RFI-687-17-001.pdf

Request for Information number: RFI-687-17-001

RFI Issuance Date: May 9, 2017

Closing Date and Time: May 23, 2017; 5:00 pm Antananarivo local time

SUBJECT: Request for Information (RFI) No. RFI-687-17-001: Total Market Initiative for

Health Product Supply in Madagascar (TMI-HPS)

USAID/Madagascar requests comments on the attached concept note for an upcoming activity to improve health product availability and accessibility in Madagascar through a total market initiative (TMI). The goal of the TMI-HPS activity will be to ensure that quality pharmaceuticals and health commodities are available and accessible to all Malagasy people on a sustainable basis through coordinated efforts of the public, private, and commercial sectors. In addition to supporting a TMI, the activity will also strengthen the capacity of the Government of

Madagascar (GOM) to manage supply of pharmaceuticals and health commodities; encourage the expansion of commercial actors into new markets; and support social marketing to increase demand for and coverage of essential health products.

In addition to general feedback on the concept note, the Mission requests that commenters consider the following issues while responding to this RFI:

1. Potential interventions under each of the four results, with a focus on innovation

2. Feasibility of achieving consensus on total market approach. What are the potential incentives and disincentives for the various actors (GOM, donors, commercial sector, etc.)?

3. Contingency planning for pharmaceutical distribution if the public sector supply chain is not able to reliably serve USAID-supported districts in early years

4. Suggested timeline and approaches for improving cost recovery of certain socially marketed products

5. USAID appreciates any additional input in response to this RFI.

USAID/Madagascar has developed this RFI for the purpose of providing industry and stakeholders an opportunity to review, comment and provide suggestions for improvement or clarification. The RFI may lead to a formal solicitation for potential offerors. The Request for

Information is provided in the following pages.

FAR 52.215-3 REQUEST FOR INFORMATION OR SOLICITATION FOR PLANNING

PURPOSES (OCT 1997)

(a) The Government does not intend to award a contract on the basis of this solicitation or to otherwise pay for the information solicited except as an allowable cost under other contracts as provided in subsection 31.205-18, Bid and proposal costs, of the Federal

Acquisition Regulation.

(b) Although “proposal” and “offeror” are used in this Request for Information, your response will be treated as information only. It shall not be used as a proposal.

(c) This solicitation is issued for the purpose of obtaining information from interested parties regarding the anticipated Resilient Waters project. (see details below).

(End of provision)

DISCLAIMER

This is a Request for Information (RFI) only. It is not a Request for Proposal, a Request for

Quotation, an Invitation for Bids, a Solicitation, nor is it an indication that USAID/Madagascar will contract for the items contained in this Notice. This RFI is an opportunity for

USAID/Madagascar to obtain information from interested parties regarding the anticipated

Resilient Waters project. In accordance with FAR 15.201(e), responses to this notice are not offers and cannot be accepted by the U.S. 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.

Responses must be received by the closing date and time indicated at the top of this cover letter to Sandy Solofonirina, Acquisition and Assistance Specialist at ssolofonirina@usaid.gov with a cc to Shahid Pervaiz, Senior Acquisition and Assistance Specialist at spervaiz@usaid.gov with a subject line RFI-687-17-001.

Please note that responding to this RFI will not give any advantage to or preclude any organization or individual from any solicitation that may be subsequently issued as any/all comments received will be strictly for information gathering purposes only. Issuance of this RFI does not constitute a solicitation. It does not represent an award commitment on the part of

USAID/Madagascar, nor does it obligate USAID/Madagascar to pay for costs incurred in the preparation and submission of any comments. Information received in response to this RFI shall become the property of USAID and shall become proprietary. Therefore, information that cannot be shared should not be sent.

