Evaluation of the project “Saving Maternal and Newborn lives in Refugee Situations” in Cameroon, Chad and Niger 534 views6 applications

In January 2016 UNHCR started to implement a two-year project ‘Saving Newborn Lives in Refugee Settings’, aiming to improve neonatal care services with a focus on low cost, high impact newborn interventions in refugee camps in South Sudan, Kenya and Jordan. The project received support from the Bill & Melinda Gates Foundation. An evaluation was carried out in 2018, covering the period 1 January 2016 to 31 October 2017. Prior to this evaluation, positive effects had already been reported from the health providers, partners and MoH authorities as well as from UNHCR teams in the field who indicated that the project significantly contributed towards improving the quality and availability of health care services to mothers and newborns in the refugee settlements. UNHCR proceeded at an early stage with a request for the expansion of the project to three further countries hosting refugees and adding maternal health and family planning to the newborn approach. The project expansion was approved and received additional support from the Bill & Melinda Gates Foundation.

Building on the original ‘Saving Newborn Lives in Refugee Settings’ project, the expansion of the project in 2018-2019 to Cameroon, Chad and Niger aimed to benefit from the consolidation of learnings and practice and an extension of action to address targeted maternal, newborn and contraception/family planning care interventions known to save maternal and newborn lives. The implementation of the expanded project ends 31 December 2019.

With the end of project evaluation UNHCR aims to assess achievements, enhance learning and to help identify contextual and organizational factors that may have had a particular enabling role in the project development and those that may have slowed progress. Further, the evaluation is meant to investigate the sustainability of the achievements in the current configuration of actors and funding and identify the essential support necessary to maintain achievement, potentially expand coverage and/or to complement any element identified as missing or insufficient. Finally, the evaluation will include some costing analysis of the key components of the project per country.

1. Subject of the evaluation and its context

UNHCR aims to ensure that all refugees can exercise their rights to access essential public health services at the community, primary and secondary health care level.

The different settings of UNHCR’s operations pose challenges due to the wide variety of health care systems, financing of health care and disease patterns and burdens, between regions, countries and even sub-regions within a country. Security and access to refugee populations can present an important additional challenge in terms of staff deployment, supervision and support visits, supply of essential medicines and medical equipment and the referral of patients. In some contexts, the national health care system is unable to address the national populations needs, and further struggles with the additional burden of refugees.

Women, girls and children are disproportionately affected in conflict and emergency situations. Globally, one in seven women will face a complication during pregnancy or childbirth. Every year, an estimated 295 000 women die during and following pregnancy; 94 percent of all maternal deaths occur in low and lower middle-income countries. Humanitarian settings present a particular concern: the lifetime risk of dying in pregnancy or childbirth for women in fragile settings (countries experiencing crisis or conflict) is estimated at 1 in 54 compared 1 in 5 400 in high income countries. Maternal deaths are defined as death occurring during pregnancy and childbirth and up to 42 days following the end of pregnancy. Direct causes of maternal mortality are those where the death is directly related to the pregnancy, related complications or interventions; the majority of maternal deaths are due to direct causes, most of which can be addressed with relatively simple means or prevented entirely. A recent analysis conducted by UNHCR of 72 audits of maternal deaths that occurred in 2018 in 29 refugee camps in seven Eastern African countries found a significant contribution of the third delay to maternal deaths and which highlights capacity gaps in provision of emergency obstetric care amongst NGO providers and national services. The analysis concludes that while evidence-based guidance on provision of quality Emergency Obstetric and Neonatal Care (EmONC) is available, implementation is often far behind.

