Individual consultancy: National Consultant – Development of Training Modules on Management of Child Acute Malnutrition and Nutritional Edema (for Mozambican nationals)

The purpose of this consultancy is to support the Ministry of Health (MoH) of Mozambique in developing comprehensive training modules and supporting documents in line with the updated national guidelines on the management of child acute malnutrition and nutritional edema. These materials will be used to train health professionals and ensure the proper implementation of the revised protocols.
The consultant will work closely with the Nutrition Department and the extended PRN Technical Group (GT-PRN) to ensure alignment with national health strategies and international standards, particularly the updated 2023 WHO guidelines.

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SCOPE OF WORK:

CONTEXT

Nutrition is a critical part of a nation’s health and development, but it is often neglected. Adequate nutrition, especially in the first years of life, combined with the provision of health care is the basis for healthy growth, a lower risk of non-communicable diseases, contributing to the development and strengthening of the immune system and good nutritional status.

The nutritional situation of children in Mozambique remains fragile, with a combined prevalence of 5.2% of acute malnutrition according to IOF 2019-20201 and 4% according to IDS 2022-2023. Despite numerous efforts to reverse the situation, factors such as social inequalities, environmental crises, health epidemics and humanitarian emergencies put pressure on the situation and negatively affect the well-being of families.

In 2010, with the approval of a new treatment protocol, the Nutritional Rehabilitation Program (PRN) was restructured, with the main objective of preventing and ensuring that all children have access to adequate treatment, thus reducing mortality from acute malnutrition and contributing to the reduction of chronic malnutrition (PRN, 2013). However, despite the recognized effectiveness of acute malnutrition management as a high-impact intervention, its coverage in Mozambique is significantly low due to frequent stock-outs and poor healthcare coverage.

SCOPE OF WORK:

CONTEXT

Nutrition is a critical part of a nation’s health and development, but it is often neglected. Adequate nutrition, especially in the first years of life, combined with the provision of health care is the basis for healthy growth, a lower risk of non-communicable diseases, contributing to the development and strengthening of the immune system and good nutritional status.

Malnutrition in all its forms has a negative impact on human health. In countries like Mozambique, where the Human Development Index is low, the coexistence of problems related to malnutrition highlights the complexity of socio-economic and health disparities, with an impact on the nutritional status of infants and young children, aggravated by humanitarian crises, including climate change, disease outbreaks and conflicts. This situation therefore challenges the achievement of global targets in relation to acute malnutrition and nutritional edema, including Sustainable Development Goal 2, which aims to achieve “Zero Hunger” by 2030.

The nutritional situation of children in Mozambique remains fragile, with a combined prevalence of 5.2% of acute malnutrition according to IOF 2019-20201 and 4% according to IDS 2022-2023. Despite numerous efforts to reverse the situation, factors such as social inequalities, environmental crises, health epidemics and humanitarian emergencies put pressure on the situation and negatively affect the well-being of families.

In 2010, with the approval of a new treatment protocol, the Nutritional Rehabilitation Program (PRN) was restructured, with the main objective of preventing and ensuring that all children have access to adequate treatment, thus reducing mortality from acute malnutrition and contributing to the reduction of chronic malnutrition (PRN, 2013). However, despite the recognized effectiveness of acute malnutrition management as a high-impact intervention, its coverage in Mozambique is significantly low due to frequent stock-outs and poor healthcare coverage.

The Department of Nutrition, under the National Directorate of Public Health (DNSP) of the Ministry of Health (MISAU), is responsible for coordinating the Nutritional Rehabilitation Program (PRN) at national level and, through this Directorate, defines the standards, supervises the provision of nutritional rehabilitation services to children, adolescents and adults with acute malnutrition, with a view to ensuring the provision of quality health care as well as the proper implementation of the treatment protocols established by the MISAU more than 10 years ago. The treatment protocols for malnutrition cover the different age groups and are divided into the following two parts: the PRN-I for children under five and adolescents and; the PRN-II for pregnant and lactating women (PBW) and adults.   Over the years the PRN has been updated in 2018 and 2019 to bring it into line with the latest WHO & UNICEF 2013 recommendations.

To ensure proper treatment, PRN services are offered through five routine healthcare platforms, namely:

1.           Treatment of patients with severe acute malnutrition with clinical complications, in hospital (TDI),

2.           Treatment of patients with severe acute malnutrition without clinical complications, on an outpatient basis (TDA),

3.           Treatment of patients with moderate acute malnutrition in the outpatient setting (TDA),

4.           Community-based treatment of patients with acute malnutrition (TDC), including the referral of cases of severe acute malnutrition with complications to health facilities and the involvement and participation of the community and,

5.           Nutritional counseling and education with cooking demonstrations for the prevention of malnutrition, as a service to be offered transversally and integrated into all care platforms.

There are currently 1,825 health facilities in the country (hospitals and health centers at all levels), of which around 1,604 (87 percent) offer outpatient malnutrition treatment (TDA) services, around 222 health facilities (12 percent) have the capacity and provide inpatient pediatric services, of which 219 (95 percent) provide TDI services, with the aim of covering all groups.

