USAID Rwanda Family Health Project final.pdf

Issuance Date: Monday, January 27, 2011 Questions Due: Thursday, February 14, 2011

Closing Date: Monday, March 7, 2011 Closing Time: 3:00 p.m. (Kigali Time)

SUBJECT: USAID/RWANDA Request for Proposal (RFP) No. RWANDA-RFP-696-11-000001 Rwanda Family Health Project (FH Project)

Dear Prospective Offerors:

The United States Government, represented by the U.S. Agency for International Development (USAID), is seeking proposals from qualified organizations interested in providing the services to implement the program entitled “Family Health Project” in Rwanda as described in the attached solicitation. The main objective is to increase the use of facility- and community-based Family Health services. For the purpose of this activity, “family health” includes an integrated package of services related to family planning and reproductive health (FP/RH), HIV/AIDS, maternal, neonatal, and child health (MNCH), malaria prevention and treatment, nutrition, and safe water and hygiene.

This is a full and open competition, under which any type of organization (large or small commercial [for profit] firms, educational institutions, and non-profit organizations) is eligible to compete. The procedures set forth in FAR Part 15 shall apply.

USAID plans to award a cost reimbursement term-type contract with a total estimated cost between $50,000,000 to $65,000,000 for the entire program to be implemented over a period of five years subject to availability of funds. The purpose of providing an estimated range for the contract is to help contractors develop their proposals; contractors should provide the lowest possible cost commensurate with their technical approach. Cost will be evaluated as part of a best value determination for contract award, including cost effective approaches to achieving the results. Contractors must demonstrate that the costs proposed are realistic and reasonable to attain the intended results. Costs proposed will be reviewed for realism and cost reasonableness in relation to the technical proposal.

USAID encourages the participation to the maximum extent possible of small business concerns, small disadvantaged business concerns and women-owned small business concerns in this activity as the prime contractor or as subcontractors in accordance with Part 19 of the FAR.

RFP, once issued, and subsequent amendments thereto, can be downloaded from the Federal Business Opportunities (“FBO”) web site. The Worldwide Web address is https://www.fbo.gov. It is the responsibility of the recipient of this solicitation document to ensure that it has been received from the internet in its entirety and USAID bears no responsibility for data errors resulting from transmission or conversion processes.

If substantive questions are received which affect the response to the solicitation, or if changes are made to the closing date and time, as well as other aspects of the RFP, this solicitation will be amended. Any amendments to this solicitation will be issued and posted on the FBO web site along with the RFP at https://www.fbo.gov. It is the contractor’s responsibility to check this site periodically for official updates and amendments to the solicitation.

Submission:

If your organization decides to submit a proposal in response to this solicitation, it must be submitted in accordance with Section L of the RFP at the designated place and time indicated in Block 9 of the RFP cover page (Standard Form 33). Any proposal not received (as electronic media) in the designated office or email account listed below by the closing date and time will be handled in accordance with FAR 52.215-1. Electronic media (Compact Disks) of proposals, and modifications thereto, must be submitted in sealed envelopes with the name and address of the contractors and the RFP number inscribed thereon to:

Contractors must submit their proposals to the following designated USAID e-mail accounts:

lgilpin@usaid.gov. This is the preferred method.

Alternatively, proposals could be sent by international air courier or delivered by hand to the following address:

DESIGNATED OFFICE:

USAID/East Africa - RFP-696-11-000001 Attn: Lauralea Gilpin Regional Contracting Officer USAID/ East Africa

United Nations Road, Girgiri Nairobi, Kenya e-mail: lgilpin@usaid.gov

Facsimile submission of proposals is not authorized and will not be accepted.

Please be advised that in the past some firms have experienced delays with international air courier services. Because the provision at FAR 52.215-1 does not cover such delays, proposals received after the closing date and time will be processed as late. Also, if you utilize the services of an independent agent in Rwanda to deliver your proposal, please be certain that s/he understands additional time may be needed to allow for security review of any packages and that the closing date and time are firm.

Please pay careful attention to, and complete in full, RFP Section K - Representations, Certifications and Acknowledgements. Contractors are now expected to comply with FAR CLAUSE 52.204-7, Central Contractor Registration and complete the annual representations and certifications electronically via the Online Representations and Certifications Applications website at http://ocra.bpn.gov.

Contractors should carefully consider Section L - Instructions to Offerors and Section M - Evaluation Factors for Award. Sections B through I of the solicitation will become the contract with blanks completed by the Contracting Officer. The proposal shall be prepared in two separate parts: the Technical Proposal shall address technical aspects only while the Business (Cost) Proposal shall present the costs. Proposals must be signed by an official who is authorized to bind the organization.

Questions

Potential contractors may submit questions in writing, by email to Ms. Lauralea Gilpin, Regional Contracting Officer, at lgilpin@usaid.gov. The deadline for receipt of questions or requests for clarifications is 1500 hours local Rwanda time, Monday, February 14, 2011. Oral instructions or explanations given before the award of the contract resulting from this solicitation shall not be binding.

Issuance of this solicitation does not in any way obligate the U.S. Government to award a contract nor does it commit the U.S. Government to pay for costs incurred in the preparation and submission of a proposal. Furthermore, the Government reserves the right to reject any and all offers, if such action is considered to be in the best interest of the Government.

Thank you for your interest in USAID Rwanda’s Family Health Project activities.

