SOL-520-14-000002_FINAL.pdf

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 ___ 180 days_____ 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)

Dion L. Glisan

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 139

SOL-520-14-000002

X

05/06/2014

Office of Acquisition and Assistance (OAA)

USAID/GUATEMALA

3190 Guatemala Place Washington, DC 20521-3190

Office of Acquisition and Assistance USAID/Guatemala Km. 6.5 Final Boulevard Los Próceres Santa Catarina Pinula, Guatemala

3 (three)

10:00 a.m. 06/20/2014

Telma Paz 502 24224133 guatemalaproposals@usaid.gov

X -

X 1-3

X 4-24

X 25

X 26

X 27-37

X 38-41

X 42-55

X 56-102

X 103

X 104-114

X 115-133

X 134-139

Table of Contents

PART I - THE SCHEDULE

SECTION B - SUPPLIES OR SERVICES/PRICES

B.1 PURPOSE

B.2 CONTRACT TYPE

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

B.4 LINE ITEMS

B.5 INDIRECT COSTS (DEC 1997)

B.6 CEILING ON INDIRECT COSTS

B.7 COST REIMBURSABLE

B.8 PAYMENT OF FIXED FEE

B.9 CANCELLATION CEILING

SECTION C – STATEMENT OF WORK/DESCRIPTION

C.1 OBJECTIVE

C.2 BACKGROUND

C.3 OBJECTIVES AND EXPECTED RESULTS

C.4 GENDER PERSPECTIVE

C.5 OTHER USAID, USG, DONOR and GOG COORDINATION

C.6 GEOGRAPHICAL FOCUS

SECTION D – PACKAGING AND MARKING

D.1 BRANDING POLICY AND COMMUNICATIONS PLAN

D.2 MARKING (752.7009 CLAUSE) (JAN 1993)

D.3 BRANDING STRATEGY FOR USAID/QUALITY IN HEALTH PROJECT

SECTION E – INSPECTION AND ACCEPTANCE

E.1 NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY REFERENCE

E.2 INSPECTION AND ACCEPTANCE

E.3 MONITORING AND EVALUATION PLAN

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 PERFORMANCE STANDARDS

F.5 AUTHORIZED WORKWEEK

F.6 REPORTS

F.7 REPORTS AND DELIVERABLES OR OUTPUTS

F.8 MONITORING AND EVALUATION

F.9 AIDAR 752.242-70 PERIODIC PROGRESS REPORTS (OCT 2007)

F.10 AIDAR 752.7005 SUBMISSION REQUIREMENTS FOR DEVELOPMENT

EXPERIENCE DOCUMENTS (September 2013)

F.11 USAID PROPERTY IN THE CUSTODY OF CONTRACTORS

SECTION G - CONTRACT ADMINISTRATION DATA

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

G.2 ADMINISTRATIVE CONTRACTING OFFICE

G.3 TECHNICAL DIRECTION

G.4 TECHNICAL DIRECTIONS/RELATIONSHIP WITH USAID

G.5 PAYING OFFICE

G.6 ACCOUNTING AND APPROPRIATION DATA

G.7 CONTRACTOR’S PRIMARY POINT OF CONTACT

G.8 CONTRACTOR’S PAYMENT ADDRESS

SECTION H – SPECIAL CONTRACT REQUIREMENTS

H.1 AIDAR 752.7032 INTERNATIONAL TRAVEL APPROVAL AND NOTIFICATION

REQUIREMENTS (JAN 1990)

H.2 AIDAR 752.7004 EMERGENCY LOCATOR INFORMATION (JUL 1997)

H.3 FOREIGN GOVERNMENT DELEGATIONS TO INTERNATIONAL

CONFERENCES

H.4 AIDAR 752.7027 PERSONNEL (DEC 1990)

H.5 AIDAR 752.225-70 SOURCE AND NATIONALITY REQUIREMENTS (FEB 2012)

H.6 INSURANCE AND SERVICES

H.7 AIDAR 752.228-70 MEDICAL EVACUATION (MEDEVAC) SERVICES (July 2007)

H.8 AUTHORIZED GEOGRAPHIC CODE

H.9 NONEXPENDABLE PROPERTY PURCHASES AND INFORMATION

TECHNOLOGY RESOURCES

H.10 LANGUAGE REQUIREMENTS

H.11 KEY PERSONNEL

H.12 EXECUTIVE ORDER ON TERRORISM FINANCING

H.13 REPORTING OF FOREIGN TAXES (JULY 2007)

H.14 PROHIBITION AND ASSISTANCE TO DRUG TRAFFICKING

H.15 AIDAR 752.7007 PERSONNEL COMPENSATION (JULY 2007)

H.16 CONFIDENTIALITY AND OWNERSHIP OF INTELLECTUAL PROPERTY

H.17 USAID DISABILITY POLICY - ACQUISITION (DECEMBER 2004)

H.18 PERSONNEL COMPENSATION

H.19 USAID IMPLEMENTATION OF SECTION 508 OF THE REHABILITATION ACT

OF 1973 AND FEDERAL ACQUISITION CIRCULAR (FAC) 97-27 "ELECTRONIC

AND INFORMATION TECHNOLOGY ACCESSIBILITY

H.20 MANDATORY COMPLIANCE REVIEWS

H. 21 CONTRACTOR’S STAFF SUPPORT, ADMINISTRATIVE AND LOGISTICS

ARRANGEMENTS AND LEGAL REGISTRATION IN THE COOPERATING

COUNTRY

H.22 ADS 206.3.12 - COVERED PARTICIPANTS

H.23 ADS 302.3.5.9- NONDISCRIMINATION (JUNE 2012)

