Country: Kenya
Closing date: 21 Dec 2015
1. INTRODUCTION
The Fred Hollows Foundation is seeking applications for a research consultant to complete a qualitative study into the barriers to accessing eye health services women that face in Kenya. The results of this research will provide an evidence base that is expected to inform the development of a robust intervention to address unequal eye health access and outcomes. The project will be implemented in Baringo and Siaya Counties in Kenya with the support of The Fred Hollows Foundation and will utilise gender-sensitive eye health programming.
The consultancy will include the development of a research report which will be used for internal and external dissemination among stakeholders as well as advocacy with partners.
2. BACKGROUND
The Fred Hollows Foundation
The Fred Hollows Foundation in an independent, non-profit organisation that was established in Australia in 1992. The Foundation has worked in over 40 countries around the world, and continues to be inspired by Fred’s lifelong endeavour to end available blindness. Since 2004, The Foundation has worked in partnership with the Kenyan Ministry of Health to improve access to high quality eye health services in Kenya through community empowerment, health system strengthening and capacity building of health professional training institutions.
Gender and Eye Health
In 2001, a meta-analysis on blindness prevalence in Asia, Africa and industrialised countries revealed that women bear approximately two-thirds of the burden of blindness in the world. While the excess blindness in women occurred in all the regions studied, the factors behind the disparity inevitably vary greatly according to situational determinants. Thus, planned interventions must be appropriately informed by situational research and tailored to the context. This premise forms the basis for this study.
In Kenya two of the leading causes of avoidable blindness are cataract and trachomatous trichiasis. Existing research informs us that, while both diseases disproportionately affect women, women are often significantly under-represented as beneficiaries for eye health services. For example, in their study of developing countries, Lewallen and Courtright found that while females accounted for 63% of all cataract cases - the cataract surgical rate was up to 1.7 times higher for males.
In the case of trichiasis, women’s gender-prescribed roles as caregivers are directly related to their increased risk of acquiring the disease and becoming blinded by it. In fact, women are three times more likely than men to be permanently blinded by trachoma, because they have both greater exposure to the disease and less access to treatment and care.
Blindness for women means more than not being able to see. It affects her ability to attend education, care for her children, earn a living and the chances of her becoming married, thus perpetuating and promoting poverty.
3. PURPOSE
The Foundation is seeking applications for a research consultant to 1) undertake a desktop review and 2) conduct primary data collection (utilising qualitative methods), to 3) analyse the supply and demand-side barriers affecting women’s access to eye health in Siaya and Baringo Counties, Kenya. The research is expected to inform the development of a robust, evidence-based intervention to address unequal eye health outcomes and ensure delivery of gender equitable services in Kenya.
4. OBJECTIVES
The objectives of this research project are to:
• Identify the supply-side and demand-side barriers women face in access and utilisation of cataract and trachoma health services in Kenya.
• Based on the research findings, provide specific recommendations for a gender-targeted intervention to mitigate these barriers and thus improve the delivery of gender equitable eye health services in Kenya.
• Produce a report that will contribute to the broader evidence base and that can be used for internal and external dissemination among stakeholders as well as advocacy with partners.
5. SCOPE OF SERVICES
The Foundation is seeking expert input to undertake a research project in Siaya and Baringo Counties, Kenya, involving the following steps:
5.1 Project planning
In planning the research project, two initial activities should be completed:
• Ethics Approval - The consultant will be required to apply for a Research Clearance Permit from the Kenya Government. The application must be submitted three months prior to conducting the field-work element of this project, as to allow adequate time for processing.
• Research Protocol – In collaboration with The Foundation’s Kenya team, the consultant will develop a research protocol to best address the research questions within the research scope. The protocol will outline the following key elements:
o Background
o Research aim and objectives
o Data collection tools, research methods
o Field plan
See Annex One for further details
5.2 Data collection and field-work
The consultant will conduct desk-based research and qualitative research through field-work in Siaya and Baringo Counties. Data collection will be guided by the following key research questions:
• What are the supply-side barriers women face in access and utilisation of cataract and trachoma health services in Kenya?
• What are the demand-side barriers women face in access and utilisation of cataract and trachoma health services in Kenya?
• Based on the findings, what are the specific recommendations for a gender-targeted intervention to mitigate these barriers and thus improve the delivery of gender equitable eye services in Kenya?
The desk-top review will involve two key activities:
• A comprehensive literature review on both published and grey literature (with a particular focus on African-based research) will be undertaken to assess the current evidence on:
o the main themes related to barriers (both supply and demand-side) women face in accessing eye health services - both for cataract and trachoma services;
o the effectiveness of gender-specific interventions that have been proposed to mitigate the barriers women face in accessing eye health services – for both cataract and trachoma; and
o identification of research gaps in this literature.
