Development of a national behavior change communication strategy to achieve COVID-19 vaccination uptak

1. Background

1.1. Context

To date, Sierra Leone has received in country 338,000 doses of COVID-19 vaccine from:

o 96,000 AstraZeneca Vaccine doses through COVAX on 8th March 2021;

o 42,000 AstraZeneca Vaccines doses through African Vaccine Acquisition Task Team (AVATT) on 22nd March 2021;

o 200,000 SinoPharm Vaccine doses from PR China.

The country is expected to receive at least 200,000 further doses of the AstraZeneca vaccine via COVAX. Vaccine rollout was launched on March 15th with high profile politicians, including the President and Minister of Health, receiving the vaccines. This was followed by a district-level roll-out starting on March 22nd. As of 11^th July 2021, 145,825 people have received their first vaccine dose, representing 59.6% of the 244,802 people targeted for vaccination in Phase I of the NVDP. To date 88,870 people are fully vaccinated.

The NVDP lays out a scientific plan based on epidemiological data and existing system capacities to equitably, efficiently and effectively distribute available vaccines. The goal is to optimize vaccine distribution in order to minimize mortality and morbidity and disruptions to the economic and social systems. While the overall strategy for vaccine rollout was developed at national-level, DHMTs will take the lead on coordinating the last mile distribution and coordination. The NVDP dictates that the COVID-19 vaccine will be rolled out in three phases, i.e. Phase I – three percent of the population (health care workers) and persons aged ≥ 70 years. Phase 2 will involve 17% of the population (persons aged > 40 years and < 70 and those below 40 years with comorbidities and risk factors), with first preference given to the districts with the highest number of new COVID-19 cases. The remaining population (16 – 40 years) will be targeted in phase three (3) as additional resources become available. This action will support with Phase I of vaccine distribution, and support uptake of second dose vaccination across all phases.

Public acceptance of vaccines has reduced in recent years. WHO has labelled this “vaccine hesitancy” as one of the top ten threats to global health, noting its potential to undermine much of the progress achieved in the 20th and 21st century to overcome infectious diseases. A variety of factors contribute to COVID-19 vaccine hesitancy, but social media has increasingly played a role in undermining public confidence in vaccine efficacy and willingness to accept vaccinations. This “infodemic” led to a rapid spread of inaccurate information and rumours regarding COVID-19 symptoms, treatment, and causes, as well as reduced confidence in the vaccines. The partners also acknowledge the rapidly changing context in relation to the safety, reputation and availability of COVID-19 vaccines. The likelihood of new variants developing also calls for a flexible and agile response.

Drawing on results from multiple studies, the most common reasons for COVID-19 vaccine refusal were generalized mistrust of all vaccines, concerns about COVID-19 vaccine safety and efficacy, and a belief that COVID-19 was either not real or not very dangerous. In Sierra Leone, more than 25% of those surveyed in 2020 said they would not take a COVID-19 vaccine if it were offered; of these refusers, nearly 60% cited fear of side effects as their main concern. Other reasons included not believing vaccines are effective at preventing infection or lack of concern over COVID-19. There remains a need to deepen understanding of the barriers to receiving accurate information and of acceptance of COVID-19 vaccination, and particularly of the differences among population groups (e.g. rural/urban, different education levels, gender and age differences, people living with a disability or chronic illness).

Due to COVID-19 vaccine safety concerns, lack of trust, misinformation, plus insufficient resources for district level vaccine program publicity and operational rollout; there is a high risk of slow progression to Sierra Leone’s population herd immunity even with availability of vaccine doses. Consequently, there are risks of increased levels of community transmission and possibilities of further viral mutations which may negatively affect vaccine efficacy and ability to prevent future ‘waves’ of infection.

There is urgent need to fully understand barriers and enablers to first and second dose vaccination and to develop appropriate MoHS approved risk communication and community engagement (RCCE) messaging education, particularly for specific groups (gender and age disaggregated, persons living with disabilities, persons living with HIV, ‘hot-spots’ with misinformation circulating etc.), thus encouraging future COVID-19 vaccine uptake.

