Individual consultant – short term assignment in Lesotho


SolidarMed is a leading non-profit organization working to improve the health care of 2.5 million people in Lesotho, Mozambique, Tanzania, Zambia and Zimbabwe. Working together with national partners to strengthen health systems and community capacities, we are committed to scientific evidence and policy dialogue both as foundations and objectives of our work.

We are looking for an

Individual consultant – short term assignment in Lesotho

Terms of reference – social enterprise component ComBaCaL project


In 2020 a consortium led by SolidarMed won a competitive call by the Swiss Development Cooperation (SDC) with a project to improve the health and well-being of people suffering from NCDs in Lesotho: CombaCaL (Community-Based chronic disease Care Lesotho). The other members of the consortium are the Swiss Tropical and Public Health Institute, the Ministry of Health Lesotho, the National University Lesotho (NUL) and a representative community leader.  Funding has been secured and the programme will last for 5 years, having started in Q1 2021.

Building on previous and ongoing community-based HIV/TB care and eHealth programs in two districts, Butha-Buthe and Mokhotlong, ComBaCaL aims to establish and validate a large-scale community-based NCD care model, built upon the Lay Health Worker (LHW) programme and integrated in HIV/TB care, with the following components:

i.            decentralized NCD care through lay health workers;

ii.           e-Health-assistance to monitor patients at village, facility, district and central level (incl. a patient
empowerment component);

iii.         self-sustainability through social entrepreneurship;

iv.          a cluster-randomized trial to generate policy-relevant evidence;

v.           co-creation of freely available generic training material and monitoring tools.

These Terms of Reference relate to (iii) the development of the social enterprise concept for the ComBaCaL programme. The social enterprise component plays an important role in the overall programme to ensure long-term sustainability beyond the secured funding cycle. It has been envisioned that the LHW will be enrolled into a programme that will enable them to earn an income in addition to the small monthly stipend provided by the Lesotho government for their health-related interventions. This initiative would lead to greater economic independence for the lay health workers, and it should ultimately enable a ‘spin off’ into an independent Lesotho-based social enterprise (or similar) by year 5 of the project.


The Kingdom of Lesotho is a mountainous, and landlocked country within South Africa. The surface of 35,000 square kilometers is divided into 10 administrative districts. Classified as a low-middle income country it has a total population of 2,173,390 with most of the Basotho (72%) residing in rural areas. The overall life expectancy stagnates at 53 years, 10 years less than South Africa.

The country experiences a double burden of disease with the continued high prevalence of communicable diseases and a rise in non-communicable diseases (NCDs). In 2018, HIV prevalence (15-49 years) was 23.6% and tuberculosis (TB) incidence was estimated at 724/100,000. During the last decades, Lesotho has made significant progress towards the global HIV and TB goals, with documented and operational cascades of care. This success is based on decentralized models of care and task-shifting to health workers at primary and community level to deliver accessible, equitable and differentiated services ensuring access for rural communities. However, NCD care in the country remains suboptimal with very poor and limited data about the actual care cascade.

SolidarMed aims to expand quality and reach of NCD care in two rural districts of Lesotho: Butha-Buthe (120,000 people) and Mokhotlong (100,000 people). Butha-Buthe is the most northern district of the country and includes lowlands (1500-2000m) and highland mountains (>2000m). The district is rural with most of its people surviving on subsistence agriculture. Butha-Buthe town is the major semi-urban town, situated about 129 km (2 hours’ drive) from the capital Maseru and hosts an increasing number of small-scale businesses. In general, the towns are growing at an accelerated pace and urbanisation is increasing. Butha-Buthe district has 2 hospitals (the government district hospital and the Catholic Seboche Mission Hospital) and 10 public health clinics spread throughout the district. Mokhotlong district is located to the south-east of Butha-Buthe and characterized by high mountains. It is extremely rural and suffers from harsh weather conditions with dry snowy winters. With the lowest population density (24/sq km), access to health services is severely compromised due to the poor terrain and road infrastructure. Mokhotlong town is 297 km from the capital Maseru (5 hours ‘drive) and 169 km from Butha-Buthe town (3 hours’ drive) along the only tarred national road in the district. Mokhotlong has 1 hospital (in Mokhotlong town) and 10 public health centres.

