Consultant for Pediatric Pneumonia Program Evaluation in Zanzibar

1. Background and Purpose

D-tree is seeking proposals from qualified firms, research institutions, or organizations to design and implement a 15-month evaluation of a program strengthening the continuum of care (CoC) in Zanzibar — defined as the bi-directional care pathway between community and facility levels, supported by health worker collaboration around patient cases. The evaluation is expected to provide credible evidence on program impact across four domains: patient experience, health outcomes, cost to the health system, and potential for adoption or scale-up.

Strengthening continuums of care is a core pillar of D-tree's 2025–2028 organizational strategy. The program portfolio is in early stages of design and implementation; Zanzibar's program focuses initially on pediatric pneumonia in the South District, Unguja.

 D-tree is therefore seeking an evaluation partner–which may be a single institution or a collaboration or consortium including multiple institutions or experts–with strong experience in health and mixed-methods approaches, including contribution based evaluation and cost-effectiveness analysis in NGO or development contexts.

2. Objectives of the Evaluation

The overarching objective is to rigorously assess the outcomes and emerging impacts of the program(s) over 15 months. Specific objectives include:

• Assess and provide robust evidence of the extent of project outcomes in improving the continuity of care across multiple levels of care (community, primary, and district) and their contribution to improved patient experience, health outcomes, and cost efficiency.
• Understand and document how collaboration and coordination across levels of care drive outcomes and continuity of care.
• Identify what is working, what is not, and the key drivers and barriers to impact at each level.
• Generate actionable learning to inform program adaptation, scale-up, and strengthening of multi-level care linkages.
• Generate high-quality evidence suitable for dissemination through peer-reviewed scientific publications.

3. Scope of Work

The breadth and depth of the evaluation will be informed by the indicative evaluation criteria and questions outlined below. The evaluation will assess the results and likely long-term impacts of the project in unlocking more efficient, cost-effective, and accurate care delivered at the right time, in the right place. The geographic scope includes Kitogani District Hospital and four primary health care facilities, namely Makunduchi Health Center, Kizimkazi Health Center, Paje Dispensary, and Jambiani Health Center, located in the South District. The overall timeframe of engagement for the evaluation is 15 months from contract signature, starting with a baseline assessment in Q2 2026 and ending in an impact assessment within 12 months from the date of contract signature. 

4. Evaluation Approach and Methodology

D-tree anticipates a mixed-methods participatory evaluation approach, combining quantitative and qualitative data sources. Data sources can include primary data collection, published secondary data, and D-tree monitoring data. The evaluation is expected to apply an implementation research lens to systematically document key design and adaptive decisions, examine the mechanisms through which these decisions were operationalized, and analyze how they influenced implementation processes, intermediate outcomes, and ultimately impact within the health system context. 

Candidates should address the following evaluation criteria and questions within the technical bid. During the inception phase, the selected vendor will be expected to refine and prioritize the evaluation questions and indicators in consultation with D-tree, and may propose a phased evaluation approach aligned with implementation milestones, learning needs, and available resources.

The approach should:

• Include collaborative engagement with D-tree stakeholders, including co-designing indicators, interpreting finding and co-creating recommendations
• Address both contribution and attribution to measurable results 
• Include baseline and impact evaluation with defined indicators
• Integrate documentation of implementation practices, learning, and reflection throughout the evaluation period to inform program adaptations, improvements, and broader application
• Leverage and triangulate using multiple sources of data, including existing monitoring and administrative data where possible
• Consider local contextual factors such as care seeking practices and epidemiological trends

Evaluation Criteria, Key Evaluation Questions, and Suggested Indicators:

Relevance

Key evaluation questions:

• How and to what extent did the project's objectives and design respond to the needs of individuals who receive care, health facilities, community health workers, and the national government?
• To what extent was the intervention implemented as intended at each level of care (community health workers, primary health facilities, district facilities)? What adaptations were made during implementation, and why?
• To what extent are populations excluded from accessing care, and what structural, geographic, or socio-economic barriers contribute to these inequities?

