TERMS OF REFERENCE FOR IYCF PROGRAMME EVALUATION STUDY

I. Introduction

ANPPCAN-SOM implemented a Community based Infant and young child feeding (IYCF) program in Hargeisa, Borama and Berbera IDPs as well as the draught affected areas in Oodweine districts of Somaliland. The project is supported by UNICEF and is being implemented in collaboration with MoHD. The IYCF project delivered IYCF/NHHP counseling and promotion package. It is also intended to create an enabling environment for the implementation of BMS code as well ILO convention 183 and related recommendations.

The project specifically aimed to:

ü Optimize the IYCF care practices with the children less than five years and pregnant and lactating women in the project intervention sites. The integrated nutrition promotion, care and support activities and services include Individual and group counselling services by the trained IYCF counsellors, advocacy and social mobilization gatherings and campaigns, nutritional screening and referral of malnutrition cases.

ü Create linkage of IYCF services delivery to peripheral healthcare facilities, integrating IYCF in immunization promotion, strengthening individual and mother support group counselling.

ü Integrate MNP into the community based IYCF to support optimal complementary feeding practices as part of the rollout of the Basic nutrition services package.

ü Create an enabling environment through supporting the ratification and enactment of the BMS code as well ILO convention 183 and related recommendations for the protection of breastfeeding mothers at work places. The program will enable Ministry of Health and other sectors to support the implementation of both BMS code and ILO convention 183.

II. Objectives of the Evaluation Study

In order to evaluate the outcome and the impact of the programme and compare evaluation results of the baseline results and the target; an independent and rigorous evaluation will be undertaken with the following objectives:

ü To investigate current status and IYCF practices among children 0-23 months. Including level and actual practice regarding Initiation of Breastfeeding; Exclusive Breastfeeding (EBF); introduction of Complementary Feeding (CF) and age appropriate Complementary Feeding in the project target sites;

ü To identify barriers to and facilitators of recommended IYC practices in Somaliland;

ü To investigate violations of international codes of Breast Milk substitute in Somaliland;

ü To assess the extent to which maternity protection is in line with ILO convention 183.

III. Scope of the Evaluation Study

In terms of geographical focus, the IYCF project is being implemented in 26 villages in Hargeisa, Borama, Berbera and Oodweine. The evaluation study explores IYCF practices, existing policies and strategies, violations of international codes of Breas Milk substitute and under five and lasting women nutrition status in the target regions in Somaliland. The proposed evaluation study will cover all the intervention regions and draw data from the representatively selected or sampled sites.

The evaluation study aims to measure the following IYCF, BMS and Maternity protection priority indicators:

· Timely initiation of breastfeeding in children aged 0-23 months (meaning children aged 0 to <24 months)

· Exclusive breastfeeding under 6 months (meaning children aged <6 months)

· Continued breastfeeding at 1 year in children aged 12-15 months (meaning children aged 12 to <16 months)

· Continued breastfeeding at 2 years in children 20-23 months (meaning children aged 20 to <24 months)

· Introduction of solid, semi-solid or soft foods in children aged 6-8 months (meaning children aged 6 to <9 months)

· Consumption of iron-rich or iron-fortified foods in children aged 6-23 months (meaning children aged 6 to <24 months)

· Bottle feeding in children aged 0-23 months (meaning children aged 0 to <24 months)

Breast milk substitutes

· Percentage (%) of Mothers who report exposure to promotions inside and outside health facilities

· Prevalence (%) of health facility staff reporting that the companies selling any relevant products had contacted them at least once.

· Prevalence (%) of health facilities where promotional materials related to infant and child feeding are found

· Prevalence (%) of informational or educational materials found at health facilities not meeting each individual criterion in Article 4 of the Code.

· Prevalence (%) of Infant formula and other related products not meeting BMS international code

Maternity Protection

· Length of maternity leave;

· Level of breastfeeding support at workplace.

