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Liberia: Liberia External Consultant to ‘Analyse vaccine hesitancy and how to support COVID-19 vaccination uptake in Liberia’

Terms of Reference

External Consultant to ‘Analyse vaccine hesitancy and how to support COVID-19 vaccination uptake in Liberia’

1.0 Background

Concern Worldwide has been operational in Liberia since 1996, primarily in emergency interventions and then moving to development programs from 2002. Concern’s vision is to eliminate poverty for the extreme poor within the country and is guided by a poverty analysis based on three dimensions; return on or lack of assets, inequality and risks and vulnerabilities. To address the root causes of poverty based on analysis Concern Liberia takes an integrated multi-sector approach focusing on health.

Although the COVID-19 virus has not had the negative health impact seen in other countries, the economic consequences of lockdown have been detrimental to food security exacerbating already extreme poverty. In Liberia, from 6 March 2020 to 30 May 2021, there have been 2,179 confirmed cases of COVID-19 with 86 deaths, reported to WHO.

Key to preventing any further economic shocks is ensuring the public are safely vaccinated against COVID-19 and further lockdowns are prevented. As of the 15th of June 2021, a total of 63,622 vaccine doses have been administered and 467 people fully vaccinated against COVID-19. That is a disappointing 1.27% of the population[1]. Concern Liberia, in partnership with IRC and funded by ECHO are eager to ensure that any messaging encouraging vaccinations are carefully targeted to overcome potential vaccine hesitancy.

Project Overall Objective: To support the national, county, and district health authorities in Liberia to effectively implement Liberia’s National Deployment and COVID-19 Vaccine Plan (NDVP)

Project Specific Objective: To contribute to optimizing vaccine distribution and uptake under the National Vaccine Deployment Plan in collaboration with the MoH, in all 15 counties of Liberia.

2.0 Project Description

2.1 Project Population

The project will reach 35,873 people with COVID-19 vaccinations and 2.5 million people with targeted vaccination messaging to assure them that the vaccination is safe.

2.2 Project Strategy

According to an Afrobarometer poll, only 20% of the population trusted vaccines[2]. The government has developed the National Vaccine Deployment Plan to contribute to the country’s overall COVID-19 response.

Through the proposed project, Concern and IRC will support the Ministry of Health at national, County and District level to implement the National Vaccine Deployment Plan. The project will specifically support County and District health teams to roll out the vaccine to all healthcare workers and vulnerable people in the country, especially those in the hardest to reach places. The project will also work with National, County and District government counterparts to develop and roll out a communications campaign on COVID-19 vaccine.

The proposed project will build upon the combined skills and experience of two of the leading NGOs in Liberia, Concern and IRC. Both organisations have experience in humanitarian and health responses in Liberia for a variety of institutional donors including ECHO. The partners will harness relationships built at multiple levels from National to County to District government officials, to international and national NGOs and most importantly with the communities and their health teams that are at the centre of this planned project.

The project will remain flexible to the changing realities in Liberia as the government refines the National Vaccine Deployment Plan, as vaccine supplies vary, and as the particular type of vaccine may vary. The partners will remain flexible to respond and ensure that the plan remains targeted on the marginalized and hardest to reach.

2.3 Partners

The primary collaborative partners on this project are Concern Liberia and IRC Liberia. Extensive collaboration with the Ministry of Health at national level, via the Incidence Management System weekly updates, the various working groups for the COVID-19 National Vaccine Deployment Plan implementation, and the EPI Manager and TWG. At County Level the County Health Teams and at District Level, the District Health Offices, at community level Community Health Assistants and Community Health Volunteers will be key partners. Concern Liberia and IRC envisage extensive coordination with other INGOs and NGOs to ensure a coherent approach to implementation.

3.0 Purpose of the Analysis

According to Afrobarometer research[3]:

1) 66% of Liberians are most likely to express a reluctance to take the vaccine;

2) 78% say Not at all/Just a little on ‘Trust government to ensure safety of COVID-19 vaccine’;

3) 49% of Liberians say very unlikely to ‘If a vaccine for COVID-19 becomes available and the government says it is safe, how likely are you to try to get vaccinated?

