Draft_PWS.pdf

ELAN - PRIVATE SECTOR

HEALTH PARTNERSHIP

ACTIVITY

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DRAFT PERFORMANCE WORK STATEMENT

List of Acronyms

ACT Artemisinin-based Combination Therapy

AMCES Association des Oeuvres Médicales Privées Confessionnelles et Sociales du Benin

ABMS Benin Association for Social Marketing and Health Communication

ABPF Benin Association for Family Promotion

ARM3 Accelerated Reduction of Mortality and Morbidity due to Malaria ANCRE Advancing Newborn Child and Reproductive Health ANC Antenatal Care

CAME Central Purchasing of Essential Drugs and Medical Supplies

CEBAC STP

Coalition des Entreprises Béninoises et Associations contre le Sida, la Tuberculose et le Paludisme

CMS Central Medical Stores

DCA Development Credit Authority DHIS District Health Information Software EPCMD Ending Preventable Child and Maternal Deaths

FP Family Planning

GHSC-PSM Global Health Supply Chain Procurement and Supply Management

GHSC-TA Global Health Supply Chain Technical Assistance

GOB Government of Benin HF Health Facilities HIHS High Impact Health Services

HTA Health Technology Assessment

IUD Intra Uterine Device

LLIN Long lasting Insecticide Treated Mosquito net

MoH Ministry of Health

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ToR Terms of Reference

IPTp Intermittent Presumptive Treatment

PSA Benin Private Health Sector Assessment

PSSP/The Platform Plateforme du Secteur Privé de la Santé/ Private Sector Health Platform

PQM Promoting the Quality of Medicines

PWS Performance Work Statement

RDT Rapid Diagnostic Test

RMNCH Reproductive, Maternal, Nutritional and Child Health

ROBS Réseau des ONG Béninoises de Santé/ Beninese Health NGOs Network SHOPS Strengthening Health Outcomes through Private Sector UHC Universal Health Care

UNFPA United Nations Fund for Population Activities

USAID United States Agency for International Development

C.1. INTRODUCTION

The purpose of ELAN is to reduce preventable deaths among vulnerable populations by increasing the use of high impact health services and healthy behaviors at the community level in all health zones in Benin.

C.2. BACKGROUND

Country Context

Despite some improvements, Benin’s health indicators remain unsatisfactory. Maternal, under-five, and infant mortality rates are estimated at 405 maternal deaths per 100,000 live births, 115 child deaths per 1,000 live births, and 66 infant deaths per 1,000 live births, respectively. While child mortality has fallen dramatically (from 166/1000) since 2006, the proportion of under-five mortality during the neonatal period rose from 23 percent in 2006 to 33 percent in 2011-12 (source: DHS 2011-2012). Endemic malaria threatens the entire population and is the leading cause of morbidity and mortality. Malaria prevalence remains high with 28 percent of children carrying malaria parasites. Despite progress in improving access to basic health services, 4 | Page achieving Sustainable Development Goals (SDGs) will remain a significant challenge, unless the private health sector is better engaged to sharply accelerate health trends.

During the five-year period of 2015 – 2020, USAID’s Benin Health Project (BHP) aims to reduce preventable deaths among vulnerable populations through increased use of high impact health services and healthy behaviors at the community level. This goal will be achieved through programming in three areas: 1) delivery of an integrated package of high-impact health services

2) improved preventative and care seeking behavior in communities and 3) improved performance of key health systems.

Key national-level results projected under the BHP include:

● Reduce maternal mortality by 5% from 405 to 385 deaths per 100,000 live births

● Reduce under-five mortality by 20% from 115 to 92 per 1000 children

● Reduce infant mortality by 15% from 60 to 51 per 1000 infants

● Increase modern method contraceptive prevalence rate by 7.6 percentage points from 12.4% to 20%

● Reduce prevalence of stunted children under five by 10% from 47% to 37%

The primary focus of the BHP is “vulnerable populations,” as opposed to a previous focus on “families.” In addition, BHP emphasizes the strengthening of a few, key health systems, strategic partnerships, and better programmatic integration with scale-up of private sector work. This approach seeks to serve the large proportion of Beninese who tend to first seek healthcare from the private sector; it will also address the varying quality of services in the private sector.

