SOL-687-14-00006_--_CHV_final_RFP_Package.pdf

Issuance Date: May 15, 2014 Pre-proposal conference: May 9, 2014 from 9:00 a.m. to 11:00 a.m. Antananarivo local time Questions Due Date: May 27, 2014, 4:00 p.m. Antananarivo local time Closing Date & Time: June 29, 2014, 11:00 a.m. Antananarivo local time

SUBJECT: Request for Proposal (RFP) No.: SOL-687-14-000006, Community Health Volunteers (CHV) Quality Assessment

The United States Government, represented by the U.S. Agency for International Development (USAID), is seeking proposals from qualified local organizations interested in conducting Community Health Volunteers Quality Assessment.

The Government expects to award one Firm, Fixed Price purchase order by September 30, 2014.

The estimated period of performance is nine (9) months from the effective award date. The authorized geographic code for procurement of goods and services under this contract is 937 which consists of the United States, the recipient country, and developing countries other than advanced developing countries, but excluding any country that is a prohibited source.

The Government will hold a pre-proposal meeting from 09:00 a.m. to 11:00 a.m. Antananarivo local time on May 23, 2014 at the U.S. Embassy which all interested parties may attend with prior registration (those parties that fail to submit the required information by the time/date stated below will not get access). The following information for the registration must be submitted to Ms. Sandy Solofonirina at antananarivoco@usaid.gov no later than 3:00 p.m. Antananarivo local time on May 20, 2014 for each planned participant: full name, date of birth, identity number, vehicle information (make/model, license tag #) if applicable. Those parties that did not attend the pre-proposal conference may still submit a proposal.

Any questions regarding the RFP requirements must be submitted to Sandy Solofonirina, Contract Assistant, at antananarivoco@usaid.gov no later than 4:00 p.m. Antananarivo local time on May 27, 2014. The Government will respond to all potential vendors by COB May 16, 2014. Oral instructions or guidance from any USAID source prior to the award of the contract shall not be binding.

Proposals must be received by the Government on or before 11:00 a.m. Antananarivo local time on June 29, 2014, to be considered. They must be sent electronically Sandy Solofonirina, Contract Assistant at antananarivoco @usaid.gov; submission of hard copies is not required.

Vendors must comply with any page limitations described in Section L of the solicitation, as well as with any other submission requirements; any pages in excess of the established limit will not be evaluated. The budget in the Cost Proposal must follow the format provided in this RFP and is to include fixed prices for the deliverables specified in this solicitation. The prices must be based on costs that are realistic and reasonable for the services to be provided. The cost proposals shall be evaluated as part of the best value determination for contract award.

This request in no way obligates the U.S. Agency for International Development to award a contract, nor does it commit USAID to pay any cost incurred in the preparation and submission of a proposal in response hereto. Furthermore, the Government reserves the right to reject any and all proposals, if such action is considered to be in the best interest of the Government. The award is subject to availability of funds.

Sincerely, /s/ Michael Ashkouri Regional Contracting Officer USAID/Southern Africa

RFP NO. SOL-687-14-000006

PART I – THE SCHEDULE

SECTION B – SUPPLIES OR SERVICES AND PRICE/COSTS

B.1 PURPOSE

The purpose of this contract is to conduct the Community Health Volunteers (CHV) Quality Assessment for USAID/Madagascar.

B.2 CONTRACT TYPE

This is a Firm, Fixed Price Contract. The Contractor must perform the services set forth in Section C, at a price consistent with Section B.3 of the Contract. For the consideration set forth in the contract, the Contractor shall provide the deliverables or outputs described in Section F and comply with all contract requirements.

B.3 CONTRACT PRICE

The total Firm Fixed Price of this contract is $_____________. The Contractor will not be paid any sum in excess of this amount.

B.4 PAYMENT SCHEDULE

Payment shall be made upon acceptance by the Government of the each of the deliverables individually priced as follows:

Deliverable Payment Amount

1. Inception Report $___________

2. Completion of Fieldwork Report $___________

3. Draft Report $___________

4. Final Report $___________

END OF SECTION B

SECTION C – DESCRIPTION/SPECIFICATIONS/STATEMENT OF WORK

C.1. PURPOSE

The purpose of this evaluation is to measure the current status and the changes that had occurred between 2011 and 2014 on the functionality and performance of community health volunteers (CHV) trained by USAID community-based health care integrated projects. The data collection includes CHVs in three zones: intervention zones of the USAID/MAHEFA, intervention zones of the USAID/MIKOLO, and former Santénet2 communes not supported by USAID community or primary health care projects.

C.2. OBJECTIVES

The gathered data from this evaluation will provide information, statistics and judgment that will help USAID/Madagascar to have informed view of the quality of the CHVs trained by USAID/Madagascar implementing partners. The Mission will use the results for its annual portfolio review, the design of follow-on community-based and primary healthcare projects, as well as to target and prioritize refresher trainings as needed. It is also anticipated that the results from the evaluation will inform other stakeholders on the quality of services provided by trained CHVs.

