Consultancy on Comprehensive assessment of Squatter settlements of Kathmandu Valley

Terms of Reference

A.     Introduction

For more than 40 years, Médecins du Monde (MdM), a campaigning medical organization committed to international solidarity, has been caring for the most vulnerable populations at home and abroad. It has continued to highlight obstacles that exist in accessing health care and has secured sustainable improvements in health-for-all policies. Those working for this independent organization do not solely dispense care and treatment but condemn violations of human dignity and rights and fight to improve matters for populations living in precarious situations. MdM currently works in more than 44 countries across all continents where it focuses on 5 priority areas: caring for the health of migrants and displaced persons, promoting sexual and reproductive health, combating HIV, and reducing the harm and risks associated with drug use, crises and conflicts and environmental health.

MdM has worked in Nepal since 1995: firstly, on Tuberculosis and HIV in western province, then on Sexual and Reproductive Health in Sindhupalchok District. Following the 2015 earthquakes, MdM implemented an emergency response program and then, a post-earthquake early recovery project in the same district.

Médecins du Monde (MdM) has been actively engaged in improving the health and wellbeing of marginalized communities, particularly informal waste workers, through initiatives like the "Healthy Waste Workers" program. This program, operational in Kathmandu, Nuwakot, and Banke, has significantly enhanced access to quality healthcare services and facilitated enrollment in National Health Insurance (NHI) schemes, in collaboration with local and federal governments. 

Building on this successful model, MdM's Strategic Plan 2024-2026 places a strong emphasis on urban-focused interventions, specifically targeting environmental and health challenges prevalent in squatter areas. Given that a substantial portion of informal waste workers reside in such areas, MdM plans to extend its interventions across wards in Kathmandu and Lalitpur. Therefore, there is a need for a comprehensive assessment to understand the living conditions and their impact on health, nutrition, healthcare accessibility, utilization, health facility readiness, and socioeconomic status of Three major areas of squatter residents.

B.     Objective of the Study:

i.     General Objectives 

This study will focus to access the health and wellbeing condition of marginalized people living in the Three squatter areas of Bagmati river corridors of Kathmandu valley including informal waste workers so as to identify their accessibility to quality health services and health seeking behavior. 

ii.     Specific Objectives

The study aims to:

1. Understand the living (health, nutrition and socioeconomic) conditions of people residing in squatter areas, including informal waste workers and other vulnerable populations.
2. Assess major health issues or problems, health-seeking behaviors, healthcare accessibility, and utilization among squatter residents, identifying barriers and facilitators to accessing healthcare services.

C.     Methodology:

The consultancy firm will adopt a rigorous and comprehensive methodology, which includes:

1.  Literature Review: Conducting an extensive review of existing literature, including government data, academic research, and reports from relevant organizations, to gain insights into the characteristics and challenges of squatter settlements in Kathmandu Valley.

2.  Mixed-Methods Approach: Utilizing a mixed-methods approach that combines quantitative and qualitative methods to obtain a holistic understanding of the issues. This will involve:

• Quantitative Methods: Conducting household surveys using a structured questionnaire to collect data on demographics, health status, healthcare utilization, and socioeconomic indicators. The sample size will be determined based on the population size of each squatter settlement.
• Qualitative Methods: Conducting Key Informant Interviews (KIIs) with community leaders, healthcare providers, and other stakeholders to gather in-depth insights into local perceptions, experiences, and challenges. Additionally, organizing Focus Group Discussions (FGDs) with community members to explore specific themes in greater detail.

3.  Direct Field Observation: Conducting direct field observations to assess the physical environment, living conditions, infrastructure, and sanitation facilities in squatter settlements.

4.  Stakeholder Engagement: Engaging with relevant stakeholders, including local authorities, community organizations, and healthcare providers, throughout the assessment process to ensure collaboration, participation, and ownership.

5.  Ethical Considerations: Ensuring compliance with ethical standards and obtaining necessary approvals (NHRC) from relevant authorities before commencing data collection activities.

D.     Management of Enumerator and Training:

The consultant will be responsible for:

1. Recruiting a team of skilled enumerators with experience in data collection and community engagement.
2. Providing comprehensive training to enumerators on survey techniques, ethical considerations, and data quality assurance protocols.
3. Supervising and overseeing data collection activities to ensure consistency, accuracy, and adherence to study protocols.
4. Conducting regular debriefing sessions and providing ongoing support and supervision to enumerators throughout the study period.

