Consultancy to conduct Implementation Research on the use of Multiple Micronutrient Supplementation (MMS) by pregnant women in Kenya Consultancy NEW

The full document is available upon request through: [email protected]

Background

Iron and folic acid are essential micronutrients for normal physiological function, growth, and development of the nervous system of the foetus. The two micronutrient deficiencies are of public health significance among pregnant women and adolescent girls. Globally, an estimated 41.8% of pregnant women are anaemic, with at least half of these cases attributed to iron deficiency (WHO, 2018). Other contributing factors include deficiencies in folate, vitamin B12, and vitamin A, as well as chronic inflammation, parasitic infections, and genetic disorders.

Iron and folic acid deficiency is one of the most common forms of mmicronutrient malnutrition, affecting over 2 billion women globally. Iron and Folic Acid supplementation (IFAS) for pregnant women is a World Health Organization (WHO)- recommended,high-impact nutrition intervention adopted in Kenya to reduce maternal anaemia and its associated adverse outcomes such as maternal mortality, low birth weight, and neural-tube birth defects. Kenya recommends a daily dose of 60 mg iron and 0.4 mg of folic acid for all pregnant women as part of focused antenatal care.

The Kenya National Micronutrient Survey (2011) reported anemia prevalence among pregnant women at 41.6 percent, iron deficiency at 36.1 percent and iron deficiency anemia at 26 percent. The Kenya Demographic and Health Survey (KDHS, 2022) showed high IFAS coverage, with nine in 10 women reporting intake of iron-containing supplements during their last pregnancy. However, adherence remains low; only 37 percent took iron tablets daily for at least 90 days. The IFAS Assessment (2022) found 67% compliance in the four selected counties, though methodologies differed from KDHS.

Despite these interventions, maternal anemia remains a major concern due to low adherence and systemic challenges. This calls for innovative approaches to improve outcomes.

Multiple Micronutrient Supplementation (MMS)

Multiple Micronutrient Supplement (MMS), which contains 15 essential nutrients (10 vitamins and 5 minerals), has been recognized globally as a cost-effective intervention for improving maternal and child health outcomes. Evidence from recent meta-analyses (e.g., Smith et al., 2025) demonstrates that MMS is most effective when adherence exceeds 75% and supplementation begins before 20 weeks of gestation. WHO currently recommends MMS for use under implementation research contexts. In 2021, MMS was added to the WHO Essential Medicines List.

MMS has been shown to significantly reduce the risk of low birth weight, preterm birth, and stillbirth compared to IFAS, especially when administered early and consistently. Its introduction in Kenya presents a strategic opportunity to accelerate progress toward SDG 2 (Zero Hunger), SDG 3 (Good Health and Well-being), and SDG 5 (Gender Equality), while contributing to Vision 2030, the Kenya Health Policy (2014–2030), and the Kenya Nutrition Action Plan (KNAP) 2023–2027.

However, successful rollout will require addressing challenges such as policy integration, supply chain readiness, capacity building for health providers, community engagement, and monitoring adherence. Implementation research is therefore critical to guide evidence-based scale-up and policy adoption.

Justification

Following the high-level advocacy meeting held on July 2, 2025, the Ministry of Health (MOH) Kenya, through the Division of Nutrition and Dietetics (DND), approved the initiation of implementation research on MMS in selected pilot counties. The research aims to generate robust, context-specific evidence to inform policy and guide scale-up.

Given the technical and multi-sectoral nature of the assignment, a consultant is required to design and coordinate the research with methodological rigor, context-specific adaptation, and alignment with the best global practices. The consultancy will provide evidence on feasibility, acceptability, supply chain integration, communication strategies, monitoring mechanisms, and policy impact.

The consultancy will also integrate equity and gender lens, ensuring that vulnerable groups, particularly adolescent girls, and marginalized communities, are effectively reached and supported. This will ensure inclusivity and support Kenya’s broader maternal and child nutrition goals.

The consultant will collect data in three counties (West Pokot, Samburu, and Wajir) as part of the assignment under the ongoing Joint Action to Stop Wasting Pilot, thereby contributing to evidence generation and the strengthening of integrated maternal and child nutrition systems.

Objectives of the Consultancy

1. Assess feasibility and health systems readiness for MMS uptake and scale-up.
2. Identify barriers and enablers to acceptability, uptake, and adherence among the pregnant women and adolescent girls.
3. Generate evidence to strengthen systems for supply chain management, service delivery, and community engagement.
4. Provide programmatic and policy recommendations to guide decision-making, local market shaping, and national scale-up strategies.

