1. Background

The Royal Government of Cambodia (RGC) has received vaccine and financial support from Gavi through the Ministry of Health (MoH). The National Immunization Program (NIP), under the National Maternal and Child Health Center (NMCHC), manages these efforts with support from provincial health departments (PHDs), operational districts (ODs), and community networks. Despite over 90% national immunization coverage, marginalized groups—such as urban poor populations—continue to face limited access to vaccines.

The Reproductive Health Association of Cambodia (RHAC), in collaboration with the National Immunization Program (NIP) and partner NGOs, is implementing the GAVI-funded project to increase immunization coverage, focusing on zero-dose children under one year old living in urban poor areas. The RCCA will provide essential data on current immunization coverage and identify gaps in reaching zero-dose children, ensuring more effective outreach efforts.

RHAC targets zero-dose children in five ODs in Phnom Penh and one OD in Siem Reap province. The RCCA questionnaire has been developed and finalized in collaboration with NIP and participating NGOs, ensuring alignment with national immunization objectives.

2. Objectives

The main objective of this consultancy is to support RHAC in implementing the RCCA to:

• Assess immunization coverage among zero-dose children under one-year-old in urban poor communities in Phnom Penh and Siem Reap

• Identify key barriers to vaccination access within urban poor areas, including socio-economic factors and health system challenges.

• Provide data-driven recommendations for improving immunization strategies in urban poor areas.

• Inform the NIP about the specific challenges faced by urban poor populations in accessing immunization services.

3. Scope of work
The consultant will be responsible for the following tasks:

Stakeholder engagement and coordination

• Meet with key stakeholders: Coordinate with the Provincial Health Department (PHD), Municipal Health Department (MHD), Operational District (OD) directors, health center chiefs, and commune/sangkat chiefs to:

  • Identify urban poor communities where the RCCA will be conducted.

  • Ensure stakeholder alignment on the RCCA objectives and methodology.

• Population data collection: Work closely with these key stakeholders to gather population data for the targeted ODs, specifically focusing on total population numbers and children under one year old (zero-dose focus) in urban poor areas.

Recruitment and identification of data collectors

• Identify data collectors: Identify and recruit health center (HC) staff and Village Health Support Group (VHSG) as data collectors for the RCCA. This ensures that individuals familiar with the local communities are involved in the data collection process, improving engagement and accuracy.

• Ensure that selected data collectors understand the goals of the RCCA and are well-positioned to support the data collection process.

Training and fieldwork preparation

• Conduct training: Develop and lead training sessions for the recruited HC staff and VHSG members on the RCCA methodology, including:

  • Use of the finalized RCCA questionnaire through Kobo Toolbox

  • Best practices for data collection in urban poor communities.

  • Ethical considerations in working with vulnerable populations.

• Develop a fieldwork plan: Create a detailed work plan that outlines the steps for data collection, including timelines, resource allocation, and logistical planning. This will ensure smooth execution during the fieldwork phase.

Field data collection leadership

• Lead the fieldwork: Oversee the field data collection in the identified urban poor communities across the selected ODs in Phnom Penh and Siem Reap. This includes:

  • Supervising data collectors to ensure they adhere to the RCCA methodology.

  • Implementing a cluster sampling approach to select villages.

  • Leading household selection using a random walk and quota sampling method, focusing on the inclusion of households with:

    • Women of childbearing age.

    • Children under one-year-old.

    • School-age children (where applicable).

• Maintain clear communication with RHAC and local health authorities, addressing any challenges that arise during the fieldwork.

Data analysis and reporting

• Analyze collected data: Carry out a comprehensive analysis of the RCCA data including data screening/cleaning to assess:

  • Immunization coverage rates for zero-dose children under one year old.

  • Socio-economic and health system-related barriers to vaccination access in urban poor areas.

• Write report with recommendations: Based on the analysis, provide actionable, data-driven recommendations for improving immunization strategies in these areas.

• Preliminary findings: Present the preliminary findings to RHAC, NIP, and other stakeholders to inform ongoing planning and decision-making.

Final reporting

• Produce a final report: Develop a detailed final report, which includes:

  • Immunization coverage data.

  • Identified barriers to vaccination access in urban poor areas.

