Terms of Reference

3 weeks ago

Islamabad, Islamabad, Pakistan Pakistan Centre for Philanthropy Full time

Terms of Reference - Consultancy to undertake Costed Roadmap Exercise for Scaling MMS in Pakistan

The current Terms of Reference are seeking consultants/firms to execute a process to develop comprehensive provincial/regional costed implementation plans for five selected provinces/regions (AJ&K, GB, KPK, Punjab and Islamabad rural) and a five year costed national roadmap of the IFA to MMS transition process to support the Government of Pakistan for the continued and sustainable country-wide scale-up of MMS.

Introduction

Maternal and newborn health and nutrition needs in Pakistan are high. The neonatal mortality rate (estimated at 42 per 1,000 live births) and the prevalence of low birthweight (LBW; 23% in 2018) are among the highest in the world. Rates of micronutrient deficiencies are also high in Pakistan, at least in part due to widespread and extreme food insecurity, with the country ranking 99 out of 129 nations in the 2022 Global Hunger Index report. According to the 2018 National Nutrition Survey, an estimated 14% of women of reproductive age are underweight, 43% suffer from anaemia, 22% are affected by vitamin A deficiency, and 80% from vitamin D deficiency.

Antenatal care (ANC), especially in resource-limited settings, plays an important role in preventing malnutrition during pregnancy and ensuring optimal birth outcomes. ANC visits are a key mechanism through which pregnant women can receive counselling, micronutrient supplementation and support regarding nutrition recommendations. According to the PDHS 2017-18, only 52% of pregnant women in Pakistan received a minimum of four ANC visits. Maternal supplementation programs for prevention of anaemia are often neglected and have poor program success; in 2018, approximately 59% took iron tablets or syrup during pregnancy, and only 29% for 90 days or more during pregnancy as recommended. COVID-19 exacerbated several existing bottlenecks in the utilization and uptake of ANC services and recommendations. Continued strengthening of the ANC platform is needed to support the Departments of Health in Provinces and Ministry of NHSR&C, Government of Pakistan (GoP) in increasing ANC coverage and quality service delivery, including antenatal micronutrient supplementation.

To reduce the risk of anaemia in pregnancy, the World Health Organization (WHO) recommends iron-folic acid (IFA) supplementation beginning as early as possible and throughout pregnancy. In 2020 the WHO updated its Recommendations on Antenatal Care for a Positive Pregnancy Experience to a context-specific recommendation that supports the use of antenatal Multiple Micronutrient Supplementation (MMS) in the context of rigorous research.

MMS are antenatal supplements that contain 13-15 micronutrients including iron and folic acid combined in one tablet. This update was based on evidence that MMS is more effective and cost-effective than IFA in improving birth outcomes, has equivalent benefits in preventing maternal anaemia, and is safe for mothers and babies.

The Advancing Maternal Health through MMS Implementation Research in Pakistan (AMMI) Project was initiated in 2021 by the Nutrition Wing of the Ministry of NHSR&C and Nutrition International (NI), guided by a Technical Advisory Group. This implementation research project in Swabi district of Khyber Pakhtunkhwa provinces was designed to answer key implementation questions to support the introduction of antenatal MMS to replace IFA supplementation through ANC. Through the AMMI project, a set of tools, systems and approaches have been developed for scaling MMS and supporting its maximum impact. This mixed-methods study involved participatory research, outcome and process evaluations and a costing study to understand effective implementation approaches for introducing MMS within the ANC platform, intended at increasing adherence and quality of care.

Based on the effectiveness and cost-effectiveness of MMS, recent WHO ANC guidance, the maternal and newborn needs in the country, learnings from AMMI, and alignment with Pakistan's newly launched Maternal Nutrition Strategy, the Government of Pakistan (GoP) is scaling MMS through routine public ANC platforms in multiple districts of Pakistan.

Responsibilities and Accountabilities:

Responsibilities and accountabilities will be defined in detail in the attached Terms of Reference.

Relevant Experience:

Current students or recent graduates in International Health or related fields are encouraged to apply.

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