Global Fund – TB program Third Party Monitoring

Word Vision International – Somalia

Global Fund – TB program Third Party Monitoring

Terms of Reference (ToR)

1. Monitoring Summary

Project Name-Somalia Global fund Tuberculosis (TB) program

Monitoring Type-Continuous monitoring and evaluation of activities

Purpose of the monitoring-Third Party Supervision, Monitoring and Evaluation

Proposed Methodologies

1. Support supervision of TB Management Units (TBMUs)
2. Support supervision of MDR Facilities
3. Support supervision of Culture Laboratories
4. (Electronic TB) e-TB data monitoring/ dhis2
5. National TB Program (NTP) interviews
6. Advocacy Communication and Social Mobilization (ACSM)/ Public-Private Mix (PPM) monitoring

Proposed Monitoring Dates

1^st January, 2021 – 31^st December, 2023

Reporting Dates

Quarterly (Every 15th of the following month after end of quarter)

2. Description of Program being Monitored

Project Goal-Reduce the incidence of TB (all forms) by 50% by 2025 and 90% by 2035 (from 2015 baseline figure)

Project Objectives/

Project Objectives

1. · Increase TB treatment coverage (case detection ratio) to 50% by 2020 (from baseline of 47% in 2015)
2. · Increase treatment success to at least 90% in all forms of detected non- Multi-Drug Resistant (MDR) TB cases
3. · Increase annual case detection of MDR- TB to 400 by 2020 (from baseline of 243 in 2016) and improve management of MDR-TB cases through country-wide implementation of the shorter MDR-TB treatment regimen
4. · Ensure that 100% of new staff receive induction training and that 50% of TB service facilities receive regular supervision and monitoring by 2022
5. Project Outcomes
6. · TB O-1a: Case notification rate of all forms of TB per 100,000 population – bacteriologically confirmed plus clinically diagnosed, new and relapse cases
7. · TB O-5(M): TB treatment coverage: Percentage of new and relapse cases that were notified and treated among the estimated number of incident TB cases in the same year (all form of TB – bacteriologically confirmed plus clinically diagnosed)
8. · TB O-5(M): TB treatment coverage: Percentage of new and relapse cases that were notified and treated among the estimated number of incident TB cases in the same year (all form of TB – bacteriologically confirmed plus clinically diagnosed)
9. · TB O-6: Notification of RR-TB and/or MDR-TB cases – Percentage of notified cases of bacteriologically confirmed, drug resistant RR-TB and/or MDR-TB as a proportion of all estimated RR-TB and/or MDR-TB cases
10. · TB O-4(M): Treatment success rate of RR TB and/or MDR-TB: Percentage of cases with RR and/or MDR-TB successfully treated

Project location (Districtsand # of villages/ sub-Locations

Puntland, Somaliland and Federal Government of Somalia )

Number of target beneficiaries –16, 109,000 which is the total population of Somalia (Worldometer)TB patients

Sectors-Health

Key Project Activities

1. Drug sensitive TB diagnosis
2. Drug sensitive TB treatment
3. Drug resistant TB diagnosis
4. Drug resistant TB treatment
5. TB/HIV collaborative activities( ACSM· PPM)
6. Procurement and supplies distribution

Donor-Global Fund to fight TB, AIDS and Malaria

Duration of the Program-3 years

Available Project Documentation

Somalia TB strategic plan, performance framework, project log frame, Inventory study report, Patients’ perspective toward TB treatment report (Quote Study), Impact Evaluation report, KAP Surveys, PU/DRs

3. Brief Background of Project to be monitored

Globally, 6.3 million new cases of TB were reported in 2016, equivalent to 61% of the estimated incidence of 10.4 million. According to WHO World TB report 2016, Somalia has one of the highest TB incidences rates in the world estimated at 270/100,000 with a prevalence rate of 481/100,000 and estimated mortality (excluding HIV/TB) rate of 64 per 100,000 population. According to the latest UNFPA report, Somali population is estimated to be 12.3 million. TB continues to contribute to the disease burden in Somali, with the latest WHOTB report estimating a Case Detection Rate (CDR) of only 49%, meaning 51% for all the cases (estimated) are being missed or undetected and majority of these are believed to be at the community level. In the last 5 years, case notifications have shown continued fluctuation and decline.

