Study the excluded groups of adolescents in districts

TERMS OF REFERENCE “Study the excluded groups of adolescents in districts Umer Kot,
Thatta, Skardu, Ghizer, Rajanpur and Vehari in relation to reproductive health and the
determinants of their exclusion. Moreover, explore youth led CSOs and assess their
capacities.”
1.
BACKGROUND
1.1 About Plan1
Plan Pakistan’s operations commenced in 1997 and the organization currently implements programs in 21
districts in all 5 provinces of Pakistan and Azad Jammu and Kashmir (AJK). These include the districts of
Chakwal, Vehari, Rajanpur, Layyah, Multan, and Muzaffargarh in Punjab; Chitral in Khyber Pakhtunkhwa;
Thatta, Ghotki, Saanghar, Badin, and Khairpur in Sindh; Ziarat in Balochistan, in 7 districts of Gilgit-Baltistan and
Neelum Valley in AJK. In addition, Plan Pakistan also has an Urban Program Unit working with the squatter
settlements of Islamabad, the capital city. Plan’s activities have focused on safe motherhood and child survival,
children’s access to quality education, water and sanitation, community capacity-building, income-generation
and child rights. Plan works in partnership first and foremost with children, their families and communities but
also with government departments, agencies and other developmental organizations in addressing the key
issues impacting children in Pakistan. Apart from the district level programs, Plan has national level programs
reaching out to children through advocacy with relevant government department and involving other civil
society organizations (CSOs).
Plan Pakistan strives to reach out to as many children as possible with programs that aim to ensure children’s
right to health and health services, right to quality education, right to adequate standard of living, and child
centered disaster risk reduction. The activities also include community capacity-building for self-reliance,
income generation to improve living standards and last but not the least, creating awareness on child rights
with an emphasis on child protection, birth registration and children’s participation.
1.2. About the Research Topic/background/rationale
a.2.1 The importance of the topic
Plan’s Global Strategy ‘One Plan One Goal’ has a strategic commitment to work with excluded and
marginalized children by mainstreaming their inclusion. Child-centred community development (CCCD)
approach of Plan International also focuses on ‘inclusion and non-discrimination’ as one of its key principles,
hence intensified the aspect in its programmes for 2010-2015 by considering exclusion as a cross cutting theme
for assessing program outcomes.
Reproductive Health Initiatives for Adolescents (RHIA) program has been designed by following rights-based,
child centred community development approach for adolescent boys and girls age 9-19. The program works on
providing knowledge and skills to deal effectively with sexual and reproductive health (SRH) issues in different
communities of Islamabad, Chakwal, Vehari, GB and AJK districts since 2009. The program implementation and
evaluations already traced the elements of inclusion. Through this study Plan wants to explore systematically,
the excluded groups of boys and girls in the selected districts which could not be reached by RHIA after many
years of implementation and the determinants of their exclusion. Moreover, the study is expected to explore
and assess the capacities of youth led CSOs working specifically on reproductive health issues of youth
a.2.2
Summary of what is known / not known
In last two decades 222 studies were conducted on adolescent sexual and reproductive health in developing
countries. Half of them focused on condom use (60 studies) or sexual initiation (45 studies) while 18-26 articles
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Detail information are available on www.plan-international.org
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covered pregnancy and childbearing, HIV and STIs and some other aspects. 2 Few studies assessed the barriers
or determinants in sexual reproductive health services and rights among young people and adolescents. It was
found that there are various factors like lack of youth friendly services, unfavorable socio cultural practices and
gender disparities that contribute to problems in accessing the ASRH services by the young people (Rita Moses
Mbeba et al)3. Gender inequalities among married youths contribute towards poor utilization of ASRH services
that result into poor reproductive outcomes. A strong association between demographic factors like age of
respondent, education and family income and utilization of RH services was found. An upward trend was
noticed in RH service utilization with the advancement in demographic characteristics. It was also noted that
