Terms of Reference

Accessibility and Safety Audit of selected Healthcare Facilities in district Badin, Sindh Province

Assignment Information

About WaterAid

WaterAid is an international NGO working in 28 countries including Pakistan. Our vision is of a world where everyone everywhere has access to safe drinking water, sanitation and hygiene (WASH). Our mission is to transform the lives of the poorest and most marginalised people by improving access to safe drinking water, sanitation and hygiene. We support local organisations and government authorities to design and demonstrate appropriate, climate-resilient, inclusive and sustainable WASH programmes. WaterAid also seeks to influence policy change to secure and protect the entitlements of marginalised and vulnerable people to safe, accessible and affordable drinking water and sanitation services.

For more information, please visit www.wateraid.org.

Background

Sustainable and safe WASH are essential foundations for human health. Adequate WASH services improve public health and significantly lower the morbidity burden. Access to improved WASH services can prevent up to 42% of underweight cases in Sindh alone correlated to bacterial and diarrheal infections. Improved water sources reduce diarrhoea morbidity by 21% and washing hands at critical times can reduce the number of diarrhoea cases by 35%. WASH related health indicators and the situation of WASH in Healthcare Facilities (HCFs) are generally lacking in Pakistan. The link between poor WASH conditions/ services, low health status, and increased health expenditure impacting their economic status is not understood at the community level. This places additional burden on the marginalised groups, especially women in part due the extra burden it places on them to care for those who are sick from poor wash and hygiene.

Gender equality and social inclusion is one of the key pillars of the programme approaches outlined in Country Programme Strategy (2023-2028) of WaterAid Pakistan. Mainstreaming gender equality and social inclusion in Water, Sanitation, and Hygiene (WASH) programs is essential for promoting sustainable and inclusive development. Gender dynamics play a critical role in access to WASH services at Health Care Facilities, (HCFs), with women, young girls, pregnant women, caregivers, children, people with disabilities (PWDs) and older people disproportionately impacted by a lack of access and safety to WASH services in HCFs and currently least likely to have voice in planning or decision making about these same services.  

Challenges in accessing safe and accessible WASH facilities in HCFs can significantly impact women's health, particularly in managing menstrual hygiene and ensuring well-being during pregnancy. Limited accessibility and safety in WASH services further heighten vulnerabilities, especially for women, pregnant women, elderly women, young girls, children and PWDs in rural or marginalized communities, where gender inequality restricts access to resources, decision-making power, and adaptive capacity. Addressing these challenges requires a gender-responsive and socially inclusive approach that prioritizes the safety and accessibility of WASH services, integrates climate resilience, and promotes equitable health protection. This approach empowers women and vulnerable groups to better adapt to and mitigate the health impacts of climate change. WaterAid is committed to ensuring that WASH services in HCFs are accessible and safe for all, including women, young girls, pregnant women, caregivers, children, PWDs and older people and other vulnerable groups. To this end, WaterAid has planned to conduct an accessibility and safety audit of WASH services in selected HCFs in Badin. This audit will evaluate the accessibility and safety of these services and ensure compliance with national and international standards for WASH in healthcare facilities.

An Accessibility and Safety Audit is a simple yet powerful tool to assist the people responsible for WASH programming, to make these services inclusive for everyone, including women, young girls, pregnant women, caregivers, children, PWDs and older people.  Accessibility and safety audits are participatory and practical tools that can be used to rapidly assess a facility's usability from the perspective of users whose requirements are often ignored in standard design. The accessibility and safety audit will provide evidence-based recommendations to take basic accessibility measures to ensure gender-responsive and socially inclusive, climate-resilient WASH services in healthcare facilities. 

Purpose of the assignment:

The objective of this assignment is to conduct the accessibility and safety of existing Water, Sanitation, and Hygiene (WASH) facilities and their surroundings in selected HCFs Identify necessary improvements to ensure these facilities meet the needs of diverse users, including women, young girls, pregnant women, care givers, children, PWDs and older people and develop actionable recommendations aligned with national and international WASH services standards for healthcare facilities.

Scope of the work:

An accessibility and safety audit will be conducted across 12 targeted primary and secondary healthcare facilities in district Badin using WaterAid standardized tool for accessibility and safety audit. This audit will provide a roadmap for enhancing the accessibility and safety of WASH facilities for all users, with a particular focus on women, young girls, pregnant women, care givers, children, people with disabilities PWDs and older people in these 12 primary and secondary-level healthcare facilities. The consultant/firm will conduct the accessibility tests for the WASH facilities based on international practices in HCFs. The audits will take into account the needs of people with different disabilities in order to improve mobility for people with multiple disabilities, such as entering and leaving the premises, as well as the use of services within the building and guidance systems for people with visual or hearing disabilities.

