01 SOW.docx

Statement of Work

Supporting Nutrition Investments (SNI) Consultancy

A. Introduction

The Millennium Challenge Corporation (MCC) has a requirement to develop and deploy a Nutrition Toolkit to guide MCC and host country government counterparts during compact assessment, development, and implementation, as the agency considers investments in nutrition and sectors that may have nutrition-related benefits. The toolkit should include analytical tools that will enable MCC Economists to determine if there is an economic case for the nutrition investments considered. The MCC will obtain the required services through a competitive procurement to provide professional consulting services for the Nutrition Toolkit development and deployment.

The focus of this assignment will be on how interventions in nutrition can promote improved human capital development while also considering how the four pillars of food security (availability, accessibility, utilization, and stability) can be strengthened, considering MCC’s model and ability to influence the private sector, national policy, and data quality and use. This should include exploring the best approach for addressing cost-benefit analysis for nutrition specific and sensitive interventions.

On January 23, 2003, the United States established the MCC, an innovative foreign assistance program designed to reduce poverty by promoting sustainable economic growth. MCC, a U.S. government corporation, is based on the principle that aid is most effective in countries that promote good governance, economic freedom, and investments in people. For more information on the MCC, please visit www.mcc.gov.

MCC’s overriding objectives are to promote economic growth and a significant reduction in poverty in our partner countries. MCC does not take it for granted that programs that stimulate growth will invariably reduce poverty. MCC looks at the likely distributive effects of projects and, to the extent that data are available to perform such an analysis, identifies the beneficiaries and estimates the impact on poverty reduction. Ultimately, MCC seeks significant and measurable increases in incomes of large numbers of poor people and significant reductions in poverty.

MCC analyzes the likely impact on economic growth of its programs by analyzing whether they are consistent with international and country evidence on drivers of economic growth and by use of economic rate of return (ERR) analysis. The essence of such an analysis is a straightforward comparison of costs and benefits, where the costs are the MCA grants, other front-end project development costs, and associated project life cycle operating and maintenance costs, and the benefits are increases in incomes in recipient countries.

B. SCOPE

The objective of this assignment is to develop and deploy a Nutrition Toolkit to guide MCC and host country government counterparts during compact assessment, development, and implementation, as the agency considers investments in nutrition or sectors that may have nutrition-related benefits.

A background on MCC’s previous work around nutrition, and the work of others which MCC could build upon is presented in Annex 1.

C. COUNTRY

MCC eligible country and/or country with on-going or recently completed MCC compact or threshold programs in development or implementation. Country eligibility to receive MCC compact or threshold programs is explained on the MCC website Selection Process page.

D. TASKS

TASK 1: Develop a Nutrition Toolkit Development that will support the design and implementation of nutrition activities in MCC selected countries.

The toolkit should provide technical expertise and guidance to host country and MCC compact development teams, MCC’s Land and Agricultural Economy (LAE), Health and Community Development (HCD) Practice Groups, and the Department of Policy and Evaluation, including both the Economic Analysis and the Monitoring and Evaluation Divisions. The toolkit should be useful during the phases of compact development. The phase of compact development are explained in depth on MCC’s Compact Development Guidance webpage and are summarized below:

a. Preliminary analysis, identify constraints through analysis of economic data, incorporate gender, poverty, human and community development, and health considerations into relevant analyses and initiate public consultations (see Annex 2 for economic rate of return).

b. Problem diagnosis, especially focused on gender, poverty, human and community development, and health issues within the root cause analysis.

c. Project definition, determine evidence-based investments, project activities, identify the logic.

d. Project development, including further due diligence, additional studies. (see Annex 3 for MCC Compact development graphic)

Within the above framework, the Nutrition Toolkit should include the following specific elements:

1. Economic tools that will enable MCC Economists to support the development and implementation of nutrition programs. The toolkit will provide analytical tools for the consideration of nutrition in Constraints and Root Cause Analysis, especially as aligned with health, gender, poverty, food security, and human and community development. MCC uses a modified version of the Hausmann, Rodrick and Velasco (HRV) model to conduct these analyses. Examples are located at: https://www.mcc.gov/our-impact/constraints-analysis. Analytical tools for evaluating the cost benefit of nutrition programs during and after program implementation need also be included.

2. An approach to clarify the relationship between agricultural systems and nutrition to help define a Nutrition-Smart Agriculture (NSA) space that can crowd-in the agricultural economy to generate more jobs and income while building a food system that contributes to positive nutrition outcomes in the population should be included.

3. Recommended evidence-supported nutrition investments likely to be useful within the MCC milieu, including discussion of both nutrition specific and sensitive approaches within the agriculture, climate/sustainability, WASH, energy, education, health, and institutional reform sectors, and in the context of necessary social and behavior change (see Annex 1 and 2 for examples). Discussion should include investments in animal source food safety and promotion, fortification, and biofortification. Particular attention should be given to evidence-based policies or government led initiatives/programs that have been shown to improve nutrition.

