Afr ican Healt h E c o no m ic s a nd P ol icy Assoc iat io n

Association Africaine d’Economie et de Politique de la Santé

PROPSAL FOR: Overcoming Hesitancy & Barriers: Strategies for Timely and Equitable
COVID-19 Vaccine Access and Uptake in Ethiopia.

PI Dr Senait Alemayehu :AfHEA consultant

Co auteurs:

Anene Tesfa: EPHI, Health system and research directorates

Jibril Bashir: Arsi University

Mosisa Bekele: Addis Abeba University

Dr Naomi Setshegetso: AfHEA ECOVA project quality assurance

Dr Pascal Ndiaye: AfHEA ECOVA project quality assurance

PI contact; Senait Alemayehu ,email senaitalb@gmil,com, phone 0911839394

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Executive summary

Background: The intimate effect that this COVID-19 pandemic has had in the lives of people
around the world has fostered an increasing circulation of user-generated content questioning the
motivations and quality of scientific knowledge around the virus and suggested strategies to
control the pandemic. Public health authorities and other stakeholders around the world have
faced substantial challenges in finding effective ways to engage with stakeholders about
concerns and anxieties regarding the distribution and uptake of vaccines especially the COVID-
19 vaccines. Moreover, vaccine equity, already a long-standing focus of global health concern,
has become a lightning rod for public debate since the outbreak of the COVID-19 pandemic.
Global Health policy discussions have tended to focus on the need to ensure widespread and
equitable vaccine allocation. Without correcting the highly consolidated topography of
biomedical R&D and equitable access to vaccines, public health crises are likely to remain a
problem. Vaccine equity with regard to vaccine availability, access and uptake, is an important
part to address public health issue including COVID-19 pandemic.
The main objective of the study is to improve equitable access to and uptake of vaccines
particularly the COVID-19 vaccines in Africa for disadvantaged and vulnerable groups towards
reducing morbidities and mortalities attributable to vaccine preventable diseases.
Methodology: This study will apply a qualitative approach involving desk review and primary
data collection through in-depth interviews with relevant stakeholders to investigate vaccine
equity, access and hesitancy in Africa using Ethiopia as a case study. Purposive sampling
technique will be used to select participants for the in-depth interviews. The data will be coded
using QSR Nvivo 12 software to aid thematic content analysis. Ethical approval will be obtained
from the Ethiopian public health association Ethics Review Board before conducting the
interviews.
Work plan: The study period including proposal writing, data collection, the analysis and report
writing; (the entire process; proposal development to report writing) is scheduled for November
2023-Jun 2024

Budget: The required cost for the study is estimated 232,200.00 Ethiopian Birr

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Table of Contents
1. Introduction ....................................................................................................................................... 5
1.1 Overview of COVID-19 Vaccine ................................................................................................. 5
1.2 Vaccine hesitancy in Ethiopia ....................................................................................................... 5
1.3 Access and Barriers to COVID-19 vaccine uptake in Ethiopia .................................................... 6
2 Objectives for activities one and two .................................................................................................... 7
3.1 Searches Engine and Strategy ........................................................................................................... 8
3.2 Study exclusion and inclusion criteria .............................................................................................. 9
3.3 Quality appraisal of the selected literature ........................................................................................ 9
3.4 Data extraction, processing and analysis .......................................................................................... 9
3.5 Data synthesis and analysis ............................................................................................................. 10
4 Research Objectives for activities three and four ............................................................................... 10
4.1 The Specific objectives include: ..................................................................................................... 11
4.2 Study Design ................................................................................................................................... 11
4.3 Data Collection ............................................................................................................................... 13
4.4 Interview Structure and Content ..................................................................................................... 14
4.5 Data Analysis .................................................................................................................................. 14
5 Ethical Considerations ........................................................................................................................ 14

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 Acronyms and Abbreviations

ACT-A Access to COVID-19 Tools Accelerator

AfCFTA African Continental Free Trade Area
AfDB African Development Bank
AfHEA African Health Economics and Policy Association
AFRINET African Research Network on Neglected Tropical Diseases
AMA African Medicines Agency
AVAREF African Vaccine Regulatory Forum
CDC Centers for Disease Control and Prevention
CHAI Clinton Health Access Initiative
COVAX COVID-19 Vaccines Global Access
CPHIA International Conference on Public Health in Africa
CSOs Civil Society Organizations
DCVMN Developing Countries Vaccine Manufacturers Network
EACN-CT East African Network for Clinical Trials
EARN East African Regulatory Network
ECA Economic Commission for Africa
GAVI Global Alliance for Vaccines and Immunisation
HPV Human Papilloma Virus
IAVI International AIDS Vaccine Initiative
IPRs Intellectual Property Rights
PAVM Partnerships for African Vaccine Manufacturing
R&D Research and Development
TRIPS Trade-Related Aspects of Intellectual Property Rights
USAID United States Agency for International Development
WHO World Health Organization
WITS World Integrated Trade Solution
WTO World Trade Organization

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1 Background

1.1 Overview of COVID-19 Vaccine

The COVID-19 pandemic caused by the SARS-CoV-2 virus has resulted in a significant loss of
human life worldwide and posed an unparalleled global health threat(1, 2). The virus is highly
transmissible through direct contact and respiratory droplets, leading to its rapid spread among
the population. Preventive measures such as physical distancing, hand hygiene, and wearing
masks and vaccine are vital in controlling the spread (3-5).

COVID-19 vaccines are crucial in preventing symptomatic illness and severe illness caused by
the virus. They aim to attain acquired immunity against the disease-causing virus. Vaccination
with COVID-19 vaccines has shown efficacy in preventing symptomatic COVID-19 infections,
with almost 95% effectiveness in some cases (6, 7).

Globally, there have been 772,166,517 confirmed cases of COVID-19, including 6,981,263
deaths. As of 22 November 2023, a total of 13,595,583,125 vaccine doses have been
administered(8). In Ethiopia, from 3 January 2020 to, 22 November 2023, there have been
501,080 confirmed cases of COVID-19 with 7,574 deaths. Ethiopia started administering
COVID-19 vaccine in 13 March 2021 and currently a total of 68,856,793 vaccine doses have
been administered as of 27 May 2023, which achieved only 59 persons per 100 population
coverage, falling behind the global average of 174 per 100 populations(2).

1.2 Vaccine hesitancy in Ethiopia

Vaccine hesitancy is an intricate and multidimensional phenomenon that refers to the
unwillingness to accept vaccinations despite their availability. It is influenced by a range factors
including demographic characteristics, political affiliation, vaccine safety concerns, lack of
knowledge and awareness, cultural and religious beliefs, and socioeconomic issues(9, 10).
Vaccine hesitancy is linked to a drop in public confidence in immunization globally and can
thwart public health initiatives intended to prevent the spread of infectious diseases(11).

COVID-19 vaccine hesitancy is a global issue, including in sub-Saharan Africa. The research
found that vaccination hesitancy varied greatly across sub-Saharan Africa, from 29% in Ethiopia
to 65% in Tanzania. The vaccine hesitancy is influenced by factors such as colonial inequities in

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global health research, social-cultural complexities, poor community involvement, and public
distrust (12, 13). Political influences, religious beliefs, and low perceived risk also contribute to
vaccine hesitancy in the region(14).

