Development of Operational Guideline for Cash and Voucher Assistance (CVA) for Nutrition Outcomes in Ethiopia

Background:

Years of conflict and recurring climate shocks have led to a prolonged humanitarian crisis and political tensions in Ethiopia. A cycle of multiple, often overlapping, crises over the years in Ethiopia is continuously deepening humanitarian needs across the country, with over 20 million people in need of humanitarian assistance and protection services in 2024, including internally displaced persons (IDPs), returning IDPs, crisis-affected communities, and returning migrants. Severe drought impact, coupled with deepening of food insecurity and lack of access to clean water are driving high levels of acute malnutrition. Some areas in Somali, Afar, Amhara, and Tigray regions where SMART surveys have been conducted in 2023 were found to face very high Global Acute Malnutrition (GAM) rates (measured through weight-for-height) beyond the emergency threshold (>15 per cent). Preliminary results from most recent rapid nutrition assessments conducted in December-January in South Wollo and Central Gondar also confirm very high proxy GAM rates (estimated through MUAC screenings) of >20 percent among children under 5 and >80 percent among pregnant and lactating women. In 2024, an estimated 2.4 million children under 5 and 1.3 million undernourished pregnant and lactating mothers will require treatment of moderate acute malnutrition, and an additional 942 thousand children under 5 require treatment of severe acute malnutrition. Malnourished children face a higher risk of morbidity and mortality from preventable diseases such as diarrhea, pneumonia, and malaria due to weakened immunity. Nutrition-related factors contribute to about 45 per cent of deaths in children under five.

The Oromia Regional Government seeks humanitarian support from partners for the return of 60,000 to 70,000 IDPs from Amhara and Benishangul Gumuz regions to their places of origin in Oromia Region by June 2024, before the meherp lanting season. In three rounds of the government’s planned exercises between February and May 2024, about 4,300 IDPs have returned from Amhara Region to East and West Wellega zones, as well as West Shewa zones in Oromia Region, according to the regional Busa Gonafa Oromia (BGO)/Disaster Risk Management Office. According to OCHA situation report (April 2024), around 421,000 people are projected to be affected, with 104,000 displaced across Borena, Guji, West Guji, Bale, East Bale, Arsi, West Arsi, East Shewa, West Hararge, and East Hararge zones. Accordingly, about 350 people (24 households) in Shala and Berbere districts of West Arsi and Bale zones of Oromia respectively According to the Food Child Poverty Report (2024), the Global Acute Malnutrition (GAM) rate currently stands at 7%, indicating some progress towards achieving the 2030 target. The report also highlights that exclusive breastfeeding rates have shown slight progress, increasing from 52% to 59% between 2016 and 2022, with the baseline set between 2005 and 2012. Regarding children aged 6-23 months, 55% receive the minimum meal frequency, 14% have the minimum dietary diversity, and only 11% have the minimum acceptable diet. Furthermore, the study reveals concerning findings, such as 87% of school-aged children being underweight at birth. Additionally, 21% of women above 18 years old are underweight, and 24% of women in the reproductive age group suffer from anaemia. The prevalence of anaemia among women of reproductive age has worsened compared to the baseline value. Disturbingly, the report indicates that 46% of children are living in severe childhood food poverty, while 41% are categorized under moderate childhood food poverty. These figures shed light on the urgent need to address the issue of childhood malnutrition and food insecurity at a global level.

Without a robust response supported by the international community, through national systems, where possible, there is a high probability of further deterioration in the humanitarian situation, which is expected to peak at the height of the hunger season in July-September 2024[1].

Cash and Voucher Assistance (CVA) has been increasingly used in humanitarian responses to address the nutritional needs of vulnerable populations. However, there is no a standard guideline on the use of CVA for nutrition outcomes in Ethiopia which dictates the need for its development for harmonized planning, implementation, follow up.

