Terms of Reference for Consultancy Service to Conduct Assessment on: Assessing Gender Dynamics in Immunization: Analyzing Vaccine Acceptance and hesitancy through life course approach

1. Introduction

Amref Health Africa is implementing a project titled “Saving Lives and Livelihoods – Phase II.” This initiative is being implemented in selected districts across the Tigray, Afar, Amhara, and Oromiya regional states, with the support of the MasterCard Foundation and in collaboration with the Africa CDC. The project is designed to save lives and enhance the livelihoods of the people in Ethiopia.

At the heart of this initiative is the goal to strengthen immunization systems and effectively integrate COVID-19 vaccinations into routine immunization and primary healthcare services. The project seeks to enhance and expand immunization vaccination programs, which are crucial for the health and well-being of communities.

To achieve these ambitious goals, the project focuses on several key areas. It aims to strengthen immunization sites, both in hospitals and through fixed and mobile primary healthcare services. Additionally, the initiative is dedicated to developing life course immunization policies and programmatic tools that align with the Immunization Agenda 2030. A significant emphasis is placed on enhancing the quality of immunization services, which involves building trust within communities to ultimately improve vaccination rates. Furthermore, the project seeks to foster collaborative networks with global partners and knowledge exchange platforms, which are essential for improving strategies that lead to better health outcomes.

As part of the project implementation, a gender analysis assessment is planned, titled “Gender Dynamics in Immunization: Analyzing Vaccine Acceptance, Community Leadership, and Policy Impacts on Caregivers.” This assessment aims to explore various critical factors, including vaccine acceptance, the influence of community leadership, and the implications of policy decisions on caregivers. By analyzing these dynamics, the project aspires to contribute to the development of more effective and inclusive immunization strategies that consider the unique challenges and perspectives of different community members.

2. Background and Objective of the Assessment

Understanding gender dynamics is crucial in shaping health behaviors and outcomes, especially within the framework of immunization programs. In numerous communities, traditional gender roles significantly influence decision-making processes regarding children’s health, including vaccination choices. While mothers typically assume the primary responsibility for child healthcare, fathers and community leaders also play pivotal roles in determining vaccine acceptance. Recognizing these dynamics is essential for crafting targeted interventions that effectively address both the barriers and facilitators to immunization, taking gender considerations into account.

Vaccine acceptance is influenced by a multitude of factors, such as education, socio-economic status, and cultural beliefs. Gender differences can markedly affect how information about vaccines is received and interpreted. For example, women may have limited access to health information compared to men, which can directly impact their willingness to vaccinate their children. Furthermore, the role of community leadership is vital in shaping public perceptions about vaccines. Leaders can either advocate for vaccine uptake or contribute to vaccine hesitancy, depending on their beliefs and the messages they communicate. By analyzing the intersection of gender dynamics and community leadership, we can gain valuable insights into effective strategies for enhancing immunization rates.

This research aims to delve into the complexities of gender dynamics in immunization by examining vaccine acceptance, the influence of community leadership, and the implications of policy decisions on caregivers. By doing so, we hope to contribute to the development of more effective and inclusive immunization strategies that consider the unique challenges and opportunities presented by gender dynamics. Ultimately, this assessment seeks to foster a deeper understanding of how gender influences health behaviors, thereby paving the way for improved health outcomes in communities.

Objectives of the Assessment

• Overall objective of this assessment is to explore the gender Dynamics in Immunization: Analyzing Vaccine Acceptance and hesitancy through life course approach

Specific Objectives

• To identify and analyze the gender differences in vaccine acceptance and hesitancy among caregivers participating in immunization programs.
• To assess the role of community leaders and health workers in mitigating gender biases within immunization programs.
• The health workers perception toward life course immunization

Key Research Questions

To achieve the objectives outlined above, the assessment will address the following key research questions:

• What are the gender differences in vaccine acceptance and hesitancy among caregivers participating in immunization programs? This question seeks to uncover the underlying factors that contribute to varying levels of acceptance and hesitancy towards vaccines among different genders, particularly focusing on caregivers’ experiences and beliefs.
• What role do community leaders and health workers play in mitigating gender biases within immunization programs? This question aims to explore how community leaders and health workers can effectively address and reduce gender biases that may hinder vaccine uptake, thereby promoting a more inclusive approach to immunization.

