Evaluation of new partnerships in the programme “Close the Gap: Sufficient, Competent and Motivated Nurses and Midwives” in Tanzania and Zimbabwe Long-term contract NEW

I. Introduction

This is the Terms of Reference (ToR) for the Evaluation of the programme CLOSE THE GAP: SUFFICIENT, COMPETENT AND MOTIVATED NURSES AND MIDWIVES (GLO-0759 RAF-23/0074) and its local partners Tanzania National Nurses Association (TANNA) in Tanzania and Zimbabwe Nurses Association (ZINA) in Zimbabwe.

The current programme agreement and plan started on 31.3.2024. The current programme period ends on 31.12.2028.

This ToR sets out the expectations for this Evaluation process and deliverables.

II. Background

a) About NNO

The Norwegian Nurses Organisation (NNO) (Norsk Sykepleierforbund, NSF) is a national professional nurses organisation and labour union representing about 130,000 registered nurses, midwives and nursing students in Norway.

NNO was founded in 1912 and focuses on professional, social, and representational policies, concerning areas such as public health, ethical nursing standards, as well as collective bargaining aimed at improving, e.g., working hours, working conditions and pay. NNO is politically neutral and has some 3000 elected union representatives.

NNO has been involved in international development work since the 1980s, with programmes/projects supporting the development of strong nurses’ organisations in Africa. This work has been, and currently is, supported and partly financed by the Norwegian Agency for Development Cooperation (Norad1).

b) About TANNA

The Tanzania National Nurses Association (TANNA) has approximately 10 000 members, with 57 regional branches across Tanzania.

The Nurses’ Association was founded in 1971. In 2005 the constitution was reviewed and the association changed to its current name to Tanzania National Nurses Association (TANNA), including both registered and enrolled nurses to join the organisation.

TANNA is a professional organisation and was established to unite and empower nurses and midwives, promote professional development, uphold ethical standards, advocate for members’ rights and welfare, and contribute to the delivery of high-quality healthcare services. TANNA is currently in process of transferring status from association to union, a change that will enable TANNA to negotiate and undertake collective bargaining for the nurses/midwives it represents.

The TANNA leadership is elected during the Annual General Meeting. Elections are conducted every three years. The association also has a board of trustees appointed for a tenure of three years. Moreover, the association is governed by a Nurses National Council of leaders from the 57 branches, and the day-to-day affairs are overseen by an elected National Executive Committee of 10 individuals.

c) About ZINA

Founded in 1980, Zimbabwe Nurses Association (ZINA) is both a nurses’ union and a nurses’ organisation. ZINA currently has a membership of around 9,400 nurses. ZINA draws its membership from public and private health facilities in the country. It is a supportive body for all nursing matters related to education, service, leadership development, standards, and quality care. The organization is managed by a standing committee of six members plus ten provincial chairmen. It operates in compliance with Zimbabwe’s National Nurses Act and Nursing Council Code of Ethics.

ZINA is the only voice of nurses in Zimbabwe covering the public sector, private sectors and mission institutions. Moreover, ZINA is registered as a trade union, with the legal mandate to negotiate with government on working conditions. As a mother body, ZINA has subgroups under its umbrella. These include the Association of Midwives, Anaesthetists, Occupational Health Nurses, and Mental Health Nurses. ZINA is also affiliated with regional, international, and local associations. These include the Southern African Network for Nurses and Midwives (SANNAM) and the Eastern, Central and Southern African College of Nursing (ESACON), and the International Council of Nurses (ICN).

ZINA’s vision is to “advocate for empowered nursing, evolving nursing profession and accessible healthcare in Zimbabwe”.

c) NNO’s partnership model

As described in NNO’s Strategy for International Development Cooperation (2023-2029), civil society is an important driving force in societal development in all countries. Strong and independent organisations can help promote democratisation, realise human rights, and reduce poverty. NNO believes that strong nurses and midwives’ organisations are important contributors in holding governments accountable for having sufficient, competent, and motivated health personnel in a country. This is at the core of NNO’s partnership model.

NNO’s partnership model puts increasing emphasis on technical and professional cooperation with decreasing financial support to administration. This is reflected in collaborative project activities like joint seminars and knowledge exchange in areas like advocacy/lobbying; membership recruitment/administration; strategic communication; and organisational development of democratic member-based organisations.

