RFP No. SOL-388-12-000001.pdf

Date Issued: February 2, 2012 Closing Date: March 19, 2012 Closing Time: 2 PM (local time in Bangladesh)

SUBJECT: Request for Proposal (RFP) No. SOL-388-12-000001

USAID NGO Health Service Delivery Project

Dear Sir/Madam:

The United States Government, represented by the U.S. Agency for International Development in Bangladesh (USAID/Bangladesh), is seeking proposals from qualified organizations interested in providing the services as described in the attached solicitation.

Section C of this solicitation sets the activities required to be implemented. Section L of the RFP sets forth instructions for the preparation and submission of proposals and specifies the required contents of proposals. Please submit your proposal in accordance with the requirements in Sections C and L of this solicitation. Section M states the criteria by which proposals will be evaluated, and the award will be made.

USAID plans to award a four-year period cost-plus-fixed fee, term contract with an estimated level of effort. The total estimated cost of the contract must not exceed $55 million and grants to various NGOs must be set at $36 million, subject to availability of funds. The North American Industry Classification System (NAICS) code for this acquisition is 621498.

Please pay careful attention to and complete in full RFP Section K – Representations, Certifications and Acknowledgements. Offers are 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 Application (ORCA) website at http://orca.bpn.gov.

Proposals must be prepared in two separate parts: the Technical Proposal must address technical aspects and the Cost Proposal must present costs. Proposals must be signed by an official who is authorized to bind the organization.

Proposals from consortia or partnerships between eligible organizations are welcome. Teaming arrangements, especially those that include U.S. small business and local Bangladesh Partners are encouraged in order to provide multi-sector integration of the project. Bangladeshi Organizations are encouraged to apply as prime offerors or as sub-partners.

Any amendments to this solicitation will be issued and posted on the website along with the RFP. Offerors are encouraged to check the FedBizOpps website (http://FedBizOpps.gov) periodically. It is the responsibility of the offeror to ensure that solicitation or any amendments to

RFP No. SOL-388-12-000001 it has been received from the internet in its entirety and USAID bears no responsibility for data errors resulting from transmission or conversion processes.

Offerors are encouraged to register and use the Interested Vendor List (IVL) on the FedbizOpps page, so that firms can contact one another for consideration of teaming arrangements and/or small business subcontracting opportunities in response to this solicitation.

Questions

Potential offerors may submit questions in writing, by email to the contract specialist, Shafique Nazim, at snazim@usaid.gov and copied to: lburnette-badinga@usaid.gov. The deadline for receipt of questions and/or requests for clarifications is 11:00 AM (local time in Bangladesh) on February 12, 2012. No questions will be accepted after this date.

Issuance of this solicitation does not constitute an award commitment on the part of the Government, nor does it commit the Government to pay for any costs incurred in the preparation or 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 programs.

Sincerely, Leslie-Ann Burnette-Badinga Supervisory Contracting Officer USAID/Bangladesh

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/PURCHASE NUMBER

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 _____________________________ 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

A SOLICITATION/CONTRACT FORM I CONTRACT CLAUSES

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

C DESCRIPTION/SPECS./WORK STATEMENT J LIST OF ATTACHMENTS

D PACKAGING AND MARKING PART IV - REPRESENTATIONS AND INSTRUCTIONS

E INSPECTION AND ACCEPTANCE

F DELIVERIES OR PERFORMANCE

G CONTRACT ADMINISTRATION DATA L INSTR., CONDS., AND NOTICES TO OFFERORS

H SPECIAL CONTRACT REQUIREMENTS M EVALUATION FACTORS FOR AWARD

K

REPRESENTATIONS, CERTIFICATIONS AND OTHER

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 ________ 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)

N/A

SOL-388-12-000001

X

02/02/2012

72000

Office of the Acquisition & Assistance C/O American Embassy USAID/Bangladesh 6120 Dhaka Place Washington DC 20521-6120

Leslie-Ann Burnette-Badinga, Supervisory Contracting Officer USAID/Bangaldesh, C/O American Embassy Madani Avenue, Baridhara Dhaka-1212, Bangladesh

Item 8 2:00 pm Bangladesh

Shafique Nazim 880 2-885-5500, ext. 2335 snazim@usaid.gov

See Attached Table of Contents

X 3

X 8-11

X 12-38

X 39-41

X 42

X 43-53

X 54-58

X 59-64

X 65-92

X 93,127-139

X 94-107

X 108-119

X 120-126

$.00

72000

USAID/Bangladesh C/O American Embassy Madani Avenue, Baridhara Dhaka-1212, Bangladesh

USAID/Bangladesh Office of Financial Management C/O American Embassy Madani Avenue, Baridhara Dhaka-1212, Bangladesh

