Terms of Reference for a Feasibility Study Program: GROW – Global Program to improve Maternal and Child Health and Nutrition in East Africa through strengthening of Health & Nutrition Systems and Operationalizing Gender- Responsive Policies for Health & Nutrition Rights in Kenya, Somalia & Tanzania

1. Summary
Project GROW – Global Program to improve maternal and child health and nutrition in East Africa through strengthening of health & nutrition systems and operationalizing gender-responsive policies for health & nutrition rights in Kenya, Somalia & Tanzania.

Project Duration: 01 July 2022 – 30 June 2026
Country: Kenya, Somalia & Tanzania
Feasibility Study Start and End Dates: 24.01.2022 – 15.04.2022

2. Background and Rationale
Eastern Africa has the world’s highest stunting rates with 34,5 % of children under 5 stunted in 2020. Globally, Africa is the only region where the number of stunted children has risen, in East Africa the number of stunted children rose from 21,1 million in 2000 to 23,1 million in 2019. The impact of poor nutrition in early life is cyclical, as poor, stunted and undernourished mothers give birth to underweight children or struggle to provide nutritious food for their families. The underlying causes of undernutrition include the limited availability and access to safe and nutritious foods, poor access to health services and an unhealthy environment as well as inadequate care, especially of women and children, and gender inequality. All these problems are rooted in basic factors, including inadequate
government commitment and resources that create the required enabling environment for nutrition security on meso and macro-levels.

World Vision Germany (WVG), World Vision Kenya (WVK), World Vision Somalia (WVS) and World Vision Tanzania (WVT) are partnering with local Civil Society Organizations in the East Africa Region to develop a comprehensive program to address underlying causes of this regional challenge for funding by the BMZ Global Programs instrument. By design, BMZ Global Programs aims to make a greater impact on structure-building by harnessing synergy effects across countries and subject areas and by focusing on capacity development and advocacy for achieving a common overall objective. In addition, Global Programs should not only have an impact at micro level, but in particular at meso and macro level (national and/or regional) and aim for systemic changes.

This proposed Global Program will address root causes of malnutrition and inequality in the three target countries through a multi-level approach targeting micro, meso and macro levels. It will build on tested strategies for the delivery of key health and nutrition interventions through local health and nutrition system strengthening, targeted advocacy and capacity strengthening of civil society and government actors on sub-national, national, and regional/continental levels and contribute to the African Regional Nutrition Strategy 2015-2025 (ARNS).

Intended Program Impact: Contribute to the reduction of maternal & child mortality in targeted regions of the 3 countries in East Africa.

Overall Outcome: An enabling policy and structural environment is leading to the improved health and nutrition status of 658,339 boys, girls, women, and men and gender equity in the targeted districts in Kenya, Tanzania and Somalia.
Outcome Module 1: Target countries are implementing updated National Nutrition Policies, Strategies and Action Plans which align with AUC’s nutrition policies and are applying Gender-responsive policies on Health & Nutrition Rights at national and sub-national levels.
Outcome Module 2: Women of reproductive age, adolescent girls and children under 2 utilize improved gender responsive nutrition and health services, in the target regions.
Outcome Module 3: Women of reproductive age, adolescent girls and children under 2 benefit from increased gender equitable production, consumption and utilization of nutritious foods and micronutrient supplements, in the target regions.