Sincerely, Lauralea Gilpin Regional Contracting Officer USAID/East Africa

1. THIS CONTRACT IS A RATED ORDER RATING PAGE OF PAGES

UNDER DPAS (15 CFR 700)

2. CONTRACT NUMBER 3. SOLICITATION NUMBER 4. TYPE OF SOLICITATION 5. DATE ISSUED 6. REQUISITION/PURCHASR

SEALED BID (IFB)

NEGOTIATED (RFP)

7. ISSUED BY CODE 8. ADDRESS OFFER TO (If other than Item 7)

NOTE: In sealed bid solicitations "offer" and "offeror" mean "bid" and "bidder".

9. Sealed offers in original and ____________1_________________ copies for furnishing the supplies or services in the Schedule will be received at the place specified in Item 8, or if handcarried, in the depository located in until local time _______________________ (Hour) (Date)

CAUTION - LATE Submissions, Modifications, and Withdrawals: See Section L, Provision No. 52.214-7 or 52.215-1. All Offers are subject to all terms and conditions contained in this solicitation.

A. NAME B. TELEPHONE (NO COLLECT CALLS) C. E-MAIL ADDRESS

AREA CODE NUMBER EXT.

(X) SEC. DESCRIPTION PAGE(S) (X) SEC. DESCRIPTION PAGE(S)

PART I - THE SCHEDULE PART II - CONTRACT CLAUSES

X A SOLICITATION/CONTRACT FORM 4 X I CONTRACT CLAUSES 46-60

X B SUPPLIES OR SERVICES AND PRICES/COSTS 5-8 PART III - LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACH.

X C DESCRIPTION/SPECS./WORK STATEMENT 9-18 X J LIST OF ATTACHMENTS 61

X D PACKAGING AND MARKING 19-20 PART IV - REPRESENTATIONS AND INSTRUCTIONS

X E INSPECTION AND ACCEPTANCE 21 X

X F DELIVERIES OR PERFORMANCE 22-27

X G CONTRACT ADMINISTRATION DATA 28-31 X L INSTR., CONDS., AND NOTICES TO OFFERORS 70-81

X H SPECIAL CONTRACT REQUIREMENTS 32-45 X M EVALUATION FACTORS FOR AWARD 82-86

K

REPRESENTATIONS, CERTIFICATIONS AND OTHER 62-69

STATEMENTS OF OFFERORS

NOTE: Item 12 does not apply if the solicitation includes the provisions at 52.214-16, Minimum Bid Acceptance Period.

12. In compliance with the above, the undersigned agrees, if this offer is accepted within ___60_____ calendar days (60 calendar days unless a different period is inserted by the offeror) from the date for receipt of offers specified above, to furnish any or all items upon which prices are offered at the price set opposite each item, delivered at the designated point(s), within the time specified in the schedule.

13. DISCOUNT FOR PROMPT PAYMENT 10 CALENDAR DAYS (%) 20 CALENDAR DAYS (%) 30 CALENDAR DAYS (%) CALENDAR DAYS (%)

(See Section I, Clause No. 52-232-8)

14. ACKNOWLEDGEMENT OF AMENDMENTS AMENDMENT NO. DATE AMENDMENT NO. DATE

(The offeror acknowledges receipt of amendments to the SOLICITATION for offerors and related documents numbered and dated:

CODE FACILITY

16. NAME AND TITLE OF PERSON AUTHORIZED TO SIGN OFFER15A. NAME AND

ADDRESS

OF OFFEROR

(Type or print)

15B. TELEPHONE NUMBER 17. SIGNATURE 18. OFFER DATE

AREA CODE NUMBER EXT.

15C. CHECK IF REMITTANCE ADDRESS IS DIFFERENT FROM

ABOVE - ENTER SUCH ADDRESS IN SCHEDULE

19. ACCEPTED AS TO ITEMS NUMBERED 20. AMOUNT 21. ACCOUNTING AND APPROPRIATION

22. AUTHORITY FOR USING OTHER THAN FULL AND OPEN COMPETITION: 23. SUBMIT INVOICES TO ADDRESS SHOWN IN ITEM (4 copies unless otherwise specified)

10 U.S.C. 2304(a) ( ) 41 U.S.C. 253(c) ( )

24. ADMINISTERED BY (If other than Item 7) 25. PAYMENT WILL BE MADE BYCODE CODE

26. NAME OF CONTRACTING OFFICER (Type or print) 27. UNITED STATES OF AMERICA 28. AWARD DATE

IMPORTANT - Award will be made on this Form, or on Standard Form 26, or by other authorized official written notice.

(Signature of Contracting Officer)

(REV. 9-97)

10. FOR INFORMATION CALL:

11. TABLE OF CONTENTS

STANDARD FORM 33

SOLICITATION, OFFER AND AWARD

SOLICITATION

OFFER (Must be fully completed by offeror)

AWARD (To be completed by Government)

1 N/A 129

RFP-696-11-000001

X

January 27, 2011 REQ-696-10-000011

Acquisition & Assistance Office USAID/Rwanda

United States Embassy Compound 2657 Avenue de la Gendarmerie, Kacyiru Kigali, Rwanda

See Cover Letter 1500 hours Kigali March 7, 2011

LAURALEA GILPIN lgilpin@usaid.gov

LAURALEA GILPIN

REGIONAL CONTRACTING OFFICER

USAID/EAST AFRICA

RWANDA RFP 696-11-000001 SECTION B

PART I - THE SCHEDULE

SECTION B - SUPPLIES OR SERVICES AND PRICE/COSTS

B.1 PURPOSE

The purpose of this contract is to provide technical assistance as described in detail in Section C, Statement of Work.

