Endline Evaluation for NCD Care for Displaced Populations in Somalia and Kenya Project

Background

NCDs represent the fastest growing disease burden in the Africa Region adding to the existing high burden of communicable diseases such as malaria, HIV/AIDS and tuberculosis. More than any other region, the health sector in Africa is particularly unprepared and under-resourced to address NCDs. Emergencies such as Conflicts, disease outbreaks, Drought and Floods have exacerbated the effects of non-communicable diseases in Kenya and Somalia.

Since November 2023, Somali Red Crescent Society (SRCS), Kenya Red Cross Society (KRCS) and Danish Red Cross (DRC) have been collaborating in the implementation of the project ‘Non-communicable Disease care for Displaced populations in Somalia and Kenya’. The project’s overall objective/goal is to improve the management of diabetes, hypertension and other non-communicable diseases among displaced populations in Kenya and Somalia. This has been through community-level actions for prevention and management of NCDs, health systems strengthening and supporting cross border collaboration between Somali Red Crescent Society and Kenya Red Cross Society in enhancing the provision of NCD care and referral system. This aims at facilitating the provision of NCD prevention, care and support for management of NCD among populations displaced due to disasters or affected by disasters while displaced thereby reaching communities that may be left out. This group’s vulnerability stems from the fact that they are on the move and will often be limited in accessing essential healthcare services due to socio-economic or demographic factors or have access to under-resourced facilities putting them at a high risk of deterioration due to inadequate access to NCD care. Direct beneficiaries of the Project in Kenya were refugees at the Dadaab refugee camp and community members, including people living with NCDs and youth. In Somalia the direct beneficiary were IDPs, host communities including people living with NCDs and low socio-economic community with hard access to NCD service. Other direct beneficiaries that will be reached by the project include KRCS and SRCS staff, volunteers and external stakeholders such as the Ministry of Health and County Department of Health, UNHCR, Department of refugee services among others. KRCS and SRC were the implementing partners in Kenya and Somalia respectively while DRC played the coordination, advisory and oversight roles. While the ministry of health had a significant role in implementing and capacity building of the staff of NCD care in both countries and cross borders.

The project has three specific objectives:

1. Enhanced access to uninterrupted NCD prevention, care and support services for refugee populations from Somalia in Dadaab, Kenya.
2. Strengthened capacity of SRCS and RCRC partners to integrate NCD prevention, care and support in health services for people affected by displacement in Somalia.
3. Improved cross border collaboration to ensure continuity of NCD care for people affected by displacement between Kenya and Somalia.

The project’s expected results areas are:

Result 1.1: Increased awareness on NCD prevention and control measures amongst the target communities

Result 1.2: Enhanced patient empowerment, selfcare and psychosocial well-being.

Result 1.3: Increased adoption of health lifestyle and primary prevention.

Result 2.1: Strengthened health service provision for quality NCD care.

Result 2.2: Increased awareness on NCD prevention and control measures amongst the target communities and enhanced linkage to treatment, care and support services.

Result 3.1: Strengthened cross-border cooperation between Kenya and Somalia on health care for people living with non-communicable diseases.

Result 3.2: Enhanced cross border referrals for PLWNCDs for continued NCD care service access.

Purpose, Objectives and Scope

Purpose

The overall aim of this evaluation is to assess the extent to which the project achieved the intended specific objectives and contributed to the overall goal. The evaluation should contribute towards building evidence to inform future interventions by identifying lessons and good practices and opportunities for scale up.

Objectives

1. To measure project achievements against statistical benchmark indicators.
2. Determine as systematically and objectively as possible the relevance, effectiveness, efficiency, impact, sustainability, and coherence of the project results considering its goals and objectives.
3. Document the intended and unintended (if any) results realized with specific examples.
4. Assess the extent to which Community Engagement and Accountability approaches were implemented and resulting Complaints & Feedback integrated in the project.
5. Identify good practices, lessons learned and recommendations for scale up/cross programming

Geographical Location

Dadaab Refugee Camp, Kenya.

