The First 1000 Most Critical Days Programme - Supported by the Scaling Up Nutrition (SUN) Fund Terms of Reference for a Consultancy to Develop Options for Pilot Work Scaling up Integrated Management of Acute Malnutrition including Community Management of Acute Malnutrition under the SUN Fund/Most Critical Thousand Days Programme, Zambia 1. Introduction In April 2013, the Government of Zambia launched the National Food and Nutrition Strategic Plan (NFNSP) 2011-2015. Within the NFNSP, the prevention of stunting by focusing on the First 1000 Most Critical Days of life (MCD) is the first strategic priority. To this end, a First 1000 Most Critical Days Programme (MCDP) has been developed by the NFNC and collaborating partners. The Scaling-Up Nutrition (SUN) Fund is a pooled fund financing mechanism established to support the MCDP. The aim of the SUN Fund is to promote harmonization and alignment among key Cooperating Partners and stakeholders, avoiding duplication of efforts as well as reducing transaction costs for all partners including the Government of Zambia. CARE and its partners, Concern Worldwide and the Nutrition Association of Zambia, are the management agent for the SUN Fund, supporting the NFNC and key line ministries (Ministry of Community Development, Mother and Child Health, Ministry of Health, Ministry of Agriculture and Livestock, Ministry of Local Government and Housing and Ministry of Education) to implement the First 1000 MCDP. Much of the work supported by the SUN Fund focuses on increasing capacity to provide nutrition services in the 14 priority districts, primarily through support to National and District level Government Line Ministries. The SUN Fund is promoting the scaling up of 14 Priority Interventions (PI). These interventions are based on international evidence and in particular the Lancet series on nutrition, recognized as the best activities to undertake to improve nutrition and ultimately lead to reduced chronic malnutrition (stunting). These 14 interventions were discussed, debated and eventually endorsed by a technical working group in Zambia in December 2013. Each line ministry has lead responsibility for one or more of the PIs. Most fall under MCDMCH but others fall under other Ministries e.g. water and sanitation (MLGH) or diversified foods/diet (MAL). One of the priority interventions is expanding integrated management of acute malnutrition. Early identification and referral, treatment and follow up of cases of severe acute malnutrition (SAM) is one of the strategic directions of the National Food and Nutrition Strategic plan which is aimed at reducing child mortality and mitigating stunting. Data from the DHS 2014 show a MAM rate of 4% and SAM rate of 2% (overall 6%). The percentages of acute malnutrition have been quite stable over the last 20 years, without any significant improvement. A number of assessments have been conducted in the past by Valid International, Every Child Fed and the Ministry of Health related to IMAM. However, there is no clear policy direction or strategy although guidelines from 2009 do exist . 2. Purpose of the Consultancy CARE wishes to engage the services of a consultant to develop recommendations for the SUN fund to support the Ministry of Community Development Mother and Child Health and the Ministry of Health to sustainably increase the coverage and accessibility of treatment of acute malnutrition. The consultancy should result in a report providing 2-3 costed options for expanding IMAM and CMAM in 14 phase 1 districts (under SUN Fund) and at national level describing clearly the sustainability of each option. The report should also include a risk assessment for each of the options. 3. Key Tasks (including but not limited to) • Review relevant documents specific to Zambia (Concern/Valid Assessment of Zambia; ECF stock out support assessment, Malawi CMAM project including cases studies, evaluations, end of project reports and National Food and Nutrition Strategic Plan, guidelines from 2009/2012 and any other relevant information e.g. health systems reviews, health workforce planning documents, community health worker national structure, curricula of relevant staff such as health clinic staff and community health workers) • Review of relevant international and regional experience and practices in scaling up coverage and accessibility of CMAM and IMAM and integration of these services into the national health system. • Review relevant assessments/reports on the MOH Commodity Supply chain. • Assess the Misisi CMAM pilot • Interview key stakeholders with experiences in CMAM and IMAM in Zambia including MOH, MCDMCH, NFNC, CHAI, UNICEF, WFP, Every Child Fed (ECF) etc. • Facilitate a 3 day visit to Malawi to learn more about the implementation of the CMAM programme or skype conversations with key players in the setting up and implementation of CMAM in Malawi. 4. Outputs 4.1. Submission to and approval by the SUN Fund management unit of a work plan and timeline for the assignment within 3 days of contract signature; 4.2. A draft report and power point presentation for sharing with stakeholders by 31 January 2015; the report should include 2 -3 options for expanding the IMAM in the phase 1 districts, with the possibility to scale up to national level implementation. The options should include description of approach or strategy, resources/skills needed and indicative costing and risks 4.3. The report should be maximum 25 pages (including an executive summary but not including annexes) that comprises the content listed in section 2 above ; 4.4. Dissemination meeting / presentation of findings and draft strategy to key stakeholders, including line ministry officials and co-operating partners; 4.5. Final strategy report delivered by 28 February 2015. Final date to be negotiated and agreed with the consultant. 5. Accountabilities and Responsibilities 5.1. The Consultant will be responsible for ensuring the timely completion of all deliverables meeting defined and agreed expectations 5.2. The SUN Fund shall provide the consultant with the necessary logistical support 6. Consultancy Duration The consultancy is estimated to require between 30 – 35 billable days. The exact number of days will be agreed with the Consultant. 7. Supervisor The consultant will report to Team Leader of the SUN Fund Management Unit and CARE Zambia’s Assistant Country Director – Programme on all matters related to the contract, terms of reference and outputs. 8. Qualifications and Experience • Knowledge of the management of acute malnutrition and health system strengthening, • Significant field experience in the design and evaluation/review of humanitarian / development projects and context analysis around health and nutrition programming • Relevant degree / equivalent experience • Experience of presenting a range of options and costing plans. • Good communications skills and experience of conducting interviews and facilitating group discussions • Ability to write clear and concise reports in English (may be required to produce examples of previous work) • Ability to manage the available time and resources and to work to tight deadlines. 9. Procedures for submitting documents Consultants should submit • A cover letter summarizing suitability and qualifications for this assignment • List of relevant similar assignments or actual outputs from these assignments • Indicative work plan showing consultant’s planned approach to the assignment • Number of days to complete the assignment • Cost proposal with proposed payment schedule • Other support required Documents should be submitted to the Country Director, Concern Worldwide and to the Team Leader-SUN Fund Management Unit on email: chibambulaM@carezam.org; copied to kolalaf@carezam.org by 9 January 2015 Annex 1 – Priority Interventions for Zambia Annex 2 – Map of SUN Fund (Phase One) Districts