Consultancy for Knowledge Attitudes and Practices (KAP) Survey on Reproductive Health and Safe Motherhood Assessment in Turkana districts

Terms of Reference (TOR)
Title: Consultancy for Knowledge Attitudes and Practices (KAP) Survey on Reproductive Health and Safe Motherhood Assessment in Turkana districts

Location: Turkana districts of Rift Valley Province of Kenya
Duration: 17 days
Start Date: Upon signing the Contract

Reporting to: Merlin Kenya/Somalia Country Director
Background
Due to the marginalization of Turkana districts, health care delivery in these districts is extremely underdeveloped. This combined with other aspects of under development including low literacy rates and low knowledge of health issues among pastoral communities in Turkana districts have conspired to create the current state of affairs of inadequate delivery of maternal and child health care services and high maternal and child morbidity and mortality.
Merlin is committed to work in collaboration with the Ministry of Health and other partners in order to reduce maternal and child morbidity and mortality
Merlin has received a grant from the European Commission to implement a project that will contribute to the improvement of health status of vulnerable women and children through the strengthening of civil society organizations in Turkana Central and Turkana South districts of Rift Valley province of Kenya.
In line with the broad policy objectives of the Kenya National Health Sector Strategic Plan for 2005 – 2010 (NHSSP II), the action intends to strengthen the capacity of indigenous non-state actors and foster state/non-state partnerships in order to improve access to health care services; improve quality of health care services; and improve efficiency of health care delivery. The three partner organizations that will be strengthened to support safe motherhood initiatives and who will work constructively with the government to improve the situation of vulnerable pastoralists are PAG, RCEA and TUPADO¹
Objectives

1. to describe the availability, use and quality of antenatal, delivery and postpartum care provided to women and newborn babies at all levels within the health care system;
2. to identify gaps in the provision of this care with particular emphasis being placed on assessing the skills and ability of health facility staff and TBAs to provide the services identified in the Mother-Baby Package, and on the availability of appropriate drugs, supplies, equipment, facilities and transport.
3. Researching norms, values, beliefs and community practices in relation to reproductive health
4. Recommend the most effective ways of promoting safe motherhood and reproductive health services in Merlin operational areas in Turkana districts

Number 1 and 2 objectives will support and serve as an instrument for planning for district health authorities and other partners for acceleration of effective and efficient maternal and child health interventions
Number 3 and 4 objectives will provide information for the facilitation of the following:

• The in-depth research on behavioral change and their underlying reasons would inform the design of appropriate and sustainable community based communication strategies for social, community mobilization and public education campaigns on reproductive health
• The survey findings will significantly contribute to the development of long term sustainable programme intervention that would influence the delivery of facility and community based maternal, child and neonatal health care services

Specific Tasks
The specific key tasks that would be expected from this consultancy include:
1. Clarification on the purpose of the survey and develop a detailed work plan for the period of the consultancy

• Consultations will be done with Merlin and stakeholders to agree on the purpose/objectives of the survey. Prior to the commencement of the survey, the consultant is expected to develop a detailed work plan for the whole exercise. This plan will be shared with relevant district health authorities, partners and Merlin country and field offices.

2. Definition of the study population.

• It is vital to ensure that the study population is clearly defined.  We propose that the survey targets women of reproductive age group. In regards to objectives number 1 and 2 representative sample of health facilities will be selected.

3. Sampling and estimating the sample size

• In order for the result to be representative of the target population, the sample size will be determined by appropriate sampling techniques and the chosen level of precision agreed by Merlin and the consultant.

4. Data Collection and analysis

• It is important to ensure that all the enumerators follow the same interview protocol. All interviewers should adopt the same approach in explaining the survey, phrasing particular questions, and recording the responses. This will minimize any observer bias. The results could be easily recorded by hand and analyzed using statistical packages such as, Statistical Package for the Social Sciences (SPSS) and Statistical Analysis System (SAS) for faster, more accurate analysis. The consultant is expected to train the enumerators on data collection, data entry.

5. Recommendations

1. Recommend the most appropriate and effective way of promoting reproductive health amongst Turkana women

6. Quality Control

• Throughout the course of the study, mechanisms have to be in place for ensuring quality of work is maintained and that the end results are reliable.

