Review of acute malnutrition situation, trends and management capacity in LAC

1. BACKGROUND 1.1 The management of acute malnutrition, also known as wasting, including nutritional oedema, is a key lifesaving nutrition intervention. Children with acute malnutrition experience negative changes in weight for height, are at higher risk of stunting, and increased susceptibility to infections and severity of illnesses. Severe acute malnutrition (SAM), the most extreme and visible form of undernutrition, is a life-threatening condition, and has been associated with poverty, inadequate nutrient intake, lack of access to adequate health services, and concurrent diseases. Without treatment, children with SAM are nine times more likely to die than children who are well-nourished. Globally, it is estimated that 1 million children under five die from SAM every year. While prevention is the first step towards the management of acute malnutrition, once it occurs, urgent action is needed to minimize complications and avoid the risk of death. Children with acute malnutrition have a severely disturbed physiology and metabolism and need to be treated with caution, since simple refeeding can lead to high rates of mortality. Countries with high prevalence of acute malnutrition at national level or among vulnerable groups, and countries with (a risk of) humanitarian situations should have in place systems that permit to identify children with acute malnutrition, refer them to specialized care, and treat them with specially formulated foods using up-to-date and evidence-based protocols and/or guidelines at the institutional and community levels. Joint global estimates from the United Nations International Children’s Emergency Fund (UNICEF), WHO, and the World Bank revealed that nearly 1.3% children under five years old (700 000 million) in Latin America and the Caribbean (LAC) had acute malnutrition in 2020, of which 100 000 had SAM . Despite having lower figures than other regions in the world, LAC is the region most severely hit by the COVID-19 health emergency and the humanitarian and socio-economic impacts of COVID-19 are having devastating effects on children nutrition and their families. In 2020, in Latin America and the Caribbean, the prevalence of moderate or severe food insecurity was 41 percent and the prevalence of severe food insecurity, that is people who had run out of food and, at worst, had gone a day or more without eating, was 14 percent . Between 2019 and 2020, in the context of the COVID-19 pandemic, the prevalence of moderate to severe food insecurity grew by 9 percentage points, the most pronounced rise in relation to other world regions. Also, during 2020, 267 million people experienced moderate or severe food insecurity, which means that 60 million people more than in 2019 did not have physical or economic access to food in the quantity and quality required for their health and development. In 2022, due to the crisis in Ukraine, LAC confronts domestic contexts marked by a sharp economic slowdown, rising inflation and a slow and incomplete recovery of labor markets, which will increase poverty and extreme poverty levels. As a result, 7.8 million people are forecast to join the 86.4 million others whose food security is already at risk . The region is composed of countries with significant differences in terms of size, economic development, and health and nutritional status; in-country capacity to address malnutrition is also heterogeneous across the region. Given the expected impact of the different factors mentioned above on nutrition and the high morbidity and mortality risk of acute malnutrition, especially SAM, it is essential to an overview of the current capacity of management of acute malnutrition in LAC (understand how children with acute malnutrition are screened, identified, referred to and treated), understand its barriers and gaps and provide recommendations to address them.

2- PURPOSE, OBJECTIVES & SCOPE OF WORK

General objective: Under the overall guidance of the Regional Nutrition Specialist, the institution will develop a panoramic review of the situation and trends of acute malnutrition and the national care/management capacity of acute malnutrition in LAC as part of routine services and as part of an emergency response.

1. SCOPE OF WORK The institution will work closely with the Nutrition Specialist to conduct the following tasks to achieve the deliverables:

o 1. Draft a concept note with proposed methodologies, tools and report index (of maximum 12 pages): draft study design, planning and implementation calendar, including proposed methodology and stakeholders to be consulted (semi-structure interview questionnaires for the different key informant groups based on key elements to explore (situation of MAM, SAM, protocols/guidance, policies, surveillance systems, etc). Outline of a tentative final report index.