Scope of Work

The consultant will undertake the following tasks:

1. Design the Implementation Research protocol: Develop a detailed protocol including methodology, study design, ethical considerations, and operational framework.
2. Landscape Analysis: Conduct a desk review, stakeholder mapping, assessment, interview, and participatory situational analysis of IFAS uptake and challenges. Mapping existing antenatal care platforms and supply chain systems, documenting the policy and regulatory environment, and delivery platforms.
3. Supply Chain Assessment: Map and analyze movement of IFAS supplies from central warehouse to health facilities. Identify bottlenecks and propose strategies for efficient distribution and inclusion of MMS in the supply chain.
4. Formative research and social norms analysis to inform behavior change communication strategies. Identify BCC materials and training modules for health workers used in Kenya and other countries and proposed for adoption/ adaptation. -Identify and propose community-level messaging to promote MMS uptake among pregnant women and adolescent girls.
5. Acceptability and Utilization Monitoring: Use mixed-methods tools to assess product acceptability including taste, packaging and assess health worker confidence and perceptions on MMS. Monitor utilization trends and identify barriers to adherence.
6. Endline evaluation: Conduct an endline evaluation to assess MMS coverage and adherence, supply chain performance, and health worker and beneficiary experiences, and support stakeholder validation workshops following the endline evaluation.
7. Disseminate findings through reports, presentations, and policy briefs.

Deliverables

1. Inception report with detailed methodology, protocol, and work plan.
2. Submission of the IR protocol for ethical clearance.
3. Baseline landscape analysis report and presentation slides.
4. Supply chain assessment report.
5. Advocacy and BCC strategy documents.
6. Midline progress report and presentation slides
7. Endline evaluation report and presentation slides
8. Policy briefs
9. Final research report with recommendations
10. Dissemination of findings
11. Manuscript for publication

Timeline and Milestones

Timeframe:

Activity

Estimated no. of days

Timeline

Milestone

Finalization of IR protocol and IRB approval

Inception and planning

Baseline and Landscape analysis

Supply chain analysis

BCC strategy development

Midline/acceptability & utilization monitoring

Endline survey

Final report and policy recommendations

Dissemination of findings

Manuscript for publication

Qualifications and Experience

• Advanced degree in Public Health, Nutrition, or related field.
• Minimum of 5 years’ experience in implementation or operational research.
• Proven experience in maternal health, nutrition programming, and health systems strengthening, with evidence of similar assignments (Attach samples of previous work delivered to clients)
• Demonstrated ability to produce policy-relevant researchoutputs.
• Strong analytical, communication, and stakeholder engagement skills.
• Familiarity with MMS formulations and global guidelines
• Familiarity with Kenya’s health and other relevant nutrition-sensitive system and county-level operations is an asset.
• Publication record in peer-reviewed journals (an added advantage).

Reporting and Coordination

• The consultant will report to the Head, Division of Nutrition and Dietetics (MOH), funding partner and work closely with key stakeholders.
• The National MMS TWG will provide technical oversight.

Payment details

Payments will be linked to deliverables and milestones:

Deliverables

% of payment

Inception report delineating the study design, methodology & technical approaches, a feasible workplan

20%

Baseline assessment and landscape analysis report

20%

Formative research and social norms analysis report and BCC strategy developed

40%

Midline: Acceptability and Utilization Monitoring

10%

Final products and dissemination of findings

10%

Safeguarding, Data protection, and ethical compliance

1. The consultant shall:

• Comply with the Kenya Data Protection Act No. 24 of 2019 and applicable General Data Protection Regulation (GDPR). All data collected must be securely stored, anonymized where appropriate, and used solely for the purposes of this assignment.
• Strictly adhere to government/partner’s safeguarding and child protection policies, including the obligation to prevent and report any actual or suspected cases of exploitation, abuse, or misconduct. The background check will include rigorous background and reference checks prior to engagement.
• Commit to uphold the “Do No Harm” principle in all research, fieldwork, and community engagement activities, with sensitivity to gender, protection, and equity considerations.
• Any breach of data protection, safeguarding, or ethical standards may result in immediate termination of the contract, withholding of payment, and/or reporting to relevant authorities as appropriate.

Intellectual Property Rights

1. All data, reports, and output under this consultancy shall remain the property of MOH and its funding partner.

Travel and Logistics

1. The consultant shall be responsible for their own insurance, equipment, and coordination (travel, accommodation, and subsistence). The MoH will facilitate necessary coordination and introductions to participating counties and partners.

Application Requirements:

Interested consultants or firms should submit:

1. Technical proposal (understanding of ToR, methodology, and workplan).
2. Summary of capability to meet the objectives of this consultancy as well as qualifications outlined in this document.
3. Resume of not more than 7 pages
4. Sample reports of previous related work.
5. Provide at least three reference contacts from previous organizations where you have conducted similar evaluation.
6. Detailed work plan for undertaking the assignment.
7. Financial proposal (detailed cost breakdown, including consultant professional fees, data collection, analysis, report writing, and taxes, etc.).
8. Mandatory Statutory Documents

• Certificate of Registration (Firm) (if applicable)
• PIN/VAT Certificate and Tax Clearance Certificate
• Company /Organization Profile (if applicable)
• Company CR12 form (if applicable)

Tagged as: Action Against Hunger, Kenya