Sincerely, /s/

Adam Walsh

Regional Agreement Officer

USAID/Southern Africa http://www.fbo.gov/ mailto:ssolofonirina@usaid.gov mailto:spervaiz@usaid.gov

Total Market Initiative for Health Product Supply in Madagascar

Purpose

The aim of the Total Market Initiative for Health Product Supply (TMI-HPS) activity is to apply an integrated approach to sustainably increase the availability and accessibility of quality health products for the Malagasy people.

The activity will use a total market approach (TMA) to maximize the relative strengths of public, private, and commercial actors to deliver health products that reach all beneficiaries and consumer markets (Figure 1). The activity will also strengthen the capacity of the Government of Madagascar (GOM) to manage supply of pharmaceuticals and health commodities; encourage the expansion of commercial actors into new markets; and support social marketing to increase demand for and coverage of essential health products.

Figure 1. Actors in the Malagasy health product market.

Background

Context

The primary purpose of USAID’s health work in Madagascar is to improve health outcomes among poor and underserved populations through healthy behaviors and increased access to quality health products and services. To achieve this, USAID has supported the implementation of the GOM's Politique Nationale de Santé Communautaire

(PNSC) which places an emphasis on the community as a building block of the health system. USAID invested in the development of a community health platform in which community health volunteers (CHVs) provide health education, socially marketed products, and basic preventive and curative services in rural communes across 15 of 22 regions in Madagascar. The community health platform is complemented by socially franchised networks of private health service providers and a comprehensive social marketing program. During the political crisis period from 2009 to 2014, when U.S. government (USG) direct assistance to the GOM was restricted, USAID support to the community health platform and socially franchised providers filled in for the deteriorating public sector health system. CHVs and private health service providers accessed health products through the USAID-supported private supply chain for resale to consumers. While this ensured that the population had continued access to life-saving health products and services, it also served to create a parallel health system relying on private health service providers and a private supply chain to provide necessary commodities.

With renewed USG engagement with GOM as of 2014, the Malagasy government is rebuilding the national health system. USAID has provided support to further strengthen linkages between CHVs and the national health system at the centre de santé de base (CSB) level, including formal referral systems, supervision, reporting, and supply for some health commodities. As established by the GOM in the PNSC, a variety of community, administrative, and health system actors work together to ensure that CHVs provide quality services as part of the national health system. In addition, certain USAID-supported health products have been re-integrated into the public sector supply chain. Since August 2015, by Ministerial mandate, malaria commodities such as artemisinin-based combination therapies (ACTs) and rapid diagnostic tests (RDTs) have been distributed through the Centrale d'Achat de

Médicaments Essentiels et de Matériel Médical de Madagascar (SALAMA) to district pharmacy depots (PhaGDis), community pharmacies (PhaGeCom), and eventually to CHVs for community-based distribution.

Despite these advances, significant difficulties remain in quantifying and forecasting, procuring, and distributing pharmaceuticals and health commodities, whether through the public, private, or commercial sectors. The multitude of actors in priority areas (e.g. malaria, family planning [FP]) complicates quantification and forecasting exercises, and delays in procurement by donors result in down-market difficulties to deliver services in the public and private sectors. The public sector supply chain remains only partially functional at the PhaGeCom level due to problems with PhaGDis and PhaGeCom management and cost recovery models. The public sector logistics management information system (LMIS) is not functional, and community based distribution of public sector products in isolated areas remains poor due to delays in integrating CHV needs into PhaGeCom product orders. Socially-marketed products remain heavily dependent on donor subsidies and despite significant investment, do not reliably reach consumers in some underserved areas. Illicit sales of low-quality and counterfeit pharmaceuticals crowd out the regulated commercial sector for certain health products, and restrictive GOM regulations (and their inconsistent application) limit the ability of the commercial sector to enter what would otherwise be profitable markets, leaving the public and private sectors to effectively subsidize customers with the ability and willingness to pay for health products.

