1.1   Introduction

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

1.2   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 programs – a Flying Eye Hospital, Hospital Based Programs, Fellowships, and Cybersight – and has country programs in Asia, Africa, Latin America, and the Caribbean.

OIZ is branch of OI which was established in 2016 and works in partnership with the Ministry of Health. OIZ’s mission is to transform lives through the prevention and treatment of blindness and a vision of networking with partners, mentor, train and inspire local teams so that they can save sight in their communities. OIZ 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. OIZ 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).

OIZ with the support from the David and Molly Pyott Foundation is currently implementing 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 heath care for all in Lusaka, Copperbelt and Eastern province. The project is being implemented in Lusaka, Copperbelt and Eastern Province. In Lusaka Province, the project supports eye health services across all levels throughout the province’s six districts. At tertiary level, the project has partnered with the University Teaching Hospital (UTH)-Eye Hospital, Kitwe Teaching Eye Hospital, Ndola Teaching Hospital and Chipata Central Hospital.

1.3   Project objectives:

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

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

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

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

1.4   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. Students from the ophthalmology residency program get placed at Chipata general hospital and in turn they will offer services to the surrounding communities and those referred to the hospital.

1.5   Project Sites

• UTH Eye Hospital, Levy Mwanawasa Teaching Hospital, Kitwe Teaching Eye hospital and Ndola Teaching Hospital: responsible for training residents, coordinating outreach activities and the performance of static services and 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 that don’t need to be referred to the tertiary hospitals.
• District hospitals (secondary level): Deliver primary eye care and carry out outreach screenings in the community, and coordinates activities of the local Health Posts and Health Centers.
• Health Facilities (Primary Level): Build 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.

1.6   Project partners:

This project is being implemented in partnership with the Ministry of Health at all levels of care. At tertiary level, the OIZ is partnering 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 is supporting eye health services across all levels throughout the province’s six districts. The supported facilities include 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

1.7   Project strategy and approach:

With support from the David and Molly Pyott Foundation, OIZ is supporting 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 of 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         Objectives and Outcomes of the Evaluation

The mid-term evaluation will analyze progress made towards achieving project outcomes, identify lessons learned, challenges faced and propose recommendations for improved delivery of outputs and achievement of the outcomes. The evaluation will also provide the opportunity to take stock, reflect, learn, and share knowledge on lessons learnt and best practices which may have emerged during the project implementation thus far and facilitate improvements in the implementation of project activities in the remaining period of implementation.

The evaluation will serve three main purposes:

1.       It will provide an independent assessment of progress to date of the project, assessing performance as per the foreseen targets and indicators of achievement at 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, partnership arrangements.

3.       Develop recommendations based on the findings of the evaluation team to improve the project activities in the remaining year of implementation.

3         Mid Term Evaluation outcome:

This mid-term evaluation will document the progress toward objectives/outcomes, 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 the remaining phase of the project.

3.1   Mid-term evaluation 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 field work.

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

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

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

3.2    Structure of the final report

The report should be written in English and 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: Progress on indicators and other qualitative project dimensions
• Discussion
• Recommendations
• Annexes: TOR; data collection tools; lists of interviewees, documents reviewed, sites visited; and disclosure of any evaluation team member’s conflict of interest, etc.

4         Study Scope, Questions, and Methodology

4.1   Scope of the evaluation:

This evaluation is a mid-term, and a final evaluation will be conducted by the end of the project in 2024. Therefore, the focus of this evaluation will be on effectiveness, efficiency and progress to date, best practices and lessons learnt emerging. It will not be possible to include all stakeholders from all supported districts and eye hospitals in this evaluation. Therefore, a sample of participants could be considered for in-depth assessments or a combination of site visits for face-to-face interviews and telephonic interviews can be considered.

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:

• Progress towards achieving established targets.
• Quality of outputs in the project period
• Document lessons learned, challenges and unanticipated effects.
• Provide recommendations for mid-course corrections to strengthen performance and areas of focus for the final evaluation.

4.2   Study questions:

4.2.1          Relevance and validity of design

a.       To what extent were the objectives of the project suited to beneficiaries’ requirements, and relevant to country needs, global priorities and partners?

b.       How effectively were the project activities aligned with the project objectives? Are there any gaps?

c.       For project target groups (Ophthalmology residents and Faculty, and Ophthalmic staff and people seeking eye health services at supported facilities) how were they involved/consulted and how well was their feedback incorporated into project design and implementation?

d.      Have there been any changes in the beneficiaries or partners, district needs, Orbis priorities, change in context since the project inception, and if so are there any changes that the project should make to adapt changes?

4.2.2          Effectiveness

a.       Is the project making sufficient progress towards its planned objectives and outputs? What are the factors that are contributing to this?

b.       To what extent are the outputs produced and delivered so far satisfactory (stakeholders should be interviewed to gauge how they perceive them)?

c.       What are the main constraints, problems, and areas in need of further attention?

d.       To what extent was the program gender sensitive?

e.       Are there any unintended results of the project?

f.        What internal and external factors may have influenced the ability of the project to meet the project targets?

g.       Are the relevant stakeholders involved in an appropriate and sufficient manner?

h.       What are the satisfaction levels of program beneficiaries and partners on program service delivery?

4.2.3          Efficiency

a.       Have the available technical and financial resources been adequate to fulfil the project plan and were resources used efficiently?

b.       Have project funds and activities been delivered in a timely manner?

4.2.4          Effectiveness of project arrangements

a.       Have the management and governance arrangements of the project been adequate; is there a clear understanding of roles and responsibilities?

b.       Does the project management facilitate good results and efficient delivery?

4.2.5          Challenges, lessons learned and recommendations.

a.       What were the strengths, gaps/challenges?

b.       How are external factors beyond the control of the project team affecting the project?

c.       What good practices can be learned from the project that can be applied in the remaining project period, especially related to:

i.             The integration of eye health into primary and district levels.

ii.            The data management system including data collection processes and other processes followed, relationships with partner staff involved in data management, and  the challenges and advantages with the system that was implemented

iii.            The partnership and relationship management with the ministry of health at a district and provincial level

d.       What are overall recommendations coming out for the remaining project period?

5         Midterm 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. Currently the COVID-19 pandemic is not a threat, and the consultant will have contact meetings with respondents.

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 mid-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 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 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
Ophthmologists, Residents, faculty, and ophthalmic staff
Levy Mwanawasa Teaching Hospital
Urban
Tertiary
Ophthmologists, Residents, faculty, and ophthalmic staff
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
6.1 Expected Competencies of the Consultant

The consultant should have:

• At least a master’s degree in the field of public health/medicine/development studies/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

1.       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.

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2.       Payment Schedule

1st installment (40%) will be made after submission of the inception report/meeting.

2nd installment (40%) will be made upon submission of first draft.

3rd installment (20%) will be made upon submission of final report.

3.       How to Apply

Interested applicants are requested to summit proposal (technical and financials with withholding tax included) and required documents on or before 1st  September 2023. Application should be submitted via email to info.zambia@orbis.org copying in enock.nsokolo@orbis.org Please mention “Strengthening Eye Health Capacity and Care in Lusaka, Copperbelt and Eastern provinces in Zambia Midterm evaluation TOR”.

4.       Considerations

10.1 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.

10.2 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.

10.3 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.