ALIMA :

ALIMA pools the expertise of international aid workers, national medical organizations and global research institutions to provide quality medical care to people in need and carry out cutting-edge research to improve humanitarian medicine. By sharing resources and know-how, ALIMA and its partners are increasing access to care for communities at risk and expanding humanitarian medical response capacity in some of the most challenging contexts in the world. ALIMA invests in operational and clinical research to improve medical care in humanitarian emergencies, including trauma surgery, nutrition, paediatric care, and Ebola prevention and treatment. ALIMA’s 3 pillars are : responding to crisis, reducing maternal and child mortality and conducting operational research.

Since its creation in 2009, ALIMA has treated more than 2 million patients, conducted 56 programs in 13 countries and launched ten research projects focusing on malnutrition, malaria, Ebola, and surgery. ALIMA has teams dedicated to acute emergencies and recurring crises.

Context :

Far-North region in Cameroon :

The Far-North region of Cameroon is the biggest and the most populated region of Cameroon. It is vividly affected by the Lake Chad Basin crisis. 75% of the population lives under the poverty threshold and health indicators are the most alarming in all Cameroon. Infantile mortality rate reaches 154‰ against 103 in the rest of the country. Access to healthcare have vastly been impacted by the crisis : qualified HR left due to insecurity and delay of payments and structures lack basic medical equipments

Since 2014, the Far North region of Cameroon, and in particular the department of Logone and Chari is the direct victim of the violent conflict between Boko Haram and the Cameroonian army. Boko Haram’s regular incursions into the region are accompanied by kidnapping, cattle rustling, looting of houses and destruction of villages and community infrastructure. The military base of Sagmé was attacked in April 2018, resulting in the killing of 6 soldiers stationed in the village. Atmosphere is still war-like in this village. A nurse was kidnapped and ransomed in August in Naga. Vigilance committee members have been targeted and traditional leaders killed in Makary and Mada districts. As a result, massive and continuous displacement of refugees and internally displaced populations are taking place in the area. It’s also having a strong impact on the living conditions of host populations, as there is strong pressure on already scarce resources and initially limited basic services cannot respond to the crisis.

According to the latest figures (DTM/OIM round 15, december 2018), 387,035 refugees, IDPs or returnees live in the Far-North region : it represents 37% of the population is composed of IDPs. 178,949 live in the department of Logone et Chari – 100 000 in Makary and Fotokol districts alone.

ALIMA in Cameroon :

 In May 2016, ALIMA started to intervene in Mokolo District Hospital where it supports the ITFC and pediatric services, handling medical complications among malnourished children under 5 years old. In December 2016, following an explo-action mission in Logone and Chari department, ALIMA extended its humanitarian response to the Makary health district (Hospital and 9 peripheral health centres). Then in May 2018, ALIMA extended its support to 3 health centers in Mada health district, following a request from community leaders. Since it started working in Cameroon, ALIMA treated 17,325 malnourished children, trained more than 100,000 mothers in the early detection of SAM through the « MUAC by Mothers » approach, cared for 28,853 above 60,000 children under the age of 5 on an outpatient basis and provided medical following for 10,000 pregnancies. ALIMA’s intervention is primarily motivated by the observation of an acute nutritional and health crisis, in a region where the armed conflict with the Boko Haram group is aggravating the structural crisis that affects all economic, educational, and health sectors; and is degrading health infrastructures.

Project evaluated : Multisectoral emergency intervention benefiting IDPs and host communities affected by the Lake Chad Basin crisis

ALIMA is operating in Makary health district since December 2016. Objectives are to :

• Reduce SAM-related mortality and morbidity among children under five years old by providing free and quality primary and secondary nutritional treatment ;
• Reduce mortality and morbidity among children under five by providing free and quality pediatric healthcare to children under 5 and free reproductive healthcare for pregnant and lactating.

Activities at community level :

• Health promotion activities ;
• MUAC for mothers trainings ;
• District-wide severe acute malnutrition screenings.

