Monday, June 15, 2015

Terre des hommes ,Consultancy on outcome mapping health programs Jobs in Tanzania



Closing date: 29 Jun 2015

TERMS OF REFERENCE: OUTCOME MAPPING EXERCISE

TDH-NL FUNDED PROJECT: ACCESS TO PRIMARY HEALTH CARE FOR PREGNANT AND LACTATING MOTHERS AND CHILDREN UNDER FIVE IN MARA REGION

1STMAY 2012 – 31ST DEC 2015

Project Title: Access to primary health care for pregnant and lactating mothers and children under five
Project No. Partner 1: TZ 018, TZ 035 & TZ 051
Partner 2: TZ 050
Partner 3: TZ 056Project
Implementation Dates TZ 018 & TZ 035: 1st of January 2013 – 31st of December 2015
TZ 050: 1st of May 2012 – 30th of June 2015
TZ 051: 1st of July 2013 – 30th of June 2016
TZ 056: 1st of January 2014 – 31st of December 2015
Location Mara Region
Assignment Type: Outcome mapping of health programmes Mara Region
Outcome mapping Purpose
  1. Mapping of outcomes achieved by the health programme in the period 2013-2015.
  2. Compare the outcomes of the health programme with the 2011/2012 baseline data (where available).
  3. Highlight most significant changes and best practice strategies used in the health programme. Proposed Dates for the assignment 15th of July - 31st of AugustAnticipated Report Release Date 31st of August
Introduction
Terre des Hommes Netherlands (Earth for Mankind) is a Dutch organization based in The Hague, founded in 1965 as a non-profit organization. Terre des Hommes Netherlands aims to improve the quality of life of children in difficult circumstances all over the world, regardless of race, faith and/or political orientation and to have their rights, as laid down in the UN Convention of the Rights of the Child, protected and assured.
In East Africa, Terre des Hommes Netherlands (TDH-NL EA) is active in Ethiopia, Kenya, Tanzania and Uganda. Our focus is to prevent child exploitation, remove children from exploitative situations and ensures these children can develop themselves in a safe environment. Direct aid through civil society partners is our core business; we have many years of experience and a large network in this field. We also focus on capacity building and advocacy / lobbying, centered on the most vulnerable children in their immediate environment.
In Tanzania, TDH-NL EA supports Tanzanian NGOs/FBO/CBO and networks in the execution of projects which aim to prevent child exploitation, provide assistance to exploited children and influence policy. TdH-NL EA programming in Tanzania is implemented Mwanza, Mara, Mtwara and Shinyanga Regions. This is underpinned by work at national level and supported by TdH staff and partners based in Dar es Salaam.
Background
As part of the MFS II funded Child and Development Alliance programme running from 2011-2015, a Health programme for Mothers and Children under five has been implemented from 01/01/2013 till 31/12/2015 covering four districts of Mara region. The districts are Musoma Municipal Council, Musoma District Council, Rorya and Bunda Districts. The health programme was implemented by three partner organisations.
Gaps identified in maternal health care in Mara region
The child mortality rates are high in the Lake Zone as 105 children/1000 live births (TDHS 2010) die before the age of 5 due to poor maternal health, malaria and diarrheal diseases. The HIV/Aids prevalence rate on the shores of Lake Victoria stands at 7.7% and is higher among women (8.6%) then men (6.6%), compared with 5.7% at national level, with little knowledge on mother to child transmission. Mother and child nutritional status in Mara indicate that 79% of children under 5 and 60% of women are anaemic. In Mara 31 % of children is stunted (2010) and 12% underweight (TDHS 2010). Some significant differences with other areas are the cultural habit of pre-lacteal feeding (giving water/porridge before the start of breastfeeding), vitamin A consumption is sufficient for 46.5% only, leading to night blindness by 5.9 % of pregnant women and is a cause of disability at birth. Only 61.6 % is fully vaccinated (DPT3 and polio 76%). The fertility rate in Mara stands at 6.7 among the highest in Tanzania, reducing from 7.3 (women 40-45 years). Maternal mortality rates are high in Tanzania.
The national average population per trained nurse, nursing officer, and nurse midwife was 3000 persons in Tanzania. In Mara region the average population per trained nurse, nursing officer, and nurse midwife for the Mara region was 4000 persons per nurse. In Tanzania 95.9% of the women received antenatal care from a skilled provider for the most recent birth; 35.4% received a postnatal check-up for the last live birth (2010). In Mara region 88.2% received antenatal care from a skilled provider for the most recent birth; 19.1% received a postnatal check-up for the last live birth (2010). In Tanzania 50.2% of live births in the five years preceding the TDHS 2010 were delivered in a health facility and 50.6% of the live births were assisted by a skilled provider (2010). In Mara region: 33.3% of live births were delivered in a health facility and 30.45% of the live births were assisted by a skilled provider (2010), because of which the risk of HIV transmission increases, disability and death.
Women in Mara Region attend antenatal clinics at a very late stage (8th month) or not at all (12%). Because of its environmental setting (Lake region, heavy rain seasons), Musoma Rural and Rorya districts suffer from malaria mortality rates twice the national average. Malaria is causing the majority of child deaths in Mara and high levels of anaemia. Because children with malaria are brought late to the health centres, they often already suffer severe malaria and the treatment is expensive, complicated or too late and they die.
The government contributes 10% of the national budget to health services throughout the country. This is supposed to include free ANC services and primary health care for pregnant mothers and children under five. But most government health facilities have a shortage of supplies, hence most people, including vulnerable groups do end up paying for services and treatment, affecting the poor in their health seeking behaviour
The Overall Programme Objective:
● To improve (reproductive) health services for (future) mothers and children under five including adolescents at risk.
Specific Programme Objectives:
● improve access to health services and increase its use in rural areas
● improve and provide comprehensive, family-centred care and treatment services for women and children in remote areas
● Prevent diseases and disability by providing health information to increase knowledge and healthy behaviour
● increase government involvement in health service provision
