TERMS OF REFERENCE FOR INSTITUTIONAL CONTRACT

 

Title of the assignment

Develop various knowledge products, documents in English and Bangla based on lessons learned, advocacy and Public Relations Materials available for Nutrition programmes/ initiatives.

Purpose

To assist nutrition section to develop identified knowledge products and materials from the new initiative that will be used to facilitate the awareness raising among government counterparts, development partners and donors toward investing in and scaling up the programmes.

Location

Dhaka, Bangladesh with 3-4 Field visits with 5 days duration for each might be required.

Estimated Duration

The contract will be established for 24 months calendar days with 197 allocated working days, from 1 November 2020 to 31 October 2022.

Reporting to Technical Supervisor of this assignment

Nutrition Specialist

 

 

1.Background

 

Following the strategy of the UNICEF’s Country Programme for 2017-2020, Nutrition programme is designed following the lifecycle approach with focus on the first 1,000 days of life – that is from conception until the child reached her/his second birthday. The next focus will be adolescents aged 10-19 years old. School aged children 6-10 years old will also be the indirect target population for nutrition programming and implementation. The determinants of child stunting and other forms of undernutrition and micronutrient deficiencies, and evidence to support their response are wide-ranging, encompassing not only programmes that address maternal and adolescent nutrition, but also those to reduce low birth weight and improve infant and young child feeding practices.  More specifically, UNICEF supports on nutrition aim to accelerate the reduction of child stunting and improve adolescent nutrition.

 

Nutrition programme covering the thematic areas targeting different groups in the lifecycle: Infant and young child feeding for children aged 0-23 months; Maternal and adolescent nutrition; Micronutrient supplementation and fortification; Management of Severe Acute Malnutrition (SAM) for children aged 0-59 months, including community-based management of acute malnutrition (CMAM); and Early Childhood Care and Development (ECCD).

 

UNICEF supports nutrition programmes through partnerships with Government of Bangladesh, particularly Ministry of Health and Family Welfare, as well as other relevant sectors such as Agriculture, Social Protection, Labour and Employment, Education, and water and sanitation, to ensure the multi-sector nature of nutrition interventions are implemented in good coordination.

 

During the first half of UNICEF’s five-year country programme, UNICEF’s Nutrition section has started some new initiatives and demonstration programmes to improve the coverage and quality of nutrition programmes. The new initiatives are designed to strengthen systems in a scalable and sustainable way. New initiatives that have been implemented in this current country programme are:

 

1. Mothers@Work, a programme to strengthen maternity rights and support breastfeeding among working mothers, particularly in the ready-made garment (RMG) sector. It is a unique programme that is implemented as a joint effort among public, private sector and civil social organization.
2. Strengthen maternal nutrition programme, including the use of prenatal multiple micronutrient supplements (MMS) in two selected demonstration districts.
3. Community-based approach to improve coverage and quality of complementary feeding programme that will be modelled in selected districts, through strengthening the existing community-based structure of the nutrition service delivery system.
4. Multi-sectoral approach (Nutrition, WASH, Social Protection) to improve dietary diversification among infants and young children in urban areas.
5. Integration of Standard Minimum Package of Nutrition Specific Interventions through the existing health service delivery system in selected urban areas

Brief Description on each programme can be found in Annex 1.

 

UNICEF recognizes the need to gain a deeper understanding of the experiences from these initiatives and to document the lessons learned from the demonstration programmes. UNICEF is hiring an International Consultant to assist with the development of knowledge management plan and outline for the list of documents and knowledge products for new initiatives, which will include suggested objectives, contents and specifications. There is a need to bring an institution that can assist with development of identified knowledge products and materials.

2. Objectives, Purpose and Expected Results

 

Objectives

The Objectives of the Assignment: to develop knowledge products and materials including briefs, case studies, videos, podcast, presentations etc, in English and Bangla, following review and further consultations with relevant stakeholders, based on the recommended list obtained from consultation facilitated by individual consultant.

 

Purpose

The purpose of assignment is to assist nutrition section to develop identified knowledge products and materials from the new initiative that will be used to facilitate the awareness raising among government counterparts, development partners and donors toward investing in and scaling up the programmes.

 

Expected Results

Key expected results are agreed knowledge products and materials from the new initiatives are developed following the agreed objectives, contents and type of products such as policy briefs, case studies, videos, podcast, presentations etc., in both English and Bangla. List of indicated knowledge products and materials is presented under Deliverables section below.

