Amendment_03.pdf

UHSS – Questions and USAID Responses:

Question 1: Given the mobile phone penetration rates of 67.9% in Uganda (DHS 2016) does USAID see mobile phones as an effective and complementary means of disseminating information for grass roots advocacy and social accountability of health service users?

Answer 1: Yes. Offerors are free to innovatively propose how to use mobile phones in their interventions focusing on information dissemination.

Question 2: Will USAID consider the use of digital and mobile technology for data collection related to monitoring and evaluation and quality assurance activities for this opportunity?

Answer 2: Yes. Offerors are free to innovatively propose how to use mobile phones in their interventions focusing on information dissemination, data collection related to M&E.

Question 3: Will USAID look favorably upon an articulated mobile & digital technology strategy in proposals that respond to this solicitation?

Answer 3: Offerors are free to innovatively propose how to use mobile & digital technology.

Question 4: Can USAID confirm that all references to “All USAID supported districts” are the same as “all USAID RHITES supported districts?” As in, will UHSS only be expected to work in and achieve the expected end-state outcomes in USAID RHITES supported districts?

Answer 4: UHSS will only be expected to work in and achieve the expected end-state outcomes in USAID RHITES supported districts, besides the national level efforts.

Question 5: Att J1, page 10, Objective 2, Outcome 2.4 last bullet – Does USAID expect UHSS to financially support the health care waste management for all USG supported activities?

Answer 5: Yes. The offeror will provide subgrants to prequalified providers to support health care waste management for voluntary male medical circumcision and other critical PEPFAR programs.

Question 6: Att J1, page 11, Objective 2 indicators, #1 – Does USAID expect UHSS to work directly with health facilities or is this work that would be done through RHITES?

Answer 6: UHSS will not work directly with health facilities.

Question 7: Att J1, page 13, Obj 3, Outcome 3.3, first bullet – Is this something UHSS is expected to do directly or through RHITES?

Answer 7: UHSS is expected to achieve this through a mix of approaches some directly, and some through the RHITES programs.

Question 8: Is the Activity expected to work only in USAID-supported regions and districts?

Answer 8: At subnational level, this activity will only work in USAID supported regions and districts.

Question 9: On page 86, USAID states that the “government will evaluate PWS to ensure it adequately defines and describes tasks/interventions, ties to the objectives to be achieved, methodologies for achieving them, and resources required (e.g. personnel, equipment, etc.).” Can

USAID specify what is meant by “resources required” since this implies costs, which should not be included in the technical proposal.

Answer 9: The examples given in the statement, such as personnel and equipment still hold.

Resources required in this case refers to proposed personnel and related staffing structure, office set up, partnerships structures. It however does not include costs attributed to these resources in the technical proposal.

Question 10: Clarification on expectations on baselines. A section on page 15, on a baseline report notes "the contractor is responsible for conducting a baseline status report on indicators …agreed to with USAID in the activity’s AMELP. Based on the baseline report, the offeror will validate the baseline data and targets described in the SOO and finalize, etc.” However, on page 7, of attachment J-1 we see: “For the indicators listed as TBD, the actual numbers will be provided at a later date when the Missions PMP is approved.”

Question 10a: Will some of these TBDs be baseline values?

Answer 10a: Yes, some of these will be baseline values as well as targets.

Question 10b: Should the eventual contractor expect USAID to provide baseline data?

Answer 10b: The offeror will conduct a baseline assessment to determine baseline values for the indicators, the baseline data determined by USAID will be provided to the eventual contractor when it is available.

Question 10c: Is the contractor expected to confirm such data?

Answer 10c: Yes, from the conduct of the baseline assessment.

Question 11: In the objective 2 table on page 11 of attachment J1, please clarify the target for #1. Should the target be 40% rather than “400”?

Answer 11: This is revised in the attachment J1 to TBD.

Question 12: Section J-1 has text that indicates the use of blue vs black fonts for outcomes vs outputs. However, we do not see any blue font indicating outcomes. This is also related to the indicator tables. Can this be fixed to ensure clarity?

Answer 12: The text will remain in black but a new column is added to indicate the hierarchy of indicators as outcome and output. Please review the revised Section J-1 and the indicator tables.

Question 13: On page 7, para B.1, the purpose statement refers to equipment/infrastructure as one of the key health system resources to be strengthened yet the Objectives do not include outcomes or indicators related to infrastructure. Can USAID provide further guidance on the anticipated role of the UHSS activity specifically as it relates to infrastructure?

Answer 13: There is no anticipated role of the UHSS activity in relation to infrastructure.

Question 14: Could USAID please indicate if they have an expectation of a specific allocation of LOE across the three Project Objectives?

Answer 14: The LOE will be determined by the offeror based on their understanding of the HSS challenges presented in the SOO and the proposed interventions in the PWS.

