TERMS OF REFEERENCE: Research on role of OPA Model in linking with health and care systems in Bangladesh and Cambodia. (SANA Phase II Project: ASR 687)
HelpAge and Healthy Ageing
HelpAge International is an international NGO and the secretariat of a global network of organisations promoting the right of all older people to lead dignified, healthy and secure lives. As the network's secretariat, HelpAge International brings together like-minded organisations to collaborate and strengthen national, regional and global influence.
HelpAge International’s strategy 2020-2030 promises that ‘by 2030, millions of the older people will enjoy a better quality of life, through improved wellbeing, dignity and voice.’ Our understanding of ‘healthy’ aligns with the WHO Framework for Healthy Ageing as described in the WHO World Report on Ageing and Health 2015. Healthy ageing is the process of developing and maintaining the functional ability that enables wellbeing in older age. Functional ability comprises the health related attributes that enable people to be and to do what they have reason to value. An older person’s functional ability is determined by their intrinsic capacity - their physical and mental capacities - and their interactions with their environment. The Framework for Healthy Ageing provides an overarching vision for health and functioning over the life course. We are all ageing and the Framework is for people of all ages, not just for people over a certain age.
We believe that everyone should have the opportunity to live a long and healthy life, experience wellbeing and do what they value. Illness and disability are not necessarily a part of ageing, however many older adults live with chronic conditions, often multimorbidities, and/or with disabilities. When well-managed, these often do not need to lead to greatly impact wellbeing. Some people may require increased support with tasks of daily living and adaptations to their environment to continue to do the things they want in the places they want to be.
Individual health is determined by a variety of factors across the lifecourse including genetic/biological, behavioural, environmental, social, and related to the health and care services they have access to. There are a lot of actions people can take at any age to improve health and functioning. HelpAge recognises both that individuals can influence their own health outcomes and also that health systems, social determinants of health and other external factors have a great deal of influence on individual health. The voices of all older people should play a key role in the design, implementation and monitoring of healthy policies, systems and services to ensure age-inclusive universal health coverage and societies for all ages.
Most health and social care systems have responded inadequately to the changing requirements associated with ageing populations, having been designed mainly to address acute medical issues and maternal and child health. Poor physical access to clinics and hospitals, including for older adults with disability, long distances from households to health services, the prohibitive cost of services and a lack of awareness of health conditions are all barriers faced by older people.
Policy provisions on health for older people are present to an extent in most countries but funding and implementation lag behind. There are also structural challenges, including systems designed to respond to a different burden of disease and often no formal systems for long term care and support, lack of an adequately trained workforce, and of available adequate quality health and social care services. Discrimination based on age, gender and disability also presents a challenge. Health systems often are not strong in addressing non-communicable diseases, rehabilitation services, mental health, and palliative and end-of-life care.
In many situations, the inadequacy or absence of health and social care services means that people have to be effectively self-reliant in looking after their health and social care needs. Older women also carry much of the caring responsibility for spouses and other family members. Even where health systems are stronger, there is a need for individuals and communities to engage in their own health and in achieving healthy longevity for all.
HelpAge International advocates for changes in policy and service delivery to ensure systems are fit for purpose in an ageing world, and older people’s right to health and care is protected and promoted. To this end, HelpAge and its network members work in partnership with governments, as duty bearers, and other key stakeholders. Alongside these efforts, HelpAge and its partners work at the community level to support older people, their families and communities to create societies for all ages.
HelpAge and Older People’s Associations (OPAs)
In numerous countries and contexts, HelpAge, network members and partners implement community-level work with community-based groups or associations of people referred to collectively as “Older People’s Associations (OPAs)” with the understanding that there are many models but that all will be inclusive of and engaging older people. OPAs are, therefore, community-based organisations that mobilise older people to improve their own lives and to contribute to the development of their communities across many domains. They are multifunctional, addressing interrelated needs of older people in the community, such as: livelihoods and support for work in later life; health and social care; social connection; rights and entitlements; disaster preparedness; women’s participation; transparent governance and community participation.
OPAs draw upon the community’s existing resources, particularly the capacities of older people themselves to serve as agents of change in their lives and communities. OPAs strengthen community level links between older people, their communities and local government and services.
In some countries, OPAs have come together at local or national level to form federations or join with others as part of national platforms on ageing. Coming together in this way can enable OPAs to scale-up their work and have greater impact on raising older people’s issues at local, regional or national level, including those related to health, care and support. In countries with national-level associations or federations of OPAs these are sometimes able to represent the interests of older people in national policy processes.
