Lebanon: LB2019-008 Consultancy Service for developing transition plan for the Mobile Medical Units (MMU) project for LRC

LB2019-008

Terms of Reference

for assisting Lebanese Red Cross (LRC) Medico-Social Department (MSD) in developing transition plan for the Mobile Medical Units (MMU) project

Background

Following large-scale population movements provoked by the on-going Syria crisis, Lebanon accepted over 1.5 million Syrian refugees. This affected Lebanon infrastructure and services, putting additional stress on its public health system. To better address the health needs of Syrian refugees in Lebanon, from September 2013, Lebanese Red Cross (LRCS) supported by Norwegian Red Cross (NorCross), Danish Red Cross (DRC), Spanish RC (SpRC), Canadian Red Cross and other Movement partners, started deploying Mobile Medical Units (MMU), providing primary health services to the most vulnerable communities in remote rural areas. By 2017 a total of 9 MMUs with 84 medical and social staff were operating in the North, South, Mount Lebanon and Bekaa: since 2013 they received 420,000 patient visits.

In December 2017 NorCross, in close coordination with the LRCS, commissioned an external evaluation aiming to evaluate the impact, effectiveness, efficiency, quality, impact and sustainability of the LRCS MMU project since September 2013, to identify key lessons learned, to suggest potential improvements to the programme components, and to contribute to formulation of the LRCS Medico-Social Department (MSD) new Strategy.

The evaluation, conducted in December 2017 - February 2018, concluded that the MMU operation effectively contributed to substantially improving access to basic primary health care services, social and psycho-social assistance in rural areas hosting over 20,000 displaced Syrian families. The project contributed to strengthening LRCS relations with the affected communities, enhancing management capacity of MSD, and increasing the overall LRCS capacity to provide medical assistance in emergencies.

The evaluation emphasised that in the Lebanese and LRCS context the “MMU model” allows delivering comprehensive multi-discipline primary health care services to remote communities, contributes to expanding LRC emergency response capacity, and provides a good opportunity for potential integration of all LRC activities in the regions, directed and supported by the LRCS HQ and coordinated by the LRCS Branches.

The MSD Strategy, adopted in August 2018, listed MMUs, together with the LRC Outreach medical and social teams, as two of the three key “pillars” of the LRC medico-social activities, that directly contribute to improving health in “underserved communities across Lebanon”, offering “affordable, continuous, exclusive and integrated services that are not offered by other actors”.

With diminishing international funding for Syria crisis, the MMU operation, funded primarily from external sources, needs to be optimized to ensure its continued functioning. Considering the substantial experience accumulated during the MMU project implementation, and the important role MMUs play in the medico-social activities of the Lebanese RC, defined in MSD 2018 Strategy, the LRC and its partners agreed to assist MSD in exploring various options to ensure continuous optimised functioning of the MMUs and Outreach teams in the context of the anticipated reduced external funding in 2019-2020 and beyond.

Purpose and objectives

The overall objective of the assignment is to assist MSD in exploring various options for optimizing the operation of LRC MMUs and Outreach teams in line with the recommendations of MMU external evaluation (2017) and the MSD 2018 Strategy (2018) and in the context of anticipated reduced international funding.

The specific objective for the assignment would include assisting MSD in developing a scenario-based plan of action for MMU operation for the “transitional” period of 2020-2021. The plan of action should be formulated based on the review and documenting of lessons, exit or transition and forthcoming vision of other actors, including MoPH on MMU operation in Lebanon, and should include, inter alia:

· proposed activities for assessing the viability of currently operational MMUs and Outreach teams from both the public health and cost-effectiveness perspectives;

· options for reducing the costs of MMU operation and identifying additional internal and in-country funding sources and income-generation options for MMU operation;

· a well-defined roadmap to initiate and transit MMU operation;

· a possible exit strategy, including defining roles and responsibilities of LRC branches, LRC health committee, LRC MSD, LRC community volunteers and PNSs currently supporting the MMU operation.

