STAIP_Qs&As-02272019-_final.pdf

AMENDMENT 01 – QUESTIONS AND ANSWERS

USAID is pleased to provide the following answers to the questions submitted by the various prospective offerors in response to the solicitation posted on February 05, 2019. Please note that duplicated questions are consolidated and some questions paraphrased for clarity. Further, the solicitation has been updated and the changes highlighted to demonstrate areas that were affected by the Q&A.

USAID would also like to thank all the prospective offerors who took part in the solicitation questions period.

GENERAL QUESTIONS – (February 19, 2019)

1. Does the Combined Synopsis/Solicitation posted as solicitation number 72066919R00008 on FBO contain requirements similar to an existing contract or will this be a new requirement?

USAID Response: The combined synopsis/solicitation posted on FBO on February 05, 2019 is considered a new requirement in which offerors are expected to submit a Performance Work Statement/Technical Approach in response to the attached Statement of Objective (SOO).

2. Please kindly confirm that a full Technical Proposal (technical narrative) is not due on March 12, 2019 5:00 PM Monrovia time. In agreement with subject solicitation section L.4.i., Technical Proposals will be requested only from those offerors that move to Phase II and due at a later date.

USAID Response: Confirmed. A full written Technical Proposal is not due on March 12, 2019.

Please read carefully Section L.4 General Instructions to Offerors. For additional instruction on what to submit under Phase I, see Section L.6. Instructions for the Preparation of Volume I - Technical Proposal (Phase I and Phase II).

3. Facility accreditation was included in the RFI, but not included in the RFP. Will this work be supported by another contractor or project? Or is it no longer a priority for the Ministry of Health?

USAID Response: Currently, only the technical priorities outlined in the RFP should be addressed.

Accreditation is not currently a technical priority under this solicitation.

4. Will USAID clarify the due date for a written proposal after the oral presentation or provide an approximate timeline between presentation and submission?

USAID Response: Shortly after oral presentations (within approximately 30 days), USAID will provide a due date for a full technical narrative proposal to only those offeror(s) who are invited to Phase II.

Amendment 01- 72066919R00008 Strategic Technical Assistance for Improved Health System

Performance and Health Outcomes (STAIP) Activity February 05, 2019

5. Who from the Government of Liberia will be attending the oral presentations?

USAID Response: USAID has submitted a request for senior members from the Ministry of Health to participate.

QUESTIONS RELATED TO SECTION B – SUPPLIES OR SERVICES AND PRICE/COSTS

6. Page 9 of the RFP (B.5 Indirect Costs) states that “Indirect costs shall not be allowed for organizations that do not have a NICRA. All costs for organizations without a NICRA shall be budgeted and billed as direct costs.” However, on page 113 under Indirect Costs and Indirect Cost Information, the RFP states that “If the offeror or major subcontractor does not have a NICRA or cognizant Government Audit Agency the proposal must include audited financial statements or reviewed financial statements.” Can organizations that do not have a NICRA or cognizant government audit agency use indirect rates if they supply audited financial statements or reviewed financial statements as detailed on page 113?

USAID Response: If an organization does not have a Negotiated Indirect Cost Rate Agreement (NICRA), then it may propose its indirect cost rate(s) and provide all supporting documentation, along with an explanation that no NICRA yet exists because [if it wins the award], it will be its first prime USG award. These indirect cost rates will then be reviewed for propriety by the Overhead, Special Cost and Closeout Branch Cost, Audit and Support Division, Office of Acquisition and Assistance (M/OAA/OCC) and the Contracting Officer will be advised of accepted rates after negotiation between M/OAA/OCC and the organization. If the organization subsequently wins the award a NICRA will then be issued. Conversely, if the organization is not successful in securing the award, no NICRA will be issued. If an organization chooses not to request a NICRA it must bill all costs as direct costs.

7. On page 10 of the RFP, Table 1 (Fee Payment Schedule) does not include sub IRs. Should the offeror propose fee payments at the sub-result level (X.X.X.X) or only to the result level (X.X.X) in accordance with Table 1?

USAID Response: Offerors have flexibility to determine at which level either at the sub-IR or sub-result level they would like to receive fee payments.

8. Will there be a shared responsibility among the contractor and the MOH to manage the TA fund? Or is the contractor the sole responsible body for the implementation and management of the fund?

USAID Response: The contractor will have the sole responsibility to manage any supplemental/responsive technical assistance provided. Guidance for use of technical assistance is outlined in the amended RFP but will require final clearance by USAID. The language in Attachment J.1 has been updated regarding the technical assistance fund. Please note that CC IR 3 will now be called responsive technical assistance.

9. Page 7 and 8, Section B.4 USAID references line item budget limits as requirements for the proposal. Is it USAID’s intention to provide the line item limits for bidders?

Performance and Health Outcomes (STAIP) Activity

USAID Response: For the purpose of consistency in submission of cost proposal from offerors, USAID considers the line item budget template as a guide for use by offerors when submitting their budget. There are no line item budget limits, the language within Section B.4 notes that line items (once approved) cannot be exceeded without prior USAID approval.

