Terms of Reference

“WAP/1618/2024 Impact Level Baseline Assessment for WASH & Health – Country Programme (CP) Aim 2 of WaterAid Pakistan”

1        About WaterAid

WaterAid is an international not-for-profit, determined to make clean water, decent toilets, and good hygiene normal for everyone, everywhere within a generation. We have been working with government and non-governmental partners to ensure that these essential services are available to poor and marginalized communities, especially women, persons with disabilities, and vulnerable groups.

WaterAid employs a public health and climate adaptation approach to addressing current water, sanitation, and hygiene (WASH) service requirements and sustaining them for the future. Hygiene behaviour change, menstrual hygiene, rural and urban sanitation and safe water systems, WASH in institutions (healthcare facilities, schools, public places) and nature-based solutions for water conservation, groundwater recharge and waste-water treatment are some of the interventions used for achieving our objectives. We also work with sector partners to support and influence the behavioural, institutional and policy mechanisms for accelerating progress toward achieving safe and sustainable WASH access for the poor and marginalized communities. For more information, please visit www.wateraid.org

2        Background

An estimate 53,000[1] Pakistani children under five die annually from diarrhoea due to contaminated water, poor sanitation and hygiene practices, which can cause stunting that currently affect almost 44% of children in Pakistan. Drinking water from 56.1% [2]of households in Pakistan is contaminated with coliforms[3], about 36.0% of households in Pakistan drink water contaminated with E. Coli, the highest prevalence of E. Coli contamination is in KP-NMD is noted as 78.3%. Most of these disease patterns and the morbidity and mortality attached accrue from lack of clean drinking water, sanitation facilities and hygiene awareness and practice. Women, adolescent girls, and children of the province are impacted by malnutrition due socio-cultural factors, poverty, gender inequality, and community norms.

The 2018 National Nutrition Survey reported that the critical high levels of malnutrition were consistent with the high rates of infant and maternal mortality. In 2019, the infant mortality in KP was 53 deaths per 1,000 live births, and maternal mortality was at 165 maternal deaths per 100,000 live births in 2019. A large proportion of these deaths are attributed to a prevalence of early childbearing, low birth weight and the high prevalence of malnutrition among pregnant and lactating women.

WASH services in healthcare facilities (HCFs) of Pakistan fall short of WHO and national standards; only 16% of HCFs have basic sanitation service, 55% have basic hygiene service, 14% have basic healthcare waste management, and only 35% have environmental cleaning, with evident neglect of inclusion (especially from gender and disability perspectives). Moreover, people attending healthcare facilities, particularly primary healthcare facilities are often perversely exposed further to WASH related health risks. 19% of non-hospital healthcare facilities have no water service and 32% have no hygiene service. Although 86% of all facilities have improved sanitation, 24% of these are non-functional and only 33% have gender-separated toilets. Low resourcing for Health and limited understanding of healthcare providers on the importance of WASH are two, out of the multiple causes of low achievements in health sector.

In order to contribute to improvement of WASH and Health including Nutrition status of people, WaterAid Pakistan intends to commence Impact Level Baseline Analysis in Pakistan to identify the entry points for WaterAid to work with health sector in Pakistan to achieve the CP Aim 2 Objectives over next five years.

3        Objectives of the Study

The primary goal of the impact baseline assessment is to evaluate the current status of WASH service levels, behaviors, and system strength in the selected districts of Sindh and Punjab provinces. This includes identifying key entry points for integrating WASH into health sector programs, assessing the strength of the health system in prioritizing WASH, setting benchmarks for future progress, and summarizing and validating key findings with relevant government stakeholders at both the federal and provincial levels using both quantitative and qualitative data.

4        Specific Objectives

The specific objectives of the study are:

• To identify the entry points for WaterAid Pakistan.

• To conduct the Health Systems building Block analysis to assess the health system through the lens of each of the identified entry points at national and provincial level.

• To validate with government (cross-ministry - e.g., Health, Water/Environment, Gender, Finance, etc.) and health and development partners and confirm commitment of government to lead on integration of WASH services and behaviours into public health programmes.

