Consultancy to conduct review of evidence on factors influencing immunization in CEE/CIS region

Consultancy to conduct review of evidence on factors influencing immunization in CEE/CIS region. Home based with travel to selected countries of CEE/CIS region. Duration: 55 days distributed over 4 months, Aug-Nov 2017.

If you are a committed, creative professional and are passionate about making a lasting difference for children, the world's leading children's rights organization would like to hear from you.

For 70 years, UNICEF has been working on the ground in 190 countries and territories to promote children's survival, protection and development. The world's largest provider of vaccines for developing countries, UNICEF supports child health and nutrition, good water and sanitation, quality basic education for all boys and girls, and the protection of children from violence, exploitation, and AIDS. UNICEF is funded entirely by the voluntary contributions of individuals, businesses, foundations and governments.

Background

Immunization is one of the most cost-effective public health interventions, saving millions of lives and protecting countless children from illness and disability. The percentage of children receiving diphtheria, tetanus and pertussis (DTP) containing vaccine is often used as an indicator of how well countries are providing routine immunization services. Although the regional coverage for the third dose of DTP increased from 74 per cent in 1990 to 93 per cent in 2000, it registered a slow decrease in 2015, to 91 per cent. Despite increased vaccine coverage against measles (up from 63 per cent in 2000 to 91 per cent in 2015) around 525,000 children in the region^[1] are still not protected against this preventable, life-threatening disease.

In several countries in the region, there are groups with extremely low immunization coverage, Roma population being the most affected. According to the most recent Multiple Indicators Cluster Surveys, in the Former Yugoslav Republic of Macedonia, only 65 per cent of Roma children age 18-29 months had all the recommended vaccinations by their first birthday, compared with 91.3 per cent of children in non-Roma population (MICS 2011). In the Roma settlements in Serbia, only 44 per cent of children age 24-35 months received all recommended vaccines, compared with 81 per cent of non-Roma children (MICS 2014). In Bosnia and Herzegovina, only 4 per cent of Roma children received all recommended vaccines, compared with 68 per cent of non-Roma children (MICS 2011-2012). Four countries in the CEE/CIS region have registered significant decrease in their immunization rates over the past decade. In Bosnia and Herzegovina, the coverage with has decreased from 93 per cent in 2005 to 82 per cent in 2015, in Romania – from 97 to 89 per cent, in Moldova – from 98 to 87 per cent, and in Ukraine from 96 to 23 percent.

The available evidence shows that the routine immunization services in several countries are no longer performing adequately, which in turn has led to the re-emergence of vaccine-preventable diseases like polio and measles in this region. The polio outbreak in Central Asia in 2010, Ukraine in 2015 and continues measles outbreak across the region underlines the consequences of a failure of routine immunization. Outbreaks occurring in one place have the potential to spread rapidly to others, revealing both the mutual interdependence and vulnerability of all countries.

 While issues related to supply have been identified in some countries as influencing the drop in immunization coverage, parents’ hesitancy (refusal or delay) to immunize their children is believed to be another major cause of the decrease in immunization rates in CEE/CIS.

Purpose  and Objectives of the Assignment

The objectives of this consultancy are:

1. 1. To analyse and document the vaccine hesitance movements in the CEE/CIS region.
   2. To identify and document successful interventions and good practices in the region (if any) to improve demand for/uptake of vaccines.
   3. To analyse and document the underlying and structural factors leading to the decrease in immunization rates in Bosnia and Herzegovina, Moldova, Romania and Ukraine.
   4. To develop a draft roadmap to increase immunization coverage, including strengthening demand for immunization and addressing vaccine hesitancy in the CEE/CIS region

To achieve the objectives above, the consultant will:

• Undertake a systematic review of evidence around vaccine hesitancy in the CEE/CIS region. The consultant will analyse and describe:
  • The magnitude of the issues in the region.
  • The profile of anti-vaccine activists in the region and at country level – who they are, where they are, and the profile of the audience (people who engage with anti-vaccine activists, consult their sources of information etc.).
  • Platforms of communication – what are the platforms used by anti-vaccine movements; how are they used; what is their coverage and audience.
  • Messages, tools and tactics – what are the messages disseminated; what communication tools do they use; how do they engage with audiences; how conversations are moderated; what strategies they use to expand the reach.
  • Sources of information – what sources of information they use or make reference too; where are those messages and materials developed, and by whom; how is the information adjusted to the local context (translated), and by who etc.
  • Interventions and practices to address vaccine hesitancy in the CEE/CIS region, including what works and what does not.
• Undertake a systematic review of evidence on regional immunization initiatives to identify and document successful interventions and good practices in the region, if any, to improve demand for/uptake of vaccines.
• Undertake a systematic review of evidence (national statistics, including national reports, peer review journals, documentation from non-governmental organizations, Multiple Indicators Cluster Surveys, Knowledge, Attitudes and Practice surveys, qualitative research etc.) and conduct semi-structured interviews and/or focus group discussions with key informants including government officials and partners in Bosnia and Herzegovina, Moldova, Romania and Ukraine to:
  • Identify, by examining both the supply and demand side, the key factors leading to decrease in immunization rates in the CEE/CIS region (causality analysis), and asses their ‘weight’, if possible.
  • Establish the extent to which vaccine hesitancy is having an impact on immunization coverage, who are the key actors, the messages and platforms used etc.
  • Identify and analyse interventions and practices to improve the demand for/uptake of vaccines, highlighting lessons learned, what worked and what not.
  • Identify evidence gaps and formulate recommendations for additional research to be conducted to understand better the key factors affecting immunization in the region.
  • Identify and recommend potential strategic partners to engage with at various levels in the CEE/CIS region to address factors affecting vaccine hesitancy.
• Develop a draft roadmap to increase immunization coverage, strengthen demand for immunization and address vaccine hesitancy in the CEE/CIS region, clearly highlighting the gaps to be addressed and suggesting relevant evidence-based approaches.