Question 15: On page 9 of RFP Attachment J-1, under Outcome 2.1, the second bullet states “Support analytics and policy advocacy to increase GOU health spending as a proportion of total health expenditure 100% of USAID supported districts used HMIS data to support health sector budgets.” Could USAID please confirm if this was intended to be two separate bullets as follows: • Support analytics and policy advocacy to increase GOU health spending as a proportion of total health expenditure • 100% of USAID supported districts used HMIS data to support health sector budgets Answer 15: USAID confirms that this was intended to be two separate bullets. RFP is revised as follows:

• Support analytics and policy advocacy to increase GOU health spending as a proportion of total health expenditure

• 100% of USAID supported districts used HMIS data to support health sector budgets

Question 16: Att J1, page 9. Objective 2, Outcome 2.1, second bullet – Should this be two separate bullets:

· Support analytics and policy advocacy to increase GoU health spending as a proportion of total health expenditure

· 100% of USAID supported districts use HMIS data to support health sector budget needs Answer 16: Yes, those are two separate bullets. RFP is revised to indicate that change.

Question 17: On page 9 of RFP Attachment J-1, under Outcome 2.1, the second bullet states “Support analytics and policy advocacy to increase GOU health spending as a proportion of total health expenditure 100% of USAID supported districts used HMIS data to support health sector budgets.” Could USAID please confirm if this was intended to be two separate bullets as follows: • Support analytics and policy advocacy to increase GOU health spending as a proportion of total health expenditure • 100% of USAID supported districts used HMIS data to support health sector budgets Answer 17: These are two separate bullets. The RFP will be revised to reflect this change.

Question 18: Att J-1, page 10, Can USAID please clarify their expectation under Outcome 2.4, "Adoption, ... of the faith-based HRIS...". In other words, is the project expected to provide direct TA to FBOs to integrate their HRIS data with the GOU's HRIS efforts underway?

Answer 18: Yes, that is the expectation.

Question 19: Attachment J-1 includes three tables with minimum required indicators and targets. Would USAID please define the indicators and the sources for each indicator’s baseline?

For example, the baseline for indicator: “Out of pocket expenditure as a proportion of the total health expenditure reduced” is set at 37%. The USAID Uganda HSS Strategy included in the RFP as Attachment J.10 on page 5 states: “(2) health costs will continue to rise, with out-of-pocket (OOP) remaining high (currently 69%).”

Answer 19: The offeror is expected to conduct a baseline assessment. This assessment will determine the values that are TBD and validate the indicator values provided in the three tables in Attachment J 1. This will inform the ultimate targets to be achieved by the offeror in agreement with the Contracting Officer. Additionally, some of the custom TBD indicators from the Mission PMP will be provided to the eventual contractor when they are available. The indicator reference sheets will be required after the award to define the indicator, frequency of data collection, and data sources as part of the final AMELP. For select indicators in the tables of indicators, see additional resources below.

For table 2:

Indicator 2: Staff Absenteeism at 50%, refer to the Uganda MoH HRH Annual Surveys of 2015& 2016.

Indicator 6: PEPFAR Seconded staff refer to the MOH Transition Plan of 2017 (Additional Attachment).

Indicator 7, 8, 9 and 10: See Health Financing Strategy, Uganda 2015/16 – 2024/25 (Additional attachment).

Question 20: Objective 1 indicator 6 on page 8 of Attachment J-1 states a target of 10 public-private or private private partnerships facilitated, brokered, strengthened or established with USG support. Outcome 1.1 on page 6 refers to the 10 twinning partnerships to be established.

Can USAID please clarify if these two items refer to the same activity?

Answer 20: These two items refer to the same activity.

Question 21: On page 11 of RFP Attachment J-1, indicator 1 under Objective 2 measures “the proportion of USG-supported high-volume health facilities that are assessed to deliver satisfactory or higher quality services” with a target of 400 facilities. Could USAID confirm that such assessments would be carried out by MOH, RHITES projects with technical support from UHSS or should UHSS budget for this type of routine assessment?

Answer 21: The assessments would be jointly carried out with the MOH, UHSS should budget for these assessments.

Question 22: On page 11 of RFP Attachment J-1, indicator 5 under Objective 2, measures “Number of district technical staff trained on Program Based budgeting” with a target of 240.

Could USAID explain whether the UHSS activity should budget for the training of 240 district technical staff in program based budgeting or if this number represents an overall target that includes training provided by other USG projects with UHSS assistance?

Answer 22: UHSS should budget for training of the 240 district technical staff.

Question 23: On page 15 of Attachment J-1 under alignment with Government of Uganda, could USAID please confirm that the UHSS activity should align with the National Health Sector Development Plan 2015/16-2019/20 that replaced the Health Sector Strategic and Investment Plan (HSSIP) 2010/11 – 2014/15 which is referred to in the RFP?

Answer 23: The UHSS activity should align with the National Health Sector Development Plan 2015/16-2019/20. This change is reflected with a revision in the RFP on page 15 of Attachment J-1.

Question 24: On page 13 of RFP Attachment J-1, indicator 4 under Objective is noted as three technical resources implemented to strengthen community health systems with USG support.

Could USAID please clarify what the three technical resources are?

Answer 24: The Community Health Extension Worker Policy, Strategy, and Training materials that are available at MoH.

Question 25: RFP Reference: Attachment J-1.5, Objective 3 Page Number: 14 Relevant RFP Language: “Minimum Required Indicators and Targets…4. Number of technical resources implemented to strengthen community health systems…” (Baseline 3, Target 8).

Question 25a: Could USAID define what “technical resources” means?

Answer 25a: This encompasses policy, implementation guidelines, tools, training materials, etc.

Question 25b: What are the 3 baseline resources?

Answer 25b: The Community Health Extension Worker Policy, Strategy, and Training materials.

