Call for offers - Developing methodology and estimating costs of implementation of WHO recommendations on the treatment of wasting and nutritional oedema

Background

Over 45.4 million infants and children under 5 years of age experience wasting each year. The risk of wasting and nutritional oedema in infants and children, particularly in high-risk contexts where health and socioeconomic indicators are at their poorest, is heightened by ongoing crises including climate change and conflict. There have therefore been major challenges along the road to achieving global targets for wasting and nutritional oedema including Sustainable Development Goal 2 to reach “Zero Hunger” by 2030. In 2019, the United Nations (UN) Secretary-General released the Global Action Plan for Child Wasting in order to establish a common focus for governments, UN agencies and civil society organizations and guide individual and collective action to accelerate progress towards targets for wasting.

One of the key commitments of World Health Organization (WHO) to this action plan was to update the normative guidance on the prevention and management of wasting and/or nutritional oedema, also known as acute malnutrition.  In 2023, WHO published recommendations on the prevention and management of wasting and nutritional oedema (acute malnutrition) in children under 5 years of age (WHO guideline on the prevention and management of wasting and nutritional oedema (‎acute malnutrition)‎ in infants and children under 5 years) . These recommendations provide a range of options for programme implementation; however, further clarity is required to assess their applicability, feasibility, and resource implications across diverse programme contexts.

WHO aims to support countries updating the national protocols aligned with WHO recommendations.  In this context, countries could benefit from information on potential cost savings associated with the adoption of evidence-informed WHO recommendations. This is expected to be achieved through the conduct of in-depth assessments in EMRO and AFRO to document costs and resource implications of implementing the WHO recommendations. 

Assignment Objective

The purpose of this assignment is to support the conduct of in-depth assessments in two countries in EMRO and two countries in AFRO, to document costs and resource implications, including potential cost savings, and to develop a methodology for assessing costs associated with the implementation of the WHO guideline on wasting.

Specifically, the study will investigate the potential costs and cost savings in implementing the following recommendations:

1. Identification and management of wasting and nutritional oedema by community health workers
2. Ready-to-use therapeutic food for treatment of severe wasting and/or nutritional oedema (reduced quantities)
3. Post exit interventions after recovery from wasting and/or nutritional oedema
   

The methodology should support in estimating the cost and potential cost savings associated with the implementation of treatment protocols and service delivery models aligned with the 2023 WHO guidelines on the management of wasting. The aim will be to refine cost optimization strategies associated with country implementation and integration of the recommendations of the WHO wasting guideline in health systems.

Countries are being supported to develop or update their national guidelines, taking into consideration the WHO recommendations. The methodology/ tool to calculate the cost implications will be used to estimate the impact of the new treatment pathway on the cost of implementing the programme.

Please note that there is a systematic review of economic evidence informing the 2023 WHO guideline, specifically around inpatient and outpatient/community management of wasting and nutritional oedema, synthesizing evidence on resources required for, costs associated with and the cost-effectiveness of: a) initiation of treatment in a community setting, b) initiation of treatment in outpatient settings, c) referral to treatment from community to outpatient settings, d) referral to treatment in an inpatient setting, e) transfer from inpatient to outpatient/community treatment, f) transfer from outpatient to community settings and, g) discharge from outpatient/community treatment. WHO guideline on the prevention and management of wasting and nutritional oedema (‎acute malnutrition)‎ in infants and children under 5 years

Work to be performed

Deliverable 1: Overall methods protocol

• development of a methodology and conduct in-depth assessments in three or four countries (to be determined) in EMRO and AFRO.  The methodology protocol should include the following:
• background and justification for the assessment
• study design
• study methods
• the protocol should be shared with and presented to the WHO technical team for review prior to completion

 Deliverable 2: Mapping of treatment pathways (both the old and the new pathway)

• Development of a standardised template for documenting current treatment pathways across countries capturing key activities, cadres involved, and resource inputs, to serve as the comparator for cost analysis in Deliverable 3. This can include:
  • desk reviews (e.g., of national and international guidelines, programme documents, other literature), and
  • interviews with country-level expert
• The outcomes of this deliverable should be shared with and presented to the WHO technical team for review prior to completion

Deliverable 3: Cost decomposition

• Baseline cost decomposition: identifying and costing the main activities and resource inputs associated with the current treatment pathway, to serve as the comparator against which the costs of the new treatment pathway

These activities can include:

• desk reviews (e.g., of national and international guidelines, programme documents, other literature), and
• interviews with country-level experts
• validation workshops with country- and international-level experts, organized in close coordination with WHO technical team.  The outcomes of this deliverable should be shared with and presented to the WHO technical team for review prior to completion.

Deliverable 5: Decision modelling (including data collection and analysis) to estimate costs and cost impact.

• The model will use information from Deliverables 2, 3 and 4 to get the cost per child treated for each pathway, and the cost impact on the new treatment pathway.
  

Deliverable 6: Reporting and Dissemination

• This deliverable will include the provision of a written report to be shared with and presented to the WHO technical team. Support in the development of presentation materials and delivery of presentations may also be requested, depending on programme needs.

Deliverable 7: Country specific deliverables based on the above developed methodology (5 countries)

Use the methodology developed in Phase 1 and tested in 3 countries to do in-depth assessments in additional 5 countries included in the Global Action Plan on child wasting.

• Mapping of treatment pathways
• Cost decomposition
• Impact of the new pathway to the cost structure
• Decision modelling (including data collection and analysis)
• Reporting
• Protocol amendments based on country context

Timeline/conditions for delivery of services:

• The bidder will be requested to provide the above services between 30/09/2026 and 31/12/2027.
• The service provider should be represented by a single interlocutor who is ready to invest in this project and review the material provided.
• The work should be performed remotely with provision for up to 6 teleconferences to discuss: the initial scope and feel of the project, and a teleconference upon delivery of each of the outputs; and for the graphics to be used, the provider should allow for one review and one revision of the images to ensure that they are correct and applicable for the training. 

Bidding Process

Please send your offer by 11 September 2026, 17h00 - (Geneva time) to NFS@who.int  with, as a subject line:
CALL FOR OFFERS / Wasting and nutritional oedema.

The bid should include:

• your proposed approach and timeline; 
• information (CV) on the project team leader (the focal point for WHO);
• summary information on two reference projects with similar scope/complexity; and
• a financial offer.  The offer should include a clear budget breakdown based on outputs.