Terms of Reference. Contract #: (to be provided by PSU)

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1 Independent Evaluation of the Accelerating the Implementation of the Investment Case for Maternal, Newborn and Child Health in Asia and the Pacific Programme Terms of Reference Contract #: (to be provided by PSU) AIM: To evaluate how the Investment Case approach influences programme delivery, policy, planning and budgeting processes and prioritization of maternal, newborn and child health issues in specific Asia-Pacific countries. A. BACKGROUND AND EVALUATION DESCRIPTION Accelerating the Implementation of the Investment Case for Maternal, Newborn and Child Health in Asia and the Pacific is an initiative funded by AusAid, from June 11 to June 13. UNICEF and the University of Queensland (UQ) Consortium are coordinating the planned work, in partnership with national and sub-national governments. UNICEF and UQ discuss with national counterparts in each country the objectives of the Investment Case that can realistically expect to be addressed between now and June 13. The Investment Case (IC) approach is a dynamic process to identify key issues and influence impacts upon maternal and child health within a country. It involves results-based analysis to inform planning, budgeting and policies, spelling out the costs and benefits of scaling-up packages of high impact interventions for addressing maternal, newborn, and child health (MNCH) and nutrition. The IC aims to address the main health and nutrition problems of the most deprived children and families; identify bottlenecks and barriers that contribute to this deprivation (using the Tanahashi model 1 ); and identify specific strategies to overcome the barriers that have created disparities. Analysis occurs first at the district level, with potential benefits arising both through the process of improving the quality and capacity for decision-making, and through reorienting the delivery of services. By synthesizing several district analyses, there are also potential beneficial impacts upon policy and programme design at national level. These analyses are also expected to guide the allocation of budgets and priorities of national and international partners, and to eventually be reflected in actual implementation (e.g. increased expenditure and actions for prioritized populations, interventions and strategies). Implementation of these strategies is expected to effectively reduce bottlenecks that impact upon disparities in MNCH, increase level and equity of coverage, and thereby decrease child and maternal mortality and malnutrition. While the logic of the IC approach involves these broad steps, in practice, they are not necessarily carried out in a linear fashion, with steps feeding into each other and occurring in parallel. Discrete components of the IC approach contribute to achieving these goals: bottleneck analysis, estimates of potential lives saved through scale-up and reorientation of interventions, costing of interventions, modeling of cost-effectiveness, and budgeting. While bottleneck analysis will occur in 1 Tanahashi T. Health service coverage and its evaluation. Bull World Health Organ 1978; 56:

2 all districts where the IC approach is used, use of the other components will depend on their usefulness in each context. The purpose of this independent evaluation is to establish to what extent use of the Investment Case approach improves programme service delivery, policy-making, strategies and budgets for MNCH, and to understand how this occurs. UNICEF and the University of Queensland Consortium have been supporting countries with tools for developing the investment case since prior to June 11. Given the heterogeneity in the context, extent, timing and manner in which countries have adopted an investment case approach, the evaluation will need to engage with these differences, and adapt the methodology used in each country. The evaluation design will need to capture a range of impacts from influencing how planning is undertaken, programmes are delivered, policies are crafted and the processes by which budgets are decided - to documenting where shifts in policies, planning and budgeting for MNCH can be demonstrated. The methodology will also aim to infer changes in processes of planning and decisionmaking, and capacities to do so, resulting from use of the IC approach. In addition, the evaluation will aim to capture the more subtle and incremental levels of change that would indicate increased political prioritization of MNCH as a result of use of the IC approach. Thus, the evaluation will utilize a study design that documents the extent to which use of the IC approach has influenced decision-making and political prioritization for MNCH, as well as important contextual factors that have helped or hindered this process in different country settings. It will document case studies from countries covered by the project, to illustrate these processes in a comparative manner and highlight lessons learned. It is proposed that case studies will be conducted in the Philippines, Bangladesh, Nepal and Indonesia. These countries have been chosen because they have been early adopters of the Investment Case approach. Use of the IC approach has already occurred in a substantive manner, AND further use is also planned. These countries also reflect jurisdictions where the IC approach has been used in different ways, and at different levels. Undertaking the evaluation in these contexts provides the ability to investigate the heterogeneity of use of the IC approach, and to understand whether there have been impacts from changes to programme delivery at district level to reconsideration of budgets and policy at national level. The evaluation should be undertaken by a lead consultant who will coordinate a team of 4 incountry consultants. Consultants will work from their preferred location and will not be expected to travel beyond the activities specified below (costs for these travels will be met by UNICEF). The research aims will be pursued through qualitative case studies, augmented by quantitative data collection, where possible, to triangulate the findings. The IC approach has already been undertaken in many Asia-Pacific countries, including the four selected, with perceptions of varying success. The case studies will involve both retrospective and prospective evaluation and the evaluation will be undertaken in 2 phases. Phase 1 will involve document review and key informant interviews about

