Country Director Lebanon
Total time frame
30 working days (approximately end of January until the end of February 2018)
Reports in the field to:
Technical Health – Health Regional Advisor
Technical WASH –WASH Project Manager
Technical M&E –Assessments,
Medair HQ contacts
Technical Health –Health Senior Advisor
Technical WASH –WASH Senior Adviser
Technical M&E – M&E Senior Adviser
TITLE: Health, Nutrition and WASH KPC Survey Analysis Consultancy
In 2017 the Syria crisis entered its sixth year with over 1.5 million registered and unregistered Syrian refugees continuing to reside in Lebanon, a third of who live in the Bekaa Valley (UNHCR, 30, June 2017). The protracted nature of this conflict has seen the number of refugees residing in Lebanon remain relatively stable since 2014 and the number is not expected to decrease in the immediate future. Syrian refugees make up as much as a quarter of Lebanon’s total population, with 80% of these refugees being women and children. The presence of refugees in such high numbers has strained the political, economic and social stability of the country, stretching basic services and systems that have weakened the host authorities’ capacity to respond to the increased needs, especially in education, water supply and healthcare. Difficult living conditions exacerbated by the weather and poor sanitation and hygiene situation in refugee settlements have a strong impact on the public health situation of the refugees and has increased the risks of outbreaks of communicable diseases.
In Lebanon the health care system is overseen by the Ministry of Health (MOH), however the primary health care system for Syrian Refugees and vulnerable Lebanese people is managed by the Ministry of Social Affairs (MOSA). Since 2014 Medair has been supporting MOSA Social Development Centers (SDC) implementing a project to improve refugees’ and affected host communities’ access to primary health care (PHC) services and currently supports seven clinics in Central, West and North Bekaa. Medair supports clinics through the provision of human resources, medicines, equipment and supportive supervision to each of the clinics.
Community Health Volunteers (CHVs) in the SDC catchment area deliver a community health promotion package and have been trained on relevant health topics including nutrition, Infant and Young Child Feeding (IYCF), family planning, essential maternal and newborn care, management of non-communicable diseases (NDCs), Sexual and Gender Based Violence (SGBV), psychosocial support and referral systems. CHVs and community midwives carry out household visits, community outreach in Informal Settlements within SDC catchment areas and as well as meet refugees and vulnerable host communities in community shared places.
The Knowledge, Practice and Coverage (KPC) household survey will measure standardized health, nutrition and WASH indicators for Syrian refugees and vulnerable Lebanese, both in the Medair-supported SDC project areas and across the Bekaa valley, in Lebanon. The purpose of the survey is to provide robust data that will inform Medair, government, beneficiaries’ and NGO programming and provide a strong evidence base to current and potential donors. The analysis will serve to compare key indicators across key target groups, as well as enable a comparison with the 2016 KPC survey.
The survey to be conducted will use a 30*13 cluster survey design to enable the calculation of 95% confidence interval point estimates with acceptable degrees of precision (likely +/-5-7%). The sampling frames will be distinct for both Syrian refugees (made up of those living in informal settlements and those not) and vulnerable Lebanese, such that two cluster surveys will be conducted across the Bekaa Valley. In addition, two cluster surveys will be conducted in the catchment areas of the 7 Medair-supported SDCs, again with the two target groups being Syrian refugees and vulnerable Lebanese.
OBJECTIVES OF CONSULTANCY:
The objective of the survey is to analyse key health, nutrition, and WASH-related indicators at the household level, including the following thematic areas:
Health seeking behavior
Reproductive health (incl. ANC, PNC and FP)
Access to Reproductive and Psychosocial services
Safe drinking water coverage
Use of improved sanitation
· Conduct initial data analysis and provide written summary of provisional results within 5 working days.
· Conduct in-depth data analysis using appropriate data analysis software (to include confidence intervals and statistically significant differences) and compare key indicators with prior surveys results
· Write draft survey report (including project background, process and partnership methodology, results, discussion, conclusions and recommendations and annexes), and finalise report following review and feedback by Medair (to be reviewed and signed off by appropriate Advisers) – first draft 15 working days after initial data analysis.
· Final draft (following Medair feedback and re-review as needed) 5 working days after submission of draft survey report weeks after draft report review.
· Write and finalise separate comparison report for key indicators of the program between the years 2015, 2016 and 2017, 5 working days after submission of final report (including Medair review).
All raw data, analyses (Excel and EpiInfo codes or dashboards) and databases remain the property of Medair and need to be submitted with the draft report.
METHODOLOGIES & TOOLS:
See Annex for extract from initial proposal submitted to the Ministry of Public Health
TIMEFRAME / SCHEDULE:
- Initial data analysis: After 5 days
- First draft of report: After 15 days
- Final draft of report: After 5 days
- Final draft of separate comparison report (inclusive of Medair review): After 5 days
Total: 30 days’ consultancy.
