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Seeking consultant - Final Evaluation of CMAM project, Tigray, Ethiopia (World Bank funded)

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Kate Golden

Senior Nutrition Advisor/ Concern Worldwide

Normal user

8 Aug 2013, 12:32

1. Project Summary The Piloting Community-Based Management of Acute Malnutrition Project, funded by World Bank-Japanese Social Development Fund and implemented by Concern Worldwide Ethiopia, began in August 2009 and aims to support the Ethiopian Government in the national scale up of community-based management of acute malnutrition (CMAM) and the improvement of nutrition outcomes in Tigray Region. The project has been supporting the Regional Health Bureau (RHB) in five woredas in Tigray to integrate CMAM into the primary health care services since August 2009. In June 2011, the project was expanded to a total of 24 woredas in four of the five zones, out of the total of 46 woredas in Tigray. It will phase out in early January 2014. When the project was originally developed and approved, the government was not allowing treatment of uncomplicated severe acute malnutrition at health post level. The operational research component was therefore designed to demonstrate that the outpatient therapeutic programme (OTP) delivered at health post level by health extension workers (HEWs) was feasible and could achieve the same treatment outcomes as those achieved at health centre level, while achieving much greater coverage. However, shortly after signing the World Bank contract, the government policy was changed to allow expansion of OTP to health posts across the regions. The project components, including the operational research, and the logistical framework were revised in late 2010 to fully support the expansion of OTP to health posts as the main focus. The project provides technical and some logistical assistance to implement optimal services for the management of SAM at health facilities. The basic support package consists of theoretical and on-the-job training of health staff on in-patient and outpatient management of severe acute malnutrition, as well as monitoring and reporting; joint supervision of CMAM services; planning and review workshops and experience exchange visits; and some hardware and logistics support for health facility and community-level services such as Child Health Days. The project strategy has been to provide either a minimum support package or a maximum support package to each woreda. The minimum support package (5 woredas) focuses on the above up to the health centre level only. The maximum focuses on the same support delivered to the more decentralised health post level, which generally requires additional resources due to distance and cadres of staff involved. In total, 107 health centres in all 24 supported woredas are included in the programme. This includes sixty two health posts in five woredas receiving maximal support. The designation of woredas as needing maximal or minimal support and to be the focus of more in-depth operations research was made at the request of the Tigray Regional Health Bureau, based on the most vulnerable woredas. Currently, linkages between the treatment of severe acute malnutrition (SAM) and promotion of optimal nutrition practices at community and health post level are not well defined. Training materials and job aids to help HEWs effectively treat and prevent SAM and promote optimal infant and young child feeding (IYCF) practices among the same communities have been lacking and fragmented. As a result, opportunities to promote improved nutrition and influence nutrition outcomes at key contact points, such as SAM treatment services, were being missed. The World Bank project has attempted to address this, largely by promoting key IYCF messages during CMAM contact points. In order to strengthen the approach and extend the reach beyond CMAM beneficiaries, a concurrent IYCF project (funded by Micronutrient Initiative (MI) and ending in 2015) was developed and is being implemented in coordination with World Bank CMAM activities in seven woredas. The MI project activities are aimed at improving the nutrition knowledge, capacity and actions of HEWs to recognise and treat/refer children suffering from SAM and help to prevent malnutrition through promotion of optimal IYCF practices. The consultant is not expected to evaluate the MI IYCF project, but to consider the effectiveness of the World Bank project’s objective to prevent undernutrition in the context of the wider MI project which aims to both complement and add value to the o the World Bank CMAM project. The goal of the project is to contribute to the reduction in morbidity and mortality due to severe acute malnutrition amongst children under five years of age in Ethiopia. The project has four main components: 1) To develop local capacity to implement quality CMAM 2) To identify specific barriers and opportunities to optimise CMAM implementation through operational research on key impact pathways 3) To contribute to the improvement of nutritional intervention modalities through sound operational research on key topics 4) Monitoring, evaluation and dissemination 2. Overall objective The overall objective of this assignment is to undertake the final evaluation of the Piloting Community Based Management of Acute Malnutrition Project to assess the effectiveness, appropriateness and impact of the intervention and, specifically, whether the project has achieved its stated goal to contribute to the reduction in morbidity and mortality due to severe acute malnutrition amongst children under five years of age in Ethiopia. All components of the CMAM project will be evaluated in terms of its processes and achievements, the extent of project integration with the Ethiopian national health services and coordination with other partners. In addition, the nested MI IYFC project will be reviewed to assess the appropriateness and complementarity of the interventions within CMAM service delivery, as an entry point to promote optimal infant and young child nutrition and childcare practices with the aim of contributing to the prevention of chronic malnutrition. The evaluation will assess the CMAM project from its beginning in August 2009 up to the time of the evaluation and review the MI IYCF intervention from July 2012 to date. Recommendations will be made for future interventions and challenges as well as lessons learnt, documented. 3. Specific objectives The key specific objectives of this evaluation are to assess: 3.1 The relevance of the project: a) Did we choose the right thing to do in the context of Ethiopia? b) Is the project in line with the needs and priorities of those targeted and were the targeting criteria followed? c) Is the project consistent with the policy and strategic direction of the Government of Ethiopia? d) Are the activities and outputs, as reflected in the project proposal, consistent with the overall goal and components? e) Are the overall goal and components of the project still valid? f) Were the assumptions in the project proposal reasonable and appropriate? g) Were the operations research topics selected most relevant to improve policy and practice of nutrition programming? 