Terms of Reference for a Feasibility Study at Christian Blind Mission

1.     SUMMARY

a) Planned Project:

Strengthening Integration of People Centred Ear and Hearing Care in Zambia

b) Country/Region:

Zambia Central, Eastern, Luapula, Lusaka, Northern, Muchinga, , Southern Provinces

c) Partner Organisation:

Beit CURE Hospital

d) Planned Project start date:

01.07.2024

e)Project Duration:

4 years

f) Study Purpose:

The aim of the requested consultancy is to assess the feasibility of the “Strengthening Integration of People Centred Ear and Hearing Care in Zambia” project concept, and to systematically check the extent to which the concept can plausibly achieve the planned changes in the suggested timeframe and the available budget. Furthermore, the study should provide baseline data and recommendations -supported with justifications- to improve the project concept.

g) Commissioning organisation/contact person:

CBM Christoffel Blindenmission Christian Blind Mission e.V. Zambia Country Office (Dr. Linda Kasonka Nonde Country Director supported by Slinganiso Homela Program Manager)

h) Planned start date of the Feasibility Study:

1st August 2023

i) Study duration:

(1.5) Months

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2. Background of the feasibility study

Beit CURE Hospital and CBM are currently developing a project which shall contribute to improve the quality of life for people with, or at risk of, acquiring hearing loss. The project is currently in its design phase and CBM is seeking to recruit a consultant to conduct a Feasibility Study to assess the feasibility of the proposed project and systematically check the extent to which the project approach can plausibly achieve the planned changes under the existing framework conditions.

It is planned to submit this project proposal to the German Federal Ministry of Economic Cooperation and Development (BMZ) for funding in early 2024.

a) About CBM

CBM Christoffel Blindenmission Christian Blind Mission e.V. CBM is an international Christian development organisation, committed to improving the quality of life of persons with disabilities in the poorest communities of the world. Based on Christian values and more than 100 years of professional expertise, CBM addresses poverty as a cause and a consequence of disability. CBM works in partnership to create an inclusive society for all. The emphasis is on local capacity development in poorer regions of the world. This includes service delivery in the fields of healthcare, education, rehabilitation and livelihood development as well as organisational development of partner organisations.

b) About Beit Cure Mission Hospital

Established in 2006, Beit CURE Hospital Zambia is a specialised 54 bed capacity teaching hospital dedicated to treatment and care of children with disabilities and their families. Annually the hospital, performs over 2,500 life-changing reconstructive, orthopaedic, ENT, and audio logical surgeries. In addition to specialized health care provision, the hospital contributes to capacity building of government health care workers through training.

3. Description of the project

The project, “Strengthening Integration of People Cantered Ear and Hearing Care” is a project aimed at contributing to the quality of life for people with or at risk of acquiring hearing loss through scaled up access to a continuum of care.  By implementing a scaled-up approach, the project aims to extend the reach of essential ear and hearing care services to a larger population. This includes individuals who are currently underserved or face barriers in accessing proper care.

The problem the planned project should address:

The WHO estimates that over 5% of the world’s population – or 430 million people – require rehabilitation to address their disabling hearing loss (432 million adults and 34 million children). It is further estimated that by 2050 over 700 million people – or 1 in every 10 people – will have disabling hearing loss.

‘Disabling’ hearing loss refers to hearing loss greater than 35 decibels (dB) in the better hearing ear. Nearly 80% of people with disabling hearing loss live in low- and middle-income countries.

Many of the causes that lead to hearing loss can be avoided through public health strategies and clinical interventions implemented across the life course.

This project therefore, will potentially contribute to some of these interventions and will directly or indirectly address the following issues:

a) Limited access to services: There is absence of formal ear and hearing care services in most parts of the project catchment area especially in low resourced or underserved communities. This lack of access increases the cost burden on people in these communities leading to increased risk of living with untreated hearing loss, communication difficulties and reduced quality of life.

b) Limited access to Rehabilitation Services: In addition to timely diagnosis and treatment, comprehensive rehabilitation services such as provision of hearing aids and other assistive listening devices, counselling, auditory training and Speech Therapy are essential for individuals with hearing loss. These services are unfortunately scantly available in Lusaka.

c) Shortage of trained professionals and specialists in the field of ear and hearing care: Early identification and management of hearing impairment and ear-related conditions can significantly improve outcomes. However, this is not attainable because Zambia, like many other countries in Sub-Saharan Africa, faces a severe shortage of specialised health care professionals such as Otologists, Audiologists, Hearing Instrument Specialists and Speech Therapists.

d) Limited public awareness and education: Insufficient awareness about ear and hearing care can contribute to a lack of public knowledge regarding signs of hearing loss, preventive measures, and available support services. This can lead to delayed seeking of help and missed opportunities for early intervention and treatment.

e) Social isolation, stigma and discrimination:  People with hearing loss often face stigma and discrimination, which can negatively impact their self-esteem and overall well-being. This usually leads to social isolation and reduced participation in various aspects of life. The situation at community level is worsened by the lack of public awareness campaigns, community engagements and inclusive initiatives that fosters understanding, acceptance and inclusive environment.

f) Policy and funding gaps: Governments world over play a critical role in formulating policies and allocating of resources for ear and care services. However, government officials lack capacity on implementation of policies that prioritize people-centred ear and hearing care and protection of their rights and needs.

g) The lack of capacity : among Organisations of People with Disabilities (OPDs), the media, and other stakeholders regarding issues related to ear and hearing care and the inclusion of people affected by disabilities is a significant challenge requiring attention.

h) Lack of research: The field of ear and hearing care, like any other healthcare discipline, relies heavily on research to inform evidence-based practices. Lack of research in this area continues to significantly affect the quality of care and outcomes for individuals with ear and hearing issues. As the actual magnitude of the prevalence of hearing loss remains unclear, it is usually considered less severe by funding agencies compared to other health conditions leading to lower ranking on the list of priority areas.

