MID-TERM EXTERNAL EVALUATION OF CHAK STRATEGIC PLAN 2023 – 2028- AND 3-YEAR PROGRAMME 2023 – 2025 RFP/SE/002/2025 CONSULTANCY / TERMS OF REFERENCE

CHAK is a national faith-based organization of the Protestant Churches, health institutions and programs from all counties of Kenya providing quality health care since 1946 through building of health systems, partnerships, and community empowerment. CHAK programmes are guided by a six-year strategic plan which is implemented through 2 phases of 3-year programmes. The current strategic plan runs from 2023 to 2028.

CHAK is seeking to engage a consultant/consultancy firm to carry out the mid–term evaluation of implementation of the Strategic Plan 2023 – 2028 and the three-year programme 2023 – 2025 to ascertain achievements (results/output/outcome/impact) and assess the effectiveness, efficiency and relevance and provide findings, conclusions and recommendations for action in the second half- period of the strategic plan. The evaluation should be completed by July 20, 2025, to inform prioritization of activities in the second phase of the strategic plan.

The evaluation process should include an entry meeting, inception report, literature review, key informant interviews and workshop with CHAK member health facilities, Board and staff and an evaluation report. The TOR for the consultancy can be accessed from CHAK Secretariat by contacting [email protected] or from CHAK website: www.chak.or.ke.

Requirements.

• The consultant/consultancy firm should have good knowledge of the health sector in

Kenya

• At least three years’ consulting experience in the evaluation of strategic plans and/or donor funded projects

• Knowledge of the prevailing health sector delivery system, health financing reforms, regulatory and policy environment and national health priorities

• Good listening, documentation and analytical skills

• Competence in strategy, research, public health and health systems

Purpose of the evaluation

The objective of this consultancy is to carry out the mid–term evaluation of CHAK implementation of the Strategic Plan 2023 – 2028 and the 3-Year Programme 2023 – 2025 to ascertain achievements (results/output/outcome/impact) and assess the effectiveness, efficiency and relevance and provide findings, conclusions and recommendations for action in the second half period of the current strategic plan and three year programme.

Scope of the evaluation

To apply/use the OECD-DAC Criteria for evaluation of humanitarian organizations, to review CHAK Strategic Plan 2023 – 2028 implementation through the two phased 3-year programmes and more specifically evaluate performance and achievements of the first half 3-year programme that covers the period 2023 – 2025, by independently assessing the performance against the objectives and target indicators in the strategy and 3-year programme implementation workplans, draw conclusions and make recommendations that CHAK will use in the light of the changing internal and external context to prioritize activities and make adjustments in the second half of the current strategic plan and the second half of the 3-year implementation programme .

More specifically the evaluation should:

a) Evaluate CHAK’s performance in the light of goals and objectives for the strategic plan and the target indicators

b) Evaluate CHAK’s performance in the implementation of CHAK Strategic Plan 2023-2028 and the 3-Year Programme 2023 – 2025 against the approved objectives and indicators.

c) Evaluate achievementsand lessonslearnt on CHAK implementation of theHealth Systems

Strengthening and advocacy activities against the backdrop of the Kenya health sector reforms.

d) Evaluate the relevance of the objectives and goals/outcome and recommend their review/retention in the second half of the current strategic plan or any re-alignment in the context of the changing political, legal, economic, donor, social and regulatory policy environment.

e) Review the relationship between CHAK and its member health units (MHUs) to determine relevance/value addition and effectiveness in representation and advocacy on their issues with government and other key health stakeholders.

f) Review CHAK’s identity and core mandate toidentify strategic positioning and advocacy strategies for the devolved County Government structures, universal health coverage policy direction and the primary health care (PHC) approach in line with the health sector reforms.

g) Make recommendations on new strategic objectives based on the above to inform the review of the current strategic plan 2023 – 2028 and the second half of the 3-year programme

BACKGROUND

Overview of the CHAK Strategic Plan 2023-2028

CHAK is a national faith-based organization of the Protestant Churches’ health institutions and programs from all counties of Kenya which was established in 1946 and is dedicated to promoting universal access to quality health care. The purpose of CHAK is to promote access to quality health care by facilitating health facilities to deliver accessible, comprehensive, quality health services to the people of Kenya in accordance with Christian values, professional ethics and national health sector policies. CHAK also engages communities to empower them to seek and access quality health care.

