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Baseline survey consultancy for Concern Worldwide nutrition project, Karamoja, Uganda in Q3 2016

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Gudrun Stallkamp

Regional Nutrition Advisor/ East & Southern Africa

Normal user

15 Jun 2016, 14:25

Concern Worldwide in Uganda has an interesting opportunity for a baseline survey consultancy in a new nutrition project in two districts in Karamoja, Uganda. Please see below the TOR with background on the project, specifics on the survey and what we're looking for, as well as on how to submit your expression of interest.
We look forward to your applications!

Terms of Reference

Consultant for Baseline of the Concern Progressing Nutrition in Karamoja (PNK) project

1. Overview
Concern Worldwide Uganda is implementing a three year nutrition project (2016 - 2019) that focuses on the prevention and treatment of malnutrition in Moroto and Amudat Districts in Karamoja through two approaches: Mother Care Groups and the Surge approach. The project is funded by the Eleanor Crook Foundation (ECF). The design of the proposed project is informed by Concern’s experience in working globally in the nutrition and specifically in working with communities and health services on nutrition in the challenging context of Karamoja. The project is being implemented in two districts: Moroto (Moroto Municipality and Tapac subcounty), and Amudat (Loroo subcounty).

2. Context
Concern Worldwide has been operational in the Karamoja region since 2009. Karamoja consistently has the worst health and development indicators in Uganda with 79% of households living in absolute poverty. Karamoja has the highest under-five mortality rates in Uganda with extremely poor child health and nutrition indicators. Stunting is a 45%, underweight at 33% and wasting at 7% (Uganda DHS 2011). Access to health care is limited with 49% of population living more than 5km from the nearest health center. Poverty in Karamoja is strongly linked to its fragile mix of pastoralism and small scale subsistence farming livelihood systems, both of which are vulnerable to frequent shocks. Frequent prolonged periods of drought and erratic rainfall continue to negatively affect this region, leading to low harvests, deficits in water and pasture availability and early migration of livestock. The overall impact is seen through chronic food insecurity and malnutrition. Nearly half of all households are food insecure. Food insecure households are defined as having inadequate food consumption, lacking dietary diversity and expend the majority of their income food.

3. Project background
The project will take a two prong approach to address prevention and treatment of malnutrition in Karamoja through two approaches: the Mother Care Group approach and the Integrated Management of Acute Malnutrition (IMAM) Surge approach.

Under the first approach, Concern will form and train Mother Care Groups to improve health and nutrition practices among pregnant women, lactating women, and women who are caregivers for children under 5 years of age to reduce the acute malnutrition levels in Moroto and Amudat districts. Each Lead Mother, supported by Concern staff, will engage the members of her household caregiver group on behavior change lessons related to two key project objectives:

i) Improve Infant and Young Child Feeding (IYCF) and child care practices at the community level;
ii) Increased availability of food from newly established kitchen gardens at the household level

The second approach focuses on treatment of malnutrition by employing Concern’s IMAM Surge approach, which improves health staff planning and management of severe acute malnutrition cases during periodic spikes or ‘surges’ presented at health facilities. IMAM-Surge enables health facility teams to determine when increased caseloads are expected and to agree on different caseload thresholds based on their assessment of the health facility’s capacity to cope, which when exceeded, trigger a set of pre-determined actions to enable health facilities to respond accordingly. PNK will implement IMAM-Surge across 23 health centers in two districts of Moroto and Amudat with the overarching goal of preventing morbidity and mortality amongst children 6-59 months suffering from severe acute malnutrition. Building the capacity of districts officials and health facilities to plan, predict and respond to high level spikes in acute malnutrition is the first objective of the IMAM Surge approach. The other objective is to improve identification, referral and defaulter tracing of children with severe acute malnutrition through using Lead Mothers. Thus, this second objective links both the MCG and the IMAM Surge approach. Lead Mothers will be trained on taking mid-upper arm circumference (MUAC) measurements to screen and identify potentially at-risk children and refer them to Village Health Teams for onward assessment and referral into for supplementary and therapeutic feeding programs that are integrated at health facilities or implemented through support by WFP (external to the PNK project). Lead Mothers will also support the follow up of children admitted to the outpatient therapeutic care (OTC) program and support the tracing and follow-up of children defaulted from the OTC program. The second approach operates based on two objectives:

i) To build capacity of district and health facility to plan, predict and respond to high level spikes of acute malnutrition through the IMAM Surge Model;
ii) To improve identification, referral and defaulter tracing of children with severe acute malnutrition through Lead Mothers

