Gender Assessment Consultancy

******Please send proposals to the Manager, People Operations, Camille Phillips, at cphillips@lastmilehealth.org, no later than March 12th, 2021. No proposals should be submitted via this portal.******

Scope of Work 

Please follow this link to find additional key information on the Background, Purpose, and Audience for this consultancy. 

Co-Impact has awarded Last Mile Health (LMH) and the Global Fund (GF) a five year grant to provide implementation support and technical assistance (TA) for the following three strategic priorities: (1) Making investments to catalyze reaching national scale and ensuring quality performance, (2) Building readiness for transition of the National Community Health Assistant (CHA) Program to the government, and (3) Ensuring the long-term sustainability of the program and its impact.

A crucial part of this work is a gender assessment. The purpose of a gender assessment of National Community Health Assistant (CHA) Program and policies is to examine the gender responsiveness of the National CHA Program policy, identify and document gender inequities that exist within the program and their root causes, such as the inequitable ratios of CHAs, and assess how the program has impacted genders differently. The primary audience for this report and subsequent recommendations is the Liberia MOH, with the goal of informing the policy revision process and subsequent improvements to the design of the program. 

The scope of the proposed gender assessment  will examine gender dynamics that exist  within communities and patients' access to care, Liberia’s community health workforce, leadership and management of the National CHA Program, and power structures that are engaged in managing it. Taking a holistic view to produce a baseline, the gender assessment will take place at both a national and subnational level, focusing on 3 counties, inclusive of LMH, CHT managed and other key implementing partners (Global Fund, USAID, etc), which also includes geographic diversity (Southeast Central and Northwestern). The following tasks are sequenced such that each task is informed by the information gathered in the prior task. Both phases of the gender assessment (for the policy and program) will go through similar tasks to help provide a comprehensive picture of the gaps within current policy and practice in Liberia, as well as broader structural barriers and gender discrimination that impact service delivery.

In an effort to align the gender assessment with the upcoming National Community Health  policy revision (present - September 2021) and subsequent improvement to the program design taking place in Liberia (October 2021-onwards), the gender assessment will happen in a phased approach, with the first phase focusing on the policy and the second shifting focus to improvements to the program package: 

1. Phase I: Policy Gender Assessment (duration approx. 2 months)

1. Focus: National Community Health Services Policy and accompanying National CHA Program policy documents
2. Questions to be answered in this phase:
   1. To what extent are Liberia’s National CHA Program policies gender responsive? What are the strengths and weaknesses? 
   2. What are the enablers or barriers within the policy that influence the inequitable gender ratios of the CHAs and other positions within the community health programming structure (i.e. Program Managers, pharmacists, M&E Officers, and CHT staff)?
   3. How do Liberia National CHA Program policies influence gender equality in the design and implementation of the national CHA programming?
   4. What actionable recommendations can be implemented to improve the policy’s gender responsiveness and therefore gender equity in community health programming?

2. Phase II: Program Gender Assessment (duration approx. 4 months)
   1. Focus: National Community Health Assistant Program
   2. Questions to be answered in this phase:
      1. What are the root causes of gender inequity in the National CHA Program? How has the program impacted genders differently?
      2. How does the program affect genders differently, including access to care and quality of care?
      3. How do gender dynamics at the household, community, and district levels influence the ability of the National CHA Program to meet its intended outcomes? 
      4. What actionable recommendation can be implemented to improve the design of the National CHA Program in a way that responds to and transforms inequitable gender norms and dynamics?
      5. How can resources be optimized and leveraged to support a gender equitable National CHA Program? 

Project Details

• Commitment – The consultancy will begin as soon as possible and the total duration 6.5 months from the effective date of contract (EDOC) and conclude by August 30, 2021. The first phase of the consultancy is expected to take about 2 months and conclude by no later than May 15, 2021. The second phase will take about 4 months, starting once phase one is complete and concluding by no later than September 15, 2021. 
• Location – Remote with planned travel to Liberia. 
• Remuneration – Please include your overall proposal cost in USD within your application materials. Consultant will be paid upon completion of each deliverable as listed below.  

Deliverables

Task 1: Literature and Desk Review 

The consultant will review and synthesize key findings from information sources such as: 

• Review of related published and gray literature
• Policy, strategy and implementation documents, inclusive of National Community Health Services Policy, Revised National Community Health Services Strategic Plan, National CHA ToRs and contracts for CHAs, and  CHSS
• Global Fund program reports as available
• Implementation Fidelity Initiative Reports 
• Program Perceptions project
• Sayana Press Report
• National CHA Implementing Partner Reports (IRC, UNICEF, Jhpiego, GIZ, etc) 
• World Bank Joint Assessment report

Information gathered with the thought the desk review will inform questions to be included in the KIIs. 

Task 2 & 3: Develop Key Informant Interviews Guide & Conduct Key Informant Interviews

The consultant will conduct key informant interviews (KIIs) with stakeholders selected in partnership with LMH staff in Liberia and  gaps in information available from the desk review will inform the development of questions to be included in the KII guide.  Collecting information from existing documentation prior to the KIIs will maximize use of interviewees’ times and allow the interview to focus on collection of new/additional information.