Methodology

The plan of action for the MMU “transitional” period of 2020-2021, drafted based on the results of the above analysis, should include the list of specific activities to be undertaken by MSD, other LRC Departments, LRC branches and/or other actors concerned in order to implement the identified options, and should include a well-defined roadmap to initiate and transit MMU operation and the tentative implementation timeline for 2020-2021.

The activities for assessing the viability of the currently operational MMUs and Outreach teams should include formulating the agreed set of criteria, e.g. geographical area covered, the current and projected number of patients serviced (“who MMUs serve”), the prevailing pathologies treated and/or prevented, the availability, actual capacity and physical, economic and perceived accessibility of other functioning health institutions in the target area, MMU contribution in completing continuum of care, the current and projected operational costs, the estimated public health and LRC image-related impact, the position and role of the LRC branches towards the three service delivery outlets (as indicated in LRC MSD strategy) etc.

The results of the viability assessment should allow LRC to be able to take informed decision about the order and priorities of a possible scaling down of the MMU operation.

The activities for reducing the costs of MMU operation and increasing income should include, inter alia identifying the list of available options/sources of funding, assessed/ranked in relation to their feasibility, potential short- and long-term overall impact, impact on the LRC branches, anticipated sustainability etc.

The required data for the formulating the plan of action could be collected from the MMU operation statistical data for 2013-2019, mapping of existing health institutions in the areas of MMU operation, interviews with MSD staff, MMU teams, LRC branches, PNSs, MOH, UN and NGOs officials working in the areas of MMU operation. Whenever necessary, focus group discussions/interviews with beneficiaries could be conducted.

The assignment should be implemented in close consultation and collaboration with the leadership and staff of LRC Medico-Social Department. Wherever possible, any activities implemented within the scope of the assignment should contribute to improved communication and collaboration between the LRC branches and the MSD.

Deliverables

The deliverables for the overall assignment would include:

· Draft scenario-based plan of action (“roadmap”) for MMU operation for the “transitional” period of 2020-2021, formulated based on the review and documenting of lessons, exit or transition and forthcoming vision of other actors, including MoPH on MMU operation in Lebanon;

· Mapping of the existing health structures (operated by LRC, MoPH, MoSA, UNHCR, local and international NGOs and other actors) in the areas, currently targeted by MMUs, including the services provided, the cost and supporting bodies if relevant;

· The assessment of the public health and economic viability of the currently operational MMUs and Outreach teams against an agreed set of criteria, that would allow LRC to be able to take informed decision about the order and priorities of a possible scaling down of the MMU operation, should it be necessary;

· The list of available options for reducing the costs of the MMU operation;

· The list of additional internal and in-country funding sources and income-generation options for continuing the MMUs operation;

· A possible exit strategy, including defining roles and responsibilities of LRC branches, LRC health committee, LRC MSD, LRC community volunteers and PNSs currently supporting the MMU operation.

Wherever feasible, MSD staff responsible for managing the MMUs and Outreach teams should be directly involved in producing the above deliverables through, inter alia, data collection and analysis, formulating recommendations and drafting the Plan of Action for 2020-2021.

Proposed timeline

• 24-Oct-19: Advertisment of LB2019-008
• 01-Nov-19: Deadline for application submission. Financial and Technical Proposal
• 06-Nov-19: Consultancy Contract Signature
• Week 1:

Activities: Desk review and analysis of the available 2013-2019 MMU statistics and operational data. Desk review of the available demographic data on the areas of MMU operation. Desk review of the public health coverage (including availability, capacity and accessibility of primary health care and referral medical facilities) in the areas of MMU operation

Deliverables: List of criteria for assessing the viability of each MMU. Draft assessment methodology. List of questions to be verified during interviews and field visits

• Week 2-3:

Activities: Interviews with the MSD partners, MOH, UN, NGOs at the central level. Field visits, interviews and data collection in the areas of the MMU and Outreach teams’ operation. Review and analysis of the collected data

Deliverables: Mapping of the public health coverage in the areas of the MMU operation. Assessment of the viability of the currently operational MMUs

• Week 3:

Activities: Interviews and focus groups discussions with MSD, LRC branches, MSD partners to explore the viable options for reducing the costs of the MMU operation. Interviews and focus groups discussions with MSD, LRC branches, MSD partners to explore various additional internal and in-country funding sources and income-generation options for continuing the MMUs operation.

