Organization: UN Children's Fund
Job ID: #684843
Country: Rwanda
City: Kigali Rwanda
Theme: Health
Job years of experience: 10+ years
Job type: Consultancy
I. Brief Background
Rwanda has made a significant improvement in health in recent years reducing the under-five mortality from 152/1000LB in 2000 to 76/1000LB in 2010 as the country strengthened the health system. Immunization is the good example that proves the strength of the health system from the central to the local level. According to the DHS 2010, fully immunised child status is 90.1% and there is a social norm to follow the routine immunization. The country has successfully rolled out new vaccines such as PCV in 2009, Rotavirus in 2012, MR in 2013 and HPV for adolescent (12-14 years old) girls in 2011.
Rwanda, as other countries using OPV in its routine immunization, is implementing the global polio eradication & endgame strategy 2013-2018. The second objective of this strategy concerns strengthening immunization systems for OPV withdrawal by introducing inactivated polio vaccine (IPV).
Currently, Rwanda is using the combination injectable pentavalent vaccine (containing diphtheria, tetanus, whole-cell pertussis (DTP), hepatitis B and Haemophilus influenza), at the same time as PCV. In November 2013, the World Health Organization’s Strategic Advisory Group of Experts (SAGE) recommended that all 125 countries that are currently using oral polio vaccine also introduce at least one dose of inactivated polio vaccine (IPV) into the routine immunization schedule by the end of 2015. Stand-alone injectable IPV is the formulation that is currently prequalified by WHO, and thus, in many countries including Rwanda,the addition of one dose of IPV to the routine infant immunization schedule will result in one additional injection that will be added to the immunisation schedule. That would create a situation in which total of three injections will be given simultaneously during the child’s EPI visit - adding a potential burden to families and vaccinators alike.
During the 2014 EPI managers meeting, participants raised their concerns on multiple injections and perceptions of care-givers and health workers towards multiple injections. Therefore this study will help to document the perceptions and concerns of health providers especially vaccinators including the feasibility, acceptability and will provide insight that will help in the preparation and introduction process. EPI managers also were concerned by the impact this can cause related to coverage and social norms due to fear of care-givers on multiple injections and which can result in drop out. This study will help to know the acceptability of IPV by caregivers/mothers and will help to develop evidence based communication plan and messages for IPV introduction.
As part of the preparation to introduce the IPV in 2015, the Ministry of Health is developing a communication plan to accompany the roll-out of this new vaccine. This study will inform the IPV communication plan. The recommendations will also inform the country’s strategy to reach Universal Coverage of the basic health care, including the most vulnerable young children.
II. Purpose
The purpose of this study is to look into the knowledge attitudes, practices and perceptions towards multiple injections as part of the routine immunization program.
This study will identify the perceptions of stakeholders including caregivers and health providers on multiple injections as the IPV will be co-administrated together with PCV13 and Penta3. It will help MOH to prevent any negative impact on the actual immunization coverage and to sustain and increase the existing coverage.
This study will also collect systematic knowledge on the provision and the uptake of routine immunization at community level, which will provide basis(data) for the Ministry of Health to identify possible weakness of the existing system as it prepares for the co-administration of IPV, PCV, pentavalent and OPV, with a special focus on the most marginalized and vulnerable young children in support of UNICEF Equity approach that will help the country reach the last unimmunised child.
Major Duties And Responsibilities
1- Identify potential risks/threat to the co-administration of IPV, PCV, Pentavalent and OPV and recommend actions for service provision and health communication (including key messages).
2- Identify perceptions, fears and concerns around multiples injections and the acceptability of the IPV as the third injection, and to recommend solutions to address the identified concerns.
3- Summarise lessons learned and good practices by analysing what works and what does not work (and why) in various aspects related to planning, management and implementation of EPI at local level (at community level and health providers’ level);
4- Identify determinants and the context in which EPI works ; including inter-sectoral coordination within the district level based on the comparison of two communities – one with almost universal coverage and another one with lower coverage;
5- Identify potential introduction of topical anaesthesia in routine immunization program as to increase babies comfortability.
6- Identify the fear related to Adverse Event s Following Immunization.
The findings will be used to prepare guidelines and a communication tool kit to support the introduction of IPV in 2015.
III. Duration
The selected institution will be contracted for three months from the date the contract is signed.