Considering the programmatic and ethical questions about how to expand access and coverage of acute malnutrition management through the Nutritional Rehabilitation Program (PRN) and decrease the high default rates of previous years (approximately 23%), especially in hard-to-reach and underserved areas, in the second half of 2017 the Ministry of Health (MoH) introduced a pilot intervention on Community Management of Acute Malnutrition (CMAM), with an Integrated Community Case Management (iCCM) approach. Overall, the CMAM pilot project has shown promise in improving the management of acute malnutrition but has highlighted the need for continued support and collaboration for sustained and scalable impact.

Among the commitments to support the implementation of impactful actions for the prevention and treatment of child malnutrition, the WHO launched, in 2023, updated guidelines that offer recommendations for the management of infants under six months of age at risk of poor growth and development, the management of infants and children aged 6 to 59 months with acute malnutrition and/or nutritional edema, post-discharge interventions and after recovery from acute malnutrition and/or nutritional edema. The guideline also provides recommendations on the prevention of acute malnutrition and nutritional edema.

Following the release of the new 2023 WHO recommendations on the prevention and management of acute malnutrition and nutritional edema among children under five, the Government of Mozambique began adopting the WHO recommendations into various guidelines according to the country’s context, including the national guideline on the nutritional rehabilitation program (PRN) and the accompanying training and on-the-job support manuals.  These guidelines call for updated training and capacity-building materials for health professionals. The consultant will play a key role in facilitating this process, ensuring that Mozambique’s health workforce is equipped to implement the new protocols effectively.

This new 2023 WHO guideline includes recommendations and good practice statements informed by the best available evidence for the prevention and management of wasting and nutritional oedema. It includes four areas of focus, including infants less than 6 months of age at risk of poor growth and development, moderate wasting in infants and children 6–59 months of age, severe wasting and nutritional oedema in infants and children 6–59 months of age, and prevention of wasting and nutritional oedema from a child health perspective.

 

PURPOSE OF THE ASSIGNMENT

The purpose of this consultancy is to support the Ministry of Health (MoH) of Mozambique in developing comprehensive training modules and supporting documents in line with the updated national guidelines on the management of child acute malnutrition and nutritional edema. These materials will be used to train health professionals and ensure the proper implementation of the revised protocols.

The consultant will work closely with the Nutrition Department and the extended PRN Technical Group (GT-PRN) to ensure alignment with national health strategies and international standards, particularly the updated 2023 WHO guidelines.

 

 

SCOPE OF WORK:

The consultant will be responsible for the following tasks, working under the supervision of the Ministry of Health’s Nutrition Department and the National Health Directorate for Training and in collaboration with the extended PRN Technical Group (GT-PRN):

Tasks

•            Task 1: Evidence Compilation

o            Collect and review existing evidence and materials related to training health and nutrition professionals on the treatment, prevention, and food/nutritional supplementation for malnourished children, including for maternal health, community health subsystem, integrated attention to mother and child health, HIV, and multisectoral interventions existent at national level.

•            Task 2: Collaboration with International Consultants

o            Collaborate with two international consultants in conducting technical discussion meetings with various working groups (at national and regional level) involved in the revision and implementation of the guidelines.

•            Task 3: Review and Update of Training Materials

o            Identify and assess all relevant and up-to-date materials and resources needed for the development of training modules for health professionals in the treatment and prevention of acute malnutrition in children under five.

o            Update the on-the-job support materials, including flowcharts and training packages, in line with the competency-based training pedagogy standards.

•            Task 4: Development of Training Package

o            Develop a comprehensive national training package on the integrated management of acute malnutrition and nutritional edema. This includes:

            Trainer and participant manuals.

            WHO reference charts/standards.

            Course guide.

            Clinical and nutritional guides for trainers of trainers.

            Standard presentations for training, capacity-building sessions, including orientation pocketbook.

•            Task 5: Stakeholder Engagement and Validation

o            Facilitate validation processes for the updated training package, ensuring alignment with the revised PRN guidelines.

o            Engage with key stakeholders, including the extended PRN Technical Group (GT-PRN) and relevant working groups, to incorporate feedback and ensure buy-in.

•            Task 6: Additional Support

o            Provide additional support as required, including facilitating workshops, capacity-building sessions, and other tasks assigned by the Ministry of Health.

DELIVERABLES:

By month 1:  Inception report received. Detailed report outlining the consultancy work plan, methodology, and timeline.

By month 2:   Field report received. Thorough report documenting outcomes of technical discussion meetings and recommendations.

By month 4:  Final PRN Training Package received. Comprehensive training package on the integrated management of acute malnutrition and nutritional edema, including participant and facilitator manuals, WHO reference materials, and standard presentations aligned with competency-based training standards.

By month 5:  Finalized detailed work plan and budget for the rollout of the training package, targeting health professionals at all levels of service provision.

By month 6:  Final Consultancy Report received. Final report summarizing the consultancy’s activities, key findings, lessons learned, and recommendations for future actions and improvements.