4. Methods for calculating BCA and ERR of nutrition investments, especially focused on identifying measurable benefit streams in both nutrition projects and as additional benefits to other projects such as those focused on agriculture, climate/sustainability WASH, energy, education, or health. These can build off the SEEMS model.[footnoteRef:2] [2: The SEEMS Nutrition project developed a common approach to measure the costs and benefits of multisectoral nutrition strategies, building on standard economic evaluation methods. SEEMS-Nutrition provides a comprehensive set of cost data collection tools for estimating financial and economic costs that can be easily used alongside planned or on-going process or impact evaluation. Financial and economic costs can be used as inputs into modeling of costs and benefits, used in economic evaluations cost to analyze the cost-effectiveness or cost-benefit of nutrition-sensitive interventions delivered through multisectoral projects.]

5. Discussion of the design and implementation of effective nutrition projects. The lessons learned should be discussed with a strong focus on incentivizing private sector involvement to reduce malnutrition globally. Furthermore, this contract will address the financing gap for small and medium enterprises (SMEs) operating in the nutritious food space since the SMEs provide most food consumed.

6. Consideration of key specific issues such as gender-related challenges, climate-change, poverty, and other cross-sectoral matters essential to securing measurable gains from improved nutrition outcomes. Another critical issue is understanding the intersection between nutrition and poverty reduction since MCC evaluates investments based on this criterion to find out how nutrition improvements result in reduced poverty.

As a guide, this SOW includes a suggested Toolkit outline in Annex 4. The Offeror may choose to propose an alternative outline or may propose to present the toolkit in a format other than a narrative report.

This task is not expected to require travel to MCC countries. Task 1 will require desk review and may involve interviews and discussions to identify best practices and to tailor the toolkit to the needs of MCC practice groups and host country government compact development teams. Recommendations and toolkit content should be presented and feedback solicited, this may be done virtually and/or through in-person workshops at MCC headquarters (HQ) in Washington, D.C. MCC will provide HQ conferencing space.

Nutrition Toolkit development, iteration and finalization is expected to occur within the first twelve months of this contract.

TASK 2: Provide Nutrition Toolkit Training Develop and deliver virtual Nutrition Toolkit trainings tailored to the following groups:

a. MCC’s Land and Agricultural Economy (LAE) and Health and Community Development (HCD) Practice Groups and any MCC and any host country government country teams developing or implementing MCC programs that may benefit from a training targeting LAE and HCD experts.

b. MCC’s Department of Policy and Evaluation (DPE), including both the Economic Analysis (EA) and the Monitoring and Evaluation (M&E) Divisions and any host country government country teams developing or implementing MCC programs that may benefit from the training targeting DPE, EA or M&E experts.

Training format and content should be developed considering virtual training best practices. Translation services maybe required.

Nutrition Toolkit trainings should familiarize participants with the content of the Nutrition Toolkit and prepare MCC or host country government participants to use or apply the tools that are relevant to their area of expertise.

Trainings may be requested with MCC and/or host country government country teams that are considering nutrition related investments.

This task is not expected to require travel to MCC countries. Task 2 will require the Offeror to facilitate virtual trainings and apply virtual training best practices.

TASK 3: Support MCC to pilot/implement the Nutrition Toolkit in Compact development, implementation and/or evaluation.

To assist MCC in piloting/implementing the tools and methods developed in the Nutrition Toolkit, MCC may exercise an option period to ensure these tools are used actively in Compact development, implementation, and evaluation.

When a country is selected as eligible for MCC assistance and nutrition related programming or benefits are seen as a possibility in the future program design the Offeror will support the MCC country team, host country government and/or MCC practice groups during the phases of compact development to apply the tools and methods in the Nutrition Toolkit to determine if there is a nutrition related constraint to growth, if there is an appropriate nutrition or nutrition-related investment/intervention and support MCC economists to analyze the cost benefits of proposed interventions. MCC practice groups most likely to benefit from Offeror support are LAE, HCD or DPE.

If a nutrition or nutrition related investment is being implemented, evaluated or is in the stage of detailed design as part of an existing MCC program, the Offeror will support the MCC country team, host country government and/or MCC practice groups to use methods and tools developed in the Nutrition Toolkit to improve the activity or alter the activity to improve it’s impact (economic, social, climate related, poverty reduction, etc..). The Offeror will also support MCC economists to analyze the cost benefit of current activities/projects or improved/altered activities/projects or activities/projects under evaluation.

This task requires desk review, participation or facilitation of virtual meetings and may require travel to country MCC countries.

