Introduction
Despite its national economic mobility, Kenya has an overwhelmingly young, poor, and rural population, which faces various disparities in demographic determinants of health. Kenya ranks 147 out of 187 countries on the UN’s Human Development Indicators’ Health Index, placing it in the lowest category of human development (2013), with the government spending just 2.1% of GDP on health. Levels of public expenditure are insufficient to link the general population of over 44 million people (World Bank, 2013) to quality preventive and curative care and to counter Kenya’s disease burden, including HIV/AIDS.
Private healthcare facilities fill some of the access gap, but large facilities are expensive while small facilities provide fragmented care, are often poorly managed, and have limited access to finance needed to scale. Meanwhile the lack of comprehensive and affordable health insurance schemes limits the uptake of private health insurance. Without health insurance, Kenyans are unprepared for when illness and disease strike, and negative economic consequences follow, including missed work, loss of income, depleted savings, loan defaults, hasty borrowing, and suspended financial plans.
Equity Afia is a sustainable, integrated health model that will train and monitor a network of clinician entrepreneurs to provide standardized, quality healthcare throughout the country. Equity Afia will also design and introduce innovative health insurance schemes that are tailored to providers’ behaviors and the health demands and purchasing power of consumers, as a key means to achieve the healthcare system’s long-term financial sustainability and solvency.
It is against this background that the health pillar seeks to engage the services of suitably qualified consultant / firm to undertake a baseline survey using triangulation approach which will primarily constitute detailed document review of data that has already been generated; such as KDHS, KAIS and other secondary data against key program indicators. The intention is to provide baseline values for outcome level indicators for the program as well as provide contextual data against which to compare program performance.
Program Approach
The overall goal of this five-year project is to increase the health status of Kenyans by increasing access to and utilization of quality healthcare and affordable, private health insurance. Equity Afia’s objectives include: 1) provide affordable, high-quality, preventative and primary health services across Kenya; 2) increase health literacy and favorable attitudes about health insurance among Kenyans; and 3) increase the uptake of comprehensive and affordable private health insurance. Key activities include: identify and provide training and technical support to a network of health entrepreneurs; assist health entrepreneurs in accessing financing to launch/improve health facilities using a high volume/low margin (HV/LM) hub and spoke model; lead outreach programs to increase the public’s knowledge of and attitude toward health insurance and overall health literacy; develop and launch health savings accounts, mobile phone applications, and social marketing activities to support outreach; perform data collection and analysis to inform insurance scheme design; engage private sector insurers to underwrite new schemes; and support health facilities in adopting capitation and bundled care payment models.
Against this background, the program primarily aims to ensure sustained improvement of health and well-being for Kenyans by increasing access to and utilization of quality and standardized healthcare and affordable, comprehensive private health insurance. Specifically, the program will aim to achieve the following objectives:
• Objective 1: Improved standardized, affordable, high quality, health care services using a high volume, low margin model
• Objective 2: Increased favorable health and health insurance attitudes, beliefs and literacy among Kenyans
• Objective 3: Increased uptake of affordable and comprehensive health insurance by at least 1,800,000 Kenyans
Theory of Change
Equity Afia believes that if it can increase overall access to standardized and affordable quality healthcare through a scalable private sector-led model, and if this model can yield comprehensive, affordable, and desirable health insurance products that are coupled with initiatives to increase understanding of health and health insurance, Kenyans will opt to direct their financial resources toward the purchase and use of these products and will increasingly place their trust in and access preventive and curative care for themselves and their families, leading to sustained and improved health.
Equity Afia’s theory of change, goal and objectives will be evaluated through three intermediate results:
• Intermediate Result 1(IR1) – Increased access of quality health services, products and information
• Intermediate Result 2(IR2) – Enhanced delivery channels for sustainable delivery of quality health services
• Intermediate Result 3(IR3) – Improved ability of Kenyans to withstand health risks and shocks
These intermediate results will be achieved using three phases through which a main activity for each phase has been developed. The first three years of the project will focus on phases one and two while the last two years will focus on phase three.

Phase 1- Health Care Services Delivery
• Main Activity – Equity Afia will support the establishment of 300 outpatient health franchises across Kenya and execute social marketing campaigns to create demand for their services.