Methodology
This work entails the integration of two separate studies, i.e an assessment of safe motherhood status in sampled areas and an assessment of knowledge, attitudes and practice of women in regards to reproductive health, and as such will entail the development of separate tools. For the safe motherhood assessment we propose the use of Safe Motherhood Rapid Assessment Tool while standard questionnaires will be developed for the KAP survey. It is envisaged that the two components of the study will be conducted concurrently.
The survey will be conducted in a participatory manner that will enable government counterparts from the MoH, other partners and beneficiaries to participate. District health authorities and key community leaders within the sample areas will be consulted and they will provide inputs to the survey. The process will entail discussions and orientation on the overall task, to agree on the requirement, scope and added value of the outcome documentation. It will involve a series of planning, consultative meetings and related sessions.
The research methodology will include:

• Desk review of existing data
• Development and administration of questionnaires to health and other technical staff
• Focused group discussions (FGD) with target groups
• Individual in-depth interviews with key informants
• Observations at health facility/ maternity units

Time Frame

• The duration of the survey will be 17 days (including submission of final report) and starting date will be the date of signature of the contract.

Expected Deliverables
Inception Report (within 2 days of commencement): The consultant is expected to submit a detailed report on how the survey will be carried from his point of view. The report will outline the tools and detailed work plan for the entire exercise. The draft questionnaires will be submitted for review.
Final Report (within 17 days after start): A detailed report outlining

1. The Knowledge, Attitudes and Practices with regard to reproductive health as it links to norms, values, beliefs and practices. The report should clearly identify the positive attitudes and best practices that need to be enhanced and the negative attitudes and poor practices that need to be addressed for improved behaviours in relation to reproductive health.
2. An analysis of the existing technical and physical capacities in the health systems for delivering safe motherhood and RH services
3. This report should incorporate specific simple and achievable recommendations, including the most appropriate communication strategies and messages that can be undertaken by district health authorities to attempt to address the issues highlighted. A draft of the report will be shared with key stakeholders for review and input a week before the end of the consultancy to allow time for refinement before the preparation and release of the final report. The final copy should be both in hard and electronic copies.

Reporting and payment schedule

• As per the terms of the contract

Expected background and Experience of the Consultant

• A reputable consultant with documented experience in conducting knowledge, attitude and practice (KAP) studies relating to safe motherhood, public health or behavioral change
• The consultant should preferably be a holder of a post graduate degree in public health, sociology, anthropology and related discipline. She/He must have good analytical, negotiating, communication and advocacy skills.
• The consultant should be fluent in spoken and written English. Knowledge of the Turkana language will be an added advantage. The consultant could be supported by another member with a strong background in statistics and data processing and related discipline.
• Excellent reporting and presentation skills. Must be familiar with Statistical Package for Social Sciences (SPSS) in particular and all relevant computer applications in general.

General Conditions: Procedures and Logistics

• Accommodation and meals will be fully covered for by the consultant. So the price component must contain an overall quotation reflecting these costs as well.
• The consultant will work from a combination of locations i.e. from Merlin Nairobi office, Merlin Lodwar office and other remote locations in Turkana districts
• The consultant should be able to conduct his task by using his /her own IT equipment and other office supplies related directly to the task.
• The movement of the consultant and his team to and from the field will be facilitated by Merlin, but the consultant is expected to cover the costs of transportation within Nairobi and Lodwar town.
• Final payment to the consultant will be dependent on the completion of all deliverables as well as hand-over notes.

Policy both parties should be aware of:

• The consultant and his team are not entitled to payment of overtime. All remuneration must be within the contract agreement.
• No contract may commence unless the contract is signed by both Merlin and the consultant.
• No travel in lieu of the contract will be undertaken by the consultant and his team to the duty station without prior submission of insurance cover and waiver in the event of injury while executing the duty.

¹PAG (Pentecostal Assembly of God) and RCEA(Reformed Church of East Africa) are implementing primary health care services through health facilities while TUPADO (Turkana Pastoralist Development Organization) has experience of working with communities in implementing animal health and other related programmes.
Please note short listing will be done as the proposals are received.  Send your proposals to Nairobi office on the following email address: recruitment@merlin-eastafrica.org cc. kenya.turkana.pc@merlin-eastafrica.org.

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