Consultant: Social and Behaviour Change and Community Engagement (Health/Immunisation), Pretoria, South Africa, 8 months (Remote)

UNICEF works in some of the world’s toughest places, to reach the world’s most disadvantaged children. To save their lives. To defend their rights. To help them fulfill their potential. 

Across 190 countries and territories, we work for every child, everywhere, every day, to build a better world for everyone. 

And we never give up. 

For every child, immunisation. 

UNICEF South Africa, there for every child.

The challenge: Thousands of children die from treatable and preventable conditions. Since 1995, South Africa has made substantial progress in transforming its health sector, making primary healthcare services available to millions who were previously denied access. Yet access to healthcare remains a challenge, with vital healthcare interventions not reaching the areas and people that need them. Read more…

The solution: UNICEF is committed to ensuring that every child survives and thrives. Our approach to South Africa’s health challenge is three-fold:

• contributing to the evidence-base for policy, advocacy and programming
• delivering innovative programmes with partners – especially in high-burden and low-performing districts 
• supporting the Government to develop and implement policies and strategies to take vital action to scale Read more…

BACKGROUND

This consultancy is requested by the Health Section to help achieve its goal of ensuring girls and boys, including the most deprived, receive an integrated package of quality and equitable maternal, neonatal and child health (MNCH), HIV/AIDS and nutrition care and services. The consultancy forms part of UNICEF’s ongoing support to targeted provinces and districts to strengthen implementation of the maternal, newborn and child health and immunisation programme, and capacity to deliver evidence-based MNCH services in a coordinated manner. (Output 1.2).

With technical oversight by the Social and Behaviour Change (SBC) Manager, the consultancy will centre on strengthening the selected provinces and districts’ capacity to integrate community engagement in immunisation planning, and to implement social and behaviour change approaches to address demand side barriers to uptake of immunisation services. SBC system strengthening is a key strategy under Output 8.8, to help ensure quality SBC and Risk Communication and Community Engagement (RCCE) interventions are delivered to reduce the spread of disease, promote safe physical and mental health lifestyles, improve uptake of services and address social, structural and behavioural barriers to action, through increased generation and use of evidence, strengthened capacity, strategic partnerships and coordination.

This consultancy has become possible through UNICEF South Africa urgently leveraging additional funding to expand its current support for the Expanded Programme on Immunisation (EPI-SA), and interventions to reach children who have missed their scheduled immunisations at six and at 14 weeks – respectively termed zero dose and under immunised children, the numbers of which have risen significantly since 2021 (fig 1).

Figure 1: Number of zero-dose children 2016 – 2023. Source DHIS

Through EPI-SA, the government offers free childhood immunization services in over 3000 public facilities, protecting children from diseases such as tuberculosis, poliomyelitis, diphtheria, pertussis, tetanus, Hemophilus influenza type B, Hepatitis B, Rotavirus diarrheal, pneumococcal disease, and measles. The EPI Programme has made commendable progress with the number of antigens in the national immunization schedule increased to 12 in 2024. However, not all eligible children receive life-saving vaccines. Children who have not received any routine immunization, specifically the first dose of the DPT-cv 1, the 6-in-1 Hexaxim© vaccine to prevent Diphtheria, Tetanus, Pertussis, Polio, Hemophilus influenza type B &Hepatitis B, are called zero-dose children. The number of zero dose children increased by 43% in 2022, and by another 50% in 2023. (Fig 1) In addition, even though SA’s national EPI Schedule provides two doses of measles containing vaccine, there is suboptimal coverage for both doses, with failure to reach the required 95% coverage for herd immunity, at national level and in most districts.

Children who are not immunized or under-immunised struggle to access multiple other life-saving interventions, such as growth monitoring, Vitamin A supplementation and curative services under IMCI, and are also more likely to be malnourished, lack access to documentation or early childhood development programmes, and be exposed to neglect and abuse. Communities with high numbers of non-immune children are prone to repeated disease outbreaks and issues such as antimicrobial resistance.

