Consultancy Terms of Reference - SomaliaNGOConsortium

Consultancy Terms of Reference

Terms of Reference

Conduct Knowledge, Attitude and Practice survey on Maternal and Child Health
Interpersonal communication messaging on safe motherhood Karkar region in the State of

Puntland

Background

Save the Children has over 20 years experience of supporting the health sector in Somalia, the focus been
mainly on the primary health care. It has been engaged in a number of support areas ranging from
providing local technical capacity at service delivery points to a broader health system strengthening at
central level. At community levels, Save the Children has sound experience of working with community
structures and building relationship between them and health facilities. The organization has been
operational in Karkaar region since 2004. This started as post-tsunami rehabilitation of health facilities.

Somalia/Somaliland has high levels of malnutrition, especially micronutrient deficiencies, resulting in
children being at greater risk of being affected by diarrhoea and other infectious diseases, such as measles
and pneumonia due to their compromised immune system. They are also at greater risk of mortality from
those illnesses. Repeated episode of diarrhoea exacerbates their poor health status and accelerates
malnutrition, creating a deadly cycle12.

Poorly diversified food and poor consumption of micronutrient rich foods play a key role in contributing
to the high micronutrient deficiency rates. In fact across the two zones (Somaliland and Puntland) diets
consist mainly of cereal (maize or rice) oil, sugar, seasonably available access to milk and occasional access
to meat. Fresh fruit, vitamin A rich vegetables, fish, egg and organ meat is poorly consumed6. Moreover,
poor infant and young child feeding practices have been reported both in Somaliland and Puntland;
prevalence of exclusive breastfeeding was estimated at 12.7% and 6.3% respectively in the two regions.

With such an adverse situation, strategies for the control of micronutrient deficiencies are needed as well
as affordable and effective means to prevent and treat diarrhoea to contribute in the reduction of child
morbidity and mortality in a more comprehensive and integrated approach.

Some of the key measures to prevent childhood diarrheal episodes include promoting exclusive
breastfeeding, improving hygiene and quality of drinking water, vitamin A supplementation and promoting
rehydration and zinc intake1. A 2010 review suggests that hand washing with soap can reduce diarrhoea
incidence by 48%3. ORS and Zinc remains the cornerstone of appropriate case management of diarrheal
dehydration and is considered the single most effective strategy to prevent diarrheal deaths in children
under< 5’s ,MNP, IYCF and hygiene practices and encourage the use of the appropriate products.

Currently, Save the Children is implementing a 3 year UKAid funded maternal and child health focused
project in the Karkaar region. The project aims at delivering key health messages targeting maternal &
child health on prevention and treatment of diarrhoeal diseases, Infant and young child feeding (IYCF) and
hygiene practises. The project will also focus on communication campaign targeting key audiences to
deliver key health topics.

3Cairncross, S. et al. (2010). Water, sanitation and hygiene for the prevention of diarrhea.International Journal of
Epidemiology, 39

Consultancy Terms of Reference

Save the Children has a rich experience implementing a nutrition programme, including an infant and
young child feeding (IYCF) interventions in Puntland. Currently Save the Children is providing a full
package of IYCF programme in all nutritional sites of IDP communities in Garowe and general host
communities. The intervention includes facility based counselling as well as community based promotion
of mothers on infant and young child feeding. Furthermore, Save the Children believes that promoting
optimum IYCF and key health and hygiene messages is critical to preventing new cases of malnutrition and
disease, as well as managing those already affected. Often the care of children is closely linked to the
situation of women in the community.

If women’s awareness and knowledge of feeding practices is low they also have little chance of
contributing to ensuring their children receive a nutritious and healthy diet. Continued health and
nutrition education is therefore crucial to bringing about positive transformation of child caring practices
and their nutritional status.

This study will therefore assess the current common IYCF practice and identify the major barrier for
acceptable child feeding and care practice. The findings of the assessment will be used by health and
community workers to advocate for positive change in behaviour.. Women of child bearing age (15-49
years old) and mothers with children under five who visit the health facilities and nutrition sites will be
specifically targeted for IYCF promotion activities.
Purpose of the survey and BCC strategy development:

The purpose of the KAP survey is to generate information that will be used to develop more
strategic and evidence based interventions that could positively impact in reduction of child
mortalities. The information generated will directly benefit malnourished children, especially those who
suffer from micronutrient deficiencies, are at greater risk of being affected by diarrhoea and other
infectious diseases, such as measles and pneumonia due to their compromised immune system and are at
greater risk of mortality from those illnesses. Repeated episode of diarrhoea therefore exacerbates their
poor health status and accelerates malnutrition, creating a deadly cycle45.

