International Consultants: Revision for updating the Rwandan National Guidelines for Management of Acute Malnutrition, UNICEF Rwanda, 21 Working Days.

UNICEF Rwanda is looking for an International Consultants: Revision for updating the Rwandan National Guidelines for Management of Acute Malnutrition

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Purpose of the Assignment

• Background and Purpose    

1. From the time when national guidelines have been adopted several gaps have been identified by the health and nutrition service providers and experts. The main gaps are related to the inpatient management of acute malnutrition among children 6-59 months, infants under 6 months of age, HIV context and other medical complications. Also there are new developments and more evidence in prevention and management of acute malnutrition. Therefore there is an imperative need of the reviewing and updating the Rwandan national guidelines for prevention and treatment of acute malnutrition.
2. The community based management of acute malnutrition in Rwanda started in 1996 and the first national guidelines was developed and adopted in 2010. Since 2010, the program of treatment of acute malnutrition has been rolled out to the entire country and all health facilities in the country are expected to be managing acute malnutrition on-site, with referrals of complicated cases for inpatient care at all the hospitals.
3. To sustain the gains and accelerating progress in reducing child death, the nutrition situation requires an effective continuous response. Many interventions have been put in place to reduce the burden of Global Acute Malnutrition (GAM). The Ministry of Health has been working closely with One UN (UNICEF, WFP, FAO and WHO) and local and international NGOs such as CONCERRN worldwide, Catholic Relief Service, (CRS) in supporting several nutrition programmes and interventions to improve the health and nutrition status of children under five and other vulnerable groups. Rwanda recognizes treatment of acute malnutrition, clinical cases management of SAM with complications, outpatient management of SAM without medical complication as well as management of moderate acute malnutrition is critical in reducing child mortality and morbidity.
4. Rwanda has made consistent progress in reducing child deaths over the last decade through strategy focused on reaching high coverage of basic public health services. The under-five mortality rates decreased from 152 (per 1,000 live births) in 2005 to 50 in 2015. However to sustain the gain made in reducing child deaths, the country should consolidate and accelerate progresses in tackling malnutrition which remains one of the major public health concern. According to the most recent Demographic Health Survey (DHS 2015), Stunting in children under five reduced from 51% to 38% while anemia in the same age decreased from 52% to 36.5% (1). Rwanda experienced a significant decrease in prevalence of wasting in children under five (3.9% DHS 2005 compared to 2.2% DHS 2015).

• Justification    

1. UNICEF in collaboration with the government of Rwanda is consequently looking for two senior international consultants to support the revision of the national guidelines for management of acute malnutrition.
2. In order to speed-up the processes and ensure quality control to finalize the revision of Rwandan national guidelines for management of acute malnutrition and to allow timely revision and updating the national guidelines along with training package and required tools a high level international expertise is required.
3. Early in 2016, the Ministry of Health in collaboration with one UN and its partners held preparatory meetings to discuss the revision of the national guidelines for management of acute malnutrition. Three sub-working groups with representation from MINISANTE, UNICEF, WHO, WFP, CONCERN worldwide, CRS etc., have been put in place by the national nutrition technical working group to compile inputs from three thematic groups namely: a) prevention of malnutrition sub-group chaired by CRS, b) management of severe acute malnutrition sub-group led by UNICEF and c) management of moderate acute malnutrition sub-group chaired by WFP.

• Objectives  

1. The consultants will provide technical assistance in the strengthening of national capacity to implement adequately the program of prevention and treatment of acute malnutrition, specifically in the areas of protocol updating, programme monitoring, reporting and capacity development for clinicians and others services providers in the management of acute malnutrition. One of the two consultants will dedicate his/her time to the "clinical" component of the management of severe acute malnutrition (SAM) in children aged less than five years, especially protocol review, design and facilitate the SAM training that required the clinical expertise of a medical doctor and pediatrician experience in the management of SAM and capacity building. The second consultant will be mainly focusing on the "community" component and management of moderate acute malnutrition (MAM) as well as program management, review and development of training manuals, visuals aids and reporting tools.

• Methodological Approach & Expected Output

1. For the revision and updating the national guidelines for management of acute malnutrition, the consultants will perform following tasks:

1. Gather all the relevant information based on the international document and input from the three sub working groups (First week, remotely).
2. Develop a draft of revised and updated national protocol based on the new development and existing international guidelines (First week, remotely).
3. Develop draft of training modules, visuals aids and material as well as monitoring and programme management tools (First weeks, remotely).
4. Conduct field visits in selected districts and health facilities in country for a rapid program analysis and gather more background information on the health and nutrition system (2nd week, in country)
5. Facilitate a three days consensus building workshop to present the final draft of updated protocol including draft of the training modules, visuals aids and material as well as the monitoring and programme management tools for technical validation by the nutrition technical working group (2nd week, in country)
6. Edit and finalize the revised protocol for submission to UNICEF and MOH for adoption and endorsement (2nd week, in country)
7. Edit and finalize the revised draft of the training modules, visuals aids and material as well as the monitoring and programme management tools (2nd week, in country)
8. Conduct a five days' workshop for capacity building through Training of Trainers (ToT) on management of acute malnutrition using the revised/updated guidelines (3rd week, in country)
9. Design and develop consensual mentoring system, plan and supervision systems with appropriate tools. (3rd week, in country)

 Major Deliverables & Timeframe  

1. The following table presents the deliverables and timeframe for the consultancy.
2. The following table presents the specific activities to be completed to achieve the objectives. It also describes the division of labour between the two consultants. The number of "x" specifies the expected contribution by each consultant based on the profile and experience of each of them.

 Stakeholder Participation   

1. The Consultancy plan will be finalized with UNICEF Rwanda nutiriton team in close collaboration with MoH. As national ownership is necessary a three days consensus building workshop will be conducted to agree on the content of the suggested revised/updated national guidelines for management of acute malnutrition. Involvement of the government, academic institutions, civil society and other national stakeholders at each steps of the process is a pre-requisite for acceptance and adoption of the final documents as national standardised and agreed guidelines.
2. The consultants will develop within two working days of contract signing a detailed work plan in consultation with the UNICEF nutrition team.
3. The consultants will work in close collaboration with MoH, under the overall supervision of the head of Nutrition Unit of UNICEF Rwanda Country Office who will support the overall process for the Technical Assistance (TA).

• Qualifications and Requirements 

1. It is expected that the consultants demonstrate:
2. Overall, the two consultants should have experience of working toghether in the field of prevention and management of acute malnutrition with a strong clinical background, prevntion of malnutrition and community based management of acute malnutrition.

• knowledge and experience with recent WHO recommendations on the management of SAM and evidence on the management of MAM,
• proven analytical, communication and strong writing skills,
• ability to work in a multicultural environment as well as experience to work together with national authorities and familiarity with UNICEF is a plus and fluency in English and French is required.As mentioned in the justification section, this consultancy entails engaging a team of two individuals who bring different skills and competencies and complementing each other. The table below describes the technical qualification and experience required for each of individual

 Please indicate your ability, availability and daily/monthly rate (in US$) to undertake the terms of reference above (including travel and daily subsistence allowance, if applicable).  Applications submitted without a daily/monthly rate will not be considered.

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