10. Page 8, Section B.5 Indirect Costs. USAID identifies major subcontractors as those “whose proposed costs exceeds 20% or more of the technical effort”. Can USAID please confirm that major subcontractors are only those subcontractors at or exceeding 20% of the offeror’s total proposed cost (exclusive of fee)? Additionally, can USAID please confirm whether the total proposed cost is exclusive or inclusive of the $2 million plug figure identified under the Supplemental Technical Assistance Fund?

USAID Response: A major subcontractor is a subcontractor that exceeds 20% of the Total Estimated Cost (inclusive of fee) of the proposed activity to furnish supplies or services for the prime contractor. The total proposed cost is inclusive of the $2 million figure identified under Section CC IR3 in the Statement of Objectives. Note that this section has been revised to eliminate any reference to a supplemental technical assistance “fund”.

11. Page 10, Section B.8 Schedule –Payment Fee. The contractor fee seems to indicate that all of the fee payment will be tied to the deliverables as laid out in Sections C, D, & F. Would USAID consider allowing a portion of the fee to be invoiced monthly? Or if not, could a portion of the fee be tied to submission of required reports as laid out in Section F.6?

USAID Response: All fee payments will be tied to only deliverables/results laid out in Sections C, D and F. The offeror has the flexibility to define deliverables/results that they will achieve and to which they would like to receive fee payments against. The due date column can have multiple dates to accommodate more frequent payments based on proposed deliverables. No portion of fees can be tied to the submission of required reports.

12. Section B.5 Indirect Costs states that, “Indirect costs shall not be allowed for organizations that do not have a NICRA. All costs for organizations without a NICRA shall be budgeted and billed as direct costs.” We request that USAID provide offerors with the flexibility of entering into Cost-Plus-Fixed-Fee (CPFF) or Time and Materials (T&M) type subcontracts with organizations when all the following conditions are met:

o An organization can provide evidence that it has an accounting system capable of administering a CPFF or T&M type subcontract.

o An organization is committed to undergoing annual audits of their indirect cost rates in accordance with the cost principles of FAR Part 31.

o The prime contractor has the appropriate subcontract management systems in place to ensure a CPFF or T&M subcontract with an organization is administered properly.

o An organization has established indirect cost rates and the use of indirect cost rates is an integral part of their cost accounting standards.

Performance and Health Outcomes (STAIP) Activity

USAID Response: Please refer to FAR 52.244-2. A prime contractor may enter into subcontracts with organizations provided prior CO consent is given. The items above are factored into the decision to provide consent. With respect to NICRAs, please refer to question #6.

13. With strong prime contractor oversight and the requirement for organizations to undergo annual audits in accordance with the cost principles of FAR Part 31, these contracting mechanisms serve as a tool to build the capacity of these organizations. Furthermore, managing direct cost allocation subcontracts typically results in higher financial and administrative burden for prime contractors and reduces overall cost control due to monthly costs’ varying significantly depending on the services being provided by the subcontractor.

Indirect cost rate ceilings (under CPFF subcontracts) and fixed multipliers (under T&M subcontracts) reduce the government’s cost risk of potential indirect cost rate increases and allow for a higher level of cost control and financial and administrative oversight by the prime contractor. Would USAID confirm that offerors can enter into CPFF and T&M subcontracts with organizations that meet the above conditions?

USAID Response: Please see response to Question #12.

14. Section B.2 states that this RFP is for a Cost-Plus-Fixed-Fee (CPFF) completion-type contract. Our understanding is that under a CPFF completion-type contract, the fee is fixed and can be adjusted only through a contract modification based on changes to the “description of services to be performed” (FAR 52.243-2). Furthermore, Section B.8 states that, pursuant to FAR 52.216-8, payment of fixed fee shall be made as specified in the schedule below. Therefore, we respectfully request that the second paragraph of B.8 that states, “If the contractor does not reach the deliverables/target, the contractor will not be paid any of the fees associated with the deliverable/target, as full contract completion will not have been demonstrated,” be removed to allow for payment of fixed fee in accordance with

FAR 52.216-8.

USAID Response: The language in Section B.8 remains. As noted in Section B.2 and in the question, this is a “completion-type” contract which “requires the contractor to complete and deliver the specified end product within the estimated cost, if possible, as a condition of payment of the entire fixed fee,” per FAR 16.306. Offerors have the flexibility to determine deliverables/results by which their fees are tied, including amount (percentage) and frequency of payments. However, if a contractor does not achieve deliverables they have committed to achieving (outlined in the fee payment schedule), fees cannot be paid out, since this may be deemed an issue of non-performance.

15. Section B.5 (page 8) gives the definition of a major subcontractor as “major subcontractor means any contract entered into by a subcontractor to furnish supplies or services for performance of a prime contract and whose proposed cost exceeds 20% or more of the technical effort.” Section L.6.6.a (page 104) states “(“major subcontractors” are those subcontractors whose proposed costs exceed 20% of the offeror’s proposed total cost *or perform a key element of the RFP*” (emphasis added). Please confirm that the definition in Section L.6.6.a applies.

USAID Response: Yes, the definition in Section L.6.6(a) applies.

