Bangladesh: Evaluation of the "Improving health and nutritional status of urban extreme poor in Bangladesh through sustainable health service provision” project

Organization: Concern Worldwide
Country: Bangladesh
Closing date: 25 Oct 2019

I.Standard Terms

1.Duration and Location:

This consultancy is required for a period of maximum four (04) weeks with Concern Worldwide, Bangladesh, starting from November 10, 2019

2.Remuneration/Fee:

Interested bidders are requested to submit their financial proposal along with the technical proposal including for the assignment for a period of four 04 (four) weeks’ consultancy, inclusive all VAT and Taxes as per policy of the government of Bangladesh which shall be deducted at source prior to the payment.
Expenses not specified in the financial proposal or not mentioned in any section of the agreement are the sole responsibility of the Consultant.

3.Payment:

The consultant will be paid an agreed amount including tax & vat for the total assigned service. Full payment will be made upon completion of the assignment. The payment mode would be in three (03) instalments for the entire assignment against invoices issued by the Consultant:

Activities, Timeline and Payment** (details activities below)

Submission of inception report

Upon completion of deliverable (a); activity 1 - 6 in section 6.

20%

Submission of the interim report

Upon completion of deliverables (b) and (c); activity 7 – 13 in section 6.

30 %

Submission of Final evaluation report and Power Point presentation with data base of collected data

Upon completion of deliverables (d), (e) and (f); activity 14 - 15 in section 6.

50 %

Concern will not be liable for any bank charges arising from incorrect bank details being provided to Concern.

4 Accommodation & Food Allowance:

No accommodation and per diem will be paid in addition to agreed consultancy fees.

5 Copyright and Confidentiality:

Concern Worldwide will have the copyright for all the documents prepared by the consultant(s) including questionnaires, survey formats, case studies if any, and the final report with due acknowledgement. No part of the document should be reproduced or published any manner without prior written approval of Concern Worldwide. The consultant will maintain the confidentiality of the stated assignment.

6 Concern Worldwide’s Policies and Guidelines:

Concern has an organisational Code of Conduct (CCoC) with three Associated Policies; the Programme Participant Protection Policy (P4), the Child Safeguarding Policy and the Anti-Trafficking in Persons Policy. These have been developed to ensure the maximum protection of programme participants from exploitation, and to clarify the responsibilities of Concern staff, consultants (individual/agency) to the programme and partner organisation, and the standards of behaviour expected of them. In this context, consultant (individual/agency) has a responsibility to the organisation to strive for, and maintain, the highest standards in the day-to-day conduct in their workplace in accordance with Concern’s core values and mission. Any consultants (individual/agency) offered a task with Concern Worldwide would expect to sign the Concern Staff Code of Conduct and Associated Policies as an appendix to their contract of employment. By signing the Concern Code of Conduct, consultants (individual/agency) acknowledge that they have understood the content of both the Concern Code of Conduct and the Associated Policies and agree to conduct themselves in accordance with the provisions of these policies.

7 Management

The Consortium Manager of the project in Concern Worldwide, Bangladesh with support SAL Advisor (M&E and Health) Concern Worldwide, Ireland will supervise the consultant. Technical and logistical support provided by the M&E department, Concern Worldwide, Bangladesh. The Programme Director, Concern Worldwide, Bangladesh will provide oversight and technical support. For the quality assurance of the key evaluation exercise, draft inception and final evaluation reports will be shared with SAL advisors, Consortium Manager and Programme Director, to obtain their technical input and clearance before finalization of the inception and final Evaluation report.

II Project Specifications

Background

Bangladesh is experiencing rapid and poorly regulated urbanisation. The number of Bangladeshis living in urban centres is expected to rise from the current 53 million to almost 80 million by 2028. However, there is no formal integrated state healthcare delivery system in urban Bangladesh. Currently the Ministry of Local Government, Rural Development and Cooperatives (MoLGRD&C) is responsible for providing primary health care services through the City corporations and Municipalities, while the Ministry of Health and Family Welfare (MoHFW) is responsible for providing secondary and tertiary level health care, policy and technical guidance. However, due to competing demands, Primary Health Care (PHC) and public health receive low priority within the City Corporation and Municipal budget system. In the absence of a well-developed system, healthcare is delivered through a diverse set of state, NGO and private providers. There is little convergence or coordination between these service provision systems. It is the urban extreme poor who suffer most severely from this situation.

