Answers_for_SOL-521-13-000011__FINAL.pdf

ISSUE DATE: February 6, 2013

QUESTIONS: February 19 th , 2013

SOLICITATION CONFERENCE: February 20 th , 2013 (Tentative)

CLOSING DATE: March 20th, 2013

CLOSING TIME: 12:00 noon, Haiti local time

SUBJECT: Request for Proposal (RFP) No. SOL 521-13-000011, Services de Santé de Qualité pour Haïti (SSQH)

To Prospective Offeror:

1. Does USAID expect the Offeror to provide IMCI services at the facility level or is the

Offeror expected to facilitate an increase in outposts? Will USAID provide IMCI literature in French? If not, is the Offeror expected to provide these materials?

Answer: IMCI services will be provided at both community and facility level. The IMCI guidance from the MOH is available.

2. Could USAID please provide Attachment S, which is mentioned on page 16 of the subject RFP, but is not available on FBO?

Answer: Please find Attachment S, provided as an addendum document.

3. Is the Offeror expected to procure necessary instruments? Or is the Offeror expected to work with USAID or other entities to obtain these instruments.

Answer: This project will support limited equipment procurement to address facility priority needs. Based on the initial assessments that will be conducted by the implementing partner(s), a gaps analysis will be developed. As a function of this analysis, certain equipment needs will be identified.

4. Does USAID expect the Offeror to support 100% of all sites within a given contract area or does USAID expect the Offeror to support 100% of the sites targeted by SDSH within a given contract area?

Answer: This project will provide continuity of direct service delivery support to sites currently supported under the SDSH project. In addition, limited support to additional facilities will be provided to sites within the geographically defined USG referral networks. This additional site support will be delivered through the mobile team/technical assistance model, not through a static presence.

5. Does "increasing utilization" mean increasing use at sites or expanding to new sites?

Answer: Increasing utilization refers to increasing uptake of the essential package of health services at existing sites. It is expected that improvements in service quality, as well as community health worker outreach, will contribute to increased utilization.

6. Attachment O lists the number of functional and non-functional facilities. Does USAID have specific expectations of the role of the Offeror in “non-functional” sites?

Answer: This refers to a national assessment of health facilities conducted in 2010-2011 by the Government of Haiti and supported by the Canadian government. The designation of sites as functional or non-functional is not fully defined. The USG is currently carrying out a service provision assessment (SPA) which will provide further details on the functioning of all health facilities in the country. The contractor shall provide focused support to address key gaps identified in the SPA.

7. The RFP indicates in several places that the SSQH project should strengthen and institutionalize key management practices. Given that several USG-funded projects in

Haiti will be addressing management practices (i.e., LMG, Support of Haiti Strategic

Information Systems), can USAID provide further clarification on which management practices, and at what level of the health system, should be the focus of the SSQH project?

Answer: This project will support targeted technical assistance and mentorship activities at the facility/community levels, as well as at the departmental level. Given rates of high staff turnover in Haiti, the focus on management systems at all levels should ensure that facility and departmental strengthening is not person dependent, but rather a reflection of strengthened and institutionalized systems and protocols. The Support to UPE Strategic

Information project focuses support at the central level as it relates to supporting coordinated development and implementation of health management information systems and monitoring and reporting frameworks. The SSQH project will support information systems at the site level which respond to MSPP policies and standards. The SSQH will be responsible for supporting data monitoring, use and information systems oversight at the sight level. The MSH/LMG project will assist with supporting UAS oversight of the

USG-supported referral networks. MSH/LMG will not have direct oversight at the facility/community level as it relates to health service delivery.

8. Page 10 indicates that contractors shall not directly pay the salaries of GOH civil servants. Are CHWs considered civil servants? If so, by whom and how are they paid?

Answer: Vital products are essential medicines that satisfy the priority health care needs of a population. They should be available at all times, in adequate amounts and at accessible cost for the population. The MOH established a list of vital drugs in 2012.

Please find Attachment T (vital drugs).

9. What are "vital" products? Is there a list or guide?

Answer: Vital products are essential medicines that satisfy the priority health care needs of a population. They should be available at all times, in adequate amounts and at accessible cost for the population. The MOH established a list of vital drugs in 2012.

Please find Attachment T (vital drugs).

As it relates to HIV and TB commodities, the PEPFAR-supported SCMS project supports procurement and distribution of testing, care, and treatment commodities. In addition, the

LMS project supports procurement and distribution of family planning commodities.

Additional information can be found USAID/Haiti website http://haiti.usaid.gov/.

10. Who will be introducing the pneumococcal and rotavirus vaccines at supported sites?

Answer: The immunization program is led by the MOH. The contractor will support the introduction of the vaccines at supported sites by advertising, counseling about the vaccines and administering them at both the community and facility level.

