BAA-388-17-000002_UHC.pdf

BAA-388-17-000002

Advancing Universal Health Coverage (UHC) In Bangladesh

List of Acronyms

BAA Broad Agency Announcement CFDA Catalog of Federal Domestic Assistance DP Development Partners (other possible donors) EOI Expression of Interest FAR Federal Acquisition Regulation IP Implementing Partner (refers to both contractor and recipient) POC Point of Contact UHC Universal Health Coverage USAID United States Agency for International Development

ADVANCING UNIVERSAL HEALTH COVERAGE (UHC) IN BANGLADESH

A Broad Agency Announcement

I. Overview

A. This Broad Agency Announcement (BAA) seeks Expressions of Interest on game changing solutions to advance Universal Health Coverage in Bangladesh. The United States Agency for International Development Bangladesh’s Office of Population, Health, Nutrition and Education (USAID/Bangladesh/OPHNE) invites organizations and companies to partner with USAID/Bangladesh, as described below, to significantly expand access to safe, affordable and quality health services in Bangladesh, while increasing financial protection, particularly of the poor, in support of the Government of Bangladesh’s National Health Care Financing Strategy (2012-2032), under which Universal Health Coverage1 is a key priority.

B. Federal Agency Name: The United States Agency for International Development (USAID)

C. Opportunity Title: Advancing Universal Health Coverage in Bangladesh

D. Opportunity Number: BAA-388-17-000002

E. Authority: This BAA is issued under Federal Acquisition Regulations (FAR) Part 35.016 (c).

This is not a FAR Part 15 Procurement.

F. Catalog of Federal Domestic Assistance (CFDA) Number: 98.001USAID Foreign Assistance

Programs for Overseas.

II. Opportunity

A. Purpose: This BAA is intended to address the challenge on how to effectively introduce and expand universal health coverage, through innovative health financing approaches including but not limited to health insurance and payment linked to credit and or performance in Bangladesh.

OPHNE seeks opportunities to partner with companies and or/organizations to develop, test and scale-up health insurance coverage and other innovate health financing approaches in Bangladesh through the Smiling Sun (SS) health clinics, that offer breakthrough solutions to expanding access to safe, affordable and quality health services in support of the GOB’s National Health Care Financing strategy2. The intent is to co-create, co-design, co-invest and collaborate on interventions that demonstrate the highest potential to dramatically improve health impacts by tackling key constraints within the existing NGO health delivery sector and health financing

1 Universal health coverage is defined herein as ensuring that all people have access to needed promotive, preventive, curative and rehabilitative health services, of sufficient quality to be effective, while also ensuring that people do not suffer financial hardship when paying for these services (WHO)

2 The GOB National Health Care Financing Strategy 2012-2032 is titled “Expanding Social Protection for Health: Towards Universal Coverage.

sector. To date there is limited health insurance coverage offered in Bangladesh, outside of recent, small, pilot based efforts. This opportunity would help to increase health insurance coverage on a massive scale. Of particular interest are opportunities that complement USAID’s strategic focus on science, technology and innovative partnerships (STIP), universal health coverage, ending preventable maternal and child deaths (including family planning and nutrition), and support the Agency’s Mission to end extreme poverty.

B. Background: USAID/Bangladesh has a long history of supporting the delivery of health services to the poor in Bangladesh through the Smiling Sun clinics to complement delivery of the GOB’s essential health service package. It has been instrumental in supporting the health needs of the poor, particularly in key areas of maternal and child health, family planning and urban health service delivery. The impact has been significant, with a substantial number of Bangladeshis with better health outcomes and access to essential health services, as well as a significant rise in the number of the poor covered with essential health services. While much has been accomplished, much remains to be done. The Smiling Sun clinics currently work with 388 primary care and MCH clinics with 205 located in urban areas and the other half located in rural areas. These include 67 emergency obstetric care and basic obstetric care facilities. Smiling Sun also operates 10,186 satellite clinics in urban slums and rural areas. Smiling Sun facilities provide fertile ground for any effort to develop institutional arrangements and initial practice in accrediting primary care and MCH service providers. With 38 million customer contacts per year, the Smiling Sun clinics provide a substantial opportunity for introduction of health insurance into Bangladesh. Through this BAA, these Smiling Sun clinics will connect horizontally into a functional network and connect vertically such that higher level Comprehensive Emergency Obstetric Centers can serve as referral facilities. The network will enter into third party payer arrangement on a capitation basis, where insurance companies provide a fixed amount per service delivered.

