Strengthening Provinces to Deliver Primary Care Health Services.pdf

REQUEST FOR INFORMATION

Subject: USAID’s Strengthening Provinces to Deliver Primary Care Health Services

RFI Number: RFI No. 72066024RFI00003 Issuance Date: May 16, 2024 Closing Date/Time: May 31, 204 23:00 Kinshasa Local time Response Email: drcoaa@usaid.gov

The United States Agency for International Development Mission in the Democratic Republic of the Congo (USAID/DRC) is seeking industry input on the draft Statement of Objective (SOO) for the USAID DRC’s Strengthening Provinces to Deliver Primary Care Health Service.

The purpose of this RFI is to solicit responses to the draft SOO in Attachment 1 based on the questions per Attachment 2. Any comments and input received will be used to inform USAID’s designs and planning for future programming in the Democratic Republic of the Congo and is voluntary. Not responding to this request does not preclude participation in any future solicitation.

Issuance of this RFI does not constitute any obligation on the part of the Government to procurement supplies or services or to issue a solicitation. Further, the RFI does not represent any award commitment on the part of the Government or obligate the Government to pay for costs incurred in the preparation and submission of any response.

Thank you for your interest and engagement in USAID/DRC programming.

Sincerely, /s/

Gregory Wang

Contracting/Agreement Officer

Attachments:

1) Attachment 1: Draft Statement of Objective (SOO)

2) Attachment 2: RFI Questions mailto:drcoaa@usaid.gov

RFI No. 72066024RFI00004

Attachment 1: Statement of Objectives for Strengthening Provinces to Deliver Primary Care Health Services

Period of Performance: Anticipated five-year activity

Provinces: Lualaba, H. Lomami, H. Katanga, Kasai Oriental

Small Business Subcontracting: At least 10% of the contract amount to Small Business

Purpose

The purpose of the Strengthening Provinces to Deliver Primary Care Health Services contract is to empower provincial authorities to optimize the delivery of health services and to improve the health status of Congolese within their province. Health services include family planning, maternal, newborn and child health, malaria, tuberculosis, and support to build a strong and resilient public health system that can prevent, detect, and respond to emerging infectious disease threats with a “one health approach (Global Health Security-GHS)”. .

The core philosophy of the activity is to empower provinces to self-manage their health programs and increase provincial level decision-making.

The activity is an opportunity for USAID to do things differently. Through the contract, USAID leverages its assistance as a tool to increase the province's commitments to financially improve health governance and technically to improve health outcomes. The underlying principle is to build resilient provincial health systems, catalyze provincial commitment and capacity to mobilize domestic resources, and strengthen governance and accountability by engaging all actors (executive, legislative, private sector, civil society). Over time, as provinces’ capacities to mobilize and manage domestic resources increase, USAID’s financial contribution will decrease.

The activity will build provinces’ public financial management capacity to assist in their transition from fixed price sub-contracts, managed by the Contractor of this activity, to direct Government-to-Government (G2G) agreements with USAID. The timing and feasibility of the provinces’ transition to G2G will depend on the results of USAID’s Public Financial Management Risk Assessment Framework (PFMRAF) Stage 1 and 2 findings and USAID/Washington’s determination of DRC’s G2G eligibility, as defined in ADS 220.

By the end of the contract, it is expected that the four provinces will be able to meet seventy percent of the cost of their Plan Operationnel d’Action through domestic funding. This activity builds upon the successes and lessons learned from the Memorandum of Understanding (MOU) approach in the provinces of Lualaba and

Haut Lomami which repositions provincial authorities at the center of governance, management, and implementation of health programs. Presently, the MOU, a legal document signed by the Governors of these two provinces, Bill and Melinda Gates Foundation (BFMG), Global Alliance for Vaccines (GAVI), and USAID, seeks to empower Lualaba and H. Lomami to improve the delivery and financing of primary health care services. The MOU provides a guiding framework for increasing provincial financial resources and improving quality of all primary care health services. On a yearly basis, MOU signatories commit with the province's authorities specific levels of funding for specific health services, based on Plan d’Action Annuel.

