EJAF HIV and Mental Health: Baseline Survey in Mombasa & Kwale Counties
Background and Context
Triggerise in Kenya, through the Tiko platform uses an ecosystem implementation approach to enable beneficiaries between the ages of 15-19 to access SRH services at a subsidized cost where they earn tiko miles redeemable at a tiko vendor through the purchase of goods after every service uptake. Triggerise received funding from the Elton John Foundation (EJAF) to implement these interventions for adolescents aged between 15-24. Access to Mental Health (MH) services, and HIV related services including: testing, PrEP, and ART in Mombasa and Kwale counties.
This programme focuses on young people in their diversity aged 15-24 with a particular focus on adolescent girls and young women, young people living with HIV and key populations such as those who inject drugs, those engaged in sex work and men who have sex with men. The programme will seek to address key barriers in accessing HIV prevention and treatment services and MH services that these groups face when navigating through the private and public sectors. The ITH platform is designed to support users through complex healthcare journeys utilizing community mobiliser and CSO support, reminders, rewards and follow up calls to motivate adherence, and tracking users to support their sustained use of health services.
The programmes aim to improve young people’s access to contraception, Mental Health, ART, HIV and PrEP services in order to improve the following poor outcomes among this age cohort and groups: Modern Contraceptive Prevalence rates which is at 44%. As part of this work, Triggerise will engage an external, local evaluator to co-design and conduct an independent mixed-methods evaluation. The aim is to understand the social and demographic characteristics of Tiko users, and to investigate the complex intersection of MH, ART, HIV and PrEP outcomes by evaluating the impact of the platform on user knowledge, awareness, attitudes and behaviors (uptake of services) over time. The specific approach will be a combination of quantitative and qualitative methods that will be used to understand the change in these indicators.
Ultimately, we will model impact on HIV prevalence rates and MH prevalence rates (focusing on stress, depression and anxiety) in Mombasa, as compared to other comparable urban areas with a focus on KPs (Key Populations). The evaluation will also seek to assess perceptions around HIV, ART, PREP and MH, and how these contribute to societal stigmas around KPs and other vulnerable populations.
The EJAF programme aims to achieve the below outcomes among young women and young men aged 15-24 in Mombasa: The goal of this project is to increase the social empowerment of young people living in Mombasa, which we expect to lead to improved and sustained mental and sexual health. Outcomes include:
- Young people have improved and sustained mental and sexual health
- Young people have improved agency and quality of care in their options of service providers
- Increased awareness for MH and HIV programmes among Government of Kenya (GoK)
- Improve the quality of HIV and MH services available on the Triggerise’s Tiko platform
- Reduce barriers to access HIV and MH services.
- Assess the availability, accessibility, affordability, and recent uptake of HIV and MH services among the target group of vulnerable young women and men aged 15-24.
- Unpack the knowledge, practices and attitudes towards HIV (including on PrEP)and MH services
- Identify factors affecting access to HIV and MH services including: socioeconomic, cultural, and political situations and identify potential solutions
- Assess service quality and evaluate how youth-friendly service providers are towards the target group
Scope of Research
The survey will be implemented in sub-counties of Mombasa where we will establish Tiko ecosystems (i.e areas in which we have contracted clinics and providers to provide subsidized or discounted HIV and MH services). To allow comparison of result and impact of the programme at the endline, health facilities of similar characteristics will be sampled in Kwale county.
The design and implementation of the baseline must ensure that principles of gender equality, disability, inclusion and non-discrimination are considered and acted upon throughout, and that the meaningful participation of the most vulnerable groups and other key stakeholders is promoted in the design and implementation of the research.
Study Population
The study population will be: adolescents and young persons aged 15 to 24 years seeking health services in the selected health facilities, health care workers in the selected health facilities; stakeholders in the HIV and mental health spheres including: relevant County governmental department staff, social workers, health facility heads, representatives of youth led/focused or KP organizations and other humanitarian organizations personnel. The target counties will be Mombasa and Kwale.
Methodology of the Study
The study will be conducted in February 2023 and will be based on a mixed-methods research approach. A quasi-experimental approach will be used to establish baseline scores for cases in Mombasa and a comparison group in Kwale.
In general, the following methodologies will be utilized, but should not be limited to:
- Desk review on knowledge and awareness of and access to HIV and MH services among Adolescent Girls Young Women (AGYW), ABYM (Adolescent Boys Young Men) and KPs (Key Populations): The consultant will review project documents and other relevant secondary data sources.
- Quantitative data to be collected through a representative survey and through tools administered during service delivery. A client exit survey will be conducted with adolescent and young people at the sampled facilities.
- Qualitative approaches, such as focus group discussions (FGDs) and key informant interviews (KII), as well as participatory exercises and approaches should be used where appropriate.
Triangulation of information gathered during the primary (quantitative and qualitative) research is crucial in this study, with reflection on how the findings relate to the secondary data. The assessment is to be consistent with SPHERE standards, specifically the principles for child protection and standards for inclusion of persons with disabilities. The baseline survey will be organized in a participatory way, and should include involvement from Triggerise staff, local actors and project beneficiaries (Rafikis).