E. TECHNICAL DIRECTIVE

The Contractor shall provide services to MCC on an as needed basis, as required. To support MCC in the flexible and timely manner needed to meet the evolving needs of Compact development, negotiation, implementation and evaluation, technical directives under this statement of work shall be issued by the COR/PM and the Contractor deployed each time the Contractor’s services are needed over the course of this contract. No additional directive shall imply any additional costs to the United States Government (USG) beyond the amount allowed for in the initial statement of work; however, this this statement of work may be amended to reflect additional costs associated with implementation planning and oversight requirements.

In each technical directive, the COR/PM will define the specific tasks, dates and location of services, and assignment deliverable(s) at least one week prior to date of Contractor deployment. The technical directive will, in one paragraph to two pages, provide clear and concise instructions on tasks and deliverables requested of the Contractor. Upon acknowledging acceptance of the technical directive by the Contractor to MCC in writing (email or fax to the COR/PM is acceptable), the Contractor will be deployed by MCC to conduct the specific tasks described therein. The Contractor shall not conduct any specific work under this contract unless such a technical directive is issued and acknowledged in writing. The Contractor will notify the contract officer if the tasks appear to fall outside the scope given herein. The Contractor is expected to submit electronic copies of all written deliverables in English and to brief MCC staff verbally upon request.

F. DELIVERABLES:

· The COR/PM will provide technical directives outlining specific tasks. In response to technical directives, the expert shall provide toolkit materials (in the format proposed), training materials, written technical assessments, implementer performance assessments, reviews of other contractors or institutions’ deliverables, project audits, trip reports, among others.

· Trip reports to the MCC COR/PM, shall include at a minimum the summary of any consultations and meetings held, and key findings and recommendations and any next steps, as appropriate.

· Other ad hoc reports and inputs, as requested by MCC COR/PM.

· Once draft deliverables are received, MCC will review the deliverable and provide feedback to the consultant. A final deliverable will be due 14 business days following receipt of this feedback.

G. PERIOD AND PLACE OF PERFORMANCE

All work shall be completed between the dates of the award through a one-year base period of performance, with two additional one-year options. The estimated level of effort is up to 2,880 for the first year and 2,930 hours per year for the 2 option years. The estimated number of international trips for the one-year base period is zero (0), with up to 12 international trips estimated during the option period or 6 per year.

MCC anticipates this level of effort but does not guarantee this level of effort as it may increase or decrease. MCC anticipates this number of trips but does not guarantee this number as it may increase or decrease.

The consultants shall perform the services and tasks generally identified above at the consultant’s home facilities, periodically in MCC’s DC offices, and in any MCC-eligible countries.

H. CONFLICT OF INTEREST

The Contractor would be precluded from bidding on work and services (design, assessment, and implementation) to be procured by the local MCA accountable entities or using funds advanced under a Compact in the relevant country, unless the Contractor submits a mitigation plan sufficient to ameliorate any conflict of interest pursuant to the rules applicable to the procurement process.

I. EVALUATION CRITERIA

Proposals will be evaluated based on:

· Proposed toolkit design

· Demonstrated experience with the provision of technical analysis and recommendations around nutrition to donor institutions such as MCC, World Bank, USAID, etc)

· Demonstrated knowledge of nutrition sensitive and specific policies and programs

· Staffing plan and expertise of proposed consultants

Bidders must present a staffing plan and document the credentials of personnel qualified to perform the tasks and prepare the deliverables specified above. The staffing plan set forth below is illustrative. Each bidder should feel free to propose a staffing plan and the personnel it deems necessary to execute their unique approach to carry out this assignment successfully.

Illustrative Personnel Evaluation Criteria:

1. Senior Manager(s)

· Advanced degree

· Minimum 15 years’ experience managing donor/host government requests for data collection, analysis and recommendations for dynamic policy, trade, nutrition, health, and gender related issues related to economic growth in a development country environment

· Demonstrated project management skills highly desired.

2. Senior Economist(s)

· Advanced degree required

· Minimum 10 years’ relevant experience; expertise in quantitative and qualitative research design, methodologies, and data analysis; experience developing, refining, and interpreting results of economic modeling

· Secondary expertise requirements include strong knowledge base in nutrition, agriculture/food systems, and poverty analysis and econometrics and modeling, as it relates to economic growth and poverty reduction.

3. Nutrition & Health Expert(s)

· Advanced degree

· Minimum 10 years’ experience with at least five of those being overseas working within an LMIC setting; experience in making recommendations on high-impact health and nutrition programming.

4. Gender Expert

· Advanced degree

· Minimum 10 years’ experience with at least five of those being overseas working within an LMIC setting

· Experience in making recommendations on high-impact health and nutrition programming with significant gender considerations.