In a country where physical access to health facilities is a challenge for many rural communities, decentralised care represents a significant opportunity to improve the reach of the health care system. In close collaboration with MoH, SolidarMed piloted and evaluated several concepts of task-shifted, decentralized HIV/TB care. With CombaCaL, the lessons learnt from decentralised HIV/TB care models will be transferred to improve NCD management at community level.


The overall objective of these ToRs is to identify and develop a scalable social enterprise concept that best fits the local context and enables LHWs to generate personal revenue besides fulfilling their NCD care tasks.

Scope of work

The selected contractor shall include following tasks in its proposal:

1.            A review (literature and online) of what initiatives and social enterprises currently exist in LMIC with
summarized key learnings document.

2.           A representative market research study in the two districts to identify market dynamics, unmet
needs, willingness to pay and opportunities for business development opportunities for LHW. Qualitative and quantitative method as well as the approach is to be proposed as appropriate. As outcome, we foresee:

a.           Structured database and report (incl. pictures). Report is finalized based on client’s comments, and is
meeting international quality standards to enable extensive distribution.

b.           A summary of the top line findings ready to present to relevant partners and stakeholders.

3.           Propose 3 social enterprise concepts including value proposition and rough business plan as well as
preliminary financial projection. Of these options, the ComBaCaL consortium will select 1.

4.           Propose concept and implementation plan for the jointly identified and selected social enterprise
opportunity, including: detailed business plan (incl. risk & mitigation), financial projection, needed management structure, and strategy for scale.

Approach and Methodology

The consultant is invited to propose a detailed methodology considering the following frame:

  • Both districts of Butha-Buthe and Mokhotlong must be covered, given their different geographical character.
  • Ensure understanding of the role that LHW will fulfill in providing NCD decentralized care to the villagers and the need to integrate these activities in any proposed entrepreneurial activities.
  • Data must ensure sufficient level of detail for realistic financial projections including the revenue generation per LHW.
  • Risk assessment and proposed mitigation in the local context.
  • Include an involvement and communication plan including the consortium and any further stakeholders (as considered relevant for the successful long-term achievement of the objective).

Professional Qualifications

The consultant will be required to possess the following qualifications and experience:

  • Demonstrated experience in and knowledge of development of social enterprise.
  • Strong track record of having led, carried out and participated in research and publications of this type.
  • Demonstrate exposure and experience in utilizing the proposed methods (qualitative, observational, and quantitative).
  • Knowledge/experience working with a range of different stakeholders.

The consultant should demonstrate the following abilities:

  • Excellent report writing and English language skills;
  • A track record of innovative thinking;
  • Work independently within strict timelines;
  • Design market research studies, elaborate tools and validate them, analyse and present complex information; and,
  • Possess interpersonal, teamwork and communication skills.


The consultant should be available to undertake the assignment from July to October 2021 in Lesotho. Strict adherence to the timeframe is required. The consultant will also be required to attend stakeholders’ meetings upon request during the assignment period until the consultancy is finalized.

The debrief meeting with the stakeholders is scheduled to be held in Q4 2021 at a date to be arranged. At this meeting, the consultant shall be expected to present their draft report.

The final report and combined master plan shall be submitted to SolidarMed by 15 November 2021.

Structure of the proposal and submission Guidelines

Eligible consultant(s) should submit a consultancy proposal letter, along with their CV(s) detailing how they will approach the task, their background and a detailed budget, including their daily rate (and include tax, per diems, travel and other incidental costs) in electronic format. The submission should also include three references that can testify to the quality of previous assignments performed by the consultant.

Only electronic submissions to [email protected] will be accepted.

Deadline for applications

26th May 2021