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Terms of Reference – Consultant Process Evaluation – Lishe Poa
1. Background and Context
Undernutrition is responsible for contributing to 2/3 of all under-5 mortality worldwide, which in 2017 stood at 5.6 million child deaths per year. Most child deaths (40%) occur in Sub-Sahara Africa with six countries (Nigeria, Democratic Republic of Congo, Ethiopia, Tanzania, Uganda and Kenya) accounting for 50% of child deaths in Sub-Sahara Africa. Specifically, acute and chronic malnutrition in children under the age of five remains as important public health problems in Kenya. The Child Survival and Development Strategy indicates that 50% of all under-five mortalities in Kenya are associated with malnutrition. Malnutrition is the most recognizable and perhaps most serious consequence of poverty in children. The Kenyan urban population growth is estimated to have been 5% annually over the last decade compared to the average population growth of Sub Saharan Africa, which is estimated at 2.3% annually.
A SMART survey assessment carried out in the informal settlements of Nairobi in January 2020 revealed that 24% of children under five years are stunted, 3.9% of children under five are wasted and 38.9% of children had diarrhoea, with only 12.5% of caregivers practicing handwashing at critical times. To address these factors contributing to under nutrition, Concern Worldwide, in collaboration with the Ministry of Health, Nairobi City County, and other partners is implementing an innovative public-private partnership program called the Lishe Poa project. The project aims to address;
a. Limited household food security
b. Poor maternal, infant and young child feeding practices. Diets fed do not meet the nutrient density requirements especially iron, zinc, Vitamin A&C and proteins.
c. High disease burden; poor access to safe water, sanitation and hygiene facilities
d. Non-optimal breast-feeding practices; non-optimal complementary feeding; non-optimal care/ poorly managed day care centers.
The Lishe poa project (‘Lishe Poa’ is Swahili for good nutrition). The project’s objective is to improve access to, and consumption of affordable nutritious snacks among young children and pregnant and lactating women (PLW) in urban informal settlements of Nairobi. In order to achieve the project objectives, a hackathon was held to identify the most suitable product. From the hackathon, three products were selected and scrutinized by the Project Steering Committee, after which two products were approved and subjected to acceptability tests to the targeted beneficiaries. Hence, the next phase of product refining, manufacturing and scaling up which will require engagement with a private manufacturer to produce, distribute, market, quality control and improve the product value chain in the targeted informal settlements.
The purpose of the terms of reference therefore is to recruit a consultant to guide the process evaluation to determine the impact of low cost, ready to use food snacks on the health and nutrition status of children aged 6 – 59 months. Various indicators, including malnutrition rates, hygiene practices and incidence of diarrheal diseases, will measure impact. By reviewing baseline and endline data and collecting relevant quantitative and qualitative data throughout the life of the project, the process evaluation will aim to answer the following:
a. To what extent did the project (including the food snack itself, its production and distribution and the complementary behaviour change promotion activities) improve the nutrition status of the target population?
b. To what extent did the project improve the feeding practices, food knowledge and dietary intake of the target population?
c. Did the activities related to the food snack – including its consumption – influence the socio-economic status of the target populations and their households?
d. Have all activities been implemented as planned, were outputs delivered and were they received and used by the intended target groups?
e. Which activities appear to be the most acceptable, relevant, effective and efficient? Which have been less so and how could they be improved for the future?
f. Has the food snack influenced policy and stakeholder investment if yes/ no, why/ why not?
g. Are there signs that the project activities and results could be sustained, including production of the snack and distribution/ consumption by the most vulnerable – if which activities are contributing the most, why and what needs to be adjusted for the future?
Given the multi-sectoral nature of this project, the five-year time frame and the novel approach of engaging the private sector to improve nutrition of the most vulnerable, an investment in a process evaluation is warranted. There is a need to follow project activities, delivery of outputs, engagement of different stakeholders; to understand if the approach is working; and to adjust activities and approaches if it is not. The process evaluation will be integral to a results based management approach to implementation.
