PS3_RFP_SOL-621-14-000017_TANZANIA_final_for_posting.pdf

RFP No. SOL-621-14-000017 The Public Sector Systems Strengthening (PS3)

ABBREVIATIONS

AAPD Acquisition & Assistance Policy Directive ADePT Software Platform for Automated Economic Analysis ACO Administrative Contracting Officer ADS Automated Directives System AIDAR Agency for International Development Acquisition Regulation BEO Bureau Environmental Officer BIP Branding Implementation Plan CAS Cost Accounting Standards CCN Cooperating Country National CCR Central Contractor Registration CCHP Comprehensive Council Health Plans CDCS Country Development Cooperation Strategy CDIE Center for Development Information and Evaluation CFAO Cognizant Federal Agency Official CFR Code of Federal Regulation CHW Community Health Workers CO Contracting Officer COP Chief of Party COR Contracting Officer’s Representative CPFF Cost-Plus-Fixed-Fee CST Contractor Salary Threshold D&B Dun and Bradstreet, Inc.

DBA Defense Base Act DCI Detailed Cost-Impact DCOP Deputy Chief of Party DEC Development Experience Clearinghouse DG Democracy and Governance DHS Demographic and Health Survey DO Development Objective DOC Documentation Outreach and Communication Officer DP(s) Development Partner(s) DQA Data Quality Assessment DRG Democracy, Human Rights, and Governance DUNS Data Universal Numbering System EAT East Africa Time EFT Electronic Funds Transfer EMMP Environmental Mitigation and Monitoring Plan ER Environmental Review ERF Environmental Review Form ETD Environmental Threshold Decision FAC Federal Acquisition Circular FAR Federal Acquisition Regulation FBO Federal Business Opportunities FM/CMP Office of Financial Management, Cash Management and Payment

Division, USAID FOIA Freedom of Information Act FP Family Planning

FSN Foreign Service National GDM General Dollar Magnitude GHI Global Health Initiative GIS Geographic Information System GOT Government of Tanzania HIV/AIDS Human Immunodeficiency Virus/ Acquired Immune Deficiency Syndrome HG Host Government HRH Human Resources for Health HSPD-12 Homeland Security Presidential Directive-12 HSS Health Systems Strengthening HUBZone Historically Underutilized Business Zones ID Identification Document IAE Integrated Acquisition Environment IEE Initial Environmental Examination IELTS International English Language Testing System iHRIS Open Source Human Resources Information Solutions IR Intermediate Result IRS Internal Revenue Service IT Information Technology K4H Knowledge for Health LGAs Local Government Authorities LIST Lives Saved Tool LOE Level of Effort LOSR Local Own Source Revenue LPA Legislative and Public Affairs LPA/PIPOS USAID Bureau for Legislative and Public Affairs/Public Information, Production and Online Services MDG(s) Millennium Development Goal(s) MEDEVAC Medical Evacuation MFD Procurement of Multifunctional Device M/IRM Office of Information Resource Management M/IRM Office of Information Resource Management, AID/W M&M Mitigation and Monitoring MOF Ministry of Finance MOHSW Ministry of Health and Social Welfare MP Marking Plan NACP National AIDS Control Programme NARA National Archives and Records Administration NBS National Bureau of Statistics NGO(s) Non-Governmental Organization(s) NHA National Health Accounts NICRA Negotiated Indirect Cost Rate Agreement NXP Non-Expendable Property OAA Office of Acquisition and Asistance OCGS Office of the Chief Government Statistician OCI Conflict of Interest OECD Organization for Economic Co-operation and Development OIG Office of the Inspector General OMB Office of Management and Budget

OP Operational Plan OPM U.S. Office of Personnel Management OPRAS Open Performance Review and Appraisal System ORCA Online Representations and Certifications Application OSDBU Small Disadvantaged Business PBMS Performance-Based Monitoring System PDF Portable Document Format PEPFAR President’s Emergency Plan for AIDS Relief PER Public Expenditures Reviews PETS Public Expenditure Tracking Surveys PhD Doctor of Philosophy PII Personally Identifiable Information PIV Personal Identity Verification PMI President’s Malaria Initiative PMO-RALG Prime Minister’s Office – Regional Authority for Local Government PMP Performance Management Plan PO-PSM President’s Office - Public Service Commission PPI Past Performance Information PPIRS Past Performance Information Retrieval System PRB Post-Retirement Benefits PRO-Net Procurement Marketing and Access Network PS3 Public Sector Systems Strengthening PSC Personal Service Contract RBF Results-Based Financing RCE Request for Categorical Exclusion RFP Request for Proposals SAM System for Award Management SAR Specifically Authorized Representative SBA Small Business Administration SDB Small Disadvantaged Business SF Standard From SFD Single-Function Device SOW Statement of Work SWAp Sector-Wide Approach TB Tuberculosis TBD To Be Determined TACAIDS Tanzania Commission for AIDS TASAF Tanzanian Social Action Fund TASC3 Technical Assistance and Support Contract Three TCN Third Country National TIN Taxpayer Identification Number TOEFL Test of English as a Foreign Language UNAIDS Joint United Nations Programme on HIV and AIDS UNICEF United Nations Children's Fund US United States of America USAID United States Agency for International Development USAID/W USAID Washington U.S.C U.S. Code U.S.P.S.C U.S. Personal Services Contract

USG United States Government URL Uniform Resource Locator WHO World Health Organization www World Wide Web ZAC Zanzibar AIDS Commission ZIP Zone Improvement Plan

PART I – THE SCHEDULE

SECTION B – SUPPLIES OR SERVICES AND PRICES/COSTS

B.1 PURPOSE

The purpose of this Contract is to support the Government of Tanzania (GOT) to strengthen the Tanzanian public system to promote the delivery, quality, and use of public services, particularly for underserved populations under the Public Sector Systems Strengthening Activity (PS3). In so doing, the Contractor will strengthen overall health care system, inclusive of GOT and USAID priority programs. Furthermore, the Contractor will strengthen key multi-sectoral components of LGA systems as part of the approach to promote inclusive and evidenced-based planning, management, and implementation of services.