National Policy Context

One of the causes of Benin’s low health indicators is the health system’s weak performance.

Poor quality healthcare remains a problem in both public and private healthcare sectors.

However, the private sector faces additional burdens in that the Government of Benin (GOB) is unable to provide effective oversight due in part to over-regulation as well as the complexity of regulations that make management difficult and do not substantially improve patient health.

Today, over half of private health providers are unlicensed and less than a quarter of the 3,000 plus facilities are registered. Moreover, only one-third of the registered providers receive supervision from the GOB, and few providers regularly report health statistics into the national

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Health Management Information System (HMIS). (source: 2014 Benin Private Sector Census)

While standards and norms exist for public sector providers, they do not exist for private providers. Additionally, there are restrictions on advertising of services and products for health facilities and pharmacies. Prices are set by professional associations rather than by health managers of private facilities. These prices are not market-based and do not take into consideration socioeconomic and geographic differences, which restrict competition and the availability of quality services and products.

There is anecdotal evidence that informal drug channels provide the bulk of the country’s pharmaceuticals. For example, the 2014 ACT Watch study found that 70% of all antimalaria product sales took place in the private sector, of which two-thirds were sold in the informal sector. Little is documented about the structure and content of the pharmaceutical market, drug flows, private sector supply chains and logistics. This lack of market information and data impedes decision-making on how to strengthen private markets and encourage private investment, which increase access to quality medicines.

The national association of pharmacists places restrictions on where pharmacies can be established and intentionally avoids placing new pharmacies near existing ones, limiting competition. The availability of key pharmaceuticals and healthcare products vary; many pharmacies do not carry oral contraceptive pills or malaria rapid test kits, and only around half carry diarrhea treatments, including Orasel-Zinc kits. Pharmacies cite a shortage of equipment and pharmaceuticals as a barrier to improving business. The highly controlled and centralized decision-making process within the GOB for product registration hinders product availability and limits both the competition for and availability of key products in the marketplace.

The Government, as opposed to markets, determines whether specific products are needed in the market. The application for market authorization review process denies registration to products similar to those already available on the market, thus limiting patient choice. Central GOB authorities set margins for wholesalers, limiting percentage spread at the wholesale level. There are strict rate controls for markups and margins. The rate controls – especially on non-generic medicines – are so strict that wholesalers are often unable to cover their direct costs. In short, the current regulatory practices hamper the ability of the private sector to sustainably make available a full range of product choices to consumers at different price points to competitively serve all population segments, including the poor and vulnerable. This subsequently limits the availability of high impact products and services.

USAID Benin’s Investment in the Private Sector

USAID Benin has a long history of strengthening Benin’s private health sector. Over the last

6 | Page decade, USAID Benin has supported private sector family planning (FP) and maternal and child (MCH) service delivery, commodity security, and malaria prevention. Recent studies commissioned by USAID indicate that the private health sector is growing in importance and has substantial potential. In light of this situation, USAID Benin is prioritizing strengthening private sector health care services and access to quality affordable healthcare products.

The USAID private sector work to date includes supporting the development of ABMS (Association Béninoise pour le Marketing Social et la communication pour la santé), established in 1994 and revitalized in 2009. In conjunction with support to the Profam healthcare network, USAID Benin has strengthened the provision and quality of private provider services through over 50 clinics nationwide.

