International Consultancy - Research Consultant to conduct an assessment of the Simplified Treatment Protocol (STP) for treatment of Severe Acute Malnutrition (SAM) in Afghanistan.

Purpose of Activity/Assignment: The research aims at supporting decision making for national scale up of the simplified protocol for SAM treatment in line with the recommendation by the IMAM steering Committee. The simplified SAM treatment protocol was designed to reduce the treatment cost per child, with a view to change the protocols if quality can be assured, and influence discussions to get RUTF on the Essential Medicines List. The research results are expected to deliver findings on the performance of simplified protocol for SAM in the 5 provinces where it’s been implemented so far and propose recommendations for wider implementation in other provinces. The audience of the evidence generated are the Government of Afghanistan, UNICEF, WHO, WFP, BPHS and humanitarian partners. The key objectives of this research are: 1. Assessing the contribution of the simplified approaches to improving programmatic coverage 2. Determining whether the simplified approaches have improved cost effectiveness at scale 3. Establishing how the simplified approaches have affected quality & continuity of care (population-based outcomes) in the 5 provinces. 4. Identify implementation/performance gaps, if any, in the simplified approaches as compared to the standard protocol and provide mitigating measures to guide scale-up to other provinces

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Scope of Work:

The research will cover overall programmatic implementation of simplified treatment protocols in the five provinces (Parwan, Kapisa, Daykundi, Kunar and Nangarhar) where the protocol has been implemented since November 2019.  The simplified protocol for SAM treatment services is being implemented in the five mentioned provinces by the BPHS and humanitarian partners under the scope of the wider health system. The research will focus on a minimum of 2 Health Facilities in each of the 5 provinces (total of 10 HFs) from which the data on key outcome indicators has regularly been collected since the programme commenced in October 2019.

Research Questions

The chosen research criteria for the STP assessment evaluation are coverage, cost effectiveness, plus quality and continuity of care. The research questions listed below aren’t exhaustive and will be refined further during the inception phase in collaboration with the research team.

Coverage

• Are interventions in the simplified protocol adequate to meet the needs of recipient communities?
• Are programme monitoring systems well integrated and utilized to generate accurate, reliable and timely data on programme implementation and uptake?
• Do program beneficiaries find the intervention activities acceptable and useful?
• Are programme implementation targets being met in the selected provinces, in terms of number of screenings by health workers, and number of SAM admissions.
• Is the revised protocol easy to understand and apply for health practitioners?

Cost Effectiveness

• What is the cost of treatment per child admitted and recovered under the revised SAM protocol compared to the original protocol?
• What are the cost savings resulting from introduction of the simplified protocols as compared to the standard protocol?

Quality and Continuity of Care

• Are simplified protocol interventions being delivered according to prescribed strategy/design, i.e. in the stipulated order, intensity, quality, consistency, and timeframe?
• What is the average length of time children stayed in the program (from admission to discharge)? 
• What percentage of children admitted into the programme recovered or were cured?
• What percentage of children involved in the programme defaulted?
• What percentage of children admitted into the programme died (mortality rate)?
• What percentage of children admitted into the programme did not respond to the treatment and were discharged as non-cured?
• What percentage of cases relapsed after receiving treatment?

Methodology

The consultant is expected to elaborate a detailed methodology to respond to the research objectives and questions. The utilization of a mixed methods approach, making use of both quantitative and qualitative data is recommended. Key data sources to be taken into consideration are suggested below:        

1. Primary data will be collected through qualitative and quantitative methods, such as qualitative data from simplified and from standard protocols, interviews and Focus Group Discussions (FGDs). The participants of the primary data collection will be:

• Children
• Mothers/ 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 BPHS & humanitarian partners, and IMAM technical working group members. 

B. Secondary data can be collected through the programme databases (National Nutrition Database for both simplified and standard protocol).

C. Costing data:  programme costing data will be collected from UNICEF which leads on supply of RUTF as well as at the service delivery level which will include costs of service delivery as linked to IMAM.

Value for money analysis

The value for money analysis is envisaged to compare between the revised simplified protocol and the original protocol in achieving results for children in the context of Afghanistan. A cost benefit analysis or cost effectiveness analysis is envisaged. A cost effectiveness analysis is best deployed where monetizing of programme outcomes is not entirely possible while a cost benefit analysis is appropriate where monetizing of most benefits is possible.

The Value for Money analysis should consider, to the extent possible, the four ‘E’s:

• Economy: absence of waste for each key output of the STP.
• Efficiency: how economically resources/inputs (funds, expertise, time, etc.) were converted into results.
• Cost effectiveness: the extent to which the STP’s objectives were achieved or are expected to be achieved at a reduced cost, relative to the cost of the standard protocol.
• Equity: whether or not benefits of the STP accrued to those most in need

Sampling Frame

The sample sizes should be sufficient to allow generalization of findings applicable to a larger population, as the protocol is expected to scale up nationally. Sampling for quantitative and qualitative data collection should be drawn based on the following criteria: 

• SAM treatment services at different levels of health facilities including Basic Health Center (BHC), Mobile Teams, Comprehensive Health Center (CHC) and District Hospital (DH).
• SAM treatment services in different geographical areas including rural, urban and IDP settlement.
• SAM treatment services in the areas where MAM treatment (Moderate Acute Malnutrition) is available and in the areas where the SAM treatment services stand alone.

