Country: Georgia
Closing date: 08 Nov 2018
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The immunization programme in Abkhazia is not self-sustainable despite of major progress since 2010 and intensive UNICEF support in recent years. Major components of the programme are either under-functional or have limited capacity. This results in very low immunization coverage rates, including birth cohorts. E.g. the immunization coverage of the 2016 birth cohort for the third doses of DTP, viral hepatitis B and polio vaccines was just above 30%, as well as MMR coverage of the 2015 birth cohort, which all are much lower than the rates of Georgia proper and the CIS states, including South Caucasus countries and Russia. At the same time, the school immunization programme is much stronger in Abkhazia and, as a result, coverage with the third doses of viral hepatitis B and polio vaccines, MMR (second dose) reaches 70-80% among teenagers. These observations were confirmed through the Joint National-International Review of Immunization and VPD Surveillance for Georgia, including Abkhazia, which was conducted in July-August 2015, as well as the recent EPI Review in Abkhazia in June 2018.
Many challenges of the immunization programme in Abkhazia are linked to the political situation around the protracted Georgian-Abkhaz conflict and the poor performance of healthcare in Abkhazia in general. However, other challenges were successfully tackled by UNICEF together with local partners. Especially, progress was achieved in regular vaccine supply, basic immunization planning and vaccine management, improved data monitoring and analysis through the establishment of an electronic immunization registry, cold chain and immunization equipment supply, several rounds of staff trainings, introduction of new vaccines, adaptation of a new immunization schedule in line with WHO recommendations and immunization promotion and communication initiatives, including the production and distribution of advocacy materials.
However, there are still many challenges to immunization in Abkhazia that need major changes in the health system and its governance, such as the lack of proper legislation, leadership and governance, lack of pediatricians, nurses, and other relevant health staff in the rural areas, and weak primary healthcare. Some of these challenges can be addressed through continuous external support. These include the high immunization drop-out rates for pre-school children, the existence of false contraindications and delayed immunization, major gaps in health communication, e.g. the lack of consistent advocacy for immunization, as well as the insufficient commitment on political level to make immunization a priority.
Recent EPI review as well as existing information suggests that some children remain unvaccinated because their families are hard to reach are inadequately informed of the need for immunization, or have misconceptions about immunization safety and effectiveness. In view of variation in the reasons for vaccine hesitancy, there is need to be better understand its dynamics in any given context to enable effective response. Vaccine hesitancy occurs under the individual and social group influences; contextual influences; vaccine and vaccination-specific issues that require specific consideration. Communication therefore plays a vital role in stimulating a dialogue between the health system and its beneficiaries, and in dispelling the hesitancy/refusals factors.
In order to better understand the reasons of refusals, delays in vaccination, as well as demand related issues for low immunization coverage, the Knowledge, Attitude and Practices (KAP) survey is planned to be carried out. The results of the survey will be used for the development of a communication strategy for immunization. The strategy will work on addressing vaccine refusals, vaccine hesitancy, rumors and misconceptions that affect immunization uptake in Abkhazia. The strategy will also include the development of an integrated health communication campaign on immunization reaching out to all audiences.
In view of the above, UNICEF Georgia is looking for an international research consultant, a group of consultants or a research institute/company which will carry out the KAP study in cooperation with a locally selected research team.
This study aims to generate and document human-centered evidence on existing factors influencing demand for immunization and vaccine hesitancy in Abkhazia. These would include individual and social group influences (attitudes, beliefs, concerns, fears, expectations, experiences and practices of caregivers/parents related to immunization etc.) with a focus on vulnerable groups (poorest households, hard to reach populations) and health professionals; contextual influences; and vaccine and vaccination-specific issues. The human-centred approach will combine a research methodology that focuses on the needs of people, a design methodology that allows for innovative solutions and an implementation strategy that uses a wide system's view.
Specific objectives of the study are to:
2. Research methodology
The study will employ quantitative and qualitative research approaches.
