DFC Healthcare Portfolio draft SOW.docx

Draft Statement of Work (SOW)

U.S. International Development Finance Corporation (DFC)

Project Title: Development Impact Performance Assessment of DFC’s Healthcare Portfolio

1.0 GENERAL INFORMATION

The U.S. International Development Finance Corporation (DFC) is financing solutions to the most critical challenges facing today's developing world. Working with businesses, we mobilize private capital to invest in projects that create jobs and opportunities in emerging markets, including building critical infrastructure, expanding access to telecommunications, and providing small business financing for women entrepreneurs. Launched in 2019, DFC helps to advance America's foreign policy by partnering with projects that create economic stability, protect sovereignty, and ensure transparency. DFC investments adhere to high U.S. business standards and respect the environment, human rights, and worker rights.

DFC’s Office of Development Policy (ODP) works to ensure DFC’s projects produce positive developmental impacts, apply best practices with respect to environmental and social safeguards, and respect human rights, including worker rights.

2.0 BACKGROUND

DFC’s ODP seeks an independent consultant to conduct a development impact performance assessment of healthcare facilities in which DFC invested directly and indirectly through DFC-supported financial intermediaries, such as investment funds (referred to hereafter as the “Healthcare Portfolio”). The assessment will encompass the Healthcare Portfolio’s impact (positive and/or negative) on healthcare accessibility, affordability, quality of care, gender equity, and impacts on the local healthcare ecosystem.

3.0 SCOPE

DFC’s ODP requires the services of an independent consultant to conduct an analysis of the development impact performance of DFC’s Healthcare Portfolio in meeting U.N. Sustainable Development Goal Three (Ensure Healthy Lives and Promote Well-being for All) (SDG 3). The objective of the assessment is to better understand DFC’s contribution to SDG 3, specifically Target 3.8 (Universal Healthcare Coverage) and its three primary components of (1) affordability, (2) access, and (3) quality of care; and recommend ways DFC could better measure these impacts using standardized metrics that are commonly used in the industry. The assessment will apply a gender lens that will enable DFC to glean lessons learned on how it can advance gender equity through investments in the healthcare sector. In addition, the assessment will include an analysis of how the investments in the Healthcare Portfolio impact the broader healthcare ecosystem in the community.

DFC’s standard healthcare metrics are largely measuring the change in the number of patients served on an annual basis. DFC also requires healthcare facilities receiving DFC capital to meet internationally recognized standards, typically achieved through international certifications (e.g., ISO and JCI). However, the high costs for accreditation are often limiting to smaller healthcare facilities operating in some markets. These challenges limit DFC’s ability to fully understand the impacts of its Healthcare Portfolio in advancing SDG 3.8.

The assessment consists of evaluative, comparative case studies of 21 healthcare facilities located in 12 different countries in which DFC made investments directly or indirectly though financial intermediaries.[footnoteRef:2] The assessment will include recommended improvements in DFC’s ability to analyze these impacts for future investments in the sector throughout its sourcing, origination, monitoring, and evaluation processes. [2: The facilities expected to participate in the assessment are located in India, Nepal, Indonesia, Vietnam, Pakistan, Ghana, Nigeria, Cameroon, Kenya, Egypt, Georgia, and Ecuador. Given the scope of this assessment and data limitations, it is infeasible to include randomized control trial experiments or other evaluation techniques that aim to devise a counterfactual.]

4.0 REQUIREMENTS

The contractor shall perform the following tasks:

Task 1: Desk Research (estimated 10% of effort)

a. Conduct desk research of the healthcare sector in the target countries to provide contextual understanding of the sector in the target country and lessons learned from past studies. The research should include but is not limited to:

i. Description of the development challenges and any government initiatives in the healthcare sector in the target countries.

ii. A synthesis of findings from past evaluations that are relevant to this assessment. A catalogue of these evaluations should be included in an appendix to the report.

iii. Identification of available country and sector databases that can be used to contextualize and benchmark findings and identify trends.

