Baseline Endline SQUEAC Survey (Re – advertisement) At Concern Worldwide


Background and context

While Kenya has continually seen improvement in nutrition indicators including improvements in dietary diversity, one notable counter trend was the prevalence of wasted children. Acute malnutrition rates in northern Kenya remain poor, but too frequently remain at or above emergency levels. Rates frequently fail to improve even when households’ access to food and quality healthcare improves. USAID is funding investment to tackle persistent acute malnutrition in Kenya, recognising that this problem requires an approach that goes beyond short-term humanitarian response and must tackle the immediate and underlying causes of acute malnutrition through integrated, multi-sectoral activities that leverage ongoing emergency and development activities.

The USAID-funded Nawiri project is a five-year (2019-2024) evidence-based development program working in Isiolo and Marsabit counties in the Arid and Semi-Arid Lands (ASAL) of Kenya. The project aims to research the local drivers of persistent acute malnutrition and to design interventions that are rooted in evidence, contextually informed, and viable for implementation and scale up. Phase 1 of Nawiri entails collaborative learning & design to inform programming (2019 – 2021). Phase 2 focuses on scale up of implementation (2021-2024). The Nawiri programme is jointly implemented with County Governments (Isiolo and Marsabit) and Nawiri partners. The partners led by Catholic Relief Services (CRS) are; Concern Worldwide, Tufts University, Village Enterprise, Global Alliance for Improved Nutrition (GAIN), The Manoff Group, IBTCI and Caritas-Isiolo and Marsabit. Concern is the health and nutrition partner lead in Nawiri.

Services for the integrated management of acute malnutrition (IMAM) are provided at health facilities for children who are wasted/ suffer from acute malnutrition as part of the Kenya package of essential health services. Community Health Volunteers (CHVs) screen and refer wasted children to health facilities. IMAM Surge is an approach adopted by the Kenyan government in 2015 to help government teams at the health facility and County/ Sub-county level better anticipate, plan for, and respond to seasonal peaks in caseloads of children with wasting/ acute malnutrition.

Within the Nawiri project, Concern is leading a pilot focused on strengthening health facility and community resilience through an expanded IMAM-Surge approach. The Nawiri IMAM-Surge pilot has two components. The first will explore how IMAM Surge analysis of caseload trends at facility level can be used to inform community level actions to improve timely screening and referral and to actually prevent the seasonal spikes in acute malnutrition/ wasting among children at certain times of the year. The second component will test expanding the IMAM Surge approach to improve the management of seasonal illnesses in addition to acute malnutrition. The pilot should generate learning on the acceptability, feasibility, and added value of these two adaptations to the current IMAM Surge approach, as well as the advocacy actions needed to support their scale up. The findings will inform the final design of a context-appropriate programme to be scaled up during implementation phase to reduce the burden of malnutrition.

Objective of the consultancy

The main objective of this consultancy is to carry out a baseline (March when cases tend to peak) and endline August/September, when cases tend to go down) coverage assessment using a robust SQUEAC and/or SLEAC methodology (to be determined with the advice of the consultant) to determine the coverage of Integrated Management of Acute Management (IMAM) services within the 12 target health facility catchment areas in the Nawiri project area in Isiolo and Marsabit County that are targeted for the IMAM-Surge Community Action pilot (pilot component 2). The secondary objective is to identify barriers and boosters to accessing the program. The assessment will provide critical reference point for assessing changes in coverage across the 12 health facilities overall and to determine if any health facility catchment areas fall below the threshold for acceptable coverage (50%) at baseline and endline.


Concern is the lead partner for health and nutrition in the Nawiri consortium and is responsible for undertaking the pilot in Isiolo and Marsabit counties. The pilot aims to test the feasibility of the approach as one of the promising strategies to address malnutrition and will guide the final design for the scale up during the second phase of the project. As such, the baseline and endline coverage assessments will provide coverage information upon which change will be measured. Concern seeks the service of an experienced consultant(s) to conduct the assessment in Isiolo and Marsabit Counties.