Vaccine hesitancy is a major challenge to the uptake of COVID-19 vaccines in Ethiopia, with
hesitancy rates ranging from 14.1% to 68.7%. Factors associated with vaccine hesitancy include
contextual factors such as young age, female sex, living in rural areas, and lack of adequate
information(15). Personal factors like lack of awareness, low perceived risk of COVID-19, poor
adherence to prevention strategies, and negative attitudes towards the vaccine also contribute to
vaccine hesitancy. Knowledge levels, attitudes, and practices regarding COVID-19 prevention
and control also influence vaccine hesitancy (16, 17).

To reduce COVID-19 vaccine hesitancy and improve advocacy for vaccine equity in Ethiopia,
several approaches have been suggested. These include the development of culturally tailored
health education materials, engagement from politicians, religious leaders, and community
members, creating awareness in highly hesitant groups, addressing safety concerns of the
COVID-19 vaccine, and providing reliable information about the vaccines through effective
community engagement, engaging community leadership, and involving the scientific
community to build trust and address concerns about vaccine safety. Additionally, addressing
contextual factors such as age, gender, residency, and education level, as well as personal factors
like lack of information, low-risk perception, and negative attitudes towards the vaccine, are
important in addressing vaccine hesitancy(18-21).

Africa-based research and development are emphasized as a sustainable solution to ensuring

vaccine equity in African countries. Increasing stakeholder communication and ensuring
universal accessibility of vaccines are also important factors to consider. Overall, a multi-faceted
approach involving tailored education, community engagement, and research and development is
necessary to improve advocacy for vaccine equity for COVID-19 in Ethiopia (22, 23).

1.3 Access and Barriers to COVID-19 vaccine uptake in Ethiopia

Access to COVID-19 vaccines in Ethiopia has been challenging with the patterns in access and
uptake of COVID-19 vaccines in Ethiopia varies among different populations. Several studies
indicated the variation in access and uptake of COVID-19 vaccine for instance according to

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study among health-care providers in Addis Ababa the uptake rate of COVID-19 vaccine will
relatively high at 75.8% whereas study in health sciences student in Wollo university showed
lower uptake at 23.3%(24, 25). A community-based study in Somalia also found that only
29.0% of participants had been vaccinated(26).

Barriers to equitable and timely access to and uptake of COVID-19 vaccines in low-income
countries include disparities in vaccine coverage driven by insufficient supply, inequitable
distribution, limited production of the vaccine in low-income countries, weak health systems,
high vaccine hesitancy, and vaccine misconceptions. Economic standing also plays a role, as
countries with smaller economies reported delayed access to vaccines compared to larger
economies(27, 28). Similarly the barriers to equitable and timely access to and uptake of
COVID-19 vaccine in Ethiopia include lack of infrastructure, shortage of vaccine supply, lack of
knowledge and positive attitudes towards the vaccine among the population(29, 30).

To address these barriers, strategies such as expanding vaccine facilities, waiving intellectual
property rights, transforming knowledge and technology into vaccines, and conducting mass
vaccination campaigns are recommended(31). The Ethiopian government had adopted different
strategies and initiatives to ensure equitable and timely access to vaccines. Having determined
COVID-19 vaccine hesitance, access, uptake, and barriers to equitable and timely uptake, along
with ways to mitigate these barriers for disadvantaged groups, policymakers, health authorities,
and other stakeholders were able to design specific vaccine campaigns and develop evidence-
based guidelines to effectively improve COVID-19 vaccine uptake. Therefore, this scoping
review aimed to estimate the pooled proportion of hesitance, access, uptake, and barriers to
equitable and timely uptake of the COVID-19 vaccine among disadvantaged groups in Ethiopia,
and explore how these barriers could be mitigated.

2 General objectives: understand and address the challenges of COVID-19 vaccine

hesitancy and uptake, particularly among disadvantaged groups in Ethiopia, in
order to achieve equitable and timely vaccination coverageObjectives for activities
one and two

 To Determine COVID-19 vaccine hesitancy status in Ethiopia.

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  To assess approaches that used to reduce COVID-19 vaccine hesitancy and improve
advocacy and equity, especially among disadvantaged groups in Ethiopia.
 To Assess uptake of COVID-19vaccines among disadvantaged groups in Ethiopia.
 To Determine Barriers to Equitable and Timely uptake of COVID-19 vaccine among
disadvantaged groups in Ethiopia.
3 Method

This scoping review will be conducted using Arksey and O’Malley’s methodological
framework(32). The following five-stage framework proposed will as follows: “(1) Identifying
the research questions, (2) Searching for relevant studies, (3) Selecting studies, (4) Charting the
data, and (5) Collating, summarizing, and reporting the results” This review will include the
Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping
Reviews (PRISMA-ScR) checklist(33).

3.1 Searches Engine and Strategy

Literature will be identified by searching the following online databases: Medline, PubMed,
Scopus, Cochrane, EMBASE, African journal online (AJOL), HINARI, Science direct, and other
Gray literature will be conducted by searching Google, Google Scholar, and other internet search
engines to search any additional articles published until early October 2023.

Medical Subject Heading (Mesh), keywords, and free text search terms will be used. The search
will be performed using the terms; “COVID-19” OR “Coronavirus” OR “nCoV Infection” OR
“SARS-CoV-2” OR “COVID19, MeSH terms: COVID-19” AND “Vaccine*” OR “Vaccination”
, MeSH terms: COVID-19 Vaccines AND (patterns)) AND AND Hesitance OR indecision OR
reluctance OR skepticism OR uncertainty AND approaches OR strategy OR method AND
Reduce OR halt OR eradicate AND Improve OR enhance AND Advocacy OR advancement, OR
encouragement AND Equity OR fairness OR justice AND (intake)) OR (Uptake)) OR (Use))
AND (access)) AND (barriers)) OR (factors)) OR (disfavor)) OR (dislike)) AND (equitable))
OR (Fair)) AND (timely)) OR (up-to-date)) OR (disadvantaged)) OR (underprivileged)) OR
(vulnerable groups)) AND (Ethiopia).

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The search strategy will be adapted from previously conducted scoping or systematic reviews
that evaluated access, uptake, and barriers to equitable and timely uptake of COVID-19 and other
vaccines (34-38).

3.2 Study exclusion and inclusion criteria

Original research studies reporting the hesitance, Access, Uptake, and Barriers to Equitable and
Timely uptake of COVID-19 vaccine, the approaches that used to reduce those barriers and
improve advocacy for vaccine equity in Ethiopia will be included in the study. Study designs in
this review will include randomized controlled trials, observational studies, cross-sectional
studies, cohort studies and qualitative studies reported from 2020 to early October 2023.

The first occurrence of COVID-19 pandemic wills the motivating factor behind this timeline.
Studies with a sole focus on COVID-19 vaccines will excluded, given that this review aimed to
examine the long-standing inequities in vaccine access and uptake. We also excluded studies;
those that did not include Ethiopia, duplicates, and studies where vaccination will not mentioned
or will not the outcome variable. Similarly, studies with no mention of demographic, geographic,
or socio-economic variation in vaccine hesitance, access, uptake or coverage, or no mention of
vaccines, will excluded. Additionally, studies without full text and data that are difficult to
extract or with no empirical data, articles missing editorial reports, letters, reviews, and
commentaries will excluded from the study.

