LRPS-2024-9193233 -to conduct baseline assessment for Project Areas in 5 districts (Kurigram, Sherpur, Bhola, Khagrachori and Sunamganj) and national level for the project “Health System Strengthening

TERMS OF REFERENCE FOR INSTITUTIONAL CONTRACT

 

Baseline assessment for Project Areas in 5 districts (Kurigram, Sherpur, Bhola, Khagrachori and Sunamganj) and national level for the project “Health System Strengthening for Primary Health Care (HSS4PHC)”

 

          Study (an initiative to establish current knowledge around a specific topic through the descriptive summarization, interpretation or assessment of information and data)

          Research (systematic process of the collection and analysis of data and information, in order to generate new knowledge, to answer a specific question or to test a hypothesis)

          Evaluation (rigorous, systematic and objective process in the design, analysis and interpretation of information to answer specific questions)

 

Purpose

To provide a comprehensive and accurate understanding of the current state of the health system, policies, programs, and the connected factors in relation to maternal, newborn, and child health services in the health sector, as well as at implementation level at the targeted districts.

Location

Five project districts (Bhola, Khagrachari, Kurigram, Sherpur, and Sunamganj),  with upazilas and unions, including Union Health and family Welfare Centre (UH&FWC), Union Sub-Centre (USC), and community clinics. In addition, Dhaka district with travel to relevant Ministries and line-departments/directorates.

Estimated Duration

4 months

Technical Supervisor of the assignment

Health Manager

 

1. Background and Context

 

During the last few decades, Bangladesh has made significant strides in improving maternal and child health. Nevertheless, despite having a well-established and unique service delivery infrastructure, the quality and utilization of emergency obstetric and newborn care services remain suboptimal, particularly in the poorer regions of the country. Currently, Bangladesh's maternal mortality ratio stands at 173 deaths per 100,000 live births, and the under-five mortality rate is approximately 31 deaths per 1,000 live births (UNICEF, 2020, State of the World's Children 2020). In comparison, the South Asia region has an average maternal mortality ratio of 157 deaths per 100,000 live births and an under-five mortality rate of about 37 deaths per 1,000 live births (World Bank, 2020, World Development Indicators).

 

With funding support from Global Affairs Canada (GAC), UNICEF and UNFPA are implementing a joint project “Health System Strengthening for Primary Health Care (HSS4PHC)” with targeted strategies in five focus districts (Sunamganj, Bhola, Kurigram, Sherpur and Khagrachori). The project has proposed three intermediate outcomes i.e. 1100: Enhanced abilities and responsiveness of the MoHFW, and its directorates to ensure enabling environment for gender-responsive high quality, equitable and sustainable SRMNCAH services; 1200: Strengthened district health systems to deliver effective, right based, patient centered, gender responsive, quality, and integrated SRMNCAH and HGBV information and services and 1300: Improved quality, coverage and gender-responsiveness of Primary Health Care and SRHR including HGBV services with effective utilization of comprehensive services for marginalized and unreached populations through health system strengthening, women’s empowerment and community participation to fulfilling the rights of women, adolescent girls and children.  The joint program focuses on system strengthening for Primary Health Care include system streamlining from national to sub national level,  to enhance the coverage and quality of 24-hour reproductive health services, emergency obstetric and newborn care (EmONC) services, adolescent health services, midwifery services, the Women-Friendly Hospital Initiative within existing facilities, supported by robust referral systems and community engagement. Through this project, UNICEF and UNFPA will focus particularly on enhancing access to and utilization of quality health services for women, adolescents, children, and newborns, with a special emphasis on marginalized groups. In alignment with the priorities of the 8th Five-Year Plan and the upcoming Health, Population and Nutrition Sector Program (HPNSP), UNICEF and UNFPA will strategically adopt a systems-building approach rooted in primary health care principles to support the Government in achieving universal health coverage. This will involve assisting in the review of national strategies and policies to make the healthcare system, especially at the primary care level, more resilient and capable of delivering higher quality services. The project will promote the expanded use of digital solutions for health care, including the development of an integrated data management system to support improved decision-making. UNICEF and UNFPA will advocate for adequate budget allocations and increased fiscal space for health, aiming to accelerate universal health coverage for all, regardless of race, geographic location, social class, or economic status. Special attention will be given to sexual and reproductive health, focusing on the needs of the most vulnerable populations, such as women and youth.

Furthermore, the project will strengthen the community health system through the evidence-based scale-up of the essential service package, combined with a social accountability system, community engagement, and demand generation. UNICEF and UNFPA will also work to enhance capacities and coordination to improve the accountability of governing bodies and increase the capacity of government actors at national, sub-national, and primary health care levels to provide gender-responsive, high-quality, equitable, and sustainable sexual, reproductive, maternal, newborn, child, and adolescent health (SRMNCAH) services. In addition, through public-private partnerships, the project will support the improvement of government health facilities at district and lower levels, as well as public, private, and NGO facilities located in municipalities under the selected districts.

At the outset of this project, a baseline survey will be conducted to establish initial data points. An end-line assessment will be carried out at the conclusion of the project to evaluate the project's success against the set indicators established during the baseline assessment.

 

1. Rationale / Purpose of the evidence activity

The baseline assessment for the "Health System Strengthening for Primary Health Care (HSS4PHC)" project is being conducted to provide a comprehensive and accurate understanding of the current state of the health system, policies, programs, and the connected factors in relation to maternal, newborn, and child health services in the health sector, as well as at implementation level at the targeted districts. This evidence-based activity is essential for several reasons:

 

The baseline assessment is necessary to establish a clear starting point that reflects the existing conditions of the health system at the national level, the processes, policies, accountability and implementation mechanisms, and at implementation level, the healthcare services in Sunamganj, Bhola, Kurigram, Sherpur, and Khagrachori. This information is critical for identifying specific gaps and weaknesses in the current system, both broadly, as well as regionally, particularly in marginalized areas where the quality and utilization of emergency obstetric and newborn care services are suboptimal. By understanding these initial conditions, UNICEF and UNFPA can design and implement targeted interventions that are effective, efficient, and tailored to the needs of the population.

 

The baseline assessment will address key gaps in knowledge, attitude and practice related to the national level policy, implementation approach, accountability, project and financial management capacity and practices, communication, monitoring and reporting chains, as well as accessibility, quality, and utilization of healthcare services for women, adolescents, children, and newborns at subnational level program implementation, particularly, in the selected districts. It will provide valuable insights into the existing barriers to accessing care, the state of health infrastructure and service provisions both public and private, availability of essential services, management operations at district and Upazilas levels, current state of service data reporting and use, and the effectiveness of current referral systems. Additionally, it will highlight disparities in healthcare outcomes across different geographic and socio-economic groups, enabling the project to focus on the most vulnerable populations.

 

The results framework of the project document is provided in annex of the TOR. As a part of its monitoring and evaluation plan for the programme, UNCIEF and UNFPA is in the process of obtaining the baseline information for the three outcome areas that will help future assessment of progress towards achieving intended program results. While UNICEF and UNFPA M&E team has identified already most of the data sources baseline and for immediate OC 1 related indicators through existing DHIS, MICS analysis, but none of the indicators under immediate OC2, 3 has information from the existing survey reports. Furthermore, alongside the result framework indicators, rigorous data collection methods—encompassing both quantitative and qualitative approaches—are essential to understand the overall situation in the project intervention areas. This includes but not limited to assessing the infrastructure of health facilities, the knowledge, attitudes, and practices (KAP) of service providers and the community, and the operating modalities with the private sector at both national and subnational levels. Therefore, there is a need to conduct the baseline assessment at the outset of the HSS4PHC project. Firstly, it aligns with the initial phase of the project, providing a foundation for measuring progress and impact over time. Secondly, it ensures that interventions are data-driven and evidence-based from the beginning, allowing for more precise targeting and resource allocation. Finally, by establishing a benchmark now, the project can systematically track improvements, make necessary adjustments, and demonstrate accountability and effectiveness to stakeholders, including Global Affairs Canada (GAC), the Government of Bangladesh, and the communities served.

 

At the national level, the baseline assessment will serve as a critical tool for informing broader health policies and strategies. The data collected will contribute to the review and development of national health strategies and policies, and provisioning of governance and process components to ensure quality healthcare, particularly those related to maternal, newborn, and child health. By providing evidence-based information, the assessment will enable the government to make informed decisions on resource allocation, policy adjustments, and strategic planning. It will also support national efforts to strengthen coordination, management operations, and integrate digital solutions and data management systems, thereby enhancing overall healthcare delivery and decision-making processes. The results will be used by national health authorities, policymakers, and other stakeholders to optimize the healthcare system, promote resilience, and ensure the delivery of high-quality services across the country.

