VACANCY NOTICE: Terms of Reference (ToR) Baseline Study and Health Systems Audit

1. Background to Human Impact Hub (Hi-Hub)

Founded in 2015, Hi-Hub is an innovative, mission-driven private voluntary organization (PVO13/19) dedicated to addressing the root causes of poverty and promoting equitable access to essential services including clean water, sanitation, hygiene, health, education, food security, and sustainable livelihoods for vulnerable and marginalized communities.

Since its founding, Hi-Hub has implemented impactful interventions across diverse contexts, with operational experience in seven districts of operation in Zimbabwe and ongoing programs across these districts.

We work collaboratively with a broad ecosystem of stakeholders including government ministries, development agencies, donors, civil society organizations, private sector actors, academic institutions, and grassroots partners to generate lasting and locally anchored impact. Our strong network of local partners ensures that our solutions are both context-specific and responsive to the realities on the ground.

By maintaining a presence in strategically important provinces, we are able to build trust, understand local governance systems, and co-create culturally sensitive and policy-aligned interventions. As an organization aligned with international humanitarian norms, we adhere to Humanitarian Principles, International Humanitarian Law (IHL), the Core Humanitarian Standards (CHS), the Humanitarian Charter, and the Sphere Standards for disaster response and accountability.

2. Background of the Enhancing Primary Health Care in Rural Zimbabwe (EPHE)

The EPHE project seeks to strengthen the delivery and utilization of primary health care services in selected rural districts to advance progress toward Universal Health Coverage (UHC). The project addresses key challenges affecting rural health systems, including inadequate infrastructure, shortages of skilled personnel, limited medical supplies, and weak information systems. In alignment with the Ministry of Health and Child Care (MoHCC) National Health Strategy and the Primary Health Care Revitalization Framework, EPHE employs an integrated approach that combines health systems strengthening, community-based interventions, digital health innovations, and capacity building for frontline and village health workers. To inform effective implementation, a baseline study and health systems audit will be undertaken to establish benchmark data on key health indicators and assess facility readiness in areas such as human resources, infrastructure, service delivery, governance, and data management. The findings will guide project planning, strengthen collaboration with stakeholders, and support the development of resilient, efficient, and people-centered primary health care systems in rural Zimbabwe.

 

3. Purpose of the Assignment

The purpose of the Baseline Study and Health Systems Audit is to establish the initial status of primary health care delivery, infrastructure, human resources, and community engagement systems within the EPHE project’s target districts. This assessment will provide a comprehensive understanding of existing service delivery capacities, gaps, and opportunities across key health domains including maternal and child health, non-communicable diseases, and mental health. The baseline will generate critical benchmark data against which project progress and outcomes will be measured over time, while the health systems audit will evaluate the functionality, efficiency, and resilience of targeted health facilities in line with the WHO Health Systems Framework. Collectively, the findings will inform evidence-based planning, guide resource allocation, and strengthen project implementation, ensuring that interventions are contextually relevant, sustainable, and aligned with national health priorities.

4. Objectives of the Baseline Study and Health Systems Audit

 

1. 1. Baseline Study Objective

Objective: To establish the current status of primary health care delivery and community health outcomes in the EPHE target districts, providing a comprehensive reference point against which progress, performance, and impact of project interventions can be measured over time.

Guiding Questions:

1. What is the current status of primary health care service delivery and community health outcomes in the target districts?
2. What are the baseline levels of key health indicators related to RMNCH, NCDs, and mental health?
3. How equitably are health services accessed and utilized across different population groups, including by gender and location?
4. How can the collected baseline information inform the development of a framework for monitoring, evaluation, accountability, and learning (MEAL)?

 

2. Health Systems Audit Objective

Objective: To assess the functionality, capacity, and resource gaps within the existing health system in the EPHE target districts, identifying potential entry points and priority areas for targeted support to strengthen health facilities and improve service delivery.

Guiding Questions:

1. How functional and adequately resourced are rural health facilities in terms of infrastructure, staffing, and availability of essential medicines and supplies?
2. What systems and processes exist for health data collection, reporting, and use at facility and district levels?
3. How are community health structures—such as Village Health Workers (VHWs) and Health Centre Committees (HCCs)—contributing to service delivery and community engagement?
4. What key opportunities and priority areas can be identified to strengthen the health system’s six building blocks and enhance service delivery under the EPHE project?