B.2 CONTRACT TYPE

This is a Cost-Plus-Fixed-Fee (CPFF), level of effort (term) type contract of five (5) years with no option years.

B.3 ESTIMATED COST, FEE, AND OBLIGATED AMOUNT

(a) The estimated cost for the performance of the work required hereunder, exclusive of fixed fee, if any, is $ . The fixed fee, if any, is $ . The estimated cost plus fixed fee, if any, is $ .

(b) Within the estimated cost plus fixed fee (if any) specified in paragraph (a) above, the amount currently obligated and available for reimbursement of allowable costs incurred by the Contractor (and payment of fee, if any) for performance hereunder is $TBD. The Contractor should not exceed the aforesaid obligated amount.

(c) Funds obligated hereunder are anticipated to be sufficient through [To be inserted at the time of award].

(d) The LOE of each of the five Components is dependent on the needs of each government authority. Operations research must not exceed 10% LOE.

B.4 BUDGET LINE ITEMS

Cost Elements by Components

Year 1 Year 2 Year 3 Year 4 Year 5 Total

Component 1 Component 2 Component 3 Component 4 Component 5 Other Direct Costs Indirect Costs

Total Estimated Cost Fixed Fee

B.5 INDIRECT COSTS

Pending establishment of revised provisional or final indirect cost rates, allowable indirect costs will be reimbursed on the basis of the following negotiated provisional or predetermined rates and the appropriate bases:

For the Prime Contractor:

Description Rate Base Type Period

% 1/ 1/ 1/ % 2/ 2/ 2/ % 3/ 3/ 3/

1/Base of Application:

Type of Rate:

Period:

2/Base of Application:

Type of Rate:

Period:

3/Base of Application:

Type of Rate:

Period:

For Each of the Major Subcontractor(s)*

Description Rate Base Type Period

% 1/ 1/ 1/

1/Base of Application:

Period:

2/Base of Application:

Type of Rate:

Period:

3/Base of Application:

*“Major Subcontractors” are those subcontractors whose proposed cost exceeds 15% of the total estimated Contract cost.

B.6 ADVANCE UNDERSTANDINGS ON CEILING INDIRECT COST RATES AND

FINAL REIMBURSEMENT FOR INDIRECT COSTS

(a) Reimbursement for indirect costs will be at the lower of the negotiated final (or re-determined) rates or the following ceiling rates:

Description Rate Base Type Period

% 1/ 1/ 1/

1/ Base of Application:

2/ Base of Application:

Period:

3/ Base of Application

Period

(b) The Government will not be obligated to pay any additional amount should the final indirect cost rates exceed the negotiated ceiling rates. If the final indirect cost rates are less than the negotiated ceiling rates, the negotiated rates will be reduced to conform to the lower rates.

(c) This understanding will not change any monetary ceiling, obligation, or specific cost allowance or disallowance. Any changes in classifying or allocating indirect costs require the prior written approval of the Contracting Officer.

B.7 COST REIMBURSABLE

(a) Allowable costs will be limited to reasonable, allocable and necessary costs determined in accordance with FAR 52.216-7, ALLOWABLE COST AND PAYMENT (JUN 2013), FAR 52.216-8, FIXED FEE (JUN 2011), if applicable, and AIDAR 752.7003, DOCUMENTATION

FOR PAYMENT (NOV 1998).

(b) In addition, the requirement and conditions concerning estimated cost and funding apply as detailed in FAR 52.232-22, LIMITATION OF FUNDS (APR 1984).

B.8 PAYMENT OF FIXED FEE

Monthly payment of fixed fee will be paid in proportion to the level of effort (LOE) delivered during that month and pursuant to FAR 52.216-8, it will be made upon receipt of a proper invoice. In the event the Contractor has not delivered the total LOE at the expiration of the Contract period, the fixed fee will be adjusted proportionately to the LOE delivered. For example, if the Contractor has expended 85% of the total level of effort, then the Contractor is entitled to 85% of the fixed fee amount, provided that the performance has been satisfactory.

B.9 LABOR

B.9.1 AUTHORIZED WORK DAY/WEEK

No terms contained in this Contract authorize overtime or premium pay. The Contractor must obtain prior written approval from the Contracting Officer’s Representative (COR) for any requested six-day work week.

B.9.2 LEVEL OF EFFORT

(a) The Contractor must devote 106,582person-days of professional level of effort (LOE) for the following categories of employees: Long-Term and Short-Term direct employees and consultants.

This total level of effort may be organized per year and by labor categories as follows:

Total

LOE

Total

LOE

Total

Year 1 Year 2 Year 3 Year 4

Year

Years 1 to 5

Professional Staff ( expatriate and local) 10,140 10,140

10,140

50,700 Short-term Staff 5,577 13,715 16,835 16,835 2,920 55,882

TOTAL LOE 15,717 23,855 26,975 26,975 13,060 106,582

(b) The number of person-days for any labor category may not be used in any other labor category for years 1 through 5, unless prior approval by the Contracting Officer has been granted. Once the required level of effort has been provided, the contract will be completed; however, the Contractor can, with the written approval of the Contracting Officer, modify the Contract by reallocating level of effort between labor categories within the general scope of the Contract. No reallocation of level of effort can result in an increase in the total estimated cost of, or exceed the obligated amount in, the Contract without the prior written approval of the Contracting Officer.