3.3 Quality appraisal of the selected literature

All authors will independently assess the quality of studies included in the review. The Joanna
Briggs Institute (JBI) will utilized to evaluate the study's quality (39). We will develop quality
assessment criteria with parameters of low (<49%), medium (50–79%), and high (80–100%)
study quality for studies assessing Access, Uptake, and Barriers to Equitable and Timely uptake
of COVID-19 vaccine, and how these barriers can be mitigated for disadvantaged groups in
Ethiopia. Data will not be excluded based on study quality, but this information will inform the
narrative synthesis and discussion.

3.4 Data extraction, processing

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A standardized data extraction sheet in Microsoft Excel will be used to collate and chart the data
into themes and summarize studies and reports. Three major headings will be used to extract
detailed information for the included studies (1) study description, which will includes authors
and years of publications; study setting (region), (2) methodology, the methodology section
consisted of study characteristics, i.e., study design, and sample size and (3) result, which will
include the proportion of COVID-19 vaccination, Barriers or factors and mitigation strategies.

Due to the heterogeneity of studies, a narrative synthesis approach will be used to collect,
synthesize, and map the literatures(40). The following categories will used to categorize the
studies: (1) COVID-19 vaccine hesitancy status in Ethiopia; (2) approaches that used to improve
advocacy for COVID-19 vaccine equity and reduce COVID-19 vaccine hesitancy in Ethiopia;
(3) Access to COVID-19 vaccine in Ethiopia; (4) uptake of COVID-19 vaccines in Ethiopia; (5)
Barriers and mitigation strategy to Equitable and Timely uptake of COVID-19 vaccine in
Ethiopia. This researcher will apply thematic narratives to report all data(41).

3.5 Data synthesis and analysis

The extracted data will be imported into STATA version 14 for further analysis. Tables and
figures will used to summarize the selected studies. Meta-analysis will implement for studies that
provided the outcome and the determinants variables. Estimates of adjusted odds ratio with 95%
confidence interval (CI) will consider as the measure of association for factors that determine
prevalence of COVID-19 vaccine Access, and Equitable and Timely uptake. The pooled estimate
of COVID-19 vaccine Access, and Equitable and Timely uptake will be estimated using a
random effect model with 95% CI.

Heterogeneity between the studies will be assessed with Cochran’s Q statistic and the I2
statistics. I2 values greater than 50% will be considered as indicative of substantial
heterogeneity. Evidence of publication bias will be assessed using the visual inspection of the
asymmetry in funnel plots and, Begg's Test and Egger’s test. Furthermore, subgroup analysis
will be done based on the region, population, gender other characteristics to reduce the random
variations among the point estimates of the primary study.

4 Research Objectives for activities three and four

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This study aims to conduct a comprehensive country-level analysis of the current vaccine
distribution and delivery mechanisms in Ethiopia, with a specific focus on ensuring timely access
to and administration of COVID-19 vaccines, particularly among vulnerable populations. The
research will investigate the existing structures and mechanisms in place, identifying strengths
and weaknesses in the system. Furthermore, the research will undertake an analytical
examination of how civil society organizations, non-governmental bodies, and the private sector
can be strategically engaged, potentially through public-private partnerships, to enhance vaccine
delivery. The primary goal is to address the disparities in access to COVID-19 vaccines in
Ethiopia, emphasizing the need for equitable distribution and coverage across diverse
demographic groups and geographic regions.

4.1 The Specific objectives include:

 Assessing the current state of vaccine distribution and delivery mechanisms in Ethiopia at
the country level, focusing on COVID-19 vaccines.
 Identifying the key challenges and gaps in existing structures that hinder equitable access
to and administration of vaccines, particularly among vulnerable populations.
 Proposing recommendations for improving and strengthening vaccine delivery
mechanisms to ensure timely access and administration, with a specific emphasis on
addressing disparities.
 Analyzing the potential roles and contributions of civil society organizations, non-
governmental bodies, and the private sector in enhancing vaccine delivery.
 Exploring opportunities for public-private partnerships to facilitate collaboration and
resource-sharing for more effective vaccine distribution in Ethiopia.
 Providing insights and actionable strategies to policymakers, health authorities, and
stakeholders for optimizing vaccine delivery systems and promoting equitable access to
COVID-19 vaccines in the country.

4.2 Study Design

The research will adopt a qualitative approach to gain a nuanced understanding of the intricate
dynamics surrounding COVID-19 healthcare, public health, vaccine distribution, and community

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engagement in Ethiopia. The qualitative method is particularly suited to explore the depth and
complexity of the subject matter, allowing for the collection of rich, context-specific insights.In-
depth interviews will be the primary data collection method, providing a platform for meaningful
conversations with key stakeholders intimately involved in various facets of the COVID-19
response in Ethiopia. These stakeholders will include individuals from healthcare organizations,
public health institutions, governmental agencies, non-governmental organizations (NGOs),
community leaders, and representatives from the private sector actively engaged in the
vaccination efforts. The selection of study participants will be purposeful, ensuring that the
chosen respondents possess direct and firsthand experience, expertise, or involvement in the
areas under investigation. This purposive sampling method aims to include participants who can
provide in-depth insights into the complexities and challenges of vaccine distribution,
administration, and community engagement in the Ethiopian context. This approach the research
captures a diverse range of perspectives and experiences, enhancing the credibility and relevance
of the findings.

The interview questions will be carefully designed to elicit detailed information on the current
state of vaccine distribution, challenges faced, successes achieved, and potential opportunities for
improvement. Additionally, the interviews will explore the role of different stakeholders, the
effectiveness of existing mechanisms, and the potential for collaboration between the public and
private sectors (table 1).Mapping stakeholders based on the annex table 1

Table 1 Stakeholders mapping

Interviewees by organizational category

Country/ Partners Frontline Total
government office workers
staff

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Surveillance and
Pharmacovigilance
Planning and
coordination
Vaccine, cold chain,
logistics &
infrastructure
Vaccine, supplies
Regulatory
Pharmaceuticals
Supply Agency
(EPSA) on
Epi surveillance
RCCE
Protection
Total 25

4.3 Data Collection and sampleing

Our study will employ purposive sampling to recruit 25 Key Informant Interview (KII)
participants who possess specific characteristics relevant to our research question. This method
ensures we gather insights from individuals uniquely positioned to offer valuable perspectives on
the topic. Face-to-face interviews will be conducted to facilitate a deeper exploration of the
nuances surrounding the challenges and opportunities associated with vaccine distribution. This
approach allows for a more profound understanding of participants' experiences and perspectives
compared to other methods. To capture the richness of participants' responses in their entirety,
interviews will be audio-recorded with their informed consent. Verbatim transcription of these
recordings will ensure meticulous documentation while subsequent anonymization safeguards
the confidentiality of each contributor.Excualtion and inculcation

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This interview will focus on individuals who have direct experience with the pandemic or hold
unique perspectives relevant to our research objectives. We will not be including participants or
stakeholders who were actively involved in the OVOID 19 outbreak response efforts

4.4 Interview Structure and Content

The structured interview guide is a carefully crafted tool that guides the research team through a
systematic exploration of critical themes. The sections within the guide are strategically
organized to cover various aspects, including the current state of vaccine distribution, issues
related to equity, stakeholder engagement dynamics, and potential structural improvements. This
comprehensive approach ensures that the interviews delve into specific dimensions, fostering a
holistic understanding of the intricate web of factors influencing vaccine delivery.

