Request for Proposal: 1578- XX and 1576-XX

Program monitoring using LC-LQAS (Large Country-Lot Quality Assurance Sampling)

method for the scale up program on Iron and Folic Acid Supplementation in four
provinces of Banten, West Java, West Nusa Tenggara and Riau provinces and the scale
up program on Zinc and ORS for the treatment of childhood diarrhoea in three provinces
of West Nusa Tenggara, West Java and Banten provinces of Indonesia

Issued by Nutrition International NI (formerly known as the Micronutrient Initiative)

Deadline for receipt of proposals at the NI:

Tuesday, September 26th, 2017

17:00 West Indonesia Standard Time

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Contents

1. Request For Proposal Notice .........................................................................................................3

2. Introduction to the RFP ..................................................................................................................3
3. General instructions and considerations ........................................................................................4
4. Conflict of Interest ..........................................................................................................................5
5. General Disclosures ......................................................................................................................5
6. Submission of Proposals ...............................................................................................................6
7. Receipt, evaluation and handling of proposals ...............................................................................6
9. Guidelines for preparing Proposals ................................................................................................8
Part 1: Covering Letter and Declaration............................................................................................8
Part 2: General and Technical Proposal ...........................................................................................9
Part 3: Financial Proposal .............................................................................................................. 10
Annexure A. Terms Of Reference ....................................................................................................... 11
Annexure B. Template Of Budget ....................................................................................................... 34

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1. REQUEST FOR PROPOSAL NOTICE

1.1 Request for Proposals

Nutrition International (NI) formerly known as the Micronutrient Initiative (MI), a renowned
International Development organization based out in Ottawa, Canada, has a commitment
to eradicate global hidden hunger by implementing interventions that focus on women
and children in developing countries. NI invites proposals from competent Organizations
or Agencies to conduct a Program monitoring using LC-LQAS (Large Country-Lot Quality
Assurance Sampling) method for the scale up program on Iron and Folic Acid
Supplementation in four provinces of Banten, West Java, West Nusa Tenggara and Riau
provinces and the scale up program on Zinc and ORS for the treatment of childhood
diarrhea in three provinces of West Nusa Tenggara, West Java and Banten provinces of
Indonesia. The submission deadline is Tuesday, September 26, 2017 at 17:00 West
Indonesia Standard Time.

2. INTRODUCTION TO THE RFP

2.1 NI aims to generate innovative and sustainable solutions to reduce vitamin and mineral
deficiencies among women, newborns, and children. It builds on robust evidence-based
research and evaluation in order to demonstrate excellent return on investment of scaling-
up highly cost-effective micronutrient interventions. NI aspires to be a global center of
excellence in technical and programmatic support in this field.

In collaboration with key stakeholders such as governments, private sectors and civil
society groups, NI seeks to tackle the aforementioned problems that affects one third of
the worlds population. NI engages in tailoring health and nutrition strategies as well as up-
scaling existing program in various regions in the globe including Africa, Asia, the
Caribbean, Latin America and the Middle East. NIs international Board of Directors directs
its interventions that reach approximately 500 million people in more than 70 countries.

One of NIs key strategic goals is to enhance the global impact of micronutrient
interventions by generating cutting-edge knowledge and utilizing it to develop sound
policies and programmes while consolidating political will to achieve its vision. NI aspires
to position itself as a global center of excellence in generating scientific research in the
field of micronutrient programmes. It provides quality assurance for research and
programmes while disseminating and translating new knowledge to influence and improve
national and global policies and programmes. NI provides guidance and support on
existing and future programme evaluations and coordinates the analysis and utilization of
evaluation activity results.

NI supported the Government of Indonesia to demonstrate a model for increasing

coverage and adherence of Iron Folic Acid supplements among pregnant women to reduce
iron deficiency anemia among pregnant women between 2011 and 2014 in one district
each of Banten (Lebak) and West Java (Purwakarta) provinces. During this demonstration
phase, NI forged strong partnerships with Directorate General of Community Nutrition
(MoH), UNICEF, Centre of Health Research at the University of Indonesia and several
local NGOs for implementation of this program. Based on the findings of the demonstration
project, NI is replicating the elements of the processes which have worked to improve
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coverage and adherence of the IFA program in 4 provinces (West Java, Banten, West
Nusa Tenggara and Riau). During the first 2 years, NI is scaling up the program in West
Java and Banten province followed by West Nusa Tenggara and Riau in years 3 and 4.

Aside NI supports Government of Indonesia on the IFA for pregnant women program,
since 2012, NI also supported a project to increase the coverage and utilization for zinc
and ORS supplementation in treatment of diarrhoea among children in 2 districts (East
Lombok and West Lombok) of West Nusa Tenggara province. NI collaborated with the
Directorate General Communicable Disease and Environment Health (CD&EH) of the
Diarrhoea Subdivision within the Ministry of Health and the District Health Office (DHO) in
West Lombok and East Lombok who are the implementers of the IMCI program. Based on
the program evaluation of NIs demonstration work in East Lombok and West Lombok
districts in West Nusa Tenggara, NI is replicating the elements of the processes which
have worked to improve coverage and adherence of zinc and ORS in childhood diarrhoea
treatment across West Nusa Tenggara province and thereafter to two high mortality
provinces of Banten and West Java.

In the interim, to monitor the program, a LC-LQAS assessment method is planned for to
inform program implementation about the current status of the activities of the program roll
out and any course correction required and also to inform the government and other
stakeholders on the feasibility of program strategies in improving IFA supplementation and
diarrhoea management practices and recommendations for scale-up programs. Further,
NI is looking for an agency to conduct a Program monitoring using LC-LQAS (Large
Country-Lot Quality Assurance Sampling) method for the scale up program on Iron and
Folic Acid Supplementation in four provinces of Banten, West Java, West Nusa Tenggara
and Riau provinces and the scale up program on Zinc and ORS for the treatment of
childhood diarrhea in three provinces of West Nusa Tenggara, West Java and Banten
provinces of Indonesia.

2.2 This Request for Proposals (RFP) and particularly the Guidelines for Preparing Proposals
that follow, are designed to help Respondents to produce proposals that are acceptable to
the NI, and to ensure that all proposals are given equal consideration. It is essential,
therefore, that respondents provide complete information, in the attached formats and on
the terms specified.

3. GENERAL INSTRUCTIONS AND CONSIDERATIONS

3.1. These instructions should be read in conjunction with information contained in the
enclosed Terms of Reference (TOR), and in any accompanying documents within this
package.
3.2. This Request for Proposals (RFP) is to support NI to conduct a Program monitoring
using LC-LQAS (Large Country-Lot Quality Assurance Sampling) method for the scale
up program on Iron and Folic Acid Supplementation in four provinces of Banten, West
Java, West Nusa Tenggara and Riau provinces and the scale up program on Zinc and
ORS for the treatment of childhood diarrhea in three provinces of West Nusa Tenggara,
West Java and Banten provinces of Indonesia.
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3.3. NI is not bound to accept the lowest priced, or any, proposal. NI reserves the right to
request any (or all) Respondent(s) to meet with the NI to clarify their proposal(s) without
commitment, and to publish on its website answers to any questions raised by any
Respondent (without identifying that Respondent).

3.4. Respondents are responsible for all costs associated with the proposal preparation and
will not receive any reimbursement from the NI.

4. Conflict of Interest

4.1. Respondents must disclose in their proposal details of any circumstances, including
personal, financial and business activities that will, or might, give rise to a conflict of
interest. This disclosure must extend to all personnel proposed to undertake the work.

4.2. Where Respondents identify any potential conflicts they must state how they intend to
avoid any impact arising from such conflicts. NI reserves the right to reject any proposals
which, in the NIs opinion, give rise, or could potentially give rise to, a conflict of interest.

