TERMS OF REFERENCE
Health Facility Assessments
UNESCO is seeking the services of a National Consultant to conduct Health Facility Assessments across 10 higher and tertiary education institutions (HTEIs) in Zambia.
1. Background and Context
Our Rights, Our Lives, Our Future (O3 Plus) project seeks to ensure that young people in higher and tertiary education institutions (HTEIs) in Zambia and Zimbabwe realize positive health, education and gender equality outcomes through sustained reductions in new HIV infections, unintended pregnancy and sexual and gender-based violence. The project will thus enable them to reach their full educational potential and contribute more effectively to the development of their countries and region as graduates, professionals and young leaders. With support from the Swiss Agency for Development and Cooperation, the project will be implemented across 20 Higher and Tertiary Education institutions (HTEIs) in Zambia and Zimbabwe from January 2021 to December 2024.
Working closely with relevant regional structures, national ministries, higher and tertiary education institutions, and key partners, UNESCO will support innovation in access to Life Skills Based Comprehensive Sexuality Education (CSE) and sexual and reproductive health (SRH) services for HTEI students while advocating for policy and practice changes to make campuses safe and inclusive learning environments for students and staff. In doing so, the project will institutionalize health and well-being programs for students while engaging leadership for long-term commitment and sustainability.
The work will be delivered through four complementary pillars or work streams as follows: institutional strengthening for sustainability; student health and well-being; safe and inclusive campus environments; and evidence building and knowledge sharing platform.
Under the student health and wellbeing work stream, UNESCO is commissioning a health facility assessment study across the HTEIs in order to collect comprehensive information on health service delivery for young people in line with existing international youth friendly services (YFS) guidelines and standards, and make recommendations for investments required for the health facilities to be fully functional and deliver services effectively.
2. Scope of the Health Facility Assessments
The Health Facility Assessments (HFAs) will be conducted across 10 HTEIs in Zambia. The Consultant is expected to develop data collection tools in line with the methodology under section 4 below, as well as update the existing Facility Observation Tool, which will be provided by UNESCO as necessary.
3. Research Questions
The key research questions to be answered by the Health Facility Assessments (HFAs) are:
i. What are the existing youth friendly health services (YFHS) guidelines, standards and policies in Zambia? How do the guidelines, standards and policies align with international guidelines i.e. WHO Global Standards for Quality Healthcare Services for Adolescents and Youth? Is delivery of health care services at health facilities in tertiary institutions in-line with the guidelines, standards and policies?
ii. What type of services are offered at health facilities in HTEIs, and what is the quality of these services as per the existing standards and guidelines? Do the health facilities have the necessary resources i.e. infrastructure, human capacity, financial etc to ensure effective service provision? Are there any guidelines or minimum standards for infrastructure of health facilities in tertiary institutions? Which ministry is responsible for the administration of health facilities in HTEIs? Is there clear ownership and linkages of the health facilities in HTEIs with district, provincial and national level Ministry of Health and Child Care? What are the major sources of funding for the HTEIs?
iii. What are the perspectives of health providers on health service delivery for young people in HTEIs? What are perspectives of young people in HTEIs on the health services provided at the health facilities? What factors enable or hinder young people’s access to health services at the health facilities in HTEIs?
iv. How can the health facilities be improved/strengthened to ensure effective health service provision to young people? What resources or capacities are required i.e. infrastructure, equipment, human resources, training etc.?
The HFAs will use a combination of methods, where primary data collection will be in-person and virtually where feasible. The Consultant is therefore expected to adhere strictly to national guidelines and regulations on COVID19 during in-person data collection.
