TERMS OF REFERENCE Turkana Health and Nutrition Project Evaluation and Impact analysis 1. Context The greater Turkana district composed of 6 districts has a total of 17 divisions with an estimated population of about 850,000 people. The local community is primarily nomadic pastoralists who mainly rely on livestock as a source of livelihood. Turkana is one of the arid and semi arid lands of Kenya that is seriously affected by severe drought and associated food insecurity and ill health. Resource related conflicts and insecurity are very common especially along the international borders with Uganda, Sudan and Ethiopia. Depressed and poorly distributed rains in 2010, as a result of La-Nina has led to prolonged dry spells across arid Turkana. This has resulted to increased migration distance in search of water and diminishing pasture is impacting on animal body conditions –which is reduce the market value for animals and the income the pastoralist earn to purchase basic food. The dry spell is leading to increase in food prices which are further compromising the food security for vulnerable Turkana populations. A nutrition survey conducted in Turkana districts in May 2010 put the Global Acute Malnutrition (GAM) at 16%, severe acute malnutrition (SAM) at 2% and moderately severe malnutrition at 16%. Nutrition surveys conducted in May 2009 indicated rates ranging from 20.2% to 28% for GAM and 2.5% to 3.4% for SAM respectively Recently there has been policy shift in that families with children in supplementary and therapeutic feeding programmes are being included in general food distribution. Currently over 300,000 people are dependent on food aid in Turkana districts. 2. Merlin Merlin is a UK humanitarian agency which responds worldwide with vital healthcare and medical relief for vulnerable people caught up in up in natural disasters, conflict, and health systems collapse. Merlin has been working in Kenya since 1998 and is currently operational in two regions of the country - the Western Highlands and Northern Kenya. After responding to a malaria outbreak in Wajir districts in 1998, Merlin has been working Northern Kenya since 2002 initially implementing community water, sanitation, and hygiene promotion programmes and since 2005/2006 has been implementing DFID and ECHO supported emergency health and nutrition interventions in addition to HIV/AIDS prevention and TB prevention and treatment projects. Merlin has also been implementing Global Fund, USAID and AED supported malaria and PEPFAR/CDC funded HIV/AIDS and TB prevention, care, and treatment programs in Nyanza province 3.0. The project The project “Primary Health Care and Nutrition Support for Drought Affected Pastoral Communities” was a continuation of implementation of an emergency health and nutrition programme funded by DFID targeting under five children, pregnant and lactating women who are malnourished or at risk of malnutrition and ill health that ended on the 31st March 2011. The project also incorporated water, sanitation and emergency preparedness and response components. The planned evaluation will asses the coverage and reach of project activities as well as the impact of the interventions. 3.1) Project Details Goal: To improve the health status of vulnerable drought affected pastoralist populations of Turkana districts of Northern Kenya Purpose: To improve access to integrated primary health, nutrition, hygiene promotion and sanitation services and to enhance local emergency preparedness and response capacity for the vulnerable drought affected pastoralist populations of Turkana districts of northern Kenya Expected Results Improved access to integrated facility and community based primary health and nutrition care to vulnerable drought affected populations, particularly children and women. Improved access to sanitation, and hygiene promotion services. Enhanced local emergency preparedness and response capacity. Main Activities 1.1 Effectively screen under-five children and pregnant and lactating women for moderate and severe malnutrition. 1.2. Referral and admission of identified malnourished under-five children and pregnant and lactating women into SFP, OTP and inpatient care 1.3. Vaccination of all under one year children and all women of child bearing age at health facilities and their outreach points 1.4 Conduct training of MOH health workers and other community based workers in the management of malnutrition in collaboration with district health authorities and UNICEF 1.5. Conduct training of MOH health workers in the management of common illnesses 1.6 Distribute Vitamin A, iron and folic acid and conduct de-worming of children and pregnant women. 1.7 Conduct nutrition and hygiene education at facility and outreach points 1.8 Conduct joint monitoring and supervision of project activities with MOH. 1.9. Conduct training of community volunteers on basic primary health care principles including community sensitization, nutrition screening, defaulter tracing and referral 1.10 Conduct nutrition survey at end of project period 1.11 Conduct an external end of programme evaluation. 1.12. Provide Water systems (Tanks) to 10 health facilities 1.13. Construction of latrines in 10 health facilities 1.14. Identify key hygiene promotion messages in collaboration with district health authorities and other partners and design tools. 