11. How does USAID define "basic critical care services"? Will USAID or another donor provide the materials necessary to provide these services once practitioners have been trained?

Answer: “Basic critical care” is defined as the provision of specialized care to ensure treatment of minor accidents and emergencies, as well as stabilization and active referral of more serious/complex cases. The focus of support under SSQH for basic critical care is related to staff training (basic life support skills capacity). In addition, the SSQH project supports minor equipment procurement for sites within the referral networks, as defined within the program description. Referral protocols shall also be strengthened under SSQH.

12. RFP SOL-521-13-000011 contains the FAR clause 52.219-9. However, pursuant to FAR

19.708 (a) (2), a plan is not required when the contract, together with all of its subcontracts, will be performed entirely outside of the United States and its outlying areas. Is this still a requirement for this solicitation?

Answer: Clause 52.219-9 will be removed.

13. Questions regarding the structure of the three contracts under this RFP:

o Section L.8.8, pg. 117: is it correct to assume that the offeror should propose a full team of key personnel and other required personnel for each contract it bids on? In other words, if the offeror bids on two of the possible contracts, then would it propose two full teams, with four key personnel and four other required personnel for each bid (or 16 candidates total)? And if the offeror bid on all three contracts then would it propose three full teams with four key and four other required personnel for each bid (or 24 candidate’s total)?

Answer: One COP, Administrative and Financial Officer and Monitoring and Evaluation

Specialist shall be proposed for the entire project. Offerors shall propose a Technical

Director for each of the geographic areas included in their proposals. For example if an offeror elects to submit a proposal that includes all three geographic regions they shall propose one COP, Administrative and Financial Officer, and Monitoring and Evaluation

Specialist and three Technical Directors.

As related to the question above, please confirm that CVs of up to three pages and

LOCs shall be submitted for each key personnel proposed under each separate contract? In other words, if the offeror bids on two of the possible contracts the page limitation for Annex C will be up to 32 pages (eight key personnel multiplied by the maximum four pages each), and if the offeror bids on all three contracts the page limitation for Annex C will be 48 pages.

Answer: Based on the explanation above the page limit for Annex C shall be changed from 16 to 24 pages.

o Section L.8.11 includes the list of annexes to the technical proposal. If the offeror bids on more than one contract, should it propose separate annexes for each contract bid? For example, if an offeror is bidding on two contracts would two implementation schedules be required?

Answer: Based on the explanation above the offeror should provide separate annexes and implementation schedules depending on the number of proposals he submits.

14. In order to maximize the participation of Haitian nationals with the strongest qualifications in leadership positions, would USAID consider replacing the “minimum qualifications for the key personnel positions” in Section F.10 (pg. 48-50) with

“illustrative qualifications for key personnel?”

The following changes were made to the Key Personnel requirements:

Answer:

o Changed COP to minimum 12 years experience, o COP RBF experience changed to preferred o Changed COP French requirements to 3/3 o “preferably in the Caribbean” removed for the Technical Director

15. In Section F.10, pg. 50, the RFP lists four other required personnel. Can offerors propose an alternate staffing structure in which the various functions of these positions are covered in other positions?

Answer: USAID expects that each contract has a dedicated Communications Officer.

For the other three required personnel (Environmental Compliance/Healthcare Waste

Management Specialist, Commodity & Logistics Specialist, Laboratory Specialist), offerors can propose an alternate staffing arrangement that incorporates the associated responsibilities of these positions.

16. To provide the most qualified staffing, can long-term subcontractors employ key personnel, rather than limiting all key personnel to be employees of the prime contractor

(Section F.10 [b], pg. 48)?

Answer: No.

17. Is USAID considering adding additional sites, beyond those supported by SDSH, as part of the USG-supported health referral networks?

Answer: This project will provide continuity of direct service delivery support to sites currently supported under the SDSH project. In addition, limited support to additional facilities will be provided to sites within the geographically defined USG referral networks. This additional site support will be delivered through the mobile team/technical assistance model, not through a static presence. Support for additional sites beyond what is stated above is not anticipated.

18. In order to provide the optimal allocation of resources across the three contracts, and to ensure that SSQH builds on the results of SDSH, can USAID please provide a price range for each of the three anticipated contracts?

Answer: The Estimated Price Range for the three Geographic Regions is as follows for the three base years and two option years:

-Contract One: $37 – $41 million

-Contract Two: $44 - $48 million

-Contract Three: $10 - $14 million

19. Please clarify whether offerors should submit a budget for a three-year base period with one option period of two years, or a three-year base period with two option periods of one year each.

Answer: USAID expects budget submissions to reflect the technical proposal period with a three year base period and one option period of two years.

20. Based on the scope of work, a considerable proportion of the budget will be allocated to service delivery subcontractors. Can USAID please provide guidance or plug figures for service delivery subcontracts under each of the three contracts?

