Health Facility Assessment for the “Health Resilience of North-East Nigeria (HeRoN)” consortium project

International Rescue Committee, Maiduguri, Nigeria

Skill Required:, Monitoring and EvaluationProject/ Programme ManagementResearch and Analysis
Preferred Experience: 
Above 10 Years
Closing Date for Applications: 
5th April, 2020

Job Description

Background Information

Public healthcare in Nigeria has suffered from years of under funding, ranking in 2016 as one of the lowest healthcare expenditures in Africa and the world[1]. This has contributed to Nigeria having the second highest total maternal mortality, second highest child mortality and some of the highest global rates of malaria, HIV, TB and neglected tropical diseases[2]. Immunization coverage is dangerously low[3] and while many health interventions are donor funded, the country is expected to be ineligible for a range of foreign health financing, including from the Global Fund and World Bank, over the next two decades

Outcome 1: Quality primary health and nutrition services are available and accessible: The partners will support the delivery of comprehensive health and nutrition services in selected LGAs, in accordance with National Guidelines and in conjunction with state government priorities. By increasing access to and demand for health and nutrition services for children, pregnant and lactating women, the HeRoN project will contribute towards reduction of infant and under five mortality rates, and reduction in the maternal mortality ratio. The increased access and availability of health and nutrition services will result in an increase in the number of clients utilizing health services, increase the percentage of births attended by skilled health personnel in health facilities. Further integration of nutrition and immunization components will lead to an increase in the percent of infants 0-5 months receiving exclusive breastfeeding, increase in the percentage of children 0-12 months who receive their third dose of DTP-containing vaccine among others. The project will improve the quality of health and nutrition services in target locations. Through improved quality assurance systems, the project will contribute towards an increase in the percentage of health facilities achieving improvements in quality services. Investment in improved technical competencies will result in an increase in percentage of human resource capacity enhancement required for improved primary health care and nutrition services.

Outcome 2: People seek timely services and take informed actions to prevent new disease, and spread of existing disease including malnutrition: We will support the roll out of the national Community Health Influencers, Promoters and Services (CHIPS) program strategy, which aims to create demand for health services by working with community health care workers. Technical support will be provided to the SMOH, SPHCDA, and LGAs to fully roll out the CHIPs program in Yobe while supporting the Borno SPHCDA to plan the introduction of the CHIPS program. In Borno we will work with LGA authorities to utilize existing community health work schemes, including community oriented resource persons (CORPs). We will also coordinate with SPHCDA and SMOH, and planned intervention under the MCRP to ensure aligned support to the CHIPS program in Borno to support the health system and align community interventions with national policy.

Outcome 3: Services are effectively planned, managed and budgeted (facility and community level): The project aims to sustainably strengthen the health system so that in the long run it is able to prevent and respond to shortfalls such as drug availability problems, low/unreliable salaries and key equipment shortages. Using a conflict sensitive approach, we will support facilities to self-assess their organizational capacity in leadership; strategic planning; management; and outreach, and to develop and implement organizational development plans (these could include supporting facilities to develop job descriptions, training staff on drug management or financial management, developing stock management procedures, etc.). We will follow the phased five-stage approach to support each targeted LGA with their organizational development (OD).

The purpose of the Health Facility Assessment (HFA):

  • HeRoN consortium partners require a detailed health facility assessment to: i) provide insights into the adequacy of health facility service delivery, ii) inform the design of packages of activities and services aimed at strengthening health facility service delivery, and iii) make available information corresponding baseline indicators for evaluation purposes.

Specific objectives of the HFA:

  • Conduct a desk review of recent health facility assessments in all target LGAs already carried out by other stakeholders (for example those conducted under the Basic Health Care Provision Fund (BHCPF) framework, or the Health Resources Availability Mapping System (HeRAMS))
  • Following the desk review produce a matrix of relevant health facilities, outlining what is known, and what are outstanding questions about each facility which need to be answered in our new assessment
  • Undertake a detailed health facility assessment (outcomes 1 and 3) in a sample of around half of the targeted health facilities (total is expected to be in the region of 80-90)
  • For project targeted health facilities that are not part of the sample under #3 above, develop a checklist for partner organizations to utilize to determine specific needs for equipment, rehabilitation, WASH facilities, physical barriers for people with disabilities etc in each health facility
  • Undertake a Knowledge, Attitudes and Practice (outcome 2) survey to provide insights to outcome 2: People seek timely services and take informed actions to prevent new disease and spread of existing disease including malnutrition.

