TERMS OF REFERENCE
For
Black Sash RMCH Project
A Process/Formative Evaluation of Black Sash’s RMCH Intervention in the subdistricts of OR Tambo and uMgungundlovu (External Evaluation/Output 3.3,
Activity 3)
I.
Background to the RMCH Programme
As part of its support to South Africa, the United Kingdom Department for
International Development (DFID) has provided funding for three years, through the
Futures Group, to support efforts by the National Department of Health (NDOH) to
reduce maternal child and neonatal mortality. The Futures Group and its South
African partner, Health Systems Trust (HST) - together with Save the Children UK
(SCUK) and Social Development Direct (SDDirect) - are working closely with the
national and provincial Department of Health, as well as district health management
teams (DHMTs), and communities to provide appropriate and responsive technical
support in 25 priority districts to contribute to improving maternal, neonatal and child
health outcomes.
The overarching objective of the RMCH project is to reduce maternal and child
mortality in South Africa by responding to demand and supply barriers to the access
and delivery of RMCH services at the district level. The project emphasises a focus
on underserved areas, strengthening the provision of community-based services and
access to a comprehensive sexual and reproductive health services. It also aims to
be catalytic by working with civil society organisations, including the Black Sash, via
a grant-making facility to identify opportunities upon which the health sector can
leverage or replicate successful and innovative initiatives in the area of demand and
accountability.
The RMCH includes Four Outputs as follows:


Output 1: Districts able to oversee improvement of MCH services: HST
lead
Output 2: Strengthened delivery of school health, ward PHC, and
obstetric and neonatal emergency services: SCUK lead


Output 3: Improved demand and accountability for MCH services:
Futures Group and SDDirect will lead through a grant making facility
(SDDirect to lead on technical support).
Output 4: New knowledge to remove barriers to uptake and access of
MCH services: Futures lead with input from other partners
II.
Background for Output 3
Why are we looking at demand and accountability as part of the RMCH
project?
There are various reasons why poor women often don’t access health services. They
may lack information about health issues, they do not know what services are
available, and they sometimes experience poor treatment by health staff. There are
also few mechanisms that allow people to enable citizens to raise concerns or
engage in a dialogue with key stakeholders in the health system about the quality of
health services that they receive.
Creating demand for services is about making sure that women - especially those
from poor and excluded groups - are able to access the healthcare services that they
need, at the time that they need them. It also means finding ways to overcome the
obstacles to accessing care such as ensuring that poor women and their families
understand the importance of healthcare services provided by skilled workers;
providing affordable transport to take women to the clinic, particularly in cases of
emergencies; and making sure that women have ability to make decisions about
their health.
Strengthening accountability is about providing opportunities for poor people to be
able to raise concerns or engage in a dialogue with relevant stakeholders within the
health system when they experience problems in accessing health services. This
includes providing citizens with information about the services that they are entitled
to, and supporting formal mechanisms through which people can voice their ideas,
needs and concerns. It also includes helping communities to monitor health services,
and involving civil society organisations in supporting dialogue between
stakeholders.
III.
Overview of the Black Sash RMCH Project
The focus of the Black Sash RMCH Project is to strengthen public and alternative
accountability mechanisms to improve maternal and child health services. This
project sets out to investigate the extent to which a multi-stakeholder approach,
whereby clinic and community health centre committees (CCs / CHCCs) form a
partnership with other public / civil society organisations and forums (e.g. War
Rooms, Imbizos, NGOs / CBOs, ward committees, school governing bodies) would
create opportunities for collaboration and problem solving to improve the
performance of health facilities. Black Sash has already undertaken a rapid
situational analysis of public and alternative accountability mechanisms to determine
whether they are functioning effectively, whether they prioritise the issue of maternal
and child health services and how well they engage with one another. A draft
baseline report has been developed which will form the basis upon which
intervention strategies will be developed to strengthen accountability mechanisms to
improve RMCH services.
The Black Sash RMCH intervention strategy is to bring CCs / CHCCs together with
other public / civil society organisations and forums to form ‘RMCH action groups’
which can address the challenge of RMCH services in their community with a focus
on demand and accountability. The intervention will involve training these ‘RMCH
action groups’ so that they can undertake community monitoring and draw up action
plans to address demand barriers to RMCH services at the local level. The training
will focus on ensuring the ‘RMCH action groups’ are equipped with a necessary
basic understanding of the roles and responsibilities of community health
committees; an understanding of health rights and as well as responsibilities of
health system users; the district health governance system and associated reporting
channels; demand barriers to RMCH services; and tools for creating partnerships
and mobilising resources. RMCH action groups’ will also be provided with training
that will enable them to co-facilitate community scorecards (a community monitoring
tool) in their respective communities.
