DRAFT
Terms of Reference
Evaluation of Save the Children Community Care Centers
1. Background
The Ebola outbreak in West Africa has been the deadliest to date, killing more than all previous known
outbreaks of the virus combined. While the first case occurred in Guinea in December 2013 the extent
of the problem only came to light in March when the World Health Organization (WHO) reported an
outbreak in Guinea with suspected cases in neighboring Liberia and Sierra Leone. It was declared an
international emergency in August 2014 when the international community began scaling up its
response. (Liberia Sit Rep 37_6 March) Save the Children’s Liberia Country office began redirecting funds
in July 2014 to respond to the Ebola outbreak. In September 2014 Save the Children declared the Ebola
crisis a Cat 1 emergency.
In response to the Ebola outbreak Save the Children developed the Community Care Center (CCCs)
concept as a complementary approach to Ebola Treatment Units (ETUs) in Liberia. Since then variations
of this approach have been developed and implemented by other actors. CCCs were developed as
smaller facilities that provided diagnosis, isolation and early treatment. Here patients were usually
admitted with a caretaker – this person was often a household member or close relative. CCC’s sought
to provide earlier isolation and care closer to home, thereby reducing transmission and possibly improve
outcome through early care. Save the Children opened two CCC’s both within walking distance of
primary health care facilities.
This evaluation will examine two Save the Children CCC’s in Margibi county, one CCC is in Dollo town and
the second CCC is in Wohrn.
2. Objectives of the Evaluation
The evaluation will examine three main aspects of the CCCs:
1. The evaluation will look at how local communities and County Health Teams perceived the
CCC’s. This aspect of the evaluation will look at how they came to know about CCC’s and their
involvement in its set up and design. This will look at what which aspects of community
messaging were successful and which aspects needed strengthening.
2. The evaluation will look at whether the CCC had any effect on ebola transmission. While the
sample is quite limited this evaluation will take a look at health outcomes of patients after they
left the CCC.
3. The evaluation will look at how CCC’s scored around key performance indicators. This aspect of
the evaluation will start by looking at how CCCs were implemented in comparison to the CCC
concept that was originally submitted to OFDA. The way CCC’s were implemented in
comparison with the protocols that were agreed with the MoH will also be examined. This
portion will look at which aspects of the CCC were successful and which aspects needed
strengthening.
Additionally, if data is available the team will look at how Save the Children’s CCCs performed against
comparable CCCs.
3. Key Questions
1. How do local communities and County Health Teams perceive the effectiveness and usefulness
of CCCs?
a. Where did they get information on the CCCs?
b. What are the barriers of seeking care at the CCC?
c. What methods of community engagement worked and how did this affect attendance?
d. What do the communities think should happen to the CCCs in the future?
e. Did communities and county health teams influence/participate in the design/location,
construction and utilization of the CCCs?
f. Where did patients at our CCC come from? Do they have any common sociodemographic characteristics
g. How did the community aspect of the CCCs come into our management? How did we
do?
2. Were there any likely cases of transmission of ebola at the CCC to patients that had initially
tested negative, to health workers, or to caregivers?
3. How did the Implementation of the CCCs compare to the CCC concept that was submitted to
OFDA? If there were changes how did they come about and what was the effect of those
changes?
a. What services were provided at the CCCs? For example, nutrition, pediatric, obstetric
care? Was psychosocial support provided to patients/caregiver/staff?
b. Did the CCC’s help to decongest the PHC and ETU?
4. How do CCCs perform against the protocols agreed with the MOH? Questions include:
a. How was patient flow managed during triage, isolation and care of suspected/confirmed
patients?
b. How was IPC managed during triage, isolation and care of suspected/confirmed patients
c. Were adjustments to the protocols required? Were additional protocols sufficient
d. What was the overall safety and security of CCCs?
5. How did CCCs perform against a set of performance indicators including:
a. Mortality
b. Average time from onset to admission
c. Average time for patient transfer when ETU bed available
d. % of patients who were transferred to ETU
e. Average time after admission for laboratory result
f. Proportion of patients that met the case definition for EVD
g. Average time for collection and disposal of EVD waste
h. Average time for collection and disposal of bodies
i. Presence of PPE stock for 2 weeks and availability of other supplies
6. .Staffing of CCCs
a. What level of training, including on-site training, did health care workers receive to work
in the CCCs?
b. What level of training did hygienists receive to work in the CCCs?
c. What were the risks CCC staff felt they were exposed to while working in the CCC?
d. What were staff perceptions on their contributions to working on the Ebola outbreak?
4. Evaluation Methodology
The evaluation will make use of qualitative and quantitative methods. Primary data collection will be
through consulting beneficiaries, community members, county health teams, CCC staff and other
relevant Save the Children staff through Focus Group Discussions, Key Informant Interviews as well as
the use of participatory workshops and other methods.
Follow-up surveys of clients of the CCC’s will be conducted. These surveys will examine how patients
came to know of the CCCs and will examine their perceptions of the CCC. The Survey will try to see if
there were any key characteristics that made CCC messaging successful for them. Additionally the
surveys will also gather data on health outcomes of patients and their caregivers. Enumerators from
Margibi and Bong will be hired and trained to conduct these surveys on electronic tablets to speed up
data collection.
The quantitative component of the evaluation will review and analyze data from the patient surveys,
from existing program documentation, and the CCC database.
Observation of care in the CCCs will also be used to examine the facilities, procedures, arrangements,
etc. Photographs will be taken to illustrate this.
5. Evaluation Team
The evaluation team will be a small team with multidisciplinary backgrounds in monitoring and
evaluation, health, anthropology, and community engagement. The team will mobilize and train
enumerators and local assistants who will facilitate direct engagement with communities.
Key Skills and Qualifications represented on the team
- Previous experience leading an evaluation
- Previous experience leading a survey and training enumerators
- Understanding of the context and social and psychological responses to the Ebola outbreak
- Experience with epidemiological analysis
- Skilled in community engagement
- Experience in managing and designing emergency health programs
- Knowledge of Liberia
- Comfort working with Excel, Access, & electronic tablets
6. Activities and Timeframe
Data collection in Liberia will begin by April 27th
Debriefing meeting with Save the Children and other key stakeholders will be held in Liberia on
completion of fieldwork to discuss preliminary key findings.
It is anticipated that the field mission will be a maximum of 15 days including the feedback meeting. 14
days for writing the first draft and an additional 4 days to incorporate feedback.
7. Coordination
The Consultants will arrange their own visas, insurance and flights to Monrovia. Save the Children will
arrange for transportation and lodging once in country. Save the Children will also support the
recruitment of enumerators and will provide the electronic tablets for data collection. Save the Children
will identify a person from Save the Children who will be the main point of contact with the evaluation
team and will ensure that the team receives a security briefing, support the identification of Save the
Children key informants, provide key documentation from the CCCs, coordinate feedback to the draft
report, and discuss any issues that emerge during the evaluation with the team in a constructive and
amicable fashion to reach agreement on solutions.
7. Expected Outputs
The following completed documents are the expected outputs of the evaluation:
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Final methodology and tools
Draft report
Final report no more than 25 pages excluding annexes
Executive summary no more than 5 pages
Debrief with relevant program staff and Senior Management Team