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. It operates in more than 20 countries across Australia, The Pacific, South and South-East Asia, and Africa. The Foundation was named The Australian Charity of the Year 2013 at the inaugural Australian Charity Awards.
In Uganda, older persons are defined as persons aged 60 years and above (Uganda National Policy for Older Persons, 2009). The current population of older persons is estimated at 1.6 million (5% of the population) and it is expected to increase to 5.5 million in 2050. According to the Uganda National Household Survey 2012/13, older persons constitute 4.7 percent of the population, representing 1.6 million people, of whom 53 percent are women and 47 percent are men. The survey indicates that of these, 64.5 percent have old-age related disability and 10.7 percent live alone.
Project background
The Integration of Health Services into Social Protection Program for Older Persons in rural Uganda project is working in partnership with government and mission-based hospitals and health centers in West, and South-Western Uganda to increase quality and equitable access to eye care services and other health services, with a focus on reaching the disadvantaged sub-populations of older persons, and more specifically older women.
Older people have the highest burden of eye conditions and non-communicable diseases in Uganda. Yet, due to mobility challenges, they are often left behind and are unable to take part in general eye and other health related camps. Many older women live in poverty in Uganda and rely on their family to access basic resources including healthcare. There is also a general perception that sickness and disability are an inevitable and ‘natural’ part of ageing, so action is not taken to prevent declines in intrinsic capacity, and to detect and address disease and disability, resulting in a systemic neglect of older populations.
Currently, the government of Uganda, under the Ministry of Gender, Labor and Social Development and with support from development partners, is implementing the Social Assistance Grant for Empowerment (SAGE) through a senior citizen grant (SCG), which is the country’s first old-age pension scheme. This scheme aims to address chronic poverty, and, as of 2020, it pays a regular monthly pension of UGX 25,000 (approximately US$ 6.70) per month to over 150,000 older persons in bi-monthly instalments. This grant must be collected in person by its recipients at their subcounty offices, which offers a unique opportunity to reach many older people in one location to provide health services.
Providing screening services at such an event to detect declines of intrinsic capacity[1] among older people, with a particular focus on older women, could guarantee high turnout, offering an opportunity to promptly detect and prevent declines in intrinsic capacity and underlying health conditions and ensure timely referral to receive a comprehensive assessment and treatment for many older people in the country who currently have limited to no access to these types of services.
Older persons who are identified to have heath conditions are referred to Ruharo Mission Hospital Eye Centre (REC) and Mbarara University Referral Hospital Eye Centre for treatment. Project partners include Christian Blind Mission (CBM), Mbarara University Referral Hospital Eye Centre and Ruharo Mission Hospital.
[1] Intrinsic capacity refers to all the physical and mental capacities that an individual can draw from at a given moment in time. It includes six different domains: visual capacity, hearing capacity, locomotor capacity (mobility), vitality (nutrition), psychological capacity, and cognitive capacity.
Project Outcomes and outputs:
Outcome 1: The capacity of healthcare providers and community development officers and parish chiefs to deliver integrated care for older people is improved.
- Output 1.1: Training content on healthy ageing for the different target audiences is created by the technical team of the project.
- Output 1.2: Healthcare providers are trained (village health teams, nurses, and medical officers) on geriatric care by a Geriatric specialist focusing on the screening and management of declines of intrinsic capacity, basic care, polypharmacy and how to manage cognitive decline.
- Output 1.3: Community development officers and parish chiefs are trained on the healthy ageing framework by the project team to mobilise older persons.
Outcome 2: Older persons, particularly older women, have increased access to integrated care.
- Output 2.1: Older people in Rwampara and Mbarara Districts have increased access to screening and referral for eye conditions and other declines of intrinsic capacity.
- Output 2.2: Older people in Rwampara and Mbarara Districts have increased access to treatment and ongoing management for diagnosed conditions.
Outcome 3: Self-care practices among older persons are improved, including nutrition and physical activity.
- Output 3.1: Self-help groups of older people and caregivers are formed to provide supportive care and share information on SAGE events, health services provided by the governmental regional referral hospital, etc.
- Output 3.2: Nutrition and physical education sessions are delivered for older persons and their caregivers including establishment of kitchen gardens.
- Output 3.3: Caregivers and communities are trained on practical skills to care for 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:
- 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.
- 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.
The primary intended users of this evaluation will be:
- Eye health Implementing organizations including CBM.
- Ministry of Health in Uganda.
- International eye health sector NGOs, the Australian Department of Foreign Affairs and Trade
- FHF Uganda team
- FHF Healthy Ageing Senior Advisor
- FHF Strategic Initiatives Team
- FHF Senior Equity and Inclusion Advisor
The evaluation will also be of interest to a range of secondary users, including:
- FHF divisions (Program Development Team, country program teams, Country Support Network and Development Effectiveness Team)
- Donors and potential partners
Evaluation scope and key questions
This evaluation will provide detailed information on all pre-defined indicators for the project and will be structured around the following evaluation criteria: Effectiveness; Efficiency; Relevance; Impact; Coherence and Equity. Additionally, the evaluation will capture lessons learned through implementation, including an identification of enablers and barriers for implementation. The consultant will have the possibility to propose expanding the set of questions to suit the country-specific evaluation, with any changes to be reviewed and approved by the FHF Evaluation Working Group led by the Healthy Ageing Senior Advisor prior to finalization. Additional guidance and resources for the country evaluation will be provided to the selected consultant upon contracting.
This is an endline evaluation that covers a subset of activities implemented from June – Dec 2023 and which will cover the following:
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?
SQ 2.1: To what extent has the integrated delivery approach used in the pilot project resulted in economies and/or efficiencies for the care of older populations?
Relevance
(Is the project doing the right things?)
KEQ 3: What is the additional value of taking an integrated care approach for older populations compared to a vertical 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 selected consultant will be provided with a pre-designed evaluation methodology and set of data collection tools to follow. The tools should be thoroughly reviewed and minimally adapted by the consultant to suit the local context where necessary, with any changes requiring to be reviewed and approved by the FHF Global Evaluation Working Group prior to finalisation.
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 and focus group discussions with project beneficiaries. 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 following the template provided;
- 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 adding any additional questions that may be needed;
- 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 outline provided, and adding additional information where required;
- Participate in a technical meeting for dissemination of the end product with Fred Hollows Foundation staff and other stakeholders as relevant; and
- Provide the final evaluation report in [local language] and English.
Key representative groups that will need to be consulted to complete this evaluation include, among others, older people, caregivers, community development officers, parish chiefs, healthcare provides (e.g. village health workers, nurses), representatives from relevant ministries.
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 and methodology.
- 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 in November 2023 and be completed by the end of January or beginning of February 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. Due to a likely delay in the ethics review process, the consultant will be expected to compile and submit the application for ethics review in mid-December, with approval and field work to commence in January 2024.
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 Ugandan health care systems and overall understanding of Ugandan 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 and Lunyakole.
- 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 Uganda. FHF’s Country Program Manager for Uganda together with the FHF Global Evaluation Working Group led by the Healthy Ageing Senior Advisor will recruit a research consultant/institution to conduct the evaluation. The recruited consultant will be supervised by the Global Evaluation Working Group led by the Healthy Ageing Senior Advisor, who will ensure that milestones are met, coordinate the evaluation, provide feedback and approval for deliverables.
The Global evaluation team 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 Uganda 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
Individual or institutions interested should submit a cover letter, resume, technical and financial proposals to The Foundation’s Kenya regional office by 30th November 2023 all in one single pdf file. Please reference “End of Project Evaluation for Integration of Health Services into Social Protection Program for Older Persons Project in rural Uganda” 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.