Final_Service_Delivery_RFP_MOD_1.pdf

TABLE OF CONTENTS:

TABLE OF CONTENTS:

SECTION B – SUPPLIES OR SERVICES AND PRICE/COSTS

B.1 PURPOSE

B.2 CONTRACT TYPE

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

B.4 LINE ITEMS

B.5 INDIRECT COSTS

B.6 COST REIMBURSABLE

B.8 752.216-70 AWARD FEE (May 1997)

SECTION C: SERVICES DE SANTE DE QUALITE POUR HAITI (SSQH) – STATEMENT OF

WORK

I. OVERVIEW

II. BACKGROUND

III. OBJECTIVES AND EXPECTED RESULTS

IV. COLLABORATION

V. GEOGRAPHY AND SITE SELECTION

VII. MONITORING

VIII. GENDER

IX. COMMUNICATION REQUIREMENTS

SECTION D – PACKAGING AND MARKING

D.1 752.7009 MARKING (JAN 1993)

D.2 BRANDING STRATEGY FOR SSQH

D.3 BRANDING AND MARKING POLICY

SECTION E - INSPECTION AND ACCEPTANCE

E.1 NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY REFERENCE

E.2 PERIOD OF PERFORMANCE

E.3 PLACE OF PERFORMANCE

E.4 WORK PLAN WITH PERFORMANCE MILESTONES

E.5 PERFORMANCE MONITORING PLAN

F.6 ENVIRONMENTAL MITIGATION PLAN AND REPORT

F.7 ADDITIONAL DELIVERABLES OR OUTPUTS

F.8 PROGRESS REPORTS

F.9 TECHNICAL APPROVALS REQUIREMENTS

F.10 KEY PERSONNEL

F.10 752.7005 SUBMISSION REQUIREMENTS FOR DEVELOPMENT EXPERIENCE

SECTION G - CONTRACT ADMINISTRATION DATA

G.1 752.7003 DOCUMENTATION FOR PAYMENT (NOV 1998)

G.2 ADMINISTRATIVE CONTRACTING OFFICE

G.3 CONTRACTING OFFICER’S REPRESENTATIVE (COR)

G.4 TECHNICAL DIRECTIONS/RELATIONSHIP WITH USAID

G.5 PAYING OFFICE

G.6 INVOICING INSTRUCTIONS

G.10 ACCOUNTING AND APPROPRIATION DATA

[To be filled in at time of award]

SECTION H - SPECIAL CONTRACT REQUIREMENTS

H.1 NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY REFERENCE

H.2 752.7004 EMERGENCY LOCATOR INFORMATION (JUL 1997)

H.3. 752.225-70 SOURCE, ORIGIN AND NATIONALITY REQUIREMENTS (FEB 1997)

H.4 INSURANCE AND SERVICES

H.5 752.228-70 MEDICAL EVACUATION (MEDEVAC) SERVICES (JUL 2007)

H.6 AUTHORIZED GEOGRAPHIC CODE

H.7 NONEXPENDABLE PROPERTY AND INFORMATION TECHNOLOGY RESOURCES.. 60

H.8 LOGISTIC SUPPORT

H.9 LANGUAGE REQUIREMENTS

H.10 CONSENT TO SUBCONTRACT

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

H.12 REPORTING OF FOREIGN TAXES

H.13 752.7032 INTERNATIONAL TRAVEL APPROVAL AND NOTIFICATION

REQUIREMENTS (JAN 1990)

H.14 USAID DISABILITY POLICY - ACQUISITION (DEC 2004)

H.15 752.7007 PERSONNEL COMPENSATION (JUL 2007)

H.16 ADDITIONAL REQUIREMENTS FOR PERSONNEL COMPENSATION

H.17 EMPLOYMENT COSTS OF THIRD COUNTRY NATIONALS AND COOPERATING

COUNTRY NATIONALS

H.18 VALUE ADDED TAX AND CUSTOMS DUTIES

H.19 ENVIRONMENTAL COMPLIANCE AND MANAGEMENT

H.20 GENDER CONSIDERATIONS

H.21 ORGANIZATIONAL CONFLICT OF INTEREST

H.22 PROHIBITION AGAINST DISCRIMINATION (OCT 2011)

H. 23 DISCLOSURE OF INFORMATION

H.24 CONTRACT COMPLETION AND CLOSEOUT (FAR 4.804)

PART II - CONTRACT CLAUSES

SECTION I - CONTRACT CLAUSES

I.1 NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY REFERENCE

I.10 52.222-50 COMBATING TRAFFICKING IN PERSONS (FEB 2009)

I.11 52.227-23 RIGHTS TO PROPOSAL DATA (TECHNICAL) (JUN 1987)

I.12 52.229-8 TAXES-FOREIGN COST-REIMBURSEMENT CONTRACTS (MAR 1990)

I.13 52.243-7 NOTIFICATION OF CHANGES (APR 1984)

I.15 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

I.16 752.219-70 USAID MENTOR-PROTÉGÉ PROGRAM (JULY 2007)

I.17 752.225-71 LOCAL PROCUREMENT (FEB 1997)

I.18 752.242-70 PERIODIC PROGRESS REPORTS (OCT 2007)

I.20 752.7101 VOLUNTARY POPULATION PLANNING ACTIVITIES (JUNE 2008)

