1.        Assessment Summary

Programme/Project	Enhancing Nutrition Services to Improve maternal and Child Health in Africa and Africa (ENRICH)
Programme Phase	First Year
Study Type	Conduct assessments of Ladies Health Workers (LHWs) mapping and their functionally at selected 3 talukas/Tehsils (Rohri, Pano Aqil & Salehpat) of District Sukkur
Assessment Purpose	The main objective of this assessment is to generate reliable information on the current status and functioning of the Lady health workers in the areas and their role in current vertical and horizontal programs, capacity building assessment. This information will be used to inform plans aimed at enhancing capacity and improving the quality of work delivered by LHWs in the ENRICH Project target areas
Primary Methodologies	Mix Methodology (Qualitative and Quantitative)
Assessment Start and End Dates	TBD
Anticipated Assessment Report Release Date	TBD

 

2.        Description of Project

Background:

World Vision aimed at contributing improved mother and child health indicators by addressing malnutrition among children and mothers. The proposed project will focus on “Strengthening Health systems” and “Improving nutrition”. Pakistan, in the pursuit of achieving Millennium Development Goals (MDGs), in lagging behind particularly in MDG-4 and MDG-5 marked by 74 children die out of 1000 (IMR) and 276 mothers die out 100000 (MMR); on the contrary, it has committed itself to reduce IMR to 40/1000 and MMR to 140 by 2015, respectively. The alarming rate of IMR is directly linked with malnutrition marked by stunting rate among children is 43%, nearly 32% of the children are underweight and wasting rate in 15%. Malnutrition not only contributes to rife in child and infant mortality, it also exacerbates MMR provided that 76% of the women suffer from iodine deficiency and 39% of the women are anaemic.

The Project

World Vision keeping the dire context in view has proposed to initiate an integrated mother and child health and nutrition program in the sub-district/talukas of Sukkur district in Sindh including Saleh Pat, Pano Aqil and Rohri. The overall objective of the initiatives is to contribute to the reduction in MMR and IMR by addressing malnutrition in the targeted regions. The program will adopt a synchronized approach that includes strengthening and enhancing service delivery capacity of 43 Basic Health Units (BHU) which operate under department of health, which in turn will benefit directly 443,059 people and 455,850 indirectly. The initiative aims to improve the capacity of health management team at district and sub-district levels, build community level capacity to implement key maternal and child nutrition initiatives, influence policies and guidelines around maternal and child nutrition, improve access to and utilization of improved health and nutrition services, enhance capacity of service providers and increase consumption of nutritious food.

The initiative will be working closely with provincial, district and sub-district health authorities and with other relevant stakeholders that directly and indirectly impact on maternal and child nutrition outcomes such as department of Food, department of fisheries and livestock, civil society and the community.

Specifically, the project is trying to address the following issues;

• Improved delivery of gender-responsive essential nutrition services for mothers, PW, newborns, & CU2
• Increased production, consumption and utilization of nutritious foods & micronutrient supplements by mothers, PW, newborns, & CU2
• Strengthened gender-responsive governance, policy and public engagement of MNCH in Pakistan

 

3.        Assessment Target Audiences (i.e., for whom is the Assessment intended?)

Target audience and respective purpose reports serves include:

 

• LHWs National Program District Coordinator and National Program Staff of District Sukkur.
• ENRICH project staff and partners 

4.        Assessment Type

Situational analysis/Need Assessment

5.         Purpose of Assessment and Objective

The main objective of this assessment is to generate reliable information on the current status and functioning of the Lady Health workers in the areas and their role in current vertical and horizontal programs, capacity building assessment. This information will be used to inform plans aimed at enhancing capacity and improving the quality of work delivered by LHWs in the ENRICH Project target areas. The assessment will look at: 

