Attachment Amend_72065620R00008.pdf

1. THIS CONTRACT IS A RATED ORDER RATING PAGE OF PAGES

UNDER DPAS (15 CFR 700)

2. CONTRACT NUMBER TBD 3. SOLICITATION NUMBER

72065620R00008

4. TYPE OF SOLICITATION 5. DATE ISSUED

05/15/2020 REQ-656-20-000002 (000001)

SEALED BID (IFB)

NEGOTIATED (RFP)

7. ISSUED BY CODE 720656 8. ADDRESS OFFER TO (If other than Item 7) SAME AS NUMBER 7

NOTE: In sealed bid solicitations "offer" and "offeror" mean "bid" and "bidder".

9. Sealed offers in original and Electronic only_____ copies for furnishing the supplies or services in the Schedule will be received at the place specified in Item 8, or if hand carried, in the depository located in 17:00 (Maputo)

(Hour) (Date) CAUTION - LATE Submissions, Modifications, and Withdrawals: See Section L, Provision No. 52.214-7 or 52.215-1. All Offers are subject to all terms and conditions contained in this solicitation.

A. NAME B. TELEPHONE (NO COLLECT CALLS) C. E-MAIL ADDRESS

AREA CODE NUMBER EXT.

(X) SEC. DESCRIPTION PAGE(S) (X) SEC. DESCRIPTION PAGE(S)

PART I - THE SCHEDULE PART II - CONTRACT CLAUSES

A I

B PART III - LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACH.

C J

D PART IV - REPRESENTATIONS AND INSTRUCTIONS

E

F

G L

H M

K STATEMENTS OF OFFERORS

NOTE: Item 12 does not apply if the solicitation includes the provisions at 52.214-16, Minimum Bid Acceptance Period.

12. In compliance with the above, the undersigned agrees, if this offer is accepted within 270 calendar days (60 calendar days unless a different period is inserted by the offeror) from the date for receipt of offers specified above, to furnish any or all items upon which prices are offered at the price set opposite each item, delivered at the designated point(s), within the time specified in the schedule.

13. DISCOUNT FOR PROMPT PAYMENT 10 CALENDAR DAYS (%) 20 CALENDAR DAYS (%) 30 CALENDAR DAYS (%) CALENDAR DAYS (%) (See Section I, Clause No. 52-232-8)

14. ACKNOWLEDGEMENT OF AMENDMENTS AMENDMENT NO. DATE AMENDMENT NO. DATE

(The offeror acknowledges receipt of amendments to the SOLICITATION for offerors and related documents numbered and dated:

CODE FACILITY 16. NAME AND TITLE OF PERSON AUTHORIZED TO SIGN OFFER 15A. NAME AND

ADDRESS

OF OFFEROR

(Type or print)

15B. TELEPHONE NUMBER 17. SIGNATURE 18. OFFER DATE

AREA CODE NUMBER EXT. 15C. CHECK IF REMITTANCE ADDRESS IS DIFFERENT FROM

ABOVE - ENTER SUCH ADDRESS IN SCHEDULE

19. ACCEPTED AS TO ITEMS NUMBERED 20. AMOUNT 21. ACCOUNTING AND APPROPRIATION

22. AUTHORITY FOR USING OTHER THAN FULL AND OPEN COMPETITION: 23. SUBMIT INVOICES TO ADDRESS SHOWN IN ITEM G.6 (4 copies unless otherwise specified)

10 U.S.C. 2304(a) ( ) 41 U.S.C. 253(c) ( )

24. ADMINISTERED BY (If other than Item 7) 25. PAYMENT WILL BE MADE BY CODE CODE

26. NAME OF CONTRACTING OFFICER (Type or print)

Eyole Luma

27. UNITED STATES OF AMERICA 28. AWARD DATE

IMPORTANT - Award will be made on this Form, or on Standard Form 26, or by other authorized official written notice.

(Signature of Contracting Officer)

(REV. 9-97)

10. FOR INFORMATION CALL:

11. TABLE OF CONTENTS

STANDARD FORM 33

SOLICITATION

OFFER (Must be fully completed by offeror)

AWARD (To be completed by Government)

N/A 3 108

X

Nelly Mahanjane Acquisition Specialist 258 21 352 2134 nmahanjane@usaid.gov

X

X

X

X

X

X

X

X

X

X

X

X

X

SOLICITATION/COCONTRACT FORM 3

SUPPLIES OR SERVICES AND PRICES/COSTS 8-11

DESCRIPTION/SPECS./WORK STATEMENT 12-25

PACKAGING AND MARKING 26-28

INSPECTION AND ACCEPTANCE 29

DELIVERIES OR PERFORMANCE 30-41 85-91

CONTRACT ADMINISTRATION DATA 42-45

SPECIAL CONTRACT REQUIREMENTS 46-70

CONTRACT CLAUSES 71-83

LIST OF ATTACHMENTS 84

INSTR., CONDS., AND NOTICES TO OFFERORS 92-102

EVALUATION FACTORS FOR AWARD 103-108

REPRESENTATIONS, CERTIFICATIONS AND OTHER

U.S Agency for International Development/Mozambique Office of Financial Management Rua 1231, No., 41 Bairro Central “C”, Maputo, Mozambique

