Terms of Reference (ToR): Baseline Study for the Eye Health Project in Eastern Ethiopia

Terms of Reference (ToR): Baseline Study for the Eye Health Project in Eastern Ethiopia

Project: Improving Equitable Access to Quality Eye Health Services and Strengthening Decentralized Eye Care Systems in Eastern Ethiopia (“Scaling Up Eye Health Care Services in Dire Dawa, Harar and East Hararge, Ethiopia”)

Implementing Partner:  Cheshire Ethiopia

Funded by SDL / BMZ

Country / RegionsEthiopia – Dire Dawa City Administration, Harari Regional State, East Hararge Zone (Oromia Region)

Project Period: 4 years (2027–2030)

1. Background

Visual impairment and blindness remain major public health challenges in Ethiopia, particularly in rural and underserved communities where access to quality eye care is limited by shortages of specialised personnel, weak referral systems, inadequate infrastructure, financial constraints, and low community awareness. In Dire Dawa, Harari, and East Hararge, long travel distances and service gaps continue to limit timely access to eye care services.

The project builds on previous BMZ-supported work and will combine infrastructure support, service strengthening, human resource development, referral and reverse referral mechanisms, community outreach, disability inclusion, and awareness-raising. A baseline study is required at inception to establish benchmark values for all project indicators and to inform implementation, monitoring, and future evaluation.

2. Purpose, Objectives and Scope

The overall purpose of the baseline study is to establish reliable benchmark data for the project before major implementation starts.

Specific objectives

•assess the current eye health situation, service availability, accessibility, affordability, quality, and utilisation patterns in the project area;

•examine facility readiness, infrastructure, equipment, supplies, referral systems, and human resource capacity;

•assess community awareness, health-seeking behaviour, gender barriers, disability inclusion, and safeguarding risks;

•establish baseline values for all project indicators and generate disaggregated data by sex, age, disability status, geography, and urban/rural residence.

Scope

•Geographic scope: Dire Dawa City Administration, Harari Regional State, and East Hararge Zone, covering urban, peri-urban, and rural settings.

•Institutional scope: planned Cheshire Ethiopia eye care facilities, Dire Dawa University Hospital, Jugel Hospital, twelve target primary health care facilities, relevant government offices, CBR structures, and selected educational institutions.

•Target groups: persons with disabilities, women and girls, older persons, low-income households, existing and potential eye health service users, health workers, teachers, CBR workers, local government representatives, and health bureau officials.

•Thematic scope: service availability and access, referral and reverse referral systems, human resource capacity, community knowledge and practices, gender responsiveness, disability inclusion, institutional readiness, and sustainability opportunities.

3. Key Baseline Questions

•What is the current eye health situation in the target areas, and which population groups are most affected?

•What services are currently available, and what gaps exist in infrastructure, equipment, medicines, supplies, and service readiness?

•How accessible and affordable are existing services, and what factors influence utilisation or non-utilisation?

•How functional are the referral and reverse referral pathways between communities, primary facilities, and referral hospitals?

•What knowledge and skills gaps exist among health professionals, HEWs, CBR workers, and teachers?

•What are the current levels of community awareness, beliefs, and preferred communication channels for eye health information?

•What gender-related, disability-related, and safeguarding barriers affect access and participation?

•What institutional capacities and coordination mechanisms already exist, and what should be strengthened first?

4. Methodology

The consultancy firm shall propose a detailed methodology in the technical proposal and inception report. Cheshire Ethiopia will review and approve the methodology before fieldwork begins.

•The study shall use a mixed-methods design, combining quantitative and qualitative techniques.

•Document review shall cover the project concept note, results framework and indicator matrix, national eye health and health sector strategies, facility reports, DHIS2 data, prior assessments, and previous Cheshire Ethiopia eye health reports.

•Quantitative data may include household, patient, and community surveys; facility assessments; structured questionnaires; and service utilisation reviews. The consultancy firm shall propose the sampling design and sample size.

•Qualitative data shall be collected through key informant interviews, focus group discussions where appropriate, and direct observation of facilities and community settings.

•Facility assessments shall review infrastructure, equipment, human resources, service readiness, patient flow, accessibility, referral systems, and environmental and waste management practices.

•All data shall be analysed using appropriate statistical and thematic methods and disaggregated, where applicable, by sex, age, disability status, geography, and urban/rural residence.

•The approach shall be participatory, inclusive, rights-based, ethically sound, and accessible for people with disabilities.

5. Study Management and Responsibilities

Cheshire Ethiopia will provide overall coordination, facilitate access to stakeholders and documents, review deliverables, and organise validation and dissemination processes.

The consultancy firm shall:

•review the concept note and relevant background documents;

•prepare the inception report, tools, and work plan;

•conduct and supervise field data collection, data cleaning, analysis, and reporting;

•present preliminary findings and submit draft and final reports;

•ensure quality assurance, ethical compliance, safeguarding, data protection, and reasonable accommodation where required.

Minimum profile for the consultant / team leader

•Master’s degree or higher in Public Health, Epidemiology, Health Economics, Development Studies, Social Sciences, Statistics, Monitoring and Evaluation, Health Systems Management, or a related field.

•At least seven years of experience in baseline studies, evaluations, surveys, or health sector assessments.

•Experience in health sector research and evaluation; familiarity with eye health, disability inclusion, community health systems, and/or public health programming is preferred.

•Appropriate insurance coverage and compliance with safeguarding and ethical standards are required.

6. Deliverables

•Inception report, including methodology, sampling framework, tools, and detailed work plan.

•Data collection tools and any relevant annexes.

•Draft baseline report.

•Presentation of preliminary findings and validation workshop with stakeholders.

•Final baseline report, cleaned datasets, and supporting documents.

•A short abridged summary report or presentation deck, if requested.

7. Indicative Timeline

No. Activity                                                                      Duration

1 Review and finalisation of the ToR                                    1 day

2 Advertisement of the ToR                                                   1 day

3 Submission of technical and financial proposals                    1 day

4 Review of proposals, selection, and contract negotiation         2 days

5 Contract signing and inception meeting                                  1 day

6 Desk review and preparation of inception report                     2 days

7 Presentation, revision, and approval of inception report and tools  2 days

8 Fieldwork, analysis, draft report, validation, and final submission   9 days

8. Costs and Payment Terms

The financial offer shall include all consultancy costs, taxes, and reasonable accommodation for an inclusive and participatory study. The following payment schedule applies after contract signing: 30% upon signature, 30% upon submission of the first draft report, and 40% upon approval of the final report.

Selection Criteria                                                                             Criterion Weight

Understanding of the assignment and project context                      15%

Proposed methodology and sampling design                                      30%

Relevant organisational experience and past performance                20%

Qualifications and experience of the proposed team                          25%

Work plan and quality assurance approach                                        10%