Background and context
Humanitarian Assistance and Resilience Programme Facility (HARP-F)
The Humanitarian Assistance and Resilience Programme Facility (HARP-F) is an innovative instrument funding humanitarian assistance in Myanmar, specifically designed to strengthen the role of national civil society in rapid onset and protracted crises. Through our partners, we have been working to address acute humanitarian needs, build resilience and reduce the vulnerability of populations affected by successive crises and natural disasters in Myanmar and on the border with Thailand since 2017. We have channelled over £74 million of UK humanitarian funding to local, national and international partners to provide assistance to the most vulnerable populations, primarily internally displaced persons (IDPs) and refugees. We have granted another £4.3 million for COVID-19 prevention and control.
We aim to strengthen the role of national and local partners in humanitarian response in Myanmar, through our grant programme and our extensive capacity enhancement training programme. This strong reliance on local partners, as well as context-specific, adaptive programming, is what enabled HARP-F to quickly mount a COVID-19 response in 2020 in Myanmar and to continue to operate and meet the humanitarian needs of the most vulnerable populations following the February 2021 military coup.
Nutrition Situation in Myanmar
Good nutrition at an early age and for women is the foundation to a child’s survival and development. In the first 1,000 days between a woman’s pregnancy to her child’s second birthday are crucial to a child’s development; the baby needs the right nutrients at the right time to feed the brain’s development. Poor nutrition in the first 1,000 days causes wasting (too thin for height) in children, increasing mortality. In the long-term, inadequate nutrition can cause irreversible damage to the child’s growing brain affecting their ability to do well in school or earn in the future. Some studies have linked early childhood undernutrition to adult obesity, diabetes and other chronic diseases. With Myanmar plagued by conflict and highly vulnerable to natural disasters and climate change, malnutrition is a major concern in Myanmar. Under-five mortality in Myanmar remains one of the highest in the South-East Asia region and Myanmar is one of Asia’s poorest countries.
Scaling-up coverage of wasting treatment in Myanmar is a priority and requires innovative approaches such as using Family Mid-Upper Arm Circumference (Family MUAC), which has been shown to be feasible, and piloting simplified approaches to wasting treatment, for example for low-literacy health workers and volunteers or in the absence of sufficient quantities of RUTF. Other opportunities also include integration of nutrition services into mobile health clinics and the use of modified protocols. The barriers to seeking maternal and child health services are multi-factorial, with Muslim households facing additional obstacles, and these will need to be addressed to achieve increased coverage. Other major gaps in nutrition service provision include identification and management of at-risk infants under six months and their mothers (MAMI) and better management of children with severe wasting with medical complications. Yet, nutrition has been neglected in the humanitarian response.
To prevent malnutrition, there is a need to scale-up nutrition-sensitive activities to address underlying and basic causes of malnutrition. Global evidence shows that nutrition-sensitive strategies such as agriculture and livelihood activities, women’s empowerment, safety nets programme, providing supplementary food, preconception programmes, and water, hygiene and sanitation promotion provide important nutrition benefits.[1] Nutrition-sensitive interventions also present an opportunity to integrate elements of wasting treatment and identification to further scale-up coverage. In Myanmar, numerous nutrition-sensitive interventions are being implemented including blanket supplementary feeding programmes (BSFP), food/cash distributions, social and behaviour change communication (SBCC) for nutrition, maternal and child cash transfer (MCCT) programmes. However, these programmes face similar barriers to wasting treatment. To improve targeting and increase coverage, more research is required. Urgently, this calls for additional research to address the evidence gaps around how to best determine the burden of malnutrition in Myanmar and how to best address gaps in nutrition (specific and sensitive) service provision.
HARP-F’s role in prioritising nutrition in Myanmar
In March 2021, HARP-F finalised a nutrition baseline report to assess the challenges impacting nutrition programming in Rakhine State, and to make recommendations to better address malnutrition moving forward. In part the recommendations called for a scale-up in provision of lifesaving nutrition services and in particular an increase in coverage of wasting treatment, infant and young child feeding in emergencies (IYCF-E) services and adolescent and maternal nutrition services.
Alongside this effort, HARP-F, LIFT and Access to Health are supporting a range of implementing partners to address nutrition needs in camp and non-camp settings and have drafted a joint Nutrition Action Plan with the aim of reducing the prevalence of wasting and stunting in Rakhine State. The Nutrition Action Plan consists of ten actions and associated activities with a humanitarian focus, designed to address the recommendations arising from the nutrition baseline report. These actions are to be completed with the support of FCDO as required, and in collaboration with the nutrition sector, their activities and strategies, from June 2021 through to June 2022.
