I.        Background

Immunization coverage for all basic immunization has progressed over the year and reached 43% in 2019 from the level 17% in 2000. It has contributed significantly for the reduction of under-five mortality Ethiopia has achieved over the years. Despite the progress in coverage, Ethiopia is still one of the ten countries in the world that contribute to 60% of pentavalent 3 unvaccinated children (WHO, 2018). Moreover, Immunization coverage is one of the proxy indicators of high inequity. However, in pastoralist areas such as Afar (19.8%) and Somali (18.2%) the coverage for fully vaccinated children remains low compared to the rest of the regions and city administrations such as Addis Ababa (83.3%) (Mini DHS 2019). The dropout rates also are significantly higher. This shows that the percentage of children who are not reached with all basic vaccination are higher in these regions. The stagnated vaccination coverage, high regional variation and high dropout rates are among the major challenges of immunization program in Ethiopia.

As a response to the disparity in performance of main health outcomes between regional and sub-regional levels, Ethiopia has put equity as one of the main pillars of the health sector transformation plan (HSTP) and strong partnership with immunization partners and beneficiary communities. Government also introduced an innovative Health Extension Program (HEP), a community based approach for delivering mainly health promotion and preventive primary health care. The HEWs are tasked with implementing the immunization program in their respective kebeles, the smallest administrative unit, and currently the HEP is contextualized for the pastoralist areas. In addition, the government has established a separate directorate, Health System strengthening, Special Support directorate (HSSSD) within the Ministry of Health that support the developing regions to perform better. However, progress in the immunization coverage in the pastoralist regions specially Afar and Somali Regional States is low (EMDHS,2019). In Afar and Somali Regional States only one fourth of children had accessed the third dose ofPentavalent vaccine. As a result of low uptake of vaccination service, and weak disease surveillance and response systems, frequent outbreaks of measles have been occurring every year.

Despite the different interventions and strategies employed to improve immunization coverage in these regions, there is little progress in the vaccination coverage particularly in the two pastoralist regions. Moreover, there is lack of evidence on the effectiveness of these interventions and strategies in delivering immunization service for pastoralist and Agro-pastoralist regions.

Therefore, this study will assess the effectiveness of existing immunization policy implementation guides and strategies and propose/recommend a region specific strategy for delivery of immunization services in the pastoralist regions.

II.        Project Overview

Through Gates Anchor III advocacy project, Save the Children aspires to achieve key results in partnership with government at all levels, and CBOs to engage communities in the implementation of the manual designed to execute pastoral sensitive health extension program (HEP). Save the Children will work to increase community demand for child health; particularly, for pneumonia, the NNP II and the finalization, endorsement and application of the Food and Nutrition policy. The existing CSO Health Forum led by the Consortium of the Christian Relief Development Association (CCRDA); and governmental and NGO forums operating at the regional level will be key platforms to amplify the health and nutrition agenda through regular dialogues, meetings, information dissemination, engaging in national and sub-national events and others.  By strengthening key partnership, both at the national and regional levels, the budget allocation and utilization at two of the project regions will be jointly carried out as part of key activities that will be sub-granted to the CSOs Forum.  Sstories and learnings will be disseminated at large; and progresses tracked on regular basis for sharing and documentation to scale up interventions and supports.

In sum, this project will contribute directly to reinforce the implementation of the government strategies; mainly the pastoralist health extension program, the nutrition and food policy and increase demand for child health services particularly for pneumonia; to work towards improving the lives of the new-born and ensuring child survival.  The project aims at proposing to ensure effective universal health coverage to address the high impact neonatal and child survival interventions with special focus on the poorest and marginalized sections of the population and advocating for the equitable resource and its utilization effectively and efficiently. Series of engagements and dialogues will be carried out with the regional officials; especially; the Bureaus of Health and Finance; to agree on the areas of improvement and gaps when it comes to the health of children in those regions while the smooth relationship is further improved. The regional partners/platform that will strengthened will influence those regular sessions of the taskforces led by the Regional Health Bureau to influence their decisions and inculcating our advocacy agenda based on evidence. We will catalyse discussions and support by strengthening our partnership with the Parliament and the media. Key community influencers who are renowned both in Afar

and Somali regions and able to convince their respective governments will be instrumental, and an innovative approach we will employ. It will also be instrumental to support demand creation by the community.

III.        Purpose of the immunization research

This immunization research will enable to investigate the routine immunization policy and strategy at national level and implementation approaches, strategies, guidelines in the pastoralist regions (particularly, in Afar & Somali). The findings of the research will be an outputs for crafting advocacy messages to influence policy makers and key immunization actors towards improving contextualized routine immunization services for pastoralist communities.

IV.        General Objectives

To assess the effectiveness of immunization plan, strategy and program implementation in pastoralist regions (Afar & Somali), Ethiopia.

Specific Objectives:

•                    To assess the effectiveness of immunization strategies/guidelines implementation at all levels

•                    To Investigate factors that affect the effectiveness of immunization program in Afar & Somali

•                    To identify best practice in immunization service delivery in Afar & Somali regions

•                    To propose/recommend an innovative region specific strategy for delivery of immunization services in the pastoralist regions

V.        Scope of the Assignment

Geography: the study will be conducted in two regions: Afar and Somali Regional States as they are the two major pastoralist regions having over 80% pastoralist and agro-pastoralist communities.

VI.    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 public health, or other related field.

·         Proven experience (minimum 10 years) in leading, coordinating and conducting national and regional quantitative and qualitative researches in the area of MCH, Strategy development, national program evaluation for immunization programs,

·         Proven experience in conducting research on the health system (HRH, service delivery, Finance, Logistics and Supply, leadership and governance, health information system)

·         Excellent understanding and exposure to the Ethiopian Health Sector transformation plan, national immunization strategy, guidelines, manuals, and health communication strategies and approaches particularly on the pastoralist areas

·         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 both quantitative and qualitative studies on MNCH, preferably on immunization

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