Médecins Sans Frontières (MSF) is an international independent medical humanitarian organization delivering emergency aid to people affected by armed conflict, epidemics, climate disasters, and exclusion from healthcare. Medical operations are implemented by five operational centres in Brussels, Amsterdam, Barcelona, Geneva, and Paris. Since its establishment in 2010, the Stockholm Evaluation Unit (SEU) has facilitated more than one hundred evaluations and reviews commissioned by the Operational Centre in Brussels (OCB).
The MSF movement currently implements, as well as supports the implementation of, humanitarian medical assistance activities across the Middle East, with four programmes offering reconstructive surgery in Yemen, Iraq, Jordan, and Palestine. Two of these programs are implemented by the OCB – Mosul and Gaza – and are the subject of the proposed evaluation, and specifically its reconstructive surgery components.
OCB has operational research (OR) ongoing on key topics such as Antibiotic Resistance (ABR) and implements an ABR OR training course for programme in Lebanon (ABR Sort-it).
Mosul
Since 2014, conflict in Mosul gives periodic rise to an increase in the number of orthopaedic and plastic surgery cases linked to violent trauma. By the time the Iraqi government regained control of Mosul in 2017, patients injured and insufficiently treated with mainly limb longstanding wounds, fractures and infections had piled up. An increase in conflict-related mental health conditions also needs addressing.
The public health system in Mosul remains chronically underfunded, understaffed, and under-equipped to respond to the more complex, post-conflict healthcare needs of Mosul inhabitants’. This is compounded by the unregulated widespread use of antibiotics in Iraq, which makes treatment of post-operative infection a challenge.
OCB’s Mosul programme’s overall objectives is to provide access to free surgical care, Sexual Reproductive Health (SRH) services and Mental Health and Psychosocial Support (MHPSS) services in order to reduce morbidity and mortality rates. These services are offered to people living in Mosul who have been injured by violent and accidental trauma, have lost sufficient access to SHR services, and/or suffer from post-conflict mental conditions.
The programme for reconstructive surgery and related activities (the evaluand for the evaluation) started in April 2018 and has evolved over three years to encompass an orthopaedic hospital and services related to surgery to the general population. When the situation is stable and conflict is low, resources from the project are channelled into treating even non-conflict linked trauma surgeries as well as other activities. With the arrival of the COVID-19 pandemic, surgical operations were completely halted between April and November 2020, with no patients being admitted for surgical care.
Gaza
Gaza is a protracted conflict affected by periodic surges in violence. OCB sets up operations in Gaza during April 2018, including reconstructive surgery, following the March of the Right to Return in March of the same year.
The OCB Gaza program objective is for Gaza’s paediatric and adult population with traumatic and post-traumatic pathologies, and anomalies to make use of the free, quality, and multi-disciplinary MSF surgical program in Al Awda Hospital.
MSF currently runs the surgical unit in Al Awda hospital. A national organization, the Union, runs the hospital. With two operation theatres and up to 23 beds, the unit saw an influx of patients needing reconstructive limb surgery or follow-up reconstructive surgery for conflict-related trauma wounds throughout 2018 and 2019. By December 2019, when the COVID-19 pandemic hit, the influx of patients for surgery decreased. In June 2020, the admission criteria for surgical care were expanded to include paediatric care (from 5 years old) as well as non-conflict trauma surgery.
The MSF movement currently operates four programs in the Middle East with reconstructive surgery components. This type of medical activity is relatively new to MSF OCB, which means there is an organizational desire to increase knowledge on this topic.
As OCB currently operates two reconstructive surgery projects in two protracted crisis settings, the evaluation will be an opportunity to gain insight and potentially cross-fertilize the existing projects.
OVERALL OBJECTIVE. The overall objective of the evaluation is to assess the relevance, appropriateness, effectiveness, efficiency, and impact of MSF-OCB’s reconstructive surgery project interventions in Mosul and Gaza. The objective is to understand where we stand on delivering on our project objectives.
