Foundations for Health and Empowerment (F4HE) Annual Outcome Study:
The Aga Khan Foundation (AKF), an agency of the Aga Khan Development Network (AKDN), is a private, non-denominational, international development agency established in 1967. It seeks sustainable solutions to long-term problems of poverty, hunger, illiteracy, and ill-health with special emphasis on the needs of rural communities in mountainous and other resource poor regions, primarily in Asia, Africa and the Middle East. Its main areas of focus are education, health, rural development, environment and strengthening civil society.
The Aga Khan Foundation (Pakistan) [AKF (P)] is seeking a high caliber professional consultant to conduct field work in Gilgit Baltistan and Chitral. This is a short-term consultancy for 8-12 weeks (October 2024 to November 2024). The beginning date will be mutually agreed upon between the consultant and AKF (P).
1. Background of the Project:
Foundation for Health and Empowerment (F4HE) is a multi-year initiative being implemented in selected areas in Afghanistan, Kyrgyzstan, Pakistan, and Tajikistan with funding from the Global Affairs Canada and the Aga Khan Foundation Canada. F4HE was developed to strengthen delivery of quality, gender-responsive, and inclusive health, early childhood development, and other sustainable development services; reduce gender and social barriers to utilization and uptake of health, early childhood development, and other sustainable development services and practices in select areas of Asia by women and girls, adolescents, men, and boys; and enhance engagement of stakeholders in gender sensitive and evidence-based development issues and programming in target geographies. This five-year initiative has been developed in the context of AKDN’s long-term presence, indigenous recognition, and extensive familiarity in the region. This project seeks to coordinate, align, expand and enrich the current activities of the various AKDN agencies in the region, in close collaboration with the local, provincial and national governments.
F4HE reach and serve rural and marginalized communities in project geographies where sexual, reproductive, maternal, neonatal, child and adolescent health (SRMNCAH) and nutrition indicators are particularly poor and where non-communicable diseases (NCDs) like breast and cervical cancer and mental health issues are rapidly increasing. And, through ECD Programming it enables parents, caregivers, and health care providers to support and promote child development holistically – socially, emotionally, cognitively, and physically. The integrated programming approach is aligned with the health and education sector policies and strategies of Pakistan.
AKF Pakistan is now commissioning an annual outcome assessment of the project to determine if F4HE is indeed contributing to enhanced access to high-quality and gender responsive health and early childhood development services in designated healthcare facilities and schools. This assessment aims to measure improvement in service delivery within the healthcare sector and quality of the teaching and learning environment offered by teachers in comparison to the project's initial benchmarks and relevant existing information. The valuable insights and recommendations obtained from this assessment will be instrumental in strengthening program interventions and delivering higher-quality services to the targeted communities.
2. Study Objectives
The overarching aim of the annual outcome assessment is to gauge the project's performance against the predefined essential immediate and intermediate outcome indicators outlined in the project PMF.
It aims to achieve three specific objectives:
Scope of Study
Study Framework
Data Collection Tools and Methodology
To ensure standardization, baseline methodology and tools will be adopted for annual evaluation. The list of indicators, data collection tools and guidelines for analysis and reporting is already available and will be provided to the consultant. Specifically, the following customized tools will be employed to assess related components of the F4HE project.
Health Component Assessment Method:
During the baseline study, a total of 39 health facilities were assessed within the project intervention districts. Also, a total of 90 healthcare providers (healthcare staff) were assessed for the purpose of determining project baseline information. The annual assessment plan will include all facilities assessed during baseline. If a facility assessed at baseline is not accessible, replacement facilities would be randomly selected to complete the sample. Along with this, 2 health workers per Health Facility or number reached at baseline (whichever is greater) will be selected using a random sampling technique (if more than 2 staff are present) for assessment on KAP module of the tool. Due consideration will be made to ensure appropriate gender representation.
Further, a total of 609 clients from health facilities were evaluated during the baseline study, with 15 clients assessed at each facility. Ideally, the annual assessment will aim to include a comparable number of clients, or the number available at that time, utilizing a random sampling method if there are more clients present at the time of evaluation. Due consideration will be made to ensure gender representation.
