Operational Research on Optimizing Non-Communicable Disease Management – Consultant

Background: 

Yemen faces significant challenges in managing Non-Communicable Diseases (NCDs) amidst ongoing conflict and humanitarian crises[1] [2]. The International Rescue Committee (IRC) has been at the forefront of addressing these challenges through innovative health interventions and research.

The situation of NCDs in Yemen is dire, exacerbated by ongoing conflict and a collapsing healthcare system. NCDs, including cancer, diabetes, cardiovascular diseases, and chronic respiratory diseases, are a significant burden on the population. An estimated 1 million people in Yemen suffer from NCDs, with limited access to necessary treatments and medications[3].  The humanitarian crisis has further complicated the delivery of healthcare services, leaving many patients without the care they need. The lack of resources, coupled with the high prevalence of NCDs, poses a substantial challenge to the health and well-being of the Yemeni population[4].

Focusing on diabetes (DM), hypertension (HTN), and cardiovascular diseases (CVD), these conditions are particularly prevalent and problematic in Yemen. One of the last documented studies in 2002 shows that the crude prevalence of known diabetes is approximately 6.57%, while hypertension affects about 13.5% of the population[5]. The exact prevalence rates are not thoroughly recorded, but a 2021 study found that 34% of the population had prediabetes and 10.6% were living with diabetes[6]. A 2013 study revealed that the prevalence of hypertension varied between 6.4% and 10.1%, depending on the geographical region of residence[7].

Cardiovascular diseases remain a major contributor to disease and death, adding to the burden of NCDs[8]. Inadequate healthcare services, poor patient adherence to treatment, and a lack of awareness and education about these diseases hinder the management of these conditions[9]. The ongoing conflict and economic instability further exacerbate these issues, making it challenging to implement effective public health interventions and provide consistent care to those affected[10].

In 2023, the IRC has provided 18,851 (11,888 CVD and 6963 DM) medical consultations through 37 health facilities and 15 mobile health teams across 7 governorates and 26 districts, with the help of 541 healthcare workers.

Research has shown that community-based strategies have a significant effect due to their cost-efficiency and their ability to foster community engagement and long-term viability. The success of community health is evident in its history of decentralizing care from medical facilities through task shifting. Extensive community health worker (CHW) programs have highlighted the importance of community involvement in expanding both preventive and curative healthcare services, especially concerning maternal and child health, thus bridging the gap left by facility-based care. Furthermore, community outreach initiatives have broadened their scope to address NCDs with results showing CHWs are capable of influencing a wider array of health determinants such as behavioural factors, managing cardiovascular risks, lowering the incidences of HTN, promoting behavioural health changes, enhancing control over hypertension and DM, providing health screenings, offering referrals to health institutions, overseeing patient care, and monitoring health outcomes. These efforts also serve to bolster the healthcare system’s capacity to provide services amidst fragility[11] [12] [13] [14].

IRC provides community health program services that include health, nutrition, immunization and mental health, through 458 CHW. One of the themes given to clients is about NCD management through behaviour change. Between March and July 2024, IRC conducted individual NCD sessions for 21,645 participants and group discussions for 18,961 participants across various governorates in Yemen.

Scope of the Research:

The project aims to evaluate and design community health interventions for NCD management in conflict-affected populations in Yemen, with a focus on governorates such as Al Dhale’e, Aden, Shabwah, Lahj, and Hodeida (with the potential for expansion to other relevant areas). The scope includes:

1. Patient Perceptions: Assess patient perceptions of NCD self-care and CHW interventions to identify effective approaches and areas for improvement.
2. Health Promotion Strategies: Evaluate and recommend health promotion strategies, including the use of various media (radio, text, visual aids, video clips, cartoons, booklets, apps) and preferred mechanisms for information dissemination.
3. Cultural Adaptation: Ensure that health messages are adapted to be culturally relevant while maintaining alignment with global health standards.

The recommendations and tools developed through this project will be implemented in the field, with an assessment of the outcomes of these new methods conducted at the end of the project’s two-year timeline.

Objectives of the Research: 

The specific objectives of the research are outlined below. These objectives are designed to guide the research in developing evidence-based, contextually relevant strategies to improve NCD management in Yemen through the effective engagement of community health workers

Specific Objectives:

