TERMS OF REFERENCE: CONSULTANT NUTRITION
Terms of Reference: Consultant
Nutrition at the Center – Endline Evaluation in Lundazi and Chadiza Districts of Eastern Province
Maternal and child malnutrition continues to be one of the leading causes of mortality and morbidity in developing countries. Despite gains globally, undernourishment in the developing world remains high especially in southern Asia and sub-Saharan Africa (34% and 34.2% of the population, respectively). Approximately 870 million people are estimated to have been undernourished in the period 2010-12 with consequences that affect each stage in the lifecycle and across generations.Nutrition has come to the forefront of global health and development, with an increasingly expanding body of evidence linking poor maternal and child nutritional status to impaired cognitive development, and impaired human capital later on in life. Malnourished mothers are more likely to die in childbirth and have low birth weight babies who, in turn, face higher mortality rates and increased risk of acute and chronic diseases. Stunted children face lifelong consequences in reduced mental capacity, lower retention in school and reduced lifetime earnings.
Narrow sectorial strategies will not solve the problem: social and behavior change strategies without the availability of sufficient nutritious food will be of limited benefit. Other obstacles such as poor absorption of nutrients resulting from chronic gut damage (environmental enteropathy), or low empowerment of women to purchase adequate food for her children or make decisions that affect the family’s heath, may further limit the overall impact of nutritional interventions. Finally, women who are themselves undernourished are more likely to give birth to preterm babies and less able to support their health and nutrition.
In addition to addressing nutrition holistically and in a multi-sectorial approach, the Lancet, a scientific peer-reviewed journal has highlighted nutrition-sensitive programs as a novel and promising platform for delivering nutrition-specific interventions, which are interventions addressing more immediate determinants of nutrition. Finally, approaches have been incorporated through efforts by multi-lateral organization and host countries. The new Scaling-Up Nutrition program funded by the United Nations includes over 50 out of 58 countries in Africa and Asia and couples nutrition specific interventions with complementary strategies addressing issues such gender inequality, food security and social protection, and access to safe water.
Nutrition at the Center ([email protected]) combines best practices together with country-specific needs to implement and evaluate an integrated approach to maternal and child nutrition, which includes activities related to strengthening
(1) Infant and young child feeding (IYCF) and maternal nutrition practices
(2) Food security
(3) Water, sanitation and hygiene (WASH) practices
(4) Women’s empowerment and
(5) Maternal health
This integrated approach will yield a significant sustainable impact for families and communities and validate the effectiveness of CARE’s women and community-centered programmatic approach.
As a global organization, CARE seeks to increase organizational and global commitment to effectively address the critical issues of hunger and malnutrition. Our vision is a world where malnutrition has been substantially reduced and where disparities in hunger have been eliminated between the poorest of the poor and those who are relatively more well off. This vision is grounded in our core belief that all children have a right to the best possible start in life and to optimal health, development and well-being.
Nutrition is part of CARE’s larger Food and Nutrition Security portfolio, which aims at reaching 50 million people by 2020. With generous support from the Sall Family Foundation, CARE has implemented the 4 country, 5 year integrated Nutrition program, Nutrition at the Center, since April 2013. The program aims at reducing stunting among children under 36 months.
2007 national statistics in Zambia indicated 45% of under-five children were stunted, and 21% were severely stunted. Prevalence of wasting was at 5% of children under five, with the highest prevalence among children 9-11 months of age (12%). Maternal nutrition has strong implications for children’s nutritional status.
4. PROGRAM GOALS AND OBJECTIVES:
The goal of Nutrition at the Center is to improve the nutritional status for women (15-49) and children less than 3 years of age in identified resource poor geographical areas. Program objectives aim to:
- Improve nutrition-related behaviors
- Improve use of maternal and child health and nutrition services
- Increase household adoption of appropriate water and sanitation practices
- Increase availability and equitable access to quality food
The results framework of [email protected] can be found in Annex 1.
4. OBJECTIVES OF THE EVALUATION
The purpose of the endline survey is to collect quantitative information on nutrition-related topics and be able to measure achievement/impact of the program during the Final Evaluation. Nutrition-related topics include: infant and young child feeding practices, food security, child nutritional status, maternal nutrition, WASH, and women’s empowerment. Households with women of reproductive age (WRA) (ages 15-49) and children under three in the sample areas will be eligible for inclusion in the survey.
The impact indicators for [email protected] are as follows:
- Reduction of stunting among children under 3 years of age
The consultant in collaboration with the respective CARE country office will review and agree upon the specific indicators as well as appropriate disaggregation and stratification for reporting endline results. This includes:
- IYCF practices
- Current nutritional status among children 0-36 months of age and among WRA
- Household food security status
- Household WASH practices
- Women’s empowerment and household food security issues as a part of the factors involve in the project context.
- Lessons learned for future programming.
5. Final Evaluation
Final evaluation of the project is planned to take place in Zambia from November – December 2017
Objectives of the evaluations are;
- To provide an objective assessment of the achievements and results, weaknesses and strengths of the project,
- To document evidence, lessons learned and good practices per country and globally to inform future nutrition programming.