PART III - LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACHMENTS

SECTION J - LIST OF ATTACHMENTS

PART IV - REPRESENTATIONS AND INSTRUCTIONS

SECTION K - REPRESENTATIONS, CERTIFICATIONS AND OTHER STATEMENTS OF

OFFERORS

K.1 NOTICE LISTING SOLICITATION PROVISIONS INCORPORATED BY REFERENCE .. 94

K.2 52.204-3 TAXPAYER IDENTIFICATION (OCT 1998)

K.3 ANNUAL REPRESENTATIONS AND CERTIFICATIONS (Dec 2012)

K.4 52.209-5 CERTIFICATION REGARDING

K.5 COST ACCOUNTING STANDARDS NOTICES AND CERTIFICATION

K.6 52.230-7 PROPOSAL DISCLOSURE-COST ACCOUNTING PRACTICE CHANGES

K.7 INSURANCE - IMMUNITY FROM TORT LIABILITY

K.8 COMPLIANCE WITH VETERANS EMPLOYMENT REPORTING REQUIREMENTS

K.9 SIGNATURE

SECTION L – INSTRUCTIONS

L.1 NOTICE LISTING SOLICITATION PROVISIONS INCORPORATED BY REFERENCE 104

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 (SEPT 2006)

L.5 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB 1998)

L.6 GENERAL INSTRUCTIONS TO OFFERORS

L.7 SUBMISSION/DELIVERY INSTRUCTIONS

L.8 INSTRUCTIONS FOR THE PREPARATION OF THE TECHNICAL PROPOSAL

SECTION M - EVALUATION FACTORS FOR AWARD

M.1 NOTICE LISTING SOLICITATION PROVISIONS INCORPORATED BY REFERENCE 124

M.2 GENERAL INFORMATION

M.3 EVALUATION CRITERIA

M.4 EVALUATION OF COST PROPOSAL

M.5 DETERMINATION OF THE COMPETITIVE RANGE AND CONTRACT AWARD

M.6 SOURCE SELECTION

SECTION B – SUPPLIES OR SERVICES AND PRICE/COSTS

B.1 PURPOSE

The overall purpose of the three-year (with the option of a two-year extension) Services de Santé de Qualité pour Haïti (SSQH) project is to improve the health status of the Haitian population.

This shall be achieved by: (1) increasing utilization of the Ministère de la Santé Publique et de la

Population’s (MSPP) integrated package of services at the primary care and community levels

(particularly in rural or isolated areas); (2) improving the functionality of the USG-supported health referral networks; (3) facilitating sustainable delivery of quality health services through the institutionalization of key management practices at both the facility and community levels;

and (4) strengthening departmental health authorities’ capacity to manage and monitor service delivery.

B.2 CONTRACT TYPE

The Government contemplates award of one to three cost-plus-award-fee (CPAF), completion type contracts resulting from this solicitation. For the consideration set forth below, the Contractor shall provide the results, deliverables or outputs described in Section C and F in accordance with the performance standards specified in Section E.

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

(a) Total Estimated Cost

i. The total estimated cost for the performance of work in the base period of the contract specified in Section C and Section F, Deliverables, of this contract is $____________

ii. The base fee for the base period is $______________

iii. The maximum award fee for the base period is $_______________

iv. The estimated cost plus all possible fees for the base period , if any, is

v. The total estimated cost for the option years is $________________

vi. The base fee for the option years is $_________________

vii. The maximum award fee for the option years is $_______________

viii. The total estimated cost plus all possible fees for the option years,if any, is

The Total Estimated cost of this contract will be based on the Statement of Work described herein and the negotiated price at the time of award. The Contractor shall not exceed the total amount awarded under this contract and may not bill advance for payment of fee.

The total sum of the base fee and award fee shall not exceed 10% of the total estimated cost of the contract.

(b) Obligated Amount

i. The amount currently obligated and available for reimbursement of allowed costs incurred by the Contractor for performance hereunder is $_____________. The

Contractor shall not exceed the aforesaid amount and may not bill for advance payment of fee.

B.4 LINE ITEMS

Item CLIN Years1,2,and 3 Option Year 4 and 5

Total Estimated Direct Costs 001

Total Estimated Indirect Costs 002

Sub-contracted Costs 003

Fixed Fee 004

Award Fee 005

Total Estimated Cost plus Award

Fee

B.5 INDIRECT COSTS

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

1/ 1/ 1/

1/Base of Application:

Type of Rate:

Period:

Source:

Note 1: Contractors are allowed to recover applicable indirect costs (i.e., overhead, G&A, etc.) on other direct costs (ODCs), if it is part of the contractor’s usual accounting procedures, consistent with FAR Part

31, and Negotiated Indirect Cost Rate Agreement (NICRA).

Note 2: While Subcontractor indirect cost rates are not incorporated above, subcontractor indirect cost rates as indicated in Note 1 above may be included in the proposals, and are subject to approval of the

Contracts Officer in accordance with FAR 52.244-2, Subcontracts.

B.6 COST REIMBURSABLE

Allowable costs shall be limited to reasonable, allocable and necessary costs determined in accordance with FAR clause 52.216-7, Allowable Cost and Payment, AIDAR clause 752.216-70, Award Fee, and

AIDAR clause 752.7003, Documentation for Payment.

B.7 CANCELATION PROCEDURES

In accordance with FAR 17.106-1(c) Cancelation procedures, all program years except the first are subject to cancellation. The cancellation ceiling shall be established below for years two and three of the contract. No cancellation ceiling will be established for option years four and five.

Year Two: ______(c) Cancelation procedures, all program years except the first are subject to cancellation. The cancellation ceiling shall be established below for years two and three of the contract.

