South Sudan: Nutrition Consultant/IMAM Guidelines

Background:

In December 2009, the Republic of South Sudan, Ministry of Health Department of Nutrition developed the Interim National Guidelines for the Integrated Management of Severe Acute Malnutrition (IM-SAM), in partnership with key agencies and stakeholders, to address the challenge of managing severe acute malnutrition in children under five. The Guidelines were the result of the efforts of the MoH Department of Nutrition and its partners to mitigate the long history of acute malnutrition in the country and to achieve a significant reduction in child mortality.

The Interim guidelines opted for the “Integrated Management of SAM” (IM-SAM[1]) approach, entailing community outreach as an essential part of the integrated approach to ensure early detection and referral of cases with SAM through community participation. The guidelines aimed at improving standardized treatment as well as monitoring and reporting (M&R) and were expected to facilitate the integration of the management of SAM into the primary health care system.

In 2011 the Ministry of Health with support from partners completed draft guidelines for the management of moderate acute malnutrition (MAM). However, the guidelines were not passed by the MAM technical working group although the annexes referred to as the Ready Packs were adopted and rolled out for field inputs.

Due to the temporary nature of the release of the current IM-SAM guidelines and MAM Ready Packs for roll-out and field testing and also as an interim measure to standardize the management of acute malnutrition, the MoH Department of Nutrition is now calling for a review process for an expanded version of a national guideline for management of acute malnutrition. This entails the updating the Current IM-SAM Guidelines to reflect new evidence and best practices in the integrated management of acute malnutrition (IMAM) including the prevention of malnutrition and promotion of appropriate nutrition, while adhering to latest World Health Organization (WHO) recommendations.

Justification

The roll out of the interim IM-SAM guidelines for field testing has generated huge context-based evidence to justify and inform an updated version of national guidelines for the management of acute malnutrition in South Sudan build upon best practices and lessons learnt in a South Sudan specific context. Based on experiences of implementing partners, outstanding lessons to be considered during the review and updating of the guidelines shall include but not only limited to the following key areas of concerns:

1) IMSAM guidelines and ready packs exist as two separate documents. This does not support the policy direction to implement a continuum of care where nutrition services should be offered holistically. There is the need to harmonize the two guidelines and have one integrated guideline for the management of acute malnutrition

2) Existing tools need to be updated to reflect latest global recommendations, within the context of South Sudan including its integration in the primary health care system.

3) Current guidelines focus on treatment of acute malnutrition. There is the need to extend nutrition services to address the root causes of malnutrition through prevention and promotion programs, as part of the overall guidelines

4) There has been growing concern over lack of guidance for nutrition of the other vulnerable groups. A new guideline has to provide for these needs.

5) There is need to strengthen the component on the management of acute malnutrition in the context of HIV/AIDS, TB, Kala Azar and similar complications.

6) The new guideline should strongly stipulate linkages with other relevant interventions and sectors to enhance multi-sector approaches and contribute towards the goals of the SUN Movement and similar initiatives.

Overall goal

To review, update, produce and disseminate national guideline on integrated management of acute malnutrition (IMAM) and its implementation tools (Job aids, training package) and roll out strategy.

Specific objectives

1) Revise and consolidate the current nutrition guidelines (IM-SAM & MAM ready pack) based on updated global evidence recommendations and field experiences in the context of South Sudan.

2) Develop IMAM training package (Training manual, training slides and job aids) based on the finalized Integrated Management of Acute Malnutrition guideline.

3) Disseminate the final IMAM guideline, training package and roll out training of trainers (TOT) for IMAM at national and state level.

Specific Tasks

Under the overaching guidance of the MoH Department of Nutrition and in close consultation with the CMAM-TWG the consultant(s) shall undertake the following responsibilities:

• Create an inventory of useful resources that will inform the development of the guidelines. This includes identification, review and documentation of existing national relevant policies, strategies, programs and guideline, as well as global and regional evidence-based guidelines, recommendations and principles, on the management of acute malnutrition.
• Undertake a technical review of current interim guidelines provisions for (IM-SAM and MAM Ready Packs) with a view to update them into one harmonized national guideline for the integrated management of acute malnutrition while adhering to current international evidence base and best practice.
• Work closely with the Ministry of Health Department of Nutrition and engage with key Stakeholders at both national and state level to ensure the guidelines are aligned with existing national policies and protocols relating to health and nutrition and draw on synergies with other relevant sector policies.
• Undertake consultative field visits (including travels) to conduct contextual analysis in collaboration with current partners implementing nutrition programs, to identify coverage gaps, operational challenges/constraints and best practices that will inform the review process.
• Participate in the relevant nutrition cluster meetings, health cluster meetings, Strategic Advisory Group (SAG) and joint programming meetings, to enrich the background for the formulation of the guidelines, and share updates on the achievements relating the formulation of the guidelines.
• In collaboration with the CMAM technical working group build consensus on all the proposed changes, and develop the draft Integrated management of acute malnutrition guidelines.
• Draft and present an initial report of key finding of the current guidelines gaps and the proposed amendments to the key stakeholders.
• Ensure continued technical consultation with CMAM TWG and Nutrition partners on the guidelines by incorporating recommendations of both local and international health, nutrition and other related actors through engagement with technical/expert groups.
• Undertake consultations with the CMAM forum, Emergency Nutrition Network, Global nutrition cluster, South Sudan MoH and UN Agencies to support the process of validation of the Guidelines.
• In collaboration with the Ministry of Health and nutrition partners facilitate the development and roll out strategy for guidelines.
• Play a lead role in facilitating the national validation of the final guidelines and implementation strategy with key stakeholders before submission of the final guidelines to Ministry of Health for approval and endorsement
• Participate in the organization of a national level workshop to launch and disseminate IMAM guidelines

Expected Deliverables

Expected Outputs

· An inception report on the consultancy with accompanying six months work plan to be develop and submitted in the 1^st month.

· Summary report on contextual analysis or findings of the current guidelines in Southern Sudan by 2^nd Month;

· Reports on national and state level engagement events/meetings shared by 3^rd month.

· First draft report on guidelines updated framework by 4^th month.

· Approved National guidelines for the management of IMAM in Southern Sudan including implementation tools (job aids, training manuals and training package) at end of contract.

· National Rollout strategy for the guidelines.

Management:

• The Ministry of Health and CMAM –TWG will provide technical guidance to the consultant. Meanwhile the supervision of the consultants’ performance and administrative issues will be managed by UNICEF the hiring agency.

Mode of operation

· Hire a lead consultant who will be responsible for the implementation of all aspects of the TOR in collaboration with a co- consultant.

· The lead consultant will support in the identification of the co-consultant whose role will be for the development of the training package.

· All processes of the IMAM guidelines development and training package shall be in close consultation with the CMAM –TWG.

· The Ministry of Health Department of Nutrition provides an overaching guidance over the entire processes of the guideline development.

· UNICEF who is financially supporting the hiring of consultant shall maintain managerial and administrative oversight including performance monitoring of the consultancy.

Expected background (Qualifications & Experience)

· Post Graduate degree in nutrition and/or public health.

· Minimum 10 years of postgraduate professional experience in nutrition, ideally in an emergency settings, including policy development, project planning/implementation/monitoring/coordination, designing and undertaking nutrition and food security assessments, nutrition surveillance and information management;

· Experience in developing national nutrition guidelines (MAM and/or SAM) and a solid knowledge of the CMAM approach and/or practice

· Experience in working in or with government structures, especially the MoH departments;

· General knowledge of UN system policies, rules, regulations and procedures governing administration;

· Excellent communication and interpersonal skills;

· Computer skills, including word processing, spreadsheet and other standard software packages and systems.

· Experience with the South Sudan health and nutrition sectors or South Sudan in general will be an added advantage

General Conditions:

· Terms of payment: Monthly payment upon completion of the deliverables.

· Note that final payment to a consultant is dependent on the completion of deliverables.

• DSA will be paid as per UNICEF regulations.
• Consultant will be required to sign the Health statement for consultants/Individual contractor prior to taking up the assignment.

· Basic & Advance Security in the Field Training Certificates are a requirement plus SSAFE training once at duty station.

[1] IM-SAM is equivalent to Community-Based Management of (Severe) Acute Malnutrition (CMAM).

Interested applicants should send their updated CV and P11 form to the HR Manager, at jubavacancies@unicef.org no later that 01st of May 2015 COB.