• A review of eye health service utilisation data. This will be completed by examining The Foundation’s existing gender disaggregated data, collected for monitoring and evaluation purposes, and conducting a comparative analysis with available cataract and trachoma disease prevalence data.
The qualitative research component will involve the following three activities:
• Semi-structured interviews will be conducted to collect information from eye health seekers. Interviews will be conducted with women who have lived with trachoma or cataract and sought treatment and women who are living with cataract or active trichiasis and have not sought treatment. A total of 6-8 women from each group will be interviewed, or until data saturation is achieved. Where possible the participant’s husbands will also be interviewed to gain an understanding of the influence of household decision-making processes. To capture differences in perceptions and experiences, women from the following groups should be represented:
o Women who have lived with cataract and women who have lived with trachoma
o Women from rural locations and women from urban locations
o Older women and younger women
o Women from Siaya and women from Baringo Counties.
• Focus group discussions (FGDs) will be conducted with women and men separately to collect information on the broader community’s perceptions and experiences regarding access and barriers to eye health care.
• Semi-structured interviews will also be conducted to collect information from eye health providers and decision makers from various levels, who will be interviewed to gain an understanding of health sector/provider perceptions regarding the barriers women face in accessing eye health care. Those to be interviewed should include; 1 member of the Kenyan National Ministry of Health, 1 member of the Ministry of Women’s Affairs, 2 County-level government officials, 2 Ophthalmologists, 2 mid-level ophthalmic assistants, 2 TT Surgeons and 2 community health volunteers, and other providers as mutually agreed by the consultant and The Foundation’s Kenya team.
The interviews and FGDs will explore four board themes being; accessibility, availability, affordability and acceptability. The participants will be selected using purposive sampling, identified with the assistance of community health volunteers and snowball sampling to identify those in the community who haven’t sought treatment for their eye problems.
5.3 Analysis
To analyse the collected data the consultant will utilise a qualitative research approach. The consultant may utilise the Research Conceptual Framework developed for a similar study recently undertaken in Cambodia to guide the analysis and interpretation of the data.
See Annex Two for further details
5.4 Project Recommendations
A key objective for the research is to provide an evidence base that will inform the development of a strategic intervention to ensure delivery of gender equitable eye services in Kenya. Thus the consultant is expected to develop a set of project recommendations from the findings. The recommendations should be delivered as a presentation at a planning workshop. The workshop will involve participation from the research team, The Foundation’s Kenya Project staff, the Africa Regional Team and Program Development representatives. Providing the research indicates that a gender-targeted project is necessary, these participants will work over the course of 1-2 days to ensure the findings are appropriately integrated into the Project Implementation Plan.
5.5 Final Report
The consultant will lead the production of a Final Research Report, to be submitted at the completion of the consultancy. The Report should present a comprehensive overview of the research project and be structured into five key sections:
• Background information
• Methods (Field and desk- based research)
• Research results
• Discussion & recommendation
• Conclusion
In developing this report, the consultant will be required to present preliminary findings to stakeholders (The Foundation’s Kenya team, MoH representatives and participating health services), and incorporate stakeholder’s feedback into the final report and recommendations.
It is also expected that the research will contribute to the broader evidence base and thus the Report should be appropriate for internal and external dissemination among stakeholders as well as advocacy with partners. It should also be noted that, depending on the outcomes of the research, the findings may be published in an academic journal.
6. ROLES AND RESPONSIBILITIES
The research team will be led by a Consultant (female), who will be supported in the logistical arrangements and technical input by two members of the FHFK programs team, two members of the Africa Regional Team and the Operational Research Coordinator. A local eye health professional may be requested to guide the process while conducting the field work component of the research.
The consultant will be responsible for obtaining ethics clearance, developing the research protocol and all data collection, data analysis, and report writing.
The Foundation’s Kenya staff will assist where necessary, for example in approvals, listing of confirmed interviewees, information to interviewees and other logistics.
7. CONSULTANCY DURATION & DELIVERABLES
The consultancy will be carried out up to a maximum of 70 working days, over the period of four months 1/03/2016 – 31/06/2016. However, due to the processing time for Ethics Clearance, the Research Application will need to be submitted prior to this starting date.
The field work required for the qualitative data collection is expected to be completed within 25 days, including data management (transcribing of the transcript and translation of some transcript). The field-work will be conducted simultaneously to the planned Situational Analysis The Foundation’s Kenya team will be conducting, in the month of March 2016.
