1.    Introduction

These Terms of Reference (TOR) outline relevant details for Orbis International Zambia (OIZ) to hire a consultant to lead an End-Term project evaluation of the project entitled “Strengthening Eye Health Capacity and Care in Lusaka, Copperbelt and Eastern provinces in Zambia”.

1.1. Background

Orbis International (OI) is a non-aligned, non-profit, global development organization on a mission to transform lives through access to quality eye health. To achieve its mission, it builds the capabilities of its partners through education and training, eye care management systems development, technical and financial support, and research. OI manages four global programmes – a Flying Eye Hospital, Hospital Based Programmes, Fellowships, and Cybersight, a telemedicine programme – and has country programmes in Asia, Africa, and Latin America, and supports training programmes in the Caribbean.

Orbis International Zambia (OIZ) is a branch of OI that was established in 2016 and works in partnership with the Ministry of Health, having done so since 2010. OIZ’s mission is to transform lives through the prevention and treatment of blindness and a vision of networking with partners, mentoring, training, and inspiring local teams so that they can save sight in their communities.

OIZ has implemented programmes in all 11 districts of the North-Western province for the past 9 years, including a targeted cataract project to serve the elderly population in the provinces that are not able to afford cataract surgery. On the Copperbelt has supported paediatric eye health services at the Kitwe Teaching Eye Hospital  since 2010 as well as and expansion across facilities in the 10 districts of the province. In Lusaka, our support for the past 7 years focused on training for Human Resources for Eye Health as well as systems strengthening at the University Teaching Hospitals Eye Hospital. The work in Lusaka district has been scaled up to include Lusaka province to support eye health services from primary to tertiary level across all the districts. The scale-up now includes UTH Eye Hospital, Levy Mwanawasa Teaching Hospital, 4 first-level hospitals, district hospitals selected health facilities, and Chipata Central Hospital in Eastern Province. OIZ has implemented projects with restricted grants in Lusaka, Copperbelt, and North-Western provinces. The projects cover areas such as Pediatric Eye Health, Trachoma elimination, Cataract surgery, and Human Resources for Eye Health, including support for residency training and faculty training as well as the use of mobile phone technology to enhance primary eye care and improve cataract surgical outcomes through use of the Better Outcomes Operating Software Tool (BOOST).

OIZ with the support from the David and Molly Pyott Foundation has implemented a 3-year project comprehensive eye project (January 2022 – December 2024) titled “Strengthening Eye Health Capacity and Care in Lusaka, Copperbelt and Eastern provinces project in Zambia”.  The goal of the project is to improve the quality of comprehensive eye health care for all in Lusaka, Copperbelt and some parts of Eastern province. The project is being implemented in Lusaka, Copperbelt and some parts of Eastern Province. In Lusaka Province, the project has supported eye health services across all levels throughout the province’s six districts. At the tertiary level, the project partnered with the University Teaching Hospital (UTH)-Eye Hospital, Levy Mwanawasa University Teaching Hospital, Kitwe Teaching Eye Hospital, Ndola Teaching Hospital and Chipata Central Hospital.

1.2. Project objectives:

1.    To Improve human resources for eye health (HReH) by increasing the number of adequately skilled ophthalmology graduates and other eye care professionals (tertiary to health center level)

2.    To develop sustainable eye care services and systems by improving clinical and operational capacity to provide comprehensive quality adult and pediatric ophthalmology services.

3.    To increase demand for eye health services and investments in primary eye care

4.    To improve the enabling environment for the implementation of eye health policies in Zambia

1.3. Target population and project sites:

Beneficiaries of the project fall into two categories: (i) Ophthalmology Residents, Faculty, and Ophthalmic staff, and (ii) patients accessing health services from the targeted facilities in the supported provinces.  The project targets both adults and children. The beneficiaries are from the three provinces, namely Lusaka, Copperbelt, and Eastern. The University Teaching Eye Hospital, Levy Mwanawasa Teaching Hospital, Kitwe Teaching Eye Hospital, and Ndola Teaching Hospital are the highest referral hospitals in the country. Chipata Central Hospital is one of the practicum sites for the Specialist Training Programme (STP) in Ophthalmology.