Rapid urbanized is expected to continue to increase due to high level of natural population increase and continued rural to urban migration fuelled by rural poverty, landlessness, climate change vulnerability and the large rural–urban wage differentials. Despite the economic progress made by Bangladesh towards attaining middle income status and achieving many of its Millennium Development Goals there is widening inequalities across the society. In the urban areas this manifests itself as large numbers of urban poor being ‘left behind’ in terms of accessing basic health and nutrition care services. The Contextual Analysis carried out by Concern in 2016 identifies a continuum of the urban extreme poor extending from the most vulnerable, poor with least security of tenure, from the pavement dwellers to the squatter dweller (living almost in similar circumstances to the pavement dwellers) to the undeveloped slum dwellers to the developed slum dwellers. In absence of urban health system, in the city corporation areas disadvantaged groups mainly extreme poor segments are either rushing to private providers or not taking any health services at all. These are negatively contributing towards the improvements of urban health indicators in general. On the otherhand more challenges are being posed to achieve the SDG targets or UHC achievements in urban areas.

Overview of the Project:

Concern Worldwide along with its consortium partner BRAC, has been implementing a European Union funded urban health system strengthening project “Improving Health and Nutrition Status of Urban extreme poor in Bangladesh through sustainable health service provision” in Dhaka North City Corporation, Dhaka South City Corporation, Chattogram City Corporation and Mymensingh City Corporation areas from December 01, 2016 - November 30, 2019.

The overall objective of the project is to improve the health and nutrition status of the urban poor in Bangladesh through sustainable service provision, managed through a coordinated, national urban health delivery system.

Related Indicators:

Reduction of maternal mortality ratio for urban poor in line with government targets by end of 2019
Reduction under 5 child mortality for urban poor in line with government targets by - end of 2019
Improved nutritional status of urban poor children under 5 years of age in line with government targets by end of 2019
Increased government policy support and budgetary allocation for Urban health service delivery

The project aims to establish and demonstrate an effective, comprehensive, integrated and sustainable health system to provide health, nutrition and population services to the urban extreme poor and poor by addressing the gaps in existing urban health services and its delivery system through working with the targeted City Corporations and Municipality, existing NGO/private health service providers, Ministry of Local Government (MoLDGRDC) and Ministry of Health and Family Welfare (MoHFW). The project is focusing on the extreme poor and most marginalised people living in slum, squatter settlements and on the pavements of Dhaka South and North City Corporations, Chattogram Corporation and Mymensingh Municipality. The action has achieved this through increasing the access of the extreme poor people in targeted locations to PHC; improving the comprehensiveness of PHC services; enhancing the quality coverage of health, nutrition and population (HNP) services; and, strengthening the sustainability of urban health, nutrition and population services in partnership and coordination with Government, NGO service providers and community groups.

The project does not intend to not create another parallel service delivery structure, rather, it will strengthen the existing systems, support convergence and facilitate synergy between the existing health, nutrition and population services benefiting the urban extreme poor. It will take the role of conductor, bringing all actors together to address the health equity gaps.

One of the fundamental principles of the action is building collaboration, coordination and synergies between the existing parallel health service provision system in order to support the MoLGRD&C and MoHFW’s commitment to universal access to health care in urban Bangladesh.

Financial barriers plays a significant role in seeking heath care services among the urban extreme poor communities. Two voucher schemes were tested from the project for those extreme poor beneficiaries who are not unable to seek health care services due to lack of financial capacities: 1) Heath voucher scheme (HVS) and 2) Micro health insurance scheme (MHIS). It was estimated that about 93,843 (which is 11% of total 878,647 extreme poor beneficiaries) people from different sub-groups will receive financial support to access free PHC services and emergency services from facilities under this action. The remaining 4% is expected to be covered by Micro Health insurance scheme.**Specific objective** of the project is to improve and increase sustainable, comprehensive and integrated primary health care, nutrition and population services to the urban poor in Dhaka and Chattogram City Corporation areas and Mymensingh Municipality. The project is being implemented largely by BRAC along with the strategic and technical partners of Concern Worldwide.

