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Aug 4, 2016

Save the Children EC Kibera Programme Operational Research on Family Planning Terms of Reference

Save the Children
Terms of Reference
EC Kibera Programme Operational Research on Family Planning
Factors affecting uptake of family planning in urban poor settlement; A focus on involvement of men and boys above 15 yrs. in Kibera

1. Organizational Background: Save the Children has been operational in Kenya since the 1950s, providing support to children through developmental and humanitarian relief programmes delivered both directly and through local partners. 

Current programming focuses on Child Protection, Child Rights Governance, Education, WASH, Child Poverty, Health and Nutrition.
Project Overview: EC-Kibera project is a 2-year project implemented by Save the Children in partnership with Carolina for Kibera and Family Health Options Kenya. 

The project has also partnered with Langata Sub County Health Management Team to enhance quality of health services in an effort to improve health outcomes in the location.

The initiative is funded by European Union with the objective to contribute to a reduction in maternal and child mortality by improving maternal and child health status for 226,160 people in Kibera informal settlement of Nairobi County (74,840 women of child bearing age, 28,392 U5s, 6,685 U1s and 11,308 pregnant women. 

This is through increasing demand for and access to quality maternal, newborn, and child health (MNCH) services at health facility and community levels; improving nutritional status of mothers, newborn and children under five by preventive actions; improvement of family planning uptake; and improvement of the capacity of the health care delivery system. 
2. Problem Statement
Kenya is one of the countries with very high maternal and neonatal death ratios. According to the KDHS 2008/2009 report, the MMR is 488/100,000 live births. Maternal deaths represent 27% of all deaths to women aged 15 to 45 years of age and abortion related complications contribute up to 30% of the deaths. 

In Kenya according to the latest study on the magnitude of abortion; 300,000 unsafe abortions occur annually. This is occurring in the face of low contraceptive prevalence rate in Kibera (37.8%) in comparison with national and county ratio at 63% in Nairobi and the national average at 58% (KDHS, 2014).

The contraceptive prevalence peaks among women in the 30-34 age-group and is lowest for women aged 15-19 years with increased utilization of all Family Planning methods by women with highest level of education at 58%. The unmet need for contraception remains high. 

About 47% of women had an unmet need for family planning and is higher among women in the 15-19 (46%) and 20-24 (37%) years age group compared to those above 30 years of age (26%). This is an indication of lower access to family planning by adolescents and youths.

This is a major gap considering that adolescents that were interviewed during the EC-Kibera KAP survey confirmed that boys and girls were sexually active as early as 10 for girls and 14 for boys, EC-Kibera KAP survey report 2015.

Statistics also indicate that, 53% of the married respondents were currently using Family Planning in the target region Kibera. 

This puts the contraceptive prevalence rates (CPR) for Kibera lower than the CPR for Nairobi County at 63% and national average at 58%. 

CPR peaks among women 30-34 age group and is lowest for women aged 15-19 years47% of women in Kibera had an unmet need for family planning services compared National figure of 18% and 11% for Nairobi County. 

Men and boys play vital roles in enhancing demand of family planning services and commodities and therefore the need to target men and boys with awareness creation interventions on FP and the role they play in providing an enabling environment that would enhance increased uptake of family planning.
Family Health Option Kenya, Save the Children partner implementing the family planning component conducts various events to improve uptake for FP. 

The activities include outreaches, sports tournament, youth forums, men at work sessions and street-theatres to increase awareness on FP and dispel myths and misconceptions surrounding FP use. 

This has reached 1240 men aged between 18-35 years through which 25 referrals have been attained through the male support.
The reality is that with the efforts the desired uptake has not yet been achieved owing to impeding factors that affect the uptake of family planning services and the commodities coupled with bottlenecks within the supply side of these commodities and services. 

These  factors include; partner’s  approval,  quality  of  the  services,  involvement  of  the  male staff  administering  the  family planning services to adolescents girls and  the  woman’s knowledge  about family planning  services and proximity to the provider; (International journal of business and social science Vol 2 No.1 January 2011).

Additional bottlenecks limiting the uptake of all FP includes: general myths and misconception around the use of FP that could lead to infertility, use of FP reduces sexual pleasure; the use of FP causing illnesses; use of FP is meant to depopulate; the use of FP disfigures women; minimum male support and fears on side effects across men and boys. 

There has also had limited access of FP services by adolescents and inadequate FP commodities supplies including IEC Materials (as per project reports). 

3. Purpose of the Operational Research
The purpose of this operation research is to assess the role of men and boys in increasing the uptake of family planning services focusing on the involvement of men and boys above 15 years. 