The target audience for the Strategy is nationwide but with a need for a multifaceted and innovative approach which will ensure accessibility to up to date, reliable, accessible and accurate information for all populations.

An experienced, efficient, collaborative and innovative Creative Agency will be identified and contracted by Concern. The Creative Agency will have presence in Sierra Leone and experience in both mass media, social and behaviour change communication and community engagement activities.

2. Purpose

The purpose of this work is to support Ministry of Health and Sanitation in designing, implementing and evaluating an innovative and effective COVID-19 vaccination behaviour change communication intervention, with reference to the existing Sierra Leone Health Promotion Strategy (2017-2021) and in collaboration with existing BCC and COVID response pillar members.

3. Indicative outputs

Research component

· An overall barrier and enabler analysis.

· Creative brief based on the findings of the barrier analysis

· An impact evaluation report outlining the results and the key learning

· Articles for possible publication

BCC

· A set of tools for the promotion of COVID-19 vaccination doses 1 and 2, adapted to the local context with clear definition between tools to be utilised in geographic regions based on sociocultural context.

4. Proposed activities

4.1. Phase 1 – Inception

4.1.1. Barrier analysis

The behaviour change focus will be uptake of both first and second dose of the COVID-19 vaccination. There will be clear recommendations for approach and tools based on geographic region and population sub-group.

Recommendations will be formulated from the results of the barrier analysis which will focus on;

· Identify the psychological and situational factors influencing the behaviour of interest (i.e. barriers and motivations to accessing COVID-19 vaccination)

· Identify the people of influence to the target audience

· Explore the influence of cross-cutting issues such as gender equality (including barriers personal agency), HIV and disability in the adoption of the behaviour of interest

4.1.2. Strategy design and creative brief

This package will be designed, developed and piloted based on the findings of the barrier and enabler analysis and in close collaboration with MoHS, UNICEF and WHO in-country. A behaviour change strategy (or creative brief) will be written and will inform the selection and development of communication tools, the selection of activities at community level and their potential impacts on the targeted behaviours. The development of the behaviour change strategy will take into account the human and financial resources available to deliver it as well as the timeframe for implementation.

Specific promotional materials and activities will be developed for each identified behaviour and implemented as one package. The production of these communication tools will be conducted in collaboration with Concern, IRC UN agencies and MoHS.

Interventions within the communities will be designed to be appropriate for maximum coverage taking into account; low literacy community members, differences in regional sociocultural norms, key accessible languages and accessibility of information to at risk groups including people living with chronic disease (including TB and HIV), People living with disabilities and the elderly.

4.1.3. Framing workshop

A ‘framing workshop’ for programme stakeholders will be facilitated to review contextual factors influencing the target behaviours and to adapt/ validate the draft BCC strategy. This workshop will target the relevant programme stakeholders for the selected behaviours such as Ministry of Health and Sanitation (MoHS), District Health Management Team (DHMT), international and national NGOs, community representatives, traditional and religious leaders etc.

During the meeting the creative brief will be presented including sample materials and activities proposed for the intervention.

The creative agency will finalise BCC materials and activities based on the creative brief and framing workshop, for the promotion of COVID-19 vaccination.

The creative agency will field test these materials and activities and pilot them to ensure they display the correct messaging, are feasible to deliver as intended, and they elicit the intended (initial) responses in the target audience

Concern will closely monitor the creative work carried out by the Creative Agency and will validate the BCC materials and activities after they have been field tested by the Creative Agency.

4.2. Phase 2 – Delivering the intervention

The creative agency is expected to deliver a full suite of tools and resources to support the developed BCC strategy (as a minimum this is expected to include social media content, radio content and visual resources). Agencies are encouraged to propose an innovative range of communication methods but must ensure that the package has the potential to reach every member of the population with a particular effort to reach vulnerable and marginalised groups (rural, low income, low literacy, poor network coverage, PWD (sight or hearing disabilities) etc.).

In order to ensure full evaluation can be conducted the creative agency is expected to also deliver these strategies in a minimum of 2 districts (Western Area Urban and Port Loko) in order to have representation of 2 contexts in the evaluation report.

