RFI-442-17-000003_Evidence_to_Policy.pdf

REQUEST FOR INFORMATION (RFI)

Evidence to Policy

The Office of Public Health and Education (OPHE) at USAID Cambodia has developed a DRAFT Statement of Work (SOW) / Statement of Objectives (SOO) for the Evidence to Policy Activity. The purpose of this RFI is to provide industry and stakeholders an opportunity to review, comment, suggest and enhance areas in the DRAFT SOW/SOO. The DRAFT SOW/SOO is anticipated to result in a finalization of the SOW/SOO that may lead to a formal solicitation for potential offerors. The potential period of performance is for five years within an award value in the range of $4 to 9.99 million (see USAID Business Forecast). The Draft SOW/SOO is provided in the following pages.

DISCLAIMER

This Request for Information (RFI) is issued solely for information and planning purposes. It is not a Request for Proposal, a Request for Quotation, an Invitation for Bids, a Solicitation, nor an indication that OAA will contract for the items contained in this Notice. The RFI is an attempt to reach out to the market in an effort to determine the scope of industry capabilities and interest and will be treated as information only. In accordance with FAR 15.201(e), responses to this notice are not offers and cannot be accepted by the Government to form a binding contract. Responses to this RFI are strictly voluntary and USAID will not pay respondents for information provided in response to this RFI. Responses to this RFI will not be returned and respondents will not be notified of the result of the review. If a Solicitation is issued, it will be announced on the Federal Business Opportunities website http://www.fbo.gov at a later date, and all interested parties must respond to that Solicitation announcement separately from any response to this announcement.

This RFI does not restrict the Government's acquisition approach on a future Solicitation.

INSTRUCTION

Responses (comments, suggestions, and enhancements) to this RFI are due to the procurement office identified below by April 13, 2017 at 4:00 pm, Phnom Penh time. Interested parties shall provide one (1) electronic copy of their response; electronic submissions, in Microsoft Word or Adobe Acrobat formats are acceptable. Please e‐mail responses to Honey Sokry at hsokry@usaid.govwith a copy to PhnomPenhOAA@usaid.govwith the subject title “Response to Evidence to Policy (E2P) RFI”.

http://www.fbo.gov/ mailto:hsokry@usaid.gov mailto:phnompenhoaa@usaid.gov

REQUEST FOR INFORMATION (RFI)

QUESTIONS

The USAID/Cambodia Evidence to Policy (E2P) project is seeking comments on the draft Statement of Work (SOW)/Statement of Objectives (SOO) attached to this letter. Please ensure comments are concise and specific to information requested. Please ensure that submitted comments make specific reference to page and section numbers of the SOW/SOO. Special consideration should be given to the following:

1. The research agenda:

● Where are the most critical gaps in health policy knowledge in the areas of nutrition, maternal and child health, family planning, TB and malaria?

2. Knowledge translation:

● What are the most effective mechanisms for translating knowledge into policy and practice in the Cambodian context?

● Which communication strategies are people most likely to respond to in adapting operational strategies in line with research outcomes?

3. Capacity building approaches:

● The E2P project aims to conduct research and evaluative assessments working collaboratively with the host government and local research institutions in support of other USAID projects in the health sector. What type of targeted technical assistance or capacity building would increase the relevance of the E2P project for the host government?

4. What are likely to be the greatest challenges for strengthening health research in Cambodia, translating research results into policy, and for this project in the next five years? How can the program design account for those challenges?

5. What would be important selection criteria for key project management and technical staff to enable this project to achieve its goal and objectives?

REQUEST FOR INFORMATION

DRAFT SOW/SOO

1. INTRODUCTION

This Statement of Objectives (SOO) describes the objectives of the U.S. Agency for International Development in Cambodia (USAID/Cambodia) for a five-year award to achieve the purpose of improving the generation and use of high-quality evidence in health policy decision making in Cambodia, which can support U.S. government development objectives focused on improving healthy behaviors, health financing, and quality of healthcare services in Cambodia.

The activity will accomplish this purpose through three specific objectives: 1) Generate high-quality evidence that meets global standards to identify critical knowledge gaps and validate interventions and innovative approaches specifically linked to activities conducted by USG-supported health activities; 2) Apply evidence to advocate for, inform, and guide the development, revision, adoption, or implementation of health policies and regulations that impact USG efforts to improve healthy behaviors, health financing, and quality; 3) Strengthen the ability of policymakers to acquire, analyze, adapt, and apply evidence in policy formulation and implementation relevant to health financing, healthy behaviors, and quality.