U.S. Agency for International Development/Mozambique Office of Acquisition and Assistance Rua 1231, No., 41 Bairro Central “C”, Maputo, Mozambique mailto:nmahanjane@usaid.gov

SOL 72065620R00008 USAID Commodities for Health: Ensuring Guaranteed Access & Reliability

(CHEGAR) - REVISED

PART I – THE SCHEDULE

SECTION B - SUPPLIES OR SERVICES AND PRICE/COSTS

B.1 PURPOSE

The purpose of this solicitation for USAID Commodities for Health: Ensuring Guaranteed Access and Reliability (CHEGAR) activity aims to establish an effective and efficient transportation system for medical commodities via engaging the private sector to provide transport and transport management solutions. By establishing effective medical commodity transportation systems, medicines will be available in health service delivery points and available for prevention, testing, and treatment activities.

B.2 CONTRACT TYPE AND SERVICES

The anticipated contract is a Cost Plus Incentive Fee-Performance Incentive (CPIF-PI) type contract. The general structure and management of the incentive fee arrangements are described in Section B.3 and B.4.

For consideration set forth in the contract, the Offeror shall provide the deliverables or outputs described in Section C (Statement of Work) and comply with all solicitation requirements.

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

(a) The period of performance for this contract is three years from award issuance. The estimated cost of the work required hereunder, exclusive of fee (s), if any, is TBD (until contract award). The possible incentive fee will be negotiated with the apparent successful offeror before contract signing and will be based upon a formula that accounts for the relationship of total allowable costs to total target costs are set out in FAR 16.405-1. The minimum and maximum target incentive fees, if any, are $TBD and $TBD respectively. The estimated cost plus all possible fees, if any, is $TBD.

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

B.4 COST SCHEDULE

The following budget table will capture the final negotiated budget for the performance of the work required to achieve the objectives of this activity.

Cost Categories Total Cost Salaries and Wages Fringe Benefits Consultants Travel, Transportation and Per Diem Equipment and Supplies Subcontracts Allowances Overhead G&A Material Overhead Total Estimated Cost Total Target Fee Total Est. Cost Plus Minimum Fee

Incentive Metrics

SOL 72065620R00008 USAID Commodities for Health: Ensuring Guaranteed Access & Reliability

Contractors should propose a reasonable base fee in accordance with the quantity and risks, given the challenges of this procurement. The performance incentive and monitoring plan is attached (Attachment J.8).

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:

Description

TBD

TBD

TBD

Rate

TBD

TBD

TBD

Base 1/ 2/

Type 1/ 2/

Period 1/ 2/

1/Base of Application Type of Rate:

Period:

2/Base of Application:

Type of Rate:

Period:

3/Base of Application:

Note 1: The contractor may recover applicable indirect costs (i.e., overhead, G&A, etc.) if it is part of the contractor’s usual accounting procedures, considered, consistent with FAR Part 31, and Negotiated Indirect Cost Rate Agreement (NICRA).

B.6 COST REIMBURSABLE

The U.S. dollar costs allowable will be limited to reasonable, allocable and necessary costs determined in accordance with FAR 52.216-7, “Allowable Cost and Payment,” FAR52.216-7 and AIDAR 752.7003, “Documentation for Payment.”

B.7 SHARE RATIOS

Should the contractor exceed the target cost during performance of the contract, the overrun cost ratio will be 75%/25%. This means that for every dollar that the contractor exceeds the target cost, the government will pay 75% and the remaining 25% will be deducted from the contractor’s incentive fee payout. The share ratio for underruns will be 25%/75%, which means for every dollar the contractor saves (below the target cost), the contractor will keep 75%. The share ratio will be calculated every three months.

B.8 MINIMUM AND MAXIMUM FEES

The minimum and maximum fees the contractor can expect to earn during the performance period will be 2% and 8% respectively of the target cost.

[END OF SECTION B]

SOL 72065620R00008 USAID Commodities for Health: Ensuring Guaranteed Access & Reliability

1. SECTION C - STATEMENT OF WORK

C.1 INTRODUCTION

To achieve the United States Government (USG) and Government of the Republic of Mozambique (GRM) health goals, medical commodities must be available to prevent disease, clinical testing, and treatment. As current systems in Mozambique struggle to ensure the availability of medical commodities at health centers, this activity aims to improve the availability of medical commodities at the site level where needed for testing and treatment of patients to enable the achievement of USAID and Ministry of Health goals. It aims to do this by establishing an effective and efficient transportation system for medical commodities. This activity is expected to have a three-year performance period. It is intended to be rolled out on a province-by-province basis. The activity focuses on the provinces to address the last mile of the public health supply chain, where challenges are most acute and current systems and support structures are insufficient. This activity aims expand private-sector led improvements to a fragmented supply chain that has been challenged by inadequate infrastructure, human resources, accountability mechanisms, and information systems.

