Job TitleConsultant, LNLocationSomalia - Garowe - Garowe, SO (Primary)
Somalia - SO
OfficeGaroweCategoryConsultantDate Needed By12/24/2025Closing Date12/18/2025Program Description (Background)

BACKGROUND OF THE PROJECT TO BE EVALUATED:

International Medical Corps has been implementing a Kidney Dialysis Project to improve access to quality renal care for patients requiring haemodialysis at Garowe General Hospital Puntland Somalia. The project supports service delivery, clinical governance, infrastructure and equipment management, staff capacity building, and patient education. To inform future programming and strengthen accountability to stakeholders, IMC is commissioning an independent external evaluation.

Chronic Kidney Disease (CKD) is recognized as a leading public health problem worldwide with an estimated global prevalence of 13.4% (11.7–15.1%), and about 4.902 and 7.083 million patients with End-Stage Kidney Disease (ESKD) needing renal replacement therapy. Through its effect on cardiovascular risk and ESKD, CKD directly affects the global burden of morbidity and mortality. The global increase in this disease is mainly driven by the increase in the prevalence of diabetes mellitus, hypertension, obesity, and aging. Nonetheless, other causes, such as infection, herbal and environmental toxins, are still common in some regions. Many deaths are attributed to poor access to renal replacement therapy in developing countries, and a large increase in patients with ESKD in the future will produce a substantial financial burden for even the wealthiest countries. The Cost-effectiveness of preventive strategies to reduce the disease burden should be evaluated in relation to the local economic development and resource. In sub-Saharan Africa, (Somalia included), the prevalence of CKD ranges from 2% to 14%.2 CKD is the 3rd most common chronic disease in Somalia, accounting for 8% of all chronic illnesses, succeeding hypertension and diabetes at 33% and 20%, respectively3 According to the World Health Organization (WHO)4, non-communicable diseases (NCDs) are estimated to account for 24% of all deaths in Somalia. NCDs are known to be the main contributors to renal pathology.

The goal of the Kidney Dialysis Project is to protect and save the lives of patients with kidney disease in Puntland state of Somalia. The primary intended outcome is Improved health condition of kidney patients by providing life-saving dialysis services in Garowe General Hospital.

The four intended sub- results of this project are:

1. Strengthening capacity of Garowe General Hospital to provide essential health care services to kidney patients
2. Increased access to integrated and specialized healthcare services for kidney patients
3. Increased awareness and community mobilization ensured
4. Improved learning, knowledge exchange, and partnerships

PURPOSE OF THE ASSIGNMENT:

The purpose of the consultancy is to conduct end-line evaluation for the above project. The evaluation is expected to provide the below outcomes: 

1. Assess the relevance, effectiveness, efficiency, impact, and sustainability of the project in achieving its goals and objectives.
2. Identify lessons learned and best practices for future programming.
3. Provide evidence-based recommendations for scaling up dialysis services in Somalia.

Scope of Work (SOW)

SCOPE OF THE ASSIGNMENT

• The evaluation will be conducted in Garowe General Hospital and associated outreach sites.
• The evaluation will cover 12 months of implementation period. (January to December 2025)
• Beneficiaries will include all patients who received dialysis services, direct and indirectly, during the project.

Program Components to Evaluate:

• Clinical services: treatment protocols, infection prevention and control (IPC), adverse event management.
• Infrastructure & equipment: installation, functionality, preventive maintenance, downtime logs.
• Supply chain: dialyzers, consumables, medications, water treatment systems.
• Human resources: staffing levels, skills mix, training, supervision, and retention.
• Patient experience & outcomes: satisfaction, affordability, continuity of care, social support.
• Financial & operational efficiency: cost per dialysis session, utilization rates, budgeting, and value for money.
• Governance & compliance: alignment with national guidelines and MoH standards.
• Equity & inclusion: access among IDPs, rural populations, gender and disability inclusion.
• Partnerships & referral pathways: linkages with nephrologists, labs, pharmacies, and tertiary centres.
• Risk management: safety incidents, biomedical waste management, water quality assurance.

Methodology

• The methodology should ensure rigor, validity, and reliability through a mixed-method approach.
• Analyze Project proposals, quarterly reports, HMIS data, supervision reports and any other secondary data to understand implementation progress and challenges.
• Quantitative Analysis will include, but not limited to patient records, dialysis session data, lab results.
• Extract and analyze patient-level data: number of dialysis sessions, lab results (eGFR, haemoglobin), and mortality trends.
• Use descriptive and inferential statistics to measure changes over time.

Qualitative Methods:

Key Informant Interviews (KIIs), Focus Group Discussions (FGDs) with patients, staff, and stakeholders. Conduct 6 Key Informant Interviews (KIIs) to assess service quality and sustainability with the following (at a minimum):

• Hospital management (1),
• Project staff (1male,2female) (Lab tech, Head Nurse, Nephrologist)
• Health authorities (1).
• IMC Project focal point
• Organize 3 focus group discussions (FGDs) with (2) patients and (1) caregivers to capture satisfaction, barriers, and perceived impact (at a minimum).
• Patients: 2 FGDs (1 Male/ 1 Female)
• Caregivers 1 FGDs

Sampling:

Stratified random sampling of patients and purposive sampling of staff.

• Patients: Stratified random sampling to ensure representation across gender, age, and treatment duration.
• Staff & Stakeholders: Purposive sampling to include decision-makers and frontline workers.
• Data Analysis: Mixed-method approach using statistical and thematic analysis.
• Quantitative: Use statistical software (e.g., SPSS, STATA) for trend analysis and hypothesis testing.
• Qualitative: Apply thematic analysis to identify recurring patterns and insights.

Triangulation

• Combine findings from multiple sources (documents, interviews, patient records) to enhance validity.

Ethical Considerations

• Obtain informed consent, ensure confidentiality, and comply with IMC and KS relief ethical standards.

DELIVERABLES DESCRIPTION:

• Inception Report should include the following:
  • Detailed methodology, tools, and work plan.
  • Refined evaluation questions and matrix
  • Detailed methodology and sampling
  • Data collection tools and analysis plan
  • Work plan and field schedule
• Data Collection Tools include: 
  • Questionnaire, interview guides, survey instruments, observation checklists. Cleaned datasets and codebooks (anonymized)
• Draft Evaluation Report including preliminary findings.
  • Executive Summary (2–3 pages)
  • Methods, limitations, findings by OECD-DAC criteria (or agreed framework)
  • Actionable recommendations (short, medium and long-term)
  • Annexes: TOR, tools, sampling, data tables/figures, references
• Final evaluation report should include comprehensive analysis with recommendations.
• The final report will be revised based on feedback with tracked changes from IMC technical team
• All annexes should be provided and in an accessible format (PDF + editable)
• The final report will be presented to IMC and other stakeholders if possible.
• Concise Executive Summary should be provided for decision making with the final report.

TIMELINES

1. Week 1: Inception report, tool development, identification of enumerators.
2. Week 2: Enumerator training and Data collection.
3. Week 3: Data analysis, reporting, and presentation.