Question 26: Page 28, section H.6 and att J-1 pg. 14, in regards to Grants Under Contract, what equipment would be supported under GUCs, and what is meant by support for healthcare waste management.

Answer 26: The type of equipment would be determined by the offeror. Health care waste management refers to process of dealing with waste generated through USG/PEPFAR programming such as that from Voluntary male circumcision at the health facility level. This may include transportation and ultimately disposal of waste at a central or decentralized incineration plant.

Question 27: On page 17 of the RFP USAID notes “The Contractor will propose technical deliverables that will be reviewed and negotiated before award.” Would USAID please elaborate on its expectations?

Answer 27: This section of the RFP is revised as follows:

13. Technical Deliverables: Right after award and for each subsequent year of the Contract, the contractor will propose technical deliverables that will be reviewed and negotiated by the COR and approved by the CO. This submission to the COR will be at the date specified in Section F.5.

Question 28: Page 17 Section F.4.13 Technical Deliverables, states that the Contractor will propose technical deliverables that will be reviewed and negotiated before award. However, under Section F.5, Delivery Schedule for reports/performance objectives, Technical Deliverables are required to be delivered to the COR each year at a TBD date. Therefore, we respectfully request the revision of Section F.4.13 to read as follows: “13. Technical Deliverables: Right after award and for each subsequent year of the Contract, the contractor will propose technical deliverables that will be reviewed and negotiated by the COR. This submission to the COR will be at the date specified in Section F.5.

Answer 28: Section F.4.13 of the RFP is revised:

13. Technical Deliverables: Right after award and for each subsequent year of the Contract, the contractor will propose technical deliverables that will be reviewed and negotiated by the COR and approved by the CO. This submission to the COR will be at the date specified in Section F.5.

Question 29: Page 87 Paragraph 5 states: Annex 4: The Offeror will submit an organizational chart showing lines of reporting among long-term team members.

Question 29a. What is meant by "long term team members" in the first organizational chart?

Answer 29a: These are key and other mid-level technical team members proposed by the offeror. This excludes short term technical assistance (STTA) team members

Question 29b. What should the Contractor's organizational chart distinguish project staff from STTA and/or consultants, either local or international?

Answer 29b: The contractor’s organizational chart does not need to include STTA.

Question 30: Page 84, section L.7.1, under annexes, for Annex 4, an Organizational chart and Staffing Plan Matrix are required, and on page 87, under factor 2: Annex 4, Can you clarify that by the “third chart” you mean a staffing plan matrix?

Answer 30: The third chart refers to the staffing plan.

Question 31: Pages 116-117 Objective 3: Strengthened Community Systems for Quality Health Services/Minimum Required Indicators and Targets: Number of community health workers (CHEWs) trained under the new community health worker strategy in the target districts Baseline: 0, Target: 3000. Can USAID clarify whether UHSS’ contribution to training of 3000 CHEWs is limited to facilitating the training and supporting trainers, or whether UHSS is expected to cover the full cost of training, including participant costs?

Answer 31: UHSS’ contribution to training will be expected to cover the full cost of training including participants’ costs.

Question 32: Page 112, second bullet in Outcome 2.1 Outcome 2.1 Use of Evidence-Based Advocacy to Support Budget Increased. “Support analytics and policy advocacy to increase GoU health spending as a proportion of total health expenditure 100% of USAID supported districts use HMIS data to support health sector budget needs.” Are the following bullets describing two separate desired end-states?

· Support analytics and policy advocacy to increase GoU health spending as a proportion of total health expenditure.

· 100% of USAID supported districts use HMIS data to support health sector budget needs.

Answer 32: There are two bullets describing two separate desired end-states. The RFP is revised to reflect this change.

Question 33: Page 113, fifth bullet in Outcome 2.4 Outcome 2.4: Management of Human, Financial and Other Health Systems Resources Improved. “Electronic systems for public financial management made functional at all levels of the health system as per the national standard.” We know the Ministry of Finance has introduced electronic IFMIS through effective implementation and use of electronic PFM may vary from sector to sector and by level.

Question 33a: What does electronic systems for PFM functionality mean to USAID?

Answer 33a: The lowest relevant level in the districts including district hospitals and health centers should be utilizing the electronic and non-electronic PFM modules as mandated by the Ministry of Finance. Offerors should familiarize themselves in regard to mandates and expectations of PFM at lowest government units.

The RFP has been revised to include both Electronic and non-electronic PFM modules implemented in the health system.

Question 33b: Will the Contractor be expected to procure hardware and software, networking, etc.?

Answer 33b: The contractor is not expected to procure hardware and software and networking related to this result.

Question 34: Page 113, last bullet in Outcome 2.4 Outcome 2.4: Management of Human, Financial and Other Health Systems Resources Improved. “Pre-qualified providers to effectively manage health care waste generated from USG supported activities identified and supported.”

This outcome suggests service delivery interventions directly with specific pre-selected providers. Is UHSS expected to contract the waste management provider or only to build their organizational capacity?

Answer 34: UHSS is expected to contract the waste management provider and not to build their organizational capacity.

Question 35: Could USAID please clarify what, if any, type of health system research would be envisioned under the UHSS activity? Is for example implementation research anticipated under the CLA approach (See “Learning” on p. 17 of Attachment J1) and be included in the AMELP?