Usage of health services by the poor under Smiling Sun clinics has been historically covered by USAID; however, there is significant potential for rapid scale-up of health insurance coverage and other creative health financing strategies through this network. The GOB recently completed Bangladesh’s first National Health Care Financing Strategy (2012-2032) with the support of donors and international organizations. The Strategy sets aggressive targets for rapidly expanding universal health coverage to 100% of the population covered by pre-payment schemes and out-of-pocket-expenditure3 (OOPE) down from 64 percent in 2007 to 32 percent by 2032. The goal of the strategy is to strengthen financial risk protection and extend health services and population coverage, with the aim to achieve universal coverage. It has the following three strategic objectives: 1. Generate more resources for health 2. Improve equity and increase health care access especially for the poor and vulnerable and 3. Enhance efficiency in resource allocation and use.

3 The World Bank defines OOPE as any direct outlay by households, including gratuities and in-kind payments, to health practitioners and suppliers of pharmaceuticals, therapeutic appliances, and other goods and services the primary intent of which is to contribute to the restoration or enhancement of health status.

Through this BAA the Smiling Sun clinic will provide an avenue for introducing new ways of contracting, including payment for performance and payment linked to credit, for delivery of packages of quality essential services for defined populations that will lay the foundation for eventual public sector contracting with private providers (fee-for-service, health insurance schemes), including the Smiling Sun clinics. These efforts will also serve to transition the Smiling Sun clinics away from significant USAID support to a self-sustaining entity.

C. USAID has pledged to support the GOB health financing strategy, specifically its goals related to UHC, which aligns with the Mission’s own strategy for strengthening health systems and governance and increasing use of effective and integrated health services.

D. Problem Statement: Bangladesh has been highly regarded for its successes in improving maternal and child health (MCH) outcomes, specifically reductions in maternal mortality rate (MMR) and under-5 mortality (U5M). However, if Bangladesh wants to continue to see improvements in MCH outcomes, the country will need to reach higher levels of financial protection and quality of healthcare. Bangladesh heavily relies on high out-of-pocket expenditures (OOPE) to fund healthcare, while government health expenditure, as a proportion of total health spending, continues to decline. This trend is the opposite of what UHC countries are striving to do. The majority of the health expenditure is spent on inpatient curative care and medical goods, which has increased over time; however the government has not contributed to this increase in spending.

As expected, OOPE has filled the gap (at 64% of total health expenditure) and the greatest proportion of OOPE (two-thirds) is spent on pharmaceutical drugs. The population is increasingly seeking care from drug retailers and at hospitals, indicated by the increased spending at both of these providers. Additionally, as government expenditures for hospitals at the sub-district and below are on the decline, it appears that patients are increasingly seeking care from the private sector providers, including NGO providers.4 Few people have the ability to adequately mitigate income and health shocks, limiting households’ abilities to invest in and grow their household income, business or access critical services (i.e. high education). There are limited institutions offering health coverage in Bangladesh. Additionally, the NGO and private or health providers need improved governance and updated management systems. Bangladeshi patients/consumers are increasingly eager to access affordable, quality, patient-centered health services while minimizing financial hardship.