4.3. With respect to this condition, please be advised that the organizations that may fall within
the scope of this evaluation will include those below, with which any association must be
disclosed:

a. Nutrition International (NI)

b. The Donor who is the primary funding source for the procurement

5. General Disclosures
5.1. Respondents must disclose:
5.1.1. If they are or have been the subject of any proceedings or other arrangements
relating to bankruptcy, insolvency or the financial standing of the Respondent
including but not limited to the appointment of any officer such as a receiver in
relation to the Respondent personal or business matters or an arrangement with
creditors or of any other similar proceedings.

5.1.2. If they have been convicted of, or are the subject of any proceedings, relating to:
a. criminal offence or other offence, a serious offence involving the activities of
a criminal organization or found by any regulator or professional body to have
committed professional misconduct.
b. corruption including the offer or receipt of any inducement of any kind in
relation to obtaining any contract, with NI, or any other contracting body or
authority
c. failure to fulfil any obligations in any jurisdiction relating to the payment of
taxes.

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6. SUBMISSION OF PROPOSALS
6.1 The Technical (only includes detail of meeting arrangement, team composition and timeline)
and financial proposal along with all requisite documentation must be received in English by
NI no later than September 26th, 2017.

6.2 The technical and financial proposal in two separate files shall be put into a covering email
specifically indicating with subject line Program monitoring using LC-LQAS (Large
Country-Lot Quality Assurance Sampling) method for the scale up program on Iron and
Folic Acid Supplementation in four provinces of Banten, West Java, West Nusa Tenggara
and Riau provinces and the scale up program on Zinc and ORS for the treatment of
childhood diarrhea in three provinces of West Nusa Tenggara, West Java and Banten
provinces of Indonesia need to be sent to email: vacancy.miindonesia@gmail.com

6.3 For any clarification required, please write an email on following email address:
vacancy.miindonesia@gmail.com

6.4 Only email bids will be accepted. Only those short-listed will receive an acknowledgment
and will be called for a personal interaction, at their own cost. The interaction will be held
at the NI office in Jakarta, Indonesia.

6.5 Late proposals will not be accepted in any circumstances. Proposals received after the
due date and time will not be considered.

7. RECEIPT, EVALUATION AND HANDLING OF PROPOSALS

7.1. Once a proposal is received before the due date and time, NI will:

7.1.1. Log the receipt of the proposals and record the business information
7.1.2. Review all proposals and disqualify any non-responsive ones (that fail to meet the
terms set out in these instructions), and retain the business details on file with a
note indicating disqualification
7.1.3. Evaluate all responsive proposals objectively in line with the criteria specified
below
7.1.4. Inform Respondents within 15 business days of the evaluation decision being
made.

7.2. NI reserves the right:

7.2.1. To accept or reject any and all proposals, and/or to annul the RFP process prior
to award, without thereby incurring any liability to the affected Respondents or any
obligation to inform the affected Respondents of the grounds for NI's actions prior
to contract award, and
7.2.2. To negotiate - with Respondent(s) invited to negotiate - the proposed technical
approach, and the proposed price based on the Respondents proposals.

7.2.3. Amend this RFP at any time.

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8. SELECTION CRITERIA
8.1. 60% of the evaluation weighting will be for the technical (50% for the capacity of firm
and 50% for Realistic Plan and ability to accomplish the task); and 40% for the financial
proposal (25% of Presented reasonable estimate of fees; 30% for Takes into
consideration all potential field expenses; 25% for presented realistic estimate for field
expenses and 20% for reasonable estimate for completing the research, analysis,
report writing expenses). For detail, please see table 1.

8.2. The Evaluation Team may, in its sole discretion, establish a short-list of Respondents
based on the Technical Scores of the Respondents (the Short-listed Respondents) for
the purpose of conducting interviews. If NI short-lists the Respondents, it will short-list
the Respondents with the highest scores.

8.3. Only the Short-listed Respondents will be interviewed. The number of Respondents
short-listed for an interview is in the sole discretion of NI.

8.4. Interviews of Short-listed Respondents will be carried out by the Evaluation Team or a
sub-group of the Evaluation Team. The Evaluation Team will score each Short-listed
Respondent based on the quality of the Respondents interview (the Interview Score).

8.5. The successful Respondent will be expected to enter into a Contract with the NI
for the duration of the Work. In the event of a Contract award, all the terms and
conditions of the RFP, including the Respondents response, will normally form part
of the Contract.

Table 1: Proposal Scoring Criteria

Name of the Agency
Assessment Category: Presentation and Proposals
Weights
discussion
Capacity of the firm (A) 50% 0.0 0.0 0.0 0.0 0.0
Adequate Professionals / Staff / Resources: The
survey team consists of :Nutrition epidemiologist
with PhD level training and more than 5 years of
experience (or Masters degree and 10 years
experience) in designing and conducting
epidemiological studies, MCH expert with more
20%
than 5 years of experience in conducting
maternal and newborn health research and
programs, Statistician with more than 5 years of
experience in data management and expert in
the in qualitative data collection, transcription,
coding and interpretation
Recognition and acceptance of firm among
30%
stakeholders
Firm's ability to complete preparatory work
30%
(recruitment, training and finalization of tools)

Firm's flexible approach in taking feedback 20%

Realistic Plan and ability to accomplish the

50%
task (B)
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Firm's clarity about methodology to be adopted

20%
to undertake the study

Firm's plan for completing the study 25%

Firm's ability to complete the task as per NI

25%
expectation mentioned in the TOR
Firm's realistic timelines to accomplish the entire
30%
work

Total Score - Technical Proposal (A+B) 100% 0.00 0.00 0.00 0.00 0.00

Overall weightage of Technical Proposal 60%

Assessment Category: Financial
Presented reasonable estimate of fees 25%

Takes into consideration all potential field

30%
expenses (i.e. no obvious omissions)

Presented realistic estimate for field expenses 25%

Reasonable estimate for completing the

20%
meeting, and report writing expenses
Total Score - Financial Proposal 100% 0.00 0.00 0.00 0.00 0.00
Overall weightage of Financial Proposal 40%
Total Weighted Score (Technical + Financial) 0.00 0.00 0.00 0.00 0.00

9. GUIDELINES FOR PREPARING PROPOSALS

9.1 Language: Proposals must be submitted in English.

9.2 Structure : Proposals must be set out in four main parts:

Part 1: Covering Letter and Declaration
Part 2: Executive Summary
Part 3: General and Technical Proposal
Part 4: Financial Proposal

Part 1: Covering Letter and Declaration

Proposals must be accompanied by a covering letter on company-headed paper showing the full
registered and trading name(s), trading and registered office address and business number of the
Respondent. The letter must be signed by a person of suitable authority to commit the Respondent
to a binding contract. It must quote the RFP number and title, and include the following
declarations:

a. We have examined the information provided in your Request for Proposals (RFP) and
offer to undertake the work described in accordance with requirements as set out in the
RFP. This proposal is valid for acceptance for 6 months and we confirm that this

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proposal will remain binding upon us and may be accepted by you at any time before
this expiry date.

b. We accept that any contract that may result will comprise the contract documents issued
with the RFP and be based upon the documents submitted as part of our proposal.

c. Our proposal (Technical and Financial) has been arrived at independently and without
consultation, communication, agreement or understanding (for the purpose of restricting
competition) with any other Respondent to or recipient of this RFP from the NI.

d. All statements and responses to this RFP are true and accurate.

e. We understand the obligations regarding Disclosure as described in the RFP Guidelines

and have included any necessary declarations.

f. We confirm that all personnel named in the proposal will be available to undertake the
services.

g. We agree to bear all costs incurred by us in connection with the preparation and
submission of this proposal and to bear any further pre-contract costs.

h. I confirm that I have the authority of [insert name of NGO/company/agency] to submit

this proposal and to clarify any details on its behalf.

Part 2: Executive Summary

A brief overview of the General and Technical proposal that summarizes how the Respondent will
use their competencies in the area to achieve the outputs/deliverables. Financial information should
not be included here; but the summary may indicate the level of effort proposed.

