UNICEF Zimbabwe: Inviting proposals from individual national consultants for Technical support to the Ministry of Health & Child Care, Zimbabwe for conducting a Knowledge,Attitudes & Practice Study that developes a National EPI Advocacy, SBCC Strategy

The KAP & SBCC Consultant will provide technical support to the EPI unit of Ministry of Health and Child Care- Zimbabwe to design and conduct a comprehensive KAP study, which will generate data on current knowledge, attitude and practices among caregivers, health workers and influential people on immunization and supporting health-related behaviors; communication barriers and drivers to accessing immunization and other health services. He/she will work in coordination with the relevant MoHCC departments (EPI, Health Promotion, Epidemiology and Disease Control).

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Background

The Expanded Program for Immunization (EPI) is at the core of Primary Health Care (PHC) and remains a dominant strategic pillar of health interventions to reduce under 5 morbidity & mortality rates. The Zimbabwe Expanded Program for Immunization (ZEPI) was launched under the Primary Health Care Program, with the main objective of reducing mortality & morbidity from vaccine preventable diseases (VPDS). During the first decades post-independence, the EPI programme sustained a high coverage of immunization above 80%. However, the success in EPI has been at significant risk because of the adverse political, social and economic environment. The implementation of the National Health Strategy & the related EPI component have been undermined by a number of health system challenges which include human resources for health, poorly performing National Health Information Surveillance System,  inadequate health financing as well as sub-optimal health infrastructure characterised by varying states of dilapidation and lack of investment in new essential equipment.

It is against this background that UNICEF Zimbabwe is looking for a Consultant to support Ministry of Health & Child Care (MoHCC) to design & conduct a Knowledge, Attitude & Practice (KAP) study to inform the development of EPI Communication Strategy to better understand communication barriers & drivers for immunization programme in Zimbabwe. The proposed KAP Study is part of the GAVI-HSS project that aims to increase community demand for immunization services through comprehensive advocacy, social mobilization & communication activities. The research findings will be used to inform the development of a National EPI Communication Strategy, which will address social norms, knowledge gaps, attitudes and key behaviours in order to improve immunization practices among caregivers.

Rationale

Within the GAVI-HSS Project, Ministry of Health and Child Care (MoHCC) is collaborating with UNICEF, WHO & other partners to strengthen the capacity of integrated health systems to deliver immunization as well as maternal & child health services. This initiative will address systems bottlenecks in order to improve immunization & child health outcomes, including coverage and equity.

Purpose of Consultancy

The KAP & SBCC Consultant will provide technical support to the EPI unit of Ministry of Health and Child Care- Zimbabwe to design & conduct a comprehensive KAP study, which will generate data on current knowledge, attitude & practices among caregivers, health workers and influential people on immunization and supporting health-related behaviors; communication barriers & drivers to accessing immunization & other health services. He/she will work in coordination with the relevant MoHCC departments (EPI, Health Promotion, Epidemiology and Disease Control).

Specific objectives of the research include:

1. Establish current levels of knowledge, perceptions of risk, attitudes & practices among caregivers, health workers and key influences (religious and community leaders) with regards to vaccine-preventable diseases & vaccinations provided by MoHCC.
2. Identify current myths, beliefs about vaccines & vaccine-preventable diseases as well as barriers & drivers for uptake of sustained immunization practices.
3. Identify norms & traditions influencing health-seeking behaviors as well as family & community resilience mechanism to safeguard health of young children.
4. Conduct a communication Analysis in the context of Immunization to establish: Target audiences, current behaviours, barriers to desired behaviours, behavioural objectives, behaviour change mass, interpersonal, group communication & information preferences [ channels, approaches, media, interventions etc]
5. Identify economic & social power dynamics in communities & decision-making processes in families & communities related to child’s health and vaccination in particular.
6. Identify possible entry points for communication including ideas for messaging.
7. Assess health workers including Village Health Workers’ knowledge & practice in communicating key immunization & other child health messages to families and caregivers.
8. Assess community & religious leaders knowledge & attitudes about vaccine preventable and other child health diseases, causes of common childhood & maternal health problems (diarrhea, malaria, pneumonia, maternal & new-born complications, vaccine-preventable illnesses), and how to prevent or treat these problems & their engagement & influence in care-seeking for immunization and child health.
9. Explore perceptions & preferences by vaccine objectors to positively uptake childhood immunization, what works for them, what has not worked, and recommendations going forward.

Scope of work

The Consultant will undertake the following tasks:

1. Undertakes literature review of existing policy and programme documents as well as available research documents & EPI KAP studies in countries with comparable context.
2. Refines the research methodology including sample size based on consultations with MoHCC and UNICEF & their experts & the National Sampling frame in order to be able to decide on the sample design.
3. Obtains the approval & support for the survey from MRCZ
4. Prepares an inception report
5. Prepares, translates into major local languages & pre-test the research instruments.
6. Conducts field research as per proposed & agreed methodology
7. Inputs, clears for errors and analyses the collected data
8. Prepares initial KAP survey report with preliminary findings & shares it with MoHCC and UNICEF and other stakeholders.
9. Review the current EPI communication strategy, design a social behaviour change communication, social marketing and demand generation strategy based on evidence gathered in the KAP, Communications Analysis . Develop an accompanying implementation plan,  costed budget & communication M&E plan.

