Provision of Consultancy Service to Conduct Life Course Immunization

Title: Health System Readiness for Life-Course Immunization in Ethiopia: Barriers and Enablers for Integrating Adult Vaccination into Routine Immunization and Primary Health Care

1. About Amref Health Africa:

Amref Health Africa is the largest African-based and led international health development organization serving over 30 million people annually across 35 countries in sub-Saharan Africa. Strategically engaging with communities, governments, and local partners for the past 65 years, we work through our European and North American network of sister organizations on program implementation, advocacy, fundraising and partnership. Our subsidiaries include Amref Flying Doctors, Amref Enterprises Limited, and the Amref International University.

Our organization is driven by its vision to bring lasting health change in Africa and its mission to catalyze and drive community-led and people-centered health systems while addressing social determinants of health. Amref believes that the power to transform Africa’s health lies within its communities and therefore strives to ensure that health systems are functioning at an optimal level and communities are empowered to hold these systems accountable for the delivery of high-quality and affordable health care.

Amref has been active in Ethiopia since the 1960s and became fully operational as of 2002. We have been partnering with the Ethiopian government and local communities to co-create solutions and implement diverse health and development project portfolios throughout the country for over twenty years. Aligning with the national Health Sector Transformation Plan II (HSTP II), we work to ensure health equity by serving women and children, reaching the most disadvantaged, inaccessible communities including pastoralist communities and placing an emphasis on youth development.

Our programs are designed to support community level interventions while strengthening health systems at the regional and national levels. With an integrated and multi-sectoral approach, Amref strategically addresses cross-cutting issues through these programmatic focus areas.

. For more information, visit our website www.amref.org.

1.1 Background:

Immunization is increasingly recognized as a life-course intervention, extending beyond childhood to cover adolescence, reproductive years, adulthood, and older age. Vaccines such as HPV for adolescents, tetanus-diphtheria (Td) for pregnant women, influenza for high-risk groups, and COVID-19 boosters underscore the importance of this broader approach.

Ethiopia has achieved notable progress in childhood immunization. However, the extent of health system readiness for a life-course immunization strategy remains unclear. Potential barriers include gaps in policy and governance, limited integration with routine services, inadequate financing, supply chain and cold chain challenges, insufficient workforce preparedness, and variable community awareness and demand. Assessing readiness across these dimensions is critical for guiding Ethiopia’s immunization program toward sustainability, equity, and alignment with WHO’s Immunization Agenda 2030.

2. Objectives

2.1 General Objective

To assess the readiness of Ethiopia’s health system to implement a life-course immunization approach, with a focus on HPV, influenza, Td for pregnant women, and COVID-19 boosters.

2.2 Specific Objectives

1. Review national policy and governance frameworks supporting life-course immunization.
2. Assess health system inputs (financing, supply chain, cold chain, workforce, data systems) for life-course vaccine delivery.
3. Examine integration of life-course immunization into service delivery platforms, including maternal health, adolescent health, and adult care.
4. Identify gaps, opportunities, and recommendations for strengthening life-course immunization in Ethiopia.

3. Research Questions

• What policies and strategies support life-course immunization in Ethiopia?
• How prepared are health facilities in terms of logistics, workforce, and cold chain for life-course vaccination?
• To what extent are vaccines for adolescents, adults, and pregnant women integrated into service delivery (ANC, schools, workplaces, elderly care)?
• What challenges and enabling factors will influence Ethiopia’s adoption of a comprehensive life-course immunization program?

3. Methodology

The consultant should propose scientifically sound and a mixed-methods, cross-sectional assessment combining of Document review, Facility survey, Key informant interviews (KIIs), and Focus group discussions (FGDs). The study design and data collection methods should also apply to selected regions of Ethiopia, including urban, peri-urban, and rural areas, to reflect diversity in health system performance and community contexts. Policy level: Officials from MoH, EPI, and development partners, Facility level: Health facility managers, EPI focal persons, ANC/MCH service providers and Community level: Adolescents, pregnant women, adults, and community leaders.

The consultant also expected to present the analysis plan for quantitative data using descriptive/inferential statistics to generate readiness scores and assess the availability of vaccines, workforce capacity, and cold chain functionality across health facilities. Qualitative data from key informant interviews and focus group discussions analysed thematically, using software such as NVivo or Atlas.ti to identify recurring themes, patterns, and contextual insights. Findings from quantitative and qualitative components will be triangulated to ensure validity, enhance interpretation, and provide a comprehensive understanding of Ethiopia’s health system readiness for life-course immunization. Ethical clearance should obtain from accreted institutions like Ethiopian Public Health Institute (EPHI)/MoH Institutional Review Board. The consultant has to obtain IRB from accreted institutions.

