Catholic Relief Services (CRS) is an International non-governmental organization supporting relief and development work in over 99 countries around the world. CRS programs assist persons on the basis of need, regardless of creed, ethnicity or nationality. CRS works through local church and non-church partners to implement its programs, therefore, strengthening and building the capacity of these partner organizations is fundamental to programs in every country in which CRS operates. CRS has been active in Ghana since 1958 and is currently implementing programs in the areas of Health and Agriculture/Livelihoods.

Job Summary

•   In collaboration with Ghana Health Service and the University for Development Studies, Catholic Relief Services is currently implementing a four year (September, 2011 – October, 2015) maternal child health (MCH) project in the East Mamprusi District (EMD) of Ghana. The project dubbed Encouraging Positive Practices for Improving Child Survival (EPPICS) aims at contributing to improving the health and survival of an estimated 27,000 women of reproductive age and 24,000 children under five in 240 communities of the district.

•   The baseline findings of the EPPICS Project revealed that rapid repeat births in EMD is very common with an average of 4 births (range 1 -10 births) per woman. Also, over 68% of women reported birth spacing of less than 24 months between their index (youngest child and the immediate previous child). Modern contraceptive use among mothers of infants (0-23 months) was relatively low (22%). Also, as few as 35% of the women surveyed did not know the risk of rapid repeat birth (RRBs) to pregnancy intervals of less than 24 months . Supporting couples to mutually take control of when and how often to have children is vital to safe motherhood and child survival .

•   Antenatal, delivery and postnatal care visits, as well as platforms created at the community level by EPPICS to engage community members, are ideal times and places to provide women and their partners with targeted information on child spacing to help them make informed choices that will enhance the health and survival of their children.  The FAITH Project seeks to test the feasibility and acceptability of introducing the standard day’s method (SDM) along other family planning methods in EPPICS project communities for improving birth spacing among project participants. Two thousand people are estimated to directly benefit from the six-month pilot intervention study.

•   The problem and rational for the study
Ghana’s East Mamprusi District (EMD), the site of the EPPICS Project, is one of the districts with the poorest maternal and child health (MCH) indicators as compared to the northern region (NR) and national averages. These poor MCH indicators are partly attributed to large family sizes and rapid repeat births (RRBs). In households (HH) with RRBs , children are prematurely weaned and therefore deprived of required antibodies and nutrients. These children are more likely to suffer from malnutrition that can result in poor mental and physical development . One of the key strategies for addressing possible negative impacts of RRBs is the use of quality and acceptable family planning (FP) services.   Yet, Ghana’s unmet need for FP is still as high as 35% among married couples

•   Against the high total fertility rate (TFR) of 7.2, the observed trend in the total use of modern FP in East Mamprusi District (EMD) is even lower (at 22%) than the national average (24%). The FP methods that are available and provided in health facilities across EMD include contraceptive pills, Intra-Uterine Devices, injectables and implants. However, a study by CRS in EMD  revealed that apart from injectables that recorded 16% of use in EMD, the other methods are rarely patronized as none of them records more than 5% user rate .

•   Research suggests that FP is not practiced due to cultural norms and inter-couple dynamics. The Demographic Health Survey indicates that even though knowledge of modern FP methods is almost universal (98%) among women aged 15–49 and readily available, the low utilization of modern FP methods could be attributed to the lack/inadequate support of husbands for their wives in using these methods, perceived fear of the side effects associated with non-natural methods , supply chain constraints, and limited awareness of natural modern methods. In many northern Ghana communities including those of EDM, decisions regarding pregnancies and children are largely male-dominated. As a result, access and use of hormonal contraceptives and other FP services among women necessarily need the consent of their husbands/partners else they risk being abused, accused of marital infidelity and in some cases divorced.

•   Available data suggest that natural family planning (NFP) may be a method that is more culturally appropriate and acceptable to most Ghanaians, including men. CRS’ studies have shown strong potential demand for NFP methods in EMD , but access to and information on such methods is very limited. In an 2013 observation and review of FP strategies in health facilities of EMD, conversations with couples rarely included NFP methods . This may be attributed to inadequate information or inadequate capacity of the health care providers and misconceptions about NFP methods and their effectiveness.

•   In addition, a study conducted by a local NGO in 2011 in 6 districts, including EMD, revealed that only 35% of health service providers reported some form of knowledge on NFP methods such as the SDM and Lactational Amenorrhea method . Therefore providing adequate training in a low-cost NFP method like the SDM will increase health providers’ knowledge about reproductive health and expand the health services they can provide to clients. Additionally, it will provide a starting point for CRS Ghana to initiate and test the feasibility and acceptability of the NFP methods. It will also engage staff of various Catholic Diocesan Units and health facilities in expanding the options available to Ghanaian couples based on Catholic social teachings and values.

In view of these factors, CRS tested the incorporation of the standard days method (SDM) into existing FP services offered in EMD.

FINAL EVALUATION SCOPE OF WORK

Objectives

This final evaluation seeks to answer two major research questions:

•   Was the SDM an acceptable  FP method as perceived by the user couples and FP providers in the East Mamprusi District?
•   Was it feasible  to introduce the SDM into existing FP service delivery sites in two sub-districts of East Mamprusi?

The evaluation team will assess the following:

•   What were the factors that influenced the acceptability of SDM as method of birth spacing? How did these factors vary across the two pilot sub-districts?
•   How did client’s knowledge, awareness and satisfaction of SDM change with the project intervention (in comparison with the baseline)?
•   What were the reasons associated with not choosing SDM, and SDM failure including user discontinuation?
•   Did the use of SDM  affect SDM user and partner  dynamics?
•   Was SDM considered a more culturally acceptable method of birth spacing for men?
•   How did health center staff  knowledge and perceptions of the SDM change with this project intervention?
•   To what extent do health center staff believe SDM is an effective and appropriate tool for couples?