 The consultancy will help understand the causes leading to the decrease in immunization rates, offering RO additional evidence to support country offices in designing and implementing evidence-based interventions in the area of immunization, including how to address vaccine hesitancy

Details of how the work should be delivered

To accomplish the tasks above, the consultant will conduct a desk review of quantitative and qualitative research, statistical data, etc. and will conduct interviews/focus groups discussions with key informants in Bosnia and Herzegovina, Moldova, Romania and Ukraine.

 The consultant is expected to implement all activities from August to November 2017, in close consultation with UNICEF RO C4D and Health teams. A detailed plan of action, with specific timeline will be developed after the contract is signed. The consultant will be responsible for undertaking the tasks outlined below (switch to internet explorer in case the table is not displayed correctly).

Performance indicators for evaluation of results

The performance of work will be evaluated based on the following indicators:

• Completion of tasks specified in ToR
• Compliance with the established deadlines for submission of deliverables.
• Quality of deliverables.
• Demonstration of high standards of work.

Qualifications/specialized knowledge/experience required to complete the task

• At least 5 years of experience in conducting systematic reviews and statistical meta-analysis.
• A post-graduate degree preferably in public health and social sciences.
• Proven knowledge on immunization.
• Proven experience in working on communication for development, including in immunization (demand side analysis; vaccine hesitancy).
• Excellent command of English. Knowledge of other language from the CEE/CIS region is an asset.
• Excellent analytical skills.
• Demonstrated ability to produce high quality results in a timely manner.
• Responsive to client requirements and feedback.
• Proven familiarity and experience working with the UN (ideally with UNICEF) is preferred.
• Initiative, passion and commitment to UNICEF’s mission and professional values.

Applications

Interested candidates should submit:

1. Please complete and submit a CV and Personal history form (downloadable from http://www.unicef.org/about/employ/files/P11.doc). Alternatively, if a candidate profile in the UNICEF e-Recruitment System is available, you may download it and submit it as part of application.
2. Please submit two examples systematic literature review previously conducted (preferably on immunization related issues).
3. Please provide a financial offer, with a daily rate in USD. Travel and accommodation expenses for the planned travels shall not be included in the financial offer, but will be reimbursed by UNICEF additionally based on submission by the consultant of the air fare receipt  economy class) and in accordance with standard UN per diem rate for each night spent in the designated location.

The candidates will be evaluated against the following criteria:

Candidate profile, based on required qualification and experience - Maximum points 40

Quality of previous work, based on the submitted examples - Maximum points 60

Total points: 100

The candidates with receive a minimum of 70 points will be considered further

 Applications submitted without a daily/monthly rate will not be considered

Payment schedule

UNICEF will issue a consultant contract in USD. The payment will be made in USD by bank transfer and in two instalments – 50% after the submission of the first draft report, and 50% after the submission of the final report and roadmap. The consultant will send invoices and payment will be made upon satisfactory completion of deliverables.

If the reports and documents are not submitted according to the deliverables and timeframe stated in this TOR, the payments will be withheld.

 UNICEF reserves the right to withhold all or a portion of payment if performance is unsatisfactory, if work/outputs is incomplete, not delivered or for failure to meet deadlines. All materials developed will remain the copyright of UNICEF and UNICEF will be free to adapt and modify them in the future.

Reporting

The contractor will be supervised by and will report to the Regional C4D Advisor and in close coordination with the Regional Health Advisor. Regular emails and phone/Skype calls will be used to update the supervisor

Administrative issues

UNICEF will facilitate both communication with key stakeholders to be interviewed, and access to UNICEF supported immunization-related research.

 UNICEF will not provide office space, equipment or any other facilities. The consultant is expected to be fully self-sufficient.

 UNICEF is committed to diversity and inclusion within its workforce, and encourages to apply qualified female and male candidates from all national, religious and ethnic backgrounds, including persons living with disabilities.

UNICEF is committed to diversity and inclusion within its workforce, and encourages qualified female and male candidates from all national, religious and ethnic backgrounds, including persons living with disabilities, to apply to become a part of our organisation.