The CVA for Nutrition Task Force was established to bring consistency to cash and voucher assistance programs aiming to achieve better nutrition outcomes. The outline of the National Operational Guideline for Cash and Voucher Assistance (CVA) for Nutrition Outcomes was developed by a consultant hired by the Global Nutrition Cluster- Technical Alliance (currently Program team) global technical support team funded in collaboration with ACF, UNICEF with close technical support by the taskforce, ENCU- Emergency Nutrition Coordination Unit-Nutrition cluster and CWG. As a follow-on task, there is a plan to finalize the guideline, endorse and disseminate it for use. This TOR is prepared to finalize the development of the guideline through a consultant using a fund granted by BHA through Concern Worldwide.

The purpose of this consultancy is to finalize the building on global best practices and adapting to the local context.

Objective of the consultancy:

The main objective of this consultancy is to develop practical tools to operationalise the current national Cash and Voucher Assistance (CVA) for nutrition outcome guideline.

Scope of Work:

The consultant will be responsible for the following tasks:

• To compile a comprehensive list of CVA for nutrition interventions in Ethiopia through documents reviews and consultations with key informants and compile a descriptive list of relevant CVA-Nutrition interventions/ initiatives and key learning in Ethiopia (and globally if relevant).
• Stakeholder Consultations: Conduct stakeholder consultations with relevant government ministries, UN agencies, NGOs, and other stakeholders to gather insights on the current CVA landscape in Ethiopia (at each four of the regions), identify gaps, and gather feedback on the guidelines. The proposed stakeholders to be consulted will include but not limited to donor organizations (BHA, ECHO, FCDO), UN agencies (UNICEF, UNHCR and WFP), government ministries and their regional bureaus (ministry of health, DRMC, MOA and food security), clusters (nutrition, health, Cash), community representatives and beneficiaries.
• Operational Guidelines and tools Development: Develop comprehensive operational guidelines with practical tools for CVA for nutrition outcomes in Ethiopia, incorporating the findings from the literature review, stakeholder consultations and using the initial guideline prepared so far.
• Organize Practical Operational Workshops at Regional Level: The consultant will arrange workshops in each of the four regions (Tigray, Amhara, Somali and Oromia), where draft guidelines and tools will be presented to relevant participants. The purpose of these workshops is to gather feedback on the practicality and simplicity of the tools, as well as to capture any additional inputs that could enhance the completeness of the tools.
• Finalization of Guidelines: Finalize the guideline based on the feedback received during the operational workshops at regional level and conduct a final validation workshop at national level.

Deliverables

• Tools that will be used for the guideline development.
• Meeting minutes and stakeholder engagement report.
• A validation workshop report summarizing the feedback received.
• Updated, detailed list of relevant CVA-Nutrition interventions/ initiatives in Ethiopia.
• A finalized operational guideline with toolkit for CVA for nutrition outcomes in Ethiopia.
• A final report summarising the consultancy work.

Requirements:

The consultant should demonstrate the following essential requirements:

• Advanced University degree in International Development, Development Economics, Social Sciences, Food and Nutrition or other relevant field OR First University degree with additional years of related work experience and/or Training/courses.
• Extensive experience in the coordination and implementation of cash-based transfer programming.
• At least 5-year experience with UN agencies or/and NGOs.
• Demonstrated ability to foster strong relationships with Government, Technical Working Groups, Clusters and other humanitarian stakeholders.
• Experience working at country level on operations and programming.
• Experience in the Cluster system and Cash Working Groups.
• Proven experience in developing guidelines or policy documents.
• Strong understanding of the Ethiopian context and CVA for nutrition outcome programming.
• Experience in the development of MEB, interim MPC guidance, CVA-Nut guidelines.
• Exhaustive experience in cash programming with knowledge of nutrition interventions.
• Understanding of UN and cluster response.
• Strong interpersonal skills: ability to liaise with a wide range of people at different levels and across different cultures and to act with credibility and diplomacy.
• Self-motivated and able to work with a high degree of autonomy, strong time management skills.
• Ability to manage and coordinate efforts from multiple stakeholders for common and purpose.

Candidates with previous work experience in the country, or familiarity with the context, will be given a preference.

[1] Humanitarian Need Overview 2024, Ethiopia