Importance of the Assessment

Understanding the gender dynamics in immunization is essential for several reasons:

• Equity in Health: Addressing gender-related barriers ensures that both men and women have equal opportunities to access immunization services, which is vital for achieving health equity
• Community Engagement: Engaging community leaders and health workers can enhance trust and acceptance of vaccines, particularly in areas where skepticism may be rooted in cultural or gender biases.
• Informed Policy Making: The findings from this assessment can inform policymakers and health organizations about the specific needs and challenges faced by different genders in immunization contexts, leading to more effective and targeted interventions.

3. Geographic coverage for the Assessment

The assessment will be conducted in selected sample woredas/districts of SLL phase II project target regions Tigray, Afar, Amhara and Oromiya using scientifically accepted sampling methods and procedures. The list of projects woredas are the following:

Region	Project implementation woredas/districts
Tigray	Abergele Yechila, Adwa Rural, Kola Tembien, Tanqua Milash, Ahferom Emba Alaje,Endamehoni, Ofla, Raya Alamata, Raya Azebo
Afar	Semera logia, Mille town ,Dulecha, Argoba Awash town, Buroimedaytu, Abida, Werer town, Yangudi , Gereni
Amhara	Debrebirhan Town, Debretabor Town, Dessie Town, Gondar Town, Kombolcha Town, Debark Town Woreda, Menz Lalo Midir Woreda, Lalibela Town, Bati Town Woreda, Kemisie Town, Adagnager Chako Woreda, Gendawuha, Metema Woreda Quara Woreda, Woldiya Town
Oromiya	Hitosa, Limu B., Monessa, Shirka, Bedele Gechi, Mana, Omo Nada, Kersa, Alge Sachi, Daremu, Chiro zuria, Daro Lebu, Gemechis, Habro

4. Methodology

The consultant is tasked with proposing a scientifically sound methodology that aligns with the objectives of the assessment. This assessment will utilize a mixed-methods approach, incorporating both quantitative and qualitative survey methods to ensure a comprehensive understanding of the subject matter.

Quantitative Methods: The quantitative component will involve the formulation of detailed assessment questions that are designed to gather numerical data. This will include defining the sampling frame, identifying the sampling unit, and outlining the sampling procedure. The consultant will determine the appropriate sample size based on statistical power analysis to ensure that the results are representative and reliable. Data collection methods may include structured surveys or questionnaires that can be administered online or in person, depending on the target population.

Qualitative Methods: The qualitative aspect will focus on gathering in-depth insights through methods such as focus groups, interviews, or open-ended survey questions. This approach will allow for a deeper exploration of participants’ perspectives, experiences, and motivations regarding the assessment topic. The consultant will also outline the method of qualitative data analysis, which may involve thematic analysis or content analysis to identify key themes and patterns within the data.

The consultant will prepare or adapt appropriate data collection tools that cover the key areas identified in the assessment’s objectives. These tools should be rigorously tested for validity and reliability. It is essential that the consultant collaborates closely with the Monitoring and Evaluation (M&E) unit of Amref Health Africa in Ethiopia, as well as project staff, to review and discuss these tools.

4.1 Specific Tasks to be done by the consultant team

• Review relevant related study documents
• Meet Amref Health Africa in Ethiopia head office and project staff at the beginning and at the end of the field work for inception reporting and debriefing.
• Discuss with Amref program development/program/project managers and M&E staffs
• Identify key partner for interviews from the government & other relevant stakeholders
• 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.
• Develop, share the detail evaluation proposal/inception report/ that includes the detail data collection tool, methodology, and time frame
• Revise the tools and inception report as per the feedbacks given and share the final approved one
• Conduct the data collection, as per the agreed inception report and time frame
• Avail all professionals and data collectors indicated in the technical proposal
• Submit the draft evaluation report, revised report and final report as per the agreed time-frame

4.2 Key Deliverables

• A Detailed inception report/protocol
• Draft and Final Data Collection Tools.
• Draft report
• Final Survey Report: hard copy, complete data set and analysis syntax / preferably stata dataset and DOfile.
• Present to Amref Health Africa and /or other stakeholders as required

5. Work Plan

The consultant is expected to complete the assignment within one month of the agreement signed with Amref. The detail time schedule need to be submitted by the consultant as part of the technical proposal and inception report subject for review and revision by Amref in discussion with the consultant.

