Background

A series of reviews conducted over the years of the Universal Immunization Programme (UIP), meetings at national and state levels, Joint Review Missions and Common Review Missions organized by Ministry of Health and Family Welfare (MoHFW) on a regular basis, have noted that whilst UIP performance in India has improved overtime, there still remain a number of key constraints impacting immunization coverage in the country. Further, there are significant inequities in vaccination coverage in different states based on various factors related to individual (gender, birth order), family area (area of residence, wealth, and parental education), demography (religion, caste) and the society (access to health care, community literacy level) characteristics.

These assessments have identified the following key constraints:

• Infrastructure issues including poor infrastructure of vaccine stores and transportation systems; lack of standards for vaccine stores at different levels; insufficient safety devices for temperature monitoring of bulk vaccines stored at GMSDs, state, and regional stores; difficulties in procuring the right quality of cold chain equipment on time with adequate after sale support; repair kits and spares cold chain technicians and inequitable cold chain point (last vaccine storage site) distribution;
• HR issues such as lack of a support unit with experts on cold chain for both the immunization division of MoHFW and at the state level; lack of induction training and a regular educational programme for staff inducted in the Cold Chain Logistics (CCL) system; insufficient institutional training capacity to manage cold chain and logistics at all levels; shortage of trained manpower and relevant job-aids for managing cold chain at all levels (state, division/regional and district levels); and lack of HR with capacity for VLM at all levels (national, GMSDs, state, district and PHCs). The shortage of HR is more acute in the poor performing states and specifically at the field level;
• Vaccine management issues and non-adherence to principles of logistics management at all levels leading to mismatch between procurement, forecasting and utilization;
• Weak capacity at the state level and inadequate HR to generate evidence based communication strategies, and effective BCC campaigns;
• Information dissemination is not timely, and often mixed messages are received by beneficiaries;
• Weak interpersonal communication (IPC) skills among health workers and community mobilizers affecting appropriate communication of messages;
• Poor monitoring and evaluation for data entry, resulting in errors in data entry and inaccurate data;
• Poor monitoring and evaluation results in insufficient data quality and reporting rates. A vast majority of states have wide gaps in reported and evaluated coverage data;
• Inadequate data quality and reporting rates result in poor surveillance of VPDs and AEFIs;
• Insufficient laboratory capacity and limited trained manpower at the district levels to carry out surveillance;
• Limited focus on operational research for immunization and finding locally suitable solutions.

Context

Although the MoHFW is actively working to improve immunization coverage rates, key constraints in the current system remain and need to be addressed. In order to increase the immunization coverage in India, the Health System Strengthening Project was envisaged by the Ministry of Health and Family Welfare (MoHFW), with funding supported by the GAVI Alliance.

The project focuses on five delivery areas namely institutional capacity, cold chain management, evidence-based policy-making and service delivery as well as increase demand for vaccination under the Universal Immunization Program (UIP).

These measures aim to increase both the quality and quantity of the vaccines delivery and immunization, targeting 12 of the 18 National Rural Health Mission (NRHM) high priority states where full vaccination coverage is currently below 61%, and eventually help India build a vaccine delivery platform for the 21st century.

The lead implementers for the project are UNICEF, WHO and UNDP, under the coordination of the Immunization Technical Support Unit (ITSU) of the MoHFW.

HSS Project Goal

The goal of the proposal is to reduce infant mortality by improving the immunization coverage in India, in alignment with the national target set by the twelfth five-year plan.

Objectives of the HSS Project

There are 5 clear objectives of the proposal; each objective is led by one of the implementation agencies as given below:

• Strengthen  cold chain management in poor performing states through  improved human resources capacity, institutional strengthening and supporting supervision; Lead Implementer - UNICEF;
• Design and implement an eVIN that will enable real time information on cold chain temperatures and vaccine stocks and flows; Lead Implementer - UNDP;
• Increase demand for RI through a national BCC strategy; Lead Implementer - UNICEF;
• Strengthen the evidence base for improved policy-making (at all levels) on programmatic areas through a well developed and implemented national M&E plan and research framework; Lead Implementer - UNDP;
• Leverage the success of the National Polio Surveillance Project to strengthen RI service delivery in 8 priority states. Lead Implementer - UNDP.

