1. Overview 

  • Project: Delivery Systems for Scale
  • Location: Yemen 
  • Support Duration: 2 months
  • Estimated start date: 1 May 2023

In July 2022, in response to the global food and nutrition crisis, the U.S. Agency for International Development (USAID) announced unprecedented funding for the rapid scale-up of acute malnutrition treatment services. This historic $200 million financial contribution is intended to enable 13 countries - including Yemen – to increase treatment coverage in record time. Together with USAID and UNICEF, the International Rescue Committee (IRC), Action Against Hunger and Save the Children are leading the ‘Delivery Systems for Scale’ project – which provides technical and coordination support in direct alignment with USAID supplemental funding.

In order to ensure that the USAID/UNICEF partnership is well-positioned to meet scale targets in Yemen, the project seeks to hire a consultant to fill a new, fixed-term Technical Advisor role. This Terms of Reference (TOR) highlights the state of the acute malnutrition crisis in Yemen as well as recent work by national stakeholders (including the Nutrition Cluster, UNICEF and WFP) that lay the foundation for this consultancy – which will collaboratively develop a roadmap for bringing acute malnutrition treatment to scale in Yemen over the coming years.

2. Background:

Yemen has been affected by a protracted protection crisis and civilian war for longer than eight years. The ongoing armed conflict in Yemen has profoundly affected children and mothers in many aspects including access to basic services including immunization and primary health care services, and access to diverse, sufficient, and affordable diets.

Health surveillance system data suggests sustained high levels of vaccine-preventable diseases including diarrheal diseases, measles, and other fevers such as malaria and acute respiratory tract infections. Additionally, the incidences of both child diseases leading to acute malnutrition and the incidence of malnutrition are overlapping in terms of seasonal occurrence and peaks. Every year malnutrition and child diseases peak during the rainy season which peaks during the month of May through early October.

Each year in Yemen, nearly 540,000 children are at risk of death because of SAM, including 86,000 children under the age of five years who acquire SAM with complications requiring hospitalization. At least 1.2 million pregnant and lactating mothers are at risk of deteriorated health status because of acute malnutrition.  So, to say that without proper and integrated management of acute malnutrition in Yemen, out of each five Yemeni children, two will eventually acquire acute malnutrition each year.

In Yemen, it’s not only the health system that is disrupted. Out of the 17 million Yemeni population living in areas affected by acute food insecurity (IPC AFI of 3 and above), there are nearly 3 million children under the age of five years who are at risk of developing acute malnutrition. Food insecurity is largely and adversely influenced by the deteriorated overall economy in Yemen and therefore, the deteriorating household economy. 5.0 million children 6-59 months are not accessing sufficient and diverse, quality food, and currently 2.4 million children with acute malnutrition live in areas of acute food insecurity. The highlands of Yemen such as Taiz and Hajjah includes areas not easily accessible even by armoured vehicles.

Treatment of acute malnutrition is provided across all of Yemen as a component of the primary and secondary health care services. Currently out of the 5141 functional primary health care centres in Yemen, Outpatient care for uncomplicated SAM is provided in 4671 of them which represents 97% percent availability coverage of outpatient management of acute malnutrition. In addition, treatment of complicated SAM has been provided in 146 primary health care centres out of the 5141 functional primary health care centres which corresponds to 80% percent availability coverage of moderate acute malnutrition (MAM). SAM with medical complications is treated at the levels of hospitals and it covers 146 hospitals out of the total functional hospitals in Yemen.

Every year in Yemen, acute malnutrition admissions peak during the rainy season which lasts from May through October every year, during which the incidence of vaccine-preventable diseases among children peaks too. Treatment of acute malnutrition is implemented with the supply of Ready to Use Therapeutic Food (RUTF) to treat uncomplicated SAM, Therapeutic milk to treat complicated SAM, and Ready to Use Supplementary Food (RUSF) to treat MAM.

3. Update: Recent Progress

The Yemen Nutrition Cluster has been advocating for the following priority activities, related to scaling the management of acute malnutrition in Yemen:

  • Development, finalization, and operationalization of targeted and costed community-based management of acute malnutrition (CMAM) scale-up plan, which could be updated on an annual basis;
  • Rolling out the simplified guidelines to treat acute malnutrition with a single product to improve programs linkages and ensure the continuum of care for the acutely malnourished children of Yemen;
  • Strengthening the linkages between CMAM services and preventive nutrition services including promotion of infant and young child nutrition, micronutrient supplementation, blanket supplementary feeding, and cash/voucher assistance operational in Yemen; and,
  • Strengthening CMAM program reporting and quality assurance such as developing and using the national CMAM database and real-time monitoring using the scoring cards or checklists.

In response, and aiming to increase programmatic coverage and efficiency, WFP and UNICEF have agreed:

  • Nationally, Yemen is not ready to implement all of the available simplified approaches at-scale yet. However, some of these simplified approaches could be implemented, strengthened, and contextualized to certain geographic areas. In the short-term, the intent is to a) explore the CHW-led treatment of wasting and b) Family MUAC. The approach of reduction of the frequency of visits is being implemented in specific contexts, not across the country.
  • Careful consideration is required on the use of a single product for the treatment of wasting due to the good distribution and co-location of OTP and TSFP services.
  • Both agencies do not advocate for the modified dosage (or reduced).
  • Both agencies do not recommend of using MUAC-only criteria for admission of acute malnutrition, because this will result in missing more than 30% of the eligible cases. This was implemented during COVID, and the country experienced a huge drop in admission.
  • Both agencies highlight the existence of a healthy supply pipeline for both RUTF and RUSF at least for the next 6 months
  • There is a strong recommendation to develop a localized scale-up plan in the priority locations of Hajjah, Hodeida, Taiz, Abyan, and Saada where there is a potential deterioration of the nutrition situation between May and September.
  • The focus in 2023 is to ensure the continuum of care and ensure to align MAM and SAM services, and where possible integrate nutrition services (MAM/SAM) within the mobile clinics to increase coverage in the hard-to-reach areas.
  • The cluster was asked to reach out to GNC and others for potential technical support to implement the localized wasting scale-up in the pocket areas.

