Terms Of Reference - Development of a One Health concept note

Terms Of Reference

A. Introduction

For more than 40 years, Médecins du Monde (MdM), a campaigning medical organization committed to international solidarity, has been caring for the most vulnerable populations at home and abroad. It has continued to highlight obstacles that exist in accessing health care and has secured sustainable improvements in health-for-all policies. Those working for this independent organization do not solely dispense care and treatment but condemn violations of human dignity and rights and fight to improve matters for populations living in precarious situations. MdM currently works in more than 44 countries across all continents where it focuses on 6 priority areas: Sexual and reproductive health and rights (including access to safe abortion), Migration, exile, human rights and health, Harm reduction, Health and environment, Healthcare systems, Humanitarian spaces.

MdM has worked in Nepal since 1995: firstly, on Tuberculosis and HIV in western province, then on Sexual and Reproductive Health in Sindhupalchok District. Following the 2015 earthquakes, MdM implemented an emergency response program and then, a post-earthquake early recovery project in the same district.

Médecins du Monde (MdM) has been actively engaged in improving the health and wellbeing of marginalized communities, particularly informal waste workers, through initiatives like the "Healthy Waste Workers" program. This program, operational in Kathmandu, Nuwakot, and Banke, has significantly enhanced access to quality healthcare services and facilitated enrollment in National Health Insurance (NHI) schemes, in collaboration with local and federal governments. 

Building on this successful model, MdM’s strategic plan 2025- 2027 places a strong emphasis on the women’s health interventions, specifically targeting socio-economic, environmental and health challenges prevalent in Lalbandi municipality, Madhesh province. Given the fact that the Lalbandi municipality is the biggest exporter of vegetables to Kathmandu and major cities and from the need assessment visit it was identified that the pesticide use in this area is increasing rampantly. At the same time, health and socio-economic indicators remain low—particularly for women and for those in single-headed households—who must manage agricultural and livestock duties in addition to caring for their children. This situation is compounded by the particularly high rate of male migration, both internal and international, in Madesh Province. Considering all these factors, MdM-France would like to explore the feasibility of a One Health in the area.

B. Objective of the Study:

The objective is to provide data and data analysis to support the development of a One Health concept note.

1. With the support of a local organization, identify a district within the Lalbandi municipality for data collection.

2. Using the appropriate methodology, collect data in order to:

At the district level:

Understand the living and working conditions as well as socio-economic status of the female farmers of the selected district.

• Assess major health problems, health-seeking behaviors, healthcare accessibility, and utilization among the female farmers in the district, identifying barriers and facilitators to accessing healthcare services. 
• Identify the local actors working on farming practices and animal health within the district.
• With these actors, identify the main challenges in agricultural and husbandry practices.
• Identify the active community organizations, and especially those focusing on women.
• Identify the existing silos and gaps between actors related to an ecosystemic and global vision and identify levers and constraints for more cooperation

At the municipality and provincial level:

• Collect health data on environment and husbandry related health issues, with a focus on :
  • zoonotic diseases
  • anti-microbial resistance
  • cancer prevalence (and esp. non-hodgkin lymphoma, leukemia, multiple myeloma,)
• Identify the local actors working on farming practices and animal health within the district.
• With these actors, identify the main challenges in agricultural and husbandry practices.
• Identify the existing silos and gaps between actors related to a ecosystemic and global vision and identify levers and constraints for more cooperation

At the provincial and national level:

• Identify potential university partners that could bring expertise on a One Health project (incl. farming, husbandry and health sectors).

C. Methodology:

The consultant will adopt a rigorous and comprehensive methodology, which includes:

1. Literature Review: Conducting an extensive review of existing literature, including government data, academic research, and reports from relevant organizations, to gain insights into the characteristics and challenges of female farmers in Madhesh. 

2. Qualitative data collection that will involve conducting Key Informant Interviews (KIIs) with community leaders, farmers cooperatives leaders, female community health volunteers, mother’s group leaders, healthcare providers, animal health actors and authorities, agricultural department heads, and other stakeholders to gather in-depth insights into local perceptions, experiences, and challenges. Additionally, organizing Focus Group Discussions (FGDs) with community members to explore specific themes in greater detail.

3. Direct Field Observation: Conducting direct field observations to assess the physical environment, living conditions, working conditions, infrastructure, and sanitation facilities in the targeted communities.

4. Stakeholder Engagement: Engaging with relevant stakeholders, including local authorities, community organizations, and healthcare providers, throughout the assessment process to ensure collaboration, participation, and ownership.

D. Deliverables:

The consultant will be required to deliver the following outputs:

A comprehensive report including all the findings and recommendations on:

• The health and socioeconomic conditions of armers in the selected district, 
• The animal health, Socio economic determinant of Health and agricultural practices that may affect human health and the ecosystem in the selected area,
• Recommendations for a potential intervention with a One Health approach. 

No inception report will be requested, however, the consultant will have to submit to his/her supervisor all the data collection tools and work plan before starting data collection. 

Regular debrief will be organized in order to re-orient part of the study if needed.

F.     Responsibilities of MdM

• Once after the finalizing the consultant, a brief discussion and orientation session will be organized. 
• MdM will provide the need based technical guidance to consultant 
• MdM shall not be responsible for any loss and damage properties of consultants while carrying out the assessment. 
• Any issues aroused during the assessment should be settled with mutual consent of both the parties.  

G. Timeframe:

The study is expected to be completed within a period of 3 weeks, with data collection commencing in December and final deliverables to be submitted by 15th January 2026. 

H. Confidentiality and Data Protection:

The consultant must adhere to strict confidentiality and data protection protocols, ensuring that all collected data, reports, and observations remain confidential and are used solely for the purpose of this study. Any unauthorized disclosure or sharing of data is strictly prohibited. The consultant should comply with policy of MdM, Government of Nepal and European Union data protection policy when any contrary. 

MDM will hold all the authority to the collected data.

I. Qualification and Experience:

The lead consultant should possess:

• A Master's degree or higher in public health, social sciences, or a related field.
• Lead consultant with at least five years of relevant experience in conducting research and assessments or relevant project interventions, particularly in the field of public health or community development.
• Proven experience in leading and managing complex research projects, including data collection, analysis, and reporting.
• Strong analytical and communication skills, with demonstrated ability to translate research findings into actionable recommendations.
• Experience working in multicultural settings and familiarity with the context and challenges of Madhesh province
• A track record of collaborating with government agencies, NGOs, and community-based organizations in similar contexts.
• The consultant should be the mastery in local language and familiar with the local context of squatter settlements. 

J. Budget:

The budget should cover:

• Consultant fees.
• Logistic arrangements, including meetings, travel, insurance, communication, material costs, and any other specified expenses.
• Report preparation and submission expenses.

K. Proposal Evaluation 

The technical and financial proposals will be evaluated separately and have 70% and 30% scores respectively. The proposals evaluation is based on the given criteria 

L.     Application Procedure

Interested candidates, firms and agencies are mandatory to submit the following documents by December 19, 2025  admin.nepal@medecinsdumonde.net with subject line “Concept Note on One Health”

• Letter of motivation (3 pages max.) indicating
  • The consultants’ suitability for the assignment and match-with previous work experience, qualifications etc.
  • The work methodology.
  • Draft work plan and suggested timetable.
• Financial proposal with proper budget breakdown 
• Professional profile of the consultant  
• For Firm: Registration & renewals, PAN, Tax clearance or for Individuals – PAN