National Individual Consultant: Case Study on the Implementation of the RED Strategy in Urban Districts in South Africa, Pretoria, 8 months (Remote)

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For every child, the right to Immunisation. 

UNICEF South Africa - committed to realising the rights of all children to help them build a strong foundation and have the best chance of fulfilling their potential.

South Africa has made significant progress in expanding immunisation services to reach its population, including the most vulnerable, yet persistent inequalities remain. This is most evident in urban and peri-urban areas where data shows thousands of children are not reached with routine immunisation and other essential health and social services. Children who have not received any vaccinations, termed ‘zero-dose’, and children who have not received the complete schedule of vaccines, termed ‘under-immunised’ children, are at a higher risk of vaccine preventable diseases, and also likely to be malnourished, lack access to early childhood development programmes, and to documentation, and to be exposed to neglect and abuse Studies globally indicate a substantial proportion of zero-dose and under-immunised children live in informal settlements, many of which are in urban/ peri-urban environments, where they face multiple challenges accessing other health and social services. Zero dose and under-immunised children therefore also serve as an indicator of the health system’s capacity to reach all vulnerable populations.

To address these gaps, UNICEF supported the South Africa National Department of Health (NDOH) to contextualise and adapt the WHO Reaching Every District (RED) Strategy for South Africa. This adaptation included the development of a RED Strategy Guideline, training materials, and tools to strengthen the Expanded Programme on Immunisation and support microplanning, community mapping and engagement, outreach planning and data monitoring at the facility and other levels of the health system.

With funding from the Elma Foundation, UNICEF then supported the NDoH to implement the adapted RED Strategy in four priority metropolitan districts, three in the Gauteng Province (Johannesburg, Tshwane and Ekurhuleni) and one in KwaZulu Natal (eThekwini), to identify and reach zero-dose and under-immunised children. This multi-component intervention aimed to strengthen EPI and improve equity in vaccine access. UNICEF trained health workers associated with the EPI programme at all levels on the five components of the RED strategy, to enable them to map and address factors associated with poor vaccine uptake, and to design tailored strategies to reach zero dose and under immunised children in an urban area context.

Additionally, UNICEF integrated its Journey to Health framework, a tool based on human-centred design approaches, to help teams with analysing and addressing barriers to vaccine uptake, including social and behavioural drivers. The RED Strategy intervention was intended to improve all aspects of the routine immunisation system and ultimately reduce the number of zero-dose children in high-risk communities in the selected sub-districts. Internal analysis of routinely available data shows a significant slow down in the rate of increase of zero dose children in Elma project districts.

Requests to provide similar training and support across the country have been increasing, and UNICEF therefore requires in-depth insight into the operational effectiveness of applying this multi-component approach. A qualitative case study methodology is best suited to this need, as it would explore the lived experience of health workers implementing the RED Strategy and generate an in-depth understanding of what worked and what did not. Case studies allow for in-depth exploration of health systems within their real-life contexts, and can ‘track and examine complex relationships, contexts, and systems as they evolve’. The research would include examining the barriers and facilitators of adopting and implementing the strategy in daily practice, and how the implementation could be strengthened to improve outcomes and reduce disparities.

This consultancy will support work under Outcome 1, Child Health and Wellbeing, Output 2, relating to improving the capacity of sub-national institutions and systems to provide comprehensive, coordinated child health services.

How can you make a difference? 

Under the supervision of the Health Officer, supported by the Social and Behaviour Change Manager, the consultant will undertake a mixed method case study on Elma-funded implementation of the RED Strategy with the National Department of Health, the Gauteng, KwaZulu-Natal and Eastern Cape Provincial Departments of Health, and selected district health teams, to strengthen the EPI programme, and develop tailored strategies to reach zero dose and under immunized children.

The objective of the assignment is to explore and describe the operational effectiveness, barriers, facilitators, and outcomes of the RED Strategy implementation in selected urban districts, and to generate actionable insights for scaling and strengthening immunisation services. In addition to UNICEF, the proposed audience for the research findings includes the South African Department of Health, all provincial and district health offices, as well as regional and global stakeholders interested in identifying zero-dose and under-immunized children in urban settings.