4) Liberia (86%) believe that prayer is more effective than a vaccine in preventing coronavirus infection; and

5) In Liberia, citizens with more formal education are not significantly more likely to want the vaccine than their less educated counterparts.

The analysis will inform the preparation of a communication strategy to support the Government of Liberia’s National Vaccine Deployment Plan. The objective is to get the highest COVID-19 vaccination coverage as possible. The methodology proposed for the analysis is a barrier analysis verified and interrogated by key informant interviews and focus groups. However, the analysis methodology can be supplemented or improved as recommended by the consultant. The analysis report needs to be a substantial document that (a) answers all the elements of the Terms of Reference (ToR); (b) provides findings, conclusions, and recommendations that are based on robust and transparent evidence; and (c) is useful for the development of a communication strategy to support the National Vaccine Deployment Plan.

The analysis report should be relevant to national level stakeholders as well as to advance policy dialogues and best practice in-country. The analysis report is intended to contribute to the development of a national SBCC strategy on COVID-19 vaccination messaging, the programme focus for Concern and IRC is in a rural environment.

The analysis report will be used to influence dialogue at the local, national and international levels on issues of COVID-19 vaccination hesitancy and how to overcome it, effective SBCC strategies, key points and messages for SBCC materials. The analysis report may serve to contribute evidence and learning for policy and programming decisions and will also contribute learning to Concern Worldwide’s COVID-19 programming. Therefore, it is important that the researcher considers the audiences listed below, when conducting the analysis and writing the report.

The following audiences may use the analysis report as a source of evidence to help inform decisions about future COVID-19 vaccination programme designs, strategies and policies:

· In-country partners at national, regional, and local levels (e.g., MoH, other relevant ministries and civil society, PVOs/NGOs, local organisations, and communities in project areas)

· ECHO and other donors looking to reduce COVID-19 vaccination hesitancy in Liberia

· IRC and Concern Worldwide headquarters

· IRC Concern Liberia to inform on-going and potential future COVID-19 vaccination focused programs

· EPI Technical Working Group and sub groups

· The international development community

The analysis report will be disseminated and made broadly accessible to various audiences and findings will contribute evidence relevant to global initiatives such as the COVAX campaign via WHO in Liberia.

3.1 Key Objectives of the Analysis

There is cause for concern about vaccine hesitancy in Liberia, as informed by the Afrobarometer poll. IRC, Concern and partners including MOH and local NGOs need evidence to guide the further development of Risk Communication and Community Engagement Communication. This analysis will identify barriers to citizens being vaccinated and therefore protected from COVID-19. Social and cultural norms must be understood in order to adjust our work to achieve success, and be taken into account when designing effective communications campaigns.

The project document sets out key results it aspires to achieve, and the result to which the analysis pertains is Result 2: “National communication campaign to promote uptake of COVID-19 vaccination is designed and delivered.”

Indicator 1: Number of people reached with national communication campaign

Indicator 2: % of healthcare workers trained or sensitized on COVID-19 Vaccination

Activities to achieve these results:

1) Build capacity of the Government of Liberia to deliver COVID-19 vaccination communications campaign

2) Mass media messaging to promote the uptake of the COVID-19 vaccine.

3) Engagement of local leaders to encourage citizens to be vaccinated against COVID-19

4) Engagement of healthcare workers to encourage citizens to be vaccinated against COVID-19

As such, it is critical that the analysis be approached with these topline ambitions in mind and is not an academic exercise but a practical applied piece of analysis.

4.0 Key Lessons and Recommendations

The analysis should make clear key lessons and recommendations on the ongoing and future COVID-19 vaccination strategy, programming and policies in Liberia:

Key lessons and recommendations for programming: What are the key lessons and recommendations to apply from the analysis to improving COVID-19 vaccination uptake in Liberia?

What recommendations can be shared based on the analysis findings in order to tailor COVID-19 vaccination delivery strategies to be acceptable to various populations in Liberia?

Key lessons and recommendations for policy: What are the key lessons and recommendations to take for advocacy to government strategy and policy makers?

What results or learnings from the analysis could be reflected in current policies or strategies and how?

