Timor-Leste: International Consultancy: Nutrition Surveillance System

UNICEF Timor-Leste is looking for a qualified international consultant to provide technical assistance for the design and implementation of a nutrition surveillance system to provide real time data for evidence based decision making and for tracking progress of nutrition indicators.

1. Background and Purpose of Assignment:

a. Background and context Timor-Leste Food and Nutrition Survey 2013 showed some decline in the prevalence of malnutrition as compared to the Demographic and Health Survey (DHS) 2009-2010. However, child malnutrition in Timor-Leste is still very high. One out of every two Timorese under-five children are stunted (too short for their age), 11% of under-five children have either moderate or severe acute malnutrition (are too thin for their height) and 38% of the under-fives are underweight (have a combination of stunting and wasting). Despite the improvement, the prevalence of the stunting remains a severe public health problem and the prevalence of wasting and underweight remain above the WHO defined threshold for considering it a public health problem. Malnutrition is high among all wealth quintiles but higher among poor and rural children. Anaemia was high with 63.2% of children under five years old anaemic and zinc deficiency is 34%.

Progress in implementation and achievement of the Timor Leste National Nutrition Strategy (NNS) 2014-2019 needs to be tracked through the log-frame and its impact, outcome and output indicators, as well as key activities and inputs. It is therefore necessary for a nutrition information system to be established and operational, utilizing existing mechanisms (HMIS/DHIS) in order to report and track progress against these indicators. The NNS log-frame identifies several information sources as means of verification, such as the TLFNS 2013, DHS, HMIS programme reports and a nutrition surveillance system, with the establishment of the Nutrition Surveillance system identified under sub-section 7.9.3 of the NNS. The TLFNS 2013 and DHS are surveys typically implemented every 4-5 years, and can report on progress, especially of the impact indicators. For the other indicators of outcomes, outputs and inputs/activities, where it is necessary to monitor more frequently, more routine sources of information need to be used, such as the Health Management Information System and the electronic District Health Information System 2. However, even these have their limitation to meet the full information needs of the NNS (2014-2019).

The HMIS department within the Ministry of Health is responsible for the collection of a significant amount of health data from the district health facilities, however, while including some indicators on nutrition, there remains a gap for what is needed to monitor the NNS. For HMIS, approximately 477 health facilities (health posts, hospitals, CHCs) throughout the 13 municipalities report on the indicators. The HMIS team is responsible for collecting data based on defined indicators at various intervals and for analysing data and producing reports to track major health indicators.

The MoH is in the process of developing and implementing an electronic District Health Information System 2 (DHIS2). It is currently in the last stages of preparation, being rolled out initially in five districts. The DHIS2 will collect a sub-set of indicators from the HMIS that are transmitted electronically to a central database, and available online for access and analysis through dashboards, tables and graphs. This system has the flexibility to allow for additional modules to be added and linked, such as a nutrition surveillance module, provided the input is a minimal set of data. Nutritional Surveillance is defined as “an ongoing system for generating information on the current and future magnitude, distribution and causes of malnutrition in populations for policy formulations, programme planning, management and evaluation” (UN 1975, World Food Conference in 1974). The Timor Leste National Nutrition Strategy (2014-2019) has identified a need to design and implement a nutrition surveillance system to make quality real time data available for evidence based decision making and for tracking progress of nutrition indicators, and is included under Outcome 3 of the NNS. The Ministry of Health (MoH), specifically the National Nutrition Programme, will be the main user of the surveillance system generated data/information for actions. Other potential users are the Konssantil, the Inter-ministerial council on food security, the Ministry of Agriculture, Ministry of Social Solidarity (which has mandate for emergency preparedness and response coordination), and Ministry of State Administration. Ministries, institutions and partners dealing with policies and programme areas in nutrition, agriculture and rural development are expected to be key stakeholders that will act on the data/information. The data/information generated will impact on all other national institutions and their policies and programmes noted above. Leadership of the project will come from the Ministry of Health, Surveillance Department, in close collaboration with Nutrition Department and HMIS. Additionally, a Surveillance Steering Committee made up of other Ministry of Health staff and key stakeholders will be established to guide the process.

b. Purpose of Assignment:

The purpose of the Nutrition Surveillance system of Timor-Leste is to provide data for a) development planning, b) Nutrition Programme Management, and c) timely warning of potential nutrition related emergencies.