Recent studies, including the 2013 Benin Private Health Sector Assessment (PSA) and the 2014 Benin Private Sector Census, indicate a need to focus on scaling up private sector work beyond these established initiatives. These studies led to several USAID Benin interventions including the private sector components of the Advancing Newborn, Child, and Reproductive Health 2014- 2018 (ANCRE), and Accelerating Reductions in Malaria Morbidity and Mortality 2011-2018 (ARM3) as well as the creation of the Private Sector Health Platform (referred to hereinafter as “The Platform”). ANCRE is responding to the PSA’s recommendations around health services including scaling up the high impact health services, and developing accreditation and fast-tracking the registration of facilities. ARM3 focuses on private sector malaria services and improving access to affordable, quality malaria commodities in the private sector. (See Annex/links for documents)

The Platform provides private providers a platform for collective advocacy with the GOB and civil society. The Platform is exclusively private, apolitical, and represents a broad cross sector of the private health sector. The Platform’s first strategic plan is underway, covering the period of 2015-2019. It is legally registered and expects to conclude a legal convention with the GOB by 2017. The Platform was created to reform the private health sector and provide a national solution to barriers facing the private sector. It has potential to be sustainable and scalable, especially with increased interest among private providers and associations. However, as a newly created organization, the Platform needs to build capacity to interface objectively and effectively with the GOB.

Other key private sector health work in Benin includes the World Bank’s performance-based financing project, which aims to use financial incentives to increase access to quality high impact services among poor and vulnerable populations in both public and private sectors in select zones.

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C.3 PROJECT, PURPOSE AND OBJECTIVES

The purpose of ELAN is to increase the use of high impact Reproductive, Maternal, Nutritional and Child Health (RMNCH) services and products delivered by the private sector nationwide.

There are the four objectives of the activity:

Objective 1: Expand volume of quality, high impact RMNCH services delivered by private sector providers

Objective 2: Increase availability of key, quality health products at different price points through private sector channels

Objective 3: Strengthen public-private engagement to promote attainment of universal RMNCH health outcomes

Objective 4: Integrate and disseminate innovative, tested, and emerging private sector models

The ELAN contractor will primarily utilize a technical assistance approach to reform Benin’s regulatory systems, strengthen healthcare administration and advocacy, as well as a direct service delivery model at the community level. ELAN activities are market-based and patient-centered and are informed by analyses of pharmaceutical market data, policy, innovative private-sector best practices, gender, and consultation with the GOB, Benin private sector organizations and associations, U.S. Government agencies, civil society, research institutions, donors and other stakeholders.

C.4. SCOPE

4.1. Geographic Scope and Focus

The Benin ELAN activity will be headquartered in Cotonou with activities covering all of the 34 health zones in Benin.

4.2 Technical Focus

The Benin ELAN contractor must strengthen the private sector’s ability to deliver high impact RMNCH services and products by reforming Benin’s regulatory practices and systems as well as strengthening the ability of the GOB to manage the private sector, including using professional market data to monitor and evaluate regulatory policy and availability of drugs in the private sector and undertake public-private partnerships. At the same time, the contractor must

8 | Page strengthen the private sector’s administrative capacity to provide high impact services, undertake public-private engagement and advocacy work. The contractor must provide assistance to roll out service delivery systems where they may be lacking and strengthen existing service delivery platforms.

The RMNCH high impact services include family planning, malaria in pregnancy, antenatal and postnatal care, safe deliveries, vaccinations, exclusive breastfeeding, water sanitation and hygiene, and integrated management of common childhood illnesses of diarrhea, acute lower respiratory infections, malnutrition and malaria.

Key RMNCH products include rapid diagnostic tests for malaria (RDTs), artemisinin-based combination therapy (ACT), injectable artesunate for hospitalized malaria patients, long lasting insecticide treated nets (LLINs), male and female condoms, hormonal and non-hormonal oral contraceptives, injectable contraceptives including Sayana Press, implants, intrauterine devices (IUDs), emergency contraception, oral rehydration solution (ORS) with zinc, and water purification tablets.

While this activity focuses mainly on supply-side activities, the contractor must illustrate how demand for preventive and care seeking behavior in communities will be strengthened through current on-going efforts as appropriate, especially strengthening the visibility of family planning demand-creation materials to support women’s choice and understanding of available quality methods, products and brands at pharmacies and drug stores.

4.3 ELAN Tasks and Performance Standards

The contractor must implement the following tasks to achieve the objectives and outcomes of

ELAN.

Under the tasks are USAID standards.