Phase 2- Health Systems Strengthening
Main Activity – Equity Afia will help deploy innovative solutions that can increase efficiency, effectiveness and quality of health service provision in the 300 outpatient health franchises
Phase 3- Health Systems Financing
Main Activity – Equity Afia will offer comprehensive and affordable health financing solutions, including health insurance, to supplement the increased access and utilization of health services, and result in sustained improved health and well-being of Kenyans.
Data Triangulation Study
The primary objective of this assignment will be to use existing data for review and analysis. Rather than drawing conclusions from a data set/survey, the consultant [s] will be required, use multiple data sources to generate a data summary. Against this background, this activity will aim to provide benchmarked information on all project indicators to set a basis for measuring project success and progress. Specifically, in collaboration with the program team, using the ‘public health triangulation approach[1],[2]’, the consultant will

1. Identify key questions for investigation (for both phases of the initiative)
2. Ensure question(s) are important, actionable, answerable and appropriate for triangulation
3. Identify data sources and gather background information, including but not limited to the Kenya Demographic Health Survey Data, Kenya AIDS Survey Data, Population and Housing Census Data, Economic Survey Data, Multiple Indicator Cluster Survey Data.
4. Refine the questions
5. Gather data/reports
6. Assess data reliability and make observations from each data set
7. Note trends across data sets (with a focus on specific geographical areas) and hypothesize
8. Check (corroborate, refute, modify) hypotheses
9. If necessary, identify additional data and return to Step 5
10. Summarize findings and draw conclusions
11. Communicate results and recommendations
12. Finalize and submit final report with indicator summaries and values
Program Indicators
Below, is the list of program impact and outcome level indicators that will be subjected to triangulation. It is recommended that both qualitative and quantitative data be used. As much as possible, all data should be disaggregated by the lowest political unit [e.g ward], sex, age.
Table 1: Equity Afia Program Indicators
Impact: Sustained improvement in the health and well-being for Kenyans
Impact: Number of disability adjusted life years
Impact: Percent of individuals that does not experience catastrophic health expenditure
Impact: Percent of individuals reporting improved quality of life
Impact: Percent of men and women aged 15-49 who received an HIV test in the last 12 months and who know their results (and on ARTs? And sustained on ART?)
IR 1: Service delivery channels increased for sustainable delivery of quality health services
IR 1.1: Increased financing of private health care facilities
Outcome: Percent of Equity Afia Franchisees recording profits
Outcome: Percent of Equity Afia Franchisees receiving affordable loans
IR 1.2: Improved health services through management systems
Outcome: Percent of Equity Afia Franchises using an EQA management system [by type]
Outcome: Percent [number] of individuals referred [by type of service referred for] that received services
Outcome: Percent of EQA clients reporting satisfaction with health services (especially costs?)
IR 1.3: Strengthened human resources for quality health services
Outcome: Percent of Equity Afia Franchisees receiving technical assistance and capacity building to provide health care
Outcome: Percent of Equity Afia health facilities with minimum compliance levels to operational protocols
Outcome: Percent of EQA Franchise Staff with change in knowledge score after training (training means induction?)
Outcome: Percent of franchise with documented routine supportive supervision visits supported by Equity Afia
Outcome: Percent of Equity Afia-supported franchise sites implementing quality improvement plans
IR 2: The utilization of affordable and quality health services, products and information increased
IR 2.1: Increased availability of affordable and quality high-impact health care interventions
Outcome: Percent of Equity Afia franchises offering comprehensive health care services
Outcome: Percent of clients seeking services from EGF clinics who are from the lower 3 wealth quintiles of Kenya
Outcome: Percent of clients seeking information from EGF clinics who are from the lower 3 wealth quintiles of Kenya
IR 2.2: Increased awareness of integrated package of quality high-impact health interventions and related products
Outcome: Percentage of clients reporting knowledge of facility from an activation event or other communication events
IR 2.3: Increased uptake for an integrated package of quality high-impact interventions
Outcome: Percent of EQA clients requesting an HIV test, receiving a test and receiving test results
Outcome: Percent of EQA clients requesting other EQA health packages (e.g. well woman, well baby etc)
IR 3: The ability of Kenyans to withstand health risks and shocks improved
IR 3.1: Increased availability of health insurance and related products
Outcome: Self-reported insurance coverage
Outcome: insurance coverage from external sources e.g. EIB, studies
Outcome: Self-reported or objective reports of use of health savings schemes
IR 3.2: Increased utilization of health insurance and related products
Outcome: Percent of EQA clients who pay for health services with health insurance
Outcome: Percent of EQA clients who pay for health services with EQA health insurance
Key Activities and Deliverables
The baseline survey will start upon signing of the contract and non-disclosure agreement between Equity Group Foundation and the consultant/firm or an otherwise agreed upon date. The due dates for all deliverables will be finalized by the evaluator and Equity Group Foundation prior to submission of the inception report/work plan. Key deliverables include
1. An inception report including a technical proposal with methodology as agreed on with EGF Health Pillar in discussions following award of contract, clear work plan indicating key outputs persons allocated for implementation at each stage, and budget in Kenya Shillings prior to engaging in field work.