social and economic vulnerability of women prevents them to express and argue on the family size with their
partner.4
Another similar type of study conducted by Hall et al. on “Determinants of and Disparities in Reproductive
Health Service Use among Adolescent and Young Adult Women in the United States, 2002–2008” shows that
the major determinants of RH service utilization are; age, education, birthplace, mother’s education, childhood
family situation and age at menarche. The study also highlighted the inequalities in reproductive health care
utilization among socially disadvantage girls and young women that contributes to poor reproductive health
outcomes.5
The studies conducted on access to ASRH information among disabled adolescence revealed a poor access to
sexuality information and high dependency on peers (30.7%) indicated a strong role of peer. It was also found
that Parents and teachers lack the appropriate knowledge and skills to provide required information and
guidance on ASRH, results in negative outcomes thus creating reproductive health challenges. The disabled
adolescent preferred mothers for seeking ASRH related information. 6
Plan International Pakistan has also conducted several studies on ASRH. A study on ‘most at risk adolescents
(MARA)’ conducted in urban centers of 13 big cities of Pakistan which mainly focused on mapping of most at
risk adolescents and explored their living conditions. The mapping was conducted around hotels, workshops,
automobile workshops, puncture/motorcycle shops, big stores and carpet looms. The existing RHIA program is
specifically catering the need of adolescents living in rural areas but MARA study findings demand a program
for those adolescents who are working and may be difficult to reach with current program strategies. Another
study was conducted on “children living in difficult circumstances in district Vehari” explored lives of working
children and push factors for being in child labor. This study will also review its findings and propose the
strategies for reaching working children living in difficult circumstances through RHIA program interventions.
a.2.3
What knowledge gap the study is aiming to fil
Although existing studies explored the determinants of accessing RH services either by adolescents and young
people but except one all of them were conducted in countries of Africa and America where the study setting
and context is totally different than Pakistan. This study is envisaged to systematically assess the excluded
groups of boys and girls in the selected districts which could not be reached by RHIA after many years of
implementation and the determinants of their exclusion. Moreover, the study is expected to explore and
assess the capacities of youth led CSOs working specifically on RH issues of youth The research have to
propose strategies for addressing exclusion and capacity building of Youth CSOs based on the research
findings.
2
Mmad K and Sabherwal S, A review of risk and protective factors for adolescent sexual and reproductive health in developing countries.
Journal of Adolescent Health, 2013, forthcoming
3
Rita Moses Mbeba, Martin Sem Mkuye, Grace Elias Magembe, William Lubazi Yotham, Alfred obeidy Mellah, Serafina Baptist Mkuwa. Barriers
to sexual reproductive health services and rights among young people in Mtwara district, Tanzania: a qualitative study. Pan Afr Med J.
2012;13(Supp 1):13
4
Asghar K, Nawaz Y, Maann A.A, Ashraf I, Ch. M.K, Batool Z, Sultana R, Saghir A, Reproductive Health; Gender Roles and Relations as Predictors
of Practicing of Reproductive Health Rights among Married Women and Men in Punjab, Pakistan Professional Med J 2014;21(1): 209-224.
5 (Am J Public Health. 2012;102:359–367. doi:10. 2105/AJPH.2011.300380)
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Taiwo, M. O.: Access to Sexuality Information among Adolescents with Disability
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2. SPECIFIC OBJECTIVES OF THE STUDY
The objectives of this study are;
a) Identify the adolescents’ boys and girls (age 9-19) who are excluded from accessing knowledge and
services regarding ASRH, their geographical location, different excluded groups of adolescents and gender
segregation. Propose 03 most vulnerable adolescents groups among them in each district for Plan to
focus.
b) Identify the determinants that are prohibiting them in accessing ASRH rights and services. Propose
strategies to address them within existing RHIA program.
c) Map the ASRH related health services and health facilities available for adolescents in public/private
sectors and identify the gaps in the provision of services. How they are catering the needs of excluded
adolescent groups and, if they do cater for excluded groups, whether they are all the groups or just some
selective ones?.