Studies globally indicate a substantial proportion of zero-dose, and under-immunized children live in informal settlements, many of which are in urban/ peri-urban environments. Eight of South Africa’s 52 districts are metropolitan municipalities, constituting about 43% of the population, with cities harbouring many urban/peri-urban individuals. Over the past five years DPT-cv 1 coverage in these eight districts has ranged from 76% to over 100 % (114%), with ongoing concerns regarding data quality. In 2022, 52,707 (36%) of the 148 1000 zero dose children nationally were in these districts. Multiple factors impact on vaccine uptake, including sporadic vaccine stock-outs at the lower levels of health facilities, sub-optimal demand generation activities, vaccine hesitancy among small specific population groups, and poor defaulter tracking mechanisms. In addition, since the start of the COVID-19 pandemic the perception of the importance of vaccines for children declined by 29.9 percent in South Africa, amid the largest sustained backslide in immunization coverage in 30 years. The COVID-19 pandemic also saw an exponential increase in mis and disinformation, on the back of which active monitoring of digital and community conversations to help inform programme action has become a priority.

In response to the need to reach all zero-dose children particularly in the urban settings, UNICEF South Africa, in consultation the National Department of Health’s EPI team is providing targeted support to four of the eight metropolitan districts: City of Johannesburg Metropolitan Municipality; City of Tshwane Metropolitan Municipality; Ekurhuleni Metropolitan Municipality in Gauteng province; eThekwini Metropolitan Municipality in KwaZulu-Natal. The support aims to improve all aspects of the routine immunisation system, and ultimately reduce the number of zero-dose children in high- risk communities The UNICEF support also aims to ensure that children who missed the measles containing vaccines receive catch up doses.

How can you make a difference? 

PURPOSE OF THE ASSIGNMENT

Under the supervision of the SBC Manager, and the Chief of Health and Nutrition, the consultant will provide technical support on community engagement and social and behaviour change strategies and approaches to the National Department of Health, 

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 immunised children. This will entail working in close consultation with UNICEF, national, provincial and district health staff, and relevant partners.

The objectives of the support to national, provincial and district DoH are to:

• Strengthen capacity to advocate for immunization as an entry point for integrated primary care.
• Support DoH to mobilise and equip community and faith leaders to champion immunisation, and integrated child health services.
• Strengthen and assess capacity of health promotion/ outreach teams to develop tailored strategies to reach zero dose children.
• Strengthen collaboration and information sharing and improve communication materials to promote immunisation.
• Monitor, evaluate and document.

The Assignment activities fall under Output 1.2, and 8.8 of the Annual Workplan, relating to strengthening the health system’s capacity to delivery integrated MNCH services and SBC interventions.

UNICEF activities are concentrated on informal settlements or sub-districts with the highest numbers of zero-dose children. They include building capacity of DoH to use the Reach Every District (RED) strategy and UNICEF’s Journey to Health framework to map factors associated with poor vaccine uptake and design strategies to reach zero dose and under immunized children tailored to the urban context, with a strong focus on community engagement and integrated and multisectoral approaches. Facility level microplanning to reach the goal of 90% immunization coverage in all districts is a key element of the RED strategy, and community engagement, one of the five components of the microplanning process. NDoH revised and piloted RED tools and resources in 2023, to ensure strategies feed into the District Health Plan and facility operational plans. A key insight emerging was that tools/resources could be adapted to create a community stakeholder version to prioritize RED’s community engagement components; this opens an opportunity to strengthen the primary health system’s mechanisms to engage underserved groups in zero dose communities.

UNICEF views community engagement as a foundational action for working with traditional, community, civil society, government and opinion groups and leaders, in line with the Minimum Quality Standards and Indicators to build acceptance and trust and support sustainable social and behavioural outcomes. Within the National Department of Health, Community Engagement activities are led by the Directorate of Health Promotion, working closely with the Directorate of Communication. Strengthening community engagement in EPI microplanning will simultaneously serve to strengthen local level emergency preparedness and capacity to respond to disease outbreaks, when, under the International Health Regulations, Risk Communication and Community Engagement (RCCE) activities become a core component of a public health emergency response.

The Journey to Health framework is one of the UNICEF-developed tools and resources. to apply a human-centred design approach to improve uptake of immunisation and other services. The framework enables teams to consider every step before, during and after the point of vaccination to deepen understanding of zero dose communities. It can also serve as the basis for an interactive journey mapping exercise with facility and community members, to strengthen relationships, and inform joint planning, making it easier for at risk and underserved groups to take up available services.

