Senior consultant to assess knowledge, attitudes, and practices (KAP) regarding barriers to enhancing acceptance, demand, and uptake of Multiple Micronutrient Supplementation (MMS) through Antenatal Care (ANC) services in Rwanda, Kigali Rwanda, 4 months

To identify barriers to the uptake and compliance of Multiple Micronutrient Supplementation (MMS) by assessing behavioral, knowledge, and attitudinal factors, and to use findings and recommendations to inform SBC interventions that enhance demand, improve coverage, and ensure adherence to MMS through ANC services, while also enhancing counselling and education for pregnant and lactating mothers to better support their nutritional needs.

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1. Background:

Malnutrition remains a critical public health challenge in Rwanda, as evidenced by the findings of the 2019-2020 Rwanda Demographic and Health Survey (RDHS). The survey highlights a high stunting rate of 33%, a 13% prevalence of anemia among women of childbearing age (15-49 years), a 25% prevalence of anemia among pregnant women, and a maternal mortality rate of 203 per 100,000 live births. To address these concerns, Rwanda is strengthening maternal nutrition interventions by introducing Multiple Micronutrient Supplementation (MMS) to replace Iron and Folic Acid Supplementation (IFAS) among pregnant women. This intervention is considered a potential game changer for improving maternal and child health outcomes.

The development of maternal nutrition guidelines commenced in June 2023 and culminated in the training of 380 healthcare providers, including 24 master trainers, in December 2023. The MMS initiative was launched in January 2024 in Kabaya District and subsequently expanded to seven pilot districts, where it achieved a coverage rate of over 90%, benefiting 30,303 pregnant women by June 2024. In Rwanda, the Multiple Micronutrient Supplementation (MMS) program seeks to combat micronutrient deficiencies among pregnant women and young children by providing comprehensive blend of essential vitamins and minerals.

Despite its objectives, the program faces significant challenges, including low awareness of MMS benefits and inconsistent adherence to supplementation guidelines. Service provider capacity gaps such as inadequate distribution infrastructure and unreliable supply chains affect the availability of MMS products at Antenatal Care (ANC) service points. Additionally, logistical barriers, including difficulties in reaching remote areas and maintaining consistent product quality, further complicate implementation. To address these issues effectively, accurate and timely data is needed to guide social, and behavior change interventions, enhance community education, and improve program coordination. These measures are essential for overcoming both supply and demand challenges and for strengthening the overall impact of the MMS program in Rwanda.

Justification

Given the complexity of identifying barriers to MMS uptake and compliance, which involves analyzing behavioral, knowledge-based, and attitudinal factors, this task requires specialized expertise and dedicated time for developing assessment tools and conducting the assessment. Due to other priorities, UNICEF Rwanda team cannot manage this process directly. Therefore, UNICEF Rwanda is seeking qualified research and evaluation firms to conduct comprehensive assessment. This consultancy will ensure efficient and effective execution of the study, providing valuable insights to improve MMS and ANC services. The assessment will be completed within four months across the selected districts.

The primary objective of this assessment is to evaluate the knowledge, attitudes, and practices (KAP) related to Multiple Micronutrient Supplementation (MMS) among pregnant and lactating women in three pilot districts Gasabo, Rutsiro and Burera. This assessment will identify and analyze barriers to MMS access, uptake, adherence, and compliance, with focus on behavioral, knowledge and attitudinal factors.

Specific objectives of the study

The primary objective of this assessment is to evaluate KAP related to MMS among pregnant women in the seven pilot districts. The assessment will:

1. Identify barriers to MMS demand, access, and utilization by determining the key challenges preventing pregnant women from fully accessing and using Multiple Micronutrient Supplementation (MMS) during Antenatal Care (ANC) visits.
2. Identify enablers and motivators for MMS utilization by exploring the factors that encourage and facilitate effective use of MMS among pregnant women.
3. Develop and recommend tailored SBC strategy and action plan to enhance demand for, access to, and full utilization of MMS.
4. Recommend prototype strategy and action plan for transferring essential knowledge, skills, and motivation to service providers to improve their support for MMS uptake and adherence among pregnant and lactating women.

Methodological Approach

The individual consultant will work closely with UNICEF SBC, PME, and Health and Nutrition Sections, as well as line partners such as NCDA and other identified stakeholders. The study will utilize a mixed-method approach, incorporating both qualitative and quantitative data through secondary and primary collection. The assessment will focus on 784 pregnant women across three pilot districts, using cluster sampling to ensure representative data. Data collection will involve in-person and online methods, including Focus Group Discussions (FGDs) and Key Informant Interviews. However, the sampling should consider the following parameters: cluster sampling to achieve enough representation of all districts and it should also apply weighting techniques to ensure fairness and equity in terms of the number of districts, district hospitals, health centers and CHWs and other relevant health frontline workers per districts. These parameters include - confidence level (1 - α): 95% (Z = 1.96); power (1 - β): 80% (Z = 0.84); margin of error (E): 5% (0.05); estimated proportion (p): 0.5 (for maximum variability).