4.5 Data Analysis

Thematic analysis will serve as the cornerstone of data interpretation, allowing for the
identification and examination of patterns, recurrent themes, and unique perspectives. A
meticulously designed codebook will guide the coding process, promoting consistency and
reliability across the analysis. By coding and categorizing the transcribed interviews, the research
team will extract meaningful insights, discerning the subtleties that might inform policy
recommendations and interventions.

5 Ethical Considerations

This study is deeply committed to ethical research practices. Stringent adherence to ethical
guidelines and protocols will ensure the protection of participants' rights, including
confidentiality, voluntary participation, and informed consent. Seeking approval from
institutional review boards or ethics committees underscores the dedication to ethical integrity
before commencing the research, prioritizing the well-being and privacy of the study
participants.

6 Quality Assurance

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To enhance the robustness and reliability of the study, inter-coder reliability checks and peer
reviews will be integral components of the analysis process. Regular debriefing sessions among
the research team members will provide a forum for discussing emerging themes, refining
interpretations, and validating the findings. This iterative approach to quality assurance
contributes to the credibility and trustworthiness of the research outcomes.

7 References

1. Vyas N, Potty PNV, Vishwanath S, Hossain SS. An overview of COVID-19: An

emerging infectious disease. Viral, Parasitic, Bacterial, and Fungal Infections: Antimicrobial,
Host Defense, and Therapeutic Strategies. 2023:223-36.
2. 2.2 million COVID-19 vaccines allocated by the COVAX Facility arrive in Ethiopia,
marking the start of the country’s COVID-19 vaccination campaign. 2023.
3. Gao Y, Wang L, Lin B, Mao H, Zhang M. Overview of the COVID-19. Diagnostic
Imaging of Novel Coronavirus Pneumonia. 2020:1-7.

15 | P a g e
4. Park SE. Epidemiology, virology, and clinical features of severe acute respiratory
syndrome-coronavirus-2 (SARS-COV-2; Coronavirus Disease-19). Clinical and Experimental
Pediatrics. 2020;63(4):119-24.
5. Tariq S, Hamza M, Muazzam A, Ahmer A, Mumtaz⁵ MT, Ahmad⁶ S. COVID-19 a brief
Overview. Brilliance: Research of Artificial Intelligence. 2022;2(3):107-13.
6. Sriram A, Aalhate M, Kumar R, Kumar Khatri D, Singh SB, K. Mehra N, et al. COVID-
19 Vaccines and Vaccination. An Update on SARS-CoV-2: Damage-response Framework,
Potential Therapeutic Avenues and the Impact of Nanotechnology on COVID-19 Therapy
Volume 1. 2022:204-35.
7. Tavilani A, Abbasi E, Kian Ara F, Darini A, Asefy Z. COVID-19 vaccines: Current
evidence and considerations. Metabolism Open. 2021;12:100124-.
8. Ethiopia: WHO Coronavirus Disease (COVID-19) Dashboard With Vaccination Data.
9. MacDonald NE. Vaccine hesitancy: Definition, scope and determinants. Vaccine.
2015;33(34):4161-4.
10. Chan B, Istasy P. An Overview of Vaccine Hesitancy. University of Western Ontario
Medical Journal. 2020;89(S).
11. Kumar M, Surya V. Hesitancy for COVID-19 Vaccines and Its Implications for Routine
Immunisation. COVID-19 Vaccines-Current State and Perspectives: IntechOpen; 2022.
12. Abubakari SW, Workneh F, Asante KP, Hemler EC, Madzorera I, Wang D, et al.
Determinants of COVID-19 vaccine readiness and hesitancy among adults in sub-Saharan
Africa. PLOS global public health. 2023;3(7):e0000713.
13. Ochola EA. Vaccine Hesitancy in Sub-Saharan Africa in the Context of COVID-19
Vaccination Exercise: A Systematic Review. Diseases. 2023;11(1):32.
14. Kabakama S, Konje ET, Dinga JN, Kishamawe C, Morhason-Bello I, Hayombe P, et al.
Commentary on COVID-19 Vaccine Hesitancy in sub-Saharan Africa. Tropical Medicine and
Infectious Disease. 2022;7(7):130.
15. Yehualashet DE, Seboka BT, Tesfa GA, Mamo TT, Yawo MN, Hailegebreal S.
Prevalence and determinants of COVID-19 vaccine hesitancy among the Ethiopian population: a
systematic review. Risk Management and Healthcare Policy. 2022:1433-45.

16 | P a g e
16. Muluneh MD, Negash K, Tsegaye S, Abera Y, Tadesse D, Abebe S, et al. COVID-19
Knowledge, Attitudes, and Vaccine Hesitancy in Ethiopia: A Community-Based Cross-Sectional
Study. Vaccines. 2023;11(4):774.
17. Dereje N, Tesfaye A, Tamene B, Alemeshet D, Abe H, Tesfa N, et al. COVID-19 vaccine
hesitancy in Addis Ababa, Ethiopia: a mixed-method study. BMJ open. 2022;12(5):e052432.
18. Dereje N, Tesfaye A, Tamene B, Alemeshet D, Abe H, Tesfa N, et al. COVID-19 vaccine
hesitancy in Addis Ababa, Ethiopia: a mixed-method study. BMJ open. 2022;12(5):e052432-e.
19. Erega BB, Ferede WY, Sisay FA, Tiruneh GA, Ayalew AB, Malka Es, et al. COVID-19
vaccine hesitancy in Ethiopia in 2021: a multicenter cross-sectional study. IJID Regions.
2023;6:120-.
20. Muluneh MD, Negash K, Tsegaye S, Abera Y, Tadesse D, Abebe S, et al. COVID-19
Knowledge, Attitudes, and Vaccine Hesitancy in Ethiopia: A Community-Based Cross-Sectional
Study. Vaccines. 2023;11(4):774-.
21. Yohannes S, Alemayehu A, Woldesenbet YM, Tadele T, Dangiso D, Birhanu M, et al.
COVID-19 vaccine hesitancy among adults in Hawillsa City Administration, Sidama Region,
Ethiopia: A community-based study. Frontiers in Public Health. 2023;11:1122418-.
22. Privor-Dumm L, Excler JL, Gilbert S, Abdool Karim SS, Hotez PJ, Thompson D, et al.
Vaccine access, equity and justice: COVID-19 vaccines and vaccination. BMJ Global Health.
2023;8(6):e011881-e.
23. Turyasingura N, James WG, Vermund SH. COVID-19 vaccine equity in Africa.
Transactions of The Royal Society of Tropical Medicine and Hygiene. 2023;117(6):470-2.
24. Worku F, Adamu A, Awgichew K. Uptake of the COVID-19 Vaccination and Associated
Factors Among Health Care Providers in Addis Ababa, Ethiopia. IDR. 2023;16:4519-34.
25. Assefa A, Segenet Z. COVID-19 vaccine uptake and associated factors among health
science University students in northeastern Ethiopia, a cross-sectional study. Human Vaccines &
Immunotherapeutics. 2023;19:2208016-.
26. Olusola O, Mowlid Aklil A, Alinoor Mohamed F, Ida Marie A, Mohamed Diaaeldin O,
Bukhari Shikh A, et al. COVID-19 Vaccine Uptake and its Determinants among Adult
Population in Somali Region of Ethiopia. Journal of Advances in Medicine and Medical
Research. 2022:17-27.

