Ethiopia has scored impressive reduction in child morbidity and mortality, having met the Millennium Development Goal target to reduce child mortality by 68.7% by 2015 from baseline 205 in 1990 to 62 deaths per 1000 births in 2013. Vaccination is among the high impact interventions Ethiopia has scaled up to avert child deaths and achieve the MDG beforehand. Vaccination has averted 107,870 (23%)[i] child deaths in Ethiopia between 2000 and 2011. The strategies for Immunization service delivery in Ethiopia include fixed (static) through public health facilities, outreach outlets, and mobile sites for the hard to reach areas. To accelerate improvement in immunization coverage the government has been implementing Enhanced Outreach Strategy/Child Health Days (providing integrated child health services including immunization services) since 2003. implementation of the reaching every districts (RED) initiative, and the Enhanced Routine Immunization Activities (ERIA) are the main strategies to increase immunization coverage targeting pastoralist areas and zones with large numbers of unimmunized children (left out and high dropout rates). The number of antigens given has also reached 13 including the newly included Human Papilloma Virus (HPV) vaccine provided for adolescent girls. DPT3 coverage has increased from 52% in 2003 to 97% in 2018.

Despite the progress in immunization coverage and the huge investment to address in equity, inequalities in coverage among regions however, are large, Somali Regional State having a 75% administrative coverage while it is 100% in Addis, 2019 HSTP Report. Evidence from different sources revealed that Somali Regional State has low immunization coverage with a large coverage disparity between woredas. According to the 2019 mini Ethiopian Demographic and Health Survey (EDHS), the penta 3 coverage for Addis Ababa is 93.1% while it is only 26.2% in Somali Regional State.

To address the low immunization coverage, both national and regional government has made huge investment in cold chain system and capacity development of health care providers, it seems that the immunization coverage for all antigens is still below expectation. A wide range of constrains prevent the government from reaching all the target population. These underlying factors include inadequate of the critical immunization system inputs such as skilled human resources, a cold chain system, vaccine management exacerbated by limited storage capacity, as well as an absence of strong Immunization management information system that promotes the use of the data for programmatic and policy decision making. Low level of coverage and weak system creates perfect environment for Vaccine preventable diseases to occur.

II.         Project Overview

With an aim to improve immunization performance in the region, Save the Children in partnership with GSK has launched a three-year Immunization Strengthening project in eight woredas of Somali Regional State: Hadigala, Dembel, Degehabur, Degehabur City, Awbere, Harawa, Berano and Adadle in its second phase.  

The project will support various interventions to expand access to quality vaccination services and improve uptake of immunization services in the community. As a result, immunization service will be delivered for communities who did not have access for vaccination service before due to distance from health facilities or unavailability of immunization services in the health facilities. Provision of vaccine refrigerators, building the capacity of health workers, and expanding the strategies for delivering immunization in the community such as establishment of outreach and enhanced immunization sites will contribute greatly for the expansion of the service. Moreover, community influential leaders will be engaged along with trained community volunteers on demand creation for immunization.

To improve the service uptake in the community, it is crucial to comprehend the bottlenecks and barriers to effective delivery of immunization services and potential drivers of increased immunization coverage. Therefore, Save the Children is looking for a qualified consultancy firm with extensive experience on conducting formative researches on the area of immunization preferably in Somali Regional State to conduct, a formative research which will yield insightful information to guide the development of BCC strategy and approaches to increase the uptake the immunization services in the community.

The purpose of the operational research is to gain insightful information on the facilitators and barriers for utilization of immunization service in the community to inform the development of the SBCC strategy to drive the community engagement and the demand creation aspect of the current immunization programme.

IV.         General Objectives

The overall objectives of the research is to identify barriers to and facilitators for increased utilization of immunization services and use the result to develop SBCC strategy with key messages to improve immunization service uptake in the project implementation woredas in Somali Regional State

Specific Objectives

·       Identify the key barriers to and facilitators for utilization of immunization service

·       Assess what strategy should be used for raising the demand for immunization by community members

·       Develop SBCC strategies to raise uptake of immunization in Somali Regional State

·       Develop key messages to raise community awareness on vaccination and address the identified barriers under the first objective

 V.         Scope of the Assignment

Scope of work for the Formative Research will broadly include

1.     Prepare a study protocol outlining research strategy, methodology, sample size, data collection method, target groups, analysis plan and timeline for the study.

