Terms of Reference (ToR) for the Rapid Assessment of MMS Implementation  and Supply Chain in Jigawa and Katsina States, Nigeria

1.0       About Nutrition International

Nutrition International is a global organization dedicated to delivering proven nutrition interventions to those who need them most. Working in partnership with countries, donors, and implementers, our experts conduct cutting-edge nutrition research, support critical policy formulation, and integrate nutrition into a broader development agenda. Operating in more than 60 countries, primarily in Asia and Africa, Nutrition International aims to transform the lives of people, especially women, adolescent girls, and children, by improving their nutritional status and health. 

In Nigeria, Nutrition International works in partnership with government and development partners to improve nutrition outcomes, particularly for women, newborns, and children. Nutrition International supports interventions in maternal and newborn health and nutrition, including Iron-Folic Acid (IFA) and Multiple Micronutrient Supplements (MMS), Vitamin A supplementation, and the use of Zinc Lo ORS in the treatment of diarrhea. Nutrition International strengthens supply chains, improves service delivery, drives demand creation, enhances data quality, and builds the capacity of health workers to deliver evidence-based nutrition services. Nutrition International offers technical assistance to embed nutrition into national and state policies, strategies, and plans, fostering sustainable and scalable solutions.

Nutrition International is supporting countries to integrate MMS into comprehensive antenatal care (ANC). In Nigeria, with funding from the Gates Foundation, Nutrition International worked with government partners to conduct MMS implementation research in Bauchi State. This research demonstrated effective approaches to support sustainable scale-up and to optimize uptake and adherence among pregnant women. 

Following the government’s endorsement of MMS scale-up, Nutrition International is supporting the Government of Nigeria and key stakeholders to expand maternal nutrition interventions, including MMS, in the states of Jigawa and Katsina. To ensure this support remains evidence-driven and responsive to local context, it is essential to assess progress, identify bottlenecks, and explore opportunities in MMS implementation and supply chain management in these States.

1.1      Context and Rationale

Nigeria continues to bear a disproportionate burden of maternal and child mortality. With an estimated 1,047 maternal deaths per 100,000 live births,^[1] Nigeria accounts for nearly 13% of all maternal deaths globally, ranking second after India. These national figures mask wide regional disparities. The Northwest region, characterized by high poverty rates and limited access to health services, reports maternal mortality ratios as high as 1,549 per 100,000 live births, while the Southwest region reports significantly lower ratios, around 166 per 100,000. ^[2] The preliminary report of the 2023-2024 NDHS indicates a concerning rise in newborn mortality, from an initial 39 per 1,000 live births in 2018 to 41/1000 Live Births in 2023.^[3]

A major contributor to poor maternal and newborn outcomes is maternal anemia, which affects approximately 61% of pregnant women in Nigeria.^[4] Moderate to severe anemia is associated with increased risks of maternal mortality, preterm birth, low birth weight, and neonatal death.  The 2021 National Food Consumption and Micronutrient Study reveals that anemia among pregnant women in Nigeria stems from multiple causes, not just iron deficiency, but also deficiencies in folate, vitamin B12, vitamin A, and contributors like malaria and helminth infection.^[5]

In 2020, the World Health Organization (WHO) updated its antenatal care guidelines and recommended MMS containing iron and folic acid in the context of rigorous research as part of antenatal care for pregnant women.  More recent global evidence now supports the use of MMS during pregnancy. Compared to IFA supplementation alone, MMS has been associated with greater reductions in the incidence of low birth weight, preterm births, and small-forgestational-age infants. ^[6]

This evidence reinforces the need to shift from an exclusively iron-focused approach to a broader MMS strategy, particularly during pregnancy.  The Government of Nigeria developed the National MMS Rollout and Scale-up Roadmap (2025–2029) in March 2025 through the Federal Ministry of Health and Social Welfare. The plan provides a phased approach, rollout (2025–2026) targeting 40% coverage and scale-up (2027–2029) aiming for 60% coverage, towards achieving 70% national coverage by 2030. It outlines strategies for integrating MMS into antenatal care, strengthening supply chains, building capacity, creating demand, and mobilizing sustainable financing, aligned with national and global nutrition targets.

Recent assessments have provided important insights into supplementation in Nigeria. The MMS Landscape Analysis (MMS-LAN), conducted in 18 states including Jigawa, reviewed readiness for MMS rollout and highlighted gaps in policy, supply chain, and service delivery. Similarly, UNICEF’s 2022 Barrier Analysis of IFA supplementation in three states identified major supply chain bottlenecks and implications for transitioning to MMS. While these studies inform national and sub-national planning, there is limited evidence on MMS readiness in Jigawa and Katsina, making this rapid assessment critical to guide state-level scale-up.