Part 3:

General and Technical Proposal

The General and Technical section should be structured as follows:

Section 1: Your understanding of the TOR provided with this RFP as Annexure A. You may
also propose qualifications to the TOR that you consider may enhance the value of the outcome
to the NI.

Section 2: Technical Response: a concise description of the methodology and approach that
are proposed for the delivery of the TOR and an implementation plan in the form of a work
breakdown analysis. This should describe the activities to be undertaken, the
deliverables/outputs and the milestone and completion dates (grouped by phase where
appropriate). The dependency of any activities and associated results on earlier results needs
to be clearly indicated.

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Section 3: Personnel Profile: names, designation and Curricula Vitae (CV) of personnel
assigned to work on the Project. CVs must not exceed 3 pages, but must include:
o a brief summary of the professional competencies of the individual relevant to the
Scope of Work/TOR
o a chronological list of relevant professional experience starting with the most recent
and showing key achievement /responsibilities
o brief details of qualifications educational / technical /professional / other
o language competencies other than English (if required to undertake the ToR)

Section 4: Personnel Inputs: include name of personnel, and person days with reference
to activity to be undertaken. Do not include any reference to fees. This will constitute a
confirmation that all personnel will be available to provide the required services for the
duration of the contract

Section 5: Company Information: proof of incorporation for registered incorporated

entities, proof of registration for registered entities.

Section 6: Previous experience: documentation demonstrating the Respondents

experience in the proposed area of work. This should include contact details for key clients
who may be contacted in respect of the Respondents relevant prior work.

Part 4: Financial Proposal

The Financial proposal must contain the expected budget for accomplishing the
complete work with detailed breakup. All amounts quoted must be in IDR. The
Respondent should provide a detailed budget, based on the format attached as
Annexure-B.

Fees should be inclusive of all VAT, Taxes, Insurance and standard training
management/overhead cost.

Please note that no fees are payable for travel days.

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ANNEXURE A
TERMS OF REFERENCE
Program monitoring using LC-LQAS (Large Country-Lot Quality Assurance Sampling)
method for the scale up program on Iron and Folic Acid Supplementation in four provinces
of Banten, West Java, West Nusa Tenggara and Riau provinces and the scale up program
on Zinc and ORS for the treatment of childhood diarrhoea in three provinces of West Nusa
Tenggara, West Java and Banten provinces of Indonesia

1. Introduction to Nutrition International

Nutrition International (NI) formerly known as the Micronutrient Initiative (MI), a renowned
International Development organization based out in Ottawa, Canada, has a commitment to
eradicate global hidden hunger by implementing interventions that focus on women and children
in developing countries. It aims to generate innovative and sustainable solutions to reduce vitamin
and mineral deficiencies among women, newborns, and children. It builds on robust evidence-based
research and evaluation in order to demonstrate excellent return on investment of scaling-up highly
cost-effective micronutrient interventions. NI aspires to be a global center of excellence in technical
and programmatic support in this field.
In collaboration with key stakeholders such as governments, private sectors and civil society
groups, NI seeks to tackle the aforementioned problems that affects one third of the worlds
population. NI engages in tailoring health and nutrition strategies as well as up-scaling existing
program in various regions in the globe including Africa, Asia, the Caribbean, Latin America and the
Middle East. NIs international Board of Directors directs its interventions that reach approximately
500 million people in more than 70 countries.
One of NIs key strategic goals is to enhance the global impact of micronutrient interventions by
generating cutting-edge knowledge and utilizing it to develop sound policies and programmes while
consolidating political will to achieve its vision. NI aspires to position itself as a global center of
excellence in generating scientific research in the field of micronutrient programmes. It provides
quality assurance for research and programmes while disseminating and translating new
knowledge to influence and improve national and global policies and programmes. NI provides
guidance and support on existing and future programme evaluations and coordinates the analysis
and utilization of evaluation activity results.
Intervention 1: Background for the program on increasing the coverage and adherence of
IFA supplementation among pregnant women
Anaemia among pregnant women of aged 15 to 49 years is a moderate public health problem in
Indonesia with 37.1% pregnant women aged 15 to 49 years suffering from anaemia, as per the
RISKESDAS 2013. NI supported the Government of Indonesia to demonstrate a model for
increasing coverage and adherence of Iron Folic Acid supplements among pregnant women to
reduce iron deficiency anemia among pregnant women between 2011 and 2014 in one district each
of Banten (Lebak) and West Java (Purwakarta) provinces. This demonstration project focused on
improving:
Strengthening the supply chain of the IFA supplements.
Strengthening government commitment.
Capacity building of health staff and frontline workers.
Behavior Change Interventions for increasing adherence, with a focus on Interpersonal

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Counseling,
Modifying the monitoring system to track coverage.
Supportive supervision

During this demonstration phase, NI forged strong partnerships with Directorate General of
Community Nutrition (MoH), UNICEF, Centre of Health Research at the University of Indonesia and
several local NGOs for implementation of this program.
Based on the findings of the demonstration project, NI is replicating the elements of the processes
which have worked to improve coverage and adherence of the IFA program in 4 provinces (West
Java, Banten, West Nusa Tenggara and Riau). During the first 2 years, NI is scaling up the program
in West Java and Banten province followed by West Nusa Tenggara and Riau in years 3 and 4.The
proposed project components are as follows:

Strengthening government commitment and integrate with other programs.

Tailored capacity building and BCI interventions for health staff, midwives and cadres to
provide effective counselling to ensure high utilization rates.
Streamlining the supply chain of IFA program at district, province and national levels.
Streamlining program monitoring and supervision from national until district levels.
National level technical assistance on improving the IFA supplement re-formulation, HMIS
and revision of national guidelines.

The data for the IFA baseline survey was collected between May and August 2015. NI will
commission an end-line survey with the key objective to establish end-line estimates of coverage
and adherence of IFA in 2018. The end-line survey will be conducted in two provinces West Java
and Banten and two comparison (non-intervention) provinces namely Central Java and Jambi. The
rationale of choosing only two provinces of the four intervention provinces for the purposes of
evaluation is because these provinces would have had maximum program exposure. The end-line
survey is planned in 2018.
In the interim, to monitor the program, a LC-LQAS assessment method is planned for both the
interventions in the intervention provinces. This ToR outlines the scope and activities to be carried
out in this assessment.
Intervention 2: Background for the program on increasing the coverage and adherence for
zinc and ORS supplementation in treatment of diarrhoea among children
According to the Basic Health Research data RISKESDAS, 2007, the proportion of child deaths
with diarrhoea as the first cause of death among under-five children is 25.2% in Indonesia. In 2008,
Ministry of Health (MoH), Republic of Indonesia adopted the WHO recommendation of zinc and
ORS supplementation for treatment of childhood diarrhoea into the National Diarrhoea Disease
Control Program (DDCP). However, this program has not been fully implemented in the country due
to various operational gaps. In addition, limitation of operational budget and delay in actual inclusion
of zinc in the National Essential Medicine List until 2012, have caused the coverage and utilization
of zinc to remain low.

To demonstrate the potential of the public health sector, NI supported a project to increase the
coverage and utilization for zinc and ORS supplementation in treatment of diarrhoea among children
in 2 districts (East Lombok and West Lombok) of West Nusa Tenggara province. NI collaborated
with the Directorate General Communicable Disease and Environment Health (CD&EH) of the
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Diarrhoea Subdivision within the Ministry of Health and the District Health Office (DHO) in West
Lombok and East Lombok who are the implementers of the IMCI program.

The strategy focused on a) strengthening the supply chain for both zinc and ORS b) strengthening
government commitment c) building capacity of the health system d) Behaviour Change
Communication (BCC) interventions with a focus on Interpersonal Counseling (IPC) e) modifying
the monitoring system to track coverage f) supportive supervision and f) program evaluation in
selected districts.