Objectives of the MTR

The HSS grant is envisaged by the Ministry of Health and Family Welfare to provide a catalytic effect on the Nation’s UIP. The HSS project in many ways infuses technical capacity, institutional strengthening and making the system more efficient to deliver immunization services to every child and expecting mother in the country.  Therefore, it is imperative that the project delivers on the objective defined.

The project paves way to innovation, effective strategy and efficient delivery of services that has a national impact especially considering India plan to introduce newer and more complex vaccines in the coming future.

Thus the objective of the mid-term assessment is to provide clear evidence of the progress and direction the project needs to take to ensure it meets success on every parameter set out at the time of initiation.

The specific objectives of the Mid Term Review are as follows:

• To assess and validate the progress on the programmatic indicators and results;
• To analyze the progress of the project towards achieving/achieved outcomes and document what worked and what didn’t;
• To provide an assessment of the potential impact of the HSS Grant on the India’s Universal Immunization Programme (UIP).

To provide recommendation to MoHFW and the implementing partners on:

• Mid-course corrections in terms of approach and strategies required on the various activities to achieve project programmatic outputs and outcomes;
• Inform the MoHFW to increasing potential of the project in terms of lessons, good practices and/or successful pilots that can be quickly adapted and scaled to the other states;
• To provide recommendations for key aspects / approaches to be considered for the end of grant evaluation.

Indicative Review questions are listed below:

• Have the activities delivered as planned (outputs)?
• What are the outcomes, visible for each of the objectives defined? (Account for progress against baselines, reasons for reaching / not reaching / superseding targets and their reasons such as targets too ambitious/too low; delays resulted in non-achievement)
• What are the signs of change (in pathway to impact)?
• What is the quality of evidence generated?
• What are the different strategies used - what is their efficacy in relation to pre GAVI HSS Grant?
• How have target audience benefited?  How have strategies to reach out to population groups especially excluded ones affected by these results?
• What have been the critical enablers and inhibitors - to achieve results (outputs, outcomes and impact)
• How has relationship of the project with various stakeholders and how has it affected the results?
• What have been the systems built to promote sustainability and how have they fared?
• What are the promising aspects of the Projects/models which have the potential for wider scaling up / national replicability? And those that may warrant continuation into future HSS grant?
• What are the lessons learnt? What is going on well and what needs to be done better?

Structure of the MTR Team

The MTR Team will have following three members:

• Lead Consultant with Public Health background, in charge of conducting the Mid Term Review and leading a group of consultants;
• Consultant with Health Communications background, leading on the communication related performance and supporting the Lead Consultant in conducting the Mid Term Review;
• Associate with analysis and writing skills, to assist the Mid Term Review team.

Duties and Responsibilities

The responsibilities of the MTR Team will largely evolve around the following:

In-depth Review of Project documents

An in-depth review of the project proposal and quarterly and annual Progress Reports, in the light of the India’s Immunization programme and policies, and other relevant documents such as; Comprehensive Multi Year Strategic Plan, EVM Reports, etc.

Develop and Share an MTR Inception Report

The MTR team will prepare an inception report, outlining the entire process of the review, as:

• review design and methodology (using varying qualitative and quantitative approaches);
• quality assurance mechanisms;
• data collection plan, including list of key stakeholders and review tools/checklists, sample size out of 12 states;
• analysis plan;
• time lines;
• broad structure of the MTR review report, expected the final deliverable;
• proposed number of meetings, workshops at national and regional levels.

The MTR team will undertake a workshop with the relevant stakeholders (including GAVI Secretariat via skype) and present the review plan to MoHFW and relevant implementing partners/ stakeholders to receive feedback and incorporate suggested changes.

A desk review of relevant information provided

The MTR team is expected to:

• Develop detailed guidance notes and information collection formats/checklist in close collaboration with the MoHFW and implementing partners;
• Review all relevant documents provided by the Ministry and Implementing partners such as Project Documents, Annual Work Plans, Quarterly and Annual Progress Reports, Evaluation and Assessment Reports, Minutes of Meetings etc.;
• Review all documents and information provided by the implementing partners and analyzed taking into account different aspects of program design, implementation, monitoring and results achieved with emphasis on cross cutting issues and knowledge management;
• Provide a brief analysis of their observations;
• Develop the check list for the proposed areas of query to undertake active data collection from identified stakeholders.

Field Visits and Data Collection

The MTR team is expected undertake field visits, to assess and validate the findings of HSS grant. The team will conduct interviews of external stakeholders in the Government, Project Implementing Partner, Civil society, and/or other relevant partners and also collect documents to support the review.