d) Carry out desk review of the existing laws, policies and frameworks for inclusion of marginalized groups
for accessing ASRH rights and services.
e) Map Youth led CSOs 7working on ASRHR in Gilgit Baltistan and Chitral, AJK and Punjab by documenting
their scope of work.
f) Identify their capacity gaps towards lobbying and advocacy for ASRHR and what capacity building
strategies the CSOs suggest for effectively advocating, monitoring and holding state accountable for
accessing their ASRH rights and related services in light of adolescents’ development policy framework.
2.1.
Main Research Questions
The study will answer following questions;
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What are different marginalized groups who do not have access to ASRH services and discriminated
from getting ASRH rights?
What are the barriers or determinants for their exclusion?
What are the key features of these groups for example locations, age, sex and gender of these
marginalized groups?
What are the basic hurdles that prevent them from going to service providers in the basic health
services?
Where do they go to seek medical help? If they are sick? Whether they go to quakes, homeopath or
allopath and what is the reason for that?
If they do not go to service provider (hospital, BHU/THQ/DHQ) what is the reason for that?
What is the capacity of service providers if an adolescent with ASRH needs requires service provision?
What is the level of awareness of service providers for catering the ASRH needs of the adolescents
from excluded group?
How sensitive are the service providers while dealing with these groups. What kind of sensitivity is
required of them by the adolescents for treating excluded adolescents with ASRH issues
What are support mechanisms available within in their community and at health facilities to ensure
provision of services related to ASRH?
How theses support mechanism can be improved both at community level and health facilities to
ensure provision of service related to ASRH.
What role these support mechanism can play and how they can be sensitized to give quality and
sensitive services to excluded adolescents.
What CSO’s that are led by youth are available that deals with ASRH issues?
What is the vision, mission and scope of work of these CSO’s to address ASRHR?
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A group, forum, club, network or a CBO formed by youth age 19-30 either registered or unregistered. It can be
school based, college, university or village based.
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What is the perception of these youth led CSO’s regarding ASRHR adolescent’s right?
What is their perception regarding monitoring state accountability regarding adolescents rights in
relation to ASRH?
What role they are playing in advocating ASRHR and holding state accountable for the provision of
these rights and services as per adolescents/youth policies?
What are the gaps in the capacity of these CSO to advocate for ASRHR
What are their suggestions to improve the capacity gaps, required for monitoring the state holding
them accountable for provision of ASRHR facilities as per adolescents/youth policy?
3. RESEARCH METHODOLOGY AND STUDY SETTINGS
This will be a mixed methods study will take into account both qualitative and quantitative study design. The
study will use the important methodological and ethical issues around conducting research with children and
adolescents age 9-19 years. Information will need to be collected in advance of the data collection in order to
understand any specific communication needs of children especially with disabilities/ prostitutes or any other
so that it can be planned to ensure that the data collection process is inclusive. Interviews will be conducted
with children at home, where possible.
3.1.
Data collection methods will include:
o Three Key Informant consultation / FGDs in each district with social activists, teachers, NGOs and plan
partners to identify the location, estimate the excluded groups and their population and determinants
of their exclusion; Youth led CSOs, the number of youth-led CSOs and nature of their work.
o Three FGDs with adolescents for preparing a social map of each districts which show the
concentration of excluded children in the area and location of youth led CSOs.
o 05 (01 at DHQ, 02 at RHC and 02 at BHU) key informant interviews in each district with health service
providers (MS, MOs and BHU staff)
o Quantitative survey of identified excluded children age 9-19 years on identified locations to explore
the determinants and barriers for children in accessing ASHR services.
o A literature review will be undertaken to review of the existing laws, policies and frameworks for
inclusion of marginalized groups for accessing ASRH rights and services.
3.2.