Suggested indicators:

• % of patients, health workers, and government staff reporting the intervention addressed a key barrier they previously faced
• % of community health workers and target health facilities implementing protocols as intended

Effectiveness (Drivers of outcomes)

Key evaluation questions:

• Who was reached by the intervention (patients, community health workers, primary health facilities, district facilities)?
• How and to what extent did the project improve adoption, usability, and interoperability of the digital systems/tools?
• How and to what extent did the project improve the collaboration of health care providers across the primary health care system?
• How relevant was the training package for healthcare workers in addressing gaps in pneumonia management?
• How and to what extent did the project strengthen the continuity of care?
• What are the main enabling factors and barriers?

Suggested indicators:

• % of health workers with improved decision-making capacity
• % of health facilities with improved collaboration with CHWs and other health facilities
• % change in referral completion rates
• % change in health worker knowledge, attitudes, and behaviors

Efficiency (Cost and cost-effectiveness)

Key evaluation questions:

• To what extent did the program reduce costs to the health system?

Suggested indicators:

• $ of averted costs by averting severe cases of pneumonia
• Average number of patients managed per month

Impact (Long-term change)

Key evaluation questions:

• How and to what extent did the project improve patient health outcomes?
• How and to what extent did the project improve the experience of patients?

Suggested indicators:

• % improvement in reported or observed care-seeking behavior by pediatric pneumonia caregivers
• % improvement in health literacy and awareness of pneumonia
• % reduction in hospitalization for pediatric pneumonia
• % reduction in recurring hospitalization rate
• Reduced under-5 mortality rate
• % increase in patient satisfaction score
• Disability-adjusted life years (DALYs) averted

Sustainability (Durability of results)

Key evaluation questions:

• How and to what extent was the project designed for long-term sustainability?
• How and to what extent have the results (outputs) of the project been integrated into the health system?

Suggested indicators:

• Description of government integration/adoption
• Estimated $ of government funding mobilized
• % of government stakeholders reporting willingness to adopt/integrate the program

5. Deliverables

The following deliverables are expected to be submitted by the evaluator(s) by the deadlines indicated below. Timelines may shift depending on the length of the contracting process and when work is able to begin:

Deliverables and deadlines are as follows:

• Detailed evaluation plan, including data collection tools — due 31 May 2026
• Baseline Assessment Report, incorporating findings against implementation research–focused questions, including documentation and analysis of program design and initial activity implementation — due 15 August 2026
• Draft impact evaluation report — due 31 March 2027
• Final impact evaluation report — due 30 April 2027
• Summary report of analysis of the intervention logic and the extent to which objectives have been achieved — due 31 May 2027
• Minimum of 2 manuscripts for peer-reviewed publication — due 30 June 2027

6. Competency profile 

D-tree invites bidders to propose an evaluation team with the following minimum qualifications and experience:

Team composition

• The evaluation team must include at least one local evaluator with demonstrated experience working in the national or sub-national context. Teams with significant familiarity with the health contexts in Zanzibar and/or Tanzania, with the ability to travel regularly and at low cost to Zanzibar, are preferred.
• The team must include a Lead Evaluator or Principal Investigator (PI) with proven experience in methodological design, ethical oversight, quality assurance, reporting, and authoring peer-reviewed publications. The PI is expected to have the skills needed for comprehensive oversight and collaboration to ensure a cohesive team approach.
• Fluency in Kiswahili and experience working in Zanzibar is mandatory for at least one team member and for any team members conducting primary data collection. Fluency in English is required of the Lead Evaluator, Principal Investigator, and other key contributors.
• Proposals that demonstrate meaningful and equitable international–local institutional partnerships are preferred.