Performance and Health Outcomes (STAIP) Activity

16. Section B.5 (page 9) states “Indirect costs shall not be allowed for organizations that do not have a NICRA. All costs for organizations without a NICRA shall be budgeted and billed as direct costs.” This statement could be interpreted as applying to prime/major subcontractors or to prime/all subcontractors. However, Section L.8.2, paragraph starting “Indirect Costs and Indirect Cost Information” (page 113) allows derived rate calculations when such organizations do not have a NICRA. Considering this apparent conflict, could USAID consider removing the statement under B.5, and confirm the requirements in L.8.2. remain?

USAID Response: Section L.8.2 does not allow “derived rate calculations when such organizations do not have a NICRA.” Please refer to the response to Question 6.

17. The RFP in B.8 (pages 10 -11) states the Fee Payment Schedule is an “illustrative table” that includes references to Results in the SOO in J.1, Section 10 that have specific results (SRs).

Please confirm that these are illustrative and that we can propose other indicators/targets at the proposal stage.

USAID Response: Yes, table B.8 is illustrative. Alternative indicator/targets can be proposed, these alternative targets/indicators should clearly and directly tie to either an IR or specific result. Also, please refer to the response to question 11. Routine reports should not be listed as deliverables for which fees will be paid.

QUESTIONS RELATED TO SECTION C – Statement of Work

18. Under CCIR2, on page 14 of the SOO, it says that a minimum of 10 percent of this award will be utilized for PBF reimbursement to the county health teams. Can you specify if this will be on top of the MOH contracting-in bonus?

USAID Response: Yes. Any performance-based financing supported by this activity will be in addition to the MOH’s own funds for PBF or contracting-in. However, USAID will work with the contractor to decide how this will be implemented after award based on discussions with the MOH and other partners.

19. The results frameworks on page 5 of attachment J1 – SOO lists only one IR under objective 3, while the description of Scope on page 12 lists two additional IRs. Does this affect the LOE/budget allocation to the Objective?

USAID Response: There is only one IR under Objective 3. There are two results under IR 3: R3.1:

Implement and refine FARA output-based costing system to guide incremental reforms to both FARA costs and structure as a strategic purchasing mechanism in alignment with the LHEF. And, R3.2: Test and evaluate new approaches that will contribute to increased financial risk protection and more efficient and effective health service purchasing in line with LHEF priorities.

20. The description of “Scope” on page 7 of attachment J1 requires the contractor to list “…For each intermediate result the contractor will detail expected number of beneficiaries to be reached along with anticipated costs to allow cost-benefit reviews…”; however, some

Performance and Health Outcomes (STAIP) Activity February 05, 2019 objectives are strongly focused on Central MOH efforts (e.g. IR 3), and presume the activities to impact national policy – hence the entire population of Liberia. Is the detail on number of beneficiaries reached still required for this scenario?

USAID response: Yes, the number of beneficiaries reached would still be required in this scenario.

● Same applies to the note in below paragraph that “…To this end, the Contractor will develop and be measured against county specific work plans which target specific bottlenecks to improving CHT capacity and county health outcomes…”

USAID Response: Measurement will be against county specific work plans which target specific bottlenecks to improving CHT capacity and county health outcomes.

21. Can the information about the project mentioned here: “…current investments made by

USAID specifically use of the national database currently under development with the Ministry of Women and Children’s Affairs to identify poor households that require financial protection…” be made available? (page. 12 under the section on Objective 3)

USAID response: This is an ongoing process and will be made available to the selected offeror after the award has been made.

22. The statement under the CCIR 2 on page 13, Attachment J1 – “Implementation of PBF and the related implementation research will inform implementation of LHEF reforms and the contractor is expected to ensure a routine feedback loop between PBF and LHEF discussions.” Does it also allow for contract resources (LOE, staffing and/or budget) to be shared and re-allocated across the CC IR2 and IR 3, if the suggested approach justifies such reallocation?

USAID response: Yes. This approach seems appropriate and can be discussed and negotiated during implementation.

23. Can you explain the modalities for how the mission will tie the reimbursement fee to the achievement of the results listed in the section? More specifically:

● How does this fit into the rules of a Cost-Plus-Fixed-Fee (CPFF) completion-type contract, as it reads more like an element for a Cost-Plus-Award-Fee (CPAF) one?

● Will these be time bound milestones? Or will there be a one-off reimbursement fee that is tied to achievement of the result at the end of the activity?

USAID response to both bullet points above: This is not designed to be an incentive contract as the proposed fee schedule will not vary with actual cost incurred; the fees are fixed to specific and

Performance and Health Outcomes (STAIP) Activity February 05, 2019 attainable deliverables proposed by the offeror. Note that the fees may be adjusted as a result of changes in the work to be performed under the contract. The offeror has the flexibility to propose the deliverables and frequency of deliverables/targets/achievements tied to each result/sub-result.

● Who will be responsible for measuring the achievement of results stated (e.g., measuring per capita out-of-pocket expenditure is usually the function of MOH under National Health Accounts activity, which, may or may not be conducted at the intervals required to measure the “success” of STAIP).

USAID response: As noted in the RFP, there will be external evaluators who will measure the results tied to achievements outlined in the “success” section of the RFP. USAID will bear the cost of these evaluations/studies. USAID will work closely with the contractor and the Ministry of Health and other stakeholders to design these evaluations.