Details of HCFs:

Methodology:

The consultant/firm will:

• Conduct a detailed desk review of relevant guidelines, policies, and standards (e.g. WHO guidelines, national WASH standards for HCFs and WaterAid’s Accessibility and Safety Audit Tool for Health Care Facilities).

• Create a team that will guide the process and conduct the audit and ensure it is conducted in a participatory way (participants of group will include member from women’s groups, disability organizations, WASH experts, HCF users (staff, clients and family caregivers), local government and HCF management. This team would inform how to approach the audit and help conducting the audit in at least 3-4 of the main HCFs.
• Consultant will lead a similar process in other HCF by assembling a team that is more local to the selected HCFs.
• Adapt WaterAid’s comprehensive accessibility and safety audit tool to Pakistan (based on national standards) and tailored to the context of the selected HCFs.
• Conduct field visits to selected 12 healthcare facilities in Badin, forming and engaging with participatory teams in each location.
• Evaluate the current state of WASH facilities, focusing on accessibility, safety and usability and compliance with relevant standards as per the accessibility and safety audit tool.
• Engage with key stakeholders, including healthcare staff and facility users, to understand existing gaps and challenges.
• Prepare a detailed report summarizing findings, gaps, and prioritized recommendations for each health facility separately.
• Provide a roadmap for implementing improvements to ensure accessibility and safety for all users.

Deliverable:

1.     Participate in a half-day training conducted by the WaterAid Pakistan team to gain clarity on the assignment's purpose, methodology, and the use of WaterAid's accessibility and safety audit tool for HCFs.

2.     Inception Report: A comprehensive report of the accessibility and safety audit methodology, tools, techniques, field implementation, data analysis and reporting plan.

3.      Draft Report:  Comprehensive report comprised of Identification of good and bad practices in the physical environment, design and layout with special reference to gender and persons with disability access and safety, identifying obstacles to people with mobility and sensory impairments, recommendations for solutions to accessibility related problems and need analysis of assistive devices in the targeted health care facilities. The recommendations will be prioritized into absolutely essential work so as to remove major obstacles or comply with international standards of WASH facilities in HCFs.

4.     Final Report: Submit revised comprehensive report incorporating WaterAid team’s feedback along with actionable recommendations, tools list and pictures for wider circulation.  This final report should include feedback and recommendations from the participatory teams and the consultants on the accessibility tool and the process followed.

5.     Policy Brief and Presentation: A summary presentation of the key findings and recommendations and policy brief for relevant stakeholders, including health department officials, Sector partners, women's organizations, and organizations working with and for people with disabilities etc.

Duration of assignment

WaterAid intends to receive the services of a selected consultant/firm with total level of efforts of 20 working days spreading over 2 months commencing from the agreement signing date.

Deliverables and timeline

Supervision

Gender Advisor, WaterAid Pakistan will be the focal point for this assignment with inputs from WASH technical experts in WaterAid Pakistan.

Intellectual Property Rights

Intellectual Property Rights in all documents/ information/ other materials prior to the date of execution of an agreement pursuant to this bid shall vest in the Party to which such document/information/materials belong. 

All Intellectual Property provided by WaterAid Pakistan to the Consultant for performing the obligations under the agreement with WaterAid shall remain the exclusive property of WaterAid Pakistan.

Any video produced/ data collected, or any other Intellectual Property generated by the Consultant pursuant to or under the agreement with WaterAid shall be the exclusive property of WaterAid Pakistan.

WaterAid will hold the intellectual property rights for the final animated video and any and all assets developed during the project.

Evaluation criteria

1. Each candidate shall submit technical and financial proposals in two separate sealed envelopes. Technical offers will first be evaluated according to the “Evaluation criteria” below and the technical qualification threshold is “70%”. Financial offers of ONLY successful candidates will be opened.
2. Selected vendors will be invited to participate in pre-award meetings to ensure a mutual understanding of the project's requirements, clarify any queries, and discuss expectations before the bid is awarded.

a.                                   Technical Evaluation criteria

b.    Financial offer

For Financial offer, each deliverable must be included in the financial offer. All deliverables MUST be completed within the assignment duration.