Background

ver the last decade, Ethiopia has shown impressive progress in improving the nutritional status of children and tackling the main causes of morbidity and mortality. Part of the success is attributed to support being provided in improving the quality of care, especially at the service delivery point level and through the health extension programmer (HEP) .

The HEP as the Government's flagship program providing preventative and curative health and nutrition services at the community level throughout the country, therefore, warrants continued support. As one of the main interventions, the community-based management of acute malnutrition (CMAM) programmer to treat and manage severe acute malnutrition, is embedded within the HEP and is delivered through more than 18,000 health facilities nationwide. Again, the government has recently approved the acute malnutrition guidelines to align with the international standards that have been proven locally and elsewhere to improve the quality care and survival of children. The CMAM approach includes four components: Community Mobilization, outpatient therapeutic feeding program (OTP) where 90-95 % of all cases are managed through health posts or health centers at Keble and woreda level; inpatient care for children with severe acute malnutrition suffering from complications, treated at stabilization centers (SC) at health centers or referral hospitals; and Targeted Supplementary Feeding Program (TSFP) to manage and treat moderate acute malnutrition among children under five years and pregnant and lactating women. While service ex pension is impressive across the country, in Developing Regional States (DRS) ensuring the quality of CMAM services remains a challenge, largely due to high staff turnover especially in remote/ hard to reach areas, and requires continued attention and support. Also, service delivery challenges have been placed on the program due to climate change-induced displacements and displacements due to insecurity caused by inter-community strife. The internally displaced persons placed a burden on the already fragile service delivery program through the HEP across many areas in the regions. These circumstances provide a big challenge for the human resource needs for an optimal nutrition response to vulnerable children.

Methodology

1. The contractor will recruit, in consultation with the RHB and UNICEF Somali regional office, One Emergency nutrition monitor for Gambella. The consultant will work closely with UNICEF regional office. 
2. One of the monitors will serve as the focal person/coordinator. The ENO will be responsible for the performance of the team and will also take the field monitor role. The coordinator will work based in the regional capital. 
3. The contractor will provide all the necessary logistics support such as vehicles. The vehicles should be appropriate for the landscapes of the different zones and woredas. 
4. Monitoring visits, on-the-job training, and other monthly activities should adhere to the agreed standard operating procedures which should be developed in consultation with the RHB and UNICEF regional office.
5. Each monitor is expected to provide a brief narrative report on recommendations reached through woreda consensus. Monthly narratives from the monitors need to be consolidated into one and submitted each month by the coordinator. 
6. The contractor will be responsible to ensure close liaison with the UNICEF Nutrition team in the region to enable a healthy nutrition supply pipeline. 

Specific Tasks

Field monitoring:
 Conduct regular monitoring visits and assess the quality of nutrition services in HPs and HCs (SAM treatment outcomes, Nutrition Screening, IYCF-E counseling).

1. If required, visit IDP sites, preferably with the woreda and kebele officials and health personnel as well as NGO counterparts, to assess needs and identify the best way to reach out to them for the provision of nutrition and health services (outreach activities in campaigns, establishment of additional facilities, or NGO operation of MHNT). 
2. OJT: Provide mentoring and on-the-job training to HEWs on Nutritional Screening, IYCF counseling and adherence to SAM treatment protocols. Much more emphasis will be placed on supporting regular nutrition screening of IDP children and women for early detection of SAM as well as MAM. 
3. Data:To improve nutrition data recording, reporting and utilization, including conducting data quality assurance. Data of interest are nutritional screening, and SAM admissions and performance. 
4. For nutrition screening: ensure the data is compiled in a timely manner and is of quality by the woreda health bureau and support communicating the screening information with the woreda disaster risk management (DRM) to facilitate TSF allocation
5. For SAM: Keep close communication with the NGO partners supporting the MHNT to ensure SAM program data through MHNT operations captured. 
6. Facility expansion: Identify and update the (1) health facilities operational/functional that can provide services to IDPs in each kebele/woreda, (2) facilities with SAM treatment services, and (3) health personnel providing SAM treatment and training needs.Conduct capacity assessment and work closely with the woreda health office and NGO partners operating in the woreda in establishing new SAM treatment centers, considering all operating options such as static facility, mobile outreach through MHNT.

Nutrition supplies: 
 

Alert the WoHo and ZHB immediately if there is any supply gap. 

Train the health personnel on supply stock management and prepositioning at zonal, woreda and facility levels. Ensure bin cards are kept for nutrition supplies, in particular RUTF and therapeutic milks. 

Coordination: To support and strengthen platforms for multi-sectoral coordination at the operational cluster levels. 

Until the zonal nutrition coordinators are on-board, support the nutrition cluster coordination by attending coordination meetings. Share the minutes and any other updates to UNICEF (to FO and cc-ing CO) and the international nutrition zonal cluster coordinator based in the UNICEF field office assigned area within the region.

Build a close working relationship with the local line bureaus (health and DRM), WFP, WHO and NGOs supporting the woredas to ensure the stakeholders keep themselves abreast of, and have the same understanding on, the latest situational updates and actions being undertaken.

Support zones and woredas for the successful conduct of nutrition review meetings and supportive supervisions.

Expected Deliverables

Monthly Travel Plans (last week of each month for the next month)

Monthly activity and Progress Report(on nutrition screening, IYCF-E, and multi-sectoral coordination and treatment outcomes for SAM management)   

Submission of monthly nutrition supply status in woredas of the assigned zone

Submission of bi-weekly updates

Reporting 

The coordinator of the CMAM monitors will submit a consolidated report to the UNICEF team in the region and to the RHB on monthly basis  for national consultant