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Vision Aid Overseas

TOR for Vision Aid Overseas work in Zambia for the past 10 years

0\. Background

Vision Aid Overseas (VAO) began work in Zambia in the year 2000. The focus
then was on increasing the availability of eye health services in underserved
communities. Our programme interventions consisted of teams of professional
volunteer optometrists and dispensing opticians visiting local clinics to
support in eye screening, full eye tests, and providing low cost spectacles.

In 2009 VAO secured a commitment from Specsavers to fund the development of
optometry services in Zambia in partnership with the Ministry of Health. In
January 2010 the NGO established an in-country representative to focus the
work on three main areas

1. Increasing human resources for eye health through training for local eye health personnel.
2. Increasing access to eye health and optometry services, through the establishment of Vision Centres.
3. Increasing community-based eye health services through the Vision Centres.

1. Increasing human resources for eye health through training of local eye health personnel.

1.*> Training for Ophthalmic Clinical Officers (OCOs) and Ophthalmic
Nurses (ONs)

During the last ten years a total of 159 OCOs and ONs as well as general and
enrolled nurses working in Ministry of Health eye departments at both district
and provincial levels have undertaken 6-week refraction training courses run
by VAO. Young doctors interested in specializing in ophthalmology have also
attended the course as a way of learning more about eye health and optics;
Furthermore, 34 OCOs and ONs who had previously attended the course have
undergone further training to upgrade and enhance their skills with a
particular emphasis on the refraction of children.

OCOs and ONs have received on the job mentorship from UK Professional
Volunteers on outreach assignments where refraction services and other skills
were taught. In addition, many equipment and materials have been donated by
VAO to attendees of these refraction courses to ensure they have the tools to
practice what they have learned.

2\. Supporting optometry students

Professional Volunteers provided by VAO have worked with groups of third year
optometry students at Chainama College of Health Sciences (now Levy Mwanawasa
University) with practical supervision of skills, lectures and the opportunity
to undertake outreach work in local communities and on a range of assignments
within the Country. They have also benefited from donations of optometry
books, some specialised equipment, and artificial eyes for training purposes.

3\. Optometry conferences for Optometry Technologists

VAO organized and hosted two conferences for graduates from Chainama College
of Health Sciences optometry course, enabling 36 optometry technologists from
three groups of graduates to learn from experienced volunteer optometrists and
dispensing opticians from the UK. Formal lectures and practical workshops were
carried out during the conferences, enabling graduates to build professional
knowledge and enhance their practical skills. The conference attendees were
enrolled in an online continuing professional development learning portal
called Synapse, which enables them to test and further develop their knowledge
and skills.

4\. Optical technicians/dispensers

As VCs were developed VAO offered a 6-week training course in spectacle making
and dispensing to complement the refraction training and to ensure that the
Vision Centres were staffed by competent skilled people. Over the last 10
years 42 optical technicians/dispensers based in the Vision Centres have
received training in spectacle making and dispensing. In addition, 22 have
received further training in equipment maintenance and skills upgrading.

5\. Supporting trainee ophthalmologists

VAO have provided experienced Professional Volunteer trainers to work
alongside Zambian ophthalmologists to train 2 groups of trainee
ophthalmologists in refraction thus enhancing their professional skills and
knowledge.

6\. Low Vision Training

VAO has run 3 two-week courses for Optometry Technologists, Ophthalmic Nurses
and Ophthalmic Clinical Officers to enhance their skills in helping patients
with low vision and visual impairment. So far 50 eye health professionals have
benefitted from the training covering 40 different eye health facilities. All
facilities where trainees work have benefitted from VAO donated low vision
aids to use with their patients and continue to do so.

7\. School eye health

VAO piloted a comprehensive school eye health programme that aimed at
developing a comprehensive and replicable method of identifying eye health
problems in children and to address them in a timely and appropriate manner.
The programme trained 150 teachers to screen 22,667 and found 5958 children
with various eye problems. Appropriate treatments were delivered to all the
children with eye problems.

8\. Training for VAO’s own staff

VAO has a commitment to develop the skills of its staff as well as providing
training to Zambian eye health professionals. In service training for staff
members takes place whenever possible and covers aspects of eye health,
management and new developments within international eye health. Staff are
encouraged to register to participate in IABP online webinars as well as to
participate in programme staff meetings where all staff from all countries
supported by VAO share the latest news from the global eye health scene.

VAO staff have undergone leadership training alongside some of the optometry
graduates, provided by experts in that field, and all staff have participated
in online Child Protection and First Aid courses. The Past Country Director
was fortunate to attend the short course in International Eye Health at the
International Centre for Eye Health at the London School of Hygiene and
Tropical Medicine in 2017.