Indicators:

55 % of extreme poor who report barriers to health services have been removed or reduced by end of the project
55% of health facilities are providing comprehensive integrated nutrition, health and population services
20% increase in number of service contacts with NGO health facilities
City Corporation and Municipality organised quarterly meetings with service providers and reviewed their performance.
Increased budget allocated for urban health by City Corporation and municipality by end of the project

The objective of the project will be achieved through following four expected results:

Expected Result 1: Increased availability of, access to and utilisation of essential health, nutrition and population services by poorest people in targeted locations

Indicators:

55% of targeted extreme poor households accessed Primary Health Care (PHC) services
55% of targeted pavement and squatter dwellers have accessed PHC services
Number of outreach service outlets of NGOs increased by 10%.
15% of targeted extreme poor people have accessed financial support through voucher system.
At least one micro health insurance scheme operationalised for the urban poor in 1 site for this action

Expected Result 2: Improved comprehensiveness of existing PHC services by integrating nutrition and addressing other service gaps including increased referral linkages between

health facilities

Indicators:

10% increase in horizontal referral of patients between PHC facilities and 15% increase in vertical referral of patients from PHC facilities to secondary or tertiary level
60% targeted PHC facilities provided integrated maternal and child nutrition and micronutrient services
70% of severe acute malnourished children who completed full cycle successfully recovered in targeted areas.
Children aged 0-23 months with pneumonia who received treatment from PHC in the last 2 weeks increased by 10% from baseline.
Mothers of children age 0-23 months receive post-natal visit from an appropriate trained health worker within two days after the birth of their youngest child increased by 10% from baseline
Adolescents those received a health and nutrition service from a PHC increased by 10% from baseline.

Expected Result 3: Enhanced quality coverage of PHC, nutrition and population services at community and facility level through an innovative roll out of the Urban Health Strategy in the 4 targeted locations

Indicators:

80% of staff of targeted PHC facilities are trained to integrate new services
Number of targeted clinics meet women-centred and youth friendly services standards as confirmed by quality assurance checklist
Number of targeted PHC facilities established complaint response mechanism (CRM)
Percentage of beneficiaries satisfied with the services provided by PHC increased by 30% from baseline.
80% of targeted PHC facilities using quality checklist on regular basis

Expected Result 4: Strengthened sustainability of urban health, nutrition and population services in partnership and coordination with Government, NGO service providers, community groups

Indicators:

City Corporation and Municipality organise quarterly meetings with service providers and review performance.
City Corporation/ Municipality increase budget allocation to support health service for urban poor
One functioning public-private partnership model between one City Corporation and one NGO established to sustain health service

Project location: Project is being implemented in selected areas of Dhaka South City Corporation and Dhaka North City Corporations, Chattogram City Corporations and Mymensingh City Corporations*.*

Purpose of the final evaluation

This evaluation will inform the results of the project based on five criteria (relevance, effectiveness, efficiency, sustainability and impact) recommended by OECD-DAC. It was part of the project design, to have a final evaluation during the final year of the implementation. The main aim of the final evaluation is to assess the extent to which the project has achieved its expected outputs and outcomes, identify contextual challenges, areas where there have been gaps and the degree of success in addressing them. A baseline survey was conducted in 2017, which will be considered as the main basis of this final evaluation. Moreover, Concern Worldwide has conducted an internal MTR in 2018, which was not mandatory requirement, but was conducted to check the progress and achievements. In September 2019, end line survey was also conducted. These three major quantitative sources will form the basis for the final evaluation.

Based on the findings and conclusions, the evaluation will provide recommendations, lessons learned & best practices for future programming that focus on policy and advocacy work for the stakeholders.

The evaluation will assess the efficiency, effectiveness, relevance, sustainability and impact of the project interventions. The captured knowledge and learnings will help to shape future similar project for the Concern Worldwide and BRAC, also for other organisation, donor communities, and ultimately for the government of Bangladesh.

4 The specific areas to be covered in this evaluation:

• To assess the efficiency of resource utilization (human, financial and material) and project management system.

• To assess the relevance, effectiveness, efficiency and sustainability of the interventions of the project, strategies and implementation process as well.

• To capture best practices and document the lesson learnt that will be used to guide the implementation of new project programming and interventions, including approaches to develop urban health system improvement

• How urban health financing among the extreme poor community can be addressed in complex urban setting ?

• How Universal Health Coverage can be achieved considering urban extreme poor segment in large city corporation areas?

• Development of a sustainable urban health system in leadership of LGI (City Corporation) in collaboration with MoLGRD&C and MoHFW

• Develop/show case effective model/concept of financial sustainability of urban heath system strengthening approach

The evaluation will follow participatory process and will give focus on key areas of interventions as per different results as well as evaluate the results following prescribed indicators as guiding questions.

Relevance:

Assess the extent, to which the project was appropriate to address the needs and constraints of communities and local authorities taking into account specific needs according to gender, age and disability. In addition how necessary and sufficient were the selected interventions according to the needs identified and working strategies in achieving project target or objectives.
How much the project interventions were aligned to increase capacity of the communities and local authorities as well as leadership development in project locations.
Does the program meet its stated objectives?

