Nutrition SQUEAC Survey Consultant

Purpose: The purpose of the Semi-Quantitative Evaluation of Access and Coverage (SQUEAC) assessment is to assess the coverage of the nutrition program and investigate or identify key factors affecting the uptake of CMAM services in Ancuabe and Metuge districts, Cabo Delgado, Mozambique.

Period of Performance: TBD (Tentatively December 1st, 2022 – January 11th, 2022)

Place of Performance: Ancuabe and Metuge Districts, Cabo Delgado, Mozambique.

Background

FHI 360’s humanitarian response in Mozambique began in 2019 when it used the country platform to launch a response to communities affected by Cyclone Idai in Sofala and Cyclone Kenneth in Cabo Delgado province. Currently, in response to the conflict in northern Mozambique, FHI 360 provides lifesaving support for communities affected by insecurity, conflict, and displacement in Cabo Delgado Province by delivering essential health, nutrition, water, sanitation, and hygiene (WASH), and protection assistance through institutional, mobile, and community-based levels. The Integrated Response to Affected Mozambique Populations (IRAMP) project’s goal is to improve the health and well-being of conflict-affected populations in Cabo Delgado province, targeting vulnerable populations—including women and girls, unaccompanied and separated children, persons with disability, and internally displaced persons (IDPs) in Metuge and Ancuabe districts. In times of emergency, the project pivots and responds to acute humanitarian needs in other districts through a rapid response mechanism. FHI 360 works closely with the government, local development organizations, and local health officials to design and implement community-level programs tailored to support the Government of Mozambique’s responses to HIV/AIDS, tuberculosis (TB), malaria, and malnutrition, and strengthening government and local institutions.

The humanitarian situation across Cabo Delgado has continued to deteriorate, and displacement figures have increased by 20 percent to 946,508 in the first half of 2022. Since 2017 Cabo Delgado province has suffered a series of attacks by non-government armed groups (NGAGs), which have expanded geographically and increased in intensity since 2020. The fragile humanitarian situation in Cabo Delgado was exacerbated by the impact of Tropical Cyclone Kenneth in April 2019. Livelihoods have been lost, and education stalled while access to necessities such as food, social services, and healthcare is hampered.

According to the June 2022 Cabo Delgado SMART survey results, GAM prevalence ranges from 4 5% to 0.9% by WHZ which falls under the low or very low category of emergency threshold classification as per the latest update WHO/UNICEF 2018 threshold. However, special attention and reinforced monitoring are needed due to various underlying risk factors in the provinces of Cabo Delgado including inadequate access to livelihood opportunities and food because of the displacements and insecurity. Chronic malnutrition in the province remains of public health concern. The prevalence of chronic malnutrition among children 6 59 months was 44.5% which is classified as very high according to the UNICEF WHO 2018 thresholds.

Results from the 2021 survey conducted by UNICEF and WFP on malnutrition highlighted that there was very low GAM treatment coverage in Cabo Delgado, with less than 30% of the cases admitted for treatment due to limited access to health facilities and limited humanitarian partners. The health centers’ low and limited water and hygiene services compound the situation. Additionally, suboptimal infant and child feeding practices in Cabo Delgado prevented any progress.

FHI 360 IRAMP project nutrition sector aims to improve the nutritional status of vulnerable populations, particularly pregnant and lactating women (PLWs), infants and young children under 2, and children 3-5 years, reducing acute malnutrition, morbidity, and mortality. Implementation involves a three-pronged approach through supported static health facilities, integrated mobile medical units (IMMUs), and community mobilization via supported Agentes Polivalentes Elementares (APE) networks.

Goals and Objectives:

The Semi-Quantitative Evaluation of Access and Coverage (SQUEAC) Survey will be conducted to ascertain the level of access for program participants to Community based Management of Acute Malnutrition (CMAM) services, determine the coverage within project locations to better inform implementation, and improve program delivery. Furthermore, the survey will assess the coverage of the CMAM program, factors affecting coverage, barriers, and boosters to access and develop recommendations for program improvement in the survey locations.

The specific objectives of the survey include:

• Determine coverage of CMAM and IYCF-E services, identification of barriers and boosters to service access, and nutrition program uptake in Ancuabe and Metuge districts in Cabo Delgado.
• Identify factors affecting the uptake of OTP and other CMAM services in the target area of operation (Barriers and boosters)
• Develop, in collaboration with the community leaders, Ancuabe and Metuge Serviço Distrital de Saúde Mulher e Acção Social (SDSMAS) and Direcção Provincial de Saúde (DPS) specific recommendations to address the identified barriers to coverage of the CMAM and IYCF-E programs.
• Enhance competencies of key FHI 360 technical teams in conducting access and coverage survey using Semi-Quantitative Evaluation of Access and Coverage (SQUEAC) methodology.
• Develop specific recommendations in collaboration with FHI 360 to improve CMAM coverage
• Establish recommendations on actions to address identified gaps to support planning, advocacy, decision-making, and monitoring.
• Determine future program focus to about survey results among children aged 6-59 months in FHI 360’s operational areas.

