Invitation Bid for Provision of Consultancy Service for Process Evaluation of Community-Based Delivery of Life-Saving Maternal and Newborn Health Interventions and Participatory Learning and Action (PLA)

About Us:

Amref Health Africa is the largest African-based and led international health development organization serving over 30 million people annually across 35 countries in sub-Saharan Africa.  Strategically engaging with communities, governments, and local partners for the past 65 years, we work through our European and North American network of sister organizations on program implementation, advocacy, fundraising and partnership. Our subsidiaries include Amref Flying Doctors, Amref Enterprises Limited, and the Amref International University.  Our organization is driven by its vision to bring lasting health change in Africa and its mission to catalyze and drive community-led and people-centered health systems while addressing social determinants of health. Amref believes that the power to transform Africa’s health lies within its communities, and therefore strives to ensure that health systems are functioning at an optimal level and communities are empowered to hold these systems accountable for the delivery of high-quality and affordable health care.  

Amref has been active in Ethiopia since the 1960s and became fully operational as of 2002. We have been partnering with the Ethiopian government and local communities to co-create solutions and implement diverse health and development project portfolios throughout the country for over twenty years. Aligning with the national Health Sector Transformation Plan II (HSTP II), we work to ensure health equity by serving women and children, reaching the most disadvantaged, inaccessible communities including pastoralist communities and placing an emphasis on youth development.  Our programs are designed to support community level interventions while strengthening health systems at the regional and national levels. With an integrated and multi-sectoral approach, Amref strategically addresses cross-cutting issues through these programmatic focus areas.  

Our program focus area  

• Reproductive, Maternal, Neonatal, Child, Adolescent & Youth Health and Nutrition 

• Health Systems Strengthening 

• Youth Development 

• Water, Sanitation and Hygiene 

• Disease Prevention and Control 

Amref Health Africa works closely with key government ministries and regional offices including the Ministry of Health, Ministry of Women and Social Affairs, Ministry of Water and Energy, Ministry of Education, Ministry of Labor and Skills, as well as multiple local and international health and development implementing organizations. We implement projects in 12 regional states and two city administrations. 

Background

In Ethiopia, approximately half of the estimated four million annual births occur at home under unsafe conditions [1]. These challenges significantly vary across segments, with high incidences of home birth aligning with more vulnerable populations [2]. Despite these facts, the current health system approach has limited focus on these vulnerable population segments. Vulnerable populations face systemic, socio-cultural, and logistical barriers that limit access to life-saving interventions. For instance, most hemorrhage-related maternal deaths occur in poorly resourced facilities or outside a health facility where there is no access to skilled obstetric care [3].

Community-based delivery of maternal and child health interventions, such as community engagement and women’s groups practicing facilitated participatory learning and action (PLA), has demonstrated improved uptake of maternal and newborn health (MNH) services, practices, and outcomes [4]. In settings where there is a high rate of home birth, optimizing existing community engagement strategies to deliver life-saving MNH interventions in community settings and expanding the contents of the community-based MNH package—such as misoprostol for the prevention and treatment of postpartum hemorrhage (PPH) and chlorhexidine for the prevention of neonatal sepsis—would maximize impact [4].

Community-based delivery of MNH interventions, including advanced distribution of misoprostol to women during pregnancy, has been implemented in Ethiopia and has demonstrated increased use [5]. However, concerns among policymakers and program managers about the diversion of facility births, misuse, and adverse effects of misoprostol have hindered the program’s appropriate scaling [6]. JSI and Amref, in collaboration with the Ministry of Health and other partners, have been conducting implementation research since November 2022 to generate rigorous evidence. Following a consultative process, a PLA approach and community-based delivery of life-saving MNH interventions have been designed for settings with persistently low utilization of facility-based MNH care. As part of the implementation research, we intend to evaluate the implementation fidelity, safety, reach, and community-level impact of a community-based maternal and neonatal health (MNH) and PLA, focusing on engagement strategies and the delivery of life-saving interventions, to identify areas for improvement and inform future program scaling.

