BACKGROUND AND RATIONALE
In Kenya, there has been improvements in the nutritional status of children: stunting declined from 35% in 2008-9 to 26% in 2014, wasting from 7% to 4% and underweight from 16% to 11% [1]. Despite the improvements in some health and nutrition indicators at the national level, undernutrition remains a public health problem in some regions such as Elgeyo Marakwet County (EMC) where the stunting prevalence is 30%, according to the KDHS 2014. In EMC County, the high rates of stunting are attributed to poor maternal nutrition during pregnancy and postpartum and poor practice of exclusive breastfeeding. The rate of exclusive breastfeeding is 35% and only 23 % of children 6-23 months are fed on the minimum acceptable diet[2].
The Government of Kenya has demonstrated commitment to addressing malnutrition through various policies, strategies and legislation aimed at improving the nutrition situation in Kenya [3]. These include the Kenya Health Policy 2014-2030, Kenya Health Act 2017, Kenya Health Strategic Plan (2013-2017), National Nutrition Action Plan (NNAP) 2012-2017, Food and Nutrition Security Policy (FNSP) 2012, FNSP Strategic Framework 2016-2020, Breastmilk Substitute Act 2012 and the National Food Fortification Strategic Plan 2018-2022. In 2012, Kenya joined the Scaling up Nutrition (SUN) movement showing further commitment to undertaking coordinated actions to improve the nutrition status of the country. Since the launch of SUN in Kenya, there has been enhanced government leadership in the nutrition sector, which has resulted in improved coordination of actors and a more harmonised approach to implementation and monitoring of nutrition programmes.
However, the national budget allocation for the health sector remains low, at 7% for financial year 2016/2017, which falls below the 15% standard stipulated in the Abuja Declaration [4]. Although the average budget allocation to health by counties is higher at 25% of the total County budgets, the funding allocation towards nutrition activities remains low. This is a contributing factor to poor adoption and implementation of nutrition policies, strategies and legislation and increased reliance on donor financing especially for nutrition programmes targeting children and women[5]. In addition, there is a human resource gap in the delivery of nutrition services within public health facilities. According to Kenya Nutritionists and Dietitians Institute 2014, there were 2,700 professional nutritionists and dietitians registered in Kenya out of which 632 of them were employed at County level within the Ministry of Health. This translates to one nutritionist for every 14,814 people and calls for increased nutrition workforce to improve quality of nutrition services.[6]
The Ministry of Health-Nutrition and Dietetics Unit with support from partners have undertaken a review of the National Nutrition Action Plan (NNAP) 2012-2017 to determine the successes and gaps in its implementation in order to inform the new NNAP 2018-2022. The new multi-sectoral NNAP will provide a framework for co-ordinated implementation of nutrition-specific and nutrition-sensitive interventions by government and other nutrition stakeholders. Each of the 47 Counties in Kenya is expected to develop a context-specific County Nutrition Action Plan that is aligned to the NNAP 2018-2022. The NNAP provides practical guidance for coordinated implementation of nutrition interventions by government and nutrition stakeholders within the County.
Nutrition International seeks a consultant to review maternal, infant and young child nutrition policy and programme implementation in EMC and provide recommendations for improvement in nutrition policy implementation and increased funding for nutrition. The nutrition policy and programme review will inform the development of the County Nutrition Action Plan and operationalization of the County Integrated Development Plan (CIDP) 2018-2023, which provides an opportunity to prioritise government objectives towards poverty reduction and nutrition and strengthening the linkages between budgeting and planning[7].
The consultant will also use the nutrition policy review findings to develop an advocacy plan for the Elgeyo Marakwet, the targeted county of the ENRICH project.
OBJECTIVE OF THE CONSULTANCY
To support advocacy efforts towards improving nutrition policy implementation and increasing commitments to nutrition-specific and nutrition-sensitive programming in Elgeyo Marakwet County.
Specific Objectives:
To identify and analyse existing national policies, programme frameworks, strategies and action plans focused on addressing maternal, infant and young child nutrition (MIYCN) – more specifically interventions targeting the first 1000 days of life – and their interpretation and implementation status in the ENRICH targeted County.
To assess the extent to which the existing national policies, programme frameworks, strategies and action plans have addressed gender inclusion and equity, and to make recommendations for improvement to be used to support advocacy efforts.
To assess the quality and effectiveness of institutional arrangements and coordination structures to support the scale up of evidence-based nutrition interventions and their appropriateness both at county and sub-county level to be used to support advocacy efforts.
To review the investments from the public sector and donors on interventions targeting the first 1000 days of life and their impact on the optimal balance between nutrition-specific and sensitive interventions to be used to support advocacy efforts.
To identify and gain a better understanding of the reasons for success and gaps in implementation of existing national nutrition policies, programme frameworks, strategies and action plans at the county level for use to support advocacy efforts.
To identify opportunities to integrate the most impactful ENRICH supported interventions into existing county programming and to use these identified opportunities to advocate for a sustainable strategy that will increase commitments to nutrition programming in EMC.
