Terms of Reference- Literature review of behavioural barriers related to the uptake of routine childhood immunisation and the HPV vaccine in Tanzania at Girl Effect (GE)

Girl Effect (GE) works to break the cycle of intergenerational poverty for girls. We believe that if we stop viewing girls as part of the problem and see them instead as participants in new solutions, they can rewrite their future and their children's - creating a better reality for all. However, social norms hold girls back. Even when the services they need are available, individual and societal barriers prevent girls from accessing them - these 'invisible barriers effectively confine them'. We want to reframe how girls are valued by changing how girls and the people around them think, feel and act.

We do this by helping connect girls to each other and to the critical assets they need by harnessing the power of mass culture media brands to reframe the value of girls. Everything we do is driven by girls and accelerated by technology to deliver the biggest impact. Working with our partners, we reach millions of girls in more than 60 countries through the technology girls use every day.

At Girl Effect, we empower girls to navigate the pivotal time of adolescence, so they are enabled to make choices about their health, education, and economic future - no matter where in the world they live.

We use our in-depth understanding of the real needs of girls, along with innovative behaviour change science, to create branded media girls love; virtual and real-world spaces where they can be inspired, informed, connected to services and to others-ultimately, so they can take action to change their lives.

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Summary of the partnership with Gavi, the Vaccine Alliance

GE first partnered with Gavi between 2016 and 2021 on routine childhood immunisation and HPV vaccine demand generation. The successful collaboration continues with a new phase starting in 2022 and will run until 2025.

The objectives of the project are:

Objective 1: Identify and understand enablers and barriers to vaccine uptake amongst the primary target groups, to inform effective programming for our target audience.

Objective 2: Design and deploy appropriate, AGYW-centred demand generation content, to address gendered and other barriers to immunisation, using media and other channels, including girl clubs/networks, to connect the hardest-to-reach girls.

Objective 3: Solidify learning and dissemination within the sector: Girl Effect will leverage existing and new partners to ensure broad programme buy-in and promote sustainability of actions.

HPV Vaccines

Human papillomavirus (HPV) vaccines prevent infection by certain types of human papillomavirus. Available HPV vaccines protect against either two, four, or nine types of HPV. All HPV vaccines protect against at least HPV types 16 and 18, which cause the greatest risk of cervical cancer.

The HPV vaccine is recognised as an important prevention strategy, with the WHO recommending HPV vaccines to be included in routine national immunisation programs as a public health priority (Perlman et al., 2014). HPV vaccines are most efficacious in females who have not been exposed to vaccinerelated HPV types (WHO, 2012). Consequently, the primary target population will likely be girls between 9 and 10 years to 13 years. This cohort is selected based on the age of initiation of sexual activity and the feasibility of reaching young adolescent girls through schools, healthcare facilities or community-based settings (WHO, 2012).

Routine Childhood Immunisation

Routine childhood immunisation (RCI) is one of the most cost-effective public health interventions and has been estimated to avert approximately 2 to 3 million deaths annually. Yet, vaccination rates in many African countries remain low. A child is considered fully immunised if they receive a BCG vaccine against tuberculosis, three doses of DPT to prevent diphtheria, pertussis, and tetanus, at least three doses of polio vaccine and one dose of measles vaccine.

What we know so far

In preparation for this partnership, Girl Effect has conducted a thorough literature review of publicly available research. Girl Effect's Evidence and Insights team has identified a whole range of barriers to the uptake of Routine Child Immunisation to be; a lack of education and awareness surrounding vaccines, poor geographical distance and transportation in enabling access to health facilities, family health problems, delays beyond the mothers' control relating to structural and service delivery issues such e.g. poor service from healthcare providers, unavailability of vaccines at the facilities during clinic visits and prolonged waiting time to access the vaccine. Beliefs around the safety and efficacy of the vaccines, lack of awareness of vaccine schedules and forgotten appointment dates. The rationale for the number of healthcare visits during pregnancy to the number of antenatal care visits, busy personal schedules, gatekeepers and community. It was found that fathers have varying roles in vaccine decision-making, ranging from being a driver or inhibitor of vaccine uptake. Mothers with daily labour jobs and religious beliefs/lack of acceptability by religious leaders contribute to low uptake of RCI.

They also identified a lack of knowledge and awareness of cervical cancer, HPV and the HPV vaccine that prevents cervical cancer. Accessibility, cost concerns and parental refusal as barriers to the uptake of HPV vaccines which also relates to parents not attending school meetings and absenteeism of girls at school. Attitude towards vaccines and vaccination, especially in the COVID-19 era, and not knowing anyone with cancer constitutes low HPV vaccine uptake. Low resources were found to be a stronger barrier than misconceptions about the HPV vaccine.

Scope of the assignment

Vaccine uptake is influenced by many behavioural factors. Per our Theory of Change, we expect vaccine uptake to be determined by individual, interpersonal, community, infrastructural and policy factors.

This assignment aims to conduct a deeper literature review focusing on the behavioural and structural barriers and facilitators of HPV vaccine uptake and routine childhood immunisation (RI) in urban and peri-urban areas in Tanzania. We would like to get an overview of the latest research that is not older than 5 years and specifically for the case of HPV, anything more recent (done in the past 1 or 2 years) from published (not reviewed by GE) and unpublished, Governmental and Non-Governmental reports.

