Desk Study: Understanding Nutrition and Health System Drivers of Acute Malnutrution at Concern Worldwide

Background and context

The NAWIRI Project is a five-year evidence-based development program that is working in Isiolo and Marsabit counties to increase project and stakeholder understanding of the drivers of persistent acute malnutrition, through a collaborative learning process involving local actors including communities, county systems and institutions, civil society and the private sector. The learning will be used to jointly design context-sensitive, systems-driven, multi-sectoral approaches to sustainably reduce acute malnutrition. Isiolo and Marsabit counties have repeatedly experienced high rates of acute malnutrition (or wasting), in recent decades. Partners in NAWIRI include; Catholic Relief Services, Concern Worldwide, Tufts University, Global Alliance for Improved Nutrition (GAIN), Manoff Group and Village Enterprise. Concern is leading the health and nutrition component of the project.

In Isiolo and Marsabit there are indications that acute malnutrition has remained at or above emergency levels, despite significant efforts to tackle the challenge. Context-determined approaches are needed to address both the immediate and underlying causes of acute malnutrition, while also addressing the basic or systemic drivers of these underlying causes.

Purpose

The aim of this desk study is to understand how the nutrition and health system influences levels of persistent acute malnutrition in Kenya’s Arid and Semi-Arid Lands’ (ASALs) counties. The desk study will be framed in terms of key health system attributes, namely access, coverage/utilization, and quality of health and nutrition services provided. Learning from this desk review will be applied specifically to Marsabit and Isiolo counties; however, the scope of the review will extend to the entire ASAL region and countries with similar characteristics (e.g. remote, pastoralist communities; similar persistent levels of acute malnutrition; similar climatic vulnerabilities).

Justification

Concern Worldwide is the lead partner for health and nutrition in the NAWIRI consortium. Concern is tasked with the responsibility of undertaking a desk study on health and nutrition systems in Isiolo and Marsabit counties. The desk study will inform the design of a pilot on adaptations of the IMAM Surge and Baby Friendly Community Initiative (BFCI) models. The organisation requires the services of a seasoned researcher to review peer reviewed and grey literature from the Kenyan ASALs and other similar contexts globally.

Technical Approach and Methodology

The following are key aspects of this research consultancy that will cover health and nutrition systems from the perspective of health service delivery (access, coverage and quality);

Key Research Questions

To what extent has the functionality of the nutrition and health system in Kenya’s northern ASALs, with a particular focus on Isiolo and Marsabit counties, influenced persistent acute malnutrition?

1. Access to health and nutrition services:

What are the documented health system-related barriers and opportunities that influence the accessibility of quality health and nutrition services in remote, pastoralist communities?

Coverage and utilization of health and nutrition services

• What is the documented change in geographic and treatment coverage for acute malnutrition and related morbidities (e.g. upper respiratory infection, malaria, diarrhoea) and key services (e.g. Vitamin A supplementation, iron and folic acid supplementation, community-level outreach services) over the past 10 years in the ASAL counties?
• What factors have contributed to these changes and what has been the impact of these changes in terms of service utilization?
• What are the documented promising strategies and approaches to improve coverage and utilization of health and nutrition services in remote, pastoralist populations and what lessons can be learned from related experiences?

Quality of services

According to routine reporting (e.g. SAM/MAM, ARI, malaria etc.), monitoring and survey data, to what extent do key health and nutrition services in the ASAL counties consistently meet globally acceptable quality standards (e.g. SPHERE standards, WHO standards)?

What approaches have been proven to improve service quality in similar contexts?

Is there documentation to show that routine monitoring and reporting data is being used for decision-making and corrective action by county/sub-county/health-facility/ Management Teams (S/C/HMT), particularly in preparation for and in times of system shocks or stresses?

Methodology

The desk study will include analysis of peer reviewed and grey literature for both Marsabit and Isiolo counties as well as the wider ASAL region and other similar contexts outside Kenya’s ASALs. County authorities will be consulted to share relevant documentation. The desk review will also include a secondary analysis of health information system and survey data from the northern ASAL region. Illustrative sources include:

• •Assessment reports including nutrition coverage surveys, barrier analyses, SMART surveys, MYCN assessments, KAP studies and IYCF studies.
• •Data from the existing health information systems including District Health Information System (DHIS-2), Kenya Health Information Systems (KHIS), Kenya Health Facility Master List system (KHFML), CMAM Surge dashboards and other related systems.
• •MoH documentation at county, sub-county and health facility levels.
• •Available qualitative studies and reports on relevant issues (e.g. by ASAL NGOs among others).