The Strategic Plan 2023-2028 was intended to chart CHAK organization growth and provide strategic guidance for CHAK network as it engages in the Global Health Agenda defined in the Sustainable Development Goals (SDGs) and the Kenya Vision 2030 and Health Policy Framework which promotes Universal Health Coverage (UHC) for both communicable and non-communicable diseases as well as Reproductive, Maternal, Neonatal, Child and Adolescent Health. CHAK planned to scale up resource mobilization and partnerships for sustainable health systems strengthening and capacity building towards enhanced quality health care in the devolved health system in Kenya

The Strategic Plan 2023-2028 has the vision; “Quality Healthcare for all to the glory of God”

To achieve this vision, CHAK Secretariat would be guided by the mission; “To facilitate provision of quality health services through health systems strengthening, innovation,

training, advocacy and partnerships as a witness to the healing ministry of Christ”

Strategic directions

The six-year plan has its core activities organized into 6 strategic directions as below

1. Health service delivery
2. Health systems strengthening
3. Advocacy, partnerships and networking
4. Sustainable financing and resource management
5. Strategic information management
6. Branding, marketing and communication

Strategic Direction 1*:* Health Service Delivery

Strategic priorities

1. Reproductive maternal neonatal, childcare and nutrition.
2. Infectious disease prevention and treatment programs like HIV, Tuberculosis, Malaria, and other emerging infectious diseases
3. Non-communicable disease prevention and management programmes targeting diabetes, hypertension, cardiovascular diseases, chronic obstructive airway diseases among others, and advocacy for affordable medicines and health products.
4. Programming around neglected tropical diseases (NTDs) and emerging infectious diseases using one-health approach.
5. Integrated mental health programmes.
6. Organizational gender and disability responsive programmes.
7. Global health programmes addressing social determinants of health

Strategic Direction 2*:* Health Systems Strengthening

Strategic priorities

1. Strengthening health systems for all MHUs by establishing systems for governance and stewardship through management Boards and RCCs, as well as developing governance guidance and facilitating capacity building.
2. Strengthening policy development and creating a responsive and competitive HRH system that promotes staff retention, motivation and performance output at all levels.
3. Medical equipment and health products sourcing, installation and maintenance and quality assurance.
4. Provision of technical support in infrastructural development in MHUs.

Strategic direction 3: Monitoring and Evaluation, Research and Learning

Strategic priorities

1. Monitoring and Evaluation

2. Research

3. Learning and Capacity Building

4. Medical Educationthrough teaching hospitals and member Medical Training Colleges (MTC)

5. Communication and Documentation

6. Health Management Information Systems

Strategic Direction 4: Sustainable financing and resource management

Strategic priorities

1. Resource mobilization

2. Healthcare financing for Universal Health Coverage

3. Financial management and efficiency initiatives

4. Audit and systems strengthening

5. Asset Management

6. CHAK business services limited

Strategic Direction 5: Advocacy, Partnership and Networking. Strategic Priorities

1. Strategic partnerships for health

2. Advocacy for CHAK member health network

3. Networking for knowledge sharing

STRATEGIC PLAN IMPLEMENTATION PROCESS

The Strategic Plan objectives, activities and M&E indicators were detailed in a log frame. The implementation management structure was organized under the directorates of finance and health programming and the four supportive of HR, M&E, ICT and HMIS.

CHAK has undertaken the implementation of the strategic plan through.

i. Two 3-Yearly Programmes which were funded by Bread for the World – Church Development Service (EED) and CHAK own sources including other partners. This evaluation focusses on the mid-term evaluation.

ii. Project proposals were developed targeting various components of the plan that mobilized additional resources and provided opportunities for priority activities implementation

iii. Engagement in strategic partnerships with the Ministry of Health, Council of Governors, County