 

3. Description of Assignment

 

The scope of work the assignment is following:

1. Review existing relevant literature, including communication strategy, proposals, technical and donor reports, awareness materials, presentations and other existing relevant documents.
2. Review and finalize identified knowledge products to be developed, suggested by the selected Individual Consultant.
3. Develop draft of contents for identified knowledge products (English version)
4. Conduct consultation with key partners and community to get feedback and improve the draft of knowledge products
5. Finalize English version of knowledge products and materials, including copy-editing and design work.
6. Finalize English version of other programmes knowledge products and materials, including copy-editing and design work
7. Translate and finalize all knowledge products and materials into Bangla
8. Prepare final documents and materials in soft copy and high resolution

4. Deliverables

 

Key deliverables:

 

Phase-1 (6 months, November 2020 – April 2021), item #1-9 in the Table

1. Inception report detailing methods and timeframe to complete each task, including final list of knowledge product and materials with specifications, along with Gantt Chart
2. Draft content and design of knowledge products and materials # 1-9 (English)
3. Final version of knowledge products and materials (English), item #1-9 (English)

 

Phase-2 (12 months, May 2021 – Apr 2022), item #10-23 in the Table

1. Draft content and design of knowledge products and materials #10-23 (English)
2. Final version of knowledge products and materials #10-23 (English)
3. Draft Bangla version of item #1-15

    

Phase-3 (6 months, May – October 2022), item # after contract signed)

1. Draft content and design of knowledge products and materials #24-26
2. Final version of Knowledge products and materials #24-26
3. Draft Bangla of item #16-26
4. Final version all materials in English and Bangla in high resolution and editable soft copy format

 

Below is initial suggested list of knowledge products and materials for each thematic programme

Note: This list needs to be refined following the recommended list from consultations facilitated by individual consultant

 

Programme/Initiative

KM Products Type/ Format

Suggested Topics/Contents

Indicative

Specifications

Phase-1 (6 months, November 2020 – April 2021)

Mothers@Work

 

Powerpoint or Prezi Presentation Videos (2 items)

1. General presentation including: why, who, what, how and what’s next

Powerpoint presentation (15-20 slides) or a Video, max 6 minutes duration

1. Results from baseline and assessment

Infographics 4-6 pages (A4), folded pages

Press coverage and blogs (2 items)

1. Engage business journalists

Journals/newspaper coverage on the achievements made by companies

1. Develop blog about Mothers@Work

Blog page and design

 

Case stories and interviews/ Podcast (3 items)

1. Serie-1 Podcast
2. Serie-2 Podcast
3. Serie-3 Podcast

of different topics related to maternity protection rights and family friendly businesses weaving evidence (global and national) with different perspectives (workers, managers, academics, advocates, government, business leaders, etc.) based on the flagship programme in an engaging way

3 minutes podcast for each episode

Strengthen Maternal Nutrition service, including the use of MMS

Policy Brief (1 item)

8) Policy brief from SitAn on Maternal Nutrition (findings from baseline assessment)

Flyer (A4 – both sides)

Phase-2 (12 months, May 2021 – April 2022)

Strengthen Maternal Nutrition service, including the use of MMS

Powerpoint or Prezi Presentation Videos (1 item)

9) Advocacy video (Details TBD)

Powerpoint presentation (15-20 slides)

Case stories (2 items)

10) Case study-1

11) Case study-2

2-One page case story (TBD)

Community-based approach for improved complementary feeding

Policy Brief (1 item)

12). The community-based approach - findings from phase-1 community-based approach

Flyer (A4 – both sides)

Powerpoint or Prezi Presentation (1 item)

13. Advocacy video (Details TBD)

Powerpoint presentation (15-20 slides)

Case stories (2 items)

14) Case study-1

15) Case study-2

 

2-One page case story (TBD)

Multi-sector approach to improve dietary diversity among children 6-23mo in urban area

Policy Brief (1 item)

16). Policy brief: Multi-sector approach to improve dietary diversity in urban setting (Baseline findings)

Flyer (A4 – both sides)

Powerpoint or Prezi Presentation (1 item)

17). Advocacy video (Details TBD)

Powerpoint presentation (15-20 slides)

Case stories (1 item)

18). One Case study (Details TBD)

One page case story (TBD)