 

1. Objectives

 

1. Health Systems:

 

1. To assess the state of policy environment, regulations, program design, monitoring, accountability, project and financial management capacity and practice, evaluation, evidence and data generation and use for decision making and course correction at national level
   • Expected Outputs and Results: A comprehensive report that analyses the state of the policy environment, regulations, program design, monitoring, accountability, project and financial management capacity, evaluation, evidence generation and use, and provides recommendations for improvement based on the assessment.
2. To assess the sector's flexibility to adopt innovative practices and new approaches that strengthen program outcomes, focusing on expanding financing sources, skill based human resource availability, diversifying service procurement models, enhancing private sector engagement in primary healthcare, and promoting compliance and active engagement from private actors.
   • Expected Outputs and Results: An assessment of the sector's capacity to adapt to innovative practices, focusing on its ability to attract new financing, strategic purchasing of human resources diversify service procurement models, engage the private sector in primary healthcare, and ensure compliance and active engagement from private actor

 

1. To establish a baseline benchmark for monitoring and evaluating the effectiveness of the "Health System Strengthening for Primary Health Care (HSS4PHC)" project.

• Expected Outputs and Results: generate baseline data for 5 year project indicators from the results framework for progress comparison, based on scopes of the HSS4PHC program, allowing measurement of the impact of project interventions on maternal, newborn, and child health outcomes over time.

1. Health Services:

 

1. To assess the status of sexual reproductive maternal, newborn, and child health and health response to GBV services in Sunamganj, Bhola, Kurigram, Sherpur, and Khagrachari districts, for improved service delivery. (including quality of care, service availability, perception and utilization in public vs private facilities, especially in SRMNCH, QoC and reporting compliance from domiciliary and community health level, from public and Private sector)
   • Expected Outputs and Results: Detailed data on SRMNCH status, access to emergency obstetric and newborn care services, and utilization of sexual, reproductive health services including health sector repose to GBV in the targeted districts, highlighting community involvement.

 

1. To identify and analyse gaps and challenges within the current healthcare system at district,level (all tiers) that impact sexual, reproductive maternal, newborn, and child health outcomes.

• Expected Outputs and Results: Clear insights into policies gaps, infrastructure deficiencies, human resource availability, structure/organogram and shortages, referral system effectiveness, resource planning and utilization skills and practice, program data reporting and data analysis skills, and disparities in service provision, attitudes of provides to service recipients, across different demographic groups in the selected districts.

1. Community Engagement:

 

1. To assess the national program design and provision for effective implementation of community mobilization, awareness and gender transformative social and behavioural change activities.
   • Expected Outputs and Results: An assessment report on current national program's design and resources for effectively implementing community mobilization, awareness-raising, and gender transformative social and behavioural change activities, including an assessment of its effectiveness in achieving desired outcomes.

 

1. To assess the knowledge, attitude, and practice both from beneficiaries and providers, with a focus, in the least, on prevailing practices of community social and behavioural change activities from providers, and the resultant change in health seeking behaviours from beneficiaries, and the perception of service recipient on providers attitude in the project locations that includes health facilities.
   • Expected Outputs and Results: An assessment of knowledge, attitudes, and practices regarding community social and behavioural change activities, including an analysis of provider practices and the resulting changes in health-seeking behaviours among service recipient in the project locations.

 

1. To assess the capacity of community support groups in selected clusters, including an current status of their role in promoting maternal, newborn, and child health care, nutrition, hygiene practices, and adolescent sexual and reproductive health and rights.

• Expected Outputs and Results: Understand the capacity and capability of community support groups on participation of promoting sexual reproductive maternal, newborn and child health care and health response to GBV services.

1. Scope

 

• The agency will conduct a health systems assessment, covering status of policy environment, regulations, capacity and practice in program design, monitoring, accountability, project and financial management related to primary health care, particularly programs for maternal, newborn and child health.
• The agency will conduct assessment of current reporting, data and evidence generation and use for decision making and course correction at national level in relation to MNCAH programs and primary health care.
• The agency will assess the flexibility in the sector to allow innovation and new practices to strengthen program results (including ones to increase financing from non-government and development partners sources, service procurement modalities, compliance, and engagement of the private sector in primary health care)
• The agency will conduct a comprehensive data collection and analysis initiative focusing on household locations and conditions, with a particular emphasis on assessing the well-being of household members, especially adolescents, pregnant women, and children across five districts (Sunamganj, Bhola, Kurigram, Sherpur, and Khagrachori districts), based on predefined indicators and result framework[1]. The information gathered will encompass individual and household data, shedding light on the knowledge and practices related to key Maternal, Newborn, and Child Health (MNCH) issues with Adolescent Sexual and Reproductive Health (ASRH) considerations. Through this process, a detailed socio-economic profile of the communities will be revealed, highlighting the foundational services available within the community and the utilization of MNCH with ASRH interventions at various levels and types.
• Furthermore, the agency will analyse the current service provision landscape within the project area, focusing on the quality and adequacy of services offered to the population. This assessment will extend to key health facilities mapping, encompassing a comprehensive overview of the existing public-private partnerships (PPP) operating nationally and in the five designated districts. The agency will also assess the current design, measurement, monitoring, implementation, reporting and evaluation processes, as well as practices around scaleup and sustainability for PPP, private sector engagement, private sector development, innovative financing (including private sector financing, results-based financing, impact financing etc.) initiatives and models.
• The agency will also assess the flexibility in the governance and program implementation approach to allow innovation and new practices to strengthen program results (including ones to increase financing from non-government and development partners sources, service procurement modalities, compliance and engagement of the private sector in primary health care). By delving into these aspects, the agency aims to gain insights into the overall healthcare service delivery framework, identifying strengths, gaps, and opportunities for improvement to enhance the well-being of the community and optimize MNCH services, including Adolescent Sexual and Reproductive Health interventions.
• The agency will also conduct assessment of the national policy and strategy context around Operational Plans connected to services for maternal, newborn, child and adolescent health, and the state of interconnectedness and integration with a mapping of intervention needs. Key areas of alignment requirements both in terms of program and data elements between DGHS and DGFP will be required to come out of this assignment. At national level, the agency will also be required to identify policy and strategy context around provisioning of service from quality provider entities both public and private including the government policy space to do this effectively.
• The agency will also assess the current provision, capacity and practice among health managers and workforce in planning, budgeting, implementing, monitoring, reporting, and evaluating performance of programs at district levels and below. The current level of knowledge, attitude and practice around public financial management and utilization need to be assessed. In line with this, the national provision and practice of revenue and operational plan budget and funding allocation, utilization and reporting to and from the health managers in districts, Upazilas also need to be assessed.

 

1. Research Questions

 

1. What are the prevailing practices and improvement areas around policy and program design, planning, regulation, monitoring, accountability, partnership, multisectoral engagement, innovation, health financing and social protection, data and evidence generation and use for decision making, public and private sector quality and reporting, at national and subnational level, in relation to primary health care, with a strong focus on MNCAH?
2. What is the status of sexual reproductive maternal, newborn, and child health services in the districts of Sunamganj, Bhola, Kurigram, Sherpur, and Khagrachari districts align with the established indicators, and what are the key areas of improvement identified through the baseline assessment?
3. In what ways do community support groups contribute to promoting maternal, newborn, and child health care, nutrition, hygiene practices, and sexual and reproductive health and rights, health response to GBV within the selected clusters, and what are the challenges and opportunities for enhancing their effectiveness?
4. What are the prevailing knowledge, attitudes, and practices of families and communities regarding maternal, newborn, and child health care, nutrition, hygiene practices, and adolescent sexual and reproductive health and rights in the targeted districts, and how can this information guide tailored interventions to address identified gaps and disparities in service provision?
5. What is the status of national context around operational efficiency, procurement and supply chain management, budget planning and utilization among the operational plans related to maternal, newborn, child and adolescent health and the practice at national and district and upazila levels in terms of operationalization of these provisions to ensure optimum care and commodities for the people?
6. What is the status of the integration of health planning, service provisioning, data reporting and alignment among different entities working in sexual reproductive maternal, newborn, child, health response to GBV and what are the programmatic recommendations?

 

1. Methodology

6.1 The organization should include the following steps but not limited to:

• Provides a relevant research methodology that is explicitly justified as appropriate for the purpose of the research topic.
• Detailed description of the research methodology, including mainstreaming of gender equality and human rights norms and standards. Gender equality and human rights dimensions need to integrate into all aspect of research as appropriate and/or criteria derived directly from human rights principles are used (e.g., equality, participation, social transformation, inclusiveness, empowerment, etc.)

6.2 Clear and relevant presentation of the framework including:

• Clear methodology to guide the research questions linked, that include standalone and mainstreamed questions of gender equality and human rights.
• Appropriate indicators for each research question
• Gender responsive and human-rights based indicators (disaggregated, gender-specific, gender-distributive, gender-transformative)
• Rubric (reference indicators as mentioned in annex 1 and benchmarks to denote success are included where relevant)
• A clear link between the indicators and the sources of evidence tools

6.3 Describe the design and methods, the rationale for selecting them, and their strengths and limitations for addressing the research's purpose, objectives, and scope:

• Qualitative and quantitative data collection methods and tools

• Qualitative and quantitative data analysis methods and tools and the links to answering the research questions, including triangulation of multiple lines and levels of evidence (if relevant)
• Reference to the use of a rights-based framework, and/or Convention on the Rights of the Child (CRC), and/or Core Commitments for Children (CCC), and/or the Convention on the Elimination of all Forms of Discrimination Against Women (CEDAW) and/or other rights related benchmarks in the design of the research.
• Description of how the methods employed are appropriate for analysing gender and human rights issues including child rights issues identified.

