Terms of Reference for Baseline survey Request For Proposal (RFP): “Baseline Survey “(Focusing on Restoring Lives of Forgotten People in Bihar, India) Supported by: Big Lottery Fund (BIG) Location: Samstipur District, Bihar in Seven blocks namely Samastipur, Warisnagar, Khanpur, Pusa, Hasanpur, Bithan, and Singhia Closing Date for RFP: 3rd August 2015 Start Date of Assignment: At the earliest Duration of work: 45 days (Starting after signing the contract) Back ground: Organisation brief: LEPRA Society a Non-government organisation is registered under the Andhra Pradesh (Telangana areas) Public Societies’ Registration Act 1350 Fasli (Act of 1350 F) No. 474 on the 22nd of February, 1989. LEPRA Society has over 25 years’ experience of tackling neglected tropical diseases (leprosy and lymphatic filariasis), malaria, TB, HIV/AIDS and loss of vision through community-based interventions in some of the poorest regions of Odisha, Bihar, Jharkhand, Madhya Pradesh, Telangana, Andhra and Western Delhi. LEPRA Society has started applying knowledge and experience of providing disability care in leprosy to the care needs of people affected by lymphatic filariasis (LF). LEPRA India has been running integrated disability care projects in Odisha and Bihar since 2005, combining approaches to address leprosy and lymphatic filariasis-related disabilities (self-care, shoes and socio-economic support). Since 2009, LEPRA Society has collaborated with four district authorities in Bihar, including Samastipur to facilitate hydrocelectomy (surgery to remove swelling in the scrotum). LEPRA Society undertakes medical research in collaboration with a number of international universities and medical schools to find a vaccine for leprosy and understanding the epidemiology of some of the most debilitating diseases through a fully-equipped and certified laboratory in Hyderabad, Andhra Pradesh. Brief Background: LEPRA Society has worked in Samastipur District since 2000, supporting planning, implementation, monitoring and evaluation of the government’s leprosy eradication programme. In particular, LEPRA Society has supported the government of Bihar’s LF Mass Drug Administration (MDA) campaign since 2008, disseminating key health messages to encourage uptake, the distribution of drugs and training government health workers in 13 endemic districts. Since 2005, LEPRA Society has implemented home-based and community-based approaches to tackling LF in Bihar and Odisha states. LEPRA Society’s integrated experience with Morbidity Management and Disability Prevention for LF and leprosy has been adopted into WHO’s regional guidelines (South-East Asia Regional Office). This current project will thus build on nine years’ experience of managing LFrelated morbidity and disability and over 15 years of preventing leprosy-related disabilities by demonstrating synergies through a combined approach in Bihar. About project: People with lymphatic filariasis (LF) and leprosy need long-term care, representation and support. LEPRA and other stakeholders believe a holistic approach can best tackle the complex array of
health, economic and social issues associated with these neglected tropical diseases (NTD). The Restoring Lives of Forgotten People project aims to establish an effective and integrated approach to the care and support of people living with leprosy and lymphatic filariasis in Samastipur District of Bihar State, India. The project’s purpose is to enable 120,000 people living in poverty to lead healthier, more productive and self-sufficient lives through an integrated and holistic approach to tackling the health issues and stigma associated with leprosy and lymphatic filariasis. The project will achieve this by working towards four interrelated outcomes, namely:
Timely treatment, care and support for 116,000 people with LF and 4,000 people with leprosy in seven Blocks of Samastipur District, Bihar, India
Improved skills and capacities of public health staff, rural medical practitioners and community based institutions to sustainably address health, social and economic needs of affected people;
Integrated approaches to lymphatic filariasis and leprosy control such as Morbidity Management and Disability Prevention (MMDP) are embedded at seven Primary Health Centres (PHCs); and