The coverage for zinc and ORS supplementation increased significantly within the public health
system in the demonstration districts. Based on the program evaluation of our demonstration work
in East Lombok and West Lombok districts in West Nusa Tenggara, NI is replicating the elements
of the processes which have worked to improve coverage and adherence of zinc and ORS in
childhood diarrhoea treatment across West Nusa Tenggara province and thereafter to two high
mortality provinces of Banten and West Java. The proposed components are:

Strengthening government commitment to promote zinc and ORS for childhood diarrhoea
program and its integration into current IMCI programs and other programs.
Tailored capacity building and BCI interventions for health staff and cadres.
Streamlining the supply chain of zinc supplements and ORS at district, province and national
levels.
Streamlining program monitoring and supervision
Exploring the support for zinc and ORS program through the private sector
National level technical assistance for the revision of National Guidelines and improving the
MIS.

The data for the baseline survey of zinc and ORS was collected during May and August 2015. NI
commissioned the baseline survey with the key objective to measure the coverage and adherence
to use ORS and Zinc for the treatment of childhood diarrhoea. The end-line survey is planned in
2018. In the interim, to monitor the program, a LC-LQAS assessment is planned for both this
intervention also.
2. Overall objective of monitoring of IFA coverage and adherence

The overall objective of this exercise is to establish interim program monitoring estimates of
coverage and adherence of IFA in areas supported by NI in Indonesia.

Specific objectives of this program monitoring of IFA coverage and adherence

The specific objectives of this LC-LQAS assessment are to:
1. Estimate the coverage and adherence of IFA supplementation among pregnant women
2. Assess the knowledge, attitude and practices among women and health workers about
causes and consequences of anaemia and the benefits of IFA supplementation
3. Identify knowledge, skill and behavior levels of health workers related to services of Anaemia
and IFA supplementation

Key research questions of program monitoring of IFA coverage and adherence

The key research questions are as follows:
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1. What is the coverage of IFA among pregnant women?

2. What is the adherence of IFA among pregnant women?
3. What are the reasons for non-adherence?
4. What is the knowledge level of women regarding IFA dosage, duration and its side effects
following consumption?
5. What is the knowledge level of Mid-wives and Kader Desa (community health volunteer)
regarding causes and consequences of anaemia?
6. What is the level of knowledge of Mid-wives and Kader Desa (community health volunteer)
regarding the benefits of IFA supplementation?
7. Do Mid-wives and the Kader Desa (community health volunteer) counsel the women
regarding solutions to the side effects from consumption of IFA?
8. Is there a stock out of supplies of IFA at the frontline distribution points?

Overall objective of monitoring of Zinc and ORS coverage and adherence

The overall objective of this exercise is to establish interim program monitoring estimates of
coverage and adherence of zinc in areas supported by NI in Indonesia.

Specific objectives of this program monitoring of zinc and ORS coverage and adherence
1. Estimate coverage and adherence of Zinc and ORS during diarrhoea episodes of children 6
to 59 months of age
2. Measure and assess knowledge, attitude and practices among mothers in treatment of
childhood diarrhoea
3. Assess the knowledge, skill and behavior of health workers related to services and advice
of 6 to 59 months old children suffering from diarrhoea.

Key research questions of this program monitoring of zinc and ORS coverage and
adherence
The key research questions are as follows:
1. What is the coverage of zinc and ORS in diarrhoea cases among care givers of children 6
to 59 months?
2. What is the level of knowledge among care givers of children 6 to 59 months regarding
diarrhoea management?
3. What is the level of adherence to Zinc and ORS?
4. What is the source of treatment for diarrhoea episodes?
5. What is the source of zinc and ORS?
6. What are the reasons for non-adherence of zinc and ORS?
7. What is the level of knowledge of health workers and Kader Desa regarding Diarrhoea
management with Zinc and ORS?
8. Is zinc distribution coverage and utilization increased in areas were Kader Desa are involved
in its distribution?
9. Are supplies of zinc and ORS adequate at the frontline distribution points? What are the
barriers to having adequate stocks?

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3. Study Objectives

The overall objective of this is to inform program implementation about the current status of the
activities of the program roll out and any course correction required. It will also inform the
government and other stakeholders on the feasibility of program strategies in improving IFA
supplementation and diarrhoea management practices and recommendations for scale-up
programs. For this purpose, rapid assessment is being undertaken to monitor key processes
indicators (activities and outputs) as well as the intermediate outcomes in order to provide guidance
on the feasibility of changing some behaviours. The results of these rapid assessments do not
claim to attribute change due to the program strategies. However, they will be used for program
decision making and learning.

4. Methods

Large Country-Lot Quality Assurance Sampling (LC-LQAS) study design: As part of

monitoring at one time point in the interim after the program roll out in the scale up areas to
understand and monitor the status of process and program indicators, a Large Country-Lot Quality
Assurance Sampling (LC-LQAS) study design will be adopted. This method has the advantage of
providing weighted point estimates for the four provinces as well as identifying focus areas where
performance is poor based on a predetermined and agreed upon decision rule. The target group of
respondents will be recently delivered mothers with an infant of less than six months of age and
caregivers of children with an episode of diarrhoea in the last 30 days and health officials and
workers.

Sample Size
In the LC-LQAS method of sample assessment, the eligible assessment respondents are sampled
from supervision areas (SA) nested in a larger catchment area. Being a health intervention, the
geographical area covered by health facilities seem to be a natural supervisory area, considering
the level of implementation, while the province is the catchment area, to which the health facilities
belong to.

In Indonesia, there are about 9,731 puskesmas in the 34 provinces as of December 2014 (Indonesia
Health Profile, 2014, Ministry of Health, Republic of Indonesia). Each puskesmas serves a
population size of ~25,909 on an average. Using the LC-LQAS sample size formula[1] in the footnote,

[1]

Where, N= total number of supervision areas (SA) in the province

m= 19 (the number of interviews to be conducted in a SA)
P= Intra-class Correlation Coefficient =0.083 (computed with the formula as described in the footnote)
lmax= the maximum desired length for the condence interval, `max , which in this case, has a value of 0.2
N*cen = total population of all the SAs in the catchment area
M2= the average of the square of the populations in each SA

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the required sample size of number of required SAs has been computed and presented in tables 1
and 2.
The total sample size of recently delivered women with an infant of age less than six months and
caregivers with children in the age group of 6 to 59 months with diarrhoea in the past 30 days is
mentioned in the following tables. The required number of SAs will be sampled from the total
sampling frame of 236, 1,004, 159 and 226 respectively for the four provinces using simple random
sampling (SRS) method (after sorting all the health facilities using random numbers generated using
excel or some other software). In the selected health facility supervision area, all the villages would
be listed and the interview locations (villages) (for the interview of 191 households with a recently
delivered woman and a caregiver or a child with diarrhoea in the last 30 days will be selected using
probability proportional to size (PPS) method based on the province, which is being covered for the
particular intervention.

In the selected village, the sampling of household for the interview will be done by dividing the
village (a village is usually about 100-150 households) into natural segments of approximately 50-
75 households each. One segment will be selected randomly from these segments. The selected
segment will be house listed for generation of two sampling frames; one for the households with a
recently delivered woman with an infant less than six months and households with a caregiver of
child 6 to 59 months of age with diarrhoea in the past 30 days will be identified. One recently
delivered women with an infant less than six months and one caregiver with a child aged 6 to 59
months with diarrhoea in the past 30 days will be selected for the interview randomly from this list
(using a random number from a random number table) in one village. Similarly, 19 interviews were
conducted in the selected 19 villages, one interview per village/ segment in a supervision area.