Objectives of the assignment

The main objective of the assignment is to design and undertake a KAP survey on Maternal and
child health in relation to management / prevention of diarrhoeal disease, uptake of key health & hygiene
messages and appropriate use of products (DTK & use of quatabs). The KAP survey should identify
knowledge gaps, cultural beliefs or behavioural patterns, practices and any other socio-cultural and
economic factors that may facilitate understanding and action or create barriers to MNCH particularly
ANC, PNC, skilled birth attendants, prevention and treatment of diarrhoeal cases and IYCF practices
including motherhood in general, motherhood in general, including ANC, IYCF, prevention and treatment
of Diarrhea including ANC, IYCF, prevention,
. The KAP survey will generate strategy that will help promote positive behaviours that are appropriate to
the setting and also to provide a supportive environment that will enable the community to initiate and
sustain positive behaviours on maternal and child health and IYCF practices.

The KAP survey should also assess communication processes/channels that are appropriate and key in
promoting MNCH. The KAP report will be used to inform a BCC strategy that will be used to plan and
implement advocacy, communication and social mobilization activities in order to increase knowledge and
utilization of health services for improved health outcomes of the target population (reduction in child
and maternal mortality in the target population)

Consultancy Terms of Reference

Specific objectives are:
1. To establish a baseline regarding knowledge and practices of the community about key health
related issues.
2. To identify the priority needs in health promotion, Nutrition (IYCFand control of diarrheal
diseases.
3. Based on the findings of the KAP surveys appropriate IPC messages for different sections of
society (Women, men, children, elders, decision makers, health managers and policy makers).
4.

The survey should establish information on but not limited to:
a) Knowledge of Maternal and Child Health related issues,
b) Thoughts about health system response to MNCH,
c) Early seeking care practises or other actions related to MNCH,
d) Sources of messages (though inadequate) about Maternal and Child Health
e) Preferred means of communication utilized to access information related to Maternal and Child
Health
f) Knowledge on diarrhoea prevention and treatment (DTK) particularly home based care
g) Knowledge on infant and young child feeding practices (IYCF) at the community level
h) Community attitudes, behaviour and belief on key optimum IYCF practices
i) Knowledge on key health / hygiene messages& practices
j) Knowledge on hand washing during critical conditions
k) Respondents reasons behind building and appropriate use of latrines as faecal disposal process
Knowledge on the reason as to why women use ANC services
l) Knowledge on importance of facility based deliveries and anything associated with skilled birth
attendants

Scope of services
The consultant shall ensure the completion of the following activities in accordance with the terms and
conditions of the consultancy contract:

1. Develop an inception report detailing the study that will be done and a proposed report structure.
The inception report will be approved by Save the Children before commencing the study.

2. In consultation with Save the Children and relevant stakeholders, develop tools and implement the
study as agreed upon in the inception report

3. Produced a draft report and final report after incorporating all feedback on the draft report
4. Design and develop key BCC strategy and BCC messages for all the key assessment areas (IYCF;

MMN;…) targeting different sections of the society (Children, women, elders, decision makers,
health managers)
5. Present and generate consensus on internal personal communication messaging messages with key
health actors and influential actors at community level

6. The consultant will also deliver:
 A complete set of tools and data submitted to Save the Children as organization’s property

Methodology:

This will be a primary study necessitating travel to the field. The KAP survey will largely employ
quantitative methods. Some qualitative methods will be employed to generate in depth understanding of
data collected using quantitative methods. Data and information will be gathered from sampled districts of
SC operational districts of Karkaar region (the region has 5 districts with a total population of 200,000).
Respondents of the survey are expected to be interview mothers and children (with special emphasis on
girl child and girl youth); mothers; health workers and managers; community and religious leaders; people
actively taking part in community health structures/systems etc. An appropriate sampling technique will be

Consultancy Terms of Reference

designed to determine sample size of respondents to generate representative conclusions. Data and
information gathered through quantitative methods will be analysed and presented systematically.
Qualitative information will be utilised to substantiate quantitative findings and draw appropriate
conclusions accordingly.

