Health Facility Assessment for the “Health Resilience of North-East Nigeria (HeRoN)” consortium project
1.0 Background Information
Public healthcare in Nigeria has suffered from years of under funding, ranking in 2016 as one of the lowest healthcare expenditures in Africa and the world. This has contributed to Nigeria having the second highest total maternal mortality, second highest child mortality and some of the highest global rates of malaria, HIV, TB and neglected tropical diseases. Immunization coverage is dangerously low and while many health interventions are donor funded, the country is expected to be ineligible for a range of foreign health financing, including from the Global Fund and World Bank, over the next two decades.
In the last ten years, conflict in the North-East has exacerbated that situation, contributing to the deterioration of health facilities and the breakdown of public services. With only 11 percent of facilities functioning (50 percent are non-functioning, 39 percent are fully destroyed), primary healthcare services, gender-based violence clinical management and reproductive healthcare is either lacking, inaccessible or seriously under-resourced. The International Rescue Committee (IRC) in partnership with Action Against Hunger UK (AAH) and Society for Family Health (SFH) recently secured funding from DFID/USAID for a project entitled Health Resilience in Northeast Nigeria (HeRoN). The HeRoN project aims at ensuring that crisis-affected communities in Borno and Yobe states have meaningful access to quality primary health and nutrition services, while contributing to sustained capacity building for health systems strengthening at LGA level. The project’s overall impact is to ensure that lives are saved and suffering is reduced for the poorest and most vulnerable persons in North-East Nigeria through the establishment of strong and more resilient health systems. The project focuses on ensuring that people (with particular focus on women, girls, and other marginalized groups) are protected from and treated for the main causes of morbidity and mortality.
The project outcomes are interconnected, leading to overall anticipated impact. The project theory of change entails three causal pathways addressing access to quality services, demand/ behavior change and health systems strengthening (HSS). The assumption is that if people – particularly women, girls and other marginalized groups – have access to and receive timely, quality and effective primary health and nutrition services, and if services are effectively planned, managed, and budgeted, then people in targeted LGAs will adopt healthy behaviors that prevent acquisition and spread of new disease and mitigate the severity of existing disease, and will be protected from and treated for the main causes of morbidity and mortality. Success will depend on cross-cutting outputs including the degree to which people of diverse backgrounds influence how health services are delivered, how response interventions are coordinated, how learning is used to generate best practice/ evidence that impacts policy, and how social norms shift to support women, girls and marginalized groups to make decisions on their health.
Outcome 1: Quality primary health and nutrition services are available and accessible: The partners will support the delivery of comprehensive health and nutrition services in selected LGAs, in accordance with National Guidelines and in conjunction with state government priorities. By increasing access to and demand for health and nutrition services for children, pregnant and lactating women, the HeRoN project will contribute towards reduction of infant and under five mortality rates, and reduction in the maternal mortality ratio. The increased access and availability of health and nutrition services will result in an increase in the number of clients utilizing health services, increase the percentage of births attended by skilled health personnel in health facilities. Further integration of nutrition and immunization components will lead to an increase in the percent of infants 0-5 months receiving exclusive breastfeeding, increase in the percentage of children 0-12 months who receive their third dose of DTP-containing vaccine among others. The project will improve the quality of health and nutrition services in target locations**.** Through improved quality assurance systems, the project will contribute towards an increase in the percentage of health facilities achieving improvements in quality services. Investment in improved technical competencies will result in an increase in percentage of human resource capacity enhancement required for improved primary health care and nutrition services.
Outcome 2: People seek timely services and take informed actions to prevent new disease, and spread of existing disease including malnutrition: We will support the roll out of the national Community Health Influencers, Promoters and Services (CHIPS) program strategy, which aims to create demand for health services by working with community health care workers. Technical support will be provided to the SMOH, SPHCDA, and LGAs to fully roll out the CHIPs program in Yobe while supporting the Borno SPHCDA to plan the introduction of the CHIPS program. In Borno we will work with LGA authorities to utilize existing community health work schemes, including community oriented resource persons (CORPs). We will also coordinate with SPHCDA and SMOH, and planned intervention under the MCRP to ensure aligned support to the CHIPS program in Borno to support the health system and align community interventions with national policy.
