TERMS OF REFERENCE FOR THE EVALUATION AND DOCUMENTATION OF THE GLOBAL FUND R5 (PHASE 1) PROJECT IN NIGERIA 

BACKGROUND

 The Global Fund is a unique global public/private partnership dedicated to attracting and disbursing additional resources to prevent and treat HIV/AIDS, tuberculosis and malaria. This partnership between governments, civil society, the private sector and affected communities represents a new approach to international health financing. The Global Fund works in close collaboration with other bilateral and multilateral organizations to supplement existing efforts dealing with the three diseases.

In 2005 Nigeria responded to a fifth call for proposals by the Global Fund and was successful. However, unlike previous rounds the Country Coordinating Mechanism which is the body responsible for the selection of Principal recipients decided that there would be multi principal recipients selected for the implementation of the Round 5 grant. The grant was signed in November, 2006 and the implementation start date was 1^st January 2007.  The Global Fund Round 5 project is expected to span a five year period and is divided into two phases. Phase 1 is for two years and ended on the 31st March, 2009. 

The Global Fund Round 5 project in Nigeria is based on a cluster model which involves developing a network or cluster of secondary and primary facilities that provide comprehensive HIV and AIDS treatment, care and support. The approach aims at strengthening capacity of and links between general hospitals, PHC facilities and community based efforts to ensure a continuum of care for people living with HIV. Decentralizing HIV and AIDS treatment and care to secondary and primary levels it is hoped will enable more people to access treatment and achieve significant impact on HIV and AIDS related morbidity and mortality.

The goal of the Nigeria Global Fund Round 5 project is ‘to scale up comprehensive HIV/AIDS treatment, care and support for people living with HIV/AIDS in all 36 states and the Federal Capital Territory.

 The project’s objectives are:

1. To scale up comprehensive HIV/AIDS treatment, care and support to people living with HIV/AIDS to all 37 states in the country
2. To expand access to HIV testing and counselling services to cover all 37 states in the country.
3. To strengthen the role of the community, civil society organizations and networks of PLWA in providing and supporting HIV/AIDS, treatment and care.
4. To increase access to care and support services for orphans and vulnerable children (OVC) in all 37 states.
5. To increase capacity of the private sector to implement workplace HIV/AIDS programs in 12 states.
6. To strengthen capacity of implementing institutions for effective program management, coordination, monitoring & evaluation.

The Principal Recipients are (NACA, SFH and ARFH) NACA was selected PR for Objectives 1, 5 and 6; SFH for Objective 2 while ARFH for Objectives 3 and 4 under the Round 5 grant. To implement the grant, the PRs also selected multi sub recipients.  These are:-

NACA

For Objective 1

• Family Health International
• HYGEIA Foundation
• National AIDS and STIs Control Programme (FMoH)

For Objective 5

• Federal Ministry of Labour.
• Society for Family Health.
• Nigerian Business Coalition Against AIDS.

For Objective 6

This Objective has no sub recipient.  It was agreed by the three Principal recipients for the Round 5 HIV grant that the funds for this activity should be used for capacity building as well as to fund the cluster meetings at the facilities.

 SFH

 For Objective 2

• Family Health International
• Plan Parenthood Federation of Nigeria

 ARFH

For Objective 3

• Federal Ministry of Women Affairs and Social Development

• National Youth Service Corps

For Objective 4

• NEPWAN
• CiSHAN

 RATIONALE FOR THE EVALUATION

One of the major components of programme development and implementation is routine monitoring of projects to ensure compliance and performance towards achievement of objective(s) of such project and  periodic evaluation to establish if the project have made desired impact on target population or not.

Having completed the first phase of the project, the PRs have concluded plans to assess and document the impact of the programme on existing outcome and impact indicators as well as good practices. This is part of the monitoring and evaluation (M&E) plan for the project. Also lessons learned from the assessment will enable documentation of the impact the project has achieved so far as well as inform future improvement in phase two and in future similar projects.

GOAL OF THE EVALUATION

To assess and document the impact of scaling up of comprehensive treatment, care and support on the HIV response in Nigeria.

 SPECIFIC OBJECTIVES OF THE EVALUATION

Evaluate and document the Global Fund’s overall performance against its goal and objectives (1- 6) after one full grant phase have been completed by assessing and document.  