 

Sampling will be designed to address behavioral, knowledge-based, and perceptual barriers to MMS uptake, adherence, and compliance. The firm should provide a detailed methodology in the technical proposal and inception report, adhering to parameters of a 95% confidence level, 80% power, and a 5% margin of error.

 

The study will involve diverse respondents to ensure demographic and socioeconomic disaggregation. The consultancy will administer FGDs and key informant interviews with pregnant women, healthcare providers, and community members to gather comprehensive qualitative and quantitative data. The final report should present detailed findings and actionable recommendations.

The FGDs will aim to achieve the following:

• 5 focus groups with pregnant mothers, lactating mothers, and husbands/partners
• 5 focus groups with CHWs and other relevant health frontline workers (such as nurses, gynecologists, pediatricians)
• 5 focus groups with community members (male/female)
• 5 focus groups with adolescents of reproductive age (girls/boys)

 

Tasks

Step 1: Inception

• Collaborate with UNICEF to prepare and present an inception report and seek research ethical clearance approval.
• Conduct a literature review on MMS, ANC, and related practices to enrich the study, focusing on existing research and studies in the Rwandan context.
• Develop and submit an inception report including detailed methodologies (study population, refined sample, data collection tools and procedures, data analysis plan, and timeframe), and research guiding tools.
• Conduct meetings with key implementing stakeholders to finalize the methodology, data collection tools, logistics, and identify enumerators with UNICEF support.
• Ensure the subsequent data collection phase is streamlined as the tools and sample size will have been pre-identified.

Step 2: Orientation of the enumerators

• Develop data collection tools tailored to the study’s objectives and context.
• Conduct an orientation workshop for enumerators on data collection tools, procedures, and data analysis techniques.
• Pre-test and refine data collection tools based on feedback and pilot results.

Step 3: Fieldwork in three districts of choice (Gasabo, Rutsiro, and Burera)

• Support enumerators in fieldwork and data collection by providing technical guidance, supervision, and logistical support.
• Collect data adhering to research standards and ensuring rigorous data quality through both quantitative and qualitative methods.
• Perform data cleaning and entry using appropriate tools and techniques to ensure accuracy and completeness.

Step 4: Analytical workshop

• Organize workshop to present data analysis and proposed actionable recommendations.
• Draft a preliminary report for review with UNICEF, incorporating feedback and refining recommendations.

Step 5: Findings presentation (to stakeholders) workshop

• Hold a meeting to present and validate findings with relevant stakeholders.
• Facilitate the co-creation of innovative solutions that will inform programming and communication strategies for behavior change interventions.
• Draft final recommendations based on KAP results and stakeholder input.

Step 6: Final report

• Develop concise final report (not more than five pages) incorporating feedback from the program teams and documenting the KAP study process.
• Prepare manuscript summarizing lessons learned and best practices for publication.
• Provide the study data set to UNICEF Plan and M&E Section for further use and analysis.

 

Deliverables                   

Payment 1: 25%

• Inception and desk review reports featuring methodology, potential updates, and requirements for additional information that may arise, necessitating accuracy for an effective human-centered design process.

Payment 2: 35%

• Conduct workshop orientation for the numerators completed informed by presentations on the desk review assessment.          
• First draft report including preliminary findings from field work ready for sharing and presentation in a workshop with partners.          

Payment 3: 40%

• Final, validated, and approved final report with clear and actionable recommendations.        
• Final well-formulated strategy and associated implementation plan.                        

 

Duration and Duty Location

This consultancy will be completed within 4 months. The consultant will be working from home.

Selection Criteria

Applications shall be assessed based on their technical and financial proposals. Maximum scores for technical and financial applications will be 75% and 25%, respectively.

 

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

• An advanced university degree (master’s or higher) in Human Nutrition, Social and Behavior Change, Public Health, or related fields.
• At least 8 years of extensive experience in designing and implementing both quantitative and qualitative studies, including KAP studies related to SBC, health and nutrition systems and social norms.
• Experience in designing and developing research tools for qualitative and quantitative approaches such as questionnaire and interview guides.
• Expertise in research and drafting high-quality reports.
• Expertise in writing manuscript and publishing in high quality journals.
• Strong analytical and writing abilities with a track record of interpreting findings and
  providing practical recommendations.
• In-depth knowledge of Rwanda’s policies, legal frameworks, and development strategies related to child education.
• Expertise in writing manuscript and publishing in high quality journals.
• Proficient in both written and spoken English, however, Kinyarwanda will be needed for interviews including FGDs.
• Flexible and fully available throughout the consultancy period.

 

For every Child, you demonstrate… 

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

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 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:  

All candidates will receive feedback of their application.

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.