Mobile Health Van SOW_04-02-2024.pdf

Statement of Work:

Chinle Service Unit Off-Road-Capable Mobile Health Van (MHV)

1) Project Description and Overview of Services:

a. Project purpose and objectives: The purpose of the project is to design, assemble, deliver to Chinle Comprehensive Health Care Facility (CCHCF), and train staff for use of an off road-capable Mobile Health Van (MHV). The MHV requires a suspension, drivetrain, and tires suitable for use on unpaved, rough roads and in conditions with poor traction. It must be equipped with a patient waiting/triage area and a separate, private exam room; sinks; refrigerators for vaccine and lab specimen storage;

equipment for measuring patient vital signs; space for centrifuging laboratory specimens; and a portable toilet for patients to use while providing laboratory specimens. The project has two objectives: 1.) to produce a MHV that can be used to provide primary healthcare, including full physical exams, laboratory specimen collection, and vaccination, in areas that are currently impossible for the service unit to provide healthcare in and 2.) train CSU staff to use and properly maintain the MHV.

b. Anticipated project achievements: The project will produce a fully functional MHV that will allow Chinle Service Unit (CSU) to provide healthcare services to geographically isolated and underserved patients who cannot equitably access healthcare in one of the service unit’s permanent facilities. It will expand capacity for rapid responses to communicable disease outbreaks by bring testing and treatment services for infections, like syphilis, to where people live, which can stop disease transmission in the places where transmission is happening. The MHV will help CSU meet the Indian Health Service

(IHS) Strategic Plan goals 1.3.2, “Develop and expand programs in locations where AI/AN people have no access to quality healthcare services,” and 1.3.4, “Increase access to quality community, direct, specialty . . . and referred healthcare services . . . for AI/AN communities.” (Goal 1 | IHS Strategic Plan). The MHV will ultimately result in healthier communities, more equitable access to healthcare for all CSU residents, and decreased transmission of infectious diseases across the service unit. The project will also produce

CSU staff who can competently use and maintain the MHV.

c. Statutory authority in support of the project: The Indian Health Care Improvement Act of 1976, (25 U.S.C 1601 et. seq.) authorizes and requires the services provided by IHS and CSU, including the services that will be provided using the deliverable of this project: the MHV, and justifies the above referenced IHS Strategic Plan.

d. Purpose for pursuit of this project: This MHV project is being pursued to increase access to care for patients who live in the most remote areas of CSU. A large proportion of the people CSU is tasked with providing healthcare to cannot adequately access basic primary healthcare and chronic disease management resources due to poor road conditions and lack of personal transportation. This MHV project will allow the service unit to bring care to our most vulnerable patients instead of solely relying on them to come to established healthcare facilities.

e. Persons involved in the project: This project will be supervised by the CSU Division of

Public Health Population Health Director; the CSU Mobile Health Services Medical https://www.ihs.gov/strategicplan/goal-1/

Provider and Population Health support staff will also be involved in the project for day to day process management. The contractor will be responsible for designing, assembling, delivering to CCHCF, and training CSU staff to use and maintain the MHV.

2) Background Information:

a. How the project came about: CSU owns a large Mobile Health Clinic which can only travel on paved roads and requires a level place to park when providing patient care.

Those vehicle constraints have limited the service unit’s ability to quickly respond to infectious disease outbreaks and natural disasters. Additionally, the current Mobile

Clinic cannot access one of the jurisdictions in our service unit, secondary to road conditions, which creates a healthcare disparity because the Mobile Clinic brings healthcare services to all of the other remote jurisdictions in our catchment area. When a vendor presented their off-road capable Mobile Health Van at the 2023 Mobile Health

Association Annual Conference we realized it was possible to design an off-road capable

MHV that would eliminate those aforementioned constraints of our current Mobile

Clinic and enable the service unit to provide more equitable access to primary healthcare for all of the patients served by CSU.

