ToR: Consultancy to Develop Eye Care Capacity-Building Training Materials and Guidelines

Terms of Reference (ToR): Consultancy to Develop Eye Care Capacity-Building Training Materials and Guidelines

Background

Cheshire Ethiopia (CE) is a pioneer Ethiopian Disability and Development organization that has been committed to improving the lives and well-being of persons with disabilities (PwDs) through rehabilitation, inclusion, and community-based development approaches since 1962. CE is currently registered as a Local Civil Society Organization in accordance with the applicable Ethiopian civil society legislation.

Through its Seeing the Future Project, Cheshire Ethiopia is working to improve access to quality eye health services and strengthen the capacity of health systems and frontline health workers to identify eye conditions at an early stage, provide appropriate primary eye care, and facilitate timely referral for conditions requiring further assessment and specialized management.

Early identification and appropriate referral are particularly important in primary health care settings, where health workers are often the first point of contact for individuals with eye-related complaints. Strengthening the knowledge, practical skills, referral competencies, and health-promotion capacity of health facility staff can contribute significantly to preventing avoidable visual impairment and improving access to appropriate eye care.

In this context, Cheshire Ethiopia intends to engage a qualified and experienced consultant to develop a comprehensive, practical, standardized, and user-friendly eye care capacity-building training package for health facility staff.

The consultancy will focus on three interrelated priority areas:

1. Basic Eye Health Screening and Early Detection
2. Primary Eye Care Management and Referral
3. Community Eye Health Awareness, Prevention, and Behavior Change

The developed materials should be practical for use in primary health care settings and aligned with relevant national policies, guidelines, standards, and referral structures.

Purpose of the Consultancy

The purpose of this consultancy is to develop a standardized eye care capacity-building package that can be used by Cheshire Ethiopia and its collaborating health facilities to strengthen the knowledge, practical skills, and competencies of health facility staff in basic eye health and primary eye care.

The package should enable health workers to:

Screen and identify common eye problems early → Provide appropriate basic primary eye care → Recognize conditions requiring further assessment → Refer clients through appropriate referral pathways → Provide appropriate counseling and promote healthy eye-care practices.

Overall Objective

The overall objective of the consultancy is to develop a practical, standardized, evidence-informed, and validated eye care training and guideline package that strengthens the capacity of health facility staff to provide basic eye health services, identify eye conditions early, provide appropriate primary eye care, make timely and appropriate referrals, and promote eye health and preventive practices within the community.

3.1 Specific Objectives

The consultancy will specifically aim to:

• Strengthen health facility staff’s knowledge of basic eye health and common eye conditions.
• Improve health workers’ ability to conduct basic eye health screening and recognize warning signs requiring further assessment.
• Strengthen appropriate management of common and uncomplicated eye conditions within the scope of primary health care.
• Establish clear and practical referral criteria and pathways for conditions requiring specialized eye care.
• Develop standardized referral tools and job aids to support health workers in day-to-day practice.
• Strengthen health workers’ capacity to provide eye health education, prevention messages, counseling, and behavior-change communication.
• Develop practical learning approaches, including case studies, demonstrations, exercises, and competency assessments.
• Ensure that the training package is appropriate for the Ethiopian primary health care context and can be integrated into routine health facility practice.

Scope of the Consultancy

The consultant will undertake the assignment in close consultation with Cheshire Ethiopia and relevant technical stakeholders.

4.1 Review of Existing Materials and Standards

The consultant will:

• Review relevant Ethiopian national eye health policies, strategies, guidelines, standards, protocols, and referral systems.
• Review relevant Ministry of Health materials and other applicable primary health care guidance.
• Review existing eye health training materials and resources used by relevant stakeholders.
• Review international evidence-based guidance and standards where appropriate.
• Identify gaps, inconsistencies, and opportunities for harmonization among existing materials.
• Ensure that the proposed package complements rather than duplicates existing national training resources.

4.2 Basic Eye Health Screening and Early Detection

The consultant will develop training content and practical guidance covering, as appropriate:

• Basic anatomy and physiology of the eye.
• Basic principles of eye health and visual function.
• Common eye conditions encountered at primary health care level.
• Identification of common symptoms and signs.
• Basic visual assessment and screening procedures.
• Recognition of abnormal findings and warning signs.
• Identification of conditions requiring urgent referral.
• Identification of avoidable causes of visual impairment.
• Basic infection prevention and control considerations during eye screening.
• Appropriate documentation and recording of screening findings.
• Practical screening demonstrations and exercises.