Sampling- Quantitative Survey
The quantitative survey will be conducted with adolescent and young people aged 15 to 24 years through a client exit survey done at the sampled facilities. In Mombasa, the EJAF programme has 6 Tiko facilities currently offering services and 19 public facilities. From these facilities, a total of 12 facilities have been sampled (6 public facilities and 6 private facilities).
In Kwale County, the Kenya District Health Information system (KDHIS) database will be used as the sampling frame. From this database, 12 facilities of similar characteristics and providing HIV test services, ART and PrEP will be sampled.
Number of Facilities Sampled
Type of Health Facility:
- Sub County health facility: 2 in Mombasa and 2 in Kwale
- Health center: 2 in Mombasa and 2 in Kwale
- Dispensary: 2 in Mombasa and 2 in Kwale
- Private health facilities: 6 in Mombasa and 6 in Kwale
A sample size of 460 interviews each has been allocated to Mombasa and Kwale Counties. In each county, sample distribution across facilities will be proportionate to the volume/ number of visits of girls aged 15-24 years accessing HIV test services, ART and PrEP.
Sampling- FGDs & KIIs
A total of 12 FGDs will be conducted with young persons (6 with key populations(KPS) and 6 with non KPs.
A total of 17 KIIs will be conducted with health officials at the county and sub-county level.
Key informants
- Sub County health facility level
Group:
- Social workers
- Purposive
- Health facility in charges (Tiko pharmacies)
- CSO/CBO (youth-led/youth focused)
- Partner (Humanitarian officer/social protection)
- Mental health counsellors
- Counsellors
Sampling Approach:
Purposive
- County-level
Respondent:
Health Department (Director)
Purposive
Social Protection Department
Gender Department
Sampling Approach:
Purposive
Health Facilities Data Abstraction and Stock Check
All the targeted health facilities will purposely have secondary data extracted and assessments of (1) the availability of stock (PrEP, HIV test kits and contraceptives) and ; (2) HIV services uptake by young persons aged 15 to 24 years (HTS, ART and PrEP will also be done.
Scope of Work
The primary purpose of the consultancy is to conduct a baseline study for the EJAF programme in Kenya (Mombasa and Kwale). This will provide Triggerise with a set of information against which to monitor and track the progress and effectiveness of the programme over the course of its implementation.
Objective of the baseline study
- The baseline study will help Triggerise gather baseline evidence against which an assessment of the programme success will be measured (endline).
Specific objectives of the baseline are to acquire the knowledge necessary to allow us to design interventions that:
- Evaluate adolescents and KP’s awareness of available tools to measure mental health
- Assess awareness of Public Health Questionnaire (PHQ4 & PHQ9)
- Awareness of the community mental health support structure
- Awareness of facility mental health intervention
- Evaluate adolescents and KP’s access to communication/messaging on awareness of the various services offered under this programme including HIV and MH services
- Assess the channel through which the messages were received (SMS, WhatsApp) and information, education and communication (IEC) materials (posters and flyers)
- Assess awareness of the various offers provided
- Evaluate adolescents and KPs’s HIV and MH, knowledge, attitudes, and motivation, and their access to HIV and MH services.
- Evaluate knowledge of available HIV and MH services
- Awareness of PreP including where to get it (awareness of access at pharmacy and clinics)
- Evaluate access to HIV and MH services for adolescents and KPs. This includes accessibility of service providers, cultural acceptability, availability and appropriateness (youth-friendly, gender sensitive, inclusive, responsive)
- Collect data and evaluate current rates and trends on HIV and MH for adolescents and KPs (secondary or primary data).
- Evaluate perceived service quality of HIV and MH services available from different service providers and identify the current community level of awareness about HIV and MH services for youth and KPs in the following areas:
- What are the specific HIV and MH needs of adolescent girls?
- The biases on KPs when it comes to accessing HIV and MH services.
- HIV/AIDS counseling and testing including PreP uptake.
- Education and counseling regarding MH.
- Evaluate barriers to access and choice by identifying the current state of coordination of MH services among youth led/focused organizations.
- Provide recommendations on areas that need attention during the project implementation and ways to strengthen on-going monitoring of the project to maximize learning and adjust/improve the program implementation and intervention.
The data collected will be both qualitative and quantitative. Data collection will adhere to the National COVID-19 safety policies and align with Kenya’s Ministry of Health COVID-19 and HIV and AIDs guidelines/ policies.
The specific research questions that this research should answer are:
HIV services:
- What do various HIV services cost in Kenya, and what kinds of services are offered at different healthcare facilities?
- Do HIV service providers offer the full range of services: ART, PreP, HIV counseling, etc?
- What is the service mix being offered? Is it to meet demand, or is it too costly to have particular services available (e.g. need a counselor/ tester)?
- How logistically feasible is it for an adolescent/KP to visit one of these facilities, and how willing are service providers to offer HIV services to that adolescent/KP when they get there?
- Do service providers believe that adolescents and KPs should access HIV services?
- What do adolescents and KPs consider to be sex that would require protection?