The Alliance for Vaccines (GAVI) and BMGF are in the process of consultations and development of primary care services MOU in Haut Katanga and Kasai Oriental. It is expected that these MOUs will be signed before

December 2024. USAID/DRC will start sensitizing the Haut Katanga and Kasai Oriental authorities about

USAID’s intentions to also sign the legal framework in these two provinces as soon as the MOUs have been signed.

This activity will facilitate discussions for expanding funding of primary care health services within the existing framework of the Memorandum of Understanding in Lualaba and Haut Lomami, Haut Katanga, and Kasai

Oriental. Expansion of services could include maternal, newborn, child health, family planning, nutrition, malaria, tuberculosis, and global health security services, based on the annual Plan d’Action

Operationnel(PAO), and their capacity to mobilize resources and deliver equitable quality health services.

Guiding principles for the activity include the following:

1) Provincial empowerment

2) Increased provincial financial contributions and financial management of the health programs over the life of the Activity.

3) Accountability for reaching the service delivery targets as defined by the PAO and the national documents and relevant protocols,

4) Transfer of expertise from the external technical assistance to the Division de la Sante Provinciale.

5) Promote multi sectoral collaboration

The contractor is expected to contribute to measurable improvements in key health outcomes. Deliverables to reach these outcomes must be developed in close collaboration with Provincial authorities and based on agreed targets set up by provincial and national documents. Funds will be disbursed when provinces reach the defined and agreed deliverables.

Contract implementation requirements:

The Contractor must perform the following:

● Fixed-price sub-contracts to local institutions (DPS). The Contractor must issue and manage

Fixed-Price Sub-Contracts. The Fixed-Price Subcontract amount will be defined on an annual basis, based on the Plan d’Action Operationnel, the provincial annual budget plan, and capacities of provinces to mobilize domestic financial resources. The annual budget plan must be developed, approved and regularly reviewed by the provincial authorities, the Contractor, USAID, and other Development

Partners who might join the MOU.

To ensure that provinces have access to initial funds for programs, deliverable “zero” will be developed such as PAO approved, MOU meetings, etc. Funds have to be available at the beginning of the year, as provinces still have limited capacity to mobilize domestic resources. The balance of funds not used during the first year must be reprogrammed for the following year.

These fixed-price subcontracts will finance the planning and delivery of health services all the way to the point of service delivery (hospital, health centers, and sites communautaires). The fixed-price sub-contracts will also finance innovations led by provinces and health zones. 50% of total contract funds will be reserved for these fixed-price subcontracts. The level of funding for these subcontracts will decrease overtime as provincial domestic funding to provincial health services increases.

● Governance, Administrative, Financial management assistance. The Contractor must provide governance, managerial, and financial assistance based on identified needs for provincial entities to receive and manage USG funds. Financial management assistance must be provided based on an assessment of provinces financial and management systems. External monitoring is essential to build accountability to results. The Contractor must fund an external monitoring system that builds the capacity of the Inspector Provincial General de la sante and other entities. It is expected that this management and financial management assistance would decrease over the five years of the contract.

● Technical Assistance for improving equitable quality of services: The Contractor must provide technical assistance to the provinces to improve quality of services and community engagement. This technical assistance will include building core competencies and attitudes of health workers for the specified health services, strengthening monitoring systems, ensuring adherence to standards, norms, and strengthening existing social accountability systems. Under this technical assistance, the Contractor must leverage USG and other development partners’ investments to support integration of technology to improve capacity building strategies and improve monitoring and reporting of results. Technical assistance is expected to decrease over the years as provinces build their own technical expertise.

Partnership/Innovation Fund: The Contractor must reserve at least $8,000,000 for competitive grants under contract to strengthen civil society’s engagement to improve health services. This

Partnership/Innovative Fund seeks to strengthen social accountability systems.