Methodology

The assessment is expected to dissect and deeply analyze the coverage challenges/barriers and enablers/boosters through an interactive process that utilizes both secondary and primary data collection methods. A full and detailed SQUEAC survey methodology will be designed by the Consultant in consultation with FHI 360 staff.

Responsibilities of the Consultant/Agency:

• Design the survey protocol and develop comprehensive tools for data collection in line with the standard FHI 360 research templates.
• Hold stakeholder meetings with the nutrition cluster, SDSMAS, and other partners.
• Conduct a one-week training for FHI 360, SDSMAS, DPS, and Partner agencies’ nutrition technical staff on SQUEAC methodology and guide and supervise them as they take part in the assessment processes – planning, data collection, data analysis, and reporting.
• Assume overall responsibility for the design and implementation of the SQUEAC Survey, including daily supervision of survey teams and daily data collection quality assurance, adequate supervision, and coordination of the survey teams in the field
• Clean and analyze data using appropriate software
• Prepare and lead a validation workshop for MOH and relevant stakeholders in Cabo Delgado, Mozambique to develop specific recommendations and a joint action plan to improve coverage of the CMAM program in the target areas and the prevalence of acute malnutrition among children aged 6 to 59 months. The presentation outcomes will be shared via the sub-national Nutrition Cluster.
• Develop a final SQUEAC survey report including but not limited to abstracts, methodology, limitations, results, conclusions, and recommendations incorporating feedback from FHI 360 and the Nutrition cluster on the draft report.
• Validate the findings with the Senior Emergency Nutrition Advisor, Nutrition Coordinator, M&E Coordinator, Deputy Response Coordinator, Response Coordinator, FHI 360 staff, DPS, SDSMAS, and Nutrition Cluster.

Deliverables

• Final SQUEAC survey report with a complete list of annexes (survey design protocols, list of data sources, detailed SQUEAC survey work plan, data collection tools, etc. A full list of annexes to be developed in consultation with the FHI 360)
• Presentation (Slide Deck) of findings and recommendations to FHI 360 and key stakeholders as needed.
• The consultant/agency will present the findings using the slide deck developed.
• A cleaned quantitative and qualitative Data Set and/or summaries to ensure the authenticity of the report in a format accessible by FHI 360.

Duration of Activity and Level of Effort (LOE):

The consultant/ agency will be required to develop the implementation and supervision strategy of the SQUEAC survey including survey protocol, data collection tools, training material, SQUEAC survey reports, etc. within 31 days from the date when the contract has been signed. For further reference, see below.

• Develop the design, implementation, and supervision strategy of the SQUEAC survey including survey protocol, data collection tools, and training material- 5 days
• Train the survey team and test the tools- 5 days
• Complete data collection in Ancuabe and Metuge, Cabo Delgado, Mozambique- 10 days
• Draft SQUEAC survey findings including background, methodology, results, limitations, conclusions, and recommendations (short-term and medium-term recommendations)- 6 days
• Submit a SQUEAC draft report incorporating the feedback from the FHI 360 IRAMP team, CO, HQ, SMOH, UNICEF, and the nutrition Cluster- 3 days
• Submission of all training materials, data, and analysis outputs (both raw and final approved report) electronically to the FHI 360 IRAMP team before final payment- 2 days
• Total number of days: 31 days

Qualifications of the Consultant/Agency:

• The consultant/team lead should have an advanced degree in Public Health, Nutrition, Monitoring and Evaluation, Research Methods, or a related field,
• Relevant technical knowledge and experience in the implementation of SQUEAC surveys and other coverage surveys.
• Prior experience in leading a SQUEAC survey in a similar context is preferred.
• Advanced proficiency in MS suite (MS Office, MS Excel, MS PowerPoint) and analytical software (ENA for SMART surveys software, EPI Info, or alternate statistical software), and Mobile Data Collection (ODK/Kobo collect).
• Strong and proven experience, at least three years, in community-based nutrition surveys
• Knowledge of designing and implementing CMAM and IYCF programs
• Excellent qualitative and quantitative data collection, analysis, interpretation, and reporting skills
• Strong communication skills with the ability to present information effectively and clearly and respond appropriately to questions from FHI 360 staff and other relevant stakeholders
• Ability and willingness to travel to FHI 360 field sites and nutrition supported facilities
• Familiarity with the Northern Mozambique context is an added advantage
• Fluent in written and spoken English is required; knowledge of Portuguese and the local languages in the operation area is an advantage.