B.2 CONTRACT TYPE

This is a Cost-Plus-Fixed-Fee (CPFF) completion contract. For the consideration set forth below, the Contractor shall provide the deliverables, results or outputs described in Section F in accordance with the performance standards specified in Section E.

B.3 ESTIMATED COST, FIXED FEE, AND OBLIGATED AMOUNT

(a) The estimated cost for the performance of the work required hereunder, exclusive of fixed fee, if any, is TBD. The fixed fee, if any, is TBD. The estimated cost plus fixed fee, if any, is TBD.

(b) Within the estimated cost plus fixed fee (if any) specified in paragraph (a) above, the amount currently obligated and available for reimbursement of allowable costs incurred by the Contractor (and payment of fee, if any) for performance hereunder is TBD. The Contractor shall not exceed the aforesaid obligated amount.

(c) Funds obligated hereunder are anticipated to be sufficient through TBD.

B.4 PRICE SCHEDULE

CLIN: Cost Line Item Number

CLIN One (Year 1, IR1) 001a Total Estimated Cost $___________________ 001b Fixed Fee $___________________ Sub Total Price (CLIN 001a+CLIN 001b) $___________________

CLIN Two (Year 1, IR2) 002a Total Estimated Cost $___________________ 002b Fixed Fee $___________________ Sub Total Price (CLIN 002a+CLIN 002b) $___________________

CLIN Three (Year 1, IR3) 003a Total Estimated Cost $___________________ 003b Fixed Fee $___________________ Sub Total Price (CLIN 003a+CLIN 003b) $___________________

CLIN Four (Year 1, IR4) 004a Total Estimated Cost $___________________ 004b Fixed Fee $___________________ Sub Total Price (CLIN 004a+CLIN 004b) $___________________

CLIN Five (Year 2, IR1) 005a Total Estimated Cost $___________________ 005b Fixed Fee $___________________ Sub Total Price (CLIN 005a+CLIN 005b) $___________________

CLIN Six (Year 2, IR2) 006a Total Estimated Cost $___________________ 006b Fixed Fee $___________________ Sub Total Price (CLIN 006a+CLIN 006b) $___________________

CLIN Seven (Year 2, IR3) 007a Total Estimated Cost $___________________ 007b Fixed Fee $___________________ Sub Total Price (CLIN 007a+CLIN 007b) $___________________

CLIN Eight (Year 2, IR4) 008a Total Estimated Cost $___________________ 008b Fixed Fee $___________________ Sub Total Price (CLIN 008a+CLIN 008b) $___________________

CLIN Nine (Year 3, IR1) 009a Total Estimated Cost $___________________ 009b Fixed Fee $___________________ Sub Total Price (CLIN 009a+CLIN 009b) $___________________

CLIN Ten (Year 3, IR2) 010a Total Estimated Cost $___________________ 010b Fixed Fee $___________________ Sub Total Price (CLIN 010a+CLIN 010b) $___________________

CLIN Eleven (Year 3, IR3) 011a Total Estimated Cost $___________________ 0011b Fixed Fee $___________________ Sub Total Price (CLIN 011a+CLIN 011b) $___________________

CLIN Twelve (Year 3, IR4) 012a Total Estimated Cost $___________________ 012b Fixed Fee $___________________ Sub Total Price (CLIN 012a+CLIN 012b) $___________________

CLIN Thirteen (Year 4, IR1) 013a Total Estimated Cost $___________________ 013b Fixed Fee $___________________ Sub Total Price (CLIN 013a+CLIN 013b) $___________________

CLIN Fourteen (Year 4, IR2) 014a Total Estimated Cost $___________________ 014b Fixed Fee $___________________ Sub Total Price (CLIN 014a+CLIN 014b) $___________________

CLIN fifteen (Year 4, IR3) 015a Total Estimated Cost $___________________ 015b Fixed Fee $___________________ Sub Total Price (CLIN 015a+CLIN 015b) $___________________

CLIN Sixteen (Year 4, IR4) 016a Total Estimated Cost $___________________ 016b Fixed Fee $___________________ Sub Total Price (CLIN 016a+CLIN 016b) $___________________

CLIN Seventeen (Year 5, IR1) 017a Total Estimated Cost $___________________ 017b Fixed Fee $___________________ Sub Total Price (CLIN 017a+CLIN 017b) $___________________

CLIN Eighteen (Year 5, IR2) 018a Total Estimated Cost $___________________ 018b Fixed Fee $___________________ Sub Total Price (CLIN 018a+CLIN 018b) $___________________

CLIN Nineteen (Year 5, IR3) 019a Total Estimated Cost $___________________ 019b Fixed Fee $___________________ Sub Total Price (CLIN 019a+CLIN 019b) $___________________

CLIN Twenty (Year 5, IR4) 020a Total Estimated Cost $___________________ 020b Fixed Fee $___________________ Sub Total Price (CLIN 020a+CLIN 020b) $___________________

B.5 INDIRECT COSTS (DEC 1997)

Pending establishment of revised provisional or final indirect cost rates, allowable indirect costs shall be reimbursed on the basis of the following negotiated provisional or predetermined rates and the appropriate bases:

