Coverage Expert Consultant Full-Time

Background and purpose of the assignment

Wasting in Mozambique affects a large number of the population. As per DHS 2011, in Mozambique, more than 260,000 children under five years of age, and 7 percent of women in reproductive age present signs of wasting. Therefore, already in 2010, the MoH has introduced a Protocol of Nutrition Rehabilitation (in Portuguese, PRN). The PRN defines the operations that health units must implement to rehabilitate children, adolescent and adults with signs of acute malnutrition. In 2017, a PRN-based task force led by the Department of Nutrition of the MoH, with support from its partners, started to develop a community-based version of the PRN (PRN-Com in Portuguese). PRN-Com is the closest version to what is globally called Community-based Management of Acute Malnutrition (CMAM).

Estimating the effectiveness of the PRN-Com is important and urgently needed. The Mozambican population resides mostly in rural areas. Health units are scarcely distributed on the territory. The Government has not implemented a policy requesting the population to settle around specific areas (roads, e.g.) to maximize the provision of basic service delivery (e.g: health, education, etc.). On the other hand, the capacity to support the health services outreach in rural communities living beyond 5 to 10 km from health facilities is challenged by limited financial, structural, logistic, human resources and programmatic capacities.

Therefore, it is not surprising to find some remote districts such like Milange, Nicoadala, Dondo e.g., respectively in the Central region Sofala and Zambézia province, with wasting prevalence (e.g. > 5 percent – SETSAN/IPC 2019 and 2018,) above the cut-offs suggesting the need for an emergency response (> 5 percent with aggravating factors, e.g. limited access to health services – source: Global Nutrition Cluster 2016).

Information on the actual percentage of the eligible population enrolled into the PRN programme (Coverage) is limited. Globally, it is recommended to estimate Coverage using primary-data collection, rather than secondary[1]. PRN Coverage can be measured at least using three methods (S3M, SLEAC and SQUEAC). Each one of them present distinctive pros and cons. SLEAC and SQUEAC have been used in Mozambique in Cabo Delgado in 2018.

Therefore, in Mozambique, even in the districts mentioned above, with moderate to high prevalence of wasting, and in the rest of the country, the information around PRN geographical coverage is scarce. Even with a secondary data approach, recent estimations of this sort (WFP 2019) suggest that districts reached 39 to 41 percent of coverage only, for children under five years of age. This is not encouraging because the expected global (Sphere) Standard is minimum 50 percent (rural areas). The same low Coverage estimation was reported also in districts benefitting from NGO’s support, and which would be supposed to reach, instead, a higher performance.

Furthermore, the available secondary data cannot offer information about the causal path for such a low coverage estimation. Therefore, pragmatic recommendations for improvements of PRN-Com programs are crippled.

Because of the reasons above, there is a great need to support the MoH, its provincial authorities and their field-based partners to introduce, estimate and, in the future, regularly monitor the PRN-Com program coverage. Therefore, WFP is looking for a Consultant with experience in capacity strengthening of Coverage surveys for PRN-Com programmes.

Vision

• Second time in Mozambique. Coverage estimation of the MoH PRN programme, using primary data, to identify in May 2020 programmatic bottle necks and recommendations for the way forward will be conducted in Sofala and Zambézia provinces, Mozambique in 2020. For this reason, at least in this current phase, it is proposed to offer MoH a refresher / in-depth around the benefits of undertaking primary data-based Coverage methods, while show-casing, at least some of them, in one or few districts in Mozambique.
• The future of Coverage. Mozambique hosts more than 150 districts, though. Therefore, the proposed approach, and the Consultancy should aim and assume that, in the future (not covered by this consultancy), (i) leveraging the lessons learnt from this second Coverage Survey, and (ii) with an adequate resource mobilization, the MoH, together with its partners, will implement PRN Coverage surveys on a far larger geographical scale (more districts).

Purpose

Therefore, the overall purpose of this consultancy is twofold:

• To refresh knowledge of the strategic Governmental Health Authorities and their partners (NGOs) on the concepts, relevance and the operational implications about Coverage Measurement of their community-based programme for management of acute malnutrition;
• To support the undertaking of a Coverage survey at least:
• In four (or more) district(s) which hosts a programme of Community-based Management of Acute Malnutrition supported by WFP (in Mozambique, this programme is called Protocol of Nutrition Rehabilitation / Community-based, or, abbreviated, PRN-Com)
• And in one (or more) district that does not (or partially) host the PRN-Com programme supported by WFP.

Where possible, the combination of the two (or more) districts in each of the above-mentioned provinces will allow to draw important recommendations to improve and up-scale PRN-Com programs, and about the effectiveness of the support from NGOs.

