Evaluating the Effectiveness of Alternative Community Engagement Strategies in Primary Health Care System of Ethiopia
- Job Description:
- 1. Background about L10K Project
The Last Ten Kilometer (L10K) project—What it Takes to Improve Health Outcomes in Rural Ethiopia—has been implemented by JSI Research & Training Institute, Inc. (JSI) through funding from the Bill & Melinda Gates Foundation since 2007. The project has been striving to improve reproductive, maternal, neonatal, and child health (RMNCH) care behaviors and outcomes in four regions of the country – Amhara, Oromia, Southern Nations, Nationalities and Peoples (SNNP), and Tigray. The first phase of funding (2007-2015) was focused on supporting 115 woredas and their health facilities in the four regions in the implementation of high impact innovative community-based solutions poised to improve RMNCH care practices and outcomes.
Since 2015, the project was designed to address challenges of the post-Millennium Development Goal (MDG) era related to barriers to achieve maternal, newborn and child mortality targets. However, based on the foundations guidance and need to align with the Ethiopia Integrated Health Program (EIHP), the project has been redesigned through a collaborative process involving experts from ministry of health (MoH), regional health bureaus (RHBs) and zonal health departments to address systemic challenges by harnessing the project’s comparative advantage areas including community engagement, quality, equity and information use in October 2017. Accordingly, the project has been providing system strengthening support to address the health system challenges at national, regional and zonal levels. The project systems support focuses on providing support to realize strategies and initiatives that aim to enhance the utilization of valid data to improve RMNCH care practices and outcomes. Designing and testing community-based solutions poised to bridging the gap between the primary health care providers and communities and forging strong community engagement has been the focus of the project throughout its lifetime.
As part of its health system support, L10K in collaboration with regional health bureaus and implementing partners, has been supporting the ministry of health to design alternative community engagement options to address recent setbacks and stagnation in community engagement in health. Currently, preparations to pilot-test the newly designed options are being finalized. L10K seeks to hire a consultant that would work in tandem with MoH and L10K staff in conducting baseline assessment to evaluate the feasibility, acceptability and effectiveness of the new community engagement options.
2. Purpose, Objectives, and Tasks of the consultancy
The Government of Ethiopia (GOE) has employed various community engagement approaches through voluntary community health workers with various titles and scopes of practice for years. However, community engagement in Ethiopia’s PHC system has been pronounced since the beginning of the Health Extension Program (HEP) in 2003, which has been a flagship program of GOE and pivotal in improving health outcomes and meeting MDG-4 of reducing child mortality three years ahead of the schedule, largely through increasing demand for and expanding access to basic curative, preventive and promotive primary health care services. In 2011, the Women Development army (WDA) Strategy was launched to reinforce HEP’s role to engage communities in PHC. Despite the tremendous gains, recent HEP reviews and assessments showed that community engagement through HEP is facing unprecedented challenges in terms of embracing unfolding challenges and sustaining the momentum in the participation of communities in Primary Health Care (PHC) related activities. To address this challenge, the ministry of health has organized an iterative and collaborative process to re-design community engagement options for agrarian settings and sustain the momentum in community engagement.
Currently, there is a plan to pilot test the proposed community engagement options before large scale implementation. To this end, preparations to begin pilot implementation of the interventions have been almost finalized. To assess the feasibility, acceptability and effectiveness of the interventions, and inform the scale-up of the interventions, L10K intends to conduct a baseline assessment in the coming two-month period.
Objective: The main objective of the assignment is to assess the feasibility and effectiveness of the newly designed community engagement options in increasing community engagement and thereby their effectiveness in improving health outcomes targeted by Ethiopian PHC system.
Specifically, the task will evaluate;
Assess feasibility of the interventions
· Explore individual and group (enabling or impending) factors related to the implementation of the interventions
· Determine the extent to which the interventions will be embedded into every day work of individuals, families and communities
· Determine the level of integration of the interventions into community health worker program activities in agrarian settings
· Gauge extent to which people delivering (implementers) or receiving the interventions (clients) consider the interventions to be appropriate in their context
Determine the effectiveness of the options
· Measure effectiveness of the interventions in improving health outcomes
· Compare the effectiveness of interventions of each of the interventions
· Determine the cost effectiveness of the interventions
Task: The consultant will work in collaboration with the L10K project team specifically with the Monitoring, Evaluation, and Research unit throughout the process under the guidance of the experts from the HEP directorate of MOH. The consultant is expected to undertake the following tasks:
· Discuss with the technical team from L10K 2020 project and HEP directorate of MOH to clarify the terms of reference and operations
· Propose a plausible robust evaluation design and discuss with the technical team from L10K 2020 project and HEP directorate of FMOH
· Develop an inception report
· Design a complete research protocol with data collection tools
· Conduct the data collection and produce clean data
· Conduct the data analysis and generate a draft report along with the technical team from the HEP directorate and L10K 2020 project
· Present the preliminary findings of the assessment to the national TWG
· Incorporate comments from relevant experts and produce and submit the final report
3. Scope of work
This assignment will have an office as well as field-level activities including Addis Ababa (MOH), Amhara, Tigray, Oromia, and SNNP regions to get insight or information from Regional Health Bureaus with focus on conducting the feasibility assessment and baseline household survey.
4.Methodology, Time frame, and Application
Taking the complexity of the interventions into consideration, and the nature of the inquiry and implementation process, we propose a developmental evaluation design where evidence will be generated and shared at each phase to inform the next phase of the pilot implementation of the interventions. As such, we propose a phased approach composed of studies with different designs to study the feasibility and effectiveness of the alternative options.
Timeline: The consultant will have three months from the date of signing the contract agreement with L10K. This is an urgent assignment that needs to be delivered with the short latitude of time. The consultant should have time to be fully dedicated to this assignment with no other competing priorities during the assignment period.
Table 1, Key deliverables for the consultancy work and the timeline
Revised tools to assess feasibility of interventions
November 20, 2020
Cleaned data of the research
December 15, 2020
Draft research report
December 31, 2020
Final research report including executive summary
January 15, 2021
Qualification of consultant:
The consultant will be expected to employ a rigorous method to evaluate the feasibility and support in conducting the baseline assessment. As such, a consultant with a track record of conducting similar assignments most specifically with a demonstrated experience on application of robust evaluation designs to evaluate community based interventions and experience in evaluations of the health extension program will be highly preferred. The consultant must have at least master degree in public health, health monitoring and evaluation, and/or other relevant fields. Knowledge of the Ethiopian Health Extension Program and/or the Primary Health Care system may have an added value.
- How To Apply:
- How to apply: Interested applicants fulfilling the above criteria should apply at This Address with application letter( Daily rate should be stated) and CV. Please also indicate the type of consultancy clearly in the subject line of your application.
Deadline for application: November 08, 2020