Terms of Reference: Consultancy to Conduct a Study on WASH Benefits for Public Health in Rwanda
1. Background
Rwanda has recorded substantial progress in water and sanitation access. The Seventh Integrated Household Living Conditions Survey reports that access to improved drinking-water sources reached 90% nationally in 2023/24, compared with 87% in 2016/17; access was 97% in urban areas and 87% in rural areas. Improved sanitation reached 94%, while improved facilities not shared with other households reached 72% (NISR, 2025a). These gains create an important opportunity to assess whether differences in the actual service received rather than infrastructure classification alone translate into better health and socioeconomic outcomes.
An improved source does not necessarily demonstrate that water is continuously available, safe at the point of consumption, affordable or accessible to all. Similarly, the existence of a toilet does not establish usability, safe containment, privacy, disability access or sustained use. Public health benefit depends on a complete service chain: safe and sufficient water, safely managed sanitation, handwashing opportunities, hygiene behaviour, reliable operation and maintenance, and supportive household and institutional conditions.
Rwanda’s National Water and Sanitation Policy seeks sustainable, reliable, affordable and equitable access to safe drinking water and sanitation as a contribution to quality of life and socioeconomic transformation. It also calls for results-based management and strengthened monitoring through the WASH management information system and related systems (MININFRA, 2023). The 2025 Rwanda Demographic and Health Survey provides an updated national reference for health and nutrition indicators (NISR, 2026), while WHO links unsafe WASH exposure to diarrhoeal diseases, intestinal nematode infections, protein-energy malnutrition and selected acute respiratory infections under SDG indicator 3.9.2 (WHO, 2024).
Against this background, WaterAid Rwanda intends to engage a qualified consultancy firm or multidisciplinary research team to conduct a mixed-methods study in Bugesera, Nyamagabe, Kirehe and Nyagatare districts. The consultant/firm will develop an independent protocol, sampling design, primary dataset and integrated analysis suited to the research questions and four-district scope defined in these Terms of Reference.
2. Purpose of the assignment
The purpose is to determine the public-health benefits associated with better WASH services in Bugesera, Nyamagabe, Kirehe and Nyagatare districts, explain the pathways through which those benefits occur, identify groups and locations that benefit least, and translate the findings into practical policy, programme, monitoring and investment recommendations.
3. Objectives of the assignment
3.1 Overall objective
To generate credible and actionable evidence on the contribution of water, sanitation and hygiene services to public-health outcomes, household welfare and equity in Bugesera, Nyamagabe, Kirehe and Nyagatare districts, Rwanda.
3.2 Specific objectives
- Measure household WASH service levels, including accessibility, availability, affordability, safety, reliability, functionality, sanitation management and hygiene behaviour.
- Estimate selected public-health outcomes and related costs by WASH service level, geographic area and population group.
- Assess the magnitude and robustness of relationships between WASH exposures and health outcomes after accounting for plausible confounding factors.
- Explain the behavioural, environmental, institutional and service-delivery pathways through which WASH conditions influence health and well-being.
- Assess inequalities in WASH-related health benefits by sex, age, disability, wealth, household composition and urban/rural residence.
- Develop prioritised recommendations and indicators that strengthen joint planning, budgeting and monitoring across WASH and health institutions.
4. Core research questions
| Area | Research question |
|---|---|
| Public health | How do diarrheal illness, selected water-related infections, child nutrition, acute respiratory symptoms and healthcare use differ across WASH service levels? |
| Service quality | Which WASH service dimensions including water-source type, reliability, continuity, quantity, accessibility, affordability, household water treatment, safe storage, sanitation conditions and hygiene practices are most strongly associated with improved public-health outcomes? |
| Pathways | How do household behaviour, storage, environmental conditions, service management, climate and healthcare access strengthen or weaken WASH benefits? |
| Equity | How do benefits and remaining risks vary by geography, wealth, sex, age, disability and household composition? |
| Economic effects | What healthcare spending, coping expenditure, time loss and school/work absence are associated with inadequate WASH? |
| Decision use | Which improvements and routine indicators should government, districts, providers and partners prioritise? |
5. Scope of work
The study will cover four districts: Bugesera, Kirehe and Nyagatare in Eastern Province, and Nyamagabe in Southern Province. The consultant will undertake all technical and operational activities required to design, obtain approval for, implement, analyse and communicate the study within these four districts. Sampling within the selected districts should capture urban and rural settings, different WASH service levels and relevant socioeconomic and population groups, as applicable. The sample design should support pooled analysis across the four districts and district-level comparisons where precision permits achieved. Findings must not be presented as nationally representative or generalised to districts outside the study scope.