2.9 million newborns die in the first four weeks of life, and 2.6 million more are stillborn, dying in-utero during the last three months of pregnancy. Neonatal deaths, defined as any death that occurs in the first 28 days of life, currently account for nearly 50 per cent of all deaths of children under five years of age in low- and middle- income countries. Approximately three-quarters of these deaths are early neonatal deaths that occur during the first week of life, including 36 per cent that occur within the first 24 hours after birth. More than half of all neonatal deaths occur in countries with a newborn mortality rate of 30 or more deaths per 1,000 live births. Many of these countries have experienced recent conflict or humanitarian emergencies and are hosting refugees. The three major causes of neonatal mortality are complications of preterm birth and low birth weight, infections, and complications that arise during the birth process (previously known as birth asphyxia). These causes account for more than 85 per cent of newborn mortality. Causes of newborn deaths in refugee settings are not different from causes of newborn death globally. However, underlying risk factors and conditions that contribute to newborn deaths can be exacerbated in refugee situations with inadequate shelter, poor sanitation and hygiene, poor maternal diets, limited access to skilled attendance at delivery, limited capacity for care in the first 24-48 hours after delivery, and low prevalence of early initiation and exclusive breastfeeding.

Access to contraception and family planning services is a human right and is an essential service in refugee operations. Scaling up access to quality contraceptive and family planning services can reduce maternal and neonatal morbidity and mortality, prevent unwanted pregnancies, reduce rates of abortion and adolescent pregnancy and avert related risks (including unsafe abortion). Family planning also provides numerous societal benefits including supporting a sustainable environment, poverty reduction, better nutrition, improving girls’ education and empowerment, and reducing HIV transmission, among others. Women in humanitarian crisis situations, including refugee settings are particularly vulnerable and their rights to access reproductive health services, including family planning, must be ensured. It is estimated that 225 million women of reproductive age in the developing world have an ‘unmet need’ for contraception – they would like to delay or stop childbearing but are not using any form of contraception. Past reviews of family planning services have found a number of barriers or gaps in family planning services in refugee operations. These include among others: inadequate and insufficient provision of modern contraceptives methods and low awareness about these methods; low uptake of contraception related to accessibility issues (distance and costs), lack of awareness, opposition to use, fertility-related reasons, and religious reasons; poor service quality, including disrespectful attitude by health providers, long waits, lack of privacy and confidentiality and poor hygiene in facilities. Provider-level barriers include poor training; lack of knowledge; biases; and hesitancy of health staff to discuss or offer contraception due to perceived sociocultural resistance.

Understanding the reasons why new-borns die, understanding the factors affecting the coverage and quality of antenatal, intrapartum and postnatal care as well as those affecting access to and acceptance of contraceptive/family planning services are crucial for improving maternal and newborn health programming in refugee settings.

The project developed in Cameroon, Chad and Niger emphasizes the expansion of key low-cost, high-impact interventions to address maternal together with newborn health, including use of the partograph, active management of third stage labor, proper cord care, thermal care, initiation of breathing and resuscitation, early initiation of exclusive breastfeeding, kangaroo mother care and eye care as well improving access to and acceptability of contraception/family planning in refugee settings and other components of EmONC in three selected countries.

The central activities carried through the project in 2018 and 2019 present as follows:

