers, etc.), other project delivery partners (e.g. Globcom, Kespa, etc.), government officials at county and national level, and focus group discussions with project beneficiaries including older people and caregivers of older people. Specifically, the consultant will undertake the following tasks for achieving the consultancy:
- Draw up a plan of action and timetable for accomplishing various components of the assignment in coordination with the Healthy Ageing Senior Advisor of Fred Hollows Foundation;
- Seek ethics approval for the evaluation where required;
- Undertake desk review based on available reports and documentation, and collect additional data if required;
- Translate the data collection tools provided by the Foundation into local languages as needed and ensure they are relevant to the local context;
- Implement data collection activities
- Analyse and synthesise the evaluation data consistent with the data collection tools guidance
- facilitate the evaluation sense-making workshop
- Prepare and ensure timely delivery of the evaluation report, following the guidance provided by the Healthy Ageing Senior Advisor of Fred Hollows Foundation, and adding additional information where required;
- Develop a short-overview of the evaluation findings in an accessible format with the identified good practices to enable adoption by the older people’s associations;
- Participate in a technical meeting for dissemination of the end product with Fred Hollows Foundation staff and other stakeholders as relevant; and
- Provide Foundation country office with the final evaluation report in English.
It is foreseen that the following key representative groups will need to be consulted, among others, to complete this evaluation but the final list will be developed in collaboration with the project team and the Senior Advisor on Healthy Ageing at The Fred Hollows Foundation: beneficiaries (e.g., older people who received health education, screening and treatment to improve eye health), healthcare and other service providers who supported implementation of the project (e.g. community health workers, health management teams, mid-level and tertiary level eye health workers, KESPA staff, etc.), leaders of older people’s associations, government officials at county and national levels
Note: the evaluation will require approval by the relevant Ethics Committee prior to commencement of data collection. This will be assessed based on the proposed methodology, with the ethics approval application to be managed by the consultant with support from the Fred Hollows Foundation.
Deliverables
The following deliverables are expected from the consultant in completing the assignment:
- Evaluation/Inception Plan and methodology, including timelines and following the template provided.
- Adapted data collection tools in line with evaluation questions (note that a full set of data collection tools will be provided to the local consultant, which may require adaptations / translations to local languages).
- Prepare and obtain ethics review to conduct the evaluation.
- Presentation and validation of preliminary findings including outputs from data collection
- Presentation for the evaluation sense-making workshop
- The evaluation sense-making workshop is delivered
- Draft and final evaluation reports (following the outline provided)
- Summary report and summarized PowerPoint presentation for dissemination of findings
- Presentation of evaluation summaries (methodology, findings, recommendations, and learning) to broader Foundation staff. The content and timing of the presentation will be negotiated with the consultant.
NOTE: All raw data collected/generated during the evaluation will also need to be provided and a backup of raw data submitted in a format accessible to The Foundation.
The Foundation will provide the following:
- Focal person to support in undertaking the assignment.
- Provide documents required for desk review.
- Provide guidance, methodology, data collection tools and reporting template.
- Give feedback on the evaluation plan, methodology and evaluation report.
- Provide feedback on draft data collection tools, reports, and other deliverables.
- Support coordination between the consultant and partners and other relevant stakeholders during the entire evaluation activities so that data collection can be effectively conducted.
Schedule
The evaluation is expected to start 1 January 2023 and be completed by mid-March 2024. This will include the preparation of an evaluation plan, an overarching submission for ethics review and the approval of the evaluation work, desk reviews, fieldwork including interviews and focus group discussions, data analysis and writing of the evaluation report and drafting of final presentations for FHF and stakeholders. The work is to commence in December 2023 to enable ethics approval to be obtained by early January. The estimated number of days required for this country evaluation is estimated to be 18-23 days.
Evaluation team & qualifications
This evaluation will be contracted to an independent evaluator or team who will work closely with The Foundation staff in the design and implementation of the evaluation. The independent individual or registered organization will have the following background and experiences.
- At least a master’s degree in medicine, Public Health, Ophthalmology, or related health sciences.
- Demonstrable experience in the evaluation of public health programs including health systems assessments.