In Somali, TB control service provision is managed under the National Tuberculosis Programme (NTP) within the Ministry of Health (MOH). However, after the collapse of the central government in Somalia in 1990, TB control service provision have been implemented through key partners who consist primarily of international and national Non- Governmental Organizations (NGOs) with WHO providing the technical expertise in collaboration with Somalia government. From 2004, TB control have been funded chiefly by the Global Fund for AIDS, Malaria and TB (GFATM). World Vision (WV) is the principle recipient. Further, the government contributes to the implementation through provision of infrastructure, security support and facilitation of the NGOs involved in the TB control.

Despite being at its infancy stage and the complex political and security in the country, the Somali government has made progress in TB control and management. Access to TB services has generally improved through an increase in the Out Patient Department (OPD) services and laboratory network for microscopy services implemented according to the Stop TB Partnership global DOTS strategy. With uninterrupted funding from the Global Fund since 1995, access to TB services and treatment have increased from 12 TBMUs in 1995 to 83 by December 2016. Quality diagnosis and treatment resulted in a treatment success rate of above the 85% global threshold. In 2015, the government finalized the development of the second National TB 2015-2019 strategic plan. This was followed by the completion of the monitoring & evaluation (M&E) plan that will guide the implementation of the strategic plan. The Strategic Plan contributes to the Somali Health Policy goal of improving the health status of the population through health system strengthening interventions and providing quality, accessible, acceptable and affordable health services that facilitate moving towards Universal Health Coverage (UHC) and accelerate progress towards achieving the health-related Sustainable Development Goals (SDGs).

Without diminishing the TB control and management progress made in Somali, TB program have not expanded as desired. There has been a slow progress in improving the existing infrastructure to increase their capacity as well as establishing new health facilities to meet the community needs or ensuring quality of the services. Required additional resources in terms of workforce, infrastructures, equipment and supplies have been limited. At present, the Global –Fund supported TB program in Somali is implemented by World Vision International Somalia Program (WVI-S) working in with other Somalia TB program implementing partners. The Somalia Health Sector Committee (HSC) and the TB Coordination Team (TBCT) provides the Country Coordination Mechanism (CCM) for the program.

4. Purpose and Objectives of the engagement

The main objective of this engagement is to ensure routine and output monitoring visits are conducted in the TBMUs, Culture laboratories and MDR facilities to provide vital information to management for timely decision making.

The successful entity in this engagement will be required to undergo initial orientation from World Vision Somalia Quality Assurance department and equally review the project design documents and its annexes including the Log frame, M&E plan, strategic plan and other relevant documents.

The following key deliverables will lead the monitoring process;

a) Provide PR, MOH, community members and other stakeholders with information to enable them understand overall project performance;

b) Conduct routine support supervision of project activities as described in project documents;

c) Measure output indicators through quarterly Monitoring and support supervisions;

d) Work toward integration of TB in the EPHS system of MOH;

e) Contribute to development of policy documents and guidelines; and

f) Provide workable recommendations aimed at improving project quality.

5. Scope of the Engagement (monitoring).

o All Somaliland TBMUs

o All Puntland TBMUs

o All Federal Government of Somalia TBMUs

6. Logistics

Based on this ToR, the successful entity will propose a suitable approach and budget for this engagement. Upon approval of the technical approach a meeting will be arranged with the project team to agree on the frame of operation and responsibilities of each party. This task is estimated to last until 31st December 2023.

WV Somalia GFTB PR team together with Quality Assurance team will support the successful entity in understanding its program model and the standard tools used in monitoring related activities. WV Somalia will also ensure that necessary linkages are created between the Third party monitor, field staff and implementing partners.