5.0 Scope of work / work assignments

The scope of work for the analysis entails the following:

§ Critical analysis of current SBC approaches towards COVID-19 vaccination uptake, methods and tools/IEC implemented by health stakeholders (government and partners) in Liberia. Capturing what others are doing differently/better, messages and the way they are disseminated (range of communication channels and methodologies that work).

§ To gain insights and address the social and behavioural determinants associated with COVID-19 vaccination uptake and the mix of communication channels.

§ The key behaviour to be examined is: ‘Person has received at least one COVID-19 vaccination’.

§ The behaviour should be studied in different population groups: Women/men, community members/people in multiplier function, by wealth group other categories as guided by innovative or good practices.

§ The programme focuses on vulnerable groups and those in hard to reach areas. As such, although it might not be possible to do Barrier Analysis on these groups due to the small number of vaccinations administered, some complementary analysis on how to tailor messages for these groups is important.

§ The individual/institutional consultant(s) will develop the research methodology. It is recommended that the Socio-Ecologic Model (SEM) is applied by the researchers to provide a comprehensive picture of the participant groups at different levels (micro, meso, and macro) and their power of influence on COVID-19 vaccination uptake. In collaboration with the Programme teams in Concern and IRC and the MoH, the consultant will identify and select communities and the target participant groups.

§ Revise the already existing Barrier Analysis tool to tailor it for use in the COVID-19 context. This refers to adaptation of the determinants to be assessed and the data collection process itself.

§ Build from the Barrier Analysis methodology to add key informant interviews, focus groups and other approaches as guided by good practice research on COVID-19 vaccination hesitancy.

§ Develop questionnaire for doers and non-doers surveys (for both quantitative and qualitative data collection) in consultation with Concern, IRC and the Ministry of Health.

§ Conduct a field testing exercise

§ After the field test, revise methodologies for data collection from recommended sample sizes for doer and non-doers

§ Carry out analysis in collaboration with the Government of Liberia and IRC.

§ Detailed SBCC final strategy action plan, including milestones and indicators to monitor and evaluate the success of the plan based on the context

§ A set of field-tested and tailored messages related to key studied behaviours.

§ Conduct dissemination meeting(s) / workshop(s) to key staff and partners MOH staff, Concern and IRC and local partners staff, community champions on how to implement effective SBCC methods guided by the findings.

6.0 Analysis Methodology**

The consultant will design the methodology and can complement the proposed approach with good practices or innovative tools. The proposed approach is a Barrier Analysis (BA), complemented with key informant interviews, and focus groups. A Barrier Analysis is an assessment, which uses a mix of qualitative and quantitative methods to identify what is preventing a target group from adopting a specific behaviour, as well as identifying enablers of the behaviour. The results of the questions are compared amongst groups of people who already have adopted the behaviour (called “Doers”); and people who haven’t yet adopted the new behaviour (called “Non-Doers”). By comparing these two groups, it is possible to assess what determines whether or not people follow this behaviour and which of these behavioural “determinants” are the most important.

Summary of process:

§ A standard questionnaire is used for each behaviour and questions are asked of individuals from the Priority Group.

§ Using the screening sections of the questionnaire, they are classified as Doers or Non-Doers

§ The interviewer then asks questions to understand why they do or do not follow the behaviour to understand how they perceive the behaviour and what makes it easy or difficult for them to follow this practice.

§ Key informant interviews and focus groups are used to verify or interrogate the results and ensure they are properly understood.

§ Following the field work, the responses of Doers are compared to Non-Doers and the key differences ‘determinants’ found. Using these determinants, a social behaviour change strategy to convert Non-Doers into Doers is developed.

Selected behaviour: ‘Person has received at least one COVID-19 vaccination’.

Concern and IRC are interested in both data security and utilization. The applicant should propose innovative ways to ensure that the study data is secure and managed in a way that meets the minimum data quality standard (Validity, Integrity, Precision, Reliability and Timeliness). Concern and IRC also need to have access to the data to conduct quality check throughout the data collection and interpretation.

7.0 Researcher Characteristics

The independent researcher should be a suitably qualified and experienced academic expert or health programme practitioner. The researcher will coordinate closely with the Concern team regarding planning, research design finalization, methodology, timeline, and draft report finalization.