A before and after study using process evaluation will provide more in-depth information regarding the intervention. Due to existing Monitoring and Evaluation plans, the team will understand the impact of the food snack, which will be informed by baseline and end line evaluations in intervention sites. This provides a ‘before and after’ picture of the nutrition status and provide an understanding of the food-snacks’ contribution. A process evaluation methodology will be used to better understand the implementation of the intervention, and work to understand outcomes of this intervention. The proposed approach is the RE-AIM Framework http://www.re-aim.org
RE-AIM, which stands for ‘Reach, Effectiveness, Adoption, Implementation and Maintenance’ is a process of evaluation, which supports implementers and researchers to pay attention to essential programme elements that can improve sustainable adoption and implementation of effective interventions. By exploring each of the 5 elements, RE-AIM translates research into action, which can help programmes translate and improve findings into more ‘real world’ actions. This study proposed to utilise several methods and tools, all aligned to understanding the 5 elements of RE-AIM, to answer the research question and provide important implementation considerations for the Lishe Poa project.
These will include:
a. Existing M&E plans, including baseline and end line KAP/SMART Surveys. This will help us understand Reach and Efficacy.
b. Focus group discussions with community members including caregivers and vendors to ascertain acceptability, barriers and adoption
c. Key informant interviews such as programme staff, MoH and food suppliers, to understand maintenance and implementation. Maintenance will also be understood through addressing Objective 3 within Lishe Poa and its associated M&E indicators.
d. Document reviews will be used to understand implementation process, specifically fidelity, and assess the project across the theory of change.
5. Outputs and Deliverables
A consultant with experience in process evaluations and practical nutrition programme is expected to deliver the following outputs.
a. Output 1: Develop a clear understanding of the Process evaluation using the RE-AIM approach; 2 days; Apr 2021
b. Output 2: Develop a clear study design;1 day; Apr 2021
c. Output 3: Present and get approval from the Nutrition Information Working group and the Research TWG in the division of nutrition and dietetics; 1 day; Apr 2021
d. Output 4: Develop and successfully submit an Ethics Research protocol to a suitable IRB; 4 days; Apr 2021
e. Output 5: Undertake regular review of the project implementation in line with the process evaluation and as part of the larger project steering committee; 8 days (2 days per quarter); April 2021 – March 2023
f. Output 6: Support the development of suitable peer reviewed publications, learning, policy and project briefs throughout the implementation of the project; 4 days; April 2021 – March 2023
g. Final evaluation: 10 days; April – June 2023
Please provide your Consultancy rate per day
7. Desired Qualifications/Specialized Knowledge
8. Working Conditions
Concern will manage the consultant and day-to-day activities of the process evaluation, including data collection and compilation and regularly report back to the sub-committee. Key staff who may present/ interact with the PE-SC include the Program Director, Health and Nutrition Coordinator, Technical Advisors, and M&E staff.
 A baseline SMART and knowledge, practice and coverage (KPC) survey has already been undertaken to establish baseline values of some key indicators.
Concern has an organisational Code of Conduct (CCoC) with three Associated Policies; the Programme Participant Protection Policy (P4), the Child Safeguarding Policy and the Anti-Trafficking in Persons Policy. These have been developed to ensure the maximum protection of programme participants from exploitation, and to clarify the responsibilities of Concern staff, consultants, visitors to the programme and partner organisation, and the standards of behaviour expected of them. In this context, staff have a responsibility to the organisation to strive for, and maintain, the highest standards in the day-to-day conduct in their workplace in accordance with Concern’s core values and mission. Any candidate offered a job with Concern Worldwide will be expected to sign the Concern Staff Code of Conduct and Associated Policies as an appendix to their contract of employment. By signing the Concern Code of Conduct, candidates acknowledge that they have understood the content of both the Concern
Code of Conduct and the Associated Policies and agree to conduct themselves in accordance with the provisions of these policies.
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