Concern Worldwide, South Sudan TOR for a Consultant to conduct a SMART Nutrition Survey in Bentiu POC (Rubkona County) Unity State, South Sudan July 2015 Background Concern Worldwide (CWW) first became operational when South Sudan as part of Sudan in 1985 providing emergency relief to Ethiopian refugees in Upper Nile State. In 1994 CWW started responding to those affected by the civil war with emergency and early recovery interventions, initially in Yei, Eastern Equatoria and then expanded to other areas of the country including Lakes, Northern Bahr el Ghazal (NBeG) and Nuba Mountains (transferred to CWW’s Sudan program in 2010) as well as Unity State. Currently, CWW operates in the Bentiu POC in Rubkona County, Unity State, Aweil West and Aweil North Counties, NBeG with its country office in Juba. The violence that erupted in South Sudan mid-December 2013 has led to a humanitarian crisis involving a massive displacement of 1.5 million people nationwide. On-going conflict has resulted in the displaced seeking refuge in Protection of Civilian (PoC) sites, host communities and neighbouring countries. As of February 2015, over 345,300 people are estimated to be displaced in Unity State alone. The displacement has generated significant need for emergency services. Despite the presence of humanitarian agencies, living conditions in the PoC sites remain deplorable. Widespread food insecurity, insufficient water and sanitation services and inadequate child feeding practices have led to increased needs for nutrition interventions. The conflict, and associated displacement, has had a significant impact on food security and, consequentially, the prevalence of malnutrition. While famine was averted in South Sudan in 2014, the December 2014 Integrated Food Security Phase Classification (IPC) projects that food security will increasingly deteriorate for displaced populations and host communities in 2015. In the Greater Upper Nile region, livestock production, crop production and markets have been severely disrupted. The land area under cultivation has reduced significantly (34% of households in Unity State did not cultivate crops in 2014) and harvests that would normally provide households with food up until April or May are unlikely to last beyond January or February for many households. In terms of the project counties, the IPC projected that Guit and Rubkona would remain in `crisis' and `emergency' levels of food insecurity, respectively, between January and March 2015. As a consequence of food insecurity, and as highlighted in the Humanitarian Implementation Plan, malnutrition is a significant issue in Unity State. In the Bentiu PoC sites (Rubkona County), a Mid Upper Arm Circumference (MUAC) assessment conducted by UNICEF in June showed that 13.3% of the children from 6 -59 months screened had a MUAC of less than 12.5 cm, and 7.1% of them had a MUAC less than 11.5cm or bilateral oedema. This equated to a global acute malnutrition (GAM) ratio of 20.4%, which is significantly greater than the “emergency” threshold (>15%). These findings resulted in a significant scale up by the humanitarian community in terms of providing additional OTP sites, including the establishment of two OTP sites in PoC 4 by CWW. Given that CWW subsequently took over an additional OTP site in PoC 5, in September, it is presently responsible for providing nutrition services for 56% of the population, including 6,130 children under five. While the nutrition status of children under five years in the PoC sites has improved since July (an assessment in December showed a GAM rate of 18.8%), the prevalence of malnutrition remains above the `critical' threshold and is highly influenced by external factors. The biometric registration in November, for example, led to an influx of new arrivals, and 285 children were admitted to the OTP during a two-week period. At the end of December 2014, 1,343 were being treated in the programme: 503 in TSFP (285 under five and 218 PLW) and 840 in the OTP. Since December, there has been an influx of approximately 20,000 additional new arrivals at the Bentiu PoC sites. The SS Nutrition cluster requires that each agency conducts one nutrition survey in their operational area each year. This provides that cluster with comparable information to see trends of malnutrition in the whole country. CWW is committed to contributing to this endeavour by ensuring that they provide survey results and data sets each year. More importantly CWW uses the data to monitor nutrition trends in their operational area and to inform programming. It is in view of this that CWW intends to conduct a SMART survey in Bentiu POC. Objectives The objectives of this nutrition survey are: 1. To determine the prevalence of global and severe acute malnutrition among children aged 6 to 59 months in Bentiu POC, Unity State 2. To determine the percentage, to compare trends to previous year’s SMART survey and track progress of the following Infant and Young Child Feeding indicators: a. - Early initiation of breastfeeding b. - Exclusive breastfeeding rates for infants 0-<6 months c. - Continued breastfeeding at 1 year d. - Introduction of solid, semi-solid or soft foods e. - Minimum meal frequency f. - Minimum dietary diversity of children 6-<24 months g. - Minimum acceptable diet 3. To formulate and provide practical and sustainable recommendations /interventions based on the survey findings to improve the nutrition status of the population. Preferred Methodology Approach: The Standardized Monitoring and Assessment of Relief and Transitions (SMART) methodology will be used from planning to report writing. Digital Data Gathering Devices (DDGs) will be used to for data collection and entry. Duties and Responsibilities of the Consultant The consultant will, in coordination with the CWW South Sudan team: ? In conjunction with the CWW team, be responsible for preparations of the survey, including review of population data, calculating the sample size, selecting clusters, developing an efficient survey schedule. ? Prepare a proposal document to present to the NIWG which outlines methodology and survey plan. ? Supported by Concern Worldwide, familiarise herself/himself with the digital data gathering devices and process. ? Train