b. Review the following DFC reference documents to understand DFC’s current strategy and practices:

i. DFC’s Healthcare Sector Strategy.[footnoteRef:3] [3: This document will be provided to the contractor following award.]

ii. DFC’s Healthcare Sector Impact Theses.[footnoteRef:4] [4: https://www.dfc.gov/sites/default/files/media/documents/DFC%20Impact%20Theses%20-%20May%202024.pdf.]

iii. DFC’s Development Impact Policies and Procedures.[footnoteRef:5] [5: This document will be provided to the contractor following award.]

iv. DFC’s Environmental and Social Policies and Procedures.[footnoteRef:6] [6: https://www.dfc.gov/sites/default/files/media/documents/ESPP%202024.pdf.]

c. Review origination and monitoring documents of the investments in the Healthcare Portfolio to understand the structure and original development goals of the investment. Documents include but are not limited to:

i. Loan agreements, ex-ante development projections, and environmental and social assessments.

ii. Financial and impact performance data, monitoring reports, and environmental and social compliance reports.

Task 2: Reconstruct Theory of Change (estimated 5% of effort)

a. Construct an ex-post logic model and diagram that illustrates the short, medium, and long-term outputs and outcomes expected to result from DFC investments that align with SDG 3.8. The model should incorporate:

i. Outputs and outcomes from the literature review in Task 1 that links to DFC’s impact target (SDG 3, in particular SDG 3.8).

ii. Metrics used to measure development outputs and outcomes (utilizing both DFC’s existing metrics and proposed new metrics where gaps exist).

iii. Assumptions and risks.

Task 3: Data Collection (estimated 30% of effort)

a. Collect quantitative and qualitative information necessary to evaluate the development impact of the selected segment of the Healthcare Portfolio. This task requires:

i. Interviews with relevant DFC staff.

1. Healthcare sector leaders.

2. Loan originators and monitors.

3. Environmental & Social specialists.

4. Impact Management specialists.

5. Gender specialists.

ii. Interviews with and data collection from healthcare investees. Topics/data may include, but not limited to:

1. Market Position.

2. Healthcare Innovations (services, products, distribution).

3. Pricing.

4. Profile of patients, including disaggregation by sex, income level, age, and other available disaggregation.

5. Quality of care metrics and data/certifications/patient surveys (disaggregated by sex, income level, age, and other available disaggregation).

6. Relationships and engagements with public health institutions/local community.

iii. Interviews with investment funds where DFC’s investment in a healthcare facility is indirect through a financial intermediary.

iv. Interviews with host country regulators.

v. Country and sector data to benchmark results.

vi. Collection of any other information/data determined to be significant.

Task 4: Analysis (estimated 30% of effort)

a. Using the data collected in Task 3, draw conclusions about the impact of Healthcare Portfolio, positive and/or negative, using country benchmarks identified in Task 1, that includes the following areas of focus:

i. Access: Does the healthcare facility provide access to services and/or products that are otherwise unavailable in the area? Does the facility provide other mechanisms to increase access to healthcare (e.g., expanded times of operations, mobile clinics, telehealth)? Does the facility provide access to underserved segments of the population? If so, how? What percentage of patients is from underserved populations?

ii. Affordability: What is the socio-economic profile of the facility’s patients? What is the proportion of the facility’s average out-of-pocket healthcare expenditures to household income?

iii. Quality: How does the facility measure quality of care? What certifications has the facility earned? What is its compliance record/reputation? Does the facility conduct patient satisfaction surveys? If so, what processes are in place to address patient feedback from these surveys?

iv. Gender Equity: Was there a statistically significant difference in health outcomes between male and female patients? If so, what may explain these differences? If the facility has patient satisfaction surveying tools, is the data sex disaggregated? Do the results reflect differences in experiences between men and women? If so, how has the facility addressed the issue?

v. Healthcare Ecosystem: How does the facility fit in the larger healthcare ecosystem in the area? What is the facility’s relationship with public health facilities? Regulators? What community activities does the facility engage in?