Outputs and Deliverables

The following are the deliverables expected of this assignment

• Inception report demonstrating understanding of task.
• A bibliography listing of published and grey literature as per the SOW
• First draft to accompany inception report
• Final bibliography as part of final report
• Technical report of no more than 25-30 pages outlining the key findings as per the SOW.
• Draft 0, Draft 1 and Final

Technical Brief

• 3-4 pager technical brief of health and nutrition desk study
• Facilitation of pre-dissemination workshop

Workshop agenda

• PowerPoint presentation summarizing key findings
• Nutrition and Health Systems Desk Review Timelines and Proposed Level of Effort

No Activity TimelinesMay June July August September LO E Days**

• Inception meeting 1
• Development of draft bibliography 2
• Inception report 1
• Literature review/report writing 10
• Draft 0 report -Concern Review 3
• Draft 1 report NAWIRI review 2
• Facilitator- Pre-dissemination workshop-Isiolo & Marsabit 3
• Final desk review report & bibliography 3
• Draft 4-pager Nutrition series-draft technical brief 2
• Final technical brief 1

Total number of days 28

It is anticipated that the consultancy will take 28 working days. The Consultancy will run from the month May to Early August 2020.

Remuneration

Concern will pay the consultant a negotiated facilitation fee per day for twenty-eight working (28) days.

NB: - The payment is subject to withholding tax and other requirements under the Laws of Kenya or applicable tax obligations as per the Consultant researcher’s country of residence.

Working conditions

The Consultant is expected to work at the direction of Concern Worldwide. Internally s/he will closely work with Concern Worldwide NAWIRI team- Project Lead, Senior Advisor-Health and Nutrition, and Nutrition Technical Specialists. Externally, the consultant researcher will interact with other NAWIRI partners that includes Tufts University and Catholic Relief Services among other consortium members.

Roles and Responsibilities

Concern Worldwide

• Technical oversight and guidance to the consultancy
• Where applicable Concern will facilitate acquisition and access of grey literature and reports from County governments, National Ministry of Health (MOH) or relevant government department/agencies and repositories not available in the public domain.
• Facilitate access to DHIS 2 and other information in government databases for secondary analysis as may be applicable to the desk-study
• Facilitate travel and accommodation as the case may apply to undertake the consultancy.
• Convene the pre-dissemination workshop with Isiolo and Marsabit counties.
• Consultant Desk Study Researcher
• Work remotely and expected to attend to meetings/workshop as scheduled. This would be both virtual and or physical as circumstance may apply.
• Undertake the desk study within agreed time frame and quality
• Responsible for searching peer reviewed and other online resources.

Qualifications

• A Minimum qualification of a master’s degree in public health (MPH), health systems, nutrition, or other relevant qualification
• More than 10 years’ experience working in nutrition, public health, health systems strengthening or a related field.
• Analytical and critical thinker with ability to critique literature.
• Fluency in spoken and written English required
• Knowledge and/or experience working in the health and nutrition sector in Kenya is desired.
• Previous experience undertaking desk studies for reputable international NGOs and or leading public health universities preferred
• Familiarity and experience with the analysis and review of routine nutrition and health data and trends. Experience in quantitative analysis and surveys preferred.

Concern has an Organizational Code of Conduct (CCoC) with three Associated Policies the Programme Participant Protection Policy (P4), the Child Safeguarding Policy and the Anti-Trafficking in Persons Policy. These have been developed to ensure the maximum protection of programme participants from exploitation, and to clarify the responsibilities of Concern staff, consultants, visitors to the programme and partner organizations, and the standards of behavior expected of them. In this context, staff have a responsibility to the organization to strive for, and maintain, the highest standards in the day-to-day conduct in their workplace in accordance with Concern’s core values and mission. Any candidate offered a job with Concern Worldwide will be expected to sign the Concern Staff Code of Conduct and Associated Policies as an appendix to their contract of employment. By signing the Concern Code of Conduct, candidates acknowledge that they have understood the content of both the Concern Code of Conduct and the Associated Policies and agree to conduct themselves in accordance with the provisions of these policies.

Concern’ is the trading name of ‘Concern Worldwide’, a company limited by guarantee, registered number 39647; registered charity number CHY 5745, registered in Ireland, registered address is 52-55 Lower Camden Street, Dublin 2, Ireland.