The division of labour, roles, and responsibilities between NNO and its partners differs slightly depending on the activity. In most cases, the partner is the implementer while NNO has a supporting and/or advisory function. For example, in terms of organisational development, the local partner is responsible for planning, executing, and evaluating local trainings. NNO may be a discussion partner in terms of e.g., the content of the training, and may also contribute with an expert.

In other areas, NNO might have more responsibility for organising and delivering capacity building activities, especially when there are specific expertise or experiences within the NNO structure that is to be shared with the partner. When NNO has a more active role in the activity, emphasis is on making sure that the capacity of the partner is strengthened during the process.

In terms of other technical support, NNO often challenges the partner when it comes to – for example – setting realistic targets, how to assess learning outcomes, how to ensure learning is applied, the documentation of results, etc. This is followed by support, e.g., on how to develop and use simple monitoring and evaluation tools, and how to analyse and apply findings.

d) Brief programme background

The 5-year programme, “Closing the Gap: Sufficient, Competent and Motivated Nurses and Midwives (GLO-0759 RAF-23/0074)” is co-funded by the Norwegian Agency for Development cooperation (Norad) and NNO and has four local partners: National Organisation of Nurses and Midwives of Malawi (NONM), Rwanda Nurses and Midwives Union (RNMU), Tanzania National Nurses Association (TANNA), and Zimbabwe Nurses Association (ZINA). The two latter are subject to this Evaluation.

In brief, the core of the programme is summarized as follows:

Nurses and midwives are the backbone of the health system. Yet they are overworked, undervalued, and underpaid. Many also lack the skills, equipment, and support to do their job effectively, and safely. These are contributors to the fact that Africa is lacking millions of health personnel.

The planned effect on society of this programme is that universally accessible, equitable, and affordable quality health services are ensured in Malawi, Rwanda, Tanzania and Zimbabwe. The goal of the programme is to contribute to having sufficient, competent, and motivated nurses and midwives capable of addressing the population’s current and emerging health needs.

Civil society, represented by strong and independent organisations, is an important driving force in development. Hence NNO provides professional, technical, and financial support to TANNA and ZINA for them to be: 1) a democratic, accountable, inclusive and sustainable organisations for nurses and midwives in Tanzania and Zimbabwe respectively; and 2) effective watchdogs and advocates.

By realising these outcomes, TANNA and ZINA will contribute to better status, pay and working conditions for nurses and midwives; a more competent, qualified, and capable healthcare workforce; greater leadership opportunities for women; and better healthcare and public-sector policy, legislation, and reforms, amongst others. This will again contribute towards the realization of countries’ current and emerging health needs.

III. Objective and purpose of the Evaluation

The evaluation is set out as a requirement in GLO-0759 RAF-23/0074, Specific Conditions §9.1: “Reviews focusing on progress to date shall be carried out for each of the country projects: TANNA and ZINA by end of 2026; […].”

The Evaluation aims to:

a) assess and describe the level of progress in TANNA and ZINA, and the partnership achieving its planned outputs, outcomes and overall objective in the programme period 2024-2026, including cross-cutting issues as gender, inclusion, and equality, as set out in the results framework.

b) assess and describe, if relevant, if there are any other achievements/results/impacts that are not covered by the project’s result framework, but that the project has contributed directly to, especially since 2024 and to date.

c) assess TANNA and ZINA and the partnership’s alignment with and potential contribution to national plans and targets/goals, and map potential opportunities at the national level.

d) reflect on potential wider societal impact that the development of TANNA and ZINA may have in the two countries, and how the organisations could position themselves to maximize potential impact.

e) give examples of positive change that TANNA and ZINA have contributed to, for 1) nurses and midwives, 2) the nursing- and the midwifery professions, 3) patients, and 4) society at large

f) assess how the programme has been managed by TANNA and ZINA, including financial management (/ anti-corruption), the efficiency and effectiveness of TANNA and ZINA’s work processes, monitoring and evaluation. Internal and external factors affecting this shall be described and explained.

g) assess and reflect on the various aspects of the partnership with NNO, and NNO technical (non-financial) support.

h) assess and describe internal and external risk factors that (may) have had an impact on activities, outcomes, ability to achieve results and the organisation’s development. As part of this analysis review the organisations’ risk matrix and assess if any adjustments are needed to better reflect the contextual risk landscape as of 2026.

i) identify prioritized areas and recommendations for the continued work of TANNA and ZINA.

j) identify key areas and indicators, internal and external, that affect TANNA and ZINA’s financial sustainability and future ability to operate without the financial support of NNO

k) reflect on the operational context in Tanzania and Zimbabwe, i.e., the space and environment for professional organisations and (labour) unions, the culture for getting organised in member-based organisations, culture of voluntarism, level of trust in the government and level of trust in the society at large.

