Terms of Reference (ToR)
Implementing Partner for Monitoring and Documentation of a Project on Preventing Maternal Mortality among Adolescent Girls and Young Women (AGYW) in Thaba-Tseka and Mokhotlong Districts
1. Background
Lesotho maternal mortality ratio is high at 530 per 100,000 live births (DHS 2024). This is largely due to limited autonomy of women and girls to make their own decisions on sexual relations, use of contraception and health care resulting from age, age at first marriage, education level, and place of residence. In Lesotho, 62% of maternal deaths are among adolescent girls and young women (AGYW) below the age of 24 (2023 Maternal Health Report). Most of these pregnancies are early and unintended for several reasons. Many AGYW, especially those in the rural areas do not have full knowledge about how pregnancy occurs and how it can be prevented. For those who have knowledge, they may not access family planning (FP) services even where they are available because their families and communities disapprove. AGYW uptake of FP services including information is also deterred by negative attitudes of health professionals and auxiliary staff (security guards and cleaners). These are largely because of societal norms that do not approve of AGYW having sex outside of marriage. Consequently, unmet need for family planning is higher at 21% in remote underserved areas and among AGYW (24.5%) than the national average (13%). New HIV infections are also high in this population, estimated at 89% and 76% for AGYW 10-19 years and 15-24 years, respectively (2023 HIV Estimates), all pointing to unprotected sex. EUP and high HIV infections among AGYW are also associated with high levels of GBV including IPV.
Many AGYW are already in marriage union sometimes against their will indicating high rates of child marriage at 24% (2016 Census). Some AGYW husbands prevent their wives from using FP for fear that they would become sterile if their wives used (UNICEF 2017). Grandmothers, who could be mothers, or the mothers-in-law of the pregnant women and are believed to have experience in childbirth and care, can also encourage or discourage uptake ANC and PNC services. Some administer traditional concoctions before, during and after pregnancy. In addition, women with no education and or come from less educated communities and families tend to use fewer contraceptives (38% of them used some form of contraceptive versus 60.2% at the national level); are less likely to give birth in a health facility (51.8%) or to have postnatal check-ups (47.3%). When they go for ANC services, it is usually late. The late presentation at ANC services is also influenced by several factors. AGYW who get pregnant outside of marriage are likely to hide their pregnancy or not get support from parents and thus not attend ANC because of the stigma related to premarital pregnancy. If they are in marriage, they are likely to hide pregnancy for fear of being bewitched if the community and relatives were to be aware of their pregnancy. Other women cite rudeness of nurses during the actual birth as a deterrent to attend ANC programmes (UNICEF 2017).
There is thus needed to address practices that limit AGYW bodily autonomy in relation to their SRHR such as knowledge of prevention of pregnancy, HIV and other STIs, child marriage and GBV, low uptake of family planning, late booking at ANC and delay in seeking help in case of obstetric emergencies. Finally, there is need to address service providers’ attitudes that deter AGYW from seeking SRH /HIV/GBV services and to strengthen systems to account for each maternal death, to increase accountability and quality improvement of MNCH services and avert more deaths.
In this connection, four UN Agencies; UNAIDS, UNFPA, UNICEF and WHO are implementing a joint multi-component intervention to reduce maternal mortality among AGYW in Mokhotlong and Thaba- Tseka, with a focus on community mobilisation, youth-friendly services and capacity building for health provider. To ensure that implementation is effective, evidence-driven, and accountable, UNAIDS requires services of an institution to lead monitoring and documentation efforts that capture progress, challenges, and lessons learned.
2. Purpose of the Assignment
To support evidence generation through continuous monitoring and comprehensive documentation of impact of interventions aimed at reducing maternal mortality among AGYW in Thaba-Tseka and Mokhotlong.
3. Objectives
- To track and assess the implementation progress of project activities across the two districts.
- To document the experiences, stories, best practices, innovations and community transformations resulting from the project.
- To generate evidence, learning, and recommendations to inform policy and programming on maternal health for AGYW in hard-to-reach areas.
4. Scope of Work
The Implementing Partner will:
a. Monitoring
- Conduct rapid baseline, midline and endline knowledge, attitudes and practices (KAP) assessment in relation to EUP, child marriage, GBV and FP will be undertaken among AGYW, men, boys and elderly women
- Develop and implement a results-based monitoring plan to monitor key indicators such as:
- AGYW knowledge and attitudes towards maternal health
- Access to and use of adolescent-responsive ANC, delivery, and postnatal services
- Community engagement and male involvement and health system responsiveness
- Referrals, uptake of maternal health services including timely ANC bookings, skilled delivery, and postnatal care
- Perform data analysis, also through secondary analysis of data from relevant national surveys etc and present key findings to project stakeholders during review and reflection meetings.
b. Documentation
- Produce human-interest stories, case studies, and thematic briefs from the project.
- Document community and system-level changes, lessons learned and best practices resulting from project interventions.
- Prepare photo essays, video documentation, and other visual evidence.
- Support the development of donor reports and presentation materials.
c. Capacity Building
- Train and mentor field staff and community volunteers on basic monitoring tools and storytelling techniques.
- Support community health workers and youth peer educators to gather and report meaningful data.
d. Reporting
- Submit monthly and quarterly monitoring summaries and reports.
- Provide data visualizations (e.g., dashboards, charts) for stakeholder presentations.
- Produce a comprehensive final documentation report with key learnings and policy recommendations.
5. Deliverables
- KAP Baseline report
- M&E plan and tools tailored to the AGYW maternal health context.
- Monthly monitoring briefs and quarterly progress reports with key data trends, success stories, and challenges
- At least 4 human-interest stories (2 per district) and 2 case studies on project impact.
- One final documentation and learning report (including photos and quotes from AGYW).
- Participation in district and national review or dissemination forums.
6. Duration
This assignment will run for 17 months.
7. Geographic Focus
- Thaba-Tseka District
- Mokhotlong District
Specific community councils and implementation areas will be defined in coordination with the District Health Management Teams (DHMTs) and the lead implementing agency.
8. Required Qualifications and Experience
- Locally registered institution with proven expertise in monitoring, evaluation, and documentation in the health or development sectors.
- Experience in adolescent and maternal health programming is highly desirable.
- Ability to work in rural, hard-to-reach areas and engage local stakeholders in Sesotho.
- Familiarity with Lesotho’s health system and rural/remote district contexts.
- Experience working with the UN
- Skilled in participatory approaches to data collection and storytelling.
- Strong analytical and report-writing skills.
- Fluency in Sesotho and English.
9. Supervision of Consultancy:
The Consultancy will be under the overall supervision of UNAIDS Lesotho Country Director and direct supervision of Equality and Rights for All Adviser.
Interested consultants must submit their Technical and Financial Proposal to [email protected] with a copy to [email protected] on or before 14 July 2025.