Task 5: Lessons Learned and Recommendations (estimated 25% of effort)

a. Create and deliver an internal written report (Word document preferred) for DFC with conclusions about the Healthcare Portfolio’s performance in advancing SDG 3.8, using standard metrics (patients reached, quality of care, pricing, etc.) that is benchmarked to the country’s industry data, to the extent feasible. The report should contain lessons learned and recommendations on how DFC could improve its ability to screen, diligence, monitor, and evaluate the impacts of its Healthcare Portfolio across the dimensions of accessibility, affordability, quality of care, gender equity, and ecosystem development.

b. The internal report shall be written in clear, concise language that can be understood by a variety of audiences that contain answers to the following questions as well address as any other recommendations or lessons learned outside of this question set.

i. Does the Healthcare Portfolio further SDG 3.8 by improving healthcare access, affordability, and quality of care in the target countries? (This analysis should use standard metrics that are benchmarked to industry standards in the target country to the extent feasible.) Has the Healthcare Portfolio advanced government initiatives in the sector in the target countries?

ii. Does the Healthcare Portfolio enhance gender equity? If so, how? What are the opportunities for DFC to further gender equity in the sector?

iii. How does the Healthcare Portfolio impact the broader healthcare ecosystem in the target countries?

iv. What were the drivers that contributed to the portfolio’s developmental results, both positive and negative?

v. How can DFC improve processes involving healthcare investments including screening potential projects, due diligence, structuring, monitoring, etc.?

vi. How can DFC more effectively assess the impact of its healthcare investments in terms of accessibility, affordability, quality of care, gender equity, and ecosystem development? What metrics can be used that are suitable and feasible to evaluate these impacts? Are there additional risks that DFC should consider for future healthcare investments?

c. Provide a written summary report of findings and recommendations for DFC.

d. Provide a PowerPoint presentation and present findings to DFC staff.

e. Provide an external-facing written report and PowerPoint presentation for the public.

Key Personnel:

The key personnel specified below are essential to work performance. At least 30 days prior to diverting any of the specified individuals to other programs or contracts (or as soon as possible, if an individual must be replaced, for example, as a result of leaving the employ of the Contractor), the Contractor shall notify the Contracting Officer and shall submit comprehensive justification for the diversion or replacement request (including proposed substitutions for key personnel) to permit evaluation by the Government of the impact on performance under this contract. The Contractor shall provide complete resumes for proposed substitutes, and any additional information requested by the Contracting Officer. Proposed substitutes should have comparable qualifications to those of the persons being replaced.

The Contracting Officer will notify the Contractor within 15 calendar days after receipt of all required information regarding the consent on substitutions. No change in fixed unit prices may occur as a result of key personnel substitution. The Contractor shall not divert or otherwise replace any key personnel without the written consent of the Contracting Officer. The Government may modify the contract to add or delete key personnel at the request of the contractor or Government.

Name Position [To be proposed]

5.0 DELIVERABLES

The contractor shall provide the following deliverables:

Specifications Due Dates

No later than XXX.

Every week until delivery of the final report.

Once per month until delivery of the final report.

a. Executive Summary.

b. Introduction (including the evaluation objectives, methodology, assumptions, and data limitations).

c. Desk Research described in Task 1.

d. Reconstructed Theory of Change described in Task 2.

e. Analysis of the development impact performance of the Healthcare Portfolio described in Task 4 and Lessons Learned and Recommendations described in Task 5.

f. An appendix inclusive of a catalogue of past evaluations that are relevant to this assessment, as described in Task 1, and all data collected during this project.

To be determined (TBD).

TBD.

TBD.

TBD.

TBD.

