Justification and Approval 72012118C00001 HRS.pdf

JUSTIFICATION AND APPROVAL (J&A)

TO: Daniel Harter, Supervisory Contracting Officer

CC: Deborah Broderick, Agency Competition Advocate

FROM: Paola Pavlenko, Senior Health Project Management Specialist, Office of Health

DATE: October 26, 2020

RE: Contract No. 72012118C00001, the Health Reform Support (HRS) Activity

SUBJECT: Justification for Other than Full and Open Competition under the Expedited Procedures Package (EPP) for Responding to Outbreaks of Contagious Infectious Diseases

You are requested to approve this justification for use of other than full and open competition pursuant to the authorities under the EPP for Responding to Outbreaks of Contagious Infectious Diseases (the “Expedited Procedures Package”), approved on March 24, 2020. Your approval of this J&A constitutes the justification for other than full and open competition as required by Tab 1 (Determination and Findings (D&F) Authorization for the Use of Other than Full-and-Open Competition in the Award or Modification of Contracts) of the EPP.

a. Nature and/or description of the action being approved .

This is a request to approve a contract modification to increase the total estimated cost (TEC) of Contract No. 72012118C00001, Health Reform Support (HRS) Activity, implemented by Deloitte Consulting, LLP (Deloitte or “the contractor”). The proposed modification will increase the TEC by $8,500,000 from $28,791,167 to $37,291,167.

The additional ceiling will increase the likelihood of successfully achieving the key objectives of the HRS Activity under the original Statement of Work (SOW), as the implementation progress over the last nine months has been negatively impacted by the COVID-19 epidemic. The epidemic has severely strained the national healthcare system, including financing, service delivery organization and workforce - all areas that are simultaneously undergoing major systemic reforms, and are areas which are the focus of the support and technical assistance by the HRS Activity. As a result of COVID, the rollout of these reforms has faced unanticipated delays, requiring additional resources and effort than originally anticipated within the award ceiling to achieve project objectives.

If approved, this action will allow HRS to extend needed support to the Government of Ukraine (GoU) in the sustainable implementation of reforms of the healthcare system at the national and sub-national levels, and will enable increased effort needed to address challenges to the healthcare reforms imposed by the COVID-19 response. It will contribute significantly to overall health system resilience, effectiveness and transparency, will help Ukraine to better respond to COVID-19 and other serious public health threats, and it will strengthen USAID’s collaboration and partnership with the GoU and other key stakeholders, including the private sector.

b. A description of the supplies or services required to meet USAID’s needs (including the estimated value).

An $8,500,000 TEC increase will allow USAID to respond to the critical need of the GoU to continue and to adjust ongoing reforms of the healthcare financial system and public health system in the context of the COVID-19 epidemic, which has a particular heavy impact on the specialized in-patient and out-patient care facilities targeted by the reforms and supported by the HRS Activity. The activities envisioned in this TEC increase align and fall within the SOW’s original objectives.

Specifically, additional support to mitigate the impacts of COVID-19 will be provided under the current five project’s objectives as outlined below, including illustrative activities to the following activities which are not limited to the list below:

Objective 1: Improve health sector governance

Additional effort is required under this objective to address governance challenges arising from the COVID-19 epidemic that are straining the implementation of health reforms. Illustrative activities include, but are not limited to:

● Provide technical assistance and build the analytical and policy-making capacities of the Ministry of Health (MOH) to review and improve the Program of Medical Guarantees, in collaboration with the National Health Service of Ukraine (NHSU), Center for Public Health, Ministry of Finance, and the Health RADA Committee.

● Provide technical assistance to the to identify and address the barriers to successful implementation of the health care reforms in the Donetsk and Luhansk conflict affected areas, taking into account the need to address the COVID-19 impact, in collaboration with the MOH, NHSU, Ministry of Temporarily Occupied Territories of Ukraine (MinTOT) and local government authorities.

● Provide organizational and expert support to the MOH in setting up and running the multi-sectoral working group to develop the new Ukraine’s health sector 10-year strategy that would address ongoing healthcare reforms and recovery of the health system from the COVID-19 pandemic.

● Provide institutional, technical and expert support to the MOH in further developing the eHealth system development and sustainable operation in Ukraine, including addressing quality of care issues.

● Review the current anti-corruption practices in health services financing and provision by the MOH, NHSU and MOH’s eHealth State-owned Enterprise, and support the implementation of the resulting recommendations for improvement.

● Support regional state administrations and local communities in developing their hospital networks, building on lessons from the COVID-19 pandemic.

● Support regional state administrations and hospital district councils in the development of an efficient network of people-centered TB services at the primary and secondary specialized levels.

Objective 2: Support the transformation of the healthcare financing model

Additional effort under this objective will support the GoU to build on Phase I and Phase II reforms, including addressing the financial strains on the state Program of Medical Guarantees (PMG) imposed by the COVID-19 pandemic. Illustrative activities include, but are not limited to:

● Support the MOH, in collaboration with the key GoU central agencies and local governments, in developing cost effective and sustainable systems of multi-channel financing of healthcare services in the context of COVID-19 epidemic.