1. Baseline assessment, detailed design of project, monitoring, programme evaluation, learning and dissemination – Understanding context-specific needs is the first step in improving health programming. Because refugee operations differ considerably in the robustness and reach of health services, programmes must be tailored to the specific opportunities and constraints of the setting to be effective. A baseline assessment was carried out by UNHCR in the three countries to understand context-specific needs and factors which fed into the country specific project design. The information and recommendations provided by the baseline assessment were used to plan the most appropriate interventions to improve services and reach the outcomes. Building on the past project in South Sudan, Kenya and Jordan, a systematic documentation of experience and monitoring tools was started from the beginning of the project to enable regular follow up of the progress and learning from the project implementation in the target countries.
2. Capacity building of human resources – The project invested into capacity building to promote access to quality emergency obstetric care, essential newborn interventions (including KMC), antenatal and postnatal care; promotion of early initiation of exclusive breastfeeding for all newborns and contraception/family planning services. Training improved professional competencies of skilled health providers such as doctors, nurses and midwives, targeted the provision of the seven basic EmONC signal functions, and respectful maternity care. Training followed a cascade approach using training of trainers from each project site and used the low-dose, high frequency methodology with the core subjects from the Helping Mothers Survive and Helping Babies Survive packages. Specific training was developed to increase knowledge and understanding of lay-persons (home visitors, community health workers, traditional birth attendants, ancillary staff) and to strengthen their role in conducting pregnancy and postnatal home visits, community mobilization and improving access to services.
3. Strengthen health facility readiness and quality. The project ensured the overall capacity of the health facilities to provide essential maternal and newborn services and family planning services by putting into place, renovating and maintaining the essential component of functional health services: essential amenities, essential equipment, standard precautions, laboratory tests, and medicines and commodities. The readiness and quality were ensured through: a) availability of skilled health providers through training, on-site supervision and mentoring; b) ensuring guidelines in place for maternal, newborn care and contraception services; c) providing adequate commodities, supplies (including Kangaroo wraps, caps and towels as well as basic materials for CHWs) and equipment for health clinics to implement clinical protocols and provide a range of modern contraceptive methods; d) engaging communities and promoting pre-conception, contraception, delivery and post-natal care; e) promote quality assurance by utilizing tested balanced score cards, and regular supervisory visits; f) reinforcing technical support system through regular structured support visits and meetings, measuring progress and identifying gaps; g) strengthening the referral systems
4. Comprehensive family planning – Contraception prevalence rate is very low in the three countries. To increase the use of family planning methods the project addressed the following: 1) overcoming stigma and promoting family planning through strengthening sensitization at community level; 2) ensuring availability of a full range of modern contraceptive methods; 3) ensuring clinical guidelines and appropriate counselling materials in all health facilities; 4) reinforcing training on contraceptive methods and counselling to health providers (doctors, nurses and midwives) as well as training of CHWs and TBAs on basic family planning concepts; 5) reaching vulnerable populations, including adolescents through the provision of context specific services.
5. Community-based programmes – In addition to standard facility-based maternity and neonatal care, community-based programs were considered. Community-based programs that are well integrated into primary health services can help ensure a continuum of care and provide linkages to facility-based services. Community-based interventional care packages have been found to reduce maternal morbidity by 25%, stillbirths by 16%, perinatal mortality by 20%, and neonatal mortality by 24%. They also play a key role in the behaviour change of their communities and also increasing referrals to health facilities for maternal complications by 40% and improved the rates of early breastfeeding by 94%. Community-based approaches that were considered in the different projects ïnclude: 1) building or expanding community-based support groups on basic RH issues, such as women’s groups, Mother’s Groups, or breastfeeding support groups, youth groups, which can create a network of support for RH and related concerns; 2) training CHWs and traditional birth attendants on evidenced based activities regarding maternal and newborn care (breastfeeding, danger signs, cord care), family planning, promoting ANC and PNC visits to health facilities, and strengthening community-based referrals for mother and newborns; 3) Implementing a program of pregnancy and postnatal home visits, which in addition to training, included implementing a fixed schedule and content of visits, supervision plan, register and communication with health facility, among other program supports 3) increasing IEC and sensitization programs on a community level to promote use of family planning.
6. Expanding learnings to an organizational level – Through the two phases of the project (2016-2018 and 2018-2020), common gaps in service delivery and management have been noted across countries and operations. In order to disseminate learnings and integrate innovative practices into other UNHCR operations, a Communication and Dissemination matrix was developed in 2019. Activities include the development of guidance materials targeted at the managerial level in order to build capacity in managing RH/MNH, such as: development of operational guidelines; webinars for management level UNHCR staff (Public Health Officers and managers of NGO partners) on improving newborn (n=2) and maternal (n=2) health and family planning (n=2) in refugee settings; and the development of short High Impact Practice primers to aid implementation of key interventions (e.g. KMC, neonatal resuscitation). Other activities include: a field support mission to additional operations (Bangladesh) to support RH/MNH service development based on lessons learned from BMGF project implementation; the addition of essential contraceptive, maternal and neonatal medications and equipment to UNHCR’s Essential Medicines List (e.g. kangaroo wraps, feeding cups, tranexamic acid, DMPA-SC, etc) based on gaps identified through the projects. External communication activities included: dissemination of baseline assessment findings; participation in/presentation at IAWG Newborn Health in Humanitarian settings experts meeting, and ongoing participation in development of 5 year strategy roadmap; presentations of project lessons learned at IAWG global meeting 2020; participation in a Spotlight session at the Global Refugee Forum highlighting maternal and neonatal deaths and, in particular, the project in Chad; publication of 2 peer-reviewed qualitative articles from the first phase of project; and re-development of UNHCR’s public health website in order to make support materials more easily available to country operations.
7. Reproductive, maternal and neonatal health population-based survey – A population-based household survey on key RH, maternal and newborn indicators was carried out in Chad and Cameroon in 2018/2019. In addition to the primary findings, UNHCR is coordinating with experts to further analyse the survey data – US Centre for Disease Control for re-confirmation of primary data analysis and University of Washington for secondary data analysis on any correlates of low birth weight.
8. Purpose and objectives