• Selection criteria of a Lady health Worker and from where and how a Lady Health worker is selected and deployed to a particular community
•  Level of understanding & awareness among community members about the role of a Lady Health worker in the community
• Assess the District Health Management team role in a Lady Health worker program and how is it aligned with the ongoing vertical & horizontal health programs? Please explain it from the health system perspective.
• Where is a Lady Health worker provided Initial Training to prepare for her role in service delivery in order to have necessary skills to provide safe and quality care
• Assess the leady health workers engagement for up gradation of existing and learning of new skills and these are practiced by the Lady Health Workers
•  Assess the LHWs engaged in management of Horizontal & Vertical programs including immunization
• Assess the supply chain of the requisite equipment and medicine made available to the Lady Health Worker to perform her functions
• Assess the mechanism and regularity for Supportive supervision of a Lady Health worker and how is the skill development, coaching carried out
• Assess the Problem solving mechanism of a Lady Health Worker and how is the skill development and data review carried out at district level
• Assess how performance of a Lady Health Worker is assessed and what are the key performance indicators available with the LHW program at the district level
• Assess,  if there is any appreciation/Incentives mechanism available with the District LHW program and what kinds of financial/Non-financial incentives given to the worker
• Are Lady Health Worker supported and accepted by the community?   
• What kind of referral mechanism is in place in the catchment area of a Lady Health Worker and what logistic arrangements (Government/ Non-Government) available?
• Is there any Community fund mechanism available for the referral system, how the LHW is linked and how the referral cases are tracked by the LHW?
• What kind of carrier progression opportunities available to the Lady Health worker?
• What kind of a documentation and information management system in place for reporting purpose?
• How the LHW generated data flows to the health system and back to the community, and how it is used for service improvement?
• How the Lady Health Workers linked to the upper level of facility based health care system?
• How Horizontal District health management is involved in recruitment, training, incentives, supervision, evaluation, equipment and supplies, use of data and referrals?
• What kind of a third-party evaluation of performance against targets, overall program objectives, and indicators carried out at district level?
• What sustainability mechanisms are in place to support LHW program by the Provincial Health Ministry in terms of policy, budgetary allocation etc.?

6.        Assessment Methodology

• Secondary data desk review
• Design of data collection,  analysis and tabulation plan of the data collected by the consultant.Statistical analysis and processing of the raw data
• Tehsil wise analysis of all LHWs
• Health facility wise detail data of LHWs, LHWs are regularly reporting and linked with which HF..
• Production of the draft and final report incorporating feedback from WVC and
  WVI Pakistan, including interpreting the data, creating summary tables and graphs
  with key results, descriptive analysis, write-up of data collection methodology and key messages.
• Production of a stand-alone summary and power point presentation with key messages 

7.        Legal Framework

In the event that there is non-performance, defective performance or late performance due to causes beyond control and occurring without fault or negligence, including without limitation, natural disasters (such as floods, earthquakes, fire), acts of any state or government, fire explosions, epidemics, quarantine restrictions, blackout, or embargoes, neither party will be held responsible. If the consultant fails to provide the services required hereunder as a result of above listed force majored and such failure continues for a period of 10 calendar days, WVI Pakistan shall have the right to terminate this agreement without any further liability resulting from such termination. The consultants will be paid for all services satisfactorily performed and accomplished up to the date of termination as determined by WVI Pakistan.

This agreement shall be deemed terminated automatically without further liability or obligation of WVI Pakistan if the consultant, is adjudicated as bankrupt, petitions or consents to any relief under bankruptcy, reorganization, receivership, liquidation or similar arrangements or makes an assignment for the benefit of creditors.

8.        Limitations

All of the data collection will be guided by World Vision Pakistan MOU with relevant government authorities; it will be consultant responsibility to get maximum understanding of limitations and constraints from World Vision Pakistan. This study has to be concluded before the end of June 2017.

9.        Ethical Consideration:

All interaction with the beneficiaries will be only made after their consent and they will be explained purpose of the data collection, and also use of the collected information. Consultant will strictly avoid indulging into any conversation of political or religious nature, and will not use any jargons, words or gestures those can be offensive on religious, ethnic, gender, age or any other ground.  Consultant will strictly avoid any sexual advances, offers or favours to beneficiaries, neither will promise any favours to survey participants. Consultant will not guide/or instigate respondents to provide specific answers, consultants will not misinterpret assessment participant inputs or distort these. Safety and security of the survey participants is of the paramount importance consultant will not act in any manner putting security & safety of the survey participant at risk. Interaction with the children will be guided by World Vision Child Protection Policy and protection protocols.

