Somalia: Consultant - Standardized Monitoring and Assessment of Relief and Transitions (SMART) Survey

1.0. Background

International Medical Corps is a global, humanitarian, nonprofit organization dedicated to saving lives and relieving suffering through health care training and relief and development programs. Established in 1984 by volunteer doctors and nurses, International Medical Corps is a private, voluntary, nonpolitical, nonsectarian organization. Its mission is to improve quality of life through interventions that build local capacity in underserved communities worldwide. Since 1991, International Medical Corps has worked in south-central Somalia and Somaliland to implement programs that build local capacity while serving the immediate health, nutrition and WASH needs of the most vulnerable. More than 2.1 million Somali women, men, girls and boys are internally displaced, with over one quarter of Somalia’s estimated 12.3 million populations in need of emergency healthcare services. Through our long-term presence on the ground, International Medical Corps has built strong relationships with communities throughout Somalia and Somaliland, making it possible to operate in highly unstable conditions. In addition to providing immediate relief, International Medical Corps builds a framework for program sustainability and long-term positive change, making Somali communities more self-reliant.

2.0. Program background

International Medical Corps has been implementing Health and Nutrition interventions in Abduak, Balambal and Jowhar Districts of Galgaduud and Middle Shebelle region since mid-2014. Conflict, and associated displacement, has had a significant impact on food security and, consequentially, the prevalence of malnutrition. While famine was averted due to the scaled up humanitarian response, the situation still remains dire for Abduak, Balambal and Jowhar districts that have GAM rates of 20% and SAM rates of 4.6% according to the FSNAU 2017 post Gu assessments. In response to the emergency caused by the four failed consecutive rainy seasons resulting in the area being classified as IPC 4, IMC interventions have been contributing to the prevention and management of acute malnutrition among the most vulnerable groups: the under five children, pregnant and lactating mothers through therapeutic and supplementary feeding programs. In addition, IMCs health interventions have contributed to a reduction in maternal and child mortality and morbidity in the district through delivery of health and nutrition services aligned with the Somalia Essential Package of Health Services (EPHS) in Abduak and Balambal districts. Currently, IMC with financial and in-kind support from UNICEF, UNFPA, DFID (SNS+ IRF) and OFDA, International Medical Corps has been operating 1 referral health center (RHC) including a Stabilization center, 4 health centers (HCs), 15 primary health units (PHUs), and 4 mobile health and nutrition teams (MHNTs). Despite this interventions, International Medical Corps has observed that very slow progress has been made in sustainably impacting on the malnutrition status with significant gaps still being sustained.

IMC would therefore like to conduct a conduct a SMART survey in Abduak, Balambal and Jowhar District so as to assess and monitor the nutrition status of children 6-59 months of age, including other Health and WASH proxy indicators for the population of Abduak and Balambal districts as well as providing recommendations for planning and deciding on future nutrition programming in the area. This is because IMC relies on statistics from FSNAU which conducts surveys across regions and livelihoods making it difficult to establish the exact nutrition situation at district level. In addition to this IMC would like to build the capacity of the Program managers on SMART methodology.

3.0. Purpose The purpose of this TOR is to spell out the guidelines for the assignment that is aimed to carry out a SMART survey amongst the communities in Abduak and Balambal Districts. The main objective of the survey will be to estimate the prevalence of acute malnutrition amongst children aged 6-59 months and in women of reproductive age of 15-49 years in Abduak, Balambal and Jowhar Districts of Galgadud and Middle Shebelle Region of South Central Somalia, with the following specific objective

Specific Objectives:

1. To estimate the prevalence of acute and chronic malnutrition in children aged 6-59 months in Abduak, Balambal and Jowhar
2. To estimate retrospective under-five and crude mortality rates in Abduak, Balambal and Jowhar Districts
3. To assess based on 2 weeks’ recall of the common Communicable and non-Communicable childhood morbidities of children under five years
4. To determine health seeking practices of the care givers and mothers
5. To determine the immunization coverage for measles (9-59months), Oral Polio Vaccines (OPV type 1 and 3), deworming and vitamin A supplementation in children aged 6-59 months.
6. To estimate coverage of iron/folic acid supplementation during pregnancy in women of reproductive age.
7. To determine the nutritional status of women of reproductive age 15-49 years by MUAC
8. To collect information on possible underlying contextual factors causing malnutrition such as household food security and IWDD, water, sanitation, hygiene practices and protection issues.
9. To formulate and provide practical and sustainable recommendations /interventions based on the survey findings to improve the nutrition status of the population.

