TERMS OF REFERENCE (ToR): Consultancy for Developing a Comprehensive Training Manual for “Stigma Reduction on Mental Health”

TERMS OF REFERENCE (ToR)

Consultancy for Developing a Comprehensive Training Manual for “Stigma Reduction on Mental Health”

1. Organizational Background 

KOSHISH is a national-level organization established in 2008 to promote mental health and psychosocial wellbeing in Nepal. Registered with the District Administration Office, Kathmandu (Reg. No. 086/065) and affiliated with the Social Welfare Council, Nepal (Reg. No. 25677), KOSHISH is recognized as an Organization of Persons with Disabilities (OPD) focused on psychosocial disability.

Guided by the principle of “Nothing About Us Without Us”, KOSHISH works through a rights-based, person-centered, and recovery-oriented approach. Its core operational areas include advocacy and policy reform, community engagement, direct mental health and psychosocial support (MHPSS) services, capacity building, and humanitarian response. Reducing stigma and discrimination associated with mental health problems and psychosocial disabilities remains central to its mission. 

2. Background of the Assignment

Stigma related to mental health problems and psychosocial disabilities remains one of the most pervasive barriers to treatment-seeking, early identification, quality health service utilization, recovery, and social inclusion across Nepal. Stigma operates through complex, interrelated layers: 

• Self-Stigma (Internalized): Individuals absorb pervasive societal biases, leading to loss of self-esteem, shame, and hesitation to access Outpatient Department (OPD) services or participate in peer groups. 
• Public/Social Stigma: Negative societal attitudes, deep-rooted cultural misconceptions (e.g., attributing mental health problems to spiritual failings or karma), and derogatory language lead to isolation, exclusion from family decisions, and community isolation. 
• Institutional & Structural Stigma: Embedded in clinical environments, public policies, and institutional systems. Health facility staff and general healthcare workers, may unconsciously exhibit diagnostic overshadowing, therapeutic pessimism, or discriminatory practices, resulting in inadequate care or violation of dignity.
• Intersectional Stigma: The compounded discrimination faced by individuals based on gender, poverty, disability, caste, geographic remoteness, and traditional social hierarchies.

Aligning directly with KOSHISH’s strategic objectives; wellbeing and empowerment of persons with lived experience, awareness and advocacy on mental health and strengthened community support system - this assignment addresses these systemic challenges regarding stigma towards mental health. Despite progressive national commitments (such as the Disability Rights Act 2017, the National Mental Health Strategy and Action Plan 2020, and the UN Convention on the Rights of Persons with Disabilities - UNCRPD), practical and actionable resources to guide diverse stakeholders in stigma reduction are severely lacking in Nepal. 

To bridge this gap, KOSHISH seeks a qualified consultant/firm to develop a practical, standardized, and adaptable Comprehensive Training Manual for “Stigma Reduction on Mental Health”. The training manual will serve a multi-stakeholder target audience, including primary health workers, Female Community Health Volunteers (FCHVs), Organizations of Persons with Disabilities (OPDs), Peer Support Groups (PSGs), Self-Help Groups (SHGs), local government actors, and community facilitators. 

3. Purpose of the Assignment

The primary purpose of this consultancy is to develop a high-quality, practical, evidence-informed, and culturally appropriate Comprehensive Training Manual for “Stigma Reduction on Mental Health” tailored to the Nepali context. 

The primary deliverable will lead and structure a 2-day Stigma Reduction Capacity Development Training comprising 8 sessions (4 sessions of 1.5 hours each day). This manual will equip health workers, FCHVs, OPDs, PSGs/SHGs, and local stakeholders with actionable tools, interactive modules, and practical strategies to recognize, challenge, and systematically reduce stigma and discrimination in healthcare settings and community spaces. 

4. Objectives

4.1 General Objective

To develop a comprehensive, standardized Stigma Reduction Training Manual and facilitator guide for a 2-day workshop that strengthens the capacity of health workers, FCHVs, OPDs, PSGs/SHGs, and local stakeholders to mitigate stigma, protect human rights, and promote full inclusion for persons with psychosocial disabilities in Nepal. 

4.2 Specific Objectives

The specific objectives of the assignment are as below;

• Synthesize national and international literature, guidelines, and frameworks (e.g., WHO Quality Rights, UNCRPD, MH GAP Community Toolkit) with emphasis on context to Nepal.
• Engage in structured consultations with persons with lived experience, self-advocates, OPD representatives, SHG/PSG members and other related stakeholders. 
• Design a 2-day training module structured into 8 distinct 1.5-hour sessions complete with facilitator guides, session plans, PowerPoint slides, role-plays, case studies, and reflection tools. 
• Develop user-tailored guidance sections within the manual specifically addressing:
  • Healthcare Workers & FCHVs reducing clinical biases, rights-based user communication, preventing diagnostic overshadowing. 
  • OPDs, PSGs, and SHGs - fostering self-advocacy, combatting internalized stigma, peer-led contact-based strategies, and Inclusive Advocacy initiatives. 
  • Community & Institutional Stakeholders (local government, FCHVs, traditional healers and community leaders). 
• Develop a standalone practical matrix on What Works vs. What Doesn't in stigma reduction interventions in Nepal (the matrix should be evidence based). 

5. Scope of Work

The consultant/firm will undertake the following tasks: 

5.1 Inception Phase

• Conduct an inception meeting with the KOSHISH leadership and advocacy team. 
• Formulate a detailed methodology, stakeholder consultation plan, initial manual outline, and time-bound work plan. 
• Submit a comprehensive Inception Report for approval. 