Overall, the PNK project is operational in Loroo subcounty in Amudat District, Tapac subcounty in Moroto District and Moroto municipality. The PNK project will target 32,197 people comprising 1,200 Lead mothers and approximately 14,000 caregivers; 28,000 children (based on an estimate of 2 children in the 0-5years age cohort during the 3 years of the program); and approximately 70 health care staff (staff of 23 health centers). It is estimated that 1,527 children will be admitted to therapeutic care (OTP & ITC) over the course of the project.

4. Objectives of baseline consultancy
The overall objective of the PNK baseline survey consultancy is to provide quantitative estimates of all project indicator values specified in the project M&E plan (Annex 1), based on a household survey conducted among a statistically representative sample of the population living in the PNK project area.

The specific objectives of the baseline survey consultancy are to
* Support the survey tools finalization considering internationally recommended standard data collection methods for the project indicators (Concern will provide a near final draft)
* Support the sampling plan finalization (Concern will provide a near final draft of scenarios and the sampling frame) and execute the sampling (site selection)
* Train enumerators on the survey tools, anthropometric measurements and the related standardization test, the use of the digital data gathering devices (with support by Concern), second stage sampling, good data collection practices, and data quality control
* Lead (supervise) the data collection of the approximately 27 indicators (Annex 1) across the project area
* Clean and analyse the data, including standard procedures for cleaning and calculation of anthropometric measurements using the SMART software
* Debrief Concern and ECF teams
* Write and finalise the survey report, including related data and documentation.

5. Methodology
The baseline survey will follow an adapted SMART method. Sampling and data management and analysis of anthropometric data will follow the SMART method, using the latest version of the ENA for SMART software. The survey will also draw on the KPC survey methodology, and will adhere to internationally recommended ways of collection information, e.g., for the infant and young child feeding indicators. Analysis of indicators other than those analyzed with the ENA for SMART software will be analyzed using Epi-Info for Windows or other suitable software packages that can analyze complex samples and account for a design effect >1. The survey will be a population-based, household level survey using multi-stage cluster sampling. Second stage sampling will follow the latest SMART method recommended procedure.

Concern will support the survey design in the following way.
* Concern will calculate sampling scenarios for the key most top level indicators and will select the most feasible scenarios. The selection will be made considering the following: ability to measure as many key indicators as possible within a reasonable sample size (presumably something between 600-1000 HH). The consultant will have the opportunity to check this in case there are any doubts or suggestions to improve scope and efficiency of the sampling.
* Concern will prepare the sampling frame for the project. The consultant will have the opportunity to check this in case there are any doubts.
Note: using the above, the consultant will execute the sampling.
* Concern will select and contract the enumerators for the survey
* Concern will prepare a near final draft of the questionnaire drawing on its organisational DDG pre-programmed questionnaire formats. Note: Concern has prep-programmed questions for all key indicators across programme sectors, including most of the indicators that the M&E plan contains. The methods for assessing these indicators follow international recommended practice; for nutrition/ health/ WASH indicators, for example, they follow the WHO IYCF indicator guidance, KPC 2000 indicators, or indicators listed in the NPDA tool. The consultant will have the opportunity to check this in case there are any doubts or suggestions to improve scope and efficiency of the survey tools. The timing for this will be a number of weeks ahead of the actual survey work in Karamoja. This is because we have to allow for a dry run with the DDG devices following a recent switch to new DDG platform. Due to the switch and in view of quality assurance as well as survey efficiency, we require a number of quality and risk control measures, such as in-depth functionality check of the survey tool on each device, the data upload and subsequent data export into e.g. ENA for SMART.