Increased number of lymphatic filariasis and leprosy-affected people seeking treatment and claiming their rights
Working across 465 villages of Samastipur District, the project will raise community awareness of leprosy and LF, tackle the stigma associated with the diseases and associated disabilities improve village-level sanitation and hygiene and promote self-care practices to affected people and their families. The project will also work with public health workers and rural medical practitioners to promote MMDP ensure surgical treatment is available to men with hydrocele (fluid collected in the scrotum due to plugged lymphatic system) and work with district level partners to support Mass Drug Administration (MDA) to help break LF transmission. By supporting MMDP, the project will contribute to halting and reversing the progression of lymphoedema for 67,000 people. The project will facilitate up to 25,000 hydrocelectomies (surgery to remove hydrocele in men) to help clear the backlog of untreated hydrocele cases in Samastipur District and provide bespoke footwear to 4,000 leprosy and 16,000 lymphoedema affected people through new partnerships. At the local level, the project will engage community and local institutions in participatory planning and capacity building for better quality care and treatment. In particular, the project will revive, strengthen and empower existing grassroots institutions such as Village Health and Sanitation Committees (VHSC) and support the work of 1,314 Accredited Social Health Activists (ASHAs), female village volunteers. The project will advocate for community-based prevention and support LF and leprosy-related disabilities, demonstrating the effectiveness of the approach at district level and promoting it within the state of Bihar. Overall aim of project: 116,000 people with LF and 4,000 people with leprosy in seven blocks of Samastipur District will have timely treatment, care and support. Objective of Baseline Survey: Guided by the project log frame, capture key baseline data from a representative sample of 120,000 people affected by LF and leprosy. A comprehensive Baseline Survey will be conducted in each of the seven blocks of Samastipur District. The Baseline Survey will:
1) Capture basic household livelihoods and health information from a representative sample of local households; 2) Identify the level of technical and social support currently used by lymphatic filariasis and leprosy affected people in the area and; 3) Assess the pre-existing attitudes and practices of village and district level health stakeholders with respect to lymphatic filariasis and leprosy. 4) Map and list people affected by LF and leprosy living in 465 villages across the seven Blocks of Samastipur. 5) Government and staff arrangements in delivery of morbidity management and prevention of disabilities services for LF and leprosy. Specific Objectives of this assignment To develop:
Monitoring and evaluation (M&E) tools to assess the project’s effectiveness and impact. These are expected to be guided by the project’s logframe (annexed) and compatible with Lepra’s existing toolkit. Methods of analyzing the information collected. Reporting templates based on donor requirements – BIG and effect: hope
To conduct: A representative sample, Baseline Survey of LF and leprosy affected children, women and men in Samastipur District, Bihar. Methods The Consultant is expected to design the methodologies and tools for the Baseline Survey including: i)
Stakeholder consultations and institutional capacity assessments for local Community Based Organisations, the government’s health systems, front line health workers - Accredited Social Health Activists (ASHAs), Village Health and Sanitation Committee, community leaders, beneficiaries, village heads and other opinion leaders.
ii) A beneficiary Baseline Survey (questionnaire to collect primary data) to provide benchmarking data for measuring the project's progress and outcomes. iii) Focus Group Discussion (FGDs) formats and KAP (Knowledge, Attitude and Practices) surveys iv) Qualitative and quantitative methods of data analysis. Key deliverables 1. Develop a plan of action, methodology and tools for the baseline survey in consultation with the Project Manager, State Coordinator of Bihar, LEPRA Society M&E Officer and Lepra (UK) Programmes Officer.