Table 1: Sample size of the number of Supervision Areas (SAs) to be covered for recently
delivered mothers with an infant less than six months of age (0 to 5 months post-partum)

Provinces Population #SAs Population ICC Sample Max #SAs # of SAs Sample
Squared Size Desired from Rounded size
per SA Length the off
for CI formula
N*Cen N M2 p m lmax n
Banten 12,415,492 236 3,690,912,683 0.083 19 0.2 18.4455 19 361
West Java 46,959,326 1004 3,389,016,041 0.083 19 0.2 22.2266 23 437

1The ICC was computed using the following formula:

Where: p= Intra-class Correlation Coefficient

DE= Design effect=2.5
m=19 (number of interviews per supervision area)

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West 4,887,865 159 1,179,658,747 0.083 19 0.2 16.9388 17 323

Nusa
Tenggara
Riau 6,506,794 226 1,283,235,289 0.083 19 0.2 21.1891 22 418
Total 1,539

Table 2: Sample size of the number of Supervision Areas (SAs) to be covered for caregivers
of children (6 to 59 months of age) with an episode of diarrhoea in the past 302 days
preceding the survey

Provinces Population #SAs Population ICC Sample Max #SAs # of SAs Sample
Squared Size Desired from Rounded size
per SA Length the off
for CI formula
N*Cen N M2 p M lmax n
West 4,887,865 159 1,179,658,747 0.083 19 0.2 16.9388 17 323
Nusa
Tenggara
Banten 12,415,492 236 3,690,912,683 0.083 19 0.2 18.4455 19 361

2 Considering the low availability of diarrhoeal children and to provide an adequate exposure of 10 days for
the measurement of adherence of zinc among those who had diarrhoea in the preceding 2 weeks (14 days),
a reference period of 30 days has been considered. Comparison with large scale surveys like; DHS: If we
would like to compare it with DHS, we can go to all children under five years of age to estimated diarrhoea
prevalence, as well as coverage of zinc and ORS and adherence to 10 days of zinc tablets/ syrup. Usually,
DHS questions do not estimate zinc adherence for 10 or 14 days. The questions related to treatment of
diarrhoea are quite few. The focus of NI surveys are more on micronutrients like zinc, IFA etc. For IFA, we
have only two questions in India and Indonesia DHSs. So, it is suggested to power for coverage and
adherence, which we would like to improve. It is quite difficult to see a change in diarrhoeal incidence and
prevalence. It may be relatively easier to see a change in coverage and adherence based on the NI supported
strategies of procurement support, ensuring supplies, estimation of stock requirement, advocacy, BCI and
training of health personnel. The survey does not aim to estimate diarrhoea prevalence among under five
years children. So, it has not been suggested to consider the caregivers of population of children under five
years (6 to 59 months). If we would like to estimate diarrhoea prevalence among the population of children
under five years children, we have to use the diarrhoea prevalence indicator for the estimation of sample size,
which may yield a higher sample size considering the period prevalence of diarrhoea of 14.3% (source: IDHS,
2012) and a coverage of zinc supplements of 1.1% (Source : IDHS, 2012). To power it for the estimation of
zinc coverage, we have to over sample the diarrhoea prevalence sample size to get to those estimated
number of children, who took zinc during their last diarrhoeal episode. The sample to be powered for
estimating adherence may be still higher, if there is a difference between receipt and adherence of zinc and
ORS and the receipt is higher than adherence to zinc syrup for 10 days. The period prevalence of diarrhea in
the last 14 days needs to be computed from the houselisting data, where there will be two columns; one on
those who had diarrhea in the past 2 weeks (14 days) and those who had diarrhoea in the last 30 days.

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West 46,959,326 1,004 3,389,016,041 0.083 19 0.2 22.2266 23 437

Java
Total 1,121

Target Respondents:
The target respondents will be women, who have recently delivered in the last six months preceding
the survey with an infant less than six months of age (0 to 5 months post-partum) and caregivers of
children with diarrhoea in the past 30 days preceding the survey. The other respondents for the
survey will be the health workers of the sampled clusters and health officials in the four provinces.
The period prevalence of diarrhoea in the last 14 days and 30 days needs to be computed from the
houselisting data, where there will be two columns; one on those who had diarrhea in the past 2
weeks (14 days) and those who had diarrhoea in the last 30 days.

Knowledge, Attitude and Practices among Physicians / Health Workers/ / cadres:

In addition to the collection of information from eligible respondents of selected households, the
assessment will also include a sub-study of KAP of Physicians, Health workers and Cadres in both
the provinces. A semi-structured questionnaire will be administered for this group. The field teams
will visit the related health facility of each cluster for interview with health workers and for collection
of data about knowledge on anaemia and IFA supplementation. Five mid-wives, Physicians and
five Kader Desa (community health volunteer) personnel in each supervisory area will be
interviewed. The following number of physicians / health workers / cadres (Kader Desa) will be
interviewed:

Table 3 : Sample of physicians / health workers / Cadres to be interviewed

Provinces Health Workers Number

Banten Physicians / Mid-wives (3+2=5 per SA) 19*5=95
Kader Desa (community health volunteer) 19*5=95
West Java Physicians / Mid-wives (3+2=5 per SA) 23*5=115
Kader Desa (community health volunteer) 23*5=115
West Nusa Tenggara Physicians / Mid-wives (3+2=5 per SA) 17*5=85
Kader Desa (community health volunteer) 17*5=85
Riau Physicians / Mid-wives (3+2=5 per SA) 22*5=110
Kader Desa (community health volunteer) 22*5=110

Table 4 : List of indicative key indicators for GAC reporting: Indicative not exhaustive
(additional indicators could be added later)

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Indicators Banten West West Riau Weighted

Java Nusa combine
Tenggara d
Primary Indicators (Key Outcomes)
IFA RECEIPT AND CONSUMPTION
COLLECTED FROM WOMEN 0-5
MONTHS POSTPARTUM FOR THEIR
RECENT PREGNANCY:
1300.1 Received-ANY
(a) Total # and % of pregnant women
who received ANY IFA supplements
from NI-supported delivery platforms in
the past year.
1300.1 Received-at least 90
(b) Total # and % of pregnant women
who received at least 90 IFA
supplements from NI-supported
delivery platforms in the past year.
1300.1 Received-at least 150
(c ) Total # and % of pregnant women
who received at least 150 IFA
supplements from NI-supported
delivery platforms in the past year
1300.1 Consumed-ANY
(d) In areas supported by NI, total #
and % of women who reported to
consume ANY IFA supplements during
their previous pregnancy.
Number and percent (%) of pregnant
women consuming 90+ tablets of IFA
1300.1 Consumed-at least 90

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(e) In areas supported by NI, total #

and % of women who reported to
consume at least 90 IFA supplements
during their previous pregnancy.
1300.1 Consumed at least 150
(f) In areas supported by NI total # and
% of women who reported to consume
at least 150 IFA supplements during
their previous pregnancy
1300.1a ANC Coverage-at least once
Antenatal Care coverage: % of women
aged 15-49 with a live birth who
received ANC by a skilled health
provider at least once during pregnancy

1300. 1b ANC Coverage-at least 4

times
Antenatal Care coverage: % of women
aged 15-49 with a live birth who
received ANC by a skilled health
provider at least 4 times in pregnancy
1310.1 Beneficiaries-Knowledge-IFA
In areas supported by NI, % and # of
pregnant women consulted in a KAP
survey who can describe one benefit or
reason for consuming IFA
supplementation during pregnancy.

