Terms of Reference (TORs)

Feasibility Study on Mapping District Headquarter Hospitals (DHQs), Eye Health Services, Human Resources, Equipment, and Security Assessment

Proposed for: Balochistan, Pakistan

Commissioned by: CBM Pakistan

Thematic Area(s):

• Health Infrastructure Mapping (DHQs)

• Eye Health Equipment Assessment

• Human Resource Mapping (Ophthalmologists, Optometrists, Eye Technicians)

• Focused Eye Health Needs Assessment (Rapid)

• Security & Operational Risk Assessment

Geographic Area of Assessment:

The feasibility study will cover ten selected districts in Balochistan: Quetta, Kech (Turbat), Pishin, Lasbela, Panjgur, Jaffarabad, Zhob, Killa Saifullah, Killa Abdullah, and Gwadar.. Given the wide geographic scope, dispersed population, and prevailing security, accessibility, and operational considerations in Balochistan, the assessment will primarily be conducted at the district headquarter level. Field visits will focus on district headquarters, including key public health facilities, relevant district-level offices, and selected private facilities located at the district level. Information related to sub-district or tehsil-level services, access barriers, and eye health needs will be captured mainly through secondary data review, key informant interviews, and virtual or remote consultations, rather than extensive field travel. This approach is intended to ensure operational feasibility, staff safety, and timely completion of the study while still generating sufficient evidence to inform future programmatic planning.

Background / Rationale:

Balochistan faces significant challenges in access to eye care due to:

• Large geographic area and scattered populations

• Limited transportation infrastructure

• Uneven availability and distribution of eye health personnel, services, and equipment

• Affordability barriers that limit timely utilization of eye care services, particularly for vulnerable populations

• Security concerns in certain districts, which affect staff mobility and service delivery

There is currently no consolidated data on which DHQs have eye health services, personnel, equipment, or whether security conditions permit safe service delivery.In addition to service availability and operational constraints, there is limited consolidated information on priority eye health needs, unmet demand, and key access barriers across different districts, which is essential for informed planning and prioritization of future interventions.

This feasibility study aims to provide a comprehensive snapshot of:

1. DHQs per district and their capacity to provide eye care

2. Available eye health personnel and equipment

3. Key eye health needs, priority conditions, and access barriers, based on a focused and rapid needs assessment to inform future programmatic prioritization

4. Security and operational risks affecting access, staffing, and service delivery

Objectives of the Feasibility Study

1. Mapping of DHQs

• Identify all DHQs in Balochistan by district.

• Collect geographic and administrative details of each DHQ.

2. Assessment of Eye Health Services

• Identify which DHQs and selected private facilities provide eye care services.

• Document the type of services offered (outpatient, surgeries, diagnostics, etc.).

3. Human Resource Mapping

• Record presence and number of ophthalmologists, optometrists, and eye technicians at each DHQ.

• Assess availability and capacity for service delivery .

4. Equipment Assessment

• Document availability and functionality of essential eye health equipment (slit lamps, phaco machines, auto-refractors, ophthalmoscopes).

• Identify gaps in equipment and maintenance needs.

5.  Focused Eye Health Needs Assessment (Rapid)

• Conduct a brief, focused assessment to identify priority eye health conditions, unmet needs, and key access barriers.

• Draw primarily on secondary data sources, complemented by a limited number of Key Informant Interviews (KIIs) and Focus Group Discussions (FGDs) in selected high-population districts where services are limited, subject to security and feasibility considerations.

• Generate evidence to support prioritization of geographic areas and interventions for future eye health programming.

6. Security & Operational Risk Assessment

• Evaluate district-level security conditions, including risks affecting staff, patients, and facility operations.

• Identify constraints for field visits, service provision, and staff deployment.

•    Classify each assessed district using a traffic-light system to reflect overall security and     operational feasibility:

• Green: Low risk – routine operations and field movement feasible

• Amber: Moderate risk – operations possible with mitigation measures

• Red: High risk – significant restrictions on movement and service delivery

• Recommend practical mitigation strategies for safe operations in each district, aligned with the assigned risk level.

7. Data Compilation:

• Compile, analyse, and synthesize quantitative and qualitative data collected through:

• DHQ and facility mapping

• Human resource and equipment assessments

• Security and operational risk assessment

• Focused eye health needs assessment (secondary data review and limited KIIs/FGDs)

• Prepare maps, tables, and summary outputs presenting:

• DHQs by district

• Facilities offering eye care services

• Distribution of eye health personnel

• Equipment availability and functionality

• Security and operational risk classification

• Key eye health needs, priority conditions, and major access barriers

Expected Approach

• Desk Review: Review relevant secondary data, including government records, health ministry reports, hospital statistics, eye health studies, and previous assessments to support preliminary mapping and inform the focused eye health needs assessment.

• Field Visits: Conduct targeted field visits to DHQs and selected private facilities to verify the availability of eye health services, human resources, equipment, and to understand the local security and operational context.

• Key Informant Interviews (KIIs) and Limited FGDs:

Conduct interviews with facility managers, eye health staff, provincial and district health authorities (including Secretary Health and DG Health), and other relevant stakeholders to assess service delivery constraints, security considerations, and priority eye health needs.
Where feasible and safe, undertake a limited number of FGDs in selected high-population districts to understand community-level access barriers to eye care services.