INTENDED USE. The evaluation is aimed primarily at informing MSF-OCB discussions about the projects’ main orientations for the next few years, including potentially necessary adaptations in Mosul and Gaza respectively.
The specific objectives of the evaluation are based on the international DAC criteria.
Relevance
EQ1. To what extent are the project approaches relevant in Gaza respectively Mosul?
· To what extent are the medical services provided in each project relevant to the existing needs, are there any gaps? · In what ways has the start-up phase been contextually relevant?
· In what ways has the re-orientation of project activities been relevant?
· To what extent has the change in admission criteria been relevant?
Appropriateness
EQ2. To what extent are the projects culturally, medically, and contextually appropriate in Gaza respectively Mosul?
· In what ways is the project design and implementation appropriate in Gaza respectively Mosul?
· Were appropriate and timely adaptations made in response to changes in the context in Gaza respectively Mosul?
Effectiveness
EQ3. To what extent are the projects effective?
· To what extent are the project activities attaining their expected results? · What are the main enabling factors and barriers to reaching results in each project site?
· Do project activities adhere to quality standards (internal and external)? · In what ways does capacity at HQ and project level contribute to reaching results, or not?
Efficiency
EQ4. To what extent are the projects efficient?
· Do the MSF projects in Mosul respectively Gaza utilize monetary, human, and material resources satisfactorily to achieve project results? · In which ways can the projects improve the reorientation of use of resources when needed?
Impact
EQ5. In what ways have the projects impacted the quality of life of patients?
· Does our project presence in Gaza and Mosul, respectively, have any unforeseen positive or negative impact in the quality of life in the patients’ lives?**
1. Inception Report
As per SEU standards, after conducting initial document review and preliminary interviews. It will include a detailed evaluation proposal, including methodology.
2. Workshop
Capacity-building workshop in M&E for medical staff.
3. Draft Evaluation Report
As per SEU standards. It will answer to the evaluation questions and will include conclusions, lessons learned and recommendations.
4. Working Session
With the attendance of commissioner and consultation group members. As part of the report writing process, the evaluator will present the findings, collect attendances´ feedbacks and will facilitate discussion on lessons learned.
5. Final Evaluation Report
After addressing feedback received during the working session and written inputs.
6. Internal Presentation of Evaluation findings
Other dissemination deliverables to be defined in a separate dissemination plan.
In addition to the initial evaluation proposal submitted as a part of the application (see requirement chapter), a detailed evaluation protocol should be prepared by the evaluators during the inception phase. It will include a detailed explanation of proposed methods and its justification based on validated theory/ies. It will be reviewed and validated as a part of the inception phase in coordination with the SEU.
§ Project documents (project proposals, logistical frameworks, situational reports, annual reports, field visit reports)
§ Documentation regarding the ongoing operational research initiatives in the project
§ National and regional documentation
§ External literature and documentation of similar experiences
§ Medical Competencies:
o Minimum of 5 years medical technical expertise in implementing/managing reconstructive surgery programming in conflict, post-conflict and/or protracted crisis settings an essential requirement; more years is an asset.
§ Evaluation Competencies:
o At least 3 years of experience of conducting programmatic evaluations, within Public Health an asset.
o Experience of working in humanitarian/development programming in the Middle East an asset.
o Fluency in English. Fluency in Arabic as an asset.
§ Desirable:
o MSF experience and/or good understanding thereof.
o Experience/understanding of Iraq and/or Palestine contexts.
We welcome applications from teams or individuals. As this evaluation requires specific medical expertise, we welcome applications from medical professionals in the field of reconstructive surgery who we would potentially match with an evaluation professional in order to achieve the objectives of this evaluation. Travel to Gaza and Mosul is envisaged in this evaluation, and therefore the right to travel to Gaza and northern Iraq is a requirement.
*Please find the Terms of Reference above to download here.*
This vacancy is archived.