Lessons Learned:  The assessment should comment on:

•   What were the lessons learned; intended and unintended benefits, best practices and any gaps in the design and implementation process?
•   What are the implications for future stakeholder support activities can be extracted from those lessons learned?

Recommendations concerning appropriate strategies for scale up in similar FAITH Project activities and an outline of the more comprehensive activities and actions necessary to realize scale up.

Work to be accomplished

The evaluation team will accomplish tasks including, but not limited to:

•   Initial conference with CRS staff and GHS representatives during which the team will present a proposed schedule for undertaking the evaluation for input and finalization;
•   Review of relevant documentation (including project proposal, memorandum of understanding, relevant detailed implementation plans, performance indicators, baseline report, training reports, field reports, progress reports, annual reports and status reports).
•   Meetings with project partners and staff ;
•   Design of survey instruments and tools, as deemed appropriate to gather all information summarized in the objectives of the scope of work above.
•   Site visits and meetings with GHS officials and other stakeholders including project staff, service providers (Nurses and midwives), District and Sub-district focal persons, Community Health Volunteers.
•   Conduct interviews and discussions with a representative sample of communities/project beneficiaries and relevant individuals and groups in the two districts to collect information in line with the objective of the evaluation.
•   Process data and information and submit a report on findings in line with proposed format outline in section E below
•   Organize dissemination meeting during which the team will present the first draft of the evaluation report, highlighting key findings and recommendations.
•   Produce a final report to receive clarification/input from stakeholders.

Methodology

The methodology to be employed in the evaluation should include both qualitative and quantitative methods. In addition the evaluation team may include the following:

•   Review of relevant project documents: field reports, progress reports and baseline reports
•   Design and administration of questionnaires and other data collection tools
•   Field visits and conduct of interviews and discussions with project implementers and beneficiaries
•   Analysis of information gathered

Place of Performance:
The place of performance of this evaluation shall be in FAITH Project supported static health facilities and communities across the Nalerigu and Langbensi-sub-districts.

Deliverables:

•   Preliminary work plan and schedule
•   Detail outline of methodology including the proposed data collection tools and guides
•   Report outline highlighting major sections and themes to be covered
•   Debriefings with CRS Management and partners
•   Submission  of draft report
•   Submission of final report integrating feedback from CRS

FINAL REPORT

Final Report in hard and soft copies and the raw data in soft copy.

The final report is expected to be organized as follows:
I. Executive Summary
II. Introduction
III. Evaluation Description
IV. Summary of key findings and conclusions
V. Recommendations for scale up
VI. Annexes:
a. Scope of Work
b. Evaluation Team Members
c. List of Interviewees
d. Methodology
e. Questionnaire tools
f. Interview summaries capturing key information

Timeframe/Schedule:
The evaluation will take place in September 2014 and should be concluded within four (4) weeks of commencement. It is anticipated that the evaluation will begin  September 15, 2014 and end not later October 15, 2014 for the meetings, document reviews, interviews, fieldwork, draft report writing, and debriefings with CRS and dissemination to stakeholders. The Team Leader will provide a final report to CRS no later than October 30, 2014.

Key Working Relationships:

•   CRS Ghana Management and Health Programming staff
•   Staff of Ghana Health Service in the project districts
•   Community leaders and agents

The team leader will report directly to the Health Program Manager and work closely with the EPPICS Project, the District Field Supervisor and other relevant CRS staff.

Contractual Relationship:
The consultant selected to perform the services described herein, or others will enter into a contract with CRS outlining the roles and responsibilities of each party and other guiding statements for the dissolution or abrogation of the contract by either party

Qualification Required & Experience

The qualification, expertise and skills of consultants/evaluation team will include but not limited to:

•   Advanced degree (Masters or Ph.D.) in Public Health, Social Sciences or other health-related field with a focus on Health Communications, Reproductive and Maternal health
•   Minimum of five years’ experience in maternal and reproductive health and child survival programs
•   Experience with and knowledge of the Ghana Health Service structures and procedures
•   Experience in research and or evaluations of child survival and or other health related programs
•   Experience in evaluating projects that employed positive deviance strategy will be an added advantage
•   Excellent writing and communication skills
•   Excellent interpersonal skills
•   Willingness to travel within the two project districts

Location: Accra and Tamale

How To Apply For The Job

Bidding Requirements:
All bids must include the following:

•   Name(s) of consultant(s) or firm and main contact
•   Curriculum Vitae of lead consultant, M&E person and any others
•   A brief response (one paragraph maximum) to address each of the qualifications stated above
•   Quote in USD to complete the services required of this SOW

Terms of payment
Three references of current or recent clients, including telephone numbers and email addresses.

The bids should be sent by enclosed sealed letter, to the Operations Manager (Final Evaluation of FAITH Project)  not later than close of business SEPTEMBER 4TH, 2014.
CRS reserves the right to select or reject any or all bids/quotes received.

CRS Contact Person

Kwasi Attuahene-Mensah
Operations Manager
Catholic Relief Services
USCCB-Ghana Program
16  Labone Crescent
P.O. Box AN 6333
Accra-North, Ghana        
Tel: (233) 0302 764743/776735
Fax: (233) 0302 777099

Closing Date: 04 September, 2014