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Principle Evaluation Consultant for conducting formative Evaluation of Integrated Management of Acute Malnutrition (IMAM)

Kabul

  • Organization: UNICEF - United Nations Children’s Fund
  • Location: Kabul
  • Grade: Consultancy - International Consultant - Internationally recruited Contractors Agreement
  • Occupational Groups:
    • Nutrition
    • Monitoring and Evaluation
  • Closing Date: Closed

Principle Evaluation Consultant for conducting formative Evaluation of Integrated Management of Acute Malnutrition (IMAM)

Purpose of Activity/Assignment:

The purpose of this assignment is to conduct formative evaluation of Integrated Management of Acute Malnutrition (IMAM). The IMAM has been implemented for several years, under the leadership of the Government of Afghanistan in collaboration with UNICEF, WFP, WHO and other stakeholders. The IMAM service delivery include mainly treatment services to children, pregnant and lactating women diagnosed with moderate acute malnutrition (MAM) and severe acute malnutrition (SAM) and elements of infant and young child counseling. The programme also includes detecting early onset of acute malnutrition in children and pregnant and lactating women (PLW), and referring them to health centers for treatment.

The evaluation will be managed by the SPPME Section. The TOR have been developed in close coordination with the Nutrition Section and other partners to ensure relevance and ownership. This evaluation is part of the evaluation plan of the CPD.

 

Background

Outpatient management of acute malnutrition was introduced in Afghanistan in 2008 to address the high caseload of acute malnutrition in children under 5. Initially, Community-based Management of Acute Malnutrition (CMAM) was introduced to integrate the management of acute malnutrition into the health system. In practice, the nutrition partners were implementing the CMAM with the support of the Nutrition Cluster as an emergency response mechanism. In order to address the need at all levels and develop a sustainable programming model, the Ministry of Public Health (MoPH) scaled up the management of acute malnutrition through Basic Package of Health Services (BPHS) and Essential Package of Hospital Services (EPHS) and redirected its focus from "emergency focused" to "development and sustainable programming".

The BPHS offer outpatient management of acute malnutrition services through five types of health facilities, ranging from Health Sub Center (HSC), Basic Health Center (BHC), Mobile Health Team (MHT), Comprehensive Health Center (CHC); and District Hospital (DH)- for outpatient and inpatient services)). While essential package of health services (EPHS) provide inpatient management of severe acute malnutrition with medical complication services through three types of health facilities ranging from DH, Provincial Hospital (PH) and Regional Hospital (RH). In addition, community outreach activities which include active screening, referral and follow up acutely malnourished children is an integral part of community-based nutrition package (CBNP)  provided by BPHS through Health Posts (HP) at the community level

The results of the first services that were delivered through the BPHS and EPHS in Takhar, Badakhshan, Balkh and Herat provinces indicated that there was a need for a comprehensive and integrated guideline that would provide clear guidance to help the health workers in proper detection and management of acute malnutrition of different levels. By January 2014, the MoPH had endorsed the Integrated Management of Acute Malnutrition (IMAM). The IMAM guidelines were developed by MoPH and UNICEF to improve the integrated management of acute malnutrition within the national health system through using a holistic approach to prevention and treatment of acute malnutrition. The IMAM guidelines cover:

  • Detection of acute malnutrition among patients at different levels of health facilities;
  • Treatment through out-patient and inpatient departments;
  • Counseling of mothers and caretakers;
  • Assessing /managing the main causes of malnutrition, such as: micronutrients, infant and young child feeding practices and home-based caring.

The IMAM prorgamme is being implemented harmoniously by the Government of Afghanistan, public health institutions and BPHS and EPHS package implementing partners at district levels throughout the country. Since the introduction, the IMAM programme has been scaled up in 34 provinces and covers nearly 78 percent (313/399) of the districts today. From 2014 to Mid-2017, In-Patient Department of Severe Acute Malnutrition (IPD-SAM) services expanded from 87 to 138 health facilities (15% increase since 2014) in 34 provinces. Similarly, Out-Patient Department of Severe Acute Malnutrition (OPD-SAM) services scaled up from 377 (19%) to 843 (42%) health facilities in 34 provinces. The number of provinces where Out-Patient Department of Moderate Acute Malnutrition (OPD-MAM) services are present increased from 22 to 26, and the number of health facilities increased from 490 to 529.

