Norway: External evaluation of the Norwegian Red Cross working modalities in the Health Care in Danger Project

1. Summary

1.1.Purpose: The Norwegian Red Cross (NorCross) seeks to evaluate the impact and effectiveness of the working modalities in its Health Care in Danger Programme in the period 2012-2016 and identify key lessons and recommendations to improve ongoing activity and inform future response.

1.2.Audience: The results will be used by NorCross to inform upcoming processes and strengthen sustainability of ongoing and future activities.

1.3.Duration: 5 weeks.

1.4.Timeframe: 8^th March 2017 – 12^th April 2017.

1.5.Methodology summary: Primarily qualitiative approach, based on intervies and desktop study.

1.6.Location: Oslo, Norway at least for part of Week 1 and Week 5.

1.7.Application requirements: Requirements include a proven track record of conducting qualitative and research and analysis, a University degree at the post-graduate level in relevant field of study, excellent written/spoken and preferably knowledge and experience working with the Red Cross Red Crescent Movement and/or experience with NorCross international programming.

1. Background

Violence against health care workers, health facilities and against beneficiaries seeking medical support in violent and conflict affected areas is widespread and affects large populations. To address these problems, the 31st International Conference of the Red Cross and Red Crescent in November 2011 called upon the ICRC to initiate consultations with experts from within the RCRC Movement and from States , as well as other actors in the health care sector, in order to find ways to make the delivery of medical and health care services safer in armed conflict and other emergencies. This resulted in the RCRC Movement leading a global initiative to raise awareness among all relevant stakeholders of the need to improve security and delivery of impartial and effective health care, to mobilize experts to develop practical measures that can be implemented in the field by decision-makers, humanitarian organizations and health professionals, and finally to implement these solutions at the national level. NorCross has been working with HCiD at the global, regional and domestic levels, but also through other national societies and the ICRC at national levels.

NorCross has since 2012, in cooperation with its Movement partners and with support from the Norwegian Ministry of Foreign Affairs (MFA), worked on HCiD and through the Global Cooperation Agreement with the MFA, NorCross has committed to do so until the end of 2017. Additionally, TV-Aksjon funding for HCiD complements MFA funding (current concept notes are for 2017-2020). In the period only funded by the MFA (2012-2016), NorCross supported HCiD activities at the global level including developing and disseminating tools and reports, mobilizing key stakeholders through the Movement Reference Group and the Community of Action for Ambulance and Emergency Prehospital Services in Risk Situations, which it is leading. At the regional level, NorCross has facilitated exchange and collaboration between National Societies and state actors. Finally, NorCross has supported HCiD activities at the national level (in Colombia, El Salvador, Honduras, Iraq, Lebanon, South Sudan) and at the domestic level in Norway (through advocacy, communication campaign, awareness raising).

Internally, the program has been divided into 3 tracks:

1. International track: support to other RCRC National Societies, tool development and dissemination

2. Diplomatic track: international advocacy

3. National track: domestic activities in Norway

Activities are seldom implemented unilaterally, usually NorCross is collaborating, supporting or coordinating with one or more actors in the implementation including RCRC National Societies, the ICRC, the IFRC, state institutions and the private sector.

Table 1: Logical Frameworkfor 2015

4.0Thematic:Preventing and mitigating the humanitarian consequenses of armed conflict and violence

4.2Outcome:Safe access to and delivery of health services in armed conflict and other situations of violence is improved (HCiD)

4.2.1Output:Needs and capacity-based HCiD activities have been carried out

4.2.2Output:The HCiD capacity of the National Society is improved

EE4.0Enabling environment outcome:Increased impact and efficiency of programming through humanitarian diplomacy, common policies, guidelines, tools and methodologies

EE4.7Enabling environment output:RCRC Movement knowledge and best practices related to the humanitarian consequences of armed conflict, violence, social exclusion are shared between RCRC Movement partners

EE4.8Enabling environment output:Tools related to the humanitarian consequences of armed conflict/ violence/social exclusion for RCRC Movement components are developed and implemented.

Thematically, NorCross has been particularly focused on challenges and solutions for Ambulance and Pre-hospital services operating in risk situations and the role of Armed Groups in safeguarding access to health-care.