Technical Approach and Methodology

Specific objectives

  1. To estimate coverage of services for severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) in the 12 health facilities targeted for the pilot in the two project counties.
  2. To identify factors affecting uptake of the SAM and MAM services in the target area of operation (barriers and boosters)
  3. To develop competencies and skills of technical staff (MOH and Concern/Nawiri) in the SQUEAC / SLEAC methodology through training and mentorship.
  4. In collaboration with the MOH teams in two Counties, Nawiri and other nutrition partners in the area, develop specific recommendations and a joint action plan to improve coverage of the programme, including how to use IMAM Surge thresholds to trigger increased screening and referral.

Specific tasks to be undertaken by the consultant in collaboration and support from Concern, Nawiri and County MOH;

· Survey method: In collaboration with the Concern and MoH team, determine if SLEAC or SQUEAC or a combination of the two is required to estimate baseline coverage estimates for the target health facilities with sufficient precision to detect a difference from baseline to endline, ideally at health facility catchment area or at a minimum the target area as a whole.

· Tools: Develop and review the data collection tools.

· Training: Train data collectors for the assessment. Transfer skills in undertaking a SQUEAC assessment to Concern staff, MOH staff and recruited SQUEAC data enumerators to equip them with skills to undertake a SQUEAC coverage assessment.

· Administration: Supervise the full coverage survey (survey planning, data collection and analysis, and reporting) in all the targeted areas of operation. **

· Implementation of survey: Lead in the organization and implementation of the actual survey: with support from Concern technical and MoH staff, ensure accurate data collection at field level. Ensure adequate supervision and coordination of the survey teams in the field.**

· Data processing and management; ensure accurate information is collected and analysis of all data is done with the team using all existing and new information available, and compile a comprehensive SQUEAC assessment report.

· Reporting and dissemination: provide regular/scheduled updates via power point presentations to the NITWG at different stages of the SQUEAC assessment for quality checks. During dissemination and validation workshops of the survey the consultant will present the results to the Nutrition Information Technical Working Group (NITWG) and the appropriate County Nutrition Forum.

· Action planning: In collaboration with Nawiri/Concern lead a one day workshop for MOH staff and partners working in the two counties to develop specific recommendations and a joint action plans to improve coverage of CMAM program in the target areas, considering the proposed.**

Methodology and Approach

Guided by the final SQUEAC and/or SLEAC methodology (to be determined jointly by the consultant and Concern), the coverage assessment will ensure adherence to the following three steps;

· Identification of barriers and boosters (stage 1),

· Testing the hypotheses (stage 2), and,

· Determination of coverage (stage 3).

Outputs and Deliverables

The following are the deliverables expected of this assignment

· An inception report outlining the methodology, teams and resources needed and final timeline to be followed

· Concise SQUEAC assessment report with executive summary

· Power point presentation outlining the methodology and preliminary findings for dissemination during the NITWG and County forums


The proposed consultancy will last for 30 days (including training, data collection and technical report). A proposed work schedule will be developed and agreed with the consultant. The expected time for the assessment is from April 2021.


§ Concern will pay the consultant a Facilitation per day for thirty- working (30) days. Indicate your daily rate in the proposal

§ The payment is subject to withholding tax and other requirements under the Laws of Kenya.

Working conditions

The Consultant is expected to work at the direction of Concern. Internally s/he will closely work with Concern NAWIRI team – Project Lead, Senior Advisor-Health and Nutrition, and Nutrition Technical Specialists. Externally, the Consultant will interact with other NAWIRI partners that includes Tufts University and Catholic Relief Services among other consortium members. At the county level, the consultant will liaise and engage with County Nutrition Officers/ Coordinators in Marsabit and Isiolo Counties. Further, this assessment involves interaction with Ministry of Health (MOH) and other national government departments and officials.

Essential Qualifications

· Must have extensive experience conducting CMAM coverage surveys, including SQUEAC and SLEAC and training and supervising teams on the approach.

· Consultancy firms based in Kenya ,with Solid experience in health and nutrition sector in Kenya are encouraged to apply.

Post graduate qualification in nutrition or related health science,

· At least 7 years’ experience working in the humanitarian/ development sector and conducting similar assessments.

· A strong understanding of the statistical basis for SQUEAC and SLEAC in order to guide the team on the best method to use for the needs outlined above.

· A good command of spoken and written English**

How to apply

Submission of proposals:

Responses should be submitted to [email protected], with subject line “SR87629 – Baseline Endline SQUEAC Survey”, by 4:00pm, 13th April 2021.

Note: Consultants who had previously applied for this consultancy should not re apply

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September 2023