Provision of Consultancy on Optimizing Vaccination Programs Through Human-Centered Design: Targeting Coverage Gaps Across Age Groups

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.

Background: 

In Ethiopia, vaccine preventable diseases are contributing substantially to under-five mortality. Measles is one of the leading causes of under-five mortality. Despite this progress, including the expansion of routine immunization services from six to twelve antigens, gaps remain in health worker training and resource allocation. Ethiopia has over a million under-immunized children and HPV vaccination rates for girls are limited.

In 2018, only 79% of planned immunization sessions were conducted, with outreach and mobile sessions falling to 19% and 10%, respectively. Community and Health system challenges, including limited human resources and inadequate infrastructures to maintain the cold chain and vaccine supply, contribute to zero dose and under immunization in developing countries1. In Ethiopia, studies have identified several barriers, such as limited human resource capacity, increased workload among health workers, and lengthy waiting periods at health facilities. Planning issues and inaccurate population denominators further hinder vaccination efforts.1 Furthermore, as country the introduction of currently emerging novel vaccines such as COVID-19, IPV2, Rotasil, malaria, and Hep B birth dosage needs high level technical and coordination skill.

The Saving lives and livelihood phase 1 implementation of the program has revealed both successes and challenges that provide valuable learning opportunities. Key successes include the successful integration of the program, effective execution of national-level COVID-19 vaccination campaigns, and ongoing routine immunization efforts. However, critical challenges have emerged, particularly related to budget and operational disruptions, such as sudden budget cuts and project pauses that pose significant risks. These disruptions highlight the need for improved financial management to ensure program continuity, enhanced operational resilience through flexible financial planning, and the importance of transparent stakeholder communication during financial uncertainties.

Additionally, challenges in technical assistance management have been noted. Key learning areas identified include the establishment of clearer communication protocols with donors, the development of robust guidance mechanisms, and the creation of flexible implementation frameworks, along with improved communication with ACDC, HQ and the Mastercard Foundation. Recommended actions encompass the development of comprehensive communication strategies, detailed contingency plans, regular donor check-ins, and adaptive project management approaches. Strategic recommendations further suggest implementing flexible budgeting models, comprehensive risk management strategies, enhanced stakeholder engagement, and transparent reporting mechanisms.

Overall, this experience underscores the critical importance of adaptability, clear communication, and strategic planning in navigating complex immunization programs Phase II of the Saving Lives and Livelihoods Programmes will primarily focus on strengthening countries ability to respond to future pandemics through programmatic activities designed to build and protect the health workforce, as well as improving the lives and livelihoods of the population.

Supporting the preparation of a national immunization strategy that encompasses a life-course approach and the introduction of new vaccines is crucial for enhancing pandemic preparedness. This strategy ensures that immunization programs are not just reactive but proactive, addressing the health needs of individuals at various life stages—from infancy through adulthood. By integrating new vaccines into the existing immunization framework, we can safeguard populations against emerging infectious diseases and reduce vulnerability during public health emergencies. In addition to developing a comprehensive immunization strategy, building health workforce capacity is essential.

A well-trained and adequately staffed health workforce is vital for effective vaccine delivery, public health communication, and community engagement. This capacity-building effort includes training healthcare professionals on the latest immunization practices, ensuring they are equipped to handle both routine immunizations and emergency responses during pandemics.

1.2 Justification

Operational Focus: The aims to optimize vaccination programs through a human-centered design approach. The focus is on enhancing the performance of existing vaccination systems—rather than creating new products—through operational research that improves service delivery, workflow efficiency, and user engagement.

HCD Integration: Human-Centered Design (HCD) offers a structured, user-driven process that integrates stakeholder insights at every stage. HCD phases Empathize, Define, Ideate, Prototype, and Test allow researchers to align service improvements with actual user experiences and system constraints.

