Scoping study on the situation of vitamin A Supplementation in Mozambique At Helen Keller International

Co-founded in 1915 by Helen Keller, Helen Keller International is dedicated to saving and consequences of blindness, poor health, and malnutrition with more than 120 programs in 20 African and Asian countries, as well as in the United States. Renowned for our reliability, efficiency, and high level of technical expertise, Helen Keller International promotes the development of large-scale, sustainable solutions to some of the most pressing issues in public health.

Background and Context

Helen Keller International supports the supplementation with high dose of Vitamin A of up to 40 million children every year in 13 countries of sub-Saharan Africa. When delivered twice a year to at least 80% of children aged 6 to 59 months in countries with high under five mortality and high rates of vitamin A deficiency, Vitamin A supplementation (VAS) can contribute to a reduction of U5M by up to 24%.

VAS is delivered to children twice a year through multiple delivery mechanisms. Some countries are organizing mass distribution campaigns where teams of distributors visit every household to give the vitamin A to children. Others have integrated VAS into their facility-based delivery systems alongside with routine immunization or growth monitoring. A third group of countries are using a hybrid system comprises of campaigns and facility-based delivery. Finally, some countries are transitioning from one approach to another.

In Mozambique, 43% of children under the age of five are stunted due to chronic illness and poor diet (MISAU et al., 2011). Stunting is higher in rural areas (46%) compared to urban areas (35 percent).

According to the latest data available, 69% of children under five suffer from vitamin A deficiency; 75% are anemic; and 36% are iron deficient due to a lack of dietary diversity.1 According to UNICEF report, less than half of children under 6 months have been exclusively breastfed and only 13 per cent of children aged 6 23 months receive the minimum recommended diet. Following the El Niño climate shocks in 2016, more than 2 million people were acutely food insecure. While the situation has improved due to above-average harvests in mid-2017, several provinces from center of the country remain at high levels of food insecurity

Over the past two decades, the under-five mortality rate has decreased from somewhere between 222 and 259 per 1,000 live births in 1990 to somewhere between 62 and 101 in 2015, with infant mortality rates dropping from 160 to 57 per 1,000 live births over the same period.2 In 2019, infant mortality rate for Mozambique was 67.33 deaths per 1,000 live births, However, 1 in 12 children continues to die before celebrating their fifth birthday.

In the las three years, Helen Keller has supported the transition of Vitamin A supplementation and deworming (VASD) from Child Health Weeks to routine services, in line with the Reaching Every Community (REC) scale-up, with the aim to ensure two doses of VASD annually. Over the past three years, HKI has supported VAS activities in 5 of the 11( Manica, Tete, Sofala, Zambezia and Nampula) Mozambique provinces. The number of children aged 6 to 59 months in 2020, supported by HKI in those provinces was 3.152, 681 which corresponds to 64% of children in this same age group throughout the country.

To assess the status of VAS delivery in terms of the partner landscape, areas of support, funding gap, supply chain, information system and coverage in Mozambique, Helen Keller International is recruiting a consultant and or consulting firm to conduct a scoping study.

The Consultant will work in close collaboration with the Helen Keller International team, the Ministry of Health and other implementing partners.

General Objective

The present consultancy aims to conduct a situational analysis of the VAS program at the national level coupled with a coverage survey in 3 provinces of Mozambique.

Specific objectives

• Finalize the protocol and data collection tools for the survey.
• Conduct a comprehensive review of available literature on Vitamin A Supplementation in Mozambique
• Collect data as per the proposed protocol and questionnaires
• Analyze and report on the data collected
• Participate in the validation workshop of the study report

Activity 1: Finalize the protocol and data collection tools

• Contribute to the development of the study protocol and the adaptation of data collection tools if necessary
• Propose a timeline for the implementation of all the activities necessary to run the study efficiently
• Contact the National Institute of Statistics for the cluster sampling (enumeration area), the provision of maps and GPS coordinates of selected clusters, the total number of clusters per stratum, the total number of households per cluster.
• Propose a detailed budget for conducting the survey Submit the protocol to the national ethics committee

Deliverables activity 1

1. Final survey protocol validated by the ethics committee
2. Final questionnaires, interview and focus group guides on Word and Excel xls form
3. Detailed timeline of all survey activities
4. Detailed budget in Excel format
5. List of clusters sampled for data collection
6. Maps and GPS coordinates of the sampling clusters
7. Detailed Excel table summarizing total number of clusters per stratum, total number of households per cluster, probability of selection of each cluster
8. The Ethics Committee approval