● External mechanism for monitoring: The vision for third party monitoring is for the Contract to support theInspectorate General de la Sante (Provincial level-existing entity which has the control function) by funding an audit firm to monitor external results twice a year per province.

Objectives

Objective 1: Expand Provincial Commitment and Mobilization of Domestic Financial Resources for Primary

Health Care Services

The Contractor must increase provincial domestic mobilization of resources and increase provincial commitment to lead and manage a broad range of health services, such as immunization, family planning, maternal newborn child health, malaria, tuberculosis, and global health security, nutrition, based on the provinces’ Plan d’Action Operationnel. Expansion of services will be determined by the Provincial authorities and the Contractor, in consultation with USAID based on the annual Plan d’Action Operational (PAO).

The provincial health sector led by the DPS every year develops a Plan of Action Operationnel (PAO), which is developed in collaboration with Chef de Zone of the Health Zones and the DPS at Provincial level. While the

PAO exists and is developed every year, it is often underfunded due to mis-timing with Province’s overall budget processes. There is a need to strengthen the capacity of Health Zone Directors (Medecin Chef) and the

DPS to develop, cost, and mobilize resources for PAO in line with provincial health priorities, and in collaboration with several stakeholders (private sector, civil society, and PTF).

Several institutions at the Provincial level have the responsibility to plan, budget and allocate resources for health services, including the Provincial Ministry of Health and its DPS, Provincial Ministry of Finance, Provincial Ministry of Plan, the Governor, Ministry for Decentralization, the Entites Territoriales Decentralisees

(ETD) and the Parliament. These institutions often operate in silos, with limited coordination and transparency in sharing levels of domestic and Partners Techniques Financiers financial contributions. There is no systematic consultation framework between the Health Zones (HZ) and the ETDs. Consultation and active engagement between the health focused planning entities and provincial budgeting and planning authorities is often missing. The limited information sharing between these two levels of planning hinder provinces’ capacities to accurately plan for financial resources for health. The Contractor shall build the competencies of these different Provincial and HZ entities to plan and cost health programs, to allocate and manage financial resources and strengthen accountability systems within the Provincial systems (MoF, MoP).

The Contractor must issue and manage Fixed-price subcontracts, with clear deliverables for fund disbursement to DPS based on lessons learned from the MOUs in Lualaba and Haut Lomami. The Contractor must build upon the structures that already exist to strengthen accountability and disbursement of funds through these fixed price sub-contracts. The Contractor shall review and revise if needed existing standards operating procedures to improve financial accountability and performance of DPS to achieve results.

Under this Objective 1, the Contractor must attain the following results:

IR 1.1 Edicts for funding primary care health services issued and signed by the Governor.

IR.1.2 DPS capacity to develop and cost PAO improved

IR. 1.3 Yearly Fixed-price sub-contracts issued based on PAO and provincial capacities. These subcontracts will fund the delivery of several primary care services, as defined by the Province

IR. 1.4 Transparent provincial financial disbursement systems for health from provinces to health zones strengthened

IR 1.5. Advocacy for greater financial contributions in place including advocacy plans and building capacity of

MOH to advocate with the Executive and Legislative provincial entities.

Target: By the end of the Activity, provinces will be able to mobilize, finance and disburse 70% of their Plan

Operationel Annuel for the health sector.

Objective 2: Quality of Health Services Improved

The Contractor must provide technical assistance to improve equitable access and quality of health services based on identified needs and requests from the DPS. This technical assistance must build the core competencies and attitudes of health workers. Under this result, the Contractor must build on technology-based tools already developed under the MOU for Lualaba and H. Lomami to build competencies and to monitor results.

Under this Objective 2, the Contractor must attain the following results:

● IR. 3.1 Core competencies of HWs to deliver quality services improved

● IR 3.2 Attitudes, communication skills of HWs improved

● IR 3.3 Learning/recognition networks in place

Targets:

1) Increase annually by 5 percent the proportion of children fully immunized in each province.