TABLE OF CONTENTS

PART I – THE SCHEDULE

SECTION B – SUPPLIES OR SERVICES AND PRICE/COSTS

B.1 PURPOSE

B.2 CONTRACT TYPE - CPFF TERM

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

B.4 PRICE/COST SCHEDULE

B.5 COST REIMBURSABLE

B.6 INDIRECT COST

B.7 CEILING ON INDIRECT COST

B.8 LABOR

SECTION C – DESCRIPTION/SPECS./STATEMENT OF WORK

SECTION D – PACKAGING AND MARKING

D.1 BRANDING AND MARKING POLICY

D.2 BRANDING STRATEGY FOR NGO SERVICE DELIVERY PROJECT

SECTION E – INSPECTION AND ACCEPTANCE

E.1 NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY

REFERENCE

E.2 INSPECTION AND ACCEPTANCE

SECTION F – DELIVERIES OR PERFORMANCE

F.1 NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY

REFERENCE

F.2 PERIOD OF PERFORMANCE

F.3 PLACE OF PERFORMANCE

F.4 REPORTS AND DELIVERABLES OR OUTPUTS

F.6 PERFORMANCE STANDARDS

F.7 LEVEL OF EFFORT

F.8 KEY PERSONNEL

F.9 AAPD 04-06-D-752.7005 SUBMISSION REQUIREMENTS FOR

DEVELOPMENT EXPERIENCE DOCUMENTS (JAN 2004)

F.10 ENVIRONMENTAL COMPLIANCE AND MANAGEMENT

SECTION G – CONTRACT ADMINISTRATION DATA

G.1 AIDAR 752.7003 DOCUMENTATION FOR PAYMENT. (NOV 1998)

G.2 ADMINISTRATIVE CONTRACTING OFFICE

G.3 CONTRACTING OFFICER’S REPRESENTATIVE (COR)

G.4 PAYING OFFICE

G.5 CONTRACTOR'S PRIMARY POINT OF CONTACT

G.6 ACCOUNTING AND APPROPRIATION DATA

G.7 TECHNICAL DIRECTIONS/RELATIONSHIP WITH USAID

SECTION H - SPECIAL CONTRACT REQUIREMENTS

H.1 NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY

REFERENCE

H.2 AUTHORIZED GEOGRAPHIC CODE

H.3 NONEXPENDABLE PROPERTY PURCHASES AND INFORMATION

TECHNOLOGY RESOURCES

H.4 AAPD752.7007 PERSONNEL COMPENSATION (JULY 2007)

H.6 GOVERNMENT PROPERTY

H.7 LANGUAGE REQUIREMENTS

H.8 LOGISTIC SUPPORT

H.9 SUBCONTRACTING PLAN REPORT FOR INDIVIDUAL CONTRACTS

AND SUMMARY CONTRACTING REPORT

H.10 SUBCONTRACTING CONSENT

H.11 EXECUTIVE ORDER ON TERRORISM FINANCING (MARCH 2002)

H.12 AAPD 04-17 USAID DISABILITY POLICY - ACQUISITION (DECEMBER

2004)

H.13 AIDAR 752.7032 INTERNATIONAL TRAVEL APPROVAL

ANDNOTIFICATION REQUIREMENTS AND AIDAR 752.7027 PERSONNEL

H.14 AIDAR 752.225-70 SOURCE, ORIGIN AND NATIONALITY

REQUIREMENTS (FEB 1997)

PART II – CONTRACT CLAUSES

SECTION I - CONTRACT CLAUSES

I.1 NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY

REFERENCE

I.2 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

I.3 AIDAR 752.219-8 UTILIZATION OF SMALL BUSINESS CONCERNS AND

SMALL DISADVANTAGED BUSINESS CONCERNS

I.4 AIDAR 752.7025 APPROVALS (APR 1984)

I.5 AIDAR 752.7031 LEAVE AND HOLIDAYS. (OCT 1989)

I.6 AIDAR 752.7034 ACKNOWLEDGMENT AND DISCLAIMER. (DEC 1991) .. 72

I.7 FAR 52.203-13 CONTRACTOR CODE OF BUSINESS ETHICS AND

CONDUCT (APR 2010)

I.8 FAR 52.204-7 CENTRAL CONTRACTOR REGISTRATION (APR 2008)

I.9 FAR 52.204-10 REPORTING EXECUTIVE COMPENSATION AND FIRST-

TIER SUBCONTRACT AWARDS (JUL 2010)

I.10 FAR 52.215-23 LIMITATIONS ON PASS-THROUGH CHARGES (OCT 2009)

I.11 FAR 52.222-50 COMBATING TRAFFICKING IN PERSONS (FEB 2009)

I.12 FAR 52.229-8 TAXES—FOREIGN COST-REIMBURSEMENT CONTRACTS

(MAR 1990)

I.13 52.247-67 SUBMISSION OF TRANSPORTATION DOCUMENTS FOR AUDIT

(FEB 2006)

I.14 AIDAR 752.7101 VOLUNTARY POPULATION PLANNING ACTIVITIES

(JUNE 2008)

I.15 DEFENSE BASE ACT (DBA) INSURANCE FOR 2010-2015

I.16 GRANTS UNDER CONTRACT

I.17 ORGANIZATIONS ELIGIBLE FOR ASSISTANCE (JUNE 2005)

I.18 CONDOMS (JUNE 2005)

I.19 PROHIBITION ON THE PROMOTION OR ADVOCACY OF THE

LEGALIZATION OR PRACTICE OF PROSTITUTION OR SEX

TRAFFICKING (ACQUISITION) (APRIL 2010)

PART III – LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACHMENTS

SECTION J - LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACHMENTS ... 93

LIST OF ATTACHMENTS

PART IV – REPRESENTATIONS AND INSTRUCTIONS

SECTION K - REPRESENTATIONS, CERTIFICATIONS, AND OTHER

STATEMENTS OF BIDDERS

K.1 NOTICE LISTING SOLICITATION PROVISIONS INCORPORATED BY

REFERENCE

K.2 AGREEMENT ON, OR EXCEPTIONS TO, TERMS AND CONDITIONS

K.3 COMPLIANCE WITH VETERANS EMPLOYMENT REPORTING

REQUIREMENTS

K.4 SIGNATURE

K.5 FAR 52.204-8 ANNUAL REPRESENTATIONS AND CERTIFICATIONS.