4. Expected Deliverables

• Readiness scorecards for life-course immunization across health system building blocks.
• Identification of policy and programmatic gaps.
• Recommendations for strengthening integration of life-course immunization into Ethiopia’s health system.
• Evidence to inform Ethiopia’s national immunization strategy and alignment with Immunization Agenda 2030.

Total Duration: Approximately 6 weeks

5. Specific tasks to be done by the consultant

• The consultant is expected to deliver the completed lifecycle research evidence
• Meet Amref Health Africa in Ethiopia head office to present the work plan as per the tasks required as per the terms of reference (ToR).
• The firm should get approvals from Amref M&E department on the body of the content, introduction, framework/s and methods used before starting the final tool development.
• Develop the final tool as per the agreed introductions, frameworks and methods.
• Get Ethical clearance from accredited institutions
• Meet Amref Health Africa in Ethiopia head office and project staff at the beginning and at the end of the field work for inception report and debriefing.
• Identify key partners for interviews from the government and private sectors at all levels
• Develop protocol that clearly how the lifecycle of research phases being implemented/completed the assignments.
• Recruit qualified data collectors and train evaluation team and pre-test data collection tools.
• The team compositions for the data collectors have to be very well qualified and have experience in both quantitative and qualitative research.
• Coordinate data collection, processing, analysis, management and reporting.
• Conduct a final debriefing at an Amref health Africa Ethiopia Office
• Develop and submit final report incorporating all comments given by Amref Health Africa Ethiopia and datasets.

6. Period for Submission and deliverables

• The consultancy firm or team should follow the overall time frame of 6 weeks starting from signing of the agreement to the finalization of report (incorporating all changes and requests from Amref) and maturing the prototypes.
• The consultancy firm will submit and present the inception report that clearly defines the methodologies for sampling and data collection tools in the first week following signing the contract. Final data collection tools will be annexed to the protocol and address the feedback.
• Training of data collectors and supervisors will take place in the second week following signing the contract.
• By the end of the fourth week, data should have been analyzed and the first draft of the report submitted. The actual data collection will take place in the second and third week following signing the contracts.
• By end of fifth-week validation meeting and final comments from Amref addressed and sixth Final research product.
• The consultant will update Amref Health Africa in Ethiopia on the progress of the work regularly.

7.Required Experience

• The team will consist of professionals in the fields of health economists, data scientist public health and Social Science with a minimum of Master’s degree. Very good professional diversity is an advantage in related areas. In addition, to the above requirement, a consultancy firm or team is required to meet the following minimum requirements in order to qualify for the submission of its proposal:
• Significant Previous experience in similar tasks or consultancies specifically in research publications and policy development; previous experience in similar tasks or consultancy.
• Previous outstanding research and publication in reputable journals.
• Ability to effectively coordinate with government, NGO, and local stakeholders’ essential, an understanding of sectors coordination mechanisms an asset.
• Analytical and conceptual ability demonstrated understanding of immunization programs and research methods to understand the impact of service integrations.
• The consultant should have experience of using digital data collection tools /technologies (ODK, big data analysis and others).
• High quality English report writing and proofreading.
• The consultancy firm should be a registered firm and whose license has been re- registered and renewed for the current Ethiopian fiscal year.

Eligibility Requirements and Technical Specifications

Any interested bidder, shall provide, in its submission in response to this TOR, sufficient documentary evidence of adherence to the eligibility and minimum qualification criteria detailed below. Amref Health Africa will assess the documents submitted by the applicants in response to this TOR;

Preliminary Evaluation Criteria

Bids will be evaluated based on the below criteria.

Bids lacking any of the documents below will be considered as non-responsive and therefore will be eliminated at this stage.

Note: Bids missing any of the 3 mandatory requirements above will be considered as non-responsive bid and therefore will be eliminated at this stage.

Technical evaluation criteria

NB: The pass mark for technical evaluation will be 52.5%. Bidders who score below the pass mark will be considered non-responsive and will not move to the next evaluation stage (financial evaluation).

The Financial Proposal

This should be an outline and is indicative only at this stage. Bidders are requested to develop a more detailed budget proposal as part of the final stage of the process.