Answer: USAID will not provide plug figures for service delivery subcontracts. This component will be evaluated as part of the competitive process and it is up to the offerors to propose budget allocations that they find acceptable for subcontracts.

21. Section H of the RFP does not currently include the authority to issue grants under contract. Could USAID please confirm that the resulting contract will include grants under contract authority?

Answer: USAID expects subcontracts to result from this contract and not subgrants because of the use of results based financing. Therefore USAID is not authorizing Grants

Under Contracts.

22. In Section L.9, Part (b)(3), on pg. 122, offerors are instructed to present their budgets using the standard cost elements included therein. Please clarify what type of costs should be included under “Direct Program Expenditures” and the difference between

“Procurement” and “Equipment and Supplies”.

Answer: USAID expects budgets to be submitted based on general accounting standards.

23. Please confirm that the successful contractor(s) are expected to complete the performance indicator reference sheets included in Attachment G once implementation starts.

Answer: Yes, the PIRS shall be submitted as part of the M&E plan which is due within

90 days of signing the contract.

24. Can USAID please provide the following documents noted in the RFP, as finalized and available?

- Ministry of Health results-based financing model (pg. 13)

- The redefined essential package of services (pg. 14)

- MSPP’s Community Health Worker model (pg. 20)

- Latest MSPP curriculum available (pg. 25)

- MSPP quality checklist (pg. 32)

Answer: The RBF model, essential package of services, and quality checklist are not anticipated to be finalized prior to the proposal deadline. They are expected to be finalized in the next few months, and the contractors shall use them in work plan development. In the meantime, USAID has provided draft documents to assist in proposal preparation. Refer to Attachment B for MSPP curriculum.

25. Section L.9, pg. 117, states that as an attachment to the Technical Proposal, offerors should include up to five (5) past performance references. Section L.11 (d), pg. 118, states that past performance information should include recipient and key partner organizations. Thus, could USAID please confirm that the prime contractor can provide up to five references and that each key partner organization can include up to five references? Please confirm that the prime contractor has a maximum of five pages for past performance references and that each key partner has a maximum of five pages for past performance references.

Answer: This is Correct.

26. Please confirm that graphics (i.e. tables, charts, and graphs), cover page, acronym list, and executive summary are not considered against the Technical Proposal page limitations.

Answer: The cover page, acronym list are not considered against the Technical Proposal page limitation. However, the Executive summary and any graphics included in the technical proposal shall count against the Technical Proposal page limitation.

27. Please confirm that a branding implementation plan and a marking plan should be included as an annex to the Technical Proposal.

Answer: Yes, a draft branding and marking plan shall be included as an annex to the

Technical Proposal.

28. Can USAID please supply the most recent SDSH annual or quarterly reports which are currently not available on the Development Experience Clearinghouse?

Answer: All SDSH annual reports will be available on the DEC by February 25, 2013.More recent quarterly reports will be posted as they are finalized. See Attachment

V for 2009 SDSH annual reports and Attachment W for 2010 SDSH annual report.

SDSH Site Level reports are available in Attachments X – FF.

29. What are the sites in the USG supported referral network #1 (i.e., Milot/Quartier

Moran/Grande Riviere du Nord/Limonade), given that Attachment C does not list any

SDSH sites in that area?

Answer: The referral network will include all sites within the designated arrondisement.

As there are no SDSH sites within the network, the contractor will only provide mobile support/TA to sites within this network.

30. Can new sites (sites that are not currently supported by the SDSH project) be added by the contractor to become part of the network in one of the Development Corridors for the purpose of delivering the MSPP essential package of services in under-served areas? If so, do they need to meet certain criteria such as being a local organization, being recognized by or run by the MSPP or meet any other criteria?

Answer: Initially, the contractor shall only support sites currently supported by the

SDSH project. However, over the life of the project, in consultation with MSPP

Departmental Health Authorities and USAID, there would be potential for shifts in site support to address gaps and challenges. Any shifts must remain within the budget and geographic parameters of the contract.

31. Can contractors enter into direct subcontracting relationships for the delivery of the essential package of services with non-MSPP or non-GOH entities?

Answer: Yes.

32. There is a clearly stated prohibition of paying salaries of GOH employees, but are contractors permitted to hire and pay for the salaries of employees who are not GOH civil servants, to be embedded as staff in an MSPP facility, as part of their proposal?

33. GOH employees be contracted to do specific roles outside of their GOH-salaried role?

Answer: GOH employees shall not be contracted by the contractor.

34. Which sites in the North are designated sites for Gender-based Violence services? Can sites be added? If so, would a site at a reference facility be eligible?