6.4 The methodology needs to describe the data sources, the rationale for their selection, and their limitations:

• Sampling method includes discussion of how the mix of data sources was used to: obtain a diversity of perspectives (or if not, provide reasons for this), ensure data accuracy, mitigate data limitations.
• Describes the sampling frame – area and population to be represented, rationale for selection, mechanics of selection, numbers selected out of potential subjects, and limitations of the sample.
• Mixed method approaches to make visible diverse perspectives and promotes participation of women and men, boys and girls, from different stakeholder groups.

 

The detailed sampling design must be presented to UNICEF for clearance prior to field work (through inception report). The tool(s) and other data collection instruments for desk and document review, institutional mapping and data collection shall be shared with UNICEF for technical inputs and clearance before their application.

 

1. Ethical Considerations

 

The research agency is expected to follow the ethical principles and considerations outlined in the United Nations Evaluation Group (UNEG) Ethical Guidelines for Evaluation and the UNICEF Procedure for Ethical Standards in Research, Evaluation and Data Collection and Analysis. In addition, the UNEG norms and standards will be observed. As per UNICEF standards for ethical research, the research agency must give special attention to ethical considerations and should put in place adequate measures for ethical oversight throughout the study/evaluation period. All researchers and field investigators involved in primary data collection should have undergone basic ethics training, which at a minimum includes completing UNICEF’s AGORA course on Ethics in Evidence Generation or its equivalent.

In conducting the study, the research agency must ensure informed consent, respecting people’s right to provide information in confidence and making study participants aware of the scope and limits of confidentiality. Furthermore, the agency is responsible for ensuring that sensitive information cannot be traced to its source so that the relevant individuals are protected from reprisals.  Data storage and security must be ensured at all stages of the study. Only select personnel from the research agency should have access to de-identified data, and only anonymised data should be shared externally, and with UNICEF (unless stated otherwise).

Ethical clearance from independent report board (IRB) is mandatory for this research, given it involves data collection with vulnerable populations. The research agency will be responsible for getting necessary IRB approvals for the protocol and other relevant components of the research and should factor in the IRB process, from both financial and timeline perspectives.  The proposal and implementation should be informed and guided by UNICEF’s Procedure for Ethical Standards in Research, Evaluation, Data Collection and Analysis.

 

Ethical issues and considerations are described and guided by the UNEG ethical standards for evaluation. As such, the research report should include:

- Explicit reference to the obligations of principle investigators / researchers (independence, impartiality, credibility, conflicts of interest, accountability).

- Description of ethical safeguards for participants appropriate for the issues described (respect for dignity and diversity, right to self-determination, fair representation, compliance with codes for vulnerable groups, confidentiality, and avoidance of harm).

- ONLY FOR THOSE CASES WHERE THE RESEARCH INVOLVES INTERVIEWING CHILDREN: explicit reference is made to the UNICEF procedures for Ethical Research Involving Children.

 

1. Use of Findings

The findings of this assessment will provide evidence on baseline situation in 5 designated district. Based on the generated evidence, appropriate adjustments to implementation will be made if necessary. Additionally, this evidence will be used to advocate to the Ministry of Health & Family Welfare, especially to Line Director- Maternal, newborn , child and adolescent health (LD-MNCAH), Line Director-Community Based health care (LD-CBHC), Line Director-Upazila health care (LD-UHC), Line Director- Health Service Management (LD-HSM), including Additional Director General (ADG) and Director General (DG).

1. Publication Plan

1. General Conditions of Contracts for Services: UNICEF entitled to all property rights with regard to material created by the Contractor.
2. UNICEF owns all rights in the publication and in the underlying data/research.
3. In the process of undergoing external academic publication by a UNICEF institutional contractor, then the review and approval process stipulated in the contract will apply. This should normally include a quality assurance review in accordance with the UNICEF Procedure for Quality Assurance in Research.
4. The contract stipulates that UNICEF owns all the intellectual property in the research collected or generated as part of the contract and does not give the contractor any right to use the research materials. In such cases, the Contractor can only issue an external academic publication with the prior written consent of UNICEF. (This consent would be from the Head of the relevant office/division, based on the advice of the relevant programme manager). UNICEF can veto the publication if it determines that it is appropriate to do so.
5. In some cases, UNICEF may have given the contractor the right to use the research generated as part of the contract for non-commercial academic or educational purposes. In such cases, UNICEF generally requires that the contractor share the proposed draft with UNICEF at least thirty days before sharing it with the third-party publisher to allow UNICEF (a) to ensure that no confidential information is included and (b) to provide comments. (This review would be done by the relevant programme manager, who should also notify the Head of the relevant office/division of the imminent publication).
6. In the interests of transparency, the following items should ideally be prominently disclosed in all external academic publications: (a) the author’s role and relationship with UNICEF; (b) any actual or potential conflict of interest by the researchers; (c) all funding sources for the research.
7. Appropriate attribution of the source of the research data should be included.

 

1. Schedule of Tasks & Timeline

S. No.

Major Task

Deliverable

Specific delivery date/deadline for completion of deliverable (please mention as date/no. of days/month)

Estimated travel required for completion of deliverable (please mention destination/ number of days)

1.

Produce inception report which cover the methodology of entire research, objectives, data collection method, questionnaires, analysis and lastly timeline

Inception report approved by UNICEF, relevant government counterpart and UNFPA

15 calendar days after signing of contract

As per requirement to complete this deliverable. All travel related cost should be included in financial proposal bid

2

Approval from IRB for conducting baseline assessment

Approval by IRB

30 calendar days after signing of contract

 

3

Organization of field teams and their training # Selection of teams           # Training & orientation of interviewers and supervisors. Data collection initiated.

Training report including composition of team members

30 calendar days after signing of contract

All travel related cost should be included in financial proposal bid

4

Produce progress report after data collection and analysis covering the initial findings of research.

This report must be submitted to UNICEF, relevant government counterpart and UNFPA. In case of national level workshop for reviewing these findings, selected organization will act as main facilitators in workshop.

Progress report endorsed by UNICEF, relevant government counterpart and UNFPA

Presentation of the national workshop and incorporation of the workshop output in the final report

60 calendar days after signing of contract

(data collection is to be completed within 30 days after completing training of field teams)

All travel related cost should be included in financial proposal bid

5

Produce final report comprised of overall findings, recommendation. Develop policy brief and presentation for advocacy.

This report must be submitted to UNICEF, to relevant government counterpart and UNFPA. In case of national level workshop for reviewing these findings, selected organization will act as main facilitators in workshop

(i)Final report endorsed by UNICEF, relevant government counterpart and UNFPA

(ii) Policy brief document

 

90 calendar days after signing of contract

All travel related cost should be included in financial proposal bid

6

Produce publications and policy document.

Facilitate dissemination workshop

The following document will be endorsed by UNICEF and government:

(i) Final report on assessment

(ii) Policy brief document including key finding and recommendations from baseline assessment   

120 calendar days after signing of contract

 

 

1. Estimated duration of contract

The research plan to start from 1st October and aim to complete by 31st Jan,2025. The exact time and date can be flexible depending on contract signing. However, the total duration will be within 4 months.

 

1. Deliverables

 

The deliverables are same as mentioned in the above table (Section 10: Schedule of tasks and timeline). Sample Table of Contents for an Inception Report (no more than 30 pages, plus annexes)

 

1.  

 

•  
•  
•  
•  
•  

 

1. INTRODUCTION*

1.1. Background and context

1.2. Scope of the assessment including literature review

1.3. Objectives of assessment

1.4. Research questions

2. METHODOLOGY*

2.1. Assessment criteria

1.  

2.3. Data collection methods

2.4. Analytical approaches

2.5. Risks and potential limitations

2.6. Ethics and UNEG Standards

3. PROGRAMME OF WORK*

3.1. Phases of work

3.2. Team composition and responsibilities

3.3. Management and logistic support

3.4. Calendar of work

1.  

1. Terms of reference of the assessment*

1.  

4. Tentative outline of the main report*

5. Interview checklists/protocols*

6. Draft Study Tools*

7. Theory of change *

8. Detailed work plan*

9. Detailed responsibilities of evaluation team members

10. Reference documents

11. Document map

12. Project list

13. Project mapping

 

*The structure of inception reports may be adjusted depending on the scope of the evaluation. Chapters and sections with an asterisk should be included by default.

 

1. Team composition, Qualifications & Experience required:

 

This assignment will be undertaken by an agency that is primarily engaged in the conduct of research studies including extensive experience of conducting surveys and qualitative research, and for this research especially in newborn and or child health related initiatives in the country.