The content should clearly distinguish between what primary-level health workers can safely assess/manage and what requires referral to an appropriate eye-care provider or higher-level facility.

4.3 Primary Eye Care Management and Referral

The consultant will develop practical guidance on:

• Principles of primary eye care.
• Basic management of common uncomplicated eye conditions within the health worker’s scope of practice.
• Appropriate counseling and follow-up.
• Identification of conditions that should not be managed at primary level.
• Referral criteria based on symptoms, signs, severity, urgency, and risk.
• Routine versus urgent/emergency referral.
• Referral documentation and communication.
• Feedback and counter-referral where applicable.
• Follow-up of referred clients.
• Linkages between primary health facilities and secondary/tertiary eye care services.

The consultant will develop a clear referral pathway/flowchart showing how clients should move through the health system from community/primary-level identification to appropriate higher-level services.

4.4 Community Eye Health, Prevention and Behavior Change

The consultant will develop practical content on:

• Key eye health promotion and prevention messages.
• Common preventable causes of visual impairment.
• Eye hygiene and infection prevention.
• Appropriate health-seeking behavior.
• Importance of early presentation and timely referral.
• Prevention of avoidable visual impairment.
• Appropriate use of eye-care services.
• Addressing misconceptions and harmful practices related to eye health.
• Counseling approaches for individuals, families, caregivers, and communities.
• Inclusive communication and consideration of persons with disabilities.
• Practical behavior-change communication approaches for health workers.

The materials should include simple, consistent, and culturally appropriate key messages that can be used during routine counseling, community outreach, health education sessions, and other awareness activities.

Key Tasks and Responsibilities of the Consultant

The consultant will be responsible for:

1. Developing an inception report and detailed work plan.
2. Conducting a desk review of relevant national and international materials.
3. Consulting with Cheshire Ethiopia and relevant technical stakeholders to clarify training needs and expectations.
4. Developing the training curriculum and detailed session structure.
5. Developing participant training materials.
6. Developing a facilitator/trainer guide.
7. Developing primary eye care guidelines appropriate for primary health care settings.
8. Developing referral criteria, referral pathways, and practical referral tools.
9. Developing community eye health promotion and behavior-change materials.
10. Developing practical exercises, case studies, scenarios, demonstrations, and competency assessment tools.
11. Ensuring consistency between the training materials, clinical guidance, referral tools, and assessment instruments.
12. Facilitating or supporting a technical review and validation process.
13. Incorporating comments and recommendations from Cheshire Ethiopia and relevant stakeholders.
14. Finalizing and submitting all materials in agreed editable and PDF formats.
15. Providing a brief orientation to Cheshire Ethiopia’s designated technical team on the use and adaptation of the developed package, if required.

Expected Deliverables

The consultant is expected to produce the following deliverables:

Deliverable 1: Inception Report and Work Plan

The inception report should include:

• Understanding of the assignment.
• Proposed methodology and approach.
• Key activities and outputs.
• Detailed work plan and timeline.
• Proposed consultation and validation approach.
• Quality assurance arrangements.
• Information/data requirements and assumptions.

Deliverable 2: Participant Training Manual

A comprehensive and user-friendly participant manual covering the three priority areas:

Module 1: Basic Eye Health Screening and Early Detection

Module 2: Primary Eye Care Management and Referral

Module 3: Community Eye Health, Prevention and Behaviour Change

The manual should include learning objectives, key technical content, practical examples, exercises, case studies, key messages, and relevant references.

Deliverable 3: Facilitator/Trainer Guide

The facilitator guide should include:

• Training objectives.
• Target participants.
• Recommended training methodology.
• Session plans.
• Suggested duration for each session.
• Facilitator instructions.
• Presentation content.
• Demonstration procedures.
• Practical exercises.
• Case studies and scenarios.
• Group work and discussion questions.
• Pre- and post-training assessment tools.
• Practical/competency assessment tools.
• Answer keys or facilitator guidance where appropriate.