● For result 4 - “Decreased average per capita out-of-pocket expenditure in pilot area by

50% by the end of the pilot period (Objective 3)” – Does this necessitate the partner to advocate for or support implementation of a “pilot” phase for the health financing reform? Or would this approach depend on MOH’s openness to do the pilot.

USAID response: USAID will work with the contractor and MOH to support implementation of the “pilot” phase. MOH is already on board with this approach.

24. Page 1 of the SOO indicates that “STAIP activity that will improve health system performance and strengthen delivery of primary maternal and child health, family planning and malaria services in public health facilities operating under the Ministry of Health for improved health outcomes.”

a. Should these primary health services include county hospitals? If so, are both outpatient or inpatient services to be included?

USAID response: County hospitals are a part of the secondary health care system, not the primary health care system. The focus of this activity is only the primary health care system i.e. health clinics and health centers.

b. Please confirm that STAIP is not expected to implement activities in private facilities.

USAID response: While private facilities are not the focus of STAIP, there are a growing and varying number of private health facilities in each county. The county health teams are also responsible for providing oversight of private facilities to ensure that they utilize MOH standards, report into DHIS 2.0, etc.; therefore most support should focus on how to strengthen the county health team’s oversight role for all health facilities in the county including the private sector.

25. The SOO states on page 7 that the contractor will detail the number of beneficiaries to be reached for each intermediate result. Given that STAIP will be providing targeted TA and not

Performance and Health Outcomes (STAIP) Activity February 05, 2019 direct implementation, can USAID confirm the contractor will not be required to report on client tracking or perform cost benefit analyses?

USAID response: Refer to the response to Question 20. When possible, the offeror should outline the number of beneficiaries (i.e. # of health care workers, # of CHT staff/departments, # of units, etc., noting that the exact number of beneficiaries will be finalized after award). Value for money is a key foundation for this award and the offeror will be required to continuously monitor cost/benefit over the life of the award.

26. Page 8 of the SOO states, “Additional assessments will take place at the county level prior to this award to identify gaps and risks identified that would require technical assistance.” When are these assessments scheduled to be completed? Will the assessments take place in all of the 8 FARA counties?

USAID response: It is expected the assessments will be completed prior to award. Findings will be made available to the successful offeror as soon as practicable after the award has been made. The assessments will take place in all 12 target counties outlined in this RFP.

27. Page 8 of the SOO states, “In advance of this award, USAID, the Ministry of Health and the

World Bank will develop a common contracting-in tool and conduct the first round of county-level assessments.” When is the common contracting-in tool scheduled to be completed? What will be the relationship between the Contracting-In Guidelines provided in Annex J.4 and the common contracting-in tool?

USAID response: Refer to the response to Question 26. The tool’s purpose is outlined in the Contracting-In Guidelines referenced in Annex J.4.

28. Page 10 of the SOO states, “The contractor must employ a county-wide and district-wide approach for this IR even though the targets do not refer to 100% of facilities.” Will USAID please provide more detail on how offerors should prioritize facilities for support?

USAID response: The percentages outlined under specific results indicate the target the contractor should strive to support; for example, for Specific Results 2.1.1.1 (JISS): “By the end of Year 1, at least 60% of all health facilities assessed will go up by one category in the total cumulative scores in 4 of out the 8 Contracting-in counties.”

It is expected that JISS will be conducted in 100% of facilities in the counties, but that it at least 60% of all health facilities’ JISS scores will go up by one category by the end of Year 1.

29. Will USAID consider allowing additional assessments if necessary for verification of SRs

2.1.2.5, 2.1.2.6 and 2.1.2.7 on page 11 of the SOO?

Performance and Health Outcomes (STAIP) Activity

USAID response: Yes.

30. On page 13 of the SOO, the DQR targets (SR 1.1.1 and SR 1.1.2) are higher for Non-FARA counties than FARA counties for Year 1. What is the rationale for this, given that contracting-in is being implemented in the FARA counties?

USAID Response: Data in FARA counties are of better quality, therefore the baselines will be higher than non-FAFA counties therefore requiring less improvement.

31. The section on CC IR3 on page 14 of the SOO states “up to $2 million and up to 10% of contract’s LOE” in one place, and in another place it states “two million dollars of the award, and approximately 10% of the contractor’s level of effort.” Please clarify whether offerors are expected to propose $2 million/10% LOE for CC IR3.

USAID response: The section CC IR3 has been retitled and narrative revised to clarify that USAID is looking for the offeror to propose up to $2 million of technical assistance in areas that support quality improvement at health facilities based on JISS findings to improve JISS scores and meet the other cross-cutting results CCR3.1 and CCR 3.2 listed in that section, and not creation of any sort of separate “fund”. The proposed technical assistance should be defined and treated as a integral part of the offeror’s scope of work that will completed through LTTA, STTA or subcontracts as deemed appropriate and with required approvals by USAID.

32. Would USAID reconsider the maternal mortality ratio target presented in Success #3 on page

16 of the SOO based on the post-Ebola progress already made in three FARA contracting-in counties?

USAID response: No.

