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 Terms of Reference for conducting Sex and Gender Based Analysis of Maternal, Newborn, Child and Adolescent Health and Nutrition, Vitamin A Supplementation and Universal Salt Iodization Programs in Tanzania

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Introduction
1.1 About Nutrition International
The Nutrition International (NI) formerly Micronutrient Initiative, is a global organization dedicated to delivery of proven nutrition interventions with a focus on pregnant women, newborn, infant, children under 5 years of age and adolescents. The vision of NI is a world where everyone, everywhere is free from malnutrition and able to reach their full potential. NI’s mission is to be a global leader in finding and scaling solutions to malnutrition through; Coverage: delivering low-cost high impact nutrition interventions, especially for women, adolescent girls and children in Africa and Asia; Leverage: Integrating nutrition across sectors to maximize impact and ensure there are no missed opportunities; and Influence: Utilizing research, technical assistance, advocacy and partnership with national and global nutrition actors to improve policies, programs and resources for nutrition.


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Background and rationale
Malnutrition affects 1 out of 3 people on the planet in different forms and its impacts are particularly heavy on children, adolescent girls and women. In Tanzania, undernutrition is still unacceptably high 31.8% of children 0-59 months are stunted (TNNS, 2018). Anaemia, affects children, z adolescent girls and women of reproductive age, 58% of children 6-59 months, 47% of adolescent girls aged 15-19 years and 45% of women of reproductive age (TDHS-MIS, 2015/16). There has been a notable decrease to 28.8% among women of reproductive age. (TNNS, 2018). The prevalence of Vitamin A Deficiency is 33% in preschool children (TDHS, 2010) and 39% of households are not consuming adequately iodated salt.

The early age at first birth creates a health risk for adolescent girls and young mothers. About a quarter (26.7%) of adolescent girls are giving birth at the age of 15-19 years and more than half (53.9%) of women are giving birth by the age of 20 years (TDHS-MIS, 2015/16). In Tanzania, maternal mortality is of great concern of 450/100,000 registered live births and with neonatal mortality of 25/1,000 registered live births (TDHS-MIS, 2015/16). Adolescent mothers are at greater risk of experiencing adverse pregnancy outcomes, including maternal and neonatal deaths. Children born of adolescent mothers are more likely to be undernourished than those of adult women of similar social status.

For decades, Tanzania has been experiencing disparities in net enrolment rates among girls and boys. The gross enrollment in primary and secondary schools is 95% girls and 93% boys and 30% girls and 29% boys respectively. Despite the high enrollment in girls, yearly, 8000 girls are forced to drop out of school due to pregnancy. Disadvantages in education and economic opportunities also act as barriers to women’s improved health and nutrition status. Many public health interventions have mainly focused on improving women’s health status without addressing comprehensive gender dimensions of women’s health. Now there is a need to look into the cultural and socially constructed gender roles, norms and resulting behaviours that affect nutrition and health outcomes for women, girls and men/boys.

In implementing its Country Strategic Plan, 2019/24, NI in collaboration with the MoHCDGEC, PORALG, TFNC and local government authorities, will provide technical support in implementing Maternal, Newborn Health and Nutrition (MNHN); Adolescent Nutrition (Ado Nutrition); Vitamin A Supplementation (VAS) to under five children and Universal Salt Iodation (USI) programs to improve the health and wellbeing of the targeted populations.

The MNHN program aims at scaling up high impact, low cost maternal and newborn interventions by delivering IFA package (comprehensive ANC attendance during pregnancy); birth packages (Skilled Birth Attendance, Optimal Cord Care and Kangaroo Mother Care – KMC) for low birth weight babies; and postnatal care packages (optimal breastfeeding and good nutrition). All these packages will have a behavior change intervention component at facility and community levels to foster an enabling environment and increase demand creation for information and services. Adolescent Nutrition, through integrated nutrition and health interventions will deliver weekly Iron and Folic Acid supplements for the prevention of anemia in girls and nutrition education to adolescents (boys and girls). In addition, Vitamin A Supplementation of two doses a year for children under-five years will improve their health and contribute to the reduction of morbidity and mortality among children. The Universal Salt Iodization initiative aims to increase the availability, accessibility and consumption of adequate iodated salt at household level, contributing to better iodine status within population especially women of reproductive age and protecting newborns against mental impairment.
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NI believes that improving nutrition is critical to achieving gender equality, and that improving gender equality leads to improved nutrition NI is committed in mainstreaming gender into all programs for improved nutrition outcomes. Women, adolescent girls and children are at the centre of the focus, and there is a need to consider other identity and social factors which may increase vulnerability and marginalization of certain groups of women. NI believes that improving nutrition is critical to achieving gender equality, and that improving gender equality leads to improved nutrition. With the intention of contributing to gender equality, NI launched Program Gender Strategy to mainstreaming gender equality systematically into nutrition programs for six years (2018-24). NI Tanzania plans to conduct a Sex and Gender Based Analysis (SGBA) of its four programs to gain an in-depth understanding of the gender issues including social cultural barriers, potential enablers which will support planning for gender equality in the implementation of a gender responsive programs.

