Somalia continues to grapple with one of the most complex and enduring humanitarian crises worldwide. Successive episodes of severe drought and flooding, escalating conflict, the worst locust infestation in decades, and the emergence of the COVID-19 pandemic have contributed to unprecedented humanitarian requirements. The ongoing pattern of increased displacement further compounds the difficulties, placing an extra strain on the approximately 3.9 million individuals already enduring prolonged displacement.
In Jubaland state, especially in Lower Juba, there has been an influx of internally displaced persons (IDPs) from neighboring regions, notably southwest state, and surrounding districts, driven by violent conflict and severe drought and flooding. This influx has intensified competition for essential services among the affected population and host communities, exacerbating living conditions. The ongoing crises in Somalia as occasioned by successive rain failures, erratic rains, floods, and conflicts have caused an increase in displacement, malnutrition, and preventable diseases such as Cholera/Acute Watery Diarrhea (AWD). Recent clashes and El Nino related flooding have forced thousands of women and children to seek food and medical support in Kismayo and other few secure towns.
According to the country-wide analysis of Acute Malnutrition under the Integrated Food Security Phase Classification (IPC) conducted in August 2023 Somalia is facing a severe burden of acute malnutrition, with an estimated 1.7 million children affected, including 430,000 severely malnourished and 1.23M moderately malnourished children, expected in 2024.
Approximately 4 million people across Somalia are experiencing high levels of acute food insecurity (IPC Phase 3 or above) between January and March 2024. Of these, 3.2 million people (17 percent of the population) are in IPC AFI Phase 3 (Crisis), and around 800,000 people (4 percent of the population) are experiencing worse conditions in IPC AFI Phase 4 (Emergency).
According to the Humanitarian Response Plan (HRP) for 2024, critical nutrition services are needed, including the treatment of children with severe acute malnutrition (SAM), supplementary feeding for children with moderate acute malnutrition (MAM), and pregnant and lactating women, along with micronutrient supplementation and interventions for infant and young children feeding. Additionally, ongoing conflict and the resulting loss of livelihoods due to recent Deyr (Oct-Dec 2023) flooding continues to impact food security in the Lower Juba region, particularly in Kismayo and Afmadow Districts.
In Jubaland State, 233,240 children under the age of five are grappling with acute malnutrition, with nearly 59,380 at risk of severe malnourishment. Stunting among children under 5 in Jubaland state is prevalent at 28.1%. Malnutrition rates among these children are 33.7%, with a 16.3% prevalence of wasting. Poor infant and young child feeding practices are evident, including low dietary diversity (5%), sub-optimal breastfeeding rates (76%), and a limited number of children being breastfed up to 2 years (30%).(JHDS, 2021) The World Food Programme (WFP) identifies Gedo and Lower Juba, regions within Jubbaland, as having the highest levels of insufficient food consumption. In Gedo,22% of the population, and in Lower Juba, 19%, are facing Crisis (IPC 3) and Emergency (IPC 4) food consumption gaps between January and March 2024 (IPC Somalia, 2024). Failed cereal harvests and global price shocks due to the Ukraine conflict have pushed staple and imported food prices beyond the means of millions of households already spending 60-80% of their income on food.
In addition to the Health and Nutrition challenges, internally displaced women and girls in Lower Juba face heightened risk of different forms of gender-based violence (GBV) including domestic violence, sexual violence and exploitation, female genital mutilation (FGM), and early or forced marriage.
CARE is a humanitarian non-governmental organization committed to working with poor women, men, boys, girls, communities, and institutions to significantly impact the underlying causes of poverty. In Jubaland, CARE programs are providing life-saving support to women and children through the provision of Healthcare, Nutrition, Protection, Sanitation and safe drinking water for both Human and livestock use, and Food security/ livelihood support (mainly Cash and Voucher Assistance).
Through MOFA Luxembourg funding projects, CARE aims to save lives, alleviate suffering, and maintain human dignity through gender-responsive health, nutrition and protection interventions for crisis-affected women, men, boys, and girls in Somalia. The Kismayo Health and Nutrition Project (KHNP) for integrated health and nutrition, in Kismayo, Lower Juba Region, Somalia, is a 1-year CARE in Luxemburg / MOFA -funded project running from 1st June 2023 to 30th July 2024. The project is implemented by CARE, which plays an overall leadership role and implements field activities. This project is in line with CARE’s overall strategic objective for Somalia which includes a long-term commitment to communities and integrated programming where projects contribute to much wider programmatic objectives aimed at addressing the underlying causes of poor health and malnutrition, as well as addressing the new emerging humanitarian crises. This project responds to the grave humanitarian situation among crisis -affected people in Kismayo District, targeting the Internally Displaced Persons (IDP), returnees, and vulnerable host communities by providing multisectoral interventions in Health, Nutritional, and Protection intervention support for acutely malnourished children and pregnant and lactating women.
The interventions provide basic emergency health and nutrition, and protection services including treatment of severe and moderate acute malnutrition, health and hygiene promotion, and protection support to children under 5 and PLWs, and support social behaviors change (SBC) on Infant and young child feeding in an emergency (IYCF-E) practice. Other interventions are the treatment for common communicable and non-communicable ailments Immunization, micronutrient supplementation, antenatal care, skilled birth attendance, postnatal care and integrated risk communication & community engagement (RCCE) and referral services for common communicable diseases. A Gender Desk facilitates access to safe, confidential survivor centred medical and non-medical GBV services.
