TOR FOR THE CONSULTANCY WORK TO UNDERTAKE RAPID ASSESSMENT TO IDENTIFY GAPS IN PLANNING, DELIVERING, TRACKING, REPORTING AND REVIEWING VAS ROUTINE HEP& CHD, AND TO REVISE EXISTING PERFORMANCE REVIEW GUIDE, PLANNING & TRACKING TOOLS AND JOB AIDS.
Background
Vitamin A Deficiency (VAD) is a severe public health problem in Ethiopia affecting 61% of under five children and leads to 150-200,000 deaths per year which represents 17% of all child deaths. A national study conducted in Ethiopia indicated that the prevalence rates of 1.7% for Bitot's spot and 0.8% for night-blindness among children, and 1.8% for night-blindness among mothers (EHNRI, 2005).
The Ethiopian government acknowledges that addressing VAD among children 6-59 months contributes for the overall child growth, development and survival. The government is currently delivering yearly two-dose Vitamin A supplementation (VAS) to children 6-59 months through three delivery mechanisms: as enhanced outreach strategy (EOS) , Community Health Day (CHD), and routine Health Extension Package (HEP). These delivery mechanisms are determined based on the strength of the existing health system at grass root level. Child screening for acute malnutrition and de-worming are also delivered along with VAS in all the three delivery mechanisms.
The Federal and Regional Ministries of Health accepts the VAS delivery through HEP as a sustainable and cost effective service delivery mechanism compared to the vertical, campaign based approach (EOS and CHD). Accordingly, with the MI’s financial and technical support, transition of VAS from EOS and CHD to an integrated routine delivery of VAS – HEP has been achieved in all sub cities of Addis Ababa, Dire Dawa and Harari City Administrations and in selected 358woredas in Amhara, Oromia, SNNP and Tigray regions. However, as summarized during a review by the MI in April 2015, still there are several gaps which are highly affecting quality and coverage of the service. These gaps include:
The above mentioned gaps were observations made during an assessment done by MI headquarters, regional and country team staff in April 2015 and a generalized to all woredas. The sites visited were varied but limited for the sake of getting a general sense of the barriers to high coverage and plan a way forward. The MI would now like to hire a consultant to build upon these findings, identify root causes where more in depth analysis is needed and to extend the assessment of the HEP to additional areas not previously visited so that urban areas, additional wored as in Agrarian regions are covered, as well as more woredas with high and low coverage. The assessment will then inform proposed revisions to the HEP section of the VAS implementation guidelines, which include among other sections detailed guidelines for supervision and review meetings, planning, tracking and service provision.
In addition to strengthening and improving the quality of VAS delivery through HEP, MI and UNICEF are supporting the 343 woredas delivering VAS through CHD, and jointly supporting 20 woredas to transition from EOS to CHD in the pastoralist regions. Despite the success of CHDs in many woredas, a joint supportive supervision conducted in SNNP and Oromia regions revealed that implementation gaps like poor data management like recording and reporting, not analyzing data locally for action, very low VAS coverage in some woredas (20 to 30% gap between administrative report and UNICEF validation survey), in adequate community mobilization delineate, and poor post event review meeting and poor monitoring to reach all target children.
Similar to the HEP, the consultant will do a rapid assessment in low performing Agrarian woredas implementing CHD, and in pastoralist region transited from EOS to CHD (Ben/Gumuz region is piloting the transition in 3 woredas)to generate evidence and propose revisions to the guideline for transitioning from EOS to CHDs and improve quality of the existing CHD planning, tracking, performance review, supportive supervision and service provision. The assessment will then inform proposed revisions to the CHD section of the VAS implementation guidelines.
Objective of the consultancy
Theprimary objective is to improve the quality and effectiveness of the planning, delivering, reviewing, tracking and reporting of the VAS services provided through the routine HEP and CHD.
Specific objectives include
1. To further identify and assess the root cause of the gaps associated with VAS routine HEP and CHD, by examining the current practices and tools for:
2. Using the evidence generated, to propose remedial actions and revisions to:
Scope of Activities
Activity 1: Review MI and GAVA partners’ gaps and bottlenecks analysis findings regarding VAS routine HEP planning, delivery, tracking, review, and reporting trends, practices and tools / guides/job aids at federal, regional, zone, woreda, health center and HEWs level, as well as supervision reports of the VAS CHDs,and carry out participatory rapid assessment/inquiry in additional areas to broaden the geographic scope of the study and identify related root causes and determining factors.
Activity 2. Revise existing tools, guidelines and job aids
Activity 3. Facilitate a three-day advocacy and consultation workshop that will be organized by MI
Activity 4. Prepare a print ready revised tools, HEP and CHD implementation guideline and job aid as appropriate
Deliverables
NB: All the deliverables will be submitted to MI-VAS Senior Program Officer in Soft Copies
Indicative Time table
Qualification and Requirement