Feasibility Study: Strengthening Ear and Hearing Care Capacities in Cameroon (BMZ-funded project)

Planned project: Strengthening Ear and Hearing Care capacities in Cameroon

Country/region: Cameroon (Northwest (Bamenda, Mbingo, Banso), Southwest (Mutengene, Kumba), West (Bafoussam), Littoral (Bonaberi, Mboppi), Centre (Etoug Ebe, Ekoumdoum, Nkoabang, Voundou),

Partner organisation: Cameroon Baptist Convention Health Services

Planned project start: 01.05.2024

Study purpose: The aim of the requested consultancy is to assess the feasibility of a proposed project of CBM and the Cameroon Baptist Convention Health Services (CBCHS) and to systematically check the extent to which the project approach can plausibly achieve the planned changes under the existing framework conditions and project budget.

Commissioning organisation/contact person: CBM

Study duration: 30 days

1. Background of the Feasibility Study

CBM and CBCHS would like to propose a project to the German Federal Ministry of Economic Cooperation and Development (BMZ), which shall contribute to improve the quality of life of people with hearing impairment or ear diseases, or at risk of them, in Cameroon through sustainable access to Ear and Hearing Care (EHC) services.

The project is currently in its design phase and CBM is seeking to recruit a consultant to conduct a Feasibility Study to assess the feasibility of the proposed project and systematically check the extent to which the project approach can plausibly achieve the planned changes under the existing framework conditions.

The proposing organisations are:

The Cameroon Baptist Convention Health Services (CBCHS) is a Christian Non-Governmental Organization with a mission to provide quality health care to all who need it as an expression of Christian love. The CBCHS is now the second largest provider of health care services, after the government in Cameroon, with 103 health facilities in 9 of the 10 regions of Cameroon. Over the years, CBCHS has developed into a multi-faceted organization offering a range of quality health care and related services to millions of people in a holistic manner, at both health facility premises and community settings. Its partnership with CBM goes back to 1982, period during which a wide range of services for the prevention, treatment, and rehabilitation of disabilities have been developed including Eye care, physiotherapy and orthopaedic care, mental health and Ear Nose and Throat (ENT) services. Its ear and hearing care services are tailored to meet the needs of people across all social strata and include subspecialties in audiology and cochlear implantation.

Christoffel-Blindenmission/Christian Blind Mission e.V. (CBM) is a Christian international development organisation, committed to improving the quality of life of people with disabilities in the poorest communities of the world irrespective of race, gender or religious belief.

CBM’s approach of Disability-inclusive Development is the framework of all its initiatives and the key theme which drives activities and the impact of its work. CBM believes that this is the most effective way to bring positive change to the lives of people with disabilities living in poverty and their communities. Through our disability-inclusive development approach, we address the barriers that hinder access and participation and actively seek to ensure the full participation of people with disabilities as empowered self-advocates in all development and emergency response processes.

Ear and Hearing Care (EHC) is one of the technical areas embedded into CBM’s Community Based Inclusive Development (CBID) Initiative. CBID is therefore both a programmatic strategic approach for CBM and a working methodology for the implementation of field projects by local partners, in coordination with CBM Country Offices.

2. The Project

The “Strengthening Ear and Hearing Care (EHC) Capacities in Cameroon” Project is designed to improve the quality of life of people with hearing impairment or ear diseases, or at risk of them, in Cameroon, through sustainable access to EHC services. The Project will be funded by the BMZ, the German Federal Ministry for Economic Cooperation and Development. The project will be implemented in 5 of the 10 regions of Cameroon, over a period of 5 years, from 2024 to 2028. During this period, quality ear and hearing care services will be provided to an estimated 200,000 people. The project will target EHC services’ users, community and primary healthcare providers, as well as EHC specialists. The proposed catchment area will include the Northwest, Southwest, West, Littoral and Centre Regions, where CBCHS already has functional EHC clinics.

3. Direct Target Group

200,000 EHC services’ users reached through CBCHS EHC services, provided by hospitals’ services during 5 years, who will directly benefit through improved infrastructure (equipment and instruments). 500 other Community and Primary Health Care workers who will be trained for EHC awareness raising, early identification, intervention and referral processes. 20 Ear & Hearing Care (EHC) workers in CBCHS-supported hospitals in the Northwest, Southwest, West, Littoral and Centre Regions, trained as Audiology Technicians; 30 new health workers in all 10 regions of Cameroon, who will be trained as clinical officers to support existing EHC services.