• Security-Sensitive and Adaptive Approach:
  Adjust fieldwork methods and geographic coverage based on security assessments, accessibility, and feasibility, prioritizing districts where services are limited and population needs are likely to be highest.

• Independent and Neutral:
  Ensure all findings are objective, evidence-based, and free from political, tribal, or sectarian influence.

• Do No Harm:
  Ensure study activities do not exacerbate tensions, raise unrealistic expectations, or place communities, health workers, or consultants at risk.

Required Activities

1. Compile a master list of District Headquarter Hospitals (DHQs) by district.

2. Conduct targeted field verification of DHQs and selected private facilities to confirm the availability of eye health services, human resources, equipment, and the prevailing security and operational context.

3. Document the type and level of eye care services offered at each assessed facility, including outpatient, surgical, and diagnostic services.

4. Record and assess the availability and capacity of human resources for eye care, including ophthalmologists, optometrists, and eye technicians, at each facility.

5. Conduct an inventory and functionality assessment of essential eye health equipment and identify gaps and maintenance needs.

6. Review and analyse secondary data related to eye health needs, service utilisation, and known priority eye conditions in Balochistan.

7. Conduct a limited number of Key Informant Interviews (KIIs) and, where feasible and safe, Focus Group Discussions (FGDs) in selected districts to identify priority eye health needs and key access barriers.

8. Assess district-level security risks and operational constraints affecting field access, staffing, and service delivery, and classify districts according to agreed risk levels.

9. Prepare maps, tables, and evidence-based recommendations synthesising findings from facility mapping, the focused eye health needs assessment, and the security and operational risk analysis.

Required Deliverables

1. Feasibility Report

The final feasibility report shall include:

• A comprehensive list of District Headquarter Hospitals (DHQs) and selected private facilities, including locations and administrative details.

• Description of eye health services offered at each assessed facility.

• Human resource mapping of eye health personnel, including ophthalmologists, optometrists, and eye technicians.

• Inventory and functionality assessment of essential eye health equipment, including identified gaps and maintenance needs.

• District-level security and operational risk assessment, including risk classification and recommended mitigation measures.

• Summary of key eye health needs, priority conditions, unmet needs, and major access barriers, based on the focused and rapid eye health needs assessment.

• Maps illustrating the geographic distribution of facilities, eye health personnel, equipment, and the security context.

2. Data and Tools

• Soft and hard copies of all data collected and reviewed during the study, including datasets from facility assessments, secondary data sources, interview notes, spreadsheets, maps, and analytical tools.

3. Presentation of Findings

• Presentation summarising key findings, conclusions, and practical recommendations to CBM Pakistan management prior to finalisation of the report.

Technical Proposal Requirements

• Consultant/team profile, including relevant CVs.

• Demonstrated experience in health facility mapping, feasibility studies, or similar assessments, preferably including eye health or health systems strengthening.

• Proposed methodology covering:

• Mapping of DHQs and selected private facilities

• Assessment of eye health services, human resources, and equipment

• Approach to conducting a focused and rapid eye health needs assessment (primarily secondary data review, complemented by limited KIIs/FGDs)

• Security and operational risk assessment

• Detailed timeline of activities (Gantt chart preferred), including desk review, fieldwork, analysis, and reporting.

• Sample data collection tools, such as facility assessment checklists, interview guides, and tools to support the focused eye health needs assessment.

Financial Proposal Requirements

• A detailed budget covering all anticipated costs related to the feasibility study, including travel, lodging, field allowances, printing, stationery, and applicable taxes.

• All costs must be inclusive of applicable taxes.

Selection Criteria and Evaluation Method

Proposals will be evaluated using a combined technical and financial scoring system. The contract will be awarded to the consultant or firm achieving the highest combined score.

1. Technical Evaluation (70 Marks)

Minimum Technical Qualification Threshold:
Only proposals scoring at least 50 out of 70 marks in the technical evaluation will be considered for financial evaluation.

2. Financial Evaluation (30 Marks)

C. Final Selection

The final score will be calculated by combining the technical and financial scores (maximum 100 marks). The contract will be awarded to the proposal achieving the highest combined score.

Indicative Timeframe and Level of Effort

The feasibility study is expected to be completed within 6–8 weeks from the date of contract signing. The proposed timeline should remain flexible and responsive to security, accessibility, and operational considerations.

An indicative breakdown is as follows:

Week 1: Inception, desk review, finalisation of methodology, and development of data collection tools

Weeks 2–4: Field visits to selected districts, facility assessments, KIIs, and limited FGDs (subject to security conditions)

Week 5: Data consolidation, analysis, and preliminary findings

Week 6: Draft feasibility report submission

Weeks 7–8: Review, validation, and finalisation of the report, including presentation to CBM Pakistan management

The consultant shall propose a detailed workplan and timeline (Gantt chart) aligned with this indicative timeframe as part of the technical proposal.

Submission Deadline & Address

• Deadline: February 13th, 2026

• Submission of Proposals:
  Proposals must be submitted in a sealed envelope, clearly marked with the title of the assignment, along with a soft copy saved on a USB drive. Submissions should be delivered to:

CBM Christoffel-Blindenmission Christian Blind Mission e.V
Country Office, Pakistan
1st Floor, IRM Complex 7, Sunrise Avenue, Park Road
Near COMSATS University

In addition, a copy must also be sent via email to:  [email protected]