SCOPE OF WORK

1. Support national and provincial DoH in Gauteng and KwaZulu-Natal to advocate for immunization as an entry point for integrated primary care.

• Develop an advocacy strategy and plan, aligned with the national zero dose plan, to demonstrate the benefit of using the immunisation programme as a point of entry for integrated child health services, and mobilise leadership support.
• Develop an advocacy briefing pack with relevant background and calls to action, including a short presentation.
• Support convening an advocacy event to champion routine immunization and strengthen support for all elements of the EPI programme, including health promotion and community engagement.

2. Support provincial and district DoH in City of Johannesburg, City of Tshwane, Ekurhuleni and Ethekwini to mobilize and equip community and faith leaders to champion immunization, and integrated child health services.

• Support district teams to convene and engage faith-based and community leaders around the urgent need for plans to reach zero dose and under-immunized children with immunization and essential services, and to address any questions or concerns.
• Support the development of district faith and community leader action plans, with clear objectives and calls to action.
• Develop and/or collate and adapt existing materials into a resource pack for community and faith-based leaders, to sustain support and equip them to build trust in and promote the benefits of immunization and child health services.

3. Strengthen and assess capacity of health promotion/ outreach teams in City of Johannesburg, City of Tshwane, Ekurhuleni and eThekwini to develop tailored strategies to reach zero dose children.

• Support District teams to report on tailored strategies and activities implemented, and identify challenges and needs, e.g. in engaging un-reached communities.
• Support development of a social and community listening strategy for immunization and vaccine hesitancy, and implementing tools, e.g., to collect community feedback, to strengthen systematic monitoring of community conversations and rumors, and use of insights to guide planning.
• Provide continuing education e.g., through updates on new social and behavioural data, on district/sub district health promotion and outreach teams role in Risk Communication and Community Engagement during outbreak responses, and tools to applying the Journey to Health framework.
• Support UNICEF’s role in the National RCCE TWG, to facilitate up to date communication on outbreaks such as mpox, and strengthening of outbreak responses, including community engagement, accountability social listening and community feedback.
• Develop and administer short capacity assessment tool to gauge effectiveness of UNICEF support.

4. Strengthen collaboration and information sharing between Districts and Sub-Districts, and improve communication materials to promote immunization.

• Review existing mechanisms for information sharing across district, provincial and national teams to identify gaps and needs.
• Strengthen/ establish a cross cutting online platform for collaboration (e.g., Internet of Good Things) to serve as a repository of relevant information and capacity building tools and forum for interaction.
• Compile repository and review existing communication materials on routine immunization, un and under vaccinated children.
• Identify gaps and requirements and develop a brief on new materials required to be co-created and produced (audience, format, language etc.) to address barriers and encourage uptake.

5. Monitor, evaluate and document.

• Attend inception and regular UNICEF project meetings; provide workplan, update reports – including on any RCCE TWG activities, and recommendations on implementation at National, Provincial and District levels.
• Identify report human interest stories (anecdotal evidence that can illustrate change), and secure permission for these to be documented by UNICEF’s communication team.

Tasks and deliverables

1. Support national and provincial DoH in Gauteng and KwaZulu-Natal to advocate for and raise the profile of immunization as an entry point for integrated primary care – deadline 30 November 2024 (payment 20% of the total fee)

• National immunisation advocacy strategy and plan.
• Immunisation advocacy briefing pack.
• National/provincial immunisation advocacy event and report.

2. Support provincial and district DoH in City of Johannesburg, City of Tshwane, Ekurhuleni, and eThekwini to mobilize and equip community and faith leaders to champion immunization, and integrated child health services – deadline 31 March 2025 (payment 20% of the total fee)

• Four district community and faith leader advocacy meetings and report.
• Four district Community/ faith leader action plans with messages and calls to actions.
• Community/faith leader resource pack.

3. Strengthen and assess capacity of health promotion/ outreach teams in City of Johannesburg, City of Tshwane, Ekurhuleni, and eThekwini to develop tailored strategies to reach zero dose children – deadline 30 April 2025 (payment 25% of the total fee)

• UNICEF District Reporting template timeously completed by four districts.
• Social and Community Listening Strategy and tools for immunisation developed.
• Two educational presentations compiled and presented.
• Capacity assessment tool developed and administered.
• Report on support to UNICEF’s role in RCCE TWG provided, including meetings, liaising with ESAR RCCE, and technical support provided.

