TERMS OF REFERENCE: OUTCOME
MAPPING EXERCISE
TDH-NL
FUNDED PROJECT: ACCESS TO PRIMARY HEALTH CARE FOR PREGNANT AND LACTATING
MOTHERS AND CHILDREN UNDER FIVE IN MARA REGION
1STMAY
2012 – 31ST DEC 2015
Project Title:
Access to primary health care for pregnant and lactating mothers and children
under five
Project No. Partner
1: TZ 018, TZ 035 & TZ 051
Partner 2: TZ 050
Partner 3: TZ
056Project
Implementation Dates
TZ 018 & TZ 035: 1st of January 2013 – 31st of
December 2015
TZ 050: 1st
of May 2012 – 30th of June 2015
TZ 051: 1st
of July 2013 – 30th of June 2016
TZ 056: 1st
of January 2014 – 31st of December 2015
Location Mara Region
Assignment Type:
Outcome mapping of health programmes Mara Region
Outcome mapping
Purpose
- Mapping
of outcomes achieved by the health programme in the period 2013-2015. - Compare
the outcomes of the health programme with the 2011/2012 baseline data
(where available). - Highlight
most significant changes and best practice strategies used in the health
programme. Proposed Dates for the assignment 15th of July – 31st of
AugustAnticipated Report Release Date 31st of August
Introduction
Terre des Hommes
Netherlands (Earth for Mankind) is a Dutch organization based in The Hague,
founded in 1965 as a non-profit organization. Terre des Hommes Netherlands aims
to improve the quality of life of children in difficult circumstances all over
the world, regardless of race, faith and/or political orientation and to have
their rights, as laid down in the UN Convention of the Rights of the Child,
protected and assured.
In East Africa,
Terre des Hommes Netherlands (TDH-NL EA) is active in Ethiopia, Kenya, Tanzania
and Uganda. Our focus is to prevent child exploitation, remove children from
exploitative situations and ensures these children can develop themselves in a
safe environment. Direct aid through civil society partners is our core
business; we have many years of experience and a large network in this field.
We also focus on capacity building and advocacy / lobbying, centered on the
most vulnerable children in their immediate environment.
In Tanzania, TDH-NL
EA supports Tanzanian NGOs/FBO/CBO and networks in the execution of projects
which aim to prevent child exploitation, provide assistance to exploited
children and influence policy. TdH-NL EA programming in Tanzania is implemented
Mwanza, Mara, Mtwara and Shinyanga Regions. This is underpinned by work at national
level and supported by TdH staff and partners based in Dar es Salaam.
Background
As part of the MFS
II funded Child and Development Alliance programme running from 2011-2015, a
Health programme for Mothers and Children under five has been implemented from
01/01/2013 till 31/12/2015 covering four districts of Mara region. The
districts are Musoma Municipal Council, Musoma District Council, Rorya and
Bunda Districts. The health programme was implemented by three partner
organisations.
Gaps
identified in maternal health care in Mara region
The child mortality
rates are high in the Lake Zone as 105 children/1000 live births (TDHS 2010)
die before the age of 5 due to poor maternal health, malaria and diarrheal
diseases. The HIV/Aids prevalence rate on the shores of Lake Victoria stands at
7.7% and is higher among women (8.6%) then men (6.6%), compared with 5.7% at
national level, with little knowledge on mother to child transmission. Mother
and child nutritional status in Mara indicate that 79% of children under 5 and
60% of women are anaemic. In Mara 31 % of children is stunted (2010) and 12%
underweight (TDHS 2010). Some significant differences with other areas are the
cultural habit of pre-lacteal feeding (giving water/porridge before the start
of breastfeeding), vitamin A consumption is sufficient for 46.5% only, leading
to night blindness by 5.9 % of pregnant women and is a cause of disability at
birth. Only 61.6 % is fully vaccinated (DPT3 and polio 76%). The fertility rate
in Mara stands at 6.7 among the highest in Tanzania, reducing from 7.3 (women
40-45 years). Maternal mortality rates are high in Tanzania.
