_Introduction_ **Abt Associates** is a mission-driven, global leader in research and program implementation in health, social and environmental policy, and international development. Known for its rigorous approach to solving complex challenges, Abt Associates is regularly ranked among the top 20 global research firms and named one of the top 40 international development innovators. The company has multiple offices in the U.S. and program offices in nearly 40 countries. **The Local Health Systems Sustainability (LHSS) Project** is USAID’s flagship initiative in integrated health systems strengthening, aiming to help low- and middle-income countries transition to sustainable, self-financed health systems to support universal health coverage. The project supports country-level efforts to reduce financial barriers to healthcare, ensure equitable access to essential health services for all people, and improve the quality of healthcare. Importantly, it equips host countries to sustain progress after the project ends by ensuring that local institutions and organizations have the technical capacity and expertise to independently design, implement, and manage continued health system strengthening activities. **In Cambodia** , LHSS seeks to improve the efficiency and effectiveness of domestic resources to strengthen social health protection, focusing on two objectives: 1. **Expand social protection systems** through global standards and best practices incorporated into the implementation of the National Social Protection Policy Framework to improve transparency and accountability. 2. **Strengthen the decentralization of health financing functions** to ensure effective use of resources for health, including HIV, TB, and malaria, to improve transparency and accountability, and enhance monitoring of HIV/AIDS financing. Under Objective 2, LHSS collaborates with the NAA, MoH, national programs (NCHADS, CENAT, and CNM), provincial governments, and provincial health departments (PHD) to improve subnational health systems across various health areas, including HIV, TB, malaria, maternal and child health (MCH), and family planning (FP). The project provides technical assistance to: a) Provinces and PHDs in their efforts for health/HIV resource allocation and budget execution through strengthening health/HIV work planning and budgeting processes. b) Build sub-national health systems to mobilize additional resources for improving TB diagnostics and care and treatment and sustaining the malaria response. c) Improve the capacity of concerned stakeholders to effectively, efficiently, and sustainably manage and operationalize the SorChorNor #213 Monitoring System. _Background_ Village Malaria Workers (VMWs), community health workers who provide vertical support for malaria in the community have been core elements of the national malaria response. The VMW program, implemented by CNM since 2004, has significantly contributed to the country’s goal of malaria elimination. As of 2019, the current 3,284 VMWs and mobile malaria workers (MMWs) conducted 70 percent of the malaria testing and treated over 50 percent of the confirmed malaria cases. Cambodia has several different cadres of community health volunteers, including community health volunteers (CHWs), village health support groups (VHSGs), VMWs, and HIV and TB community health workers. It is not uncommon for one individual to serve in multiple roles for their community. Cambodia needs to retain VMWs with the skills and experience critical for effective active case detection, prevention, and case management in the community. Their work remains important for both elimination and prevention of malaria re-establishment. The National Malaria Program (CNM) conducts an annual risk stratification exercise to determine which villages in Cambodia are high, low, and no risk for malaria. Allocation of and funding for VMWs is based on this assessment. VMWs do not work in no-risk areas; malaria activities are conducted by others. As malaria has declined, the number of VMWs has also declined. Transition in the Cambodia context is the process of transferring work previously performed by VMWs to other community health workers, including VHSGs. Integration is the process of changing the status of workers from within the authority of the National Malaria Program (VMWs) to within the Ministry of Health, working with health centers, and the Ministry of Interior, working with Village chiefs who appoint VHSGs and commune chiefs who monitor their performance. VHSGs are selected by their village, often by the village chief, and report to the health center management committee, headed by the commune chief and the health center director. VMWs, who also report to health center management committees, are funded by donors. Very little funding from the national budget, health center budgets, or commune budgets is allocated to VMWs. Considering the critical roles of VMWs, particularly as Cambodia’s malaria response approaches the elimination phase, LHSS will support CNM in conducting a rapid landscape assessment. This assessment will review the implementation progress of the CNM VMW integration roadmap, analyze the role of VMWs, and identify challenges they face in implementing the new integrated role for malaria activities—such as surveillance, prevention, diagnosis, treatment, and other community health activities outlined in the roadmap. The findings and recommendations from this assessment will inform the development of sustainable options for the role of VMWs across two distinct periods: i) the Elimination Certification phase (2025-2028) and ii) the post-elimination