Terms of Reference- Literature review of behavioural barriers related to the uptake of routine childhood immunisation and the HPV vaccine in Ethiopia At Girl Effect

Terms of Reference- Literature review of behavioural barriers related to the uptake of routine childhood immunisation and the HPV vaccine in Ethiopia

About Girl Effect

Girl Effect (GE) works to break the cycle of intergenerational poverty for girls. We believe that if we stop viewing girls as part of the problem and see them as participants in new solutions, they can rewrite their future and their children’s – creating a better reality for all. However, social norms hold girls back. Even when the services they need are available, individual and societal barriers prevent girls from accessing them – these ‘invisible barriers effectively confine them’. We want to reframe how girls are valued by changing how girls and the people around them think, feel and act.

We do this by helping connect girls to each other and to the critical assets they need by harnessing the power of mass culture media brands to reframe the value of girls. Everything we do is driven by girls and accelerated by technology to deliver the biggest impact. Working with our partners, we reach millions of girls in more than 60 countries through the technology girls use every day.

At Girl Effect, we empower girls to navigate the pivotal time of adolescence, so they are enabled to make choices about their health, education, and economic future – no matter where in the world they live.

We use our in-depth understanding of the real needs of girls, along with innovative behaviour change science, to create branded media girls love; virtual and real-world spaces where they can be inspired, informed, connected to services and to others—ultimately, so they can take action to change their lives.

Summary of the partnership with Gavi, the Vaccine Alliance

GE first partnered with Gavi between 2016 and 2021 on routine childhood immunisation and HPV vaccine demand generation. The successful collaboration continues with a new phase starting in 2022 and will run until 2025.

In Ethiopia, the objectives of the project are:

Objective 1: Identify and understand critical barriers, with particular emphasis on gender-related

barriers that 13 – 29-year-olds face around

• understanding the need for and importance of vaccine programmes (childhood immunisation and HPV),
• vaccine uptake and health decision-making behaviour (childhood vaccinations and HPV),
• gaining knowledge and confidence to use available health services for vaccinations

Objective 2: Use findings from the research into barriers to create and deploy specific and demand

generating strategies to increase awareness of health issues and increase vaccination rates

(childhood vaccinations and HPV) in target locations.

Objective 3: Analyse programme results and disseminate learnings within the sector (with MoH

and other partners) to ensure tools are appropriately devolved for sustained use.

HPV Vaccines

Human papillomavirus (HPV) vaccines prevent infection by certain types of human papillomavirus. Available HPV vaccines protect against either two, four, or nine types of HPV. All HPV vaccines protect against at least HPV types 16 and 18, which cause the greatest risk of cervical cancer.

The HPV vaccine is recognised as an important prevention strategy, with the WHO recommending HPV vaccines to be included in routine national immunisation programs as a public health priority (Perlman et al., 2014). HPV vaccines are most efficacious in females who have not been exposed to vaccine-related HPV types (WHO, 2012). Consequently, the primary target population will likely be girls between 9 and 10 years to 13 years. This cohort is selected based on the age of initiation of sexual activity and the feasibility of reaching young adolescent girls through schools, healthcare facilities or community-based settings (WHO, 2012).

Routine Childhood Immunisation

Routine childhood immunisation (RI) is one of the most cost-effective public health interventions and has been estimated to avert approximately 2 to 3 million deaths annually. Yet, vaccination rates in many African countries remain low. A child is considered fully immunised if they receive a BCG vaccine against tuberculosis, three doses of DPT to prevent diphtheria, pertussis, and tetanus, at least three doses of polio vaccine and one dose of measles vaccine.

Scope of the assignment

Vaccine uptake is influenced by many behavioural factors. Per our Theory of Change, we expect vaccine uptake to be determined by individual, interpersonal, community, infrastructural and policy factors.

This assignment aims to conduct a deeper literature review focusing on the behavioural and structural barriers and facilitators of HPV vaccine uptake and routine childhood immunisation (RI) in urban and peri-urban areas in Ethiopia. We would like to get an overview of the latest research that is not older than 5 years, specifically for the case of HPV, anything more recent (done in the past 1 or 2 years).

The consultant will be expected to source grey literature (i.e.unpublished documentation from other organizations and local government) and programme implementation reports from relevant organisations and to triangulate these findings with the previous desk literature review (as well as to complete this review if any other outstanding published documentation can be identified). The consultant will also be requested to conduct approximately 5 semi-structured key informant interviews (KIIs) with key stakeholders from organizations identified by the GE team, or through the grey literature search. These KIIs aim to get more nuanced information on the challenges and opportunities around vaccine uptake. Girl Effect will work with the selected consultant to identify these key informants and formulate the interview questions.

