Consultant - Process Evaluation and Baseline Study for the Stop Diarrhoea Initiative Project at Save The Children

Introduction to Save the Children and Project Background

• Save the Children has over 20 years’ experience of supporting the health sector in Nigeria, focusing mainly on the primary health care. It has been engaged in a number of support areas ranging from providing local technical capacity at service delivery points to a broader health system strengthening at central level.
• At community levels, Save the Children has sound experience of working with community structures and building relationship between them and health facilities. The organization has been operational in the Northern Nigeria since 2001.
• The Stop Diarrhoea project is an initiative supported by Reckitt Benckiser aimed at contributing to a two third reduction in diarrhoea-related deaths among children under the age of five in Somolu, Lagos State, Nigeria.

Incidence, Risk Factors and Treatment of Diarrhoea in Nigeria:

• Nigeria has high incidence of diarrhoea cases in children across the geo-political zones, especially in children 0-5years, resulting in percentage increase in children being affected by diarrhoea.  Repeated episodes of diarrhoea exacerbate children’s poor health status and accelerate malnutrition, creating a deadly cycle of infection and malnutrition.
• The recent 2013 NHDS shows that 10% of children under age 5 were reported to have had diarrhoea in the last two weeks and 2% had diarrhoea with blood with an average 7.5% of children with diarrhoea cases reported in Lagos State. Diarrhoea was most common among children aged between 12–23 months (17%) and least common among those aged between 48-59 months (5%). Diarrhoea with blood was also most common in children age 12-23 months.
• Dehydration caused by diarrhoea is a major cause of illness and death among young children, even though the condition can be easily treated with oral rehydration therapy (ORT). Exposure to diarrhoea-causing pathogens is frequently related to the consumption of contaminated water and to unhygienic practices in food preparation and disposal of excreta. The combination of high cause-specific mortality and the existence of an effective remedy make diarrhoea and its treatment a priority concern for the health sector. Diarrhoea leads to stunting due to its association with poor nutrient absorption and appetite loss.  Thirty-seven percent of children under age 5 are stunted, eighteen per cent are underweight.
• Children of mothers with no education were twice as likely as children of mothers with more than a secondary education to have had diarrhoea. There was also a direct relationship between family wealth and diarrhoea prevalence, with children from wealthier households being less likely to have diarrhoea. Overall, 29 percent of children under age 5 with diarrhoea were taken for advice or treatment at a health facility or provider across the LGAs in Lagos.
• Some of the key measures to prevent childhood diarrheal episodes include promoting exclusive breastfeeding, hand washing with soap, improving hygiene and quality of drinking water, vitamin A supplementation and promoting rehydration and zinc intake as prescribed in the WHO/UNICEF 7-point plan for diarrhoea prevention and control. ORS and Zinc remains the cornerstone of appropriate case management of diarrheal dehydration and is considered the single most effective strategy to prevent diarrheal deaths in children under-five.

The Stop Diarrhoea Initiative (SDI):

• Through the Stop Diarrhoea Initiative (SDI), Save the Children in partnership with the Lagos State Government and Reckitt Benckiser (RB), aim to fully implement the WHO/UNICEF 7-point plan as a Signature Programme in Shomolu Local Government Area (LGA).
• This four year programme will contribute to Save the Children and RB’s global ambition of removing diarrhoea as a top five leading cause of death amongst children by 2020. In line with Save the Children’s theory of change, the programme will: test the effectiveness and efficacy of the WHO/UNICEF 7-point plan; collate evidence to demonstrate proof of concept and value for money and advocate the Lagos State and Federal Government of Nigeria, and its partners, to replicate and scale up the approach nationally.
• The Stop Diarrhoea Initiative (SDI) focuses on the treatment and prevention of diarrhoea in the targeted communities. The aim is to contribute to at least 50% reduction in the prevalence of diarrhoea.
• The core programme elements include child health, Water, Sanitation and Hygiene (WASH), advocacy, community capacity building/participation, service delivery and partnership.
  

Purpose of the Study:

• The overall purpose of the process evaluation is to assess the effectiveness of selected SDI interventions and document the evidence on the process: (what is working / not working and explore the reasons why; assess whether the interventions have been implemented as design intended; the extent of uptake; challenges; lessons; whether they have achieved their intended outcomes;), and assess the level of participation of community members and children.
• In addition, the process evaluation will be used to validate the impact so far, with specific focus on the results that have been achieved in the implementation to provide a transparent basis for accountability for results, decision making, learning and for drawing lessons and for improvement on future programming.
  