Total market approach

Although universal health coverage remains a key objective of the GOM, these questions of poor coordination, inappropriate regulation, supply chain inefficiencies, and misallocated health resources have severely limited the ability of the health system to sustainably serve the Malagasy people with quality health products. In this time of increasing scarcity of resources for health, it is critical to capitalize on the relative strengths of the public, private, and commercial sectors; to improve the allocation of health resources accordingly; and to grow the market for health products. To achieve this, USAID will support the implementation of a TMI led by the GOM in coordination with private and commercial stakeholders, complemented by investments in social marketing and in strengthening public and private supply chains to ensure the availability and accessibility of key pharmaceuticals and health commodities to the Malagasy people.

A TMI is a system in which all sectors – public, private, and commercial – coordinate to deliver health choices for all population segments. The application of a TMI in Madagascar will allow the GOM to leverage the expertise, supply chain infrastructure, and financial resources of the private and commercial sectors in a strategic way. The goal of a TMI is to ensure that health products are available and accessible to all consumers in the health system.

Ideally, the poorest households receive free products, middle income households benefit from partially subsidized products, and households with the ability to pay purchase products from the commercial sector. Greater efficiency in the market improves sustainability by better targeting public and donor subsidies and decreasing crowding out of the commercial sector. This partnership, with support from TMI-HPS to create demand through social marketing and to strengthen supply chains, will create cost efficiencies across the health system, thereby improving the reach of health resources from the public sector and donors and contributing to the GOM’s goal of achieving universal health coverage.

Madagascar’s previous experience with TMA includes the 2010 DFID-financed Total Market Initiatives project for

FP products, implemented by PATH, Futures Group, and Marie Stopes Madagascar. The project conducted detailed market analysis and consultation with stakeholders to reach consensus on a variety of commitments, few of which were realized. Currently, the TMA concept is incorporated into GOM’s Plan Stratégique Intégré en Planification

Familiale et en Sécurisation des Produits de la Santé et de la Reproduction 2016-2020. In 2016, UNFPA conducted a TMA assessment on FP products in Madagascar, categorizing the market as “developing” for all FP products, and recommending a TMI as appropriate for all products except for female condoms. In 2016, PSI/Madagascar conducted a TMA assessment on the market for sanitation products and services, which was used by the former

Ministry of Water, Sanitation, and Hygiene (MoWASH) to inform their strategic priorities in sanitation. At present, other sectors do not yet have experience with TMA.

Health product markets in Madagascar

Total sales revenue for the pharmaceutical market in Madagascar has been estimated at about 250 billion MGA/year, not including donated products or the informal sector/black market. SALAMA, the only public sector pharmaceutical wholesaler in Madagascar, accounts for approximately 9-15% of market revenue for pharmaceuticals. This revenue is drawn entirely from products included on the national essential medicines list;

SALAMA is not permitted to procure or sell other products. On average, 80% of SALAMA sales revenue results from sales to PhaGDis, hospitals, and private non-profit service providers and 20% from service fees paid by donors related to the storage and distribution of vertical program products (e.g. FP, malaria). In 2015, subsidies from the

GOM to buy essential medicines represented 8% of sales revenues. The commercial sector also plays a crucial role in pharmaceutical and health commodity supply in Madagascar. There are 35 registered wholesalers, of which seven are active in the market, accounting for as much as 91% of all sales revenue. On the commercial side, pharmaceuticals flow from these wholesalers to 220 pharmacies and more than 2,000 medicine depots run by licensed professionals. Despite a recent December 2016 mandate for PhaGeCom to make their purchases through the official channel, the public sector depends heavily on commercial wholesalers for pharmaceutical supply. In

2012, only 38% of primary health clinics and district hospitals purchased regularly from their respective PhaGDis. It has been estimated that only about 50% of CSB purchases originate from SALAMA.

Market characteristics vary significantly by category of health product. However, some primary concerns for

USAID priority products (e.g. malaria, FP, maternal and child health [MCH], etc.) are illustrated in Table 1. In general, the market for health products in Madagascar demonstrates gaps in service to rural communities, where transportation of products remains a major challenge; households with poor education and low incomes who demonstrate low demand and ability to pay; youth, who lack a port of entry into the health system; and middle income consumers seeking reasonably priced, higher quality products.

