Consultant, Case Study Research On Conflict Sensitivity In The Health Sector

  Terms of Reference: Case Study Research Good practice of conflict sensitivity in the health sector in Lebanon   Introduction International Alert is seeking to commission a case study research within the framework of its project on conflict sensitive healthcare provision. The project is funded by the European Union, through the United Nations High Commissioner for Refugees (UNHCR), and under the leadership of the Ministry of Public Health (MOPH) and implemented in partnership with UNHCR, WHO, UNICEF and International Relief and Development. The project aims to reduce tension between Lebanese host communities and Syrian refugees through improved healthcare services. As part of the project, in June-July 2014 Integrity Research & Consultancy conducted a conflict sensitivity institutional capacity assessment of the health sector. One of the findings points to the use of ad hoc measures by primary healthcare centres (PHCs), which were introduced in response to the decreasing number of Lebanese patients. Among the most common measures are segregation of waiting areas, separate appointment schedule for Syrian and Lebanese patients, and fast-tracking of Lebanese patients. The overall objective of this case study research is to increase the understanding of healthcare actors in Lebanon of the conflict sensitivity of their work. Specifically, the case study should identify and present at least five examples of good practice in conflict sensitive healthcare provision.   Background on conflict sensitivity in the Lebanese health sector   A growing number of reports point to an increasing tension between the Lebanese population and the 1.1 million registered Syrian refugees who have mostly found shelter in towns and villages across the country. The causes for such tensions are to be found inter alia in the competition over jobs and accommodation, which have pushed wages down and rent prices up. The presence of the refugees has also put a strain on the weak service provision, including primary public healthcare. A number of factors cause tensions related to healthcare provision. Firstly, out-of-pocket primary health care expenses for Lebanese patients are higher than the cost incurred by the Syrian refugees due to UNHCR providing subsidies for refugees’  consultations at the PHCs and for subsidized medication. With decreasing humanitarian funding healthcare NGOs face the challenge of using scarce funds to cover the healthcare needs of the most vulnerable. Secondly, behaviours and attitudes of PHC staff are often seen as discriminatory towards Syrian patients; negative attitudes usually relate to perceived lack of hygiene of the refugees and high birth rates. Thirdly, Lebanese healthcare users are themselves prejudiced against Syrians – issues of poor hygiene are paired with fears of lice and scabies, and often fueled by inaccurate perception that the refugees receive all services free of charge. In this context PHCs and health NGOs have introduced a range of temporary measures aimed to respond to the increased workload in the PHCs and specifically to the fears and concerns of the Lebanese. Examples of good practice include extension of waiting areas to accommodate a higher number of patients or delivery of awareness raising sessions in the waiting room to decrease tensions caused by longer waiting hours and to respond to identified needs. This case study aims to identify additional examples of good practice.   Scope of the case study and methodology This case study aims to inform the policies of PHCs and those of health INGOs, which partner with PHCs, related to the conflict sensitivity of the service provision. The specific objective of the case study is to identify examples of good practice in coping with the increased workload and the concerns of Lebanese patients in the PHCs. The case study is expected to identify at least five cases where positive measures have been applied. The following key questions are to be explored: -       What are the reasons behind PHCs adopting these measures? Were they introduced as reactionary or precautionary measures? Were they suggested by staff or PHC users? -       What reaction (approval, resistance) did these measures provoke among Lebanese and Syrian refugee patients? -       What possible mechanisms can be used for monitoring this impact? The analysis should be based on the following data sources: -       Desktop review of relevant documents, including project documents, baseline survey and institutional capacity assessment -       Interviews with NGO staff, PHC staff and Lebanese and Syrian refugee healthcare users about the effectiveness of the applied measures The case study research is anticipated to require 5-10 working days, including travel to conduct interviews with selected PHCs. Alert will provide support with the identification of NGOs and PHCs and ensuring access. The report will be property of International Alert. It will be presented to health care actors in Lebanon and used to stimulate discussion of models for increasing the conflict sensitivity of healthcare provision.   Researcher’s profile -       Strong knowledge of the Lebanese context and the implications of the Syrian refugee crisis on the Lebanese population -       A knowledge of the health sector and good grasp of the concept of conflict sensitivity -       Interpersonal skills that evoke trust and are gender and culturally sensitive -       Ability to conduct interviews in Arabic or planned work with an Arabic speaking assistant with strong interpersonal skills and cultural sensitivity -       Strong analytical skills -       Excellent English language writing skills   How to apply Please e-mail i) a CV and ii) expression of interest including a brief methodology, work plan and budget including fees and transportation costs, and stating your availability to islavova@international-alert.org by 20 May 2015.