SGBA is a deliberate effort in NI programming, and lessons learned will be documented throughout the programming cycle to inform the design of program components, behavior change intervention components and provide insights on incorporating gender sensitive indicators and sex desegregated data) for monitoring and evaluation.

Based on this background, NI is looking for a gender expert to conduct a SGBA exercise in order to 1) understand the intersectionality (i.e. their multiple identities) which may influence the strategy itself as well as the potential to participate – be it marital status, pregnancy, educational status, religion, geography etc. and 2) to identify strategies to increase girls, particularly adolescents girls and women’s participation/decision-making and access to resources.

This TOR describes the purpose/objective, expectations, scope of work, required deliverables and timelines of the SGBA exercise.

Objectives, activities and deliverables
The purpose of this consultancy provide a deeper understanding of gender issues by conducting a Sex and Gender Based Analysis (SGBA) of Nutrition International’s programs i.e. MNHN, Adolescent Nutrition, VAS, and USI; implemented in six regions of Mwanza, Simiyu, Katavi, Lindi, Mtwara and Shinyanga; assess the current status of gender sensitivity and responsiveness within programs; provide recommendations for developing short- and long-term strategies for promoting gender equality and implementing gender responsive programs.

Key objectives:
  • Assess the gender equality issues relevant to MNHN, Adolescent Nutrition, VAS and USI in selected program areas and target regions, including socio-economic status (gender roles and their status within households, income levels, control over assets), access to nutrition services including commodities, vulnerabilities (including GBV).
  • Assess outcomes and outputs and indicators for MNHN, AN, VAS and USI program design and suggest opportunities to be more gender sensitive and responsive as applicable.
  • Identify and explain gender barriers, lessons, key entry points that worked well in the MNHN, Ado Nutrition, VAS and USI programs.
  • Identify potential opportunities, barriers and enablers and make recommendations for developing short- and long-term strategies that will promote gender equality and girls’ and women’s empowerment through the programs.

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Scope of Work
Objective/Activities
Objective 1:
Assess the gender equality issues relevant to MNHN, Adolescent Nutrition, VAS and USI in selected program areas and target regions, including socio-economic status(gender roles and their status within households, income levels, control over assets), access to nutrition services including commodities, vulnerabilities (including GBV).

Activity 1:
Undertake landscape analysis using the GE tool (Annex1, GE Tool 1), review of secondary literature, data bases, NI monitoring reports. etc. (Include relevant disaggregated data where applicable (include by sex, age, geographical location, caste, etc.)

Using the available literature and data sets, undertake an analysis and highlight gender equality issues in VAS, USI, MNHN and adolescent nutrition. This would include issues of access to nutrition, vulnerabilities to malnutrition, potential to participate and other vulnerabilities that are gender sensitive including gender-based violence.

Activity 2:
Assess the current level of gender sensitivity/responsiveness of the 4 programs and analyze program data (qualitative and quantitative) from NI’s programs to highlight the current level of gender mainstreaming.

Activity 3:
Key Informant Interviews (KIIs) with stakeholders at micro (i.e. household), macro (i.e. community) and meso levels (society/government – health facilities’ level) to identify gender related barriers of beneficiaries, service providers and health systems

Objective 2:

Assess outcomes and outputs and indicators for MNHN, AN, VAS and USI program design and suggest opportunities to be more gender sensitive and responsive as applicable. Activity 1:
Identify the key barriers and entry points to gender equality in these programs (Map gender roles including access and control of resources at micro, meso and macro levels) Activity 2:
Analyze/Assess adolescent girls’ and women level of participation and empowerment in identifying nutritional barriers and opportunities, agenda setting and decision-making at the micro, macro and meso levels.