The Evaluation may also assess and reflect on other areas that come up during the review process, that are relevant to the objective and purpose of the Evaluation.

IV. Methodology

Background: NNO’s system for result management

NNO’s system for result management is based on Results Based Management (RBM) principles and a human rights-based approach. In practice this means that NNO uses various feedback loops to assess and map progress towards set targets.

The feedback loops are, among others: quarterly activity-, output- and outcome monitoring tools (partner to NNO); data collection and monitoring tools used by the local partners; partnership meetings between NNO and the local partners; local stakeholder meetings; quarterly NNO steering committee meetings; and regular partner-NNO online meetings.

NNO uses external evaluators to perform mid- and end-term reviews and evaluations. In addition, NNO facilitates south-south and partner-to-partner exchanges (e.g., seminars) for additional learning and sharing of experiences and good practices.

For the programme under review, there is a joint logical results framework (consolidating two partners) that uses several defined concepts such as overall objective, outcomes, outcome indicators, outputs and output indicators. The framework was developed in close collaboration with TANNA and ZINA, and the other partners. It is expected that all activities supported by NNO/Norad, as defined in detailed annual plans developed by TANNA and ZINA, contributes towards achievement of the outcomes and objective in the results framework.

NNO’s system for results management also includes planning and results-based budgeting that involves calculating and proposing resource requirements based on pre-determined results, rather than merely based on scheduled outputs or activities. A central tool is the overall programme budget, which provides a direct link between expected results and resource requirements.

The framework is dependent on critical assumptions about the environment and context, taking into consideration major external and internal factors and conditions as well as clearly defined accountabilities and indicators for results. The budget is reported against in every quarter. When conditions and requirements change, the budget is revised accordingly. This is a partner-NNO process that is usually done once or twice a year.

The human rights-based approach specifies the subjects of the project results, i.e., the rights-holders and the duty-bearers. Typically, the rights-holders are the nurses or their patients, while the duty bearers are different levels of government, or employers. The outputs aim to close capacity gaps while outcomes reflect improvement in the performance of, or the strengthened responsibility of, the rights-holders and duty-bearers. Furthermore, the results specify the realisation of human rights as laid down in the SDGs (and other international instruments).

NNO and local partners have mutual accountability, which applies to both the use of resources as well as the achievement of results. This is done through a shared agenda, ensuring space for dialogue and negotiation, reciprocal trust, transparency, and evidence that is collected and shared amongst all partners.

Methodology for the evaluation

The consultant(s) should describe how they will proceed to conduct the evaluation.

The proposed methods must sufficiently address the issues and questions outlined within the ToR, specifying the specific review issues, questions, methods of data collection, and analysis that will be undertaken. Preferably, it should encompass a mixed method approach. It should also allow for wide consultation with all interested partners and stakeholders. Assumptions and limitations must be stated clearly.

Approaches that allow for review over a longer period are of particular interest.

It is suggested that the methods should include, but not be limited to the following,

a) Document review.

Should include, but not be limited to, the following documents:

– Programme application / proposal

– The TANNA/ZINA-NNO Project Agreement

– Annual work plans

– Results Framework

– Progress, results and financial reports (periodic and annual)

– Audit reports and Management Letters

b) Field visits.

During these visits, the consultant(s) may contact, amongst others,

-Secretariat

-Province/Branch leaders / offices

– Elected representatives, local and board members

– Members

– Local or national stakeholders or alliance partners

c) Focus Group Discussions (FGDs)

– Local representatives/executives

– Members

d) Interviews.

• Key informants can be drawn among FGD participants, stakeholders (governmental and non-governmental), members, workplaces, staff and others.

V. Qualifications / expertise

The Evaluation as outlined in this ToR will require competence and experience within several disciplines and areas. The proposal must outline how these requirements are met. If the proposal includes a team of consultants, the team must have a team leader. The team leader shall (besides having a supervisory and coordinating role) be the main point of contact, and responsible for contractual and all other administrative arrangements (including payments).