The selected agency should have a successful track record of conducting high quality literature reviews, as well as designing, implementing, and analyzing both quantitative and qualitative surveys with a track record of at least five years of relevant activities in development, health, and significant experience within the government system especially on newborn health at community and facility level. The organization must have a substantial research infrastructure to support field-based data collection, electronic archiving of the data and capable of ensuring the highest level of confidentiality for research subjects as well as ensuring the validity of responses obtained.

Agencies are free to associate for this assignment to ensure that sub-studies are conducted simultaneously; it should be stated which agency is managing which sub-study, and what the responsibilities will be of the lead agency. The agencies conducting sub studies should not have any potential conflict of interest.

Senior team members should:

• Hold a post-graduate degree in master’s in public health or PhD in health, Social Sciences with specialist knowledge and experience of newborn health. Knowledge on gender equality including child rights is added benefit.
• Have clear understanding of government health structure, processes and systems.
• Be familiar with the overall health system including but not limited to hospital service management, upazilla health care, primary health care, procurement, supply chain management, quality of care, reporting and accountability, innovative financing, health financing, social protection, private sector and enterprise development, private sector engagement, public private partnerships, public financial management, NNHP&IMCI program and SCANU program in the country.
• Have a minimum of 10 years’ experience, with preferably at least five years in the maternal, newborn and child health.
• Possess excellent verbal and written communication skills (English, Bengali)
• Possess excellent analytical, report writing and presentation skills.
• Be proficient in the use computer software. i.e., Windows 8, MS Office, Internet searches, including statistical data analysis software such as Stata or R.

Suggested composition of the expert team:

• A senior investigator (team leader); she/he should have the following: at least 10 years’ experience leading projects in the child health  field, including operational research; experience in interdisciplinary work related to new initiatives and reviewing the existing system; track record of relevant research and scientific publications; at least 5 years project/program management and leadership experience; personal and team skills; experience with quantitative data packages; and good working knowledge of Bengali and English languages. Previous experience in maternal, child and newborn health programs is preferred. A track record of relevant research and scientific publications is required.
• A senior health expert and statistician with the following: at least 10 years’ experience in quantitative research; experience in interdisciplinary work, including economic aspects; track record of relevant research and scientific publications; research management and leadership experience; personal and team skills; experience with quantitative data packages; and good working knowledge of Hindi and English languages. Previous experience in water and/or sanitation programs is preferred.
• A senior research field manager with the following: at least 5 years’ experience in leading field studies in the social sciences, in both qualitative and quantitative research; personal and team skills; experience with quantitative data packages; and good working knowledge of Hindi and English languages.

Enumerators must have the ability to interview respondents, facilitate and collect data in English, Bengali and other local languages and translate the research material. The enumerators should have at least two years of experience in field work, be fluent in the necessary local languages and must have completed a high school diploma.

 

1. Duty Station

 

The organization will be based in Dhaka with frequent travel to sites. The sites are listed as below, however subject to changes as per need. (Dhaka, Bhola, Khagrachari, Sherpur, Kurigram,Sunamganj).

 

1. Management and Supervision
   1. The contracted research or evaluation agency will play a critical role in executing the activity with a clear set of responsibilities and expected standards. Primarily, the agency will be responsible for designing the study, collecting data, and analysing the results. They will ensure rigorous adherence to quality assurance measures, such as the meticulous recording and reporting of any suspected adverse events. Further, the agency will implement robust data handling and record-keeping protocols with quality check to maintain data integrity and confidentiality. Quality control will be integral to their processes, with regular audits and validations to ensure accuracy and reliability of the data collected. The agency will also be required to provide comprehensive, transparent reports and updates to keep all stakeholders informed and engaged throughout the study period. This combination of roles and responsibilities, along with stringent quality measures, will ensure that the research is conducted to the highest standards and yields actionable insights.
   2. UNICEF and UNFPA: UNICEF and UNFPA will provide overall technical management for this research. The contracted agency will operate under the supervision of a health specialist, who will report to the health manager and, ultimately, to the Chief of Health. All materials, including reports, questionnaires, and other documents, must be certified by the health specialist before being finalized. The selected agency is required to share drafts of all materials and present them to government counterparts after receiving endorsement from UNICEF.
   3. Government: Ministry of health and family welfare will be overall management and supervision of this task. Selected organization will act as facilitators in reporting to UNICEF, UNFPA and government bodies.
2. Official travel involved

 

All travel related cost needs to include in the financial proposal. In line with UN procedure for contracted partner, only economy class travel is applicable, regardless of length of travel.

 

1. Payment Schedule

 

• 1st payment (15%): upon acceptance of, IRB approval letter, onboarding of team member, finalized inception report (to be shown in inception report) (Deliverable-1,2 and 3)
• 2nd payment (30%):  upon finalization of progress report including findings, as agreed with UNICEF (Deliverable-4)
• 3rd payment (30%): upon submission and acceptance of final report and policy brief, as agreed with UNICEF (Deliverable-5)
• 4th payment (25%): upon submission and acceptance of dissemination workshop and acceptance of all finalized deliverables and raw data (Deliverable-6)

 

1. IDENTIFICATION OF RISKS FOR THE CONSULTANCY AND PLAN FOR MITIGATION

• Environmental risk - the political environment, market environment or delivery infrastructure environment, among others.
• Programme risk - the complexity associated with the nature of the service to be acquired, among others.
• Implementation risk - risk associated with the capacity of the implementation unit/team.

 

Risk Identified

Mitigation measures

Environment Risk-

The political environment- The country is undergoing rapid changes, potentially leading to unrest such as roadblocks, protests, and civil disturbances during the implementation period.

UNICEF will collaborate closely with national and local security teams to safeguard the staff's safety and well-being involved in this initiative.

The selected organization will be responsible for the safety of its staff when traveling outside Dhaka and must promptly report any delays to UNICEF.

Program risk – the need to secure approval from the country's Ethical Board for the implementation research (IR).

The selected organization will be tasked with obtaining Institutional Review Board (IRB) approval for this assessment.

During the selection process, the organization's capacity to conduct IR and secure IRB clearance will be thoroughly evaluated.

Implementation Risk – Challenges in securing government endorsement for the initiation of IR, its reports, and policy briefs.

UNICEF will support relevant programs to host multiple workshops at national and sub-national levels.

Key stakeholders, including ADG, LD, PM, and technical experts in newborn health, will participate in these workshops to discuss methodology, timelines, and data collection of assessment.

This approach aims to gain government buy-in from the onset, facilitating the endorsement process. 

 

 

 

Annex 1:

1. Predefined indicators

These outlines the predefined indicators to be collected during the baseline assessment of five districts. These indicators are considered essential, and the selected organization is required to provide additional indicators relevant to addressing the research questions outlined in the Terms of Reference (ToR).

1. Basic socioeconomic status of household using wealth index and educational level

o             Household characteristics

o             Respondents’ characteristics

1. Maternal health
   • Proportion of deliveries conducted by skilled birth attendants
   • Proportion of deliveries conducted by certified midwives
   • Proportion of delivery conducted at facilities (by public (BEmONC/CEmONC)/private)
   • Proportion of delivery conducted by skilled birth attendants and a post-natal visit conducted within 2 days
   • Number of women who received respectful women friendly services from 5 accredited districts hospitals
   • Proportion of mothers who received antenatal care from a medically trained provider
   • Proportion of women who completed 4 ANC visits or more during last pregnancy
   • Proportion of mothers receiving postnatal care from a medically trained provider
   • Number of high-risk pregnant women referred into higher facility (UHC + DH) per year
   • Proportion of mothers consumed IFA supplementation
   • Birth preparedness: Percentage of women of reproductive age who can identify 3 activities to prepare for birth.
   • Unmet need of complicated pregnancy
   • Tetanus toxoid vaccination
2. Newborn care
   • Proportion of male and female newborn treated at SCANU
   • Proportion of newborns who received thermal care (drying and wrapping, Skin To Skin) within 10 minutes
   • Proportion of newborns who received thermal care (Drying, wrapping and skin to skin) within 10 minutes and breast feeding within 1 hour of birth
   • Proportion of newborns (boys and girls) who received thermal care immediately after birth (Drying, wrapping, Skin to Skin and delayed bathing by 72 hours)
   • Clean cord care with Chlorhexidine
   • Proportion of newborns who received postnatal visit
   • Proportion of newborns with suspected infection or sepsis who received care (antibiotics) from a medically trained provider or primary health care facility or above
   • Number of eligible newborns referred to KMC Unit
   • Number of eligible newborns referred to SCANU based on valid recommendation from physician
3. Newborn, young child nutrition care
   • Exclusive breast feeding
   • Complementary feeding
   • IYCF feeding practice
   • Vitamin A supplementation
4. Availability of MNCH services and facilities
   • Facility mapping using GIS tool for both public and private facilities against population density at upazila level
   • Service mapping of key MNCH services (EmOC, ANC, ENC, EPI, IMCI and SCANU) from union, upazila to district levels.
   • Proportion of facilities (MCH, UHCs) with no stock out of commodities in last three months (antibiotics, ORS, zinc, Oxytocin, and vaccines)
   • Proportion of service providers who were trained on management of sick newborn and maternal complication management at health facilities (MCH, UHCs, UHFWCs)
5. Quality of MNCH services from selected health facilities at district, upazila and union level