H.24 CONSENT TO SUBCONTRACT

H.25 AIDAR 752.204.70 PARTNERS VETTING PRE-AWARD REQUIREMENTS (FEB

2012)

PART II - CONTRACT CLAUSES

SECTION I - CONTRACT CLAUSES

I.1 NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY REFERENCE

I.2 AIDAR 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

I.3 AIDAR 52.203-14 DISPLAY OF HOTLINE POSTER(S). (DEC 2007)

I.4 AIDAR 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS. (JUL

2013)

I.5 AIDAR 52.216-7 ALLOWABLE COST AND PAYMENT (JUN 2013)

I.6 AIDAR 52.216-7 ALLOWABLE COST AND PAYMENT (JUN 2013) – ALTERNATE

IV (AUG 2012)

I.7 AIDAR 52.222-50 COMBATING TRAFFICKING IN PERSONS (FEB 2009)

I.8 AIDAR 52.222-50 COMBATING TRAFFICKING IN PERSONS (FEB 2009) –

ALTERNATE I (AUG 2007)

I.9 AIDAR 52.227-23 RIGHTS TO PROPOSAL DATA (TECHNICAL) (JUN 1987)

I.10 AIDAR 52.229-8 TAXES—FOREIGN COST-REIMBURSEMENT CONTRACTS

(MAR 1990)

I.11 AIDAR 52.243-7 NOTIFICATION OF CHANGES (APR 1984)

I.12 AIDAR 52.244-2 SUBCONTRACTS (OCT 2010)

I.13 AIDAR 52.244-2 SUBCONTRACTS (OCT 2010) - ALTERNATE I (JUN 2007)

I.14 AIDAR 752.202-1 DEFINITIONS (JAN 1990)

I.15 AIDAR 752.209-71 ORGANIZATIONAL CONFLICTS OF INTEREST DISCOVERED

AFTER AWARD. (JUN 1993)

I.16 AIDAR 752.211-70 LANGUAGE AND MEASUREMENT (JUNE 1992)

I.18 AIDAR 752.219-70 USAID MENTOR-PROTÉGÉ PROGRAM (JULY 2007)

I.19 AIDAR 752.227-14 RIGHTS IN DATA – GENERAL - (OCT 2007)

I.20 AIDAR 752.228-3 WORKER’S COMPENSATION INSURANCE (DEFENSE BASE

ACT)

I.21 AIDAR 752.229-70 FEDERAL, STATE AND LOCAL TAXES

I.22 AIDAR 752.231-71 SALARY SUPPLEMENTS FOR HG EMPLOYEES. (OCT 1998)

I.23 AIDAR 752.245-70 GOVERNMENT PROPERTY-USAID REPORTING

REQUIREMENTS

I.24 AIDAR 752.245-71 TITLE TO AND CARE OF PROPERTY (APR 1984)

I.25 AIDAR 752.7001 BIOGRAPHICAL DATA (JUL 1997)

I.26 AIDAR 752.7002 TRAVEL AND TRANSPORTATION. (JAN 1990)

I.27 AIDAR 752.7006 NOTICES (APR 1984)

I.28 AIDAR 752.7008 USE OF GOVERNMENT FACILITIES OR PERSONNEL (APR

1984)

I.29 AIDAR 752.7010 CONVERSION OF U.S. DOLLARS TO LOCAL CURRENCY (APR

1984)

I.30 AIDAR 752.7013 CONTRACTOR-MISSION RELATIONSHIP

I.31 AIDAR 752.7014 NOTICE OF CHANGES TRAVEL REGULATIONS (JAN 1990)

I.32 AIDAR 752.7015 USE OF POUCH FACILITIES (JULY 1997)

I.33 AIDAR 752.7018 HEALTH AND ACCIDENT COVERAGE FOR USAID

PARTICIPANT TRAINEES (JAN 1999)

I.34 AIDAR 752.7019 PARTICIPANT TRAINING (JAN 1999)

I.35 AIDAR 752.7023 REQUIRED VISA FORM FOR USAID PARTICIPANTS (APR 1984)

I.36 AIDAR 752.7025 APPROVALS (APR 1984)

I.37 AIDAR 752.7028 DIFFERENTIAL AND ALLOWANCES. (JUL 1996)

I.38 AIDAR 752.7029 POST PRIVILEGES (JULY 1993)

I.39 AIDAR 752.7031 LEAVE AND HOLIDAYS (OCT 1989)

I.40 AIDAR 752.7033 PHYSICAL FITNESS (JULY 1997)

I.41 AIDAR 752.7034 ACKNOWLEDGMENT AND DISCLAIMER (DEC 1991)

I.42 AIDAR 752.7035 PUBLIC NOTICES (DEC 1991)

I.43 AIDAR 752.7101 VOLUNTARY POPULATION PLANNING ACTIVITIES (JUNE

2008)

I.44 AIDAR CONSCIENCE CLAUSE IMPLEMENTATION (ACQUISITION)

(FEBRUARY 2012)

I.45 AIDAR CONDOMS (ACQUISITION) (JUNE 2005)

I.46 AIDAR FAR CLAUSE 52.232-40, PROVIDING ACCELERATED PAYMENT TO

SMALL BUSINESS SUBCONTRACTORS (DEC 2013)

