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Terms of Reference (TOR) for Baseline Evaluation for the Strong Bodies, Strong
Minds Project

Overview

Grassroot Soccer Zambia (GRS Zambia) is seeking the services of a LOCAL
consultant to conduct a baseline evaluation on the integration of mental
health within its sexual and reproductive health and rights (SRHR) programming
and its contribution to adherence outcomes among young people living with HIV
(YLWHIV). GRS proposes to adopt a mixed methods, quasi-experimental study to
collect baseline data on the feasibility, acceptability, effectiveness, and
scalability of an innovative sport-based mental health (MH) model focusing on
SRHR and HIV adherence support programme for young people living with HIV in
Zambia.

Background and Context to the Evaluation

In Zambia, like many other countries faced with high a HIV burden, existing
gaps in mental health programming pose challenges in achieving adherence
outcomes for youth living with HIV (YLWHIV). GRS in partnership with Strong
Minds Zambia (SMZ) will be implementing a three-year (2020-2023) Comic Relief-
funded project titled “Strong Bodies, Strong Minds in Lusaka and Eastern
Provinces of Zambia.” Project beneficiaries will include YLWHIV, family
members, service providers, and community and national stakeholders working in
the Mental Health landscape in Zambia.
In 2018, at the request of the Ministry of Health (MoH), GRS and SMZ
proactively developed a partnership to combine respective expertise in
adolescent SRHR and MH. SMZ delivers MH care using Interpersonal Psychotherapy
Group (IPT-G), endorsed by WHO as a possible first-line treatment for
depression in developing settings. SMZ has observed the overwhelming need for
this work among youths in Lusaka and that IPT-G is highly effective among this
group. GRS and SMZ recognise this partnership as an opportunity for true
integration of each evidence-based models given their promising
complementarity, as well as to build the evidence base for scaling MH
programming via existing adolescent SRHR programmes. This integrated approach
will combine GRS and SMZ’s evidence-based models to deliver an integrated
package of MH, antiretroviral treatment (ART) adherence support, and SRHR and
well-being information and services specifically tailored for YLWHIV.

GRS has demonstrated the impact of the SKILLZ Plus Programme to support YLWHIV
to adhere to treatment and maintain viral load suppression. Developed in
Lusaka, the programme has scaled to Zimbabwe, South Africa, and Malawi and
graduated more than 5131 YLWHIV since 2012. A study in Zambia found 90% of
participants remained in treatment throughout the program and were 62% more
likely to adhere to treatment than the control group. However, participant and
Coach feedback has highlighted an urgent need to provide concurrent MH support
to YLWHIV to holistically address their needs.

Tested and refined over five years, SMZ’s cost-effective group talk therapy
model for women and youth transforms their psychological health, economic
wellbeing, and the lives of their families. With its IPT-G model, SMZ has
reached 50,000 women in Africa with +75% depression-free at the end of IPTG
and equipped to overcome future MH challenges.

The evaluator is expected to collect baseline data on a set of key performance
indicators to guide the partnership’s aims and implementation through a
variety of methods and provide practical recommendations to optimize design,
delivery, and quality for future scale up. The quantitative component of the
evaluation will include routine data on key adolescent SRHR outcomes, analysis
of participant clinical data, and participant scores on the PHQ-9, and
additional survey data, while the qualitative component will include
traditional focus group discussions (FGDs) and in-depth interviews (IDIs) and
non-traditional youth-led methods with beneficiaries, as well as limited semi-
structured observations during implementation. The scalability portion of the
evaluation will include costing of the integrated intervention and key
informant interviews (KIIs) with National Mental Health Technical Working
Group (TWG) members and policymakers.

GRS recommends that the evaluator uses the Consolidated Framework for
Implementation Research (CFIR) to guide method choice, sampling framework, and
processes of planning, engaging, reflecting, and learning. It is anticipated
that this evaluation will provide sufficient evidence for GRS and SMZ to
develop an investment case for MH and SRHR programming among government, civil
society, and private sector. Furthermore, the baseline evaluation findings
will also be used to refine future programming, learn how to better address
the specific MH needs of YLWHIV, and disseminate findings through local and
global research platforms.