9\. Dame Mary Perkins Optometry Training Centre and the Optometry Technology
Course

Working in partnership with Sightsavers International and the MoH VAO provided
funding for the development of an optometry curriculum in 2009 and a three-
year diploma course in optometry technology was developed. To operationalize
the provision of the diploma course, VAO built a training centre named after
the Founder of Specsavers Dame Mary Perkins and sponsored 3 people to travel
to India to the Lotus College of Optometry in Mumbai to study a degree course
in optometry. The purpose of this venture was to have Zambian personnel who
would have the skills to return to the country to become optometry lecturers.
Since their return, the two graduates have lecturing at the Chainama College
and have so far produced 93 graduates from the 2013 to the 2016 intakes. 123
students from the 2017 to 2019 intakes are expected to graduate in August 2020
(29), in 2021 (33) and in 2022 (61).

In 2013 VAO provided further funding through Specsavers to develop a Vision
Centre within the building enabling patients to receive a more comprehensive
service and students to learn practical glazing and dispensing skills in
addition to their existing course skills. At the same time personnel employed
within the hospital complex were retrained to become optical
technicians/dispensers.

Sadly in 2017 due to the expansion of Levy Mwanwasa Hospital and medical
university the building was demolished, and the services provided by the Dame
Mary centre moved to the Chainama College of Health Sciences campus. Services
continue to be provided there to date.

1\. Increasing access to eye health and optometry services in particular,
through the establishment of Vision Centres.

Vision Centres (VC) developed by VAO are permanent optical facilities, within
Ministry of Health hospitals, usually at provincial level, where patients can
receive eye examinations and prescription spectacles manufactured to their
precise requirements. Vision Centres also act as a hub for community-based
outreach services providing a central location where spectacles can be glazed
for the local community.

The development of the centres included the provision of machinery to
manufacture spectacles (glazing machine, lens edger, focimeter etc.)
consumables to support the manufacture of spectacles (lenses, spectacle
frames, cases, etc.), the cost of adapting a suitable room/s to create
dispensing and glazing facilities (e.g. workbenches, storage cupboards,
shelving) and training eye health personnel in the hospital and surrounding
districts in refraction. In addition, VAO trained personnel in each facility
to manufacture and dispense spectacles and provided training in VC management.

Operational Agreements with each VC stated that for the first year VAO would
provide all consumables, during which time income received from the sale of
spectacles would either be placed in a separate bank account or be ring-fenced
for future procurement. During year two the VC was expected to purchase 50% of
its needs with VAO providing the remainder, and in year three the VC would
purchase 75% of consumables with VAO providing 25%. At the end of the three-
year period the VC was to be self-sustaining purchasing all consumables. VAO
agreed to continue to provide technical support and additional training for
optical technicians/dispensers where needed.

VAO up the first VC at the University Teaching Hospital (UTH) in 2008. In the
ten years since then VCs have been set up at the following places

1. Kabwe General Hospital Central Province.
2. Ndola Teaching Hospital Copperbelt Province (2014)
3. Kasama General Hospital Northern Province (2012)
4. Mansa General Hospital Luapula Province (2011)
5. Solwezi General Hospital North Western Province.
6. Livingstone General Hospital Southern Province (2012
7. St Francis Hospital, Katete Eastern Province (2013)
8. Chinsali General Hospital Muchinga Province (2016)
9. Chainama College of Health Sciences Lusaka Province (2012)
10. Lewanika General Hospital, Mongu Western Province (2013)
11. While all VCs were funded by Specsavers, the VC at the Chinsali General Hospital was not.

3\. Increasing community-based eye health services through the Vision
Centres.

VAO began supporting Zambia with outreach services in 2000. At that time the
organisation worked with local NGOs and other eye health providers, visiting
underserved communities to offer free eye tests and low-cost spectacles.
However, over the last ten years outreach services have been programmed to
support the Vision Centres that have been set up by VAO in order to generate
awareness of the services in areas surrounding the VCs and providing services
to communities who were far enough away from the service to find reaching the
provincial centre problematic.

Outreach services have also given local eye health professionals and those who
benefitted from VAO’s refraction courses opportunities to offer services to
patients beyond the hospital and to work alongside VAO’s experienced
Professional Volunteers in the community, enabling them to practise their
refraction skills under supervision and learning to adapt their clinical
skills to a busy outreach situation. VAO outreach services have dispensed new
ready-made spectacles and a selection of frames from the Vision Centres have
been carried along, so that people requiring prescription spectacles could
choose preferred frames which were then made to their prescription at the
Vision Centres and the spectacles returned to where the patient were seen
during outreach.

Through these outreach services, over 44,000 people have been screened, of
whom more than 14,000 have received a full refraction. Almost 14,000 pairs of
spectacles have been dispensed as a result.

4\. Rationale

The evaluation of the 10 years of VAO’s operations in Zambia is an important
step in helping VAO and its partner the Ministry of Health (MOH) to assess
overall impact of the Organization’s interventions. Over the last 10 years,
the Organization secured funding from Specsavers which have been used to
implement various interventions to achieve three main objectives to (1)
increase human resource for health, (2) increase access to eye health and
optometry services and (3) increase community-based eye health services. The
Evaluation is intended to assess the relevance, effectiveness and efficiency
of these interventions and their overall impact on the Zambia communities.