The Black Sash will then support The ‘RMCH action groups’ to implement a
Community Score Card (CSC) model in their community. The CSC is a hybrid tool
which combines the different accountability approaches of social audit, community
monitoring and citizen report card. The Black Sash sees the CSC as providing much
potential to improve the functioning of accountability mechanisms because it has
proven to be a successful tool in exacting social and public accountability and
responsiveness from service providers. CSCs have proven very successful
particularly in rural settings and in the context of monitoring Primary Health Care at
the facility and district level. The CSC is a very simple tool which enables broad
community participation and will be easy to handover to CCs / CHCCs and APAMs
to sustain beyond the lifespan of the Black Sash RMCH Project. We envision that the
RMCH Action Groups would act as the facilitators of the CSC process and Black
Sash’s role will be to support and oversee the implementation during the pilot
phases.
The Black Sash is also interested in how we could combine certain elements of the
Partnership Defined Quality (PDQ) approach with the CSC approach to develop an
innovative ‘hybrid’ tool to strengthen accountability mechanisms and demand for
MCH services. The PDQ process is about analysing problems, determining causes,
and developing solutions to the identified quality issues. The PDQ process facilitates
a joint understanding and vision of ‘quality of care’ between community and
healthcare workers. Together, the community and health workers identify and
prioritise problems and constraints that make it difficult to achieve quality health
services and develop solutions to improve these. Black Sash feels some aspects of
this approach which focus on building trust and consensus between community and
healthcare workers could be particularly beneficial during the preparatory phase and
interface meeting phase of the CSC process. However the CSC will remain the key
model for the intervention.
IV.
Understanding of the Brief
The Black Sash requires a suitable service provider to conduct a process/formative
evaluation of our RMCH project. The deliverables would include:
a. The production of a process / formative evaluation report of the Black Sash’s
RMCH project;
b. A short (+-15mins) evaluative and educational documentary film of the RMCH
intervention which can be shared with stakeholders to disseminate learning.
The consultant would be required to:
1) Evaluate the training workshops provided to the ‘RMCH action groups’ which are
composed of clinic / community health centre committee representatives and
their civil society/multi-stakeholder partners in pilot sites in our focus districts of
OR Tambo in the Eastern Cape and uMgungundlovu in KwaZulu-Natal;
2) Evaluate the process in which the Black Sash will support the ‘RMCH action
groups’ to implement the community scorecard process in pilot sites in our focus
districts of OR Tambo in the Eastern Cape and uMgungundlovu in KwaZuluNatal;
3) The consultant would be expected to interview beneficiaries of the project and
other relevant stakeholders as detailed in the table below:
Key Informants for interviews
Direct Beneficiaries of the Black Sash
Other Relevant Stakeholders
RMCH Project
Clinic and community health centre
District Department of Health officials
committee representatives
(District Manager, Sub-District Manager,
Clinic supervisors, District Portfolio
Councillor of Health etc.)
Civil society/multi-stakeholder
Community Health Workers (CHWs),
organisations and forums (NGOs, CBOs, Community Development Workers
SGBs, ward committees, etc.)
(CDWs) and Community Care Givers
(CCGs)
Service users of health facilities (with a
Traditional Leaders
focus on women seeking RMCH
services)
Health facility staff (Operational
Black Sash Project Staff (Fieldworkers,
Managers, nurses, doctors)
RMCH Project Manager, Researchers,
Regional Managers, Advocacy Manager,
Education and Training Manager,
National Programme Manager etc)
The consultant should explore the following guiding evaluation questions both in the
short documentary and the formative / process evaluation report. These questions
will be elaborated on in discussion with Black Sash staff and presented in the
evaluator’s concept document which is the first deliverable of this project.
Guiding Evaluative Research Questions:
1. Review, analyse and document the case studies of the interventions to be
delivered at the pilot sites, highlighting implications for good accountability
practices;
2. Assess the intervention against four standard evidence based criteria credibility, relevance, outcomes and transferability;
3. Evaluate the transferability potential and limitations of this intervention and the
mechanisms or potential for institutionalisation and sustainability of this
intervention;
4. Describe some of the contextual factors which are responsible for the
intervention succeeding or not in the pilot sites;
5. Assess whether the intervention (training workshops and community
scorecard process) is deemed appropriate by stakeholders and beneficiaries,
and the reasons why?
6. Is the intervention effectively addressing the capacity issues of clinic/
community health centre committees? If not, why is this the case?
7. Is the intervention improving dialogue and fostering mutual accountability
between the clinic / community health centre committees and civil society /
multi-stakeholder organisations and forums?
8. Assess whether the intervention has improved the relationship between
service users and providers?
9. Has the intervention promoted solution-based dialogue and mutual ownership
of the health system by the community and health professionals?
10. Assess whether the intervention has the potential to improve community
mobilisation, decision making and participation in improving RMCH in the
medium-term;
11. Evaluate in what ways the intervention has the potential to lead to
improvements in the medium-term to the functioning of these accountability
mechanisms?
