GRC EU Midterm Review in Egypt Consultancy

The German Red Cross (GRC) is inviting quotations for the Mid-term Review (MTR) of a project currently being conducted in Egypt titled “Supporting Communities –Health for All”.

Political- and socio-economical context
Egypt is with over 100 Mio. inhabitants the most populous country in the Arab world and the third most populous country in Africa, behind Nigeria and Ethiopia. The capital Cairo is home to more than 20 Mio. people. Most of the country is desert, so about 95% of the population is concentrated in a narrow strip of fertile land along the Nile River, the Nile Delta and the coast, which represents only about 5% of Egypt’s land area. Egypt’s rapid population growth – 46% between 1994 and 2014 – stresses limited natural resources, health care, jobs, housing, sanitation and education.

Egypt is vulnerable to natural hazards such as flash floods, earthquakes, droughts, landslides, wind- and sandstorms. With climate change, some of these hazards will occur more often and with more intensity. People and their livelihoods at the coast and in the Nile Delta will be affect-ed by rising sea levels. Fast population growth and urbanization is leading to overcrowded urban areas also increasing the risk and/or the severity of man-made disasters such as fires, bombing, civil unrest or large accidents.

About one third of the population lived below the poverty line before the COVID-19 pandemic emerged in 2020. Of course, the economic shock that followed COVID-19 containment and prevention measures such as suspension of air traffic, slow down or closure of various economic and social activities destroyed a huge number of jobs in tourism, sale, manufacturing, transport and construction sectors, affecting especially informal workers that struggle to pay their rent and feed their families. Middle of 2021 saw some recovery of the affected sectors, the annual revenues of the Suez Canal even noted a record high. So economic growth picked up again in 2021, but labour force participation and employment rates remained low at the working-age population. It is clear that the COVID-19 crises has worsened social conditions in the country.

Egypt has been a significant destination and transit country on regular and irregular migration routes since 1990s. More than half a million migrants are currently living in Egypt as per IOM. This includes irregular and regular migrants recorded with IOM and UNHCR. Next to the registered migrants there is a large number, IOM estimates 6 Mio., of undocumented migrants in the country, about half from Sudan and South Sudan. The inward flow of asylum seekers and irregular migrants has been increasing since mid-2000s in response to political eruptions and armed conflicts taking place in the Middle East and East Africa. Hence, Egypt has become a transit and host country for various nationalities including (but not limited to) Syrian, Palestinian fleeing Syria, Iraqi, Sudanese, South Sudanese, Ethiopian, Eritrean and Yemeni.

As of 30 April 2020, a total of 258,812 asylum-seekers and refugees were registered with UNHCR in Egypt, 50% of them being Syrian asylum seekers. In the absence of major organised refugee camps, Egypt’s refugee and migrant populations are thus self-settled in urban areas like Cairo and Alexandria where people rely on networks within long established communities.

Refugees face lengthy administrative procedures during which they cannot count on any support. Furthermore, despite entitlement to public services11 (such as education, housing and healthcare) equally as Egyptian nationals, once registered, refugees find themselves confronted with an overstretched health care system trying to cope with a steadily growing Egyptian population. The increased demand negatively affects the availability and quality of social services, affecting the poorest Egyptians and migrants tremendously. Migrants have limited options for economic activities and struggle to access health care, housing and education. Many migrants from Sub Saharan A frica face linguistics barriers and discrimination which further contributes to their marginalization and risk of exploitation.

Existing response
There are tremendous challenges for any kind of data collection due to the limited access to migrant communities outside the UNHCR-IOM caseload.

The Egyptian Red Crescent (ERC), the local beneficiary of this grant, is part of the international Red Cross & Red Crescent movement and it works as an auxiliary body to the government of Egypt in times of crises and disasters as part of its mandate. Additionally, the ERC has been serving the vulnerable communities as part of its multiple roles. ERC aims to contribute to the overall community resilience and social cohesion through utilising health as a key entry point to gain further understanding on socio-economic aspects about its targeted beneficiaries. This enables the organisation to be proactive and adaptive to identified needs and implementation gaps.

The Syrian crisis has stimulated ERC to develop and expand its migration profile. ERC has been a sub-recipient of the EU MADAD funding targeting Syrian refugees and their host communities in Cairo and Alexandria. Besides this, ERC is currently recipient of funding from the UK Department of Foreign and International Development (DFID), Swiss Development Cooperation, UNRWA, UNICEF and UNHCR as part of its migration portfolio.