 

5. Scope of Work

The baseline study and health systems audit will be conducted across selected rural health facilities and communities in Bulilima, Chirumanzu, Gwanda and Shurugwi districts. The assignment will combine quantitative and qualitative methodologies to generate comprehensive data that will inform project implementation, monitoring, and evaluation frameworks.

 

5.1 Geographic Coverage

The study will be implemented in Bulilima, Chirumanzu, Gwanda and Shurugwi districts which are target project districts and their respective catchment areas, including selected rural health facilities, outreach sites, and surrounding communities. The sampling frame will ensure representation of different facility levels (rural health centres, district hospitals) and community health structures (Village Health Workers, Health Centre Committees /Health Facility Committees, community leaders).

 

5.2     Key Thematic Areas

The study will cover, but not be limited to, the following thematic areas:

1. Primary Health Care Service Delivery: Availability, accessibility, and quality of essential health services, including RMNCH, NCDs, and mental health.
2. Health Workforce: Staffing levels, skills mix, workload, supervision, and motivation of health personnel and Village Health Workers (VHWs).

• Health Information Systems: Functionality of data collection, management, and reporting systems (including DHIS2), and readiness for digital health solutions.

1. Medicines, Equipment, and Supplies: Availability, functionality, stock management, and supply chain performance.
2. Health Financing: Sources, flow, and adequacy of financial resources for service delivery at facility and district levels.
3. Leadership and Governance: Coordination mechanisms, decision-making processes, and accountability structures within facilities and districts.

• Community Health and Social Inclusion: Health-seeking behaviors, gender and equity considerations, participation of marginalized groups, and community engagement in health promotion and service delivery.

 

5.3 Methodological Approach

 

The study will employ a mixed-methods approach, integrating Quantitative data collection through structured facility assessments, household surveys, and health information system reviews. Qualitative assessments via key informant interviews (KIIs), focus group discussions (FGDs), and participatory tools with health workers, VHWs, community leaders, and local authorities. Health Systems Audit tools will be adopted from MoHCC standards and WHO’s six health systems building blocks.

 

5.4 Stakeholder Engagement

The process should involve close consultations and engagements with:

• MoHCC departments at national (where necessary), provincial, and district levels.
• Health facility managers, health facility staff (where necessary), VHWs, and community representatives.
• Partner organizations and donor representatives, ensuring data harmonization and ownership of findings.

 

6. Methodology and approach

The baseline study and health systems audit should utilize a mixed-methods approach, integrating quantitative, qualitative, and participatory techniques. This comprehensive methodology will ensure an in-depth understanding of baseline conditions and the functionality of rural health systems within the EPHE target areas. The approach aligns with WHO’s Health Systems Framework and MoHCC standards to ensure relevance, accuracy, and comparability of data. Desk review of secondary data.

6.1 Study Design

The study should adopt a cross-sectional and descriptive design, combining facility-based assessments, community surveys, and stakeholder consultations to capture the existing status of primary health care systems, service delivery, and community-level health indicators. The methodology should be structured to capture both system-level capacities and community-level outcomes relevant to primary health care, RMNCH, NCDs, mental health, and digital health readiness. It should combine health facility assessments, community surveys, and stakeholder consultations. This design will provide a strong foundation for measuring change and impact throughout EPHE’s implementation cycle.

6.2      Sampling Strategy

A multi-stage sampling strategy should be used to ensure representativeness and coverage of key population groups and service delivery points. Sampling should encompass districts, target facilities, and communities targeted by EPHE to balance statistical rigor with logistical feasibility while ensuring the inclusion of marginalized and hard-to-reach communities.

1. District Selection: All EPHE-targeted districts should be included to ensure representativeness.
2. Facility Sampling: All 20 health facilities targeted by the project should be included in study and audit.

• Community Sampling: Villages and catchment areas linked to sampled facilities should be included for household surveys.

1. Respondent Categories: Health Facility Staff, Village Health Workers (VHWs), Health Centre Committee members, community leaders, and beneficiaries.