  • Recommendations for addressing gaps in immunization services and improving outreach to zero-dose children.

• Ensure that the report aligns with the objectives of the NIP and provides tailored, actionable strategies to overcome the challenges faced by urban poor communities in Phnom Penh and Siem Reap.

4. Study population

The RCCA will focus on urban poor households with children under one-year-old, with a particular emphasis on zero-dose children. The assessment will also include women with one- year-old children in selected households to gather comprehensive insights into immunization behaviors and challenges.

5. Sampling strategy and methodology
The sampling strategy is based on guidelines provided by the NIP, focusing on urban poor populations. The following key steps will be implemented for effective data collection:

• Cluster sampling for village selection: Villages within each OD will be selected either randomly or purposively, ensuring proportional representation of urban poor communities in five ODs in Phnom Penh and one OD in Siem Reap.

• Household selection: Within selected villages, households will be selected using a random walk method, with quota sampling applied to include:

  1. Household/Women of childbearing age (15-49 years)

  2. Children under one year old, with a focus on children who received zero-dose or missed any recommended doses

  3. School-age children, where relevant
     The selection process will continue until the target sample size for each village is reached.

• Survey instrument: The assessment will utilize the NIP-PMG approved RCCA questionnaire to capture:

  1. Immunization status of children under one-year-old

  2. Household demographics and socio-economic data

  3. Barriers to accessing immunization services

• Data management and quality control: Field supervisors will oversee data collection to ensure accuracy and consistency, with data entered into a digital platform for analysis.

The sample size will follow the proportions suggested by the NIP based on the total population and children under one year in each OD, as shown in the table below:

7. Deliverables

The consultant will be responsible for delivering the following:

1. Training of RHAC staff, health center staff, VHSG on RCCA data collection procedures.

2. Supervision of field data collection in the six targeted ODs.

3. Primary report to RHAC

4. A preliminary findings presentation to RHAC, NIP, and GAVI stakeholders.

5. A final report detailing the immunization coverage rates, barriers identified, and recommendations for improving coverage.

8. Ethical considerations

Ethical considerations will be paramount throughout the RCCA process. The assessment will ensure:

• Informed consent: Participation in the survey will be voluntary, and informed consent will be obtained from all participants before conducting the interviews.

• Confidentiality: Data collected will be treated confidentially, and no personal identifying information will be shared.

• Child safeguarding: All interactions with children and their families will follow ethical standards to ensure the protection and well-being of children under two years old.

9. Timeline

• Inception report submission after pre-assessment field trip December 6, 2024

• Data collection period: December 9-20, 2024

• Draft report submission: December 23-27, 2024

• Presentation to RHAC, Municipal/Provincial Health Departments, and NIP: December 30-31, 2024

• Final report submission: January 1-8, 2025

10. Required expertise

The consultant(s) should have:

• Expertise in immunization coverage assessments or similar health surveys.

• Experience working with urban poor populations or marginalized communities.

• Experience in carrying out qualitative and quantitative research

• Familiarity with cluster sampling and household survey methodologies.

• Strong analytical and report-writing skills.

 10. Budget and payment terms

The total budget will cover consultancy fees and other expense. Payments will be made in three instalments:

• 20%

  • after pre-assessment field trip

  • submit the inception report

  • the incept report approved by PMG

• 30% upon approval of the RCCA implementation plan.

  • Training to data collection conducted

  • Field data collection completed

• 30% upon completion of primary RCCA assessment finding report.

• 20% upon the presentation conducted, the final submission and approval of the final report.

11. Submission requirements

Interested consultants should submit:

• A cover letter detailing relevant experience.

• A CV.

• A proposal including methodology, timeline, and consultant fee.

• Two references from similar assignments

12. Closing date and submission

• Closing date: November 25, 2024, 5:00 PM Cambodia time.

• Submission email: Submit to Dr. Heng Kheng at hkheng@rhac.org.kh, with a copy to admin@rhac.org.kh.

13. Organization information

Reproductive Health Association of Cambodia (RHAC)

• Head Office: #05, St. 600, Sangkat Boeng Kak Ti Pir, Khan Tuol Kouk, Phnom Penh, Cambodia

• Website: www.rhac.org.kh

• Email: info@rhac.org.kh