Consultancy for Impact and Cost-effectiveness Research

1. INTRODUCTION

The Fred Hollows Foundation (The Foundation) is a secular non-profit public health organization based in Australia, which was founded in 1992 by eminent eye surgeon Professor Fred Hollows. The Foundation focuses on strengthening eye health systems and the treatment and prevention of avoidable blindness caused by Cataract, Trachoma, Diabetic Retinopathy, and Refractive Error. The Foundation operates in more than 20 countries across Australia, The Pacific, South and Southeast Asia, and Africa. The Foundation was named The Australian Charity of the Year 2013 in the inaugural Australian Charity Awards.

The Foundation began working in Vietnam in 1992. Today it is one of the leading eye care International Non-Governmental Organisations (INGO) in Vietnam. The Foundation works in partnership with the Government; Ministry of Health, Ministry of Education & Training, Vietnam National Eye Hospital (VNEH); medical universities; Departments of Health, Departments of Education and Training; and more than 20 provincial eye care service providers and other INGOs who are working in Vietnam both in eye health or other fields such as IAPB and WHO in Vietnam.

Since 2016, The Fred Hollows Foundation Vietnam (FHFVN) and its partners have worked to strengthen eye health leadership, governance, and workforce capacity at all levels in Vietnam to improve the impact and sustainability of the national eye health system. The District Eye Care Model for Underserved Districts (DECMUD), launched in October 2021, aims to gather evidence on effective eye care at the district level. From 2025 to 2029, it will continue promoting equity and prioritise primary care, supporting the Ministry of Health’s strategy to reinforce prevention-focused primary healthcare.

2. PROJECT BACKGROUND

In 2021, the Ministry of Health approved Decision No. 5669/QD-BYT, establishing district eye care guidelines. This provided the legal foundation for the DECMUD project, which aimed to implement a district eye care model to improve access to quality eye care for underserved populations across nine remote and mountainous districts in three disadvantaged provinces – Hoa Binh (North), Dak Nong (Central Highlands), and Ben Tre (Mekong Delta) – where eye care services are limited or non-existent. Findings from the Mid-Term Review and the Final Evaluation show that DECMUD has enhanced the availability and quality of eye care services, increased community access – especially for marginalized groups – and demonstrated potential for replicating the model elsewhere.

Building on DECMUD’s achievements, the launch of a new phase is crucial to advancing equity in eye care for underserved communities. To promote greater inclusion and develop scalable models, the “Advancing Equity Through District Eye Care Model” (AED project) was initiated in July 2025. The AED project seeks to improve equity and inclusion in remote regions such as Hoa Binh, Dak Nong, and Ben Tre, which now belong to new provinces after recent government restructuring of Phu Tho, Lam Dong, and Vinh Long, by extending services to six additional areas and maintaining a baseline level of support in current locations under DECMUD. This strategy enables effective tracking of impact and encourages knowledge sharing between the original and expanded project sites.

The AED project incorporates an overall goal, and three desired outcomes as follows:

Project goal: Improve equitable eye care for marginalised communities through the primary eye care model.

Outcome 1: Increased access to quality eye care services by women and girls, people with disabilities and people living in remote communities.
Outcome 2: Equity in eye care becomes a priority of the health and other related sectors.
Outcome 3: The primary eye care model is recognised at provincial and national levels for up-scaling.

3. PURPOSE OF THE RESEARCH

In alignment with the Ministry of Health’s strategy to strengthen prevention-oriented primary healthcare, the AED project will conduct research to demonstrate the impact and cost-effectiveness of the district eye care model, now referred to as the primary eye care model following government restructuring in July 2025, when district administrative levels were removed.

The purpose of this research is to generate robust evidence to inform and advocate with key stakeholders, including the Ministry of Health, the eye care sector, provincial health authorities, the Vietnam Social Security Fund (Health Insurance), and international nongovernmental organizations specializing in eye care. The findings will contribute to evidence-based policy discussions aimed at scaling up the model nationally and promoting sustainable financing mechanisms, with a particular focus on improving access and outcomes for marginalized populations in remote and mountainous areas.

Building on data and lessons learned from the DECMUD project, including the 2022 baseline assessment of barriers to eye care access among diverse marginalized groups, the mid-term review conducted in late 2023, and the final evaluation completed in June 2025, this research will leverage substantial existing evidence to deepen understanding of equity in eye care, a core objective shared by both the DECMUD and AED projects.

Objectives

To evaluate the impact of the primary eye care model, with particular emphasis on promoting equity in eye care and identifying evidence-informed adaptations and implementation strategies to strengthen prevention-oriented primary healthcare and support sustainable scale-up by provincial and national authorities.
To assess the model’s cost-effectiveness, focusing on its potential to enhance equitable access to eye care among underserved and marginalized populations and to inform evidence-based strategies for sustainable scale-up within the post-2025 health system.