Requirements for Researcher

§ Post graduate qualification in Public Health with a specialization in overcoming vaccination hesitancy, or related discipline

§ At least five years’ demonstrated experience leading similar highly specialized research projects or conducting Barrier Analysis preferably relating to health related behaviours and ideally related to vaccination hesitancy

§ Experience with applied research and translating findings to recommendations and action

§ Strong understanding of community, community health systems and the interaction of community stakeholders and the linkages to government

§ Excellent English writing skills (Concern will not be providing editing services), ability to deliver a quality product that meets Concern’s and ECHO’s standards on time

§ Team player and willingness to lead this innovative piece of research with Concern’s COVID-19 response team

§ Adaptable, flexible, and able to spend several weeks in rural Liberia leading the research and supporting dissemination events in-country

§ Excellent communication and facilitation skills with which to foster effective relationships with staff and project stakeholders in country

§ Recent experience with Liberia and the health system and policy landscape

§ Ability to mobilize and manage enumerators and support staff in-country

§ Any experience on COVID-19 related research would be really helpful

Desired but not essential

§ Prior major donor experience, preferably ECHO

§ COVID-19 related experience

§ Barrier Analysis experience

8.0 Expected Timeline and Deliverables

The researcher will submit the final report to Concern who, in turn, will share with IRC, ECHO and the MoH in Liberia and other partners. The main body of the report must be limited to 50 pages (excluding annexes). The report should include a summary of findings according to the research topics listed above. The researcher will collaborate with Concern to host a National level technical working group meeting with key stakeholders from MoH and partners to disseminate the findings.

8.1 Key Tasks of the Team Leader

The following tasks are expected to be completed under the consultancy. All tasks under pre-field work should be completed and approved before commencement of field work period.

Pre-Field Work

§ Review project documents and resources to understand the project

§ Participate in a call with Concern Liberia to review the scope of work and methodology

§ Participate in a planning call with Concern to discuss the field research schedule, team composition, and methods

§ Produce a brief inception report

§ Develop methodology including creation of data collection tools, training and facilitation guides, and sampling plan. Methodology and tools require approval by Concern.

§ Recruit enumerators for data collection, as necessary

Field Work

§ Train final research team members on objectives and process of the Barrier Analysis including data collection tools

§ Lead the team in person to complete the collection, analysis, and synthesis of supplemental information

§ Interpret whatever quantitative and qualitative results are needed to inform the Barrier Analysis and draw conclusions, lessons learned, and recommendations regarding project outcome

§ Lead an in-country debriefing for Concern and IRC when fieldwork is completed.

Post Field Work

§ Draft report on or before July 29th 2021.

§ Prepare final report and submit to Concern on or before August 16th 2021. The final report will be free of grammar errors and formatted according to ECHO guidelines, with input and comments from Concern addressed.

§ After the final report is agreed, lead in-country dissemination meeting(s) / workshop(s) for Concern, IRC, MOH, and partners on the implications of the findings for SBCC strategies with PowerPoint slideshow, oral presentation deliverable.

8.2 Proposed Timeline

The length of the consultancy is expected to be approximately 45 working days as illustratively detailed below. Exact working days should be proposed by consultant with the listed deadlines in consideration.

Approx Working Days

Timeframe

Consultant location

Major task

1 day

June

Any location

Coordination with Concern to agree scope of work, methodology, planning, team and schedule

3 days

July

Any location

Review of documents, complete inception report, questionnaire development.

2 days

July

Travel time*

Travel To/From rural Liberia

5 days

Pre field work in Concern Buchanan Office / IRC Office

Questionnaires finalised, translated and piloted / pre-tested and enumerators trained and briefed.

12 days

Liberia

Community based research, (barrier analysis, key informant interviews and focus groups) completed on or before July 22nd 2021.

2 days

Post field-work Concern Buchanan Office / IRC office

Review, analyse and discuss findings with research team and debrief, finalise in-country aspects of the research.

5 days

July

Any location

Draft report shared on or before July 29th 2021.