Program Implementation Modality
The program has been implemented in collaboration with three local partner organisations, who received grants and technical assistance from Terre des Hommes Netherlands to deliver community health services to mothers and children under five. They conducted five programs.
The boundary partners involved in the Mara Health Programme:
  1. Government of Tanzania; Mara Regional Hospital (Musoma), government health centres and dispensaries, Community Health workers
  2. Community Health Committees, Traditional Birth Attendants, local leaders,
  3. Pregnant and lactating mother and children under five
  4. Consultants, health specialists.
The programs all focus on (a variety of) topics for example nutrition, HIV/Aids, Malaria, PMTCT, disability and antenatal care. They are not all active in the same districts, but some areas overlap. They all have in common that they work in remote areas, making a difference for mothers and children who before had little access to quality service and knowledge on how to prevent and seek treatment for life threatening diseases. In all projects there is a strong community component, training community health workers and committees and working with support groups, expert mothers and women’s groups to be able to reach people and increase sustainability. For more information on the specifics of each program see Annex 1.
Outcomes to be documented on
Partner
Data availableProgress monitoring reports and field visit reports
Gaps/ Questions to be addressedWhat is the quality of the services they deliver? Limited information on how they cooperate.
Children (esp. under five)
Data availableNumber of children receiving care/ treatment and training Is there an improved health status of children under five?
Gaps/ Questions to be addressedDo they receive treatment in an earlier stage of their disease? What are the changes in behavior on hygiene (washing hands, toilet use, malaria prevention). What is the level of knowledge on, and are there changes in, HIV transmission?
Parents
Data availableNumber of (pregnant) mother and fathers receiving training and education.
Gaps/ Questions to be addressedChange in attitude towards early health seeking behaviour and successful methods being used by partners to stimulate this behaviour.Knowledge level on healthy behaviour family planning, hygiene, malaria prevention and use of nets, Hiv transmission, care for disabled child? Changes in behaviour of parents in prevention and provision of care to (disabled) child.
Community
Data availableNumber of groups created and trained (expert mothers, women groups, village health committee). Number of events, home visits,
Gaps/ Questions to be addressedHow do the members of different groups cooperate and influence local government and how are they perceived by and cooperate with village members. How sustainable are the different created groups within the community and how are they of support to the overall community. How effective are they in supporting women and children and, what kind of changes have they inspired in them?
Health care workers
Data availableNumber of people trained (TBA, Nurses, Community health workers, and others who attended trainings
Gaps/ Questions to be addressedWhat changes are seen in their approach, knowledge level, and expertise in providing (preventive) health care, differentiated by type of health worker) The results of the training and attendees; how are the knowledge and tools presented during the training, being used in day to day health activities/work? What are behaviour changes of the trainees?
Health services
Data availableImprovements in record keeping in clinics/hospitals. Mobile clinics. equipment available. Overall information on current health care provided and statistics.
Gaps/ Questions to be addressedData on changes in care provided by mobile clinics and hospitals, analyses of the increase/decrease in number of patients and referral. Specifically numbers on possible reduced child mortality and reduced incidences of maternal mortality among patients in hospital, reduction in birth complications or early detection of birth complications.
Government
Data availableNumber of events and training's joined by government officials and people contacted. Gaps/ Questions to be addressedHow does the government perceive the programme partners and TdH NL, (in which way) do they perceive the programme partners are representing the target group? Which contributions have they actually made to improved quality of health care in Mara region. (How) Are they implementing new programs and lobbying/advocating for changes/improvement?
Purpose of the assignment
The purpose of this outcome mapping exercise is to collect information on outcome results achieved and to compare this with the 2011 baseline information as documented in the Ecorys 2011 MDG report and previously known statistical data and paying particular attention to the outcomes and impacts of the specific projects actions. Additionally the final report will highlight best practices and ‘most significant change’ as a result of the health programme, mostly implemented in the period 2013-2015.
Objective of the Assignment:
The overall objective of the outcome mapping is to document the outcomes of the ‘access to primary health care for pregnant and lactating mothers and children under five’.
Specific objectives of the Assignment:
The outcome mapping aims to accomplish the following:
  1. Document improvement of health services on grass root level, delivered to communities in rural and remote areas and its effect on the health of the community. Specific outcomes for mothers and children resulting from the health programme (with clear attribution). Documented behaviour change and improved skills among health workers: like TBA, CHW, health officials, staff in health centres etc.
  2. To what extend did the programme influence the access to health care in Mara Region? How did the situation improve? Which positive/negative outcomes can be attributed to the programme?
  3. What are the behaviour changes observed within the communities in accessing health care and practising hygiene and prevention (of malaria, PMTCT, early health seeking behaviour, pregnancy care/ANC)? Which positive/negative outcomes can be attributed to the programme?
  4. What was the involvement of local, regional and national government in the program. How were they being involved and what was the result? What did they commit to? What are their priorities and how do they reflect on the Terre des Hommes Netherlands sponsored program.
  5. What has been the overall outcome level effect of the health programme in Mara Region?