Consultancy beneficiaries

• Government Health Authorities. The Governmental Health Authorities to be capacitated in the estimation of Coverage, and using surveys collecting primary quantitative and qualitative information, will include (i) the Department of Nutrition at the Ministry of Health (MoH/DoNut) in Maputo, (ii) the National Bioethics Committee for Health (CNBS in Portuguese) also based in Maputo and its Provincial Branches (e.g. NIOP in Sofala and Zambézia province), and (iii) the Provincial Health Directorates (DPS in Portuguese).
• MoH field partners. In Sofala and Zambézia province, any DPS from other provinces, and NGO interested in being strengthened in PRN Coverage estimation will be invited to the training around methods. WFP and / or NGO will be supporting the DPS in implementing the Coverage Survey in the field. This will be under the direct supervision of the Consultant.

Objectives, activities and deliverables

More in detail, based on the two-fold purpose described above, four sets of objectives, activities and deliverables (and one optional) can be foreseen in this Consultancy.

1. Objective: The Revised coverage survey protocol answer to National Bioethical Committee for Health (CNBS) comments. Activity: To revise and adjust the survey protocol version that have been introduced to Bioethical Committee based on the technical CNBS comments. Deliverable: high level protocol describing the coverage methodology selected in two or more districts in Zambezia and Sofala provinces. Location: Remotely and Maputo.
2. Objective: Health Authorities, and its partners plan a Coverage survey. Activity: To train health authorities and its field-level partners in (i) planning, (ii) costing and (iii) conducting a survey (data collection, results analysis and reporting) to measure coverage of existing PRN-Com programs. Deliverables: Field Level Coverage Training Manual including power point presentations, data collection forms, and ToRs of stakeholders involved (DPS, NGOs, e.g.); applications and software for data collection and analysis (open source), risk analysis on data collection quality. Location: Province level only.
3. Objective: The quality of data and information collection is controlled and risks on quality are managed. Activity: to directly supervise the data and information collected during the first quarter of the survey, while strengthening the capacity of quality monitoring by key stakeholders. Deliverable: risk analysis and report, field monitoring report and recommendations about first days of data and information collection. Location: Province level only.
4. Objective: The MoH and the DPS(s) Authorities endorse the results and the recommendations of the Coverage survey. Activity: to support the stakeholder discussion around both the preliminary and definitive results of the survey, participating to their dissemination to the field-level authorities. Deliverable: final report on the Coverage Survey to be endorsed by the health authorities. Location: Maputo and provincial.
5. Objective (optional): The results of the Coverage Survey are published in a peer-reviewed scientific journal (knowledge management). Activity: to draft and/or comment on the manuscript. Deliverable: manuscript of the paper. Location: Remotely.

Duration of the consultancy

The duration of the consultancy will be 60 days. The number of days in the field will be agreed with WFP but not less than 25 days will be based in the field. The phases will match the objectives and the activities described above and will include at least:

• a. Inception mission – activity number 1).
• b. Training and quality assurance mission – activities number 2) and 3).
• c. Result discussion and dissemination mission – activity number 4).

Supervision

WFP Nutrition Emergency Coordinator of Maputo Country Office will directly be supervising the Consultants, with inputs from the WFP Nutrition Monitoring and Evaluation, and once in the field, from the WFP Head of the provincial Sub-Office and WFP Nutrition Emergency Coordinator assistant. One of the consultants will lead the process and will be accountable for deliverables of both surveys.

Desired expereinces

1. Having worked previously for WFP – existence of WFP vendor.
2. 5+ years’ experience working with Coverage surveys.
3. Published papers on peer-reviewed journals, possibly on coverage-related topics.

Qualifications & experience required

Education:

• Advanced University degree in a relevant field, or First University degree with additional years of relevant work experience and/or training/courses.

Experience:

• Typically, 3-5 years’ experience with Coverage surveys;
• Past experience in training, implementing and /or supervising the implementation of Coverage Surveys using methods such as SQUEAC, SLEAC, and/or S3M in a number of countries and settings;
• 6-7 years’ experience on leading nutrition related programme activity and / or nutrition survey rapid screening, SMART survey etc;
• Leadership, working on team with another consultant

Knowledge & Skills:

• Capacity to work with limited supervision
• Team spirit and leadership capacity
• Management of stress in time-limited working setting

Languages:

• High proficiency in oral and written English.
• Fluent knowledge in oral Portuguese, Spanish or Italian desirable.

[1] Secondary data Coverage method consists basically of employing not-up-to-date demographic data (denominator) against the number of PRN beneficiaries enrolled in the rehabilitation programme (numerator).