(Annex A)
United Nations World Health Organization, AFGHANISTAN COUNTRY OFFICE
CALL FOR PROPOSALS
IMPORTANT: Proposals that do NOT follow the requirements stated herein will NOT be considered.
1. Subject /ASSIGNMENT: External Evaluation of Partnership with Private for Profit Health Services Providers project under CSO Support Type B
2. Partners / WHO and MoPH3. Location of implementation / Farah, Urozgan, Kandahar, Helmand, Paktia and Nooristan provinces.
4. Planned number of staff / Minimum key staff envisaged to be scored are 1 (please refer to QUALIFICATION AND PROJECT KEY STAFF of the TOR for details. Consulting organizations may consider appropriate number of project staff based on their approach.
5. Budgetary expectation / To be determined by implementing partner
The ceiling is approximately USD 50,000
The procurement will be based on fixed budget (FB) selection method and the available budget (ceiling) is approximately (50,000) USD. Proposals exceeding the ceiling will be counted unqualified.
The agreed cost will be paid upon submission of final evaluation report.
6. Planned beginning date / 15th February 2015
7. Duration of project / 2 months (15th February 2015to 14th April 2015)
8. Objective(s) of the assignment / OBJECTIVES OF THE ASSIGNMENT:
These six remote, insecure and underserved provinces which have difficult terrain and low literacy rate (especially female) deserve innovative ways to provide effective health interventions for improvement of health status of the population living in these areas. Through involving private sector in health provision, an endeavour will be made to improve the health indicators especially of EPI and Basic RH. A successful implementation of this project in these provinces and documented benefits of this experience will pave the way to replicate/expand implementation of this strategy to the other provinces also.
Rationale:
Partnership with private health services providers is a new intervention, implemented for the first time in Afghanistan. There is limited country experience in this field, therefore, it is necessary to evaluate the project and figure out lessons learned, project outcome and take evidence based decisions for policy making.
Purpose of evaluation:
· Identify the relevance of the project to national priorities· Evaluate the outcome of the project
· Ensure that funds are used effectively and efficiently to reach beneficiaries
· Recommendations for future extension and expansion
· Identify to improve the health equity concept in these insecure provinces
· Document and share lessons
· Policy recommendation
9. Project explanation and TOR / BACKGROUND:
Since 2002, Afghanistan has made substantial progress in improving the accessibility of health care. As a result, noticeable impact on the health of the population is now well documented. However, the country continues to face many challenges and remains among the countries with the poor health indicators. In addition to high infant and child mortality, high maternal mortality[i] the health sector faces the challenges of poor nutrition, poor sanitation and high burden of communicable diseases and insecurity in a country where population growth remains very high.
Trends of infant and child mortality, known to be among the highest in the world, were the first signals of success. Infant and child mortality rates were decreased from 165 and 257/1000 in 2002 to 129 and 191 respectively in 2008. Further the Afghanistan Mortality Survey 2010 (AMS) shows a further reduction to 77 and 97/1000 live births respectively. In addition the AMS shows that Maternal mortality is reduced from 1600/100000 live births in 2002 to 327/100000 live births in 2010 which is significantly impressive.
The MoPH and donors has contracted CSOs/NGOs, both national and international, to deliver the health services via different partnership mechanisms, maintaining stewardship role of MoPH. Contracting out health care service delivery specifically to CSOs/NGOs, is reported to have resulted in improved health care service delivery, expanded immunization coverage, increased transparency in the health and nutrition sector, and reduced overall health care costs. Further, as cooperative partners to MoPH, most health CSOs/NGOs have shown a remarkable commitment to implementing the new health strategies and policies. A Network of CSOs working in health sector is being established to enhance coordination and improve partnership amongst CSOs themselves and MoPH.
CSOs have demonstrated remarkable achievements in the quality immunization services provision to the communities throughout the country. National immunization coverage with three doses of Diphtheria, Pertussis & Tetanus (DPT3) vaccine among children under one year of age reached to 77% in 2006 from 31% in 2000. Also national immunization coverage with measles vaccine among children under one year of age reached to 68% in 2006 from 35% in 2000. However, the goal is to increase the percentage of coverage up to 90% by the year 2011. Promotive and curative services in insecure and unstable areas where public health providers' involvement in delivery of primary health services happens to be challenging and even unfeasible. Establishing and strengthening of the private for Profit Health Service providers (PPHSP) model in insecure areas of Afghanistan could prove a pragmatic solution to increase the coverage of health indicators and thus results in reduction of maternal and infant mortality in Afghanistan and contribute to the accomplishment of Health and Nutrition Sector Strategy (HNSS) objectives and Millennium Development Goals (MDGs).