1320.1 Beneficiaries-Practice-IFA
In areas supported by NI, % and # of
pregnant women consulted in a KAP
survey who can explain how to
overcome at least one typical barrier to
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consuming IFA supplements during

pregnancy.
1210.1 Providers-Knowledge-IFA
In areas supported by NI, % and # of
providers consulted in a KAP survey
who can describe at least three benefits
or reasons for consumption of IFA
during pregnancy.
1220.2 Providers-Practice-IFA
In areas supported by NI, % and # of
providers able to correctly identify how
to overcome at least two typical barriers
to IFA consumption by pregnant
women (counseling skills)
1312.2 BCI Exposure IFA
In areas supported by NI, % and # of
pregnant women who have been
exposed to BCIs about daily IFA
supplements throughout pregnancy.
FACILITY ESSENTIAL
1200.1 Stock Quantity-IFA
(a) In areas supported by NI, % of
contact points that experienced a stock
out of IFAs at any point during the year
(average of the monthly/quarterly
monitoring).
1200.1 Stock Quality IFA
(b) In areas supported by NI, % of
contact points (community/facility) with
IFA supplements adhering to local
standards at the time of monitoring

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visit. (Standards may be related to

packaging, dose per tablet, etc.)
1200.1 Stock Adequacy-IFA
(c) % of targeted women for whom
adequate supply of IFAs were procured

Table 5: List of Indicators for GAC reporting Zinc and ORS coverage and adherence:
Indicative not exhaustive (additional indicators could be added later)
Indicators West Nusa West Java Banten Weighted
Tenggara Combined
Prevalence of diarrhoea among children 0- IDHS, IDHS, IDHS, IDHS,
59 months in the past two weeks and past 2012/ From 2012/ From 2012/ From 2012/ From
30 days preceding the survey House listing House listing House House listing
in this survey in this survey listing in in this survey
this survey
Prevalence of diarrhoea among children 6- From House From House From From House
59 months in the past two weeks and past listing in this listing in this House listing in this
30 days preceding the survey survey survey listing in survey
this survey
% of care givers who reported any treatment
for their children with diarrhoea sought
outside home
a)% of care givers who reported any
treatment for their children with diarrhoea
sought from Public health facility
b) % of care givers who reported any
treatment for their children with diarrhoea
sought from Community Health Workers
c) % of care givers who reported any
treatment for their children with diarrhoea
sought from the Private sector
d) % of diarrhoea cases reported treated
with zinc and ORS that obtained Zinc and
ORS treatment from Public health facilities
% of children with diarrhoea for which care
was sought within 24 hrs

a) % of diarrhoea cases reported treated

with zinc and ORS that obtained Zinc and
ORS treatment from Public health facilities
b) % of diarrhoea cases reported treated
with zinc and ORS that obtained their
treatment from Community Health Workers
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c) % of children with diarrhoea treated with

Zinc and ORS from private sector
d) Treatment offered to children with
diarrhoea for whom care was not sought
outside their home
ZnORS practice:
a) % of caregivers who used Zinc and ORS
who reported treating most recent episode
with full course of Zinc and ORS
% of caregivers who know the benefits of
using Zinc and ORS for diarrhoea treatment
% of caregivers who know where to get Zinc
and ORS
% caregivers who recall messages from at
least one channel regarding treatment of
child with diarrhoea using Zn and Lo ORS
Proportion of caregivers/mothers who
correctly know how to prepare ORS and
Zinc
% of caregivers who express intention to
treat child diarrhoea with zinc and ORS
(a) Knowledge (Providers): % of health
providers who can describe the benefits of
Zinc and ORS for treatment of diarrhoea
(b) Knowledge (Providers), % of frontline
providers and supervisors who correctly
describe how to treat child diarrhoea with
Zinc and ORS
Awareness (Providers): % health providers
who received training or orientation on the
benefits of treating childhood diarrhoea with
Zinc and ORS
Stocks of Zinc - In areas supported by NI, %
of districts where less than 20% of service
delivery points had any stock out of
treatment courses (2 ORS:1 zinc blister)
(question to ask for stock outs during the
survey, last 6 months, last 12 months)
Stocks of ORS - In areas supported by NI, %
of districts where less than 20% of service
delivery points had any stock out of
treatment courses (2 ORS:1 zinc blister)

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(question to ask for stock outs during the

survey, last 6 months, last 12 months)

1200: Stocks: Stocks (either quality or

quantity) of Zinc + LO-ORS are a barrier to
coverage
% / # of facilities with stockouts in the
previous year
1300: Coverage: # of additional children
aged 1-59 mos. presenting with diarrhoea
that receive the recommended course of
zinc and LO ORS through both delivery
platforms
1300: Coverage: # of Total children aged 1-
59 mos. presenting with diarrhoea that
receive the recommended course of zinc
and LO ORS through NI delivery platforms
1300(a): Coverage: # of Total children
(episodes) aged 1-59 mos. presenting with
diarrhoea that receive the recommended
course of zinc and LO ORS through private
delivery platforms
1300(bc): Coverage: # of Total children aged
1-59 mos. presenting with diarrhoea that
receive the recommended course of zinc
and LO ORS through public delivery
platforms
Girls (#)
Boys(#)
(b) From the public sector (#)
From the public sector (%)
(c) From the private sector (#)
From the private sector (%)
1300: Treatment -seeking: % of children
suffering from diarrhoea in the past two
weeks whose caregivers sought care from
the
(a) public sector
(b) private sector
1320 Knowledge (Caregivers): in areas
supported by NI, % of caregivers who
correctly describe how to treat child
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diarrhoea with Zinc and ORS according to

national guideline/minimum standard
1222: Learning completed- Training : #
front-line health workers, supervisors and/or
managers who completed training in the
past year on relevant aspects2 of the
program
(a) in public sector
(b) private sector
1312: In areas supported by NI, estimated #
of caregivers exposed to mass media
behaviour change messaging

Indicative information areas

This section presents illustrative information and questions which need to be answered as part of
this LC-LQAS assessment. The list is indicative not exhaustive.

Table 6: Indicative information areas (not exhaustive): Respondent category - Recently

delivered woman
Respondent category : Recently delivered woman
1. Consent Agree/Disagree to participate in interview
2. Identifiers Province
District,
Household number,
Hamlet
Village
Name and Age of Household Head,
Name and age of Respondent,
3. Household Literacy of Respondent
and Literacy of Husband;
Respondent
Characteristics Relation of respondent to head of household;
Highest class completed by respondent;
Highest class completed by husband;
Size, age and sex composition of household members;
Exposure to mass-media
Source(s) of household income;
Religion of respondent, source of household drinking water; kind of
household toilet facilities;
Type of fuel used for cooking;

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Assets owned by household (irrigation pumps, working radios,

cycles, rickshaws, almirahs/ showcases, cot/bed, clocks, sewing
machines, working televisions, motorcycles, mobile phones,
tubewells, livestock);
Construction material used for house (ground floor walls, roof,
kitchen);
Number of living rooms;
Presence of household electricity;
4. Ante-natal Care (ANC) and IFA supplementation
Pregnancy Last pregnancy registered;
Registration
Type of health worker who registered the pregnancy; where, type of
service
Months running (i.e. gestational age) when pregnancy was
registered;
Information given during pregnancy registration; only relevant to
anemia identification prevention, treatment IFA
ANC Whether the woman received ANC
How many ANC did she receive during the last pregnancy
What services were provided (iron tablets, blood-pressure, weight,
TT);
What advice was given (nutrition during pregnancy, anemia, IFA
supplements, methods of overcoming side effects)
What gestational age did first ANC visit occur;
How many times was respondent visited by health worker to check
on her pregnancy;
Was PNC mentioned during ANC visits;
Was the timing of PNC mentioned during ANC visits?
IFA Did respondent hear about iron tablets;
Knows about correct dosage of iron tablets
Aware about benefits of IFA
Did respondent take iron tablets during last pregnancy;
How many sachets (30 tablets per sachet) did she receive to
complete the full recommended dosage of IFA
How many sachets (30 tablets per sachet) did the respondent
consume;
For how many days did she consume IFA tablets during the last
pregnancy
At what gestational age did respondent started taking iron tablets;
From where did respondent obtain iron tablets; private or public
Number of tablets received from the Government source
Number of tablets received from the TTD Mandiri
Who gave the tablets

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Did she have any side effects

Did she receive counseling on the benefits, dosage and side effects
of IFA and from whom
How did she manage the side effects (if she experienced one)? And
did the side effects disrupt her routine / stopped her for taking the IFA
tablet for a while?
Reasons for non-adherence
Did the woman face any trouble with the resupply
Was the supply free or did the woman buy the tablets
If yes , what was the cost

For Mid-wives/ Kader (community health volunteer), the illustrative information to be collected
include;
Respondent category : Mid-wives/ Kader (community health volunteer)
1. Consent Agree/Disagree to participate in interview
2. Identifiers District, village, (and for cadres) hamlet / posyandu name.
Name and Age
Number of households in workers catchment area,
3. Characteristics Age of Mid-wife/ Kader;
Highest class completed by Mid-wife/ Kader (community health
volunteer);
Duration of service as Mid-wife; Year Mid-wife received basic Mid-
wife training;
Primary functions/activities performed;
4. Catchment area Number of households,
Reproductive aged women and total population in Mid-wifes
catchment area;
Size of catchment area in square kilometers
5. Trainings Has the health worker received any training/ meeting on Anaemia
and IFA supplementation for pregnant women
Has the health worker received training on strengthening the IFA
supplementation program for pregnant women?
6. Knowledge of Does the worker understand and know the definition of Anaemia
anaemia and Does the worker know about the consequences of Anaemia
IFA
Is the worker able to state the correct dosage of IFA supplements
correctly?
Is the health worker able to mention the prevention of side effects
correctly?