Approvals, technical orders or other direction from the COR do not constitute authorization to increase the total LOE for this Contract. The Government is not obligated to reimburse the Contractor for any actions which increase LOE unless such actions have been authorized in writing by the Contracting Officer.

[END OF SECTION B]

SECTION C: DESCRIPTION/SPECIFICATIONS/STATEMENT OF WORK

C1. PURPOSE

USAID/Tanzania aims to support the Government of Tanzania (GOT) to strengthen the public system to promote the delivery, quality, and use of services, particularly for underserved populations.

C2. BACKGROUND

C.2.1 SOCIO-ECONOMIC CONTEXT

Ranked among the world’s top 30 fastest growing economies,1 Tanzania has experienced considerable economic growth over the past decade, averaging seven percent per year. As stated in the Tanzania Development Vision 2025 and MKUKUTA II,2 the nation’s long term plan is to achieve middle-income country status by 2025.

While economic growth efforts are important for achieving middle-income status, Tanzania experiences critical vulnerabilities that may impede achievement of broader development targets.

Specifically, the country has 1) a large (45 million) and rapidly growing population (2.7% per annum) based mainly in rural areas, 2) significant poverty levels (28.2% of the population living below the basic needs poverty line)3, 3) considerable inequities in access to basic services, 4) high youth unemployment (accounting for 33% of the unemployed),4 and 5) numerous pressing health concerns. Addressing these issues, concurrently with the nation’s focus on economic growth, will be critical to reaping the benefits of the demographic dividend. Specific key health and social issues include:

Maternal Health: Maternal Mortality is considerable at 454 deaths per 100,000 live births.5 Only half of women deliver in a health facility. Low availability of emergency obstetric and new born care services, chronic shortage of skilled health providers and a weak referral system also contribute to the high number of maternal deaths.6

Child health: Tanzania’s infant mortality rate is 45 deaths per 1,000 live births,7 while the under-five mortality rate is 68 deaths per 1,000 children.8 Although under-five deaths have dropped, recent care-seeking behavior for the major killers of children under five (pneumonia, malaria, and diarrhea) is low and has been attributed to poor quality of health services.9

1 IMF World Economic Outlook Database 2 Also known as the National Strategy for Growth and Reduction of Poverty (NSGRP), a 5-year strategic plan aimed at accelerating economic growth, poverty reduction, improving governance, and the achievement of the Millennium Development Goals (MDGs).

3 Tanzania Household Budget Survey 2011/2012. National Bureau of Statistics – Reference ID TZA-NBS-HBS-2013

- www.nbs.go.tz 4 Integrated Labor Force Survey 2006. National Bureau of Statistics – Reference ID TZA-NBS-ILFS-2006-v01.

5 National Bureau of Statistics (NBS) [Tanzania] and ICF Macro. 2011. Tanzania Demographic and Health Survey 2010. Dar es Salaam, Tanzania: NBS and ICF Macro.

6 UNICEF Maternal and Child Health Overview for Tanzania http://www.unicef.org/tanzania/6906_10741.html 7 World Health Statistics 2013. World Health Organization.

8 World Health Statistics 2013. World Health Organization.

9 Ministry of Health and Social Welfare. 2013. Mid-term review of the Health Sector Strategic Plan III. UNICEF Maternal and Child Health Overview for Tanzania

HIV/AIDS: Mainland Tanzania has an estimated adult prevalence of 5.3%.10 As of December 2013, Tanzania has an estimated 1.4 million people infected with the disease11, That said, Tanzania has seen a growing number of people with HIV/AIDS receiving treatment for the disease, with over 500,000 people currently receiving treatment12.

Malaria: Between 60,000 to 80,000 people die from malaria each year on the Mainland.

Approximately 10 to 12 million clinical malaria cases are reported each year, and more than 40% of all health visits are attributed to malaria.13

Tuberculosis (TB): Tanzania has one of the highest TB burdens worldwide, and TB remains the leading cause of disease burden and deaths in people living with HIV/AIDS.

Family Planning: On average, Tanzanian women have 5.4 children, and the unmet need for family planning is considerable at 25% of married women.14

Nutrition: Prevalence of childhood stunting in Tanzania is currently 47%, with similarly high levels of maternal anemia. 15

Education: The majority of Tanzania’s primary school children cannot read with comprehension and lack the foundational skills for lifelong learning and success.

Agriculture: This sector employs 74% of Tanzania labor force, yet most are women subsistence small-holder farmers who lack access to markets. 16

Most of the issues mentioned above are derived from weak country systems. The public sector is the key stakeholder of these country systems and a critical player in economic growth efforts.

