EVALUATION OF PPAG’S ABORTION SELF-CARE INTERVENTIONS – TERMS OF REFERENCE

Consultant
Head Office
Posted 1 week ago
  1. Project Details
  2. Background

Unsafe abortion is one of the highest contributors to maternal deaths in Ghana, with more than one in every ten maternal death attributed to unsafe abortion[1]. Despite the progressive policy reforms that the Ghana Health Service (GHS) have implemented to increase access to safe abortion services in recent years[2], entrenched social barriers such as provider attitudes prevent women from seeking person-centred and inclusive care on their terms. A recent study published on post-abortion care experiences reports that many women use clandestine abortion pills and “suffer in silence” with severe complications to avoid letting people know about their abortion[3]. However, we know from a recent observational study managed by Ipas Ghana that individuals who accessed high-quality medical abortion (combination regimen) from pharmacies had comparable health outcomes as those who accessed medical abortion in clinics. This illustrates the need to expand access to high quality self-managed medical abortion that is not only safe but also available in a stigma-free and enabling environment of a woman’s choosing.

The Planned Parenthood Association of Ghana (PPAG) with funding the International Planned Parenthood Federation (IPPF), is implementing a project with the goal of improving women and girls’ sexual and reproductive health rights (SRHR) through sustainable, innovative, and client-centred approaches. The project is currently being implemented in seven project locations across Ghana, namely: Accra, Cape Coast, Sunyani, Kparigu, Techiman, Sogakope and Tamale. The project’s specific objectives include:

  • Women and girls have increased access to quality services and support for self-managed medical abortion, within a package of comprehensive abortion care (CAC) and integrated SRH services.
  • Young people are empowered as leaders and agents in SRHR in their communities.
  • Increased access to SRHR through digital health interventions.

The underlying principle of the project is to adopt innovative and people-centred approaches, which places the individual in control of their reproductive health journey. PPAG is implementing interventions to support individuals with a safe and stigma-free experience of self-managed medical abortion[4] in line with Ghana’s national protocols for Comprehensive Abortion Care Service Delivery. PPAG’s abortion self-care (ASC) interventions are defined in two phases as follows:

Phase 1 (1 April 2021-1 November 2022)

  • Community cadres such as over the counter (OTC) drug sellers and pharmacies (n=45), and youth volunteers (n=21) have been trained on harm reduction. The training covered the concept of harm reduction, referrals, how to use informational materials, identifying warning signs and complications, an eligibility questionnaire, and digital platforms to provide accurate information on the abortion process.

Service providers and contact centre agents (n=36) have been trained to provide in-person and remote support to clients to manage their abortion process. Clients attend one of the six PPAG facilities for initial counselling and consultation with a service provider. In this pathway, individuals take their first dose (mifepristone) of the combination regimen (mifepristone and misoprostol pills) in the presence of a service provider. The client is then provided with the misoprostol and takes it outside the health facility at a site of her choosing, with support from the service provider if needed. This form of self-care is what Ghana’s protocols allowed during the inception of the project. Service providers and contact centre agents remotely support clients who are

[1] Ghana Statistical Service (GSS), Ghana Health Service (GHS), and ICF. 2018. Ghana Maternal Health Survey 2017. Accra: GSS, GHS, and ICF.
[2] Ghana Health Service. Prevention and management of unsafe abortion: Comprehensive abortion care services. Standards and protocols. Accra: GHS; 2006.
[3] Experiences of women seeking post-abortion care services in a Regional Hospital in Ghana (plos.org) (link)
[4] IMAP Statement Abortion Self-Care – English.pdf (ippf.org)

  • outside the facility to manage any stage of the abortion process the clients may have already initiated. This remote support involves calls and texts between the service provider and the client to provide counselling and guidance through the abortion process.
  • Value Clarification and Attitude Transformation (VCAT) workshops on ASC for PPAG clinic and project staff (n=8). This workshop was designed to allow staff to reflect, discuss and evaluate their knowledge, attitudes and practices on ASC in their everyday work.
  • Advocacy meetings with GHS to generate support for full ASC

Phase 2 (to be implemented from 1 October 2021-1 April 2022)

PPAG will implement a full ASC intervention in one district in Q4 2021. In this district, abortion users will lead the abortion process on their own with support from PPAG staff. This will include accessing and taking the abortion pills to complete the abortion, all outside a health facility. However, the user would need to be counselled and evaluated by a registered service provider remotely, as the currently modified national Comprehensive Abortion Care Service Delivery Protocols demands. This engagement entails counselling and guidance on abortion pills and how to administer them. As part of phase 2, community cadres will continue to receive support and training on ASC and its contextual modalities for implementation. Advocacy meetings will also continue at the national level.