Scope of work and deliverables

Desk review of HeRoN documents, the results framework and recent health facility assessments in all target LGAs already carried out by other stakeholders (for example those conducted under the Basic Health Care Provision Fund (BHCPF) framework, or the Health Resources Availability Mapping System (HeRAMS)).

Production of a matrix of health facilities, as outlined above

Detailed health facility assessment

in a sample of around half of the targeted health facilities, working closely with the IRC health team to develop/review Health Facility Assessment Tools. The assessment includes (but is not limited to):

  • Adequacy of infrastructure as per States’ plans and guidelines (including adequate WASH facilities and power sources)
  • Analysis of health services including service packages provided by the health facility and utilization rates of the services
  • Adequacy of staffing levels as per States’ plans and guidelines, including attrition analysis
  • Adequacy of diagnostic medical equipment (including cold chain)
  • Adequacy of medical supplies including drugs, vaccines, equipment and supply chain management (based on storage practices, retrospective stock information, review of SOPs, review of stock and inventory documents), as well as other consumables and commodities
  • Adherence to a standardised health management information system (HMIS, based on review of past reports – timeliness, completeness, archiving process)
  • Access to telecommunication (mobile) networks
  • Access to emergency referral system (ambulance or other)
  • Presence of other organization(s) that support the health facilities and, if so, in what specific areas (such as drug supply, support to human resource etc).

Knowledge, Attitudes and Practice survey

in sample locations from target LGAs in Borno and Yobe states[6] (likely to be in the region of 20-25 LGAs), to provide insights to outcome 2: People seek timely services and take informed actions. This task will include (but is not limited to):

  • Determine appropriate methodology and sampling procedures
  • Develop/review data collection tools for the KAP survey
  • Undertake field data collection, and subsequent data management and cleaning
  • Conduct data analysis

Produce one comprehensive report that includes presentation of findings and insights for all three components (desk review, matrix, Health Facility Assessment and Knowledge, Attitudes and Practice Survey), identification of cross-cutting themes, and presentation of corresponding baseline values. This task will include:

  • Share preliminary report with consortium coordination team as per agreed timeframe
  • Finalize the report including clear baseline measurement benchmarks and recommendations
  • Final presentation meeting to IRC and partners of key findings and recommendations presented in the report.


For both the health facility assessment and the survey, the IRC suggests a mixed methods approach, integrating quantitative and qualitative methods, ensuring collection and reporting of corresponding baseline data. Data triangulation and integration including Key Informant Interviews, Focus Group Discussions (FGDs) with beneficiaries, observations of existing infrastructure, and service delivery components at the facilities will be essential. The consultant is free to suggest an appropriate methodology that fully addresses all ToR requirements with reference to the following:

  • Health Facility Assessment (outcomes 1 and 3) – after the initial desk review of recent assessments by other stakeholders, the current assessment is to include consideration of all three levels of Health Facility, staff, and client perspectives, ensuring that there is a strong quality of care component as well as adequate infrastructure, qualified human resources and inventory. This also includes the analysis of health service packages provided by the health facilities and the utilization rates of the services as well as the roles of other non-HeRON partners in those health facilities (if any).
  • Knowledge, Attitudes and Practice Survey (outcome 2) – community level data collection focusing on knowledge, attitudes and practices for health seeking patterns, prevention of new disease and spread of existing disease including malnutrition

Indicative timeframe and budget

  • The overall expected timeframe for this work is 35 to 40 days
  • Budget submissions should not exceed US $40,000


Profile of consultant(s)

The Health Facility Assessment and Knowledge, Attitudes and Practices survey call is open to all interested and qualified national and/or international consultants meeting the under-listed criteria:

  • Master’s degree or higher in Health background, Nutrition, Public health or related field with strong understanding of humanitarian emergency programming.
  • At least 10 years proven experience in research, assessments and evaluations in areas of health, Nutrition, reproductive health and health systems strengthening in emergency context.
  • In-depth knowledge of quantitative and qualitative research methods
  • A good understanding of consortium programming
  • Excellent analytical, presentation and writing skills in English
  • Experience in similar assignments or context in health programming.
  • Proposal deadlines and contact details


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