4. RESEARCH SCOPE AND KEY QUESTIONS SCOPE OF THE RESEARCH

This study will be implemented within the framework of the AED project, in continuation of evidence generated under the DECMUD project. The research will focus on assessing the impact, and cost-effectiveness of the primary eye care model (formerly the district eye care model), with an emphasis on equity in access and outcomes for marginalized populations.

The study will include nine sites previously involved in the DECMUD project and six newly selected sites under the AED project, as determined by the research sampling design. This design will allow for comparative analysis between areas where the model has already been implemented (DECMUD sites) and those newly introduced (AED sites), thereby enabling early assessment of the model’s impact and scalability. The impact evaluation is planned for early 2026, coinciding with the initial phase of AED project implementation, to assess baseline differences and early effects across both groups of provinces. Findings from these evaluations will inform both programmatic improvements and policy recommendations for national scale-up.

Key Research Questions:

Objective 1: Assess whether the DECMUD intervention reduces inequities in service use, experience, and financial protection for marginalised groups (women/girls, older people, ethnic minority people, people with disabilities and remote communities).

Service utilization (Access): To what extent is the project contributing to a reduction in equity gaps in line with baseline data for the priority population groups? How does the intervention affect service utilization rates (e.g, per 10,000 population) across equity groups (by sex, age, ethnic minority background, disability status, and remoteness) between the strengthened and newly strengthened sites? What changes in eye health service coverage and quality have occurred in the DECMUD implementation areas compared to the new ones in the AED areas? What are the key factors leading to this change? What are the key factors leading to this change?
Client experience (Quality and Acceptability): Does the intervention improve client experience (respect, communication, wait time, and accessibility) and reduce disparities between groups? If so, in what ways? What more could be done to improve client experience going forward?
Financial protection (Affordability): How does the intervention influence equity in financial protection, specifically catastrophic or impoverishing eye-care expenditures and median out-of-pocket costs, among targeted groups?
Intersectional and site-level equity effects: How do equity of outcomes change for individuals with intersecting disadvantages (e.g., women with disabilities or those in remote areas) – whether improving, worsening, or remaining unchanged – and what site-level factors explain these differences across locations?
Attendance at outreach and referral completion: To what extent does the model improve equitable attendance at outreach and primary eye care services, and referral completion rates among priority groups? What are the key factors leading to this change?

Objective 2: To determine whether DECMUD is a cost-effective approach for improving equitable access, quality, and financial protection, compared with standard practice, and to estimate the incremental cost required to achieve health and equity gains.

Cost and resource use: What is the total and per-site costs of implementing the DECMUD?

Effectiveness measurement: What measurable changes in service utilization and health gains result from the DECMUD, compared with standard practice?
Incremental cost-effectiveness ratio: What is the incremental cost per additional unit of outcome achieved in DECMUD compared with standard practice?
Sensitivity: How sensitive are cost-effectiveness results to variations in key parameters (utilization rates, staff costs, discount rate, service quality improvements)?
Distributional (equity-adjusted) cost-effectiveness: How do the costs and benefits distribute across equity groups (women/girls, older people, ethnic minority people, people with disabilities and remote residents)?
What are the costs associated with implementing the primary eye care model at the facility and community levels, including personnel, equipment, and operational costs?

Note: other key questions will be further discussed between the selected consultant and FHF Research Team before conducting.

5. APPROACH

Approach: The consultant is requested to propose an appropriate approach/methodology for data collection and analysis based on the key questions to be answered, and this needs to be agreed upon with the FHF Research Team. The selected approach will be ideally applied consistently throughout the research process, incorporating an equity lens that ensures the participation of marginalised groups.

Research methods should be a mixed-methods design, combining quantitative and qualitative approaches to comprehensively assess the impact, cost-effectiveness, and equity implications of the primary eye care model. These methods are used to collect and analyse data to inform the findings and recommendations. Various tools can be used for data collection and analysis e.g., quantitative research, qualitative interviews, project records…

The methodology must apply an equity lens, using disaggregated data and gender-sensitive, disability-inclusive tools and processes. Data analysis must include disaggregation by sex, age, disability, ethnicity, socio-economic status, and geography, with intersectional analysis.

The methods will be carefully reviewed and agreed by FHF Research Team which includes FHFVN, Monitoring and Evaluation advisor, Research Advisor, GAPSED advisor during the selection process.

FHFVN team will provide existing project monitoring data such as project design document, annual work plans, monitoring and evaluation framework and data, project reports, findings from eye care resource mapping, barrier assessment, mid-term review report, policy documents and national and provincial level strategy documents, including any baseline data that has been collected against the key evaluation questions, together with FHF’s GAPSED+ Equity Framework.