5.2 Document and Literature Review

Review key policy, legal, and operational documents, including: 

• Constitution of Nepal (2015)
• National Health Policy (2019). 
• Public Health Service Act (2018).
• Act related to Rights of Persons with Disabilities (2017) and UN Convention on the Rights of Persons with Disabilities (UNCRPD, 2006). 
• WHO Quality Rights Toolkits, MH GAP Community Toolkit, and Global Stigma Reduction guidelines. 
• KOSHISH’s institutional reports, self-advocacy training materials, and peer support group resources.
• National and International documents related to stigma reduction on mental health.

5.3 Stakeholder Consultations

• Conduct Key Informant Interviews (KIIs) and Focus Group Discussions (FGDs) with:
  • Persons with lived experience and self-advocates. 
  • Healthcare providers and FCHVs. 
  • Representatives from OPDs, Peer Support Groups (PSGs), and Self-Help Groups (SHGs). 
  • Community facilitators, and municipal health officers. 
  • Traditional Healers and local leaders.

Ensure meaningful, safe, and ethical involvement of rights-holders following the principles of informed consent and safeguarding. 

5.4 Development of the Stigma Reduction Manual

The manual must be explicitly tailored to the Nepali socio-cultural, legal, and operational healthcare landscape. It must adopt an accessible, low-literacy-friendly, pictorial, and practical approach. 

The core of the manual will be structured around a 2-Day (8-Session x 1.5 Hours) curriculum.

Contextual Features for Nepal:

• Use local case studies, illustrations, and culturally resonant analogies. 
• Include tailored facilitation modules for low-literacy peer group environments using pictorial tools and role-plays. 

5.5 Review, Validation, and Finalization

• Submit the draft manual to KOSHISH for technical review. 
• Develop a standalone practical guidelines document: "What Works and What Doesn't in Stigma Reduction".
• Organize a multi-stakeholder validation workshop (including health workers, FCHVs, OPD leaders, PSG/SHG members, self-advocates, and KOSHISH team members). 
• Finalize the manual in both English and Nepali.

6. Deliverables

The consultant/firm will be required to deliver the following outputs: 

1. Inception Report: Including detailed methodology, consultation tools, proposed manual structure, and work plan. 
2. Stakeholder Consultation Report & Desk Review Summary: Synthesizing key findings from KIIs, FGDs, and national/international literature. 
3. First Draft of the Stigma Reduction Manual: Comprising the full 2-day / 8-session curriculum in English/Nepali. 
4. Standalone Matrix: "What Works and What Doesn't in Stigma Reduction". 
5. Final Stigma Reduction Training Manual: Delivered in both English and Nepali (in editable Word format and PDF). 
6. Complete Training Slide Decks: PowerPoint presentations in English and Nepali covering all 8 training sessions. 
7. Validation Workshop Summary Report: Documenting feedback gathered during validation and detailing the revisions incorporated into the final manual. 

7. Duration of Assignment and Reporting

• Total Duration: The assignment shall be completed within 45 days from the date of contract execution. 
• Reporting Line: The consultant will work in close coordination with the Advocacy Manager of KOSHISH. 

8. Required Qualifications and Expertise

The prospective consultant or firm should possess the following qualifications: 

Education: Master’s degree or higher in Public Health, Psychiatry, Clinical Psychology, Psychiatric Nursing, Social Work, Medical Anthropology, Disability Studies, or related Social Sciences. 

Professional Experience:

• Minimum 5 years of professional experience in MHPSS, disability rights, public health curriculum development, or stigma reduction initiatives in Nepal. 
• Demonstrated experience designing training manuals, ToT packages, or clinical toolkits for health workers, OPDs, and community groups. 
• In-depth understanding of the UNCRPD, WHO Quality Rights framework, and Nepal’s healthcare system (OPD and primary healthcare operations). 

9. Payment Schedule

Payment will be disbursed in installments based on the achievement of key milestones: 

1. 30% upon approval of the Inception Report and proposed Manual Outline. 
2. 40% upon submission and technical acceptance of the First Draft Manual. 
3. 30% upon full acceptance of the Final Manual (English and Nepali), slide decks, and all agreed final deliverables. 

(Applicable taxes will be withheld at source as per the existing tax laws of the Government of Nepal.) 

10. Proposal Submission Guidelines

Interested individual consultants or consulting firms are requested to submit the following documents: 

1. Technical Proposal: Detailed methodology, proposed 2-day session framework, stakeholder engagement strategy, and team structure. 
2. Financial Proposal: Itemized budget breakdown in NPR, inclusive of all operational costs and applicable taxes. 
3. Curriculum Vitae (CVs): Updated profile(s) emphasizing manual development and relevant MHPSS experience. 
4. Work Samples: Copies or links to previously developed training manuals, guidelines, or toolkits. 
5. Administrative Documents: Firm registration, PAN/VAT certificate, and tax clearance certificate (if applying as a firm). 

Submission Address:

Sealed proposals marked “Consultancy for Development of Comprehensive Training Manual for Stigma Reduction on Mental Health” must be delivered by courier or hand to: KOSHISH Central Office, Dakshinkali Road, Balkhu, Kathmandu, Nepal by 5th October.

Note:

• Equal Opportunity: KOSHISH promotes equal opportunities and encourages applications from qualified women, persons with disabilities, persons with lived experience, and individuals from marginalized communities.
• Safeguarding: KOSHISH is committed to ensuring the safety, dignity, and well-being of all individuals and maintains a zero-tolerance policy for sexual exploitation, abuse, harassment, or any other form of harm.  All consultants are required to adhere to KOSHISH's Safeguarding Policy and Code of Conduct
• Compliance: All shortlisted candidates will be required to comply with KOSHISH’s Safeguarding Policy and Code of Conduct and undergo appropriate safeguarding checks.
• Rights Reserved: KOSHISH reserves the right to accept or reject any or all proposals without assigning any reason.