SCOPE OF WORK
Workplan
Develop detailed workplan that clearly outlines key steps and timelines for completion of deliverables as outlined in the Terms of Reference and engagement with relevant stakeholders in the process including framework for desk review and KII questionnaires
Analysis of Policy Environment, Governance, Interpretation and Implementation
Conduct a desk review of existing national policies, programme frameworks, strategies/guidelines and action plans relevant to MIYCN programmes in EMC and Key Informant Interviews (KII) at county level to understand: 1) planning and budgeting process for nutrition, 2) human resource capacity for nutrition, 3) implementation coverage and gender-sensitivity of nutrition programming, 4) existing coordination mechanisms for the implementation of nutrition-specific and nutrition-sensitive interventions, 5) integration of the programmes, 6) investment/financing and 7) monitoring and evaluation of nutrition indicators at county level. These should include, but are not limited to: National Nutrition Action Plan 2012-17, Kenya National Food and Nutrition Security Policy (2011), County Integrated Development Plan/County Nutrition Action Plan and budgets and ENRICH project implementation plans.
Develop a draft report with findings from the review of existing national policies, programme frameworks, strategies/guidelines and action plans and key informant interviews (KII). The report should include recommendations for improving gender inclusion and equity, effective coordination structures for nutrition programmes and increased investments in nutrition to support policy interpretation, implementation and scale up of impactful ENRICH project interventions.
Stakeholder Consultation workshop
Collaborate with the County Department of Health to organize a two-day workshop to present findings of the review and KII and key recommendations (short-term/long-term) to key stakeholders from county government departments (Planning, Health, Agriculture, Gender) and nutrition partners for review and feedback.
Consult the key stakeholders on priority areas for nutrition advocacy.
Update the draft Nutrition Policy and Programmes Review report incorporating feedback from the stakeholder consultation workshop.
4. Advocacy Plan for Elgeyo Marakwet County
Develop a draft advocacy plan informed by the findings of Nutrition Policy and Programmes Review report and feedback from key stakeholders. The plan should include specific activities and allocated budget for its realization by various stakeholders.
Collaborate with County Department of Health to organize a one day workshop to validate the updated Nutrition Policy and Programmes Review report and draft advocacy plan.
Finalize the Advocacy Plan incorporating feedback from the validation workshop.
Collaborate with County Department of Health to organize a one day workshop to disseminate the Nutrition Policy and Programmes Review Final Report and Advocacy Plan at county level.
DELIVERABLES
Inception report
The consultant(s) will develop an inception report that accounts for the considerations outlined in the Terms of Reference as well as the methodology. The inception report will also provide a detailed work plan for the work, desk review template, list of stakeholders to be interviewed and the KII questionnaire.
First draft nutrition policy and programmes review report
The report should clearly outline the focus and scope of the review including the methodology (desk review, KII), under the headings policy environment and governance, policy interpretation and implementation, key findings, conclusions and recommendations.
Stakeholder consultation workshop report and presentation
The report should capture discussion/feedback from stakeholders on the review findings and their recommendations to finalize the nutrition policy and programmes review report as well as priorities for the advocacy plan. A list of participants with designation and contact information (phone number and email) and workshop agenda should be attached as annexes to the workshop report. The draft report and presentations should be submitted to NI for review prior to the workshop.
4. Second draft nutrition policy and programmes review report
The report should incorporate the feedback and recommendations from the stakeholder consultation workshop.
5. First Draft Advocacy Plan
The plan should identify key influencers and target audiences (decision makers) for nutrition messaging based on the nutrition policy review and programmes report. It should contain objectives and a plan of action, indicating the resources necessary for the implementation of the activities.
Validation workshop report and presentations
The report should capture discussion of issues raised in the stakeholder consultation workshop and their recommendations to finalize the advocacy plan. A list of participants with designation and contact information (phone number and email) and workshop agenda should be attached as annexes to the workshop report. The second draft nutrition policy and programmes review report and first draft advocacy plan and presentations should be submitted to NI for review prior to the workshop.
Dissemination Workshop report and Final Advocacy Plan
Final Nutrition Policy and Programmes Review Report
All technical documents are subject to approval by the NI technical team before moving on to the next activity/deliverable
TIMEFRAME
This work is expected to be conducted between February 2019 and May 2019 for a maximum of 40 working days.
Inception meeting-Inception meeting report including detailed workplan, desk review template, list of stakeholder to be interviewed and KII questionnaire. -(3 days Within one week of signing contract )
Desk Review and Stakeholder interview -First draft nutrition policy and programmes review report (20 days)
Stakeholder consultation workshop , Second draft nutrition policy and programmes review report incorporating feedback from stakeholders at County level – Workshop Report 4 days
Develop Advocacy Plan -(First draft Advocacy Plan 3 days)
Validation workshop – Final nutrition policy and programmes review report incorporating feedback from stakeholders at County level – Workshop report 3 days
Update Advocacy Plan – Second draft Advocacy Plan 2 days
Dissemination Workshop – Final nutrition policy and programmes review report ,Final Advocacy Plan and Workshop report 5 days
CONSULTANT QUALIFICATIONS
For this assignment, NI require a consultant with expertise as follows:
Master’s Degree in Nutrition Science, Public Policy or in a related discipline, At least a post-graduate degree in Nutrition, Food science, or Public Health
Minimum of 7 years of relevant experience at the national or international level in policy dialogue, formation and advocacy
Extensive experience in research, policy analysis and advocacy
The consultant is also expected to possess the following skills and competencies:
Ability to work with minimal supervision
High level written and oral communications skills in English
Must be result-oriented, a team player, exhibiting high levels of enthusiasm, tact, diplomacy and integrity
Demonstrate excellent interpersonal and professional skills in interacting with government and development partners
Skills in facilitation of stakeholder engagements/workshops
Evidence of having undertaken similar assignments