Study Setting
This research will be undertaken in the districts of Umer Kot, Thatta, Skardu, Ghizer, Rajanpur and Vehari. Plan
has already implemented RHIA program in Thatta, Vehari, Skardu and Ghizer where some traces of inclusion
were informed by RHIA program evaluation as well as projects progress reports and the implementation team
is interested to make RHIA an inclusive program by systematically addressing the exclusion. The study findings
could feed into the next Country Strategic Plan for 2016-20.
3.3.
Sample Design
The cluster sampling technique will be applied to calculate the sample size for quantitative survey where 05
primary sampling units (PSUs) or blocks per district will be selected based on the concentration of excluded
groups’ population and the secondary Sampling Units (SSU) 20 children / HHs of those children will be
interviewed in each of the selected district.
Three Key Informant Interviews in each district with social activists, teachers, NGOs and plan partners to
identify the location, estimate the excluded groups and their population and determinants of their exclusion;
Youth led CSOs, the number of youth-led CSOs and nature of their work.
Three FGDs with adolescents for preparing a social map of each district which show the concentration of
excluded children in the area and location of youth led CSOs.
05 (01 at DHQ, 02 at RHC and 02 at BHU) key informant interviews in each district with health service providers
(MS, MOs and BHU staff)
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3.4.
Research participants
o Children and adolescents age 9-19 years
o social activists, teachers, NGOs and plan partners
o Health services providers
3.5.
SOME OF THE VARIABLE OF INTEREST FROM BOTH QUANTITATIVE AND
QUALITATIVE DATA
Some variables of interest Plan we will looking for; demographic characteristics of excluded children like age,
sex, education, marital status, their father and mother educational status, factors associated to inaccessibility
to ASRH services, determinants of their exclusion, the social status of their family related of caste system in the
village. Ages of youth members of CSOs, locations of CSOs, their capacity gaps, funding mechanisms, scope of
their work etc.
3.6.
Data Analysis
Appropriate software will be used for quantitative data analysis, while thematic analysis will undertake for
qualitative data analysis by taking into account the reproductive health rights and needs specifically focusing
the following rights as per Universal declaration of sexual rights at the 14th World congress of sexology (Hong
Kong, 1999)
i.
Right to make free and responsible reproductive choices
ii.
The right to sexual information based upon scientific inquiry
iii.
The right to comprehensive sexuality education
iv.
The right to sexual health care
Reference group
A small reference group will be set up to guide the research process. The membership of that group will be
guided by the Plan country office. Ideally it will include a member from CMT, a member from SNO, Health
adviser, RHIA coordinator, MER manager and Research Coordinator.
4. OUTPUTS / DELIVERABL ES
The following deliverables are expected:

 Ethics approval application
 An inception report with a detailed work plan, methodology, and data collection instruments/tools.
 A draft report of the study
 A final report after incorporating comments from Plan team in Ms. word version (page size A4)
 Logos and pictures (with written consent form the person, duly signed) in report should also be
submitted in original form separately along with final report.
 All materials produced by the study including hard copy of the report and raw data either in SPSS,
excel, FGD and IDI transcripts in soft form.
 The consultant will be responsible to present most significant findings to the Plan Management and
key stakeholders including community, to get their feedback on critical areas.
 The consultant will also be responsible for sharing key findings of the report in research dissemination
events.
5. FINAL REPORT FORMAT SHOULD HAVE AS MINIMUM INCLUDES:
Standard cover sheet; having data on (title, date, evaluator, programme)
Executive Summary (Having contents; Objectives, Methods, results & conclusion)
Acknowledgment
1.
2.
Background [literature review]
Literature review
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3.
Methodology (having below mentioned components)
a. Objectives of the study
b. Operational definitions
c. Study design
d. Sampling Method and Sample Size
e. Data Collection Procedure
f. Data Analysis
g. Significance / Importance of the study, Human subject protection
4. Limitations
5. Findings
6. Conclusions
7. Recommendations
8. References
9. Annexure [TOR, data collection tools, case studies…]
Following lists must be given at the start;
1. Table of contents (automatically generated)
2. List of Figures
3. List of Tables
4. Acronyms and abbreviations
6. TIME FRAME AND INDICATIVE BUDGET
The assignment will start on October 15th , 2014 upon signing of the contract and is expected to take 45
working days.
