Terms of Reference (TOR)

Development of Inclusive Strategy, Governance and Policy Documents for Community Organizations for quality HIV/TB and Malaria delivery and sustainability.

TERMS OF REFERENCE FOR A CONSULTANT TO DEVELOP AN INCLUSIVE STRATEGY, GOVERNANCE AND POLICY DOCUMENT FOR CAPACITY BUILDING OF COMMUNITY ORGANISATIONS TO IMPROVE QUALITY OF HIV, TB AND MALARIA SERVICES AND INTERVENTIONS.

Community System Strengthening
27/11/2024

1. BACKGROUND AND CONTEXT
DAPP-Zambia is a local Non-Governmental Organization (NGO) whose goal is to improve health, livelihoods and education for people in Zambia.
From June 2024 to December 2026, with support from Churches Health Association of Zambia (CHAZ) and with funding from the Global Fund, DAPP commenced implementation of a three-year program to reduce malaria incidences and mortality through Community System Strengthening.

The project will mobilize the communities to increase community engagement to improve health services related to HIV, TB and Malaria and as well take part in disease severance.

HIV: Zambia is facing a widespread HIV/AIDS epidemic, with approximately 1.25 million people living with HIV. While the country has managed to stabilize the epidemic, reducing HIV prevalence from 15.6% in 2002 to 11% in 2021, around 28, 000 (0.31%) new infections still occur annually, along with about 17,000 AIDS-related deaths. Adolescents, particularly girls, are disproportionately affected, and additional measures are needed to curb new infections. Sexual coercion and violence against girls and women contribute significantly to the spread of HIV, highlighting the need for continued efforts to protect vulnerable populations.
The people affected by HIV and AIDS constitute 7% of the total population, of which 60% are women. Latest data from the 2021 ZAMPHIA report shows that about 88.7% know their HIV status, 98% of them are on ARV treatment and 96.3% have suppressed viral load. Although this is good, teenagers and young adults aged 15-34 years old are far behind at average 66-80%. There is need to identify the remaining HIV positives who don’t know their HIV status and are unknowingly spreading the HIV virus.
Tuberculosis (TB): According to the 2022 UNAIDS data, in Zambia there were an estimated 23,000 incident cases of tuberculosis among people living with HIV in 2020, with an estimated TB incidence of 59,000 (319 TB cases per 100,000 in 2020), Zambia is ranked 21st among the 30 high TB burden countries. (ZAMPHIA 2021 and WHO Global TB report, 2021).
In 2020, Zambia reported 40,000 new and relapse cases, with a treatment coverage of 68%. Most of the missing cases are expected to be found in large peri-urban informal settlements of large cities. Based on data from the TB prevalence survey, about 50% of the symptomatic TB cases are missed at the health facility. TB cases are missed at the health facility due to low index of suspicion of TB, failure to complete the TB diagnostic cascade, use of less sensitive diagnostic tools, out of pocket expenditure for patients, low awareness for TB in communities and weak public private coordination.
Malaria: Zambia remains a high burden malaria country. In 2021 there were 7,050,968 malaria cases; malaria case incidence was estimated to be 340/1,000 population/year; prevalence in children under 5 was found to be 29%; and the incidence of inpatient malaria deaths was 8/100,000 population per year.
The burden of malaria incidence across the country varies widely, from zero to more than 500 cases per 1,000 populations. Malaria prevalence differs among provinces from as high as 63% in Luapula Province to 3% in Lusaka and Southern Provinces.
In response to the above challenges, Zambia through the Ministry Health and its partners intends to continue implementing key interventions which include distribution of Insecticide Treated Nets (ITNs), Indoor-Residual Spraying (IRS), Presumptive Treatment of malaria in pregnancy and provision of prompt diagnostic and treatment services at both health facility and community levels.
Public health surveillance is the continuous, systematic collection, analysis and interpretation of health-related data for action. Disease surveillance data serves as the basis for the detection of potential outbreaks for an early warning system to prevent what could become public health emergencies. It enables monitoring and evaluation of the impact of an intervention, helps track progress towards specified goals and clarifies the epidemiology of health issues.

Introduction to Community Led-Monitoring CLM): Community-Led Monitoring (CLM) refers to models or mechanisms by which service users and/or local communities continuously collect, analyze and use service-related data to improve access, quality and impact of services and, hold service providers and policymakers to account. CLM is a dynamic process encompassing ongoing data collection, meticulous analysis, and strategic utilization by communities.

Community-led monitoring (CLM) has gained momentum in recent years as an intervention that mobilizes communities affected by health inequalities to monitor how services are provided and co-create solutions with key partners to improve them. CLM as part of the community-led response is playing a significant role in bridging the “last mile” gaps by providing good-quality services to the right people, in the right ways, in the right places, at the right time, thereby contributing to reducing or ending diseases of public health concern, as HIV, TB and malaria, and minimizing health inequalities.

