J_ _A_H4L-Mod_8.pdf

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In the health sector, the Ministry of Health and Population (MoHP) estimates that around 769 health facilities in the 14 districts are destroyed or severely damaged, and primary health care services in these facilities have been interrupted. Services are slowly being restored, but often these health facilities are only being partially staffed, with poorly trained health workers using in many cases unfamiliar donated supplies and equipment.

Also, many donors are constructing pre-fabricated buildings to serve as health facilities in areas where existing health facilities were damaged. Intentions are good, but without proper coordination and organization, there is evidence that some pre-fabricated buildings might not be suitable for Nepal; they may not be erected where they are most needed; and the most appropriate health services that are urgently needed by communities may not be offered.

To manage this recovery process, effective local governance in the health sector is needed immediately to support the planning and budgeting of recovery efforts; re establish health services; re-construct health systems; and create the building blocks for future development. This need was specifically identified in the GON's Post-Disaster Needs Assessment. Currently, the H4L contract is providing similar services in the Midwest Region, supporting the development and execution of annual health plans at the district level and strengthening local-level health governance. As local capacity for organization, coordination and management of health service planning and budgeting already exists within USAID's H4L contract, USAID feels that they are best placed to provide similar support to ten earthquake-affected districts as they attempt to re-establish health services and allocate resources to respond to post-earthquake needs. This effort will include the development of recovery plans, support for the resumption of the health management information systems (HMIS) and expansion of efforts to improve the quality of health services.

These proposed interventions are crucial to ensuring that Nepali authorities work with communities to rationalize the placement of new health facilities and the types of services they will provide. H4L will support the analysis and synthesis of necessary data from the recovered HMIS and other locally available sources to make certain that health facilities are built based on population and need with an eye towards ensuring equitable access to services. Once services are resumed, H4L will scale-up its quality improvement approach and work with the GON to develop appropriate tools to support the overall improvement of the quality of health services in these earthquake-affected districts.

The estimated cost of this proposed expansion to ten earthquake-affected districts is approximately $10,600,000, raising the total estimated cost for the H4L award to approximately $28,900,000.

4. Statutory authority permitting other than full and open competition.

AID AR 706.302-70 states that full and open competition need not be obtained when it would impair or otherwise have an adverse effect on programs conducted for the purposes of foreign aid, relief, and rehabilitation. The authority allows for other than full

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and open competition for : (ii) Awards for countries, regions, projects, or programs for which the Administrator of USAID makes a formal written determination, with supporting findings, that compliance with full and open competition procedures would impair foreign assistance objectives, and would be inconsistent with the fulfillment of the foreign assistance program.

5. A demonstration of the proposed contractor's unique qualifications or the nature of the acquisition that requires use of the authority cited.

As stated above, the U.S.G. has publically pledged to support the recovery and rebuilding of Nepal following the April 25, 2015 earthquake, making it a key foreign policy objective. Because of the sheer scale of the disaster, efficient and effective recovery efforts are stalling within the most earthquake-affected districts and will continue to be a problem until there is better organization, management and coordination on the ground.

GON disaster funds remain underspent for all sectors (including health) and/or may be being spent on the wrong priorities; donor funds and the activities of a myriad of international and local NGOs and charitable groups are also not always well coordinated at district levels. There is urgent need for better and more coordinated district-level governance, including health governance that involves affected communities for both the relief and recovery periods, otherwise resources will be wasted and those in most need of assistance will not receive it. Given the procurement lead times required for a new award, along with the unique capacities of RTI, USAID has determined that a modification to the existing H4L contract is the most efficient and effective mode of providing this critical assistance.

RTI has been working under the H4L contract since its award in December 2012. During that time, RTI has provided technical assistance and other support services to strengthen the GON's capability to plan, manage and deliver high-quality, equitable family planning and maternal, newborn, and child health services. Over halfway into the H4L period of performance, RTI has gained valuable in-depth knowledge of the healthcare system, developed strong relationships at national and local levels, and invested in the corporate infrastructure to quickly support the proposed activities. They also have a tested methodology and management structure to support health governance activities in districts, VDCs and other local structures that can be readily transferred to the earthquake-affected districts. Unlike heath service delivery, which is a readily available capacity among many groups in Nepal, technical assistance for health governance and systems is a unique and uncommon skillset. RTI is exclusive in its ability to deliver this type of technical assistance in Nepal.

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Additionally, the activities proposed contribute directly to the goal of the H4L contract, which is working to strengthen health systems nationally and in 14 districts of the Mid western and the Western regions of Nepal. Of the seven H4L objectives, the proposed activities will contribute to the three that are most relevant for the 14 most affected earthquake districts :

• Objective 1 - Improve health system governance of district health offices and sub-district level health facilities.

• Objective 2 - Develop and implement national evidence-based health policy

• Objective 4 - Institutionalize a nationwide system for Quality Improvement

Timing of this work is crucial as districts and VDCs are just beginning efforts to develop recovery plans that include discussion on the nature and placement of new health facilities . USAID will only be able to successfully support this process if an implementing partner is operational no later than mid-fall 2015. Procurement action lead times would likely mean that any new competed contract would not be operational until almost a year after the original earthquake occurred. This missed opportunity may result in poorly developed health plans, misplaced newly constructed health facilities, a dysfunctional HMIS system, and poor quality of care. To date, USAID is the only development partner that has stated plans to provide this type assistance to these ten earthquake-affected districts, and any delays in this support would limit USAID's ability to respond effectively to recovery efforts in Nepal in the health sector.

6. A description of efforts made to ensure that offers are solicited from as many potential sources as is practicable, including whether a notice was or will be publicized as required by Federal Acquisition Regulation (FAR) 5.202

[AIDAR 705.002).

Because this is a modification to an existing award and these services are of critical need, no attempt has been made to solicit proposals from other sources.

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

An Independent Government Cost Estimate (IGCE) was developed by the Health and Education Office and submitted to the Contracting Officer. The IGCE is based on current costs of the H4L contract and other market data for Nepal. The Contracting Officer will use the IGCE, in addition to OAA's own analysis techniques, to determine the reasonability of the eventual cost proposal.

UROINT

Front Office Clearance Request

ACTION MEMO

Title: Exceptions to Competition and Restricted Eligibility for Specified Modifications and New Awards for Nepal Earthquake Recovery Date Received by ES: 7/21/2015 Date Due: 7/22/2015

Draft Drafter: Asia/SCAA: Mike Bradow Phone: 6-3488 Approved: ASIA/A-DAA- TSorenson

Bureau Level Clearances

Ml AA: ACrumbly M/OAA: ADjahabani M/OAA/ACTS: DBroderick Asia/ Acting DAA: TSorenson Asia/SCAA: MBradow BRM/ AID/ A/BRM: CCapozzola BRM: SGenson GC/A&A: JCone GC/ Asia: EHsieh LP A: BBennett USAID/ Nepal MD:BDunford ES-SA: JPicard 0-ES: LSwayzer

FO Approval

ES: MHannafin

A-DCoS: Dan Corle

CoS: MSumilas

Assoc. Admin: EPostel

A-Al AID: ALenhardt

ACTS Folder No.: ES201501981 ES Analyst: Jennifer Lowry

Initials Clearance Status

AC clear AD clear DB clear TS clear MB clear cc clear SG clear JC clear EH clear BB clear BO clear JP clear LS clear ovt of offi &e ---o{pv

For Signature

7117/15 7/17/15 7/17/15 6/19/15 6/19/15 6/27/15 6/27115 6/27/15 6/24/15 6/25/15 7/16/15 7/22/1 5 7/22/15