(NOV 2011)

K.6 52.209-5 CERTIFICATION REGARDING RESPONSIBILITY MATTERS

(APR 2010)

K.7 FAR 52.215-6 PLACE OF PERFORMANCE. (OCT 1997)

K.8 FAR 52.219-1 SMALL BUSINESS PROGRAM REPRESENTATIONS. (APR

2011)

K.9 FAR 52.222-25 AFFIRMATIVE ACTION COMPLIANCE. (APR 1984)

K.10 FAR 52.230-1 COST ACCOUNTING STANDARDS NOTICES AND

CERTIFICATION. (OCT 2008

K.11 FAR 52.230-7 PROPOSAL DISCLOSURE--COST ACCOUNTING PRACTICE

CHANGES. (APR 2005)

SECTION L - INSTRUCTIONS, CONDITIONS, AND NOTICES TO BIDDERS

L.1 NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY

REFERENCE

L.2 FAR 52.216-1 TYPE OF CONTRACT (APR 1984)

L.3 FAR 52.233-2 SERVICE OF PROTEST (SEPT 2006)

L.4 FAR 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY

REFERENCE (FEB 1998)

L.5 GENERAL INSTRUCTIONS TO OFFERORS

L.6 INSTRUCTIONS FOR THE PREPARATION OF THE TECHNICAL

PROPOSAL

L.7 INSTRUCTIONS FOR THE PREPARATION OF THE COST PROPOSAL . 116

L.8 SMALL BUSINESS PARTICIPATION

SECTION M- EVALUATION CRITERIA

M.1 GENERAL INFORMATION

M.2 DETERMINATION OF THE COMPETITVE RANGE AND CONTRACT

AWARD

M.3 EVALUATION CRITERIA

M.4 SOURCE SELECTION

ATTACHMENT 1

ATTACHMENT 2

ATTACHMENT 3

ATTACHMENT 4

ATTACHMENT 5

ATTACHMENT 6

ATTACHMENT 7

PART I – THE SCHEDULE

SECTION B – SUPPLIES OR SERVICES AND PRICE/COSTS

B.1 PURPOSE

The purpose of this contract is to secure technical services for the implementation of a NGO Health Services Delivery Project in Bangladesh. The NGO Service Delivery Project will support the delivery of essential service packages through a network of non-governmental organization (NGO) clinics that primarily target the poor and underserved. The contractor shall be responsible for providing all services and activities described throughout this contract document.

B.2 CONTRACT TYPE - CPFF TERM

This is a Cost-Plus-Fixed-Fee (CPFF) term contract. For the consideration set forth below the Contractor shall perform the services further described in Section C.

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 [___]. The fixed fee, if any, is [___]. The estimated cost plus fixed fee, if any, is [___].

(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 [___]. The Contractor shall not exceed the aforesaid obligated amount.

(c) Funds obligated hereunder are anticipated to be sufficient through [___].

The remainder of this page left blank intentionally.

B.4 PRICE/COST SCHEDULE

Project Management Cost $__________ Other Direct Cost $__________ Indirect Costs including G&A $__________ Grants Under Contract $36,000,000 Total Estimated Cost $__________ Fixed Fee $__________ Total Est. Cost Plus Fixed Fee $__________

Individual subcontractors should include the same cost element breakdowns in their budgets as applicable.

B.5 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.

FAR 52.232-20 Limitation of Cost (applies while the contract is fully funded).

FAR 52.232-22 Limitation of Funds (applies while the contract is funded in an amount less than the total estimated cost).

B.6 INDIRECT COST

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 [Description] [Rate] 1/[___] 1/[___] 1/[____] [Description] [Rate] 2/[___] 2/[___] 2/[____] [Description] [Rate] 3/[___] 3/[___] 3/[____]

1/Base of Application: [_____] Type of Rate: [_____] Period: [_____] Source: [_____]

2/Base of Application: [____] Type of Rate: [____] Period: [_____] Source: [_____]

3/Base of Application: [____] Type of Rate: [____] Period: [____] Source: [____]

The remainder of this page left blank intentionally.

B.7 CEILING ON INDIRECT COST

(a) For each of the contractor's accounting periods during the term of this contract, the parties agree as follows:

(1) The distribution base for establishment of final overhead rates is

(2) The distribution base for establishment of final G&A rates is

(b) The contractor will make no change in its established method of classifying or allocating indirect costs without the prior written approval of the contracting officer.

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

Indirect Cost FY [XX] FY [XX] FY [XX] FY [XX]

[Reference respective accounting periods specified in Section B, Indirect Costs.]

(d) The government shall not be obligated to pay any additional amount on account of indirect costs above the ceiling rates established in the contract. This advance understanding shall not change any monetary ceiling, cost limitation, or obligation established in the contract.