6. Duties and responsibilities of the consultant
The consultant will, in coordination with the Concern Worldwide Uganda team:
* Undergo online course in Digital Data Gathering technology by Concern Worldwide (access will be provided prior to arrival in country/ survey site, course takes a few hours)
* Conduct a desk/document review of currently available documents, including project proposal, M&E plan
* Support the finalization of the survey tools
* Support the finalization of the sampling and execute the sampling/ site selection
* Train enumerators and supervisors
* Support logistical and operational organization of the survey
* Supervise data collection process across the PNK implementation area: supervision of enumerator teams, daily data quality checks with appropriate feedback to improve data collection
* Conduct preliminary data cleaning and analysis using Epi-Info, STATA, SPSS, or other statistical software that is able to account for a design effect >1/ complex samples.
* Provide debriefing in Moroto/ Karamoja to the project team and others as relevant and identified by Concern Worldwide
* Present key findings at a feedback meeting to Concern Uganda Country Management Team at the Concern Uganda Head Office; a phone debriefing Skype call with ECF can be arranged.
* Prepare and submit the baseline survey report, including incorporation of feedback from the program team.

7. Expected Outputs
* Training tools/ module for the survey.
* Final sampled survey sites.
* Provide feedback during debriefing of project staff in Moroto, which will include sharing of preliminary survey findings.
* Debrief in Concern Kampala Head Office with Country Director and Country Management Team on the baseline findings.
* A detailed written final survey report in English language (maximum 35 pages without annexes), submitted in both two electronic and three hard copies following the format outlined (Annex 2), that includes major components such as Executive Summary, introduction, methodology, findings and conclusions/ recommendations. The report must be written in English language based on the structure specified below.
* The raw and cleaned data sets and variable codebook of the baseline survey in a widely readable format, such as MS Excel.
* An electronic folder of softcopies of all tools or documents developed during the baseline process, including but not restricted to questionnaires, sampling documentation, training tools and documentation.

8. Key competencies of the consultant
* The consultant must hold at least a Master’s Degree in Nutrition, Public Health Nutrition and/or Health related disciplines or Social Sciences/ Epidemiology/ Monitoring and Evaluation with a strong Nutrition/Health bias and have extensive international experience of Nutrition/Health programming.
* He/she must have proven experience of not less than 7 years in nutrition surveys and project evaluations (and at least 4 years of leading them), including large scale quantitative surveys of donor funded nutrition and health projects.
* Excellent skills in quantitative sampling and statistical analysis for nutrition and health related surveys, including analyses of surveys with complex sampling, e.g., use of ENA for SMART, EPI Info, SPSS, STATA, etc.
* Able to use the ENA for SMART software package for survey planning, cleaning, analysis and reporting in relation to anthropometric data
* Experience in organising the logistics and operational tasks of cross-sectional surveys
* Possesses knowledge of electronic data collection and willingness to familiarise themselves with the process and devices that are specific to Concern.
* Strong communication skills.
* Ability to work independently with minimum supervision.
* Aware of the latest developments in the area of nutrition and assessment methodologies.
* Fluency English, with excellent English report writing skills.
* Consultant must be able to provide evidence of past performance via past enumerator training programs and evaluation reports as well as writing examples.

9. Use of software package and computer
The consultant will be responsible for supplying her/his own laptop, including appropriate statistical data analysis software. The software package used must allow for analyses of surveys with complex sampling strategies (application of a design effect > 1).

10. Time Frame
The baseline will cover a total of 30 working days from 18 July to 16 September 2016.
The final report should be submitted by 16th September2016.
A suggested draft schedule of the survey process is provided in Annex 3.

11. Lines of communication.
The consultant will report to the Uganda Programme Director. The consultant will liaise closely with other key project staff namely, the Project Manager, Monitoring and Evaluation Specialist and Senior Nutrition Advisor.

