Terms of Reference: End line Review for HBCC Project: Inclusive Communities: Changing behaviours to respond to COVID-19At CARE


1.0 Overview and Background

CARE International UK received funding from Unilever-DFID HBCC (Hygiene Behaviour Change Coalition) to drive hygiene behavior change communication to the vulnerable communities living in rural, urban, and IDP centers, across five countries: Zimbabwe, Rwanda, Somalia, Jordan, and North-Eastern Syria. The overall objective(s) of the project: was to Minimise the transmission of and harmful impact of COVID-19 by delivering inclusive and interactive gender-responsive mass media and digital communications, supported by product availability and community interventions that improve personal and environmental hygiene practices, and reduce stigma and discrimination CARE International Somalia secured one-year funding to implement the HBCC project in Somaliland, Puntland, Galmudug, and Jubbaland. The project was undertaken through an extensive mass media, digital and interpersonal hygiene promotion information, and messaging campaign in communities and institutions supported by the provision of water supply and handwashing kits and infrastructure as well as provision of relevant Personal Protective Equipment-PPE, as per the context.

The project aimed to rapidly disseminate messaging in support of the government’s actions for a wider reach of information coverage and to curb the COVID -19 pandemic. The project also worked with relevant government institutions and community-based organizations to engage vulnerable communities and institutions to promote effective hygiene with a focus on COVID-19 preventive measures. Messages were developed following a rapid baseline assessment survey using mainly WASH’Em approach (an approach developed and promoted by the London School of Hygiene and Tropical Medicine and that is mainly qualitative in nature) to understand the health characteristics of target communities; most preferred touch-points and to have a basis on which to adapt existing messages or to design new ones. Some countries also combined the use of the WASH’Em approach and quantitative approaches to enrich the process, especially on quantitative processes. A mix of existing government messages and UNILEVER assets were brought in for both the design of promotional materials and campaign management.

1.1 The Theory of Change is below

Objective Statements


Goal: Contribute in reducing incidences of COVID -19 transmissions in Somalia

R-0’ value maintained below 1.0 between Jan and March 2021 in all HBCC targeted regions in Somalia**




· Outcome1: Handwashing with water and soap practiced at key times for at least 20 seconds to interrupt the spread of covid19 transmission

· % of the targeted population who demonstrate correct handwashing practice with water and soap for at least 20 seconds**

· % of mothers/caregivers observed to wash hands with water and soap for 20 seconds before eating, before preparing food, before feeding young children, after using the toilet, after cleaning child feces.

· % of targeted people who report being satisfied with the quality and quantity of hygiene kits distributed

Outcome2: increased knowledge and information of the targeted people on COVID-19 prevention and mitigation

· % of targeted populations recalling three messages from the radio spots (billboards, posters etc

· % of target populations recalling at least 3 key times for handwashing with soap and water

Outcome3: Social distancing and avoidance of public gatherings are practiced widely in all the targeted areas

· % of target populations who maintain social distancing while interacting with the community

· % of the target population who avoid public gatherings in the last one month.**

Outcome4: more people accept the severity of COVID-19 and that it can affect everyone in the community

· % of the target population who are willing to get the COVID-19 vaccination

· % of the target population who are confident to report if they are tested with COVID-19**

2.0. CARE International HBCC Campaign Approach

At a local level, the project focused on mass media, digital media, and community level interpersonal campaigns (where possible due to lockdowns and travel restrictions) across all project areas. CARE International executed a variety of messages in line with the MoH and WHO Health Service approved guidelines as well as some of the Unilever Global assets like the PASSWORD Campaigns, Mums Magic Hands, , School of 5 among others. Messages covered issues of COVID-19 transmission, signs and symptoms, prevention, stigma, protection, safety, security and where to seek early support when showing signs and symptoms of COVID-19.

The messages were delivered through a variety of channels, including:

  1. Public Service Announcements (PSAs) targeting the Community through vehicle-mounted loudspeakers and discussing various aspects of COVID 19 (methods of transmission, signs and symptoms, preventive measures, and issues relating to stigma)
  2. Call waiting based Messaging on COVID-19 (transmission, signs and symptoms, prevention, stigma) through the three main telecommunication service providers in Somalia/land (Hormuud, Golis, and Telesom), in mosques, religious leaders delivered sermons covering topics on COVID-19 transmission, signs and symptoms, prevention and stigma management.
  3. Installation of foot pedal handwashing facilities in public centers, like markets, hospitals, health clinics (MNCH Schools, IDP camps community social halls etc
  4. Provision of essential Water, Sanitation, and Sanitation (WASH) supply to health facilities and training on Infection Prevention and Control-IPC
  5. Distribution of l hygiene kits in IDPs and vulnerable host communities targeting the aged and physically impaired persons, e.g. handwashing/laundry soaps, hand sanitizers, face masks, water containers, aqua tabs etc
  6. National/Community radio stations and TV through live talk shows and spot messages
  7. Posters, flyers/stickers, , Murals and outdoor billboards
  8. Interpersonal campaigns (door to door )by Community Health Volunteers (CHVs) targeting in households in IDP camps and host community and schools through student ‘*champions*’
  9. Development of cartoon videos, posters songs and poems on COVID 19
  10. Digital campaign messaging using Social Media accounts and including those of 3 CARE staff social media influencers mainly using Twitter, Facebook, and YouTube.