B.8 LABOR

Compensation of personnel under this contract or any resulting subcontract must be in accordance with AIDAR 752.7007 Personnel Compensation, the full text of which is in section H.

[END OF SECTION B]

SECTION C – DESCRIPTION/SPECS./STATEMENT OF WORK

List of Acronyms:

ANC Antenatal Care ARI Acute Respiratory Illness BCC Behavior Change Communication BCWG Behavior Change Working Group CDC Centers for Disease Control and Prevention CDCS Country Development Cooperation Strategy CHCP Community Health Care Provider CSP Community Service Provider CYP Couple Years Protection DGFP Director General of Family Planning DGHS Director General of Health Services DFID UK Department for International Development DOTS Directly Observed Treatment, Short Course DSF Demand-Side Financing EPI Expanded Program for Immunization ESP Essential Service Package FP Family Planning FTF Feed the Future GDA Global Development Alliance GIZ German Technical Cooperation GHI Global Health Initiative GOB Government of Bangladesh HIV/AIDS Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome HPNSDP Health, Population and Nutrition Sector Development Program HTSP Healthy Timing and Spacing of Pregnancies IPC/C Interpersonal Communication and Counseling IR Intermediate Result IYCF Infant and Young Child Feeding LAPM Long-Acting and Permanent Methods MDG Millennium Development Goal MOCAT Modified Organizational Capacity Assessment Tool MOHFW Ministry of Health and Family Welfare MOLGRDC Ministry of Local Government, Rural Development and Cooperatives NGO Non-Governmental Organization OPHNE Office of Population, Health, Nutrition and Education PHC Primary Health Care PNC Post-Natal Care SBA Skilled Birth Attendant SS Smiling Sun SSFP Smiling Sun Franchise Program STI Sexually-Transmitted Infection UHFWC Union Health and Family Welfare Center UNFPA United National Family Planning Agency UNICEF United Nations Children’s Fund UPHCP Urban Primary Health Care Project USAID United States Agency for International Development USG United States Government WHO World Health Organization

C. 1 BACKGROUND and CONTEXT FOR USAID ASSISTANCE

C.1.1 Purpose

USAID/Bangladesh seeks to secure technical services for the implementation of activities under the new, four-year NGO health service delivery activity. The purpose of the contract is to support the delivery of an essential service package (ESP) through a network of non-governmental organization (NGO) clinics that primarily targets the poor and underserved. This activity will build on previous experiences and current successes in NGO service delivery and will incorporate new approaches to promote optimal health behaviors and community participation, and to enhance local ownership of service delivery through institutional strengthening. This activity will embrace new US government initiatives and reforms, including the Global Health Initiative (GHI) and the USAID Forward procurement reforms, and will complement and support the Government of Bangladesh (GOB) health sector program.

C.1.2 Health Sector Challenges and Inequities

See Annex A for essential background information on the health and population sector in Bangladesh.

C.1.3 Overview of Bangladeshi Health Sector

The GOB vision for the health sector is to see the people healthier, happier and more economically productive in order to make Bangladesh a middle-income country by 2021, the golden jubilee of Bangladesh’s independence. In line with the country’s Millennium Development Goals (MDGs), the Health, Population and Nutrition Sector Development Program (HPNSDP) 2011-16 was finalized in June 2011. Under its goal to “Ensure Quality and Equitable Health Care for All Citizens of Bangladesh”, the two main objectives are service delivery improved and strengthened health systems (see Annex B for

HPNSDP 2011-2016).

The previous GOB Health, Nutrition and Population Sector Program (HNPSP) 2003-2010 was formulated to ensure that government action and resources make a cost-effective contribution to the priority health needs of the poor, particularly women and children. Currently, there are 17 donors providing pooled funding under the HPNSDP. Non-pool partners such as USAID/Bangladesh are also active participants and ensure that their programs are in direct support of the HPNSDP.

The Ministry of Health and Family Welfare (MOHFW) has developed many policies and guidelines with which this award should be aligned. Key national policies include:

Population Policy (2004), now under revision Adolescent Reproductive Health Strategy (July 2006) Maternal Health Strategy (Oct 2001) Newborn Health Strategy (Mar 2009) Food and Nutrition Policy (2008) Infant and Young Child Feeding Practices (2004- 2006) Communication Strategy for Family Planning/Reproductive Health, Nov 2008 Strategic Plan for HIV/AIDS, 2004-2010 Improving the Uptake of Long-Acting and Permanent Methods in the Family Planning Program, National Strategy 2010 – 2015

Most of these documents were developed through national technical working groups that meet regularly and have representation of Ministry officials, donors, non-governmental organizations (NGOs) and other stakeholders.

C.1.4 Health Care Delivery System

In rural areas, the MOHFW is responsible for the provision of all levels of health services provided as part of the Essential Service Package (ESP), defined as a set of interventions designed for delivering services to the most disadvantaged people of Bangladesh both in rural and urban areas including hard-to-reach areas.

The target population is women, children, the poor and the elderly. The specific services are:

Table 1: The GOB’s Essential Service Package

Reproductive Health, including:

Safe motherhood - e.g. antenatal care (ANC), clean and safe delivery by skilled birth attendants, postnatal care (PNC), exclusive breast feeding, child immunization and nutrition.