Table 1. Illustrative market characteristics for health products in Madagascar.

Market players Barriers, failures, and inefficiencies

Opportunities

Public: Ministry of Health (MOH);

MOH Direction de la Pharmacie, des Laboratoires et de la Médecine

Traditionnelle (DPLMT); MOH

Direction de l’Agence du

Médicament de Madagascar

(DAMM); Ministry of Finance and

Budget and Ministry of Trade (for issues related to taxation);

SALAMA (NGO); PhaGDis;

PhaGeCom, CHVs

Donors: USAID; Global Fund;

UNFPA

Private: Social marketing organizations (e.g. PSI); non-profits; faith-based organizations

(FBOs); professional associations

(e.g. pharmacists)

Commercial: Importers, pharmaceutical wholesalers;

pharmacies; medicine depots;

informal/black market

Insufficient knowledge of market opportunities among market actors

Non-transferability of licenses to import and distribute pharmaceuticals among commercial actors

Taxation of FP products

Multitude of GOM departments interfacing with private and commercial sector for supply chain oversight

Free and subsidized products from vertical programs crowding out commercial sector

Leakage of subsidized pharmaceutical products from CSB to black market

Counterfeit and low quality products on informal/black market escape GOM regulation

Low household incomes, particularly in rural areas

Poor demand for most non-curative health products

Last mile transportation solutions remain elusive

Lack of financing for health sector businesses to expand into unproven markets

Conduct and disseminate market assessments for priority products

Reduce regulatory and tax barriers to market entry for private and commercial actors

Streamline processes for oversight of private and commercial sector by

GOM departments

Improve market segmentation to target subsidized products to low income consumers

Assess extent of informal sector market and assist GOM to develop strategy to address illicit pharmaceutical sales

Create incentives for commercial supply chain to serve rural communities

Grow the health product market through demand creation

Develop, pilot, and scale-up innovative solutions for transportation of health products to consumers

Leverage financial sector resources for health businesses through development credit authority (DCA) agreements

Results framework

This activity will contribute to the following results as outlined in USAID/Madagascar’s Health, Population, and

Nutrition (HPN) Office’s results framework (Figure 2):

IR 1: Care Seeking and Healthy Behaviors Adopted

1.1 Knowledge of Healthy Behaviors, Services and Products Improved

IR 2: Availability and Delivery of Quality Integrated Health and Water, Sanitation, and Hygiene (WASH) Services

Increased

2.4 Availability of Commodities (equipment, materials, drugs) Improved

IR 3: Health System and WASH Sector Performance Improved

3.1 Quality Data Reporting for Decision-making Improved

3.3 Commodity Supply Chains Strengthened

IR 4: Enabling Environment for Health and WASH Strengthened

4.1 Supportive Laws, Regulation, and Policies Developed and Disseminated

4.2 Financial Resource Leveraging and Mobilization Improved

4.3 Coordination between GOM, Donors and Civil Society Improved

Figure 2. HPN results framework.

Program principles

The following principles will guide TMI-HPS implementation:

1. Malagasy households should pay for health products according to their means; subsidies should benefit the poorest Malagasy people.

2. The health supply chain in Madagascar should be viewed as one system with multiple channels - public, private, and commercial - to ensure national coverage of pharmaceuticals and health commodities.

3. The GOM should play an integral role in supporting and regulating private sector and commercial supply chains.

4. In the absence of barriers (regulatory, knowledge, etc.), the market for health products operates efficiently according to incentives.

Objective

The objective of this activity is that quality pharmaceuticals and health commodities are available and accessible to all Malagasy people on a sustainable basis through coordinated efforts of the public, private, and commercial sectors. To achieve this, the following results are expected (as depicted in Figure 3):

1. The public, private, and commercial sectors coordinate to ensure that health products are available and accessible for all Malagasy people.