CLM has been implemented for some years in Zambia under various mechanism. This includes the CLM HIV/TB program currently reaching all facilities in Zambia through 10 implementing organisations and with funding from PEPFAR. The recently started CLM Malaria implemented in 51 districts across all districts with funding from Global Fund through CHAZ and with DAPP as the lead subgrantee. Further, the OneImpact program focusing on Malaria is implemented by 3 civic society organizations with funding from Stop TB Partnership.

The CLM projects are good entry point for CLAR activities. However, other structures and programs include the utilization of Scorecards by the Neighbourhood Health Committees among other programs and initiatives implemented by government and Civic Society Organizations.

Further Community Based Organisations and community structures are in various ways directly implementing activities to improve service delivery and outcomes related to Malaria, HIV and TB prevention, care and treatment.
CSOs and community structures can significantly impact the health system but to improve sustainability of the organizations and increase outcome and impact capacity building of CSO’s and Community Structures most be carried out.

Many tools are available for the assessment/self-assessment of the capacity of organizations. This assignment is specifically directed towards developing of a capacity building guide to support organizations in the capacity building of community structures such as Neighborhood Health Committees (NHCs) as well as the capacity building of smaller CBOs in order to improve service delivery of HIV/ TB and Malaria – including improving sustainability of the CSOs and their interventions.

2. OBJECTIVES OF THE ASSIGNMENT

Develop an inclusive strategy, governance and policy document for capacity building of community organizations to improve quality of HIV, TB and Malaria services and interventions and to increase the efficiency and sustainability of Community Organizations and community structures.

3. SCOPE OF WORK
3.1. Expected Impact:
Aligned with Zambia’s national malaria, TB and HIV programs objectives and their strategic funding request to the Global Fund, this initiative is focused on enhancing resilient and sustainable health systems (RSSH) and driving social behaviour change (SBC) through intensified community engagement. By improving the capacity and sustainability of CSOs and community structures, the health service delivery is expected to improve through community interventions in terms of direct service delivery as well as through advocacy and demand creation towards government service systems.

3.2. Target audience
3.2.1. Primary audience:

• Sub grantees and Sub-sub grantees under CHAZ with funding from Global Fund. Their staff will utilize the guide to provide capacity building of NHCs, other community structures and local CSOs.
• Civil Society Organizations (CSOs): Engaged to support the efforts of CBOs, NHCs, CHWs, and community leaders, ensuring that community voices and perspectives are integrated into health policies and practices.
• Other CSOs interested to utilize the guide for capacity building of CSOs.
• Ministry of Health staff on health facility, district, provincial national level and ZPHI for them to support NHCs, CSOs and other community actors in the implementation.

3.2.2. Secondary audience:

• Neighbourhood Health Committees (NHCs): Equipped to lead local health initiatives, spearhead social behaviour change campaigns, and advocate for enhanced healthcare services.
• Community Health Workers (CHWs) including Community Based Volunteers (CBVs) and CLM data collectors/facilitators: Trained to gather and analyze health data, conduct data quality audits, and utilize the CLAR guideline to monitor and improve healthcare delivery.
• Community leaders: Provided with resources to facilitate community dialogues, advocate for health improvements, and disseminate crucial health information effectively.

3.3. Expected outcomes

• Enhanced community and CSO ability to conduct services including direct implementation, CLM and CLAR for improved health delivery on community, district, provincial and national levels.
• Enhanced community leadership: Empowerment of local entities to drive health initiatives, lead SBC efforts, and advocate for improved healthcare services.
• Increased accountability: Communities are better positioned to hold service providers and policymakers accountable, ensuring equitable and efficient healthcare delivery.
• Stronger collaborations: Fostered partnerships among communities, healthcare providers, and decision-makers to identify and address barriers to healthcare access and service quality.

3.4. Proposed methodology
a) Review of existing organizational and community structure assessment and capacity development tools as well as sharing on best practices.
b) Key Informant interview with CSOs implementing organizational capacity building.
c) Key Informant interviews with MoH staff on various levels to appreciate how the guide will supplement and fit into government strategies and implementation.
d) Community and CSO meetings to assess how the proposed guide can be support them to improve capacity building of CBOs and Community Structures.
e) Hold Focus Group Discussion with some recipients of care RoCs.

3.5. Key Components
1. Conduct a comprehensive desk review of existing literature on CBO/ Community Structure Capacity Building methodologies/ practices/ successes under existing / former projects.
2. Conduct key informant interviews with staff from the implementing organizations under CHAZ (SRs and SSRs) as well as CHAZ and DAPP.
3. Conduct key informant interviews with staff from organizations implementing Capacity Building of CBOs and Community Structures. Document and share best methodologies, best practices and successes.
4. Meet with Health Facility staff and volunteers, District, Provincial and National Health Office (DHO) staff.
5. Develop draft CSO/ Community Structure Capacity Building Guide and gather feedback on the proposed guide from relevant stakeholders, including project staff, CSOs, MoH and service beneficiaries.
6. Finalize the Capacity Building Guide for CSOs and Communities focused on Malaria, HIV, TB and Public Health Surveillance.
7. Present it in the final dissemination of the developed guide (note the dissemination meeting is not to be budgeted for).