17 | P a g e
27. Acharya KP, Ghimire TR, Subramanya SH. Access to and equitable distribution of
COVID-19 vaccine in low-income countries. npj Vaccines. 2021;6(1).
28. Asundi A, O'Leary C, Bhadelia N. Global COVID-19 vaccine inequity: The scope, the
impact, and the challenges. Cell Host and Microbe. 2021;29(7):1036-9.
29. Moltot T, Lemma T, Silesh M, Sisay M, Shewangizaw A, Getaneh T, et al. COVID-19
vaccine acceptance among health care professionals in Ethiopia: A systematic review and meta-
analysis. Human Vaccines & Immunotherapeutics. 2023;19(1):2188854.
30. Adella GA, Ambaw Kassie G, Yosef Gebrekidan A, Atnafu Gebeyehu N, Mesele Gesese
M, Chekol Abebe E, et al. Knowledge and attitude towards COVID-19 vaccine in Ethiopia:
Systematic review and meta-analysis. Human Vaccines & Immunotherapeutics.
2023;19(1):2179224.
31. Kunyenje CA, Chirwa GC, Mboma SM, Ng'ambi W, Mnjowe E, Nkhoma D, et al.
COVID-19 vaccine inequity in African low-income countries. Frontiers in Public Health.
2023;11:1087662-.
32. Arksey H, O'Malley L. Scoping studies: towards a methodological framework.
International journal of social research methodology. 2005;8(1):19-32.
33. Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA
extension for scoping reviews (PRISMA-ScR): checklist and explanation. Annals of internal
medicine. 2018;169(7):467-73.
34. Anakpo G, Mishi S. Hesitancy of COVID-19 vaccines: Rapid systematic review of the
measurement, predictors, and preventive strategies. Human Vaccines & Immunotherapeutics.
2022;18(5):2074716.
35. Robinson E, Jones A, Daly M. International estimates of intended uptake and refusal of
COVID-19 vaccines: A rapid systematic review and meta-analysis of large nationally
representative samples. Vaccine. 2021;39(15):2024-34.
36. Li M, Luo Y, Watson R, Zheng Y, Ren J, Tang J, et al. Healthcare workers’(HCWs)
attitudes and related factors towards COVID-19 vaccination: a rapid systematic review.
Postgraduate medical journal. 2023;99(1172):520-8.
37. Wang Q, Hu S, Du F, Zang S, Xing Y, Qu Z, et al. Mapping global acceptance and
uptake of COVID-19 vaccination: A systematic review and meta-analysis. Communications
medicine. 2022;2(1):113.

18 | P a g e
38. Kukreti S, Rifai A, Padmalatha S, Lin C-Y, Yu T, Ko W-C, et al. Willingness to obtain
COVID-19 vaccination in general population: A systematic review and meta-analysis. Journal of
Global Health. 2022;12.

Committee Committee Role Type of Organizations No of Selection

stakeholder individuals criteria (role
to of individual)
interview
39. Institute JB. CRITICAL APPRAISAL TOOLS [cited 2021 December 15]. Available
from: https://jbi.global/critical-appraisal-tools.
40. Lisy K, Porritt K. Narrative Synthesis: Considerations and challenges. JBI Evidence
Implementation. 2016;14(4).
41. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in
Psychology. 2006;3(2):77-101.

Annex table1 The Government Ethiopia has set up a National Coordination Committee for KKI

19 | P a g e
National Acts as the National Government Ministry of Gender, 1 Risk
Coordination Technical Advisory Children and Social protection
Committee for the Group for Action department
Introduction of the Vaccination that deals
COVID-19 with
Vaccine/task force vulnerable
groups
(women and
children)
Ministry of Education 1
and Human
Development
General Inspection of 1
Health (IGS)
Instituto Nacional de 1
Saúde/National
Institute of Health
Multilateral World Health 1 The person
organization Organization who deals
directly with
medical
supply chain,
distribution,
guidelines,
SoPs at
country level
Global Alliance for 1
Vaccines &
Immunisation (Gavi)
The World Bank 1
Bilateral The Foreign, 1
organization Commonwealth &
Development Office
(FCDO)
USAID 1
International FGH (Friends in 1
ONG Global Health)
Três Sub-comités
Técnicos para
Introdução da
Vacina Contra
COVID-19
Planning and Monitoring vaccine Government
Implementation safety
Subcommitte/Sub- vaccine; adverse
comité de event following
Planificação e immunisation and

20 | P a g e
Implementação ensuring
injection safety/
Monitoria da
segurança da
vacina;
Budget Planning and Ministry of Finance
Management 1
Monitoring & MoH Epidemiological Surveillance
Evaluation/Monitoria Surveillance (to capture
e Avaliação Department preparedness
& response)
Expanded
Immunization
Programme/Programa
Alargado de
Vacinação (PAV) 1
MoH - Department for
Information Systems
(DIS) of the
Directorate for
Planning and Co-
operation (DPC) 1
Logistics and Cold Vaccine Multilateral UNICEF The person
Chain management, cold organization who deals
Subcommittee/Sub- cold chain directly with
comité de Logística requirements, medical
e Cadeia de Frio logistics and supply chain,
safe waste disposal distribution,
guidelines,
SoPs at
1 country level
Government MoH National
Regulatory Authority
for Medicines
(ANARME) 1
Central Medical
Stores (CMAM - Deals
directly with medical
supplies, procurement
and distribution that
can guide with how
medicine was
delivered 1
National Directorate
of Medical Services 1
Central Laboratory
Department 1

21 | P a g e
 Provincial warehouses
to manage the
country’s supply chain 1
International Village Reach
ONG (provides support to
the national
immunization
program ) 1
International JSI provides support
ONG to the national
immunization
program 1
Bilateral USAID Global Health
organization Supply Chain
Program-Procurement
and Supply
Management
(GHSC-PSM) project
(provides technical
and operational
assistance to the
Ministry of Health
(MOH) 1
Advocacy, Social Training and
Mobilization Supervision 0
and Vaccine Acceptance
Communication and Adherence
Subcommittee/Sub- (Demand)
comité de
Advocacia, Ethiopia
,Social e
Comunicação 0
Civil Society
organizations (CSO)
Dealing with PLHIV 1
Dealing with SRH 1

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23 | P a g e
Category No. of Unit No. of Amount Costs Assumptions
people cost days (local Amount
currency) (USD)

