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1. Background
The Mali Red Cross Society (Croix-Rouge Malienne, CRM) and the Canadian Red Cross (CRC) are collaborating in the implementation of a new project entitled "Improving the health of Mothers, Newborns and Children in Mali” (Mali MNCH), funded by the Global Affairs Canada (GAC) and the Canadian Red Cross.

The CRM and CRC are seeking qualified individuals/firms to support the Qualitative and Gender Barriers Study in the collection and analysis of data in its targeted regions and districts as one of three components that will make up the project baseline survey (the two other components are a household survey and a health facility survey, both completed).
2. Qualitative and Gender Barriers Study Objectives
The CRM and the CRC will use the study findings to inform the development of project activities and review and revise, where needed, the gender strategy for improving maternal, newborn and child health in the two targeted regions. The findings can also be used by government agencies (e.g. Ministry of Health). CRC is committed to the quantitative and qualitative survey results being fed back to the communities in order to meet community engagement and accountability standards.
There are two main objectives for the Qualitative and Gender Barriers Study:
1. To collect qualitative data that will provide further context and understanding to the quantitative results obtained by the baseline household and health facility surveys conducted in October-November 2016 .
2. To explore how several key immediate and intermediate MNCH indicators may be influenced by institutional, economic, and socio-cultural gender norms and barriers (including violence against women and children).
3. Project Description:

The “Improving the health of Mothers, Newborns and Children in Mali” project is a four-year initiative, implemented by the CRM and the Government of Mali through the Ministry of Health (at national, regional and district levels), and in partnership with the CRC. The project aims to improve the health and lives of more than 1,261,400 women, children and men in the districts of Nara, Dioila, Kolokani, Koulikoro, and Banamba in Koulikoro Region and Sikasso district in Sikasso Region.

The project will reach communities located more than 5 kilometers from a health facility to prevent and address the major threats to the lives of women, children and newborns, significantly contributing to the objectives of the Ministry of Health’s (MoH) Maternal Newborn Child Health (MNCH) and Integrated Community Case Management (ICCM) strategies. The partners will achieve this by harnessing the potential of communities and by extending the reach of the MoH through Community Health Workers (CHWs) based in communities, to implement practical, proven and cost effective maternal, newborn and child health (MNCH) interventions. The Community Health Workers are supported by Red Cross volunteers who promote CHW services and conduct health education sessions in communities.

The project will support the primary and secondary health care centers (CSCOMs and CSREFs) improve the quality of their MNCH services, provide curative services at the community level through integrated community case management and promote good MNCH and preventive practices to communities. It will also support the health information system in the targeted districts. Furthermore, social and behaviour change communication will be used to address social barriers, particularly gender barriers, to maternal, newborn and child health.

The project aims to promote positive MNCH outcomes for mothers, including adolescents, and their children by working at both facility and community levels to address relevant gender-related barriers to access and control over health resources, a realization of their human rights (lack of violence against women and children) and decision-making of women to health. This includes addressing, as far as possible, existing gender norms, values, attitudes, behaviors, roles and responsibilities. The project aims to improve access and utilization of quality MNCH services as well as improving men’s engagement in MNCH. It is from this background that the project’s draft gender equality strategy was developed to ensure gender barriers are addressed throughout project implementation; it will be further refined based on the findings of this study.

The project is supported by a Canadian research institution, the Centre for Global Child Health (CGCH) at the Hospital for Sick Children in Toronto, Canada which is contributing additional technical support to strengthen performance management and accountability for the duration of the project, from local data collection, monitoring and evaluation, operational research and analysis of results.

4. Ethics, PSEA and child protection:
CRC is committed to actively protecting individuals from sexual exploitation and abuse (PSEA) and safeguarding children from harm and ensuring children’s rights to protection are fully realized. All CRC supported interventions must ensure appropriate, safe, non-discriminatory participation of all participants, regardless of age or sex. This includes free and un-coerced consent to participate in, or withdraw from this study; confidentiality and anonymity of participants. Consultants must provide a statement within their proposal on how they will ensure ethics PSEA and child protection in the process of data collection and visits. This must also include consideration of any risks related to the study and how these are mitigated. The Consultants will be required to sign the CRC Code of Conduct and Child Protection Policy.

