In-Country Consultant For Project Design Phase – Integrated Care For Older People – Terms Of Reference At Fred Hollows Foundation

INTRODUCTION
The Fred Hollows Foundation (The Foundation) is a secular non-profit public health organisation based
in Australia, which was founded in 1992 by eminent eye surgeon Professor Fred Hollows. The Foundation focuses on strengthening eye health systems and the treatment and prevention of avoidable blindness caused by Cataract, Trachoma, Diabetic Retinopathy, and Refractive Error. The Foundation operates in over 20 countries across Australia, The Pacific, South and Southeast Asia, and Africa. The Foundation was named The Australian Charity of the Year 2013 in the inaugural Australian Charity Awards.

In Ethiopia, The Foundation has been working with the Ministry of Health (MOH) and Oromia Regional Health Bureau to reduce preventable blindness mainly focusing on trachoma prevention and control, comprehensive eye care program with disease focus of cataract surgery and uncorrected refractive error.
In 2023, The Foundation also effectively implemented a project in 2023 that provided integrated eye, ENT and oral health services for older people in Addis Ababa and Arsi Zone.

PROJECT BACKGROUND
The global population of older persons has surpassed 1 billion, accounting for approximately 13.5% of the total population as of 2021. By 2030, one in six individuals will be aged 60 or older. Currently, most older people reside in low- and middle-income countries, a trend expected to intensify. By 2050, it is projected that 80% of the global older population will live in these settings, where policies and programs addressing their needs remain insufficient. With a population of over 115 million, Ethiopia is the second most populous nation in Sub-Saharan Africa. Of this population, 80.5% reside in rural areas and approximately 5.3% or around 6.1 million people are over the age of 60 years. The health and social protection policies and strategies in the country are disjointed, and a situational analysis of the government system indicates the absence of a multisectoral coordinating mechanism. Vision impairment is a significant challenge among older adults, with 73% of avoidable vision loss occurring in individuals aged 50 and above. Age-related eye conditions such as cataracts, glaucoma, age-related macular degeneration, and diabetic retinopathy are currently among the primary global causes of vision impairment and blindness. Importantly, cataracts are behind 94 million cases of blindness and vision impairment in people aged 50 and over. This is a condition that can be effectively treated with a straightforward and cost-effective intervention.

Addressing these unmet needs requires new approaches to deliver high-quality healthcare services,
including the delivery of integrated care, inclusive of eye care. This approach is essential to address the
longstanding limitations of vertical eye care programs, which are often narrow in scope and fail to meet
lifelong eye care needs. These programs also typically overlook age-related and chronic conditions and
do not effectively reduce health inequalities among older populations.

To achieve eye care integration in the older population, the Foundation will use WHO’s Integrated Care
for Older People (ICOPE) model. ICOPE addresses six key health domains: vision, mobility, hearing, nutrition, psychological capacity, and cognition, recognizing their interconnectedness in supporting overall health and well-being in older age.
By implementing ICOPE through strategic partnerships, the Foundation will not only deliver Integrated
People-Centred Eye Care (IPEC) in the older population but also convene and collaborate with partners
to address other critical health domains. Evidence suggests that person-centred and integrated care is
the best approach for implementing the spectrum of interventions needed in older age. Ultimately, this
approach can help enhance both the eye health and overall health of older populations, helping to
prevent or delay care dependence, and fostering healthy ageing. The potential impact of this approach is
significant: it can lead to improved health outcomes, increased access, reduced healthcare costs, and
enhanced quality of life for older people. By fostering early detection and intervention, the strategy aims
to maintain functional ability and independence, contributing to healthier older populations.

Ethiopia is already at the forefront of the Foundation’s work on ageing. In 2023, a project was implemented in Addis Ababa and Arsi zone to deliver integrated eye, ENT and oral healthcare services for older populations. Building on the successes of this project and key lessons gleaned from this effort, together with those derived from other country projects that took place that same year and which specifically focused on older populations, a new project is being conceived in Ethiopia to deliver integrated care for older people.

PURPOSE OF THIS CONSULTANCY
The purpose of this consultancy is to support the design of a new project in Ethiopia aimed at delivering
integrated care for older populations. The consultancy will be divided into two key steps, as outlined
below:
1. Initial mapping, needs identification and stakeholder engagement
As part of this step, the consultant will:
• Conduct a comprehensive mapping of organizations, facilities, and services within Ethiopia that can support the delivery of integrated care for older people. This will include also describing existing capabilities and exploring potential synergies to enhance service provision. The mapping will focus on Ethiopia as a country but also provide more detailed information for the region where the project will be implemented.
• Analyse referral pathways across all domains of intrinsic capacity to identify gaps in service provision that could hinder the implementation of integrated care for older people. A preliminary assessment of the readiness of stakeholders and systems to deliver integrated care in Viet Nam will also be conducted using the WHO ICOPE scorecard.
• Plan and prepare for an in-country workshop, including securing a suitable venue in collaboration with the Foundation’s Healthy Ageing Senior Advisor and the Ethiopia office, developing a list of participants, and preparing draft invitations. The aim of this workshop is to build capacity on integrated care for older people, explore implementation options based on the findings of Step 1 and the contributions of participants, and identify necessary adaptations for the local context.
2. In-country workshop and project design
As part of this step, the consultant will:
• Prepare workshop materials as required, including the development of a presentation
summarizing key findings from the previous step.

