Terms of Reference (TOR)

I. Presentation of CDE and context

La Chaîne de l’Espoir (CDE) is an international NGO working to strengthen pediatric healthcare systems and expand access to specialized services. CDE works in 25 countries with a global approach, focusing on the child but also on mothers and vulnerable communities:

- Prevention and screening from the earliest age, particularly in the context of school health programs. 

- Care and surgery to meet the most urgent needs of children and their mothers. 

- Training and capacity building of local teams through our international network of experts in all areas of surgery. 

- Construction and equipment of hospital structures adapted to local needs. 

Humanitarian crises to provide aid in situations of conflict, natural disasters and economic collapse. 

- Improving maternal health through medical care to prevent risks due to pregnancy and childbirth.

Brief presentation of CDE’s work in Jordan

La Chaîne de l’Espoir (CDE) in Jordan works to strengthen pediatric and healthcare systems while expanding access to specialized cardiac and orthopedic services for vulnerable children. Under its previous multi-year strategy, CDE combined early detection and screening, medico-surgical care for congenital anomalies, rehabilitation services, and psychosocial support to improve the continuum of care.

The organization reinforced national capacity through accredited training, and structured skills transfer to Ministry of Health teams. It also supported the primary health care department with medical equipment, protocol activation, and referral network development. This approach laid the foundation for a progressive transition from humanitarian surgical response toward sustainable system strengthening and institutional anchoring.

CDE seeks to recruit an external consultant to lead and conduct this integrated analytical and strategic planning process.

 II. Objectives and purposes of the Consultancy

Principal aim

The purpose of the consultancy is to build a comprehensive and updated picture of the pediatric and maternal health system needs in Jordan, particularly in relation to specialized cardiac and orthopedic services, as well as to identify strategic opportunities for future program development. This consultancy is particularly relevant at this stage as CDE Jordan is transitioning from predominantly humanitarian surgical interventions toward a more structured, system-strengthening and development-oriented approach, in line with its previous three-year strategy. Over the past years, CDE has laid the foundations for institutional capacity building, referral network strengthening, and specialization pathways; however, evolving national priorities, funding landscapes, and health system pressures require an updated, evidence-based assessment to inform the next strategic cycle. The needs assessment will therefore ensure continuity with the previous strategy while refining CDE’s positioning, priorities, and partnership approach for the coming years.

The findings will be compiled into a comprehensive report that will directly inform the development of the next multi-year strategic framework.

The objective of this consultancy is to produce an evidence-informed, prioritized, and financially feasible 4-year strategy for CDE Jordan (2026–2029), grounded in:

- A focused analysis of pediatric health needs  

- A targeted assessment of selected public hospitals (estimation of 3 tertiary hospitals in different governorates to be further identified) 

- Priority Investment and Capacity Strengthening Needs

The strategy must reflect donors and stakeholders' mapping, and take into account funding uncertainty and include scenario-based planning.

The primary users of the strategy and needs assessment reports will be CDE Jordan, who will use the findings to guide strategic planning, prioritization of interventions, and operational decision-making for the period 2026–2029.

In addition, the reports are expected to serve as reference and positioning documents for external stakeholders, including institutional donors, strategic partners, and relevant national health authorities such as the Ministry of Health, to support coordination, partnership development, and resource mobilization aligned with identified pediatric health priorities in Jordan.

Scope of Work

Duration of consultancy: Indicative: 16 – 20 weeks

Geographical scope: Jordan (with hospital visits in selected governorates)

Analytical approach – The consultant needs to structure the work using WHO existing health system strengthening framework (WHO building blocks).

The consultancy will consist of two main analytical components designed to inform the development of CDE Jordan’s multi-year strategic framework. The consultant will propose a structured approach linking key objectives and activities related to the WHO framework.

1. National Child Health Needs Assessment & WHO building blocks

Purpose

Identify priority pediatric health needs and system gaps in Jordan that are related to WHO health systems framework relevant to CDE’s mandate, while mapping the broader ecosystem mechanisms and key actors involved in child health service delivery.