C.3. BACKGROUND INFORMATION

In 2011, USAID/Madagascar conducted a CHV assessment to evaluate the overall functionality and performance of the CHV system and provision of primary health care services to rural communities in Madagascar. CHVs are providing integrated community case management for children under 5 (CU5) and short-acting family planning - reproductive health (FP/RH) services to rural population. Currently, USAID/Madagascar is working with two partners to implement community-based and primary health care in 12 regions, 58 districts of Madagascar. In addition, from 2009 to 2013 with the SANTENET2 project, USAID had worked in additional 13 regions (39 districts).

The Integrated Management of Childhood Illness (IMCI) was first developed launched by WHO and UNICEF in 1995 with the aim of prevention, early detection, and treatment of childhood illness. IMCI guidelines were developed and designed initially for use in health facilities to address the major causes of child mortality (Gove, 2007). IMCI has since been adapted to the community level (c-IMCI) where there is limited or no access to health facilities and seeks to strengthen the linkage between health services and communities, to improve selected family and community practices and provide community-based services. The objective of c-IMCI is to ensure survival, reduce morbidity and promote healthy growth and development (WHO, 2004).

In Madagascar, the burden of CU5 mortality remains high at 42/1,000 live births (MDG 2013).

Most of these deaths are attributed to preventable or easily treatable diseases. Madagascar has promoted CHV programs to reduce the burden of childhood illness. By the end SANTENET2 in July 2013, the project reported having 5,602 functional CHVs providing integrated case management services through the C-IMCI model. These CHVs are working in approximately half of the communes in Madagascar that are beyond 5 km from the nearest primary health care facility.

The current primary health care project continues to provide assistance to CHVs located in 375 communes in six regions previously supported by the Santénet2 project. Similarly in the northwest, western and northern regions of Madagascar, the MAHEFA project trains 4,582 CHVs on c-IMCI.

Use of modern family planning (FP) methods has rapidly expanded in Madagascar. The 2012-2013 Millennium Development Goal Survey results show that since 1992 the modern contraceptive prevalence rate increased from 5% to 33%, total fertility rate decreased from 6.1 to 5.0, with slight increase from 2009 to 2013; and unmet need remained unchanged at about 15%.

Despite these successes, Madagascar’s population, estimated at 22 million, is still facing rapid population growth and is expected to reach 42.3 million by 2050. The population is very young, with 44% under 15 years of age (PRB, 2009). There are still urban (39%) and rural (32%) discrepancies in modern contraceptive prevalence (CPR) rates with wide regional variations (MDG 2013). For example, in Androy region, only 4.5% of women who are sexually active utilize modern contraception. CPR also varies significantly across wealth quintiles. Only 22% of the poorest Malagasies use modern methods compared with 35% of the richest (MDG 2013) tough the gap is reduced compared to the DHS 2008 (17.6% vs. 36.4%). In addition, unmet need, at 15%, remains a serious constraint and the current contraceptive mix continues to rely heavily on short-term methods such as injectable contraceptives (20% of all sexually active women) and oral contraceptives (7%).

To date, about 9,847 CHVs (5,122 under Santénet2 and 4,725 under MAHEFA) were trained by USAID implementing partners to provide counseling and treatment for women of reproductive age (WRA) in rural communities. Madagascar’s family planning efforts have depended heavily on financing from donors (UNFPA, USAID, and World Bank), which altogether accounted for 99% of spending for contraceptives from 2004 – 2008 (World Bank, 2010. USAID and UNFPA continue to procure the large majority of Madagascar’s contraceptives, with USAID procured commodities supplied to the private sector and community channels through PSI’s social marketing program.

These integrated community-based health projects are complemented by a large scale social marketing program that provides access to life-saving, short-acting family planning commodities for community distribution (including oral contraceptives, injectable, male and female condoms, and cycle beads).

Family planning and reproductive health services and commodities are delivered through an expansive network of CHVs reaching the most remote and underserved rural communities across Madagascar.

C.3.1 USAID/MAHEFA

USAID/MAHEFA is a community-based healthcare project of USAID/Madagascar Award Number 687-A-11-00013-00. The project started on May 23, 2011 and will end on May 22, 2016.

The project LOA budget is estimated at $35 million.

USAID/MAHEFA project is implemented by JSI Research and Training Institute with two international partners: the MANOFF Group and TRANSAID. The objective of the project is to increase the use of proven community-based interventions and essential products among underserved populations in six northern and western regions of Madagascar (see map in Annex A).

This objective is subsequent to the achievement of the following three intermediate results:

1. Increase demand for high quality services and products:

The project conducted rapid barriers and needs assessment; used trial of improved practices for PAFIs; conducted community mobilization and participation for KMS implementation and advocacy platform; worked with CHWs in BCC, counseling and setting community norms; improved the capacity of local NGOs for behavior change implementation and community mobilization.

2. Increase availability of high quality services and products:

The project implements range of high-impact services in integrated packages;

increase availability of potable water and sanitation infrastructure and products, improve supply chain and community logistics, establish community financing to increase financial access, implement appropriate range of services with wide range of actors reaching remote populations.

3. Improve quality of services and products through community health agents in 24 districts within 6 regions1 of Madagascar:

The project set up CHW quality of care program protocol and standardized materials, provided formative supervision to CHWs, implemented quality as part of community monitoring and management, provided community logistics, HMIS for community health, Job Aids, and launch kits for CHWs

Within the six regions of interventions, USAID|MAHEFA targets 275 communes within 24 districts (See Map of intervention zones in Annex A).