The national average
population per trained nurse, nursing officer, and nurse midwife was 3000
persons in Tanzania. In Mara region the average population per trained nurse,
nursing officer, and nurse midwife for the Mara region was 4000 persons per
nurse. In Tanzania 95.9% of the women received antenatal care from a skilled
provider for the most recent birth; 35.4% received a postnatal check-up for the
last live birth (2010). In Mara region 88.2% received antenatal care from a
skilled provider for the most recent birth; 19.1% received a postnatal check-up
for the last live birth (2010). In Tanzania 50.2% of live births in the five
years preceding the TDHS 2010 were delivered in a health facility and 50.6% of
the live births were assisted by a skilled provider (2010). In Mara region:
33.3% of live births were delivered in a health facility and 30.45% of the live
births were assisted by a skilled provider (2010), because of which the risk of
HIV transmission increases, disability and death.
Women in Mara Region
attend antenatal clinics at a very late stage (8th month) or not at all (12%).
Because of its environmental setting (Lake region, heavy rain seasons), Musoma
Rural and Rorya districts suffer from malaria mortality rates twice the
national average. Malaria is causing the majority of child deaths in Mara and
high levels of anaemia. Because children with malaria are brought late to the
health centres, they often already suffer severe malaria and the treatment is
expensive, complicated or too late and they die.
The government
contributes 10% of the national budget to health services throughout the
country. This is supposed to include free ANC services and primary health care
for pregnant mothers and children under five. But most government health
facilities have a shortage of supplies, hence most people, including vulnerable
groups do end up paying for services and treatment, affecting the poor in their
health seeking behaviour
The Overall
Programme Objective:
● To improve
(reproductive) health services for (future) mothers and children under five
including adolescents at risk.
Specific
Programme Objectives:
● improve access to
health services and increase its use in rural areas
● improve and
provide comprehensive, family-centred care and treatment services for women and
children in remote areas
● Prevent diseases
and disability by providing health information to increase knowledge and
healthy behaviour
● increase
government involvement in health service provision
Program
Implementation Modality
The program has been
implemented in collaboration with three local partner organisations, who
received grants and technical assistance from Terre des Hommes Netherlands to
deliver community health services to mothers and children under five. They
conducted five programs.
The boundary
partners involved in the Mara Health Programme:
- Government
of Tanzania; Mara Regional Hospital (Musoma), government health centres
and dispensaries, Community Health workers - Community
Health Committees, Traditional Birth Attendants, local leaders, - Pregnant
and lactating mother and children under five - Consultants,
health specialists.
The programs all
focus on (a variety of) topics for example nutrition, HIV/Aids, Malaria, PMTCT,
disability and antenatal care. They are not all active in the same districts,
but some areas overlap. They all have in common that they work in remote areas,
making a difference for mothers and children who before had little access to
quality service and knowledge on how to prevent and seek treatment for life
threatening diseases. In all projects there is a strong community component,
training community health workers and committees and working with support
groups, expert mothers and women’s groups to be able to reach people and
increase sustainability. For more information on the specifics of each program
see Annex 1.
Outcomes to
be documented on
Partner
Data
availableProgress
monitoring reports and field visit reports
Gaps/
Questions to be addressedWhat
is the quality of the services they deliver? Limited information on how they
cooperate.
Children (esp. under
five)
Data
availableNumber
of children receiving care/ treatment and training Is there an improved health
status of children under five?
Gaps/
Questions to be addressedDo
they receive treatment in an earlier stage of their disease? What are the
changes in behavior on hygiene (washing hands, toilet use, malaria prevention).
What is the level of knowledge on, and are there changes in, HIV transmission?
Parents
Data
availableNumber
of (pregnant) mother and fathers receiving training and education.
Gaps/
Questions to be addressedChange
in attitude towards early health seeking behaviour and successful methods being
used by partners to stimulate this behaviour.Knowledge level on healthy
behaviour family planning, hygiene, malaria prevention and use of nets, Hiv
transmission, care for disabled child? Changes in behaviour of parents in
prevention and provision of care to (disabled) child.
Community
Data
availableNumber
of groups created and trained (expert mothers, women groups, village health
committee). Number of events, home visits,
Gaps/
Questions to be addressedHow
do the members of different groups cooperate and influence local government and
how are they perceived by and cooperate with village members. How sustainable
are the different created groups within the community and how are they of
support to the overall community. How effective are they in supporting women
and children and, what kind of changes have they inspired in them?