It will also explore the behaviour aspects of adolescent boys (15 – 24 years) on understanding and perceptions regarding family planning together with their key role in support for the uptake of family planning services.

It will also assess barriers in the supply of family planning services and commodities to women and adolescents and learn from the process, achievements and challenges encountered in the supply side of the family planning commodities.

It will also be integral to develop recommendations to address these challenges and factors to enhance the performance of the program, improve outcomes, assess feasibility of new strategies and/or assess or improve the programme Theory of Change.

It should aim at finding solutions to perceived challenges on the involvement of men and boys above 15 years and the supply side bottlenecks in the delivery of family planning services within the project location. 

The perceived challenges on involvement of men and boys ranging from;
  • Messaging of family planning information and communication methodologies.
  • Cultural practices within the community.
  • Attitude of men and boys on family planning.
  • Knowledge levels and understanding on family planning (myths and misconceptions).
Service delivery access points bottlenecks;
  • Availability of health workers.
  • Health workers knowledge and capacity.
  • Efficiency of supply system.
  • Integration of family planning with other primary health care services.
The operational research will derive models and approaches to address the bottlenecks and challenges identified and propose innovative methods to strengthen engagement of men and boys above 15 years in improving FP uptake.
4. Methodology
The methods of operational research will range from the qualitative to quantitative techniques. 

This will be an exploratory study focusing on the involvement of men and boys together with the supply systems of the family planning services and commodities within the location.

The data sources will comprise of primary and secondary sources. 

The secondary sources will involve information derived from other research work conducted on male involvement in uptake of family planning services. 

Primary data will be derived from the following informants of the study;
a)    Men and boys above 15 years. (Adolescent boys of 15 – 24 years to explore behaviour and perceptions on FP)
b)    Women of reproductive age at the community level
c)    KII (including the Langata Sub-County Health Management Team)
d)    Family Health Options Kenya/ Carolina for Kibera
e)    Other NGO’s and stakeholders as may be identified.
Sampling methodology: The recruited consultant will recommend an appropriate study design applicable in effectively addressing the objectives of the study. The project works in 9 villages out of a total of 13 villages.

Tentative work plan
The exercise is projected to be undertaken in 20 days from 15th August to 5th September 2016. 

The Consultant(s) is expected to deliver the following:

a) Introduction/inception meeting with EC-Kibera project Core team & relevant staff.
b) Research tools and framework for the research, in line with project documentation and with input of partner, project and MEAL team.
c) Visit project sites, interview respondents from the project sites (Men and boys above 15 years), women and KII.
d) De-briefing including recommendations at end of the data collection process.
e) Deliver one in-depth report with detailed analysis and methodology for findings of the operational research.

The consultant will have the primary responsibility of conducting the operational research and preparing the report. 

The consultant will be expected to lead and coordinate the data collection, entry and analysis of data and report writing.

5. Qualifications and Experience:
Specifically, Consultant will possess:

a. Relevant academic qualification in public health/ health systems management or related health field.
b. Specific experience in family planning research and/or evaluation is essential.
c. At least 7 years of experience in the area of maternal, newborn and child health and public health and in conducting research and evaluations for health programmes in Kenya. Experience conducting evaluations in an urban informal setting is an added advantage
d. A demonstrated high level of professionalism and ability to work within tight deadlines.
e. Strong interpersonal and communication skills.
f. Computer skills and proficient in English.
6. Duration and Timeline of Consultancy
The consultancy is expected to take a maximum of 20 days. Data collection is expected to take 5 days out of the 20 days. The following will be the requirements.
a. A technical proposal outlining the objective, methodology to be employed with mention of the data collection tools and approaches to be used for the research. The technical proposal should also include a detailed implementation plan outlining key timelines within the outlined period.
b. Financial proposal should only include the fees payable (In Kshs) to the consultant(s).  The consultant is expected to cover costs related to travel, accommodation, meals and allowances and data collection.
7. Intellectual Property Rights
All products developed under this consultancy belong to the project exclusively, guided by the rules of the grant contract between EU and Save the Children. 

Under no circumstances will the consultant use the information of this evaluation for publication or dissemination without official prior permission (in writing) from Save the Children. 

8. Submission of Proposals
CLICK HERE to download the EOI format

The submission of proposals is only open to the prequalified consultants (firms).

The technical and financial proposals should be e‐mailed to [email protected] by close of business (5.30pm), August 18, 2016.

9. Evaluation and Award of Consultancy
Save the Children will evaluate the proposals and award the assignment based on technical and financial feasibility criteria guided by this ToRs. 

Save the Children reserves the right to accept or reject any proposal received without giving reasons and is not bound to accept the lowest, the highest or any bidder. 

The consultancy is subject to Save the Children policies.

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