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Background
Lesotho faces significant challenges in achieving equitable immunization coverage, particularly among zero-dose children. Gender disparities play a crucial role in access to immunization and primary health services.
Gender disparities in immunizing children and adolescents are influenced by several interconnected factors that include but are not limited to:
Negative interactions with health care providers, reduced access to information or education, limited autonomy in healthcare decision-making particularly among women, restricted mobility and control over resources, Gender-Based Violence (GBV) leading to poor health seeking behaviour, cultural norms and gender roles that influence responsibility for seeking child health services and how health information is shared within families.
Addressing these barriers requires a multifaceted approach that includes improving healthcare services, increasing educational opportunities, empowering women in household decision-making, and addressing broader societal norms and gender inequalities.
Adolescent and young mothers face various challenges that hinder their ability to vaccinate their children. According to data from the Lesotho Demographic and Health Survey (2014), 19% of women aged 15-19 have initiated childbearing.
These adolescent and young mothers are likely to have been raised facing significant socioeconomic challenges. This young age group often faces socio-economic difficulties, including limited education and financial resources. These factors contribute to a lack of awareness about the importance of vaccinations and the recommended immunization schedules and on most of the primary health care services. Additionally, cultural, and social barriers play a role in hindering vaccination uptake among adolescent and young mothers. The trend of vaccine coverage in Lesotho have not been favourable. The proportion of children aged 12–23 months in Lesotho who have received all basic vaccinations dropped from 68% in 2004 to 62% in 2009, rebounded to 68% in 2014, and then fell again to 63% in 2023–24 children aged 12-23 months. Indicating critical gaps in the delivery of a responsive immunization programme. Further, it remains unclear what proportion of zero-dose children are born to young mothers.
Gender disparities in Lesotho are evident with the progress of COVID-19 Vaccination as a public health agenda. As of November 2023, national coverage among people over 12 years reached 60.5% yet coverage amongst adolescents aged 12-17 years stood at only 39.7%. Further, in this age group with 34% coverage amongst males compared to 45% amongst their female counterparts. In 2023 the World Health Organization revised the COVID-19 Vaccination Guidelines that aim to routinize COVID-19 vaccination for high-risk groups such as People Living with Human Immuno-Deficiency Virus (PLHIV), young people with co-morbidities and pregnant women. Amongst people living with HIV, the country performance is at 63% fully vaccinated with only 27% receiving boosters. There is paucity of age-disaggregated data for COVID-19 vaccination among children and adolescents living with HIV.
How can you make a difference?
Purpose of Activity/Assignment:
The gender situational analysis in immunization and primary health specifically in the context of the Sexual Reproductive, Maternal, Neonatal, Child and Adolescent Health and Nutrition (SRMNCAH+N) aims to understand the gender-specific barriers and facilitators affecting immunization coverage and primary health outcomes. This analysis will be crucial for developing gender-sensitive health policies, programme implementation and monitoring.
UNICEF in collaboration with the Ministry of Health and GAVI seek to undertake a baseline and situational Analysis of gender, social and behavioural barriers, and enablers of immunization in the context of SRMNCAH+N in urban, peri-urban, and rural settings.
Goal: To enhance gender and social transformative interventions to address zero-dose in the context of primary health.
Specific Objectives:
To conduct a comprehensive situational analysis of gender in the context of immunization and primary health care that will:
Identify gender-related barriers faced by caregivers, health workers and adolescents (including adolescent and young mothers) to immunization at all ages in the context of primary health care (PHC) services. Identify the facilitative or prohibitive socio-cultural, economic, programmatic and policy factors influencing gender disparities using an intersectional gender analysis framework.
Provide recommendations and develop a gender mainstreaming toolkit to operationalize gender in immunization and primary health services.
Scope of Work
The consultant will undertake the following tasks:
Literature Review: Review existing literature on gender, social and behavioral barriers, and enablers of immunization in the context of SRMNCAH+N in urban, peri-urban, and rural settings of Lesotho and similar contexts. Data Collection: Conduct qualitative and quantitative data collection, including interviews, focus group discussions, and surveys with key stakeholders (e.g., health workers, community leaders, parents, school heads, religious leaders). Data Analysis: Analyze the collected data to identify key gender-related barriers and facilitators to immunization in the context of SRMNCAH+N in urban, peri-urban, and rural settings of Lesotho and similar contexts. Report Writing: Prepare a comprehensive report detailing findings, analysis, and recommendations. Stakeholder Engagement: Present findings to the Ministry of Health and relevant stakeholders, incorporating feedback into the final report. Presentation and Final Report Provide a presentation slide deck and final report to the Ministry of Health and relevant stakeholders, incorporating feedback into the final report.