Objective 1: Expanded volume of quality, high impact RMNCH services delivered by private sector providers

By 2022, it is expected that Benin’s private sector will deliver high impact RMNCH services to approximately 6 million people. Per the 2014 Strengthening Health Outcomes through Private Sector (SHOPS) census report, there were 3,174 estimated unregistered clinics and only 50.8% of the 2,486 private sector providers licensed to practice (excluding medical aides, laboratory technicians, radiology technicians, health logisticians, first aid responders, and “other” providers, who would not be expected to be licensed).

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The contractor must build the capacity of providers in the private sector to deliver quality, high impact services reaching poor and vulnerable populations as well as increase the number of quality, high impact RMNCH services, as defined by the GOB. This will include completing the recently established national accreditation process.

Key stakeholders such as the GOB, the Platform, donors and other private sector actors are working to strengthen private sector healthcare and public-private partnerships in Benin. The contractor must strengthen the Platform’s members and collaborate with the Platform, the GOB and other key stakeholders to obtain nationwide coverage.

A dearth of technical assistance or continuing medical education contributed to the result of few private providers with up-to-date skills of high impact services. The contractor must support professional associations to provide technical assistance and training for quality assurance to facilitate/promote the scale-up of high impact health programs (ie. malaria, family planning, vaccinations, antenatal and postnatal care etc.) in the private sector and ensure continuous improvement.

The contractor must provide technical and material assistance to the GOB and private professional associations to reform regulatory standards, conduct training and increase the registrations of private facilities and licensing of private providers as well as scale up neonatal services.

Outcome 1.1. Significantly increased number of registered private facilities and licensed providers

The contractor must:

Task 1.1.1. Convene the GOB, professional healthcare associations, and private providers to review and simplify the process for registration for the private sector facilities and providers.

Task 1.1.2. Provide technical assistance to the Ministry of Health’s (MoH) Direction of Public Health to officially deregulate processes for licensing private providers and registering private facilities, focusing on patient and consumer needs.

Task 1.1.3. Determine the feasibility of putting in place a system of quality norms led by a non-governmental organization (NGO) that could also help providers understand their rights in the registration process.

Task 1.1.4. Identify at least three innovative financing channels accessible to private sector health facilities.

Task 1.1.5. Provide technical assistance through selected organization(s) to provide registration

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Performance Standards for Outcome 1.1:

Performance Standard Acceptable Quality Level

Quality Assurance Plan

Method of Surveillance

At least three innovative strategies are identified for financing private health facilities

At least three strategies are known to private facility managers

-Written strategies -Communication from financing sources

100% COR review and approval of written strategies

750 health facilities receiving training in service delivery, administration and business management by professional associations

5% Standard Deviation

-Training Plan -Training Participant List -Training evaluations

Quarterly reports contain:

- Annex with a list of trained health facilities

- Synopsize results of training evaluation

Five deregulation meetings are organized with GOB and stakeholders

5% Standard deviation

Meeting notes Quarterly reports contain:

- Meeting outcomes

- List of participants

Support 700 private health providers to obtain a license

10% Standard deviation

Verified license numbers posted at Health Facility (HF)

Periodic COR inspection

800 newly registered private facilities

10% Standard deviation

Verified registration number posted at HF

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Outcome 1.2. At least 35% of registered health facilities are RMNCH accredited

Task 1.2.1. Provide technical assistance to the Platform to implement the accreditation of private facilities, focusing on patient and consumer needs and provide accreditation support services.

Task 1.2.2. Convene the MoH, professional healthcare associations, and private providers to establish standards and norms for quality for the private sector.

Task 1.2.3. Support on-the-job training in high impact RMNCH services as well as improving providers’ and pharmacists’ understanding of government standards and norms.