Description Rate Base Type Period

TBD TBD 1/ 1/ 1/

TBD TBD 2/ 2/ 2/

1/Base of Application: TBD Type of Rate: Predetermined Period: TBD

2/Base of Application: TBD Type of Rate: Predetermined Period: TBD

B.6 CEILING ON INDIRECT COSTS

(1) Reimbursement for allowable indirect costs shall be at final negotiated rates but not in excess of the following ceiling rates:

Description Rate Base Type Period

1/ 1/ 1/ 1/Base of Application:

Type of Rate:

Period:

(1) The Government will not be obligated to pay any additional amount should the final indirect cost rates exceed the negotiated ceiling rates. If the final indirect cost rates are less than the negotiated ceiling rates, the negotiated rates will be reduced to conform with the lower rates.

(2) This understanding shall not change any monetary ceiling, obligation, or specific cost allowance or disallowance. Any changes in classifying or allocating indirect costs required the prior written approval of the Contracting Officer.

B.7 COST REIMBURSABLE

The U.S. dollar costs allowable shall be limited to reasonable, allocable and necessary costs determined in accordance with FAR 52.216-7, Allowable Cost and Payment, FAR 52.216-8, Fixed Fee, if applicable, and AIDAR 752.7003, Documentation for Payment.

B.8 PAYMENT OF FIXED FEE

Subject to FAR 52.216-8, Fixed Fee: (i) payment of fixed fee may be made upon receipt of a proper invoice; and (ii) if applicable, payment of fixed fee shall be allocated based upon the fee schedule specified below.

FEE Schedule: TBD

[END OF SECTION B]

RWANDA RFP 696-11-000001 SECTION C

SECTION C - DESCRIPTION/SPECIFICATIONS/STATEMENT OF WORK

C.1 SCOPE OF WORK (SOW)

I. Activity Objective and Results

The objective of the Family Health Project is to increase the use of district-level facility and community-based family health (FH) services. For the purpose of this activity, “family health” includes an integrated package of services related to family planning and reproductive health (FP/RH), HIV/AIDS, maternal, neonatal, and child health (MNCH), malaria prevention and treatment, nutrition, safe water and hygiene, and tuberculosis. “Integration” means the organization, coordination and management of multiple activities and resources to ensure the delivery of more efficient and coherent services in relation to costs, outputs, impacts and use.

The Family Health Project will work at district-level facilities and communities to:

Result 1: Improve quality of facility and community-based family health (FH) services.

Result 2: Expand access to FH services, primarily by increasing the number of skilled health care providers.

Result 3: Increase demand for facility and community-based FH services.

Result 4: Strengthen management of facility and community-based FH services.

Note: Levels of effort are for guidance only and are not intended as contractual limits.

Intermediate Result 1: Improved quality of facility and community-based FH services

Providers and users of FH services typically have very different perspectives on quality, yet both would agree that quality largely determines outcomes. Quality increases demand for services, influences timely and appropriate use of treatments, and supports household care and follow up.

The Contractor shall strengthen the quality of services from both the provider’s and consumer’s perspective, for example by:

Ensuring that women who wish to delay, space, or limit pregnancy receive appropriate counseling about family planning options (including long-acting and permanent methods), as well as guidance and information on possible side effects

Strengthening diagnostic capabilities so that children with fever is tested before receiving anti-malaria drugs

Assisting providers to apply algorithms correctly, especially for IMNCI, ART, TB screening, CT and PMTCT, and supporting the review of these algorithms as more scientific evidence becomes available. The FH partner will take the lead in supporting the national program on MCH components of FH and pre-service nursing education.

Applying cold chain and supply procedures correctly so that vaccines, drugs and supplies are effective

Making preventive services attractive so that intended users are more eager to use them, and will return for further treatment or care

Analyzing and improving referral processes to ensure that those in need receive higher level care Facilitating the creation and maintenance of evidence based quality improvement approaches within and across health facilities, to foster understanding and reinforcement of norms and standards for good quality of care

Providing a comprehensive package of ANC services that are client friendly so that women come back for all visits and are more likely to give birth in a health facility

Ensuring functional linkages are made between services such as ANC, PMTCT, FP, prevention, ART, etc.

Providing small grants to Rwandan partner organizations to improve quality of services.

Note that quality relates closely to access. Health workers who lack essential skills, or clinics which lack essential drugs, cannot provide quality services. For purposes of LOE, this Result Area pertains to quality of care (how services are provided), while Result Area 2 applies to what services are available, at what times and how far from users.

In several Rwandan districts, community health teams composed of community members and service providers identify problems within the community and health facilities, and test solutions to improve the quality of services and health outcomes. The strength of such teams over traditional improvement methods is the flexibility and speed of implementation and follow-up, as well as the opportunity to empower local facilities and communities to address local problems with local solutions. Better use of data in this process and other improvement methodologies (e.g., gap analysis, resource mapping, process mapping, run-time diagrams, team building) can improve the effectiveness of such teams. The collaborative approach can be used to link community health teams to activities in other communities within the district for broader resource mobilization and action-oriented learning. The Contractor will apply evidence-based quality improvement activities at district-level facilities and community levels, stressing rapid problem-solving and replication of solutions.

The Contractor shall identify opportunities and propose an approach and specific management and technical support activities to achieve improved quality of community- and facility-based FH services that can be sustained by Rwandan partners in the longer-term.

