Consultancy for the Design of a Micronutrient and Diet-Related NCDs Survey.

1. Programme Information:

UNICEF Gambia Programme of Cooperation 2017-2021:

 Output 2.1: Institutional capacities strengthened to plan and monitor for improved quality and equitable IMAM, IYCF and micronutrient services including during emergencies

Activity 2.1.1: Strengthen micronutrient deficiency control

The United Nations Children’s Fund (UNICEF) is mandated by the United Nations General Assembly to advocate for the protection of children’s rights, to help meet their basic needs and to expand their opportunities to reach their full potential. The UNICEF staff and experts/consultants should act in accordance with the UN Code of Conduct and UNICEF Mission.

2. Background

Undernutrition in all its forms among children under the age of five has not improved over the years in The Republic of The Gambia. The National Nutrition Survey (NNS) using the Standardised Monitoring and Assessment of Relief Transition (SMART) methodology conducted in 2015 estimated the prevalence of stunting among children under five at 22.9 per cent, Global Acute Malnutrition (GAM) at 10.3 per cent and Severe Acute Malnutrition (SAM) at 2.2 per cent. These results were higher than those reported by the 2012 SMART survey when 21.2 per cent of the children under five were stunted, GAM was 9.9 per cent and SAM 1.6 per cent. Prior to that, in 2000, the Multiple Indicator Cluster Survey (MICS) estimated that 19.1 per cent of children under five were stunted while 8.2 per cent were wasted.

Micronutrient deficiencies notably Vitamin A Deficiency (VAD), Iodine Deficiency Disorders (IDD) and Iron Deficiency Anaemia (IDA) are also a common public health problem in Gambia. A survey conducted by NaNA in 2001 showed 64 per cent of children under five of years are deficient in vitamin A and 76 per cent anaemic. Anaemia, due to iron deficiency, is also very common among women, especially during pregnancy, and is a major contributory factor to the high maternal morbidity and mortality rates. The same study showed that 73 per cent and 56 per cent of pregnant women and lactating mothers respectively are anaemic. It also found that 34 per cent and 16 per cent of pregnant women and lactating mothers respectively are deficient in vitamin A. However, in 2013, the Demographic Health Survey (DHS) estimated that 73 per cent of children under five suffer from some level of anaemia while 4 per cent were severely anaemic in the country. The prevalence of anaemia was higher among children in rural areas (78%) compared to 67 per cent in urban areas. The study also showed that rural women were more likely to be anaemic (68%) compared to urban women (53%). Another study conducted in 1999 showed that the Total Goitre Rate, a manifestation of IDD, was 16 per cent which is considered mild.

The causes of child malnutrition in the Gambia are varied and multi-sectoral in nature. The most common immediate causes in children under five are inadequate infant and complementary feeding practices, frequent illnesses such as diarrhea due to poor hygiene and sanitation, malaria and pneumonia and poor maternal nutrition.

Although the 2013 DHS showed an increase in the proportion of children 0-6 months who are exclusively breastfed (47%) compared to 34 per cent in 2010 (MICS 2010), the feeding practices were inadequate for children 6-23 months with only 8 per cent of the children fed in accordance with the three core Infant and Young Child Feeding (IYCF) practices. The situation is worse in Central River and Upper River regions where only 3 per cent and 7 per cent respectively of the children 6-23 months received a minimum acceptable diet (DHS 2013).

Coverage of micronutrient supplementation is also low, with only 17 per cent of the under-five being supplemented for iron and 69 per cent for vitamin A (DHS, 2013) while data for routine VAS from HMIS reported a coverage of around 31 per cent in 2015. This trend is similar for de-worming with 34 per cent of children 6-59 receiving deworming tablets (DHS, 2013).

