United Nations Children s Fund (UNICEF)

Transcription

1 United Nations Children s Fund (UNICEF) Phnom Penh, Cambodia Individual Consultancy: Technical support for a landscape analysis of complementary feeding and maternal nutrition in Cambodia Terms of Reference 1. Background The UNICEF, WHO, World Bank joint global and regional child malnutrition estimates from 1990 to 2017 reveal uneven and insufficient progress to reach the World Health Assembly (WHA) targets set for 2025 and the Sustainable Development Goals set for 2030 for nutrition. Childhood undernutrition remains a major health problem in resource-poor settings. Approximately one in four children less than five years of age in Southeast Asian countries is stunted (low height-for-age), this translates to 15 million stunted children. It is well-recognized that the period from conception to two years of age is the critical window for the promotion of optimal growth, health, and development. Evidence shows that the largest proportion of stunting in low and middle-income countries occurs during two time periods: during gestation and during the complementary feeding period of 6-23 months of age which is a transition time from exclusive breastfeeding to consuming a wide range of family foods with continued breastfeeding. In Southeast Asia, poor maternal nutrition is linked to adverse outcomes for both the mother and her baby. Maternal height and body mass index are strong predictors of low birth weight and wasting and stunting in early childhood. Maternal anemia, especially in its severe form, is strongly linked to maternal mortality and accounts for 12 percent of low birth weight, 19 percent of pre-term births and 18 percent of perinatal mortality. Of the eleven Southeast Asian countries, none are on track to meet the WHA target to reduce anemia in women of reproductive age, none are on track for the wasting target, and while five countries are making some progress towards the stunting target, none are on track. Improved nutrition status of pregnant women and improved feeding of children under two years of age is particularly important because children during the first 1000 days experience rapid growth and development, they are vulnerable to illness, and there is evidence that feeding practices and maternal nutrition status is poor in most low and middle income countries. There are global guidelines available to guide the development of national policies and programmes for both maternal nutrition and complementary feeding. The nine essential principles of complementary feeding from the 2001 FAO/WHO Guiding Principles for Complementary Feeding of the Breastfed Child and the 2005 FAO/WHO Guiding Principles for Complementary Feeding of the Non-Breastfed Child are summarized in Annex 1. These guiding principles were intended to guide policy and programme development at a global, regional and national development. In November 2016, the World Health Organization (WHO) released Recommendations on antenatal care for a positive pregnancy experience, including s on nutrition interventions (see Annex 2). These new guidelines present a renewed opportunity to intensify efforts on maternal health and nutrition. In addition to these s, antenatal care provides a platform to support the intent to initiate breastfeeding immediately after delivery and to exclusively breastfeed for the first six months of life. 1

2 In 2019, UNICEF and its partners are planning to convene two regional consultations on complementary feeding and maternal nutrition policies and practices. The consultations seek to shine a spotlight on complementary feeding and maternal nutrition issues globally and in ASEAN countries and to identify actions to accelerate improvements at scale within the context of ongoing multi-sectoral actions to improve nutrition across the region. In preparation for these meetings, there is a need to understand the status of the complementary feeding and maternal nutrition policy and programming landscape in core ASEAN countries. This information will guide country governments and development partners to understand the complementary feeding and maternal nutrition landscape in the greater region, and to identify gaps and barriers in the policy and programme landscape where accelerated action is needed. Findings from the landscape analyses will be used to support the modeling of improved approaches and innovations, replication, institutionalization and scale up of key maternal and child nutrition interventions with a focus on complementary feeding and maternal nutrition. This consultancy is part of a regional effort to support the systematic collection, appraisal, mapping and synthesis of the complementary feeding and maternal nutrition stakeholder, policy and programming landscape in each of the six core ASEAN countries (Cambodia, Indonesia, Laos PDR, Philippines, Myanmar, Vietnam). The country-specific consultant will lead data collection and analysis efforts at the country level and a regional consultant will support the data collection and analysis process, lead the development of country level briefs and consolidate and review country findings for a broader ASEAN perspective. 2. Purpose UNICEF Cambodia Office is seeking an individual consultant to support the implementation and documentation of landscape analyses for complementary feeding and maternal nutrition. 3. Work Assignments a) Review standardized landscape analysis methodology and finalize workplan. b) Conduct a stakeholder mapping exercise for both complementary feeding and maternal nutrition and document the findings. c) Consolidate relevant documents from a desk review, questionnaires to stakeholders and key informant interviews to determine the current status and trends of indicators, policies and programmes on complementary feeding and maternal nutrition at the national level. Along with a regional consultant modify a bottleneck questionnaire to send to organizations identified in the stakeholder mapping exercise, introduce the landscape analysis and requesting documents on complementary feeding and maternal nutrition policies, practices and programmes. Through on-line searches of public documents and through documents sources from the questionnaire, consolidate soft copies of the following documents on complementary feeding: - Policies, strategies, plans and programme guidance - Advocacy and communication materials 2