6.0 QUALIFICATIONS

The contractor shall possess the following qualifications:

a. A strong expertise assessing the development impact of healthcare investments made by development finance institutions, such as the International Finance Corporation (IFC), British International Investment (BII), the World Bank, the African Development Bank (AfDB), European Bank for Reconstruction and Development (EBRD), the Dutch development bank FMO, and IDB Invest.

b. A strong expertise in measuring qualitative and quantitative impacts of healthcare facilities, such as quality of care, affordability, gender equity, and accessibility, in emerging markets.

c. Possess at least 5 years’ experience in conducting development impact performance assessments that result in actionable recommendations.

d. When required, the IC shall deploy additional experts and support staff.

e. Possess strong analytical, report writing, and presentation skills.

f. Be fluent in English, as all communication and deliverables will take place in English. Additionally, possess the ability to communicate in the local language where each healthcare facility is located.

7.0 TRAVEL

Engagements with DFC’s clients in the target countries may require travel if the contractor or its sub-contractors, if any, are not already presently located in the region.

The contractor shall obtain written approval from the COR prior to undertaking any travel. All travel will be reimbursed at-cost in accordance with the Federal Travel Regulation (FTR).

8.0 PLACE OF PERFORMANCE

The principal place of performance will be the contractor’s facility.

9.0 HOURS OF OPERATIONS:

DFC standard hours of operation:

Monday - Friday, 9:00 a.m. – 5:00 p.m.

10.0 PERIOD OF PERFORMANCE (POP)

The period of performance shall be one year, from XXXXXX, through XXXXXX.

11.0 RESTRICTIONS ON REPRODUCTION AND DISCLOSURE OF GOVERNMENT DATA

The Contractor agrees, during the performance of this contract, to keep the information and data, including any controlled unclassified information (CUI), furnished by the Government or acquired and/or developed by the Contractor in performance of this contract in the strictest confidence. The Contractor agrees to maintain the confidentiality of all such data to which access may be obtained throughout contract performance whether the data is transmitted, in process or at rest. Title to any confidential information furnished, acquired and/or developed by the Contractor under this contract does not vest in the Contractor unless expressly provided under the contract. The Contractor agrees not to use, redistribute, publish, divulge, reproduce or disclose, in whole or in part, including any interpretation thereof or data derivative, the information or data obtained, furnished, developed or acquired under this contract, whether in process, at rest or transmitted by the Contractor, nor authorize others to do so, except as specified by the contract.

All personnel under the contract with access to Government data under this contract must sign a Non-Disclosure Agreement (NDA) to guarantee the protection and integrity of Government information and data. The Contractor shall provide copies of the signed NDA to the Contracting Officer’s Representative within 72 hours of execution of the form.

The Contractor agrees to comply with the security requirements of this contract, including the personnel, data handling and information technology requirements, and to take reasonable measures to restrict access to such information while in the Contractor’s possession to those employees needing such information to perform the work described herein, i.e. on a “need to know” basis. At the Contracting Officer’s discretion, any violation of security requirements under the contract may result in DFC availing itself of any of the remedies available under the contract including contract termination. The Contractor is responsible for safeguarding all government data and property provided under the contract and implement the requirements under the media sanitization policy.

The Contractor must insert this clause in all subcontracts and require subcontractors, teammates, and independent contractors to include the clause in all lower-tiered contracts.

12.0 NOTIFICATION REQUIREMENTS

The Contractor must comply with all notification of potential or actual breach and/or incident provisions under this contract. In addition, if the Contractor discovers or has reason to suspect confidential patent applications, related data or any part thereof have potentially or actually been publicly displayed on unapproved platforms or applications and/or accessed, viewed, provided to or obtained by persons or entities without need to know or not performing on the contract, the Contractor must immediately notify the Contracting Officer with a statement of the facts and circumstances known at the time within 72 hours of identification. Nothing in this provision relieves the Contactor from any other reporting requirements in this contract.

The Contractor must insert this clause in all subcontracts and require subcontractors, teammates, and independent contractors to include the clause in all lower-tiered contracts.

13.0 TRANSMISSION OF FEDERAL CONTRACT INFORMATION

All federal contract information, as defined in the clause at FAR 52.204-21, shall be transmitted between the Contractor and DFC using DFC’s secure Box.com™ account.