Answer 35: The offeror should make the determination based on their CLA agenda if implementation research is the approach that will most appropriately fulfill the CLA agenda.

Question 36: On page 28, section H.6 Grants Under Contract states that USAID must be significantly involved in establishing the selection criteria for grantees. Additionally, page 14 of Attachment J-1, under Operating Considerations, states selection of grantees will be done in consultation with USAID. Would USAID please clarify if grant making must be competitive?

Answer 36: It is not necessary that all grant making must be competitive as it envisaged that specific public sector entities may be grant recipients during the life of the award. The offeror should propose sound grants approaches, that will ultimately be negotiated with the Contracting Officer after award.

Question 37: Section L.9.6 (page 111) states that the Offeror should provide a matrix of relevant projects and then complete Attachment J-3 only for those projects with CPARs unavailable online. However, Attachment J-3 itself states that the form should be provided for each relevant project—with the top portion completed for all, and the bottom portion only for projects without online CPARs. Please confirm that Offerors should follow the instructions in Attachment J-3.

Answer 37: The offerors should follow the instructions in Attachment J-3.

Question 38: RFP Reference: L.7.2 Page Number: 86 Relevant RFP Language: “In the AMELP, the Offeror must also include performance indicators to measure CLA and sustainability of activities.” Question: Are there specific indicators for measuring CLA and sustainability of activities that USAID would like offerors to include?

Answer 38: Yes, there are specific indicators for measuring CLA and sustainability that USAID would like offerors to include. These indicators will be shared as an additional annex. The Offeror should propose any additional indicators as deemed necessary.

Question 39: RFP Reference: F.4.3 Page Number: 15 Relevant RFP Language: “The plan will identify core indicators for every result and intermediate result/outcome and provide preliminary five-year performance indicator targets for these core indicators.” RFP Reference: L.7.2 Page Number: 86 Relevant RFP Language: “The plan will identify indicators for every result and intermediate result/outcome and provide preliminary five-year performance indicator targets for these indicators. The draft AMELP must provide a rationale as to how the proposed targets are realistic and achievable.” Question: Can USAID confirm that the Offeror are required to identify indicators for every result and intermediate result, but we are required to propose preliminary five-year indicator targets only for a set of core indicators?

Answer 39: USAID confirms that the offeror will have to set targets based on the baseline findings for the full set of core indicators.

Question 40: 11. RFP Reference: Attachment J-1.5, Objective 1 Page Number: 6 Relevant RFP Language: “Biannual public hearings on accountability for performance institutionalized in all supported districts.” Question: Could USAID clarify if these hearings should address accountability for performance within the health sector alone or all sectors?

Answer 40: The hearings should address accountability for performance within the social sectors with the health sector as the focus.

Question 41: Attachment J-1, Section 6 (Operating Considerations – paragraph 1, Sustainability) provides a list of desired areas of emphasis that are numbered from 1 to 6; however, there is no #5. Please confirm that this was a typographical error, and that no desired areas of emphasis are missing.

Answer 41: No desired areas of emphasis are missing, the desired areas are renumbered from I to V.

Question 42: GOU continues to create new districts, which increases the need for district level health administration and management. How will UHSS be expected to accommodate new districts over the life of the project?

Answer 42: As long as new districts are curved out of existing districts that will at the time be supported by UHSS, it is expected that the activity will possess the robustness to support the new districts, if any.

Question 43: Can USAID share indicator reference sheets and data source for baseline for the minimum required indicators listed in Annex 1: AMEL Plan?

Answer 43: USAID will share all relevant documentation for the AMELP after the award.

Question 44: Did PEPFAR complete a data call to identify all PEPFAR supported HRH, and if so, will it be shared with the bidders?

Answer 44: PEPFAR Uganda maintains an HRH database that has updated particulars on all PEPFAR seconded staff. Bidders will not have access to this database.

Question 45: Objective 3, Indicator 4 (SOO pg. 14) requires the “Number of technical resources implemented to strengthen community health systems with USG support” to be measured.

Would USAID please clarify the type of “technical resources” to be measured by this indicator?

Answer 45: Technical resources will include implementation guidelines, other tools such as for program supervision, monitoring and evaluation etcetera

Question 46: RFP Reference: Attachment J-1.5, Objective 1 Page Number: 6 Relevant RFP Language: “All USAID supported districts conduct budget and program performance reviews with stakeholders (citizens included) on bi-annual basis, and the reports from such reviews are made publicly available.” Question: Could USAID clarify if these budget and program performance reviews should address the health sector alone or all sectors?

Answer 46: The reviews should address the health sector alone.

Question 47: RFP Reference: Attachment J-1.5, Objective 1 Page Number: 6 Relevant RFP Language: “All USAID RHITES supported districts conduct routine consultative meetings with citizens on planning and monitoring development activities.” Question: Could USAID clarify if these routine consultative meetings with citizens are to include development activities only in the health sector or all sectors?

Answer 47: Yes, the focus of the consultative meetings should focus on health issues.

Question 48: RFP Reference: Attachment J-1.5, Objective 1 Page Number: 6 Relevant RFP Language: “USAID supported districts develop and execute integrated annual plans that reflect support from GoU, donors and other key stakeholders involved in development activities and addresses equity and contextual needs in district.” Question: Could USAID clarify if these integrated annual plans will be limited to the health sector or all sectors?