5 days

August

Any location

Preparation of report, recommendations, and annexes. Final report is due on the 16th of August 2021.

10 days

August

Concern Office / IRC Office / MOH

Lead in-country dissemination meeting(s) / workshop(s) for Concern, IRC, MOH, and partners on the implications of the findings for SBCC strategies with PowerPoint slideshow, oral presentation deliverable.

*Travel time should be adjusted based on consultant base location.

8.3 Final Deliverables

Over the course of the consultancy period, the following are expected to be completed, submitted, and approved by Concern:

· Inception report including literature review, final methodology, and a detailed plan for fieldwork and post-fieldwork.**

· Data collection tools.

· As appropriate, financial invoices and supporting documentation for payment.**

· Completion of fieldwork by July 22nd 2021

· Lead an in-country debriefing for Concern and IRC when fieldwork is completed.

At the conclusion of the fieldwork period, the consultants are expected to complete the following deliverables:

· Submit final tools and all raw data collected and a clean set of data used in the analysis report to Concern.

· Prepare a draft report in line with the guidelines and submit to Concern with at least 5 working days’ time for review by July 29th 2021.

· Prepare the final report, addressing responses and comments from Concern on the draft, for submission to Concern, IRC, MoH and partners on or before August 16th 2021. It is expected the final report will be of exceptional quality, written in British English and free of all formatting errors. The researcher will be responsible for editing in-line with this structure and ensuring the final report is free of all grammar errors.

· After the final report has been agreed, lead in-country dissemination meeting(s) / workshop(s) for Concern, IRC, MOH, and partners on the implications of the findings for SBCC strategies with PowerPoint slideshow, oral presentation deliverable.

· As appropriate, standard financial invoices and supporting documentation for payment(s).**

9.0 Budget

The total budget for the analysis will be negotiated with Concern and the researcher in compliance with ECHO rules and regulations. In addition to consultancy fees, Concern will cover international and local travel, visa expenses, field lodging, and costs associated with field work to conduct the analysis. All anticipated costs should be included and detailed in the budget. Proposals submitted without a detailed budget will not be considered. Insurance and medical expenses, including vaccinations, are not covered by Concern. If other expenses are anticipated, these must be approved by the Country Director in advance.

[1] COVID-19 Dashboards (Concern Worldwide Country Operations) | Tableau Public

[2] ad432-covid-19_vaccine_hesitancy_high_trust_low_in_west_africa-afrobarometer-8march21.pdf

[3] ad432-covid-19_vaccine_hesitancy_high_trust_low_in_west_africa-afrobarometer-8march21.pdf

How to apply

All interested persons/consultants/consultancy firms should submit an application including the following to:

By Email: Liberia.hr@concern.net

  1. CV(s) of the lead person(s)
  2. A list of projects, clients, and dates of previous works
  3. A sample of a similar research report undertaken by the applicant
  4. Technical proposal that includes methodology and a detailed workplan
  5. Financial proposal detailing all cost elements with clear budget item lines and unit costs, number of units, and total unit costs. Financial proposal should include any and all costs associated with training, enumerator fees, per diems, and accommodations in Liberia, transport to and from rural Liberia, Value Added Tax (VAT) or Goods & Services Tax (GST) or Sales tax if applicable.[1]

CLOSING DATE FOR APPLICATIONS IS Monday 12th July 2021

ONLY SHORTLISTED CANDIDATES WILL BE CONTACTED

1.0 Travel restriction due to COVID-19

If travelling from outside Liberia, please see travel guidance regarding COVID-19 restrictions on the National Public Health Institute of Liberia website at https://www.nphil.gov.lr/index.php/covid-19-travel-guidance/

And also at: https://www.nphil.gov.lr/index.php/liberia-health-ministry-introduces-new-covid-19-protocols-for-travelers/

[1] Budget and financial proposal should be inclusive of VAT/GST/Sales Tax, and/or Withholding Tax as applicable. Consultants should notify Concern if they propose/are required to charge taxes. Where so notified Concern will pay such VAT/Sales Tax (if any) as may be chargeable subject on the receipt of an appropriate VAT invoice. Withholding Tax of 15% should also be included in the budget as applicable.

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