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Consultancy: Improving monitoring of nutrition through integration of nutrition indicators in DHIS2 in ESAR countries.

Apply now Job no: 516935
Work type: Consultancy
Location: Kenya
Categories: Nutrition

UNICEF works in some of the world’s toughest places, to reach the world’s most disadvantaged children. To save their lives. To defend their rights. To help them fulfill their potential.

Across 190 countries and territories, we work for every child, everywhere, every day, to build a better world for everyone.

And we never give up.

TERMS OF REFERENCE FOR INDIVIDUAL CONTRACTORS/ CONSULTANTS

PART I: 

Title of Assignment

Consultant: Improving monitoring of nutrition through integration of nutrition indicators in DHIS2 in ESAR countries.

 

Section

Nutrition

Location

Nairobi, with travel in ESA region

Duration

11 months

Start date

From: 1 November 2018

    To:  30 September 2019

 

 

Background and Justification        

Background

Despite significant socio-economic progress in some countries, the Eastern and Southern Africa (ESA) region is still home to fifteen per cent of the worlds stunted children, and the number of stunted children continues to grow as populations across the region grow. Reducing stunting, in order to provide opportunities for children to realize their full potential, is the second Regional Priority, maintaining UNICEF’s commitment to this important issue for the coming 4-year period (2018-2021).

A recent review of nutrition programming in the Eastern and Southern Africa region found that the nutrition agenda, and particularly stunting reduction, is often not given the priority it requires by national Governments if, as a region and globally, we are to reach the World Health Assembly targets for stunting reduction (a 40% reduction in the number of stunted children) by 2025. Nationally representative data on nutrition in countries across the region is often outdated and/or lacking, and nutrition indicators are often absent from national health management information systems (HMIS). In countries where nutrition programme data is routinely collected, it is often in a parallel system to the HMIS and therefore not as reliable, timely or sustainable compared to health data. In addition, and as a result of being outside of the national HMIS, nutrition indicators are not routinely monitored at national level or brought to the attention of national leaders, thus perpetuating the lack of attention to improving nutrition status of women and children as a national priority.

Nutrition status is typically monitored through national level representative population surveys rather than through routine systems. These surveys are typically conducted every 4-5 years or less frequently and there is a lack of up-to-date information in many countries in the region. Some countries have invested in conducting national nutrition surveys to assess more frequently progress towards nutrition targets, however these surveys are costly and time consuming and usually yield information at an aggregated level (usually national or for the next level administrative unit) which may not be useful for local-level programme planning and monitoring. In addition, there is a need to monitor more regularly the progress of interventions and activities that are proven to be effective in reducing stunting, at both the health facility and community level, especially as scale-up of such activities is underway as a priority for UNICEF in the region.

Achievement of the health-related targets of the Sustainable Development Goals will require strong and resilient health systems. Health information systems are one of the six essential building blocks of health systems. The realization of better health and nutrition outcomes for women, adolescents, and children is dependent upon well-informed and timely decisions and action taken by health system managers and policy-makers which, in-turn, are dependent upon the availability and use of quality data and information on the health system’s performance as well as the determinants thereof. Many health information systems are inadequate in terms of completeness, timeliness, and quality of data; health information sub-systems are often fragmented, creating duplication and limiting utility of the sub-systems to decision-makers; and capacity of institutions and human resources to manage, analyze and use data is often weak. Efforts to strengthen health and nutrition systems must include improving health and nutrition information systems, leveraging the potential of the data revolution to achieve better and more equitable outcomes for women, children, vulnerable groups and the general population in terms of health, nutrition, development and overall well-being.

UNICEF views strong information systems and data use as critical to all aspects of its mandate to advocate for children (i.e. Health, HIV/AIDS, Nutrition, Child Protection, WASH, and Education).

DHIS2 is an open source platform for national health management information systems (HMIS). It is a flexible, web-based, scalable HMIS solution, enabling data entry, management, validation, analysis and visualization of aggregate, event and individual level data. The software has been field-tested and continuously improved for over 15 years. As of 2018, DHIS2 has been implemented in over 57 low-income and middle-income (LMIC) countries, and has become the HMIS software of choice in these contexts and has also been adopted for education, WASH, nutrition and other sectors in some countries. In ESA region, currently 19 of the 21 countries are using DHIS2, either as a pilot or are scaling up nationally[1]. This convergence will enable tremendous improvements in information systems globally and is of strategic importance to UNICEF.

UNICEF views DHIS2 as a critical entry point for equity-based programming and district health systems strengthening work, through facilitating enhanced data availability, integration, quality and use, at subnational levels/point of care. UNICEF country offices, in coordination with Ministries of Health and partners, are supporting DHIS2 implementation/strengthening in several countries.

With this background, UNICEF ESARO is supporting the inclusion of nutrition indicators into national health information systems together with the strengthening the use of data for action in the DHIS2 platform. Use of DHIS2 at district level is being further supported in 4 countries in ESAR (Kenya, Malawi, Tanzania, Uganda) during 2019, and this consultancy will involve close collaboration with the health section and T4D section in ESARO to ensure coordinated and integrated support.