Answer 48: These plans should be limited to the health sector.

Question 49: RFP Reference: Attachment J-1 Page Number: 7, 10, & 13 Question: Before each of the three indicator tables, USAID writes, “The indicators highlighted in blue font relate to outcomes while those in black font relate to outputs.” However, all of the text in the tables is in black. Could USAID specify which are outcome indicators and which are output indicators?

Answer 49: A revised indicator matrix is included in the revised RFP to show the hierarchy of indicators as outcome or output.

Question 50: The RFP refers to the requirement of the PAD approval process. Could you please tell us how long the PAD approval process is expected to take?

Answer 50: We anticipate that the PAD will be approved at the latest by September 30, 2018.

Question 51: Att J1, page 14, section 6 Operating considerations, GUC – Can USAID specify what type of “select government institutions” would be eligible for grants?

Answer 51: The most appropriate government institutions eligible for grants will be determined by the offeror based on the needs identified, and will be approved by USAID.

Question 52: Att J1, some of the targets laid out seem too ambitious to be attained within the life and resources of the project, such as page 6 Outcome 1.2, bullet 1, “95% have unqualified audits”, will these targets be negotiable after the award?

Answer 52: Some of the targets will be negotiable during the work plan development process and will be informed by the baseline assessment done by the offeror.

Question 53: Att J1, Page 7, Objective 1 indicator table, #1. Percent improvement of USAID- Supported leaders – Does USAID mean percent improvement in leadership skills? Does USAID expect the contractor to develop the measures by which the improvement is determined?

Answer 53: USAID means percent improvement in leadership skills. The contractor will develop the measures by which improvement will be determined in consultation with USAID.

Question 54: Att J1, page 8, Objective 1 indicator table, #8 Percentage of all USAID-supported district submitting plans that meet defined standards of good management of health services – Does USAID have specific defined standards of good management of health services they would like the contractor to reference or should the contractor develop these?

Answer 54: The contractor should propose appropriate standards with matching indicators and present them as part of the M&E plan.

Question 55: Was HRH transition discussed with the GOU during the most recent COP? Can USAID share with bidders the outcome of those discussions?

Answer 55: Transition of PEPFAR seconded HRH has been discussed with GOU resulting in a clear transition roadmap. This will be shared with offerors (as an attachment).

Question 56: What progress has been achieved by the Intrahealth HRH project in transitioning PEPFAR staff to MOH and districts to date?

Answer 56: By the time of award, it is projected that 800 PEPFAR seconded HRH will still be on the books of the USG. Of these 400 will be USAID supported and therefore UHSS will bear their payroll costs, while providing TA for the absorption of the entire 800 HRH.

Question 57: Could USAID please confirm we do not need to submit detailed budgets for subcontractors unless their budgets are over 20% of the total value of the project?

Answer 57: Detailed budgets are required for all proposed subcontractors.

Question 58: Page 9 of RFP Attachment J-1 states “This UHSS activity will be responsible for initially funding over 900 positions through USAID but will provide the technical assistance to ensure that the 1,600USG HRH secondments are transitioned to GOU.” Could USAID provide an estimate of the total cost of the 900 seconded PEPFAR staff to be funded and whether this cost is to be borne solely by UHSS or by other USG projects?

Answer 58: The number of PEPFAR seconded staff to be paid by the Contractor at the time of the award is revised to 400. This number is expected to be absorbed in a staggered approach over a three year period with costs reducing from $2M for Year 1, $1.5M for Year 2, $1M for Year 3 (these costs include fringe) when full transition of PEPFAR seconded staff for USAID should be completed. The seconded staff are to be paid by the contractor.

The RFP has been revised as follows: “This UHSS activity will be responsible for initially funding over 400 positions through USAID until full transition to the GOU payroll in addition to providing the technical assistance to ensure that the 800 USG HRH secondments are transitioned to GOU.”

Question 59: On pg. 9 of the RFP, USAID mentions that UHSS will be responsible for funding 900 health workers. Could USAID please confirm whether the 900 health workers are new health workers to be recruited and hired by the successful contractor, or transferred from existing contracts over to the contractor?

Answer 59: The number of PEPFAR seconded staff to be paid by the Contractor at the time of the award is revised to 400 to reflect the number anticipated by award date. These 400 health workers will be existing at the time of the award, and will be transferred from existing contracts to the contractor.

Question 60: Attachment J-1, Objective 2 page 9, indicates that UHSS will be responsible for funding (initially) over 900 health workers’ salaries, and will provide technical assistance to support moving a total of 1,600 positions from USG payrolls on to GOU payrolls. Would USAID please provide guidance on the length of time that UHSS will be expected to fund health workers salaries and, for budgeting purposes, what the total cost of the 900 (presumably current) health workers is?

Answer 60: The number of PEPFAR seconded staff to be paid by the Contractor at the time of the award is revised to 400 to reflect the number anticipated by award date. The PEPFAR seconded health workers are expected to be transitioned over a period of 3 years from award date. The budget is also projected to reduce from $2M for Year 1, $1.5M for Year 2, $1M for Year 3 (these costs include fringe).