Family planning – all seven modern family planning methods, especially LAPM Maternal nutrition Adolescent reproductive health Prevention of unsafe abortion, and post-abortion care Prevention of RTIs/STIs Infertility prevention and treatment Neonatal care Child Health Behavior Change Communication Communicable Disease Control – TB, Malaria, Leprosy, Dengue, HIV/AIDS Limited Curative Care – e.g., treatment of common cold, fever, pain relief, eye care, drowning, snake bites, accidents and injuries, and other primary care of other non- communicable diseases

ESP services are provided through a network of field workers, satellite clinics organized by field workers, Community Clinics, Union Health and Family Welfare Centers (UHFWCs), Mother and Child Welfare Centers (MCWC) and Upazila Health Complexes (UHCs). MOHFW delivers health services directly through its own facilities under the direction of two separate executing authorities, the Directorates of Health Services and Family Planning. District and Medical College hospitals offer PHC as well as tertiary care services. There are 1,275 UHFWCs managed by the Director-General of Health Services (DGHS) and about 3,000 under the control of Director-General of Family Planning (DGFP). MOHFW also is revitalizing 18,000 community clinics to support basic health, population and nutrition services through newly trained Community Health Care Providers (CHCP).

In urban areas, including municipalities and the seven City Corporations, public health management (including delivery of the ESP and food safety) and solid waste disposal are the responsibility of the Ministry of Local Government, Rural Development and Cooperatives (MOLGRDC) as of 1998. In 1999, MOLGRDC issued an administrative order, based on an understanding between MOLGRDC and MOHFW, authorizing City Corporations (through their Chief Medical Officers) to undertake coordination, planning and implementation of public health services. Despite that assigned responsibility, City Corporations have no health budget from the GOB, thus all of their health activities have to be paid out of the local revenue budget. As a result they have few staff, there are many vacancies and they have primarily focused on sanitation and child immunization. There is an underlying upazila (i.e., sub-district) administrative system in urban areas but these upazilas have few staff and no primary care facilities, except for a few urban dispensaries.

Utilization of NGO health services delivery in Bangladesh varies by type of service (e.g., 15 percent for ANC, 5.2 percent for modern contraceptive methods). NGOs fill critical gaps in public and private services and mainly aim to reach the poor and marginalized. NGOs are contracted by the MOLGRDC, largely supported through the donor-funded Urban Primary Health Care Project (UPHCP), and USAID’s Smiling Sun Franchise Program (SSFP).

The dominant role of the private sector in Bangladesh’s health care system is well known, both in health provision and financing. Bangladesh is a developing country where households allocate a large portion of their expenditure to health care. WHO National Health Account estimates for Bangladesh indicate that 67 percent of all health spending is from private contributions, with the government providing 33 percent.

Total health spending per capita is $19 (or $48 at purchasing power parity). It is estimated that 86 percent of consumers use the private sector services while only 14 percent use GOB services. This varies by type of service: more people use GOB services for FP and preventive care services such as maternal, neonatal and child health. The private sector is used more for curative services and in urban areas where there is wide access to many different providers.

C.2. USAID AND OTHER DONOR ACTIVITIES IN THE HEALTH SECTOR

C.2.1 Overview of USAID/Bangladesh Health Service Delivery

USAID has been funding NGO networks to support service delivery for over 30 years, starting with commodities distribution, and then expanding in the late 1990s to a clinic-based model for one-stop centers for an ESP. The two most recent iteration of this activity are the 2002-2006 NGO Service Delivery Program (NSDP), and the current (2007-2012) Smiling Sun Franchise Program (SSFP). SSFP supports a franchise model to provide integrated family planning and health service coverage through 27 NGOs, which support 323 static clinics, 8,700 satellite clinics and more 6,300 than Community Service Providers (CSP). The total catchment area for the 323 clinics is approximately 20 million people, and these clinics account for approximately 28 million service contacts a year. In SSFP Project Year Three, 40 percent of SSFP clinics (i.e., 130 clinics) were situated in rural areas, which accounted for 63 percent of total client contacts and 60 percent of client contacts with the poor (see Annex C for recent SSFP service information).

Through user fees and the development of a franchise, under which clinics are licensed to use the Smiling Sun brand, the program hoped to achieve financial sustainability for NGOs through cost recovery while increasing its share of poor clients. Service provision was expected to increase, while USAID’s costs declined. Although overall volume of services provided has increased, a mid-term assessment conducted by a third party identified significant missed opportunities for service provision (see Annex D for SSFP Mid-Term Assessment Report). This assessment highlighted the disparity between goals of serving the poor and cost recovery, as clinics located in rural areas or slums that serve large poor populations and certain service elements in the GOB expanded ESP that greatly benefit the poor (e.g., immunizations) have very low cost-recovery potential. SSFP reported that 31 percent of the service contacts were for the poor in the fourth year of the activity. Cost recovery among the network reached 42 percent in the fourth year (see Annex C), which demonstrates substantial gains, but remains far below the original target of 70 percent (later revised down to 45 percent). USAID’s focus is now pivoting to emphasize service delivery to the poor, with less emphasis on cost recovery, though it is important not to lose the gains that have been made in this area.

