Maternal Nutrition/IYCF/ECD Counselling Review in ESA Region

Contract

This is a Consultancy contract. More about Consultancy contracts.

UNICEF works in some of the world’s toughest places, to reach the world’s most disadvantaged children. To save their lives. To defend their rights. To help them fulfill their potential.

Across 190 countries and territories, we work for every child, everywhere, every day, to build a better world for everyone.

And we never give up.

TERMS OF REFERENCE

Background and Justification

The maternal, infant and young child nutrition situation in a number of countries in the Eastern and Southern Africa region (ESAR) has been improving over time, but further progress is needed to address all forms of malnutrition—undernutrition, overweight/ obesity, micronutrient deficiencies—in order to achieve the global SDG nutrition and health targets. The quality of young child diets also remains very poor, with only one in ten children aged 6-23 months in ESAR receiving a minimum acceptable diet. In Sub-Saharan Africa, 66% of under 5 children are at risk of poor developmental outcomes - far too few children are thriving because of poor health, inadequate nutrition, exposure to stress, a lack of early stimulation, and limited opportunities for early learning. They are not thriving in the crucial first 1,000 days when the foundations for healthy, lifelong physical growth and mental development are laid.

Scaling up interventions to improve key direct determinants of malnutrition and poor child development outcomes- with a focus on the “1000 days” period during pregnancy and the first two year’s of a child’s life - including maternal and infant and young child feeding (IYCF) practices and behaviors, responsive caregiving and stimulation, are essential to accelerate progress. The provision of skilled, quality infant and young child feeding counselling is critical to improving breastfeeding rates, the quality of complementary feeding practices and responsive caregiving/stimulation. The provision of counselling on breastfeeding to mothers and other family members by community health workers, peer-to-peer counsellors, nurses, midwives, lactation counsellors, or other health providers, can increase exclusive breastfeeding significantly. Full integration of these interventions into the health and community systems and ensuring quality of care in their provision is crucial for achieving progress on national and global nutrition targets.

The 2013 “WHO guidance on counselling for maternal and new-born health care: a handbook for building skills” lays out a framework for counselling for maternal and new-born health (see Figure 1). Several nutrition global guidelines define the expected maternal and IYCF counselling services and competencies of staff and they include the 2016 “WHO recommendations on antenatal care for a positive pregnancy experience” (WHO, 2016a), the 2018 “WHO guidelines on counselling of women to improve breastfeeding practices” (WHO, 2018), the 2020 “UNICEF programme guidance on improving young children’s diets during the complementary feeding period” (UNICEF, 2020). and the 2021 UNICEF-WHO “Implementation guidance on counselling women to improve breastfeeding practices (UNICEF 2021). To further improve responsive caregiving and stimulation, UNICEF and WHO, with partners, developed and rolled-out Care for Child Development and Caring for the Caregiver interventions. The Care for Child Development (CCD) Intervention provides tools for counseling families on play and communication activities to stimulate the child’s learning and to strengthen caregiving skills and the interaction between caregivers and their children. The Caring for Caregiver (CFC) interventions is designed to promote caregiver’s mental health and emotional wellbeing, encouraging self-care, partner and family engagement, and problem-solving barriers to resources.

To ensure provision of quality IYCF counselling to mothers and caregivers, in 2010 UNICEF published an IYCF counseling package[1] targeting frontline health workers and community cadres to build their capacity on providing counselling to mothers and caregivers. In 2012 the second edition of the package integrated key content on early childhood development (ECD). The package is currently undergoing a further updating to enhance the ECD content further, add a more substantive reflection of overweight prevention and make various other updates. Some countries were early adopters of the first edition of this package and others the second edition, while some of the early adopters also added additional elements such as ECD later on. The extent to which the ECD elements are effectively integrated and well-implemented is not known.