2. Analyse the findings of the Baseline Survey and share a draft report first, seek feedback from concerned stakeholders and prepare a final report. 3. Share all quantitative and qualitative raw data collected during the Baseline study. 4. Draft frameworks for mid-term and end of project evaluation studies along with an impact assessment study in alignment with the project's log frame and indicators used in the baseline. Knowledge and Experience: 1. The Consultant / Consultancy Agency must have strong knowledge of India’s public health policies and national programmes on leprosy, lymphatic filariasis and disability in general; Bihar’s in particular. 2. The team must comprise of members with Post-Graduate degrees in public health, social science and related fields with proven writing and documentation skills. 3. Proved record of undertaking similar assignment/consultancies in the development sector (minimum 5 years) 4. Relevant experience of undertaking research studies (minimum 5 years) Consultancy Fee: Please include travel, accommodation, data collection, analysis, drafting and submission of final report in your quote. RFP submission process: The agency/institute/consultant/s should submit a proposal clearly outlining the proposed methodology and timelines, a basic structure of the final reports, resumes of the key members of the team and a budget (daily fee rates, expenses related to travel and communication). Apply to: Interested individuals/organisations can send their quotations in sealed cover to the address given below on or before 3rd August 2015. For further details if any, please contact: Mary Mamatha, 091-040- 44586060 Extn. 211 or
[email protected]
LEPRA Society Post Box No: 1518; Plot No. 17, Krishnapuri Colony, West Marredpally, Secunderabad, Telangana, India Pin: 500 026 Ph: 091-040- 44586060 / 27802139 / 27807314 Extn: 211 Fax: 091-040-27801391
Annexure: Project Logframe
Project objective/purpose AIM OVERALL PURPOSE
Indicator
Enable 120,000 people living in poverty to lead healthier, more productive, and selfsufficient lives through an integrated and holistic approach to tackling the health issues and stigma associated with leprosy and LF
1. Improved health for leprosy and LF affected people
Level
Timescale
Means of verification and who will do it
Assumptions and Risks
40,000 leprosy and LF affected people demonstrate improved health
By the end of Year 3
Annual project reports
Project activities can effectively reach and benefit the entire target group irrespective of gender, location and social status
120,000 leprosy and LF affected people demonstrate improved health
At the end of the project
30% of leprosy and LF affected households have improved livelihood opportunities and quality of life
By the end of Year 3
50% of leprosy and LF affected households have improved livelihood opportunities and quality of life
At the end of the project
M/F
2. Improved quality of life and livelihoods for people affected by LF and leprosy
Mid-term and Final Project Evaluation reports
Risk: Floods and elections hamper community-level activities
Annual project reports Mid-term and Final Project Evaluation reports
Improved health and project- related support can translate to better socioeconomic opportunities and well-being irrespective of gender, location and social status Risk: Floods and elections hamper community-level activities
Project outcomes Project outcome
Indicator
Level
Timescale
Means of verification and who will do it
OUTCOME 1
1.1 Community demonstrate improved knowledge and awareness of self-care practices
10% increase of LF and leprosyaffected households that demonstrate improved knowledge and awareness of self-care practices
End of Year 1
Baseline survey
50% increase of LF and leprosyaffected households that demonstrate improved knowledge and awareness of self-care practices
End of Year 3
80% increase of LF and leprosyaffected households that demonstrate improved knowledge and awareness of self-care practices
At the end of the project
100 self-support groups are established and functioning
End of Year 1
250 self-support groups are established and functioning with at least 70% attendance at monthly meetings
End of Year 2
20,000 Grade I cases return to normalcy
At the end of the project
34,000 Grade II cases reversed to Grade I or normalcy
At the end of the project
13,000 Grade III cases reversed to Grade II or have enhanced mobility
At the end of the project
116,000 people with LF and 4,000 people with leprosy in seven blocks of Samastipur district will have timely treatment, care and support.
1.2 The number of functioning self-support groups
1.3 The number of LF and leprosy affected people that demonstrate increased mobility as a result of self-care practices and protective footwear
Household KAP (Knowledge, Attitudes and Practices) survey as part of baseline annual KAP surveys survey and subsequent
Assumptions and Risks
The project efficiently transfers new knowledge to the target group.
Annual CBO/institutional survey
Self-support groups have the incentive to meet and operate.
Annual institutional surveys
lage health volunteers (government-appointed) will help facilitate and support the groups.
seline, mid-term and project end evaluation reports Project reports and individual patient sheets End of project evaluation (HH/patient surveys) Social audit
Uptake of improved selfcare is at sufficient levels. Sufficient footwear is delivered and results in improved mobility.
Project outcome
Indicator
Level
Timescale
Means of verification and who will do it
OUTCOME 2
2.1 Project villages with effective Village Health and Sanitation Committees (VHSCs) demonstrate improved sanitation and hygiene
10% of underperforming VHSCs demonstrate improved capacity
End of Year 1
Baseline survey
30% of underperforming VHSCs demonstrate improved capacity 60% of underperforming VHSCs demonstrate improved capacity
End of Year 3
15 Programme Managers have received training and/or sensitisation on LF and leprosy issues
By the end of year 2
20 Medical Officers have received training and/or sensitisation on LF and leprosy issues
By the end of year 2
250 para medical staff have received training and/or sensitisation on LF and leprosy issues
At the end of the project
248 Auxiliary Nurse Midwives (ANM) have received training and/or sensitisation on LF and leprosy issues
At the end of the project
1,314 ASHAs have received training and/or sensitisation on LF and leprosy issues
At the end of the project
Public health staff, private medical practitioners and local communitybased institutions will have improved skills and capacities to address health, social and economic needs of people affected by LF and leprosy
2.2 Public and private health care providers have improved knowledge, awareness and skills to effectively respond to LF and leprosy-affected people
Annual institutional and KAP survey
At the end of the project
End of project evaluation Annual project reports
Assumptions and Risks
Panchayat (local selfgoverning bodies) elections may disrupt the composition of VHSCs and impact their participation in project activities.