Outcome 3: Services are effectively planned, managed and budgeted (facility and community level): The project aims to sustainably strengthen the health system so that in the long run it is able to prevent and respond to shortfalls such as drug availability problems, low/unreliable salaries and key equipment shortages. Using a conflict sensitive approach, we will support facilities to self-assess their organizational capacity in leadership; strategic planning; management; and outreach, and to develop and implement organizational development plans (these could include supporting facilities to develop job descriptions, training staff on drug management or financial management, developing stock management procedures, etc.). We will follow the phased five-stage approach to support each targeted LGA with their organizational development (OD).
2.0 The purpose of the Health Facility Assessment (HFA):
HeRoN consortium partners require a detailed health facility assessment to: i) provide insights into the adequacy of health facility service delivery, ii) inform the design of packages of activities and services aimed at strengthening health facility service delivery, and iii) make available information corresponding baseline indicators for evaluation purposes.
2.1 Specific objectives of the HFA:
- Conduct a desk review of recent health facility assessments in all target LGAs already carried out by other stakeholders (for example those conducted under the Basic Health Care Provision Fund (BHCPF) framework, or the Health Resources Availability Mapping System (HeRAMS))
- Following the desk review produce a matrix of relevant health facilities, outlining what is known, and what are outstanding questions about each facility which need to be answered in our new assessment
- Undertake a detailed health facility assessment (outcomes 1 and 3) in a sample of around half of the targeted health facilities (total is expected to be in the region of 80-90)
- For project targeted health facilities that are not part of the sample under #3 above, develop a checklist for partner organizations to utilize to determine specific needs for equipment, rehabilitation, WASH facilities, physical barriers for people with disabilities etc in each health facility
- Undertake a Knowledge, Attitudes and Practice (outcome 2) survey to provide insights to outcome 2: People seek timely services and take informed actions to prevent new disease and spread of existing disease including malnutrition.
2.2 Scope of work and deliverables
Desk review of HeRoN documents, the results framework and recent health facility assessments in all target LGAs already carried out by other stakeholders (for example those conducted under the Basic Health Care Provision Fund (BHCPF) framework, or the Health Resources Availability Mapping System (HeRAMS)).
Production of a matrix of health facilities, as outlined above
Detailed health facility assessment in a sample of around half of the targeted health facilities, working closely with the IRC health team to develop/review Health Facility Assessment Tools. The assessment includes (but is not limited to):
- Adequacy of infrastructure as per States’ plans and guidelines (including adequate WASH facilities and power sources)
- Analysis of health services including service packages provided by the health facility and utilization rates of the services
- Adequacy of staffing levels as per States’ plans and guidelines, including attrition analysis
- Adequacy of diagnostic medical equipment (including cold chain)
- Adequacy of medical supplies including drugs, vaccines, equipment and supply chain management (based on storage practices, retrospective stock information, review of SOPs, review of stock and inventory documents), as well as other consumables and commodities
- Adherence to a standardised health management information system (HMIS, based on review of past reports – timeliness, completeness, archiving process)
- Access to telecommunication (mobile) networks
- Access to emergency referral system (ambulance or other)
- Presence of other organization(s) that support the health facilities and, if so, in what specific areas (such as drug supply, support to human resource etc).
Knowledge, Attitudes and Practice survey in sample locations from target LGAs in Borno and Yobe states6, to provide insights to outcome 2: People seek timely services and take informed actions. This task will include (but is not limited to):
- Determine appropriate methodology and sampling procedures
- Develop/review data collection tools for the KAP survey
- Undertake field data collection, and subsequent data management and cleaning
- Conduct data analysis
Produce one comprehensive report that includes presentation of findings and insights for all three components (desk review, matrix, Health Facility Assessment and Knowledge, Attitudes and Practice Survey), identification of cross-cutting themes, and presentation of corresponding baseline values. This task will include:
- Share preliminary report with consortium coordination team as per agreed timeframe
- Finalize the report including clear baseline measurement benchmarks and recommendations
- Final presentation meeting to IRC and partners of key findings and recommendations presented in the report.