In collaboration with donors and partners, ERC aims to develop a comprehensive approach to the current migration challenges and to ensure complementarity between activities rather than duplication of efforts towards ensuring better social integration and cohesion, and community resilience. Furthermore, ERC has managed to adapt the scope of its projects in the light of COVID-19 to ensure better response to community needs.

Intended sector of intervention (Describe the intended sector of intervention of Red Cross and partners and stakeholder)

Health Care and Mental Health in Egypt

The concentration of migrants in specific poor districts has stretched the already overburdened health service sector even further. The impacts are evident through the increasingly problematic access to existing primary health care for vulnerable people as well as the substantial deterioration in the quality of health care services. The extremely harsh living conditions for both – Egyptian and Non-Egyptian families – challenge their overall existence in Egypt and might motivate the decision of leaving the country or resorting to other negative coping mechanisms.

The Government of Egypt (GoE) has, as a long-term goal, the achievement of universal coverage of basic health services for all of its citizens. It has also stated the prioritization of targeting the most vulnerable population groups. Furthermore, the Ministry of Health and Population (MOHP) took a strategic decision in offering public primary healthcare for refugees and migrants on equal footing to nationals. Even though the health system in Egypt is rather complex, the MoHP is the main entity responsible for service provision.

The Egyptian health care system, with its public and private arms, is under a lot of pressure. In addition, the COVID-19 pandemic stresses the system additionally. The Government of Egypt (GoE) has recognised the various challenges for the strained health sector in the long-term and welcomes relief of the public services by non-state actors in the short-term.

A nation-wide survey in 2017 survey of the General Secretariat of Mental Health and Addiction Treatment (Section of the Ministry of Health) revealed that around 25% of the whole population sample are living with a form of mental health disorder: mood disorders (i.e. depression and anxiety, 43.7%), and substance-abuse related manifestations 30.1%). The survey also highlights the scanty access to mental health care services versus the apparent need. Only 0.4% of those living with a mental health disorder are accessing care and receiving medications for their mental health disorders.

In the field of migration, both migrants and refugees are facing additional mental health challenges compared to hosting communities. There is a need for Mental Health and Psychosocial Support (MHPSS) services that answers to the needs of migrant and refugee groups who may have been subject to extreme emotional and psychological stress (e.g., Survivors PTSD (post-traumatic stress disorder), SGBV (Sexual and Gender Based Violence), trafficking survivors, domestic abuse, bullying, and psychiatric patients). This situation is currently worsening for all the population due to the additional stress from the Covid-19 situation (economic scarcity, fear of infection, mental impact of the lockdown, etc.). Vulnerable people are less able to rely on healthy coping mechanisms and at the same time might experience increased stigmatisation leading to complex multi-layered trauma

Refugees and migrants living scattered in urban areas face various challenges to access health care that are also faced by the Egyptian host communities living in the same areas. An inequitable distribution of health facilities, the lack of standardisation of treatment protocols and lack of an integrated Health Information System (HIS), the weak referral system, lack of transparency regarding costs and treatment protocols – especially within the private sector – and poor medical record-keeping result in a lack of epidemiological analysis of the incidence of health conditions and changing needs. As a result, vulnerable communities face a double burden – increased risk of diseases associated with bad living conditions plus the limited access to adequate health care. Irregular migrants and some refugee groups are, in addition, also facing linguistic barriers that hinder their access to health care or experiencing fear to go to public health services for fear of being reported. The continuous influx of irregular migrants and refugees, the current population growth and new emerging challenges to the health system (e.g., COVID-19 pandemic) will make achieving UN Sustainable Development Goal 3 very difficult to attain in Egypt by 2030.

Access to livelihoods

Prior to COVID-19 pandemic, the unemployment rate among Egyptians reached the lowest level in 5 years (2015 – 2020) below 8%. However, the unemployment rate in the youth (15–24) age range remains the highest in comparison to other population brackets. Also, Egyptian women tend to be less employed than men (14% to 82.7%).19 On the contrary, there is a paucity of reliable data on access to livelihoods among refugees and irregular migrants. Nonetheless, available research shows discrepancies on access to work according to the country of origin, and irrespective of their educational level.
Obtaining a work permit for non-nationals is highly regulated and subject to strict criteria and entails increasingly high fees that most employers are not willing to pay. Recognized refugees and irregular migrants alike typically fail to meet those requirements. Both groups are likely to work in similar unregulated environments as day labourers and often face exploitations.
Considering the COVID-19 pandemic and the measures taken to contain the outbreak (incl. lockdowns and physical distancing), the livelihood situation has significantly deteriorated for many, with migrants and refugees being especially vulnerable to the economic crisis linked to the pandemic, as their source of income comes mainly from the non-formal economy. Many are unable to offer a hot meal a day for them and their families.