C.2.2 LOCAL GOVERNMENT CAPACITY FOR SERVICE DELIVERY

The public sector serves as an important steward over economic growth efforts. To facilitate this process and to strengthen governance, the GOT adopted a “Decentralization by Devolution” process under the Local Government Reform Act of 1996 and has moved many planning and budgetary responsibilities for service delivery from the central level to 161 districts. However, considerable challenges remain at the district level to meet the needs of Tanzanians, particularly the rural poor. These include --

Inadequate financing for critical functions to provide quality assurance of services Incomplete decentralization of some core functions thereby weakening district empowerment Insufficient coordination and involvement of district stakeholders (i.e multiple line ministries, non-governmental organizations (NGOs), civil society and private entities) leading to fragmentation and duplication

Lack of clarity on roles, responsibilities, and communication channels

10 Tanzania Commission for AIDS (TACAIDS, Zanzibar AIDS Commission (ZAC), NBS, Office of the Chief Government Statistician (OCGS), and ICF International. 2013. Tanzania HIV/AIDS and Malaria Indicator Survey 2011-12. Dar es Salaam, Tanzania: TACAIDS, ZAC, NBS, OCGS, and ICF international.

11 www.UNAIDS.org - Global AIDS Response Progress country report, March 31, 2014 12 Document available upon request to the National AIDS Control Programme (NACP) 13 President’s Malaria Initiative, Tanzania http://www.pmi.gov/docs/default-source/default-document-library/malaria-operational-plans/fy14/tanzania_mop_fy14.pdf?sfvrsn=12 14 NBS [Tanzania] and ICF Macro. 2011 Tanzania Demographic and Health Survey 2010. Dar es Salaam, Tanzania:

NBS and ICF Macro 15 NBS [Tanzania] and ICF Macro. 2011 Tanzania Demographic and Health Survey 2010. Dar es Salaam, Tanzania:

NBS and ICF Macro 16 Tanzania Household Budget Survey 2011/2012. National Bureau of Statistics – Reference ID TZA-NBS-HBS- 2013 - www.nbs.go.tz

Paucity of mechanisms to receive and respond to client concerns Weak planning and management capacities Few internal controls and awareness of best practices for financial management

C.2.3 USAID/TANZANIA COUNTRY DEVELOPMENT COOPERATION

STRATEGY AND CROSS SECTOR LINKS

To holistically address and strengthen country support needs, USAID/Tanzania’s activities are influenced by its new Country Development Cooperation Strategy (CDCS) and cross sector links to promote a multi-sectoral approach to activities where strategic and feasible. As such, USAID/Tanzania leadership values integrated programming. PS3 is strongly aligned with the new CDCS framework and contributes to all development objectives and Intermediate Results (IR), particularly to IRs in DO3 as well as IR 1.2 in DO1.

As shown above, USAID recognizes the complexity of multi-dimensional development challenges and the value of addressing them using multiple perspectives and tools across sectors.

In this respect, the CDCS calls for a strategic approach to systems strengthening inclusive of sectoral specific and multi-sectoral approaches. As such, the PS3, while it is primarily focused on health sector system strengthening, will also strengthen systems at the local level extending beyond the health sector.

In recognition of this approach, in addition to Health, USAID Tanzania’s Economic Growth;

Democracy, Human Rights, and Governance (DRG); and Education programs have a vested interest in this Activity. PS3 will leverage synergies within multiple Mission programs facing similar system challenges at the district level to address the following issues:

GOAL

Tanzania’s socio-economic transformation toward middle income status by 2025 advanced

DO 1

Tanzanian women and youth empowered

IR 1.1

Gender equality increased

IR 1.2

Health status improved

IR 1.3

Lifelong learning skills improved

DO 2

Inclusive broad-based economic growth sustained

IR 2.1

Binding constraints to private sector investment reduced

IR 2.2

Agricultural productivity and profitability increased in targeted value chains

IR 2.3

Stewardship of natural resources improved

IR 2.4

Unmet needs for family planning reduced

DO 3

Effective democratic governance improved

IR 3.1

Citizen engagement made more effective

IR 3.2

Government delivery of services improved

IR 3.3

Government accountability increased

Cross-Cutting IR: Data-driven decision-making and action plan implementation improved

Inclusive Economic Growth: PS3 will strengthen the capacity of Local Government Authorities (LGAs) to budget, procure, financially manage, and account for their funds – systems which are critical to all services rendered by LGAs, including LGA maintenance of road networks that are essential to advancing Tanzania’s rural and agriculture-based economy. Poor rural roads inhibit the flow of all economic goods, greatly increasing costs for the consumer and limiting Tanzania’s competitiveness in regional markets. The Feed the Future Initiative supports roads and infrastructure activities through Government-to- Government arrangements that call for strong financial management capacities at the district level. In addition, PS3 will support LGAs to better identify, assess, and develop new options for local own source revenue (LOSR) that are transparent and do not dis-incentivize investment and agricultural production.

DRG: PS3 aims to strengthen target LGAs by improving financial management, local revenue collection and management, and use of data in planning and monitoring. In addition, DRG investment supports the strengthening (or creating where necessary) of mechanisms for civic oversight and accountability, including oversight of LGA implementation of audit recommendations.

Education: PS3 will build the capacity of LGAs to use data from district human resource information systems to inform workforce-planning decisions, particularly as it relates to reducing teacher staffing shortages in rural areas. By strengthening human resource management capacities at the district level, USAID/Tanzania’s Education program aims to facilitate a more equitable distribution and supervision of teachers across schools.

Given both its health and multi-sectoral emphasis, PS3 includes a strong operational research component to monitor and demonstrate relevance, causal-link, and effect of PS3 on USAID priority health areas (maternal and child health, malaria, TB, family planning, nutrition, and HIV/AIDS) in addition to cross-cutting and holistic results at the local government level pertinent to health, education, agriculture, rural roads, and water and sanitation sectors.