In the context of related efforts at the policy and regulatory levels, as herein described, USAID has identified the follow focus opportunities for meeting GOB and USAID strategic goals through this BAA:

• Innovative approaches to move Bangladesh towards Universal Health Coverage: The GOB has committed to achieving UHC by 2032. In the private sector, owners of private, commercial and NGO hospitals and clinics need to see it in their interest to establish, maintain and enforce high quality standards in service provision. They need to see market opportunities in providing high quality essential services to people at low cost. They need to shift from serving market segments

4 Ministry of Health and Family Welfare. Bangladesh National Health Accounts 1997-2012. Research Paper No. 42a, Dhaka: Health Economics Unit, ministry of Health and Family Welfare, Government of the People’s Republic of Bangladesh.

based on ability to pay at the time of service to becoming able to provide services to people with third party payers, some through pre-payment and others through subsidies. Several possible pathways to UHC may include:

o Greater Health Insurance Coverage: Demonstrate how health insurance can work in Bangladesh while increasing the number of Bangladeshis covered under health insurance.

o Innovative financing for Performance for Results: Incentivize providers to provide high quality services by linking performance to their payment. Different elements of performance could become the focus (e.g. quality, service to the poor, etc.)

o Payment linked to credit for providers of health services: Enable cashless payments through stored mobile phone credit, or small-scale mobile financial services (e.g. bKash).

• Increase Knowledge and Awareness of Universal Health Coverage - the lack of fundamental knowledge of or familiarity with universal health coverage/health insurance, products or requirements, resulting in limited enrollment and coverage by financial risk protection mechanisms and high out-of-pocket expenditures.

• Formalize a functional, accredited5 network of clinics (NGO, private or mix) - to offer quality, standardized essential services covered under a sustainable re-imbursement mechanism, operating under the principles of a social enterprise6, reducing NGO health service delivery that is dependent upon donor resources, and ensuring a high-quality alternative to services in the high-priced private sector.

The BAA seeks to identify innovative approaches and designs to implement an intervention or combination of interventions that can be most impactful in the face of these constraints to advancing universal health coverage. OPHNE seeks innovative, practical, cost-effective solutions to these constraints through basic and applied research and development. 7

5 Accreditation is a process applied to organizations usually performed by a multidisciplinary team of health professionals and is assessed against published standards for the environment in which clinical care is delivered to ensure quality of services. (Quality and accreditation in health services: A global review. (2003), WHO) 6 The World Bank’s definition of social enterprise is as a social-mission-led organization that provides sustainable services to Base of the Pyramid (BoP) populations/the poor and the poorest of the poor.

7 Federal Acquisition Regulation (FAR) 2.101 Definitions: "Basic research” means that research directed toward increasing knowledge in science. The primary aim of basic research is a fuller knowledge or understanding of the subject under study, rather than any practical application of that knowledge. FAR 35.001 Definitions: “Applied research” means the effort that (a) normally follows basic research, but may not be severable from the related basic research; (b) attempts to determine and exploit the potential of scientific discoveries or improvements in technology, materials, processes, methods, devices, or techniques; and (c) attempts to advance the state of the art. When being used by contractors in cost principle applications, this term does not include efforts whose principal aim is the design, development, or testing of specific items or services to be considered for sale; these efforts are within the definition of “development,” given below. “Development,” as used in this part, means the systematic use of scientific and technical knowledge in the design, development, testing, or evaluation of a potential new product or service (or of an improvement in an existing product or service) to meet specific performance requirements or objectives. It includes the functions of design engineering, prototyping, and engineering testing; it excludes subcontracted technical effort that is for the sole purpose of developing an additional source for an existing product.

III. Collaboration

A. Types of Collaboration:

1. Co-creation: Co-creation occurs after an Expression of Interest is approved, but before the concept is developed. The prospective partners, the U.S. Government (represented by the Activity Manager employed by USAID) and potentially others work together to write and/or revise the Concept Paper, and jointly present the Concept Paper to USAID’s Peer and Scientific Review Board.

2. Co-design: Co-design occurs after the Peer and Scientific Review Board recommends the project for further development, and the Contracting Officer or Agreement Officer has determined the proposers to be Apparently Successful Partners. At this point, the Contracting Officer or Agreement Officer may determine the general nature of the award type or the specific award type, depending on the nature of the project, to facilitate project design. During co-design, the Apparently Successful Partners and the Activity Manager will design the technical approach, general resource requirements, and management control of the project under the guidance of the Contracting Officer/Agreement Officer.

