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International Health Resilience Consultant Libya

International Health Resilience Consultant Libya

Supervisor: Country Director Libya

Location: Tripoli, Libya

Starting Date: Asap

Term of Reference for Conducting Baseline and Knowledge, Attitudes and Practices (KAP)

Survey on Improving the Health Resilience of Rural Communities

Introduction

CARE Germany has been working in Libya since 2021 where the organization started a health resilience program targeting rural Tripoli and Sabha where there is a gap in accessing health services for the poor and vulnerable communities.

This was instigated after the organization conducted a needs assessment in the targeted municipalities where the health system has collapsed because the central government could not deliver and provide rural community health services on reproductive health, specialist health treatments, provision of basic essential drugs, safe delivery of services for women, messaging of health information to adolescents, and quality care for pregnant and nursing women.

A 5-year project “Improving the Health Resilience of Rural Communities in Libya” is being implemented in a consortium with ACF, which leads health system strengthening outcomes 1 & 2, CARE Libya will lead outcomes 3-5 which focus on changing behaviours and social norms to support girls’ and women’s decision-making, leadership and access to RMNCAH services and thereby increasing the accountability and responsiveness of health providers to the communities they serve and increasing the health system’s allocation of resources for RMNCAH services.

The consortium works closely with the Libyan Ministry of health, PHCC’s at Municipal level, community leaders and coordinates with health actors like WFP, UNFPA and IOM who currently work in Libya.

Primary Health Care services are currently overstretched due to its demand for quality services. Therefore, the project is looking forward in order to enhance the service delivery for increased access to vulnerable communities and reduce the cost of seeking more services at referral hospital, which is costly.

Project Overview

Improving the health resilience of rural communities in Libya program is a consortium program to be implemented by CARE Germany (Lead), ACF, in Rural Tripoli and Sabha. The project aims at ensuring Primary and specialist Sexual, Reproductive, Maternal, Newborn and Child health (SRMNCAH) services, and community-based activism and accountability to improve the health outcomes and resilience of vulnerable rural communities in Libya.

This program was designed to revive the collapsing health systems in Libya after the Arab spring that led to a total non-existence of basic primary health CARE system for the vulnerable communities affecting women and girls. This has also compromised other services like SRH, awareness and messaging of health information, quality rights service provisions, information systems for tracking diseases, accountability platforms and hence sustainability of the health service providers.

The project targets 7 health facilities in the two regions and will be working with Municipal authorities who will be the grass roots administration focus under which the PHCC/PHCI are managed.

The project aims to rehabilitate, enhance and sustain primary and specialist Sexual, Reproductive, Maternal, Newborn and Child health (SRMNCAH) services, increase community-based activism and accountability, and improve the health outcomes and resilience of vulnerable rural communities in Libya. It will do this by achieving the the following outcomes.

• Increased availability of rehabilitated and capacitated primary health services in rural areas that meet basic standards, and provides an enhanced model of SRMNCAH, quality of care and referrals for women, girls and people with disabilities
• Increased availability, access to clean, safe delivery, life-saving emergency obstetric and newborn care (EmoNC), and other critical services for women and girls in rural areas
• Vulnerable women, girls and other marginalized groups have improved health behaviors and self-reliance, social capital is strengthened, and households and communities show greater support for gender equality and can better withstand shocks
• Primary and specialist services (public and private) are more responsive to needs of vulnerable members of rural communities, and communities more actively engage, support and hold these services accountable
• Health authorities provide sufficient and sustainable allocation of resources for SRMNCAH services, are more resilient and institutionalize care in rural communities
• The project has conducted some initial assessments to inform project design. ACF conducted a rapid health facility assessment in 2022 to help select health facilities for intervention and accordingly proceeded with seven HF’s
• CARE conducted a rapid gender analysis in summer of 2022 to understand the different needs, capacities and coping strategies of women, men, boys and girls in rural Tripoli and Sabha and to identify key issues contributing to gender inequalities, many of which also contribute to poor RMNCAH outcomes.

Consultancy Objective

CARE seeks a health resilience consultant to conduct a baseline study aimed at improving the Health Resilience of Rural Communities in Libya.

This study will include three components: 1) a health facility assessment to determine the readiness of health facilities to provide quality primary and specialist RMNCAH services; 2) a population-based survey to understand factors (e.g. individual agency, knowledge, behaviors, social norms, etc.) influencing women’s, girls’ and people living with disabilities’ access to and use of primary health information and services, especially RMNCAH; 3) a desk review of RMNCAH protocols & norms for service delivery The overall objective of the survey is to assess the current situation of Rural health systems in Libya, services provided, SRH services availability, accessibility and uptake by the local vulnerable reproductive age women and young populations, to assess their current knowledge and attitude towards sexual and reproductive health and rights as well as to identify socio-economic and cultural factors affecting the access to reproductive health services among women and young people.