The expectation of CRC is that the successful proposal will include a detailed description of the various steps that will be taken to ensure the following:

• Recognize and address any social and cultural, and particularly gender-related barriers to participation in the study.
• All tools, such as consent scripts and focus group/interview guides, should be developed with CRC, CRM and other key project stakeholders, then piloted and reviewed through discussions with Sick Kids and local health and gender equality experts. These tools should then be translated locally in languages appropriate to Koulikoro and Sikasso, back-translated, and field-tested with women/men, girl/boys as appropriate.
• Adolescents and all other participants must provide consent to participate
• Interviewers should ensure that all participants know they can stop or withdraw at any time, without negative repercussions or consequences
• Investigators must provide all participants, including adolescents, with information about the activity in a manner appropriate to their culture and education level
• Avoid undue influence on participation through use of incentives. If incentives are provided, they should be in line with local living standards and be approved by research ethics authorities in Mali.
• Interview procedures must protect participants’ best interests, with particular consideration for adolescent participants. Consultation with community members should inform appropriate practices.
• Use appropriate procedures to maintain the safety and security of participants.
• Use appropriate procedures to encourage full participation of women and adolescent girls such as logistics, timing, venue etc.
• Use an independent advocate to represent the views of adolescents if there is any doubt about the protection provided by their guardian
• Outline protocols and procedures in cases where domestic/gender-based violence or child protection violations are reported/detected during the study, as well as an appropriate referral process.
5. Scope of the Consultant’s Role:
The consultant’s role will include:
• Secondary data review (desk review): project design and objectives, review of baseline reports, and key publications on sociocultural norms and gender as they relate to select MNCH indicators in Mali.
• Primary data collection:
• Work with SickKids, CRM and CRC on the development of data collection tools and to finalize the data collection methodology and sampling.
• Recruit all focus group facilitators, translators, note-takers, transcribers and coders. Interviewers and focus group facilitators should include both men and women who are knowledgeable and experienced in collecting qualitative data regarding matters of gender and MNCH in Mali.
• Develop data collection tools and customized questionnaire per each interview group according per the Scope of Study section below.
• Translation and back translation of all data collection tools into local languages of Koulikoro and Sikasso.
• Work with the Mali Red Cross to gain necessary ethical clearance to undertake study.
• Training focus group facilitators and/or interviewers, note-takers, and translators following the field manual and data collection protocols developed in consultation with SickKids.
• Pilot test all data collection tools developed in collaboration with SickKids and CRC; revise/refine tools following the pilot, as appropriate, in collaboration with SickKids and CRC.
• Complete data collection and follow quality assurance protocols according to the methodology and sampling developed with SickKids.
• Provide CRC and CRM with scanned versions of the written notes, electronic digital recording files and summary of key points from each interview/focus group when submitting the draft report.
• Provide regular field reports, detailing any challenges, lessons learned, modifications to data collection protocols and any remediation required. Regular reports can be informal via minuted Skype conversations, and a formal field report will be required at the end.
• Conduct qualitative data analysis according to methodology outlined by SickKids (using Nvivo software or equivalent)
• Submit a draft report of findings, including recommendations for key issues to address in the project and strategies for addressing them (to inform the project’s Gender Strategy), and a final report responding to the feedback from CRM, CRC and SickKids. An outline of the report template will be provided by CRC.
• The consultant should not share any of the assessment results with any third party nor use them for any personal publications.
• All work to be done in collaboration with the CRC, CRM and SickKids, as well as the local gender consultant hired by the project. SickKids, CRC and the CRM will provide technical support on the development of data collection tools, methodology, and quality assurance guidelines. The CRM, SickKids and CRC will also supervise training, field visits and data collection.
6. Scope of the Study
The study will address three research questions (with suggested sub-points), with an emphasis on sociocultural and gender-related aspects of MNCH care-seeking:
1. What are the main barriers to, and facilitators of, MNCH care-seeking and service utilization in target districts of Koulikoro and Sikasso according to women and men?
• What are the overall barriers/facilitators to care seeking?
• Which of those barriers/facilitators are impacted by gender norms and biases?
• What additional barriers/facilitators exist that were not mentioned by interviewees, but that are determined by gender norms in Mali? (i.e. laws, institutional structures, access to resources).
2. How is MNCH care-seeking and service utilization by women and men influenced by traditional gender roles, care practices, and cultural norms?
• Are there recent/existing activities focused on changing traditional gender roles, care practices and cultural norms and if so what are they and who is implementing them?
• How does age, class, ethnicity and residence (i.e. urban vs. rural) influence traditional gender roles, care practices, and cultural norms?
• Who are the most important drivers of traditional gender roles, care practices and cultural norm at the community and facility levels and how can they be engaged in the project?

