Knowledge, Attitudes, Beliefs & Practices and Communication for Development (KABP C4D) - West Pokot
TERMS OF REFERENCE
Knowledge, Attitudes, Beliefs and Practices and Communication for Development (C4D) Assessment in West Pokot
General details for the assignment
*Location:** West Pokot county (West, Central, South and North Pokot Sub Counties)
*Duration: 45 days**
Start Date : Upon signing the contract (Expected to be End February 2017)
Operationally Reports to : Nutrition Program manager West Pokot
Technical reporting: MIYCN/Research/SBC Coordinator
West Pokot County is one of the Arid and Semi-Arid Lands in Kenya. It is situated in the north rift along Kenya’s Western boundary with Uganda border. It borders Turkana County to the North and North East, Trans Nzoia County to the South, Elgeyo Marakwet County and Baringo County to the South East and east respectively. The County covers an area of approximately 9,169.4 km2 stretching a distance of 132 km from North to South with population estimated at 631,231 persons as per 2013 projections. This population consists of 313,746 males and 317,484 females giving sex ratio of 100:101. The county inter-censal growth rate is 5.2% which is higher as compared with the national average of 3.0%. The county has four constituencies namely: Kapenguria, Kacheliba, Sigor and Pokot South and a total of twenty county wards. In addition, West Pokot county has four main sub counties namely West, Central, South and North Pokot with three major livelihood zones: pastoralism (dominant in Pokot North), agro-pastoralism (dominant in Pokot Central), and mixed farming (practiced in West Pokot).
West Pokot County has 75 health facilities in the county currently implementing high impact nutrition interventions out of 105 health facilities and 20 integrated health and nutrition outreach sites. The vastness and harsh terrain pose challenges to delivery and access of nutrition and health services. This calls for different ways or working by the stakeholders in collaboration with county governement to adequately meet the required needs. Major challenges in reduction of child mortality include: inequity in access to health care service, high cost of accessing health care due to the high poverty levels, inadequate medical personnel in government facilities among other cross-cutting issues. The county has plans to have multi-sectoral approach MOA, MOH, MOE, Environment and others to strengthen the linkage and address gender issues affecting health and nutrition systems strengthening.
1.1 Humanitarian context
Food security situation in the county has deteriorated with food prices for staple food (maize, beans, Irish potatoes) going up due to instability in supplies and over-reliance on market for household food supply. There is notable depletion of pastures and browse leading to increased conflict between West Pokot, Turkana and Elgeyo Marakwet. The county has reported approximately 80% of out-migration of livestock from Kasei to Uganda and Kasei to Turkana in the month of December, 2016. In addition 60% of livestock moved from Central to Turkana. Animal body condition is worsening due to prolonged dry spell. The county has recorded drying up of water pan negatively affecting access to water for household and livestock. However there is slight increase in livestock birth rate due to good performances of previous long rains which is not a normal incidence. Milk production at household is approximately 1 litre below expected 2litres. In addition milk prices have gone up currently traded at Ksh 60/ litre negatively affecting access to milk for household consumption. Livestock prices are currently very low due to the poor body condition. Slaughter destocking is being encouraged by the government to cushion the pastoralists from the loosing the critical livelihood asset. Increased pressures to raise funds for school fees has led to increased sale of livestock. Further, Terms of Trade expected to worsen due to increased maize prices and worsening of livestock body condition with 1 mature goat for 1 bag of maize.
In regards to water, the county has recorded increased trekking distance to water point. The cost of transporting water has increased from 20-30 Ksh due to drying up of water points and low ground recharge of water. However, water is free at water point. Water scarcity has led to sharing between livestock and humansleading to contamination of water sources hence increased diarrheal diseases. The situation has been exacerbated by lack of water treatment chemicals and poor hygiene and sanitation in the county. Pastoral and agro-pastoral areas experience severe water shortage especially areas around Kodich, Konyao, Alale, Sook, Sekerr and parts of Central Pokot around Masol with 1500 people per water source.
1.2 Nutrition and Health Situation
Poor nutrition among under-fives [boys and girls] and PLW remains a challenge in West Pokot. The MIYCN KAP survey conducted in February, 2014 revealed poor breastfeeding and complementary feeding practices. Exclusive breastfeeding was recorded at 37.9%, minimum dietary diversity for children 6-23months at 16.3% while minimum acceptable diet at 12.6%. The county recorded high stunting rates at 44.5% which can be attributed to myriad risk factors including poor prioritization of household resources, maternal workload, poor hygiene and sanitation, poor diversification of household income and resources and poor dietary diversity.