Deliverables: The list of available viable options for reducing the costs of the MMU operation. The list of additional internal and in-country funding sources and income-generation options for MMUs.

• Week 4-5:

Activities: Developing draft plan of action for the MMU “transitional” period of 2020-2021.

Deliverables: Draft plan of action for the MMU “transitional” period of 2020-2021

• Week 6:

Activities: Collecting feedback on the draft plan of action for the MMU “transitional” period of 2020-2021

Deliverables: Feedback on the draft plan of action

• Week 7:

Activities: Finalising the plan of action for the MMU “transitional” period of 2020-2021

Deliverables: Plan of action for the MMU “transitional” period of 2020-2021

Evaluation quality and ethical standards:

The evaluators should take all reasonable steps to ensure that the evaluation is designed and conducted to respect and protect the rights and welfare of the people and the communities of which they are members, and to ensure that the evaluation is technically accurate, reliable, and legitimate, that it is conducted in a transparent and impartial manner, and that it contributes to organizational learning and accountability. Therefore, the evaluator should adhere to the evaluation standards and specifics, and applicable process outlined in the IFRC Framework for Evaluation. The IFRC Evaluation Standards are:

1. Utility: Evaluations must be useful and used.

2. Feasibility: Evaluations must be realistic, diplomatic, and managed in a sensible, cost-effective manner.

3. Ethics & Legality: Evaluations must be conducted in an ethical and legal manner, with regard for the welfare of those involved in and affected by the evaluation.

4. Impartiality & Independence: Evaluations should be impartial, providing a comprehensive and unbiased assessment that considers the views of all stakeholders.

5. Transparency: Evaluation activities should reflect an attitude of openness and transparency.

6. Accuracy: Evaluations should be technically accurate, providing enough information about the data collection, analysis, and interpretation methods so that its worth or merit can be determined.

7. Participation: Stakeholders should be consulted and meaningfully involved in the evaluation process when feasible and appropriate.

8. Collaboration: Collaboration between key operating partners in the evaluation process improves the legitimacy and utility of the evaluation.

It is also expected that the evaluation will respect the seven Fundamental Principles of the Red Cross and Red Crescent: 1) humanity, 2) impartiality, 3) neutrality, 4) independence, 5) voluntary service, 6) unity, and 7) universality. Further information can be obtained about these principles at: www.ifrc.org/what/values/principles/index.asp

Qualifications

The assignment can be implemented by an individual consultant or a team of consultants having the following qualifications:

· Minimum of 7 years of experience in management consulting, capacity-building, monitoring and evaluation, organizational development,

· University degrees at the post-graduate level in management, development, public health, monitoring and evaluation,

· Experience in quantitative and qualitative data collection and data analysis techniques,

· Proven track record of conducting qualitative research including the development of interview schedules and qualitative data analysis,

· Excellent written and spoken English skills,

· Excellent analytical, writing and presentation skills,

· Strong interpersonal and organizational skills required,

· Knowledge and experience working with the Red Cross Red Crescent Movement required,

· Experience working in Lebanon or in the Middle East strongly preferred

· Knowledge of the local languages (Arabic, French) is an asset

· Demonstrated capacity to work both independently and as part of a team,

· Strong interpersonal and communication skills.

Application procedure

1. Interested candidates should submit their applications latest on 01-November-2019 by email to tender.mena@redcross.no, with the subject “**LB2019-008 LRC MMU Financial Proposal / Technical Proposal**”. Application materials shall include:

· Curricula Vitae (CV) for all members of the team applying for consideration,

· Technical proposal not exceeding five pages expressing an understanding and interpretation of the TOR, the proposed methodology, and a time and activity schedule,

· Financial proposal itemizing estimated costs for services rendered (daily consultancy fees), accommodation and living costs, transport costs, stationery costs, and any other related supplies or services required for the evaluation.

· Financial and Technical proposals must be submitted separately in two different emails.

Incomplete applications packages will not be considered. Application materials are non-returnable.

We thank you in advance for understanding that only short-listed candidates will be contacted for the next step in the selection process.