Answer: The 31 sites with GBV/CP activities under SDSH are identified in Attachment

C. As indicated under Objective 1, additional sites may be added in consultation with

USAID. However, GBV/CP activities under the project are expected to be integrated with the essential package of services; as such, stand-alone activities at sites not otherwise supported by SSQH will not be permitted.

35. Can physicians and nurses at tertiary care facilities (hospitals) receive training and support on basic critical care services as part of this RFP?

36. The RFP states that “the referral network can provide the essential package of services through a continuum from a community outreach program to reference hospital” (pg29).

Is the Justinian University Hospital included in the referral network for Cap-Haitien as the reference hospital? If so, can essential services at the hospital be supported through this RFP?

Answer: Justinian University Hospital is a Center of Disease Control (CDC) supported site. To avoid duplication of effort; the SSQH project will not support services at this hospital.

37. Can the Justinian University Hospital and other tertiary and referral hospitals (public or private) receive onsite mentorship under Objective 3 of the RFP?

Answer: Yes, but only if the hospital is not already supported by other USG-funded project.

38. There is a reference to training “matrons” in providing a basic package of maternal neonatal, and FP counseling services. Does “matron” include traditional birth attendants?

Can they be paid for their services through this project?

Answer: Matron is the common noun for traditional birth attendant (TBA). The matrons are typically paid directly by the women who use their services. We don’t encourage the project to pay for their services. In some cases, transportation fees may be provided to them when they refer and accompany a woman in labor.

39. Are the mobile clinics listed under community activities intended to provide primary care and/or to serve as outreach/engagement clinic that encourage people to use fixed facilities?

Answer: While expensive, mobile clinics are quite efficient. It is expected that the mobile clinics will provide primary care but also encourage patients to seek healthcare at rally posts, fixed posts and at the facilities.

40. Is there an established or functional UAS in the Cap-Haitien referral network? If so, who is it composed of, and what relationship has it had to date with the referral network in

Cap-Haitien, if any? If none, is it the responsibility of the contractor to establish a UAS?

Answer: There is no UAS in the Northern corridor (North and North-East departments).

Under Contract 1, the SSQH contractor shall participate in the establishment of the two

UAS for the Northern corridor; however, it is not the contractor’s responsibility to establish such an entity.

41. Would an NGO that signed an exclusive letter of commitment to provide technical assistance to one contractor be excluded from being a sub-contractor for service delivery with another contractor, if the first contractor were not to win the award?

Answer: There is no exclusivity permitted in this solicitation.

42. Would an NGO that is a key partner in one application be excluded from being a sub-contractor for service delivery with another contractor, if the first contractor were not to win the award? Or a sub-contractor for technical assistance with another contractor, if the first contractor were not to win the award?

Answer: See response in #41 above.

43. Since one of the objectives of the USG health program is to “establish disability care to support GOH and civil society capacity to provide care and rehabilitation services for persons with disabilities” (pg 16), can rehabilitation or disabilities services that are not explicitly spelled out in the essential services, be introduced or enhanced as part of a proposal?

Answer: Primary healthcare including HIV, MCH, tuberculosis and nutrition should be provided to the target population regardless of their status as disabled persons. USAID has several projects dedicated to disabled persons. The SSQH project will coordinate with these projects to refer disabled patients who need more specific care such as surgery and physical therapy.

44. There are no numerical evaluation criteria in the RFP. In absence of such criteria how would USAID compare different proposals?

Answer: FAR 15.305(a) states that, “Evaluations may be conducted using any rating method or combination of methods, including color or adjectival ratings, numerical weights, and ordinal rankings.” Section M.2 of the RFP details the relative importance of the evaluation criteria.

45. Some of the performance indicators seem highly ambitious. For example, the rate of fully immunized children has increased from 41% in 2006 to 45% in 2012 despite the efforts of MSPP and USAID through SDSH project. Given the limited health infrastructure and prevailing socio-economic condition in Haiti that is not expected to change dramatically, what is the basis for USAID expecting a fully immunization rate of 95% in the next three years? Similarly, contraceptive prevalence rate has increased by a percentage point a year for the last six years, how would USAID justify a minimum of three percentage point annual increase in the coming years?

Answer: USAID is expecting a fully immunization rate of 95% in the next three years in the target areas where the SSQH project will intervene. For the fiscal year 2012, SDSH had an immunization rate of 92% in its target areas. The contractor is required to build upon SDSH efforts. Over the life of the SDSH project, modern contraceptive prevalence rate in project-supported catchment areas increased by ten percentage points; it is anticipated that focused support for family planning will continue to improve performance on this indicator. It is important to note that indicators are based on target areas populations and not the general Haitian population.

46. USAID plans to implement result-based financing similar to Zambia which is a pilot scheme. Additionally, the MSPP is in the process of developing result-based financing model. If the Zambia model is changed or adjusted using the results of the pilot program and the MSPP model is not developed on time, how the new project will be impacted and what is USAID’s plan to mitigate that impact?