C.3.2 USAID/MIKOLO

USAID/MIKOLO is a 5-year project started in August 2013 and will end in July 2018.

USAID/MIKOLO aims to increase community-based primary health care service uptake and the adoption of healthy behavior in six regions of Madagascar2. Within the six regions of interventions, USAID/MIKOLO targets 34 health districts comprising 506 communes in the eastern, southern highland, and south-western areas of Madagascar (See Map in Annex B). The project budget is approximately $24.7 million.

USAID/MIKOLO has four sub-purposes:

1 SAVA, DIANA, SOFIA, BOENY, MENABE, MELAKY

2 Atsinanana, Vatovavy Fitovinany, Haute Matsiatra, Ihorombe, Atsimo Andrefana, Amoron’i Mania.

1. Sustainably develop systems, capacity, and ownership for local partners;

2. Increase availability and access to primary health care services;

3. Improve quality of community health care services;

4. Increase adoption of health behavior and practices

USAID/MIKOLO is implemented by Management Science for Health (MSH), partnering with Catholic Relief Services (CRS), Overseas Strategic Consulting (OSC), Action Socio-Sanitaire Organization Secours (ASOS), and the Institut Technologique de l’Education et du Management

(ITEM).

The project focuses on engaging and developing Malagasy NGOs, community-based organizations, and a cadre of CHVs to serve as quality service providers, agents of change, and a sustainable network for long-term development. This approach works with and through community structures to strengthen local systems and institutions, increase the number of CHVs, fortify linkages with providers of long-acting and permanent methods of Family Planning, and improve commodity security (sub-purpose 2). USAID/MIKOLO will implement a quality improvement system (sub-purpose 3) and BCC interventions (sub-purpose 4), so that more Malagasy can readily adopt healthy behaviors and access health services of standardized quality.

The USAID/MIKOLO activities specifically target pregnant women, WRA, children under five years of age and their caretakers, and rural youth. USAID assistance includes the areas of Family Planning and Reproductive Health (FP/RH); Maternal and Child Health (MCH); Nutrition;

Malaria; Water Supply, Sanitation, and Hygiene (WSSH). To support community-based healthcare system, USAID/MIKOLO works with community health volunteers (CHWs) in rural and remote areas located more than five kilometers from the nearest health facility. Services provided by CHVs include prevention and treatment of child non-severe disease that includes diarrhea and pneumonia, and malaria, safe motherhood, essential nutrition actions, hygiene and sanitation promotion, family planning promotion and education, referral for vaccination and other health services. An Integrated Social Marketing project distributes selected health products through an expanding network of community supply points.

C.3.3 FORMER USAID COMMUNITY HEALTH PROJECTS REGION OF

INTERVENTIONS

The 5-year Santénet2 project, implemented by RTI International, is a major component of USAID/Madagascar’s fourth phase of assistance to the health sector in Madagascar under Strategic Objective “Use of selected health services and products increased, and practices improved.” The project started in 2009 and ended in 2013 and worked in 16 regions (see Map in Annex C), 73 districts covering more than half of the communes in Madagascar.

The project includes the following components:

Improve child survival, maternal health, and nutrition

Reduce unintended pregnancy and improve healthy reproductive behavior

Prevent and control infectious diseases of major importance

Improve water and sanitation in target communes

Reduce transmission and impact of HIV/AIDS.

C.4. EXISTING INFORMATION

USAID will provide the following documents to the Contractor, at least 5 days after the effective start data of the award:

1. Final report of the SANTENET2 project

2. Program Description of the USAID/MAHEFA project

3. SOW for the USAID/MIKOLO project

4. Evaluation Report of Quantitative Assessment of CHVs Quality in 2011

5. Database for the 2011 data collection on CHVs assessment

C.5. AUDIENCE AND INTENDED USE

The main audience for this evaluation is the USAID/Madagascar Mission, its implementing partners, USAID/Washington and other entities promoting community-based health care.

More specifically, USAID/Madagascar shall use the results if necessary to adjust the approaches of the two ongoing community-based health projects.

C.6. SCOPE OF WORK

C.6.1 TASKS

The Contractor shall:

1. Get approval of the survey protocol from the National Ethics Committee

2. Describe the CHVs socio-demographic profile, work-load, key program elements

(recruiting, training, equipment and supplies, supervision, performance evaluation, incentives, community involvement, referral system, opportunity for advancement, information management, linkages to the health system, and performance evaluation as appropriate)

3. Evaluate the quality of C-IMCI and Family Planning Reproductive Health care provided by CHVs.

4. Conduct multivariate analysis to identify the relations between independent variables that may suggest important factors related to optimum CHV performance and quality.

5. Complete a comparative analysis of key indicators with results from the 2011 CHV assessment survey.

C.6.2 DATA COLLECTION

Data collection tools and methods used in the 2011 survey will be replicated to ensure reliability and validity of the comparative analysis. A probability sample will be used to evaluate the quality of CHVs using the following two methods:

1. Representative quantitative survey: The Contractor will administer a basic structured questionnaire to each CHV to ask about their socio-demographic profile, workload, recruitment, training, supervision, activities, knowledge and motivation, availability of supplies. Frequency of stock-outs, and accessibility of the CHVs to the community. Questions will address key areas thought to be essential to a well-performing CHV program. The questionnaire shall be administered prior to observation.

