Terms of Reference (ToR) Rapid Assessment of Primary Health Centers, Schools, and Communities to Strengthen Eye Care Services and Referral Systems (Re-Advertised)

Seeing the Future Project_10625
Terms of Reference (ToR)
Rapid Assessment of Primary Health Centers, Schools, and Communities to Strengthen Eye Care Services and Referral Systems. –

Assessment Areas: Menagesha and Hawassa Areas

Date: July 2025

1. Background

Cheshire Ethiopia, in collaboration with CBM International, is implementing the Seeing the Future project (10625) aimed at strengthening inclusive, accessible, and affordable eye health services in the Oromia, Sidama, Central Ethiopia, South Ethiopia, and Amhara regions. A key component of the project is the establishment of effective and sustainable eye referral systems and demand creation mechanisms at the primary level.

This rapid assessment will focus on 20 Primary Health Centers (PHCs)10 each in the Menagesha and Hawassa areas, along with selected schools and community-level structures, to evaluate current capacities and identify areas of improvement for the integration of inclusive eye health services. The two areas are targeted as it is finally intended to increase the referral uptake of patients to the eye care centers at Menagesha and Hawassa.The assessment will also explore existing linkages with rehabilitation centers and community-based structures for enhancing referral systems.

2. Main Goal

To assess and identify PHCs, primary hospitals, schools, and community structures that can be strengthened and integrated as nodes for eye health service delivery (health promotion, prevention and early identification in PEC), demand creation & strengthening the referral system, in the Menagesha and Hawassa areas.

3. Specific Objectives

The assessment aims to:

• Assess facility readiness -infrastructure, equipment staffing and leadership to deliver eye care services,
• Map community support: demand, awareness, referral role
• Determine the availability, condition, and gaps in essential eye care equipment and supplies
• Understand the eye health needs, and demand patterns of the communities served
• Map and assess community-level structures (e.g., Community based Inclusive Development (CBiD) , Health Extension Workers, Women Development Army, religious/community leaders) that could support awareness creation and referral linkages
• Evaluate existing referral pathways: schools, rehab centers, health facilities
• Identify access barrier- gender, disability, cost and cultural norms.

4. Scope and Coverage

The assessment will cover:

• Sites: 10 PHCs(health facilities including health center or primary hospitals) in the Menagesha area and 10 PHCs in the Hawassa area
• Target Institutions: PHCs, primary hospitals, schools, and identified community-based organizations
• Stakeholders’ engagement: Health professionals, PHC management, school administrators, community leaders, local health offices, and CBID actors e.g…name the local NGOs, faith-based groups etc

Activities include:

• Conducting field visits and facility assessments
• Engaging with key informants and community stakeholders
• Collecting and analyzing service, infrastructure, and patient data
• Documenting referral systems and governance mechanisms
• Identifying training, system integration, and resource gaps

5. Methodology

The assessment will apply both quantitative and qualitative approaches using the following tools and techniques:

• Structured facility observation checklists and infrastructure audits
• Mentioning the sampling method for PHCs and community groups – random, purposive or convenience
• Key informant interviews with approximately 30 individuals (20 PHC managers, 4 local health officials, 6 community/school stakeholders)
• Desk review of service data, registers, and health management information system (HMIS) entries
• Ranking of PHCs based on standardized criteria such as infrastructure, readiness, staffing, equipment, referral systems, and community integration (Health promotion, awareness creation, prevention) using Likert scale
• Mapping of existing referral pathways, community-based structures, and service gaps
• Disaggregation of findings by gender, age, and disability status where data is available

6. Key Deliverables

• Inception Report: A brief Executive summary Methodology, tools, work plan
• Draft Assessment Report: Findings, PHC rankings, key gaps(Include data sharing (Excel/PDF of raw scoring matrix, tools used) as part of the deliverables)
• Final Assessment Report: Recommendations, sustainability strategies, and integration pathway, Findings report Presentation to stakeholders for feedback

 

7. Roles and Responsibilities

• CBM International: Technical oversight, review of deliverables
• Cheshire Ethiopia: Coordination, logistics, stakeholder engagement
• Consultant/Assessment Team: Tool development, data collection, analysis, report drafting, presentation
• Regional Health Bureaus: Local facilitation, technical support

8. Timeline (18 Working Days Total)

Phase	Duration
Preparation & Tool Design	3 Days
Field Assessment	9 Days
Report Writing	3 Days
Finalization and presentation of finding report	3 Days

9. Required Qualifications

• Advanced degree in Public Health, Ophthalmology, or related field
• Proven experience in assessments of health systems
• Knowledge of Ethiopia’s health system and primary health care framework
• Experience in disability-inclusive and community-based programming is an asset
• Demonstrated analytical, facilitation, and report-writing skills
• Availability of a qualified photographer for documentation purposes
• Experience working in eye health, referral systems, or related public health fields
• knowledge of local language (Amharic and Oromifa)

 

10. Submission of Proposals

Interested consultants or consulting teams should submit:

1. Technical Proposal (40%): Assessment approach, methodology, timeline, team composition
2. Financial Proposal (30): detailed budget
3. Experience CVs (30%): Key team members

11. Ethical Considerations

• Approval of local health offices or ethics board
• Informed consent will be obtained from all participants
• Confidentiality and anonymity of respondents will be maintained throughout the process
• All activities will adhere to ethical standards in health research and assessments

12. Budget and Payment Schedule

The consultant will propose a detailed financial plan. Payments will be disbursed in traches:

• 30% upon approval of Inception Report
• 40% upon submission of Draft Assessment Report
• 30% upon approval of Final Report