Based on the desk review, the consultant will develop a semi-structured interview guide that includes questions and probes designed to supplement the information available from the data sources. The KII guide will be reviewed and approved by LMH prior to the consultant conducting the KIIs. Some KIIs may be able to combine stakeholders and the consultant can consider focus groups if appropriate considering the power and gender dynamic involved in group settings around this topic. Please note, IRB protocol will be required for certain Phase two KIIs. Each phase of the gender assessment will have a slightly different targeted audience for the KIIs:

• Phase I - 15-20 stakeholders total across 3 counties including:
  • MOH national and subnational stakeholders - including Ministry of Gender 
  • Implementing partners (UNICEF, Plan International, USAID, World Bank etc.)
  • LMH Staff
  • National CHA Program staff at National and County Level
  • Officers-in-charge and health facility staff
• Phase II - 25-30 stakeholders total, across 5 counties (1 in each region of Liberia) including:
  • Community Health Committees (CHCs) and other community structures
  • Health Facility Development Committees (HFDCs)
  • CHAs, CHSSs, and TTMs
  • Patients, civil society, and community members. 

The consultant should maintain interview notes and develop a summary document of key findings from the KIIs.

Task 3: Develop Gender Assessment Report and Recommendations 

Based on the desk review and KIIs, the consultant will develop two reports for each phase, summarizing and triangulating the key qualitative and quantitative findings that emerge. The reports will be strategic in nature to ensure usage by the MOH and partners during the policy and program review  and at a minimum, they will include the following components: 

• A synthesis of structural and other gender barriers in Liberia’s health workforce, MOH, County Health Teams, and other power structures that surround it, as well as their variation, determinants, root causes, historical efforts to address those barriers, and appraisal of their success or failure. 
• Intersectional analysis of National CHA Program Design with a gender lens, including a synthesis of identified barriers limiting women’s power, agency, and representation as CHAs, CHSSs, and women seeking health services in Liberia.
• Actionable recommendations that have been informed with key stakeholders during KIIs to implement measurable changes to people-level, systems-level, and institutional -level outcomes over a three-year time horizon.
• The anticipated length of the report for phase 1 is 5-10 pages and for phase 2, the report is anticipated to be 20-30 pages. Any changes to these lengths must be discussed with the LMH team. 
• Development of the analysis reports will occur in the following phases
  • Phase 1: Develop and submit a detailed report outline that clearly indicates the goal and type of information to be included in each section of the report.  The LMH team will review the report and provide feedback to be integrated by the consultant.
  • Phase 2: Develop and submit a complete draft report. The LMH team will review the report and provide feedback to be integrated by the consultant. 

Task 4. Presentation of Findings

Upon finalization of each report, the consultant will develop a slide deck and present the report to selected members of the LMH team, Co-Impact, External Evaluation Group, Global Fund, MOH and key stakeholders supporting the Liberia National CHA Program. The slide deck will be used by the MOH and key partners during the policy review process to inform key design choices. The presentation shall include methods employed, key findings, conclusions and recommendations. Additionally, the presentation should also allow time for questions, answers, and discussion.

Task 5. Respond to follow-up questions, as needed

To support reporting to the funder, the consultant will be available to respond to follow-up or clarifying questions from LMH staff. The level of effort for these discussions is low and will likely entail responding to a few emails or participating in a few meetings

Task 6. Project Management and Oversight

Regular check-in calls will be conducted between the consultant and LMH staff to review progress and address questions. Meeting cadence will be established at the start of the contract.

Final Deliverables

1. Two final reports - Phase 1 report 5-10 pages in length and Phase 2 report 20 - 30 pages in length. Final report that is 30 - 40 pages in length.
2. Slide decks and presentations summarizing findings from the report and key recommendations for both Phase 1 & 2. 

Required Experience

• Several years of professional experience in public health and/or international development with a gender emphasis, with at least 3 years conducting gender-related work
• Experience in Liberia highly desired with direct experience in gender mainstreaming programming and assessment 
• Demonstrated ability to collaborate with Liberian and external partners and government counterparts.
• Deep knowledge of scientific report writing standards, strong quantitative aptitude, and a thorough understanding of public health research methodologies.
• Strong qualitative skills, including demonstrated experience developing KII and FGD guides, leading KIIs and FGDs, qualitative data, and reporting findings.  
• Ability to clearly communicate complex technical information to a wide variety of audiences.

• The contract may be awarded to one person with the required skill set or a two person team that brings technical skills and Liberian contextual experience. 

Application Process

Applications should be no longer than 5 pages in length (not including CV/Resume). Please include the following with your application: 

• Describe your methodological approach to complete the tasks described above including a time-bound work plan.
• Resume or CV
• Description of your experience that qualifies you to do this work
• Budget for project including pricing in USD
• Three references who can speak to your relevant experience

About Last Mile Health

Last Mile Health (LMH) saves lives in the world's most remote communities by partnering with governments to bring critical primary care services to the doorsteps of people living in the last mile. LMH is a registered 501(c)3 non-profit organization with offices in Liberia, Malawi, Boston and New York. For more information, visit www.lastmilehealth.org.

We are an equal opportunity employer and value diversity at LMH. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.