4. Consultancy: Purpose & Scope

The Technical Advisor (TA) will support the Yemen Nutrition Cluster in reviewing bringing treatment of acute malnutrition to scale. More specifically, the primary functions of this role are expected to include:

  • Mapping of the existing CMAM services and the existing linkages with the primary health care services and the community-based nutrition preventive services.
  • Based on the mapping above, support in advising the nutrition cluster and its partners and in close collaboration with the CMAM working group on the best modality of the simplified guidelines which could be implemented and rolled out in Yemen.
  • Drafting a targeted and costed CMAM scale-up plan focusing on high-burden governorates including Hudaydah, Hajjah, Taiz, Ma’arib and Abyan.

The successful candidate will also be responsible for ensuring alignment and collaboration across multiple agencies and partners (e.g., UNICEF, WFP, WHO, MOH, INGOs and other partners).

5. Priority Activities and Outputs

ACTIVITY DELIVERABLE DAYS

Develop an inception report outlining: a detailed activity workplan highlighting draft review periods and circulation groups, detailed methods and content outline for each required deliverable, and a list of options for the technical focus areas of the case study.   

1. Inception report 5

Conduct a mapping of the existing CMAM services and the existing linkages with the primary health care services and the community-based nutrition preventive services. Mapping will be accomplished using a combination of agency briefings, tools, strategies, plans and other secondary resources.

Compile all resources into a centralized SharePoint folder of Yemen-specific tools and documents.

2a. Synthesis report

2b. Resources binder

8

2

Based on the mapping, support in advising the nutrition cluster and its partners and in close collaboration with the CMAM working group on the best modality of the simplified guidelines which could be implemented and rolled out in Yemen.

3. Guidance note and/or standard operating procedures for simplified approaches

12

Draft a targeted and costed CMAM scale-up plan focusing on high-burden governorates including Hudaydah, Hajjah, Taiz, Ma’arib and Abyan.

4. Scale-up plan 13

Consolidate and document recent learning in the form of a short Case Study.

5. Case study  5

6. Deliverables 

By the end of June 2023, the Technical Advisor will provide:

  • An Inception Report;
  • A Synthesis Report of CMAM service mapping in Yemen;
  • An accessible folder – on SharePoint – consolidating all available, Yemen-specific tools and resources useful for future scaling efforts;
  • A Guidance Note and/or (TBC) Standard Operating Procedures for simplified approaches in Yemen context,
  • A targeted and costed CMAM scale-up plan for high-burden governorates; and,
  • A case study documenting recent learning in Yemen.

7. Contract Arrangements

As mentioned, this is a seconded role based with the Nutrition Cluster in Yemen. This consultancy will likely be based in Sana’a for the duration of the contracting period, although alternatives may be considered depending on the location of the consultant and possible travel needs.

The consultant will be expected to complete work over a period of 45 days, with final deliverables submitted no later than June 30, 2023. Payment will be made upon final approval of all required deliverables.

8. To Apply

Recruitment for this position will be expedited.

Interested candidates should submit:

  • A brief, 1-2 page technical proposal outlining the candidate’s own understanding of the required scope of work;
  • An updated CV that clearly spells out his/her/their qualifications and experience in alignment with the scope of work;
  • A financial proposal showing expected daily rates / fees;
  • Examples of similar work completed in past years; and,
  • At least 2 reference contacts related to the aforementioned examples.

Applications should be sent by email to Ellyn.Yakowenko@rescue.org with Racheal.Kintu@rescue.org in copy. 

Materials will be reviewed on a rolling basis, with priority given to early applicants that meet the essential qualifications listed below. We encourage interested candidates to submit their materials as soon as possible.

9. Successful Candidate Profile

Essential requirements for this Technical Advisor role include:

  • Advanced degree in nutrition, public health, or a related field, with at least seven years of relevant work experience.
  • Strong technical skills in community-based management of acute malnutrition, including treatment of uncomplicated SAM cases, with specific expertise and experience in the context of Yemen
  • Demonstrated ability to translate research and evidence into practice and policy shifts
  • Knowledge of relevant SAM treatment protocols, plans and strategies in Yemen.
  • Knowledge of the latest research, best practices, and emerging trends in acute malnutrition treatment, especially simplified approaches
  • Excellent written and verbal communication skills in both English and Arabic, with demonstrated ability to communicate complex technical information to a variety of audiences, including donors, government officials, and community members.
  • A deep commitment to equity, inclusion, and social justice, including sensitivity to the needs and perspectives of marginalized populations, and experience working with diverse communities in Yemen or similar contexts.
  • Prior experience working directly with stakeholders in Yemen, including UNICEF, WFP, WHO, National Ministry of Health and civil society organizations. 

Desirable characteristics include:

  • In-depth knowledge of the social, cultural, and economic factors that contribute to high rates of acute malnutrition in Yemen, and strategies for addressing these factors through community engagement, behavior change, and policy advocacy.
  • Proven experience designing and implementing large-scale acute malnutrition treatment programs in Yemen or similar contexts, including expertise in project management, budgeting, reporting, and monitoring and evaluation.
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