Outcome Module 4: National civil society organizations and health and nutrition providers apply strengthened organizational capacities to cooperate for the sustainable delivery of improved gender sensitive Health and Nutrition services.
Micro-level: Activities include direct health and nutrition (HN) interventions targeting individuals at household and community levels to create demand and achieve social and behavior change through improved knowledge and skills to address the immediate needs to achieve good H&N outcomes. This will be done by scaling-up tested approaches from successful Reproductive Maternal, Newborn, Child and Adolescent Health (RMNCAH) and nutrition interventions such as Adolescent Girl Power Groups and Men Care Model for gender equality and women empowerment to address deeply entrenched gender norms that result in discriminatory attitudes and practices against WAG. In addition, Positive Deviance Hearth Training, Peer-to-Peer Nutrition Networks, IYCF (-E) will be used to achieve social, behavior change for positive HN outcomes.
Meso level: Activities will impact the health and nutrition environment on a meso-level through improving the capacity of service providers e.g., health workers, community health volunteers (CHV) on quality gender and adolescent-responsive nutrition screening, treatment, and referral services. CHV will conduct effective outreach, home visits and referrals to reduce gendered barriers in access to RMNCAH and nutrition care and support. Community health committees will monitor and support gender responsive HN service delivery and promote female participation and leadership. Capacities of national civil society and authorities to collaborate in advocacy and policy dialogue will be strengthened through Citizens Voice in Action (CVA) to enable further the implementation of gender
responsive RMNCAH and nutrition strategies. Specific activities include supporting CSOs and subnational government authorities to participate in the review and development of national and subnational nutrition action plans and strategies including influencing adequate budget allocation, setting up inter-sectoral coordinating committees, local value chain development for selected subsectors, the establishment of multi-stakeholder mechanisms and sensitize the community on health services delivery and empower them to demand for better health care access at community level.
Macro level: Advocacy to bring about policy changes at macro (national/regional) levels which creates a supportive and enabling environment for RMNCAH and nutrition through a gender lens will be conducted through cooperation with local NGOs and authorities to engage in evidence-based advocacy and policy dialogue at continental, national and sub-national levels to operationalize gender responsive policies on RMNCAH and nutrition. The program will collaborate with CSOs, UN agencies and government partners to share relevant nutrition information at political and technical forums at national and AU levels.
Networks and partnerships: One systematic change to address existing barriers to rights-realization will be achieved through working in partnership with, and building the capacity of, local CSOs and Women’s Rights Organizations(WROs) including Anglican Development Services – North Rift in Kenya, Kivulini Women’s Rights Organization in Tanzania, and Puntland Minority Women Development Organization (PMWDO) in Somalia. The project will strengthen these organizations’ capacities through targeted training and mentoring and facilitate networking and exchange of best practices and learning among CSOs working on similar issues in the target areas and collaboration between governments to advance the health & nutrition and women’s rights agenda.

WV has demonstrated experience in health system strengthening (HSS) approaches resulting in improved access, quality, and utilization of RMNCAH at community- and lower- health facility levels, supporting national guideline development and inclusion of nutrition indicators in the HMIS at national levels. A recent WV global health & nutrition project (“ENRICH” 2016-2021) in Bangladesh, Kenya, Pakistan, Myanmar and Tanzania, targeted 2 million people and saw reduced maternal and child mortality by ensuring equitable access to essential health and nutrition services. The planned design draws on strong evidence from studies and evaluations generated in the ENRICH project, which provides a solid basis of data on RMNACH service delivery in the target locations, including on the
effectiveness of innovative and locally tailored project models with potential for up-scaling. The data further details important lessons learned about how community mobilization, strengthening of

community health systems, and educating parents on health and nutrition created a link between households and health facilities that promoted demand for services and transfer of knowledge. Essentially important for the present design are also the documented experiences of how Citizen Voice and Action groups can promote local advocacy and lead changes in government health services through their engagement, demonstrating potential to create sustainable community-led development.

3.  Purpose, Objectives and Use

The objective of the Feasibility Study (FS) is to provide World Vision offices and local partner organizations with a solid basis for finalizing the project proposal by filling gaps in data, clarifying preconditions, opportunities, resources, systems, policies and risks of the planned program. Specifically, it is intended to provide an assessment of the feasibility of the program’s approach and an analysis of the plausibility of achieving the envisioned changes within the specific context. The Feasibility Study should provide actionable recommendations and data for the improvement of the concept.

The primary audience of the Feasibility Study in addition to the donor agency is comprised of staff at World Vision offices and local partner organizations involved in the planning process, as well as beneficiaries, civil society representatives, local service providers, national authorities and regional bodies that are identified as key stakeholders and will be participating in the design consultations.