Primary health activities :

• Support to free nutritional and reproductive care in 12 health centers in Makary and Mada health district for children under 5 and pregnant and lactating woomen (support to deliveries, pregnancy follow up and post-natal care) ;
• Support to pediatric consultations in 8 health centers in Makary and Mada for children under 5 ;
• Referral and counter-referral of cases with medical complications to Makary district hospital ;
• Health promotion and MUAC for mothers trainings for parents/caretakers.

Secondary health activities :

• Free and quality care for children under 5 suffering from severe acute malnutrition with medical complications in Makary health district ;
• Free and quality care for children under 5 hospitalized in the pediatric ward ;
• Health promotion and MUAC for mothers trainings for parents/caretakers ;
• Support for complicated deliveries in the district hospital maternity ward will start in the first trimester.

ALIMA started operating in Makary in December 2016 and implements sexual and reproductive health activities since June 2017. An assessment was led in these districts to better understand the context and ensure activities’ pertinence. Early project’s implementation faced several difficulties: geographic inaccessibility during the rainy season, traditional practices, traditional birth attendants activities, insecurity, the cost of medical acts, distance from health centers etc leading to low SR indicators and frequentation.

These lessons learnt oriented the 2018 project towards a reinforced community approach. ALIMA carries out health promotion activities. Outreach workers deliver sentization and information messages relating to the importance of pregnancy follow-up, postnatale care adapted to context, situation and community demand.

Evaluation purpose :

ALIMA develops innovative approaches designed to fill the gap between medical needs in crisis situations and the responses of the humanitarian aid system. This approach is based on four principles: proximity, alliance, quality, and research.

ALIMA is striving to improve child and maternal mortality rates. Our activities in Cameroon focus on pediatric healthcare, struggle against severe acute malnutrition and maternal and reproductive health. While nutrition and pediatric care activities showed encouraging and satisfactory indicators fulfillment and beneficiaries approval level, maternal and reproductive health faced major setbacks. For instance, pregnancy follow-up rates is low and postnatale consultations rates is even lower.

This evaluation will be used to identify and further understand social and cultural barriers impacting pregnant and lactating women access to health care. Those conclusions shall lead to adaptation and reinforcement of the reproductive health component in the Makary project.

Evaluation Objective and Expected Results :

 General objective : To assess the impact of the reproductive health program (targeting mothers and newborns) implemented by ALIMA in the Makary and Mada Health Districts.

Specific objectives :

Collect and analyse ALIMA program data on management of pregnant women from antenatal consultations, childbirth to postnatale care in Makary/Mada district :

• Identify and analyse the different management tools related to reproductive health ;
• Identify and  analyse  the  availability  and  use  of  materials  and  inputs  related  to reproductive health ;
• Analyse compliance with national reproductive health protocols and standards ;
• Analyse the effectiveness of the referral and counter-referral system ;
• Analyse the impact of community-based activities conducted by ALIMA with a focus on the involvement of traditional birth attendants ;
• Meet various actors (social, humanitarian, administrative, religious) in the area to better understand the barriers of access to care for pregnant women in health facilities.

Expected results :

• The impact of reproductive health program supported by ALIMA is evaluated ;
• The coverage and quality indicators of reproductive health program is evaluated ;
• An analysis of access barriers to reproductive health care in the Makary and Mada health districts in particular is carried out jointly with health workers and the various actors (social, humanitarian, administrative, religious) ;
• An analysis of opportunities and possibilities for intervention more adapted to cultural and religious contexts is found by the community itself :
• A better knowledge of the actors (social, humanitarian, administrative, religious) in the intervention zone is acquired ;

• An analysis of the ALIMA response in the reproductive health component is conducted and recommendations made.

Evaluation type

The evaluation will focus on the performance of ALIMA 2018/2019 strategy on reproductive health activities.

Evaluation questions :

1. Is the project an appropriate solution to reproductive health issues in the affected areas?
2. What are the trends of the main indicators, particularly relating to assisted delivery and antenatal consultations rates?
3. What are the strengths, weaknesses, opportunities, and threats of the project?
4. Does the presence of the partner and the coordination mechanisms allow the project to achieve the expected results?
5. To what extent have project resources promoted behavioral changes in reproductive health?
6. Do beneficiaries endorse the reproductive health awareness messages?
7. Has the project created the conditions for scaling up resilience within health facilities?
8. Does the design of the project as defined allow it to be sustainable?
9. To what extent have trained health workers applied theoretical and practical knowledge taught?
10. Is the community satisfied with the services delivered in supported health facilities?

