Concern Worldwide, South Sudan TOR for a Consultant to conduct a SMART Nutrition Survey in Juba POC Kator Payam, Central Equatoria State, South Sudan June 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 and UN House POC in Juba 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. Concern Worldwide started its emergency nutrition activities in POCs in Juba in May 2014 as a result of the mid-December 2013 crisis which caused a huge displacement of people from across the country and thus a need to save lives. Concern’s response to the emergency has been to prevent and manage acute malnutrition among the most vulnerable groups: the under five children, pregnant and lactating mothers through therapeutic and supplementary feeding programs. Currently, CWW is running 3 OTP and 3 TSFP sites in UN House in Juba, located in POC 1, POC 2, and POC3 and blanket supplementation for all under-fives in POC 1 and 2. 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 June 2014, Concern worldwide conducted a Rapid Nutrition Assessment (RNA) and the MUAC assessment revealed a GAM and SAM of 14.2% and 3.5% respectively. Since January 2015, 150 children 6 to 59 months have been admitted into the OTP and 263 children into the TSFP program. 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. To date, no nutrition survey has been carried out in the POCs, in Juba since the December 2013 crisis. This survey will aim at assessing and monitoring the nutritional status of children 6-59 months of age, a proxy of the nutritional status for the wider POCs population and providing recommendations for planning and deciding on future nutrition programming in the POCs. Objectives The objectives of this nutrition survey are: 1. To estimate the prevalence of global and severe acute malnutrition among children aged 6 to 59 months in Juba UN House POC 2. To estimate retrospective under-five and crude mortality rates in the POCs in Juba. 3. To assess the morbidity of children under five years and treatment seeking practices. 4. To determine and track progress of the following indicators: a. % of children 12-59 months and PLW dewormed in last 6 months, by sex b. % of children 6-59 months and LW who received a high dose vit A in last 6 months, by sex c. % of PLW who took iron supplements during their last pregnancy 5. To formulate and provide practical and sustainable recommendations /interventions based on the survey findings to improve the nutrition status of the population. Preferred Methodology: 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. ? 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 ? 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 Final nutrition survey report Submit the initial raw and final clean data sets in ENA- SMART. 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 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: July 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 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 ‘Juba SMART survey’ in the email subject.