The main purpose of this evaluation is to assess the relevance, impact and effectiveness of the “Saving maternal and newborn lives in refugee situations” project in the three targeted refugee operations. The evaluation should help to identify contextual and organizational factors that may have had a particular enabling role in project implementation and those that may have slowed progress. The evaluation is meant to assess the sustainability of the achievements in the current configuration of actors and funding and identify the essential support necessary to maintain achievements, potentially expand coverage and/or to complement any element identified as missing or insufficient. Finally, the evaluation will include some costing analysis of the key components of the project per country.

The evaluation will be used both for learning and accountability; findings will be used to guide programme practices to improve maternal, newborn and contraception/family planning care in refugee operations; and to demonstrate what worked well, why, and lessons learned from implementation to the funders and organizational leadership.

Specifically, the evaluation seeks to address the following and provide specific, actionable and practical recommendations for future programming:

• Evaluate the extent to which project objectives and proposed outcomes were achieved by measuring performance against each performance outcome indicator under each result area. Analyse key determinants that, positively or negatively, influenced the achievement (or not) of these results.
• Comparing different project countries and project sites, identify enabling factors and factors that may have slowed progress.
• Provide recommendations on future project design including how to ensure planning, management, monitoring and evaluation frameworks are more effective and taking account of above factors.
• Evaluate the effectiveness and efficiency of the organisational set‐up for the project, tools and systems used in the delivery and monitoring of the project and to what extent these contributed to delivery of the project outcomes.
• Assess the sustainability of the individual project components, and identify critical factors that may affect sustainability and recommend support necessary to maintain achievements, potentially expand coverage and/or to complement any element identified as missing or insufficient
• The draft report will be shared with partners in the respective project countries and discussed at the coordination meetings to ensure ownership.

A final report will be prepared and shared with all UNHCR public health staff globally. The same final report will also be shared with health partners in respective countries by the public health officers and made available on the public health website.

1. Evaluation Approach

4.1 Scope

The evaluation scope – relating to population, timeframe and locations– is as follows:

Timeframe to be covered in the evaluation: April 2018 – 31th December 2019.

Population location and details:

Cameroon

• In the Extreme North of Cameroon, 57,000 Nigerian refugees live in Minawao refugee camp, with 30,000 others living in sites outside the camp. Minawao camp has 2 health centres, one of which provides delivery services. The health partner is International Medical Corps (IMC).
• In the East of Cameroon, UNHCR is supporting more than 185,000 refugees from the Central African Republic in 38 health centres and seven health districts. For this project five locations were chosen, including four refugee sites and one host village (Gbiti) where many refugees are living together with the host population on the border with the Central African Republic (RCA). In addition, three district hospitals that serve as the main secondary level of care were included: DH Batouri, DH Kette and DH Garoua-Boulaï. The health partner in the East region is African Humanitarian Action (AHA).

Chad

• In the South of Chad, 98,645 refugees fleeing war in the Central African Republic are living in multiple districts along the border. This project includes six refugee camps and their five primary health centres, supported by three district hospitals. The health partners in the South are Association pour Developpement Economique et Sociale (ADES) and CSSI.
• In the East of Chad over 332,048 Sudanese refugees fleeing war in the Darfur region have occupied 12 camps for more than a decade. This project focuses on five camps and their primary health centres, supported by two district hospitals that serve as the secondary referral hospitals. The health partner in the East is the International Rescue Committee (IRC)

Niger

• In the south of Niger, more than 100,000 Nigerian refugees have fled Boko Haram, and are living in settlements along the border, integrated with internally displaced persons and the host population. Around 13,000 also live in the camp of Sayam Forage, which is the main site included in this project.
• In the south-west of the country around 56,000 refugees from Mali live in three camps (Tabareybarey, Mangaize and Abala) as well as Intekane, a “Zone d’Accueil de Réfugiés” (ZAR), an area where refugees are able continue their semi-nomadic life. The project includes the health centres in each of the four sites. The health partner for both regions in Niger is the Association Pour le Bien-Être (APBE).

