Background
Concern Worldwide developed the CMAM Surge Approach to support health systems to become more resilient to the shocks and stresses that regular surges in the demand for treatment of acute malnutrition present in vulnerable contexts. The model draws heavily from Concern’s experience supporting CMAM and health services in a range of contexts over the past fifteen years. To date, Concern has piloted the CMAM Surge Approach in Marsabit County in Northeast Kenya (2012-2014) and has introduced elements of the approach in a number of other country programmes, including in the Karamoja District of Uganda (2014). The Marsabit County CMAM Surge programme was externally evaluated in November 2014 with positive results. An internal review of Concern’s Uganda CMAM Surge programme also recommended continuation and scale up. There is also growing interest in other countries with similar ‘surges’ in caseload to pilot the CMAM Surge approach, particularly in East Africa and the Sahel. To do this, practical tools and guidance are required, and ideally key implementing partners will have the opportunity to influence these as they are developed to improve the usefulness of the final product.

To date, evaluative work on the CMAM Surge Approach has focused on its ability to respond to increases in caseloads. It has not, however, been able to assess whether this represents Value for Money as compared to the traditional emergency response. The evaluation of the CMAM Surge Pilot in Kenya recommended organizations such as Concern adopt "a value for money approach, based on examining the impact of sustained health system strengthening (HSS) and the surge model on reducing costs over time…demonstration of the cost savings of the approach…would be a powerful argument for sustained investment…to respond to emergencies in an effective and efficient way.”

Purpose
The purpose of the consultancy is to develop a practical cost-effectiveness analysis framework/protocol and related analytical tools and lead on its immediate use in two contexts where the CMAM Surge approach will be implemented.

Objective
To evaluate the cost effectiveness of the CMAM Surge Approach in two contexts versus the standard government delivery of services and versus the more traditional emergency responses as provided often by NGOs.

Scope of duties and responsibilities
The consultant will be responsible for initial discussion with the Concern Nutrition Advisor and country teams on the key elements and metrics for development of the protocol and tools. The approach will incorporate a societal perspective, measuring opportunity costs to health workers as well as beneficiaries when calculating costs.

The protocol and related analytical tools will be drafted and shared with the Concern Nutrition Advisor for discussion and finalization. The protocol and tools may also be shared with USAID and other relevant stakeholders for further feedback.

The CEA metric will be finalized in consultation with the Concern team, the identified research partner, government consultation and existing literature, but is likely to be the cost per child treated and the cost per life saved. The cost-effectiveness analysis framework and tools should also be able to determine which costs are the main drivers of the CMAM Surge Approach (e.g. using a sensitivity analysis if possible) and the implications of this for programming.

After feedback on drafts, the final protocol and tools will be produced for the immediate use in Ethiopia and Niger. The consultant will support the evaluation analysis throughout the project period.

A final report will be produced upon completion of the analysis. Feedback will be given from the Concern Nutrition Advisor and Concern country teams, as well as other stakeholders before finalization of the report.

Expected deliverables
- Cost Effectiveness Analysis Protocol and related analytical tools developed
- Cost Effectiveness Analysis process carried out
- Cost Effectiveness Report produced

Supervision
The consultant will be supervised by the Concern Nutrition Advisor based in the head office. During country trips the consultant will report to the Program Director with support from the Nutrition Advisor.

Time frame
Approximately 70 days over August 2017 to November 2018. Home based with two trips to Ethiopia and one trip to Niger over the time period.

Qualification and competencies
1. At least 5 years of past experience carrying out Cost Effectiveness Analysis
2. Knowledge of CMAM
3. Experience in West and Horn of Africa
4. The ability to work in both English and French
5. Excellent analytical, report writing, and human relation skills

Application
Qualified individuals, consultancy firms, or universities are requested to submit CVs of key personnel along with expression of interest, including costed plan and methodology of a maximum of 3 pages, to: suzanne.fuhrman@concern.net by 18 August 2017. Applications without costed plans will not be considered. Late submission will not be considered. Successfully shortlisted applicants will subsequently be invited to submit detailed proposals.