C.2 BACKGROUND

C.2.1 Background

USAID currently invests $254 million annually in health in Mozambique with a particular focus on HIV/AIDS, malaria, and maternal and child health. The goal of the President's Emergency Plan for AIDS Relief (PEPFAR) in Mozambique is to support country efforts to achieve HIV epidemic control by 2020 through evidence-based policies and interventions to drive progress and save lives. Malaria interventions aim to achieve a 40% reduction in the prevalence of malaria and deaths caused by malaria by 2020 in addition to providing 100% of pregnant women with malaria prophylaxis. In maternal and child health, the overarching USG goal is to reduce maternal and child morbidity by expanding contraceptive availability and use to increase the use of modern contraceptives and improving the modern contraceptive prevalence rate.

In support of these goals, USAID, via PEPFAR, supports nearly $60 million in commodities procurement annually in Anti-Retroviral (ARVs) medication, laboratory reagents, and rapid test kits among others. In the past 5 years, USAID, via the President’s Malaria Initiative, procured 100% of the long-lasting insecticide treated mosquito nets (LLINs) for antenatal care and 40-60% of the national need for malaria rapid diagnostic tests and antimalarial medications. USAID is also the major donor of family planning commodities, covering 40-60% of the national contraceptive need annually.

Mozambique is a rural country of 11 provinces and 29.6 million people1 and ranks low on the Human Development Index at 180 out of 189 countries.2 Sixty percent of Mozambicans live on less than $1.25/day with a gross national income of $600 per capita.3 Seventy percent of Mozambicans are estimated to be poor and 37% destitute. National HIV prevalence is estimated at 13%, with substantial variation in provincial prevalence rates and an estimated 1.9 million people living with HIV. Of the estimated number of people living with HIV (PLHIV), 45% are currently on Anti-Retroviral Treatment (ART). Mozambique has one of the highest rates of multi-drug resistant tuberculosis (TB) at 3.5 percent.4 Antenatal care (ANC) coverage, defined as at least one ANC clinic visit, is at 93% with 70% of women delivering in a health facility.5 Under-five child mortality is 90/1,000 live births, declining from 103/1,000 live births in 2010.6 Malaria, acute respiratory infections, and vaccine-preventable diseases are the main causes of child mortality, with malaria contributing to one-third of deaths. Forty-three percent of

1 World Bank, 2017 2 Human Development Report, 2018, UNDP 3 World Bank, 2014 4 National Tuberculosis Drug Resistance Survey (2010). Mozambique has the highest rate of MDR-TB in Southern Africa

5 IMASIDA, 2015

6 Mozambique DHS, 2011 & UNICEF, 2012

SOL 72065620R00008 USAID Commodities for Health: Ensuring Guaranteed Access & Reliability children-under-the-age of 5 years are stunted. Generally, rural health indicators are much worse than urban.

The health system contends with major challenges, including limited funding, insufficient infrastructure, and a critical shortage of human resources. Over 90% of Mozambicans live in an underserved primary health care area defined as over a one hour walk from a primary health care center.7 Overall, the ratio of population per hospital bed is 1 bed per 1,038 persons, with substantial variation across the country.8 Human resources for health (HRH) are severely constrained with 7.8 doctors, 26.8 nurses, and a total of

100.2 health care workers (HCW) per 100,000 people.9 Together with uneven geographic distribution and limited supervision, there are an inadequate number of trained and competent health care workers in all cadres.

Despite these challenges, there has been remarkable progress. The number of people on ART in 2018 reached 1,109,579 up from 16,155 in 2005. Growth has been particularly strong in recent years, more than doubling from 2014 and 2018. The number of health facilities offering ART increased from 255 in 2011 to over 1,300 in 2018. From 2014 to 2018, there was a 200% increase in couple years of contraceptive protection in Sofala and Nampula where 29% of the Mozambican population resides. In 2018, 61% of pregnant women received preventive treatment for malaria and from 2015-2016, progress in key malaria behaviors and improved access to commodities resulted in 32% fewer malaria deaths. With the health system growing and increasing the number of people served, the public health supply chain must keep up to meet the medical commodities need.

The health supply chain in Mozambique has struggled to keep up with the growing and increasingly complex demands of the health system. Without significant investment in infrastructure, warehousing space is severely limited, which negatively impacts proper warehouse management, commodity storage, and distribution. The supply chain is not exempt from the human resource shortages plaguing the entire health system. Compounding the human resource challenges is the absence of a cadre of staff specialized in supply chain and logistics. The result is poor stock management practices that hinder the availability and quality of required stocks. The supply chain also lacks end-to-end visibility in the logistics management information systems (LMIS). While information systems exist to meet the basic needs of the health system, the quality of data remains subpar and there is significant opportunity to improve the use of data for decision making.

Adding to these challenges is the supply chain structure that mimics the administrative structure of the health system, which results in an inefficient, fragmented system. The central level managed by the Central Medical Stores (CMAM, Central de Medicamentos e Artigos Médicos in Portuguese) is currently responsible for distributing commodities from the central level to all eleven provinces. The provinces managed by the Direcção Provincial de Saúde (DPS) are currently responsible for distributing commodities to the district. The district managed by the Serviço Distrital de Saúde, Mulher, e Acção Social (SDSMAS) is responsible for distributing commodities to the health units, and the health units are responsible for distributing commodities to the community level. Community health committees are responsible for overseeing the receipt of commodities at the health centers. Each level currently has their own budget and autonomy over their portion of the supply chain. This complex chain of custody results in a lack of accountability and traceability throughout the system and demands duplicated resources. For example, every province and district must avail and maintain warehousing space, means of transportation, and human resources for supply chain rather than concentrating those resources at a limited number of hubs for a more streamlined supply chain that can rebalance stock between sites. This structure also results in commodities making several physical stops before reaching patients, and each stop requires additional stock and represents a set of potential blockages and challenges in the supply chain.

