ACRONYMS CRS SAHARAWI REFUGEE POPULATION CAMPS MSP SAHARAWI PUBLIC HEALTH MINISTRY SADR SAHARAWI ARAB DEMOCRATIC REPUBLIC CGS GENDER AND HEALTH COMMITTEE DAS RIGHT OF ACCESS TO HEALTH PES GENDER AND HEALTH STRATEGIC PLAN PGS GENDER AND HEALTH STRATEGIC PLAN SIS HEALTH INFORMATION SYSTEM PISIS SAHARAWI CHILD HEALTH PROGRAM PNEC NATIONAL CHRONIC DISEASES PROGRAM PNSSR NATIONAL SEXUAL AND REPRODUCTIVE HEALTH PROGRAM PNSM NATIONAL MENTAL HEALTH PROGRAM 3 1. INTRODUCTION AND CONTEXT……………………………………………………….……4 2. BACKGROUND AND JUSTIFICATION…………………………………………………………….5 3. OBJECTIVES OF THE BASELINE………………………………………………………………………7 4. SCOPE……………………………………………………………………………………………..8 5. TYPOLOGY AND QUANTIFICATION OF THE BENEFICIARY POPULATION………………………9 6. IDENTIFICATION OF KEY ACTORS AND INFORMANTS………………………………10 7. CONCEPTUAL FRAMEWORK AND METHODOLOGICAL APPROACH………………………………12 8. PRODUCTS OF THE BASELINE………………………………………………………….13 9. PROPOSED FINAL REPORT………………………………………………………………………14 10. ROLES AND RESPONSIBILITIES IN MANAGEMENT……………………………………………15 11. SUGGESTED ACTIVITY SCHEDULE…………………………………………………………16 12. CONDITIONS…………………………………………………………………………………….16 13. WORK TEAM PROFILE, SELECTION CRITERIA ……………………..17 14. CONFIDENTIALITY REQUIREMENT……………………………………………………….17 15. DEADLINE AND FORM OF SUBMISSION OF PROPOSALS………………………………….18 16. AUTHORSHIP OF THE REPORT AND DISSEMINATION RIGHTS…………………………………..19 4 INTRODUCTION AND CONTEXT Médicos del Mundo (MdM) is an independent international solidarity organization that promotes human development through the fundamental right to health and a dignified life for all people, especially for vulnerable populations living in poverty, experiencing gender inequality and social exclusion, or victims of humanitarian crises. Throughout its history, MdM has established itself as a leading organization due to its organizational nature and its contribution to the development of public health policies and the implementation of the framework of international agreements in favor of vulnerable and excluded populations and minorities. All MdM interventions are developed in an integrated manner with the dynamics of the public institutions (duty holders) of the countries where it works,supporting their strategies through work focused on supporting the actions carried out rather than directly implementing them. Doctors of the World Spain’s presence in the Sahrawi Refugee Camps (CRS) dates back to 1995. The work carried out aims to strengthen the pillars of the Sahrawi healthcare system by improving the accessibility, availability, quality, and acceptability of healthcare services. The purpose of this document is to establish the Terms of Reference for a service provision for the preparation of the BASELINE in a mixed modality (between MdM and the external service provision), hereinafter LdB, of the Program: “IMPROVING THE QUALITY AND EQUITY OF PREVENTIVE AND ASSISTANCE SERVICES AIMED AT THE SAHARAUI POPULATION IN SAHARAUI REFUGEE CAMPS”, financed by AECID in its 2022 call and whose duration runs from 2023 to 2026. Given that a previous baseline is currently not available, this process will allow the generation of key information that will be used to measure results, monitor and evaluate the impact of the program. Program Details: Partner/Local Partner(s) Sahrawi Ministry of Public Health Duration 01/01/2023 to 31/12/2026 Total Cost €3,247,541 AECID Grant €3,000,000 5 Other public contributions €163,166 Médicos del Mundo Contribution €84,375 BACKGROUND AND JUSTIFICATION Health is a complex and dynamic process influenced by biology, sociocultural context, and lived experience. These factors, known as determinants of health, have a different impact on men and women, generating inequalities that translate into differences in health status, access to services, and health outcomes. Therefore, ensuring an efficient, fair, and equitable health system requires systematically incorporating a gender perspective into the analysis, planning, management, and evaluation of health policies and programs. This approach makes it possible to highlight existing gaps, promote equity in access to care, and ensure that interventions adequately respond to the specific needs of women, men, girls, boys, and other vulnerable groups. Analyzing power relations and responsibilities in the health sector is a central element from a gender perspective, given that, although women represent the majority of operational personnel in the health system, they continue to have limited participation in decision-making and the definition of public policies. Recognizing and addressing this inequality is essential to moving toward a more inclusive, equitable, and sustainable health system. Within this framework,The objective of the agreement “Improving the Quality and Equity of Preventive and Healthcare Services for the Sahrawi Population in Sahrawi Refugee Camps” is to contribute to the