LRPS-2023-9184214: for documentation of the implementation processes of critical nutrition services delivering under Health and Gender Support Project (HGSP)

TERMS OF REFERENCE FOR INSTITUTIONAL CONTRACT

 

Title of the assignment

Documentation of the implementation processes of critical nutrition services delivering under Health and Gender Support Project (HGSP)

Purpose

To document implementation process and generate evidence to:

• enhance advocacy for policy/programme change
• account for mitigation and leveraging strategies in emergencies
• encourage actions to mitigate service delivery, accessibility and utilization barriers and leverage drivers
• to encourage adoption of innovative approaches/best practices in the context of humanitarian-development situation

Location

Dhaka and Cox’s Bazar (both camp and host community)

 

Estimated Duration

7 months, starting from 1 August 2023

Reporting to Technical Supervisor of this assignment

Nutrition Specialist, Nutrition Section, UNICEF Bangladesh Country Office

 

1. Background

Cox’s Bazar is one of the most socio-economically vulnerable and lowest performing districts in terms of malnutrition reduction in Bangladesh. In Cox’s Bazar, the proportion of underweight (29.4%) and stunting (34.6%) among under-5 children are much higher than the national figure (22.6%, 28% respectively) though the wasting rate is similar (9.7% vs. 9.8%)[1]. The situation in Cox’s Bazar has been exacerbated by the massive influx of Rohingya refugees in 2017 and the COVID-19 crisis in 2020-2021. Approximately, 884,000 Rohingya refugees[2] migrated from  Myanmar to Bangladesh and reside in 34 camps in Ukhiya and Teknaf Upazilas of Cox’s Bazar District since 2017[3]. The Rohingya refugees currently represent 37% of the Cox’s Bazar population[4] and more than half of them are women and girls3 who need specific attention for health and wellbeing. In the host community of Ukhia and Teknaf, prevalence of stunting is 20.7% and 25.8% whereas underweight is 25.8% and 21.9% respectively. The wasting situation among children aged 6-59 months of these upazilas (9.9% in Ukhia and and 8.9% in Teknaf)[5] is worse compared to that of national (8.8%)[6]. Thus, this district is facing a dual challenge of handling refugee crisis as well as its host communities in terms of malnutrition.

 

To address the malnutrition challenge in Rohingya Refugee and host community of Cox’s Bazar district, UNICEF’s approach is to prioritize actions to prevent malnutrition, while at the same time supporting curative action through community and facility based different nutrition programs targeting children under 5, pregnant and lactating women and adolescent women and girls.

 

Under the Additional Financing (AF) for Health Sector Support Project (HSSP), with the funding from the World Bank, UNICEF supported to implement critical nutrition services in line with NNS-OP, strengthen community-based referral and follow up systems, community mobilization and Social & Behaviour Change Communication (SBCC) activities at selected camps and adjacent communities (Upazila Health Complex). These activities were aimed to improve the quality of nutrition services delivery specifically, in the areas of Infant and Young Child Feeding (IYCF), maternal nutrition under the Additional Financing for Health Sector Support Project (HSSP) in Ukhia and Teknaf upazila from 21 March 2019 to 28 Feb 2022. Though the project has ended in February 2022, some of the priority activities (e.g. counselling, monitoring, coordination, community mobilization etc.) are being carried over through Health and Gender Support Project (HGSP).

 

To protect, promote and support infant and young child feeding (IYCF) in the camp setting, under HSSP UNICEF has deployed IYCF counsellors in the 24 health facilities in Rohingya camps and in two Upazilla Health Complexes of Ukhiya and Teknaf. These IYCF counsellors, with the necessary precautions for COVID-19, provided IYCF counselling to pregnant and lactating mothers. UNICEF has reached 41,000 mothers annually with IYCF counselling and messaging services. A real-time, external monitoring and online reporting system has been designed and operationalized with UNICEF’s support to report and track IYCF counselling at these health facilities. The nutrition counsellors and health workers were trained as per the national Comprehensive Competency-Based Training on Nutrition (CCTN) approach. The health workers also received mentoring support through routine supportive supervision. UNICEF equipped all the health facilities in the project area with relevant job aids and social and behavioral change communication (SBCC) materials. UNICEF has thereby deployed a senior professional within the Civil Surgeon’s Office to strengthen the Government’s capacity in leadership and coordination, as well as ensuring delivery of critical nutrition interventions in line with NNS OP.

