Consultancy for Mid-term Project Review – VUFO NGO Resource Centre

TERM OF REFRENCE (TOR) – MID TERM PROJECT REVIEW (MTR)

Project title: WORKING TOWARDS A LEARNING EYE HOSPITAL IN PHU YEN (LEH)

Country: Viet Nam

Date: 17^th April 2025 (revised)

Introduction

The Fred Hollows Foundation (The Foundation) is a non-profit public health organisation based in Australia, which was founded in 1992 by eminent eye surgeon Professor Fred Hollows. The Foundation focuses on strengthening eye health systems; treatment and prevention of avoidable blindness and visual impairment caused by Cataracts, Trachoma, Diabetic Retinopathy, and Refractive Error (R.E). The Foundation operates in more than 20 countries across Australia, The Pacific, South, and Southeast Asia, and Africa. The Foundation was named The Australian Charity of the Year 2013 in the inaugural Australian Charity Awards.

The Foundation began working in Vietnam in 1992. Today it is one of the leading Eye care International non-governmental organisations (INGO) in Vietnam. The Foundation works in partnership with the Government; Ministry of Health, Ministry of Education & Training, Vietnam National Eye Hospital (VNEH); medical universities; Departments of Health, Departments of Education and Training; and more than 20 provincial eye care service providers and other INGOs who are working in Vietnam both in eye health and other fields such as IAPB; WHO in Vietnam. Since 2016, The Fred Hollows Foundation Vietnam (FHFVN) and its partners have developed and implemented the school eye health program through the Vietnam Child Eye Care and Better Eyes for Better Education projects which aim to improve eye health among Vietnamese school children by advocating for the national eye care guidelines and policies in place to prevent visual impairments caused by refractive errors for primary and secondary school students in Viet Nam. These both projects finished and achieved the set objectives by the end of 2020 and 2021. To scale up the impact of these projects, a new project named School Eye health Expansion Project was approved and started implementation from the beginning of 2021.

Project background

The Foundation started working in Phu Yen in 1999 with a small fund and IOLs for cataract surgical camps. After a few years, Phu Yen proved they were capable of implementing larger projects and expressed their desire to make a dramatic change to the prevention of blindness in the province. In 2003, FHF funded Phu Yen to pilot a Comprehensive Eye Care project. Since then, its eye care has been remarkably developed. Specifically, its former eye station was transformed successfully into an eye centre, then an eye hospital in 2012. Importantly, apart from prioritising control of cataracts, the leading cause of avoidable blindness, the hospital has provided various eye care services to help the local people access the services locally in the province instead of travelling to metropolitan settings in Ho Chi Minh or Ha Noi. Thus, out-of-pocket expenses are minimised. In addition, compared with other provinces with similar economic and population conditions, Phu Yen Eye Hospital is among the few who can operate independently and no longer need much financial support from the government as they have started to pursue financial autonomy since 2019.

From 2013 onwards, Phu Yen has achieved annual incomes at 1 million USD thanks to their emphasis on quality service improvement and management innovations, such as all cataract patients receive the surgeries and go home in the day that save time and expenses for patients’ families, or each eye doctor is a multi-tasker, for instance an ophthalmologist can provide examination, perform cataract surgeries and treat diabetic retinopathy, or they assign specific staff to look after operation of equipment to extend equipment lifespan as long as possible to increase the efficiency. They have become a destination for Vietnam’s eye care partners and programmers and FHF international teams to visit and exchange experiences, such as Laos and Indonesia for global country offices’ staff and partners, and in-country eye doctors from Quang Nam, Ha Giang, Dak Nong, Ca Mau, Vinh Long and so on. However, what the hospital has tried to perform has not met their expectations and wants to more standardise the service quality. That is why they submitted FHF a proposal to seek additional support to help improve their model of care, especially improve equity and inclusion and perspective of vulnerable groups in accessing eye care services. FHF Vietnam considered this an excellent opportunity to promote learning across FHF’s country offices and project partners to leverage sustainability in eye care projects. This learning hospital model can motivate other FHF country offices to document and develop a similar model for cross-learning, replicating and boosting eye care programs in their countries. The doctors and hospitals from surrounding countries are welcomed to visit Phu Yen Eye Hospital for experience exchange like Lao and Indonesia partners once visited Phu Yen before.

