General Information
The MOMENTUM Routine Immunization Transformation and Equity (The project) project applies best practices and explores innovations to increase equitable immunization coverage in the U.S. Agency for International Development (USAID) partner countries. Aligning with global strategies such as the Immunization Agenda 2030 and Gavi 5.0, the project builds the capacity of countries to identify and overcome barriers to reaching zero-dose and under-immunized children and older populations with life-saving vaccines and other integrated health services.
John Snow Incorporated (JSI) is a U.S.- based not- for- profit organization that supports Nigeria to strengthen health systems. The project is part of a suite of innovative awards funded by USAID to holistically improve family planning and maternal and child health in partner countries around the world. M-RITE has improved immunization coverage across five states in Nigeria; Bayelsa, Edo, Imo, Jigawa and Lagos State.
Immunization programs have long overlooked gender-related barriers to immunization. Notably, household surveys in most countries reveal no real difference in vaccination coverage between boys and girls. The key is understanding the impact that gender-related barriers have on women as caregivers. M-RITE recognizes that these barriers lie on the critical pathway to improving equity and must be addressed so that all children are protected from vaccine-preventable diseases.
A review by the Equity Reference Group for Immunization identified several key gender-related barriers affecting women that, in turn, affect vaccination of all children. In addition to the physical, financial, and cultural barriers and time constraints that often limit women’s access to services for themselves, many women have lower status than men within their communities and families, restricting their control over family resources and decisions on care for their children. In many instances, women also have lower levels of education and health literacy than men yet commonly are relied upon as the primary caregivers for their families. As such, they are responsible for taking their children to receive care, often experiencing poor quality services but having little input as to where, when, or how those services are provided.
The COVID-19 pandemic has exacerbated these inequities and increased barriers to access and use of vaccination services. With global immunization coverage stalled for the past decade at 85 percent (with much lower coverage in urban slums, rural remote areas, and conflict and fragile settings), an urgent need exists to identify and address these obstacles. The project is teaming up with WHO; UNICEF; Gavi, the Vaccine Alliance; and other key players to implement the strategies reflected in the Immunization Agenda 2030 (IA2030) and Gavi’s gender policy adopted in 2020.
IA2030 calls for tailored strategies to understand and overcome gender-related barriers faced by caregivers and health workers to immunization service access. Similarly, Gavi’s multi-faceted gender policy calls for: building in-country capacity to recognize and analyse gender-related barriers; advocating for action; promoting an integrated, gender-sensitive approach to reach zero-dose and under-immunized children and communities; learning from emerging experience; and expanding partnerships beyond the health sector.
Building on this groundswell of attention and support, the project is collaborating with partners at global, regional, country, subnational, and community levels to promote practical steps to:
Assess:
- Ensure that baseline assessments actively seek and identify gender-related barriers to immunization so they can be addressed.
Advocate and communicate:
- Sensitize counterparts at national and subnational levels on why and how to reduce gender barriers to vaccination. Communicate regularly about gender-related barriers to immunization and progress in overcoming them.
Engage:
Increase female representation in co-creating interventions, applying a gender lens to design activities to reduce zero-dose and under-immunized children. Two ways of doing so are to:
- Partner with trusted local organizations whose expertise includes gender equity, and
- Expand the engagement of women in planning where and when vaccination services are provided.
Increase male support:
- Expand male engagement in immunization through targeted communication that clearly explains the steps they can take and why it’s in their interests to do so.
Learn and share:
- Apply tailored, meaningful measures to monitor and evaluate interventions to improve gender equity and adapt efforts based on learning. Share experience across countries and with global and regional partners to amplify learning and strengthen strategies.
Measure:
- Monitor and measure service quality (including services provided by private practitioners), access, gender-sensitive communication and women’s decision-making.
Enhance protection:
- Support the introduction and uptake of vaccines against diseases across the life course, such as human papillomavirus (HPV) that disproportionately affects the health of women.
Purpose of the Gender Analysis
The purpose of this gender analysis is to inform the integration of gender equality considerations in our design, planning, implementation, and monitoring, evaluation, and learning. Per USAID Automated Directives System (ADS) 205, USAID implementing partners are responsible for integrating gender in programming.
This gender analysis will examine key gender dynamics and considerations that will influence and inform M-RITE activities and how gender is integrated throughout the life of the project. The analysis will identify gender-based constraints to equitable participation and access of men and women in immunization programs and services in Bayelsa, Edo, Imo, Jigawa and Lagos states and:
- Identify how gender inequalities and constraints could impede the program’s goals and how to address the root causes of those inequalities.
- Examine anticipated levels of and possible barriers to the participation of men and women in attendance of immunization session; attendance of outreach sessions; developing micro plans; identifying and reporting zero dose and under immunized children; reporting AEFI; and how they may benefit from the program.
- Identify how the program might affect men and women differently, including unintended or negative consequences.
- Identify ways the program can narrow gender gaps, address inequalities, and/or empower women and girls in the specific activities and areas of the program.
- Identify strategies and approaches the project can use to enhance the access and equity of RI services for both female and male caregivers.
- Analyse the potential impacts of the project on equity in immunization and reduction of zero dose children.
- Assess key constraints related to gender equity and identify opportunities for strengthening of gender-sensitive approaches by state Governments and withinMOMENTUM Routine Immunization Transformation and Equity.
- Identify those gender-related issues that have the greatest potential impact on equitable access to immunization.