1. Evaluation Purpose & Scope

In 2017, NorCross will be applying for funding from MFA for 2018-2020, revising its International Strategy and defining its role in the initiative entitled "Protection within the Movement". In order to inform these three processes, it has been determined that an external evaluation should be undertaken of NorCross' working modalities in HCiD and the impact of the approach used. The results of the evaluation will help guide the ways in which NorCross decides to work on "Protection within the Movement" as well as shape what is included in the MFA application and International Strategy. The evaluation should also make informed recommendations regarding whether or not NorCross should alter/expand its current HCiD portfolio and the structural implications this will have (including for human resources). These recommendations should be based in part on how working modalities, during the 2012-2016 period, have or not contributed to sustainability.

NorCross is one of the only Movement actors with the capacity to support partners in implementing HCiD measures. There is therefore a risk of HCiD activities fading out in certain contexts when NorCross no longer supports them. To mitigate this and ensure a sound exit strategy, NorCross has strengthened global networks (such as the Community of Action), but also regional networks by facilitating horizontal cooperation in the Americas region and bringing together national societies in the Americas and MENA regions around a common themes of interest. With the ICRC reducing its HCiD Project Team considerably after 2017 and continuing its engagement on the HCiD initiative in a different and perhaps more mainstreamed manner, ensuring sustainability will be a key factor. An external evaluation can assess the value of the above-mentioned mitigation and recommend measures to ensure stronger sustainability.

The evaluation will encompass NorCross' program as a whole in the period 2012-2016. While the consultant will need to interview some individuals involved in the implementation of individual projects to get an informed picture of the working modalities, the evaluation does not need to study individual projects in depth. An evaluation of the Colombia Project is planned before this global evaluation and can be used to get a more field-based perspective.

1. Evaluation Criteria – Objectives - Questions

As mentioned above, NorCross will be at a crossroads of various applications, strategic processes and new initiatives in 2017. This evaluation will inform sound decision making during these processes and should focus in particular on the extent to which the working modalities and approach ensured that NorCross was able to achieve intended objectives. Sustainability within the HCiD initiative will receive more attention in 2017 and an external evaluation can provide useful recommendations for how to further strengthen this aspect of the HCiD programming.

As such, the evaluation will identify and assess:

1. Where the HCiD Programme differs in its working modalities, from other NorCross international programmes.
2. The appropriateness and effectiveness in planning and reaching outputs and outcomes (see Table 1 for example).
3. The appropriateness and efficiency of the working modalities used at different times (unilateral, bilateral, regional, multilateral, global).
4. The relevance of the various NorCross HCiD team structures in reaching objectives.
5. How the working modalities have contributed to sustainability and how they can be adapted to strengthen sustainability.
6. Given the above, make general recommendations of how NorCross can maximize its impact in the next funding phase (where is the "untapped potential", what approaches should Norcross continue with and what needs to be adapted). This should include a short section on suggestions for how NorCross could best expand its HCiD programme should it apply for more resources in the next funding phase.

The HCiD Programme has been structured in different ways and is implemented differently from most other NorCross programmes: unilaterally, bilaterally and multilaterally, at the domestic and international levels (globally, regionally, nationally) simultaneously. The overaraching question is therefore what worked best given the objectives of the HCiD Programme?

1. Evaluation Methodology

The methodology will be further detailed with the assistance of the evaluator once commissioned (it is recommended that the applicant include reflections on methodology in the inception report).

Given the objectives above, the approach should be mainly qualitative approach, but where/if possible quantitative data can be used to increase the rigor of the evaluation.

Primary data can be collected through interviews, focus groups, email correspondence or other. The level of corroboration of findings should be reflected in the importance assigned to it in the evaluation report. The consultant should interview NorCross field and headquarter staff, ICRC field and headquarter staff, IFRC headquarter staff, sister National Society staff (ex: Lebanese RC, Libyan RC, Colombian RC, Honduras RC, El Salvador RC, Kenya RC, Magen David Adom in Israel, Ecuador RC, Swedish RC), non-RCRC Movement organisations (ex: Geneva Learning Foundation, University of Geneva, Swedish Association of Ambulance Nurses, Falck, International Association of EMS Chiefs, Ambulance Today), Norwegian Stakeholders (ex: Health Directorate, Public Health Institute, Delta, MFA, Norwegian Armed Forces). In order to collect primary data from the ICRC and IFRC headquarters, the consultant will need to travel to Geneva, Switzerland, for a few days.