Alleybaday in Somaliland; Goldogob, Dhobley and Belethawa in Somalia.

Target Population

Populations affected by Displacement, Health Care Workers, Health promoters and Community Health Volunteers, community members, including people living with NCDs, special interest groups (youth, women, persons with disabilities and other groups that have distinct vulnerabilities) and stakeholders within targeted locations, KRCS, and SRCS.

Scope

The evaluation is expected to address the above objectives based on the following guiding questions:

a) Achievement of the project results against project targets.

• What was the project achievement against baseline values?
• What is the end-line value for indicators as per the project plan?
• What factors hindered achievement of project targets and contribution to objectives and goals?

b) Relevance

1. Was the project relevant to the needs of the target population?
2. How satisfied are the project target groups with the interventions undertaken by the project?
3. To what extent was the project, including its activities and modality, responsive to the changing context of NCDs in emergency.
4. What do the beneficiaries feel is the effect of the project on their lives in the short term and in the long run?
5. Develop a case study and lessons learned from the application of the SRCS-KRCS cross-border referral tool? Did it address intended needs?

c) Effectiveness

1. Did the project focus on the most relevant risk factors, or have other priorities emerged?
2. Based on patients data which approaches and activities have produced statistically significant improvement in project indicators in relation to the baseline values?
3. How effective was the SRCS-KRCS cross-border collaboration and partnership in achieving project goals and fostering regional cooperation?
4. How effective was the SRCS-KRCS cross-border referral tool in facilitating patient referrals and monitoring?
5. What changes as reported by the community/stakeholders can be attributed to the project (positive, negative, expected, and unexpected)?
6. Were all the activities carried out? If not, why?

d) Efficiency

1. To what extent did the program and project governance and management structures((internally within SRCS / KRCS, among partners at national and regional levels, between DRC, KRCS and SRCS) and processes enable, or hinder, the efficient implementation of the joint project and its results achievement?
2. Was the project implemented according to the implementation plan? If not, was timely corrective action taken where necessary? Was additional support identified or provided to overcome implementation challenges?
3. Were all activities done within the budget? If there were any significant variances (whether early or late, over or under expenditure), what caused them? What has been done innovatively?
4. Was the process of achieving results efficient?
5. Could a different approach have produced better results?

e) Sustainability

1. To what extent are the benefits of the projects likely to be sustained beyond completion of this project and what sustainability measures – institutional/financial/technical/community-based have been implemented to ensure continuity of gains made?
2. To what extent has the project potentially ensured continued availability of comprehensive NCD services? Have there been any challenges?
3. What is the project’s perceived impact on strengthening the overall health system including the cross-border referral tool for the long-term impact, on health authority capacity and sustainability of the action?
4. What approaches should be adopted by the Red Cross Red Crescent while designing similar projects in the future?

f) Coherence

1. To what extent was the project complementary to, and coordinated with, other work undertaken by KRCS, SRCS and other implementing partners including public authorities?
2. How well has the project’s intervention compatible with other interventions in the project implementation sites (Dadaab, Goldogob, Alleybaday, Dhobley, Beledthawa)

g) Community Engagement and Accountability

1. To what extent were the KRCS/SRCS minimum accountability standards integrated?
2. How much do the beneficiaries understand the services being made available through the project?
3. How much were beneficiaries involved in decision-making around services provided through the project?
4. What complaints and feedback mechanisms were put in place? What were the common community complaints addressed during the project period? To what extent did the CF mechanisms affect/impact the program design/activities, reviews, etc? Sample of resolved matters through the mechanisms.
5. Do the community members think that the project activities respected their culture/religion/daily routines/community calendars etc. and how did that affect the project uptake?
6. What were three preferred means of communicating complaints to KRCS/ SRCS? How many of channels were used for information sharing to reach different groups? Such disability groups, women, men, youth?
7. Did KRCS and SRCS include the community during development and testing of community awareness tools?