I.47 AIDAR 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

J.1 103

J.2 103

J.3 103

J.4 103

J.5 103

SECTION K - REPRESENTATIONS, CERTIFICATIONS, AND OTHER STATEMENTS

OF OFFERORS

K.1 NOTICE LISTING SOLICITATION PROVISIONS INCORPORATED BY

REFERENCE

K.2 52.204-8 ANNUAL REPRESENTATIONS AND CERTIFICATIONS (JAN 2014)

K.3 52.209-5 CERTIFICATION REGARDING RESPONSIBILITY MATTERS (APR 2010) .. 108

K.4 52.222-22 PREVIOUS CONTRACTS AND COMPLIANCE REPORTS (FEB 1999)

K.5 52.222-25 AFFIRMATIVE ACTION COMPLIANCE (APR 1984)

K.6 52.227-15 REPRESENTATION OF LIMITED RIGHTS DATA AND RESTRICTED

COMPUTER SOFTWARE (DEC 2007)

K.7 52.230-1 COST ACCOUNTING STANDARDS NOTICES AND CERTIFICATION.

(MAY 2012)

K.8 52.230-7 PROPOSAL DISCLOSURE--COST ACCOUNTING PRACTICE CHANGES

(APR 2005)

K.9 INSURANCE - IMMUNITY FROM TORT LIABILITY

K.10 AGREEMENT ON, OR EXCEPTIONS TO, TERMS AND CONDITIONS

K.11 AUTHORIZED NEGOTIATORS

K.12 SIGNATURE

SECTION L - INSTRUCTIONS,CONDITIONS, AND NOTICES TO BIDDERS

L.1 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE

L.2 52.215-1 INSTRUCTIONS TO OFFERORS—COMPETITIVE ACQUISITION (JAN

2004)

L.3 52.216-1 TYPE OF CONTRACT. (APR 1984)

L.4 52.233-2 SERVICE OF PROTEST (SEP 2006)

L.5 GENERAL INSTRUCTIONS TO OFFERORS

L.6 DELIVERY INSTRUCTIONS

L.7 INSTRUCTIONS FOR THE PREPARATION OF THE TECHNICAL PROPOSAL

L.8 INSTRUCTIONS FOR PREPARING THE COST/BUSINESS PROPOSAL

SECTION M – EVALUATION FACTORS FOR WARDS

M.1 GENERAL INFORMATION

M.2 EVALUATION CRITERIA

M.3 COST PROPOSAL EVALUATION

M.4 DETERMINATION OF THE COMPETITIVE RANGE AND CONTRACT AWARD

M.5 CONTRACTING WITH SMALL BUSINESS CONCERNS AND DISADVANTAGED

ENTERPRISES

M.6 EVALUATION SYSTEM

SOL-520-14-000002-SECTION B

PART I - THE SCHEDULE

SECTION B - SUPPLIES OR SERVICES/PRICES

B.1 PURPOSE

The purpose of this contract is to obtain the services of a firm to provide technical assistance and support to Guatemala’s Ministry of Health (MOH) to structure and implement a comprehensive and sustainable quality management system for the public network of health services, with the ultimate objective of improving the quality of care and improving the health and nutrition status of the Guatemalan population.

B.2 CONTRACT TYPE

The Government contemplates award of a Cost Plus Fixed Fee (CPFF) completion contract resulting from this solicitation.

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

(a) Period of Performance: Four (4) Years

(1) 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 $__________.

(2) Within the estimated cost plus fixed fee (if any) specified in paragraph (a)(1) 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.

(b) Funds obligated hereunder are anticipated to be sufficient through ___________.

B.4 LINE ITEMS

The Total Estimated Cost of this contract is within the following range:

$4,000,000 to $5,000,000 Million

The summary budget for the four year period is as follows:

Direct Labor $____________ Other Direct Costs $____________ Indirect Costs $ ___________ Fixed Fee $ ___________

Total Estimated Cost plus Fixed Fee $____________

NOTE: The Contractor will not be paid any sum in excess of the ceiling price. The only person authorized to commit or obligate additional funds is the Contracting Officer. Incurrence of costs in excess of the total amount obligated based on directions received from any individual other than the Contracting Officer and without prior Contracting Officer’s approval, shall not be reimbursed to the Contractor.

LIMITATION OF FUNDS

The ceiling price of this contract is $___________. In accordance with FAR clause 52.232-22, funds currently obligated under this contract are limited to $_________. The Contractor is not authorized to incur expenses in excess of $_________ and shall notify the Contracting Officer in writing whenever it has reason to believe that the costs it expects to incur under this contract in the next 60 days, or when added to all costs previously incurred will exceed 75% of the total obligated amount.

B.5 INDIRECT COSTS (DEC 1997)

For the Contractor:

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 1/ 1/ 1/

1/Base of Application:

Type of Rate: Predetermined Period:

B.6 CEILING ON INDIRECT COSTS

For the Contractor:

(1) Reimbursement for indirect costs shall be at the lower of the negotiated final rates or the following ceiling rates:

Description Rate Base Type Period

TBD 1/ 1/ 1/

1/Base of Application:

Type of Rate: Predetermined Period:

(2) 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.

(3) This understanding shall not change any monetary ceiling, obligation, or specific cost allowance or disallowance. Any changes in classifying or allocating indirect costs require 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

Payment of fixed fee, subject to FAR 52.216-8, may be made upon receipt of a proper invoice.

Subject to FAR 52.216-8, Fixed Fee, shall be allocated based upon the proportion of the labor provided over the period covered by the invoice. In the event that the contractor does not provide the total Level of Effort stipulated in the contract budget, the total amount of fixed fee will be reduced in similar proportion.