Support the in-country workshop. This will include, for example, documenting and consolidating participant input during the workshop to inform the design of a project to deliver integrated care for older people in the country.
• Prepare a complete project design draft and M&E framework drawing from the input provided during the workshop and further input and guidance from the Healthy Ageing Senior Advisor. The project design is expected to include the care pathways tailored to local needs and include all elements of the pathway, such as screening, diagnosis, treatment, and referral processes for each domain of intrinsic capacity.
• Prepare the final project design and M&E framework addressing the feedback received from
implementing partners and others.

APPROACH
The work to be undertaken by the consultant will involve a desk review of existing documentation (e.g.
evaluation of the ageing related projects that were carried out in 2023 in 5 countries, ICOPE implementation framework, ICOPE care pathways, etc.); the identification of key stakeholders who can
support this work, which is likely to require phone calls, the organization of introductory meetings, etc.; consultations to complete the mapping; analysis of the referral pathways; analysis of the readiness to
deliver ICOPE; and drafting of presentations and documents.
The consultant will work under the supervision of the Healthy Ageing Senior Advisor at The Fred Hollows
Foundation who will oversee the project. Regular reporting/check in meetings will be scheduled with the
selected consultant and take via Teams. Written feedback will also be sent (as required) to the selected
consultant on the deliverables so that it can be duly incorporated.

Specifically, the consultant will undertake the following tasks for achieving the consultancy:
• Draw up a plan of action and timetable for accomplishing various components of the assignment in coordination with the Healthy Ageing Senior Advisor of Fred Hollows Foundation;
• Undertake a desk review based on available reports and information (e.g. national policies related to ageing) as well as documentation provided by the Fred Hollows Foundation, and seek additional information to prepare a preliminary mapping of key organizations, facilities, and services related to each domain of intrinsic capacity as per the WHO ICOPE guidelines;
• Prepare a list of organizations / stakeholders to consult and visit to gather additional information to inform the mapping of stakeholders and analysis of context, the review of referral pathways in the selected geographical areas and the assessment of readiness to deliver ICOPE using the ICOPE Implementation Framework. This will involve stakeholder consultations (virtual and / or face-to-face), site visits, etc.
• Prepare a PowerPoint presentation including the findings from Step 1.
• Support the organization of the in-country workshop, including through the identification of possible
venues, preparing a list of possible workshop participants, and by preparing draft invitations;
• Support the facilitation of the in-country workshop as required, with a specific focus on documenting
and consolidating the input provided by workshop participants into the preliminary design of the
project.
• Prepare a meeting report as well as the detailed design of the project and M&E framework, drawing from the input provided during the in-country workshop, and following any additional guidance provided by the Healthy Ageing Senior Advisor;
• Prepare the final meeting report and project design with the M&E framework incorporating the feedback received from implementing partners and others, as well as an associated PowerPoint presentation;

Participate in a final technical meeting with The Fred Hollows Foundation staff and other stakeholders as required.

DELIVERABLES
The following deliverables are expected from the consultant in completing the assignment:
• Action Plan, including timelines for the completion of the various tasks and deliverables and in alignment with the anticipated schedule included in this TOR.
• List of organizations and stakeholders to visit / interview / consult.
• PowerPoint with the findings of Step 1, including, among other aspects, the context, stakeholder and service analysis, the ICOPE readiness scores and explanatory notes, the assessment of the referral pathways for each domain of capacity. The consultant will be expected to prepare an outline of the PowerPoint for review and approval by The Fred Hollows Foundation, ahead of preparing it.
• Meeting report.
• Detailed design of the project and related monitoring and evaluation (M&E) framework.
• Summary PowerPoint presentation including the complete and final design of the project and the
M&E framework, stakeholders involved, etc.

NOTE: All raw data collected/generated during the project will also need to be provided and a backup of
raw data submitted in a format accessible to The Foundation.
The Foundation will provide the following:
• Focal person to oversee the assignment and provide technical guidance.
• Provide background documents to support desk review.
• Give feedback on the different deliverables.
• Coordinate the organization of the in-country workshop through the Foundation’s country office, including sending out invitations, booking the venue, etc.
• Coordinate the collection of feedback from implementing partners and others.