C.2.4 RELATIONSHIP OF PS3 TO USAID/TANZANIA’S GLOBAL HEALTH

INITIATIVE STRATEGY17

In addition to the CDCS, PS3 is guided by USAID/Tanzania’s Global Health Initiative (GHI) Strategy. PS3 falls within GHI’s intermediate result two (IR2) of the GHI strategy-improved health systems to strengthen the delivery of healthcare services. It will also contribute towards the achievement and long term sustainability of the two other objectives: Intermediate result one (IR1) - increased access to quality integrated services with focus on maternal, neonatal and child health; family planning and reproductive health; and intermediate result three (IR3) - improved adoption of healthy behaviors- including health care seeking behaviors – with a focus on women and girls. Together, USAID/Tanzania’s health activities will support the GOT and its partners towards developing Tanzania’s social and economic status.

C.2.5 RELATIONSHIP OF PS3 TO USAID/TANZANIA’S HEALTH SYSTEMS

STRENGTHENING (HSS) APPROACH

As mentioned above, Health Systems Strengthening (HSS) is a key intermediate result of the

17 Tanzania Global Health Initiative Strategy 2010-2015. USAID / Tanzania, Dar es Salaam. For more information, please see http://www.ghi.gov/whereWeWork/docs/TanzaniaStrategy.pdf

GHI, and achievement of this result is guided by the Mission’s HSS strategy (2013).18 PS3 is a critical contributor to the implementation of this strategy.

Per the Strategy, PS3 will target improvements in Tanzania’s health systems that are sustainable after donor support ends, including institutionalized capacity for ongoing improvement. As such, it is expected that the country will increasingly rely on its own financial resources and have the human resources and institutional capacity to sustain and improve health services for all of its citizens.

PS3 will support the HSS Strategy using the following underlying approaches:

An integrated response19 across the World Health Organization (WHO) health system ‘building blocks’20 (i.e. service delivery, health workforce, information, commodities, financing, leadership and governance)

Prioritization of long-term sustainable ‘strengthening’ interventions over stop gap/‘support’ measures21

Increased leveraging of multiple funding sources e.g. the President’s Emergency Plan for AIDS Relief (PEPFAR) and the President’s Malaria Initiative (PMI) to support a more strategic and purposeful portfolio that helps address the major weaknesses in Public Sector Systems Strengthening

Added emphasis on monitoring and evaluation of activities to inform programming and document outcomes relevant to both the overall system strengthening and to specific priority areas.

Greater leveraging, partnering, and liaising with a variety of stakeholders

In addition to the USAID/Tanzania Health Systems Strengthening Strategy, the Midterm Review of the Health Sector Strategic Plan III provides detailed background on current issues facing the Tanzanian health care system. The Mid Term Review along with other useful references is listed in Annex A. Illustrative tools and methodologies for systems strengthening are provided in Annex B.

C.2.6 CRITICAL ASSUMPTIONS

PS3 assumes a continued commitment in the following policy and institutional areas at both the national and LGA levels:

Political will and commitment to implement necessary policy changes and public sector systems strengthening

The GOT will continue to experience economic growth rates that can potentially be leveraged to sustainably finance healthcare and other critical services

The GOT possesses political will to implement a comprehensive health financing strategy GOT possesses political will to improve administration of local taxes The GOT continues to invest in attracting and retaining a skilled workforce

18 Available on the USAID’s Clearing House (dec.usaid.gov); Document ID - 8311bc55-9259-449e-b368-c21af084503a 19 Reference: Don de Savigny and Taghreed Adam, Eds. Systems Thinking for Health Systems Strengthening. Geneva: Alliance for Health Policy and Systems Research and World Health Organization, 2009.

20 The WHO building blocks for the health system comprise of 1) Health Finance, 2) Governance, 3) Human resources, 4) Information, 5) Medical Products, Vaccines and Technologies, and 6) Service Delivery.

21 Chee G., N Pielemeier, A Lion, C Connor. 2013. ‘‘Why differentiating between health system support and health system strengthening is needed?’ International Journal of Health Planning and Management: 28(1):85-94.

The GOT and stakeholders desire an integrated health information system The GOT policy agenda and its implementation will focus on addressing the most binding constraints to growth in order to unleash Tanzania’s potential to advance inclusive broad-based economic growth and reduce poverty

C3. STATEMENT OF WORK

C.3.1 SCOPE

The Contractor will support the Government of Tanzania (GOT) to strengthen the public system to promote the delivery, quality, and use of services, particularly for underserved populations. In so doing, The Contractor will strengthen overall health care systems, inclusive of GOT and USAID priority programs. Furthermore, the Contractor will strengthen key multi-sectoral components of LGA systems as part of the approach to promote inclusive and evidenced-based planning, management, and implementation of services.

The Contractor will use an integrated approach across the World Health Organization’s (WHO) systems’ building blocks22 of governance, financing, human resources, and information to strengthen health systems at the national level, while simultaneously building these capacities at the LGA level to improve service delivery and planning across all sectors. The Contractor will work with the following key GOT entities at a minimum:

Ministry of Health and Social Welfare (MOHSW) Prime Minister’s Office – Regional Authority for Local Government (PMO-RALG) President’s Office - Public Service Commission (PO-PSM) Ministry of Finance (MOF)

As a part of the operational research component, the Contractor will demonstrate relevance, causal-link, and effect of the program on USAID priority health areas to include maternal and child health, malaria, TB, family planning, nutrition, and HIV/AIDS in addition to cross-cutting and holistic results at the local government level pertinent to the health, education, and agriculture sectors. As such, PS3 will include a robust learning agenda to define and track indicators needed to guide contract implementation and to continually measure if systems are being strengthened and results are being achieved.