2. BACKGROUND

Context

Since 2000, Cambodia has made significant progress in improving the health of its people. Life expectancy at birth rose from 61.9 in 2000 to 71.4 years in 2012, and solid achievements have been made toward reaching Millennium Development Goals 4, 5 and 6. Childhood mortality has decreased by more than half, from 83 deaths among children under five per 1,000 live births in 2005 to 35 in 2014. Significant increases in deliveries attended by skilled health workers have contributed to dramatic reductions in maternal mortality; from 472 per 100,000 live births in 2005 to 170 in 2014. The use of modern contraceptive methods has more than doubled, from 19 percent in 2000 to 39 percent in 2014, and there is currently nearly universal knowledge about contraceptive methods. Malnourishment has also dropped significantly in Cambodia.

Among children under five, there has been a 36 percent decrease in rate stunting, a 41 percent fall in rate wasting, and a 38 percent drop in rate those underweight for their age according to DHS data on 2000 and 2014. The Human Immunodeficiency Virus (HIV) prevalence rate has decreased by more than half from 1.7 to 0.6 percent between 1998 and 2014, and the number of people dying from tuberculosis (TB) and living with the disease has been reduce by half between 2004 and 2013. The number of malaria cases in Cambodia has fallen dramatically from almost 113,855 in 2004 to approximately 56,271 in 2014. Cambodia reported only one death from malaria in 2016, down from nearly 400 a decade ago.

Policy Environment

There are numerous Royal Government of Cambodia (RGC) policies, strategies, and regulations in place that guide the health system across all of the main health elements. Some important examples include the Health Sector Strategic Plan (HSP-3), the RGC’s Rectangular Strategy, National Strategic Development Plan (NSDP) 2014-2018, National Strategic Plan IV (NSP-IV) for HIV/AIDS, National Social Security Framework, National Program for Sub-National Democratic Development (2010-2019), and the Fast Track Initiative for Reducing Maternal and Newborn Mortality. Cambodia is also a signatory to a range of high profile global development agreements, like the Sustainable Development Goals, and is a member of global health bodies, like the Scaling Up Nutrition (SUN) movement.

Line ministries develop policies and regulations, and a range of standing Technical Working Groups (TWGs) that include relevant donor, non-governmental organization (NGO), and civil society representatives are useful fora for discussing these documents and their impact. On an ad hoc basis, research that may guide these policies and regulations is shared in these TWGs.

The RGC’s National Institute of Public Health (NIPH) is the primary organization for public health research in the Ministry of Health, and it has the potential to become the main RGC entity for driving the translation of evidence into policy. NIPH is currently taking the lead in establishing a Health Research TWG, which will be an important forum for public health evidence to policy activities in Cambodia.

Challenges

There are many health-focused and related RGC policies, strategies, and regulations as noted above. However, there are still gaps. For example, there is no national strategic behavior change policy. Such a policy would help address the key issue of Cambodians appearing to be highly aware of what healthy behaviors are but not practicing them. Another example is that recent research has shown the efficacy of selected HIV prevention approaches, but these have not been integrated into current national program policies or strategies. Consequently, there is still significant scope for improving evidence generation to strengthen existing documents and develop new impactful RGC guidelines, particularly to help improve healthy behaviors, health financing, and quality.

Numerous global health initiatives have promoted the application of knowledge to policy, yet the use of evidence by policymakers to inform programs remains a challenge. In a policy environment where design and implementation decisions are not consistently based on lessons learned, there is a good opportunity to strengthen traditional approaches to knowledge translation, such as policy dialogue and media-based strategies, and to build the capacity of researchers to communicate results to policymakers, or media-based strategies. Effective knowledge translation calls for more innovative mechanisms to bridge the divide between knowledge generation and uptake. Policymakers need to be engaged in the production and use of the knowledge to ensure its relevance and increase the prospect of it being applied in future decision-making. Taking this one step further, the goal of an evidence-to-policy approach is for local policymakers to be generating demand for the evidence needed to solve their own implementation and operational challenges.

