GOVERNMENT OF Sindh

Department of Health

Nutrition Support Program Sindh (NSPS)

TERMS OF REFERENCE

for

Behavior Change Communication Firm

Background

Pakistan is making progress towards the health related Millennium Development Goals however the progress is slow as compared to its South Asian neighbors. Pakistan suffers from high rates of childhood and maternal malnutrition. There has been little progress in improving nutrition outcomes over the last two decades. With 38% of children under 5 being underweight (<-2SD) and 12.3% severely underweight (<-3 SD), the burden of malnutrition is higher than in sub-Saharan Africa although it is slightly lower than in India, Bangladesh, or Nepal. In addition, 12% of Pakistani children under 5 were severely malnourished (<-3 SD) based on weight for age and 3% were suffering from acute, severe malnutrition (<-3 SD weight for height). In addition, micronutrient deficiencies are widespread such as iron-deficiency anemia, zinc and vitamin A particularly among pre-school children and pregnant women. One in three children 0-5 years and one in four mothers 15-49 years suffer from Iron deficiency anemia. Malnutrition is also prevalent among women of reproductive age group with 13.6% being underweight, and 2.5% severely thin. Based on current trends Pakistan is not on track to achieve MDG 1C, i.e., halving the 1990 level of malnutrition by 2015.

The overall objective of the Nutrition Support Program Sindh (NSPS) is to improve the nutritional status of children under five years and that of pregnant and lactating women by improving the coverage of effective nutrition interventions with a focus on the poor and marginalized within these groups.

The program aims to increase its access to the nutrition intervention in selected 9 Districts. The nutrition program has following five components

  • Component 1: Improving Food and Nutrient Intake and Adequate Care for Young Children and Pregnant & Lactating Women
  • Component 2: Increasing Intake of Essential Vitamins and Minerals
  • Component 3: Changing Key Nutrition-Related Behaviors
  • Component 4: Strengthening Institutional Capacity
  • Component 5: Monitoring and Evaluation of the program

The objective of component 3: Behavior Change Communication is to enhanced levels of knowledge and improved practices with regard to maternal, infant and young child feeding, health and hygiene.

The outcomes include improved maternal as well as infant and child feeding practices and increase utilization of nutrition services, which will make significant contribution in the reduction of stunting;

Objectives of the assignment:

The primary objectives of the assignment are:

a)Collect/compile/adopt existing advocacy, behavioural change and communication materials including pictorial, audio and video and finalize them for Sindh province in consultation with concerned stakeholders;

b)Develop and implement a comprehensive province-based and culturally appropriate executable Advocacy and Communication Strategy, this includes the dissemination of materials to the intended audience and target population.

c)Facilitate nutrition specific communication skills of the relevant Governmental institutions, primarily the Provincial Nutrition Program Cells,with focus on addressing multiple causes of all forms of malnutrition.

The firm will work in close collaboration with the Nutrition Support Program, other related administrative and government entities, and related community and service delivery projects in Pakistan.

Scope of Work:

Nutrition Support Program Sindh would like to hire services of a consultancy firm withdemonstrated track record in implementing health and nutrition related behavioural change and communication campaigns at scale. NSPS will procure these services for a period of two yearsthrough a competitive process. Performance-based contract will be signed with a qualified firm. The payment will be linked with a set of agreed outputs. A third party agent will carry out independent verification of claimed outputs. The selected firm will build on context specific expertise in deciding how services will be delivered to achieve the project objectives. Following is the indicative matrix of the area of focus, target audience and possible channels of communication.

Type / Focus/ / Primary Audience / Possible Channels of Communication
Advocacy and Behaviour Change Communication / 1. Health Nutrition related material to create an enabling environment for all those at risk of acquiring malnutrition. Healthy nutrition includes maternal nutrition,breast feeding promotion, complementary feeding for children 6 to 24 months, micro nutrient supplementation, consumption of iodised salt, and fortified wheat. /
  • Policy makers
  • Politicians
  • Uniformed and security personnel
  • Religious leaders
  • Community elders
  • Media
  • Health care providers
  • Educational institutions
  • Large industrial employers
/ Seminars, meeting, Information brochures, videos, Radio, sponsorship events, etc.
Mass Communication/Mass Awareness / Nutrition related behaviours (themes as outlined under advocacy) /
  • Special target on caretakers, parents and grandparents and mothers of children under five and pregnant and lactating women
  • General population
/ TV, Radio, community theatres, hoardings billboards, seminars, etc.

