Medair received a grant from the German Humanitarian Assistance (Auswärtige Amt) for the period 1 January 2018 – 31 December 2018 to reach Syrian refugees and vulnerable Jordanians with cash-for-health assistance in Jordan. As a part of this grant, AA has requested an external quality evaluation of the project.

Background:

As of September 2018, there are 671,428 Syrian refugees in Jordan, with 81% living outside of camps (UNHCR Portal, September 2018). The Syrian crisis, now in its seventh year, shows little sign of abating. As displacement continues, refugees are becoming increasingly economically vulnerable.

In Jordan, basic services and provisions are available, with functioning markets for food and other goods, health services, shelter, stable security and good infrastructure in most locations. A key problem is that many refugees lack the financial resources to access these services. Up to 75% of Syrian households are adopting one or more negative coping mechanisms (A promise of tomorrow, UNHCR, Oct. 2017) including taking exploitative jobs, child labour, increasing debt, reducing food consumption and withdrawing children from school. An estimated 85% of Syrian refugees live below the poverty line (UNHCR Factsheet, Aug 2018) and an estimated 14% of Jordanians live on less than 5.50 USD a day (World Bank). The “Jordan Compact” which was presented in February 2016 led to opportunities for Syrians to obtain legal work permits. This was a significant milestone for the refugee crisis in Jordan with the government subsequently waiving the fee for work permit applications for Syrians. However, administrative issues and lack of employment opportunities have meant that – in practice – not all Syrian refugees have been able to avail of these work permits.

With many families living on minimal resources, when urgent and significant healthcare needs arise, the additional financial burden to spend on medical treatment is often impossible to overcome and exacerbates pre-existing vulnerabilities.

In November 2014, the Jordanian government reversed their previous policy of providing free medical treatment to Syrian refugees, such that Syrians were charged the rate of a non-insured Jordanian for all medical care since that time. However, recent changes to Government regulations in January 2018 mean that registered Syrian refugees are no longer able to access the non-insured Jordanian rate for health and should now pay 80% of foreigner rates. This is expected to have wide ranging implications for the provision and access to health services for Syrian refugees in Jordan. Unregistered Syrian refugees continue to pay the full foreigners’ rates, making this group even less able to afford healthcare costs in Jordan.

Medair has significant experience in implementing health programmes in Jordan and has been working in Jordan since 2012. Medair’s current health programme includes both community-based health education, focusing on reproductive health, including ANC, PNC, SBA for delivery, FP, SGBV and early marriage, infant and young child feeding practices, psychosocial support and NCD’s and C4H for deliveries, emergency surgeries and NCD’s. Medair is already working in the areas targeted under this project (Amman, Irbid, Mafraq and Zarqa), with existing community relationships and programming. Medair also has substantial experience in cash programming in Jordan having run cash-for-rent and unconditional cash assistance programmes as major responses to the current crisis. Lessons learned from Medair’s cash programme have been incorporated into Medair’s C4H programme and the knowledge and best practices established will be essential in delivering an effective programme that brings financial support to those with significant health care needs.

Since Medair began C4H interventions in 2015, other actors have adopted the modality to help Syrians overcome the financial barriers to healthcare, including PU-I and Islamic Relief; however the scale of their assistance is relatively small. UNHCR is the other main provider of C4H, however they do not accept cases of unregistered refugees, resulting in a gap of assistance towards this vulnerable population. Medair is actively engaged in the cash coordination meetings with PU-I. These meetings are chaired by UNHCR and have been designed to be a forum for sharing knowledge, standardizing cash for health methodologies, and to avoid overlap in areas of coverage. Medair and PU-I have coordinated areas of coverage for this call for proposals.

Medair is planning to continue its existing health programme in order to have further reach and help meet ongoing and urgent health needs. Medair has the experience, resources and structure in place to identify and connect with refugees and vulnerable Jordanians in each community in a cost effective and meaningful way that can help promote healthy practices and improve education and access to services for Syrians and Jordanians in areas such as maternal and child health, reproductive health, infant and young child feeding, nutrition, SGBV and psychosocial support.

Purpose:

Medair received a grant from the German Humanitarian Assistance (Auswärtige Amt) for the period 1 January 2018 – 31 December 2018 to reach Syrian refugees and vulnerable Jordanians with cash-for-health assistance in Jordan. As a part of this grant, AA has requested an external quality evaluation of the project to look at:

• Relevance of the project and its activities in Jordan for the selected target group
• Effectiveness: Have the aims been reached through the means anticipated? Is the target group in a better situation after this project?
• Efficiency: Were the funds appropriately used and in the most cost-effective way? Is there a better way to deliver the same results?
• Impact: How did activities contribute to the overall objective?
• Coverage: Was this project able to reach the right people? Was the coverage sufficient? If not, why not? Who was not reached and why? Did non-needy people benefit?
• How does this project compliment other support given for Syrian refugees in Jordan by UNHCR, WFP and others? Is the coordination sufficient?
• What are the unintended consequences of this project, either positive or negative?
• What are recommendations for future health projects in Jordan?