2. An initial report (word document) and power point presentation of preliminary findings from the assessment in relation to the above result areas and indicators done in a presentation to EGF team
3. A power point presentation, a soft copy and 2 hard copies of the full report of the final findings from the baseline assessment. The report should clearly present a summary of all indicators and baseline values for the respective indicators and should incorporate feedback from the initial powerpoint session.
4. Presentation of baseline findings at a dissemination workshop for the stakeholders
Suggested Report Structure
1. Title page
2. Contents page
3. List of abbreviations and acronyms
4. Executive Summary (maximum 2 pages, clearly summarizing the assessment and key findings)
5. Background (maximum 3 pages on the context of the intervention and project objectives)
6. Methodology (maximum 3 pages detailing what data synthesized, how it was collected and by whom, what the sample size was, any possible limitations to the assessment etc.)
7. Findings and analysis (approximately 15 pages giving the results of the assessment according to the objectives given in this ToR, combining qualitative and quantitative data, disaggregated by sex and age. The Findings section should also include a summary table showing updated information for program indicators)
8. Conclusions and/or Recommendations (approximately 4 pages, conclusions and recommendations must be clearly related to the evidence given in the Findings section of the report.
9. Annexes:

These might include: • Itinerary/ schedule
• List of people and organizations consulted
• References / list of documents/data reviewed
• Additional methodological information if required (e.g. more detailed information on sampling used for the research)
• Additional maps, photos or more detailed case studies if available
• Not in the actual report, but all raw data (quantitative data files etc.) should also be submitted for reference and future use. Profile of the Consultant
We are looking for a consultant/firm with the following skills and qualifications:
• Basic education qualifications in health systems research/evaluation, or public health or epidemiology or social sciences research
• Referenced (provide referee for assignment) experience of conducting similar assessment or work including program evaluations in the area of health for large-scale, regional or national level projects or programs in the last three years in Kenya
• Knowledge of health data and sources in Kenya
• Demonstration of experience as lead person/s of using and conducting literature reviews or data synthesis for service availability, readiness and quality of services
• Good report writing and oral communication skills
• Timely delivery of expected outputs from assessment
• Knowledge and experience of using statistical packages for analysis of data
Other attributes
The consulting firm or consultant (s) will be selected on the basis of their proven experience, qualifications and ability to deliver a quality product in a timely and efficient manner. Particular qualifications and experience of the lead consultant team members include:
• Post graduate qualification in Health systems research, Epidemiology or public health and at least 8 years of relevant experience ( Team leader);
• Excellent communication skills, especially ability to write very well in English.
• Excellent knowledge of issues in health programming and health systems in Kenya

HOW TO APPLY:
Application process:
Interested candidates will be expected to provide the following documentation:
• • Detailed Expression of Interest, with specific focus addressing the purpose and objectives of the assignment
• • Initial work plan based on methodology outlined
• • Company profile or CV including a minimum of 3 professional references
• • Detailed budget breakdown based on expected daily rates and initial work plan
Contact Information
Vendors should make electronic bid submission to the following Contact:
Jamlick Wanyoike,
Procurement Manager, Equity Bank Ltd
Equity Center, 3rd Floor, Hospital Hill Road, Upper Hill
P.O. Box 75104, 00200, Nairobi.
Phone: +254 20 226 292 1, Fax: +254 20 271 143 9
Email: jamlick.wanyoike@equitybank.co.ke
cc mathew.ngunga@equitygroupfoundation.com
Key Timelines
Vendors should respond with the timelines stipulated in the table below:
Re-Issuance Date:Sept 28, 2017
Vendor Formal Proposals Submission Deadline:Oct 19, 2017 [16:00 hrs Kenyan Time]