realization of the Right to Health (RAS) of the Sahrawi refugee population by guaranteeing access to quality and equitable healthcare services in the Sahrawi Refugee Camps (CRS). The agreement works by consolidating the self-management capacities of the Sahrawi Ministry of Public Health (MSP) and strengthening community participation mechanisms, from a gender, equity, and inclusion perspective. It also promotes the expansion of the network of quality healthcare services in priority programs at the community level, promoting the active participation of the beneficiary population. The intervention fosters the participation of civil society in the health sector, the empowerment of women, and structured dialogue with health authorities and international organizations that support the sector. All actions are aimed at strengthening the governance, accountability, and self-management of the Sahrawi health system at its various levels, thus contributing to improving the health status of the population, including the management of the effects of the COVID-19 pandemic, and always applying a gender, rights, and equity approach. Currently, Médicos del Mundo, in partnership with the Sahrawi Ministry of Public Health (priority partner) and with the financial support of the Spanish Agency for International Development Cooperation (AECID), is implementing this agreement for a period of four years (2022-2026). This agreement seeks to strengthen the capacities of the Sahrawi health system and contribute to the sustainable improvement of the health conditions of the Sahrawi refugee population. General Objective Contribute to making the right to health effective in the Sahrawi refugee camps, from a gender equity perspective Specific objectives SO1 Improve self-management and accountability of the MSP in the governance and management of Sahrawi health services at the national, regional and community levels from a gender perspective Expected results SO1 • The strategy for influencing public health policies in the CRS will have been strengthened from a participatory approach. • The capacities of the MSP in the strategic and operational planning of its priority programs from a gender perspective will have been improved, and the participation of health professionals in health policy will have increased. • The capacities of the Health Information System will have been improved through the collection, analysis and interpretation of data from the population served in the services of the priority programs. SO2 Improve the health status of the population in the CRS,including the management of the consequences of the COVID-19 pandemic, from a gender perspective 7 Expected results SO2 • The services of the MSP priority programs are strengthened in quality and accessibility at all levels of the CRS health system. • Health will have been promoted at the community level from an intersectional gender perspective and the autonomy of women in decision-making about their own health. • Detection and care actions will have been promoted for the most vulnerable population groups in CRS within the framework of priority programs. BASELINE OBJECTIVES Given the proximity of the end of the current agreement and the need to prepare a solid, evidence-based proposal for a new intervention, it is essential to carry out a thorough analysis of the current situation of the project. This consultancy is not intended to be a traditional “baseline,” but rather a situational analysis that serves a dual purpose: a) To serve as a snapshot or preliminary assessment of the current project, measuring key health indicators at this time (year 3) and comparing them with the data available to date, in order to assess progress and remaining challenges. b) To act as a starting point and foundation for the design of the new post-2026 agreement, identifying critical gaps, existing capacities, and future intervention priorities. This consultancy will ensure that the next agreement does not start from scratch, but is built on lessons learned and real data, optimizing resources and maximizing the impact on the health of the Sahrawi refugee population. General Objective The general objective of this consultancy is to generate a comprehensive and evidence-based analysis of the current situation of the agreement “IMPROVING THE QUALITY AND EQUITY OF PREVENTIVE AND ASSISTANCE SERVICES AIMED AT THE SAHARAWI POPULATION IN SAHARAWI REFUGEE CAMPS” which, on the one hand, allows to assess the resulting context at this point of the intervention of the current agreement and, on the other hand, serves as a fundamental basis for the design, formulation of a final external evaluation and future interventions, from a gender, equity and inclusion perspective. 