The Evidence and Guidance Note on the Use of Cash and Voucher Assistance (CVA) for Nutrition Outcomes in Emergencies (2020) produced by the Global Nutrition Cluster outlines five approaches for using CVA to contribute to nutrition outcomes, two of which focus on the management of acute malnutrition/ wasting in children: 1) Provide CVA to facilitate access to treatment for [acute] malnutrition (e.g. transport and opportunity costs) and 2) Provide household CVA to caregivers of children with severe wasting/ severe acute malnutrition (SAM) (e.g. to improve treatment outcomes and reduce relapse by protecting nutritional status).
The guidance note also highlights the limited evidence on using CVA to overcome financial barriers to accessing SAM treatment (e.g. cost of transport and meals during inpatient stays) and how cash assistance can be combined with SAM treatment without causing unintended consequences (e.g. providing an incentive to keep children malnourished in order to access CVA).
CVA is widely recognized as having a valuable role in the prevention of malnutrition, especially when it is combined with deliberate actions to improve access to nutritious foods and essential services and promote the uptake of feeding and caring practices essential for good nutrition. While the potential role of CVA to specifically support the management of wasting is less clear/ well documented, there is strong and growing interest in its potential to do so. This is particularly the case in humanitarian contexts where cash programming continues to expand, the prevalence of wasting is often high, and there is a simultaneous need for wasting treatment and prevention.
The Nutrition and Cash and Voucher Assistance GTWG, within the Global Nutrition Cluster, has within its 2024 priorities, building evidence on the use of CVA to support the management of wasting.
The purpose of this consultancy is to identify and synthesize evidence, experiences, emerging and promising practices, potential risks, and relevant tools in the use of Cash and Voucher Assistance (CVA) for the management and treatment of SAM. It will also provide practical recommendations and considerations for designing and implementing programs aimed at supporting the management of SAM using CVA.
The consultant(s) will be closely collaborating with and reporting to the CVA GTWG, within the Global Nutrition Cluster.
Purpose of consultancy
The purpose of the consultancy is to identify and synthesise evidence, experience, emerging and promising practices, potential risks and relevant tools in the use of CVA for the management/ treatment of SAM and provide practical recommendations and considerations for the design and implementation of programmes aiming to support the management of SAM using CVA. The GTWG foresees three broad areas for review, subject to adaptation with the consultant:
1. Improving adherence to inpatient transfer and treatment for SAM cases with complications by providing CVA
2. Improving treatment outcomes (i.e. increasing recovery rate) for children admitted to services for the outpatient treatment of SAM or management of MAM
3. Sustaining recovery (i.e. reducing relapse) among children who were in treatment for SAM or targeted supplementary feeding for MAM
Specific objectives
Objective 1. Synthesise the latest evidence on CVA for management of wasting via a review of published literature. This may include some review of evidence for CVA to support related outcomes, such as improved access to child or maternal health services, which use similar mechanisms.
▪ Suggested methodology: desk review, including findings from the AAH scoping review on MAM.
Objective 2. Gather and synthesise experience, emerging and promising practices, identified risks and related tools from practitioners using CVA for the management of wasting. Ideally, these will be synthesised under the three broad intervention types above (or alternative typology if supported by what is emerging) and a pathway to expected impact provided for each. It should also include programmes along the spectrum from the more standalone to those fully integrated with health, nutrition, food security or other interventions.
▪ Suggested methodology: document review and interviews or group discussions, predominantly with practitioners/ implementers in countries with a high wasting burden, significant experience in CVA and nutrition response and current or recent emergency response. Inputs from other technical experts from different levels of government, NGOs, UN agencies and donors should also be gathered, but efforts should focus on capturing the practical perspectives of implementers. An online questionnaire may also be used. Again, the consultant should first take into consideration findings from the AAH review on MAM.
Objective 3. Provide recommendations and key considerations for designing and implementing programmes using CVA to improve the management of wasting. This should include any associated risks and how to assess and mitigate them; in what contexts CVA for nutrition is most appropriate; approaches to setting transfer aspects (values, duration, frequency); targeting criteria and approaches; timing and mechanisms for CVA delivery; the most common and effective complementary activities to deliver with the CVA; and key indicators and tools to monitor and evaluate outcomes. Recommendations and key considerations should be presented in the context of other strategies that may be more effective/ cost-effective and sustainable in improving access to and outcomes of wasting services, such as expanding the reach of or support to existing health services.
▪ Suggested methodology: synthesis from desk review and methodology and one participatory workshop (virtual or hybrid if feasible) to refine and agree the final recommendations.
Specific tasks to be undertaken
- Tasks Inception report
- Feedback incorporated into inception report
- Desk review of literature (linked to ACF literature review)
- Identify stakeholders, conduct interviews / group discussions with practitioners and other key actors; online questionnaire; map experience
- Draft final report
- Workshop to present/ refine key considerations
- Integrate feedback on report from GTWG and finalise report
- Webinar (1 hour) to present findings to GTWG & other stakeholders
Expected outputs
- Brief inception report
- A summary of existing evidence (based on literature review) on the use of CVA for management of wasting – ideally with a more visual summary for ease of understanding (not more than 8 pages).
- An updated map/ list of programmes/ interventions (including in a research setting) where CVA to manage wasting has been used, building on the matrix developed by KAC for the learning brief on CVA for Nutrition in Emergencies: A Summary of Challenges and Promising Practices (to be provide by GTWG). This should include details on location, approach, implementing partners and link to any documentation.
- A workshop with key stakeholders conducted
- A final report with: ⁻ A summary of experience, potential risks and emerging/ promising practices, grouped by intervention type (see 3 broad categories above); key learning and considerations; and a compendium of existing tools and useful tools from practitioners using CVA for the management of wasting; ⁻ A set of recommendations and considerations and tips regarding if, when and how CVA may be an appropriate intervention to support the management of wasting; essential design elements, potential risks and how to assess and mitigate them; and knowledge/ evidence gaps for future research and piloting.
- A webinar sharing the recommendations and case studies emerging from the review.
Timeline
The consultancy is expected to take place between October 31st 2024 and February 28th 2025.
Essential and desirable experience/ qualifications
Essential
- At least 5 years of experience working in CVA or management of wasting in low-income countries in emergencies and at least 1 year working in the other sector (i.e. CVA or management of wasting). A team of individuals covering these skills is also welcome.
- Demonstrated ability to lead a synthesis such as described above, including summarising participatory interviews and workshops on CVA and/or wasting management (e.g. experience in programme evaluations, development of learning briefs or case studies)
- Experience conducting interviews effectively in English and French
- Ability to write in English (and at least read French)
- Willingness to travel to at least one country with a high density of CVA for management of wasting interventions for up to two weeks.
- Ability to provide regular updates to the GTWG co-chairs and keep to agreed timelines
- Ability to work collaboratively and respectively with stakeholders and the appointed consultancy managers from the GTWG (likely the co-chairs)
- Knowledge of and experience working with the Cluster systems and Cash Working Groups
Desirable
- Experience working on CVA to support the management of wasting
- Ability to communicate well in other languages (e.g. Arabic).
For the detailed ToR see here.
How to apply
Please submit your application by email to both, [email protected] and [email protected] by 20th of October 2024.
Title the email “Application for consultancy: CVA to support the management of wasting” –
In the email please provide:
● A technical proposal with a summary of the approach to be used, including a workplan and the number of days overall and for each task listed above.
● A financial proposal in line with the technical proposal.
● CVs of the individual or team members
● Cover letter indicating how you/your team match essential and desirable qualifications as specified in the ToR.
Only selected candidates will be contacted.