3.2 The effectiveness of the project: a) To what extent were the components of the project, as in the project proposal, achieved? In terms of treatment outcomes, coverage, capacity building. b) Were the activities sufficient to achieve the component deliverables/outputs? c) What are the major factors influencing the achievement or non-achievement of the project components? d) Are the assumptions as reflected in the project proposal still valid? 3.3 The efficiency of the project: a) Was the project cost effective? b) Was the coordination between the Concern Worldwide Ethiopia team, Tigray Regional Health Bureau, zonal and woreda health offices, other international NGOs, UN agencies and government organisations effective? c) Was the engagement with these desirable and/or possible? 3.4 The impact/sustainability of the project: a) Did the project achieve what it set out to achieve? b) What positive changes are observed in the lives of the target group as a result of the implementation of the project? c) Did the response reduce future vulnerabilities, particularly to acute malnutrition, both in Tigray and nationally through operational research and, subsequently, policy influence? d) Are there factors that impede the achievement of the overall project goal? e) What are the unintended positive and negative impacts of the implementation of the project? f) What measures have been and can be taken to eliminate or reduce the negative impacts, if any? 3.5 The adherence to external standards for CMAM programme quality, particularly national and Sphere standards for coverage and performance of CMAM programmes and also for standards for operational research. 3.6 The adherence to the Programme Participant Protection Policy with specific focus on activities involving children. 3.7 The monitoring and evaluation system and the appropriateness of the indicators used for this purpose. 3.8 With reference to accountability to beneficiaries: a) Were appropriate mechanisms developed to enable health staff at all levels and communities to actively participate in the design, planning, implementation and monitoring of the project? 3.9 The extent to which lessons learned or recommendations from reviews/ field visits/ regional annual workshop of the project were incorporated into this response. 4. Specific issues to be evaluated 4.1 Assess the degree to which management and monitoring systems for CMAM have been efficiently integrated into existing health and community systems and their potential to be sustained by the regional, zonal and woreda health teams and community networks – identifying any barriers/successes. 4.2 Assess the effectiveness of the training packages and materials developed to build skills and capacity of counterparts at various levels and suitability/ ease of replication. 4.3 Assess the project’s coverage of SAM within the woredas (CSAS coverage survey will have been conducted and results available by the time of the evaluation) and potential ‘barriers’ or ‘boosters’ of coverage for future consideration. 4.4 Assess the degree to which the CMAM maximal support package was effective in the five woredas versus the minimal support package offered elsewhere. 4.5 Assess the appropriateness, relevance and use of the operational research. 5. Methodology The consultants are expected to present, in detail, their approach, methodology and tools, with an action plan and time frame that addresses the expected outputs, with reference to the overall and specific objectives. Concern and the consultants will agree upon this methodology and will continue to adapt as needed throughout the evaluation process. 6. Expected outputs • De-briefing meeting on the preliminary findings with Concern Worldwide and partners before submission of the draft report • Comprehensive draft evaluation report (in both hard and electronic format) written in English to maximum 30 pages, excluding annexes, that will contain the following: o A stand-alone executive summary - maximum three pages o Introduction o Methodology o Analysis of main findings o Targeted recommendations o Lessons to be learnt, best practices and challenges faced • Final evaluation report based on Concern Worldwide, donor and partners’ feedback - same report criteria as draft report applying. 7. Reporting In all matters relating to the evaluation, the consultant team leader will communicate with the Director of Programmes and the World Bank Project Coordinator at Concern Head Office every two weeks to discuss the progress of the evaluation and the challenges, if any. The Terms of Reference and proposed time frame will serve as the basis for monitoring the progress of the final evaluation. 8. Proposed time frame The evaluation is expected to start during the last two weeks of September 2013, with the field work taking place from the end of September into October. The preliminary draft report is expected by the 15th November and submission of the final report must be by 10th December 2013, after adjustments have been made in respect of the stakeholder comments received. 9. Evaluation team profile The evaluation team will include an international consultant. Required qualifications: • An experienced consultant or team, or legally registered consulting firm with a renewed license and TIN number, with an understanding of evaluation of complex projects, operational research principals and approaches in the nutrition and health sector. • Knowledge of the Ethiopian context, including policy and programming, including: National Nutrition Programme, Health Extension Programme and other associated policies. • Extensive knowledge of CMAM and IYCF activities, especially capacity building approaches. • Understanding of health systems • Ability to communicate clearly with a wide range of stakeholders. • Good understanding of development issues and the context in Tigray region. • Previous experience working with international NGOs. • Excellent writing skills in English. 10. Costs Covered The funding can be used to pay for salaries and travel costs that are related to meeting the project evaluation objectives. 11. Process, next step If you are interested to apply for this consultancy, please submit an expression of interest and your CV to Anita McCabe at by Thursday 15th August. You will be provided with some additional documents and be asked to submit an action plan to outline your method, approach, timeframe and expected daily rate. A decision will be taken based on the quality of these proposals.

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