1.

Background


The province of Masbate belongs to Region 5 (Bicol) and consists of 3 major islands and 21
barangays: the Mainland Masbate- with 15 municipalities; Ticao Island with 4 municipalities- in
the northeast side of the mainland, and Burias Island with 2 municipalities in the northwestern
side. It is one of the 10 poorest provinces since 1997 with a poverty incidence of 42.5% (NSCB
2009) and 44.2% (NSCB 2012) respectively. Four (4) municipalities having the poorest socio-
economic indicators were pre-selected for this project, namely: Aroroy, Cawayan, Milagros and
Monreal which are also UNICEF areas for its country program and sites for MYCNSIA (Maternal
and Young Child Nutrition Security Initiative in Asia).

In 2012, FNRI conducted an EU/UNICEF-funded baseline data called MYCNSIA at the
regional and provincial levels of Regions 5, 6 and 9. For Masbate, the result showed an
increasing underweight prevalence rate after the age of 6 months and up, that is even worst at
the age between 24-35 months. Chronic malnutrition in this province is higher than the national
average (35.6% vs. 29.4%) and considered as high magnitude or serious as per WHO
standard. Anemia is also very severe (50.2%). IYCF Practices in Masbate is also low (Early
Initiation of Breastfeeding (BF)= 50.8% as only 48 % of mothers are aware of EBF; continued
BF and beyond is < 50%) with bottle feeding for 0-23 months at 30.2%. Although children 6-23
months consume 7 food varieties, only 19% meets the MDDS

and the minimum acceptable diet.
Only 35.7% of mothers have knowledge that complementary feeding will be given at 6 months.
Vit. A supplementation and measles vaccination coverage are high but those who receive
deworming are only 58.2%.

On the other hand, WASH indicators are also low. Though, maternal knowledge that
diarrhea is caused by poor hygiene practices is high (85.7%) with 98% of HH having designated
washing areas, surprisingly only 28.1% wash their hands before preparing food and 24.9%
washes hands after using the toilet. More than half of the households dont have toilet facilities.
This project wants to look at the relationship of Water, Sanitation and Hygiene, Health and
Nutritional status of each Municipality to the prevalence of acute and chronic undernutrition. It
will include the following surveys the Nutritional Causal Analysis (NCA) and Soil-Transmitted
Helminthiasis (Intestinal Parasitism) and Anemia study under University of the Philippines
National Institute for Health

Nutrition Causal Analysis
(NCA) Study Lead
MASBATE, PHILIPPINES

Terms of Reference
It is anticipated that the information obtained from the NCA will be used in the development
of WASH and nutrition sensitive and context specific interventions for Masbate and other
stakeholders in the area, as well as provide an opportunity for testing and adapting the
methodology to Philippine context. There is therefore a high interest by the stakeholders to
further understand the root causes of malnutrition so as to be able to develop tailor made
programs to reduce stunting also. The core objective of a Nutrition Causal Analysis (NCA) study
is to understand the risk factors of under-nutrition and their interplay with nutrition outcomes for
a given study population. Compared to KAP and SMART surveys, NCA provides a more holistic
view on the dynamics of wasting. It looks at the severity of under nutrition based on various
issues such as time and seasonality and provides a ranking of the causes of malnutrition.



2. Main Objective

The main objective of the consultant will be to complete an NCA study in Masbate,
Philippines with the UP Study Group and communicate the findings.