Answer: The Zambia model was provided as an illustrative example. As the MSPP has not finalized its RBF model, offerors will propose their own RBF schemes; however, it is the expectation that once the MSPP finalizes its RBF model, the SSQH project will modify RBF approaches to be fully in-line with the MSPP model.

47. Are NGOs considered private sector? Are any of the SDSH facilities for-profit?

Answer: NGOs are private sector as they are not state controlled. However, NGOs are usually non-profit organizations and are defined as part of the voluntary sector under the private sector. None of the SDSH-supported sites are for-profit.

48. What is USAID’s plan for ensured contraceptive supply at least for the duration of the project?

Answer: USAID will ensure contraceptive supply for the project through the duration of the project.

49. We understand that USAID has done need -assessment of MSPP health facilities. Will

USAID share the results with the bidders?

Answer: Yes. The USG is currently carrying out a service provision assessment (SPA) which will provide further details on the functioning of all health facilities in the country. The contractor shall provide focused support to address key gaps identified in the SPA. Results will be provided on a rolling basis, starting with the development corridors. A final report is expected Q1 of FY14.

50. We understand that CHWs have been recruited by a number of different groups. Has anyone looked at the different compensation models and training used? If so, can we have access to any reports or recommendations made?

Answer: The Ministry of Health has completed a training curriculum for CHWs. Refer to Attachment B.

51. CHWs are responsible for a long list of activities (25). Was any assessment conducted on their performance? Will USAID make the reports available to the bidders?

Answer: The types of activities supported by CHWs vary by implementing partner. A common list is part of the MoH efforts to standardize the CHW training curriculum and is, therefore, a work in progress.

52. Will USAID make any or all assessment and mapping reports conducted under SDHS available to the donors?

Answer: Yes. USG is in the process of conducting a partner inventory with Global Fund to map PEPFAR and Global Fund activities. The final report is expected to be available in Q4 of FY13.

53. Can USAID provide an expected start date for this project?

Answer: USAID will not provide and expected start date.

54. Page 36 of the RFP states, “It is expected that contractors shall have head offices based in the geographic region of the contract.” Please confirm that an applicant applying for all three contracts may propose one head office and two regional offices.

Answer: This is correct.

55. The Ministry of Health has stated that its guidance is 100 families per CHW. Please confirm that this is in alignment with the RFP’s guidance on page 31 of 1000 people per

CHW as an expected result.

Answer: The MSPP recently updated the National Policy for Health. The Standards state that there should be one officer (CHW) per 1,000 inhabitants , equivalent to 200 households.

56. Page 65 of the RFP states that “Unless otherwise approved by the Contracting Officer, the maximum prevailing compensation will be the same as the maximum salary under the

Haiti Mission Local Compensation Plan.” Please confirm that organizations that have a

USAID-approved salary scale for use on existing USAID programming in country may use that in lieu of the Mission’s Local Compensation Plan.

Answer: USAID expects contractors to follow the Haiti Mission Local Compensation

Plan.

57. Please confirm the Acronyms List, as referenced in the RFP on page 114 does not count against the 25-page limit.

Answer: That is correct; the acronym list does not count towards the page limit.

58. Page 115 of the RFP delineates the required sub-sections for the technical approach.

Please confirm applicants may provide this information in an alternative sequence, so long as all subsections are included.

Answer: Offerors may provide information in an alternative sequence so long as all subsections are included.

59. Page 116 of the RFP (section 8.i) states a requirement of a “proposed organogram with staff list”. Please confirm applicants may include all professional staff with their level of staff as part of the organogram rather than a separate list.

Answer: This is acceptable.

60. Page 119 of the RFP (section L.9 Cost Proposal Format) states “Budgets shall be broken down by the Geographic Regions” and further (section (b) Part 2 – Proposed

Costs/Prices) states “The Offers shall provide a separate budget for each geographic award it is applying for.” Please confirm that a single budget is acceptable, provided it shows the costs per Geographical Region, and that USAID does not require three separate budget templates.

Answer: USAID does not require three budgets; however Geographic Regions need to be clearly separated within the proposed budget.

61. Page 117 of the RFP states “Contractors must provide past performance information for itself and each subcontractor (not include the service-delivery sub-contractors). List in an

Attachment to the Technical Proposal up to five (5) of the most recent and relevant awards for efforts similar to work in the subject proposal.” Page 118 of the RFP states

“All potential recipient organizations and key partners (sub-contractors excluded) are subject to past performance scrutiny. Offerors must provide five names of organizations, both commercial and federal, from which they have received contract or assistance over the past three years.” This is limited to five pages maximum. Please confirm that a subcontractor/key partner for this RFP is partner receiving a minimum of 20% of the budget. Additionally, please confirm the five page limit is per applicant organization (or partner) each.