1.4. Project Sites

• UTH Eye Hospital, Levy Mwanawasa University Teaching Hospital, Kitwe Teaching Eye Hospital, and Ndola Teaching Hospital: responsible for training residents, coordinating outreach activities, and the performance of static services in the district facilities during outreach camps.
• 1st level hospitals: Responsible for diagnosis, treatment, and screening of patients as they receive referrals from the health posts. They also carry out community outreach screening and treating those who don’t need to be referred to the tertiary hospitals.
• District hospitals (secondary level) in Lusaka Province: Deliver primary eye care, carry out outreach screenings in the community, and coordinate activities of the local Health Posts and Centers
• Health Facilities (Primary Level): Build the capacity of general health care workers such as nurses and clinical officers as well as community health workers so that they can identify and treat eye diseases within the community.

1.5. Project partners:

This project is being implemented in partnership with the Ministry of Health at all levels of care. At the tertiary level, OIZ partnered with the University Teaching Hospital (UTH)-Eye Hospital, Kitwe Teaching Eye Hospital, Ndola Teaching Hospital, Levy Mwanawasa Teaching Hospital, and Chipata Central Hospital to support the priority capacity and equipment needs to ensure infrastructure, operational capacity, and staffing to provide comprehensive and equitable adult and pediatric eye health care services. In Lusaka Province, OIZ supported eye health services across all levels throughout the province’s six districts. The supported facilities in each respective district are as follows:

• Lusaka District – Chipata First Level Hospital, Matero First Level Hospital, Chawama First Level Hospital and Chilenje First Level Hospital
• Chilanga District – Nakachenje Mini Hospital
• Rufunsa District – St Lukes Mission Hospital
• Luangwa District – Luangwa District Hospital
• Chongwe District – Chongwe District Hospital
• Kafue District – Kafue General Hospital

1.6. Strategy and approach:

With support from the David and Molly Pyott Foundation, OIZ has supported MOH to:

a)    Improve the human resource for eye health by supporting the training of skilled ophthalmology graduates and other eye care professionals at all levels.

b)    Develop sustainable eye care services and systems by providing access to equipment and consumables, and operational capacity to provide comprehensive quality adult and pediatric ophthalmology services.

c)    Increase demand for eye health services through community mobilization while simultaneously increasing capacity for training and equipment availability at the primary care level, as well as opportunities for residents to gain hands-on experience.

d)    Enhance the enabling environment for the implementation of eye health policies.

2. Evaluation Objectives

The End-term evaluation will analyze the extent to which project outcomes have been achieved, identify lessons learnt, and challenges faced, and propose recommendations for future projects of a similar nature. The evaluation will also provide the opportunity to take stock, reflect, learn, and share knowledge on lessons learnt and best practices that may have emerged during the project implementation which will facilitate improvements in the implementation of future projects

The evaluation will serve three main purposes:

1.    It will provide an independent assessment of the outcomes and impact of the project, assessing performance as per the foreseen targets and indicators of achievement at the output level; strategies and implementation modalities chosen; partnership arrangements, constraints, and opportunities; and

2.    It will provide lessons learnt and best practices emerging from the project in terms of strategies, institutional arrangements, and partnership arrangements.

3.    Develop recommendations based on the findings of the evaluation team to facilitate improvements in the implementation of future projects

3.    Outcomes:

This End-Term evaluation will document the progress toward objectives/outcomes, and identify best practices and lessons learnt which could inform models of programme implementation. The evaluation will generate information and recommendations Orbis can use to improve the effectiveness and efficiency of future projects.

4.    Deliverables:

1.    An inception package, outlining:

a.    Study design and methodology. In the methodology section, detail:

• Study Approach
• Data collection tools and organization
• Sampling procedures
• Quality assurance
• Data analysis
• Ethical considerations

b.    Work-plan

c.     Proposed Budget

2.    A presentation to Orbis International Zambia highlighting significant findings and draft recommendations before the end of fieldwork.

3.    A draft report to be reviewed and commented on by Orbis International Zambia.

4.    A final report of a maximum of 40 pages, excluding annexes, but including an executive summary of a maximum of two pages.

5.    A PowerPoint presentation of the main findings, conclusions, and recommendations, suitable for Orbis International Zambia to use in a presentation to stakeholders.

