UNICEF Nepal Country Office (NCO) Terms of Reference National Consultancy for National Integrated Micronutrients Guideline Development and updating training package on Micronutrients (Vitamin A Deficiency, Iron Deficiency Anemia, Iodine Deficiency Disorders, and Zinc in management of diarrhoea) Duty Station: Kathmandu 1. Background and Justification for Consultant / Individual Contractor Contract Nepal is on the verge of meeting all micronutrient goal. In last 21 years, more than 90% children (out of 2.4 million children age 6-59 months) consistently received biannual vitamin A supplements while 80% of children 12-59 months have been de-wormed twice yearly since 2001; as a result Vitamin A deficiency is expected to be no more a public health problem at sub-clinical level. Similarly, household use of adequately iodized salt ( 15 ppm iodine) reached to 80% with improvement of Median Urinary Iodine Excretion up to 188 µg/ Liter in the population. Also, there is around 80% pregnant women in Nepal who are accessing Iron Folic Acid tablet with 58% compliance (90+ days) on its use; as a result the anemia prevalence has gone down to 48% in 2011. Besides, Nepal is moving with new micronutrient initiative such as Multi Micronutrient Supplementation to Children age 6-23 months to address the high level of anemia, ~70%, in this age group. Other dietary measures to promote micronutrient rich foods under the multi sector nutrition plan (MSNP) is in the process of implementation in more than 65 districts of Nepal with the support from UNICEF and other key development partners. However, there still remains policy gaps related to consolidated guideline on micronutrient supplementation for the reference of policy makers, program implementers, program managers, field workers and community volunteers, which is required for the further sustaining of the program. In addition, UNICEF is supporting Nepal Government to roll out the Multi Sector Nutrition Plan in 20 districts during the period from 2013 to 2017 with funding from the European Union. Micronutrient Promotion is one of the key nutrition actions included in the MSNP, using both complementary approaches of: micronutrient supplementation; and food-based approach involving support on production and consumption of micronutrient rich or diverse foods. It requires to develop a consolidated training package on the micronutrient from the health sector in order to include this into the health sector component of the MSNP training package, or MIYCN package, which is focusing on the first 1,000 days of life. In this regard, Child Health Division, MoHP is seeking for UNICEF s technical and financial assistance to develop the National Guideline on Micronutrients Deficiency Control and Health Sector Training Manual on Micronutrients, as central core component of the MIYCN package, as per the signed CPAP between UNICEF and Nepal Government and the approved 30 months rolling work plan. UNICEF Nepal entered into the 30 months rolling plan with DoHS/MoHP on 18 April, 2013 in order to provide technical and coordination support to the Nepal Government in piloting, maintaining/sustaining and scale up national micronutrient initiatives implement priority action on nutrition. One of the key activity underscored in the 30 months rolling plan is to maintain and strengthen national micronutrient program, which requires National Guideline on Micronutrients Deficiency Control for the intended users. Development of the National Micronutrients Guideline also requires an extensive knowledge and experience on Nepal s micronutrient program, followed by the skill of program documentation. Finally, development of these materials require a thorough understanding of the micronutrients situation and their key determining factors across the country, disaggregated
by gender and ethnicity and social and economic factors. To this end, UNICEF aims to strengthen the national level knowledge management and information system related to micronutrients by establishing a central repository of all the existing data and literature on this important topic. At this moment, UNICEF Nepal is supporting National Planning Commission to implement MSNP, where all three officers in the section, two nutrition specialist and one nutrition officer, are fully engaged with the NPC, Key Ministries and Central Bureau of Statistics. In addition, Nutrition officer in the section is also directly involved in activities related to donor proposal drafting, micronutrient program design and implementation and other supply planning related to nutrition. Similarly, Nutrition Section of Child Health Division has only two nutrition officers, having expertise in nutrition and data handling related to nutrition program. These two officers have to oversee the many nutrition programs that Nepal is implementing within