Activity 2: Recruit and train experienced field staff

• Identify, recruit and train enumerators, team leaders and supervisors in the appropriate administration of quantitative and qualitative questionnaires
• Develop training materials (power point presentation and role-play scenarios) for quantitative and qualitative data collection teams
• Ensure the training of enumerators, team leaders and supervisors for the collection of quantitative and qualitative data
• Organize the pilot survey (site identification, deployment of collection agents, pre- testing of questionnaires)
• Propose a deployment plan for the teams (enumerators, team leaders, supervisors) according to the clusters drawn
• Establish a progression path for each team
• Revise and finalize the questionnaire based on the results of the pilot survey. Develop the quantitative and qualitative data analysis plan

Deliverables activity 2

1. Finalized training tools
2. Training report including the list of people trained
3. Team deployment plan / Selection and allocation of interviewers, team leaders and team supervisors
4. Detailed plan for conducting the survey including identification of survey sites, assignment of teams (supervisors, team leaders and enumerators) to the field with the itinerary and schedule for each;
5. Report of the pilot survey
6. Finalize questionnaires and guides (interviews and focus groups)
7. Quantitative and qualitative data analysis plan.

Activity 3 : Implement quantitative and qualitative data collection

• Develop the supervision grid with quality indicators during data collection Ensure quality supervision and monitoring of all stages of data collection
• Ensure that enumerators, team leaders and supervisors strictly follow the instructions provided during training
• Ensure that enumerators survey the sampled clusters strictly according to the methodology provided. No ad-hoc replacement clusters will be allowed. In case of a problem, the interviewer must immediately contact the supervisory team and wait for guidance from them
• Ensure daily synchronization of the data collected between the interviewers, team leaders, supervisors, and the consultant

Deliverables activity 3

1. Supervision and reporting templates for teams and supervisors
2. Summary of daily monitoring reports of the data collected
3. Data collection report with details of sites covered, problems encountered, and proposed solutions, including basic statistics of data captured
4. Daily raw database (of survey data) and a record of all documentation for literature review and qualitative data

Activity 4 Management, quality control, processing of data and information collected to refine the evaluation analysis.

• Organize and implement data quality control measures during collection to ensure the quality of information collected during the conduct of surveys Ensure the security of all data in electronic and hard copy formats
• Maintain strict anonymity of data to protect survey respondents and to comply with ethical standards. Data should never be used to identify respondents except for follow-up purposes
• Conduct regular checks of electronically entered data to proactively identify and correct any errors
• Clear the data and information collected to refine the analysis of the survey Develop dofiles for data analysis according to the analysis plan

Deliverables activity 4

1. Data quality control report
2. Data processing report
3. Provide a raw database, as well as a cleaned and complete database in STATA and Excel format, depending on the sample of respondents
4. Provide the do files used to perform the analysis (STATA .do files or similar); this facilitates verification (or redoing it if necessary) later

Activity 5: Analyze study data and information

Conduct data analysis based on study objectives and key indicators of the vitamin A supplementation program

Deliverables activity 5

Data analysis report

Activity 6: Develop a draft of the study report

• Propose a draft report of the situational analysis of the vitamin A supplementation program coupled with a coverage survey
• Make recommendations for effective strategies for administering the vitamin A and other services provided during VAS
• Prepare a power point presentation of the report

Deliverables activity 6

Draft of the study report including strategy recommendations. Presentation of the report on power point

Activity 7: Participate in a validation workshop of the study report

Deliverables activity 7

Workshop report including summary of recommendations and amendments from the workshop

Activity 8: Finalize the study report

Deliverables activity 8

• Final version of the study report
• Prepare an article for publication in accordance with the report

DURATION OF THE CONSULTANCY

The present consultancy has a duration of 6 months.

CONSULTANT QUALIFICATIONS :

The selected consultant or team of consultants must have the following qualifications:

• Good knowledge of the country’s health system
• Demonstrated experience in organizing large-scale household and community surveys in the country, knowledge of local formalities and customs in the implementation of household surveys, document reviews, quantitative and qualitative
• CV of the lead consultant (at least 10 years experience required) and of each team member
• Strong demonstrated ability in data management.
• Good knowledge of STATA, ONA, ODK or similar software. In-depth analytical and synthesis skills.
• Strong writing skills.

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