1. Evaluate Self-Care Practices: Assess the current self-care practices among patients managing NCDs in Yemen, focusing on their effectiveness and areas for improvement.
2. Assess CHW Communication Effectiveness: Analyse the effectiveness of community health workers’ communication styles in promoting NCD management, identifying best practices and areas needing enhancement.
3. Explore Patient Perceptions: Investigate patient perceptions of NCD management interventions and identify health promotion strategies that resonate with the target population.
4. Examine Self-Care Impact: Explore the impact of introducing NCD self-care practices on health outcomes and quality of life among patients and their caregivers in various community setting
5. Explore CHW Roles: Investigate the attitudes and perceptions of CHWs’ roles in diabetes and hypertension care from the perspectives of healthcare providers, patients, and the broader community.
6. Evaluate CHW Interventions: In 2026, conduct a cost-effectiveness analysis of contextualized CHW interventions in diabetes and hypertension care in Yemen, assessing outcomes such as client reach, patient knowledge, healthcare utilization, skills, and documentation.
7. Collaborate on Culturally Relevant Materials: Work with patients and stakeholders to create or adapt culturally relevant health promotion materials, ensuring alignment with global standards. Document the development process.
8. Recommend Improvements: Provide actionable recommendations to enhance NCD management practices within community health settings, including applicable outcome/output monitoring and evaluation strategies.
9. Develop Training Materials: Create/Adapt NCD practical training materials and tools (such as PEN-H NCD) for CHWs. Document the current roles of community health workers (CHWs) in managing diabetes and hypertension in Yemen, with a focus on identifying both facilitators and barriers. This includes an analysis of their capacity, available support systems (financial, technical, social), and relevant policies.

Methodology: 
This research will employ a comprehensive, mixed-methods approach to gather real-time data from beneficiaries and stakeholders, ensuring an adaptive management process that continuously enhances program quality, efficiency, and effectiveness. The research should ensure a participatory approach, actively involving key stakeholders throughout the process to enhance relevance, ownership, and impact. The methodology includes the following components:

• Desk Review: Conduct an in-depth desk review of the current state of NCDs in Yemen, the provision of NCD services, and community health interventions, with comparisons to similar contexts. This review will establish the foundational understanding necessary for the research.
• Qualitative Data Collection: Implement qualitative research methods, including semi-structured interviews and focus group discussions, to capture diverse perspectives from key community stakeholders. This includes patients, community health workers, community leaders, healthcare workers, local government representatives, and other relevant health actors. These insights will inform the contextual relevance and cultural sensitivity of the interventions.
• Quantitative Surveys: Design and administer structured surveys to quantitatively assess the effectiveness of various health promotion strategies. These surveys will provide measurable data on the impact of interventions and identify key areas for improvement.
• Data Analysis: Utilize advanced data analysis techniques to identify trends, correlations, and insights related to community-based NCD management practices. This analysis will help in understanding the effectiveness of interventions and in shaping evidence-based recommendations.

By integrating these methodologies and ensuring a collaborative, participatory process, the research aims to deliver a nuanced understanding of NCD management within Yemen’s community health framework, leading to actionable insights and improvements.

Specific Tasks and Deliverables:

The consultant will be responsible for completing the following specific tasks, aligned with the research objectives:

Desk Review: Conduct a comprehensive desk review of existing primary and secondary assessments, data, and studies related to the current state of NCDs in Yemen, the provision of NCD services, and community health interventions. This review should include comparisons with similar contexts to identify best practices and inform the research design.

Inception Report: Develop an inception report that outlines the proposed methodology, sampling strategy, data collection tools, analysis plan, and fieldwork plan. This report should also summarize the desk review findings, providing key takeaways that will guide the subsequent research phases. The report will be written in English and will include the following sections:

• Provide a summary of the desk review findings with key takeaways
• The methodological approach to the formative research including the domains of inquiry
• Planned qualitative and quantitative data collection activities in line with the proposed methodology
• Sampling strategy
• Data collection tools to be applied and procedures
• A detailed work plan

Data Collection: Oversee and manage the data collection process, which includes piloting and refining tools, training the data collection team, and coordinating with IRC’s Monitoring, Evaluation, Accountability, and Learning (MEAL) Coordinator. The consultant will collaborate with IRC and its consortium partners to conduct data collection in targeted areas, focusing on gathering qualitative and quantitative data from diverse stakeholders.

Qualitative Research Validation: Conduct a validation workshop to ensure the accuracy and reliability of the qualitative data collected. This workshop should engage key stakeholders to validate the findings and refine the research approach if necessary.

Comprehensive Research Report: Draft and finalize a comprehensive research report that details the findings on NCD self-care practices, CHW communication effectiveness, patient perceptions, and the impact of self-care practices on health outcomes. The report should include actionable recommendations to enhance NCD management in Yemen, incorporating both qualitative and quantitative insights. The report should be no longer than 25 pages, excluding annexes and follow the following format:

• Cover Page
• Table of Contents
• Abbreviations
• List of Tables and Figures
• Executive Summary must be a standalone summary, describing the research, main findings, conclusions and recommendations. This will be no more than 3-4 pages in length
• Background and Objective
• describe the methodology used, sampling approach, provide evidence of triangulation of data and presents limitations to the methodology
• Results and Key Findings against the areas of inquiry ensuring that differences in specific locations for each partner are highlighted to ensure a localized approach to behavior change
• Conclusion and Recommendation synthesizing the main findings and providing recommendations for actions and approaches to be considered
• List of annexes including data collection instruments etc.