Answer: The five page limit is for the technical proposal. This section refers to providing a list of past organizations with contract information who the offeror has received funding from. The five page limit includes the list for the offerors and all major sub-contractors.

62. Page 117 of the RFP states that there should be no more than 3 international staff. Please confirm that the definition of international staff for this purpose consists of employees to be provided with an expatriate allowances package.

Answer: The RFP states that each AWARD shall not exceed three international personnel.

63. Pages 118 – 119 of the RFP delineate the five required attachments. Please confirm that applicants may submit additional attachments.

Answer: Offerors may submit additional attachments.

64. Page 120 of the RFP (section (D) Procurement) states that bidders should “Specify all equipment to be purchased, including the type of equipment, the manufacturer, the unit cost, the number of units to be purchased and the expected geographic source.” In order to allow contractors to seek out the best value to the government upon implementation, would USAID consider removing “manufacturer” from this list? This way, bidders could determine specs for different types of equipment at the proposal stage but not be locked down to a specific manufacturer at implementation, allowing them to shop for the best price while still following USAID Procurement Procedures.

Answer: Will remove “manufacturer” and insert “specifications” in its place.

65. In Section J of the RFP, Attachment F (Enquête Mortalité, Morbidité et Utilisation des

Services – EMMUS-V Preliminary report) dates from 2005-2006. However, the

Ministère de la Santé Publique et de la Population has provided a 2012 version of this report on its website. Please confirm that applicants are expected to refer to the more recent iteration of this document when citing data.

Answer: The offerors are expected to refer to the more recent information when citing data. The offerors should always provide sources of information when citing data.

66. On page 10, the RFP states “Contractors shall not enter into direct subcontracting relationships with GOH entities or directly pay the salaries of GOH civil servants”. At the same time, contractors are supposed to pass funds to public facilities (quote from the

RFP: “It is important to note that all funds passed through to NGOs or public facilities, earned via the results-based financing framework, shall be used for operational or investment costs at the facility level”). How will these funds be passed to these public facilities without the sub-contract entering into a sub-contract with these public facilities?

Answer: No funds shall be passed through to public facilities.

67. Page 33 of the RFP states that “Contractors shall develop a plan…to provide key technical support and potential staffing support.” Can USAID please clarify what is meant by “potential staffing support” if the project is not to pay salaries of GOH civil servants? Can stipends be given to GOH civil servants as part of the “potential staffing support”? Page 29 of the RFP states that “this project shall provide for the expansion of support for CHWs within the 12 USG-supported referral networks in order to achieve this compliment of CHWs within the supported networks”. Does this mean that CHWs are not considered civil servants?

Answer: CHWs that are hired and paid by a project are not civil servants. Therefore, staff supported by the project is contract employees.

68. On page 22, the RFP states: “Support basic and comprehensive Emergency Obstetrical and Neonatal Care (EmONC) in sites where these services are currently supported by

USAID; increase number of sites providing EmONC in consultation with USAID”.

Could USAID provide the list of sites currently supported to provide EmONC?

Answer: Attachment C: SDSH II Supported Sites & CHW Support provides indications of sites currently provided with support for EmONC under the MSH/SDSH project. It is expected that this support will continue under the SSQH project.

69. In sites where the existing provider does not have the capacity to offer maternity care

(delivery, C-section etc.), or is unable for religious reasons to distribute condoms and provide a choice of methods for family planning, can an additional facility be selected at such geographic sites that can be reimbursed for the provision of these services?

Answer: No, this project will not support additional sites, unless under the direction and in consultation with USAID.

70. The MSPP contracting mechanism will adopt a results-based financing model for all health service providers financing. Providers are to be reimbursed based on “tariffs”, volume and quality of services. At the same time, the RFP states: “It is important to note that all funds passed through to NGOs or public facilities, earned via the results-based financing framework, shall be used for operational or investment costs at the facility level”. Given that providers have faced challenges such as not having vehicles to be used for project related transport, how will these capital investments be paid for? Will they be covered by the reimbursements paid to the facilities?

Answer: It is the expectation that the implementers of the SSQH project will work with supported sites to prioritize gaps and needs for sites in order to inform the re-investment of funds into the site based on RBF returns.

71. This contract is described as a “completion” contract with an award fee. Can USAID clarify what milestones are expected to assess an award fee against? In addition, many of the Expected Results or the Objectives will require more than just inputs from this project but will require MOH and strong local/regional support. How will the contractor be held accountable from an award fee basis?

Answer: Please see sections G.7 and G.8 in the SSQH RFP, as it describes the award fee process. As described, based on a set of quality indicators, sites will be evaluated on a quarterly basis. These scores will inform the allocation of award fee to SSQH contractors.