2.     Conduct Literature Review: it should provide an overview of the work that has been conducted in the past and the authors of these work. That will help familiarize the prevailing theories and hypothesis. The Desk review will involve in the review of the secondary data of relevant formative researches done in Ethiopia, with focus on studies conducted in Somali Region. Moreover, policy, strategy, and program documents at national and regional level should be part of the desk review. The literature review will guide on the method for sampling, data collection, and analysis.    

3.     Review of relevant works on strategies/approaches that have been used for BCC and community mobilization especially in Somali Region

4.     Propose plan for Primary and secondary data collection to meet the specific objectives and develop data collection instruments that captures both quantitative and qualitative data and propose the data collection platform to use the collection and collating the relevant data and information.

·       Develop field guides to help the effective implementation of the study

·       Define the target population study and study participants: Information will be gathered from various community based and key stakeholders including children, residing within Save the Children’s target intervention areas. Respondents are expected to be mothers, fathers, and children of school age; Health workers and managers; community and religious leaders; people actively taking part in community health structures/systems etc.

·       Determine the sample size for each target group

5.     Pre-test the data collection instruments and use the findings to fine tune the tools

6.     Implement and supervise data collection activities to ensure fidelity of the data collection.

7.     Prepare a quality assurance plan to safeguard the data integrity, quality and confidentiality through the study.

8.     Develop analysis plan outlining the type of software to use the analysis of the key indicators. 

9.     Prepare a presentation summarizing key findings and present to key stakeholder’s which will be defined by Save the Children.

10.  Prepare concise and yet comprehensive report that meets international quality standards and final report should be finalized based on Save the Children’s comments.

Specific Tasks for the consultant

•                Conduct literature review of national government policy, strategy, and reports; related studies, strategies, and different related reports by UN agencies, and development partners, studies, lessons, and reports from other similar settings both in country and abroad. Synthesis of relevant literatures and documents related to immunization program such as: strategies, guidelines, manuals, surveys, formative studies and assessments, reports, tools, training materials, etc.

•                Conduct In-depth review, Focus group discussion

•                Recruit, train and deploy, and manage highly experienced and qualified qualitative data collectors who are proficient in the language and familiar with the local context

•                Pretest and adapt the data collection tools based on the findings of the pretest

•                Lead, coordinate and supervise the data collection process

•                Ensure data quality

•                Ensure the safety and security of survey participants and comply with the ethical standard as per approved IRB requirement 

•                Analyze and synthesize the data collected from the field and desk review

•                Present preliminary findings and recommendations to Save the Children project team

•                Develop SBCC strategy for the GSK/Tobbel project that complements the demand creation strategy.  The detail outline of the strategy document will be jointly defined by Save the Children and the consultant at the inception stage; among the key expected sections are:

o   Analysis of demographic and psychographic characteristics of the target audience.

o   The key barriers and facilitators for utilization of immunization service at individual, community, organization, and policy level

o   Strategies for addressing the key barriers and promoting potential facilitators for utilization of immunization services

o   Prioritized list of key messages taking into account potential barriers and maximizing use of potential facilitators

o   Prioritized list of the most appropriate channels and time for reaching the intended target audiences

o   Strategy implementation modalities

o   Strategy monitoring framework and checklist

•                Write and submit draft and final quality report.

VI.         Scope of the study

GSK/Tobbel Project is operating in eight woredas of somali regional state. This particular formative research will be conducted in woredas sampled from the project implementation sites based on the proposed sampling strategy.

Study questions

·       What are the barriers to and facilitators for utilization of immunization service in selected woredas of Ethiopia Somali Region?

·       What strategies should be used for raising the demand for immunization by community members in the selected woredas of Somali Regional State?

 VII.         Expected Key Outputs and deliverables:

·         Study protocol

·         Detailed inception report

·         Data collection tools and field guides

·         Data collectors training manual /guide

·         Data collectors training report

·         Draft report of preliminary findings.

·         Progress updates shall be provided every two weeks throughout the implementation of the study to assigned Focal person ( more frequent updates will be expected during data collection. 

