Request for Proposals (RFP) Kisumu County Community Health Program Evaluation: Evaluation Design & Baseline Implementation Oversight, Analysis and Report at Living Goods

Introduction

 The strategic direction Living Goods is taking is to build the capacities of National and County Governments on Community Health. This is done by leveraging digital technology for service delivery as well as community health systems strengthening. Findings of this study will be used to develop policy on investment in digital technology for community health. It will, identify gaps and best practices, and help mobilize stakeholders in addressing challenges in implementing community health programs.

Section II: Purpose and objective of the research

To assess the impact of a community health program leveraging Digitally-Equipped-Supervised-and-Compensated (DESC) community health workers model to increase knowledge on best practices and improve maternal and child health outcomes. Anticipated outcomes of the collaboration between Kisumu County and Living Goods include; a strengthened community health system which will result in improved reproduction maternal, newborn and children health (RMNCH) outcomes. Therefore, the research study will seek to establish the impact of the implementation of the DESC community health volunteer program on RMNCH outcomes. The evaluation includes a community health system strengthening component, household survey to assess impact and cost effectiveness.

To assess impact, household surveys will be conducted at 3-time points; baseline, Midline (month 12) and Endline (month 24). In addition, the surveys will gather views from the community on healthcare, health seeking behaviors, health problems, barriers faced in utilization of health services and community utilization CHV services by the community.

Objective

The other objectives are: -

1. To assess the trends in utilization of maternal and child health services before and after the intervention.
2. To determine factors associated with utilization of maternal and child community health services.
3. To determine the changes in health seeking behaviour of caregivers of under-5 for iCCM and women for maternal health services.
4. Assess cost effectiveness of the DESC intervention.
5. To measure changes maternal and child health outcomes following the intervention.
6. To delineate challenges and best practices in providing technical assistance to counties in Kenya – best practices in digital health (opportunities and lessons of implementing the community health system leveraging on digital technology).

Description

Studies have shown that many community-based projects have led to better maternal and child outcomes due to more enhanced service delivery by CHVs. Nonetheless, there are limited studies on the impact of community health programs leveraging digital technology. Digital health is still a novel approach in community healthcare. However, several pilots do not scale due to lack of sustainable financing and limited stakeholder support.

Effective community health services can lead to provision of quality and timely basic health care services. This will in turn lead to an improvement in maternal and child health outcomes. However, community health programs face challenges that include performance management of community health workers as well as getting quality real-time data to support data-driven decision making.

With the premise that community health systems will be strengthened, Kisumu County entered a bilateral partnership with Living Goods, a non-governmental organization based in Nairobi, Kenya which applies digital decision-support tools to improve the performance supervision of CHVs. Specifically, LG will provide technical assistance to Kisumu County based on over 10 years of experience in supporting community health programs in Uganda and Kenya that leverage digital technology. Additionally, Kisumu will provide county health services including community health services. By leveraging a digitally enabled Community Health Program, families will have higher access to timely and quality maternal, newborn, and child healthcare services. This will ultimately improve maternal, newborn and child health outcomes.

Living Goods aims to provide technical assistance to Kisumu County on digital community health applications. Living Goods will provide the technology and continuously build the capacity of the county to support the digital system. CHVs equipped with a Smartphone and the Smarthealth application will offer services guided by the application. Supervisors will make supervision visits and coach CHVs guided by the Supervisor application. Data collected using the applications will be visualized on a real-time basis. This will enable the Sub County Health Management Team (SCHMT) to make decisions based on data. The study will provide knowledge on best practices as well as evidence on effectiveness of community health programs leveraging digital technology.

Section III: Scope of Research Design, Timelines, Deliverables and Budget

Study Design and Sampling

The research consultant will prepare a relevant and detailed study design, rationale for design, sampling strategy and sample calculations at the proposal stage for assessment by Living Goods. The design should be robust enough to demonstrate the impact of the community health program across the county. The consultant should include a recommended design for the entire study. The feasible design in this case is a two-stepped wedge cluster non-randomized trial. In addition, cost effectiveness analysis and process evaluation will be conducted alongside the impact evaluation.

 The key area of focus will include: -

1. Study protocol Development

• Develop study aims, research questions and objectives.
• Develop the study methodology.
• Develop an approach on cost effectiveness analysis.
• Support the systematic selection of areas for programme and research sites including making recommendations on the inclusion and exclusion criteria.
• Develop the data collection tools, quality monitoring and control, and data collection approaches.
• Develop a data analysis plan.

1. Ethical Review and Approval

• The research consultant will be responsible for designing and seeking ethical approval from a Kenya approved ethical review board and approval from the National Commission for Science, Technology and Innovation (NACOSTI).

1. Design of validation approaches

• Test the quantitative and qualitative data collection tools.
• Develop a data audit and feedback mechanisms to ensure high quality data capture and continued improvement.

1. Data collection

• Recruit and contract research assistants.
• Develop a data collection methodology and tool training guide for research assistants.
• Train the research assistants on data collection and protocols.
• Develop a work plan for data collection according to the methodology prescribed.
• Monitor and support Quality Control during data collection.

1. Data analysis and reports

• Impact data analyses and report; baseline, midline and endline.
• Process evaluation and report
• Cost effectiveness analyses and report

1. Dissemination, documentation, and publication

• Support in dissemination and buy-in from relevant stakeholders.
• Identify the possible publications for the study.