As shown in the flow diagram below, PPAG has been implementing phase 1 of ASC as detailed above since the second quarter of 2021 and would continue to offer such services based on clients’ preferences. However, the MA intends to implement full ASC from the fourth quarter of 2021. After its operationalization, it will be offered together with the other abortion pathways for all clients to choose from.

Phase 3 (to be implemented from April 2022 to December 2022)

PPAG will scale the implementation of full ASC to all six (6) clinics by December 2022.

* Support for in-clinic abortion care continues to be available available in these districts

**Support for partial ASC and in-clinic abortion care continues to be available in these districts

The project’s focus on ASC is also reflected in its community impact work as well. This regards the work of community volunteers, and the use of digital health platforms to disseminate quality information on SMMA and also to link clients to services. This continues to be the project’s focus till its closure in 2022.

  1. Project Outcomes

The intervention is expected to facilitate the following outcomes:

  1. Increased knowledge in abortion-self care among PPAG Staff, volunteers and implementing stakeholders.
  2. Increased acceptability of ASC among users.
  • Establishment of mechanisms to facilitate the provision of SMMA to users. Measurement would include the number of clients supported to access SMMA.
  1. An increase in the number of users receiving and accessing quality information and services on SMMA via digital health channels.

      2. Study Details
      a. Background and Objectives

PPAG started implementing abortion self-care interventions from March 2021 in six (6) MA Clinics. Since the inception of the project, relevant staff have been trained in the concept and practice of self-care, within our local context, and robust systems have been set up to facilitate the provision of self-care services (including the establishment of digital platforms, and community-based networks). As of June 2021, more than 133 women had accessed self-care services in the MA Clinics, while another 902 had been reached with SRHR information, including abortion self-care. These are early indications that reflect the possibilities of much better results as the project consolidates.

WHO, IPPF and other international organizations are intensely advocating for the scaling of self-care interventions across the world, and this has become more pronounced during the Covid-19 pandemic. Hence, as a matter of evidence generation to support the global advocacy, it would be important to evaluate PPAG’s work in self-care to understand the quality and acceptability of our interventions. This evaluation is proposed to be done after at least six (6) months of the intervention’s implementation by PPAG; allowing for more depth in learnings. This assessment will be in-depth and will cover pertinent components of the intervention, including but not limited to clinical systems for supporting self-care, digital platforms, and community-based networks (including pharmacies and youth volunteers). This will represent the first part of the study.

The overall goal of the study is u to understand the acceptability of transitioning from clinic-based to client-led abortion pathways for PPAG staff, volunteers and individuals who have accessed services and support for abortion.

     b. Study Outcomes

To meet the goal of the study, the research consultant will conduct a mixed-methods study including quantitative and qualitative components. Specifically, this would include the following:

  • Perform a comparative analysis from project baseline to endline between clinic-based abortion care and self-care at the MA Clinics for the following
    • Quality of support for clients accessing abortion-related services (emphasis on facility-based and self-care)
    • Acceptability for abortion-related facility-based service or self-care.
    • Complications rate/Adverse events. Measured within the following parameters:
      • Need for intervention to complete the abortion
      • Need for additional in-person care (for signs or symptoms of adverse events)
    • Comparative analysis of financial sustainability
    • Uptake of post-abortion contraception.
  • Evaluate knowledge acquisition and attitudes towards ASC based on the following indicators:
    • Knowledge on ASC among staff, volunteers and implementing stakeholders
    • Attitudes towards ASC amongst staff, volunteers and clients

This component will also include a qualitative process evaluation to understand the mechanisms for change in the two groups. This will involve in-depth interviews and focus group discussions with (1) PPAG staff members & volunteers and (2) Individuals who have received support for ASC from PPAG contact centres, clinic staff or digital health platforms.

  • Analyse the contribution of digital health platforms towards access to ASC. This will be measured based on the following indicators:
    • Effectiveness of digital platforms in creating access to ASC information and services.
    • Comparative analysis between ASC received via digital platforms and ASC received via other manual platforms. Based on the following indicators:
      • Level of satisfaction with service received.
        • Cost
        • Time
        • Attitude of service provider/contact centre agent

    c. Research Questions

The study will seek to respond to the following questions:

  • To what extent is full clinic-based abortion comparable to partial and full ASC? Comparisons based on:
    • Quality of support for clients
    • Acceptability
    • Complications rate/adverse events (Need for intervention to complete the abortion; Need for additional in-person care (for signs or symptoms of adverse events)
    • Post-abortion contraception.
  • To what extent is ASC as offered by PPAG financially sustainable, when compared to facility-based care?
  • What is the level of knowledge of ASC among staff, implementing volunteers, and stakeholders?
  • What is the attitude of service providers, and implementing stakeholders towards ASC?
  • What is the level of satisfaction with accessing ASC via PPAG’s digital health channels?
  • What is the service uptake conversion rate for clients who received ASC information via PPAG’s digital health channels?
  • What were the main challenges of the project, key lessons learnt, and best practices implemented?

   d. Sampling and Data Collection

The research consultant would design the sampling strategy based on the projected number of clients that will be recruited to take part in the study.