Specific Objectives

1. Assess the implementation fidelity of community-based delivery of life-saving MNH interventions and PLA
2. Evaluate the reach and safety of community-based delivery mechanisms for life-saving MNH interventions and PLA strategies
3. Explore community perceptions and acceptability of the strategies 
4. Assess the extent of integration of the strategies with the primary health care system 

5. Assess the performance of VHLs (Makfta and Reers) in distributing and delivering lifesaving package with basic information and referral linkage 

Purpose and scope of the process evaluation 

Improve primary Health Care Service Delivery (IPHCSD) project is looking for self-motivated Research consultant with a passion for community health who will be able to conduct process evaluation of the community-based delivery of life-saving maternal and newborn health interventions in and participatory learning and action (PLA) approaches. The consultancy firm will work in collaboration with the Research, Monitoring, and evaluation team of IPHCSD project. Through this project, a substantial body of data and evidence has been generating that needs critical follow up and documentation to produce knowledge products that inform the prototype development for community-based lifesaving package distribution inline to the national selfcare guideline of Ethiopia. The community-based delivery of life-saving maternal and newborn health service as supplement project with in the broad IPHCSD project is being implemented in Chifra Woreda of Afar Region and Degahbur and Gursum Woredas of Somali region. The consultancy firm is/are expected to carry out process evaluation the lifesaving MNH package distribution and PLA-MNH approaches status at three Woredas, and work with the Amref Health Africa IPHCSD project Regional and Country office staff. 

Methods

Project description and setting

Since December 2023, JSI and Amref have been designing and implementing home-based interventions such as promoting facility births, educating communities on birth preparedness and complication readiness, and facilitating the advance distribution of iron and folic acid (Fefol) supplementation, misoprostol, chlorhexidine, and progesterone-only family planning pills (POP). These efforts are being carried out at seven health centers and across 38 vulnerable communities, serving a population of 210,787, through home visits conducted by community volunteers to address barriers related to geographic distance and lack of facility access in the Chifra woreda of Afar, Degahabur woreda of Somali. Since March 2024, PLA has been implemented in Three woredas across 35 communities (i.e., kebeles) in pastoral context, particularly in the Chifra woreda of Afar, Gursum and Degahbur woredas of Somali.

Community-based delivery of MNH interventions for vulnerable women: Following a series of consultations and co-design processes, a consensus was reached to deliver these life-saving interventions through Village Health Leaders (VHLs). VHLs are responsible for identifying pregnant women who meet the eligibility criteria for the MNH intervention package. Once enrolled, VHLs monitor the women throughout their pregnancy and provide postpartum support, including three home visits to deliver these critical interventions, as illustrated in Figure 1. During these visits, VHLs will ensure that women receive the necessary health commodities and care, including guidance on birth preparedness, complication readiness, and other MNH-related services. For this purpose, the project recruited and trained 198 VHLs (89 in agrarian areas and 109 in pastoral areas). After the training, each VHL was provided with a start-up kit containing misoprostol, chlorhexidine, POP, Fefol, counseling materials, and data collection tools. They are actively identifying and enrolling pregnant women within their communities. 

Community-based delivery of MNH services and home visitation schedule for vulnerable communities

1. Identification of pregnant women

• Active surveillance and identification of pregnant women
• Promote facility birth and household practices
• Link the pregnant women with PLA

         2.  1st visit (< 7 months of pregnancy)

• Register pregnant women
• Distribute Fefol supplement
• Counsel on birth preparedness and complication plan

        3. 2nd visit (7-9 months of pregnancy)

• Distribute misoprostol, chlorohexidine, and Fefol
• Counsel on birth preparedness and complication plan

        4. 3rd visit (within first week of postpartum)

• Postpartum home visit to check mother and newborn
• Promote kangaroo mother care for preterm and small babies
• Postpartum family planning (POP)

To support these efforts, the project developed several key tools: an implementation guide, an orientation manual for distributors, package inserts for mothers, a cohort monitoring tool, and an adverse event reporting tool, all translated into the local language (Amharic, Afar, and Af-Somali). Additionally, the project secured essential drugs from the health system to ensure the availability of evidence-based intervention packages (misoprostol, chlorhexidine, POP, and Fefol). 

As part of strengthening community-based lifesaving MNH interventions, the project also aims to enhance the health system to promote facility deliveries. This includes improving maternity waiting homes and strengthening referral links within the intervention Primary Health Care Units.