● Support the review, costing, development and possibly piloting of the specific financing mechanisms for the HIV/AIDS and TB related services at the primary and specialized care levels.

● Support MOH and NHSU in the development and piloting of the system of key performance quality indicators in the financing of primary care services, and TB services of specialised health care facilities.

● Support MOH and NHSU in exploring the opportunity and piloting the inclusion of telemedicine services into the packages of services in the Program of Medical Guarantees to support continuity of health system functioning during a public health emergency.

Objective 3: Strengthen the health workforce

Additional effort under this objective will build on efforts to strengthen the workforce for health reform, accelerating efforts slowed by the COVID-19 pandemic. Illustrative activities include, but are not limited to:

● Support the development of training opportunities for telemedicine services to respond to the COVID-19 quarantine limitations of travel and meetings.

● Support the design and piloting of health workforce innovations linked to broader reforms to improve resilience of the health system’s response and recover from COVID.

● Develop motivation mechanisms for the primary healthcare providers to deliver infectious diseases services, such as tuberculosis and HIV, under the state Program of Medical Guarantees.

Objective 4: Enhance transparency, accountability, and responsiveness of the health care system

Additional effort under this objective will build on efforts to strengthen health system responsiveness, accelerating efforts slowed by the COVID-19 pandemic. Illustrative activities include, but are not limited to:

● Support interoperability of the telemedicine functionality with the eHealth system central database (CDB).

● Support the development and launch of the ’patient cabinet’ functionality that is interoperable with the eHealth system CDB.

● Strengthen the role of Ukraine’s professional association of medical information systems in continued quality improvement, user-friendliness and reliability of the eHealth system.

Objective 5: Improve service delivery system at all levels

Additional effort under this objective will further efforts to improve service delivery, with an emphasis on addressing quality of care, and helping to mitigate the impacts of the COVID-19 pandemic on delivery of essential services. Illustrative activities include, but are not limited to:

● Support MOH and selected regional state administrations in the design and implementation of hospital district development plans, taking into account the lessons of the current COVID-19 response.

● Support integration of public health related key quality indicators in primary health care (for example, coverage by immunization and vaccination; ambulatory care of TB patients, monitoring of blood pressure of patients with risk of CVD, monitoring of blood sugar by patients with diabetes)

● Support the MOH and NHSU in the implementation of the quality control of provision of selected critical services, including TB services according to the national Standards of TB services provision.

● Support the design and launch of a public-private partnership to showcase private sector investment into a modern hospital facility reprofiling with the quality of care and infection control (incl. for COVID-19 ) meeting the best international standards.

As a result of augmented and expanded activities supporting the implementation of health system reforms, with due attention to the COVID-19 response and recovery measures, USAID expects the HRS Activity will achieve the goals and objectives originally expected under the subject award that have been hampered or delayed by the COVID pandemic. At the same time, the HRS Activity will continue to support efforts that may contribute to a more resilient healthcare system better able to respond to severe public health threats, while advancing more tangible results in reducing corruption in the health sector and improving the access of Ukrainians to better quality services.

c. Identification of statutory authority permitting other than full and open competition .

AIDAR 706.302-70(b)(3) and 40 U.S.C. §113; See the “Expedited Procedures Package for Responding to Outbreaks of Contagious Infectious Diseases” approved March 24, 2020. The

D&F is attached to this file in Tab 1. The EPP can only be used for an Infectious Disease Outbreak, as defined in paragraph 2 of the D&F (Tab 1). The COVID-19 outbreak was declared a Public Health Emergency of International Concern by the World Health Organization (WHO) on January 30, 2020 and therefore the class D&F applies to COVID-19 emergency response activities.

d. A discussion of the proposed contractor’s unique qualifications or the nature of the acquisition that requires use of the authority cited .

The impacts of COVID-19 are negatively affecting health systems and the pace of health reforms in Ukraine. Additional support is needed to mitigate longer term consequences of the pandemic on these systems to ensure better access to healthcare. Deloitte is uniquely positioned to bring the greatest degree of effectiveness and expertise to the implementation of the activities for strengthening health reform efforts in the context of COVID-19 for the following reasons:

(i) Complementarity with Existing Programming: Deloitte is the current implementer of HRS, and an increase in funding will allow Deloitte to seamlessly build upon the activities and efforts already supported through HRS. For example, HRS is already working closely with MOH, NHSU, and selected regional state administrations to help them design and implement their hospital districts development plans that would take into account the lessons of COVID-19 response and address the secondary impact of COVID on the routine healthcare services and facilities networks.

(ii) Operations: Operationally, Deloitte has a well-established office in Kyiv, which is fully staffed with highly qualified technical international and local experts that have built strong relationships with key stakeholders. The existing office space can be easily expanded and additional staff mobilized to provide additional support needed to strengthen current efforts to address and mitigate the impact of COVID-19. Deloitte’s organizational and staff expertise have solid records of performance in Ukraine.