In 2016, the World Bank raised Cambodia’s status from a low-income to a lower-middle income economy. As a lower-middle income country undergoing rapid growth and development, Cambodia is expected to take a greater role in and responsibility for improving the lives of its people. Consequently, the trend of decreasing donor funding for development activities will continue. Health is a prime example of an area where the RGC will have to take on an increased responsibility for developing, financing, and implementing programs. To ensure that the health needs of Cambodians are being met, it is critical that the RGC has the most appropriate policies and regulations in place to support health programming, based on rigorously generated evidence that shows what are the most effective and efficient ways to address health issues in Cambodia.

3. Activity Description

(a) Purpose

The purpose of this Activity is to improve the generation and use of high-quality evidence for health policy decision making in Cambodia in order to support U.S. government (including USAID) activities and development objectives focused on improving healthy behaviors, health financing, and quality of healthcare services in Cambodia.

Achievement of the purpose will be demonstrated through the application of evidence to policy formulation, related to improving healthy behaviors, health financing, and quality of healthcare services in Cambodia. Activity impact will be measured at an outcome level by analyzing the number of policies and operational guidelines that incorporate lessons learned from the research conducted; evaluating the extent to which the Activity has built the capacity of local researchers to conduct global standard research and of policy-makers and implementers to identify and use evidence in solving implementation problems; and through evidence of increased demand from policy makers for additional evidence on implementation and operational strategies. Given NIPH’s crucial role in translating evidence either generated by themselves or through local partners into RGC policies and regulations, the Activity will coordinate closely with and strengthen the NIPH, support the Health Research TWG, and contribute to the development of a National Agenda for Health System Research to ensure that the Activity’s research activities are aligned with the RGC’s priorities. An n important measure of the Activity’s impact will be how well NIPH can take the leadership role in coordinating the uptake of the research based policies and guidelines that are developed through this Activity. Longer-term impact will be measurable at the health sub-sector level, as policy improvements result in the practice of improved healthy behaviors, greater domestic resource mobilization for health financing, and improved quality healthcare.

(b) Program Principles

Gender equality and women empowerment

USAID recognizes gender equality and female empowerment as core development objectives, fundamental to the realization of human rights and key to achieving positive health and development outcomes. Gender norms and expectations, as expressed in the different roles and responsibilities and reflected in the differential status of women, men, boys and girls within society, fundamentally affect health at the individual, community and societal levels. Gender norms and expectations, which are established early in life and reinforced by families and in communities, often dictate health-related behavior. USAID’s investments across sectors, including health, are aimed at achieving and sustaining three overarching outcomes related to gender equality:

• Reduce gender disparities in access to, control over and benefit from resources, wealth, opportunities and services- economic, social, political, and cultural;

• Reduce gender based violence and mitigate its harmful effects on individuals and communities;

• Increase capability of women and girls to realize their rights, determine their life outcomes, and influence decision making in households, communities, and societies.

As stated in USAID’s Global Health Strategic Framework, USAID’s goals to address gender equality in health include:

• Ensure equitable access to essential health services at facility and community levels;

• Increase the meaningful participation of women and girls in planning, design, implementation, monitoring, and evaluation of health program decision making bodies;

• Monitor, prevent, and respond to gender based violence;

• Empower adolescent and pre-adolescent girls by fostering and strengthening their social networks, educational opportunities, and economic assets;

• Engage men and boys as clients, supportive partners, and role models for gender equality;

• Promote policies and laws that will improve gender equality and health status and/or increase access to health and social services;

• Address social, economic, legal and cultural determinants of health through a multi-sectoral approach;

• Utilize multiple community-based programmatic approaches, such as behavior change communication, community mobilization, advocacy, and engagement of community leaders/role models to improve health for women and girls as well as men and boys;

• Build the capacity of individuals, with a deliberate emphasis on women, as health care providers, caregivers, decision makers throughout the health systems, from the community to national level; and

• Strengthen the capacity of institutions that set policies, guidelines, norms and standards that impact access to, and quality of, health-related outreach and services – to improve health outcomes for women and girls and promote gender equality.

(c) Objectives and Expected Results

Objective 1: Generate global standard evidence that identifies critical knowledge gaps and validates interventions and innovative approaches specifically linked to and based on activities conducted by USG’s projects focusing on improving healthy behaviors, health financing, and quality.

Illustrative results:

● Roadmap jointly developed with the RGC identifies key SBC, health financing, and quality gaps in the Cambodian health system for research.

● International standard quality research activities aligned with RGC research priorities for improving healthy behaviors, health financing, and quality are finished, disseminated, and published.