Integration of Standard Minimum Package of Nutrition Specific Interventions in urban

 

Infographic (1 item)

19). Service modality followed for the exiting urban health system

Flyers infographic (TBD)

Case stories and interviews (2 items)

20) Case study-1

21) Case study-2

(How the common people benefitted from the integrated approach)

2-One page case story (TBD)

Policy brief (1 item)

22). Urban model for nutrition service delivery

Flyer (A4 – both sides)

Phase-3 (6 months, May - October 2022)

Strengthen Maternal Nutrition service, including the use of MMS

Policy Brief (1 item)

23) Findings from demonstration programme to strengthen maternal nutrition and the use of MMS

Flyer (A4 – both sides)

Community-based approach for improved complementary feeding

Policy Brief (1 item)

24). The community-based approach - findings from phase-2 & 3 community-based approach

Flyer (A4 – both sides)

Multi-sector approach to improve dietary diversity among children 6-23mo in urban area

Policy Brief (1 item)

25) Policy brief: Multi-sector approach to improve dietary diversity in urban setting (Evaluation/RCT findings)

Flyer (A4 – both sides)

5. Reporting requirements

Additional reports might be asked, to be discussed and agreed at the inception stage, including monthly progress update and workshops/consultations reports.

6. Payment Schedule

For the phase wise activities payments will be done maximum through five instalments after receiving the acceptable planned deliverables:

 

No

Deliverables

Working Day

(Timeframe)

Payment (%)

Phase-1 (6 months, November 2020 – April 2021)

1

Inception report detailing methods and timeframe to complete each task, including final list of knowledge product and materials with specifications, along with Gantt Chart

10 days (3 weeks after signing contract)

 

2

Draft content and design of knowledge products and materials # 1-8 (English)

 

27 days (4 months after signing contract)

 

3

Final version of knowledge products and materials (English), item #1-8 (English)

 

18 days (within 6 months after signing contract)

 

 

Total Phase-1

55 working days (6 months calendar day)

28%

Phase-2 (12 months, May 2021 – April 2022)

4

Draft content and design of knowledge products and materials #9-22 (English)

 

42 days (5 months after signing new contract/10 months of continued contract)

 

5

Final version of knowledge products and materials #9-22 (English)

 

28 days (9 months after signing contract/14 months of continued contract)

 

6

Draft Bangla version of item #1-15

30 days (12 months after signing new contract/18 months of continued contract)

 

 

Total Phase-2

100 days (12 months)

51%

Phase-3 (6 months, May - October 2022)

7

Draft content and design of knowledge products and materials #23-25

9 days (1 month after signing contract/20 months of continued contract)

 

8

Final version of Knowledge products and materials #23-25

6 days (2 months after signing contract/22 months of continued contract)

 

9

Draft Bangla of item #16-25

9 days (4 months after signing contract/23 months of continued contract)

 

10

Final version all materials in English and Bangla in HiRe and editable soft copy format

20 days (6 months after signing contract/24 months of continued contract)

 

 

Total Phase-3

42 days (6 months)

21%

 

Overall

197 days (24 months)

100%

 

 

7. Qualification requirement of the company/institution/organization

 

Institutions/organizations with the following minimum qualifications are encouraged to submit proposal/application:

1. Have team members with advanced university degree in communications, journalism, communications or related field with strong knowledge of programming is highly desirable; or advanced degree in public health, nutrition or related field with strong writing skills.
2. The institution at least 5 years of relevant Mid/Senior level professional work experience at national and international levels.
3. Demonstrated record of leading the writing of publications/knowledge products on programming in nutrition, health, or other sectors, for advocacy purposes and communication to general audiences.
4. Excellent presentation and writing skills. Design and layout skills highly desirable.
5. Excellent time and project management skills. 
6. Experience of working with UN Agencies, or other donor organizations
7. Familiarity with UNICEF programmes (Nutrition, Health, WASH, Social protection, Child protection) and nutrition-sensitive programmes, and knowledge of the challenges of implementing such programmes in fragile and conflict affected countries, will be a strong asset.
8. Experience working in developing countries. Experience working in Bangladesh is considered an asset.
9. Affiliation with international consulting firms, agencies or associations will be an advantage.
10. Fluency in English language.