4.1. Structure of the final report

The report should include the following sections:

• Acknowledgments
• Table of contents
• Executive summary
• List of abbreviations
• Introduction
• Background: overview of project, strategy, and activities
• Methodology: methods, limitations
• Findings: Achievement of targets and outcomes and other qualitative project dimensions
• Discussion
• Recommendations
• Annexes: Data collection tools; lists of interviewees, documents reviewed, sites visited; and disclosure of any evaluation team member’s conflict of interest, etc.

5.    Study Scope, Questions, and Methodology

5.1. Scope of the evaluation:

This is the final evaluation of the project. The focus of this evaluation will be on relevance, effectiveness, efficiency, and sustainability, including best practices, success stories, and lessons learned. Due to constraints, it may not be possible to include all stakeholders from all supported districts and eye hospitals in this evaluation. Therefore, a sample of participants could be selected for in-depth assessments, or a combination of site visits for face-to-face interviews and telephonic interviews can be conducted.

The evaluation will cover all outcomes of the project. The evaluation will assess key outputs produced since the start of the project and where relevant make recommendations regarding:

• Achieving established targets.
• Quality of outputs in the project perio
• Document lessons learnt, challenges, and success stories.
• Immediate impact of the project

5.2. Study questions:

5.2.1.   Assess the Project’s Relevance and Alignment:

a)    Evaluate the extent to which the project’s objectives and strategies were relevant to the eye health needs of the target populations in Lusaka, Copperbelt, and Eastern provinces.

b)    Determine how well the project aligned with national health policies, priorities, and the strategic goals of Orbis International Zambia (OIZ) and the Ministry of Health.

c)    How effectively were the project activities aligned with the project objectives? Were there any gaps?

5.2.2.    Measure the Achievement of Project Outcomes and Impact:

a)    Assess the progress made towards achieving the project’s objectives, including improvements in human resources for eye health (HReH), the development of sustainable eye care services and systems, increased demand for eye health services, and the enhancement of the enabling environment for eye health policies.

b)    Quantify the project’s impact on the beneficiaries, particularly in terms of access to and quality of eye health services.

c)

5.2.3.    Evaluate Project Effectiveness:

a)    Analyze the effectiveness of the strategies and approaches used in the project, including training programmes, capacity-building initiatives, and partnerships with health facilities and the Ministry of Health.

b)    Identify the key factors that contributed to or hindered the achievement of the project’s outcomes.

5.2.4.    Assess the Efficiency of Resource Utilization:

a)    Review the allocation and utilization of financial, human, and material resources throughout the project’s implementation.

b)    Determine whether the resources were used efficiently to achieve the desired outcomes and whether there were any areas of resource waste or duplication.

5.2.5.    Examine the Sustainability of Project Interventions:

a)    Evaluate the likelihood of the continuation of project benefits after the conclusion of the project.

b)    Assess the capacity of local partners, health facilities, and the Ministry of Health to sustain the improvements in eye health services and systems.

5.2.6.    Identify Lessons Learnt and Best Practices:

a)    Document key lessons learnt from the project’s implementation, including successes, challenges, and innovations.

b)    Highlight best practices that could be replicated or scaled up in future eye health programmes within Zambia and other regions especially related to:

• The integration of eye health into primary and district levels.
• Data management system including data collection processes and other processes followed, relationships with partner staff involved in data management, and the challenges and advantages of the system implemented
• The partnership and relationship management with the Ministry of Health at a district and provincial level

5.2.7.    Provide Recommendations for Future Programming:

a)    Offer actionable recommendations for Orbis International Zambia and its partners to enhance the design and implementation of future eye health projects.

b)    Suggest strategies for scaling up successful interventions and addressing any gaps or weaknesses identified during the evaluation.

5.3. End-term evaluation methodology:

The consultant is expected to design an appropriate methodology to answer the study questions. The methodology and data collection tools will be finalized in consultation with Orbis. Typically, the consultant is required to travel to project sites and have face-to-face discussions with various project stakeholders to gather required information.

The methodology should include:

a.    Review of secondary data including but not limited to the project plan; M&E operational plan, data collection instruments, quarterly and annual progress reports; financial reports; medical/hospital data; and event reports, case studies, and special assessments/surveys. Retrieve core indicator data directly from the HMIS/records and analyse to unearth trends in volume of patient services provided (e.g., # of patient visits, # of surgeries performed, referrals, Ophthalmic drugs received by the facilities etc.) from partner hospitals, as well as validate data that has already been reported.