 

WORK ASSIGNMENT OVERVIEW

TASKS/MILESTONE:       

Collect and review existing evidence and materials related to training health and nutrition professionals on the treatment, prevention, and food/nutritional supplementation for malnourished children.

Deliverables/Outputs:  

Inception report received.

Timeline            

30 days

Estimate Budget

20%

 

Tasks/Milestone:           

Collaborate with two international consultants in conducting technical discussion meetings with various working groups (at national and regional level) involved in the revision and implementation of the guidelines.

Deliverables/Outputs:  

Field report documenting outcomes of technical discussion meetings and recommendations received

Timeline            

30 days

Estimate Budget

20%

 

Tasks/Milestone:           

Review and Update of Training Materials and Development of Training Package

Deliverables/Outputs:  

Final PRN Training Package finalized and received

Timeline            

60 days

Estimate Budget

30%

 

Tasks/Milestone:           

Stakeholder Engagement and Validation

Deliverables/Outputs:  

Detailed work plan and budget for the rollout of the training package, targeting health professionals at all levels of service provision finalized and received.

Timeline            

20 days

Estimate Budget

15%

 

Tasks/Milestone:           

Final report summarizing the consultancy’s activities, key findings, lessons learned, and recommendations for future actions and improvements.

Deliverables/Outputs:  

Final consultancy report received

Timeline            

20 days

Estimate Budget

15%

To qualify as an advocate for every child you will have… 

Bachelors degree in pediatrics and Child Health, Clinical Nutrition or Public Health and Nutrition, Nursing Public Health

Economy

Finances

Knowledge/Expertise/Skills required:

A minimum of 2 years’ proven experience in the development or implementation of interventions for the prevention and management of acute malnutrition in children under five years of age.

Experience in developing strategies, guidelines and/or protocols.

Experience in conducting training and in the prevention and management of acute malnutrition in infants and children under five.

In-depth knowledge of national health systems and primary health care

In-depth knowledge of national and international guiding documents and technical guidelines in the field of child health and nutrition.

Experience in nutrition programs in the African region.

Skills/Knowledge:

1.           Computer skills in basic software programs.

2.           Proven understanding of the existing and needed quality of public health nutrition and case management in Severe Acute Malnutrition (SAM) with medical complication practices at health facilities

3.           Excellent communication, writing, leadership and analytical skills.

Languages and level required:

Fluency in Portuguese and excellent knowledge of English.

CONSULTANTS ARE ASKED TO STIPULATE ALL-INCLUSIVE FEES, INCLUDING LUMP SUM TRAVEL AND SUBSISTENCE COSTS, AS APPLICABLE

For every Child, you demonstrate… 

UNICEF’s values of Care, Respect, Integrity, Trust, Accountability, and Sustainability (CRITAS). 

To view our competency framework, please visit  here. 

UNICEF is here to serve the world’s most disadvantaged children and our global workforce must reflect the diversity of those children. The UNICEF family is committed to include everyone, irrespective of their race/ethnicity, age, disability, gender identity, sexual orientation, religion, nationality, socio-economic background, or any other personal characteristic.

UNICEF offers reasonable accommodation for consultants/individual contractors with disabilities. This may include, for example, accessible software, travel assistance for missions or personal attendants. We encourage you to disclose your disability during your application in case you need reasonable accommodation during the selection process and afterwards in your assignment. 

UNICEF has a zero-tolerance policy on conduct that is incompatible with the aims and objectives of the United Nations and UNICEF, including sexual exploitation and abuse, sexual harassment, abuse of authority and discrimination. UNICEF also adheres to strict child safeguarding principles. All selected candidates will be expected to adhere to these standards and principles and will therefore undergo rigorous reference and background checks. Background checks will include the verification of academic credential(s) and employment history. Selected candidates may be required to provide additional information to conduct a background check. 

Remarks:  

Only shortlisted candidates will be contacted and advance to the next stage of the selection process. 

Individuals engaged under a consultancy or individual contract will not be considered “staff members” under the Staff Regulations and Rules of the United Nations and UNICEF’s policies and procedures, and will not be entitled to benefits provided therein (such as leave entitlements and medical insurance coverage). Their conditions of service will be governed by their contract and the General Conditions of Contracts for the Services of Consultants and Individual Contractors. Consultants and individual contractors are responsible for determining their tax liabilities and for the payment of any taxes and/or duties, in accordance with local or other applicable laws. 

The selected candidate is solely responsible to ensure that the visa (applicable) and health insurance required to perform the duties of the contract are valid for the entire period of the contract. Selected candidates are subject to confirmation of fully-vaccinated status against SARS-CoV-2 (Covid-19) with a World Health Organization (WHO)-endorsed vaccine, which must be met prior to taking up the assignment. It does not apply to consultants who will work remotely and are not expected to work on or visit UNICEF premises, programme delivery locations or directly interact with communities UNICEF works with, nor to travel to perform functions for UNICEF for the duration of their consultancy contracts.