The consultancy team is expected to complete the following activities:
Deliverable Timeframe
Research Clearance Permit application to
be submitted to the Government of Kenya December 2016 Research Protocol is finalised 22/02/2016
Field-work is conducted 1/03/2016 – 31/03/2016
Data Analysis is conducted 1/04/2016 – 30/04/2016
Present draft research report to stakeholders 2/05/2016Project
Recommendations submitted 1/06/2016
Final Report is produced 31/06/2016
8.QUALIFICATIONS & ESSENTIAL SKILLS
Successful applicants must have the following competencies:
• Relevant professional qualification(s) with established expertise in gender and development
• Significant experience in conducting research to inform project design, preferably in the health sector
• Strong skills in qualitative research design, interviewing, and qualitative data analysis.
• Experience in undertaking gender equity related field research and writing
• Fluency in English
It is desirable that the consultant will also have:
• Proven portfolio of research and/or relevant experience in gender and development
• Knowledge of health system strengthening and eye health care
• Proven ability to translate research into project design objectives and activities
• Experience in publishing research in academic journals
9. OTHER CONSIDERATIONS
9.1 Confidentiality
The consultancy team agrees to not divulge confidential information to any person for any reason during or after completion of this contract with The Foundation. Upon completion or termination of this contract, the consultancy team undertakes to return to The Foundation any materials, files or property in their possession that relate to the business affairs of The Foundation.
9.2 Intellectual Property
All intellectual property and/or copyright material produced by the consultant/s whilst under contract to The Foundation remain the property of The Foundation. The consultant/s is required to surrender any copyright material he or she has created during the term of the contract to The Foundation upon completion and termination of the contract. The consultant/s also consents to The Foundation using any works produced as part of this consultancy without attribution and waives all other moral rights in this work.
9.3 Insurance
The consultant/s involved in this research project will be required to have insurance arrangements in place appropriate to provision of the requirements in this Terms of Reference, including travel insurance.
9.4 Other
The Fred Hollows Foundation strongly condemns all forms of child abuse and categorically states that it is unacceptable in any circumstance. The Foundation is committed to ensuring a safe environment and culture for all children with whom we come in contact during the course of our work. The Consultant and all other members of the research team will be required to comply with The Foundation’s Child Protection Policy and sign the Child Protection Code of Conduct.
ANNEX ONE: Guidance on Project Planning
ETHICS APPROVAL
All persons wishing to conduct research in Kenya must have a Research Clearance Permit from the Kenya Government. Permits are issued by the National Council for Science and Technology located at Utalii House House, along Uhuru Highway in Nairobi city.
Applicants must submit a completed application form (available here in PDF format: for Kenyan Nationals or for Foreigners) three months before the start of the research project.
Below are the steps to apply for research permits:
Step 1: Carefully read PART 1 before completing the research application form. This part explains the terms and conditions for getting a research permit and the list of support documents.
Step 2: Identify an appropriate affiliating institution in Kenya. A complete list of the approved affiliating institution is provided in the ANNEX. Please, note that each affiliating institution has its own terms and conditions. It is the applicant’s responsibility to contact and seek approval from the relevant departments in the affiliating institution. The affiliation must be confirmed in writing.
Mpala Research Centre qualifies as an affiliating institution for short-term research visits and student projects. For proposals to conduct long-term research at Mpala Research Centre the affiliating institution is usually the Kenya Wildlife Service (send a fax to: "Research Department, KWS"; fax number +254 20 501188), or National Museums of Kenya (send fax to: "NMK Representative to Mpala Research Centre"; fax number +254 20 3741424).
Step 3: Send the completed research application form (A or B) and affiliation form D to the affiliating institution for endorsement. This can be done by courier service or e-mail.
Each person in project is required to fill a separate research application form.
Step 4: Assemble all the paperwork including the support documents listed in PART 1, and forward the application parcel (DO NOT include the research fee) to the research clearance office in Nairobi. The address to use is:
Attn: Mr. Edward Opiyo,
The Research Registry Office,
National Council for Science and Technology,
Utalii House, 8th Floor, Room 806
P.O. Box 30623-00100,
Nairobi, Kenya
Step 5: Send the research fee by wire-transfer to Mpala Research Centre. Contact Mr. Tuni Mburu (tuni@mpala.org), the MRC Operations Manager for account details.
Step 6: Wait for official communication from the Head of Research Division, NCST (the review process can take at least one month to complete).
Step 7: Enter Kenya on a tourist visa when you receive official confirmation from the NCST that your permit has been approved and is therefore ready for collection.
Important notes
• A diplomatic visit to the Officer in Charge of Research Clearance at the start of your research is strongly recommended, and will facilitate further permit renewals. Make sure you book an appointment when you visit the office.
