Christian Health Association of Malawi (CHAM) is the biggest faith-based non-profit organization implementing health programs and providing healthcare services to 30% of the population and also trains up to 80% of the mid-level healthcare workforce in Malawi through 184 health facilities and 11 training colleges respectively. Further, over the past years, CHAM has built a strong partnership with the communities around CHAM catchment areas including faith-based structures which has contributed to improved performance of community-based projects.
At the National level, CHAM participates in the national technical working groups related to Non-Communicable Diseases (NCD) which provides policy and technical direction on NCD programming. Quick wins from CHAM’s participation in these forums have resulted in CHAM implementing NCD projects in selected facilities within its network and improving routine NCD interventions across all CHAM facilities under the essential health package (EHP).
- About the project
Non-communicable diseases (NCD) are on the rise, becoming the leading cause of death and disability globally. One of these NCDs is hypertension, which significantly increases the risk of developing further heart, brain, and kidney diseases. The World Health Organization (WHO) estimates that 1.13 billion people in the world have hypertension and out of those, three-quarters live in low and middle-income countries (LMICs). Moreover, 46% of these patients are unaware of their hypertensive status. According to a recent review of 15 geographically representative countries, direct medical costs associated with hypertension reached USD 1, 497 per person and dozens of billions of dollars. Another review in LMICs showed that average annual costs of care associated with hypertension exceeded the total health expenditure per capita4. Malawi, one of the LMICs, had an estimated hypertension prevalence of 32.9% in adults in 2009, while in 2015, cardiovascular diseases collectively contributed 12% of the total DALYS5 . Unfortunately, support for NCDs is inadequate with 2% of program funds allocated to NCDs in Malawi during the Health Sector Strategic Plan 1.
Diabetes Mellitus (DM) on the other hand, has risen in prevalence more than three times over the last half a decade. In 2021, according to the International Diabetes Foundation (IDF), the global prevalence reached 537 million among adults (20 – 79 years) costing around USD 966 billion in health expenditure. That said, 3 in 4 of these adults are living in LMICs like Malawi. Consequently, DM type 2 in Malawi is estimated to be about 1.94 % of all prevalent cases in 2019. However, in Malawi DM disproportionally affects younger people compared to global trends5. DM has no cure and, as such, patients are bound to lifelong treatment which, if committed to, is associated with the prevention of complications, lower medical costs, and consequently a better quality of life11.Strategies such as self-management education and support have been known to improve outcomes for NCD patients as well as reduce healthcare costs. Such strategies are seldom used or championed in Malawian settings, necessitating the investigation of such practices and their effectiveness in such settings. At a programmatic level, issues such as lack of guidance and adherence to national disease management guidelines, low linkage to specialist care, few quality improvement initiatives in NCD care, inadequate community awareness, inefficient data capture, and low diagnostic and treatment capacity are among other factors that reduce the effectiveness of NCD strategies in achieving the national goal.
Currently, NCD programming in Malawi is coordinated nationally by the NCD unit that is housed under the directorate of curative and rehabilitative services. The unit is given oversight by a technical working group that reports to senior management in the Ministry of Health. At the subnational level, NCD programs are coordinated by district coordinators who report to district health management teams that oversee all healthcare operations within a district. This team is also given oversight by the district council and council health committees. Oversight structures further cascade down to the facility and community level through health Centre management and village health committees respectively.
In terms of service delivery, most NCD clinics are run mostly at secondary facilities by rotating facility healthcare workers on a weekly basis under the supervision of the district NCD coordinator. Current public sector models do not have deliberate community NCD structures. On the other hand, Partners in Health (PIH/AZPU), a non-governmental organization based in Neno district, Southern Malawi, has had success implementing evidence-based service delivery models and system structures. Under PIH/AZPU, NCD care is provided through an integrated chronic care model. The model, called IC3, aims to centralize service delivery for several chronic conditions including communicable diseases such as HIV/AIDS. Such integrated service delivery models are recommended by MoH and have proved to present better health outcomes. IC3 clinics also help to reduce stigma towards chronic disease patients. Furthermore, by centralizing care, patients with comorbidities also find it easy to navigate the care system by being treated for several diseases in one session. Structurally, PIH/AZPU clinics are supervised by IC3 officers and run by medical officers. These officers are supported by a team of information systems, nursing, and clinical officers. Furthermore, NCD clinics under PIH/AZPU also place community extension workers who implement community NCD management strategies. The project will thus leverage existing expertise and strategies from both the Ministry of Health and PIH/AZPU to improve NCD care systems in 3 Northern Region districts namely Mzimba South, Mzimba North, and Nkhata Bay. As explained above, NCD control requires a form of integrated approach. The project as such will use the chronic care model to guide the implementation of an integrated set of interventions that is in line with national principles. This model works on improving routine service delivery through interrelated systems and interventions.
- The project Goal
The overall goal of the project is to enhance and strengthen NCD systems for hypertension and Diabetes care in Nkhata Bay Mzimba North and Mzimba South districts.
- Purpose of the Baseline Survey
The baseline study is intended to provide the NCD data at the beginning of the project. The survey acts as an accompaniment to the quantitative and qualitative data that is also recommended when implementing a project for the first time at the beginning of the project. Through this survey, we hope to identify any major issues and provide some insights into the opinions of key stakeholders including communities in relation to NCD systems for hypertension and Diabetes care. The baseline results will point to how best the project will be rolled out and set priorities of the project at the same time providing information that acts as a benchmark for measuring project success or failure. The baseline will also produce information that will be used to direct and guide the implementation of the project.