B.9 CANCELLATION CEILING

In the event that the Government cancels requirements for services in subsequent program years under this contract, the following conditions will apply.

(a) If cancellation under the clause at 52.217-2, ― “Cancellation Under Multi-year Contracts” occurs, the Contractor will be paid a cancellation charge not over the cancellation ceiling defined as follows:

The cancelation ceiling shall be the amount allotted to this contract under the Limitation of Funds clause (FAR 52.232-22) at the time the cancellation notice is issued by the Contracting Officer.

(b) In accordance with the Cancellation Under Multi-year Contracts clause, the cancellation charge will cover only:

(1) Costs-

(i) Incurred by the Contractor and/or subcontractor;

(ii) Reasonably necessary for performance of the contract; and

(iii) That would have been equitably amortized over the entire multi-year contract period but, because of the cancellation, are not so amortized; and

(2) A reasonable profit or fee on the costs.

[END OF SECTION B]

SOL-520-14-000002-SECTION C

SECTION C – STATEMENT OF WORK/DESCRIPTION

Quality in Health Project

Health and Education Office/Guatemala

List of abbreviations and Acronyms

ADS Automated Directive Systems BS Branding Strategy BIP Branding Implementation Plan CA USAID Cooperating Agencies CAIMI Centros de Atención Integral Materno Infantil CAM Central América and México CAP Centros de Atención Permanente CDC Centers for Disease Control and Prevention CDCS Country Development Cooperation Strategies / USAID CIDA Canadian International Development Agency CONASAN Consejo Nacional de Seguridad Alimentaria y Nutricional COP Chief of Party COR Contract Officer Representative DAS Direcciones de Área de Salud DEC Development Experience Clearinghouse ENSMI Encuesta Nacional de Salud Materno Infantil ER Environmental Review ERF Environmental Review Form FP/RH Family Planning/Reproductive Health FTF Feed the Future GDP Gross Domestic Product GHI Global Health Initiative GIS Geographic Information System GOG Government of Guatemala HIV/AIDS Human Immunodeficiency Virus/ Acquired Immune Deficiency

Syndrome HSS Health Systems Strengthening IEC Information, Education, and Communications IEE Initial Environmental Examination IGSS Instituto Guatemalteco de Seguridad Social IMCI Integrated Management of Childhood Illness (AIEPI, acronym in Spanish) ISO International Organization for Standardization JICA Japanese International Cooperation Agency LAC-IEE Latin America and Caribbean Initial Environmental Examination LOE Level of Effort M&E Monitoring & Evaluation MCH Maternal and Child Health MOH Ministry of Health (MSPAS- Ministerio de Salud Pública y Asistencia

Social – Guatemala , in Spanish) MNCH Maternal, Neonatal and Child Health MP Marking Plan MSM Men who have sex with men NGO Non-governmental Organization OPQ Optimizing Performance and Quality PAHO Pan-American Health Organization

PEC Programa de Extension de Cobertura PEPFAR President’s Emergency Plan for AIDS Relief PF Partnership Framework ProCONE Promotion of Essential Obstetric and Neonatal Care (acronym in Spanish) QA Quality Assurance QIH USAID/Quality in Health Project RFP Request for Proposal SIAS Sistema Integrado de Atención en Salud SOW Statement of Work STI Sexually transmitted infection TA Technical Assistance TCN Third Country National USAID United States Agency for International Development USG United States Government WH Western Highlands WHO World Health Organization WHIP Western Highlands Integrated Programs

C.1 OBJECTIVE

Under the Quality in Health (QIH) project, the Contractor shall provide technical assistance and support to the Guatemalan MOH to strengthen its quality management system for establishing, monitoring, and improving the quality of the health care system.

The USAID/ QIH project will support Guatemala’s MOH to develop a comprehensive and sustainable quality management system to improve the quality of care and the health and nutrition status of the Guatemalans with a focus on the rural poor. The technical assistance and support provided by QIH will encompass the policy, regulatory framework and management aspects of the health quality system at the central MOH and selected Direcciones de Área de Salud (DAS, or local health area directorates). The implementation of QIH will be at all levels of service delivery at health facilities delivering maternal, neonatal and child health, nutrition and family planning/reproductive health (FP/RH) services in 30 selected municipalities1 in six departments: Huehuetenango, San Marcos, Quetzaltenango, Quiché, Totonicapán and Alta Verapaz, as well as health facilities delivering HIV/AIDS integrated care. Technical assistance will be provided to the MOH to strengthen policies, regulations and systems for planning and implementing quality improvement actions and for supervision and monitoring to ensure achievement and ongoing maintenance of quality standards. The establishment of a comprehensive, integrated and well-functioning quality management system in the MOH will have a positive impact on all aspects of health care and programs under the ministry’s jurisdiction (Components 1, 2, and 3 QIH). Support for monitoring the implementation of the systems in specific facilities will focus on maternal, neonatal and child health (MNCH), nutrition, FP/RH and HIV/AIDS services (Component 4 of QIH). The QIH project will contemplate four components, as follows:

1. Situational analysis

2. Policy and regulations

3. Establishing the quality management system

4. Monitoring the implementation of the quality management system

The health sector is characterized by the World Health Organization (WHO) as a complex set of systems, including: governance, financing, logistics, information, human resources, and quality health services. USAID/Guatemala supports the MOH in each of these systems, but QIH will be primarily concerned with the quality of health services. Technical assistance to the MOH under QIH to develop and implement a health quality system will focus on the six principal domains for quality interventions2 outlined in the WHO Quality of Care framework: leadership, information, patient and population engagement, regulation and standards, organizational capacity, and models of care. The identification of these six domains by the WHO as the essential core of a quality system is based on many decades of experience in countries around the world that have made efforts to improve the quality of their health systems.