8 Specific Objectives o Collect, systematize and analyze updated information on the indicators and data referred to in the results matrix of the Agreement o Evaluate and analyze progress (degree of compliance with results and indicators) and limitations in relation to the proposed objectives, identifying achievements, existing gaps and factors that have facilitated or hindered implementation. o Analyze the resolution capacity of the Sahrawi health system, through the analysis of the progress of the indicators contained in its strategic documents:Sahrawi Strategic Health Plan (2022-2026) and Strategic Gender and Health Plan (2022-2026) and the lines of work referred to in the Agreement (priority programs, salt information system, etc.) o Identify priority gaps and needs in health – including nutrition, sexual and reproductive health, mental health, and communicable and non-communicable diseases – as well as in the provision of and access to clinical services, in order to assess the level of coverage, quality, equity and inclusion of the care provided to the beneficiary population. o Identify strategies and recommendations based on the evidence collected, to guide the design and formulation of a new agreement that responds to the current needs of the beneficiary population, ensuring alignment with the PES and the PGS and the priorities of AECID. SCOPE Temporal The preparation of the LdB is expected to take place within a period of 8 weeks (56 days) from the signing of the contract. While this is true, the duration may vary depending on external factors such as the availability and accessibility of key informants. Services are expected to be provided in November and December 2025. 9 Geographic The intermediate baseline survey will be carried out in the five Sahrawi refugee camps located in the Tindouf district (Algeria), where the direct beneficiary population of the agreement is concentrated: El Aaiun, Smara, Boujdour, Auserd, and Dakhla. Furthermore, the study will include the central structures of the Sahrawi Ministry of Public Health (MSP) and the main levels of care within the Sahrawi health system, such as national hospitals, regional hospitals, and clinics. Fieldwork will be carried out in coordination with Doctors of the World and the MSP, ensuring the territorial representativeness of the agreement’s interventions and the participation of different population profiles—women, men, youth, the elderly, and people with disabilities—in line with the gender, equity, and inclusion approach that guides humanitarian action. TYPOLOGY AND QUANTIFICATION OF THE BENEFICIARY POPULATION The beneficiary population of the agreement is made up of the Sahrawi refugee population residing in the five camps located in the wilaya of Tindouf (Algeria) – El Aaiún, Smara, Dakhla, Auserd and Boujdour -, estimated at approximately 173,600 people, according to the latest census carried out by UNHCR in 2018. This population has been living in a situation of prolonged displacement for more than five decades, characterized by a high dependence on humanitarian aid, limited economic opportunities, and structural restrictions in access to basic services, especially in the areas of health, nutrition and sanitation.Unlike other contexts where it is possible to distinguish between groups directly receiving services and indirectly impacted communities, in the Tindouf camps, the health system is universal and community-based, aimed at covering the entire refugee population without segmentation by area, gender, or socioeconomic status. The improvements promoted by the agreement—whether in infrastructure, equipment, staff training, institutional management, or quality of care—have a direct and indirect impact on the entire population. Furthermore, the healthcare model of the Sahrawi Ministry of Public Health (MSP), supported by Doctors of the World and funded by AECID, is based on a community-based public system, where preventive and healthcare services are free, accessible, and widely available. Consequently, there is no “indirect” population receiving secondary or delayed benefits, as the effects of the agreement extend uniformly to all residents of the five camps. Direct and indirect population SOURCE: UNHCR IDENTIFICATION OF KEY ACTORS AND INFORMANTS The participation of different actors in the program has been identified, which are described below: Beneficiary population Geographic location Community/ Settlement/ Camp Total Women Men Refugee population Tindouf, Algeria Smara 50,700 25,300 25,400 Refugee population Tindouf, Algeria Boujdour 16,400 7,800 8,600 Refugee population Tindouf, Algeria Laayoune 50,500 24,600 25,900 Refugee population Tindouf, Algeria Ausserd 36,600 18,100 18,500 Refugee population Tindouf, Algeria Dakhla 19,400 9,400 10,000 TOTAL POPULATION DIRECT AND INDIRECT BENEFICIARY 173600 85200 88400 11 continued: Key Actors and Informants Ministry of Health (Minister, Secretary General, Central Directorates) â–ª Identification, formulation, and validation of tools to be implemented at the CRS level. â–ª Coordinate the