Work Assignment Overview/ Expected Deliverable and payment Schedule:
Key Activities
Onboarding with UNICEF Attend a Kick-off meeting – Prepare a PowerPoint presentation (PPT) for an Inception meeting with MOH Family Health Division, GAVI, UNICEF, WHO, CHAI, USAID. Development of an inception report detailing proposed methodology, workplan and proposed data collection tools to meet the consultancy deliverables. Undertake a desk review of the latest legislations, policies, quantitative data, national and regional literature, and evidence on gender, social and behavioral barriers, and enablers of immunization in the context of SRMNCAH+N in urban, peri-urban, and rural settings of Lesotho and similar contexts. Conduct qualitative and quantitative data collection, including interviews, focus group discussions, and surveys with key stakeholders (e.g. children, adolescents and young people, health workers, community leaders, parents – including adolescent and young mothers and fathers, school heads, religious leaders) with priority in high zero-dose settings in Lesotho. Analyze the collected data to identify key gender-related barriers and facilitators faced by caregivers (including fathers and adolescent parents, to immunization with a focus on zero-dose and under vaccinated in the context of SRMNCAH+N in urban, peri-urban, and rural settings of Lesotho. Draft report detailing findings, analysis, and recommendations from the literature review and field analysis and in alignment with the National Immunization Strategy. Stakeholder Engagement: Present findings to the Ministry of Health and relevant stakeholders, incorporating feedback into the final report. Provide a final technical report for publication and comprehensive presentation slide deck to the Ministry of Health and relevant stakeholders, incorporating stakeholder feedback.
Expected Deliverables and Payment Schedule Deliverable Duration (# of days) Timeline/Deadline Schedule of payment
- Kick-off meeting with MOH and EPI Core team members
1 1st day of Consultancy 2. Inception report detailing proposed methodology, and workplan to deliver the consultancy 5 7 days following start of Consultancy 10% 3. Desk Review on latest policies, literature, regional or global evidence on gender barriers and facilitators in the context of SRMNCAH+N 5 14 days following start of Consultancy 20% 4. Conduct qualitative and quantitative data collection, including, focus group discussions, and interviews with key stakeholders (e.g., health workers, community leaders, parents including adolescent parents, school heads, religious leaders) at district level 10 6 weeks following start of Consultancy 30% 5. Data analysis and drafting of report detailing findings, analysis, and recommendations. 5 10 weeks following start of Consultancy 20% 6. Stakeholder review and validation 1 7. Final report and power point submission 3 12 weeks following start of Consultancy 20% Total 100%
Expected Deliverables
Deliverables #1 and #2 – Inception report detailing proposed methodology, and workplan to deliver the consultancy – 7 days. Payment Schedule 10%
Deliverable #3 – Desk Review Report on latest policies, literature, regional or global evidence on gender barriers and facilitators in the context of SRMNCAH+N) – 14 days. Payment Schedule 20%
Deliverables #4 – Field mission Report on qualitative and quantitative data collection, including interviews, focus group discussions, and surveys with key stakeholders (e.g., health workers, community leaders, parents, school heads, religious leaders) at district level – 6 weeks.Payment Schedule 30%
Deliverable #5 – Data analysis and drafting of report detailing findings, analysis, and recommendations. – 10 weeks. Payment Schedule 20%
Deliverables #6 and #7 Stakeholder review and validation and final submission of report – 12 weeks. Payment Schedule 20%
To qualify as an advocate for every child you will have…
Minimum Qualifications required: Masters
Disciplines: Public Health, Research
Education: Advanced university degree in public health, social sciences, gender and development, behavioural sciences.
Work experience: 5 years knowledge and expertise on health and gender in development ESA
Qualifications and specialized knowledge:
Advanced degree in social sciences, public health, gender studies, or related fields. At least five years of experience in gender analysis, preferably in the health sector. Proven experience in conducting situational analyses and research. Strong analytical and report-writing skills. Excellent communication and presentation skills.
Familiarity with the context of Lesotho or similar settings is an advantage.
Language: Fluency in English
Knowledge of local language is an asset.
Required:
Expertise in mixed methods of data collection and analysis. Expertise in writing technical documents, applying analytical skills in gender. Ability to organize, compile and summarize inputs from different writers, provide clarity using result-based languages. Ability to synthesize complex documents into key messages. Familiar with children’s rights and gender issues in the context of development and humanitarian action.
Following skills/experiences are an asset:
Understanding of / working experience with the GAVI and /or UNICEF is an added advantage. Advocacy and presentation skills are an asset.
Functional Competencies
Analysing (II) Applying Technical Expertise (II) Planning and Organizing (I) Following Instructions and Procedures (II)
For every Child, you demonstrate…
UNICEF’s values of Care, Respect, Integrity, Trust, Accountability, and Sustainability (CRITAS).
Closing date: 17 December 2024