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Terms of Reference (ToR) for a consultant to conduct a research study to explore perceptions of persons with disability towards the inclusiveness of health services in two areas of Nigeria

Introduction

Seeing is Believing (SiB) is a three-year (2017-2020) Comprehensive Child Eye Health in Nigeria (CCEHiN) programme, that seeks to make comprehensive child eye health services available and accessible through promotion, prevention, medical care and rehabilitation/inclusive education targeted at vulnerable children. The SiB programme is being implemented in eleven (11) States of the Federation divided into four clusters as follows: Cluster 1: Oyo, Ogun and Osun States; Cluster 2: the Federal Capital Territory, Nasarawa and Plateau States; Cluster 3: Kano, Katsina and Jigawa States; and Cluster 4: Cross River and Akwa Ibom States. The goal of the programme is to contribute to the reduction of avoidable blindness and visual impairment through the provision of comprehensive child eye health services to over 1.5 million children aged 0-14 in selected states of Nigeria. Quality of care is critical for client’s satisfaction and sustained use of health care services.

Disability inclusive eye health programming provides holistic services that takes cognizance of all members of a community whether they have a disability or do not have a disability. It caters for all ranges and different types of disability. Working in two pilot secondary health facilities, the SiB Project will ensure barriers are identified and removed if possible, and that disability-specific processes are in adequately put in place.

Purpose of Assignment:

This study will provide a endlineline survey for work on disability inclusion at the two pilot facilities under the Seeing is Believing programme. The purpose of the study is to examine the perception of persons with disability regarding the inclusiveness of health services in their local area and compare with a baseline study, commenting on significance of any changes.

The findings of the research will guide planning, programming and policy formulation as well as work to address barriers militating against access to services and inclusiveness of persons with disability. This study will also evaluate how well the SiB programme addressed the identified barriers that affects access to services and inclusiveness of persons with disability in the pilot sites.

Objectives of the research study:

The objective of this research study will be to assess the perception persons with disabilities and other relevant stakeholders about the inclusiveness of basic services (focusing particularly on health, also covering education and other services) for people with disabilities including children with disabilities and their peers without disabilities in comparison to baseline findings.

The specific objectives of the study are to:

• To understand the perceptions and experiences of persons with disability and other community members regarding the inclusiveness of health and other services, including the barriers to accessing services;
• To determine the level of satisfaction of persons with disability regarding inclusiveness of health and other services;
• To understand the perceptions and attitudes of health workers in pilot facilities regarding the inclusion of persons with disability in the pilot health facilities;
• To recommend interventions and strategies that should be put in place to make pilot facilities more inclusive of persons with disability, and to improve access of people with disabilities to health services;
• Understand the broader context for inclusion of persons with disabilities in society in the pilot areas (attitudes towards persons with disabilities, root causes of any discrimination encountered).
• To discern how much point 1-5 has changed (if any changes are observed) after programme implementation and noting any possible attribution to programme implementation.

Scope of Work

• The study will focus on two project sites - Gwagwalda (FCT) and Doma (Nasarawa state) - where inclusive eye health services were piloted in secondary health facilities. The target groups for the study will include the following stakeholders:
• community members;
• health facility staff (CHEWs, doctors and Nurses) and non-facility care providers (e.g. TBAs);
• community gatekeepers and opinion leaders;
• parents and care givers of children (0-14 years) with disabilities;
• people with disabilities;
• their peers without disabilities in the same age group.

The sample size will endeavour to be representative of the diversity of the population in the catchment areas; the methodology to achieve a representative sample should be clearly outlined in the research protocol. The study is expected to respond to but not limited to the following research questions:

• What are the perceptions of persons with disabilities regarding the inclusiveness of and access to public health services in the area?
• What are the perceptions of persons with disabilities regarding the inclusiveness of and access to the two pilot secondary health facilities?
• To what extent are persons with disabilities, including children with disability, accessing health services at the two pilot secondary health facilities?
• What level of knowledge, awareness and understanding do stakeholders in the pilot areas have about accessible and inclusive health services?
• What barriers are faced by persons with disability, including children with disability, in accessing health services, in the two pilot secondary health facilities?
• What factors support the access and inclusion of persons with disability, including children with disability, in accessing health services, in particular in the two pilot secondary health facilities?
• What interventions and strategies should be put in place to improve inclusiveness and access of persons with disabilities to health services, in particular in the two pilot secondary health facilities?

Methodology:

The consultant(s) is/are expected to present, in detail, their approach, methodology and tools, with an action plan and timeframe that addresses the expected outputs, with reference to the overall and specific objectives as well as a budget. A mixed methods study is envisioned, comprising of: a review of hospital records, quantitative survey and qualitative research.

The research protocol will use representative sampling as appropriate, considering both quantitative (survey) and appropriate qualitative approaches. Two sets of tools will be developed; a questionnaire to administer the quantitative component of the survey and qualitative tools. These tools may be as used in the baseline for easy comparative evaluation where appropriate.