Direct Institutional Target Group: National and Regional (Provincial) policy makers at Ministry of Health, Ear and Hearing Care (EHC) and Community Based Inclusive Development (CBID) programmes. Health and Sciences professional and academic institutions, associations of deaf and hard of hearing persons and key Civil Society Organizations (CSO) working towards improving accessibility and quality of EHC services and to strengthening national systems.

Indirect Target Group: 2.96 million people, 12% of Cameroon population, who currently live in the catchment area of CBCHS hospitals and have access to Ear and Hearing Care services throughout the country.

4. The Feasibility Study

4.1. Purpose

The study will determine the feasibility of the proposed project by assessing whether it is well founded and meets the demand identified. It will provide decision makers with sufficient information on the project opportunities and risks as well as concrete recommendations for improving the project concept. The study will be submitted to BMZ together with the project proposal.

The study will deliver the following:

• an assessment of the relevance of the proposed project and its activities to address the problems identified in the target groups and target sectors;
• an assessment of the proposed logical framework including outcomes and outputs and respective indicators and assumptions, risks and risk mitigation strategies;
• a detailed analysis of the potential sustainability of the project results;
• an assessment of the synergies and complementarities of the project, including between programmatic areas (sectors) and project stakeholders;
• an assessment of the feasibility of the financing proposal in relation to the project activities;
• an assessment of the project organisation and any phasing of activities considered necessary, including considerations around the institutional structure required for project implementation.
• an assessment of the inclusiveness of the project, i.e. the active participation of person with disabilities and their representative organisations in all aspects of the project.
• recommendations for any further actions (including project modifications)

4.2. Assessment according to DAC Criteria – Quality Standards for Development Evaluation, Evaluation Network (EvalNet) of the Development Assistance Committee (DAC) of the Organization for Economic Co-operation and Development (OECD):

Relevance – To what extent is the planned project doing the right thing?

• Does the planned project approach address a developmental problem or a crucial developmental bottleneck of the partner country or region? development bottleneck of the partner country or project region?
• Are the focus, prioritisation, and objectives (approach) of the planned project aligned with the target groups and are they clearly defined?
• To what extent do the project objectives and design adequately take into account the specific needs of the target groups and structural obstacles in the project region, partner/institution, policy programmes?
• Are norms and standards of the approach compatible with those of the target groups?
• Is the project designed in a conflict-sensitive way (Do-No-Harm principle)?

Coherence – How well does the intervention fit?

• How coherent are the planned activities with human rights principles (inclusion, participation), conventions and relevant standards/guidelines?
• To what extent are there synergies and linkages between the planned project and other interventions by the same actor (organisation) and other actors?
• What are the similarities or intersections between the target groups and the projects of other actors in the same context? To what extent does the project add value and avoids duplication?

Effectiveness – Which project approach can best achieve the objectives?

• Are the causal relationships (including assumptions) plausible? What negative effects could occur?
• Is the chosen methodological approach appropriate to the context and sufficient to achieve the project objective? Are alternatives necessary?
• At which level (multi-level approach) are additional measures to increase effectiveness to be envisaged?
• How are changes measured? Which indicators (fields) are more suitable for this?

Efficiency – Does the use of funds planned by the project appear economical in terms of achieving the objectives?

• To what extent can the planned measures be implemented with the budgeted funds and personnel in the planned duration?
• To what extent are the planned expenditures used economically and are the investments, operating expenses and personnel in proportion to the intended objectives?

Impact (significance) – To what extent does the planned project contribute to the achievement of overarching developmental impacts?

• What specific contribution does the project objective (outcome) make to the overall objective (impact)?
• To what extent does the planned project have a structure-building, exemplary and broad impact?
• At what levels will norms or structures be changed?

Sustainability – To what extent will the positive effects (without further external funding) continue after the end of the project?

• How can the sustainability of the results and impacts be ensured and strengthened? (structural, economic, social, ecological)?
• What long-term capacities are built up in the target group to be able to continue the implemented measures on their own?
• What positive changes (role behaviour, mechanisms, networks and others) benefit civil society in the long term?
• Which personal risks for the implementers, institutional and contextual risks influence sustainability and how can they be minimised?

For more information on DAC criteria, please see: Evaluation Criteria – OECD

4.3. Recommendations

Based on the main findings and the assessment according to the DAC criteria, the consultant should provide concrete suggestions for the concept of the project

• Which components, if any, are missing in the project concept to make the cause-effect relationships more coherent and to sustainably achieve the planned objectives?
• Which planned components are not suitable or could have negative effects, and for what reasons?
• Which assumptions of the cause-effect relationships are viable?
• Which findings and project-relevant data of the study are suitable to be integrated into the project logic? (Impact matrix of the project proposal)?
• What are the recommendations for possible indicators for impact monitoring and data collection?

