EJAF/ELMA Programme Evaluation in Uganda At Tiko

Background and context

Established in 2014, Tiko is a non-profit organisation that leverages technology and behavioural insights to design, implement, and scale access to sexual reproductive health (SRH) services among adolescents and young people (AYP) aged 15-24 years. Using the Tiko platform, Tiko Uganda connects low-income adolescents and young people with non-judgmental, quality-assured SRH services that meet their specific needs. We envision a world where all AYP have the power to choose where, when, and how they meet their SRH needs. Further, Tiko connects partners and actors across demand and supply to give young people access to quality SRH products and services, thereby enabling young people to: postpone or prevent unplanned pregnancies, know their HIV status, use Pre-Exposure Prophylaxis (PrEP) to reduce their risk of HIV acquisition, adhere to Antiretroviral Therapy (ART), screen for and obtain support to address mental health challenges and acquire the necessary skills to secure income or entrepreneurship opportunities.

In Uganda, Tiko has successfully established an ecosystem of partners, including private clinics, community pharmacies and public facilities, as well as Community-Based Organizations (CBOs). Our work in Kampala is dedicated to empowering adolescents and young people (aged 15-24 years) to access essential services, such as contraceptives, HIV testing, ART, PrEP and mental health. We achieve this through a multi-faceted approach:

• Empowering AYP to have a voice and hold providers to account to ensure that SRH, HIV and mental health services are responsive to their needs
• Leveraging the private sector (clinics, pharmacies and direct-to-consumer service providers) to provide SRH, HIV and mental health services for AYP, enabling them to make choices of where to access these services and complementing the public sector
• Enabling availability and visibility of near real-time service delivery data including; individuals enrolled and referred for services, services provided, active clinics and service integration, among others
• Service integration and availability of SRH and HIV services – HIV testing, PrEP, ART, as well as mental health, enable AYP to choose where, when, and how they meet their health needs. The need to optimise the functionality of the Youth and Adolescent Peers (YAPs) programme to ensure that it fully achieves its stated mandate to contribute to the reduction of HIV-related morbidity and mortality among adolescents and young people living with HIV

Through these interventions, we aim to improve the agency of young people aged 15-24 years to take up and sustain the use of contraceptives, mental health services and HIV prevention and treatment services.

Purpose of the Evaluation

The programme has been implemented in Kampala since August 2023. This endline evaluation focuses on the entire implementation period.

This evaluation aims to capture lessons learned while providing insights into the effectiveness, impact, and sustainability of the Tiko programme in meeting its objectives. The evaluation will critically examine the design, scope, and implementation status of the Tiko programme, assessing its capacity to enhance access to services and empowerment for young people (AYP) and adolescent peer supporters (YAPS). Through a detailed analysis of achievements, challenges, and best practices encountered during implementation, this evaluation will offer guidance for the programme’s strategic direction in the next phase. Specifically, the evaluation will focus on four primary objectives:

1. Determine the extent to which the Tiko app improves the satisfaction, performance and retention of Young People and Adolescent Peer Supporter (YAPS) on the platform.
2. Determine the extent to which Tiko’s call centre approach improves AYP’s access to information and HIV services on the Tiko platform.
3. Determine the extent to which Tiko’s KP Navigators increase the ability of hard-to-reach AYP to access HIV testing, HIV self-testing, ART and PrEP services.
4. Understand the extent to which AYP reached by the programme access integrated, user centric SRH, HIV and mental health services and the extent to which they are empowered on their mental, sexual and reproductive health and wellbeing.

Scope of Work

Tiko Uganda aims to assess the program’s impact in Kampala City, particularly within areas where Tiko ecosystems are established. This evaluation will cover three distinct levels: market, individual, and social.

The primary objective is to design and conduct an endline study, scheduled for January-February 2025 in Kampala City. The evaluation’s design and implementation must integrate the principles of gender equality, disability, inclusion and non-discrimination. Participation of the most vulnerable groups and other key stakeholders throughout the process is imperative.

Evaluation Questions

The evaluation needs to address and answer the following objectives and research questions:

Determine the extent to which the Tiko app improves the satisfaction, performance and retention of Young People and Adolescent Peer Supporter (YAPS) on the platform

• To what extent does the Tiko approach improve the satisfaction of YAPs with the Tiko platform?
• To what extent does the Tiko approach improve the retention of YAPs on the Tiko platform?
• To what extent does the Tiko approach improve performance of the YAPs to engage on the Tiko platform?

Determine the extent to which Tiko’s call centre approach improves AYP’s access to information and HIV services on the Tiko platform

• To what extent does Tiko’s call centre approach improve AYP’s access to information and HIV services on the Tiko platform?