The BCC and policy advocacy strategy is expected to cover the following and beyond as deemed appropriate:

  1. Key stakeholder analysis and Formative Assessment: The firm is required to undertake thorough mapping of the key stakeholders to understand their views and perception about barriers to implementation of nutrition interventions. For this assessment, the firm will undertake face to face interviews and study various published and gray material including their speeches and interviews of the key stake holders. Based on the findings, the firm is expected to map out various facilitating and restricting factors as well as change agents that will need to be mobilized. Identified barriers will be addressed in the strategy and appropriate interventions will be introduced to address addressed as well as barriers to implementing approved legislation and develop appropriate intervention for positioning these messages. The aim is to create an enabling environment for nutrition promotion at the provincial level. These policy implementation areas may include, but not restricted to, enforcing and institutionalization of food authority, mandatory food fortification, salt iodization and institutionalization “Breast feeding and young child nutrition ordinance.
  1. Advocacy package development: The firm is expected to develop an advocacy package for convincing policy makers and relevant stakeholders and for motivating them to ensure appropriate actions for achieving expected results of the program. The firm will develop and institute mass media and mid-level media interventions as well as organize seminars and conferences to convey key policy action intervention.
    The firm will also undertake audience analysis and map out most commonly available and accessible platforms areas such as a TV drama, TV spots, radio spots and recorded telephonic messages for creating public demand for action on nutrition related policy areas. The purpose of these interventions would be to mobilize public support and concern about gravity of malnutrition in Sindh province. Socioenvironmental determinants resulting malnutrition of women and children. These may include, but not restricted to, the: Iron fortification of wheat, Ban on the sale of non-iodized salt, girl child education, the role of LHWs in addressing the issue of malnutrition, creating breast feeding corners in the workplace, midday meal in the marginalized schools etc.
  1. Public education package: The firm is expected to develop a public education package for communicating key nutrition messages to the specific target groups such as pregnant and lactating women and children less than five years of age and adolescent girls . The firm will develop and institute mass media and mid level media interventions for reaching out to the population in the nine districts. The firm will undertake audience analysis with reference to priority group and will conceptualize and will broadcast key message these may include programs on cooking channels for promoting healthy and nutritious recipes for targeted audience

Implementation plan, Monitoring and evaluation framework for theBCC intervention

  • The firm is required to propose an annual implementation plan for the effective and timely implementation of the assigned deliverables.
  • The implementation plan should outline strategies, , events, their frequency and durations to ensure that the above objectives are achieved.
  • The firm will submit a performance monitoring framework and tools for the monitoring of the BCC strategy implementation. The firm will also submit a costed BCC strategy with key responsibilities and timelines.

Reporting

  • Inception report with two-year work plan within two weeks of award of the contract. The report will also include implementation arrangements systems and processes for management, reporting, M&E, quality assurance in addition to an exit strategy.
  • The selected firm/agency is expected to submit monthly, quarterly and annual reports describing progress against the agreed work plan. Deadlines of reports are as follow:
  • Monthly: 1st week of Next Month
  • Quarterly: 2nd Week of next Quarter
  • Annual: by the end of 1st month of next year
  • Completion report in the last month of the contract period.
  • Report of pre-testing of the material developed
  • Report of workshop and trainings

Moreover, agency is expected to

  • Maintain a log of activities in sufficient detail to allow a review and assessment by the supervisory personnel of the quality of services, both internal and external;
  • Maintain a log of the number of audience reached by activities (by event, by period)
  • Maintain a log of production and dissemination of materials (by audience, by material)
  • Maintain a log of TV and radio spots broadcasted

Qualification of Firm:

Have at least 10-yearexperience of providing comprehensive BCC / mass awareness services to at least five (5) organizations. Have a documented track record of completing at least 5 similar BCC assignments with comparable coverage as is required under this assignment. Experience of working in Sindh will be of additional advantage presence.

The agency is expected to provide documentary evidence of a) technical and best practice experience in communication and advocacy, b) local knowledge and experience in communication and advocacy demonstrated by current and on-going activities, and c) examples of related communication and advocacy products. .

Selection Process:

Consultant will be selected in accordance with the procedures set out in the World Bank’s Guidelines: Selection and Employment of Consultants by World Bank Borrowers, (January 2011) through Quality- and Cost-Based Selection (QCBS)

Coordination:

The Consulting firm will closely work with NSPS and will interact with a wide range of entities and stakeholders including federal,provincial governments, local governments. NGOs etc.

Facilities to be provided by SNPS:

The Program will provide the following facilities to the firm during the execution of contract:

  • Updated national guidelines for CMAM and IYCF.
  • Standard recording and reporting formats – to be developed jointly by mutual consultation
  • Authorization from the government as necessary to execute tasks relevant to assignment
  • Invitation to attend National Days, conferences and key seminars with expenses for participation to be borne by the firm
  • Copies of key reports and research carried out in Pakistan
  • Support in training and capacity building activities while firm will bear the cost of travel and boarding/lodging for its participants
  • Access to public sector health facilities and community groups.

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