The recent SMART survey findings (2016), revealed a worsening nutrition situation with Global Acute Malnutrition (GAM) at 15.3 % (12.3 - 18.9 95% C.I) and Severe Acute Malnutrition (SAM) at 2.9% (1.9-4.4) 95%CI) compared to GAM of 12.4% and SAM of 1.3% in 2015. Although the GAM and SAM rates are not statistically significant, the county nutrition situation has deteriorated from serious to critical levels. Further analysis of malnutrition rates based on age categories; 6-23 months and 24-59 months indicates children aged 24-59 months are more malnourished compared to children aged 6-23 months. This could be associated with the absence of children from home since they are engaged in herding or participating in other activities as well as attention having shifted to the younger child in the family. The most likely causes of acute malnutrition among children <5 years include inadequate food intake, poor dietary diversity, high prevalence of childhood illness and low IMAM program coverage. June 2016 SMART survey revealed a significant increase in coping strategy index from 15.4 to 22.3 with 75% of households purchasing cereals for household consumption. This is highly associated with depletion of household food reserves as clearly indicated by the hiked prices of maize from Kenya shillings 35 to 41 in June compared to May 2016.
Nutrition causal analysis findings conducted in West Pokot pointed out high child morbidity, inadequate quantity and diversity of age-specific foods and poor access to safe water as the major risk factors to malnutrition. Bottlenecks such as inadequate health facility staff, inadequate access to services by the beneficiaries, limited capacity of the health system and service providers to support and respond in times of shocks, limited resilience to shocks by the beneficiaries, inadequate translation of knowledge to practice, inadequate prioritization and funding commitment to nutrition by the county government among others are still persistent.
1.3 Response analysis
Action Against Hunger (ACF) in collaboration with State/ County Department of Health, UN agencies (UNICEF and WFP) and local partners (SIKOM peace network for development and Pokot Youth Bunge County Forum) have been implementing high impact nutrition interventions (HiNi), evidence based advocacy and communication, social behaviour change (SBC) geared to achieving nutrition resilience among the West Pokot households . So far 75 health facilities and 20 integrated outreach sites have integrated HiNi package in routine health service delivery with other interventions such as promotion of optimal MIYCN and prioritization of nutrition at all levels being undertaken. AAH supported training of 29(17m, 12f) MoH health management team and local partners staff on communication for development (C4D). The team trained on C4D are currently engaged in development of SBCC strategy with focus on MIYCN.
Notably ACF through funding from European Union and UNICEF has been implementing two (2) projects namely: Advocacy, System Strengthening and Capacity Enhancement for Nutrition Transformation’ (ASCENT) and Maternal, New-born and Child Nutrition Project (MCNP) which commenced December and August 2015 respectively. These projects target to contribute to the reduction in morbidity and mortality related to malnutrition in children under five years of age and pregnant and lactating women. In effort to enhance community resilience, ASCENT project supported training of community health extension workers (CHEWs), nutritionists and community strategy focal persons on community nutrition technical module 8 with plans to train CHVs ongoing.
The projects are implemented in close liaison with different stakeholders including county government of West Pokot, UNICEF, SIKOM peace network for development, Pokot Youth Bunge County Forum (PYBCF), National Drought Management Authority (NDMA) among others. In addition these projects targets to make significant steps in enhancing adoption of optimal maternal infant and young child nutrition (MIYCN) practices through community based approaches and enhance nutrition resilience through capacity enhancement and partnerships in West Pokot. These initiatives target to see translation of knowledge to practice with focus on maternal health and care practice.
Rationale for the KABP and C4D Assessment
ACF has been implementing MIYCN and HiNI initiatives to reduce morbidity and mortality among underfive in West Pokot as ultimate outcome. To achieve this outcome, immediate and intermediate outcomes need to be monitored to inform the design of the projects. This will ensure necessary corrective measures are undertaken to keep the project on course for achieving the intended impacts. Therefore KABP/C4D assessment is aimed at providing real time qualitative and quantitative information on the status of the MIYCN practices and attributable impact on maternal nutrition and child survival and development.
2. Objectives of the KABP/C4D assessment:
To assess knowledge, attitudes and practice of appropriate Maternal, Infant and Young Child Nutrition and hygiene among mothers and caregivers;
To determine the actual food intake by children aged 6-23 months through 24 Hr Dietary Recall.