33. Table 1 on p18-19 of SOO states the timeline for five of the eight FARA counties as “TBD.”

However, these counties were included in some of the results to be achieved by end of Year

1. Can USAID please advise on the anticipated timeline for rolling out activities in those counties?

USAID response: There have been some delays in contracting-in the additional counties. Currently only Bong, Lofa and Nimba are contracted in. At the time of award, the successful offeror will be advised on the current number of contracting-in counties and targets and achievements will be adjusted for Year 1. However, this should not affect the targets and proposed achievements for the proposal stage. All review of proposals will be against the SOO and expected results outlined in this

RFP.

Performance and Health Outcomes (STAIP) Activity February 05, 2019

34. Attachment J.1, Page 5, Section 6. Results Framework. USAID provides the following assumptions numbered 1, 2, and 4. Does USAID have a fourth assumption to add (the missing number 3?).

USAID response: This is an error; there are only three assumptions for the results framework. This has been corrected in Attachment J.1, Amendment 01.

35. Attachment J1, Page 8, Statement of Objectives (IR.1.1). The SOO indicates that “…. a Public Financial Management Risk Assessment (PFMRAF) was conducted with an accompanying Risk Mitigation Plan ….” Can USAID share the reports for the counties to enable the offerors response be grounded on the gaps identified in the assessment reports?

USAID response: The Risk Mitigation Plan is being updated frequently and the most updated plan will be shared with the successful offeror after the award has been made.

36. Attachment J.1, Page 14, Section CC IR 3 Establishment and Implementation of Supplemental Technical Assistance Fund for responsive technical assistance. Would USAID be able to provide additional details and requirements related to the fund and confirm that this fund will be used to reimburse the Contractor for the Supplemental Technical Assistance LOE the Contractor will expend as envisioned under CC IR 3?

USAID response: Please see the response to Question #31.

37. Will USAID please provide the results from the Public Financial Management Risk Assessment (PFMRAF) and accompanying Risk Mitigation Plan referenced on page 8 of Attachment J.1 HSS Statement of Objectives?

USAID response: Please refer to Question #35.

38. In Attachment J-1 on page 1, the overview section says “select technical assistance will be provided at the central technical assistance to ensure alignment” – does USAID mean at the central level or the county level?

USAID response: The statement should read, “Select technical assistance will be provided at the Central level to ensure alignment and implementation of national priorities and processes at the county level.” This has been updated in amendment 01.

39. In Attachment J-1 IR 1.2, can USAID tell us the status of the development of the contracting-in tool and the first round of county level assessments referenced on page 8?

USAID response: Refer to Question 26.

40. Will USAID please share the National Data Quality Review report from July 2018 cited on page 13 (footnote 13) of Attachment J.1 HSS Statement of Objectives?

Performance and Health Outcomes (STAIP) Activity February 05, 2019

USAID response: The footnote details that a separate tool and process will need to be completed after the time of award; once available it will be shared with the contractor The focus for this results is at least a 20% increase in data quality.

41. From Attachment J-1 can USAID clarify how IR 1.2 (on pp. 8-9), is different from CC IR 2 (on p. 13), since the contracting-in guidelines describe performance-based financing as a contracting-in tool?

USAID response: Contracting-in is not necessarily only a performanced-based financing tool.

Contracting-in relates to the relationship between the Central MOH and county health teams. PBF indicators include a standard set of MOH indicators. (Please Refer to pages 42-26 in Annex J.6 (PBF Manual) for a full list of the current MOH PBF indicators.

42. From Attachment J-1 CC IR3 p. 14, what percentage of this STA fund is anticipated to be used for technical assistance, eg. labor and associated expenses and what is expected for other quality improvements such as supplies or repairs?

USAID response: Please see response to Question #31. There is no predetermined amount for STA to be used for technical assistance.

43. From attachment J-1 on pages 8 – 14, are contract’s LOE, contractor’s efforts, or the given percentages the same? Please clarify if this is the proportion of the budget to be allocated to each IR.

USAID response: These percentages reflect the amount of effort that the contractor should focus on for each objective and intermediate result. Management and oversight costs should be included in these percentages. There is flexibility within these percentages, but they were included to ensure that each technical area/result received sufficient resources and staffing to achieve results.

44. On page 15 of attachment J1 under section 11, USAID states reimbursement of fees will be tied directly to achievement of 20% increase in overall capacity assessment scores. Which assessments are these referring to?

USAID response: Refer to the response to Question 26. This refers to the county capacity assessment scores.

45. According to page 14 of the J.1 a “minimum of 10 percent of this award will be utilized for

PBF reimbursement to the county health teams.” Can USAID confirm this will be done in grants or direct G2G funding?

USAID response: The mechanism needs to be proposed by the contractor, but will not be implemented through a G2G funding mechanism. USAID will work with the contractor and other stakeholders to finalize the appropriate mechanism to reimburse for PBF achievement. The contractor will be responsible for the management and administration of any performance-based financing.

Performance and Health Outcomes (STAIP) Activity February 05, 2019

46. From attachment J-1 on page 18, can USAID clarify they want us to co-locate with 7 CHTs per 12.6 – geographic focus?

USAID response: The contractor will be expected to co-locate in all 12 counties as well as with central MOH office/units as appropriate.

