Tender Announcement – SRH Assessment

Consultancy – Study on medical services provided to victims of sexual gender-based violence (SGBV) in NWS health facilities

Request for Proposals

1. Background to the Consultancy

RI is one of the lead health service providers in Northwest Syria (NWS). Based on information coming from bilateral meetings with health field staff operating in the supported Health Facilities (HF) in Idleb and Aleppo governorates. It emerged how the provision of sexual and reproductive health, and in particular medical services for victims of sexual and other types of gender-based violence (SGBV), is extremely challenging due to a series of factors that include lack of resources, lack of trained staff, lack of supervision and lack of safe and confidential reporting mechanisms as well as specific elements linked to the context and security situation in the areas of implementation. This results in provision of partial or poor-quality services or incapacity to deliver the services all together, including referrals to other health facilities as well as complementary protection services. From additional conversations with cluster, sub-cluster and working group coordinators, it seems that this situation is not specific to RI-supported health facilities but rather the general condition of health service providers throughout NWS.

1. Purpose of the study

Due to the complexities of the context in NWS and the multiple challenges that have been identified while discussing the provision of medical services to women and girl survivors of SGBV, it has been agreed that there is the need to carry out a thorough assessment on this topic covering all the RI-supported static HFs and WGSS centres in NWS. The assessment aims to provide detailed and systematic information on the current situation in each HF, which will enable management to identify gaps, develop an action plan to address them, and identify needed resources to ensure the implementation of corrective actions. While the specific context of NWS poses a great number of challenges that makes the delivery of certain sensitive services very complex, the proposed study will be conducted to ensure that those challenges and barriers are properly identified, with the aim of addressing the main challenges and ensure the delivery of safe and quality health services to affected populations. Moreover, the findings of the study will be used to support discussions at cluster level about delivery of services to SGBV survivors in HFs in NWS, as well as advocacy efforts with relevant stakeholders, including donors, to ensure that gaps related to the lack of funding are addressed.

The study will include:

• An initial desk review of relevant defined procedures and protocols for NWS and activity reports of services provisions in RI HFs as well as conduct discussions with health and protection program management teams to analyze the present situation of provision of medical support in SGBV cases in NWS,
• Assessment of HFs in terms of the availability of trained staff, their capacity to safely handle disclosures and treat survivors of SGVB as the outlined protocols and make safe referrals to complementary support, such as protection services
• Assessment of the understanding and attitude of medical staff (responsible for providing the services) well as the management of the HFs toward SGBV, the need and type of services to SGVB survivors and maintaining privacy/confidentiality of the survivor
• Assess the availability of appropriate space for the provision of medical services to survivors of SGVB with acceptable privacy and confidentiality
• Assess the availability of adequate quantities of all medical equipment, medicines and supplies required for service provision Assess the process of receiving, treating and referral of survivors of SGVB and evaluate if it follows the defined protocols and procedures
• Identification of main risks and challenges faced by health staff when providing medical support to victims of SGBV, including but not limited to clinical management of rape (CMR)
• Assessment at community level, involving women and girls, both survivors and non-survivors, to understand factors influencing the decision of accessing (or not) health services in case of sexual violence

Assess the knowledge of women and girls in the catchment areas of the HFs about the availability of services for survivors of SGVB and their attitude about accessing services from these HFs Timeframe / Schedule

The anticipated level of effort for this assignment is 40 days. Ideal start date is August 1, 2022.

1. Methodology

The study is expected to generate significant learning for RI and other health service providers operating in Syria. RI technical teams have developed the methodology and tools for the study, including adaptation of existing tools and facilitator guidance, which are comprehensive, and seeks the support of an external service provider to field test the tools, suggest and get approval from RI in case changes are needed, and then use this mixed methods approach combining both quantitative and qualitative methodologies relevant to the overarching purpose and study questions. Study methodologies include desk reviews, key informant interviews, survey with female community members and observation checklist for targeted health facilities. Due to the sensitive nature of the topic, data collection with community members will be directly done by RI within its protection centers in NWS, while the analysis of such data and those generated from the other tools will be the full responsibility of the service provider. Successful proposals will detail strategies for triangulating data from multiple sources.