b. Why the project is needed: This MHV project is needed to eliminate a major disparity in access to healthcare within the service unit, which also fulfills part of the IHS strategic plan. It is also necessary to increase our ability to respond to infectious disease outbreaks and prevent transmission sexually transmitted, and other types of, infections.

c. Relationship of the project to other agency goals and major programs: Upon completion of this project, the MHV will be available to support the majority of CSU Division of

Public Health strategic objectives and existing programs. It will expand the service unit’s

Mobile Health Program which increases the positive visibility of the of the service unit and will multiply the existing goodwill between the service unit and Navajo Nation governmental entities. The MHV will free up the existing Mobile Clinic to diversify the types of services it can provide to include maternal and child healthcare and ancillary health services like nutrition, physical therapy, and dental services. the MHV will also expand the areas that can be reached by vaccination campaigns and novel one-health endeavors.

d. Other projects related to the work defined in the SOW: Once this scope of work is completed, the final outcome MHV will require an internet system, which will be installed or contracted by CSU Information Resource Management staff; permanent external messaging, which will be designed and contracted by CSU Health Promotion staff; and ongoing maintenance with a local vehicle maintenance service provider, which will be contracted by CSU Population Health staff.

3) Scope of work for this Statement of Work:

The Contractor must design, assemble, deliver to Chinle Comprehensive Health Care Facility

(CCHCF), and train staff for use of an off-road capable Mobile Health Van (MHV). The MHV must be delivered to CCHCF with all necessary documentation and vehicle paperwork fully prepared by the contractor and the vehicle must meet the following specifications: It must be a cargo van equipped with modifications to satisfy off-road capability requirements while housing a fully-functional medical clinic with reception/triage area separated from the exam area by a privacy door, which cargo van must have a 159-inch wheel base and have a gross vehicle weight rating of 9,350 LBS, a 3.6L V6 gas engine that produces 280HP/260 LB-FT of torque. The vehicle must have a 9-speed automatic transmission, cruise control, and a back-up camera.

a. External vehicle modifications must include a 1.5-inch lift kit, rear progressive springs suitable for uneven/unpaved road conditions, self-adjusting shocks and struts, steel front strut spacers with a rear block system, 245/70/R16 10-ply wheels and tires, additional underbody steel protection using powder coated steel. Additional external vehicle modifications must increase frame durability on rough roads by installation of a rear body shell stiffener at the rear doors and a front grille guard consisting of at least a

4-point tubular steel frame system for maximum strength and rigidity. The standard sliding door must be modified to dual leaf door using P4 Flex - Side Opening Bus Doors with an opening width of 37 inches that is side mounted and must include a multiple step entrance with ambulatory entrance handles and an electric step that complies with

D409-16 8 & 9.4.5. A 98-inch running board suitable for supporting patient and staff weight must be mounted on the passenger side, 54-inch running board of comparable quality and durability must be mounted on the rear, and 36-inch comparable running board must be mounted on the driver side.

b. Internal vehicle modifications must transform the space behind the driver and front passenger seats of the standard van into a fully functional mobile medical lab vehicle

(see below layout) and must include the following: Closed cell insulation with white wipeable, non-fabric, lining on walls and ceiling, colored anti-slip flooring throughout the rear. Interior LED lighting and a rear ceiling mounted exhaust fan must also be present. The interior should be painted white. Structural additions to the van should include a solid white partition between the driver and passenger seats and the rest of the van. All storage all compartments should have lockable latches and/or latch-able clear sliding cabinet doors. Further structural additions to the van should conform to the following specifications, based on location in the rear space:

i. Along the partition behind the passenger seat: There must be a multifunctional bench/desk area with removable top cushion and under-desk stool storage with securements and a five-wheel rolling stool.

ii. Along the partition behind the driver seat: There must be a wall mounted medical grade diagnostic unit compliant with CSU biomed standards, with power supply.