• The percentage of people (adults and children, also disaggregated by sex) still alive 12 months after initiation of antiretroviral treatment.
• The percentage of HIV positive infants born to HIV infected mother
• The percentage of newly diagnosed HIV positive clients receiving INH prophylaxis.
• The percentage of HIV infected women receiving a complete course of antiretroviral prophylaxis for prevention of mother to child transmission.
• The number of private enterprises providing interventions for HIV/AIDS prevention and treatment to the workforce.
• Percentage of service delivery points submitting timely reports.
• Project’s contribution to human and institutional capacity building.
• How has the training of Peer Educators impacted on the behaviour of people in the community
• How has the “Cluster Model” implementation increased demand for HIV/AIDS services (HCT, ART, PMTCT, OVC, HBC etc)?
• What factor or factors are responsible for a relatively high level of non-adherence to the drug regime among patients who are counselled and monitored closely?
• What impact have effective coordination and management on project performance?

• The contribution of the Establishment of Support Group and their stigma reduction outreach programs to increased access to HCT, ART, and PMTCT services.

• HCT service coverage, accessibility and availability in terms of geographical spread and representation and quality of service.
• Supply and commodity logistic management which include commodity utilization, warehousing, distribution, stock-out of commodities.
• The Contribution of the PSS training of CBOs for OVC to the quality of services delivered to OVC or the cost-effectiveness for assisting the OVC?
• If there is an increase in HIV/AIDS knowledge due to PET training using the trained corps members as experimental group and the non-PET as a control group?
• Client (Project beneficiaries) satisfaction with Project Implementation

 EVALUATION METHODS

The evaluation includes but is not necessarily limited to the following methods:

• Desk review of relevant documents (project document, quarterly, semi-annual and annual project reports, minutes of technical meetings, reports on project activities, other relevant GF project documents etc.);

• Key Informant interviews with relevant staff of PRs, SRs and implementing partners;

• Field visits to selected service delivery points established/supported by the project;

 Qualitative Analysis / Documentation

Case study/ documentation of best practices is proposed as a component of this assignment. For each objective, the consultant is expected to produce case study/ documentation of best practices of programme effect on programme recipients, beneficiaries and health systems. This will complement impact, outcome and output data and provide non- qualitative information to illustrate the effect of the programme and beneficiary view on programme usefulness.

Other qualitative methods such as key informant interview and focus group discussion may be used to generate qualitative information as required.

 Key responsibilities of the consultant

The responsibilities of the impact evaluation consultant will include the following: 

1. Submit for review and approval by NACA, a Detailed Implementation Plan (DIP) for the evaluation/documentation.
 
2. Submit to NACA for review and approval a protocol for the evaluation explaining the methodology to be adopted, coverage of the evaluation exercise, design, data collection tools and data collection/analysis procedure, provide outline of reporting format.
 
3. Interact with NACA during planning meeting, desk review, field activities and dissemination activities, seeking clarification on project implementation issues, demand for use (mainly for the impact evaluation process only) GF project data/information.
 
4. Work together with NACA to ensure that the approved implementation plan is adhered to and all component activities are completed as scheduled. 
 
5. Submit all categories of reports on or before agreed deadline as specified in the survey protocol.
 
6. Carry out all responsibilities as stated or implied in this ToR with due diligence, independent mind and professional conduct free of any influence within and outside NACA and the GF project.
 
7. Participate fully in the dissemination of the Impact Evaluation final report.

Deliverables

The final deliverables of the Consultant will include:

1. Interim report of the Impact evaluation at a time agreed to by the Consultant and the management of NACA
2. Final report of the evaluation two weeks after the consideration of the interim report of the evaluation by NACA.
3. Submit all hard and electronic copies of materials, data collected/analyzed and other relevant documents pertaining to the evaluation at the end of the exercise.

 Report Writing

A draft report outline will be developed in close consultation with NACA Director of Strategic Knowledge Management and other Principal Recipients’ (PRs) M&E focal persons. 

Timeline

 THE CONSULTANT/ ORGANIZATION

The Consultant / organization for this impact evaluation of the Global Fund Round 5 project must have previous experience in conducting evaluation activities. S/he must be knowledgeable about Global Fund and its activities and possess necessary skills to lead a team of evaluators and produce quality report within a short period of time.

• Minimum of a Masters degree in Public Health, Epidemiology or related discipline.
• At Least 5 years experience in Monitoring and Evaluation of Health programmes in Nigeria. Three of the years must be in HIV/AIDS related programme.
• Ability to take initiative to deliver required outputs and planned results.
• Excellent information technology skills, including word processing, database applications, presentation software and internet.
• Excellent analytical skills and report writing ability.
• Excellent interpersonal communication skills including ability to facilitate and work in a multi disciplinary team.