3. Co-invest: Co-invest refers to the Government’s strategic aim that the partnerships resulting from the individual BAA awards represent opportunities to achieve mutual or complementary development goals of the Partner, USAID, and potentially other resource partners, and therefore embrace shared responsibility, shared risk, and shared resourcing. Shared resourcing may be accomplished through funding by both parties, either through cash resources or the exchange of other resources, both tangible and intangible, such as in-kind contributions, expertise, intellectual property, brand value, high-value coordination, and access to key people, places, and information.

Co-investing does not require equally shared resourcing (such as 1:1 leverage), but rather resource contributions that are appropriate to the specific project’s objectives, considering the comparative advantages brought by the participation of each party and the award type.

IV. Specific Rights Reserved for the Government under this BAA

A. The U.S. Government reserves specific rights, in addition to rights described elsewhere in this document or by law or regulation, including:

1. The right to award multiple awards, a single award, or no awards.

2. The right to make award(s) without discussions, or to conduct discussions and/or negotiations, whichever is determined to be in the Government’s interest.

3. The right to accept proposals in their entirety or to select only portions of proposals for award or co-investment.

4. The right to select for award an instrument type that is appropriate to the specific development context, partner relationship, and proposal selected for award. Instruments types include but are not limited to contracts, grants, cooperative agreements, Global Development

Alliance agreements, Development Innovation Agreements, Inter-Agency Agreements, Government to Government Agreements, Donor to Donor Agreements, and Memorandums of Understanding. In addition, the Government may craft a new instrument type to meet the needs of a specific relationship.

5. The right to co-create projects with one or more proposers under the BAA, when it is in the best interest of the Government.

6. The right to request any additional, necessary documentation upon initial review. Such additional information may include, but is not limited to, a further detailed proposal, budget, and representations and certifications.

7. The right to fund or co-invest in proposals in phases, with options for continued work at the end of one or more of the phases.

8. The right to award instruments under this BAA that does not commit or exchange monetary resources.

9. The right to remove proposers from award consideration should the parties fail to reach agreement on award terms, conditions, and cost/price within a reasonable time, the proposer fails to timely provide requested additional information, or the Government believes it is in its best interest.

V. General Criteria for Consideration

A. Submissions are not evaluated against other submissions, but solely against the evaluation criteria from the BAA.

B. Decisions regarding USAID’s pursuit of a particular project, technology or relationship are based on the available evidence, data, and resulting analysis. USAID seeks solutions that have a significant impact (i.e. breakthroughs, not incremental improvements), and can achieve that impact at scale.

C. The reputations of an organization, its past performance, the managerial and technical ability of the person or team of people engaged in the endeavor are always significant considerations in assessing the potential and the risks associated with each award.

D. For the purposes of this BAA, USAID/Bangladesh/OPHNE seeks co-creation partners that possess a number of the following experiences:

● connecting disparate communities, i.e. academia, private sector, civil society;

● innovatively addressing/harnessing challenges/opportunities to universal health coverage, innovative health financing approaches; delivery of health services through a network of clinics, accreditation of health facilities, franchising/network development experience; mHealth solutions

● connecting with experts in nontraditional and diverse sectors;

● implementing adaptive and/or iterative programming;

● managing successful peer-to-peer networks; and

● catalyzing new ideas effectively.

E. Criteria to be applied to all Expressions of Interest:

1. Idea/Approach: Soundness of your idea/approach, including appropriate evidence, to fostering systems that address the challenges and harness opportunities to advance universal health coverage through a network of clinics in Bangladesh.

2. Partnership Expectations and Value: Strengths of your organization as a partner, including a brief description of your organization’s experience and /or expertise with regard to the objectives of the BAA, demonstrated organizational capacity to partner with other organizations and your ability to provide a financial, in-kind, or leveraged match at various stages of the process.

Award Process

A. The amount of resources made available under this BAA will depend on the concepts received and the availability of funds. The award process under this BAA has the following steps:

Stage 1. Expression of Interest: Please submit an Expression of Interest in accordance with Section IX. Expressions of Interest must indicate the development idea which will work towards discovering potential solutions to the Problem and Challenge Statement(s), by increasing knowledge and understanding of potential solutions, exploiting improvements in current systems, structures, technology, materials, processes, methods, devices, or techniques, advancing the state of the art, or using scientific and technical knowledge in the design, development, testing, or evaluation of a potential new Smiling Sun network structure, product or service (or of an improvement in an existing product or service).