Annex table 1 Giantt Chart for ECOVA Project Activity

Timelines GIANTT CHART FOR ECOVA PROJECT ACTIVITY TIMELINES (NOV. 2023-OCT.2024)

vSN Activity 2023 2024

NOV DEC JAN FEB MAR APR MAY JUN
1 Inception plan/report

2 Developing of data
collection tools
3 Finalized protocol and
seeking ethical approval
4 Meeting with Data
collectors assistant
6 Data collectors
training and Field data
collection (qualitative
interviews)
7 Data processing and
analysis
8 Draft Deport
10 Developing of policy
briefs and scientific
papers for publication

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1 Personnel costs for
data collectors
Fee for data 25 3800 95,000.00 $1,685.59 A total amount of 56,000 ETB is budgeted to
analysis(transcription engage a people to transcribe and translate the
and translation) 25 recorded interviews. An amount of 3800
ETB is budgeted per each transcribe and
transcript
Lunch 5 650 3 9,750.00 $173.00
Refreshment 5 350 3 5,250.00 $93.15 Includes water and tea break
Hall Rental 1 2500 3 7,500.00 $133.07
Subtotal 117,500.00 $2,084.81
2-
Transportation/fuel
Vehicle rent for data 3 3800 5 57,000.00 $1,011.36 Assume a total of 25 experts will be interview
collections and , each data collectors will be interview two
supervisor people per day for five days (2*2)*5=20 and
supervisor will be interview 5 (five) KII the
(most key informant) may not be interview by
the data collectors. Total of the 3 vehicle for
5days will be need for 2(tow) data collectors
and 1(one) supervisor
Fuel 3 1580 5 23,700.00 $420.51 The cars are expected to travel average of 120
KM p+K29:P29er day , 6KM/Liter 1 liter 79
ETB. Calculated " 3 cars consuming 20 liters
of fuel per day x 5 days
Subtotal 80,700.00 $1,431.87
3-
Logistics/Supplies/Co
nsumables
Audio 3 4500 3 13,500.00 $239.53
recorders

Subtotal 13,500.00 $239.53

4- Communication
Printing 1 500 1 500.00 8.87
Phone card 3 4500 1 13,500.00 $239.53
with WiFi
Subtotal 13,500.00 $239.53
6. Expedited ethics 1 7000 1 7,000.00 $124.20
review fees
Total Budget 232,200.00 4,119.94

Annex table 2 Budget for ECOVA Project Activities

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Annex3

Tool 2: Interview topic guide for key informants’ interview (KII) for activates
three and four
Section 1: General information
Interview type: Key Informant Interview (KII)
Country
Level of the interview: [MoH], [Partners]….
Affiliation and role of interviewee:
Location of Interview:
Respondent number (ID):
Name of Interviewer:
Date of interview:
Duration of the interview Starting time:
Ending Time:
Duration: /____/_____/ minutes
General observations/comments
e.g., interview cut short, noisy environment etc.

Section 2: Background information

No Characteristics Responses

1 Age:
2 Sex:
3 Highest level of your educational qualification:
4 Brief description of his/her role in organization
5 Years of service in COVID-19 vaccination related
works/vaccine/immunization related works
6 Years of service in management or leadership
position in the public health system/management
structure [current position]

[No item should be left unanswered; say none if no comments. Use additional paper as needed].
Interviewer: __________________________

26 | P a g e
 Qualitative topic guide to assess COVID-19 vaccines distribution and delivery

Section 1: Introduction

1. How familiar are you with the vaccine distribution and delivery mechanisms in country [call
out the country of study] particularly for COVID-19 vaccines? What is your role and
responsibility in this?
Section 2: Understanding Existing Mechanisms

2. Can you describe country/ [call out the country of study]’s current vaccine distribution and
delivery mechanisms for COVID-19 vaccines?
3. What challenges or gaps have you observed in the existing vaccine distribution and delivery
mechanisms in country [call out the country of study]?
Probe: Especially concerning reaching out to vulnerable populations?
4. How do you see the availability of resources including manpower?
5. What does the supply chain look like? Are there any challenges that were encountered
[kindly spell them out in order of importance]?
6. What is your opinion about the demand creation and surveillance work in the country [call
out the country of study] with regard to vaccine sourcing, manufacturing & distribution?
7. Are there any efforts at country level to start vaccine manufacturing domestically and/or
attract foreign investments to set up manufacturing companies for vaccines?
8. If there are manufacturing companies for vaccines set-up, which vaccines are being
produced?
Section 3: Vulnerable Populations and Equity

9. Who, in your opinion, are the most vulnerable populations in country [call out the country
of study] concerning access to and administration of COVID-19 vaccines?
Probe: Are there vulnerable populations including refugees and other displaced populations,
and people living with disabilities in country/ [call out the country of study]?
10. Were these vulnerable populations reached and vaccinated for COVID-19 during the 2020,
2021 year when COVID-19 was at its peak?
11. What percentage of the vulnerable population received COVID-19 vaccines during these
outreaches of vaccination for COVID?
12. What is your opinion regarding equity in vaccine distribution?
13. How do you think these vulnerable populations can be identified or reached effectively for
vaccination?
Section 4: Required Structures and Mechanisms

14. What additional structures or mechanisms do you believe are necessary to ensure timely
access to and administration of vaccines in country [call out the country of study],
particularly for vulnerable populations?
15. Are there any successful models or practices that country [call out the country of study]
used or should adopt for improved vaccine distribution and delivery?
Section 5: Stakeholder Involvement

16. Which major stakeholders are engaged in a coordinated action plan including advocacy to
address inequities in access to vaccines in your country?
17. How important is it to involve various stakeholders, such as government agencies, healthcare
providers, community organizations, and international partners, in the improvement of

27 | P a g e
 vaccine distribution and delivery mechanisms?
18. What specific roles do you think these stakeholders should play in ensuring equitable vaccine
distribution in country/ [call out the country of study]?
Probe: How can non-governmental bodies, such as humanitarian organizations, contribute to
addressing vaccine delivery challenges in the country [call out the country of study]?
19. Do you have experience or expertise in engaging civil society organizations and the private
sector in public-private partnerships for healthcare initiatives in country/ [call out the
country of study]? Can you describe your experience?
20. What are the key advantages of public-private partnerships in improving vaccine delivery
and access in [call out the country of study]?
21. Can you provide examples of successful public-private partnerships in the healthcare sector,
particularly regarding vaccine distribution, that can serve as models for country/ [call out the
country of study]?
22. How can the private sector, including pharmaceutical companies and healthcare providers, be
effectively engaged in supporting equitable vaccine distribution in country/ [call out the
country of study]?
Probe: What incentives or strategies can encourage private sector involvement in addressing
vaccine access disparities?
23. What potential challenges or concerns do you foresee in engaging civil society organizations,
non-governmental bodies, and the private sector in improving vaccine delivery in country/
[call out the country of study]?
24. How can these challenges be mitigated or addressed to ensure the success of such
collaborations?
Section 6: Impact and Evaluation

25. How would you assess the impact of improved vaccine distribution and delivery mechanisms
on the overall public health situation in country/ [call out the country of study]?
26. What key performance indicators or metrics should be used to evaluate the success of these
mechanisms?
Section 7: Recommendations

27. Do you have any specific recommendations for policymakers and healthcare authorities in
country/ [call out the country of study] to enhance vaccine distribution and delivery
mechanisms for COVID-19 vaccines, with a focus on vulnerable populations?
Section 8: Additional Comments

28. Is there any other information or insights you would like to share regarding this topic?

28 | P a g e
 Annex 3, Information sheet

[TITLE OF THE STUDY]: EQUITABLE ACESS TO THE COVID-19 VACCINES IN ETHIOPIA

In this study Senait Alemayehu is PI she has working as consultant for the ECOVA project.