collection of health system data and indicators. â–ª Facilitate access to strategic documents (PES, PGS) and technical reports, including health data. â–ª Participate in the analysis of the health system’s resolution capacity. â–ª Authorize the participation of MSP and health personnel in consulting activities. â–ª Validate recommendations for the new agreement. Priority Program Coordinators (PISIS, PNEC, PNSM, PNSSR) â–ª Support in the systematization of information on progress and indicators. â–ª Identify achievements, gaps, and factors affecting implementation. â–ª Participate in workshops/meetings to analyze and validate results. â–ª Propose improvements to program management: PISIS, PNEC, PNSM, PNSSR. â–ª Contribute to the design of strategies for future interventions. Health Information System (SIS) â–ª Support the validation of data collection and analysis tools proposed for the preparation of the consultancy, according to specific groups.â–ª Participate in the systematization of indicators and results of the agreement, as well as the strategic plans (PES and PGS). â–ª Identify gaps in the quality, coverage, and timeliness of available data. â–ª Contribute to strengthening local capacities in health information management. â–ª Facilitate access to databases and technical reports for the analysis of results. 12 Health personnel from all levels of health â–ª Participate in interviews and focus groups on the quality of and access to services. â–ª Identify clinical and community needs based on daily practice. â–ª Contribute to the analysis of equity and inclusion in care. â–ª Support data collection in hospitals and dispensaries. Civil society organizations (UNMS, UESARIO, UJSARIO) â–ª Participate in focus groups to identify perceptions and needs. â–ª Validate proposals from a gender, equity, and inclusion perspective. â–ª Contribute to the analysis of coverage and quality from a community perspective. â–ª Support the identification of beneficiaries and local priorities in the context of the CRS, through their active participation. International Organizations and NGOs â–ª Provide technical information and follow-up reports on lines of work of the agreement. â–ª Participate in the formulation of strategic recommendations in alignment with identified cooperation priorities. â–ª Support the coordination between local and international actors. â–ª Contribute to the strengthening of institutional capacities. CONCEPTUAL FRAMEWORK AND METHODOLOGICAL APPROACH The preparation of the baseline will require a prior analysis to identify the available information, the necessary information, and the precision of the criteria that guide the greatest use of the information obtained. The external team in charge, in collaboration with the MdM team, must ensure a methodological design that adequately combines qualitative and quantitative techniques for both the generation of primary information and the structured review of existing secondary information on the intervention area for the measurement of indicators. Furthermore, the methodology must meet clear criteria of representativeness and participation of the different actors, allowing for the generation of relevant information on the context and adequate identification and measurement of the indicators. 13 The implementation of the Baseline must take into account the following methodological considerations for its design and execution: • Define the scope in order to develop a consistent matrix between the logical framework and the Baseline of the Agreement. • Identify the different sources of information, both primary and secondary, that allow for the development of participatory instruments and methods for its collection, as well as triangulation of the information to ensure greater rigor in the collection.• Provide up-to-date information about the Convention’s intervention territory, its main actors, and the beneficiary population. • Design tools adapted to the participating agents, guaranteeing the participation of all populations. Data collection techniques should include: documentary analysis, direct observation, in-depth interviews, semi-structured and open interviews, and focus groups. • The baseline design should mainstream gender, human rights, anthropological, and environmental approaches. • The information presented must be up-to-date and disaggregated. BASELINE PRODUCTS The following deliverables are expected from the consultancy: Product Details Deadline Product 1 Work plan and methodological proposal Detailed work plan for the execution of the consultancy, indicating the work strategy, methodology, proposed indicators, and including the data collection instruments. Week 2 Product 2 Situational Analysis Report This is a document that presents the current situation of the Agreement with disaggregated data, including a comparative analysis with the data presented/approved in the Agreement, as