Intermediate Result 2: Expanded access to FH services, primarily by increasing the number of skilled health care providers

In a broad sense, quality means little if providers are unable to offer the full range of FH services, either because they have not been trained to do so or because essential infrastructure, equipment and supplies are unavailable or poorly maintained. In certain cases, basic services may not be accessible because of poor infrastructure. This project will work closely with GOR initiatives to extend access to basic services countrywide. In short, the objective is to ensure that every facility and community health worker routinely provides the full range of FH services (as defined in national guidelines). This may require procurement of equipment and supplies, a trained workforce, and emergency transport to secondary facilities (especially for emergency obstetrical care). The Rwandan Ministry of Health web site address is: http://www.moh.gov.rw/

The 2007 Rwanda Service Provision Assessment (SPA) identified many gaps in access to health services due to inadequate staff availability or skills, poor infrastructure, poorly maintained equipment, and other shortfalls. Even when theoretically available, essential resources for FH services may be poorly organized or deployed, resulting in perceived gaps in service, choice of family planning methods, etc. The Contractor will address these gaps through a mix of pre-service and in-service skill enhancement (including training for mid-level [A2] and registered [A1] nurses using the competency-based nursing and midwifery curriculum), and it may also support short term training for more senior staff of district-level facilities, including doctors. All training must be directly coordinated with the GOR and utilize nationally approved materials.

The Contractor will work with relevant institutions to emphasize the training of nursing and midwives. The 2007 Rwanda Service Provision Assessment (SPA) can be located at the following web site: http://statistics.gov.rw/

The Contractor will also support expansion of community level services which reflects a major and largely successful Rwandan initiative. Starting initially with home-based management of fever (focused on malaria), the program is now expanding to include IMNCI, maternal health and safe delivery, a broad range of FP services, and home-based care for PLWHA. Community health workers (CHW) already provide a basic package of maternal and newborn services and refer clients for antenatal and postnatal care, and for post abortion care services. In the future, they will expand community based distribution of injectable contraceptives, as well as condoms and oral contraceptives. They will also use Rapid Diagnostic Tests for identification of malaria. Cutting across all FH services, CHWs have a special role in ensuring adherence (especially for ART), referrals, and follow-up, especially for women and HIV-exposed infants.

While the Community Health Policy emphasizes a full package of integrated services, the practicality of this approach has not been fully tested, nor have comprehensive programs been fully installed in all locations. The MOH is currently considering the most feasible and effective options for rolling out community health activities nationwide, in conjunction with community PBF. To ensure sustainability, the MOH is exploring income generating activities (IGAs) and point of use sale of water treatment and hygiene kits to generate resources for the development of CHW associations and/or cooperatives.

In order to provide quality FH services, health providers (facility as well as community-based) must be skilled and supported to deliver services. The skills needed will depend, to some extent, on the location (i.e., hospital, health center or community), while other skills will be needed by all providers, such as interpersonal and counseling skills. Those tasked with managing, planning and supervising service delivery may need specialized skills in management and supervision. There are a number of partners working to strengthen the skills of health providers at all levels.

The Contractor will contribute to national access objectives in close collaboration with the MOH and other partners. The Contractor will need to identify achievable targets and budgets for sustainable inputs, in conjunction with other contributions through field assessments of gaps and ongoing dialogue with the

MOH.

In order to ensure that clients in facilities and in communities receive the best care, it is critical that there be positive interaction and synergy between both venues. The Contractor will strengthen both facility-and community-based services. At the community level, mobilization and outreach activities encourage people to access FP/RH, MNCH, and HIV services. Health facilities are the source of re-supply for short-term FP methods and drugs for community case management of malaria and ART, and act as referral points for clients who desire LAPMs. Special community events (coordinated with the BCSM project) have been critical to improving immunization rates, treatment of major childhood illnesses, including pneumonia, malaria and diarrhea, use of HIV prevention services, including CT and PMTCT, uptake of family planning and adherence to ART. The Contractor is expected to meet the challenge of building and strengthening the link between facilities, communities, supervisors, staff, and volunteers thru small grants to Rwandan partner organizations to increase access to Family Health services.

The Contractor shall identify opportunities and propose an approach and specific management and technical support activities to expand access to community- and facility-based FH services that can be sustained by Rwandan partners in the longer-term.

Intermediate Result 3: Increased demand for facility- and community-based FH services

This project’s goal of service utilization requires not only accessibility and quality, but also user knowledge of and demand for appropriate FH services. Intended users must both be aware of the availability and use of essential services AND have the motivation to seek them in a timely manner. For certain services, intended users need specific information about home implementation and follow up, e.g., for nutrition and use of LLINs. Community leaders must support their local health workers and the efforts of the national government.

While demand for FH services is growing, myths, rumors, biases, and negative images still limit uptake and demand. The GOR is promoting behavioral change and solidifying social norms to ensure that the community, caretakers, health providers, and leaders understand the importance of maintaining FH services. Special community events, outreach efforts, communication campaigns and community empowerment initiatives have all been implemented in an effort to promote improved FH. In order to motivate and encourage individuals, families and communities to improve their health, providers at all levels need to be able to answer questions and address concerns, increase knowledge about FH interventions, and explain how available services are conducted and organized. The Contractor will provide small grants to Rwandan partner organizations to generate demand for Family Health services.