5.1 Inception and evidence review
- Review national policy, administrative and statistical sources, relevant peer-reviewed evidence, survey instruments and WASH–health conceptual frameworks. The review must use the latest available sources at inception.
- Consult WaterAid Rwanda and relevant institutions (RBC, Ministry of Health, Mentioned districts & district hospitals and any relevant body) to clarify the decisions the research will support, agree on the main and supporting indicators to be measured, identify existing data sources, and define the roles and responsibilities of all parties involved in overseeing the research.
- Submit an inception report containing the refined questions, conceptual framework, methods, workplan, risk register, stakeholder plan and detailed budget.
5.2 Protocol and instruments
- Develop a full protocol, pre-specified statistical analysis plan, qualitative analysis framework, sampling plan, field manual and data-management plan.
- Develop and program a household questionnaire (In Both English and Kinyarwanda languages) , structured-observation checklist, key-informant interview guides, focus-group discussion guides and any approved anthropometry module.
- Align core WASH measures with WHO/UNICEF JMP service ladders while adding continuity, quantity, affordability, household water treatment, safe storage, usability and accessibility.
5.3 Fieldwork and quality assurance
- Recruit and train qualified field teams; translate, cognitively test and pilot tools; document all revisions; and secure approvals before main data collection.
- Implement household interviews, structured observation, qualitative inquiry and approved routine-data extraction using auditable quality controls.
- Maintain daily field dashboards, supervisor checks, back-checks, incident reporting and a documented response to data-quality concerns.
5.4 Analysis, validation and uptake
- Prepare weighted estimates, multivariable and multilevel models, matched comparisons, equity analysis, qualitative themes, integrated joint displays and sensitivity analyses.
- Facilitate technical interpretation and validation without presenting unstable rankings or identifying respondents.
- Produce decision-oriented reports, briefs, presentations, datasets and an evidence-to-action matrix with responsible actors, resource implications and indicators.
6. Minimum methodological requirements
Bidders may refine the methods, but proposals must meet or exceed the requirements below and clearly justify departures. The selected consultant will finalise the design with the contracting authority and relevant national technical institutions before ethics submission.
| Component | Minimum requirement |
|---|---|
| Design | A four-district mixed-methods study combining a cross-sectional household survey, structured observation, qualitative inquiry and analysis of relevant secondary and routine data. The consultant should propose appropriate comparison and analytical methods for examining relationships between WASH service levels and public-health outcomes. Where reliable historical or programme data are available, the consultant may assess the feasibility of matched comparisons or change-over-time analysis. |
| Sampling | A stratified, multistage sampling design within Bugesera, Nyamagabe, Kirehe and Nyagatare districts. Households and communities within each district should be selected using probability-based procedures, capturing urban and rural settings where applicable, different WASH service conditions and relevant socioeconomic contexts. The consultant must document sample allocation across the four districts, community and household selection, non-response procedures and sampling weights. The four districts are fixed study locations; the sample is not intended to represent Rwanda nationally. |
| Indicative household sample | The consultant will propose and justify the final household sample using statistical power and precision calculations. The calculation should consider the primary public-health outcome, expected prevalence or effect size, design effect, non-response, subgroup analysis and pooled four-district reporting and planned district-level comparisons. An indicative sample of approximately 3,000 households may be used for budgeting, but the final sample and cluster allocation will be agreed during inception. |
| Qualitative component | Approximately 40–50 key-informant interviews, 20 focus-group discussions and four contrasting district case studies, one in each of Bugesera, Nyamagabe, Kirehe and Nyagatare, refined through saturation and preliminary quantitative findings. |
| Routine data | Assess and, subject to approval, analyse de-identified HMIS, WASH MIS, service-provider and climate data. Document completeness, case definitions, denominators and comparability before use. |
| Analysis | Complex-survey estimation; confidence intervals; multivariable and multilevel models; matching or balancing diagnostics; effect modification and equity analysis; missing-data strategy; sensitivity tests; disciplined causal interpretation. |
| Integration | Use joint displays or comparable techniques to integrate survey, routine and qualitative findings and investigate divergent evidence explicitly. |
6.1 Indicative measurement domains
WASH exposure indicators should include the main drinking-water source, collection time, water availability, quantity, continuity, affordability, household water treatment and storage, sanitation type, sharing, usability and management, availability of handwashing facilities with water and soap, hygiene practices, and accessibility for persons with disabilities. Public-health outcomes should include diarrhoeal illness, selected water-related diseases, healthcare use and expenditure, days of normal activity lost, school or work absenteeism, acute respiratory symptoms associated with hygiene conditions and child nutrition indicators, where their inclusion is methodologically and ethically justified.