Like many developing countries, The Gambia is also experiencing a ‘triple burden of malnutrition’ with the emergence of diet-related Non-Communicable Diseases (NCDs) such as diabetes, hypertension, coronary heart disease, obesity and some forms of cancers. Adverse trends in diet, exercise, obesity and other risk factors, means that the level of chronic conditions will continue to increase. These conditions affect general wellbeing and quality of life as well as account for most of the healthcare resources used, and present a significant economic burden in The Gambia. With infectious diseases still a major public health burden, the increase in the prevalence of diet-related non-communicable diseases poses a challenge for the allocation of scarce resources and is exerting immense pressure on an already over-stretched health budget. A study by Semeeh A. Omoleke[1] between 2008 and 2011 in The Gambia showed an increasing trend in the morbidity, hospitalization and mortality due to NCDs by 19.8 per cent, 9.9 per cent and 23.4 per cent increments respectively.

In order to obtain updated and reliable information on the current status of micronutrient deficiencies and diet-related NCDs, there is need for a population-based survey to accurately quantify the burdens and their risk factors. The results of the survey will be used to develop evidence-based policies and strategies to improve nutritional status of women and children in the Gambia.

3. Objectives

The purpose of the assignment is to develop the study protocol, tools, sampling and cost estimation of a micronutrient and diet-related NCDs survey in The Gambia.

4. Scope of work

The consultancy is expected to accomplish the following tasks:

·       Survey Protocol: Write up a survey protocol to assess micronutrient and diet-related NCDs status among children under five and women in the reproductive age group (15-49), including: background, aim, specific objectives, methodology, sample size, sampling procedures; key indicators, composition of survey teams, ethical issues, timeline, data collection; management of human specimens collection, codification, storage; HemoCue and laboratory test, salt collection and test; field supervision, quality control; field test plan; technical guidance on data entry, data cleaning, data analysis, tabulation plan and reporting.

·       Sampling: Design the sample size to allow reliable estimation of micronutrient and diet-related NCDs survey indicators based on a representative probability sample both at the national and Local Government Area (LGA) levels. Further, the sample should allow an urban- rural, seasonality, gender and specific intra-age group comparisons. Appropriate sample size for the survey, should also take into account the balance between precision and cost.

·       Tools: Development of questionnaires, informed consent forms, data collection forms for anthropometric measurements, data collection forms for biochemical indicators, laboratory support forms and other tools.

·       Budget: Provide a cost estimation of the survey, with detailed cost breakdown for different activities.

●    In-country planning meeting: After the initial design, the consultant will come into the country and

      present the draft protocol to UNICEF and other stakeholders for discussions and clarifications. The 

      consultant will do the required adjustments and debrief key partners such as NaNA, MRC and MoHSW to 

      ascertain that all the key issues heighted during the consultations have been incorporated before launching  

      the validation workshop.

·       Validation workshop: Organize a workshop in The Gambia to present the methodology, sampling, tools, cost-estimates and guidelines for tabulation plan to stakeholders including UNICEF, NaNA, the Gambia Bureau of Statistics (GBoS), Medical Research Council (MRC), other UN Agencies, MoHSW and other key stakeholders. Make revisions as needed and finalize the Survey protocol and Budget and including timetable.

5. Schedule of Tasks, Deliverables, Duty-Station& Timeline

The contract with specialized expert consultancy companys will be for a period of 25 working days within July – August 2017, out of which 12 days will be done in country in Banjul, The Gambia.

6. Estimated duration of contract; Remuneration; Other Terms and Conditions

The Consultant will be engaged under short-term institutional contract on part-time basis, for an estimated period of 25 days, between July to August. The exact dates to be proposed by the Consultant and discussed with and confirmed, including the specific deadlines, by UNICEF and NaNA before signing the contract.

Amounts and terms of payment will be negotiated based on value for money and in line with UNICEF standards.

UNICEF reserves the right to withhold all or a portion of payment if performance is unsatisfactory, if work/outputs is incomplete, does not meet the quality standards of both UNICEF and the Government of The Gambia, not delivered or has failed to meet deadlines (fees reduced due to late submission: 5 days – 10 per cent, 12 days – 20 per cent; 1 month or more – 50 per cent payment withheld).