The CSO Support Type B Project Partnership with Private for Profit Health Service Providers (PPHSP) Model in Urozgan, Farah, Paktia, Nuristan, Helmand and Kandahar Provinces of Afghanistan is supported by Global Alliance for Vaccines and Immunizations (GAVI)/MoPH and implemented by Civil Society Organizations with technical and financial management support of World Health Organization. The project provides immunization and basic Reproductive Health services to the population living in four insecure and under-served provinces mentioned above.
Partnership with Private for Profit Health Service Providers (PPHSP) is a sole model in Afghanistan aiming at providing immunization and basic reproductive health care services to the most vulnerable population living in these six insecure and underserved provinces through involving private health services providers (PHSPs). The current project is not only the continuation of CSO Support Type in Farah and Urozgan, Nuristan and Paktia Provinces but also has expanded to further two insecure and hard to reach provinces, Helmand and Kandahar Provinces.
1. Goal of the Partnership with Private for Profit Health Services Providers (PPHSP) project:
To reduce maternal, new-born and child morbidity and mortality through improving access to Health care services especially EPI and Basic RH services to be provided by private health service providers in remote and insecure areas of Urozgan, Farah, Paktia Nuristan, Helmand and Kandahar provinces.
3. Objectives
A. Objective 1: To establish a model of partnership with private sector service providers to provide immunization and basic health services to the vulnerable population living in six insecure and under-served provinces of Afghanistan.
The models of partnerships with private health service providers (PPHSP) component of the project continued in six insecure and underserved provinces of Uruzgan and Farah. The private health service providers are providing immunization and basic reproductive and child health services in return for incentives. The private health service providers are trained for providing immunization and basic reproductive and child health services.
§ 143 Private Health Facilities (PHF) were operational during project period in Uruzgan, Farah, Paktia, Nuristan, Helmand and Kandahar provinces. The projects are implemented by CSOs in provinces mentioned above. The private practitioners received trainings in immunization, IMCI, basic reproductive health services, reporting and basic management. The PHFs received regular supplies of required medicines, equipment and supplies. The PHFs were also renovated for provision of required services. The project facilitated establishment of Private Medical Association (PMA) in Uruzgan, Farah, Paktia Nuristan, Helmand and Kandahar Provinces. The Provincial Medical Associations (PMAs) introduced a representative to Provincial Public Health Coordination Committee (PPHCC), a higher provincial decision making body in the health sector. The private practitioners actively participated in NIDs and through their assistance some uncovered areas were covered with NIDs.
§ All relevant tools, guidelines and strategies are developed and are in place for PPHSP pilot model. This helps us to easily replicate mentioned model in similar settings.
Objectives 2 (Continuation of CSO Support Type B)
Mid-term and End of Project Evaluation of GAVI Type B Funding has proven direct contribution to the key results articulated in Afghanistan’s GAVI/HSS proposal showing linkage of the Millennium Development Goals (MDG), the Afghanistan National Development Strategy (ANDS). It will contribute to expansion of basic health services including immunization to insecure and hard to access areas through effective and active involvement of private sector.
1. Specific Objectives
The specific objectives of the PPHSP projects are as following:
1. To establish a replicable model of partnership with PHSP through:
1.2. Mapping and PHSP and selecting them based on coherent and logical criteria;
1.3. Supporting PHSP to establish associations or other type of coordination and
Collaboration mechanisms as required at the field level;
1.4. Conducting continuous consultations, documented interviews, with key stakeholders including the PHSP to improve the implementation mechanisms and arrangements;
1.5. Set up appropriate monitoring and supervision mechanisms including reporting system;
1.6. Evaluating outcomes, documenting and sharing achievements and lessons learned with stakeholders.
2. To provide immunization and basic RH services to vulnerable populations living in in six insecure and under-served provinces of Uruzgan,Farah, Paktia and Nuristan, Helmand and Kandahar through:
2.1. Selecting PHSP in the above mentioned provinces
2.2. Providing guidance, developing mechanism, tools, formats
2.3. Establishing appropriate monitoring mechanisms
2.4. Training of the selected private service providers to enable them to provide preventive health services;
2.5. Providing necessary equipment and supplies to trained private practitioners;
2.6. Carrying out demand creation for services through private sector health service providers;
2.7. Enhancing coordination and cooperation among the public sector, non for profit private sector and for- profit private sector health services providers
If the intervention is found successful, the results of the evaluation will attract funding from various donors to finance the intervention. Subsequently, the intervention will help in boosting up the coverage of basic health services beyond current 85%.