The objectives of the National Nutrition Surveillance system of Timor-Leste will have to consider the multiple purposes of the Nutrition Surveillance system. The following are the objectives of the proposed Nutrition Surveillance systems:

• To provide reliable and real time data on nutrition impact, outcomes and outputs to help identify and make adjustment in policy, programme and resource allocation and use
• To identify potential nutrition related emergencies in the communities and to issue alerts.

c. Scope

The scope of work involves designing, training and supporting roll-out of a National Nutrition Surveillance System considering the following needs:

• Identification of users, decisions to be taken and based on data, purpose and the type of surveillance required to meet the purpose. This entails identifying policies and programmes affected by nutritional problems, ministries, departments and institutions that are expected to take actions;
• Identification of problems, the nutritional indicators, affected in geographic and economic terms and causes of malnutrition in these groups;
• Mapping of information currently available, baselines and sources, information gaps and identification of information needed, assessment of quality and suitability of existing data for surveillance including variables and level of disaggregation, regularity, timing, reliability and use of IT for improving data handling and reporting;
• Institutional arrangement for surveillance organisation and analysis (including capacity needs, staffing), linkage to decision making, means for supporting field operation including data collection and supervision;
• Linking HMIS/DHIS2 and other nutrition and related data, produce dashboards and reports (national, district and sub-district, depending on level of representativeness)
• Drafting a Protocol for a sustainable national scaled up surveillance system, including inputs/costs required for setup and full operation; and
• Training staff, testing and implementing the surveillance system, including troubleshooting and scale implementation in three districts initially.

d. Desired key features

The desired key features of the expected National Nutrition Surveillance system are: • Desired outputs: The surveillance system is expected to provide real time programme performance data that helps track national programme performance in ensuring key inputs are in place and to measure progress towards outputs, outcomes and impact. • Representativeness: National or District representative data (for tracking trends of key Nutrition Indicators), depending on identified information needs • Sample sites: Sucos from each of the 13 districts and Aldeias (sub-village or hamlet) that give representative data. Data is expected to be collected from the health facility of the selected Suco and periodically from communities in its catchment area through home visits. Includes assessment and recommendation on feasibility of implementing a rolling sample. • Frequency of data collection: Health facilities will report following HMIS reporting schedule but will have a separate reporting module for the surveillance indicators. Community data will be collected through home visit by the Suco-based doctors once every six months. • Surveillance targets: Pregnant women, children 0-59 months. • Indicators: The indicators used will be subset of National M&E framework indicators. Some of the current indicators will be modified/broken down/simplified to facilitate ease of data collection and reporting. • Use of Information Technology: The system is expected to use SMS/mobile and/or internet technology, linked to the MoH HMIS/DHIS 2. The system should be designed so that it produces automated output dashboards using the facility and community data. • Institutional arrangement: For implementation of the proposed National Nutrition Surveillance, including the process, process management, data analysis and use of data from the proposed National Nutrition Surveillance system is described below: • HMIS/DHIS2 department of Ministry of Health will lead and own the surveillance system. MoH is expected to assign one person as Nutrition Surveillance Manager responsible for data management, analysis and reporting. • A Nutrition Surveillance Working Group will be established by the Ministry of Health, made up of members from the Surveillance, Nutrition Department, HMIS/DHIS and key stakeholders. This group will guide the process of review and finalization of the surveillance protocol and tools, serve as think-tank and resource group during the design and implementation, assist the designated Nutrition Surveillance Manager in addressing problems encountered during surveillance implementation, and validate the generated reports. • Data will be generated using Suco-based Primary Health Care (PHC) network of health care providers. The health care providers who collect the data will be trained and mentored to keep the system to continue working. • Suco-based PHC Doctors are expected to do domiciliary/house visits as part of their routine work. Community data will be collected by these doctors during these house visits. The house visits will be times to capture trends during food scarce (dry season) and post-harvest season. • The health facilities of the selected Sucos will have trained Nutrition Focal Points who will keep record of all services provided and report on key nutrition indicators, including supply related information. The reporting completeness and timeliness criteria will be pre-determined and the performance of the focal point will be assessed using these criteria. • The data collected from the facilities and communities will be inputted into internet based platform and produce automated dashboard outputs (described above). • The MoH Nutrition and Surveillance Departments will do secondary analysis of the output dashboard information. The people who do secondary analysis will be trained by the consultant to use the template for producing an analytical report. • The output dashboard information with secondary analysis report will be published 6-monthly.

