Consultancy work for the
Assessment of Gender and Other Social-Cultural Barriers to RMNCH Service Utilization
USAID Transform Health in Developing Regions Project
1. Background
Ethiopia has shown remarkable gains in improving access to Reproductive, Maternal, Neonatal and Child Health (RMNCH) services for its citizens in all regions, however, the Developing Regional States (DRS) are currently experiencing low quality and coverage of health services, worsened by underinvestment, gender inequalities, cultural, geographic and environmental factors. These factors, compounded by weak health system, lack of awareness of MNCH/FP services and socio-economic disparities, have challenged Ethiopia’s overall progress in the reduction of maternal and child deaths. Gender inequality is a key challenge in attaining reduction of maternal and child deaths in Ethiopia in general and particularly in the DRS. Gender is a key social construct which impacts all of our interactions, including care seeking behavior, how the health system functions and how men and women experience their health interaction with the health system and their access to health services. Women and girls face a number of sex-specific health challenges including maternal morbidity and mortality. In addition to gender, there are many other factors that prevent men and women; boys and girls from accessing RMNCH services. These factors range from individual attitudinal and behavioral to the wider community level norms, values and stereotype attitudes. The effort to ensure equitable access and increased utilization of RMNCH services in DRS, calls for understanding major gender issues and other socio-cultural, economic and geographical barriers that hinder women and men; boys and girls from utilizing available RMNCH/FP services thus, the need to conduct this assessment.
USAID Transform Health in Developing Regions (USAID Transform HDR) project is a USAID-funded five-year cooperative agreement aimed at reducing mortality and morbidity among mothers and under-five children in the Developing Regional States (DRS): Afar, Benishangul-Gumuz, Gambella and Somali Regions. This will be accomplished through increasing access to integrated quality high impact maternal, newborn, child health (MNCH) and family planning (FP) services, improving health seeking behaviors enhanced by reducing gender inequalities, improving evidence-based decision making, program learning; and with the overall goal of strengthening Developing Regional States (DRS) health systems. The project is implemented by a consortium of organizations (Amref Health Africa (the prime), with IntraHealth International, Project HOPE and General Electric (implementing partners). The project will build on existing government structures such as the Federal Ministry of Health (FMOH), Regional Health Bureaus (RHB) and Woreda Health Offices (WrHOs) and will prioritize Woredas with the lowest level of MNCH/FP indicators to implement a phased approach in scaling up high-impact MNCH/FP interventions.
USAID Transform HDR consortium members are committed to addressing barriers to RMNCH/FP service utilization and understanding gender and other socio-cultural, financial and geographic barriers that can negatively affect women and men in the DRS. To this effect, USAID Transform HDR will assess gender and other socio-cultural barriers to RMNCH service utilization in the DRS to understand how the roles of men and women in society and power relation affect access and utilization of health services; how other socio-cultural determinants are in play in the utilization of the services and how the project’s work may impact men and women differently. The assessment will also focus on exploring how Gender as a social determinant of health interrelates with other socio-cultural barriers to affect decisions to utilize RMNCH services. The analysis of findings will help to better understanding on the existing gender equality and equity gaps and develop sound strategies and benchmarks that will guide the consortium to develop gender transformative strategy, health communication strategy and use the findings for trainings, communication, and policy interventions.2. Objectives of the Assessment
· To explore gender issues and other socio-cultural barriers and facilitators that influence RMNCH/FP service utilization, health outcomes and health seeking behavior among women and men; boys and girls at the community and health facility level in DRS (Afar, Benshangul, Gumz, Gambela and Somali Regional States)
· To guide the development of evidence based, responsive, integrated and sound gender transformative and health communication strategies
· To guide USAID, Transform HDR facility and community-based programming to best meet the needs of both women and men, girls and boys to address barriers to RMNCH/FP service utilization and contributes to improved gender equality in the four DRS
· To identify areas for further in-depth exploration to improve gender equality and addressing other socio-cultural barriers to RMNCH/FP service utilization in the four DRS
3. Responsibilities and Tasks of the Consultant/Consulting Firm· Develop draft assessment protocol and data collection instruments/tools, consistent with the National/ regional IRB guidelines and the lead partners standards, make necessary revision to the protocol and instruments addressing internal and external (IRB) comments
· In consultation with the in-country and HQ project technical experts, design appropriate study methodology to uncover the gender and other socio-cultural barriers and facilitators for RMNCH services utilization;
· Discuss and have common understanding with the technical lead and advisors to finalize sample size, site selection and identify relevant stakeholders that will be included in the assessment
· Coordinate with the USAID Transform HDR technical lead in completing the ethical clearance process with Regional Health Bureaus or at the national level with EPHI as appropriate;
· In consultation with the USAID Transform HDR technical lead communicate with Regional/district health offices, selected public health facilities, managers, health care providers, clients and other relevant stakeholders to organize and schedule for interview, FGD, and KII;
· Develop list of key informants and FGDs for each region;