Working toward in a Learning Eye Hospital in Phu Yen project (LEH) was designed with the overall goal is to reinforce Phu Yen Eye Hospital’s model of care to serve all patients, including vulnerable groups better and to promote this model of establishment across Vietnam. Where appropriate we will also share lessons across FHF’s country offices and partners. This goal will be achieved through the following outcomes:

Outcome 1: Standard operating procedures are applied across the hospital.

Outcome 2: Hospital workforces are able to provide diverse quality eye care services.

Outcome 3: Equitable and quality eye care services are accessible to all patients, including vulnerable groups.

Outcome 4: Good models and practice are documented, promoted, and shared.

Purpose of the Midterm review (MTR)

This mid-term review (MTR) aims to identify the key successes and challenges in project implementation to date, identify factors which have contributed to the project’s successes, and areas of weakness that have impeded progress. This MTR is expected to be conducted as an External review led by qualified external consultant and learning plus technical supports by others to have a comprehensive review of the project.

The specific purpose of the MTR will be:

Assess progress against the project objectives as per the timeline set out in the Project Design Document (PDD).
Identify effective approaches and lessons learnt from project implementation and recommend any necessary changes that should be incorporated in the remaining period of the project.

The review’s findings will be provided to the project donor, FHF, Phu Yen Project Management Board, and Phu Yen Eye Hospital, along with recommendations to all stakeholders on addressing identified challenges and informing ongoing project plans and practices. This may include recommendations on variations to project design to improve delivery for the remainder of the project.

MTR scope and key questions

The MTR will seek to answer the following key questions:

Effectiveness – IS THE INTERVENTION ACHIEVING ITS OBJECTIVES?

To what extent has Phu Yen EH achieved the project progress as planned? If yes/no, what needs to be changed in the coming years?
How has the quality of eye care services at the hospital been changed due to the process of becoming a model of care? What has contributed to quality…..

Impact – WHAT DIFFERENCE DOES THE INTERVENTION MAKE?

What key positive changes have been observed so far for hospital staff (motivation, skills), and patients including vulnerable groups?
What were key changes on learning that the project should be given to FHF countries and partners?

Relevance / Appropriateness – IS THE INTERVENTION DOING THE RIGHT THINGS?

How Phu Yen EH was designed and implemented to meet strategic directions Phu Yen Provincial Department of Health in providing eye care services for all patients including vulnerable groups?
How Phu Yen EH was designed to meet learning purposes for other hospitals, eye care units… (on patient centred; cross cutting issues, clinical quality improvement)… of FHF and project partners

Equity (including gender equity) – HOW IS THE INTERVENTION CONTRIBUTING TO GENDER EQUITY AND INCLUSION?

To what extent Phu Yen LEH was the model of care to better serve all patients, including the vulnerable?
What were key factors / evidence for the success of the model of care (in terms of equitable and quality access to eye care services for vulnerable groups…)

Recommendations for action

Provide actionable recommendations to FHF VN and project partners on:
What are the key learnings that the project has created that can be shared with wider stakeholders (the model, process, implementation successes and challenges etc.?
What challenges project is currently facing that needs the attention? Causes and reasons behind those challenges
Specific Recommendations: Actions and changes to improve the project results for the remainder of the project duration in light of any changed circumstances or challenges identified through the MTR. (specify who does what and when?)

Note: other key questions will be further discussed between global FHF MnE, FHFVN before conducting MTR.

Approach

The approach to this evaluation will be a mixed-method approach. The review will take the form of a Utilisation- Focused evaluation, which is a type of evaluation that ensures that the evaluation is planned and conducted in a way that enhances the likely utilisation of both the findings and the process itself to inform decision and improve performance. More information about this type of evaluation can be found here:

https://www.betterevaluation.org/plan/approach/utilization_focused_evaluation

The review will be led by a qualified external consultant plus the technical supports given by Global MnE. The team chosen to conduct this evaluation will be expected to provide a detailed methodology for data collection and analysis based on the Key Evaluation Questions above. It is suggested that this review adopts a participatory approach to involve key stakeholders in the process. This will foster a culture of learning through seeking to produce information about a project’s achievements and lessons learnt that is of value to stakeholders.

The project team and Phu Yen PMB will provide the necessary support to provide context and documentation, and will coordinate the field visit schedule, including requesting and scheduling interviews with key stakeholders as required.