The creative agency is expected to deliver a full suite of tools and resources to support the developed BCC strategy (as a minimum this is expected to include social media content, radio content and visual resources). Agencies are encouraged to propose an innovative range of communication methods but must ensure that the package has the potential to reach every member of the population with a particular effort to reach vulnerable and marginalised groups (rural, low income, low literacy, poor network coverage etc).

In order to ensure full evaluation can be conducted the creative agency is expected to also deliver these strategies in a minimum of 2 districts (Western Area Urban and Port Loko) in order to have representation of 2 contexts in the evaluation report.

Proposals from creative agencies may include nationwide delivery of some or all strategies, this should be clearly stated in the narrative and budget proposals including timeline and frequency. If an agency plans to utilise a sub-contractor for any part of the project this should be clearly stated in both Narrative and financial proposals.

Following the barrier analysis and framing workshop the intervention will be finalised and must respond to the issues raised in the BA.

4.3. Phase 3 – Monitoring & Evaluation

4.3.1. Ongoing Monitoring

Ongoing monitoring of the BCC strategy will be carried out by Concern through review of reports, and regular coordination (minimum monthly) meetings (remote or in person) with the creative partner, project staff and MoHS/ UN partners. Assessing the implementation fidelity of the intervention will be important for understanding intervention effects. The BCC partner will be expected to present the results of initial impact/ effectiveness evidence (after 3 months) to this forum.

Through these meetings, adaptation of the strategies in line with measured impact/ effectiveness should be considered. Including discontinuation of any interventions reported as showing little value for money.

4.3.2. Evaluation purpose

The creative partner will conduct an after action evaluation which will aim at responding to the following research questions:

1) Did the intervention result in a change in the target behaviour(s) and barriers identified in the inception phase?

a. For whom did the intervention work or fail? Why?

b. Do communitiees/ target groups consider that the BCC strategy met their needs.

2) What aspects of the intervention implementation process explain the outcome?

3) What adaptations are recommended for the BCC strategy’s continued use?

4) Were there any unintended/ unexpected results (positive or Negetive.

If the final intervention package results in the development of interventions that needs to be evaluated in different populations, this would need to be taken into consideration in the evaluation.

4.4. Selection of creative agency

Creative agencies are expected to apply for this opportunity with the following;

1. Pitch presentation in a format which highlights the agencies range of skill and innovative approaches as well as their level of in country capacity.
2. Examples of past performance in health BCC and documentation reports.
3. Detailed outline of proposed barrier analysis methodology including sampling methodology, proposed tools and timeline.
4. A detailed implementation plan (August 2021-March 2022) with assumptions to complete activities in the proposed time frame.
5. Full detailed budget inclusive of all project and overhead costs clearly highlighting in country taxes where applicable.
6. CVs of key team members for the proposed project.

Project lead requirements;

Qualifications

· Minimum of MA/MS in Communications or International Development with an emphasis on communication for development (a combination of strong field experience and a Bachelor’s degree will also be considered).

· At least 5 years of relevant experience required (8 years, preferred), including 2-3 years of implementation experience.

· Excellent interpersonal, teambuilding, problem solving, and program management skills required.

· Demonstrated experience in the use of new and emerging communication technologies to reach audiences effectively and at scale, and in assessing knowledge sharing needs and identifying appropriate dissemination activities.

· Demonstrated experience in conducting and analysing a barrier analysis especially in relation to vulnerable or marginalised groups.

· Successful planning, facilitation, and management of events including stakeholder/audience consultation workshops, materials/product pretesting activities, focus groups, meetings, conferences, and program launches.

·
Outstanding interpersonal and intercultural skills.

· Experience supporting field teams to complete objectives/activities on time and within budget, while meeting high standards.

· Knowledge of international development and/or health promotion.

· Excellent analytical, writing, and oral presentation skills: English fluency required.

· Experience working with local and national media, radio, TV and social media platforms in low-income settings (preferably in Sierra Leone).

Selected agencies will attend a pitch meeting with representatives of Concern Worldwide, IRC and partner agencies including MoHS and UN.

The successful applicant will meet with Concern worldwide to finalise budget, deliverables and contract signing.