All Consultants proposed shall have the following skills:

· Professional oral and written fluency / command of English

· Demonstrated experience engaging effectively with international colleagues and adapting to changing communication and document sharing platforms, including but not limited to: setting up and participating in virtual meetings using video, using shared file software and applications, using communication applications (Whatsapp, Skype, etc…).

J. OTHER REQUIREMENTS

International travel may be required. The Contractor may be requested to mobilize on a short notice and will be expected to deliver high quality finished products in a timely manner based on the instructions of the COR/PM.

K. TIMING AND REPORTING

All formal communication with MCC, including reports, will be submitted to the COR/PM. The COR/PM for this requirement will be identified via separate correspondence.

The COR/PM will have technical responsibility for monitoring the contractor’s performance. The COR/PM will review and evaluate the contractor’s performance and will coordinate any communications with relevant counterparts and other donor agencies and organizations.

Any changes in the terms of the Call Order will be made in writing and approved by the Contracting Officer. No representation of the COR/PM shall serve as a basis for an alteration in the general scope of this Call Order or of the terms and conditions of the Call Order unless confirmed in writing by the Contracting Officer. The contractor must communicate with the Contracting Officer on all matters that pertain to the Contract terms. Proceeding with the work without proper contractual coverage could result in nonpayment for that work.

Annex 1. Background information

MCC applies an innovative philosophy to foreign aid with a mission to aid support economic growth and poverty reduction in carefully selected countries that demonstrate a commitment to just and democratic governance, economic freedom, and investments in their citizens. Eligible countries develop, in coordination with MCC, a program agreement (Compact) that is then implemented for five years. MCC’s model is defined by core principles of competitive country selection, country-led solutions and implementation, transparency, and a focus on results.

MCC’s model is focused on interventions that address the most important binding constraints to growth – which are those challenges that play the most important role in undermining inclusive economic growth, poverty reduction, and private investment.

MCC has identified human capital as a significant potential barrier to poverty reduction in our partner countries – with malnutrition playing a significant role in preventing MCC partners from approaching their potential. The role of malnutrition in undermining economic growth has been extensively discussed in the literature because of its negative effects on human developmental and lifetime productivity, increased vulnerability to disease, and higher medical costs. One estimate puts the economic costs of chronic undernutrition from stunting alone at 12% of GDP in some low-income and middle-income countries and around 8% of global GDP during the 20th century.[footnoteRef:3] [3: Malnutrition: global economic losses attributable to malnutrition 1900-2000 and projections to 2050, Horton S, Steckel RH. In: Lomborg B, ed. How much have global problems cost the earth? A scorecard from 1900 to 2050. Cambridge: Cambridge University Press, 2103: 247–72.]

To address the challenge and support the development of human capital, MCC seeks to invest directly or indirectly in improving nutrition when nutrition is identified as a binding constraint to economic growth or a benefit to a nutrition-related investment.

MCC & Nutrition: Work to Date

Despite the central role nutrition play in the long-term development of human capital, MCC has only focused on nutrition in one project to date, a $120 million investment under the Indonesia I Compact. Under this Compact, The Nutrition Project aimed to avert undernutrition of children in 11 provinces. It trained health workers on infant and young child feeding, growth monitoring, and sanitation; conducted community sanitation events; provided iron-folic acid to pregnant women; conducted a communications campaign on stunting; and provided grants to incentivize the use of health services through Generasi, a community-driven development program.

Specifically, MCC supported the Ministry of Health to update maternal and child health and nutrition (MCHN) policies and training. Specific activities included a focus on Ante-natal Care (ANC) behavior change focused on iron and folic acid (IFA) supplementation (IFA) and Infant and Young Child Feeding (IYCF) and growth monitoring to include stunting. Other activities included training health workers in updated MCHN guidelines, and funding community nutrition development initiatives in collaboration with the World Bank.

According to an MCC evaluation, the project’s key long-term outcome was to improve health and nutritional status among pregnant women and children, as measured by rates of child stunting, wasting, underweight, and low birthweight. However, the project had no impact on these outcomes, even for the cohort with the most project exposure, although stunting declined in both treatment and control areas.

While the project had statistically significant impacts on some nutrition-related outcomes, these were modest in size. Specifically, it improved the likelihood of pregnant women consuming the recommended 90 IFA tablets during pregnancy, by nine percentage points, likely through the provision of IFA to district health offices. Similarly, it improved the likelihood of exclusive breastfeeding, also by nine percentage points.

MCC has also been building the analytical base for nutrition work through recent engagement with the International Food Policy Research Institute (IFPRI) that included papers on Linkages between Nutrition and Economic Growth, Economic Returns to Nutritional Investments, Correlates of Stunting, and Urbanization and Nutrition.