A wide range of approaches to health, care, support and wellbeing are currently being used across HelpAge and the HelpAge Network in work with community based groups. Most groups encourage older people to engage in health-promoting activities and provide them with health information. OPAs may also facilitate access to health services by organising health checks by health professionals and helping with the costs of healthcare. Some conduct regular screening for NCDs such as blood pressure and weight measurement. Some groups include home visits and home care services among their activities which can contribute to reducing social isolation and risks of being homebound.
HelpAge is working with the Network and interested others to develop common approaches to health, care, support and wellbeing interventions for OPAs and to identify, develop and share guidelines and tools to support this work.
The research is an activity of the Improving the well-being of older people, their families and their communities in Asia, through resilient and self-sustaining community-based organisations and improved social protection (commonly referred to as SANA Phase II). The intended outcomes of the project are that: 1) Older people and other members of OPA/CBOs have improved health, increased opportunities for income generation and more effective care in the community, and 2) The dignity of older people is enhanced through the increased coverage and adequacy of social pensions.
Currently the project is piloting the implementation of an intergenerational and multi-functional OPA model with the targeted village level OPAs in Bangladesh, Cambodia, and Indonesia. Vietnam is engaged in the project, sharing their model with the other countries and working on the process of national replication of the model (referred to as Intergenerational Self-Help Club in Vietnam).
In 2016, Vietnam conducted a small study to consider how to better integrate the health and care activities of the OPAs with the national health and social welfare systems. This included a review of context, health system, OPA health activities and existing linkages with the health system. It also developed recommendations for strengthening the linkages between OPAs and the health system. This review and an ongoing study in Myanmar and Vietnam on OPAs and primary health care linkages with a focus on non-communicable diseases are helping to shape and improve the practice of the OPAs on health and care and serve as a basis for this proposed research in Bangladesh and Cambodia. These two countries have not yet conducted a review of their health and care activities in OPAs and their appropriate integration with the health system or social welfare services.
The purpose of this assignment is to work in close collaboration with HelpAge staff and the project partners in 2 countries (Bangladesh and Cambodia) to identify strategies for the appropriate integration of health and care activities of OPAs into health and social welfare systems in order to increase their positive impact on health of older people and their communities.
A secondary purpose will be to develop and record the methodology for this used in Bangladesh and Cambodia for future use in other countries.
Provide overview of health situation and health and care systems in the country:
- To summarize prominent national research on the major causes of ill-health and disability (including social determinants of health) and burden of disease.
To summarize the current health and care systems analysis inclusive of national or sub-national plans and policies. Some considerations:
- Utilise health systems building blocks and AAAQ
- Examine situation of traditional medicine including the legal aspects
- Conduct an inclusion analysis
- Care systems are not formally developed, but what is the situation of care more generally
- Identify rights and entitlements related to health and care
- Conduct age-inclusive universal health coverage analysis- mapping gaps and identifying potential advocacy aims
Develop and test tools that communities can use to conduct local level health situation and health and care system analysis:
- To develop and test a community-specific health situation analysis including an environmental health risk analysis tool which could be used by communities in future.
- To develop and test a local-level health and care system analysis to be used by communities in future
Analyse existing OPA health and care activities and potential linkages with local level health and care systems and services:
- Assess the current services and activities of the OPA which relate to health and care
Analyse potential role of OPAs in or alongside national systems and plans
- How can OPAs link with/support primary health care services and social welfare services (where available)
- To provide analysis of current OPA activities and identify opportunities and priorities for OPAs and HelpAge Cambodia and HelpAge Bangladesh for effective health and care work in response to health system and health situation analysis
Notes: HelpAge has a minimum standard sex, age, disability disaggregated data policy and further disaggregated is encouraged if useful.
4. Specific tasks for consultant
The key tasks in the process are:
- Design a detailed research framework, methodology and workplan according to this TOR in consultation with the project team.
- Secondary data analysis and literature review for initial health situation and health system analysis
- Key informant interviews and focus discussion groups at national, sub-national and community-level (initial set of consultations can be done online with HelpAge Bangladesh and HelpAge Cambodia; remainder during week-long visit to the country)
- Action research for testing community-level assessment tools (testing while in country)
- Draft full reports for each country
- Deliver package of tools, templates and detailed methodology used to develop the reports. Simple language as these would be used by civil society staff in other countries in the future
The process will be managed by the Regional Programme Adviser- Care and Health with support from the SANA project manager and a reference group comprising staff members of HelpAge and project partners. As the outputs of this research are reports along with tools usable by non-researchers, regular engagement with HelpAge Bangladesh, HelpAge Cambodia and HelpAge focal point will be needed (e.g. bimonthly skype meetings).