Health Departments, Development Partners and other NGOs

One major development during the past 3-years was the Kenya health sector reforms. The health financing space in Kenya has undergone transformation with changes in national insurance scheme provider payment mechanisms through transition from National Health Insurance Fund (NHIF) to Social Health Authority (SHA), with three different funding mechanisms (Primary Health Care Fund), Social Health Insurance Fund (SHIF) and Emergency, Critical and Chronic Illnesses (ECCI) fund). The project supported ongoing advocacy and capacity building throughout 2024 in response to these changes. CHAK participated in the FBO health financing Technical Working Group (TWG) to develop tariffs for various services to inform the SHA benefit packages and tariffs formulation. The project has additionally supported advocacy meetings between the member health facilities, NHIF and SHA secretariat to unpack the bottlenecks in facilities claims processing and reimbursements. The project further supported engagement meetings between the Social Health Authority (SHA) and MHUs during transition from NHIF to SHA, the meetings were key advocacy avenues for support to MHUs through the transition period to overcome challenges with electronic contracting, obtaining SHA portal credentials, portal access challenges, training on the functionality of the SHA portal, challenges with registering and verifying SHA beneficiaries among others. The settling of claims has remained a major hindrance, occasioning cash flow challenges to MHUs affecting operations and service delivery.

Another change has been the implementation of the Linda Mama project with the pausing of support and delays in settling pending claims. This in turn has caused poor utilization of maternity services as cost has become a barrier.

Of note also, is that CHAK has operationalized CBSL-Chak business services limited; a social enterprise engaging in profit business and contributing to financing CHAK’s mission. The business under this umbrella includes medical equipment services, the CHAK developed HMIS system and the CHAK guesthouse and conference centers. CBSL is also exploring opportunities I the land/real estate business space.

CHAK 3-YEAR PROGRAMME: 2023 – 2025

The first phase ofthe Strategic Plan had a large component implemented through a 3-Year Programme 2023 – 2025 which was funded by Bread for the World – Church Development Services with co-funding from CHAK and other donors. The programme had a development goal, several objectives and indicators targeting strategic directions. These included.

Development Goal:

Improved access to quality health care services to communities in Kenya through empowered CHAK member health units that are well aligned to the global and national strategy on Universal Health Coverage (UHC) and Primary Health Care (PHC), as well as policies and guidelines in the devolved county health system.

Kindly specify the project objective to be accomplished within the project period (outcome level).

Project objectives: The 3-year programme had 5 objectives.

1. Health services delivery strengthened, and scope expanded to include non-communicable diseases using PHC strategies

2. Health Systems Strengthened for efficient quality service delivery

3. Advocacy, partnerships and networking for support and enabling policy environment

4. Resource mobilization and financial management enhanced for sustainable health care financing for UHC

5. M&E Data Management, Research and Training enhanced

Project indicators

The project indicatorsare elaborated in the Project Agreement Document which will be availed for the consultants review;

Objective 1: Health services delivery strengthened, and scope expanded to include non-communicable diseases

Indicators:

1. Objective 1: Improve sexual and reproductive health services for women

• At the end of the project period, the proportion of women who attend 4 ANC visits is increased by 20%.
• At the end of the project period, CHAK project implemented MHUs to register 20% increase in the uptake of available family planning products

1. Objective 2: Improve health outcomes for children up to the age of 5

• At the end of the project period, 90% of new births are fully immunized at the age of one year
• At the end of the project period, mother to child transmission of HIV is reduced to below 5% among pregnant mothers living with HIV.

1. Objective 3: Health systems strengthening for resilience and sustainability

• At the end of the project period, 100% of MHUs level 2-5 have reliable access to essential medicines
• At the end of the project period, 100% CHAK implementing MHU’s are compliant with national regulatory requirements for service delivery to contribute to the UHC objectives

1. Objective 4: Improve data reporting and information systems for planning and evidence based decision-making

• At the end of the project period, 100% of CHAK implementing MHU’s are enlisted in the Ministry of Health’s (MOH) master facility list (MFL) and are reporting through the Kenya’s MOH digital health platform

1. Advocacy and engagement with MOH at national and county level and MHUs

• Enhanced MHU partnership with Government and aligned with GOK policy

EVALUATION PROCESS

The evaluation process should include the following.

1. Prepare an inception report with the proposed methodology/evaluation approach, stakeholder engagement, ethical considerations, reporting and timelines

2. Develop data collection tools/interview guide and data analysis system/templates for the evaluation process

3. Carry out desk review of all relevant CHAK Policies, Reports and Publications and Health Sector Laws, Policy documents, strategic plans and reports. These will include but not limited to;