Achieving universal access to quality counselling services requires more explicit attention to how health systems function. UNICEF acknowledges that a health-systems strengthening (HSS) focus is imperative in the post-2015 context, and even more so in the (post) COVID-19 context. UNICEF defines HSS as actions that establish sustained improvements in the provision, utilization, quality and efficiency of services delivered through the health system, and encourage the adoption of healthy behaviours and practices. These actions may also influence the health system context, including key performance drivers such as policies that impact on health in all sectors, governance, financing human resource capacity for implementation, supplies, service delivery models and platforms, and information systems. They also implicitly improve health and nutrition security by strengthening the system’s resilience and its preparedness to respond efficiently and effectively in the context of emergencies. The figure below displays how IYCF can be incorporated in the 6 health systems building blocks.

UNICEF’s HSS approach includes activities appropriate to the three major functional levels of health systems (community, sub-national and national) in different contexts, enabling the promotion of good health, delivery of essential interventions to all children and women, accountability, and achievement of equitable outcomes.

Despite the heavy investment by UNICEF country offices and other partners to train health workers and community cadres to deliver IYCF counselling, the service of IYCF/ECD counselling is not well integrated in the health system building blocks and is often not delivered as a routine essential service at scale in many countries in the region. It often still depends on external funding and is delivered in selected areas only, and sometimes only for the duration of a funding cycle. Despite existing evidence on the cost effectiveness of IYCF/ECD counselling, the service is not reflected in health policies, strategies and standards, has no budget allocation and minimal efforts have been done to integrate it in pre- and in-service trainings for health workers. Furthermore, IYCF/ECD counselling is not included in the essential package for continuum of care and there is no standard definition, recording and reporting. Often countries report existence of an IYCF programme linking to the number of trainings conducted. There are also issues with the quality of services. Monitoring of delivery of IYCF/ECD counselling is weak and coverage of IYCF/ECD services is difficult to assess: in many countries, counseling and education or messaging are lumped together without the possibility to disaggregate or to discern whether a mother/caregiver has been counseled or reached with messages multiple times. No country is able to follow a single mother/child pair longitudinally to assess whether the minimum number of counseling contacts from pregnancy through to the second year have been received.

Against this background, the nutrition and ECD sections in UNICEF ESARO propose to issue a consultancy to understand how maternal nutrition and IYCF/ECD counselling, focusing on the 1000 days period, is integrated in the building blocks of health systems in selected countries of the region and is being delivered at both health facility and community levels. A comprehensive understanding of the health system bottlenecks and enablers to fully integrate and deliver quality maternal nutrition and IYCF/ECD counselling services at facility and community level is essential in order to identify and prioritize context specific barriers and enabling factors to inform the design of evidence-based policies and programmes to deliver skilled counselling support and nutrition and ECD education that is fully integrated within all building blocks of the health system. The findings will help to guide countries to better integrate maternal nutrition/IYCF/ECD counseling in the building blocks of the health system and exploring possibilities of institutionalizing in other systems outside the health sector, e.g. ECD and child care centres that include children less than two years old.

Scope of work

Goal and objective: To understand how maternal nutrition/IYCF/ECD counselling is integrated in the building blocks of health systems in selected countries of the region and is being delivered at both health facility and community levels. A comprehensive understanding of the health system bottlenecks and enablers to fully integrate and deliver quality maternal nutrition and IYCF/ECD counselling services at facility and community level will be obtained in order to identify and prioritize context specific barriers and enabling factors to inform the design of evidence-based policies and programmes to deliver skilled counselling support and nutrition and ECD education that is fully integrated within all building blocks of the health system. The findings will help to guide countries to better integrate maternal nutrition/IYCF/ECD counseling in the building blocks of the health system. A two-tier assessment is proposed: a multi-country scoping (in the 15 ESAR countries using the package), and a deep dive in four countries (to be decided in the inception phase of the consultancy).

Provide details/reference to AWP areas covered: Nutrition Workplan: “Technical support and oversight is provided to ESA countries in scaling up optimal MIYCN & MN deficiency prevention and control in all contexts”. Contracts plan: *“**A review of systems structures for IYCF counselling to inform better institutionalization”*

Activities and Tasks:

The activities will have two main strands: a multi-country systems-focused desk review, survey and key informant interviews (1-3), and a deep dive in 4 selected countries, followed by a facilitated stakeholder consultation (4-5). The tools for the survey, deep dive and the approach to undertaking the stakeholder consultation will be written up as tools/guides that other countries can also use.