The service provider will be required to coordinate with RI to arrange all the logistical aspects required for the primary data collection, elaborating a detailed, well-aligned schedule of field visits. Similarly, weekly communication will be conducted with RI to share progress updates, with potential real-time recommendations. As well as ensure, a safe, confidential and ethical system to handle and store data.

Sampling

• Survey with community members:

This survey will cover around 100 female community members in various locations where RI provider protection services linked to HFs. Due to the sensitive nature of the topic, RI itself will use its own survey tool to conduct the community members survey with women and girls, using its protection centers and trained protection staff. Therefore, interested consulting firms/individuals are requested to consider this while compiling their financial offer.

• Key informant interviews (KIIs)

The KIIs will be held with relevant stakeholders, including but not limited to health workers responsible for the provision of this service in the target HFs (such as midwives, gynecologists, general doctors, nurses), health facility management staff (e.g. medical directors of hospitals, head of PHCCs…), and RI field health & protection staff (medical officers, protection officers, MEAL staff). We suggest conducting at most 59 KIIs with medical staff in the HFs (@5 per hospital i.e. 5*5 =25 and @3 per PHC i.e. 17*2 = 34). RI will facilitate in providing the service provider with the relevant contact details of HFs management, and will facilitate the coordination between the two parties to organize the KIIs. However, the total number of KIIs may increase/decrease subject to the point of saturation. RI will provide a pre-designed tool for these KIIs, which will be finalized during the inception stage with the consultant.

• Health facility assessment tool

This tool aims to evaluate the availability of the required medicines & medical supplies, availability of space with the required privacy, availability of trained staff and evaluate their capacity and evaluate the presence of clear and appropriate procedure for the reception, safe reporting mechanisms, treatment and referral of SGVB survivors in all the 22 sites[1]. This checklist will be completed with information coming both from physical observation and interview of HFs staff responsible for the provision of services. RI will provide a pre-designed tool to conduct the observations, which will be finalized during the inception stage with the consultant.

Confidentiality: All external service providers involved will commit to strictly complying with the confidentiality of information obtained during the assessment process (this includes but is not limited to: program documents including datasets, reports and annexes and the technical proposal) given the sensitivity of the program and context.

1. Roles and Responsibilities

RI’s responsibilities:

RI will be responsible to share the finalized methodology and tools with the service provider. RI will be equally responsible for any support relevant to the data collection, such connection with the HFs management to organize field visits and provision of tools for the data collection. RI will be responsible to provide timely feedback to the service provider throughout data collection and analysis should anything of concern be raised. Due to the sensitive nature of the topic, RI will be responsible to conduct the survey at community level with women and girls, using its protection centers and trained protection staff. RI is responsible for sharing the results of the community survey in a timely manner with the external service provider to allow for data analysis and triangulation of information. RI MEAL staff should ensure that the service provider is conducting the study accurately as they report in terms of quality control and days worked/hours spent etc.

Service provider’s responsibilities:

The service provider will be responsible for logistics: office space, administrative and secretarial support, telecommunications, printing of documentation, travel arrangements and logistics for fieldwork, etc. The service provider will be leading and managing the data collection and coordinating their field team.

The service provider will be responsible to request from RI the list and contact details of the protection staff that will conduct the data collection with community members in the protection centers. The service provider will then be responsible to train the RI’s selected protection team on how to run the questionnaire and collect quality information to ensure proper analysis.

Data collection at health facility level and analysis of all data collected will be the sole responsibility of the service provider. Furthermore, the service provider will continuously and proactively consult RI during the data analysis and reporting stages, especially in case of findings that warrant further explanation or immediate action. The service provider is responsible to ensure quality data collection and analysis, and promptly flag any issue or challenge that can have an impact on the assessment of RI’s programme in the field.