Draft content of the CBO/ Community Structure Capacity Building Guide

• Introductions.
• Description of existing Capacity Assessment and Capacity building. methodologies and tools. Including sharing of best practices.
• Guide for CSOs to train CBOs and Community Structures. These will include:
• Organizational Governance.
• Human Resource Policies.
• Resource mobilization.
• Coordination and collaboration.
• Community strategies for implementing quality HIV/TB and Malaria Services
• Annexes: Toolbox – various tools for CSO Capacity Building activities.

4. CONSULTANCY DELIVERABLES
The consultant will provide the following deliverables to DAPP Partnership Unit within the estimated timeframe stated below.
a. Inception Report: 5 working days after signing the contract, a detailed report on the consultant’s proposed approach and tools will be submitted for approval. This will provide rationale and detailed description of methodology and tools, budget with breakdown of costs and detailed work plan for the entire exercise. Any draft questionnaire or interview forms will also be submitted for review at this stage.
b. Development of the Capacity Building Draft Guide – 10 working days.
c. Improve the assignments following comments from DAPP and other stakeholders.
d. Incorporate feedback into the draft guide.
e. Prepare a power point presentation to key stakeholders during engagement meeting (including implementing sub-sub recipients, MoH, NAC, CHAZ, DAPP and others concerned) – note this is not to be included in the budget.
f. Finalize the guide according to any feedback received.
g. Submission of final report.

5. MANAGEMENT AND IMPLEMENTATION RESPONSIBILITIES
The consultant will report to the Project Manager/Coordinator and DAPP National Partnership M&R Officer.

6. DAPP, CHAZ and sub-sub recipients of the grant will provide:
a. Guidance and technical support as required throughout the process.
b. Introductory meetings with key government staff.
c. Comments and feedback on all deliverables within agreed timeline.

7. PROPOSED METHODOLOGY
a. Participatory and consultative processes involving key stakeholders.
b. Evidence-based and context-specific content derived from existing literature.
c. User-friendly and interactive format using adult learning principles.
d. Application of diverse tools and techniques.
e. Testing of the guide through visits to communities.

8.BUDGET AND PAYMENT MODALITIES
The ceiling for the assignment is K150,000.00. The budget to be proposed should include all costs including transportation, printing and consultancy fees as well as taxes.
The payment modalities will be as follow:

• 40% of total budget upon acceptance of the Draft Inception Report.
• 30% upon production of first acceptable draft assessment report.
• 30% upon production of acceptable final assessment report.

9.TIMEFRAME
The assignment must commence immediately after signing the contract and are to be completed within 6 weeks after signing the contract.

10. REPORTING AND COORDINATION
The consultant will report the progress of the assignment to DAPP’s contact person for this assignment Mr. Fredrick Mabele, who will also be available to support and set up appointments with relevant partners/authorities.

11. EVALUATION CRITERIA
The consultant will be selected among applications received using the following criteria. The technical proposal will be evaluated together with the financial proposal (budget).
a. The experiences and capacity to deliver the required assessment by the lead consultant and other members of the team if applicable.
b. Ability to deliver within the proposed time frame.
c. Quality and feasibility of the proposed assessment methodologies.
d. The budget is realistic and cost efficient.

12. QUALIFICATIONS AND EXPERIENCE
a. The Lead consultant must have a minimum of a degree in public health, social sciences, or development studies.
b. The lead consultant and eventual team members must have demonstrated experience in conducting research.
c. Familiarity with the program’s thematic areas, context, and target audience.
d. Excellent communication skills in English.
e. Ability to work independently and collaboratively, meeting tight deadlines.

13. APPLICATION REQUIREMENTS AND PROCESS
Submission Details:
All applications or Expressions of Interests to undertake this consultancy, firms or individuals are requested to submit:
a. Cover letter.
b. A Project Proposal detailing your interpretation to the TOR, proposed methodology, including framework schedule and time frame.
c. Proposed budget in Zambian Kwacha (ZWK) detailing the type of expenses.
d. Capability statement demonstrating how you meet the required qualification and competencies.
e. Copies of all relevant Curriculum Vitae (CVs). Only CVs for specific individuals that will form the proposed survey and /or assessment team–and will be directly involved should be included.
f. Contact details for three references for former clients.

All documents must be addressed to The DAPP Managing Director and be submitted via email to procurement@dappzambia.org with copy to info@dappzambia.org by close of business on 9th December, 2024. The email should be labelled: CBO Capacity Building Guide Application.

Only short-listed prospective consultants will be communicated to and this will be within one week of submission closing date.