3 - Training materials - Monitoring, recording and reporting formats (e.g. HMIS) - Data/information on programme coverage - Any reports, analysis or other documents on system gaps (supplies, training etc.) - Any other identified relevant information For key stakeholders identified in the mapping exercise, conduct key informant interviews by phone/skype or in person to seek clarification on gaps in data and information and to gain insights into system bottlenecks. Key informant interviews may include government, development partners, academic/research institutions and others, as required). Multi-sectoral partners should be included in key informant interviews. - Develop the script for key informant interviews with support provide by the regional consultant. - Organize notes into regional data management files from key informant interviews to incorporate into the larger literature review. d) Based on information collected from the literature review and key informant interviews, and with support from the regional consultant, analyze data to develop with the following: Provide data to the regional consultant on the current situation and trends of complementary feeding indicators and influencing variables as listed in the landscape analysis methodology Complete a policy matrix to map the availability and quality of complementary feeding policies using national level data Complete a programme implementation matrix to map the types of complementary feeding programmes in place, their quality and their outcomes. e) With UNICEF and key partners, and with support from the regional consultant, review the findings from the landscape analysis and prioritize key barriers and gaps in complementary feeding. Based on feedback from discussions, finalize the influence framework to map the prioritized gaps and barriers by their level of influence. f) Provide guidance to the regional consultant for the development of a country synthesis brief presenting the major findings and key s from the landscape analysis. 4. Qualifications or Specialized Knowledge/Experience Required Qualifications and Experience A) 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 is required. B) Work Experience: 3

4 A minimum of 8 years of relevant professional experience in public health/nutrition planning, management, policy research at the international level, including in low and middle-income countries Experience in nutrition and public health policy and programming Proven experience in conducting policy and programing landscape analyses, analyzing and synthesizing policy and programme information, and in conducting literature reviews on health and nutrition is a major asset. Knowledge of IYCF policy and programme landscape is an asset. Expertise in Infant and Young Child Feeding is an asset. Competencies Excellent communication skills Excellent organizational skills Demonstrable analytical and research skills, review and synthesis of data and information Languages Excellent oral and written English skills are required. 5. Location The assignment will be implemented only in Phnom Penh, Cambodia 6. Duration The assignment should take place between 22 nd of October 2018 and 15 th of February Deliverables Deliverables No. of Days Target Date* 1. Implemented stakeholder mapping for complementary feeding and maternal 2 October 31th nutrition 2. Modify stakeholder bottleneck questionnaire and disseminate to identified organizations 2 November 15 th and individuals 3. Conduct a desk review of published materials and non-published materials obtained from the questionnaires with 20 November 30 th organization of materials for analysis 4. Conduct KII s as needed with stakeholders with inclusion of notes into the desk review 10 December 15 th 5. With the regional consultant, conduct analysis of gathered materials and finalize the policy matrix, programme matrix and 20 January 15 th lead the stakeholder review for the influence framework. 6. Support the regional consultant in the development of the country synthesis brief 6 February 15 th 4