Successful implementation of QIH interventions will improve the coordination of MOH units managing the three levels of health services (described under Guatemalan health system section). By implementing a Quality Management System, the QIH project in coordination with other stakeholders, will contribute to the strengthening of the MOH to manage the health information system, the financial management system, the pharmaceutical and commodity logistics system and the human resource system. Thus, the MOH will strengthen its normative capacity as well as its capacity for using

1 USAID/Guatemala’s Western Highlands Integrated Program Municipalities (see attachment J.3, Annex 13) and List of health facilities targeted by the HIV/AIDS Regional Program (see Attachment J.3, Annex 14) 2 World Health Organization ‐ Quality of Care: a process for making strategic choices in health systems.

information for decision making which will facilitate processes at the service delivery level to improve its quality and coverage.

Activities under QIH should be well-coordinated with other USAID health and nutrition projects as well as USAID projects in the economic growth, education, food assistance and local governance sectors to achieve the cross-sectoral integration USAID is implementing in its Western Highlands Integrated Development Program (WHIP). WHIP is a Mission-wide effort to integrate USAID programming across sectors including health, education, economic growth, local governance, and the environment. WHIP supports GOG strategic plans including the Zero Hunger Pact to reduce chronic malnutrition in Guatemala. In accordance with Guatemala’s Country Development Cooperation Strategy (CDCS), only simultaneous improvements in health, education, nutrition and economic growth, as well as local governance and the environment will lead to greater socio-economic development and reduced chronic malnutrition in the Western Highlands (WH). Coordination with other donor organizations and U.S. Government (USG) partners, under the U.S. Presidential Global Health Initiative (GHI), such as the Centers for Disease Control and Prevention (CDC), Peace Corps, and the Department of Defense will also be required for the QIH project.

USAID is issuing this statement of work as a means of reducing the number of USAID health partners currently working with the MOH in order to reduce costs, USAID’s management burden, and to improve coordination among different elements (MCH, HIV/AIDS and FP/RH) and other activities supported by USAID in Guatemala. Current activities include principally: the USAID/TRAction Project implemented by University Research Co., LLC, and the USAID/Capacity Project implemented by IntraHealth International, Inc. More information about each of these activities is provided in Attachment J.3, Annexes 6 and 7.

Therefore, to integrate the various components and activities included in this SOW, as well as reduce costs and promote competition, USAID would prefer a single Contractor rather than a consortium composed of various Cooperating Agencies (CA) and sub-contractors.

C.2 BACKGROUND

Guatemala is a priority country for GHI as well as the Global Hunger and Food Security Initiative, also known as Feed the Future (FTF). The Guatemala GHI Strategy (see Attachment J.3, Annex 1) includes three focus areas: (i) improve access to and the quality of health services in Guatemala, with an emphasis on rural, indigenous, and other vulnerable populations; (ii) prevent chronic malnutrition for children less than two years of age with a focus on rural and indigenous populations; and (iii) strengthen the collection and use of information for action at all levels of the health system.

USAID/Guatemala’s BEST Action Plan for Family Planning, MCNH, and Nutrition (see Attachment J.3, Annex 2) outlines an activity plan for implementing GHI in the country by incorporating the nutrition and health components of the FTF strategy. The Guatemala FTF Multiyear Strategy (see Attachment J.3, Annex 3) focuses on efforts to increase food security and reduce chronic malnutrition among rural and indigenous populations in five departments of the WH.

Guatemala is also one of the countries in the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) Central America and Regional Partnership (see the Regional Partnership Framework in Attachment J.3, Annex 4.) Under the PEPFAR Regional Partnership Framework, signed by all seven Central American countries in March 2010, the USG supports host country governments to more effectively and efficiently lead the national and regional responses to the epidemic through strategic technical assistance and close coordination with all key stakeholders in the region from the Global Fund and UN organizations, to civil society, as well as limited but increasing involvement of the private sector. The Regional Partnership Framework principally focuses on four areas of HIV/AIDS programming: prevention, policy, strategic information and health systems strengthening. The PEPFAR Regional Partnership Framework supports the overall objective of the Program under the USAID Central America–Mexico (CAM) Strategic Plan Investing in People: Healthier, Better Educated People, CAM Intermediate Result 4: HIV/AIDS Contained in Central America through a more effective and coordinated regional response. This above mentioned activity will work towards achieving the following results under Sub-Intermediate Result 3 of the Revised HIV/AIDS Regional Plan: a) Best practices for a comprehensive care delivery system appropriate to locally available resources developed and applied; and b) A comprehensive HIV/AIDS training and mentorship program for health professionals developed and implemented.

Country Development Cooperation Strategy (CDCS) (see Attachment J.3, Annex 5).

The goal of USAID/Guatemala CDCS is to establish “a more secure Guatemala that fosters greater socio-economic development in the WH and sustainably manages its natural resources.” This goal supports the hypothesis that only parallel improvements in the income, food utilization, health care, nutrition, adaptation to climate change impacts, and equitable control over income by men and women who live in poverty in the WH will foster the sustainable rural development necessary for social and economic equity. To this end, the USAID/Guatemala health and nutrition program will contribute to the achievement of Development Objective 2 (DO2) under the CDCS: Improved levels of economic growth and social development in the WH.