To ensure campaign consistency and access to hard-to-reach audiences, CARE International collaborated with BBC Somalia Media Action and a host of local TV and Radio stations. CARE also has been closely working with the ministries of health at the federal state member levels. These partnerships enabled the process of campaign messaging design and deployment to be as inclusive as possible, targeting specific people, such as persons with disabilities, marginalized groups, and the elderly, leaving no one behind in the fight against the pandemic. At a global level, CARE International as a member of the HBCC initiative continued to be supported and coordinated by CARE UK/ UNILEVER in developing and releasing COVID-19 enhanced versions of their hygiene campaign materials such as: School of 5 and Mum’s Magic Hands, Global PASSWORD Campaign etc.

3.0 End line Assessment Review Objectives and Methodology

3.1. Purpose and Objectives of the End line Assessment Review

The primary purpose of this End line Review is to assess the overall change outcomes of the COVID-19 Hygiene Behaviour Change Campaign as per the Theory of Change above and identify key lessons learned for the campaign and for future strategies.

The end line assessment should focus on the following key objectives:

  1. Measure the behavioral outcomes, and determine how the project has contributed to these changes; with a special focus on how the project has generated positive changes in the lives of targeted women, girls, boys, and men; including vulnerable groups such as those living in remote locations as well as the elderly and people with disabilities
  2. Identify unintended consequences of the project, both positive and negative; for target groups and others impacted;
  3. Document the enabling factors and challenges or barriers that influenced project implementation; and
  4. Provide evidence-based recommendations for all stakeholders for future programming in light of the review findings, including specific recommendations in relation to gender equality/women’s empowerment issues.

While this process may give early indications of possible behavior change, the review is not expected to provide a full impact-level assessment of behavioral changes due to the difficulties of attribution.

3.2 Key Learning Questions

Key Learning Questions: (refer to Risk Communication and Community Engagement-RCCE Strategy questions)

  1. Primary question: How did the HBCC program influence participants’ adoption of COVID-19 preventive practices and related behaviors?
  2. Are there components of the messages which were difficult to understand or actions that were difficult to implement?
  3. Secondary questions:

· 1.a) How did the HBCC program impact participants’ frequency of handwashing w/ soap?

· 1.b) How did the HBCC program impact participants’ adoption of other COVID-19 preventive measures, such as wearing face masks, physically distancing and cleaning surfaces?

4. Other/optional questions based on countries’ behavior change focus outlined in their RCCE strategies (examples below).

· How did the HBCC program impact the reduction of stigma, rumors, and misinformation?

· Were the levels of partnership with stakeholders such as MOH, and media houses among others strongly contributed to any achievements in project implementation

3.3 The specific Methodology and Review questions are as follows:

3.3.1 Assessment Methodology

It is expected that this review will adopt a mix of qualitative and quantitative approaches. Some of the basic tools in the WASH’Em approach like in-depth interviews using focus group discussions (FGDs), structured demonstrations and observations as well as quantitative approaches including self-reporting hygiene behavior measures; open and close-ended questions; and secondary information including use of log records derived from digital media, will be utilized.

The following are data collection methods to consider in undertaking this assessment (not exhaustive):

• Review and analysis of project documents from the HBCC Project (Milestone and quarterly project reports) as well as from local, national and international agencies including relevant government Ministries, local partners, WHO, UNICEF, UNILEVER, and any other response documents from key partners

• Meetings/discussions/interviews with key team members at the Country level

• Meetings/discussions/interviews with key authorities and key implementation partners listed above

• Focus group discussions and key informant interviews with key user groups and individuals targeted to receive messaging/engage in HBCC programs to better understand their perspectives on if and how the program has impacted their behavior and well-being. Disaggregated by sex, age, and disability, where possible.

• Household Surveys should be considered where an appropriate sampling methodology is able to locate those who are likely to have received messaging but are not a firm requirement of the assessment review.

3.3.2 Possible Review questions (to be adapted, as per context)

a) Acceptability of behavior change campaign materials

· Assess the quality of the various communications materials. Did some provide more compelling or memorable messages than others?

· Have the messages been contextualized to the local context (considering the cultural and religious values)

· How was messaging under the project well-aligned and complementary to the national hygiene strategy and other major COVID-19 communications?

· Are there critical supplies or services that would have increased the project’s impacts that were missed during the project design or implementation?

· What was the project’s level of integration with other ongoing CARE projects?

b) Campaign reach and inclusion

· Assess the effectiveness of the various communications channels. Were some channels more trusted, credible or impactful than others?

· Assess the extent to which intended recipients recall receiving messages through different channels. Were some channels more likely to be overlooked or ignored?

· . I don’t think this is feasible

· Did recipients understand the messaging? How did ease of understanding compare to other materials being distributed at the time?

· Were intended recipients able to recall key components of the communication materials?

· Were intended recipients able to recall where they learned these key components?