E.     Deliverables:

The consultant/firm will be required to deliver the following outputs:

1.    Inception Report: A detailed inception report outlining the study methodology, including survey tools, sampling strategy, data collection procedures, and work plan.

2.     Comprehensive Reports:

a)  A concise two-page summary report highlighting key findings and recommendations for policy and programmatic interventions.

b)  A comprehensive report on the health and socioeconomic conditions of squatter residents, including findings from household surveys, KIIs, FGDs, and field observations.

c)  A report on the barriers to accessing healthcare services, including challenges related to infrastructure, transportation, affordability, and awareness of available services.

d)  A report on the knowledge, attitudes, and practices related to the National Health Insurance (NHI) scheme among squatter residents, identifying barriers to enrollment and utilization.

3.  Clean Database: A clean and organized database containing all collected data, ensuring confidentiality and data protection.

4.  Slum Settlement Profile: A detailed profile of squatter settlements in Kathmandu Valley, providing an overview of demographics, living conditions, infrastructure, and health-related challenges.

5.  List of Key actors and players working in the 3 squatter areas.  

F.     Responsibilities of MdM

1)     MdM will organize one brief session once the consultant finalized, date will be informed to the consultant in later days. 

2)     MdM will provide the list of different squatter settlements upon request from bidder. 

3)     MdM shall not be responsible for any loss and damage properties of consultants while carrying out the assessment. 

4)    Any issues aroused during the assessment should be settled with mutual consent of both the parties.  

G.     Timeframe:

The study is expected to be completed within a period of one and half months, with data collection commencing in April 2024 and final deliverables to be submitted by the end of 15th of May 2024. 

Indicative Schedule 

• Week 1-2: Desk review of core documents; drafting and validation of the inception report with detail work plan, checklists, tools, and questionnaires. Enumerators’ orientation after the approval of tools and inception report.
• Weeks 3-6: Field visits to sites, coordination with relevant stakeholders and data collection and analysis. Report finalization and sharing within 6th Week. 

H.     Confidentiality and Data Protection:

The consultant/firm must adhere to strict confidentiality and data protection protocols, ensuring that all collected data, reports, and observations remain confidential and are used solely for the purpose of this study. Any unauthorized disclosure or sharing of data is strictly prohibited.The  consultant should comply with policy of Government of Nepal and European Union data protection policy when any contrary. 

MDM will hold all the authority to the collected data and relevant publications if any.

I.     Qualification and Experience:

The lead consultant/team leader should possess:

• A Master's degree or higher in public health, social sciences, or a related field.
• Lead consultant/team leader with at least five years of relevant experience in conducting research and assessments or relevant project interventions, particularly in the field of public health or community development.
• Proven experience in leading and managing complex research projects, including data collection, analysis, and reporting.
• Strong analytical and communication skills, with demonstrated ability to translate research findings into actionable recommendations.
• Experience working in multicultural settings and familiarity with the context and challenges of squatter settlements in Nepal.
• A track record of collaborating with government agencies, NGOs, and community-based organizations in similar contexts.
• The consultant should be the mastery in local language and familiar with the local context of squatter settlements. 

J.     Budget:

The budget should cover:

1. Team salaries, including the team leader, coordinator, and enumerators.
2. Logistic arrangements, including local travel, communication, material costs, and any other specified expenses.
3. Data tabulation and analysis costs.
4. Report preparation and submission expenses.

K.     Proposal Evaluation 

The technical and financial proposals will be evaluated separately and have 70% and 30% scores respectively. The proposals evaluation is based on the given criteria 

L.     Application Procedure

Interested candidates, firms and agencies are mandatory to submit the following documents by 20 March 2024  on info.mdmfrance@gmail.com. If you have any queries related to settlement areas please write an email in the same address mentioned above.

i)    Technical proposal and letter of motivation (7pages max.) indicating

• The consultants’ suitability for the assignment and match with previous work experience, qualifications etc.
• How the team will be composed and the division of work between team members.
• Discussion of the work methodology it will use.
• Draft work plan and suggested timetable.
• Economic offer and budget break down.

ii)     Professional profile of the evaluating team/ company (CV of least lead consultant/team leader of consultancy team)

iii)     A copy of previous research/assessment report on the similar issue will be an added value

For firms/agencies following additional documents must be submitted:

• Copy of certificate of company registration
• Copy of tax registration certificate
• Copy of tax clearance certificate