7. Indicative Budget
The budget allocated for this study is Rs.1, 000,000
8. Team composition/ qualification and experience of the consultant
The consultant should have experience in adolescents sexual and reproductive health(ASRH) issues (relevant
technical field e.g. ECE, RHIA, DRR etc.), research including mixed method studies and surveys, evaluations,
knowledge about existing initiative and interventions regarding ASRH ( RHIA, DRR, ECE etc.), child rights,
development issues and (or) interventions with reputable organizations indicating:
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Evidence of availability of appropriate qualifications, manpower and key staff that will constitute the team.
CVs of the assigned team member(s) detailing relevant experience.
9. Payments
Terms of payment shall be 50% on approval of the inception report and tools, 25% upon submission of the 1st
draft report and 25 % on submission of approved final report. Professional fees, administrative costs related to
transport, accommodation, ethics approval and stationary will be handled by the consultant.
10. Application process
We invite interested candidates to submit the following application documents:
a)
b)
c)
d)
e)
Expression of interest addressing expertise and track record – max 2 pages;
An ethics statement
proposed methodology and rationale, budget and timeline;
CV; and
One example of previous similar work.
The financial proposal must be submitted in Pak Rupees with a detailed break up of all activities budgeted for,
showing unit, unit cost and duration.
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11. Ethical and child protection Considerations
The researcher must follow Ethical Principles 8 for involving human subjects in a research and obtain written/
verbal consent from the human subjects. Permission from elder must be sought if the children under 18 years
are involved as subjects. Signed informed consent of each child and his/ her parents need to be taken after
explaining purpose of the study and its usage. Responses that can be traced back to individuals should not be
shared or should be provided anonymously (see below) to observe confidentiality of data. Plan has to ensure
that no risk or harm is involved in this study. Study findings has to provide evidence to implementers and
planners in that it will benefit the population overall. If human subjects are part of the research ethical
approval must be sought prior to the start of the research in line with Plan’s global research policy and
standards.
The consultant should understand and sign the child protection policy of Plan International, Pakistan and the
Research Policy and Standards at time of signing agreement with Plan. In case, the report contains photos; the
consultant has to take written consent from the photographed person, on a form will be shared by Plan and
should be submitted in original form separately along with final report. Moreover, to protect the children, do
not use their family names when providing a quote in the report. The preferred style for giving reference to an
individual child is to provide the first name, first initial of last name, age and where he/she is from. For example:
“Maria O., 13-years-old, from Chak-480GB”. Consultant shall avoid plagiarism9of any kind and abide by the
principle of intellectual property and joint data ownership in the case of study carried out in collaboration with
others.
12. Submission Procedure:
The technical and financial proposals (both in hard form and soft copy of only technical proposal) should be
sent in separate sealed envelopes, marked on the top right hand corner Technical and financial Proposals for
“Study the excluded groups of adolescents in districts Umer Kot, Thatta, Skardu, Ghizer, Rajanpur and Vehari
and the determinants of their exclusion. Moreover, explore youth led CSOs and assess their capacities.”
Please submit proposals to The Country Director Plan Pakistan, P.O. Box 537, F-7 Markaz, or to House 9, Street
32, and Sector F 7/1 Islamabad by or before close of business by October 03th, 2014
Only short listed applicants will be contacted. Plan reserves the right to reject any or all proposals and is not
bound to any legal claim in this regard. No telephone inquiries will be entertained.
8 Helsinki Declaration 2012: Ethical Principles for Research Involving Human Subjects
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Plagiarism is the appropriation of another person's ideas, processes, results, or words without giving appropriate credit. Research misconduct
does not include honest error or differences of opinion.
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