 

7a. Qualification requirement of the team (optional)

 

The institution is required to have team members with proven experience and skills in the following areas:

• Conducting qualitative information collection and analysis
• Conducting quantitative date analysis
• Having Bangla knowledge skills
• Copy editing
• Videography
• Podcast development etc.

 

 

 

Annex 1. Programme Description

 

1.Mothers@Work

 

Mothers@Work programme is a national programme, developed to address the challenges faced by working mothers to be able to continue breastfeeding in the workplace. It is currently implemented in the Ready-Made Garment (RMG) sector, in partnership with public, private and civil society organizations.  About 2.1 million of RMG sector employees is female. The majority of these women are of reproductive age, and many are mothers who are responsible for nurturing the next generation of Bangladeshi citizens.

 

Guided by the national and global policy framework and regulations on maternity protection and breastfeeding support in the workplace, Mothers@Work programme was developed through a national consultation in 2016. The consultation was done under the leadership of the National Nutrition Service-Institute of Public Health and Nutrition, Ministry of Health and Family Welfare. The consultation was a joint effort with Ministry of Labour and Employment and support from development partners including UN-Agencies such as UNICEF, ILO, WHO; Civil Social Organizations such as BBF, BRAC, WABA, CWCH and other NGO/INGOs members of Infant and Young Child Feeding Alliance.

 

Mothers@Work recommends seven minimum standards of maternity protection and breastfeeding support in the workplace. They are:

1. Breastfeeding spaces. All organizations shall provide a private space for mothers to breastfeed and/or express and store breastmilk.
2. Breastfeeding breaks. Nursing mothers shall be allowed to reduce their working hours or take breaks to breastfeed their babies or express their breastmilk. All nursing mothers should be given the option of flexible working arrangements.
3. Child care provision. Child care facilities shall be provided in all private organizations with more than 40 women employees of reproductive age.
4. Paid maternity leave. Paid maternity leave as per national law shall be provided to women employees.
5. Cash and medical benefits. Cash and medical benefits shall be provided to women on maternity leave to support the health and well-being of both mother and child.
6. Employment protection and non-discrimination. All women shall have the right to return to a job of the same grade or an equivalent pay after maternity leave and shall not be subject to discrimination in accessing employment.
7. Safe-work provision. Women who are pregnant or nursing shall not perform work that is potentially dangerous to their health or to the health of their foetus or young children.

 

Key Interventions

1. Orient Company’s Senior Management or owner on the 7 minimum standards and resources required to implement the programme.
2. Support the company to develop a workplace policy to upholding exclusive breastfeeding, especially among working mothers
3. Support company to establish and maintain breastfeeding space
4. Capacity building of company’s staff including HR manager/officer, Health Workers and Social Welfare Officers.
5. Establish mothers support group among the employees, mentored by the experienced working mothers.
6. Knowledge Management, Communications and PR for advocacy
7. Monitor and track the implementation of 7 minimum standards

 

Key Achievements

Programme progress assessment has been completed and will be disseminated in the Quarter-2 of 2019. Below is list of key achievements that have been noted from the implementation and monitoring of Mothers@Work programme. More details information will be available from the progress assessment and Cohort of pregnant and lactating mothers and their infants.

 

• Mothers@Work programme at five factories continues to grow stronger with the establishment of a monitoring framework and tools to track the programme delivery and scale up.
• Partnerships that bring programme scaled up at speed. Mothers@Work programme has expanded to 80 factories, reaching around 150,000 workers and their young children through partnership with ILO-BetterWork.
• Improved knowledge of working mothers regarding their maternity rights and ways to continue breastfeeding after returning to work.
• Improved knowledge of welfare officers to provide breastfeeding support and counselling to working mothers.
• A toolkit contains of Resource Guide for step-by-step guidance, capacity building and communication materials to be used by RMG companies is developed.

 

Some key milestones of the programme are following:

 

 

 

2.Improving maternal nutrition interventions, including the use of prenatal multiple micronutrient supplements through the ANC platform of public health services

 

In Bangladesh, malnutrition among women and adolescent girls represents a serious public health issue. The most recent national survey indicates that 24% of women aged 15-19 years are undernourished (BMI < 18.5 kg/m²) while 17% are overweight or obese (BMI > 25 kg/m²). Moreover, 13% of women have short stature (height <145 cm). An estimated 38% of all pregnancies result in low birthweight; this high prevalence of fetal growth restriction is a major cause of stunting and neonatal mortality in Bangladesh. National-level data on anemia prevalence is outdated. Most recent evidence from 2011 indicates that 42% of women of reproductive age are anemic. Even though iron deficiency is a contributing factor, less than one third of anemia appears to be related to iron deficiency. The contributory role of other hemopoietic nutrients, such vitamins A, B12 and folate, has been documented through local research.