DO2 hypothesizes that integrated improvements in the income, health and nutrition, and education of Guatemala’s rural poor will foster the sustainable rural development necessary for social and economic equity. Improved income alone is insufficient to reduce poverty, illness and malnutrition in Guatemala’s rural poor communities; therefore, USAID will work with the GOG in the WH to improve economic opportunities as well as increase access and utilization of quality health, nutrition, and education services. Therefore, the purpose of the health and nutrition program is to expand access to and use of sustainable quality health care and nutrition services. USAID/Guatemala will achieve this through three outputs: 1) Adoption of health and nutrition practices expanded, 2) Availability of sustainable and culturally adapted health care and nutrition services improved, and 3) Quality of sustainable health care and nutrition services improved.

The health context Guatemala’s demographic and health indicators show some of the poorest outcomes in the Americas (Pan American Health Organization –PAHO- data3), such as:

Life expectancy at birth of 71.3 years, ranked sixth lowest in the Americas, after Haiti, Bolivia, Guyana, Suriname, and Trinidad and Tobago.

Maternal mortality ratio (MMR) of 139 deaths per 100,000 live births, one of the highest in the Americas.

Crude mortality ratio of 31.8 deaths per 1,000 people, the highest in the Americas.

Infant mortality of 30 deaths per 1,000 live births, only below Bolivia among the countries with data.

Mortality in children under five years old is 40 per 1,000 live births, the third worst in the

Americas, just below Haiti and Bolivia.

Additionally, while the 2008-09 National Maternal and Child Health Survey (ENSMI, acronym in Spanish) showed some progress in health and nutrition status from the 2002 ENSMI, it demonstrated a

3 Organización Panamericana de la Salud, Información y Análisis de Salud: Situación de Salud en las Américas.

Indicadores Básicos 2011. Washington, D.C., Estados Unidos de América, 2011.

continued high rate of chronic malnutrition in children less than five years (50%) and a high level of anemia (30%) in pregnant women.

The poor health and nutrition situation is markedly aggravated in indigenous and rural populations, 70% of whom live in poverty (compared with 53.7% nationally).4 National data also demonstrates significant gaps for key health indicators, as well as in access to and use of health services between indigenous and non-indigenous population groups:

Stunting prevalence in children less than five years of age is 58.6% in indigenous populations versus 30.6% in non-indigenous populations.5

MMR of 163 deaths per 100,000 live births for indigenous women versus 78 deaths per 100,000 live births for non-indigenous women.6

Births attended by physician/nurse, 29.5% vs. 70.2%.

Modern contraceptive use by women of reproductive age in union 28% vs. 54.2%.

The factors underlying the disparities between the indigenous and non-indigenous and between the urban and rural populations are complex and reflect historical patterns of political and economic marginalization that are woven into the structure of the country. Continuing cultural and language heterogeneity (24 languages in addition to Spanish are spoken in the country) also contribute to a situation where large proportions of indigenous populations lack access to quality health services.

Departments in the Western Highlands and Alta Verapaz department have some of the worst health and nutrition indicators in the country.

The HIV epidemic in Guatemala is concentrated in certain key populations at higher risk, such as sex workers and men who have sex with men (MSM). Against the backdrop of widespread homophobia and stigma and discrimination, these hidden epidemics of HIV continue with the threat of spreading into the general population through well-established bridges with the key populations. Guatemalan’s HIV-infected population lives primarily in urban areas along major transportation routes. Available data indicate that HIV has affected mainly urban populations. However, preliminary data indicate that there could be increased HIV infection among some indigenous populations but the data is insufficient to determine the extent of the epidemic in this population. More than 80% of reported HIV cases occurred among 15-49 year-olds and 20-34 year-olds account for more than 52% of all cases. National HIV prevalence among sex workers is 3% to 4%, and among groups of street-based female sex workers, the prevalence is as high as 3% to 12%. National HIV prevalence among MSM is between 7% to 18%.7 Other vulnerable populations include the incarcerated, sex workers’ clients, youth at social risk, and street children.

The Guatemalan health system The Guatemalan health system has developed over the years somewhat accidentally, with little overall planning, into a complex, poorly coordinated network of services, divided into subsystems that are in turn fragmented without clear organization or integration8. The public subsector includes a network of services delivered by the MOH, the Instituto Guatemalteco de Seguridad Social (IGSS:

4 Fortalecimiento del Primer Nivel de Atención. Una estrategia segura para la universalización de la salud y el cumplimiento del Pacto Hambre Cero. Ministerio de Salud Pública y Asistencia Social, Guatemala. Octubre 2012.

5 ENSMI 2008‐2009

6 Estudio Nacional de la Mortalidad Materna. Guatemala, 2011. SEGEPLAN/MSPAS, Guatemala. Nov. 2011 7 Ministry of Health, USAID/PASCA, et al. Central America Multisite Study.

8 Diagnóstico Nacional de Salud. Ministerio de Salud Pública y Asistencia Social, Guatemala March 2012 (see Attachment J.3, Annex 12)

Guatemalan Social Security Institute), the health services of the Ministries of Defense and Government, and San Carlos University. The for-profit private subsector is made up of hospitals, nursing homes, clinics, pharmacies, and laboratories authorized by MOH. The non-profit private subsector consists of services provided by Non-Governmental Organizations (NGOs) and by practitioners of traditional medicine.