Activities

The consultant will conduct a desk review of key national and sector documents, to:

- Map key structures providing specialized peadiatric and maternal healthcare services 

- Map key institutions and private training healthcare staff on peadiatric and maternal healthcare services 

- Map key national and international NGOs engaged in peadiatric and maternal healthcare 

- Map key national and international partners, such as biomedical equipment and infrastructure companies, engaged in peadiatric and maternal healthcare 

- Summarize key financing mechanisms for peadiatric and maternal healthcare 

- Including the following documentation review

* MoH Health Sector Reform Vision 2030

* National health strategies and policies 

* National equipment and infrastructure health regulations 

* Recent health sector assessments and studies 

* Donor strategies and priorities relevant to child health

- Conduct Key Informant Interviews, Focus Group Discussions and surveys with relevant stakeholders, including representatives from: 

* Ministry of Health 

* Donor agencies 

* UN agencies 

* Selected NGOs and implementing partners 

* Pediatric clinicians and technical experts 

* Beneficiaries

- Conduct a focused 4Ws mapping (Who does What, Where, and Whom) using available coordination data to identify key actors and interventions in pediatric health.

- Analyze findings using WHO building blocks to identify: 

* Service delivery gaps in pediatric healthcare 

* Health workforce – training/motivation 

* Health Information system 

* Access to essential medicine, equipment, consumables and spare-parts 

* Financing mechanisms and gaps 

* Leadership and governance 

* Barriers affecting access for vulnerable children 

* Coordination gaps and potential duplication among actors 

* Strategic niches where CDE could contribute added value.

Output

- National Child Health Needs & Ecosystem Analysis Report

2. Public Hospital Readiness Assessment

Purpose Assess the readiness and technical capacity of selected public hospitals (taking into account geographical coverage and spread across the country) to provide pediatric services with a focus on cardiac and orthopedic surgical services and identify priority investment and capacity strengthening needs.

Activities

The consultant will:

- Map key hospitals providing services accessible to the most vulnerable (including public and private not for profit hospitals) and cross-map results using a geographic representation of existing populations in Jordan to identify key gaps 

- In each region select a sample of key hospitals 

- For each hospital sampled and in collaboration with CDE develop a simplified hospital assessment framework covering key dimensions with regards to pediatric and maternal healthcare, including: 

 *Catchment area & referral facilities 

* Volume and type of activities and patients 

* Infrastructure facilities, and more specifically surgical and sterilization areas, 

* Biomedical equipment availability and functionality 

* Technical services available, such as electricity, water, ventilation or medical fluids, 

* Human resources by specialty and clinical capacity along with training and capacity building opportunities if available  

* Financial resources and independence 

* Referral and patient flow systems 

* Accessibility considerations in general and more specifically for vulnerable populations 

* Infection Prevention and Control (IPC) systems and protocols.

- Conduct hospital site visits and structured interviews with hospital management, maintenance teams, clinicians, relevant technical staff and beneficiaries; 

- Apply a readiness scoring framework to assess hospital capacity across the different dimensions. 

- Identify key gaps and propose priority investments and capacity strengthening measures required to support safe and effective delivery of pediatric cardiac and orthopedic surgical services.

Outputs

- Map with the geographic positioning of each hospital cross-mapped with populations known to be vulnerable 

- Hospital Assessment Report 

- Individual Hospital Fact Sheets 

- Comparative Hospital Readiness Overview allowing to identify key gaps

Needs assessment and strategy criteria and example of questions

National Child Health Needs Assessment – Health system including WHO building blocks

        Thematic area 

        Type of questions  

        Service Delivery & Providers, including quality, safety, and accessibility 

        Who are the main service providers at the primary, secondary and tertiary care levels? And what are their main scope of intervention in children  health? 

        What are the main quality challenges affecting pediatric care delivery (staffing, training, equipment, referral systems, clinical protocols)? Where are the most significant quality gaps across levels of care? 

         

        Infrastructure and Equipment 

        Do you have national or regional policies or specific regulations for pediatric and maternal care ? Do you have centralized purchasing offices or is each hospital independent for its final choice ? 

        Burden of pediatric diseases and unmet  needs 

        What are the main causes of morbidity and mortality among children in Jordan? Which conditions represent the highest unmet needs in pediatric care? 

        Access to service and medicine 

        What barriers prevent vulnerable children from accessing care (financial, geographic or social)? Which population groups face the greatest access constraints (refugees, rural populations, low-income households)? 

         

        Health information system 

         

        How are data collected, records kept, patients followed up?  

