Request for Proposals: Systems Mapping for the Health Systems Leadership Development in Liberia, Malawi, and Uganda

******Please send proposals to cphillips@lastmilehealth.org, no later than July 30, 2021. No proposals should be submitted via this portal.******

Background

Last Mile Health:We partner with governments to design and build community-based primary health systems that save lives in the world’s most remote communities. Having successfully worked alongside the Government of Liberia to design, pilot, implement, and scale a national community health worker (CHW) program, Last Mile Health is now leveraging digital education to grow health workforce capacity in several low- and middle-income countries.

Program Design: As aligned with Last Mile Health’s organizational Theory of Change, we partner with governments to design and digitize curricula to upskill the community health workforce and supplement the expertise of health systems leaders who manage community health programs. The goal of these efforts is to increase capacity to manage and sustain high-quality community-based primary care, and to ultimately improve health system performance. 

Within each country, Last Mile Health works with governments and other partners to identify priorities for upskilling among health systems leaders, and to tailor programming to the country context with the aim of strengthening community-based primary care systems. Our approach to health systems leadership development includes the development and delivery of online and blended courses and skill-building workshops focused on key pillars of community health systems strengthening, including health finance, community engagement and digital health, among others. 

Learners from across the world participated in Last Mile Health’s first global online course, Strengthening Community Health Worker Programs, including over 300 from Uganda, 270 from Liberia and 70 from Malawi. Last Mile Health is now shifting to a more targeted, country-driven approach to course delivery that is better aligned with the upskilling needs and priorities of government partners and leverages practical application of learning to achieve real impact in health systems. 

• In Liberia, 42 students from the University of Liberia School of Public Health participated in a blended learning pilot course on Strengthening Community Health Worker Programs as part of their Master of Public Health program. More recently, 17 health systems leaders from Liberia participated in Last Mile Health’s 3-month facilitated course series, Financing Community Health Programs for Scale and Sustainability. As next steps in this work, we are building and expanding upon collaborations with the Liberia Ministry of Health (MOH), professional organizations, and regulatory bodies to refine upskilling opportunities in alignment with identified priorities. 
• In Uganda, 38 health systems leaders participated in Last Mile Health’s 3-month facilitated course series, Financing Community Health Programs for Scale and Sustainability, which included a mix of online and in-person activities aimed at building competencies to secure and sustain funding for community health. Last Mile Health is now working to identify opportunities to engage additional health systems leaders and alumni of the health financing course series in deeper, more targeted upskilling activities aligned with government priorities. 
• In Malawi, Last Mile Health is in the early stages of scoping priorities of the governments and its partners for health systems leadership development in support of community-based primary healthcare.

Monitoring, Evaluation, Research, and Learning (MERL): Last Mile Health’s Global Monitoring, Evaluation, Research, and Learning (MERL) team is leading the design and implementation of the evaluation of health systems leadership training activities. Our evaluation methods are suited to understand the dynamic, multidimensional, and interconnected relationships that influence the uptake of learning and their application within health systems. Drawing from developmental evaluation and complexity responsive evaluation, our methods are responsive to the underlying contextual factors, characteristics of the intervention, participating stakeholders, and processes of change that influence critical outcomes, such as acceptability, adoption, appropriateness, feasibility, fidelity, and sustainability. In short, our methods acknowledge that health systems are complex and ever-changing in ways that are often unpredictable. Last Mile Health’s program design and MERL teams work together collaboratively to ensure that evaluation findings are used to support data use and adaptive management overtime. 

Foundation Botnar: Last Mile Health proudly partners with Foundation Botnar, a Swiss-based foundation that champions the use of artificial intelligence (AI) and digital technology to improve the health and wellbeing of children and young people in growing urban environments. To achieve this, the Foundation supports research, catalyzes diverse partners, and invests in emerging technologies and scalable solutions globally.