5 summarizing the landscape for CF and the key s for the landscape analysis. Total 60 days 8. Reporting Requirements As described in the payment schedule (section 9), the consultant would have to submit: - The literature review report - Interview reports - Policies matrix - Program matrix - Influence framework 9. Payment Schedule linked to deliverables Deliverables 1. Deliverable 1 and 2: stakeholder mapping and modified questionnaire submitted 2. Deliverable 3 and 4: Desk review (see regional template submitted) submitted with the comments of the stakeholders 3. Deliverable 5 and 6: policy matrix, programme matrix, influence framework submitted (see template from regional office) Amount (in USD) 40% 20% 40% * The fees shall be calculated based on the days estimated to complete the assignment in the Terms of Reference and shall be considered the maximum compensation as part of a lump sum contract and agreed on a work plan for submission of deliverables. No additional fees shall be paid to complete the assignment. Payment will be made upon delivery of all final products and full and satisfactory completion of the assignment. 10. Administrative Issues The Consultant will have an office desk, and will use UNICEF resources and facilities such as UNICEF laptop, access to printer and office space. 11. Contract supervisor Nutrition Specialist, UNICEF Cambodia 12. Penalties for underperformance Payment of fees to the Contractor under this contractor, including each instalment or periodic payment (if any), is subject to the Contractor s full and complete performance of his or her obligations under this Contract with regard to such payment to UNICEF s satisfaction, and UNICEF s certification to that effect. 5

6 Performance indicators: Consultants performance will be evaluated against the following criteria: timeliness, quality, and relevance/feasibility of s for UNICEF Cambodia. 13. Termination of contract This Contract may be terminated by either party before its specified termination date by giving notice in writing to the other party. The period of notice shall be five (5) business days (in the UNICEF office engaging the Contractor) in the case of contracts for a total period of less than two (2) months and fourteen (14) business days (in the UNICEF office engaging the Contractor) in the case of contracts for a longer period; provided however that in the event of termination on the grounds of impropriety or other misconduct by the Contractor (including but not limited to breach by the Contractor of relevant UNICEF policies, procedures, and administrative instructions), UNICEF shall be entitled to terminate the Contract without notice. 14. Submission of applications Interested candidates are kindly requested to apply and upload the following documents to: Letter of Interest (cover letter) CV or Resume Performance evaluation reports or references of similar consultancy assignments (if available) Financial proposal: All-inclusive lump-sum cost including travel and accommodation cost for this assignment as per work assignment. 15. Assessment Criteria A two-stage procedure shall be utilized in evaluating proposals, with evaluation of the technical proposal being completed prior to any price proposal being compared. Applications shall therefore contain the following required documentation: 1. Technical Proposal, including a cover letter, updated CV, and copies of 2 relevant evaluations performed earlier by the consultant. 2. Financial Proposal: Lump-sum offer with the cost breakdown: Consultancy fee, travel costs (economy class), per-diem to cover lodging, meals, and any other cost related to the consultant's stay in Phnom Penh, including transportation inside the city and other costs. The travel (if involved) shall be based on the most direct and economy fare. No financial information should be contained in the technical proposal. For evaluation and selection method, the Cumulative Analysis Method (weight combined score method) shall be used for this recruitment: a) Technical Qualification (max. 100 points) weight 70 % Degree Education in Public Health Nutrition, Nutritional Epidemiology, International Health and Nutrition, Maternal and Child Nutrition, or other nutritionrelated science field (20 points) Knowledge of IYCF policy and programme landscape is an asset (30 points) Expertise in nutrition and public health policy and programming (30 points) Experience in conducting policy and programing landscape analyses, analyzing and synthesizing policy and programme information, and in conducting literature reviews on health and nutrition 20 points) 6

