Terms of Reference – Nutrition International (NI), the former Micronutrient Initiative

Consultancy and Training, Health Care

Nutrition International (NI), the former Micronutrient Initiative

MI offers its knowledge and technology to the food industry to add nutrients, such as iron and folic acid, to food cost-effectively without affecting its quality or taste, helping to improve the quality of life for women and their families.

MI focuses on strengthening and integrating delivery platforms for micronutrients and other health interventions; advising governments on how to use their own resources to finance the marginal costs related to adding micronutrient supplementation, including vitamin A, iron and folic acid to existing health services and programs.

MI is working on the following priority objectives in Ethiopia:

• Increase the number of children receiving vitamin A supplementation (VAS) by expanding it to previously unreached districts. Integrate VAS into routine health systems, such as the Health Extension Program, to build sustainability.
• Support Health Extension Workers and caregivers in using therapeutic zinc supplementation, along with oral rehydration salts, to treat diarrhoea in children.
• Strengthen the ability of salt producers to properly iodize salt and work with partners to support efforts to enforce universal salt iodization legislation.
• Conduct operational research into factors that could improve adherence rates of pregnant women taking daily iron and folic acidsupplementation on a daily basis.
• Assist community members in micro-fortification of staple foods.

TOR to Consultancy to provide write up and compile the revision of the national guidelines for the prevention and control of Micronutrient Deficiency 

The Government of Ethiopia endorsed a Food and Nutrition Policy[1]  (FNP) and developed Food and Nutrition Strategy[2] (FNS) to provide guidance to the implementation of the policy. The FNP and FNS provided the policy framework and guidance to address food and nutrition system challenges that enables the attainment of optimal nutritional status at all stages and conditions of life, to a level that is consistent with good health, quality of life and productivity. The policy also  addressed system-level issues including multi-sectoral approaches and institutional arrangements for food and nutrition governance.

In the FNP & FNS, there are new promises and commitment included that believed to support attainment of the global commitment for nutrition in 2025, the national and SDG targets by 2030. To streamline with the FNS and effectively micronutrient interventions, MoH planned to revise and update the National Guidelines for the Prevention and Control of Micronutrient Deficiency.  The guideline revision will also be informed from MN specific national and global landscape changes, needs and lessons.

In the 2016 National Guidelines, no enough attention given to Folate Nutrition and its consequence in Ethiopia, i.e., NTDs. The MN guideline devoted a separate chapter for food-based approach including fortification. NTD prevalence studies conducted and reported that NTD level is Ethiopia worrisome. Systematic review of the effectiveness of FF with Folic acid to prevent NTD published.  The FNS recognized the importance of folate nutrition and outlined key interventions. A separate Chapter for Folate Deficiency prevention and Control improves commitment, quality program design and implmentation. The chapter need to be harmonized with goals set in the  FNS. The FNS  sets i) a goal to upgrade the voluntary  fortification standard to mandatory fortification standard, ii) a plan to develop Preconception Nutrition Package that includes Folic Acid supplementation and nutrition counseling, and iii) national food-based dietary guideline.

WHO updated the Nutrition recommendations included in the 2016 ANC Guideline  that upgrade the recommendation of prenatal MNS in Least Develop Countries. The recent ANC guideline promotes calcium supplementation to all pregnant women starting form 14 week and MNS is included as an alternative to IFAs.

The revision must be informed from ongoing program implementation plan and directions.

•  The capacity to fortify edible oil with Vitamin A and Vitamin D created.
• There are lessons learned from demonstration programs like form programming Weekly IFAS program could be used to design to inform the national scaling up. 

The MN guideline revision is also an opportunity to review, discuss and address implementation and monitoring challenges like reporting and coverage monitoring of bi-annual VAS, prenatal IFA supplementation

Purpose:  Produce quality and implementable national guideline that is consistent and in agreement with national FNP and FNS, global recommendations, sector specific intervention guideline & strategies.

Expected process and scope of activities 

1. Evidence informed guideline revision:  conduct or guide desk review of national and global guidelines,  recommendations and evidences to ensure that the MN guideline is informed up-to-date and quality informed with new evidences.
2. Guideline has to be forward looking in addressing future directions in nutrition such as importance of NCDs and food systems in its approach 
3. Readability and usability MN Guideline produced: 
• the national guideline need to is consistent with national policy, guidelines and strategies. The proposed strategies within a MN intervention and between relevant MNs need to be constant and integrated.  
• Ensure that the guideline is comprehensive enough that the target audiences (practitioners, program managers, researchers & policy makers) get clear and adequate information to discharge their responsibility in the implmentation of the guideline.  

Participatory Process adapted: Support MoH to organize working sessions  and consultative workshops. Facilitate discussion session, effectively record the outcomes of the discussions and ensure that decision are included into the guideline.  As the process multiple stakeholder, ensure that stakeholders are timely consulted and engaged in the decision making process & /or informed the outcome of critical consultations. 

For More Detail Click Here: Advert Consultancy MN Guideline revision.docx

Qualification

• PHD in Public Health and Human Nutrition
• Experience of desk review and critical analysis of policy documents
• Experience of developing training curricula/manual
• Experience of managing policy level muti-stakeholder processing 

Deliverable

• 1^st Draft MN guideline & workshop proceeding, by May 30, 2022

• Final draft MN guideline & workshop proceeding, by June 20, 2022

Lien