IV. Activities and Deadlines
As a first step, a desk review will be conducted to provide an overview of the EPI system with a focus at the community level. The findings will inform the development of a research tool to ensure that key informants are covered.
The analysis should cover the following:
1- Brief description of the following programme dimensions: targeted population; programme objectives; type of service delivery mode in relation to ages of children targeted; length and intensity of services; special services such as outreach programme that helps the country reach the last child
2- Effectiveness: The analysis should follow the 10 determinants under the bottleneck analysis framework and look for output, outcome and/or impact. The analysis should look into and document the evidence on the extent to which existing system is providing the services as envisaged in the EPI system -- for example, the impact of vaccination in the reduction of respiratory disease and diarrheal disease, and the impact of outreach programme to identify children who were previously out-of-system;
3- Programmatic gaps, constraints and lessons learned;
4- Identification of the factors (predictors) that facilitate/hinder the effective and sustainable EPI programmes as the number of vaccines continues to increase and the disease cases continues to decrease;
5- Strategies applied and strategic outcomes reached;
6- Use of innovative approaches and new technologies;
7- Efficiency and cost effectiveness: direct and indirect costs, programme costs per unit of beneficiaries, source of funding, feasibility, sustainable scalability;
The following information sources are available including but not limited:
National documents: HSSPIII, Health policy, c-MYP, Census report, MOH reports, RDHS, M&E findings related to EPI and community health (HMIS report and SISCOM report),
District level/Health facility level documents related to EPI and outreach
Global documents: Polio eradication strategies and reports, Global vaccine action plan
In the second phase, qualitative study will be planned and implemented in two communities to be selected in consultation with the Ministry of Health and UNICEF based on the desk review: one with almost universal EPI coverage and one with lower coverage. The qualitative study will include visits to the programme sites in the health centre and in the community. In order to meet all the key stakeholders involved, each visit should last at least seven days. The site to be visited will be complemented with discussions with Ministry of Health, UNICEF and other partners. The main activities proposed are:
In-depth interview with key informants (including Directors of Health centre, vaccinators, Community Health Workers, mothers, key influencers of social norm such as village chief, and other key informants identified in the desk review)
Focus group discussion with mothers
The data gathered will be analysed and cross-referenced and compared with existing sources to ensure validity. The study instruments will be reviewed in advance to ensure that it is ethical and that interviewees can openly express their opinions. The researchers will protect the anonymity and confidentiality of individual informants, so that the sources of information are protected and known only to the interviewers. Evaluators will also be sensitive to beliefs and act with integrity and respect to all stakeholders.
I. Expected Products
The following deliverables are expected:
Inception report (including work plan, presentation of methodological approach, instruments to be used, annotated outline of final report), to be presented and approved by the Steering Committee within 2 weeks after signature of the contract;
Interim report(including draft findings, conclusions and recommendations from all data sources used in the analysis);
Presentation set (PPT presentation, two-page summary…), to be analysed and approved by Steering Committee;
Preliminary field reportwithin 2 weeks after the field visit
Final report, as end product, and six case studies, and a monitoring and evaluation plan/framework, subject to approval by the Steering Committee.
Key skills, technical background, and experience required
The institution has a minimum of 10 years’ experience and demonstrated expertise in research, including data collection skills; and qualitative data analysis
Demonstrated analytical skills related to the use of statistics for decision-making in the area of public health;
International work experience in Africa;
Experience in working with UN agencies desired;
The qualification and skills of the lead consultant include:
Advanced degree in Public Health ;
Demonstrated skills and experience in conducting and presenting evaluations/analysis;
Familiarity with technical aspects related to immunization and health system;
Language to be used: English required. Knowledge of French and/or Kinyarwanda will be an advantage;
Work experience in Sub-Saharan Africa;
Experience in working with UN agencies desired;
Evaluators should be sensitive to beliefs and act with integrity and respect to all stakeholders. Evaluators should protect the anonymity and confidentiality of individual interviewees.
How to apply:
Applicants must submit:
Proposal of overall strategic approach for desk analysis and web search;
Sample of similar evaluations/analysis;
List of relevant analytical reports or academic publications;
Curriculum vitae of key members that will conduct the study;
The proposed timeline for the activities;
The expression of Interest should be sent by email to rwasupply@unicef.org and copy to Denis Mupenzi (dmupenzi@unicef.org) and Yvonne Kasine (ykasine@unicef.org)
Application Closing date: 29 Aug 2014
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