Performance Standards for Outcome 1.2:

Performance Standard Acceptable Quality Level

Quality Assurance Plan

Method of Surveillance

70% of registered, non-accredited HFs receive quarterly accreditation visits

No deviation unless approved in advance by the COR

-Completed checklist -Quarterly report by Accreditor(s)

Quarterly report

35% of registered private facilities are accredited (after completion of 2 years of visits)

No deviation unless approved in advance by the COR

Verified certificate of accreditation posted at HF

1500 providers reached by the on-the-job training in high impact RMNCH services, leveraging professional associations

10% standard deviation

Trainees certificates

Quarterly reports:

- Annex provides a list of trained health facilities

- Synopsize results of training evaluation

Outcome 1.3. 50% of registered health facilities routinely reporting on high impact RMNCH

12 | Page services into the national HMIS

Task 1.3.1. Develop systems with the MOH to ensure that registered, private facilities are covered by routine MoH data management supervision at the health zone level. This will require innovative models for supervision in high density private sector areas in the Porto Novo, Cotonou, Calavi corridor.

Performance Standards for Outcome 1.3:

Quality Level

Quality Assurance Plan

Method of Surveillance

50% of private facilities were supervised at least once by the MoH in past six months

No deviation unless approved in advance by the COR

Integrated supervision checklist

Quarterly report

50% of registered private clinics reporting to HMIS on quarterly basis

No deviation unless approved in advance by the COR

DHIS2 Quarterly report

Objective 2: Increase availability of key, quality health products at different price points through private sector channels

The contractor must strengthen the capacity of pharmacies, pharmacists and wholesalers to import and distribute quality drugs and health care products– especially drugs and products supporting high impact health services - as well as increase their availability and build a simple but routine approach to monitor the market to benefit private and public sectors. Routine data will be used to monitor regulatory reform, health care programming and encourage private investment. The contractor must support a shift in mindset in all sectors and legal framework governing the pharmaceutical supply environment to allow the private sector to reach its potential in supplying quality drugs.

Outcome 2.1. Increased volume (i.e., gross unit sales) of quality key RMNCH products in the private sector at the department level

Studies on health care products are sometimes done by market or health care players, which create a conflict of interest or less than optimal results. The contractor must use a third-party, 13 | Page expert pharmaceutical market data vendor to analyze the structure of the private sector supply chain, highlighting intersection with and potential synergies with the public sector supply chain, and on a routine basis collect and analyze market data on key products for private and public sector use as mentioned previously.

Task 2.1.1. Manage an expert, “conflict-of-interest-free” sub-contractor to conduct in-depth study of flow, logistics and quality testing of key RMNCH products from manufacturer to end-user.

Task 2.1.2. Manage an expert, “conflict-of-interest-free” sub-contractor to collect routine pharmaceutical market data based on existing panels (such as QuintilesIMS or Nielson) and including data such as manufacturer, source, lot number, brand, presentation, pack, price and outlet in total market.

Task 2.1.3. Ensure semi-annual routine analysis of key RMNCH product data by expert, “conflict-of-interest-free” sub-contractor measuring change in players (e.g., Central Medical Store (CMS), manufacturers and distributors), volume, products and pricing of key RMNCH products in total market.

Task 2.1.4. Assist the GOB and private sector actors to interpret and use market data analysis findings to inform quantification, drug quality testing, and regulatory reforms.

Performance Standards for Outcomes 2.1:

Performance Standard

Acceptable Quality Level

Quality Assurance Plan

Method of Surveillance

Complete mapping of key RMNCH product availability in private sector from manufacturer to end users, including product quality testing status, nationwide

No deviation unless approved in advance by the

COR

Map indicating all tracer products flows from manufacturer to end-users and quality testing status

-100% COR

inspection of protocol -Preliminary and final reports

Semi-annual market data of tracer products

10% standard deviation

Contractor will provide monthly

-Monthly updates -Quarterly and final reports

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(timeliness, completeness and exactitude) update on the status of the data collection process

-Meetings with contractor

35% increased unit volume of tracer RNMCH semi-annually

10% standard deviation

Verified from routine market data collection

- Report on a semi-annual basis in the quarterly reports

Evidence that the GOB has used market data for either quantification, budget, or policy or program monitoring exercises at least 4 times annually

25% standard deviation

Quarterly review of GOB documents with the MoH

Quarterly reports

Outcome 2.2. Improved regulatory environment for key RMNCH products

Task 2.2.1. Identify regulatory articles needed for reform to increase availability of pharmaceuticals, especially the key RMNCH products, and improve ease of networking of pharmacies.