The following however would be the target groups for the study.

No. Study Outcome Target Group Data Collection (Type)
1. Quality of support for    clients accessing abortion-related services Users/Clients Exit Interviews – Survey
Service Providers IDI
Contact Centre Agents IDI
2. Acceptability for abortion-related facility-based service or self-care Users/Clients Exit Interviews – Survey
3. Complications rate/Adverse events Users/Clients Exit Interviews – Survey
Service Providers IDI
Contact Centre Agents IDI
Client Records/Service Statistics Desk Review
4. Uptake of post-abortion contraception Users/Clients Exit Interviews – Survey
Service Providers IDI
Client Records/Service Statistics Desk Review
5. Comparative analysis of financial sustainability Users/Clients Survey
Service Providers IDI
Financial Reports Desk Review
6. ·     Knowledge on ASC among staff, volunteers and implementing stakeholders

·     Attitudes towards ASC amongst staff, volunteers and clients

·    Service Providers

·    Project Staff

·    Youth Champions

Surveys

 

IDI
7. Effectiveness of digital platforms in creating access to ASC information and services. Project Staff IDI
8. Comparative analysis between ASC received via digital platforms and ASC received via other manual platforms. Users/Clients Survey

e.  Scope

This assessment will focus on PPAG’s self-care intervention in six (6) MA clinics, as supported by IPPF. There will also be adoption of PPAG’s digital health platforms for evaluation as per the study objectives.

f.  Schedule

Activity 2021 2022
Sept Oct Nov Dec Jan May Jun Jul Aug Sept Oct Nov
Recruit Consultant x                      
Design and finalize research design with PPAG and IPPF

This will include the study tools.

  x                    
Acquire Ethical Clearance     x x x              
Field Work/Data Collection/Report           x x x x      
Validation and Report Finalization                   x    
Report Dissemination                     x  
Prepare articles for publishing in journals                       x

g.  Deliverables/Task of Consultant

The consultant will be expected to produce/develop/lead the following as part of the engagement:

  1. Facilitate ethical clearance for baseline and endline assessments.
  2. Proposed Research Design (including methodology, and research tools) and Financial Proposal
  3. Inception Report – Revised research design and plan based on consultations with the MA and IPPF.
  4. Coordinate data collection
  5. Baseline and Endline Study Report
  6. Baseline and Endline Findings Summary Report/Presentation for Dissemination

3. Management & Supervision

The evaluator will be overseen directly by the Research, Monitoring and Evaluation Unit of PPAG. The Monitoring and Evaluation Manager of PPAG will be the focal person at PPAG for the evaluator.

4. Consultant’s Qualifications and Requirements

The lead consultant is expected to have the following qualifications:

  • An advanced degree (minimum of a research-based master’s degree) from a recognized university in Public Health, Health Quality, Health Economy, Population Studies, Development Studies, International Development, Research Methodologies, Planning, Monitoring and Evaluation, or any related field.
  • At least 5 years of progressive experience performing research and evaluation exercises for health-related programs.
  • Excellent knowledge and understanding of research methodologies and processes.
  • Good understanding of the local health system, particularly regarding Sexual and Reproductive Health and Rights (SRHR).
  • Fluency in English is required. Knowledge of a local language, preferably Akan would be an added advantage.

The consultant or firm should provide the following in their application:

  • CVs of key personnel who will be involved in the assessment.
  • Evidence of similar assignments conducted within the last 3 years, including references. This should be captured in a table with the following headings: title of project/assessment; type of assessment (baseline, midterm, endline, etc); total budget; source of funds (donor); scope (geographic); subject area; and duration.
  • Technical Proposal – detailed research design, including schedule. (max. 10 pages)
  • Financial Proposal – Budget should include all expected costs e.g. Accommodation, Travels, meals etc. The budget should also indicate the requisite national tax provisions.
  • Tax Clearance Certificate from GRA and Company Registration documents (if applicable).

How to Apply

All interested Consultants or  Firm with requisite qualification(s), should kindly send their Application Letters with detailes as requested above to:

consultancy@ppag-gh.org

Only shortlisted applicants will be contacted.

Note:

Closing Date: 24th September, 2021

 

Job Features

Job CategoryConsultancy, Non-Executive Position

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