Save the Children
Consultancy Terms of Reference

Linking Nutrition and Integrated Community Case Management (iCCM) in Kenya

Location: Nairobi, Kenya

Background

Global perspective ICCM and Nutrition
‘Nutrition is crucial to both individual and national development. Recent estimates suggest that improving access and coverage of specific nutrition interventions could save hundreds of thousands of lives every year.

 

In spite of this potential, the reach of many of these interventions remains limited. Integrated Community Case Management (iCCM) of childhood illnesses may be a logical platform, perhaps currently a missed opportunity, for increasing the reach and coverage of treating malnourished children, and potentially for preventing malnutrition.’ {Friedman, L.& Wolfheim, C.(2014) Linking Nutrition and (integrated) Community Case Management (iCCM/CCM): A Review of Operational Experiences (London, 2014)}

In 2014 round table meetings, conferences and global evidence review, a number of agencies came together to explore existing operational experience, evidence and potential linkages between ICCM and Nutrition. 

This evidence review classified existing experience of linking and integrating nutrition and ICCM into 4 typologies:
  1. Typology 1 Advising on “feeding the sick child” within existing Health system iCCM services.
  2. Typology 2 Linkages with Social & Behaviour Change activities on child nutrition.
  3. Typology 3 Linkages between iCCM activities and acute malnutrition treatment through assessment and referral.
  4. Typology 4 Treatment at community level of uncomplicated Severe Acute Malnutrition.
In contrast to the abundant evidence supporting the need to integrate or link, and the equally abundant evidence for each of the two domains separately, the paucity of hard evidence of how linkages could be done confirms the limited experience.  
The recommendation of the evidence review was that future work will need to examine the best combination of actions – probably crossing over the proposed typologies – to ensure better coverage of interventions that identify and ensure treatment and prevention of childhood illness and acute malnutrition {Friedman, L.& Wolfheim, C.(2014) Linking Nutrition and (integrated) Community Case Management (iCCM/CCM): A Review of Operational Experiences (London, 2014)}.

Kenya ICCM and Nutrition/SAM

In 2013, Kenya developed a national framework and plan of Action for implementation of iCCM (2013-2018) that outlined the scope and scale of child survival, growth and development interventions. 
The scope of iCCM includes pneumonia, diarrhoea, malaria, new-born health and positive healthy behaviours and practices and Malnutrition (identification and referral using MUAC, use of RUTF at community level). 
However, the use of RUTF at community level has not been implemented. iCCM has been introduced in 13 counties and research is ongoing in Homa-Bay (for inclusion of use of antibiotics for pneumonia) and Narok (increasing access for ORS and Zinc for management of diarrhoea). 
ICCM is anchored on the community health services, that are offered by community health volunteers (CHVs) supervised by community health extension workers (CHEWs).

Given that coverage of high impact nutrition interventions (HiNi) like OTP and SFP is below 30%, preventive interventions such as IYCF and micronutrient supplementation (Vitamin A at 30%) are largely sub-optimal. 

Community approaches and integration of interventions (such as nutrition and ICCM) have the potential to increase the coverage in a cost-effective manner.  
The increasing call by donors and implementing partners for county governments to take up and support outreaches sustainably has seen less resources being allocated for outreach services. 
If measures such as iCCM are not taken, coverage of SAM treatment may deteriorate further.

Overall Objective: To develop an implementation research proposal to generate evidence on integration of nutrition and iCCM geared towards initiation of uncomplicated Severe Acute Malnutrition treatment at community level. 