Lessons learned from previous USAID support for NGO health service delivery include:

NGOs must increase their linkages with communities and services at the village level to increase their ability to address key maternal, newborn, and neonatal health problems and barriers to uptake of family planning services. Successful pilot activities, such as training and supporting skilled birth attendants for home deliveries and expanding use of community-based distributers of contraceptives (i.e., depot holders), can be brought to scale to achieve increased impact. These programs also help build ownership and community involvement in clinic and satellite clinic services and programs

Clinic-level marketing efforts need to emphasize the availability of long-acting and permanent methods of family planning (LAPM) and the capacity of clinics to provide these services needs to be upgraded in order to ensure that cost-effective contraception is available to those who choose these methods

NGOs’ outreach capacity to the poor can be maximized by (i) re-directing support for cost-ineffective clinics in rural areas so that they operate more as hubs for increasing the number of satellite sites and (ii) linking these sites with “village doctors,” drug sellers and traditional birth attendants

Systematic strategies to increase human resource retention are needed as high rates of attrition among qualified health professionals have resulted in higher than anticipated levels of investment of time and resources for staff recruitment and training, distracting NGOs from their priorities in quality service delivery

NGOs can greatly improve cost recovery and operating efficiency by having greater flexibility to use program income for operating costs, by reducing overhead costs, and by better managing drug funds. Furthermore, NGOs need to increase the volume of services, undertake clinic level marketing, expand curative care for services in demand by clients, and expand programs intended to identify and subsidize care for the poorest clients

The franchise model overemphasizes cost recovery at the expense of the goal of providing quality services to the poor. Many staff under the franchise model view their primary mission as income generation

Close collaboration with and support from the GOB at all levels is critical to achieve success and to complement, not duplicate, GOB’s health service delivery by avoiding overlap in program catchment areas and maximizing reach of these services. One of the example has been the three Smiling Sun clinics opened with active support from GOB in the hill tract districts, where services did not previously exist

USAID-supported NGOs have demonstrated success in leveraging support through third-party payers, discounted commodities (e.g., SSFP procures drugs and supplies at a 23 percent discount), and through donations from corporate partners such as Chevron and Grameenphone through global development alliances (GDAs)

USAID-supported NGOs have been able to participate in the GOB’s Demand Side Financing (DSF) initiative, which issues vouchers to poor pregnant women to receive free ANC, emergency transportation, delivery and PNC, in nine different upazilas to help reduce the financial barriers for pregnant and post-partum women to receive vital maternal health services

While cost-recovery, business planning and leveraging additional support will continue to be crucial to sustaining NGO health service delivery, additional attention needs to be paid to the non-financial aspects of program sustainability, particularly strengthening NGO partners’ institutional capacity

Graduating NGOs from USAID dependence must be explicit from the beginning. Moreover, future programs must be structured and managed in ways that provide optimal conditions to encourage the graduation process. NSDP used the Modified Organizational Capacity Assessment Tool (MOCAT) to assess the capacity of its local NGO partners in relation to three pillars (i.e., programmatic, institutional and financial). SSFP is supporting its current local NGO partners to apply this tool to conduct self-assessments in order to identify areas needing institutional strengthening and to develop organizational development plans. The Essential NGO Guide to Managing Your USAID Award is another tool developed by FHI360 in 2010 that provides useful information on capacity assessments as well as on how to prepare local NGOs to directly receive USG awards. In addition, the successful completion of a pre-award assessment, which is conducted by USAID prior to awarding a grant to a first-time recipient, is a clear indication that a local NGO has the administrative and financial systems in place to effectively manage a USAID award. These tools provide valuable information on the profile of a sustainable NGO that can serve as an end goal to capacity building efforts (see Annex E for Existing Capacity Assessment Tools).

Based on this experience, this new activity is designed to further strengthen the current USAID-supported NGO health service delivery model in several areas:

There will be greater emphasis on NGO clinics serving the poor. The Contractor will be required to pursue innovative financing schemes for services provided to the poor and to propose rational cost recovery (i.e., at least 40% of total operating costs covered by program income and other sources), program income expenditure and reimbursement/pricing plans to provide such services.

As described below, USAID expects the Contractor to describe how they will define and identify the poor in rural and urban catchment areas for the purpose of targeting them for services

While maintaining a consistent standard of quality, greater responsibility and authority should be devolved to local NGO sub-partners to allow them to develop dynamic service delivery models suited to the local context to more effectively serve the poor and to better complement existing government and private health services

There will be a greater emphasis on five ESP components (LAPM, Maternal Health, Newborn care, Acute Respiratory Infections, and mainstreaming Nutrition), as well as to provide services specifically tailored to women and the youth

Services will be more responsive to and better coordinated with local health authorities, local government bodies (e.g., Union Parishad, City corporations), other development programs, and private sector providers. This coordination will continue to be a dynamic process, particularly as community clinics are revitalized and new community-level health workers are hired and trained

There will be a greater emphasis on increasing healthy behavior through Behavior Change Communication and increasing focus on service delivery in the community to:

o promote knowledge of and access to LAPM and healthy timing and spacing of pregnancies

(HTSP),

o promote safe motherhood and optimum nutrition among pregnant women and young children o improve essential and sick newborn care o increase demand for acute respiratory infection (ARI) treatment o promote early and exclusive breastfeeding, complementary feeding, and hygiene (especially hand washing practices for newborn and child health and survival)

A more proactive community engagement model is needed to not only increase service utilization, but to also link NGO health facilities to communities in order to increase transparency, accountability and coordination at the grassroots level

There will be greater emphasis on establishing defined NGO institutional strengthening milestones for sustainability and building the administrative, organizational, financial, and managerial capacity of local NGOs to meet these standards (see Annex F for NSDP partner MOCAT reports)

There will be concerted emphasis on transitioning larger, higher-performing NGOs from grants under contracts (GUC) to direct awards with USAID, when specific, time-bound milestones linked with the successful completion of a pre-award assessment are achieved

This activity will continue to offer the ESP services associated with the technical focus areas listed above in an integrated manner, making improvements that enhance efficiency, expand reach (particularly for the poor) and incorporate new technologies as appropriate. This activity will also continue to use the Smiling Sun (SS) brand for clinics.