 

Currently, the provision of maternal nutrition services through government systems is weak. As part of effort towards scalable maternal nutrition intervention programme, a demonstration programme will be implemented with number of key interventions. The demonstrating programme will document the lessons learned and number of case studies that will be used to develop scale up plan of the demonstrating programme.

 

Key interventions under this initiative are:

1. Conduct analysis of enabling environment and ANC and maternal nutrition delivery systems
2. Conduct bottleneck analysis on the use of IFA and procurement and production of multiple micronutrients
3. Design a strategy and the implementation of the demonstration program on the use of MMS, maternal nutrition interventions and an improved ANC service overall.
4. Develop a community-based approach and community mobilization strategy
5. Develop capacity of service care providers to deliver a defined set of maternal nutrition interventions
6. Develop a comprehensive national scale up plan for maternal nutrition interventions.
7. Improve tracking systems for individual pregnant women through DHIS2 and innovative methods for reminders and follow ups, such as using mobile apps, RapidPro, etc.
8. Develop communication materials and job aids to provide overall education on maternal nutrition and ensure proper use of MMS (C4D).
9. Conduct policy dialogues (i.e., round table discussions) among decisionmakers on the effectiveness of the use of MMS and the way forward for mainstreaming maternal nutrition services that include the use of MMS into the government system and at national scale.

 

The development of advocacy plan and materials and documenting of lessons learned are included as key activities under this initiative.

 

3.Community-based approach to improve complementary Feeding Practices in Rural Area

 

Complementary foods given to infants and young children in Bangladesh are often nutritionally inadequate and unsafe, leading to malnutrition. Foods from animal sources such as fish, chicken, beef and egg are expensive and not commonly given to children: About half of the children aged 6-9 months are not given foods from animal sources (BDHS, 2014). Nutrient rich plant foods such as fruits and vegetables are also not given to children daily. Children often receiving poor quality foods with a too low feeding frequency which are too far from meeting their nutrient requirements. According to the latest national survey, complementary foods are not introduced in a timely fashion for all children. Overall, only 23 percent of children age 6-23 months are fed appropriately based on the WHO recommendations on IYCF practices which is also referred as Minimum Acceptable Diet (MAD).

The Government of Bangladesh has put more efforts to improving nutrition situation towards SDG Goals where infant and young child feeding and maternal nutrition programme are among key national programmes defined by the National Nutrition Policy and the 2nd National Plan of Action for Nutrition. The National Nutrition Service has included key interventions to improve the quality coverage of infant and young child feeding and maternal nutrition in its Operational Plan.

 

There are number of guidelines and framework established by the GoB towards an improve infant and young child feeding coverage, such as Infant and Young Child Feeding Strategy 2007 that is being revised and finalized. Additionally, the GoB has also been implementing national initiative to improve the infant and young child feeding practices among infants and young children under two years of age as part of health system strengthening strategy, with a lot of focus on the interventions at health facilities.

 

The community-based interventions for both maternal nutrition and infant feeding is rather weak. While few initiatives are in place with support of NGO and CSO, their implementation is limited to small geographical area. For example: Mother Support Group (MSG) under the Community Clinic (CC) coordinated by the CHCP implemented by the Institute of Public Health and Nutrition (IPHN) with support from the Bangladesh Breastfeeding Foundation (BBF). The government also has initiated multi-purpose health volunteer for community outreach to improve the coverage of health and nutrition services. These community-based approaches are also critical building block for a comprehensive system strengthening for nutrition service delivery towards a universal coverage of high impact nutrition interventions for infants and young children and mothers.

 

Overall, these initiatives aim to provide peer support in teaching the recommended practices including addressing the barriers and challenges. Peer support is defined as ‘the provision of emotional, appraisal and informational assistance by a created social network member who possesses experiential knowledge of a specific behavior or stressor and similar characteristics as the target population. Peer supporters could be either voluntary or in receipt of basic remuneration, or honorary incentives or money for expenses.