The key intended outcomes of the area under this study are:
One activity included in the Nutrition Action Plan, under priority 1 (to improve understanding of the current needs, gaps and opportunities in capacity and services, to reduce barriers to accessing services and improve nutrition practices) is to consolidate nutrition research currently being undertaken in Myanmar and to identify key nutrition research questions that remain. This analysis will help develop the research and learning agenda for the nutrition sector, including the HARP Facility, LIFT and Access to Health, to understand what research is required to support improved nutrition programming across Myanmar and in Rakhine State in particular.**
Purpose and Approach
The purpose of this research is firstly to ascertain what nutrition research is currently being carried out in Myanmar and Rakhine State in particular, including on aetiology of malnutrition, wasting, kwashiorkor and stunting trends, and on effective identification and management of malnutrition, to identify research gaps. Secondly, to identify the key research questions that remain on the effective management of malnutrition, including wasting, stunting and micronutrient deficiencies, in all vulnerable groups including infants, children under five years of age, school-age children, adolescents, women of reproductive age and pregnant and lactating women (PLW). Although there has been progress in reducing wasting and stunting in Myanmar, given the change in context over recent years an understanding of the fundamental risk factors, mechanisms and pathophysiological changes contributing to the condition’s development in Myanmar remains limited. Additionally, a critical gap in the ability to scale-up nutrition programmes is the lack of robust evidence on how to do this most effectively. While there may be existing operational and rigorous research and evidence generated by implementing partners, it will be valuable to document this for shared learning.
Global level research prioritisation exercises have been conducted for wasting[2] in general, specifically for the prevention of wasting,[3] management of small and nutritionally at-risk infants under six months and their mothers (MAMI),[4] and nutrition for school-aged children and adolescents (ongoing).[5] These prioritisation exercises used the Child Health and Nutrition Research Initiative (CHNRI)[6] methodology guided by an expert advisory group to prioritise key research questions. Out of 40 prevention of wasting and 53 general wasting questions, the top 10 from each category has been identified. Out of 60 MAMI questions broken down into three categories (1 – basic epidemiological research, 2 – health policy and systems research, 3- technical questions and interventions), 15 research questions with the highest overall research priority score were selected. These questions cover operational, technical and biological aspects of wasting. ENN has identified 39 potential research questions on nutrition for school-aged children and adolescents, plus 8 focused on pregnant adolescents. While these research questions are determined for the global context, the same research activity has not been completed for Myanmar specifically, although the results can be reviewed, adapted and applied to the Myanmar setting in the absence of the opportunity to conduct a CHNRI in Myanmar specifically.
The analysis should use qualitative and quantitative methods to identify priority research questions that need to be addressed in Myanmar and Rakhine State in particular, through secondary data analysis, interviews with key stakeholders, and a prioritisation survey. Stakeholders will be identified purposefully to reflect the views of nutrition programme implementers (national/local organisations, non-governmental organisations [NGOs], United Nations [UN] agencies), donors, and research organisations if possible in Myanmar. The minimum number of interviews should be 15.
The selection of research questions will be based on the priority research questions identified in the global prioritisation exercises mentioned above. Stakeholder interviews will further refine, adapt and add additional questions specific for the Myanmar context.
Once research questions have been identified, a research prioritisation exercise based on the CHNRI methodology[7] should be conducted in order to accelerate progress in preventing and managing malnutrition in Myanmar and Rakhine State specifically. The consultant will determine the most appropriate priority-setting criteria.[8] It is anticipated this exercise will be done via an online survey with a wide range of stakeholders mentioned above from the national, subnational and if possible field level stakeholders.
Target audience: The Nutrition Cluster and nutrition sector at large in Myanmar including key stakeholders, such as implementing partners and donors (including LIFT and Access to Health).
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Analysis objective and scope
Geographic Scope
The analysis will focus on Myanmar, with a more in-depth focus on Rakhine State. Relevant evidence from other states such as the World Fish research project in the Delta will also be included.
Target groups to be included in the analysis
While nutrition programming tends to focus on children under 5 years of age (including infants), plus PLW, this exercise will also include school-age children, adolescents and women of reproductive age more broadly.
Time period covered by the analysis
The analysis will cover nutrition research conducted in Myanmar since 2015, including research currency underway or planned in the next two years.
Analysis questions
● What research relating to the epidemiology of wasting/stunting, treatment and prevention of wasting/stunting has been conducted since 2015 in Myanmar? What research is planned in Myanmar?
