Terms of Reference Consultant Nutrition Advisor March - April 2011 Background Concern has been responding to the urgent humanitarian needs of flood affected population in Pakistan since end July 2010. To date, Concern has reached approximately 900,000 persons through the provision of food, non food items, WASH and emergency medical assistance in the worst affected districts of Khyber Pakhtunkhwa (KPK), Punjab, Sindh and Balochistan provinces. Concern is aiming to assist and reach close to 2 million people affected by floods in Pakistan and is raising funds from various sources (external donors and own fund raising) for its ongoing flood response. Concern has so far prioritised the following areas of intervention for the emergency response phase: 1. Food and non-food distributions 2. Access to clean water and sanitation 3. Shelter It is estimated that 7.3 million people have been affected by the floods in Sindh province. More than one million (1,073,847) houses in Sindh Province were damaged by the floods. Provincial authorities estimate that around 1.4 million people have been living in informal settlements and organised camps, including in schools. Overall return movements in Sindh include an estimated 386,547 flood affected people out of the reported 1.4 million who were living in camps and informal settlements, leaving more than one million people still displaced. Although the situation is stabilizing in some areas, it remains critical in others, especially in the Sindh province. Following a number of nutrition surveys that took place in late 2010, the malnutrition rates are alarmingly high and the level of response by humanitarian agencies quite low. The following is the executive summary of the report on the Survey in Sindh As a result of the floods in July/August 2010 in Pakistan, there was a need for improved data on nutritional status of children under five and pregnant and lactating women. It was decided to conduct separate surveys in each province. In Sindh, two surveys were conducted by the Department of Health (DoH) in collaboration with UNICEF, ACF-Canada and CDC. The areas included were the flood affected districts and camps of Northern and Southern Sindh (Ghotki, Jacobabad, Kashmore, Khaipur, Larkana, Shahdadkot, Shikarpur and Sukkur districts for Northern Sindh. Dadu, Hyderabad, Nawabshah, Jamshoro, Mitiari, Noushero Feroz and Thatta districts for Southern Sindh). Both residents and IDPs were included in the surveys. The survey data collection started on October 29th and ended on November 4th, 2010. SMART methodology was used for both surveys following a cluster design. Households were selected using either simple or systematic random sampling after segmentation was applied, where needed. The main indicators measured were child's acute and chronic malnutrition, vitamin A supplementation, measles vaccination, polio immunization, child morbidity, maternal malnutrition, food consumption and access to water and sanitation at household level. The table below shows the results for the main indicators for both North and South Sindh and for all Sindh province. North Sindh South Sindh Households surveyed 397 389 Eligible children included 446 391 Global Acute Malnutrition (<-2 z-score and/or oedema) 22,9 % (19,0 - 27,4 95% C.I.) 21.2 % (17.3 - 25.6 95% C.I.) Severe Acute malnutrition (<-3 z-score and/or oedema) 6,1 % (3,9 - 9,3 95% C.I.) 2.9 % (1.7 - 5.1 95% C.I.) Chronic Malnutrition (<-2 z-score) 53,9 % (46,2 - 61,5 95% C.I.) 51,8 % (44,5 - 59,0 95% C.I.) Vitamin A supplementation 26,1% (13,6 - 38,7 95% CI) 80,4% (68,1 - 92,7 95% CI) Measles Vaccination 8,9% (1,6 - 16,2 95% CI) 9,5% (2,7 - 16,2 95%CI) Polio Immunization (n of doses) 4,78 (3,73-5,78 95% CI). 2,89 (2,41-3,37 95% CI) Child Morbidity 54,2% (45,8 - 62,7 95% CI) 42,8% (33,5 - 52,1 95%CI) Maternal malnutrition (Moderate Malnutrition) 11,2 % ( 7,1 - 15,3 95% C.I.) 10,1% ( 5,1-15,1 95% CI) Maternal malnutrition (Severe Malnutrition) 1,9 % ( 0,1- 3,6 95% C.I.) 0 % (0,0- 0,0 95% CI) However, the coverage in Northern Sindh is very limited and UNICEF and the cluster have requested Concern to initiate a response. In Pakistan, Concern implements its work entirely through local partners and will work in the same manner for this nutritional response. The identification of local partners may already be completed before the incumbent takes up his/her role, but if not, this will form part of the initial work Purpose Assist the country team to start a nutrition response in Sindh Province by providing support to local partners in training, capacity building and implementation of a quality emergency nutrition response. Main Duties and Responsibilities ? Assist in the recruitment of national Nutrition staff for Concern. ? Conduct any training that will be necessary for these staff. ? Capacity assessments of identified local partners in relation to a nutrition intervention. ? Plan for and conduct appropriate training for partners on CMAM and other responses required for this intervention. Government staff may be included in the training as appropriate. ? Continue on-the-job training for the both Concern and its partners' staff to ensure that a quality response is being implemented. ? Ensure strong links are made and maintained with government health and nutrition services ? Train local partners in the collection of data, and ensuring that a good understanding of the need for the data to be collated into formats for submission to Concern and to the District Health office. ? Design a community mobilisation strategy ? Assess IYCF practices and suggest ways to improve practices. ? Suggest ways in which this intervention can be linked to other interventions by Concern or by other agencies - livelihoods, WASH, etc. ? Liaise with UNICEF and other international partners in nutrition through the cluster group ? Monitor partners' work and suggesting changes as necessary. ? Prepare any reports due during this assignment. ? Represent Concern at Provincial and District level cluster and government meetings. Timing: It is anticipated that this assignment will be for a 2-month period (possibly extended to 3 months) from early March. Location The post-holder will primarily be based in Sukkur with frequent travel to the targeted districts and to Islamabad. Reporting The consultant will report to the Director of Programmes and will liaise closely with the programme manager for Sindh Province. Outputs Partner staff trained and confident in their delivery of the CMAM approach. Community mobilisation strategy finalised and rolled out. Linkages between the nutrition intervention and other interventions are in process. Reports submitted in a timely manner Capacity building plans for partners in place. Final report on assignment submitted to Director of Programmes. Consultant profile The nutrition consultant should have experience in CMAM and emergency programme set up, assessing and capacity building local partners. The consultant should also have a public health or nutrition degree, preferably masters level. They should be able to work well under pressure and work to tight deadlines for implementation, monitoring and reporting. Good written English is also required. Interested applicants should submit their CV and a cost proposal (daily rate and any other costs) to Kate Golden, Senior Nutrition Advisor, Concern Worldwide: kate.golden@concern.net