Mid-term Evaluation of Gedo Regional Safe Motherhood Programme

Terms of Reference

Mid-term Evaluation of Gedo Regional Safe Motherhood Programme

Introduction

The Gedo Regional Safe Motherhood Programme strengthens the care of mothers and newborns within the larger primary health care programme implemented by Trócaire Somalia and builds on current and previous Trócaire interventions in the provision of basic health services to a population of 220,000 in Gedo Region of South Central Somalia.

The broader primary health care programme supports health and nutrition services in five of the seven districts in Gedo Region, Southern Somalia.

The current EC funding began in January 2011 and will end in December 2013. It is a continuation of a previous three year phase of the programme (June 2007 – March 2011), with an overlap between this current funding and the previous project between January and March 2011 due to a no-cost extension of the previous grant.

The broader programme is funded by DFID, EC, Trócaire, UNICEF and Irish Aid.

The security situation in South Central Somalia has changed significantly over the one and half years since the start of the programme with a resultant reduction in access for programme implementation.

Constant changes to the implementation strategy have been necessary to respond to this reduced access.

Trócaire is now proposing to carry out a midterm evaluation of the programme progress build on the outcomes of the ROMS mission and the outcomes of the DfID-led review.

The results of the evaluation will be used to inform the donors on progress made and for future programming.

Due to the on-going security restrictions, the evaluation will be largely a desk-based study with interviews of key staff and informants.

It is unlikely that field work in Gedo will be possible (currently only Dollow); access to Mandera may also be minimal.

It is estimated that this work will take approximately 22 working days in September 2010.

Purpose of the Evaluation

The purpose of this final evaluation is to:
  • Determine the degree of progress against the Programme Purpose and Results in the one and a half year (January 2011 – June 2012) of implementation build on the outcomes of the EC Results Oriented Mission (ROM) and the outcomes of the DfID-led review, taking into account the changes in the context as well as evaluate the programme with regard to its effectiveness, efficiency, relevance, sustainability and impact.
  • Draw major lessons from the programme implementation and make practical recommendations, so that the programme can deliver better and effective services in the remaining period.
  • Suggest innovative strategy for increasing the quality and the demand of Health services delivery in the Gedo context.
  • Produce an assessment tool able to capture the impact of any training after six months & 1 year.
  • Determine the best methodology to assess whether messages on maternal health and safe delivery is being understood by the targeted community.
Background

Gedo Gedo Region is situated in south western Somalia. With an estimated population of 380,000, Gedo is divided into seven administrative districts. The population is mainly pastoral with agriculture practised along the Juba and Dawa river valleys.

The Gedo region has historically been one of most underdeveloped areas of Somalia, with minimal infrastructure, a weak economic base and only very basic health and education services available to the communities.

The region is largely food insecure due to its dependence on erratic rainfall for the production of crops and pasture.

Gedo has been chronically insecure due to on-going inter and intra-clan conflicts largely related to control of resources. Currently the security risks in the region are linked to external threats and influences associated with the political situation at the national level intertwined with the internal conflict. Three of the five operational districts are controlled by pro TFG forces and two are under the Al Shabaab control. Guerrilla tactics used by Al Shabaab result in surprise attacks upon towns, mining of roads, IEDs etc. This limits access and compromises supplies and requires a flexible operational mode.

In this environment, traditional conflict mitigation and resolution mechanisms previously used by Trócaire are less effective and the use of community acceptance as a security mechanism for programme staff and resources has become less reliable resulting in a reduction in time technical staff can spend in Gedo.

Trócaire Trócaire has been implementing a variety of humanitarian and community development programmes in Gedo region since 1992 and currently focuses on health & nutrition, education and emergency response programmes.

Gedo Regional Health Programme The Gedo Regional Health Programme supports primary health service delivery to an estimated population of 220,000 in five of the seven districts of Gedo, (Belet Hawa, Dollow, Luuq, Garbahaarey and Burdhubo) with the support of 5 District Health Boards.

