Health Systems Assessment TOR/Consultant Engagement

I.Background

The International Rescue Committee (IRC) responds to the world’s worst humanitarian crises and helps people to survive and rebuild their lives. Founded in 1933 at the request of Albert Einstein, the IRC offers lifesaving care and life-changing assistance to refugees forced to flee from war or disaster. At work today in over 40 countries and 22 U.S. cities, we restore safety, dignity and hope to millions who are uprooted and struggling to endure. The IRC leads the way from harm to home.

The IRC has been present in Nigeria since 2012 when the organization responded to flooding in Kogi state. In response to humanitarian needs resulting from the ongoing conflict in the country’s northeastern states, the IRC currently operates in eight sectors (health, nutrition, WASH, protection/rule of law, child protection, women’s protection and empowerment, education, and economic recovery and development) based out of six field offices in Northeast Nigeria

Lafiya-HeRoN Project Overview:

The Lafiya-HeRoN project is a Health consortium partnership of three organizations led by the IRC, with Action Against Hunger (AAH), and Society for Family Health (SFH) the other 2 partners. The consortium aims to ensure that crisis-affected communities in Borno and Yobe states have meaningful access to quality primary healthcare and nutrition services in the immediate term, while also contributing to the sustained capacity of health systems strengthening at the LGA level.

The overall outcome of the HeRoN project is that people, with a particular focus on women, girls, and other marginalized groups are protected from and treated for the main causes of morbidity and mortality. To achieve the project outcome, the project theory of change will address three main areas: access and quality, demand and behavior change, and health systems strengthening.

II.Rationale of the intervention

The Lafiya-HeRoN project aims to sustainably strengthen the health system in Yobe and Borno in its locations of intervention so that in the long run it can prevent and respond to shortfalls such as drug availability problems, low or unreliable salaries, and key equipment shortages and additionally, develop a project sustainability approach that is responsive to the prevailing context.

The covid-19 pandemic posed a challenge to the HeRoN project at the inception phase, delaying the conduct of a Health systems assessment which would include a Political Economy Analysis (PEA) and a Social Network analysis (SNA).

The PEA will include a mapping of power structures and procedures around health systems management and service delivery to understand the root causes of service delivery problems.

The SNA will be carried out to identify the individuals, gatekeepers, state ministries, departments, and agencies (MDAs) and organizations, known or perceived to be important within the HeRoN project implementation locations who would be able to promote sustainable health systems strengthening and drive positive behaviour change for service uptake at the Primary Health Care facilities.

This health systems assessment will be led by an external consultant, in collaboration with the HeRoN program leadership as well the IRC HQ’s Governance Technical Advisor.

The intent is also for relevant key project staff to actively participate in the health systems assessment to optimize their local knowledge and provide for a first community-level entry and relationship building.

The external consultant is expected to work independently and efficiently throughout the consultancy.

III.Objectives of the study

1.Overall objective:

• To conduct a context analysis aiming at a better understanding of the root causes of primary Health care (PHC) service delivery glitches in Yobe and Borno States of Northeast, Nigeria, and propose policy recommendations in support of mitigation

2.Specific objectives:

• To conduct a policy analysis with identification of gaps, strengths, challenges and opportunities within existing frameworks and policies
• To Conduct a desk review of recent reports on health systems assessment in Yobe and Borno states, and identify patterns.
• Conduct meetings with key stakeholders in Yobe and Borno states to map stakeholders and their relationships.
• To draw practical recommendations to redefine policy goals by supporting strategic planning, sustainability frameworks, alignment of resources, interventions and to contribute to the increase of service availability and access.
• To design an action plan and propose a roadmap, leveraging domestic financing, and identifying where policy or legislation needs to be enacted/ protected from regression, in order to respond to critical gaps in PHC service delivery
• Organize a workshop with project consortium teams and stakeholders to discuss findings and map a way forward.

IV.Methodology

The consultant shall develop/ adapt appropriate quantitative and qualitative tools and specific checklist based on assessment objectives. Desk review and data derived from series of observations, meetings including Key Informants Interviews (KII), In-Dept Interviews (IDI) and Focus Group Discussions (FGDs) with relevant stakeholders at state and LGA level.

Proposed assessment methodology:

The consultant shall adapt the techniques to be applied accordingly

V.Work Plan/ Assessment Activity Schedule:

1. Home-based work to include (approx. 7 days before deployment, and 7 days after deployment):

• Executive Summary.
• PEA
• SNA
• Recommendations.
• PowerPoint with key findings.
  
  2. Field trips to include (approx. 16 days of work):

Tasks under this ToR should be completed within 60 Days.

The table below is for indicative purpose; the consultant is welcome to propose her/his own action plan for the accomplishment of this assignment.

VI.Commencement, Completion and Penalty

The Consultant shall begin performing the services on the prescribed date of the work plan on which execution of the contract shall take place, but not earlier than and without undue delay after the contract has come into force. The consultant shall deliver the services in accordance with the work plan or time schedule and shall complete the services within the Completion Period, subject to any further extensions to the contract

VII.Confidentiality and copyright:

All documents shared with the Consultant are confidential to IRC Nigeria and should not be used outside IRC without prior permission. Information received by the Consultant from IRC and its stakeholders should be treated as confidential. The final assessment report will be owned by the IRC, who will in turn be responsible of onwards disseminations to relevant actors and government authorities.

VIII.Principles and values

The consultant should comply with IRC’s ethical rules and protection policies, in particular the Child Protection, Protection of beneficiaries, and Protection against Sexual Exploitation and Abuse; these policies will be integral part of the final contract.

IX.Deliverables:

1.Detailed work plan

2.Desk review report

3.A package of tools for policy review and analysis: reference frameworks, checklists, question guides (for both quantitative and qualitative data collection), etc.

4.A draft report outline, to be agreed with HeRoN consortium before report writing and that should include at least: a table of contents (sections, subsections); executive summary; methods; findings; recommendations; quantitative data tables

5.Facilitate workshops with project teams, and produce a drafts report from the workshops detailing recommendations to feed into the implementation plan and proposed roadmap

6.Filled-in copies of all tools and check-lists used in policy analysis and interviews (hard copies only)

7.Photographs, primary notes, etc.

8.Final assessment report

A.Final full report (hard and e-copy) and a Power Point Presentation for relevant actors and government authorities.

B.Summary of SNA i) List of stakeholder meetings including a summary matrix highlighting each stakeholder’s influence, power, and leverage to make change happen, a recap of desk research, and a summary of emerging findings. ii) Summary of government and stakeholders (formal and informal) (at all levels) priorities, as well as their incentives and disincentives for HeRoN-led changes

C.Summary of the PEA specific to Yobe and Borno states and the Health system, including a summary of answers to key questions listed above.

D.Identify political, economic, social, and cultural factors that drive or impede health reforms.

E.Make recommendations from findings for project design, adaptation, and sustainability initiatives.

X.Payment Rate and Schedule:

• 30% after contract signing
• 30% after draft report submission
• 40% after final report validation