Deliverable 4: Primary Eye Care Guidelines

A practical guideline for health facility staff covering:

• Basic eye screening.
• Common eye conditions relevant to primary care.
• Basic assessment and management.
• Red flags and urgent conditions.
• Referral indications.
• Follow-up and documentation.
• Scope and limitations of primary-level eye care.

Deliverable 5: Referral Guidelines and Tools

The consultant will develop a standardized referral package including:

• Referral criteria.
• Referral decision-making guidance.
• Referral pathway/flowchart.
• Urgent and routine referral guidance.
• Standard referral form/template.
• Referral and follow-up job aids.
• Counter-referral/feedback guidance, where applicable.
• Contact/referral directory template, if appropriate.

Deliverable 6: Community Eye Health and Behavior-Change Materials

These should include:

• Key eye health promotion messages.
• Prevention messages.
• Counseling guidance.
• Frequently asked questions and suggested responses.
• Community awareness/job aids.
• Practical behavior-change communication messages.
• Messages suitable for health education and community outreach.

Deliverable 7: Validation and Final Training Package

The consultant will facilitate/support technical review and validation of the developed materials with Cheshire Ethiopia and relevant stakeholders.

The final package should incorporate all agreed technical comments and recommendations and should include:

• Final participant manual.
• Final facilitator guide.
• Final primary eye care guideline.
• Final referral guidelines and tools.
• Final community eye health and behavior-change materials.
• Final assessment and competency tools.
• Final reference list and source materials.

Proposed Methodology

The consultant is expected to propose a participatory and technically sound methodology. The methodology should, at minimum, include the following stages:

Phase I – Inception and Needs Assessment

• Consultation with Cheshire Ethiopia’s project and technical team.
• Review of existing materials and national guidance.
• Identification of priority learning and capacity gaps.

Phase II – Development of Draft Materials

• Development of the curriculum and training framework.
• Preparation of draft manuals, guidelines, job aids, referral tools, and assessment instruments.
• Internal technical quality assurance.

Phase III – Technical Review and Validation

• Presentation of draft materials to Cheshire Ethiopia and relevant stakeholders.
• Technical review and validation.
• Documentation and incorporation of comments.

Phase IV – Finalization

• Revision and finalization of all materials.
• Quality assurance, formatting, and consistency checks.
• Submission of editable and PDF versions.
• Orientation/handover to Cheshire Ethiopia.

The consultant should use adult-learning principles, competency-based training approaches, practical demonstrations, case-based learning, and participatory learning methods to ensure that the materials are useful beyond classroom training and can support routine health facility practice.

Proposed Payment Schedule

Target Participants and Users

The primary target users of the training materials will be health facility staff involved in primary health care and eye health services, including relevant frontline health workers who are responsible for:

• Initial identification and screening of clients.
• Basic eye health assessment.
• Primary-level eye care.
• Referral and follow-up.
• Health education and community awareness.

The final materials should be adaptable to different primary health care settings and levels of staff responsibility.

Quality and Technical Requirements

All materials developed under this consultancy should:

• Be evidence-informed and technically accurate.
• Align with applicable Ethiopian national health and eye health policies, guidelines, standards, and referral structures.
• Be appropriate for the Ethiopian primary health care context.
• Use clear, practical, and user-friendly language.
• Clearly define the scope of practice of primary-level health workers.
• Emphasize patient/client safety and timely referral.
• Avoid unnecessary duplication of existing national materials.
• Use consistent terminology across all modules and tools.
• Include practical examples and case-based learning.
• Incorporate disability-inclusive and gender-responsive approaches where relevant.
• Be suitable for both classroom training and subsequent use as workplace reference materials.
• Be professionally formatted and easy to reproduce and use.

Where national guidance does not adequately address a specific issue, the consultant should clearly identify the relevant evidence-based source used and discuss the proposed approach with Cheshire Ethiopia before finalization.

Duration and Level of Effort

The consultancy is expected to be completed within 25 working days from the date of contract signing.

The proposed duration should cover:

• Inception and desk review.
• Consultation and needs assessment.
• Development of draft materials.
• Technical review.
• Validation.
• Revision and finalization.

The consultant will submit a detailed work plan indicating the number of working days allocated to each activity and deliverable.

Reporting and Coordination

The consultant will report to Cheshire Ethiopia/Seeing the Future Project through the designated project focal person.