        Health workforce capacity 

        What is the availability and distribution of pediatric specialists, nurses, and allied health professionals? Are there shortages or skills gaps affecting pediatric care provision? 

        Financing 

        How are hospitals funded, staff paid, out-of-pocket for patients?  

        Leadership and governance 

        What are key stakeholders, key policies and regulations, and gaps?  

        Strategic opportunities for CDE  

        Based on identified gaps and existing actors, where could CDE add the most value within the pediatric health ecosystem? What potential partnerships or strategic niches should be explored?

Public Hospital Readiness Assessment

Purpose

Assess selected hospitals’ capacity for pediatric care in general with a specific focus on cardiac and orthopedic pediatric surgeries.

        Thematic area 

        Type of questions  

        Hospital catchment area and referral structures 

        Where is the hospital situated, what is the number of people covered, what are referral mechanisms or gaps?  

        Hospital infrastructure 

        Does the hospital have adequate operating theaters, recovery rooms, ICU/PICU beds, and inpatient wards suitable for pediatric surgical care? Are facilities adapted for pediatric cardiac and orthopedic surgeries? 

        Do you know an average bed occupancy rate by sector ? 

        Availability of technical services 

        How often do you face technical shortages, as well in electricity, water or medical fluids ? And which available mitigation measures do you have ? 

        Maintenance 

        What are the policies for maintenance, is it done preferably with internal or external teams ? Do you know the annual budget available for maintenance ? 

        Biomedical equipment availability  

        What essential equipment is available and functional for pediatric cardiac and orthopedic surgeries (e.g., anesthesia machines, surgical instruments, imaging equipment, monitoring devices)? Are there maintenance systems in place? 

        Clinical capacity 

        Does the hospital have qualified pediatric surgeons, anesthesiologists, nurses, and specialized technicians? What is the level of experience in pediatric cardiac and orthopedic procedures? Are additional training or staffing investments required? 

        IPC 

        Are IPC protocols implemented in operating theaters, surgical wards, and ICUs? What systems exist for sterilization, infection monitoring, and clinical safety? 

        Priority Investment and Capacity Strengthening Needs 

        What key infrastructure, equipment, human resources, or system improvements are needed for the hospital to safely and effectively deliver pediatric cardiac and orthopedic surgeries?

3. Strategic Planning 2026–2029

Purpose

Develop a realistic and prioritized 4-year strategy informed by assessment findings, structured by key thematic areas

Activities

- Conduct a structured strategic co-construction process with CDE Jordan leadership and HQ focal points as required 

- Define CDE’s comparative advantage within the pediatric ecosystem and the most vulnerable communities 

- Co-develop a clear Theory of Change 

- Co-define 2–3 strategic pillars 

- Establish prioritization and sequencing logic 

- Define partnership and coordination approach 

- Integrate cross-cutting issues: 

* Gender 

* Disability inclusion 

* Environmental considerations 

* Accountability towards affected populations

Develop three financial scenarios:
- Conservative (minimum sustainability)
- Moderate (stability)
- Growth (expansion)

Outputs

- Develop 4-Year Strategic Plan (including advocacy strategic axes) 

- Implementation Roadmap (4-year phased plan) 

- Resource Mobilization & Donor Targeting Matrix 

- Donor-Facing Strategic Summary

Methodology

For the needs assessment (components 1 and 2), a mixed-methods approach will be employed, combining both secondary and primary data collection to provide a comprehensive understanding of the pediatric healthcare landscape in Jordan, along with public hospitals technical capacity. Data triangulation will be used to validate findings and ensure accuracy, consistency, and reliability across different data sources.

The consultancy team will propose a methodology integrating:

Desk review
Targeted stakeholder interviews, survey and FGDs
Focused 4Ws mapping
Hospital facility assessments

For the multi-year strategy:

Participatory strategic workshops
Scenario-based planning

Deliverables

The consultant is expected to deliver:

- Inception Report

- National Child Health Needs & Ecosystem Analysis 

- Hospital Assessment Report + Fact Sheets 

- Final 4-Year Strategic Plan including:  