The Contractor will work with various local partners to develop and conduct qualitative and quantitative research activities about health interventions and innovations that are relevant to USAID's efforts to improve SBC, health financing, and quality. The short-term impact of this Activity will be increased capacity of local researchers both within and outside the RGC to conduct international standard research. The project will coordinate closely with NIPH, actively participate in the Health Research TWG, and contribute to the development of a National Agenda for Health System Research to ensure that the Activity’s research activities are aligned with the RGC’s priorities.

Objective 2: Apply evidence to advocate for, inform, and guide the development, revision, adoption, or implementation of health policies and regulations that support USG activities focused on improving healthy behaviors, health financing, and quality.

Illustrative results:

● Efficacy, cost-effectiveness, and scalability of interventions and innovations for improving healthy behaviors, health financing, and quality are assessed in collaboration with policy-makers, implementers and end-users of the data.

● Political awareness increased on proven methods for improving healthy behaviors, health financing, and healthcare service.

● Evidence-based national and subnational policies and regulations for SBC, health financing, and quality are developed, revised, adopted, or implemented.

While the short-term impact of this Activity will be the generation of high-quality evidence and increased capacity of local researchers to continue similar research in the future, the long-term impact of this Activity will be the introduction of a new approach to policy decision making. As a result of collaboration between policymakers, implementers and end-users of evidence, it is anticipated that policies and regulations will be introduced that more readily support U.S. government (USG) and USAID development objectives focused on improving healthy behaviors, increasing financing for health, and improving quality of healthcare services in Cambodia. Additionally, as a result of this Activity, NIPH will solidify its role as the key RGC entity for translating evidence into policy, and the Health Research TWG will be the main platform for evidence to policy actions.

The Contractor will need to propose the most effective means for translating the evidence generated under Objective 1 into policy actions.

Objective 3: Strengthen ability of policymakers to acquire, analyze, adapt and apply evidence in policy formulation and implementation relevant to health financing, healthy behaviors, and quality.

Illustrative results:

● Capacity of public and local policymakers to analyze and use data to develop, update, implement, monitor, and evaluate policies and regulations relevant to health financing, healthy behaviors, and quality is strengthened.

● Policymakers are engaged in collaborative approaches to demand, generate and apply new knowledge.

Ensuring that policymakers have the capacity to transform evidence into policy is critical for the success of this Activity and for more broadly strengthening the enabling environment for improved healthy behaviors, health financing, and quality in Cambodia, building on the support provided to date by the U.S. Government. This activity will develop the skills of policymakers to analyze evidence and use this data to develop, implement, monitor, and evaluate macro-level and operational policies and legal and regulatory frameworks. Since USAID/Cambodia’s new Health projects as well as the U.S. CDC will be engaged in a range of capacity building activities, this Activity will coordinate closely with NIPH and the Ministry of Health to ensure that efforts are complementary rather than duplicative and that the most appropriate and effective capacity building techniques are used. The impact of these capacity building efforts will be a health policy making system where evidence-to-policy approaches, or more rational policy making approaches, are institutionalized, resulting in turn in the development, revision, adoption, and implementation of policies and regulations that more readily support U.S. government (USG) and USAID development objectives focused on improvements in healthy behaviors, increased financing for health, and improvements in the quality of healthcare services in Cambodia.

4. Relationship to Other Development Programming and Mission CDCS

(a) Relationship to USAID and Other Development Partners’ Programming

Current

This E2P Activity will support current activities that will still be active when it starts in January 2018.

● The Quality Health Services (QHS) activity improves the services in public-sector clinics and hospitals to improve maternal, neonatal and child health. QHS has been active in the policy arena and has successfully advocated for the adoption of Health Center Safe Motherhood and Midwifery Coordination Alliance Team (MCAT) protocols. The E2P activity will explore ways to promote the scale-up of these strategies.

● The Cambodia Malaria Elimination Project activity intensifies malaria elimination activities in Cambodia by supporting a Model Elimination Package for Malaria, quality malaria control and prevention interventions in targeted operational districts, improved national malaria surveillance systems, and improved capacity of RGC staff working on malaria. The E2P Activity will support building an evidence base to shift policy from malaria control to elimination and conducting therapeutic efficacy studies of antimalarial drugs that may result in a policy change for malaria treatment.

● The GIZ activity is working with the Quality Assurance Office within the Department of

Hospital Services to update the National Policy on Quality Assurance and its accompanying master plan. The Activity will also help support the rollout and scale-up of this policy.