the policy framework and concept of Scaling Up Nutrition (SUN) with a focus on the first 1000 days of life; Nepal is one of 51 early SUN riser countries. They are required thus to undertake frequent field travels to various part of country as well as to prepare for and facilitate nutrition review and monitoring meetings involving key stakeholders; thus, they have no time to work in concentration to develop the National Micronutrients Guideline and Health Sector Training Manual on Micronutrients, which will then be included in the comprehensive MIYCN package of the MoHP. Given that neither the UNICEF officers nor the Child Health Division officers can fully commit their time to draft the guideline and training package, external technical assistant to CHD is sought by the Nutrition Section of Child Health Division. Therefore, it is deemed necessary to acquire the support of an external consultant to support drafting and finalizing process of the above documents. A request letter in this regard is received from Child Health Division on date 02.05.2014. 2. Goal / Objective - Programme Group Result/Intermediate Result (PCR/IR) relevance The basic purpose of the consultancy is to provide technical assistance and coordination support in developing national micronutrients guideline, health sector training package on the micronutrients deficiency control and establishing central hub of health sector database at Nutrition Section Child Health Division. The proposed consultancy will contribute in PCR 2, IR 2.2 and activity 2.2.1.4 of 30 months rolling plan. The PCR 2 states, By 2017, in selected areas (the most disadvantaged districts and municipalities), social sector systems are providing integrated, quality services to fulfill the survival, development, protection and participation rights of children, adolescents and women with equity in all contexts, including humanitarian situations. Similarly, IR 2.2 states By 2017, access to and utilization of essential nutrition services increased targeting newborn, infant, young children, adolescents, pregnant and lactating women, including those with disabilities and HIV. The activity 2.2.1.4 under the IR states, Technical and coordination support to maintain and strengthen national micronutrient programs (VAD, IDD, IDA, and zinc in management of diarrhea). The proposed activity is relevant to the PCR 2, IR 2.2 and activity plan since it contributes in the maintaining and strengthening national micronutrient program by providing technical guidelines on micronutrient supplementation, training material for micronutrients and establishing the central database hub on micronutrients for providing further data input on the multi sector nutrition plan and action. 3. Specific Tasks Under the direct supervision of the Nutrition Officer of UNICEF and overall guidance of the Chief, Nutrition Section, at UNICEF as well as the Child Health Division, the consultant will accomplish the following tasks
Support the revision of Vitamin A Supplementation (VAS) guideline for early expansion phase: Organize field visits in the first three VAS program model districts - Chitwan, Kavre and Jumla, facilitate discussions/ meeting, revise the Vitamin A Supplementation guideline for children age 6-11 months and assist in developing Vitamin A Action Plan to roll out the program in the early expansion districts, to reach hard to reach children (6-8 months) with Vitamin A supplementation (VAS) immediately after the children reach 6 months in 15 priority early expansion districts. Develop national guideline on integrated micronutrients deficiency control Collect and review all the technical documents and policy documents on micronutrients deficiency control including the WHO/UNICEF global recommendation and check national documents for its local adoption. Also, refer the micronutrient deficiency control guideline developed in other countries as reference document for developing Nepal s Micronutrients Guideline. Develop format of the micronutrient guideline, compile the information collected from the document review into a standard format and facilitate peer review process over the document for its finalization. Organize consultative meetings to update the micronutrients guideline. Incorporate the feedback/ comments and finalize the draft document for further endorsement from Ministry of Health and Population. Develop Health Sector Training material on Integrated Micronutrients Control: Review the existing training materials on micronutrient program and consolidates all the training materials in one including updated information on the micronutrient control including supplementation, fortification, improved diet, and public health measures. Organize consultative meetings, include feedback/ comments and finalize the draft training material for the further endorsement from Ministry