International consultant to provide technical support in strengthening measles and rubella routine immunization

Ukraine is facing a measles outbreak for the last 18 months which is not decreasing. The health team is comprised of a chief of section, a health and an HIV/AIDS specialists implementing on-going country programme. There is no dedicated function at the country office level to support data collection analysis. Therefore, the country office is seeking external expertise to undertake this work.

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Purpose of Activity/Assignment:

Ukraine is a Middle-Income country in ECA region with one of the lowest immunization coverage rates in the region. According to latest WHO/UNICEF Joint Reporting Form (JRF), DTP3 immunization rate is 50% and 84% for MMR2. Country didn’t report subnational coverage in the JRF, however many districts have coverage lower that 80%. There are several factors influencing immunization coverage in the country: weak commitment and public health leadership to immunization at subnational level, system related bottlenecks, including poor planning and procurement capacities, weak vaccine supply management and monitoring system coupled with lack of knowledge and low confidence among health workers. The ongoing health reform poses challenges to primary health care services including for immunization. In addition, ongoing conflict in the East of Ukraine influences immunization program in affected regions. Ministry of Finance does not recognize the need for additional funding/ budget in a course of outbreaks, and it is not recognized by local authorities either.

Behavioral analysis demonstrates that caregivers are becoming more inclined towards vaccinations in both  their perceptions and practices. Positive attitudes towards vaccination among parents in Ukraine have grown from 28% in 2008, to 46% in 2012, to 72% in 2014, and up to 75% in 2017. Some 84% of parents stated that they are vaccinating (or trying to vaccinate) their children according to national vaccination schedule in 2017, while there were only 63% of parents with such statement in 2014^[1]. Key factors contributing to these positive trends are improvement in access to vaccines due to changes in the state procurement system, and comprehensive efforts in building capacities of health workers as well as building knowledge among parents. 

System delivery and performance are in need of strengthening through technical support. Gaps related to the immunization programme management remain at regional level, where vaccines are not timely distributed and are not timely picked up by the health facilities. There is a need to enhance management capacity and leadership, and to foster ownership by the newly established “consolidated” municipalities. Remaining challenges for the immunization programme are observed at national and local levels and are related to both system delivery and demand among beneficiaries.

Due to low immunization coverage and cumulation of susceptible population, Ukraine experienced polio outbreak in 2015/16 and currently has the largest measles outbreak in Europe with over 40,000 measles cases only in 2018. The country remains vulnerable to other outbreaks, including diphtheria. There are reported cases of tetanus in children, including lethal cases and also frequent pertussis outbreaks. Despite some positive results, the overall vaccine coverage remains suboptimal, demonstrating that the polio and measles outbreaks are a symptom of a more profound and complicated issue; obstacles surrounding immunization are systemic and require a more evidence based comprehensive and sustainable approach in order to address critical bottlenecks, which are preventing the success of the national routine immunization program. 

The overall objectives of the consultancy are:

- To perform the review, including desk review of existing evidence, of the measles and rubella routine immunization program with the identification of program strengths and weaknesses, as well as perform root causes analyses to identify critical bottlenecks of low MCV1 and MCV2 coverage at subnational level in 2 selected regions (to be decided in consultation with MoH);

- To assess the response of ongoing measles outbreak, including desk review of partner’s analytical reports with identification of main causes of inefficient response and propose strategies/ recommendations for improvement;

- To develop national and subnational strategy improve MCV1 and MCV2 coverage, including improvement of the ability to respond to measles and rubella outbreaks. Develop   costed action plans to improve MCV1 and MCV2 coverage for two low performing regions (to be identified together with consultant)

- Oversee piloting of action plan in one selected region (region to be identified together with consultant and MOH).

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UNICEF is committed to diversity and inclusion within its workforce, and encourages all candidates, irrespective of gender, nationality, religious and ethnic backgrounds, including persons living with disabilities, to apply to become a part of the organization.

UNICEF has a zero-tolerance policy on conduct that is incompatible with the aims and objectives of the United Nations and UNICEF, including sexual exploitation and abuse, sexual harassment, abuse of authority and discrimination. UNICEF also adheres to strict child safeguarding principles. All selected candidates will, therefore, undergo rigorous reference and background checks, and will be expected to adhere to these standards and principles.

Remarks:

Mobility is a condition of international professional employment with UNICEF and an underlying premise of the international civil service.

Only shortlisted candidates will be contacted and advance to the next stage of the selection process.

“UNICEF has a zero-tolerance policy on sexual exploitation and abuse, and on any kind of harassment, including sexual harassment, and discrimination. All selected candidates will, therefore, undergo rigorous reference and background checks.”