The deliverables were four papers, presented to MCC in 2021. The first paper summarizes evidence on the linkages between child nutrition and economic growth and returns to nutritional investments. The second paper uses benefit-cost analyses to estimate the returns to selected nutritional investments (studied as part of the Lancet Series) in Africa and Southern Asia. The third paper empirically examines the determinants of child undernutrition in Africa, focusing on nutritional and dietary outcomes of children in different farming systems. As part of a case study from Burkina Faso, the fourth paper constructs indicators of urbanization using remotely sensed data to empirically examine the link between urbanization and child nutrition. These papers laid part of the foundation for further work that is envisioned in this assignment.[footnoteRef:4] [4: A full list of IFPRI papers is at: https://econpapers.repec.org/paper/fprifpmcc/ ]

MCC also co-chaired development of the second U.S. Government Global Nutrition Coordination Plan 2021–2026, which is an interagency effort to strengthen the impact of the many diverse nutrition investments across the U.S. Government through better communication and collaboration and by linking research to program implementation. Through coordination mechanisms, the U.S. Government is working to maximize its support to country-led programs, continue its global leadership and partnerships, and generate, share, and apply knowledge and evidence in the nutrition sector to accelerate progress toward shared nutrition goals.

MCC & Nutrition: Capabilities & Potential Value Add

Since MCC is not disease focused and sees improved nutrition as an important potential driver for human capital development and economic growth, it is free to concentrate where the need is the greatest. It can develop multi-disciplinary approaches focused on addressing the nutrition problem whether it is food system performance, health financing, improving nutrition in-service training, WASH, or supporting digital health.

Beyond its approach and despite its relatively short record in nutrition programs, MCC brings resources and capabilities that could be effective in leading transformational work:

· Execution of large-scale transformation by addressing fundamental constraints to improving food/nutrition system performance, including in conflict areas through multidisciplinary and multisectoral approaches (e.g., WASH, health system, agriculture and food systems, health financing, and relevant technologies).

· Improvement of the enabling environment for nutrition, including health and food systems, social assistance programs and associated regulatory and policy issues with governments and other stakeholders.

· Strong focus on gender issues and empowerment, which are strongly associated with poor nutrition outcomes. Enabling women to influence household decisions can improve system performance.

· Support of institutional & policy reform to facilitate government or private sector production of nutrient dense foods and micronutrient supplements based in market systems as opposed to systems needing donor replenishment.

· Support for better defined standards & stronger market linkages to promote biofortification, fortification, and other nutrition improvements by reducing costs of systemic change.

· Development of economically sustainable programs to support better nutrition through private sector engagement and the development of value chains beyond staples grown through subsistence agriculture.

· Improvement of post-harvest systems to boost food safety and mitigate value destruction and increase supply of nutrient dense foods (animal source foods & horticulture).

· Capacity-building of farmer-based organizations to support improved nutrition outcomes.

· Improvement of public or private health services delivery through collaboration with governments and other stakeholders.

· Capacity building for social and behavior change (SBC) within nutrition related ministries and other relevant stakeholders, as well as implementation of national or local SBC campaigns to support achievement of nutrition-specific or nutrition-sensitive goals.

Building upon the Nutrition Work of Others

Stunting Successes & Lessons Learned

Lessons learned from national efforts that successfully reduced stunting in children under 5 years of age by 15-20 percentage points in < 15 years.

The table below includes three examples of countries that reduced stunting significantly and the interventions that contributed to this reduction. Throughout MCC’s compact development and implementation process MCC has opportunities to influence national policy and programs and tailor successful international strategies to individual country contexts.

2. Conditional cash transfer for meeting health and education requirements

3. Growth monitoring and behavior change counseling

4. Expansion of health insurance to the poor for preventative health and nutrition services

5. Results-Based Budgeting

6. Communication strategy

1. Coordinated national stunting reduction plan

2. Improved water and sanitation

2. Access to more and diversified foods from increased agricultural outputs

3. Increased access to health services

1. Inter-ministerial government commitment and coordination

2. Improved infant and young child feeding

3. Safety net program for rural poor

4. Growth monitoring and behavior change counseling

5. Therapeutic feeding for severely underweight children

6. Control of micronutrient deficiencies

Sources of funding:

Funding sources may not be comprehensive.

As a participant in the US Governments Global Nutrition Coordination Plan (GNCP) 2021–2026, MCC shares its vision to, “Save millions of lives and promote broad-based economic development by ending malnutrition in all its forms, optimizing US Government technical and financial resources, and convening capacity, to elevate nutrition as essential to enhancing health and well-being,” by focusing on the goals that align most closely with its mission, including:

· Food systems are critical to increasing consumer access to safe, nutritious, and affordable foods—and encompass all the agricultural and commercial processes and structures required to grow, harvest, process, package, transport, market, and trade nutritious food for consumption and manage food waste and its disposal. Food systems also create opportunities for more robust livelihoods and income generation among smallholder farmers to improve their means to purchase safe and nutritious foods for their own families.

