Evaluation of the Family planning counseling training program

UNFPA’s mandate revolves mainly around delivering a world where every pregnancy is wanted, every childbirth is safe and every young persons’ potential is fulfilled. UNFPA emphasizes that every individual has the right to make his/her own choices about sexual and reproductive health (SRH) and make informed decisions about family planning (FP) choices. While reaching out to the population at large is at the core of its work, UNFPA strives to reach out to vulnerable population including adolescents, refugees and young mothers in both normal and emergency/humanitarian situations. Since 2011, UNFPA Lebanon CO has been considerably supporting nationwide health and protection related interventions particularly around enhancing access to SRH and preventing/responding to gender based violence (GBV) with due attention to the Syrian refugees and the Lebanese in hosting communities. Those interventions translated mainly into reinforcing national systems and structures, enhancing quality of care, capacity and institutional development, raising community awareness as well as development of advocacy campaigns against early marriage and promoting favorable environment for social change.

In line with its efforts to reduce unmet needs for Family Planning, UNPFA partnered with the Lebanese Order of Midwives (LOM) starting 2016 to develop the capacities of service providers, mainly midwives, on FP including for counseling. A specific human-rights based family planning counseling guide was developed by LOM with the support of UNFPA and in partnership with the Ministry of Public health (MOPH). The guide was used in a capacity development program on FP counseling. The aim of such initiatives is to equip health care providers and health front line workers with the knowledge and skills necessary to promote healthier practices at community level (mainly among Syrian refugees) in relation to FP including use of modern contraceptive methods, size of family, birth spacing, etc.  It should also be noted that UNFPA supported the development of a 5 years Family Planning Strategy in 2016-2017 which was endorsed and launched by MOPH in 2018 and adopted as an overarching framework for prioritizing FP interventions at primary and secondary care levels.

Rationale

The partnership established between UNFPA and LOM for the period 2016-2020 was meant to promote a holistic and universal access to RH/FP through adopting behavior change/modification among women beneficiaries. This approach consisted of adopting a human rights-based FP approach through applying a comprehensive training and coaching plan, ensuring access to contraceptive information and related services and providing men and women with their FP choices. The series of training sessions on FP counseling targeted more than 250 midwives since 2017 practicing in primary health care centers and hospitals across Lebanon developing their knowledge and skills to promote quality practices on Family Planning counselling.  The training sessions were complemented by a coaching and mentoring program seen as imperative to further enhance the practice of FP counseling.

UNFPA is seeking to undertake an evaluation of the Family Planning counseling knowledge and practice among the midwives that have been trained in the past four years with the aim to measure the impact of the training program as well as to retrieve lessons learned, best practices, challenges and constraints, as well as suggest actionable recommendations. . The findings of the evaluation will also allow UNFPA, and partners to assess possibility for revising the FP counseling training program and scaling up its interventions based on the effectiveness, efficiency, relevance and coverage of the FP training program.

Purpose

The main purpose of the evaluation revolves around two main axes as follows:  

1. Support evidence-based decision making for tailoring/adapting and expanding the Family planning counseling, training and coaching program;
2. Contribute to key lessons learned to the existing knowledge base on how to promote access to family planning including through enhancement of care provider’s capacities on FP counseling at both primary and secondary health care levels.

The evaluation will focus on the relevance, efficiency, effectiveness, coverage and sustainability criteria so as to better understand successes and gaps of the FP counseling training program for promoting family planning and enhancing capacities of health care providers on FP, and what measures could be adopted for tailoring/adapting and expanding interventions.

Objectives

While the overall goal of the evaluation is to produce an independent and useful report, with a view to informing similar programs and contributing to the elaboration of the next UNFPA country programme for Lebanon, the evaluation will address selected aspects of the effectiveness, efficiency, relevance, coverage and sustainability criteria through specific tasks under this evaluation as well as tapping on existing related documents/reports generated during the partnership with LOM.