7 Luis & Cabral, Geographic accessibility to primary healthcare centers in Mozambique, 2016 8 MISAU/MOH – DRH. Relatório Anual dos Recursos Humanos. Maputo, Abril 2014 9 MOH/MISAU, 2016. WHO (2006) estimates 230 medical professionals per 100,000 people as a minimum threshold necessary to provide essential health interventions

SOL 72065620R00008 USAID Commodities for Health: Ensuring Guaranteed Access & Reliability

In 2013, the Mozambique Ministry of Health (MISAU) adopted the Pharmaceutical Logistics Strategic Plan (Plano Estratégico de Logistica Farmacêutica or PELF in Portuguese) that addresses many of these challenges. The PELF is a 10-year $124 million plan and, despite implementation struggles due to a lack of funding, some progress has been achieved. The plan calls for a number of reforms including establishing CMAM as a semi-autonomous institution of MISAU, consolidating 160 provincial and district warehouses into 30 intermediary warehouses throughout the country, consolidated management of the supply chain from central level to the health units by CMAM, expansion of electronic logistics management information systems (LMIS), and the establishment of a cadre of supply chain and logistics staff.

The USG in Mozambique aims to rapidly achieve a number of health goals. However, the ability to achieve these goals is limited without availability of medical commodities in the health centers. While the public health supply chain is not currently performing at the level necessary to achieve health objectives, important reforms in the PELF would improve the overall performance and efficiency of the supply chain if implemented successfully.

The USAID Commodities for Health: Ensuring Guaranteed Access and Reliability (CHEGAR) activity aims to improve the availability of medical commodities at the site level where needed for prevention, testing and treatment. This goal directly contributes to the USAID Mozambique Country Development Cooperation Strategy (CDCS) Development Objective (DO) 4 to improve the health status of targeted population groups. Specifically, it contributes to the CDCS Intermediate Result (IR) 4.3 to strengthen the systems to deliver health, nutrition, and social services and sub-IR 4.3.2 to improve the logistics management of commodities to ensure availability at local levels. Furthermore, this activity is part of the Health Systems Strengthening Project Appraisal Document that targets improved logistics management of commodities via improved public sector warehousing, distribution and management of health commodities at all levels.

Worldwide, the supply chain industry is deemed to be a male dominated sector where nearly 70% of job holders are men, and men hold 85% of leadership positions.10 Transportation and Logistics specifically has traditionally been a male-dominated industry, which has led to unfavorable treatment for minority groups in promotion and professional development.11 European Union analysis also found low portion of transportation and logistics jobs filled by women at 21% and noted possible reasons as a higher physical workload and being unfavorable for family life as well as social reasons such as difficulties for women to enter male-dominated occupations and safety issues, especially concerning long distance freight transport and safe parking areas (in order to observe resting periods).12

USAID Mozambique gender assessments have found that women in Mozambique generally have limited voice, agency, capacity to make decisions or act independently. Cultural and ethnic norms weigh heavily against women and girls. Gender roles and the power relations resulting from them are integral factors in determining women’s and men’s control over health-related decisions within the household. Despite the fact that the country has laws against violence the socio-cultural factors contribute to the high rates of all forms of gender-based violence in the country. Opportunities for addressing the prevalent gender inequalities, often reinforced by tradition, beliefs and attitudes exist and to prevent and respond to gender-based violence in the workplace and in the communities. As such, the offeror will be required to promote women’s employment in the sector and to encourage women in leadership positions.

USAID understands the importance of commitment and capacity to plan, finance and implement solutions to local development challenges. The Theory of Change to self-reliance determines that the increase of country’s commitment and capacity should increase the level of self-reliance. Therefore, as self-reliance

10 McCrea, Bridget. ‘Women in the Supply Chain: How far have we come?’ Logistics Management, Northbrook, IL, Peerless Media LLC, 2018, https://www.logisticsmgmt.com/article/women_in_logistics_how_far_have_we_come (accessed July 18, 2019).

11BSR. ‘10 Human Rights Priorities for the Transport and Logistics Sector’ BSR, New York, NY, https://www.bsr.org/en/our-insights/primers/10-human-rights-priorities-for-the-transport-and-logistics-sector (accessed July 18, 2019).

