Consultancy to Conduct a Baseline Health Facility Assessment

TERMS OF REFERENCE

Consultancy to Conduct a Baseline Health Facility Assessment

Integrated Programme on Inclusive Eye Health, Ear and Hearing Care, Physical Rehabilitation, and Trachoma/Trichiasis, EthiopiaBackground

Grarbet Tehadiso Mahber (GTM) in collaboration with CBM is preparing to implement an integrated programme in Ethiopia across four areas that have historically been delivered in isolation: inclusive eye health; ear and hearing care; physical rehabilitation; and trachoma/trichiasis. These areas share delivery platforms, frontline cadres and an at-risk population, and integrating them through the primary health care unit (PHCU) model offers greater efficiency, reach and person-centredness.

Effective integration requires a precise understanding of each facility's capacity, workforce, equipment, commodities, infrastructure, accessibility, referral routes, recording systems, and existing challenges. This understanding is presently incomplete. The consultancy will address this through a baseline assessment of 38 health centres across 18 districts in central Ethiopia and Oromia, which will guide programme design and implementation.

The assessment tools are already developed and will be handed over at the project's start. They are derived from the WHO comprehensive Harmonised Health Facility Assessment (HHFA), with specific modules for eye health, trachoma/TT, ear and hearing care, and physical rehabilitation drawn from the full tool, and expanded with cross-cutting modules covering workforce, infrastructure, WASH, physical accessibility, disability inclusion, referral systems, and supply chain. The consultant's role is to review, pre-test, and refine these tools before full implementation.Purpose and ObjectivesPurpose: to gather robust baseline information on facility capacity to deliver the four integrated services, and to analyze it so it can inform programme design and serve as the reference point for measuring future progress.Objectives:

1. Pre-test, finalize and digitize the assessment tools provided.
2. Assess the availability of the four services in 38 facilities across 18 districts.
3. Assess readiness of trained workforce, equipment, medicines and commodities, guidelines and infrastructure.
4. Assess physical accessibility and disability-inclusiveness of facilities.
5. Assess referral pathways and PHCU linkages, and linkages to the community.
6. Assess recording, reporting and supply chain systems for the four areas.
7. Analyze data to identify capacity gaps, patterns and opportunities for integration, disaggregated by facility level and geography.
8. Produce a baseline report with actionable recommendations and a clean, documented dataset.

Scope of WorkIn scope:

• Facility coverage — the consultant will conduct assessments in 38 selected health facilities in Central Ethiopia and Oromia regions.
• Pre-testing, refining, and digitizing the tools — the consultant will review the given facility assessment tools and conduct pilot tests to evaluate their clarity, relevance, completeness, and functionality. Based on these results, the tools may be improved and digitized using approved platforms such as KoBoToolbox, ODK, CSPro, and SurveyCTO to ensure efficient data collection and management.
• Ethical clearances and permissions — the consultant shall obtain the necessary ethical approvals, administrative clearances, and authorizations required for implementation of the assessment, and ensure compliance with applicable ethical standards, data protection requirements, and confidentiality principles.
• Primary data collection at all sampled facilities — including direct observation and physical verification, not interview alone. The consultant shall conduct on-site assessments at all facilities included in the sample, collect data through direct observation, facility walkthroughs, and interviews with relevant personnel, and physically verify the availability and functionality of infrastructure, equipment, commodities, and other resources to validate reported information.
• Data quality assurance and cleaning — the consultant shall establish and implement data quality assurance procedures throughout data collection and management, conduct routine quality checks and verification of submitted data, and clean and prepare the final dataset for analysis, ensuring completeness, accuracy and reliability.
• Quantitative analysis — the consultant will examine assessment data with suitable statistical and analytical techniques, produce summaries of key indicators at the facility, district, and overall levels — covering readiness, capacity, service delivery, and gaps — and display results in clear tables, graphs, and charts as appropriate.
• Reporting — the consultant shall draft and submit an inception report detailing the methodology, tools, and workplan; present preliminary findings to key stakeholders for validation and feedback; and develop a comprehensive final report summarizing the methodology, main findings, gaps and challenges identified (including a map of Ethiopia highlighting the facility locations), conclusions, and actionable recommendations to support project implementation and facility enhancement efforts.

Methodology

• Design: cross-sectional, facility-based, using the structured tools provided, combining interviews with the facility head, direct observation and physical verification, and review of registers and records.
• Data collection: electronic (e.g. KoBoToolbox, ODK, CSPro, SurveyCTO) with offline capability, validation rules, skip logic and GPS capture. Tools translated into Amharic and other local languages as required, with documented back-translation.
• Analysis: descriptive analysis of availability and readiness by programme area, disaggregated by facility level and geography; readiness scores with documented construction; accessibility and disability-inclusion analysis; referral and PHCU linkage analysis; and identification of gaps and integration opportunities, presented through tables, charts and maps where useful.

Duration of the AssignmentThe consultancy is expected to commence upon contract signature and be completed within three calendar weeks. This period covers all phases of the assignment, including inception; pre-testing and tool refinement and digitization; recruitment and training of data collectors; field data collection; data cleaning and analysis; stakeholder validation of findings; and submission of the final assessment report. The consultant is expected to complete all activities and submit the final approved report within the agreed consultancy period.DeliverablesAll deliverables are subject to written approval by GTM. Timelines are to be proposed and agreed at inception. All outputs in English; the final report in Word and PDF.#Deliverable1Inception report: methodology, sampling frame and facility list, refined and digitized tools, translation plan, fieldwork and training plans, data management and QA plan, ethics and permissions plan, risk register.2Pre-test/pilot note: issues identified, changes made to tools, and completion time confirmed per facility.3Training report: content, participants, competency checks and field practice outcomes.4Fieldwork progress updates: regular updates against the target, with data quality issues flagged.5Cleaned dataset and codebook: de-identified, in an open analyzable format, with variable definitions, documented cleaning decisions and reproducible analysis syntax.6Draft baseline report: findings by programme area and facility level; accessibility, referral and readiness analysis; gaps and integration opportunities; limitations; recommendations.7Final baseline report: revised, with a comment-response matrix.8Summary presentation: key findings and recommendations for programme staff, advisors and government stakeholders.9Baseline indicator values: a concise table for direct entry into the programme monitoring framework, for comparison at midline and endline.