Analysis and Development of the MTR Report

MTR team will conduct data analysis by triangulating data from desk reviews and field reviews, analyze all information and develop a draft MTR Report. The draft report including the recommendations will be shared with MoHFW and Implementing partners for their feedback and inputs, upon which the consultant will be responsible for delivering the final report.

Deliverables:

• Inception Report, including proposed methodology and detail plan;
• Draft MTR Report, including final structure of the report and key findings and recommendation to MoHFW and the implementing partners;
• Final MTR Report;
• Power Point Presentation with notes.

Hiring and Reporting:

• The Lead Consultant will be overall responsible to supervise and orient the team with regards to all aspects of the MTR process, data collection and analysis;
• The consultant will directly report to the GAVI Secretariat based at MoHFW for all the technical issues and to UNDP for all the administrative issues.

Competencies

• Excellent communication, interpersonal and liaison skills with government, inter-governmental agencies, UN system and international and regional development partners, academic institutions, civil society organizations, and other relevant institutions;
• Demonstrated capacity to write clear and well-constructed reports, training manuals, process documents; and
• Promote the highest standards of ethics and integrity;
• Strong human rights and gender focus;
• Support creativity and innovation;
• Help create an enabling environment for open communication.

Required Skills and Experience

Education:

• Advanced degree in Public Health, Public Policy, Economics, or other related fields. 

Experience:

• Minimum of 15 years of experience in program reviews / evaluations / assessments in public health nationally and multi state, in special relation to immunization will be an asset;
• Clear knowledge of the India’s public health structure and service delivery and demand generation mechanisms in the public health sector;
• Clear knowledge and understanding of India’s Universal Immunization Programme (UIP) and implementation mechanism at National and State levels;
• Understanding issues of public health on issues availability, accessibility and other nuances;
• Previous experience of working for/partnering with Government of India, Ministry of Health and Family Welfare and other ministries at the national and state level;
• Demonstrated and proven experience managing a team of experts to address the various needs of this assessment.

Language:

• Written and oral proficiency in English is required.

Travel:

• The position will require nearly 10 days of travel to the designated states.

Duty Station:

• The Consultant is required to be based at New Delhi and report regularly to the GAVI Secretariat based at MoHFW;
• Relocation expenses, if any, would be borne by the successful Consultant.

Financial Matters

• Payments will be made at the end of the consultancy for the actual days worked, on satisfactory completion of activities, as agreed with the GAVI Secretariat;
• UNDP will cover the cost of consultancy as per the per day consultancy rates;
• UNDP will organize the preapproved official travel;
• Any other travel related claims will be reimbursed as per actuals;
• Any kind of miscellaneous charges i.e. internet, phone etc. would not be reimbursed.

Documents to be submitted

• Curriculum Vitae including experience in similar projects, and Names/Contact Details of 3 referees;

A brief technical proposal (not more than 3 pages) that includes:

• One page on your individual expertise and experience in special relationship to the terms of reference;
• One to two pages on proposed activities in response to the MTR responsibilities, methodology and time lines (not exceeding two months);
• Sample of final reports of similar related evaluations/assessments;
• A Financial proposal indicating all-inclusive per day consultancy rate;
• Declaration for no conflicts of interest i.e. no involvement in implementing any of the activities that are being evaluated.

Evaluation Criteria

The award of the contract shall be made to the individual consultant whose offer has been evaluated and determined as:

• Responsive - Having received the highest score out of a pre-determined set of weighted technical and financial criteria specific to the solicitation.

Technical Criteria weight – 70 Marks; Only candidates obtaining a minimum of 49 points (70% of the total technical points) would be considered for the Financial Evaluation.

• Technical Proposal: 35 Marks;
• Relevant Experience:25 Marks;
• Qualification:10 Marks;
• Financial Criteria weight – 30 Marks.

Notes:

• Individuals working with institutions may also apply, contract would be issued in the name of institution for the specific services of individual;
• Please note proposals without financial proposal will not be considered;
• Personal CV and P.11, indicating all past experience from similar projects and at least three (3) professional references;
• CV, P.11 and Financial proposal can be clubbed in one file for uploading;
• The consultants must bring his/her own computing equipment.

UNDP P.11 Form can be downloaded from

http://www.undp.org/content/dam/undp/library/corporate/Careers/P11_Personal_history_form.doc