Post Title:International consultancy to provide technical assistance in reviewing Rapid Test Kit (RTK) Strategy implemented as part of Universal Salt IodisationProject in Khatlon

Duration of contract: 20 April- 5June 2015

Location: Dushanbe, Tajikistan

Closing date: 26March 2015

TERMS OF REFERENCE

  1. BACKGROUND AND JUSTIFICATION

Tajikistan is a mostly mountainous and landlocked country covering an area of 143,000 square kilometres, and sharing borders with Uzbekistan, the Kyrgyz Republic, China and Afghanistan. High mountain ranges make communication among regions difficult, especially during the winter. Despite the strong economic growth over the past decade, Tajikistan remains the poorest nation in the CIS region with a Gross National Income (GNI) of US$990 per capita (Atlas method, World Bank, 2013) and an estimated 36% of its population living below the national poverty line in 2013. Public expenditure on health stands at 1.9% of GDP in 2013 and is the lowest in the region. As a result, there is a high proportion of out-of-pocket health spending, which raises serious concerns around equity. Child survival and development remains the greatest challenge for the country’s fragile health system. Poor nutritional status of children continues to be one of the major contributing factors to high infant mortality and morbidity rates. According to the Demographic and Health Survey (DHS)[1], more than one-fourth of children suffer from chronic malnutrition with half of them severely stunted. The proportion of wasted and underweight children has increased somewhat since 2009.

Iodine Deficiency Disorders (IDD) remain a crucial public health problem in Tajikistan, with high prevalence observed especially in the south and in mountainous areas. According to the 2009 Tajikistan Micronutrient Status Survey[2], more than half of women (58.6%) and children (52.9%) were affected by iodine deficiency (based on urinary iodine levels). In Khatlon Oblast and Rayons of Republican Subordination (RRS), this rate exceeded 73 per cent. Indeed, in Khatlon, the prevalence went up from 64.6 percent in 2003 to 84.8 percent in 2009. Severe cases of iodine deficiency among both women and children were most prevalent in Khatlon (5.2% and 1.2%, respectively), while for the rest of the country the prevalence remained under 1% for both groups. The same survey indicated that the proportion of households using iodised salt was 62 percent nationally, with wide regional variations from 94 percent in Sughd to 27 per cent in RRS, which is far below the recommended 90 per cent threshold.

In response, major efforts have been made by the Government and various donors in the area of IDD and Universal Salt Iodisation (USI), and the latest data (2012 DHS survey) indicates that over 84% of households (in a sample of over 6,300) used iodised salt. However, those consuming adequately iodised salt (>15 ppm) made up only about 39 percent. This suggests that significant problems remain in iodised salt production, quality control and regulation, despite the relative success in social mobilisation for families to adopt a lifestyle that includes regular purchase of salt labelled as iodised.

Since 2013, with GAIN/USAID support, UNICEF has been working to eliminate IDD through the project, ‘Improving access of population of Khatlon oblast to adequately iodised salt: A step towards Universal Salt Iodisation in Tajikistan’. The project has three specific objectives:

  • Increase availability of adequately iodised salt (>90%) in the markets and village shops through provision of access to salt testing with Rapid Test Kits (RTK) to the retailers and community leaders in Khatlon oblast;
  • Improve capacity building of salt producers and inspection agencies on basic salt iodisation quality assurance using the WYD checkers and lab titration;
  • Increase awareness of more than 90% of consumers in Khatlon oblast on IDDs and benefits of iodised salt.

To achieve these objectives, UNICEF has supported the following interventions in close collaboration with Ministry of Health and Social Protection (MoHSP), Institute of Nutrition under Ministry of Industry and New Technology, civil society organisations, GAIN and USAID: 1) Advocacy with salt producers and policy makers for compliance with legislation related to USI; 2) Procurement and distribution of Rapid Test Kits (RTKs) to all salt retailers and community leaders in Khatlon, and capacity building on the use of RTKs to protect their respective community members from illegal sale of non- or inadequately iodized salt; 3) Capacity development of salt producers and inspection agencies on iodized salt production, distribution and quality assurance (including provision of laboratory equipment); and 4) Effective communication and social mobilization interventions toward USI. Above all, interventions around RTK formed a central strategy of the project.

In 2013, with GAIN and UNICEF support, the Institute of Nutrition conducted a household survey to measure the baseline level of iodised salt coverage in Khatlon oblast. Around 100 clusters consisting of 8 households were randomly selected, covering all 25 districts and cities of Khatlon oblast. Guidelines and training manuals were developed and training was facilitated by UNICEF and GAIN local experts. Assessment included testing of salt at household level using the RTK and bringing samples to Dushanbe lab for titration. In addition, a few questions were asked to assess the knowledge of the surveyed population about benefits of iodised salt and their attitude towards buying and storing salt at household level. Salt samples were taken from 779 out of 800 surveyed households.

Before the project completion in June 2015, UNICEF Tajikistan wishes to carry out the review of RTK strategy implementation toward achieving universal salt iodisation, and thus it seeks an international consultant to lead an end-line project assessment in Khatlon.