4.2. Key Evaluation Questions (KEQs) and Sub-questions (SUQs)

The evaluation will address the following headline questions. The analysis needed to answer them is likely to touch on other possible sub-questions that may be further refined during the evaluation inception phase.

Key Evaluation Question on relevance of the project design:

• KEQ 1: To what extent are the activities of the 2018-2019 project (baseline assessment, capacity building of human resources, strengthening of health facilities, community-based programmes, organizational learning activities, RH survey, etc.) relevant and appropriate for the overall goal of the project to improve maternal, neonatal and contraception/family planning care services in Cameroon, Chad and Niger?
  • SUQ 1.1. How could the project design and the choice of activities be strengthened to improve its relevance to reaching the goal of the project? How does this vary or not across the different country contexts?

Key Evaluation Question on effectiveness of project implementation:

• KEQ 2: To what extent was project implementation in each country delivered as intended in the following areas: capacity building of care providers, health facility strengthening, comprehensive maternal and newborn care packages, comprehensive family planning services, best practices and guidance to improve care? Did implementation vary between countries?
  • SUQ 2.1. To what extent did the organisational set-up of the project, the tools and systems used in the delivery of the project contribute to timely implementation?
  • SUQ 2.2. What were the major factors influencing the implementation of the project as intended? Did factors vary by context? If so, how?
  • SUQ 2.3. Which enabling and challenging factors, if any, should be taken into account in future program implementation? Why?
• KEQ 3: What were the costs of implementing key components of the project and the project across the three contexts?
  • SUQ 3.1. What were the main drivers of cost? Did this vary by context?

Key Evaluation Questions on contribution to results:

• KEQ 4: To what extent did the project reduce maternal and neonatal mortality and morbidity and what were the major factors that influenced changes in mortality and morbidity in targeted populations in Cameroon, Chad and Niger? To what extent did the project increase contraceptive uptake? A detailed table of key outcomes is available in Annex 1.
  • SUQ 4.1. What were the specific changes in health care workers’ maternal and neonatal knowledge, beliefs, and practices and do they correlate with any changes in their maternal and neonatal health? Why/why not? Did this vary between contexts? If so, how?
  • SUQ 4.2. What were the specific changes in health care workers’ knowledge, beliefs, and practices related to the counselling for and provision of contraceptives and did these contribute to improved contraceptive uptake? Why/why not? Did this vary between contexts? If so, how?
  • SUQ 4.3. To what extent did the community-based programme contribute to the project objectives? How, if at all? Did this vary between contexts? Why/why not?
  • SUQ 4.4. What were specific changes in CHW (community health worker) knowledge, beliefs and practices around maternal and newborn care and care-seeking and family planning practices? Why/why not? Did practices vary between contexts? If so, how?
• Key Evaluation Question on sustainability:
• KEQ 5: To what extent does the project demonstrate sustainability in terms of the continuation of key activities of value and sustaining results in each country?
  • SUQ 5.1. What are major factors that affect the sustainability of activities and results achieved from the project in each country?
  • SUQ 5.2. What support will potentially remain necessary to maintain activities and achievement, and/or to complement any element identified as missing or insufficient in each context?
  • SUQ 5.3. To what extent has UNHCR institutionalised these approaches to maternal and neonatal health and family planning into their public health work globally? What other actions could UNHCR take to better incorporate learning from this project into their public health programming globally?

4.2 Approach and methodology

The methodology – including details on the data collection and analytical approach(es) used to answers the evaluation questions – will be designed by the evaluation team during the inception phase and presented in an evaluation matrix.