To determine factors (boosters and barriers) that influence MIYCN practices and suggest how these can be overcome;
To establish existing and other possible Communication for Development (C4D) channels to support and sustain social and behaviour change towards optimal MIYCN.
To explore opportunities for integration and linkages of nutrition and health interventions to improve uptake of MIYCN messages and behaviour change.
The information generated will form the baseline for measuring change in uptake of MIYCN messages and help in scaling up of HiNi, capacity enhancement on C4D, design effective C4D strategies, integration of C4D in ongoing programming and monitoring behavioural outcomes. The findings will also be used to inform policy and advocacy for MIYCN at national and county level.
The survey will employ both quantitative and qualitative approaches to establish the prevalence of core MIYCN practices as has been agreed upon in the nutrition sector, focusing on the knowledge, attitude, Beliefs and practices relating to maternal nutrition, infant and young child feeding, Water Sanitation and Hygiene (WASH) promotion interventions. The survey shall further explore the Communication for Development (C4D) approaches to drive social and behaviour change towards adopting optimal MIYCN practices. A sub-sample of 30% of households will be drawn from total KABP sample where the caretaker/mother who usually prepares the complementary food and feeds the baby will be interviewed to determine the actual food intake by the child 24 hours preceding the survey. If the mother has more than one eligible child 0-23months, the youngest child will be preferred. This will be conducted in a participatory manner to involve MOH, NGO partners, UN agencies and beneficiaries. The consultant with support from County Department of Health and National ACF coordination team, will ensure the methodology is presented at relevant committees and working groups at national and county level for approval and later validation of the survey results. The planning and implementation of the assessment will be done in consultation with West Pokot field officers. The MIYCN quantitative questionnaire developed and approved by the nutrition sector as containing questions for the minimum MIYCN indicators will be used as the primary questionnaire. However, the consultant in consultation with the ACF technical team may include additional indicators as deemed necessary to fulfil ACF programing needs and/or donor requirements.
3.1 Survey scope:
· Detailed Survey Plan: Detailing the aim, purpose, objectives, hypotheses as well as survey approach and methodology with adequate representation of different population segments relevant to MIYCN. The survey should target representative communities in West Pokot with a focus on pregnant women, mothers and caretakers including men, influencers of MIYCN practices, decision-makers, leaders/managers who have stake in health, nutrition and MIYCN. Other key informants should be identified, including but not limited to partners, community leaders etc.
· Clear Survey Design: This should outline systematically sampling and sampling frame, sample size calculation, statistical analysis plan and implementation plan (Gannt chart) detailing the chronology of activities. The sample size will be determined by appropriate sampling techniques and the agreed level of precision by ACF and the consultant.
· Survey Tools: Well-designed data collection tools including questionnaires, focus group discussions (FGD) and key informant interviews (KII) interview guides. Interview and discussion guides and questionnaires shall be developed in consultation with ACF program staff utilizing the MoH MIYCN KAP tool for minimum core indicators for MIYCN and in line with the survey objectives.
· Data management: Showing how filled questionnaires will be handled as well as how data entry, analysis and storage will be managed.
· Dissemination plan of the survey findings at national and county levels.
· Survey report that meets the expectations of ACF after validation of the results by nutrition information working group and MIYCN steering committee.
· Quality control: A clear description of the quality control mechanism that will ensure a quality survey should be stated. This should include bt not limited to vetting and approval of methodology by NIWG and MIYCN steering committee.
· The duration of the survey will be 45 days (including final report submission). The start date will be the date of contract signing.
4 Expected Deliverables
Upon receiving this Call for Consultancy, the consultant shall;
· Submit concept note on your understanding of the TORs and scope of work detailing how you will carry out the assignment. The concept note should cover introduction, objectives and methodology survey plan and survey tools (if available) and Indicative Budget. This should also include any workshops/meetings to be undertaken outlining who should be involved.
· Submit reports/materials of previous work as an evidence of experience in undertaking similar assignments.
Upon successful bidding and signing of the contract, the consultant shall undertake the following;
Inception plan (within 7 days of commencement). The consultant is expected to submit a detailed plan of how the survey will be carried out. The plan will outline the tools and detailed work plan for the entire exercise.