47. On page 11 of Attachment J.1, HSS Statement of Objectives, will USAID please confirm that

SR 2.1.2.6 is referring to cases of malaria?

USAID response: Yes, SR 2.1.2.5. refers to cases of malaria.

48. J.1 (SOO), page 7 states, “For each intermediate result the contractor will detail expected number of beneficiaries to be reached along with anticipated costs to allow cost-benefit reviews.” Given that the RFP states the technical proposal should “not make reference to pricing data” (p. 99 – L.5.d), please confirm that the expected beneficiaries along with anticipated costs are not required at the proposal stage.

USAID Response: Refer to the responses for Questions 20 and 25.

49. In J.1, Objective 2 (page 9) states, “The IRs under this objective (2) will also support implementation of key priorities to support the PMI Scale-up Plan in Montserrado, Maryland, Grand Kru and Bomi counties. As per Table 1, there are currently no partners or donors supporting these counties, thus results under IR 3 should support greater coverage of quality malaria services and improved patient outcomes.” Please confirm that IR3 is a typographical error and should be replaced with Objective 2.

USAID Response: Confirmed - is an error. This has been replaced with Objective 2 in Amendment 1.

50. In J.1 SOO, IR 2.2 (page 11) mentions that “the contractor shall propose how it will improve the delivery of malaria related services outside of the activities covered in IR 2.1 and 2.2.”

Did USAID mean to state “…malaria-related services beyond the activities covered in 2.1.”?

USAID Response: Yes, this should state malaria-related services beyond activities covered in 2.1.

This is updated in Amendment 1.

51. Referring to the Supplemental Technical Assistance Fund, Attachment J.1 CCIR 3 on p. 14 states, “Two million dollars of the award, and approximately 10% of the contractor’s level of effort, will be set aside for adaptive, responsive technical assistance.”

This could be interpreted to mean:

a. the 10% LOE is expected to have a cost of $2 million

b. the cost of the 10% LOE is in addition to the $2 million for the fund

c. the $2 million fund is a plug figure for a mix of LOE and procurement of goods.

52a. Please confirm that the $2 million is a plug figure for the Fund that includes LOE and

Performance and Health Outcomes (STAIP) Activity February 05, 2019 procurement of goods and thereby enables flexibility in management of the fund.

USAID Response: No

52b. If the answer to (a) above is “yes,” please confirm that associated flow down costs for labor (such as fringe, OH, G&A, and travel) should be included within the $2M for the STA Fund.

USAID Response: This section has been revised to remove all references to a STA “fund.” Any proposed technical assistance to achieve results should incorporate normal labor, fringe, travel, etc.

costs associated with provision of that service.

52c. For the STA Fund, please confirm the 10% LOE is to be dedicated to labor costs for other than proposed project staff on the budget (LTTA and STTA).

USAID Response: Please see response to Question 52b.

52. In J.1, Section 11 Success (page 15), it states: "Additionally, USAID/Liberia will tie reimbursement of fees directly to achievement of: At least 20% increase in overall capacity assessment scores from baseline to midline and a minimum of an additional ten percent increase in overall capacity assessment scores from mid-line to end-line capacity assessments. This measurement will be verified by the MOH and USAID. (Objective 1)."

Please confirm the referenced capacity assessment scores are for the CHTs. Please also state the baseline for the 20% improvement.

USAID response: These are the county capacity assessment scores for the county health teams. The baselines will be completed and shared with the successful offeror shortly after the time of award.

53. In J.1, Section 12 Special Considerations, please confirm that items 12.3 and 12.4 are left out intentionally.

USAID response: Yes, the numbering in Section 12 is incorrect. It should be Section 12.1-12.6, reflecting six sub-sections. The numbering has been updated in Amendment #1.

54. Attachment J-1 Section 12.6 (page 18) states that the contractor must be co-located with the

Ministry of Health. For budgeting purposes, please advise what specific costs (furniture, internet, telephone, office security, office cleaning, etc.) will be provided by MOH and the County Health Teams.

USAID response: Generally, costs for contractor operations will be borne by the contractor. Note that CHT facilities may only have the bare necessities in terms of furniture, and may not have consistent power, internet or telephone services. There may be some office furniture available at the CHT, but an assessment needs to be done for each CHT to better determine the required equipment.

The contractor should budget for these items within their budget.

55. On Page 1 of Attachment J-1, the RFP states “USAID intends to support the strengthening of the Ministry of Health’s (MOH) systems in order to improve patient outcomes at primary

Performance and Health Outcomes (STAIP) Activity February 05, 2019 health care facilities by providing sustainable capacity building and incentivizing better health systems performance through performance-based financing.”. On Page 2, the second objective states “Strengthened quality of reproductive, maternal, neonatal, child and adolescent health (RMNCAH) and malaria primary health care services for improved health outcomes”. Please clarify if you mean “primary health services”, inclusive of community health services, or only primary health care facilities.

USAID response: This includes primary health care facilities only.

56. On Page 1 of Attachment J-1, the RFP states “USAID intends to support the strengthening of the Ministry of Health’s (MOH) systems in order to improve patient outcomes at primary health care facilities by providing sustainable capacity building and incentivizing better health systems performance through performance-based financing.”. Please clarify if the primary health care facilities, include private for-profit and nonprofit facilities.