 

Under the Health and Gender Support Project (HGSP), in partnership with the World Bank and under the leadership of Director General of Health Services (DGHS), National Nutrition Services ((NNS) and the Civil Surgeon, UNICEF is working to scale up, streamline and standardize the critical nutrition services in Cox’s Bazar during the period of 7 February 2021 to April 2023 (likely to be extended until June 2024). The project is expected to benefit around 3.4 million people currently residing in the district including 860,000 Rohingya refugees. The host population includes an estimated 75,000 pregnant women (per year) and 320,000 under-five children whereas among Rohingya refugees, 52% are women and girls with an estimated 25,560 pregnant women (per year) and 188,960 under-5 children. UNICEF is dedicating its efforts to ensuring improved coverage and uptake of essential nutrition services both at the facility and community level of the host and camps through community-based preventive nutrition interventions including promotion of IYCF and caring practices, and prevention of maternal and child malnutrition. In the host community, the HGSP project is designed to strengthen nutrition services in the GoB health facilities. Community engagement is expected to be strengthened by the deployment of nutrition supervisors and nutrition counsellors and by building the capacity of existing government cadres and structures like Community Support Groups. UNICEF also supports community mobilization and behavior change communication activities such as Growth Monitoring and Promotion (GMP), IYCF counselling, some innovative nutrition interventions like Mukhe Bhaat[7] and Cooking Demonstrations at the community level are also being implemented covering the entire district. UNICEF has thereby initiated the pay for performance (P4P) model, a performance-based incentive initiative for GoB health frontline workers to improve, motivate and enhance quality of nutrition services. Moreover, supportive supervision allowances (SSA) are also provided to GoB health supervisors.

 

2. Objectives, Purpose, and Expected Results

 

The overall objective of this assignment is to document implementation processes to gain a stronger understanding of barriers and drivers for access to, utilization, and delivery of critical nutrition services in the camps and host communities of Cox’s Bazar. It thereby aims to identify innovative/good practices and strategies to strengthen both demand for and supply of service delivery both at the facility and in the community in the context of humanitarian-development situation.

 

The specific learning objectives are:

1. To understand barriers and drivers for access to, and utilization of facility and community based critical/essential nutrition services by the Rohingya refugees and host community
2. To understand the barriers and drivers to provide critical nutrition services in the facility and community for Rohingya refugees and host community
3. To determine knowledge, attitude and practices (KAP) of the nutrition service providers and the recipients
4. To understand barriers and drivers to utilization of emergency nutrition information system by camps managers to improve nutrition service delivery in camps
5. To understand barriers and drivers to ensuring continuity of essential nutrition service delivery during emergencies/pandemic
6. To identify best practices and understand how these practices including innovative approaches are effective in achieving behavior/practices change and promoting utilization of nutrition services
7. To develop knowledge management products including policy briefs/statements based on the key findings to inform and guide effective implementation of the nutrition programme in the context of humanitarian-development situation

 

The purpose of this assignment is to document implementation processes and generate evidence to support policy/programme change to account for mitigation and leveraging strategies in emergencies, to encourage actions to mitigate service delivery, accessibility and utilization barriers and leverage drivers, and to encourage adoption of innovative approaches/best practices in the context of humanitarian-development situation.