12 F. van der Zee et al, Investing in the Future of Jobs and Skills: Sector Report Transport and Logistics, (Amsterdam, TNO Netherlands Organization for Applied Scientific Research, 2009), 24 https://www.logisticsmgmt.com/article/women_in_logistics_how_far_have_we_come https://www.bsr.org/en/our-insights/primers/10-human-rights-priorities-for-the-transport-and-logistics-sector https://www.bsr.org/en/our-insights/primers/10-human-rights-priorities-for-the-transport-and-logistics-sector

SOL 72065620R00008 USAID Commodities for Health: Ensuring Guaranteed Access & Reliability increases, USAID’s partnerships should also evolve-ensuring that the programs the Agency implements are best-supporting a country’s journey to greater self-reliance. Under the Journey to self-reliance, USAID launched the Private Sector Engagement policy, which is a call to action to work hand-in hand with the private sector to design and deliver development and humanitarian programs in all sectors. The PSE policy signals an intentional shift towards enterprise-driven development as a more sustainable way to empower people, communities and countries on their journey to self-reliance.13 The health supply chain provides numerous opportunities for the engagement of the private sector as a means towards self-reliance.

C.2.2 Summary of Relevant USG and Donor Activities The USG invests significantly in the health supply chain in Mozambique, primarily through the Global Health Supply Chain – Procurement and Supply Management (PSM) project, Last Mile Supply Chain (LMSC) project and clinical implementing partners based in the provinces. USAID anticipates that the CHEGAR activity will maintain a close coordination and working relationship with LMSC at the central and provincial levels and the clinical implementing partners in the provinces.

Starting in 2018, USAID’s LMSC project outsourced distribution of medicines through the use of a Fourth Party Logistics provider (4PL) while also building the activity of the GOM assisting with improvements to supply chain visibility. In addition to contracting the 4PL, LMSC has carried out the following activities:

2. Working with the 4PL and the Provincial Health Directorate (DPS) to develop streamlined procedures and processes for outsourced medical commodity distribution.

3. Training and coordinating the Provincial Health Directorate (DPS) on how to work with the 4PL.

4. Developing and implementing visibility and analytics capabilities with the DPS that utilizes information from existing information systems as well as data from the 4PL vehicle tracking tools thereby facilitating continuous improvement and virtual control of medicine distribution at the DPS and the Central Medical Stores –Central de Medicamentos e Artigos Médicos (CMAM).

5. Strengthening stakeholder and technical management of medical commodity distribution through the establishment of a provincial logistics technical working group (TWG) composed of DPS and key supply chain partners to support planning, accountability and recommendations of continuous system improvements.

6. Documenting processes, tools and methods, and the provision of associated training and technical support, to ensure CMAM and provincial government stakeholders can operate autonomously.

USAID requires the contractor to work with LMSC on implementation in the provinces and LMSC may play a third party validation role to verify the contractor’s performance.

USAID’s Global Health Supply Chain Procurement and Supply Management (PSM) is based at the central level and is an extension of CMAM’s central warehousing and distribution planning, transportation to the provincial (and eventually intermediate) level, medicine and supply procurement, forecasting and quantification, central supply chain monitoring and evaluation, and supply chain strategic planning and policy development. PSM also has one technical advisor based in each of the provinces who supports linking the provincial and central levels of the supply chain. USAID expects the contractor to coordinate with CMAM and PSM on upstream stock and provincial distribution, communicate LMIS software problems and trends in use observed in the field, share data analysis, and participate in PSM supported supply chain data reviews.

Clinical implementing partners include but are not limited to PEPFAR partners (for example FGH, ICAP, ECHO, EGPAF, Ariel Foundation, CCS), Quality Health Improvement (QHI)/Alcançar, among others.

The clinical implementing partners are often considered the primary partners of the DPSs focused

13 USAID Journey to Self-Reliance and Private Sector Engagement Policy.

SOL 72065620R00008 USAID Commodities for Health: Ensuring Guaranteed Access & Reliability primarily on clinical activities and involved in the supply chain because they depend on the supply chain to avail medical commodities necessary to provide clinical services. As such, their activities vary but can generally be summed up as supporting health services and management to implement and monitor quality services; supporting the public system with local equipment, infrastructure, transportation; rolling out supply chain LMISs (Sistema de Informação de Medicamentos e Artigos Medicos (SIMAM) and Sistema de Gestão Logistica das Unidades Sanitarias (SIGLUS)) and provide local support; and support facilities and districts to submit quality logistics data and use the data for decision making. This activity is expected to maintain a relationship with the clinical implementing partners by communicating at province, district, and health unit level when there are stock problems and respond to the problems and communicating challenges encountered/identified regarding health unit or district submitting logistics data and in storage conditions. It is also expected that the clinical implementing partners may support emergency medical commodity distributions but their support for routine medical commodity distribution should stop as the contractor’s activities are started. With exception of rare emergencies, we expect clinical implementing partners to no longer support routine and emergency distributions. Experience shows that the need for emergency distributions declines with routine, reliable transportation as protocol requires monthly distributions of multiple months of stock.

Other technical partners for MISAU include UNICEF and the Clinton Health Access Initiative are also active in the supply chain space. Their activities aim to strengthen the nutrition, malaria, and HIV/AIDS supply chains with targeted provincial level support. USAID expects that, as a general rule, CHEGAR will identify relevant partners in each province where the services are active and actively participate in provincial partner coordination forums to communicate and coordinate activities.