CONSULTANCY FEES AND TERMS OF PAYMENT
- For an International consultant, international flights will be arranged by Medair via pre-selected travel agents and will therefore be paid directly by Medair (maximum 2,000 USD)
- Accommodation and travel in Lebanon will be paid by the consultant, with recommendations from Medair.
- The consultancy fees will be negotiated based on a proposed budget that includes daily rates for the consultant, and estimated budget for per diem to cover accommodation, food and transport within Lebanon.
- Half of the consultancy fee will be paid into a bank account designated by the consultant on satisfactory completion of the main draft report.
- The remaining amount will be paid when the main final report and separate comparison report have been finalized and approved by Medair.
- All travel arrangements to and from the airport of departure in country of abode
- Fulfill the above outputs as listed within the timeframe stated.
- Obtain the necessary vaccinations before the start of the consultancy (not reimbursable by Medair).
- Comply with and field location security plan and recommendations on dress and behavior, as given to expat staff.
- Provide laptop, software (EpiInfo), or any other relevant equipment for personal use and report writing (not chargeable to or reimbursable by Medair).
- Provide proof of any mandatory liability insurance.
- Provide proof of adequate medical and accidental health insurance coverage
- Provide recommendations for accommodation and transport while in Lebanon.
- Provide transport and access to field sites in Lebanon.
- Provide supplementary health coverage for consultants operating in the field will be provided under a group insurance plan (it is not offered as primary medical coverage). This does not include insurance against natural disasters, epidemics, any infectious or chemical risk, and all instances of force majeure.
- Provide interpreter for consultant as needed.
- Provide working facilities which will be as secure as is practical in the circumstances.
- Provide staff and tablets for data-collection.
- Provide dataset for analysis
- Previous experience conducing household surveys, including analysis and report writing, preferably for humanitarian organizations.
- Previous demonstrable experience with cluster survey sampling methodology and statistical analysis using EpiInfo or equivalent software.
- Samples of previous similar work and references for that work, submitted as part of the bid.
All reasonable steps will be taken to provide safety and security for the consultant; both Medair and consultant accept the inherent risks in working in humanitarian contexts. Medair will not be required to do more than what is reasonable and possible in the circumstances whilst providing a safe and appropriate work environment.
At the end of the field data analysis, the consultant will arrange for a debriefing meeting with the M&E Manager, Health Project Manager, Health Advisor, M&E advisor at Medair headquarters and relevant project staff, to share any preliminary findings or conclusions.
ANNEX: EXTRACT FROM PROPOSAL SUBMITTED TO THE MINISTRY OF PUBLIC HEALTH
The specific indicators proposed to be analysed are:
Measles vaccination coverage
% of children aged 6 months- 5 years who are vaccinated for measles in clinics coverage area
% of mothers of children under two years of age who had 4 comprehensive antenatal visits when they were pregnant with their youngest child
% of mothers of children under two years of age who received a post-partum visit from an appropriate trained health worker within two weeks after birth of their youngest child after discharge from health facility
Health care access general
% of residents in catchment area of SDCs who went to a health facility when they needed medical services (measured by survey)
Health care seeking for children with ARI
% of children under 5 with fast or difficult breathing for whom advice or treatment was sought from an appropriate health facility or provider
ORS and zinc for diarrhea
% of children under 5 years with diarrhoea receive ORS or zinc supplementation
Knowledge about NCD prevention
% of women who know 2 or more ways to reduce the risk of NCDs
% of infants 0-6 months who are exclusively breastfed
Use of modern FP methods
% of mothers of children 0-23 months who are using a modern contraceptive method
Health care access RH and PSS
% of mothers of children under 5 who report accessing RH or PSS support services in the 6 months prior to the survey
FP and PSS discussion with health provider
% of mothers of children under 5 who report discussing FP or PSS with a trained service provider in the 12 months preceding the survey
Fully immunized children
% of children age 12-23 months who received age appropriate vaccination at time of survey
Access to safe and sufficient drinking water
% households with access to sufficient and safe drinking water
Use of improved toilet facility
% households using an improved, accessible and hygienic toilet facility
Appropriate Handwashing Behavior
% households having soap who used soap for washing hands during 24 hours recall at least at 2 critical times* (after defecation and one of the following 4: after cleaning a young child, before preparing food, before eating, before feeding a child)
Use of soap for handwashing
% households that have soap readily available for handwashing
Household Water Treatment
% households that treat water effectively
The surveys to be conducted will use a 30×13-cluster design to achieve 95% confidence interval point estimates with an acceptable degree of precision (likely +/-5-7%).