Project outcome
Indicator
2.3 Uptake of LF drugs during Mass Drug Administration (MDA) increases in communities
OUTCOME 3
Integrated approaches to LF and leprosy control such as Morbidity Management and Disability Prevention are embedded at seven Primary Health Centres through advocacy of the needs of persons affected by LF and leprosy to improve government service provision.
3.1 PHCs include Morbidity Management and Disability Prevention (MMDP) in their treatment programmes
3.2 District health administration includes MMDP and Disability
Level
Timescale
Means of verification and who will do it
Assumptions and Risks
1,000 Rural/Private Medical Practitioners (RMP/PMP) have received training and/or sensitisation on LF and leprosy issues
At the end of the project
End of Year 3
Household KAP as part of baseline survey and subsequent annual KAP surveys
The public will become more amenable to consuming these drugs via awareness raising by project staff.
20% increase in number of people who are willing to take DEC and ALB during MDA
At the end of the project
MDA evaluation reports of the government
Local government will accommodate Lepra inputs into its MDA rounds.
5 PHCs include Morbidity Management and Disability Prevention in their treatment programmes 7 PHCs include Morbidity Management and Disability Prevention in their treatment programmes Improved quality of public health services to effectively respond to the needs of people
End of Year 3
Outpatient records of government health centres
PHCs do not resist adopting integrated approaches
At the end of the project
Baseline, mid-term and end term evaluation reports
At the end of the project
Institutional survey
Officials of the District Health Society Samastipur, Department of Social Welfare, Department of Social Securities and Disabilities, the State Vector-Borne Disease Control Programme and Panchayati Raj Insitutions have received 10% increaseon in number sensitisation LF and of people who are willing to leprosy take Di-ethyl-carbamazine (DEC) and Albendazole (ALB) during MDA
DHA does not resist adopting integrated approaches
Project outcome
OUTCOME 4
Increased number of LF and leprosyaffected people seeking treatment and claiming their rights through improved public awareness and reduced stigma.
Indicator
Level
Timescale
Means of verification and who will do it
Assumptions and Risks
Prevention and Medical Rehabilitation (DPMR) in their Project Implementation Plans and allocates funds
with LF and leprosy
3.3 The number of hydrocelectomies performed at PHCs
25,000 hydrocelectomies have been performed at 5 PHCs
By the end of Year 3
PHC records
49,000 hydrocelectomies have been performed at 7 PHCs
At the end of the project
Mid-term and project end evaluations
PHCs develop the required capacity to undertake hydrocele surgery
4.1 The number of LF affected people claiming social benefits
An additional 10% (6,700) of LF affected people are claiming social benefits
By the end of Year 3
Monthly and quarterly project reports
An additional 25% (16,750) of LF affected people are claiming social benefits
At the end of the project
4.2 The number of leprosy affected people claiming social benefits
An additional 70% (2,800) of leprosy affected people are claiming social benefits
At the end of the project
Monthly and quarterly project reports
4.3 Positive community attitude towards LF and leprosy affected people
20% increase in positive attitudes towards LF and leprosy affected people
By the end of Year 3
Household KAP as part of baseline survey and subsequent annual KAP surveys
30% increase in positive attitudes towards LF and leprosy affected people
At the end of the project
250 self-support groups are registered into a federated CBO and are advocating for the rights of people with LF
At the end of the project
4.4 Self-support groups are registered as CBOs and are advocating for the rights of people with LF
Awareness-raising translates into improved access to support. Demand from communities drives the social welfare department to process claims on a timely basis
Institutional survey