Methodology

The consultants will propose the most suitable study design, sampling methods and approach, sample size, data collection, and analysis approaches that are suitable for this project during the end-line. (Note that the evaluation will be undertaken in Kenya and Somalia). This should be clearly outlined in the bidding document/proposal and if qualified to the oral stage to have further discussion with the evaluation management team. The consulting team should propose respondents to interview or data sources that can answer the log frame indicators and provide comparable statistics (meaningful comparison between baseline and end-line) to document any changes.

Roles and responsibilities

Consultants

• Development of inception report, data collection tools and final report including 2 case studies on the cross-border referrals and NCD service provision at the clinics.
• Facilitating of inception meeting and dissemination meeting following data collection.
• Responsible for collection of data, following up on appointments with support from SRCS and KRCS
• Ensuring consulting team comprises persons who speak local languages
• Submission of invoices and necessary documentation in time to facilitate payment as agreed in the contract.
• Handover of raw data and signed consent forms to DRC upon completion of assignment.

KRCS and SRCS (project and M&E team)

• Review of assessment products including the inception report, data collection tools, and evaluation reports.
• Support consultants with logistical planning necessary for data collection
• Avail data collectors within agreed criteria.
• Provide all the necessary secondary information for desk review.
• KRCS and SRCS will be the link between the community, stakeholders and the consultant and coordinate data collection activities (identifying respondents together with consultants and setting up appointments)
• DRC, KRCS and SRCS will have exclusive rights to all data generated from the evaluation.

DRC

• DRC will be responsible for preparation and execution of contract with selected consultant.
• DRC will facilitate payment of consultant in accordance with the payment schedule stipulated in the contract.
• DRC will be responsible for coordination of tasks between all parties – KRCS, SRCS and the consultants- including constituting an oversight committee.
• DRC, KRCS and SRCS will jointly select a most suitable consultant.

Deliverables & Schedule

The key deliverables under this evaluation are as listed below:

Deliverable

Timeline

Inception report and tools

25.03.2025

Inception meeting with DRC, KRCS, SRCS

27.03.2025

Data collection

04.04.2025

Report (Draft)

16.04.2025

Evaluation dissemination meeting with KRCS, SRCS and DRC

17.04.2025

Final report (Consolidated multi-country report) and 2 case studies

25.04.2025

Skills and Qualifications

The lead consultant must possess the following qualifications:

1. A minimum of a master’s degree in public health/social science/community health and health systems strengthening or related field.
2. A minimum of 5 years’ extensive experience in carrying out comprehensive evaluations or similar assignments.
3. Good understanding of NCD programming, disability, and gender inclusion.
4. Proven experience in participatory and results-based M&E knowledge and practical experience in quantitative and qualitative research methods.
5. Must have led in at least five participatory assessments. Experience of conducting end-lines, monitoring and assessment work in the target or similar communities (preferred).
6. High level of professionalism and an ability to work independently and in high-pressure situations under tight deadlines.
7. Strong interpersonal, facilitation and communication skills with knowledge of local languages (preferred).
8. The team must have a statistician able to analyze quantitative and qualitative data as well as key technical team members in to handle specific components of the project evaluation.
9. Firm/bidder must have experience in participatory data collection methods and using mobile phone technology for data collection, monitoring and reporting.
10. The lead consultant must have strong analytical skills and ability to clearly synthesize and present findings, draw practical conclusions, make recommendations and to prepare well-written reports in a timely manner.
11. The firm must have legal registration in either Kenya and Somalia and the lead consultant should be familiar with both contexts.
12. Availability for the period indicated and ready to carry out the assignment and deliver results within the specified period/time.

The availability of experts in each of the subject areas, with experience and relevant qualifications for the assignment will be highly preferred. The firm/bidder must have a team member/s who understands the local language/s and culture.

Available data and documentation

Sources of secondary information will include but not limited to:

1. Project Baseline assessment report (9.2023)
2. Regional Feasibility study conducted in Somalia, Sudan, South Sudan and Ethiopia report (2023)
3. Midterm review reports (November 2024)
4. Project proposal, logical framework and quarterly and annual National Society reports as well as milestone reports submitted to the donor
5. Documents, policies and frameworks by partners, public authorities that are related to the evaluation.