Health care workers
Data
availableNumber
of people trained (TBA, Nurses, Community health workers, and others who
attended trainings
Gaps/
Questions to be addressedWhat
changes are seen in their approach, knowledge level, and expertise in providing
(preventive) health care, differentiated by type of health worker) The results
of the training and attendees; how are the knowledge and tools presented during
the training, being used in day to day health activities/work? What are
behaviour changes of the trainees?
Health services
Data
availableImprovements
in record keeping in clinics/hospitals. Mobile clinics. equipment available.
Overall information on current health care provided and statistics.
Gaps/
Questions to be addressedData
on changes in care provided by mobile clinics and hospitals, analyses of the
increase/decrease in number of patients and referral. Specifically numbers on
possible reduced child mortality and reduced incidences of maternal mortality
among patients in hospital, reduction in birth complications or early detection
of birth complications.
Government
Data
availableNumber
of events and training’s joined by government officials and people contacted. Gaps/ Questions to be
addressedHow does the government perceive the programme
partners and TdH NL, (in which way) do they perceive the programme partners are
representing the target group? Which contributions have they actually made to
improved quality of health care in Mara region. (How) Are they implementing new
programs and lobbying/advocating for changes/improvement?
Purpose of
the assignment
The purpose of this
outcome mapping exercise is to collect information on outcome results achieved
and to compare this with the 2011 baseline information as documented in the
Ecorys 2011 MDG report and previously known statistical data and paying
particular attention to the outcomes and impacts of the specific projects
actions. Additionally the final report will highlight best practices and ‘most
significant change’ as a result of the health programme, mostly implemented in
the period 2013-2015.
Objective of the
Assignment:
The overall
objective of the outcome mapping is to document the outcomes of the ‘access to
primary health care for pregnant and lactating mothers and children under
five’.
Specific
objectives of the Assignment:
The outcome mapping
aims to accomplish the following:
- Document
improvement of health services on grass root level, delivered to
communities in rural and remote areas and its effect on the health of the
community. Specific outcomes for mothers and children resulting from the
health programme (with clear attribution). Documented behaviour change and
improved skills among health workers: like TBA, CHW, health officials,
staff in health centres etc. - To what
extend did the programme influence the access to health care in Mara
Region? How did the situation improve? Which positive/negative outcomes
can be attributed to the programme? - What
are the behaviour changes observed within the communities in accessing
health care and practising hygiene and prevention (of malaria, PMTCT,
early health seeking behaviour, pregnancy care/ANC)? Which
positive/negative outcomes can be attributed to the programme? - What
was the involvement of local, regional and national government in the
program. How were they being involved and what was the result? What did
they commit to? What are their priorities and how do they reflect on the
Terre des Hommes Netherlands sponsored program. - What
has been the overall outcome level effect of the health programme in Mara
Region?
Scope
of the Assignment
In the outcome
mapping and final assessment the following will be taken into consideration;
- Collection
of substantial and good quality outcome data according to the project
results planned and including the C&D alliance indicators for outcome
and proxi indicators as mentioned in the Ecorys MDG Report 2011. - Outcome
mapping involves at least 25% of all beneficiaries and 25% of each type of
boundary partners reached by the projects against the indicators. - Clear
analyses, presentation and assessment of the outcome mapping data
including conclusions towards the overall performance, benefits
sustainability and financial sustainability. What were the major factors
which influenced the achievement or non-achievement of outcomes of the
project?
Methodology
To sufficiently
address the key questions raised above, the outcome mapping will need to adopt
methodologies and tools that combine both qualitative and quantitative
techniques. The consultant is expected to propose his/her methodology, which
should include but is not limited to:
● Consultation with
Country Manager, programme teams and partner and project team on methods and
techniques and to finalize methodology before execution of field activities.
● Regular
consultation with the Project Partners, as well as government health service
providers, stakeholders and government officials
● Review project
documents, reports and case studies developed by the project.
● Develop variables
for surveys and interview guides for Focused Group Discussions (FGDs) and Key
Informant Interviews (KIIs).