1. Programme Area and Specific Project Involved:

Country Programme Action Plan 2015-2019 Child Survival and Development Outcome 1: By 2019, reduced child mortality and undernutrition through improved and equitable use of high impact health, nutrition and WASH interventions.

The specific project involved is the Integrated Nutrition Project in Timor-Leste: Reducing Burden of Malnutrition in Timor-Leste, funded by the European Union.

1. Tasks/Activities and Deliverables

2. Data tables, dashboard and report template development Deliverable: Data tables, output dashboards, report templates (4 weeks)

3. Methodology, Protocol and guideline development Deliverable: Protocol, tools, tally sheets (4 weeks)

4. Working with HMIS/DHIS, design IT based data collection (tablets) and develop protocol for use
   Deliverable: Programme for tablet data collection and protocol (2 weeks)

5. Training materials developed and relevant staff trained as Trainers for use of equipment and implementation of system Deliverable: Training materials, 15 persons trained as Trainers (2 weeks)

6. Assist with facilitation of training for system users/data collectors Deliverable: Training of system users from three districts (2 weeks)

7. Pilot test of system, troubleshooting of system components such as IT equipment, data management and reporting/dashboards Deliverable: Pilot test of system in one municipality (4 weeks)

8. Assist with implementation of one round of nutrition surveillance in three municipalities, including analysis and reporting Deliverable: Surveillance report from three municipalities (4 weeks)

9. Reporting of consultancy, including recommendations for continued surveillance system implementation Deliverable: Final Consultancy report (4 weeks)

10. Qualifications or Specialized Knowledge/Experience Required:

• Must have advanced university degree in Nutrition, Public Health or related sciences and minimum 10 years of work experience, with at least five years in developing countries • Must have demonstrated experience in designing and operationalising a nutrition information/surveillance system, in a developing country context, preferably in the last 5 years. • Must have proven experience in adopting information technology for complex data management (mobile SMS, PDA, tablet, database) • Must have a track record of developing local capacity. The individual is expected to work closely with individuals from the Ministry of Health and Institute of Health Sciences to work with them and transfer skills to continue surveillance

1. Duration of Assignment:

The selected consultant will be engaged over a six month time period, in the months of October 2016 to March 2017

1. Official Travel involved:

International travel costs should be part of the contract costs. UNICEF will support the consultant by facilitating local travel and arranging meetings and workshops.

1. Contract Supervisor:

The consultant will work under the supervision of the UNICEF Nutrition Specialist who will provide day-to-day technical guidance, and operational management. The consultant will further receive guidance and support from the UNICEF Nutrition team, Ministry of Health and the Steering Committee.

1. Proposed payment schedule based on deliverable:

• 5% upon submission of deliverable 1 • 10% upon submission of deliverable 2 • 10% upon submission of deliverable 3 • 10% upon submission of deliverable 4 & 5 • 20% upon submission of deliverable 6 • 35% upon submission of deliverable 7 • 10% upon submission of deliverable 8

1. Consultant’s Work Place:

The consultant will work in Timor-Leste. Upon the consultant’s arrival to Timor-Leste, UNICEF will provide office space and office support. UNICEF will support the consultant in establishing contact with necessary stakeholders and arrange meetings with all relevant stakeholders. Laptop or computer will not be provided.

Please apply through UNICEF global recruitment site at http://jobs.unicef.org/cw/en/job/499076 and submit the following documents:

• Provide a Letter of Interest, which includes the following:

• A succinct summary of similar work completed by the individual presented in a table showing a) description of work, b) dates (period), c) country, d) employers/partner agency’s name and address

• Brief proposal showing how the work will be completed (taking into account the scope and the deliverables described above)

• Any other document that shows evidence of the expertise noted above

• Financial proposal. The financial proposal shall specify a total lump sum amount breaking down a daily professional fee and international travel expenses (from the country of origin to Dili and back in case not resident in Timor-Leste), visa and other travel related costs.

• CV/P-11 form (UN Personal History Form)