Evaluation Of Health Planning Based On Acf’s Rss Method And Its Effects On The Health System At Action Against Hunger France

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TERMS OF REFERENCE:

EVALUATION OF HEALTH PLANNING BASED ON ACF’S RSS METHOD AND ITS EFFECTS ON THE HEALTH SYSTEM IN THE REPUBLIC OF CÔTE D’IVOIRE, MADAGASCAR AND CAMEROON

CONTEXT AND JUSTIFICATION:

Funded by the French Development Agency (AFD) and led by Action Against Hunger (ACF) and its local partners since 2022, the Confluences 2 project aims to contribute to nutritional security in six French-speaking African countries. As part of this project, activities to strengthen the health system in each country have been carried out, notably in Côte d’Ivoire, Cameroon, and Madagascar.

These activities aim to support District and Regional health authorities in their strategic planning work. They are based on ACF’s Health Systems Strengthening (HSS) methodology , which allows for the assessment of the health system at the local level, the identification of major bottlenecks, their prioritization, and the subsequent collaborative development of multi-year action plans for health authorities. These action plans, implemented by the Ministry of Health with the support of partners over several years, are designed to improve the functioning of local health systems in the short, medium, and long term. These activities are conducted collaboratively with all health stakeholders in the area and under the leadership of District and Regional health authorities, with the central level also involved. This approach has been implemented in various localities across seven Districts:

  • Morombe District – Madagascar
  • Districts of Ferkéssédougou, Kong and Ouangolodougou, in the Tchologo Region – Republic of Côte d’Ivoire
  • Districts of Tokombéré, Ketté, Ndélélé – Cameroon

It should be noted that the Confluences project, which took place between 2018 and 2022, was already underway in the District of Tokombéré in Cameroon, but not in the other localities concerned by this evaluation.

ASSESSMENT OBJECTIVES:

OVERALL OBJECTIVE:

The overall objective is to evaluate the health planning process based on ACF’s RSS method implemented in the aforementioned Districts of the Republic of Côte d’Ivoire, Madagascar and Cameroon, as well as the effects observed on each of the short-term health systems.

SPECIFIC OBJECTIVES :

Specifically, for each country, this will involve:

  1. To evaluate the progress of the diagnostic and planning phases in the different localities, as well as the factors that facilitated or hindered the success of these steps
    1. To assess the progress of the implementation phase of the action plans in the different localities
    2. To assess the effects generated by this planning method on the governance of the different Health Districts and Regions
    3. To assess the changes generated on the health system, through the implementation of action plans from the RSS in different Districts and Health Regions, compared to previous years
    4. Produce methodological and operational recommendations to improve the quality of health planning for local health authorities, as well as for ACF teams in the countries and at headquarters

CHAMPS D’EVALUATION :

MISSION 1: In each country, evaluate the progress of the diagnostic and planning phases inherent in the ACF RSS method, in the different localities, as well as the factors that have promoted or limited the success of these steps.

This mission will:

  • To evaluate how the diagnostic and planning steps of the ACF RSS method were implemented
  • To identify the factors that promote and limit the progress and success of the diagnostic and planning steps derived from the ACF RSS method
  • To identify recommendations for replication in other Districts and Regions with similar and varied contexts

Evaluation method:

  • Identification of quantitative and qualitative indicators on the progress of the implementation phase based on the tools provided by ACF
  • Utilize project documents (RSS report, workshop minutes, meeting minutes, and other documents, annual capitalization reports, project indicator tracking tables, etc.)
  • Document review to evaluate quantitative indicators on the progress of the different stages and qualitative indicators on how the stages were implemented
  • Focus groups or interviews with key informants to identify factors that influenced the unfolding of the stages

MISSION 2: For each country, evaluate the progress of the implementation phase of the action plans in the different localities.