 

6.3     Data Collection Methods

Multiple complementary data collection methods should be used to ensure comprehensive coverage of both quantitative and qualitative dimensions. Each method should be tailored to address specific objectives and indicators within the EPHE framework.

1. Facility Assessments: Standardized audit tools to assess infrastructure, staffing, supplies, and service delivery capacity.
2. Health Systems Audit Tools: Structured around the six WHO health system building blocks.
3. Household and Community Surveys: Capture health-seeking behaviors, access, and satisfaction with health services.
4. Key Informant Interviews (KIIs): Gather expert insights from MoHCC, district health officials, and development partners.
5. Focus Group Discussions (FGDs): Obtain qualitative perspectives from women, youth, and other vulnerable groups.
6. Document Review: Analyze existing MoHCC and DHIS2 data, reports, and prior assessments.

7. Expected Deliverables

 

The following are expected deliverables of the assignment:

Deliverable	Description	Medium
Inception Report	Detailing the methodology, sampling framework, data collection tools, and work plan	e-copies
Development of data collection tools	The final version of survey instruments/tools, questionnaires, checklists, etc. in English   Digitized form in KOBO Toolbox or ODK for quantitative data collection (English and indigenous languages)	e-copies     Program in KOBO toolbox or ODK
Field work	Clean and final datasheet of the quantitative survey in SPSS and or STATA and Excel version and NVIVO	e-copies
Draft Baseline and Health Systems Audit Report	Presentation of initial findings and baseline data	e-copies
Presentation of findings	To MoHCC, implementing partners, and donor representatives for validation and integration into the project’s MEAL framework.	e-copies
Final Baseline and Health Systems Audit Report	Comprehensive Health Systems Audit and Baseline Study report capturing data analysis, and visualized results with recommendations

 

 

8.0 Duration

 

The assignment is expected to take 34 calendar days, inclusive of preparation, fieldwork, analysis, and reporting.

Deliverable	Timeline
Inception Report	4 days
Development of data collection tools	4 days
Field work	20 days
Draft Baseline and Health Systems Audit Report	3 days
Presentation of findings	1 day
Final Baseline and Health Systems Audit Report	2 days

 

9. Reporting and Supervision

The consultant will report to the Director of Programs at Hand in Hand Zimbabwe and work closely with the Monitoring, Evaluation, Accountability and Learning (MEAL) Manager for technical guidance. Regular progress updates will be required during the assignment.

10. Budget and Payment Procedures

 

The individual consultant/firm shall propose a total budget (including tax) with a detailed breakdown including applicable taxes at the time of proposal submission. The budget covers consultancy fees of thematic experts and other direct costs related to the scope of work. The consultant/firm shall bear all tariffs, duties, and applicable taxes or charges levied at any stage during the execution of the work. The total consultancy cost (agreed) will be paid in three installments:

1. 30% upon submission and acceptance of the inception report
2. 40% upon submission of the draft report including sharing the survey findings in an internal meeting and acceptance of the draft report

• 30% upon acceptance of the final report

Note: The organization will not be responsible for covering insurance and other hidden costs related to the survey

 

11. Consultant Qualifications

 

The consultant or consulting firm is expected to possess a solid academic and professional background in public health and health systems research. A postgraduate qualification in Public Health, Health Systems Management, Epidemiology, or a related field is required. The consultant must have a minimum of seven (7) years’ experience in conducting health systems assessments, baseline studies, or programme evaluations, preferably within the Zimbabwean health sector. A comprehensive understanding of the Ministry of Health and Child Care (MoHCC) structures, policies, and operational frameworks is essential. The assignment requires strong analytical and report writing skills, demonstrated ability to interpret data effectively, and the capacity to undertake multi-site fieldwork within tight timelines.

12. Application Requirements

Interested consultants or firms are invited to submit:
– A technical proposal (max 8 pages) outlining their understanding of the assignment, approach, methodology, and work plan.
– A financial proposal, inclusive of all costs.
– CVs of the consultant(s) and or profile of the consulting firm.

Proposals should be submitted electronically to hr@humanimpacthub.org with the subject line “EPHE Baseline Study & Health Systems Audit” on before 21^th November, 2025 by 1700hours.