No cancellation ceiling will be established for option years four and five.

Year Two: _______TBD_______

Year Three: ______TBD________

Cancellation dates for years two and three shall be the following:

Year Two: ________TBD_______

Year Three: ________TBD_______

B.8 752.216-70 AWARD FEE (May 1997)

(a) The Government shall pay the Contractor for performing this contract such base fee and such additional fee as may be awarded, as provided in the Schedule.

(b) Payment of the base fee and award fee shall be made as specified in the Schedule; provided, that after payment of 85 percent of the base fee and potential award fee, the Contracting Officer may withhold further payment of the base fee and award fee until a reserve is set aside in an amount that the Contracting

Officer considers necessary to protect the Government’s interest. This reserve shall not exceed 15 percent of the total base fee and potential award fee or $100,000, whichever is less. The Contracting Officer shall release 75 percent of all fee withholds under this contract after receipt of the certified final indirect cost rate proposal covering the year of physical completion of this contract, provided the Contractor has satisfied all other contract terms and conditions, including the submission of the final patent and royalty reports, and is not delinquent in submitting final vouchers on prior years’ settlements. The Contracting

Officer may release up to 90 percent of the fee withholds under this contract based on the Contractor’s past performance related to the submission and settlement of final indirect cost rate proposals.

(c) Award fee determinations made by the Government under this contract are not subject to the Disputes clause.

[END OF SECTION B]

SECTION C: SERVICES DE SANTE DE QUALITE POUR HAITI (SSQH) –

STATEMENT OF WORK

I. OVERVIEW

The overall purpose of the three-year (with the option of a two-year extension) Services de Santé de Qualité pour Haïti (SSQH) project is to improve the health status of the Haitian population.

This shall be achieved by: (1) increasing utilization of the Ministère de la Santé Publique et de la

Population’s (MSPP) integrated package of services at the primary care and community levels

(particularly in rural or isolated areas); (2) improving the functionality of the USG-supported health referral networks; (3) facilitating sustainable delivery of quality health services through the institutionalization of key management practices at both the facility and community levels;

and (4) strengthening departmental health authorities’ capacity to manage and monitor service

USAID anticipates awarding three contracts to implement this project, but reserves the right to award between one and three contracts, as defined in Table 1 below.

Table 1: Contract Geographic Boundaries

DEPARTMENT

CATCHMENT POPULATION (FOR

SITES CURRENTLY SUPPORTED

BY SDSH PROJECT)

CONTRACTS

ESTIMATED

RANGE

Nord Ouest 130,000

CONTRACT 1

$37 - $41

Million

Nord 510,000

Nord Est 365,000

Artibonite 630,000

Total 1,635,00

Centre 274,000

CONTRACT 2

$44 - $48

Ouest 1,739,000

Total 2,013,00

Sud Est 100,000

CONTRACT 3

$10 - $14

Nippes 121,000

Sud 127,000

Grand Anse 291,000

Total 639,000

The project shall support the direct delivery of clinical and community-based services for people living in geographic areas currently supported by the USAID-funded Santé pour le

Développement et la Stabilité d’Haïti (SDSH) project (described in Objective 2 below). Support to geographic areas shall be achieved through the delivery of a “package” of primary healthcare services, defined within the draft MSPP Essential Package of Services (see Attachment A), and shall include support for: 1) HIV/AIDS; 2) Tuberculosis (TB); 3) Maternal and Child Health

(MCH) (including Water, Sanitation and Hygiene (WASH) and Nutrition); and 4) Family

Planning (FP). This project shall also support gender-based violence and child protection services at selected sites, as well as the provision of systemic training and limited support for critical care (accident and emergency) for sites within the USG-supported development corridors

(see USG Haiti Strategy 2010-2015, http://www.state.gov/documents/organization/156448.pdf).

Support for community-based services shall prioritize support for community-health workers

(CHWs) linked to individual facilities, facilitating the supervision of this cadre of personnel, as well as strengthening active referral to services. Support to Orphans and Vulnerable Children

(OVC) affected by HIV shall include facility-based clinical and psychosocial service support.

In addition to supporting the provision of services, this project shall place emphasis on site-level governance and accountability through structured mentorship and targeted assistance to build the capacity of facility managers (public and private) to address gaps and deficiencies identified within routinized data analysis and site assessments. The intent is to ensure the institutionalization and functional sustainability of management systems that are not personnel dependent, fostering the application of quality assurance standards and continuous quality improvement. Health departments must also be included in the governance and accountability assistance as the respective health departments (and sub-department structures) remain responsible for ensuring sites adhere to quality assurance standards and implement continuous quality improvement.

A key mandate within for this project is to provide technical assistance and support in partnership with Department Health Directorates and Unités d’Arrondissement de Santé (UAS -

District Health Unit), where established, as well as other USG-supported implementing partners to support prescribed referral networks defined within Contracts 1 and 2 (see Table 3 under

Objective 2). Contractors shall not enter into direct subcontracting relationships with GOH entities or directly pay the salaries of GOH civil servants. Contract(s) shall require engagement by implementing partners to respond to identified gaps within the UAS referral networks (and within the parameters of awarded contracts). This collaboration shall be driven by a common vision for achieving functional UAS level networks by emphasizing: (1) increased quality of the basic package of service delivery; (2) increased coordination, supervision, and monitoring of referral network services; and (3) increased coordination of infrastructure improvement projects.

