Kenya Trachoma Elimination Project - Terms of Reference for Trachoma Trichiasis Surgical Audit in Baringo County
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.
2. Project Background
The Kenya Trachoma Elimination Project has over the years realized great achievements of its planned outcomes however, the elimination end game needs to be strengthened for achievement of elimination of Trachoma as a public health problem. The Foundation has supported trachoma elimination interventions involving combined efforts to conduct TT surgeries, accelerate Mass Drug Administration(MDAs) in the remaining endemic counties by conducting bi-annual treatment where indicated, intensified WASH interventions and Behaviour Change Communication (BCC) and mainstreaming all components of SAFE strategy into the National Health system for sustainability.
The project aims to contribute to Trachoma Elimination in Kenya by the year 2027. It will achieve the following outcomes:
- TT prevalence reduced to WHO recommended threshold of below 0.2% in persons 15 years and above in 5 counties by 2023.
- Trachoma inflammation follicular (TF) Prevalence reduced to acceptable WHO elimination goal of <5% in children 1-9 years old in 3 counties.
- Demonstrated change in behaviour towards facial cleanliness and environmental improvement amongst communities.
- Strengthened County governments’ engagement to sustain the interventions beyond control and elimination period.
The TT Surgical Audit in Baringo is a critical quality assurance mechanism used in trachoma elimination programs to monitor surgical outcomes, assess surgeon performance, and ensure that patients receive safe and effective surgical care. The audit typically involves reviewing outcomes among patients who previously underwent TT surgery to determine whether surgical standards are being met.
The audit findings inform decisions regarding supportive supervision, mentorship, retraining of surgeons, and overall programme improvement, thereby strengthening surgical quality and contributing to the elimination of trachoma as a public health problem.
3.Purpose and Objectives of the TT Audit
3.1 Purpose
To ensure high-quality trachomatous trichiasis(TT) surgical services through systematic monitoring of surgical outcomes and strengthening surgeon performance.
3.2 General Objective
To assess the quality and outcomes of TT surgeries performed by TT surgeons 2025 in Baringo County.
3.3 Specific Objectives
- To assess surgical outcomes including eyelid position, complications, and overall patient recovery.
- To identify surgeons who may require additional training, mentorship, or supportive supervision.
- To ensure adherence to recommended surgical procedures for TT surgery.
- To strengthen programmatic quality assurance mechanisms for TT surgery.
4.Scope of the Consultancy
The audit will cover Tiaty West and Tiaty East in Baringo County where TT surgeries were conducted in from June to December 2025.
The audit exercise will focus on:
- All TT surgeons who conducted TT surgeries in 2025.
- Patients operated on between June -December 2025.
- Assessment of surgical outcomes in sampled patients.
5. Approach and Methodology
5.1 Patient Sampling
The audit team will identify and examine an adequate sample of patients who underwent TT surgery between June to December 2025.
Patients will be traced through:
- Surgical registers
- Community health volunteers
- Local health facility records
5.2 Timing of the Audit
The audit will be conducted during the month of June and July.
5.3 Clinical Assessment
Each identified patient will undergo a standardized examination conducted by a senior experienced TT surgeon and a certified master trainer.
- Presence of post-operative trichiasis (PTT)
- Eyelid contour abnormalities
- Granuloma formation
- Surgical scars and healing outcomes
- Any other surgical complications
5.4 Data Collection
Data will be collected as per ICTC guidelines and using standardized WHO tools.
6.Results and Deliverables
6.1 Expected Outcomes
The audit is expected to contribute to:
- Improved TT surgical quality
- Strengthened clinical skills among TT surgeons
- Enhanced patient safety
6.2 Expected Outputs/Deliverables
A comprehensive TT surgical audit report.
7. Roles and Responsibilities
7.1 Ministry of Health – Kenya National Public Health Institute
- Provide oversight for the TT surgeon’s audit.
- Coordinate county-level implementation
7.2 Audit Team
- Conduct patient tracing and examinations
- Ensure standardized assessment procedures
- Record and validate audit data
- Compile a comprehensive report
7.3 County Health Teams
- Facilitate access to surgical records
- Support patient tracing
- Coordinate logistics and community engagement
7.4 The Fred Hollows Foundation
- Provide technical and logistical support
- Support data management and reporting
8. Duration/Schedule
The TT surgical audit exercise is expected to be conducted over 30 days and will include:
- Preparation, planning and mobilization.
- Field data collection
- Data analysis
- Reporting and dissemination
9. Consultant Qualifications
- Formal training in ophthalmology or ophthalmic clinical practice.
- Demonstrated experience in trachoma management, particularly TT surgery.
- WHO certified TT surgeon and a master TT surgeons trainer.
- Strong understanding of and TT surgical outcomes
- Proven experience conducting TT audits or surgical outcome assessments
- Familiarity with WHO ICTC TT audit protocols and guidelines
- Ability to work independently, proactively seek information and manage feedback and input.
- Excellent spoken and written communication skills.
10.Management and Logistics
The consultancy on TT Audit exercise is being commissioned by The Fred Hollows Foundation Kenya. The program team will work closely with the consultant to ensure delivery of timely and quality consultancy outcomes.
11. Confidentiality
The consultant agrees 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 consultant undertakes to return to The Foundation any materials, files or property in their possession that relate to the work of The Foundation. The consultant will be responsible for safety, security and administration of any data and information collected from FHF or otherwise.
12.Intellectual Property
All intellectual property and/or copyright material produced by the consultant 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 consultant is required to surrender any copyright material created during the term of the contract to The Foundation upon completion or termination of the contract.
13.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. The consultant will be expected to sign and adhere to The Foundation’s Safeguarding Code of Conduct and provide any background checks as required.
14.Insurance
Any consultant involved in this assignment will be required to have in place insurance arrangements appropriate to provision of the requirements in this Terms of Reference including travel insurance.
15. Ethical and Other Considerations
The consultant is expected to maintain high professional and ethical standards and comply with The Foundation’s policies. The Foundation is committed to ensuring a safe environment and culture for all people, including children, with whom we come in contact during our work. The consultant will be required to comply with The Foundation’s Safeguarding People Policy and sign the Safeguarding Code of Conduct.
16. Application Procedures
Qualified and experienced Trachoma specialists who are interested in the consultancy should submit a cover letter, resume, technical and financial proposals on or before 21st May 2026, at 4:00PM. Please reference “Consultancy for TT Audit in Baringo County” and send to the following email address: procurementkenya@hollows.org
Only submissions with complete documents as stated in the Terms of Reference and those meeting minimum requirements will be considered. Qualified consultants will be subjected to a background and child protection checks as a condition for engagement.