Save the Children Study on Engagement of Traditional Birth Attendants to Influence Policy Consultancy in Bungoma Kenya

Terms of Reference (TOR) for Operations Research 

Assignment: Study on Engagement of Traditional Birth Attendants to Influence Policy

Location: Bungoma

Required: Firms Only

Programme Title: Accelerating Reduction in Maternal and Newborn Mortality in Bungoma county, Kenya 
 

Subject of Service Contract: Study to determine how to engage traditional birth attendants  
 

Duration of Service Contract: 18 months

1. Background and Context

1.1. Save the Children Signature Programmes: Save the Children aims to accelerate our progress towards achieving dramatic change for children over the next four years. To increase the impact of our current approach, we are developing a number of signature programmes. 

A signature programme is one which is designed to achieve breakthrough for children through the implementation of evidence based interventions that are replicable and scalable and that can generate positive results for children. 

These programmes will be used as beacons to attract more funding. The success of the signature programme is measured by the adoption of the successful intervention and replication to scale by government and other agencies. 

These programmes will demonstrate how Save the Children, in partnership with others, tackles issues that threaten children’s ability to survive, thrive and achieve their rights. We are developing innovative ways to ensure we have maximum impact so that children can directly benefit from large, high quality programmes on the ground. 

Critically, signature programmes will allow us to clearly demonstrate evidence of our successful impact, evidence that we will use to persuade others to replicate them on a mass scale, within a country and across continents.  We’ll also use this evidence to change the policies and practices of governments and other actors.

1.2. The Kenya Context: According to the 2008 Kenya Demographic and Health Survey (KDHS), only 44% of deliveries in Kenya are conducted by a skilled attendant with 28% being conducted by TBAs and 21% by relatives. 

Anecdotal information shows that the proportion of skilled attendance at delivery has increased to 66% since the onset of free maternity care in Kenya. 

However, there are still stark regional variations in skilled attendance with a higher proportion of pregnant women in the rural areas opting for TBA care as opposed to the urban areas. The KDHS showed that TBAs deliveries were more likely to occur in rural (30.4%) than urban areas (15.2%). 

A similar variation was evident depending on the geographic area ranging from 5.6% usage in Nairobi which is predominantly urban and 26-45% in the predominantly rural areas in the former Rift Valley and Western provinces. In the former North Eastern Province, 64% of all deliveries were conducted by TBAs

The policy on the use of TBAs in Kenya has followed the changes in global policy. Between 1970 and 1990, there was a push to train TBAs to increase their capacity in conducting deliveries.

In 1997, a technical consultation by the Safe Motherhood Interagency Group excluded TBAs from the definition of skilled birth attendants and this led to the withdrawal of support from training of TBAs and the change of focus to training of skilled attendants. 

The Kenya National Reproductive Health Policy (2009-2015) does not recognise TBAs a providers of skilled care and recommends that they should only be used as advocates of safe childbirth by encouraging women who seek their services to get care from a health facility and where possible, accompanying them to the facility. 

In Kenya, various programmes have engaged TBAs in maternal and newborn health in different ways each with varying outcomes.

2. Scope of Work: One of the interventions that the programme will implement is the use of TBAs to improve maternal and newborn health outcomes. 

The successful applicant will be responsible for the planning and execution of a study to determine the most appropriate and sustainable method of engaging TBAs.  

Some of the questions the study should be able to answer are:

• How are TBAs being used in maternal and newborn health in Kenya today?
• What would be a sustainable way of engaging TBAs in maternal and newborn health

The successful applicant will be expected to:

• Conduct a thorough literature review on the current methods of engagement of TBAs in Kenya
• Propose the 2 most appropriate methods to be trialled by the study
• Develop and implement the proposed study including obtaining the necessary ethical approval
• Provide regular updates on the progress of the study
• Provide the study report complete with all the data sets at the end of the study. This should also include a dissemination plan

The key outcomes of the study are:

• Sustainability of the method of engagement
• Relationship with the health system
• Client and provider satisfaction

The applicant will also provide a capacity statement showing their previous experience in carrying out this type of work in the same or a similar context. 

3. Methodology: The applicant will propose methodology, tools, and workplan for the study. 

4. Time Frames: The time frame for the activities is January 2015 to June 2016

5. Expected Deliverables
 

The expected deliverables are
 

5.1.1. A study protocol with ERB approval 
 

The study protocol should provide a detailed methodology outlining how the successful applicant will address the questions in section 2 above. 

The applicant will also be expected to obtain the relevant ethical review and approval. 

5.1.2. Data collection tools and templates
 

The applicant will be expected to develop the relevant data collection tools and templates. 

These will be shared with SCI for review and approval in accordance with the agreed-upon timeline
 

5.1.3. Study report including findings and recommendations for programme implementation as well as the raw data set 
 

The draft study report must be submitted to the SC designated contact person within 30 working days after completion of field work and data analysis. 

The final report of the study, after integration of the various comments made, must be submitted within 10 working days after reception of the comments from SC. 
 

5.1.4. Dissemination workshop
 

The applicant will be expected to hold a dissemination workshop where they will present the methodology, challenges faced, key findings and main recommendations. 

The participants of the workshop and the venue will be agreed upon between SCI and the applicant.
 

5.1.5. Final report
 

The final report should be submitted within 10 working days after the dissemination workshop. 

This will be submitted in soft copy by email and 5 copies on CD/Flash disk

6. Administrative / Logistical Support 
 

6.1. Budget and work plan
 

The applicant should submit to Save the Children forecast of the budget. 

Save the CHilden will be responsible for all transport and accommodation costs in-country in accordance with our policies.

The budget should be accompanied by a work plan for the duration of the contract.

6.2. Schedule of payment 
 

The following payments will be made to the consultant using and agreed mode of payment. 

The payment for the 2 deliverables will be made independent of each other

• 20% of the budget will be paid upon signing of the contract.
• 20% of the budget will be paid upon submission of the study protocol with ethical approval
• 40% of the budget will be paid upon completion of field data collection
• 20% of the budget will be paid upon submission of the final study report.

6.3. Taxation
 

5% withholding tax will be retained as part of the payment and remitted directly to the Kenya Revenue Authority. 

The applicant should ensure that their budget includes this figure.

7. Desired competencies of the successful applicant (only institutions should apply, STRICTLY NO INDIVIDUALS)

• At least 15 years’ experience in Kenya conducting reproductive health research especially with the Ministry of Health (evidence of this will be required). Previous research work with traditional birth attendants is a plus
• Proven experience in conducting policy research and analysis
• Proven experience publishing in reputable journals. Evidence of this should be provided with the application
• Demonstrated ability to conduct complex programme evaluations
• Proven experience in working as as the monitoring & evaluation partner for service delivery programs
• A demonstrated high level of professionalism and an ability to work independently and in high-pressure situations under tight deadlines.
• Strong interpersonal and communication skills
• High proficiency in written and spoken English
• Understanding of child safeguarding and child participation procedures

How to Apply

CLICK HERE to download the EOI Application Form

All interested firms are requested to express interest following the attached EOI format ONLY by email to: Kenya.jobapplications@savethechildren.org with a copy to Angela.Muriuki@savethechildren.org by 15th December 2014.   

Please indicate ‘Study on Engagement of Traditional Birth Attendants’ on the subject line.