UNICEFWCARO

TERMS OFREFERENCE

Version 7 September 2015

Title of consultancy:Technical supporttheanalysis of Equity in immunization in Central and West Africa Region

Planned Duration of Consultancy: 40 days (from 10/01/2016 to 30/03/2016)

Submitted by: Health section

Duty Station:Home with 2 weeks mission in UNICEF Regional Office in Dakar

Level: P4

Planned Duration of Consultancy: 40 working days(from 10/01 /2016 to 30/03/2016)

Contract Type: Consultancy - SSA Individual Contract

Closing Date: 14 December 2015

1.Background and Context

UNICEF WCARO intends to undertake an analysis of immunization coverage to raise awareness and influence policies to address the issue of inequity in access to immunization in West and Central African countries.

The Global Vaccine Action Plan (GVAP) approved by the World Health Assembly in May 2012 provides the framework for universal access to immunization to all people, regardless of where they are born, who they are, or where they live. Its third strategic objective reads as follows: “The benefits of immunization are equitably extended to all people (all children, adolescents and adults)”.

Achieving this strategic objective requires that every eligible individual is immunized with all appropriate vaccines - irrespective of geographic location, age, gender, disability, educational level, socioeconomic level, ethnic group or work condition. This means reaching under-served populations and reducing disparities in immunization both within and between countries.

Gavi (The Vaccine Alliance)’s 2016-2020 mission is to save children’s lives and protect people’s health by increasing equitable use of vaccines in lower-income countries. The goal is to accelerate equitable uptake of immunization services and coverage of vaccines.

UNICEF as a key partner of Gavi is leading the refocus on equity in immunization. Inequities need to be tackled because underserved populations typically carry a heavier disease burden. The equity refocus in immunization will require to

(1) Determine if inequities in immunization coverage exist (using DHS/MICS data),

(2) Identify the marginalized communities suffering immunization inequities,

(3) Identify barriers to vaccination for these underserved communities

(4) Develop strategies to address barriers, e.g. Reaching Every Community,

(5) Ensure cMYP, Annual EPI Plan, New Vaccines Introduction specifically target underserved communities

2.Justification

At the global level, the immunization coverage for DPT3 is 84%. Renewed efforts are needed to reach the last 16% still excluded from vaccination. In West and Central Africa, despite commendable progress, the DTP3 coverage in 2014 (WHO/UNICEF estimates) was 73%: at least 1 child out of 4 children were not fully vaccinated. Ten countries in the world account for 75% of all unimmunized children, including 31% in Nigeria and 7% in DRC.

A total of 4,632,000 children (2,300,000 in Nigeria, 525,000 in DRC) did not received the third dose of DTP3, including 3,322,000 children (1,695. 000 in Nigeria, 499,000 in DRC) who did not receive the first dose. In recent years, there has been noted progress in reducing the number of under-served and unreached children in Nigeria and DRC.

Progress towards greater equity in immunization is assessed by monitoring the percentage of districts with more than 80% coverage with three doses of diphtheria-tetanus-pertussis-containing vaccine (DTP3) using routine data. In addition, coverage gaps between lowest and highest wealth quintile collected through DHS/MICS survey data are also monitored.

As of 2014, only 9 out of the 24 WCAR countries reached the target of 80% DTP3 coverage in 80% of districts. The lowest performances are recorded in CAR, Equatorial Guinea, Liberia and Mali with less than 20% of districts reaching 80% DPT3 Coverage.

The “Reaching Every District” (RED) strategy was introduced in 2002 by WHO, UNICEF and other partners with the aim of achieving more equitable coverage. This strategy has been the core strategy implemented in WCAR. The RED operational components include re-establishing outreach services, providing supportive supervision, engaging with communities, monitoring and use of data and district planning and resource management.

Bottlenecks for the delivery of immunization include low health service coverage, weak health systems affecting the cold chain, human resources, availability of vaccines and other key supplies). Bottlenecks on the demand side include low involvement of community and civil society in information sharing and social mobilization.

In 2013, Gavi and other immunization partners identified globally 10 priority countries with large inequities, including four in WCAR (Chad, Nigeria, CAR and Liberia), where UNICEF implements specific strategies for narrowing the gap. Additional funds have been allocated to these priority countries to address issues identified and quarterly reports are produced.

The twenty other WCAR countries may face significant inequities in immunization. UNICEF WCARO thus intends to undertake a thorough analysis of inequities in immunizationfor each country, to be carried out by a consultant.

3.Purpose and Objective
  1. In-depth regional and country specific equity analysis to answer the following questions:
  2. What are trends and magnitude in inequities in immunization (improved/static, getting worse)?
  3. What are most important factors/conditions of such inequities in each country (e.g. gender, wealth, geographical location, mother’s education, caste, religion, ethnicity, habitat, or other factors) that generate inequities in immunization?
  4. What are the most important communities affected by inequities (marginalized and unreached communities) (from key informants, surveillance reports, outbreak investigations…)
  5. What are systems-based and demand-related bottlenecks driving inequities in immunization? (from EPI reviews, annual EPI reviews, EVMs, KAPB, independent monitoring data)
  6. Using survey data available in each country, proposal of indicators to report on progress in reducing inequities in immunization.

a)Based on the most important equity factors propose indicators and data sources

b)Develop tools to allow countries to analyze equity monitor progress in bottleneck removal that contribute to narrow equity gaps in immunization to be used during mid-year and end-of-the-year planning reviews.