C.2.2 Alignment with Existing GOB and USG Strategies

This activity will fit within and contribute to achieving the goals of three major strategies – the GOB’s HPNSDP, the US Government’s Global Health Initiative (GHI) Strategy for Bangladesh, and the USAID/Bangladesh Country Development Cooperation Strategy (CDCS) (see Annexes G and H for GHI/Bangladesh Strategy and CDCS Consultative Discussions, respectively). With these strategies, and the shared vision they reflect, this service delivery activity offers an exciting opportunity to significantly impact the health and development of the people of Bangladesh.

The CDCS is designed to contribute to the USG’s overarching goal of helping the people of Bangladesh develop a more mature democracy that creates broad-based economic opportunities and delivers basic services, while ensuring an environment that rejects extremism, fosters social development and promotes regional stability. The strategy focuses on achieving the goals of the Presidential Initiatives in food security, global health and global climate change. Its four development objectives focus on democratic governance, broad-based economic growth, reduced fertility and maternal and child mortality, and climate change mitigation. This activity will be expected to align with the geographic focus and the cross-cutting themes that emerge from the CDCS.

The U.S. Government (USG) has identified its strategy of support for HPNSDP in the GHI strategy for 2011-15. This strategy aims to mobilize the combined capacity of the USG in Bangladesh – including USAID, the U.S. Centers for Disease Control & Prevention (CDC), the Department of Defense (DoD), the National Institutes of Health (NIH) and any other USG agencies which may contribute – in support of a common goal of stabilizing population and improving health and nutrition. The GHI places a focus on gender equality for women and girls as it is important for maternal and child health, but also for social status, livelihood, and participation of women in the economy (see Annex I for GHI Supplemental Guidance on Women, Girls and Gender Equality). To achieve these goals, the GHI strategy calls for increased, equitable use of effective, integrated health, population and nutrition services and strengthened health systems. The Contractor shall also apply the principles of USAID/Bangladesh’s Best Practices at Scale in the Home, Community and Facilities (BEST) action planning process to ensure that state-of-the-art programming in FP, maternal, neonatal and child health, and nutrition draws on evidence-based interventions (see Annex J for USAID/Bangladesh BEST Action Plan).

In addition to these key policy documents, USAID has embarked on a comprehensive effort to reform foreign assistance modality. This reform agenda, known as USAID Forward, aims to change the way the Agency does business-- including diversifying partnerships, an emphasis on country ownership and leadership, innovation, and a relentless focus on results. This activity will be one of the flagship procurements to incorporate many of these principles, particularly the strategies of engaging new and innovative partners, increasing our focus on leveraging other funds available in country, and increasing and making more effective our partnerships with local, in-country NGOs, who will increasingly take more ownership of their own development.

This activity will also be aligned with other USAID/Bangladesh health initiatives supporting commodities, technical assistance, research or policy support related to service delivery in both the public and private sector. As described in Intermediate Result 1.2, this activity will create linkages as appropriate with USAID’s activities related to health system strengthening and governance, which will include support to MOHFW through national-level technical advisors, upazila health system strengthening, human resource capacity development and policy support to reposition family planning as a development priority. Please see Annex K for an overview of the current USAID/Bangladesh health program, along with summaries of individual projects.

C.2.3 Other Donor and Partner Programs Supporting Health

USAID is in the process of forming development alliances with United Nations Children’s Fund (UNICEF) to promote low cost technology for community based newborn resuscitation, to revive behavioral change communication (BCC) in health, and to combat malnutrition. In addition, USAID is rolling out Global Alliances with: (1) Australian Aid (AusAID), the Department for International Development (DFID), and the Bill & Melinda Gates Foundation to promote reproductive health; (2) Japan’s new “EMBRACE” Initiative focusing on maternal and neonatal health; and (3) GDAs on hand washing, hygiene and sanitation campaigns with Unilever (see Annex L for 2010 USAID/Bangladesh GDA Assessment on further GDA opportunities). Discussions are underway with the World Health Organization to collaborate on human resources strengthening and capacity building for health workers at the community and district levels. USAID is also working with the United Nations Fund for Population Activities (UNFPA) to revitalize family planning and support the GOB BCC efforts for FP and population.

USAID will also coordinate with the WB and German Technical Cooperation (GIZ) to establish an effective monitoring and evaluation system to support GOB in tracking progress of the Millennium Development Goals (MDG) for the next sector program.

