The objective of the survey is to collection data on key health and nutrition related indicators at the household level, including the following thematic areas:

  • Health seeking behavior
  • Diarrhea and respiratory tract infection management for children
  • Vaccination
  • Reproductive health (including antenatal care, postnatal care and family planning)
  • Breastfeeding practices
  • Access to reproductive and psychosocial services

BACKGROUND:

In 2019 the Syria crisis entered its eighth year with almost 1 million registered, and as many as 550,000 unregistered Syrian refugees continuing to reside in Lebanon, a third of whom live in the Bekaa Valley (UNHCR Data Portal, July 2019). The protracted nature of this conflict has seen the number of refugees residing in Lebanon remain relatively stable since 2014 and the number is not expected to decrease in the immediate future. Syrian refugees make up as much as a quarter of Lebanon’s total population, with 80% of these refugees being women and children. The presence of refugees in such high numbers has strained the political, economic and social stability of the country, stretching basic services and systems that have weakened the host authorities’ capacity to respond to the increased needs, especially in education, water supply and healthcare. Difficult living conditions exacerbated by the weather and poor sanitation and hygiene situation in refugee settlements have a strong impact on the public health situation of the refugees and has increased the risks of outbreaks of communicable diseases.

Since 2014 Medair has been supporting Ministry of Social Affairs (MOSA) Social Development Centers (SDC) implementing a project to improve refugees’ and affected host communities’ access to primary health care (PHC) services. Medair, in close collaboration with MOSA, currently supports sixclinics in Central, West and North Bekaa, with a focus on mother and child health, in addition to mental health and psychosocial support.  Medair supports clinics through the provision of human resources, medicines, equipment, capacity building and supportive supervision to each of the clinics.

Community Health Volunteers (CHVs) in the SDC catchment area deliver a community health promotion package and have been trained on relevant health topics including exclusive breastfeeding, family planning, essential maternal and newborn care, early marriage, lice and scabies treatment and referral systems. Community midwives provide antenatal care, postnatal care and family planning. CHVs and community midwives carry out household visits, community outreach in Informal Settlements within SDC catchment areas and as well as meeting refugees and vulnerable host communities in community shared places.

SURVEY PURPOSE

The Knowledge, Practice and Coverage (KPC) household survey will measure standardized health and nutrition indicators for Syrian refugees and vulnerable Lebanese, in the Medair-supported SDC project areas. The purpose of the survey is to provide robust data that will inform Medair, MOSA, Ministry of Public Health (MOPH) and other NGO programming and provide a strong evidence base to current and potential donors. The analysis will serve to compare key indicators across key target groups, as well as enable a comparison with the 2016,2017 and 2018 KPC surveys.

SURVEY METHDOLOGY

The survey to be conducted will use a cluster design to enable the calculation of 95% confidence interval point estimates with acceptable degrees of precision. The sampling frames will be distinct for both Syrian refugees (made up of those living in informal settlements) and vulnerable Lebanese, such that two cluster surveys will be conducted.

OBJECTIVES OF SURVEY

The objective of the survey is to collection data on key health and nutrition related indicators at the household level, including the following thematic areas:

  • Health seeking behavior
  • Diarrhea and respiratory tract infection management for children
  • Vaccination
  • Reproductive health (including antenatal care, postnatal care and family planning)
  • Breastfeeding practices
  • Access to reproductive and psychosocial services

KEY INDICATORS TO BE MESAURED

The specific to be measured are:

Programme area Indicators
Socio-demographic info % of mothers of children ages under 5 years who got married before the age of 18 years (early marriage)
% of mothers of children ages under 5 years who do not know how to write and read
% of households (HH) with a crowdedness index above 1.5
Health care access general % of mothers of children aged under 5 years of age in project area who went to qualified health services when they needed medical services
% of mothers of children aged under 5 years of age in project who visited any Medair supported SDC during the 12 months prior to the survey
Reproductive Health (RH) services % Women in the targeted communities who correctly identify available RH services
% WGMB in the targeted communities who correctly report where to access RH services
% Women in the targeted communities who report that they would be comfortable and able to access these (RH) services as needed
% of mothers of children under 5 years who report accessing RH services in the 6 months prior to the survey
% of mothers of children under 5 years receiving RH services who report satisfaction with support provided
ANC visits

 

% of mothers of children under two years of age who had at least 4 comprehensive antenatal visits when they were pregnant with their youngest child
% mothers of children aged 0-23 months who had their first ANC visit within the first 3 months of pregnancy
% mothers of children aged 0-23 months who had their last ANC visit less than 1 month before delivery
Delivery

 

% of mothers of children under 5 years who delivered their youngest child at hospital
% of mothers of children under 5 years who delivered by caesarian section
% of mothers of children aged 0-23 months who received a health booklet during their stay at hospital
% of mothers of children aged 0-23 months who stayed at 24h in the hospital after delivery
Postnatal Care (PNC) % of mothers of children under two years of age who received a post-partum visit from an appropriate trained health worker within two weeks after birth of their youngest child
% of children under two years of age who were examined by an appropriately trained health worker 3 days after delivery
% of mothers of children under two years of age who received at least 3 post-partum visits within 40 days after delivery
(Exclusive) breastfeeding % of infants 0-6 months who are exclusively breastfed (calculation method 1)
% of infants 0-6 months who are exclusively breastfed (calculation method 2)
% of mothers of children 7-23 months who breastfed their child within 1 hour after delivery
Family Planning (FP)

 

 

% of mothers of children under 5 years who report discussing FP with a trained service provider in the 12 months preceding the survey
% of mothers of children 0-23 months who are using a modern contraceptive method
% of mothers of children 0-23 months who know at least one risk of getting pregnant within 2 years of last delivery
% of women of children 0-23 months who know what is the best birth spacing
Vaccinations % of children aged  12 months- 5 years who are vaccinated for measles in clinics’ coverage area
% of children aged 1- 5 years who are vaccinated for polio in clinics’ coverage area
% of children aged 1- 5 years who are vaccinated for Diphtheria and Pertussis and Tetanus (DPT) in clinics coverage area
% of children age 12-23 months who received age appropriate vaccination at time of survey
Treatment of sick child % of children under 5 years that had fast or difficult breathing in the last 2 weeks
% of children under 5 years with fast or difficult breathing for whom advice or treatment was sought after more than 24h of fast or difficult breathing, in the last 2 weeks
Treatment of children with Acute Respiratory Infection (ARI) % of children under 5 years with fast or difficult breathing for whom advice or treatment was sought from an appropriate health facility or provider in the last 2 weeks
% of children under 5 years with fast or difficult breathing or cough by type of treatment in the last 2 weeks (inclusive of antibiotics)
Treatment of children with diarrhea % of children under 5 years with diarrhea receiving ORS and zinc supplementation
Prevalence of diarrhea % of children under 5 years that experienced diarrhea in the last 2 weeks
Non Communicable Diseases (NCD) % of mothers of children under 5 years who reported having at least one HH member with NCD
% of women who know 2 or more ways to reduce the risk of NCDs
Psycho Social Support (PSS) services % women in the targeted communities who correctly identify available PSS services
% women in the targeted communities who correctly report where to access PSS services
% of mothers of children under 5 years who report discussing PSS with a trained service provider in the 12 months preceding the survey
% women in the targeted communities who report that they would be comfortable and able to access these (PSS) services as needed
% of mothers of children under 5 years who report accessing PSS support services in the 6 months prior to the survey
% of mothers of children under 5 years receiving PSS services who report satisfaction with support provided
Child registration % of children under 5 years officially registered in their country (for Syrians)
% of children under 5 years without birth certificate
Mortality related to pregnancy % of women’s sisters who died due to problems related to pregnancy

 

SURVEY METHODOLOGY

The surveys to be conducted will use a cluster survey design to achieve 95% confidence interval point estimates with an acceptable degree of precision.

 

Target population Clusters x cluster respondents Planned household respondents
Syrian refugees (in Informal Settlements) 60 x 25 1500
Vulnerable Lebanese 30 x 25 750
TOTAL 2250

 

The sampling frames are Syrian refugees (made up of those living in informal settlements only) and vulnerable Lebanese in the catchment areas of the 6 Medair-supported SDCs (Talia, Brital, Marj, Kabelias, Jib Janine and Rafid). For further details on the clusters selected, see the Annex below. The respondents will be women of child bearing age with children under the age of 5, or their care givers. The data will be collected by approximately 70 enumerators, trained and supervised by Medair staff, using tablets and ODK (Open Data Kit) data collection software. A total of 2250 questionnaires are planned to be completed.

 

TIMEFRAME / SCHEDULE:

Survey questionnaire pre-testing – August 2019

Enumerator training – September 2019

Field data collection: 16th – 27th September2019

Consultant: Data analysis and report writing: October – November 2019

Review of draft report – November 2019

 

SECURITY

Medair will liaise closely with the local authorities and Municipalities for security information across Bekaa.

 

PERSONS TO CONTACT

Survey focal point: Farah Darwiche (Medair Health Project Manager:  healthco-leb@medair.org

M&E focal point: Alastair Punch (Assessments, Monitoring and Evaluation Manager): monitoring-leb@medair.org

 

FUNDING

Funding for this consultancy will come from Medair donor, EU-Madad. The other costs of the survey are also supported by Medair donor Global Affairs Canada-IHA

ANNEX: Sampling approach

 

General cluster selection procedure:

  1. Syrian refugees:
    1. Using IAMP 63, the number of Syrian refugee households living in Informal Tented Settlements (ITS) within the coverage area of the 6 Medair-supported SDCs (23 Cadasters) was broken down by Cadaster and ITS, and a cumulative population list was made.
    2. Based on the total household population, and the required sample size, an interval was calculated for 60 clusters, the starting point for which was selected by a random number.
    3. The cluster locations (ITS/Pcodes) were then selected using the interval through systematic random sampling.
    4. At the field level, the 25 household respondents will be chosen firstly from within the selected ITS. Where there are not enough households with mothers (or care givers) with children under 5, the next nearest ITS will be located in order to reach the required cluster sample size.
  1. Vulnerable Lebanese:
    1. In the same way that IAMP 65 was used for Syrian refugees in ITS, a cumulative population list of Lebanese was made by household per Cadaster. Starting with the 2018 KPC survey Municipality statistics on the number of Lebanese living in the Cadaster and the proportion of vulnerable Lebanese among them, additional sources were used to verify these numbers. These included a) updated Municipality data (through a phone survey), b) Wikipedia statistics, and c) staff local knowledge. The revised list was then used to conclude a final 2019 version of Cadaster populations of Lebanese and vulnerable Lebanese.
    2. Based on the total vulnerable Lebanese household population (from across the 23 Cadasters), an interval was calculated for 30 clusters, the starting point for which was selected by a random number.
    3. The cluster locations (Cadasters) were then selected using the interval through systematic random sampling.
    4. At the field level, where there is only one cluster in the Cadaster, the enumerator teams will be directed either by the Medair-supported CBO, or by the Municipality, to a starting point in the Cadaster that contains high numbers of vulnerable Lebanese. After the first household has been identified, snowball sampling will be used to reach the 25 required households per cluster.
    5. Where there is more than one cluster in the Cadaster, the same approach will be used, but the Cadaster will be delineated into the number of clusters through natural geographical boundaries, such as roads, rivers or urban areas.

Syrian refugee cluster selection

PCode PCode Name District Cadaster Cluster selection
53139-01-028 Taibet Baalbek 028 Baalbek Taibet Baalbek 1
51329-01-013 Haouch El-Ghanam 013 Zahle Haouch El-Ghanam 2
51329-01-001 Haouch El-Ghanam 001 Zahle Haouch El-Ghanam 3
53437-01-090 Serraaine Et-Tahta 090 Baalbek Serraaine Et-Tahta 4
52277-01-045 Marj BG 045 West Bekaa Marj BG 5
52237-01-014 Qaraaoun 014 West Bekaa Qaraaoun 6
51231-01-024 Saadnayel 024 Zahle Saadnayel 7
51231-01-016 Saadnayel 016 Zahle Saadnayel 8
52217-01-009 Kamed El-Laouz 009 West Bekaa Kamed El-Laouz 9
52227-01-010 Ghazzé 010 West Bekaa Ghazzé 10
51281-01-049 Aanjar (Haouch Moussa) 049 Zahle Aanjar (Haouch Moussa) 11
51329-01-008 Haouch El-Ghanam 008 Zahle Haouch El-Ghanam 12
52277-01-100 Marj BG 100 West Bekaa Marj BG 13
51267-01-048 Barr Elias 048 Zahle Barr Elias 14
51231-01-083 Saadnayel 083 Zahle Saadnayel 15
53419-01-036 Haouch Er-Rafqa 036 Baalbek Haouch Er-Rafqa 16
51264-01-003 Haouch Qayssar 003 Zahle Haouch Qayssar 17
52211-01-043 Joubb Jannine 043 West Bekaa Joubb Jannine 18
53419-01-038 Haouch Er-Rafqa 038 Baalbek Haouch Er-Rafqa 19
51227-01-038 Taanayel 038 Zahle Taanayel 20
51227-01-005 Taanayel 005 Zahle Taanayel 21
51383-01-083 Dalhamiyet Zahlé 083 Zahle Dalhamiyet Zahlé 22
51227-01-003 Taanayel 003 Zahle Taanayel 23
51264-01-001 Haouch Qayssar 001 Zahle Haouch Qayssar 24
51227-01-008 Taanayel 008 Zahle Taanayel 25
51267-01-131 Barr Elias 131 Zahle Barr Elias 26
53139-01-005 Taibet Baalbek 005 Baalbek Taibet Baalbek 27
51267-01-143 Barr Elias 143 Zahle Barr Elias 28
51251-01-004 Haouch Es-Siyadé 004 Zahle Haouch Es-Siyadé 29
51264-01-006 Haouch Qayssar 006 Zahle Haouch Qayssar 30
52234-01-001 Khiara 001 West Bekaa Khiara 31
52277-01-017 Marj BG 017 West Bekaa Marj BG 32
51383-01-064 Dalhamiyet Zahlé 064 Zahle Dalhamiyet Zahlé 33
52227-01-044 Ghazzé 044 West Bekaa Ghazzé 34
51281-01-002 Aanjar (Haouch Moussa) 002 Zahle Aanjar (Haouch Moussa) 35
51267-01-029 Barr Elias 029 Zahle Barr Elias 36
53437-01-014 Serraaine Et-Tahta 014 Baalbek Serraaine Et-Tahta 37
51231-01-076 Saadnayel 076 Zahle Saadnayel 38
52211-01-004 Joubb Jannine 004 West Bekaa Joubb Jannine 39
51267-01-036 Barr Elias 036 Zahle Barr Elias 40
52277-01-004 Marj BG 004 West Bekaa Marj BG 41
52271-01-001 Harimé Es-Soughra 001 West Bekaa Harimé Es-Soughra 42
52227-01-011 Ghazzé 011 West Bekaa Ghazzé 43
51267-01-017 Barr Elias 017 Zahle Barr Elias 44
51231-01-045 Saadnayel 045 Zahle Saadnayel 45
53419-01-040 Haouch Er-Rafqa 040 Baalbek Haouch Er-Rafqa 46
52277-01-024 Marj BG 024 West Bekaa Marj BG 47
51267-01-013 Barr Elias 013 Zahle Barr Elias 48
51267-01-011 Barr Elias 011 Zahle Barr Elias 49
51383-01-061 Dalhamiyet Zahlé 061 Zahle Dalhamiyet Zahlé 50
52227-01-001 Ghazzé 001 West Bekaa Ghazzé 51
53419-01-004 Haouch Er-Rafqa 004 Baalbek Haouch Er-Rafqa 52
52227-01-003 Ghazzé 003 West Bekaa Ghazzé 53
53139-01-006 Taibet Baalbek 006 Baalbek Taibet Baalbek 54
52277-01-019 Marj BG 019 West Bekaa Marj BG 55
51234-01-007 Qabb Elias 007 Zahle Qabb Elias 56
52211-01-003 Joubb Jannine 003 West Bekaa Joubb Jannine 57
52254-01-006 Haouch El-Harime 006 West Bekaa Haouch El-Harime 58
51267-01-018 Barr Elias 018 Zahle Barr Elias 59
52277-01-001 Marj BG 001 West Bekaa Marj BG 60

 

Vulnerable Lebanese cluster selection

Area Code District Cadaster Cadaster for MADAD Phase 1&2 Lebanese Cluster selection
51251 Zahle Haouch Es-Siyadé 1
52237 West Bekaa Qaraaoun 2
51264 Zahle Haouch Qayssar 3
52217 West Bekaa Kamed El-Laouz Yes 4
53419 Baalbek Haouch Er-Rafqa Yes 5
52211 West Bekaa Joubb Jannine Yes 6,7
52227 West Bekaa Ghazzé 8
52277 West Bekaa Marj BG Yes 9,10
51227 Zahle Taanayel 11
53437 Baalbek Serraaine Et-Tahta 12,13
51231 Zahle Saadnayel Yes 14,15
53453 Baalbek Brital Yes 16,17,18,19,20
51267 Zahle Barr Elias Yes 21,22,23,24,25
51234 Zahle Qabb Elias Yes 26,27,28,29,30

 

Send your application to corinna.drechsel@medair.org.

Application deadline: 20 August 2019.