5        Scope of Work

• Identify and analyze key entry points within in Federal and Provincial Health Systems where WASH can be integrated to improve health outcomes.

• Validation of selected entry points through Key Informant Interviews with Federal, Provincial and District line departments.

• Consultative workshops with federal and provincial development partners.

• Contextualize and complete a building block analysis to assess the health system through the lens of WASH in each of the selected entry points at national level and provincial level.  

• Create comprehensive baseline profiles for each entry point that capture the qualitative aspects of WASH conditions and practices.

• Include narratives on stakeholder perspectives, observed practices, and contextual factors.

• Develop strategic action check list for intervening in the identified entry points for system strengthening.

6        Methodology of the Study

The study will be based on both quantitative and qualitative research methodology including literature review, focused group discussion and key informant interviews. The final summarized findings will be validated with Government counterparts at all level.

The consultant will conduct desk review, field visits, and meetings with key stakeholders. In doing this work, the consultant will develop tools to collect and analyse the needed information, which will be vetted by WaterAid prior to utilization. Some of the suggested key informant interviews are as follows. However, the consultant may suggest more keeping in view the need of the required data/information:

• Focal person of WASH technical working group, Ministry of National Health Services.

• Officials of Provincial Health Departments of Sindh and Punjab.

• Officials of Provincial PHED Departments of Sindh and Punjab.

• Officials from District Health Department, Karachi, Thatta, Badin, Lodhran and Muzaffargarh.

• Medical officers of Basic Health Units and RHCs (2 from each of the target districts).

• In addition, the consultant is also required to conduct provincial consultative workshops in Sindh and Punjab to validate the key findings related to impact level baseline. The suggested participants of the workshops include provincial health departments, Public Health Engineering Departments, civil society organizations, members of PHF/NHN, UN agencies and provincial teams of WaterAid Pakistan in Sindh and Punjab.

 The consultant is expected to deliver the:

1. Desk review report to understands and learn from studies (formative research) already conducted in this and/or similar areas.

2. Develop tools like interviews questionnaire in line with this concept in close coordination with WaterAid team and using the learning from desk research

3. Conduct building block analysis as well as KII informant interviews   for entry point analysis

4. Validate data analysis and key findings with the relevant Government stakeholder from different departments  

5. Production of a quality report (summary, detailed report) both MS Word and power point  

7        Deliverables  

The consultant is expected to produce the following:

1)     An inception report outlining the methodology and approach, tools, work plan with clear timelines on how the assignment will be carried out.

2)     Building block analysis summary.

3)     Final impact level baseline report as per format given by WaterAid.

4)     Impact Level Baseline brief.

5)     Electronic and hard copies of the research report (including relevant data tables if any).

8        Supervision

The consultant will report to the Programme Quality and Partnership (PQP) team at WaterAid Office Islamabad.

9        Duration of Assignment

WaterAid intends to receive the services of a selected consultant for a period of 25 days commencing from the agreement signing date.

10    Evaluation Criteria

Each candidate shall submit both technical and financial proposals in two separate sealed envelopes. The technical proposals will be evaluated first according to the Evaluation Criteria provided in the table below. The technical qualification threshold is set at 70 points. Only the financial proposals of candidates who meet this threshold will be opened.

11    Financial Offer

For financial offer, each deliverable must be included in the financial offer. All deliverables MUST be completed within the assignment duration. Please submit your technical proposal and financial proposal in 02 separate sealed envelops clearly marked with company/individual name and the title of assignment “Impact Level Baseline Assessment for WASH & Health – Country Programme (CP) Aim 2 of WaterAid Pakistan”.

12    Application Process and Closing Date

All proposals must be sent via registered mail/courier or delivered by hand to the following address on or by September 18, 2024, COB. The consultancy title “WAP/1618/2024 Impact Level Baseline Assessment for WASH & Health – Country Programme (CP) Aim 2 of WaterAid Pakistan” must be clearly marked on the envelope/email subject.

Manager Administration and Security - WaterAid Pakistan

2nd Floor, Executive Heights, West, 65 A.K. Fazl-ul-Haq Road,

 Islamabad, 44000, Tel: +92 51 2806120

Enquiries may be directed to email: [email protected]