The proposed data collection methods include, but are not limited to the following:
- Desk Review of relevant literature including policies and guidelines such as WHO Global Standards for Quality Healthcare Services for Adolescents and Youth; reports on researches, evaluations, assessments or reviews on youth friendly health service delivery, reports on health facility assessments, as well as relevant government policy, strategy, guidance documents, etc
- Observation and administration of facility observation checklist/tool to assess the following: availability of medication, type of equipment, infrastructure etc
- In-depth interviews with representatives from Ministry of HTEI, Ministry of Health and Child Care, and CSOs that are active in relation to health and wellbeing in HTEIs, to understand more about the ownership of HTEI health facilities; any existing guidelines or minimum standards for infrastructure of health facilities in tertiary institutions; funding from both Treasury and the ministries, key barriers/challenges to service provisions, and recommendations for strengthening health service provision for young people in health facilities in tertiary institutions
- ·In-depth interviews with health care service providers at the health facilities to examine operational realities, assess service provision and capacity related issues; examine perspectives on health service delivery for young people, and identify areas for improvement to strengthen service provision
- Focus Group Discussions with young people, including young people with disabilities, HIV and from the LGBTIQ community, to assess knowledge and use of services; determine factors that enable or hinder access to the health services; examine expectations in relation to delivery of services at the health facilities, and recommendations for improvement
- In-depth interviews with young people, including young people with disability, HIV and from the LGBTIQ community, who have used the health facility to assess knowledge and use of services, examine experiences, and satisfaction with services received. Emphasis will be on young people who would have immediately used the health facility (client exit interviews).
5. Ethical Clearance
The Consultant is expected to obtain ethical clearance from relevant authorities prior to commencement of data collection. Costs related to the ethical clearance are the responsibility of the Consultant.
It is expected that the Health Facility Assessments will commence in February 2021 for an estimated duration of 30 working days, and conclude by 28th April 2021.
The deliverables are as follows:
- Research Protocol which will be submitted to UNESCO 7 days after the inception meeting. The research protocol will outline in detail, the research questions; methodology; data collection tools, data management and analysis plan, data quality assurance plan, ethical considerations, etc
- Draft report which will be submitted to UNESCO on 9th April 2021. The report will also be presented to UNESCO and key stakeholders by the Consultant, at a virtual validation workshop of which the date will be agreed. The Consultant will facilitate this workshop which will be aimed at discussing preliminary findings and conclusions
- A final report, which incorporates comments from the validation workshops, will be submitted to UNESCO on 28th April 2021. The proposed structure for the report is as follows:
- Executive Summary
- Project description
- Objectives and Research questions
- Recommendations and conclusions
- A PowerPoint presentation summarising the contents of the final report will be submitted to UNESCO on 28th April 2021
8. Required Expertise and Qualifications
- Master’s Degree in any of the following fields: Public Health, Social Sciences, or other related studies; a PhD will be an added advantage
- At least five years’ experience working in the field of adolescents and young people’s Sexual and Reproductive Health and Rights (SRHR) programmes within the country
- Experience conducting participatory, qualitative assessments, supported by at least 3 references
- Experience conducting health facility assessments, supported by at least 2 references within the country or region
- Previous experience working with the UN on similar or related assignments
Lead Research Assistant
- Bachelor’s Degree in any of the following fields: Public Health, Social Sciences, or other related studies; a Master’s Degree will be an added advantage
- Aged between 22 and 30 years
- At least two years’ experience working/volunteering in the field of adolescents and young people’s Sexual and Reproductive Health and Rights (SRHR) programmes
- Experience in conducting participatory, qualitative assessments supported by at least 2 references
- Previous experience working with the UN on similar or related assignments
9. Evaluation of proposals
All interested Consultants are required to submit a Technical and Financial proposal separately via email. The technical proposal should be no more than 10 pages, and will be assessed on the following:
- Approach to assignment that demonstrates extent to which the Consultant understands the requirements as set out in TOR
- Feasible and technically sound methodology
- Realistic work plan with specific treatment of key deliverables and priorities, and distribution of tasks among team members
- Expertise, experience and qualifications of the Team leader
The financial proposal should be no more than 4 pages and should detail the following:
- An appropriate Price Schedule which includes, as a minimum, the consultancy rate per day, and number of workdays per main activity in order to assist the Contracting Unit to determine, which items may be negotiated, if applicable, or which items can be modified as per the budget. All prices shall be quoted in US dollars.
The Consultant will report to UNESCO National Programme Officer under the overall leadership and guidance of the Regional Health Advisor for ESA region.
The Consultant will be responsible for costs related to ethical clearance; overheads and logistical requirements such as office space, administrative and secretarial support, telecommunications, and printing of documentation.
All deliverables will be prepared in English.
11. Submission of proposal
Interested Consultants to submit technical and financial proposals separately via email to [email protected] no later than 27th January 2021.