This study aims to conduct a comprehensive country-level analysis of the current vaccine distribution and
delivery mechanisms in Ethiopia, with a specific focus on ensuring timely access to and administration of
COVID-19 vaccines, particularly among vulnerable populations. The research will investigate the
existing structures and mechanisms in place, identifying strengths and weaknesses in the system.
Furthermore, the research will undertake an analytical examination of how civil society organizations,
non-governmental bodies, and the private sector can be strategically engaged, potentially through public-
private partnerships, to enhance vaccine delivery. The primary goal is to address the disparities in access
to COVID-19 vaccines in Ethiopia, emphasizing the need for equitable distribution and coverage across
diverse demographic groups and geographic regions.

BENEFITS OF THE STUDY RESULTS

The findings of the present study is expected to examine the status COVID-19 vaccine equitable, uptake
and hesitancy this finding will also be used to improve access of COVID-19 vaccine across the country
Ethiopia especially for variable group.

ASSURANCE OF THE PRINCIPAL INVESTIGATOR:

I the undersigned agree to accept responsibilities for the scientific, ethical, and technical conduct of the
research project and for provision of progress reports as per term , submission of technical reports and
scientific publications to the if the project is approved as a result of this application.

Name Dr Senait Alemayehu Signature_________________

Date______________________

ባሪ 3፣ የመረጃ ወረቀት

[የጥናቱ ርዕስ]፡ በኢትዮጵያ የኮቪድ-19 ክትባቶችን በእኩልነት ማለፍ

29 | P a g e
በዚህ ጥናት ሰናይት አለማየሁ ፒአይ (PI) ነች ለኢኮቫ ፕሮጀክት በአማካሪነት ትሰራለች።

ይህ ጥናት በኢትዮጵያ ያለውን ወቅታዊ የክትባት ስርጭትና አቅርቦት ዘዴዎችን አስመልክቶ በሀገር አቀፍ
ደረጃ አጠቃላይ ትንታኔ ለማድረግ ያለመ ሲሆን በተለይም ተጋላጭ በሆኑ ህዝቦች ላይ የ COVID-19
ክትባቶችን ወቅታዊ ተደራሽነት እና አስተዳደርን ማረጋገጥ ላይ ያተኮረ ነው። ጥናቱ በስርአቱ ውስጥ
ያሉትን ጥንካሬዎች እና ድክመቶችን በመለየት በስራ ላይ ያሉትን አወቃቀሮች እና ዘዴዎችን ይመረምራል።
በተጨማሪም ጥናቱ የክትባት አቅርቦትን ለማጎልበት የሲቪል ማህበረሰብ ድርጅቶች፣ መንግሥታዊ ያልሆኑ
አካላት እና የግሉ ሴክተር ስትራቴጂያዊ በሆነ መንገድ በመንግስት እና በግሉ ዘርፍ እንዴት ሊሳተፉ
እንደሚችሉ ትንታኔያዊ ምርመራ ያደርጋል። ዋናው ግቡ በኢትዮጵያ የኮቪድ-19 ክትባቶችን ተደራሽነት ላይ
ያለውን ልዩነት መፍታት ሲሆን ይህም በተለያዩ የስነ-ሕዝብ ቡድኖች እና ጂኦግራፊያዊ ክልሎች ፍትሃዊ
ስርጭት እና ሽፋን አስፈላጊነት ላይ አጽንኦት ሰጥቷል።

የጥናቱ ውጤቶች ጥቅሞች

የዚህ ጥናት ግኝቶች የኮቪድ-19 ክትባት ፍትሃዊ፣ መውሰድ እና ማመንታት ያለበትን ደረጃ ይመረምራል
ተብሎ ይጠበቃል።

የዋና መርማሪው ማረጋገጫ፡-

እኔ በስምምነት የተፈረምኩት የምርምር ፕሮጀክቱን ሳይንሳዊ፣ ስነ-ምግባራዊ እና ቴክኒካል ስነምግባር እና

የሂደት ሪፖርቶችን ለማቅረብ፣ የቴክኒካል ሪፖርቶችን እና ሳይንሳዊ ህትመቶችን የማቅረብ ሀላፊነቶችን
ለመቀበል ተስማምቻለሁ ፕሮጀክቱ በዚህ ማመልከቻ ምክንያት ከተፈቀደ .

ዶ/ር ሰናይት አለማየሁ ፊርማውን ይሰይሙ

ቀን__________________

30 | P a g e
መሳሪያ 2፡ የቃለ መጠይቅ ርዕስ መመሪያ ለቁልፍ መረጃ ሰጭዎች ቃለ መጠይቅ (KII) ለሶስት እና ለአራት ገቢር

ክፍል 1: አጠቃላይ መረጃ

የቃለ መጠይቅ አይነት፡ ቁልፍ መረጃ ሰጪ ቃለ መጠይቅ (KII)

ሀገር

የቃለ መጠይቁ ደረጃ፡ [MoH]፣ [Partners]….

የቃለ መጠይቁ ግንኙነት እና ሚና፡-

የቃለ መጠይቁ ቦታ፡-

ምላሽ ሰጪ ቁጥር (መታወቂያ)፡-

የጠያቂው ስም፡-

የቃለ መጠይቁ ቀን፡-

የቃለ መጠይቁ ቆይታ

መነሻ ጊዜ፡-

የማለቂያ ጊዜ፡

የሚፈጀው ጊዜ: /____/____/ ደቂቃ

አጠቃላይ ምልከታዎች / አስተያየቶች

ለምሳሌ፡ ቃለ መጠይቅ አጭር፡ ጫጫታ አካባቢ ወ዗ተ

ክፍል 2፡ ዳራ መረጃ

ምንም የባህርይ ምላሾች የሉም

1 ዕድሜ፡

2 ወሲብ:

3 የትምህርት መመ዗ኛዎ ከፍተኛ ደረጃ፡-

4 በድርጅቱ ውስጥ ስላለው ሚና አጭር መግለጫ

በኮቪድ-19 ከክትባት ጋር በተያያዘ ስራዎች/ከክትባት/ክትባት ጋር በተያያዘ ስራዎች የ5 ዓመታት አገልግሎት

31 | P a g e
በሕዝብ ጤና ሥርዓት/የአስተዳደር መዋቅር ውስጥ በአስተዳደር ወይም በአመራር ቦታ 6 ዓመታት ያገለገሉ [የአሁኑ
የሥራ መደብ]

[ምንም ነገር ሳይመለስ መተው የለበትም; አስተያየት ከሌለ ምንም አትበል። እንደ አስፈላጊነቱ ተጨማሪ ወረቀት
ይጠቀሙ].