In addition, the baseline will also look at relevant protocols in Libya and assess the relevance in relation to the reproductive health program to be implemented and provide recommendations on how to integrate the program for efficiency and effectiveness.

The project expects the following information and data to be collected and analyzed in this baseline survey.

• Secondary data from the health statistics at county level on service uptake or utilization on the following reproductive health services including maternal health, family planning, STIs/HIV, for the reproductive age women and young people in rural Tripoli and Sabha.
• The information, knowledge, behavior, attitude toward sexual and reproductive health and rights among women of reproductive age and young people in Rural Tripoli and Sabha and their access to services.
• Services quality of the current local and municipal level health systems (PHCC/PHCI), primary health CARE services, and sexual and reproductive health services provided for the reproductive age women and young people and referral systems in place for the targeted PHCC’s.
• Availability of basic health services and accessibility to different health services and provision of sexual and reproductive health services, specifically in aspects of SRMNCAH to reproductive age women and young people in rural vulnerable populations.
• Availability of continuous supply chain on essential medicine to Primary Health Care Centers and Primary Health CARE institutions and method of accountability and administration of institutions and existing community governance and accountability for sustainability.

After the collection of key information for the project in relation to the baseline, the key indicators entered into the logframe, collected, analyzed and reports compiled in order to have a basis for future evaluation. Baseline values for those indicators are estimated and provided in the report and measurement should be done to a quantifiable figure that accurately reflects the true information of services provided at health facilities, linkage of PHCC to Central government and community involvement on the sustainability of the existing health facilities.

Main tasks and scope

• Conduct desk review – Review existing national technical guidelines or SOPs for the above-mentioned health resilience program focusing on SRHMNCAH services, access to clean, safe delivery, life-saving emergency obstetric,
• Responses of public and private health facilities on special services, and accountability of health authorities on sustainability of supported facilities.
• Review core national/local statistic data about the above-mentioned health services
• Review the existing health statistics/indicators that are regularly collected at PHCC/PHCI, reported through health information system, and collect the list of project baseline indicators.
• Review ACF HFA and CARE RGA and any other data collected by project
• Review the project logframe and develop a protocol (methodology and tools) for HFA and population-based survey including sampling and data collection method based on basic data on the target population who are the rural communities in Rural Tripoli and Sabha.
• Develop data collection tools: This should be finalized with CARE Germany before putting into action and this should be tailored to the indicators of the project as per the logframe.
• Submit protocol to relevant ethical or institutional review boards
• Conduct on-spot survey – Work with the local project-implementing partner to conduct the survey and ensure the whole process of data collection is culture/language appropriate and confidentiality secured way. The consultant should also coordinate with MoH and the PHCC to understand the actual situation of the systems in Rural Tripoli and Sabha in coordination with the target communities.
• Analyze data
• Write baseline survey report: Develop a report with clear analysis covering the SRHMNCAH services quality, referral systems, data collection and storage system, quality of delivery services, governance and accountability and gender participation and decision making on service gap (mainly from perspective of services seekers/up takers) among reproductive age women, SRHR knowledge, attitude and behaviors and socio-economic and cultural factors affecting the access to reproductive health services among women and young people.
• Get feedback on the report from key stakeholders and modify the report as needed

We are planning to conduct key informant interviews with health providers, community leaders and CHWs. This will provide information on their knowledge, attitudes, practices, social norms, and factors that impact access to services.

Expected deliverables

• Detailed work plan with the approach on how he/she wants to handle the work within the stipulated timeframe.
• A SRHMCAH indictors list, a protocol (methods and data collection tools), including core indicators as per the logframe with clear definitions, reporting timeline and reporting frequency, data resource.
• ERB/IRB approval (if needed)
• Training materials for IOCS team
• Clean data sets from HFA and population-based survey
• A completed baseline survey report (in English) based on the collection and analysis of the key project indicators, key findings, results and recommendations.
• Summary of existing SRHMNCAH protocols and recommendation on where need to be updated to meet the required standard based on global WHO standards.

Timeline

The baseline survey needs to be completed in a month period with the consultant delivering all expected outcomes of the program survey. The consultant should develop a detailed work plan with the approach on how he/she wants to handle the work within the stipulated timeframe.

Requirements

The organization is looking of a professional institute with experts on health resilience projects with following qualifications:

• Extensive academia experiences in quantitative research on sexual and reproductive health, on maternal and child health, family planning, gynecology, E HIV, breast cancer and cervical cancer, health education and communication.
• Experience of working with minority populations.
• Thorough understanding of local ethnic culture/norms in project areas about sexual issues and sexual and reproductive health rights and being gender sensitive.
• Proven in-depth understanding and consulting experiences on institutional set-up of complex development programs on health resilience.
• Substantive knowledge of participatory monitoring and evaluation processes and experience with multi-stakeholder/community development interventions on reproductive health.