A lot of secondary data is available including Project Proposals, Approval Documents, Agreements, Minutes of Meetings, Mission Reports, Annual Reports, a Theory of Change, Monitoring data, Publications and other Tools.

1. Deliverables (or Outputs)

Inception report. A short inception report of 5-10 pages should demonstrate a clear understanding of the ToR and realistic plan of work for the evaluation. It should include the proposed methodologies, a data collection and reporting plan with identified deliverables, draft data collection tools such as interview guides and logistical arrangements for the evaluation.

Presentations. The evaluator should update stakeholders on the progress and findings to check accuracy of data, confirm findings, and provide additional input and impressions to include in the final assessment

Draft report and Final report. The draft and final reports must be written in English, reflect the requirements included in the ToR and should include an executive summary, background of the intervention evaluated, a description of the evaluation methods and limitations, findings, conclusions, lessons learned, recommendations, and relevant appendixes, including a copy of the TOR, data collection instruments, and full citations for any cited resources. The Final report should not exceed 20 pages (excluding annexes).

1. Proposed Timeline (or Schedule)

The below is a proposed timeline and a more detailed timeline must be prepared by the evaluator with additional information (not necessary for public dissemination in this TOR).

First 7 working days

Activities: Planning for data collection. Desktop study and initial consultations with HCiD Senior Adviser.

Deliverables: Update proposal after initial consultations with HCiD Senior Adviser and include agreed methodology, schedule, and data collection tools.

Second 7 working days

Data collection NorCross HQ and field, ICRC HQ and Field, IFRC, non-Movement actors and Norwegian stakeholders. Expectected number of interviewees: up to 40 people.

Deliverables: Presentation of progress and preliminary findings

Third 7 working days

Finalize and present draft evaluation report.

Revise and submit final evaluation report (should integrate feedback received)

Deliverables: Presentation of draft report and collecting feedback. Final evaluation report

1. Evaluation Quality & 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 people and the communities of which they are members, and to ensure that the evaluation is technically accurate, reliable, and legitimate, conducted in a transparent and impartial manner, and contributes to organizational learning and accountability. Therefore, the evaluation team should adhere to the evaluation standards and specific, 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 particular 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 takes into account the views of all stakeholders.

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

6. Accuracy: Evaluations should be technical accurate, providing sufficient 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”

1. Evaluator/s & Qualifications

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

· University degree at the post-graduate level in relevant field of study required.

· Excellent written and spoken English required (including analysis, writing and presentation skills), good spoken Spanish considered an asset.

· Strong computer skills required.

• Strong interpersonal and communication skills skills.
• Knowledge and experience working with the Red Cross Red Crescent Movement preferred.
• Knowledge and/or experience with NorCross international programming and working modalities considered a strong asset.

• Demonstrated capacity to work both independently and as part of a team.

• Application Procedures

Interested candidates should submit their application material by 20^th February 2017 to Frederik Siem (frederik.siem@redcross.no). Application materials should include:

1.Curricula Vitae(CV)

2.Cover letterclearly summarizing your experience as it pertains to this assignment, your daily rate, and three professional references.

3.A brief description of your firm or institution (for applicants other than individual contractors).

4.Technical proposalnot exceeding five pages expressing an understanding and interpretation of the TOR, the proposed methodology, and a time and activity schedule.

5.Financial proposalitemizing 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.

6. *At least one example of an evaluation report most similar to that described in this TOR.*

Application material are non-returnable, and we thank you in advance for understanding that only short-listed candidates will be contacted for the next step in the application process.

1. Appendices

For more information about the global Red Cross and Red Crescent-led Health Care in Danger initiative, please go to http://healthcareindanger.org/hcid-project/

ANNEX:

Cooperation Project Description

Health Care in Danger (HCiD) Project

Annex to the Partnership Framework Agreement (PFA) of 12 March 2012 between the Norwegian Red Cross (NorCross) and the International Committee of the Red Cross (ICRC)

Introduction

The ICRC and NorCross have entered into a key partnership (2012-2017) on the Health Care in Danger Project, which aims at reducing violence against patients, health care providers medical transports and facilities in contexts of armed conflict or other emergencies. This annex describes the details of the partnership.