Resource Areas of Focus

The consultant is expected to make use of the following data resources:

• RCI and HPV vaccine uptake-related studies in Tanzania • Gender-specific studies conducted concerning vaccine uptake and health-seeking behaviours in

Tanzania

• Peer-reviewed individual studies conducted in Tanzania.
• Literature published by government organisations, non-governmental organisations, universities,

UN institutions or anything similar.

• Situational analysis done by the Ministry of Health (MOH) or other partner organisations.
• Any grey literature, defined as unpublished materials including any reports and briefs (government or otherwise), conference papers and presentations, white papers, email chains etc
• Kll with 5 people from different organisations to be identified by GE Team and the consultant

Questions to be addressed

• What approaches are currently and previously been used to encourage the uptake of RCI and HPV vaccine?
• What were the successes and failures of the identified approaches?
• What are existing gaps in RCI and HPV vaccine service delivery?
• What are specific populations which have lower RCI and HPV coverage and may require tailored demand messages/interventions? This will include a review of the Zero-Dose population segments of urban and remote-rural.
• What are the cognitive and emotional drivers toward positive health-seeking behaviour for RCI and

HPV vaccines?

• What are there specific gender-related barriers with regards to RCI and HPV vaccine uptake?
• What socio-economic barriers are experienced by young mothers and young women overall and caregivers in these health areas?
• Which behavioural barriers seem most neglected?
• What are the media habits of the segmented target population groups?
• Do structural barriers (e.g. vaccine availability, staff presence) outweigh behavioural barriers?
• Are there opportunities to design behavioural interventions to remove service provider-related behavioural barriers (e.g. nurses forgetting to invite new mothers for RCI)?

Deliverables

The consultant will receive an Excel spreadsheet to complete the literature review. The consultant will also be expected to prepare a presentation responding to the key questions above and recommendations for further research and programme design.

Reporting

The consultant will work under the supervision of E&T Manager TZ and E&I Senior Manager Global.

Expected Commitment

The assignment is expected to take approximately 15 consultancy days to complete.

Tentative Timelines:

• Terms of reference published: August 5th 2022:
• Deadline for responses: August 11th 2022:
• Supplier selection, contracting and briefing: August 15th 2022:
• Project commencement: August 19th 2022:
• Project submission: September 9th 2022:

Who You Are:

Skills and expertise:

• Minimum of 5 years of professional experience in research, specifically literature review

. Proven research analytical skills and knowledge in Routine Immunization and Vaccines

• Expertise in finding and leveraging unpublished reports and documents to support the findings
• Experience working with International Organizations in Tanzania
• Strong communication and writing skills and experience in preparing reports
• Fluency in English written and spoken
• Great attention to detail and ability to work under pressure and tight deadlines.
• Ability to remain flexible and find solutions to challenges.
• Ability to work collaboratively in multicultural and remote teams.
• Excellent organizational and planning skills
• Commitment to realising the potential of girls and to the vision and values of Girl Effect

Proposal Submission

Your proposal (Max 3 pages), should you be interested, should cover

Technical Proposal

Your understanding of the brief and why you feel you are well placed to provide consultation for this

• Credentials -
• Please showcase any previous relevant work experience
• Detailed reference list indicating the scope and magnitude of similar assignments
• Work plan for performing the task

Financial Proposal

• A breakdown of the financial proposal in USD indicating the daily rate for each of the proposed experts, time input and all applicable reimbursable expenses • All applicable taxes should be quoted separately;

Technical and Financial proposals will need to be submitted as separate documents. Financial bids will not be opened until the technical evaluation and only for those proposals deemed qualified and responsive.

GE is not liable for any cost incurred during the award/contract preparation, submission, or negotiation of the award/contract. All submitted documentation and/or materials shall become and remain the property of GE.

The VALIDITY of the proposal shall be for 90 days from the date of bid closure.

Evaluation Criteria

The criteria against which proposals will be evaluated are listed below.

• A well-written capability statement clearly outlines your experience in delivering the scope of

Work and how you meet the 'Who You Are' requirements above - 20%

• Demonstrate geographic experience in Tanzania - 15%
• Clear and Concise CV demonstrating relevant expertise - 30%
• Evidence of a minimum of three contactable references - 15%
• Financial Quote - 20%

Tax

Applicants are advised to ensure that they clearly understand their tax position regarding local jurisdiction tax legislation provisions when developing their proposals.

Disclaimer

GE reserves the right to determine the structure of the process, number of short-listed participants, the right to withdraw from the proposal process, the right to change this timetable at any time without notice and reserves the right to withdraw this tender at any time, without prior notice and without liability to compensate and/or reimburse any party. GE shall inform ONLY successful applicant(s). The process of negotiation and signing of the contract with the successful applicant(s) will follow.

Safeguarding

You may be required to undertake safeguarding checks. Shortlisted consultants will be assessed on our organisational values at the interview stage. The successful consultant will be expected to adhere to our safeguarding policy. We encourage you to read and understand our safeguarding policy, the executive summary of which can be found at www.girleffect.org/safeguarding. We have zero-tolerance for all forms of violence against children, beneficiaries and staff.

Equal Opportunities

Girl Effect Services is committed to equal opportunity regardless of race, color, ancestry, religion, sex, extensively with the communities that we serve. To this end, due regard will be paid to procuring consultancy service organisations and individuals with diverse professional, academic and cultural backgrounds.

Submission Procedure

Please submit proposals, as described above, to suppliers@girleffect.org by 11th August 2022, 5:00 pm EAT latest. Please clearly mark your email with the subject 'Literature review- Tanzania.'