The study shall provide an analysis of the political, economic and cultural program context on micro, meso and macro-levels for all three target countries and consider available data relevant to the target sectors of Health & Nutrition, Food Security, and Gender Equality. The context analysis should specifically focus on the structures relevant to the planned program, including local civil society groups, service providers, national and regional policy forums.

The Feasibly Study will entail an analysis of target groups and stakeholders, their specific needs, capacities and potentials and an analysis of the capacity assessments and capacity strengthening plans developed with local partners as part of the pre-design.

Based on the context and stakeholder analysis, the FS shall assess how well the selected approaches are suited to solve the identified problems for the target beneficiaries and how plausibly the initial activities and outputs will be able to realize the intended program outcomes in the specific context of the targeted countries and region. This should entail an analysis of the potential for up-scaling and transfer between contexts of locally developed project models and approaches, especially lessons learned within fragile contexts and the applicability of successful ENRICH approaches to maximize cross-learning between CSOs of the different target countries. Recommendations should be made based on the FS results on how to improve the overall programme design and proposed activities to better achieve the programme outcome.

Additional program-specific need for analysis concerns the unique value addition of the BMZ Global Program instrument. Therefore, the FS shall place special focus on analysing opportunities and entry points for achieving Outcome Module 1, strategies that are already being deployed and how they can be improved to support target countries in implementing updated National Nutrition Policies, Strategies and Action Plans which align with AUC’s nutrition policies, and applying Gender-responsive policies on Health & Nutrition Rights at national and sub-national levels. This shall specifically examine strategies to empower (sub-)national and regional civil society to influence policy making and hold decision makers to account (Module 4).

Creating lasting networks between local civil society organizations within and between the target countries and in the wider East Africa region and strengthening their long-term organizational and

technical capacities to deliver community services, share learning on best practices and innovations and organize to advocate for an enabling policy environment is an important foundational outcome of the planned program. Therefore, the FS shall analyse the capacity strengthening plans and specific activities under this outcome with the aim of providing tangible recommendations on how to improve this cooperation and re-enforce an equal partnership between World Vision offices and the local CSOs partners, guided by mutual learning.

Further, the feasibility of the planned program shall be measured against the OECD DAC evaluation criteria of Relevance, Coherence, Effectiveness, Efficiency, Impact, Sustainability.

4.  Methodology

The consultant should propose a methodology for the feasibility study. However, it is envisaged that the feasibility study will use mixed methods including focus group discussion, key informant interviews and desk reviews. Field visit and observation will be considered depending on the COVID-19 situation and policy and requirements for external visitors. The activities include:

1. Desk review relevant RMHNCAH project documents from Kenya, Tanzania and Somalia e.g. ENRICH phase one design, reporting and evaluation
2. Stakeholder analysis to provide a description of micro, meso and macro level partners, specific target groups/departments engaged in the proposed project, their potential roles and any risk associated and mitigation
3. Desk review of national and local levels of stakeholders reports and statistics on maternal and child health and nutrition, food security and gender, eg. County Integrated Development Plan (CIDP, 2018-2022), Annual Development Plan, Fiscal Strategy Papers, National, and County Nutrition Action Plans, Nutrition Guidelines, etc.
4. Key informant interviews (KII) with civil society organizations, UN, health partners and stakeholders for example technical experts from World Vision and consortium partners involved in ENRICH Phase I; representatives of international and national NGOs active in the relevant health & nutrition, food security clusters at national and sub-national levels in all three countries and target countries.
5. Interviews with relevant government line ministries including MoH, Gender and women’s affairs agriculture/food security in each of the target countries and at sub-national
6. Field visit by the consultant or delegated country level partners to conduct observations and Focus groups discussions (FGD) with community
7. Interviews with representatives of regional governance bodies and technical working groups such as the AU, Eastern Africa Reproductive Health Network (EARHN), African Leaders for Nutrition (ALN), and others identified in the stakeholder mapping to understand regional policies, advocacy strategies and ways of working with and across target countries impacting macro level

