Duration: 2 Months
Start Date: April 25,2021
Number of Required: 01
Reporting to: Nutrition Specialists/Officers based in UNICEF Field Office Gambella
Over the last decade, Ethiopia has shown impressive progress in improving 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 quality of care especially at service deliver 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 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 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.
UNICEF provides support to the government to develop the capacity of Regional Health Bureaus (in Oromia , Amhara, Somali, Afar , Gambella, SNNP , Benishangul-Gumuz and Tigray) to treat and manage children with severe acute malnutrition in OTPs and SCs. Provision of supportive supervision as part of CMAM services has been inadequate to date . Compounding is the resource constraints , low motivation of staff and other challenges that affect the HEP. UNICEF support strengthening the health service delivery system at all levels through various strategies targeting policy formulation support , technical support , resource mobilisation and advocating for children to be supported in nutrition responds needs and other areas in health and other humanitarian needs. This support at lower service delivery points level is meant to achieve better long term outcomes through the provision of technical support (capacity building through training, monitoring and technical joint reviews with government at all levels) , logistics support (storage, transportation), and provision of all the nutrition commodities to manage SC and OTP services (RUTF, essential drugs, and therapeutic milks), with additional support from the FMOH to ensure sufficient second line drugs to complement the SC materials . To address nutrition service quality and emphasise its importance within the health system , UNICEF provides technical support (UNICEF nutrition officers and additional short-term consultants 'monitors'/ emergency nutrition monitors in target regions) to strengthen the supervision system through regular site supervision, mentoring/ on the job training , monitoring and promote better data management and timely reporting for CMAM programme . These consultants are tasked with developing the skills and capacity of government counterparts/ front-line health workers at woreda , zone and regional levels to analyze , report and utilize CMAM and IY CF data and align w ith the nutrition information from the DHIS2/ HMIS. Front-line hea lth work ers'/ health exten sion workers' capacity is also built through on the job training and mentorship to deliver life-saving quality service at the lowest level.
The CMAM monitoring approach is based on a standardized scorecard/monitoring tool developed with the MOH to support the capacity of government supervisors to assess service quality for all aspects of OTP and SC service delivery at all health facilities . Use of this standardized score card/ monitoring tool guides appropriate mentoring and a systematic identification of gaps requiring remedial action and support. Since 2009, UNICEF has periodically deployed 'CMAM Monitors' to support quality assurance using this system in Somali, Afar , Oromia , Amhara , SNNP and in Benishangul Gumuz and Gambella Regions. The monitors are also tasked with improving Government expanded service provision (train staff and support new SC and OTP set up) as well as monitoring infant and young child feeding (IYCF) provision and TSFP at health facility level. The experience in deploying monitors who are skilled nutritionists is a key part of UNICEF's emergency nutrition response to provide additional support when needed to ensure that the increased caseloads are being provided quality services , ensure supply pipelines to health facility level and ensure timely reporting and data utilization is maintained. This is particularly critical during periods of crises where response needs can easily overwhelm available capacity. Therefore , the need for high technical support is essential given the inherent weaknesses and need to boost the service delivery system .