Task 2.2.2 Develop a business case for policy makers for the liberalization of product prices using pharmacoeconomics or Health Technology Assessment analyses.

Task 2.2.3. Working with MoH and private sector players including the Platform, streamline pharmaceutical registration process and harmonization with regional regulatory bodies.

Task 2.2.4. Develop and present a business case to policy makers on the public health benefits and limits of advertising of pharmaceutical products.

Task 2.2.5. Strengthen collaboration between the Platform and private sector associations and universal health care insurance.

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Performance Standards for Outcomes 2.2:

Quality Level

Quality Assurance Plan

Method of Surveillance

Provide evidence to policy makers of liberalization of product prices using pharmacoeconomics or HTA analysis

100% of standard Policy document and stakeholder/policy maker presentation

Quarterly reports

One registered pharmacy or registered depot by arrondissement

No deviation unless approved in advance by the

COR

Records of registered pharmacies and registered depots

-Periodic COR inspection of approach -Quarterly reports

Present a business case to the policy makers on the importance of networking/franchising and advertising on pharmaceuticals

100% of Standard

Business analysis completed and presented to policy makers and stakeholders

-Periodic COR inspection of approach -Quarterly reports

Present a business case to the policy makers on the public health benefits and limits of advertising on pharmaceutical products

100% of Standard

Business case developed and presented to policy makers and stakeholders

-Periodic COR inspection of approach -Quarterly reports

Objective 3: Strengthen public-private engagement to promote attainment of universal RMNCH outcomes

The contractor must contribute to a strengthened enabling environment for the private health

16 | Page sector and public-private engagement to promote universal health outcomes. The contractor must strengthen the capacity of the Platform as well as reduce the conflict of interest among the Platform members as well as among professional orders and private sector association.

Outcome 3.1. Increased leadership, management and governance capacity of the Platform

Task 3.1.1. Identify gaps in the Platform’s membership base and establish written strategies to grow the membership

Task 3.1.2. Support the Platform to develop and carry out a resource mobilization plan to strengthen its financial base

Task 3.1.3. Establish a functional mechanism to mitigate conflicts of interest between individual members / associations within the Platform. Develop specific approaches to address conflicts between professional associations, new applicants to their respective associations and the Platform, establishing an inclusive environment for informal providers and expansion of pharmacy networks/chains.

Task 3.1.4. Provide technical assistance to the Platform to establish an Advocacy Agenda and implement an action plan, including quarterly meetings with the Ministry of Health, to enhance the Platform’s influence on health policy issues

Task 3.1.5. Provide actuarial technical expertise through the Platform to support the GoB with costing terms to enable the private sector to participate in national health insurance and other health sector reforms.

Performance Standards for Outcome 3.1:

Standard

Acceptable Quality Level

Quality Assurance Plan

Method of Surveillance

Resource mobilization plan in place and increased resource based on existing by 50% over the life of the activity

No deviation unless approved in advance by the

COR

Membership receipts;

documentation of financing sources;

verified bank accounts

Contractor and the Platform financial

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Membership growth plan established and at least 10 additional associations joined

No deviation unless approved in advance by the

COR

Membership ledger Contractor and the Platform reports

Functional mechanism in place to mitigate conflicts of interest between members / associations within the private sector

100% of Standard Charter or similar document

Monthly updates

Advocacy Agenda established and action plan implemented

No deviation unless approved in advance by the

COR

COR invitation to meetings

Quarterly reports

Advocacy meetings between MOH and the Platform held quarterly

No deviation unless approved in advance by the

COR

Verified meeting notes; verified participants’ list

Quarterly and final

Outcome 3.2. Biannual landscape of Benin’s private health care regulations produced

Task 3.2.1. Working closely with PSSP, other private sector associations and the MoH, contractor must produce a landscape of Benin’s private health care regulation on a biannual basis.

