National Senior Consultant for strengthening ANC through multiple micronutrient supplementation (MMS), implementation research and monitoring, Kigali Rwanda, 8 months ( Remote/ Work from home) – For Rwandan Nationals ONLY at United Nations Children’s Fund: (Deadline 26 April 2024)

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Background:

While the 2019/2020 Rwanda Demographic and Health Survey (RDHS) showed a significant decline in stunting prevalence among children under five years from 52% in 2005 to 33% in 2020 for over the last 15 years, stunting remains high and above the public health threshold of severity (30%) according to WHO classification, and still far from the national target of 19% to be reached by 2024. Twenty out of 30 districts in the country exhibit > 30% stunting rates for children. There are distinct differences in stunting reduction across wealth index quintiles, regions, child sexes, child ages, maternal education levels, and areas of residence. Anemia among children 6-59 months is persistently high at 36.6%, close to the public health crisis levels of 40% as per WHO classification. Meanwhile, the anemia rate among women of the reproductive age group was also high at 22% in 2020. While ANC coverage for at least one visit is as high as 98%, coverage of four or more ANC visits in a pregnancy is as low as 47%.

Malnutrition in Rwanda is a complex issue influenced by various factors. A recent study conducted in August 2022 identified the overall inequality, 75% was explained, and it is due to the difference in the social determinants of stunting between the poor and non-poor households. The compositional factors found contributing to the stunting inequality significantly were the maternal factors of BMI (Body Mass Index) – defined as weight over height squared, height, years of education and low birth weight, care, and adequate health services factors of health insurance, four or more ANC (antenatal care) visits and leaving the child with another child for more than one hour. The largest contributing factor to the socioeconomic inequality in stunting was intergenerational transfer – a phenomenon whereby A malnourished mother will give birth to a low-birth-weight baby; the low-birth-weight baby will grow as a malnourished child, then to a malnourished teenager, then to a malnourished pregnant woman, and so the vicious transfer continues – accounting for 31% of the inequality and comprised of maternal BMI (Body Mass Index) (coefficient=0.05, P<0.001), maternal height (coefficient= 0.11, P<0.001), and low birth weight (coefficient=0.02, P<0.001). Low birth weight and prematurity are considered a leading cause of death or newborns in Rwanda according to administrative data.

Evidence has revealed that effective maternal nutrition is the key to breaking the vicious cycle of undernutrition similar to context in Rwanda. Different studies revealed that poor maternal nutrition has consistent contributions to poor fetal growth, low birth weight, child stunting, maternal and child morbidity and mortality. Therefore, there is a need to invest in comprehensive, effective, and efficient maternal nutrition in Rwanda.

Strengthening maternal nutrition interventions by introducing Multiple Micronutrients supplementation (MMS) for pregnant women in replacing iron-folic acid supplementation (IFAS) is considered as a game changer to accelerated reduction of stunting besides addressing the major issues mentioned under the problem. Several meta-analyses have shown that MMS with iron and folic acid leads to a consistent relative risk reduction for several outcomes, including low birthweight, small-for-gestational-age births, preterm births and stillbirths, when compared to the benefits of IFAS (Sight and Life Scientific Update, 2023).

In December 2023, UNICEF supported the Ministry of Health (MOH) and Rwanda Biomedical Centre (RBC) to introduce MMS into ANC services in seven districts, in line with the government’s two-year plan to accelerate stunting reduction and with an eye towards full scale-up in the near future. Effective research and monitoring are crucial to optimize the introduction of MMS for pregnant women, ensuring effective implementation, with a particular focus on compliance and adherence. These Terms of Reference (TOR) outline the scope, objectives, and activities for a research and monitoring project focused on MMS in seven districts of Rwanda among targeted 100,000 Pregnant women.

Purpose of Activity/Assignment:

 The purpose is to contribute to improved implementation of MMS introduction into ANC in the seven districts through comprehensive research and monitoring in the seven districts.

Specifically:

• • To monitor and assess:
    • The coverage, compliance, and adherence to MMS among the target population
    • The effect of introduction of MMS on ANC coverage/uptake.
    • The effect of MMS programs on ANC coverage/uptake, ANC quality, LBW, small-for-gestational-age births, preterm births, and stillbirth rates, as well and mortality.
  • To Identify factors influencing effective implementation, supply chain, coverage, and impact.

Strengthen the monitoring and evaluation system for ANC programmes including MMS.

Key Tasks:

The consultant is expected to undertake the following activities:

• • Review of existing literature and program documents.
  • Development of a monitoring framework and research and monitoring tools and procedures using the latest National Maternal Nutrition and ANC Guidelines.
  • Provision of routine technical supportive supervisory support to all Health centers in the seven districts
  • Conducting initial, monthly, and follow-up data collection based on the developed framework.
  • Analyze data to assess program coverage, adherence, impact, and influencing factors.
  • Capacity building for service providers and other stakeholders in monitoring and evaluation.
  • Dissemination of findings through reports, publications, and presentations.