Scope of the Assignment

In the outcome mapping and final assessment the following will be taken into consideration;
  1. Collection of substantial and good quality outcome data according to the project results planned and including the C&D alliance indicators for outcome and proxi indicators as mentioned in the Ecorys MDG Report 2011.
  2. Outcome mapping involves at least 25% of all beneficiaries and 25% of each type of boundary partners reached by the projects against the indicators.
  3. Clear analyses, presentation and assessment of the outcome mapping data including conclusions towards the overall performance, benefits sustainability and financial sustainability. What were the major factors which influenced the achievement or non-achievement of outcomes of the project?

Methodology

To sufficiently address the key questions raised above, the outcome mapping will need to adopt methodologies and tools that combine both qualitative and quantitative techniques. The consultant is expected to propose his/her methodology, which should include but is not limited to:
● Consultation with Country Manager, programme teams and partner and project team on methods and techniques and to finalize methodology before execution of field activities.
● Regular consultation with the Project Partners, as well as government health service providers, stakeholders and government officials
● Review project documents, reports and case studies developed by the project.
● Develop variables for surveys and interview guides for Focused Group Discussions (FGDs) and Key Informant Interviews (KIIs).
● Conduct FGDs and KIIs with TDH team, partners, stakeholders and beneficiaries (Mothers, community members, health staff, government officials)
● Conduct data analysis (quantitative and qualitative) and, where possible, trend analyses
● Prepare draft report as per guidelines
● Presentation of findings and recommendations at stakeholder meetings
● Incorporate feedback and presentation of final report

