Despite a 60% reduction in child mortality in the past two decades, the region continues to experience high numbers of newborn deaths with over a million children dying each year before their 5th birthday. 53.8 million stunted children live in the region and more than 47,000 maternal deaths occur each year. These high numbers of maternal, under-five and infant mortality are mainly driven by inadequate and unequal access to antenatal and postnatal care.

Additionally, the burden of disease in the region has increasingly become complex, with non-communicable diseases (NCDs) on the rise due to urbanization and lifestyle changes. NCDs contribute to 65% of the overall disease burden in the region. Immunization coverage has recovered since the COVID-19 pandemic; however issues with access and equity remain, with 3.8 million zero-dose children living in South Asia, the region has the second-highest number of zero-dose children globally. These are children who tend to experience multiple deprivations such as poor nutrition, limited access to safe and clean water, in addition to challenges accessing basic primary health care services.

With access to basic primary health care and its quality having severely been affected by the COVID-19 pandemic, repeated natural disasters and ongoing conflicts in the region, the health and well-being of children and mothers are at risk, with the danger of countries experiencing reversing progress in child survival and development. Therefore, particular attention and investments need to be oriented in making health and nutrition systems more responsive and resilient, with a focus on building stronger health and nutrition service delivery systems, with particular emphasis on community-based primary health care and nutrition services.

It is based on this background that UNICEF Regional Office for South Asia and UNICEF Country Offices in the region are prioritizing strengthening primary health care and nutrition services at the community level and Community Health and nutrition as a critical agenda for reaching the Universal Health Coverage (UHC) but also for building resilient communities to ensure adequate response and preparedness again future health emergencies.

The use of the term “Community Health and Nutrition” (CHN) aims to underscore a broader scope of Health and well-being, emphasizing the burden of nutrition issues on the health and well-being agenda, particularly in South Asia. CHN is defined as a framework that encompasses a comprehensive approach to promoting and protecting the health and well-being of children and community members. The inclusion of nutrition into the concept of community health acknowledges the intricate link between nutrition and health outcomes.

Furthermore, the consultant will be responsible for bringing these work streams together to produce regional overview documents for South Asia which synthesize the CO investment cases and costing exercises, producing a compelling regional narrative for investing in CHN.

• Conduct an initial desk review, supported by key informant interviews with relevant UNICEF staff, to provide a summary overview of the relevant data, evidence and background documentation that will support the three COs (Afghanistan, Bangladesh, Pakistan) with developing their investment cases.
• Develop an inception report (work plan) that sets out the detailed timelines for the project. This should also set out the gaps in data and evidence, with guidance on how to address these gaps for each CO. This exercise will be coordinated and guided by the ROSA health economics and public finance specialists.
• Develop methodological guidance and template approaches to ensure consistency in the methodological and presentational approaches for costing, financing and fiscal space analyses for their Community Health and Nutrition Roadmaps and/or strategies. Where relevant, the consultant can utilize established methodologies and examples of good practice. This will involve the development of product templates.
• Provide hands-on support to the three COs. The consultant will be required to peer-review the data collection, inputs and analysis carried out by CO consultants. Furthermore, the consultant will be responsible for quality assuring the final products to ensure they are ready for publication. Support and feedback will be provided by UNICEF staff in reviewing these documents, though the consultant will be responsible for ensuring this feedback is adequately reflected in the finalized deliverables.
• Conduct a brief review of the community health and nutrition costs and analysis in the remaining five South Asian countries (Bhutan, India, Maldives, Nepal, Sri Lanka).
• Develop a brief regional synthesis publication that pulls together the evidence generated and published across the region. This will include a region-wide financial gap analysis, based upon the CO deliverables, and a synthesis of the investment cases that demonstrate the urgent need for investment in community health and nutrition in South Asia.

Key Deliverables:

Develop methodological guidance and template approaches to ensure consistency in the methodological and presentational approaches for costing, financing and fiscal space analyses for their Community Health and Nutrition Roadmaps and/or strategies.