The decentralization of CMAM services promotes the early detection of SAM and mitigates the presentation of unmanageable numbers of children presenting at individual health facilities . However, ensuring quality across more than 18,000 service delivery points poses a challenge for the MOH. While the supervision system is in place, often supervisors lack the means of transportation to regularly visit health facilities within their cluster to provide the needed on the job training and mentoring. Furthermore, supervisors need additional skills development to monitor and support health workers effectively. In addition, when nutrition crisis arises and CMAM admissions increases, (above 350 ,000 children were treated from 2015 through to 2018) , boosting support for service quality is particularly critical in priority crises affected regions to ensure children receive optimal treatment and fully recover. Treating the child early and effectively will support the child's full recovery from any episode of malnutrition and markedly contributes to reduction of mortality. Saving children in these very difficult circumstances is essential for their future development. In Somali. Gambella and Benishangul-Gumuz , continued effort is needed to ex pand coverage and promote quality to ensure each woreda has access to SC and each kebele has one OTP at health posts level. Therefore, there is a need for monitors to be deployed to priority regions/zones until the CMAM service coverage target with adequate capacity to deliver quality treatment is reached across all regions. The approach used ensures the ownership and involvement of the government as RHB are the lead in managing how the monitors work and help supervising their itinerary on a regular basis. Each Nutrition Officer works in collaboration with government supervisors and woreda/zonal/regional nutrition focal leads to ensure the capacity is built into the system . Monthly findings are endorsed by the Woreda Health offices and reviewed by the RHBs for follow up actions by RHB, UNICEF and partners. All treatment information is disaggregated by sex to ensure that gender issues are addressed if observed and to promote gender equality in service utilization.
The objective of this term of reference (TOR) is to continue the work initiated under various institutional contracts to ensure quality and optimal ex pansion of CMAM services for SAM and IVlAM treatment (SC/OTP and TSFP) and promote IYCF service delivery through the health system 1 in specified Hegions and avoid interruption of services between contracts.
The huge emergency in !DP/returnee situation on top of the recurrent drought in lowland woredas has made the situation more complex demanding high-level expertise to support and bring about resilient system and reduce impact of under nutrition . The recent initiative of integrating management of MAM in to health system also demanding extra support.
Cyclical drought-induced crises/ emergencies and displacements caused by conflicts in communities have caused increased number of !DPs/returnees. These emergency situations have increased response needs beyond the capacity available in affected areas. Also , the already stretched resources (human, financial, material, infrastructural etc) in these resource constrained settings have further weakened response capacity with slim chances of recovery . Thus , UNICEF has provided support through third party recruitment approach to adequately and effectively respond to save lives of children and women . Optimal response will be guaranteed through a high-quality SAM management and IYCF-E service delivery. The service delivery is both at OTP and SC level through on the job support provided by the Emergency Nutrition Officers
Additionally, coordination of the response and other region-specific response like monitoring of vaccines in Somali Region adds to the support being provided. Considering the limited capacity of the government staff at zonal and woreda level, UNICEF support will strengthen the zonal and woreda level coordination structures in responding to the current emergency in the identified areas . The current emergency calls for intensive technical support to the government system have become very necessary.
In additional to emergency monitoring, the Emergency Nutrition Officers will support the monitoring of CINus program whenever possible and strengthening of the Nutrition Information through the DHIS2. Results will be achieved within the UNICEF Core Commitments to Children (CCC) in Humanitarian Situations in response to the current humanitarian emergencies in the region.
Specific Tasks of the Emergency Nutrition Officers:
Coordination: Participate in cluster-level nutrition as well as inter-cluster coordination meetings and response that is cross-sectorial to meet the needs of the communities affected. Also, focal points will represent UNICEF
1 TSFP monitoring is conducted in 'second generation' woredas only, where monthly TSFP is provided by HEW at kebele level- health posts. UNICEF has suppm1ed IYCF and IYCFE training of Government staff and is keen to ensure that HEW/HW are promoting IYCF best practice s at health facility level.
Nutrition; report to UNICEF Nutrition Specialist on the outcome and follow-ups of the meeting and coordinated responses . Capacity building at Zonal Health Departments (ZHD) and Zonal OPP in emergency nutrition response, information management and analysis and decision making (IMAM admission trends, performance and prioritization, call for ad hoc surveys and assessments as needed, contextual data triangulation across health and WASH and field mission updates) is one of the main result areas. Based on the information provided, the analysis and action should be able to trigger immediate alert and response to the nutrition needs through a multi- sectorial approach that addresses multi-faceted needs.
