Consultant

Training of Trainers (TOT) for Leveraging Pakistan's Social Protection Programs for Adolescent Girls' Nutrition - SOPRAN

A.     BACKGROUND

Pakistan faces a triple malnutrition burden, with overweight rates rising from 18% to 29% (1999–2016) alongside significant nutrient deficiencies. Iron deficiency anaemia affects 54.7% of adolescent girls[1], impacting their cognitive development, academic potential, and health, particularly for pregnant adolescents. In response, the Ministry of National Health Services launched the Pakistan Adolescent Nutrition Strategy and Operational Plans for 2020-25, advocating iron and folic acid supplementation for adolescent girls. Addressing malnutrition’s complex roots requires broader socio-cultural change and socioeconomic improvements. The Benazir Income Support Program (BISP) now promotes Weekly Iron & Folic Acid Supplementation (WIFAS) and fortified foods for families. Through the Leveraging Pakistan's Social Protection Programs for Adolescent Girls' Nutrition (SOPRAN) Project, Nutrition International (NI) leverages the Taleemi Wazaif (TW) program from the Benazir Income Support Programme (BISP) to empower 100,000 adolescent girls (ages 10-19), including both TW beneficiaries and non-beneficiaries, as recipients of WIFAS and advocates for nutrition. This initiative equips them with essential nutritional education and provides access to WIFAS and fortified wheat flour. Community leaders and influencers, including religious leaders, will support these adolescents in promoting community-wide improvements in nutrition and food systems. To sustain this change, NI with the joint finances from the Bill & Melinda Gates Foundation (BMGF) and the German Federal Ministry for Economic Cooperation and Development (BMZ) has tailored training manuals, a TOT, and cascade training program for teachers and health workers in collaboration with health and education departments.

Through the SOPRAN Project, Shifa Foundation is supporting Nutrition International (NI) in tasked with providing technical support to achieve the project's objectives. One of the key activities involves training teachers and health workers on WIFA management, its supply chain, and adolescent nutrition. The goal is to equip teachers and Lady Health Workers (LHWs) with the knowledge, job aids, and materials needed to educate adolescent girls on proper nutrition and the importance of WIFA supplementation. As per outcome 1, the training will help teachers and LHWs effectively distribute WIFAs to adolescent girls, ensuring they receive the nutritional support necessary for their health and development. This TOR aims to engage an individual consultant or firm to conduct the Training of Trainers (TOT) and cascade sessions utilizing the pre-developed, contextualized training manuals.

 B. KEY OBJECTIVES

The primary objective of this assignment is to support the effective administration and compliance of Weekly Iron and Folic Acid Supplements (WIFAS) in schools by training teachers and health workers on safe and consistent WIFAS intake and related nutritional practices for adolescent girls and their families

The specific objectives of this assignment are as follows:

• Facilitate Training of Trainers (TOT) and follow-up cascade sessions by utilizing the existing (finalized & contextualized) modules designed for teachers and health workers.

 C. SCOPE OF WORK The consulting firm and individual consultant(s) will be responsible for:

•  Facilitation of one-day Training of Trainers (TOT) session for master trainers from the Health and Education Departments in Khyber Pakhtunkhwa, Punjab, Sindh, Baluchistan, as well as in the Islamabad, AJK, and GB regions, in close collaboration with Shifa Foundation, local health and education departments, Nutrition International's Program Section and Zonal Managers.
• The organization and support of subsequent one-day cascade sessions to disseminate the training to additional staff, ensuring effective implementation of the contextualized modules.

 D. TOPICS OF TRAININGS FOR HEALTH WORKERS:

Main Topics to be Covered During the One-Day Training Session (TOT and Cascade):

 Understanding Anaemia and its effect on well-being:

• Provide an overview of anaemia, including its causes and prevalence in adolescent girls, with a key focus on nutrition of adolescent girls.
• Impact of anaemia on health, particularly in adolescent girls.

Raising Awareness of Anaemia Reduction:

·        Strategies for raising community awareness about anaemia.

• Addressing misconceptions and promoting healthy practices.
• The role of the influencers particularly health workers addressing anaemia.

 Weekly Iron Folic Acid Supplementation (WIFAS):

• Overview of WIFAS and its significance in preventing anaemia.
• Guidelines for WIFA management, administration, and storage.

Nutrition Education:

• Key nutritional components which are essential for a balanced diet and especially preventing anaemia

• Dietary recommendations and locally available, affordable food sources rich in iron and folic acid, tailored to the local food system.