Question 61: Page 9 of RFP Attachment J-1 states “This UHSS activity will be responsible for initially funding over 900 positions through USAID but will provide the technical assistance to ensure that the 1,600USG HRH secondments are transitioned to GOU.” Could USAID provide an estimate of the total cost of the 900 seconded PEPFAR staff to be funded and whether this cost is to be borne solely by UHSS or by other USG projects?

Answer 61: The number of PEPFAR seconded staff to be paid by the Contractor at the time of the award is revised to 400 to reflect the number anticipated by award date. The PEPFAR seconded health workers are expected to be transitioned over a period of 3 years from award date. The budget is also projected to reduce from $2M for Year 1, $1.5M for Year 2, $1M for Year 3 (these costs include fringe).

Question 62: Page 112 in Attachment J-1 Paragraph 1 states: In order to temporarily address the HRH shortages, the US government seconded and funded over 1900 positions of critical cadre to districts and central MOH in support of HIV, malaria, TB and RMNCH programs. These include health workers funded through USAID, CDC and DoD. The expectation is that over the next three to five years, the 1,600 health workers will be transitioned to government of Uganda payroll, as a sustainable measure for improving the health system. This UHSS activity will be responsible for initially funding over 900 positions through USAID but will provide the technical assistance to ensure that the 1,600USG HRH secondments are transitioned to GOU. Question 62a. Can USAID clarify what is meant by “initially” funding “over 900 positions” through

USAID?

Answer 62a: The number of PEPFAR seconded staff to be paid by the Contractor at the time of the award is revised to 400 to reflect the number anticipated by award date. The UHSS activity will pay salaries for the positions until they are transitioned to the GOU.

Question 62b:.Can USAID confirm that the “over 900 positions” initially funded through UHSS are included in the 1,600 HRH secondments that are to be transitioned to GOU?

Answer 62b: The number of PEPFAR seconded staff to be paid by the Contractor at the time of the award is revised to 400 to reflect the number anticipated by award date. The total HRH secondments to GOU at the time of award are expected to be 800. The 400 HWs to be paid by the UHSS activity are included in the total 800 HRH secondments. The revised numbers are included in the revisions to the RFP. The UHSS award will pay salaries for the 400 HRH, but will provide TA for the total 800 HRH secondments to the GOU by award date.

Question 62c: Can USAID confirm that the ‘over 900 positions’ to be initially funded through UHSS are all currently seconded to GOU?

Answer 62c: The 400 positions are/will be seconded to the GOU by the award date.

Question 62d: Will the funding for these 900 positions be provided by USAID in addition to the budget available to UHSS to strengthen above-facility health systems and community-level services or is it to be budgeted for within the $37-40 million budget?

Answer 62d: The funding for these 400 (not 900) positions will be budgeted for within the $37 - 40 million budget.

Question 63: In Attachment J-1, Objective 2, the RFP states, “This UHSS activity will be responsible for initially funding over 900 positions through USAID but will provide the technical assistance to ensure that 1,600 USG HRH secondments are transitioned to GOU.” To facilitate USAID’s evaluation of cost proposals and a best value evaluation for the U.S. government, could USAID please provide a plug figure for this cost?

Answer 63: The number of PEPFAR seconded staff to be paid by the Contractor at the time of the award is revised to 400 to reflect the number anticipated by award date. The PEPFAR seconded health workers are expected to be transitioned over a period of 3 years from award date. The budget is also projected to reduce from $2M for Year 1, $1.5M for Year 2, $1M for Year 3 (these costs include fringe).

Question 64: RFP Reference: Attachment J-1.5, Objective 2 Page Number: 9 Relevant RFP Language: “In order to temporarily address the HRH shortages, the US government seconded and funded over 1900 positions of critical cadre to districts and central MOH in support of HIV, malaria, TB and RMNCH programs. These include health workers funded through USAID, CDC and DoD. The expectation is that over the next three to five years, the 1,600 health workers will be transitioned to government of Uganda payroll, as a sustainable measure for improving the health system. This UHSS activity will be responsible for initially funding over 900 positions through USAID but will provide the technical assistance to ensure that the 1,600 USG HRH secondments are transitioned to GOU.”

Question 64a: To allow for an even comparison across offerors, could USAID please provide a lump sum figure that should be budgeted each year and the number of years to budget for the workers?

Answer 64a: The number of PEPFAR seconded staff to be paid by the Contractor at the time of the award is revised to 400 to reflect the number anticipated by award date. $2M for Year 1, $1.5M for Year 2, and $1M for Year 3 (inclusive of fringe).

Question 64b: If a lump sum figure is not possible, could USAID provide information to assist offerors to effectively budget for the 900+ positions that will be initially funded through the

UHSS Activity? If possible, please provide guidance as to the civil servant salary scale, the number of staff by cadre (doctors, nurses, etc.), their average salary rate, the number of months they should be budgeted, and any additional suggestions that would help an offeror to budget appropriately.

Answer 64b: The number of PEPFAR seconded staff to be paid by the Contractor at the time of the award is revised to 400 to reflect the number anticipated by award date. $2M for Year 1, $1.5M for Year 2, and $1M for Year 3 (inclusive of fringe).

Question 64c: Based on our estimates, covering the salary of 900+ positions will cost several million dollars. Could USAID clarify if this cost is in addition to the $37-40 million estimate or if it is included in the $37-40 million?