> Contracting organization Grassroot Soccer Zambia
> Proposal deadline 9th October 2020
> Contract start date TBA
> Suggested proposal length 4-6 pages
> Submissions and questions Devyn Lee, Research Officer (dlee@grassrootsoccer.org)

Grassroot Soccer Zambia

Grassroot Soccer is an adolescent health organisation that uses the power of
soccer to educate, inspire, and mobilise young people to live healthier lives
and be agents for change in their communities. GRS Zambia was founded in
Lusaka in 2005 as a registered Non-Profit NGO with a local board (60% Zambian)
and all-Zambian staff (100%). GRS Zambia reaches over 25,000 adolescents and
young adults across seven provinces each year, over 60% of which are
adolescent girls and young women (AGYW) 10-24 years old.

GRS programmes combine sport-based interventions with health and life skills
education curricula, delivered by young adults who are trained as mentor
“Coaches.” GRS works through schools and community centres to reach vulnerable
adolescents, actively linking them with health service providers in their
communities. Since its registrations in 2005 in Zambia, GRS has reached over
200,000 youth in Zambia. GRS measures impact by assessing on knowledge,
attitudes, behaviours, tracking referrals to and uptake of high-impact health
services, and investigates biomedical outcomes through modelling exercises and
impact evaluations.

Strong Minds Zambia

Strong Minds is a social enterprise founded in 2013 that provides life-
changing mental health services to impoverished African women. Since many
African women cannot even begin to tackle issues like poverty and economic
development until they overcome depression, Strong Minds provides treatment
for women who suffer from this pervasive and debilitating mental illness. By
providing group talk therapy delivered by community health workers, Strong
Minds is the only organization scaling a cost-effective solution to the
depression epidemic in Africa.

Objectives of consultancy

The specific aims for this consultancy is to enable the evaluation of the
sport based SRHR and MH support programme for YLWHIV in improving ART
-adherence and other key MH and SRHR outcomes, through the establishment of a
baseline assessment.

The specific aims are as follows

> Assess feasibility, acceptability, and effectiveness of the integrated model
> Assess intervention effects on adolescent assets, focusing on life skills and resilience of YLWHIV to maintain good MH and adherence to ART into adulthood.
> Assess effects of the SKILLZ Plus integrated SRH and MH intervention, as well as the IPT-G intervention for YLWHIV with depressive symptoms
> Examine YLWHIV perceptions of and attitudes towards the quality and youth-friendliness of MH, HIV and SRHR services.
> Describe key factors contributing to adherence to ART for YLWHIV, including triangulation of routine, self-report data on ART adherence with clinical registers
> Explore service providers’, community- and family-level awareness, stigma, and support for YLWHIV in relation to MH, HIV & SRHR challenges.
> Assess the scalability of the integrated model
> Identify factors in the enabling environment contributing to improved MH service provision for youth at provincial and national levels
> Cost the integrated package
> Describe the perceptions of and coordination amongst key stakeholders including TWG members, service providers, and policy makers.
> Identify enabling factors and barriers to effective partnership between GRS & SMZ
GRS proposes that the evaluation use a quasi-experimental design, with a
comparison group constructed of YLWHIV receiving the standard of care in two
districts, and the intervention group of YLWHIV receiving the SKILLZ Plus and
SMZ intervention in two other districts.

GRS proposes that the evaluator enrolls YLWHIV at baseline in Year 1 (2020)
for both intervention and comparison groups. YLHWIV who score 10 or greater
(indicating moderate-severe depression) on the PHQ-9 will be recruited into
IPT-G clubs in addition to the SKILLZ Plus intervention, while those scoring
below 10 will receive SKILLZ Plus only. In line with the proposed methodology,
Grassroot Soccer will ensure these cohorts, to the best of GRS’s ability, of
adolescents are maintained at two points; at mid-term in Year 2 (2022) and
end-line in Year 3 (2023) . The intervention group will receive the dosage as
per GRS programming and the control group will not get any programming.