7 b) Financial Proposal (max. 100 points) weight 30 % The maximum number of points shall be allotted to the lowest Financial Proposal that is opened /evaluated and compared among those technical qualified candidates who have attained a minimum 70 points score in the technical evaluation. Other Financial Proposals will receive points in inverse proportion to the lowest price. The Contract shall be awarded to candidate obtaining the highest combined technical and financial scores, subject to the satisfactory result of the verification interview. 7

8 Annex 1: FAO/WHO Guiding Principles for Complementary Feeding of the Breastfed and Non-Breastfed Child 1. Duration of exclusive breastfeeding and age of introduction of complementary foods Practice exclusive breastfeeding from birth to six months of age and introduce complementary foods at six months of age (180 days) while continuing to breastfeed. 2. Maintenance of breastfeeding and fluid needs of non-breastfed children Continue frequent, on-demand breastfeeding until two years of age or beyond. Because breast milk is almost 90% water, infants and young children who are breastfed frequently generally receive plenty of fluids. However, non-breastfed children need to obtain fluids from other sources. Non-breastfed infants and young children need at least ml/d of extra fluids (in addition to the ml/d of water that is estimated to come from milk and other foods) in a temperate climate, and ml/d in a hot climate. Plain, clean (boiled, if necessary) water should be offered several times per day to ensure that the infant s thirst is satisfied. 3. Responsive feeding Practice responsive feeding, applying the principles of psycho-social care. Specifically: a) feed infants directly and assist older children when they feed themselves, being sensitive to their hunger and satiety cues; b) feed slowly and patiently, and encourage children to eat, but do not force them; c) if children refuse many foods, experiment with different food combinations, tastes, textures and methods of encouragement; d) minimize distractions during meals if the child loses interest easily; e) remember that feeding times are periods of learning and love - talk to children during feeding, with eye to eye contact. 4. Safe preparation and storage of complementary foods Practice good hygiene and proper food handling by a) washing caregivers and children s hands with soap (or a rubbing agent such as ash) before food preparation and eating, b) storing foods safely and serving foods immediately after preparation, c) using clean utensils to prepare and serve food, d) using clean cups and bowls when feeding children, and e) avoiding the use of feeding bottles, which are difficult to keep clean. 5. Amount of complementary food needed Start at six months of age with small amounts of food and increase the quantity as the child gets older, while maintaining frequent breastfeeding. In developing countries, complementary foods should provide infants whose breast milk intake is average with approximately 200 kcal per day at 6 8 months of age, 300 kcal per day at 9 11 months and 550 kcal per day at months of age. For non-breastfed infants and children these needs are approximately 600 kcal per day at 6-8 months of age, 700 kcal per day at 9-11 months of age, and 900 kcal per day at months of age. 6. Food consistency Gradually increase food consistency and variety as the infant gets older, adapting to the infant's requirements and abilities. Infants can eat pureed, mashed and semi-solid foods beginning at six months. By eight months most infants can also eat finger foods (snacks that can be eaten by children alone). By twelve months, most children can eat the same types of foods as consumed by the rest of the family (keeping in mind the need for nutrient-dense foods, as explained in #8 below). Avoid foods that may cause choking (i.e. items that have a 8