2. The Government of Madagascar sustainably serves the Malagasy people with quality health products.

3. The commercial sector increases participation in the health product market according to consumer demand.

4. Sustainable social marketing efforts stimulate demand for health products and deliver accessible health products to the Malagasy people.

This activity is designed to complement USAID’s investments in Madagascar’s community health system through the USAID Mikolo and Mahefa Miaraka activities, which support public sector service delivery at the community level through CHVs and CSBs, and the Maternal and Child Survival Program (MCSP), which supports service quality improvements at CSBs and district hospitals.

Figure 3. Objective and expected results of the TMI-HPS activity.

Intervention areas

Specific interventions in this award will consist of:

1. The public, private, and commercial sectors coordinate to ensure that health products are available and accessible for all Malagasy people

Desired outcomes:

● The total market for health products in Madagascar is understood and documented

● GOM leads TMI stakeholders to coordinate health product quantification and forecasting, procurement, and distribution according to market assessments and segmentation

This activity will work closely with GOM to develop and implement a TMI to improve the reach of health systems investments by leveraging the relative strengths of public, private, and commercial actors to deliver health products that reach all beneficiaries and consumer markets. On-going implementation of the TMI will include the active participation of health system partners such as the MOH, SALAMA, DAMM, donors, NGOs, social marketing organizations, FBOs, and the commercial sector (importers/distributors, retailers, etc.). The incumbent will endeavor to ensure that all relevant stakeholders are brought to the table by appropriately framing the incentives for TMI participation (see Results 2, 3, and 4 for supportive measures for each sector). TMI interventions will also contribute to the GOM’s universal health coverage (UHC) objective and therefore should be coordinated with the UHC committee.

Throughout the activity, the incumbent will focus on building the capacity of the GOM to lead TMIs. Interventions may include training, study tours to countries implementing successful TMI models, secondment of activity staff to the MOH or vice-versa, and hands-on experience conducting TMA assessments and leading TMI workshops. Other capacity building activities for the MOH may be incorporated.

In Year 1 and 2 of TMI-HPS, the incumbent will conduct in-depth total market assessments for priority products, including an examination of market structures and actors; gaps in service to consumers; market failures, barriers, and inefficiencies; market stage; and potential supportive measures. Studies may also include household health expenditure studies and policy analyses. These assessments will inform recommendations on actions to improve market efficiency and service to Malagasy consumers. Particular emphasis will be given to questions of how best to target subsidized and partially-subsidized products to poor and underserved Malagasy. A second focus area will be encouraging increased participation of and fair competition in the commercial sector. The incumbent will then assist the GOM to disseminate assessment results, convene stakeholders, foster debate, and reach consensus on priority actions. Once consensus has been reached, the TMI-HPS activity will assist the public, private, and commercial sectors to implement agreed-upon actions. This will include support to the GOM to plan for the forecasting and quantification, procurement, and distribution of key pharmaceuticals and health commodities, whether through the public, private, or commercial sector.

Finally, reaching beyond the TMI stakeholders, the incumbent will also seek to engage private sector companies interested in opportunities for corporate social responsibility (CSR) investments to leverage additional resources for investment in the health sector.

2. The Government of Madagascar sustainably serves the Malagasy people with quality health products

● Health commodities and pharmaceuticals are continuously available and accessible in the public sector

● The public sector supply chain increases financial sustainability

The incumbent will work closely with the GOM to ensure that public sector pharmaceuticals and health commodities are available for use in the right place at the right time. The incumbent will assist the GOM and

SALAMA to establish a logistics management information system that accurately tracks distribution and stock of key products; to quantify and forecast pharmaceutical and health commodity needs; to procure health products and exercise quality assurance; to distribute health products through PhaGDis to PhaGeCom; and to ensure product availability to consumers at the community level (whether through CSBs, CHVs, or other public sector outlets). This may include the development and piloting of innovative management and cost recovery models for PhaGDis and

PhaGeCom. The activity will also coordinate with the USAID community health activities to build the capacity of

PhaGeCom and CSBs to effectively oversee community-based distribution of health products by CHVs. It is expected that the activity will achieve agreed upon objectives for reduction in stock-outs of key tracer drugs at the

CSB and CHV levels.