Outputs:

A written report to be provided, in German and English, on the quality of AA-funded Medair programme in Jordan entitled “Cash-for-Health Assistance for Syrian Refugees and Vulnerable Jordanians”.

Project details:

Overall objective: Relieve suffering, reduce preventable morbidity and mortality, and strengthen resilience among vulnerable Syrian populations and Jordanians affected by the Syrian crisis

Operation purpose: Support vulnerable Syrian refugees and Jordanian households to have increased access to urgent health services (through cash-for-health) and support WGMB in targeted communities to have increased awareness, understanding and individual capacity to adapt healthier behaviours

Result 1: Increased awareness among WGBM due to health promotion efforts by CHVs

Indicator 1: # of beneficiaries reached through awareness raising, promoting healthy reproductive health practices including infant and young child feeding and new-born care  (Baseline: 0, Target: 22,440)

Indicator 2: 26 CHVs trained on case finding for cash for health beneficiaries and behaviour change communication

Indicator 3: % of post-partum mothers who receive a new-born visit from a Medair CHV within 2 weeks after delivery (Baseline: TBD, Target increase 5%)

Indicator 4: % increase in CHV knowledge of RH, NCDs, PSS, SGBV and BCC strategy after Medair training (Baseline: TBD. Target: >20%

Result 2: Increased cash availability to vulnerable Syrian refugees and Jordanians for payment of health care

Indicator 1: 305 vulnerable refugees receive cash support for uncomplicated delivery

Indicator 2: 275 vulnerable refugees receive cash support for other essential health related needs e.g. emergency operations, C-sections

Indicator 3: 249 vulnerable Jordanians receive cash for health for deliveries

Methodologies and Tools:

To be suggested by the applying consultant.

Qualifications:

The relevant candidate will:

• Have a Master’s degree
• Have at least two years’ experience of project evaluations, preferably in complex humanitarian settings
• Be committed to the Humanitarian Charter and Minimum Standards in Disaster Response (SPHERE) and the Red Cross/Red Crescent Code of Conduct
• Be fluent in written and spoken German, English, and Arabic (if the consultant does not have fluency in either Arabic or German, the cost of a translator should be included in the quote provided)

Timeframe: 1 January – 15 March 2019

Security:

All reasonable steps will be taken to provide safety and security for the consultant; both Medair and consultant accept the inherent risks in working in humanitarian contexts. Medair will not be required to do more than what is reasonable and possible in the circumstances whilst providing a safe and appropriate work environment.

Consultancy fees and terms of payment:

To be determined.

Consultant Responsibilities:

• Fulfil the above outputs as listed in the section “output” and “purpose” within the timeframe stated.
• Provide laptop, software, or any other relevant equipment for personal use and report writing (not chargeable to or reimbursable by Medair).
• Provide proof of any mandatory liability insurance or, as applicable, professional services insurance.

Medair Responsibilities:

• Provide timely payment for services
• Provide all project related documents including M&E plan, logframe, proposal, post-distribution monitoring results, data on achieved results, etc.
• Provide contacts for partner organisations if required

• Provide staff for data-collection if required
• Provide staff and access to beneficiaries for focus group discussions and other activities, if required
• Provide working facilities which will be as secure as is practical in the circumstances.
• Medair is responsible for line management of all Medair employees and this cannot be transferred onto the Consultant. In some cases Medair can help hire casual labourers that can be managed by Consultant (but paid for out of the evaluation costs)
• Coordinate field visits to relevant stakeholders

• Arrange appropriate accommodation, per diem and travel to Jordan
• Transport to/from Medair office

To apply:

Submit a written proposal including:

• Rational, design and methodology suggested for evaluation
• Proposed schedule for travel to Jordan, information gathering, and report writing
• Provide a sample(s) of project evaluations of similar scope or context
• Personal contact details and qualifications
• Statement of agreement with above ToR
• Proposal of costs including consultancy fees, casual labour if needed, translator and/or translation fees and transportation inside Jordan (Jordan team can help advise on common costs if needed) – please submit your quotations only in USD

Deadline for written proposal:

Proposals should be sent to corinna.drechsel@medair.org by 17 December 2018.