well as an assessment of what has been achieved so far. The report must detail the methodology and tools used. Week 6 14 Product 3 Final Report The final report will have to include the following analyses: – Updated measurement of all Agreement indicators and proposed tools for their monitoring, where appropriate, in line with the monitoring and evaluation system currently in use by the MdM mission in the CRS – Lessons learned and critical gaps matrix: a matrix that summarizes the main successes, difficulties and lessons learned from the current agreement, as well as a prioritized list of the most significant gaps in the CRS health system – Strategic proposal for a new agreement: this document must contain at least the following: • justification based on the findings of the analysis. • proposed general and specific objectives • strategic components or expected results – preliminary indicators • recommended implementation strategies (examples: gender, capability approach, sustainability, etc.) • risk assessment and assumptions Week 8 FINAL REPORT PROPOSAL The Baseline report will be written in Spanish and must contain at least the following sections: • Cover page (includes the title of the agreement, NGO, Local Partners, report completion date, funders). • Executive summary. • Brief presentation of the work team. • Description and objectives of the consulting service. • Scope of the consultancy. • Work plan. • Activities carried out and techniques used in the data collection stage. • Information processing and analysis.• Conditions for the work performed. • Baseline results, which must include: 15 o Lessons learned and critical gaps matrix o Strategic proposal for a new agreement o Review of the agreement’s planning matrix (objectives and results) and their measurability (indicators) • The database generated for the development of the study. • Conclusions. • Recommendations. ROLES AND RESPONSIBILITIES IN MANAGEMENT MdM will be responsible for validating and supervising the quality of the process, the hiring of the team, and the dissemination of results. For this purpose, there will be an LdB Management Committee, which will be made up of: • MEAL Technician (field) • Medical Coordination (field) • Gender Coordination (field) • Country Coordination (field) • Sahara Coordination (Headquarters) • MEAL Referent (Headquarters) The main functions of the management committee are the following: • Maintain permanent dialogue with the service provider. • Provide the service provider with contact information and access to all relevant information. • Provide methodological advice and oversight of the process, supporting the development of the most appropriate tools for the context and ensuring the integration of gender and human rights approaches and an anthropological approach. • Conduct quality control and ensure compliance with deadlines. • Validate the preparatory report, the final report, the Project Monitoring Planning Matrix, and other technical service products. • Facilitate the dissemination of the process results to the MdM team and the donor. 16 SUGGESTED ACTIVITY SCHEDULE Phase/Activity Outputs S1 S2 S3 S4 S5 S6 S7 S8 Phase I: Desk work, proposal design Meeting to clarify likely adjustments Output 1: Work plan and methodological proposal Presentation of the technical proposal Phase II: Fieldwork Definition of information gathering instruments and tools Output 2: Situational analysis report Validation of instruments Work plan / Information collection Data processing Presentation of the situational analysis report Phase III: Desk work Draft final report Product 3. Dissemination of results Approved final report Presentation of the final report CONDITIONS The maximum budget for this study is 12,000 euros. The resources required for the payment of this service provision correspond 100% to those provided for in the Program: “Improving the quality and equity of preventive and care services aimed at the Sahrawi population in Sahrawi refugee camps”, funded by AECID in its 2022 call. Payment will be made upon submission of defined products, according to the following details:• 30% upon submission and approval of Product 1 • 30% upon submission and approval of Product 2 • 40% upon submission and approval of Product 3 The service provider will submit the corresponding invoice for each payment made; otherwise, Médicos del Mundo, in its capacity as withholding agent, will apply the tax deductions regulated by law. 17 WORK TEAM PROFILE AND SELECTION CRITERIA Profile: • Specific training in the areas of social sciences, public health, social work, or related fields. • Specific training in gender and development. • Demonstrable prior experience in the design and preparation of baseline studies, final interim evaluations, and/or impact assessments for development projects (at least five studies prepared, of which three must have been in the health sector). • At