Stage 2. Development of the Concept Paper. For Expressions of Interest which are deemed to have merit by USAID, USAID will issue an invitation to collaborate to apparently successful applicants in Dhaka, Bangladesh to develop the ideas presented while working alongside USAID staff and other organizations selected to participate. Working together, USAID and the apparently successful applicants will collaborate on Concept Paper to achieve the above objectives. This will result in one or more concept papers, generally 5-10 pages, outlining a concrete programmatic plan, focus areas, goals, timelines, etc. Travel costs for participants will not be reimbursed by

USAID.

Additional Partners/Resources. During the project co-creation and co-design, both the Apparently Successful Partner(s) and USAID will identify additional partners and resources, and whether additional mechanisms are necessary to implement the project. An invitation is sent to a apparently successful applicant(s) to participate in a co-creation workshop, conference, meeting, or the method designated by USAID to work together with all invitees to further develop the idea presented in the expression of interest. All apparently successful applicant(s) may not move forward to Stage 3.

Stage 3. Review by the Peer and Scientific Review Board. All final Concept Papers will be reviewed by the Peer and Scientific Review Board, comprised of experts from USAID, partners, and/or outside parties. The Peer and Scientific Review Board will review Concept Papers and recommend whether to accept or deny the Concept Paper(s), or request further information from the co-creation group. A successful Concept Paper will advance to the next stage for a “Request for Proposals or Request for Applications.” Using its technical expertise, the Peer and Scientific Review Board will also suggest revisions/additions to the project, and recommend potential implementing partners and resources. NOTE: Not all apparently successful applicant(s) may move forward to Stage 4. Only those apparently successful applicants that are selected by the Peer and Scientific Review Board as apparently successful implementing partners will advance to Stage 4.

Stage 4. Contracting/Agreement Officer Determination. The Contracting/Agreement officer will review the Peer and Scientific Review Board’s recommendations and consider other information, such as resource availability, preliminary partner responsibility assessment, and Agency priorities, will make a determination that the respondent is an Apparently Successful Implementing Partner(s). The Contracting/Agreement Officer may also determine the anticipated instrument type to facilitate project design, including cost share and leverage requirements. Per regulation, mandatory due diligence through field visit or pre-award survey may occur at this stage or a later stage.

Request for Additional Information. USAID will work with the apparently successful implementing partner(s) identified by the Peer and Scientific Review Board, and other development partners to co-design the project and may request the partner to provide additional information with respect to its technical approach, capacity, management and organization, past performance, and budget, as well as representations and certifications, as needed.

Final Review and Negotiation. The USAID Contracting/Agreement Officer will engage in final review, negotiation, and determinations of instrument type, responsibility cost reasonableness, etc., and will craft an award instrument with the Apparently Successful Implementing Partner(s).

If the Apparently Successful Implementing Partner(s) and USAID cannot arrive at a mutually agreeable arrangement, the Contracting/Agreement Officer will cancel the project at no cost to the Government.

Award. Where USAID determines that the award of an instrument is appropriate, the USAID Contracting/Agreement Officer will award the instrument. However, USAID is not obliged to issue a financial instrument or award as a result of this BAA.

VI. Award Information

A. Number of awards could vary and may not mirror the number of expressions of interests or invitees to co-creation.

B. Awards under this BAA will be made to Apparently Successful Partners on the basis of their ability to further USAID’s goals of advancing quality, equitable service delivery in Bangladesh.

USAID is seeking new applications of science, innovations, and partnerships that provide the best value to the Government and have the potential to substantially contribute to these goals.

C. Proposals identified for negotiation may result in a contract, grant, cooperative agreement, Global

Development Alliance agreement, Development Innovation Agreement, Inter-Agency Agreement, Government to Government Agreement, Donor to Donor Agreement, Memorandum of Understanding or alternative agreement type, depending upon the nature of the work proposed, the required degree of Government involvement, and other factors. The Government Contracting/Agreement Officer will determine award instrument type and negotiate instrument terms and conditions with selectees. USAID may select the award instruments it deems appropriate.

