HIV and Mental Health: Baseline Survey in Mombasa- Triggerise

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.

This programme will focus 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 and will work 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:

1. Young people have improved and sustained mental and sexual health
2. Young people have improved agency and quality of care in their options of service providers
3. Increased awareness for MH and HIV programmes among Government of Kenya (GoK)
4. Improve the quality of HIV and MH services available on the Triggerise’s Tiko platform
5. Reduce barriers to access HIV and MH services.
6. 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.
7. Unpack the knowledge, practices and attitudes towards HIV (including on PrEP)and MH services
8. Identify factors affecting access to HIV and MH services including: socioeconomic, cultural, and political situations and identify potential solutions
9. Assess service quality and evaluate how youth-friendly service providers are towards the target group.

Scope of Research

The survey will be implemented in all sub-counties in 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).

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.

Methodology of the Study

The consultant will develop a detailed research methodology in consultation with Triggerise’s Research and M&E team. The following methodologies will be utilized, but should not be limited to:

1. 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.

2. Quantitative data to be collected through a representative survey and through tools administered during service delivery.

3. 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).

Scope of Work

The primary purpose of the consultancy is to conduct a baseline study for the EJAF programme in Kenya (Mombasa). 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:

1. Evaluate adolescents and KP’s awareness of available tools to measure mental health

a. Assess awareness of Public Health Questionnaire 4 (PQ4)

b. Awareness of the community mental health support structure

c. Awareness of facility mental health intervention

2. Evaluate adolescents and KP’s access to communication/messaging on awareness of the various services offered under this programme including HIV and MH services

a. Assess the channel through which the messages were received (SMS, WhatsApp) and information, education and communication (IEC) materials (posters and flyers)

b. Assess awareness of the various offers provided

3. 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).

4. 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.

5. Evaluate barriers to access and choice by identifying the current state of coordination of MH services among youth led/focused organizations.

6. 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. Therefore, remote data collection methods should be adopted as much as possible and in cases where in-person data collection has to be done, social distancing, wearing of masks and washing of hands must be observed.

The specific research questions that this research should answer are:

HIV services:

1) What do various HIV services cost in Kenya (Mombasa), and what kinds of services are offered at different healthcare facilities?

a) Do HIV service providers offer the full range of services: ART, PreP, HIV counseling, etc?

b) 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)?

2) 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?

a) Do service providers believe that adolescents and KPs should access HIV services?

3) What do adolescents and KPs consider to be sex that would require protection?

a) What is considered safe/unsafe sex?

b) Under what circumstances would they seek HIV services preemptively?

4) What commonly held beliefs around HIV exist among young people?

a) What myths and misconceptions do they believe?

5) Where do adolescents and KPs feel most comfortable going for HIV services?

a) What about those facilities makes them feel more comfortable?

6) What are the major HIV projects in Mombasa, and the surrounding areas? What evidence is there of their impact?

a) What is the coverage of these projects?

Mental Health:

1) What do various MH services cost in Kenya (Mombasa), and what kinds of services are offered at different healthcare facilities?

a) 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)

2) 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?

a) Do service providers believe that adolescents and KPs should access MH services?

3) What commonly held beliefs around MH exist among young people?

a) What myths and misconceptions do they believe?

4) Where do adolescents and KPs feel most comfortable going for MH services? a) What about those facilities makes them feel more comfortable?

Expected Deliverables

1. Work plan and Inception Report (with key parameters and indicators to be considered for the baseline survey including the methodologies for data collection and dissemination). Time frame: 27th of June 2022. Deliverable: Comprehensive work plan document with:

a) Detailed methodology

b) Key data points

c) Data collection and analysis timeline

2. Research protocol. Time frame: 29th of June 2022. Deliverable: A complete protocol with data collection tools (Draft 1 for Triggerise’s review)

3. Feedback on protocol and tools. Time frame: 30th of July 2022. Deliverable: Role for Triggerise’s team

4. Revised data Collection tools/instruments based on study objectives. Time frame: 5th of July 2022. Deliverable: Final study instrument(s)/tools to be used in the study.

5. Protocol submitted to AMREF Ethical Review Board. Time frame: 6th of July 2022. Deliverable: Submission to be done by Consultant

6. Draft report for stakeholder review. Time frame: 31st of August 2022. Deliverable: Draft research report including data analysis and proposed recommendations for Triggerise’s review

7. Cleaned final dataset(s) containing all data collected for the baseline, including survey responses and KII/FGD transcriptions. Time frame: 15th of September 2022. Deliverable: Access to the final, cleaned data set, .csv where appropriate.

8. Final Report (incorporating inputs from the review). Time frame: 30th of August 2022. Deliverable: 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:

1)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

2)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

3)Budget:

• Value for money
• The estimated budget guide for this work is $10 000 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.

Application Process

All applications should be sent to bills-kenya@triggerise.org by the 21 June 2022 with “EJAF Baseline” in the subject line.