Accelerating National Wasting Treatment Reform in Tanzania

Project and evaluation summary

Project Name: Accelerating National Wasting Treatment Reform in Tanzania

Sector: Nutrition

Implementing partners: Tanzania Ministry of Health and Action Against Hunger

Project duration: January 2024 to April 2025

Project Language: English
Proposed assessment dates: February 5th – March 7th 2025

1. INTRODUCTION

Action Against Hunger is the world’s hunger specialist and a non-profit leader in a global movement that aims to end life-threatening hunger for good. For over 40 years, the humanitarian organization has innovated better ways to treat and prevent hunger. It serves more than 21 million people annually across 55 countries – with 7 countries within the Horn and Eastern Africa Region including Tanzania. In Tanzania, the organization was established in 2015 and has been intervening in the areas of nutrition and health in Dodoma and Singida region supporting the implementation of the National Multi-sectoral Nutrition Action Plan in close association with the Ministry of Health, PO-RALG, and other sector ministries as well as local government authorities.

2. BACKGROUND AND CONTEXT

Childhood undernutrition remains disproportionately high, affecting children below the age of five years globally. In Tanzania, initiatives have been in place to address the problem with the presence of national level actions to accelerate collaborative and joint efforts. The National Multi-Sectoral Nutrition Action Plan (NMNAP) II, guides a holistic approach to reduce the levels of undernutrition and maintaining other forms of malnutrition within acceptable sphere standards. Through the lifecycle approach emphasized in the action plan, prevention and management of individual malnutrition cases is key to address the problem. While Tanzania has sustained a progressive reduction of undernutrition particularly in children over the past decade, whereby the 2022 national demographic and health and survey data indicated that at least 3 out of 10 children to be stunted and 500,000 children are wasted across the country that remain a central public health concern.

In January 2024, the Ministry of Health in collaboration with Action Against Hunger, initiated a consultative process to review the 2018 National Guideline for the Integrated Management of Acute Malnutrition (IMAM) following WHO recommendation released in 2023. It is however understood that for the effective implementation of the revised guidelines, the health system requires preparedness geared towards knowledge and skills of care providers, access and utilization of nutrition services, supply chain management, equipment for screening and diagnosis of nutrition status, tools for monitoring and reporting.

3. PROJECT BACKGROUND

Accelerating National Wasting Treatment Reform is a 15-months project funded by Eleanor Crook Foundation; with a focus on accelerating the adaptation of the new WHO guideline on the prevention and management of wasting and nutritional oedema in infants and children under 5 years of age by the national government in close collaboration with all stakeholders in the country under the leadership of the Ministry of Health. The project is also implemented in six other countries across Asia and Africa continents namely Mauritania, Solomon Islands, Central Africa Republic, Ivory Coast, PDR Laos, and Tanzania.

The project is expected to contribute to the 2020 Global Action Plan (GAP) on child wasting through the acceleration of the delivery of essential actions and the creation of a more enabling environment to achieve the Sustainable Development Goals (SDG) targets of reducing wasting prevalence to less than 5% by the year 2025 and further reducing wasting prevalence to less than 3% by the year 2030.

In July and November 2023, the World Health Organization (WHO) issued a revised guideline on the prevention and management of wasting and nutritional oedema in infants and children under 5 years of age. The guideline provided 19 recommendations and 10 good practice statements to tackle an expanded range of nutritional challenges that include four areas of focus: infants less than 6 months of age at risk of poor growth and development, moderate wasting in infants and children 6-59 months of age, severe wasting and nutrition oedema from a child health perspective. These recommendations, however, will only be able to save lives once they are contextualized and incorporated into national policies, guidelines, and strategies.

Action Against Hunger and other nutrition partners acknowledge that the 2018 National Guideline for the Integrated Management of Acute Malnutrition has been useful in supporting the treatment of acute malnutrition, ensuring quality treatment among all wasted children including children with nutritional oedema. The National Multi-sectoral Nutrition Action Plan (NMNAP) II, addresses childhood undernutrition holistically to save lives and further prevent underlying causes of malnutrition across the life cycle. It is in this view that, Action Against Hunger in collaboration with Ministry of Health take the advantage of this opportunity to collaboratively contribute to the government efforts to address childhood undernutrition through facilitating adoption and contextualization of the WHO recommendations and good practices into a national policy for implementation.

4. PURPOSE OF THE CAPACITY ASSESSMENT OF SERVICE PROVIDERS AND CARE PATHWAY

The purpose of the capacity assessment is to evaluate the health system preparedness and capacity to implement the revised 2024 national guideline for the prevention and treatment of wasting and nutritional oedema. Findings from the assessment will inform the development of realistic and achievable targets and indicators throughout the implementation period of the revised guideline. It is understood that the new guideline was revised based on the 2023 WHO recommendations and adapted to fit in the local context; however, establishing baseline information on the current capacity of health system will be a critical measure to document learning for next revisions and improvement. Moreover, the assessment will help identify key areas of needs and gaps that need to be addressed before the implementation of the new guideline and to generate actionable recommendations such as resource allocation, infrastructure investment, deployment of health workers, capacity building of frontline health workers and community health workers, that would require attention by key stakeholders.