While there may be number inputs which result in improvements (or lack thereof) in quality scoring, it is not the inputs that are considered in the awarding of fee, but rather the composite quality score percentage. It is the expectation that SSQH implementing partners will identify relevant inputs and will formulate corrective actions, as well as collaborate with MSPP counterparts, in order to respond to comprehensive site gaps and needs.

72. The framework for monitoring implementation of quality improvement practices discussed on page 14 of the RFP suggest a centrally driven strategy which seems to be at odds with a regional strategy of having potentially several implementing partners. How does USAID envision achieving a centrally driven strategy in light of the contractual split and suggested regional focus?

Answer: It is the intent of USAID to support MSPP strategic information guidelines and policies. USAID has a distinct project, Support to UPE, which will support strengthening of MSPP/UPE strategies for coordination and implementation of monitoring and reporting systems, including implementation of health management information systems.

The SSQH project will support site level support of information system implementation, including fostering effective data capture and use.

73. How does USAID envision the implementing partner’s coordination of information systems, accreditation, and similar activities as well as the coordination of these systems and activities by and with the MSPP: independently by contract geographical area or countrywide?

Answer: It is the intent of USAID to support MSPP strategic information guidelines and policies. USAID has a distinct project, Support to UPE, which will support strengthening of MSPP/UPE strategies for coordination and implementation of monitoring and reporting systems, including implementation of health management information systems.

CONNASYS, chaired by the MSPP/UPE, is the committee that provides strategic input to the MPSS/UPE as it relates to coordination and oversight of information system implementation in Haiti.

74. Will USAID please provide evaluation point allocation for each criterion listed under

M.3, RFP pages 125 to 128?

Answer: See answer to question #44

75. Aside from a brief mention made of the procurement of contraceptives through the MSH

LMS project, nothing is said about other commodities such as HIV tests, ARVs, drugs for prophylaxis such as cotrimoxasole and INH, drugs to treat STIs, vaccines, drugs for use in obstetric care, micronutrients and TB drugs. What mechanisms will be available to providers to access these drugs? Should the Offeror budget for small supplemental medical supplies, routine supplies, drugs, etc.?

Answer: Under the PEPFAR-funding SCMS project, support is given to the procurement and distribution of HIV and TB-related commodities. Please see Attachment

U for a list of PEPFAR-funded commodities supported under SCMS.

76. Under Objective 2, page 29 of the RFP states that “Based on MSPP guidance, a functional referral network requires key inputs that include staff, equipment, health commodities, infrastructure, and training…the health centers in this network shall be equipped and staffed to offer quality primary integrated services…”. Will the Offeror be responsible for the procurement of equipment and health commodities referred to in this statement?

Answer: The SSQH project supports minor equipment procurement to support the referral networks. USAID supported health commodities are supported through multiple mechanisms:

1) The Leadership Management and Sustainability (LMS) provides the family planning commodities

2) The Supply Chain Management System (SCMS) provides the HIV/AIDS commodities

Additional information on these projects can be found USAID/Haiti website http://haiti.usaid.gov/.

77. Does USAID have a preferred breakdown of the total contract amount across regions? Is there a contract amount range per region?

Answer: See response to question #18

78. Page 36 of the RFP also specifies that “it is expected that contractors shall have head offices based in the geographic region of the contract”. Will the contractor also be able to set up an office at the central level to facilitate coordination with MSPP and other implementing partners?

Answer: As stated the contracted shall have head offices based in the geographic region of the contract. While a office at the central level may be justified by the offeror, a decentralized approach with a more substantial regional office is preferred.

79. If an Offeror submits a proposal for all three contracts and USAID chooses to award two or three separate contracts will the Offeror be eligible to receive one of the contracts?

Answer: Yes.

80. For Past Performance References, page 117 of the RFP states that “contractors must provide past performance information for itself and each subcontractor (not include the service-delivery sub-contractors). List in an Attachment to the Technical Proposal up to five (5) of the most recent and relevant awards…” As the page limit designated for the

PPR attachment is “up to 5 pages”, can USAID clarify if it requires:

a. 5 PPRs from the prime contractor and an additional 5 per subcontractor; or 5 PPRs in total (prime contractor plus subcontractors)?

Answer: 5 PPRs for both the prime and additional subcontractors.

81. On page 118, the RFP asks Offerors to “provide five (5) names of organizations, both commercial and federal, from which you have received contracts or assistance awards for similar activities over the past three years,” with a page limit of up to 5 pages.” Does this mean that each of the 5 PPRs should be from a different organization (meaning no two

PPRs can be from the same client/donor/organization)?

Answer: USAID will accept PPR’s from same client or donor organizations.

82. On page 37, the RFP states that there is currently a USAID Public Financial Management

Risk Assessment underway. Can USAID please clarify:

a. Where is USAID in this process – which Phase?