· Conduct desk review of relevant reports, publications, health communication materials, project materials (M&E frameworks, indicators, activity plan, progress reports, evaluation and other relevant documents) and studies including government legislation/polices, implementation guideline, health facility standards, supervision tools, region specific studies, project evaluations specific to gender including Transform PHC gender assessment and other social-cultural barriers and facilitators to health service utilization;
· Regularly meet with the gender and health communications advisors (Technical leads) and other relevant project team members to report on implementation, as well as for quality control of data and data analysis
· Present the study design, methodology, analysis plan and the timeframe to USAID Transform HDR team;
· Recruit the local assessment team, including data collectors and data entry personnel from Afar, Somali, Gambella and Benishangul-Gumuz;
· Train data collectors in research ethics and qualitative methods (in-depth interviews, focus group discussion moderation and note-taking as well as gender sensitive observations);
· Manage the pre-test of tools and revision of tools (directly after or attached to the data collection training);
· Coordinate data collection, transcriptions, coding, organizing themes and analysis;
· Travel to each region to ensure quality of data collection and supervise the field data collection;
· Orient data entry personnel on gender sensitive and qualitative and quantitative data analysis requirements;
· Coordinate and align translation and back translation of data collection tools and transcripts to/from local languages to English to assure comparability of data collection and development of transcripts;
· Create full transcripts for focus group discussions (and other qualitative tools, as needed) in English;
· Develop the field data collection strategy/tools and monitor an implementation plan; Analyze all data including developing codebooks, analyze qualitative data, run frequencies;
· In consultation with the project technical team interpret data, findings and conclusions for each study regions;
· Draft assessment report with 1) description of methods and data collection strategy 2) findings/conclusions 3/ recommendations based on the evidence from the assessment); and produce key graphics;
· Provide practical recommendations for tackling gender inequality and other socio-cultural barriers that men and women face accessing health services specifically RMNCH/FP services;
· Share draft report with project team and incorporate feedback and comments to develop revised and final reports; and present assessment findings to the USAID and Transform Technical Team, as appropriate (e.g., PowerPoint presentations, handouts), and submit the revised final assessment report to the organization.
4. Methodology and Available Resource Materials
As gender and other barriers for RMNCH service utilization include socio cultural practices, participatory and multiple methods are required for the assessment and for a better understanding of the root causes of gender inequality and socio-cultural factors in the DRS. Both primary and secondary data sources and qualitative approaches will be used to conduct the analysis. Data collection will be carried out in the selected woredas with in the four DRS. See Annex 1: Transform HDR target woredas. The technical methodologies that will be used to conduct the assessment and analysis are presented in the sub-sections below:
Secondary documents will comprise an important part of the information needed for the assessment that will be obtained from USAID Transform HDR office, (the consortium), government and relevant stakeholders at national and DRS. Relevant documents will be collected and reviewed including, but not limited to, the following:
· USAID Transform HDR project documents, progress reports, M&E framework, activity plan, performance indicators;· Relevant policies, legislations, implementation guideline, facility standards, supervision tools, checklists etc. and; other related researches, published studies, assessments, baseline surveys on gender and barriers to RMNCH service utilization in Ethiopia and particularly in the four DRS.
The review of secondary sources of information will help to triangulate the analysis and findings of the assessment.
b) Primary data source
The purpose of primary data collection in the assessment process is to obtain in-depth qualitative information to identify key gender issues and other socio-cultural barriers that affect the ways in which the unequal roles and opportunities in men, boys, women and girls lives impact RMNCH outcomes in the four DRS. The data collection tools will be In-depth Interviews, Observation, Key Informant Interview (KII) and Focus Group Discussions (FGDs). The assessment also includes the views of key stakeholders in the DRS.
The selection of informants and project sites should be purposive sampling in order to maximize relevant data collection within the limited time frame.
5. Deliverables and Reports
The main deliverables of the study include:
· Study protocol with data collection instruments in English language both in electronic and hard copies with in two weeks from the date agreement signed
· First draft, revised draft and final assessment report with key findings and recommendations,
including identifying existing areas that warrant further exploration to prioritize key determinants of behaviors, barriers and facilitators/enablers of change, (first draft report within two months of IRB approval)
· Conceptual framework depicting how Gender and other socio-cultural barriers affect service utilization;
· Power point presentation and handouts on major findings and recommendations;
· All raw data sources, transcripts and other relevant documents used in the assessment;
· Data collectors training report with participants contact information; and action plan to guide implementation of assessment findings.
6. Location
The consultant will be based in Addis Ababa, Ethiopia.
7. Travel
The consultant(s)/consulting firm is expected to travel to the selected woredas in the four developing regions: Afar, Ethiopia Somali, Gambella, and Benishangul Gumuz. Transportation from Addis Ababa to the regions will be provided by the project.