Project set-up and intervention

The Action aims to improve the access and to eliminate the physical, social and financial barriers to health services, for especially African migrants-refugees and host communities, as well as barriers to livelihood opportunities. The two main lines of support include:
a) Health: provision of primary health care services, health promotion, and referrals to secondary health care services;
b) Livelihoods support: i.e., vocational and preparation for wage-employment trainings.

This shall be achieved through six community hubs that are located in Greater Cairo, in areas with high concentrations of migrant and refugees’ groups. They shall be adapted and upgraded to provide the above-mentioned services. The action builds on solid capacities as well as experiences and results from previous programmes implemented by the ERC, but it is not a continuation of a previous action (i.e., EU MADAD) as such. The project will contribute to form a support network (and/or strengthen existing ones).

In Egypt the clinics/health care units do not offer tertiary services. This project will offer primary and secondary health care including specialities of ortho, dermatology etc. Beneficiaries will be given recommendations about other centres, labs and services they might need beyond the ERC services to be provided.

Possible stakeholders
(Describe the possible stakeholdersstakeholders, which should be involved in the assessment.)

Egyptian Red Crescent (ERC)

ERC is responsible for the operational planning, implementation, monitoring, financial management and dissemination of Action’s outcomes with support from the Project Delegate of GRC/SRC. A dedicated ERC Project Manager is coordinating with involved partners and internal departments for timely and effective implementation of planned activities.

The Community Hubs are part of the existing ERC network of centres that will be transformed into resource centres to cater the new activities to be provided under this project by ERC with the authorisation of the local authorities to benefit migrants and vulnerable host communities. Both ERC staff and volunteers will be involved in the day-to-day activities and there will be a manager/coordinator to run the centre.

The ERC is the biggest volunteer organization in Egypt with branches in all 27 governorates of the country. The proximity on local level facilitates access to the most vulnerable communities in Egypt. Being established in 1911, the ERC has gained credibility on all levels. A broad portfolio of activities (blood bank, community development, vocational training, emergency response teams, health care and others) is implemented.

German Red Cross (GRC)

As contracting party GRC assumes the role of overall lead of the consortium with SRC, including responsibility for quality assurance of implementation, monitoring, expense verification and submission of narrative and financial reporting including external visibility and communication to the EU. GRC provides technical and managerial support to the ERC in coordination with SRC and will monitor that the action is implemented in accordance with the contract. Further, GRC commits its expertise and own human resources to ensure successful implementation of the action and will look for resource mobilisation possibilities enabling replication of the action. GRC has been a partner to the ERC since 2014 and was assigned as Country Lead under the regional RCRC MADAD project.

Project management and grants management capacity building for ERC will be an integral part of the support in the form of tailor-made trainings. A joint GRC/SRC delegate for Egypt will support and work alongside ERC project staff. Furthermore, ERC will receive support through a “delegate assistant”, an expert in EU guidelines and project implementation, of Egyptian origin and working full time within the ERC structure. This constant presence on the ground cannot be granted through the GRC/SRC international delegate due to legal reasons, however it is essential for the successful implementation of the Action. Resource persons from the GRC Regional MENA Office in Beirut are part of the project implementation structure, especially in regard to regional harmonization, finance and communication. The Communications Delegate and the GRC HQ Communication Unit will ensure appropriate visibility for the action.

Swiss Red Cross (SRC)

SRC provides technical and managerial support to the ERC in close coordination with GRC. SRC has been a partner to the ERC since 2012, first in relief (at the Libyan border) and since May 2012 in capacity building in logistics. Since then SRC has expanded its collaboration with further trainings and institutional preparedness in logistics. In addition, in February 2015 SRC started with the ERC a project titled “Improving livelihoods and health in slum areas of Cairo” which has further helped the ERC to make use of its strong experiences in health (increased access to health, hygiene and health awareness) to support the vulnerable population of three slum areas in Central Cairo in health and livelihoods.