USG support for health referral networks will focus on “gap filling,” meaning USG will assist the Government of Haiti (GoH) in identifying gaps at both the individual facility level and between facilities in the network that are preventing the network from functioning properly. The goal of the USG approach will be to catalyze rapid improvements in health outcomes and accelerate access to quality health services through linking patients to functional referral networks.

As this project shall respond to principles defined within the GOH/USG 2012 Partnership

Framework to Support Haiti’s Health Strategy

(http://www.pepfar.gov/countries/frameworks/haiti/index.htm) (described in Secton II.c.ii and see Attachment P), which promotes ownership and oversight of health services by the GOH (as well as reduced dependence on donor support over time), a central component of this project shall be the requirement to make use of, and strengthen, host country systems (i.e. regulatory, monitoring and evaluation, human resources, procurement, and financial). The scope and timing http://www.pepfar.gov/documents/organization/197762.pdf http://www.pepfar.gov/documents/organization/197762.pdf of the project's use of country systems shall be aligned with the results of USAID's public financial management risk assessment (PFMRA) of GOH procurement systems, as well as GOH achievement of risk mitigation milestones identified by the PFMRA. To foster the increased use of Haitian procurement systems, this project shall serve as a “bridge” to a contracting program by the MSPP (described in Section II below). It is currently envisioned that over the life of this three-year project (with the option of a two-year extension), support for geographically defined areas shall transition from direct USAID support to the MSPP contracting program (however the number of departments transferred to the MSPP will be at the discretion of the USG and GOH).

The MSPP contracting mechanism will adopt a results-based financing model for all health service provider financing. The model has a focus on measuring both the quantity and quality of services provided. Contractors shall adopt the MSPP’s results-based financing model as the basis for its sub-contracts with service providers (see http://www.rbfhealth.org/rbfhealth/library for further resources on RBF models).

II. BACKGROUND

a. Haiti health context

As one of the poorest nations in the world, Haiti is plagued by persistent poverty and lagging development. Haiti’s per capita gross domestic product (GDP) is $1,179, well below the Latin

America and Caribbean (LAC) average of $10,739. More than half of Haiti’s population lives below the poverty line of $1.25/day. Life expectancy at birth is 62.1 years, compared to 74.4 years for the LAC region. Fifty percent of the population is below 24 years of age, and over 60% of Haitians have never attended or did not complete primary school. Only 66.2% of youth 15 to

24 years of age are literate, compared to 95.5% for the LAC region.

Haiti’s health indicators clearly reveal the weaknesses in the country’s health system. While the recent Demographic and Health Survey (DHS) 2012 suggested that trends in mortality and morbidity were improving, poor health outcomes and low utilization of services persist. Nearly

40% of Haitians have no access to basic primary health care. Nearly one in four children (22%) under five years is chronically malnourished. The country also has the highest rates of tuberculosis in the Western Hemisphere, with a 2010 TB incidence rate of 230 cases per 100,000 people.

Table 2: Health Indicators3

2006 DHS 2012 DHS

Under-five mortality (per 1,000 live births) 86 88

Infant mortality (per 1,000 live births) 68 59

Maternal mortality 630 Not captured

Total Fertility Rate 3.9 3.5

Women using modern method 25% 31%

% of children fully immunized 41% 45%

1 DHS 2012 preliminary data 2 World Health Organization (WHO) Global TB Report 2010 DHS 2006 data, DHS 2012 preliminary data http://www.rbfhealth.org/rbfhealth/library

% of children who receive DPT3 53% 63%

HIV prevalence 2.2% 2.2%

ART coverage (% of eligible HIV+) 68% (est)

% of children under 5 who slept under ITN the night before the survey

N/A 52%

While the majority of women receive some prenatal care (90%), there is a lack of emergency obstetrical care due to large distances between inpatient facilities, lack of qualified attendants, and availability of essential services. And while the percentage of live births attended by a skilled attendant has increased from 26% in 2005 to 35% in 2012 (with 37.5% of births taking place in a health facility), in rural areas, only 24% of births are assisted by skilled birth attendants.

Although the national HIV prevalence is low by comparison to most PEPFAR focus countries, this prevalence rate is the second highest in the Caribbean region.

Haiti has a generalized

HIV/AIDS epidemic, with higher prevalence rates among most-at-risk populations such as commercial sex workers (CSW) and men who have sex with men (MSM). The Ministry of

Health estimates the treatment coverage to 68% of HIV-infected individuals who need treatment while only 30% of the general population has access to counseling and testing. A major challenge that remains is the high level of stigmatization toward HIV-positive individuals in the country, especially at the community level around HIV/AIDS sites (sites which services related to HIV counseling and testing, palliative care, prevention of mother-to-child transmission, and antiretroviral treatment).

As expected, the total fertility rate is highest in rural areas. It is 76% higher than in the capital and other urban areas. Use of modern contraceptives is highest in Centre and Nord (around 40%) departments and lowest in the west Ouest and Sud-Est (around 26.5%). In terms of the overall method mix, injectables remain the most popular method since 1994-95. There has been a dramatic increase in use of injectables according to the DHS 2012, with nearly four times more use of injectables than any other method. The second most popular method is male condoms.

Adolescents also choose injectables first and condoms second (although at lower rates than older women). There appears to be a narrowing of the method mix, as the share of users choosing implants, female sterilization, condoms, IUDs and pills have all diminished. Expanding the method mix is essential to ensuring quality of family planning services in Haiti.