9 shape or consistency that may cause them to become lodged in the trachea, such as nuts, grapes or raw carrots). 7. Meal frequency and energy density Increase the number of times that the child is fed complementary foods as he/she gets older. The appropriate number of feedings depends on the energy density of the local foods and the usual amounts consumed at each feeding. For the average healthy breastfed infant, meals of complementary foods should be provided 2 3 times per day at 6 8 months of age and 3 4 times per day at 9 11 and months of age, with additional nutritious snacks (such as a piece of fruit or bread or chapatti with nut paste) offered once or twice a day, as desired. Snacks are defined as foods eaten between meals, usually self-fed, convenient and easy to prepare. If energy density or amount of food per meal is low, or the child is no longer breastfed, more frequent meals may be required. 8. Nutrient content of complementary foods Feed a variety of foods to ensure that nutrient needs are met. Meat, poultry, fish or eggs should be eaten daily, or as often as possible. Vegetarian diets cannot meet nutrient needs at this age unless nutrient supplements or fortified products are used (see #9 below). Fruits and vegetables rich in vitamin A should be eaten daily. Provide diets with adequate fat content. Avoid giving drinks with low nutrient value, such as tea, coffee and sugary drinks such as soda. Limit the amount of juice offered so as to avoid displacing more nutrient-rich foods. For nonbreastfed infants and children, if adequate amounts of other animal-source foods are consumed regularly, the amount of milk needed is ~ ml/d; otherwise, the amount of milk needed is ~ ml/d. 9. Use of vitamin mineral supplements or fortified products for infant and mother As needed, use fortified foods or vitamin-mineral supplements (preferably mixed with or fed with food) that contain iron (8-10 mg/d at 6-12 months, 5-7 mg/d at months). If adequate amounts of animal-source foods are not consumed, these fortified foods or supplements should also contain other micronutrients, particularly zinc, calcium and vitamin B12. In countries where vitamin A deficiency is prevalent or where the under-five mortality rate is over 50 per 1000, it is recommended that children 6-24 months old receive a high-dose vitamin A supplement (100,000 IU once for infants 6-12 months old and 200,000 IU biannually for young children months old). In some populations, breastfeeding mothers too may need vitamin mineral supplements or fortified products, both for their own health and to ensure normal concentrations of certain nutrients (particularly vitamins) in their breast milk [such products may also be beneficial for pre-pregnant and pregnant women]. 10. Feeding during and after illness Increase fluid intake during illness, including more frequent breastfeeding if breastfed, and encourage the child to eat soft, varied, appetizing, favorite foods. After illness, give food more often than usual and encourage the child to eat more. Annex 2: Summary of the list of WHO nutrition s on antenatal care. Dietary interventions Counselling about healthy eating and keeping physically active during pregnancy is recommended for pregnant women to stay healthy and to prevent excessive weight gain during pregnancy In undernourished populations, nutrition education on increasing daily energy and protein intake is recommended for Recommended 9

10 pregnant women to reduce the risk of low-birth-weight neonates. Iron and folic acid supplements Calcium supplements Vitamin A supplements Zinc supplements Restricting caffeine intake Anemia Preventative anthelminthic treatment In undernourished populations, balanced energy and protein dietary supplementation is recommended for pregnant women to reduce the risk of stillbirths and small-for-gestational-age neonates Daily oral iron and folic acid supplementation with 30 mg to 60 mg of elemental iron and 400 g (0.4 mg) of folic acid is recommended for pregnant women to prevent maternal anemia, puerperal sepsis, low birth weight, and preterm birth. Intermittent oral iron and folic acid supplementation with 120 mg of elemental iron and 2800 ug (2.8 mg) of folic acid once weekly is recommended for pregnant women to improve maternal and neonatal outcomes if daily iron is not acceptable due to side-effects, and in populations with an anemia prevalence among pregnant women of less than 20%. In populations with low dietary calcium intake, daily calcium supplementation ( g oral elemental calcium) is recommended for pregnant women to reduce the risk of preeclampsia. Vitamin A supplementation is only recommended for pregnant women in areas where vitamin A deficiency is a severe public health problem, to prevent night blindness Zinc supplementation for pregnant women is only recommended in the context of rigorous research. For pregnant women with high daily caffeine intake (more than 300 mg per day), lowering daily caffeine intake during pregnancy is recommended to reduce the risk of pregnancy loss and lowbirth-weight neonates. Full blood count testing is the recommended method for diagnosing anemia in pregnancy. In settings where full blood count testing is not available, on-site hemoglobin testing with a haemoglobinometer is recommended over the use of the hemoglobin color scale as a method for diagnosing anemia in pregnancy In endemic areas preventative anthelminthic treatment is recommended for pregnant women after the first trimester as part of worm infection reduction programmes. Recommended (research) 10