4. Strengthen collaboration and information sharing between Districts and Sub-Districts and improve communication materials to promote immunization – deadline 30 November 2024 (payment 15% of the total fee)

• Report on existing mechanisms of communication and collaboration.
• Online platform and repository for collaboration established/strengthened.
• Review of existing communication materials to promote immunisation and gaps.
• Brief on new SBCC materials required.

5. Monitor, evaluate and document – Bi-weekly (as agreed) and final by 31 May 2025 (payment 20% of the total fee)

• Inception meeting report, with workplan and timeline, within 2 weeks of signature/meeting.
• Summary minutes and action points of bi-weekly (tbc) project meetings recorded, including feedback from mentoring, lessons learned, human interest stories, and RCCE activities.
• Final project report providing overview of activities, compendium of tools etc developed, photos, agenda, registers, and other evidence of meetings convened, as well as recommendations to sustain system of developing tailored strategies to reach vulnerable populations with essential child health services.

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

• An advanced university degree (Master’s or higher) in social and behavioural science, sociology, public health, anthropology, psychology, communication, development, education, or another relevant technical field
• A minimum of 10 years of proven experience and expertise in providing technical support for community engagement and social and behaviour change interventions in South Africa
• Previous experience in supporting the National Department of Health’s Expanded Programme on Immunisation is an advantage
• Previous experience with Journey to Health framework, human-centred design processes, or Behavioural and Social Drivers (BeSD) model is an advantage, as well as experience with emergency response to disease outbreak
• References of previous similar work done are required
• Developing country work experience and/or familiarity with emergency is considered an asset
• Fluency in English is required
• Knowledge of another local language is an asset

Specialized skills and/or training if needed:

• Facilitation
• Participatory processes
• Capacity building

Please submit a technical proposal with your application.

Please indicate your ability, availability, and financial proposal (in ZAR for national consultants/ in USD for international consultants) to undertake the terms of reference above (including admin cost if applicable).

For every Child, you demonstrate… 

UNICEF’s values of Care, Respect, Integrity, Trust, Accountability, and Sustainability (CRITAS). 

To view our competency framework, please visit here. 

UNICEF is here to serve the world’s most disadvantaged children and our global workforce must reflect the diversity of those children. The UNICEF family is committed to include everyone, irrespective of their race/ethnicity, age, disability, gender identity, sexual orientation, religion, nationality, socio-economic background, or any other personal characteristic.

UNICEF offers reasonable accommodation for consultants/individual contractors with disabilities. This may include, for example, accessible software, travel assistance for missions or personal attendants. We encourage you to disclose your disability during your application in case you need reasonable accommodation during the selection process and afterwards in your assignment. 

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. UNICEF also adheres to strict child safeguarding principles. All selected candidates will be expected to adhere to these standards and principles and will therefore undergo rigorous reference and background checks. 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. 

Remarks: 

Only shortlisted candidates will be contacted and advance to the next stage of the selection process. 

Individuals engaged under a consultancy or individual contract will not be considered “staff members” under the Staff Regulations and Rules of the United Nations and UNICEF’s policies and procedures, and will not be entitled to benefits provided therein (such as leave entitlements and medical insurance coverage). Their conditions of service will be governed by their contract and the General Conditions of Contracts for the Services of Consultants and Individual Contractors. Consultants and individual contractors are responsible for determining their tax liabilities and for the payment of any taxes and/or duties, in accordance with local or other applicable laws. 

The selected candidate is solely responsible to ensure that the visa (applicable) and health insurance required to perform the duties of the contract are valid for the entire period of the contract. Selected candidates are subject to confirmation of fully-vaccinated status against SARS-CoV-2 (Covid-19) with a World Health Organization (WHO)-endorsed vaccine, which must be met prior to taking up the assignment. It does not apply to consultants who will work remotely and are not expected to work on or visit UNICEF premises, programme delivery locations or directly interact with communities UNICEF works with, nor to travel to perform functions for UNICEF for the duration of their consultancy contracts. 

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