On the Job Mentorship/ Training and Capacity Building: Undertake and facilitate on the job training and mentorship using the standardized scorecard/monitoring tool, profile and identify capacity gaps among health staff and health extension workers and capacity building and tailor-make mentorship support to meet the training needs. Training needs to be met includes, supplies management (requests/ pre-positioning/ re-positioning, ordering as required documentation), optimal quality care provision for SAM (screening, management, referral, linkages to livelihoods programs and health and nutrition education/ IYCF messaging)
IMAM mapping: Closely monitor and regularly map out the functionality of the health facilities and of SAM treatment program in the respective cluster. Regularly update training database , IMAM capacity mapping database, and produce intervention scales and gaps in the respective cluster .
CINuS Implementation Support (where applicable) . Support implementation of a comprehensive integrated nutrition service (CINuS) through: providing on-the-job mentoring to health workers and HEWs on provision of quality preventive nutrition services such as; growth monitoring and promotion, Iron folic acid supplementation and nutrition counseling to pregnant women. Provide technical support and monitor deworming and vitamin A supplementation programs and report on the challenges and progress in quality and coverage for these services . Support and monitor proper utilization of CINuS registers and use of DHIS2 to improve reporting of nutrition indicators at all levels in 100 CINuS woredas. Conduct end user monitoring for preventive nutrition supplies along with RUTF and other treatment supplies.
Facility expansion: Through collaboration with the NGO partners , support the Woreda Health Offices (WoHo) and Primary Health Care Units (PHCUs) expand Acute Malnutrition (SAM & MAM) treatment programme by establishing/rehabilitating facilities with OTP, TSFP and SC sites. Expansion to new sites should be delicately balanced with the need to provide sustainable quality service and the capacity available.
Nutrition supplies: Identify the nutrition supply needs (particularly RUTF, therapeutic milks, routine medicine for SAM treatment , recording and reporting materials, and equipment for OTPs and SCs) , shortages and gap and immediately alert UNICEF for remedial action; Strengthen the capacity of the WoHo and Zonal Health Departments (ZHD) for supply planning, prepositioning, dispatch, warehousing, and inventory management at facility level. 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 and
Support the health facilities to provide monthly supply consumption report. In addition, conduct end user monitoring to assess nutrition supplies are properly utilized.
IMAM/IYCF Monitoring: Conduct regular monitoring visits and assess quality of nutrition services in HPs and HCs (SAM treatment outcomes, Nutrition Screening, IYCF-E counselling) . 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. Visit Health facilities sites , preferably with the woreda and kebele officials and health personnel as well as NGO counterparts, to assess the needs and identify the best way to reach out to them for provision of nutrition and health services . Support the government health personnel in mainstreaming of the Infant and Young Child Feeding in Emergencies (IYCF-E) messages during nutrition screenings , SAM treatment , and other campaigns.
Joint Support and Supervision and Routine Monitoring : Participate on joint supportive supervision with Nutrition focal persons and partners ; build the capacity of the WoHos and PHCUs on providing technical oversight of IMAM program in their respective catchment areas . As well , participate on nutrition review meetings and give effective contributions and share reports of the SS & RM
Assess the Health and WASH situation, impacting the nutritional situation, provide technical support and provide feedback.
Data Management: Support collection, analysis and dissemination of nutrition programme data, including screening for acute malnutrition and referral to IMAM programme, admissions and performance for SAM treatment , vitamin A supplementation and deworming ; and Growth Monitoring and Promotion (GMP) ; Ensure
Nutrition interventions, in particular the IMAM program, are aligned to the national and international standards; Build the capacity of the WoHos and PHCUs in data recording, reporting, triangulation, and evidence-based decision making. Also support the WoHos to ensure monthly TFP data are captured into the DHIS and local level analysis and triangulation for action on the CMAM data .