3 past experiences of IC processes to inform baseline analyses in each country. Phase 2 will involve further key informant interviews 12 months later, to assess the outcomes of further IC work. Further information and a suggested evaluation strategy are included in Annex One, for review and revision by the lead consultant and in-country consultants in consultation with the Evaluation Reference Group (comprised of representatives from Governments, UNICEF, AusAID, and UQ). B. EXPECTED RESULTS A set of four country case studies summarizing the analysis of the Investment Case process in the selected countries and an Evaluation Report summarizing the case studies, comparing the IC process between the countries, and putting forward lessons learned and recommendations. C. DURATION: 1. Phase 1 - June 12 to November 12 (approximately 5 days of work) 2. Phase 2 - July to October 13 (approximately 55 days of work) D. ACTIVITIES, RESOURCES AND DEADLINES : Phase 1 1. Review available documentation regarding the investment cases that have been or are being developed (from UQ consortium and UNICEF). 2. Develop an inception report outlining proposed evaluation strategy, timelines, and potential in-country consultants. 3. Develop a protocol for each country based on a common conceptual framework, outlining the methodology for the evaluation (including analytical framework and tools). This methodology will need to be approved by the Evaluation Reference Group. The methodology should, as a minimum: o Adapt a common analytical framework and tools for the evaluation methodology o Document what activities/processes have been undertaken (including their sequence and timeline) to develop Investment Cases in the selected country. o Indicate core thematic areas and key data sources (e.g. district reports, policy documents, media reporting, and key informant interviews) for assessing changes in district and national programme and policy shifts relating to the Investment Case. o Indicate the kinds of key informant interviews or other activities that should be conducted with selected interviewees based upon their involvement in or knowledge of MNCH advocacy, policy decisions, research and programme implementation in the country/region. (e.g. representatives of government agencies, international agencies and donors, nongovernmental organizations, medical and research communities). o Indicate how data will be collected, entered, cleaned, and analysed. 4. Pilot, modify and finalize the tools prior to conducting the evaluation and share these with the Evaluation Reference Group for approval. 5. In collaboration with the Evaluation Reference Group, identify and recruit a local consultant in each country. 6. Train and supervise in-country consultants to support the evaluation. 7. Conduct the document review and first stage of key informant reviews in each of the four countries. 8. Conduct quality control and ensure a common methodology is used across all case studies

4 for use of research instruments, data collection, entry, cleaning, and analysis. 9. Complete draft interim reports to be shared with Evaluation Reference Group for feedback.. Present interim findings in mid-term workshop, potentially aligned to Second Global Symposium on Health Systems Research in Beijing, China. Phase Conduct second phase of key informant interviews and document analysis. 12. Analyse second phase of data collection. 13. Organize feedback workshops in each country to validate findings. 14. Produce draft final country reports and synthesis findings for feedback from Evaluation Reference Group. 15. Draft, revise (based on feedback), and finalize the Evaluation Report. 16. Compare country case study reports and provide a synthesis of findings across country studies. 17. Compile finalized case study reports and a synthesis of findings across country studies. 18. Draft, revise (based on feedback), and finalize the Evaluation Report. Outputs/ Deliverables 1. Review available documentation regarding the investment cases that have been or are being developed in all four countries (from UQ consortium and UNICEF) and develop and submit inception report. 2. Develop a protocol for each country based on a common conceptual framework, outlining the methodology for the evaluation (including analytical framework and tools), for submission and approval by Evaluation Reference Group 3. Pilot, modify and finalize the tools prior to conducting the evaluation and share these with the Evaluation Reference Group for approval, including (in collaboration with the Evaluation Reference Group), identifying, recruiting and training a local consultant in each country to support the lead consultant s work in the evaluation. 4. Conduct first phase of key informant interviews. 5. Analysis of first phase of data collection and production of interim country reports and synthesis findings 6. Present interim findings in mid-term workshop, potentially aligned to Second Global Symposium on Health Systems Research in Beijing, China. 7. Conduct second phase of key informant interviews and document analysis. 8. Analysis of second phase of data collection. 9. Country workshops to review findings. Days Dates -29 June 12 Days Subtotal Payment Schedule 2-13 July 30 1 st July Aug 13 Aug 14 Sep 17 Sep 12 Oct 29 Oct 2 Nov 8-28 July July 9 Aug Aug 50 2 nd rd

5 . Production of draft final country reports and synthesis findings for feedback from Evaluation Reference Group. 19 Aug 30 Aug 30 Sep 11 Oct 11. Draft, revise (based on feedback), and finalize the Evaluation Report. TOTAL *Note that this timeline includes weekend days for some in-country travel (outputs 4 and 7) th E. KEY SKILLS, TECHNICAL BACKGROUND, EXPERIENCE REQUIRED Advanced university degree in Public Health, Social Sciences, or a related technical field. At least ten years experience in health policy and systems analysis with: o Experience in qualitative and longitudinal evaluations o Experience in Asia-Pacific region an asset o Experience in maternal and child health an asset o Experience with investment cases or with the Tanahashi model an asset Demonstrated skills in writing research reports Demonstrated ability to work in multi-cultural environment and establish harmonious and effective working relationships with diverse teams F. APPLICATION Qualified candidates are requested to submit a cover letter, CV and P-11 form (which can be downloaded from the UNICEF website at ) to krasanathan@unicef.org with subject line Investment Case Evaluation by 15 June 12. Please indicate your daily/monthly rate and availability to undertake the terms of reference above. Applications submitted without a monthly rate will not be considered.