Three district hospitals, 5 OPD/MCH units, 5 district outreach teams and 50 Health Posts receive support in terms of maintenance, expatriate & national technical staff, national staff salaries, transport, supplies and capacity building. Trócaire has offices in Nairobi and Mandera.

The overall objective of the programme is: To reduce maternal mortality and morbidity in the Gedo region of Somalia by increasing access to sexual and reproductive services.

The specific objective is: To ensure that women living in the five project districts will have equitable access to quality, sustainable and effective maternal health services and awareness and information on the importance of the maternal health for them and their families.

The expected results are:

R1 – Improved access to quality, sustainability and effective maternal health services in the project area.
R2 – Improved capacity of health staff to deliver maternal health services.
R3 – Improved capacity of District Health Boards (DHBs) and District Health Management Teams (DHMTs) to manage and supervise maternal health services.

The current EC supported project started on 1st January 2011 for €1,080,000 (79.75% of the estimated total eligible cost of the action).

A three-year funding contract was signed with DFID (£2,867,786) in June 2010. Additional support for MCHs and HPs, malaria and nutrition interventions is received from UNICEF, GFATM and Irish Aid, as well as Trócaire own funds.

Specific Objectives of the Evaluation

The specific objectives of the evaluation are:
  • To determine the degree of progress against the purpose and expected results (as described in the log-frame), have been achieved build on the outcomes of the ROMS mission and the outcomes of the DfID-led review. This analysis should be related to the log-frame indicators, taking account of the challenges posed by the changes in context
  • To assess the effectiveness, efficiency, relevance, sustainability and impact of the programme.
  • To assess the extent to which the recommendations of the final evaluation of the previous phase (August 2010) have been addressed.
  • To develop specific lessons learnt and recommendations based on the above analysis and current Somalia/Gedo context, which will guide the strategy and methodology of Trócaire’s health interventions for the future.
  • Suggest innovative strategy for increasing the quality and the demand of Health services delivery in the Gedo context.
  • Produce an assessment tool able to capture the impact of any training after six months & 1 year.
  • Determine the best methodology to assess whether messages on maternal health and safe delivery is being understood by the targeted community.
Format for the Evaluation

Due to the security-related access problems in Gedo, the evaluation will be largely a desk based study supported by interviews with key informants and perhaps trips to Dollow and Mandera, if security allows.

5.1 The methodology should include but is not limited to;
  • Document/data analysis and review in Nairobi.
  • Focus Group Discussions and individual interviews with Trócaire staff.
  • Review workshop in Mandera with Trócaire staff.
  • Individual interviews with donors, selected NGOs relevant to the sector, DFID consortium partners, and other key informants based in Nairobi.
  • Some telephone interviews may be possible with key Gedo-based informants and if the border restrictions/security allow, meetings with them in Mandera may be organised.
  • Field visit to Dollow, if security allows.
5.2 The programme components to be reviewed are:
  • Safe Motherhood Services including referral.
  • Hospital Services.
  • Programme Management structures.
5.3 The key issues for analysis must include:

Progress made against planned objectives as in the log frame as well as effectiveness, efficiency, relevance and sustainability 2. Possible future strategies that could improve programme delivery 3. The effectiveness of the programme management structure for the implementation of the Gedo Regional Health programme.