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7 Home visits Does the health worker make home visits during the course of
pregnancy?
Do the health workers check on IFA utilization? How?
8 Anaemia testing Does the health worker conduct anemia examination by Hb meter
to pregnant women?
9 Supplies and Does the health worker have adequate stock of IFA supplements?
stock (Minimum 110 % of IFA supplements amount of stock)
How many IFA supplements were received at the health facility for
distribution in the previous month? (Check from stock registers and
note the number)
How many IFA supplements have been distributed in the previous
month? (Check from stock registers and note the number)
Were there any stock outs for IFA supplements at the health facility
at any point in the previous month? (i.e. 0 stock anytime during the
past calendar month)
Were any damaged / expired IFA supplements reported at the
health facility in the previous month ?
Number of pregnant women enrolled for ANC at Posyandu in the
previous month
(Verify from the register and note the number)
Number of pregnant women provided with IFA supplements in the
previous month (Verify from the register and note the number)
10 Recording and Whether stock registers and reporting form is available at the
reporting HF/CC?
Whether the recording of information is correct and complete in the
Register?(Assess from a sample of atleast 5 entries in the
Register)
Whether monthly report is submitted timely (along with submission
of HMIS Report)? (Verify from the last months report)

11 BCI Are the BCI materials available with the health worker? What
kinds of BCI materials are available?
Are the health workers using the BCI materials for counseling
pregnant women? When?
What kind of BCI materials used? (Flip chart, cadre book or
leaflet?)

Table 7: Indicative information to be collected and questions to be asked: Respondent

category: For caregivers of children with diarrhoea in the past 30 days

Respondent category : For caregivers of children with diarrhoea in the past 30 days
1. Consent Agree/Disagree to participate in interview
2. Identifiers Province
District,

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Cluster number,
Household number,
Hamlet
Village
Name and Age of Household Head,
Name and age of Respondent Mother / caregiver,
Date of interview, Name of Interviewer,
3. Household Literacy of Respondent Mother; Marital status;
and Literacy of father of the child;
Respondent Relation of respondent to head of household;
Characteristics Highest class completed by respondent;
Highest class completed by father of the child;
Size, age and sex composition of household;
Source(s) of household income;
Religion of respondent, source of household drinking water; kind of
household toilet facilities;
Type of fuel used for cooking;
Assets owned by household (irrigation pumps, working radios,
cycles, rickshaws, almirahs/showcases, cot/bed, clocks, sewing
machines, working televisions, motorcycles, mobile phones,
tubewells, livestock);
Construction material used for house (ground floor walls, roof,
kitchen);
Number of living rooms;
Presence of household electricity;
Exposure to mass media

5. Health seeking behavior
Episode of Recent diarrhoea affected child;
diarrhoea in Type of person who was contacted
the last one Days (i.e. after diarrhoea affliction) when treatment was sought;
month Information given during treatment;
Prescription given
What type of health worker provided treatment;
What services were provided
What advice was given;
Diarrhoea Does the respondent have correct knowledge of dosage, preparation
management and administration of zinc tablets
with Zinc and Is the respondent aware of any 2 benefits of administering zinc in
ORS diarrhoea
Did respondent hear about ORS; where?
Did respondent hear about zinc tablets; where?
Whether ORS was given alone or with zinc?
How many were given both Zinc and ORS?
How many were given only ORS?
Did respondent give zinc tablets to her child during diarrhoea?

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How many zinc tablets did respondent give to her child?

What was the source of ORS and Zinc?
What other treatment / medicine was given in addition to Zinc and
ORS?
How many packets of ORS was given by the health worker?
How many tablets of zinc was given?
Counselling Who visited the care giver during the episode of diarrhoea?
Whether health worker / mid-wife/ Kader Desa visited the care giver
during the episode of diarrhoea?
Whether the health worker / mid-wife/ Kader Desa counseled the
respondent?

For Mid-wives/ Kader (community health volunteer), the illustrative information to be collected
include;
Mid-wives/ Kader (community health volunteer)
1. Consent Agree/Disagree to participate in interview
2. Identifiers District, sub district/puskesmas
Name and Age
Number of households in workers catchment area,
3. Characteristics Highest class completed
Duration of service
Primary functions/activities performed;
4. Catchment Number of households,
area Children <5 years and total population in the catchment area;
Size of catchment area in square kilometers
5. Trainings Training on Management of Childhood Diarrhoea
Number, duration and dates of trainings attended on zinc for
diarrhoea treatment
6 Knowledge Understanding of the definition of diarrhoea
Understanding of the signs of mild to moderate dehydration
Awareness about the correct dosage of zinc tablets (20 mg/day for
children 6-59 months)
Awareness about the correct duration for zinc tablets intake
(10 days)
Ability of workers to demonstrate preparation of ORS correctly
Ability of workers to demonstrate use of dispersible zinc tablets
correctly
Awareness of benefits of giving zinc tablets in acute diarrhoea
Awareness of the reason for intake of zinc tablet for 10 days
duration even if diarrhoea stops
Workers having latest edition of Diarrhoea Disease Control
Program Guideline by Ministry of Health

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7 Stock / Supply Workers with adequate stock of diarrhoea treatment courses -ORS
Situation (e.g. 20 courses i.e., 40 ORS packets & 200 zinc tablets / 20 zinc
blisters)
Workers with adequate stock of diarrhoea treatment courses -Zinc
Number of zinc supplements were received at the health facility for
distribution(check from stock registers and note the number)
Number of ORS sachets were received at the health facility for
distribution
Number of zinc supplements have been distributed in the previous
month(check from stock registers and note the number)
Health facilities reporting no stock outs for zinc supplements/ORS
in the previous month
8 Recording and Whether stock registers are available
Reporting Whether reporting forms are available
In the last month
Number of children of age 6-59 months with diarrhoea seen during
the last month
Number of children of age 6-59 months who have received both
zinc supplements and ORS sachets
Number of children of age 6-59 months treated with antibiotics /
anti-protozoal drugs/ anti-motility drugs
Number of children of age 6-59 months referred
Number of health facilities where recording of information is correct
and complete in the register
Number of health facilities where monthly report is submitted in a
timely manner (along with the submission of HMIS report)
9 BCI Number of health facilities displaying BCI materials related to
project displayed at the centre
Number of health workers reporting availability of Inter Personal
Communication (IPC) tools
type of tools available (flip chart, pocket book)
Number of service providers using IPC tools (in case the IPC tools
are available with her)
other- health promotion at posyandu, counselling at pustu,
poskesdes etc
10 Counselling health workers visiting homes of children suffering from diarrhoea
and home health workers having the latest version of Diarrhoea Disease
visits Management Flowchart available
health workers who have received any BCI materials/IPC tools
related to this project