· The health system comprises human, physical, scientific, medical resources policies, and services that protect, promote, restore, and maintain health.

· Water and sanitation systems provide the infrastructure to deliver one of the fundamental inputs to agricultural production and ensure good environmental health necessary to protect communities from the infectious pathogens that undermine health and the absorption and utilization of nutrients.

· Education systems build the capacity for lifelong learning and for critical thinking, convey knowledge about healthy food choices, and often provide platforms for school feeding and supplementation programs that support child nutrition and learning.

· The environment includes the air, water, and land that provide the foundation for life and good nutrition. Optimal nutrition requires protection from pollution and access to clean water and air, fertile soils, and a healthy habitat.

· Social protection systems are an integrated national portfolio of interventions which aims to protect the minimum standard of living, prevent deprivation through increasing resilience to shocks, and promote of sustainable livelihood improvements.

While MCC’s five-year compact lifecycle does not make the provision of social protection assistance a viable intervention, MCC can support national or state governments to adopt and sustain nutrition focused social protection systems, including policies, regulations and government funded programs.

Specific MCC activities considered under the GNCP, include:

· Mobilize private sector investments in enterprises that will improve global food supply and public health systems.

· Advance initiatives aimed at elevating the role of women in agriculture and achieving positive nutritional outcomes for women within bilateral and multilateral partnerships.

· Participate in the Scaling Up Nutrition (SUN) movement at global and country levels.

· Support the adoption of policy and reforms that protect and support healthy nutrition.

· Develop and realize multi-sectoral and multichannel strategies to support and encourage families to embrace exclusive and continued breastfeeding.

· Increase availability, access, desirability, and consumption of nutrient-rich foods, including fortified foods; and strengthen nutrition care within health services and monitoring, evaluation, surveillance of breastfeeding and complementary feeding.

· Engage with multilateral, government, and civil society partners to implement programs globally to strengthen strategic approaches across humanitarian assistance, health, and food security programming to address wasting across the prevention-treatment continuum of care.

· Encourage governments to integrate wasting management strategies into national health systems, link wasting management services with other relevant programs, and protect infant and young child feeding during emergencies.

· Mobilize public-private partnerships as well as collaboration with civil society, donors, and impact investors to promote robust agriculture value chains, agro-processing and storage, link farmers to inputs and markets to expand supplies of nutrient-rich foods in low- and middle-income countries.

· Provide technical assistance to countries to design, implement, scale up and scale down effective micronutrient interventions and population-based assessments.

· Raise awareness within the US Government and globally of the determinants of nutrition and food security and promising solutions and the crucial intersection of environmental change, agriculture and food systems, nutrition, and health.

· Mobilize public-private partnerships in enterprises that increase climate resilience, including post-harvest storage, cold-chain solutions, and information technologies.

· Promote policies and programs that support healthy lifestyles and contribute to the long-term reduction in noncommunicable diseases.

· Leverage all financing instruments to increase private investments in nutrition-sensitive investments in low- and middle- income countries.

· Work collaboratively with governments, donors, and civil society to identify health system strengthening solutions to improve countries’ ability to deliver improved nutrition and reduced disease burden.

· Partner with local government, private sector, farmers, and supply chain actors to build private sector and government capacity to increase agricultural productivity and ensure a reliable and affordable supply of nutritious foods.

· Strengthen data measurement and analysis to inform countries’ nutrition priorities and policies and to prioritize nutrition in national policies, plans, budgets, and programs, and transition to sustainable financing for nutrition.

· Document learning and best practices from multi-sectoral nutrition policies, plans and programs.

· Provide open access to data collected on nutrition-specific interventions throughout the world, removing personal identifiers and making them machine readable.

Within food systems, MCC is considering these possible interventions that could be consistent within its model that are listed below:

· Increase production of nutrient dense foods, such as fruit, vegetables, and animal source proteins by reducing constraints to the development of these sectors.

· Consider ways to incorporate biofortification in food systems through “nudges” that give the private sector an incentive to produce these products. This may need a complementary consumer education program.

· Incentivize the private sector to invest in infrastructure that reduces losses that result in lower nutrition availability and/or food safety problems. This can come via traditional infra and/or through better cold chains.

· Shift policy away from poorly targeted input subsidies, when possible, for “food security” towards support nutrition (this is not an easy lift since we don’t even do this in the USA).

· Support the creation of a research infrastructure to promote the development of nutrient dense crops.

Note: The lists above are not an exhaustive compendium of possible interventions. Some of these activities may be worth pursuing at MCC while others may provide less opportunity for an MCC value add. The consultant should recommend those most likely to advance MCC’s mission in its partner countries.