The outputs for this ToR will be:
An Inception Report to propose research framework and methodology. The report must be in English and should include;
- Findings from desk research review with evidence/justification for methods selected
- Proposed framework, methodology, and data collection tools *note as this will be the basis for the output for future use by NGO staff, it should be written simply and clearly
- Draft final report outline
- Work plan
- Draft reports 1) Bangladesh 2) Cambodia, following the same length and format and incorporating the elements above
- Field data collection and/or participation in project event as necessary
- Prepare a draft report for each country for review, circulation and comment
- Revise and share draft package of tools, templates and detailed methodology used to develop the reports for other countries to use in future
- Present findings and recommendations to project stakeholders via skype
- Prepare and submit final outputs
HelpAge will require a full research report for each of two countries (Cambodia and Bangladesh) in English language with maximum of 25,000 words written in clear non-technical language, encompassing:
- Up to 3 pages of Executive Summary
- Up to 40 pages describing the research methods, results, analysis, discussion and conclusions.
The structure of the report will be agreed during the discussion about the research framework and methodology.
For the package of tools, templates and detailed methodology, language should be simple, clear and concise. Detailed methodology should be no more than 10-15 pages. Tools and templates developed through the process would be annexed.
6. Time requirements and duration
The following is an indicative timeframe for the assignment. Specific deadlines may shift slightly depending on the timing of the event that consultants may have to attend, and availability of consultants and project partner to support field data collection.
- April 2020: Consultant appointed and review of the research proposal and planning
- May 2020: Desk Review and Inception report
- June 2020: Field data collection
- July-August 2020: Analysis and draft Reports and toolkit
- September 2020: Review and revise outputs
- October 2020: Final reports and toolkit delivered
7. Indicative budget
HelpAge is looking for Expressions of Interest (see Section 8) for this assignment in the general range of US$10-12,000 including all costs e.g. consultant fee, air tickets, subsistence allowances and miscellaneous travel expenses for visiting Bangladesh and Cambodia for field research. Field research costs such as transport, translators, meeting costs in country, will be covered by HelpAge through a separate budget.
8. Qualifications/requirements of consultant
HelpAge anticipates hiring a single consultant or agency with the following qualifications.
- B.A. or above in a field highly relevant to the nature of the study (e.g. public health, social science)
- familiarity with the Asia region, and preferably one or more of the two target countries for this research
- proven experience in research methods and development research tools
- strong communication skills, proficient in working across all levels of institutions with experience of conducting interviews sensitively in a range of contexts
- excellent report writing skills in English with emphasis on simple, easy-to-read language
- Previous experience of working on Older People Associations (OPAs) or Community Based Organizations (CBOs) health-related research/studies
9. How to apply
Interested consultants are invited to submit an Expression of Interest for delivery of the assignment. The short Expression of Interest (about 4 pages) should include:
EOI should include:
- a cover letter: A short (one page) cover letter addressing the selection criteria above.
- Proposed methodology and any comments on TOR and Research Proposal
- financial proposal: The financial proposal should provide cost estimates for services rendered including daily consultancy fees.
- Clear work plan including output/deliverable and time frame for each stage of the project
- Costing of each aspect (including day rates and any additional costs)
- Appendixes (not included in 4 pages)
- the applicant’s CV (maximum 3 pages) outlining his/her experience
- Examples of relevant studies previously produced
- Contact information for 2 professional references
Selection of the consultant will be by a HelpAge project committee and based on the experience of the consultant, the quality and relevance of the expression of interest, and the proposed budget. Selection will be based on value for money, within resources available. Final negotiated fees will be specified in the consultancy contract.
The deadline for submission is midnight 25 March 2020. Please contact Ms Chitlekar Parintarakul at email@example.com for further information or to submit your EOI.
At HelpAge International we work hard to achieve our goals together as a team with a clear shared purpose. Everyone who works at HelpAge share our values and are committed to behaviours that demonstrate and support them.
Our values inform how we work together:
We respect people, value diversity and are committed to equality.
We value and recognise the contribution of our staff and network
members, as we put older people at the centre of everything we do.
We work alongside network members and others to increase reach, influence and impact. We are committed to a culture of collaboration and building positive relationships.
We are passionate about learning, accountable and work together to find creative solutions
HelpAge International is committed to creating an inclusive working environment, promoting and providing equal opportunities and respecting diversity in employment. We welcome applications from all suitably qualified individuals regardless of their age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex and sexual orientation. We encourage and facilitate a flexible working environment.
Everyone has a role in creating and sustaining a safe and respectful working environment, where no one comes to any harm or is maltreated. At HelpAge we take our responsibilities very seriously and will take action against wrongdoing. We will do everything we can to ensure that we do not engage people that pose a safeguarding risk and will undertake criminal record checks as required.
 (More information in this briefing from Asia Pacific Region: Older People’s Associations: a briefing on their impact, sustainability and replicability.)