6. Structure and Presentation of the final evaluation report

The consultant will produce a report that contained the following basic information

The consultant will prepare a comprehensive report that includes the following essential components:

• Project Title
• Agency Name
• Country
• Names of consultant firm
• Compiled By: Name of the individual responsible for creating the assessment report, along with a summary of contributions from other team members.
• Assessment Period: Duration during which the assessment was conducted.
• Contents Page
• Abbreviations/Acronyms Page
• Executive Summary: A concise overview of the assessment report, limited to one page.

Report Sections:

1. Introduction
   • Background and Purpose: Outline the context and aims of the assessment.
2. Detailed Methodology
   • Methodology and Applied Techniques: Describe the methods and techniques employed throughout the assessment.
   • Constraints and Limitations: Discuss any challenges and limitations encountered during the study.
3. Analysis of Information Gathered
   • Provide a thorough analysis of the information collected and present evidence related to the previously established issues. This section will include an interpretation of the evidence in relation to the assessment questions.
4. Findings of the Assessment
   • Present the key findings derived from the analysis.
5. Conclusions
   • Summarize the main takeaways from the assessment.
6. Lessons Learned
   • Highlight significant insights and lessons gained from the process.
7. Recommendations
   • Offer actionable recommendations based on the assessment findings.
8. Annexes
   • Include the following supplementary materials:
     • Terms of Reference (ToR)
     • Work Plan: Composition and description of the mission.
     • Proposed Methodology: Techniques and sources utilized for data collection.
     • Documentary Review: List of secondary sources referenced.
     • Interviews: List of informants, interview scripts, transcripts, and notes.
     • Surveys: Models, raw data compiled, and statistical analyses conducted.

1. The Consultant teams (qualification and composition)

The potential consultant team members for the assessment are required to meet the following minimum requirements in order to qualify for the submission of his/her proposal:

• Relevant Experience: Applicants for the bid must demonstrate prior experience in similar tasks or consultancies, specifically in Gender Analysis related to immunization/vaccination, as well as monitoring, evaluation, impact assessment, and data collection methods for related projects and programs.
• Professional Qualifications: Applicants should comprise a team of professionals with backgrounds in Gender, Health, Data Science/Statistics, or other social sciences. All team members must possess at least a Master’s degree in relevant fields to effectively conduct the proposed assessment.
• Supporting Documentation: It is required that all supporting documents, including evidence of the consultant’s previous experience, be attached to both the technical and financial proposals.
• Registration and Licensing: The consultant must be a registered firm, and their license should be renewed for the current Ethiopian fiscal year.

2. Premises of the Assessment, Authorship and Publication

• Anonymity and confidentiality. – The consultant must respect the right of individuals to provide information ensuring their anonymity and confidentiality.
• Integrity. – The consultant will be responsible for highlighting issues not specifically mentioned in ToR if this is necessary to obtain a more complete analysis of the intervention
• Validation of information. – The consultant must ensure the accuracy and reliability of the information collected during the assessment. This responsibility extends to the preparation of the final report, for which the consultant will be accountable for the integrity of the information presented
• Incidents. – Should any problems arise during fieldwork or at any other stage of the assessment, it is crucial that these incidents are reported immediately to Amref Health Africa. Prompt communication will facilitate timely resolutions and maintain the integrity of the assessment process

3. Presentation/submission/ of the Technical and financial Proposal and valuation criteria

Competitive bidders are expected to submit their bid proposal as follows:

• Cover letter: – Signed one page cover letter containing, the name, mailing, address, telephone number and brief relevant information of the applicant.
• Detail Technical Proposal In addition to detailed technical matters, the technical proposal shall provide a description of the consultant including an outline of the consultant’s recent experience in similar undertakings and a detailed plan for accomplishing the tasks described in the specific task section. This proposal should be submitted with a separate sealed envelope.
• Detailed Financial Proposal: – The financial proposal should list itemized details of costs associated with the Assessment. All proposed costs should be expressed in Ethiopian Birr and this proposal should be submitted with a separate sealed envelope.
• References: – A list of three former or current clients for whom similar work has been done together with their addresses and telephone numbers.
• Annexes– Any documents such as curriculum vitae or other information which the applicants feel will assist the proposal review team in evaluating the proposal may be attached as annexes

4. Evaluation Criteria

Evaluation Criteria of Applicants

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

A. Preliminary Evaluation Criteria

Bids will be evaluated based on the criteria below.