(iii) Technical Expertise: Deloitte’s technical team has developed great expertise as a result of working in Ukraine for over three years , providing extensive technical assistance to the GU on health sector improvements and strengthening health systems . Collaborating with the key central government agencies, including MOH, Ministry of Finance, NHSU, and sub-national governments has provided Deloitte technical staff with a deep understanding of the national and local health systems strengths, weaknesses, and opportunities to respond to the systemic reforms launched by the GOU. Deloitte, together with their implementing partners, have a diverse capacity on which to draw to provide expanded assistance to the MOH and the GoU in many technical areas of strengthening health reform efforts, including legal, communication, health services, and management. This uniquely qualifies them to work effectively to help the GOU and local communities to continue reforming the health sector while addressing the COVID-19 impact and improving resilience to the similar public health challenges.

(iv) Relationships with Key Stakeholders: Over the course of three years, Deloitte and its implementing partners – Deloitte-Ukraine and Palladium have developed strong relationships and built partnerships with government organizations, civil society, multilateral organizations and other stakeholders to collaborate on health reform activities, which are critical to the successful continuation of the current health care reform efforts in the context of COVID-19. For example, Deloitte is working closely with the Lviv Oblast State Administration, building on the foundational preparatory work done jointly with the World Bank experts, to de sign a Hospital District Development Plan (outlining how the region will target investments, modernize and strengthen hospitals, and modify patient pathways to provide timely, high quality medical care to all patients) that would address ongoing healthcare reforms and recovery of the health system from the COVID-19 pandemic.

This gives the current HRS implementer – Deloitte - an overall comparative advantage of continuing this activity with increased funding and exceeds the benefits of a competitive process encouraged by law and required by Agency policy. A new implementer will likely not have the same breadth and depth of productive relationships with GoU counterparts, and would require considerable time to develop such relationships given the current situation with COVID epidemic and limited availability of counterparts.

e. A description of efforts made to ensure that offers are solicited from as many potential sources as is practicable.

No efforts have been made to ensure that offers were solicited from as many potential sources as practicable because the needed services described herein are within the original scope of the contract’s current objectives. This requirement to meet the GoU’s needs is based on Deloitte’s unique qualifications and proven work under the current contract to enable rapid, responsive support during the context of the ongoing COVID-19 outbreak.

f. A determination by the Contracting Officer that the anticipated cost to the Government will be fair and reasonable.

The estimated budget is based on historical costs for similar services. The Contracting Officer has determined that awarding this TEC increase will cost substantially less and be of shorter duration than competitively procuring a new contract. The Contracting Officer, by signing this document, certifies that the estimated costs to the U.S. Government, as required by the independent government cost estimate, for the award under the subject contract, represent the best value to the Government and that such an acquisition is appropriate and reasonable. Upon approval of this justification, the Contracting Officer will request technical and cost proposals from the contractor for the additional work requested. The Contracting Officer will conduct a thorough cost analysis of that proposal, with the same level of rigor as used with a competitive procurement, to ensure that the actual cost to the U.S. Government is fair and reasonable.

g. A description of the market research conducted (see FAR Part 10) and the results or a statement of the reason(s) market research was not conducted .

No new market research was conducted. Deloitte was competitively selected as the contractor through a full and open procurement in 2018. Since the purpose of the proposed TEC increase is to mitigate the impacts of COVID-19, it is not feasible to select another contractor that would be able to undertake these activities promptly given the GoU’s needs for support and technical assistance, as well as the contractor’s established relationships with key GoU and private sector counterparts.

h. A listing of the sources, if any, that expressed, in writing, an interest in the acquisition.

Publication of a notice is not required per the determination at AIDAR §705.202(b) and no sources submitted a written expression of interest in this acquisition.

i. A statement of the actions, if any, USAID may take to remove or overcome any barriers to competition before any subsequent acquisition of the supplies or services required.

The proposed modification is a specific and unique case based on the GoU’s specific needs for continuity of support on health reform implementation. Any subsequent or future need of support will be procured through full and open competition.

RECOMMENDATION

It is recommended that you approve this justification for use of other than full and open competition pursuant to the “Expedited Procedures Package for Responding to Outbreaks of Contagious Infectious Diseases”, approved on March 24, 2020. Your approval of this J&A constitutes the justification for other than full and open competition as required by Tab 1 (D&F for the Authorization of Less than Full and Open Competitive Procedures in the Modification or Award of Contracts) of the EPP.

Ecl. Tab 1- EPP D&F for the Authorization of Less than Full and Open Competitive Procedures in the Modification or Award of Contracts.

CERTIFICATION:

The requirement for technical certification at FAR 6.303-1(c) is fulfilled through:

Paola Pavlenko

Digitally signed by Paola Pavlenko Date: 2020.11.20 11:35:17 +02'00'

Daniel Harter Digitally signed by Daniel Harter Date: 2020.11.23 10:56:18 +02'00'