Term of References

Lessons Learned CMAM Surge Approach and Services for a More Resilient Health System-Chachro Taluka District Tharparkar

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Costing to Establish a Surge Facility

Background

Pakistan's current situation can be defined as a complex mix of emerging opportunities and persistent challenges. Despite its strategic location, vast endowments of natural resources and an emerging youth bulge, the country's socio-economic indicators stand in stark contrast to its potential. The propensity to ignore structural causes has negated the development of its resource potential – human capital, the backbone of a country's socio-economic growth, is not an exception. Sustained high level of malnutrition is among the underlying causes for Pakistan's decelerated human capital growth.

Pakistan is facing high burden of malnutrition with high prevalence of under-weight, over-weight and micronutrient deficiencies. Pakistan is one of the ten countries in the world where more than half of the under-five-year population suffers from either stunting or wasting, or both. According to a recent study, each year, 177,000 children die because of malnutrition in Pakistan. Diet, health and disease are strongly interrelated and responsible for low productivity and increased morbidity and mortality.

For many years Pakistan has had persistently high rates of acute malnutrition exceeding emergency thresholds. The community-based management of acute malnutrition (CMAM) was initially piloted in Pakistan in 2008/9 to address acute malnutrition among internally displaced communities in Khyber Pakhtunkhwa. The widespread floods of 2010/11 resulted in an influx of NGOs and significant scale-up of CMAM in the affected provinces of Sindh, Punjab and Baluchistan.  Currently CMAM in Pakistan is implemented by the Provincial Department of Health (with support provided as loan/grants by World Bank to the provincial governments) and also by the UNICEF, WFP and WHO and some key NGOs.UN World Food Programme and Concern Worldwide in close collaboration with Department of Health, Govt of Sindh has successfully completed the CMAM Surge Approach- A-Step Towards Building Health System Preparedness, Umerkot District, Sindh Province (2017-2021). The pilot project in district Umerkot Sindh adapted a set of practical tools delineated in local context to capacitate provincial and district health authorities to determine the seasonal malnutrition caseload and strengthen the health system resilience to face surges of malnutrition.

Leveraging upon the best learnings and practices documented under the CMAM Surge Pilot- Independent Evaluation,  the intervention was proposed to be scaled up in existing CMAM implementation in one taluka (Chachro) of district Tharparkar, which is  geographically marked to  prone multiple vulnerabilities like high food price, locust attack and recurrent droughts. According to the National Nutrition Survey (NNS)  2018, the district marked among the list of districts with high cases of acute and chronic malnutrition as highest prevalence of wasting i.e.,33.3% and Stunting 60%. NNS2018, showed that household (HH) Food insecurity in Tharparkar is about 78.8%, out of which 48.2% HHs are severely food insecure, while 30.86% HHS are mild to moderately food insecure. Around 89 % of the population falls in the 5th quintile. The proposed interventions were built on the Umerkot CMAM Surge model with an application of multi risk lens ( Locust, attack, drought, floods, epidemics and price hike) in Chachro Taluka of Tharparkar for a period of two years to generate evidence for a plausible surge model which can be easily replicated and up scaled at national and provincial level.

Project Summary

The CMAM SURGE pilot pursues the shift from an emergency projects to a program fully integrated into ongoing health services and further scale up to Chachro Taulka of Tharparker District. Considerable progress has been made since inception of the CMAM Surge Approach from pilot to further scaling up to Chachro. The learning has already been well documented under the CMAM Surge Pilot- Independent Evaluation conducted in May 2021. The subject independent evaluation highlighted;

–  This evaluation finds that the CMAM Surge Pilot has strengthened the health system to manage increased caseloads of acute malnutrition while maintaining quality treatment outcomes

–  Average score of 3.8 out of 5: a favorable result showing that the pilot was able to support the shift from emergency programming and focus on health system strengthening.

–  Evaluation recommends further scale up within Umerkot District and wider scale within Sindh

Effectiveness: The Surge Pilot demonstrated that the approach is effective in strengthening the health system to respond to increased caseloads of Acute Malnutrition.

Impact: The Surge Pilot demonstrated that the approach had an overall positive impact on the health system at all levels from the community to the District.

Efficiency: The Surge Pilot has limited evidence for cost savings as a true cost analysis was not possible.

Acceptance/ Relevance: The surge pilot indicates that the approach is accepted by stakeholders at all levels and has generated interest at higher levels.

Sustainability: The Surge pilot has indicated that sustainability is possible, within the context of functioning CMAM services.

Key Lessons Learned:

–  Capacity building helps develops skills, empower health workers and District teams leading to improved confidence and timely response to challenges

–  Analyzing admission trends provides insight into causes of increased caseloads providing better understanding of community events and improved data analysis and reporting

–  Strong coordination platforms provided leadership and technical oversite supporting health system strengthening improving coordination at District level and between the district and health facilities

–  Improved data management allowed for a better understanding of CMAM indicators and strengthened the foundation for the integration of CMAM indicators into DHIS.

–  Faster detection and response time to increase in caseloads of other morbidities.  This includes a diarrhea outbreak and provides a strong justification to apply the Surge Approach to other health services.

–  Improved monitoring and management of commodities including a strengthened association between caseload and supply demands.

–  Improved coordination within the health facility led to a better understanding of the treatment of acute malnutrition for all health facility staff

Revised Scope of the Assignment

Deliverable-1: Lessons learnt from CMAM Surge

• Identify major strategic success and failures in designing and planning stage of project
• Identify operational challenges that hampered the project outcomes
• Understand and document evidence through
• Key Informant Interviews from relevant stakeholders from Al-Shifa Trust and PPHI
• Identify challenges and solutions to the surge information management system and reporting channels
• Identify costing challenges in the previous program
• Identify major bottlenecks for scaling up the CMAM surge.

Deliverable-2: Costing for Surge Facility

• The Government of Sindh appreciates the initiative and asks for a comprehensive costing to establish a surge facility.

• Since the data on parameters, population, interventions in terms of respective costs and cost effectiveness and efficiency are limited, so this costing exercise will not base on econometric or statistical model, but this will certainly identify all components of costs, their dependencies under various scenarios with respective assumptions.

• Subject to availability of the data and relevant parameters the costing exercise will include;
  • lessons learnt from recent programme
  • major costing issues, uncertain costs during recent program if any
  • identifying major costs
  • review of costing of CMAM Surge Program in Taulka Chahchro
  • recurrent and capital cost to establish the facility
  • cost of operations
  • tentative costs for various treatment options
  • identify ancillary costs
  • baseline costing with DRR and costing without DRR.

Timelines:

10 days for review of program documents, literature, online meetings with the teams etc.

02 days for field visit and gathering reflection.

Remuneration:

• Between the range of PKR 1,800,000 -2,200,000.
• If third party contracting, only Federal withholding income tax is applicable.
• Travel cost is reimbursable.

Experience and Qualification:

• At east PHD with 10 years of professional experience.
• Mandatory experience on cost economics.
• Mandatory experience on development economics.
• At least 03 years of experience on conducting research on finance, development economics.
• Mandatory working experience with academia.

1. 5.     Financial Proposal

Terms& Conditions

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• Human Appeal Pakistan reserves the right to reject any or all quotations without assigning any reason thereof.
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• Quoted rates shall remain valid for at least 60 days from the date of opening.
• Consultant/Vendor should send the quotation by hand/electronically via email at [email protected]  and [email protected] by Date: 08-12-2024 before 4:00 pm