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 of valid business Trading License.	1 or 0
2	Provide VAT Certificate	1 or 0
3	Provide a copy of Valid TIN/Tax Compliance Certificate	1 or 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.

Requirement	Criteria	Max Score	Actual Score	Remarks
Introduction & frameworks, & method used	[54 marks] total Marks	54 Marks
	Description of local area contexts and population- relating to the study nature (2) Clarity of the study population description- How specifically explain (2) Determined justifiable sampling procedure and sample size Method selected for the study -3 Sample size and determination -2 How the sampling frame mentioned-5 Options presented for the methods-2
	Does the consultant understand the ToR and show an approach for the approaches ( 10) Stated appropriate and relevant data collection approaches as per the ToR ( 10) Clarity of Methods used to address objectives and target groups for this evaluation ( 5) Does the consultant explain clarify the analysis for each objectives- 4 Method to capture the targets/study units -5 How the ethical issues addressed mentioned-1 Feasibility of the study with stated method Vs objective- 3
	Letter of interest addressing track record.[5 marks]
Work Experience	Provide appropriate references to demonstrate having the technical experience specified in the TOR. Track record in similar assignments, (Attach relevant documents as proof of previous works handled) Provided 4 reference & contact details [6 Marks] Provided 2 reference & contact details [4 Marks] Provided 1 reference & contact detail [2 Marks] Iv, Did not provide reference [0 Marks]	6 marks
Organizational Capacity, Team Composition and Qualification	Team Qualifications (Provide CVs and academic certificates of the team which includes educational background, professional certifications, ) [10 marks) Years of relevant experience of the team [5 marks] Attach company profile. – [5 Marks]	10 Marks
	Total Score	70
Note that: The technical proposal should have met the high quality has to get a score of 75% or 52.5/70 of the technical marks.

The remaining 30% accounts for the finance offer of the consultants. Only technically qualified consultants are invited to the financial proposal.

• Proposals will be evaluated based on experience and qualification of the candidates, price/cost effectiveness, and conceptual understanding and suggested methodology/approach. The evaluation mainly considers the three blocks namely methodological proposal/technical proposal/, the profile of the evaluators/consultant team members/ and the economic/financial/ offer.
• The weight for technical and financial proposals shall be 70 % and 30% respectively. The financial proposal will be considered when only the technical assessment is above 60 out of 100%.
• Failure to respect the statements in the TOR by the consulting firm will result in the termination of the contract agreement by Amref Health Africa.
• The consultant is obliged to avail all the experts mentioned in the technical proposal for the assignment. If the consultant wants to change any personnel, he/she should formally communicate to Amref Health Africa and get approval

1. Logistics

Amref Health Africa in Ethiopia will not provide office space, computers, copying, printing and telephone services to the Consultant, The consultant is expected to cover the costs related to vehicle for the fieldwork and thus, advised to include all those costs that Amref Health Africa will not cover including vehicle costs for the field work within prices to be quoted by his/her firm.

Others

• The consultant will work closely with Amref health Africa Ethiopia Program Manager, Project Manager, Knowledge Management Coordinator and M & E unit and project staff at field level
• All relevant documents should be submitted to Amref health Africa upon completion of tasks both in hard and soft versions.
• The consultant should not share any of the evaluation results to third party

2. Payment Modalities

The consultant will be issued consultancy contracts and paid in accordance with Amref Health Africa’s financial rules and regulations. Payment needs to be correlated to deliverables – two installments are typically planned for:

• The first payment of 30% advance of the total agreed contractual amount will be made immediately after the signing of the contract agreement based on Amref Health Africa’s financial regulations and procedures.
• The second payment of 70% of the total agreed contractual amount shall be made effective to the consultant upon the approval and acceptance of the final evaluation report.