The evaluation methodology is expected to:

• Refer to and make use of relevant internationally agreed evaluation criteria such as those proposed by OECD-DAC and adapted by ALNAP for use in humanitarian evaluations.
• Employ a mixed-method approach incorporating qualitative and quantitative data collection and analysis tools including the analysis of monitoring data – as available, by measuring the following outcomes listed and detailed in Annex 1:
• Reduced maternal and neonatal morbidity and mortality
• Improved maternal and neonatal care practices of health care workers, including uptake of specific practices such as kangaroo mother care
• Improved counselling for and provision and uptake of contraceptives
• Strengthened community-level activities such as improved capacity for pregnancy and postnatal home visits

The evaluation team is responsible to gather, analyse and triangulate data (e.g. across types, sources and analysis modality) to demonstrate impartiality of the analysis, minimise bias, and ensure the credibility of evaluation findings and conclusions. It will try to document best practices and lessons learned to improve maternal, neonatal and contraceptive/family planning care.

Qualitative data sources should include, but are not limited to key informant interviews and focus group discussions with UNHCR and partner staff, medical providers, community health workers/traditional birth attendants and community level stakeholders are relevant and caregivers targeted for the project.

Quantitative data sources should include use of secondary data sources, which are listed below. Since there has been an abundance of survey data collected from refugee households, any further collection of household surveys is undesirable. Brief Knowledge, Attitude and Practice type assessments with health care providers would be possible.

Data and information sources including the following existing sources:

• Project background documents and training reports;
• UNHCR’s Health information system (HIS): data can be used to provide monitoring data on service coverage and health outcomes;
• Facility registers and other routine data sources can be used to assess patient needs and provide indications of program quality;
• Trimester reports from all health facilities supported through the project;
• Facility checklists that were used by UNHCR/partners to monitor facility capacity for service provision;
• Standardized Expanded Nutrition Survey, which was used to monitor early initiation of breastfeeding and exclusive breastfeeding as well as the proportion of pregnant women reporting receiving iron and folic acid supplementation from ANC facilities.
• Birth, maternal and newborn death reports, stillbirth data and maternal death audits from HIS data and maternal mortality reports completed by NGO health partners.
• Reproductive, Maternal and Neonatal population level survey data
• Baseline assessment in 2018.

4.3 Evaluation Quality Assurance

The evaluation consultants are required to sign the UNHCR Code of Conduct, complete UNHCR’s introductory protection training module, and respect UNHCR’s confidentiality requirements.

In line with established standards for evaluation in the UN system, and the UN Ethical Guidelines for Evaluations, evaluation in UNHCR is founded on the inter-connected principles of independence, impartiality, credibility and utility, which in practice i.a. call for: protecting sources and data; systematically seeking informed consent; respecting dignity and diversity; minimising risk, harm and burden upon those who are the subject of, or participating in the evaluation, while at the same time not compromising the integrity of the exercise.

The evaluation is also expected to adhere with the ‘Evaluation Quality Assurance’ (EQA) guidance, which clarifies the quality requirements expected for UNHCR evaluation processes and products.

The Evaluation Manager will share and provide an orientation to the EQA at the start of the evaluation. Adherence to the EQA will be overseen by the Evaluation Manager with support from the UNHCR Evaluation Service as needed.

1. Organisation, management and conduct of the evaluation

The UNHCR Public Health Section will serve as the Evaluation Manager. They will be responsible for: (i) managing the day to day aspects of the evaluation process; (ii) acting as the main interlocutor with the evaluation team; (iii) providing the evaluators with required data and facilitating communication with relevant stakeholders; (iv) reviewing the interim deliverables and final reports to ensure quality – with the support of the Evaluation Service at HQ.

The Evaluation Team should comprise a senior team leader and 1-3 team members. The team is expected to produce written products of high standards, informed by evidence and triangulated data and analysis, copy-edited, and free from spelling and grammatical errors.

The language of work of this evaluation will be in English and French and the deliverables will be in English.

5.1 Expected deliverables and evaluation timeline

The evaluation should be completed from Mid-February 2020 to September 2020 and will be managed following the timeline tabled below.

