Afghanistan: Evaluation of Essential Package of Hospital Services (EPHS) of Laghman and Wardak Provinces in Afghanistan under the System Enhancement for Health in

1. BACKGROUND

1.1 Swedish Committee for Afghanistan (SCA)

Swedish Committee for Afghanistan (SCA) is non-governmental, non-profit, membership based organization. The organization has been operating since 1982 with a mission of empowering individuals, communities and local organizations, primarily in rural areas and with particular focus on women, girls, boys and vulnerable groups such as people with disabilities so that they may participate fully in society and influence their own development. SCA is achieving this by working closely with communities, local and national civil society organizations and relevant levels of government.

Our Vision is: an Afghanistan free from poverty, violence and discrimination, where human rights are respected and all live in dignity, enjoy equal opportunity and social justice.

SCA is currently implementing substantial development programmes in Health, Education, Disability and Rural Development across 13 provinces. Main contributors to SCA budget are Sida, World Bank and increasingly, private contributions and donations.

SCA strategic plan 20114-2017 focuses on rural communities, women, children and persons with disabilities and it has been built upon our previous successes and competencies in providing services in areas where the Government of Afghanistan continues to face serious capacity shortfalls. Service delivery, capacity building, gender mainstreaming and right based approach are the key building blocks of the new organizational strategy.

1.2 Health Programme Description

As a major provider of health services since 1982 to the Afghan people, SCA is currently implementing Basic Package of Health Services (BPHS), Essential Package of Hospital Services (EPHS) in Laghman and Wardak provinces, Community Health Nursing Education (CHNE), Community Midwifery Education (CME), learning for Healthy Life (LHL) and School Health projects in Laghman, Wardak and Samangan provinces of Afghanistan.

1.2.1 About SEHAT Project

The development objectives of the System Enhancement for Health Action in Transition (SEHAT) Project for Afghanistan are to expand the scope, quality and coverage of health services provided to the population, particularly to the poor, in the project areas, and to enhance the stewardship functions of the ministry of public health (MOPH).The SEHAT Project finances the implementation of the BPHS and EPHS through contracting out and contracting in arrangements both in rural and urban areas in provinces supported by the EU, the ARTF the USAIF and the World Bank in all 34 provinces of the country.

SCA has partnered with MOPH to execute BPHS and EPHS projects in Laghman and Wardak provinces of Afghanistan through 2 provincial hospitals (PH), 2 district hospitals (DH), 4 comprehensive health centers plus (CHC+), 14 comprehensive health centers (CHC), 40 basic health centers (BHCs), 39 sub health centers (SHCs),2 prison health clinics, one mobile health unit and 549 health posts. The total beneficiary is the total population of Laghman and Wardak provinces, estimated at 1,103,676.

The current evaluation study will only focus on the EPHS component of SEHAT and hence will take into account the two provincial hospitals –one in each two provinces (Laghman and Wardak).

Specific Objectives of EPHS project (based on contract):

*Increasing access, utilization and quality of hospital services in equitable and sustainable manner

• Improving access and utilization through maximizing efficiency


• Improving access and utilization through strengthening Reproductive Health (RH) and Maternal and Child Health (MCH) Care Services


• Improving access and utilization through managing health care in insecurity


• Improving access and utilization through health care to marginalized groups


• Improving access to and utilization of PH through innovative interventions to strengthen overall delivery of EPHS


• Improving the quality of hospital services in an equitable and sustainable manner


• Improving access and utilization through ensuring pharmaceutical, supplies, and other medical/non-medical logistics and emergency preparedness


• Building the capacity of hospital staff


• Delivering all components of EPHS in an integrated manner with strong emphasis on strengthening management and leadership systems


• Ensuring effective coordination, supervision and promoting the use of monitoring and evaluation data

The project seeks to achieve the following key performance indicators

• Score on the hospital balanced score card (BSC) that examines quality of care, amount of services, equity and management processes at two provincial hospitals


• Proportion of pregnant women who have cesarean section


• Bed Occupancy Rate (BOR)


• Average Lengthen of Stay (ALOS)


• % of Technical Staff positions filled according to EPHS minimum staffing requirement


• Number of hospital community board meeting conducted per year


• Proportion of children under 5 years with severe acute malnutrition (SAM) who were successfully treated and discharged from treatment program


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  Functionality Equipment Index

  
  


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  2. OBJECTIVES OF THE EVALUATION

  
  


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  To assess the degree to which the project achieved the defined targets in the signed contract between MOPH and SCA.