In developing the IPC messages, a participatory process shall be followed to ensure social – cultural
appropriateness of the messages and strategies for disseminating. In this regard, the views of the people
that took part in the KAP survey should be sought.

With the above guidance consultants that apply for the job are expected to indicate in their technical
proposals the details of the data/information collection, analysis and reporting techniques (using both
quantitative and qualitative techniques) that they plan to deploy. Moreover, their technical proposal
should also indicate the process and methods they intend to adopt to develop the BCC strategies and
messages. The proposed methodologies and approaches will then be further elaborated in consultation
with SC.

The consultant shall work with the Technical specialists for Health, Nutrition, MEA and Head of MEA for
technical and quality backstopping.

Duration of role
The assignment is planned to be accomplished in 30 working days and is expected to start in mid-
November, 2013 and end in December 2013. Below is a draft schedule of activities

Activity Days Location
Consultant work
4 Nairobi
Document review and finalize design of assessment tool, 1
Travel to Garowe-Puntland 1 Garowe
Meeting with Ministry , SC field team, 3
Recruitment local data collectors and training (the process of Gardo
recruitment will start before the consultant travels to Puntland) 7 Garowe
Data collection 5 Garowe
Data Analysis and report writing 5 Garowe
BCC strategy and message development 1
Conduct validation meeting 1 Nairobi
Travel to Nairobi 2
Finalization of reports 30 days
Total

Key selection criteria
 Lead consultant
 Post graduate Degree in Public Health or Medical Anthropology or Economics or Sociology
 Extensive experience in health program research demonstrated by assignments conducted with
reputable INGOs
 Proven consultancy experience in undertaking KAP surveys messages
 Advanced skills in data collection and analysis
 Strong analytical skills and ability to clearly synthesize and present findings, draw practical
conclusions and to prepare well-written reports
 Knowledge of the socio-economic and health development issues in relation to Somalia is
desired.

Co investigator

 Postgraduate qualification in social science, development studies or in a discipline relevant to this
assignment

Consultancy Terms of Reference

 Knowledge and experience in research methods

 Experience in Somalia and knowledge of the local context
 Ability to speak the local language is desired

 Knowledge in safe motherhood

Communication expert

 Degree in communication or journalism or any other relevant post graduate training
communication

 Extensive experience in behavioural change and communication
 S/he should have practical skills in designing and developing BCC strategies and health message

development

All team members

 S/he should have appropriate level of sensitivity to the children/ young population needs and be
mindful of their basic rights.

 Willingness to a bid by the SC child safe guarding policy

Payment details
 Payment will be in accordance with a detailed budget breakdown as submitted through the
proposal, and invoices will be expected from the consultant prior to payment

Application specifications

Candidates interested in the position will be expected to provide the following documentation:
[email protected]

 Detailed response to ToR, with specific focus addressing the scope of work, methodology to be
used and key selection criteria

 Initial work plan based on methodology outlined, and availability of applicant
 Company profile or CVs of core team members including a minimum of 3 references
 Detailed budget breakdown based on expected daily rates and initial work plan

11. Code of conduct
Save the Children's work is based on deeply held values and principles of child safeguarding, and it is
essential that our commitment to children's rights and humanitarian principles is supported and
demonstrated by all members of staff and other people working for and with Save the Children. Save the
Children's Code of Conduct sets out the standards which all staff members must adhere to and the
consultant is bound to sign and abide to the Save the Children’s Code of Conduct.
A contract will be signed by the consultant before commencement of the action. The contract will detail
terms and conditions of service, aspects on inputs and deliverables.
The Consultant will be expected to treat as private and confidential any information disclosed to her/him
or with which she/he may come into contact during her/his service. The Consultant will not therefore
disclose the same or any particulars thereof to any third party or publish it in any paper without the prior
written consent of Save the Children. Any sensitive information (particularly concerning individual
children) should be treated as confidential.
An agreement with a consultant will be rendered void if Save the Children discovers any corrupt activities
have taken place either during the sourcing, preparation and implementation of the consultancy
agreement.

Consultancy Terms of Reference