This mission will:

  • To assess the level of integration of the roadmaps from the RSS into the action plans of the Districts and Region
  • To assess the level of implementation of action plans in the Districts and the Region
  • To evaluate the support actions proposed by ACF during this implementation phase
  • To identify the factors that promote and limit the progress and success of the implementation phase
  • To identify recommendations for replication in other Districts with similar and varied contexts

Evaluation method:

  • Utilize project documents (workshop minutes, meeting minutes, and other documents, annual capitalization reports, project indicator tracking tables, etc.)
  • Leverage the capitalization continuously generated by the teams
  • Identification of quantitative and qualitative indicators on the progress of the implementation phase based on the tools provided by ACF
  • Document review to evaluate quantitative indicators on the progress of the implementation phase
  • Focus groups or interviews with key informants to identify factors that influenced the unfolding of the stages

MISSION 3: For each country, evaluate the effects generated by this planning method on the governance of the different localities.

This mission will allow us to assess the evolution of governance in different localities, looking in particular at:

  • Social participation (civil societies, communities and populations) in governance
  • The planning and coordination processes
  • The resilience of the health system
  • The skill level of decision-makers and stakeholders

A comparison with the situation in DS during previous years will need to be made.

Evaluation method:

  • Definition of quantitative and qualitative indicators to assess the evolution of the different components of governance, based on a literature review and qualitative data (focus groups/interviews). The assessment tools developed by ACF will serve as a basis.
  • Document review to note the different indicators
  • Focus groups or interviews with key informants to gather the perceptions of various stakeholders on the subject and to note the indicators

MISSION 4: For each country, evaluate the changes generated on the health system through the implementation of action plans resulting from the health system reviews in the different localities.

This mission will allow us to assess:

  • The improvement in performance of the pillars of the health system on which the Action Plans stemming from the RSS (Regional Health System) have focused will need to be assessed. A comparison with the situation in previous years will be necessary.

Evaluation method:

  • Definition and evaluation of quantitative and qualitative indicators to assess the evolution of the pillars of the health system on which the action plans from the RSS have focused (diagnostic indicators, action plan monitoring indicators, SIS, etc.)
  • Focus groups or interviews with key informants (system stakeholders and users) to gather their perceptions on changes in the healthcare system and contribute to scoring the indicators
  • Focus groups or interviews with communities/patients to gather their perceptions on changes in health services, their use and perception of services, and to contribute to scoring indicators

EXPECTED DELIVERABLES:

Following this evaluation, the health planning method will have documents that allow it to be critiqued, replicated, and improved in other locations. The following deliverables will be expected for each of the three countries:

  • The evaluation report on the missions presented above (15/04/2026) [1]
  • A summary of the evaluation report (15/04/2026)
  • A presentation document outlining the evaluation results (15/04/2026)
  • A workshop to present the results during a collective workshop at the national or local level (varies depending on the country, but before 15/04/2026)

At the global level, the following deliverables are expected:

  • A concise note summarizing the results of the 3 countries and proposing overall guidelines (01/05/2026)
  • A comprehensive feedback workshop at ACF headquarters (01/05/2026)

All documents must be submitted in French and in Word format.

MANAGEMENT PROCEDURES AND WORK PLAN

The evaluation team will be in direct contact with the Health Systems Strengthening Officer at headquarters, as well as the Nutrition and Health technical teams in the various countries. These teams will be responsible for connecting the evaluation team with the relevant authorities and stakeholders.

EVALUATION METHODOLOGY

This section presents the methodological approach suggested to the evaluation team for collecting quantitative and qualitative data. Examples of tools available at Action Against Hunger will need to be reviewed by the evaluation team prior to data collection.

Evaluation briefing

Before the evaluation takes place, the evaluation team will be briefed on the technical aspects of the evaluation by the Action Against Hunger team. A general briefing will be provided, followed by country-specific briefings. The general documents required for this initial phase will be shared with the evaluation team for the different countries. It should be noted that specific terms of reference for each of the three countries will be provided to ensure that the specificities of each context are taken into account.