In the IFPRI papers commissioned by MCC, child undernutrition results in, “impaired cognitive and non-cognitive development, poor educational performance, low productivity and earnings, and higher healthcare costs.” Investments to enhance child nutrition can target either the immediate determinants (known as nutrition-specific investments) or the underlying determinants (known as nutrition-sensitive investments).[footnoteRef:5] [5: Prioritizing Agricultural Investments for Income, Poverty Reduction, and Nutrition, IFPRI, 2021]

IFPRI notes that child undernutrition is determined by several factors including the quantity and quality of dietary intake – which are themselves affected by, “household food security, care and feeding practices, condition of living environment, and access to health services. At the highest level are the basic determinants that include households’ access to productive resources, the available stock of capital, as well as socioeconomic and environmental factors that affect nutrition through their effects on the underlying and immediate determinants.”[footnoteRef:6] Household assets also can reduce malnutrition. [6: What are the correlates of childhood undernutrition? An analysis of DHS data from Sub-Saharan Africa, IFPRI, 2020.]

According to IFPRI, the primary drivers of improved nutrition are female access to healthcare, education, and control over resources, along with economic growth and poverty reduction, reduced disease and infection burdens, improved supply chains for nutrient dense foods, access to power and clean water, and in areas with irrigated and perennial-mixed systems.

Source: Prioritizing Agricultural Investments for Income, Poverty Reduction, and Nutrition, 2021, IFPRI IFPRI has also noted that some effective nutrition-specific investments have significant economic returns. This can include micronutrient supplementations to pregnant women, provision of complementary foods and therapeutic feeding, but are not enough to fully resolve the malnutrition challenge – which is why MCC also will consider nutrition-sensitive interventions.

Another set of tools comes from the Strengthening Economic Evaluation for Multisectoral Strategies (SEEMS) Nutrition project which is designed to measure the costs and benefits of multisectoral nutrition strategies using standard economic evaluation methods. It was funded by the Bill & Melinda Gates Foundation and developed by the University of Washington, IFPRI, Helen Keller International, Results for Development (R4D), and the International Livestock Research Institute (ILRI).

SEEMS-Nutrition provides a “comprehensive set of cost data collection tools for estimating financial and economic costs that can be easily used alongside planned or on-going process or impact evaluations. Evidence on the costs and cost-effectiveness of multisectoral strategies will help program designers and policy makers make informed decisions about what interventions to prioritize to achieve nutrition-related development targets.”[footnoteRef:7] [7: SEEMS background is at: https://www.anh-academy.org/sites/default/files/AHN%20Academy_EconEval_Digital_19Aug.pdf and associated tools are located at: https://drive.google.com/drive/folders/1n6qxDQ9nSL5TRFci8OMA00Oem-G_Jzyi?usp=sharing ]

In agriculture, integrating malnutrition goals into investment decisions can boost production diversification into nutrient-dense value chains (e.g., animal-sourced foods, fruits, and vegetables) while integrating micronutrients through fortification. Biofortification will likely be a major area of focus in agriculture/nutrition interventions.[footnoteRef:8] [8: Prioritizing Agricultural Investments for Income, Poverty Reduction, and Nutrition, 2021, IFPRI]

Outside the agricultural economy, other nutrition sensitive investments involve boosting women’s access to productive resources, improved education and health care, and better employment opportunities along with investments in roads, power, education, health, water, hygiene, and sanitation. Adaptation programs that address one of the climate stressors: increasing average temperatures, may help reduce the incidence of infectious diseases (water-borne and vector-borne (and hence, improve nutrition outcomes.

MCC sees the creation of rigorous and comprehensive economic models to inform the development of compacts and the determination of ERR as a key goal of this assignment. To better understand the possibilities for measuring gains from improved nutrition, IFPRI created this chart that can be the base for calculating concrete benefit streams from nutrition programs. It includes all stages of life and channels by which MCC could construct an Economic Rate of Return for nutrition interventions:

Source: Prioritizing Agricultural Investments for Income, Poverty Reduction, and Nutrition, 2021, IFPRI

Beyond its work in Indonesia, IFPRI, and the GNCP, MCC also seeks to build on the work of others and adapt it to its model, especially programs supported by USAID, the World Bank, and other leading donors and actors such as the Scaling Up Nutrition (SUN) network, the Global Alliance for Improved Nutrition (GAIN), and the World Health Organization (WHO).