FS Criteria	Assessment Questions
Section A	These are suggested assessment questions to be reviewed by the consultant based on identified gaps in available data
1.  Initial situation and problem analysis (at macro, meso and micro level)	What is the (initial) situation like in the sector, the region and the country? What is the socioeconomic, political, policy and cultural context?
	Which problems were identified? What are the root causes of these problems and how do they affect the living situation of which population groups? (e.g. Women of reproductive age, Pregnant and lactating women, caregivers/grandparents of children under 2 years; adolescent girls)
	What resources are available to address these problems? And until when?
	Which need was derived from the problem analysis? How was/is this determined?
	Who was involved in the project planning process? How were they involved?

 

	What are the socio-cultural barriers for the approach and how can they be removed?
	What are the barriers to gender equality and social inclusion and how can they be removed?
	What additional risks (for example location targeting and implementation) are seen and how can they be addressed?
	Are there alternatives to the planned project or its individual components?
2.  Partner and stakeholder analysis	Which local organizations can be considered as potential implementation partners and why? Which capacities (institutional, technical, personnel and financial) do they offer and which capacities relevant for the project are missing (Based on existing partner assessments)?
	Which measures are necessary for strengthening the organization and capacity of the local partner (Based on existing partner capacity development plans)?
	Which vested interest/ownership do the local implementation partners have in the success of the project?
	What kind of relationship do local partners have with the target group and stakeholders (legitimacy)? Are there convergences of interest or conflicts of interest? How can interaction be improved?
	Who is part of the target group and what criteria exist for selecting this target group? Are there perhaps several target groups that are affected in different ways? What are the criteria for selecting target groups? How are do-no-harm aspects taken into account?
	How homogenous or heterogeneous is the target group with regard to factors such as gender, ethnic origin, age, sexual orientation, language, capacity, disability etc., and to what extent must the project take this into account?
	What specific needs do target group members have and how can these be addressed?
	What role is played by the target group(s) in a social context? Which conflicts of interest with other population groups could arise through this funding?
	Analysis of the capacities of stakeholders, including target group: Which potential does the target group have, particularly with regard to its own initiative, self-help efforts and local problem-solving capacities? How can this be strengthened?
	Who are the most important government and non-government stakeholders in this sector? Who are the most important ones in the project location, in the planned project region and in the project countries (Based on stakeholder mapping)?
	What are the existing relevant initiatives related to the project objective being supported by partners and for how long will the run?
	Does the planned project tie in with the government’s development strategy/policies?
	What interests do the stakeholders have? Are any conflicts of interest evident? What interactions exist with other stakeholder projects? How do they find their way into the project concept?
	Do the stakeholders have a common understanding of the problems? Have they derived project objectives from this?

 

	How big is the various stakeholders’ support for the project? In what ways can they influence the project and to what extent? Are there already agreements in place between stakeholders?
Section B	DAC Criteria – assessment of DAC criteria required by donor
3.  Relevance	Will the planned project approach address an important development problem or a key developmental bottleneck in the partner countries or regions?
	Is the planned project geared towards the needs of the target groups?
	Which specific change is to be brought about by the project after it has come to an end?
4.  Coherence	How does the planned project contribute to the strategies and programs of state or other organizations presented in the context analysis? How does it distinguish itself from them?
	To what extent will use be made of synergy effects with measures undertaken by other donors or programmes?
	To what extent will the project complement and build synergy with other projects/partners/program aligning with donor requirements?
5.  Effectiveness	Are the measures and the chosen methodological approach suitable for achieving the project objective?
	Will the activities planned at the micro, meso and macro levels sustainably address the needs of beneficiaries?”
	What additional activities should be planned at the meso and/or macro level (multilevel approach) in order to increase sustainability?
	What further measures does the study recommend for achieving the objectives at different levels, particularly at a macro level (goal, outcome, outputs)?
	Which impact logic/ theory of change should the project be based on? Who checks the effects when and at what intervals; how are the changes measured? (impact monitoring and evaluation)
	Which sociocultural barriers exist with regard to this approach and how can these be overcome?
	Which barriers exist regarding gender equality and social inclusion and how can these be overcome?
	Which negative consequences and effects could project measures or sub- objectives bring about? To what extent can this be taken into account in the project (concept) – e.g. “do no harm” approach, conflict-sensitive effectiveness monitoring, etc.?
	Which risks (personnel risks for those implementing the project, institutional and reputation risks, context risks) exist when implementing the project? How can these be minimised?
6.  Efficiency:	Which financial, structural and personnel resources are needed?
	Can the planned measures be implemented with the envisaged funds in the envisaged time period and can the desired effects be achieved efficiently (cost- benefit), economically and using as few resources as possible? Based on which criteria is the judgement made?