(Data collection from Health facility assessment and Key Informant interview at national, divisional and district level)

• Number of districts which have an established network of facilities providing 24/7 EmONC services
• Number of UHCs health facilities who have provided 4 out of 7 signal functions in the last 3 months
• Number of midwives providing midwife-lead continuum of care
• Number of facilities providing SCANU and NSU services as per SOP
• Number of facilities implemented 5S-CQI-TQM in MNCH units with functional QIT and WIT team
• Number of Service Providers trained on essential newborn care (ENC)
• Number of Service Providers trained at national level institutes and staff in facilities offering care for very sick newborns in project districts
• Numbers of health managers and service providers trained on QI
• Number of districts with monitoring and supervision systems in place for midwives
• Number of facilities with functioning default tracking system
• Proportion and numbers of Health Managers trained on management & district evidence-based planning and budgeting for MNCAH programs.
• Number of districts implemented evidence-based planning and budgeting for effective coverage of MNCH
• Service provider absenteeism

1. Indicator for quality assessment of health facilities

• Bed occupancy rate, ANC/PNC utilization, C-sections, obstructed labour, admission
• Maternal death, in-hospital maternal mortality rate, in-hospital neonatal mortality rate
• Functioning generator backup, round the clock safe blood transfusion service, functioning ambulance
• Mode of communication (Landline, Cell, Internet),
• source of drinking water
• Reception room or waiting area for patients and visitors (OPD, Labour room, ward, operation theatre)
• Human resource gap
• Quality of overall outlook of facilities, quality of provision of responsive health services
• Quality of infection control and waste management
• Quality of outpatient department, quality of indoor service
• Quality of patients’ diet and kitchen management
• Availability of laboratory facility, availability of equipment
• Quality of care (ANC, delivery, PNC, asphyxia, LBW, neonatal sepsis management)
• Proportion of District Hospitals/hospitals at district level with validated HSS Score above 85
• Proportion of District Hospitals/hospitals at district level with validated HSS Score above 90
• Proportion of Upazila Health Complex/hospitals at upazila level with validated HSS Score above 85
• Proportion of Upazila Health Complex/hospitals at upazila level with validated HSS Score above 90
• Proportion of cases of critical/high risk women and children referred out of UHCs
• Proportion of cases of critical/high risk women and children referred out of DHs
• Number of monitoring visits to upazila health complex to evaluate service quality
• Number of monitoring visits to hospitals at district level /district hospitals to evaluate service quality
• Number of internal reviews of service quality in a year at upazila health complex/district hospital
• Proportion of hospitals with displayed important phone numbers to lodge comments/complaints
• Proportion of hospitals with an active grievance/comment/feedback reporting process for patients/service recipients.
• Number of grievances/complaints received in a year
• Proportion of grievances/complaints resolved in a year
• Proportion of district hospitals with over 70% satisfaction rate in routine patient surveys/feedback mechanism
• Proportion of upazila health complexes with over 70% satisfaction rate in routine patient surveys/feedback mechanism

 

1. Home-based MNCH services

• Proportion of community groups (CG) and community support groups (CSG) functioning with regular meeting
• Proportion of caretakers know at least 3 danger signs of pregnancy, delivery and postnatal period
• Number of women of reproductive age who identify midwives as safe birth attendants to perform deliveries
• Proportion of caregivers know at least 3 newborn danger signs
• Proportion of caregivers know at least 3 danger signs of child
• Proportion of caregivers who sought care from facilities used referral system
• Care-seeking behaviours for Maternal Newborn Child health
• Knowledge of respondents on maternal newborn danger signs
• Referral of complicated pregnancy and sick newborn and child
• Number of targeted populations reached during social autopsy in community
• Percentage of pregnant mothers fully tracked* for services
• Focus Group Discussion - key barriers of accessing to, or utilizing MNCH services in public and private facilities

1. SRHR including FP services

• Number of women receiving education and services on GBV from midwives in the 5 districts

• Number of MR services provided by midwives in the 5 districts
• Number of midwives trained on counselling skills for SRHR service provision
• Number of workshops on SRHR, gender-based violence, and preventing early marriage and early pregnancy
• Number of education/training institutions teaching gender-responsive Life Skill Education according to developed curricula
• Number of service delivery points with at least one trained service provider who can provide adolescent - friendly sexual and reproductive information
• Percentage of adolescents who know the places within their reach to comfortably seek ASRHR services
• Percentage of women in the reproductive age who have heard of at least four modern methods of contraception
• Percentage of current users of modern methods, who were counselled on side effects at the time of acceptance of the method
• Number of women counselled and provided with post-partum family planning services in the 5 districts.

 

1. Accessibility of health services

• Time taken for reaching major health facilities at community, sub-district, and district levels
• Is there any other intervention by other development partner exists?

1. Health Systems Strengthening

• Number of national level approved and implemented policies/guidelines to ensure regular financial reporting
• Number of national level approved and implemented policies/guidelines to ensure regular service reporting from upazila and district
• Number of national level approved and implemented policies/guidelines to ensure monitoring of financial reporting
• Number of national level approved and implemented policies/guidelines to ensure monitoring of service reporting
• Number of district level reviews of data to validate service reporting and data quality
• Percentage of district officials responsible for financial management, who received Financial Management training
• Percentage of upazila officials responsible for financial management, who received Financial Management training
• Percentage of fund utilization by district level health offices
• Percentage of fund utilization by upazila level health offices
• Percentage of district level offices with over 90% rate of reporting on program outputs
• Percentage of upazila level offices with over 90% rate of reporting on program outputs
• Percentage of district level offices with over 90% rate of reporting on financial and budget management
• Percentage of upazila level offices with over 90% rate of reporting on financial and budget management
• Number of monitoring visits from national and divisional levels to district level health offices in a year to monitor program results.
• Number of monitoring visits from national, divisional and district levels to upazila level health offices in a year to monitor program results.
• Number of monitoring visits by health management to district level health offices in a year to monitor financial management.
• Number of monitoring visits by health management to upazila level health offices in a year to monitor financial management.
• Number of independent financial audits to district level health offices in a year
• Number of independent financial audits to upazila level health offices in a year
• Number of unqualified (without any significant findings) financial audits at district level health offices in a year
• Number of unqualified (without any significant findings) financial audits at district level health offices in a year
• Number of monitoring visits to private sector providers in district, by district health office manager
• Number of monitoring visits to private sector providers in upazila, by upazila health office manager
• Number of post-market surveillance visits for drugs in the market monitored by district level officials in a year
• Number of post-market surveillance visits for drugs in the market monitored by upazila level officials in a year
• Percentage of private sector service providers in district reported on health service in DHIS2 in a year
• Percentage of private sector service providers in upazila reported on health service in DHIS2 in a year
• Number of private sector entities from whom health service was sourced by district level offices in a year
• Number of private sector entities from whom health service was sourced by upazila level offices in a year
• Number of private sector providers from whom health service was sourced by district level offices in a year
• Number of private sector providers from whom health service was sourced by upazilla level offices in a year
• Number of PPP engagements/partnerships from district level health offices in a year
• Number of PPP engagements/partnerships from upazila level health offices in a year
• Number of local partnerships/community engagements by district level health offices to cover gap in service provision/budget gap/for optimization of service quality
• Number of local partnerships/community engagements by district level health offices to cover gap in service provision/budget gap/for optimization of service quality

 

1. Result Framework

 

Expected Results

Indicators

Baseline

INTERMEDIATE OUTCOME

1100: Enhanced abilities and responsiveness of the MoHFW, and its directorates to ensure enabling environment for gender-responsive high quality, equitable and sustainable SRMNCAH services

(1100.01) Percentage of gender responsive national health policy and plan documents endorsed.

Indicator Definition: This indicator will be measured by a simple count of the total number of national plans and policies developed with a focus on gender responsiveness.
Numerator: Inclusive plans
Denominator: Total target (e.g., ENAP-EPMM, REMN, Family Planning, Clinical Mentorship Action Plan)

0 (2024)

(1100.02) percentage of budget spent in SRMNCAH related OPs (7 OPs) against budget allocation

Indicator definition: This indicator refers to the utilization of the annual allocated budget of 7 (seven) Operational Plans of the 5th Health Sector Programme (2024-2029).

Numerator: Total annual utilized budget of 7 OPs
Denominator: Total annual allocated budget of 7 OPs ((i) Maternal, Newborn, Child, and Adolescent Health-MNCAH,
(ii) Maternal child reproductive adolescent health-MCRAH, (iii) Primary Health Care-PHC, (iv) Upazilas Health Care-UHC, (v)Nursing and Midwifery Services, (vi) Clinical Contraception Service Delivery Programme-CCSDP, and (vii) Family planning Field Services-FP FSD

TBD

IMMEDIATE OUTCOMES

1110: Improved planning, budgeting and management of SRMNCAH program informed by gender-based analysis and optimum utilization of the allocated resources through strengthening the capacity of MOHFW

(1110.01) Number of operational plans supported for rational budgeting and their implementation

Definition: This indicator is measured by a simple count of the total number of operational plans supported for rational budgeting and implementation. This is a cumulative indicator.