Life-saving nutrition services through the CMAM approach are core to the project’s design, the components of CMAM being community outreach and mobilization; management of SAM without medical complications through outpatient therapeutic programs (OTP); inpatient management of SAM with medical complications at stabilization centres (SC); and outpatient targeted supplementary feeding programs (TSFP) to manage MAM. The project teams work through community-based approaches to raise awareness of good nutrition practices (particularly infant and young child feeding (IYCF)) and early referral to nutrition services, given their importance for the prevention of malnutrition, and reducing risk of associated mortality and adverse developmental outcomes.
The ongoing interventions seek to meet the immediate needs of the most vulnerable girls, boys, and women in the new Kismayo IDP in Kismayo town. The Project will prioritize the management of Acute Malnutrition (MAM) and Infant and Young Child Feeding (IYCF) practices. The project targets reaching the following with lifesaving assistance:
Project objective: To improve Health and Nutrition status amongst children under 5 and pregnant and lactating women through the provision of quality Health and Nutrition services and contribute to the reduction of maternal and childhood morbidity and mortality.
Objectives of the Project Endline Evaluation
The primary aim of the endline evaluation is to evaluate and establish dependable concluding data regarding the project's performance through predefined parameters across its three components: Health and Nutrition, and Protection. The evaluation report will pinpoint best practices and essential insights in both technical aspects and the program management approach, facilitate continuous learning and enhance the effectiveness of humanitarian emergency response. The outcomes of this concluding assessment will be incorporated in future programs and will also be communicated to donor CARE Luxemburg and Luxembourg MoFA Specific objectives include:
Evaluation Questions
Evaluation Criteria
The evaluation will be done in line with OECD-DAC recommended criteria based on the three criteria – effectiveness, sustainability, and impact. The end-line assessment will contribute to both strengthening the accountability of CARE International in Somalia to its donors and key stakeholders including beneficiaries, and to learn from this experience to inform future programming.
Effectiveness
Efficiency
Sustainability
Impact
Equity
Approach and Methodology
The final evaluation serves as a performance assessment, utilizing a non-experimental design to enable a simple pre-post comparison of results. This evaluation employs a combination of quantitative and qualitative methods, involving a beneficiary household survey, document reviews, and interviews with both participants and stakeholders. The reporting of project accomplishments linked to specific indicator values will take a comparative analysis approach.
The technical support team is anticipated to put forth a fitting and comprehensive evaluation methodology that includes the right evaluation approach, sampling techniques, data analysis methods, presentation and reporting strategies, and ethical considerations for the evaluation.
Scope of the Evaluation
The end-line assessment will cover the Bacadweyn health facility in Kismayo district of Lower Juba, Somalia. The participants of the evaluation survey will include IDPs, returnees, host rural and urban communities in the target area as well as government authorities and partner agencies.
Responsibilities of CARE
Responsibilities of the Consultant
Key Deliverables
The evaluation deliverables are:
CARE suggests the final evaluation report have the following format/structure,
Annexes: Evaluation Terms of Reference
Duration of the Assignment
The duration of the assignment is 13 working days after the signing of the contract. Days are inclusive of traveling, fieldwork, and reporting. The evaluation is expected to take place from 1st -13th July 2024.
Qualification of the Consultant
The evaluation assessment will be carried out by an external party. The consultant or consulting team must have considerable experience in conducting evaluations for projects similar to those supported by MOFA Luxembourg in Somalia-funded projects. Moreover, they should exhibit significant proficiency in the Somali context, with a specific focus on the regions of Jubaland State, to ensure a comprehensive grasp of the local circumstances.
Relevant qualifications for the consultant or team are outlined below.
· The lead consultant & co-consultant must have the following qualifications: Masters or degree in health sciences, public health, social sciences, sociology, development studies and other health related fields.
· Over 5 years of international humanitarian and development experience, specifically in the Somalia context.
· Demonstrated experience in conducting humanitarian evaluations. Specifically, profound understanding of the factors influencing malnutrition and poor health in the Somalia context, coupled with experience in evaluating health and nutrition programs.
· Over 7 years’ experience of conducting baselines and endline evaluations on health-related projects in Somalia: especially southern Somalia with International organizations.
· Substantial experience and understanding of integrated nutrition programming in emergency situations notably Health, WASH (Water, Sanitation, and Hygiene), Protection, Food Security, and Livelihoods.
· Comprehensive knowledge and experience of the Somalia context, with preference for teams that include Somali speakers.
· Robust experience and understanding of the application of humanitarian standards such as SPHERE and Core Humanitarian Standards (CHS).
· Capability to grasp the broader context and provide practical recommendations for implementation and on-the-ground improvements.
· Proficiency in collecting, analyzing consolidating, and communicating succinctly credible project information.
· Excellent interpersonal skills.
· Experience and ability to operate in insecure-volatile environments.
· Willingness to travel to Somalia within the security framework established by CARE International.
· Proficient in participatory facilitation and workshop design.
Excellent English report-writing skills
All applications MUST be accompanied by a technical and financial proposal including a brief outline of the proposed methodology, 3 references with contacts, and a tentative work plan as well as the candidate’s availability during the months of May to June 2024. The proposals shouldn’t exceed 5 pages. The deadline for submission of technical and financial proposals is 25th May 2024.
Interested consultants or firms are expected to conduct their own security and accessibility of the target project locations before application. Updated CVs of individuals or profiles of applying companies expressing interest in conducting the assessment should be sent to som.consultant@care.org no later than 25th May 2024. Please indicate “Kismayo Health and Nutrition Project (KHNP)– Project End-line Evaluation’.