Members of the target communities

ERC has direct contact with the communities and acts as a link between the Community Leaders and other institutional stakeholders. Target communities are the Egyptian host community and migrant and refugee communities consisting of various nationalities including (but not limited to) Syrian, Palestinian, Iraqi, Sudanese, South Sudanese, Ethiopian, Eritrean and Yemeni.

The European Union Delegation to Egypt/ DG NEAR (EUTF)

This action is funded by the EU Emergency Trust Fund for stability and addressing root causes of irregular migration and displaced persons in Africa, through its programme Enhancing the Response to Migration Challenges in Egypt (ERMCE). The programme is articulated through seven different projects, amongst others the ERC ‘Health for All’ project. Objectives are: 1) to enhance Egypt’s migration management; 2) to address the root causes of irregular migration; and 3) to support Egyptian communities hosting migrants and refugees. The evaluation will serve to identify challenges and opportunities in the implementation of the action to steer it towards reaching its foreseen results. This evaluation will feed The European Union Delegation/DG NEAR with regard to future programming and the further development of their framework for project support.

Responsibilities and duties

(Please list and describe the different responsibilities of GRC, the HNS, the assessment team and if needed other persons involved.)

GRC

The overall management of this assessment shall be coordinated by the GRC/SRC Delegate and the ERC Project Manager. GRC/SRC will coordinate with the ERC on the organization of all assessment related logistics. More specifically, GRC/SRC will:

• Select, recruit, and contract a consultant (GRC HQ Berlin/Beirut) in consultation with ERC;
• Be responsible for all payments for the evaluation process;
• Make available to the consultants all necessary briefing materials and be available to respond to questions and requests;
• Be involved closely in the evaluation process with a GRC counterpart signing off the documents;
• Maintain full ownership, copyright and responsibility for publication;
• Give a security briefing for the consultant and take care that security regulations are applied.

Egyptian Red Crescent (ERC)

The overall management of this assessment shall be coordinated by the ERC Project Manager and the GRC/SRC Delegate. More specifically, the ERC will:

• Ensure overall management of the assessment, in terms of supervision and monitoring, approvals, providing project related documents, publication, protection of data;
• Make available to the consultants all necessary briefing materials and be available to respond to questions and requests;
• Make logistical arrangements in the field;
• Facilitate access to communities and stakeholders organizing meeting and interviews;
• Obtain necessary approval for assessment;
• Provide staff to accompany the survey team, and provide volunteer enumerators;
• Provide his expertise in specific sectors which shall be considered during the assessment;
• Support the logistics and the implementation of security regulations;
• In general, participate in the assessment exercise to ease the access to the communities and support the data gathering with staff and volunteers.

Consultant

The consultant is responsible for:

• Determining the evaluation methodology, time schedule, content, and materials required for meetings, interviews and workshops;
• All organisational issues related to the implementation of the assessment, which he/she will coordinate with ERC and GRC/SRC;
• Leading and implementing the evaluation, including but not limited to:
  o Organization of the assessment team and training of the team members;
  o Training of the assessment team members (e.g., enumerators) at the beginning of the exercise;
  o Collection of data and analysis;
  o Presentation of results and submission of final report to ERC and GRC/SRC;
  o Revision of the final report, based on the comments from ERC and GRC/SRC;
• Daily feedback to ERC and GRC/SRC.

Consultant Profile
The consultant should meet the following criteria:

Essential:

• At least 5 years’ experience in conducting evaluations and participatory assessment processes;
• A proven record in delivering professional results

➢ Consultant is required to send 2 samples of relevant evaluation;

• In-depth knowledge and experience in Health and Livelihood projects;
• Knowledge of strategic and operational management of humanitarian and/or development operations, as well as proven ability to provide strategic and practical recommendation to key stakeholders;
• Strong analytical skills and ability to clearly synthesize and present findings, draw practical conclusions, make recommendations, and prepare well-written reports in a timely manner;
• Language skills: Fluency in written and spoken English, ideally in conjunction with good skills in written and spoken Arabic.

Preferable

• Experience with administration and evaluation of EU funded projects;
• Knowledge/experience of the Red Cross Movement;
• Experience working in MENA.

Find here more information:

https://daleel-madani.org/civil-society-directory/german-red-cross/calls/call-quotations-grc-eu-midterm-review-egypt-consultancy-tender-ref-2022-04-26