Although MMS implementation has begun in Jigawa and Katsina, activities has however mostly focused on MMS distribution with no defined rollout plan (training of service providers, provision of data tools, procurement and equitable distribution of MMS) to ensure effective MMS implementation. Nutrition International will support both states to adapt and operationalize the national rollout plan, distinguishing between areas of active implementation and those still at the readiness stage. The assessment will identify gaps across procurement, distribution, service delivery, behavior change communication (BCC), supervision and monitoring. Findings will guide program planning, strengthen coordination, and inform targeted technical assistance for sustainable, high-quality MMS delivery during pregnancy. The assessment will be guided by Nutrition International’s MMS Program Readiness and Systems Assessment Matrix, which will be made available to the consultants to ensure consistency with global and regional approaches. The assessment framework is developed by Nutrition International to evaluate both system readiness before rollout and the fidelity of early MMS implementation during scale-up. It is designed as a structured, evidence-based tool that guides governments and partners in identifying gaps, strengths, and enablers across all domains critical for MMS delivery.

2. Purpose of the Assignment

The overall objective of this assignment is to review the status (coverage, feasibility, acceptability and fidelity) of MMS implementation, assessing quality and performance in sites where rollout is already underway, and readiness and system capacity in sites that are still at preparatory stage and identify barriers and opportunities to inform scale-up strategies and strengthen delivery systems in the two states. 

Specific objectives 

1. Assess the current status of MMS rollout and integration into routine antenatal care services at state, LGA, and facility levels, distinguishing between active implementation sites (capacity, quality, coverage, counselling, adherence) and readiness sites (training, planning, and service delivery preparedness).
2. Assess the functionality and gaps in the MMS supply chain system, including forecasting, procurement, distribution, stock management, and reporting, with a focus on supply chain performance in active sites and supply chain readiness in preparatory sites.
3. Identify implementation barriers and enabling factors in both states.
4. Provide actionable recommendations to improve MMS delivery and supply chain performance, including short-term corrective measures in active implementation sites and longer-term readiness and system-strengthening measures for preparatory sites to support effective and sustainable MMS scale-up in the two states. 

4. Scope of Work

1. Desk review of relevant documents such as National Policy on Food and Nutrition (NPFN), 2016; National Strategic Plan of Action for Nutrition (NSPAN) 2021–2025;National Guidelines for the Prevention and Control of Micronutrient Deficiencies in Nigeria; National Guidelines for the Implementation of Antenatal Care (ANC);

RMNCAEH+N National Strategy, 2022–2026; Nigeria Essential Medicines List

(NEML), National Supply Chain Strategy for RMNCAEH+N Commodities; Global MMS Evidence Summary (WHO/UNICEF/Nutrition International); Nigeria’s Commitment to the Nutrition for Growth (N4G) Summit.

• Key Informant Interviews with stakeholders. This will include policy makers, federal, state directors of key government departments, Zonal pharmacists, stock incharges, implementing agencies/nutrition partners, and public and private facility in-charges representing both rural and urban health facilities, any other relevant partner, and exit interviews with pregnant women.  
• Facility assessment to assess practices and stock: Observe ANC consultations- Is supplementation discussed and prescribed during ANC? Is MMS distributed at the point of care? Is counselling messages provided to pregnant women? Review ANC registers -Check completeness of data on supplement distribution, look for consistency in ANC client records, and commodity usage; Check stock cards and inventory; Assess storage conditions-Cleanliness, organization, ventilation, expiry dates; Identify supply chain issues.
• Supply chain assessment (ordering, distribution, stock): Review existing supply chain documents (e.g., Logistics Management Information System [LMIS], stock reports, NHLMIS/DHIS2 data). Identify key stakeholders -PHCDA, State Logistics Management Coordinating Units (LMCUs), Central Medical Stores, and partners. Map the supply chain system -From procurement to distribution at health facility level (central > state > LGA > facility). Assess ordering practices- Frequency of orders from health facilities to LGA or state. Assess distribution schedules- Regularity and adherence to timelines, Mode of transport and distribution responsibility (push or pull system), Verify last delivery records- Date, quantity, and condition of received stock. Track last-mile delivery- From State to LGA, and to facilities – who transports, how often, and any gaps?
• Triangulation, analysis and synthesis of findings.
• Report writing and stakeholder presentation.

