Consultants (#2): – >Evidence-Informed Design of Sustainable and Efficient KP Service Delivery Models in Ethiopia

Ethiopia has made significant progress toward the UNAIDS 95-95-95 targets [EPHIA, 2020]; however, HIV remains high and highly concentrated among key populations (KPs) and the 2019/2020 Bio-Behavioral Surveillance (BBS) study showed that female sex workers (FSWs) had HIV prevalence rates of 18.7% (95% CI: 17.8%-19.7%), far higher than the general adult population. Ensuring access to effective, acceptable, and sustainable KP-focused services is central to achieving national HIV targets and achieving impact.

For several years, Drop-In Centres (DICs) have provided wrap-around services for KPs, in particular for FSWs, providing peer-led, confidential, and stigma-free services valued for their proximity, flexibility, and ability to reach vulnerable sub-populations of FSWs. However, programmatic and funding pressures, including Grant Cycle 7 (GC7) budget reductions and reprioritization requirements, have prompted a review of long-term delivery options, and CCM-E has made difficult decisions to adjust the mix of KP service delivery models.

Concerns about the shift in service provision for KPs have been raised at repeated CCM-E meetings by members from a range of constituencies. They noted that while overall HIV epidemic indicators are very well controlled in Ethiopia, there are high rates of HIV (and other public health challenges) among FSWs and other KPs, making effective interventions for these populations an important national priority. While CCM-E members accepted the difficult GC7 reprioritization decisions, they requested that careful analyses be undertaken ahead of GC8 processes to ensure that services continue to reach these key and priority populations.

At the 119th CCM-E, a decision was made that the HAPC LEO should engage DPs to conduct a rapid assessment of KP-friendly service modalities (DICs and KP-friendly clinics) and condom distribution challenges. In addition, the DP constituency made a formal offer to the CCM-E that they would support an independent assessment, with a particular focus on the user needs from service provision to ensure that KP services were accessible and had an impact. In October 2025, following some informal discussions with DPs, the MoH/HAPC LEO conducted a national DIC operational assessment to evaluate the status of DICs and KP-friendly clinics in providing HIV prevention, care, and treatment and to identify strengths, gaps, and operational challenges. Findings were shared in two presentations at the 120th CCM-E in December 2025. The CCM-E welcomed these, and it was also agreed that an independent assessment should be conducted to build on this important MoH-led work. This independent assessment will provide additional, complementary evidence and insights, in particular from a user perspective, to assist future decision-making by the CCM-E, especially as preparations for GC8 begin. This is reflected in the 2 (draft) decision points:

• The CCM/E has accepted the technical assistance (TA) support offered by FCDO (on behalf of the development partner constituency) for the independent assessment of the KP-friendly services modality.
• Conduct an independent assessment of the HIV KP-friendly service modality and develop a transition plan in preparation for the GC8 funding request.

In addition, the CCM-E has noted, following a visit to KP-focused facilities, that “in preparation for the GC8 funding request, a KP service modality transition plan – which builds on an independent assessment, including the views of the beneficiaries – shall be prepared and guide the process.

Under GC7 reprioritization, CCM-E decided to maintain 35 performing DICs while scaling up KP-friendly public health facilities from 50 to ~300 woredas. The PR noted that this shift would allow the government to offer greater opportunities for sustainability and integration. Some members of CCM-E raised concerns that this also presents risks around service reach, continuity, confidentiality, and equity—particularly for FSWs and subgroups who rely on the unique strengths of DICs.

Given this evolving context, there is a need for evidence-informed design of sustainable and efficient KP service delivery models, and in particular to understand the perspectives of FSWs and other KP users of the services to have clearer understanding of the services that they will access most readily. The consultancy will build on the rapid assessments undertaken by the MoH, and use targeted additional inquiry to provide independent evidence of the needs of service users, and related evidence to help generate feasible transition options, identify risks and mitigation measures, and propose models that preserve the strengths of DICs while enabling the expansion of KP-friendly facility-based services and provide options for an optimal mix of services for KPs, responding to the needs of KPs and reflecting the changed financial environment.

This consultancy will inform the Global Fund GC8 planning process by assessing the best mix of sustainable, evidence-based KP service models for Ethiopia and providing essential inputs to assist the CCM-E in assessing the right mix of services for the funding request processes. The consultancy will build on the two MoH-led rapid assessments of the DIC modalities, and also of condom supply challenges. This independent review will supplement these important assessments, internal MoH processes, and CCM-E deliberations and decisions. It will be grounded in the user experience, incorporating perspectives of access to and utilization of services, including interviews with FSWs and other KP users, CLOs and CSOs, and KP service providers. It will also consider emerging data on HIV prevalence and population size estimates.

