Save the Children Internation, Gates Anchor IV child survival and nutrition advocacy Project end-review and documentation, Addis Ababa, Ethiopia.

Type of work: Terms of Reference (ToR) to hire consultancy service conducting Gates Anchor IV Health & Nutrition project End–Review and Documentation of Lessons Learned.

Expected length: 45 days (1 1/2 months)

BACKGROUND

Gates Anchor IV Child Survival and Nutrition Advocacy Project April 2021-March 2025

Ethiopia has made significant progress in improving access to primary health care and reducing undernutrition. This success is largely attributed to the implementation of the health extension program (HEP) and integrated community case management (ICCM) approaches. However, in the pastoralist regions of Somali and Afar, maternal and child mortality and morbidity rates have remained high with minimal improvements over the past two decades. The health system in these regions is under-resourced and ill-equipped to address the unique challenges, resulting in poor-quality and inaccessible services.
Save the Children International (SCI) Ethiopia is promoting inclusive decision- making and rights-based advocacy through its governance and rights pillar. Funded by BMGF in April 2021, the ETH-Gates Anchor IV project focuses on child survival and nutrition advocacy in Afar and Somali regions. Its goals include increasing health sector funding allocation, strengthening civil society coalitions for governance, and enhancing accountability mechanisms at the community level. The project collaborates with the Ethiopian Civil Society Health Forum (ECSHF) and the Coalition of Christian Relief and Development Association (CCRDA) to improve transparency and accountability in the health sector.

The SCI child survival nutrition advocacy project has to contribute to policy change through evidence-based advocacy and empowering ECSHF/CCRDA partners to participate and vibrantly engage with policymakers (policy process) on issues that affect citizen’s lives as they arise from the Community Score Card (CSC) process and other public spaces and fora.
Over the past four years, Save the Children International and The Bill and Melinda Gates Foundation (BMGF) have built a strong partnership to support our ambition to ensure no child dies from preventable causes before their fifth birthday. This partnership has funded our integrated child survival advocacy efforts at global and national levels, influencing policy and financing in both donor markets and implementing countries.

Save the Children International has aimed to address the equity gap in child health: immunization, and nutrition indicators (contribute to the reduction of child mortality to 30/1000 live births and achieve UHC by 2030 and beyond) in the context of COVID-19 through achieving improved financing for health through enhanced accountability and strengthened civil society engagement on budget transparency, equitable financing and delivery of health and nutrition interventions in Afar and Somali Regions. Further, SCI has been strengthening CSOs’ capacity, including raising children’s voices, to advocate for enhanced National to Global Accountability Mechanisms on the SDGs. We have built on our programming, research, and advocacy expertise to design and deliver our strategic outcomes. A focus on gender equality, child-centeredness, and social accountability is at the heart of delivering this project.

The Gates Anchor IV project has made significant progress in advocating for health and nutrition budgets in collaboration with local governments and civil society organizations. Health budget allocations in the Somali regional government increased from 6.5% in 2014/15 to 17.8% in 2021, despite ongoing challenges such as drought and conflict.
Similarly, in Afar, intensified evidence-based budget advocacy efforts led the regional government to progressively increase its budget allocation for the health and nutrition sector, growing from 7.2% in 2014/15 to 13.48% in 2019/20. However, the invasion of Tigray forces into the adjacent woredas negatively impacted budget priorities, shifting funding towards security and the resettlement of internally displaced persons (IDPs). As a result, the allocation fell to 8% in 2020/21. Following the end of the conflict, Save the Children International (SCI) and its partners advocated to cabinets and parliamentarians to reconsider the allocation, which was adjusted to 11% for the 2023/24 budget.

However, recent fiscal assessments reveal a decline in health allocations and a need for ensuring lasting impact amidst emerging budgets from new sector agencies and reduced revenues. The urgency for an end review stems from the necessity to document lessons learned, assess advocacy successes, and refine strategies for future initiatives.
This review will analyze the contribution of the Ethiopian Civil Society Health Forum (ECSHF) in promoting health equity and governance, evaluate the impact of community social accountability initiatives, and assess the alignment of health programs with strategic goals. By capturing insights from the project, Save the Children aims to strengthen future health advocacy efforts and ensure sustainable improvements in health services, ultimately driving progress toward universal health coverage.
SCI will hire an external consultant to review project implementation with stakeholders at national and sub-national levels, providing logistical support. The MEAL managers and coordinators from the Semera and Jigjiga Field offices will assist the consultant during this process. The consultant will develop a methodology, using mixed and participatory methods to gather insights on the Gates Anchor IV RMNCAH and nutrition advocacy project, reflecting on successes, challenges, and lessons learned from the past four years.

OBJECTIVES

The project end-review aims to evaluate the Gates advocacy project on child survival, and Nutrition (CS&N), focusing on primary health care and child survival. It will highlight achievements, challenges, and lessons learned to inform future advocacy in the Afar and Somali regions. The final assessment will be shared with the Ministry of Health, regional health bureaus, and over 270 civil society organizations involved in health and nutrition advocacy.

The specific objectives of the project-end review and documentation are as follows:

• Conduct an in-depth review of the Gates Anchor IV project to review its implementation processes and effectiveness in achieving objectives related to Primary Health Care (PHC), and Universal Health Coverage (UHC).
• Assess the degree of involvement and collaboration among all project stakeholders at national and sub-national levels, highlighting successful practices and areas that require enhancement.
• Capture and distill significant lessons learned throughout the project duration to provide valuable insights for future initiatives and refine advocacy tactics within the health and nutrition domains.
• Systematically review the outcomes of advocacy efforts on health budget allocations and policy transformations, with a specific emphasis on their effect on child health and nutrition in the targeted regions.
• Formulate practical recommendations derived from the review findings to inform future programming and ensure the long-term viability of health interventions.
• Ensure effective communication of the identified lessons learned and best practices to all relevant stakeholders to promote sustained commitment to health advocacy and improve the design and execution of future projects.

For Full information please refer the linked document: TOR for hiring consultant on project-end evaluation Sc-UK edits cleannn BW (003).pdf – Google Drive