Target Population Specificity: The study targets multiple age groups, enabling comparison of experiences and barriers across demographics such as children, caregivers, adolescents, and elderly adults. This segmentation allows for the design of tailored interventions based on the specific needs of each group.

2. Objectives

General Objective: To optimize vaccination service delivery by identifying and addressing barriers using Human-Centered Design (HCD) methodology.

Specific Objectives:

1. To map the vaccination journey for various age groups.
2. To identify barriers—structural, behavioral, emotional—that impact vaccine uptake.
3. To design and prototype interventions based on user feedback.
4. To pilot test and refine proposed solutions for scalability and usability.
5. Provide training on HCD for health care workers.

3. Methodology

The selected consultant will be expected to lead the full Human-Centered Design (HCD) process and deliver scientifically sound and contextually relevant results. The proposed methodology should align with the objectives of optimizing vaccination service delivery, while being rigorous enough to inform programmatic decisions and contribute to peer-reviewed publications.

Amref encourages the consultant to propose an innovative, yet practical mixed-method research approach, incorporating both qualitative and quantitative tools. The methodology should include a clear sampling strategy, robust data collection methods, quality assurance mechanisms, and capacity-building components. In particular, the consultant will also be responsible for capacitating Amref staff who will be part of the HCD core team, ensuring long-term sustainability of the approach.

The methodology must include a complete lifecycle of HCD phases as described below:

Phase 1: Empathize (Qualitative)

• Training Health Care workers
• Ethnographic Observation: Observe how clients interact with vaccination services to understand real-time behaviors and pain points.
• In-Depth Interviews (IDIs): Conduct semi-structured interviews with caregivers, adolescents, adults, and health workers to explore perceptions and challenges.
• Journey Mapping: Develop visual representations of vaccination experiences to identify key friction points, motivations, and gaps.

Phase 2: Define

• Data Synthesis Workshops: Lead collaborative sessions to consolidate insights, uncover patterns, and develop actionable user personas.
• Quantitative Surveys: Design and conduct structured surveys to validate qualitative findings and measure barrier prevalence.

Phase 3: Ideate

• Co-Design Workshops: Facilitate interactive sessions with users, health workers, and managers to brainstorm practical, user-centered solutions.
• Problem Framing and Prioritization: Support stakeholders in identifying and ranking potential interventions based on feasibility, scalability, and user alignment.

Phase 4: Prototype

• Low-Fidelity Prototyping: Develop initial service tools, communication materials, or service delivery enhancements.
• Pre-Implementation Review: Conduct walkthroughs and solicit feedback from key stakeholders to refine concepts.

Phase 5: Test and Refine

• Pilot Testing: Deploy prototypes in selected sites to test real-world applicability.
• Exit Interviews & Usability Testing: Evaluate user interaction and feedback to assess ease of use, effectiveness, and satisfaction.
• Iterative Redesign: Modify and improve interventions based on feedbacks and implementation outcomes.

Consultant’s Additional Responsibilities within the Methodology

• Lead the full HCD process from inception to final delivery, ensuring all phases are executed effectively.
• Deliver final HCD outputs, including user journey maps, validated barrier analyses, and actionable prototypes.
• Build capacity of Amref staff, especially the HCD core team, through continuous coaching, knowledge transfer, and direct involvement in HCD phases.
• Ensure inclusive stakeholder engagement across all levels to promote ownership and contextual relevance of outcomes.
• Provide regular progress updates to Amref teams and adapt the methodology based on feedback or emerging needs.
• Embed sustainability by equipping Amref with tools, skills, and strategies to continue applying HCD beyond the project period.

4. Target Population

This broad participant group ensures a 360-degree understanding of vaccine uptake challenges across the lifecycle and across service levels.

• Caregivers of children
• Adolescents and young adults
• Pregnant mothers
• Adolescent Girls
• Elderly vaccine recipients
• Health providers
• Program managers and administrators

5. Expected Deliverables

• User journey maps and personas
• Barrier analysis (validated)
• User journey maps and personas
• Barrier analysis (validated)
• Intervention prototypes for HCD, Pilot results with recommendations
• Conduct co design workshops and Training

Anticipated Impact: Ultimately, the aim is a more effective, responsive, and equitable vaccination program that meets people where they are.