The MTR should include the following:

Desk review of all relevant project documentation and other materials such as the PDD, annual work plans, monitoring and evaluation framework and data, project reports as well as other documentations, any commissioned research findings, policy documents and national and provincial level strategy documents (to be compiled and provided by FHFVN)

Interviews and discussions with relevant personnel from FHFVN, project partners and other relevant stakeholders. (Vietnamese-English interpretation services will be arranged for interviews if required).

Processing and analysis of data, preparation of key findings and recommendations for presentation to FHFVN and Phu Yen PMB, Eye hospital.

Presentation and discussion of findings, key lessons learned and recommendations for action with FHFVN Country Manager, Senior Program Manager, project team and project partners if requested.

Submission of the MTR report, reflecting comments and feedback received from selected staff from FHFVN and FHF M&E Team.

Present key findings at dissemination or sharing workshop held by FHFVN or project stakeholders.

Deliverables

The MTR Team will produce the following documents:

The MTR plan: The MTR Plan will elaborate on this ToR and on how the MTR will be conducted.

The MTR plan will include: an updated field review schedule; a list of persons to participate/consult during the MTR; a definition of MTR team member roles and responsibilities; and the key MTR approaches and methodologies, including questionnaires (and/or compile appropriate questions and discussion points) to guide discussions during field review consultations.

Presentation of initial findings and recommendations: to be presented to the FHFVN Country Manager, Senior Program Manager and project team for validation and discussion before commencing the MTR report.

The MTR report: The production of this report will include facilitating and incorporating comments, and feedback from the MTR team members and project partners. The final report, following initial feedback from FHFVN and the FHF M&E team, will be submitted to FHF Vietnam about 4-6 weeks after the fieldwork ends at the latest.

The MTR report must be written in English and Vietnamese, provided in the requested template, and in electronic format (Microsoft Word). The final report format should include the following headlines: Acknowledgments, Acronyms, Introduction, Executive Summary, Background, Objectives, Methodology, Results/findings, Lessons learnt, Study Limitations, Conclusions and Recommendations, Appendices, References. Template will be provided to the consultant

A PowerPoint summary report to support the dissemination of findings to stakeholders at workshop held by FHFVN or project stakeholders.

FHF VN will be responsible for the subsequent sharing of the report and its recommendations with relevant national stakeholders in Vietnam.

Tentative Schedule

FHFVN will enter a contract for services with the MTR Team Leader or his/her company. The Team Leader will be required to undertake the following tasks within 30 working days between Jun and to Mid August 2025 as per the following tentative schedule:

Activities	Duration	Person in charge
Desk Review of Project Documentation	3 days (Jun 2025)	MTR Team Leader and team members
MTR Plan Production, including phone consultation with FHF VN on design of MTR plan	2 days (Jun 2025)	MTR Team Leader and core MTR team members
Site visit to Phu Yen, interview project stakeholders. Access the quality of Phu Yen EH will be conducted by a representative of MSA (Quality control department)	5 days – (Mid-Jun 2025)	All MTR Team (FHFVN, MoH’s representatives, data consolidator)
Analysis of data collected from interviews and consultations, including documenting key findings and recommendations	7 days (End of Jun 2025)	All MTR Team (FHFVN, MoH’s representatives, data consolidator)
Final Report Production and share key findings (time to be confirmed)	10 days (3rd of Jul 2025)	MTR Team Leader/reporter
Sign-off, including the incorporation of feedback from key stakeholders	3 days (2^nd week, Aug 2025)	MTR Team Leader/reporter, FHF VN, FHF Asia MnE Advisor. Medical advisor
Total	30 days

Evaluation Team & Qualifications

Given the scale of this evaluation, the MTR team will comprise one consultant as the team leader and his/her team member, with support from Phu Yen Project Management Board (PMB), Phu Yen project team. The Team Leader is responsible for the planning and delivery of the MTR, coordinate the report completion and providing recommendations. The project team will provide the necessary support to provide context, documentation and will coordinate the field visit schedule.