PLA groups for MNH: The project team provided Training for Trainers (TOT) on PLA. The PLA manual, picture cards, and monitoring and evaluation (M&E) tools were subsequently adapted and translated for local use. Following a co-design workshop, 265 PLA MNH groups were formed- 119 in pastoral areas.  These PLA groups operate under the leadership of VHLs, who facilitate monthly meetings in line with PLA implementation guidelines. Health Extension Workers (HEWs) oversee facilitators and meetings, while Health Extension Program (HEP) focal persons manage the initiative by providing oversight, supporting training, and assisting with monthly data collection. 

Design and sampling methods

A mixed-methods process evaluation will be conducted to address the research questions by combining qualitative data with quantitative program monitoring data. The qualitative component will employ a phenomenological study design and purposive stratified sampling to explore program implementation experiences among program managers, implementers (VHLs), and beneficiaries in both agrarian and pastoral settings.

For the community-based delivery of the MNH strategy, beneficiaries are postpartum women who gave birth within the last six months, implementers are VHLs, and program managers include HEWs, PHCU directors, HEP focal persons, woreda experts, and project field officers. In the PLA strategy, participants include women (pregnant and non-pregnant), men, VHLs, and adolescents, with VHLs serving as facilitators and HEWs and HEP focal persons acting as managers.

Theoretical sampling will ensure rich data collection, continuing until category saturation is achieved[7], typically after a minimum of six in-depth interviews per category [8]. Quantitative data will include monthly PLA reports via Kobo Collect and longitudinal tracking of a cohort of mothers from early pregnancy to the first postpartum week, with follow-ups conducted by trained VHLs at home. Data have been captured using smartphone-based data entry integrated with the DHIS2 tracker. 

Qualitative data collection will involve in-depth interviews (IDIs) and focus group discussions (FGDs) with VHLs, program managers, and beneficiaries (Table 1) using a semi-structured guide (Annexes A & B). 

Table 1: Study participants and required sample for the qualitative component of the study

Table 2 depicts a summary of the study objectives, research questions, and methods.

Table 2: Matrix of study objectives, research questions, and methods

Data collection and analysis

Interview and discussion guides with open-ended questions will be used to gather qualitative data from informants and discussants. Trained qualitative experts will conduct interviews and FGDs in natural settings, with conversations audio-recorded using digital recorders after obtaining participants’ consent. Audio recordings will be transcribed verbatim, and the transcripts will be analyzed using ATLAS.ti software. Throughout data collection, the IDI and FGD guides will be revisited and adjusted as needed to ensure comprehensive information is captured. Emerging categories and concepts from one group of informants or discussants will be verified by cross-referencing data from other groups to enhance the trustworthiness of the analysis. These categories will also be supported with direct quotes from key informants and discussants to improve reliability. The qualitative and quantitative methods will be integrated during the interpretation phase in February 2025 to provide a comprehensive description of the study findings and produce the final report (Table 3).

Research Consultancy Firm Responsibilities and Deliverables

Research Consultancy Firm is responsible for providing the following deliverables 

• Develop inception report and submit within seven days

• The research consultant is/are responsible for recruitment of data collectors selecting, preparing, training, and assigned to perform the process evaluation and learning documentation  

• Conduct the data collection using mixed method approach form MNH and PLA. 

• Carry out review of paper-based data (Pregnant women cohort monitoring and PLA meetings) collected at 3 woredas in two regions: Afar and Somali and confirm with the number submitted to DHIS2

• Conducted data analysis of the collected data in both qualitative (KII, IDI, FGDs, and co-design reports) and quantitative methods (DHIS2 and Kobo tool). 