Performance Standards for Outcome 3.2:

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Standard

Acceptable Quality Level

Quality Assurance Plan

Method of Surveillance

Biannual documentation of Benin’s regulatory landscape developed

No deviation unless approved in advance by the

COR

Landscape document

Quarterly and final

Objective 4: Integrate and disseminate innovative, tested, and emerging private sector models The contractor must contribute to integrating existing innovative and tested models and disseminating and applying them in Benin. To this end, the contractor must review the innovative tested models below and incorporate them in Benin’s private sector, seeking funding from such organizations as the West Africa and Africa Private Health Organizations.

Outcome 4.1. At least one innovative, tested and emerging private sector model applied

Task 4.1.1. Explore and investigate at least four possible innovative and tested private sector models to disseminate.

Task 4.1.2. In collaboration with the Platform and GOB, apply at least one model.

Performance Standards for Outcome 4:

Standard

Acceptable Quality Level

Quality Assurance Plan

Method of Surveillance

At least one tested, innovative and emerging private sector model applied

100% of Standard Project results verified by COR during site visits

-Quarterly and final

C.5 ADDITIONAL CONSIDERATIONS

5.1 Coordination with Other Initiatives and Implementing Partners

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In addition to reducing preventable deaths among vulnerable populations by increasing the use of high impact health services and healthy behaviors at the community level in all health zones in Benin, the ELAN contractor will coordinate with other U.S. Government initiatives. These include but are not limited to: Creating an AIDS-free Generation; Ending Preventable Child and Maternal Deaths (EPCMD) as USAID-supported initiatives such as WHO Eliminating Malaria Strategy; Ouagadougou Initiative and FP2020.

The ELAN contractor must promote country ownership of high impact RMNCH strategies and programs that are consistent with GOB health sector priorities. The ELAN contractor must adapt and utilize, where possible, available capacity-building tools and resources that were developed through other global, regional, and Beninois health activities. The ELAN contractor must abide by the Benin government’s standards and guidelines during the provision of all technical assistance and direct service delivery.

5.2 Gender

Gender refers to the socially constructed roles, behaviors, activities and attributes that a given society considers appropriate for men and women. USAID is committed to promoting gender equality and female empowerment, and seeks to improve the lives of citizens around the world by advancing equality between women and girls and men and boys and empowering women and girls to participate fully in and benefit from securing better lives for themselves, their families and their communities.

Gender-based violence (GBV) is one of the most serious problems facing women and girls in Benin. Common forms of GBV include domestic violence, sexual gender-based violence, molestation of students by teachers, and harmful traditional practices such as early and forced marriage. About 75% of women report having experienced physical violence during their lifetime, and a third of women report having experienced sexual violence in Benin. USAID’s support helped to pass important landmark laws, including the 2006 Anti-Sexual Harassment law and the 2012 GBV law, which has penalties for perpetrators. USAID follows the implementation of those laws, support safer learning environments for girls in schools, and works across government entities to provide holistic response services to GBV survivors, particularly by integrating health, psychosocial, and legal services in hospital centers.

Offerors will support a range of local initiatives that expand awareness and change attitudes.

Offerors will establish safer learning environments in the schools by working with mother’s associations, youth clubs, teachers associations, advocacy groups, students, and communities.

Offerors will work with mayors and civil society organizations to identify underserved urban and remote rural communities, and provide technical assistance to health care providers to create new

20 | Page models for outreach to ensure that health services are more readily available.

A gender analysis was conducted in 2015 to identify relevant gaps between men and women in the health sector, and to consider how gender norms and power relations in Benin might affect intended project outcomes. Based on this analysis, Benin’s Strategic Framework integrates gender into all activities, seeking to address these recommendations in the following ways directly relevant to this PWS:

- gender sensitive communications to promote optimal health prevention and care seeking behavior at the household level

- strengthening women’s role regarding health care decisions for themselves and their children

- favour the selection of health providers who are champions of women’s health needs and gender equality, and including referral services for sexual and physical gender-based violence response within all community and facility-based health activities.

The offeror must take into consideration the gender landscape in Benin and incorporate these gender health delivery recommendations in their proposed work.

[END OF SECTION C]