Justification

Technical expertise is required to:

  •  To identify which countries are currently using DHIS2 and which are planning to adopt DHIS2 (and when).
  • Carry out a mapping across the 21 ESAR countries of the existing extent to which nutrition indicators are included in the national health information system used for routine reporting (list of standard indicators to check shown as Annex 1)
  • To what extent plans to support and improve DHIS2 at UNICEF country office level include nutrition indicators.
  • To identify the main barriers and bottlenecks for integration of Nutrition indicators into DHIS2, and identify action required to address them.

    This information is expected to be collected through a variety of  means, including review of existing information (e.g. GAVI tracking sheet, DHIS2 tracking etc), online surveys, documents reviews as well as key informant interviews in the selected countries. This work will build on and further strengthen existing health management information systems, and will therefore require close collaboration with the health section.

Scope of Work

In close collaboration with ESARO health and T4D sections, this consultancy will review the extent of integration of nutrition indicators within the national health information system in ESA countries, including which indicators are captured, how information is being  collected, the frequency and level of data collection, and how the indicators are being used/monitored (e.g. reflected in national scorecards). The consultancy will also document country experiences on the use of DHIS2 for nutrition monitoring and provide orientation and training for nutrition staff (primarily, but not limited to, UNICEF staff) on DHIS2 – what it is and how it works. In addition, the consultancy will document key lessons learned from countries that have already successfully integrated nutrition indicators into the national health information system, and assess the level of and plans for digitalisation.

Objectives

The overall objective is to promote the rights of children through the strengthening of information systems and use of information for evidence based decision making, action and accountability in low and middle-income countries. 

The specific objectives of this consultancy are:

  1. To carry out a landscape analysis across all 21 ESAR countries of national routine systems for monitoring of nutrition information.
  2. To orientate UNICEF nutrition staff in all 21 countries in ESA region on DHIS2, the applications available and how to support Government systems to use them through webinars, and individual remote support. In addition, carry out in-country training for UNICEF and Government relevant staff on the DHIS2 platform and how to use it for better monitoring.
  3. To provide in-country technical assistance (at varying levels and depending on country needs) in at least 9 countries[2] in the region to include nutrition indicators in their DHIS2 and related Apps (e.g. scorecard)
  4. To document key lessons learned and success stories in the region from countries that have integrated nutrition indicators into the routine Government-lead health information system and develop a Regional Guidance Document for inclusion of nutrition indicators into HMIS/DHIS2.

Activities and Tasks

    • Carry out a landscape analysis, to include all 21 ESAR countries:
    • Desk review / on-line data collection / key informant interviews to assess the system used for monitoring routine nutrition programme data, answering the following questions:
    • Which indicators are collected; how they are collected; how they are monitored; if/how nutrition data is linked to the HMIS; if DHIS2 is used as the platform; if DHIS2 is used is it at pilot stage, being rolled out or fully implemented; if nutrition indicators are reflected in the DHIS2; which countries are planning digital patient records (patient tracker) or other digital data collection; what is the degree of digitalisation of the HMIS (nutrition components); what are the plans to digitalise; what are the opportunities and constraints for digitalisation; what other systems are used for digital data collection for nutrition (e.g. RapidPro) and what are the advantages / disadvantages in comparison to DHIS2 and what are the possibilities for inter-operability for reporting through DHIS2 to avoid parallel systems; when was the HMIS last reviewed and when is it due to be reviewed again; were nutrition indicators included in the last review; will nutrition indicators be included in the next review; what is the extent of nutrition sectoral collaboration with the health sector for a unified approach to health and nutrition information systems. 
    • Produce a report on the situation of nutrition within the HMIS and use of DHIS2 in the region, with an inventory of country specific information and recommendations for improvement, including enhanced collaboration with health sector (landscape analysis report).
    • Identify countries (minimum to include Kenya, Rwanda, Tanzania, Ethiopia) who have already integrated nutrition indicators within DHIS2 and document the process and approach used by the CO, highlighting what worked well and what could have been done better (lessons learned).
    • In collaboration with the health section and the activities under the DHSSi, identify areas for implementation research and work with country offices to carry it out.
    • Based on the learning identified, produce regional guidance on inclusion of nutrition indicators into HMIS/DHIS2 for use by countries that have not yet started / are early in the process of including nutrition into DHIS2. The guidance should also include a recommeded set of nutrition indicators that are feasible for routine monitoring systems based on lessons learned and best practices in the region. This should be in coordination with the work on defining a standard set of nutrition indicators in HQ.
    • In-country training to nutrition staff in selected countries on the DHIS2 platform and it’s applications available, how to make use of them and how to report and monitor information (dashboards), including use of scorecards and the scorecard App.
    • Act as focal point to keep the region updated with regard to forthcoming developments in DHIS2, including the Patient Tracker App.
    • Provide technical assistance to countries working to integrate nutrition indicators into DHIS2 to the 9 focus countries as needed.
    • Coordinate (with UNICEF HQ and the University of Oslo) and ensure the delivery of at least 2 webinars covering the above topics to be available to all 21 ESAR countries.