 

The IMAM has covered over million children diagnosed with SAM and MAM since 2014. The current performance status of IMAM is above the Sphere Standards (>75% for admission and <15% for defaulter rates), yet the cure and defaulter rates are found below these standards for management of severe acute malnutrition in Badghis, Faryab, Kabul, Sarepul, Uruzgan, and Wardak for the OPD/IPD SAM management services. The formal evaluation of IMAM for children and women with acute malnutrition is important for identifying ways to increase the coverage, scale-up, and measure to what extent it meets the needs of the most vulnerable and marginalized children. The evaluation results are expected to contribute to improving the performance of the interventions in challenging locations of the country.

Formative evaluation is being initiated to measure the extent to which the IMAM has met the needs of the population and gather lessons learned. The evaluation results are expected to deliver recommendations that will contribute to improving the programme performance. The audience of the evaluation are the Government of Afghanistan, UNICEF, WFP, WHO, BPHS and non BPHS implementing partners, and other stakeholders.

Evaluation Purpose

The main purpose of the formative evaluation is to gather evidence on the results of the IMAM and contribute to:

  • Promoting accountability among stakeholders and partners;
  • Evidence-based policymaking in preventing and treating acute malnutrition among affected children, lactating and pregnant women;
  • Organizational and global learning, and improving programming on effective treatment of children diagnosed with acute malnutrition.

The evaluation's main objective is to yield results that will contribute to enhancing the programme performance and strategies to deliver effective results through:

  • Assessing the progress made and identifying gaps, good practices and lessons learned;
  • Evaluating the programme’s relevance, efficiency, effectiveness and sustainability;
  • Generating knowledge and providing recommendations that will be useful for strengthening the prorgamme performance, advocacy and policy dialogue on acute malnutrition among children, lactating and pregnant women.

The recommendations that the evaluation will deliver are expected to cover:

  • Strategies for developing policy on effective implementation of the IMAM interventions in addressing acute malnutrition issues, improving the quality of services, and achieving equitable outcomes for children at the national level.
  • The effectiveness of related cross-cutting issues such as coordination and management; gender and other forms of equity; capacity development; advocacy and policy development; and information/data management.

Evaluation Scope and Criteria

The evaluation will cover overall programme activities and implementation strategies at the national level from 2013 to 2017.  The collaborated interventions of UNICEF with the WHO and Government evolved gradually through the last two decades and the IMAM and CMAM models were begun to be firmly utilized since 2010. It is, therefore, essential to highlight the trends of acute malnutrition cases and actions implemented by UNICEF and partners from 2010 to 2017 as well.

Considering the national nutrition strategies of the Government of Afghanistan, the evaluation will examine the IMAM's performance in:

  1. Increasing access to nutrition services and products for children and their families
  2. Improving nutrition behaviours and practices among target groups
  3. Improving the quality of nutrition services and products
  4. Strengthening social, regulatory and political environment for nutrition

The evaluation will assess relevance, effectiveness, efficiency and sustainability of the IMAM and the extent to which it contributed to equitable and equality based outcomes for children. The evaluation will be conducted according to the OECD DAC and UNICEF evaluation criteria through the following evaluation questions that can be adjusted by the evaluation team:

Relevance: to assess the extent to which the IMAM interventions are relevant to the needs of the children and their mothers,   the capacity of our Government partners we will focus on:

  • To what extent have IMAM interventions met the needs of children and their mothers?  Did the IMAM interventions adequately target the needs of the poorest quantile, remote populations and the most vulnerable children?
  • To what extent were UNICEF's interventions gender-proportionate? How the cases of girls and boys were adequately addressed in both UNICEF's downstream and upstream interventions?
  • Are there any issues related to gender, geographic or other form of equity in CMAM service delivery and access that are evident? What measures could be proposed to improve programme targeting?
  • To what extent have IMAM capacity development activities covered the development needs of communities and Government partners in preventing and treating acute malnutrition? 
  • How are the efforts of UNICEF and partners in treating acute malnutrition aligned with the national priorities in nutrition?

Effectiveness: the extent to which UNICEF and partners have achieved the IMAM's intended results:

  • To what extent have the expected outputs and outcomes been realised through the IMAM programme? If there are shortfalls, what are the contributing factors?
  • How developed and successful are the specific IMAM components and strategies (community outreach and mobilization, screening/enrolment, feeding, treatment, information management, follow up) and the interventions (as per the programme logic model) in realising overall programme objectives?
  • Have all targeted number of children diagnosed with SAM and MAM, and their families been reached in the planned timeline? 
  • Have UNICEF and partners achieved the optimum level coverage for acute malnutrition treatment?
  • Have the counselling services led by UNICEF to mothers and caretakers yielded substantive results? What is the difference between understanding of mothers and caretakers of nutrition needs of children before and after UNICEF provided them with the counselling services?
  • Has treatment of acute malnutrition by UNICEF and partners through the IMAM approaches contributed to reducing nutrition mortality and morbidity among the population? Has it contributed to economic development and changing social norms and behaviour of the population?
  • How effective is the vertical and horizontal coordination (involvement of various sectors) in planning and implementing IMAM?
  • How strong is the national /sub-national engagement and ownership of CMAM programme (including national budget allocations)?