Qualitative research is expected to include:

• People with disabilities within the community, including parents (of both genders), children and young people:
• Key opinion leaders in the communities, community gate-keepers, group leaders, religious leaders ;
• Health facility manager/lead.

Analysis:

The findings of the survey will, where possible, be disaggregated by type of disability, age, sex, rural/urban, and other standard socioeconomic characteristics.

Ways of working:

Research tools will be developed in collaboration with the research committee from the Seeing is Believing team (Programme Manager, Programme Director, Knowledge Management and M&E Manager) The baseline tool was developed by studying existing tools and questionnaires developed for International Agencies for the Prevention of Blindness (IAPB), other national household surveys, Washington group questionnaires and WHO developed tools.

The consultant will conduct the research in an ethical manner, that is sensitive with regards to different cultures, local customs, religious beliefs and practices, personal interaction and gender roles, disability, age and ethnicity. Requirements for participant informed consent and confidentiality will be maintained, including children participating in the research. Ethical clearance will be sought as required.

Work Schedule:

The consultancy will primarily be responsible to plan, design, manage, conduct and report on the research.

The consultant will be responsible for the following tasks:

• Review existing literature.
• Develop research protocol, including methodology, tools and analysis plan.
• Adjust and finalize the research protocol.
• Recruit and conduct training of enumerators.
• Pre-test research tools (quantitative and review of hospital records)
• Data collection and entry
• Data cleaning, processing and analysis of data
• Drafting of the Preliminary Research Report
• Present the draft research report to research committee
• Integrate the feedback and comments received from research committee and finalise research report

Final deliverables:

• Power Point Presentation including speaker notes
• Research Report with annexes
• Data Sets

Structure of the research report:

The Research Report should incorporate the following main components:

I. Title Page and Opening Pages (including executive summary)

II. Introduction and Background

§ Introduction/Background - context of inclusion pilot and purpose of research

III. Research Methodology: Description of the methodology of the research

Rationale for choice and design of methodology, including sampling approach

Data sources used, data collection

Analysis methods used for both quantitative and qualitative data, including how the data was mixed

Major limitations

Description of who was involved and in what capacity

V. Data Analysis, Quality and Results

Sample size and response rates

Key demographics

VI. Key findings of the research, under each research question

Integrated analysis of the findings of different elements of the research (quantitative and qualitative)

Includes key graphs and diagrams to illustrate data

VIII. Conclusions, Lessons Learned and Recommendations for future implementation and the government

Annexes

TOR

• Research protocol, including tools
• Additional relevant statistical tables and graphs
• List of persons interviewed (anonymised by role)
• List of abbreviations and sources used
• Supervisor Name and Type of Supervision that will be provided:
• Supervision, regular contact, feedback and comments on deliverables will be provided through the research committee, led by the Programme Director and KM & M&E Manager. The consultant will work under the general guidance of the research committee.

Consultant’s Work Plan and Official Travel Involved:

• The consultant(s) is required to make his/her own return travel arrangements from Place of recruitment-Duty Station-Place of recruitment on the most direct route.
• Travel costs will be reimbursed to the consultant upon submission of invoice and travel documents.
• All related (internal/external) official travel of the consultancy will be organized by the consultant and costs reimbursed accordingly.
• The consultant(s) is also required to organize his travel schedule. Research committee, wider SiB team and partners will support him/her in arrangements.

Consultant’s Work Place:

The consultant will be based either at home, in the field or at the CBM country office in Abuja/Jos field office.

Qualifications or Specialized Knowledge/Experience Required:

Qualifications

• Seven years of professional work experience relevant to research and/or disability inclusion. In particular, experience of conducting KAP studies is desirable.
• Advanced degree in a relevant social sciences.
• A consultant with multi-disciplinary background such as disability, statistics, research and analysis, social sciences and development is preferable.

Experience

• The suitable consultant(s) should have experience in designing, conducting, and managing studies related to disability, children’s issues and/or social development.
• Proven experience in conducting qualitative and quantitative research is required, including household surveys
• Experience of consulting with people with disabilities, and experience in conducting researchs with children is desirable.
• Experience in producing high-quality reports and analysis.
• Work experience in international organizations is an asset.

Languages

The consultant(s) must have good inter-personal communication and negotiation skills. Excellent English report writing and editing skills and additional knowledge of Hausa language is an asset.

Competencies

• Good facilitation and qualitative research skills.
• Understanding of human rights-based approaches to programming and results based management principles is required, in particular related to child rights and disability rights.
• Ability to bring together diverse stakeholders.
• Effective oral and written communication skills.
• Ability to work in an international and multicultural environment.
• Sensitivity towards different cultures, local customs, religious beliefs and practices, personal interaction and gender roles, disability age and ethnicity.
• Strong quantitative analysis skills.
• Good attention to detail.