UNICEF does not provide or arrange health insurance coverage for the consultant. The Consultant will make his own transport arrangements (including airfares, local transportation, etc.). Obtaining entry visa to The Gambia for the team members shall be the responsibility of the Consultant.

All travel costs including daily subsistence allowances of the team members or any such expenses are the responsibility of the Consultant. The Consultant will be responsible for arranging accommodation for team members while in The Gambia, however, UNICEF shall extend administrative/logistical support to facilitate this.

7. Supervision and Reporting Arrangements

The Consultant will be supervised by and report to the UNICEF CSD Specialist with briefing and de-briefing to the UNICEF Deputy Representative about the progress of the consultancy. The CSD Specialist will interact with the Consultant through email correspondence while the Consultant is outside of The Gambia. The PO/or team will also provide support to the Consultant during visit to The Gambia (if applicable). A Steering Committee comprising of relevant Government Institutions, MRC, WHO and UNICEF Officers will be set up to provide oversight to the study and provide comments.

8. Duty station and official travels

·       The Consultant will work from home to draft the study protocol, sample size, survey tools, and cost estimates for the survey.

·       The Consultant will spend 12 days in The Gambia to have a stakeholder consultations, debriefing, facilitate a workshop to discuss and validate the study methodology, sampling, tools, cost estimates and guidelines for tabulation plan with NaNA, UNICEF, GBoS, other UN Agencies, MRC, MoHSW and other key stakeholders.

·       During the time in The Gambia, the Consultants will work in the UNICEF Office.

9. Qualifications & Experience required

The Consultant will have to put together a resource team, under the supervision of a Coordinator who will be responsible for coordinating the team, assuring that all activities are conducted as specified in the ToR and that all deliverables are structured (contain information required) and submitted on time as specified in the ToRs.

The Consultant must have:

·       Advanced university degree in either of the following disciplines, epidemiology, public health, medical sciences, nutrition and other related disciplines;

·       Proven experience in conducting research and surveys, analyzing medical and social statistics related to nutrition;

·       Proven experience in the sampling design for household surveys;

·       Experience in undertaking micronutrient and diet-related NCDs surveys (design and methodologies, tools, field supervision and data analysis/write up);

·       High-level proven expertise and familiarity in micronutrient deficiencies disorders and diet-related NCDs survey methodologies;

·       Relevant international experiences; knowledge and experience of work in the West African Region will be an added advantage;

·       Results driven, ability to work under pressure and to meet required deadlines;

·       Good report writing and editing ability in English.

10. Intellectual property rights

UNICEF, the National Nutrition Agency (NaNA) and the Ministry of Health and Social Welfare (MoHSW) retain the right to patent and intellectual rights, as well as copyright and other similar intellectual property rights to the survey protocols and tools, discoveries, inventions, production or works arising from the consultancy. Neither the Consultant nor its personnel shall communicate to any other person or entity any confidential information made known to it by UNICEF, NaNA and MoHSW in the course of the performance of its obligations under the terms of this Agreement nor shall it use this information for private or company advantage. This provision shall survive the expiration or termination of this Agreement. The right to reproduce or use materials shall be transferred with a written approval of UNICEF in consultation with NaNA and MOHSW based on the consideration of each separate case.

11. How to apply

UNICEF accepts applications from institutional Consultant. The Selection Committee, comprising of UNICEF and NaNA will review applications and make a final decision of a successful application.

All applications should contain the following documents:

I.               Technical Project Proposal, which would include at least:

-        Licence, registration, statute, mission statement

-        Statement of the research problem

-        Conceptual framework and methodology

-        Consultant’s profile/portfolio

-        Proposed timeframes (days)

-        Names and contact details of reference persons.

-        List of publications or analytical reports (if applicable)

-        Any other additional information to support the application (optional).

II.             Financial Proposal:

-        Detailed budget breakdown (in US Dollars).

Deadline for applications: 3^rd July 2017