One very important aspect of communication, often neglected, focuses on routine interaction between providers and clients. Providers must listen as well as disseminate information. They need to understand and respond to the preferences and requirements of individual users so as to increase timely use of both preventive and curative services. CHWs, moreover, are responsible not just for providing basic services and informing clients, but also for visiting individual families and ensuring effective implementation.

The ultimate expression of demand is appropriate and timely utilization of services and providers must listen and adapt as well as educate.

The Contractor shall identify opportunities and propose an approach and specific management and technical support activities to increase demand for community- and facility-based FH services that can be sustained by Rwandan partners in the longer-term.

Intermediate Result 4: Strengthened management of facility and community-based FH services

Resources are scarce within Rwanda, and appropriate and effective use of available manpower, equipment and commodities is essential. Specific management systems of greatest importance for FH services include:

Logistics systems for both routine requisitioning and restocking of drugs, testing kits, LLINs, etc., as well as equipment maintenance

Inventory and storage systems for supplies once received Referral systems, including feedback to originating health workers Transport systems, for emergency evacuation as well as routine supervision and supply Financial management systems, including for PBF-supported cooperatives Data management, to ensure the accuracy of reports received from communities as well as the quality of aggregate reports transmitted to higher levels Patient flow, to reduce waiting times, facilitate adequate time with providers, and increase client satisfaction Personnel management, to ensure staff coverage at all times, including back up arrangements when individuals are not available.

The Contractor will primarily strengthen management within and between communities and facilities by, but not limited to, initiating and/or reinforcing:

Supervision of CHWs by health center nurses Maintenance of CHW kits Referral systems, including emergency transport systems Accurate record keeping and reporting

Ensuring secure re-supply along with a strengthened record/reporting system is essential for providers to have the supplies they require, and the skills to track distribution to clients. Supply management at facility- and community-levels requires clear policies, plans and resources, and the use of data for monitoring and decision making. It may also require interventions to promote accountability and sound management of public goods. The Contractor will also support the MOH in the planning and implementation of relevant assessments and studies like the National Immunization coverage surveys.

The Contractor will provide small grants to Rwandan partner organizations to improve management of Family Health services.

The Contractor shall identify opportunities and propose an approach and specific management and technical support activities to strengthen the management of community- and facility-based FH services that can be sustained by Rwandan partners in the longer-term.

II. Alignment with USG Strategies

In the U.S. Foreign Assistance framework, the FH Project falls under Investing in People (IIP), Program Area 1: Health. Specific Elements that may be addressed by this activity include 1.1: HIV/AIDS; 1.2:

Tuberculosis; 1.3: Malaria; 1.4: Avian and Other Influenza; 1.5: Other Public Health Threats; 1.6:

Maternal Health and Child Health, including Nutrition; 1.7: Family Planning and Reproductive Health;

1.8: Clean Water and Sanitation Services; and Health Systems Strengthening Activities. Global health goals for key Program Elements are summarized below:

USG Foreign Assistance health goals HIV/AIDS Reduce the transmission and impact of HIV/AIDS through support for prevention, care and treatment programs Malaria Support the implementation of PMI, related malaria control programs, and malaria research activities to reduce malaria-related mortality. Develop effective malaria vaccines, new malaria treatment drugs, and targeted operations research

MCH Increase the availability and use of proven life-saving interventions that address the major killers of mothers and children and improve their health and nutrition status

FP/RH Expand access to high-quality family planning services, information and reproductive health care in order to reduce unintended pregnancy and promote healthy reproductive behaviors

The Results Framework for the FH Project aligns with USAID’s objectives in Washington and Rwanda, as well as those of PEPFAR and PMI. All of these objectives address the needs of women and men of reproductive age, children under-five, and other vulnerable groups. Because HIV/AIDS , malaria prevention and control, and tuberculosis have strong district-level facility- and community-based programs, and work with a variety of partners, current PEPFAR and PMI activities are well placed to complement and supplement the efforts of the Contractor. The Contractor shall be expected to network, coordinate and collaborate with other assistance and Rwandan partners in its selected districts. The Contractor is also expected to maximize opportunities to complement and coordinate with other relevant projects operating nationally or in the selected districts, and with other donors in line with the vision of the GOR.

The Contractor shall seek opportunities to scale up innovative interventions, improve monitoring and evaluation techniques, and utilize creative operational research strategies and approaches.

Additionally, gender issues are central to the achievement of strategic plans and Assistance Objectives (AO) and USAID strives to promote gender equality, in which both men and women have equal opportunity to benefit from and contribute to economic, social, cultural and political development; enjoy socially valued resources and rewards; and realize their human rights. The Contractor shall therefore utilize relevant gender analysis in planning, implementation, and evaluation stages.

III. Funding Levels, Earmarks, and Program Duration

Rwanda is currently a focus country for the President’s Emergency Plan for AIDS Relief (PEPFAR), the President’s Malaria Initiative (PMI), the new Presidential Feed the Future Initiative and the new Global Health Initiative. USAID anticipates a split in funding for this project with funds coming from PEPFAR, FP/RH, MNCH, PMI, Safe Water, and Nutrition resources. While an integrated approach is anticipated, the contractor must maintain the ability to report separately on the use of each funding stream, abiding by restrictions in the Foreign Appropriations Act and other relevant requirements. Program implementation is expected to run from FY 2011 through FY 2016.