* Implementation & Financial Scenarios Annex 

* Donor-Facing Strategic Summary 

 - Summary presentation to CDE Jordan & HQ

Timeline

        Phase 

        Activity 

        Timeline 

        Key Deliverable 

        Phase 1 

        Desk Review & Inception Phase 

        Weeks 1–4 

        Inception Report 

        Phase 2 

        Data Collection (Interviews, 4Ws, Hospital Visits) 

        Weeks 4-8 

        Field Data & Assessment Inputs 

        Phase 3 

        Analysis & Drafting of Assessment Reports 

        Weeks9-12 

        National Child Health Needs & Ecosystem Analysis (Draft)  
        Hospital Assessment Report + Fact Sheets (Draft) 

        Phase 4 

        Strategic Validation & Prioritization Session (with CDE Jordan + HQ consultation) 

        Week12-13 

        Validated Strategic Directions 

        Phase 5 

        Draft Strategy Development 

        Weeks 13-18 

        Draft 4-Year Strategic Plan  
        Implementation & Financial Scenarios Annex  
        Donor-Facing Strategic Summary (Draft) 

        Phase 6 

        Finalization & Presentation 

        Week 18-20 

        Final 4-Year Strategic Plan  
        Final Implementation & Financial Annex  
        Final Donor-Facing Summary  
        Presentation to CDE Jordan & HQ

Budget

The maximum available budget for this consultancy is 20,000 euros

Consultants are expected to submit a detailed technical and financial proposal

Proposals will be evaluated based on methodological rigor, contextual understanding, strategic insight, and cost-effectiveness.

Consultant Qualifications

Qualifications and experience requested:

- Experience in Public Health, Health Systems, Health Economics, or related field. 

- Experience in health systems analysis, needs assessments and strategic planning 

- Experience in developing multi-annual strategies for international NGOs. 

- Experience working with Ministries of Health in the Middle East. 

- Experience of the Jordanian context.  

- In the case of a consultancy team, propose a gender-balanced team to ensure access for women and girl beneficiaries.  

- Experience in participatory/qualitative information collection methodologies.  

- Experience within evaluations of complex strategies or projects in international development cooperation, especially in health projects.  

- Strong analytical and facilitation skills 

- Proven track record in conducting data collection and evaluation studies, especially in health projects, is an asset.  

- Demonstrated experience in cultural sensitivity.  

- Excellent English writing skills and Arabic proficiency.

Reporting and Coordination

The consultant will report to CDE Jordan Head of Mission and coordinate closely with the technical and program teams.

Application Process

Interested candidates should submit:

A technical proposal including:

- An understanding of the Terms of Reference; 

- The evaluation methodology put forward by the evaluation team;  

- The composition of the team, distribution of responsibilities among its members, CVs submitted and availability -of members;  

- The provisional timetable for the assignment as well as an estimate of the costs per person per day;  

- References from two similar previous assignments;  

 

A Financial proposal including: 

- The total budget including all tax and incorporating a break-down of the budget – fees, living costs, transport, etc, following the below budget template

        CODE 

        DESCRIPTION 

        Qty 

        Unit 

        No. of Unit 

        Unit cost 
        (EUR) 

        Total Cost (EUR) 

          

        1. National Child Health Needs Assessment 

        1 

        XXXXX 

          

          

          

          

          

        2 

        XXXXX 

          

          

          

          

          

        3 

        XXXXX 

          

          

          

          

          

        .. 

        … 

          

          

          

          

          

        .. 

        … 

          

          

          

          

          

          

        2. Public Hospital Readiness Assessment 

        1 

        XXXXX 

          

          

          

          

          

        2 

        XXXXX 

          

          

          

          

          

        3 

        XXXXX 

          

          

          

          

          

        .. 

        … 

          

          

          

          

          

        .. 

        … 

          

          

          

          

          

          

        3.Strategic Planning 2026–2029 

        1 

        XXXXX 

          

          

          

          

          

        2 

        XXXXX 

          

          

          

          

          

        3 

        XXXXX 

          

          

          

          

          

        .. 

        … 

          

          

          

          

          

        .. 

        … 

          

          

          

          

          

         

         

         

         

         

         

         

          

        Sub Total 

          

          

          

        VAT XX% 

          

          

          

          

        Total Budget

Deadline for applications: 25 April 2026. Submit applications to: admin.jordan@chainedelespoir.org

La Chaîne de l’Espoir

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Consultancy: Pediatric Health Needs Assessment and Strategy Revision