Consultancy VAS Technical Advisor for Rwanda At Nutrition International

Vitamin A deficiency (VAD) remains a widespread public health problem in much of sub-Saharan Africa and South Asia [1], despite changes in under-5 mortality rates and morbidity patterns, and innovative intervention options. Vitamin A supplementation (VAS) is a life-saving intervention that is vital to reduce the risk of child mortality, morbidity, and malnutrition in countries with high levels of VAD [2]. The abundant evidence supporting the positive effect of VAS on child survival was translated into international guidelines, the most recent of which was released by the World Health Organization (WHO) in August 2011 [6]. VAS is considered one of the most successful public health interventions given its impact on child survival, the ease with which it is integrated into primary health care programs, and the ability for it to have high, sustained and equitable coverage in different contexts.

The spread of COVID-19, an unprecedented health emergency, triggered an economic crisis touching nearly every corner of the world. Global economic shutdowns and disrupted supply chains devastated livelihoods and incomes, and reduced purchasing power further limited access to nutritious food for millions of the world’s most vulnerable people. Governments have been forced to divert limited health and nutrition resources to treating immediate medical needs, to the detriment of essential care. Combined, these factors are ushering in a malnutrition crisis which threatens to undo a decade of progress.

To avoid further spread of COVID-19, national governments and partners mounted comprehensive responses to the pandemic, including modifications and restrictions to activities and movement. These measures have serious implications for public health and nutrition interventions and essential health and nutrition services, including VAS. Delivery of VAS relies on mass campaigns and/or delivery through routine health systems in facilities and the community, bringing caregivers and children together from across the region. However, due to COVID-19 mitigation measures including physical distancing, movement restrictions and the prohibition of large group gatherings, many countries have had to postpone VAS campaigns, leaving children unprotected from preventable illness and death.

It is estimated that roughly 100 million children missed their first round of VAS in 2020 due to COVID-19, with millions more at risk of missing their second. Gaps in VAS coverage, when combined with other missed child survival interventions – such as vaccinations for measles – heighten the risk of severe spikes in child mortality. Decreased VAS coverage due to the COVID-19 pandemic also threatens to reverse years of efforts by countries to improve the delivery of VAS and promote equity in VAS coverage.

To avoid this, NI is implementing the “Savings Lives Through Vitamin A” program to help countries “catch-up” on missed VAS coverage due to COVID-19. This program will deliver emergency vitamin A catch-up campaigns, co-packaging with other essential child survival services, to limit missed opportunities and deliver the maximum impact at the lowest cost for those most in need.

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Nutrition International will work with countries to build tailored packages administering life-saving VAS along with a combination of nutrition screening, deworming, distribution of insecticide-treated bed nets, immunization catch-up and nutrition and COVID-19 education.

To ensure the supported rounds are successful and program data is available for decision-making, Nutrition International will also support post-event coverage validation assessments in targeted areas. This will ensure review data is available quickly post-event to allow for course corrections in time for the next round of implementation. The program will also produce data and guidance that is needed to curb child deaths and maximize every dollar invested.

To strengthen the overall response to this emergency, Nutrition International will scale up its technical assistance and advisory services to reinforce government capability and programming. NI will engage consultants in each country to ensure campaigns are designed and delivered effectively and with attention paid to equity. This includes the application of best practices and the adaptation of global guidance to the country’s context.

1. Overall Accountability and Function

The VAS Technical Advisor is accountable for the provision of nutrition technical support to governments to mobilize “catch-up campaigns”. The VAS Technical Advisor will be responsible for supporting the Ministry of Health at national and sub-national levels to plan, budget and implement child health days/events, including high-level advocacy, training, support for microplanning, supply chain planning, monitoring and supervision, and post-campaign surveys. The goal is to ensure that catch-up campaigns are implemented according to national guidelines and drawing on best practice to ensure that high coverage is achieved safely.

This position will directly report to the Senior Manager, Vitamin A Emergency Response, Africa. Under a matrixed delivery approach model, the Senior Grant Manager for OPS-HQ will provide operational direction to the TA.

The work-plan for this position will be signed-off by the two supervisors.

2. Key Duties and Responsibilities

Focal Point for the “Savings Lives Through Vitamin A” program

· Be the primary focal point and lead for NI in the country

· Build strong relationships with and engage regularly with senior government officials to ensure programming gaps and needs are clearly articulated and coordinated with other partner support.

· Ensure visibility of Nutrition International’s support to national and sub-national authorities

· Identify new programming needs and opportunities

· Develop additional networks and collaborative relations to facilitate and reinforce sharing of best practice

Support the planning, budgeting and implementation of emergency VAS programming

· Support the government to adapt GAVA COVID-19 protocols to the local context to ensure that campaigns are delivered safely.

· Conduct a rapid landscape assessment to map the extent of COVID-19 in-country and the level of disruptions to service delivery platforms for our programming; status of service

delivery platforms, including frontline health workers; impact of COVID-19 on gender dynamics and implications to our program; availability of supply and access to nutrition commodities; effects on care-seeking and coverage.

· Support the Ministry of Health to develop and implement a plan to improve coverage of vitamin A supplementation, wherever possible looking to deliver integrated packages of essential child survival and health services as part of this catch-up effort.

· Develop training curricula, tools, guidance, and recommendations to strengthen the capacity of health workers to ensure that VAS is delivered safely.

· Provide guidance and technical support to the Ministry of Health to improve their capacity to deliver quality catch-up campaigns.

Improved monitoring of emergency VAS programming

· Assess VAS coverage and identify areas with low coverage and conduct post-event coverage surveys to understand who is being reached and not reached and why. Once bottlenecks are defined advocate for greater focus of efforts and resources on these areas.

Strengthened procurement of Vitamin A and other nutrition-related commodities/supplies

· Ensure that supply is not a barrier to coverage by working with government to ensure sufficient supplies of Vitamin A capsules, other commodities/supplies that will be co-delivered as part of the catch-up campaigns (deworming tablets, bed nets, etc.) and PPE supplies.

Improved management of emergency VAS programming

· Provide guidance, training and recommendations to relevant staff on preparing Technical and Financial reports to account for Nutrition International funding provided in accordance with the quality standards outlined in the grant agreements.

· Critically review VAS monthly reports and provide feedback to relevant staff with recommendations for appropriate action, and provide follow up advice as needed to help ensure that appropriate action is taken.

3. Key Deliverables

· Agreed quarterly work-plan

· Monthly activity report. Includes a narrative explaining progress against agreed deliverables.

· Monthly, Quarterly and Bi-annual VAS coverage report submitted and summarized. Coverage data should be presented as numerator and denominator, resulting percentage and disaggregated by Age (6-11 months) and (12 to 59 months), by Gender and by mode of delivery (EOS, CHD, Routine).

· Report on the bottlenecks to high coverage

4. Qualifications

· Master’s in Public Health, Nutrition or Food Science

· At least 8 years working experience nutrition and health systems strengthening

· Experience in program management and evaluation

· Experience providing technical assistance to Ministries of Health in the region

· Experience in VAS programming would be an advantage

5. Reporting and working hours

· The consultant will report to the Regional Manager for East and Southern Africa.

6. Duration

The consultancy will be for up to 10 days per month