Efficiency: to assess the extent to which the outputs of the programme contributed to achieving the outcome results, the following questions will be used:

  • Are UNICEF's investments to implement IMAM sufficient to achieve intended results in the context of the country? Are there less costly options that UNICEF could have used for achieving planned results in treating SAM?
  • To what extent has UNICEF partnership with WFP, WHO and Government stakeholders at different levels support the delivery of the programme results? 
  • How have UNICEF's monitoring and reporting systems been used to gather credible evidence on the response to SAM, measure results, detect and prevent bottlenecks on time?
  • To what extent does the service delivery meet expected quality standards? What factors have contributed to meeting quality standards? Where quality standards are not met, what are the key bottlenecks/constraints that need to be addressed in order to meet quality standards?
  • What are per unit costs of IMAM implementation in the context of Afghanistan? Can any conclusions be drawn regarding cost effectiveness / efficiency?

Sustainability and scaling up: the extent to which IMAM  contributions to preventing and treating acute malnutrition, promoting knowledge and capacity development of local stakeholders are going to be sustained and scaled up:

  • Have UNICEF and partners set up a system at the national level that will continue responding to acute malnutrition cases effectively without external support? 
  • Are there relapsed cases of children who were treated? If so, what are those issues that caused SAM and MAM among those children again?
  • To what extent do mothers and caretakers who received counselling sessions continue practicing the knowledge that they gained through the IMAM?
  • How systematically has institutional capacity development been pursued at all levels for long term sustainability of the programme? What more needs to be done?

Evaluability

Due to the absence of solid baseline data and considering the overall framework of IMAM, this evaluation will not cover possible impact of the interventions. Available databases and monitoring systems have data that will be used to evaluate relevance, effectiveness, efficiency and sustainability of the IMAM interventions.

The Programme's interventions are evaluable through qualitative and quantitative methods, and additional secondary data can be obtained for pre and post comparison analysis on the programme performance. The logical framework and Theory of Change must be redeveloped in order to establish clear relationship between the activities, outputs and outcome of various actors jointly collaborating on IMAM.

Limitations

Security challenges and possible limited access to the target groups may impede timely implementation of data collection activities. Additionally, limited reliable secondary data and absence of proper documentation at the provincial and district levels, and in the target schools, can pose challenges in the evaluation process. Certain aspects directly linked to limitations in data collection to consider are sensitive religious, cultural and tribal norms of the target population.  

Evaluation Design and Methodology

The evaluation design must be based on primary and secondary data collection. A critical stage before producing an inception report is to conduct a detailed research on the programme documents that will be used to asses: a) the nature of the prorgamme interventions; b) the availability of data and c) to develop adequate evaluation design and sampling strategy. The research in the inception phase will include: a) document reviews; b) consultations and interviews with UNICEF and partners; c) field review. 

Evaluation methodology should be based on mixed methods, participatory, gender, equity and human rights based approaches. Two types of data will be collected:

  1. Primary data will be collected through qualitative and quantitative methods, such as surveys, interviews and Focus Group Discussions (FGDs). The participants of the primary data collection will be:
  • Children
  • Mothers and caretakers
  • Community people including Community Health Workers (CHWs), Family Health Action Group (FHAG), and Health SHURA
  • Health workers, BPHS, EPHS 
  • UNICEF Nutrition Section
  • Ministry of Health, WFP, WHO and other stakeholders (2-3 LNGOs and 2-3 INGOs), and IMAM technical working group members. 
  1. Secondary data can be collected through the programme databases (National Nutrition Database) and monitoring systems (National Nutrition Surveillance System and the recent SMART surveys).

Data collection activities must be accompanied with photographic evidence and collected via real-time data collection technologies (such as Open Data Kit).