 

The WHO and UNICEF recognize peer support and counselling as an important component of policies and programs to support IYCF. Mother to Mother Support Group (MSG) is such a peer support approach (community led and includes influential positive deviant mothers, mothers-in-law etc.) which is already being proved to be effective in improving breastfeeding practices in Bangladesh and Government (IPHN/MoHFW) has adopted the approach in improving comprehensive IYCF practices.

 

Good practical skill training on counselling approach, the presence of local women in the support group, skilled supervision, a supportive health system and administration, the presence of referral centers and timely referral, frequent contacts, regular orientation, refresher courses, and incentives for the work are identified as critical in making this peer/community support approaches effective.

 

Key interventions under this initiative:

1. Mapping of existing community-based nutrition programme in Bangladesh and identify strength and gaps/scopes for improvement
2. Review existing SBCC strategies, guidelines, tools for community-based nutrition programme. 
3. Develop community-based approach and SBCC strategy and package (e.g. guidelines, SoP, training modules and materials, job aids and M&E framework and tools)
4. Capacity of existing structure and delivery system to plan, execute and scale up efficient and evidence-based a multi-sectorial community-based nutrition programme with a focus on infant and young child feeding and maternal nutrition
5. Increased knowledge and skills of frontline workers on SBCC to promote adoption of optimal practice of infant and young child feeding and maternal nutrition
6. Building capacity of frontline workers to use acquired skills on social mobilization and community engagement to mobilize, train and supervise community support networks (Community Leaders, religious leaders, CSG etc).
7. Rolling out comprehensive community-based nutrition programme in selected districts to set a scalable model through testing and refinement of community approaches.

    

   Strengthen knowledge management by documenting process, lessons learned during implementation and the results for advocacy and scale up strategy will be one of key activities under this initiative.

    

   Community-based nutrition programme will be initiated in the mid of 2019 and implemented throughout until the end of 2020.

 

4.Multi-sectoral approach (Nutrition, WASH and Social Protection) to improve dietary diversity among infants and young children in urban areas.

 

This project will seek to establish proof of concept for an effective intervention model that combine three approaches to tackle the specific constraints to complementary feeding among infants and young vulnerable children aged 6-23 months in urban slum areas, namely use of “Nutrition Vouchers”, ‘BABY-WASH’ and Behaviour Change Communication (BCC) which will be a cross cutting intervention.  This integrated intervention modelling approach is expected to result in improving young children diet diversity along with maintaining essential hygiene and responsive feeding practices leading to prevention of stunting among those vulnerable children. 

 

The Nutrition Voucher approach will be used to address financial constraints faced by poor households in accessing nutritious and healthy complementary foods as well as to shift the wrong food choices. Baby-WASH is an emerging concept that links water, sanitation & hygiene behaviours with complementary feeding practices. While the SHINE study results showed limited impact on stunting reduction, the BABY WASH practices will directly support food safety in complementary feeding practices. Through the targeted ‘Voucher’ approach, improved access/affordability of diversified nutritious complementary food combined with dietary diversity and responsive feeding counselling/early stimulation are likely to reduce stunting via improved complementary feeding behaviours. Evidence from testing this model approach will be used for influencing policy and financial allocation decisions, multi-sectoral programme designing or scale-up planning. 

 

Key interventions to be included under this initiative are combination of nutrition specific and sensitive nutrition, including infant and young child feeding and maternal nutrition counselling; growth monitoring and promotion with specific focus on periodical weighing of all children and MUAC measurement if found underweight and referral and treatment of SAM as per detection; hygiene promotion, support for access to routine primary health care (PHC) services and linkage with existing social protection. This initiative will be implemented in one City Corporation in coordination with WASH, Health and Social protection sectors. The programme is at initial stage and will be implemented throughout 2019-2021.

 

Key activities are:

1. Procurement and distribution of "Nutrition Voucher" Card each with an exchange value of one "egg" and a "portion" of vitamin A-rich fresh vegetables (e.g. pumpkin or carrot or red spinach etc.) per child per day through weekly BCC group sessions;
2. Distribution and demonstration the use of in-kind BABY-WASH kits including equipment/hygiene aid such as feeding bowl & cover, soap, handwashing and household waste storing devices;
3. Conducting intensive BCC sessions (group/Inter Personal Counselling (IPC), Interactive Popular Theatre (IPT) shows etc.) on weekly and monthly basis to encourage mothers to shift their choices on right/diversified food even when they are purchasing on their own and educating on recommended feeding guideline, essential hygiene practices   and responsive feeding for better uptake and utilization of diversified complementary feeding.
4. Engaging dedicated community Mobilizers/Volunteers and frontline health service providers in existing public and private sector programmes through an existing partnership with the respective City Corporations and the Urban Primary Health Care service delivery programme (UPHCSDP) implemented though Ministry of Local Government Division (LGD). They will be made accountable for coordination and performance tracking.
5. Training to the frontline health and nutrition service providers and additionally recruited community mobilizers/volunteers on ‘Nutrition Voucher’, BABY-WASH and ‘Behaviour Change Communication (BCC)’ implementation approaches.
6. On the job coaching and supportive supervision so as ensure appropriate delivery of Voucher and BABY-WASH services and strengthen the BCC and practical demonstration capacity
7. Follow-up/home visits by frontline and supervisory level staff to monitor on the recommended practices, encouraging in positive behaviour and providing necessary guidance/demonstration to mothers on the recommend practices.
8. Development/adoption of appropriate BCC module including hygiene and responsive feeding guideline.
9. Coordination among the key stakeholders and technical oversight

 

The initiative will include baseline and evaluation to generate evidence for scale up.

 

 

1. Integration of Standard Minimum Package of Nutrition Specific Interventions through the existing health service delivery system in selected urban areas

 

Urban healthcare in Bangladesh falls under the responsibility of two main government ministries, i.e. the Ministry of Health and Family Welfare (MoHFW) as the technical lead, and the Ministry of Local Government, Rural Development and Cooperatives (MOLGRD&C) as the implementing authority. MOHFW is the designated ministry for all matters related to health, and for ensuring and/or arranging health services for the entire country including urban and rural. However, unlike rural, MoHFW does not have a systematic health service delivery system/centers at the community level specially the vulnerable population (e.g. slum dwellers).

 

The Local Government Division (LGD) within MOLGRD&C is responsible for providing primary health and public health services in urban areas but this ministry has very limited service delivery platforms. As of government policy (Nutrition policy, 2nd plan of action on nutrition), National Nutrition Services (NNS) are to be delivered through the health service delivery system be it in rural or in urban. Nutrition services delivery in urban areas are included into the essential service package (ESP) under the primary health care (PHC) but they are not fully aligned with the National Nutrition Service (NNS) delivery protocol which is developed based on the rural health system. In urban, main platform for nutrition service delivery is the urban primary health care service delivery programme (UPHCSDP) under the City Corporations, MoLGD and Smiling Sun clinics and few other private health centers from NGOs and private sectors. 

 

In the absence of MoHFW led platforms, NNS should be mainstreamed through the existing MoLGD led programme platforms specially to serve the vulnerable population.  Among vulnerable urban population, during first 1000 days window of opportunity, minimum standard nutrition specific interventions are identified and aim is to integrate them through the health service delivery system, these include: Maternal nutrition and IYCF counselling, Growth Monitoring & Promotion (GMP) with specific focus on periodical weighing of all children and MUAC measurement if found underweight and referral and treatment of SAM as per detection, ensuring Vitamin A for children, IFA for PLWs etc. Although the responsibility for urban health service delivery is shared by MOHFW and MOLGRD&C, the lack of meaningful coordination between these ministries significantly constrains the provision of urban health care services, resulting in fragmented governance arrangement and inadequate coverage for the urban poor.

 

The proposed initiative will develop evidence and knowledge for policy dialogue and advocacy to influence the national policy on urban nutrition and expansion of positive practices at scale. Embedded implementation research and documentation across the project objectives will be used as evidence for policy dialogue and advocacy. In turn, all such evidence generation is expected to strengthen the enabling environment for introducing sustainable model for institutional reforms for strengthening the urban health system for integrating nutrition services for improving nutrition of newborns, infants, young children and their mothers of Bangladesh.

 

Key interventions under this initiative are:

1. Capacity building of the Service Providers and their Supervisors/Managers following national Competency Based Comprehensive Training on Nutrition (CCTN)
2. Support procurement service and distribution of nutrition supplies and tools (e.g. including IEC   materials, GMP & SAM screening tools, IFA supplies
3. Strengthen coordination among the implementing partners, City Corporation and IPHN  to review and follow-up on the implementation and Unicef Urban management team for using the existing platforms and making convergence.