USAID response: Please Refer to the response to Question 24b.

57. Page 13 states “USAID expects the contractor will introduce and test PBF in the implementation of activities at the county level in the 8 FARA counties, in addition to the routine GoL system.” However, with past USAID investments, PBF has already been introduced and is in place in 3 FARA counties – Nimba, Bong, and Lofa. Please clarify if you mean PBF introduction into 5 additional FARA counties?

USAID response: The PBF section of the SOO talks about PBF reform that would include revisiting PBF overall, including in Nimba, Bong and Lofa. PBF should also be introduced into the 5 additional counties and potentially the PMI counties. The offeror has flexibility to propose how it will reform the current PBF model for improved system performance and quality of care, including identifying in which counties it will test any PBF reform ideas. The contractor can work with the current PBF in Bong, Lofa and Nimba to also include additional funds/indicators. These decisions will be finalized after consultation with USAID and the MOH.

58. On Page 15 of Attachment J-1, the RFP includes this success target “Increased proportion of suspected malaria cases tested with RDTs or microscopy (malaria test rate) and treated:

Annual increase to be proposed by the Contractor after the baseline has been determined.”

Please clarify whether the proportion of malaria cases included in this parameter include those tested at both the facility and community levels?

USAID response: This should only be the proportion of cases tested at the facility level (this however can include outreach services conducted and led by a health facility), but not through community health assistants/volunteers through the community health program.

59. Page 10 of Attachment J-1, SR 2.1.1.1 and SR 2.1.1.2 – For these two SRs, USAID states that the health facilities must “go up by one category in the total cumulative scores”. The footnote states that this is based on the JISS tool and scoring. It also states that this includes only 10 out of 13 categories for FARA Contracting-in counties and 5 out of 13 categories for non-FARA counties. Can USAID please confirm that “total cumulative scores” means a total

Performance and Health Outcomes (STAIP) Activity February 05, 2019 for only those categories listed in footnotes 9 and 11 and not a total cumulative score on all 13 JISS categories?

USAID response: Correct, this means a cumulative score for categories listed in the footnote and not all 13 categories. Therefore, the cumulative scores are out of 10 categories for FARA counties, and out of 5 categories for the non-FARA counties.

60. Page 11 of Attachment J-1, SR 2.1.2.4 – USAID states: “At least 20% increase in the total number of health facilities conduct appropriate internal quality control for all procedures as per National Guidelines…”. We understand that the National Guidelines include a wide range of procedures all of which may not apply to the RFP’s stated result areas. Can USAID please confirm that “for all procedures” refers only to the five basic tests that are the focus of IR 2.1.2 and not to all procedures found in the National Guidelines?

USAID response: Yes, this refers to the five basic tests only and not all procedures in the National Guidelines.

61. On Page 8 of the Attachment J1, the RFP states “In advance of this award, USAID, the Ministry of Health and the World Bank will develop a common contracting-in tool and conduct the first round of county-level assessments.” Please clarify if the tool for county-level assessment is the same tool as the one found in Attachment J4 Contracting-In Guidelines.

USAID response: Yes, this is the same tool. This is currently under further development and finalization. The intent is the same, but the tool is being updated.

62. To what extent does USAID expect the STAIP implementer to develop and integrate health information systems (e.g., DHIS2 and other sub systems referenced on page 13 of the SOO, CC IR 1)?

USAID response: These systems are all currently developed. The intent of the statement on page 13 is to focus primarily on analysis and use of the data across the sub-systems, and not specifically development of any new subsystems. If the contractor believes that a different technology/solution is necessary, the contractor has the flexibility to make that proposal.

63. Page 13 (CC IR 1, SR 1.1.1) references the National Data Quality Review, which was conducted in July 2018. We respectfully request that USAID share a copy of this DQR Report.

USAID response: Review response to Question 40.

64. Several routine health information subsystems have been referenced as data sources in the SOO (page 13, CC IR 1), what does USAID envision as the priority sub-system for improving data availability and quality?

Performance and Health Outcomes (STAIP) Activity February 05, 2019

USAID response: DHIS 2.0 is the priority subsystem for improving data availability and quality as this provides routine health information for the country and is the foundation for GOL public health responses.

65. Under CCR 1.1, the SOO provides metrics for improving data quality. However, the overall CCR1.1 states that the availability of data at the facility, district, county and central level must be improved. Please clarify what you envision as “improved data availability” under this IR?

USAID response: Each county may have varying reporting rates (no reporting to inconsistent reporting), and completeness of data/records may also be an issue. Therefore, the contractor may need to work with the counties to improve receipt of reports and completeness of records as a first step towards improving data availability, with the ultimate aim of improving data quality (including accuracy).

66. To what extent does USAID expect the STAIP implementer to assist the MOH with HIS governance, data security strategy, and/or HIS costing plans, given that these are goals of the Liberia HIS Strategy referenced in CC IR 1 (page 13)?