Resource Areas of Focus

The consultant is expected to make use of the following data resources:

• RI and HPV vaccine uptake-related studies in Ethiopia.
• Gender-specific studies conducted concerning vaccine uptake and health-seeking behaviours in Ethiopia.
• Peer-reviewed individual studies conducted in Ethiopia.
• Literature published by government organisations, non-governmental organisations, universities, UN institutions or anything similar.
• Situational analysis done by the Ministry of Health (MoH) or other partner organisations.
• Any grey literature, defined as unpublished materials including any reports and briefs (government or otherwise), conference papers and presentations, white papers, email chains etc

Questions to be addressed

• What is the evidence base for the cognitive and emotional drivers of health-seeking behaviour for RI and HPV vaccines?
• Are there specific gender-related barriers with regards to RI and HPV vaccine uptake?
• What barriers are experienced by young mothers and young women overall and caregivers in these health areas?
• Which behavioural barriers are most actors designing programmes for? What has been done so far, and what is the level of change achieved?
• Which behavioural barriers seem most neglected?
• What are the media habits (use/consumption) of the segmented target population groups?
• What evidence gaps still exist in RCI and HPV demand creation and service delivery?
• What approaches are currently or previously being implemented in encouraging the uptake of RI and HPV (specific dose 2 for the HPV vaccine)?
• What are the successes and failures of the identified approaches?
• What are the supply-side barriers that affect access to RI and HPV?
• What does the zero dose data look like, and what is the segmentation based on zero dose per region in the country?
• Do structural barriers (e.g. vaccine availability, staff presence) outweigh behavioural barriers?
• Are there opportunities to design behavioural interventions to remove service provider-related behavioural barriers (e.g. nurses forgetting to invite new mothers for RI)?

Deliverables

The consultant will be provided with an Excel spreadsheet to complete the literature review. The consultant will also be expected to prepare a report and presentation responding to the key questions above and recommendations for further research and/or programme design.

Reporting

The consultant will work under the supervision of the SBC Lead and Head of Impact.

Expected Commitment

The assignment is expected to take approximately 15 consultancy days to complete.

Tentative Timelines:

● Terms of reference published: August 5th 2022

● Deadline for responses: August 11th 2022

● Supplier selection, contracting and briefing: August 15th 2022

● Project commencement: August 19th 2022

● Project submission: September 9th 2022

Who You Are:

Skills and expertise:

• Minimum of 5 years of professional experience in research, specifically literature review
• Proven research analytical skills and knowledge in Routine Immunization and Vaccines or a proven analytical skill specific to health-related studies
• Expertise in finding and leveraging unpublished reports and documents to support the findings
• Experience working with International Organizations in Ethiopia
• Strong communication and writing skills and experience in preparing reports
• Fluency in English written and spoken
• Great attention to detail and ability to work under pressure and tight deadlines.
• Ability to remain flexible and find solutions to challenges.
• Ability to work collaboratively in multicultural and remote teams.
• Excellent organizational and planning skills
• Commitment to realising the potential of girls and to the vision and values of Girl Effect

Proposal Submission

Your proposal (Max 3 pages), should you be interested, should cover

Technical Proposal

• Your understanding of the brief and why you feel you are well placed to advise us on this
• Credentials –
  • Please showcase any previous relevant work experience
  • Detailed reference list indicating the scope and magnitude of similar assignments
• Work plan for performing the task

Financial Proposal

• A breakdown of the financial proposal in USD indicating the daily rate for each of the proposed experts, time input and all applicable reimbursable expenses
• All applicable taxes should be quoted separately;

Technical and Financial proposals will need to be submitted as separate documents. Financial bids will not be opened until the technical evaluation and only for those proposals deemed qualified and responsive.

GE is not liable for any cost incurred during the award/contract preparation, submission, or negotiation of the award/contract. All submitted documentation and/or materials shall become and remain the property of GE.

The VALIDITY of the proposal shall be for 90 days from the date of bid closure.

Evaluation Criteria

The criteria against which proposals will be evaluated are listed below.

• A well-written capability statement clearly outlines your experience in delivering the Scope of Work and how you meet the ‘Who You Are’ requirements above – 20%
• Demonstrate geographic experience in Ethiopia – 15%
• Clear and Concise CV demonstrating relevant expertise – 30%
• Evidence of a minimum of three contactable references – 15%
• Financial Quote – 20%

Tax

Applicants are advised to ensure that they clearly understand their tax position regarding local jurisdiction tax legislation provisions when developing their proposals.

Disclaimer

GE reserves the right to determine the structure of the process, number of short-listed participants, the right to withdraw from the proposal process, the right to change this timetable at any time without notice and reserves the right to withdraw this tender at any time, without prior notice and without liability to compensate and/or reimburse any party. GE shall inform ONLY successful applicant(s). The process of negotiation and signing of the contract with the successful applicant(s) will follow.

Safeguarding

You may be required to undertake safeguarding checks. Shortlisted consultants will be assessed on our organisational values at the interview stage. The successful consultant will be expected to adhere to our safeguarding policy. We encourage you to read and understand our safeguarding policy, the executive summary of which can be found at www.girleffect.org/safeguarding. We have zero-tolerance for all forms of violence against children, beneficiaries and staff.

Equal Opportunities

Girl Effect Services is committed to equal opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, marital status, disability, gender, gender identity or expression. We are proud to be an equal opportunity workplace.

We are committed to building an organization that is increasingly representative of and works extensively with the communities that we serve. To this end, due regard will be paid to procuring consultancy service organizations and individuals with diverse professional, academic and cultural backgrounds.