Scope Of Work

The consultant will undertake a mixed method case study on Elma-funded implementation of the RED Strategy in selected districts to generate actionable insights to improve the capacity of the health system to provide routine immunization and integrated child health services in settings with high numbers of zero dose and under immunized children. The case study will involve a combination of documentary review, sub-district and facility level analysis of DHIS data, key informant interviews and focus group discussions, e.g. with implementers.

The consultant will undertake the research by completing the following phases and tasks:

1. Inception Phase• Develop a detailed workplan and methodology• Conduct initial consultations with UNICEF and key stakeholders• Submit an inception report
2. Desk Review• Review existing documentation, including RED strategy guidelines, training materials, implementation reports, and sub-district and facility level analysis of DHIS data comparative analysis of routine immunisation data to compare ELMA and non-ELMA districts over time. • Produce a synthesis report highlighting key themes and gaps
3. Research Design & Ethics• Develop a comprehensive research proposal including objectives, methodology, and tools• Submit for ethics clearance through a registered Human Research Ethics Committee (HREC), and for administrative approval from the DoH, at national, provincial and district level.• Finalize interview guides and consent forms
4. Data Collection• Extract relevant DHIS data• Conduct Key Informant Interviews (KIIs) and focus group discussions across multiple levels, in Cities of Jhb, Tshwane and Ekurhuleni, and in eThekwini:- Provincial: EPI managers, district support teams, health promotion coordinators, CHW programme leads, pharmacy, training centers, surveillance and data managers- District/Sub-District: MCH/EPI managers, CDC, pharmacists, health promotion coordinators; CHW/Outreach Team Leads- Facility: Operational managers, Data capturers, EPI nurses, health promotion officers • Ensure ethical standards and informed consent procedures are followed
5. Data Analysis• Analyse comparative data between Elma and non-Elma districts and priority facilities, over time• Transcribe and code qualitative data• Identify themes, patterns, barriers, and facilitators• Draft preliminary findings
6. Reporting & Dissemination• Prepare a draft report for review• Incorporate feedback from UNICEF and stakeholders• Submit final report, presentation materials
7. Publication in agreed academic journal• Develop draft journal article for review• Submit final journal article for publication
8. 1. Inception and Planning

Work Assignment Overview

Tasks

Deliverable/Output

Timeline/Deadline

Estimated Budget/Payment Structure

Develop detailed workplan      Conduct initial consultations with UNICEF and stakeholders

Inception Report and Workplan

10 Working Days

7% of total budget

2. Desk Review

• Review RED strategy documents
• Analyze routine immunization data
• Review internal reports and resources, inc. consultant

Desk Review Report

15 Working Days

• 15% of total budget
• 3. Research Design & Ethics -
• Draft research proposalDevelop tools (interview guides, consent forms)Submit for ethics clearance

Research Proposal

Ethics & DoH approval

15 Working Days

15% of total budget

4. Data Collection

• Conduct Key Informant Interviews (KII) at provincial, district, sub-district, and facility levels
• Collect consent forms

Raw data and consent forms

30 Working Days

• 23% of total budget (including travel)
• 5.Data analysis and drafting report
• Analyze qualitative and comparative data
• Identify themes, barriers, facilitators

Draft Findings

Qualitative data analysis and draft Report

Analysis of comparative DHIS data between Elma and non-Elma districts and draft Report

20 Working Days

• 15% of total budget
• 6. Finalisation & Dissemination
• Finalise report based on feedbackPrepare presentation materialsSubmit final report
• Final Report, Presentation Slides

20 Working Days

15% of total budget

7. Journal Article

Draft journal article for review

Final accepted journal article

Draft and Final Articles

20 Working Days

10% of total budget

To qualify as an advocate for every child you will have… 

• Education: 
• Work Experience: 
• Skills:
• Language Requirements: 
• An advanced degree (Master's or above) in sociology, public health, public health systems, anthropology, psychology, communication, development, education or another relevant technical field
• At least 10 years’ proven experience and expertise in mixed method research in South Africa related to public health, health systems strengthening and health workforce capacity strengthening
• Previous experience with the EPI Programme, Implementation Research and case study research methodology is an advantage
• References of previous similar work done are required
• Qualitative and quantitative research
• English
• Knowledge of another local language is an asset
• Knowledge of another UN language will be considered an advantage

Please indicate your ability and availability; and attach a technical proposal and financial proposal in ZAR to undertake the terms of reference above (including admin cost if applicable). Proposals submitted without a detailed financial proposal aligned to the assignment will not be considered.