The project is funded by GAVI with technical and financial management support from WHO. The service delivery is contracted out to NGOs; HN TPO in Uruzgan and Paktia province and CHA in Farah province and HADAAF in Nuristan, ACTD in Helmand and AHDS in Kandahar Province.
Totally, 143 private health facilities (PHFs) are contracted for partnership to deliver basic
Reproductive and child health services. 30 PHFs are contracted in Tireen Kot, Chora, Charchin and Khas Uruzgan districts of Uruzgan province and 25 PHFs in Bakwa, Gulistan and Purchaman districts in Farah province 40 private health facilities (PHFs) are contracted in in Dand-e- Patan , Jaji Aryo , Wazi Zadran and Ahmad Khan District of Paktia Province and 17 private health facilities in Paroon, Wama, Noorgaram, Doab and Wygal districts of Nuristan Province 15 PHPs are contracted in Garamsir,Khanishin,Deshio,Nawa,NadAli,Margah,Nahe-seraj,Sangeen,Musakala,Nawzad,,Washir and Baghlan districts of Helamand province and 13 PHPs are contracted in Panjwai,Dand,Takhta pol and Spin boldak districts of Kandahar province.
These six remote, insecure and underserved provinces which have difficult terrain and low literacy rate (especially female) deserve innovative ways to provide effective health interventions for improvement of health status of the population living in these areas. Through involving private sector in health provision, an endeavor will be made to improve the health indicators especially of EPI and Basic RH. A successful implementation of this project in these provinces and documented benefits of this experience will pave the way to replicate/expand implementation of this strategy to the other provinces also.
2. Expected Outputs
The consultancy firm/consultant will provide MOPH/WHO and the implementing partners with a comprehensive draft report (hard and soft copies) for review and comments. The report will include:
§ Basic information: project title, Name of local partners, name of person who compiled the evaluation report including summary of role/contribution of others, period during which the evaluation was undertaken.
§ Executive summary
§ Purpose of the evaluation and the methodology
§ The main findings: The main findings should focus on following issues.
o Reviewing and documenting project outputs
o Evaluating project outcome against objectives
o Investigation of the relevance of these objectives to the MOPH objectives and priorities,
o the and the needs of beneficiaries
o Review of the project design, management and operations and recommendations
o for implementation of the same intervention in future
o To evaluate the feasibility of extension and expansion of the intervention
o Identify and document lessons learned in terms of feasibility, operations and
o contribution of the private practitioners in improving the utilization of immunization and
o basic child and reproductive health services
o To evaluate the sustainability of the intervention considering results, effects and resources
o Identification and documentation of unintended results
o To assess client and private practitioners satisfaction and put recommendations for
o improvement
o To collect observations of the beneficiary communities about the project.
§ Lessons learned: feasibility, equity, effectiveness, efficiency, outcome, sustainability, operations and developmental lessons.
§ Conclusions and recommendations for improvement, extension and expansion.
§ Annexes: TOR, Itinerary, List of people met, List of documents reviewed and others
3. Scope of Work
PPHSP projects in Uruzgan, Farah, Paktia, Nuristan, Helmand and Kandahar will be evaluated. The evaluation includes reviewing the progress of the PPHSP projects through assessing direct project outputs, outcome, project design, management, operations, effectiveness, efficiency, relevance, and sustainability of the intervention. The evaluation also includes recommendations for improvement in intervention, extension and expansion to other similar settings within the country. The evaluation will take one and half month to be completed.
4. Methodology
The consultancy firm/consultants may come up with an appropriate evaluation methodology.
6.1 Disk Review:
The evaluation consultant will review and analyse project related documents e.g. Proposal to donor, CSO proposals, project TOR, contracts, Annual Donor Report, Quarterly technical reports, contracts with PHSPs, Private Medical Association TOR and related documents,