of Health and Population. Establish and maintain, at the Nutrition Section, Child Health Division, central repository integrated micronutrient related information: Establishe the central data repository on micronutrients in Nutrition Section, Child Health Division and orient the focal staffs of Nutrition Section, Child Health Division on data handling and interpretation working together with the Chief, Planning and Monitoring Section of Child Health Division and Chief, Health Management and Information System (HMIS) of DoHS since there will be large number of data available in the Nutrition Section, Child Health Division with the expansion of multi sector nutrition plan in 20 districts. Methodology: The consultant will follow the methodology as stated below in accomplishing the mentioned tasks: a. Support revision and update of Vitamin A Supplementation Guideline for use in the early expansion phase (61 days): 1 September 2014-31 October, 2014 Organizes field visits in the first three VAS program model districts - Chitwan, Kavre and Jumla, facilitates discussion meeting, revises the Vitamin A Supplementation guideline for children age 6-11 months and assist in developing Vitamin A Action Plan in order to roll out the program in the early expansion districts, to reach the hard to reach children (6-8 months) with vitamin A supplementation (VAS), immediately after the children reach 6 months in the 15 priority early expansion districts. b. Desk review of the global and national documents on integrated micronutrients control (30 days): 1-30 November, 2014 The consultant will review technical documents and policy documents on micronutrients based on the WHO/ UNICEF global recommendation and checks the country documents for its local adoption. Also, the consultant will cite examples from other countries on the national documents related to micronutrient supplementation.
c. Drafting of the integrated micronutrients guideline ( 31 days ): 1-31 December, 2014 The consultant will draft micronutrients guideline based on review of global and national documents and examples of other countries, and through a consultative process involving the key members of the MOHP s NUTEC. d. Finalization of Integrated Micronutrients Guideline with consultative meetings and discussion (31 days): 1-31 January, 2015 The consultant will facilitate the peer review process on the micronutrients guideline. In this process, consultative meetings and discussions on the guideline will be organized. The consultant will incorporate all the feedback/ comments received from the participants of the consultative meeting and discussion program and finally submit it to Ministry of Health and Population for endorsement. e. Desk review of existing global and national training materials on integrated micronutrients control ( 28 days): 1-28 February, 2015 The consultant will review all exiting training materials on micronutrient program including the training materials of global reference. Then, these materials will be checked for relevancy in country context for effective messaging both in picture and text. If required, the consultant will test the materials and content in the nearby districts and develop a summary report on observation. f. Consolidation of integrated micronutrient training material in single training material on micronutrients ( 31 days): 1-31 March, 2015 Based on the review of the all training materials and field testing and observations, the consultant will consolidate final training materials on micronutrients. g. Finalization of training materials on integrated micronutrients control through consultative meetings and discussion ( 30 days ): 1-30 April, 2015 The consultant will facilitate the consultations and discussions on the new training material. The consultant will incorporate all the feedback/comments received from the participants of the consultative meeting and submit it to Ministry of Health and Population for endorsement. h. Development of central repository on the integrated micronutrient information (61 days): 01 May 2015 30 June, 2015 The revised Health Management and Information System (HMIS) have an array of information areas on Micronutrients (including in MNPs) and other areas of nutrition, which should be regularly updated, and analyzed to provide inputs to the nutrition section of both UNICEF and Child Health Division. The consultant, using existing sources of micronutrient related information, develops a central repository on micronutrient information and capacitates the nutrition focal officer of the Nutrition Section for its entry, analysis, interpretation and reporting in order to contribute from health sector in the Multi Section Nutrition Plan. In this process, the consultant will work to coordinate the planning section and HMIS to support developing the central repository.