Timely Reporting: The officers are requested to provide weekly/bi -weekly situation update and monthly progress reports to UNICEF (FO Nutrition Specialist/Officer) and ABH (coordinator at ABH)
Immunization Monitoring: Ensure children under CMAM program receive immunization services in line with the national guideline. Work with the WoHos/immunization focal persons to ensure timely and regular availability of vaccines and cold chain supplies for immunization activities in all OTP and SC sites. Provide bi weekly immunization update from the CMAM sites using the immunization guide. Note: this extra responsibility shall only be applicable to specific regions where such support is required.
Execute other tasks as relevant, based on the evolving emergency situation.
The LTA contractor will recruit, in consultation with the RHB and UNICEF CO two regional coordinators and one national coordinator who will be responsible for the overall oversight of the Emergency nutrition officers’ work. The Regional coordinators will be assigned regions of focus while the national coordinator will be the overall technical person for the project.
The LTA contractor will recruit, in consultation with the RHB and UNICEF CO and regional office the Emergency nutrition officers for the assigned tasks. The Emergency Nutrition Officer will work closely with UNICEF Regional Field offices.
The contractor will provide all the necessary logistics support such as laptop with internet access (EVDO) and vehicles. The vehicles should be appropriate for the landscapes of the different zones and woredas .
Monitoring visits, on-the-job trainings and other monthly activities should adhere to the agreed standard operation procedures which should be developed in consultation with the RHB and UNICEF regional office.
Each Emergency nutrition officer is expected to provide a brief narrative report with recommendations reached . Monthly narratives from the officers need to be consolidated into a comprehensive document and submitted each month by the regional coordinators .
The LTA contractor will be responsible to ensure close liaison with UNICEF Nutrition team in the region to enable healthy nutrition supply pipeline . All Emergency Nutrition Officers will be trained on End User Monitoring and the App will be installed onto their phones for data collection and submission with a view to avoid any stock-out or leakage of supplies through a close monitoring system .
1. Weekly/ Bi-weekly/monthly situation updates and more frequent updates as may be required
2. Monthly Travel/ Activity Plans (last week of each month for the next month)
3. Updated IMAM mapping and training data base of detailed identify of staff supported, capacity gaps identification and resolution at local level
4. Facilities visited , support provided , gaps identified, recommendations/ or other support required
5. Monthly supplies status for visited health facilities/ actions taken to address gaps (anticipated shortages , documentation gaps if any (focusing on soon to ex pire supplies , re-positioning done to Avoid expiry, pre-positioning should it rain, or flooding be anticipated in the near future , timely requests done to avoid stock-outs)
6. Complete and timely TFP data submission monthly basis.
· The Regional coordinators of the Emergency nutrition officers will submit consolidated report to UNICEF team in the region and to the RHB on monthly basis.
· The National coordinator will share consolidated monthly reports to the UNICEF CO and hold
· Quarterly update meetings with UNICEF Emergency Nutrition team. The reports have to be as concise as possible to facilitate easy reading, identification of gaps and supports
Expected Background, Qualification and Competencies
· National and Regional Coordinator need to have the following qualifications and experiences:
· Master's degree in either Medicine , Public Health or Nutrition
· Proven track record of at least 5 years ' experience in emergency nutrition programing (CMAM)
· Experience in providing capacity building (training, mentoring, supervising)
· Experience in IYCF, Adolescent and Maternal Nutrition, CHO , GMP
· Fluency in English (verbal and written) .
· Good knowledge of the local language is required .
· NGO experience is an asset.
· Emergency nutrition officer need to have the following qualifications and experiences :
· University Degree in either Medicine, clinical or public Nursing, public health or nutrition
· Proven track record of at least 3 years' experience in emergency nutrition programing (CMAM)
· Experience in providing capacity building (training , mentoring, supervising)
· Experience in IYCF, Adolescent and Maternal Nutrition, CHO, GMP
· Fluency in English (verbal and written) .
· Good knowledge of the local language is required.
· NGO experience is an asset.
Qualified applicants can submit their application letter along with an updated CV with three professional references by clicking Apply Now
Qualified candidates who fulfill the criteria will be hired only following the approval and endorsement by UNICEF.