Back ground 

Immunization serves as a cornerstone of public health and have made significant contributions to the control of infectious diseases all over the world. Vaccination directly protects individuals, including children who receive the bulk of vaccines globally. Vaccination boosts a body's defense system, which is also called the immune system. Vaccines create immunity that protects an individual from an infection without causing suffering or the disease itself, while also preventing the spread of vaccine preventable diseases in the community and nation, and more broadly, globally.

Immunization in Rwanda is one of the basic essential services, which is observed to have closely reached universal coverage. The vision of the Expanded Programme on Immunization (EPI) is to eradicate all Vaccine Preventable Diseases (VPDs), thereby enhancing the well-being of the people through the reduction of morbidity and mortality.

To further strengthen this vision, a strategic and comprehensive Multi-Year Plan (MYP 2017-21) was put in place to maintain the achieved performance in terms of the immunization programme. The MYP, which is also an offshoot of the Health Sector Strategic Plan (HSSP) is in full consonance with the overall National strategy for Economic Development and Poverty Reduction Strategy (EDPRS). 

Notwithstanding the achieved successes, there are also some observed variances in the districts in terms of the outcomes of the immunization programme, most probably related to knowlege, attitudes, practices and behaviours  of the parents/primary caregivers and community leaders regarding vaccination.

Part of the challenge might also be due to the fact that health service providers  at all levels ineffectively counsel parents and are unable to provide them with sufficient information on the benefits of vaccination. In addition, some of the challenges highlighted by the Ministry of Health include ineffective or outdated immunization communication strategy, communication materials, communication interventions not reflected enough in the operational plans at all levels as well as poor knowledge about new vaccines by parents and caregivers, especially male caregivers (as the responsibilities related to immunization are traditionally assigned to female caregivers).

Hence, the Ministry of Health with support from UNICEF is implementing the Health Systems Strengthening programme funded by the GAVI, Vaccine Alliance to increase trust in vaccination among the population in general and, in particular, among most vulnerable population groups.

To address the challenges above, maintain the high coverage of the immunization programme and to further increase effectiveness of the immunization effort, UNICEF Country Office in Rwanda will support the Ministry of Health (MOH)/Rwanda Biomedical Center (RBC) in the design of a Knowledge, Attitudes, Practices and Behaviours (KAPB) study on immunization. The study results will further inform the social and behaviour change communication (SBCC) interventions and policy advice around vaccination and ensure that all children irrespective of gender and health status equally enjoy their right to health.

1.Rationale and Justification

Designing and conducting the KAPB study requires a highly qualified institutional consultancy onboard. Therefore, UNICEF plans to contract an experienced and competent research institution to undertake this exercise.

2.Purpose, objectives and expected results 

The purpose of the study is to: 1) understand the prevailing knowledge, attitudes, practices and behaviours of the key respondents around immunization issues; 2) identify enablers as well as barriers for demand and utilization of immunization services; and 3) understand the communication needs of the respondents to ensure the immunization services uptake.

Critical consideration of gender dimensions will be considered during this exercise. 

Ministry of Health and UNICEF will use the results of the study to design a comprehensive evidence-based SBCC strategy to increase understanding of and demand for immunization services throughout the country. As necessary, the results will also inform the required policy advice and recommendations for strengthening the immunization programme.

The overall objectives of the study are:

· To collect the KAPB data from parents/primary caregivers (women and men) of children 0-5 years old (including most vulnerable population groups, especially poor families and families with children with disabilities), health workers, including at central level, district hospital health centre level and community health workers as well as community leaders, including religious leaders of different denominations, with regards to immunization; 

· To identify the enabling factors as well as barriers to immunization, including from gender, inclusion, level of education and economic well-being points of view;  

· To identify most effective channels and influencers to inform the design of the comprehensive SBCC strategy to maintain and further increase the immunization services uptake.

Key elements of the study:

The output of the study is a comprehensive report, including the following elements:

1.Desk (literature) review with a gender analysis component including information on available EPI policies and programme documents as well as other research documents related to immunization.

2.       Data collection and analysis with a gender lens:

a.Existing knowledge, attitudes, practices and behaviours of parents/primary caregivers of children 0-5 years old (quantitative);

b.Perceptions of parents/primary caregivers of children 0-5 years old on the impact of immunization on their children, including prevailing myths and misconceptions (qualitative);

c.Perceptions of health workers at all levels and community leaders, including religious leaders of different denominations, with regards to immunization, including prevailing myths and misconceptions (qualitative);

d. Enabling factors as well as barriers for the immunization services’ uptake (parents/primary caregivers and health workers at all levels – qualitative);

e.  Communication needs assessment of the parents/primary caregivers (quantitative and qualitative).

NB: Kindly refer to the attachedment for details description of work