3. Which approaches or solutions would be most effective in addressing the challenges/barriers identified?
• Which groups would be important to enlist as allies for change?
• What are pros and cons of these suggested approaches or solutions (i.e. a matrix)
• Which of these issues could be most effectively impacted within the project time frame?
To answer these questions, approximately 10-12 focus groups (FGDs) will be conducted with pregnant women and/or mothers of reproductive age in target districts. FGDs/interviews will additionally be conducted (separately) with female adolescents and male community members/adolescents/caregivers and other women to capture barriers to good MNCH for female adolescents and men’s perspectives on gender-related aspects of MNCH.
Follow up one-on-one interviews will be conducted with a small sub-sample of FGD participants to gain additional insights into their personal experiences and opinions. These will provide rich narrative data on women’s lived experiences of particular phenomena. This approach will be particularly important where sensitive topics emerge. One-on-one interviews with these individuals can be used as an opportunity to elaborate on themes that emerge during FGDs. Focus group facilitators are expected to be able to identify such cases and make appropriate decisions regarding selection of participants for follow-up in-depth discussion.
In addition to the FGDs/interviews with women and men, 3-4 key informant interviews will be conducted in each region (6-8 in total). Example of key informants could be CHWs and Red Cross volunteers who were part of the previous CRC-MNCH project, District Health Departments, CSREFs, CSCOMs, ASACOs and NGOs working in MNCH. These interviews will be used to triangulate and contextualize FGD findings, and will provide additional perspectives on programming and policy implications of the research findings. Where appropriate, researchers should ask participants what they believe are the best ways to address the issues at hand, and should capture local perspectives on existing strategies that are working well. This will be achieved through interviews with a diverse group of local stakeholders and community members.

7. Proposed Study Methodology
What follows is a proposed study methodology; the consultant is welcome to propose another methodology or suggest changes/additions to the one outlined here.

As outlined above, data will be collected by means of 10-12 focus groups with approximately 75-80 women/mothers total, follow-up one-on-one interviews with 10-12 women (and/or men, as appropriate), as well as semi-structured interviews with 6-8 key informants . Furthermore, approximately 5-6 focus groups will be conducted with female adolescents, male community members/adolescents/caregivers and other women.

FGDs will be led by an experienced facilitator, and assisted by a note-taker. Individuals responsible for coding/analysis must be in attendance for the fieldwork. If they cannot be present for all FGDs, at the very least, they must be part of the daily de-brief meetings.

All FGDs/interviews will be digitally recorded with the permission of research participants. The lead consultant will review the recorded transcripts and accompanying notes throughout the data collection process. This will provide an opportunity for coaching on interview skills (probing, question phrasing, engagement of all participants) and ensure consistency in interviewing techniques between teams/interviewers and across regions. To ensure high quality data, daily consultative team meetings will be held throughout data collection to debrief, compare and confirm notes, identify emergent themes, and highlight particularly rich narratives warranting further exploration. The lead consultant will also review field notes to ensure they are legible and adequately capture the key issues. This iterative process is critical as it shapes the preliminary analysis and serves as an important quality assurance measure. SickKids researchers will be available to help support this process and provide inputs where needed.

The following two-stage protocol should be followed for processing all qualitative data:
1. One team member will transcribe all interview/FGD recordings (conducted in Bambara or other local language ) into written French, using Microsoft Word.
2. A second team member (fluent in both languages) will review the French transcripts while listening carefully to the original digital recording, making note of any omissions or misinterpretations in the French version. The lead consultant should ensure this is done thoroughly to ensure that all recorded content is well documented.
Complete French transcripts and field notes will be imported into Nvivo software (or equivalent qualitative analysis software) for coding. The team will work with SickKids and CRC to develop a systematic coding framework based on emergent themes and consultative discussions throughout data collection. This will form the basis of a two-stage directed content analysis. The first stage of coding will be guided by pre-determined topics and questions in the interview guide, with reference to the general coding framework. The secondary coding cycle will involve the use of more specific sub-codes to categorize participant statements into themes derived directly from the data.

Transcripts will be analyzed independently by two research team members (a primary and secondary coder); this will ensure consistency between coders and will help to identify any discrepancies or misinterpretations. Throughout this process, analytic memos will be used in Nvivo to annotate emergent ideas, surprising or otherwise noteworthy findings, connections between FGDs and interviews, and other details that may inform interpretation.