A. Quantitative part will aim to:
B. Qualitative component will aim to:
Target group to be involved in the survey:
Quantitative Survey Respondents
Mothers (or other primary caregivers) of children under five years (IDIs)
Health service providers (IDIs)
Influencers: Family or society members who influence mothers in their decision-making with regards to immunization and other child healthcare services (IDIs)
Qualitative Survey Respondents
Mothers (or other primary caregivers) of children under five years (FGDs), including rural and urban, parents who immunized their children and those who are hesitant
Health service providers, including immunization experts (IDIs)
Influencers: Family or society members who influence mothers in their decision-making with regards to immunization and other child healthcare services (FGDs)
An outline of the proposed methodology for conducting the study based on this Terms of Reference should be included in the technical proposal. Bidders are expected to indicate in their proposal which tasks will be performed remotely and in country, as well as the distribution of tasks among international and local researchers.
The research instruments for the KAP survey will be developed by the selected bidder in cooperation with the local research team. It is anticipated that in-depth interviews (IDIs) will need to be conducted for which appropriate questionnaires need to be developed as follows:
The selected consultant(s)/institution/company will also develop appropriate research instruments for the informative qualitative survey. It is anticipated that both In-Depth Interviews (IDI) and Focus Group Discussions (FGD) will need to be conducted with the different respondents. The FGDs and IDIs should not take longer than 1-2 hours. The selected consultant(s)/institution/company will also be required to develop moderation guides and interview guides/questionnaires. The number of participants of an FGD should range between 8-10 people (preferably, not familiar with each other, but are from the same general category, homogenous and have similar beliefs and ideas to allow more in-depth discussions, without the dominance of some people).
For the assessment of immunization coverage the Multiple Indicator Cluster Survey (MICS) methodology will be used.
Geographical Coverage
All districts will be covered. The survey should be designed to be representative of parents from both rural and urban areas, ethnic groups, education/socio-economic status etc. Information should be collected directly from the caregivers, as well as from other informants e.g. health professionals and associates etc. Triangulation of data coming from different sources should be used to verify the qualitative findings.
ETHICAL CONSIDERATIONS
Adequate measures should be taken to ensure that the process responds to quality and ethical requirements. The contracted consultant(s)/institution/company should be sensitive to beliefs, manners, and customs and act with integrity and honesty in their relationships with all stakeholders. Furthermore, it should protect the anonymity and confidentiality of individual information.
Scope of Work
The contracted consultant/agency will be responsible for the following activities:
Deliverables and preliminary timelines
The following is the list of preliminary timelines for the different deliverables:
Estimated Project Timeline for the Surveys
Description
Quantitative Survey Estimated time: November/December 2018
Qualitative Survey Estimated time: January/February 2019
Travel
Bidders shall be required to include the estimated cost of travel in the financial proposal.
Payment Schedule
Quantitative Survey
Proposed evaluation criteria
Criteria
Candidate profile, based on required qualification and experience Maximum points 40
Quality of previous work, based on the submitted examples Maximum points 60
Total points 100
Candidates who receive a minimum of 70 points will be considered further.
Qualification and Experience Requirements for consultant (or team lead)
All bidders are requested to submit a detailed technical proposal including a description of:
Reporting and Supervision
Direct supervision of the company / consultants will be provided by the UNICEF's Health and Nutrition Specialist in Sukhumi under the overall supervision of UNICEF's Chief of Sukhumi Office. In case of need, support will also be provided by UNICEF's Health Specialist and UNICEF's Statistics and Monitoring Officer in Tbilisi.
The consultant(s)/company will have to submit the final report by 28 February 2018.
Duration
1 November 2018 28 February 2019
Remuneration
Applicants are required to submit a financial proposal for the requested services including the consultancy fee and travel costs. The remuneration will be negotiated between the applicants and UNICEF Georgia on the basis of the applicants initial proposal and will be paid in line with the above mentioned payment schedule.
UNICEF response in case of unsatisfactory performance
The Contractor's fee may be reduced if the assignments / deliverables are not fulfilled to the required standard. In case of serious dissatisfaction with the Contractor's performance the contract may be terminated in line with UNICEF procedure in such matters.
How to apply:
UNICEF is committed to diversity and inclusion within its workforce, and encourages qualified female and male candidates from all national, religious and ethnic backgrounds, including persons living with disabilities, to apply to become a part of our organization. To apply, click on the following link http://www.unicef.org/about/employ/?job=517333