·         Power Point presentation of preliminary findings and recommendations. The consultant is expected to make presentation to selected Save the Children (project manager, Health and Nutrition Thematic Director – PDQ, Country Office Technical Advisor, Advocacy Advisor and other project and management staff), partners and government staffs for discussion and additional inputs to the interpretation and analysis.

·         Final report incorporating feedbacks from Save the Children, government, and other partners, in hard and electronic copy. The report should incorporate a separate section for each objective. The report has to be professionally edited, of best quality, clearly indicating zonal variations with detail recommendations and as per the agreed outline in the inception report. Number of pages is expected to be 25-30 excluding annexes.   

·         Data sets, copy of voice records, soft and hard copy of questionnaires and expanded notes.

·         Complete SBCC strategy document for immunization and key messages

 Roles and Responsibilities of Save the Children:

·       Provide the TOR for interested applicants

·       Obtain IRB and ethical clearance

·       Assign technical focal person to oversee the task.

·       Avail relevant reference documents for the consultant.

·       Review and provide timely feedback on the proposed data collection tools, reports and other related issues.

·       Facilitate orientation on Save the Children’s child safeguarding policy for the individuals involved in the task.

·       Facilitate payments for the consultant as per the agreed payment schedule.

Roles and Responsibilities of the Consulting Firm:

·       Develop and share the detail study protocol

·       Perform the list of activities indicated in section III to Section VI of the TOR above and elsewhere in the document.

·       Conduct in-depth review, analysis and synthesis of relevant literatures and documents to the task such as: surveys, formative studies and assessments, strategies, guidelines, reports, tools, training materials, etc.

·       Submit inception report that details the key aspects of the task. 

·       Meet with project team to discuss and address comments on inception report.

·       Develop data collection tools and field guides based on approved protocol

·       Recruit, train and deploy highly experienced and qualified data collectors who are familiar with the local context

·       Pretest and adapt the data collection tools based on the findings of the pretest

·       Lead, coordinate and supervise the data collection process

·       Ensure the quality of data

·       Ensure the safety and security of survey participants. Compliance with ethical standards

·       Analyze and synthesize the data collected from the field and desk review

·       Present findings and recommendations to Save the Children project/technical team and partners.

·       Incorporate the input from the project team, partners, and government on the strategy development

·       Develop: the communication strategy; key messages considering the potential barriers and potential facilitators; communication strategy implementation plan; monitoring framework; and monitoring checklist

·       Ensure that the comments/feedback given on the draft reports are fully incorporated in the final report, that the reports are of professional quality and well edited

·       Participate in briefing and other meetings related to the assignment and present the final study findings and strategy document for Save the Children Project/technical team, and partners

·       Provide legal financial documents for all the payments as per the agreement

·       Adhere to the SCI’s Child Safe Guarding Policy and Code of Conduct.

·       The consulting firm shall sign the SCI’s code of conduct

 IX.     Time Frame:

The duration of the assignment shall not take more than 45 working days including travel, field work, report preparation and submission of the final work. The consultant should indicate a breakdown of timeframe showing the detail work plan and expected dates for each phase of the evaluation undertaking.

 X.     Compliance with child Safeguarding policy of SCI

Save the Children International is committed to safeguarding children with maximum possible extent from any deliberate or inadvertent actions that come into contact and our contractual agreement reflects our commitment to ensuring that only those who are suited to work with children and to apply strict child safe recruitment practice are considered for this consultancy. Thus, the selected consulting firm is required to receive orientation on our Child Safeguarding Policy, must sign on it and comply with the standards stated in the policy.

 XI.     Compliance with SCUS’s Research & Evaluation Ethics Policy

SCUS has a Research & Evaluation Ethics Policy that requires all studies involving interaction with people to collect personal data to undergo a human subject ethics review and obtain “approval” prior to data collection.

The organization will assign a committee composed of management and technical team to evaluate the proposals submitted by consulting firms/firms. The selection committee will evaluate the bidders based on the criteria set below. The consulting firm/firm is expected to provide detailed information based on the given framework to ensure fair and effective comparison. The committee reserves the right to drop a competitor that scores the least. The proposals submitted will be reviewed based on the following criteria.