ጠያቂ፡- __________________________

የኮቪድ-19 ክትባቶች ስርጭት እና አቅርቦትን ለመገምገም ጥራት ያለው ርዕስ መመሪያ

ክፍል 1፡ መግቢያ

1. በሀገሪቱ ውስጥ ያለውን የክትባት ስርጭት እና አሰጣጥ ዗ዴዎችን ምን ያህል ያውቃሉ (የትምህርት ሀገር ይደውሉ)
በተለይ ለኮቪድ-19 ክትባቶች? በዙህ ውስጥ የእርስዎ ሚና እና ኃላፊነት ምንድነው?

ክፍል 2፡ ነባር ዗ዴዎችን መረዳት

2. ለኮቪድ-19 ክትባቶች ወቅታዊውን የክትባት ስርጭት እና የማስተላለፊያ ዗ዴዎችን ሀገር/ [የተማረውን ሀገር
ይደውሉ] መግለፅ ይችላሉ?

3. በሀገሪቱ ባለው የክትባት ስርጭት እና አቅርቦት ዗ዴዎች ምን ተግዳሮቶች ወይም ክፍተቶች ተመልክተዋል
(የተጠናውን ሀገር ይደውሉ)?

ምርመራ፡- በተለይ ለችግር ተጋላጭ የሆኑ ህዝቦችን መድረስን በተመለከተ?

4. የሰው ሃይልን ጨምሮ የሃብት አቅርቦትን እንዴት ያዩታል?

5. የአቅርቦት ሰንሰለት ምን ይመስላል? ያጋጠሙ ተግዳሮቶች አሉ?

6. በሀገሪቱ ስላለው የፍላጎት አፈጣጠር እና የክትትል ስራ [የትምህርት ሀገር ይደውሉ] በክትባት አቅርቦት፣
በማኑፋክቸሪንግ እና ስርጭት ላይ ምን አስተያየት አለዎት?

7. በአገር ደረጃ የክትባት ምርትን በአገር ውስጥ ለመጀመር እና/ወይም የውጭ ኢንቨስትመንቶችን ለመሳብ
የማምረቻ ኩባንያዎችን ለክትባት ለማቋቋም የተደረጉ ጥረቶች አሉ?

8. ለክትባት ዝግጅት የማምረቻ ኩባንያዎች ካሉ የትኞቹ ክትባቶች እየተመረቱ ነው?

ክፍል 3፡ ተጋላጭ ህዝብ እና ፍትሃዊነት

9. በእርስዎ አስተያየት፣ የኮቪድ-19 ክትባቶችን ማግኘት እና አስተዳደርን በተመለከተ በአገሪቱ ውስጥ በጣም
ተጋላጭ የሆኑት ማን ናቸው?

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ምርመራ፡ ስደተኞችን እና ሌሎች የተፈናቀሉ ህዝቦችን እና አካል ጉዳተኞችን ጨምሮ ለአደጋ የተጋለጡ ህዝቦች
በሀገሪቱ ውስጥ አሉ/(የትምህርት ሀገርን ይደውሉ)?

10. በ2020፣ 2021 ኮቪድ-19 ከፍተኛ ደረጃ ላይ በነበረበት ዓመት እነዙህ ተጋላጭ ህዝቦች ለኮቪድ-19 ደርሰው ነበር?

11. በእነዙህ የኮቪድ-19 ክትባቶች ወቅት የተጋላጭ ህዝብ መቶኛ ምን ያህል ነው?

12. በክትባት ስርጭት ውስጥ ያለውን ፍትሃዊነት በተመለከተ የእርስዎ አስተያየት ምንድን ነው?

13. እነዙህ ተጋላጭ የሆኑ ህዝቦች ለክትባት ውጤታማ በሆነ መንገድ ሊታወቁ ወይም ሊደርሱ የሚችሉት እንዴት
ይመስልዎታል?

ክፍል 4፡ የሚፈለጉ አወቃቀሮች እና ዗ዴዎች

14. በሀገሪቱ ውስጥ ክትባቶችን በወቅቱ ማግኘት እና ማስተዳደርን ለማረጋገጥ ምን ተጨማሪ አወቃቀሮች ወይም
዗ዴዎች አስፈላጊ ናቸው ብለው ያምናሉ [የጥናት ሀገር ይደውሉ] በተለይም ተጋላጭ ለሆኑ ህዝቦች?

15. አገሪቷ [የተማረችበት አገር ይደውሉ] የተጠቀመቻቸው ወይም ለተሻሻለ የክትባት ስርጭትና አቅርቦት
የምትጠቀምባቸው የተሳካላቸው ሞዴሎች ወይም ልምዶች አሉን?

ክፍል 5፡ የባለድርሻ አካላት ተሳትፎ

16. በአገርዎ ውስጥ በክትባት ተደራሽነት ላይ የሚስተዋሉ ኢፍትሃዊነትን ለመቅረፍ ቅስቀሳን ጨምሮ በተቀናጀ
የድርጊት መርሃ ግብር ላይ የተሰማሩት ዋና ዋና ባለድርሻ አካላት የትኞቹ ናቸው?

17. የተለያዩ ባለድርሻ አካላትን ለምሳሌ የመንግስት ኤጀንሲዎች፣ የጤና አጠባበቅ አቅራቢዎች፣ የማህበረሰብ
ድርጅቶች እና አለምአቀፍ አጋሮች በክትባት ስርጭት እና አሰጣጥ ዗ዴዎች ላይ ማሳተፍ ምን ያህል አስፈላጊ ነው?

18. እነዙህ ባለድርሻ አካላት በአገሪቱ ፍትሃዊ የክትባት ስርጭትን በማረጋገጥ ረገድ ምን ልዩ ሚና ሊጫወቱ ይገባል
ብለው ያስባሉ/[የተጠናውን አገር ይደውሉ]?

መርማሪ፡- እንደ ግብረሰናይ ድርጅቶች ያሉ መንግሥታዊ ያልሆኑ አካላት በሀገሪቱ ውስጥ ያሉ የክትባት አቅርቦት
ተግዳሮቶችን ለመቅረፍ የበኩላቸውን አስተዋፅዖ ማድረግ የሚችሉት እንዴት ነው?

19. የሲቪል ማህበረሰብ ድርጅቶችን እና የግሉ ሴክተሩን በመንግስት-የግል ሽርክናዎች ውስጥ ለጤና አጠባበቅ
ስራዎች በሀገር ውስጥ በማሳተፍ ልምድ ወይም እውቀት አለዎት? የእርስዎን ተሞክሮ መግለጽ ይችላሉ?

20. የክትባት አቅርቦትን እና ተደራሽነትን ለማሻሻል የመንግስት-የግል ሽርክናዎች ቁልፍ ጥቅሞች ምንድናቸው?

21. በጤና አጠባበቅ ዗ርፍ በተለይም የክትባት ስርጭትን በተመለከተ ለአገር ሞዴልነት የሚያገለግሉ የመንግስት እና
የግሉ ዗ርፍ ሽርክናዎችን ምሳሌዎችን ማቅረብ ይችላሉ/

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