 

7.  Impact	To what extent does the planned project build structures, set examples and contribute to a longterm impact?
	Is a multilevel approach (micro, meso and macro level) a good way to increase significance and longterm impact?
	Are the planned project approaches efficient to strengthen the existing systems
8.  Sustainability:	How can the sustainability of the positive changes and effects be ensured and strengthened (structurally, economically, socially, and ecologically)?
	Which role/responsibility is assumed by state and/or civil society structures to enhance sustainability? To what extent can local potential, structures and procedures be built on?
	Which measures and instruments are most suitable for strengthening local ownership, participation and capacities?
	What are the major local and national and regional level factors which will influence sustainability?
9.  Recommendations:	What specific recommendations can be made for project proposal in the specific context?
	Which components are missing in the project proposal in order to achieve the planned objectives on a sustainable basis?
	Which planned components are not suitable for which reasons?
	Do the assumptions on effects and sustainability on which the theory of change is based appear plausible and viable for the project proposal; how would these have to be adapted if necessary?
	What are suitable qualitative and quantitative indicators (to be SMART) that reflect the changes for target group? Which findings from the study are recommended as a basis for incorporating them into the project logic (impact matrix)?

 

Ethical considerations: The evaluation will respect the essential WV ethical guidelines concerning conducting studies with children (anyone under 18) and community members (adults). It is crucial to ensure that the risks of potential harm to participants resulting from the data collection process are minimized and are outweighed by the potential benefits of the outcomes of the study. This also requires the planning and design of a favorable and non-harmful research setup (e.g. location, time, social environment). The consultant is required to abide by the same ethical principles and guidelines developed by WV during this mission, including child and adult safeguarding.

5.  Limitations

It is likely that the COVID-19 situation and each country’s entry requirements may limit the travel capacity of consultant during the FS to conduct field visits. The consultant shall propose alternative arrangements for data collection in case international travel to the target countries is being restricted. Consultants must adhere to the existing MoH COVID 19 protocols in each of the countries where data is collected. This includes a general limitation of participant numbers for gatherings, physical distancing, provision of hand washing / sanitizer, and the wearing of masks when in gatherings.

Somalia: Nugaal region in Puntland State is relatively stable compared to other areas in Somalia. The most frequent security challenges in the areas are community disputes which are usually resolved and contained by local authorities and community leaders. WVS does not anticipate major access challenges to this area, but the planning of the exercise should remain flexible to cater for possible delays in case of security incidents.

Kenya: While no major physical access limitations are expected in most target locations, terrain in East Pokot necessitates adequate vehicles.

Tanzania: January is the rainy season in most regions of Tanzania, which makes some parts of the country hard-to-reach, necessitating early planning and utilization of adequate vehicles for field visits.