The operation plans are - i) Maternal, Newborn, Child, and Adolescent Health-MNCAH, ii) Maternal child reproductive adolescent health (MCRAH), iii) Primary Health Care (PHC), iv) Upazilas Health Care (UHC), v) Nursing and Midwifery Services, vi) Clinical Contraception Service Delivery Programme (CCSDP), and vii) Family planning Field Services-FP FSD

0

1120: Increased advocacy and technical leverage to strengthen national health system to ensure facility readiness through equitable coverage of skilled health workforce, improved program management and evidence-based program monitoring for delivery of quality and gender responsive SRMNCAH services.

(1120.01) Number of SCANUs with retention of trained nurses (no rotation within the hospital) following SOP

Indicator definition: This indicator is referred to the number of SCANUs with trained nurses who are not rotated following the SOP in five project districts.

0

(1120.02) Percentage of UHCs having at least 4 midwives among project districts providing SRMNCAH services

Indicator definition: This indicator is referred to the number of UHCs that have at least 4 midwives who are dedicated to provide SRMNCAH services
Numerator: Number of UHCs with at least four midwives assigned to provide SRMNCAH services.
Denominator: Total number of UHCs in the project districts (34)

TBD

(1120.03) Percentage of union level facilities having at least 2 midwives providing SRMNCAH services

Indicator definition: This indicator is referred to the union level facilities that have at least 2 midwives (government and project-supported) who are dedicated to provide SRMNCAH services.

Numerator: Number of union level facilities with at least two government and project-supported midwives assigned to provide SRMNCAH services.
Denominator: Total number of union level facilities (UHFWC and Union Sub Centre) in the project districts

0%

(1120.04) Percentage of UHCs who have provided 7 signal functions of BEmONC in last 3 months

Indicator definition: This is the number of Upazila Health Complexes in the project districts that provide 24/7 basic emergency obstetric and newborn care (BEmONC) services. The 7 signal functions are - i) administer parenteral antibiotic, ii) administer parenteral anticonvulsants, iii) administer uterotonic drugs (such as parenteral oxytocin), iv) perform manual removal of placenta, v) perform removal of retained products (manual vacuum
aspiration), vi) Perform assisted vaginal delivery (with vacuum extractor or forceps); and vii) Perform neonatal resuscitation with bag and mask. The target of the indicator is cumulative.

Numerator: Number of UHCs providing 7 signal functions.
Denominator: Total number of UHCs (34)

TBD

1130: Demonstrated innovative approaches integrated by respective program managers through evidence-based policy advocacy to strengthen health systems for delivering gender-responsive and rights-based SRMNCAH services.

(1130.01) Number of best practices integrated into OPs

Definition: This indicator is simply count the number of best practices integrated into the operational plans (OP) of the 5th Health Sector Programme.

0

OUTPUTS  

1111: Improved efficiency and timely programme planning and budget approval of the MOHFW to execute and monitor programme to deliver equitable, human rights based, gender responsive and quality integrated SRMNCAH services

(1111.01) Number of inter-Operation Plans coordination and review meetings with actions identified

Definition: This indicator is simply count the number of coordination and review meetings of inter-operation plans by the OP Managers. The meetings will include the participants of respective OPs. 

0

1112: Strengthened timely planning, implementation and monitoring of service delivery performances by the Line Directors to address the gap and bottlenecks to deliver gender responsive SRMNCAH services

(1112.01) Number of workshops for review the progress of implementation of OPs

Indicator: This indicator will ne measured by a simple count of the number of workshops where the progress of implementation of each OP will be reviewed during the entire project period by the line directors.

0

1121: Strengthened the capacity of MOHFW for HR management for equitable coverage of skilled health workforce based on monitoring of the HR availability (SCANU, midwives, CEmONC pairs) for gender responsive and rights based SRMNCAH services

(1121.01) Number of health managers and finance personnel capacitated on financial management

Indicator definition: This indicator is measured by a simple count of health managers and finance personnel from the project districts who will receive training on financial management, supported by the project.

0

(1121.02) Number of monitoring reports of available HR by level published (especially for SRMNCAH)

Indicator definition: This indicator will be measured by a simple count of the HRM reports on available HR by designation, especially who provide SRMNCAH services in project districts.

0

(1121.03) Number of need based directives sent from MOHFW for retention of skilled workforce for SRMNCAH

Indicator: This indicator is referred to the number of need based directives to be issued from MoHFW and its Directorates (DGHS, DGFP and DGNM) for the retention of skilled workforce (e.g.; doctors, midwives, Nurses, FWVs) to provide  SRMNCAH services.

0

1131:Established/sensitized national policy dialogue platform/forum for necessary policy advocacy and support for mainstreaming gender equality and provision of gender responsive and rights based SRMNCAH services

(1131.01) Number of policy dialogues conducted with MOHFW, Parliamentarians, CSOs and academicians

Indicator definition: This indicator will be measured by a simple count of policy dialogues conducted with MoHFW, Parliamentarians, CSOs and academicians to mainstream gender equality and for provision of gender responsive SRMNCAH services. 

0

1132: Generated evidence through innovations and policy briefing for mainstreaming gender responsive and high quality SRMNCAH program in health sector plan

(1132.01) Number of policy briefs developed based on innovations and evidence based best practices as advocacy tools

Indicator definition: This indicator is referred to the number of policy briefs which will be developed based on innovations and evidence based best practices (on REMN, Clinical Mentorship, M-SCANU, and Community KMC) for mainstreaming gender responsive and high quality SRMNCAH services.

0

INTERMEDIATE OUTCOME

1200: Strengthened district health systems to deliver effective, right based, patient centered, gender responsive, quality and integrated SRMNCAH and HGBV information and services

(1200.01) Percentage of deliveries at district, upazila and union level facilities conducted by midwives

Indicator definition: This indicator will be measured by a count of the number of deliveries to be conducted by midwives at the facilities (district, upazila and union level).

Numerator: Number of deliveries by midwives
Denominator: Total number of deliveries at the district, upazila and union level facilities that have midwives in project locations.

TBD

(1200.02) Percentage of demand for modern contraception satisfied

Indicator definition: See UNFPA CP10 metadata

70%

(1200.03) Number of small vulnerable newborns received services through SCANU at district and upazila level facilities

Indicator definition: This indicator will be measured by a simple count of small vulnerable newborns who received services through SCANU at the district hospitals in project locations. Disaggregated information will be collected and reported by districts.

17,794 (DHIS2, 2023 report from 5 district in SCANU admission

Kurigram-4,453
Sherpur-4,856
Khagrachari-1,172
Sunamganj-301
Bhola-4,989

 

(1200.04) Number of small vulnerable newborns received services through at district and upazila level facilities

Indicator definition: This indicator will be measured by a simple count of small vulnerable newborns who received services at district and UHCs in project locations. Disaggregated information will be collected and reported by districts.

 3,586 (DHIS2, 2023 report from 5 district in SCANU admission

Kurigram-139
Sherpur-561
Khagrachari-120
Sunamganj-360
Bhola-383

IMMEDIATE OUTCOMES

1210 : Strengthened district health system for improved district evidence-based planning and budgeting, implementation and monitoring of evidence based, gender responsive and patient centered quality SRMNCAH and HGBV programmes and strengthening institutionalized QoC structure and system

(1210.01) Number of facilities scored more than 80% in national QoC standard (DH, MCWC, UHC, UHFWC) including facility readiness criteria for delivering post-partum, post MR and PAC FP services

Indicator definition: This indicator is referred to the number of facilities (DH, MCWC, UHC, UHFWC, USC) that scored more than 80% in national QoC standard. This will be measured through an assessment using the checklist by the national QoC team at the selected facilities in project districts. Assessment plan includes site selection and QoC assessment checklist with scoring criteria.

0

1220: Improved management capacity of health managers for data analysis and data driven, evidence-based planning, implementation, and monitoring of the “district plans” that enables equitable utilization and coverage of high quality, integrated, gender responsive, human rights-based evidence based SRMNCAH services at scale

(1220.01) Number of districts developed data driven, evidence-based plans aligning with OP budget.

Indicator definition: This indicator will be measured by the count of DEPB for the districts.

0

(1220.02) Percentage of public health facilities in supported districts providing midwifery-led high-quality care

Indicator definition: This indicator will be measured by a simple count of facilities (DH, UHC and UHFWC) in the project districts that have midwives to provide midwifery-led quality maternal health services.