Delivery of MOH services includes three levels of care, according to the type and complexity of services provided. There are organizational, characterization and categorization anomalies, particularly in the first and second level, where multiple categories of facilities have very similar responsibilities.

The first level of health care is provided by basic health care teams (equipo básico de salud) in health posts (puestos de salud), reinforced health posts (puestos de salud fortalecidos), reinforced health posts open during the week end (puestos de salud fortalecidos con fin de semana), and the essential units (unidades mínimas). The first level includes the centros de convergencia (convergence centers to provide permanent, not mobile, care) of the Coverage Extension Program ( Programa de Extensión de Cobertura –PEC-), which is implemented by 67 NGOs providing basic MCH and FP/RH care to 54% of Guatemala’s rural population. Strengthening PEC and the first level of health care is one of GOG’s principal health policy strategies under the current administration, to ensure the legal mandate of providing universal access to health care and to ensure the effective implementation of the 1,000 Days Window approach for the success of the Zero Hunger Pact.9 The first level of care, including the PEC, provides 74% of MOH services in 1,101 facilities across the country (2011 data).

The second level of health care includes services provided by health centers (centros de salud, types A and B), peripheral maternities (maternidades periféricas), comprehensive maternal and child health care centers (centros de atención integral materno-infantil - CAIMI), and permanent health care centers (centros de atención permanente - CAP). The second level provides 23% of MOH services in 346 facilities, and includes 1,200 beds mainly for normal deliveries.10

The third level of health care is the network of 13 district, 10 departmental, 13 regional, and 9 national general and specialized public hospitals. It provides 3% of MOH services.

The first level of care, including the PEC, and the second level of care are rather uncoordinated and managed independently from the network of hospitals, under two different vice-ministries of the MOH.

The MOH is, by law, the authority for all health services in the country.

Primary care provided at the first level of services includes 26 basic services, of which eight are for women, eight for pediatrics, six for emergencies and prevalent diseases, and four are focused on the environment. Nutrition interventions take place primarily at the primary health care level for women and children. HIV/AIDS diagnostic and treatment services take place at the hospital level and in health centers, particularly in STI (sexually transmitted infection) clinics. IGSS services have programs for accidents, disease, maternity, disability, seniors, and survival for members, and preventive and curative care for members’ children less than five years of age. Coverage by specific programs is not equal throughout the country. Overall, MOH services received 49.6% of health care visits in 2011, IGSS 15.7%, and the private sector 34.3%.11

9 Ley por la Maternidad Saludable. Decreto No. 32‐2010. Congreso de la República de Guatemala 10 Diagnóstico Nacional de Salud. Ministerio de Salud Pública y Asistencia Social, Guatemala, March 2012.

11 Protección Social en Salud: Guatemala, Informe Final. 2002. MSPAS.

Public expenditure on health is low: 2.1% of the Gross Domestic Product (GDP) in 2010 (50% for the IGSS network, which covers just 17.4% of the population), and there is a high level (54% of all health expenditures) of inequitable out-of-pocket expenses.12 It has been estimated that the MOH budget should be three times its current percentage of GDP to enable it to meet current population needs. In terms of human resources, the challenges are in inadequate numbers, inadequate training and qualifications, and high turnover and movement of staff in health facilities. Currently, 14% of MOH personnel are physicians or nurses; 31% are nurse assistants (auxiliares de enfermería) with low academic training who perform most health care services; and 49% are administrative personnel.

Quality management in the health system There have been various MOH initiatives over the years to improve quality in the health care system and establish quality management processes and structures but none has resulted in an on-going institutionalized quality management system. USAID support has been critical for these efforts as has support from other international cooperation agencies, among them the Pan American Health Organization (PAHO), the Japanese International Cooperation Agency (JICA), the Canadian International Development Agency (CIDA). The efforts have focused on individual pieces of the system, such as certification of the ministry’s administrative and financial management systems through the International Organization for Standardization (ISO) or establishing quality improvement teams at the health facility level to address specific weaknesses identified. The MOH has, at various times, created a specific unit at the central level to be responsible for managing the quality of all administrative procedures and health services, but it has never functioned as expected nor lasted beyond one government administration. The lack of a specific national law on quality or a formal policy from the MOH to define and regulate quality has been an important vulnerability and typically each new administration starts over again to address the issue instead of building on previous structures and systems. Lack of coordination within the MOH, a narrow focus on specific quality problems lacking a clear systemic and holistic vision and a mostly external approach that is unsustainable over the medium and long term make it difficult to fully institutionalize and sustain these important efforts.

In line with the MOH’s recent emphasis on strengthening the first level of care, a new Quality Management Unit has been created; however, it has been placed under the General Directorate for Integrated Health Care Services (SIAS). The SIAS is in charge of health services at the second and first level of health care, including the NGOs delivering care through the PEC, and thus does not cover hospital services and the overall functioning of the entire ministry.

To overcome organizational obstacles to the improvement of service quality and accountability, the health service network needs to improve coordination. The vision for these improvements will eventually result in the characterization and accreditation of health facilities by level to be able to perform as part of a functional health network and provide quality of health services.

USAID-funded initiatives to improve the quality of health care USAID’s support for improving health care quality over the years has focused on MNCH and FP/RH at the first and second levels of care, ISO certification of administrative and financial procedures, improved health care for populations with HIV/AIDS and the cultural adaptation of health services (“interculturalidad”). There have been some key achievements from this support:

(1) The MOH reproductive health program was granted official status in 2000, and in 2002 the MOH became the largest provider of FP services in the country. In 2003 national FP

12 Organización Panamericana de la Salud, Información y Análisis de Salud: Situación de Salud en las Américas. Indicadores Básicos 2011. Washington, D.C., Estados Unidos de América, 2011.

norms that eliminated several medical and institutional barriers to the provision and use of FP services were updated and disseminated.