3. Specific Objectives
The consultants specific objectives will be:
To lead and implement the ACF-developed methodology for a Nutrition Causal
Analysis (NCA) in Masbate, Philippines with the UP local study group
To train and capacitate the UP study group on NCA Methodology
To facilitate the entire NCA process (including data collection, analysis and
interpretation) with the local group
To write the NCA preliminary and final report and present findings to
stakeholders with the UP study group
To share final study findings at relevant forums in the province of Masbate to
include the county forum, WASH information working group and the WASH-
nutrition technical forum.
To coordinate across the various stakeholders in the relevant sectors in Masbate,
Philippines



Specific Survey Objectives will include the following:
To identify main causes of wasting and stunting in order to inform the technical
strategy and programs (WASH and Nutrition) for the prevention of the same at a
local level
To understand the local seasonal and historical pathways to wasting and stunting
To support technical advocacy on causes of wasting and stunting so as to plan
technical strategy especially in WASH

The study proposes to answer the following specific questions:
a. What is the prevalence and severity of wasting and stunting in the selected
Municipalities of Masbate?
b. Does the prevalence and severity of wasting and stunting in the selected areas vary
geographically or by characteristics such as WASH practices, livelihood, religion, clan or
any other relevant characteristics identified during the inception stakeholder workshop
c. What is the prevalence of known risk factors for under nutrition amongst the
population in the 4 municipalities?
d. What are the causal 'pathways of malnourishment by which children in become
wasted and stunted?
e. How has wasting and stunting amongst children less than five years of age and its
causes changed a) over time due to historical trends, b) seasonally due to cyclical trends, c)
due to recent shocks if any?
f. Which risk factors are most prevalent in this population? Which sets of risk factors and
pathways are likely to be the most modifiable by stakeholders within a given context? What
type of action can be taken in response to these findings?
g. To what extent does the study produce plausible results?
h. What are the operational issues related to the study in Masbate to include cost, timing
and expertise required in the event of final adoption of methodology by the sector

4. Methodology
The consultant will be expected to work closely with the ACF technical team, and the UP
Study Group in the development and implementation of the Nutrition Causal Analysis in
Masbate.
An update on progress shall be provided to the ACF technical group on weekly basis by
the lead consultant. This will be in close liaison with the UP group.
The consultant with the local UP Study group will use a primarily qualitative approach
based on standard ACF guidelines for Nutrition Causal Analysis, to assess the probable
causes of malnutrition as well as causal pathways of malnourishment by which certain
children in this population become wasted and stunted. Secondary data review, key
informant interviews, focus group discussions and an interative analytical process
based on consultations with key stakeholders will form the backbone of the NCA
process.
The qualitative inquiry will therefore be used to develop a local definition and
understanding of undernutrition; characterize food security, WASH practices, knowledge
and attitude, health and care practice in the community and explore local perceptions of the
causes of poor food security, heath and care; identify seasonal and historical trends and
understand how the community prioritizes risk factors related to undernutrition. This inquiry
will eventually be used to determine key risk factors, which of these are modifiable by
stakeholders and eventually determine suitable response.

The Nutrition Causal Analysis study in Masbate shall be carried out in the following phases:
(Subject to change as agreed by the NCA Consultant and UP Study group)

1. To conduct initial preparatory work for a Nutrition Causal Analysis (NCA)
Ensure adequate background information regarding possible causes is collected
and analyzed to draft malnutrition causes hypothesis.
Hold preliminary discussion with UP Study group and other key stakeholders at
the national and/or county offices so as to finalize NCA strategy

2. To facilitate data collection and field research
Develop and pre-test discussion guides and other survey instruments for the
qualitative inquiry
Establish key quality assurance mechanisms at sampling, instrument
development, recruitment and training as well primary data collection and
analysis stages
Ensure timeframe, planning, sampling plan, logistics and HR means as well as
necessary material are adequate and available.
Conduct fieldwork and ensure key quality assurance mechanisms are
implemented throughout

3. To facilitate data analysis and interpretation, write the NCA preliminary and final
report and communicate results
Ensure appropriate coding and entry of all collected data, check the quality of the
data entered in the software and clean the database
Analyze the collected data and compare/link data with results from previous
studies from include nutrition surveys, surveillance, coverage assessments and
KAP results
Rank causal pathways by order of importance
Present and validate results in collaboration with key stakeholders in a final
workshop at the provincial , regional, national and/or county levels
Write a preliminary report with summary of methodology, results and
recommendations
Write a final report, including methodology, results, analysis of results, conclusion
and recommendations
Facilitate a presentation/debriefing for ACF on capital level with the coordination
team, as well as in the WASH and other cluster meetings.
Share findings with participating communities
Record any suggestions and inputs on the ACF NCA methodology for further
improvement of the methodology and its finalization




4. Timeframe

The duration of this consultancy is four (4) months.