Numerator: Number of facilities that provide midwifery-led quality maternal health services.
Denominator: Total facilities that have midwives to provide midwifery-led quality maternal health services. This includes- DH:5, UHC: 34 and UHFWC:128)

0

1230: Strengthened health facilities and institutions with improved data sources, increased capacity to analyze and use sex and age disaggregated data with innovative context-specific solutions for equitable access to essential lifesaving SRMNCAH services and supplies

(1230.01) Number of districts reporting on  SRMNCAH indicators progress using integrated dashboard (disaggregated by sex, age, disabilities)

Indicator definition: This indicator is measured by the count of districts that report SRMNCAH indicators in the dashboard in the relevant disaggregation.

0

OUTPUTS  

1211: Institutionalized effective monitoring system following national QI framework for gender responsive SRMNCAH services

(1211.01) Number of assessments on facility for monitoring QoC standard completed that includes gender responsive indicators

Indicator definition: This indicator is measured by a count of assessments of targeted facilities based on the assessment plan by the national QoC team.

0

(1211.02) Percentage of public health facilities (MCWC, UHC and UH&FWC) supervised by the family planning clinical supervision -quality improvement team (FPCS-QIT)

Indicator definition: This indicator is measured by the count of facilities (MCWC, UHC and UH&FWC) where FPCS-QIT monitored periodically.

Numerator: Number of facilities supervised by FPCS-QIT
Denominator: Total number of facilities in the project districts (359; MCWC: 5, UHC: 34, and UHFWC: 320)

TBD

1212 : Improved capacity of health managers and service providers at DHs, MCWCs, UzHCs, UHFWCs and CCs to manage and deliver high-quality gender responsive SRMNCAH and HGBV services

(1212.01) Number of health managers and service providers who secured ≥80% score in post-assessment training on SRMNCAH related trainings

Indicator definition: This indicator will be measured by the simple count of health managers and other service providers who received training on SRMNCAH. Pre- and post-training assessment will be a part of the training. Training are related to Clinical MNH package,
KMC training/community KMC training, NIPSOM Flagship course on QI, AFHS with psychosocial counselling, and leadership training.

0

1213 : Strengthened national and sub-national level to equip health facilities with resources and tools for institutionalizing mentoring, coaching, and supportive supervision to motivate nurses, midwives and other service providers to deliver compassionate, respectful, dignified  and  gender responsive SRMNCAH care

(1213.01) Number of facilities conducted PDCA cycles

Indicator definition: This indicator is measured by simple of facilities who administered PDCA tool at targeted facilities in a district, which is NIPSOM QI Flagship course in sub-national level. The PDCA assessment tool is available at the facility level.

9 (Kurigram)

(1213.02) Number of facilities (with maternity staff) receiving mentoring support on the provision of a comprehensive, integrated SRH information and services

Indicator definition: This indicator is measured by simple count of facilities who have maternity staff and received mentoring support on provision of a comprehensive, integrated SRH information and services by the mentors (e.g.; DPHN, ADPHN, Gyne Consultant, Doctors)

0

1221 : Health managers and service providers are capacitated with necessary training, resources and tools for district evidence-based planning, implementation and monitoring of patient centered, equitable, human rights based and gender responsive integrated RMNCAH services as per the national standards

(1221.01) Number of health managers and workforce completed training on evidence-based planning

Indicator definition: This indicator is measured by simple count of facility managers and service providers involved in budget/program planning and supervision, including Civil Surgeon, DCS, MOCS, MOICT, Health Ed Officer, Statistician, DDFP, ADCC (FP-CS-QIT), UHFPO, RMO, MODC, Statistician, Health Inspector, UFPO, etc. on  evidence-based planning at the district and sub-district. At national level, relevant officials from DGHS and DGFP (planning, HSM, UHC, MNCAH, CCSDP, FPFSD) will also be involved.

0

(1221.02) Number of districts including sub-districts developed and implemented data driven MPDSR action plan

Indicator definition: This indicator is measured by simple count of districts and sub-districts where an MPDSR plan has been developed and implemented in project districts. 

TBD

1222: Expanded midwifery-led SRMNCAH care at DHs, MCWCs, UzHCs and UH&FWCs with a full complement of skilled midwives, basic amenities, equipment, supplies, job aid and safe and conducive working environment to offer comprehensive SRMNCAH and HGBV services

(1222.01) Number of district hospitals that provide colposcopy and pre-cancer treatment services.

Indicator definition: This indicator is measured by simple count of district hospital providing both colposcopy and pre-cancer treatment services in the project locations.

0

(1222.02) Number of district hospitals that managed obstetric complications between 2pm and 8am.

Indicator definition: This indicator is measured by a simple count of targeted district hospitals managing obstetric complications between 2pm and 8am in project districts.

1 DH

(1222.03) Number of public hospitals providing comprehensive STI services including screening, treatment and counselling

Indicator definition: This indicator is measured by a simple count of public facilities (district hospitals and UHCs) in project districts that provide comprehensive STI services, including screening, treatment and counselling.

0

(1222.04) Percentage of health facilities (DH & UHC) providing health sector response to GBV services (medical care, medico-legal care, psycho-social care and referral)

Indicator definition: This indicator is measured by a simple count of public facilities (district hospitals and UHCs) in project districts that provide comprehensive STI services, including screening, treatment and counselling.

Numerator: Number of facilities providing HGBV services (medical care, medico-legal care, psycho-social care and referral)
Denominator: Number of health facilities (5 DH & 34 UHC)

0

1223 : Improved capacity of district and UHC health team to manage and monitor supply chain for life saving commodities to ensure equitable access and utilization of uninterrupted  gender responsive and quality SRMNCAH service delivery

(1223.01) Percentage of facilities (DH, MCWC, UHC, UH&FWC) having no stock out of modern methods of family planning in the last three months

Indicator definition: This will be measured by a simple count of facilities (DH, MCWC, UHC, UH&FWC) that don't have stock-out of modern methods of FP during the consecutive three months.

Numerator: Number of facilities without stock-out of modern FP methods
Denominator: Toral number of facilities (364, including 5 DH, 5 MCWC, 34 UHC, and 320 UHFWC)

93% (2023)

(1223.02) Proportion of health facilities (DH+UHCs) have continue stock of Survivor kit (standardized rape kit) to provide medical and medico-legal services to the GBV survivors

Indicator definition: This indicator will be measured by a simple count of facilities (DH and UHCs) that have no stock-out of Survivor kit/standardized rape kit to ensure providing medical and medico-legal services to the GBV survivors in project districts.

Numerator: Number of facilities with no stock-out of survivor kits
Denominator: Toral number of facilities (39, including 5 DH, and 34 UHCs)

0%

(1223.03) Number of facilities monitoring the availability of essential drugs through eLMIS

Indicator definition: This indicator will be measured by a simple count of facilities in the project districts that monitor the availability of essential drugs through eLMIS. The number of target facilities is 39, including 5 DHs and 34 UHCs.
 

0

1231: National and sub-national level health managers are capacitated for gender  analysis at sub-national, facility and community level and increase use of data for context- specific solutions to overcome bottlenecks and disparities for quality improvement of services and increase equitable access to essential MNCAH and SRHR services

(1231.01) Number of health managers and workforce completed training on data analysis and data driven decision making (disaggregated by age, sex and disability)

Indicator definition: This indicator will be measured by a simple count of health managers and providers of district and Upaliza level facilities on data analysis and data driven decision making with disaggregated data. Trainees include national level officials from MIS (DGHS and DGFP), MNCAH, MCRAH, HSM, UHC, FP-FSD, CCSDP, and district level managers and workforce including Civil Surgeon, DCS, MOCS, MOICT, Statistician, DDFP, ADCC, upazila level concerns including UHFPO, UFPO, RMO, MODC, MOICT, Statistician, MO-MCH&FP, Health Inspector, AHI, FPI, etc.

0

1232 : Individual data tracking system established and implemented for  gender responsive and high quality SRMNCAH services

(1232.01) Number of upazilas implemented digital individual tracking of mothers and newborns 

Indicator definition: This indicator will be measured by a simple count of upazila health facilities that implements digital individual tracking of mothers and newborns in project districts.  

0

Number of district hospitals and UHCs where safe and ethical information management systems for gender-based violence service monitoring are established and/or supported through project support

Indicator definition: This indicator is calculated through a simple count of the number of GAC funded districts in which a national or localized GBV management information system exists. In order to be counted, the facility to submit service statistics and district to produce reports at least once per year.

0

INTERMEDIATE OUTCOME

1300: Improved quality, coverage and gender-responsiveness of Primary Health Care and SRHR including HGBV services with effective utilization of comprehensive services for marginalized and unreached populations through health system strengthening, women’s empowerment and community participation to fulfilling the rights of women, adolescent girls and children.