The Contractor must support the GOT needs at both the national and local government authority (LGA) levels.

National level efforts will focus on informing the development and operationalization of key strategies, policies, and guidance to include the National Health Care Financing Strategy, Health Sector Strategic Plan IV, Human Resources for Health Strategy, the Social Welfare strategy, and e-Health Strategy. Local government-level efforts will focus on translating national guidance into action, while informing the national dialogue based on LGA-level realities on the ground.

Furthermore, the Contractor will accommodate the multi-sectoral nature of LGAs, where relevant and appropriate, to promote inclusive and evidenced-based planning, management, and implementation of services.

22 The WHO building blocks for the health system comprise of 1) Health Finance, 2) Governance, 3) Human resources, 4) Information, 5) Medical Products, Vaccines and Technologies, and 6) Service Delivery.

To the maximum extent feasible, the Contractor will work within government systems, and must engage citizens to participate in improving system accountability to achieve the targeted results. The Contractor will work in close coordination with civil society and related national and local programs (including those supported by the U.S. Government (USG), Development Partners (DPs), the GOT, and/or civil society) to enhance the impact of PS3 investments.

PS3 will operate at a national level, as well as in all districts of 13 targeted Tanzania Mainland regions. The Contractor must support the following five PS3 components.

CATEGORY EXPECTED RESULTS

Component 1 Governance and

Citizen Engagement Strengthened governance at national and LGA levels to use resources transparently, enable citizen engagement in planning and monitoring, and produce results across all sectors.

Component 2 Human Resources Improved equity in the distribution of human resources for effective service delivery to the most vulnerable populations.

Component 3 Finance Increased domestic resources for services that deliver public goods and improved use of funds in terms of effectiveness, efficiency, and obtaining value for money.

Component 4 Information Systems Strengthen host country information systems and data use among local stakeholders.

Component 5 Operations Research Small-scale operations research conducted and used to address barriers and provide data to convert unforeseen opportunities into desired results.

The Contractor must support the strengthening of GOT systems at the national and LGA level across all components and in alignment with GOT priorities for improving systems. The Contractor must engage with MOHSW, PMO-RALG, PO-PSM and MOF at the national level and additional entities, as required, addressing gaps identified during PS3 implementation. At the LGA level, the Contractor will engage with all relevant stakeholders to include civil society and individual citizens as defined by the five components within the purview of the District Executive Director and the Council Chairman. Additionally, the Contractor will examine existing mechanisms of the Government for obtaining and considering civil society and citizens’ input strengthening and supporting the implementation. The Contractor must target systems strengthening interventions and approaches that contribute to improved and sustainable systems performance that will last beyond PS3 implementation.

In addition to cross-sectoral system strengthening, the Contractor will support the GOT to strengthen the overall health care system. The health system includes: public, faith-based, and private sector health providers, as these entities fall within the purview of the GOT’s stewardship and coordination function.

C.3.2 PERFORMANCE AREAS

At the local government level, the Contractor must support all LGAs within the 13 targeted regions of the Tanzania Mainland: Dodoma, Iringa, Kagera, Kigoma, Lindi, Mara, Mbeya, Morogoro, Mtwara, Mwanza, Njombe, Rukwa, and Shinyanga. These regions have been selected based on the following criteria.

Location of current USAID programming efforts: Specifically, those relating to USAID’s democracy and governance program, Feed the Future Initiative, Education, health program, including recent HSS local government targeted efforts in governance, human resources for health (HRH), and financial management.

Location of donor partner programming for HSS activities: Specifically, those relating to supportive supervision, governance, health management information systems, community health fund, public private partnerships and results based financing initiatives.

Areas of highest burden of disease: Namely, contraceptive prevalence, stunting, HIV prevalence and malaria prevalence.

LGAs with low performance on HSS indicators: Specifically, the percent of planned activities executed per the LGA comprehensive council health plan, gaps in the establishment of potential public private partnerships, per capita personnel expenditures, per capita other charges expenditures, the number of nurses per 1,000 population.

C.3.3 EXPECTED RESULTS AND OBJECTIVES

The following are the expected results and objectives for each of the five components under PS3.

USAID expects that PS3 will include interventions to achieve each one of these component’s expected results and objectives.

Component One: Governance and Citizen Engagement

Expected Result: Strengthened governance at national and LGA levels to use resources transparently, enable citizen engagement in planning and monitoring, and produce results across all sectors.

Strengthened governance, and the leadership and management that underpins it, is essential for effective implementation of PS3 at all levels. Critical to a well-functioning system is the extent to which the government responds to public and civil society needs, preferences, and demands;

answers citizens’ complaints or requests for information; and incorporates community-level opinions into policy and planning.

Objectives:

1. Government delivery of services improved

2. Citizen engagement made more effective

3. Government accountability increased

Tasks: Contractor interventions will include, but not be limited to the following, in support of each above expected result and objectives.

1. Government Delivery of Services Improved

1.1. National Level-Health: Support the MOHSW, PMO-RALG, PO-PSM, MOF, key stakeholders and additional entities as required on major national policy initiatives for increased delivery, quality and use of health services by rural Tanzanians.

1.2. National Level-Health: Strengthen the GOT stewardship and coordination of health issues and actions across all stakeholders, to include public, private sector, and civil society.

1.3. National Level-Health: Support the GOT to institutionalize systems for sharing best practices and lessons learned from LGAs.

1.4. National Level-Health: Support facilitation for the national government to institutionalize a process for health management training through institutions to include the Local Government Training Institute and/or Mzumbe University as appropriate.