Effectiveness:

Document the extent to which the inputs/activities have adequately rendered to achieve its clearly stated project outcomes/results.
To assess the achievement of project outcomes though a baseline/midline/endline assessment of indicators, supported by routine monitoring data
To what extent have the activities contributed to increase preparedness and adaptive capacity of the target communities?
How did the activities and subsequent preparedness differ between men and women and how effective was this approach?

Efficiency:

Are the effects being achieved at an acceptable cost compared to alternative approaches of accomplishment of project objectives?
Assess the overall contribution of Concern and BRAC using available monitoring and evaluation data and reports in particular Concern’s contribution to systemic and sustainable change within the opportunities and confines the contexts involved while considering value for money implications.

Impacts:

What indications are there of significant changes taking place beyond the programme - both positive and negative?
How have the programme interventions impacted differently on men and women (and other vulnerable groups as identified) in the programme area?
Assess the impact on extremely poor and vulnerable target groups of the programme using the DAC criteria.

Sustainability:

Have the activities contributed to changing people’s attitude, behaviours and practices in term of response to cyclone or disaster, preparedness measures and adaptation planning.
To what extent the pilot model is sustainable at community level, institutional mechanism and action planning at different level.
Where interventions are coming to a conclusion the evaluation should review any exit strategy and the appropriateness of this.

In addition to the above analytical measures, the final evaluation must provide commentary on the following issues:

To what extent project covered the gender issues
How the project ensured quality implementation of its planned activities
To what extent was equality taken into account at each stage of the project – design, implementation and monitoring
To what extent the accountability to beneficiaries was practiced/promoted and the progress made against the Core Humanitarian Standards (CHS) principles, Complaints Response Mechanism (CRM) in place?
How the advocacy interventions of the program contributed to achieve the result and sustainable operation of certain project interventions even after the project period.

5 *Methodology

A mixed-method approach is required for this final evaluation including the systematic use of qualitative (e.g, structured interviews and focus groups, key informant interview) and quantitative (e.g. recent survey results, existing routine data) methods. A participatory approach by involving various social groups stakeholders including the extreme poor beneficiaries and relevant others to capture their opinion and for better understanding of the approach. An initial proposal for a more detailed methodology is to be submitted by the applicant (individual consultant) at the time of submission of the technical proposal which will be used as a basis for proposal assessment by Concern Worldwide. Afterwards, the contracted consultant will be requested to develop a more holistic evaluation plan which must contain a work plan, a detailed description of a specific methodological approach, a design for the evaluation with a list of questionnaires, and information collection and analysis methods and tools including sampling plans, as necessary.

Please note that three major quantitate evidences viz. Baseline survey (2017), Mid Term Review (2018) and End line survey (2019) will provide the quantitative evidence for the final evaluation. Updated result framework will help the final evaluators to understand the progress or results.

Please follow the outline below to develop technical proposal. There are mainly four phases in this evaluation exercise:

I). Desk review and refinement of methodology

The list of references and documentations will be shared with the selected consultant. In relation to this project, the baseline (2017) and end-line (2019) results are available. These data need to be reviewed and utilized for the evaluation together with other existing sources (urban health survey, recent national survey, slum census etc. Joint Monitoring Report, Project progress reports, etc.) as appropriate by considering the disparities based on geography, challenges and other key variables based on the availability of data. To ensure the participatory approach and refine the methodology based on the context of the country and project, the selected consultant will have the opportunity to fine tune the methodology during the first inception report after meeting with project officials and other key stakeholders.

II) Use of end line survey data

Concern Worldwide has already conducted end line survey in September 2019. This will be considered as the latest quantitative data source for this final evaluation. No additional major data collection will be required for this evaluation. The final report of the end line survey and data will be made available to the consultant for comparison and understanding of the impact.

III) Data collection, field work ( site visit/interviews)

The systematic use of qualitative (e.g, structured interviews and focus groups) and quantitative (e.g. recent survey results, existing routine data) methods are required to collect the additional evidence in consultation with project officials. As a challenging health system strengthening project, it is important that triangulation among 3 dimensional evidences are helping to draw right conclusions. Meeting with project beneficiaries and key stakeholders will be accompanied by project and partners staff during the field work. Due to the nature of this “final evaluation” and within time and budget limitation, it is highly recommended to plan together in a participatory manner to choose project site for visiting and interviewing and data collection, focus group discussion in the field based on the desk review analysis. The respondents and methods/tools (interview, questionnaires, and focus group) need to be strategically selected based on the evaluation questions.