 The specific objectives of the evaluation are:

• Assess the effectiveness, efficiency, relevance, and coverage of the FP counselling training program.
• Identify challenges, constraints encountered in the provision of the FP counselling including retrieving lessons learned and good practices.
• Determine gaps in the FP counselling training including for the information, modality applied, coaching, evaluation etc.
• Measure key achievements and success in the provision of the FP counselling
• Determine elements for sustainability of the FP counselling program
• Propose recommendations for tailoring/adapting and expanding family planning counselling interventions

Scope of the Evaluation

The evaluation will adopt a four staged process namely 1) interviews with key informants, 2) survey with midwives trained on FP counseling, 3) interviews with beneficiaries and 4) review of the various reports and documents generated by LOM about FP counseling.  The evaluation will take place over a period of 8 weeks.

The final evaluation report will entail i) developing an analytical report highlighting strengths, challenges and gaps of the FP counseling program including for the coaching and the implementation of FP counseling; ii) developing a matrix summarizing 1-2 findings for each of the following criteria: relevance, coverage, effectiveness, efficiency, and sustainability, and iii) providing a concise set of practical and feasible recommendations for scaling up/future programming.

Process and Methodology

Preparation and Inception

• Preliminary communication to clarify terms of evaluation between the consultant and UNFPA.
• Delivery of brief 3 – 5 page inception report detailing the individual consultant understanding of the work required the proposed approach to work, methodology, approaches, risks and assumptions and timeframes for product delivery.

Desk Review

• Desk review of documents including national reports, LOM project documents including training reports, evaluation reports and the family planning counseling training document.

Data collection phase

The consultant will design an evaluation methodology (including data collection tools, evaluation questions, and evaluation matrix with associated assumptions to be assessed) using qualitative and quantitative data

• The consultant will hold meetings with UNFPA, LOM representatives and trainers, MoPH and with the head of maternity departments and director of hospitals/ PHCs.
• The consultant will conduct survey with a representative sample of midwives trained on family planning counseling.( self-administered questionnaire)
• The consultant will conduct interviews with beneficiaries that received family planning counseling
• It is expected that the consultation process will consist of 8 to 10 meetings , survey with midwives and 20-25 interviews with beneficiaries

Synthesis phase

• During this phase, the individual consultant will proceed with the analytical work based on the desk review, and the consultation process. A preliminary report to be shared with UNFPA team for review and input.

Final report

• The consultant will incorporate comments received from UNFPA into final report
• The consultant will submit (a) a complete, copy-edited and cleanly formatted English analytical report (25-30 pages excluding annexes) with references as a Word document (template to be discussed and agreed upon at a later stage), (b) an executive English and Arabic summary (2-3 pages each language) with the key findings and recommendations, and (c) a power point presentation in English/Arabic language (with 15-20 slides each language) summarizing key outcomes and findings of the evaluation exercise.
• The consultant will be expected to take part in 1 technical meeting (person or remote) depending on the situation to present the findings

Support to be provided by UNFPA

• Clarify consultancy TORs and expectations
• Avail all documentations
• Be available for meetings with the consultant when need be
• Facilitate organization of meetings and interviews where possible
• Provide additional and immediate advice and information when need be
• Review draft report and provide input

Indicative time frame for the consultancy

Engagement of the consultant and development of the evaluation methodology

Week 1

Desk review and development of instruments ( interview guide and questionnaire)

Week 2-3

Conducting Interviews, FGDs + survey

Week 3-5

Data analysis and report writing

Week 5-7

UNFPA review period

Week 7

Submission of Final report including feedback from UNFPA

Week 8

Skills and experience required

This consultancy will require 32 working days over 8 weeks and therefore the consultant requested to fulfill this task need to be fully dedicated to this exercise and equipped to undertake requested multiple tasks. He/she should be available to start as of July 1st 2021.

The consultant must have relevant experience in reproductive health including family planning, research, evaluation, experience in development and/or humanitarian settings, knowledge of evaluation methodology, and experience and in-depth knowledge of the Lebanese context.

Qualifications

The consultant must offer the following demonstrated expertise and qualifications:

• A university degree in midwifery/ nursing/ public health/ medicine/ social sciences or other relevant specialty
• Excellent research and analytical skills
• At least 3years of extensive experiences in carrying out evaluations/assessments/ research
• Experience and knowledge in the field of SRH is essential
• Working with international organizations/ UN agencies/ donors is an asset.
• Knowledge and understanding of the culture and working modalities in Lebanon; Knowledge of the Lebanese health system is an asset
• Excellent Arabic and English spoken and written skills