 

To reach the specific learning objectives, both quantitative and qualitative (mixed method) research methodology consisting of survey, Key Informant Interviews (KIIs), Focus Group Discussions (FGDs), observations and In-Depth-Interviews (IDIs) with beneficiaries, service providers, and community facilitators/groups will need to be engaged. The expected results from this assignment will be in the shape of several concrete outputs:

 

1. four (4) human interest stories on barriers and drivers to accessibility and utilization of nutrition services and innovative approaches/best practices
2. a technical report on implementation processes; barriers and drivers of behavior change; provision, access and utilization of nutrition services; innovative approaches/best practices; key lessons learned, and recommendations based on qualitative and quantitative research
3. a summary report capturing summary of findings, best practices/innovative approaches, key lessons learned and recommendations
4. policy brief based on technical and summary report findings
5. video documentations (2) of integrated nutrition service delivery in camps and essential nutrition services deliveries in host community
6. one article for peer-review and publication based on the technical report 

 

3. Description of Assignment

This seven month long assignment is aimed to review and document the Government-WB-UNICEF supported project interventions focusing on nutrition specific services providing for Rohingya refugees in the camp and CXB host community. It is expected that this assignment will generating evidence and guidance on how access to and utilization of community and facility-based preventive critical nutrition services can be strengthened and delivered to improve coverage and uptake of critical/essential nutrition interventions and practices in the context of humanitarian-development situation. The scope of this assignment are as follows:

1. Desk review of the programme, relevant background documents, reports and policies: To fully understand the context, essential nutrition services being provided at the facility and community level, to understand the linkages and referral systems available, both nationally and those supported by the project in Cox’s Bazar in both host and camp settings.

 

1. Conduct process documentation of implementation of essential nutrition services in host communities and camps: Document the implementation of and experiences with essential nutrition service delivery in host and camp settings, both at the facility and the community, through surveys, KIIs, FGDs, observations and IDIs. The process documentation should seek to address the learning objectives identified above. The process can be divided into three phases:

 

1. Pre-project phase (retrospective): to understand the status, barriers and drivers of critical/essential nutrition service delivery, accessibility and utilization in both host community and camps before the project started. For example, in the context of host community, need to explore what were the roles and responsibilities of service providers, what were care-seeking behaviours of the beneficiaries, were there any community-facilitators, did they conduct any sessions on nutrition before the project started, what were barriers and drivers to service provision and utilization etc.
2. Project implementation phase (retrospective/present): to understand how the project is supporting system strengthening for delivering of facility and community-based preventive quality essential/critical nutrition services with improved accessibility, coverage and uptake in emergency and development settings. Some queries that can be addressed are, did roles and responsibilities of service providers and the facility and the community change during the project implementation period, if yes, how and what are perceived barriers and drivers in an emergency setting, both to these changes, and to ensuring quality service provision, did the responsibilities of community-based facilitators change, what trainings were provided, how often, what was the impact of those trainings etc.
3. Institutionalization phase (prospective): to propose mitigation and leveraging strategies taken before and during emergencies, to encourage actions to mitigate service delivery barriers and leverage drivers & sustainability and adoption of innovative approaches. This phase will be fully informed by the first two phases.

 

1. Develop key documentation outputs:

1. Four (4) human interest stories on barriers and drivers to accessibility and utilization of nutrition services and innovative approaches/best practices
2. A technical report on implementation processes; barriers and drivers of behaviour change; provision, access and utilization of nutrition services; innovative approaches/best practices; key lessons learned and recommendations based on qualitative and quantitative research
3. A summary report capturing summary of findings, best practices, key lessons learned and recommendations
4. Policy brief based on technical/summary report findings
5. Video documentation (2) of integrated nutrition service delivery in camps and essential nutrition services deliveries in host community; and
6. One article for peer-review and ready for publication based on the technical report 

 

Key activities:

1. Develop an inception report with detailed workplan and methodology in consultation with dedicated Nutrition Specialist at UNICEF Bangladesh Country Office (BCO) and Nutrition Specialist in Cox’s Bazar
2. Desk review of the programme and relevant background documents, reports etc.
3. Develop qualitative and quantitative data collection tools, data collection plan and guidelines for collecting information from government counterpart, implementing partners, service providers, service recipients through Key Informant Interviews (KI), Focus Group Discussions (FGD), observations checklist, interview with structured/semi-structured questionnaires
4. Review relevant documents (monitoring reports, inventories, registers etc.) and collect quantitative and qualitative information on nutrition services from service providers and service recipients (pregnant and lactating women, children of under 5 years, adolescents etc.). Information collection not only limited to,
5.  
6.  

- quality of delivered nutrition services, training, supervision & reporting

- accessibility to the critical nutrition services in camp and host community

- competencies and KAP of the service providers and supervisors

- KAP, perception and satisfaction of the service receivers

1. Analyse the primary and secondary information in the context of camp and host community, COVID-19 pandemic and pre project phase (based on the data availability) and project implementation phase
2. Develop final report including findings of the quantitative and qualitative assessment on implementation processes; barriers and drivers of behaviour change; provision, access and utilization of nutrition services; innovative approaches/best practices; lessons learned and strategic recommendations
3. Develop knowledge management products including policy brief, human interest stories, videos, journal article, reports etc. on nutrition response and lessons learned in the context of humanitarian-development setting
4. Develop strategic and high-level nutrition advocacy messages out of the knowledge management products critical for influencing policies to enhance efficiency in nutrition programming

 

4. Deliverables

Tasks

End Product

Duration

Tentative Deadline

1. Prepare inception report and detailed workplan 

Inception report including background, objectives, detailed methodology, detailed work plan with activities, deliverables, & timelines, risks assumption and mitigation plan

2 weeks after signing contract

15 August 2023

 

1. Conduct desk review of programme, relevant background documents, reports, and policies

Desk review report of programme, relevant background documents, reports and policies including Background, Objectives, detailed Methodology and Findings

2 weeks

31 August 2023

Process documentation

1. Develop and share draft data collection tools (structured, semi-structured, guidelines etc.), data collection plan for feedback

Draft data collection tools, data collection plan

1 weeks

07 September 2023

 

1. Finalize data collection tools, and data collection plan

Finalized information collection tools, and data collection plan

1 week

15 September 2023 (1st payment)

1. Hold monthly update meetings with UNICEF project team

Meeting minutes

2 days after the monthly meetings

Every month/ as necessary

1. Monitor and collect information (data collection period 3 months); report monthly progress of data collection

Qualitative and quantitative information collection progress reports (monthly)

8 weeks

15 November 2023

Development of key documentation outputs

1. Produce 1st draft of the technical report and summary report and share with UNICEF

Draft technical report and summary report

5 weeks

22 December 2023 (2nd payment)

1. Finalize the report after incorporation of comments and share with final data set and analysis

Final Report (soft and printed copy) with final data set and analysis

1 week

31 December 2023

 

1. Develop and share draft policy briefs, human interest stories, videos and share for review

Draft knowledge management products:

1. Policy brief 1
2. Human interesting stories 4
3. Video documentation

4 weeks

31 January 2024

 

1. Finalize policy briefs, human interest stories, videos, practical guidance documentation, after incorporation of feedback from UNICEF

Final key documentation products policy briefs, human interest stories, videos

1 week

07 February 2024 (3rd payment)

 

1. Prepare presentation materials and conduct final report sharing workshops (national level and Cox’s Bazar)

Final presentations and workshop report

1 week

15 February 2024

1. Draft one journal article for peer review and share

Draft journal article ready for peer review

6 weeks

22 February 2024

 

1. Revise the journal article for peer review as per feedback

One journal article ready for peer review

1 week

 28 February 2024 (4th payment)

 

 

Ethical and other considerations:

 