7. Ethics, safeguarding and data protection
The consultant will obtain ethical approval from an authorized institutional review board, and all required national and administrative permissions (Including RNEC, UR and NISR visa, etc.) before fieldwork. Participation must be voluntary. Adult respondents will provide informed consent; parental or guardian permission and age-appropriate assent will be obtained for eligible minors. No biological specimens are envisaged.
The consultant will prepare safeguarding, referral and adverse-event procedures; train all personnel; and ensure respectful inclusion of women, children, older people and persons with disabilities. Field teams must avoid stigma, coercion, public disclosure of illness or sanitation status, and any practice that allows authorities, providers or community leaders to identify individual responses.
The data-management plan must describe legal and ethical basis, data minimization, encryption, access control, identifier separation, secure transfer, retention, deletion, breach response, disclosure control and approved data sharing. The consultant must comply with applicable Rwandan data-protection requirements and the contracting authority’s policies. Identifiable data may not be transferred, published or reused without written authorization.
8. Quality assurance requirements
| Stage | Required controls |
|---|---|
| Design | Expert review; pre-specified primary outcome; power calculation; validated or harmonized measures; translation and cognitive testing. |
| Training and pilot | Competency assessment; role-play; field pilot outside selected clusters and enumerator. |
| Collection | Digital validation, audit trails, daily dashboard, supervisor observation, GPS only where approved, random back-checks and documented corrective action. |
| Analysis | Reproducible syntax, weighting documentation, code review, missing-data assessment, model diagnostics and sensitivity analysis. |
| Reporting | Triangulation, limitations, uncertainty, disaggregated findings, source verification and independent technical review. |
9. Required qualifications and team composition
The assignment requires a registered consultancy firm, research institution or consortium with demonstrated experience in household research across multiple districts, WASH and public health. The proposed team should combine expertise in public health or epidemiology, WASH systems, survey sampling, statistics or econometrics, qualitative research, health economics, data management, research ethics and safeguarding. One team member may cover more than one area where their qualifications, experience and proposed level of effort make this arrangement credible.
Team composition preference:
| Role | Minimum profile |
|---|---|
| Team leader / principal investigator | At least Masters degree in public health, epidemiology, WASH, health economics or related field; at least 10 years of relevant research experience (with completion certificates); leadership of comparable complex studies; strong report and stakeholder-facilitation record, or PhD in those mentioned fields with 5 years of experience. |
| Data Analysist and sampling design: | Survey statistician: Postgraduate degree in statistics or biostatistics, Economics, Demonstrated complex sample design, weighting, power calculation and multilevel/causal-inference analysis. |
| WASH specialist | At least 7 years of experience in household and service-level WASH, JMP-aligned monitoring, functionality, sanitation systems and inclusion. |
| Qualitative research lead | Has to have a degree in Statistics or Economics: with advanced qualitative or mixed-methods experience, team supervision, thematic analysis, integration and sensitive community research. |
| Data manager | Has to have a degree in Statistics or Economics: Will Secure digital data systems, validation, audit trails, anonymization, version control, reproducible workflows and data-protection compliance. |
10. Proposal submission requirements / Evaluation criteria:
- A technical proposal clearly demonstrating understanding of the assignment and presenting a justified methodology, sampling strategy, analysis plan, quality-assurance system, ethical approach and evidence-use plan.
- A workplan and staffing schedule showing responsibilities, level of effort, field arrangements and deliverable dates.
- A team structure, concise CVs, signed availability statements and evidence of relevant comparable assignments.
- A separate and itemised financial proposal in Rwandan francs, including professional fees, field costs, taxes and reimbursable expenses.
- Supporting Documents:
- Company profile
- Legal registration and tax clearance documents
- At least 3 recommendation letters or certificates of service for the similar work completed.
11. Disclaimer:
WaterAid Rwanda will contact only shortlisted applicants for further negotiation; If not required, only the selected candidate will be notified.
12. Submission deadlines:
Proposals should be submitted to WARwanda@wateraid.org no later than 12th November 2026. Late submissions will not be considered.