Despite the numerous investments in the supply chain, the current support models allow for gaps in the last mile supply chain, particularly in light of the fragmented administrative structure and limited geographic scope. Furthermore, USAID is interested in expanding engagement with the private, for profit sector as a sustainable manner to develop health systems and provide health systems services. As such, there is a need for an activity to focus specifically on the last mile of the supply chain at a large geographic scale and as a distinct discipline with professionalized focus.

C.2.3 Lessons Learned

a. A number of lessons have been learned regarding the operation of the health supply chain in Mozambique.

1. The fragmented supply chain administrative structure allows for a lack of accountability and transparency in the supply chain, leading to numerous bottlenecks in the availability of medical commodities at the site level.

2. There is a significant demand for quality and timely supply chain data, but existing practices, operations, and systems are not sufficient to meet that need.

3. Despite shortfalls in supply chain data, focused regular meetings to review supply chain data and making decisions based on that data, results in improved supply chain performance.

4. Medical commodity shortages and stock outs are not systematically reported or understood, making it difficult to understand the impact of stock availability on health services.

5. Supply chain is not a professionalized field in Mozambique and is not a cadre of expertise that is hired by the GOM. A shortage of qualified personnel is at the foundation of many supply chain problems.

6. There is a generalized lack of understanding of how the supply chain works and what an individual’s role is in it. This problem grows in magnitude the further down the supply chain.

7. There are numerous reasons for commodity stock outs at health units making resolving problems extremely challenging and time consuming. Efforts to prevent commodity stock outs would be significantly more efficient.

8. There are no clear allocation methodologies or stock re-balancing practices to mitigate the impact of stock shortages.

9. Commodity storage conditions are insufficient in terms of space and quality throughout the system.

SOL 72065620R00008 USAID Commodities for Health: Ensuring Guaranteed Access & Reliability

10. Public health system core capacity is not maintaining and running a transportation fleet and it distracts from critical clinical activities the public health system is uniquely positioned to address.

Yet, the public sector is reluctant to engage with the private sector.

11. Commodity and lab sample transportation in the provinces is heavily supported by clinical implementation partners who employ a variety of approaches. Successful approaches are customized to the specific provinces’ conditions.

12. Private sector transportation is under-developed in many of the provinces throughout the country.

This creates implementation challenges for outsourcing at a time when there is increased interest, will, and demand to outsource health supply chain transportation.

13. The public sector medical commodity distribution often lacks proper planning and organization causing challenges for the private sector and creating a need for an intermediary between the public health sector and private sector service providers.

C.3 PURPOSE AND ACTIVITIES

C.3.1 Purpose The purpose of this activity is to establish an effective and efficient transportation system for medical commodities via engaging the private sector to provide transport and transport management solutions. By establishing effective medical commodity transportation systems, medicines will be available in health service delivery points and available for prevention, testing, and treatment activities.

C.3.2 Geographic Focus The contractor shall collect commodities from provincial warehouses but must remain flexible and will pick up commodities from 30 intermediary warehouses if and when the warehouses come online and may pick up commodities at the port or central warehouse. Commodities will be delivered to an estimated 1600 sites across Mozambique (see attachment J.7. Warehouse and Site Locations). While these locations will serve as the basis for the original contract scope, pick-up and delivery locations are subject to change as reforms included in the PELF are introduced or supply chain optimization data is shared. The contractor shall plan for distribution to all sites, although select sites may be removed during implementation to allow for CMAM to contract directly. After the contractor start date, the contractor shall use supply chain optimization data to establish exact routes and vehicle requirements and discuss with USAID and the government when deviations from the routing is established. The contractor and USAID shall review route optimization data furnished by another party (government or other technical assistance partner) on a periodic basis thereafter, on an agreed upon schedule.

This project is envisioned to roll out on a province by province basis, but may be modified to align with changing priorities, systems redesign, the contractor’s abilities, and available funding. The chart below shows how USAID envisions this activity rolling out. Green represents scale-up when the contractor would begin and expand transportation activities until reaching all districts in the province and continuing to improve the processes. The yellow cells represent carrying out the transportation activities while preparing to transition the activity management to the government of Mozambique or another entity.

Finally, the red cells represent a completed transition to the government of Mozambique whereby the contractor no longer carries out transportation activities under this contract. USAID intends to continue supporting these activities through the Government of Mozambique directly14 on a province-by-province basis as the number of districts covered reaches zero. Should GRM contracting capacity require support to enable the GRM directly contracting the services following this activity, USAID intends to provide that support through another mechanism but expects the contractor to be cooperative and collaborative in the process.

14 Depending on availability of funds

SOL 72065620R00008 USAID Commodities for Health: Ensuring Guaranteed Access & Reliability

The contract will finalize this plan with USAID and may accelerate the start-date in a given province and/or extend activities in a given province.

The contractor shall maintain an understanding of the actual distances required, vehicle types and security needs to complete commodity deliveries to sites. The table below provides the best available data related to distances and volumes at the national level during full-scale implementation.

C.3.3 Results, Activities, And Milestones The table below summarizes the objectives, results, key activities and indicators of this activity. The targets listed in the table below apply once the activities have started in a given province following time for mobilization and start up.