2. Direct Observation and Standard Comparison: CHVs will be observed performing child and FP/RH assessments. Child assessments will include diagnosis or disease classification, treatment decisions and referral tasks and counseling. FP/RH assessments will include client interview for FP history, risk profile, counseling on side-effects, identification of barriers and problem solving with unmet need clients, sharing of information on all methods, communication.

The goal is to evaluate the CHVs ability to diagnose disease, identify danger signs, and treat, refer and counsel appropriately as requires. The Contractor will compare the observed assessment with the gold standard assessment and case management by an independent trained expert to determine how well CHVs perform.

CHVs will be evaluated in primary healthcare center that serve their commune. This will enable the observation of multiple encounters between the selected CHV and CU5 as well as CHV and women arriving for consultation at the health facility. The contractor shall hire expert observers and gold standard evaluators, which must be trained for the evaluation.

The Consultant shall ensure that the expert observer and the gold standard evaluator do not know the CHV that they will be evaluating.

The Contractor shall use tablet computers to collect data. USAID will NOT provide this equipment. The goal is to ensure high quality and effective monitoring of data collection, and to reduce the time spent on data entry, processing, and analysis. It is the responsibility of the Contractor to train its staff on the proper use of the equipment.

C.6.3 SAMPLING

The Contractor shall use two-stage cluster sampling for this evaluation. The communes will be the cluster. The sampling frame for this evaluation includes the 97 districts of Madagascar that have CHVs within the current USAID|MIKOLO zones of interventions (34 districts), the current USAID|MAHEFA (24 districts), and the former SANTENET2 zones outside USAID|MIKOLO (39 districts).

The sampling frame will include CU5 ill-children and WRA in communities where there are established CHVs providing C-IMCI and community-based FP/RH services for at least 6 months.

The 2011 CHV assessment indicates that CHVs correctly prescribe recommended treatment 50-60% of the time. Assuming and estimated proportion of 60%, a sample size of 1,166 ill-CU5 assessments is expected to provide an estimate of the percentage of assessments for which recommended treatments are prescribed during ill-CU5 consultation with a 5% error margin (80% power, alpha of 5%, and design effect of 2). With 10% refusal, the final sample is estimated at 1,280.

Based on the required sample size of 1,280 ill-CU5 and an estimated 4 assessments for each CHV, there is a need for 320 c-IMCI CHVs. To ensure lower intra-cluster correlation, 4 CHVs per commune will be randomly selected resulting in a total of 80 clusters. To get to the 80 clusters, the design shall randomly select one cluster for each district in the MAHEFA zones ending up with 24 clusters; one cluster for each district in the MIKOLO zones ending up with 34 clusters; and 22 clusters from the 39 districts in the non-MIKOLO zones, without repetition of districts i.e. no more than one cluster in one selected district. The selection in the non-USAID zones shall take into account the number of communes with SANTENET2 activities in each district i.e. districts with more communes shall be favored.

The sample size for WRA is assumed to be the same as for the c-IMCI. Similarly, in each of the 80 clusters, the Contractor will select 4 CHVs (mother) and each CHV will assess and counsel 4 WRAs for a total of 1,280 encounters. For the sake of practicality, the selection of communes is the same for the C-IMCI and the FP/RH. The selected CHVs will be evaluated at the commune’s CSB.

The total number of samples is presented in Table 1.

Table 1. Number of Samples

MAHEFA

zones MIKOLO zones Non-USAID zones Total

Total Districts 24 34 39 97 Sampled Districts 24 34 22 96 CHV (Child) 96 136 88 320 CU5 assessed 384 544 352 1,280 CHV (Mother) 96 136 88 320 WRA assessed 384 544 352 1,280

The cluster will be randomly selected within the districts for each project’s zone, using probability proportional to size (PPS). In this case, the “size” refers to the number of CHVs trained by USAID/Madagascar projects and fulfilling the inclusion criteria below. It follows that communes with high number of CHVs have higher probability to be selected. On the other hands, since the sample size within each commune is fixed, each CHV in large communes will have lower probability to be sampled, compensating the initially PPS approach. Within each selected commune, the Contractor will establish the list of CHVs complying with the inclusive criteria and randomly select 4 CHVs certified for c-IMCI and 4 CHVs certified for FP/RH.

Inclusion Criteria

For C-IMCI, the inclusion criteria are:

CU5 presenting to health facilities for initial acute illness consultation defined as the first time the patient has been to the facility for this illness episode

CHV has been providing C-IMCI for at least 6 months

CHV trained by SANTENET2 or MAHEFA in C-IMCI

Informed consent given by CU5 parent or caretaker

For FP/RH, the inclusion criteria are:

Women 15-49 years old presenting to health facilities for themselves or their family members

CHV has been providing FP/RH services for at least 6 months

CHV has a minimum of two (2) FP clients

CHVs trained by SANTENET2 or MAHEFA in FP4 and injectable

Informed consent by woman

Exclusion criteria

C-IMCI:

Refusal or inability to provide informed consent

Children older than 5 years

CU5 with danger signs or other evidence of severe illness where participation in the evaluation would interfere with provision of appropriate or timely medical care

