Over the last decades, South Asian countries have made notable progress in strengthening the health systems and in improving the health status of children. Despite these achievements, South Asia continues to face complex political, economic, social and health challenges. Repeated health emergencies including the COVID-19 pandemic, natural disasters, political conflicts and socio-economic crises have put the health systems in South Asian countries under stress, leading to disruptions in the provision of essential health care, insufficient service coverage for the most vulnerable populations, and high out of pocket health-related costs.
Despite a 60% reduction in child mortality in the past two decades, the region continues to experience high numbers of newborn deaths with over a million children dying each year before their 5th birthday. 53.8 million stunted children live in the region and more than 47,000 maternal deaths occur each year. These high numbers of maternal, under-five and infant mortality are mainly driven by inadequate and unequal access to antenatal and postnatal care.
Additionally, the burden of disease in the region has increasingly become complex, with non-communicable diseases (NCDs) on the rise due to urbanization and lifestyle changes. NCDs contribute to 65% of the overall disease burden in the region. Immunization coverage has recovered since the COVID-19 pandemic; however issues with access and equity remain, with 3.8 million zero-dose children living in South Asia, the region has the second-highest number of zero-dose children globally. These are children who tend to experience multiple deprivations such as poor nutrition, limited access to safe and clean water, in addition to challenges accessing basic primary health care services.
With access to basic primary health care and its quality having severely been affected by the COVID-19 pandemic, repeated natural disasters and ongoing conflicts in the region, the health and well-being of children and mothers are at risk, with the danger of countries experiencing reversing progress in child survival and development. Therefore, particular attention and investments need to be oriented in making health and nutrition systems more responsive and resilient, with a focus on building stronger health and nutrition service delivery systems, with particular emphasis on community-based primary health care and nutrition services.
It is based on this background that UNICEF Regional Office for South Asia and UNICEF Country Offices in the region are prioritizing strengthening primary health care and nutrition services at the community level and Community Health and nutrition as a critical agenda for reaching the Universal Health Coverage (UHC) but also for building resilient communities to ensure adequate response and preparedness again future health emergencies.
The use of the term "Community Health and Nutrition" (CHN) aims to underscore a broader scope of Health and well-being, emphasizing the burden of nutrition issues on the health and well-being agenda, particularly in South Asia. CHN is defined as a framework that encompasses a comprehensive approach to promoting and protecting the health and well-being of children and community members. The inclusion of nutrition into the concept of community health acknowledges the intricate link between nutrition and health outcomes.
Investing in community health as the equity arm of Primary Health Care is essential in addressing the main drivers of maternal and child deaths, in responding to growing rates of chronic, noncommunicable diseases as well as in ensuring adequate preparedness against future epidemics and emergencies.
UNICEF works with Governments and key development partners to elevate community health and nutrition as a priority in national and global agendas. Working closely with governments and key development organizations, UNICEF prioritizes community health and nutrition on both national and global scales. This effort is guided by high-level commitments and advocacy actions, particularly for community-based primary health care (PHC) and is led by the Executive Director’s office.
In 2023, UNICEF ROSA undertook a rapid mapping of community health and nutrition programmes and polices initiative across all eight countries. Overall, the assessment revealed limited performance, scalability, and sustainability of CHN programmes in South Asia due to weak enabling environments around policies, financing, and multisectoral coordination.
A key pillar of the support that UNICEF offers is with evidence generation, both to support its advocacy efforts, and to support governments with the development of sustainable financing strategies that offer value-for-money.
This will include the development of Cost-Effectiveness Analysis (CEA) to identify areas where additional investment can lead to the highest levels of impact. This exercise will underpin multi-year investment cases which set out credible policy options to scale up financing, with a view to delivering well-funded and efficiently run community health and nutrition approaches are adequately supported across the region. This will be accompanied by financing (or fiscal space) strategies, which include clear and credible options for creating the fiscal space necessary to support the increased investments despite tight macro-fiscal conditions.
The primary purpose of this consultancy is to provide guidance and support to three Country Offices (COs) – Afghanistan, Bangladesh, and Pakistan – in UNICEF’s South Asia region which are undertaking costing exercises (including a financial gap analysis), cost-effectiveness, and fiscal space analyses for community health and nutrition. Each CO will employ the services of a national consultant, who will be primarily responsible for the additional data collection analysis required to develop these knowledge products. It is worth noting that COs are building on previous work that has already been conducted, with Community Health Worker strategies and nutrition plans already fully or partially costed, supported by Social and Behavior Change (SBC) strategies.
The role of the consultant will be to harmonize the approach taken across the COs, and to provide detailed guidance and hands-on support to COs with methodological guidance, guiding and reviewing data collection and analysis, and supporting the drafting of succinct knowledge products that are suitable for advocacy purposes. This will involve the development of guidance and template documents.
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Furthermore, the consultant will be responsible for bringing these work streams together to produce regional overview documents for South Asia which synthesize the CO investment cases and costing exercises, producing a compelling regional narrative for investing in CHN.
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