5. Qualifications of the proposed survey team:

a) Nutrition epidemiologist with PhD level training and more than 5 years of experience (or Masters
degree and 10 yrs. experience) in designing and conducting epidemiological studies. A track
record for publications in high impact peer reviewed journals is a plus. This individual will directly

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guide the development and implementation of this survey, in collaboration with and upon
approval from NI.

b) Maternal and child health expert with more than 5 years of experience in conducting maternal
and newborn health research and programs. A track record for publications in high impact peer
reviewed journals is a plus. This individual will provide technical guidance on tools and data
collection related to the maternal and newborn components of questions for women and as
relevant for health facilities, health services and health posts.

c) Statistician with more than 5 years of experience in data management and expertise in design
and analysis of quasi-experimental studies and/or program evaluations. The statistician will be
responsible for developing the data analysis plan, ensuring data collection tools are adequate
for the approved collection methodologies and for conducting or supervising quantitative data
management and cleaning and data analysis according to the approved plan.

d) One of the above will also be an expert in qualitative data collection, transcription, coding and
interpretation or an additional team member will be included who is such an expert. This
individual will lead on reviewing all qualitative questionnaires and guides, and will supervise
required training of staff conducting IDIs /KIIs / FGDs and implementation of qualitative activities
including entry, coding and analysis using appropriate software program such as Nvivo or atlas
Ti. This individual will ensure that all qualitative questionnaires and guides are approved by NI
prior to implementation.

e) The survey agency needs to submit previously carried out study reports similar to the current
study.

The survey team will be responsible for having the licenses for both qualitative and quantitative data
analysis software. The survey teams up-to-date CVs with current level of time commitment and
previous/current grants must be provided to NI as annex to the project proposal.

6. Deliverables

The following deliverables are to be submitted in hard copy and electronic form by the firm as the
implementation progresses to the Nutrition International
Timeline to complete the assessment
Detailed Implementation Plan (DIP) with all steps of proposal and implementation of LC-
LQAS Survey
Ethical clearance
Final English and Bahasa Indonesia language questionnaires
Plan for training interviewers and supervisors
Field procedures manual in English and Bahasa language
Codebook including questions, variable names, value names
Excel sheet for random sample selection of supervisory areas (Puskesmas) for each
province separately
Excel tabulation sheet for population weighted average estimates
Cleaned and labeled datasets in PASW/ SPSS format
Report of survey finalized after review by Nutrition International
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Power point presentation summarizing the key findings

Provincial research briefs for provincial health authorities

7. Report Outline

The selected agency/ consultant will submit to NI a report, which may have the following broad
sections / chapters: The report should be succinct and the main text should not run beyond 50-55
pages followed by the required annexures.

1. Executive summary
2. Introduction
3. Study design
4. Key findings about IFA supplementation among women
5. Key findings about diarrhoea management among children
6. Key findings from interview of health workers and officials
7. Conclusion and Recommendations

The agency/ consultant will submit a draft report to NI for review and will be finalized after
incorporating suggestions and comments from Nutrition International.

Guidance for prospective consultants/ agencies/ firms/ NGOs/ CBOs

Please visit the following references for templates for DIP, data tabulation and report writing.
LC-LQAS
1. http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Resources/28
1627-1095698140167/LCLQAS.pdf
2. http://www.lstmed.ac.uk/the-lqas-generic-toolkit

8. Timeline

The selected agency for this consultancy will adhere to the following timeline. The timeline is in
reference to the time of signing the contract with Nutrition International. It is expected that period of
consultancy will be 20 weeks and the final report will be finalized within this period.

Table 8: Tentative Timeline

Weeks
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Translating and Pretesting
data collection instruments
(semi-structured
questionnaires) and sampling
plan
IRB clearance

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Training of investigators
Data collection
Data entry and analysis
Report writing and finalization

ANNEXURE B
TEMPLATE OF BUDGET

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Serial Time Cost/Unit Amount

Activity Quantity Unit
number Week/month (in IDR) (in IDR)
A PREPARATION
Development of training materials,
1 sets x 0 0
questionnaires and template database
Preparation: training tools, pretesting
and data collection, Stationary tools,
2 sets x 0 0
training kits, questionnaires, meals and
beverages
Ethical approval, Permit/authority
3 sets x 0 0
letters and site arrangement
Subtotal A. Preparation 0
B TRAINING
Training for technical support, field
1 days x area 0 0
supervisor enumerator, and prelister
Training for data base manager and
2 days 0 0
staff
3 Honorarium for facilitators days x people 0 0
Subtotal B. Training 0
TRAINING, PRE SURVEY,
C
PRETESTING and SITE SETTING
Banten Province
1 Transportation Jakarta-Serang-Jakarta package x people 0 0
2 Local transportation in district package x days 0 0

3 Per diem for Project Director and people x days 0 0

Assistant Research
4 Per diem for Technical Coordinator people x days 0 0
5 Per diem for Supervisor people x days 0 0
6 Field enumerator people x days 0 0
West Java Province
Transportation Jakarta-Bandung-
1 package x people 0 0
Jakarta
2 Local transportation in district package x days 0 0

Per diem for Project Director and package x days 0 0

3 Assistant Research
4 Per diem for Technical Coordinator people x days 0 0
5 Per diem for Supervisor people x days 0 0
6 Field enumerator people x days 0 0
Riau Province
1 Transportation Jkt- Pekanbaru-Jkt package x people 0 0
2 Local transportation in district package x days 0 0

Per diem for Project Director and package x days 0 0

3 Assistant Research
4 Per diem for Technical Coordinator people x days 0 0
5 Per diem for Supervisor people x days 0 0
6 Field enumerator people x days 0 0
West Nusa Tenggara Province
1 Transportation Jkt- Mataram-Jkt package x people 0 0
2 Local transportation in district package x days 0 0

Per diem for Project Director and package x days 0 0

3 Assistant Research
4 Per diem for Technical Coordinator people x days 0 0
5 Per diem for Supervisor people x days 0 0

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6 Field enumerator people x days 0 0

Subtotal C. Pre Survey and
0
Pretesting
D. DATA COLLECTION
Rent car (24 hours) for local
transportation in district (including
gasoline, driver fee)
Per diem (accommodation and meal)
for enumerator, field supervisors, field
coordinator
Per diem (accommodation and meal)
for Project Director and assisstant
Per diem (accommodation and meal)
for field coordinator and enumerator
Subtotal D. Data Collection 0
E OFFICE SUPPLY
Copying
1 material/questionnaire/training module all package x set 0
etc.
2 Communication all package x people
3 Other office supplies all package x set
Subtotal E. Office supply 0
HONORARIUM (include daily
F transportation)
1 Database manager package x people 0
2 Database staff package x people 0
3 Research Advisor weeks x people 0
4 Project Director weeks x people 0
5 Assistant Research weeks x people 0
6 Technical Coordinator weeks x people 0
7 Supervisor weeks x people 0
8 Field enumerator people x set 0

9 Qualitative Expert and enumerator people x set 0

10 Observer (conducted during FGD) people x set 0
11 Field enumerator (In Depth Interviews) people x set 0
Field enumerator (caregivers)
clusters x HH 0
12 household-listing
Subtotal F. Honorarium 0
TRANSPORTATION,
ACCOMODATION AND
G RESPONDENTS

1 Transportation at Jakarta package x people 0 0

2 Local transportation at district package x days 0 0

Accommodation for Technical

3 package x days 0 0
Coordinator at district
Accommodation for Project Director
4 package x days 0 0
and Assistant Research at district
5 Transportation for respondents (FGD) package x people 0 0
6 Accommodation for monitoring package x days 0 0

7 Respondents gift/reward package x people 0 0

Subtotal G. Transportation and

0
accommodation
H DATA MANAGEMENT
1 Data entry and Cleaning set x day 0 0
2 Data analysis and reporting person x day 0 0
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3 Hardcopy of final report package x set 0 0

Subtotal H. Data management 0
I Overhead Cost 0
TOTAL BUDGET IDR

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