Evaluation Methods :

Key project documentation will be provided to the successful candidate and will include, : project documents, project progress reports, logical framework, indicator monitoring plan, joint supervision reports. The consultant will develop a methodology document and questions for interviews and focus groups, which will be validated together with the project team (based on the key questions already defined in the evaluation criteria). It will at least include :

• In-depth analysis of activity reports, mission reports, sector, survey data ;
• Interviews with the different actors of the project: ALIMA field teams, direct and indirect beneficiaries, traditional and institutional authorities, health professionals (MOH staff, community leader, traditional birth attendants) ;
• Field visits ;
• Immediately after the end of the collection and before submitting the final report, the evaluator will facilitate a debriefing meeting to present his or her initial conclusions for a discussion with the project team.

ALIMA will ensure full cooperation from each of its staff. Besides, ALIMA will reach to stakeholders (institutional, traditional, religious, administrative etc.) to make sure the evaluators get all the support and information they will need while conducting this assessment.

Potential limits to the evaluation :

• Insecurity could be the main limitation in the progress of this assessment ;
• Social limitations to freedom of expression, such as social pressure, gender issues.

Evaluation Timeline :

The evaluation will take place from 1st of April to 30th of April 2019 (one month prior to the end of the project) :

• 1 – 17/04 : Visit to the evaluation zones. Meeting, visits and daily schedule to be discussed according to the methodology agreed upon ;
• 22 04 : Presentation of a preliminary report to ALIMA’s coordination for inputs and feedbacks ;
• 30 04 : Submission of the final report. The final report will be drafted in English ;
• 15 05 : Submission of a french version of the final report.

While on the field, accommodation will be provided at ALIMA guest house in Makary. UNHAS flight leave three times a week to N’Djaména, where the successful candidate will be picked up by ALIMA field teams.

Evaluator profile :

 The evaluation will be led by a consultant. The successful applicant will show the following profile :

• Owner of a public health diploma or extended experience in NGO-led humanitarian health project management ;
• Basic training or experience with sexual and reproductive health in Sub-Saharian Africa ;
• 5 to 10 years experience in the field of humanitarian project cycle implementation and management ;
• Experience in living and working in insecure context ;
• Proven record of evaluating health projects ;
• Fluent in French and English (spoken and written). Knowledge of local languages (Haoussa, kanuri, fulfuldé ) is an asset ;
• Previous knowledge of the intervention area is desirable.

Final Report :

 The final report will be submitted in French and English and meet all USAID evaluation report requirements (accessible here).

It will include :

• Describe the evaluation method(s) for data collection and analysis ;
• Presentation of quantitative and qualitative data analysis ;
• A list of meetings and visits made while in the targeted zone ;
• Quote and answer each questions mentioned above ;
• Presentation of the project’ outcomes and results regarding sexual and reproductive health ;
• Evaluation findings, conclusions and recommendations ;
• Recommendation on how to ensure durability to the project’s impact ;
• Proposition of strategic orientation on how to strengthen the project’s impact ;
• Major difficulties faced and limits ;
• List of all sources of informations ;
• Include all comments and feedbacks given on the first version.

Application :

 Successful candidate will be chosen by ALIMA’s coordination in Yaoundé. To apply, candidates must provide the following documents at cdm@cameroun.alima.ngo and cofirh@cameroun.alima.ngo The deadline for submission is March 10, 2019 at 12:00pm :

• A detailed resumé and 3 contacts from former clients/employers ;
• A cover letter ;
• Details on the evaluation methodological design in line with those ToR ;
• At least 1 previous final evaluation report of a humanitarian project in the health sector, preferably including sexual and reproductive health activities ;
• A free proposal, calculated on a daily basis, including national and international transportation to/from Cameroon, accomodation and living expenses.