TOR for Vision Aid Overseas

Zambia, Full Time Salary:

TOR for Vision Aid Overseas work in Zambia for the past 10 years
0. Background
Vision Aid Overseas (VAO) began work in Zambia in the year 2000. The focus then was on increasing the availability of eye health services in underserved communities. Our programme interventions consisted of teams of professional volunteer optometrists and dispensing opticians visiting local clinics to support in eye screening, full eye tests, and providing low cost spectacles.
In 2009 VAO secured a commitment from Specsavers to fund the development of optometry services in Zambia in partnership with the Ministry of Health. In January 2010 the NGO established an in-country representative to focus the work on three main areas:
Increasing human resources for eye health through training for local eye health personnel.
Increasing access to eye health and optometry services, through the establishment of Vision Centres.
Increasing community-based eye health services through the Vision Centres.
Increasing human resources for eye health through training of local eye health personnel.
1. Training for Ophthalmic Clinical Officers (OCOs) and Ophthalmic Nurses (ONs)
During the last ten years a total of 159 OCOs and ONs as well as general and enrolled nurses working in Ministry of Health eye departments at both district and provincial levels have undertaken 6-week refraction training courses run by VAO. Young doctors interested in specializing in ophthalmology have also attended the course as a way of learning more about eye health and optics; Furthermore, 34 OCOs and ONs who had previously attended the course have undergone further training to upgrade and enhance their skills with a particular emphasis on the refraction of children.
OCOs and ONs have received on the job mentorship from UK Professional Volunteers on outreach assignments where refraction services and other skills were taught. In addition, many equipment and materials have been donated by VAO to attendees of these refraction courses to ensure they have the tools to practice what they have learned.
2. Supporting optometry students
Professional Volunteers provided by VAO have worked with groups of third year optometry students at Chainama College of Health Sciences (now Levy Mwanawasa University) with practical supervision of skills, lectures and the opportunity to undertake outreach work in local communities and on a range of assignments within the Country. They have also benefited from donations of optometry books, some specialised equipment, and artificial eyes for training purposes.
3. Optometry conferences for Optometry Technologists
VAO organized and hosted two conferences for graduates from Chainama College of Health Sciences optometry course, enabling 36 optometry technologists from three groups of graduates to learn from experienced volunteer optometrists and dispensing opticians from the UK. Formal lectures and practical workshops were carried out during the conferences, enabling graduates to build professional knowledge and enhance their practical skills. The conference attendees were enrolled in an online continuing professional development learning portal called Synapse, which enables them to test and further develop their knowledge and skills.
4. Optical technicians/dispensers
As VCs were developed VAO offered a 6-week training course in spectacle making and dispensing to complement the refraction training and to ensure that the Vision Centres were staffed by competent skilled people. Over the last 10 years 42 optical technicians/dispensers based in the Vision Centres have received training in spectacle making and dispensing. In addition, 22 have received further training in equipment maintenance and skills upgrading.
5. Supporting trainee ophthalmologists
VAO have provided experienced Professional Volunteer trainers to work alongside Zambian ophthalmologists to train 2 groups of trainee ophthalmologists in refraction thus enhancing their professional skills and knowledge.
6. Low Vision Training
VAO has run 3 two-week courses for Optometry Technologists, Ophthalmic Nurses and Ophthalmic Clinical Officers to enhance their skills in helping patients with low vision and visual impairment. So far 50 eye health professionals have benefitted from the training covering 40 different eye health facilities. All facilities where trainees work have benefitted from VAO donated low vision aids to use with their patients and continue to do so.
7. School eye health
VAO piloted a comprehensive school eye health programme that aimed at developing a comprehensive and replicable method of identifying eye health problems in children and to address them in a timely and appropriate manner. The programme trained 150 teachers to screen 22,667 and found 5958 children with various eye problems. Appropriate treatments were delivered to all the children with eye problems.
8. Training for VAO’s own staff
VAO has a commitment to develop the skills of its staff as well as providing training to Zambian eye health professionals. In service training for staff members takes place whenever possible and covers aspects of eye health, management and new developments within international eye health. Staff are encouraged to register to participate in IABP online webinars as well as to participate in programme staff meetings where all staff from all countries supported by VAO share the latest news from the global eye health scene.
VAO staff have undergone leadership training alongside some of the optometry graduates, provided by experts in that field, and all staff have participated in online Child Protection and First Aid courses. The Past Country Director was fortunate to attend the short course in International Eye Health at the International Centre for Eye Health at the London School of Hygiene and Tropical Medicine in 2017.