1. Multi-country desk review and mapping of relevant policies, strategies and guidelines:

Information will be gathered through a descriptive review and mapping of relevant overarching nutrition and health sector policies, strategies, plans, guidelines and other documents at the national and sub-national level that contain maternal, IYCF and ECD counselling, with a particular focus on the integration of counselling in the 6 building blocks on health systems. This will also encompass review of published and grey literature and programme documents.

2. Online survey-The survey aims to fill in gaps in information on IYCF/ECD in the 6 building blocks identified from the desk review. The process of completing the survey will be two staged involving consultations and consensus building among IYCF and ECD technocrats in country and completion of the survey by UNICEF IYCF focal person.
3. Semi-structured interviews with key informants

Semi-structured interviews with key informants (technical experts and stakeholders) involved in maternal and IYCF policy making and programme implementation will be conducted to solicit views and provide an in-depth understanding on the barriers and enabling factors for integration of maternal/IYCF/ECD counselling across all health system pillars. The key informant interviews will also help validate information gathered through the policy document review and mapping and the online survey.

4. Deep dive in 4 selected countries

This will consist of more in-depth interviews and a purposive small sample of health facilities and communities to assess how counselling is integrated and delivered. Information on maternal/IYCF/ECD counselling services availability and service delivery readiness will be collected through a mixed methods approach involving both qualitative and quantitative data collection. A health facility assessment based on a purposive small sample of health facilities covering urban/rural/peri-urban, large/small facilities, and the range of contacts – e.g. ANC, PNC, well child, sick child, outreach, and inpatient and outpatient treatment of wasting, as well as community services, will be undertaken to assess service delivery readiness using a semi-structured questionnaire. Semi-structured interviews with key informants (perspectives of service providers and managers on service delivery and utilisation) will be conducted to inform the understanding of programme delivery environment for maternal/IYCF/ECD counselling.

5. Stakeholder consultation workshop

Facilitated discussion among technical experts and stakeholders can be instituted to identify underlying causes and appropriate actions to address the key bottlenecks/barriers and enablers to maternal and IYCF counselling across the health system pillars. The stakeholder validation workshops should involve a wide range of stakeholders working in the health system who have an influencing role on the integration and delivery of maternal, IYCF and ECD counselling services.

Development of 1 brief with overarching findings and recommendations for strengthening the institutionalization of maternal/IYCF/ECD counselling in all health system building blocks (all countries) and 4 country briefs with specific findings and recommendations for the 4 deep-dive countries. Slide decks and a synthesis report will also be prepared, as well as a draft peer-reviewed paper.

Table 1: Key areas of enquiry across health system functions for evaluating health-system bottlenecks affecting delivery of maternal nutrition and IYCF counselling services.

Output/Deliverables

Expected Outcomes:

Regional and country specific knowledge on the bottlenecks and enabling factors affecting integration of maternal nutrition, IYCF and ECD counselling services is generated. The findings of the assessments will feed into country level briefs and a workshop and report in the deep dive country that will identify practical solutions to health system bottlenecks to greater institutionalization of maternal nutrition/IYCF/ECD counseling.

Detailed output/deliverables will be shared with the shortlisted candidate (s).

Work relationships: the consultant will report to the Nutrition Specialist, in close collaboration with ECD Regional Adviser. The consultant will coordinate closely with UICEF country office Nutrition and ECD staff.

Payment Schedule

Payment shall be made on satisfactory completion of the deliverables, as detailed above, in 7 payments.