5. OBJECTIVES OF THE CAPACITY ASSESSMENT

The overall objective of the capacity assessment is to assess capacity of health care facilities and community health care workers and the care pathway to implement the 2024 national guideline for the prevention and treatment of wasting and nutritional oedema.

The specific objectives of the assessment are;

1. To conduct assessment of existence of standard guidelines, SoPs, IEC tools, and health care providers’ availability, sufficiency, skills and competency in prevention and treatment of wasting and nutritional oedema in infants and children under five years.
2. To assess the infrastructure of health facilities, including availability of dedicated spaces for nutrition services, hygiene, sanitation, safety as well as Infection Prevention Control measures, privacy etc.
3. To explore community structures, including Community Health Workers (CHWs) availability, level of functionality, needs and opportunities for implementing and strengthening community interventions on prevention and treatment of wasting and nutritional oedema as part of the care pathway.
4. To map out interventions of existing partners to identify opportunities for facilitating roll-out and implementation of guideline and leveraging them to contribute to the broader implementation of key recommendations, such as financing, capacity building, supply chain, close monitoring and supervision, coordination, and quality delivery of care and services.
5. To assess overall supply chain management and trends of essential medical and nutrition supplies (therapeutic milk and anthropometric equipment).
6. To assess referral pathways and linkages of health facilities and CHWs.
7. To assess data management and reporting systems or HMIS of health facilities.
8. To assess funding and financial management for the implementation of the new guideline.
9. To identify and assess existing barriers and limitations in the implementation of the revised guideline within the care pathway, at HF and community level, and to generate actionable insights and recommendations to overcome these gaps and challenges.

6. SCOPE of the capacity assessment

Understanding that the national guidelines for the prevention and management of wasting and/or nutritional oedema will be implemented across Tanzania mainland, the capacity assessment will be conducted in accordance with geographical area zone in randomly selected health facilities and communities surrounding the health facilities. The selected health facilities will however be a representative of both urban and rural care pathways with regional referral hospitals and district level health facilities purposively selected. A minimum of two health centers and three dispensaries will be assessed during the study to ensure context specific practices are captured during the study.

The assessment will target health workers from Ministry of Health (MOH), Tanzania Food and Nutrition Centre (TFNC), President’s Office Regional Administration and Local Authority (PORALG), Regional and Council Health Management team, health facility in-charge from regional and district health facilities, health centers and dispensaries dispensaries; Pharmacist in-charge, Nutritionist

7. METHODOLOGY

The capacity assessment of care providers and care pathway will involve a mixed method; whereas both quantitative and qualitative designs or methods will be used. The assessment encourages a participatory approach during consultation with key stakeholders in the implementation of the guideline. The assessment will use a range of data collection methods and tools to ensure comprehensive information collection and align with OECD guidelines. The consultant will be expected to present a detailed methodology in their technical proposal entailing evaluation matrix, indicators, sampling methods, data sources, data collection methods, data quality assurance, ethical and administrative approaches relevant to this assignment.

Data sources and collection techniques: a mix of qualitative and quantitative data source and collection methods will be applied to get the maximum and the most appropriate information for the assessment, including the following:

1. Desk review: review and analyze key documents (Studies, Health facility records, HMIS reports, supply chain reports, the 2024 national guideline for the prevention and treatment of wasting and nutritional oedema; NMNAP II priorities; Health Sector Strategic Plan (HSSP V) and CHWs national guidelines and policy analysis with regard to nutrition) to identify key areas of integration for the successful roll-out and implementation of the national guidelines for the prevention and treatment of wasting and nutritional oedema. (Predominantly qualitative)
2. FGDs and IDI: Key Informant Interviews (FGD), and in-depth interviews (IDIs) with key stakeholders, including health workers, CHWs, representatives from relevant ministries, sectors and partners. (Qualitative).
3. Health Facility Needs Assessment using specific tools and checklists to collect numerical data at health facility level pertaining nutrition services for instance, nutrition products, staff, medical supplies etc. (Predominantly quantitative).
4. Community voices: gathering feedback from beneficiaries, particularly caregivers whose children are on treatment of acute malnutrition or attending GMP. (Qualitative).
5. Observation: to observe practices and compliance to standard procedures at HF and community level. (Qualitative).
6. Questionnaire for individual interviews at HF targeting health workers.(Quantitative).

Triangulation of evidences and secondary sources: To establish key insights relevant to effective implementation of the 2024 national guidelines for prevention and treatment of wasting and nutritional oedema for infants and children, a review of relevant recommendation, and studies will be important. Similar information will be triangulated against field assessments and information collected to give a thorough recommendation on the actionable key interventions while implementing the guidelines.