Answer 64c: The number of PEPFAR seconded staff to be paid by the Contractor at the time of the award is revised to 400 to reflect the number anticipated by award date. The cost for the 400 staff is included in the $37-40 million. The average per annum cost for each position is $5,000 inclusive of fringe benefits.

Question 64d: Because this has implications on how we apply our NICRA, could USAID please indicate who will be the employer of record? Would another organization facilitate payroll?

Answer 64d: The offeror should propose the employer of record and the facilitation of the payroll.

Question 65: In Attachment J-1, Objective 2, the RFP states, “This UHSS activity will be responsible for initially funding over 900 positions through USAID but will provide the technical assistance to ensure that 1,600 USG HRH secondments are transitioned to GOU.” So that offerors may present a more tailored approach to transition these health workers to the Government of Uganda, could USAID please provide breakdowns for the size of each of the cadres of these 900 health workers?

Answer 65: The number of PEPFAR seconded staff to be paid by the Contractor at the time of the award is revised to 400, while the total number of USH HRH secondments to be transitioned to GOU will be 800.

The RFP has been revised as follows: “This UHSS activity will be responsible for initially funding over 400 positions through USAID until full transition to the GOU payroll in addition to providing the technical assistance to ensure that the 800 USG HRH secondments are transitioned to GOU.”

The breakdown of cadres for transition are reflected in the USG/MOH Transition plan for 2017.

Question 66: On page 9 of J-1, USAID states the “UHSS activity will be responsible for initially funding over 900 positions through USAID but will provide the technical assistance to ensure that the 1,600 USG HRH secondments are transitioned to GOU.” As UHSS will be responsible for funding these 900 positions, can USAID share information on the estimated cost per month per person for compensation for the 900 holders of positions to be transitioned?

Answer 66: The number of PEPFAR seconded staff to be paid by the Contractor at the time of the award is revised to 400, while the total number of USH HRH secondments to be transitioned to GOU will be 800.

The RFP will be revised to state “The RFP has been revised as follows: “This UHSS activity will be responsible for initially funding over 400 positions through USAID until full transition to the

GOU payroll in addition to providing the technical assistance to ensure that the 800 USG HRH secondments are transitioned to GOU.”

Question 67:Has PEPFAR conducted a comparison of HCWs’ pay to the GOU scheme of service? Is there alignment between contractor compensation and GOU pay scales at central and district levels and with the private sector?

Answer 67: PEPFAR is cognizant of the HCWs pay in comparison to GOU scheme of service.

Transitioning of PEPFAR supported staff to the GOU has been going on for the last 4 years and is expected to be completed within the first three years of the UHSS award. Please see the attached PEPFAR/GOU transition plan for additional details.

Question 68: Can USAID confirm that UHSS will only be providing payroll support, and not overseeing or supervising these 900 staff?

Answer 68: UHSS will only be providing payroll support, while supervision will done by implementing partners utilizing the services of these HRH.

Question 69: Can USAID share information on the anticipated transition timelines? Have the costs for these 900 staff have already been included in a GoU budget request for MoLG, and if so, for what GoU fiscal year?

Answer 69: Transition will be expected to be completed in Year 3. See attached PEPFAR/GOU transition plan for further details.

Question 70: In Attachment J-1, Objective 2, the RFP states, “This UHSS activity will be responsible for initially funding over 900 positions through USAID but will provide the technical assistance to ensure that 1,600 USG HRH secondments are transitioned to GOU.” So that offerors may present an ambitious and realistic performance work statement, could USAID define how long it expects this “initial” support to continue? For example, does it anticipate this support ceasing before the end of the activity and, for instance, only providing funding in Years 1 and 2?

Answer 70: The PEPFAR seconded health workers are expected to be transitioned over a period of 3 years from award date. The budget is also projected to reduce $2M for Year 1, $1.5M for Year 2, $1M for Year 3 (these costs include fringe). See details of the PEPFAR/GOU transition plan attached to this solicitation.

Question 71: In Attachment J-1, page 14, USAID says that “Contractor will develop a grants mechanism for about 25% of the contract award for the life of the activity” however under section B.4, USAID specifies an amount of $8,000,000 for grants, just 20% of the max budget.

Would USAID please confirm that the expected grants program (exclusive of any relevant management or administrative expenses incurred by the Contractor) is $8,000,000?

Answer 71: The expected grants program is up to $8 million.

Question 72: Pages 7 and 117 - The RFP indicates a maximum ceiling of 25% of the budget for Grants Under Contract, but the ‘up to $8 million’ suggests a contract ceiling of $32 million. Can USAID confirm that the maximum amount in GUC over the life of the project is $8 million?

Answer 72: The expected grants program is up to $8 million.

Question 73: On page 8, under section B.4 the budget shows that GUC will account for up to $8M of the total budget; however, on page 14 of Attachment J-1, under Operating Considerations, GUCs are stated to be 25% of the contract value (37M – 40M) which would be at least $9.25M. Could USAID please clarify which figure we should propose?

Answer 73: The expected grants program is up to $8 million.

Question 74: Can USAID confirm whether the value of grants under contract is up to $8 million as mentioned on pg. 7 of the RFP?

Answer 74: The expected grants program is up to $8 million.

Question 75: Page 14, att J-1, “the Contractor will develop a grants mechanism for about 25% of the contract award for the life of the activity”, while on page 7 under section B.4 Budget, it states that GUCs will be up to $8M (lump sum), can you please clarify?