least one member of the consulting team (or the consultant themselves) must have proven specific training in social research methodologies and techniques. • Demonstrate solid experience in data collection and analysis for health programs/projects. • Extensive experience in international cooperation projects in the health sector and in mainstreaming the intersectional gender approach. • Strong analytical skills for preparing technical reports. • Mastery of data processing and analysis software (qualitative and quantitative). Selection criteria: • Profile and professional experience of the consulting team: 40%. • Quality and content of the technical and financial proposal: 60%. CONFIDENTIALITY REQUIREMENTS During the process, the following basic premises of ethical and professional behavior must be followed: Anonymity and confidentiality. – Research must respect the right of individuals to provide information, ensuring their anonymity and confidentiality. 18 Responsibility. – Any disagreement or difference of opinion that may arise among team members or between them and program officials regarding the conclusions and/or recommendations must be mentioned in the report. Any assertion must be supported by the team, or the disagreement regarding it must be recorded. Integrity. – The team in charge will be responsible for highlighting issues not specifically mentioned in the terms of reference if necessary to obtain a more complete analysis of the intervention. Independence. – The team in charge must guarantee its independence from the intervention, not being linked to its management or any component thereof. Incidents. – Should problems arise during the development of the Baseline, these must be immediately reported to MdM. Otherwise,The existence of such problems may under no circumstances be used to justify failure to achieve the results established by the organization in the terms of reference. Validation of information. – The contracted team is responsible for ensuring the accuracy of the information collected and will ultimately be responsible for the information presented in the Baseline Report. Sanctions regime. – In the event of a delay in the delivery of reports or in the event that the quality of the reports submitted is clearly inferior to that agreed upon, the full amount of the previously agreed payment will not be made. DEADLINE AND FORM FOR SUBMISSION OF PROPOSALS Applicants must submit their technical and financial proposal accompanied by a cover letter and CV of the applicant team by November 2, 2025 at 11:59 p.m. to the following email address: evaluacion@medicosdelmundo.org with the Ref.: AECID AGREEMENT BASELINE [2022/PCONV/000364] 19 MdM promotes equal opportunities for all people and establishes affirmative action measures for those who, due to functional diversity or social and/or cultural exclusion, belong to underrepresented groups in the positions offered. Therefore, no candidate with a valid profile will be rejected due to their functional diversity or for being culturally or socially excluded due to birth, ethnicity, race, sex, gender or any other personal, social or cultural condition or circumstance. AUTHORSHIP OF THE REPORT AND DISSEMINATION RIGHTS All products of the consultancy will be the sole and exclusive property of the contracting organization. The contracted person or team is prohibited from selling, reproducing or transferring them to third parties and is required to maintain complete confidentiality of the results.Therefore, no candidate with a valid profile will be rejected due to functional diversity or for being culturally or socially excluded due to birth, ethnicity, race, sex, gender, or any other personal, social, or cultural condition or circumstance. AUTHORSHIP OF THE REPORT AND DISSEMINATION RIGHTS All consulting products will be the sole and exclusive property of the contracting organization. The contracted person or team is prohibited from selling, reproducing, or transferring them to third parties, and full confidentiality of the results is required.Therefore, no candidate with a valid profile will be rejected due to functional diversity or for being culturally or socially excluded due to birth, ethnicity, race, sex, gender, or any other personal, social, or cultural condition or circumstance. AUTHORSHIP OF THE REPORT AND DISSEMINATION RIGHTS All consulting products will be the sole and exclusive property of the contracting organization. The contracted person or team is prohibited from selling, reproducing, or transferring them to third parties, and full confidentiality of the results is required.
How to apply
Applicants must submit their technical and economic proposal accompanied by a cover letter and CV of the applicant team until November 2, 2025 at 11:59 p.m. to the following email address: evaluacion@medicosdelmundo.org with the Ref.: AECID AGREEMENT BASELINE [2022/PCONV/000364]