Policy Briefs: Develop policy briefs against recommendations to inform IRC’s NCD management strategies. These briefs should present key research findings and provide strategic recommendations for policy improvements, focusing on enhancing community health interventions and should not be more than three pages each.

Health Promotion Materials: Collaborate with patients, the Ministry of Health, and other stakeholders to design a set of culturally relevant health promotion materials. These materials should align with global standards while being tailored to the cultural context of Yemen, and should be tested for effectiveness during the project.

Monitoring and Evaluation Framework: Develop a set of output and outcome indicators to monitor the effectiveness of the applied techniques and their impact on NCD management. These indicators should be part of a comprehensive monitoring and evaluation (M&E) strategy that tracks both short-term and long-term outcomes.

Presentations on Findings: Prepare and deliver a presentation on the research findings and recommendations to IRC and partner staff. Additionally, conduct a separate presentation tailored for FCDO, donors, and the broader humanitarian community. These presentations could take the form of webinars to facilitate broader participation and engagement.

Management Arrangements:

The evaluator is expected to work remotely and in person through a field deployment to complete the assignment. This includes travel to field sites depending on the final geographical locations. The consultant will directly report to IRC’s MEAL Coordinator in collaboration with the Consortium Coordinator & Health Coordinator and will coordinate directly with these focal points throughout the assignment. All deliverables should first receive validation from the focal points before being considered final.

The focal points from IRC will be responsible for engaging any other stakeholders (either consortium staff or external project stakeholders as required) in the review of the deliverables, as needed. The focal point will consolidate any comments and send these to the consultant by the date agreed or as soon as the comments are received from stakeholders. General expectations include:

The consultant to reference to the TOR and approved inception report completing each task within the specified timeframe.

The consultant is to communicate any challenges or delays promptly to IRC’s focal points.

Keep detailed records of the consultancy including meeting minutes and documentation of challenges faced, observations made, and any adjustments to the original plan.

Duration & Workplan:

The duration of this consultancy is estimated to be 47 working days from 1 October 2024 – 15^th January 2025. Review and validation of all deliverables for IRC is necessary to be considered as part of the timeline. The anticipated number of days are suggestions and should be adjusted by the proposed consultant in their technical submission based on their anticipated work plan.

Minimum Qualifications:

Consultant profile:
For the consultancy to implement the operational research on NCD management in Yemen, the ideal candidate profile should include:

• Education: A Master’s degree or higher in Public Health, Epidemiology, Health Systems, or a related field.
• Experience: At least 7 years of experience in conducting operational research, preferably in conflict-affected or low-resource settings. Experience in the MENA region, particularly in Yemen, is highly desirable.
• Technical Skills: Proficiency in quantitative and qualitative research methodologies, data analysis, and interpretation. Familiarity with digital health systems, monitoring, and evaluation (M&E) processes is essential.
• Knowledge: A deep understanding of NCD management, health promotion strategies, and community health worker interventions. Knowledge of the cultural context of Yemen and experience in adapting health messages to align with global standards and local relevance.
• Communication: Excellent communication skills, with the ability to collaborate effectively with patients, health workers, and stakeholders. Fluency in English is required, and proficiency in Arabic is a significant advantage.
• Project Management: Strong project management skills, including budgeting, planning, and delivering within timelines.
• Adaptability: Ability to work in challenging and unpredictable environments, demonstrating resilience and cultural sensitivity.
• The candidate should also have a track record of producing high-quality reports and policy briefs, as well as designing health promotion materials that resonate with the target audience.

Selection Criteria and Application Process:

Interested parties are required to submit a technical and financial proposal for the consultancy including the following:

Technical Proposal:A cover letter outlining relevant experience and suitability for the consultancy (one page); Individual or team CVs; contact details of at least three references; an outline of the methodology that will be taken for conducting the assignment and timeline (two pages), and at least three samples of previous similar work completed

Provide a sample report(s) of work conducted previously – the client’s name may be redacted. IRC will only use the sample reports to identify a consultant for this assignment.

Financial Proposal: An indicative budget covering daily rate(s) and any related expenses. Rates should be in United States Dollar (USD) and exclusive of VAT. The budget should be inclusive of all expenses associated with carrying out the consultancy including but not limited to any necessary travel, translation and data analysis costs.

For evaluation of the consultant, technical qualifications, experience and quality of past work with be weighted at 70%, with the financial proposal weighted at 30% based on the criteria below. An interview will then be requested with the top two consultants prior to final selection, to validate their suitability.

Intellectual Rights and Ethical Considerations

All documentation related to the Assignment shall remain the sole and exclusive property of IRC and the project’s donor. It is expected that the consultant provides all documents associated with the assignment to IRC upon the completion of the works. The consultant will adhere to ethical guidelines, ensuring the confidentiality, anonymity, and informed consent of participants. Data will be securely stored and used solely for the NCD research.

The consultant will be transparent in the use of artificial intelligence and large language model tools, describing which tools they are using and for which purpose.