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Evaluation of Sida-funded Components of SCA’s Health Programme in Afghanistan

Terms of Reference

18 April 2012

1. Background:

1.1 Swedish Committee for Afghanistan

Swedish Committee of Afghanistan (SCA) is a membership non-governmental development organization that has been operating in Afghanistan for almost thirty years. The mission of SCA is to empower poor women, children and men through combining service provision, capacity development and advocacy in the implementation of development programmes predominantly in rural areas. In Afghanistan, SCA runs four large programmes in the fields of Health, Education, Rural Development and Rehabilitation of People with Disability in 17 of the country’s 34 provinces. There are support units for all programme activities relating to quality assurance, civil society, human rights & gender and information.

1.2 Health Programme

SCA’s Health Programme delivers basic health care in four provinces (Laghman, Sar-e Pul, Samangan, and Wardak) according to the Afghan government’s Basic Package of Health Services (BPHS). In Laghman and Wardak provinces SCA has recently started managing services in the provincial hospitals to provide the Essential Package of Hospital Services (EPHS). In addition to this, SCA provides supplementary services for maternal and child health care, community capacity building and health education and awareness rising. These supplementary projects are all funded by Sida and are the subject of this evaluation.

1. Community Midwifery Education (CME): The long-term goal of the CME programme is to improve the health status of the population. The purpose of the project is to reduce the high maternal and neonatal mortality in the province by increasing the availability and quality of maternal and newborn care in collaboration with community and MoPH. Since 2004 SCA has been implementing CME programme in different provinces of Afghanistan. Total number of midwives graduated so far from the SCA’s CME programmes is 176. Currently, SCA is implementing the programme in Samangan, Sar-e-pul and Wardak with the total number of 62 students. CME is competency-based training for duration of 2 years

2. Learning for Healthy Life (LHL) : LHL is a health-focused literacy course for illiterate women of reproductive age. Its core objectives are:
• To train illiterate women to read and write;
• To empower women to make informed decisions related to their health and;
• To increase utilization of reproductive health services
The class duration is 9 months and is composed of 2 hours of lessons every day for 6 days a week.

3. School Health (SH): SCA runs the School Health Project in Samangan, Balkh, Laghman and Wardak provinces. The project has following objectives

• To ensure that school children have adequate health conditions
• To reduce morbidity and absenteeism among school children
• To establish healthy school environment conducive for effective learning
• To provide the children with the knowledge that promotes healthy attitudes and behaviors
• To emphasize the role of the schools in promoting health in their communities

4. Quality Assurance (QA): The Quality Assurance Project includes activities which ensure the implementation of QA standards in health facilities, the supply of medical equipment etc. It is implemented in Samangan and Sar-e Pul provinces

5. Construction: SCA has constructed, and is still constructing health facilities in Samangan, Sar-e Pul and Laghman provinces, with the overall objective of improving access to quality services.

6. Capacity building (CB): Since 2010, a large number of health facility staff, management staff and local health authorities have been trained through the Sida fund.

7. Supply of equipment and medicine to health facilities: For the last 3 years most of SCA’s, health facilities have been equipped.

2. Purpose and objectives

Overall Objective:

The purpose of this evaluation is to assess the contribution of Sida-funded projects to the health status of SCA’s target groups, and to SCA’s Health Programme. It is also expected to provide practical recommendations for future design and implementation of current Sida-funded projects, as well as to suggest other innovative interventions in order to support SCA health strategic objectives.

Specific objectives are:

1. To asses the relevance of Sida funded projects with regard to Health Sector Strategies and SCA’s Health Strategy and Strategic Plan. It should also explore to what extent the present interventions address current health sector priorities and the health needs of women and children, and to what extent these interventions are acceptable in Afghan cultural context

2. To asses the effectiveness of Sida projects. Have the projects achieved their objectives, do results contribute to the overall development objective. How did this improve the SCA image, value and core principles?

3. To assess the efficiency of Sida projects. Were there sufficient resources, and could SCA have done more with the available resources? What is the cost per intervention, per unit (CME student, LHL student, etc?

4. How much the current implemented Sida-funded projects have contributed to increased utilization of quality health services in SCA health facilities

5. To asses the management/ implementation approaches of these projects. How have these projects been planned, executed, coordinated and monitored? Are the current structures appropriate for the management of these projects?

6. To identify lessons learnt and to provide SCA health programme with recommendations for optimizing results and improving quality as well as on how to further build on the action in its future direction.

3. Scope and methodology

3.1 Scope

The evaluation will cover all Sida-funded projects within SCA’s Health Programme, including Community Midwifery Education (CME), Learning for Healthy Life (LHL) School Health (SH), Quality Assurance (QA), Construction, Capacity building (CB), and Supply of equipment and medicine to health facilities

The evaluation will start in SCA’s Kabul Management Office (KMO), and will then proceed to take in visits to four field offices (Wardak, Sar-e Pul , Samangan and Laghman), in order to gain a practical understanding of the Health Programme’s operations in these four locations. The field work will cover health facilities, CME Schools, and LHL classes, in these locations.