4.0. Methodology

A cross sectional study utilizing a two-stage cluster sampling and the Standardized Monitoring of Relief and Transition (SMART) methodology will be used. A standardized integrated nutrition SMART survey tool will be used and uploaded electronically using ODK or KOBO. Emergency Nutrition Assessment (ENA) for SMART software, SPSS version 21 and will be used for analysis.

5.0. Main Tasks by the survey consultant

1. Develop a survey protocol (including review of population statistics, calculating the sample size, selecting sample villages and respondents, developing an efficient survey schedule) and tools in consultation with IMC technical team using the Nutrition Cluster approved templates & tools.
2. Present the survey Methodology at Nutrition Cluster Assessment and information Management Working Group (AIMWG) for validation
3. Review appropriate documents (nutrition survey reports, HIS reports etc.) relevant to the survey
4. Conduct a SMART managers training for IMC program staff.
5. Train the survey team (including pre-testing questionnaire and conducting standardizing tests with all enumerators in collaboration with IMC program staff.
6. Upload the final data collection tool to the digital mobile platform either ODK or KOBO
7. Assume overall responsibility for implementation of the survey, including daily supervision of survey teams and daily data quality checks. This includes the data entry step because digital data gathering devices will be used.
8. Be responsible for data cleaning and analysis using anthropometric software (ENA for SMART, SPSS and others as needed) for the core anthropometric and additional variables. Conduct some 2X2 tables to identify any associations or relationships between variables.
9. Prepare and present an overview of preliminary findings and share this with IMC technical team for comments and discussion.
10. Present the final survey findings with the AIM working group for validation
11. Write and submit a comprehensive Final nutrition survey report Submit the initial raw and final clean data sets in ENA- SMART

6.0. Deliverables

Deliverables under this assignment will include the following:

1. A detailed inception plan demonstrating how the consultant plans to conduct the survey. The report will include a feasible methodology and data collection tools, data analysis plan and a detailed work plan. This will be presented 3 days after the signing of the contract
2. A SMART managers training material and report.
3. A preliminary report to be submitted 1 week after completion of the field activities.
4. The final report to be submitted to the Program Director in soft and hard copies and together with all the raw data

N/B: As with all population surveys it is imperative that the results are available to IMC 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, standardization test during training (procedure & results)), results), discussion, conclusions/recommendations, and references. The annex should contain but not necessary be limited to a map, final questionnaires, sampling frame indicating the clusters selected, actual survey schedule, teams & supervisors, plausibility test, TOR. As mentioned above the consultant will conduct debriefing meetings with IMC field team and Technical teams and other relevant stakeholders.

7.0. Proposed Time Frame

• The assignment is expected to last approximately 30 days including all the stages of the survey as shown below • The Survey is expected to begin on April 9th 2018 and to be completed by 13th May

Responsibilities of International Medical Corps:

1. Provide oversight during the survey
2. Logistics arrangements including transportation for all field travel
3. Approval of all deliverables including sign off for the purpose of making payments
4. Recruit enumerators
5. Provide means of travel to the site and accommodation during the survey period.
6. Provide the data collection devices
7. Ensure nutrition/program staff are available to co-lead survey

Consultant’s qualifications and experience required:

1. The consultant is expected to demonstrate a track record of not less than three (3) years of experience conducting similar assessments in a developing country set up with diverse geographic and ethnic/clan compositions. The consultant should also list the scale of similar projects worked on in the past
2. Advanced University degree in Nutrition, Health and/ or Public Health and proven experience in carrying out SMART surveys
3. The consultant must be a Trainer of Trainers (ToT) for SMART
4. The consultant must have a strong background in statistics and data analysis
5. Knowledge of the project area and the local language (s) will be considered a plus
6. Have experience training and working with non-English speakers and people with low levels of education
7. Experienced in use of adult learning methodologies
8. Possess documented experience in conducting Nutrition Assessments including SMART surveys
9. Excellent reporting, presentation and interpersonal skills
10. Attachment of all supportive documents with the technical proposal is required
11. Excellent skills in statistical analysis for nutrition and health related surveys using software’s such as ENA for SMART, SPSS, STATA, among others

Technical Proposal Format The proposal should include the following at minimum:

1. A cover letter
2. Resumes of consultants and team and their roles
3. Consultants’ understanding of the TOR attaching the legal documents
4. Proposed methodology and timelines
5. Proposed work plan and budget (should express all proposed costs in USD)
6. The financial proposal should list itemized details of costs associated with the survey
7. The consultant’s availability
8. Copies of previous survey reports

Conditions:

1. 30% of the total amount to the consultant at the signature of the contract
2. 30% of the total amount of expenses to the consultant will be paid after receiving the preliminary survey report
3. 40% will be paid after reception of final SMART survey report. The receipt will have the date of contract

iruiz@internationalmedicalcorps.org.uk