Target area

Zambia: Central, Eastern, Luapula, Lusaka, Northern, Muchinga, Southern Provinces

Target group

• 410 Health Care Workers of different Cadres will be trained in ear and hearing care and audiology
• 60 school teachers will be trained as Trainers of Trainers (Tots) in identification of schoolchildren experiencing hearing loss.
• 4.2 million people in the total catchment population will have equitable access to comprehensive ear and hearing care and rehabilitation services (Target will be measured using trained health care workers per 100,000 populations.

4. Purpose of the feasibility study

The project is currently in its development phase and CBM is seeking to recruit a consultant to conduct a feasibility study of the planned project to systematically check the extent to which the suggested project concept can plausibly achieve the planned changes in the suggested timeframe and the available budget. The assessment shall be based on the OECD/DAC evaluation criteria. Quality Standards for Development Evaluation: Development Assistance Committee (DAC) of the Organization for Economic Co-operation and Development (OECD):

Furthermore, the study should provide recommendations-supported with justifications- to improve the project concept. The recommendations will be integrated into the final project concept as far as possible. The study will be submitted to BMZ together with the project proposal.

5. Methodology

Independent of the methods to be used, there are mandatory mechanisms that must be adhered to during the entire process:

• Participatory and inclusive methods
• Safeguarding of children and adults at risk
• Data Disaggregation (gender/age/disability)
• Data Security and privacy (informed consent)

The consultant is expected to use a variety of methods to collect and analyse data. Participatory methods should be used to collect qualitative and quantitative data. The consultant shall indicate the methodology he/she intends to use in his/her offer.

To speak to deaf or hard of hearing target group representatives, local sign language interpretation and assistive technology in case of remote virtual interviews of persons who are hard of hearing, will need to be provided to support interaction with consultant.

6. REQUIRED EXPERTISE OF THE CONSULTANT/ CONSULTANT TEAM:

The team of consultant should have the following attributes among others;

• Academic Degree and extensive expertise and experience in the field of ENT health and/or Audiology.
• Solid understanding of ear and hearing care in low-resourced settings.
• Extensive knowledge of the Zambian health system.
• Proven record of carrying out similar studies in the region and/or Zambia;
• Track record in designing and conducting quantitative and qualitative studies;
• Experience in undertaking research with remote and marginalized communities;
• Knowledge of international instruments and national statutes for persons with disabilities;
• Experience in designing and conducting disability inclusive and participatory studies;
• Excellent interpersonal and communication skills including ability to facilitate and work in a multidisciplinary team;
• Strong analytical skills and ability to clearly synthesise and present findings;
• Ability to draw practical conclusions and to prepare well‐written reports in a timely manner and availability during the proposed period;
• Ability to speak local languages
• Ability to communicate in sign language (local and/or international SL) will be an asset.
• Experience in working with Deaf communities and/or Hard of Hearing persons’ groups is considered an advantage.

Safeguarding Policy: As a condition of entering into a consultancy agreement the consultants must sign the CBM’s or Beit Cures Safeguarding Policy and abide by the terms and conditions thereof.

7. Expression of Interest

The consultant is expected to submit both the technical and financial proposal including the following:

• An outline of the understanding of these TORs
• An itemised detailed work plan for the entire assignment.
• A technical and detailed financial proposal with a specific focus on addressing the scope of work and methodology (indicating description of activities in chronological sequence and dates for each activity).
• A profile of the consultant including full name, physical address/es, telephone number(s).
• Copy of CV of consultant who will undertake the feasibility study.
• CV of suggested team members and description of the role of each team member needs to be included.
• Detailed breakdown of the daily rates of each feasibility study team member and expected number of working days per team member. CBM reserves the right to negotiate the final fees in line with the budget available for this feasibility study and based on the experience of the chosen candidates.
• Details reimbursable (travel cost, accommodation and substance allowance during travel, communication)
• The budget should be presented in Zambian Kwacha
• The costs for organizing the workshop with stakeholders will be covered by CBM

A detailed budget for the expected assignment. (This shall include all costs needed to conduct a disability inclusive and participatory study, and all taxes according to the rules and regulations of the consultants’ local tax authorities)

CBM reserves the right to terminate the contract in case the agreed consultant/s are unavailable at the start or during the assignment.

The proposal should to be sent to via email to: procurement.zambia@cbm.org by 14th July, 2023. Detailed TORs will be shared upon engagement.

Only complete applications will be accepted and assessed by the selection committee based on the above requirements.