1.5. National Level-Health: Support the GOT’s efforts to develop and implement action plans across Ministries for the coordination of an individual health system issue.

1.6. National Level-Health: Support the development of partnerships and available programs to institutionalize health management training.

1.7. LGA Level-Health: Support the roll-out and operationalization of health policies, strategies, initiatives and technical guidelines at the LGA levels.

1.8. LGA Level-Health: Strengthen capacity of LGAs to develop and execute high quality Comprehensive Council Health Plans (CCHP).

1.9. LGA Level-Health: Support the districts to institutionalize systems that will enable LGAs to adopt inclusive planning approaches as per GOT planning guidelines for CCHP.

1.10. LGA Level-Multisectoral: Strengthen capacity to carry out strategic planning across all sectors including processes for prioritizing investments.

1.11. LGA level- Multisectoral: Support LGA staff to connect with peers through networking to exchange experiences and improve activities.

1.12. LGA level- Multisectoral: Strengthen the capacity of managers and LGA administrators to manage activity resources, time, money, scope, and the operationalization of following GOT systems: PlanRep3,23 Epicor24 and HR information systems.

2. Citizen Engagement Made More Effective

2.1. National Level-Health: Strengthen capacity of PMO-RALG to strengthen and institutionalize systems at LGAs to encourage and respond to civic engagement in the monitoring of service delivery particularly on the availability, accessibility, responsiveness, and perceived quality of services rendered. This will include creative ways to link the community voice to funding decisions for LGAs to include the national results-based financing for health initiative.

2.2. LGA Level-Multisectoral: Support the districts to institutionalize systems that will enable LGAs to engage with civil society for social accountability monitoring across all sectors.

2.3. LGA level-Multisectoral: Identify and strengthen existing LGA-Civil Society mechanisms overseeing the implementation of relevant audit recommendations; where no suitable

23 PlanRep is a tool designed for planning and reporting database. Main Features: - Create a Performance Budget framework of objectives, targets and activities. - Link any target to an MKUKUTA cluster strategy (MKUKUTA is the national strategy for growth and poverty reduction). Link each activity with a responsible person.

24 Integrated Financial Management System used by the GOT mechanism exists, the contractor should support the LGA to develop appropriate mechanisms, as part of a larger civil society-LGA mechanism for dialogue, advocacy, and oversight.

3. Government Accountability Increased

3.1. National Level-Health: Provide members with objective health policy analysis specific to the needs of Parliamentarians, National and local GOT stakeholders, other policymakers and people of influence.

3.2. LGA Level-Multisectoral: Support LGAs to institutionalize systems that provide opportunities for local community boards.

3.3. LGA Level-Multisectoral: Strengthen the overall procurement systems through interventions that may include but are not limited to training and capacity building, to increase efficiency and transparency.

3.4. LGA Level- Multisectoral: Support LGAs to institutionalize systems and to conduct and undergo internal and external audits to improve management of procurement processes and LGA finances and implement recommendations.

3.5. LGA Level-Multisectoral: Support LGAs to improve transparency, programmatic and fiscal accountability through formal and documented internal controls.

3.6. LGA Level-Multisectoral: Support accounting systems to provide coherent information on resources reaching the lower levels of service delivery.

3.7. LGA Level-Multisectoral: Support accounting systems to produce periodic reports as required that are accessible by Management.

Indicators The Contractor will use the following indicators with targets to be set in the annual work plan.

The Contractor may use additional indicators to capture activity impact.

Health: Increased percentage of all districts submitting plans that meet and/or exceed CCHP assessment criteria

Health: Increased number of LGAs that meet defined standards of good management of health services

Health: Increased number of CCHPs developed with non-GOT stakeholders to include civil society and private sector participation

Health: Increased percentage achieved of targeted results in districts implementing the Results Based Financing Initiative for Health

Multisectoral: Increased percentage in citizens' understanding of public leadership accountability in targeted districts

Multisectoral: Increased number of LGA budget cycle phases that incorporate feedback from citizens

Multisectoral: Increased public perception of the quality of public or government services disaggregated by sector and gender

Multisectoral: Increased percentage of districts receiving clean financial audit reports Multisectoral: Increased citizen perception that civil society and citizens’ advocacy and oversight efforts are effective Multisectoral: Number of functioning LGA-civil society dialogue and planning mechanisms

Component Two: Human Resources

Expected Result: Improved equity in the distribution of human resources for effective service delivery to the most vulnerable populations.

In addition to ensuring the correct numbers of workers are being produced in the system, and to have sustainable impact on reducing vacancy rates at the LGA level, it is necessary to strengthen HR recruitment, distribution and retention systems in the GOT.

1. Equitable distribution of human resources achieved in target areas

2. Inter-ministerial coordination across PO-PSM, PMO-RALG, MOF and MOHSW enhanced

3. Performance monitoring enhanced

4. Strengthened HR recruitment and retention systems at the LGA level

1. Equitable Distribution of Human Resources Achieved in Target Areas

1.1. National Level-Health: Enhance capacity and support to the GOT to deliver and maintain its national HRH commitments presented at the 3rd Global Health Workforce Forum in Recife, Brazil of Nov. 9-13, 2013:

Reduced vacancy rates in dispensary and health center levels in the most hard to reach areas by 2017

Increased available financing for the recently established pay and incentive policy for the most hard to reach areas by 2017

Develop and operationalize a national task sharing policy by 2017

1.2. National Level-Health: Support GOT to develop and operationalize a national task sharing policy by 2017.

1.3. LGA Level-Multisectoral: Facilitate LGAs use of human resource information systems and relevant staffing norms and policies to equitably distribute their workforce, to include HRH, teachers, and agriculture extension agents, focusing on rural areas that are among the most underserved areas.