Answer: Fieldwork for the Public Financial Management Risk Assessment stage one

(rapid appraisal) has been completed. The PFMRA stage one report is being finalized.

b. Is this being done in all the geographic areas under the three contracts?

Answer: The PFMRA is conducted at the central and departmental levels and does not address the geographic areas specifically.

83. Can USAID clarify if financial management is part of the project’s scope of work at the national level under capacity building support?

Answer: No, the SSQH project does not entail addressing financial management gaps and needs at the national level.

84. On page 123. For those Offerors with previous contracts with USAID - on Part 4 (D) requirement (Policies and procedures), this requirement is stated as mandatory. If an organization is registered under ORCA and/or has a NICRA still need to submit its organization’s Policies and Procedures? Please clarify.

Answer: USAID recommends that offerors comply with all of the instructions indicated in section “L” instructions to offerors.

85. The project envisions that some departments will be able to take over direct contracting of service providers during the project life.

a. Does this include direct contracting for the referral network support in Contracts 1 and 2?

Answer: No

b. If the government assumes responsibility for contracting with service providers in some areas before end of project, will the project continue to provide technical assistance, training, etc to meet needs of service providers that the departments may not yet be able to assume?

Answer: The USG, in collaboration with other donors, is assisting the Government of

Haiti in strengthening contracting and contract management mechanisms. It is envisioned that as key risk mitigation measures are implemented, the USG and other donors, will make increasing use of GOH systems. However, these exercises are in the very early phases of implementation and are not likely to impact the early implementation of the

SSQH project. Should USAID be positioned to make use of GOH systems within the life of the SSQH project, modification of contracts would be achieved through consultation and negotiation with SSQH implementing partners and the GOH.

The entirety of support as defined under SSQH would not transfer to the GOH contracting mechanism, i.e. certain technical assistance, referral network support, and departmental technical assistance. Continuity of support for activities not captured under the GOH mechanism would be negotiated between USAID and SSQH implementing partners.

86. On page 119, the RFP requests Letters of Commitment from each key partner organization to be included as an Attachment to the Technical Proposal. However, on page 124, the RFP lists Letters of Commitment as Part 7 of the Cost Proposal. As the

RFP specifies that LOC are not expected from service delivery subcontractors, can

USAID clarify if it is referring to the exact same LOCs being submitted twice, in both the

Technical and Cost Proposals or if the LOCs are expected as part of one proposal and not the other?

Answer: LOCs are required only once as an Attachment to the Technical Proposal.

87. Section C, III. Objective 1. Increase utilization of the MSPP’s essential package of services at the primary care and community levels (particularly in rural or isolated areas). The RFP states that this project will focus on scaling up access and use of the

MSPP essential package of services. The RFP includes specific requirements, by technical area, for provision of the essential package of services, but only includes limited activities for increasing public demand for these services and includes very limited activities for changing behavior to ensure increased use of MSPP essential services. Could USAID confirm that scaling up and increasing use, specifically through behavior change and demand creation activities, is expected to be included in this proposed project and not limited to the community based activities nor the two specific groups outlined on page 25.

Answer: It is envisioned that improvements in facility and community-level quality of care will be the ultimate drivers of increasing utilization of the MSPP essential package of services. While the project supports facility-based delivery of health messaging, including HIV prevention guidance, infection control measures, and family planning option information, the SSQH does not inherently support large-scale behavior change communication (BCC) or media campaign efforts. In addition, as the project does support the use of community health workers to strengthen outreach within supported community, use of this cadre of personnel to deliver key health messaging will be an important component of the project.

88. On page 106 of the RFP USAID requests “A statement specifying the extent of agreement with all terms, conditions, and provisions included in the solicitation ...” Will

USAID be amenable to reviewing Contractors requested changes to some of the terms and conditions? If USAID is amenable, is the Contractor correct to assume that any requested changes be listed in the Representations, Certifications, and Assurances

Answer: USAID will not review Contractors’ requests to change some of the terms and conditions. Terms and conditions shall remain as they are in the RFP.

89. On page 106 of the RFP USAID requests “… agreement to furnish any or all items upon which prices are offered at the price set opposite each item.” We are somewhat unclear as to USAID’s intent in this statement, are Contractor’s correct in assuming the term

“items” refer only to Commercial Goods? It seems unreasonable to hold the Contractor to costs estimated in the proposal phase, as consumer inflation is likely to impact costs between proposal submission and project implementation. As USAID will be granting approval of all equipment with a unit cost of greater than $500, and can guarantee at that time that quotes were secured to ensure the best value to the government, would USAID consider eliminating this language? If not does USAID want this data represented in a table in the budget narrative?

Answer: This language shall remain in the RFP.

90. Are contractors expected to procure commodities for malnutrition activites?

Answer: No