The Second Urban Primary Health Care Project (UPHCP-II) is implemented under the GOB’s Ministry of Local Government, Rural Development & Cooperative (MOLRDC) with support from numerous donors (e.g., ADB, DfID) to support the delivery of primary health care services through local NGOs in six City Corporations and five municipalities (please see Annex M for link to UPHCP-II website). Other large networks of NGO clinics providing the primary health care services include Marie Stopes International (MSI), the Family Planning Association of Bangladesh and BRAC.

In another initiative, GOB has piloted a Demand-side Financing (DSF) scheme to increase uptake of maternal health services for poor women. A recent evaluation conducted by GIZ of this scheme shows that institutional deliveries doubled in the intervention districts as compared to control districts (see Annex N Overview of GIZ Evaluation of DSF). Encouraged by these results, the GOB will be rolling out this DSF scheme to an additional 53 upazilas.

C.3. ROLES

C.3.1 Role of Government of Bangladesh (GOB)

The primary role of the GOB in support of this activity will be implemented through the MOHFW through its HPNSDP 2011-2016, although the MOLGRDC, the Ministry of Women and Children’s Affairs (MOWCA) and Ministry of Social Work (MOSW) may also influence activity design and implementation. The GOB will provide overall policy guidance for the activities outlined below. Local GOB authorities (e.g., upazila health and FP officers, City Corporations) will also play a key role in ensuring the coordination of the various actors within their areas of authority, including those supported under this contract. GOB also supports NGO clinics through the provision of vaccines for the Expanded

Program on Immunization (EPI), family planning commodities, training and through linkages with new initiatives (e.g., DSF). The GOB Local Consultative Group on Health will be the key coordination mechanism for ensuring that USAID activities and results are widely shared with key stakeholders in the sector. In support of its decentralization agenda, the GOB will also facilitate coordination mechanisms at the sub-district levels (e.g. Upazila Management Committee, micro-planning meetings for EPI).

C.3.2. Role of USAID

The USAID office responsible for the direction and management of this activity is the Office of Population, Health, Nutrition and Education (OPHNE). The OPHNE, through the Contracting Officer’s Representative (COR), will provide overall technical direction on technical, management and policy issues relating to the achievement of results. OPHNE will also promote and monitor progress on GOB policy initiatives affecting activity implementation and will ensure coordination with other donor-funded programs. Furthermore, in support of its Evaluation Policy approved in January 2011, USAID will make separate awards to one or more third-party entity to conduct one mid-term performance assessment and one impact evaluation. Central questions to be answered in these independent evaluations will address issues related to overall impact in terms of coverage and health outcomes, responsiveness of the service delivery approach to meeting the needs of the poor, and program sustainability.

In addition to providing quality health services, USAID through this award is renewing emphasis on capacity building and strengthening health systems of local partners as described below in IR 3. It is expected that as a result of the capacity development interventions provided by the Contractor up to two local NGOs will be eligible for transition to receive direct service delivery grants from USAID within a timeframe negotiated by the Contractor and USAID. Once the local NGO(s) eligible for transition have been identified by the Contractor within the first six months of this award, USAID will conduct pre-award assessment(s) and will oversee the transition of local NGO partners to direct support.

C.3.3. Contractor's Role

This flagship health activity will be USAID’s major investment for aligning its support for the MOHFW new health sector program and for harmonizing assistance among other donors. The Contractor shall provide guidance and support to a network of local NGOs, which will be represented by a Membership Council. This network will serve as a common platform to share experiences and to continue to standardize effective methods of delivering high-quality essential services to the poor under the Smiling Sun brand, while simultaneously enabling NGOs to exercise greater flexibility and innovation in establishing priorities for service delivery, revenue generation, marketing and capacity building. The selected NGOs must exhibit strengths in integrated service delivery targeting women, children, marginalized populations and the poor, and behavior change communication including community mobilization in order to reach the target population and geographic focus outlined below.

While the majority of NGO partners are likely to be partners who have previously benefited from USAID support for health service delivery, the Contractor has the option of also including some new partners, provided that no more than 20 percent of clinics currently supported by USAID are affected by the change in partners (please refer to C.4.4 Geographic Focus). The Contractor shall be responsible for ensuring a smooth transition of support (e.g., retain existing clinic premises, staff transition/recruitment, equipment) from SSFP to this new activity for the those NGOs and clinics that are being retained, as well as the potential inclusion of new clinics (see Annex O for a list of staff and assets of current SSFP NGO partners and clinics). During the first quarter of the activity the Contractor shall work closely with USAID and local GOB authorities to handover support for retained clinics to minimize the disruption of clinical service delivery and to avoid a decrease in the quantity and quality of patient contacts.

This activity represents a significant increase in overall resources from its previous iterations. It is anticipated that at least 70 percent of the USAID funds made available through this contract will directly support the local NGO partners and their clinics to enable them to achieve the three Intermediate Results described below (please refer to C.4.7 Description of Results). The USAID/Bangladesh Mission Director has approved the use of Grants Under Contract (GUC) to be awarded by the Contractor to its NGO partners to oversee clinic- and community-based operations (e.g., salaries, supplies/materials, occupancy expenses). These GUC will total at least $36 million over the life of the activity and will constitute the majority of the direct support provided by the Contractor to its local NGO partners. In addition to the GUC, costs borne by the Contractor for the direct benefit of the NGO partner network (e.g., training, equipment, assessments, supplies/materials) can also count towards the 70% of direct support to local NGO partners.