(2) Contraceptive stock-outs in MOH facilities were reduced from 45% in 2001, to 20% 2002, 18% 2003, and 15% in 2004. Contraceptive security was advanced by the creation of a national commission. Annual contraceptive procurement plans are now prepared by the MOH and contraceptives are purchased by the MOH with its own resources.

(3) The Integrated Management of Childhood Illness (AIEPI, acronym in Spanish) program with a strong community-based MCH and nutrition component, known in Guatemala as the AIEPI AINM-C program, was officially launched in 2001 and is now up and running nationwide, sustained with regular MOH resources.

(4) MOH capacity was strengthened at the facility level through a variety of collaborative approaches that engage all levels of staff to improve the quality health services, to actively engage communities, and to scale up proven, successful interventions in maternal, neonatal and child health, family planning and reproductive health, and HIV/AIDS.

(5) The MOH adopted and expanded beyond a few pilot facilities an integrated approach, called the Promotion of Essential Obstetric and Neonatal Care (ProCONE, acronym in Spanish), to improve the quality of maternal and neonatal care as well as the management of obstetric complications. The standards and indicators of ProCONE were published by the MOH as the “Guide for the Implementation of the Integral Maternal and Neonatal Care.” As a complement to ProCONE, the MOH implemented, on a limited basis, a maternal mortality surveillance system down to the community level.

(6) Thirty hospitals at the district and departmental levels have established systems to improve the quality of services provided to HIV-infected persons and expand these same improvements to all services provided by the hospital. The gaps in quality that are identified are addressed through a “gaps-closing plan” and progress is measured on a quarterly basis.

Currently, USAID support to the MOH quality improvement efforts is provided primarily through two projects, the TRAction project and the Capacity project, both of which will end between late 2013 and mid- 2014.13 The QIH project will be the follow-on to these two projects.

USAID/TRAction is providing technical assistance to improve the quality of MNCH services at primary and secondary care facilities in six departments, Huehuetenango, San Marcos, Quetzaltenango, Totonicapán, Quiche and Alta Verapaz. Details on the TRAction project are found in Attachment J.3, Annex 6. The USAID/Capacity project is providing technical assistance to improve the quality of HIV/AIDS services in hospitals throughout the country. These quality improvement processes in hospitals are expanding to other services as well. Details on the Capacity Project are found in Attachment J.3, Annex 7. In addition to their principal focus on improving the quality of service delivery, both projects are providing technical assistance to the central level of the MOH to establish ministry-wide quality assurance and quality improvement systems. Five other USAID projects are also contributing to MOH efforts to improve the quality of specific aspects of health service delivery: Supply Chain Management Systems project is assisting the National AIDS Program (Programa Nacional de ITS/VIH/SIDA) to strengthen the logistics system for essential commodities for diagnosis and treatment of HIV and opportunistic infections; the Deliver Project is providing assistance to strengthen the national logistics system for drugs, medical supplies, and

13 Only quality improvement activities in Guatemala ended in late‐2013 to combine efforts with those of the TRAction project in a consolidated mechanism which is the new QIH project. Capacity Project implements activities throughout the Central America region with an end‐of‐project date of 2016.

essential commodities to address the frequent stock-outs at first and second level facilities; the PlanFam project provides assistance to the MOH reproductive health program to disseminate national norms and guidelines, and to improve the quality of family planning and reproductive health services at hospitals and health centers in USAID’s six focus departments in the west and north of the country; the HEPP (Health and Education Policy Project) is providing support to strengthen national and subnational policy, advocacy and program integration, focusing on key health issues – reproductive health/family planning, HIV and maternal health- and with the education sector to incorporate a more holistic approach; and the Nutri-Salud project, which works with the MOH to expand and improve services at the first level of care in health posts and Centros de Convergencia, has a quality assurance and quality improvement component integrated into project interventions.

Attachment J.3, Annex 8 provides details on these five projects.

USAID/Guatemala assessment of MOH quality management systems and efforts to improve quality of care USAID recently commissioned an assessment of quality improvement efforts in the MOH health care system and USAID’s role in providing assistance for these efforts over the years. The assessment report “USAID/Guatemala: Sector Assessment of Quality Improvement in Health Services”, found in Attachment J.3, Annex 9, provides an evaluation of the current state of MOH systems for managing quality and also lays out a conceptual framework for analysis and improvement of health care quality that is the platform for the QIH project and its components. Offerors responding to this request for proposals (RFP) are strongly advised to review the assessment report for better comprehension of the context and background of the proposed QIH project as well as the conceptual model used in the development of this RFP. The WHO publication, “Quality of Care: A Process for Making Strategic Choices in Health Systems” (see Attachment J.3, Annex 10) should also be consulted by offerors to better understand the framework of this RFP.

USAID/Guatemala gender assessment USAID/Guatemala recently performed a gender assessment for the health program of its Country Development and Cooperation Strategy 2012-2016 which identified a set of gender analysis question: “What are the possible gender gaps that will affect the program’s ability to reach its objectives or people’s ability to participate in and benefit from the project?” The Health team identified previous studies and other written sources as input into the assessment and identified key informants who assisted with additional and updated information which resulted in an analysis of the gender gaps relevant to the implementation of USAID health projects and a discussion of potential project responses to each gender gap.