CU5 presenting for non-acute illness or vaccinations

C-IMCI trained CHVs with less than 6 months of experience in C-IMCI

C-IMCI trained CHVs with no formal healthcare training or refresher training provided by SANTENET2 or MAHEFA

Non-active c-IMCI CHVs i.e. no more receiving/treating patients

FP/RH:

Refusal or inability to provide informed consent

Women younger than 15 or older than 49 years

Women with danger signs or other evidence of severe illness where participation in the evaluation would interfere with provision of appropriate or timely medical care

FP/RH trained CHVs with less than 6 months of experience in FP/RH

FP/RH trained CHVs no formal healthcare training or refresher training provided by SANTENET2 or MAHEFA

Non-active FP/RH CHVs i.e. no more receiving/counseling patients

C.6.4 PROCEDURES FOR FIELD WORK

C.6.4.1 Pre-Field Work

The Contactor shall provide 5-day training for the experts and data collectors before the field work data collection. Below is an illustration of the training:

Day 1 and 2:

Introduction of the evaluation to participants

Introduction, simulation, and pre-testing of the questionnaires by the participants

Instructions on how to observe and perform c-IMCI assessments

Produce c-IMCI guidelines on evaluation Day 3:

Instructions on record review

Role playing to practice observation and evaluation techniques Day 4 and 5:

Field practice, preferably in health facilities that are not selected for the actual evaluation.

After the practice session, the team will be assembled again for feedback and logistic discussions

For the field work data collection, the Contractor shall hire the service of sufficient expert observers, IMCI experts, and FP/RH experts to complete the tasks.

C.6.4.2 Before arriving at each selected commune, the Contractor shall:

Contact in advance the selected health care facilities

Brief the health facility director on the purpose of the evaluation and the data collection processes

Ensure that selected CHVs are well-aware of the purpose of the evaluation and will arrive at the health facilities for the evaluation on the specified date.

C.6.4.3 Day 1 at the health facility

Introduce the evaluation team to the facility director, the health facility staff, and the CHVs to be evaluated that day

Provide orientation briefing to the health workers at the facility on the evaluation processes

Ask for a brief tour of the facility and work with the health facility staff to establish posts for the CHVs evaluation and for the gold standard assessments.

C.6.4.4 Each day at the health facility

Provide orientation briefing to the CHVs on the evaluation processes

Administer the questionnaire to the CHVs to be evaluated; the data collector shall take the lead for this activity.

Identify each questionnaire by a unique identification number

Invite the health facility director to announce the presence of the survey team in the waiting areas, and alert patients of possible selection and the process to follow if they are willing to participate in the evaluation.

C.6.4.5 As ill-CU5 and WRA arrive at the facility

Sequentially approaches and assesses children that are in the line waiting for consultation services for eligibility

Discuss the evaluation with parents/caregivers of eligible children, risks and benefits of participating shall be clearly explained; and if whether they will voluntarily provide informed consent to participate in the evaluation.

C.6.4.6 If the child complies with the inclusion criteria and the parent/caretaker signed the consent form

Provide an evaluation identification number to the child

Take the first child to the CHV to be evaluated: The CHV assesses the child and records findings on the standard individual patient encounter form. The expert observer documents the CHV’s action on a standard checklist

Once the assessment for the child is complete: The CHV assesses the next eligible child from whom consent has been received and proceeds as indicated before. The previously assessed child is taken to the IMCI expert for the gold standard evaluation. The gold standard IMCI expert collects the identification card at the beginning of the evaluation

Once a child has undergone both the CHV and gold standard assessments, a team member will coordinate the child’s care with one of the health facility staff to expedite any necessary lab work, diagnostic tests, referrals or medication administration.

C.6.4.7 As WRAs arrive at the facility

Sequentially approaches and assesses WRA are in the line waiting for consultation services for eligibility

Discuss the evaluation with the patient, risks and benefits of participating shall be clearly explained; and if whether s/he will voluntarily provide informed consent to participate in the evaluation.

C.6.4.8 If the patient complies with the inclusion criteria and signs the consent form

Provide an evaluation identification number to the patient

Take the first patient to the CHV to be evaluated: The CHV assesses and counsels the patient and records findings on the standard individual patient encounter form. The expert observer documents the CHV’s action on a standard checklist.

Once the assessment for the patient is complete: The CHV assesses the next eligible WRA from whom consent has been received and proceeds as indicated before.

C.6.4.9 Before leaving the facility

The team members will review all data forms to ensure they are complete and correct. The team will thank the facility staff and depart. The CHV will be given verbal feedback and allowed to return home.

C.6.5 DATA ANALYSIS

CHV demographic information and characteristics obtained from the questionnaire will be calculated and reported as simple proportions. Continuous variables such as age will be analyzed both as continuous and as categorical variables.

Observation and patient encounter outcome data, as well as the analysis of the difference (before and after, using the 2011 dataset and the current survey) will be reported as frequencies and proportions both in aggregate and stratified by interest group (USAID/MAHEFA; former SANTENET2 not supported by USAID/MIKOLO; and USAID/MIKOLO). Key evaluation indicators are listed in Annex. Confidence interval (95%) will be estimated and presented in the Annex of the final report.