the survey team (including pre-testing questionnaire and conducting standardising tests with all enumerators in collaboration with CWW and County Health staff ? Assume overall responsibility for implementation of the survey, including daily supervision of survey teams and daily data quality assurance. This includes the data entry step because digital data gathering devices will be used. ? Be responsible for data cleaning and analysis using anthropometric software (SMART, EPI INFO, EPINUT and others as needed) for the core anthropometric and additional variables. Conduct some 2X2 tables to identify any associations or relationships ? Prepare an overview of preliminary findings and share this with CWW nutrition staff for comments and discussion. ? Write and submit a comprehensive nutrition survey report outlining the background, methodology, findings and recommendations, including annexes. ? Submit the initial raw and final clean data sets (.as format and/or MS Excel or equivalent format). ? Lead the synthesis and sharing of findings during meetings and discussions with CWW staff and other stakeholders including the Nutrition Information Working Group (NIWG). Key Competencies for the Consultant ? Well versed with the SMART methodology for conducting nutrition surveys. ? Able to use the ENA software for survey planning, training, data analysis and report writing. ? Able to use other statistical software packages for the analysis of additional data such as IYCF. ? Possesses knowledge of DDGs or willingness to familiarise themselves with the process and devices. ? Conduct standardised SMART training including standardisation tests, able to interpret standardisation test results and help teams to collect reliable data ? Check quality of data on a daily basis and provide teams with appropriate feedback to improve data collection ? Guide supervision of data collection teams ? Able to produce the survey report within the time period specified in these ToR. Expected outputs The expected outputs of the nutritional survey are: ? Training module for the survey; ? Preliminary findings - overview ? Final survey report: Consultant submits the draft report for review to the Country Director. Based on the feedback, the Consultant submits the final report to CWW. ? Consultant will submit final data sets from the survey ? Feedback on findings: The Consultant gives a briefing on preliminary findings for the survey to CWW, the NIWG & MOH staff before leaving South Sudan. CWW will: ? Pay for return flight from the consultant’s country of origin to CWW’s designated location in South Sudan ? Support/facilitate visa/ travel permits for South Sudan ? Facilitate/ provide all in-country transport for the consultant ? Recruit survey team with adequate skills to carry out surveys ? Provide accommodation for the consultant in South Sudan and while in transit ? Provide support for understanding Concern’s DDG process ahead of travelling to the country (access to online eLearning course and manuals) ? Support with the development of the sampling frame ? Concern will draft the survey tools and will submit the proposal to the NIWG, including the consultants protocol ? Support with the programming of the DDG devices ? Support with the transfer of the initial DDG data set for use in ENA Suggested Survey Process Survey Period: June 2015 Number of days Task 1 • Familiarisation with Concern Worldwide’s Digital Data Gathering (DDG) process • Pre-travel preparation for survey 1 • Travel day 5 • Review cluster survey questionnaire and check of draft DDG questionnaire • Finalise sampling frame for cluster selection • Conduct sampling (using ENA software) • Organise survey equipment and training materials and training preparation • Inform all county officials about survey (in conjunction with CWW) 4 • Train survey enumerators, including use of DDG devices, anthropometric measurements and standardisation tests, IYCF indicator assessment, cluster level sampling (2nd stage sampling), pre-testing survey questionnaire using the DDG devices and revising/ finalising survey tools based on pre-test. 5 • Teams collect data electronically, data quality check by supervisors, overall supervision by survey leader 1 • Ensure teams hand in survey equipment and other supplies 4 • Data cleaning and survey analysis - • Submission of preliminary findings 1 • Travel back 5 • Report writing - • Circulate draft report for comments 2 • Incorporate comments and finalise report - • Submit final report and raw and final data set 29 Report Format As with all population surveys it is imperative that the results are available to CWW and operational partners as soon as possible. The report will be presented in English and will include at minimum: Introduction and details of the study population, study design (sampling frame, survey sites, sampling procedures, sample size, data collection methods, tools, training description, enumerator capacity, standardisation test during training (procedure & results)), results), discussion, conclusions/recommendations, and references. The annex should contain but not necessary be limited to a map, final questionnaire (DDG format), sampling frame indicating the clusters selected, actual survey schedule, teams & supervisors, plausibility test, TOR. As mentioned above the consultant will conduct debriefing meetings with CWW field team, this could include other relevant stakeholders. Education and Professional Experience: ? Advanced university degree in nutrition. ? Professional experience in the latest f smart nutrition methodology and the use of ENA software ? Knowledge in conducting nutrition surveys Desirable Qualifications and Competencies: ? Strong analytical and communication skills. ? Ability to work independently with minimum supervision. ? Aware of the latest developments in the area of nutrition and assessment methodologies. ? Knowledge of South Sudan operation context in the POCs Language Skills: ? Fluency English, with excellent writing skills. ? Strong analytical skills, use of ENA, EPI info, SSPS etc. How to Apply: Please send your CV, an outline of your suggested survey protocol and your daily total fee to gudrun.stallkamp@concern.net. Please specify ‘Bentiu SMART survey’ in the email subject.