BASELINE ASSESSMENT FOR THE IMAM SURGE PILOT IN MARSABIT AND ISIOLO COUNTIES.

Background and context

While Kenya has continually seen improvement in nutrition indicators including improvements in dietary diversity, one notable counter trend was the prevalence of wasted children. Acute malnutrition rates in northern Kenya remain poor, and too frequently remain at or above emergency levels. Rates frequently fail to improve even when households’ access to food and quality healthcare improves. USAID is funding investment to tackle persistent acute malnutrition in Kenya, recognising that this problem requires an approach that goes beyond short-term humanitarian response and must tackle the immediate and underlying causes of acute malnutrition through integrated, multi-sectoral activities that leverage ongoing emergency and development activities.

The USAID-funded Nawiri project is a five-year (2019-2024) evidence-based development program working in Isiolo and Marsabit counties in the Arid and Semi-Arid Lands (ASAL) of Kenya. The project aims to research the local drivers of persistent acute malnutrition and to design interventions that are rooted in evidence, contextually informed, and viable for implementation and scale up. Phase 1 of Nawiri entails collaborative learning & design to inform programming (2019 – 2021). Phase 2 focuses on scale up of implementation (2021-2024). The Nawiri programme is jointly implemented with County Governments (Isiolo and Marsabit) and Nawiri partners. The partners led by Catholic Relief Services (CRS) are; Concern Worldwide, Tufts University, Village Enterprise, Global Alliance for Improved Nutrition (GAIN), The Manoff Group, IBTCI and Caritas-Isiolo and Marsabit. Concern is the health and nutrition partner lead in Nawiri.

Services for the integrated management of acute malnutrition (IMAM) are provided at health facilities for children who are wasted/ suffer from acute malnutrition as part of the Kenya package of essential health services. Community Health Volunteers (CHVs) screen and refer wasted children to health facilities. IMAM Surge is an approach adopted by the Kenyan government in 2015 to help government teams at the health facility and County/ Sub-county level better anticipate, plan for, and respond to seasonal peaks in caseloads of children with wasting/ acute malnutrition. For more on the IMAM Surge approach in Kenya please see this article in the Field Exchange and for more on the CMAM/ IMAM Surge approach generally, please see additional articles in the Field Exchange and the Concern CMAM Surge website.

Within the Nawiri project, Concern is leading a pilot focused on “*strengthening health facility and community resilience through an expanded IMAM-Surge approach.* The Nawiri IMAM-Surge pilot has two components. The first will explore how IMAM Surge analysis of caseload trends at facility level can be used to inform community level actions to improve timely screening and referral and to actually prevent the seasonal spikes in acute malnutrition/ wasting among children at certain times of the year. The second component is a trial of expanding the IMAM Surge approach to improve the management of seasonal illnesses in addition to acute malnutrition. The pilot should generate learning on the acceptability, feasibility, and added value of these two adaptations to the current IMAM Surge approach, as well as the advocacy actions needed to support their scale up. The findings will inform the final design of a context-appropriate programme to be scaled up during implementation phase to reduce the burden of malnutrition.

Objective of the baseline assessment

The objective of the baseline assessment is to establish values for the quantitative indicators that will help answer the main research questions for the two pilot components (see Annex 1 & 2) and to generate qualitative perspectives and observations from key stakeholders before the pilot activities commence. The baseline information will help refine the final pilot design to optimise acceptability, relevance and feasibility; allow the Nawiri project to assess changes associated with the pilot activities; and make inferences as to the potential effectiveness of the adapted IMAM Surge approach.

Justification

Concern Worldwide is the lead partner for health and nutrition in the Nawiri consortium and is responsible for undertaking the pilot in Isiolo and Marsabit counties. Concern seeks the services of an experienced consultant(s) to conduct the assessment in Isiolo and Marsabit Counties. **

Technical Approach and Methodology

Guided by the Pilot Scope of Work approved by USAID, the consultant will collect the baseline information for the final set of indicators agreed by Concern Worldwide. The current list of research questions and indicators can be found in Annex 1 and 2.

The baseline assessment will include primary data collection and secondary data analysis of relevant health and nutrition indicators. Primary data will be collected through KIIs and FGDs with community health workers, community members and health facility staff, Assessment/ observation tool and client exit interviews. Secondary data will be compiled from the Kenya Health Information System (KHIS) and previous surveys conducted for both Marsabit and Isiolo counties.

Specific Tasks;

The Consultant is expected to undertake the following guided by the TOR:

· Secondary Data Analysis: Undertake secondary analysis guided by the assessment objectives and pilot components outlined in the Annexes of this TOR

· Design and Tools: Design the baseline survey methodology and tools focusing on the assessment objectives

· Training: Train data collectors and the baseline assessment team in Isiolo and Marsabit

· *Assessment Oversight and field level activitie*s: Provide oversight of the baseline assessment field level activities-data collection(KII/FGDs etc.), supervision, data analysis and reporting

· Reporting and dissemination-ensure timely and quality baseline reports and presentations as per the TOR deliverables

Outputs and Deliverables

The following are the deliverables expected of this assignment

· Inception report demonstrating understanding of task and outlining the specific assessment methods proposed and enumerator training plan (to be agreed with Concern Worldwide).

· Baseline assessment report detailing the results for all quantitative indicators, qualitative areas of inquiry and key findings (including a concise executive summary).

· A concise power-point presentation for dissemination of the findings.

Timeframe

The following Gantt chart presents the key milestones of the consultancy.

No Activity Description Timelines

1 Recruitment of consultant Week 1 and 2

2 Inception meeting & report Week 3

3 Review of the existing data and analysis Week 4 and 5

4 Field work and field data collection week 4 and 5

5 Draft 0 report -Concern review Week 6 and 7

6 Draft 1 report – wider NAWIRI review Week 7

7 Dissemination Week 8

It is anticipated that the consultancy will take 30 working days. The Consultancy will run from the month Mar to Apr 2021.

Remuneration

Concern will pay the consultant a facilitation fee per day for twenty working (30) days. Indicate your rate per day.

The payment is subject to withholding tax and other requirements under the Laws of Kenya.

Working conditions

The Consultant is expected to work at the direction of Concern Worldwide. Internally s/he will closely work with Concern Worldwide Nawiri team – Project Lead, Senior Advisor-Health and Nutrition, and Nutrition Technical Specialists. Externally, the Consultant will interact with other Nawiri partners that includes Tufts University and Catholic Relief Services among other consortium members. At the county level, the Consultant will liaise with County/ Subcounty- Nutrition Officers/ Coordinators in Marsabit and Isiolo Counties. The Consultant will also engage with staff from the Ministry of Health (MOH) and other national government departments as lead by Concern.

Qualifications

· A master’s degree in Nutrition, public health, health systems, or relevant qualification

· At least 7 years’ experience working in the field of humanitarian/ development programmes on nutrition or health programmes and/ or related assessment and M&E.

· Strong experience in quantitative data collection and data analytics, statistics and related packages-SPSS, EpiInfo, Stata and other relevant applications

· Strong experience in qualitative research, including the design, implementation, analysis and interpretation of focus group discussions (FGDs), key informant interviews (KIIs), observation walks/ visits and other participatory methods.

· Experience with MOH reporting tools and systems: KDS/DHIS-2 etc.

· Analytical and critical thinker with ability to critique and synthesize secondary data

· A good command of spoken and written English

· Solid experience in health and nutrition sector in Kenya is desired.

· Previous experience undertaking baseline assessments for reputable international NGOs and or leading public health universities is highly desired.

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