The researcher/s is responsible to propose and collect data as per the most recent Vietnam data privacy policy and the quality and to observe ethical standards as set out in The Foundation’s Research and Evaluation Policy and Handbook and specify if ethical or any other approvals need to be obtained.

6. DELIVERABLES

The selected researcher/s is expected to deliver specific output outline in the table below. These include aa research plan and detailed methodology; presentation of preliminary and ultimate findings; draft and final research reports; materials to support dissemination of findings (e.g. slide decks, posters, infographics) etc. For the final report, the researcher/s should follow a 1-3-25 reporting format. This will enable a more reader-friendly research report. It should include:

1-page summary of main messages,
3-page executive summary,
and a 25-page main report, plus any annexes.

A Learning Note should also be included as an annexe to the research report, documenting both the researcher(s) and The Foundation’s reflections on the research process. You can also include the reflections from partners and other key stakeholders.

Schedule:

Activity	Timeframe	Person in charge
1. Draft research plan and tools, including: Approach, method, criteria, and tools Timelines for delivery of key outputs Process for obtaining Ethics Approval Note: the draft plan should be provided to The Foundation for review and input. The Foundation will consolidate comments from internal stakeholders and provide these to the consultant within 2 weeks.	3 days (tentative start: February 2026)	The consultant research team
2. Presentation of final research plan to the FHF Research Team (or project management team)	0.5 day	The consultant research team
3. Final Research Plan	1.5 day	The consultant research team
4. Desk review of project and government documents	2 days	The consultant research team
5. Fieldwork (to be conducted following Ethics Approval)	9 days	The consultant research team
6. Analysis of data collected from the desk reviews and field trips	3 days	The consultant research team
7. 1^st draft report completion – using the provided 1:3:25 format. Note: the draft report should be provided to The Foundation for review and input. The Foundation will consolidate comments from internal stakeholders and provide these to the consultant.	5 days	The consultant research team
8. Final reports include: A full report in English. An executive summary report in Vietnamese to disseminate to partners. A short, visually well-designed, bilingual (English & Vietnamese) policy brief that translates research findings into actionable recommendations for scaling up an effective, sustainable and equitable primary eye care model nationwide.	4 days	The consultant research team
9. Dissemination: Present the report at the three provincial planning workshops in Q3&Q4 2026, ensuring that the findings for each province are tailored to support their respective 5-year planning processes. (dates to be confirmed).	0.5 day/province x 3 provinces = 1.5 days	The consultant research team
10. Share the research’s findings, methodology and key lessons learned within FHF upon completion, to support internal learning and future program improvement (date to be confirmed).	0.5 day	The consultant research team FHF staff
Total	30 days

7. SCHEDULE

The research is anticipated to be completed within about 30 working days. The researcher/s is expected to follow the key events outlined in the above deliverable section, for example desk review; briefing; research plan; data collection and analysis; presentations; draft and final reports etc. These dates can be negotiated and refined with FHFVN.

8. CONSULTANT TEAM & QUALIFICATIONS

The consultant team will consist of one team leader and other team members from an external consultancy agency, and three project staff from FHFVN, with support from one member per the Project Management Board (PMB) of the three provinces. The external consultant should act as the Team Leader and is responsible for the planning and delivery of the research independently. The project team of FHFVN will provide only the necessary support on project context, documentation and other logistic arrangements but will not be involved in data collection. One member of FHFVN will be nominated to coordinate communication amongst the consultants, FHFVN and the Research Team.

TEAM LEADER AND THEIR TEAM MEMBERS:

The Team Leader will be responsible for:

Development of the research plan and methodology.
Obtaining ethics approval.
Leading on delivery of the research, including managing the literature review and data collection.
Analysis of data, documentation of key findings and recommendations.
Preparation of the final research report.
Sharing key findings with project stakeholders.

The Team Leader and their team members should have the following skills:

Minimum 10 years’ experience leading research teams, ideally with a health economics background, focusing on impact evaluation, cost-effectiveness, and equity.
Knowledge and experience with blindness prevention programs and the Vietnamese health system.
Demonstrated experience conducting gender-responsive and disability-inclusive data analysis and participatory research approaches.
Knowledge and experience in health policy influencing and advocacy.
Knowledge and experience in obtaining ethics approval processes where appropriate.
Demonstrable experience in evaluating public health programs/eye health programs using both quantitative and qualitative tools, with expertise in equity and cross-cutting issues.
Research team should include a technical advisor from a national-level institutions (e.g., Vietnam National Eye Hospital or Department of Medical Service Administration – MoH, or a national university with a health-related focus).
Strong analytical skills.
Excellent English report writing skills.

FHFVN TEAM MEMBERS

FHFVN team members will be responsible for:

Compiling and providing relevant documentation and information for background context, and to inform the literature review (to be provided to the team leader)
Support the researcher/s by providing/introducing contact details of the relevant stakeholders so that the researcher/s can select the sample and organize the field data collection schedule and execute independently.