Reporting

The consultant(s) will produce a report of no more than 40 pages plus appendices, in Microsoft Word using Palatino font 10 (minimum spacing). It will include:
● Title page
● Table of Contents
● Acronyms
● Acknowledgments
● Executive Summary
● Background and Project Description
● Purpose of the assignment
● Scope of the assignment
● Methodology
● Findings – Including all relevant issues stated under specific objectives of the assignment and gaps identified (20 pages)
● Analyses of data (5 pages)
● Best practice strategies in improving access and quality of education (3 pages)
● References
Annexes:
● Outcome mapping Tools
● TOR
● Other relevant documents (List of people interviewed, List of documents reviewed etc)

Time Frame

The study shall commence from 15th of July and completed by 31st of August 2015. A draft schedule is given below, which can be refined after consultation with consultant.
Activity,No of days Specific Dates Meeting with partners and identify data collectors, organize dates for field work (1) Review of project documents (2) Design of data collection tools (2) Induction of field data collectors (1) Data collection (to include children, parents, health care workers, clinics, government stakeholders KII etc) (8) Data entry/Coding (2) Data analysis and report writing (draft) (3) Incorporating feedback and finalize report 2 Grand Total 21 days

Team

The team for this assignment will comprise of the consultant who will have overall responsibility of designing, implementing and coordinating the entire outcome mapping process guided by the TOR. The skills and expertise are as outlined below:
Qualifications/experiences required
● At least a post-graduate degree in Social sciences and Public Health
● Experience with health projects (projects addressing health concerns) in Tanzania
● Proven experience in conducting outcome mapping (preferably with multiple partners), using a variety of techniques including interview and skills to facilitate Focus Group Discussions.
● Experience in working with NGOs, CBOs and beneficiary communities
● Excellent communication skills in written and spoken English
● Good report writing skills (concise and clear reporting, good presentation of data and sources of information)
● Strong analytical skills.
● Ability to devote enough time to this assignment and meet deadlines.
● Willingness to travel and flexibility to manage changing circumstances.
● Good working knowledge of Kiswahili.
● The Consultant may seek support from an Assistant and some data collectors.

Deliverables and tasks

The key tasks are:
● Submits a letter/ proposal of interest, outlining how the areas outlined in the ToR will be addressed
● Signing the agreements for this assignment
● Reviews all relevant documents
● Shares the tools with partner and TdH-NL and amend as per feedback and update for final approved version.
● Visits field and collects information as per defined methodology and approved formats.
● Submit Draft outcome mapping report outlining general findings and analyses of best practice strategies for feedback to TdH-NL and Partners
● Present key findings with PowerPoint during a stakeholder meeting.
● Incorporate feedback and Submit final report
The key deliverables are:
● Proposal of interest
● Drafts tools for information collection as per project documents
● Field visit notes and raw data
● Draft report on outcome mapping
● Power point presentations of key findings of the outcome mapping
● Final report, one original signed hard-bound copy and in Electronic copy (that includes all photos of the outcome mapping exercise)

Management

The consultant will formally report to partners for day to day support. Facilitation and field support will be provided by the project partners in Tanzania, this includes setting up interviews, meetings and FGDs and informing relevant stakeholders. Partners and TdH-NL will provide documentation related to the project.

Expression of Interest

Interested consultants should send the information listed below to TdH-NL
  1. Assignment bid (4 pages max) outlining:
a. how you meet the qualifications, skills and experience required (see Section 8 above)
b. outline of proposed methodology
c. suggested timetable of activities
d. a description of the fee schedule, including a schedule of person-days
  1. Latest curriculum vitae (of consultant and any supporting team members) Sample report of outcome mapping conducted contact names of organization submitted to.
How to apply:
Proposals should be send to Tanzania Office: s.koet@tdh.nl with copy to a.groot@tdh.nl

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