TO CONDUCT A COMPREHENSIVE SITUATIONAL ANALYSIS OF THE EYE HEALTH SYSTEM WITHIN THE ASSIGNED STATE/ASSESSMENT AREA AND PROVIDE EVIDENCE-BASED RECOMMENDATIONS FOR STRENGTHENING EYE HEALTH SERVICES AND IMPROVING ACCESS TO QUALITY EYE CARE.

Terms of Reference for Situation Analysis

1. SITUATION ANALYSIS (SITAN) SUMMARY
Project ID and Program/Project Name                                            P11150 – SightQuest Nigeria Programme
Project start and end dates; phase of project if applicable           2026 – 2031
Evaluation Purpose                                      To conduct a comprehensive situational analysis of the eye health                                                                            system within the assigned state/assessment area and provide                                                                                  evidence-based recommendations for strengthening eye health                                                                                services and improving access to quality eye care.
Evaluation Type                                                                                    Situation Analysis (SITAN)
Location                                                          Jigawa, Imo, Abia/Rivers, Plateau, Borno, Adamawa, Ogun &                                                                                  Kogi States.
Contracting organisation/contact person                                         CBM CO Nigeria
Evaluation Team members (if known)                                               External Consultants – not yet identified
Primary Methodology                                                  (Mixed Methods; quantitative and qualitative methods)
Proposed Evaluation Start and End Dates               September – October 31st, 2026
Recipient of Final Evaluation Report                        CBM COUNTRY OFFICE (CO)NIGERIA

2. PROJECT DESCRIPTION
Blindness and severe visual impairment (SVI) remain major public health challenges globally, particularly in low and middle-income countries where access to quality eye care services is limited. In Nigeria, cataract and uncorrected refractive errors continue to be the leading causes of blindness and visual impairment, while emerging conditions such as diabetic retinopathy and age-related macular degeneration (ARMD) are contributing to an increasing burden of eye diseases. Access to eye health services is often constrained by inadequate financing, shortages of trained personnel, weak health information systems, insufficient infrastructure, and gaps in the implementation of existing policies and strategies.
To address these challenges, CBM is implementing SightQuest Nigeria Programme, a ten-year programme aimed at strengthening eye health systems and scaling up inclusive eye health services across 14 states in Nigeria. The programme seeks to eliminate avoidable blindness and severe visual impairment by improving access to quality, affordable, and inclusive eye care services. The main objective of the programme is to increase effective cataract surgical coverage (ECSC) by 30 percentage points and (EREC) effective refractive
The SightQuest Programme seeks to employ a health systems strengthening approach that addresses gaps in service delivery, human resources, infrastructure and equipment, financing, governance, and health information systems. The main areas of intervention include strengthening district eye health programmes, improving access to primary eye care services, establishing vision centres and eye centres, improving referral pathways, enhancing the quality of cataract surgical services, and strengthening sustainable financing for eye health services. Programme implementation will be phased, beginning in Bauchi and Oyo States in 2026, and subsequently expanding into Imo, Jigawa, and Plateau States before scaling to all 14 target states by 2029.
Given the diverse contexts and varying levels of eye health system development across states, there is a need for a comprehensive situational analysis to generate evidence for effective planning and implementation. The situational analysis will assess the eye health system using the World Health Organization (WHO) Health System Building Blocks Framework and provide a clear understanding of the status of eye health services, resources, policies, and systems within each selected state.
To facilitate a context-specific and comprehensive assessment, one consultant will be engaged per state to lead the Situation Analysis (SITAN) process. Each consultant will work closely with relevant state-level stakeholders and the SightQuest Programme team to collect, analyse, and validate data on the eye health system, identify key gaps and opportunities, and develop a state-specific SITAN report. The findings will provide an evidence base for prioritising interventions, informing programme design, and guiding implementation within each state.
The SITAN will be implemented as separate state-specific consultancy assignments. One consultant/consulting firm will be engaged for each assigned state/assessment area.
Each engagement will cover one state/assessment area only and will result in one standard, state-specific SITAN report. The consultancy is therefore not intended to produce one comparative or consolidated report covering all selected states.
For the purpose of this assignment, Abia/Rivers will be treated as one combined assessment area and will result in one consolidated Abia/Rivers SITAN report, subject to the final procurement structure.
Each consultant/consulting firm will be responsible for the full SITAN process within the assigned state/assessment area, including stakeholder engagement, data collection, analysis, validation of findings, and preparation of the final report.
A standardized assessment framework, methodology, and agreed tools will be applied across all assignments to promote consistency and comparability of findings, while allowing sufficient flexibility to capture state-specific priorities, gaps, opportunities, and contextual factors.
3. SITAN OBJECTIVES AND INTENDED USE

Specifically, the situational analysis aims to:
1. Assess the status of eye health services in the assigned state/assessment area using the WHO Health System Building Blocks Framework.
2. Determine the strengths, weaknesses, opportunities, and threats (SWOT) within the State eye health system, particularly in relation to:
• Leadership and Governance;
• Health Financing;
• Human Resources for Eye Health;
• Service Delivery;
• Medical Products, Equipment and Technologies; and
• Health Information Systems.
3. Assess the management structure and implementation challenges of existing CBM-supported eye health programmes in the assigned state/assessment area, where applicable.
4. Evaluate the availability, accessibility, quality, and inclusiveness of eye health services across primary, secondary, and tertiary levels of care.
5. Identify barriers and facilitators to accessing eye health services, especially among vulnerable and marginalized populations, including persons with disabilities.
6. Map key stakeholders, programmes, facilities, workforce, and resources supporting eye health service delivery in the States.
7. Generate baseline information and actionable recommendations to guide strategic planning, programme implementation, policy development, advocacy, resource mobilization, and future investments under the SightQuest Nigeria Programme.
The findings from the situational analysis will provide the evidence base for strengthening sustainable, equitable, and inclusive eye health systems and will inform the design, implementation, and scale-up of the SightQuest Nigeria programme in the selected states.

4. SCOPE OF THE EVALUATION
The situational analysis will be conducted between September and 31 October 2026 and will cover the eye health systems of the selected assessment areas: Imo, Abia/Rivers, Plateau, Borno, Adamawa, Ogun, and Kogi States. The assessment is being undertaken within the framework of the SightQuest Nigeria Programme, a ten-year CBM initiative aimed at strengthening eye health systems and scaling up inclusive eye care services to eliminate avoidable blindness and severe visual impairment.
The scope of the assessment will cover the eye health system across the six WHO Health System Building Blocks, namely: leadership and governance, health financing, human resources for eye health, service delivery, medical products, equipment and technologies, and health information systems. It will also assess the management structure and implementation arrangements of existing CBM-supported eye health programmes where applicable.
The assessment will examine a range of interventions and service delivery approaches, including district eye health programmes, primary eye care services, referral pathways, vision centres, eye centres, cataract surgical services, workforce, and financial systems that support access to eye care services.
Geographically, the assessment will be conducted across the selected states and will include a representative sample of eye health facilities and stakeholders at the primary, secondary, and tertiary levels of care. Data will be collected in selected Local Government Areas (LGAs), health facilities, communities, and relevant institutions within each state to ensure adequate representation of the eye health system while remaining feasible within the evaluation timeline and resources available.