Specifically, the proposal will examine:
  • Review current iCCM structures in Kenya and propose the best combination of actions – probably crossing over the proposed typologies – to ensure better coverage of interventions that identify and ensure treatment and prevention of childhood illness and acute malnutrition
  • Review current IMAM services at community level
  • Define requirements of an implementation research project which will support community health volunteers to identify and initiate treatment of uncomplicated SAM within current iCCM framework. 
  • Define criteria for identification of potential geographical areas and health service delivery locations to implement nutrition and iCCM during the implementation research.
  • Identify the role of actors to be involved in the iCCM implementation research. Identify potential barriers / facilitating factors and opportunities for linking/integrating iCCM and CMAM interventions at community level. This should include a review of current analysis, motivation and performance of CHVs, CHVs incentives, supply management in consultation with KEMSA and partners.
  • Address key questions needing to be addressed to define how best to link/integrate iCCM and nutrition interventions in the Kenyan context with reference to:
  1. General recommendations for improvement.
  2. Proposal development for an implementation research.
Proposed Activities

It is envisaged that the proposal roadmap development process will involve the following activities:

  • Identify approaches / methods for developing an integrated implementation research proposal to be shared and agreed by nutrition/iCCM Steering Group.
  • Lead technical consultation / workshop(s) with key stakeholders.
  • Work with MOH/ Action Against Hunger/ Save the Children/ UNICEF / other stakeholders to review possible nutrition/iCCM bottlenecks to implementation.
  • Conduct a technical review of Kenyan existing iCCM policies and CMAM guidelines on treatment of malnutrition. Review existing iCCM and CMAM protocols and propose a process for development of a single protocol suitable in the Kenyan context. Learn from nutrition/iCCM protocols that have been successful elsewhere in other countries.
  • Design appropriate implementation research questions identified by nutrition/iCCM Taskforce.
  • Scope and identify potential donors to fund operational iCCM/nutrition implementation research.
Outputs / Deliverables
  • Present the draft implementation research proposal to iCCM and nutrition task force
  • Consultancy report and recommendations.
  • Stakeholder consultation workshop report(s) for external audience at iCCM and nutrition task force
  • Present final costed proposal document with M&E framework for implementation research.
Timeframe: The consultancy is expected to take 30 days and complete assignment (including workshops and presentations) not longer than 1.5 months.

Accountability: Save the Children will act as the prime contract holder for this consultancy and will be responsible for the administrative and financial oversight of the consultancy. 

Save the Children and ACF will coordinate and serve as the primary focal points for this consultant(s). 
The consultant(s) will work with nutrition/iCCM task force on linking nutrition and iCCM for the timely and successful completion of the deliverables. 
The task force will consist of:
  • Kenya MoH(NCAHU, Nutrition, CHS)
  • UNICEF (nutrition and health)
  • Action Against Hunger
  • Save the Children
Personal Specification
Essential
  • Direct experience of conducting iCCM / community health and nutrition related programs and research. Sound understanding of the international standards on ICCM and CMAM.
  • Good and highly developed writing skills – both at a programmatic level (assessment reports, proposals, budgets) and at policy level (policy papers, guidance notes)
  • Strong analytical and communications skills (both written and verbal) and ability to tailor communications to different audiences.
  • Flexible approach to managing and prioritising a high and diverse workload in a fast paced environment with tight deadlines.
  • Track record of success in applying good project management practices (including project governance, resource management, activity scheduling).
  • Demonstrated ability to work with a range of actors and cultures with working experience within Kenya health system.
  • Commitment to humanitarian principles values and approach.
  • Computer literate.
  •  An academic/professional qualification at post graduate level or equivalent in nutrition health and health systems.
  • Previous experience in implementation research
  • Broad understanding of rights and development issues, international relations and the international humanitarian systems.
Desirable 
  • Working knowledge of Kiswahili.
  • Involvement in the development of the Kenya iCCM framework
  • Prior experience in Kenya iCCM/nutrition programming.
How to Apply

All interested Individuals/firms are requested to express interest following the attached EOI format ONLY (CLICK HERE to download) by email to: Kenya.jobapplications@savethechildren.org with a copy to caroline.njogu@savethechildren.org by 27th Oct 2015 indicating the Assignment Title on the subject line.

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