• Importance of balanced diets for overall health and performance.

Role of Lady Health Workers (LHWs):

• Responsibilities of LHWs in anaemia reduction and community awareness.
• Building trust and engaging with the community on different aspects of health and iron deficiency anaemia.
• Providing guidelines as per cultural context for the best use of the supplementation.

Practical Skills and Techniques:

• Effective communication strategies for sensitizing the community.
• Tools and resources for educating and motivating community members.

Monitoring and Evaluation:

• Identifying anaemic girls in communities and schools and referring them for treatment at nearby health facilities.
• Reporting and feedback mechanisms for continuous improvement.

E. TOPICS OF TRAININGS FOR TEACHERS:

Main Topics to be covered during the One-Day Training session for Teachers (TOT and Cascade):

Understanding Anaemia:

• Provide an overview of anaemia, including its causes and prevalence among adolescents in public schools and overall, in the community (through SMCs/PTCs).
• Impact of anaemia on health, academic performance, and overall development.

Raising Awareness of Anaemia Reduction:

• Strategies for raising awareness about anaemia within the school community.
• Addressing misconceptions and promoting healthy practices among students.

The importance of iron and folic acid for girls in supporting optimal school performance and cognitive development.

 Weekly Iron Folic Acid Supplementation (WIFAS):

• Overview of WIFAS and its significance in preventing anaemia.
• Guidelines for WIFA management, administration, and storage.
•  Skills to sensitize adolescent girls for the supplementation.

Administering WIFAS under Directly Observed Therapy (DOT) in Schools:

• Best practices for administering WIFAS to students under DOT.
• Ensuring compliance and monitoring consumption.

Nutrition Education:

Key nutritional components are essential for preventing anaemia.

Dietary recommendations and locally available, affordable food sources rich in iron and folic acid, tailored to the local food system.

Importance of balanced diets for overall health in girls.

Organizing Peer Education Training for Adolescent Girls:

• Strategies for empowering adolescent girls to educate their peers about anaemia and nutrition.
• Developing leadership and intergenerational communication skills among students.

Role of Teachers:

• Responsibilities of teachers in anaemia reduction and health promotion.
• Engaging students, PTAs/SMCs and parents in health initiatives.

Practical Skills and Techniques:

• Effective communication strategies for sensitizing students and their families.
• Tools and resources for educating and motivating the school community.

Monitoring and Evaluation:

• Maintain records of WIFAS consumption, dropout cases, and referral cases.
• Identifying anemic girls in schools and referring them for treatment at nearby health facilities.
• Reporting and feedback mechanisms for continuous improvement.
• Ensuring the adequate supply of WIFAs in the schools.

F. DETAILS OF TASK AND RELATED ACTIVITIES:

Plan to deliver training sessions (TOTs and cascade), for teachers and health workers in Khyber Pakhtunkhwa, Punjab, Sindh, Baluchistan, and the regions of Islamabad, AJK, and GB. Each session will incorporate pre- and post-training questionnaires to assess knowledge gained and training impact. These sessions will be conducted simultaneously across all provinces and regions from December 2024 to March 2025. Maintaining good attendance through attendance sheet.

F1. Selection criteria of Participants:

Teachers and health workers will be nominated by their respective district and tehsil departments, in close collaboration with BISP and Nutrition International.

 F2. Details of Trainings and Participants:

S#

District

Tehsil

Number of Health Staff to be trained as Master Trainers

Number of Health Staff to be during Cascade

Number of Teachers trained as Master Trainers

Number of Teachers Trained during Cascade

1

ICT

Islamabad

24

240

60

240

2

Quetta

Quetta City

24

240

60

240

3

Shaheed Benazirabad

Nawabshah

24

240

60

240

4

Swat

Babuzai

24

240

60

240

5

Faisalabad

Jaranwala

24

240

60

240

6

Skardu

Skardu

24

240

60

240

7

Kotli

Kotli

24

240

60

240

168

1680

420

1680

 Tentative Training Plan with estimated trainee numbers; final figures will be confirmed in consultation with the District Health and Education Department upon implementation.

F3. Profile of Participants/Trainees:

a)    Schools:

1)     Teachers from schools

2)     Tehsil Education Officer

3)     Deputy Education Officer at Tehsil Level

4)     Adolescent Girls

5)     BISP District officials

b)    Health:

6)     Deputy Health Officer at Tehsil level