This study will be held to the highest standards employed by UNICEF. It is expected that the proposal will include a section on the expected ethical challenges and issues that the study will need to overcome, as well as a description of ethical safeguards for participants. The institution/consultant will also be responsible for getting IRB ethical clearance. IRB ethical clearance is needed before data collection, and the proposal should include a clause on how to deal with interviewing children and adolescent boys and girls, if that is proposed, as well as how to collect data effectively and safely in the time of COVID-19. The IRB approval letter will need to be attached in the annexure of the final report. The proposal will need to spell out how the UNICEF Procedure for Ethical Standards in Research, Evaluation, Data Collection and Analysis, the UNICEF Procedures for Ethical Research Involving Children (if speaking with 0-17 year olds), and UNICEF Strategic Guidance Note on Institutionalizing Ethical Practice for UNICEF Research will be followed/met, rather than only mentioning that the study will abide by them.

 

Any sensitive issues or ethical concerns arising during implementation should be raised with UNICEF right away. All data collected through this study as well as reports and dissemination materials are the intellectual properties of UNICEF and shall not be used for purposes other than those approved by the registered Institutional Review Board during the ethical clearance. Additionally, the study should be human rights-based (including child rights) and gender sensitive. All applicable data will be narratively written to provide any distinctions by sex, age, and disability status.

 

5. Reporting requirements

 

Submission of,

• inception report with detailed workplan and final data collection tools (quantitative and qualitative) and plan within 2 weeks of signing the contract
• meeting minutes within 2 days after monthly progress meetings conducted
• monthly data collection progress report during the data collection phase
• draft report and knowledge management products within 5 weeks of completion of data collection
• soft (PDF & MS Word) and hard copy of final report within 1 weeks of receipt of comments by UNICEF team
• printed report with data set and analysis, final version of the knowledge management products e.g. policy brief, videos etc. (both soft and hard copies) within 1 week of final report submission

 

Reports have to adhere to the following format:

• Table of contents, list of annexes/figures/tables, etc.
• List of Acronyms
• Executive Summary (5 pages)
• Introduction & Background including Objectives
• Methodology, including Limitations and Ethical Considerations
• Findings
• Conclusions & Lessons learned
• Recommendations

• References

 

6. Payment Schedule

• 20% upon submission of inception report with detailed workplan and final data collection tools (quantitative and qualitative) and plan
• 30% upon submission of draft technical and summary process documentation report
• 20% upon submission of final key documentation outputs
• 30% upon submission of journal article ready for peer review approved by the technical supervisor

 

7. Qualification requirement of the institution/organization and proposed team

Institution/organization level:

• At least 5 years demonstrable institutional experience in research/monitoring/ documentation/evaluation of health and/or nutrition specific programmes
• The organization (local/international) should be registered and licensed to provide required services
• The institution/organization should have implemented at least three assignments of similar nature in the field of nutrition specific interventions and/or health and nutrition service delivery systems monitoring, evaluation or documentation with organizations/companies of similar magnitude and complexity
• Experience of working with UNICEF/UN programming will be an asset
• Technical publications in areas related to the activities of this TOR are highly desirable

 

Team competencies:

Team leader/team members should have,

• Educational background in the field of nutrition, public health etc.
• Have proven knowledge and experience of the nutrition-related policies and programmes of Bangladesh
• Demonstrated experience in conducting both quantitative and qualitative studies
• Strong experience in designing/ management/ implementation/ monitoring of development programmes or research or evaluation study in the context of Bangladesh
• Experience in assessing quality of health and nutrition service delivery in a humanitarian-development nexus setting, preferably in Cox’s Bazar
• Knowledge of programming principles e.g. gender equality and Results Based Management (RBM) Excellent written and oral communication skills in English; proficiency of data collectors and field supervisors in local language of the study area would be an asset

 

Please note that Individual Consultants are not eligible to apply for this request for proposals (RFP)