Coordination: The consultant needs to coordinate with stakeholders within the Government, development partners and I/NGOs working for micronutrient deficiency prevention and control while developing guideline, training material and central repository on micronutrient under the overall guidance of Chief, Nutrition Section UNICEF and close consultation with the Nutrition Officer of UNICEF and Chief Nutrition Section of Child Health Division. Various stakeholders to coordinate with are suggested below: Child Health Division (CHD): Within the Ministry of Health and Population (MoHP), CHD (Nutrition Section) is the body responsible for prevention and control of micronutrient deficiency among children, adolescents and women of Nepal. The CHD/Nutrition Section has a technical advisory group represented in NUTEC, under which the working group and core working group have been formed for various thematic areas on micronutrient. The consultant will organize meetings with NUTEC s core group and workshop with the wider working group for micronutrient malnutrition to inform the committee members of progress and developments towards developing the guideline, training material and central repository. Health Information and Monitoring Section (HMIS)/ Planning and Monitoring Section (PMS) Child Health Division: During the establishment of Central Repository System on Nutrition Information, the consultant will work closely with the Planning and Monitoring Section (PMS) of Child Health Division and Health and Information and Monitoring Section (HMIS) in capacity building of the focal officers in the section to collect, compile, manage and interpret the nutrition related information. The consultant will also coordinate with the nutrition partners in bringing the information in the central repository system. UNICEF: UNICEF is one of the lead technical agencies supporting the MoHP s micronutrient deficiency prevention and control program. The agency is also providing lead support in the development and implementation of the Multi Sector Nutrition Plan The consultant needs to coordinate with UNICEF s Nutrition Section Chief and Nutrition Officer for their technical feedback/suggestion during the course of developing micronutrient guideline, training material and central repository on micronutrient information. Other partners: Several other donor partners such as WHO, Micronutrient Initiative (MI) and others NGOs like NTAG and maxpro, SUAAHARA are supporting Child Health Division, MoHP in developing training materials on micronutrient. They need to be consulted and also coordinated during consolidating training materials on micronutrient in one single document. 4. Duration of the contract: The total duration of the consultancy is 10 months from 1 August 2014 to 30 June 2015. 5. Deliverables: The schedule should include deadlines for completion of tasks and submission of deliverables. Payments should be linked to satisfactory deliverables. Description of Deliverables Target Delivery Date Revised and Updated Vitamin A Supplementation Guideline for use in early 30.10.2014 expansion phase National Integrated Micronutrient Control Guideline 31.01.2015 Health Sector Training material on Integrated Micronutrients Control 31.04.2015 Final Report including Central Repository Excel Software on Integrated 30.06.2015 Micronutrients Information
6. Working Conditions a) Location (Home-based/Office-based/other): Office Based, Nutrition Section, Child Health Division b) Logistic Requirements: UNICEF will provide logistic support (Meeting Hall, Projector, Stationaries, Printing of presentation materials) to organize meetings and workshops in close coordination with the Nutrition Section, Child Health Division. 7. Minimum Qualifications Required Education : Master degree in Public Health, Nutrition or related field Work Experience: A minimum of two years experience in the field of health and nutrition Special skills: Familiarity with the children, adolescent and maternal health and nutrition issues in Nepal, high skilled in technical paper documentation and nutrition related training material development, excellent communication and coordination skill, analyzing, negotiating, communication and advocacy skills, Good data analysis and database management skills, Good documentation and report writing skills and Fluency in English and Nepali List any special skills and/or knowledge required: Technical knowledge and skills on document drafting on nutrition, good skill on coordinating in health and nutrition program at the central level, knowledge of standard operation procedure in the MoHP/Nepal Government, Competencies: Good working relation with the National Planning Commission, Ministry of Health and Population, Development partners, I/NGOs and Research Organization, Technical knowledge on nutrition and communication for development, learning and researching to develop documents base on the global and national evidences. 8. Contract Supervision The national consultant will work under the direct supervision of the Nutrition Officer of UNICEF and overall guidance of the Chief, Nutrition Section, at UNICEF. At the Ministry of Health and Population, the consultant will work in close coordination with Chief, Nutrition Section/ Child Health Division and in consultation with NUTEC.