Health Systems Strengthening- Performance Evaluation of PATA and Uzazi Staha USAID Tanzania Monitoring, Evaluation, Learning, and Adaptation (T-MELA)

Social Impact (SI) is a global development management consulting firm. To advance development effectiveness, we provide monitoring, evaluation, strategic planning, and capacity-building services. We work across all development sectors including democracy and governance, health and education, environment, and economic growth. Since 1997 we have worked in over 100 countries for clients such as US government agencies, bilateral donors, multilateral development banks, foundations, and nonprofits.

Project Description:

The Christian Social Services Commission (CSSC) implements the PATA activity through a network of faith-based health facilities. PATA supports the provision of sustainable financial and managerial solutions, quality improvement, comprehensive and integrated HIV prevention, care, treatment, as well as reproductive, maternal, newborn, child, and adolescent health (RMNCAH) services to faith-based health facilities. The activity is implemented in two components: Component 1 focuses on health system strengthening for self-reliance of the network of faith-based facilities, while Component 2 focuses on RMNCAH and HIV/AIDS services provision in faith-based health facilities. Listed below are the main components and expected intermediate results:

Component 1: To create a network of financially and managerially sustainable HFs and a self-reliant sector for medicine, and a commodity supply chain for its healthcare network

IR 1.1: Market segmentation increases revenue for CSSC health facilities

IR 1.2: A reliable and sustainable medical supply chain is established to support CSSC health facilities

IR 1.3: Innovative financing mobilizes capital for the CSSC health facilities and Mission for essential Medical Supplies

Component 2: To improve staff skills and retention and improve the CSSC network’s capacity to provide a continuum of care for TB/HIV/AIDS and RMNCAH services.

IR 2.1: Knowledge, skills, and retention of the healthcare workers are increased

IR 2.2: The continuum of care in HIV/AIDS services, including TB services, is strengthened.

IR 2.3: RMNCAH and allied health services are enhanced

Furthermore, PATA is working to achieve the following specific objectives by 2025:

· Market-based approaches adopted and implemented at HFs.

· Improved governance and management systems of HFs

· Improved QI and QA for health services delivery

· A reliable and sustainable medical supply chain is established to provide HIV/AIDS and other health commodities to the network of CSSC health facilities

· Innovative financing mobilizes capital for CSSC HFs and iMEMS

· Increased knowledge, skills, and retention of CSSC healthcare workers

· Strengthened capacity of CSSC lower-level non-PEPFAR HFs to provide comprehensive HIV services.

· RMNCAH and allied health services are enhanced at CSSC HFs.

Uzazi Staha is a five-year activity working with and through community- and facility-based health services to increase the uptake of RMNCAH and family planning (FP) services by addressing disrespectful and abusive maternity care and expanding the number of new and underutilized partners to implement such activities. In Tanzania, the activity is implemented in the Mwanza Region covering five councils (Nyamagana MC, Ilemela MC, Sengerema DC, Buchosa DC, and Ukerewe DC).

The issue of disrespect and abuse directly and negatively affects the uptake of essential maternal and child health services by women and their families. At the same time, the best evidence-based practices put delivery with a skilled birth attendant (SBA) – a midwife, nurse, or doctor who has undergone specialized training – near the top of the list of interventions that have the greatest impact on maternal mortality. Empowering women by increasing their knowledge on health services they should receive and how health care providers should treat them is an important contributor to decision-making which leads to increased healthcare seeking and improved quality of services.

Uzazi Staha is addressing both the supply and demand sides of reproductive and maternal health services, specifically by improving the quality of clinical services and respectful care, building community-facility linkages, and generating demand within communities to increase the uptake of essential RMNCAH and FP services. Through this approach, the activity aims to strengthen women’s health-seeking behavior and their experience of care at facilities, which will help lead to better health outcomes and continued uptake of essential services.

The activity is primarily working with a private, faith-based partner – CSSC – which manages more than 900 health facilities in Tanzania. Through these health facilities, CSSC can influence societal norms related to respectful maternity care that has yet to be harnessed. CSSC is the largest ecumenical organization in Tanzania, working under more than 87 dioceses and provinces and owning or managing 42% of hospital health services of which 56% are in rural areas.

Uzazi Staha aims to contribute to the reduction of maternal and child morbidity and mortality through achieving the following results:

Result 1: Improved provision of quality RMNCAH and FP Services.

Result 2: Increased health seeking behavior

Result 3: Private sector capacity to implement RMC and FP Strengthened.

Statement of Purpose:

The intent of this evaluation is to conduct individual activity evaluations of USAID Tanzania’s faith-based RMNCAH activities, while also providing an overall picture of what the Mission’s faith-based RMNCAH programming has achieved over the last 3 years. This will provide the health Office with the information and learnings that it needs in order to inform the next round of RMNCAH activity designs. An important note is that while PATA provides both maternal and child health (MCH) and HIV services, for the purpose of this evaluation only the MCH services will be examined.