2. Inter-ministerial Coordination across PO-PSM, PMO-RALG, MOF and MOHSW Enhanced

2.1. National Level-Health: Support the facilitation of linkages across all key HRH stakeholders

(PO-PSM, PMO-RALG, MOF, MOHSW) to enhance effective planning, budgeting, recruitment and retention of the health workforce.

2.2. National Level-Health: Support health financing and HRH analyses that influence policy and budget for workforce planning and distribution.

2.3. National Level-Health: Support the GOT to streamline routine HRH data collection, accessibility, and utilization for planning authorities.

2.4. National Level-Health: Coordinate and ensure that all GOT stakeholders (MOF, PMO- RALG, PO-PSM and MOHSW) have clearly defined roles related to HRH and participate in the implementation of the National HRH Production Plan.

2.5. National & LGA Level-Health: Facilitate the formalization and roll out of the national Community Health Worker (CHW) cadre within the GOT public service establishment – to include completion of necessary GOT regulation and administration for operationalizing a new cadre, cost, career trajectory, scope of responsibilities, training, and sources of financing.

3. Performance Monitoring Enhanced

3.1 National Level-Health: Assist the national government to utilize results-based resource transfers linked to the Open Performance Review and Appraisal System (OPRAS)25 and National results-based finance initiative for health workers.

4. Strengthened HR Recruitment and Retention Systems at the LGA Level

4.1. LGA Level-Multisectoral: Support LGAs with creative financially viable approaches to work around gaps in staffing.

4.2. LGA Level-Multisectoral: Support LGAs with creative and financially viable approaches in implementing PO-PSM’s Pay and Incentive policy for underserved populations.

4.3. LGA Level-Multisectoral: Support LGAs to use human resource policies and practices to provide sufficiently skilled workers.

4.4. LGA Level-Multisectoral: Support LGAs in developing and financing context-specific retention packages.

The Contractor will use the following indicators with targets to be set in the annual Work plan.

Health: Reduced vacancy rates in dispensary and health center levels in the most hard to reach areas by 2017

Health: Increased available financing for the recently established pay and incentive policy for the most hard to reach areas by 2017

Health: Increased density of healthcare workers in rural areas Health: Increased number of LGAs using laws, regulations, amendments or provisions, that permit ways to hire, issue, and appoint across all sectors, focusing on underserved areas

Health: Increased percentage of trained Health Workers deployed, disaggregated by cadre and gender

25 For more information on OPRAS, please see www.utumishi.go.tz

Multisectoral: Reduced percentage of approved posts which are vacant at the district level, disaggregated by sector and cadre

Multisectoral: Increased percentage of HR professionals, to include health workers and teachers, distributed in areas deemed most underserved at the LGA level

Multisectoral: Increased retention rates in targeted regions of recruited staff who have stayed for at least one year

Component Three: Finance

Expected Result: Increased domestic resources for services that deliver public goods and improved use of funds in terms of effectiveness, efficiency, and obtaining value for money.

The finance component targets innovative mechanisms for domestic resource mobilization and payment of GOT services, particularly at the district level. In addition, this component strengthens routine finance data collection systems and their use for budgeting and planning.

Long-term sustainability is a core underlying principle for the Finance component of PS3.

1. Develop and operationalize innovative financing and payment schemes incorporating results based financing and mobile payment systems

2. Increased domestic financing for services that deliver public goods

3. Strengthen production of finance data and its use for planning, budgeting and management of resources

4. Improve collection and diversity of LGA ‘own source’ revenue generation and management

Tasks: Contractor interventions will include, but not be limited to the following, in support of each above expected result and objectives.

1. Develop and operationalize innovative financing and payment schemes incorporating results-based financing

1.1. National Level-Health: Support the GOT in rolling-out a national results-based financing (RBF) initiative to improve health systems performance and demonstrate value for money as part of the country’s overall health care financing strategy. This will involve RBF approaches to resource transfers for health service delivery, possibly including insurance.

1.2. LGA Level-Multisectoral: Support the LGAs to pilot mobile payment technologies for cess 26and other local taxes.

2. Increased Domestic Financing for Health

2.1. National Level-Health: Support the GOT to develop and roll out an operational plan for its new health care financing strategy, which includes risk-pooling, efficiency-strengthening strategies, RBF, HIV-AIDS trust fund, and other innovative financing approaches.

2.2. National Level-Health: Support the GOT in effectively communicating its new healthcare

26 For purposes of PS3, Cess is used in the agriculture context – as pre-profit tax at farm-gate on crops.

financing strategy to all relevant stakeholders.

2.3. National Level-Health: Support the GOT to increase local27 investments in health, with focus on underserved populations.

3. Strengthen Production of Finance Data and its Use for Planning, Budgeting, and Management of Resources

3.1 National Level-Health: Support the GOT with routine tracking of health resources in alignment with international norms, and with the development of cost estimates, resource gap analyses, and cost-effective and cost-efficiency studies to produce policy strategies that improve resource equity and reduction of catastrophic household out-of-pocket spending for essential health services by underserved populations. Also support the GOT to coordinate and ensure that health resource tracking information will be available to the public in a user friendly format.

3.2 National Level-Health: Support the GOT to improve equity for the distribution of resources across LGAs through improved application and revisions of the resource allocation formula;

better informed budget requests; and…