With guidance from GRS, the evaluator will consult and engage identified key
stakeholders at baseline. GRS intends to share experiences and findings from
the study with these key stakeholders (government, adolescents, as well as
non-governmental partners) throughout the course of the programme and
typically disseminates its findings on country- and global-level scientific
conference fora. The findings will also inform GRS scale and partnerships
strategy in this geography and beyond.

To strengthen the relevance and applicability of findings, the GRS Research
Team takes an active role in the analysis and interpretation phase, and
expects to be involved in decision-taking on analytic methods, development of
key themes, and recommendations.

Building the capabilities of GRS Coaches as Young Investigators

As part of this evaluation, GRS aims to build the capabilities and research
skills of Coaches as ‘young investigators’ through training and ongoing
mentorship from the evaluator this cost should be built into the evaluator’s
budget. The evaluator will be expected to work with a team of GRS Coaches that
will support data collection in line with our objective of amplifying the role
of young people in leading the design, implementation, and evaluation of
sport-based SRHR interventions for YLWHIV.

Scope of Evaluation Consultancy

> Lead drafting of Internal Review Board (IRB) applications
> Develop evaluation design, plan and tools
> Ethical procedures (parental informed consent and youth informed assent forms)
> Evaluation protocol
> Quantitative methods and tools
> Qualitative methods and tools (including proposed use of participatory methods)
> Train and mentor GRS Coaches as young investigators
> Guide and oversee data collection at baseline (Y1)
> Conduct analyses of quantitative and qualitative data sources
> Perform appropriate statistical analyses to address evaluation aims
> Conduct analyses of qualitative data using CAQDAS
> With support from GRS, integrate GRS routine monitoring data into interpretation of results
> Prepare Executive Summary for Baseline Report

Proposed Deliverable schedule

Activities and outputs

Timelines

Proposal submission to GRS 9th October 2020
Notification from GRS on selected evaluator 16th October 2020
Inception meeting with GRS Research and Innovation team 20th October 2020
Inception Meeting/Baseline survey plan finalised 27th October 2020
IRB application submission 27th th October 2020
Quantitative survey finalised 16th November 2020
Baseline survey 30th November 2020
Qualitative methods, guides and plan finalised 16th November 2020
Draft baseline survey report 23rd December 2020

We expect the evaluator to conduct relevant sub-activities for these
deliverables, which may include, but are not limited to

> Desk review of key documents
> Initial training and ongoing mentoring of field teams, including young investigators on qualitative methods
> Analysis and interpretation of quantitative and qualitative findings, in coordination with GRS Research Team
> Incorporating comments and revising the baseline reports
> Submission of the final report

Evaluation Team Composition & Required Competencies

Competencies

> Large-scale, complex programme design, including monitoring and evaluation
> Mixed methods research and data analysis
> Mentorship of young investigators
> Policy analysis

Qualifications

Successful candidates must have an advanced university degree(s) in social
sciences and/or public health and an understanding of international
development.

Experience

> Previous experience undertaking large-scale, complex program evaluations
> Ability to work independently and within tight, evolving timelines
> Knowledge of YLWHIV mental health issues is desirable
> Knowledge of and experience evaluating adolescent SRHR programmes in Southern Africa is desirable
> Knowledge of the use of sport for development is desirable

Submission Requirements

Submissions must include

> Outline of research framework proposed methods, summary description of data collection instruments and procedures, information sources and procedures of
analysing data, reporting schedules, details on quality assurance and the
approach for completing the deliverables within the timeframe.

> Proposed evaluation budget This should be inclusive of all fees and expenses i.e, withholding tax
> CVs of the evaluator(s) for the consultancy
> Evidence/examples of evaluation experience and writing samples for each team member proposed.
> Referees (2) from previous clients demonstrating ability to conduct similar assignment and write succinct baseline reports

Budget & Management of the Evaluation

The provider will be expected to provide a costed evaluation plan that clearly
sets out how the evaluation will be carried out in line with the approach and
principles outlined.

Proposals must account for related costs such as travel, accommodation, and
materials etc.



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Email dlee@grassrootsoccer.org


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