• Collect and analyze secondary data from eye health facilities.

b.    Generate primary data via methods such as the following:

• Interview health facility staff, management, and other key informants
• Consult with relevant Orbis staff.
• Conduct partner and beneficiaries’ satisfaction surveys using Orbis tools.

6.    Selection of sites or partners for the End-Term evaluation:

The consultant is required to sample some sites using a method that will help select a representative sample of the total sites. The project is implemented in urban, peri urban and rural districts. This therefore means the health facilities are at different levels. Some districts have ophthalmic staff and others don’t have, and this should be considered during sampling. The other factors to be considered but not limited to while sampling is:

• Service delivery level (e.g., primary, secondary, or tertiary)
• Geographical representations (e.g., rural vs. urban)
• Facilities with Ophthalmic staff (Ophthalmologists, Ophthalmic Clinical Officers and Ophthalmic Nurses)
• Gender representation

The following sites are the project implementation areas.

NAME OF ORGANIZATION
GEOGRAPHICAL REPRESENTATION
SERVICE DELIVERY LEVEL
OPHTHALMIC STAFF
Lusaka Provincial Health Office
Urban
Primary, secondary & Tertiary
Ophthalmologists, OCO & ONs
University Teaching Eye Hospital
Urban
Tertiary
Ophthalmologists, Residents, faculty, and ophthalmic staff
Chipata Central Hospital
Urban
Tertiary
Ophthalmologists, Residents
Kafue District Hospital
Urban
Primary & Secondary
OCO & ONs
Nakachenje Mini Hospital
Peri-urban
Primary
None
Chongwe District Hospital
Peri-urban
Primary & Secondary
OCO & ONs
St Lukes Mission Hospital
Rural
Primary & Secondary
None
Luangwa District Hospital
Rural
Primary & Secondary
OCO
Chilenje 1st Level Hospital
Urban
Primary
Ons
Chawama 1st Level Hospital
Urban
Primary
Ons
Matero 1st Level Hospital
Urban
Primary
ON
Mandevu Urban Clinic
Urban
Primary
OCO & ON

7.    Expected Competencies of and Selection Criteria for the Consultant

7.1. Expected Competencies of the Consultant

The consultant should have:

• At least a master’s degree in the field of public health/medicine/development studies/Demography/social science or other relevant discipline.
• Experience in research and evaluation in health systems, public health, community health, community development, and eye health care services
• Professional familiarity with hospital settings
• Available during the period of the evaluation
• Strong methodological skills in the development and implementation of data collection tools, data management, and analysis
• Excellent written English and report writing skills
• Available during the period of evaluation
• Oral and written proficiency in the local language

8.    Submission Checklist for Proposal

The consultant will submit a detailed proposal. The proposal must describe the methodology, tools, and analysis plan in detail. The proposal should be divided into two parts: technical and financial. The financial proposal will include the study’s estimated cost and list the consultant’s daily rate. The technical part will contain the following sections:

Background of the study company or organization
Detailed study methodology
Detailed work plan/timeframe
Consultant’s CV listing relevant experience.
References
Proposals will be subject to a price and quality comparison.

9.    How to Apply

Interested applicants are requested to submit proposals (technical and financials with withholding tax included) and required documents on or before 18th October 2024. Application should be submitted via email to info.zambia@orbis.org. Please mention “Strengthening Eye Health Capacity and Care in Lusaka, Copperbelt and Eastern provinces in Zambia Midterm evaluation TOR”.

10. Ethical Considerations:

The evaluation will respect human subjects’ considerations such as confidentiality of responses in interviews or discussions as well as any personal patient information (which will not include identifiers) and obtaining informed oral consent from patients participating in interviews or surveys.

10.1.            Child Protection Policy:

The firm/individual shall comply with the Child Protection Policy of Orbis International. Any violation/ deviation in complying with Orbis’ child protection policy will result in the termination of the agreement.

10.2. Binding:

All documents, papers, and data produced during the assessment are to be treated as Orbis property and restricted for public use. The contracted agency/consultant will submit all original documents, materials, and data to Orbis International Zambia.