Team Leader And Their Team Members

The Team Leader will be responsible for:

Development of the MTR plan, methodology and data collection tools
Obtaining ethic approval is required. In case that he/she faces challenges in getting ethic aproval, this will be further discussed to get alternative solutions as exceptional.
Leading on delivery of the evaluation, including managing the literature review and data collection
Analysis of data, documentation of key findings and recommendations
Writing of the final MTR report
Sharing key findings with project stakeholders

The Team Leader and their team members should have the following skills:

At least 10 years of team leader experience in project management.
Knowledge and experience of programs focused on blindness prevention and the health system in Viet Nam.
Knowledge and experience in health policy influencing and advocacy.
Demonstrable experience in monitoring and evaluating public health programs/eye health programs, including the development and use of quantitative and qualitative data collection tools and participatory evaluation methods.
Strong analytical skills
Excellent English report writing skills.

FHFVN project team

FHFVN project team members will be responsible for:

Compiling relevant documentation and information for background context, and to inform the literature review (to be provided to the team leader)
Coordinating the field visit schedule, including requesting and scheduling stakeholder interviews and organising travel logistics for the team lead and team members
Arranging interpretation/translation services for interviews, if required
Monitoring data collection process, participating in a reflection workshop to provide feedback on initial review findings.
Provide feedback on the draft MTR report and recommendations.
Dissemination of the final report and recommendations to relevant national stakeholders and subsequent actions.
Logistic support for the consultant as requested

FHF M&E Team & Medical Advisors

They will provide limited support to the project through:

Technical review on developing Methodology, key evaluation questions, data collection
Providing feedback on draft MTR report and recommendations

Other Expected MTR Participants

Provincial Level: Project management boards, representatives from Phu Yen Provincial Department of Health, Phu Yen provincial Departments of Education and Training, Quality control department of Medical Service Administration/, visitors: Quang Nam Eye hospital, Daknong and Hoa Binh Provincial Department of Health and FHF’s medical advisors
District/Community Level: District Hospitals (eye departments) and Commune Health workers, and schoolteachers participating in the project.
Service users:
- Phu Yen Eye Hospital will conduct a survey to assess the satisfaction of service users, including patients and their caregivers. The survey will involve a sample of 200 randomly selected service users—100 patients and 100 caregivers—who have utilized the hospital’s services. The findings will be shared with the MTR team leader before the field visit for analysis and will serve as baseline data for comparison with the endline data as part of the final review.

Management and Logistics

The two FHFVN staff who are managing the Phu Yen Learning project will be the focal point for the MTR throughout the evaluation process, coordinating communications between the evaluator/s and The Foundation’s commissioning team, ensuring milestones are met, and coordinating review and providing feedback for FHFVN country manager for approval of deliverables.

Confidentiality

The evaluator/s agree to not divulge confidential information to any person for any reason during or after completion of this contract with The Foundation. Upon completion or termination of this contract, the evaluator/s undertake to return to The Foundation any materials, files or property in their possession that relate to the business affairs of The Foundation.

Intellectual Property

All intellectual property and/or copyright material produced by the evaluator/s whilst under contract to The Foundation remain the property of The Foundation and will not be shared with third parties without the express permission of The Foundation. The evaluator/s are required to surrender any copyright material created during the term of the contract to The Foundation upon completion or termination of the contract.

Safeguarding People

The Fred Hollows Foundation is committed to ensuring that its activities are implemented in a safe and productive environment which prevents harm and avoids negative impacts on the health and safety of all people, particularly children, vulnerable people, and disadvantaged groups. The Foundation has a zero-tolerance approach to sexual exploitation, abuse, and harassment of any kind. All personnel including contractors/consultants are expected to uphold and promote high standards of professional conduct in line with The Foundation’s Safeguarding People Policy including Code of Conduct. Contractors/consultants will be expected to sign and adhere to The Foundation’s Safeguarding Code of Conduct and provide any background checks as required.

Insurance

Any consultants involved in this evaluation will be required to have in place insurance arrangements appropriate to the provision of the requirements in this ToR, including travel insurance.

Ethical And Other Considerations

The MTR will be carried out in line with The Foundation’s Research, Ethics and Data Management Policy. This will inform seeking informed consent, as well as quality control of data collection, use and storage. While acknowledging that this assignment holds negligible/low risk as it will not collect sensitive personal information, the consultant/s is expected to adhere to and uphold the principles of ethical research conduct at all stages of this assignment.

In case the selected consultant faces challenges in getting ethical approval from the ethics-related approvers, possible solutions will be discussed and agreed upon by FHF before the data collection takes place.

Applications should be sent by 30^th May at 17.00h Viet Nam time. Please include the following as email subject “Consultant for the mid-term review (MTR)” and send to the following email address: [email protected]