The key evaluation deliverables are:

• Inception report with evaluation matrix, data collection toolkit (including questionnaires, interview guides, focus group discussion guides) and details on the analytical framework developed for / used in the evaluation;
• Preliminary findings sensemaking workshop with UNHCR Public Health Section
• Three country-level reports including recommendations (40 pages excluding annexes)
• One synthesis evaluation report including recommendations (20-30 pages excluding annexes)
• Power Point Presentation for purpose of dissemination of the evaluation findings
• Executive summary
• All raw data (quantitative and qualitative) collected should be anonymised and provided to UNHCR Evaluation Service.

Activity

Deliverables and payment schedule

Indicative timeline

Minimum # of estimated days

Phase 1: Inception phase including:

• Initial desk review and key informant interviews.
• Circulation for comments and finalisation

Final inception report – including methodology, refined evaluation questions (as needed) and evaluation matrix; logistics support requirements for data collection.

Payment 30%

Mid to late March 2020

21

Phase 2: Data collection including:

• In-person/virtual interviews with

UNHCR staff and partners (HQ and

countries)

-Field visits to Chad, Cameroon and

Niger

All secondary and primary data collected across 3 countries and HQ.

Payment 30%

Late March-June 2020

50

Phase 3: Data analysis and sensemaking/validation workshop including:

• Data analysis of each country
• Data analysis across countries
• Facilitate sensemaking/validation workshop of preliminary evaluation findings, conclusions and proposed recommendations

Facilitation of a sensemaking/validation workshop of preliminary findings, conclusions and recommendations with UNHCR HQ

Payment 20%

July 2020

21

Phase 4: Report drafting and finalisation

• Draft evaluation reports per country
• Draft synthesis evaluation report
• Powerpoint presentation of findings and recommendations
• Finalise reports

3 country-level evaluation reports for Cameroon, Chad and Niger with executive summaries and recommendations

1 synthesis evaluation report across all 3 countries and HQ-level with executive summary and recommendations

1 powerpoint presentation of findings and recommendations

All raw data anonymised

Payment 20%

Aug-Sept. 2020

45

Evaluation team qualifications, selection and contracting

The evaluation will be undertaken by a team of a team of independent consultants – an evaluation Team Leader and 1-3 Team Members – selected by means of a competitive selection process. It is considered important that the same 2-person team will go through all 3 countries for the evaluation; the participation of the team leader in all country visits is not negotiable.

The evaluation consultants’ selection process will be carried out by the UNHCR Public Health Section in cooperation with the Evaluation Service. In line with the UNHCR Evaluation Policy, prior to hiring the consultant(s)/Evaluation Team, any actual or potential conflict of interest will be assessed.

Contracting will be via individual consultancy contract. Only proposals submitted by a team of consultants will be reviewed, and each member of the team will be contracted separately.

Functional requirements for the individual consultants – who should both be able and willing to travel to the selected sites are as follows:

Evaluation Team Leader

• Advance university degree in public health or related health field.
• A public health or clinical background (nurse, medical doctor) with a strong experience in maternal/newborn health care and contraception/family planning.
• At least 10 years’ experience in the area of maternal, newborn and child health and public health, preferably in programmes in low resource settings.
• Track record of experience in project evaluations, particularly multi-country evaluations.
• Strong expertise in both qualitative and quantitative data analysis and research methods.
• Proven experience in leading an evaluation team in challenging contexts.
• Experience in the formulation, monitoring and evaluation of MNCH projects
• Experience working with refugees and/or in humanitarian settings would be desirable.
• Familiar with costing RMNCH programmes and conducting cost-effectiveness analysis
• Excellent spoken, writing and reporting skills in French and English.
• Good communication skills

Desirable: understanding of the forward vision regarding the refugee context and assistance to refugees, namely the Global Compact on Refugees, and inclusion and integration of refugees into national policies, strategies and systems.

Evaluation Team Member

• University degree in public health
• Experience in maternal, neonatal and child health programmes in resource limited settings
• At least 4 years of experience in evaluating MNCH programming
• Experience in quantitative and qualitative data analysis and research methods.
• Experience in costing analysis, preferably of MNCH programmes.
• Excellent spoken and written French and English.
• Good communication skills.
• Desirable: additional experience in health economics.