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Activity 3:

Identify/Assess the key barriers and opportunities with regards to service providers (health, education) and system level interventions that impact the service delivery and as well as adolescent girls’ and women participation and access to services with regards to the MNHN and adolescent nutrition program

Activity 4:

Analyze social relations and men and boy’s potential engagement and anticipated challenges in promoting project outcomes related to girls’ and women’s nutrition and health Objective 3:
Identify and explain gender barriers, lessons, key entry points that worked well in the MNHN, Ado Nutrition, VAS and USI programs.

Activity 1:
Identify the key barriers and entry points to gender equality in these programs (Map gender roles including access and control of resources at micro, meso and macro levels) Activity 2:
Analyze/Assess adolescent girls’ level of participation and empowerment in identifying nutritional barriers and opportunities, agenda setting and decision-making at the micro, macro and meso levels.

Activity 3:
Identify/Assess the key barriers and opportunities with regards to service providers (health, education) and system level interventions that impact the service delivery and as well as adolescent girls’ participation and access to services with regards to the VAS, USI, MNHN and adolescent nutrition program

Activity 4:
Analyze social relations and men and boy’s potential engagement and anticipated challenges in promoting project outcomes related to girls’ and women’s nutrition and health

Objective 4:
Identify potential opportunities, barriers and enablers and provide recommendations for developing short- and long-term strategies that will promote gender equality and girls’ and women’s empowerment through the programs.

Activity 1:
Identify the gender inequalities and negative social norms in these programs context that can be addressed by NI.

Activity 2:
Highlight potential opportunities (potential entry points) and enablers at all levels that can be translated into short- and long-term strategies by NI


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Activity 3:
Identify strategies and program pathways that NI can adopt to address the above gender inequalities and positive social norms in the program cycle.

Activity 4:
Propose sex and age disaggregated target and data that could be collected in order to monitor and evaluate gender responsive results are being/were achieved
The consultant/consulting organization will take responsibility of designing and conducting the SGBA and submitting an assessment report. The consultancy team will work closely with the NI team to achieve this.

Deliverables

  • Desk review report
  • Preliminary data analysis
  • A concise report (preferably not more than 40 pages) consisting of:
  • Detailed description of current gender equality landscape including systematic and cultural barriers and facilitators relevant to the four NI programs and target regions.
  • The current level of gender sensitivity/responsiveness of the NI’s four programs
  • Suggested adaptations to current indicators and proposed means of data collection for the NI’s four programs
  • Potential opportunities for the program to build in gender indicators and pathways into the programs and the expected outcomes at all levels
  • Short- and long-term recommendations/strategies for gender mainstreaming within the four programs
Proposed timelines
  • This consultancy is expected to be delivered within 30 person-days from 16th November to 19th December, 2020.
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Required competencies and knowledge
  • At least 5-7 years of direct program experience in sex and gender based analysis, gender mainstreaming, gender training, and/or gender –based research
  • Experience in researching and developing gender equality policy guidance in Tanzania
  • Experience with adolescent and school based programs
  • Experience in researching gender within health, nutrition or food security programmes and policies, ideally in Tanzania
  • Experience conducting quantitative and qualitative research, especially key informant interviews and FGDs
  • Experience in duo method research i.e. conducting and analyzing quantitative and qualitative data and skills in quality report writing
  • Completion of SGBA+ training or equivalent
  • Gender expertise and graduate/post graduate training form a relevant academic institution
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MODE OF APPLICATION:
Interested consultant/s should submit their expression of interest that details the methodology and work plan for this assignment. In addition, the submissions to be considered must include the below;
  • Detailed copy of their CV/s and copies of academic and professional certificates for all consultancy team members
  • Description of the consultant/s experience including examples of previous similar work
  • Proposal clearly describing methodology, proposed data collection methods and sample tools, analytical and triangulation frameworks
  • A Sample outline of presentation of results within the scope of work
  • Budget proposal clearly showing the daily LOE rates and expenses
The EOI should include their daily consultancy rate for this assignment.
Proposals should be submitted via email to: bidsTANZANIA@NUTRITIONINTL.ORG
Deadline for submission of Quotations: 10th November, 2020.