• Carry out comprehensive health post readiness and service availability data set

• Prepare concise report with publishable manuscript 

Work plan

Table 3: Gantt chart for the process evaluation of community-based delivery of MNH interventions and PLA, February-March 2025

Report To: The IPHCSD Technical Director

Professions and Skills requirement of the consultant 

• PI and co-investigators should have an advanced university degree (Master’s degree or PhD preferred) in public health, behavioral science, health education, social sciences, or a related field

• Proven experience in utilizing data to support research efforts and a high level of data literacy

• Demonstrated experience in qualitative data collection and analysis

• Previous experience working with local consultants in conducting research and analysis

• Experience in program implementation process evaluation

• Strong interpersonal and communication skills

• Fluency in both written and spoken English, as well as among members who have proficiency in local languages (Amharic, Afar, and Somali)

Requirements and Evaluation Criteria

 Technical proposal (70%) and financial proposal (30%)

Technical evaluation 

• Organizational/Consultant Experience (10%)…….(Relevant attached experience A brief of past relevant assignments (in similar regions) indicating scope, geographic coverage, staff involved, budget, and client (name and contacts))
• Understanding of the TOR and Proposed Approach (30%)
• Overall structure of the proposal/Understanding of TOR and Proposed Approach and Methodology/Work Plan (
• A clear organizational perspective on the assignment.
• Key considerations for successful implementation.
• Detailed proposed methodology and work plan
• Qualification & Experience of Staff /Team composition of the staff (CVs for nominated staff indicating their academic qualification and clear relevant experience summary)
• Qualification and Experience of Staff (25%)
• Team composition with CVs indicating academic qualifications and relevant experience.
• Specific roles and responsibilities of each team member
• Work Schedule (5%)

      Realistic and detailed schedule for the assignment, including key milestones and deliverables.

The pass mark for technical evaluation will be 55%. Bidders who score below the pass mark will be considered non-responsive and will not move to the next evaluation stage (financial evaluation).

 Financial Evaluation Criteria (30%):

• 30 % finical evaluation (A breakdown of costs detailing proposed staff days, daily rates, taxes, and other direct expenses related to the assignment in the regions)
• A detailed cost breakdown including:
  • Staff days and daily rates.
  • Taxes and other direct expenses related to the assignment in the regions.

Preliminary Evaluation Criteria

Bids will be evaluated based on the below criteria.

Bids lacking any of the documents below will be considered as non-responsive and therefore will be eliminated at this stage.

Note: Bids missing any of the 3 mandatory requirements above will be considered as non-responsive bid and therefore will be eliminated at this stage. 

Logistics

The consulting firm will cover all logistical costs, including transport, accommodation, and other expenses related to the assignment in the field.

Payment Terms

Payment will be made in three installments upon assignment milestone 

• The first installment payment of 30% advance of the total agreed contractual amount up on approval of the inception report;
• Second installment (40%) up on completing data collection (entry to DHIS2 for community based intervention and Koboo tool fro PLA meetings) and preliminary report submission 
• 30% of the total agreed contractual amount upon the approval and acceptance of the final research report(S)

Duration

The research consultant will deliver the assignment within 40 days within February – March 2025 with possibility of extension based on availability of resource. with specific timelines for deliverables to be agreed upon prior to the commencement of work.

How To Apply

Amref Health Africa, Ethiopia Office invites bids from eligible bidders for the provision of consultancy service for process evaluation of community-based delivery of life-saving Maternal and Newborn Health interventions and Participatory Learning and Action (PLA)

Complete sets of tender documents in English be obtained from 2merkato site link ( https://tender.2merkato.com/tenders/6790fe45e822cb7736effa6c and ethiojobs website by all interested and eligible bidders.

1. All firms organized and licensed under the laws of Ethiopia that qualify to bid are invited to participate in this bid and have to fulfill the following requirements

a. Bidders should have a valid and renewed trade license for the year;

b. Bidders should be VAT registered

c. bidders should have TIN certificate 

2. Bidders must submit their technical and financial offer separately in soft copy only marked as technical and financial document at  Tender.Ethiopia@amref.orgon or before February- 5 -2025- 10:00 AM

 The financial bid will only be opened for those bidders who will have qualified in the technical evaluation. 

Tender Documents should be received on or before February- 5 -2025- 10:00(morning) at Tender.Ethiopia@amref.org Late tenders will be rejected. 

The aforementioned Office reserves the right to accept or reject any or all bids and is not bound to give reasons for its decision.

Remarks 

The knowledge generated by this process should be used by Amref Health Africa to inform and amplify its future activities and projects in the country and will also be used by other national stakeholders to further refine the quality, cohesiveness and timeliness of policies in the field of Health system. However, the research assistant can serve as a co-authorship role but not as a principal investigator as per Amref research publication policy.