To replicate the 2011 analysis, multivariate analysis using regression shall be conducted to test model identifying potential associations between CHV characteristics and observed performance in c-IMCI and FP/RH. The dependent variable will the proportion of children correctly treated/women counseled and key independent variables will include CHV recruitment, training, supervision, status of commodity stocks; controlling variables will include sex, age, and patient load of the CHVs. Additional fixed-effect multivariate analysis shall be conducted, pooling the data from 2011 and 2014.

C.6.6 DATA LIMITATIONS

The evaluation has the following limitations:

This is not an impact evaluation; rather it is primarily designed to provide information to the community-based health program in Madagascar, to guide efforts to improve projects’ interventions.

The evaluation is limited to CHVs performing c-IMCI case management and FP/RH assessment and counseling tasks. The evaluation does not address every aspect covered by CHVs such as community awareness raising, tuberculosis, nutrition, and other aspects of maternal and child health.

The performance of CHVs is compare to the gold standard conducted by health experts, which indeed are also subject to some kind of errors.

The evaluation will not be able to compare the quality of the health services received from CHVs with the quality of the services received from CSBs since there is no data collected for this later.

C.7. DELIVERABLES

The Contractor is required to deliver the following deliverables and reports:

1. Inception Report

2. Completion of fieldwork report

3. Draft Report

4. Final Report

C.7.1 INCEPTION REPORT

The schedule uses calendar days to determine the timeline.

No later than 30 days after the effective award date, the Contractor submits the Inception report, either in English or in French, to the USAID/COR for approval.

No later than 10 days after receiving the Inception Report, USAID will organize a meeting with the data collection team for validation. The Contractor has 5 days after the meeting to revise the document and submit the final version to USAID/COR for approval.

The fieldwork must not begin until the USAID/COR approves the Inception Report.

The Inception Report shall not exceed 25 pages, excluding Annexes. The plan includes at a minimum:

Introduction: brief background, purpose and scope of the activity (up to 2 pages)

Detailed presentation of the three methodologies to collect data (up to 3 pages)

Detailed sampling process and presentation of data collection instruments, and any limitation (up to 10 pages)

Presentation of the process for quality control: assessments and management (up to 2 pages)

Detailed data analysis methods (up to 5 pages)

Presentation of key implementation challenges and risks, including those related to the 2011 survey data (1 page)

Detailed schedule for the baseline information study (up to 2 pages)

Annexes including A map and list of sampled villages for the survey List of contact information interviewed during the inception phase Data collection instruments: questionnaire, guide for interviews Other documents as needed

C.7.2 COMPLETION OF FIELDWORK REPORT

Fieldwork will take 60 days, including 15 days for recruitment and training of expert and gold standard evaluators, pre-testing of survey and interview tools; testing of the system using tablets for data collection. In addition, this timeline includes travel and courtesy call to local authorities.

No later than 10 days after the end of the fieldwork, the Contractor will provide the USAID/COR a report showing the completion of the fieldwork and the raw data set.

The completion report may be submitted either in English or in French. The report must include the list of the selected villages with the number of CHVs, ill-CU5 and WRA, the proportion of refusal and replacement. A brief description of each commune such as infrastructure, access to media and social services, and other socio-economic characteristics must be presented in an Annex.

USAID has to either approve or reject the completion report within 10 days after submission.

C.7.3 DRAFT REPORT

No later than 60 days after the end of the fieldwork, a draft report must be submitted to the USAID/COR. The written draft report must be submitted in English.

USAID has to either to approve or reject the final report within 20 days after submission.

The draft report must follow the requirements below:

Executive Summary (3-5 pages)

Methodologies, Analysis, and Limitations (2-4 pages)

Results and narratives for each indicator (15-20 pages)

C.7.4 FINAL REPORT

No later than 30 days after USAID approves the draft report, the Contractor submits a final report that incorporates the team responses to Mission’s comments and suggestions. The final report will be submitted in English and French, electronically.

USAID has to either to approve or reject the final report within 15 days after submission.

The final report must follow the standard USAID branding guidelines. The USAID Graphic Standards Manual is available at http://pdf.usaid.gov/pdf_docs/PNADB334.pdf. The report should not exceed 30 pages in length in its body, not including title page; table of contents; list of acronyms; references; usage of space for tables, graphs, charts, or pictures; and annexes.

The final report must include:

Executive Summary (3-5 pages)

Methodologies, Analysis, and Limitations (2-4 pages)

Results and narratives for each indicator (15-20 pages)

In addition, the final report must also include the list of acronyms, and at minimum, the following annexes:

a) Tables and Maps supporting the main report

b) Statement of work of the current activity

c) Location and map of sites visited during the survey

d) Detailed methodologies and limitations

e) Data collection instruments

f) Source of information such as bibliography of document reviewed

g) Disclosure of any conflicts of interest for the two key personnel

No later than 10 days after the approval of the final report, the contractor shall submit 10 hardcopies (all in English) and two electronic copies of the USAID approved final report to USAID/Madagascar (1 in English and 1 in French). The electronic copies of the final report shall be in both PDF and MS Word format. The contractor will also send an electronic copy of the English version of the final report to the Development Experience Clearinghouse for archival within three months of the approval of the final report by USAID.