· Assess recipient attitudes towards the key behaviors in the communication materials following the project. How serious a risk do they consider COVID -19 to be? To what extent do they consider these behaviors important in mitigating that risk?

c) Outcomes-based Behaviour Change

To what extent has the HBCC Project achieved the following outcome objectives as per the Theory of Change (TOC)?

1) People, disaggregated by sex, age and disability practice frequent handwashing with water and soap at key times for at least 20 seconds to interrupt the spread of COVID-19 transmission.

2) Low-income households have access to and are satisfied with the quality and quantity of hygiene materials/products received.

3) Increased knowledge and information of the targeted people, disaggregated by sex, age and disability, on COVID-19 prevention and mitigation.

4) Social distancing and avoidance of public gatherings are practiced widely in all the targeted areas.

5) People, disaggregated by sex, age and disability practices correct wearing of masks in public places.

d) What lessons can be learnt in relation to project delivery and coordination

· Were there key achievements of the project and what enhanced this success

· What were the key challenges that arose during the project implementation and how could these have been mitigated?

· How can these lessons be integrated into CARE International programs for future similar programming?

· Assess whether project activities are likely to continue beyond the support received in the period of intervention.

3.5 End line Review Dates

The end line review is expected to take place between 15th July to 31st Aug

Milestones/Deliverables with Dates




preliminary meetings with CARE staff **

15th July

  1. Inception report describing the methodology/approach and considerations for carrying out each of the deliverables and containing a work plan with dates of submission of deliverables.

15- 22nd July

  1. Finalization of inception report and the data collection tools

22nd -24th July

  1. Enumerators training and pre-testing tools

26th-28th July

  1. Field data collection, including

29th July 8th Aug

  1. First draft report

20th Aug

  1. Technical Review feedback

22nd Aug

  1. Presentation of Key findings

27th Aug

  1. Submission of final report.

29th Aug

4.1 Profile

To achieve efficiency and objectivity in this process, CARE International seeks to engage a Consultant with the following profile:


  1. Demonstrated knowledge and experience in assessing and reviewing complex public health interventions and behavior change communication (BCC) campaigns.
  2. Ability to manage a potentially large-scale and complex review and research process, including remote data collection
  3. Experience in managing data and information systems capable of handling large datasets for monitoring and evaluation purposes
  4. Extensive experience in communications, public relations, marketing, or relevant Social Sciences, and use of WASH’Em approach among others

5. Experience collaborating with high-level government stakeholders and/or private sector senior management.**

6. Be able to interact with and engage in in-depth discussions with people with no or low literacy levels **

7. Strong analytical and writing skills and the ability to clearly present findings and drawing practical conclusions and recommendations.**

8. Experience of working in Somalia and be able to travel to insecure project sites across various regions in Somalia.**

  1. Provision of evidence documents such as contracts on past experience

4.2 Reporting and Liaison

The consultant will closely work with the Emergency MEAL Specialist and Emergency WaSH Manager. In Addition, further technical support will be given by CARE USA WaSH Technical Advisors.

4.3 Responsibilities of CARE

· CARE will provide all logistics support including flights, accommodation, transport, enumerators recruitment etcs.

· Provide consultancy fee for the task

· Review and approve the study instruments/tools

· Support supervision of the consultant during the entire process of planning, enumerator training, data collection, and reporting

· Provide input to the draft report and final report

4.4 Responsibilities of the Consultant

· Develop methodology and tools for the data collection and analysis process. The tools will be shared and approved by CARE before starting fieldwork

· Develop a practical work plan for the work

· Do field travel and data collection?

· Train enumerators who will be involved in the data collection.

· Prepare and submit a final evaluation report to CARE Somalia/Somaliland as per time frame set in the ToR.

4.5 Deliverables

The consultant will produce a precise final report (maximum 45 pages) written in simple and understandable English. The draft report is to be shared with field teams and discussed with CARE Somalia. Comments and inputs from the CARE teams will be included in the final report. We expect the report to have clearly articulated and actionable recommendations which is informed by the study findings. We also expect him/her to hand over all data of any form collected for this exercise to CARE.

5. Application procedure

Interested firms/individuals with the expertise should send their Proposal which should include the following: Letter of expression of interest/technical understanding of the TOR; proposed methodology and detailed work plan, study team composition, and Curriculum Vitae(s) for lead consultants demonstrating the relevant technical skills, with references; and a financial quote for the consultancy specifying specific unit’s costs and time frame (applicants should only quote for professional fees only). Please send your application to SOM.consultant@care.org quoting “Application for HBCC Endline Review” as the subject line of the application no later than 10th July 2021**

How to apply

Interested firms/individuals with the expertise should send their Proposal which should include the following: Letter of expression of interest/technical understanding of the TOR; proposed methodology and detailed work plan, study team composition and Curriculum Vitae(s) for lead consultants demonstrating the relevant technical skills, with references; and a financial quote for the consultancy specifying specific unit’s costs and time frame (applicants should only quote for professional fees only). Please sent your application to SOM.consultant@care.org quoting “Application for HBCC Endline Review” as the subject line of the application no later than 10th July 2021**


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