Answer 75: The expected grants program is up to $8 million.

Question 76: RFP Reference: Cover Letter Page Number: 1 Relevant RFP Language: “total estimated range of $37,000,000 to $40,000,000 for the implementation of this activity” RFP Reference : B.4 Page Number: 7 Relevant RFP Language: “The amount of up to $8M is a lump sum exclusively reserved for GUCs.” RFP Reference: Attachment J-1, Section 6 Page Number:

14 Relevant RFP Language: “the Contractor will develop a grants mechanism for about 25% of the contract award for the life of the activity.” Question: A maximum of $8M for the GUC fund would be 20% - 21.6% of the estimated total cost for the UHSS Activity. Can USAID confirm that $8M is the maximum that offerors may budget for grants?

Answer 76: The expected grants program is up to $8 million.

Questions 77: Page 29 under GUCs, “the total value of all GUCs that provide funds to a particular government entity must not exceed $300,000 for the duration of the contract”. In specific cases the project may have to provide grants above this ceiling, will there be some flexibility?

Answer 77: This will be subject to discussion with Office of Assistance and Acquisition after award.

Question 78: Could USAID confirm that international organizations are able to receive grants under contract?

Answer 78: GUCS will be limited to local (Ugandan) firms in order to promote local capacity and solutions as envisioned in the CDCS 2.0.

Question 79: RFP Reference: J-1, Section 2, Page Number 1: Relevant RFP Language: “The sub-national level activities will be predominantly implemented in USAID supported districts located in the regions where USAID Regional Health Integration to Enhance Services (RHITES) activities operate as reflected in the map in Annex 1.” The RFP does not appear to contain an Annex 1 with a map of RHITES activities. Will USAID provide this map so that all offerors have access to the information needed to design a geographically appropriate approach? The due date for questions is posted as April 19, 2018, however we request that the Annex 1 be provided as soon as possible, in order to allow offerors to maximize the time available to design an approach that best meets the needs of USAID/Uganda?

Answer 79: This map was provided on April 9, 2018 as Amendment 1. It can be found on fbo.gov.

Question 80: On pg. 1 of Attachment J-1, there is a reference to an Annex 1 with a map of the districts to be covered by the HSS Activity, but there is no map included in Annex 1. Can you please provide clarification on the districts to be covered by UHSS?

Answer 80: This map was provided on April 9, 2018 as Amendment 1. It can be found on fbo.gov

Question 81: Per ADS 302.3.4.13.b. “Additional requirements for GUC Providing Funds to Partner Government Entities,” can USAID confirm that non-in-kind grants of up to $300,000 to Government of Uganda entities will be authorized?

Answer 81: Yes, USAID confirms.

Question 82: RFP Reference: Attachment J-1, Objective 3; Page Number: 14; Relevant RFP Language: “Number of community health workers (CHEWs) trained under the new community health worker strategy in the target districts. Baseline 0, Targets 3000” --- Question: Could USAID please confirm the assumption that the costs of training for the 3000 CHEWs will be provided for within the respective RHITES program budgets and the UHSS Activity will provide technical assistance?

Answer 82: The funding for the CHEW training will be provided for within the UHSS activity this is in addition to the anticipated related Technical Assistance. The RHITEs will be better positioned to support CHEW roles once they are trained.

Question 83: RFP Reference: F.4.4 Page Number: 15 Relevant RFP Language: “4. Baseline Report - The Contractor is responsible for conducting a baseline status report on indicators -disaggregated by gender and geography, agreed to with USAID in the activity’s AMELP.”

Question: Could USAID confirm that although Contractors will be responsible for conducting and budgeting for the baseline report, the mid-term and final evaluation should not be part of offerors’ budgets and will be conducted by USAID through an external evaluator?

Answer 83: The mid-term and final evaluation will be conducted through an external evaluator.

Question 84: RFP Reference: L.7.2 Page Number: 84 Relevant RFP Language: Annex 1 Activity Monitoring Evaluation and Learning Plan (AMELP) (not to exceed 4 pages) Question:

Would USAID consider extending the AMELP page limit to 8 to account for the extensive list of indicators that must be included in this section?

Answer 84: The page limit for the AMELP has eliminated from the RFP.

Question 85: RFP Reference: B.4 Page Number: 7 Relevant RFP Language: “* The amount of up to $8M is a lump sum exclusively reserved for GUCs. This amount does not include any relevant management or administrative expenses incurred by the Contractor.” Question: Under B.4 Budget, page 7 of the RFP, a budget table is provided that does not match the Excel budget template (Attachment J.8). In the budget template, GUCs are included in the Subcontract and Grant Fund line, which comes above the Indirect Costs and Fixed Fee lines. However, the table in Section B.4 places GUCs below Indirect Costs and Fixed Fee. Could USAID confirm that the budget template in Attachment J.8 should be the guiding format for the budget and that offerors should apply their indirect rates based on their NICRA?

Answer 85: Offerors should apply indirect rates based on their approved NICRAs. Please note, even if your organization is expecting updated provisional rates, please use the current rates on your signed NICRA.

Question 86: RFP Reference: L.8, Part 5 (H) Page Number: 91 Relevant RFP Language:

“Grants Under Contract - Offeror must provide information sufficient to determine reasonableness of costs proposed for each grantee.