It is expected to evaluate the impact of the trainings conducted for the
various categories of health personnel in the Country, the operations of
Vision Centres and sustainability of results, including the contribution to
capacity development of the Eye Hospitals where they are established, and the
impact of community-based eye health services conducted through the Vision
Centres.

The Evaluation will also identify/document lessons learned and make
recommendations that VAO and MOH might use to improve on its interventions in
terms of their relevance, efficiency and effectiveness. The evaluation is
expected to indicate whether the programme delivers value for money, and
specifically suggest how VAO (and partners) can adapt programming in the
future to maximise the impact of each pound spent to improve poor people’s
lives.

5\. Scope of the Evaluation

The evaluation is expected to cover the following components

VAO will primarily answer the overarching evaluation question for the
government and Ministries of Health and \General Education – To what extent
has VAO helped the Government of Zambia and Zambian MOH deliver on its

> eye health strategy and plan regarding URE
> strategy and plan for Human Resource for Eye Health regarding optometry
> School Health regarding the integration of Eye Health

The Evaluation will also seek to establish

> in what ways VAO have supported the increasing commitment of the government/MOH to eye health and to addressing URE,
> whether the long-term results have been achieved – integration of eye health into health, more accessibility and equal distribution of services and improved knowledge, what is the evidence for this (in terms of government stats/can we identify any secondary evidence),
> any anecdotal evidence (from personal testimonies) linking results to VAO.

To obtain responses to the specific areas of interventions, the following
areas will be analysed

1. Human Resource Development

1. Knowledge gaps and challenges faced in practice post training
2. Participants’ views on training
3. Partner training organization feedback
4. The outputs vs expectations

2. Vision Centres

1. Assess to what extent the parties to the establishment agreements adhered to their responsibilities as defined in the operational agreements
2. To identify successes and challenges in the operations of the Vision Centres
3. To assess to what extent Vision Centres have reached their sustainability and issues achieving sustainability
4. Assess the impact of Vision Centres. Scale of impact in terms of patients reached including the types of patients (age/gender). Case studies for individuals who have been positively impacted. Impact on staff working at VCs.
5. Assess performance of Vision Centres in terms of effectiveness, efficiency, and timeliness of producing the expected outputs (including considering equity – do vision centres provide services to the poorest and most marginalised members of society Are the needs of women and girls specifically targeted);
6. Identify capacity gaps, if any, to effective and efficient operations of the Vision Centres
7. Assess the economy, quality and timeliness of inputs, the reporting and monitoring system and extent to which these have been effective;
8. Assess relevance of the Vision Centres management arrangements; identify advantages, bottlenecks and lessons learn about the management arrangements;
9. Provide key recommendations to VAO and its partner MOH that will contribute to improved operations of the Vision Centres in terms of their efficiency, effectiveness, equity of service delivery and sustainability.

3. Community Outreach Services
1. Assess the reach/coverage of eye health services (Number of people reached/covered, children and adults)
2. Relevance, efficiency, effectiveness, equity and sustainability of the eye health services provided
3. Knowledge acquisition of the communities on the eye health issues
4. Level of demand creation of eye health services
5. Level of compliance in wearing glasses

6\. Deliverables

1. Inception meeting to further clarify the Terms of Reference (ToR) and budget available
2. An inception report demonstrating understanding of the assignment and a detailed timeline for delivery of assignment.
3. An evaluation design methodology that satisfactorily demonstrates how the operations of the Vision Centres and other interventions will be evaluated
4. A timetable for the evaluation exercise
5. Tools for the evaluation exercise
6. Draft report that will be used for a validation workshop with key stakeholders and a 1 or 2 page summary document drawing out key points of the evaluation.

A well written project evaluation report of not more than 20 pages addressing
the scope of the assignment within 30 days of the assignment. (Outline of the
report to be shared to successful consultant)

7\. Technical Support

The successful consultant will work under the supervision of the Country
Director and the Program Development Adviser with the Technical Support from
the Programme Director

8\. Specific Requirements

1. Academic Qualifications A higher degree in public health, development studies or any related relevant field
2. Professional Qualifications An evaluation specialist with a minimum of seven years’ experience programme/project evaluation in an international development context.
3. Experience of results-based monitoring and evaluation;
4. Ability to design and plan the evaluation approaches and research methodologies, including quantitative and qualitative research methods. Where feasible and proportionate, the person or team should include skills and expertise required to design, plan and conduct impact evaluation
5. Relevant subject matter knowledge and experience such as health sector (eye health), education sector, genders, Youth programming, non-state actors and economic growth to ensure the evaluation design and research methods are as relevant and meaningful as possible given the aims and objectives of the project and the context in which it is being delivered;
6. Must have appropriate knowledge/experience of Zambia including understanding of the context of the Vision Centres impact areas.
7. Excellent writing skills;
8. Fluency in English required

9\. Expression of Interest

Vision Aid Overseas Requests Financial and Technical Proposals (including
estimated budget) from qualified research agencies, project evaluators and
individual consultants. The proposals should be sent to

The Country Director
Vision Aid Overseas


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Email godfrey.mwelwa@visionaidoverseas.org


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