TERMS OF REFERENCE (“TOR”) Сonducting needs assessment in Kyiv and Chernihiv Oblasts

1. Context

The invasion by the Russian Federation of Ukraine on 24 February 2022 has resulted in loss of life, injuries, and mass displacement of the civilians. The ongoing violence has also resulted in widespread destruction and damage to residential housing stock and civilian infrastructure. In addition, access to healthcare has been severely limited, as health facilities have suffered significant damage, with some being completely destroyed causing disruption in providing essential lifesaving services across Ukraine. According to the WHO, there have been 550 attacks on health care infrastructure, resulting in 129 injuries and 100 deaths, reported between 24 February and 30 September 2022. This escalation in fighting has exacerbated existing humanitarian crisis already present for the past eight years, especially in eastern Ukraine.

According to OCHA, nearly 40% of the country’s population (18 million people) needs humanitarian assistance and the situation is expected to deteriorate further in the winter as a new wave of displacement is expected, particularly from the east. Over the 7 months of war, one-third of Ukrainians have been displaced so far, making this one of the largest human displacements in the world today. According to UNHCR, 6.5 million people have been displaced inside Ukraine, while most displaced persons are women and children. According to the Ministry of Health Ukraine, one of the main critical needs is the provision of medical assistance to people with chronic diseases in eastern parts who have been deprived of medical care for months.

1. Background

The humanitarian aid organization Medicos del Mundo is the Spanish branch of the international network Médecins du Monde/Doctors of the World (MdM). MdM has been operating in Ukraine since August 2015 and is currently implementing an emergency response across Ukraine. The program is implemented around three main components: direct delivery of services through multidisciplinary mobile units (including primary healthcare services (PHC), sexual and reproductive health (SRH), Mental Health and Psychosocial support services (MHPSS) and gender-based violence (GBV) response services); strengthening of local health system (with a specific focus on PHC, SRH, MHPSS and GBV) through capacity building of health and non-health staff, awareness raising and advocacy.

To limit the impact of war on health, MdM is scaling-up and strengthening their efforts utilising multi-sectoral approach through improving access to health, MHPSS, as well as supporting locally-led responses. Furthermore, within the rapidly shifting dynamics, MdM is reconfiguring its programming within humanitarian-peace-development nexus, with a particular focus on scaling up access to health and MHPSS as actual programming. In the current context, among the most vulnerable groups are internally displaced persons, health care workers and personnel of essential services, pregnant/lactating women, older persons, children under five years, children and adolescents attending organized activities (e.g., daycare, schools, etc.), as well as people with chronic medical conditions and physical and mental disability.

In November 2020, MDM started the implementation of the project Strengthening community and health system resilience in Luhansk Oblast funded by BMZ (German Federal Ministry for Economic Cooperation and

Development). The project is currently being modified to reach vulnerable population in Kyiv and Chernihiv regions and will link MdM’s humanitarian assistance with transitional aid/development activities resulting in creation of a sustainable access to health and social services in communities affected by the conflict.

1. Purpose of the consultancy

The purpose of the consultancy is to build a comprehensive picture of the health and social needs of selected communities, as well as to identify opportunities for future development in Kyiv and Chernihiv oblasts. The result of this identification will be compiled into a needs assessment report.

The data collection will be carried out in Kyiv and Chernihiv oblasts through secondary data review, Key Informant Interviews (KII), Focus Group Discussions (FGDs), survey with community members, and assessment of targeted health facilities. Logistical support will be provided by MdM for travel and security, the accompaniment of the MdM team in Ukraine. Data collection methodology (questionnaires, scripts for FGDs and KIIs) will be provided by MdM. Following the data collection by the consultant, MdM will provide support to the consultant on analysing the data.

1. Methodology

   • Desk review: to conduct a desk review of the available literature on the project documentation
   • Key Informant Interviews & Community leader’s quantitative survey: to assess perceived satisfaction, problems, and barriers associated with health and social services provision of health and social workers, as well as community leaders
   • Focus Group Discussions: to conduct focus group discussions with community members (with emphasis on inclusion of vulnerable groups)
   • Survey with community members: to conduct a questionnaire with community members to assess social and health needs
   • Assessment of health and social infrastructure: to assess the capacities, strengths, weaknesses of health and social systems to provide quality medical care and basic social services

2. Targeted Locations

Kyiv Oblast: Kyiv oblast was largely affected by the hostilities. Settlements were targets to missiles; thus local infrastructure was damaged. Many routes, bridges and highways were destroyed since the beginning of the conflict. In addition, , the health system was damaged and looted, ultimately, it has significantly impacted the service provision. Kyiv oblast hosts 325,074 IDPs according to the IOM report (IOM Area Baseline Assessment, September 2022). Liberated territories encounter the lack of essentials and healthcare items. The flow of IDPs results in the increased workload at medical facilities. Local health systems struggle to manage the high number of patients combined with the lack of resources and capacity for providing assistance.

Chernihiv oblast: Chernihiv oblast is located near the Russian border and has been a target to massive attacks since the beginning of the full-scale conflict. According to IOM assessment, it hosts 78,407 IDPs (IOM Area

Baseline Assessment, September 2022). . Hostilities and occupation led to critical damage to the civilian infrastructure, particularly the healthcare sector. According to the WHO, 24 health facilities (HF) were attacked with 30,000 people residing in the catchment area of these facilities. Disrupted roads and bridges caused limited mobility of community members unable to access HFs, mental health services, medications and basic items. Local health systems encountered the lack of funding and human resources and decreased the level of support from the state bodies.

1. Organisation of the data collection

The data collection will be performed by the consultant. The core functions and responsibilities of the consultant are the following:

1. Plan, schedule of KII, FGD, Community members survey and health and social infrastructure assessment: The planning and scheduling of data collection will be identified in agreement with the Coordination Team (Emergency Coordinator and Field Coordinator Kyiv).
2. Conduct the KII, FGDs, Community members survey and health and social infrastructure assessment in the locations that will be planned and agreed based on the consultations with local authorities, and with other key stakeholders.
3. Proposed Timeline and Deliverables

Time Schedule

Activities

Deliverables

Week 1

1. Desk Review: review of intervention documentation, and related primary/secondary resources for the needs assessment
2. Development of the data collection plan and schedule
3. Е-numerator training
4. Data collection/analysis plan and schedule
5. Draft methodology, including samples design for KII, FGD, community survey

Week 2-3

1. Data collection according to the data collection schedule

1. Data collection completed according to the data collection plan

Week 4-5

1. Debriefing with the initial findings
2. Analysis of findings (jointly with the MdM team)
3. Preparation of draft needs assessment report
4. Address feedback with revisions in the needs assessment report where appropriate
5. Revise and submit the needs assessment report
6. Debriefing meeting
7. Draft version of the needs assessment report, including a community portrait
8. Final version of the needs assessment report, including a base line and targets proposal

Total duration:

5 weeks