4.4. Scope

a. Stakeholders

The consultant will work closely with all partners, including CBM, CBCHS and relevant local government/non-governmental agencies. He/She will report to the CBM Country Office team. The consultant will execute his/her mission in complete independence and will receive only general instructions by CBM, justified by the necessities of the independent collaboration between the parties and the orderly execution of the confined tasks.

b. Geographical Scope

The project is located in five of the 10 regions of Cameroon including Northwest, Southwest, West, Littoral and Centre Regions. Thus, the study shall analyse the situation in 12 CBCHS facilities: Northwest (Nkwen Baptist Hospital, Mbingo Baptist Hospital, Banso Baptist Hospital) Southwest (Baptist Hospital, Mutengene, Kumba Baptist Health Centre), West (Baptist Hospital, Bafoussam), Littoral (Bonaberi Baptist Health Centre, Mboppi Baptist Hospital), and Centre (Etoug Ebe Baptist Hospital, Ekoumdoum Baptist Hospital, Nkoabang Baptist Hospital, Voundou Baptist Hospital) regions.

c. Documents to be reviewed

The following documents will be reviewed: the Cameroon Health Sector Strategy, CBCHS 10 years strategic plan, CBCHS annual reports, Project reports, project concept note, and evaluation reports. As well as CBM Cameroon Strategic Country Plan, CBM’s CBID Initiative Plan, World Health Assembly Resolution WHA70.13 and WHO’s World Report on Hearing.

5. Methodology

Independent of the methods to be used, there are mandatory mechanisms that must be adhered to during the entire process:

• Participatory and inclusive
• Safeguarding of children and adults at risk
• Data Disaggregation (gender/age/disability)
• Data Security and privacy (informed consent)

The evaluator is expected to use a variety of methods to collect and analyse data. Participatory methods should be used to collect qualitative and quantitative data. The consultant shall indicate the methodology he/she intends to use in his/her offer.

6. Limitations

Due to safety and security concerns in the Northwest Region, data from Banso Baptist Hospital will be collected remotely through zoom interviews and/or phone calls.

To speak to deaf or hard of hearing target group representatives, sign language interpretation for Francophone, Anglophone or other local Sign Languages, and assistive technology in case of remote virtual interviews of persons who are hard of hearing, will be provide by the partner to support the consultant.

7. Deliverables and Schedule

7.1. Deliverables

• Inception report including proposed data collection tools and feasibility study question matrix (matching feasibility study questions with data collection tools);
• Final report (max. 30 pages without annexes) according to CBM’s report template and in accessible format;
• Materials, data collected/analysed and other documents related to the feasibility study;
• A summary Power Point Presentation highlighting main findings and recommendations.
• Presentation of findings and recommendations in a validation workshop

7.2. Time Frame and Schedule

The study is expected to start no later than Augst 28, 2023, taking a maximum of 30 days. An itemised action plan should be submitted with the expression of interest.

• Briefing and review of relevant documents, remote, 3-5 days
• Inception Report, tools development, remote, 2-5 days,
• Data collection, Northwest (Bamenda, Mbingo, Banso), Southwest (Mutengene, Kumba), West (Bafoussam), Littoral (Bonaberi, Mboppi), Centre (Etoug Ebe, Ekoumdoum, Nkoabang, Voundou), 8-14 days,
• Data analysis and preparation of draft report, remote, 5-8 days,
• Validation Workshop, Bamenda, 1 day
• Finalisation of feasibility study and submitting final report, remote, 2-3 day

The consultant should have the following attributes among others;

• Academic Degree and extensive expertise and experience in public health, community development, international health, social/political science or any other related field;
• Proven record of carrying out similar studies in Cameroon and/or beyond;
• Track record in designing and conducting quantitative and qualitative studies;
• Experience in designing and conducting disability inclusive and participatory studies;
• Experience in undertaking research with remote and marginalized communities;
• Knowledge of international instruments and national statutes for persons with disabilities;
• Excellent interpersonal and communication skills including ability to facilitate and work in a multidisciplinary team;
• Strong analytical skills and ability to clearly synthesise and present findings;
• Ability to draw practical conclusions and to prepare well‐written reports in a timely manner and availability during the proposed period;
• Ability to speak English, and French;
• Ability to speak Sign Language (British and/or French and/or International) is considered an advantage.
• Experience in working with deaf communities and/or Hard of Hearing persons’ groups is considered an advantage.

Safeguarding Policy: As a condition of entering into a consultancy agreement the evaluators must sign the CBM’s or the partner organisation’s Safeguarding Policy and abide by the terms and conditions thereof.

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