CHAK documents

• CHAK Strategic Plan 2023 – 2025

• Three Year Funding Proposal & Budget 2023 – 2025

• Project Funding Contract and approved workplans

• Annual Budgets

• Six monthly Narrative Progress Reports to Bread for the World

• Health Systems Strengthening reports – Medical Equipment Enhancement Project, CBSL

documents and Report

• Quarterly and Annual Project Reports to other Donor Partners

• Funded Projects Work Plans, Budgets and Reports

• Published Annual Association’s Reports

• CHAK Constitution, Governance Charter and Management Policy Documents

• CHAK Publications

• CHAK Times Newsletters

• Audited Accounts

• Annual Health Conference and AGM Reports

• Minutes of EXCO, Sub-Committees and AGM

• CHAK Website

• CHAK Communication Strategy

• Other Evaluation Reports

Health Sector Laws and Policy Documents

• Kenya Health Policy 2015-2030

• MDGs, SDGs and the Kenya Vision 20/30

• Universal Health Coverage (UHC) Policy 2020 -2030

• National Health Sector Strategic & Investment Plan 2019 – 2023

• MoU between Government MOH & Council of Governors and the Kenya Faith Based Health Services Consortium (CHAK/KCCB/SUPKEM/MEDS)

• Kenya Health Act 2020

• Kenya Health Partnership Framework Policy

• Kenya National AIDS Strategic Framework

• Kenya Demographic Health Survey (KDHS) Report and DHIS2/Kenya HMIS Reports

• Social Health Authority act.

• Primary Health Care act
• Kenya digital health Act
• Facility improvement financing act

• Kenya HIV/AIDS Annual Reports

4. Facilitate review/evaluation ofthe performanceof CHAK in the implementationof theStrategic Plan 2023 – 2028 and 3-Year Programme 2023 – 2025, in a workshop of CHAK members, EXCO and Secretariat Staff. A four-day workshop will be held with a representative group of all MHUs from the 4 Regions of CHAK held centrally at the CHAK Guest House in Nairobi, who will be substantially engaged through focus group discussions

5. Conduct interviews of key informants/stakeholders – to include Chairman, Treasurer, RCC Chairs, Trustees, MOH, County Government Representatives, MEDS, Auditors, Donor representative, Consortium Partners, CHAK Management Team and focus group discussion of technical project staff, patient/community representatives

6. Assess and document the achievement of results/impact by the Secretariat and member health units through the implementation of activities in the Strategic Plan and 3-Year Programme

7. Assess the progress and achievements of the implementation of the Health SystemsStrengthening including CBSL

8. Facilitate documentation of lessons learnt, gaps and challenges to facilitate learning and inform the new strategic plan development

9. To facilitate environmental analysis/scanning through a SWOT process by a representative team of CHAK members & secretariat that will identify relevant environmental context to inform the new strategic priorities

10. Compile the evaluation report which highlights findings, conclusions and recommendations for action

11. Present the draft evaluation report to Management Team and EXCO and incorporate their feedback and recommendations for action in the final evaluation report

12. Submit toCHAK twohard copies and a soft copy of the final evaluation report for dissemination to stakeholders and use in the development of new Strategic Plan and the first 3-Year Programme

Expected outputs

i. Inception Report

ii. Evaluation Report and it’s dissemination to Management and EXCO

iii. Executive Summaryof the evaluation report which highlights key findings, conclusions, recommendations for action and lessons learnt

Time frame

The evaluation process shall be conducted within the months of April and June 2025. The total externalconsultancy days shall be limited to 30 days covering all the TOR with time allocated as follows.

Activity/Item No. of Consulting Days

1. Preliminary meetings – Discuss TOR 1

2. Desk Review ofrelevant documents 5

3. Develop inception report, the Study tools and Planning 2

4. Interviews with key Stakeholders 9

5. Facilitation ofa ConsultativeWorkshop with CHAK member

health facilities and Secretariat 4

6. Interviews follow up with Management and Staff 2

7. Draft Report Writing 4

8. Presentation of Draft Report toManagement Team 1

9. Finalization and Presentation of Final Report to EXCO 2

TOTAL 30

How to apply

Submission details

Interested consultants/consultancy firms should submit their expression of interest, accompanied by capacity statement and consultancy proposal responding to the TOR that includes methodology, costing, team composition, referees and delivery timelines clearly marked RFP No.:(RFP/SE/002/2025/Midterm Strategic Plan External Evaluation Services) in sealed envelopes to:

General Secretary

Christian Health Association of Kenya

Musa Gitau Road, off Waiyaki Way

P.O Box 30690, 00100, Nairobi

The closing date for receiving the Expressions of Interest is April 26, 2025.