period (2029 and beyond), contributing to the long-term sustainability plan. The landscape assessment will provide an overview and analysis of current VMW program operations, share experiences, and explore the potential benefits of integrating VMWs into the broader CHW system as CNM moves towards full integration. It will highlight the contributions of vertical-program malaria workers (VMWs/MMWs) to malaria elimination and offer insights into the current and desired community roles of this diverse cadre of Cambodia’s CHWs.The assessment will also make the case for expanding the scope of services currently provided by VMWs to sustain high testing rates and care-seeking among at-risk populations. It will provide options and recommendations for services based on Cambodia’s population health needs. A Standard Operating Procedure (SOP) and training materials, developed in 2021 and revised in 2024 for integrated VMWs, are included in the annexes to detail the roles and responsibilities of integrated VMWs. The landscape assessment will share analysis of other models and what needs further research. It will include a review of evidence, including from other countries, and provide recommendations for next steps. LHSS is now seeking an internationally experienced consultant to support this rapid VMW landscape assessment. The international consultant will collaborate with a national consultant, the LHSS Cambodia project team, and key staff from the national program (CNM). Specific roles, responsibilities, tasks, and effort levels are outlined in the section below. _Key Roles and Responsibilities:_ The international consultant, together with a national consultant, will be required to perform the following tasks based on the concept note of the Rapid VMW Landscape Assessment: 1. **Inception Phase** Based on the three phases/scenarios outlined in the concept note, the international consultant, with the assistance of the national consultant, will develop a rigorous assessment protocol. This will include a detailed methodology, data collection tools, and a strategy and plan for data collection, which will encompass both desk reviews and other secondary data sources. The protocol will also include a sampling strategy and a detailed plan for primary data collection, such as stakeholder interviews and consultations. Additionally, the consultant will outline a data analysis plan/synthesis and the approach for disseminating results at the end of the process. The international consultant will assist the national consultant in facilitating a consultation meeting to review and finalize the assessment protocol. It would also be beneficial to include a draft outline of the assessment report. The study protocol will be presented at stakeholder consultations to ensure consensus. 1. **Data Collection** The data collection will begin with a document review of key resources, including the VMW integration roadmap, SOP, VMW program implementation reports, the new malaria sustainability roadmap, the national guideline on prevention of re-establishment, relevant publications and articles, and any other necessary secondary data available both in-country (such as relevant databases) and internationally. The international consultant will guide the national consultant in collecting fresh data through stakeholder consultations and workshops to gather insights on the current VMW situation and VMW program implementation. This will involve key players such as UNOPS (as the GF principal recipient), CNM, other GF sub-recipients, CSOs implementing malaria activities and providing technical assistance, as well as development partners including PMI/USAID. Selected VMWs/MMWs will also be invited for interviews or group discussions. Other important stakeholders include the National Center for Health Promotion, various departments/programs of the Ministry of Health (MoH), and the Department of Sub-National Administrations of the Ministry of the Interior (MoI). 1. **Data Analysis and synthesis** The data analysis and synthesis will align with the three scenarios outlined in the concept note: + **Phase 1:** The retrospective analysis will examine the progress and results of implementing the "Roadmap to Integrate VMW 2021-2025," focusing on the experiences and challenges encountered during implementation. This in-depth analysis will address key questions such as: How was the implementation carried out? What tools and strategies were used to achieve this? What aspects of the implementation were successful, and why? What challenges were faced, and how can these challenges be overcome? + **Phase 2:** This analysis will focus on recommendations and options for VMW services during the elimination verification phase (2026-2028), in which CNM aims to retain the current VMW approaches (e.g., the number of VMWs and the services they provide). It will build upon the experiences and strategies from Scenario 1, addressing how the challenges identified in the first phase can be overcome and using this as a foundation to develop recommendations for VMW approaches during this phase. It will also incorporate evidence from other countries on how to maintain community engagement during verification of elimination. The recommendations need to include options based on expectations of reduction in donor funding. + **Phase 3:** This scenario will explore long-term options for the VMW service strategy, assuming the country has received WHO's malaria elimination certification, which will impact the donor funding landscape. The goal is to sustain VMW services within the integrated CHW approach under the primary healthcare strategy. Other considerations include the decline in donor funding resulting from the success of malaria elimination and the transition to domestic financing. Each of these analyses will need to carefully consider the context, conditions, and assumptions outlined in the scenario table of the concept note. 1. t **Report development** The consultant is required to develop the assessment report. The consultant will put together a draft report outline at the beginning and flesh out with findings and analyzed information and data of the retrospective assessment, recommendations/options for the medium and long-terms when they are available. 