Background

Insecurity of health care in armed conflicts or other emergencies is widespread and affects large numbers of people. Between 2008 and 2010, the International Committee of the Red Cross (ICRC) analyzed 655 violent events affecting health care in 16 operational contexts. Additionally, between January 2012 and December 2014, the ICRC registered 2,398 incidents of violence against health care personnel, health transport, health facilities and patients in 11 countries, indicating high levels of vulnerability both for the wounded and the sick and for health personnel.

Direct threats to health care in these situations increase the acute need for emergency and life-saving medical assistance at a moment when they are most needed. The consequences are dire for local communities when hospitals or first aid posts have to close. Insecurity also exacerbates chronic needs when obstacles prevent rapid access to health facilities or when the delivery of basic health care can no longer take place, for example making it impossible to carry out vaccination campaigns. Because of its combined effects on chronic and acute needs, the insecurity of health care is probably one of the biggest humanitarian concerns today in terms of the number of people affected. Yet it is a largely under-recognised issue.

As the protection of the sick and wounded lies at the core of the Red Cross and Red

Crescent Movement's mission, the Movement has a crucial role to play in ensuring adequate respect for and protection of health care, both by bolstering its own capacity to respond to this problem in the field and by mobilizing and engaging all major stake-holders, particularly States and the wider health community. It therefore launched a Movement-wide initiative to address this pressing humanitarian issue at the 31^st International Conference of the Red Cross and Red Crescent. Resolution 5 from this Conference called on the ICRC to initiate consultations with experts from National Societies, the International Federation, States and the health community with a view to formulating practical recommendations for making the delivery of health care safer in armed conflict or other emergencies, and to report to the 32^nd International Conference in 2015 on the progress made. Reflecting the strong resolve of Movement components and the community of concern to build on the momentum generated, the ICRC extended the project until end of 2017. Similarly Norwegian Red Cross extended its HCiD project for the same timeframe.

Partnership objectives

The overall objective of the Health Care in Danger Project is to strengthen the protection of the sick and wounded and to improve the security in accessing and delivering health care. In phase 1 (2011 – 2015) the focus has been on the following:

1. The operational track consists of the operational field response by ICRC and National Societies and focuses mainly on improving the delivery of health care on the ground, including some aspects that contribute also to improving its security, through a protection dialogue and prevention activities. Operational practice, experience and data on incidents has fed into the expert consultation and communication strategy and campaign with relevant, timely and contextual analysis.
2. The expert consultation & diplomatic track consists of mobilizing States, the health community and all relevant stakeholders in a process of consultation to identify new and concrete measures to address insecurity of health care in their areas of responsibility. The results of the expert consultations are being injected into the operational response, to be promoted amongst relevant stakeholders for implementation at national level. They are also integrated into the communication campaign, as well as presented at the 2015 International Red Cross and Red Crescent Conference.
3. The communication strategy supports both the operational and the expert & diplomatic tracks and consists in profiling this humanitarian issue and promoting solutions emanating from the expert workshops on a regular basis on a global level and operational level. The HCiD communication campaign targets a wide range of audiences both in contexts where the lack of safe access to health care is an operational concern and in countries with a global and regional influence.

In Phase 2 (2015 – 2017) the focus will shift to increasing activities at the national level, making use of the recommendations developed in the expert consultations, and keeping the issue alive as an important humanitarian concern internationally.

The comprehensive body of recommendations to inform future work were generated from a a series of expert global consultations that addressed seven broad themes. Most themes are addressed at workshops in two different locations:

1. Military practice and operational orders (Sydney)

2. The role and responsibility of National Societies to deliver safe health care in armed conflict or other emergencies (Oslo and Tehran)

3. Responsibilities & rights of health care personnel (London and Cairo)

4. Ambulances/pre hospital services in risk situations (Mexico)

5. Health structures’ physical safety (Pretoria and Ottawa)

6. National legislation & penal repression.(Brussels)

7. Civil society mobilizing opinion leaders (Dakar and Abuja)

Additional consultations were held on the following themes:

Ethical principles of health care in armed conflict or other emergencies

Safeguarding the provision of health care and armed groups

NorCross has agreed to be one of the key partners with the ICRC in the Health Care in Danger Project and will take a central role in driving forward the second and fourth thematic issues, respectively “The role and responsibility of National Societies to deliver safe health care in armed conflict or other emergencies” and “Ambulance/pre hospital services in risk situations”. This does not preclude engagement on the other main themes. NorCross will also play an important role in mobilising other National Societies in support of the Project and its objectives. ICRC and NorCross will cooperate at field level in selected contexts to support National Societies in developing an operational response to improve safe access to and protection of health care.

Roles and responsibilities (2012 – 2017)

NorCross will

• host and finance one workshop on National Societies' role in delivering safe health care in armed conflict or other emergencies in Oslo on 3-5 December 2012
• draft the report on “Ambulance and pre-hospital services in risk situations” and a second more operational collection of NS best practices on the same theme.
• take a lead role in mobilizing relevant National Societies and in ensuring their involvement in and support of the Project
• actively contribute to the Movement Reference Group and to preparations for the Statutory Meetings and any other Movement events related to this project.
• promote the recommendations and measures coming out of expert consultation process over the next four years;
• together with the ICRC and other Movement partners, support several National Societies with needs-based activities combining the recommendations developed by the Project and local solutions;
• actively promote and facilitate the development of a community of practice around ambulance and pre-hospital services in risk situations;
• support ICRC ambitions and plans (where relevant and feasible) to develop other communities of practice which may involve National Societies.
• participate actively in the rolling out of the HCiD communication campaign, 'It is a Matter of Life and Death' and promoting the campaign amongst National Societies;
• second for the project period one person to work with the ICRC on the HCID project;
• finance its own participation in the project and support other National Societies – if relevant - to be able to take part in the Movement Reference Group.
• finance relevant human resources within the ICRC’s HCiD team in Geneva and South Sudan, where there is funding and the terms of reference are aligned with NorCross’s objectives
• Mobilize domestic actors of influence to join efforts to address HCiD as a global issue.
• Will provide consultancy services in support to HCiD-related specific objectives regarding the establishment of National Data Collection Mechanisms.

The ICRC will

• keep NorCross fully and regularly informed of the development of the project and regularly consult with NorCross during its implementation;
• share analysis of the core issues linked to the HCiD project and share analysis of the humanitarian problem based on ICRC data gathering;
• support NorCross with expertise to develop capacity related to HCiD;
• support NorCross, where feasible, in developing additional HCiD related initiatives apart from the mentioned workshop (such as a possible TV telethon in 2016);
• collaborate with NorCross at field level in contexts identified jointly through consultation between ICRC delegations and NorCross field representatives, with the aim of assisting National Societies in implementing the recommendations from the workshops.
• Will provide financial resources for consultancy services on the establishment of National Data Collection Mechanisms.

Coordination

The ICRC’s HCiD project team and NorCross’ Policy and International Law Unit (Communications and Marketing Department) with the External Resources and Policy Unit (International Department) retain the overall coordination responsibility for the implementation of this agreement. They will report to their respective hierarchy on the progress of implementation.

Monitoring and Review

In order to ensure implementation of the objectives described in this agreement, both partners will review the progress made and outcomes achieved at least once per year and adapt it according to the common findings if needed. Regular dialogue between NorCross and the ICRC HCiD team is reinforced through the human resource provided by NorCross to the HCiD team in Geneva.

Interested candidates should submit their application material by 20^th February 2017 to Frederik Siem (frederik.siem@redcross.no). Application materials should include:

1. Curricula Vitae(CV)

2. Cover letterclearly summarizing your experience as it pertains to this assignment, your daily rate, and three professional references.

3. A brief description of your firm or institution (for applicants other than individual contractors).

4. Technical proposalnot exceeding five pages expressing an understanding and interpretation of the TOR, the proposed methodology, and a time and activity schedule.

5. Financial proposalitemizing 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.

6. *At least one example of an evaluation report most similar to that described in this TOR.*

   Application material are non-returnable, and we thank you in advance for understanding that only short-listed candidates will be contacted for the next step in the application process.