Applications and queries to be sent to evaluations@harpfacility.org using the subject line ‘Nutrition Barriers and Bottlenecks Consultancy’.

Background and context

Humanitarian Assistance and Resilience Programme Facility (HARP-F)

The Humanitarian Assistance and Resilience Programme Facility (HARP-F) is an innovative instrument funding humanitarian assistance in Myanmar, specifically designed to strengthen the role of national civil society in rapid onset and protracted crises. Through our partners, we have been working to address acute humanitarian needs, build resilience and reduce the vulnerability of populations affected by successive crises and natural disasters in Myanmar and on the border with Thailand since 2017. We have channelled over £74 million of UK humanitarian funding to local, national and international partners to provide assistance to the most vulnerable populations, primarily internally displaced persons (IDPs) and refugees. We have granted another £4.3 million for COVID-19 prevention and control.  

We aim to strengthen the role of national and local partners in humanitarian response in Myanmar, through our grant programme and our extensive capacity enhancement training programme. This strong reliance on local partners, as well as context-specific, adaptive programming, is what enabled HARP-F to quickly mount a COVID-19 response in 2020 in Myanmar and to continue to operate and meet the humanitarian needs of the most vulnerable populations following the February 2021 military coup.

Nutrition Situation in Myanmar and Rakhine State

Good nutrition at an early age and for women is the foundation to a child’s survival and development. In the first 1,000 days between woman’s pregnancy to her child’s second birthday are crucial to a child’s development; the baby needs the right nutrients at the right time to feed the brain’s development. Poor nutrition in the first 1,000 days causes wasting (too thin for height) in children, increasing mortality. In the long-term, inadequate nutrition can cause irreversible damage to the child’s growing brain affecting their ability to do well in school or earn in the future. Some studies have linked early childhood undernutrition to adult obesity, diabetes and other chronic diseases. With Myanmar plagued by conflict and highly vulnerable to natural disasters and climate change, malnutrition is a major concern in Myanmar. Under-five mortality in Myanmar remains one of the highest in the South-East Asia region and Myanmar is one of Asia’s poorest countries.

Nutrition-specific and nutrition-sensitive service provision in Rakhine specifically has been decreasing since 2017, prior to the COVID-19 pandemic, leaving many children untreated and thus increasing the risk of malnutrition, morbidity and mortality. Nutrition services, including active wasting case detection, referral and treatment, have been severely disrupted by insecurity and increased access restrictions since 2017. Service provision, including outside of Rakhine state, has been further reduced by COVID-19 and the recent political instability. There is a lack of cohesion between and within malnutrition treatment and prevention services, increasing the risk of children missing lifesaving treatment. In addition wasting and stunting are seen as separate manifestations of malnutrition, with no programmes to jointly address both and their shared risk factors.

Scaling-up coverage of wasting treatment in Myanmar and Rakhine in particular requires innovative approaches such as using Family Mid-Upper Arm Circumference (Family MUAC), which has been shown to be feasible, and piloting simplified approaches to wasting treatment, for example for low-literacy health workers and volunteers or in the absence of sufficient quantities of RUTF. Other opportunities also include integration of nutrition services into mobile health clinics and the use of modified protocols. The barriers to seeking maternal and child health services are multi-factorial, with Muslim households facing additional obstacles, and these will need to be addressed to achieve increased coverage. Other major gaps in nutrition service provision include identification and management of at-risk infants under six months and their mothers (MAMI) and better management of children with severe wasting with medical complications. Yet, nutrition has been neglected in the humanitarian response. Urgently, this calls for a new coordinated strategy to prioritise nutrition as a central part of the humanitarian response in Myanmar.

HARP-F’s role in prioritising nutrition in Myanmar

In March 2021, HARP-F finalised a nutrition baseline report to assess the challenges impacting nutrition programming in Rakhine State, and to make recommendations to better address malnutrition moving forward. One recommendation was to increase coverage of wasting treatment services, including screening and referral, with a focus on severe wasting treatment of children 6-59 months and management of at-risk infants under 6 months and their mothers (MAMI).

Alongside this effort, HARP-F, LIFT and Access to Health are supporting a range of implementing partners to address nutrition needs in camp and non-camp settings and have drafted a joint Nutrition Action Plan with the aim of reducing the prevalence of wasting and stunting in Rakhine State. The Nutrition Action Plan consists of ten actions and associated activities with a humanitarian focus, designed to address the recommendations arising from the nutrition baseline report. These actions are to be completed with the support of FCDO as required, and in collaboration with the nutrition sector, their activities and strategies, from June 2021 through to June 2022.