7. Responsibilities of Third Party Monitor (Consultant/NGO)

1. Conduct Quarterly Monitoring and support supervision of TBMUs and documenting successes and challenges
2. Provide support and on job training to TB staffs at TBMUs.
3. Help provide solutions at local level to issues identified during supervision
4. Lead the implementation of Community Feedback Mechanisms in all communities.
5. Ensure that core monitoring team members are properly trained on the M&E tools
6. Work with PR to coordinate monitoring schedules
7. Conduct data verifications both during data collection and data entry.
8. Conduct continuous e-TB / dhis2 data monitoring and basic analysis
9. Provide quarterly reports to PR
10. Provide summary presentation of findings at review meetings and to PR management when called upon
11. Periodic presentation of key findings to management.
12. Raise the attention of PR when urgent issues/challenges come up
13. Conduct asset verification to each TBMUs accessed
14. Verify staff numbers, names, cadres and other related information
15. Provide status update on COVID-19 preparedness and related activities

8. WV Responsibilities during evaluation

1. Provide necessary orientation and training to the selected entity
2. Provide the selected 3rd Party Monitor with necessary documents to enable clear understanding of the project
3. Create linkages with field staff, Implementing Partners/SRs and other stakeholders
4. Provide on-going supervision and guidance to the selected individual/firm/NGO
5. Review and approve field approaches to be used by the Monitoring team.
6. Review reports and data sets to ensure quality. Equally provide on-going feedback to the selected Monitor.
7. Where necessary make arrangement for the Monitor’s travel to field locations for supervisory purposes.

9. Products

At the end of every quarter, the third party monitor shall be expected to submit the following to

World Vision Somalia:

1. Provide summary report highlighting the following information (Maximum: 5pages)

2. Locations/sites visited during the month and individuals who conducted the monitoring

3. Activities conducted during the month

4. Summary findings from the monitoring activities conducted

5, Key lessons learned during the monitoring exercise.

1. Attach photos and quotes highlighting significant change

2. Soft copy of raw data set for any quantitative data

3. Soft copy of cleaned data set for any quantitative data

4. Soft copies of data collected during qualitative data collection exercises

10. Means of Verification

Tasks

Means of verification

1. Conduct Quarterly Monitoring and support supervision of TBMUs and documenting successes and challenges

· Quarterly supervision schedule developed with PR and MOH.

· Letter of acknowledgment of TBMU from MOH/NTP confirming supervision

1. Provide support and on job training to TB staffs at TBMUs.

· Provide in the main report summary of on job training done during supervision

1. Help provide solutions at local level to issues identified during supervision

· Provide summary of solution provided at TBMU level as a segment in main report

1. Lead the implementation of Community Feedback Mechanisms in all communities.

· Provide feedback to hospital/TBMU management on TB control program in the area and performance of local TBMU

1. Ensure that core monitoring team members are properly trained on the M&E tools

· Provide updated monitoring tools and show analysis of main indicators in the main report.

1. Work with PR to coordinate monitoring schedules

· Quarterly monitoring schedules shared with PR for records

1. Conduct data verifications both during data collection and data entry.

· Provide data verification findings summary within quarterly report

1. Conduct continuous DHIS2 data monitoring and basic analysis

· NTP to share TB DHIS2 data with TPM team for analysis to be included in quarterly report

1. Provide quarterly reports to PR

· Quarterly report submission by 15^th of April, August, November and January to PR to be used for processing of funds every end of quarter.

1. Provide summary presentation of findings at review meetings and to PR management when called upon

· Power point presentations for QRMs filed by PR

1. Periodic presentation of key findings to management.

· Key findings summary shared quarterly with PR and MOH

1. Raise the attention of PR when urgent issues/challenges come up

· Flag urgent issues identified during supervision through e-mails. Filing of such mails by PR

11. Proposal Contents

Proposals from Individuals/Firms/ should include the following information (at a minimum)

1. Proposed approaches, including field teams to be used

2. Proposed timelines

3. Proposed budget

4. CVs of key team members for this engagement.

5. Access and security approaches

6. Financial report for last three (3) years annexed

12. Evaluation Criteria

1. TB clinical, Laboratory and pharmaceutical knowledge and experience
2. MDR-TB and culture Laboratory technical knowledge and experience
3. DS and DR TB pharmaceutical and commodity supply chain technical expertise with regards to drug regimen, storage, forecasting and training of staffs
4. Please work experience in Somalia or any other fragile context
5. Experience working with National TB Program staff