In addition to these current USAID awards, this Activity will coordinate with development partners implementing evidence-to-policy interventions. For example, the project will ensure that its activities align with the World Health Organization’s (WHO) assistance to the RGC to develop evidence-based policies and guidelines.

The E2P Activity will also support future activities that USAID is currently or anticipates designing under its current Health Strategy.

Planned Activities

● The Quality Improvement activity aims to improve health care service quality in both public and private sectors through improved efficiency and effectiveness of service delivery, and improved regulation, licensing and accreditation systems. In the policy realm, the activity will work to ensure that policies and guidelines for quality improvement incorporate key quality requirements by different program areas (such as MCH, FP, HIV, TB, and malaria) that are aligned with international standards. The E2P Activity will help develop these policies and guidelines and support their rollout.

● Linkages across the Continuum of HIV Services for Key Populations Affected (LINKAGES) will provide technical assistance to the national and provincial HIV/AIDS programs to optimize the NCHADS Community Action Approach (CAA) for national scale-up; rapidly scale up cost-effective interventions that can improve and accelerate new case detection; and adapt and implement guidelines for services that are free of stigma and discrimination, to increase case detection and retention. LINKAGES will also assist NCHADS and provincial programs to analyze community-based HIV testing data, address operational challenges, and use the findings to refine the CAA approach and to inform policy. The E2P Activity will support the use of data and evidence to promote policies that can lead to sustained elimination of HIV.

● The Health Financing activity will provide technical support and capacity building to the government's Social Health Protection (SHP) Framework, social health insurance (SHI) schemes and health financing approaches toward sustainable Universal Health Coverage (UHC). The E2P Activity will support evidence and advocacy efforts to promote the adoption and implementation of UHC.

● The Water, Sanitation, and Hygiene (WASH) activity will address this complex public health challenge by promoting the use of latrines, practical water treatment methods and best practices for personal hygiene to reduce water-borne diseases. The E2P Activity will help generate evidence and explore the possibility for WASH policy changes in Cambodia.

● The Social and Behavior Change (SBC) activity will strengthen the capacity of the RGC’s National Center for Health Promotion (NCHP) to work with other relevant ministries to develop, budget, monitor, and mobilize resources for quality and impactful SBC strategies and campaigns. Additionally, the activity will explore and develop strategies for engaging the private sector in SBC strategies. The E2P Activity will help assess the most cost-effective SBC interventions and will also support development of a national SBC strategy.

● The Cambodia Democratic Development Program (CDDP) activity, funded through the Democracy and Governance Office, will build more responsive, democratic local governance and service delivery in Cambodia. OPHE’s contribution to CDDP will improve local governance and financing for health and social service delivery and foster inclusive citizen engagement on health and social services. The E2P Activity will support the CDDP’s efforts to strengthen and develop evidence-based policies and strategies that improve health governance at the sub-national level.

(b) Alignment with USG Country Development Cooperation Strategy and

USAID/Cambodia Health Strategy

This Activity will help improve the policy and regulatory framework that is critical for achieving the USAID/Cambodia Health strategy’s sub-purposes of improved health and child protection behaviors, improved health financing and social health protection, and improved quality of public and private health and social services. Progress on these sub-purposes will contribute to attaining the new Health strategy purpose of “Cambodian people seek and receive quality health care and social services with decreased financial hardship through more sustainable systems.” Progress toward this purpose in turn supports the achievement of USAID’s 2014-2018 Country Development Cooperation Strategy (CDCS) Development Objective (DO) 2: Improved Health and Education for Vulnerable Populations.

Other United States government agencies working on health in Cambodia include the Centers for Disease Control and Prevention (CDC); the President's Emergency Plan for AIDS Relief (PEPFAR); Peace Corps; the Department of Defense; the Armed Forces Research Institute of Medical Sciences; and the Naval Medical Research Unit. The Activity will coordinate with these agencies' efforts, especially the CDC, to ensure that activities complement rather than duplicate each other. The CDC has provided significant support to strengthening the NIPH, and this Activity will involve close coordination and collaboration with the CDC to help increase the NIPH’s capacity to translate evidence into policy.

5. Other Information

In order to achieve the project purposes of generating evidence of an international standard that can inform future health-related policy-making, and strengthening the capacity of local partners to conduct such research, it is anticipated that the lead partner would sub-contract with local Cambodian organizations. Offerors are invited to propose the contractual relationships it would enter into to deliver on the project and the organizational structure it would put in place to manage those relationships.