IV) Analysis and Reporting

The results of analysis need to systematically respond to the evaluation questions, and the report has to be written in a reader-friendly manner. Before finalization of the evaluation report, Concern Worldwide will organize one day workshop, gathering project team, stakeholders, beneficiaries and the evaluation team, to discuss together recommendations and action plan drawn from the evaluation. This workshop would help ensure recommendations are appropriate and owned by the project team and stakeholders, this workshop will be facilitated by Concern Worldwide, with the final evaluation team.

Activities, task, deliverables and timeframe

The assignment is for four week over the period of November 10, 2019 to December 10, 2019. The consultant will provide a detailed timetable in its technical proposal, specifying the distribution of tasks and duration to complete each task. The proposed sequencing in the table below is an indicative proposal which could be improved in the technical offer. The right column indicates an estimated duration for the activity.

Activity

**Phase 1: Desk Review From Distance

Participate in a briefing session on the assignment with technical committee (through skype call)
Review and analyse the relevant documents, reports (Baseline 2017, MTR 2018, Endline 2019, Health voucher/MHI cost effectiveness study, Interim annual reports to EU etc.), other materials
Finalization of the questions and sub-questions of the evaluation

**Phase 2 : Country Visits and Consultations

Identification of the evaluation methodology, information/data collection method for each evaluation question, sampling for interviews and field visits, and development of data collection, and data analysis plan
Development of detailed planning for the evaluation with support of programme section for logistical arrangement (field visit)
Draft inception report and submission of inception report
Data collection in project sites (interviews, KII, FGD and complementary document review )
Debriefing meeting

**Phase 3 : Analysis and Reporting

Processing and analysis of the collected data, and drafting of the interim report
Presentation of the interim report to the technical committee for feedback (written and oral presentation or skype meeting)
Completing the interim report by incorporating feedback from the technical committee and an action plan proposal prioritized for the project, EU and other stakeholders.
Submission of the interim report to the technical committee. The consultant will present the report for validation (physical or skype)
Submission of the Final report and a PowerPoint presentation incorporating feedback
A six page summary for publication in the newsletter or website.
End Product/ deliverables

a) Inception report (activity 1- 6)

b) PowerPoint debriefing meeting after completion of field activities ( activity 7 – 9)

c) Interim report (activity 10 – 12)

d) Final Report in English and PowerPoint presentation (at the latest two week after the draft version): Soft copy (1 electronic version with PDF and word/excel) (activity 13)

e) Database of collected / cleaned data ( Excel file preferable)

f) Max 6 page summary for publication in WASH newsletters, websites etc (activity 14)

The final evaluation report should not exceed more than 25-30 pages (without the annexes) and will include at least the following:

Executive Summary
Brief description of the program, its context , financial arrangements , areas of intervention, timing, implementation modalities and actors
Objectives , methodology, timing of evaluation and challenges / limitations of the analysis
Results in terms of relevance , efficiency, effectiveness , impact, sustainability
Analysis , including reflection on gender, human rights
Lessons learned , challenges , conclusions, recommendations , action plan
Annexes including list of the data with maximum disaggregation

8 Qualifications and experience required:

Training and experience in the field related to health system strengthening, health financing with academic qualifications (at least a Master’s degree) in public health, health financing, global health, health system development, urban health system, social sciences or combination of it.
Proven international expertise with at least 8 years of professional experience in planning, implementation, management, monitoring and evaluation of public health, health system development, health financing, urban health, integrated health and nutrition services related projects/ programmes in developing countries.
Proven experience with similar programme evaluations in the health sector in developing countries, preferably for the fields of health system development, health financing, UHC, urban health related interventions in complex urban context.
A team in combination of national and international experts would serve the purpose better.
Proven experience for EU project evaluations will be an asset.
Ability to work independently.
Good interpersonal communication, easy presentation and report writing skills in English.
Commitments to deliver the final products in line with the set TOR within the agreed timeline.

The consultant should adhere to OEDC-DAC criteria, GDPR, EU standard policy (EuropeAid and the European External Action Service (EEAS) and other UN standards related to evaluation (UNEG’s ethical guidelines for UN evaluations; to UNEG’s code of conduct for evaluation)

Condition of Work

The consultant will be provided a working desk in Concern Worldwide office, Dhaka. The consultant will use his /her/their own laptop for the assignment.

Concern Worldwide will facilitate the arrangement of meetings and workshops with partners and other stakeholders as required. The consultant will be responsible for all travel and accommodation related expenses while undertaking field trips to the selected project locations.

How to apply:

Interested candidates are kindly requested to submit the following information: