Country: Turkey
Closing date: 12 Nov 2018
ABOUT RI:
Relief International (RI) is committed to transforming adversity into renewal for the world’s most vulnerable populations. By partnering with beneficiaries and communities on the front-lines, RI innovatively bridges the gap between immediate relief and long-term community development.
Launched in 2015, RI’s program in Turkey is now implemented in 8 provinces across Turkey with 7 implementing partners. The program entails the following:
• Contribute to improving access to specialized health service delivery for refugees, focusing on mental health and psychosocial support services (MHPSS), physiotherapy, prosthesis & orthotics, dental hygiene promotion, and leishmaniasis prevention and control;
• Work with local partners to build their capacity (organizational and project management) in order to ensure long term sustainability;
• Replicate the existing successful models in other geographic areas with high numbers of refugees;
• Contribute to scientific studies by engaging in technical and needs assessments to fill the evidence gap on disability and MHPSS for refugees in Turkey.
ABOUT Mülteciler Association:
Mülteciler association was established in 2014, to seek solutions to the problems of refugees who have left their country and are in need of international protection. Multeciler association located in Sultanbeyli, IstanbulMuteciler provides services in the following fields; protection, case management mental health, physical rehabilitation, education, vocational trainings, legal consultation, refugee councils, business and career counseling
Multeciler association work in cooperation with the private sector, NGOs, public institutions and organizations to help solve refugees’ problems enhance the social inclusion between the refugees and the host community.
Background to the Context and Problem:
In 2016, the United Nations identified around 5 million refugees outside of Syria, of whom more than 3 and a half million are registered in Turkey. Access to health care for refugees is mostly restricted in host countries with great variation in entitlements.[1] Practical barriers impede access to health care services for refugees —e.g. inadequate information and awareness about the availability of services, insufficient financial means, restricted access to transport, insufficient cultural sensitiveness in the health care structure and delivery, and inadequate provision of interpreters remain as major obstacles, especially at secondary and tertiary levels.[2] The WHO situation report for Turkey covering May-June 2018 regarding the Syria refugee crisis reiterated the gaps in health care delivery. The mental and psychological consequences of conflict and displacement among the refugee population still place high burdens on refugees’ health and household expenditures. Conflict-related injuries, the long-term disruption of Syria’s health system and the poor or insufficient management of chronic conditions have left behind large numbers of refugees with disabilities.
For refugees with disabilities, locally available health care focuses on emergency medical situations and not the continuous healthcare support that many adults and children with disabilities often need. The lack of chronic care coverage for displaced persons with disabilities (PWDs) in healthcare and rehabilitation services creates frustration, anger, and deteriorating health status, and can sometimes lead to death.[3] In Turkey, the lack of interpretation services, especially for secondary and tertiary health care services, is an underlined gap. Nonregistered refugees face barriers in accessing curative care and specialized health care and treatment.[4]
Several studies have shown significant levels of anxiety, grief and social isolation among people with disabilities.[5] Psychological adjustment plays a vital role in amputees’ quality of life; difficulties in adjustment are associated with reports of depression, feelings of hopelessness, low self-esteem, fatigue, anxiety and sometimes suicidal ideation.[6] A multitude of related problems, including maladaptive coping behaviors (e.g., drug/alcohol consumption), greater disability, poorer social functioning, and loss of functional independence, may result from difficulties in psychological adjustment (Shobhana et al., 2000).
Moreover, as presented in WHO guidelines, the populations affected by emergencies are expected to have increased prevalence of mental health problems from psychological reactions to mild/ moderate and severe mental disorders after the emergencies. Refugees not only have to deal with the acute stressors of war, but also often face post-migration challenges, such as marginalization, acculturation problems, socioeconomic disadvantage and ‘cultural bereavement’ which negatively impact their well-being. Specifically, it is found that refugees often experience a wide variety of both physical and mental health problems, such as depression, anxiety and post-traumatic stress disorder.[7] Nevertheless, stigma related to mental health among Syrian refugees[8] and challenges related to availability and access to these specialized services in Turkey represent important barriers to address the specific mental health needs of the refugee population at large, and those with disabilities.
While there is no concrete data regarding the number of Syrian refugees with disabilities and their specific needs in Istanbul, RI and Mülteciler’s program data shows significant needs for physical rehabilitation and MHPSS services that need in-depth analysis and understanding.
Objectives of the Research:
The overall aim and purpose of the proposed assessment is to enhance the understanding of refugees’ needs in MHPSS and physical rehabilitation in Turkey (with a focus on refugee households in Sultanbeyli), and to highlight gaps as well as to recommend good practices and appropriate service design to meet these needs and enhance effective specialized health care provision for future projects.
Accordingly, RI Turkey is seeking an experienced research or academic institution focused on public health to conduct a needs assessment research on MHPSS and physical disability & rehabilitation.
In line with the main purpose and objectives, the research should should accomplish the following:
· To put together a literature review of existing relevant studies and research conducted on mental health and disability needs among Syrian refugees residing in Turkey in order to demonstrate if any of the findings and recommendations have been put to action by actors on the field to alleviate the suffering of the subject population, and what gaps remain moving forward;
· To gather information from refugee households and at individual level (as household members are identified) and determine specific needs and vulnerabilities to better understand the burden of disability and mental health disorders among Syrian refugees in Sultanbeyli municipality;
· To collect in-depth information on the perceived needs/ problems faced by the refugee community and the impact of these problems on their well-being (physically, socially and economically);
· To estimate the actual prevalence of mental health disorders and disability among refugee households;
· To gather information on the perception of the community regarding disability and mental health disorders, identify catalyzers and trends of help-seeking behaviors and coping mechanisms, as well as barriers to access services;
· To identify important psychosocial factors which affect quality of life among people with disabilities and their care givers;
· To identify the existing gaps in capacity and service delivery at the secondary and tertiary health care and specialized services such as MHPSS and physiotherapy in Istanbul;
· Focus on the vulnerable groups such as children, single mothers, and the elderly to analyze what types of further obstacles are in place for these groups and suggest the best ways to overcome these obstacles according to the findings of the research.
Methodology
RI Turkey expects this research to be conducted using a comprehensive approach with mixed-methods and resources. There is insufficient data related to MHPSS and physical rehabilitation in Sultanbeyli municipality database[9], and therefore, both quantitative and qualitative approach with refugees and other service provision actors should be implemented to the design of the research. The findings should depend on both individual refugee assessments, perception and views and on discussions with the service providers and key informants from local and national organizations (where possible).
It is suggested to design a research plan which includes an assessment of refugees through various technical and non-technical quantitative survey tools.[10] The surveys should be conducted at the household level and relevant information should be obtained from multiple household members to make the best use of the sample population to collect more data, especially if people with the target background are identified. In addition to quantitative household surveys or technical assessments with target refugees of interest, qualitative tools such as focus group discussions (FGDs) and in-depth interviews (IDIs) should be included in the data collection process of this research. MHPSS related measurements are suggested to be conducted through qualitative approach based FGDs and IDIs with people with, suffering from psychosocial problems or already diagnosed with mental health disorders, and their care givers in Sultanbeyli. Same for people with disabilities and their care givers. FGDs are suggested to be designed tailored towards the profiles that come across during the research and Multeciler association can also support in arranging beneficiaries who are already receiving services and have access to specialized services.
These tools should be designed and applied in order to get better understanding of the following but not limited to:
Demographic information,
Details on the arrival to the host community,
Health history and health status,
Disability status,
History of mental health disorders or other psychological reactions, The cause of the physical disability, stresses of psychosocial problems.
The impact of disability & mental health disorders in daily life (social, economic, health etc.)
Basic needs, level of access to services & barriers to access
General status of wellbeing and functioning
History of health service utilization and satisfaction level
The availability, affordability, accessibility and quality of specialized services for physical rehabilitation and mental health
Quality of life dependent on stories and experiences of real life examples explained in depth
Underlying factors that are impeding or accelerating the progress of a PWD or a refugee suffering from mental health disorders
Behavioral and other educational difficulties experienced by children in the households and the coping-mechanisms and help seeking behaviors to mitigate the challenges.
The quantitative findings should be visualized and presented in the report and the qualitative findings will be presented as descriptive summaries and interpretations of the key themes, supported and illustrated by quotes from the raw data. The proposal should include sections detailing how the analysis will be conducted and the contents of the final research reports.
The sampling and selection methodology should be clearly presented in the research proposal per each tool to be used. The number of Syrian families in Sultanbeyli municipality are an estimated 4,500. The technical and financial proposal should take into consideration that the enumerators/ data collectors will be hired by RI’s implementing partner, Mülteciler Association; and therefore there is no need to budget for the data collection staff, except for training efforts. In case the research design put forth in the research proposal requires people with a technical background on the sectors of interest at the data collection stage in addition to that of the analysis stage, the applicant should provide a clear explanation of the nature of involvement and importance to produce higher quality research dependent on scientific findings. This will only be considered if the applicant can make sure to hire these positions to engage in data collection adhering to the Turkish law and obtain the necessary permissions.
Deliverables and Payment Plan
After the signature of the contract, a kick-off meeting between the winning applicant and RI will take place in Gaziantep (if the selected entity is not based in Gaziantep, the parties will meet over a Skype call or through representatives), that will provide further background to the program and answer any questions relevant to the research and expected deliverables. This will include discussions on the final scope of work, timelines, research tools, field support and methodologies which will then be presented in the inception report.
The successful applicant will be requested to provide the following major deliverables:
1) Inception Report containing the intervention logic of the research (based on literature review), research methodology and plan, and a list of reviewed documents. The research/needs assessment plan should contain the proposed data collection methods and data sources to be used for addressing each objective question. The inception report should include all data collection tool templates and details on how, where, and to whom they will be administered. It is advisable to use a matrix (which connects questions to data collection methods/sources).
2) Draft Report: A stakeholder workshop should be facilitated to discuss preliminary research findings and conclusions at this stage. The timeline should allow sufficient time for stakeholders to review and discuss the draft report. Holistic and final sector-specific analysis and feedback will be provided to enable the technical units to analyze the findings before completion of analysis, validation, and triangulation. The selected applicant will share the final draft report with RI for revision.
3) Final Report will be a high quality report that meets publication standards, including clear findings, recommendations and suggestions (revised in accordance with the decisions taken at the meeting which will take place between all stakeholders after the submission and review of the draft report).
RI aims to adhere to the following tentative timeframe for some components feeding in to the deliverables per each evaluation to take place:
Deliverables/ Components
Dates/ Deadlines
RI application review and selection process
RI will inform the applicant of the decision within 3 weeks after the application deadline.
Please note: there could be additional information requested from the applicants during the review process.
Kick-off meeting
As soon as the applicant is informed of the official decision and contract is signed
Please Note: RI HQ review of the contract might take up to 2 weeks.
Literature review and research methodology/ tools development & inception report submission
1-2 weeks after the kick-off meeting
Follow-up meeting regarding feedback on the Inception Report
The week following the Inception Report submission
Training of enumerators (note: enumerators will be recruited during the period after contract signature)
1 full week after the inception report feedback meeting
Primary data collection
2-3 weeks (dependent on the sample and number of enumerators)
Data analysis and reporting & submission of Draft Report to RI (including access to the raw data)
Submission in 3 weeks after data collection is complete (2 weeks data analysis, 1 week reporting)
Follow-up meeting regarding feedback on the Draft Report
The week following the draft report submission
Final report
1 week after draft report feedback meeting
Obtaining Ethical Clearance from the university in Turkey in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments, as well as the specific national laws. Details will be discussed at kick-off.
Obtaining an ethical clearance to conduct research will be responsible of academic institution. The timeline will depend on the time of obtaining the ethical clearance – and if needed, pushed to further dates in line with the same timeframes for deliverables explained above.
Deliverable
Payment % of Total
Inception Report
30%
Draft Report
30%
Final Research Report
40%
Qualifications/Experience:
The successful applicant for this research proposal should have the following qualifications/ experiences:
Essential criteria:
Ø Academic institution with a t least 5 years of experience conducting research in the field of mental health and or/physical rehabilitation (Experience in both fields is preferable) or public health.;
Ø Availability of lead researchers with a background and experience in the relevant fields.;
Ø The applicant must make sure that the relevant personnel are proficient in English. The research would be conducted in the local language of the participants with the help of translators and enumerators; however, all communication with RI should be in English, included all reporting.
Preferred criteria:
Ø Previous experience working with international/ national non-governmental organizations (NGOs) is a plus;
Ø Experience doing research in humanitarian crises.
Ø Ability to demonstrate a number of previous publications supporting a record of published research papers in peer-reviewed and high impact factor journals;
Ø Have permission to conduct research in Turkey.
Application Process:
Interested applicants should ask to receive tender dossier from tender.turkey@ri.org to fill on and submit their clear and detailed technical and financial proposal including a detailed budget and a work plan for literature review, tools development, data collection, analysis and reporting with all mentioned activities are required as part of the application package. The CVs of lead researchers need to be provided along with the application package as well. More details can be found in tender dossier.
Application deadline (Asking to receive tender dossier) is 5th November 2018.
Bid submission deadline is 12th November 2018.
RI Values:
We uphold the Humanitarian Principles: humanity, neutrality, impartiality, and operational independence. We affirmatively engage the most vulnerable communities. We value:
- Inclusiveness
- Transparency and Accountability
- Agility and Innovation
- Collaboration
- Sustainability
[1] Norredam M, Mygind A, Krasnik A. Access to health care for asylum seekers in the European Union-a comparative study of country policies. Eur J Public Health. 2006; 16:286–90.
[2] Ibid
[3] Members of the Arab Forum for the Rights of Persons with Disabilities, Disability Inclusion among Refugees in the Middle East and North Africa. 2016
4 Regional Refugee & Resilience Plan (3RP) 2018-2019
[5] Schubert et al., 1992;Frierson and Lippmann, 1987;Thompson and Haran, 1984
[6] Desmond and MacLachlan, 2002
[7] Smeekes, A., Verkuyten, M., Çelebi, E., Acartürk, C., & Onkun, S. (2017). Social identity continuity and mental health among Syrian refugees in Turkey. Social Psychiatry and Psychiatric Epidemiology, 52(10), 1317–1324. http://doi.org/10.1007/s00127-017-1424-7
[8] Culture, Context and the Mental Health and Psychosocial Wellbeing of Syrians, UNHCR, 2015
[9] Also in the whole of Turkey other than basic demographics of households and registered refugees, there’s a lack of information available on the number and profile of the affected people. This research aims to investigate and go beyond the acknowledgment of the higher prevalence of mental health problems and disability in refugee populations post-conflict (proven through some studies around the world) and gain more information on the profile of the affected people - how they survive, where they live and where they seek treatment and more.
[10] The technical assessment tools might not be applicable as the data collectors such as enumerators/ interviewers will most likely not have enough technical knowledge to administer such tests, unless there is a suggested and approved training plan, which is welcomed by the applicants.
How to apply:
Interested applicants should ask to receive tender dossier from tender.turkey@ri.org to fill on and submit their clear and detailed technical and financial proposal including a detailed budget and a work plan for literature review, tools development, data collection, analysis and reporting with all mentioned activities are required as part of the application package. The CVs of lead researchers need to be provided along with the application package as well. More details can be found in tender dossier.
Application deadline (Asking to receive tender dossier) is 12 November 2018.