(1300.01) % of women received at least four antenatal care from a medically trained providers

 

37% (2019) (national coverage);

Bhola: 22%,
Sherpur: 12%,
Khagrachari: 15%,
Kurigram: 36%,
Sunamganj: 30%

(Source: MICS 2019)

(1300.02)% of live births attended by skilled health personnel

Indicator definition: Percentage of births attended by skilled health personnel (generally doctors, nurses, midwives and Community Skilled Birth Attendant-CSBA) is the percentage of deliveries attended by health personnel trained in providing lifesaving obstetric care, including giving the necessary supervision, care and advice to women during pregnancy, labour and the postpartum period, conducting deliveries on their own, and caring for newborns.
Denominator: Total number of live births occurring within the reference period; Numerator: Number of births attended by skilled personnel during the reference period.
Method of computation: (Number of births attended by skilled personnel during the reference period / Total number of live births occurring within the reference period) x 100

59% (2019) (national coverage)

Bhola: 35%,
Sherpur: 20%,
Khagrachari: 27%,
Kurigram: 39%,
Sunamganj: 44%

(Source: MICS 2019)

(1300.03) % of babies breastfed within one hour

Indicator definition: See MICS.

47% (2019) (national coverage)

Bhola: 62%,
Sherpur: 62%,
Khagrachari: 68%,
Kurigram: 53%,
Sunamganj: 72%

(Source: MICS 2019)

(1300.04) % of babies received skin to skin immediately after birth

Indicator definition: See MICS.

2% (2019) (national coverage)

Bhola: 4.5%,
Sherpur: 4.9%,
Khagrachari: 3.3%,
Kurigram: 5.8%,
Sunamganj: 3.9%

Source: MICS 2019)

(1300.05) % of babies exclusively breastfed first 6 months

Indicator definition:  See MICS.

62.6 (MICS-2019), national coverage

There is no district coverage in MICS

(1300.06) % of babies, who received postnatal care within two days of childbirth

Indicator definition: See MICS

67% (2019)
(national coverage)

Bhola: 38.9%,
Sherpur: 33.5%,
Khagrachari: 48.5%,
Kurigram: 27.6%,
Sunamganj: 94.7%

Source: MICS 2019)

(1300.07) % of mothers, who received postnatal care within two days of childbirth

Indicator definition: See MICS

65.3% (2019)
(national cocerage)

Bhola: 35.6%,
Sherpur: 33.4%,
Khagrachari: 38.5%,
Kurigram: 27.1%,
Sunamganj: 94.0%

Source: MICS 2019

(1300.08) Number of SOP/guidelines/directives prepared and disseminated

Indicator definition: This indicator will be measured by a simple count of SOP/guidelines/directives which will be prepared with the support from UN Agencies (UNICEF and UNFPA), and endorsed by the MoHFW.

0

IMMEDIATE OUTCOMES

1310: Improved delivery and effective utilization of high-quality, human rights-based comprehensive, gender responsive integrated SRMNCAH and HGBV information and services at Primary Health Care, especially for the vulnerable and marginalized communities

(1310.01) Proportion of union level facilities are functional to provide quality SRMNCAH service

Indicator definition: This indicator will be measured by a simple count of union level facilities (UHFWC and USC) that are providing at least 70% of eight elements of SRMNCAH services in project locations. The details of eight elements are provided in the project document.

TBD

1320 :  District health authorities implementing gender responsive  ‘Primary Health Care service delivery’ by integrating existing service delivery platforms, structures and functionaries with an effective referral system for achieving UHC

(1320.01) Number of Upazilas implemented reaching every mother and newborn (REMN) strategy

Indicator definition: This indicator refers to a number of Upazilas in project locations where they will execute REMN strategy aiming to reach out the pregnant women for them benefit to SRMNCAH services.

5

1330: Increased capacity of the community service delivery structures supported by a functioning PHC delivery with social accountability in coordination with local government institutions , community support for demand generation and improved access to quality PHC including SRMNCAH  services addressing gender-based constraints, social and financial barriers and ensure rights to women’s health

(1330.01) Percentage of union level facilities (UHFWC, USC) established with functional referral system

Indicator definition: This indicator will be measured by a simple count of UHFWCs where patients are reffered to higer level facilities through an established referral system and recored in service register. The service providers of UHFWCs will be capacitated for management of BEmONC and referral to higher level facilities for management of complication and CEmONC services. 

0

OUTPUTS  

1311: Health managers and service providers are capacitated to deliver quality PHC and SRMNCAH services to  empower marginalized and unreached women, adolescent girls and children

(1311.01) Number of health managers and service providers and community health workers capacitated to develop and implement REMN micro plan

Indicator definition: This indicator will be measured by a simple count of health managers of district and Upaliza level facilities to develop and implement REMN micro plan.

0

1312: Strengthened monitoring and mentoring capacity of district health teams to deliver quality PHC and  right based gender responsive SRMNCAH services

(1312.01) Number of quarterly district and sub-district project monitoring committee meetings held with followed up action points

0

1313: Training institutions strengthened to use innovative  methods for training health workers, including midwives to enhance ream teams of quality PHC and gender responsive quality  SRMNCAH services

(1313.01) Number of education training institutions in target districts that adopted gender-transformative Life Skills Education curriculum addressing reproductive health and gender equality for in school adolescents

Indicator definition: This indicator is the measurement of education institutions at the targeted districts who are providing gender transformative and gender responsive LSE education to students from grade 6-9. The number of target education institution is 350 out of 1715 in five districts.

0

(1313.02) Number of adolescents (girls and boys) who received life skills education for the protection and prevention against child marriage and adolescent pregnancy in target districts with high child marriage rate
 

0

1321: Improved understanding of the health managers and service providers on primary health care service delivery to improve access of gender responsive SRMNCAH services for marginalized and unreached population with special focus to women, adolescent girls and children

(1321.01) # of UHCs providing initial stabilization of PPH/eclampsia referred in from the community

Indicator definition: This indicator will be measured by a simple count of the UHCs that are providing initial stabilization of PPH/eclampsia and referred to higher level facilities in project locations.

0

(1321.02) % of union level facilities with midwives providing initial stabilization of PPH/eclampsia referred from the community

Indicator definition: This indicator will be measured by a simple count of the union level facilities that are providing initial stabilization of PPH/eclampsia and referred to higher level facilities in project locations.

Numerator: Number of union level facilities providing initial stabilization of PPH/eclampsia and referred to higher level facilities 
Denominator; Total number of union level facilities (320)

TBD

(1321.03) Proportion of public health facilities in supported districts where service providers including midwives are providing post-partum, post MR and PAC IUDs

Indicator definition: This indicator will be measured by a simple count of the facilities (DH, MCWC, UHCs and targeted UHFWC) where service providers are providing  post-partum, post MR and PAC IUDs.

Numerator: Number of facilities where service providers are providing  post-partum, post MR and PAC IUDs.
Denominator; Total number of facilities (104, including 5 DH, 5 MCWC, 34 UHC and 60 UHFWCs)

TBD

(1321.04) Proportion of women who receive VIA screen-positive results and are followed up with further diagnosis and/or treatment

Indicator definition: This indicator will be measured by a simple count of women who were VIS positive tested and followed up for further diagnosis and treatment in project locations.

Indicator definition: Number of total tested positive women who were followed for further diagnosis and/treatment.
Denominator: Total number of screened women who were tested positive.
 

TBD

(1321.05) Number of fistula cases identified and referred to the higher facilities for confirming diagnosis and management

Indicator definition: This indicator is measured by a simple count of fistula cases identified in the project locations who will be referred to higher level facilities for further diagnosis and management (referral, treatment, and rehabilitation to be linked with available social services)

TBD

1322: Increased professional capacities to establish strong national and sub-national network of professional associations, academia and institutes including private sectors to achieve UHC through primary health care service delivery and linkages with higher level

(1322.01) Number of workshops/review meetings with professional association at sub national level for strengthening SRMNCAH services

0

1331: National Socio-Behavioral Change and Communication strategy developed and implemented to improve delivery and utilization of quality gender responsive  SRMNCAH and HGBV services by the marginalized and unreached population, including adolescents and people with disabilities

(1331.01) National Socio-Behavioral Change and Communication strategy on SRMNCAH updated and implemented in 5 districts

No

1332: Strengthened community engagement and social mobilization through existing community structure to create awareness for gender responsive  SRMNCAH service uptake by marginalized and unreached population, including adolescents and people with disabilities

(1332.01) % of community group and UH&FWC management committee functionalized with action plans

Indicator This Definition: CG formed and conduct regular meeting to discuss the gender responsive SRMNCAH services including unreached population including adolescent and people with disabilities. This indicator is counted by number of CG group formed and continue to functionalize that is conducting regular meeting

0

(1332.02) Number of targeted community awareness sessions held (mothers assembly, adolescent session, etc.)

0

1333: Established social accountability in coordination with local government institutions and community support group to realize the rights of women, adolescents and children

(1333.01) Number of Union parishad Standing committee meeting held with local government institutions and CGs

0

1334: Increased utilization of gender responsive  SRMNCAH and HGBV services from the UHFWCs and Community clinics, including referrals to Upazila Health Complexes and District Hospitals

(1334.01) Number of SRMNCAH and GBV services provided at DH, UHC, CC and UHFWC disaggregated by gender

TBD

 

• The set of variables and indicators is subject to change upon the discussion and agreement between stakeholders.
• The quality of data should be ensured through close monitoring from the contractor to meet minimum standard.
• Raw data to be shared on finalization of the report.