  1. Using the latest survey data, establish a baseline for WCAR countries on inequalities in immunization
  2. Develop profiles in inequity in immunization at regional and country-level for advocacy. Profiles should be structured around key summary information on trends in equity in immunization, determinants of inequity, marginalized and unreached communities, bottlenecks analysis)
  3. Organize consultation with key experts to share findings from the equity analysis, facilitate discussion on strategies to accelerate reduction in equity gaps in immunization, and summarise recommendations on strategies from the expert group
  4. Develop methodologies and protocol to be used in country-level process to conduct a national immunization equity assessment
  5. Produce a report and publication summarizing findings and highlighting relevance to programming
4. Methodology and Technical Approach
  1. Desk review of immunization coverage reports, DHS/MICS surveys and other sources (e.g. EPI review reports, disease outbreak reports, findings from EPI managers meeting)
  2. Analysis of DHS/MICS data and WHO/UNICEF vaccination estimates to analyze trends in inequities in immunization
  3. Multivariate analysis of determinants of inequity in immunization.
  4. Analysis of systems-based and demand-related bottlenecks driving inequities in immunization, using the 5-Why methodology
  5. Interviews with key informant
6.Activities, Tasks, Outputs and Deliverables
  1. Inception report on the analysis of equity in immunization for the 24 countries in West and Central Africa (with 1a, 1b, possibly 1c of the objectives)
  2. Preliminary findings report showing trends analysis of inequities in immunization, drivers of inequities and bottleneck analysis (previous plus 1d of the objectives)
  3. Equity profile for each country and WCAR equity landscape (including country-specific baseline) (individual 1a-d per country)
  4. PowerPoint presentation summarizing key preliminary findings
  5. Summary report on the consultation with immunization experts and their key recommendations
  6. Protocol to conduct or update the immunization equity assessment in the countries.
  7. A final report for the entire study
  8. A final PowerPoint presentation with final findings
  9. Joint paper based on the findings that can be submitted for publication

6. Management, Organization and Timeframe

Under the direct guidance and with the technical oversight of the Regional Immunization Adviser, the incumbent will have regular technical support from the Regional Health/immunization Specialist.

The consultant will work from home but will also be required to travel to Dakar to work from the Regional Office during 1 week for the briefing and another week for expert consultation and debriefing

UNICEF will:

  • Organize an initial briefing for the consultant;
  • Provide continuous technical support by the Regional immunization Specialist
  • Evaluate the work provided;

Remuneration:

The consultant will be under contract from the 10th January 2016to the 30th March 2016, with a total of 40 working daysduring this period and will be paid:

The incumbent will implement the activities and deliverables as outlined below:

Deliverables / Deadline
Inception report / 20 January 2016
Equity profiles and protocol / 15 February 2016
Consultation with immunization experts / 1rst March 2016
Summary report on expert consultation / 15 March 2016
Final report and power point / 30 March 2016
Paper for publication / 15 March 2016

Payment Schedule:

Deliverables / Payment Schedule
Inception report / 30%
Preliminary findings report , equity profiles and protocols / 30%
Final report and paper for publication / 40%
TOTAL / 100%

8. Qualifications and Specialized Knowledge/Experience Required

a) Education

At least Master`s Degree (or equivalent) in Demography or Statistics or in relevant areas of Social Sciences with developed statistics and analytical skills

b) Work experience

Minimum of eight years of work experience, at least five years of which should be related to use and analyses of household survey data required. Strong analytical skills including use of sophisticated demographic /statistical analysis using MICS and/or DHS a must.

Familiarity with immunization programmes and health systems in low-income countries

Previous experience with UNICEF programs and knowledge of WCA region are an asset

c) Languages

  • Fluency in English and/or French requested
  • 9. Conditions of Work
  • 40 working days within the period of 10th January 2016 to 30th March 2016;
  • Duty Station: Home with 2 week mission in UNICEF Regional Office in Dakar and WCARO is in charge of ticket and DSA
  • Support Services: IT service. The consultant will use his personal equipment: laptop, phone.

10. UNICEF recourse in case of unsatisfactory performance:

Payment will only be made for work satisfactorily completed and accepted by UNICEF.

UNICEF West and Central Africa Country Offices are located in the following countries: Benin, Burkina Faso, Cameroon, Cape Verde (UN Joint Office), Central African Republic, Chad, DR Congo, Congo, Cote d’Ivoire, Equatorial Guinea, Gabon, Gambia, Ghana, Guinea, Guinea Bissau, Liberia, Mali, Mauritania, Niger, Nigeria, Sao tome & Principe, Senegal, Sierra Leone, Togo.

If you are qualified and interested in the position and meet the requirements, please submit proposed daily professional fee and forward your application with updated curriculum vitae and UN Personal History Form (available at), with “the title of the position as the subject’’, via email to and by 14 December 2015.

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.

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