At the national and departmental levels, few departments show uptake of long acting reversible contraceptives. IUD use is extremely rare (~0.25%). Permanent methods (female sterilizations) have also declined since the last DHS, with 0.4% - 2.6% uptake.

In Haiti, the HIV epidemic is generalized and about 120,000 people are estimated to be living with HIV/AIDS. Of that total, 12,000 children are expected to be living with HIV/AIDS. Beyond the direct HIV/AIDS impact on children, widespread poverty and the overall socio-economic conditions has created a significant number of vulnerable children that need to be taken into account in the PEPFAR OVC program. Issues on child protection and social support in this

4Joint United Nations Program on HIV/AIDS (UNAIDS) 2010 context, most of all in the aftershock of the 2010 earthquake, are important concerns. The

PEPFAR support to the OVC population in Haiti has evolved from 300 beneficiaries in 2004 to

44,376 in September 2012, with national coverage.

The USG is also working to strengthen Haitian capacity to provide basic services and ensure public safety, including the prevention of and response to gender-based violence (GBV). GBV includes, but is not limited to battery, rape, sexual violence, sexual harassment in the work place, commercial sex exploitation, trafficking of girls, adolescents and women, and violence perpetrated against domestic workers, including unpaid domestic child labor, i.e. restaveks. In

Haiti, sexual violence and other forms of GBV are serious, life-threatening protection issues primarily affecting women and children. Throughout Haitian history, violence against women and girls has been a stark reality. The high risk of physical and psychological violence, trafficking, and rape of women and girls is compounded by the fear of devastating social stigma and shame, trapping survivors in a culture of silence. This is exacerbated in Haiti by organized crime and impunity, political instability, poverty and unequal power relationships between many groups. For many families still displaced by the 2010 earthquake, the risk of GBV has been increased due to unsafe living conditions and deeper poverty.

Women are the backbone and engine of the Haitian economy, as the primary operators in markets nationwide. However, during the past few years, especially since the 2010 earthquake, the economic situation of women in Haiti has slowly deteriorated. In rural areas, the situation is even worse, with many families living with high food insecurity and facing economic collapse due to recent natural disasters and high food prices. One immediate consequence of this situation is the increasing numbers of families sending their children away to live with other families in hope of obtaining better opportunities for them. These “restavèk” children are overwhelmingly female, and are often mistreated, sexually abused, and denied basic rights. Although official statistics do not exist, estimates range from 150,000 to 500,000 restavèks in Haiti. A second consequence of the deteriorating economic condition of women is their increased vulnerability to violence, particularly in rural areas.

b. Overview of the Haitian Ministry of Health’s approach to nationalizing service delivery contracting

i. MSPP Contracting Function

The MSPP has developed a new strategy for contracting health services in Haiti. It is envisioned that this strategy will be implemented in phases, with a pilot project to begin around May of

2013. Public and non-public providers will be contracted by the MSPP for delivery of the essential package of services, which includes both institutional and community-based services, based on eligibility criteria outlined in the to be developed MSPP Contracting Program

Operational Manual. At the community level, the delivery of services will be provided by community health workers trained to the standard curriculum of the MSPP. A tariff-for-service reimbursement system for providers will be applied for these high-impact primary and preventive services, with tariffs set in advance. It is planned that tariffs will be calculated on the basis of an expenditure study analyzing the recurrent costs associated with the delivery of the service in question to the targeted population, while taking into account existing financing to sites. To ensure increased equity and address government priorities to its population health outcomes, the setting of fees for each tariff (i.e. quantity indicator) will be set higher than the actual cost of delivering that specific service (e.g. third dose of DTP vaccine to a child). It is to

(1) incentivize health facilities to deliver the specific tariffs and (2) subsidize the overall delivery of the essential package of services set forth by MSPP (see Attachment A).

ii. Results-based financing (RBF)

The Ministry of Health is currently developing a results-based financing model which will be used for all health service provider financing. The model will have a focus on both the quantity and quality of services provided. The model will have defined quantity and quality indicators which will apply across all sites. These indicators will be set by the Ministry of Health based on the priorities for the health sector and the current context. The quantity indicators (see

Attachment N for a draft list of indicators) will have set tariffs, the sum of which will set the quarterly reimbursement amount provided to the service provider. The quality indicators will result in a quarterly quality score, externally assessed, which will supplement the reimbursement amount to the service provider.

The model, including the tariff schedule, is currently being finalized.

iii. Continuous Quality Improvement

The MSPP is leading an effort to organize, monitor and reinforce the performance and quality of health service providers. USAID is supporting this vision with assistance from the Leadership, Management and Governance (LMG) project which is implemented by Management Sciences for Health (MSH). The LMG project will allow the MSPP to better organize, monitor and reinforce the performance and quality of health service providers. The LMG Project provides support to the Central, Departmental and sub-Departmental Health Authorities (within the USG-supported referral networks) to:

Carry out their functions of organization, accreditation and supervision of all service providers.

Provide significant technical assistance to the contracting team and related units of the MSPP as they implement the Contracting Program

Support the MSPP to implement a referral network model approach in Development

Corridors to ensure access to and use of a continuum of health care services

One of the key quality improvement approaches that is currently being supported by the MSPP is improvement teams at the site and department levels, as supported by the USG-supported

HEALTHQUAL (http://www.healthqual.org/) project (with 57 sites currently supported). Under this approach, Equipes de Sites monitor site-level data on a routine basis (at a minimum, monthly). In addition, the Equipes de Sites collaborate with the Equipes Départementales to conduct quarterly reviews of site functionality. Further formalizing and expanding this model is a key priority of the MSPP and aligns with Objective 2 and 3 of this project. This model represents an approach to monitoring performance and use of data reviews to inform change.