● What do we know about the following? These priority research questions identified in the global priority research focused largely on the following:
○ What we know / what evidence there is about the community-based approaches taken to address wasting/stunting (what existing evidence exists from research conducted by NGOs/ CSOs in Myanmar on the effectiveness of certain interventions such as mothers groups, volunteers, peer mothers etc.)
○ Medium and longer-term outcomes of wasting and stunting in Myanmar (including NCDs)
○ Key drivers of wasting and stunting
○ The relationship between body composition and anthropometry in Myanmar
○ Current knowledge on wasting relapse and interventions to prevent relapse
○ Current evidence and knowledge on interventions to prevent stunting
● What are some of the evidence gaps around the epidemiology of wasting/stunting, wasting treatment and wasting/stunting prevention? (operational, technical, or biological/descriptive)
● What are priority research questions around wasting/stunting, wasting treatment, and wasting/stunting prevention for Myanmar and more specifically for Rakhine? (Priority-setting criteria to be determined by the consultant based on the secondary data analysis and interviews building on the criteria used for the global level research prioritisation exercises.[9])
● What are the recommendations for next steps to conduct the research? :
○ What is the feasibility?
○ What are the resources needed?
○ What are the recommended approaches and next steps? Who will be involved?
Tasks
- Secondary literature review of available Myanmar-specific nutrition evidence to identify evidence gaps, including both formal research trials with ethical review and informal operational research conducted by implementing partners.
- Comparison of Myanmar findings to global-level identified CHNRI nutrition research priorities to determine which global-level research priorities are applicable potentially to the Myanmar context.
- Remote stakeholder consultations through key informant interviews to identify and prioritise potential Myanmar-specific nutrition research questions (Annex 4).
- Survey to consult a wider stakeholder group to rank the list of nutrition research questions.
- Report writing on available nutrition evidence, evidence gaps, priority research questions, recommendations, and next steps (see deliverable 1 for additional details). To include a wider review and incorporation of feedback.
6. Dissemination of report through the National Nutrition Cluster and Rakhine State Nutrition Cluster. **
Timeline and deliverables
The consultancy is expected to start by the 14th February 2022, conclude by the end of March 2022 and require 24 days for completion of work. A rough outline of the anticipated timeline is presented below together with the expected deliverables:
Inception phase (6 days)
Inception report should contain:
● Findings from the secondary literature review on nutrition research conducted in Myanmar since 2015, currently underway or planned for the next two years. This would include formal research and informal analysis of feasibility, effectiveness, and any other documented experiences on nutrition interventions.
● List of potentially applicable research questions from global-level research priority lists to the Myanmar context.
● Finalised interview questionnaire for key informant interviews.
● Finalised survey template to rank the nutrition research questions.
DELIVERABLE 1: Submission of inception report.
Multi-stakeholder consultation phase (6 days)
● Conduct ~15 remote stakeholder consultations through key informant interviews to identify and prioritise potential Myanmar-specific nutrition research questions (Annex 4).
● Conduct survey to consult a wider stakeholder group to rank the list of nutrition research questions.
● At the end of the consultations, preliminary findings and conclusions will be presented to relevant HARP-F staff
DELIVERABLE 2: Compiled interview and survey data in electronic format.
DELIVERABLE 3: Presentation of preliminary findings to relevant HARP-F staff.
Reporting phase (12 days)
The final report should:
● Provide a comprehensive analysis of compiled data from the key informant interviews and survey.
● Include a finalised list of priority nutrition research questions for Myanmar and Rakhine State specifically.
● Be circulated to HARP-F, LIFT and Access to Health for review and comment before finalisation
● Incorporate feedback as relevant.
● Be disseminated through a webinar/ presentation to the National Nutrition Cluster and the Rakhine State Nutrition Cluster to share key findings.
DELIVERABLE 4: Submission of draft report for review.
DELIVERABLE 5: Submission of final report and annexes (with HARP-F signoff).
DELIVERABLE 6: Webinar/ presentation to relevant fora.
The final report should follow HARP-F branding guidelines and be no more than 20 pages long.
Required competencies
● Master’s degree in nutrition or public health or equivalent professional experience
● Demonstrable experience working in the international nutrition sector, including experience working in developing countries (to provide understanding of field realities)
● Knowledge of the international nutrition sector across a broad range of topics (management of wasting in particular)
● Proven experience conducting and analysing research in the nutrition sector
● Strong qualitative and quantitative data analysis skills
● Practical experience in conducting evaluations or research on area under evaluation
● Familiarity with the Myanmar context
● Excellent English report writing skills
● Strong interpersonal skills, motivated, takes initiative and drives progress
https://www.harpfacility.com/resources/call-proposals-consolidating-and-prioritising-nutr/
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