- KII and FGD guides (within 5 days of start)
- 24 hour recall questionnaire (within 1 week of start)
- Questionnaire (within 1 week of start)
Final Report (within 45 days after start):
The knowledge, attitudes and practices, and barriers to optimal IYCF practices, including how this links to norms, values and beliefs. The report should clearly identify the positive attitudes and best practices that need to be enhanced and the negative attitudes and poor practices that need to be addressed to improve behaviours in relation to IYCF
This report should incorporate specific realistic and achievable recommendations, including the most appropriate behavior change communication strategies and messages that can be passed on to the communities to address the issues highlighted.
A draft of the report will be shared with key stakeholders for review and before the end of the consultancy to allow time for refinement before the release of the final report. All data must be provided electronically and all filled surveys forms/tools remain the property of Action Against Hunger-USA.
5 General Conditions and Fees for the consultancy;
- The consultant will conduct his/her work using his/her own computer equipment. Other costs related directly to the task, like photocopying of questionnaires, shall be covered by ACF
The movement of the consultant and team during training of survey teams, pre-test of survey tools and during the data collection in the field will be facilitated by ACF
Payment tranches for the consultant will be dependent on quality deliverables as follows:
1st trance – 30% upon successful submission of inception report including survey methodology, tools and work plan,
2nd tranche – 70% upon submission of final Acceptable report, data sets and satisfactory dissemination of findings. This includes successful pre-test of survey tools, training of survey teams and completion of data collection, data analysis and report writing and dissemination to ACF technical team, national and county level e.g. NIWG, MIYCN TWG, CNTF, .
6 Qualification and Experience of the Consultant:-
- Advanced university degree and experience in surveys and assessments
- A reputable consultant with documented experience in conducting KAP studies relating to IYCF.
- The consultant should preferably be a holder of a post graduate degree in public health, sociology, anthropology or related discipline. S/he must have strong analytical, negotiating, communication and advocacy skills.
- Qualified National or expatriate consultant who is fluent in spoken and written English.
- The consultant must have a strong background in statistics and data analysis. Must be familiar with Statistical Package for Social Sciences (SPSS) in particular and all relevant computer applications in general.
- Excellent reporting and presentation skills
7 Intellectual property
All writings, books, articles, artwork, computer programs, databases, source and object codes, and other material of any nature whatsoever produced in the course of this assignment produced in whole or in part by the consultant in the course of his/her service to ACF shall be considered a work made for hire, or otherwise, and therefore ACF's property.
8 Location of work
West Pokot County, Kenya. ACF will provide working space in the office for the consultant.
9 Minimum Information to provide on the quotation
Consultants who meet the above requirements should submit their proposal that include the following:
- A capability statement (not exceeding one page), including a firm commitment to be available to undertake the entire assignment.
- Consultant understanding of the Terms of Reference and detailing the methodology and design to be used in undertaking the assignment.
- Specify and elaborate on the tools to be used to facilitate the active participation of all relevant target groups
- Time and activity schedule.
- Propose an implementation time schedule and prepare a detailed Gantt chart and any other relevant illustrations. The schedule should detail how the consult intends to cover all the 4 sub-counties within the stated period.
A detailed financial proposal, including consultant’s fees per day, travel and accommodation costs needed to meet the objectives of this assignment. At minimum the financial proposal should include:
An itemized line by line budget proposal for consultancy fees as well as administrative costs such as travel, accommodation, meals, stationary and any other required support items.
Copy of VAT Compliance Certificate and PIN.
Currency quoted should be in Kenya shillings.
Up-to-date curriculum vitae or consultancy firm portfolio with CV(s) of lead consultant/s and other staff who will be involved in the exercise, that clearly spells out qualifications and experience.
Executive summaries or copies of 2 institutional capacity technical assistance reports of previous work conducted in similar assignments.
Names, addresses and day time telephone numbers of at least three referees representative of organizations for whom the consultant has previously supported on similar assignments.
Submission of Quote
Interested candidates who meet the above criteria are kindly requested to submit their proposals to**: firstname.lastname@example.org** by Friday 24th February, 2017, clearly indicating ‘Knowledge, Attitudes, Beliefs and Practices and Communication for Development (C4D) Assessment in West Pokot’ on the email subject line.
Only shortlisted candidates will be contacted. Applications sent after the closing date will not be considered.
Action Against Hunger - Kenya reserves the right to accept or reject any application, in whole or in part and is not bound to give reason(s) for any of its decisions.
- Organization: Action Against Hunger
- Location: Kenya
- Grade: Mid level
- Closing Date: 2017-02-24