6.  Logistics

The consultants will be responsible:

• for their own international travel, including visa application, to the target countries
• for the training of the enumerators
• for study design, data collection, data analysis, report writing

World Vision Field Offices in Kenya, Somalia and Tanzania will

• jointly be responsible for selection and contracting of the consultants
• support in provision of reference documents like project proposal and previous reports
• assist in communication with localities and communities
• review the study design and data collection plan and tools before use
• be responsible to organize in-country accommodation and travel for the consultants,
• facilitate recruitment of enumerators in the target counties, meet costs for hall hire, accommodation, meals, and transportation during training and field data
• provide stipend for field guides/translators (as necessary) based on the work
• provide airtime for enumerators and supervisors as
• preposition and make available the necessary electronic devices, printing and photocopy services during training and data collection

WV Germany will:

• support the selection of the consultancy and agrees on the final candidate
• support the quality assurance of the feasibility study
• review and approve study design, inception report and final report

7.  Products/ deliverables

• Inception Report with study design (including data collection instruments) 10-15
• De Briefing to WV and local partners
• Feasibility Study report, 30 pages without Annex, a template will be provided by WV.

Expected Timeframe

Call for applications	10.12.2021-25.01.2022
Selection and contracting of evaluation team	26.01.-01.02.2022
Kick-off	02.02.2022
Inception report	12.02.2022
Review inception report by World Vision	Until 14.02.2022
Data collection	14.02.-14.03.2022
Debriefing workshop	18.03.2022
Preliminary Feasibility Study Report	31.03.2022
Review of draft report by World Vision	Until 08.04.2022
Submission of final evaluation report	15.04.2022

8. Consultant Selection Criteria

• Proven experience conducting feasibility studies for donors such as BMZ
• Technical expertise in RMNCAH programme design, implementation, or evaluation
• Sound knowledge and experience in measuring Maternal, Infant and Young Child indicators
• Experience in measuring Food Security indicators
• Sound knowledge of the three countries’ contexts
• Ability to travel to each of the three target countries or mobilize data collection with delegated team members within those countries
• Excellent English language skills (writing and speaking)
• An advanced degree (Masters or PhD) in Social Sciences, Nutrition, Health, or Food Security
• Proven and practical experience in undertaking participatory research methods for qualitative and quantitative research and feasibility assessments especially for integrated sectors such as nutrition, health, food security and gender inclusion
• Excellent analytical, organizational, facilitating, presentation and communication
• Extensive expertise and experience in project planning, project design, applying the logical framework, project implementation and
• COVID-19 vaccine

9.      Tender

All applications must include the following;

1. A financial proposal with amount of working days and daily rates based on the details in the TOR
2. An Expression of Interest (EOI) of not more than 30 This shall contain:
   1. the consultants’ understanding of the TOR and general methodological suggestions
   2. how the consultants will undertake the study using the proposed methodology
   3. proposed work plan with rough timeline
3. CVs of individuals or team members with relevant experience and their roles in delivering the
4. Organizational capacity statement, past experience and activities relevant to the assignment, as well as tax compliance certificate and registration certificate
5. Two samples of prior studies that the consultants have undertaken in RMNCAH, nutrition, or livelihoods
6. Names of at least two references who can be contacted regarding the consultants’ relevant experiences.

All interested consultants are requested to submit their proposals via Email, suing the subject BMZ GROW Feasibility Study, addressed to:

The Secretary Procurement Committee, World Vision Kenya,

Karen Road, Off Ngong Road, P.O Box 50816 (00200)

Nairobi-Kenya

Email: kenya_procurement@wvi.org

No later than 5.00 pm on 25 January 2022.

10. Payment process

Payment upon submission and acceptance of the Inception Report to World Vision	40%
Payment upon submission of first draft of the FS report to World Vision	30%
Payment upon submission and acceptance of Final FS report to World Vision	30%

 NB:

• The Consultant’s compensation shall be paid NET, within 30 days from receipt of a proper invoice unless otherwise
• Payment will be made by cheque unless otherwise
• The payment shall be subjected to 10% withholding tax as required by the Law at the time of
• The consultancy quotation will only include professional fees and related travel
• Other related to meals, accommodation, transport in the field during data collection, airtime and stipends for enumerators will be covered by World