The framework for monitoring implementation of quality improvement practices at each governmental level is defined within the figure below:

http://www.healthqual.org/

iv. Essential package of services

The Ministry of Health is currently working to redefine an essential package of services. Based on the National Package of Services, the redefined essential package will identify a smaller subset of priority services that all health facilities shall be expected to deliver. While the package is not yet finalized (see Attachment A for draft list), it is expected to include service support for the following:

Reproductive Health

Pre- and post-natal consultations

Post-natal home visits

Delivery (both institutional deliveries with skilled birth attendants and home-based deliveries with trained traditional birth attendants)

Family planning, including long-acting and permanent methods

Treatment of sexually-transmitted infections

Child Health

Neonatal conjunctivitis

Vitamin A supplementation

Growth monitoring and promotion

Vaccination

Newborn care

Gastro-intestinal worms (diagnosis and treatment)

Tuberculosis

Identification of suspected cases

Treatment

Transmission prevention

HIV/AIDS

Voluntary counseling and testing

Prevention of mother-to-child transmission

Antiretroviral treatment

Clinical care

Support groups for people living with HIV/AIDS

Prevention of transmission

Clinical care

Acute respiratory infections

Pneumonia

Malaria

Typhoid

Anemia

Diabetes

Chicken pox

Hypertension

Asthma

Community Activities

Information, education, and communication (IEC) activities

Health promotion

Social mobilization

Mobile clinics

Rally post

Group meetings

Home visits

Evaluation of the quality of services by the community (client satisfaction survey)

c. United States Government priorities

i. USG Haiti Strategy 2010-2015

The earthquake on January 12, 2010, struck an already weak health system (with historically poor health outcomes) and weakened it further. The most powerful earthquake to strike Haiti in

200 years resulted in approximately 230,000 deaths and an estimated 300,000 injuries, and displaced approximately 2.3 million individuals at the height of displacement, including 550,560 displaced persons who remain displaced nearly two years later. Moreover, on October 21, 2010, an outbreak of cholera was confirmed in Haiti, further burdening the country’s health system.

The five-year USG strategy for health

(http://www.state.gov/documents/organization/156448.pdf) targets USG development corridors

(see Attachment S for the Development Corridors map) (USGDC)—based on GOH growth poles—for focused investment, while continuing to provide access to essential health care for nearly half the population throughout the country. The strategy builds upon Global Health

Initiative (GHI) and Feed the Future (FTF) principles as well as the Paris declaration and Accra

Accords by 1) increasing direct support for the Ministry of Health; 2) coalescing the private sector (mostly NGOs and other civil society organizations) for joint action, harmonization of effort, and more explicit linkages with the MOH; and 3) strengthening the leadership, policy, and steering role functions of the MOH. In addition, given the comprehensive nature of USG health objectives and Haiti’s history of natural disasters, the strategy was designed with the forethought of potential emerging health epidemics. The USG has identified four focus areas or “pillars” of investment critical to achieving economic growth and stability, including private-sector led sustainable development: (A) infrastructure and energy, (B) food and economic security, (C) health and other basic services, and (D) governance and rule of law. The USG has outlined a set of objectives and intermediate results to guide efforts over the life of this five-year strategy (see

Attachment H for the USG Assistance Objectives). The SSQH project shall contribute to the objectives under the health pillar.

The five objectives of the USG health program are to: 1) Support the delivery of a basic package of services and targeted infectious disease prevention; 2) Establish disability care to support

GOH and civil society capacity to provide care and rehabilitation services for persons with disabilities; 3) Rebuild and reform management of public health infrastructure; 4) Increase support to the MOH in strengthening systems and governance; and 5) Develop comprehensive referral networks at the communal and departmental levels within the USG development corridors.

ii. GOH/USG 2012-2017 Partnership Framework

In June 2012, the Governments of Haiti (GOH) and the United States (USG) signed a Partnership

Framework on Health (PF) that lays out a mutually accountable, joint strategic agenda to accelerate the development of Haiti’s public health services to reach the Millennium

Development Goals over the next five years (2012-2017). The PF builds upon the foundations laid by the GOH, civil society, the private sector, NGOs and bilateral and multilateral partners, including existing coordination mechanisms such as the Global Fund Country Coordinating

Mechanism.

Specifically, the PF aims to advance the GOH’s ownership and oversight of an adaptable and self- correcting public health system in Haiti, and to reduce its dependence on donor support over time through the following four objectives:

1. Improve GOH leadership and oversight of the health sector

2. Increase access to quality integrated health services with a focus on maternal and child health, nutrition, family planning/reproductive health, HIV and other infectious diseases, and disabilities

3. Improve health information and supply chain management systems

4. Rebuild health facilities and physical health infrastructure

At the end of the PF five year period, it is expected that results in maternal and child health, reproductive health, HIV/AIDS, other infectious diseases, and care for disabilities shall improve, and that the GOH should have made significant strides toward assuming primary responsibility for the management and performance monitoring of the overall health system, as well as increasing its financial support.