The final calendar is subject to changes.
Months
Main Technical Step Actual Activity 1 2 3 4
Clear design of the
Nutrition Causal Analysis

Preparation of TOR and JD of
consultant and recruitment

X

Preliminary workshop with stakeholders
on the proposed study to buy in ideas on
what their needs are for final proposal draft

X

Gathering and review of all relevant
secondary data

X

Clearly defining the objectives of NCA in
each of the proposed sites; Clearly
prioritize study outcomes in Masbate ;
study population, methodology and timing

X

Identifying causal
hypothesis at stake

Fine tuning and study of secondary
literature available from SMART surveys,
KAP, coverage assessments, surveillance
among others to get a good understanding
of local context



X

Technical meeting and workshop to
review and validate hypothesis with UP
Study group and ACF technical team


X

Gradual development of study
instruments
X
Preparation for actual field study X
Gathering evidence of
causality

Recruitment of survey teams as well as
further mobilization at county level

X

X

Pretesting and validation study
instruments
X X
Training of data collection team X
Primary data collection X
Participatory ranking of
hypothesis

Analysis of data gathered and ranking
of hypothesis

X

Final stakeholder workshops at national
and county levels; agreement on priority
causal pathways
X
Presentation of preliminary results at
the study site
X
Validation of results

Internal validation of survey findings
(ACF HQ)
X
Presentation of findings and validation
at NIWG and NTF
X
Report writing, validation and debrief
workshop/dissemination
X
Documentation of process and case
study in Kenya
X

5. Expected Outputs

Report: A comprehensive report in English detailing the study background, objectives,
methodology, results, conclusions/recommendations and key annexes will be drafted. The
report structure will be developed and agreed prior to drafting the contents. Documentation
of the study process should form part of this.

Presentation: A presentation of the key findings and recommendations to UNICEF, alliance
and a larger group of stakeholders will be carried out by the study consultant and the group.


6. Consultancy Cost and Logistics Support/Arrangements

The consultant shall manage, responsible and consider in his/her consultancy cost offer the
following:
- Health insurance and travel insurance
- International transportation from Madrid to Philippines and vice versa including
accommodation in Madrid when needed
- Application for entry visas
- Laptop and other equipment needed to facilitate the job.
- Per diem or meal allowance

Philippine Mission will be responsible for all the logistics arrangements when the consultant
arrives in the mission for the following:
- Local transports for all official movements
- Hotel accommodations in Masbate and Manila for the entire duration
- Communication costs
- Facilitate application of domestic visas however administrative cost shall be
reimbursed by the consultant

7. Consultant profile
Min. bachelors degree in anthropology, nutrition or social sciences;
Previous experience and demonstrated skills in applied research in particular
qualitative research, writing and analytical skills
Broad knowledge and experience of nutrition specific and nutrition sensitive
principles and programming
Excellent communication and interpersonal skills
Familiarity with ACF and acceptance of ACF principles
Mastering fundamentals concepts of Nutrition, the prevention and detection of
acute malnutrition
Mastering Nutrition Causal conceptual framework
Complementary skills in Anthropology and Community based approach
Knowledge of NCA methodology developed by ACF
Mastering SMART methodology for nutrition surveys
Mastering data management and data analysis software - ENA, EPIDATA or
SPSS


8. Budget

The maximum budget available for this consultancy is 14.870 Euros.
Nevertheless, the competitiveness criterion, in addition of others criterions, will be
considered among the consultant selection.