8. PHASES OF THE CAPACITY ASSESSMENT AND REQUIRED OUTPUTS (Key deliverables)

The capacity assessment will be carried in four main phases, for a successful implementation. These phases will include Inception, Field, Synthesis and Dissemination. A summary of key activities to be conducted for each phase is given in the table below against expected outputs for each phase.

1. Inception phase

   a) Key activities: Methodological design of the capacity assessment tools, testing and validation (questions and with judgement criteria, indicators, and methods of data collections and analysis) and evaluation matrix

• Development of data collection tools, testing and validation
• Sampling of study areas, stakeholder analysis and validation
• Document analysis/reviews
• Planning of field phase

b) Outputs (Deliverables and meetings): Inception meeting with capacity assessment committee (physical meeting)

• Inception report
• Slide presentation of the inception report

2. Field phase:

a) Key activities: Data collection on primary evidence

b) Outputs (deliverables and meetings): Slide presentation of key findings of the field phase. Face-to-face presentation and validation of preliminary report to selected key stakeholder

3. Synthesis phases:

a) Key activities: Analysis of collected information and reporting

b) Outputs (deliverables and meetings): Draft final report (max 30 page in MS-word, excluding annexes and in English)

• Final report (max 30 page in MS-word, Lato font size 11, excluding annexes and in English)
• Slide presentation
• Final report presentation to the capacity assessment committee.

4. Dissemination phase

a) Key activities: Preparation of one-page summary report

• Preparation and submission of power point presentation of the capacity assessment exercise

5. Outputs (deliverables and meetings); The consultant will be obliged to provide or share the dataset for the assessment upon official request from Action Against Hunger.

• The consultant will produce a final administrative report for Action Against Hunger summarizing the key activities undertaken during its partnership with Action Against Hunger, along with the final versions of the assignment report (both in soft and hard copy).
• Presentation and dissemination of assessment findings to nutrition partners and stakeholders (MOH, PORALG, DPG-N)

9. TIMELINES

The assessment exercise is expected to commence during the first week of February, 2025 through the first week of March (1st February – 7th March 2025). The entire assignment will be implemented in full in a span of 1 month.

10.QUALIFICATIONS AND EXPERIENCE

The Lead consultant or consultancy firm shall have a cumulative experience of at least 8 (eight) years in the area of evaluation in Tanzania, with qualifications of at least master’s in nutrition, International Development, Public Health, Global Health or any other related field.

Minimum requirements of the evaluation team should include:

• Evidence of availability of appropriate qualified team with skills among key staff earmarked for deployment on the assignment
• Thorough knowledge of Tanzania and global nutrition and health, policies, frameworks, action plans and how they are integrated in the health system
• A research specialist with a minimum of eight years’ experience in project evaluation in an international development context. Often a mixed approach that incorporates the technical skills of evaluation research but includes strong inputs from a sector specialist is most effective;
• Ability to design and plan the integrated health systems capacity assessments and research methodologies, including quantitative and qualitative research methods.
• Relevant subject matter knowledge and experience such as nutrition programming and guidelines implementation, to ensure the evaluation design and research methods are as relevant and meaningful as possible given the aims and objectives of the project and the context in which it is being delivered.
• Ability to manage a potentially large-scale and complex evaluation and research process, including interpreting baseline data.
• Ability to design, manage and implement primary research in potentially challenging project environments, such as fragile and conflict-affected communities. This may include the design of surveys, in-depth interviews, focus groups, and other research.
• Consideration of the extent to which the research team has appropriate country knowledge. This includes language proficiency to conduct the research required or resources be available e.g. translators to enable the research to go on smoothly, the research team should be a good balance of men and women and a person(s) with a disability.
• Gender balance in the proposed team, at all levels, is highly recommended and should be striven for.

How to apply

HOW TO APPLY

• Only, qualified Tanzania national/Firm are encouraged to apply.
• Up-to-date personal CVs of the team members, indicating their professional qualifications, any previous experience, and their contact details (email and telephone number) as well as at least three (3) professional references.
• Technical proposal with a strong justification for your application outlining why you are best suited to do the assignment with a maximum of 15 pages, core competencies in line with the assignment, proposed methodology, a detailed work plan, expected deliverables and team composition.
• A detailed financial proposal and at least a sample of a similar work you recently undertaken and other supporting documents.
• A soft copy of technical and financial proposal with cost breakdown based on the Terms of Reference outlined above must be submitted by January 31st, 2025 and addressed to**;**

Country Director,

Action Against Hunger, Tanzania

P.O Box 54274, Dar es Salaam

Applications should be submitted by email to: tender@tz-actionagainsthunger.org. Please quote USH8L – Capacity Assessment of Service Providers on the subject line of your email.