The key intended outcomes of the area under evaluation are:

One activity included in the Nutrition Action Plan, under priority 2 to increase coverage of nutrition services, is to conduct an analysis to identify the barriers and bottlenecks for implementation of nutrition programming in Rakhine State, Myanmar. This analysis would look at all nutrition services being provided, with a particular focus on wasting treatment, and identify solutions to challenges identified.

Purpose of the analysis and target audience

The purpose of this research is to understand what the current situation is regarding nutrition service provision, in particular for lifesaving services such as wasting treatment, in order to determine needed solutions to identified challenges. As there is a lack of understanding of the common barriers and bottlenecks to nutrition programming in Rakhine State in Myanmar, this research aims to identify such challenges and bottlenecks and develop realistic actionable solutions to overcome the challenges.

Recent changes in the nutrition context in Myanmar are likely to have created further challenges to an already inadequate service provision in Rakhine State. Changes to the Myanmar context include the COVID-19 pandemic, the military coup in February 2021, the resulting violence and conflict, and disruption to health service provision due to participation in and arrests related to the civil disobedience movement (CDM).

This work would build off of previously conducted work and already known barriers, such as a poor referral system for wasting treatment, weak supply management, reporting issues, poor linkages for case management etc. This work should also include a gender analysis as a known barrier to access. The results of this analysis will inform future adaptations required to increase coverage of nutrition service provision by the nutrition sector, improving access to services by the population in need and identifying how the nutrition sector, partners and broader humanitarian response can support this effort. This work may also influence FCDO’s future funding priorities.

Analysis objective and scope

Geographic scope

This analysis will focus on Rakhine State in Myanmar.

Target groups to be included in the analysis

While nutrition programming tends to focus on children under 5 years of age, plus pregnant and lactating women (PLW), this analysis should include any beneficiary of nutrition programming including fathers, male caretakers, grandmothers etc. as relevant.

Nutrition services to be included in the analysis

• Severe and moderate wasting treatment (inpatient severe wasting care, outpatient therapeutic programmes (OTP) for severe wasting, targeted supplementary feeding programmes (TSFP) for moderate wasting treatment and community mobilisation, including referrals between all services (this should be the main focus of the analysis given the lifesaving nature of this service)
• Infant and young child feeding (IYCF), including in emergencies (IYCF-E) e.g. IYCF individual counselling, mother support groups, IYCF safe spaces, Baby WASH, breastmilk substitutes (BMS) code monitoring
• Maternal/ female adolescent nutrition services including micronutrient supplementation, blanket supplementary feeding programmes (BSFPs), food/cash distributions and social and behaviour change communication (SBCC) strategies for nutrition, maternal and child cash transfers (MCCT)
• Growth monitoring and BSFPs for children under 5 years of age
• Nutrition services, e.g. MUAC screening, integrated into other sector activities, e.g. water, sanitation and hygiene (WASH), and vice versa

Time period to be covered by the analysis

This analysis will focus on the provision of nutrition services since 1st February 2021 onwards, given the acute change in context from this date. The analysis will concentrate on where nutrition service provision has stabilised to now, given this is the ‘new normal’, looking at the barriers and bottlenecks in existence currently and recommending solutions relevant for the current context, in order to improve coverage of nutrition services moving forward.

Analysis questions and tasks

Primary questions of the analysis:

1. What barriers and bottlenecks exist in Rakhine State to increasing coverage of wasting treatment services? Consider Northern Rakhine State (NRS) versus South/Central Rakhine State, and camp versus non-camp settings.
2. What are the root causes of the identified barriers and bottlenecks for increasing coverage of wasting services?
3. What solutions are recommended to overcome the identified barriers and bottlenecks to increasing wasting treatment services? What solutions are proposed by key informants familiar with the context? Identify immediate, medium-term and long-term priorities in order to achieve the recommended solutions. Consider NRS versus South/Central Rakhine State, and camp versus non-camp settings.