12. Evaluate the extent to which the project has the potential in the medium-term
to improve demand for RMCH services by the community in the two pilot sites
in OR Tambo and uMgungundlovu;
13. Assess the likely outcomes for RMCH in the long term of the intervention
against the baseline;
14. Provide suggestions regarding what can be done to improve the intervention
moving forward. Recommendations should be targeted to the various
audiences, including National Department of Health, Provincial Department of
Health, District Department of Health, the Black Sash and other relevant
stakeholders.
V.
Approach and methodology
The methodology for this evaluation is a formative / process evaluation, the purpose
of which is to understand whether the project’s intervention strategy is working well
or not and what factors (internal and external) are impacting on this. This type of
evaluation is helpful for pilot / learning projects such as the Black Sash’s RMCH
Project. The aim is to improve the project’s design by suggesting refinements to the
intervention strategy as the project is being rolled out, taking into consideration the
tight timeframes and to analyse whether the project activities are being delivered
efficiently and effectively. The evaluation will extract key learning for dissemination
and contribute towards the final project report and refinement to the training tools.
The most appropriate methodology for a formative evaluation is qualitative. More
open questions which explore processes from the viewpoint of participants as well as
other stakeholders and project staff are appropriate. Participatory approaches to
research are encouraged.
The Formative Evaluation Report
The Short Evaluative/Educational
Documentary
1/3/25 format: 1 page of main messages, Approximately 15 minutes.
3 page executive summary and a
maximum of 25 pages for the full report Should explore key research questions
(including subsections on context, and include interviews with key
implications,
methodology,
results, informants. It should document some of
further research required and references the training workshops and community
etc).
scorecard process (where appropriate
and with the consent of stakeholders) to
allow for dissemination of the learning
drawn
from
reflections
on
the
intervention.
VI.
Deliverables and Work-plan
Deliverable/Activity

1
Review
Key
Project
Documents:
Baseline
Study
and
training
manuals and tools
Estimated Number of
Days1
Deadline
2
28 April
Note: This is an estimated number of days. Required days for the consultant to observe fieldwork is flexible
and days for editing the footage and writing up the report can also be negotiated with Black Sash and then
agreed upon and written up in the concept note.

Submit a concept
document for documentary
film and formative
evaluation report
(including a section on
ethical considerations
such as receiving
permission from
stakeholders interviewed)
 Selectively document
training workshops in the
field in pilot sites in OR
Tambo and
uMgungundlovu;
 Selectively document
community scorecard
process including multistakeholder meetings to
draw up RMCH action
plan, in the field in pilot
sites in OR Tambo and
uMgungundlovu
 Prepare formative
reflections / evaluation and
present at 2 district
meetings which will be
held with stakeholders
who participated in the
intervention to assess the
intervention
 Draft one of the
documentary due
 Draft one of the formative
evaluation report due
 Final Draft of the
documentary due
 Final Draft of the
Formative Evaluation Due
Total number of days:
VII.
2
2 May
8
8 Days between 19 May18 July (exact dates still
to be confirmed)
6
District meetings to be
held during week 28 July1 August
8
11 August
3
15 August
4
25 August
3
5 September
36 days
Requirements
The consultant must meet the following requirements:
o At least 5 years’ experience in applied social research and monitoring
and evaluation of development projects;
o Experience in producing evaluative / educational documentaries;
o Experience in working with communities in development projects /
programmes;
o Master’s degree in development studies, social policy, monitoring and
evaluation, community development, public health or related field;
o Thorough understanding of the health sector and maternal and child
health in particular is an advantage;
o Understanding of accountability mechanisms such as community
scorecards and/or PDQ models and/or other participatory community
monitoring practices is an advantage;
o Experience in working with clinic and community health centre
committees a advantage;
o Must align with the Black Sash’s commitment to social justice.
Length of Contract: 36 days over the period of 25 April to 15 September 2014
Location: The consultant will be expected to travel to OR Tambo district of Eastern
Cape and
uMgungundlovu district of KwaZulu-Natal to observe fieldwork.
Preparation of the documentary and report would be done at the consultant’s
preferred location.
Budget: The consultant should present a quote for outlined deliverables reflecting
proposed daily rate. Payment would be in four instalments to be negotiated with the
successful consultant.
Costs of travel and logistics: Black Sash will arrange and pay for all flights, other
transport and accommodation for the successful consultant to attend fieldwork and
training workshops together with Black Sash staff. Therefore the budget should not
include travel and logistics
Technical Equipment: All equipment necessary for the evaluation should be
provided by the
consultant.
Interested service providers please contact:
Brittany Bunce
RMCH Project Manager
E-mail: brittany@blacksash.org.za
Tel: +27 21 686 6952
Kindly submit the following before Tuesday 1 April 2014:
1) CV and cover letter, including three contactable referees;
2) Quote for outlined deliverables;
3) Examples of documentary materials and evaluation reports developed.