At the 119th and 120th CCM-E meetings, the DP Constituency offered to provide support for this consultancy through their TA programmes designed to maximize the impact of Global Fund investments. At meetings of the CCM-E DP constituency, and in joint meetings with the Civil Society constituency, it was agreed that this will initially be provided through the UK’s Global Fund Accelerator (GFA) programme, implemented by CHAI.

• Position Title: Consultant – Evidence-Informed Design of Sustainable and Impactful Key Population Service Delivery Models in Ethiopia
• Location: Ethiopia
• Duration: 12–14 weeks. | Consultancy Contract
• Start Date: TBD (subject to contracting)
• Reports to: Technically, for the Steering group that will be established by the CCM/E. Administratively, the consultant will report to the CHAI Ethiopia Global Fund Accelerator (GFA) Programme Manager.

2. Objectives

Overall Objective

To develop evidence-informed, sustainable, and efficient service delivery models for services that meet the needs of KPs in Ethiopia, especially FSWs, with maximum impact on HIV and other public health priorities. Existing assessments will inform the initial evidence, notably the two MoH-led KP-service assessments and other limited targeted inquiries, to support the design of feasible transition pathways that move from the mix of current service delivery models to provide the best mix of sustainable services that will be accessed by, and meet the needs of, FSWs, and other KPs and vulnerable populations.

Specific Objectives

1. Synthesise and interpret the findings of the MoH-led DIC assessments, and other countries’ experience, as well as existing data and reports, to identify implications for future KP service delivery models.
2. Conduct targeted complementary inquiries to fill critical evidence gaps, in particular gathering user perspectives, as well as insights from CLOs, CSOs, and service providers.
3. Consider facility readiness and assess the needs and vulnerabilities of the sub-population, drawing on emerging new data on (sub-)population size and HIV prevalence.
4. Develop and compare KP-service models and transition scenarios that balance sustainability, efficiency, equity, quality, accessibility, and KP-friendliness under different operational conditions.
5. Identify the requirements, enablers, and risks for various KP-service delivery model options and transition processes, including implications for access and utilization, continuity of care, safeguarding, stigma reduction, confidentiality, and equity.
6. Propose a range of KP-service models and transition pathways, taking into account potential roles for public facilities, CSOs, and peer-led mechanisms.
7. Develop actionable recommendations and implementation pathways, including timelines, decision points, capacity needs, and operational guidance for MoH and partners.
8. Provide inputs to CCM-E decisions on GC7 implementation and GC8 funding request preparations, including draft text for the GC8 funding request documentation, and support HIV NSP updates, ensuring alignment with national priorities and the Lusaka Agenda Key Shift 3.

Scope of Work

The consultant will undertake a forward-looking, evidence-informed analysis to support the CCM-E in preparing for GC8, and considering the right mix of sustainable, accessible, and efficient KP service delivery models. The work will use the MoH-led DIC assessments and include targeted complementary inquiries, with a focus on user perspectives, to ensure that CCM-E considerations are grounded in the widest possible evidence base and reflect user perspectives to maximize impact on HIV targets. The scope of work is organised into four task areas:

A. Evidence Synthesis and Interpretation

1. Review and synthesise the key findings of the MoH/HAPC LEO Drop-in center assessments, including performance, user experience, operational barriers, and regional variations.
2. Identify the implications of the assessment for future KP service delivery, including strengths to preserve DICs and gaps to address in KP-friendly public facilities.
3. Review any additional assessments and reviews of KP-friendly services produced since GC6
4. Consider emerging evidence of HIV prevalence rates (and other related public health challenges) as well as emerging size estimates for FSWs and other KPs
5. Continuously review and incorporate emerging evidence from new BBS or other national data as it becomes available during this consultancy.
6. Summarise critical evidence gaps that require targeted follow-up.

B. User-informed Perspectives

1. Structured interviews and/or focus group discussions with FSWs, other KPs, and service users, prioritizing sub-groups potentially at higher risk (e.g., adolescents, new entrants, mobile FSWs).
2. Key informant interviews with CLOs, CSOs, DIC operators, facility staff, regional health teams and/or local government representatives.
3. Review of facility readiness or quality considerations relevant to KP-friendliness in terms of use of the national standards /protocols, such as SOPs, and guidelines for DICs and KP clinics as reference

C. Development of potential KP- Service Delivery Models and potential Transition Scenarios

1. Develop a range of potential KP-service delivery models, considering:
   • Accessibility and likely use of services.
   • Range of services desired and likely to be provided by different facility models.
   • Priority needs of KP-services, including access to other facilities for specialized follow-up.
   • Potential mix of KP-services related to “Hot Spots”, scale of FSW need, HIV/STI prevalence, etc.
2. Explore potential feasible transition scenarios, such as:
   • Direct transition of performing DICs to facility-linked KP-friendly models
   • Phased or hybrid models retaining key DIC functions
   • Community outreach–facility linkage models
   • Regionally differentiated models, based on hot spots and prevalence levels
   • Alternative service delivery models
3. Compare scenarios for KP-service model structures and mix using criteria such as:
   • Accessibility, KP-friendliness, trust, confidentiality, and accessibility
   • Equity implications for diverse sub-populations of FSWs and other KPs
   • Financial sustainability and service delivery efficiency
   • Feasibility, resource needs, and implementation complexity
4. Identify risks and mitigation measures for each option.