1. **Findings Validation** All findings of the assessment, conclusions and discussions, recommendations will be validated in a consultative and participatory process in a national workshop in which participants will review, discuss and provide inputs, opinions that will be considered to be incorporated into the draft report to make it the final draft that will need to be reviewed and endorsed by TWG and CNM. _Skills/Knowledge Required:_ The international consultant for this assignment must blend technical expertise in malaria programming, health system, policy and strategic formulation, and stakeholder engagement skills. This combination will ensure the success of the rapid VMW landscape assessment. Therefore, the international consultant should possess the following skills, knowledge, and experience: + Postgraduate degree in public health, health system strengthening, human resources for health, health financing, health economics, or another relevant health field. + MA/MS/MB with 12 years of experience or a Ph.D. with 8 years of experience. + A solid knowledge of public health principles, comprehensive and inclusive primary healthcare and community health systems, community health workforce, universal health coverage (UHC). Good understanding of global health initiatives, funding mechanisms, and strategies for program sustainability, particularly the donor funding transition approaches of the community-based malaria programming. + Extensive experience in conducting in-depth analysis of community health system, service delivery of the primary healthcare and community health workforce in limited-resource settings, especially in southeast Asian countries. + Strong experience in designing, leading, and conducting similar assessments in health/disease programs, as well as quantitative data analysis using software such as SPSS or STATA, and qualitative analysis software like NVIVO.. + Knowledge of the linkages between the UHC and primary healthcare, financial barriers to accessing equitable and quality healthcare, the concept of "no one left behind," and people-centered health services. + Experience in conducting and facilitating meetings, discussions, and workshops. + Advanced written and spoken English language skills. + Good interpersonal skills; well-organized and self-motivated. _Deliverables_ Below are the expected deliverables from the consultancy: 1. **Inception Phase** 2. The **Assessment protocol** which includes methods, tools and detailed work plan (Gantt Chart). 3. **A draft report outline** of the Rapid Landscape Assessment. 1. **Final Deliverables** 2. Along with the national consultant(s) completed data collection and analysis 3. Completed validation workshop 4. **Final report of the Rapid VMW Landscape Assessment Report** _Level of efforts and Timelines_ **Activity** **\# of Day** **Timeframe** **Note** 1. **Inception Phase** + Develop the **assessment protocol** which will include detailed methodology, data collection tools, strategy and plan for data collection which includes desk review and other secondary data collection, sampling strategy, detailed plan for collecting primary data collection such as stakeholders interviews and consultations, data analysis plan/synthesis, up to the end of the process in results dissemination. Support national consultant to conduct stakeholder consultation of the study protocol. + Develop a **draft outline of the assessment report** . The study protocol will need to be brought to the stakeholder consultations to get consensus. 5 Feb 2025 1. **Data Collection** + The international consultant will mainly conduct desk review + The international consultant supports the national consultant to collect data based on the agreed data collection tool. S/he may be required to be directly involved in the process of interview/meetings, consultations or discussion if the national consultant requested. + The data collection will also involve reviewing findings/results of all recent assessments/studies related to TB, including the TB Optima Study supported by USAID-LHSS and the TB Financial Sustainability Index. There will be no primary data collection. 5 Feb 2025 1. **Data Analysis and synthesis** + Analyze data of the assessment with the assistance of the national consultant + Develop recommendations based on the scenarios 2 2 March 2025 1. **Report development** Based on the agreed draft report outline, the international consultant will **develop the assessment report** with the assistance of the national consultant 4 March 2025 1. **Findings Validation** + Preparing materials + Facilitate validation workshop along with the national consultant 1.5 April 2025 Validation can be done through TWG meeting or a validation workshop + Final short term technical assistance consultancy report- STTA 0.5 By end of consultancy Template is given **Total** **20** **Period of Performance** : January 31, 2025 – April 30, 2025. **Location:** Phnom Penh, Cambodia **Travel Required:** one round-trip flight to Cambodia for in-country work