1.15. Conduct hygiene promotion activities in schools, water points, and communities in coordination with the MOH and other actors on the basis of the key identified Undertake EP&R knowledge, skills and capacity gap analysis of district MOH and District Steering Committees. 1.16. Design and provide EP&R training to district MOH 1.17. Provision of technical support to District Steering Committees to develop district EP&R. 1.18. Provide support to facilitate monthly district EP&R planning and coordination meetings. 1.19 Facilitate quarterly consultation meetings between Health Committees and local MOH health facilities 2.0. Support the MOH and communities for early detection, reporting, investigation and response to disease outbreaks. 2.1 Conduct hygiene Knowledge, Attitudes and Practice (KAP) survey at beginning and end of project period 4. Purpose of the evaluation under this consultancy The primary purpose of this evaluation and is to analyse the results obtained by the project compared to the goal (the overall impact to the people of Turkana) and objectives of the project and draw the key lessons in order to help improve relevance, impact, sustainability, effectiveness and efficiency of the intervention in Turkana. The results of the study will facilitate decision making regarding improvements made in current action and to establish lessons learnt to be shared with partners and health authorities The main components of the programme that is to be evaluated include: Nutrition Health Capacity Building and Mentoring of DHMT, health workers and community structures Supervision and Coordination Activities Hygiene Promotion and Sanitation Water Supply to health facilities Emergency preparedness and outbreak investigation and response 5. Scope of the evaluation The evaluation will cover Merlin’s interventions in Health, Nutrition, Water and Sanitation interventions in addition to emergency preparedness and response interventions in Turkana districts. This study will be based upon Merlin Kenya Country Strategy, MOH guidelines for health and nutrition, Merlin guidelines on the design of programme interventions, the results of previous assessments, reviews and evaluations including comparison with other relevant themes or sectors. The specific project sites within Turkana to be covered during the field phase of this evaluation will be proposed and selected during the planning meetings with the Consultant but a sample of key sites from our current 9 divisions will be selected. The selection criteria will be agreed with the field team. Among other aspects, the evaluation and impact study will focus on the following specific areas: Assess the extent to which the project has contributed to overall improvement of health indicators in Turkana district Assess the extent to which the project interventions have contributed to achievement of objectives and expected outcomes. Determine the extent to which the project conforms to national and district guidelines on health and nutrition and how it relates to the MOH strategies as well as its links with local health and livelihood interventions by other actors. Assess effectiveness of Merlin’s support to outbreak investigations and response in the project area. Evaluate the effectiveness of Merlin’s support to raising the capacity of district health authorities and communities to implement the nutrition programme when trying to reach pastoralist groups and to enhance their ability to respond to humanitarian disaster through the strengthening of epidemic preparedness and surveillance systems. Review the extent to which the project results and approaches are sustainable beyond the project period. Assess effectiveness of approaches adopted by Merlin for implementing the project including integration of the project activities within the existing MOH health system. Assess the impact on communities of Merlin hygiene promotion and sanitation interventions especially in regards to improvement in sanitation practices 6. Responsibilities and lines of communication Merlin’s Programme Cycle Management defines the members of the organisation and external stakeholders that are Accountable, Responsible, Consulted and Informed at each stage of an evaluation. 7. Outcomes Evaluation report with action recommendations completed on Merlin’s Evaluation Report template: 2 hard bound copies and 2 soft copies on CDs. Presentation on findings of the evaluation and recommendations to Merlin Senior Management Team (SMT) in Nairobi and to stakeholders in Lodwar, Turkana. An Action Plan that details activities and timelines to meet evaluation recommendations. 8. Key evaluation questions a. How far has the implementation and delivery of the project activities, especially the choice of beneficiaries and organisational modalities, facilitated the achievement of specific objectives? b. To what extent has the project addressed the health and nutrition needs identified in the target communities as reflected in the May 2010 nutrition Survey? c. What is the level of integration of health and nutrition activities in the MOH facilities in areas of Merlin operation and what lessons can be derived from current implementation approach? d. What is the level of sustainability for the project results? What linkages have been created and or exploited by the project to sustainably address malnutrition and ill health among the target communities? e. What are the costs and effectiveness of implementing the health and nutrition activities in Turkana? Are the project implementation approaches cost effective in