The goal of the gender analysis is to provideresult in practical recommendations for how to advance gender equality and women’s empowerment across the program. Based on the gender analysis, the project will develop a gender integration strategy with recommendations that support what the project is already doing including:
- Improve convenience and access of immunization services – so that caregivers (who are mostly women) can access them.
- Improve communication with caregivers and families (both women and men) about immunization: the importance, the safety, the where and when for the schedule
- Improve the quality of immunization services (both technical quality and service experience, including perceived satisfaction) so that it is a safe, effective, and good experience that invites completion of the vaccination schedule.
- Improve agency and autonomy of caregivers to be able to make use of the services. This involves both women and men.
- Improve conditions/circumstances of health workers, who are mostly women; AND
Recommendations that consider:
- The program’s design, such as specific gender and inclusion related objectives, strategies to incorporate within the program’s workplan to overcome gender and inclusion challenges, and potential new or adjusted activities.
- The monitoring, evaluation, and learning plan, such as adding/modifying indicators and identifying gender- and inclusion- related learning questions.
- Staffing and HR approaches, such as gender supportive supervision, hiring and workforce practices, components of job descriptions, and required competencies for staff.
Analytical Framework for the Gender Analysis
Gender Analysis Domains: The analysis will gather data to examine gender dynamics across the five gender analysis domains, per USAID ADS 205:
- Laws, Policies, Regulations, and Institutional Practices
- Cultural Norms and Beliefs
- Gender Roles, Responsibilities, and Time Use:
- Access to and Control over Assets and Resources
- Patterns of Power and Decision-making
- Gender Analysis Questions per Intermediary Result (IR): M-RITE will refine key analysis questions to be examined in consideration of activities planned under each IR and findings of desk reviews. Possible questions may include but are not limited to:
Intermediary Result 1:
- What resources do women and men in project communities need to ensure that their child is immunized?
- Who has access to and control over these resources?
Intermediary Result 2:
- How do gender-related beliefs and practices in project communities impact RI service acceptance and use?
- What gender-responsive platforms and leadership structures are available and can be used for galvanizing support for RI?
Focus Areas of Analysis
The gender analysis will consider how characteristics like age, education, and geographic location affect how participants and beneficiaries interact with the Project:
- Geographic Focus. MOMENTUM Routine Immunization Transformation and Equity works in five distinct/different geographical locations, within three geopolitical zones. The Gender Analysis will be done in each of the states. This is to ensure that the information from each context is harvested to enrich the findings. For the purpose of getting information from across the states, Bayelsa, Edo, Imo, Jigawa and Lagos are selected for the Gender Analysis.
- Intersectional Variables and/or Key Groups. The analysis will focus on open and closed groups for maximal comparison and context analysis. For example, it will look at women at home with no source of income (closed group) and women with a source of income (open group). It will also consider variables such as age, level of education, language, religious affiliation, class, ethnicity, nationality, and disability status.
Methodology
The analysis will utilize a mixed-method approach. Quantitative and/or Qualitative data will be accessed and analysed through:
- A desk review of relevant national and state reports/studies: Information from the Health Sector Gender Analysis will be used to enrich the analysis. Research questions may be refined based on the findings of the desk review.
- Sampling and data collection: To bridge the information gap from the desk review, the analysis will involve primary data collection at various levels using various data collection techniques including:
- Household level: The study population will be reached through Questionnaire deployment and semi-structured interviews
- Community level: The study population will be reached through key informant interviews and focus groups
- Institutional level: The study population will be reached through key informant interviews,
- Design and pre-test of primary data collection tools, collection of data and analysis of data.
- Draft gender analysis report.
- MOMENTUM Routine Immunization Transformation and Equity will conduct an internal presentation of findings to staff/partners/stakeholders to validate findings and brainstorm recommendations for how to further improve gender integration in the project.
- Finalize gender analysis report and strategy (in FY 25)..
Task & Deliverables:
- The consultant will lead the gender analysis process supported by the gender point of contact (POC) for the project. Other project staff at HQ and State levels will also be involved in tools development and data collection to strengthen in-house capacity for identifying gender-related issues in the project.
The consultant will:
- Develop a proposal to conduct the gender analysis, outlining the consultant’s understanding of the task, proposed methodology, and work plan.
- Desk Review – Review relevant reports/studies that provide answers to gender analysis questions and identify information gaps not covered by secondary data.
- Finalize sampling strategy and data collection plan.
- Develop data collection tools and pre-test them.
- Train staff/data collectors.
- Lead the data collection and make available an electronic copy of raw data, including a list of persons contacted and assessment participants.
- Conduct gender analysis and submit draft report (soft copy).
- Prepare slides and facilitate validation meeting (s).
- Facilitate the development of the gender action plan with the M-RITE team.
- Finalize and submit the gender analysis report.
Level of Effort
- The Consultant is expected to conduct the assignment during the period for a total of 22 days.
| Proposed Activities to be Undertaken | Days |
| Preliminary meetings and fine-tuning of gender analysis proposal | 5 |
| Main work described in approved proposal, including desk review, tools development, staff training and data collection | 10 |
| Preparation and submission of Draft gender analysis report | 3 |
| Presentation of gender analysis findings to relevant stakeholders | 1 |
| Facilitate Gender and Inclusion Action plan/Strategy development | 2 |
| Submission of Final Report | 1 |
| Total | 22 |