QUALIFICATIONS
The consultant will have the following background and experience:
• At least a master’s degree in medicine, Public Health, Ophthalmology, Ageing, or related health
sciences.
• Demonstrable knowledge and hands-on experience in designing public health projects., including
a proven track record developing projects that involve comprehensive stakeholder mappings and
consultations.
• Expertise in creating effective and practical Monitoring and Evaluation (M&E) frameworks aligned
with project objectives.
• Experience preparing meeting reports and consolidating stakeholder feedback.
• Strong familiarity with the Ethiopian healthcare system, including a solid understanding of national
policies in these areas.
• Strong analytical, oral and written communication skills.
• Proficiency in spoken and written English as well as fluency in Oromo and Amharic with the ability
to convey complex ideas clearly and effectively.
• Advanced computer literacy, including expert-level skills in Microsoft Office Suite.
• M&E experience will be an advantage.
• Experience in eye health and / or healthy ageing will be an advantage.

ANTICIPATED SCHEDULE
The project is expected to start early March 2025 and be completed by mid-July 2025.
DUE DATE FORMAT
EoI due 24 February
Confirmation of consultant 6 March Contract with consultant
Review of background documentation and
provision of a detailed action plan by consultant
11 March Document sent by email
Check in / report back 13 March Virtual meeting / document edits
List of possible organizations and stakeholders to
visit / interview
19 March Document sent by email
Check in / report back 20 March Email update and / or virtual
meeting and document edits
Consultations with local stakeholder’s w/c 24 March and w/c 31
March
Draft outline for PowerPoint, venue options, list of
participants for the workshop and draft invitations
7 April Documents sent by email
Check in / report back 9 April Virtual meeting and document
edits
Revised list of participants and invitations 10 April Document sent by email
Draft PowerPoint 21 April Document sent by email
Check in / report back 24 April Email update and / or virtual
meeting and document edits
Final PowerPoint 2 May Document sent by email
Support workshop w/c 19 May
Draft meeting report and draft design of the
project and M&E framework
4 June Document sent by email
Check in / report back for internal feedback 11 June Email update and / or virtual
meeting and document edits
Revised documents following internal feedback
and draft outline for PowerPoint Presentation
17 June Document sent by email
Check in / report back 3 July Virtual meeting
Revised documents following external feedback
and associated PowerPoint Presentation
11 July Document sent by email
Final documents and PowerPoint Presentation
based on final feedback
16 July Document sent by email

PAYMENT TERMS & SCHEDULE
The maximum budget allocated for this work is 10,000 USD and the work is estimated to take around 50
days over the 6-month period between March and July 2025. Any local travel needed to perform this work
will need to be approved in writing by The Foundation and will be covered separately in accordance with
The Foundation’s Travel Policy.
Phase of work Deliverables Payment
terms
Estimated
schedule
Step 1. Initial mapping,
needs identification and
stakeholder engagement
– Detailed action plan for the
completion of the consultancy
– List of organizations and
stakeholders
– PowerPoint with results from Step 1
40% May 2025
Terms of Reference
– Draft meeting invitations and list of
participants
Step 2. In-country workshop
and draft project design
– Workshop support
– Draft meeting report
– Draft detailed design of the project
and the M&E framework
30% June 2025
Step 2. Project design – Final meeting report
– Final detailed design of the project
including the M&E framework
– Associated PowerPoint Presentation
30% July 2025

CONFIDENTIALITY
The consultant (s) agree to not divulge confidential information to any person for any reason during or
after completion of this contract with The Foundation. Upon completion or termination of this contract,
the consultant (s) undertake to return to The Foundation any materials, files or property in their possession that relate to the work of The Foundation. The consultant will be responsible for safety, security and administration of primary and secondary data collected from FHF or otherwise.

INTELLECTUAL PROPERTY
All intellectual property and/or copyright material produced by the evaluator/s whilst under contract to The Foundation remain the property of The Foundation and will not be shared with third parties without the express permission of The Foundation. The evaluator/s are required to surrender any copyright material created during the term of the contract to The Foundation upon completion or termination of the contract.

SAFEGUARDING PEOPLE
The Fred Hollows Foundation is committed to ensuring that its activities are implemented in a safe and
productive environment which prevents harm and avoids negative impacts on the health and safety of all
people, particularly children, vulnerable people, and disadvantaged groups. The Foundation has a zerotolerance approach to sexual exploitation, abuse, and harassment of any kind. All personnel including
contractors/consultants are expected to uphold and promote high standards of professional conduct in line with The Foundation’s Safeguarding People Policy including Code of Conduct. Contractors/consultants will be expected to sign and adhere to The Foundation’s Safeguarding Code of Conduct and provide any background checks as required.

INSURANCE
Any consultants involved in this project will be required to have in place insurance arrangements
appropriate to provision of the requirements in this Terms of Reference including travel insurance.

ETHICAL AND OTHER CONSIDERATIONS
The evaluator and evaluation team are expected to maintain high professional and ethical standards. The
Foundation is committed to ensuring a safe environment and culture for all people, including children, with whom we come in contact during our work. All members of the evaluation team will be required to comply with The Foundation’s Safeguarding People Policy and sign the Safeguarding Code of Conduct.