For every Child, you demonstrate...

UNICEF’s Core Values of Care, Respect, Integrity, Trust and Accountability and Sustainability (CRITAS) underpin everything we do and how we do it. Get acquainted with Our Values Charter: UNICEF Values

• The UNICEF competencies required for this post are…
• (1) Builds and maintains partnerships
• (2) Demonstrates self-awareness and ethical awareness
• (3) Drive to achieve results for impact
• (4) Innovates and embraces change
• (5) Manages ambiguity and complexity
• (6) Thinks and acts strategically
• (7) Works collaboratively with others 

Familiarize yourself with our competency framework and its different levels.

UNICEF promotes and advocates for the protection of the rights of every child, everywhere, in everything it does and is mandated to support the realization of the rights of every child, including those most disadvantaged, and our global workforce must reflect the diversity of those children. The UNICEF family is committed to include everyone, irrespective of their race/ethnicity, disability, gender identity, sexual orientation, religion, nationality, socio-economic background, minority, or any other status.

UNICEF encourages applications from all qualified candidates, regardless of gender, nationality, religious or ethnic backgrounds, and from people with disabilities, including neurodivergence. We offer a wide range of benefits to our staff, including paid parental leave, breastfeeding breaks and reasonable accommodation for persons with disabilities. UNICEF provides reasonable accommodation throughout the recruitment process. If you require any accommodation, please submit your request through the accessibility email button on the UNICEF Careers webpage Accessibility | UNICEF. Should you be shortlisted, please get in touch with the recruiter directly to share further details, enabling us to make the necessary arrangements in advance.

UNICEF does not hire candidates who are married to children (persons under 18). UNICEF has a zero-tolerance policy on conduct that is incompatible with the aims and objectives of the United Nations and UNICEF, including sexual exploitation and abuse, sexual harassment, abuse of authority and discrimination based on gender, nationality, age, race, sexual orientation, religious or ethnic background or disabilities. UNICEF is committed to promote the protection and safeguarding of all children. All selected candidates will, therefore, undergo rigorous reference and background checks, and will be expected to adhere to these standards and principles. Background checks will include the verification of academic credential(s) and employment history. Selected candidates may be required to provide additional information to conduct a background check, and selected candidates with disabilities may be requested to submit supporting documentation in relation to their disability confidentially.

Appointments may be subject to inoculation (vaccination) requirements, including against SARS-CoV-2 (Covid). Should you be selected for a position with UNICEF, you either must be inoculated as required or receive a medical exemption from the relevant department of the UN. Otherwise, the selection will be canceled.

Remarks:

As per Article 101, paragraph 3, of the Charter of the United Nations, the paramount consideration in the employment of the staff is the necessity of securing the highest standards of efficiency, competence, and integrity.

UNICEF is committed to fostering an inclusive, representative, and welcoming workforce. For this position, eligible and suitable national candidates are encouraged to apply.

Government employees who are considered for employment with UNICEF are normally required to resign from their government positions before taking up an assignment with UNICEF. UNICEF reserves the right to withdraw an offer of appointment, without compensation, if a visa or medical clearance is not obtained, or necessary inoculation requirements are not met, within a reasonable period for any reason. 

UNICEF does not charge a processing fee at any stage of its recruitment, selection, and hiring processes (i.e., application stage, interview stage, validation stage, or appointment and training). UNICEF will not ask for applicants’ bank account information.

Humanitarian action is a cross-cutting priority within UNICEF’s Strategic Plan. UNICEF is committed to stay and deliver in humanitarian contexts. Therefore, all staff, at all levels across all functional areas, can be called upon to be deployed to support humanitarian response, contributing to both strengthening resilience of communities and capacity of national authorities.

All UNICEF positions are advertised, and only shortlisted candidates will be contacted and advance to the next stage of the selection process. An internal candidate performing at the level of the post in the relevant functional area, or an internal/external candidate in the corresponding Talent Group, may be selected, if suitable for the post, without assessment of other candidates.

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