SOL 72065620R00008 USAID Commodities for Health: Ensuring Guaranteed Access & Reliability

Objectives Results (Outputs) Key Activities Targets

SOL 72065620R00008 USAID Commodities for Health: Ensuring Guaranteed Access & Reliability

An effective and efficient transportation system for medical commodities to the last mile established

Result 1 - Medical commodities are delivered to the health service delivery point on a routine monthly timeline

Ensure all transport is suitable in terms of availability, quality, reliability, and expediency via alignment with international standards of medicine delivery protocols. (See attachment J9 for international standards.)

Conduct last mile distributions to districts and health facilities.

Conduct a facility segmentation to determine appropriate transportation means.

Coordinate scheduling, vehicle types and routes with relevant stakeholders.

Implement seasonality risk mitigation plans.

Monitor Key Performance Indicators (KPIs) for continuous improvement.

90% of sites receiving a delivery within 33 days

100% of sites receiving orders in full

100% vehicles meeting medical commodity transport standards

Facility segmentation completed

Completion of seasonally adjusted transport plans

Completion of emergency commodity delivery procedures

SOL 72065620R00008 USAID Commodities for Health: Ensuring Guaranteed Access & Reliability

Result 2 - Appropriate control mechanisms are in place for distribution of medical commodities throughout the covered geographies

Implement electronic delivery notes and vehicle trackers.

Deliveries are conducted with closed cabs and sealed containers where possible.

Create records of communication between distributor and site announcing the date and approximate time of commodity delivery.

Implement driver and/or transport entity accountability agreement.

95% of delivery notes where quantity sent matches the quantity received

90% of pickups and deliveries communicated within at least 24 hours’ notice

The objective of this activity is to establish an effective and efficient transportation system for medical commodities to the last mile. To achieve this objective, two results are expected:

1. Medical commodities are delivered to the health service delivery point on a routine monthly timeline.

2. Appropriate control mechanisms are in place for distribution of medical commodities throughout the covered geographic areas.

Several activities are expected to achieve the first result of medical commodity deliveries. While the offer is encouraged to define the specific activities, the following must be included:

● Conduct last mile distributions to districts and health facilities. The contractor is expected to conduct a facility segmentation to determine appropriate transportation means. While the contractor may make use of their own transportation assets, the contractor is expected to engage and contract local transporters as well. We encourage subcontracting of transport companies to be local Mozambican-owned. Loading and unloading must be included with the transportation services.

● All transportation used must be suitable in terms of availability, quality, reliability, and expediency via alignment with international standards of medicine delivery protocols (see Attachment J.9). The contractor should maintain an understanding of temperature requirements based on the products being shipped and is encouraged to use temperature and humidity tracking devices in all or a select sample of transportation routes.

● The contractor must develop seasonality risk mitigation plans and coordinate them with the local government and designated stakeholders to ensure that even difficult to reach health service delivery points have sufficient medical commodities throughout the year.

● The contractor is expected to monitor Key Performance Indicators (KPIs) and carry out continuous improvement.

SOL 72065620R00008 USAID Commodities for Health: Ensuring Guaranteed Access & Reliability

● The contractor is expected to develop an emergency commodity delivery procedure and standards, including setting clear expectations around limits to the frequency and extent of emergency deliveries.

● The contractor is expected to participate and provide mutually agreed upon data for monthly post-distribution meetings with local stakeholders to review implementation and achieve continuous improvement.

There are two specific targets the contractor must meet for Result 1:

● 90% of sites receiving a delivery within 33 calendar days. This result is to be measured monthly and requires the collaboration of the local health authorities to make the medical commodities available and plan the deliveries on a routine monthly schedule.

● 100% of vehicles used meet medical commodity transportation standards.

In addition to the regular report deliverables described below, Result 1 involves the following three deliverables:

● Facility segmentation report due six months after the start of activities on a province-by-province basis.

● Seasonality mitigation plan due six months after the start of activities on a province-by-province basis.

● Emergency commodity delivery procedure documented within six months of the start of the contract.

● Annually updated Subcontracting Plan

Result 2 - appropriate control mechanisms also has a number of activities the contractor is expected to fulfill while also being encouraged to define the details required to achieve the result. These required activities are:

● Implement a web-based electronic delivery note and vehicle tracking system to provide visibility about the status of a delivery and monitor performance. The delivery note and vehicle tracking system does not need to track specific commodities or the content of the delivery. Preferably offers will use an existing corporate system. While USAID does not require access to the system data directly, USAID must have access to reports from the system.

● Medical commodity deliveries must be conducted with closed cabs and sealed containers where possible. In some cases, closed cabs will not be available such as transportation on motorcycles, bicycles, or boats.

● The contractor must document records of communication between the contractor and recipient at the delivery sites communicating the date and approximate time of commodity delivery at least 24 hours in advance.

● The contractor must implement a driver and/or transport entity accountability agreement.

● The contractor must provide packaging material as necessary and appropriate and clearly communicate to stakeholders the extent of packing material provided.

There are two specific targets the contractor must meet for this result:

● 95% of delivery notes where the quantity sent matches the quantity received.

● 90% of deliveries communicated within at least 24 hours-notice.