1. Required qualifications of the service provider

The service provider should have a proven experience of working on similar studies/assessments in NWS, the team must have a Postgraduate or higher degree in Health studies (preferably in SRH), or any related field; experience and technical expertise on sexual and reproductive health and linkages with protection and SGBV programming. Due to the sensitive nature of the topic and the level of specialization required, it is also important that the service provider is able to deploy field enumerators with health background and expertise in similar studies and assessments. For this purpose, a list of field enumerators with individual CVs are requested at the proposal stage. In addition to the demonstrated contextual and thematical experience, the service provider must provide tailored technological solutions to a unique operating environment, including using remote data collection technologies for surveys. Advanced quantitative and qualitative data analysis skills are required, in addition to good reporting capability. Given the volume of qualitative interviews, successful responses will demonstrate experience working with computer assisted qualitative data analysis software (CAQDAS) in the submitted CVs of staff.

1. Criteria for evaluation of responses

RI will evaluate the responses to this Request for Proposals based on the consultants’ ability to provide a specific overview of the relevant services their organization has provided in the past, including the number of years they have been engaged in the sector, the number of relevant professional consultants or CVs they have access to, and their experience of working with clients on similar assignments. They will also be required to submit examples of past similar work, both thematically and contextually in NWS. The availability of highly experienced and trained data collection team will also be a required criterion.

1. Deliverables and schedule

Four major deliverables requested are:

1. An inception report outlining the service provider’s plan of action and timeline for conducting the assessment.
2. Data collection: Successful data collection conducted in a timely professional manner meeting RI’s standards and deliverable schedule, ensuring clean data sets and interview notes/transcripts provided to RI for review
3. A draft report on the present situation of medical services provided to victims of sexual violence in NWS HFs including:
   • Description of the context in NWS which affects the health sector and in particular the provision of SRH services, including the ones for sexual violence and clinical management of rape (description coming from both primary and secondary data – desk review)
   • Description of the methodology and tools used for the study, including limitations
   • Main findings and analysis divided as follows:
     • Availability and appropriateness of services
     • Readiness and infrastructure
     • Identification of patients who have experienced IPV or SV
     • Patient centered clinical care and communication
     • Referral system and follow up of patients
     • Training and quality improvement
     • Health care policy and provision
     • Reporting and information systems
     • Service providers’ attitudes on SGBV
     • Providers’ experience of service provision in NWS
     • NWS community members’ attitudes, help-seeking behaviours and barriers to care
   • Recommendations for suggested interventions on how to address main gaps, challenges and risks (including resources needed in order to do so)
4. A final report with all elements mentioned above, finalized after having addressed all comments and feedback provided by RI on the draft report.

The service provider is also expected to prepare a summary presentation and present the final report to RI’s team as per availability to validate findings and refine interventions. In addition, raw data from field interviews, surveys, or focus groups should be provided to RI. Draft versions of the reports will be submitted to RI for review and feedback provided before final versions are submitted.

1. Payment schedule

RI will schedule the payment according to the submission of the following deliverables:

• 20% of the total amount will be paid upon reviewing the developed tools and the inception report that the consultant will present to RI (Deliverable 1).
• 40% completion of data collection (Deliverable 2) to be confirmed by email.
• 20% upon sharing the first draft of the study, which will be reviewed by RI for review and comments (Deliverable 3).
• 20% upon the delivery of the final version of the study report (Deliverable 4).

1. Proposals submission package

Interested service providers should submit the following:

1. A detailed workplan that reflects the timeline and the tasks that will be followed to finalize the requested deliverables.
2. Detailed past experience working in NWS and in the aforementioned thematic topics.
3. A detailed financial proposal that lists the costs of the data collection process inside Syria, in addition to other costs of consultants, trainings, translation, etc.

To be able to have a clear criteria of comparison between the bids that will be submitted, RI requests to have the unit costs as shown below :

-KII (An interview with 1 ket informant) -Checklist (Conducting 1 checklist) -Consultant (working day) – Field Supervisor (Working day) -Translations (Lumpsum) -Training for data collectors (one training)

The mentioned unit costs will be used to calculate the total amount of each proposal.

4. The CVs of the evaluation team including the lead consultant, sector specialists, proposed field enumerators.

5. Documents of the consultancy company registration in Turkey or other countries.