Outputs/Deliverables 

  • Monthly progress reports
  • Inception report
  • Landscape analysis report with inventory of country specific information and a set of recommended indicators
  • Set of recommended standard indicators for inclusion in DHIS2 in ESA region
  • Lessons learned documented and guidance note produced
  • Standard DHIS2 training package for use in ESA region
  • Final report, (detailed report in Word and containing an executive summary, and a summary in a PowerPoint presentation), detailing the project, achievements, and lessons learned

Location and duration

The consultant will work remotely with travel to at least 4 countries in the Eastern and Southern Africa Region.

The contract will be for 11 months, from the 1 November 2018 to 30 September 2019

Reporting requirements

  • Monthly reports detailing progress against specific activities and tasks listed above.
  • Monthly Skype calls to discuss progress reports.
  • Trip reports from any missions undertaken.
  • Service Provider completed assessment form
  • Final report, (detailed report in Word and containing an executive summary, and a summary in a PowerPoint presentation), detailing the project, achievements, and lessons learned

Required qualification, experience, languages and competencies

  • Education:  Advanced degree health and/or nutrition information management, health systems strengthening or related field.
  • Proven experience of working with health and nutrition information systems and / or nutrition monitoring and indicator development.
  • At least 5 years of relevant professional work experience in health and nutrition information management, preferably with experience of working with public health nutrition data.
  • Proven report writing skills.
  • Competencies:  Excellent communication skills; excellent analysis skills; good team work; good drive for results
  • Fluent written and spoken English required. Proficiency in French and/or Portuguese is an asset.

Administrative issues

The Consultant is required to be in the East and Southern Africa regional Office for the inception period to facilitate briefings and orientation and to allow rapid review and endorsement of inception report. Thereafter home-based work is acceptable, with regular meetings with the ESARO nutrition team (weekly basis).

Project Management

The consultant will work under the overall supervision of the Regional Nutrition Specialist (M&E);

The consultant will complete all activities and deliverables listed above within the allotted time-frame.

UNICEF ESARO will facilitate introductions to relevant Nutrition and UNICEF staff at country level in the region, and to other relevant sections in ESARO – namely T4D and Health sections.

Payment Schedule

Month

Deliverables

Duration Estimated # of Days

Timeline

Schedule of Payment

1

Inception report

Monthly progress report

21

30 Nov 2018

 

2

Monthly progress report

21

31 Dec

 

3

Monthly progress report

21

31 Jan 2019

 

4

Monthly progress report

21

28 Feb

 

5

Landscape analysis report

Monthly progress report

21

31 Mar

 

6

Standard indicators

Monthly progress report

21

30 April

 

7

Lessons learned and regional guidance document

Monthly progress report

21

31 May

 

8

Monthly progress report

21

30 Jun

 

9

Nutrition in DHIS2 training package

Monthly progress report

21

31 Jul

 

10

Monthly progress report

21

31 Aug

 

11

Final assignment report

21

30 Sep

 

UNICEF's policy is to pay for the performance of contractual services rendered or to effect payment upon the achievement of specific milestones described in the contract. UNICEF's policy is not to grant advance payments except in unusual situations where the potential contractor, whether a private firm, NGO or a government or other entity, specifies in the bid that there are special circumstances warranting an advance payment. UNICEF will normally require a bank guarantee or other suitable security arrangement.

Conditions

  • Office space will be provided by UNICEF for the periods when the consultant is expected to be in the Regional Office.
  • The consultant is expected to use their own IT equipment (laptop, cell-phone etc.), where operating communication costs – long-distance calls, internet if any should be part of the overall quoted fees (no reimbursement will be applied).
  • In addition to the daily rate the consultancy will include DSA and travel costs when outside of duty station. 
  • Due to security issues, the consultant / consulting firm will be required to stay in housing that meets UN security standards. UNICEF can make recommendations on housing options in Nairobi, however housing in Nairobi shall be paid by the consultant / consulting firm.
  • As per UNICEF DFAM policy, payment is made against approved deliverables. No advance payment is allowed unless in exceptional circumstances against bank guarantee, subject to a maximum of 30 per cent of the total contract value in cases where advance purchases, for example for supplies or travel, may be necessary
  • No contract may commence unless the contract is signed by both UNICEF and the consultant or Contractor.
  • For international consultant outside the duty station, signed contracts must be sent by fax or email.  Signed contract copy or written agreement must be received by the office before Travel Authorization is issued.
  • The consultant / consulting firm selected will be governed by and subject to UNICEF’s General Terms and Conditions for individual / institutional contracts.

     

All applicants must submit an all inclusive financial proposal to carry out the work above. This should include all travel and miscellaneous expenses.



[1] In ESA Region, Eritrea and Swaziland are not currently using DHIS2

[2] Countries are Botswana, Ethiopia, Kenya, Malawi, Mozambique, Rwanda, Tanzania, Uganda and Zimbabwe.

Advertised: E. Africa Standard Time
Applications close: E. Africa Standard Time

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