Nutrition Information Systems Consultant- Drought response

In response to the current drought and building forward for future programming, the Ministry of Health has expressed a need for nutrition data that fulfills the following objectives:

1. Improved targeting of interventions, including geographic targeting as well as the ability to predict changes in nutritional status in specific areas and plan accordingly
2. Setting of evidence-based thresholds to trigger different levels of response interventions
3. Demonstration of interventions effectiveness through observed changes in nutritional status of children

The specific objectives of the assignments are to:

 Assess the reliability of routinely collected data for informing decision-making

 Assess the relationship between the different malnutrition indicators, making inferences on interpretation of one indicator in the absence of the other. E.g. Determining the relationship between weight-for-age and weight-for-height to inform better interpretation of weight-for-age data in the absence of weight-for-height data

 Subject to outcomes of the Phase I assessment (refer to Section 3 below), undertake analysis of existing weight-for-age, weight-for-height, height-for-age and MUAC data to fulfill general objectives listed above

 Review and develop an immediately implementable plan for strengthening existing data collection and analysis system to improve quality, strengthen utilization and incorporate WFH and MUAC in the routine data collection, analysis and reporting. The plan must provide adequate specificity at each implementation step, draw lessons from previous bottlenecks related to existing nutrition information system reviews, and clearly outline alternative ways to resolve the barriers in the short term.

1. CONSULTANT SCOPE OF WORK The consultant will be supervised by the Health and Nutrition Specialist for UNICEF Botswana in close collaboration with the Chief of Nutrition & Food Control Division, Ministry of Health. The entirety of the consultant’s work will be done in collaboration with the Nutrition Taskforce led by the Ministry of Health with representation from UNCEF and Research Institutions as may be deemed appropriate

The consultancy will cover 3 work phases, with Phase I being a rapid field assessment and data validation, phase II- analysis of existing routine data covering a period of 12 months and all 28 Health Districts, and phase III- review and strengthening of nutrition information systems to meet set data utilization objectives. Phases I and II (described in Section 3 below) are critical rapid response steps to the current drought, and are therefore particularly time-sensitive. 3

Phase I: Rapid Field Assessment: Validation of data for weight-for-height, weight-for-age and MUAC

 Facilitate planning and progress updates meetings for the taskforce

 Develop methodology and tools, including sampling, for the rapid field assessment and validation exercise

 In collaboration with MoH-Nutrition Division, prepare submissions to the Health Research Unit for expedited ethical clearance or waiver (as may be deemed appropriate by the MoH based on assessment methodology)

 Calibrate anthropometric equipment to be used in the exercise

 Train the taskforce on anthropometric measurements, data collection and recording, quality assurance, and data analysis using recognized data analysis packages for the activity. By the end of the Consultancy, the taskforce should have technical capacity to independently repeat the exercise

 Develop/modify database for entry and analysis of Phase I data

 Develop data handling protocols as appropriate

 Oversee training of data collectors and quality assurance

 Adequately document the process, clearly showing steps at each stage, data and process strengths and limitations

 Test the usability/dependability of routinely collected height measurements

 Analyze stage I data to answer, at a minimum, the following questions:

1. What is the prevalence of acute and chronic malnutrition (and underweight) in these communities (disaggregating by severity)?
2. How do weight-for-age data from this analysis compare to prevalence reported to the MoH. How can the difference be factored-in when interpreting routine data for decision-making?
3. What is the relationship between Weight-for-Age, and Weight-for-Height to aid interpretation of nutritional status changes seen in weight-for-age data in the absence of weight-for-height data
4. What is the relationship between MUAC and WFH in the Botswana context i.e. what proportion of children with acute malnutrition will MUAC pick in the absence of routine WFH measurements? This result will inform whether and how MUAC is built into routine programme data collection and analysis

 Write a report from Phase I analysis and provide technical guidance to Phase II approach based on Phase I results

 Disseminate the findings to key stakeholders

This exercise will serve as a starting point for incorporation of WFH, Height-for-Age and MUAC in routine data collection

Phase II: Comprehensive analysis of routinely collected anthropometric data

 Based on findings from Phase I, provide technical leadership to the comprehensive analysis of routinely collected data which has not been routinely analyzed and utilized

4

 Develop a sampling framework for a statistically representative analysis of routine anthropometric data from all 28 Health Districts, providing technical guidance to the selection of health facilities and individual children

 Train data entry personnel on entry and handling of data for the previous 12 months, overseeing data cleaning and documenting data limitations as appropriate

 Train the taskforce on all stages of Phase II analysis (it is expected that this small group will include Nutritionists, Statisticians and other Nutrition Researchers from different departments and institutions)

 Develop/provide a database for data entry and analysis. The database should be modifiable and useable by the MoH and UNICEF beyond the duration of this consultancy, to enable repeat analysis every 6 months.