Total HH Respondents
Syrian refugees (IS+non-Is)
Total HH Respondents
Syrian refugees (IS+non-Is)
FINAL TOTAL HH respondents (after removing duplicate clusters)
For the Bekaa Valley, the sampling frames will be Syrian refugees (made up of those living in informal settlements and those not) and vulnerable Lebanese. In addition, two cluster surveys will be conducted in the catchment areas of the 7 Medair-supported SDCs (Talia, Kawkaba, Brital, Kfarzabad, Marj, Kabelias, Jib Janine), again with the two target groups being Syrian refugees and vulnerable Lebanese. For further details on the clusters selected, see the Annex below. The respondents will be women between the ages of 15-49 with children under the age of 5. The data will be collected by approximately 36 enumerators, trained and supervised by Medair staff, using tablets and ODK (Open Data Kit).
TIMEFRAME / SCHEDULE:
Survey questionnaire pre-testing – December 2017
Enumerator training – December 2017
Field data collection: December 2017
Consultant: Data analysis and report writing: January/February 2018
Review of draft report –February 2018
Medair will liaise closely with the local authorities and municipalities for security information across Bekaa.
PERSONS TO CONTACT
Survey focal point: (Medair Regional Health Advisor)
Health focal point: (Medair Health Project Manager)
M&E focal point: (Assessment, Monitoring and Evaluation Manager)
Funding for this survey will come from Medair donor, Global Affairs Canada-IHA, and will be used as an evaluation of our current health programming in the Bekaa valley.
ANNEX: Sampling approach
A. General cluster selection procedure taken for the Bekaa Valley (for producing the cluster selection table):
- Syrian refugees:
a. Using the IAMP data, the numbers of Syrian refugees living in IS was broken down by Cadastre, and a cumulative population list was made by household (with the assumption of 5 members per household).
b. Since no accurate data on numbers of Syrian refugees not living in IS existed, a breakdown of 40% IS Syrians to 60% non-IS Syrians was applied (based on the statistics from the 2016 KPC survey) to create equivalent cumulative population list for non-IS Syrian refugees.
c. The two lists were then combined to create a consolidated ‘all-Syrians’ cumulative household level population table, per Cadastre.
d. Using an interval, the 30 clusters were selected for ‘all-Syrians’.
- Vulnerable Lebanese:
a. Data on the number of vulnerable Lebanese was collected for the 2016 KPC survey, but this did not cover the whole Valley. (This is in the process of being collected). And so for the purposes of this initial cluster selection process, an assumption (based on the 2016 KPC data) was made that 35% of the average Cadastre’s Lebanese population is ‘vulnerable’ (according to the official definition) so that this proportion was applied to those Cadastres awaiting data on vulnerable Lebanese. This in turn was based on the assumption (again, using the 2016 KPC survey as a starting point, that on average the Lebanese population is three times that of the Syrian refugee population in the Bekaa Valley).
b. Based on these calculations, a cumulative household population table was constructed by Cadastre for vulnerable Lebanese, and using an interval calculated for 30 clusters, the clusters were selected.
B. General cluster selection procedure taken for the SDC-covered areas:
- Syrian refugees:
a. The same procedure as used above was applied to the Cadastres within the coverage (5km radius) of the 7 Medair-supported SDCs to gain the cluster selection.
b. Where the clusters randomly selected had already been included in the sample for the whole Bekaa, no additional cluster was selected.
- Vulnerable Lebanese: The same approach was used for vulnerable Lebanese as for the Syrian refugees
C. Individual field level Cadastre cluster selection procedure to be taken for the Bekaa Valley and SDC covered areas:
- Syrian refugees:
a. Using the P-codes, randomly select (using the Excel RAND function) an individual IS in which the required number of HH respondents can be interviewed. (Where the selected IS does not contain a sufficient number of eligible household respondents, the enumerators should go to the next nearest IS to complete the sample).
b. For the non-IS Syrian refugees (who will be more difficult to locate), snowball sampling should be used as they will be scattered across a Cadastre. This involves asking those interviewed in the IS to help the enumerators find a Syrian refugee outside the IS. Once located, the next household can be identified with the help of the respondent just interviewed. If no non-IS Syrian refugees are known in the sampled IS, then the starting point should then be the same as for vulnerable Lebanese (see below).
- Vulnerable Lebanese:
a. Using the Municipality building in the Cadastre as a starting point (since they are usually located centrally), use ‘spin the bottle’ and estimate how many dwellings stand between the Municipality building and the Cadastre’s administrative boundary. Using all the numbers up until this number, randomly select a starting dwelling to enquire about vulnerable Lebanese (in line with the official definition). Then use snowball sampling to interview households that meet the criteria up until the required number of respondents is achieved.
· Interested applicants should submit their applications including the below documents:
· Cover Letter: A letter of no more than 2 pages highlighting specific work experience (beyond what is listed in a CV) that applies to the TOR.
· Curriculum Vitae: A current CV, including at least 3 professional references.
· Financial Proposal: A budget for the estimated cost of delivering these services, based on a daily consulting fee rate.
Only shortlisted candidates will be contacted.