Programme Evaluation – Uganda At Triggerise

Background and context

Established in 2014, Triggerise 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, Triggerise 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, Triggerise 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, enabling 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

Scope of research

Triggerise’s goal is to assess the impact of the program in Kampala, particularly in areas where we have established Tiko ecosystems. The evaluation will encompass three distinct levels: the market level, individual level, and social level. The evaluation process will involve data collection and analysis at both the baseline and endline stages. The baseline is planned for January 2024 while the endline will be done in January 2025.

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.

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

Market level evaluation

Determine the extent to which Tiko increases the availability of integrated, AYP centric SRH, HIV and mental health services in the public and private sector

• What is the effect of the tiko platform in the private and public sector service provision (MH, HIV self-care and ART treatment)? (Do the facilities provide integrated (SRH, HIV and mental health) youth-friendly services as a result of their partnership with the Tiko platform?)
• To what extent does Tiko improve the ability of facilities and health service providers to meet the SRH, HIV and mental health needs of AYP?
• To what extent does Tiko improve the ability of facilities to provide quality health services AYP?
• To what extent does the Tiko approach improve the performance of the Youth and Adolescent Peers (YAPs) to enrol young people into the programme and to be sustained in the programme?
• What has been the impact of the Tiko platform on integrated facilities? To what extent is there a ripple effect from integrated facilities to non-integrated facilities at the local level (To what extent is the Tiko platform stimulating the local health market on SRH/MH/HIV?)?
• To what extent is Tiko playing a role in health district or national-level management?

Individual level evaluation

Understand the extent to which AYPs 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, HIV and mental health services?
• To what extent do Tiko 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?
• To what extent does the Tiko platform/approach/model improve AYP behaviours on SRH, HIV and mental health services?
• To what extent does the tiko platform and integrated MH services help to improve coping mechanisms to mental health issues? (The behaviour to observe are: HIV testing, ART use, PrEP use, contraceptive use, mental health screening and outcome of mental health counselling)
• To what extent does the Tiko platform/membership improve AYP’s agency to access SRH, HIV and mental health services?
• To what extent does the Tiko platform/membership influence intended/planned behaviour such as use of condoms, HIV testing, and screening for mental health?
• To what extent does the Tiko platform/membership increase AYP’s knowledge of mental health, HIV testing, ART and/or PrEP and family planning?
• To what extent does the Tiko platform/membership improve AYP’s attitudes towards mental health, HIV testing, ART and/or PrEP and contraceptives?
• To what extent does the Tiko platform/membership improve AYP’s confidence in seeking mental health, HIV testing, ART and/or PrEP and contraceptive g services?

Social network evaluation

Assess the extent to which Tiko influences the social environment and ultimately access to mental health, HIV testing, treatment, prevention and family planning services

• What type of messaging/content helps unlock diffusion of service access information to AYPs’ social networks?
• How does the Tiko platform facilitate a positive narrative across non-Tiko platform user peers and influencers around MH, HIV self-care and ART treatment?
• Do some Tiko users intend to or become supporters of uptake of SRH services (i.e. mobilisers, counsellors, community health workers, health workers etc)?
• What are the barriers for diffusion of service access and information to AYPs’ social networks?

Methodology of the study

The baseline evaluation is scheduled for January 2024 while the endline is planned for January 2025. The evaluation will employ a mixed methods approach to evaluate the impact of the programme. The impact will be established by collating various sources of data and triangulating the insights to determine the impact across the three levels. These data sources include:

1. Government DHIS2 service data
2. Tiko platform service data
3. Primary data collected from Tiko users
   1. We could also collect some data from Tiko user’s networks including their sexual partners and friends
4. Data collected from facility providers, mobilisers and YAPs

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

Scope of work

The primary purpose of the work is to design and conduct a baseline survey to be implemented in January 2024 in Kampala Uganda. The findings of this evaluation will provide Triggerise with a set of baseline measurements against which to monitor and track the progress, effectiveness and impact of the Tiko Platform over the course of implementation.

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

• Co-design study protocol with Triggerise by Dec 2023

Deliverable:

Study protocol

• Methodology
• Data collection tools
• Renown Principle Investigator and research team
• Project work plan
• Submit and obtain approval of evaluation protocol by Institutional Review Board (IRB) by Jan 2024

Deliverable:

Approved study protocol

• Draft inception report, field work plan and quality control plan by Jan 2024

Deliverable

• Inception report
• Research/Evaluation team
• Presentation of the inception report
• Scripting of tools by Dec 2023

Deliverable

Scripted questionnaire

• Data collection by Jan 2024
• Cleaned final dataset(s) containing all data collected for the baseline, including survey responses and KII/FGD transcriptions & codebook by Feb 2024

Deliverable

Access to the final, cleaned data set, Stata and SPSS

• Final Report (incorporating inputs from the review) by Mar 2024

Deliverable

Final Report

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:

• Organisational expertise and experience in undertaking similar activities in Uganda
• Team expertise in undertaking similar work within the past 3 years
• Letters of support/recommendation

Weight: 40

Strength of the technical proposal:

• Overall strength of proposed co-design approach, overall methodology and timelines

Weight: 40

Budget:

• Value for money

Weight: 20