Purpose of Activity/Assignment:
The main purpose of this consultancy is to support Ministry of Health (MOH) to conduct an in-depth assessment of nutrition intervention /programme coverage in the context of Covid-19 pandemic and establish the main issues leading to low service utilization especially in IMAM program in arid and semi-arid and urban counties. The assessment is aimed at strengthening the available quantitative evidence by explaining the observed trends (the “Whys”) and generating recommendations based on community and stakeholder feedback to inform program improvement strategies.
The assessment will respond to the following:
How the various arid and semi-arid and urban counties are performing in nutrition program service delivery against set targets and threshold through a comprehensive data review: Identification of areas of high or low performance from the available program data including identification of those least or most affected by the Covid-19 pandemic to inform further investigation and selection of counties to be included in in-depth qualitative assessment.
Identification of key factors pre and during COVID 19 period (facilitators and bottlenecks) affecting performance against set targets. What the supply and demand side bottlenecks to meeting program targets are. Investigate how the Covid-19 pandemic has affected nutrition service utilization - both demand and supply side by engaging various stakeholders and targeted communities. Investigate how program adaptations have been implemented, successes, limitations and opportunities for scale up (including use of ICT) considering COVID-19 pandemic. Identify strengthens, quick wins and lessons learned in the context of COVID-19
Assess the level of awareness and compliance with guidance released on nutrition and related components in the context of COVID-19 and understand from communities their experiences in accessing health and nutrition services in the context of COVID-19 pandemic.
Undertake in-depth qualitative assessment in sampled counties to identify WHY the utilization of services has gone down, and suggest potential remedial actions resulting in improved access to and coverage of integrated nutrition services. Identify key successes and document good practices and generate evidence-based lessons to strengthen and expand the good practices in other areas in case of emergency or future pandemics.
Generate key proposed or recommended sustainable strategies from key stakeholders to address challenges and improve nutrition programs delivery and uptake. These include strategies related to Covid-19 pandemic and other shocks to improve program resilience.
Scope of Work: (see end note below  )
2.1 Background and Justification:
The Ministry of Health with support from UNICEF and other partners has been implementing High Impact Nutrition Interventions including maternal infant and child nutrition, micronutrient supplementation and IMAM program to reach population in the greatest need in arid and semi-arid (ASAL) counties. However, there has been a notable interruption of services by the COVID-19 pandemic across health and nutrition interventions. The revision of selected health and nutrition protocols such as the guidance to visit child welfare clinic (CWC) at critical points only (such as scheduled immunization). In this regard, growth monitoring and promotion (GMP) which has been a key platform for nutrition counselling and education has been affected. Although an upward trend has been observed, the number of clients seen are still way below those reported in February 2020. Malezi bora activities normally conducted in May every year were also halted though catch up activities have been implemented in vitamin A supplementation program to ensure children are reached through community health strategy. A notable decline in IMAM admissions continues to be observed in 2020 compared to previous years and seasons. According the Ministry of Health, only thirty three percent of children targeted for treatment of acute malnutrition in 2020 have been admitted to the IMAM program between January and August 2020 and the annual 2020 target is unlikely to be met if the same trends continue. From a general perspective the reduced admissions have been linked to COVID-19 pandemic, scaling down of outreach activities, stock-out of IMAM commodities and a better food and nutrition security situation. However, they are gaps in understanding the specific issues leading to the low performance from a community perspective (demand side perspective) and there is need to understand their behavior and interest as regards nutrition interventions for program improvement. The general factors such as outreach strategy due to long distances to facilities and availability of supplies require concerted sustainable approaches in the face of a changing financial landscape. There is therefore need to engage key decision makers and programmers to understand bottlenecks related to prioritization and investment towards high impact nutrition interventions including procurement of IMAM commodities. With technical and financial support from UNICEF, the Ministry of Health has therefore set out to systematically gather evidence geared towards improving nutrition interventions through recruitment of a highly qualified and experienced consultant to conduct an in-depth assessment of nutrition interventions.
The in-depth assessment will be mainly qualitative with application of relevant quantitative approaches. The assessment will be preceded by a desk review of existing literature (relevant strategies, guidelines and frameworks) including critical analysis of the relevant available quantitative data to inform further enquiry/investigation and sampling of three counties to be included in the in-depth qualitative assessment. Sampling of the three counties will ensure representation of arid, semi-arid and urban counties with consideration of program performance and county admissions with preference to counties with higher IMAM program admissions in each category. The assessment will ensure consideration of gender, marginalized groups and geographical differences within the three selected counties. The assessment will engage various stakeholders including community members through focus group discussions; in-depth interviews with key influencers; key informant interviews with government authorities, local/community leaders, and other relevant stakeholders. Online data collection methods will be used to gather information on selected health system indicators across the urban and ASAL counties.
Goal and Objective
Under the supervision of UNICEF Kenya Office and close collaboration with the Ministry of Health Division of Nutrition and Dietetics, the overall objective of this consultancy is to conduct an in-depth assessment of nutrition interventions in the context of Covid-19 pandemic. Specifically, the objectives of the assessment are:
Provide details/reference to RWP areas/UNDAF output covered
This project component aligns with the UNICEF (2018-2022) Outcome 2 (Reduced Mortality & Stunting); Output 1.5 – By 2022, Government and non-governmental partners adopt risk-informed approaches to emergency preparedness, planning and response.
Activities and tasks
The consultant will work under the overall supervision of the Nutrition Specialist, Emergency in collaboration with the Head, Division of Nutrition and Dietetics, Ministry of Health. The assessment will be jointly led by the MOH DND and UNICEF in close collaboration with implementing partners and County governments where the assessment will be done. Co-leadership of the process will be undertaken by the Emergency Nutrition Advisory Committee (ENAC) and the Nutrition information working group (NITWG) with an expanded task team that draws members from other programmes at DND being put in place at National level. The Head, Division of Nutrition will be responsible for establishing contacts between the consultant and key stakeholders; making available copies of government documents, facilitating access to internal documents and organizing the validation workshop. The Nutrition Emergency Specialist will monitor the progress of the consultant work through progress updates, their reviews and feedback to the consultant.
Education: Academic qualifications and required level of education;
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