Data collected through this study will become the property of USAID and should be made available to the public barring rare exception. The contractor will submit to USAID (with the final report) all instruments and tools used in implementation of this study and all collected data -- on appropriate storage devices, e.g., flash drive, compact discs, etc. The database will be provided in an electronic file, formatted in STATA, SPSS and TAB-delimited; organized and fully documented (codebook) for use by those not fully familiar with the data.

C.8. TEAM COMPOSITION AND SKILLS

The evaluation team shall consist of three key personnel, including one team leader. The evaluation team shall be external consultants, outside USAID/Madagascar and outside the implementing partners.

The Team Leader must have a graduate degree in evaluation, economics, public health, medicine, international development, or similar disciplines; and should have at least ten years of experience in managing evaluation activities. The Team Leader should have a strong understanding of data collection and data analysis methodology; and should have proficiency in conducting quantitative or qualitative evaluation. The Team Leader is the primary point of contact between USAID and thus must have excellent communications skills. The Team Leader will ensure that the deliverables are completed in a timely manner and are responsive to the scope of work and USAID comments. The Team Leader will provide leadership for the team and coordinate activities.

The Senior Data Analyst must have a graduate degree in statistics, evaluation, economics, public health, international development, or similar disciplines; and should have at least five-year experience in quantitative data analysis and econometrics, using STATA software.

The Health Specialist must be a medicine doctor; and should have at least five-year experience in maternal and child health and/or family planning. The Health Specialist must be able to travel in remote areas as required by the sampling process, by foot if needed. The Health Specialist is the main responsible for the direct observation activity described in this SOW.

Language Requirements

The Team Leader must be proficient in spoken and written English to facilitate the discussion with USAID and to ensure the quality of the evaluation report.

The three key personnel must be proficient in French. Most of the project key documents are in French and some implementing partners do not speak English.

Because part of the evaluation will involve interviews and discussions with local key informants who may not be able to clearly express their idea in French, at least two of three key personnel must be proficient in Malagasy.

C.9. EVALUATION MANAGEMENT

C.9.1 DATA COLLECTION TEAM

Each survey team consists of at least two IMCI and one FP/RH experts. One IMCI expert will observe the CHV receiving ill-CU5, and the second IMCI expert i.e. the gold standard evaluator will observe the sick child afterward. The FP/RH expert will observe the CHV counseling WRA.

There must be enough team to collect the data in the field for the duration of the fieldwork stated in C.9.3.

As part of the USAID/Forward, one USAID/Haiti health Officer will participate in the preparatory work and the data collection for one month. Her task will be determined jointly with the Contractor. There shall be no cost associated with the USAID/Health Officer in the proposal budget from the Offeror.

C.9.2 DATA MANAGEMENT

Data collection will be done by trained evaluation and clinical staff on electronic format. Each CHV and each patient will be assigned a unique identifier. A logbook shall be kept which records only the name of patient evaluated, their unique identifier and any test results to ensure that results of tests performed are made available to the appropriate healthcare provider and feedback to the health facility is included in the evaluation. There will be no documentation of the patient’s name on the data collection form. The logbook linking the name to the ID will be securely maintained to protect patient privacy.

Data collection forms will be translated into French and Malagasy by a certified translator and/or using the translation/back translation method.

Data will be stored and analyzed using STATA format.

Data from the collection forms (tablets) will be entered into the database by the Contractor, using the assigned evaluation number for each CHV and patients (names will not be entered). With the use of tablets, most of the data cleaning shall be done during the data collection. Data will be stored securely at the offices of the Contractor; all information from the surveys shall be wiped out from the hard drive of the tablets after the data were transmitted to the Contractor’s office.

Electronic records shall be stored in password-protected files, and subject information will only be shared with qualified evaluation personnel and medical providers as necessary and will be kept confidential to the extent allowed by law. The evaluation logbook, which records the link between the patient names and their evaluation code numbers, will be stored securely in a separate location from the data collection forms. Information linking the names and evaluation numbers shall be destroyed after the data collection and analysis are complete. The Contractor will store and back up secure electronic copies of the data, identifying patients by their evaluation number only.

C.9.3 SCHEDULING

The following is the schedule for the survey.

Activities Estimated number of days

Days after effective Date

Award Date D0

DESK REVIEW

Submit the Inception Report to USAID 30 D30 Inception Report approved by USAID 15 D45

FIELD WORK

Start field work D46 Field work preparation includes: logistics, pre-testing of survey instruments, training of field staff, design of data collection tools using tablet

End of field work 60 D105 Completion of Field Work Report 10 D115 COF Approved 10 D125

DRAFT REPORT

Submit Draft Report to USAID 60 D185 Draft report approved by USAID 20 D205

FINAL REPORT

Submit final report to USAID 30 D235 Final report approved by USAID 15 D250 Submission of 10 hardcopies (all in English) and two electronic copies of the USAID approved final report to USAID/Madagascar (1 in English and 1 in French)

10 D265

Annex A – MAHEFA Zones of Interventions

Annex B – MIKOLO Zones of Interventions

Annex C – SANTENET2 Zones of Interventions (INCLUDING Current MIKOLO zones)

SECTION D – PACKAGING AND MARKING

D.1 AIDAR 752.7009 MARKING (JAN 1993)

(a) It is USAID policy that USAID-financed commodities and shipping containers, and project construction sites and other project locations be suitably marked with the USAID emblem.

