1.     Introduction

These Terms of Reference (TOR) outline the requirements of conducting a research study to investigate the barriers and enablers of primary eye care in Lusaka, Eastern, and Copperbelt provinces.

2.     Background

The Zambian Ministry of Health’s National Eye Health Strategic Plan (2022-26) is a comprehensive framework that guides the planning, delivery, and management of quality eye health care services across all levels of eye health delivery systems in Zambia. The aim of this plan is to address the various eye problems faced by the people of Zambia through a strategic approach to eye health system strengthening, integration with the wider health system, improving equity of access, building strong partnerships and health research. According to the strategic plan, comprehensive eye health services are presently offered from primary to tertiary levels in all ten provinces of Zambia, providing coverage of 80% mainly along the line of rail in Copperbelt, Southern, and Lusaka provinces. In addition to the public eye health services, several private health facilities are also providing quality eye care services, including five private hospitals.

In recent years, Zambia has recognized the significance of eye healthcare services in maintaining overall well-being. Vision plays a fundamental role in daily life, impacting education, employment, and quality of life. Despite the progress made in eye care, there is still a significant gap in understanding the utilization patterns of these services. Zambia, like many developing countries, faces unique healthcare challenges that affect the delivery and uptake of essential services, including primary eye care. The country continues to struggle with disparities in healthcare access, limited resources, and a high burden of preventable eye conditions.

In Zambia, the available data on eye health mainly relies on information from the WHO and studies conducted within the region. To address this gap, the National Eye Health Strategic Plan (NEHSP) for 2022-2026 has identified research as a crucial intervention to provide information for planning, policy formulation, decision-making, and strengthening of health systems.

Against this backdrop, Orbis intends to hire a consultant to conduct research to investigate the barriers and enablers of primary eye care utilization in three provinces, namely Lusaka, Eastern, and Copperbelt.

3.     Orbis International

Orbis International (OI) is a partner to the Ministry of Health supporting the prevention and treatment of blindness, scaling up of universal eye health services to ensure equitable access to quality, affordable and inclusive eye health for everyone. 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 programs – a Flying Eye Hospital, Hospital Based Programs, Fellowships, and Cybersight, a telemedicine program. Orbis operates in Asia, Africa, Latin America, and the Caribbean.

Orbis International Zambia (OIZ) is a branch of Orbis International that has been working in partnership with the Ministry of Health since 2010. Orbis Zambia’s mission is to transform lives through the prevention and treatment of blindness and a vision of networking with partners, mentoring, train and inspiring local teams so that they can save sight in their communities. Orbis Zambia has implemented programs in all the 11 districts of North-Western province for the past 9 years, including a targeted cataract project to serve the elderly population in the province that are not able to afford cataract surgery. In Lusaka, our support for the past 7 years focused on training for Human Resource 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 and selected health facilities. Orbis Zambia implemented projects with restricted grants in Lusaka, Copperbelt and North- Western provinces. The projects covered areas such as Pediatric Eye Health, Cataract surgery, Human Resource 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 improving cataract surgical outcomes through use of the Better Outcomes Operating Software Tool (BOOST).

4.     Objectives of the proposed study

Eye health is a critical component of overall health, yet many individuals in Zambia may not be accessing primary eye care services as needed. This lack of utilization of eye health services can lead to undiagnosed and untreated vision impairments, ultimately affecting individuals’ daily lives, productivity, and overall well-being. Addressing the barriers and enhancing enablers to primary eye care utilization is essential for promoting a healthier population. Despite the acknowledged importance of eye health care services, there remains a significant gap in (1) research and understanding concerning the access and utilization patterns (2) Limited empirical evidence exists regarding how people access and utilize these services, leading to a lack of targeted interventions to address disparities. These gaps in knowledge hinders efforts to ensure equitable access to eye healthcare services and prevent avoidable vision impairment and blindness.

This study will help Orbis Zambia by (1) providing evidence-based insights and recommendations that will improve the efficiency of its programming and practices to make them more inclusive and responsive to the needs of its partners and beneficiaries; and (2) to help identify barriers and enablers to primary eye care that exist and affect access to eye health services in communities that Orbis programs serve, including the vulnerable and differently-abled.

By comprehensively understanding these dynamics, Orbis Zambia can develop evidence-based strategies to improve access, reduce disparities, and enhance eye health outcomes.

The research study will address the following specific objectives:

1.     To identify barriers and enablers influencing access to eye healthcare services.

2.     To identify specific demographic groups that face unique barriers to accessing and utilizing eye care,

3.     To analyze patterns of utilization of eye healthcare services

5.     Methodology

The assignment should adopt a mixed method- combining quantitative and qualitative strategies in the study to complete the assignment in line with the outlined outputs. The consultant will design the methodology and develop data collection tools which will be finalized in consultation with Orbis Zambia. The study should capture knowledge of local dynamics, challenges, and possible solutions regarding access to eye health.  Further, the consultant must sample sites using a method that will help select a representative sample of the supported Orbis provinces. The study should include respondents from urban, peri urban and rural districts. The other factors to be considered but not limited to while sampling are:

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 methodology should include:

Preparatory phase – A consultative/planning meeting with Orbis Zambia, and other partners working in eye health. Other preparatory meetings to be held with other key stakeholders as identified.

Generate primary data – Interview health facility staff, management, community gatekeepers and members and other key informants.

Data validation, analysis and report writing.

Develop evidence-based recommendations for interventions aimed at improving access and utilization of eye healthcare services.

6.     Assignment Outputs

1.     A final report of a maximum of 40 pages, excluding annexes, which includes an executive summary of maximum two pages, summarizing all findings, should be submitted to Orbis Zambia for review and approval.

2.     A power-point presentation of the main findings, conclusions, and recommendations, suitable for Orbis International Zambia to use in presentation to stakeholders.

7.     Expected competencies of the Consultant

The consultant should have:

1. At least a master’s degree in the field of public health/medicine/development studies/social science or other relevant discipline.

2. Experience working with the Ministry of Health at levels.

3. At least 10 years’ experience in research and evaluation in health systems, public health, and eye health care services

4. Strong methodological skills in the development and implementation of data collection tools, data management, and analysis (including use of statistical packages)

5. Excellent written English and report writing skills

6. Availability during the period of the assignment

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 summit proposal (technical and financials with withholding tax included) and required documents on or before 10th June 2024. Applications should be submitted via email to info.zambia@orbis.org Please mention “Primary Eye Care Research TOR”.

10.  Considerations

a.     Ethical Considerations:

The research study should 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.

b.     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 termination of the agreement.

c.     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.