● Conduct FGDs and
KIIs with TDH team, partners, stakeholders and beneficiaries (Mothers,
community members, health staff, government officials)
● Conduct data
analysis (quantitative and qualitative) and, where possible, trend analyses
● Prepare draft
report as per guidelines
● Presentation of
findings and recommendations at stakeholder meetings
● Incorporate
feedback and presentation of final report
Reporting
The consultant(s)
will produce a report of no more than 40 pages plus appendices, in Microsoft
Word using Palatino font 10 (minimum spacing). It will include:
● Title page
● Table of Contents
● Acronyms
● Acknowledgments
● Executive Summary
● Background and
Project Description
● Purpose of the
assignment
● Scope of the
assignment
● Methodology
● Findings –
Including all relevant issues stated under specific objectives of the
assignment and gaps identified (20 pages)
● Analyses of data
(5 pages)
● Best practice
strategies in improving access and quality of education (3 pages)
● References
Annexes:
● Outcome mapping
Tools
● TOR
● Other relevant
documents (List of people interviewed, List of documents reviewed etc)
Time
Frame
The study shall
commence from 15th of July and completed by 31st of August 2015. A draft
schedule is given below, which can be refined after consultation with
consultant.
Activity,No of days
Specific Dates Meeting with partners and identify data collectors, organize
dates for field work (1) Review of project documents (2) Design of data
collection tools (2) Induction of field data collectors (1) Data collection (to
include children, parents, health care workers, clinics, government
stakeholders KII etc) (8) Data entry/Coding (2) Data analysis and report
writing (draft) (3) Incorporating feedback and finalize report 2 Grand Total 21
days
Team
The team for this
assignment will comprise of the consultant who will have overall responsibility
of designing, implementing and coordinating the entire outcome mapping process
guided by the TOR. The skills and expertise are as outlined below:
Qualifications/experiences
required
● At least a
post-graduate degree in Social sciences and Public Health
● Experience with
health projects (projects addressing health concerns) in Tanzania
● Proven experience
in conducting outcome mapping (preferably with multiple partners), using a
variety of techniques including interview and skills to facilitate Focus Group
Discussions.
● Experience in
working with NGOs, CBOs and beneficiary communities
● Excellent
communication skills in written and spoken English
● Good report
writing skills (concise and clear reporting, good presentation of data and
sources of information)
● Strong analytical
skills.
● Ability to devote
enough time to this assignment and meet deadlines.
● Willingness to
travel and flexibility to manage changing circumstances.
● Good working
knowledge of Kiswahili.
● The Consultant may
seek support from an Assistant and some data collectors.
Deliverables
and tasks
The key tasks are:
● Submits a letter/
proposal of interest, outlining how the areas outlined in the ToR will be
addressed
● Signing the
agreements for this assignment
● Reviews all
relevant documents
● Shares the tools
with partner and TdH-NL and amend as per feedback and update for final approved
version.
● Visits field and
collects information as per defined methodology and approved formats.
● Submit Draft
outcome mapping report outlining general findings and analyses of best practice
strategies for feedback to TdH-NL and Partners
● Present key
findings with PowerPoint during a stakeholder meeting.
● Incorporate
feedback and Submit final report
The key deliverables
are:
● Proposal of
interest
● Drafts tools for
information collection as per project documents
● Field visit notes
and raw data
● Draft report on
outcome mapping
● Power point presentations
of key findings of the outcome mapping
● Final report, one
original signed hard-bound copy and in Electronic copy (that includes all
photos of the outcome mapping exercise)
Management
The consultant will
formally report to partners for day to day support. Facilitation and field
support will be provided by the project partners in Tanzania, this includes
setting up interviews, meetings and FGDs and informing relevant stakeholders.
Partners and TdH-NL will provide documentation related to the project.
Expression
of Interest
Interested
consultants should send the information listed below to TdH-NL
- Assignment
bid (4 pages max) outlining:
a. how you meet the
qualifications, skills and experience required (see Section 8 above)
b. outline of
proposed methodology
c. suggested
timetable of activities
d. a description of
the fee schedule, including a schedule of person-days
- Latest
curriculum vitae (of consultant and any supporting team members) Sample
report of outcome mapping conducted contact names of organization
submitted to.
Proposals should be
send to Tanzania Office: s.koet@tdh.nl with copy to a.groot@tdh.nl