The consultant/consultant team shall have the following competencies and experience:

• A master’s degree or higher in relevant subject matter(s)
• At least 10 years of evaluation expertise (evaluating programmes of a similar nature and scope), preferably having conducted evaluations in the areas of labour unions / professional organisations and organisational development. Additional experience from and/or comprehensive understanding of health systems preferred.
• Demonstrated experience in designing evaluation methodology and data collection tools, quantitative and qualitative
• Documented analytical abilities
• Documented experience in reviewing organisational capacity building initiatives focusing on, but not limited to, financial management
• Excellent written and oral communication skills in English
• In-depth first-hand experience from Tanzania and/or Zimbabwe, and extensive familiarity and understanding of the two contexts.
• Excellent inter-personal skills
• Excellent organizational and administrative skills
• Impeccable time management
• Independence and absence of conflict of interests
• Strong references from similar work

All consultants that are contracted for the Evaluation assignment must adhere to the principles of “do no harm”. Further it is important that the contracted consultant(s) are not representing NNO, TANNA or ZINA.

It is important that all data and information collected for this Evaluation is collected, treated, and stored in a secure manner.

VI. Deliverables / expected outputs

a) A final report, not exceeding 30 pages including an executive summary, but excluding appendices.

– The report must answer to this ToR.

– The executive summary should not exceed 1 page and should present key findings and recommendations.

– In addition, key findings should be summarised and presented in a table.

– All findings in the report must be supported by evidence. Conclusions must build on the findings, and recommendations must derive logically from the conclusions.

– Appendices may be of such nature that they support the analysis, conclusions, and recommendations in the main report, but are not essential for interpreting the findings.

b) An overview of results vs. targets, structured in the same format as the results framework (indicating whether behind, on or ahead of target)

c) Two (2) results examples of 800-1000 words, in a given format

d) Two (2) validation meetings (with virtual participation from NNO)

e) Verbal presentation of final report (virtual meeting)

VII. Schedule

The specific timeline for the Evaluation exercise is flexible (depending on the chosen methodology), as long as the schedule is agreed with TANNA, ZINA and NNO.

An inception meeting shall be held by 16.04.2026. The field visits and engagements with TANNA and ZINA, and the desk review and engagement with NNO, may start directly after this.

A dissemination meeting in which preliminary findings are presented is to be held in early June 2026. Based on the feedback in the dissemination meeting, a draft report should be submitted by 01.07.2026.

The final report must be submitted and approved no later than 15.08.2026 (unless otherwise agreed and approved by NNO in writing).

The date for the verbal presentation shall be agreed between TANNA, ZINA and NNO and the consultant(s), but it is expected to occur in late August 2026 hence the consultant(s) must be available for this after the final report is approved.

VIII. Proposal process: submission of bids

Applicants shall submit the following documents (all in English only):

1. A 1-page cover letter with a brief description of relevant previous experiences
2. Contact details of 3 references expected to support claims of knowledge, skills and experience
3. A technical proposal of no more than 6 pages
4. A detailed budget that specifies fees and all other costs related to the Evaluation assignment
5. A 1-page resume of each team member’s qualifications and experiences specifically relevant to the current Evaluation assignment
6. Team composition, roles and responsibilities – if applicable
7. A proposed work plan, with milestones and deliverables
8. A completed and signed Integrity Due Diligence form (one for each consultant), to confirm (amongst others) independence and absence of conflict of interests.

Submission of copies , or links to online versions, of final reports of comparable evaluations recently carried out is an advantage. If this is not possible, other written work of similar assignments should be made available.

Tender rules

The technical and financial (budget) proposals should be sent electronically (email) to bistand@nsf.no.

The subject field of the email shall be specified as “PROPOSAL FOR TANNA-ZINA-NNO- EVALUATION – [NAME OF APPLICANT]”

The deadline for submission of proposals is 03.04.2026.

Tentative shortlisting is estimated to be completed by 10.04.2026.

Any need for clarification of the ToR should be addressed to bistand@nsf.no.

Award criteria:

• Demonstrated understanding of the needs of the assignment
• Relevant qualifications and experience of the evaluator(s) including consistency of their experience with eligibility criteria
• Adequacy of the work plan with the technical specifications

IX. Financial ceiling and payment modalities

The total financial ceiling for the Evaluation exercise is NOK 300,000 (equivalent to app. USD 31,190.40 as of 03 March 2026).

Payment will be made in three instalments upon agreed deliverables.

The contractual arrangement and all payments will be made with one (lead) consultant.

All consultants that are contracted for the Evaluation assignment are responsible for their own insurance and payment of applicable taxes.

Tagged as: Agriculture, Food Security and Livelihoods