D. Eligibility Information. Public, private, for-profit, and nonprofit organizations, as well as institutions of higher education, public international organizations, non-governmental organizations, U.S. and non-U.S. governmental organizations, multilateral and international donor organizations are eligible under this BAA. All organizations must be determined to be responsive to the BAA and sufficiently responsible to perform or participate in the final award type.

E. Standard Clauses and Provisions of Award. The standard clauses or provisions for awards are generally prescribed by law and regulation and will vary considerably by award type. Information regarding clauses and provisions will be offered to the selected Apparently Successful Partner when the award type is identified.

F. Organizations are encouraged to consider providing reasonable cost sharing, leverage, or other exchange of resource arrangements, and are encouraged to suggest creative approaches to resourcing projects.

VII. Information Protection

USAID’s goal is to facilitate the research and development that will lead to innovative, and potentially commercially viable, solutions. Understanding the sensitive nature of submitters’ information, USAID will work with organizations to protect intellectual property.

Expressions of Interest should be free of any intellectual property that submitter wishes to protect, as the expressions of interest will be shared with other USAID apparently successful applicants and USAID partners as part of the selection process. However, once submitters have been invited to engage in further discussions, submitters will work with USAID to identify proprietary information that requires protection.

Therefore, organizations making submissions under this BAA grant to USAID a royalty-free, nonexclusive, and irrevocable right to use, disclose, reproduce, and prepare derivative works, and to have or permit others to do so to any information contained in the expressions of interest submitted under the BAA. If USAID engages with the organization regarding its submission, the parties can negotiate further intellectual property protection for the organization’s intellectual property.

Organizations must ensure that any submissions under this BAA are free of any third party proprietary data rights that would impact the license granted to USAID herein.

VIII. Expression of Interest Information

A. Be in English.

B. Be submitted electronically to Tricia Siaso at tsiaso@usaid.gov , Tariq Bin Azam at tazam@usaid.gov , and Ahsanur Rahman at marahman@usaid.gov.

C. Be up to 5 pages in length, no smaller than 12 point font.

D. Contain a header with the following information (included in the page count): i. Respondent Name/Group and Contact Information; ii. Response Title; iii. BAA Addendum Name/Number; iv.

Contain one optional graphic that fits on an 8.5”x11” or A4 piece of paper (included in the page limit);

E. Be in .pdf, .docx, or .odf format.

F. Expressions of Interest may be accepted on a rolling basis for 20 days after the release of this

BAA.

Your Expression of Interest, if accepted, will result in your participation in one or more co-creation events with other successful applicants, to jointly develop programs and activities for funding. All applicants are encouraged to read the full announcement closely for guidance on the co-creation process.

IX. Review of Submissions

The following criteria will be applied to all Expressions of Interest:

A. Idea/Approach: USAID will focus on how the applicant contributes fresh, informed and realistic thinking, and how the applicant uses support evidence and analysis to clearly demonstrate how the proposed idea will support the introduction of health insurance into the Smiling Sun network for increased access to essential health services, particularly for the poor. Equally important are the unique qualities that the applicant would bring to the discussion.

B. Partnership Expectations and Values: Strengths of your organization as a partner, including your ability to make unique contributions to this critical development challenge. Please provide specific examples of collaboration or co-creation with other parties or partners.

mailto:tsiaso@usaid.gov mailto:tazam@usaid.gov mailto:marahman@usaid.gov

C. Diversity of Perspectives and Capabilities: USAID seeks to bring together a diverse set of co-creators in collaboration in order to enable broader thinking and innovation. The selection of individual applicants will be made with the goal of achieving a well-thought out design/activity to reach the stated goals and objectives.

D. Impact and goals of the program: Indicate broad and discrete goals of the concept and how they relate to universal health coverage and systems strengthening of NGO clinics for increased service delivery and access, particularly by the poor and vulnerable populations.

E. Private-sector partnerships: Indicate specific relationships with private sector actors, and any pre-existing company/industry partnership commitments to identify and addresses universal health coverage, quality of care, accreditation process, establishing/strengthening clinics, etc.