Determine the extent to which Tiko’s KP Navigators increase the ability of hard-to-reach AYP to access HIV testing, HIV self-testing, ART and PrEP services

• To what extent does the KP-Navigators’ approach improve hard to reach and at risk AYP’s ability to access HIV services (HIV testing, HIV self-testing, ART and PrEP) through the Tiko Platform?
• To what extent does the KP-Navigators’ approach improve knowledge about HIV services (HV testing, HIV self-testing, ART and PrEP) among hard to reach and at risk AYP?
• To what extent does the KP-Navigators’ approach improve attitudes around HIV services (HIV testing, HIV self-testing, ART and PrEP) among hard to reach and at risk AYP?
• To what extent does the KP-Navigators’ approach improve access to and retention to HIV care (HIV testing, HIV self-testing, ART and PrEP) among hard to reach and at risk AYP?

Understand the extent to which AYP reached by the programme access integrated, user centric SRH, HIV and mental health services and the extent to which they are empowered on their mental, sexual and reproductive health and wellbeing

• To what extent does the Tiko platform/membership increase AYP’s access to SRH (family planning), HIV (HIV testing, ART, PrEP) and mental health services?
• To what extent do the users feel satisfied with services provided through the Tiko platform?
• To what extent does the Tiko platform/approach/model improve service continuation and retention to care for SRH, HIV and mental health services?

Methodology of the evaluation

Tiko expects to apply the same methodological approaches used in the baseline study, that is, a mixed-methods approach based on a cross-sectional study design. The applicant will apply these methods:

1. A quantitative survey conducted through client exit interviews with Adolescents and Young People (AYP) aged 15-24, who accessed FP, HIV, mental health (MH), and family planning (FP) services at health facilities in Kampala.
2. Analysis of service data from facilities (sourced from DHIS2 and Tiko platform).
3. A facility assessment survey to track commodity stocking.
4. Qualitative data collected from AYP source from Tiko clubs and groups using focus group discussions.
5. Qualitative data collected from health providers and district / division officials using key informant interviews.

Applicants are expected to outline the proposed methods and the questions these will answer. Applications should also include proposed analytical approaches to use.

Deliverables

The successful bidder is responsible for ensuring timely submission of the following deliverables:

1.Activity Update the study protocol Time Frame November 2024

Deliverable

Study protocol

• Methodology
• Data collection tools
• Renown Principle Investigator and research team
• Project work plan

Responsible Party Tiko

2. Activity Submit and obtain approval of evaluation protocol by Institutional Review Board (IRB) Time Frame December 2024 Deliverable Approved study protocol Responsible Party Tiko

3. Activity Draft inception report, field work plan and quality control plan Time Frame January 2025

Deliverable

• Inception report
• Research/Evaluation team
• Presentation of the inception report

Responsible Party Consultant

4. Activity Scripting of tools Time Frame January 2025 Deliverable Scripted questionnaire Responsible Party Consultant

5. Activity Data collection Time Frame January 2025 Deliverable Raw dataset, including survey responses and KII/FGD transcriptions Responsible Party Consultant

6. Activity Cleaned final dataset(s) containing all data collected for the endline, including survey responses and KII/FGD transcriptions & codebook Time Frame February 2025 Deliverable Access to the final, cleaned data set, Stata and SPSS Responsible Party Consultant

7. Activity Draft of Final Report Time Frame February 2025 Deliverable Draft Final Report Responsible Party Consultant

8. Activity Final Report (incorporating inputs from the review) Time Frame March 2025 Deliverable Final Report Responsible Party Consultant

We are looking for a bidder with the following skills and qualifications:

• Demonstrable expertise in Adolescent and Young People (AYP) SRH, HIV (HIV testing, PrEP, ART) and mental health research and evaluation in Uganda
• Demonstrable expertise in public health policy and service delivery in Uganda
• A team with a track record of designing, implementing and reporting on programme research/evaluations in Uganda
• Demonstrable ability to co-design impact evaluations with multiple stakeholders in a highly adaptable environment
• The team leader and members with the following skills and expertise:
• A postgraduate degree in a research-oriented social science or a related discipline with extensive knowledge of and experience in leading (designing and undertaking) large scale quantitative and qualitative research
• A team leader/team member with global standing in the public health space, specifically in AYP SRH, experience in digital health technologies is an added advantage
• A history of publication on AYP SRH, HIV and mental health in peer-refereed, high impact journals, preferably in high impact journals
• Track record of managing and coordinating evaluation/research exercises, and delivering agreed outputs on-time and on-budget
• Experience in data collection and analysis using participatory methodologies
• Excellent and demonstrated understanding of ethical issues in research, including in child protection and safeguarding of research participants
• Ability to respond to comments and questions in a timely, appropriate manner
• Capacity to use mobile data collection for data collection, and analysis of survey results
• Excellent verbal and written communication in English and Luganda required

Evaluation criteria

Proposals will be assessed against the following criteria:

Team expertise, experience, and composition:

• Expertise and experience in undertaking similar research activities in Uganda

Weight: 40

Strength of the technical proposal:

• Overall strength of proposed methodology, including the to address the specific tasks outlined above within the anticipated timelines

Weight: 40

Budget:

• Value for money
• We will consider strongly competitive proposals to deliver the engagement within our set limit

Weight: 20

Total Weight: 100