- Extensive knowledge and practical experience in conducing evaluations including a proven track record conducting quantitative and qualitative research, including all phases of research (from data collection to management and data analysis).
- Experience in the development and use of quantitative and qualitative data collection tools and evaluation methods including, for example, FGDs and KIIs.
- Experience in preparing ethics application and obtaining ethics approval from a research institute for qualitative and/or mixed-method research.
- Demonstrable experience writing evaluation reports and developing presentations in English.
- Strong knowledge and experience working with the Kenyan health care systems and overall understanding of Kenyan health sector policies.
- Strong experience in using equity framework(s) to evaluate progress against equity objectives.
- Strong analytical skills and oral and written communication skills
- Excellent spoken and written communication skills in English.
- Computer literacy, including expert use of Microsoft Office package.
- Experience in eye health, healthy ageing and/or gender equity will be an advantage.
Management and logistics
This evaluation is being commissioned by The Fred Hollows Foundation Kenya. FHF’s Country Program Manager for Kenya together with the FHF Global Evaluation Working Group led by the Healthy Ageing Senior Advisor will recruit a local consultant/institution to conduct the evaluation. The recruited consultant will be supervised by the Healthy Ageing Senior Advisor of the Fred Hollows Foundation, who will ensure that milestones are met, coordinate the evaluation, provide feedback and approval for deliverables.
The Global evaluation team, under the guidance of the Healthy Ageing Senior Advisor will also be responsible for supplying the selected evaluator with the evaluation protocol and the evaluation tools pack as well as other needed documentation. It will be essential for the evaluation to fully meet pre-specified requirements and be aligned with what is expected at global level so project activities should only start once guidance and approval is provided from the evaluator working group.
The Global Evaluation team will liaise with FHF’s Country Program Manager for Kenya to ensure that the country evaluator can effectively liaise with partners, organize meetings and collect data as required, and have access to needed documentation.
Confidentiality
The consultant (s) agree to not divulge confidential information to any person for any reason during or after completion of this contract with The Foundation. Upon completion or termination of this contract, the consultant (s) undertake to return to The Foundation any materials, files or property in their possession that relate to the work of The Foundation. The consultant will be responsible for safety, security and administration of primary and secondary data collected from FHF or otherwise.
Intellectual Property
All intellectual property and/or copyright material produced by the evaluator/s whilst under contract to The Foundation remain the property of The Foundation and will not be shared with third parties without the express permission of The Foundation. The evaluator/s are required to surrender any copyright material created during the term of the contract to The Foundation upon completion or termination of the contract.
Safeguarding People
The Fred Hollows Foundation is committed to ensuring that its activities are implemented in a safe and productive environment which prevents harm and avoids negative impacts on the health and safety of all people, particularly children, vulnerable people, and disadvantaged groups. The Foundation has a zero-tolerance approach to sexual exploitation, abuse, and harassment of any kind. All personnel including contractors/consultants are expected to uphold and promote high standards of professional conduct in line with The Foundation’s Safeguarding People Policy including Code of Conduct. Contractors/consultants will be expected to sign and adhere to The Foundation’s Safeguarding Code of Conduct and provide any background checks as required.
INSURANCE
Any consultants involved in this evaluation will be required to have in place insurance arrangements appropriate to provision of the requirements in this Terms of Reference including travel insurance.
Ethical and other Considerations
The evaluator and evaluation team are expected to maintain high professional and ethical standards and comply with The Foundation’s Research and Evaluation Policy. The Foundation is committed to ensuring a safe environment and culture for all people, including children, with whom we come in contact during our work. All members of the evaluation team will be required to comply with The Foundation’s Safeguarding People Policy and sign the Safeguarding Code of Conduct.
How to apply
Individuals or institutions interested should submit a cover letter, resume, technical and financial proposals to The Foundation’s Kenya Country Office by 8 December 2023 all in one single pdf file. Please reference “Healthy Ageing Pilot – Kenya Project, End of Project Evaluation”and send to the following address: [email protected]. Only submissions with complete documents as stated in the TOR and those meeting minimum requirements will be considered. Qualified consultants may be subjected to a background check on child protection as a condition for engagement.