ECD Component Assessment Method:
During the baseline study, a total of 33 Early Childhood Development (ECD) facilities (Phase I schools) were assessed in the project intervention districts. In the third year of implementing the project, additional ECD facilities(schools) were introduced into the project's population framework, marked as Phase II for ECD intervention. In light of this, the annual assessment will include the evaluation of 33 ECD facilities from Phase I which were assessed during baseline and Y3 annual outcome assessment and an additional 66 ECD facilities assessed during Y3 annual outcome assessment from Phase II. If a facility is inaccessible in either phase geography, replacement will be randomly selected from same district out of the available list of targeted ECD facilities.
On the other hand, a total of 66 ECD teachers assessed during baseline. The annual assessment plan will include ECD teachers from both Phase I and Phase II schools, specifically involving two teachers per ECD facility, which represents a twofold increase from the baseline assessment. Moreover, during the baseline, a total of 170 ECD clients were evaluated, with an average of 5 clients assessed at each ECD facility. The annual assessment plan will include ECD clients from both Phase I and Phase II schools, with a particular focus on assessing 5 clients per ECD facility. This indicates a doubling of the number compared to the baseline assessment.
Government Institutions Performance Assessment Method:
For the government institutions targeted for support under F4HE, the standard government performance index will be administered in all selected institutions. A total of 8 representatives from the Education and Health department entities assessed at baseline will be assessed for the annual outcome assessment using the GPI tool.
Project Indicators
The annual outcome assessment will include quantitative evaluation method to assess the project targeted indicators. Project indicators to be measured under the study are listed in table 1 below.
Table 1: Project Indicators to be included in Annual Outcome Evaluation:
Indicator Tool
Health Facility Assessment
% of health institutions and facilities that are gender responsive and adolescent/child responsive as per standards (by facility type (gender-responsive and adolescent friendly), and geography) Health Facility Assessment (HFA)
Data source: Supported health facilities
% of AKF supported health facilities that implement quality assurance (by geography) Health Facility Assessment (HFA)- Data source: Supported health facilities
% of AKF-supported health facilities with effective management systems (by geography) Health Facility Assessment (HFA)-Data source: Supported health facilities
% of supported health facilities with at least 3 modern family planning contraception methods on the day of the assessment (by geography) Health Facility Assessment (HFA)-Data source: Supported health facilities
% of clients who are satisfied with their access to health services, including SRHR and family planning (by gender, age, geography) Client exit interview-Data source: Client at interview at supported health facility
% of health workers in project geographies with appropriate knowledge, attitudes and practices related to gender-responsive and respectful health service delivery (by gender, geography) KAP - Data source: Supported health facilities staff
ECD Facility Assessment
% of AKF-supported ECD centers meeting the minimum quality and secure learning environment standards (by geography) Teach ECE tool-Data
source: Supported ECD centers
Level of client satisfaction with the quality of AKF-supported early learning and ECD services (by gender) ECD client (parents/caregivers) exit interview
% of supported ECD staff (government or community health workers, pre-school teachers and others) with improved knowledge, attitudes and practices regarding ECD (by gender, geography) Teach ECE Classroom Observations and Educator’s survey
% of education facilities with contextually relevant and age-appropriate teaching and learning resources Teach ECE tool
Data source: Supported ECD facilities
Government Institutions Performance Assessment
% of AKF-supported government agencies with improved performance (by geography) GPI tool- Data source supported government agencies assessed
Specific Tasks of Consultancy
The consultant will be responsible for all aspects of work related to enumerator recruitment and training, data collection, data entry, field reporting (including electronic data capture and submission, data quality assurance and developing the draft and final report. The consultant/firm will be responsible for all aspects of work related to survey implementation.
The specific tasks of the consultant include:
6. Ethical Consideration
Outputs and Suggested Timeframe
Selection Criteria
The Consultant should have:
Application Procedure
The selection of the consultant will be carried out in accordance with the procedures of the AKF Pakistan. Qualified and interested parties are asked to submit the following:
Consultant profile
The Aga Khan Foundation (AKF), an agency of the Aga Khan Development Network (AKDN), is a private, non-denominational, international development agency established in 1967. It seeks sustainable solutions to long-term problems of poverty, hunger, illiteracy and ill-health with special emphasis on the needs of rural communities in mountainous and other resource poor regions, primarily in Asia, Africa and the Middle East. Its main areas of focus are education, health, rural development, environment and strengthening civil society.