12. Fees/ costs
The consultant will propose the total cost within their Expression of Interest (EOI).

13. Application Process
Consultants interested in this opportunity should develop an EOI including: (1) methodology, (2) cost proposal and (3) consultant’s CV, highlighting relevant past evaluation experience and capability of what types of statistical analysis. Two writing samples for proof of previous experience will be required from short-listed candidates if not submitted alongside the EOI. The application files should be submitted GMT Sunday 26th June, 2016.

The methodological proposal should include the consultant’s understanding of the TOR, proposed sampling methodology, including second stage sampling and estimated sample size , any methodological needs not addressed by this TOR, staff (enumerator) needs and a detailed estimated timeline/ work plan for the activity. The methodological proposal should also highlight the key contents of enumerator training/ draft enumerator training tools as well as the minimum data quality protocols that the consultant will use. The consultant should also mention the statistical software or packages that will be used. The consultant is required to consider the methodological aspects already outlined in this TOR, including its annexes.
The cost proposal should include consulting fees, international travel (if applicable) and any other costs that might arise. ). Concern will budget separately for local transport and in country travel and accommodation for the consultancy as well as enumerator fees and training related costs.


Annex 1. Indicator categories for the survey

Nutrition (around 13 indicators)
> Child anthropometry
> Infant and young child feeding
> Maternal nutrition
> Control and prevention of micronutrient deficiencies

Maternal and child health (around 5 indicators)
> Common childhood disease burden and treatment
> Antenatal and postnatal care
> Health care seeking behavior
> Reproductive health

Water, sanitation and hygiene (around 3 indicators)

Agriculture (around 6 indicators)
> Kitchen gardening
> Production: diversity, use
> Seeds: production, management, sources

Annex 2. Report Outline

> Title page
> Table of contents
> Acronyms
> Executive summary (max 2 pages)
> Introduction/ background (max 2 pages)
> Methods (max 6 pages), including but not restricted to the following: sampling frame, survey sites, sampling procedures, sample size, data collection methods, tools, training description, enumerator capacity, standardisation test during training (procedure & results), limitations
> Findings (max 20 pages), including but not restricted to the following: detailed results related to on each of the indicator themes/ categories or those agreed with Concern, including basic disaggregation (e.g. by sex) and statistical relations. Findings should include graphs, tables, figures or other data visualizations (as necessary) to support ease of understanding.
> Conclusions/ recommendations (3 pages)
> Annexes, including but not limited to the following (listed here in no particular order): the TOR, map of survey area, questionnaires and interview guides, list of names of enumerators/ supervisors by team, training materials (may be separate folder), additional analysis/ results, additional methods: detailed sampling method, sampling frame used including selected sites, detailed standardization results, plausibility test results (ENA for SMART software), Logical Framework/ M&E plan (excerpt of all relevant indicators) with updated with baseline values and methods used, actual training and survey schedules.

Annex 3. Suggested Draft Survey Schedule

Number of days and Tasks

1.5 days
* Pre-travel preparation for survey, including brief review of proposed tools, sampling, methods
* Familiarisation with Concern Worldwide’s Digital Data Gathering (DDG) process
1 day: * Travel day to Karamoja
2 days:
* Execute sampling (e.g. using ENA for SMART software)
* Organise training materials and training preparation
* Start preparing analysis plan
5 days:
* Train survey enumerators, including use of DDG devices, anthropometric measurements and standardisation tests, assessment of IYCF/ other nutrition/ agriculture/ maternal and child health, family planning and WASH indicators, cluster sampling (especially 2nd stage sampling)
* Pre-testing survey questionnaire using the DDG devices
* Revising/ finalising survey tools based on pre-test.
* Logistic arrangements for the survey
6 days: Teams collect data electronically, data quality check by supervisors, overall supervision by consultant
4 days:
* Data cleaning and preliminary survey analysis
* Preparation for debriefing
* Debriefing in Moroto, including submission of preliminary findings
1.5 days:
* Travel back for debriefing in Kampala
* Debriefing in Kampala
7 days:
* Further data analysis and report writing
* circulate draft report for comments
1 day: Incorporate comments and finalise report
* Submit final report, raw and final data sets and other related files
1 day: Regional international travel days (optional and dependent on base of consultant)

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