Shipping containers are also to be marked with the last five digits of the USAID financing document number. As a general rule, marking is not required for raw materials shipped in bulk (such as coal, grain, etc.), or for semi-finished products which are not packaged.

(b) Specific guidance on marking requirements should be obtained prior to procurement of commodities to be shipped, and as early as possible for project construction sites and other project locations. This guidance will be provided through the cognizant technical office indicated on the cover page of this contract, or by the Mission Director in the Cooperating Country to which commodities are being shipped, or in which the project site is located.

(c) Authority to waive marking requirements is vested with the Regional Assistant Administrators, and with Mission Directors.

(d) A copy of any specific marking instructions or waivers from marking requirements is to be sent to the Contracting Officer; the original should be retained by the Contractor.

D.2 BRANDING AND MARKING POLICY

In accordance with provision D.1 above, and where applicable, the Contractor shall comply with the requirements of the policy directives and required procedures outlined in USAID Automated Directive System (ADS) 320.3.2 “Branding and Marking in USAID Direct Contracting” (version from January 8, 2007) at http://www.usaid.gov/sites/default/files/documents/1868/320.pdf; and USAID “Graphic Standards Manual” available at www.usaid.gov/branding, or any successor branding policy.

D.3 BRANDING STRATEGY

Per ADS 320.3.2.1, the Branding Strategy for this contract is as follows:

Project Name:

2014 COMMUNITY HEALTH VOLUNTEER QUALITY ASSESSMENT

How the materials and communications will be positioned:

• The USAID identity and the USAID logo must be posted at every static support position.

The final report must comply with the requirements presented in the following page.

• Direct local language translation of the USAID identity and project name should be sued as appropriate

• The USAID identify must be used on all project-related reports, communications and printed materials.

• Contractor employee business cards will be market so that any person reading the card can know this is a Contactor employee, not a USAID employee.

• Contractor employee e-mail and correspondence will be marked so that any person reading the document can know this is a Contactor employee, not a USAID employee.

Desired level of visibility:

Where required, the USAID Identity should be equal or greater prominence than all other logos and symbols. No project specific name or logo will be developed or used for this activity.

Other organizations to be acknowledged:

No other organizations are required to be acknowledged. The presence of any logo or symbol belonging to the Contractor must conform to the policy in ADS 320 and is subject to negotiation.

Disclaimer:

Since this survey is not USAID authored, the following statement must be in the cover:

“This publication was produced at the request of the United States Agency for International Development. It was prepared independently by <organizations involved in the preparation of the report>.”

The following disclaimer must be clearly visible at the beginning of the report: “The author’s views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development or the United States Government.”

Restrictions:

Currently, the U.S. Government does not recognize the Government of Madagascar. Therefore, neither USAID nor its implementing partners will co-brand with the Government of Madagascar;

and, USAID funding will not be used to produce co-branded materials.

END OF SECTION D

SECTION E – INSPECTION AND ACCEPTANCE

E.1 INSPECTION AND ACCEPTANCE

USAID inspection and acceptance of services, reports and other required deliverables or outputs shall take place at USAID/Madagascar or at any other location where the services are performed and reports and deliverables or outputs are produced or submitted. The COR identified in Section G has been delegated authority to inspect and accept all services, reports and required deliverables or outputs. The Government will perform inspection and acceptance in accordance with clause 52.212-4 Contract Terms and Conditions—Commercial Items.

END OF SECTION E

SECTION F – DELIVERIES OR PERFORMANCE

F.1 PERIOD OF PERFORMANCE

The period of performance for this contract is nine (9) months from the effective award date.

F.2 PLACE OF PERFORMANCE

The Contractor shall perform the services described in Section C in Madagascar.

F.3 KEY PERSONNEL

(a) The Contractor shall furnish key personnel as stated below [name to be filled in at award]:

- _____________, Team Leader

- _____________, The Senior Data Analyst

- _____________, The Health Specialist

(b) The key personnel specified above are considered to be essential to the work being performed hereunder. Prior to replacing any of the specified individuals, the Contractor shall immediately notify both the Contracting Officer and USAID COR reasonably in advance and shall submit written justification (including proposed substitutions) in sufficient detail to permit evaluation of the impact on the program. No replacement of key personnel shall be made by the Contractor without the written consent of the Contracting Officer.

F.4 REPORTS AND DELIVERABLES OR OUTPUTS

The Contractor shall furnish reports and deliverables described in Section C and below to the USAID/Madagascar COR:

DELIVERABLE DEADLINE

Draft Inception Report 30 days after award

Completion of Field Work Report 10 days after completion of field work

Draft Report 60 work days after completion of field work

Final Report 30 work days after approval of the draft report

Submit 10 hardcopies (all in English) and two electronic copies of the USAID approved final report to USAID/Madagascar (1 in English and 1 in French)

10 days after approval of the Final Report

F.5 AIDAR 752.7005 SUBMISSION REQUIREMENTS FOR DEVELOPMENT

EXPERIENCE DOCUMENTS (SEP 2013) (Class Deviation OAA-OEV-13-01 c)

(a) Contract Reports and Information/Intellectual Products.

(1) Within thirty (30) calendar days of obtaining the Contracting Officer Representative's approval, the contractor must submit to USAID's Development Experience Clearinghouse (DEC) one copy each of reports and information products which describe, communicate or…