- What is considered safe/unsafe sex?
- Under what circumstances would they seek HIV services preemptively?
- What commonly held beliefs around HIV exist among young people?
- What myths and misconceptions do they believe?
- Where do adolescents and KPs feel most comfortable going for HIV services?
- What about those facilities makes them feel more comfortable?
- What are the major HIV projects in Mombasa and Kwale, and the surrounding areas? What evidence is there of their impact?
- What is the coverage of these projects?
Mental Health:
- What do various MH services cost in Kenya, and what kinds of services are offered at different healthcare facilities?
- Do MH service providers offer the full range of services: (MH screening, assessment and diagnosis; treatment/intervention – individual and/or group counseling; psychotropic medication; in-patient treatment/hospitalization for individuals whose functioning is severely impaired; and referral)
- How easy is it for an adolescent/ KP to visit one of these facilities, and how willing are service providers to offer MH services to that adolescent/ KP when they get there?
- Do service providers believe that adolescents and KPs should access MH services?
- What commonly held beliefs around MH exist among young people?
- What myths and misconceptions do they believe?
- Where do adolescents and KPs feel most comfortable going for MH services?
- What about those facilities makes them feel more comfortable?
Expected Deliverables
- Protocol submitted to AMREF Ethical Review Board, time frame 3rd of January 2023, Submitted by Triggerise (Done)
- Detailed work plan by the consultant, time frame 28th of January 2023, Comprehensive work plan document with:
Recommended changes to data collection tools and approach
- Draft report for stakeholder review, time frame 31st of February 2023, Draft research report including data analysis and proposed recommendations for Triggerise’s review
- Cleaned final dataset(s) containing all data collected for the baseline, including survey responses and KII/FGD transcriptions, time frame 15th of March 2023, Access to the final, cleaned data set, .csv where appropriate.
- Final Report (incorporating inputs from the review), time frame 30th of March 2023, Final Report.
The following survey report structure will be adopted:
- Executive Summary This section should include the major findings of the baseline, and summarize conclusions and recommendations.
- Baseline Survey Objectives agreed upon between Triggerise and Consultant
- Final Research Questions agreed upon between Triggerise and Consultant
- Methods and Techniques to include a summary of relevant underlying values, assumptions, and theories, a justification of the sampling strategy, and an outline of any limitations of the survey.
- Analysis and Findings to address the status of outcome indicators and changes to project assumptions
- Conclusions
- Recommendations
Required Skills and Expertise
We are looking for a Consultant/team with the following skills and qualifications;
- Demonstrable expertise on SRH, HIV public health and gender equality in Kenya.
- Demonstrable expertise on public health operations especially in Kenya.
- Demonstrated expertise on research around mental health and HIV, preferable on PrEP as well..
- An individual with demonstrable experience in qualitative & quantitative research, data analysis and reporting with a focus on social science research and evaluation, preferably in Kenya.
- The team leader should preferably possess a postgraduate degree in a research-oriented social science or a related discipline with extensive knowledge of and experience in leading (designing and undertaking) large scale quantitative surveys as well as qualitative research.
- Experience in managing and coordinating evaluation/research exercises, and delivering agreed outputs on-time and on-budget.
- Experience in data collection and analysis using participatory methodologies.
- Excellent and demonstrated understanding of ethical issues in research, including in child protection and safeguarding of research participants.
- Ability to respond to comments and questions in a timely, appropriate manner.
- Capacity to use mobile data collection for data collection, and analysis of survey results.
- Excellent verbal and written communication in English required.
Evaluation Criteria
Proposals will be assessed against the following criteria:
Team expertise, experience, and composition:
- Organizational expertise and experience in undertaking assurance activities, including verification and audit of project outputs in Kenya
- Team expertise in undertaking similar work
Total Weight: 40
Strength of the technical proposal:
- Overall strength of proposed methodology, including the ability to address the specific tasks outlined above within the anticipated timelines
Total Weight: 40
Budget:
- Value for money
- The estimated budget guide for this work is $18,000 and we will consider strongly competitive proposals to deliver the engagement within this limit
Total Weight: 20
Proposal and Submission Guidelines
Firms and individuals are invited to submit proposals for this engagement. Proposals should include the contents below and not exceed a maximum length of 10 pages, excluding annexures (budget and summary profiles of proposed personnel).
- Cover Page: Summary with basic information such as names, address, contact information, proposed budget, etc.
- Capacity Statement: A brief capacity statement as to why your firm and the team you are proposing is well positioned to undertake the engagement
- Qualification to the Scope of Work: Any qualifications that you may have regarding the scope of work
- Proposed Approach: Your proposed approach to delivering on the scope of work requirements
- Work Plan: proposed work plan with tasks, responsible person/s and timeline
- Budget: Total budget envelope required to deliver the work (in Dollars), and line-item breakdown of direct costs and overheads
- References of similar engagements undertaken by the firm in the last 5 years
The submission must be clear, concise, and complete. Applicants should submit only such information as is necessary to respond effectively to this request for proposals. Unless specifically requested, extraneous presentation materials are neither necessary nor desired.