The companion document to the PF, the Partnership Framework Implementation Plan (PFIP), puts the PF in action by detailing the policy reforms, joint commitments, key activities and targets necessary to reach the goals set forth in the PF. The PF/PFIP promotes a comprehensive approach to developing the health sector that includes improving governance, increasing public financing, integrating services and building physical and systems infrastructure, while hastening the scale up of critical programs.

iii. USAID/Haiti Health Strategy 2010-2015

USAID approved a new health strategy for Haiti in August 2011, which is fully in-line with the

USG January 2012 Post-Earthquake strategy for Haiti. The Development Objective (DO) of the current USAID/Haiti health strategy is “Health and Nutrition Status of the Haitian Population

Improved.” Through the DO, USAID’s health program contributes to the Mission’s objective of ensuring long-term stability through investments in public institutions, thereby contributing to the goal of a stable and economically viable Haiti. The immediate results under this

Development Objective that this project shall serve to support are the following:

IR3.1: Access to essential health, nutrition and family planning services increased

IR3.2: Services for persons with disabilities improved

IR3.3: MOH capacity to manage health care delivery strengthened

IR3.5: Increased services for vulnerable youth

This three-year project (with two-year extension option) shall focus on Intermediate Result 3.1

(Access to essential health, nutrition and family planning services increased). In coordination with the MOH, NGOs, and other donors, USAID expects to improve health and nutrition status in Haiti, as measured through higher-level outcomes including reduced infant mortality rates, reduced maternal mortality ratio, increased contraceptive prevalence, lower prevalence rates of infectious diseases (HIV, tuberculosis, and cholera), reduced levels of malnutrition in children under five, and improved sanitation and hygiene). The project shall also help to support

Intermediate Result 3.3 as it relates to supporting departmental health authorities, strengthening strategic information at the facility level through improved management systems, improved data quality and use, and institutionalization of electronic medical systems (where appropriate).

iv. Current Program Achievements

Since 2007, USAID/Haiti has supported the Santé pour le Développement et la Stabilité d’Haïti

(SDSH) project. This six-year, $101 million project has increased access to basic health care services for more than four million people throughout all ten departments of Haiti through performance-based financing (PBF) subcontracts with more than 60 NGO and MSPP partners.

SDSH provides access to a priority package of integrated health services across 164 NGO and

MSPP sites throughout Haiti. This service package includes HIV prevention, care, and treatment; tuberculosis prevention, detection, and treatment; maternal health; child health and nutrition; and family planning. In the last year of the project, limited gender-based violence and child protection services, focused on increased identification and referral of cases, were added to the package of services.

Each year, SDSH has helped an average of 95,878 people receive HIV tests and learn their status, has made it possible for 12,665 women on average deliver their child with assistance from a facility-based, skilled provider, and has reached an average of 449,376 children with nutrition programs. In the SDSH network, upwards of 89 percent of infants under one were fully vaccinated in four of the program’s first five years. By the end of the project, SDSH shall have more than tripled the number of sites offering antiretroviral therapy (from six to 21 sites). In addition, SDSH is implementing point-of-care diagnostics (HIV and TB) in key regions with challenges related to turnaround times in order to rapidly initiate treatment services.

Another key component of the project is focused on strengthening the MSPP at both the central and departmental levels. In collaboration with the MSPP and taking into account national priorities, SDSH has supported four main areas of MSPP executive function: strategic planning and decentralization, performance-based financing, governance and financial management, and health information systems.

III. OBJECTIVES AND EXPECTED RESULTS

The four main objectives of this project are to:

1) Increase utilization of the Ministère de la Santé Publique et de la Population’s (MSPP) integrated package of services at the primary care and community levels (particularly in rural or isolated areas);

2) Improve the functionality of the USG-supported health referral networks;

3) Facilitate sustainable delivery of quality health services through the institutionalization of key management practices at both the facility and community levels; and

4) Strengthen departmental health authorities’ capacity to manage and monitor service

The MSPP has provided guidance to all partners working in the health sector that the results-based financing framework of the MSPP must be used by all service delivery projects in the health sector. Contractors are encouraged to consult with the MSPP to ensure alignment in this regard.

The results-based financing approach to be adopted by the MSPP will be similar to that of countries such as Burundi and Zambia. For more information on these approaches there are numerous resources available on the Internet, such as http://www.rbfhealth.org/rbfhealth/library/Country%20Examples. The main aspects of the approach envisaged by the MSPP are:

A supply-side, fee-for-service approach;

Sub-Contracting to support both NGO-run and public facilities;

A limited number of quantity indicators, i.e. 20 or fewer;

A limited number of quality indicators, i.e. 40 or fewer;

Reimbursement is principally based on the quantity indicators, however the quality score, will increase the overall reimbursement up to a defined threshold.

The quantity and quality figures will be ex-ante independently verified on a quarterly basis;

http://www.rbfhealth.org/rbfhealth/library/Country%20Examples

There will be no ex-post verification;

The quality checklist to be used by MSPP is under discussion but will use the Zambia model as a base. A draft list of quantity indicators has been drawn up by the MSPP and is to be found in the attachments (see Attachment N). Equally an illustrative quality checklist from Zambia is provided in Attachment M. Profit for the prime(s) is constituted by the base fee and award fee.

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. These funds contain no profit element.

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)

In ensuring access to high-impact, high-quality health interventions, this project shall focus on continuing the provision of health services in USAID-supported catchment areas and scaling up access and use of the MSPP essential package of services, as well as other key USAID priorities

(detailed below). Specifically, the project shall provide continuity of support at sites currently supported by the SDSH project (the list of SDSH sites can be found in Attachment C).