  
  


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  To gauge the project’s responsiveness to the needs and expectations of the SCA’s target groups, national health policy, guidelines (EPHS), RFP and SCA’s strategy

  
  


• To assess the project design in terms of resource (human & financial) availability, gender and right sensitivity, contextual adaptability and disability inclusiveness.


• To review programmatic aspects of the EPHS project focusing on status of the implementation, outcomes, achievements, challenges, lessons learnt and recommendations


• The assess patient’s satisfaction

3. EVALUATION APPROACH

I. Relevance and design

• To assess how the project design and implementation is appropriate to community needs, National Health Policy and SCA’s country strategies.

II. Effectiveness

• The extent to which the specific objectives have been achieved via the activities implemented; measure and analyze the discrepancies between what was planned and what was actually delivered


• What were the major factors influencing the achievement or non-achievement of the objectives?


• To assess patient’s satisfaction

III. Efficiency

• If the project is sufficiently funded?


• If the results obtained at an acceptable cost?

IV. Impact

• What real difference has the project activities made to the beneficiaries?


• Has the project led to increased access and utilization of health services (total consultation, inpatients, ANC, PNC, delivery, immunization coverage etc.)

4. METHODOLOGY

The evaluator will be required to design the methodology for the evaluation. The process will involve but not limited to collection of quantitative and qualitative data through desk reviews of provided documentation, in depth interviews and discussions with SCA target groups and stakeholders. The methodology, tools and scheduling used must be gender and target group sensitive.

key documents to be reviewed

• Request for proposal (RFP)


• Project proposal and contract


• Quarterly reports


• Survey Reports


• Monitoring reports


• Afghanistan National Health Policy


• SCA Strategic Plan 2014-17

Key people/institutions to be interviewed

• SCA’s health management team in Kabul


• Provincial management team (BPHS/EPHS)


• Provincial Hospital staff


• Randomly selected patients (interviews)


• Provincial Public Health Directorate


• Hospital community board members and health Shuras (councils)

5. DURATION

15 days

6. DELIVERABLES / EXPECTED OUTPUTS

The consultant will be responsible for the following

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  Inception report: stating the evaluation approach and methodology, work plan, tools need for the evaluation and a full budget.

  
  


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  Presentation of findings: At the end of an evaluation, the consultant will present preliminary findings to the senior program management team in Kabul

  
  


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  Draft report: Indicating the preliminary results of the exercise. This will be presented and discussed among the relevant program staff for comments. The consultant should submit the draft report a week later after departure from Kabul

  
  


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  Final report: Including the executive summary, intervention description, purpose, methodology, findings, conclusion, recommendations and annexes. The final report will be shared/send to the SCA ‘s Health Program Manager within one week of the draft commented report sent to the evaluator.

  
  

7. SCA INPUTS

The major role and responsibilities of SCA includes:

• To provide the consultants with all relevant SCA organizational and programme documents


• SCA will arrange logistics for field work including vehicles, accommodation and related travel expenses. Also, if needed, arrangements for travel to/from home country (if not Afghanistan), visa and in-country accommodation.


• SCA will provide translation or interpretation services in the field during the data collection


• SCA will facilitate mobilization of required persons for interview schedules and discussions in the study areas


• SCA will arrange meetings of the relevant government departments to avail the necessary information and required persons for the study


• SCA will organize logistic for the presentation and discussion of preliminary findings of the study.


• SCA will provide inputs and comments to the work plan, assessment tools and report


• SCA will update the consultant about security situation in target provinces

8. QUALIFICATIONS

• Health professional with advanced degree (MPH, HPM, PhD, DrPH)


• Proven experience of carrying out evaluations


• Highly driven/motivated, dependable and results oriented


• Excellent verbal and written skills in English


• Knowledge of and experience in BPHS and EPHS and experience of working in Afghanistan would be an additional advantage