Objectives

The goal of this consultancy is to conduct systems mapping in Liberia, Malawi, and Uganda to complement and inform program design refinement and MERL activities. Specifically, the objectives are: 

1. Identify key components of the health system and related systems (e.g., finance, education), the links between those systems, including the positive and negative points of influence that may be targeted for change (e.g., departments, roles, skills gaps) to maximize the impact of health system leadership training activities in each country.
2. Identify and target gaps based on needs of the health system to support design and delivery of more customized programming for each country.
3. Identify specific health system leadership capacity gaps that can be addressed to catalyze the key community health policy reforms or initiatives in each country. 
4. Assess the health system leadership capacity building strategies (where they exist) for partner governments and propose a roadmap to development and/or improvement of such strategies.
5. Ensure that the work to meet each of the objectives is approached from a gender mainstreaming perspective.

Additionally, country specific objectives are as follows:

• Uganda: To help prioritize community health systems learning activities to support health systems leaders.
• Liberia: Inform prioritization of upskilling activities related to the upcoming Community Health Services Policy and revision and accompanying curriculum package related to training, staff development, retention, and motivation. 
• Malawi: To inform future activities, including the new national Human Resources for Health Strategy, given that the current strategy ends in 2022. 

(Bamberger, M., & Vaessen, J., & Raimondo, E. (2015) Dealing With Complexity in Development Evaluation - A Practical Approach. SAGE publications.)

Scope of Work

The activities for this scope of work are as follows.  Please note that all deliverable dates are based on the effective date of contract (EDOC):

1. Conduct an informal conversation with country teams and desk review to understand program priorities and background. Review published literature, and gray literature to establish a baseline understanding for health systems leadership as related to goals of health system leadership programming in each country. Describe the current state of the health system with regard to health systems leadership development program goals, including successes, challenges, gaps, and a systems map in 10-15 pages per country, by 4 weeks from EDOC. 
2. Conduct 5-10 key informant interviews (KIIs) and/or focus group discussions (FGDs) with stakeholders per country who lead or influence human resources for health.  While these stakeholders will vary by country, this will generally include MOH officials, clinicians (e.g., Liberian Community Health Service Supervisor), and partners supporting government HRH programming, including capacity building, in order to understand challenges, needs, and priorities regarding learning and training for current and pipeline health systems leaders over the next 3-5 years by 8 weeks from EDOC.
   1. Draft KII and/or focus group guide, and request and integrate feedback.
   2. Conduct KIIs and/or FGDs.
   3. Conduct qualitative analysis and share summarized themes and findings.
3. For each country, develop intervention and future state system maps.  The intervention map will build on the baseline map by indicating priorities as identified through the KIIs and points of influence within the system that may be targeted to achieve or make progress on those priorities. The future state map will show the ideal state of the system within approximately 5 years, if the prioritized programming were to be implemented successfully. Accompanying narrative will include recommendations for how to move from the current state to the future state of the system by 12 weeks EDOC.
4. Give a presentation of findings to Last Mile Health and other stakeholders with time for questions and answers by 14 weeks EDOC.

Payment Deliverable Schedule

Application Process

Included with your application materials, please describe your methodological approach to complete the tasks described above including a time-bound work plan for tasks described above and associated person-time and costs. Additionally, include resumes or CVs for all team members who will work on this project, a description of the experience that qualifies each person, and three references who can speak to your relevant experience. 

Applications will be considered for those applying to do this work in one, two, or all three countries.  Please specify the countries where you are applying for this contract.

Preference will be given to applicants who apply for and have experience working in all three countries.

Budget

The total budget ceiling available for this work is $100,000 USD, including all objectives, activities and deliverables described for each country. If you apply to do this work in one or two countries, the budget must be prorated accordingly. Please present your budget for each country by task.  Cost will be a factor in selecting the recipient of the contract.

Required Experience

• Several years of professional experience in public health and/or international development with a focus on health systems, human resources for health, training and education, and systems mapping.
• Experience in countries of focus is strongly preferred.
• Demonstrated ability to collaborate with 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.