It should be noted that, at the time of designing the project, a set of performance indicators were selected to measureprogress in achieving the expected project outcomes. A few more process indicators were added at the mid-point of the project particularly to monitor the accelerated implementation of RTK strategy. The list of the main indicators are provided in the below table. The original list includes mostly the process indicators, which are being measured through the ongoing monitoring system of the project. The selected consultant is expected to take into account these outcomes and indicators while proposing the methodology for the review of the project RTK strategy.

Expected outcomes: / Major progress indicators: / Remarks:
Capacity of public health professionals, government officials at every level and the salt trade on USI strengthened / Number of WYD procured and distributed
Number of people trained on importance of iodized salt and use of WYD and RTK
% of home visiting nurses who have received RTKs (in the sampled villages)
Number of action plans developed (by village leaders)
Number of RTKs distributed by village leaders / The agreed indicators are being measured through the ongoing monitoring system of the project.
Increased awareness of population and commitment to change their behaviour on benefit of iodized salt / Number of IEC materials produced and distributed
Number of people in the communities covered with communication activities / The agreed indicators are being measured through the ongoing monitoring system of the project. Outcome-level indicators (e.g., knowledge and awareness of the population regarding IDD and salt iodization) were also measured at baseline household survey in 2013.
Quality assurance practices improved through use of WYD and lab titration and capacity building of salt producers and inspection agencies / No systematic monitoring mechanism is in place to measure this outcome.
Increased availability of iodized salt in more retail outlets in the markets resulting in more household use of iodized salt / Number of tests conducted with RTKs per month
Proportion of retail outlets where adequately iodized salt is available
% packets at retailers with iodised salt (in the sampled villages)
Proportion of households using iodized salt / The second and third indicators are measured through spot checks as part of ongoing monitoring. The last indicator was measured at baseline household survey in 2013.
  1. OBJECTIVES

Main purpose of this review is to take stock of the achievement and challenges related to the implementation of RTK strategy towards universal salt iodisation. The review should include: i) the survey to measure the household consumption of adequately iodised salt in randomly selected districts as well as the population’s knowledge and awareness on IDD and iodised salt; and ii) analysis and documentation of the RTK strategy, including its implementation status (e.g., RTK coverage in the communities[3]) andits facilitating and constraint factors.The household and community surveys will be conducted by the Public Health Institute of Ministry of Health and Social Protection (MoHSP) in charge of data collection and analysis with support from an international consultant, in collaboration with other relevant institutions.

The proposed consultancy aims to assist the Government of Tajikistan inconducting the above-mentioned review of RTK strategy implemented as part of USI Project in Khatlon.

The international consultant is expected to i) come up with the appropriate methodology for the review of RTK strategy, which will include surveys, ii) ensure that necessary data is collected, and iii) analyse and document the findings and recommendations. For the conduction of surveys, the consultant should work closely with the Public Health Institute and other relevant institutions to provide technical and management oversight to the entire process through:

-Proposing and finalizing the survey methodologies and protocols, including detailed sampling procedure, plan for data collection and analysis, data collection instruments, and the entire work plan with timeframe;

-Training of a survey teamwithin the Public Health Institute, who will be engaged indata collection, supervision, and analysis;

-Supervising the data collection process in the field to ensure quality;

-Data analysis and report writing on survey results, with full involvement of the Public Health Institute

Throughout the process, the consultant will work closely with the MoHSP,the Public Health Institute, and other relevant institutes with a view to building their institutional capacity to enable the independent undertaking of the similar review in future.

  1. MAJOR TASKS TO BE ACCOMPLISHED:

An international consultant will be responsible for the tasks as stipulated below:

  1. Prepare an inception report outlining the review methodology and protocols, including survey sampling procedure, plan for data collection and analysis, data collection instruments, and the entire work plan with timeframe.For this purpose, the consultant should conduct a literature review. The desk review can make use of UNICEF documentation (donor and other reports, project specific documents and data), the government documents including, orders, policy papers, assessments, plan of actions, national reports and strategies, survey results, and administrative data. Above all, the consultant should review the project baseline report and Salt Situation Analysis report.
  2. Assist the Public Health Institute in leading and coordinating the overall survey process, including:

-Finalize the survey methodologies and protocols and the entire work plan with timeframe. The survey protocols will ensure that the data collected will be unbiased. Before finalization, pilot-testing of the data collection instrumentsshould be done.

-Design and facilitate the training of interviewers and supervisors on data collection.

-Ensure thesalt sample collectionand laboratory testing of the salt iodine level (titration) are done in good order.

-Supervise data collection in the field for quality assurance.

-Develop suitable data entry application and supervise data entry and cleaning process.

-Conduct data analysis and report writing on survey findings, with full engagement of the national partners (MoHSP and the implementing agency), and provide necessary technical assistance and capacity building support in the process.