Scoring criteria:

Generic Criteria

There are common (generic) criteria for technical proposal review developed by SC Ethiopia procurement department. The technical proposal weighs 60 % and each criterion has its description as well as value as follows:

Understanding of the TOR

This criterion will cover the consultant's understanding and reflection on the terms of reference. It considers how deep the consultant understood the work including the scope? How such understanding is explained and linked with the subsequent criteria (e.g. with the approach/methodology, team composition, etc.)  How consistent is the understanding of the TOR reflected in the various sections of the technical proposal?

Professional team composition and qualifications

The research team members should have at least an MSC level qualification in Public health, and nutrition, Economics/statistics/, etc. The team members should also have a minimum of 10+ years relevant quantitative and qualitative research experience and especially relevant program evaluations and design in the areas of Somali region.

Methodology (quality of assessment tools)

The consultancy firm should clearly describe its choice of approach for the various phases and objectives, and strong justification should be provided for each of the suggested approaches Critical review shall be made on the proposed approaches. Generic presentation of the methodology section e.g. proposing approaches without linking with the objectives will result in very lower scores. Hence, the technical proposal shall be reviewed with distinct and relevant approaches as per each of the objectives. Thus, the consultancy firm shall propose appropriate approaches that are cost efficient and justified.

Timeframe/Work plan

The assumption is to come up with feasible and cost effective approach as per the time frame suggested in this TOR There might be a number of ways to deliver tasks within the proposed timeframe, e.g., by deploying relevant (in terms of qualification and experience) and adequate (in terms of number) teams for the work

NB. Financial proposal will be opened/considered for those bidders that scored the technical proposal above 45 (out of 60).

Interested applicants are advised to collect the TOR. They are also required to submit the following:

Technical Proposal:

The technical proposal should at least include the following:

·  Detailed work plan and methods to achieve the tasks in the TOR.

·  Details of organizational capacity to undertake the TOR and previous relevant work experience, including three recent references with contact information.

·  Names and backgrounds of key personnel responsible for the task (including CVs of two pages each).

·  Two selected sample copies of similar previous work.

  XVI.     Date of Proposal Submission

The technical and cost proposal shall be submitted in separate sealed envelopes to Save the Children Ethiopia Country Office in both hard and soft copy. The deadline for proposal submission is: 10 Dec 2019.  

XVII.     Reference Materials –consultant should review before further data collection

Ø  Project proposal

Ø  SC children participation technical guide

Ø  SC community mobilization technical guide,

Ø  The consultants should also be able to carry out their own individual desk review of policy, strategy, and research documents, conducted in the region, country and other countries with similar context, related to this research

Ø  Barrier and Bottleneck analysis document

Skills and competencies required:

The consultant/firm shall be a registered firm with renewed license and Tin number. The lead consultant should fulfill the following minimum requirements:

·       A minimum of post graduate degree level education in social sciences, public health, communications or other related field.

·       Proven experience (minimum 10 years) in leading, coordinating and conducting national and regional qualitative studies in the area of MCH, designing and implementing SBCC strategies for health programs.

·       Excellent understanding and exposure to the Ethiopian health sector transformation plan, the health communication strategies and approaches particularly on the pastoralist Health Extension Program

·       Proven experience in the national immunization program

·       Excellent analysis and writing skills; ability to present large information in a concise manner (including good command of English)

·       Excellent track record in completing similar tasks as per agreed quality, resource and time lines

Similarly, field supervisors and data collectors should have a minimum of:

·       BA/BSc in the field of social science or public health and

·       Five years and above relevant experience in public health interventions particularly on qualitative studies on MNCH, preferably on immunization

·       Understanding of the local context and ability to speak the local language

·       3 Experience of the Firm in related work (14)

·       This captures the experiences of the consultant in of having specific and hands-on experience on conducting midterm evaluation and other related assessments related with health and nutrition particularly on national immunization program

·       4.        Professional team composition and qualifications (8)

·       The research team members should have at least an MSC level qualification in Public health, and nutrition, Economics/statistics/, etc. The team members should also have a minimum of 10+ years relevant quantitative and qualitative research experience and especially relevant program evaluations and design in the areas of Somali region.