FHF RESEARCH TEAM

They will provide support to this research through:

Technical review on developing key research questions and methodology.
Providing feedback on draft research report and recommendations

Other Expected Participants

Provincial Level: Project management boards, representatives from the Provincial Departments of Health.
Primary/Community Level: Directors of Health Centres, Eye Units and Commune Health workers.
Beneficiaries:
- Direct: Local health staff and Commune Health Workers, and patients.
- Indirect: Family and community members in the project areas.

9. MANAGEMENT AND LOGISTICS

FHF Viet Nam will assign one staff as the research contact point from The Foundation. The assigned personnel will be the focal point for the researcher/s throughout the process, coordinating communications between the researcher/s and The Foundation’s research reference group, ensuring milestones are met, and coordinating review and approval of deliverables.

The focal point will provide all the secondary data/documents outlined in above sections. For example, access to relevant documents and data; introductions to partners and other key participants; logistical support to conduct field work; support with travel and accommodation as required.

The Foundation research reference group will be involved in key milestones outlined in the deliverable section.

10. CONFIDENTIALITY

The researcher/s agree to not divulge confidential information to any person for any reason during or after completion of this contract with The Foundation. Upon completion or termination of this contract, the researcher/s undertake to return to The Foundation any materials, files or property in their possession that relate to the business affairs of The Foundation. The consultant is responsible for safety, security and administration of primary and secondary data collected from FHF or otherwise.

11. INTELLECTUAL PROPERTY

All intellectual property and/or copyright material produced by the evaluator/s whilst under contract to The Foundation remain the property of The Foundation and will not be shared with third parties without the express permission of The Foundation. The evaluator/s are required to surrender any copyright material created during the term of the contract to The Foundation upon completion or termination of the contract.

12. SAFEGUARDING PEOPLE

The Fred Hollows Foundation is committed to ensuring that its activities are implemented in a safe and productive environment which prevents harm and avoids negative impacts on the health and safety of all people, particularly children, vulnerable people, and disadvantaged groups. The Foundation has a zero-tolerance approach to sexual exploitation, abuse, and harassment of any kind. All personnel including contractors/consultants are expected to uphold and promote high standards of professional conduct in line with The Foundation’s Safeguarding People Policy including Code of Conduct .

Contractors/consultants will be expected to sign and adhere to The Foundation’s Safeguarding Code of Conduct and provide any background checks as required.

All personnel including contractors/consultants are expected to uphold and promote high standards of professional conduct in line with The Foundation’s Safeguarding People Policy including Code of Conduct . Contractors/consultants will be expected to sign and adhere to The Foundation’s Safeguarding Code of Conduct and provide any background checks as required. Any safeguarding concerns and or queries can be sent to [email protected] and to local ethics review board, once approval has been granted.

The Consultant team are expected to maintain high professional and ethical standards and comply with The Foundation’s Research and Evaluation Policy. The Foundation is committed to ensuring a safe environment and culture for all people, including children, with whom we come in contact during the course of our work. All members of the Consultant team will be required to comply with The Foundation’s Safeguarding People Policy and sign the Safeguarding Code of Conduct.

Other key ethical and safeguarding considerations that should guide the entire equity analysis process to ensure “Do No Harm” principles are applied throughout are detailed below:

Informed Consent: Obtain informed consent from all participants, especially members of ethnic minority communities and other vulnerable groups, before involving them in the study. Ensure that participants understand the purpose, risks, and benefits of their involvement. Consent materials must be made available in ethnic minority languages and in accessible formats, as appropriate for low-literacy and non-Vietnamese speaking communities.
Privacy and Confidentiality: Safeguard the privacy and confidentiality of participants. Ensure that any data collected, especially personal and health information, is securely stored and anonymized to protect participants’ identities.
Data Protection: Comply with data protection laws and regulations to ensure that personal and sensitive data is handled and stored in accordance with legal requirements.
Anti-Discrimination: Avoid discrimination and bias in the research process. Ensure that the analysis does not reinforce stereotypes or discriminate against any groups, including people with disabilities and marginalized populations. This includes ensuring the accessibility of venues and information provided as part of this research process, so that persons with disability can participate meaningfully on an equal basis with others.
Gender Sensitivity: Address gender equity considerations throughout the research, acknowledging the unique challenges faced by women, including those with intersecting experiences of marginalisation such as women with disability, older women and women from ethnic minority communities.
Disability Inclusion: Ensure that the data collection activities are accessible to people with disabilities and that reasonable accommodations are made to facilitate their participation.

13. INSURANCE

Any consultants involved in this research will be required to have in place insurance arrangements appropriate to provision of the requirements in this Terms of Reference including travel insurance.