IV. Geographic Scope

In the first two years, the Contractor shall focus its work in up to 16 districts, to be determined with the Ministry of Health and USAID. During this phase, assistance for HIV/AIDS services in FH Project districts will be supported primarily by CDC, Peace Corps, DOD, the Global Fund, and USAID. Thus, the FH Project will have greater emphasis on FP/RH, MNCH, malaria, nutrition, and water and sanitation.

During the last three years of the contract, the Contractor shall expand to support HIV clinical services in districts currently supported by USAID Clinical Service partners as existing projects come to an end.

This may include an expansion of up to 6 additional districts. In both phases, consideration will be given to how best to complement assistance from all USG HIV/AIDS Clinical Partners, the Global Fund and other partners. All decisions regarding selection and final number of districts will be made in collaboration with GOR leadership.

C.2 MONITORING AND EVALUATION

Monitoring of results is a key element of USAID programs. USAID/Rwanda requires data and information to improve performance and effectiveness as well as to inform planning and management decisions. Data also must be available to demonstrate program impact. Specific indicators and targets for achievement of the activity objective and each of the four intermediate results will be developed by the Contractor and submitted as part of the overall Performance Monitoring Plan (PMP) for this activity. The plan should, at a minimum, incorporate appropriate standard indicators as defined under the Foreign Assistance Framework and the PEPFAR/PMI/GHI/FTF reporting frameworks. The Contractor shall also consider a broad array of indicators most suited to management of project activities and overall performance measurement. The contractor may also be asked to collect data on indicators currently being established by the GOR as part of a national harmonization exercise. The PMP submitted by the Contractor shall be subject to approval of the USAID Contracting Officer Technical Representative (COTR) and will lay the basis for quarterly performance reporting. Partners will be expected to update their PMP, at a minimum annually, in consultation with their COTR and provide updated plans to their USAID COTR and the USAID/Rwanda Program Office.

The PMP shall be comprehensive and consolidated for the entire project with measurable, quantitative and qualitative indicators, baselines, targets, and time frame for achieving these indicators.

Indicators and targets for each result should illustrate how the project will contribute to improved delivery of services for each element. Measurement of achievements under this Award should directly relate to the technical assistance and other support provided under this project, including the identification of best practices. Indicators should have widely shared definitions and allow aggregation of results across countries, regions and/or the entire program where appropriate.

The Contractor shall monitor national and where possible local progress in achieving the following indicators and targets indicative of family health from the Logical Framework of the HSSP II (Section 3.4, pp. 39-48) and the 2009 – 2012 National Strategic Plan on HIV and AIDS; the purpose of this monitoring is to enable the Contractor and USAID to monitor and assess FH Project contributions towards country goals and to align and adjust project implementation accordingly. The relevant indicators include but are not limited to:

Reduce the Total Fertility Rate (TFR) from 5.5 to 4.5 Increase use of modern contraceptive methods by women ages 15 – 29 in union from 27% to 40% Reduce MMR from 750 to 600 per 100,000 Increase number of deliveries in health facilities from 45% to 60% Increase percent of pregnant women completing four ANC visits from 24% to 50% Reduce IMR from 86 to 50 per 1,000, and U5MR from 152 to 70 per 1,000 Reduce percent of children with chronic malnutrition from 43% to 27% Reduce HIV incidence among youth (ages 15 – 24) from 1.0% to 0.5% Increase percent of children sleeping under insecticide-treated nets (ITNs) from 58% to 85% Increase percent of pregnant women sleeping under ITNs from 62% to 85% Increase percent of households possessing one LLIN from 56% to 85% Increase percent of households and institutions using hygienic latrines from 28% to 80%, and hand-washing with soap from 34% to 80% Increase the percent of households and schools exercising safe drinking water handling Increase ratio of qualified nurses (A1, A0 and Master’s) to inhabitants from 0.36 to 1.0 per 5,000 Increase number of health facilities with a midwife present from 1/100,000 to 1/20,000 Increase percent of health staff outside of Kigali from 68% to 90% Increase the percent of CHWs trained to deliver basic package of services (no baseline available) Increase the percentage of adults and children with HIV known to be on treatment 12, 24 and 36 months after initiation of antiretroviral therapy to not less than 90% for 12 months Ensure the percentage of people living with HIV and AIDS in poverty is not more than the general population

(Baselines cited are from the 2005 DHS, 2008 IDHS, and the 2008 HRH Database)

USAID/Rwanda will require frequent quantitative and qualitative review of this project, in conjunction with national and district stakeholders. Quarterly discussions with Rwandan partners will focus on implementation status and issues, including progress against work plan schedules and targets. Semi-annual reviews will consider outcome and output indicators for quality, access, demand and management.