• Improved vaccine access and equity
• Higher uptake through user-aligned solutions
• Scalable strategies for system-level improvement

Total Duration: Approximately 15 weeks

1. Timeline

Phase	Duration
Empathize	2 weeks
Define	2 week
Ideate	1 week
Training and prototype	6 weeks
Test & refine/coaching	2 weeks
Monitoring and Reporting	2weeks on wards

 

Specific tasks to be done by the consultant

• The consultant is expected to deliver the completed lifecycle of HCD phases as described above
• 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.
• 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 partner for interviews from the government and private sectors at all levels
• Develop protocol that clearly how the lifecycle of HCD phases being implemented/completed the assignement.
• 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 who has an 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.
• Provide human centered design tailored to immunization program for 200 health care workers from selected facilities (the cost of the training covered by Amref health Africa)

8. Period for Submission and deliverables

• The consultancy firm or team should follow the overall time frame of 15 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 in the second week of the agreement.
• Along data collections, training of health care workers about HCD in the second, third and fourth week
• 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 co design and training and final comments from Amref addressed and Final prototype.
• The consultant will update Amref Health Africa in Ethiopia on the progress of the work regularly.

1. 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.

 

No.	Particulars	Marks	Compliant	Non-compliant
1.	Provide a copy Valid License	1 or 0
2.	Provide a copy of Valid TIN/Tax Compliance Certificate	1 or 0
3.	Provide a copy of VAT certificate	1 or 0 1r 0

 

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.

 

1. Technical evaluation criteria

	Title of the task	Technical proposal to …………………..
	Name of consultant
	Dimensions	Description	Wt	Score	Remark
1	Methods used (54)	Description of local area contexts and population- relating to the study nature	4
		Clarity of the study population description- How specifically explained	4
		Determined justifiable sampling procedure and sample size Method selected for the study -6 Sample size and determination -6 How the sampling frame mentioned-2 Options presented for the methods-2	16
		Stated appropriate and relevant data collection methods as per the ToR- Does the consultant include and show clue for the tools	10
		Appropriateness of data analysis methods planned Does the consultant explain clarify the analysis for each objectives	5
		Clarity of Methods used to address objectives Method to capture the targets/study units -5 How the ethical issues addressed mentioned-4 Feasibility of the study with stated method Vs objective- 6	15
2	Team composition (4)	5 or more professional team relevant to the work done	4
		4 or more professional team relevant to the work done	3
		3 or more professional team relevant to the work done	2
		2 or more professional team relevant to the work done	1
		1 or more professional team relevant to the work done	0
3	Experience (6)	At least 5 and more relevant attached experience	6
		4 relevant attached experience	4
		3 relevant attached experience	3
		2 relevant experience	2
		1 relevant experience	1
		None (0) and records of unsuccessful assignment	0
4	Work schedule (3)	Work schedule was prepared as Per the ToR	3
5	Overall structure of the proposal(3)	Please give rate the maximum three to the lowest -0: as general summary	3
	Total Score =(70)		70

2. 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.

Description	Amount in ETB
Financial Quotation – Indicative budget to accomplish the task (Detailed cost proposal in ETB for the consultancy)
All Applicable Taxes
Total Amount in ETB

Target Population

• The team will consist of professionals in the fields of behavioral science, health communication and promotion, public health and Social Science with a minimum of Masters 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 human center design; previous experience in similar tasks or consultancy. In particular, the applicant must have experience in conducting human center design approaches and performing impact data collection methods associated with service integration setting.
• 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 human center design and social 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) as part of human center design.
• 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.
• Partnership and have mechanism to own and sustain the findings and prototypes for the future by the government.

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;