5. Deliverables

1. Inception Report
2. Detailed Work Plan
3. Draft assessment report  
4. Validated assessment report and recommendations. Recommendations should distinguish between short-term corrective actions and long-term systemstrengthening measures to support sustained MMS delivery.
5. Final report, with feedback from stakeholders incorporated 

6. Submitting the proposal  

Consultant or Consulting Organization is expected to submit to Nutrition International a proposal (ideally not more than ten pages – excluding Annexes, team members’ resumes, previous reports, description of roles, timeline, and the financial proposal), which should have the following outline:  

     I.      Background of organization 

• Summary of the mission and mandate of the organization. 
• Description of the organization’s relevant experience in delivering programs or projects that included gender equality outcomes and/or activities (include links to relevant reports if available) 
• Technical implementation plan (max 10 Pages) detailing: 
  • Rationale and Context for the work to be carried out under the consultancy.  
  • The consultancy’s Overall and Specific Objectives. Describe the proposed approach including a workplan with activities and timeframe, monitoring and reporting 
  • Proposed data collection methods including (desk reviews, focus groups, interviews, surveys, etc.) should be clearly identified and their accompanying sample tools (e.g. questionnaires, observational tools, interview guides etc.) submitted  
  • Proposed sampling, analytical and triangulation frameworks  
• Qualifications of the key personnel of the team. This shall include:  
  • Resumes of each of the key team members (up to 3 pages per resume) with: 
  • Qualifications in public health interventions 
  • Relevant experience of working on maternal health and nutrition at a community and institutional level 
  • Track records of previous work, including references to specific supply chain tools/guides used. 
  • Fluency in the local languages spoken in the targeted states desired. 
  • Experience in research on supply chain within health, nutrition or food security programs 
  • Experience conducting quantitative and qualitative research, especially key informant interviews 
  • Experience in analyzing qualitative data  
  • Supply chain expertise and graduate/post graduate training from a relevant academic institution. 
  • Contacts for references 
  • A description of roles and responsibilities of each of the team members (up to 2 pages), indicating their level of effort and aligning with the proposed cost plan.  
  • Sample of presentations of results within the scope of work.  

VI. Plan with a timeline for the objectives and activities: Timeline, which includes specific deadlines for each of the implementation activities, milestones and deliverables.   

V. Financial Proposal (up to 2 pages): Submit a Financial Proposal in a separate file detailing:  

• Breakup of all activities, outputs and deliverables.  
• Fees should be inclusive of all insurance, tax, and standard business overheads.  

Based on these Terms of Reference, applicants should submit a proposal and support documents by September 4th, 2025, to  [email protected]. 

Annex 1: Draft Budget Table (Indicative)

Budget Line Item	Estimated Cost (NGN)	Notes
Consultant Fees (daily rate x 30 days)	6,000,000	Lead assessment and reporting
Travel and Accommodation	3,000,000	Field visits in Jigawa and Katsina
Stakeholder Meetings and Validation	3,000,000	Venue, refreshments, logistics

AAnnex 2: Gantt Chart (Indicative Timeline)

• Inception Report & Tool Development: Oct 12 – Oct 13, 2025
• Data Collection: Oct 14 – Oct 31, 2025
• Data Analysis & Draft Report: Nov 1 – Nov 07, 2025
• Validation & Final Report: Nov 08 – Nov 14, 2025

---

[1] WHO, UNICEF, UNFPA, World Bank Group, UN DESA/Population Division, 2023 report

[2] Meh C, Thind A, Ryan B, Terry A. Levels and determinants of maternal mortality in northern and southern Nigeria.

BMC Pregnancy Childbirth. 2019 Nov 12;19(1):417. doi: 10.1186/s12884-019-2471-8. PMID: 31718572; PMCID:

PMC6852989.

[3] Federal Ministry of Health and Social Welfare of Nigeria (FMoHSW), National Population Commission (NPC)

[Nigeria], and ICF. 2024. Nigeria Demographic and Health Survey 2023–24: Key Indicators Report. Abuja, Nigeria, and Rockville, Maryland, USA: NPC and ICF

[4] NDHS 2018

[5] Federal Government of Nigeria (FGoN) and the International Institute of Tropical Agriculture (IITA). 2024. National

Food Consumption and Micronutrient Survey 2021. Final Report. Abuja and Ibadan, Nigeria: FGoN and IITA. 550 pp

[6] Gomes F, Askari S, Black RE, Christian P, Dewey KG, Mwangi MN, Rana Z, Reed S, Shankar AH, Smith ER, Tumilowicz A. Antenatal multiple micronutrient supplements versus iron-folic acid supplements and birth outcomes: Analysis by gestational age assessment method. Matern Child Nutr. 2023 Jul;19(3):e13509. doi: 10.1111/mcn.13509. Epub 2023 Mar 31. PMID: 37002655; PMCID: PMC10262881.

Please submit your proposal along with other relevant documents listed in the TOR to: [email protected] only not later than Thursday 4^th  September 2025 before 11:59PM deadline for submission.

For further enquiries or clarification, please write to [email protected]  on or before Wednesday 3^rd September 2025.