TERMS OF REFERENCE FOR 

BASELINE ASSESSMENT OF AGENTS OF CHANGE PROJECT IN NYAMAGABE DISTRICT – RWANDA

Background

WaterAid, founded in 1981, is an international NGO dedicated to improving access to safe water, sanitation, and hygiene (WASH) in developing countries. WaterAid Rwanda, established in 2010, works with national partners such as the Ministry of Health and Ministry of Infrastructure to strengthen Rwanda’s WATSAN sector. From January 2026 to March 2028, WaterAid Rwanda is implementing the Agents of Change Project in Nyamagabe and Bugesera Districts, funded by Scottish Water and Northern Ireland Water. The project delivers gender-responsive, climate-resilient WASH services integrated with health promotion, infection prevention and control (IPC), and behavior change communication (BCC) in Kaduha and Kigeme District Hospitals and four Bugesera schools.

The 27-month project (Jan 2026–Mar 2028), led by WaterAid Rwanda will deliver climate-resilient WASH interventions including water supply networks, rainwater harvesting, inclusive sanitation, and Menstrual Hygiene and Health (MHH) facilities, alongside behavior change communication campaigns. These efforts aim to reduce healthcare associated infections and waterborne diseases, improve sanitation in schools and health facilities, increase girls’ school attendance through MHH rooms, and support the national school feeding programme with clean water. The Project interventions will target different institutions including Kaduha and Kigeme District Hospitals and four schools (GS Rutonde, Dihiro, Mbyo, and Mayange), benefiting 372,101 people in hospital catchment areas, 9,527 schoolchildren, and 252 staff. 

Outcome 1: Improved standards of WASH in health care facilities to contribute to the reduction of healthcare-associated infections in Nyamagabe District (Kigeme and Kaduha hospital), by March 2028.

Outcome 2: Improved WASH service in Kaduha and Kigeme Hospitals, by March 2028

Outcome 3: Enhanced Hygiene behavioral change practices in health care facilities

Outcome 4: Improved sustainable, inclusive and climate resilient WASH services in Schools

This project will deliver integrated solutions to close WASH-IPC gaps in Nyamagabe Healthcare facilities (HCFs) and Bugesera targeted schools: (i) Provide gender-responsive and inclusive WASH infrastructures in HCFs and schools, (ii) Improve WASH services access and contribute to the reduction of WASH related diseases in the two HCFs in Nyamagabe District (iii) Enhance IPC and hygiene practices capacity for healthcare providers, cleaners, and community health workers (iv) Improve water access in four schools of Bugesera District through provision of rainwater harvesting (RWH) systems, and (v) Enhance staff knowledge and skills on proper maintenances of the RWH systems.

2. Rationale of the baseline assessment 

The baseline assessment is going to be carried out to be the foundation of any evidence-based hygiene behaviour change initiative, WASH and IPC status in healthcare facilities in Kigeme and Kaduha catchment area. The current baseline assessment will cover two key important thematic areas including the formative research; IPC and WASH assessment: (1) The formative research will be used to collect evidence on current hygiene practices, the factors that influence them, and the types of hygiene behaviour change needed in Nyamagabe District. An understanding of the barriers to practices among target populations is also needed to plan and design effective, engaging programmes. (2) Infection Prevention and Control (IPC) and WASH assessment is to determine the status of IPC and WASH implementation and measure compliance with established standards at Kigeme and Kaduha Hospitals, as well as the health centers within their respective catchment areas.

3. Purpose of the assignment

The main purpose of this consultancy is to conduct a baseline assessment in Kaduha and Kigeme District Hospitals including the health centers in the catchment area to establish the pre-intervention status of WASH (Water, Sanitation and Hygiene) and IPC (Infection Prevention and Control) services. The assessment will also generate benchmark data for measuring project outcomes and impacts over time and provide formative research findings to guide the design of the Hygiene Behaviour Change Communication (HBCC) package.

Specifically; 

 WASH and IPC Baseline Assessment:

The consultant is expected to but not necessarily limited to the following specific areas:

1. Assess the status of WASH services, waste management and Environmental Cleaning services in Kigeme and Kaduha hospitals including 30 health centres. Assess the proportion at district hospital level for health centre level comparison.
2. Evaluate the establishment and functionality of IPC committees and focal persons in healthcare facilities.
3. Identify the level of HCAIs in Kigeme and Kaduha Hospitals including in health centres 
4. To assess monitoring, supervision, and reporting mechanisms supporting IPC programme performance including feedback mechanisms.
5. Assess the IPC knowledge level of healthcare staff and other support staff
6. To identify the gaps in the IPC program and overall staff and patient safety in Kaduha and Kigeme hospital, including the health centres in their respective catchment area. 
7. To determine the adequacy of resources, staffing, and budget allocation for IPC programme implementation.
8. To identify gaps in IPC programme implementation and recommend actions to strengthen infection prevention and control practices.

 Behavior change 

The consultant is expected to but not necessarily limited to the following specific.

areas:

1. Understand specific WASH behavior determinants (environmental motives and barriers). Specifically:

a) Assess current institutional hygiene behaviors below and their determinants (physical, social, biological, and psychological) in selected HCFs. Document differences by geography and by socio-demographic variability:

• Handwashing with soap at critical moments that are context specific (HCF)
• Hygienic use of sanitation facilities including child faeces management
• Water treatment and storage practices
• Waste management
• Environmental cleanliness
• Food hygiene (food handling practices)
• Child feeding practices.
• Menstrual Hygiene Management in HCFs

b) Other relevant behaviors as identifying through initial mapping i.e. review of documents and previous interventions

c) Identify the most promising motivators for change in behavior, i.e., the aspirations and desires most likely to be effective in promoting change in WASH behaviors in different settings. (Motives for practicing different behaviors should be clearly documented). 

d) Identify cues for hygiene behavior change in the setting.

e) Identify barriers to the prioritized hygiene behaviors in the setting.

f) Assess and document current hygiene promotion activities/interventions in the setting and lessons learnt; available corresponding hygiene messages, including institutional financing and departmental responsibilities as well as propose other possible entry points for good hygiene promotion.

g) Assess and determine various touchpoints to reach with different target populations (HCW, women, youths, clients, adolescents, husbands) through the robust hygiene behavior change promotion initiative.

h) Identify the most appropriate means/channels of communication for hygiene promotion, to inform the design of the promotion package thus the designing for behavior change (BCD) process.

i) Document current routine hygiene behavior change lessons provided at the centers and propose other possible entry points for good hygiene promotion activities. 

j) Assess the potential public health risk from the current hygiene practices

2. Assess the extent to which hygiene promotion in HCFs, is happening and is suited to the priorities and needs of HCW, patients intend to benefit, with specific reference to the experiences and opinions of HCW and communities. 

3. Assess the extent to which WASH is integrated into different HCF services or departments.

4. Assess whether there are indications or measures for long-term sustainability of the WASH interventions and the extent to which user communities and other local structures are or could be integrated in the project implementation processes.

Key questions to be answered by the formative research.

The formative research will try to answer following questions among many others: 

• Social norms: Under what circumstances is open defecation considered acceptable in rural communities? At what age are children expected to start using a toilet?
• Sanctions/enforcement: What are negative consequences, if any, for those who defecate in the open? To what extent are sanctions enforced and effective influencing behaviors? Who are the community whistle-blowers and how influential are they? 
• Knowledge: What do people consider a safe or sanitary toilet? Do they know where to get quality sanitation services? What sanitation products are they aware of?
• Skills/self-efficacy: Among individuals who intend to build a toilet themselves, how confident are they in their skills/ability to build a good one?
• Social support: To what extent in the community are disabled, elderly or children assisted to go to a toilet? To what extent do people let neighbors use their toilets and under what circumstances?
• Roles/decisions: Who initiates the discussion about sanitation in rural households? Who decides on the budget? Who influences decisions on features? Who “shops” for the toilet? How does gender affect decision making?
• Affordability: What can the household afford to pay for a toilet all at once? In multiple installments? How is affordability influenced by seasonality? How does perceived affordability differ from the actual?
• Beliefs and attitudes: At what age are children’s excreta considered harmful? What beliefs might explain this? What taboos and beliefs exist with respect to feces and menstruation that would influence behavior?
• Values: Which social or cultural values, if any, do sanitation support (such as modernity and progress)? To what extent is improved sanitation seen to increase a home’s value?
• Drivers: What are the principal drivers (social, physical, or other) that motivate people to stop defecating in the open, stop sharing, or to improve their facility? How do these vary by gender and life stage?

Key questions to be answered by for WASH and IPC assessment

• Does the facility have access to water services for healthcare activities and patient needs? 
• Are adequate, accessible, clean, and functional sanitation facilities available for patients, visitors, and staff?
• Are hand hygiene facilities available, and are healthcare workers consistently practicing proper hand hygiene?
• Healthcare waste safely segregated, handled, treated, and disposed of according to recommended standards?
• Are healthcare environments routinely cleaned and disinfected using appropriate procedures and supplies? What are the strategies in place to monitor?
• Does the facility have an effective IPC program with governance structures, guidelines, monitoring systems, and resources?
• Do healthcare workers, cleaners, guards and other support staff possess adequate IPC knowledge and consistently apply recommended infection prevention practices?
• Is appropriate PPE available, accessible, and correctly used by healthcare workers when required?
• What is the burden of HAIs in the facility, and how effective are current measures in preventing them?
• Are WASH and IPC standards adequately implemented in high-risk areas such as maternity, neonatal, and surgical units?
• How effectively do leadership, policies, financing, and accountability systems support WASH and IPC implementation
• Do all patients, and People with disabilities, have equitable access to WASH and IPC services?
• Is the facility adequately prepared to prevent, detect, and respond to infectious disease outbreaks and public health emergencies?

4. Methodology

The baseline assessment will be descriptive, observational and exploratory in nature, employing a mixed methods and cross-sectional study design. The research will be conducted in Nyamagabe District (Kigeme and Kaduha District hospital catchment areas). The entire process of conducting the Baseline assessment and submitting the final report will last four (4) weeks including design of intervention from Final agreement on tools and process. 

Thwell-detailed will provide a well-detailed methodology for this assignment. 

5. Timeframe 

This baseline assessment is expected to be completed within four weeks after signing the contract, this period including preparation, agreeing on the research methods, field work, sharing preliminary findings, designing the approaches, report writing, and sharing of the finalised reports and presentations with WaterAid.

6. Scope and key deliverables of work 

A firm or individual consultant will be required to undertake the review or develop baseline survey tools, deep analysis and developing a comprehensive baseline survey report that reflect the status of WASH and IPC in Kigeme and Kaduha District hospitals and health centers in their catchment area and the current hygiene practices in HealthCare facilities. 

A. Tasks and Responsibilities of short-term consultant 

The assignment encompasses the following activities among others:

• Review of project documents (project proposal, result framework) to get familiar with the key activities, expected outcomes, and indicators for which baseline values are needed.
• Elaborate inception report including data collection tools for quantitative and qualitative data collection. 
• Review/develop of qualitative and quantitative indicators with variables responding to the project result framework indicators.
• Conduct data collection and frequency checks in the targeted areas,
• Review, data cleaning and analysis, including sex, age, and disability disaggregation for all indicators where possible. 
• Report writing and addressing comments from reviewers, 
• Finalization of the baseline assessment report and its presentation during validation and dissemination session.

B. Key expected deliverables:

The consultant (s) or firm is expected to produce the following deliverables:

• Final inception report including detailed Methodology and approaches, data collection tools and research protocol to meet all objectives and answer all research questions, in English and in Kinyarwanda.
• Draft reports detailing the results of the baseline assessment. 
• A single, integrated analysis report on the approaches and recommended communication strategy.
• Study fact sheet
• Presentation slides and other research uptakes for the dissemination workshop. 
• A final baseline report for the accomplishment of the forementioned tasks.
• Raw data and metadata files (data collection tools for both qualitative and quantitative).

The final assessment report will include the background and review of the literature on Hygiene behavior change, research objectives, research methods, results (prevalence practices, determinants, motives, barriers, touch points for all hygiene behaviours and sanitation), and WASH/IPC status, discussions and recommendations for developing intervention strategies. WaterAid Rwanda shall be the owner of the study and its deliverables including the data generated from the research.

a. Ethical Considerations, Confidentiality and Proprietary Interests

The baseline survey must adhere to WaterAid’s Global Evaluation Policy, Global Standard on Child Safeguarding, and Code of Conduct. The survey will require ethical approval from legalized Institutional Review Board, working under RNEC mandate to allow the publication of the study findings in different journals where necessary. The survey will also be carried out under the authorization of the respective Mayor of the District.

WARW will ensure confidentiality of interviewee statements is respected, refraining from making judgmental remarks about stakeholders, and collecting informed consent before any data is collected.

7. Supervision and approval of the work

WaterAid Rwanda, Ministry of Health through the Environmental Health and districts’ stakeholders will lead and supervise this consultancy 

8. Essential Skills and Experience / Evaluation criteria

The consultancy firm or consultant should have the following;

• The head consultant must hold a postgraduate qualification (with PhD or Masters) in Environmental Health or public health or with experience in applying qualitative and quantitative research methods with at least 10 years of relevant experience.
• Demonstrated practical and relevant experience in conducting similar assessments in WASH sector specifically for NGOs or INGOs and Donor funded projects (with at least three completion certificates / Reference letters). 
• Knowledge and experience in using statistical packages or other tools for data collection and analysis such as CsPro, Stata, Mwater, R or Python, Nvivo , among others.
• Administrative documentation : RDB certificate, Tax clearance certificate and recent CIT certificate.
• Financial Offer: Clear and well-structured presentation of the key cost components, with detailed allocation of costs.

9. Application 

Potential qualified individual consultants or companies are encouraged to submit both technical and financial proposals via WARwanda@wateraid.org; no later than 10th July 2026. Late submissions will not be considered.

All inquiries should be sent to the same email address above.

10. Disclaimer

WaterAid Rwanda will contact only shortlisted applicants for further negotiation; If not required, only the selected candidate will be notified.

Note:

WaterAid has zero tolerance for all forms of harassment, discrimination, abuse and bullying, especially pertaining to children and vulnerable adults. Consultant(s) will be required to commit to adhere to WaterAid’s safeguarding policies & code of conduct. Consultant or consultancy firm will ensure all staff on the project sign up to safeguarding policies as required. The consultant(s) will be required to support district and community level structures in understanding and implementation of safeguarding policies.