• All permit holders must:
a) read and comply with the regulations listed on research permit application Forms A and B (including reporting obligations)
b) deposit a photocopy of their Research Permit with the Operations Manager upon arrival at Mpala Research Centre before commencing research
• Masters and PhD candidates are required to apply for their own research permits. Undergraduate students participating in field courses must apply for research clearances, and will get attached on the Professors permit.
• NCST DOES NOT ACCEPT CHEQUES or POSTAL MONEY ORDERS. Payment of the fee will be required before your research permit is processed.
• Co-PIs are required to apply for a research permit under the Lead PI. The application paper work and procedure is same as the above.
• Researchers intending to stay in Kenya for longer than a month must also obtain a Pupils Pass from the Department of Immigration. Click here to download the application form and instructions.
• For individuals who require exportation of biological materials from Kenya, the following permits MUST be acquired:
a) Material Transfer Agreement (MTA)
b) Export permit
c) Phytosanitary Certificate
For further information on the government research permit application process, please contact Chris Odhiambo, codhiambo@mpala.org.
RESEARCH PROTOCOL
The following draft structure is included to assist thinking only.
1) Introduction and problem statement: an introduction consisting of a description of the research topic and problem statement
2) Background and a description of the literature: summary of the literature review outlining preliminary studies.
3) Conceptual framework: identification of where the research question sits within a complex interplay of relationships, theories, events or actions. This can be illustrated either by a diagram with relevant peer reviewed citations (especially for causal events) or alternatively, provided as a written piece.
4) Research aim and objectives: the major aim of this research should stem directly from the literature review and the 2-5 objectives will express the major questions to guide the research.
5) Importance and relevance: explain why the research is important and how the findings might impact:
a. Policy
b. Practice or programming
c. Knowledge
6) Methodology: short description of the approach to be used to answer the research objectives / questions.
7) Method: the technique or procedure used to collect the data/information. This may include:
a) Study design: method chosen and why
b) Study population (who, where) and sampling frame (how many, justification)
c) Data collection procedure: how will you collect data, how will you recruit research participants, data collection instruments
d) The type of data analysis needed
8) Work plan / timeline for the research. Suggested format for the timeline: Gantt chart
9) Implementation: in simple statements a description of:
a) Who is part of the research team
b) Any stakeholders that must be involved for the research to be conducted
c) Any special considerations, such as special approval from a government agency, or community group or other issue.
d) Any special requirements for personnel or equipment
e) Tasks of the research team
10) Ethics: a clear statement outlining all ethical considerations specific to the research that will need to be managed as part of the project.
11) Budget
12) Translation and dissemination plan: explanation of how the research findings will be used to influence policy and/or practice through a translation and dissemination plan.
13) Limitations of this research
14) References
15) Data collection tools: include any tools utilised, such as questionnaires for interviews and focus group discussions.
ANNEX TWO: CONCEPTUAL FRAMEWORK
The following eye health and gender equity conceptual framework provides an analytical framework for assessing gender-related barriers in eye health care access . The consultant may consider it useful to shape the structure of the research and has been included to assist thinking only.
The framework may need to be adjusted on the basis of initial desk-top review findings on the gendered issues within the context of eye health care in Siaya and Baringo Counties, Kenya.
DEMAND-SIDE - Factors that influence eye health SUPPLY-SIDE– Barriers to Access Eye Health outcomes for women Care
Accessibility Availability Affordability Acceptability
- Social & Cultural factors
Cultural: Status of women
Social: Age & Sex - Access to and control over resources
Household resources:
a) Education level
b) Maternal Occupation
c) Marital Status
d) Economic status - Economic Factors
a) Cost of care
b) Treatment
c) Travel
d) Time - Geographical Factors
Distance & Physical access from eye health services - Institutional/Organisational factors
Perceived quality of eye health care from service user perspective, eg: -Availability of sex/age disaggregated data -Attitudes of staff -Interpersonal process (participation of patients in eye heath decision-making
In addition to this framework, the following questions have been drafted to help shape the analysis and recommendations.
• What are the differences in the access and utilisation of eye-care services by men, women, boys and girls in the target areas? How has this differed by age, disease type (cataract or trachoma) and the location of communities?
• Why haven’t eye care services been delivered / accessed / used equitably to men and women within the Counties previously?
• When eye care services have been accessed and used by women, what have been the enabling factors?
• How could the health system function more effectively to promote gender, equity and social inclusion in Kenya?
• Where do the opportunities or entry points for change exist along the continuum of care from a supply and demand side perspective?
• What additional service delivery mechanisms might be required for women or men to address any gaps?
How to apply:
Individual or consulting company who is interested can submit resume, quotation for services and a brief work plan for consultancy (1-2 pages) to The Foundation by email: fredhollows-ea@hollows.org
The submission deadline is 21st December, 2015.