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Context

Comprehensive Child Eye Health in Nigeria (CCEHiN) is a three-year (2017-2020) Seeing is Believing (SiB) programme that seeks to make comprehensive child eye health services available and accessible through promotion, prevention, medical care and rehabilitation / inclusive education targeted at vulnerable children. The SiB programme is being implemented in eleven (11) States of the federation divided into four clusters as follows: Cluster 1: Oyo, Ogun and Osun States, Cluster 2: the Federal Capital Territory, Nasarawa and Plateau States, Cluster 3: Kano, Katsina and Jigawa States, and Cluster 4: Cross River and Akwa Ibom States. The Seeing is Believing programme kicked off in December 2017 and would be concluded in December 2019. The programme objectives include:

• Develop skilled and adequate manpower to provide comprehensive child eye health services at various levels of health care in the targeted project areas
• Improve the quality, accessibility and scope of eye health services to children
• Embed child eye health in the policies and programme work of the Ministries of Health and Education
• Pilot strategies for inclusive eye health
• Establish the school eye health programme as a sustainable model to deliver eye health services to children
• Improve the quality of early intervention and education of blind children and children with severe visual impairment

Objectives

The main objective for this study is to conduct an endline evaluation to find out how well the implementation of the Seeing is Believing programme is at achieving the overall objective of the programme, which is to contribute to the reduction of avoidable blindness and visual impairment through the provision of comprehensive child eye health services to over 1.5 million children aged 0-14 in selected states of Nigeria

Specific Objectives

• To review the internal and external documents (programme reports, case studies, national eye health documents, etc.) related to the implementation of the SiB programme.
• To conduct fieldwork to obtain data/information for the evaluation.
• To provide a comprehensive endline report, useful in evaluating the implementation of the Seeing is Believing programme in Nigeria.

Research Questions

• What impact has the SiB programme made in increasing the coverage of primary eye health care in Nigeria?
• Has the SiB programme contributed to the increase in the number of cataract surgeries in children at targeted tertiary hospitals, in comparison to pre-programme implementation?
• Has the SiB programme contributed to an increase in the number of consultations of children at targeted secondary eye care institutions, in comparison to pre-programme implementation?
• Has the SiB programme contributed to an increase in the number of institutions offering specialised refraction and low vision services, in comparison to pre-programme implementation?
• What strategies/approaches of programme delivery have been effective and what has not been effective?
• Is the implementation approach a sustainable model after the end of the SiB project?
• Do the importance and the quality of the programme (and associated outcomes) justify the amount of resources used?

Key Stakeholders Involved

The Programme Director – Seeing is Believing programme, implementing partners (including supported health facilities), Knowledge Management/Monitoring and Evaluation Manager, the Federal Ministry of Health – Eye Health Coordinator, supported schools – mainstream schools and special schools, and the cluster coordinators.

As key actors during programme implementation, they are going to provide their perspective for the triangulation of the information collected during the secondary data review.

Methodology

This study should follow a qualitative approach. A desk review of internal and external documents relating to the SiB programme will be done. Interviews with some key stakeholders will also be done. Observations and checklists can also be used to gather information. Answers to the research questions will be drawn from the desk review and interviews with key stakeholders.

Expected Deliverables

The expected outputs are:

• Inception report (including tools and methodology)
• Zero draft of the evaluation report for review by the SiB team.
• Final draft of the evaluation report and raw data/tools used for the endline evaluation.
• A PowerPoint presentation of evaluation methodology, findings and recommendations, conclusions and learnings.
• Present findings in a validation/dissemination meeting

The evaluation report should not exceed 30 pages, excluding annexes. Potential sections to include in the report are:

• Introduction and Purpose of the endline evaluation
• Evaluation Objectives
• Research Questions

4.       Methodology

a. Data Collection Methods

b. Sampling

c. Research Tools

• Findings
• Conclusion
• Recommendations – for the government and future programmes in eye health
• Annex

Timelines

• Tool design
• Inception report
• Primary and secondary data review
• Interview key stakeholders
• Develop Zero draft of the evaluation report
• Integrate feedback and develop draft 1 of the evaluation report
• Integrate feedback and develop final draft of the evaluation report

Validation/dissemination

The deadline to complete this exercise is 24/02/2020

Selection Criteria for Consultants

For this exercise, CBM international is looking for a consultant having:

• Proven expertise in Child Eye health in Nigeria
• Experience in conducting endline evaluations and ability to distil various viewpoints into a cohesive report.
• Advanced university degree in education, social work or another related discipline.
• Experience in conducting studies in West Africa Region
• Fluency in English
• A team of 2 with the lead consultant having at least 10 years’ experience in planning and conducting evaluations within the health and development sector.
• The consultants team shall prepare and submit by January 11th 2020 a financial and technical proposal including
• detailed curriculum vitae with three references (two professional and one personal)
• a proposal outlining how and when they intend to accomplish this task
• a detailed financial proposal
• The selected consultant will be contracted and will start work shortly after recruitment. A service contract will be signed between the team and the SiB Nigeria.