According to the World Bank, the most successful nutrition interventions focused on social and behavior change communication (SBCC) on nutrition and health practices through community and support groups, providing supplementary energy-dense foods, biofortified foods, family planning, health systems strengthening, women’s land rights, safe water storage, and conditional cash transfers. As noted above, some interventions may not fit into MCC’s model. A summary of results is posted below.[footnoteRef:9] [9: World Bank Support to Reducing Child Undernutrition: An Independent Evaluation, 2020, World Bank]

World Bank Support to Reducing Child Undernutrition: An Independent Evaluation, 2020, World Bank

The evidence on the linkage between agricultural systems and improved nutrition outcomes is slowly becoming clearer. The strongest evidence appears to support biofortification, but other interventions such as increased food production, improved food safety, price interventions to reduce costs of nutrient dense foods, livestock-oriented programs to support animal source foods (ASF), nutrition sensitive value chain investments, and irrigation may have the significant effects on nutrition outcomes – even if the data is relatively limited. [footnoteRef:10] [10: Nutrition-sensitive agriculture: What have we learned so far?, Ruel et al, IFPRI]

A well-developed methodology for developing NSA was laid out in the Methodology for Developing Nutrition Smart Agriculture (NSmartAg) Country Profiles. The paper outlines steps to identify local malnutrition problems, identify needed nutrients and food groups, and then create a menu of solutions.[footnoteRef:11] [11: Methodology for Developing Nutrition Smart Agriculture (NSmartAg) Country Profiles, May 2020, World Bank. ]

[i] Marini, A., Rokx, C., Gallagher, P. Standing tall: Peru’s success in overcoming its stunting crisis. International Bank for Reconstruction and Development and the World Bank, 2017 [ii] Chaparro, C.; Oot, L.; and Sethuraman, K. 2014. Overview of the Nutrition Situation in Seven Countries in Southeast Asia. Washington, DC: FHI 360/FANTA, pg. 17.

[iii] Chaparro, C.; Oot, L.; and Sethuraman, K. 2014. Vietnam Nutrition Profile. Washington, DC: FHI 360/FANTA.

[iv] Malabo Montpellier Panel (2017). Nourished: How Africa Can Build a Future Free from Hunger and Malnutrition. Dakar. August 2017, p. 24.

[v] WB/Peru: Close to 5 Million Poor to Benefit from Social Programs. 2012, World Bank.

[vi] Chaparro, C.; Oot, L.; and Sethuraman, K. 2014. Vietnam Nutrition Profile. Washington, DC: FHI 360/FANTA.

[vii] Ethiopia, Productive Safety Net Programme. Quick Facts 2012, https:// www.wfp.org/sites/default/files/PSNP%20Factsheet.pdf.

Annex 2: Economic Rate of Return: Nutrition Example

Example of the economic rate of return calculated for a USG nutrition investment, that partners with the private sector.

USDA Food and Nutrition Service Special Supplemental Program for Women, Infants, and Children (WIC) The WIC Program aims to safeguard the health of low-income women, infants, and children up to age 5 who are at nutritional risk by providing nutritious foods to supplement diets, information on healthy eating, and referrals to health care. Originally authorized in 1972, the program has evolved over decades of experience and changing needs. In 2019, WIC served 43 percent of all infants born in the United States, providing nutrition counseling through a wide range of settings, from hospitals to mobile clinics. Electronic Benefit Transfer is currently used by over 91 percent of WIC participants for supplemental foods and benefits can be redeemed at approximately 39,000 authorized retailers. A Congressional cost-benefit analysis[footnoteRef:12] of the WIC program estimated that each federal dollar invested in WIC benefits returns an estimated $3,502 over 18 years in discounted present value, and $2.89 within the infants’ first year to federal, state, and local governments and to private payers. [12: United States General Accounting Office (GAO). 1992, April. Report to Congressional Requesters. Early Intervention Federal Investments Like WIC Can Produce. GAO/HRC-92-18, Washington, D.C: GAO.]

Annex 3: The MCC compact development process is summarized below:

Source: MCC

Annex 4: Proposed Report Table of Contents

I. Introduction II. MCC’s Mission & Nutrition A. Nutrition as Essential B. Nutrition & Health C. Nutrition & Economics D. Nutrition & Poverty Reduction E. Food Systems III. Preliminary Analysis & Problem Diagnosis A. Constraints Analysis B. Problem Diagnosis & Root Cause Analysis IV. Defining the Nutrition Problem A. Nutrition & Constraints to Growth B. Market Failures C. Causes: Food, WASH, or other V. Project Definition A. Key Questions: Project Definition B. Investment Principles C. Intervention Menu: Nutrition Sensitive D. Intervention Menu: Nutrition Specific E. Intersection(s) with Agriculture, WASH, & Other Sectors VI. Private Sector Engagement A. Traditional Models B. Blended Finance C. Investing in Research & Innovation VII. Policy & Institutions A. Policy Instruments to Consider B. Tools for Policy Analysis VIII. Project Development A. Key Questions: Project Development B Nutrition Program Logic C. The Economic Rate of Return for Nutrition D. Identifying New Benefit Streams E. Beneficiary Analysis IX. Sustainability X. Negotiation & Implementation A. Results-Based Financing XI. Evaluation & Learning A. USAID Evaluations B. MCC Evaluation: Indonesia XII. Emerging Issues XIII. References

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