9. Dame Mary Perkins Optometry Training Centre and the Optometry Technology Course
Working in partnership with Sightsavers International and the MoH VAO provided funding for the development of an optometry curriculum in 2009 and a three-year diploma course in optometry technology was developed. To operationalize the provision of the diploma course, VAO built a training centre named after the Founder of Specsavers Dame Mary Perkins and sponsored 3 people to travel to India to the Lotus College of Optometry in Mumbai to study a degree course in optometry. The purpose of this venture was to have Zambian personnel who would have the skills to return to the country to become optometry lecturers. Since their return, the two graduates have lecturing at the Chainama College and have so far produced 93 graduates from the 2013 to the 2016 intakes. 123 students from the 2017 to 2019 intakes are expected to graduate in August 2020 (29), in 2021 (33) and in 2022 (61).
In 2013 VAO provided further funding through Specsavers to develop a Vision Centre within the building enabling patients to receive a more comprehensive service and students to learn practical glazing and dispensing skills in addition to their existing course skills. At the same time personnel employed within the hospital complex were retrained to become optical technicians/dispensers.
Sadly in 2017 due to the expansion of Levy Mwanwasa Hospital and medical university the building was demolished, and the services provided by the Dame Mary centre moved to the Chainama College of Health Sciences campus. Services continue to be provided there to date.
1. Increasing access to eye health and optometry services in particular, through the establishment of Vision Centres.
Vision Centres (VC) developed by VAO are permanent optical facilities, within Ministry of Health hospitals, usually at provincial level, where patients can receive eye examinations and prescription spectacles manufactured to their precise requirements. Vision Centres also act as a hub for community-based outreach services providing a central location where spectacles can be glazed for the local community.
The development of the centres included the provision of machinery to manufacture spectacles (glazing machine, lens edger, focimeter etc.) consumables to support the manufacture of spectacles (lenses, spectacle frames, cases, etc.), the cost of adapting a suitable room/s to create dispensing and glazing facilities (e.g. workbenches, storage cupboards, shelving) and training eye health personnel in the hospital and surrounding districts in refraction. In addition, VAO trained personnel in each facility to manufacture and dispense spectacles and provided training in VC management.
Operational Agreements with each VC stated that for the first year VAO would provide all consumables, during which time income received from the sale of spectacles would either be placed in a separate bank account or be ring-fenced for future procurement. During year two the VC was expected to purchase 50% of its needs with VAO providing the remainder, and in year three the VC would purchase 75% of consumables with VAO providing 25%. At the end of the three-year period the VC was to be self-sustaining purchasing all consumables. VAO agreed to continue to provide technical support and additional training for optical technicians/dispensers where needed.
VAO up the first VC at the University Teaching Hospital (UTH) in 2008. In the ten years since then VCs have been set up at the following places:
Kabwe General Hospital : Central Province.
Ndola Teaching Hospital : Copperbelt Province (2014)
Kasama General Hospital : Northern Province (2012)
Mansa General Hospital : Luapula Province (2011)
Solwezi General Hospital : North Western Province.
Livingstone General Hospital : Southern Province (2012
St Francis Hospital, Katete : Eastern Province (2013)
Chinsali General Hospital : Muchinga Province (2016)
Chainama College of Health Sciences : Lusaka Province (2012)
Lewanika General Hospital, Mongu : Western Province (2013)
While all VCs were funded by Specsavers, the VC at the Chinsali General Hospital was not.
3. Increasing community-based eye health services through the Vision Centres.
VAO began supporting Zambia with outreach services in 2000. At that time the organisation worked with local NGOs and other eye health providers, visiting underserved communities to offer free eye tests and low-cost spectacles. However, over the last ten years outreach services have been programmed to support the Vision Centres that have been set up by VAO in order to generate awareness of the services in areas surrounding the VCs and providing services to communities who were far enough away from the service to find reaching the provincial centre problematic.
Outreach services have also given local eye health professionals and those who benefitted from VAO’s refraction courses opportunities to offer services to patients beyond the hospital and to work alongside VAO’s experienced Professional Volunteers in the community, enabling them to practise their refraction skills under supervision and learning to adapt their clinical skills to a busy outreach situation. VAO outreach services have dispensed new ready-made spectacles and a selection of frames from the Vision Centres have been carried along, so that people requiring prescription spectacles could choose preferred frames which were then made to their prescription at the Vision Centres and the spectacles returned to where the patient were seen during outreach.
Through these outreach services, over 44,000 people have been screened, of whom more than 14,000 have received a full refraction. Almost 14,000 pairs of spectacles have been dispensed as a result.
4. Rationale
The evaluation of the 10 years of VAO’s operations in Zambia is an important step in helping VAO and its partner the Ministry of Health (MOH) to assess overall impact of the Organization’s interventions. Over the last 10 years, the Organization secured funding from Specsavers which have been used to implement various interventions to achieve three main objectives to (1) increase human resource for health, (2) increase access to eye health and optometry services and (3) increase community-based eye health services. The Evaluation is intended to assess the relevance, effectiveness and efficiency of these interventions and their overall impact on the Zambia communities.