While the FH project will contribute to the HSSP II indicators noted above, the majority of these indicators are only measured through national prevalence surveys, such as the DHS, and clearly cannot be measured and reported by this project. Therefore, the Contractor will also be required to report on the following required indicators, semi-annually. Management reviews will include the following specific required indicators and others that may be required at a later stage by USAID/Washington and other USG or Congressional entities:

Number of ANC visits by skilled providers from USG assisted facilities Number of people trained in maternal/newborn health through USG assisted programs Number of people trained in child health and nutrition through USG-supported health programs Number of deliveries with a skilled birth attendant (SBA) in USG assisted programs

Couple Years Protection (CYP) in USG-supported programs Number of people trained in FP/RH through USG assisted programs Number of counseling visits for FP/RH in USG assisted programs Number of USG-assisted service delivery points (SDPs) providing FP counseling or services Number of new family planning users Number of people trained with USG funds in malaria treatment and prevention Number of LLINs distributed, reported routinely Number of facilities offering PMTCT, basic care and support, including HIV/TB coinfection, VCT and ART Number of pregnant women who are counseled and tested for HIV and receive their test results Number of HIV positive pregnant women who receive ARV to reduce the risk of mother to child transmissions Number of persons provided with post exposure prophylaxis (PEP) Number of individuals who receive Testing and Counseling services for HIV and receive their test results Number of HIV positive adults and children provided with a minimum of clinical service Number of HIV positive individuals screened and treated for active TB disease in HIV services and number of TB patients that are counseled and tested for HIV disease.

Number of adults and children receiving ART Number of health care workers who successfully complete an in-service training program Number of HIV positive pregnant women who receive nutritional support Number of HIV-exposed infants who receive complementary weaning foods.

In addition to the required indicators listed above, the Contractor will propose appropriate quantitative and qualitative indicators, with associated benchmarks and targets, for inclusion in the project Performance Monitoring Plan on the topics listed below. The topics have been listed according to relevance to specific intermediate results. The Contractor will also propose other indicators that will measure progress towards project goals and results in addition to the topics listed below.

Project Result 1: Improved quality of facility and community-based FH services

Implementation of the GOR’s quality assurance policy Implementation and effectiveness of evidence-based quality improvement The frequency and quality of CHW supervision and reports Quality of health worker performance, at both facility and community levels Quality of each of the core FH services, from user and clinical perspectives User friendliness of key preventive services.

Intermediate Result 2: Expanded access to FH services, primarily by increasing the number of skilled health care providers

The degree to which the full range of FH services is routinely available at all health facilities The degree to which those in need have convenient access to the full range of FH services Access indicators for each of the core FH services Availability of skilled providers for FH services (emphasis on obstetric care, PMTCT and ART services) Number of CHWs trained to deliver basic package of services

Intermediate Result 3: Increased demand for facility- and community-based FH services

Appropriate care-seeking behavior for each of the core FH services, including follow-up for PLHA and PMTCT

Client implementation of home follow-up requirements for each FH service Community support for CHW activities CHW knowledge of specific community and family needs and constraints

Intermediate Result 4: Strengthened management of facility and community-based FH services

Commodity management (inventory maintenance and restocking) at facility and community levels

Equipment maintenance Data quality and use for program management Overall clinic management Referral system functionality Facility and community level financial performance management systems are fully established and efficiently functioning to improve the quality of health services Budget and financial reports are available in good time to national and local government officials, public, media, and civil society organizations

C.3 MANAGEMENT REVIEWS AND EVALUATIONS

The Annual Work Plan will form the basis for a joint management review by USAID and program staff to review program directions, achievement of the prior year work plan objectives, and major management and implementation issues, and to make recommendations for any changes as appropriate. A semi-annual management review will also be held to review progress.

At any time during program implementation, USAID may conduct one or more evaluations to review overall progress, assess the continuing appropriateness of the project design, and identify any factors impeding effective implementation. USAID will utilize the results of the evaluations to recommend any needed mid-course changes in strategy and to help determine appropriate future directions. Site visits may occur at any time.

C.4 GRANTS AND SUB AWARDS

The Contractor shall be expected to support recipients of small grants in achieving the level of capacity and accomplishment that will enable them to either achieve long-term sustainability or receive direct funding in the near future.

USAID intends to implement USG and Rwandan policies to support country leadership, capacity, and sustainability. Consistent with all applicable U.S. law governing USG procurement and acting within legal authorities, the contractor making procurement decisions for goods and services in support of USAID operations in Rwanda, will actively solicit Rwandan suppliers who can immediately or prospectively meet our requirements on a price, quantity, and quality competitive basis. If necessary, procurement officers will work with contractors and grantees to meet required price, quantity, and quality standards within reasonable time horizons. Rwandan organizations know the terrain and can often provide goods and services with comparable quality at competitive prices. With a shorter supply chain, local procurement is often the best way for the buyer to maximize value and timely delivery of needed goods and services.

The Contractor shall make every attempt, per the guidance above, to award and administer grants and contracts to Rwandan governmental, non-governmental organizations and firms for work that supports the achievement of contract objectives and outcomes.

The following requirements apply to any grant awarded by the contractor under this contract:

a) USAID shall have significant involvement in the establishment of selection criteria and shall approve the selection of grant recipients. Unless otherwise directed by Contracting Officer, the COTR shall have the authority to approve the grant recipient selection.

b) The contractor is not authorized to execute or administer cooperative agreements on USAID’s behalf.

c) Requirements which apply to USAID-executed grants shall also apply to grants signed by the contractor.

[END OF SECTION C]

RWANDA RFP 696-11-000001 SECTION D

SECTION D - PACKAGING AND MARKING

D.1 AIDAR 752.7009 MARKING (JAN 1993)

(a) It is USAID policy that USAID-financed commodities and shipping containers, and project construction sites and other project locations be suitably marked with the USAID emblem. Shipping containers are also to be marked with the last five digits of the USAID financing document number. As a general rule, marking is not required for raw materials shipped in bulk (such as coal, grain, etc.), or for semi finished products which are not packaged.

(b) Specific guidance on marking requirements should be obtained…