USAID response: This assistance should be limited. The focus should be on decentralized management of data systems i.e. DHIS 2.0. and improved data quality at the subnational level. HIS governance is a broad category, but may have implications for decentralized management of data systems.

67. Under CC IR 1, SR 1.1.1 – the SOO states that a decentralized DQR tool and process are needed. Does USAID expect the STAIP implementer to design and implement this decentralized DQR tool and process?

USAID response: As referenced in the footnote, the DQR is a national tool applied annually, however the contractor will need to work with the MOH to develop a tool and process to decentralize data review and improvement. Accomplishing this may require the contractor to design new data quality review tools or revise the existing tools for more routine data quality checks at the subnational level.

68. Page 9 of the RFP indicates that institutionalization of accreditation is a priority of the Quality Management Unit. However, there is no IR that specifies desired results for accreditation. Could USAID please clarify if Liberia STAIP will include any activities related to accreditation?

USAID Response: Accreditation is not a priority under STAIP. No activities should be proposed related to accreditation.

69. Sr 2.1.1 Expected results: Can USAID confirm that total score increase are acceptable for improved performance against the JISS standards? There appears to be two different definitions of the performance indicators regarding the calculation of the score from the JISS.

Performance and Health Outcomes (STAIP) Activity February 05, 2019

USAID response: Refer to the response to Question 60.

70. Does USAID have examples of achieving the following results within a four year timeframe?

If so, what are those examples?

● Decreased facility maternal mortality ratio in 3 FARA contracting-in counties by 40% by the end of the award (Objective 2). This measurement will be verified by a third party maternal death facility audit.

● Decreased average per capita out-of-pocket expenditure in pilot area by 50% by the end of the pilot period (Objective 3)

USAID response: These are expectations under this award.

71. Can USAID clarify the PEPFAR funding levels that this project will receive and will this project be required to report into DATIM?

USAID response: There are no PEPFAR funds under this award that would trigger reporting into

DATIM.

72. On p. 9 of J1 the SOO under Objective 2 there is reference to the IRs aligning with the priorities of the Quality Management Unit including institutionalization of the national facility accreditation system. However, those results have been removed from this iteration of the SOO. Can USAID clarify expectations?

USAID response: Please refer to the responses to Questions 3 and 69.

73. The Statement of Objective (Attachment J.1) assigns percentages indicating “the expected amount of effort and budget allocations for achievement of results.” However, for many of these IRs these percentages will not likely align. Furthermore, a significant level of effort from the contractor will be necessary for non-technical work, such as management and oversight of the project, which are not accounted for in this document. Can USAID please clarify that these percentages are meant to be general guidance for the technical proposal and the budgeted percentage may deviate from them, within reason?

USAID response: These percentages reflect the amount of effort that the contractor should focus on for each objective and intermediate result. Management and oversight costs should be included in these percentages. There is flexibility within these percentages within reason, but they were included to ensure that each technical area/result receives sufficient resources and staffing to achieve results.

74. Can USAID provide the JISS assessment report results from the counties or DHTs done in

2018?

USAID response: This is internal MOH data and not publicly available. Reports will be made available at the time of award to the successful offeror.

Performance and Health Outcomes (STAIP) Activity February 05, 2019

QUESTIONS RELATED TO SECTION F – DELIVERIES OR PERFORMANCE

75. Will USAID kindly clarify the qualifications for the Chief of Party from F.4 on page 17 of the RFP? It appears that the final clause of the sentence was omitted. Strong communication skills, including interpersonal, presentation, written and oral English, to fulfill the diverse technical and managerial requirements of the activity and to coordinate effectively with a wide range of stakeholders; and

USAID response: That is the final sentence, the semicolon and “and” is an error. This has been updated in the RFP - Amendment #1.

76. Will USAID kindly clarify the qualifications for the Finance and Operations Manager from

F.4 on page 19 of the RFP? It appears that the final clause of the sentence was omitted.

Strong Communication skills, including interpersonal, presentation, written and oral English, to fulfill the diverse technical and managerial requirements of the activity and to coordinate effectively with a wide range of stakeholders; and

USAID response: That is the final sentence, the semicolon and “and” is an error. This has been updated in the RFP - Amendment #1.

77. What is the anticipated need for international experience for the MELAMD as stated in the qualifications: “demonstrated international experience in rigorous quantitative research” on page 19 of the RFP?

USAID response: The offeror should make this determination. The complexity and rigor of M&E required for this award should be reflected in the type/level of international experience proposed by the offeror.

78. In F.6 on page 21 of the RFP, the four year work plan is described as being a five year work-plan in the due date column. Please confirm that this procurement is four years.

USAID Response: This is an error. This is a four year activity and the reference has been updated in the RFP - Amendment #1.

QUESTION RELATED TO SECTION H – SPECIAL CONTRACT REQUIREMENTS

79. H.7(d)1 on page 40 of the RFP indicates that employees of the contractor can be offered a salary increase of not more than 5% after completion of 12 months of satisfactory service under the Contract. However, H.6(a) on page 39 of the RFP directs contractors to follow their own established policies and procedures. If a contractor has an established policy of allowing annual increases at the beginning of its own fiscal year (once per annum, based on performance), will USAID allow the increase for long-term employees who have served 12 months, but not all on this Contract?