5.4 The main Trócaire reference documents to be consulted are;
  • The EC funded Safe Motherhood Proposal, log-frame and budget
  • EC ROM mission report
  • DFID proposal and budget and reports
  • DFID annual reviews reports - 2011 & 2012
  • The UNICEF/GFATM Malaria proposal and budget, and reports
  • The Irish Aid proposal, log-frame and budget, and reports
  • The Trócaire PPD
  • The DHB MOUs
  • Two interim reports against the current programme and the final report for the previous EC funded phase
  • Final Evaluation, August 2010
  • Health Information System data
  • Somalia Health Sector EPHS policy
  • RH strategy for Somalia
  • Somalia Health Sector Staff incentives proposal
Expected Outputs & Reporting Format
  • A clear and concise written evaluation report (20 - 25 pages, including the executive summary but excluding annexes), structured around the objectives of the evaluation and clearly analysing and answering the key questions identified. The report should at a minimum, contain the following elements:
  • A 2-3 page executive summary highlighting the key findings and recommendations of the evaluation, which can serve as a standalone document.
  • Progress Made Against Original/Adjusted Targets 3. Effectiveness, efficiency, relevance, sustainability and impact analysis 4. Suggestions for increasing the quality and the demand of Health services delivery in the Gedo context.
  • An assessment tool able to capture the impact of any training after six months & 1 year.
  • Methodology to assess whether messages on maternal health and safe delivery is being understood by the targeted community.
  • Major Questions 8. Conclusions 9. Recommendations and lessons going forward 10. Annexes, to include description and justification of the methodology used
  • The report should include some consideration regarding VfM activities and their impact on the ground.
  • The report should analyze the importance of quantitative target for each MCH depending on specific criteria (catchment area or number and capacity of staff....)
  • Clearly stated, realistic and practical recommendations for future phases of the programme, which should be based on the analysis.
  • Debriefing/feedback presentations to Trócaire management staff after field work is complete.
  • The report is intended to serve as a mid-term evaluation of the EC supported programme. The principle client is Trócaire. The report will serve as a mid-term evaluation for donors and should be structured to answer all donor major questions so that findings can be used to complete donor reporting requirements.
A draft report should be submitted by email within two weeks of completion of the data collection work. Trócaire and donor will supply comments/corrections within 14 days, and the final version should be submitted within one week of receiving the comments.

The report should be written in English and the final version provided in hard copy and soft copy. Maps and photos should also be provided in soft copy (CD; DVD).

Timing

Trócaire estimates the following time will be necessary to complete the work:

Literature Review:

Three days Travel Two days Interviews/workshop– Nairobi: Three days Interviews – Mandera/telephone Three days Field visit to Dollow One day Feedback workshop/meetings in Nairobi One day Preparation of draft report: Seven days Finalisation: Two days

Total: 22 days

This consultancy should start on 1st of September 2012

Required Expertise of Evaluator

8.1 The proposed evaluator should have the following expertise;
  • At least ten years experience in public health programmes with emphasis on public health in complex emergencies and safe motherhood services, preferably in Somalia.
  • Previous experience of evaluating health programmes in complex emergencies, preferably in Somalia.
  • Good understanding of the Somalia context.
  • Experience of community health management structures such as District Health Boards, Village Health Committees.
  • Sound knowledge of Project Cycle Management
  • Ability to evaluate comprehensively without having access to programme site (using written reports, telephone interviews and meetings with key informants.)
  • Excellent reporting and communication skills, both written and verbal
Support Services/Logistics

Trócaire will organize logistical arrangements for all work in Gedo/Mandera including transport, accommodation, briefings, translation and administration.

Transport (including one economy class return ticket to/from Kenya), briefing, accommodation and administration support will be provided in Nairobi for consultants originating from outside of Kenya.

Application

If you feel you/your organisation fits the required profile, please submit a short proposal that outlines how you propose to undertake the assignment (including timeframe & budget), a covering letter highlighting how your qualifications and experience meet with the ToR above and Curriculum Vitae (max 3 pages) to

The Regional HR and Admin Manager,
Trócaire,
P.O. Box 66300, 00800,
Westland’s, Nairobi,
or email to: hr@trocaire.or.ke

by Sunday 29th July 2012. Please include contact number, present salary, and contact details for three referees (including current or most recent supervisor).

Only short listed candidates will be contacted.

Trócaire is an equal opportunity employer. Qualified female candidates are encouraged to apply.
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