8. Period of Performance
Approximately from May 14th to July 31st, 2018
9. Deadline for application: May 7, 2018
Annex 1: USAID Transform HDR target woredas
Region | Zone | Woreda |
Afar | One | Mille |
Afar | One | Elidear |
Afar | One | Chifra |
Afar | Two | Erebti |
Afar | One | Adear |
Afar | Four | Golina |
Afar | Four | Teru |
Benishangul Gumuz | Asossa | Assosa Woreda |
Benishangul Gumuz | Asossa | Bambasi Woreda |
Benishangul Gumuz | Metekel | Dangur Woreda |
Benishangul Gumuz | Metekel | Dibate Woreda |
Benishangul Gumuz | Kamashe | Kamishe Woreda |
Ethiopia Somali | Jarar | Aware |
Ethiopia Somali | Fafan | Awbare |
Ethiopia Somali | Sitti | Aysha |
Ethiopia Somali | Korehey | Marsin |
Ethiopia Somali | Jarar | Dagah Bur |
Ethiopia Somali | Shabele | Danan |
Ethiopia Somali | Jarar | Daroor |
Ethiopia Somali | Erer | Fik |
Ethiopia Somali | Jarar | Gashamo |
Ethiopia Somali | Erer | Hamaro |
Ethiopia Somali | Fafan | Harshin |
Ethiopia Somali | Korehey | Kebridahar |
Ethiopia Somali | Erer | Salahad |
Ethiopia Somali | Fafan | Tulli Guled |
Gambella | Nuwer | Lare Woreda |
Gambella | Agnewak | Gambela Town Woreda |
Gambella | Mejenger | Godere Woreda |
Gambella | Nuwer | Jikawo Woreda |
Gambella | Etang Special | Etang Specal Woreda |
Gambella | Angewak | Gog Woreda |
Afar | Two | Dallol |
Afar | Two | Berhale |
Afar | Five | Dewe |
Afar | One | Dubti |
Afar | Two | Koneba |
Afar | Five | Telalak |
Afar | Four | Ewa |
Afar | Two | Megalle |
Benishangul Gumuz | Kamashe | Belo Jegenfoy Woreda |
Benishangul Gumuz | Metekel | Bulen Woreda |
Benishangul Gumuz | Metekel | Mandura Woreda |
Benishangul Gumuz | Mao Komo Special Woreda | Mao Komo Special Woreda |
Benishangul Gumuz | Metekel | Wenbera Woreda |
Ethiopia Somali | Fafan | Babile |
Ethiopia Somali | Jarar | Dagah Bur City |
Ethiopia Somali | Sitti | Dambal |
Ethiopia Somali | Dollo | Danot |
Ethiopia Somali | Korehey | Dobowayn |
Ethiopia Somali | Nogob | Duhun |
Ethiopia Somali | Sitti | Hadigale |
Ethiopia Somali | Fafan | Jigjiga City |
Ethiopia Somali | Shabele | Kelafo |
Ethiopia Somali | Sitti | Meiso |
Ethiopia Somali | Korehey | Shilaabo |
Ethiopia Somali | Dollo | Warder |
Ethiopia Somali | Sitti | Erer |
1. Qualifications and Composition
Required Qualifications
Individual consultant/team of consultants or consulting firm should fulfill the following requirements:
· Masters’ degree in Gender Studies, Sociology, Public Health, Cultural Anthropology or other relevant fields with experience in data collection (qualitative) in the health sectors;
· Up to date professional consulting license;
· Demonstrated experience and knowledge of gender theory, gender analysis frameworks and gender equality issues in Ethiopia and gender issues in the DRS;
· Demonstrated experience and knowledge of health communication theories and behavioral studies;
· Familiarity with research sampling and qualitative data analysis;
· Knowledge of local languages is an advantage;
· Excellent report writing skills;
· Experience and good track record in conducting gender assessments, gender analysis, socio-cultural and behavioral studies;
· Excellent qualitative data analysis (Nvivo or Dedoose) skills;
· Excellent English communication skills (writing and presenting); and with application, must submit the assessment report in English written by lead Research Consultant and; two recommendations from similar previous studies.
2. Proposal submission
While applying to this task, the consultant(s)/ consulting firm is requested to submit a full technical and financial proposal in a sealed envelope to the address below:
a) Technical proposal describes clearly:
· Methodology/ approach; including a plan to coordinate data collection and translation/back translation from local languages to English languages, the proposed gender analysis framework to be used and the data quality checking mechanisms
· Proposed technology solution
b) Detail work plan and timeline
· Cost estimation
· Detail estimated cost based on work plan
c) Human resources
· List of required team members and their expertise and/or organization expertise;
· Consultant’s CV and separate relevant experience/testimonials in developing regional states
d) Plan of human resource allocation for this task (based on detail work plan).
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