ToR Evaluation of a Pilot: Health Services Community Based Monitoring Project

Background and Context

South Africa continues to experience challenges in meeting national and global targets in relation to health outcomes. Recently the National Department of Health launched the primary health care (PHC) re-engineering strategy, aimed at strengthening primary health care in order to accelerate attainment of government’s vision for ’A long and healthy life for all South Africans’. PHC re-engineering is anchored on the four priority areas of the National Service Delivery Agreement (NSDA), namely, increasing life expectancy, reducing maternal and child mortality rates, combating HIV and AIDS and decreasing the burden of disease from TB, and strengthening the effectiveness of the health system.

In line with the PHC re-engineering objective of strengthening the effectiveness of the health system, the Soul City Institute for Health and development communication (SCI) will be piloting a community based monitoring project in PHC. The aim of the project is to promote increased demand and accountability of the health services, particularly maternal & child health services, through strengthening community participation and increased collaboration between the community, health services and civil society organisations. The pilot is based on a similar model implemented in India through a comprehensive framework for community based monitoring and planning. The pilot will take place in 9 districts in South Africa and the evaluation will focus on 5 of the 9 districts, namely Fezile Dabi, Ugu, Amatole, Bojanala and Francis Baard.

Objectives of the intervention:

• To provide regular and systematic information about community needs in relation to health
• To provide feedback according to the locally developed yardsticks, that are also synergised with the Office of Standards Compliance as well as the Health Information System indicators.
• To provide feedback on any gaps and deficiencies in services and levels of community satisfaction, this can facilitate corrective action in a framework of accountability.
• To enable the community to become equal partners in the health planning process. It would increase the community's sense of involvement and participation to improve responsive functioning of the public health system.

Objectives of the evaluation:

Soul City Institute seeks to appoint a service provider to conduct an evaluation of the project on the 5 pilot districts to inform scaling up the intervention and optimising its implementation in 4 additional districts. The process evaluation will seek to answer the following questions:

• How has the intervention facilitated enhanced communication between the community members and the health services?
• What structures are important in facilitating such interactions?
• What lessons can be learnt about good practice in the selection and constitution of various teams and committees?
• What are the capacity needs of the general public and various committees to effectively monitor health services?
• What is the best vehicle to deliver and strengthen these capacity needs?
• What processes and tools are necessary to increase public participation and involvement in the successful implementation of the model?
• How can efficiency be improved and the model optimized?
• Describe good practice in the selection and constitution of various teams and committees.
• Assess the capacity needs of the public and various committees to effectively monitor health services.
• Assess the efficiency of the processes, tools and reporting mechanisms.
• Assess the effectiveness of a community monitoring and accountability model in increasing demand, access to and utilisation of quality RMC health services.
• What other lesson can be learnt?

The evaluation should also document baseline information to, utilisation and quality of services in each of the 5 communities. This should focus on:

• Collecting and analysing data at district, facility and ward levels on key health service indicators using quality measurements pertaining to the 6 quality standard areas, focusing on maternal child health;
• Providing qualitative data from the community on state of services at district, ward and facility levels;
• Identifying benchmarks and indicators which can be used as a point of reference for monitoring and evaluation of the community based monitoring project

Evaluation Methodology:

It is the responsibility of the researcher to design detailed methodology to address the study’s objectives set out in this TOR. However, the study should be guided by the key principles of transparency, accountability and independence.

The successful bidder will be expected to provide a COSTED evaluation plan that clearly sets out how the study will be carried out in line with the approach and principles outlined. Such an evaluation plan should include (but not limited to) the following:

• Additional information required from Soul City and suggested information sources
• Stakeholders to be consulted and justification
• Key outcomes and processes that will be measured
• Sampling approaches
• Data collection methods and instruments
• Data analysis plan
• Suggested layout of report (contents page)
• Ethics approval—to be obtained by a recognised ethics review committee

Scope of Work:

The successful bidder will be expected to undertake the following activities:

• Review available secondary data, including literature review, key health indicators, facility level audits, formative research and local IDPs ,
• Identify any gaps in the data and collect additional data as required
• Develop and share baseline data analysis plan with SCI.
• Conduct a process evaluation of the community based monitoring project
• Produce a detailed evaluation report utilising all primary and secondary data
• Prepare and present on preliminary findings/ draft report of findings in a meeting attended by SCI staff and any other stakeholders

Deliverables, Outputs and Reporting requirements:

It must be noted that all outputs from this exercise remain the sole property of Soul City. The researcher can and may not use the report for anything other than specified in these TORs for anything unless with written permission from Soul City. All written documents will be made available electronically in Word/ Excel as well as PDF format.

Table 1: Deliverables, Outputs and Reporting requirements  

All supporting documents and secondary data (literature reviews, formative research reports and HST facility data report) will be made available to the researcher. The M&E manager will be available for consultation.

Budget & contracting:

Budget: R500 000.

Work will commence immediately and timelines will be negotiated at contracting.

All interested bidders should submit detailed proposals to viwe@soulcity.org.za no later than 24th June 2013.