The consultant will work closely with:

• Cheshire Ethiopia’s Seeing the Future Project team.
• Relevant technical/program staff.
• Designated eye health professionals.
• Relevant government health stakeholders and/or collaborating health facilities, as appropriate.

The consultant will be responsible for maintaining regular communication with the designated CE focal person and seeking technical clarification whenever necessary.

All draft deliverables will be subject to review and approval by Cheshire Ethiopia before finalization.

14. Ownership, Copyright and Confidentiality

All materials, documents, tools, guidelines, training content, templates, and other outputs developed under this consultancy will become the exclusive property of Cheshire Ethiopia, unless otherwise agreed in writing.

The consultant shall not reproduce, publish, distribute, sell, share, or use the developed materials for another organization or purpose without the prior written authorization of Cheshire Ethiopia.

The consultant shall maintain confidentiality concerning all information and materials obtained during the assignment and shall comply with applicable ethical and professional standards.

Proposal Submission Requirements

Interested consultants or consulting firms should submit the following:

A. Technical Proposal

The technical proposal should demonstrate:

• Understanding of the assignment.
• Proposed methodology and approach.
• Proposed training-material development process.
• Proposed quality assurance and validation approach.
• Proposed team composition, where applicable.
• Risk management/mitigation approach.

B. Work Plan and Timeline

A detailed work plan indicating:

• Key activities.
• Expected deliverables.
• Proposed timeframe.
• Level of effort/person-days.

C. Consultant/Team Profile

• Updated CV(s).
• Relevant academic and professional qualifications.
• Summary of relevant consultancy experience.
• Evidence of similar assignments completed.

D. References

At least two relevant professional references, preferably from organizations for which similar eye health training materials, guidelines, or referral tools have been developed.

E. Financial Proposal

A detailed financial proposal indicating:

• Professional fees.
• Applicable taxes.
• Other relevant costs, if any.
• Total consultancy cost.

The financial proposal should clearly indicate whether all applicable taxes and associated costs are included.

 16. Selection Criteria

Proposals will be evaluated based on the following broad criteria:

Cheshire Ethiopia may adjust the weighting and selection methodology in accordance with its procurement procedures.

17. Expected Results of the Consultancy

At the completion of the assignment, Cheshire Ethiopia is expected to have a practical, standardized, technically sound, user-friendly, and validated eye care capacity-building package that can be used to train and support health facility staff.

The package should enable health workers to:

Screen and detect eye problems early

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Recognize common eye conditions and warning signs

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Provide appropriate primary eye care within their scope of practice

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Make timely and appropriate referrals through established pathways

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Follow up and document referred clients appropriately

6. Promote eye health, prevention, early care-seeking, and healthy eye-care behaviors in the community

Ultimately, the consultancy is expected to contribute to improved quality, accessibility, continuity, and coordination of primary eye care services, particularly through stronger capacity of frontline health facility staff and more effective linkages between communities, primary health facilities, and appropriate secondary or specialized eye care services.

Mandatory requirements:

1. Incomplete applications will be disqualified without review.

2. FIRMS only- Individual consultants will not be accepted under any circumstances

1. The firm must field a multidisciplinary team capable of delivering the required deliverables.
2. Legal registration, tax clearance, and institutional governance documentation are mandatory

Consultant Qualifications and Experience

The consultancy will be undertaken by an individual consultant or qualified consulting team with the following minimum qualifications and experience:

Essential Qualifications

• Advanced degree in Optometry, Ophthalmology, Public Health, Health Sciences, or a closely related field.
• Demonstrated professional experience in eye health and primary eye care.
• Strong understanding of primary eye care and eye health systems.
• Demonstrated experience developing health training materials, manuals, guidelines, protocols, or job aids.
• Demonstrated experience developing referral systems, referral pathways, or referral tools.
• Strong technical writing and communication skills.
• Experience working with government health systems and/or development organizations.

Desirable Experience

• Experience in community eye health and health promotion.
• Experience in behavior-change communication.
• Experience in competency-based health worker training.
• Experience in developing materials for primary health care workers.
• Experience working in Ethiopia and familiarity with the Ethiopian health system and national eye health guidelines.
• Experience working on disability-inclusive health or inclusive health programming.
• Experience facilitating technical validation workshops.

The consultant/team should demonstrate a strong combination of technical eye health expertise, training-material development experience, and practical knowledge of primary health care systems.