Specific Objectives
The process evaluation seeks to address the following issues and provide specific, actionable and practical recommendations for programme improvement:

• Determine the effectiveness of selected SDI interventions that form part of the SBC strategy (School Health Clubs, Community Action Cycle and Photo Voice)
• Assess the effectiveness of the school health clubs focusing on: the functionality of the clubs according to training guidelines; effective facilitation by teachers; and meaningful participation of children as change agents for social and behaviour change around health and hygiene at school, home and in the community;
• Assess the effective uptake of the Speaking Book in school health clubs, including creating a baseline for schools yet to receive the book and setting up periodic monitoring opportunities and tools to gauge changes in knowledge, attitudes and practices  of children exposed to the  speaking book and their capacity built for improved health outcomes at school, home and in the community
• Assess the effectiveness of community action cycle approach on the capacity of the community to organize themselves to identify, prioritize and develop local solutions to community issues, plan, implement and evaluate their progress in a gender sensitive and empowering way for improved health and social outcomes, reaching the most marginalised; 
• Assess the effectiveness of Photo Voice on children’s capacity as change agents to use the approach as a means of raising their voice on issues of concern to them to influence policy making and policy implementation.
• To document evidence on successes, challenges, and lessons learnt and actionable recommendations for improved programming for SDI on selected intervention.
• Assess the level of effective participation of community members and children in selected interventions and gather stories of most significant change for selected interventions;
• To review current monitoring tools and plans for selected SDI interventions and assess their effectiveness in gathering periodic data which can be used to document changes in behaviours and practices, as well as monitor improvements in the effectiveness of selected approaches.
• Modify and/or create new tools to improve programme monitoring, including participatory monitoring tools that can be institutionalised (used by existing structures) to enhance sustainability.

Methodology:

• The successful consultant will be expected to develop a detailed study methodology, data collection tools, budget and workplan to undertake the research study.
• The research consultant must be skilled and prepared to work with children. Efforts should be made to ensure that terminology and language used facilitates the integration of children into the discussions of sophisticated topics and debates.
• Child safeguarding and Ethical considerations regarding data collection, storage and analysis, including confidentiality must be clearly highlighted in the methodology. As required, the study protocol and instruments will be subject to review and approval prior to the study’s initiation.

Scope of Work:

• The scope of the research study will focus on the Process evaluation questions on programme effectiveness. These include what is working and not working, what are the successes achieved so far, what are the challenges encountered, what recommendations should be incorporated into the implementation for the next two years, which mechanisms within the interventions triggered changes and are these changes being maintained,  what are the conducive conditions for the intervention to work, what is the level of child participation in Schools Health Committees and wider community members for CAC and to gather stories of most significant change. 
• The work will also include a baseline for school health clubs focusing on their existence, functionality and activities to involve children as change agents; a baseline for speaking book; a baseline for community Action Learning Cycle; a baseline for photo voice; and a review of current monitoring tools for selected interventions with suggested modifications/ new tools that will facilitate participatory monitoring for the process evaluation embedded into existing structures.

The process and tasks within this work will be the following:

• Collaborate with SCUK Advisors and SDI project team to define the scope of the research study
• Carry out preliminary preparation of the research proposal for Nigiera, including a review of background literature and key project documents;
• Produce a brief inception report which will be used to input into a more detailed research proposal
• Full literature and background review and detailed methodology for the research design
• Preparation for field work, including the production of a topic guide and tools for data collection
• Preparation of logistics for field work
• Carry out fieldwork in x wards in Somolu over a xx period, carrying out xx FGDs, xx KIIs etc (detailing duration and scope). Final details will be agreed on.
• Preliminary analysis in the field at the end of data collection presented to key stakeholders for their input
• Full data analysis and a sub-set produced which will be used for benchmarking
• Produce a substantive report
• Produce a one page advocacy summary of the results which will be shared with MoH
• Represent the project and its findings as appropriate and agreed throughout this process
  

Key Deliverables for the Consultancy

• Tools for Baseline, Process Evaluation, and participatory monitoring
• Inception report
• Substantive report including a presentation of data collected and an in-depth analysis as well as ramifications of the data for programming
• Power Point summary of key actionable recommendations

Educational Background, Skills and Competencies

• At least MSc degree in Statistics, Sociology, Demography, Psychology or any other related Social Science. A Ph.D. holder in any of the above subject will be an added advantage and preferred;
• At least 5 to 10 years field experience in work related to survey or operational research;
• Demonstrable and practice ability indicating good experience in household survey through previous work in rural communities, in particular participative data collection work directly with children;
• Experience in quantitative and contemporary statistical packages, as well as in systematically analysing qualitative data;
• Experience in conducting high quality quantitative and qualitative research in communities in Nigeria;
• Child safeguarding and Ethical considerations regarding data collection, including confidentiality must be clearly highlighted in the methodology. Planning should take into consideration Ethical Checking Requirements in country.