D. Data synthesis, Guidance and Recommendations

1. Synthesis of the perspectives of users and service providers, as well as any new data emerging
2. Propose a workable model for KPs’ service delivery that fulfills the needs of KPs, including drawing on
3. experiences and models of good practice from other countries with a similar context, Outline potential roles and responsibilities for MoH, public health facilities, CSOs, and peer-led mechanisms in each model.
4. Develop inputs, including draft text, for GC8 funding request development and HIV NSP updates, as well as GC7 implementation adjustments, ensuring alignment with national priorities and considering how the proposed models address Lusaka Agenda Key Shift 3.
5. Provide operational recommendations, including training, supervision, community engagement, and service quality measures to be considered for KP-Service models.
6. Identify monitoring and accountability considerations, including suggested indicators.
7. Consider transition pathways, including steps, sequencing, and decision points for MoH and partners.

 Deliverables

The consultant will produce the following deliverables, each aligned with the evidence-informed design mandate and complementing the MoH-led assessment:

1. Inception Report: including refined methodology, scope, work plan and timelines, assessment tool development, monitoring the progress of the assessment, confirmation of data sources, inquiry needs, stakeholder engagement plan, and analytical framework for scenario development and design.
2. Evidence Synthesis Brief: Concise synthesis of MoH-led DIC assessment findings, additional data sources, identification of key implications for future KP services, and evidence gaps needing follow-up.
3. Targeted Inquiry Summary: Concise documentation summarizing findings from user-focused interviews and/or small group discussions; Key insights related to trust, accessibility, confidentiality, and facility readiness; Supporting evidence to inform scenario and model design.
4. Stakeholder Validation Workshop: Present draft scenarios/models to CCM-E constituencies, in particular DPs and Civil Society, and PR (MoH) and key CSO SRs, with structured feedback and a workshop report documenting recommendations and adjustments.
5. Draft Report on Service Delivery Models and Transition Scenarios: Description and rationale for proposed scenarios; comparative analysis (sustainability, feasibility, equity, KP-friendliness, resource needs); identification of risks and mitigation strategies; and summary of feedback from initial consultations.
6. Final Strategic Report for national task force and CCM-E to include draft text that can be considered during GC8 FR development: A comprehensive report including evidence gathered and related proposed service delivery models, potential roles for MoH, facilities, CSOs, peer networks, equity and quality safeguards, monitoring and accountability, and inputs for GC7 implementation, GC8 FR preparation, and to contribute to HIV NSP updates, potential implementation plan and timeline, and transition scenarios.
7. Presentation Deck: High-level presentation for CCM/E and its constituencies; PR, summary of findings, recommended models, and proposed transition pathway.

Coordination

• The CCM/-E will establish a task force composed of representatives from the Ministry of Health – HIV/AIDS Prevention and Control Lead Executive Office (2 members), Development Partners constituency (2 members), Civil Society constituency (3 members), and the CCM/E Secretariat (1 member), with a total of eight members. The task force will nominate a chair and vice chair, with facilitation by the CCM-E secretariat. The Consultant will report technically to the task force, which in turn will report to the CCM-E. All task force members will be required to safeguard against conflicts of interest across all levels.

Indicative Timeline

The consultancy is expected to be completed within 12–14 weeks. The following indicative timeline may be refined during the inception phase, in alignment with MoH and Development Partner schedules.

Note: Timeline may be adjusted to accommodate MoH-led processes, CCM-E schedules, or GC8 preparation milestones.

The team of consultants (preferably two: one with international experience and the other with local knowledge and context) should have:

• At least 7 years of experience in HIV programming, especially related to KP service modality and health systems strengthening.
• Proven experience in evaluating KP-targeted interventions, preferably in the Ethiopian context and ideally with familiarity with international models of good practice.
• Strong qualitative and quantitative research skills, including data collection, analysis, and interpretation.
• Advanced degree in Public Health, Health Policy, Social Sciences, Implementation Science, or related field.
• Familiarity with Ethiopia’s HIV response and Global Fund processes and mechanisms.