Simultaneously, the incumbent will support the public sector to increase cost recovery for pharmaceuticals and health commodities through improvements to quantification and forecasting, procurement, distribution, pricing, and packaging, among others. A key result will be to reduce loss to expiration at the PhaGDis and PhaGeCom levels.

The incumbent will also provide intensive technical assistance to the MOH for the reform of the Financement pour l’Approvisionnement Non-stop en Médicaments Essentiels (FANOME) cost recovery model for non-subsidized goods.

At the beginning of the activity, USAID will continue its practice of purchasing FP commodities through the Central

Contraceptive Procurement (CCP) activity, most of which will continue to be socially marketed and distributed at the community level by the activity (see Result 4 below). MCH and malaria commodities will be purchased through the TMI-HPS activity and distributed via the public and social marketing supply chains, as appropriate. Over the course of the five-year activity, it is expected that the public sector supply chain will build in competence, and the number of commodities procured directly by the GOM and distributed through the public supply chain will increase.

The incumbent will monitor the success of this integration and advise on a timetable for incorporating USAID-financed FP and MCH pharmaceuticals and health commodities.

3. The commercial sector increases its participation in the health product market according to consumer demand

● Commercial actors are incentivized to expand into new health product markets

● GOM facilitates the work of the commercial sector

The incumbent, with the facilitation of the GOM, will support increased participation of the commercial sector in the

Malagasy health product market by addressing barriers and incentives. The incumbent will as a matter of policy share TMA assessments and market research broadly with the private and commercial sectors to improve their knowledge of health product markets. As appropriate, TMI-HPS may build the capacity of commercial sector actors to undertake further market research to identify opportunities to expand into new and growing health product markets. The activity will also support the expansion of credit to health and WASH businesses through

USAID/Madagascar’s DCA agreements with local financial institutions (see IR3). The incumbent will assist

USAID’s DCA partner institutions to analyze health sector opportunities and develop and promote loan products for private sector health providers and commercial supply chain actors, including small and micro-enterprises. Where appropriate, loans will be accompanied by management training for business owners. Finally, TMI-HPS will work to organize commercial actors to advocate for regulatory reform and other supportive measures to the GOM and donors. This may include support to the Ordre National des Pharmaciens and other professional or private sector associations.

While the commercial sector is and will remain an independent actor under a TMI, it is important that the GOM facilitate and oversee the commercial supply chain. The incumbent will work with the GOM and the commercial sector to reduce regulatory barriers and to disseminate applicable regulations and policies to involved stakeholders to ensure their comprehension and consistent application. Such interventions may include securing tax and custom duty exemptions for certain health products; improving processes for issuing importation and distribution licenses;

and streamlining oversight of the commercial supply chain into fewer divisions at the MOH. TMI-HPS will also support the GOM to exercise oversight of the commercial supply chain, including issues of quality assurance, importation and distribution, and taxation. The incumbent will establish routine market data surveillance through an expert, third-party vendor to avoid conflict of interest and maximize data quality and transparency. Finally, the activity will assist the GOM to assess the extent of the informal sector and develop a plan to reduce illicit sales of pharmaceuticals, thereby reducing the market share captured by counterfeit and low-quality products.