Sampling

The candidates are requested to develop and present their sampling approach in the technical proposals. The sample sizes should be sufficient to allow generalization of findings applicable to a larger population. Sampling for quantitative and qualitative data collection should be drawn based on the following criteria:

  1. 17 Provinces with SAM > 3 percent, received collaborative support of UNICEF and WFP in all accessible districts. (Badakhshan, Samangan, Badghis, Nimroz, Helmand, Kandahar, Urozgan, Zabul, Ghazni, Paktika, Wardak, Paktia, Khost, Nengarhar, Laghman, Kunar and Nooristan provinces).
  2.  8 Provinces with SAM < 3 percent where MAM management services are functioning, MoPH and partners maintained the services and ensured SAM and MAM management is integrated in the same facilities. MoPH and NGOs used the same partners. (Herat, Ghor, Daikunid, Bamyan, Balkh, Sar-e-Pul, Kunduz and Takhar provinces).
  3. 9 Provinces where WFP did not implement programming due to funding constraints and other reasons. (Farah, Faryab, Jawzjan, Logar, Kabul, Parwan, Kapisa, Panjsher and Baghlan provinces). 

Cases for the qualitative in-depth assessment must be selected from the OPD-SAM and IPD-SAM databases.

Data Collection Tools

Data collection tools (surveys, interview and FGD protocols) must be culturally appropriate. The form and contents of the data collection tools should be sufficient for capturing correct information on the main indicators of the programme and deliver adequate level of analysis that will illustrate a measurable change. Surveys, interviews, and focus group discussions with sampled groups must be anonymous, in the local language and documented with consent.

Data Analysis and Findings

Data must be disaggregated by gender, location and ages of respondents. Data analysis must cover the IMAM performance according to the SPHERE Standards. The analysis will cover findings according to determined evaluation criteria and assessments of the local socio-economic and political issues and any other assumptions and risks that can potentially have effect on changing the course of the expected results.

Evaluation Management

The evaluation will be managed by the Evaluation Specialist under the overall oversight and guidance of the Chief of the SPPME Section. UNICEF ACO/SPPME Section will lead the evaluation process and ensure that it is conducted according to UNICEF Evaluation Policy and UNEG Norms and Standards.

Quality assurance

Evaluation Management Team (EMT) composed of relevant UNICEF Staff Members will provide support for ensuring the quality and independence of evaluation process. Additionally, Evaluation Reference Group (ERG) composed of up to 6-8 UNICEF staff members and stakeholders will review evaluation deliverables and provide comments regularly on the evaluation's scope, methodology, findings, conclusions and recommendations.

Evaluation Conduct

The Principal Evaluation Consultant will be responsible for conducting the evaluation with the support of a national data collection team to be contracted with the support of the consultant. Specifically, the consultant will be responsible for:

  • Liaising with and interviewing relevant Programme Sections to gather the programme's essential documents. The consultant must review and analyze every programme document before developing evaluation framework and methods;
  • Developing a sampling strategy and calculating a representative sample sizes and budget for the evaluation of the programme. The sampling approach must be included in the draft Terms of References (ToR) for a data collection contract.
  • Reviewing submitted technical proposals of institutions and participate in recruitment process of a selected data collection team.
  • Guiding and working with the data collection team during throughout the evaluation, ensuring systematic and high-quality data collection, and providing capacity development support as required. The consultant will analyze the evidence, produce the inception and evaluation reports; develop evaluation methods, sampling approach and data collection tools based on gender equality, human rights and equity approaches. The consultant will also manage the data collection process and ensure the quality of data.
  • Monitoring the evaluation work, detecting and preventing or addressing bottlenecks. The consultant will ensure timely submission of progress reports on the evaluation work and deliverables to UNICEF.
  • Presenting the evaluation findings and recommendations to the main audience, ERG members and partners.

3. Location and Duration of Consultancy

A consultant will be based in Kabul during the inception and data collection phases, and work remotely on producing the evaluation report. The consultant is expected to travel to at least 5 provinces with the data collection team.

 

 Required Qualifications and Experience:

  • Advanced university degree in nutrition, sociology, statistics, health and related technical field. 
  • Minimum ten years of relevant work experience in social research, nutrition and evaluations in the development and humanitarian fields
  • Solid experience in conducting and managing evaluations of nutrition and development programmes required
  • Strong quantitative and qualitative skills
  • Excellent analytical and writing skills
  • Excellent research skills
  • Familiar with results-based management principles and tools
  • Fluency in English

Competencies:

  • Excellent command of English and report writing skills
  • Strong interpersonal, communication and organizational skills
  • Excellent analytical and research skills

 

This vacancy is now closed.
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