iii. Along the passenger side wall: the front quarter should be open to allow for folding door access. To the rear of the door access should be a front facing full height cabinet for storage with storage for glove boxes in the top shelf that is accessible from the door area/vehicle exterior. To the rear of a floor to ceiling dividing insulated partition with lockable swing door, there should be a desk area with a simple sink/tap/canister set up with 12v water pump, and rear door access with pull out loading tray and a vaccine refrigerator. Over the desk should be upper cabinets, with protective edging.

iv. Along the driver side wall: the front quarter should have a wall mounted desk with simple sink/tap/canister set up that includes a 12v water pump and vaccine fridge. There should also be a counter top mounted self-leveling tray for device storage. To the rear of the dividing insulated partition with lockable swing door, there should be a narrow exam bed. Under the exam bed should be lower drawers, and storage for a portable toilet, above the exam bed should be a wall mounted sharps container.

v. In the rear quarter of the van there should be a ceiling mounted track with a privacy curtain and the rear door area should include door-mounted storage for glove boxes and a waste bin.

c. Electrical modifications/additions should include LED lighting and 120V receptacles throughout the patient care space and a full sized Medical Van High Capacity Rear

Compartment Heat and Air Conditioning Unit that is D409-16 6.11.3 compliant

d. The following additional equipment must be appropriately installed and include the following: a 10-pound fire extinguisher with vehicle bracket, back-up alarm, triangle kit with holder, first aid kit, and ambulatory entrance lighting that complies with D409-16

6.12.1, 6.13, 6.15; A domestic portable toilet with mounting brackets, rugged rear door slam resistor straps, compatible and high-quality remote start kit.

4) Applicable standards and general requirements: The MHV will be manufactured and equipped according to prevailing US standards and as referenced in the foregoing specification list when applicable.

5) Deliverables from the contractor:

a. An off-road capable Mobile Health Van that was designed, built, and equipped to the above specifications and delivered to CCHCF.

b. Training for selected CSU staff to ensure they are oriented to the van and understand operation of the MHV equipment.

6) Project tasks:

a. Contractor will complete the following tasks:

i. Design MHV to above specifications

ii. Procure the vehicle and all necessary equipment and parts

iii. Assemble the MHV according to above specifications

iv. Deliver MHV to CCHCF within 12 weeks of the contract being signed

v. Orient selected CSU staff to MHV equipment and operation

b. Chinle Service Unit will complete the following tasks:

i. Ensure Biomedical Department approval of installed medical equipment

ii. Identify and prepare internet communications system

iii. Design and contract external messaging for vehicle

iv. Arrange for vehicle licensing and insurance with General Services Administration

(GSA)

v. Add MHV to existing Mobile Health fleet credit card or obtain additional fleet credit card if necessary

vi. Schedule orientation to MHV with contractor and selected SCU staff

vii. Identify MHV vehicle service entity for routine maintenance.

7) Location of Work:

a. Design; vehicle, parts, and equipment procurement; and assembly of the MHV according to the above specification will be performed at the contractor’s location of choice.

b. Delivery will be from the contractor’s assembly location to CCHCF in Chinle, AZ

c. Orientation of CSU staff will preferably be at CCHFC if that does not incur additional costs. If orientation at CCHCF will incur additional cost, orientation can be completed virtually.

d. All tasks completed by CSU staff tasks will be performed at CCHCF.

8) Responsibilities: The contractor is only responsible for accomplishing those elements that are included in the signed contract.

9) Acceptance Standards: The MHV will be accepted upon demonstration that the vehicle operates according to normal vehicle operation expectations, all equipment is in good working order, equipment manuals for the vehicle itself and any installed equipment are provided, and orientation to the vehicle and its equipment is completed by selected CSU staff.

10) Delivery schedule: The MHV should be delivered 8 to 10 weeks, but no longer than 12 weeks, after the contract is signed.

11) Acronyms:

a. MHV: mobile health van

b. CSU: Chinle Service Unit

c. IHS: Indian Health Service

d. SOW: Statement of Work

e. GSA: General Services Administration