Conducts stakeholders meeting to present major communication strategy components & prioritize interventions based on evidence generated from the KAP Study

10. Finalises the KAP Survey report & EPI communication/demand promotion Strategy based on comments and suggestions from the Technical Advisory Group and submits it to MoHCC and UNICEF in a publishable format. The KAP Survey report and  the EPI communication, social marketing & demand generation strategy shall be based on UNICEF standard format.

Research Methodology

The methodology for the study will include quantitative (household/caregivers core survey) and qualitative research (FGD and in-depth interview) be closely linked to the specific objectives of the KAP study. The research consultant is expected to propose a detailed methodology & sampling size for both components of the study. The caregiver survey is intended to provide quantitative measures of caregiver’s knowledge, risk perception, attitudes and practices & will serve as a basis for analysis of changes over time as well as geographic differences across & within the regions. The qualitative research will capture the range of data needed to understand the existing practices,

social norms & traditions as well as barriers & motivators to the recommended immunization & child health practices

Eligible respondents: will include

1.  
2. 1. Caregivers/Caretakers of children under one year of age, predominantly mothers, but will also include fathers);
   2. Primary health care workers;
   3. Community & religious leaders.

The focus on these respondent groups is explained by their role and influence in immunization of children. Therefore, establishing current levels of their knowledge, attitudes and practices as well as concerns and constrains with regards to immunization and key supportive child health practices will be critical for determining communication intervention strategies. In addition to background characteristics of the main respondent, the questionnaire should also include the household listing of all members & their characteristic (age, sex, marital status, educational attainment). Equally important is to determine caretakers mass-media consumption, sources of information for child immunization & health as well as to determine the main & credible sources of information on child health.

Geographical locations: The KAP study will be conducted in all the 11 Provinces & Selected Districts of Zimbabwe using an agreed sampling technique. The questionnaire must be translated in the main local languages of the selected districts.

 Sample Design: A representative sampling frame can be obtained from Zimbabwe Statistical Offices (ZIMSTAT) which will be used to select Enumeration Areas (EAs).

Key areas of inquiry: The consultant is encouraged to use a conceptual framework such as the Social Ecological Model and/or PRECEDE-PROCEED Model/or any relevant Health Behaviour Theories, in the conceptualization of survey variables.

Organization of the KAP Study ; EPI Communication/ Demand Promotion Strategy Design: The consultant will be responsible for implementation of the survey on behalf of the MoHCC and UNICEF. The Consultant will work closely with all relevant departments of the Ministry. The MoHCC will nominate a resource person that will collaborate closely with the survey coordinator, especially at the survey design stage. This resource person is expected to participate in the training, fieldwork supervision and approval of the final report.

Other requirements for the research:

Overall, the research & its report must pay particular attention to & respect dimensions of equity, gender, human rights & humanitarian context. The rights and dignity of those to be interviewed, including children, adolescents, vulnerable populations, women and men must be respected. The norms and standards of UNICEF procedure for ethics standards in research, evaluation, data collection & analysis shall guide the conduct of this research and any persons, institution & affiliates associated with this exercise shall abide by the provisions therein, including conduct, ethics, behavior etc.

Major tasks, Deliverables, Timeframes Payment Schedule

Reporting and Coordination mechanisms

In collaboration with Ministry of Health & key partners, an advisory group will be formed to actively work with the appointed Consultant and to guide the KAP, the process of EPI Communication Strategy Development and capacity building frameworks. This group will develop a progress monitoring & coordination mechanism, & will monitor progress of the projects goals & objectives to ensure their achievement. The consultant will also document minutes of these meetings of the advisory group & all other meetings held related to KAP. This group will be Chaired by Director Epidemiology & Disease Control. The Health Promotion Manager and the EPI Manager will be co- Deputy Chairs.

Consultancy Timeframe

The Key outputs of this KAP study and EPI demand promotion/social behaviour change communication strategy must be complete by the 15^th of October  2018 within a period of 60 working days.

Consultancy Requirements

The Consultant should have the following qualifications

· Advanced university degree in Public Health, Health Promotion or any other related field with emphasis on Health Behaviour Research.

· Minimum of 10 years of progressively responsible professional work experience in the development, planning and management of behavioural change communication programmes, with practical experience in the adaptation and application of communication planning processes to specific programmes.

· A track record in the development of Research Study Designs, Data Collection, and Use of Software packages for Quantitative (Stata, EPI Info7, SPSS etc) and Qualitative (Nvivo, Cs Pro etc) for Data Analysis, Report Writing and Publication.

· Must have Published works in Peer Reviewed Journals

· Able to make Poster presentations for Publication.

· Able to Publish the KAP study in Peer Reviewed Journals

· Demonstrated experience in developing demand promotion/social behaviour change communication strategies for health programmes

· Fluency in English is required

Application Procedure

If interested and available, please submit your application letter, CV, Technical and an all-inclusive financial proposal detailing monthly professional fees, travel related costs for estimated 20 field travel days over the duration of the contract and other miscellaneous expenses. Note that UNICEF shall provide transport for authorised field travel outside Harare

UNICEF is committed to diversity and inclusion within its workforce, and encourages qualified candidates from all backgrounds to apply.