2) Increase annually by 1 percent the proportion of deliveries assisted by qualified health workers in each province

3) Increase annually by 3 percent the proportions of women 19-45 years using modern contraceptive methods in each province

4) By the end of the Activity, 80 percent of children under-five years and pregnant women will be sleeping under an Insecticide Treated Net ( ITN).

5) By the end of the Activity, 80% of HWs (at health center, hospitals) are providing services according to national protocols.

6) Increase annually by 10 percent the proportion of individuals reporting satisfaction with health center services.

Objective 3: Accountability Systems In Place

Provincial Assemblies and members of parliament can play an important role in advocating and allocating for the release of the provincial budget, to be transparent and disseminated with the private sector, civil society and PTFs. In addition to playing an active role in ensuring that the provincial budget is known, these members of parliament have a role to play on budgetary control, ensuring that the disbursement of funds for health services are done according to the voted budget. During recess, parliamentary members can also play an active role in monitoring quality of health services as defined in the provincial budget. The contractor must strengthen capacities of the legislative entities to enhance budget transparency, budgetary controls and to monitor quality of services.

The Provincial Inspectorate Division (Inspectorate Provinciale Generale de la Sante (IPGS)) plays an active role in monitoring disbursement of equipment, medicine, financial resources, human resources available at the point of service delivery and health zones. The Contractor shall allocate resources for the IPGS to perform its monitoring functions, all to increase accountability. The Contractor shall also build the IPGS capacity to perform its audit functions.

Civil society actors (local NGOs, institutions such as the Institute of Public Health, or other associations of midwives, youth associations, etc) play a critical role in increasing accountability and governance of health services management and delivery. The Contractor will improve social accountability systems by increasing civil society active participation in both the planning for health programs (PAO level) and implementation

(quality of services).

Under this Objective 3, the Contractor must attain the following results:

IR 3.1 Parliamentary engagement for health increased

IR 3.2 IPGS capacity to conduct audits and follow up on findings improved

IR 3.3 Civil society engagement for planning, allocation and implementation domestic financial resources increased

Targets:

1) 100% of Parliament Members reached by advocacy campaign for financing for health

2) Mechanism in place for civil society feedback when defining PAO-consultation framework done

3) Audit systems in place to be led by IPS and Audit firm-2 audits per year

Attachment 2: RFI Questions

The Attachment 1: draft SOO describes the proposed purpose, objectives, guiding principles, and some contract implementation requirements of the USAID’s Strengthening Provinces to Deliver Primary Care Health Services.

Please submit responses by email only to the Point of Contact (POC) indicated above by the closing date and time specified above.

Respondents can choose to answer all or some of the questions below. USAID appreciates brief and concise responses that will help inform activity planning.

1. The goal, objectives and results as described in the draft Statement of Objectives (SOO):

a. Which interventions are critical to ensure provincial financing for health beyond the life of this

Activity?

b. Which barriers currently exist that hinder building provincial entities’ financial and managerial capacities?

c. What are the interventions critical to build provincial entities (DPS and IPS) financial and managerial capacities to improve the delivery of primary health care services?

d. What are some of the critical provinces’ technical gaps that need to be addressed to improve the quality of primary care services: maternal, newborn, child health, family planning, nutrition, malaria, and global health security.

2. USAID seeks to acquire services from a contractor to issue and manage fixed-price-subcontracts to provincial entities (Division Provinciale de la Sante) for provinces to self-manage the delivery of primary health care services.

a. What are some of the critical issues USAID needs to consider when designing this activity?

b. What might be some of the challenges the Contractor could face when issuing and managing fixed-price sub-contracts to provincial entities (DPS and IPS)?

c. What do you recommend to alleviate such challenges?

3. Increasing civil society's role in strengthening accountability of service delivery is part of this activity.

a. What structures, tools or skills do local organizations need to actively hold provinces, health zones and service delivery points accountable for quality of primary care services?

4. USAID is considering a cost plus fixed fee completion type contract. Please provide input on the targets specified under each objective and recommendations for the development of specific pragmatic deliverables and performance standards.