This result involves the following deliverable:

● Implementation of electronic delivery note and vehicle tracking system at the first month’s delivery for each geographic area covered.

SOL 72065620R00008 USAID Commodities for Health: Ensuring Guaranteed Access & Reliability

The design of this activity includes a number of assumptions as follows:

● Commodities are available in the designated pickup point in sufficient supply to be distributed.

● Quality logistics data is submitted on time and in full, from province, district, and health unit level. This is a critical step to ensure that commodities are available in the provinces.

● Emergency orders are placed when needed to avert commodity stock outs.

● In the case of transportation outsourcing, the local private sector is available and capable as needed or capacity can be built to meet project demands.

It is expected that this activity achieves quick results and manages significant operations in a province.

With the exception of the activities noted above, the contractor is free to propose adjustments and improvements to the initial results framework in the statement of work. Activity implementation is expected to be completed on a province by province basis, with some flexibility for phased initiation and accommodating distribution system reforms such as intermediary warehouses or distribution from the port of entry to the health facilities.

In addition to alignment with the Plano Estratégico de Logística Farmacêutica (PELF), this activity contributes to the goals and objectives of MISAU, the DPS, and the implementing partners. Commodities are required to meet health goals and the current underperforming public health supply chain is not able to make commodities available as needed. Furthermore, USAID supports MISAU in the key goals of HIV, Malaria, maternal and child health, and family planning.

The contractor is expected to work closely with a local USAID implementing partner, the SDSMAS, DPS, MISAU, and other implementing partners. USAID will name a local implementing partner who will serve as a facilitator and oversight mechanism in each province at least for project start up. This partner will carry out monitoring and evaluation activities, support post-distribution analysis and meetings, identify implementation challenges and solutions, coordinate the contractor’s work with DPS on a higher level, ensure shared and clear expectations between the contractor and DPS, provide the contractors local staff with training on medicines handling, work with DPS to prepare delivery notes prior to dispatch, and support adapting the contractors work to distribution system reforms. While the partner will provide oversight of the contractors work, they will not direct the contractor to make changes. The contractor and partner are expected to closely collaborate and work together to achieve the same intended outcomes of medical commodity availability at the health facilities.

As described above, CMAM, the DPS, and the SDSMAS have a role in the distribution of medical commodities. As the GRM adopts decentralization and health sector reforms, the roles of the different entities may change and the contractor is expected to work with the relevant entities as appropriate for distribution planning and information sharing. The activity is expected to work closely with the DPS by participating in provincial coordination forums, complying with DPS reporting requirements, ensuring support is on budget, coordinating activities with DPS and securing high-level buy-in to the approach ideally through a Memorandum of Understanding (MOU) with the DPS. The contractor should maintain close relationships with DPS leadership, pharmacy department, the provincial medicines warehouse (Depósito Provincial de Medicamentos, or DPM) leadership and staff, the laboratory department, and the health facilities and labs. The project will obtain commodities from the DPM although this is a subject to change with system reform and the offeror is expected to adapt to the system reform changes, which may include providing temporary warehousing services along the transportation route, offering options for cost and operations optimization, among others. Project transportation activities should be part and parcel of the DPM and DPS distribution plans. The offeror will also work with DPS to establish monthly schedules, quantities, vehicle types, and routes.

The contractor is also expected to maintain close coordination and harmonization of activities with other health implementation partners in the provinces. These partners may participate in DPS coordination fora and post-distribution meetings, planning sessions, and other fora involving the availability of medical

SOL 72065620R00008 USAID Commodities for Health: Ensuring Guaranteed Access & Reliability commodities in the province. The contractor is also expected to engage with community health committees to observe the receipt of commodities at the health centers. The contractor should consider and propose means to most effectively build and maintain the above relationships and close coordination.

C.4 TECHNICAL APPROACH

The contractor is expected to serve as a fourth party logistics provider (4PL) to carry out this activity. In this role, they are expected to contract transportation providers, either entirely or as a complement to using the contractor’s own transportation fleet. As a 4PL, the contractor should provide an integrated transportation solution, coordinating various transportation providers, using a single information system and shared technologies, and continuously analyzing data and performance in the aim of creating a more cost-effective medical commodity supply chain. As a 4PL partner, the offeror is expected to employ specialist resources such as industrial engineers and supply chain practitioners; leverage knowledge and experience across regions, sectors, and industries; and provide cost efficiency by deploying at scale.

Offerors are expected to propose the use of existing information systems, including Commercial Off-The- Shelf (COTS) systems from global vendors or systems offerors currently use with other clients of logistics services although other systems can be proposed. Proposals must explicitly demonstrate adherence to these expectations.

To successfully work within the public health system, the contractor is also expected to adapt, apply creativity, and patience as appropriate. As the Mozambican public health system is not accustomed to working with the private sector, making the relationship work will take some effort and time with each new geographic implementation. This should be taken into consideration in the offeror’s operating procedures recognizing for example that there may be need for additional communication and intervention to ensure commodities are picked and ready to load when needed; the GRM credentialing process is time consuming and the offeror may need to work with GRM personnel to ensure a deputy warehouse manager will be available to approve in the absence of the warehouse manager; and warehouse managers should not be relied upon to manage load weights.