Rapport initial

The evaluation team will prepare a brief initial report. This document will be written in French and will include the following elements:

  • Evaluation Methodology and Tools: Drawing heavily on the evaluation tools (questionnaires, indicators, etc.) developed by Action Against Hunger teams, the evaluation team will propose country-specific tools to collect the information necessary for the evaluation objectives. These tools will be submitted for validation by the ACF RSS (Social and Human Rights) coordinator. The methodology will also be described, justified, and validated beforehand.
  • The evaluation analysis plan, a preliminary analysis plan, will be described for each country.
  • A detailed work plan, including the distribution of office work, fieldwork, and workshops, with a schedule and budget, for each country.
  • Preliminary analysis of the information gathered during the literature review, which will allow us to evaluate a number of indicators presented in the method.
  • A statement of adherence to Action Against Hunger’s evaluation policy and an overview of the structure of the evaluation report.

The initial report will be presented to the country teams during a group discussion and will then be approved by Action Against Hunger’s evaluation committees.

In-depth documentary study

For each country, the evaluation team will undertake a review of key project documents. These documents include intervention-related documents and proposals, such as the RSS Guide, RSS reports and documents, progress and capitalization reports, project monitoring tables and indicators, etc. Documents related to health structure planning at the district and regional levels will also be consulted. The complete list of documents to be consulted will be specified at the beginning of the evaluation for each country.

Field mission

In each country, field data collection will be organized with the evaluators and the Action Against Hunger team to gather the necessary primary information, as outlined in the evaluation tools. The data will be analyzed by the evaluation team according to the analysis plan approved by ACF. ACF will facilitate the field data collection.

  • Primary data collection

The evaluation team will conduct interviews and focus groups with key stakeholders at the international, national, regional, district, and local levels. Key documents at the health facility, district, regional, and national levels will also be consulted, as outlined in the evaluation tools.

National or local feedback workshop with stakeholders and the health planning working committee

The evaluation team will facilitate a learning workshop in the country to present the preliminary findings to stakeholders at the national, regional, district, and local levels. They will gather feedback on the findings and build consensus on the recommendations. They will develop an action-oriented workshop report outlining lessons learned and proposed improvements for the future.

Data analysis and report writing

Based on a thorough literature review and field data collection, an analysis will be produced, following the initially developed methodology. The various deliverables will be reviewed and shared with the ACF teams to gather feedback and incorporate it into the final documents.

Overall feedback workshop and debriefing with the evaluation manager

A workshop to present the results of the entire evaluation will be organized online, in order to present all the results to the various stakeholders and other actors interested in these results, particularly at the headquarters of ACF France.

In addition to the regular monitoring provided by the RSS Coordinator at headquarters and the ACF teams in each country, the evaluation team will have to make a final report to the Action Against Hunger teams, following which any problems concerning the quality of the evaluation report will be addressed.

CALENDAR :

The final deliverables are expected no later than mid-April 2026. For the Republic of Côte d’Ivoire, possible field visit dates could be from March 1st to April 7th, 2026.

BUDGET :

A pre-allocated budget is identified for each country:

  • Republic of Ivory Coast: €16,000
    • Madagascar : 19,000€
    • Cameroon: €15,000

A total budget of a maximum of €50,000 should be considered for the entire assessment.

EXPECTED QUALIFICATIONS OF EVALUATORS

The evaluation team is expected to have the following skills and expertise:

  • Experiences in health systems evaluation
    • Excellent knowledge of health governance in French-speaking African countries
    • Experiences and knowledge of health systems in the Republic of Côte d’Ivoire, Madagascar and Cameroon
    • Experience with ACF’s RSS method is an asset

RECRUITMENT PROCESS

Interested candidates will need to provide the following documents:

  • A detailed assessment project for the 3 countries concerned
    • A financial offer for each of the countries
    • A description of the people who will carry out the evaluation (CVs, examples of similar work, etc.)

EVALUATION CRITERIA

Candidates will be evaluated on the following criteria:

  • Relevant experience and qualifications
    • Understanding the scope of the evaluation work in the 3 countries concerned
    • Proposed work plan with methodology, budget and timeline

How to apply

APPLICATION DEADLINE

Applications must be sent to Rémi Goossens rgoossens@actioncontrelafaim.org and Alexandre Dupont adupont@actioncontrelafaim.org before November 27 (11 a.m. Paris time) and must include:

  • CV of the consultant.e
  • Financial proposal
  • Methodological proposal and agenda (maximum 3 pages)

Interviews will be conducted with shortlisted candidates.