  1. Collect additional qualitative information, if/as necessary, in order to analyze the achievements and challenges related to the implementation or RTK strategy towards US.
  2. Produce a final report, elaborating the reviewfindings and recommendationsand share a draft with UNICEF Country Office for review and feedback. Supplemental analysis based on feedback from UNICEF country office should be conducted and final report should be produced incorporating all the comments and feedback.
  1. METHODOLOGY

In order to perform the above-mentioned assignment, a consultant is expected to conduct a desk review of the relevant documents. While the consultant will work with the government stakeholders, UNICEF and GAIN to finalize the review methodologies, theymayconsist of primary data collection from: i) interviews with the relevant government agencies / partners as well as civil society organisations responsible for USI project implementation; ii) focus group discussions or in-depth interviews with salt producers, inspection agencies, and local government officials; iii) household survey to measure knowledge, attitude and practices, including the

coverage of adequately iodised salt and the awareness and reactions to RTK strategy; and iv) interviews or surveys involving health workers, village leaders, and retailers to measure their knowledge, attitude and practices, including the RTK coverage. To test the iodine level in salt, use of titration should be prioritized, while use of RTKs should be considered as second alternative. While interpreting the household survey outcomes, the consultant may take into account the possible effects of the ongoing Russian economic crisis amongst other facilitating and impeding factors affecting the RTK strategy implementation and the project outcome in itself.

  1. DELIVERABLES, TIME FRAME AND PAYMENT SCHEDULE

№ / Deliverables / Timeframe / Payment Schedule
1 / Inception Report / 20-27April 2015 / 25%, upon UNICEF approval of the submitted draft
2 / Training of interviewers and supervisors on data collection (agenda, material and actual facilitation); Pre-testing of the survey protocols and instruments; and finalization / 28 April – 1 May 2015 / 75%, upon UNICEF approval of the submitted draft
3 / Field work, data entry, data cleaning, data analysis, and report writing / 2 – 25 May
4 / Debriefing and submission of the draft report elaborating the assessment outcomes and recommendations / 26 May 2015
5 / Final report, incorporating feedback and comments from UNICEF, GAIN, and government stakeholders / 5 June 2015

The payment will be made in two instalments. First instalment will be paid upon completion of the inception report, and the second upon completion of all remaining assignments and submission of the final report.

  1. PLACE OF WORK

The consultant will be stationed in Dushanbe with travel to the field. After debriefing and submission of the draft report, finalisation of the report can be done home-based.

  1. DURATION OF THE ASSIGNMENT

Estimated number of working days required for this assignment is about 35 days, within April - June of 2015. Timing for the consultancy is negotiable, but the entire exercise needs to be completed before mid-June.

  1. TRAVEL

The consultant will be stationed in Dushanbe with travel to all regions of the country.UNICEF Tajikistan will cover travel-related costs, including return travel of the consultant by the most direct route in economy class from her/his home country to Tajikistan and within Tajikistan. The consultant will receive UN-approved Daily Subsistence Allowance (DSA) for the first 10 days and reduced DSA rate of USD 100 for each subsequent day while in Tajikistan, by visit.

  1. REQUIRED QUALIFICATION
  • Advanced degree in Mother and Child Nutrition/Micronutrient Deficiencies, Public Health and other related discipline.
  • 8-10 years of professional experience in evaluation and assessment of public health programmes, especially in nutrition. Prior engagement in USI project is an asset.
  • Experience in quantitative and qualitative data analysis and reporting.
  • Relevant consultancy experience with international/UN organizations in the field of public health/nutrition. Experiences in CEE/CIS countries is preferable. Prior experiences with UNICEF would be an advantage.
  • Fluency in English. Knowledge of Tajik or Russian language is an asset.
  • Very good organizational, strong judgement, excellent analytical and communication skills.
  • Excellent writing skills.
  1. REPORTING ARRANGEMENTS

While the consultant will directly report to the Nutrition Specialist of UNICEF Tajikistan, under the overall supervision of Chief, Health and Nutrition of UNICEF Tajikistan. The evaluation of the consultant shall be completed based on the timely submission of the deliverables, and accuracy and quality of the products delivered.

  1. APPLICATION PROCEDURES:

Qualified candidates are requested to submit a Letter of interest, CV, UN Personal History Form (P11) (at and references from previous consultancies to by the deadline of 26 March 2015. In their Letter of Interest, candidates should highlight previous work experience relevant to the assignment, the attributes that make them suitable, their proposed approach to the assignment, their anticipated fee for the consultancy work.

UNICEF is committed to diversity and inclusion within its workforce, and encourages qualified female and male candidates from all national, religious and ethnic backgrounds, including persons living with disabilities, to apply to become a part of our organization

CONDITIONS OF THE SERVICE:

General Conditions of Contracts for the Services of Consultants / Individual Contractors

1. Legal Status

The individual engaged by UNICEF under this contract as a consultant or individual contractors (the “Contractor”) is engaged in a personal capacity and not as representatives of a Government or of any other entity external to the United Nations. The Contractor is neither a "staff member" under the Staff Regulations of the United Nations and UNICEF policies and procedures nor an "official" for the purpose of the Convention on the Privileges and Immunities of the United Nations, 1946. The Contractor may, however, be afforded the status of "Experts on Mission" in the sense of Section 22 of Article VI of the Convention and the Contractor is required by UNICEF to travel in order to fulfil the requirements of this contract, the Contractor may be issued a United Nations Certificate in accordance with Section 26 of Article VII of the Convention.