Contractors shall ensure that all services are delivered according to the norms and guidelines established by MSPP. Contractors shall not enter into direct subcontracting relationships with

GOH entities or directly pay the salaries of GOH civil servants. Activities shall include maternal, neonatal, and child health care, including appropriate self-care, health-seeking and preventative interventions related to nutrition and water, sanitation and hygiene (WASH);

reproductive health and family planning; and HIV/AIDS and TB prevention, detection, care and treatment; and identification, care, and referral for gender-based violence and child protection cases. In addition, the project shall provide support for basic critical care services (as described below) within appropriate sites within the development corridors. Diagnostic services provided by public health laboratory systems shall be coupled with community and clinical services, ensuring that the two systems are coordinated to improve the quality of patient care.

The project shall provide support for a continuum of care support model that includes support for community-based services. In order to ensure maximum coverage of basic health care services

(e.g., vaccination, FP, health education), as well as to facilitate utilization of facility-based services, the project shall link community workers [including community health workers

(CHW), traditional birth attendants to individual health facilities and, in some cases, organized into health referral networks (defined in Objective 2) to provide better access to essential services.

This project shall also place emphasis on providing systematic referral and counter-referral from the site level to the community level in order to ensure a continuum of services for vulnerable populations, including orphans and vulnerable children and their families, in complementarity with clinical services. All community health workers shall be trained according to MSPP guidelines, and the project shall align with the MSPP’s CHW model, which is currently being further defined by the MSPP. The community health worker model shall ensure that CHWs serve a well-defined catchment area (with a feasible ratio of CHWs to population) and that they are able to provide regular home visits, prioritizing families and individuals based on risk factors. In addition, CHWs shall play a key role in reducing loss to follow up through active tracking of

LTFU clients, and also promoting facility-based deliveries. Specific tasks of CHWs are detailed within MSPP guidelines (see Attachment B). At a minimum, the project shall support the compliment of CHWs currently supported by the SDSH project, as well as scale up support of

CHWs in the referral networks. The matrix of current support for CHWs by SDSH can be found in Attachment C.

Specific requirements, by technical area, for provision of the essential package of services include (but are not limited to):

The project shall:

1) Support an integrated package of antiretroviral (ARV) treatment; palliative care, HIV/TB, PMTCT and voluntary counseling and testing services (VCT) at sites currently supported by the SDSH project.

2) Support the expansion of HIV and TB services, with the intent of inserting the provision of the full package of anti-retroviral services (ART) services (VCT, PMTCT, palliative care, and ART) at all sites currently providing palliative care and/or PMTCT. This scale up of ART shall increase the number of sites offering ART from 21 to 40 over the life of

SSQH (the current services and sites to be supported in SSQH are described in

Attachment C).

3) Support general HIV prevention activities at the facility and community levels, with support for specialized services for vulnerable populations such as orphans and vulnerable children as well as any other high-risk category.

4) Continue to support pediatric treatment, care and support at current sites; expand these services to a limited number of sites, as necessary, and in consultation with USAID.

5) Ensure that HIV rapid testing (finger prick) is available at all service delivery sites offering HIV-related services. This shall include the development of training plans for sites not currently capacitated to deliver testing services.

6) Address high lost-to-follow up (LTFU) rates by strengthening referral to facilities, as well as implement systems for active tracking and tracking of LTFU clients.

7) Ensure that all HIV-exposed OVC, whether infected or affected, be tested by DBS DNA

PCR. For appropriate OVC, initiate ART as soon as possible, and ensure appropriate care and treatment. Ensure active finding of siblings and regular home visits to detect other infected children, including TB cases.

8) Support access to psychosocial care and support for PLWHA and OVC. The project shall ensure that existing support groups within organizations of PLWHA are maintained and supported, prioritizing a community-based approach to provide a more stable environment for vulnerable families. Group networks in the community and creation of child friendly spaces (e.g kids’ clubs) shall also be encouraged. Particular attention shall be paid to adolescents who are faced with issues related to disclosure, sexual and reproductive health, and exposure to alcohol and other substances.

9) Support a clear framework for actively linking HIV-positive clients to HIV/TB treatment services. The project shall support activities, with clear benchmarks, for increasing TB screening within HIV programming, in order to reach the objective of >90% TB screening within HIV programming.

1) Develop and implement a strategy to scale up the provision of isoniazid preventative therapy (IPT) across sites supporting TB-related services.

2) Support the implementation of bi-annual comprehensive infection control assessments

(using an MOH-endorsed tool provided by USAID), as well as support comprehensive infection control standards (management systems, patient flow plans, minor infrastructure modifications) in all sites supporting TB-related services.

3) Support procurement and provision of personal protective equipment (PPE) for all supported sites.

4) Support intensified case finding of TB suspects through community-based outreach and linkages to diagnostic and treatment centers.

5) Support the provision of TB treatment services at all sites where USAID is currently supporting these services. This shall include diagnosis of TB at treatment sites, as well as at other supported sites supporting HIV-related services.

Maternal and child health

1) Provide basic maternal, neonatal, and child health care (including antenatal and post-partum care, FP integration, birth planning and birth preparedness, safe delivery, essential newborn care, vaccination, diarrhea prevention and treatment, acute respiratory infection treatment, vitamin A supplementation, and integrated management of childhood illness) in all targeted sites, ensuring utilization of quality of care protocols based on MSPP norms and guidelines

2) Provide basic maternal and child nutrition services including iron and folic acid supplementation, promotion of early and exclusive…