Health posts and other community platforms must be selected for qualitative information.

Ethical Review

Research methods and procedures for obtaining informed consent should be consistent with UNICEF Ethical and Principle Guidelines for the reporting on children and young people under 18 years old. http://childethics.com

The research methods and data collection tools involving children and sensitive topics must be approved by MoPH Institutional review Board (IRB). The research team with the support of UNICEF ACO SPEAR Section will submit the final version of the inception report and data collection tools to an external IRB for approval before commencing fieldwork. 

Researcher is required to identify and consider any potential ethical issues and must disclose in writing any past experiences or relationships, including of their families and friends, to the object of the research. The research must exercise independent judgement and resist undue influence from any party, including:

1. Be partial and produce a comprehensive presentation strengths and weaknesses of the policy, programme and take due account of the view of stakeholders based on unbiased findings.
2. Illustrate evidence on verified findings and lessons learned.
3. Exercise honesty, integrity and respect for dignity and diversity.
4. Produce research reports based on fair representation of knowledge, vulnerable groups, gender, and ethnic groups.

The researcher is required to receive consent from participants before involving the enumerators in the data collection process and respect their right to provide information in confidence. Researcher must inform participants about the scope and limits of confidentiality and ensure that all information provided remains confidential. It is mandatory to prepare risk management plans to minimalize potential harm to participants before starting the fieldwork.

Confidentiality

Data collected under this assignment will be treated as strictly confidential. The rights of distribution and/ or publication will reside solely with UNICEF. Data collected cannot be used for any purpose not related to this assignment. The contracted institution will not retain any data related to this assignment after completion of deliverables; all datasets will be transferred to UNICEF.

Dissemination and advocacy of research findings

Researchers must obtain explicit permission from UNICEF prior to disclosing any materials or utilizing data collected under this assignment for other uses beyond this assignment. Data must be securely retained or disposed according to UNICEF’s policy on the disposal of records. 

The communication strategy to disseminate evaluation findings and promote their utilization among relevant stakeholders will include:

• Publishing a final research report plus a 1-page brief and PPT slides to be shared among relevant partners.
• Publishing an article or story covering research findings on UNICEF ACO website and SharePoint in English, Dari and Pashto.
• Holding knowledge exchange meetings including webinars and PowerPoint presentations with relevant stakeholders to share research findings and exchange ideas on utilization of evidence generated.

UNICEF is responsible for monitoring the dissemination of evidence products and the uptake of findings and recommendations by Government and implementing partners. The research results should contribute to evidence-based policy making and programming for children in Afghanistan. 

Specific Tasks

Stakeholders to be consulted during this assignment will include nutrition cluster partners from government (PND; MoPH), UN agencies (UNICEF, WHO, WFP), INGOs, LNGOs, donors, plus policy and frontline health workers at different levels right from the central government, provinces, and districts, right down to communities.

To qualify as an advocate for every child you will have…

• At least ten years’ experience in leading the design and conduct of evaluations/ research of programmes focusing on public health nutrition and ideally experience in fragile countries.

  Experience conducting research or evaluations in the nutrition/health sector programmes, preferably in Afghanistan. 

  Special skills: Experience leading cost effectiveness studies of health and/or nutrition programmes plus Value for Money (VfM) assessments is a distinct advantage.

For every Child, you demonstrate…

UNICEF's values of Care, Respect, Integrity, Trust, and Accountability (CRITA) and core competencies in Communication, Working with People and Drive for Results.

The UNICEF competencies required for this post are...

UNICEF's values of Care, Respect, Integrity, Trust, and Accountability (CRITA) and core competencies in Communication, Working with People and Drive for Results.

Core Competencies

• Nurtures, Leads and Manages People (1)
• Demonstrates Self Awareness and Ethical Awareness (2)
• Works Collaboratively with others (2)
• Builds and Maintains Partnerships (2)
• Innovates and Embraces Change (2)
• Thinks and Acts Strategically (2)
• Drives to achieve impactful results (2)
• Manages ambiguity and complexity (2)

To view our competency framework, please visit here.

Click here to learn more about UNICEF’s values and competencies.

UNICEF is committed to diversity and inclusion within its workforce, and encourages all candidates, irrespective of gender, nationality, religious and ethnic backgrounds, including persons living with disabilities, to apply to become a part of the organization.

UNICEF has a zero-tolerance policy on conduct that is incompatible with the aims and objectives of the United Nations and UNICEF, including sexual exploitation and abuse, sexual harassment, abuse of authority and discrimination. UNICEF also adheres to strict child safeguarding principles. All selected candidates will be expected to adhere to these standards and principles and will therefore undergo rigorous reference and background checks. Background checks will include the verification of academic credential(s) and employment history. Selected candidates may be required to provide additional information to conduct a background check.

Remarks:

Only shortlisted candidates will be contacted and advance to the next stage of the selection process.

Individuals engaged under a consultancy or individual contract will not be considered “staff members” under the Staff Regulations and Rules of the United Nations and UNICEF’s policies and procedures, and will not be entitled to benefits provided therein (such as leave entitlements and medical insurance coverage). Their conditions of service will be governed by their contract and the General Conditions of Contracts for the Services of Consultants and Individual Contractors. Consultants and individual contractors are responsible for determining their tax liabilities and for the payment of any taxes and/or duties, in accordance with local or other applicable laws.