Academic and technical expertise

• Advanced degree (Master's minimum; PhD preferred) in public health, epidemiology, health economics, biostatistics, implementation science, program evaluation, development, or a related field.
• Demonstrated track record of leading and authoring multiple peer-reviewed publications in reputable academic journals.
• Proven expertise in the design and delivery of robust quantitative and qualitative evaluations, including experimental and quasi-experimental designs and health economic evaluations where appropriate.
• Experience developing, implementing, and supervising field data collection.
• Strong grounding in implementation research methodologies, including process evaluation, context analysis, fidelity assessment, and mixed-methods approaches.

Professional experience

• Minimum 10 years of experience leading evaluations of health interventions in low- and/or middle-income countries.
• Demonstrated experience evaluating interventions at the health facility level, community health level (e.g., CHWs, outreach, referral systems), and patient level.
• Experience conducting evaluations within complex health systems, including policy, health education, service delivery, and/or primary health contexts.
• Experience evaluating digital health interventions is strongly preferred.
• Demonstrated experience working in Zanzibar, including navigating regulatory, ethical, and institutional approval processes, is preferred.

7. Budget

The consultant will submit a proposed budget which will be reviewed and approved by D-tree. The consultant's proposed budget and costs should be presented in United States Dollars (USD). The total cost submitted by the consultant must be inclusive of VAT where applicable, and any other applicable taxes, duties, or charges in accordance with relevant laws and regulations. For the successful offeror, all invoices must be submitted in United States Dollars (USD), and all payments will be made in United States Dollars (USD) or in the equivalent amount in local currency as dictated by the terms in the  final contract.

Bidders are expected to demonstrate a realistic and cost-efficient allocation of resources aligned with the proposed methodology and scope of work. The budget must reflect the true cost, including all resources required to execute the scope of work, including but not limited to: 

• Team member fees;
• Field researchers, enumerators, supervisors, and data management personnel;
• International and domestic travel (including flights, accommodation, per diem, and local transport)
• Institutional overheads and administrative costs.
• Ethical approval costs
• Peer-reviewed publication costs
  
  

8. Duration and key milestones

The assignment is expected to run over a period of approximately 15 months from contract signature. The anticipated timeline is as follows:

The baseline assessment is expected to be conducted over approximately six weeks in (Q2 2026), and the impact assessment over approximately six weeks in (Q1 2027).

The remaining contract period allows for ongoing follow up with the D-tree team on implementation. It also enables ongoing evaluation plan refinement, protocol development, ethics approval, data cleaning, analysis, reporting, and stakeholder validation as required. 

9. Safeguarding and Ethical Considerations

The consultant(s) must:

• Sign and comply with D-tree’s Code of Conduct prior to starting the evaluation.
• Ensure all evaluation activities are conducted in a safe, inclusive and respectful manner.
• Apply ethical research standards, including informed consent, confidentiality and the do-no-harm principle.
• Promptly report any safeguarding concerns arising during the evaluation 

8. Application

To apply, please submit the following materials using this link:

1. Technical Proposal (not to exceed 5 pages) Include an overview of your team and roles; relevant past experience or credentials; technical approach; methodology; and proposed evaluation timeline.
2. Financial Proposal. Using the above scope of work, provide a detailed budget and budget narrative outlining proposed costs and the unit breakdown for each cost. Major budget categories to include salaries, fringe benefits, travel, equipment, supplies, contractual/consultants, other direct costs, and indirect costs/overhead. Budget should be submitted in an MS Excel or Google Sheets worksheet with formulas. Budget narrative explaining the budgeted costs to be submitted in MS Word or PDF and is not to exceed 2 pages. 
3. CVs of Key Personnel

Note:

• Upload the Technical Proposal and Financial Proposal (including budget narrative) under the “Cover Letter” section
• Upload CVs of key personnel under the “CV” section

Please note that by applying to this position, you consent to your name being checked against a terrorist watch list prior to an offer of employment.  

The deadline for submitting applications is April 24, 2026. Only shortlisted candidates will be contacted.