3.2 Methodology

The consultant will be responsible for the detailed design of the methodology, which will be developed in close cooperation with SCA. However, it is expected that the evaluator will combine a comprehensive desk study of all relevant documentation, with field visits, covering a range of qualitative methods and tools, which will be chosen and designed by the consultant. These might include semi-structured interviews, focus group discussions, workshops, “walk rounds” of health facilities and the community, etc.

The consultant will consult with Health Programme staff and other senior management staff from SCA’s Project Implementation Department (PID) and Policy and Quality Assurance Department (PQA), project management staff in the field, SCA health workers, as well as health users and members of the communities where the Health Programme works.

3.3 Scheduling

Following schedule is proposed for this evaluation purpose
1. Evaluation conducted from 1st July – end July
2. Finalization of report 10th August
3. Management Response 10th September

Following steps and time frame for evaluation is proposed
- Preparation / desk study 3 days
- Interviews and consultations, Kabul 3 days
- Field Trip (incl. travel) 11 days
- Feedback presentation (Kabul) 1 day
- Analysis and report writing 5 days
Total 23 days

4. Implementation and Management

4.1 Consultant

The evaluation will be carried out by an external national or international consultant, an expert in health project/ programmes with significant experience in conducting evaluations and assessments of health projects. The consultant will be responsible for conducting all aspects of the evaluation and delivering the stated outputs.

4.2 SCA Inputs and oversight

Overall management of the evaluation will be the responsibility of SCA’s Health Programme while a panel/reference group consisting of SCA’s Head of Health Programme, the Sida-funded Senior Officer of Health Programme, the Director or Deputy Director of Programme Implementation and a representatives of SCA’s Stockholm Management Office and Planning Monitoring and Evaluation in KMO will select the consultant and review and approve the report.

The parties should jointly discuss and decide upon the mission and the definite work plan, which has to be accepted by SCA before the work continues. This should include that the consultant shall present the programme, approach and key questions (revised work plan) to the reference group representatives in a Skype session.

SCA’s Health Programme Management Unit shall provide the consultant with assistance in arranging meetings and analysis events, as well as the organizing of travel to and within the field and the provision of accommodation in the field in SCA’s guest houses.

4.3 Expected outputs

- A) Presentation of preliminary findings of the evaluation to SCA staff at KMO on finishing the field work;

- B) Draft final report with executive summary in English (to a maximum 25 pages excluding annexes) within two weeks after the feedback presentation in Kabul giving recommendations of both a practical nature in the planning and implementation of targeted projects, and also of a more strategic and policy-oriented nature, to be applied within the Health Programme for future

- C) Within two weeks from receipt of draft the SCA will provide the consultant with feed back on the draft report.

- D) Final report incorporating or responding to collected feedback from SCA, to be delivered no later than seven days after receiving SCA feedback.

4.3 Profile required of the evaluation consultant

- Relevant academic qualifications to minimum of BSc/BA level;
- Extensive experience in designing and implementing studies, and / or evaluations of health or similar projects in developing countries
- Specific knowledge and / or experience of health projects and delivery of health care services in developing countries
- Knowledge of rights-based approaches in development.
- Practiced in the use of participatory methods for conducting research, planning and evaluations
- Highly proficient in written and spoken English. Proficiency in Dari and / or Pasto is an asset
- Background knowledge of the political and cultural situation in Afghanistan, as well as experience of working in conflict or post-conflict areas desirable.
- Strong communication skills, with the ability to communicate detailed concepts clearly and concisely both in writing and verbally.


10.1 Tender Procedure

The assignment is subject to a tender procedure where SCA advertise the ToR internationally and local Afghanistan. The bids will then be assessed considering the following aspects;
• The contents of the tender (that all the required information is enclosed)
• The qualifications and experience of the Consultant
• Experience from working with country/sector/conflict countries
• The methodology and approach proposed.
• The cost for the tender.
SCA reserves the right not to accept any of the tenders submitted. In addition SCA reserves the right to take references on the proposed candidate.

10.2 Documentation and information required

The consultant should present a CV showing relevant experience and background for the assignment and the following information:
- Cover letter, stating the reasons why the consultant is particularly suited to carrying out the assignment and highlighting relevant experience;
- An indicative work plan and time table;
- A description of the approach and methods (methodology) to be applied,
- A specification of Costs including Consultant fee per day and all costs related to international travel to Afghanistan. (SCA will cover all costs within Afghanistan directly, including, accommodation, local travel and food)
The full documentation – excluding CVs – is not to exceed three pages.

10.3 Submission of tender

The tender, including all required information is to be submitted to SCA electronically to by 16.00 Afghan time (13.30 CET), 17 May 2012. Please reference the application Sida Health Evaluation in the subject line.
For further information please contact Shams-ul-Islam Shams at

10.4 Validity of the Tender

Tenders shall remain valid for a period of 60 days.

Organisation Swedish Committee for Afghanistan

Country Afghanistan