Consultant LMIS and HMIS at Action Against Hunger | ACF-International

(REF: LC.NG.00053)
Terms of Reference;
Consultant in Nigeria

Reference: ACF USA – LMIS and HIMS

Language: English

CONTRACT DETAILS
Key dates of the consultancy

Planned starting date:

1st Dec 2016

Language of the consultancy

Required language for the consultancy:

English

Language of the report:

English
Back ground context
ACF has been operating in North Eastern Nigeria since 2010 supporting a number of development and humanitarian initiatives; employing a multi sectoral approach to addressing issues of maternal and child malnutrition, and food livelihood security.

There two major strands to addressing issues of child malnutrition: treatment of SAM and management of MAM children at the established SC and OTP sites; and training plus sensitization on recommended IYCF practices using Mother to Mother (MtM) support group model. Currently there 62 OTP and 04 SC sites spread across the six LGAs of Damaturu, Fune, Potiskum, Fika, Machina and Yunusari; and 397 MtM support groups – comprised of volunteer women of child bearing age group supported by AAH.

Building on existing capacities and national guidelines, the treatment component of the project aims to create commitment from local authorities to maintain quality CMAM services beyond the project period through capacity building, system strengthening, and integration into existing primary health care system plus advocacy.

AAH is currently implementing a wide range of projects (WINNN, Integrated Assistance for Persons Affected by the insecurity Situation, and Integrated Basic Nutrition Response to the Humanitarian Crisis) all funded by DFID and ECHO. The project aims to supports treatment and prevention of severely acute malnourished (SAM) U5 children via Community Management of Acute Malnutrition (CMAM) and Infant and Young Child Feeding (IYCF) practices. A number of trainings of Health Workers (HWs) and Community Volunteers (CVs) on CMAM and IYCF; and LGA, State MOH and SPHCMB officials on various aspects of health nutrition Management have been undertaken.

In addition, and as part of the minimum WASH in nutrition strategy implementation, WASH interventions are integrated into the nutrition interventions to avoid any cases of relapses attributed to poor hygiene and sanitation practices. Some of the WASH interventions include rehabilitation of WASH infrastructure at Health Facilities (HFs) and provision of hygiene kits to reduce treatment duration and relapses. All these interventions are delivered as an integrated package.

Previous initiatives on the HMIS and LMIS by ACF

Cognizant of the need to prudently manage nutrition data and supply of other nutrition essentials like RUFT and essential drugs; in the initial phase of the programme, ACF was hands-on supporting LGA staff at HF level collect and compile weekly and monthly data on the management of nutritional supplies and tracking OTP beneficiaries. ACF also actively involved in the supply chain management of the RUTF; ordering supplies to transporting the RUTF - from the State central level warehouse to LGAs and HFs, albeit on an ad hoc basis with little planning from the HF. It was then observed that it is essential for the State and LGA to take over the responsibility of these initiatives.

Thus, ACF in collaboration with the SMoH placed much effort to support the establishment of a system for nutrition related data collection and management. Trainings were conducted with the State Nutritionist and LGA NFP’s together with Health workers in the respective HFs. At LGA and State level, computers were procured and given to health facilities and SPHCMB; and basic computer trainings administered with the State Nutritionist and the LGA NFPs. On job mentoring and support was also given.

Since then, the State (at all levels) took an increased role in management of CMAM data, ordering and management of nutrition supplies. As a result of the above initiatives, there is some improvement at HFs, LGAs and the SPHCMB to manage nutrition data and RUTF supplies. Although the RUTF and other supplies are not delivered in a timely manner, however, there is a feeling of ownership by Health workers in general. Nutrition and other related data is collected monthly by HF staffs and shared with LGA NFPs during monthly coordination meetings. This data is then compiled by the NFP at the LGA and shared with the State Nutrition Officer (SNO).

Similarly, the in-charge at the HF is responsible for ordering the RUTF on a monthly basis and this is not released until the monthly report is received at the LGA.

Under the current nutrition projects funding initiatives, an assessment of HMIS and LMIS in the broader context of nutrition interventions is earmarked to gain more insights into, and identify any challenges and opportunities for delivering quality nutrition services in the LGAs and State at large.
Rationale for the assessment

According to WHO, Health Management Information Systems (HMIS) and its associated logistical requirements are one of the key six building blocks essential for health system strengthening. HMIS is a data collection system designed to support planning, management, and decision making in any effective health service delivery system. In essence, all information generated by design and implementation of health information systems must be action oriented - to serve the process of action taking at all levels: within communities, for case management, at HF for health unit management, for the LGA management, for State level health management, and for policy and planning at higher levels of the health system.