It is expected to evaluate the impact of the trainings conducted for the various categories of health personnel in the Country, the operations of Vision Centres and sustainability of results, including the contribution to capacity development of the Eye Hospitals where they are established, and the impact of community-based eye health services conducted through the Vision Centres.
The Evaluation will also identify/document lessons learned and make recommendations that VAO and MOH might use to improve on its interventions in terms of their relevance, efficiency and effectiveness. The evaluation is expected to indicate whether the programme delivers value for money, and specifically suggest how VAO (and partners) can adapt programming in the future to maximise the impact of each pound spent to improve poor people’s lives.
5. Scope of the Evaluation
The evaluation is expected to cover the following components:
VAO will primarily answer the overarching evaluation question for the government and Ministries of Health and General Education – To what extent has VAO helped the Government of Zambia and Zambian MOH deliver on its:
eye health strategy and plan regarding URE?
strategy and plan for Human Resource for Eye Health regarding optometry?
School Health regarding the integration of Eye Health?
The Evaluation will also seek to establish:
in what ways VAO have supported the increasing commitment of the government/MOH to eye health and to addressing URE,
whether the long-term results have been achieved – integration of eye health into health, more accessibility and equal distribution of services and improved knowledge, what is the evidence for this (in terms of government stats/can we identify any secondary evidence?),
any anecdotal evidence (from personal testimonies) linking results to VAO.
To obtain responses to the specific areas of interventions, the following areas will be analysed:
Human Resource Development
Knowledge gaps and challenges faced in practice post training
Participants’ views on training
Partner training organization feedback
The outputs vs expectations
Vision Centres
Assess to what extent the parties to the establishment agreements adhered to their responsibilities as defined in the operational agreements
To identify successes and challenges in the operations of the Vision Centres
To assess to what extent Vision Centres have reached their sustainability and issues achieving sustainability
Assess the impact of Vision Centres. Scale of impact in terms of patients reached including the types of patients (age/gender). Case studies for individuals who have been positively impacted. Impact on staff working at VCs.
Assess performance of Vision Centres in terms of effectiveness, efficiency, and timeliness of producing the expected outputs (including considering equity – do vision centres provide services to the poorest and most marginalised members of society? Are the needs of women and girls specifically targeted?);
Identify capacity gaps, if any, to effective and efficient operations of the Vision Centres
Assess the economy, quality and timeliness of inputs, the reporting and monitoring system and extent to which these have been effective;
Assess relevance of the Vision Centres management arrangements; identify advantages, bottlenecks and lessons learn about the management arrangements;
Provide key recommendations to VAO and its partner MOH that will contribute to improved operations of the Vision Centres in terms of their efficiency, effectiveness, equity of service delivery and sustainability.
Community Outreach Services
Assess the reach/coverage of eye health services (Number of people reached/covered, children and adults)
Relevance, efficiency, effectiveness, equity and sustainability of the eye health services provided
Knowledge acquisition of the communities on the eye health issues
Level of demand creation of eye health services
Level of compliance in wearing glasses
6. Deliverables
Inception meeting to further clarify the Terms of Reference (ToR) and budget available
An inception report demonstrating understanding of the assignment and a detailed timeline for delivery of assignment.
An evaluation design methodology that satisfactorily demonstrates how the operations of the Vision Centres and other interventions will be evaluated
A timetable for the evaluation exercise
Tools for the evaluation exercise
Draft report that will be used for a validation workshop with key stakeholders and a 1 or 2 page summary document drawing out key points of the evaluation.
A well written project evaluation report of not more than 20 pages addressing the scope of the assignment within 30 days of the assignment. (Outline of the report to be shared to successful consultant)
7. Technical Support
The successful consultant will work under the supervision of the Country Director and the Program Development Adviser with the Technical Support from the Programme Director
8. Specific Requirements
Academic Qualifications: A higher degree in public health, development studies or any related relevant field
Professional Qualifications: An evaluation specialist with a minimum of seven years’ experience programme/project evaluation in an international development context.
Experience of results-based monitoring and evaluation;
Ability to design and plan the evaluation approaches and research methodologies, including quantitative and qualitative research methods. Where feasible and proportionate, the person or team should include skills and expertise required to design, plan and conduct impact evaluation
Relevant subject matter knowledge and experience such as health sector (eye health), education sector, genders, Youth programming, non-state actors and economic growth to ensure the evaluation design and research methods are as relevant and meaningful as possible given the aims and objectives of the project and the context in which it is being delivered;
Must have appropriate knowledge/experience of Zambia including understanding of the context of the Vision Centres impact areas.
Excellent writing skills;
Fluency in English required
9. Expression of Interest
Vision Aid Overseas Requests Financial and Technical Proposals (including estimated budget) from qualified research agencies, project evaluators and individual consultants. The proposals should be sent to:
The Country Director
Vision Aid Overseas

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