Methodology

Survey Location

The evaluation exercise will take place in four districts where ANPPCAN-SOM implements the IYCF project in Somaliland in the following locations; Hargeisa, Berbera, Odweyne and Borama respectively. The project targets 15 IDPs and 11 villages in the above-mentioned districts.

Study period

The study will be conducted from 14 April to 11 May 2020 (See the work-plan).

Study design

The survey will employ a cross sectional study with two-stage cluster sampling utilizing a Mixed Method Approach (MMA). The evaluation study will employ both quantitative and qualitative techniques and will include the collection of primary and secondary data from target respondents and relevant source documents. The Villages /IDPs will be considered as the smallest geographical unit (clusters).

Target population

· Interviewing with Mothers of children 0-23 months of age at household level.

· Focus Group discussions (FGD) will be conducted in every selected village with furthers, pregnant in the 2^nd and third trimester and lactating mother who had under two years of age children.

· Key informant interviews will be carried out with IYCF program staff from implementing partners to document challenges and common influencing factors of IYCF. These include; MoHD and UNICEF Staff, community-based health and nutrition functionaries IYCF counsellors and supervisors from the previous IYCF implementation sites and facility-based health practitioners (i.e. Nurses and Midwives in Health Centers).

Key informant interviews using semi-structured questionnaires on BMS violations will be conducted with distributors, retail outlets, health-care workers, media company officials and policy makers.

Key informant interviews using semi-structured questionnaires will also be conducted on Maternity protection with professional working mothers who have one or more children. Mangers of organizations or institutions will form part of the study interviewees.

Sample size

Evaluation consultant to come up with a representative sample size that estimates the true value with the desired precision and confidence.

Methods for Data Collection

Data will be collected from different target groups using the following data collection tools:

Comprehensive Desk Review: A comprehensive document review including existing policies and strategies will be conducted in order to provide an overview and analyses of the current status of IYCF key indicators. The project document, health facility records, service delivery reports, existing IYCF guidelines and policies will be critically reviewed.

Household questionnaire for mothers and care givers:

HH questionnaire will be used to collect quantitative data from mothers/caregivers with children 0 -24 months. The HH questionnaire will ask KAP questions on breastfeeding practices, complementary feeding and breast milk substitutes. (See attached questionnaire).

Structured and Semi-structured questionnaires for Key informant:

· Health facility directors/managers, regional health officers and key UNICEF and MOH officials will be interviewed on challenges and common influencing factors of IYCF using semi-structured interview guideline.

· Distributors, retail outlets, health-care workers, media company officials and policy makers will be interviewed using a semi structured questionnaire on BMS violations.

· Professional working mothers who have one or more children and mangers of organizations or institutions will be interviewed on Maternity protection based on a structured checklist on good practices for Maternity Protection in the workplace.

Focus Group Discussions:

Focus group discussions will be conducted based on FGD guidelines with selected mother and father groups representing the direct beneficiaries of the IYCF intervention. IYCF and BMS related information will be collected during the FGDs. **

Direct Observation:** In order to document observations on IYCF practices, BMS and maternity protection, structured observation checklist, videos and photography will be used.

Team composition and training

The IYCF programme evaluation will be led by a senior researcher supported by ANPPCAN-SOM MEAL Manager. Enumerators and supervisors will be provided with a practical training. The training module will be developed by the consultant composing of introduction to the evaluation assessment, its objectives and familiarizing the team with the interviewing and focus group discussion guiding questions and other tools.

Data analysis and report writing

Household survey data will be entered in EPI info 7 software and transferred to MS-Excel for cleaning. The entries for the variables for all the questionnaires will be re-checked and cleaned again. Post data cleaning will be done by randomly sampling questionnaires from each of the sites visited. All data entries from these questionnaires will be compared with the data on the physical/hard copy of the questionnaires. Perfect matching between the physical copy and data entries will be confirmed. Content analysis techniques will be used to extract key insights, explanations and quotations from the qualitative data of key informant interview and FGDs.

WORK PLAN

Will be available to the successful candidate or company