Once transcripts are coded, results will be summarized and displayed in spreadsheets organized by themes and sub-themes. These data will be interpreted with reference to coding summaries, contextual field notes, memos and annotations, and direct quotes from participants. Interpretation of the findings will be done in consultation with SickKids, CRC and CRC partners.
Further input on the study methodology by the consultant is welcome.
8. Outputs and suggested timeframe
The period of the contract will be approximately from February 1 to April 30, 2017 with an expected contribution of approximately 70 working days over 3 months. The consultant is expected to carry out all the preparation required to roll out the study as per the suggested time frame below.
The deliverables are listed in the table in bold font.
Output/Deliverable Suggested timeframe Estimated Timeline
a. Skype call with Red Cross and SickKids to review proposal, plans, questions, trainings, logistics 1 day
b. Desk review and completion of inception report 4 days
c. Development of data collection tools 3 days
d. Translation of data collection tools 2 days
e. Recruitment and training of note-takers/transcribers and translators (if required) 5 days
f. Pilot-test of tools completed and analysis of pilot results shared 2 days
g. Data Collection, including daily debriefs and frequent skype calls with SickKids and CRC 18 days
h. Review of data collected; compiling field notes; transcription and translation of digital recordings 12 days
i. Field report writing; share a summary of preliminary findings with SickKids, CRM and CRC 2 days
j. Qualitative data analysis (coding transcripts; compiling results in table and narrative format) in consultation with CRC/CRM/SickKids; writing and submission of draft report
16 days
k. Revision and submission of final report 5 days
l. Original notes sent to SickKids and CRC n/a
Suggested total 70 days
9. Skills and qualifications of the Consultancy team
The team must be multidisciplinary as the qualitative survey is an opportunity to set the direction of all project components. The team may be made up of both local and international consultants, but must include a local consultant who is knowledgeable of the social context with respect to gender and social norms, who is experienced conducting qualitative research in Mali.
At minimum the consultancy team must posses the following:
i. Lead consultant must have a minimum of 10 years of experience in administering studies, collecting qualitative data and producing high quality qualitative study reports, preferably for international non-governmental organizations or multilateral agencies, with proven experience triangulating qualitative and quantitative data from various sources, as well as gender equality and child-protection related qualitative analysis and expertise;
ii. At least one team member must be a gender specialist who has conducted similar gender assessments in Mali
iii. Demonstrated expertise in maternal, newborn and child health
iv. Team must be gender balanced
v. At least a Masters degree in public health, demography, sociology, women and/gender studies or related field and demonstrated experience in qualitative research and data collection related to MNCH and gender.
vi. A professional licence for consultancy in similar tasks
vii. Good knowledge of Mali and preferably Sikasso and Koulikoro where the project is being implemented with demonstrated research experience in Mali.
viii. Evidence of similar work in the recent past is a key requirement.
ix. Experience of effective interaction with local non-government organizations, government departments, and international organizations.
x. Ability to recruit focus group facilitators/interviewers with local language skills in Koulikoro and Sikasso and team members who speak these languages.
xi. Lead consultant must have excellent spoken and written communication skills in French and also be proficient in English. Consultant who will lead the data collection must have excellent communication skills in Bambara.
10. Application Packages and Procedures
Qualified and interested parties are asked to submit the following:
1. A letter of interest

2. A detailed technical proposal that:
• Demonstrates previous experience in conducting quantitative and qualitative study approaches on MNCH or health-related topics
• Shows a thorough understanding of these terms of reference including the gender equality focus
• Demonstrates inclusivity, gender equality and non-discrimination in the conduct of the study as well as in the analysis
• Includes a description of the preferred data gathering and sampling methods
• Proposes data analysis and management
• Proposes a methodology for data capture through audio recordings and/or notetaking, with a plan in the event that participants do not consent to audio recording
• Demonstrates approaches that will be used to ensure child protection and ethics and principles will be applied throughout the design and data collection phases of the project, and how marginalized or vulnerable people will be included
• Procedures and protocols to ensure meaningful and active participation of adolescents (both female and male) and other female respondents, taking into account specific socio-cultural barriers to participation, including explicitly identifying potential risks for female respondents, especially adolescent female respondents, and proposed mitigation strategies,
• Measures in place to elicit information on sensitive issues, including confidentiality of the information generated,
• Measures in place to support / link to support services for any need and/or request for further counseling identified during the study.

3. A proposed timeframe detailing activities and a schedule/work plan (including a Gantt chart), in line with the timeframe provided in this TOR and with consideration for the time it will take to review documents (inception and end line report, etc.) before finalization.

4. Team composition including a table clearly stating the role and level of effort of each proposed team member

5. Curriculum Vitae(s) of proposed team members outlining relevant education, expertise and experience relevant to each role

6. Names and contact information of three references who can be contacted regarding relevant experience

7. A copy of 2 previous reports of similar work undertaken

8. A Consulting Firm Profile (if applicable), including:
i. Full name and contact information of the contact person within the consulting team
ii. Physical address of the fir

Organisation Canadian Red Cross

Country Mali