However, in Yobe State, there still gaps in ensuring consistency and timeliness in data collection and management, plus sharing with key stakeholders at various levels. Management of nutrition supplies (like RUTF, essential medicines etc.) is still very weak and adhoc in a manner - with frequent stock outs of essential nutrition supplies. Coupled to this, some nutrition indicators at SMoH and SPHCMB are not harmonized. All these issues need to be addressed without which timely delivery of quality nutrition health services will still be a challenge.

Objectives of assessment:
The objective of the assessment is to analyze and identify gaps and opportunities for improving HMIS and LMIS at all level of primary health service delivery; at the community, HF, LGA and state levels.

The assessment will help highlight areas of focus to improve quality of data collected and subsequent information available for decision making across all health system building block on selected health nutrition indicators of HMIS performance.
Specific objectives.

• To conduct an assessment of HMIS and LMIS to identify the challenges in logistic system stock keeping, consumption records, and supplies projections based on the needs at health facilities level.
• Identify capacity gaps for training support at various levels of primary health care delivery – especially nutrition services.
• ACF aims to improve the State and LGA's ability to provide for, evaluate and report on the CMAM delivery by conducting a Health system strengthening analysis on Health Information Management and Health Logistics Information Management Systems (HIMS & HLMIS), developing a plan to improve data quality and management of essential nutrient supplies.

Scope and Duration of the Assessment
The assessment will be conducted in randomly selected health facilities – at least 1-2 from each of the 9 implementing local Government area of (Damaturu, Fune, Potiskum, Fika, Machina, Yunusari, Tarmuwa, Nangere and Gujba). The assessment will broadly look at the HMIS and LMIS at various levels of the State health service delivery system with a focus on primary health care service delivery.

Key informant interviews will be conducted by a lead consultant supported by AHH staff in collaboration with the nutrition teams in the respective LGAs. Key informant interviews will be conducted in selected health facilities, LGA NFP person and Director SPHCMB or his designate using a structured questionnaire. Observation methods will also be employed to gather real time information/status of HMIS and LMIS at the health facilities, LGA and possibly at SMoH.

The assessment (actual field data collection) is expected to take a minimum of 10 working days (1st to 10th Dec) of December 2016. The consultant is expected to share draft report 5 days after completing data collection - by end of December for input and final consideration.

Methodology for data collection by Source and nature of data

Nature of Data

• Sources of Data (Primary)
• Secondary

Quantitative

• Review LGA and Health Facility Inventories
• Baseline Surveys and assessments
• Routine Monitoring data
• Nutrition Information System

Qualitative
Direct Observation

In-depth individual interviews &

Consultative meetings

• Based on the LIMS Policy and Program track the flow of supplies based on a pull mechanism
• Other development partners’ documents e.g. UNICEF, WHO,
• FMoH and State MoH reports
• Triangulations
• Mix of qualitative and quantitative data findings at state level
• Review of SMoH and SPHCMB nutrition indicators

 Key tasks and expected outcomes:

• Conduct desk review of reports, HMIS and LMIS data
• Come up with a detailed plan, with clear tools for assessment with a realistically itemised budget in NGN
• Conduct comprehensive capacity assessment of HMIS and LMIS at HF, LGA, SPHCMB and State levels
• Review the nutritional health indicators at all levels – from HF to MoS levels for consistency and completeness
• Identify clear gaps and opportunities (human and otherwise) for improving HMIS and LMIS especially in the delivery of nutrition health services at the HF, LGA, SPHCMB and State levels.
• Make reasonable but concrete recommendations for capacity building support for improved HMIS and LMIS at HF, LGA, SPHCMB and state levels
• For HMIS, the following issues can be further interrogated:
• Given the benefits of a community based nutrition health information system, how can it effectively be linked to the facility-based routine health information system?