 Analyze anthropometric data for all districts over a 12 month period to give an indication pf prevalence of underweight, stunting and wasting (disaggregating by severity)

 Write a report from the Phase II data analysis, with simplified representation of the data for incorporation in reports to the Rural Development Council and other decision-makers

o Drawing from relationships between indicators as determined in Phase I, provide guidance on interpretation of results from Phase II and beyond

o Identify and facilitate linkages of the analysis results to standard governmental assessment processes relevant to nutrition, particularly, the Drought Assessment process, and the Vulnerability Assessment process

 Write a policy brief for use as an advocacy tool with policy makers

 Should the height measurements from Phase I be deemed of poor quality and not usable for the purposes of determining wasting prevalence:

o Use findings from Phase I to analyze weight-for-age data from the 12 months period, facilitating interpretation and setting of intervention thresholds and monitoring intervention effectiveness in the absence of weight-for-height data

o Provide technical guidance on alternative ways to improve the quality of height measurements

Phase III: Incorporation of MUAC, weight-for-height assessments and other programme indicators in the Botswana National Nutrition Surveillance System (or an alternative)

 Review existing nutrition data collection systems/processes in Botswana

 Based on the extent of the relevance and dependability of MUAC to identify acutely malnourished children in Botswana, incorporate MUAC into the routine data collection, analysis and utilization

 Review the frequency of height data collection, analysis and utilization, and incorporate weight-for-height into routine data collection and analysis for monitoring of acute malnutrition (from first point of collection to last point of utility)

 Develop implementation plan for the revised data processes in selected priority districts (to be agreed with MoH)

 Develop a scale-up and monitoring plan for roll-out of the revised system

5

o Propose and define linkages of the improved routine data to standard governmental assessment processes relevant to nutrition, particularly, the Drought Assessment process, and the Vulnerability Assessment process

 Train selected Taskforce members in the implementation processes

4. DELIVERABLES Deliverable

Proposed submission/completion date

Submission format

Inception report, covering all 3 phases of the consultancy (in consultation with key partners)

24th June 2016

Electronic- MS Word document

Feedback and approval of inception report

1st July 2016

Phase 1: Rapid Field Assessment

 Assessment methodology, data handling protocols and tools, including sample size and selection criteria

6th July

Electronic- MS Word document

 Ethical clearance submissions to HRDC (if necessary)

 Taskforce trained on assessment design and data analysis

13th July 2016

 Data collection/field work teams trained (national level)

20th July 2016

n/a

 Data collection/field work teams trained (district level)

5th August 2016

n/a



 Data collection

19th August 2016

 Data analysis report, answering all the specified questions (at a minimum)

5th September 2016

Electronic- MS Word document (for comments)

PDF format- final

 Database with the entered and cleaned data in a useable format for analysis beyond the consultancy(e.g. csv format ready for export to statistical analysis packages)

5th September 2016

To be decided during Consultancy

Phase II: Comprehensive data analysis

 Sampling framework and selection of individual children for phase II data analysis

9th September 2016

Electronic- MS Word document

 Database for Phase II analysis (developed or adapted)

16th September 2016

 Data entry personnel trained

23rd September 2016

 Taskforce trained on Phase II analysis

28th September 2016

 Report of Phase II analysis

14th October 2016

Electronic- MS Word document (for comments)

PDF format- final

 Policy brief on nutritional status for advocacy with policy makers

18th October 2016

Electronic- MS Word document (for comments)

PDF format- final

 Feedback and finalisation of report and policy brief

25th October 2016

HOW TO APPLY:

Interested candidates should apply via UNICEF's e-Recruitment. Please indicate your ability, availability and daily/monthly rate (in US$) to undertake the terms of reference above (including travel and daily subsistence allowance). Applications submitted without a daily/monthly rate will not be considered.