Evaluation Questions:

1. To what extent are the interventions implemented by the PATA and Uzazi Staha activities relevant to the RMNCAH needs of Tanzania and to USAID’s RMNCAH strategies?

2. In what ways have these activities improved RMNCAH outcomes in Tanzania’s healthcare system?

3. To what extent did the implemented activities facilitate local ownership, coordination, partnerships, and sustainability? How will the outcomes of these activities be sustained once they end, or if they will not what can be done to improve their sustainability?

4. What are the most important learnings from these activities that can be used to inform future faith-based RMNCAH programming, especially regarding the factors that affect the ability of faith-based health facilities to provide high-quality healthcare services?

5. To what extent has there been coordination and integration between the two activities? Have learnings been shared between them?

6. What role have Community Health Workers (CHWs) played in achieving RMNCAH outcomes and how can that role be sustained after these activities end?

Position Description:

SI is seeking a Health Systems Strengthening Specialist to support T-MELA with the Performance Evaluation of PATA and Uzazi Staha. The Health Systems Strengthening specialist will bring expertise in enhancing the efficiency and sustainability of health services, including financial management, supply chains, and governance within health facilities. Familiar with the Tanzanian health system and the role of faith-based organizations, they assess how well the activities have integrated health service delivery with systemic strengthening efforts, offering insights into the sustainability and potential scalability of these interventions. This is a consulting position with an estimated period of performance of March – September 2024. The estimated level of effort (LOE) for the Health Systems Strengthening Specialist will be 58 LOEs.

Responsibilities:

· Evaluate the effectiveness of health system strengthening initiatives under PATA and Uzazi Staha, including financial management, supply chain, and governance.

· Assess the contribution of these initiatives to creating a sustainable network of health facilities.

· Identify best practices and lessons learned in health systems strengthening that can be scaled or adapted for future programming.

· Collaborate with evaluation team members to integrate health systems strengthening perspectives into the overall evaluation.

· Provide technical expertise on health systems strengthening to the evaluation team.

Deliverables:

With support from USAID/T-MELA and team members, the Team Lead will be expected to take overall responsibility for the production and management of the following:

1. Final Assessment Design: A detailed, full assessment design and work plan following an initial consultation with USAID that will include chosen methodologies and data collection tools.

2. Kick-off meeting/In brief: A PowerPoint/Google Slides presentation summarizing the methodological approach to be used to excute the assessment for USAID/T-MELA and key partners prior to the launch of data collection.

3. Findings Conclusions and Recommendations (FCR) Matrix: An analysis tool through which data is triangulated and findings, conclusions, and recommendations specific to each assessment question are produced. Two FCR matrixes are expected, a preliminary document after the first full week of data collection, and a final matrix at the end of the data analysis period.

4. Preliminary Findings PPT: The team will present the key findings to the wider USAID/Tanzania Mission through a PowerPoint/Google Slides presentation. The TL is expected to update this PowerPoint after the final report.

5. Draft Evaluation Reports: A draft regional reports with fully developed findings, conclusions, and recommendations, no longer than 30 pages excluding annexes, will be submitted to the T-MELA COP who will submit to the USAID COR for T-MELA activity. The format will include an executive summary, table of contents, methodology, findings, and recommendations. USAID/T-MELA and key local stakeholders will provide comments on the draft report.

6. Final Reports: The team will submit a final report that incorporates responses to USAID’s/partner’s comments and suggestions. The report will be submitted electronically in English. The report will be disseminated within USAID and key stakeholders.

7. Weekly progress report: Provide weekly progress report to USAID-TMELA and SI in the agreed format.

Qualifications and Skills:

The Health Systems Strengthening Specialist must be Tanzanian who have/hold:

· At least 8 years of senior-level experience working on evaluation/assessment is desirable.

· Master’s degree in health administration, Public Health, or related field with a focus on health systems.

· Proven experience in evaluating health systems strengthening projects.

· Knowledge of the Tanzanian healthcare system and challenges to health facility sustainability.

· Extensive experience in designing and conducting evaluations, including both quantitative and qualitative research methods.

· Strong understanding of health data systems in Tanzania, including DHIS2.

· Experience in the designing of instruments for data collection including quantitative questionnaires, qualitative tools such as KIIs and Focus Groups using diverse technology.

· Experience working with international donors, especially USAID.

· Preferably, the applicant will possess experience conducting evaluations in East Africa, Tanzania in particular.

Level of Effort (LOE):

Expected up to 58 days. Only actual time spent is billable.

Expected timeline: March – September 2024

To apply, please merge both your CV and a cover letter into two different PDF files and submit it through the online portal.

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Only selected candidates will be contacted for an interview. Please, no phone calls.