Some HMIS aspects to probe:

• How can patient/client data recording and reconciling be improved at all levels in order to help care providers to monitor and maintain the quality of the nutrition services?
• What innovative structural interventions can be proposed to better link routine service statistics with other non-routine data collection systems (surveys, vital events registration, rapid assessments methods, etc?)
• In the current hierarchical vertical transmission systems; how can the speed of data transfer be improved?
• What is the most efficient way to provide feedback to lower levels in systems where data is compiled at higher levels?
• To assess an LMIS, it’s important to understand the logistics system it serves; i.e, one cannot evaluate the reporting feedback loop without knowing whether the distribution system is a “push” or a “pull” system.
• Other elements of the logistics system that may be essential to understanding the LMIS include:—
• Sources of supplies and products distributed; number of levels in the supply system.
• Number and types of facilities at each level and nature of service delivery points—clinic, community-based distribution (CBD), and others.
• Storage capacities, constraints and type of inventory control system in place; maximum and minimum stock levels; periodicity of orders and deliveries including lead times.
• Transport modes/mechanisms (how products are moved from State to LGA and to HF levels, or between health facilities); including management/supervision structure of the distribution system.
• At minimum, there is a need to determine:—
• If the nutrition LMIS is integrated with LMIS for other primary health care supplies?
• How is the reporting cycle supposed to work for nutrition related data (reporting interval, data flow, levels at which data is aggregated)?
• Who is supposed to be responsible for collecting, reporting, and processing the data? Who is supposed to be responsible for overseeing these activities?
• Is the commodity re-ordering, consumption records and data reporting systems the same or different (i.e. are people who collect, report, and process LMIS data the same staff who actually order and issue supplies)?
• What logistics management decisions are supposed to be made with the nutrition LMIS data, and who is supposed to make them? How often and when are these decisions supposed to be made? Etc etc.

Qualifications of the consultant Resource person to lead this exercise should have the following minimum qualifications:

• Masters level degree in a relevant field such as public health, public administration, health administration, demography, statistics, computing, epidemiology, etc.
• Good understanding with demonstrable country context experience, in facilitation of health information system strengthening, including central level coordination and systems integration, and sub-national strengthening for quality collection, analysis, dissemination, and use of health information;
• At least 5 years “hands on experience” in HMIS, LMIS, data quality assessments and related areas, with a health or related international NGO or bilateral/multilateral organization
• Practical experience in the development and operations of robust Health Information Systems, and specific knowledge of and experience with DHIS 2.0;
• Superior analytical skills including quantitative research activities in terms of planning, implementation and data analysis;
• Good interpersonal and people management skills and demonstrated ability to work effectively and harmoniously with other project staff.
• He/she should be aware of Nigeria Federal Ministry of Health minimum standards/ protocols for primary health service delivery
• Experience of working in Northern Eastern Nigeria and cultural awareness of Yobe State.
• Evidence of similar work done (to be submitted with the proposal/application).
• Working Knowledge of the Hausa Language for full explanation of various aspects being interrogated in the assessment.
• Superior knowledge management, communications, report writing and presentation

CONDITIONS

• To have an insurance policy, and details of the coverage to be shared with ACF before departure.
• The consultant is responsible for ensuring he/she has a valid visa before entering NIGERIA:
• The consultant is responsible for acquiring and paying for their entry visa(s) to NIGERIA prior to arrival. The cost of the visa(s) will be reimbursed by ACF NIGERIA, upon presentation of receipt(s). An invitation letter will be provided and paid for by ACF NIGERIA to assist the consultant in acquiring the entry visa. Be aware the NIGERIA visa process can be long and requests anticipation
• If there is no NIGERIA Embassy in the consultant’s country of residence, the mission will be responsible for acquiring and paying for the entry visa (visa volant). The process for acquiring a visa volant is complicated and time consuming.
• His or her own computer.
• The Consultant is responsible for any and all administrative costs that do not derive from ACF’s responsibility (for example: passport renewal, photos, penalties or administrative fees related to prior stays in NIGERIA, among others.)
• The Consultant is responsible to cover the costs of his or her food during the stay in NIGERIA. If meals are taken at the ACF guesthouses, then the Consultant will have to reimburse ACF based on the daily rate for the corresponding ACF base.
• The accommodation in NIGERIA will be provided for and covered by ACF. Transport in NIGERIA and the other costs directly related to the consultancy (daily workers, local translator, etc.) will be covered by ACF

RIGHTS
The ownership of the draft and final documentation belong to the agency and the funding donor exclusively. The document, or publication related to it, will not be shared with anybody except ACF before the delivery by ACF of the final document to the donor.

ACF is to be the main addressee of the evaluation and its results might impact on both operational and technical strategies. This being said, ACF is likely to share the results of the evaluation with the following groups:

Donor(s)
Governmental partners

Various co-ordination bodies

Intellectual Property Rights

All documentation related to the Assignment (whether or not in the course of the consultant’s duties) shall remain the sole and exclusive property of ACF.