Methodology:

The consultant will employ a mixed-methods approach, combining quantitative and qualitative data collection and analysis. Specific methods might include:

• • • Supportive supervision to ensure implementation is being conducted as planned, identify bottlenecks, and solve problems.
    • Health center data assessment and monitoring: To assess the impact of MMS on ANC uptake and quality.
    • Morbidity and mortality surveillance: To assess the impact of MMS on birth outcomes.

Focus group discussions, in-depth interviews, including exit interviews and household visits: To understand factors influencing program implementation and assess coverage, adherence, and knowledge of MMS and ANC.

Work Assignment Overview

Tasks/Milestone:

• Development of a monitoring framework and research and monitoring tools and procedures using the latest National Maternal Nutrition and ANC Guidelines.

• Conducting initial, monthly, and follow-up data collection based on the developed framework.

• Analyze data to assess program coverage, adherence, impact, and influencing factors.

• Provision of routine technical supportive supervisory support to all Health centers in the seven districts

• Capacity building for service providers and other stakeholders in monitoring and evaluation.

• Dissemination of findings through reports, publications, and presentations

 Deliverables/Outputs:

Payment 1: 40%

1. Baseline report: Describing the context, program implementation, and baseline coverage, compliance, and adherence data, as well as presenting the monitoring framework.
2. Monitoring reports: Monthly reports detailing updates on key process and output indicators as well as implementation challenges, actions, and solutions.

Payment 2: 30%

1. Capacity building materials: Training/orientation course and manuals for local stakeholders on monitoring and evaluation of ANC and MMS.

Payment 3: 40%

1. Final report and slide deck: Presenting findings on effectiveness, influencing factors, and recommendations for improvement.
2. Peer-reviewed scientific publications: Authoring at least one publication to disseminate key findings for broader audience.

Duration and Duty Location

This consultancy will be completed within 8 months. The consultancy is home based. The national consultant will be working in the Seven Districts in Rwanda (GASABO, GICUMBI, MUSANZE, RUTSIRO, NGORORERO, NYABIHU and BURERA Districts).

Selection Criteria

Applications shall be assessed based on their technical and financial proposals. Maximum scores for technical and financial applications will be 75% and 25%, respectively.

To qualify as an advocate for every child you will have…

• An advanced university degree (Master’s or higher) in Nutrition, Public Health or related field, with experience in nutrition/micronutrients policy, strategy and guidelines development in the context of Rwanda.
• Minimum 8 years of professional experience.
• Proven expertise in the development and implementation of programmatic research tools and guidance for maternal health/nutrition/early child development programming.
• Clear understanding of maternal nutrition and health programming at the PHC level.
• Highly motivated, with the ability to work independently, take initiative and finalize deliverables.
• Flexible to make frequent field trips to service delivery points – the health centers.
• Strong interpersonal, verbal and written communication skills in both English and Kinyarwanda.
• Knowledge of Rwanda’s nutrition landscape is an asset.

For every Child, you demonstrate…

UNICEF’s values of Care, Respect, Integrity, Trust, Accountability, and Sustainability (CRITAS).

To view our competency framework, please visit here.

UNICEF is here to serve the world’s most disadvantaged children and our global workforce must reflect the diversity of those children. The UNICEF family is committed to include everyone, irrespective of their race/ethnicity, age, disability, gender identity, sexual orientation, religion, nationality, socio-economic background, or any other personal characteristic.

UNICEF offers reasonable accommodation for consultants with disabilities. This may include, for example, accessible software, travel assistance for missions or personal attendants. We encourage you to disclose your disability during your application in case you need reasonable accommodation during the selection process and afterwards in your assignment.

UNICEF has a zero-tolerance policy on conduct that is incompatible with the aims and objectives of the United Nations and UNICEF, including sexual exploitation and abuse, sexual harassment, abuse of authority and discrimination. UNICEF also adheres to strict child safeguarding principles. All selected candidates will be expected to adhere to these standards and principles and will therefore undergo rigorous reference and background checks. Background checks will include the verification of academic credential(s) and employment history. Selected candidates may be required to provide additional information to conduct a background check.

Remarks: 

Individuals engaged under a consultancy will not be considered “staff members” under the Staff Regulations and Rules of the United Nations and UNICEF’s policies and procedures and will not be entitled to benefits provided therein (such as leave entitlements and medical insurance coverage). Their conditions of service will be governed by their contract and the General Conditions of Contracts for the Services of Consultants. Consultants are responsible for determining their tax liabilities and for the payment of any taxes and/or duties, in accordance with local or other applicable laws.

The selected candidate is solely responsible to ensure that the visa (applicable) and health insurance required to perform the duties of the contract are valid for the entire period of the contract. Selected candidates are subject to confirmation of fully vaccinated status against SARS-CoV-2 (Covid-19) with a World Health Organization (WHO)-endorsed vaccine, which must be met prior to taking up the assignment. It does not apply to consultants who will work remotely and are not expected to work on or visit UNICEF premises, programme delivery locations or directly interact with communities UNICEF works with, nor to travel to perform functions for UNICEF for the duration of their consultancy contracts.