Desired competencies, technical background and experience

1. Education: An Advanced University Degree in Public Health Nutrition, Nutritional Epidemiology, International Health and Nutrition, Maternal and Child Nutrition, or other Nutrition-related science field including Early Childhood Development is required. *A first University Degree in a relevant field combined with 2 additional years of professional experience may be accepted in lieu of an Advanced University Degree.
2. A minimum of 8 years of relevant professional experience in public health/nutrition assessment, planning, management, health and nutrition systems strengthening, policy research at the international level, including in low and middle income countries;
3. Experience of IYCF and ECD counseling programmes an asset

4. Must exhibit UNICEF Core Values of:

5. Care

6. Respect
7. Integrity
8. Trust
9. Accountability

10. Sustainability

11. The Consultant must have the following competencies:

12. Work collaboratively with others

13. Thinks and acts strategically
14. Manages ambiguity and complexity
15. Drive to achieve results for impact
16. English both oral and written is a must and ability to read, analyze and interpret complex documents

Administrative issues

• The Consultant will be working remotely with potential travel to up to four countries (Kenya, Tanzania, Uganda and Mozambique) in the ESA region for which the UNICEF office would cover subsistence allowances and travel costs. The consultant is expected to complete the deeper dives within 10 days for each country.
• Consultant will need to make their own travel arrangements and will be reimbursed for travel costs and subsistence allowance in line with and limited to those payable by UNICEF.
• Monthly progress meetings will be scheduled throughout the contract duration.
• When requested, the Consultant should be available for scheduled meetings between 10 am to 4 pm Nairobi time.
• Selected candidates are subject to confirmation of fully vaccinated status against SARS-CoV-2 (Covid-19) with a World Health Organization (WHO)-endorsed vaccine, which must be met prior to taking up the assignment.
• The Consultant is solely responsible to ensure that the visa (applicable) and health insurance required to perform the duties of the contract are valid for the entire period of the contract.

Conditions

• The consultancy is based remotely. No office space or equipment will be provided from UNICEF and will be the sole responsibility of the consultant.
• The consultant is expected to use their own IT equipment (laptop, cell-phone etc.), where operating communication costs – long-distance calls, internet if any should be part of the overall quoted fees (no reimbursement will be applied).
• As per UNICEF DFAM policy, payment is made against approved deliverables. No advance payment is allowed unless in exceptional circumstances against bank guarantee, subject to a maximum of 30 per cent of the total contract value in cases where advance purchases, for example for supplies or travel, may be necessary.
• The candidate selected will be governed by and subject to UNICEF’s General Terms and Conditions for individual contracts.
• As per UNICEF DFAM policy, payment is made against approved deliverables. No advance payment is allowed unless in exceptional circumstances against bank guarantee, subject to a maximum of 30 per cent of the total contract value in cases where advance purchases, for example for supplies or travel, may be necessary”.
• Individuals engaged under a consultancy or individual contract will not be considered “staff members” under the Staff Regulations and Rules of the United Nations and UNICEF’s policies and procedures and will not be entitled to benefits provided therein (such as leave entitlements and medical insurance coverage). Their conditions of service will be governed by their contract and the General Conditions of Contracts for the Services of Consultants and Individual Contractors. Consultants and individual contractors are responsible for determining their tax liabilities and for the payment of any taxes and/or duties, in accordance with local or other applicable laws

Risks

• Risks include a delay in progress of the work due to country level instabilities like elections or changes in political situation that can impact on decision making of policy makers, or simply a lack of responses from countries. To avoid any foreseen and unforeseen delays, this will be mitigated having regular check in calls with targeted countries to monitor progress of the consultancy and to ensure the country offices have adequately consulted with Government.

How to apply

Interested candidates should apply online using the button below. As part of their application, candidates should provide: 1. A cover letter that specifies how you meet the desired competencies, technical background and experience (no more than 3 pages) 2. A short CV (no more than 4 pages) 3. Interested candidates to indicate availability and daily rate expressed in USD to undertake the terms of reference. Applications submitted without a fee/rate will not be considered. 4. Three (3) Referees.

UNICEF is committed to diversity and inclusion within its workforce and encourages qualified female and male candidates from all national, religious and ethnic backgrounds, including persons living with disabilities, to apply to become a part of the organization.

UNICEF has a zero-tolerance policy on conduct that is incompatible with the aims and objectives of the United Nations and UNICEF, including sexual exploitation and abuse, sexual harassment, abuse of authority and discrimination. UNICEF also adheres to strict child safeguarding principles. All selected candidates will be expected to adhere to these standards and principles and will therefore undergo rigorous reference and background checks. Background checks will include the verification of academic credential(s) and employment history. Selected candidates may be required to provide additional information to conduct a background check.