4. Sustainable social marketing efforts stimulate demand for health products and deliver accessible health products to the Malagasy people

● The market demonstrates sufficient and sustained demand for socially-marketed and commercial health products

● Socially marketed products are continuously available at convenient and accessible locations

● Socially-marketed products achieve cost recovery at an affordable price for consumers

To sustain the health improvements achieved through USAID’s social marketing of key commodities, this activity will continue to develop, promote, and distribute socially marketed branded products. Such products may include injectable and oral contraceptives, oral rehydration salts and diarrhea treatment kits, water treatment products, condoms, and micronutrient powders, or other health products according to market needs. Interventions will include the continuous distribution of long-lasting insecticide treated bednets subsidized by the President’s Malaria Initiative

(PMI). USAID may also subsidize the procurement of other socially-marketed products. The activity will consider all potential distribution channels for socially-marketed products, including the public supply chain and commercial distribution, as well as last-mile solutions such as the community health platform, where socially-marketed products are sold at a markup by CHVs. Interventions may include strengthening the supply chain for socially-marketed products by ensuring that appropriate incentives exist for distributors and retailers or by organizing wholesaler or retailer associations.

Further, the incumbent will ensure that socially marketed products remain accessible to Malagasy consumers by employing market segmentation techniques, improving product mix, and achieving cost efficiencies along the entire supply chain to be passed on to consumers. Supply chain cost efficiencies will be achieved through improvements to quantification and forecasting, procurement, distribution, pricing, and packaging, among others. It is expected that a portion of the socially-marketed portfolio will achieve 100% or greater cost recovery by the end of the activity. The incumbent will apply all program income to support the full life cycle of social marketing interventions with the goal of reducing dependency on donor subsidies for procurement and promotion.

For both socially marketed products and health products distributed by the commercial sector, broad-based demand will be critical to generating a financially viable market and ensuring their sustainability. Accordingly, the incumbent will promote socially marketed and generic products or product categories, as appropriate, to a broad

Malagasy audience using mass media, mid-media, and interpersonal communication, as well as through networks of local retailers and “prescribers” including CHVs.

Finally, the incumbent may be requested to build the capacity of private sector service providers to deliver health services and commodities in certain markets, particularly where gaps in public sector service provision exist.

Illustrative indicators

● System-wide quantification and forecasting exercises conducted

● Stock outs of tracer health commodities in public sector facilities and with CHVs reduced

● Loss to expiration of tracer health commodities at the PhaGDis and PhaGeCom levels reduced

● Cost recovery of FANOME products increased

● Sales of socially marketed commodities increased

● Stock-outs of socially marketed products among CHVs and other retailers decreased

● Cost recovery of certain socially marketed products increased

● Commercial market share increased for specific health products

● Market size increased for specific health products

Geographical coverage

This activity will have two modes of operation: national and district-level and below. National level interventions will include market assessments; TMI coordination; capacity building of GOM; quantification and forecasting;

LMIS; social marketing promotion (mass and mid-media) and supply chain strengthening; public sector supply chain strengthening; improved cost recovery in public and private sectors; increasing commercial sector participation; and DCA support.

USAID will fund the following “field-level” interventions only in USAID-supported community health districts:

procurement of subsidized products; interpersonal communication for social marketing promotion; community based distribution (public and socially marketed goods); and piloting/financing of improved models for public sector supply chain management and cost recovery. The incumbent is encouraged to support these interventions in additional districts by developing low-cost models, or through program income and/or financial support from other donors.

Timeline

It is expected that this activity will proceed along two timelines. Interventions related to market assessment, TMI coordination, supply chain cost efficiencies, commercial sector involvement, etc. will begin in Year 1 and culminate in Year 5, with increasing levels of involvement from the GOM and TMI stakeholders in out-years. The incumbent’s approach will emphasize capacity building of various stakeholders to assume key functions at the end of the activity.

Interventions will emphasize USAID-priority products (malaria, FP, MCH) in the early years and grow to incorporate a range of other products in later years according to GOM priorities.

Interventions to support the functioning of public and social marketing supply chains in USAID-supported community health districts must be operational in Year 1 to ensure the continued availability of key pharmaceuticals and health commodities to the Malagasy people. It is expected that results will be achieved beginning in Year 1.

These interventions may be adjusted throughout the activity as the TMA is defined and the capacity and involvement of various stakeholders develops.