10.   Authority and Responsibility

10.1.           Team Members and Roles

Phase	Responsibilities	Team Member
Planning	Development of TORs for assignment.	PM ENRICH
Review and Approval of the TOR	To review the TORs according to the protocols of the World Vision-MEER	MEAL & PDC
Hiring of Consultant	Advise on TOR for national consultant and minimum competencies
	Advertisement of the TORs.
	Technical review of the consultant proposal.	PM & PDC
	Shortlisting of the consultants bid committee.	PM & PDC
	Pre-selection interviews with shortlisted consultant Health specialist & Area Development Manager.	ADM and PM
	Award of the contract.
Technical Supervisions Liaison and Coordination.	Briefing to the consultant on the project, process and expectation.	PM
	Provision of required documentation to the consultant.	PM ENRICH PDC
	Coordination of feedback on the development on tools for the assignment.
	Follow ups on the agreed plans and deliverables.
	Coordination with stakeholder to organize the assignment.
	Ensuring compliance to agreed standard in data collection, respondent selection and geographic coverage.
	Overall supervision of the assignment in the field.	MEAL Team
Study Design, Data Collection & Analysis	Submission of the technical & financial proposal and profile.	Consultant
	Design tools for quantitative & qualitative data collection.
	Providing detailed plan for the assignment with milestone.
	Approval assignment plan and tools.
	Qualitative and Quantitative Data Collection.
	Data Cleaning & Analysis.
Reporting  & assignment closeout	Draft Report on the agreed timeframe.
	Coordination of World Vision feedback on the report.	MEAL , PM and PDC
	Response to rounds of feedback provided by World Vision Pakistan.
	Report’s approval.
	Processing of invoices and payment.	Logs
Final Review	To review of the deliverables, provision of feedback and approval.

 

11.   Team Advisors

Project Manager ENRICH

Health specialist

Senior Monitoring Evaluation and Accountability Officer (MEAL)

Area Development Manager Sukkur

12.   Logistics

All of the logistics arrangement related to assignment will be the responsibility of the consultant. World Vison Pakistan field team will extend support to the consultant through providing information and guidance in arranging logistics for the assignment – however consultant will arrange these through their own resources. ENRICH team will help consultant in identification of the area and location to collect data, project manager and his/her team will facilitate consultant in organizing meetings stakeholder. Part of the budget consultant will propose all logistical costs. 

During the course of the assignment consultant in agreement with World Vision field admin staff will use field office facilities (space, furniture and internet) to execute field plan. In case of use World Vision facilities all the relevant policies, SOPs and procures will be binding.

13.   Product/Deliverables/Responsibilities

Products expects of this assignment include:

• Assessment Design – This has to be approved by World Vision.  
• Final Assessment report – Report will be produced based upon the World Vision provided template.
• Power point presentation of key findings to be presented to external audience (donors, government official etc.)
• Final data base and data tables/charts used in analysis.
• Final set of tools used for quantitative and qualitative data collection.
• Consultant will provide World Vision Pakistan three hard copies of final report and CD with final version of report, tools, database and analysis. Assignment completion certificate will be signed after consultant will submit above mentioned documents.  

14.   Budget

The total amount will be released in 4 segments of payment, 15% mobilization advance, 15% on initial plan/tools and design level-depending on nature of consultancy, 30% upon approved draft and remaining 40% on approval deliverable. 10% of the total of the contract will be retained as a performance bond which can only be released upon the completion of work as per agreed TOR and timeline specified in the contract. This can be taken as 10% of each installment. Withholding tax of 10% will be deducted from the total amount.

15.   Documents

All outputs created/ made under this assessment will be the sole property of WVP and consultant has to abstain from exercising any rights on such outputs, furthermore, the consultant shall keep the confidentiality of all information including documents provided to him OR output produced under this study and shall not disclose those to others without prior written consent from WVP.

16.   Appendices

Level of Efforts: 05 days of work.   

Responsibilities		% of time
	Inception meeting, Assessment Design  & document review	11%
	Tools development and finalization.	18%
	Data Collection.	25%
	Data cleaning, entry and analysis.	13%
	Preliminary findings presentation and reporting.	33%
Education Experience	MBBS/MD, MPH and, statistics, social sciences or other related areas for other team members. At least 10 years of experience in monitoring & evaluation of Health & Nutrition projects. Extensive knowledge of MNCH, Health & Nutrition issues, especially in rural context of Sindh. Understanding of government laws and policies (National/Provincials) regarding MNCH, Health & Nutrition Sound knowledge of community based approaches, preferably. Demonstrable understanding of gender and equity analyses	N/A
Required Skills	Practical experience with quantitative and qualitative research methodology. Extensive experience in survey design including sampling. Strong analytical, presentation and writing skill. Strong documentation skills. Ability to present complex information in a simple and compelling manner, and to use innovative forms of communication.	N/A

 

How to Apply:

Sealed proposals through Courier services are required to be submitted “TO: Procurement Committee address:3^rd Floor,  Plot 33, Al Rehman Plaza G11 Markaz, Islamabad. Last date for submission of proposals is Sunday 11^th June 2017. Consultancy title should be clearly mentioned on envelop.

Note: Tender bids received after the last date will not be accepted and final selection of the potential Consultants/Institutes will be based on technical & financial evaluation. Organization reserves the right to accept or reject any proposal without assigning any reasons