- Approach and Methodology
In order to conduct the baseline survey effectively, a participative methodology is envisioned where different stakeholders will be involved and take part in planning the evaluation, information gathering, analysis, and interpretation of the results and making recommendations. To achieve this, the survey will employ a variety of data collection and analysis techniques for both quantitative and qualitative data to ensure a comprehensive baseline exercise. This will include the following, at a minimum;
- Desk review: Literature and secondary data review of relevant NCD documents in all the implementing districts
- Surveys: Application of structured survey questionnaires with a representative, random sample of the target population to quantitatively assess outcomes.
- Focus Group Discussions: With target groups and other stakeholders to assess implementation experiences and effectiveness, document successes, challenges, and lessons learned, and develop recommendations for improvement.
- Key Informant Interviews: Consultations with key district implementing partners/donors and other local key players. Guidance on appropriate stakeholders to engage during the exercise will be provided by MOH and District Health Office (DHO).
- The Baseline Survey Process Phases
The methodology of the baseline survey processes is divided into phases as follows;
Phase 1: This phase will consist of planning – clarifying the baseline assessment objectives, literature review, refining the data collection tools, planning logistical arrangements, and orienting the interviewers and selecting survey sites.
Phase 2: This phase will consist of data collection. To achieve this, the Consultant will conduct consultations and interviews with key district implementing partners and other stakeholders. The consultant will assemble a separate team in consultation with CHAM.
Phase 3: This phase will consist of the analysis and interpretation of the findings/results of the survey. The consultant will produce the draft report and submit it to CHAM Secretariat Survey Team for input.
Phase 4: This phase will consist of the production of the final baseline survey report of the SANOFI Project and the debriefing and dissemination workshop.
6. Composition of the Baseline Survey Team
In order to encourage a participatory process and to avoid bias in the survey findings, the CHAM will recruit a Consultant who will be supported by CHAM Secretariat team.
- Specific Roles and Responsibilities
- Consultant Responsibilities
- Give regular feedback to CHAM Secretariat on progress.
- Conduct literature and secondary data review of relevant documents.
- Lead and supervise data collection teams to ensure effective execution of the baseline survey processes.
- Analyze data and produce draft report on findings.
- Incorporate comments from CHAM Secretariat Survey Team on the draft report; and
- Production and submission of a final report.
- CHAM Secretariat responsibilities
- Select and hire a consultant to carry out the baseline survey.
- Guide and manage the Consultant in all aspects of their work. Ensure that outputs from the consultant are completed in a satisfactory and timely manner.
- Provide logistical support for the baseline survey team to be able to access the data collection sites.
- Devise a budget for the survey and manage financial expenditures.
- Supervise the field data collection processes
- Approve the final report.
- Consultant Responsibilities
Who can Apply
A reputable registered research institution and/or an accredited institution of higher learning in Malawi
- Consultant Qualifications and Experience
The consultants to be selected should bring a mix of the following expertise:
- More than seven years of experience in conducting organizational surveys/assessments, institutional reviews and strategic plan development/evaluations.
- Excellent understanding of current MOH Strategic Plans and Policies, Public-Private Partnerships (PPP), CHAM Structure, Decentralization and District Health Management Systems.
- Excellent understanding of Essential Health Package (EHP), its program indicators, and Health Management Information System (HMIS/DHIS-II) including Non-Communicable Disease Indicators.
- The lead consultant should have a minimum of a Master of Science degree in relevant fields, including Public Health, Health Informatics, Monitoring and Evaluation, and Strategic Management and Planning.
- Experience working with, the Ministry of Health, Local Councils, Community structures, Churches, and Health care delivery systems in Malawi and
- Excellent facilitation and communication skills in both English and Chichewa
- Expected Outputs and Deliverables
The consultant will be expected to deliver the following:
- Production of an Implementation Plan of the Baseline Survey with the CHAM Secretariat team.
- Develop and share data collection tools for the baseline survey with CHAM Secretariat
- Train survey team members on all the data collection tools and approaches
- Produce and submit a draft baseline survey report to the CHAM Secretariat team for their input and feedback.
- Submit three copies of the final reports of the baseline survey in hard and electronic copies within two weeks of receipt of CHAM Secretariat comments and questions on the draft report.
- Facilitate Stakeholders’ Dissemination Workshop of the survey findings, and
- Develop an Action Plan for project implementation based on the survey findings and comments from stakeholders.
- Application submission information
Interested candidates should submit their two (2) envelopes of the Technical and Financial Proposals sealed envelopes marked, “PROPOSAL SUBMISSION TO CONDUCT BASELINE SURVEY OF THE SANOFI PROJECT, ENTITLED; “STRENGTHENING NCD SYSTEMS IN NORTHERN MALAWI” addressed to:
The Executive Director
Christian Health Association of Malawi (CHAM)
P.O Box 30378
Interested candidates may obtain a full Request for Proposal (RFP) document from CHAM Secretariat’s Procurement Officer and M&E Manager: firstname.lastname@example.org email@example.com, firstname.lastname@example.org prior to the deadline below.
All completed applications should be submitted to CHAM Secretariat no later than 18th August 2023.