o 2. Conduct a desk review of: o the current situation, trends, and projections regarding MAM and SAM in LAC in terms of burden/prevalence and incidence at national and sub-national levels, including in emergency or crisis situations, through secondary data. When data permits, conduct analysis of trends by middle-up arm circumference (MUAC), by weight-for-height (and compare MUAC with weight-for-height), age, and sex breakdown. o existing national policies/regulations/legislations, surveillance systems, protocols and guidelines related to the care/management of acute malnutrition as part of routine services and as part of an emergency response, including identification, referral and treatment of MAM and SAM and determine to what extent these are aligned with the latest WHO guidance and what, if any adaptations have been made (e.g. simplified approaches). Include a mapping of the type of intervention used (community/facility level), type of product used, inclusion of MAM treatment, inclusion of infants under 6 months, section for emergencies situation etc.;

o 3. Conduct a qualitative study to obtain primary qualitative data on current standards and practices on the above themes from national health and nutrition authorities, managers of health institutions, nutritionists, health professionals in selected health institutions and countries, UN agencies, NGOs and any other relevant stakeholder working at the country level in specific countries. Countries would be suggested and identified after the desk review is conducted using purposeful sample and agreed with UNICEF beforehand;

o 4. Develop a comprehensive report (of maximum 20 pages) with the findings on the review, the analysis of secondary data, and the qualitative study, and recommendations;

o 5. Develop a Power Point presentation with key findings and recommendations; o 6. Develop a policy brief (maximum 4 pages) with a summary of the findings and recommendations, including key advocacy messages calling for action.

o 7. Prepare a scientific article and submit it for publication in a peer reviewed journal.

2. EXPECTED DELIVERABLES AND TIMELINE The institution will be responsible for developing the following products:

Description Expected deadline

Deliverable 1: Methodological proposal and report index 15 March 2023

Deliverable 2: Interim report on situation, trends, and projections of acute malnutrition in the LAC region capacity to manage acute malnutrition (part of the desk review) 29 March 2023

Deliverable 3: Interim report of the review of national regulations, legislation, and guidelines/protocols in countries of the LAC region, including a mapping on their content and alignment with latest WHO guidance (part of the desk review) 26 April 2023

Deliverable 4: Report on the results of the qualitative study 14 June 2023

Deliverable 5: Comprehensive report on situation, trends and capacity to manage acute malnutrition, including findings from the desk review (deliverables 2 and 3) and the results of the qualitative study (deliverable 4) – maximum of 20 pages 28 June 2023

Deliverable 6: Policy brief (maximum 4 pages) with a summary of the findings and recommendations, including key advocacy messages calling for action and Power Point presentation 12 July 2023

Deliverable 7: scientific article submitted for publication in a peer reviewed journal. 9 August 2023 *Dates can be adapted depending on the starting date of the contract

2. SOLICITATION

2.1 The purpose of this Request for Proposals for Services (“RFPS”) is to invite proposals for Review of acute malnutrition situation, trends and management capacity in LAC as fully detailed in the Terms of Reference/Statement of Work attached at Annex B

2.2 This RFPS document is comprised of the following:

• This document • The UNICEF General Terms and Conditions of Contract (Services) which are attached as Annex A to this document

• The full Terms of Reference/Statement of Work attached at Annex B

• Request for Proposal for Services Form as Annex C

• Vendor Form MDM as Annex D

• Online registration to UNGM -United Nations Global Market – link: https://www.ungm.org/Account/Registration • Instruction to bidders

2.3 This RFPS is an invitation to treat and shall not be construed as an offer capable of being accepted or as creating any contractual, other legal or restitution rights. No binding contract, including a process contract or other understanding or arrangement, will exist between the Proposer and UNICEF and nothing in or in connection with this RFPS shall give rise to any liability on the part of UNICEF unless and until a contract is signed by UNICEF and the successful Proposer.

PART II – PROPOSAL SUBMISSION PROCESS

1. PROPOSAL SUBMISSION SCHEDULE CONTRACTUAL PROCESS

The schedule of the contractual process is as follows:

ACTIVITIES SCHEDULE: 1.Send Proposal: 24.01.2023

2.Questions and Answer if necessary: Until 06 February 2023.

3.Consolidates Q & A posted in UNGM: February 08, 2023.

4.Deadline for Proposals: February 14, 2023. Before 23:59 Panama Time

5.Proposals Review: February 15, 2023.

6.Evaluation Period/Review of Proposals: February 16, 2023, approximately

7.Award Notice sent and posted in UNGM: February 24, 2023

8.Contract begins March 2023 approximately