****Terms of Reference: Evaluation of the Health Institution Capacity Assessment Process (HICAP)****
- Background
For nearly 20 years, Concern Worldwide has implemented community health initiatives designed to expand access to services, foster healthy practices at the household level, and strengthen community health systems. Central to all of these programs is the commitment to building the capacity of local governance structures responsible for the provision and/or oversight of community health services.
Responding to a need to measure and monitor local organizational capacity and create actions plans to foster change at the community level, Concern Worldwide developed and refined the Health Institution Capacity Assessment Process (HICAP), under a USAID-funded Child Survival grant in Bangladesh (1998-2008). The HICAP is a participatory, capacity building approach that assists local governance structures to fulfil their roles and responsibilities with regards to health issues in their community. The assessment focuses on crucial issues of health service delivery, while maintaining a continued focus on the capacity development process of the local structures.
The application of the HICAP with local governance structures in the Bangladesh program was identified as a critical element of the program’s sustained success, by transforming Concern’s relationship with municipal health committees and increasing the role of local government in coordination health promotion and services in their area[1].
****2. Introduction****
In Malawi, Concern has been implementing a health and nutrition programme in Nkhotakota District since 2010. From 2010 to 2013, Concern implemented a programme to reduce morbidity and mortality among children under five. From 2013, Concern began implementing a maternal and reproductive health project with funding from Merck for Mothers and the Scottish Government.
A key strategy of both programmes has been strengthening of local governance structures such as Village Development Committees and Village Health Committees, with an objective of improved capacity of government and traditional leadership structures to plan, manage, support and monitor key health activities.
Beginning in 2010, Concern Malawi applied the HICAP tool to assess the specific functions of the Village Development Committee (VDC), which is the lowest level of formal governance structure under Malawi’s Decentralization Policy. After a short orientation on VDC roles and responsibilities, Concern facilitators use the HICAP tool to guide the VDC in assessing their own level of capacity on indicators under five key capacity areas: leadership and governance, collaboration and coordination, resource mobilization, participatory planning, and monitoring and evaluation.
Every six months, Concern staff, in partnership with local government counterparts, follow up with VDCs to reassess their progress. The self-generated capacity scores are recorded in a database for tracking over time. There are currently 58 VDCs in Nkhotakota that have gone through the HICAP process. Concern is now replicating the HICAP approach with 36 VDCs under an integrated agriculture and nutrition programme in Mchinji district, and Concern is also implementing the HICAP as a key element of its child survival programme in Sierra Leone.
****3. Purpose of Evaluation:****
The HICAP has provided Concern with a key method to engage with local governance structures around community health. As the application of the tool continues to expand within the organization, not only within the health sector, but also within the Food, Income and Markets and potentially other sectors, Concern seeks to review the effectiveness, relevance, and sustainability of the HICAP process in strengthening health capacity and coordination at community level. Specifically, the evaluation seeks to understand:
- Process: What are the overall strengths and weaknesses of the HICAP process as perceived by VDCs and other stakeholders?
- Accuracy: Are the HICAP self-assessment scores accurate reflections of increases in capacity? To what extent do the scores actually correlate to improvements in real-life capacity?
- Relevance: Are the capacity areas measured relevant to VDCs’ capacity-building needs?
- Effectiveness: To what extent has the HICAP tool served to strengthen community capacity to plan and manage community health initiatives, and how has it done so?
- Is there evidence of improved VDC leadership capacity on health?
- Is there evidence of improved linkages between communities and the health system?
- What changes have community members, VDCs, or other stakeholders identified as a result of the HICAP process?
- Has the process been inclusive of the needs of the extreme poor, how are women’s voices/ needs represented in the process?
- Has the process of capacity building of VDCs impacted on women’s voice and representation at a community level?
- Efficiency: Are resources used well? What needs to be done differently?
- Sustainability:
- Are the improvements in capacity attained by the VDCs sustained over time, as members come and go through election cycles?
- What is the potential for the HICAP tool to be incorporated into Ministry of Local Government procedures within Nkhotakota District?
While the evaluation will take place within the context of Concern Malawi’s Nkhotakota district health programme, the evaluation will generate learning that may be applied to other country programmes implementing the HICAP approach.
****4. Methodology****
The evaluation will focus primarily on qualitative data collection through key informant interviews, but will also review existing secondary data, such as the bi-annual HICAP assessment scores, and collect comparative information on VDC capacity. The evaluation will primarily involve stakeholders at the community level, such as community members, VDC members, and extension workers. In addition, Concern staff and district stakeholders will be included in the assessment. Preferably, the evaluation will compare communities where VDCs have been through the HICAP process with those that have not.
The evaluation will be informed by the following data sources:
- Review of project documents including the HICAP tool and training guide, HICAP database, and project reports; as well as relevant documents from the original HICAP in Bangladesh
- Interviews with community level stakeholders including VDC members, community members, and extension workers
- Key informant interviews with local leaders, staff from the District Community Development office, District Health Office, and Concern Worldwide project staff
****5. Specific Tasks****
- Develop evaluation tools and methodology:
- Review project documents and resources to understand the project
- Draft evaluation methodology and schedule (including the proposed number of and type of key informant interviews or focus groups discussions, and/or activity observations)
- With Concern Worldwide, identify VDCs, communities, and key stakeholders to be included in the assessment
- Develop questionnaires, interview guides, and other data collection tools as needed
- Carry out data collection:
- Review and analyse HICAP database data for key trends
- Conduct interviews and focus group discussions, and lead other data collection methods as needed
- Synthesize findings:
- Interpret results, draw conclusions, and make specific recommendations for future uses of the HICAP tool
- Prepare report on the findings of the evaluation, including recommendations for strengthening, scaling up, replicating, and handing over (if indicated) the HICAP process to district stakeholders
****6. Outputs****
- Evaluation report, with an executive summary (2-3 pages), to be submitted at the end of the assignment. Report should summarize findings against each of the evaluation questions, and provide specific recommendations for the future use of the HICAP tool.
- Presentation on key findings to be shared with senior management and other national-level stakeholders
****7. Lines of Communication****
Briefing and de-briefing with the Country Director and Programmes Director; daily coordination with the Health and Nutrition Coordinator.
****8. Travel Dates****
July – August 2015
****9. Person specifications:****
Essential:
- Master’s degree in Development, Public Health, or other related field
- Robust understanding of concepts related to community capacity, organizational capacity building, and capacity assessment tools
- Experience in collecting, analysing, and interpreting qualitative and quantitative data through a range of methods
- Strong analytical abilities; capable of synthesizing and making sense of data and information across a range of sources
- Previous experience in sub-Saharan Africa
- Ability to work independently with minimal supervision
- Excellent written English communication skills
[1]Sarriot, E., Kouletio, M., Jahan, S., Rasul, I., and Musha, A. 2014. Advancing the application of systems thinking in health: sustainability evaluation as learning and sense making in a complex urban health system in Northern Bangladesh.Health Research Policy and Systems (2014) 12:45.
HOW TO APPLY:
Please submit an ****Expression of Interest**** by June 12th 2015toemily.bradley@concern.net outlining exact availability in line with the approximate timeline. The expression of interest should contain: (a) a technical offer and (b) a financial offer, comprising: Technical offer:
- Up to date CV of the consultant
- Technical proposition detailing proposed methodology and resources needed (max 3 pages).
- An example of a report from similar work which demonstrates evidence of the skills and experience required.Financial offer:
- A list of all expenses expected to be incurred by the consultant including a daily rate. (Please note per diems will be paid in line with Concern’s policies).