relation to practical realities on the ground? f. What lessons have been learnt through the implementation of the project? g. In addition to the evaluation questions above, the following aspects will also be assessed: 9. Output to Purpose review (OPR) A review of the reported and observed outputs of the project against the planned and stated purpose to assess the efficiency and effectiveness with which Merlin has implemented project activities 10. Assessment against OECD-DAC criteria An analysis of the project against the following OECD-DAC evaluation criteria will be necessary: Relevance / Appropriateness Connectedness of interventions Coherence of the project and its components Coverage both in beneficiary numbers, technical aspects and geographically Efficiency of programme operations Effectiveness of our interventions Impact (intended and unintended) Refer to the ALNAP’s guide for humanitarian agencies ‘Evaluating humanitarian action using the OECD-DAC criteria’ 11. Assessment against agreed standards and policies (internal and external) SPHERE guidelines on health and nutrition MOH Nutrition protocols/guidelines Merlin Kenya Country Strategic framework 12. Assessment of cross-cutting themes Participation of primary stakeholders/beneficiaries Beneficiary accountability and feedback Gender equality Protection and child rights People in Aid standards 13. Methodology Merlin and the selected Evaluator shall refine and agree on the tools, techniques and approaches that this evaluation will use but primarily they include the following: Consultative meetings with staff, management and key stakeholders key informant Interviews Focus group Discussions especially with beneficiaries and community stakeholders Documents/literature review Data/Records review and analysis Unless otherwise stated or because of mitigating circumstances (security), the evaluation will be conducted with participation of all relevant stakeholders enabling the evaluation purpose to be communicated in an accessible way assuring the communication of the reporting and follow-up protocol. 14. Report The consultant will report to Merlin Country Director but will work closely with Merlin Country Health Director based in Nairobi as well as the Programme Coordinator and Project Health Coordinator based in Lodwar. The Evaluation will be reported using Merlin’s Evaluation Report format but at the minimum it should include the following sections: Cover page Table of contents List of key terms and acronyms Executive Summary Context Findings Conclusions and Recommendations Annexed ToR Annexed Costs and Effectiveness Analysis data Annexed Recommendation Action Plan Annexed List of People Consulted 15. Follow-up of the evaluation An evaluation results feedback workshop shall be held in Lodwar following submission of the Final Report by the consultant. This feedback will involve district level partners, stakeholders and representatives of target communities. An action plan for implementation of the recommendations shall be agreed and Merlin together with MOH will lead the process for action plan implementation. Lessons learnt shall be integrated in continuation phases of the current programme. 16. Profile of the consultant • Advanced university degree in public health, nutrition, humanitarian assistance or related field • Strong experience in evaluation of nutrition programmes preferably in emergencies. • Strong analytical and report writing skills • Strong interpersonal and communication skills • Knowledge/understanding of the national (Kenya) and local (Turkana) context • Knowledge of DFID regulations/policies (preferable) • Ability to undertake extensive travelling and work with minimum supervision • Ability to withstand harsh climatic conditions and work in areas of varying security levels 17. Time Frame The evaluation exercise will take a maximum total of 20 working days to complete as detailed below: Start date 15th June 2011 Initial Planning and Literature/document review 15th – 16th June 2011 Meetings with relevant stakeholders in Nairobi 17TH June 2011 Travel to Lodwar, Turkana 18th June 2011 Field Planning meeting with Turkana team and MOH 18TH - 21st June 2011 Field evaluation activities 22rd – 28th June 2011 Debriefing to field teams 28th June Return to Nairobi 29th June 2011 Report writing 29th June – 1st July 2011 Submission of draft evaluation report 4th July 2011 Feedback from Merlin on the report by 11th July 2011 Prepare final evaluation report 11th and 12th July 2011 Submission of final evaluation report to Merlin 13th July 2011 Presentation of findings of the evaluation 15th July 2011 The timeframe for travel arrangements are tentative and is subject to revision and change based on mutual agreement following discussions and negotiations between Merlin and the consultant. Key Reference Documents 1. Merlin evaluation Policy 2. ALNAP Guide for evaluation 3. Project Documents (Proposal; Budget; etc) 4. Project Reports (Interim reports; Monthly Statistical reports; Financial Reports) 5. People in Aid standards 6. Humanitarian Accountability Partnership benchmarks 7. Merlin Kenya Country Strategy 8. MOH Nutrition protocols/standards 9. National Health Strategy (MPHS) 10. ALRMP Monthly Bulletins (July08-June2011), Turkana 11. Nutrition Survey 2011 Final report 12. KFSSG Short Rains and Long Rains Assessment Reports (2008, 2009,2010) For further information and application details please email recruitment@merlin-eastafrica.org