Secondary questions of the analysis:

1. What barriers and bottlenecks exist in Rakhine State to increasing coverage of other nutrition services including IYCF/IYCF-E, MNP distribution, BSFP, food/cash distributions, SBCC for nutrition, GMP, MCCT and nutrition activities integrated into other sectors? Consider NRS versus South/Central Rakhine State, and camp versus non-camp settings.
2. What are the root causes of the identified barriers and bottlenecks for increasing coverage of other nutrition services?
3. What solutions are recommended to overcome the identified barriers and bottlenecks to increasing coverage of nutrition services other than wasting treatment? What solutions are proposed by key informants familiar with the context? Identify immediate, medium-term and long-term priorities in order to achieve the recommended solutions. Consider NRS versus South/Central Rakhine State, and camp versus non-camp settings.

Approach and Methodology

This analysis can be completed in various ways, with the final methodology to be discussed with the successful consultant. A proposed scope of work is as follows:

• Secondary literature review of existing documentation available from previous studies/ analyses relating to the barriers/ bottlenecks to increasing coverage of nutrition services
• Collection and analysis of all relevant data available e.g. data on stock-outs, data on referrals vs arrivals at wasting treatment sites in public and private sectors etc.
• Multi-stakeholder consultation to interview ~15-20 key informants to identify key barriers, bottlenecks and root causes of these, and to identify potential solutions e.g. Nutrition Sector Coordinator, UNICEF, WFP, INGOs including Save the Children and ACF, NNGOs including MHAA and State health Department (where feasible)
• Report writing including identified barriers and bottlenecks, with solutions recommended for each. Solutions to be determined by best practice from global/similar contexts and from suggestions made in interviews with key informants
• Workshop with key informants to present draft report and agree on potential solutions
• Incorporation of internal and external feedback to produce final report

Timeline and deliverables

The consultancy is expected to start by the end of October 2021, conclude by the end of January 2022 and require 26 days for completion of work. A rough outline of the anticipated timeline is presented below together with the expected deliverables:

Inception phase (8 days)

Inception report should contain:

• Secondary literature review of existing documentation and relevant data
• Proposed questions for key informant interviews including list of key informants to be contacted

DELIVERABLE 1: Submission of inception report.

Multi-stakeholder consultation phase (6 days)

• Conduct ~15-20 key informant interviews
• At the end of the consultations, preliminary findings and conclusions will be presented to relevant staff

DELIVERABLE 2: Compiled interview data in electronic format.

DELIVERABLE 3: Presentation of preliminary findings to relevant staff.

Reporting phase including key informant workshop (12 days)

The final report should:

• Provide a comprehensive analysis of compiled data
• Include workshopped solutions from key informants
• Be circulated to HARP-F, LIFT and Access to Health for review and comment before finalisation
• Incorporate feedback as relevant

DELIVERABLE 4: Completed workshop to agree solutions with key informants.

DELIVERABLE 5: Submission of draft report for review.

DELIVERABLE 6: Submission of final report and annexes (with HARP-F signoff).

The final report should follow HARP-F branding guidelines and be no more than 20 pages long.

Required competencies

• Master’s degree in nutrition or public health or equivalent professional experience
• Demonstrable experience working in the international nutrition sector, including experience working in developing countries (to provide understanding of field realities)
• Knowledge of the international nutrition sector across a broad range of topics (management of wasting in particular)
• Proven experience conducting barrier and bottlenecks analyses, including identification of solutions, for the nutrition sector
• Strong qualitative and quantitative data analysis skills
• Practical experience in conducting evaluations or research on area under evaluation
• Familiarity with the Myanmar context
• Excellent English report writing skills
• Strong interpersonal skills, motivated, takes initiative and drives progress

Budget and Payment

Bids shall include budgets that are based on the scope of work and proposed questions. The agreed sum shall cover all fees and costs incurred in conducting the consultancy tasks.

Payment will be made in two instalments: - 20 per cent upon signing the contract, - 80 per cent upon submission and approval of the finalised consultancy outputs.

Proposal Submission

Application deadline: Close of day 8th October 2021.

Bids must include the following:

a) Cover letter: stating candidate skills and experience suitable for the consultancy (max 1 page)

b) Outline of proposed methods, proposed timeframe, work plan and budget (max 3 pages; bids over limit will be automatically excluded).

c) CV of proposed individual and sample of similar analyses carried out previously (abbreviated work is adequate, though we may ask for additional text if submission is insufficient to assess quality of work performed).

Applications and queries to be sent to evaluations@harpfacility.org using the subject line ‘Nutrition Barriers and Bottlenecks Consultancy’.