For both the health facility assessment and the survey, the IRC suggests a mixed methods approach, integrating quantitative and qualitative methods, ensuring collection and reporting of corresponding baseline data. Data triangulation and integration including Key Informant Interviews, Focus Group Discussions (FGDs) with beneficiaries, observations of existing infrastructure, and service delivery components at the facilities will be essential. The consultant is free to suggest an appropriate methodology that fully addresses all ToR requirements with reference to the following:
Health Facility Assessment (outcomes 1 and 3) – after the initial desk review of recent assessments by other stakeholders**,** the current assessment is to include consideration of all three levels of Health Facility, staff, and client perspectives, ensuring that there is a strong quality of care component as well as adequate infrastructure, qualified human resources and inventory. This also includes the analysis of health service packages provided by the health facilities and the utilization rates of the services as well as the roles of other non-HeRON partners in those health facilities (if any).
Knowledge, Attitudes and Practice Survey (outcome 2) – community level data collection focusing on knowledge, attitudes and practices for health seeking patterns, prevention of new disease and spread of existing disease including malnutrition
4.0 Indicative timeframe and budget
- The overall expected timeframe for this work is 35 to 40 days
- Budget submissions should not exceed US $40,000
Profile of consultant(s)
The Health Facility Assessment and Knowledge, Attitudes and Practices survey call is open to all interested and qualified national and/or international consultants meeting the under-listed criteria:
- Master’s degree or higher in Health background, Nutrition, Public health or related field with strong understanding of humanitarian emergency programming.
- At least 10 years proven experience in research, assessments and evaluations in areas of health, Nutrition, reproductive health and health systems strengthening in emergency context.
- In-depth knowledge of quantitative and qualitative research methods
- A good understanding of consortium programming
- Excellent analytical, presentation and writing skills in English
- Experience in similar assignments or context in health programming.
Proposal deadlines and contact details
This consultancy assignment is anticipated to start in April, lasting between 35-40 working days including final report submission. The deadline for submission of technical and financial Expression of Interests and other accompanying documents is 20 March 2020 at 12:00am Western Africa Standard Time (GMT +1). The criteria for submitting Expression of Interests are outlined below:
- Detailed technical proposal with clear understanding and interpretation of the ToR, including tasks, recommended survey methodology and proposed work plan and timeline for the two assignments. The proposal should include highlights of relevant experience and technical expertise in the health sector and/or health systems strengthening work. (maximum 4 pages)
- Detailed, itemized financial proposal cost, including daily professional fee and any other associated costs. All costs should be indicated in the submission. The IRC will only cover field related costs to program areas during field work. All costs need to be clearly stated in the bid submission.
- CVs of key personnel that will be involved in executing the assignment.
- Two written samples of relevant past consultancies and three references from previous assignments conducted within the last 3 years.
- Shortlisted candidates who have submitted a successful EoI will be invited to submit a more detailed financial and technical proposal in writing, and to produce a 10mn presentation detailing their approach, methodology, team and work plan. The presentation can be held remotely (i.e via Skype or other virtual tools as appropriate). Only one candidate will be selected to carry out this assessment
7.0 Ethical standards and Intellectual Property
- The consultants will take all reasonable steps to ensure that the baseline survey is designed and conducted in a respectful manner that protects the rights and welfare of communities involved.
- The consultants will commit to adhere to the IRC Way: Standards for Professional Conduct.
- All products resulting from this survey will be owned by IRC and the HeRoN consortium.
- The consultants will not be allowed, without prior authorization to present the report results as his/her own research work.
All EoI should be addressed stating the subject line “HeRoN Health Facility Assessment ”. Any additional queries and clarifications should be directed to Senior Program Coordinator, Shiferaw Demissie Shiferaw.Demissie@rescue.org, M&E Coordinator Martin Ebao, Martin.Ebao@rescue.org, Aamir Fida HR Coordinator Aamir.Fida@rescue.org and Moshin Khan Project Lead, Mohsin.Khan@rescue.org