Immunization Equity Assessment

The General objective of this assignment is to conduct equity assessment in three Regions (Gash Barka, Northern and Southern Red Sea) and support the development of context specific action for addressing immunization inequity

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Purpose of the Assignment

The Global Vaccine Action Plan (GVAP 2011 - 2020) calls for the “Reaching Every District” strategic approach to be recast as “Reaching Every Community (Strategic Objective 3).  This is to address inequities in immunization coverage that today results in one out of every five of the world’s children failing to receive at least a basic set of vaccinations during infancy.  These missed children are likely to be found in marginalized and underserved communities outside traditional social and government structures.

In recasting “Reaching Every District” to “Reaching Every Community” as a strategy to address immunization inequities, the GVAP states that National Immunization Programs will need a detailed understanding of the barriers to access and use of immunization; the underserved to be identified, and micro plans at the district and community levels to be reviewed and revised in order to ensure that these barriers can be overcome.  This is particularly relevant today, with the introduction of additional new life saving vaccines, whose benefits will be maximized when the most vulnerable children are reached. 

In Eritrea, Penta 3 coverage is 94.7 nationally as per the EPI coverage survey of 2017. This national average masks the disparity that exists in different Regions (Zobas) of the country where Southern Red Sea, Northern Red Sea and Gashbarka regions have penta 3 coverage of 86%, 91% and 90.8 respectively. The routine EPI data also show that ten districts in the three Zobas are reporting below 80% coverage. The national dropout rate for 2016 was 5.4% which may show below the WHO cut off rate, however the dropout rate differs by Zoba, with some being above the recommended cut off point.

The need to reduce the high drop-out rates and numbers of un-immunized children in Gash Barka, Southern Red Sea and Northern Red Sea region is critical to particularly avoid resurgence of vaccine-preventable diseases, which have been relatively under control.

 In the 2016 EPI review, most of the health facilities visited had EPI micro plans. These plans need to be updated to ensure the interventions include the high risk communities identified. The planned outreach activities have not been implemented regularly, the supervision and mentorship from the Zonal Ministry of health has been weak. The immunization equity assessment will reveal some of the other key bottlenecks to achieving the REC strategic approach.

Assignment Tasks

The General objective of this assignment is to conduct equity assessment in three Regions (Gash Barka, Northern and Southern Red Sea) and support the development of context specific action for addressing immunization inequity. The specific objectives include:

1. Develop training guideline on equity assessment
2. Train Zonal EPI focal persons and build capacity to conduct the equity assessment.
3. Support the National and sub-national stakeholders do immunization equity assessment by reviewing the following sources of data: administrative coverage data, EPI Coverage survey, EPI review, Surveillance review , recent immunization campaign data,  to come up with the following:

• List of categories of high risk communities in Eritrea that are associated with inequities in immunization.
• List of districts affected by immunization inequities.
• Barriers to access and use of immunization for the identified districts and kebabis

• A set of recommendations for programs / districts to include or consider in the annual action plans for high risk communities not be left out

   

1. Support districts to use the REC operational guide and the simple micro-planning guide to update their district and facility micro plans to include interventions for those high risk communities for instance outreaches, health education sessions, tracking of immunization status in such communities
2. Support Health facilities establish regular contact with immunization community focal persons in the catchment area through maintaining a list of their phone contacts, regular feedback meetings on immunization status of the children in the area, involving them in planning and mobilization for outreaches /community health education sessions, facilitating them to maintain a master list of all children 0 – 23 months with regard to their immunization status (Registration of children 0-23months)

Expected Deliverables

Deliverables expected for the consultancy are:

1. Inception report on understanding the assignment
2. Work plan developed on how the activities are going to implemented – by one week after contract signing 
3. Immunization equity assessment report highlighting; categories of high risk communities in Eritrea, districts with immunization inequities,  barriers to access and use of immunization for the identified districts with immunization inequities, recommendations for programs / districts to include or consider in the annual action plans for high risk communities.
4. Report on updates of facility micro plans, feedback meetings of health workers with community immunization focal persons and community participation in outreaches / health education

5. Final consultancy report on delivery of key tasks identified in the work plan, including recommendations, challenges, gaps & best practices – by end of six months

   Timeframe for the Consultancy:

   Estimated total work days for the Consultancy     = 30 days (one and half month)

   Estimated total days for the Consultancy     = 43 days (one and half month) as this includes week end and travel time.

Qualifications of Successful Candidate

• University degree in public health, health and development
• Eight or more years of working experience in the field of immunization  equity, health system strengthening,
• Technical knowledge and experience in application of the RED/REC strategy in other similar settings.
• Experience in undertaking / analyzing data, surveys, and assessments
• Strong facilitation skills, with prior training experience in bottleneck analysis and

Competencies of Successful Candidate

Communication (II), Working with People (II), Drive for Results(II), Leading and Supervising(II), Formulating Strategies and Concepts(II) and Analyzing (III)

To view our competency framework, please click here. 

Please indicate your ability, availability and daily/monthly rate (in US$) to undertake the terms of reference above (including travel and daily subsistence allowance, if applicable).  Applications submitted without a daily/monthly rate will not be considered.

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